STEVE SAUNDERS: All right. Well, everybody that knows me knows that I’m challenged when it comes to working with computers. In fact, it took quite a while for my staff to get me to finally use the email in my office. And the other day--it seems like it was the other day--I think maybe two or three months ago we were putting in order for new computers and we ordered, oh, I don’t know, maybe 50 computers the office to get everybody upgraded and, you know, some of their computers, as you can appreciate, are a number of years old. I looked at the list and I said, “Well, where’s mine?” They said, “Well, you don’t need one.” So I think you see that, perhaps, that’s the case.
Well, like Arden , I also want to welcome you to Illinois . As Arden , said I’m the MCH Director for the State of Illinois and it looks like you’ve hit us a very sunny and nice day. Actually, this last weekend it was very cold for Illinois for this time of year. In fact, in Springfield , where I’m from, yesterday it was in the--last night it was in the 30's. So hopefully it’ll be warming up and there’ll be some nice weather for the next couple of days.
What I wanted to do is just, you know, other than welcome you all here to this conference and, like I said, we’re certainly happy to see you here today. I’ll just, kind of, give you a brief overview of how I see translating research into MCH practice. Okay.
Well, I think you look at translating research into practice on three levels, one of which is the MCH Bureau or the state can conduct the program evaluations by itself, directly or in partnerships with universities like the University of Illinois . Or we can implement programs based on other people’s research from outside the state or from national research or other areas. And I think we always need to keep in mind that we always need to think about how we can implement programs in political and economic context. So I want to cover these three areas here this morning briefly.
This is an example of where we’ve actually done some research ourselves. This is a program called the Family Case Manger Program. It’s a statewide care coordination program to reduce infant mortality. We actually provide case management or care coordination for all Medicaid pregnant women and infants in the state and there’s about 80,000 Medicaid paid-for deliveries in the state. We get about 92% of them in this program. So it’s really quite comprehensive.
Over the years we’ve done internal evaluations looking at matching vital records to our program data to Medicaid and MIS data. And every time we did that, as you can see here, we get very good results in terms of reductions in low-birth weight, reductions in infant mortality and cost savings when we compare the women that were involved in this program to the women that were not involved in the program.
But we weren’t satisfied with that. We also got some help from our friends at the CDC to do a little bit more rigorous evaluation where we control for a number of selections biases, prematurity bias, and so on. And anyway after doing all that we still found a 24% reduction in early pre-term labor and actually a 38% reduction in late pre-term labor for women that were involved in this program versus women that were not involved in the program.
So this is an example within our own evaluation. This has been helpful over the course of time. There was a time, here a few years ago, when the general assembly wanted to cut the funding for this program and actually our early evaluations--the one that had crude rates--were certainly adequate for that audience and we maintained without having to lose any of that money. So certainly this is an example where a state can do it’s own evaluation.
The next one that I want to just mention is a program called Targeted Intensive Prenatal Case Management, which is, kind of a spin off of that word general case management program. This is a program targeted at high-risk pregnant women and they have to meet certain medical risk factors, like prior pre-term delivery or hypertension and that kind of thing, and this really was an outgrowth of those prior evaluations. So this is an example of how one evaluation or one effort can spin-off into other programs.
Now we use the evaluation on the case management program to actually help us get this one funded. It’s currently funded at about $3.5 million and they’re going to increase it again this year in times of tough resources up to $5 million. So we’re encouraged some of our evaluation work has actually led increased funding for these programs. And this was based the argument that if we could provide this intensive prenatal case management to Medicaid women we could actually reduce Medicaid cost. And, in fact, the data I think tells us that. Okay.
The second example was working with other university partners. And in Illinois we have had a couple examples of that that I’ll just mention. One is we have Healthy Families program, and I think most of you are aware of what program that is. That’s the home visiting program--paraprofessional home visiting program--whose purpose is to provide parenting support to at-risk families and ultimately reduce child abuse.
We are involved with a large evaluation with the Northern Illinois University . We’ve been doing this evaluation now for about four years. This is about a $10 million program in Illinois and we’re certainly anxious to see how that evaluation pans out. Some of the early evaluation information is encouraging. I think most of you are aware that there’s somewhat of a controversy between this program model and more nurse program model as advocated by David Olds and this will be interesting to see how this pans out.
The other one that we’re doing--actually we’re just getting involved in it right now working with the University of Illinois, Arden and her shop, and we’re going to be looking at the Department of Public Aid and Ann Marie Murphy’s over there sitting where I can see her, barley through the light, and we’re going to be looking at trying to evaluate the quality of prenatal care as delivered in certain high-risk communities in Chicago.
And we started this off as a part of our Closing the Gap federal grant application which is a grant to help us reduce racial disparities and as we’ve gotten more and more involved in this evaluation it’s become clear that when you look at the research, not much of this has been done. There’s HMO’s that looked at some of these issues but never on a community based level, so we’re really quite excited about this and hopefully get this off the ground here soon. We’re in the stage now where we’re developing the tools and the experimental design.
This is an example of where we’ve used other people’s research to implement a program and the example here is Universal Newborn Hearing Screening. This is a little bit of an older example because you know now--I don’t know maybe what, two thirds or three fourths of the states no have newborn hearing screening programs, but back when we started our program about six or seven years ago there were only a handful of states that were doing this.
But the way we got this program started was, again, based on the national research of others. Not our own research. Not our own university research, but other research came out of other states that indicated that if you did newborn hearing screening early and you identified with kids with congenital hearing loss, you could actually improve cognitive development and improve the speech and language development of these kids.
And so we were able to use that research to actually implement this program and now we have a statewide newborn hearing screening program, where all the newborns or virtually all the newborns in Illinois are screened. We’re still working on making sure they all get appropriate follow-up. But at least we’re basing--this was an example of a program that was developed solely based on date from outside research.
Next slide here. But sometimes just so we don’t leave this--my brief introduction here, thinking that research is the panacea for the world, sometimes research is not everything I would suggest. And I would suggest that some services should be provided for reasons other than research that's just professional consensus. I think a good example of those are prenatal care and well-child visits. People have been arguing for the last 10 or 15 years is prenatal care effective? Is it not effective? Is it good for high-risk or low-risk or everybody? I don’t think the juries in on that one but I would suggest we would still want to keep doing prenatal care because of what I’m suggesting here.
And the same with well-child visits. In fact, that’s never been adequately, I don’t think, researched and studied very well. But I think you’ll find almost universal agreement that it’s an important strategy for kids. So sometimes research isn’t everything is what I’m trying to say here. These are just two examples of that and sometimes it’s not enough.
The example here is family planning. We all know the date on family planning. There’s been studies that say that when you do, every dollar invested in family planning, you save $4.40. And we know that family planning reduces infant mortality, but yet we still--states still have to go through a rigorous Medicaid waiver process if they want to implement family planning in a Medicaid program, despite the fact that over 20 states have demonstrated that these family planning waivers are effective at reducing costs, at reducing subsequent pregnancies, at, you know, improving birth outcomes, yet we’re still having to do this.
So this is an example where research probably hasn’t really been enough to get this ball moving. And despite this cost benefit, I would point out that most states--most states, including our state of Illinois --do not invest any state resources in family planning.
In Illinois , actually, we do invest about $700,000, but that’s just a, I would say, a paltry amount in a state budget the size of ours. So sometimes research is not enough or sometimes research doesn’t matter at all.
As you can see from this slide you’re ahead of me here. Some services have strong political support despite the lack of evidence to support them or the presence of evidence that says they’re ineffective and I think a classic example of that is abstinence education.
I was teaching a class at UIC this semester and we were pointing how the budget for this program has grown consistently over the last three or four years despite what you see on this slide. And if you contrast that, for example, with comprehensive school health programs out of the CDC, which have not grown and are budgeted at much less of a level. So this is an example where apparently research doesn’t matter.
So in conclusion then, I think all levels of government of MCH programs have a role in translating research into practice from the state level, the federal level, the university level, the local level. And I think government MCH programs depend on research conducted by our partners, as I mentioned. And translation takes place in the political context with both scientific and economic arguments.
So I think with that I’ll conclude. And once again welcome you all to Illinois and hope we have a wonderful conference. I’m sure that we will.
Thank you, Arden.