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Federal Programs to Promote Child Health
The U.S. Department of Health and Human Services’ (HHS) Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau (MCHB) works to improve the physical and mental health, safety, and well-being of the maternal and child population, which includes all of the nation’s women, infants, children, adolescents, and their families through a variety of programs.1
Enacted in 1935, the Title V Maternal and Child Health Block Grant Program is the Nation’s oldest federal-state partnership. State maternal and child health agencies apply for and receive formula grants each year that support programs designed to improve the health of women, infants, children and youth through population-based public health and preventive health care services. Some goals of the Title V program include ensuring access to quality care, especially for those households with limited incomes or limited care availability; increasing the number of children receiving health assessments and follow-up diagnostic and treatment services; providing and ensuring access to preventive and child care services and rehabilitative services for certain children; and implementing family-centered, community-based systems of coordinated care for children with special health care needs. A total of 59 states and jurisdictions receive Title V Maternal and Child Health Block Grant funding administered by MCHB. In fiscal year 2013, Title V programs served nearly 42 million individuals, including 2.3 million pregnant women, 4.0 million infants, 27.6 million children, and 2.7 million children with special health care needs.2, 3
The Healthy Start Program, also administered by MCHB, works to reduce the rate of infant mortality and improve perinatal outcomes through grants to communities with high infant mortality rates. In 2013, 105 Healthy Start projects were providing services in 39 states, the District of Columbia, and Puerto Rico, serving 196 different communities. These projects provide core services: direct outreach and client recruitment, health education, case management, depression screening and referral, and services between pregnancies.4 The life course perspective posits that birth outcomes can have long-term impacts on a child’s health. Healthy Start aims to improve birth outcomes and thereby reduce the likelihood of adverse childhood health outcomes. Adverse consequences of being born preterm or with low birth weight include developmental problems, poorer health and social/emotional functioning throughout young adulthood, poorer educational achievement, lower college attendance, and higher incidence of health issues in adulthood such as high blood pressure and respiratory disorders.5, 6, 7, 8
HRSA’s Maternal, Infant, and Early Childhood Home Visiting
Program facilitates collaboration and partnership at the federal, state,
and community levels to improve health and developmental outcomes
for at-risk children through evidence-based home visiting programs.
The program provides grants to support programs to improve maternal
and newborn health, promote school readiness and achievement,
prevent family violence and child injury, and develop family economic
self-sufficiency. In 2013, HRSA awarded $109.5 million to the 52 eligible
states and territories. In addition, approximately $69.6 million was
awarded to 13 states to expand existing programs.9
There is also a
Tribal Maternal, Infant, and Early Childhood Home Visiting program for American Indian and Alaska Native communities.10
The Maternal, Infant, and Early Childhood Home Visiting
Program is part of a portfolio of early learning initiatives that work together
to support access to high-quality early education for all children.
These initiatives focus on the early years in a child’s life, since research
has shown that the early years are a window of opportunity to develop
a child’s potential and shape academic, social, and cognitive skills that
determine a child’s success in school and life. This agenda includes
the Preschool for All initiative to improve quality and expand access
to preschool; the Child Care Development Fund
initiative to subsidize
the cost of child care for low-income households and increase the
availability and quality of that care; Race to the Top: Early Learning
Challenge
, which challenges states to compete and deliver better training and education for early educators; and the reformation and
expansion of Head Start
. Through the American Recovery and Reinvestment
Act, $2.1 billion is invested in Head Start and Early Head
Start. Efforts are underway to raise Head Start standards, promote
accountability, focus on school readiness, and utilize a process to ensure
only the highest quality programs receive Head Start grants.11
Text messaging is a means of improving health knowledge, behaviors,
and clinical outcomes, especially among hard-to-reach populations.
Text4Baby is a free mobile health education service that provides evidence-based health messages regarding issues such as
breastfeeding, immunizations, safe sleep, and nutrition. These text
messages are intended for pregnant mothers and parents and caregivers
of infants less than 1 year of age. Text4baby is a campaign
of the National Healthy Mothers, Healthy Babies Coalition. TXT4Tots
distributes short, evidence-based messages regarding nutrition and
physical activity. These text messages are intended for parents and
caregivers of children aged 1–5 years. Content for messages is derived
from the American Academy of Pediatrics (AAP) Bright Futures
recommendations. A 2012 environmental scan found that research
has shown that health text messaging programs can bring about
behavior change and improve treatment compliance to improve outcomes.12
Injuries are the leading public health threat facing those aged 1–44
years. More children die from injuries and violence than all diseases
combined. Injuries are also the leading cause of disability and medical
spending for children. Funded by MCHB, the Children’s Safety
Network aids states in planning, implementing, strengthening, and evaluating injury and violence prevention programs. The National Center for the Review and Prevention of Child Death
strengthens state capacity to perform Child Death Reviews (CDR), develops
prevention-oriented recommendations, and translates those recommendations
into local policies and programs. CDR is a community-based action process intended to guide communities in identifying
and solving problems that contribute to poor child and adolescent health outcomes.13 The CDC supports the Essentials for Childhood
Framework
, with evidence-based strategies for communities to promote relationships and environments that help children grow up to be
healthy and productive, as well as the national Striving To Reduce
Youth Violence Everywhere (STRYVE)
initiative which focuses on
preventing youth violence before it starts.14, 15
HRSA’s Adolescent and Young Adult Health Program provides
information and resources to assist health professionals, program administrators, and policymakers in the development of programs and
policies at the community, state, and national levels that will help adolescents
and young adults thrive. This program supports the National Adolescent Health Information and Innovation Center, which collects and disseminates relevant information on the health, safety,
development, and social and economic well-being of school-aged
children in transition to adolescence.16
HRSA’s Stop Bullying Now! (SBN!) campaign serves children and adolescents. Bullying is intentionally aggressive behavior that involves an imbalance of power. It can take many forms, and studies show that 15–25 percent of U.S. students are bullied. Bullying can affect educational success and have social and emotional consequences. The SBN! campaign connects with its audience through the Web. When SBN! began in 2001, only nine states had legislation regarding bullying; today 45 states have such legislation. The SBN! campaign has more than 80 active partners, and six federal departments are working together to coordinate bullying prevention activities.17
Part of HHS, the Administration for Children & Families (ACF) promotes the economic and social well-being of families, children, individuals, and communities.18
Programs for children include adolescent
pregnancy prevention, adoption, child abuse and neglect prevention
and intervention, child care, child and family services reviews,
child support, child welfare, early childhood development, foster care,
Head Start, and runaway and homeless youth and unaccompanied
children’s services.19
The ACF Office of Head Start
administers the Head Start program, which aims to improve school readiness of
young children from low-income households through local community agencies. Head Start and Public Early Head Start
programs provide comprehensive services to support emotional, social, and mental
development for children aged 0–5 years. The program provides education,
health, nutrition, social, and other services. Programs also
support positive parent-child relationships and family well-being. Head
Start services are delivered by 1,700 public and private nonprofit and
for-profit agencies. More than 80 percent of the children served by
Head Start in 2013 were 3–4 years old. Early Head Start serves pregnant
women, infants, and toddlers and is available to families until
their child turns 3 years old. More than 1 million children are served by
Head Start programs annually. In 2013, with a budget of $7.6 billion,
Head Start programs served 932,164 children and their families, and
Early Head Start served 150,100 children.20, 21
The HHS Centers for Medicare and Medicaid Services’ (CMS) Children’s Health Insurance Program (CHIP) was enacted in 1997. This program provides health care coverage to children
in households whose incomes are too high to qualify for Medicaid
but who cannot afford private coverage. CHIP is administered by the
states and funded by both the federal government and states.22 From 1997 to 2012, the rate of uninsured children was halved, from 14 to 7
percent.23
For 2013, $19.1 billion was set aside for CHIP allotments, and 8.5 million children received insurance through CHIP at some time during the year.24
The Affordable Care Act of 2010 extends CHIP and enhances federal funding for the program by maintaining CHIP eligibility
standards through 2019 and extending funding through October 1, 2015. The CHIP federal matching rate will be increased by 23 percent, resulting in an average federal matching rate for CHIP of 93 percent.
The Affordable Care Act provided $40 million to continue efforts to
promote Medicaid and CHIP enrollment.25
Launched by the First Lady, the Let’s Move! program is a comprehensive
initiative intended to address the challenge of childhood
obesity within a generation. The program involves parents, elected
officials, schools, health care professionals, community-based organizations,
and private-sector companies. Components of the program
include providing information for parents to foster environments that
support healthy choices; providing healthier foods in schools; ensuring
that all families have access to healthy, affordable food; and
helping kids become more physically active.26
As part of this effort, the President established the first-ever White House Task Force on
Childhood Obesity to develop and implement an interagency plan to end childhood obesity.27 The Let’s Move! program is supported by the U.S. Department of Education, the U.S. Department of the Interior, the U.S. Department of Agriculture (USDA), HHS, the White House, and
numerous other organizations.28, 29
The USDA Food and Nutrition Service administers the Supplemental
Nutrition Assistance Program (SNAP)
, which helped more
than 47 million low-income Americans put food on the table in 2013.
SNAP primarily serves vulnerable populations, especially households
with children, elders, and disabled members. About 44 percent of all
SNAP participants are children.30, 31 Nutrition educators teach SNAP
participants the importance of a healthy diet and how to prepare
healthy foods and make healthy choices.32
In 2013, the SNAP budget was $79.9 billion, resulting in an average monthly benefit of $133.07
per person.33
The USDA Special Supplemental Nutrition Program for Women, Infants and Children (WIC) serves low-income pregnant, postpartum and breastfeeding women, and infants and children up
to age 5 who are at risk for poor nutrition. Foods provided through
the WIC program are designed to supplement recipients’ diets with
specific nutrients. Some WIC foods include iron-fortified adult cereal,
vitamin C-rich fruit or vegetable juice, eggs, milk, cheese, and peanut
butter. WIC served approximately 4.6 million children, 2 million infants,
and 2 million women in 2013.34
The Food and Nutrition Service administers other programs that
provide healthy food to children, including the National School Lunch Program, the School Breakfast Program
, the Child and
Adult Care Food Program
, the Summer Food Service Program
,
the Fresh Fruit and Vegetable Program
, and the Special Milk
Program
. These programs are administered by state agencies and
help fight hunger and obesity by reimbursing organizations such as
schools, child care centers, and after-school programs for providing
healthy meals to children.35
The National School Lunch Program operates
in about 100,000 schools and child care institutions. It provided
nutritionally balanced low-cost or free lunches to about 30 million
children each school day in 2012.36
The School Breakfast Program
also operates in schools and child care institutions. Breakfasts served
meet federal requirements, and eligible children are offered free or
reduced-price breakfasts. In 2012, nearly 13 million children participated
daily; of those, more than 10 million received their meals at a
reduced price or for free.37
Endnotes
1 U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. About Us. Accessed September 16, 2014.↑
2 U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health. Title V Maternal and Child Health Services Block Grant Program. Accessed September 16, 2014.↑
3 U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health. Title V Information System: Data Summary Report for Number of Individuals Served by Title V by Class of Individuals. Accessed September 16, 2014.↑
4 U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. Healthy Start. Accessed September 22, 2014.↑
5 Morse SB, Zheng H, Tang Y, Roth J. Early school-age outcomes of late preterm infants. Pediatrics. April 1, 2009;123(4):e622–e629. Accessed September 22, 2014.↑
6 Zwicker JG, Harris SR. Quality of life of formerly preterm and very low birth weight infants from preschool age to adulthood: a systematic review. Pediatrics. February 2008;121(2): e366–e376. Accessed September 22, 2014.↑
7 Ment LR, Kesler S, Vohr B, et al. Longitudinal brain volume changes in preterm and term control subjects during late childhood and adolescence. Pediatrics. February 2009;123(2):503–511. Accessed September 22, 2014.↑
8 Hack M. Young adult outcomes of very-low-birth-weight children. Seminars in Fetal & Neonatal Medicine. April 2006;11(2):127–137. Accessed September 22, 2014.↑
9 U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. Home Visiting Grants and Grantees. Accessed September 22, 2014.↑
10 U.S. Department of Health and Human Services, Office of the Administration
for Children & Families. Tribal Maternal, Infant, and Early Childhood Home Visiting. Accessed February 16, 2015.↑
11 The White House. Early Learning. Accessed September 16, 2014.↑
12 U.S. Department of Health and Human Services, Health Resources and Services Administration, Health Information Technology. Text 4 Health. Accessed September 16, 2014.↑
13 U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health. Injury and Violence Prevention and Safety Promotion. Accessed September 16, 2014.↑
14 Centers for Disease Control and Prevention. Essentials for Childhood Framework:
Steps to Create Safe, Stable, and Nurturing Relationships and Environments for all Children. Accessed March 2, 2015.↑
15 Centers for Disease Control and Prevention. Striving to Reduce Youth Violence Everywhere (STRYVE). Access March 2, 2015.↑
16 U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health. Adolescent and Young Adult Health Program. Accessed September 16, 2014.↑
17 U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health. Bullying Prevention Campaign. Accessed September 16, 2014.↑
18 U.S. Department of Health and Human Services, Health Resources and Services
Administration, Administration for Children and Families. What We Do. Accessed September 16, 2014.↑
19 U.S. Department of Health and Human Services, Health Resources and Services Administration, Administration for Children and Families. Programs. Accessed September 16, 2014.↑
20 U.S. Department of Health and Human Services, Health Resources and Services Administration, Administration for Children and Families. Office of Head
Start: Head Start Services. Accessed September 16, 2014.↑
21 U.S. Department of Health and Human Services, Health Resources and Services Administration, Administration for Children and Families. Office of Head Start: What We Do. Accessed September 16, 2014.↑
22 U.S. Department of Health and Human Services. Children’s Health Insurance Program (CHIP). Accessed September 16, 2014.↑
23 Rudowitz R, Artiga S, Arguello R. Children’s Health Coverage: Medicaid, CHIP, and the ACA. March 26, 2014. Accessed September 16, 2014.↑
24 U.S. Department of Health and Human Services, Centers for Medicare &
Medicaid Services. HHS FY2015 Budget in Brief: Children’s Health Insurance Program. Accessed September 16, 2014.↑
25 U.S. Department of Health and Human Services. Children’s Health Insurance Program (CHIP). Accessed September 16, 2014.↑
26 Let’s Move. Learn the Facts. Accessed September 16, 2014.↑
27 Let’s Move. Learn the Facts. Accessed September 16, 2014.↑
28 Let’s Move. White House Task Force on Childhood Obesity Report to the President. Accessed September 16, 2014.↑
29 Let’s Move. Initiatives. Accessed September 16, 2014.↑
30 U.S. Department of Agriculture, Food and Nutrition Service. Characteristics of Supplemental Nutrition Assistance Program Households: Fiscal Year 2012 (PDF). Nutrition Assistance Report Services, Report No. SNAP-14-CHAR. Accessed February 16, 2015.↑
31 U.S. Department of Agriculture. Supplemental Nutrition Assistance Program Participation and Cost (PDF). Accessed February 16, 2015.↑
32 U.S. Department of Agriculture. The Benefits of the Supplemental Nutrition Assistance Program (SNAP) (PDF). Accessed September 16, 2014.↑
33 U.S. Department of Agriculture. Supplemental Nutrition Assistance Program Participation and Cost (PDF). Accessed February 16, 2015.↑
34 U.S. Department of Agriculture, Food and Nutrition Service. Nutrition Program Facts: WIC—The Special Supplemental Nutrition Program for Women, Infants and Children (PDF). Accessed September 16, 2014.↑
35 U.S. Department of Agriculture, Food and Nutrition Service. School Meals: Child Nutrition Programs. Accessed September 16, 2014.↑
36 U.S. Department of Agriculture. National School Lunch Program (PDF). Accessed September 16, 2014.↑
37 U.S. Department of Agriculture. The School Breakfast Program (PDF). Accessed September 16, 2014.↑