Perinatal/Infant

CDPH/MCAH identified the below Perinatal/Infant Health Domain Priority Need Statement, National Performance Measure (NPM), objectives, and Evidence-Based and -Informed Strategy Measure (ESM) based on the comprehensive five-year state needs assessment.

Perinatal/Infant Priority Need: Advance healthy birth outcomes by supporting mothers and families to have thriving infants.

Performance Measures

• Breastfeeding NPM:
1. Percent of infants who are ever breastfed.
2. Percent of children, ages 6 months through 2 years, who were breastfed exclusively through 6 months.
• Perinatal/Infant Mortality Objective 1: By 2030, reduce the rate of Black infant deaths from 8.81 per 1,000 live births (2023 CCMBF/CCMDF) to 8.37 per 1,000 live births.
• Perinatal/Infant Objective 2: 
1. By 2030, increase the percentage of infants who are breastfed exclusively in-hospital from 68.8% to 73.8%.
2. By 2030, increase the percentage of infants breastfed exclusively through three months from 30.8% to 35.8%.
• Perinatal/Infant ESM: Number of trainings of Black Infant Health staff and their networks (e.g., doulas) to increase the knowledge, skills and abilities to provide community-aligned breastfeeding support.
• Perinatal/Infant ESM Goal: CDPH/MCAH aims to complete eight trainings a year.

Surveillance

CDPH/MCAH will monitor selected quantifiable characteristics to track the health of California infants as part of its routine health surveillance efforts. The indicators and measures listed in the table below are continuously and systematically collected, analyzed and interpreted to guide program planning, implementation and evaluation of interventions. These indicators will be analyzed by state and sub-state levels (to the extent sample-size allows) to identify specific improvement opportunities.

The selected indicators and measures to identify emerging issues, target program interventions, track progress toward specified objectives in the Five-Year Action Plan, allow priorities to be re-evaluated, and inform public health policy and strategies. CDPH/MCAH will utilize information gleaned from health surveillance data to lead, fund, partner and support efforts at the state and local levels to reach desired outcomes.

To provide greater depth in understanding the health status of infants and to uncover differences across populations, analysis of these indicators and measures will include stratification by key demographic factors, as appropriate, given the specific measure and the data constraints.

Strategies & Activities by Focus Area

The comprehensive five-year state needs assessment led to the development of five CDPH/MCAH Division-wide focus areas. The Perinatal/Infant Health Domain Team developed strategies in four of the five focus areas to achieve the Perinatal/Infant Health Domain objective:

• Perinatal/Infant Focus Area 1: Access to Quality Care & Services
• Perinatal/Infant Focus Area 2: Community Health Factors & Family Supports
• Perinatal/Infant Focus Area 3: Physical Health & Prevention
• Perinatal/Infant Focus Area 4: Injury Prevention & Safe Environments

Perinatal/Infant Focus Area 1: Access to Quality Care & Services

Perinatal/Infant Focus Area 1: Strategy 1: Translate Fetal Infant Mortality Review (FIMR) findings and recommendations into action, including recommendations on the care experience.

Activities:

• Collect and disseminate FIMR findings, best practices and recommendations on health care access and quality, including the care experience.  
• Facilitate FIMR Learning Collaborative with peers and experts to support practice change by sharing best practices and applying quality improvement efforts.

Perinatal/Infant Focus Area 2: Community Health Factors & Family Supports

Perinatal/Infant Focus Area 2: Strategy 1: Partner to increase economic and social supports (e.g., transportation, childcare, parenting resources) to families.

Activities:

• Increase the number of programs that involve fathers in maternal and child health by sharing fatherhood best practices across MCAH programs.
• Partner to identify best practice strategies for MCAH programs to provide families with economic and social supports.

Perinatal/Infant Focus Area 2: Strategy 2: Promote community-aligned grief and bereavement and support services.

Activities:

• Identify or create an infant and/or maternal loss toolkit that provides information on navigating the legal aspects of loss (e.g. death certificates, adding unmarried spouse to birth certificate, etc.)

Perinatal/Infant Focus Area 3: Physical Health & Prevention

Perinatal/Infant Focus Area 3: Strategy 1: Partner on maternal anemia prevention through policy, systems and environmental change (PSE) strategies to improve perinatal and infant outcomes.

Activities:

• Partner with the California Maternal Quality Care Collaborative (CMQCC) and WIC for primary prevention of poor infant outcomes by using PSE strategies for maternal anemia prevention.

Perinatal/Infant Focus Area 3: Strategy 2: Promote breastfeeding initiation and duration through PSE and workforce strategies, including considerations of the care experience.

Activities:

• Partner to train local staff to increase capacity of the breastfeeding workforce through lactation training opportunities including International Board-Certified Lactation Consultants (IBCLC's), Lactation Consultants, Breastfeeding Peer Counselors, Lactation Educator Specialists, Certified Lactation Counselors and other lactation professions aimed to support breastfeeding families.  
• Develop trainings and tools to support efforts to promote hospital and health care clinic implementation of infant feeding and lactation accommodation policies to increase breastfeeding rates.

Perinatal/Infant Focus Area 4: Injury Prevention & Safe Environment

Perinatal/Infant Focus Area 4: Strategy 1: Identify new partnerships to improve SIDS/SUID prevention.

Activities:

• Develop population-specific recommendations and community-aligned strategies for safe sleep practices based on FIMR data.
• Utilize Preconception Health Council of California (PHCC) to disseminate safe sleep practices. 

Child

CDPH/MCAH identified the below Child Health Domain Priority Need Statement, National Performance Measure (NPM), objective, and Evidence-Based and -Informed Strategy Measure (ESM) based on the comprehensive five-year state needs assessment.

Child Priority Need: Improve the physical and mental health and development of all children so they flourish and thrive.

Performance Measures 

• Medical Home – Overall NPM: Percent of children with and without special health care needs, ages 0 through 17, who have a medical home.
• Child Objective: By 2030, increase the percentage of children who have received care within a medical home from 40.1% (NSCH 2021-2023) to 42%.
• Child ESM: Number of strategic planning, capacity building and education/outreach efforts completed by CDPH/MCAH to promote medical home for children and families.
• Child ESM Goal: CDPH/MCAH will complete 25 strategic planning, capacity building, and/or education/outreach efforts promoting medical home for CA children and families over a five-year period, consisting of approximately five sessions per year.

Surveillance

CDPH/MCAH will monitor quantifiable characteristics to track the health of California children as part of routine health surveillance efforts. The indicators and measures listed in the table below are continuously and systematically collected, analyzed and interpreted to guide program planning, implementation and evaluation of interventions. These indicators will be analyzed at the state and sub-state (where sample-sizes allow) levels to identify specific improvement opportunities.

Strategies & Activities by Focus Area

The comprehensive five-year state needs assessment led to the development of five CDPH/MCAH Division-wide focus areas. The Child Health Domain Team developed strategies in four of the five focus areas to achieve the Child Health Domain objective:

• Child Focus Area 1: Access to Quality Care & Services
• Child Focus Area 2: Mental Health & Substance Use
• Child Focus Area 3: Physical Health & Prevention
• Child Focus Area 4: Injury Prevention & Safe Environments

Child Focus Area 1: Access to Quality Care & Services 

Child Focus Area 1: Strategy 1: Promote the pediatric medical home through school-linked and school-based health prevention, education and services.

Activities:

• Partner with CDPH/Office of School Health to increase access to and availability of school-based and school-linked health centers.
• Partner with Department of Health Care Services and California provider networks to increase education, build capacity and improve access to promote the pediatric medical home.

Child Focus Area 1: Strategy 2: Promote linkage and referrals to care and support services, especially those that target community health factors.

Activities:

• Partner with other state agencies to improve outreach, enrollment, linkage and navigation between Medi-Cal and state sponsored support services, including MCAH.
• Collaborate with partners and disseminate information regarding economic supports for families, housing supports, affordable, quality childcare, early education and parenting resources.

Child Focus Area 2: Mental Health & Substance Use 

Child Focus Area 2: Strategy 1: Promote social connectedness.

Activities:

• Promote family and parent/child dyad positive relationships, bonding, protective childhood experiences, wellness and resilience.
• Partner to promote socioemotionally and physically safe schools and communities.
• Partner with the CDPH/Center for Healthy Communities to promote free play and access to green spaces for children and families.

Child Focus Area 2: Strategy 2: Collaborate to improve education and awareness of, and access to mental and behavioral health care.

Activities:

• Lead technical assistance and outreach to state and local MCAH regarding trauma-informed practices and primary prevention of mental and behavioral health for the MCAH population through the CDPH/MCAH Mental Health Initiative.
• Partner with other statewide efforts (e.g. Children and Youth Behavioral Health Initiative (CYBHI)) to increase access to mental and behavioral health for children and youth and their caregivers.

Child Focus Area 3: Physical Health & Prevention

Child Focus Area 3: Strategy 1: Increase child preventive health rates.

Activities:

• Partner with CDPH/Office of Oral Health and CDPH/Office of School Health to promote child oral health and disseminate information to local MCAH programs and local education agencies.
• Partner to promote childhood immunization access and improve routine childhood immunization rates.

Child Focus Area 3: Strategy 2: Promote early childhood prevention, screening and intervention.

Activities:

• Partner with state-wide early childhood leaders on initiatives such as the Early Childhood Home Visiting Collaborative (ECHCV) to promote developmental screening and early childhood intervention.
• Promote early childhood screening, intervention and support, including promotion of and care coordination with the medical home, across the state through the California Home Visiting Program (CHVP).

Child Focus Area 3: Strategy 3: Optimize nutrition and physical activity for children.

Activities:

• Partner to promote and disseminate information regarding healthy physical activity and nutrition for children and families.

Child Focus Area 3: Strategy 4: Identify and work to reduce negative child health outcomes for all children.

Activities:

• Lead statewide data access and analysis on major child health indicators to improve health outcomes for all children.

Child Focus Area 4: Injury Prevention & Safe Environments 

Child Focus Area 4: Strategy 1: Promote safe environments and communities and prevent unintentional injury for children and families.

Activities:

• Partner with CDPH Center for Healthy Communities and other statewide efforts to improve community safety (e.g. Public Health Roadmap for Violence Prevention, All Children Thrive, Transportation Safety Program).
• Partner with CDPH Center for Healthy Communities Injury and Violence Prevention Branch to reduce unintentional child injuries and promote child passenger, teen driving safety and child water safety efforts.

Child Focus Area 4: Strategy 2: Uplift prevention efforts to reduce child abuse and neglect.

Activities:

• Fund local child fatality reporting efforts through collaboration with CDPH Center for Healthy Communities Injury and Violence Prevention Branch.
• Partner to disseminate information on prevention of adverse childhood experiences, child abuse and neglect.
• Partner on data access and analysis regarding child injuries and fatalities to identify opportunities for intervention. 

Adolescent

CDPH/MCAH identified the below Adolescent Health Domain Priority Need Statement, National Performance Measure (NPM), objective, and Evidence-Based and -Informed Strategy Measure (ESM) based on the comprehensive five-year state needs assessment.

Adolescent Priority Need: Enhance strengths, skills and access to supports, ensuring all youth thrive.

Performance Measures

• Adolescent Well-Visit NPM: Percent of adolescents, ages 12 through 17, with a preventive medical visit in the past year.
• Adolescent Objective: By 2030, increase the percentage of adolescents, ages 12 through 17, with a preventive medical visit in the past year from 62.9% (NSCH 2021-2023) to 66%.
• Adolescent ESM: Percentage of local MCAH programs that implemented at least one Scope of Work (SOW) activity in Adolescent Focus Area 1: Access to Quality Care & Services.
• Adolescent ESM Goal: By 2030, 40 percent of Local MCAH programs will have chosen to implement a SOW activity in the Adolescent Focus Area 1: Access to Quality Care & Services.

Surveillance

CDPH/MCAH will monitor quantifiable characteristics and measures to track the health of California adolescents as part of its routine health surveillance efforts. The select indicators and measures listed in the table below are continuously and systematically collected, analyzed, and interpreted to guide program planning, implementation, and evaluation of interventions. These indicators will be analyzed at the state and sub-state levels to identify specific improvement opportunities.

 *Note: California did not participate and as such will not have access to 2023 YRBS data due to staff transition at the California Department of Education.

Strategies & Activities by Focus Area

The comprehensive five-year state needs assessment led to the development of five CDPH/MCAH Division-wide focus areas. The Adolescent Health Domain Team developed strategies in three of the five focus areas to achieve the Adolescent Health Domain objective:

• Adolescent Focus Area 1: Access to Quality Care & Services
• Adolescent Focus Area 2: Mental Health & Substance Use
• Adolescent Focus Area 3: Physical Health & Prevention

Adolescent Focus Area 1: Access to Quality Care & Services 

Adolescent Focus Area 1: Strategy 1: Improve awareness of and access to quality youth-friendly care.

Activities:

• Lead efforts within CDPH/MCAH to promote characteristics of youth-friendly care.
• Partner to promote information about access to care, insurance coverage, minor consent, and confidentiality for primary and behavioral health care services.
• Partner to promote school-linked/school-based services and school-based health centers.
• Partner to promote the use of evidence-based screening tools and assessments to link youth to services.

Adolescent Focus Area 1: Strategy 2: Support youth in valuing and prioritizing preventive care.

Activities:

• Partner to remove barriers and identify incentives for youth to attend preventive care visits.
• Partner to educate youth about the benefits of preventative care and what happens at preventive care visits.
• Partner to promote virtual visits, telehealth, and online/app-based resources.

Adolescent Focus Area 2: Mental Health & Substance Use

Adolescent Focus Area 2: Strategy 1: Promote primary prevention and early intervention best practices for behavioral health.

Activities:

• Partner to promote behavioral health training opportunities for youth engaged in peer-to-peer or near-peer programs and adults that work with youth.
• Partner to promote supports for positive engagement with digital technology.
• Partner to promote the identification, utilization, and impact of third places and spaces in communities, defined as a public space where people can gather and socialize, separate from their home and work.

Adolescent Focus Area 2: Strategy 2: Support youth in enhancing their resilience and coping skills.

Activities:

• Partner to help youth build skills and access supports for healthy relationships with themselves and others (family, mentors, peers, romantic and/or sexual partners).
• Partner to promote peer-to-peer supports and near-peer mentorship.
• Partner to promote self-help and harm reduction strategies.

Adolescent Focus Area 3: Physical Health & Prevention

Adolescent Focus Area 3: Strategy 1: Promote youth-friendly sexual and reproductive health services, information and education.

Activities:

• Partner to disseminate sexual and reproductive health information that is appropriate to the different stages of adolescence through young adulthood.
• Partner to increase youth knowledge of, access to, and the use of contraception and STI prevention methods.
• Partner to inform youth about their sexual and reproductive rights and improve their sexual health media literacy.

Adolescent Focus Area 3: Strategy 2: Enhance skills for health and wellness and growth into adulthood.

Activities:

• Fund the Adolescent Family Life Program (AFLP) to implement a Positive Youth Development (PYD) model to support pregnant and parenting youth and partner to promote PYD models to other youth-serving programs.
• Partner to encourage youth participation in decision-making about programs and initiatives that serve young people.
• Partner to promote universal life-skills education and supports for college and career readiness.

Children and Youth with Special Health Care Needs

CDPH/MCAH identified the below Children and Youth with Special Health Care Needs (CYSHCN) Domain Priority Need Statement, National Performance Measures (NPMs), objectives, and Evidence-Based and -Informed Strategy Measures (ESMs) based on the comprehensive five-year state needs assessment.

CYSHCN Priority Need 1: Improve access to supports and services for children and youth with special health care needs.

CYSHCN Priority Need 2: Increase engagement and build resilience among CYSHCN and their families.​

Performance Measures

• CYSHCN NPM 1: Medical Home – Overall Percent of children with and without special health care needs, ages 0 through 17, who have a medical home.
• CYSHCN Objective 1: By 2030, increase the percentage of children with special health care needs, ages 0 through 17, who have a medical home from 34.3% (NSCH 2021-2023) to 35%.
• CYSHCN ESM 1: Number of strategic planning, capacity building and education/outreach efforts completed by CDPH/MCAH to promote medical home for California children and families.
• CYSHCN ESM 1 Goal: CDPH/MCAH will complete 25 strategic planning, capacity building, and/or education/outreach efforts promoting medical home for CA children and families over a five-year period, consisting of approximately 5 sessions per year.
• CYSHCN NPM 2: Transition NPM: Percent of adolescents with and without special health care needs, ages 12 through 17, who received services to prepare for the transition to adult health care.
• CYSHCN Objective 2: By 2030, increase the percentage of adolescents with special health care needs, ages 12 through 17, who received services to prepare for the transition to adult health care from 17% (NSCH 2021-2023) to 18%.
• CYSHCN ESM 2: Number of identified key organizations engaged in at least one structured meeting or discussion with CDPH/MCAH on improving transition to adult care for CYSHCN in California.
• CYSHCN ESM 2 Goal: CDPH/MCAH will engage at least 5 new organizations and hold at least one convening session per year.

Surveillance

CDPH/MCAH monitors the prevalence of California CYSHCN and CYSHCN activities at the Local Health Jurisdiction (LHJ) level as part of routine health surveillance and data collection efforts. The following indicators and measures listed in the table below are continuously and systematically collected, analyzed and interpreted to guide program planning, implementation and evaluation of interventions. These indicators are analyzed at state and sub-state levels (where sample sizes allow) to identify specific improvement opportunities. 

Strategies & Activities by Focus Area

The comprehensive five-year state needs assessment led to the development of five CDPH/MCAH Division-wide focus areas. The Children and Youth with Special Health Care Needs (CYSHCN) Health Domain Team developed strategies in three of the five focus areas to achieve the CYSHCN Domain objectives:

• CYSHCN Focus Area 1: Access to Quality Care & Services
• CYSHCN Focus Area 2: Mental Health & Substance Use
• CYSCHN Focus Area 3: Community Health Factors & Family Supports

CYSHCN Focus Area 1: Access to Quality Care & Services 

CYSHCN Focus Area 1: Strategy 1: Partner to improve access to quality, coordinated care and support services for CYSHCN and their families.

Activities:

• Partner with California Home Visiting Program (CHVP) to connect the work of home visitors to care coordinators within California Children's Services (CCS) and improve medical home care coordination efforts, linking CYSHCN and families to needed care and services.
• Partner with key agencies to improve care coordination and promote the medical home model.
• Lead CDPH/MCAH efforts to build relationships with Office of School Health, the California Department of Education, and health care transition-focused organizations to identify and incorporate best practices that ensure CYSHCN and their families receive support for successful transition to adult health care.
• Partner with Family Voices of California to engage and include the voices CYSHCN and their families.
• Attend regular meetings of the Big 6 states (California, Florida, Illinois, New York, Pennsylvania, Texas) whole group and subgroups, sharing California's State Action Plan (SAP) components related to Medical Home/CYSHCN with peers, and providing feedback and suggestions to other states' SAPs as appropriate. 

CYSHCN Focus Area 1: Strategy 2: Fund the Department of Health Care Services (DHCS) to provide necessary care coordination and case management for California Children's Services (CCS) program clients and improve systems to assist CYSHCN families in navigating services.

Activities:

• Fund DHCS to support County CCS program collaboration with Medi-Cal Managed Care Plans and other organizations on facilitating transition to adult services for CYSHCN.
• Fund DHCS to improve medical home care coordination for Neonatal Intensive Care Unit (NICU) babies transitioning to home/community and link families to home visiting programs or other support services.
• Fund DHCS to engage with universities and other entities working to increase identification of neonates requiring High-Risk Infant Follow-Up (HRIF) program follow-up and assess referral patterns.
• Fund DHCS to improve the referral system, eligibility requirements and service requests for CCS clients through provision of training and resources on their services.

CYSHCN Focus Area 2: Mental Health & Substance Use 

CYSHCN Focus Area 2: Strategy 1: Partner to develop programs and resources to enhance resilience and mental wellness support for CYSHCN and their families.

Activities:

• Partner with MCAH Adolescent programs to incorporate CYSHCN populations, CYSHCN considerations and CYSHCN voices in programming and resource development.
• Partner with Family Voices of California and connect to other family-serving organizations in California to build and/or expand family and youth support groups for CYSHCN across California.
• Partner with MCAH Mental Health Initiative to develop and elevate upstream strategies, resources and technical assistance that promote resilience and mental wellness for CYSHCN and their families.

CYSHCN Focus Area 2: Strategy 2: Support LHJs to build workforce capacity in supporting CYSHCN and their families.

Activities:

• Partner with state-level MCAH programs and initiatives to enhance LHJ capacity to meet the mental health needs of CYSHCN and their families.
• Lead state and local capacity-building efforts to improve and expand services and support for CYSHCN and their families.

CYSHCN Focus Area 3: Community Health Factors & Family Supports 

CYSHCN Focus Area 3: Strategy 1: Partner with various organizations to build workforce capacity to serve CYSHCN and their families.

Activities:

• Fund CYSHCN Innovation Grants to support local MCAH programs in implementing innovative public health strategies that enhance systems of care for CYSHCN and their families across California.
• Partner with the CDPH Office of School Health, the State Board of Education and the California Department of Education to promote and enhance supportive services in schools for CYSHCN.
• Strengthen relationships with Regional Centers and County CCS programs to build a capable and qualified workforce serving CYSHCN and their families.

CYSHCN Focus Area 3: Strategy 2: Lead development of informational platforms and tools for CYSHCN and their families.

Activities:

• Lead the development of CYSHCN-related resources to be shared with LHJs.
• Lead the expansion and improvement of the MCAH CYSHCN data dashboard.