Maternal and Child Health Services
Title V Block Grant

State Narrative for
Arizona
Application for 2010
Annual Report for 2008

Document Generation Date: Wednesday, July 15, 2009

Table of Contents
I. General Requirements ................................................................................................................. 4
A. Letter of Transmittal................................................................................................................. 4
B. Face Sheet .............................................................................................................................. 4
C. Assurances and Certifications................................................................................................. 4
D. Table of Contents .................................................................................................................... 4
E. Public Input .............................................................................................................................. 4
II. Needs Assessment...................................................................................................................... 6
C. Needs Assessment Summary ................................................................................................. 6
III. State Overview ........................................................................................................................... 8
A. Overview.................................................................................................................................. 8
B. Agency Capacity.................................................................................................................... 22
C. Organizational Structure........................................................................................................ 29
D. Other MCH Capacity ............................................................................................................. 33
E. State Agency Coordination.................................................................................................... 37
F. Health Systems Capacity Indicators ...................................................................................... 43
Health Systems Capacity Indicator 01: .................................................................................. 44
Health Systems Capacity Indicator 02: .................................................................................. 45
Health Systems Capacity Indicator 03: .................................................................................. 45
Health Systems Capacity Indicator 04: .................................................................................. 46
Health Systems Capacity Indicator 07A:................................................................................ 48
Health Systems Capacity Indicator 07B:................................................................................ 48
Health Systems Capacity Indicator 08: .................................................................................. 49
Health Systems Capacity Indicator 05A:................................................................................ 50
Health Systems Capacity Indicator 05B:................................................................................ 52
Health Systems Capacity Indicator 05C:................................................................................ 53
Health Systems Capacity Indicator 05D:................................................................................ 54
Health Systems Capacity Indicator 06A:................................................................................ 55
Health Systems Capacity Indicator 06B:................................................................................ 56
Health Systems Capacity Indicator 06C:................................................................................ 57
Health Systems Capacity Indicator 09A:................................................................................ 57
Health Systems Capacity Indicator 09B:................................................................................ 58
IV. Priorities, Performance and Program Activities ....................................................................... 60
A. Background and Overview .................................................................................................... 60
B. State Priorities ....................................................................................................................... 60
C. National Performance Measures........................................................................................... 66
Performance Measure 01:...................................................................................................... 66
Performance Measure 02:...................................................................................................... 69
Performance Measure 03:...................................................................................................... 72
Performance Measure 04:...................................................................................................... 75
Performance Measure 05:...................................................................................................... 79
Performance Measure 06:...................................................................................................... 82
Performance Measure 07:...................................................................................................... 86
Performance Measure 08:...................................................................................................... 90
Performance Measure 09:...................................................................................................... 92
Performance Measure 10:...................................................................................................... 94
Performance Measure 11:...................................................................................................... 97
Performance Measure 12:.................................................................................................... 100
Performance Measure 13:.................................................................................................... 103
Performance Measure 14:.................................................................................................... 106
Performance Measure 15:.................................................................................................... 108
Performance Measure 16:.................................................................................................... 111
Performance Measure 17:.................................................................................................... 113
Performance Measure 18:.................................................................................................... 115

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D. State Performance Measures.............................................................................................. 118
State Performance Measure 1: ............................................................................................ 118
State Performance Measure 2: ............................................................................................ 120
State Performance Measure 3: ............................................................................................ 123
State Performance Measure 4: ............................................................................................ 126
State Performance Measure 5: ............................................................................................ 129
State Performance Measure 6: ............................................................................................ 132
State Performance Measure 8: ............................................................................................ 134
State Performance Measure 9: ............................................................................................ 137
E. Health Status Indicators ...................................................................................................... 140
Health Status Indicators 01A:............................................................................................... 140
Health Status Indicators 01B:............................................................................................... 142
Health Status Indicators 02A:............................................................................................... 143
Health Status Indicators 02B:............................................................................................... 144
Health Status Indicators 03A:............................................................................................... 145
Health Status Indicators 03B:............................................................................................... 147
Health Status Indicators 03C:............................................................................................... 148
Health Status Indicators 04A:............................................................................................... 149
Health Status Indicators 04B:............................................................................................... 151
Health Status Indicators 04C:............................................................................................... 152
Health Status Indicators 05A:............................................................................................... 153
Health Status Indicators 05B:............................................................................................... 154
Health Status Indicators 06A:............................................................................................... 156
Health Status Indicators 06B:............................................................................................... 157
Health Status Indicators 07A:............................................................................................... 158
Health Status Indicators 07B:............................................................................................... 159
Health Status Indicators 08A:............................................................................................... 159
Health Status Indicators 08B:............................................................................................... 161
Health Status Indicators 09A:............................................................................................... 162
Health Status Indicators 09B:............................................................................................... 163
Health Status Indicators 10: ................................................................................................. 164
Health Status Indicators 11: ................................................................................................. 164
Health Status Indicators 12: ................................................................................................. 165
F. Other Program Activities...................................................................................................... 165
G. Technical Assistance .......................................................................................................... 167
V. Budget Narrative ..................................................................................................................... 169
A. Expenditures........................................................................................................................ 169
B. Budget ................................................................................................................................. 169
VI. Reporting Forms-General Information ................................................................................... 174
VII. Performance and Outcome Measure Detail Sheets ............................................................. 174
VIII. Glossary ............................................................................................................................... 174
IX. Technical Note ....................................................................................................................... 174
X. Appendices and State Supporting documents........................................................................ 174
A. Needs Assessment.............................................................................................................. 174
B. All Reporting Forms............................................................................................................. 174
C. Organizational Charts and All Other State Supporting Documents .................................... 174
D. Annual Report Data ............................................................................................................. 174

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I. General Requirements
A. Letter of Transmittal
The Letter of Transmittal is to be provided as an attachment to this section.
An attachment is included in this section.

B. Face Sheet
The Face Sheet (Form SF424) is submitted when it is submitted electronically in HRSA EHB. No
hard copy is sent.

C. Assurances and Certifications
Certification and assurances will be kept on file at the Arizona Department of Health Services.

D. Table of Contents
This report follows the outline of the Table of Contents provided in the "GUIDANCE AND FORMS
FOR THE TITLE V APPLICATION/ANNUAL REPORT," OMB NO: 0915-0172; published March
2009; expires March 31, 2012.

E. Public Input
Public input regarding the MCH Block Grant and the associated performance and outcome
measures has been incorporated as a continuous process within OWCH and OCSHCN. Program
managers and staff who work directly with the public, contractors, and community partners
brought the perspective of those stakeholders to the process. The Office of Women's and
Children's Health produces quarterly newsletters which are transmitted to partners electronically
and posted on the OWCH website. These newsletters keep our partners up to date on our
activities and priorities. The Office of Women's and Children's Health and the Office for Children
with Special Health Care Needs met with stakeholders independently and jointly.
/2008/
In addition to the public input activities listed above, the Bureau of Women's and Children's
Health conducted a number of public input meetings during the last two years. In 2006 and 2007,
all of the bureau chiefs of Public Health Prevention Services are visiting each county health
department in Arizona. The purpose of the visits is to learn about the unique needs of each local
area, and gather feedback on how we can better meet those needs. During the spring of 2007,
the Bureau of Women's and Children's Health posted their 2006 -- 2010 Strategic Plan and a
draft of this application on the internet for public comment and feedback. Additionally, a
community advisor read a draft of the application and provided feedback.
OCSHCN's direct service programs now collect survey data on family satisfaction, and OCSHCN
has implemented a new telephone inquiry tracking system to identify trends in family's concerns.
In addition, the OCSHCN website has a link through which annonymous input can be given.
OCSHCN continues to get feedback through its Integrated Services Grant, which brings together
partners from state child-serving and community-based agencies, parents and youth, and
OCSHCN's community development teams are an ongoing source of feedback. An intensive
stakeholder input series designed for CRS identified issues that applied more generally to
children with special health care needs.
//2008//
/2009/In addition to the activities outlined above, OCSHCN provided copies of the draft narrative
from the 2009 application to contractors, community partners, parents and youth for review and

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comment.//2009//
/2009/ A draft of the 2009 block grant application was placed on the ADHS web and stakeholders
were notified and asked to comment. //2009//
/2010/OCSHCN collected survey data on family satisfaction for CRS, FRC, DME and
Telemedicine. In 2008 and 2009 OCSHCN conducted key informant and partner interviews
to get input into what the community sees as strengths and weaknesses and unmet needs
of current system of care for CYSHCN. Participants were asked to help provide solutions.
The Bureau of Women's and Children's Health (BWCH) informed several stakeholder
groups about the Title V Needs Assessment process and invited their participation. BWCH
continued to produce newsletters to keep the public and partners up to date on maternal
and child health issues and Bureau activities.
The Draft 2010 Title V MCH Block application was posted on the Department's website for
public input. The draft application was transmitted to the public through Twitter. Staff also
emailed the draft application to key stakeholder groups such as the MCH section of the
Arizona Public Health Association, the Arizona Rural Women's Health Network, primary
care providers Head Start, and contractors. //2010//

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II. Needs Assessment
In application year 2010, it is recommended that only Section IIC be provided outlining updates to
the Needs Assessment if any updates occurred.

C. Needs Assessment Summary
Needs assessment activities for the Bureau of Women's and Children's Health (BWCH) included
many public input activities. In 2006 and 2007, the bureau chief is visiting each county health
department in Arizona. The purpose of the visits is to learn about the unique needs of each local
area, and gather feedback on how we can better meet those needs. During the spring of 2007,
the Bureau of Women's and Children's Health posted their 2006 -- 2010 Strategic Plan and a
draft of this application on the internet for public comment and feedback. Additionally, a
community advisor read a draft of the application and provided feedback. Feedback obtained
during these public input activities supported continuation of the seven priority needs identified for
the BWCH in the 2005 Needs Assessment. These priority needs are listed in section IV B of this
application.
All of OCSHCN's direct service programs now collect survey data on family satisfaction, and
OCSHCN has implemented a new telephone inquiry tracking system to identify trends in family's
concerns. In addition, OCSHCN has implemented a website with a link to provide annonymous
feedback on OCSHCN programs.
The Integrated Services Grant brought together partners from state child-serving and communitybased agencies, parents and youth, to identify barriers to statewide implementation of medical
home and care coordination for CYSHCN. The grant's task force and committees represent the
Arizona Chapter of the American Academy of Pediatrics, Arizona Medical Association, all of the
major child-serving agencies, the three state universities, family organizations, parents and youth,
the Governor's office, and many other key stakeholders. A key activity is to evaluate how current
systems for serving CYSHCN, including OCSHCN programs, promote Title V performance
measures, which encompass family-friendly, community-based care. OCSHCN strategic planning
uses results from this evaluation to target scarce Title V resources and align them with identified
gaps. A primary evaluation question will be whether OCSHCN is effectively directing its Title V
resources to address performance measures.
OCSHCN's 13 community development teams choose projects based on the needs of their own
communities. Raising Special Kids and their affiliated family-advocacy groups recruited families
for focus groups throughout the state to help inform the design for Children's Rehabilitative
Services as the program is scheduled to go out for a new procurement. Stakeholder input also
included physicians and other providers, AHCCCS administration and health plan medical
directors. Input went beyond the CRS Program and identified issues that applied more generally
to children with special health care needs.
Concerns among providers and families alike indicated that the system of care is fragmented and
is confusing to navigate, with lengthy and redundant eligibility processes and unpredictable
benefits. Children are often split up among several agencies for different aspects of their care.
Fragmentation also exists between primary and specialty care, and a need was voiced for a
reimbursement system that adequately compensated providers for primary care for C/YSCHN.
Provider shortages were identified as contributing to long waiting times for appointments for
pediatric sub-specialists. Overall, a need was identified to better educate families, providers, and
agencies about the child-serving systems of care and their eligibility processes.
Because of the identified need to clarify systems of care and facilitate linking children and youth
with appropriate services, OCSHCN is refocusing two of its priorities.

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New Priority #8. Educate families, providers, and child-serving agencies on eligibility rules and
processes for accessing services.
OCSHCN will target education efforts within its own agency by training OWCH Hotline staff,
Neonatal Intensive Care Program staff and Community Nursing staff on eligibility rules and
coverage of programs within OCSHCN and other agencies. OCSHCN will also develop
resources to train AHCCCS and other providers, hospital discharge planners, families, and
eligibility workers within other agencies. The OCSHCN website and e-learning system will be
expanded to include trainings on navigating the systems of care for CSHCN.
New Priority #9. Increase access to available and appropriate services for children and youth
with special health care needs.
Through the SSDI grant, OWCH and OCSHCN are defining processes to identify newborns who
test positive through the state's Newborn Screening Program and refer them to appropriate staff
within both offices and facilitate their enrollment into programs for care coordination and direct
medical services. OWCH and OCSHCN are also collaborating to define a new state performance
measure, which will track the percent of children identified through the newborn screening
process who receive services through an OWCH or OCSHCN program.
/2010/ ADHS has begun working on the next Title V 5-Year Needs Assessment and will be
completed by July 2010. Through consideration of quantitative data and public input,
ADHS will establish new state MCH priorities in 2010 that will shape Arizona's MCH
program 2010-2015. //2010//

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III. State Overview
A. Overview
The Governor's Commission on the Health Status of Women and Families was formed in 1999
with key leaders in the public and private sector appointed to serve on it. Title V funds a position
in the Governor's office to staff the Commission, and in May of 2005, the Governor approved the
Commission's recommendations and empowered them to develop an implementation plan
around the following recommendations:
1. Increase access to health care for the women of Arizona through: a) Comprehensive,
continuous health insurance coverage throughout the life cycle; b) Integrate dental and behavioral
health with physical medicine; c) Increasing access to family planning services for low-income
women in Arizona; and d) promoting cultural and linguistic competency among the health care
community to achieve appropriate care for diverse populations.
2. Improve the health and well-being of women in Arizona by increasing women's awareness of
how they can positively impact their health and well-being.
3. Reduce the teen pregnancy rate in Arizona, with a particular emphasis on reducing the
number of second pregnancies to teens.
4. Increase prenatal care and pre-conception care for women in Arizona through: a) Increasing
the number of women who access early prenatal care to improve birth outcomes; b) Increasing
access to better oral health to improve birth outcomes; and c) Promoting healthy preconception
lifestyles to women.
/2007/ The Governor's staff position moved to ADHS Division of Public Health Prevention
Services to coordinate women's health efforts within the Division, act as a liason among partners,
staff the Governor's Women's Commission, oversee implementation of the plan, and provide
technical assistance. //2007// /2009/ The Governor signed an executive order reauthorizing the
Commission. The Governor's staff are in the process of appointing members and determining
future activities. The Women's Health staff position moved back to the Governor's Office to
enhance the visibility of women's health issues as well as to better integrate with various
statewide efforts. //2009//
POPULATION
Arizona is the second-fastest growing state in the nation, with an estimated population of
5,832,150 in 2004. The state population grew by nearly 1.9 million people in the period between
1993 and 2004, representing an increase of 48 percent. An estimated 200,000 undocumented
immigrants moved to the state during the past five years, and Arizona now has the fifth-largest
population of undocumented immigrants in the United States, with an estimated undocumented
population of 500,000.
Since the last five-year maternal child health (MCH) needs assessment in the year 2000, there
has been a 14 percent increase in Arizona's population, while the population growth within the
nation as a whole for the same time period was only 4.3 percent. Over the next 25 years, the
U.S. Census projects that Arizona will grow by five million people, doubling by the year 2030. By
2004, the maternal-child population included 2,797,421 women of childbearing age and children
under age 21.
There are 15 counties in Arizona; however, 77 percent of the state's population resides in either
Maricopa or Pima Counties. Maricopa County alone added 500,000 people since 2000, more
than any other county, making it the third largest county in the United States. Overall, three of
every four Arizonans lives in an urban area, one in five lives in a rural area; 2 percent live in a

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frontier area, and 3 percent live on Indian reservations.
/2007/Arizona is the second-fastest growing state in the nation, with an estimated population of
6,044,985 in 2005. The population grew by over two million people between 1993 and 2005,
representing an increase of 53%. Since the year 2000, there has been a 15% increase in
Arizona's population, while the population growth in the nation for the same time period was only
5%. By 2005, the MCH population included 2,901,142 women of childbearing age and children
under age 21. Maricopa County alone added 576,396 people since 2000.//2007//./2008/During
the 12 months ending July 1, 2006 Arizona was the fastest growing state with a population
increase of 3.6%. //2008// /2009/ In 2007, Arizona's population grew to 6,338,755 -- an increase
of 1,208,140 persons (23.5%) since 2000, making Arizona the second-fastest growing state in the
nation.
Fifteen percent of the people living in Arizona in 2006 were foreign born. Eighty-five percent was
native, including 36 percent who were born in Arizona. //2009///2010/ According to Census
population estimates, Arizona's population was 6,500,180 in 2008 and increased by
1,369,548 persons since 2000 (26.69%). Approximately 161,425 persons increased since
2007 with Maricopa county ranking number one in population growth. //2010//

RACE/ETHNICITY
Twenty-one American Indian tribes reside in Arizona, each representing a sovereign nation with
its own language and culture. Tribal lands span the state and even beyond state borders, with
the Navajo Reservation crossing into New Mexico and Colorado, and the T'odono Odham
Reservation crossing international boundaries into Mexico.
Approximately 18 percent of tribal members reside on tribal lands while 82 percent are
considered urban. Some counties have high proportions of American Indians among their
population. Seventy-seven percent of Apache County, 48 percent of Navajo County, and 29
percent of Coconino County residents are American Indians.
Four counties border Mexico, and Arizona has an increasing Hispanic population, with a higher
proportion of Hispanics (28 percent) compared to the nation (13 percent). An even higher
percentage of children are Hispanic (39 percent in Arizona, compared to 19 percent nationally).
In 2003, the number of births to Hispanic mothers surpassed Anglos for the first time. Arizona
has a smaller percentage of African Americans than the nation (3 percent compared to 13
percent) and a higher proportion of Whites (88 percent compared to 81 percent nationally). /2009/
For people reporting one race alone in 2006, 79 percent was White; 3 percent was Black or
African American; 5 percent was American Indian and Alaska Native; 2 percent was Asian; less
than 0.5 percent was Native Hawaiian and Other Pacific Islander, and 11 percent was Some
other race. Two percent reported two or more races. Twenty-nine percent of people in Arizona
were Hispanic. Fifty-nine percent of the people in Arizona were White non-Hispanic.
//2009///2010/ The composition of Arizona's population in 2008 includes 70 percent nonHispanic population and 30 percent Hispanic population. The majority of the Hispanic
population is found in Santa Cruz (80%) and Yuma counties (56%). In 2008, of those who
reported one race alone and those who were not Hispanic or Latino, approximately 83.5
percent were White. Five percent was African American; approximately six percent was
Native American; approximately 3 percent were Asians; less than one percent was Native
Hawaiian and/or Pacific Islander; and the remainder was some other race, which included
two or more races. //2010//
LANGUAGE SPOKEN
Arizona residents are more likely to speak a language other than English at home (26 percent in
Arizona compared to 18 percent nationally), and more likely to report speaking English "less than
very well" (11 percent in Arizona compared to 8 percent nationally). Among Arizona residents

9

who spoke English "less than very well," 85 percent spoke Spanish, while the other 15 percent
spoke one of many other languages. /2009/ Among people at least five years old living in Arizona
in 2006, 28 percent spoke a language other than English at home. Of those speaking a language
other than English at home, 78 percent spoke Spanish and 22 percent spoke some other
language; 44 percent reported that they did not speak English "very well." //2009//
ECONOMY
Arizona is second in the nation in generating jobs; however, wages and personal income lag
behind the rest of the nation. Arizona's main economic sectors include services, trade and
manufacturing, and most of the fastest growing jobs in Arizona are jobs with relatively low wages
and fewer benefits (such as health insurance). The average per capita personal income in
Arizona ranked 38th among the 50 states, at $27,232 in 2003. Although the cost of living in
Arizona mirrors national averages, the per-employee compensation tends to be lower. /2007/
The average per capita personal income in Arizona ranked 38th among the 50 states, at $30,267
in 2005. //2007///2009/ The median income of Arizona households in 2006 was $47,265. Seventynine percent of households received earnings and 19 percent received retirement income other
than Social Security. Twenty-eight percent of the households received Social Security. The
average income from Social Security was $14,582. //2009//
/2009/ Arizona is currently facing a billion-dollar shortfall in its $11 billion budget. This is coupled
with the housing crisis, which has seen housing prices in Phoenix drop by double-digit
percentages for the past two years. A sharp decline in construction jobs caused the record-low
unemployment rate to spike by a full point, to 3.9 percent, from May to December 2007.
Population growth has slowed by half in Arizona and retail and office development are also
ebbing. In Maricopa County, there are about 13,000 homes in foreclosure, which is a six-fold
increase over two years ago. The decline in residential activity is leading to downturns in retail
and commercial construction as well. Many business people and economists do not expect
things to pick up until the Phoenix-area works through its inventory of about 37,000 unsold
homes, which could take three or four years. //2009/// /2010/ A critical aspect of the economy
in Arizona was the real estate market. In late 2007 and early 2008 Arizona experienced
tremendous decline in the real estate market. According to the Bureau of Labor Statistics,
the unemployment rate in the State of Arizona almost doubled (4.2 in December 2007 to 8.2
in May of 2009). Unemployment rates in Apache (10%), Santa Cruz (10%) and Yuma (17%)
counties were the highest in 2008 compared to rest of the counties in Arizona //2010//
Based on the 2003 U.S. Census three-year average estimate of 2001-2003, 13.9 percent of
Arizona's population earned incomes below the federal poverty line, while the national rate was
12.1 percent. In Arizona, 21 percent of children under the age of 18 years lived in poverty in
2003, relative to 17 percent children in the nation as a whole. Children continue to constitute a
large proportion of the poor population (45 percent) while representing only 30 percent of the total
population. In 2001, 26 percent of Arizona children lived in families in which no parent had fulltime, year round employment, and 29 percent lived in families headed by a single parent. These
families bear an increased risk for living in poverty. /2009/ In 2006, 14 percent of Arizonans were
in poverty. Nineteen percent of related children under 18 were below the poverty level, compared
with 8 percent of people 65 years old and over. Ten percent of all families and 27 percent of
families with a female householder and no husband present had incomes below the poverty level.
//2009// /2010/ The percent of Arizonans in poverty in 2007 did not change for all ages
according Census estimates. However, as per Kaiser State Health Fact analysis Arizona
ranked number 9 in regards to economic distress measured using foreclosure rates (AZ
ranks 4th) , unemployment rates (AZ rank 33), and food stamps (AZ rank 8th). //2010//
Hispanic and American Indian children were more likely to live in poverty than other racial and
ethnic groups. A study recently released by the Harvard Project on American Indian Economic
Development determined that American Indians, who are among the poorest minorities in the
United States, made gains during the 1990s in income, educational attainment, housing, poverty

10

and unemployment, and Arizona tribes shared in those gains. The report cautioned that
substantial gaps remain between American Indians and the rest of the United States.
HOMELESSNESS
In Arizona, "homeless" means the individual has no permanent place of residence where a lease
or mortgage agreement exists. Determining the number of homeless individuals is a significant
challenge because they are difficult to locate and/or identify. The best approximation is from an
Urban Institute study, which states that about 3.5 million people nationwide, 1.35 million of them
children, are likely to experience homelessness in a given year. Based on actual shelter and
street accounts in 2004, approximately 22,000 people are homeless on any given day in Arizona.
/2007/ Based on actual shelter and street accounts in 2005, there were approximately 20,00030,000 homeless people on any given day in Arizona. //2007///2010/ According to Arizona's
Department of Economic Security (AZDES) 7,776 persons were counted as sheltered
homeless persons throughout Arizona, including only those in emergency and transitional
facilities. One-third of sheltered homeless persons were children or unaccompanied
youth. //2010//
There are many factors that contribute to homelessness, including poverty, domestic violence,
gender (the majority of homeless adults are males), substance abuse, mental illness, lack of
affordable housing, decreases in public assistance, low wages and lack of affordable health care.
Families, specifically women with children, are the fastest-growing subpopulation of people who
are homeless. Twenty-seven percent of homeless women, children, and teens came from a
domestic violence situation. In spite of an overall positive economic picture in the state, the large
number of households earning less than a livable wage and a disproportionate rise in housing
costs versus incomes points to increasing numbers of homeless persons.
EDUCATION
Arizona has more than 583 school districts, which includes 364 charter holders. Arizona's has
2,270 schools and the largest number of charter schools in the nation. According to the National
Educational Association, Arizona per pupil spending is among the lowest in the nation. In a
national study of reading proficiency, nearly half of Arizona's 4th graders (46 percent) read below
proficiency, compared to 38 percent in the rest of the nation. /2009/ The total school enrollment in
Arizona was 1.6 million in 2006. Nursery school and kindergarten enrollment was 173,000 and
elementary or high school enrollment was 1.0 million children. College or graduate school
enrollment was 404,000. //2009//
Among Arizona's population age 25 and older, 84 percent have graduated from high school, and
24 percent have a college degree, similar to the proportions of all United States residents.
However, Arizona has one of the highest high-school dropout rates in the nation. During the
2003-2004 school year, the statewide dropout rate was 7.4 percent. For American Indians and
Hispanic students, the dropout rates were even higher (12.4 percent and 10.1 percent,
respectively). /2009/ In 2006, 84 percent of people 25 years and over had at least graduated from
high school and 26 percent had a bachelor's degree or higher. Sixteen percent were dropouts;
they were not enrolled in school and had not graduated from high school. //2009//
Arizona adopted high stakes testing requiring students to pass proficiency tests in reading,
writing, and mathematics in order to earn a high school diploma. The Arizona Instrument to
Measure Standards (AIMS) has been administered annually in recent years. Although passing
the test has not yet been required to earn a high school diploma, students have been taking AIMS
for purposes of evaluating school performance. High proportions of students across the state,
and even higher proportions of minority students, have failed to meet AIMS standards for
graduation. Implementation of the requirement to pass the AIMS before receiving a diploma was
postponed in order to give schools time to align their curriculum to testing standards. The class
of 2006 will be the first graduating class required to pass the test in order to graduate. In 2005,

11

legislation was passed to allow students to apply points towards their AIMS scores for some
classes in which they earned As, Bs, or Cs./2007/The Arizona Department of Education is
currently conducting a survey of all schools with graduating classes in 2006 to study the impact of
the AIMS requirement on graduation rates. The study is expected to be completed in September,
2006.//2007// /2009/ In the Fall of 2007, 83 percent of Arizona high school students who took the
AIMS test failed to meet state standards in Mathematics; 82 percent fell below standards in
reading; and 73 percent failed to meet the standards in the subject of writing. //2009//
According to the Annie E. Casey Foundation Kids Count 2004 study, a disconnected youth is
defined as a teen that is not in school or working. Currently, there are an estimated 3.8 million
(15 percent) young adults nationally who are neither in school nor working. In Arizona, 12
percent of teens age 16 to 19 are not in school or working. Referred to as "disconnected youth,"
they lack the skills, support and education to make a successful transition to adulthood. This
study determined that the most disconnected youth were the teens in foster care, youth involved
in the juvenile justice system, teens that have children of their own, and those who have never
finished high school. These subgroups were determined to need the most urgent attention.
/2007/ During the 2004-2005 school year, the statewide dropout rate was 6.9 percent. For
Hispanic and American Indians students, the dropout rates were even higher (10.2 percent and 8
percent, respectively). //2007//
/2009/ The 2006-07 school dropout rate for the state was 4.2 percent for all grades. Native
American students had the highest dropout rate at 8.9 percent and Asian American students had
the lowest dropout rate at 1.7 percent, followed by Whites with a rate of 2.8. African American
students had a dropout rate identical to the state average (4.2) and Hispanic or Latino students
had a slightly higher than average dropout rate (5.3). //2009//
JUVENILE DELINQUENCY
The proportion of violent crimes attributed to juveniles by law enforcement has declined in recent
years, while drug and alcohol-related arrests have increased. Between 1993 and 2002, there
were substantial declines in juvenile arrests for murder (64 percent), motor vehicle theft (50
percent), and weapons law violations (47 percent) and major increases in juvenile arrests for drug
abuse violations (59 percent) and driving under the influence (46 percent). Fourteen percent of
all arrests in Arizona were juveniles under age 18, compared to 16 percent nationally, and 71
percent of the arrests were male. Of the arrests of Arizona juveniles ages 8 through 17 in 2003,
16 percent of those offenses were larceny/theft. Runaways, drug violations, and assaults each
make up 10 percent of the total number of juvenile offenses, and liquor law violations made up 9
percent of the total violations. /2007/ In 2004, 17% of all arrests in Arizona were juveniles under
age 18, compared to 16% nationally, and 76% of the arrests were male. Of the arrests of Arizona
juveniles ages 8 through 17 in 2004, 17 percent of those offenses were larceny/theft. Runaways,
drug violations, liquor law violations, and assaults each make up 10% of the total number of
juvenile offenses. //2007// /2009/ In FY 2007 the rate of referrals to Arizona's juvenile justice
system declined to 5258 per 100,000 youth aged 8 to 17 years old. The majority of new offenses
were related to property crimes (46.2%); 21 percent were for crimes against persons, 15.7% were
for drug offenses and 10.8 percent were for public order offenses. As of 6/30/2007, 606 juveniles
were in the custody of the Arizona Department of Juvenile Corrections (ADJC) in one of five
secure-care facilities. An additional 476 juveniles were on parole. //2009//
HEALTH INSURANCE
Eighty-three percent of Arizona residents have some kind of health insurance, according to 2003
United States Census data. Many people have more than one kind of insurance: 64 percent of
people have private insurance--either employment-based (55 percent) or direct purchase (9
percent); and 30 percent had some kind of government-sponsored insurance--such as Medicaid,
(13 percent), Medicare (14 percent), or military health insurance (6 percent).
/2009/ Eighty-two percent of Arizona residents have some form of health care coverage,

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according to CDC's Behavioral Health Risk Factor Surveillance System (2007). There are
however major disparities in coverage between the different sexes, age groups and
race/ethnicities. For example, 85.0 percent of females in Arizona have health insurance/coverage
whereas only 78.7 percent of males are covered. 25-34 year olds have the lowest rate of
coverage (72.4%) whereas the vast majority of elderly residents in Arizona are insured/covered
(98.7%). And 90.8 percent of Whites in Arizona have some form of health coverage, but the same
is true for only 57.1 percent of Hispanics. //2009///2010/ A review of Arizona Healthcare
Dollars (In Billions) by Primary Market Segment, 2002--2010 by St. Luke's Health Initiative
indicates that: a) the healthcare expenditures for the under-65 population are expected to
more than double between 2002 and 2010 and these increases are a function of both
population growth and medical inflation; b) the individual coverage market segment is
projected to grow most rapidly due to lower coverage by employers; c) expenditures in the
Medicaid and uninsured market segments reflect a similar trend as individuals previously
covered through their employers may lose coverage, seek Medicaid coverage, or become
uninsured. //2010//
Ninety-three percent of all businesses in Arizona are small businesses with 50 or fewer
employees. There are more than 100,000 small businesses in Arizona, and each year, small
businesses add more workers to the workforce than large businesses. One of their top
challenges is to offer competitive benefits. Only 28 percent of Arizona small businesses offer
employer-sponsored health coverage, and cost is the primary barrier. For many Arizonans,
healthcare remains unaffordable.
Recognizing the importance of affordable health care, the Healthcare Group was created in 1985
by the Arizona State Legislature with the support of the Robert Wood Johnson Foundation. It is a
state-sponsored, guaranteed issue health insurance program for small businesses and public
servants. AHCCCS, Arizona's Medicaid agency, oversees and administers the program,
although it will receive no state subsidies after July of 2005. Over 4,000 businesses participate in
Healthcare Group, covering more than 12,000 Arizona residents.
The very concept of health insurance must be redefined as it applies to American Indians, who
are entitled to healthcare through treaties with the United States government. However, tribal
members face significant barriers to accessing care, including provider shortages and sometimes
a confusing array of barriers when accessing services.
MANAGED CARE
The health care delivery system and its financing has dramatically changed in the last 25 years,
and managed care has played a dominant role in its evolution. Approximately 70 percent of the
population in the United States under age 65 currently has private health insurance, the majority
of which is managed care based, obtained through the workplace. Under the managed care
umbrella, health maintenance organizations have become a major source of health care for
beneficiaries of both employer-funded care and of the public funded programs, Medicaid and
Medicare. 72 million people in the United States had health insurance through a health
maintenance organization in 2003. Participation rapidly increased until hitting peak enrollment in
1999; however, it has dropped by 9 million enrollees by 2003.
ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM
Arizona was the last state in the nation to implement a Title XIX Medicaid program. After much
debate, the legislature rejected traditional fee-for-service financing arrangements in favor of an
innovative plan for Medicaid managed care. In October 1982, the nation's first Section 1115
demonstration waiver for a statewide Medicaid managed care program was approved and the
Arizona Health Care Cost Containment System (AHCCCS) was created. AHCCCS is a prepaid
managed care Medicaid program that has become a national model.

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From the beginning the AHCCCS program was envisioned as a partnership, which would use
private and public managed health care health plans to mainstream Medicaid recipients into
private physician offices. This arrangement opened the private physician network to Medicaid
recipients and allowed AHCCCS members to choose a health plan and a primary care provider
who can be a physician, nurse practitioner or physician assistant. Primary care providers
manage all aspects of medical care for members. There are a limited number of plans available
in the rural areas, making fewer choices available to rural beneficiaries.
Fully medically necessary health care services are covered for individuals who qualify for
Medicaid, including comprehensive dental coverage for children under the age of 21 and
emergency dental care (extractions) for adults 21 years of age and older. For individuals who
qualify for the Federal Emergency Service (FES) and State Emergency Services (SES)
programs, AHCCCS health care coverage includes only emergency services.
In 1998, KidsCare became Arizona's Title XXI Children's Health Insurance Program (CHIP). It is
a federal and state program administered by AHCCCS to provide health care services for children
under the age of 19 living in families with a gross income at or below 200 percent of the Federal
Poverty Level (FPL). Since KidsCare began, enrollments have steadily risen. The outreach
efforts undertaken to identify children eligible for KidsCare have also resulted in identifying
additional children who are eligible for Medicaid. The KidsCare application is short, clear, and
relatively easy to use, and allows people to apply for health care coverage without having to go
through the longer and more detailed application process that is needed for Temporary
Assistance for Needy Families (TANF) cash assistance, food stamps, and other family assistance
programs.
The passing of Proposition 204 in 2001 expanded eligibility from 34 percent of the federal poverty
level to 100 percent. Expanded eligibility, together with Arizona's growing population, increased
enrollment in AHCCCS and KidsCare more than 40 percent--from 411,152 enrollees in federal
fiscal year 2001 to 579,640 enrollees in federal fiscal year 2003. By May 2005, enrollment in
KidsCare increased from 3,710 in December 1998 to 50,682 and AHCCCS was providing health
care coverage to 1,054,558 eligible members, approximately 18 percent of Arizona's population.
The state budget passed in 2003 directed AHCCCS to increase the premiums paid by families
with children enrolled in KidsCare. The new premiums are based on a sliding scale depending on
family income and number of children. Before July of 2003, the scale ranged from $0 to $20,
depending on income. As of July 2004, the premiums increased to a range of $10 to $35. /2007/
By March 2006, enrollment in KidsCare increased from 3,710 in December 1998 to 55,998 and
AHCCCS was providing health care coverage to 1,039,433 eligible members, approximately 17%
of Arizona's population. With the introduction of premium increases for KidsCare, enrollment
dropped by 16.4% in the 6 months following the increase, while the SOBRA kids program
(AHCCCS) reported an increase in enrollment by 18.8%, indicating that some children who did
not enroll in KidsCare or dropped may have enrolled in Medicaid instead. //2007///2010/ Dramatic
shifts in AHCCCS population indicate the volatility of Arizona's Medicaid. From June 2008
to June 2009 there was a dramatic decrease (-19%) in KidsCare enrollment and AHCCCS
for Parents (-3%) even though the AHCCCS population increased from 1,110,377 to
1,255,363, a 13 percent increase. //2010//
GENERAL AND SPECIAL HOSPITALS
According to the Arizona Department of Health Services Division of Licensing Services, there
were 59 general acute care hospitals in the State of Arizona in 2004, with 11,235 beds and 25
specialty hospitals with 1,790 beds. There are two children's hospitals, both of which are located
in the Phoenix metropolitan area. The state overall has 1.9 inpatient beds per 1,000 population,
one-third fewer beds per population than the national average of 2.8 per 1,000. According to the
United States Department of Health and Human Services, Arizona ranks 45 in the number of
hospital beds per 100,000 population. /2010/ The number of hospitals have grown since 2004.

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In 2009 there were 124 general acute care hospitals in Arizona of which 65 are short term,
15 are critical access, 10 long term, 9 psychiatric, 7 rehabilitation, 5 transplant, 2 children's
hospitals and remainder unclassifiable. //2010//
PROFESSIONAL HEALTH CARE PROVIDERS
Arizona has 12,121 physicians, representing 208 doctors per 100,000 residents. Although the
number of doctors practicing medicine in Arizona has grown faster than the population, the
physician-to-population ratio in Arizona remains far below the national average of 283. Eighty-six
percent of physicians practice in either Maricopa or Pima County, and the physician-to-population
ratios range from a high of 277 in Pima County per 100,000 to a low of 48 per 100,000 in Apache
County. Arizona has 606 registered nurses per 100,000 population, compared to 784 nationally,
and ranks 48 in the number of employed registered nurses per capita.
Federal regulations establish health professional shortage areas based on three criteria: the area
must be rational for the delivery of health services, more than 3,500 people per physician or
3,000 people per physician if the area has high need, and healthcare resources in surrounding
areas must be unavailable because of distance, over-utilization, or access barriers.
Since 2000, there has been a 25 percent increase in the number of federally designated health
professional shortage areas in Arizona. There are 60 areas that are federally designated
shortage areas in Arizona. Twelve of these areas are considered frontier, 35 are nonmetropolitan, and 13 are in metropolitan areas.
Arizona has developed its own designation system for identifying under-served areas. All
federally designated shortage areas are automatically designated as Arizona shortage areas. In
addition, Arizona's system involves the application of an index which weights 14 indicators such
as providers to population ratios, travel time, percent of population below poverty and adequacy
of prenatal care. There are 13 state designated Arizona medically under-served Areas. A recent
survey of State Title V Directors on pediatric provider capacity for children with special health
care needs pointed out network concerns specific to CSHCN. The most commonly identified
significant access barrier in this survey was the uneven distribution of pediatric providers.
Arizona has only one state medical school and a college of Osteopathic Medicine. As a result,
Arizona trains fewer of its own providers than do most other states and many Arizona medical
graduates leave to practice in other parts of the country. Arizona also has a higher percentage of
older physicians than the national average, and more physicians are retiring earlier as well.
These factors all affect Arizona's ability to develop and maintain an adequate provider network.
The American Academy of Pediatrics recommends one pediatrician per 10,000 people. Of the 14
counties in Arizona that have a population of at least 10,000, only Coconino, Maricopa and Pima
Counties meet this recommendation and 107 of the state's 109 pediatric specialists all practice in
these same three counties. The other two specialists practice in Yuma County.
According to the National Center for Vital Statistics, the percentage of midwife-attended births
has gradually increased from 1 percent in 1975, to 8 percent in 2002. Arizona reached a high of
10 percent of births being attended by a midwife in 1997. However, since 1997 there has been a
gradual decrease in the percentage of midwife- attended births to 7 percent in 2003. However,
nearly one in three American Indian births continue to be attended by midwives. As reported by
the Arizona Department of Health Services Licensing Division, as of April 2005, there were a total
of 34 licensed midwives, and 150 certified nurse midwives.
Although midwifery is a recognized alternative to the medical model of prenatal care, it is faced
with a number of challenges. Hospitals that admit women and babies who received midwifery
services use the same protocols as if the women had not received any prenatal care and most
insurance plans do not cover midwifery services. AHCCCS rules allow coverage for midwife

15

services and most of the AHCCCS-contracted health plans contract with them.
PERINATAL SYSTEM
Arizona is the home of a unique perinatal regional system. Voluntary participation by the Arizona
Department of Health Services, AHCCCS, the Arizona Perinatal Trust, private physicians,
hospitals and transport providers result in a statewide comprehensive system that is considered a
model nationally.
The Arizona Perinatal Trust endorses a voluntary program that certifies levels of perinatal care
provided at hospitals throughout Arizona. Level I perinatal care centers provide services for low
risk obstetrical patients and newborns, including caesarean deliveries. Level II facilities provide
services for low risk obstetrical patients and newborns, plus selected high-risk maternity and
complicated newborn patients. Level II EQ facilities provide expanded services of level II
perinatal care centers for defined maternal and neonatal problems through a process of
enhanced qualifications. Level III centers provide all levels of perinatal care and treatment or
referral of all perinatal and neonatal patients.
The perinatal system reduces neonatal mortality by transporting critically ill newborns from rural
hospitals to urban intensive care centers that are equipped to provide higher levels of nursing and
medical care during acute phases of illness. Neonatologists provide 24-hour consultation and
medical direction for transport, and the Arizona Department of Health Services Newborn Intensive
Care Program serves as payer of last resort for families with no insurance for care delivered at
Arizona Perinatal Trust certified facilities. The regional system has expanded and changed over
the years. Currently services are available to all Arizona residents from the first identification of a
high risk condition in pregnancy through post discharge and until the child is three years old.
ORAL HEALTH
Arizona has 15 counties that have been subdivided into 94 Dental Care Areas, which are
geographic areas defined by the state of Arizona based on aggregates of census tracts. These
Dental Care Areas are considered rational service areas for dental care by the State and are
used for Federal Dental Health Professions Shortage Area designations. Thirty of the 94 areas
are designated by the federal government as Dental Health Professional Shortage Areas. An
area may also be designated as a "vulnerable population" if it is in the top quartile of any of the
following: percent of the population less than 200% of the federal poverty level, percent of
population that is Hispanic, or percent of the population that is American Indian.
The Center for California Health Workforce studies at the University of California, San Francisco
in collaboration with the Arizona Department of Health Services Bureau of Health Systems
Development analyzed dental workforce data on the distribution of dental providers and the
availability of dental care services in Arizona. The project focused on profiling the statewide
distribution of dental services in order to inform oral health policy in Arizona. Data were collected
by the Arizona Department of Health Services Office of Oral Health through a statewide
telephone survey of dentists licensed and practicing in Arizona during the months of July 2000
through September 2001.
According to the survey, 58 percent of dental practices had at least one staff member that could
interpret for non-English speaking patients, while 63 percent said that they had patients who
needed that service. Among office staff who could interpret, 80 percent spoke Spanish, and a
total of 28 different languages were spoken. Vulnerable populations were more likely to need
interpreter services and were less able to meet the need. While 5 percent of practices overall
said that their staff were rarely or never able to meet interpretation needs, 12 percent of practices
in high Hispanic areas rarely or never met the need.
From 2000 to 2004, there was a net increase of 590 dentists and 999 dental hygienists licensed

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in Arizona. By September 30, 2004, 2,854 dentists and 2,439 dental hygienists had a license and
address in Arizona. In 2003 the Governor signed a bill into law that creates a new opportunity for
dentists and dental hygienists to expand the traditional walls of a dental practice through the
creation of an affiliated practice relationship, expanding the scope of practice for dental
assistants. Through an affiliated practice relationship, hygienists can provide preventive oral
health services (e.g., fluoride, cleanings, sealants) to children in a variety of community-based
health and educational settings without a prior examination by a dentist. It allows underserved
children access to preventive services at an earlier age in a convenient setting, such as a Head
Start Program or a school. It also provides an opportunity for early referral to dental services.
In 2004, legislation was passed to allow licensure by credentials, which provides a method for
dentists and dental hygienists licensed in other states to receive an Arizona license without a
clinical examination. Although it is expected that this change will increase the number of licensed
dental professionals in the state, the impact on access to care in underserved areas is yet to be
realized.
In 2003, the Arizona School of Dentistry and Oral Health opened its doors in Mesa to 54 dental
students as Arizona's first dental school. Students will earn the Doctor of Dental Medicine degree
and a Certificate in Public Health Management. The school specifically recruits students to work
in rural and underserved dental areas. In 2004, Mohave Community College in Bullhead City
accepted 18 students into its new Dental Hygiene Program. Students will provide preventive
therapies to this rural community as part of their educational experience. Two colleges in
Maricopa County are pursuing accreditation for dental hygiene programs.
BEHAVIORAL HEALTH
The Arizona Department of Health Services Division of Behavioral Health Services has
reorganized permanent statutory authority to operate the state's behavioral health system,
including planning, administration, and regulation and monitoring of all facets of the state
behavioral health system. The division's focus is to promote healthy development and to provide
effective prevention, evaluation, treatment, and intervention services to people in need who would
otherwise go unserved.
Behavioral health services are delivered through community-based and tribal contractors, known
as Regional Behavioral Health Authorities (RBHAs). Contractors are private organizations that
function in a similar fashion to a health maintenance organization, managing networks of
providers to deliver a full range of behavioral health care supports and services.
At this time there are six active Regional Behavioral Health Authorities: one serving northern
Arizona, one serving Yuma, La Paz, Gila, and Pinal Counties, one serving Maricopa County, one
serving Graham, Greenlee, Cochise, Santa Cruz, and Pima Counties, one serving the Gila River
Indian Community, and one serving the Pascua Yaqui tribe. In addition to other state and federal
funds, clinics receive funds from Title XIX and Title XXI. The Division of Behavioral Health
Services also has Intergovernmental Agreements with two additional American Indian Tribes to
deliver behavioral health services to persons living on the reservation. These tribes are the
Colorado River Indian Tribe and Navajo Nation.
The Division of Behavioral Health Services' strategic plan recognizes that the promotion of mental
health in infants and toddlers is key to the prevention and mitigation of mental disorders
throughout the lifespan. With the involvement of Tribal and Regional Behavioral Health
Authorities (T/RBHAs), other child-serving agencies, specialists in infant mental health, and
parent advocates, a uniform new approach to assessments and service planning has been
developed and will be implemented across Arizona effective October 1, 2005.
The ADHS Birth to Five assessment and service planning process differs from the system's
strength-based assessment process for all other persons in two ways: first, it focuses not on any

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particular attribute of a child, but on the context of the child's life, seeing the child as a product of
the environment in which he/she is immersed. Second, service plans must be written to support
and reinforce normalized child development; to promote and reinforce health-promoting parenting
and child rearing skills; to enhance child/parent attachment and bonding; and to reduce the longterm effects of any trauma. In regards to infants and toddlers, then, behavioral health
interventions will include preventive as well as corrective measures, and like the assessment, will
target the family, as well as the individual.
ARIZONA IMMUNIZATION PROGRAM
The Arizona Department of Health Services Arizona Immunization Program provides funding,
vaccines, and training support to public immunization clinics and private providers throughout
Arizona. The program works to increase public awareness by providing educational materials to
county health departments and community health centers and through partnerships with local and
statewide coalitions. The program monitors immunization levels of children in Arizona, performs
disease surveillance and outbreak control, provides information and education, and enforces the
state's immunization laws. The Arizona State Immunization Information System collects, stores,
analyzes and reports immunization data through a central registry maintained at the Department
of Health Services.
In 1992 the Arizona Department of Health Services founded the Arizona Partnership for Infant
Immunization (TAPI) as part of Arizona's federal Immunization Action Plan. TAPI is a non-profit
statewide coalition of more than 400 members. TAPI was formed in response to the alarming fact
that in 1993, only 43% of Arizona's two-year-olds were fully immunized against preventable
childhood diseases like measles, mumps, polio and whooping cough. Through the efforts of
TAPI's partners from public and private sectors, immunization coverage rates in Arizona have
dramatically improved, with more than three in four children fully immunized by age two. The goal
of TAPI is to deliver age appropriate immunizations by the year 2010 to at least 90 percent of
Arizona's two-year-old children before their second birthday and to encourage appropriate
immunizations through the lifespan.
MEDICAL HOME PROJECT
The Medical Home Project, administered through the Arizona chapter of the American Academy
of Pediatrics, was designed to increase access to and utilization of primary care services for
Arizona's uninsured children from low-income families. The Medical Home Project provides
delivery of medical services in participating physicians' offices to children without health
insurance and to those who do not qualify (or are in the process of qualifying) for public
assistance. The Medical Home Project creates a system of linkages between medical providers
and school nurses to assist with health care provision to the target population. School nurses
identify children who are eligible to participate in the Medical Home Project and facilitate their
enrollment. To be eligible for the Medical Home Project a child must have no health insurance;
must not be eligible for AHCCCS, KidsCare, or Indian Health Services; and must have a
household income less than 185 percent of the federal poverty level. For children who appear to
be eligible for AHCCCS or KidsCare, the school nurse is encouraged to identify resources to
assist families with the application process. A child with an acute illness may be seen through the
Medical Home Project while in the qualifying process. The child is provided with a referral form to
a participating health care provider and the school nurse makes the appointment.
A network of physicians (pediatricians, family practice physicians and specialists) provides care to
children qualifying for the Medical Home Project for a fee of either $5 or $10 as payment-in-full for
an office visit. The health care providers agree to provide a certain number of appointment slots
to Medical Home Project children each month. Development of the provider network has been an
ongoing effort since the beginning of the project in 1993. In addition, prescription medications,
diagnostic laboratory services, and eyeglasses are provided as necessary to qualifying children.

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Funding for the Medical Home Project has been provided by a number of entities. The Arizona
Department of Health Services Office of Women's and Children's Health has had a contract with
the Arizona chapter of the American Academy of Pediatrics since 1993 to fund the project
management. Other sources of funds include the Robert Wood Johnson Foundation, St. Luke's
Charitable Health Trust, Arizona Diamondbacks Charities, Diamond Foundation, as well as many
others. In addition to the primary care providers, a variety of specialist providers (e.g. cardiology,
dermatology, ears nose throat, orthopedics, pulmonology) have donated their services to children
in need of care.
The Medical Home Project is currently operating in seven Arizona counties involving school
nurses from 834 schools (representing 61 school districts). The primary care provider network
consists of 20 pediatric group practices, 38 individual pediatricians, 6 family practice groups, and
an additional 17 individual family practitioners.
COMMUNITY HEALTH CENTERS
Community health centers were established in the 1960s by federal law to treat and provide
primary care to all patients regardless of their ability to pay. The Arizona Association of
Community Health Centers reports that their membership includes 35 community health centers
with more than 100 satellite locations statewide, serving more than 400,000 people in 2002. The
Association represents health centers statewide and provides advocacy, professional education
programs, financial services, and programs for health centers to improve and ensure clinical
excellence. /2007/ 14 of the 35 centers are Federally Qualified Health Centers (FQHC's). In 2005
the FQHC's served 295,966 patients and logged 1,130,149 patient visits. It is estimated that in
2005 patient load and patient visits increased 40 to 60% in the remaining clinics. Eleven of the
clinics are tribal or serve significant populations of Indian people. //2007//
SCHOOL-BASED HEALTH CENTERS
There were 100 school-based or school-linked health care clinics in Arizona, delivering more than
45,000 medical visits to over 14,000 children during the 2002-2003 school year. Most of the
children served had no health insurance (79 percent). Thirty-five percent of the centers operate
in rural areas, and six operate on tribal lands. These clinics offer access to health care in
communities where there is a significant provider shortage and transportation to health care
services may be problematic.
School-based and school-linked health centers allow students to have immediate access to
health care providers for problems ranging from minor aches and scrapes to acute illnesses.
They are staffed with nurse practitioners and physician assistants who work closely with a
medical director. For many students, these centers are the only source of medical care.
Most school-based clinics are affiliated with a hospital-based outpatient department that provides
on-call services and after-hours coverage when the school-based clinic is closed. This
configuration not only offers a location for the child to go at times when the school clinic is not
open, but the affiliated location is also available as a medical home for all family members. All of
the clinics encourage parental involvement and parental consent is required before any services
are provided. The clinics support the philosophy of the parent participating as a partner in the
decision making process.
OTHER PROJECTS TO INCREASE ACCESS TO CARE
Health-e-Arizona is a web-based electronic screening and application process for public health
insurance. It was initiated by El Rio Community Health Center in Pima County and piloted there
beginning in June 2002. It is now used in most federally designated community health centers
throughout Arizona as well as in several hospitals. Since its inception, 32,000 people have
submitted electronic applications for processing by AHCCCS. The electronic application has

19

many advantages over the paper application. The electronic version requires full and complete
information before the application could be submitted, resulting in more complete and accurate
applications. As a result, the approval rate of electronic applications is much higher. The
electronic application process automatically screens for eligibility for a number of programs thus
helping to link patients with health care coverage; a total of 95 percent of those seeking health
care coverage through Health-e-Arizona have been linked to some health program.
Another community-based program, the Pima County Access Project (P-CAP) and Healthcare
Connect in Maricopa County are offering discounted health care to those not eligible for public
health insurance and unable to afford commercial insurance products. With federal grant funding,
the project recruited the participation of medical providers who are willing to charge discounted
rates to enrolled patients. P-CAP has 8,000 patients enrolled and Maricopa County Healthcare
Connect began enrolling patients in June 2004.
TELEMEDICINE
Telemedicine is the practice of medicine using a telecommunication system to provide clinical
services at a geographically separate site. Service can be delivered "real-time" using interactive
video conferencing or through "store and forward" which relies on the transmission of images for
review immediately or at a later time.
The University of Arizona Telemedicine Program is a statewide program intended to increase
access to healthcare to all residents in Arizona using telemedicine technologies. The use of
telemedicine reduces the need for rural patients and their families to travel to urban centers for
health services as well as enhances the rural health infrastructure. The program's
telecommunications network spans the entire state and serves as a hub for linking all of the
telemedicine networks in Arizona. Arizona's telemedicine network serves three functions: health
care delivery, education and training, and videoconferencing administrative meetings.
CULTURAL COMPETENCE
As racial and ethnic disparities in health outcomes and access to care persist, there has been
much interest in the concept of cultural competence. A recent study evaluated states not on
disparities in health outcomes, but on their efforts, leadership, capacity, and infrastructure that
would be sensitive to direct policy intervention to create state minority health policy report cards.
Four measures were defined: insurance coverage disparity, diversity ratio, offices of minority
health, and number of race/ethnicity vital statistics categories (Amal N. Trivedi, et al. "Creating a
State Minority Health Policy Report Card." Health Affairs 24.2 (March/April 2005): 388-396).
Since insurance coverage among people whose incomes fell below 200 percent of the federal
poverty level is correlated with state Medicaid policy, the authors used data from the 2001 and
2002 Current Population Surveys to find the states' low-income populations. By dividing the
state's percentage of low-income non-elderly minorities by its percentage of low-income nonelderly whites, they calculated the insurance ratio. The insurance gap is the relative risk of
uninsurance for minorities compared to whites among non-elderly poor, with low scores
representing lower relative risk levels for minorities. Arizona's insurance gap was 1.52, meaning
that minorities in Arizona were 52 percent more likely to be uninsured than whites. Delaware had
the lowest insurance gap, at 0.74, and Idaho had the highest gap, at 2.13.
The diversity ratio is a measure of the degree to which the demographic composition of a state's
physicians matches the demographic composition of the state as a whole. The ratio is calculated
by first dividing the total state minority population by the number of minority physicians in the
state. This number is then divided by the ratio of the total state white population to the number of
white physicians in the state. The diversity ratio is the factor by which underrepresented minority
physicians must be increased to reach population parity with whites. Arizona scored a 5.70 on
this measure. The state with the best ratio was Maine, with a score of 0.94. Illinois was worst, at

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11.53.
The office of minority health measure is a simple yes or no field. At the time of the analysis,
Arizona had discontinued its office. There were 27 states with minority health offices. Since the
time of the study, a Center for Minority Health in the Office of Health Systems Development was
reestablished.
The number of race/ethnicity vital statistics categories measures how precisely states record
race/ethnicity. For example, a state with two categories may break it down by "white/other" or
"black/white," while a state with three may say "black/white/other." Arizona tied with 16 other
states that used 5 categories. Three states only used one category.
The Center for Minority Health is currently conducting its own infrastructure assessment within
the Arizona Department of Health Services to determine minority health resources existing within
the agency, examine the capacity of the agency to identify and address health disparities and
barriers to access to care among minority groups and vulnerable populations, and to establish an
inventory and directory of minority health resources. /2007/ In fall of 2006, OWCH will be
conducting a nursing satisfaction survey of the High Risk Perinatal Program clients which will ask
a series of questions including if the community health nurse the client saw was aware of their
family's values and beliefs, and if the nurse cared about and was sensitive to those beliefs. The
OWCH developed and is implementing a new office policy and procedure on utilizing community
advisors in programs. Advisors are recruited and paid for a variety of tasks such as assisting in
developing programs, evaluations, request for proposals, and providing input on improvements to
program grant applications and priority-setting. Community advisors will enhance cultural
competence in programs by providing insight from the respective communities. The Center for
Minority Health is initiating training on Culturally and Linguistically Appropriate Services (CLAS)
with ADHS programs and contractor staff. //2007// /2009/ The Director of ADHS hired the
Department's first cultural competency advisor. All BWCH program managers attended training
on CLAS. The Department will be requiring all new employees to attend CLAS training. The
Center for Health Disparities features "brown bag sessions" highlighting different cultures and
their health issues and beliefs. //2009// /2010/ The Center for Minority Health is now known
as the Arizona Health Disparities Center (AHDC). //2010//
/2010/ The Arizona Health Disparities Data Profiles will compare leading indicators of
health status and health access for racial and ethnic populations relative to the general
population of Arizona. The analyses will be presented in the context of current social and
economic conditions affecting health outcomes. The AZ Health Disparities Center
supports the national Healthy People 2020 overarching goals. The AZ data profiles will
provide a framework for HP 2020 on the measurement and reporting of health disparities
in Arizona. The data profiles will be most useful for public health and healthcare
practitioners, state and local leaders, researchers, community-based organizations, and
others working to identify health priorities to achieve health equity improvements in
Arizona. //2010//
/2008/Critical Udates
In 2006, Arizona passed "First Things First", a ballot initiative that funds a voluntary system of
early care and education. The mission of the initiative is to increase the quality of, and access to,
early childhood programs that will ensure a child entering school the first time comes healthy and
ready to be successful. This mission will principally be achieved through regional grants tailored
to the specific needs and characteristics of the communities the region serves, and with a focus
on demonstrating how improved outcomes will be attained given the challenges the region faces.
In November of 2006 the voters of Arizona passed Proposition 201, The Smoke-Free Arizona
Act. The new law became effective May 1, 2007 and prohibits smoking in most indoor public
places including restaurants, bars, gaming facilities, bowling centers, public buildings, grocery

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stores or any food service establishment , lobbies, elevators, restrooms, reception areas,
hallways and any other common-use areas in public and private buildings, condominiums and
other multiple-unit residential facilities, indoor sports arenas, gymnasiums and auditoriums, health
care facilities, hospitals, health care clinics, doctor's offices and child day care facilities, common
areas in hotels and motels, and no less than 50% of hotel or motel sleeping quarters rented to
guests.//2008//

B. Agency Capacity
The capacity of the state Title V agency to meet all of the needs of the Title V population is limited
by both financial and programmatic restrictions. The Office of Women's and Children's Health
(OWCH) provides services and facilitates systems development to improve the health of all
women of childbearing age, infants, children, and adolescents. OWCH funds programs based
upon various criteria of need (financial, risk factors, health status, etc.).
The Office of Children with Special Health Care Needs (OCSHCN) has policy and program
development responsibilities for children to age 21 who have any one of a broad range of
disabilities or chronic illnesses diagnosed at any time during childhood, including the prenatal
period.
The Core Public Health Pyramid is used as a model for program planning and evaluation. This is
accomplished by use of needs assessment, technical assistance, and coalition building.
Arizona's MCH programs have components in each level of the Core Public Health Services
Pyramid. Program capacity is described below for each level of the pyramid.
OWCH DIRECT HEALTH CARE SERVICES
The High Risk Perinatal Program provides direct health care services in two of its three
components: the maternal /2010/ and neonatal //2010//transport component authorizes and
funds the transport of high risk pregnant women /2010/ or critically ill neonates //2010//to
appropriate medical centers for delivery /2010/ or care //2010// and the community nursing
component provides in-home nursing consultation to enrolled families. /2007/ Hospital and
Inpatient Physician Services has contracts with physician groups to provide care to infants in the
Newborn Intensive Care Unit. Developmental Follow-up Service provides developmental
assessments after discharge//2007//. /2010/ Due to substantial budget reductions in state
fiscal year 09, the developmental component of the program was eliminated; changes
were made to eligibility; and payments to providers were reduced; and community nursing
visits were reduced. //2010//
The Reproductive Health/Family Planning Program contracts with county health departments to
provide education, counseling, referral, and medical care services to women of childbearing age.
The Domestic Violence Program provides shelter services and counseling to victims of domestic
violence and their children. The Health Start Program provides in-home prenatal outreach
services through lay health workers to at-risk women.
OCSHCN DIRECT HEALTH CARE SERVICES
Children's Rehabilitative Services (CRS). The Arizona Department of Health Service (ADHS),
Office for Children with Special Health Care Needs (OCSHCN) transitioned from direct service
delivery to administrative oversight of the Children's Rehabilitative Services network of contracted
providers in 1985. CRS provides medical treatment, rehabilitation, and related support services
to Arizona children, birth to 21 years of age, who have certain medical, handicapping, or
potentially handicapping conditions. The objective of CRS is to assure the highest quality
comprehensive care through a family-centered, multi-specialty, interdisciplinary team approach in
a cost-effective managed care setting. CRS provides these services through four regional
Centers of Excellence; each with its own hospital and physician support. In addition to the four

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regional sites, services are provided through outreach clinics throughout the state. The outreach
clinics are designed to provide a limited specific set of services including evaluation, monitoring,
and treatments in settings closer to a family's home. The OCSHCN monitors the service delivery
system, ensures contractual compliance, initiates quality improvement activities, and provides
education, support, and technical consultation.
High Risk Community Nursing. Through contracts with private agencies and county public health
departments, public health nurses provided follow-up nursing services to children with special
health care needs and infants discharged from newborn intensive care units. This program
served approximately/2010/ 5,000 //2010// families each year.
OCSHCN provides Community Home Nursing services to assist families who have children/youth
who are medically fragile or are at risk for developmental delays. Specially trained community
health nurses are available throughout the state to support the family during a transition from
hospital to home, to conduct developmental, physical, and environmental assessments and
referral to appropriate community resources. The community health nurse provides support,
education, and guidance to family as they develop plans for their child's ongoing care.
/2010/In June 2008 Arizona Physicians IPA was awarded a contract to manage the CRS
Program. OCSHCN continues as program administrator//2010//
OCSHCN ENABLING SERVICES
Service Coordination. The OCSHCN provides service coordination for Arizona families with
children, birth to three years of age, who are eligible for the Arizona Early Intervention Program
(AzEIP) and for children/youth with chronic medical problems, developmental delays, or traumatic
brain injuries. Service coordination is an enabling function that assists families to access needed
services and work toward independence. Through the program, families and community-based
providers develop and implement an Individualized Family Service Plan, a Family Service Plan,
or an Individualized Service Plan. Program objectives include having families: acquire knowledge
and skills to support the development of their child with special needs; communicate and
coordinate all services among providers, emphasizing the team approach; and identify their
concerns, priorities, and resources.
AzEIP is a collaborative program of the Department of Economic Security, Arizona Health Care
Cost Containment System (AHCCCS), Department of Health Services (ADHS), Department of
Education, and Arizona Schools for the Deaf and Blind (ASDB). The ADHS' Office for Children
with Special Health Care Needs provides developmental screening and referral services to
Arizona infants/toddlers, birth to three years of age, who are exhibiting developmental delays and
who may benefit from early intervention./2009/AzEIP moved to the Arizona Department of
Economic Security. OCSHCN will continue involvement as a liaison to provide input regarding
CYSHCN.//2009//
Traumatic Brain Injury Program. Children and teenagers with traumatic brain injuries (TBI), their
families, and professionals are provided an array of coordination services to assist in: the
determination of priorities and the creation of the Individualized Service Plan; assessment of
resources and needs; identification of other/additional resources; navigation of the multiple
service delivery systems; completing forms and applications for services; locating service
providers; coordination of services; and supporting the child/family in the Individual Education
Plan (IEP) process. Also, as needed, TBI Program service coordinators can advocate for the
child/family with providers, services, school and insurance; provide continuity as child moves
through stages of recovery and other aspects of service delivery; and assist in transitions (from
hospital/rehabilitation/home/school). Additionally, the program provides community education
and awareness of TBI and its effects.
/2010/The relationship between OCSHCN and the Governor's Council for TBI/SCI has

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changed from service delivery to providing technical assistance on transition to adult
services and providing information about resources and accessing services for
CYSHCN//2010//
OWCH ENABLING SERVICES
Enabling services such as outreach, health education, family support services, coordination with
Medicaid, and case management are provided through numerous OWCH programs. The Health
Start Program is a neighborhood outreach program that works with women who are pregnant, or
think they may be pregnant, and their families to help them improve their health and the health of
their families.
The Children's Information Center Hotline and the Pregnancy and Breastfeeding Hotline make
referrals to AHCCCS, KidsCare, and other community health resources. The Pregnancy and
Breastfeeding Hotline serves as the referral source for the Baby Arizona Project that links callers
with prenatal care services. The AZAAP Medical Home Project, helps uninsured and
underinsured children to find a medical home by linking with a primary care provider.
Community Health Services contracts for community-based efforts addressing specific
performance measures related to women and children. Contractors provide a variety of services.
One contractor implemented a program to provide health education and activities addressing
smoking, physical activity, stress reduction, and proper nutrition for adolescents. Another
contractor is targeting efforts directed toward women who are low-income, have a limited
education and women of color. They are providing a program that addresses healthy weight
management, nutrition, physical activity, stress management, and smoking cessation. Many of
the contractors are also focusing on injury prevention by providing child safety seats and bicycle
helmets, conducting car safety seat inspections, training in the proper use of car seats, educating
pregnant women regarding proper seat belt use, and training car passenger safety technicians.
/2007/ The County Prenatal Block Grant (CPBG) funds all 15 County Health Departments to
develop programs to encourage entry into early prenatal care. Activities include pregnancy
testing, childbirth education, support programs for dads, and health education. //2007// /2010/
The County Prenatal Block Grant was suspended at the end of the third quarter of the
state fiscal year due to state budget reductions. //2010//
/2008/The Pregnancy Services Program is a new initiative that was established by the 2006 State
Legislature to provide individual grants to non-profit agencies whose primary function is to assist
pregnant women seeking alternatives to abortion. The goal of the program is to provide funding
for medically accurate services and programs related to pregnancy. The priority service areas
focus on positive public health activities for pregnant women and their children. In 2007, 13
contractors were funded to provide one or more of the following pregnancy related services:
options counseling; prenatal vitamins; education on folic acid, prenatal care, breastfeeding,
infant/child care and development, childhood immunization schedule and the importance of age
appropriate immunizations; parenting skills training; and preconception care education and
support.//2008//
/2009/ The Pregnancy Services Program was eliminated as a result of budget cuts in the FY09
state budget. //2009//
OWCH POPULATION-BASED SERVICES
The Newborn Screening Program screens for all newborns for eight conditions prior to hospital
discharge. Screening results for all children are reported to the child's physician of record. Follow
up is provided to ensure that second screenings are conducted. The Newborn Hearing
Screening Program provides hearing screenings of newborns prior to hospital discharge and
provides technical assistance, data collection, and collaboration to provide screening equipment
to Arizona hospitals. The Sensory Program facilitates the implementation of hearing and vision

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screenings in Arizona schools. Schools submit hearing and vision results to the Sensory
Program. /2007/ Legislation was enacted to expand screens to 29 conditions and to require
reporting initial and subsequent hearing tests performed on a newborn. //2007//
/2008/As a result of state legislation passed in 2006, the Bureau of Women's and Children's
Health developed and is distributing educational pamphlets on cord blood banking. Cord blood
banking is a relatively new procedure that can save lives, and is completely safe for babies and
mothers. It provides a unique biological safeguard, which can come in handy later in life. The
pamphlets include information such as banking options, how cord blood is collected, and the
costs, benefits, and risks of storing and donating cord blood.//2008//
/2009/ As a result of state legislation passed in 2008, the NBS program will be moved into the
ADHS State Laboratory so that all components of NBS are centralized under one authority.
//2009//
/2010/ The Sexual Violence Prevention and Education Program reaches nearly 28,000
Arizonans per year with primary prevention education. The program has worked with
multiple stakeholders to develop the first state plan specific to prevention of sexual
violence. The program develops multi-faceted, evidence and theory based activities
and/or strategies; addresses change at multiple levels; and focuses on multiple life
stages; child, adolescent, and adult. //2010//
OCSHCN POPULATION-BASED SERVICES
Sickle Cell Anemia Program. Statewide screening, referral, and genetic education are provided
to infants, children, adults/couples with ancestry from the "world wide malaria belt," (i.e., Africa,
Italy, Greece, Spain, India, Pakistan, Mexico, South America, and countries of the Middle East,
Asia, Southeast Asia, and the Caribbean) who carry the sickle cell gene. Program goals are: early
diagnosis and treatment; education to enable persons with sickle cell disease or trait to make
informed decisions regarding child bearing; provision of guidelines and protocols to physicians;
and public education about the economic and social impact of sickle cell disease./2009/The
Sickle Cell Program was integrated into BWCH Newborn Screening(NBS)to facilitate coordination
between Sickle Cell and other conditions identified by NBS.//2009//
/2010/TheSickle Cell Program returned to OCSHCN in September 2008//2010//
OWCH INFRASTRUCTURE-BUILDING SERVICES
OWCH facilitates infrastructure development through coalition building to enhance service
delivery and addresses issues of the Title V population. The Governor's Commission on the
Health Status of Women was established in October 2000 as the result of collaboration between
the Arizona Department of Health Services Office of Women's and Children's Health and the
Governor's Office. Over the past five years, the commission has brought together public and
private parties concerned with women's health to promote women's health activities, educate the
public and establish policy that supports women's health. This year, the commission presented
their recommendations to the Governor which focused on four areas: 1) increasing access to
health care for women, 2) improving health care response and raising awareness about health
risks for women, 3) reproductive health and family planning: access to services and 4) prenatal
care. /2010/ The Governor's Commission on Women's and Children's Health was reestablished in September 2008. The Commission developed an action plan targeting the
area of obesity prevention among children and families. The Governor's Office staffs the
Commission with the support of Title V funding through the Bureau of Women's and
Children's Health. //2010//
Other examples of OWCH coalition building efforts include: the Adolescent Health Coalition that
addresses adolescent health status issues, the Arizona Perinatal Trust that works to improve

25

perinatal outcomes through professional and public education, voluntary hospital certification, and
data for participants in the regional certification process, and the Arizona Family Planning
Coalition that provides education and supports efforts to improve women's reproductive health
and the right to make informed decisions. The Domestic Violence Program administers the
federally funded Family Violence Prevention and Services Grant. The funds are used to work with
existing Rural Safe Home Networks (RSHN) to ensure continued funding; to establish Rural Safe
Home Networks (RSHN) for persons experiencing family and domestic violence in rural
communities; to expand and link these RSHN so that they are modeling on "best practice"
prevention models; and to develop a set of standards and guidelines for rural safe home/shelters
that will ensure the use of "best practices" in service delivery for domestic violence victims.
Many OWCH contractors have been required to conduct comprehensive needs assessments as
a contract deliverable (e.g. the County Prenatal Block Grant requires each of the fifteen counties
to develop a needs assessment of the prenatal population). All projects funded by the
Community Health Services Grant are required to use the Logic Model to define their program
goals, objectives, measurements and program evaluation component. Staff members from the
OWCH PEP Section provide training to potential contractors and those awarded contracts in the
use of the Logic Model.
The OWCH's organizational structure is based on a functions approach rather than programs for
specific populations. The office provides technical assistance to entities serving the Title V
population (i.e. communities, contractors, coalitions, schools, county health departments, other
state agencies, etc.). The Planning, Education, and Partnerships Section (PEP) provides
technical assistance on adolescent growth and development, dealing with adolescents,
adolescent risk behaviors, and health and safety in child care settings. The Newborn Hearing
Screening Program provides technical assistance to hospitals implementing universal hearing
screening. A PEP Section employee sits as a non-voting member of the Arizona School-based
Health Care Council board. The OWCH is working with the Governor's School Readiness Board
to improve early childhood systems. A statewide plan will be completed by June 2005. /2007/
Emergency Medical Services for Children offers child emergency care training statewide to those
who respond to child emergencies. The Arizona Injury Surveillance and Prevention Plan
established objectives and proposed strategies to avoid injury. Arizona Safe Kids is a state-wide
program to prevent unintentional injury to children under age 15 and provides local coalitions with
leadership and technical assistance. //2007//
/2010/ The Bureau of Women's and Children's Health works closely with the Governor's
Office for Children , Youth, and Families, and the First Things First Board to improve early
childhood systems. The Bureau's Office of Children's Health coordinates a workgroup
within the Arizona Department of Health Services (ADHS) focused on the needs of children
0 -- 5 years of age. This Zero to Five Workgroup consists of representative of each Bureau,
Office or program focused on the young child. The mission of this group is to coordinate
programs and services offered by the Arizona Department of Health Services around
infants and young children and to provide timely and authoritative information from all of
the ADHS programs who serve or study this population when needed.
The Bureau of Women's and Children's Health supports a strong infrastructure for
assessment and evaluation of maternal and child health programs. The Office of
Assessment and Evaluation conducts program evaluation, provides technical assistance
to programs, provides data analysis and database management, assists with or authors
grant applications, and produces reports for bureau programs as well as stakeholders and
the general public. The Bureau's Injury Prevention Program includes an injury
epidemiologist who provides state, local, and specialized reports for various stakeholders
and the public. //2010//

OCSHCN INFRASTRUCTURE-BUILDING SERVICES

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OCSHCN has five primary activities associated with infrastructure building; the development and
maintenance of coalitions with external constituents; the enhancement and integration of data
collection efforts, the development and utilization of the telehealth/telemedicine system
throughout Arizona; the development and implementation of a learning management system; and
the enhancement of the community action team philosophy.
Asthma Program. This public health program primarily supports local coalitions throughout the
state in their efforts to develop and implement community-based programs to address the needs
of children who have asthma. Additionally, OCSHCN uses its network of providers, communitybased organizations, and those with an interest in asthma to share information on: materials,
advances in diagnosis and treatment, grant opportunities, data, and conferences./2009/This
program has moved to ADHS Bureau of Chronic Disease Prevention and Control. OCSHCN will
provide technical assistance regarding CYSHCN.//2009//
Beginning in 2004, OCSHCN brought together members of state agencies, community agencies,
educational institutions, providers, and families to identify what services were being provided to
C/YSHCN in Arizona, who had formed partnerships to conduct these activities, and whether there
were missing pieces in the service delivery model. That group will form the Statewide Integrated
Services Task Force funded by MCHB. This group will be charged with evaluating the needs of
C/YSHCN, the service delivery system, gaps in services, and barriers to services and to draft a
white paper to the Governor on recommended changes. There are numerous subcommittees
that will enhance the work of the task force; one of these subcommittees will evaluate specialty
services which will focus on maximizing the development of the telehealth/telemedicine
throughout the state of Arizona, a second committee will focus on establishing standard for
cultural competency in the service delivery systems, a third will develop, implement, monitor, and
provide reports on various quality improvement methodologies including program evaluation tools
Annual Family Centered CRS Survey. OCSHCN conducts an annual survey of families enrolled
in CRS to assess the degree to which family centered care is provided at the regional centers and
outreach clinics. This bilingual tool assesses the degree to which family members believe the
national performance measures are being achieved in the CRS clinics and how satisfied they are
with the services they receive.
Annual CRS Provider Survey. Beginning in 2005, an annual survey of all CRS contracted
providers will be conducted to evaluate the system issues within CRS. Are there barriers to care
that are experienced by the providers, how responsive is CRS administration to the needs of the
providers, and to determine if they have unmet educational needs.
Quality Improvement Activities. CRS must submit to AHCCCS two Performance Improvement
Projects on an annual basis. These PIPs must identify a quality of care issue that will be
monitored for improvement against a pre- and post-intervention time frame. Currently the four
regional CRS sites are collecting information on the development and implementation of a
transition plan for youth when they reach their fourteenth birthday.
Quality of care is monitored through site visits with all contracted providers of their policies and
procedures, clinical case records, and financial billing procedures. Any deficiencies are
addressed through the completion of a corrective action plan submitted to OCSHCN for review
and acceptance.
Consumer satisfaction surveys are conducted with every CRS provider and family participating in
telemedicine activities. Additionally annual satisfaction surveys are conducted with contracted
service coordinators and the clients they serve.
Development and enhancement of the telehealth/telemedicine system. A statewide network of
sites that have the capacity for simultaneous audio and visual communication is used for: the

27

provision of clinical services to patients who live in areas that do not have ready access to
specialists; conduct administrative meetings among staff living and working in different parts of
the state; provide networking and information sharing opportunities for families and/or providers;
and conduct training. OCSHCN has continued to expand its telehealth network. Funding from the
Arizona Department of Health Services provided for the purchase of compatible equipment by
each of the CRS clinics.
Learning Management System. ADHS has created the infrastructure to develop a learning
management system by combining the resources of four office: the Office of Nutrition and
chronic Disease, Public Health Preparedness and Response, the Office for Children with Special
Health Care Needs, and Emergency Medical Services. This system will allow the electronic
tracking and evaluation of all web-based educational modules. These modules are available 24/7
and can be utilized real time or can be stored and reviewed at a later time. In addition to the
tracking and educational modules, there will be a list serve available to participants to discuss the
information with other e-learners. This system will be available to the four offices to provide
training opportunities to their staff, their community partners, and family members. OCSHCN
plans to utilize this technology to implement many of its training curriculums.
Community-Based Systems of Services. Through its community development initiative,
OCSHCN continues to seek to improve family access to information and understanding of the
eligibility and service delivery system through parent leadership and the development of local
community action teams in selected communities. Working in partnership with community parent
leaders, providers, and citizens, OCSHCN staff provide information, technical assistance and
support services to create healthy environments within which organized community initiatives can
grow and be nurtured.
Community parent leaders are placed under contract to reimburse them for their time and
expertise in facilitating and supporting the work of their local community action teams. In addition,
parents are integral members of CFHS and participate in developing budgets, planning and
facilitating retreats and conferences, working on teams and developing strategic plans.
Partnership with both parents and professionals is one way to ensure that the development of
community-based systems of services addresses the needs of the population served.
Family participation in the decision-making process is incorporated in contractual agreements
with the Children's Rehabilitative Services (CRS), through the Parent Action Councils (PAC).
Each regional PAC provides a parent representative to the quarterly ADHS/OCSHCN/CRS
Administrators and the Medical Directors meetings to promote continuous family centered care.
PAC meetings are held at least quarterly to provide education, training, and support among PAC
members.

/2010/ Economic Downturn Affects Agency Capacity
During State FY 2009, the economic downturn had a severe impact on Arizona. A hiring
freeze has been in effect for well over a year, and the agency capacity has been reduced
by approximately 25%. The mortgage crisis hit particularly hard in Arizona, and the state
deficit necessitated deep cuts in order to balance the budget. Each state agency was
asked to make a lump sum reduction. Agencies adjusted with a combination of costcutting measures from restricting airconditioning, lighting, maintenance, travel, and staff
reductions, including layoffs and furloughs.
ADHS cut approximately one-fifth of its budget. This was accomplished by having all
employees take ten unpaid furlough days before the end of the fiscal year, which
amounted to one day per two-week pay period from the time the cuts were implemented in
February until June 30th. In addition, program budgets were cut. Since the cuts were
implemented late in the fiscal year, this had the effect of ending many programs. For
example, Children's Rehabilitative Services (CRS) was forced to end payment for medical

28

services for children with chronic and disabling conditions who were not enrolled in
Medicaid. There were approximately 1,200 children who lost state assistance for their
medical care in March. As the economy worsens, it is expected that the need for services
will grow at the same time that the capacity to deliver them is diminished.
As of July 13, 2009 the SFY 2010 Budget had not been resolved and further substantial
budget cuts are expected. //2010//

C. Organizational Structure
Governor Janet Napolitano was sworn into office in January 2003. Prior to being elected
Governor of Arizona, she served one term as Arizona Attorney General and four years as U.S.
Attorney for the District of Arizona. A hallmark of Governor Napolitano's administration has been
government reform on all levels. She established an efficiency review initiative that has identified
hundreds of millions in savings over five years. Her various citizens' commissions have
recommended important improvements to Child Protective Services, Department of Corrections,
and the Arizona tax code. She erased a billion-dollar state budget deficit without raising taxes or
eliminating vital services. She has tackled the spiraling price of prescription drugs by launching
what is now the CoppeRx CardSM, a discount program that is saving Medicare-eligible Arizonans
more than $100,000 a week. She is a distinguished alumna of Santa Clara University and the
University of Virginia Law School.
The Arizona Department of Health Services (ADHS) is one of the executive agencies that report
to the Governor. ADHS was established as the state public health agency in 1973 under A.R.S.
Title 36 and is designated as Arizona's Title V MCH Block Grant administrator. Eight divisions in
ADHS report to one of two deputy directors: Office of the Director, Arizona State Hospital,
Division of Assurance and Licensure Services, Division of Behavioral Health Services, Division of
Business and Financial Services, Division of Information Technology Services, Organizational
and Employee Development, and Division of Public Health Services.
/2010/ Janice K. Brewer became the 22nd person to take the oath of office as Governor of
Arizona on January 21, 2009. She is Arizona's fifth Secretary of State to succeed to
Governor in mid-term. Jan Brewer has lived in Arizona for 38 years, and she has spent the
past 26 of them serving the people and upholding the public trust. There are few, if any,
elected officials in Arizona with a broader range of productive experience in public
service. Prior to her succession to Governor, she served as Arizona Secretary of State, as
Maricopa County Supervisor, and as a highly respected member of both houses of the
Arizona Legislature, where she rose to leadership of the State Senate. //2010//
The Division of Public Health Services is organized into two primary service lines; Public Health
Preparedness Services and Public Health Prevention Services (PHPS). PHPS administers Title V
funds and coordinates activities through the Office of Women's and Children's Health (OWCH)
and the Office for Children with Special Health Care Needs (OCSHCN). Included in PHPS are
the Office of the Deputy Assistant Director which includes the medical director, business
operations, and epidemiology services. Other offices within PHPS are the Office of Chronic
Disease Prevention and Nutrition Services, (including WIC), the Office of Oral Health (OOH), the
Office of Health Systems Development, and the Office of Tobacco Education and Prevention.
Title V funding is used to support many activities throughout the various offices within the Division
of Public Health Services as well as other bureaus. /2007/The Center for Minority Health was
added to the Office of Health Systems Development. This office is a central source of information
and resources on minority health and health disparity. It provides leadership and builds networks
and community capacity. //2007//
/2008/To align with other areas within the Division of Public Health, Offices within Public Health

29

Prevention Services were reorganized into Bureaus during the spring of 2007.//2008//
/2008/
In August of 2006, the Office for Children with Special Health Care Needs merged with the
Division of Behavioral Health both because of similarities in function and because of overlapping
populations. //2008//
/2009/ The Office of Oral Health was moved into the Bureau of Health Systems Development to
enhance infrastructure and capacity. //2009///2010/ Public Health Prevention Services
implemented a realignment plan that saves $670,000 per year in state funds. Changes
include: 1) Office of Oral Health moved to Bureau of Women's & Children's Health; 2) Well
Woman Health Check Program moved to Bureau of Health Systems Development; 3)
Integrated School Health Grant and Physical Activity Program moved to Bureau of USDA
Nutrition Programs; and 4) Bureau of Chronic Disease merged with Bureau of Tobacco
Education and Prevention //2010//
OFFICE OF WOMEN'S AND CHILDREN'S HEALTH
The OWCH office organizational structure is comprised of four sections: Assessment and
Evaluation; Community Services; Planning, Education and Partnerships; and the Finance
Section. Administrative Assistants are assigned to each section and support staff personnel are
assigned to each unit within a section.
The Assessment and Evaluation Section is responsible for supporting research and evaluation
related to women's and children's health, including statewide performance, outcome, and health
status indicators. The section evaluates OWCH programs' effectiveness through designing
studies as well as providing technical assistance to OWCH program managers as they design
and implement evaluation strategies. The section also supports data collection, management,
analysis and reporting for OWCH programs. Current Assessment and Evaluation programs and
projects include: Child Fatality Review Program, Citizens Review Panel, Unexplained Infant
Death Title V MCH Block Grant Application, and Five-Year Maternal-Child Health Needs
Assessment.
The Community Services Section programs provide services to children and their families who
are at risk for developmental delay, metabolic/genetic disorders or hearing impairment. The
programs within this section are Newborn Screening, Newborn Hearing Screening, Health Start,
the High Risk Perinatal Programs, the Pregnancy and Breast Feeding Hot Line, the Children's
Information Center, and the WIC Hot Line./2008/Two new initiatives were added to the
Community Health Services Section. The Blood Cord Pamphlet and Pregnancy Services projects
are described in detail in the Agency Capacity section of this application.//2008//
The Planning, Education and Partnerships Section (PEP) provides leadership for statewide
priority setting, planning, and policy development, and supports community efforts to assure the
health of women, children, and their families. PEP works with a variety of public, private, and nonprofit community partners to identify health needs, improve systems of care, and develop public
health policies. PEP provides and supports educational activities that advance good health
practices and outcomes, including promoting the use of "best practices," providing client and
provider education, sponsoring public information campaigns, and developing and distributing
education materials. Current Planning Education and Partnership programs include: Abstinence,
Sensory, Domestic Violence, Rural Safe Home Network, Rape Prevention and Education, County
Prenatal Block Grant, Reproductive Health/Family Planning, the Medical Home Project, and
Community Health Services. /2007/Injury Prevention, Emergency Medical Services for Children,
and Safe Kids were added to the PEP section. Comprehensive Sexuality Education Program
was also added to the PEP section and funded by state lottery dollars.//2007///2008/In 2007,
Planning, Education and Partnership hired a full-time health educator. The health educator
develops educational materials and assists with office strategies.//2008//

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The Finance Section coordinates all budget, fiscal, and operational issues for the office.
OWCH identifies and prioritizes the needs of women and children in Arizona through a
participatory process. This results in funding decisions that have the best chance to make an
impact on the health of the maternal and child health population. The OWCH strategic plan is
available at the OWCH web site www.azdhs.az.gov/phs/owch. The plan identifies two priority
areas 1) reduce mortality and morbidity of the maternal and child population 2) increase access to
health care, and identifies the need to decrease health disparities as an overarching priority. The
functions of the various office sections are specified within the plan. The plan is used to make
funding decisions and to establish staff priorities.
The OWCH Financial Management Plan was developed to: 1) reduce the amount of year two
funds that had historically occurred 2) provide closer management of Title V funds. 3) reduce
administrative costs 4) streamlined budget oversight by reducing the number of contracts and
cost centers
OWCH funds block grants to communities to address maternal and child health priorities. The
block grants give latitude to local communities in developing strategies but require that the
strategies be research based.
The OWCH Partnership Initiative enhances the relationship of OWCH with community partners to
better address the needs of women and children. Community partners include a broad group of
agencies and organizations. The designated OWCH partner is assigned to serve as the primary
office contact for each identified partner agency. The partner is available to answer questions,
provide technical assistance and information, serve on committees, and provide updates on the
health status of women and children. The OWCH partner presents an overview of current health
status data and trends to the partner agency.
/2009/ The Office of Women's and Children's Health became the Bureau of Women's and
Children's Health (BWCH). The Bureau includes an Office of Community Services, Office of
Planning, Education, and Partnerships, Office of Assessment and Evaluation, and Finance and
Business Section. //2009//
/2010/ As part of the realignment occurring in Public Health Prevention Services, the
Bureau of Women's & Children's Health reorganized in 2009. The new structure accounts
for changes in funding and supports an increased focus on preconception health and
early childhood. The Bureau now includes an Office of Children's Health, Office of
Women's Health, Office of Oral Health, Injury & Child Fatality Section, Office of
Assessment & Evaluation, and Business & Finance Section. //2010//
OFFICE OF CHILDREN WITH SPECIAL HEALTH CARE NEEDS
The OCSHCN was restructured in July 2004 to streamline functions and enhance the data
analysis and reporting capabilities. OCSHCN is now comprised of five sections: Data, Planning,
and Evaluation, Education and Advocacy, Finance and Business Operations, Quality
Management, and Systems of Care. The CRS Medical Director and CRS Contract Compliance
Officer report to the Office Chief, along with the OCSHCN Office Manager.
The Data, Planning, and Evaluation Section is responsible for developing, publicizing, and
updating the strategic plan and the annual action plans; designing, conducting, analyzing, and
producing written reports on all needs assessments, surveys, and program evaluations; preparing
grant applications; and convening various groups of key partners and stakeholders to provide
input on the design, implementation, and evaluation of all OCSHCN activities. This section is
also responsible for implementing the use of the Logic Model in the design, implementation, and
evaluation of all office activities.

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The Education and Advocacy Section provides oversight and technical assistance for all training
and educational activities within the office and with external constituents; provides oversight and
coordination of all telehealth and telemedicine activities; coordinates activities related to Medical
Home, adolescent health including transition, school nurses, asthma, web-based education and
resources including managing the OCSHCN website, and the publication of the OCSHCN and
ADHS Native American Newsletters
The Finance and Business Operations Section coordinates all budget, fiscal, and operational
issues for the office. They define and monitor all contracts with external providers and track fiscal
compliance with these contractual obligations. In conjunction with AHCCCS, they manage the
capitation payment and reporting systems for CRS.
The Systems of Care Section is responsible for the three service coordination programs, Arizona
Early Intervention (AzEIP), Traumatic Brain Injury/Spinal Cord Injury (TBI/SCI), and OCSHCN
(children not covered under the AzEIP or TBI/SCI programs), as well as the Community
Development Program that includes the community action teams and the Community
Development Initiative.
The Quality Management Program is responsible for providing administrative oversite to the CRS
regional clinics and providing services through quality improvement education and monitoring,
utilization review of services including monitoring of the denial and appeals process. The CRS
Contract Compliance Officer works closely with this section to ensure all contractual obligations
are met.
/2008/
OCSHCN has reorganized into six divisions: Clinical Programs, Quality Management, Utilization
Management, Grievance and Appeals, Business and Finance, and Compliance. Division chiefs
from each of these areas report directly to the office chief, as do the medical director, a corporate
compliance officer, and a cultural competence officer. The business and finance function, as well
as the officers for corporate compliance and cultural competence are now shared resources with
the Behavioral Health Services. The majority of Title V funded positions and activities are housed
in the Division of Clinical Programs, although blended funding from Title V, XIX, and XXI occur in
other divisions, and Title V concepts infuse the programmatic activities of the Title XIX and XXI
programs.
//2008//
/2010/The Division of Clinical Programs was reorganized to become the Division of
Member and Provider Services, Education and Advocacy, encompassing CRS member
and provider services and education and advocacy for CRS members and the larger
OCSHCN population//2010//
OCSHCN established formal relationships with external stakeholders and partners 2004 and
2005. Beginning in November 2004 when a large group of state and local community agencies,
providers, and families of C/YSHCN were brought together to plan the response to the Request
for Proposals for the Integrated Services grant and continuing with the Needs Assessment
Planning Group, OCSHCN has made a strategic decision to become the repository of information
related to activities serving C/YSHCN throughout the state. With the award of the Integrated
Services grant, many committees and tasks force were developed that allow for a formal
mechanism to include external stakeholders in the planning, development, and evaluation of all
activities related to C/YSHCN. The activities of these committees will be made public through the
posting of their action plans, agendas, and minutes from their meetings on the OCSHCN website.
Numerous relationships have been established with National committees that will broaden the
perspective of OCSHCN and provide an opportunity for the exchange of best practices
throughout the US. These include a relationship with the National Center for Cultural

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Competency, the National Center for Health Care Financing, and the MCHB State Leadership
Network.

D. Other MCH Capacity
Arizona Department of Health Services (ADHS) administrative offices are located in the capitol
mall area in the city of Phoenix. This location enhances collaboration between ADHS divisions as
well as other state agencies.
ADHS SENIOR LEVEL MANAGEMENT
Susan Gerard was appointed director of ADHS on April 29, 2005. Ms. Gerard previously served
as a member of Governor Janet Napolitano's administration as a policy adviser for health care
issues, assisting with crucial decisions involving state and federal budgets. Ms. Gerard served in
the state legislature from 1988 to 2002, chairing the health committee for 10 years and earning
recognition as a statewide leader on healthcare issues.
During her legislative career, Ms. Gerard directed the effort to create the Child Fatality Review
Program to reduce preventable child deaths and led a year long study and implemented one of
the country's first advance health care directive programs. She led efforts to fund and create
intervention and prevention programs such as Healthy Families, Health Start, and Head Start.
She was instrumental in obtaining funding for the seriously mentally ill, the Arizona State Hospital,
and other mental health programs. Ms. Gerard has served on a variety of boards and service
organizations and has received awards for leadership and honors from all the major health
organizations in Arizona. Ms. Gerard received a Bachelor of Arts from Drake University in Des
Moines, Iowa, and a Masters in Business Administration from Arizona State University.
/2010/ Susan Gerard resigned her position as Director of ADHS in July 2008. January
Contreras, formerly Governor Napolitano's Health Policy Advisory, served as Acting
Director August 2008 -- January 2009. Ms. Contreras resigned in January 2009 upon
Governor Napolitano's departure. Will Humble was named Interim Director on January 21,
2009. Mr. Humble was most recently the Deputy Director of the Division of Public Health
Services, and has been with ADHS since 1992. Mr. Humble holds a Masters Degree in
Public Health with a emphasis in environmental science. He has served as chief of the
Office of Environmental Health and was the Assistant Director of Public Health
Preparedness in ADHS. //2010//
Rose Conner is the assistant director of the Division of Public Health Services. Ms. Conner is a
registered nurse with a Bachelor's of Science degree in Vocational Education and a Master's
Degree in Education/Counseling. She has spent the past twenty-nine years in local county and
state government service in Arizona, in a variety of positions including direct patient care,
management, executive leadership roles and has an extensive background in licensing and
health care regulation. /2007/ In 2005 Rose Conner was appointed Deputy Director of ADHS. Niki
O'Keeffe was appointed Assistant Director of Public Health Services. Ms. O'Keeffe is an RN with
a BS degree. She has experience in health care recruitment, human resources, developing
hospital based community outreach programs in school-based clinics, tele-nursing, parish
nursing, and wellness centers. She has served as the Deputy Assistant Director for ADHS Public
Health Preparedness that included Epidemiology and Disease Control, State Laboratory,
Emergency Medical Services, Public Health Emergency Preparedness and Response. //2007//
/2008/Rose Conner and Nikki Okeefe resigned their positions in 2006. Sarah Allen was appointed
Deputy Director for Division of Public Health Services in 2007. Mrs. Allen came to ADHS with
over 20 years of experience managing health care organizations and in the training of future
health professionals. Previously Mrs. Allen was the CEO for Canyonlands Community Health
Care for 14 years. Before coming to CCHC Mrs. Allen ran the Area Health Education Center for
Maricopa County in Arizona and taught at the University of New Mexico Medical School. Mrs.
Allen completed her M.S. at the University of New Mexico and is in the final stage of her PhD in

33

Health Education and Epidemiology. She is a past president of the Arizona Public Health
Association and an Athena Award recipient. Jeanette Shea-Ramirez was appointed Assistant
Director for Public Health Prevention Services in 2007.//2008//
Raul V. Munoz Jr., B.S., M.P.H., is the deputy assistant director of Public Health Prevention
Services. Mr. Munoz received his Masters of Public Health from the University of Texas Health
Science Center at Houston in 1975. He has an extensive background in public health with the
State of Texas. Prior to his move to Arizona, Mr. Munoz was an administrator with the Managed
Health Care Program at Texas Tech University. He was affiliated with the El Paso City-County
Health and Environmental District for twenty-five years, serving in a number of positions,
including: associate director, chief of staff services, and chief of environmental health services. In
addition to the above, Mr. Munoz was a lecturer at the University of Texas at El Paso, College of
Nursing and Allied Health. /2007/In 2005 Raul Munoz retired, Jeanette Shea-Ramirez was
appointed Deputy Assistant Director of Public Health Prevention Services. //2007//
/2008/The deputy assistant director position was eliminated in 2007 /2010/ and Jeanette SheaRamirez was promoted to Assistant Director for Public Health Prevention Services
//2010//.//2008//
OFFICE OF WOMEN'S AND CHILDREN'S HEALTH
Jeanette Shea-Ramirez is the office chief for Office of Women's and Children's Health. Ms. SheaRamirez has served in many public health leadership positions. A Master's Degree in Social
Work with specialization in planning, administration, and community development, combined with
professional experience in case management and as a Medicaid policy specialist brought Ms.
Shea-Ramirez to public health in 1990 as manager of the Teen Prenatal Express Program. She
has served on numerous state and national boards. She has provided consultation to the
Association of State and Territorial Health Officers (ASTHO) Policy Committee and serves as a
consultant to the Arizona Perinatal Trust Board of Directors. Her presentations at the national
conference for the American Public Health Association have included "Team Management in a
Public Health Environment", 1995; "Promoting a Family Focus in Public Health Case
Management Programs Through Skills Training", 1993; and "Coalition Building with Public Health
Social Workers", 1992. A member of the Office of Women's Health Region IX Advisory Council,
Ms. Shea-Ramirez received a scholarship to travel to New Zealand to attend the Aotearoa World
Indigenous Women and Wellness conference last November. /2007/In 2006 Sheila Sjolander
was appointed Chief of the Office of Women's and Children's Health, replacing Jeanette Shea
Ramirez. //2007//
Sheila Sjolander has been the section manager for Planning, Education and Partnerships (PEP)
since 2001. PEP provides leadership for statewide priority setting, planning, and policy
development, and supports community efforts to assure the health of women, children, and their
families. Ms. Sjolander oversees a variety of statewide maternal and child health programs,
including domestic violence and rape prevention, injury prevention, prenatal block grant to the
counties, community health projects targeting Title V priorities, hearing screening, family
planning, and teen pregnancy prevention. For the last twelve years, Ms. Sjolander has used her
expertise in strategic planning and policy development in the states of Arizona, Wisconsin, and
Oregon, and has had leadership roles in public health for the past eight years. /2007/ In 2006
Catherine Hannen became section manager for the PEP section. Ms. Hannen has a B.A. in
Political Science and is an MSW, LCSW. For the past five years she has been a program
manager for OWCH. She also has prior experience in acute health care and long-term care.
//2007//
Joan Agostinelli joined the Office of Women's and Children's Health as the section manager for
Assessment and Evaluation in 2004. The section is responsible for supporting research and
evaluation related to women's and children's health. Ms. Agostinelli has over twenty years
experience in health care, including ten years as a private consultant providing services to both
public agencies and private health care organizations related to research design, needs

34

assessment, performance measurement, program evaluation, and reimbursement system design.
/2007/Lisa Anne Schamus became the section manager for Assessment and Evaluation in 2006.
Ms. Schamus had been the Research and Statistical Analysis Unit Manager for Assessment and
Evaluation since 2004. This unit was responsible for supporting the research needs of the office,
collecting data, reporting, providing technical assistance, program evaluation, needs assessment,
and performance and outcome measurement. Ms. Schamus has an M.P.H. in Epidemiology and
a BA in Spanish with a minor in Latin American studies. //2007//
/2009/ Paul Holley joined BWCH in October 2007 as Chief of the Office of Assessment and
Evaluation. Mr. Holley has more than seven years of experience in the evaluation field and has
led evaluations of several federal grant initiatives related to public health prevention and early
intervention. He is skilled in research design and implementation, data collection methods, and
statistical analysis. Paul received his PhD in Sociology in 2006. //2009// /2010/ Paul Holley
resigned his position in December 2008. Syed (Khaleel) Hussaini was appointed Acting
Chief of the Office of Assessment and Evaluation in January 2009. Dr. Hussaini has been
an international consultant previously and has conducted several research and evaluation
studies, including a 2007 evaluation of the Health Start Program which is currently being
peer-reviewed for publication. Syed received his Ph.D. in Sociology at Arizona State
University.
Toni Means serves as the Office Chief of Women's Health. Ms. Means has 17 years of
progressively responsible program management experience, and has served in the Bureau
of Women's & Children's Health since 1991. Ms. Means received a Masters in Business
Administration in Health Care Management from the University of Phoenix. Mary Ellen
Cunningham is the Acting Chief of the Office of Children's Health. Ms. Cunningham has
led the Bureau's High Risk Perinatal Program since 2005. Formerly with the U.S. Navy, Ms.
Cunningham is a registered nurse with a Masters in Public Administration. //2010//

OFFICE OF CHILDREN WITH SPECIAL HEALTH CARE NEEDS
Cathryn Echeverria, RN was appointed OCSHCN Office Chief in January 2002. She speaks
nationally at conferences and workshops and participates and serves on board of directors and
advisory boards. She is known for her leadership in financing healthcare for special needs
populations and has recently been asked to serve on a committee for Boston University School of
Public Health as the National Center on Health Insurance and Financing for CSHCN. She is a
serves as our state liaison with federal, state and local projects related to improving the systems
of care for C/YSHCN. Recently, Cathryn was invited by the Child, Adolescent, and Family
Branch, Center for Mental Health Services, Substance Abuse and Mental Health Services
Administration and the U.S. Department of Health and Human Services and the Technical
Assistance Partnership for Child and Family Mental Health to participate in a working meeting on
linking the medical home model with mental health systems. She also participates on the 2010
Leadership States Committee headed by Merle McPherson. /2007/In 2006 Cathryn Echeverria
resigned and Joan Agostinelli was appointed Office Chief. Ms. Agostinelli had been the section
manager for Assessment and Evaluation in OWCH. //2007//
Jacquilyn Kay Cox, PhD joined the OCSHCN staff in 2004 as the Manager for the Data, Planning
and Evaluation Section. This section is responsible for all of the data collection, analysis, and
reporting for OCSHCN. Additionally this section is responsible for the MCH Block Grant, the 5year Needs Assessment, strategic planning, and grant applications. Dr. Cox has 25 years of
management experience in the health care industry with a particular focus on Behavioral Health.
Prior to coming to OCSHCN, she conducted research utilizing the Centers for Medicare and
Medicaid Health Outcomes data which measures changes in the quality of life of Medicare
beneficiaries in managed care plans throughout the United States. She has presented the results
of original research at numerous national conferences and has published in peer-reviewed
journals./2009/Dr. Cox resigned in June 2006. Over the past two years OCSHCN has

35

substantially increased capacity around data collection and analysis. Lisa Anne Schamus joined
OCSHCN's staff in July 2007.//2009//
OTHER PUBLIC HEALTH SERVICE PREVENTION MANAGEMENT
Margaret Tate, M.S., R.D., joined the Arizona Department of Health Services in June 1999 as the
chief of the Office of Chronic Disease Prevention and Nutrition Services. Ms. Tate is active in
numerous nutrition organizations. She has served as president of the Association of State and
Territorial Public Health Nutrition Directors and is active in the American Dietetic Association.
/2010/ Ms. Tate resigned in 2009. Veronica Perez serves as the current Director of Chronic
Disease Programs in the Bureau of Tobacco and Chronic Disease. Ms. Perez was formerly
the Cultural Competency Advisor for ADHS. //2010//
Joyce Fleiger is office chief of the Office of Oral Health Services. She a graduate of the University
of Southern California Dental Hygiene Program and received her Masters in Public Health from
the University of Michigan in Ann Arbor. She has experience in the clinical practice of dental
hygiene, public health and dental hygiene education including Director of Dental Hygiene
Program and Department Chair of Dental Studies at Pima Community College in Tucson. /2010/
Ms. Fleiger resigned in November 2007. Julia Wacloff joined the Office of Oral Health as
Office Chief on July 6, 2009. Ms. Wacloff previously worked with Office of Oral Health as a
consultant for 13 years. She holds a Master's degree in Dental Public Health and is a
registered dental hygienist. She most recently served an an epidemiologist with the
Centers for Disease Control and Prevention. //2010//
ROLE OF PARENTS OF CHILDREN WITH SPECIAL HEALTH CARE NEEDS
The OCSHCN has, since its inception, accepted parents and other caretakers as integral
members of the team. Parents are included as partners in all phases of program development,
implementation, and policy-making. Block grant funds are used to pay parents for consultant
services, travel expenses, and childcare. Children and youth with special health care needs and
their families participate in a variety of activities with OCSHCN: the Youth Action Council, the
Cultural Competency Team, the training of families and professionals, and they have assisted
with data collection, and prioritization of system issues. The CRS State Parent Action Council
includes parents from the four regional CRS sites and advocacy group representatives. Parents
also participate n the CRS Quality Improvement Committee and assist with the CRS Biennial
Conference.
OCSHCN works to develop parent-led, self-reliant, self-sustaining community organizations that
can mobilize local, state, and federal resources to improve the quality of life for C/YSHCN and
their families. Each community identifies its unique resources and issues impacting C/YSHCN
and their families, and purposefully works to improve the system of care within their community.
Building on the success of OCSHCN community development teams, parent leaders proposed an
expansion the Community Development model to all agencies serving children and youth in
Arizona to the Governor and the Governor's Children's Cabinet. The cabinet endorsed the
participation of all state agencies in a summit, "Circles of Success, Communities of Strength."
The statewide partnership includes representation from the Office of the Governor, Arizona
Department of Economic Security, Arizona Department of Education, Arizona Department of
Health Services (OCSHCN and Behavioral Health Services), Arizona Department of Juvenile
Corrections, AHCCCS, as well as families working with or being served by these agencies.
/2010/ The Community Development Program was designed to provide resources to train
parent leaders and develop community capacity. Due to changes in state procurement
procedure in 2008 non-competitive individual purchase orders (POs) were no longer
permitted. To replace individual PO's OCSHCN partnered with the Bureau of Women's and
Children's Health and ADHS Behavioral Health Services to develop the Building
Partnerships for Quality Care RFP. This RFP provides ADHS with a vehicle to see systems

36

through the eyes of families, consumers and youth and enables those who have first hand
experience with systems of care to have direct and meaningful input into the health
systems, policies, and/or practices that affect service delivery. The Contractors for this
RFP will provide a mechanism to include a diverse group of families, consumers and
youth for ADHS time-limited and project specific work and will identify, support and train
families, consumers and youth to provide expertise and involvement to ADHS based on
first hand experiences with systems of care//2010//

E. State Agency Coordination
The Office of Women's and Children's Health (OWCH) Partnership Initiative enhances the
relationship of OWCH with community partners. OWCH staff is assigned as the primary office
contact for each partner agency and is available to answer questions, provide technical
assistance, serve on committees, and provide updates on the health status of women and
children.
COORDINATION AMONG STATE HUMAN SERVICES AGENCIES
Governor's Commission on the Health Status of Women and Families in Arizona: The OWCH
office chief/Title V director is appointed to the commission. In 2004 and 2005 the Commission
met to develop public policy recommendations and strategies to improve the overall health of
women focusing on the following areas: access to health care, general health concerns affecting
women, family planning, teen pregnancy prevention, prenatal care. /2008/ The ADHS Assistant
Director is appointed to the commission and the Women's /2010/ Health //2010// Coordinator
works closely with the BWCH Bureau Chief to ensure BWCH priorities are taken into account in
Commission planning. //2008//
Governor's Office for Children Youth and Families: OWCH funds the Women's Health Policy
Advisor position. /2007/The Governor's staff position moved to ADHS, PHPS in 2006. Jessica
Yanow was hired as Women's Health Coordinator. Ms. Yanow has an MPH with a focus in
community health practice. She has experience in domestic violence, reproductive health and
family planning, obesity, physical activity, nutrition, chronic disease prevention, and HIV/AIDS.
//2007// /2008/ BWCH funds the Women's Health Coordinator, who is responsible for staffing the
Governor's Commission on the Health Status of Women and Families in Arizona. //2008//
/2010/ The Governor's Commission on Women's and Children's Health was re-established
in September 2008. The Commission developed an action plan targeting the area of
obesity prevention among children and families. The Governor's Office staffs the
Commission with the support of Title V funding through the Bureau of Women's and
Children's Health. //2010//
Governor's School Readiness Board: OWCH uses the State Early Childhood Comprehensive
Systems Grant to support a position in the Governor's Office for Children, Youth, and Families to
staff the School Readiness Board. OWCH staff participate on the Health Implementation
Committee of the board, which focuses on the implementation of the health recommendations of
the board.
/2010/ First Things First: In November 2006, the voters of Arizona passed proposition 203,
the Early Childhood Development and Health (ECDH) initiative (First Things First).
Proposition 203 raises revenue for early childhood programs (0 -5 years of age) through
an 80 cent tax on cigarettes. This initiative presented an unprecedented opportunity to
make significant progress in achieving the goals and objectives of the Early Childhood
Comprehensive Systems grant planned and implemented by the School Readiness Board.
With the passage of the initiative, the consensus of the School Readiness Board members
was that the ongoing activities to support and promote school readiness and early
childhood comprehensive system building should continue under the structure of the

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Early Childhood Development and Health Board (ECDHB) created by the initiative. The
objectives of the ECDH Initiative are aligned with the five critical components of the ECCS
and provide a dedicated revenue stream through an additional tax on tobacco products to
support and strengthen early childhood programs and services and a comprehensive
system of care. The Acting Office Chief of the Office of Children's Health serves as the
designee of the ADHS Director to the ECDHB and on the Health Advisory Board of the
ECDHB.
For the 2009 extension of the State Early Childhood Comprehensive System grant, ADHS
and ECDHB agreed that the ECDHB would be the applicant for the grant to facilitate further
integration of the early childhood system. The Chief of the Office of Children's Health
devotes a quarter of her time to coordination and alignment of ADHS activities and
programs with the ECDHB as well as integration with the SECCS grant. //2010//
Governor's Commission to Prevent Violence Against Women: OWCH staff participate on
subcommittees of this commission and participated in the development the commission's State
Plan on Domestic and Sexual Violence.
Governor's Efficiency Review Board: The Governor's Efficiency Review Report requires the
Department of Economic Security, the Arizona Health Care Cost Containment System and the
ADHS/OCSHCN to establish procedures that will streamline application processes for children
born with severe birth defects.
Governor's Council on Developmental Disabilities: OCSHCN community teams are working with
the Council on education regarding self-advocacy and community-based services for children and
their families.
Governor's Council on Head and Spinal Cord Injuries: OCSHCN and the Arizona Governor's
Council on Spinal and Head Injuries have established a partnership to address the needs of
children with brain and spinal cord injuries. The council provides funding to OCSHCN for service
coordination of children and youth with head and spinal cord injuries and support two analytic
staff within OCSHCN to develop an Arizona traumatic brain and spinal cord injury registry.
/2008/Governor's Interagency Workgroup on Teen Pregnancy and STD Prevention: BWCH
actively participates with the Governor's Office and other state agencies to identify policies and
strategies to address teen pregnancy and STD prevention among youth in care, i.e. in foster care
and the juvenile justice system. The workgroup will also be addressing issues of subsequent
pregnancies.//2008//
State Agency Coordination Team (SACT): OWCH staff represent ADHS on this team of various
state agencies that meets monthly to work together on domestic violence and sexual assault
system issues. The team is organized and led by the Governor's Office for Children, Youth, and
Families, Division for Women. Participating agencies include: Department of Economic Security,
Department of Public Safety, Attorney General's Office, Department of Housing, Criminal Justice
Commission, Arizona Supreme Court, Department of Corrections, and Arizona Health Care Cost
Containment System (AHCCCS).
Interagency Coordinating Council: The Governor established the State Interagency Coordinating
Council to advise and assist the lead agency, DES, in the development and implementation of
policies that constitute the statewide system of early intervention services, Part C of the IDEA.
OCSHCN serves on the Council by appointment of the Governor.
Arizona Department of Economic Security (DES): DES funds support the OWCH Child Fatality
Review Program. DES administers state funds for domestic violence shelters, and the OWCH
domestic violence program (known as the Rural Safe Home Network) works closely with DES to
coordinate services for domestic violence victims. The Arizona Early Intervention Program

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(AzEIP) is a collaborative program of the Department of Economic Security (DES), Arizona
Health Care Cost Containment System (AHCCCS), ADHS/OCSHCN; the Arizona Department of
Education; and the Arizona Schools for the Deaf and Blind (ASDB). OCSHCN provides
developmental screening and referral services through contracted providers to Arizona's infants
and toddlers age birth to three years who are exhibiting developmental delays and may benefit
from early intervention.
Arizona Department of Public Safety (DPS): OWCH and DPS work closely on sexual assault and
domestic violence issues, and have jointly funded projects in the past. DPS participates on the
ADHS Injury Prevention Advisory Council, and provides a source of data for homicide and sexual
assault.
Arizona Department of Education (ADE): OWCH staff sits on a committee reviewing HIV/AIDS
educational material. ADE works with ADHS on the Youth Risk Behavior Factor Survey and
general school health issues. OCSHCN participates on the Arizona Transition Leadership Team
(ATLT), developed by the ADE to develop statewide policies to ensure timely access to postsecondary disability resources and to design of research of post school outcomes. OCSHCN
partners with ADE on the state transition conferences. /2007/ ADE participates on the ADHS
Injury Prevention Advisory Council and has collaborated with OWCH staff to review
comprehensive sex education proposals and identify opportunities to coordinate violence
prevention efforts. //2007//
Arizona Department of Corrections: OCSHCN develops and provides training and technical
assistance to incarcerated and paroled adolescents and those working directly with them.
Children's Cabinet: The Director of the Department of Health Services is on the Governor's
Children Cabinet along with other state agencies concerned with children. The cabinet provides
an opportunity to work with other state agencies on issues related to children's health.
Arizona Health Care Cost Containment System (AHCCCS): Arizona's Title XIX agency. OWCH
programs collaborate to improve access to health care and increase enrollment. OCSHCN works
with AHCCCS to providing administrative oversight to the CRS program; these activities include
formal data sharing agreements, the development and implementation of quality improvement
activities, and coordination of capitated payment mechanisms to the four regional CRS sites.
/2007/ State Agency Survey Coordination Committee: OWCH, ADE, and the Arizona Criminal
Justice Commission meet quarterly to coordinate school-based surveys such as Youth Risk
Behavior Survey, Youth Tobacco Survey, and Arizona Youth Survey. //2007//
COORDINATION WITH PUBLIC HEALTH AGENCIES, FEDERALLY QUALIFIED HEALTH
CENTERS, OTHER ORGANIZATIONS, ASSOCIATIONS, UNIVERSITIES
Northern Arizona University/Institute for Human Development: OCSHCN provides financial
support for parents of children with special health care needs and OCSHCN staff to provide
training twice a year to this group of students. The Flagstaff CRS clinic also arranges for home
visits with families. Students will acquire knowledge and skills through the 12-hour program of
courses and practicum.
University of Arizona (UofA): OCSHCN works with the UofA to implement the Telemedicine
Program. /2009/ BWCH and the University of Arizona College of Public Health coordinated an allday orientation to MCH programs for interested MPH students. //2009///2010/ The Bureau Chief
of Women's and Children's Health provided an overview of bureau programs and the
status of maternal and child health in Arizona to MPH students in Tucson. The Bureau has
placed U of A MPH students as interns and volunteers. //2010//
Arizona State University (ASU): OCSHCN works with ASU on implementing the LMS system and
the ADHS Leadership Academy

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Residency Programs: OCSHCN provides financial support for training physicians in pediatric and
family practice residency programs. The residents complete a one-hour orientation at Raising
Special Kids that focuses on the importance of family-centered care and a two-hour Home Visit
with the Family Faculty who are trained volunteer parents who are raising a child with special
needs.
Arizona Local Health Officers Association (ALHOA): Includes health officers from all county
health departments and tribal health agencies. OWCH provides funds to county health
departments and tribal agencies for services to women, infants, and children.
Association of Community Health Centers: OWCH provides funds to the health centers for
immunizations through The Arizona Partnership for Immunization (TAPI). OWCH also has
contracts with some community health centers for the Health Start program. As a result of
HRSA's Strategic Partnership Session for Arizona grantees, the BWCH continues to work with
the Arizona Association of Community Health Centers on the issue of improving integration of
behavioral health. Other partners involved in this collaboration include the State Office of Rural
Health and the Bureau of Health Systems Development. Also as a result of HRSA's Partnership
Session, the BWCH invited the Office of Rural Health to join its advisory committee for the HRSA
EMSC grant.
Arizona Department of Health Services (ADHS): ADHS has created the infrastructure to develop
a learning management system by combining the resources of four offices: the Office of Nutrition
and Chronic Disease, Public Health Preparedness and Response, OCSHCN, and Emergency
Medical Services. This system will allow the electronic tracking and evaluation of all web-based
educational modules.
Arizona Chapter of American Academy of Pediatrics: OWCH provides funds to support the
Medical Home Project, and works with them on development of a statewide child care health and
safety consulation system. OCSHCN/CRS Medical Director is a member of the AzAAP and has
been appointed as the Arizona liaison for the National AAP Council on Children with Disabilities.
OCSHCN staff assist AzAAP in policy revisions regarding the role of the school nurse in providing
school health services.
Arizona Perinatal Trust partners with OWCH to maintain and improve the regionalized perinatal
system of care in Arizona. OWCH acts as a technical advisor to the Trust, participates on site
visits that the Trust conducts to certify birthing hospitals, and assists with data analysis and
dissemination to Level I, II, and III birthing hospitals.
March of Dimes (MOD): Ongoing partnership. MOD provided technical support for the expansion
of screening tests provided by the OWCH Newborn Screening program./2008/BWCH participates
on the MOD Program Services committee and the assistant director serves on the legislative
committee.//2008///2010/ The March of Dimes provided grant funding to initiate new
promotion of the Baby Arizona hotline and website in order to help uninsured or
underinsured pregnant women access prenatal care early in their pregnancies. //2010//

Arizona Family Planning Council: the Title X agency shares family planning data and other
information with OWCH. Collaborates with OWCH to ensure family planning services are in
every county. OWCH participates as a reviewer in the Title X RFP process.
Arizona Family Planning Coalition: OWCH staff sit on the steering committee of this statewide
coalition focusing on advocacy, education, and legislation affecting reproductive rights. OWCH is
a sponsor of the Coalition's annual conference.
Alliance for Innovations in Health Care: The Alliance is affiliated with the National Friendly Access

40

Program, a national initiative to bring about changes in the maternal and child health care system.
OWCH is funding the implementation of the Friendly Access baseline survey assessment for
prenatal clients and the development of a community plan based on findings. OWCH is a
member of the Alliance.
Arizona Public Health Association (AZPHA): OWCH staff sit on the board and are association
members. OWCH and OCSHCN support AZPHA's two annual conferences. OWCH works with
AZPHA to identify maternal and child health issues and policies that the association could help
support. OCSHCN staff participate in the monthly AzPHA School Health Section Meetings.
/2009/ BWCH staff facilitated the creation of an MCH section in the AZPHA. A manager within
BWCH will become the President of the AZPHA in September 2008. //2009//
School Based Health Council: OWCH staff attends board meetings to exchange information.
Arizona Coalition Against Domestic Violence: OWCH Rural Safe Home Network Program
provides funding to the coalition for training, advocacy, information and referral services, and
technical support of domestic violence community-based programs. OWCH has worked with the
coalition to apply for additional federal grants for Arizona, and sought the coalition's input on
development of plans related to domestic violence and a variety of other issues.
Arizona Sexual Assault Network: The OWCH Rape Prevention and Education Program works
closely with the network in a variety of ways. To enhance collaboration, the network director
attends contractor meetings as well as annual CDC grantee meetings with the rape prevention
program manager. OWCH provided funded to the Arizona Sexual Assault Network, in
partnership with Department of Public Safety, to conduct training on emergency room department
response and protocol to sexual assault victims.
ADHS Injury Prevention Advisory Council: The advisory council is appointed by the director of
ADHS to make recommendations on policies and actions that the department can take to help
prevent injuries in Arizona. The advisory council oversees the development, update, and
progress on the Arizona Injury Surveillance and Prevention Plan. OWCH staffs the advisory
council and facilitates the meetings. Agencies comprising the council currently include: Inter
Tribal Council of Arizona, Indian Health Services, Arizona Local Health Officers Association,
Arizona Coalition Against Domestic Violence, Department of Public Safety, Arizonans for Gun
Safety, St. Joseph's Medical Center, Desert Samaritan Medical Center, Governor's Office for
Highway Safety, EMPACT -- Suicide Prevention Hotline, Poison Control Center, Phoenix Fire
Department, Phoenix Children's Hospital, Mothers Against Drunk Driving, Drowning Prevention
Coalition, University of Arizona Health Sciences Center, Safe Kids Yuma County, Tucson Fire
Department, Arizona Center for Community Pediatrics, Governor's Council on Spinal and Head
Injuries, Phoenix Baptist Hospital School Based Clinics, University of Arizona CODES Project.
Arizona Coalition on Adolescent Pregnancy and Parenting (ACAPP): OWCH collaborates with
ACAPP to identify and share information regarding best practice strategies to prevent teen
pregnancy. OWCH has worked with ACAPP to determine programming for new teen pregnancy
funds awarded to ADHS, and to disseminate a parent guide developed by ACAPP.
Arizona Medical Association: A representative from OWCH sits on the Arizona Medical
Association Committee on Maternal and Child Health Care as well as the Adolescent Health
Community Advisory group. This group has received a grant and is currently working on a
statwide action plan for improving adolescent access to appropriate health care. The OCSHCN
Medical Director is an appointed member of the ArMA Maternal and Child Health Committee.
OCSHCN staff participates on the ArMA, Maternal and Child Health Adolescent Subcommittee's
Adolescent Health Community Advisory Group to create a state plan to address how adolescents
access appropriate health care. OCSHCN oversees adolescent involvement with the Advisory
Group to provide feedback on, and suggestions for the Adolescent Health Plan.

41

Arizona Adolescent Health Coalition (AAHC): OWCH collaborates with the AAHC to promote
healthy adolescents and the reduction of high risk behaviors through the sponsorship of their
annual conference, participation at their quarterly meetings and promotion of their training
programs. OCSHCN attends bimonthly Board meetings to share information and have
issues/concerns of youth with special health care needs included in the AAHC activities.
OCSHCN contributes to the Arizona Adolescent Health Coalition's annual publication.
Healthy Start: A representative from OWCH sits on the advisory board and participates in
strategic planning activities. OWCH provides maternal and child health data and technical
assistance regarding outreach strategies to the Healthy Start Program. Healthy Start staff has
been invited to participate in Health Start training workshops and other meetings related to child
development and maternal health.
Arizona Asthma Coalition: OCSHCN participates in the Arizona Asthma Coalition and OCSHCN
provides funding to develop and implement community-based programs to address the needs of
children who have asthma. Through a contract with the American Lung Association, OCSHCN
funds the Executive Director of the Coalition. OCSHCN participated and provided funding for the
development the Comprehensive Asthma Control Plan for the State of Arizona.
Raising Special Kids (RSK): OCSHCN contracts with the local chapter of Raising Special Kids to
facilitate of training sessions for residents from pediatric and family practice programs that include
home visits with families with children/youth with special health care needs (C/YSHCN). Both
organizations plan, conduct, and evaluate family-centered training and training materials for CRS
staff, student nurses, and dental students. RSK participate in bi-annual CRS statewide
conference planning and presentations. RSK staff (who are also parents of children with special
health care needs) participate in ADHC/OCSHCN planning, program development, training
activities, and any activities requiring family perspective.
Pilot Parents of Southern Arizona/Partners in Public Policy Making: Pilot Parents of Southern
Arizona promotes the CRS Parent Action Council activities within the regional CRS clinic in
Tucson by providing assistance in identifying and supporting parents and youth to participate in
CRS activities. OCSHCN is working with Pilot Parents of Southern Arizona to recruit parents,
youth, and self-advocate graduates to participate in various advocacy activities within OCSHCN.
Family Voices: Family Voices is a national, grassroots clearinghouse for information and
education concerning the health care of children with information and education concerning the
health care of children with special health needs. OCSHCN with Family Voices through
participation in regularly scheduled regional calls, regional listservs and "FV Talk", and by
attending Family Voices meetings.
Children's Action Alliance: Children's Action Alliance (CAA) is a non-profit, nonpartisan research,
policy and advocacy organization dedicated to promoting the well-being of all of Arizona's
children and families. Recently, CAA participated in an informal School Health Focus group that
was facilitated by OCSHCN to discuss how the health needs of children and youth with special
health care needs are being addressed in the school setting. /2007/OWCH funded CAA to do a
time series analysis to assess the impact premium sharing increases made in the AHCCCS's
KidsCare program enrollment. //2007//
BHHS Legacy Foundation: BHHS Legacy Foundation (BHHS Legacy) is an Arizona nonprofit
charitable conversion foundation. OCSHCN has a grant from BHHS Legacy to assist
children/teens with Traumatic Brain Injuries (TBI) and their families through cross agency intake
and referrals for children/teen with TBI. There are additional joint projects to monitor the quality
of services through surveys of children with TBI and their families, the development of clinical
guidelines, and the development of public listings of resources and services available in Maricopa
County related to TBI.

42

/2010/ Arizona Rural Women's Health Network: The Arizona Rural Women's Health
Network is a new statewide network that coordinates and improves health outcomes for
rural and underserved women in Arizona. The network primary focus areas are to: 1)
assess needs of rural women in Arizona; 2) increase awareness and advocate for needs of
rural women in Arizona; 3) gather and disseminate information on resources and services
available for rural women in Arizona; and 4) provide networking opportunities among
organizations that provide services for rural women in Arizona. The Bureau of Women's &
Children's Health and the Bureau of Health Systems Development have been part of a core
group of partners that have been working on the development of the network. Other
partners include: Mogollon Health Alliance, Arizona Health Education Centers, North
Country Health Care, Mariposa Community Health Centers, and the Arizona State Office of
Rural Health at the University of Arizona College of Public Health.
Rocky Mountain Public Health Education Consortium: The mission of the Rocky Mountain
Public Health Education Consortium is to build and maintain partnership among/between
the public health workforce and universities to improve the health and well being of all
women, children, and families through workforce development, and collaborative
research, assessment, and evaluation. Consortium activities include an annual MCH
institute, the MCH Certificate Program, distance learning opportunities, and collaborative
research. In 2008, the Consortium provided a Title V Needs Assessment Workshop to its
members, and also submitted an article about the Consortium to the Maternal and Child
Health Journal. The Bureau Chief of Women's & Children's Health serves on the Executive
Committee. Other Consortium members currently include but are not limited to: University
of Arizona College of Public Health, Navajo Nation Division of Health, and other
universities and MCH/OCSHCN directors in western states. //2010//
STATE SUPPORT FOR COMMUNITIES
Community Teams: OCSHCN works to develop parent-led, self-reliant, self-sustaining
community organizations that can mobilize local, state, and federal resources to improve the
quality of life for C/YSHCN and their families. Each community identifies its unique resources
and issues impacting C/YSHCN and their families, and purposefully woks to improve the system
of care within their community. The community is strengthened by recognizing and building upon
local community capacities to care for children. The goal is to provide this program throughout
Arizona; currently services are provided in Page, Prescott, Prescott Valley, Chino Valley,
Bullhead City, Kingman, Somerton, San Luis, Gadsen, St. Johns, Springerville, Eager, Concho,
Mesa, Flagstaff, and the Verde Valley (Cottonwood, Clarksdale, and Sedona).
Building on the success of the OCSHCN community development teams, parent leaders
recommended expanding the Community Development model to all agencies serving children
and youth in Arizona to the Governor and the Governor's Children's Cabinet. The statewide
partnership includes representation from the Office of the Governor, Arizona Department of
Economic Security, Arizona Department of Education, Arizona Department of Health Services
(OCSHCN and Behavioral Health Services), Arizona Department of Juvenile Corrections,
AHCCCS, as well as families working with or being served by these agencies.

F. Health Systems Capacity Indicators
Introduction
Over the past four years, the eligibility levels for enrollment in the state's Medicaid program and
the State Children's Insurance Program (SCHIP) for children age 1-18 have remained the same.
/2009/ The eligibility levels for enrollment into AHCCCS decreased for pregnant women, from
140% FPL in 2002, to 133% FPL in 2003. However, eligibility levels for pregnant women
increased to 150% FPL in 2007. Eligibility levels for enrollment in SCHIP for pregnant women

43

have remained at 200% FPL from 2002 through 2007. //2009//
/2010/ Eligibility levels for enrollment in Arizona Medicaid (AHCCCS) remained the same
across all population groups in 2008. However, AHCCCS received permission to increase
the premiums for children and households/parents for FY 2010. It is expected that an
estimated 25,089 children will be impacted by the increased premiums. //2010//

For the Health Systems Capacity Indicators that were broken down by payor, the Medicaid
population had worse outcomes than the non-Medicaid populations. Medicaid populations had
higher percentages of low birth weight infants, lower percentages of women entering prenatal
care in the first trimester, and lower percentages of women receiving adequate prenatal care.

Health Systems Capacity Indicator 01: The rate of children hospitalized for asthma (ICD-9
Codes: 493.0 -493.9) per 10,000 children less than five years of age.
Health Systems Capacity Indicators Forms for HSCI 01 through 04, 07 & 08 - Multi-Year Data
Annual Objective and Performance Data
2004
2005
2006
2007
2008
Annual Indicator
35.6
29.1
27.4
28.1
28.1
Numerator
1533
1299
1323
1400
Denominator
430549 446162 482344 499045
Check this box if you cannot report the
numerator because
1.There are fewer than 5 events over the
last year, and
2.The average number of events over the
last 3 years is fewer than 5 and therefore a
3-year moving average cannot be applied.
Is the Data Provisional or Final?
Final
Provisional
Notes - 2008
Problems with hospital discharge data prevented reporting on this measure for 2002. Data for
2008 are not yet available. The estimate for 2008 is provisionally set at the 2007 rate until data
become available in the Fall of 2009.
Notes - 2007
Problems with hospital discharge data prevented reporting on this measure for 2002. Data for
2007 are not yet available. The estimate for 2007 is provisionally set at the 2006 rate until data
become available in the Fall of 2008.
Notes - 2006
The provisional eastimate for 2006 was incorrect. The case population included children 1 to 6
years of age. The revised "final" estimate for 2006 includes only children 1 to 5 years of age.
Problems with hospital discharge data prevented reporting on this measure for 2002.

Narrative:
The Bureau of Women's and Children's Health /2009/ (BWCH) //2009// has direct access to
Hospital Discharge data to report on this measure. The Hospital Discharge data does not include
Federal or Native American facilities. Over the course of the last two years, the Arizona
Department of Health Services has made a concerted effort to improve the quality of the Hospital
Discharge data including a series of data audits and enforcement of requirements to submit data.
It is unknown what impact these changes in data management have had on asthma
hospitalization rates.
Starting with calendar year 2004 data, Arizona also has access to emergency department data

44

for analyses. Analysis of emergency department data will enhance the State's ability to track
changes in primary care sensitive conditions such as asthma. /2009/ In previous years the rate
for asthma related emergency department admissions per 10,000 children incorrectly included
cases 1 to 6 years of age. The revised rates for asthma related emergency department
admissions per 10,000 children under age 5 were as follows: 2004: 105.0, 2005: 100.5, 2006:
95.6. //2009//
/2010/ Although the rate of hospitalization for asthma among this age cohort increased
slightly in 2008, when compared with 2004 (35.6 per 10,000 children) the 2008 rate (28.1 per
10,000 children) was significantly lower (P<0.0001, CI 7.47 - 7.53). In 2009-2010 the Office
of Oral Health Sealant Indicator Survey will collect information on asthma prevalence
among third grade school children across Arizona. //2010//

Health Systems Capacity Indicator 02: The percent Medicaid enrollees whose age is less
than one year during the reporting year who received at least one initial periodic screen.
Health Systems Capacity Indicators Forms for HSCI 01 through 04, 07 & 08 - Multi-Year Data
Annual Objective and Performance Data
2004
2005
2006
2007
2008
Annual Indicator
95.0
96.1
97.6
96.4
99.1
Numerator
51326 54373 56520 58301 58861
Denominator
54047 56587 57884 60473 59373
Check this box if you cannot report the numerator
because
1.There are fewer than 5 events over the last year,
and
2.The average number of events over the last 3 years
is fewer than 5 and therefore a 3-year moving
average cannot be applied.
Is the Data Provisional or Final?
Final
Final
Narrative:
The data source for HSCI 02 is the /2009/ HCFA 416 //2009//report. Data for the /2009/ HCFA
416 //2009// report is taken from medicaid encounters and eligibility/enrollment.
The health plans that contract with AHCCCS (Arizona's Medicaid program) conduct various
interventions during the course of each year to increase EPSDT participation. Interventions
include outreach to members and providers related to well visits, dental, TB and lead screening,
immunizations and other preventive health services. The health plans monitor and evaluate the
effectiveness of interventions and report to AHCCCS quarterly. Efforts are under way to work with
the health plans to develop new and innovative interventions.
/2010/ According to 2008 data provided Arizona Medicaid (Arizona Health Care Cost
Containment System) nearly 100 percent of infants enrolled in health plans that contract
with AHCCCS received at least one initial periodic screen even though the total number of
enrollees increased four of the past five years. AHCCCS continues to provide Early and
Periodic Screening Diagnosis and Treatment (EPSDT) Services for Medicaid eligible
children under age 21. AHCCCS data has not been linked to other MCH data sources
beyond payer fields within the AZ Birth Certificates and Hospital Discharge Data system.
//2010//

Health Systems Capacity Indicator 03: The percent State Childrens Health Insurance
Program (SCHIP) enrollees whose age is less than one year during the reporting year who
received at least one periodic screen.

45

Health Systems Capacity Indicators Forms for HSCI 01 through 04, 07 & 08 - Multi-Year Data
Annual Objective and Performance Data
2004 2005 2006 2007 2008
Annual Indicator
79.7 82.1 78.4 82.5 84.0
Numerator
484
517
580
721
646
Denominator
607
630
740
874
769
Check this box if you cannot report the numerator because
1.There are fewer than 5 events over the last year, and
2.The average number of events over the last 3 years is
fewer than 5 and therefore a 3-year moving average cannot
be applied.
Is the Data Provisional or Final?
Final Final
Narrative:
The data source for HSCI 02 is the /2009/ HCFA 416 //2009//report. Data for the /2009/ HCFA
416 //2009//report is taken from Medicaid encounters and eligibility/enrollment. The health plans
that contract with AHCCCS (Arizona's Medicaid program) conduct various interventions during
the course of each year to increase EPSDT participation. Interventions include outreach to
members and providers related to well visits, dental, TB and lead screening, immunizations and
other preventive health services. The health plans monitor and evaluate the effectiveness of
interventions and report to AHCCCS quarterly. Efforts are under way to work with the health
plans to develop new and innovative interventions
/2010/ According to 2008 data provided by Medicaid (Arizona Health Care Cost
Containment System) the percentage of infants enrolled in SCHIP (KidsCare) receiving at
least one periodic screen rose from 79.7 percent in 2004 to 84.0 percent in 2008 (+4.3
percent). This increase in coverage occurred despite a greater than 25 percent jump in the
number of infants covered by KidsCare. A child's KidsCare coverage must be renewed
once a year. Coverage can be renewed until a child turns 19 years old, as long as the
family still qualifies. In FY 2010, AHCCCS sought and received approval to increase
KidsCare premiums for children and households/parents. Premiums for children in
households with incomes between 150-175% FPL will increase: (a) for one child, from $20
to $40; (b) for more than one child, from $30 to $60. Premiums for children in households
with incomes between 176-200% FPL will increase: (a) for one child, from $25 to $50; (b)
for more than one child, from $35 to $70. Premiums for parents between 150-175% FPL will
increase from 4% of household income to 5% of household income. It is expected that an
estimated 25,089 children will be impacted by the increased premiums.
The AHCCCS data has not been linked to other MCH data sources. Beyond payer fields
within the AZ Birth Certificates and Hospital Discharge Data system the Bureau of
Women's and Children's Health requests all Medicaid and SCHIP data pertinent to the Title
V Grant directly from AHCCCS. //2010//

Health Systems Capacity Indicator 04: The percent of women (15 through 44) with a live
birth during the reporting year whose observed to expected prenatal visits are greater than or
equal to 80 percent on the Kotelchuck Index.
Health Systems Capacity Indicators Forms for HSCI 01 through 04, 07 & 08 - Multi-Year Data
Annual Objective and Performance Data
2004
2005
2006
2007
2008
Annual Indicator
69.3
70.1
69.8
70.3
70.3
Numerator
64499 66943 70976
71865
Denominator
93093 95486 101749 102246
Check this box if you cannot report the
numerator because

46

1.There are fewer than 5 events over the last
year, and
2.The average number of events over the last
3 years is fewer than 5 and therefore a 3-year
moving average cannot be applied.
Is the Data Provisional or Final?
Final
Provisional
Notes - 2008
Data for 2008 are not yet available. The estimate for 2008 is provisionally set at the 2007 rate
until data become available in the Fall of 2009.
Notes - 2007
Data for 2007 are not yet available. The estimate for 2007 is provisionally set at the 2006 rate
until data become available in the Fall of 2008.
Notes - 2006
Data for 2006 are not yet available. The estimate for 2006 is provisionally set at the 2005 rate
until data become available in the Fall of 2007.

Narrative:
/2009/ BWCH utilized 2006 //2009//birth certificate data to report on the Kotelchuck
index. The fields used to perform a Kotelchuck analysis include month prenatal care began and
number of prenatal visits. Both of these fields are self reported and as such may have reliability
issues. Kotelchuck index results appear to be similar in Arizona to national figures.
/2009/ The percent of women with adequate prenatal care utilization on the Kotelchuck index
varied widely by county, from a low of 45% of women in Greenlee County to a high of 82% in
Cochise County. //2009//
A survey of low-income postpartum women conducted in an urban area of Maricopa County in
2006 (Friendly Access) revealed that for those women who did not receive adequate prenatal
care, lack of money or insurance was the primary reason cited for the delay or lack of care.
An analysis of the 2006 birth certificate file demonstrated that the percentage of women who
entered prenatal care in the first trimester varies by county. The percentage of women entering
prenatal care in the first trimester by county is as follows: Apache 61%, Cochise 85%, Coconino
80%, Gila 68%, Graham 72%, Greenlee 72%, La Paz 62%, Maricopa 80%, Mohave 79%, Navajo
70%, Pima 73%, Pinal 77%, Santa Cruz 69%, Yavapai 71%, and Yuma 62%. Overall, 78 percent
of women delivering a baby in 2006 began prenatal care in the first trimester in Arizona.
/2010/ All data for analyzing prenatal care was obtained through the Arizona Birth
Certificate database. The Healthy People 2010 goal for women entering prenatal care
during the first trimester is 90 percent. The percentage of Arizonan women aged 15
through 44 who entered prenatal care during the first trimester in 2007 was 77.6 percent.
This percentage varied by county of mother's residence. Apache 63.1%, Cochise 81.8%,
Coconino 82.8%, Gila 69.9%, Graham 71.0%, Greenlee 67.4%, La Paz 67.7%, Maricopa
80.4%, Mojave 76.1%, Navajo 68.5%, Pima 71.5%, Pinal 79.7%, Santa Cruz 64.9%, Yavapai
72.2%, and Yuma 64.5%.
The percentage of women aged 15 through 44 with adequate prenatal care utilization, as
defined by the Kotelchuck index, had a slight but insignificant increase in 2007. However,
the percentage varied widely by county, form a low of 29.7 percent of women in Greenlee
County to a high of 82.5 percent in Cochise County. The 2010 State MCH Needs
Assessment will explore barriers to accessing prenatal care and other recommended MCH
services by counties and regions with below average performance across the MCH
indicators. //2010//

47

Health Systems Capacity Indicator 07A: Percent of potentially Medicaid-eligible children
who have received a service paid by the Medicaid Program.
Health Systems Capacity Indicators Forms for HSCI 01 through 04, 07 & 08 - Multi-Year Data
Annual Objective and Performance Data
2004
2005
2006
2007
2008
Annual Indicator
72.6
73.7
74.5
74.7
76.8
Numerator
402079 424014 432605 434205 468812
Denominator
553763 575577 580568 581632 610091
Check this box if you cannot report the
numerator because
1.There are fewer than 5 events over the last
year, and
2.The average number of events over the last 3
years is fewer than 5 and therefore a 3-year
moving average cannot be applied.
Is the Data Provisional or Final?
Final
Final
Narrative:
/2009/ BWCH //2009// obtains data for HSCI 07A from AHCCCS. Because we
do not know the denominator for potentially Medicaid-eligible children, Arizona reports the
percent of Medicaid enrolled children who have received a Medicaid-eligible service for this
measure. The measure reported is the total number of Medicaid members age 1-20 with at least
one paid service during the reporting year divided by the total number of members age 1-20
eligible for Medicaid at any time during the reporting year. A single point-in-time estimate of the
potentially eligible population is actually smaller than the number of service recipients yielding a
result of over 100%.
/2010/
The percent of children enrolled in Medicaid (AHCCCS) who have received a service paid
by AHCCCS increased over 2 percent from 2007 to 2008. The Bureau of Women's and
Children's Health receives this estimate from AHCCCS. The Bureau is not able to
determine the number of potentially AHCCCS-eligible children (the denominator) and
AHCCCS does not include this figure when it shares data with the Bureau. //2010//

Health Systems Capacity Indicator 07B: The percent of EPSDT eligible children aged 6
through 9 years who have received any dental services during the year.
Health Systems Capacity Indicators Forms for HSCI 01 through 04, 07 & 08 - Multi-Year Data
Annual Objective and Performance Data
2004
2005
2006
2007
2008
Annual Indicator
49.2
45.5
54.1
56.6
59.6
Numerator
56991
54909
66522
71063
80349
Denominator
115746 120763 122975 125470 134811
Check this box if you cannot report the
numerator because
1.There are fewer than 5 events over the last
year, and
2.The average number of events over the last 3
years is fewer than 5 and therefore a 3-year
moving average cannot be applied.
Is the Data Provisional or Final?
Final
Final
Narrative:

48

Data for HSCI 07B is obtained through the HCFA 416 form provided to the maternal and child
health program by AHCCCS. The Office of Oral Health provides referrals to high-risk children to
ensure that they receive dental services.
The percent of EPSDT eligible children aged 6-9 years who have received any dental services
during the year has continued to improve. In 2005 the ADHS dental sealant program placed
sealants on 1825 EPSDT qualified children aged 6-9 years. In 2006,1882 eligible children
received this dental care.
The program is increasing funding thus supporting the expansion of the dental sealant program.
In 2005 the program served 5 counties, in 2006 ADHS was in 6 counties and in 2007 we are
expanding to two new counties.
Arizona is tied for the 3rd highest decay rate in K-3rd graders and has a dental workforce
shortage in a lot of the same areas. Some of the unmet need is being met by out of state, for
profit mobile dental companies who are providing services in underserved, high need areas.
/2010/ The percent of Early Periodic Screening Detection and Treatment (EPSDT) eligible
children aged 6 through 9 years who received dental services increased by three percent
from 2007 to 2008. Since 2005 this population cohort has significantly increased its
utilization of dental services from 45.5 percent to 59.6 percent.
The Office of Oral Health continues to monitor AHCCCS Health Plans on policies for dental
care and case management, collaborates with school based dental clinics to ensure
success and partners with private organizations and foundations to enhance preventive
activities. Through a HRSA Work Force Grant, the Office is continuing to initiate
teledentistry programs in several rural/underserved locations and two additional sites
have been added. The Office continues to work with the Arizona Dental Association and
Arizona Dental Hygiene Association in an effort to improve the number of providers for the
underserved. Efforts continue to promote the practice of establishing a dental home by
age. The dental sealant program continues to provide services to underserved children.
The Office of Oral Health will continue promoting a dental home by age one and training
those who provide services to young children in childcare, learning and health care
environments. //2010//

Health Systems Capacity Indicator 08: The percent of State SSI beneficiaries less than 16
years old receiving rehabilitative services from the State Children with Special Health Care Needs
(CSHCN) Program.
Health Systems Capacity Indicators Forms for HSCI 01 through 04, 07 & 08 - Multi-Year Data
Annual Objective and Performance Data
2004
2005
2006
2007
2008
Annual Indicator
58.1
58.9
43.1
47.4
46.4
Numerator
8849
8945
6627
7540
7630
Denominator
15230 15189 15392 15891 16443
Check this box if you cannot report the numerator
because
1.There are fewer than 5 events over the last year,
and
2.The average number of events over the last 3 years
is fewer than 5 and therefore a 3-year moving
average cannot be applied.

49

Is the Data Provisional or Final?
Final
Final
Notes - 2008
The measures for 2004 and 2005 contained duplicate members. The 2006, 2007, and 2008
measures are unduplicated. The 2006 measure looked at the SSI status at the end of the year.
Newer measures count a member as SSI eligible if they had any SSI eligibility at any time during
the year.
Notes - 2007
The measures for 2004 and 2005 contained duplicate members. The 2006 and 2007 measures
are unduplicated. The 2007 measure was correct from what was reported in the 2008 application
to include any member with SSI eligibility at any time during the year.
Notes - 2006
The measures for 2004 and 2005 contained duplicate members. The 2006 measure is
unduplicated.

Narrative:
CRS members with SSI eligibility are included in this measure. It is estimated that 46 percent of
SSI eligibile children were served through CRS in FY2008, very similar to the percent in 2007.
OCSHCN sends information to SSI applicants and an SSI coordinator enters referral information
into a database. Applicants are referred to programs, such as Children's Rehabilitative Services,
Community Nursing, OCSHCN care coordination programs, and Arizona Early Intervention
Program. A desktop protocol was developed to guide this process. OCSHCN works with the
Birth Defects Registry, High Risk Perinatal program, the Newborn Screening Program and state
school nurse organizations to inform families about CRS eligibility, and supports the BWCH
Children's Information Services Hotline, providing education to its staff on services and programs
for CYSHCN.
OCSHCN has not achieved its objective to link databases across programs for the purpose of
tracking progress. To date, BWCH and OCSHCN have not yet developed an automated process
through the SSDI initiative to link Newborn Screening Program data to data in the Children's
Rehabilitative Services database first because of an inability to identify a qualified job applicant
for the position of SSDI epidemiologist, and later due to a statewide agency hiring freeze.
CRS has revised Administrative Rules to simplify the eligibility process. An in-person medical
evaluation to verify the presence of a CRS eligible condition is no longer needed if sufficient
documentation is provided with the referral. For applicants already enrolled in AHCCCS, only
documentation of a CRS eligible medical condition is required.
OCSHCN collaborates with BWCH Community Nursing on children ineligible for other care and at
risk for developmental delay and provides care coordination for TBI/SCI in home and community
settings. Children and teenagers with traumatic brain injuries their families, and professionals are
provided information, resources and assistance with accessing services. Help with navigating
multiple service delivery systems including transition to adult services is also provided.

Health Systems Capacity Indicator 05A: Percent of low birth weight (< 2,500 grams)
INDICATOR #05
Comparison of health
system capacity
indicators for Medicaid,
non-Medicaid, and all
MCH populations in the

YEAR

DATA SOURCE

POPULATION
MEDICAID NONMEDICAID

ALL

50

State
Percent of low birth weight
(< 2,500 grams)

2007

payment source
from birth certificate

7.4

6.8

7.1

Narrative:
/2009/ The percent of infants weighing less than 2,500 grams rose slightly from 6.9 percent in
2005 to 7.1 percent in 2006. This increase was seen in both Medicaid (from 7.2 to 7.5) and nonMedicaid births (from 6.6 t 6.7). //2009//
Results of the PPOR analysis indicate that many of the excess infant deaths occur during the
prematurity/maternal care and maternal health peroids. Decreasing deliveries of low birth weight
infants would improve outcomes in both of these periods. /2009/ BWCH //2009// has utilized the
PPOR results to guide program activities geared towards decreasing low birth weight deliveries
and infant deaths.
BWCH has implemented an internal preconception care workgroup to address low birth weight
and prematurity. The goals of the workgroup are to develop strategies for increasing awareness
of the importance of preconception health among medical providers and the general public and to
integrate preconception care into existing BWCH programs. /2009/ The monthly internal
preconception care meetings have included presentations on training opportunities within the
state for various preconception care topics in order to identify resources for contractors as they
look at integrating preconception care at the local level. There have been presentations on
available training related to smoking cessation, improving nutritional behaviors and mental health
resources. The High Risk Perinatal Program (HRPP) Community Nursing component had
planned to implement a pilot project in Yavapai County to provide preconception care visits in
addition to visits focused on the NICU graduate. Due to a change in senior management at the
Yavapai County Health Department, the pilot project was not implemented. The Maricopa County
HRPP Community Health Nursing program is working with the Maricopa Integrated Health
Systems (MIHS) to identify their role in providing interconceptual care to the mothers of the HRPP
enrolled baby. MIHS received a grant from the local March of Dimes chapter to develop and
implement an internal care program based on the Grady Memorial model. The grant will work
with HRPP mothers who delivered at the Maricopa Medical Center, a public hospital.
Efforts are continuing on integrating preconception care into other BWCH programs as
appropriate. The County Prenatal Block Grant program added a focus on preconception care in
the policy and procedure manual and the program manager is monitoring those activities during
site visits. The Family Planning Program has revised the health assessment form to group topics
related to preconception care in one area of the form. The revised forms will be distributed during
a contractor's meeting in June. The Health Start Program is in the process of revising the home
visiting forms to capture education provided to clients on preconception care topics and to
capture any referrals made in response to an identified health risk. The Health Start data base
will also be revised to allow for the collection and reporting of this information. //2009//
The workgroup also identified working with the Department of Education as an important strategy
for reaching youth with the message of preconception care. A /2009/ BWCH //2009// Health
Educator has a very close working relationship with Department of Education staff and sits on a
school health standards committee. This person will also take the lead in identifying or
developing educational materials on the importance of preconception care for health care
professionals and the general public.
/2009/ The Bureau has been participating on conference calls with Florida state's Every Woman,
Every Time workgroup. The workgroup is revising the original educational packet developed by
California and while other states were also reportedly interested in using California's materials
there has not been a coordinated effort to share resources on a broad basis. Once Florida has
finalized their educational packet, the Bureau will convene an external workgroup to modify it for
use in Arizona. //2009// /2010/ The Bureau produced "Every Woman Arizona" Preconception

51

Health Materials in July 2009. //2010//
/2010/ The percent of infants weighing less than 2,500 grams (low birth weight) remained
steady at 7.1 percent. The disparity between the Arizona Medicaid (AHCCCS) and nonMedicaid infant populations narrowed slightly with 7.4 percent of Medicaid and 6.8 percent
of non-Medicaid infants born at low birth weight. Traditionally Medicaid populations in
Arizona have higher percentages of low birth weight infants, lower percentages of women
entering prenatal care in the first trimester, and lower percentages of women receiving
adequate prenatal care. The AHCCCS data has not been linked to other MCH data sources.
The Bureau of Women's and Children's Health requests all Medicaid and SCHIP data
pertinent to the Title V Grant directly from AHCCCS. //2010//

Health Systems Capacity Indicator 05B: Infant deaths per 1,000 live births
POPULATION
INDICATOR #05
YEAR
DATA SOURCE
Comparison of health
MEDICAID NONsystem capacity
MEDICAID
indicators for Medicaid,
non-Medicaid, and all
MCH populations in the
State
Infant deaths per 1,000
2007
other
0
0
live births
Notes - 2010
Mortality data is not available by payer. Data source is death certificates.

ALL

6.8

Narrative:
Infant death statistics in Arizona are not available by payer.
To better target interventions that will improve Arizona's ability to reduce preventable infant and
fetal deaths, the state has been conducting Perinatal Periods of Risk (PPOR) analysis on an
annual basis. PPOR analysis is one of the activities defined in Arizona's State Systems
Development Initiative plan. ADHS uses PPOR results better target prevention activities and to
guide funding decisions related to reducing preventable infant deaths.
The most recent PPOR analysis of the 2000 to 2003 birth cohort found that overall, 32 percent of
fetal and infant deaths in Arizona were found to be preventable. Excess infant deaths are fairly
evenly divided among the maternal health/prematurity period, the maternal care period, and the
infant health. The conclusion from the state-wide analysis is that, in order to reduce preventable
infant mortality, our prevention efforts should be focusing on preconception (and interconception)
care, prenatal care, safe sleep, breastfeeding, and other interventions that are proven to be
successful during these three periods. However, subgroup analysis showed that some
populations have different patterns of excess infant death than the state as a whole. For instance,
in the African American population, the period with the highest excess death rate is the maternal
health/prematurity period (4.3 per 1,000 fetal deaths and live births) while in the American Indian
population, the period with the highest excess death rate is the infant health period (2.5 per
1,000). In addition to being used to guide prevention efforts within the Department, the results of
these analyses were shared with stakeholders and partners to encourage them to utilize the
information to guide prevention strategies.
/2009/ BWCH //2009// is using these results to work with pograms to integrate preconception care

52

as appropriate. One example is that the Health Start program is moving towards a stronger
emphasis on preconception and interconception care. BWCH will also be working with the
Arizona Department of Education to integrate preconception care into health classes/health
standards.
/2010/ The total infant mortality rate per 1,000 live births increased from 6.3 in 2006 to 6.8
in 2007. Preliminary analysis indicates that the rate has declined to 6.3 in 2008 birth
cohort. Arizona's infant mortality rate has remained between 6.9 and 6.3 per 1,000 live
births during the past decade. Infant death statistics in Arizona are not available by payer.
The Bureau of Women's & Children's Health has taken action to reduce infant mortality for
at-risk populations of infants. The Bureau received a 1st Time Motherhood Grant
from HRSA. The focus is on reducing infant mortality among African Americans through
social marketing of preconception health, promotion of existing programs, and community
development.
In 2008, Child Fatality Review teams reviewed deaths for all children in Arizona, including
infant deaths. The data were analyzed for public policy and prevention campaigns and
reports were provided to the public for research, media reports, and public health
campaigns. Recommendations regarding prevention of infant deaths included
implementation of an infant safe sleep campaign, establishing Cribs for Kids programs,
and implementation of the CDC recommendations to improve preconception health care.
In 2008 the County Prenatal Block Grant funded infant mortality prevention programs from
car seat education and installation, to prenatal care and immunization education. The
program is likely to be discontinued due to state budget reductions. //2010//

Health Systems Capacity Indicator 05C: Percent of infants born to pregnant women
receiving prenatal care beginning in the first trimester
INDICATOR #05
Comparison of health
system capacity
indicators for Medicaid,
non-Medicaid, and all
MCH populations in the
State
Percent of infants born to
pregnant women receiving
prenatal care beginning in
the first trimester

YEAR

2007

DATA SOURCE

payment source
from birth certificate

POPULATION
MEDICAID NONMEDICAID

ALL

68.4

77.6

87.8

Narrative:
The percent of women entering prenatal care in the first trimester /2009/ remained at 77.7% for
2006 . Although the percent of women entering prenatal care in the first trimester increased for
those women whose births were paid by Medicaid, there was a disparity for prenatal care
between the Medicaid (71.8%) and non-Medicaid (90.2%) populations. //2009//
Eligibility levels for Medicaid and SCHIP remained unchanged in 2005. Changes in poverty level
for eligibility in AHCCCS and SCHIP rest with the Medicaid agency (AHCCCS), the legislator and
the public. Historically, changes in poverty levels for Medicaid eligibility have been generated as
the result of voter propositions. BWCH works with our partners who support increasing poverty
levels for Medicaid eligibility and will provide data as appropriate.
The Pregnancy and Breast Feeding Hotline is a statewide, bilingual service that has been

53

sponsored by the Arizona Department of Health Services (ADHS) since April 1988. The Hotline's
mission is to ensure the health, safety, and well being of pregnant women and their families
through community based, family centered, and culturally sensitive systems of care. One of the
many services that the Hotline provides is to assist Arizona's Medicaid program, the Arizona
Health Care Cost Containment System (AHCCCS), with pre-screening for the Baby Arizona
Program. Baby Arizona is a program that helps pregnant women begin the important prenatal
care they need by providing a simple, faster way to get health care before the application process
for AHCCCS health insurance is complete.
A woman will call the Hotline at 1-800-833-4642 stating that she thinks she is or knows she is
pregnant. Hotline staff will ask if she is interested in completing a pre-screening for Baby Arizona.
If she says yes, the Hotline representative will ask a series of questions that will provide potential
eligibility. If the woman is potentially eligible she will be given the name and address of three
Baby Arizona providers in her community. The woman will select one of the providers and
schedule an appointment. At the first appointment the woman will be asked to complete a Baby
Arizona application and will have her first prenatal visit. The Provider's office will submit the
application paperwork to the Department of Economic Security (DES) and will await notification of
eligibility. If the woman is determined eligible she will continue with that provider through delivery
and AHCCCS will pay the bills. If she is determined in-eligible she can still continue her visits with
the provider but she and the provider will need to work out a reasonable payment plan. If during
the pre-screening process the woman appears ineligible, the Hotline representative will provide
information on low cost care available in the woman's community. If program eligibility is too
difficult to determine, the woman will be encouraged to apply at DES directly.
/2010/ The percentage of Arizonan women aged 15 through 44 who entered prenatal care
during the first trimester in 2007 was 77.6 percent. However, a significant disparity exists
between the Medicaid (AHCCCS) and non-Medicaid populations. Only 68.4 percent of
women on AHCCCS reported having initiated prenatal care during the first trimester, while
87.8 percent of the non-AHCCCS population obtained prenatal care during the first
trimester (19.4 percent difference). Traditionally Medicaid populations in Arizona have
higher percentages of low birth weight infants, lower percentages of women entering
prenatal care in the first trimester, and lower percentages of women receiving adequate
prenatal care. The AHCCCS data has not been linked to other MCH data sources. The
Bureau of Women's and Children's Health requests all Medicaid and SCHIP data pertinent
to the Title V Grant directly from AHCCCS.
Through 2007 the County Prenatal Block Grant funded all 15 County Health Departments
to develop programs to encourage entry into early prenatal care. However, the County
Prenatal Block Grant was suspended at the end of the third quarter of the 2009 state fiscal
year due to state budget reductions.
Baby Arizona facilitates a presumptive eligibility process which guarantees physicians
who see pregnant women that their first prenatal care visit will be covered by AHCCCS,
even before the woman is determined to be eligible for AHCCCS services. The Pregnancy
and Breastfeeding Hotline continues to assist in referring women to Baby Arizona. In
addition, the March of Dimes provided grant funding to initiate new promotion of the Baby
Arizona hotline and website in order to help uninsured or underinsured pregnant women
access prenatal care early in their pregnancies. //2010//

Health Systems Capacity Indicator 05D: Percent of pregnant women with adequate
prenatal care(observed to expected prenatal visits is greater than or equal to 80% [Kotelchuck
Index])
INDICATOR #05

YEAR

DATA SOURCE

POPULATION

54

Comparison of health
system capacity
indicators for Medicaid,
non-Medicaid, and all
MCH populations in the
State
Percent of pregnant
women with adequate
prenatal care(observed to
expected prenatal visits is
greater than or equal to
80% [Kotelchuck Index])

2007

payment source
from birth certificate

MEDICAID

NONMEDICAID

ALL

61.9

79.4

70.3

Narrative:
The data source for HSCI 05D is birth certificate data. /2009/ BWCH //2009//has direct access to
this data. The percent of women with adequate prenatal care in both the Medicaid and nonMedicaid populations is similar to point estimates reported in the 2005 Medicaid and nonMedicaid populations.
/2010/ There was a slight, but insignificant increase (+ 0.5 percent) in the percentage of
pregnant women with adequate prenatal care from 2006 to 2007 according to the
Kotelchuck Index. However, a significant disparity exists between the Medicaid (AHCCCS)
and non-Medicaid populations. Only 61.9 percent of women on AHCCCS had at least
adequate prenatal care, while 79.4 percent of the non-AHCCCS population had adequate
care according to the Kotelchuck Index (19.4 percent difference). Traditionally Medicaid
populations in Arizona have higher percentages of low birth weight infants, lower
percentages of women entering prenatal care in the first trimester, and lower percentages
of women receiving adequate prenatal care. The AHCCCS data has not been linked to
other MCH data sources. //2010//

Health Systems Capacity Indicator 06A: The percent of poverty level for eligibility in the
State’s Medicaid and SCHIP programs. - Infants (0 to 1)
INDICATOR #06
The percent of poverty level for eligibility in the State's
Medicaid programs for infants (0 to 1), children, Medicaid and
pregnant women.
Infants (0 to 1)
INDICATOR #06
The percent of poverty level for eligibility in the State's SCHIP
programs for infants (0 to 1), children, Medicaid and pregnant
women.
Infants (0 to 1)

YEAR

PERCENT OF
POVERTY LEVEL
Medicaid

2008
YEAR

140
PERCENT OF
POVERTY LEVEL
SCHIP

2008

200

Narrative:
Eligibility levels for Medicaid and SCHIP remained unchanged in /2009/ 2007 //2009//. Changes
in poverty level
for eligibility in AHCCCS and SCHIP rest with the Medicaid agency (AHCCCS), the legislator and
the public. Historically, changes in poverty levels for Medicaid eligibility have been generated as
the result of voter propositions. /2009/ BWCH //2009// works with our partners who support
increasing poverty levels for Medicaid eligibility and will provide data as appropriate.
/2010/ Eligibility for Medicaid (AHCCCS) and SCHIP(KidsCare) as determined by federal
poverty level remained unchanged in 2008. See National Performance Measures #4 and
#13 for programmatic efforts to support the publically insured and uninsured MCH

55

populations .
In FY 2010, AHCCCS sought and received approval to increase KidsCare premiums for
children and households/parents. Premiums for children in households with incomes
between 150-175% FPL will increase: (a) for one child, from $20 to $40; (b) for more than
one child, from $30 to $60. Premiums for children in households with incomes between
176-200% FPL will increase: (a) for one child, from $25 to $50; (b) for more than one child,
from $35 to $70. Premiums for parents between 150-175% FPL will increase from 4% of
household income to 5% of household income. It is expected that an estimated 25,089
children will be impacted by the increased premiums. //2010//

Health Systems Capacity Indicator 06B: The percent of poverty level for eligibility in the
State’s Medicaid and SCHIP programs. - Medicaid Children
INDICATOR #06
The percent of poverty level for eligibility in the State's
Medicaid programs for infants (0 to 1), children, Medicaid and
pregnant women.
Medicaid Children
(Age range 1 to 6)
(Age range 6 to 18)
(Age range to )
INDICATOR #06
The percent of poverty level for eligibility in the State's SCHIP
programs for infants (0 to 1), children, Medicaid and pregnant
women.
Medicaid Children
(Age range 1 to 18)
(Age range to )
(Age range to )

YEAR

PERCENT OF
POVERTY LEVEL
Medicaid

2008
133
100
YEAR

PERCENT OF
POVERTY LEVEL
SCHIP

2008
200

Narrative:
Eligibility levels for Medicaid and SCHIP remained unchanged in /2009/ 2007 //2009//. Changes
in poverty level
for eligibility in AHCCCS and SCHIP rest with the Medicaid agency (AHCCCS), the legislator and
the public. Historically, changes in poverty levels for Medicaid eligibility have been generated as
the result of voter propositions. /2009/ BWCH //2009// works with our partners who support
increasing poverty levels for Medicaid eligibility and will provide data as appropriate.
/2010/ Eligibility for Medicaid (AHCCCS) and SCHIP(KidsCare) as determined by federal
poverty level remained unchanged in 2008. See National Performance Measures #4 and
#13 for programmatic efforts to support the publically insured and uninsured MCH
populations .
In FY 2010, AHCCCS sought and received approval to increase KidsCare premiums for
children and households/parents. Premiums for children in households with incomes
between 150-175% FPL will increase: (a) for one child, from $20 to $40; (b) for more than
one child, from $30 to $60. Premiums for children in households with incomes between
176-200% FPL will increase: (a) for one child, from $25 to $50; (b) for more than one child,
from $35 to $70. Premiums for parents between 150-175% FPL will increase from 4% of
household income to 5% of household income. It is expected that an estimated 25,089
children will be impacted by the increased premiums. //2010//

56

Health Systems Capacity Indicator 06C: The percent of poverty level for eligibility in the
State’s Medicaid and SCHIP programs. - Pregnant Women
INDICATOR #06
The percent of poverty level for eligibility in the State's
Medicaid programs for infants (0 to 1), children, Medicaid and
pregnant women.
Pregnant Women
INDICATOR #06
The percent of poverty level for eligibility in the State's SCHIP
programs for infants (0 to 1), children, Medicaid and pregnant
women.
Pregnant Women

YEAR

PERCENT OF
POVERTY LEVEL
Medicaid

2008
YEAR

150
PERCENT OF
POVERTY LEVEL
SCHIP

2008

200

Narrative:
Eligibility levels for SCHIP remained unchanged in 2006. /2009/ Eligibility levels for Medicaid
increased from 133% to 150% of the poverty level //2009//. Changes in poverty level for eligibility
in AHCCCS and SCHIP rest with the Medicaid agency (AHCCCS), the legislature and the public.
Historically, changes in poverty levels for Medicaid eligibility have been generated as the result of
voter propositions. /2009/ BWCH //2009// works with our partners who support increasing poverty
levels for Medicaid eligibility and will provide data as appropriate.
/2010/ Eligibility for Medicaid (AHCCCS) and SCHIP(KidsCare) as determined by federal
poverty level remained unchanged in 2008. See National Performance Measures #4 and
#13 for programmatic efforts to support the publically insured and uninsured MCH
populations. //2010//

Health Systems Capacity Indicator 09A: The ability of States to assure Maternal and Child
Health (MCH) program access to policy and program relevant information.
DATABASES OR
Does your MCH program have
Does your MCH program
SURVEYS
the ability to obtain data for
have Direct access to the
program planning or policy
electronic database for
purposes in a timely manner?
analysis?
(Select 1 - 3)
(Select Y/N)
ANNUAL DATA LINKAGES 3
Yes
Annual linkage of infant
birth and infant death
certificates
1
No
Annual linkage of birth
certificates and Medicaid
Eligibility or Paid Claims
Files
2
No
Annual linkage of birth
certificates and WIC
eligibility files
3
Yes
Annual linkage of birth
certificates and newborn
screening files
REGISTRIES AND
3
Yes
SURVEYS
Hospital discharge survey
for at least 90% of in-State

57

discharges
2

No

1

No

Annual birth defects
surveillance system
Survey of recent mothers at
least every two years (like
PRAMS)
Notes - 2010
Narrative:
/2009/ BWCH //2009//submitted an application for the upcoming State Systems
Development Initiative (SSDI) cycle. For the 2006 through 2011 cycle of SSDI, the program
proposed using SSDI funding to 1) establish and implement protocols for linking newborn
screening data with birth, infant death, and data from the Arizona School for the Deaf and Blind,
2) establish and implement a protocol for linking newborn screening and Children's Rehabilitative
Services data, 3) utilize Arizona Births Defects Registry data to enhance stillbirth, infant death
and childhood death reports, 4) establish and implement a protocol for linking birth certificate data
with data from Women, Infants and Children (WIC), and 5) refine the methodology for linking birth
and infant death data. A key element of the upcoming SSDI will be a communication cycle in
which reports provided from the linked datasets are reviewed by stakeholders and revised based
on their input.
/2009/ The Arizona Birth Defects Registry will have complete data for 2001-2006 in the fall of
2008. This data will be linked to Birth and Death Certificate data from Vital Statistics in effort to
fulfill an objective of the SSDI grant initiative. //2009// The Hospital Discharge data collection rules
are currently being revised. One of the proposed revisions will include the collection of the fourthdigit of the revenue code, which for infants indicates the level of care that an infant receives while
in the hospital. This revision will enable /2009/ BWCH //2009// to be able to identify infants who
were admitted to the Neonatal Intensive Care Unit. The ability to identify these infants will greatly
enhance the ability to evaluate the Neonatal Intensive Care Program, and to ensure that every
infant who spends at least 72 hours in the NICU is enrolled in the NICP program.
/2010/ The Arizona H72 Death Certificate System was replaced by the new VSIMS (Vital
Statistics Information Management System) as of July 1, 2008. The Transax data is merged
with VSIMS daily, thus allowing for more timely mortality surveillance. This advancement
will allow for more precise determination of infant underlying cause of death when
complete VSIMS data is merged with Arizona Birth Certificates.
The Bureau of Women's and Children's Health and the Arizona WIC Program updated a
data share agreement in 2009. This will allow the Bureau to link Arizona Birth Certificate
data to limited number of WIC variables using a probabilistic method.
Since the last funding cycle in federal fiscal year (FFY) of 2009 Arizona's State Systems
Development Initiative (SSDI) has made critical progress in accomplishing data linkages.
The last successful linkage of birth certificate data and Health Start Program data resulted
in development of a evaluation report now available publicly on the Bureau's website is
currently being peer reviewed in Maternal and Child Health Journal. In addition to this, the
Bureau is currently in the process of completing a path-analytic study explaining mortality
among African Americans using linked birth and death files. The linked birth and death
files were further linked with CDCs (Link Plus) software to hospital discharge data to
further investigate other causal factors influencing birth outcomes. //2010//

Health Systems Capacity Indicator 09B: The Percent of Adolescents in Grades 9 through
12 who Reported Using Tobacco Product in the Past Month.

58

DATA SOURCES

Youth Risk Behavior
Survey (YRBS)
Notes - 2010

Does your state
participate in the YRBS
survey?
(Select 1 - 3)
3

Does your MCH program have direct
access to the state YRBS database for
analysis?
(Select Y/N)
Yes

Narrative:
The Arizona Department of Education began implementing the Youth Risk Behavior Survey
during the 2002/2003 school year, and also participates in the Arizona Youth Tobacco Survey
and the Arizona Youth Survey. The maternal and child health program has direct access to the
YRBS through a data share agreement. Staff from the maternal and child health program
participate in the Inter-Agency Survey Coordination Committee. Members of this committee have
worked together to coordinate timing and administration of the Youth Risk Surveillance Survey,
the Youth Tobacco Survey and the Arizona Youth Survey to reduce the burden on school districts
of responding to multiple surveys.

59

IV. Priorities, Performance and Program Activities
A. Background and Overview
BWCH continues to follow the method it defined after the year 2000 needs assessment for
identifying and prioritizing the needs of women and children in Arizona. The goal of this method
is to create a participatory process that is easily articulated and strategic in nature, resulting in
funding decisions that have the best chance of making an impact on the health of the maternal
and child health population. The BWCH strategic planning process is used to accomplish three
goals: 1) identify the health needs of women and children, 2) allocate funding to address the
needs and 3) evaluate the effectiveness of those efforts.The BWCH strategic plan, which is
available at the BWCH web site, identifies two priority areas: to reduce mortality and morbidity of
the maternal and child population; and to increase access to health care. The plan also identifies
the need to decrease health disparities as an overarching priority. The functions of the various
office sections are specified within the plan. These priorities and related measures are chosen by
a multi-step process: 1) reviewing data to identify the most significant issues; 2) excluding those
issues already being addressed by another entity within the state; and 3) determining those
issues that most likely could improve with a targeted effort. The plan is used to make funding
decisions and to establish staff priorities. State priorities resulting from this strategic plan are
presented in section IV.B. of this document.

B. State Priorities
Through a series of public meetings and other communications related to the five-year needs
assessment process, priorities were established that the community and the Title V agency jointly
identified as important and that are within their capability to address.
Many issues were raised during public input sessions that affect the health and well being of the
maternal-child health population that are beyond the scope of Title V services. For example,
affordable housing, general educational attainment, opportunities for economic and social
activities for youth, and parental involvement with their own children were all recognized as
important contributing factors to women's and children's health. The themes of home, school,
and neighborhood environments may not be specifically reflected in the top priorities identified,
however opportunities to work with schools, parents, and the larger community on issues that
affect health will continue to permeate programmatic activities and remain top priorities in
themselves.
PRIORITY 1: REDUCE TEEN PREGNANCY AND INCREASE WOMEN'S ACCESS TO
REPRODUCTIVE HEALTH SERVICES
A recurrent theme that was heard at each of the public input sessions was that there is a need for
enhanced teen pregnancy prevention, sexuality education, and family planning services to
prevent unwanted pregnancies and sexually transmitted diseases. Teen pregnancy was seen as
important both as an outcome and as a cause. In addition to the consequences that pregnancy
has for the teenager's health and life chances, babies born to teenagers are less likely to get a
healthy start at life. There was a recognition that services should be aimed both at delaying the
onset of sexual activity as well as supporting responsible choices among sexually active teens.
Family planning for women of all ages plays an integral role in bolstering the health and well
being of both women and children. In fact, during public input sessions, a WIC director from one
of the American Indian tribes stated that spacing of children was the most important nutrition
issue they faced. In addition, the ability to plan pregnancies helps women gain flexibility in
education and employment opportunities.
$2 million in lottery funds will be aimed at teen pregnancy, and another $2 million in state and
federal dollars will be directed specifically towards abstinence education. Community-based

60

programs are being piloted in two communities with the highest teen pregnancy rates. $1 million
of Title V funds are being spent on family planning, and OWCH initiated the Family Planning
Coalition, which has been in operation for about 4 years.
/2007/ The state budget for FY07 included a $500,000 increase for the Abstinence Program
resulting in a total of $1.5 million in state funds dedicated to abstinence beginning July 2006.
//2007//
/2008// Lottery dollars are used to fund several comprehensive sexual education projects
throughout Arizona. In 2007 BWCH worked with the Navajo Nation and Inter Tribal Council of
Arizona to develop new teen pregnancy projectsamong the tribes. Also in 2007 a parent
education campaign is launching as well as pilot projects serving youth in the juvenile justice
system. //2008//
/2009/ Arizona will not apply for federal FY09 abstinence funding, and the state legislature did not
include any state funding for abstinence in the state FY09 budgets. Budget cuts also resulted in
the loss of some of the lottery-funded comprehensive sexual education projects. //2009//
/2010/ The Abstinence Education Program continued in 2008 and 2009 through the use of
remaining federal FY08 abstinence dollars. Funded organizations implemented youth
development projects, and provided the matching dollars to meet the federal match
requirements. With Governor Jan Brewer's leadership, Arizona applied for the available
federal FY09 Abstinence Education grant in the spring of 2009. //2010//
PRIORITY 2: REDUCE OBESITY AND OVERWEIGHT AMONG WOMEN AND CHILDREN
Maintaining a healthy weight through healthy eating patterns and physical activity is a critical
component of chronic disease prevention. Over the last decade, strides have been made in
increasing the level of physical activity and healthy eating. However, obesity has reached
epidemic proportions, affecting all regions and demographic groups.
Being overweight during childhood can carry life-long health consequences. Risk factors for
heart disease, such as high cholesterol and high blood pressure, occur with increased frequency
in overweight children and adolescents, and type 2 diabetes, which was previously considered to
be an adult disease, has increased dramatically in children and adolescents.
OWCH focuses community grants for women's health on healthy weight in women, and partners
with the Office of Chronic Disease and Nutrition, including participation in developing a statewide
obesity plan and sponsoring Women's Health Week to promote healthy lifestyles. Promoting
Lifetime Activity for Youth, or PLAY, promotes 60 minutes of daily independent physical activity in
4th through 8th grade.

PRIORITY 3: REDUCE PREVENTABLE INFANT MORTALITY
Although infant mortality in Arizona has declined, disparities remain in the rates of death among
various subgroups of the population. African American, American Indian, and Hispanic infants
die at higher rates than White infants, as do infants born to less educated women and teens.
While not all infant mortality can be prevented, disparities suggest that interventions directed at
excess mortality within high-risk populations provide an opportunity for further progress.
The Office of Women's and Children's Health used the CDC Periods of Risk Model to analyze
infant and fetal deaths in Arizona. Excess deaths were analyzed to estimate the proportion of
infant deaths that were preventable, and to associate deaths with periods of risk in order to
effectively target interventions within high-risk populations. Resources will be directed towards
preconception and maternal health. Good nutrition, physical activity, and reducing risk behaviors

61

such as smoking and alcohol use will be promoted for all women of childbearing age. Because a
high proportion of deaths were associated with the postneonatal period (after the first month of
life through the first year), interventions will emphasize promoting breastfeeding, proper sleep
positions, preventing and diagnosing infection and injury, recognition of birth defects and
developmental abnormalities, and prevention of sudden infant death syndrome.
/2007/ OWCH is developing a preconception health initiative and is piloting an educational project
with the Black Nurses Association. //2007//
/2009/ The Bureau of Women's & Children's Health is integrating preconception health into
existing programs. //2009//
/2010/ The Bureau of Women's & Children's Health received a 1st Time Motherhood Grant
from HRSA. The focus is on reducing infant mortality among African Americans through
social marketing of preconception health, promotion of existing programs, and community
development. //2010//
PRIORITY 4: REDUCE THE RATE OF INJURIES, BOTH INTENTIONAL AND
UNINTENTIONAL
For many years, Arizona's injury mortality has exceeded national rates. Injuries, both intentional
and unintentional, are among the leading causes of death among children of all ages and women
of childbearing years in Arizona. In addition, nonfatal injuries account for a high volume of both
inpatient hospitalizations and emergency outpatient visits. The impact of injuries is felt by more
than the just the person who is injured. Injuries also affect families, schools and employers. The
Arizona Department of Health Services has developed a state injury surveillance and prevention
plan.
OWCH has been designated as the agency lead for injury prevention. A new CDC grant was
awarded to the office, which will fund a full-time injury epidemiologist and half-time administrative
assistant to focus on injury. A statewide injury plan will be updated by the end of December,
2005. In addition, community grants focus on preventing motor vehicle crashes, and other
programs will contribute to the reduction of both intentional and unintentional injury (e.g., Safe
Kids, Domestic Violence and Rape Education, Child Care Consultation, and participation on the
State Agency Coordination Team).
/2007/ The Rural Safe Home Network funds programs to provide temporary, emergency safe
shelter and related services to victims of domestic violence.
The Rape Prevention and Education program supports communication, coordination, and
collaboration among contractors and with other organizations involved in rape prevention and
sexual assault services. Contractors use a variety of methods to convey rape prevention
messages including classroom presentations, peer mentoring/education, teen theater
productions, long-term/on-going interaction with at-risk youth, workshops and trainings, social
marketing, and student coalitions.
The Child Fatality Review Program coordinates the activities of 13 local teams comprised of
volunteers with roots in their communities. Team compositions reflect the diversity of the
populations they serve.
OWCH is working with Prevent Child Abuse Arizona to conduct a statewide Never Shake a Baby
initiative. //2007//
/2008/ BWCH hosts an annual injury prevention symposium. The 2006 sumposium was focused
on policy, and the focus for /2009/ 2007 //2009//is burden of injuries on businesses. The Injury
prevention program is organizing a challenge among high schools to improve seat belt usage.

62

//2008//
/2009/ The Sexual Violence Prevention & Education Program launched a strategic planning
process to develop a statewide sexual violence prevention plan. //2009//
/2010/ Last year Rural Safe Home Network programs provided 14,107 shelter nights to 472
women, 747 children and 7 men. Programs provided 1,465 batterers intervention services,
and 3,085 hours of domestic violence training and prevention services to 23,672
participants. Between November 1, 2007 and October 31, 2008, the Sexual Violence
Prevention & Education Program provided primary sexual violence prevention educational
sessions or events to 27, 808 people in Arizona. //2010//
PRIORITY 5: INCREASE ACCESS TO PRENATAL CARE AMONG MEDICALLY
UNDERSERVED WOMEN
Prenatal care is an opportunity to identify risks and mitigate their impact on pregnancy outcomes
through medical management. Prenatal visits also offer an opportunity for education and
counseling on proper nutrition and risk factors, such as smoking and alcohol use during
pregnancy. Prenatal care is more effective when women enter care early in their pregnancy.
Although there has been an upward trend in the proportion of women receiving prenatal care in
their first trimester of pregnancy, Arizona continues to lag behind the rest of the nation. The
proportion of women who enter prenatal care early in their pregnancies varies in Arizona by race,
ethnicity, education, source of payment for delivery, and geographically. Recommendations at
each public meeting were made to increase funding to the Health Start Program, which is a
program to identify women early in their pregnancies and get them into prenatal care.
In addition to the Health Start Program, OWCH facilitates entry into prenatal care through its
Pregnancy and Breastfeeding Hotlines. OWCH is also participating in the revitalization of Baby
Arizona, which is a presumptive eligibility program to encourage physicians to serve pregnant
women before their eligibility is confirmed.
/2007/ The Office of Women's and Children's Health will be geo-mapping Baby Arizona Providers
over the Arizona medically underserved areas to identify areas lacking providers. The Health
Start Program identifies women early in their pregnancies, facilitates their entry into prenatal care,
and supports families throughout the pregnancy and the postpartum period. The program
identifies natural community leaders and recruits them as lay health workers who live in and
reflect the ethnic and cultural characteristics of their communities. //2007//
/2009/ The Bureau of Women's & Children's Health is working with the state Medicaid agency,
AHCCCS, and the March of Dimes to enhance promotion of Baby Arizona, the presumptive
eligibility program that facilitates pregnant women receiving access to prenatal care prior to the
Medicaid application being finalized. //2009//
PRIORITY 6: IMPROVE THE ORAL HEALTH OF CHILDREN, ESPECIALLY AMONG HIGH
RISK POPULATIONS
United States Surgeon General David Satcher dubbed dental disease the "silent epidemic," yet it
is preventable with early intervention and the promotion of evidence-based prevention efforts like
dental sealants. In an effort to improve the health and well being of children, it is imperative that
interventions be targeted at preventing dental disease, especially in high-risk children. Concern
about oral health was expressed at each public meeting. In fact, oral health was identified as the
number one issue for one of the Indian Tribes, according to a review of medical records.
Title V Block Grant funds support the Office of Oral Health in providing sealants, exams, and
referrals to high-risk children, as well as the flouride mouth rinse program. Title V funds also

63

support continuing education courses to WIC educators and other community health providers
and Office of Oral Health efforts in working with medical professionals on early recognition,
prevention, and referral for dental needs.
/2007/The Office of Oral Health (OOH) identified communities with below optimal levels of water
with fluoride and offered a school based fluoride mouth rinse program. 21,448 children received
intervention. OOH provided a conference to targeted communities on water fluoridation//2007//.
/2010/ The OOH is conducting a dental sealant indicator survey of 8,000 3rd grade children
statewide. //2010//
/2009/ The Bureau of Health Systems Development and Oral Health provides an evidence-based
sealant program that is expanding to 9 counties with an emphasis on increasing student
participation as well as numbers of participating schools. //2009//

PRIORITY 7: INTEGRATE MENTAL HEALTH WITH GENERAL HEALTH CARE
Widespread concern was expressed at every public input meeting about the need to integrate
mental and physical health care. Mental and behavioral health screening of women and children
in general, and for postpartum depression in particular were consistent themes. It is important for
primary care providers to be aware of both screening and treatment options.
An initial meeting was held between OWCH and the ADHS Behavioral Health Division to talk
about strategies to educate providers on screening and referral for mental and behavioral health
issues for both women and children. OWCH provides funds for developmental care in hospitals
and participates in an infant mental health interagency work group and in the formation of a new
postpartum depression group. OWCH is also supporting an integrated services model grant to
integrate mental and physical health screening and services.
/2007/The Office of Women's and Children's Health continued collaborative efforts with Mountain
Park Health Center on the Physical and Behavioral Health Integration Project, which is a planning
grant to develop a model to integrate behavioral health care with pediatric care.
OWCH will partner with ADHS Division of Behavioral Health to promote maternal and child
mental health, behavioral health, drug and alcohol use screening; promote mental health and
behavioral health screening among OWCH partners; increase awareness among partners and
the community about mental and behavioral health issues; identify and partner with agencies and
organizations involved in maternal and child mental/behavioral health issues. //2007//.
/2008/ In 2006, the BWCH High Risk Perinatal Program began requiring community nurses to
conduct post partum depression screening at early home visits. BWCH is working with the
Division of Behavioral Health to provide training to MCH programs about the behavioral health
syste. HRSA conducted a strategic partnership session among the major Arizona HRSA grantees
in 2007. The session has resulted in a new collaboration among the grantees regarding the
integration of behavioral health. The grantees identified behavioral health as an issue all were
concerned about and interested in working on together. //2008//.
/2009/ BWCH was awarded funding through Northrup Grumman to integrate screening for alcohol
use into an existing MCH program, Health Start. The program is using an evidence-based
screening tool among pregnant women, providing brief intervention, and making referrals for
treatment. //2009//
/2010/ BWCH was awarded $900,946 annually for five years for Project LAUNCH, a new
SAMSHA program designed to promote the wellness of young children ages birth to 8
years of age, including behavioral health. //2010//

64

C/YSHCN PRIORITIES
The data gathered from numerous sources pointed to the fact that C/YSHCN and their families
have many unmet or partially met needs. These needs were for specific services and for system
changes to allow better access to services. However, there were also more ephemeral needs
such as the need to have a provider understand the culture of the family, to speak the language
of the family, and to engage the family as a partner in the decision making process. Not all of the
needs delineated by the survey data, the focus groups, and other information are incorporated
into the priority needs. Many of the needs for specific services will be addressed through the
Specialty Care subcommittee of the Integrated Services grant and still other issues will be part of
the office's strategic plan for 2005-2010.
The determination of the priority needs for Arizona's C/YSHCN was achieved through a group
consensus of the Needs Assessment Planning Group after reviewing the data from the
NSCSHCN, the focus groups, and the provider community. While they all agreed there were
many specific service and coordination needs, there was very little OCSHCN could do to directly
impact those needs. The group decided to address the needs from more of a systems approach
that would focus interventions on education of providers as well as the families of C/YSHCN. The
following three statements of need are the result of that consensus.
PRIORITY 8: INCREASE THE ACCESSIBILITY AND AVAILABILITY OF INDIVIDUALIZED
HEALTH AND WELLNESS RESOURCES FOR CHILDREN AND YOUTH WITH SPECIAL
HEALTH CARE NEEDS IN ARIZONA.
PRIORITY 9: INCREASE THE AVAILABILITY OF A COHESIVE AND STABLE CONTINUUM
OF RESOURCES WITHIN A MEDICAL HOME THAT INCLUDES AN IMPROVED QUALITY OF
LIFE APPROACH.
PRIORITY 10: INCREASE THE RECOGNITION OF FAMILIES AS INTEGRAL PARTNERS IN
THE CARE OF THEIR CHILD'S HEALTH AND WELLBEING./2009/This priority is tracked using
data from NPM #2.//2009//
The priorities outlined above will be reflected in the Title V agency's strategic plans and block
grant applications over the next five years. Progress will be tracked using a combination of
national performance measures, which are required by all states, and new state-defined
measures, which reflect Arizona priorities. Details on newly defined state performance measures
can be found in the 2006 Title V Block Grant Application accompanying this needs assessment.
Subsequent applications will report on the actual measures and discuss accomplishments,
activities and plans related to them.
/2008/
Because of the identified need to clarify systems of care and facilitate linking children and youth
with appropriate services, OCSHCN is refocusing two of its priorities.
NEW PRIORITY 8: EDUCATE FAMILIES, PROVIDERS, AND CHILD-SERVING AGENCIES ON
ELIGIBILITY RULES AND PROCESSES FOR ACCESSING SERVICES.
OCSHCN will target education efforts within its own agency by training OWCH Hotline staff,
Neonatal Intensive Care Program staff and Community Nursing staff on eligibility rules and
coverage of programs within OCSHCN and other agencies. OCSHCN will also develop
resources to train AHCCCS and other providers, hospital discharge planners, families, and
eligibility workers within other agencies. The OCSHCN website and e-learning system will be
expanded to include trainings on navigating the systems of care for CSHCN.
NEW PRIORITY #9: INCREASE ACCESS TO AVAILABLE AND APPROPRIATE SERVICES

65

FOR CHILDREN AND YOUTH WITH SPECIAL HEALTH CARE NEEDS.
Through the SSDI grant, BWCH and OCSHCN are defining processes to identify newborns who
test positive through the state's Newborn Screening Program and refer them to appropriate staff
within both offices and facilitate their enrollment into programs for care coordination and direct
medical services.
To track progress on new priorities 8 and 9, BWCH and OCSHCN are collaborating to define a
new state performance measure, which will track the percent of children identified through the
newborn screening process who receive services through an BWCH or OCSHCN program.
//2008//
/2009/BWCH and OCSHCN did not develop a process through the SSDI Initiative to link newborn
screening data to the CRS database first because of the inability to identify a qualified job
applicant for the SSDI epidemiologist position and later due to a statewide hiring freeze.
OCSHCN developed SPM#8 to measure priorities 8 and 9.//2009//

C. National Performance Measures
Performance Measure 01: The percent of screen positive newborns who received timely
follow up to definitive diagnosis and clinical management for condition(s) mandated by their
State-sponsored newborn screening programs.
Tracking Performance Measures
[Secs 485 (2)(2)(B)(iii) and 486 (a)(2)(A)(iii)]

Annual Objective and Performance Data
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Data Source

2004
100
100.0
75
75

2005
100
100.0
80
80

2006
100
100.0
79
79

2007
100
100.0
85
85

2008
100
100.0
93
93
AZ Office of
New Born
Screening

2009
100

2010
100

2011
100

Final
2012
100

Final
2013
100

Check this box if you cannot report the
numerator because
1.There are fewer than 5 events over the last
year, and
2.The average number of events over the last
3
years is fewer than 5 and therefore a
3-year moving average cannot be applied.
Is the Data Provisional or Final?
Annual Performance Objective

a. Last Year's Accomplishments
The Office for Children with Special Health Care Needs (OCSHCN) provided follow up education
to families of newborns identified with sickle cell disease and with positive screens for other
hemoglobin traits. OCSHCN provided education to pediatric hematologists on how to get
newborns with positive screens into healthcare.
In September 2008 the Office of Newborn Screening merged with the Bureau of State Laboratory
Services and is now able to provide transparent continuity of care for all newborn screens.
Services, beginning with the receipt of a blood spot card, through case management follow up
services, demographics entry, and up to diagnosis, are completed in the same location.

66

The Newborn Screening Program reported 96,963 initial bloodspot screens and 87,503 second
screens in 2008 (preliminary). Of those screened, 93 were diagnosed with clinically significant
disorders, including 51 cases of primary congenital hypothyroidism; 7 cases of congenital adrenal
hyperplasia (CAH); 1 case of biotinidase deficiency; 2 cases of classic galactosemia; 6 cases of
sickle cell anemia and 1 case of hemoglobin SC--both hemoglobinopathies; 1 case of
homocystinuria; 2 cases of classic phenylketonuria; 1 case of citrullinemia; 4 cases of medium
chain acyl-CoA dehydrogenase deficiency (MCADD); 1 case of carnitine update deficiency; 1
case of 3-methylcrotonyl CoA carboxylase deficiency (3MCC), and 14 cases of cystic fibrosis
(CF). This year was the first full year of CF screening. Through a partnership with the statewide
CF centers, each baby with abnormal results was referred for further evaluation and testing. The
Newborn Screening program located 100% of affected infants who had screen results suggestive
of target diseases.
The Newborn Screening Advisory committee, including stakeholders, parents, and clinicians, met
in April 2008 to discuss the current panel of disorders (29) including hearing screening. The
committee reviewed data, discussed possible statute changes and agreed to meet yearly in the
future.
Licensed midwifes participate in education about newborn screening. If a parent chooses not to
have the screening completed, the midwives inform the parents about their rights and what the
screening covers for their babies. There were 633 reported home deliveries over the past
calendar year from January 1, 2008 through December 31, 2008. For the women who chose no
screening for their infants, the midwife must document provision of informed consent so the
parents have knowledge to make a good decision about the screenings. Data collected by
licensed midwives is limited to "screened" and "not screened". If a pattern of refusals of the
screening is seen with a specific licensed midwife, an investigation is conducted to determine the
quality of information that is shared with parents about testing for their newborn.
The Public Health Services Medical Director provided consultation and technical assistance to all
Title V programs that requested assistance and collaborated with several programs, especially
the Newborn Screening Program (NBS).
Metabolic disorder is an inherited disorder of body chemistry that, if untreated, causes cognitive
disability. Fortunately, through routine newborn screening, almost all affected newborns are now
diagnosed and treated early, allowing them to grow up with normal intelligence. Mental
retardation can be prevented if the baby is treated with a special diet that is begun within the first
7 to 10 days of life. Individuals with some rare metabolic disorders must remain on a restricted
diet for life. The cost of the medical foods (formula and low protein food) is very expensive, but is
the only treatment for the disorder.
Public insurance covers the cost of medical foods for children with metabolic disorders that are
discovered on the newborn screen. Private insurance cover half the cost of medical foods with a
cap of $5,000. State funding covers the family copay for medical food for children with special
health care needs that are enrolled at the Children's Rehabilitative Services clinics.
Public insurance covers the cost of enteral feedings as well as oral nutrition supplements when
medically necessary. The MCH nutritionist has coordinated with the Arizona WIC program and
the Arizona Health Care Cost Containment System to ensure that Children with Special
Healthcare Needs (CSHCN) are covered in a timely manner and receive appropriate medical
nutrition therapy, as prescribed.

Table 4a, National Performance Measures Summary Sheet
Activities
1. OCSHCN partners with the NBS Program to direct families to

Pyramid Level of Service
DHC ES
PBS
IB
X
X

67

care and services and provide education and resources to
families and physicians.
2. Newborn screening services have been integrated into the
same location.
3. Newborn screening has expanded collaboration with key
stakeholders.
4. Newborn screening protocols are being revised by the NBS
Advisory Committee.
5. Newborn Screening continues to educate parents about the
need for second screens.
6. Newborn Screening offered cystic fibrosis screening for the
first time.
7. Midwife Licensing Program provided information to all
midwifes about NBS.
8. The PHS Medical Director provides consultation and acts as
liaison to medical community
9. The Community Health Nurses educate families about the
importance of a second newborn screen.
10.

X
X
X
X
X
X
X
X

b. Current Activities
OCSHCN provides education and resource information to families of newborns with a positive
screen for sickle cell disease. OCSHCN partners with the Newborn Screening Program (NBS) to
identify ways to get information and resources to families about other diseases identified by NBS.
OCSHCN and NBS are modifying letters to families to be more family centered and to provide
resource and education information about services and programs for which their children may be
eligible.
In an effort to provide more effective case management services, the Newborn Screening
Program is streamlining processes. Protocols are being revised, partnerships with specialists are
being redefined, and CLIA regulations are being implemented. Expanding collaboration with
partners ensures timely diagnosis and clinical management by creating tiered levels of support
based on high risk criteria. Sub-specialists intervene earlier, often resulting in better long term
outcomes for infants. Peer-on-peer training and case management review is being expanded.
Additionally, the Medical Director continues to provide consultation to the program and acts as
liaison within the medical community.
Averaging 20,000 hits per year, the Newborn Screening web site continues to offer parents and
providers educational resources and training tools. Specific email accounts are established to
communicate with partners based on specific disorder categories; electronic comments from the
general public are welcome and reviewed.

c. Plan for the Coming Year
OCSHCN will continue to direct newborns with positive screens to care and services. OCSHCN
and NBS will continue to develop letters for families providing information on care and services.
Nursing staff turnover challenges hospitals to keep staff trained on performing NBS testing.
OCSHCN will partner with NBS to host training for nurses on the OCSHCN e-learning platform.
OCSHCN and NBS will work with pediatric specialists to develop disease-specific educational
information for families and will partner with NBS to educate contracted physicians on best
practices for getting CSHCN into care.
Through continuous education and data analysis, Newborn Screening goals are to reduce the
numbers of unsatisfactory specimens received, and to refine the positive and negative predictive
values of analytes, thereby improving testing specificity. Also, using culturally sensitive materials,

68

the Newborn Screening Program continues to educate parents about the need for a second
screen, timely referrals to specialists, and access to Children's Rehabilitative Services, Office for
Children with Special Health Care Needs, Arizona Early Intervention Program, and other local
resources. Performance measures will be reviewed to ensure laboratory standards are met.
Newborn Screening Program will review and update brochures, as well as expand provider
educational materials. As new disorders are added or analyte cut off values changed, materials
will be revised. Internal employee training manuals will be updated, and continuous education on
evidence based laboratory and case management services will be explored.
The Medical Director will continue to provide consultation, technical assistance and identify any
bottlenecks in the medical community that can potentially impact the NBS program.
If the need arises, Community Health Nurses will be utilized by the Office of Newborn Screening
to find families that cannot be reached by conventional means. Community Health Nurses will
continue to educate families about the need for a second newborn screen and facilitate referral to
a medical home for those screens. In an effort to ensure comprehension of the urgency of the
screens, the Program will continue to ensure that Community Health Nurses have bilingual staff
available.

Performance Measure 02: The percent of children with special health care needs age 0 to 18
years whose families partner in decision making at all levels and are satisfied with the services
they receive. (CSHCN survey)
Tracking Performance Measures
[Secs 485 (2)(2)(B)(iii) and 486 (a)(2)(A)(iii)]

Annual Objective and Performance Data
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Data Source
Check this box if you cannot report the numerator
because
1.There are fewer than 5 events over the last year, and
2.The average number of events over the last 3 years is
fewer than 5 and therefore a 3-year moving average
cannot be applied.
Is the Data Provisional or Final?
Annual Performance Objective

2004
53
51.4

2005
54
51.4

2006
55
51.4

2007
56
53.6

2008
54
53.6

SLAITS

2009
55

2010
56

2011
57

Final
2012
58

Final
2013
58

Notes - 2008
Indicator data comes from the National Survey of CSHCN, conducted by HRSA and CDC, 20052006. The same questions were used to generate the NPM02 indicator for both the 2001 and the
2005-2006 CSHCN survey. No new data has been released for this measure since last year's
application.
Notes - 2007
Indicator data comes from the National Survey of CSHCN, conducted by HRSA and CDC, 20052006. The same questions were used to generate the NPM02 indicator for both the 2001 and the
2005-2006 CSHCN survey.
Notes - 2006

69

The data reported in 2006 are pre-populated with the data from 2005 for this performance
measure.
a. Last Year's Accomplishments
From it's inception, the Office for Children with Special Health Care Needs (OCSHCN), has
infused family and youth partnerships throughout its business. Parents and youth reviewed
RFP's; developed and reviewed curriculum, presentations, policies, procedures; facilitated
meetings and reviewed the OCSHCN website. Requirements for family and youth involvement
are incorporated into contracts and grants. The Family Resource Coordination Program (FRC)
required family participation to develop Individual Service Plans (ISP's) for members.
OCSHCN has a paid parent representative working in the office one day a week. The parent-staff
member participated in staff meetings and promoted the benefits of family centered care in
interactions with staff. The parent-staff member provided in-service training on Breaking the
Diagnosis. The training had strategies to help providers inform families about their child's
condition and offered staff the opportunity to hear a personal perspective on what it is like to learn
this news. The parent-staff member participated on an RFP review team for the Bureau of
Women's and Children's Health's (BWCH) Community Nursing Program.
OCSHCN relied on family and youth volunteers to work on activities. OSCHSN used its contract
with Raising Special Kids (RSK) to identify family partners for activities. The contract with RSK
Family-to-Family Health Information Center (RSK-F2FHIC) provided training on family centered
care to health and dental providers and coordinated resident-in-training home visits to help future
physicians understand the strengths and needs of families caring for CYSHCN.
Conducted in English and Spanish, the 2009 CRS Family Satisfaction Survey asked several
questions related to decision making. Families generally felt they were well informed and involved
in decision making. When decisions were made 87% reported usually or always being offered
choices about their child's health care. 85% reported usually or always being asked to tell the
health care provider what choices they prefer. 91% said they were usually or always involved as
much as they wanted when decisions were made.
The survey also revealed that families were highly satisfied with their services. CRS care was
rated at an average of 9.0 on a 10-point scale, with 10 being the highest level. The average rating
on a scale from 0 to 10, with 10 being the best specialist possible, was 9.1. 90% of respondents
gave their child's specialist a score of 8 or higher.
Several survey items asked about the way that children and their families were treated by clinic
staff. 86% felt that clinic staff were always as helpful as they should be. 80% said that they
always had their questions answered by their CRS providers and 82% always received
information that was needed from their CRS providers. 87% reported that clinic staff always
listened carefully to them.
The survey asked several questions related to cultural competency. 85% said that clinic staff
always explained things to them in a way they could understand. 85% reported that CRS doctors
or other health providers always showed respect for what they had to say and always made it
easy to discuss their questions and concerns. 95% said they were always treated with courtesy
and respect. Of those respondents that needed an interpreter, 93% always received translation
services when they were requested and 96% were satisfied or very satisfied with the interpreters'
assistance.
The 2008 DME/Wheelchair Survey revealed positive feedback from families regarding CRS
wheelchair services. 86% reported that the equipment met the member's needs very well and
94% were satisfied or very satisfied with the wheelchair equipment and services provided. 89%
said the member's wheelchair was very reliable. 81% said they were always involved when
decisions were made about wheelchair-related needs, and 99% reported being treated with

70

courtesy and respect. The FRC Family Satisfaction Survey revealed that 84% rated the
coordination of services as excellent, very good or good. 94% reported being involved in
developing ISP's and were satisfied or very satisfied with the process.

Table 4a, National Performance Measures Summary Sheet
Activities
1. Parents and youth review curriculum, presentations, policies,
procedures, facilitate meetings and review the OCSHCN
website.
2. Family satisfaction surveys are used to determine if families
feel involved in decision making. Survey results are used to
modify program and policy.
3. The RFP Buliding Partnerships for Quality Care will recruit,
train and support families, consumers and youth to involve them
in decision making.
4. OCSHCN is part of a collaborative with the Governors Council
on Traumatic Brain Injury/Spinal Cord Injury providing technical
assistance on best practices for CYSHCN and especially on
issues around transition.
5. A paid parent staff member works in the office one day each
week.
6. All contractors are required to involve families and youth iin
decision making.
7. The OCSHCN web page has a place for comments and
questions. OCSHCN has an email address inviting comments
and input.
8.
9.
10.

Pyramid Level of Service
DHC ES
PBS
IB
X
X

X

X

X

X

X

X

X

X

X
X

b. Current Activities
OCSHCN requires family and youth involvement in contracts. OCSHCN relies on family agencies,
parents and youth willing to volunteer to review curriculum, website, handbooks and other
material for family centeredness, cultural appropriateness and ADA compliance. A parent-staff
member works in the office one day a week with additional time outside the office to participate in
meetings and provide input into projects.
OCSHCN leads an effort with BWCH and ADHS Behavioral Health Services to involve family,
consumer and youth partners in decision making. Building Partnerships for Quality Care, an
agency wide RFP is out for bid to agencies or organizations with better capacity to recruit, train
and support family, consumer and youth who reflect the diversity of Arizona's population.
OCSHCN is using a template for the RFP developed by parents who were part of the Integrated
Services Grant.
OCSHCN's web page has an email address inviting comments, input or questions. CRS requires
parents to be on State and Local Parent Action Councils. FRC requires program coordinators to
involve families in developing service plans and provide support and education on advocating for
their child. OCSHCN uses satisfaction surveys to identify strengths and weaknesses in family
decision making in programs and to identify opportunities to improve program design and
delivery.

71

c. Plan for the Coming Year
Having families of children with special health care needs involved in all levels of decision making
is widely accepted as a best practice. To ensure that families always feel involved in decision
making and are satisfied with care and services they receive, OCSHCN will continue conducting
family satisfaction surveys.
OCSHCN will continue to recruit families and youth for leadership development training.
OCSHCN contracts will provide funding for and will require contractors to include parent and
youth leaders on boards and committees and to develop strategies to involve families and youth
in all levels of decision-making. OCSHCN will continue to encourage other agencies and offices
to include family and youth as decision makers, include family and youth partnership in contracts,
and encourage developing mechanisms to reimburse or support parents and youth for their time,
leadership, travel and accommodations. CRS will continue to increase participation of parents as
decision makers through committees and State and Local Parent Action Councils.
OCSHCN will provide technical assistance on family involvement for children and youth with
special health care needs for the agency wide Building Partnerships for Quality Care RFP.
OCSHCN will work with families to develop curriculum that promotes families as key partners in
all levels of decision-making. Education will be provided to other agencies, AHCCCS health
plans, NICU staff and families, medical residents, physicians, dental students, BWCH Hot Line
staff and new OCSHCN staff. E-learning modules on family centered care coordination and an
OCSHCN overview will be developed. OCSHCN's paid parent advocate will assist with the
curriculum review and rewrite.
OCSHCN will join a collaborative involving the Governor's Council on Traumatic Brain
Injury/Spinal Cord Injury (TBI/SCI) and other agencies working with families with TBI/SCI.
OCSHCN will provide technical assistance on best practices for children and youth with special
health care needs (CYSHCN). OCSHCN will provide education to increase the collaborative
member's knowledge about partnering with families and including families in decision making.
Technical asssitance will also be provided to the collaborative on developing programs, materials
and support for families of CYSHCN.

Performance Measure 03: The percent of children with special health care needs age 0 to 18
who receive coordinated, ongoing, comprehensive care within a medical home. (CSHCN Survey)
Tracking Performance Measures
[Secs 485 (2)(2)(B)(iii) and 486 (a)(2)(A)(iii)]

Annual Objective and Performance Data
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Data Source
Check this box if you cannot report the numerator
because
1.There are fewer than 5 events over the last year, and
2.The average number of events over the last 3 years is
fewer than 5 and therefore a 3-year moving average
cannot be applied.

2004
51
50.5

2005
51.5
50.5

2006
52
50.5

2007
52.5
40.4

2008
41
40.4

SLAITS

72

Is the Data Provisional or Final?
Annual Performance Objective

2009
41

2010
42

2011
42

Final
2012
43

Final
2013
43

Notes - 2008
Indicator data comes from the National Survey of CSHCN, conducted by HRSA and CDC, 20052006. Compared to the 2001 CSHCN survey, there were wording changes, skip pattern revisions
and additions to the questions used to generate the NPM03 indicator for the 2005-2006 CSHCN
survey. The data for the two surveys are not comparable for PM #03. No new data has been
released for this measure since last year’s application.
Notes - 2007
Indicator data comes from the National Survey of CSHCN, conducted by HRSA and CDC, 20052006. Compared to the 2001 CSHCN survey, there were wording changes, skip pattern revisions
and additions to the questions used to generate the NPM03 indicator for the 2005-2006 CSHCN
survey. The data for the two surveys are not comparable for PM #03.
Notes - 2006
The data reported in 2006 are pre-populated with the data from 2005 for this performance
measure.
a. Last Year's Accomplishments
OCSHCN has integrated the medical home concept into training, presentations, published
materials and new staff orientation. OCSHCN promoted the medical home concept to other
ADHS offices, other agencies and community partners. The Medical Home concept is a required
element in OCSHCN's contracts.
The RFP for the Children's Rehabilitative Services (CRS) Program included a medical home
requirement. The CRS RFP was awarded to Arizona Physicians IPA (APIPA). APIPA was tasked
with transforming a regional system of care into a single, statewide, seamless service delivery
system. The RFP required that each member have an integrated medical record to facilitate
coordination of care delivered by multiple providers. APIPA was responsible for coordinating
member care consistent with the principles of a patient-centered medical home. The contractor
ensured that Service Plans were developed for members that combined the elements of multiple
treatment plans with family support services and identified specific agencies and organizations
with which treatment must be coordinated.
OCSHCN leveraged the administration of the CRS program to reach Arizona's larger population
of CYSHCN. CRS served a small proportion of Arizona's CYSHCN (10%) representing the most
medically complicated. However the APIPA-CRS provider network included most of Arizona's
pediatric specialty providers. APIPA is a provider for Arizona's Medicaid program the Arizona
Health Care Cost Containment System (AHCCCS) and the Arizona Department of Economic
Security's (DES) Division of Developmental Disabilities (DDD) Program. Promotion of best
practices, including medical home, required by APIPA-CRS providers reached beyond CRS
membership to other CYSHCN served by these same providers. Administration of the CRS
Program also brought OCSHCN to the table with multiple providers and allowed OCSHCN the
opportunity to broaden the discussion past CRS membership to the larger population of
CYSHCN.
The Arizona Medical Home Care Coordination Manual has been revised to incorporate recent
changes in state programs eligibility and service availability. 217 copies of this manual have
been distributed to organizations such as the Foundation for the Blind, Mountain Park Community
Health Center, Banner Good Samaritan Hospital, Gateway Community College School Nurse
Certification Program and OCSHCN Family Resource Coordination Program contractors. Raising
Special Kids (RSK) has integrated the medical home concept into resident physician training
materials and has given each resident a copy of the manual. RSK also distributed manuals to

73

parents and professionals at the Conference for Parents: Learn Collaborative Strategies for
Therapy conference.
School Health partnered with a statewide school nurse organization to host 81 school nurses and
50 school nursing assistants in an annual conference that promoted medical home concepts.
School Health also partnered with a local childrens hospital to host 125 school nurses and 62
school nursing assistants at a conference where best practices, including medical home for
CYSCHN were integrated into each session. OCSHCN presented to 54 pediatricians at the
annual American Academy of Pediatrics, Arizona Chapter statewide meeting. OCSHCN
presented on the importance of providing a medical home for CYSHCN, provided a review of the
components of medical home and answered questions related to involving families in decisionmaking.
In 2008, OCSHCN added an outreach staff position that represented OCSHCN at meetings with
other state agencies and with community partners. The outreach staff member provided
education and offered information about OCSHCN programs and best practices for CYSHCN to
agencies such as the DES Arizona Early Intervention Program (AzEIP), First Things First
(Arizona's Early Childhood Development and Health Initiative) DES/DDD, the DES Family
Assistance Administration, the Arizona Association of Community Health Centers, Mountain Park
Community Health Center, Native Health, Raising Special Kids, Spina Bifida Association, and the
Foundation for Blind Children. Resource information, including medical home for youth, was also
provided to high-risk youth in the juvenile justice system. Family Resource Coordinator (FRC)
Contractors were monitored for compliance with medical home implementation plans. All 402
children and youth in the FRC Program identified, during the intake process, as having a medical
home.

Table 4a, National Performance Measures Summary Sheet
Activities
1. The medical home concept is integrated into training,
presentations, published materials, contract language and new
employee orientation.
2. Outreach staff provides technical assistance on the medical
home concept to other ADHS offices, other state agencies and
community partners.
3. The Arizona Medical Home Care Coordination Manual is
updated as needed and distributed to other ADHS offices, other
state agencies, and community partners.
4. OCSHCN's CRS Program Contractor is responsible for
coordinating member care consistent with the principles of a
patient-centered medical home.
5. CRS Member service plans are developed combining
elements of multiple treatment plans, family support services and
identifying specific agencies and organizations with which care
must be coordinated.
6.
7.
8.
9.
10.

Pyramid Level of Service
DHC ES
PBS
IB
X
X

X

X

X

X

X

X

X

X

X

X

b. Current Activities

74

APIPA is responsible for coordinating member care consistent with the principles of a patientcentered medical home. Integrated medical records and treatment service plans are required for
each member. APIPA has a grant from United HealthCare Foundation to implement an electronic
medical record and scheduling system for CRS. The system provides appointment scheduling
and uses flexible clinical protocols so that specific needs of a member can be addressed. Lab,
pharmacy, progress notes and encounter data are tracked building a comprehensive profile on
each member that is shared with each specialist on the member's care team. The system
generates alerts for member specific care information. This capability allows CRS to expand the
family centered medical home concept. Use of the electronic medical record and scheduling
system also is influencing the use of a similar system in the practices of these physicians who
also provide care to the larger population of CYSHCN.
OCSHCN integrates the medical home concept into training, presentations, published materials,
contracts and new staff orientation. Medical home is promoted within ADHS, to other agencies
and community partners. The Medical Home Care Coordination Manual is distributed to
community partners and other ADHS offices. OCSHCN's outreach staff member provides
information about best practices, including the medical home concept, and programs for
CYSHCN to partners.

c. Plan for the Coming Year
The APIPA-CRS electronic medical record and scheduling system for the CRS program will be
used in conjunction with a new Arizona state system that electronically exchanges hospital
discharge and emergency room data. CRS providers using the system will be able to e-prescribe
and share clinical information among other providers involved in the member's care. The system
tracks lab, pharmacy, progress notes and encounter data so a comprehensive profile can be built
for each member and shared with other specialists and primary care providers. This capability will
allow CRS to expand the family-centered medical home.
The Arizona Medical Home Care Coordination Manual will be updated as needed and distributed
to other ADHS offices and community partners. OCSHCN will explore partnering with the
American Academy of Pediatrics Arizona Chapter to distribute the Arizona Medical Home Project
Care Coordination Manual to physicians.
OCSHCN will identify ways to expand outreach and increase educational opportunities on best
practices, including medical home for CYSHCN. The OCSHCN Outreach staff member will offer
education and training information on care coordination and medical home best practices to
AzEIP, DDD and other agencies. School Health will provide training on the medical home concept
to school nurses. OCSHCN and RSK-F2FHIC will continue partnering to develop educational
materials and support medical home activities that empower families to act as their own
advocates, to develop individual service plans and connect families with resources.
OCSHCN will continue to integrate the medical home concept into training, presentations,
published materials, contracts and new staff orientation.OCSHCN will promote the medical home
concept to other ADHS offices, other agencies and community partners. OCSHCN would like to
reach out to the BWCH Medical Home Project providers to give them information and technical
assistance on the MCH Medical Home philosophy. OCSHCN will explore the possibility of
awarding small dollar contracts, under $5,000, to our partner agencies to work on targeted, short
term projects promoting best practices around the Medical Home concept.

Performance Measure 04: The percent of children with special health care needs age 0 to 18
whose families have adequate private and/or public insurance to pay for the services they need.
(CSHCN Survey)

75

Tracking Performance Measures
[Secs 485 (2)(2)(B)(iii) and 486 (a)(2)(A)(iii)]

Annual Objective and Performance Data
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Data Source
Check this box if you cannot report the numerator
because
1.There are fewer than 5 events over the last year, and
2.The average number of events over the last 3 years is
fewer than 5 and therefore a 3-year moving average
cannot be applied.
Is the Data Provisional or Final?
Annual Performance Objective

2004
61
60.8

2005
61
60.8

2006
61
60.8

2007
61
58.1

2008
59
58.1

SLAITS

2009
59

2010
59

2011
59

Final
2012
59

Final
2013
59

Notes - 2008
Indicator data comes from the National Survey of CSHCN, conducted by HRSA and CDC, 20052006. The same questions were used to generate the NPM04 indicator for both the 2001 and the
2005-2006 CSHCN survey. No new data has been released for this measure since last year’s
application.
Notes - 2007
Indicator data comes from the National Survey of CSHCN, conducted by HRSA and CDC, 20052006. The same questions were used to generate the NPM04 indicator for both the 2001 and the
2005-2006 CSHCN survey.
Notes - 2006
The data reported in 2006 are pre-populated with the data from 2005 for this performance
measure.
a. Last Year's Accomplishments
Since 1992, the Arizona Department of Health Services through OCSHCN has had a contract
with the state Medicaid agency, the Arizona Health Care Cost Containment System (AHCCCS) to
provide care and services for children and youth with special health care needs who are carved
out of the general AHCCCS population. Through this contract with AHCCCS, OCSHCN
administers the Children's Rehabilitative Services Program (CRS). In 2008 OCSHCN awarded a
contract to Arizona Physicians/IPA (APIPA) to administer the CRS program.
CRS is a statewide network of inpatient and outpatient services providing medical treatment,
rehabilitation, and related support services to Arizona children, birth to 21, who have certain
medical, disabling, or potentially disabling conditions. CRS assures quality comprehensive care
through a family-centered, multi-specialty, interdisciplinary team approach in a cost-effective
managed care setting. 23,884 children received care through CRS in 2008 representing
approximately 10% of CYSHCN in Arizona. These children have conditions that are among the
most medically complicated of all CYSHCN.
CRS provides care related to the member's qualifying condition. Members who are enrolled in
AHCCCS have a PCP who delivers primary and preventive care, including EPSDT services. CRS
contractors are required to identify a primary pediatric care provider for all members and an adult
care provider for youth aging out of the program.
CRS is funded by a combination of state and federal funds. 17,991 members were funded by Title

76

XIX and 1,447 members were funded by Title XXI, the remaining 4,446 were funded by private
insurance or state dollars. Families are required to apply for AHCCCS, and the Contractor is
required to assist families with the application process.
OCSHCN has several systems in place to help link families to available services for CYSHCN.
OCSHCN developed a letter in collaboration with the ADHS Birth Defects Registry to send to all
families of children born with spina bifida and cleft lip/cleft palate informing them of coverage
available through the CRS program. Currently 43 newborns identified with spina bifida or cleft
lip/cleft palate are enrolled in CRS. 2 newborns diagnosed with Sickle Cell disorder were referred
to the CRS program. 402 children received service coordination through OSCHCN's Family
Resource Coordination Program (FRC).126 children served through FRC had private health
insurance, 240 had insurance through public programs and 36 children were without insurance or
unable to afford services. 30 of these 36 children received Direct Care Services funded by FRC.
Direct Care Services can include therapy, transportation and equipment.
Children and youth with certain rare metabolic disorders must remain on a restricted diet for life.
Medical food is very costly, but is the only treatment for the disorders. Neither public nor private
insurance covers all of the costs of these foods. The WIC program pays for formulas for certain
disorders for children and youth who are uninsured. Public insurance covers the cost of enteral
feedings as well as oral nutrition supplements when medically necessary. The Bureau of USDA
Nutrition Programs has coordinated with WIC and AHCCCS to ensure that CYSHCN are covered
in a timely manner and receive medical nutrition therapy as prescribed. The Bureau has also
provided training on the approval process with WIC special needs nutritionists and AHCCCS
MCH Coordinators. An agreement was made with the formula manufacturer to ship formula
directly to members at no cost.
OCSHCN supports the BWCH Children's Information Services Hotline to educate families on
AHCCCS and provide other insurance information. Education was provided to Hot Line staff on
services and programs for CYSHCN, including CRS eligibility. The SSI project sent 405 letters
that provided insurance information for families and made referrals to RSK-F2FHIC. The
OCSHCN Information and Referral Project provided information on health care and available
resources to 614 family callers. According to 2005-2006 SLAITS data, 89.5% of Arizona's
CYSHCN had public or private insurance, 88.4% had no gaps in coverage and 88.7% had
insurance that usually or always met their child's needs.

Table 4a, National Performance Measures Summary Sheet
Activities
1. OCSHCN has an Interagency Service Agreement with
Arizina's Title XIX and XXI agency (AHCCCS) to administer the
CRS Program to 23,884 children and youth with certain medical
and disabling conditions.
2. Systems are in place with other ADHS offices and with SSI to
help link families to services for CYSHCN.
3. Contractors are required to assist families in applying for
AHCCCS.
4. OCSHCN develops resources, offers training and education to
providers, families and community partners about private and
public insurance options for CYSHCN.
5.
6.
7.

Pyramid Level of Service
DHC ES
PBS
IB
X
X
X

X

X

X
X

X

77

8.
9.
10.
b. Current Activities
Due to the state budget cuts, CRS discontinued paying for care for non-Medicaid members.
Members may still participate in CRS but must pay for all medical care and services 100% of
AHCCCS allowable fees. This impacts approximately 1,200 families whose incomes are below
200% of the FPL. OCSHCN has been working with these families and providers to find coverage
for the care and services they need. OCSHCN meets regularly with AHCCCS to discuss
strategies for improving coordination of care among health plans.
OCSHCN sends information to SSI applicants, and works with the ADHS Birth Defects Registry
to notify parents of children with cleft lip/cleft palate and spina bifida of resources and health
coverage. OCSHCN educates parents of newborns with Sickle Cell disease about insurance and
available resources. OCSHCN is working with the Newborn Screening Program (NBS) to provide
insurance and resource information to parents of newborns identified by the program with a
disorder. OCSHCN directs infants identified through NBS to CRS sub-specialty care providers.
The OCSHCN Information and Referral Project provides insurance and resource information to
callers.
The School Health Project educates state school nurse organizations so they can inform families
about programs for CYSHCN, AHCCCS and CRS. OCSHCN supports the BWCH Children's
Information Services Hotline and provides education to the staff on services and programs for
CYSHCN.

c. Plan for the Coming Year
OCSHCN will continue to require that contractors assist families in applying for private health
insurance, for AHCCCS and answer general questions about the process. OCSHCN will partner
with RSK-F2FHIC and BWCH Community Nursing to help families gain access to providers and
services. OCSHCN will partner with RSK's F2FHIC grant to convert their Arizona Health Care
Systems Workshop into an on-line interactive class available to families and providers.
CRS contractors will continue to be required to identify a primary care provider for youth
transitioning out of CRS services. CRS will continue to make pharmacy, laboratory, vision, DME
and provider services available to members in or near their communities. OCSHCN will explore
ways to make more CRS specialty services that do not require an interdisciplinary setting,
available in the community.
OCSHCN will continue to develop resources and offer training and education to providers,
families and community partners on public and private health insurance options for CYSHCN.
OCSHCN will explore developing, educating and recruiting businesses to participate in a pilot
project that provides education to families on evaluating health care plans for care and services
for CYSHCN. OCSHCN will continue to review SSI applications, provide referral information to
applicants and track and trend referral outcomes related to disability, age, geographic area and
referral sources. OCSHCN will continue to use telephone call log data to track barriers identified
by families in gaining access to adequate health insurance. OCSHCN will share this information
with responsible agencies through meetings with the AzEIP ICC, the Division of Developmental
Disabilities and with AHCCCS health plans.
OCSHCN will continue efforts with the ADHS Birth Defects Registry to send resource information
and information about CRS to all families of children born with spina bifida and cleft lip/cleft
palate. OCSHCN and NBS will update NBS notification letters annually to ensure that information
remains current. OCSHCN will provide education to the BWCH Children's Information Services
Hotline staff on programs and services for CYSHCN. OCSHCN will continue to provide financial

78

support to the Hotline Program for education to families on resources for CYSHCN, AHCCCS,
CRS and private insurance information.
Because of the uncertainty regarding the 2010 state budget OCSHCN will need to look at revising
the CRS rules to change the program eligibility requirements for those members who are not
eligible for AHCCCS.

Performance Measure 05: Percent of children with special health care needs age 0 to 18
whose families report the community-based service systems are organized so they can use them
easily. (CSHCN Survey)
Tracking Performance Measures
[Secs 485 (2)(2)(B)(iii) and 486 (a)(2)(A)(iii)]

Annual Objective and Performance Data
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Data Source
Check this box if you cannot report the numerator
because
1.There are fewer than 5 events over the last year, and
2.The average number of events over the last 3 years is
fewer than 5 and therefore a 3-year moving average
cannot be applied.
Is the Data Provisional or Final?
Annual Performance Objective

2004
72
70.9

2005
73
70.9

2006
74
70.9

2007
75
86.5

2008
87
86.5

SLAITS

2009
87

2010
88

2011
88

Final
2012
89

Final
2013
89

Notes - 2008
Indicator data comes from the National Survey of CSHCN, conducted by HRSA and CDC, 20052006. Compared to the 2001 CSHCN survey, there were revisions to the wording, ordering and
the number of the questions used to generate the NPM05 indicator for the 2005-2006 CSHCN
survey. The data for the two surveys are not comparable for PM #05. No new data has been
released for this measure since last year’s application.
Notes - 2007
Indicator data comes from the National Survey of CSHCN, conducted by HRSA and CDC, 20052006. Compared to the 2001 CSHCN survey, there were revisions to the wording, ordering and
the number of the questions used to generate the NPM05 indicator for the 2005-2006 CSHCN
survey. The data for the two surveys are not comparable for PM #05.
Notes - 2006
The data reported in 2006 are pre-populated with the data from 2005 for this performance
measure.
a. Last Year's Accomplishments
In 2008 OCSHCN awarded a contract to Arizona Physicians/IPA (APIPA) to administer the
Children's Rehabilitative Services (CRS) Program. APIPA has been a provider for the Arizona
Health Care Cost Containment System (AHCCCS) for over 25 years. The new contract opened
up the CRS system of care from a program with four regional multispecialty interdisciplinary
clinics (MSICs) to the statewide APIPA network of labs, pharmacy, therapy, vision care and
provider offices that are often in or close to a member's community. CRS also added a toll free
24/7 Member Services line.

79

CRS revised Administrative Rules to simplify eligibility and enrollment. In previous years, this was
identified by stakeholders as problematic and cumbersome. The process was streamlined by
requiring the Contractor to make a determination of eligibility and enroll the member within 14
days when there is sufficient information received with an application. The requirement to send an
applicant to visit a CRS provider to confirm a diagnosis before enrollment was eliminated. In 2008
the mean number of days to get a child enrolled in CRS from the date of referral was 42 days.
After the new process was implemented the mean number of days to get a child enrolled from the
date of referral was 12 days.
A performance improvement project (PIP) was developed to increase the percentage of original
applications with eligibility determinations of eligible and ineligible within 14 days. The Contractor
was able to make definitive determinations of eligible or ineligible within 14 days for 49% of
applicants during October through December of 2008. Enrollment was also streamlined for
newborns identified by the Newborn Screening Program (NBS) as positive for disease. The
pediatric specialist consulted directly with the CRS medical director about the newborn. Following
consultation, the newborn can be enrolled in CRS after hospital discharge. The application to
CRS also triggers an application to AHCCCS.
CRS served over 23,884 children in FY 09. The 2009 Family Satisfaction Survey included
questions about the ease of using services. 88% reported that it was not a problem to see a
specialist when needed. 94% had seen a CRS specialist in the past 12 months; higher than last
year's survey response of 82%. Of the respondents calling the clinic during regular hours, 81%
reported usually or always getting the help or advice they needed. When urgent care was
needed, 88% reported being satisfied or very satisfied with how long it took to get care. 85%
reported being satisfied or very satisfied with how long it took to get an appointment at a CRS
clinic. 92% reported that they usually waited 45 minutes or less before being taken to the exam
room.
The 2008 DME/Wheelchair Satisfaction Survey included questions relating to access to services
and member service. 87% did not have a problem getting a referral to a wheelchair equipment
supplier and 86% were satisfied or very satisfied with how long it took to get wheelchair-related
services. 90% of respondents stated that they were told or shown how to use the wheelchair or
wheelchair accessories and the majority felt the instructions were very helpful.
The CRS Telemedicine Program is a network of sites that offers providers a telecommunication
system to conduct clinical services at geographically separate sites to patients living in areas
without access to specialists. CRS provided medical services matching complex orthopedic and
neurosurgical patients in outlying areas to providers through the use of telemedicine technology.
In January 2009 CRS started a pilot telemedicine neurology clinic in Yuma.
OCSHCN responded to over 640 family calls and sent 405 SSI letters that directed families to
services within their community. The Family Resource Coordination Program (FRC) referred
members to community-based service systems and promoted provider awareness of the
importance of understanding the culture of the family. OCSCHN continued as the ADHS
representative to the Arizona Department of Economic Security (DES)/Arizona Early Intervention
Program's (AzEIP) Interagency Coordinating Council (ICC).
As of February 2009, RSK-F2FHIC provided Family Centered Care training to 57 medical
residents and 38 nursing students. RSK-F2FHIC's residency training program focused on family
centered care practices and promoted family home visits. Approximately 15 faculty families
hosted a resident.

80

Table 4a, National Performance Measures Summary Sheet
Activities
1. OCSHCN"S CRS Program has 4 regional multispecialty
interdisciplinary clinics and a statewide network of labs,
pharmacy, therapy, vision care and provider offices that are often
in or near a member's community.
2. The CRS program revised Administratives Rules to simplify
eligibility and enrollment in the CRS Program.
3. CRS developed an eligibility performance improvement project
to increase the percentage of original applications with
determinations of eligible and ineligible within 14 days.
4. Family satisfaction surveys ask respondents if services are
arranged so that they are easy to use. Program and policy
changes are made based on survey responses.
5. Telemedicine offers providers a system to conduct clinical
services at geographically separate sites to members living in
remote areas without access to specialists.
6. Information and referral services are provided about
community-based service systems for CYSHCN.
7. OCSHCN is participating in Health-e-Arizona, an on-line
application for medical coverage, food stamps, and cash
assistance.
8. The OCSHCN CRS Program Contractor will implement an
electronic medical record and scheduling system. Labs,
pharmacy, progress notes and encounter data can be shared
with other providers. Hospital discharge and ER data can be
exchanged .
9. OCSHCN will provide technical assistance to Building
Partnerships for Quality Care contractors about the needs of
CYSHCN.
10.

Pyramid Level of Service
DHC ES
PBS
IB
X
X
X

X
X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

b. Current Activities
Family satisfaction surveys indicate that a majority of families find OCSHCN services easy to use.
The CRS contract with APIPA opens up a network of labs, pharmacy, therapy, vision care and
provider offices in or close to a member's community. Telemedicine provides a way to conduct
clinic services at a geographically separate site to members living in areas without access to
specialists.
OCSHCN partners with BWCH to provide resource information to Community Nursing, supports
the CIS Hotline and trains staff to help callers access systems of care for CYSHCN. FRC
educates contractors, families and child-serving agencies on eligibility rules and processes to
access services. The Information and Referral and SSI Projects refer families to communitybased services.
OCSHCN is the ADHS liaison to the AzEIP/ICC and the ICC Executive Committee. OCSHCN
provides information to ICC agencies about community based programs serving CSHCN, advises
and assists in developing and implementing policy and participates in coordinating agencies to
develop a statewide system of early intervention services.
OCSHCN is not renewing an InterAgency Service Agreement (ISA) with DES. The ISA provides
follow up and tracking for CRS members applying to AHCCCS for primary care. OCSHCN is
instead participating in Health-e-Arizona, an on-line application for medical coverage, food
stamps, and cash assistance. OCSHCN and AHCCCS are identifying pilot sites to implement

81

Health-e-Arizona within the CRS program.

c. Plan for the Coming Year
CRS requires that integrated medical records and a treatment service plan be maintained for
each member, to date this has been a paper-based system that limits effective collection and
information sharing among providers. The CRS Contractor, APIPA has been awarded a grant
from the United Healthcare Foundation to implement an electronic medical record and scheduling
system. The system will provide scheduling for members and use flexible clinical protocols so the
specific needs and characteristics of CRS members can be addressed. Lab, pharmacy, progress
notes and encounter data will be tracked to build a comprehensive profile that can be shared with
other specialists in the system. The system will be used in conjunction with a new Arizona state
system that electronically exchanges hospital discharge and emergency room data. CRS
providers using the system will be able to e-prescribe and share clinical information among other
providers involved in the member's care. This capability will allow CRS to expand telemedicine,
field clinics, and the family-centered medical home.
OCSHCN will educate CRS providers, staff and pediatric subspecialists on best practices by
introducing these concepts into clinics where they practice. The same subspecialists also serve
the larger population of CYSHCN. Consequently, OCSHCN will be able to influence the care of
CYSHCN beyond the CRS Program. For example, APIPA is a line of business of United Health
Care. APIPA will explore using the CRS model of care as a model for their programs serving
CYSHCN in other states.
OCSHCN will promote best practices with partners, other ADHS offices and contractors, provide
training on navigating systems of care, continue to provide education to recognize families as
integral partners, and conduct consumer satisfaction surveys to identify strengths, barriers and
strategies for improving services and increasing access to resources. School Health will explore
ways to strengthen and promote relationships between school nurses and families.
OCSHCN will provide technical assistance to Building Partnerships for Quality Care RFP
awardees to represent the needs of CYSHCN and provide education on best practices.
OCSHCN, BWCH and Raising Special Kids will partner on the Smooth the Way Home Grant to
explore and pilot ways to improve the transition process for babies and families leaving the NICU
and returning home to a network of community services.
OCSHCN will target trainings to providers and child-serving agencies on best practices for
CYSHCN. OCSHCN will explore developing training to providers, health plans, hospital discharge
planners and NICU nurses on programs and services for CYSHCN as well as information on the
eligibility requirements and the application process for these services and programs. OCSHCN's
46 training modules will remain available on-line. The family/youth leadership modules will
continue to be available with English and Spanish split screens.

Performance Measure 06: The percentage of youth with special health care needs who
received the services necessary to make transitions to all aspects of adult life, including adult
health care, work, and independence.
Tracking Performance Measures
[Secs 485 (2)(2)(B)(iii) and 486 (a)(2)(A)(iii)]

Annual Objective and Performance Data
Annual Performance Objective
Annual Indicator

2004
6
5.8

2005
6
5.8

2006
6
5.8

2007
6
39.4

2008
39
39.4

82

Numerator
Denominator
Data Source
Check this box if you cannot report the numerator
because
1.There are fewer than 5 events over the last year, and
2.The average number of events over the last 3 years is
fewer than 5 and therefore a 3-year moving average
cannot be applied.
Is the Data Provisional or Final?
Annual Performance Objective

SLAITS

2009
40

2010
41

2011
42

Final
2012
43

Final
2013
43

Notes - 2008
Indicator data comes from the National Survey of CSHCN, conducted by HRSA and CDC, 20052006. Compared to the 2001 CSHCN survey, there were wording changes, skip pattern
revisions, and additions to the questions used to generate the NPM06 indicator for the 2005-2006
CSHCN survey. There were also issues around the reliability of the 2001 data because of the
sample size. The data for the two surveys are not comparable for PM #06 and the 2005-2006
may be considered baseline data. No new data has been released for this measure since last
year’s application.
Notes - 2007
Indicator data comes from the National Survey of CSHCN, conducted by HRSA and CDC, 20052006. Compared to the 2001 CSHCN survey, there were wording changes, skip pattern
revisions, and additions to the questions used to generate the NPM06 indicator for the 2005-2006
CSHCN survey. There were also issues around the reliability of the 2001 data because of the
sample size. The data for the two surveys are not comparable for PM #06 and the 2005-2006
may be considered baseline data.
Notes - 2006
The data reported in 2006 are pre-populated with the data from 2005 for this performance
measure.
a. Last Year's Accomplishments
Since 2002, OCSHCN has infused youth partnership throughout its business. Youth have shared
their knowledge and expertise on RFP review teams, have reviewed contract language,
contributed to developing and improving resources including curriculum, member handbooks, fact
sheets and brochures. Youth reviewed web pages and other materials for ADA compliance and
accommodations were provided as needed. Contracts, policies and procedures for all OCSHCN
programs were revised to require youth involvement. OCSHCN relied on youth volunteers to work
on activities. Several past OCSHCN youth leaders became employed by state and community
organizations. OCSHCN continued to partner with these youth who have moved on from being
consultants to positions in other agencies such as the Governor's Councils on Developmental
Disabilities, Southwest Autism Research and Resource Center, Spinal Cord Injury Association,
and Southwest Institute.
School Health promoted best practice information for health care transitions of YSHCN and
partnered with other agencies responsible for youth transition to include health care as a self
determination component. School Health exhibited at transition fairs and at the Arizona
Department of Education's (ADE) annual statewide Transition Conference. OCSHCN provided
technical assistance to add a health track to the conference and developed a display for
OCSHCN's online transition training for healthcare providers. Transition training for healthcare
providers was developed in partnership with youth from the ISG and the training was put into an
e-learning format. OCSHCN partnered with ADE and Vocational Rehabilitation to add health as a
quality of life component to the Arizona Transition Leadership Team's (ATLT) State Capacity

83

Building: Secondary Education and Transition Service document.
School Health participated in a round table discussion for 32 team members attending the
Arizona Community Transition Team training. The transition teams are grant funded and receive
training through the University of Kansas, Transition Coalition in collaboration with ADE.
Transition teams include schools, parents, students, businesses, and social service
representatives. OCSHCN discussed the importance of including healthcare in transition
planning.
The Family Resource Coordination Program (FRC) trained contractors on how to assist young
adults to transition out of the program. 111 youth in the program were provided with education
and information including information on health care, work and maintaining independence.
OCSHCN promoted the inclusion of a youth track as a way to encourage youth attendance at the
annual Brain Injury conference.
OCSHCN has a representative on the Arizona Collaborative for Adolescent Health that formed as
an outgrowth of two adolescent health committees from the Integrated Services Grant. This new
collaborative is under the umbrella of the American Academy of Pediatrics-Arizona Foundation.
The mission of the collaborative is to improve the health of adolescents by providing
comprehensive resources for health care professionals, adolescents, families and communities.
OCSHCN mandated that Children's Rehabilitative Services (CRS) contractors participate in a
performance improvement project (PIP) that was developed to promote transition to adult
planning. A performance indicator was developed to measure the proportion of members who
turned 15 during the contract year that had documentation in their medical record of a transition
plan that was initiated by their 15th birthday. The baseline measurement in 2004 had found no
documentation of planning in the medical records. Providers were subsequently trained and a
significant improvement in documentation of transition planning was seen over the past two
years. In FY2007, 29% of the charts had documentation of transition plans which increased to
49% in FY2008. This PIP has been completed.

Table 4a, National Performance Measures Summary Sheet
Activities
1. Youth review contract language, help develop resources,
review curriculum, member handbooks, educational material and
the OCSHCN web site.
2. The School Health Project partners with other agencies to
promote health care as a self-determination component of
conferences and contracts.
3. OCSHCN's CRS Program developed a performance
improvement project to measure the proportion of members who
had a transition plan documented in their medical record.
4. OCSHCN is partnering with the Governor's Council on
TBI/SCI on the Arizona TBI Transitions Project. OCSHCN will
provide technical assistance on best practices for and will help
adapt exisitng information to fit TBI needs for providers and
families.
5. The Governor's Council on TBI/SCI and OCSHCN will
develop, pilot and evaluate a training module to support
transition for youth with TBI.
6. OCSHCN requires contractors to do transition planning.

Pyramid Level of Service
DHC ES
PBS
IB
X
X

X

X

X

X

X

X

X

X

X

X

84

7.
8.
9.
10.
b. Current Activities
OCSHCN relies on youth partners who are willing to volunteer to review contract language and
website content. The agency wide RFP, Building Partnerships for Quality Care, includes a youth
partner component. OCSHCN, RSK-F2FHIC and youth are working to develop a video game to
help youth understand transition issues and the need to develop a transition plan. Based on ISG
recommendations OCSHCN is seeking CME-CEU's for on-line transition training for physicians
and school nurses.
OCSHCN exhibits and presents at transition fairs, the annual ADE transition conference and the
school nurse conference. OCSHCN will present resource information for 65 members of the
Arizona Community Transition Teams with ADE and the University of Kansas. OCSHCN is
represented on the Arizona Collaborative for Adolescent Health and is a member of ATLT.
FRC contracts require transition plans for youth age 16. CRS contractors begin transition plans
for members before they reach age 15. Plans must be age appropriate, address member needs
and continue until the member exits CRS. OCSHCN monitors Contractors to ensure that
appropriate transition services are provided.
OCSHCN and the Governor's Council on Spinal and Head Injuries partner on the Arizona TBI
Transitions Project, a HRSA grant, assisting youth with TBI to transition into adult focused health
care and support systems.

c. Plan for the Coming Year
OCSHCN contracts will require transition planning. OCSHCN will monitor the CRS Contractor to
ensure that members receive transition services and will continue to provide training. On-line
training and CEUs will be offered to adult providers of transitioning youth. OCSHCN will explore
providing information to AHCCCS health plans on the needs of transitioning youth.
OCSHCN will continue to support youth leadership. Building Partnerships for Quality of Care
contract awardees will recruit, support, train, and provide leadership development for youth. The
Contractor will develop a youth council to participate in and facilitate meetings and provide input
into OCSHCN activities at all levels. Contractors will be required to recruit youth that reflect
different disabilities and the cultural and economic diversity of Arizona. Organizations outside of
state agencies will be in a better position to address barriers to participation and support the
needs of youth partners, including advances for travel, conference expenses, mileage and
stipends.
OCSHCN will partner with ADE to plan the annual Transition Conference ensuring that a
Medical/Social Empowerment track is included on the agenda. OCSHCN plans to bring in Patti
Hackett from the National Center on Transition to present on the importance of health for
transitioning youth. The School Health Project will exhibit at transition fairs, provide input about
YSHCN at annual conferences, remain active on ATLT and represent OCSHCN on the Arizona
Collaborative for Adolescent Health. The Collaborative plans to seek funding to develop and
maintain an adolescent health website that includes health risk screening training opportunities
and resources and will link to the OCSHCN website.
Adult health care systems expect participants to effectively articulate needs and concerns,
respond accurately to questions and follow through with instructions. Deficits in processing
information and impaired memory and judgment create greater challenges for youth with a TBI

85

than the general population faces and can interfere with successful transition. OCSHCN will
partner with the Governor's Council on Spinal and Head Injuries (GCSHI) on the Arizona TBI
Transitions Project to address this issue. OCSHCN will help assess existing best practices for
CYSHCN and adapt the information to fit TBI needs for providers, families and youth.
GCSHI and OCSHCN will develop, pilot and evaluate a training module to support transition for
youth with TBI. Youth with TBI will be included on the OCSHCN Youth Council and will advise
and participate in all activities. TBI awareness will be integrated into OCSHCN outreach activities
with a focus on the traditionally underserved African American, Hopi and Navajo populations.
OCSHCN will provide technical assistance and partner with the Brain Injury Association to
support development of programs and resources for children and youth with TBI and share data
regarding services and outcomes.

Performance Measure 07: Percent of 19 to 35 month olds who have received full schedule of
age appropriate immunizations against Measles, Mumps, Rubella, Polio, Diphtheria, Tetanus,
Pertussis, Haemophilus Influenza, and Hepatitis B.
Tracking Performance Measures
[Secs 485 (2)(2)(B)(iii) and 486 (a)(2)(A)(iii)]

Annual Objective and Performance Data
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Data Source

2004
71
78

2005
78
78.6

2006
79
79.2

2008
80
76.7

National
Immunization
Survey

Check this box if you cannot report the
numerator because
1.There are fewer than 5 events over the last
year, and
2.The average number of events over the last
3
years is fewer than 5 and therefore a
3-year moving average cannot be applied.
Is the Data Provisional or Final?
Annual Performance Objective

2007
79.5
76.2

2009
80

2010
80

2011
80

Final
2012
80

Final
2013
80

Notes - 2008
The source of immunization data is the CDC National Immunization Survey
(http://www.cdc.gov/vaccines/stats-surv/nis/tables/0607/tab03_antigen_state.xls). Previously, the
reported rate represented the coverage level for 4DPT, 3OPV and 1 MMR only, because data
were not reliably available for the full series recommended by the CDC, which also includes 3
doses of Hep B and 3 doses of Hib. No data were available for this measure for 1998, but the
data points for 1999 forward have been changed to reflect the full 4:3:1:3:3 series. Performance
objectives were also changed to reflect the change in the measure. Estimates for data points are
based on reports for the following date ranges:
1999 = July 1998 through Jun 1999
2000 = "2000"
2001 = Jan 01 through Dec 01
2002 = Jul 01 through Jun 02
2003 = Jul 02 through Jun 03
2004= Jul 03 through Jun 04

86

2005= Jan 04 through Dec 04
2006=Jan 05 through Dec 05
2007= Jul 06 through Jun 07
2008= Jul 07 through Jun 2008
The 2008 estimate reflects the immunization status of children by age two for children who were
19-35 months of age, born between July 2004 and December 2007. The estimate tolerates 7.5
error at a 95% confidence level.
Notes - 2007
The source of immunization data is the CDC National Immunization Survey
(http://www.cdc.gov/vaccines/stats-surv/nis/tables/0607/tab03_antigen_state.xls). Previously, the
reported rate represented the coverage level for 4DPT, 3OPV and 1 MMR only, because data
were not reliably available for the full series recommended by the CDC, which also includes 3
doses of Hep B and 3 doses of Hib. No data were available for this measure for 1998, but the
data points for 1999 forward have been changed to reflect the full 4:3:1:3:3 series. Performance
objectives were also changed to reflect the change in the measure. Estimates for data points are
based on reports for the following date ranges:
1999 = July 1998 through Jun 1999
2000 = "2000"
2001 = Jan 01 through Dec 01
2002 = Jul 01 through Jun 02
2003 = Jul 02 through Jun 03
2004= Jul 03 through Jun 04
2005= Jan 04 through Dec 04
2006=Jan 05 through Dec 05
2007= Jul 06 through Jun 07
The 2007 estimate reflects the immunization status of children by age two for children who were
19-35 months of age, born between July 2003 and December 2005. The estimate tolerates 5.4%
error at a 95% confidence level.
Notes - 2006
The source of immunization data is the CDC National Immunization Survey
(http://www.cdc.gov/nip/coverage/NIS/01/toc-01.htm). Previously, the reported rate represented
the coverage level for 4DPT, 3OPV and 1 MMR only, because data were not reliably available for
the full series recommended by the CDC, which also includes 3 doses of Hep B and 3 doses of
Hib. No data were available for this measure for 1998, but the data points for 1999 forward have
been changed to reflect the full 4:3:1:3:3 series. Performance objectives were also changed to
reflect the change in the measure. Estimates for data points are based on reports for the following
date ranges:
1999 = July 1998 through Jun 1999
2000 = "2000"
2001 = Jan 01 through Dec 01
2002 = Jul 01 through Jun 02
2003 = Jul 02 through Jun 03
2004= Jul 03 through Jun 04
2005= Jan 04 through Dec 04
2006=Jan 05 through Dec 05
The 2006 estimate reflects the immunization status of children by age two for children who were
19-35 months of age, born between February 2002 and July 2004. The estimate tolerates 4.2%
error at a 95% confidence level.
a. Last Year's Accomplishments
The Arizona Partnership for Immunization (TAPI) home web page, www.whyimmunize.org allows
parents to ask medical experts questions about vaccines and was updated to include more
information for providers.

87

TAPI supplied articles for the quarterly "Immunications" newsletter produced and distributed to
immunization providers by the Arizona Department of Health Services (ADHS) Immunization
program. Bi-lingual education flyers, "Is Your Child Protected?" and vaccine safety concern flyers
were revised and distributed. Additionally, reminder/recall postcards were printed and widely
distributed to immunization providers throughout the state.
TAPI organized and conducted ten regional immunization programs with the Vaccines for
Children Program and the Arizona State Immunization Information System for providers
statewide. Three hundred fifty individuals from provider offices and health departments
participated in the ten statewide trainings. The programs emphasized the importance of using
resources such as reminder/recall cards and parent education flyers. Because of an incentive
program initiated by the Arizona Immunization Program Office (AIPO) to increase completion of
the 4th DTaP by 24 months of age, the demand for reminder/recall postcards and other materials
required additional printing of several materials. TAPI developed a curriculum for pediatric offices
that had fallen below the national average for immunization coverage of their patient population.
TAPI partnered with the ASU School of Nursing, in a training seminar for graduate level
community nursing students, to instill the value of community partnerships in immunization, and
fostered continued hands on learning through several internships. TAPI partnered with Maricopa
County and ADHS to train medics to give shots in Fire Department sponsored Baby Shot clinics.
In cooperation with Arizona Immunization Program Office (AIPO), TAPI designed and mailed a
provider satisfaction survey for the Vaccines for Children Program to 870 provider sites. Analysis
of the survey data indicated 90 percent of respondents were very satisfied/satisfied with the
program; 93 percent strongly agreed/agreed VFC representatives are knowledgeable and helpful;
78 percent strongly agreed/agreed that VFC reports were easy to complete, and 94 percent
strongly agreed that VFC helped keep kids current on their immunizations.
TAPI partnered with Maricopa County, ADHS/AIPO, the Governor's Office, the Arizona Hospital
Association and the Arizona Medical Association to develop a flu prevention outreach campaign
that aimed to keep families healthy. The campaign ended with free flu shots being offered to
underserved families. Over 20,000 doses of donated flu vaccine were given in community clinics
and used to generate media coverage about the importance of flu prevention.
The Health Start Program educated pregnant and postpartum women about immunizations and
many other health and behavioral health topics during and between pregnancies. The Community
Health Workers provided visits with the clients to verify that they and their children up to age two
are attending medical appointments and receiving needed immunizations. Referrals are made to
immunization clinics and social and behavioral health programs as needed. Approximately 65%
of Health Start children were fully immunized and 35% were not fully immunized.
During 2008 the County Prenatal Block Grant (CPBG) supported the monitoring of 1,022 children
and infants under the age of two years to insure that they received the full scale of age
appropriate immunizations. 1,500 additional parents were educated in the importance of age
appropriate immunizations and the diseases they prevent.
The High Risk Perinatal Program (HRPP) Community Health Nurses monitored the immunization
status of the children enrolled in their program and continued to promote and facilitate
immunizations. In order to communicate with all clients the importance of maintaining the
immunization schedule many of the HRPP utilized bilingual Community Health Nurses and, if
necessary, translation services.
The Bureau of USDA Nutrition Programs (BNP) coordinated statewide immunization record
screening and referral by WIC staff to ensure proper timing of the DtaP shots in WIC children.

88

Table 4a, National Performance Measures Summary Sheet
Activities
1. TAPI designed, printed, and distributed immunization
materials for parents and providers.
2. TAPI worked with managed health care plans to promote ontime immunizations for enrollees 0-18 yrs of age.
3. TAPI conducted educational/training programs to improve
immunization practices of providers.
4. TAPI trained medical providers in immunization service
delivery to decrease pockets of under-immunization.
5. Community Health Workers educated pregnant and
postpartum women about the importance of immunization.
6. Community Health Workers ensured clients attended medical
appointments.
7. High Risk Perinatal Program Community Health Nurses
monitored the immunization status of enrolled infants.
8. Arizona WIC participants were screened and referred for
proper timing of the DtaP.
9.
10.

Pyramid Level of Service
DHC ES
PBS
IB
X
X
X

X
X
X

X
X
X
X

b. Current Activities
TAPI is continuing to print and distribute immunization materials to public and private providers
throughout the state. TAPI conducts additional trainings to certify Medics in Immunization
delivery. TAPI will plan and conduct at least ten immunization workshops for staff of public and
private clinics, medical offices, schools and other VFC enrolled sites. TAPI works with
immunization service providers to ensure immunization services are available in underserved
areas ("pockets of need").
The Health Start Program Community Health Workers continue to monitor the status of
immunizations among enrolled children up to age two. Community Health Workers will provide
education and promotion of the need for proper immunizations of all enrolled children and their
families.
During the first three quarters of the state fiscal year, County Prenatal Block Grant contractors
continue screening and educating new mothers on age appropriate immunizations. Workers
attend health fairs and home visits to educate new parents and worked closely with other
community groups such as school organizations, Health Start, and Early Head Start.
HRPP Community Health Nurses continue to monitor the immunization status of the children
enrolled in their program and continue to promote and facilitate immunizations.
The Bureau of USDA Nutrition Programs (BNP) continues to coordinate statewide immunization
record screening and referral by WIC staff to ensure proper timing of the DtaP shots in WIC
children.

c. Plan for the Coming Year
Provided that program funding continues to be available, TAPI will continue to print and distribute
immunization materials to public and private providers throughout the state. TAPI will conduct
additional trainings to certify Medics in Immunization delivery. TAPI will plan and conduct at least

89

ten immunization workshops for staff of public and private clinics, medical offices, schools and
other VFC enrolled sites. TAPI will meet and confer with managed care plans to promote and
institute methods to ensure local health departments are reimbursed vaccine administration costs
for AHCCCS enrolled children. TAPI will work with immunization service providers to ensure
immunization services are available in underserved areas ("pockets of need") - areas/locations
identified where children lack access to immunization services. TAPI will revise and update web
site and print materials as needed to keep current with established Immunization
recommendations and practices. TAPI will assist fire departments in developing new clinics in
underserved areas.
Health Start Program will obtain the most current immunization requirements and distribute to
contractors. Program will continue to review each immunization record of each woman and child
up to age two to ensure immunizations are up to date. The Community Health Workers will
continue to provide education on the importance of immunizations for the whole family and will
direct them to immunization providers and other resources within their community.
The County Prenatal Block Grant is likely to be discontinued due to state budget reductions, so
no further immunization services are expected through this program.
The HRPP Community Health Nurses will continue to monitor the immunization status of the
children enrolled in their program and continue to promote and facilitate immunizations. In order
to communicate with all clients the importance of maintaining the immunization schedule, many of
the HRPP community Health Nurse are bilingual and if they are not bilingual they will continue to
utilize appropriate translation services.
The Bureau of USDA Nutrition Programs will continue train WIC staff to screen and refer WIC
participants to receive the proper timing of the DtaP shots. WIC will continue to assess screening
and referral services and implement coordination between local WIC clinics and the Health Start
program. The Office of Immunizations will continue to provide screening and referral training to
WIC staff.

Performance Measure 08: The rate of birth (per 1,000) for teenagers aged 15 through 17
years.
Tracking Performance Measures
[Secs 485 (2)(2)(B)(iii) and 486 (a)(2)(A)(iii)]

Annual Objective and Performance
Data
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Data Source

2004

2005

2006

2007

2008

41
35.8
4227
118082

35
34.1
4179
122496

35
34.0
4450
130905

34
32.3
4361
134897

33
32.3

AZ Birth
Certificates

Check this box if you cannot report the
numerator because
1.There are fewer than 5 events over the
last year, and
2.The average number of events over the
last 3 years is fewer than 5 and
therefore a 3-year moving average
cannot be applied.
Is the Data Provisional or Final?
2009

2010

2011

Final
2012

Provisional
2013

90

Annual Performance Objective

32

32

32

32

32

Notes - 2008
2008 data are not yet available. The rate is provisionally set at the 2007 rate until the data
becomes available in Fall 2009.
Notes - 2007
2007 data are not yet available. The rate is provisionally set at the 2006 rate until the data
becomes available in Fall 2008.
Notes - 2006
2006 data are not yet available. The rate is provisionally set at the 2005 rate until the data
becomes available in Fall 2007.
a. Last Year's Accomplishments
In the spring of 2008, budget reductions resulted in the loss of nearly $9 million in lottery revenue
for teen pregnancy prevention programs. State funding for abstinence education was also
eliminated. While many teen pregnancy prevention and abstinence education contracts were
terminated, some programs continued through remaining lottery and federal abstinence dollars.
The Bureau of Women's and Children's Health Teen Pregnancy Prevention Program funded 14 of
the 15 Arizona county health departments with lottery revenue to provide Teen Pregnancy
Prevention programming to youth and parents. The program provided funding to the Navajo
Nation directly while three other tribes were funded through the Inter-Tribal Council of Arizona.
The funded programs have a youth development/service learning focus and/or provide parent
education related to talking with your teens about responsible sexual health. Programs
successfully developed partnerships with county juvenile probation offices in order to encourage
participation in the program from youth on probation.
Three pilot programs were funded with lottery revenue through the Arizona Division of Behavioral
Health to integrate teen pregnancy prevention messages into current programming. These
programs were cancelled due to state budget cuts in 2008.
Seven abstinence programs were federally funded and focused on youth development/service
learning.
The Teen Pregnancy Prevention Program worked with the Department of Education to establish
a youth advisory council to provide input to the two state agencies on sexual health issues.
Arizona participated in a roundtable on teen pregnancy and youth in foster care sponsored by the
National Campaign to Prevent Teen and Unplanned Pregnancy. The state agency overseeing
foster care has incorporated training on sexual health of teens in their staff training.

Table 4a, National Performance Measures Summary Sheet
Activities
1. The Teen Pregnancy Prevention Program provided a youth
development/service learning program to Juvenile Probation
Youth and other high risk youth.
2. The Teen Pregnancy Prevention Program provided parent
education on how to talk to teens about responsible sexual
behavior.
3. The Teen Pregnancy Prevention Program provided technical
assistance to providers of teen pregnancy prevention services.

Pyramid Level of Service
DHC ES
PBS
IB
X

X

X

91

4. The Teen Pregnancy Prevention Program provided
abstinence education programming.
5.
6.
7.
8.
9.
10.

X

b. Current Activities
If full funding is available, the Teen Pregnancy Prevention Program will continue to build on the
strengths of the community-based projects that were funded in 2008. The Teen Outreach
Program is the primary curricula being used in most of the programs. The Program will continue
to support training for those who are teaching the curricula to ensure that they are implementing
the program with fidelity.
In 2009, ADHS applied for federal FY09 Abstinence Education dollars. If the federal Abstinence
Education Program is reauthorized by Congress, the Abstinence Program in Arizona will be
expanded to include classroom education, and currently funded youth development projects will
continue. Without Congressional approval, the currently funded abstinence programs will end on
June 30, 2009.

c. Plan for the Coming Year
Continuation of Teen Pregnancy Prevention programs for 2010 is fully dependent on funding. If
lottery revenue continues, the county health departments and tribal youth development/service
learning programs will continue. ADHS plans to continue funding Abstinence Education in 2010 if
the program is reauthorized by Congress.

Performance Measure 09: Percent of third grade children who have received protective
sealants on at least one permanent molar tooth.
Tracking Performance Measures
[Secs 485 (2)(2)(B)(iii) and 486 (a)(2)(A)(iii)]

Annual Objective and Performance Data
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Data Source

2004
30
24

2005
25
36.2

2006
36.5
36.2

2008
36.5
36.2

AZ Office of
Oral Health
survey

Check this box if you cannot report the numerator
because
1.There are fewer than 5 events over the last
year, and
2.The average number of events over the last 3
years is fewer than 5 and therefore a 3year moving average cannot be applied.
Is the Data Provisional or Final?
Annual Performance Objective

2007
36.5
36.2

2009
36.5

2010
37

2011
37

Final
2012
37

Final
2013
37

92

Notes - 2008
The figure for 2008 is from a statewide oral health survey of over 80 communities, for 1999-2003.
This survey will be re-done for each needs assessment year, with the next survey scheduled for
2010.
Notes - 2007
The figure for 2007 is from a statewide oral health survey of over 80 communities, for 1999-2003.
This survey will be re-done for each needs assessment year, with the next survey scheduled for
2010.
Notes - 2006
The figure for 2006 is from a statewide oral health survey of over 80 communities, for 1999-2003.
This survey will be re-done for each needs assessment year, with the next survey scheduled for
2010.
a. Last Year's Accomplishments
The Office of Oral Health used data for the sealant indicator performance measure from the
statewide oral health survey of over 80 communities, for 1999-2003. A new survey was launched
in October of 2008 and is scheduled for completion in 2010. During the 2007/2008 school year,
the Arizona Dental Sealant Program provided dental screenings and referrals to 10,481 children
and 29,628 dental sealants to 7,860 children attending eligible public schools. Eligible schools
are those with at least 65 percent of students participating in the National School Lunch Program
(free/reduced lunch program). Students may participate if they attend an eligible school, are in
2nd or 6th grade, have informed parental consent, and do not have private dental insurance.
Uninsured children, Medicaid and SCHIP beneficiaries, those covered by Indian Health Services
or by state-funded tobacco tax health care program were eligible to receive sealants.
Collaboration with the Bureau of Health Systems Development enabled expansion to two
contracted primary care clinics.

Table 4a, National Performance Measures Summary Sheet
Activities
1. Office of Oral Health provided dental sealants to high-risk
children.
2. Office of Oral Health evaluates the dental sealant program.
3. Office of Oral Health collaborated with key stakeholders to
expand services.
4. Office of Oral Health conducted open mouth survey on sealant
prevalence.
5.
6.
7.
8.
9.
10.

Pyramid Level of Service
DHC ES
PBS
IB
X
X
X
X

b. Current Activities
The Office of Oral Health joined the Bureau of Women's and Children's Health in 2009. The
Office of Oral Health continues to provide an evidenced-based sealant program that is currently
active in seven Arizona counties with efforts being made to increase student participation as well
as number of schools served. Lack of providers in rural areas is a barrier to expansion to rural
populations. Increased use of Affiliated Practice Hygienists will be promoted as one strategy to
reach rural counties. Efforts also include promotion of the recommendation to establish a ‘dental
home' by utilizing Affiliated Practice Dental Hygienists employed by Community Health Centers to

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provide sealants to neighboring schools and refer those children to the Center dental clinic for
follow-up care. Working with Centers that have already established school-based health clinics is
also being emphasized. In an effort to increase the rate of return of consent forms several small
pilot projects have been implemented but the results have not shown significant improvement in
the return rate. The Office of Oral Health will continue to pursue this problem with additional pilot
projects. The sealant indicator survey is being conducted and includes collection of height and
weight that will constitute baseline data for Arizona. The survey is also collecting information on
asthma prevalence. Approximately 8,000 3rd grade children statewide will participate.

c. Plan for the Coming Year
The Arizona Dental Sealant Program will continue to provide dental screenings, referrals and
dental sealants to high-risk children and focus on increasing the number of children served and
the rate of return of consent forms. Collaborations and outreach to expand the program to new
service areas will continue. New delivery models for the dental sealant program such as
integrating with community health centers will continue. The Office of Oral Health will review the
efficiency of the dental sealant program and make recommendations for improvement.
The affiliated practice dental hygienist/teledentistry sites being established through a HRSA grant
will have five sites active in 2009. This model will be evaluated for effectiveness and future
potential to deliver services to rural areas. The sealant indicator survey will continue to collect
data on the prevalence of dental sealants in 3rd grade children through the fall of 2009 and
analyze and report the data in 2010.

Performance Measure 10: The rate of deaths to children aged 14 years and younger caused
by motor vehicle crashes per 100,000 children.
Tracking Performance Measures
[Secs 485 (2)(2)(B)(iii) and 486 (a)(2)(A)(iii)]

Annual Objective and
Performance Data
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Data Source

2004

2005

2006

2007

2008

5.9
4.5
58
1300444

5
4.2
56
1347557

4.2
4.0
55
1390127

4
4.0
57
1412725

4
4

AZ Death
Certificates

Check this box if you cannot report
the numerator because
1.There are fewer than 5 events
over the last year, and
2.The average number of events
over the last 3 years is fewer than
5 and therefore a 3-year moving
average cannot be applied.
Is the Data Provisional or Final?
Annual Performance Objective

2009
3.8

2010
3.5

2011
3.5

Final
2012
3.5

Provisional
2013
3.5

Notes - 2008
Data for 2008 are not yet available. The estimate for 2008 is provisionally set at the 2007 rate
until data become available in the Fall of 2009. Estimates for 2001 on reflect motor vehicle death
rates for all children ages 0-14. Prior to 2001, estimates were based on ages 1-14.

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Notes - 2007
Data for 2007 are not yet available. The estimate for 2007 is provisionally set at the 2006 rate
until data become available in the Fall of 2008. Estimates for 2001 on reflect motor vehicle death
rates for all children ages 0-14. Prior to 2001, estimates were based on ages 1-14.
Notes - 2006
Data for 2006 are not yet available. The estimate for 2006 is provisionally set at the 2005 rate
until data become available in the Fall of 2007. Estimates for 2001 on reflect motor vehicle death
rates for all children ages 0-14. Prior to 2001, estimates were based on ages 1-14.
a. Last Year's Accomplishments
In 2008, the 15th Annual Child Fatality Review report was produced, summarizing reviews of all
child deaths that occurred in Arizona during 2007. In 2007, there were 122 deaths among
children in Arizona due to motor vehicle crashes. Sixty percent (73) of the victims were ages 14
years and younger. Twenty-three children were killed by drivers who were impaired by alcohol.
Fifty children were not properly restrained in vehicles. The most frequent contributing factors to
motor vehicle crash deaths were excessive driving speed, lack of vehicle restraints, and drugs
and/or alcohol. The Child Fatality Review annual report was used to support legislation
introduced in the 2008 session related to reduction of motor vehicle crash deaths, including a
proposed enactment of booster seat legislation (bill was not passed).
During state fiscal year 2008, 385 families received car seat education, training, inspections and
free car seats through the County Prenatal Block Grant (CPBG).
High Risk Perinatal Program (HRPP) Community Health Nurses monitored car seat usage with
every home visit and continued to educate the families on the importance of car seat usage.
The Title V Community Health Grants (CHG) funded four car seat safety projects throughout the
state and through these programs, 1409 car safety seats were installed with accompanying
education including self-installation of the child car seat by the caregiver/parent. Grant funded
projects checked 565 infant car seats in local communities for proper installation, wear, damage,
or product recalls. Projects also assessed and measured 440 preschool children for booster seat
use. An additional 28 booster seat classes were provided to preschool and kindergarten
students.
Two Title V funded county contractors partnered together with Safe Kids, Horne Auto, Lakeside
Fire, and Boy Scouts of America to hold a large event at the Cub Scout Day Camp. Information
included vehicle safety, not playing in the trunk or with the emergency release lever, not playing
in or around vehicles, how fast a vehicle's temperature can elevate, and booster seat awareness.
Attendees included 131 scouts ages seven to 10, leaders, and some parents.
Title V Community Health Grants provided 5,258 students with education on seat belt safety,
crash dynamics, and the danger of drugs and alcohol while operating a vehicle through schools,
community presentation and community events. The projects also educated 5,840 community
members about the importance of and the methods of seat belt safety, reducing transportation
related injuries, and keeping their children safe. Twelve child car seat safety events were
conducted and 39 new Child Car Seat Safety Technicians were certified.
Seven events to address seat belt safety, car seat safety, and the dangers of drugs and alcohol
were held to reach organizations that work with the Native American population. An additional
two events were held educating Native Americans on the proper use and installation of vehicle
restraints. 192 Native American women completed a car seat safety course and received new
car seats. All of the Community Health Grants include outreach to racial/ethnic minorities.
Each Community Health Grant contractor partnered with a variety of organizations including Head
Start, Women Infants and Children, Partners USA Baby, Channel 15 News, St Joseph's Hospital,

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Univision, AAA Arizona, Home Auto, local fire department, Boy Scouts of America, schools, a
detention center, medical transport company, the Governor's Office of Highway Safety, and Safe
Kids Coalition. One of the contractors is registered as a permanent car seat fitting station with
Safe Kids World Wide.
The Health Start Program funded five Community Health Workers to attend Car Seat Safety
Technician training and 10 to receive recertification training. The Community Health Workers
provided 15 car seat safety education classes and educated over 200 pregnant women and their
families.
The Injury Prevention Program built capacity for child passenger safety through providing certified
car seat training, particularly in tribal communities. The program helped to revise the Indian
Health Services' Safe Native American Passengers curriculum, and helped to develop CEU
curriculum on using car seats in ambulances and airplanes.

Table 4a, National Performance Measures Summary Sheet
Activities
1. Child Fatality Review Program reported on motor vehicle
crashes among children.
2. County Prenatal Block Grant provided car seats and/or
training to parents when no other funding source was available
3. County Prenatal Block Grant included importance of proper
car seat use in prenatal classes.
4. High Risk Perinatal Program educated parents about car seat
safety.
5. High Risk Perinatal Program monitored car seat usage with
every home visit.
6. Title V Community Health Grants provided child car seat
safety education and correct self-installation of the car seat.
7. Injury Prevention Program provided car seat safety technician
training.
8. Injury Prevention Program assisted with development and
update of car seat safety curriculum.
9.
10.

Pyramid Level of Service
DHC ES
PBS
IB
X
X
X
X
X
X
X
X

b. Current Activities
The Child Fatality Review (CFR) annual report recommends legislation be re-introduced in the
2009 session related to reduction of motor vehicle crash deaths, including a proposed enactment
of booster seat legislation. The annual report recommends education efforts regarding the
dangers associated with children riding or driving all terrain vehicles. CFR also recommends that
the Arizona Department of Transportation create a new class for all terrain vehicle registration to
enable enhanced, consistent injury surveillance and monitoring of all terrain vehicle use in
Arizona.
The CFR will review deaths of children due to all causes, including motor vehicle crashes. The
CFR will continue to provide specialty data reports for local, statewide, and national initiatives to
reduce preventable child fatalities.
The Title V Community Health Grant Program continues to fund the four contractors that are
addressing motor vehicle crashes among children and promoting vehicle safety. These grants
are funded through 2010.

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The Injury Prevention Program builds capacity for child passenger safety through providing
certified training and continuing education for recertification. Courses will add an additional 60-70
technicians throughout Arizona. The program is also collaborating with OCSHCN to ensure
Children's Rehabilitative Clinics are connected to car seat safety technicians trained in special
health care needs.

c. Plan for the Coming Year
The Child Fatality Review Program will continue to review the deaths of all children in Arizona to
identify preventable factors and to conduct surveillance of the causes and circumstances
surrounding these deaths. The 17th annual report will be produced in 2010. The CFR Program
will analyze any trends observed due to the enactment of graduated driving license restrictions for
teen drivers (enacted July 1, 2008).
HRPP Community Health Nurses will continue to monitor car seat usage with every home visit
and continue to educate the families on the importance of car seat usage.
The Title V Community Health Grants will continue to fund the four contractors that are
addressing the problem of motor vehicle injuries and deaths among children and to promote
vehicle safety. Grants are funded through 2010.
The Injury Prevention Program will work with the Governor's Office of Highway Safety to map
Arizona child passenger safety infrastructure to determine where training should be directed.

Performance Measure 11: The percent of mothers who breastfeed their infants at 6 months
of age.
Tracking Performance Measures
[Secs 485 (2)(2)(B)(iii) and 486 (a)(2)(A)(iii)]

Annual Objective and Performance Data
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Data Source

2004

2005
37.6

2006
38
46.5

2008
50
51.7

CDC National
Immunization
Survey

Check this box if you cannot report the
numerator because
1.There are fewer than 5 events over the last
year, and
2.The average number of events over the last
3
years is fewer than 5 and therefore a
3-year moving average cannot be applied.
Is the Data Provisional or Final?
Annual Performance Objective

2007
38
43.7

2009
50

2010
50

2011
50

Final
2012
50

Provisional
2013
50

Notes - 2008
The data for 2008 (2005 birth cohort) is a providional estimate from the CDC National
Immunization Survey. The survey used a smaller sample size than was used in previous years,
thus the confidience intervals for the 2008 estimate are wide (+/- 7.5) and the estimate is not a

97

statisitcally significant difference from 2007. In addition the survey had fewer than 100
respondents from Maricopa County--Arizona's largest county.
Prior to 2006 the source of this performance measure was the "Mother's Survey", Ross Products
Division, Abbott Laboratories, Inc.
Notes - 2007
Source: The CDC National Immunization Survey ; Table 2. Geographic-specific Breastfeeding
Rates among Children born in
2004(http://www.cdc.gov/breastfeeding/data/NIS_data/data_2004.htm). Prior to 2006 the source
of this performance measure was the "Mother's Survey", Ross Products Division, Abbott
Laboratories, Inc.
Notes - 2006
Source: "Mother's Survey", Ross Products Division, Abbott Laboratories, Inc. Data for 2006 is not
yet available. The estimate for 2006 is provisionally set at the 2005 rate until data for 2006
become available.
Data for the 2005 datapoint is the percent of mothers breastfeeding at 6 months of age for 2004.
a. Last Year's Accomplishments
The Health Start Program educates pregnant and postpartum women about prenatal care,
nutrition, and the benefits of breastfeeding. Community Health Workers receive training on
breastfeeding and many other topics. The program increased outreach to the most vulnerable
populations, Native Americans and African Americans, in targeted communities to focus on new
prenatal enrollments. Approximately 42% of the prenatal clients committed to breastfeeding their
baby in 2008.
The County Prenatal Block Grant (CPBG) builds infrastructure by providing breastfeeding
education to contractors. During state fiscal year 2008, 689 pregnant or postpartum women were
provided with education on breastfeeding and/or support from lactation counselors through the
CPBG.
Former Governor Napolitano reestablished the Commission on Women's and Children' Health
(GCWCH) in April 2008. The Commission chose to focus primarily on the promotion of nutrition
and physical activity for a healthy weight. Selection of this focus area recognizes the following:
Obesity is one of the most serious health problems in Arizona and affects Arizonan's of all ages
and socioeconomic groups. The Commission's proposed actions were focused on policy and
environmental change that will promote improved nutrition and increased physical activity where
Arizonans learn, live, and work and can be implemented with limited resources by the
Commission and its partners. One of the first work groups started under the Commission was the
worksite wellness group. This group will support breastfeeding at work policies and programs.
Under the Licensed Midwife Program, licensed midwives continued support for postpartum
nursing through the six week evaluation.
The High Risk Perinatal Program (HRPP) contracted with every NICU in the state. Each NICU
had a lactation consultant available to help encourage and support breastfeeding. The hospitals
also facilitated the use of a breast pump for mothers of infants unable to breastfeed at that time.
When mothers were discharged they were able to either contact the NICU with concerns about
breastfeeding or discussed the concern with the HRPP Community Health Nurse during a home
visit. Many of the Community Health Nurses are Certified Lactation Consultants.
The BWCH Hotlines are staffed by two bilingual Certified Lactation Consultants who answered
calls from around the state with concerns about breastfeeding. ADHS provided training and
technical assistance to the 24-Hours Breastfeeding Hotline staff to enhance services provided to

98

callers.
The Arizona Department of Health Services (ADHS), Bureau of USDA Nutrition Programs (BNP)
continues the statewide coalition called LATCH-AZ, which aims to serve as an umbrella coalition
to bring together breastfeeding advocates with the WIC community and provide educational and
networking opportunities.
Scholarships to lactation courses were offered to WIC staff and selected community partners and
CLC training was provided to 75 WIC and Community partners. Funding has continued for four
WIC agencies to continue breastfeeding peer counseling programs. Additional breast pumps
have been purchased for the breast pump loan program through WIC so that wait lists can be
avoided and Lactina hospital grade pumps are made available to WIC participants in addition to
the Medela Pump-In-Style to support mom's returning to work or school.
The Nurse Family Partnership program in Yavapai County is partly funded through a Title V
Community Health Grant. The Nurse Family Partnership program is an evidence-based national
program that provides education and support for first time mothers through regular home visits
from a public health nurse. Each participant received education and support related to
breastfeeding. Of all infants born to mothers participating in the program, ninety percent were
breastfeeding at the time of discharge from the hospital.

Table 4a, National Performance Measures Summary Sheet
Activities
1. Health Start Community Health Workers educate pregnant
and postpartum women about breastfeeding.
2. County Prenatal Block Grant provided the public with
educational materials on importance of breastfeeding.
3. HRPP Community Health Nurses assisted with breastfeeding.
4. Bilingual Certified Lactation Consultants answered BWCH
Pregnancy and Breastfeeding Hotlines.
5. WIC conducted free lactation education and networking
events and provided scholarships for training.
6. Title V Community Health Grant provided breastfeeding
education and support.
7.
8.
9.
10.

Pyramid Level of Service
DHC ES
PBS
IB
X
X
X
X
X
X

b. Current Activities
The Health Start Program conducted the Health Start Annual Meeting in March 2009. Many
Community Health Workers attended sessions on breastfeeding and lactation counselor training.
Through March 2009, the County Prenatal Block Grant provided education and supportive
services related to breastfeeding.
The worksite wellness workgroup of the Governor's Commission on Women's & Children's Health
(GCWCH) will begin establishment of a Worksite Wellness Employer Recognition Program during
2009. Breastfeeding at work policies will be incorporated into the criteria for programs being
recognized. GCWCH included breastfeeding promotion as part of the National Women's Health
Week activities in May.

99

The HRPP contracts with every Newborn Intensive Care Unit (NICU) in the state. When mothers
are discharged they are able to either contact the NICU with concerns about breastfeeding or
discuss the concern with the HRPP Community Health Nurse during a home visit.
The BWCH Hotlines are staffed by two bilingual Certified Lactation Consultants who answer calls
regarding breastfeeding.
The BNP 5-year Breastfeeding Strategic Plan has been finalized and distributed to WIC and
community partners. Free, quarterly lactation education is provided to urban and rural health
professionals and paraprofessionals through statewide coalition LATCH-AZ.

c. Plan for the Coming Year
The Health Start Program will continue to provide access to breastfeeding education classes so
that Community Health Workers have the knowledge and training to promote and encourage all
clients to commit to breastfeeding. The Program will increase the number of Community Health
Workers that are certified breast feeding counselors, certified lactation counselors and certified
breast feeding educators.
The Licensed Midwife Program will continue to complete research for nursing changes related to
nutritional aspects for infants and better care of the mother to improve their ability to nurse.
HRPP will continue to contract with every NICU in the state. Each NICU has a lactation
consultant available to help encourage and support breastfeeding. The hospitals will also
continue to facilitate the use of a breast pump for mothers of infants who are still too ill to
breastfeed. When mothers are discharged they will be able to either contact the NICU with
concerns about breastfeeding or discuss the concern with the HRPP Community Health Nurse
during a home visit. Many of the Community Health Nurses are Certified Lactation Consultants.
The BWCH Hotlines will continue to be staffed by two bilingual Certified Lactation Consultants
who will answer calls from around the state with concerns about breastfeeding.
The breast pump loan program will continue to be a service through WIC local agencies. Peer
counseling services will be provided through selected local WIC agencies and expanded to serve
all counties. WIC staff from local agencies will perform outreach efforts through the "Adopt a
Doctor" program. This involves having staff visit clinics and to inform providers about WIC
breastfeeding support. The state will support this initiative by tracking visits and providing
materials for local agencies to use in this effort.
Low-income pregnant women and teens will participate in the Nurse Family Partnership program
sponsored through a Title V Community Health Grant. Each participant will receive education
and support related to breastfeeding.
The County Prenatal Block Grant is likely to be discontinued due to state budget reductions.

Performance Measure 12: Percentage of newborns who have been screened for hearing
before hospital discharge.
Tracking Performance Measures
[Secs 485 (2)(2)(B)(iii) and 486 (a)(2)(A)(iii)]

Annual Objective and Performance
Data
Annual Performance Objective

2004

2005

2006

2007

2008

98

98.5

98.8

97

97

100

Annual Indicator
Numerator
Denominator
Data Source

98.3
96876
98551

98.2
94750
96487

96.3
98363
102095

95.4
97986
102687

98.3
97496
99215
AZ Early Hearing
Detection and
Intervention Prog.

2009
98

2010
98

2011
99

Final
2012
99

Final
2013
99

Check this box if you cannot report
the numerator because
1.There are fewer than 5 events over
the last year, and
2.The average number of events over
the last 3
years is fewer than 5
and therefore a 3-year moving
average cannot be applied.
Is the Data Provisional or Final?
Annual Performance Objective

Notes - 2008
All 49 birthing hospitals in Arizona continue to voluntarily screen for hearing and follow the
mandate to report initial and subsequent screens. Of the infants not screened prior to hospital
discharge, 44 % returned for outpatient screens, most within 30 days.
Notes - 2007
The data reported are estimated from 45 of 49 birthing hospitals. There are now 49 reporting
hospitals; 48 birthing facilities and 1 children's hospital that provide screens to neonatal intesive
care unit infants. All sites voluntarily screen and are mandated to report data weekly. Although
97, 986 infants were screened prior to hospital discharge, another 475 were given an initial
screen as part of outpatient services. This occurred because some infants were transferred prior
to screening.
Notes - 2006
The rates of newborn hearing screening from previous years were based on a combination of
reported screen results and inferred rates from non-reporting screening sites. Due to the
promulgation of rule this year, requiring providers to report newborn hearing screening results,
the newborn hearing screening rate for 2006 is based on actual reported data from all birthing
hospitals.
Newborn Screening Rules were approved in April 2006. Two of the 47 birthing hospitals began
reporting after the rules had been approved. Two hospitals began birthing services during 2006.
Of the 47 hospitals 102,095 babies were born (Vital Records) and 98,363 were screened before
discharge (HI*Track).
a. Last Year's Accomplishments
Arizona is surpassing the Healthy People 2010, Object 28-11 goal of screening 90% of all infants
by one month of age, as 96% (97,496) of those babies born in Arizona in 2008 received a hearing
screen prior to discharge. All 49 birthing hospitals continue to voluntarily screen for hearing and
follow the mandate to report initial and subsequent screens. Of the infants not screened prior to
hospital discharge, 44 % returned for outpatient screens, most within 30 days.
The Arizona Early Hearing Detection and Intervention (AzEHDI) program has made significant
progress in several areas over the past year. Most notably are changes in the Arizona
Department of Health Services (ADHS) follow-up program, education of audiologists, medical
home providers and hospital programs, development of a Guide By Your Side (GBYS) program
through the Arizona chapter of Hands and Voices and expansion of the involvement of
stakeholders in the EHDI process.

101

Hearing screening is mandated in all private, public, transitional, and charter schools in Arizona.
In 2008 the Arizona Department of Health Services, Sensory Program contracted with University
of Arizona Train the Trainer (T3) Program to provide Vision Screening training, in addition to
Hearing Screening. During school year 2008, 16 new T3 hearing and vision screening trainers
were trained and approximately 900 hearing screeners were trained. In the school year 20072008, 608,572 students were screened and 1,591 were identified for the first time with a hearing
disorder. The Sensory Program monitors school compliance with the Arizona Hearing Screening
Rules. The Program loans hearing screening equipment to schools upon request. The Program
also is responsible for this equipment to make sure they have been properly calibrated and
repaired if needed.
The Sensory Program participated in the Statewide Vision Screening Initiative. This taskforce
was convened by Vision Quest 20/20 in partnership with the Arizona Department of Health
Services. Members invited to attend task force meetings included representatives from Vision
Quest 20/20, the Sensory Program, the Arizona Department of Education, Arizona School for the
Deaf and Blind, the Arizona School Nurse Consortium, the School Nurse Organization of Arizona,
optometrists, ophthalmologists, and others. The taskforce developed recommendations for
promoting better children's vision health.
The ADHS reviewed with midwife community regarding who is completing the hearing screening
following the infant's birth. Thus far only 1 midwife is completing the hearing screening tests. The
remainder of the midwives have provided information where to obtain the testing or are referring
the families to a pediatrician or hospital facility for review of the newborns ability to hear.

Table 4a, National Performance Measures Summary Sheet
Activities
1. Newborn Screening Program provided on-site technical
assistance and training for hearing screening.
2. Newborn Screening Program is enhancing education for
parents and providers.
3. Sensory Program collaborated with the University of Arizona
to train hearing screening trainers.
4. Sensory Program disseminated information about mandatory
school hearing screening and ADHS Rules.
5. Sensory Program purchased, repaired and calibrated hearing
screening equipment.
6. Sensory Program partnered with the Statewide Vision
Screening Initiative.
7. Midwife Licensing Program reviewed quarterly report
documentation for information related to the newborn
evaluations.
8.
9.
10.

Pyramid Level of Service
DHC ES
PBS
IB
X
X

X
X
X
X
X

X

b. Current Activities
The ADHS Newborn Screening follow-up team continues work to determine small tests of change
that might impact the number of families who are able to meet the 1-3-6 goals. Although data are
not final, it is clear that there has been a significant impact based on the preliminary numbers for
infants born in 2009.

102

Changes in the program that have been tested and found effective include: close contact with
hospital screening programs to ensure that state follow-up efforts are focused on those infants
who are not already in the screening or diagnostic process; on-site technical assistance to
screening programs incorporating strategies to ensure that screeners more accurately record the
disposition of infants including transfers, deceased, parental refusals; scheduled rescreens and
inpatient versus outpatient screening results; and optimizing the timing of calls to hospitals versus
parents or medical home providers. As well, increased focus of follow-up efforts on those who are
considered at greater risk will be assessed, including those who have failed a two stage screen
and those who referred on an inpatient screen and had a neonatal intensive care unit stay of
greater than 5 days.
The Sensory Program provides hearing and vision screening training for screening of school-age
children, monitoring of data, and audiometer loan-out to schools.
The Midwife Licensing Program continues to provide information related to hearing screening
requirements to all licensed midwives.

c. Plan for the Coming Year
Through continuous education and data analysis, our goals are to reduce the numbers of
unsatisfactory specimens received, and to refine the positive and negative predictive values of
analytes, thereby improving testing specificity. Also, through culturally sensitive materials,
continue to educate parents about the need for a second screen, timely referrals to specialists,
and access to CRS, OCSHCN, AzEIP, and other local resources. Performance measures will be
reviewed to ensure laboratory standards are met.
Reviewing and updating brochures as well as expanding provider educational materials are
planned. As new disorders are added or analyte cut off values changed, materials will be revised.
Internal employee training manuals will be updated, and continuous education on evidence based
laboratory and case management services will be explored.
The Sensory Program will continue contracting with the University of Arizona to train hearing and
vision screening trainers, disseminate newsletters to all known schools, and continue to provide
technical assistance to school health nurses.
The Sensory Program will work with Vision Quest 20/20 and other stakeholders to begin
implementation of recommendations to improve vision screening in Arizona. Implementation
includes updating of vision screening guidelines and creation of an inventory of vision screening
resources.
The Midwife Licensing Program will set up training for midwifery community with newborn
screening program as new information comes available. The ADHS will seek to make progress
on revisions of the Arizona Administrative Code, Title 9, Chapter 16, Article 1 in order to capture
data relevant to this measure.

Performance Measure 13: Percent of children without health insurance.
Tracking Performance Measures
[Secs 485 (2)(2)(B)(iii) and 486 (a)(2)(A)(iii)]

Annual Objective and Performance Data
Annual Performance Objective
Annual Indicator
Numerator

2004
14
14.7

2005
14
16.7

2006
14.5
17

2007
16.5
17

2008
16.3
13.8

103

Denominator
Data Source

US
Census

Check this box if you cannot report the numerator
because
1.There are fewer than 5 events over the last year,
and
2.The average number of events over the last 3
years is fewer than 5 and therefore a 3-year
moving average cannot be applied.
Is the Data Provisional or Final?
Annual Performance Objective

2009
16

2010
15.9

2011
15.7

Final
2012
15.7

Provisional
2013
15.7

Notes - 2008
Estimates were revised based adjustments made by the US Census
(http://www.census.gov/hhes/www/hlthins/historic/hihistt5.xls). The point estimate has a standard
error of 1.50. The final data estimate for 2008 not yet available.
Notes - 2007
Estimates were revised based adjustments made by the US Census
(www.census.gov/hhes/www/hlthins/historic/hihistt5.html). Data for 2007 not yet available. The
estimate for 2007 is provisionally set at the 2006 estimate until the data become available in the
Fall of 2008..
Notes - 2006
Data for 2006 not yet available. The estimate for 2006 is provisionally set at the 2005 rate until
data become available in the Fall of 2007.
a. Last Year's Accomplishments
The Medical Home Project (MHP) continued to link uninsured children that do not qualify for
AHCCCS with medical providers. The MHP is available in eight out of 15 counties in Arizona. In
2008, the Medical Home Project made 165 referrals to primary care physicians and 251 referrals
to specialists were made for school age children and younger siblings of school age children.
Each year, the number of specialist referrals through the MHP has increased. This reflects the
higher level of care provided through the MHP. Services provided through the MHP included 70
eyeglasses; 48 diagnostic laboratory services; and 143 prescription medications. The Medical
Home Project has 65 primary care physicians providing acute care services, five physicians
willing to provide a true medical home, 53 specialty physicians and 889 referral sources. In
addition, the MHP added a dentist to the list of participating providers. The MHP has bilingual
and bicultural support staff available to address the cultural diversity of the population served in
Arizona. In addition, wherever possible, Spanish-speaking families are referred to bilingual
physician's offices. All written materials about this program are available in both English and
Spanish.
The High Risk Perinatal Program (HRPP) Community Health Nurses assessed the health
insurance status of each client throughout program enrollment. Families were educated about
the importance of establishing and maintaining a medical home and assisted in overcoming the
barriers to accessing health care. With every home visit the Community Health Nurses assessed
the insurance status of the family and assisted the family to access insurance.
The BWCH Hotline staff assisted callers with prescreening for Arizona's Medicaid health plan and
helped link callers to services.
The Health Start Program Community Health Workers reviewed and assessed the health
insurance status of every client throughout enrollment in the program. Families were provided

104

assistance in applying for coverage and finding prenatal care providers in their community.

Table 4a, National Performance Measures Summary Sheet
Activities
1. Medical Home Project provided uninsured children with health
care service
2. Medical Home Project screened children for AHCCCS
eligibility and refer as appropriate.
3. HRPP Community Health Nurses educate the family on the
importance of maintaining a medical home.
4. High Risk Perinatal Project assisted families in accessing
insurance.
5.
6.
7.
8.
9.
10.

Pyramid Level of Service
DHC ES
PBS
IB
X
X
X
X

b. Current Activities
During 2009 ADHS opened a Request for Proposal to provide medical home services. The
Medical Home Project continues to link uninsured children that do not qualify for AHCCCS with
medical providers. The MHP continues to provide acute care services to school age children and
to younger siblings of school age children. The MHP continues to provide a true medical home to
a small number of families. The Medical Home Project continues to seek additional providers and
school nurses and public health nurses to refer children to the Medical Home Project. The
Medical Home Project assists Hispanic families in accessing appropriate resources to prevent
duplication of services. All written materials about this program are available in both English and
Spanish.
The HRPP Community Health Nurses continue to assess the health insurance status of each
client throughout program enrollment. Families are educated about the importance of
establishing and maintaining a medical home and assisted in overcoming the barriers to
accessing health care. With every home visit the Community Health Nurses assesses the
insurance status of the family and assists the family to access insurance. The program works
closely with AHCCCS, Arizona's Medicaid agency, to ensure families receive coverage as quickly
as possible.
The BWCH Hotline staff assist callers with prequalifying for Arizona's Medicaid health plan and
links them to needed services. Health Start assists clients in applying for Medicaid coverage.

c. Plan for the Coming Year
The Medical Home Project will continue to link uninsured children that do not qualify for AHCCCS
with medical providers. The MHP will continue to recruit additional physicians to provide services
to children and increase the number of participating school nurses, public health nurses, and
Head Starts that refer children to the MHP. The goal will also be to continue to increase the
number of children who receive a true medical home from the Medical Home Project.
The HRPP Community Health Nurses will continue to assess the health insurance status of each
client throughout program enrollment. Families will continue to be educated about the importance

105

of establishing and maintaining a medical home and assisted in overcoming the barriers to
accessing health care. With every home visit the Community Health Nurses will continue to
assess the insurance status of the family and assist the family to access insurance.
The BWCH Hotline staff will continue to assist callers with prequalifying for Arizona's Medicaid
health plan and linking them to needed health and social services.
The Health Start Program and Family Planning Programs will continue to ensure all eligible
clients apply for insurance coverage through AHCCCS, the state's Medicaid agency.

Performance Measure 14: Percentage of children, ages 2 to 5 years, receiving WIC services
with a Body Mass Index (BMI) at or above the 85th percentile.
Tracking Performance Measures
[Secs 485 (2)(2)(B)(iii) and 486 (a)(2)(A)(iii)]

Annual Objective and Performance Data
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Data Source

2004

2005
35.1
31345
89325

2006
35
35.6
31537
88620

2007
35
36.9
34535
93555

2008
34.5
37.3
38670
103755
AZ WIC
Program
database

2010
34.5

2011
34

Final
2012
34

Final
2013
34

Check this box if you cannot report the
numerator because
1.There are fewer than 5 events over the last
year, and
2.The average number of events over the last
3
years is fewer than 5 and therefore a
3-year moving average cannot be applied.
Is the Data Provisional or Final?
Annual Performance Objective

2009
34.5

a. Last Year's Accomplishments
Former Governor Napolitano reestablished the Commission on Women's and Children' Health in
April 2008. The Commission is charged with identifying priorities and advising the Governor on
effective policies and practices to improve health and wellness of women and children. The
Commission launched in September 2008 and completed an action plan in December 2008.
As required by Executive Order 2008-18, the Commission assessed the health status of Arizona's
women and children, using key indicator data provided by the Arizona Department of Health
Services. After review of the data, the Commission established criteria for selecting a primary
focal area to concentrate efforts. The focal area chosen should be amenable to policy and
environmental change, sustainable, allow the Commission to have an impact by 2010, and result
in long-term health benefits across the state with existing funding or at no cost to the state. It was
also a top priority to build on existing efforts and leverage knowledge and projects already
underway.
The Commission chose as its focal area the promotion of nutrition and physical activity for a
healthy weight. The Commission's proposed actions were focused on policy and environmental
change that will promote improved nutrition and increased physical activity where Arizonans
learn, live, and work and can be implemented with limited resources by the Commission and its

106

partners.
The Bureau of USDA MCH Nutrition Team continues to work closely with AHCCCS (Arizona
Health Care Cost Containment System--Medicaid) in promoting early intervention in childhood
obesity and appropriate referrals for WIC children.
"Fit WIC" group classes and incentives in association with Arizona Nutrition Network have also
been initiated in 21 Arizona WIC local agencies including nutrition and physical activity education
curriculum for healthy lifestyles after a successful pilot with Mariposa Community Health Center.
The goals of the Fit WIC program for children is to increase their physical activity through
caregiver education; introduce children to good nutrition; and stress the importance of physical
activity through activities in WIC.

Table 4a, National Performance Measures Summary Sheet
Activities
1. Governor’s Commission on Women’s & Children’s Health
selected promotion of health weight as its priority area.
2. Continue Fit WIC programs
3. USDA Nutrition provided overweight resources to health care
providers in Arizona.
4.
5.
6.
7.
8.
9.
10.

Pyramid Level of Service
DHC ES
PBS
IB
X
X
X

b. Current Activities
The Commission on Women's & Children's Health started three work groups: a worksite wellness
workgroup, a policy forum workgroup, and a Women's Health Week planning workgroup. The
Commission and Governor's staff will work closely with ADHS to plan and implement a policy
forum that will bring local, tribal and state policy makers together to create an obesity policy
agenda for our state. The policy forum is planned for the fall of 2009.
Arizona WIC continues to work closely with Arizona Nutrition Network (AZNN)and the "Grow a
Healthy Child" campaign. The second series of the "Healthy Eating" TV spot began airing
statewide. The integrated marketing campaign includes AZNN, Arizona WIC, and Nutrition and
Physical Activity Program (NUPA).
Arizona WIC also continues to work with AZNN on the "Go Low" campaign targeted at
skim/lowfat milk and dairy choices for children. Fit WIC was expanded to include all 21 local WIC
agencies. Arizona WIC is branding new education brochures and materials that will emphasize
emotion-based messages in childhood obesity and health.

c. Plan for the Coming Year
The Commission will work with ADHS on next steps generated from the obesity prevention policy
forum and any recommendations that emerge from the worksite wellness group.
Arizona State WIC will complete branding of new emotion-based education materials for obesity

107

prevention.
The Bureau of USDA Nutrition Program will continue to assist Health Care Providers in Arizona in
counseling and referring children to overweight prevention programs. Common statewide
prevention messages will be developed and distributed. Nutrition curriculum will be developed for
the management of overweight and obesity in children with special healthcare needs with
emphasis of coordinated efforts in the management of energy needs in WIC children on tube
feeds or supplemental nutrition products.

Performance Measure 15: Percentage of women who smoke in the last three months of
pregnancy.
Tracking Performance Measures
[Secs 485 (2)(2)(B)(iii) and 486 (a)(2)(A)(iii)]

Annual Objective and Performance Data
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Data Source

2004

2005
5.4
5128
95798

2006
5
5.1
5225
102042

2007
5
4.7
4826
102687

2008
4.5
4.9
4859
99215
AZ Birth
Certificates

2010
4

2011
4

Final
2012
4

Final
2013
4

Check this box if you cannot report the
numerator because
1.There are fewer than 5 events over the
last year, and
2.The average number of events over the
last 3 years is fewer than 5 and therefore a
3-year moving average cannot be applied.
Is the Data Provisional or Final?
Annual Performance Objective

2009
4.2

Notes - 2008
The State of Arizona does not have a survey like PRAMS that would collect data related to
smoking during the last 3 months of pregnancy. The only data available is from the birth
certificate, which records wether or not the mother smoked during the pregnancy, but is not
specific to the last 3 months of the pregnancy. Therefore, the percent reported is the percent of
women giving birth in 2008 who smoked at any time during pregnancy.
Notes - 2007
The State of Arizona does not have a survey like PRAMS that would collect data related to
smoking during the last 3 months of pregnancy. The only data available is from the birth
certificate, which records wether or not the mother smoked during the pregnancy, but is not
specific to the last 3 months of the pregnancy. Therefore, the percent reported is the percent of
women giving birth in 2007 who smoked at any time during pregnancy.
Notes - 2006
The State of Arizona does not have a survey like PRAMS that would collect data related to
smoking during the last 3 months of pregnancy. The only data available is from the birth
certificate, which records wether or not the mother smoked during the pregnancy, but is not
specific to the last 3 months of the pregnancy. Therefore, the percent reported is the percent of
women giving birth in 2006 who smoked at any time during pregnancy.
a. Last Year's Accomplishments

108

The Licensed Midwife Program provided informational materials to all midwives about the
negative health outcomes associated with smoking during pregnancy and state MCH smoking
cessation resources for pregnant women.
The BWCH bilingual Hotline staff referred pregnant women who called requesting smoking
cessation information to the ADHS Tobacco Education and Prevention Program.
The Health Start Program provided training on tobacco cessation strategies for pregnant and
postpartum women and their families at the annual meeting held March 2008. The training was
attended by 52 community health workers and coordinators representing 15 contractors. The
training included practice on providing a brief intervention to clients who disclosed smoking during
pregnancy.
During the Title V Reproductive Health/Family Planning Program Annual Contractor meeting, a
representative from the Tobacco Education and Prevention Program (TEPP) provided the group
with information on how to do a three minute intervention, how to refer a patient to the program
and what services the program provides. The TEPP representative also provided the contractors
with new smoking cessation materials to use in the clinic and the contact information for the
TEPP program in their area.
Over the past fiscal year, the Arizona Smoker's Helpline (ASHline), funded by the ADHS Bureau
of Tobacco and Chronic Disease, increased its capacity considerably. For calendar year 2007,
the total number of women who utilized the ASHline was 2,328, of which 56 women reported
being pregnant and using tobacco. This accounted for 2.4% of all women who utilized ASHline.
For calendar year 2008, 3,304 women utilized the ASHline, of which 43 reported being pregnant
and using tobacco. This accounted for 1.3% of all women who utilized the ASHline.
According to the Behavioral Risk Factor Surveillance System, Arizona's smoking rates among
adults significantly improved from 19.7 percent in 2007 to 15.6 percent in 2008. Some of the
reasons for this include; 1) 2008 was the first complete year of the Smoke Free Arizona Act, 2)
Arizona has well established quit lines to help people stop smoking, 3) increased use of nicotine
replacement therapies that are more often covered by health insurance plans, and 4) taxes on
cigarettes have continued to increase making smoking more expensive in Arizona.

Table 4a, National Performance Measures Summary Sheet
Activities
1. The Midwife Licensing Program provided materials to the
midwifery community regarding tobacco prevention programs.
2. BWCH bilingual Hotline staff refer pregnant women to ADHS
tobacco education and cessation programs.
3. Health Start and Family Planning Programs provided training
to contractors on tobacco cessation.
4.
5.
6.
7.
8.
9.
10.

Pyramid Level of Service
DHC ES
PBS
IB
X
X
X

b. Current Activities

109

The licensed midwife program continues to inform the midwifery community of tobacco prevention
services available to their pregnant clients.
BWCH bilingual Hotline staff continue to refer at-risk pregnant women to smoking cessation
resources within the ADHS Tobacco Education and Prevention Program.
The Health Start Program provided Interconceptional Education and Counseling materials to
contractors which are being utilized during family follow-up visits with the client. The topics
address risk factors related to smoking, a smoking survey and techniques to help women quit or
cut down on smoking during and between pregnancies. Community Health Workers refer any
pregnant or postpartum woman who is using tobacco to local cessation programs and provide
education on the health risks.
The Title V Family Planning/Reproductive Health Program collaborates with the county level
Tobacco Education and Prevention Program to provide brief interventions and referrals for clients
who are using tobacco. If a patient identifies herself as someone who uses tobacco during an
exam or a pregnancy test, clinic staff provides information on smoking cessation and a referral to
the county Tobacco Education and Prevention Program.
Public Health Prevention Services bureaus are collaborating on better integration of tobacco
prevention and cessation strategies into existing programs.

c. Plan for the Coming Year
The Licensed Midwife Program will review tobacco prevention information for changes and share
this with the midwifery community. The Licensed Midwife Program will seek to make progress on
revisions of the Arizona Administrative Code, Title 9, Chapter 16, Article 1 in order to capture data
relevant to this measure.
BWCH bilingual Hotline staff will continue to refer at-risk pregnant women to smoking cessation
information provided by the Tobacco Education and Prevention Program.
The Health Start Program will conduct a training workshop on Tobacco Education and Cessation
Strategies with Pregnant and Postpartum Women for the Community Health Workers and
Coordinators for all contractors in 2010. The Program plans to use the Basic Tobacco
Intervention Skills for Maternal and Child Health Guidebook developed by the University of
Arizona Health Care Partnership.
The Title V Family Planning/Reproductive Health Program will continue to work with the Tobacco
Education and Prevention Program to provide smoking cessation interventions and referrals as
needed.
In 2009 and moving forward, the Arizona Smoker's Helpline is increasing outreach efforts to
priority populations, like pregnant women, by partnering with WIC and other programs.

Public Health Prevention Services bureaus will implement an action plan that enhances
integration of tobacco prevention and cessation into existing programs. Bureau involved in this
initiative include: Women's & Children's Health, USDA Nutrition Programs, Health Systems
Development, and Tobacco and Chronic Disease Prevention.

110

Performance Measure 16: The rate (per 100,000) of suicide deaths among youths aged 15
through 19.
Tracking Performance Measures
[Secs 485 (2)(2)(B)(iii) and 486 (a)(2)(A)(iii)]

Annual Objective and Performance
Data
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Data Source

2004

2005

2006

2007

2008

16.4
11.8
49
417019

9.5
14.1
61
431964

11.5
13.0
57
439190

13.5
8.5
38
444825

13
8.5

AZ Health
Status and Vital
Statistics

Check this box if you cannot report the
numerator because
1.There are fewer than 5 events over
the last year, and
2.The average number of events over
the last 3
years is fewer than 5
and therefore a 3-year moving
average cannot be applied.
Is the Data Provisional or Final?
Annual Performance Objective

2009
12

2010
11

2011
10

Final
2012
10

Provisional
2013
10

Notes - 2008
Data for 2008 not yet available. The estimate for 2008 is provisionally set at the 2007 rate until
data become available in the Fall of 2009.
Notes - 2007
Data for 2007 not yet available. The estimate for 2007 is provisionally set at the 2006 rate until
data become available in the Fall of 2008.
Notes - 2006
Data for 2006 not yet available. The estimate for 2006 is provisionally set at the 2005 rate until
data become available in the Fall of 2007.
a. Last Year's Accomplishments
In 2008, the 15th Annual Child Fatality Report was produced, summarizing reviews of child
deaths that occurred in Arizona during 2007. For the third time since its inception, the Child
Fatality Review (CFR) Program reviewed 100 percent of child deaths that occurred in Arizona.
During 2008, Child Fatality Review Teams reviewed the circumstances surrounding the suicides
of 28 children that occurred during 2007. Thirty-one (75 percent) of the suicides were among
children 15 through 17 years, and seven children (25 percent) were 14 years and younger. The
most common methods of suicide were hangings and gunshot wounds. The most commonly
identified contributing factors to child suicides were drug and/or alcohol use, access to firearms,
and lack of mental health treatment.
One Title V Community Health Grant contractor held two community events which reached 500
teens, to promote awareness and prevention of suicide.
The Injury Prevention Program collaborated with the Division of Behavioral Health Services on a
grant application that would include depression screening in emergency departments. The
program also assisted with the new state plan on suicide prevention.

111

The Division of Behavioral Health Services provided information to BWCH program managers
regarding behavioral health resources for women and children.

Table 4a, National Performance Measures Summary Sheet
Activities
1. Child Fatality Review Program produces an annual report on
the causes of child suicide.
2. Title V Community Health Grants supports community events
increasing awareness and prevention of suicide.
3.
4.
5.
6.
7.
8.
9.
10.

Pyramid Level of Service
DHC ES
PBS
IB
X
X

b. Current Activities
For 2009, recommendations in the annual Child Fatality Review Report related to child suicides
included developing education materials for parents with children of all ages regarding the safe
storage and disposal of prescription medications and seeking to increase funding to improve
youth substance abuse treatment services and accessibility to treatment.
In 2009, the Child Fatality Review Program will continue to review deaths of children due to all
causes, including suicide. Reviews continue to identify circumstances surrounding each death
and factors contributing to the death. The Child Fatality Review Program will continue to provide
specialty data reports for local, statewide, and national initiatives to reduce preventable child
fatalities.
The State Child Fatality Review Team will produce the 16th Annual Child Fatality Review Report
in November, 2009. The report will include recommendations to reduce preventable deaths of
children that occurred in 2008. The Child Fatality Review Program staff will continue to provide
technical assistance to the local child fatality teams in the development and implementation of
local culturally sensitive teams, and will identify and promote campaigns to educate the public on
preventing child deaths.
A Title V Community Health Grant contractor is holding community events to promote awareness
and prevention of suicide.

c. Plan for the Coming Year
The Child Fatality Review Program will continue to review the deaths of all children to identify
preventable factors and will continue to conduct surveillance of causes and circumstances
surrounding child suicides in Arizona. The Child Fatality Review Program staff will continue to
provide technical assistance to the local child fatality teams in the development and
implementation of local culturally sensitive teams, and will identify and promote campaigns to
educate the public on preventing suicide among children. The 17th Annual Child Fatality Report
will be produced and will include data on suicides and recommendations to prevent suicides
among children.

112

A Title V Community Health Grant contractor will hold a community event to promote awareness
and prevention of suicide. The grant is funded through 2010.
The Division of Behavioral Health Services will continue to participate in the ADHS Injury
Prevention Advisory Council and the ADHS Internal Injury Prevention Workgroup. Programs in
the Bureau of Women's & Children's Health will continue to collaborate with the Division of
Behavioral Health Services to help partners understand existing resources and service system.
Using federal materials from HRSA and SAMSHA, BWCH will work on promoting mental wellness
messaging in existing maternal and child health programs.

Performance Measure 17: Percent of very low birth weight infants delivered at facilities for
high-risk deliveries and neonates.
Tracking Performance Measures
[Secs 485 (2)(2)(B)(iii) and 486 (a)(2)(A)(iii)]

Annual Objective and Performance Data
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Data Source

2004
81.5
81.6
805
986

2005
82
77.6
868
1119

2006
82
77.5
960
1238

2008
82.5
78.8

AZ Birth
Certificates

Check this box if you cannot report the numerator
because
1.There are fewer than 5 events over the last
year, and
2.The average number of events over the last 3
years is fewer than 5 and therefore a 3year moving average cannot be applied.
Is the Data Provisional or Final?
Annual Performance Objective

2007
82
78.8
971
1232

2009
83

2010
83.5

2011
84

Final
2012
84

Provisional
2013
84

Notes - 2008
Data for 2008 are not yet available. The estimate for 2008 is provisionally set at the 2007 rate
until data become available in the Fall of 2009.
Notes - 2007
The data source for this measures is birth certificate data for live births. Births in which the birth
weight was recorded as being under 450 grams are excluded as a data quality measure, as it is
unlikely that these records represent actual birth weights. Only facilities certified by the Arizona
Perinatal Trust as level III facilities are included in the numerator. Banner Desert Samaritan
became certified as a Level III on 10/1/02. Data for 2007 are not yet available. The estimate for
2007 is provisionally set at the 2006 rate until data become available in the Fall of 2008.
Notes - 2006
The data source for this measures is birth certificate data for live births. Births in which the birth
weight was recorded as being under 450 grams are excluded as a data quality measure, as it is
unlikely that these records represent actual birth weights. Only facilities certified by the Arizona
Perinatal Trust as level III facilities are included in the numerator. Banner Desert Samaritan
became certified as a Level III on 10/1/02. Data for 2006 are not yet available. The estimate for
2006 is provisionally set at the 2005 rate until data become available in the Fall of 2007.

113

a. Last Year's Accomplishments
The maternal transport component of the High Risk Perinatal program (HRPP) continued funding
for a centralized Information and Referral Service. This 1-800 telephone line offered toll free 24/7
consultation services by board certified Maternal Fetal Medicine (MFM) specialists throughout
Arizona to providers caring for pregnant women who presented with high risk factors. Providers
make one telephone call to be connected with this service. If a transport is deemed necessary,
the board certified Maternal Fetal Specialists determined the availability of the appropriate level of
perinatal bed and authorizes and provides medical direction for the transport regardless of the
woman's ability to pay. The MFM was able to utilize the perinatal screen of the EMSystem, a
web-based program with real time information of perinatal bed availability in Arizona, including
high-risk labor and delivery and Newborn Intensive Care Unit (NICU) beds. The program
continued to fund all uncompensated care associated with the transport itself of pregnant women
to Level II Enhanced Qualification or Level III perinatal centers.
During FY 2008, 1,455 women received maternal transport to the appropriate level of perinatal
care. The HRPP continued to visit hospitals and providers to educate them about the availability
of the transport system.
The Licensed Midwife Program reviewed quarterly reports from licensed midwives for any infants
that were below 3000 grams. If the infant was below that weight the Program contacted the
midwife who delivered the infant to determine if there were problems with either the delivery or
the pregnancy.

Table 4a, National Performance Measures Summary Sheet
Activities
1. High Risk Perinatal Program transported high risk pregnant
women to appropriate level of care regardless of ability to pay.
2. High Risk Perinatal Program promoted public awareness of
availability of transport.
3.
4.
5.
6.
7.
8.
9.
10.

Pyramid Level of Service
DHC ES
PBS
IB
X
X

b. Current Activities
The maternal transport component of the High Risk Perinatal Program (HRPP) continues funding
for a centralized Information and Referral Service. This 1-800 telephone line offers toll free 24/7
consultation services by board certified Maternal Fetal Medicine (MFM) specialists throughout
Arizona to providers caring for pregnant women who presented with high risk factors. If a
transport is deemed necessary, the board certified Maternal Fetal Specialists determines the
availability of the appropriate level of perinatal bed and authorizes and provides medical direction
for the transport regardless of the woman's ability to pay. The MFM is able to utilize the perinatal
screen of the EMSystem, a web based program with real time information of perinatal bed
availability in Arizona, including high risk labor and delivery and NICU beds. The program
continues to fund all uncompensated care associated with the transport itself of pregnant women
to Level II Enhanced Qualification or Level III perinatal centers.
The High Risk Perinatal Program is funded primarily with state general funds; while.the transport

114

component is funded with EMS operating revenue. State budget cuts in this fiscal year reduced
the program by about $1.4 million. As a result, the program modified eligibility criteria, reduced
community nursing visits, and reduced or ended payments to providers. Further budget cuts are
anticipated for the state fiscal year starting July 1, 2009.

c. Plan for the Coming Year
The plan for the High Risk Perinatal Program is contingent upon the amount of funding available.
Assuming adequate funding remains, the maternal transport component of the High Risk
Perinatal program (HRPP) will continue funding for a centralized Information and Referral
Service. This 1-800 telephone line will continue to offer toll free 24/7 consultation services by
board certified Maternal Fetal Medicine (MFM) specialists throughout Arizona to providers caring
for pregnant women who presented with high risk factors. Providers will be able to continue to
make one telephone call to be connected with this service. If a transport is deemed necessary,
the board certified Maternal Fetal Specialists will determine the availability of the appropriate level
of perinatal bed and authorize and provide medical direction for the transport regardless of the
woman's ability to pay. The MFM will be able to utilize the perinatal screen of the EMSystem, a
web based program with real time information of perinatal bed availability in Arizona, including
high risk labor and delivery and NICU beds. The program plans to continue to fund all
uncompensated care associated with the transport itself of pregnant women to Level II Enhanced
Qualification or Level III perinatal centers. The HRPP will continue to visit hospitals and providers
to educate them about the availability of the transport system.

Performance Measure 18: Percent of infants born to pregnant women receiving prenatal care
beginning in the first trimester.
Tracking Performance Measures
[Secs 485 (2)(2)(B)(iii) and 486 (a)(2)(A)(iii)]

Annual Objective and Performance Data
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Data Source

2004
80
76.3
71268
93396

2005
78
77.7
74453
95798

2006
78
77.7
79299
102042

2008
79
77.6

AZ Birth
Certificates

Check this box if you cannot report the
numerator because
1.There are fewer than 5 events over the
last year, and
2.The average number of events over the
last 3 years is fewer than 5 and therefore
a 3-year moving average cannot be applied.
Is the Data Provisional or Final?
Annual Performance Objective

2007
79
77.6
79683
102687

2009
80

2010
80

2011
80

Final
2012
80

Provisional
2013
80

Notes - 2008
Data for 2008 are not yet available. The estimate for 2008 is provisionally set at the 2007 rate
until data become available in the Fall of 2009.
Notes - 2007

115

Data for 2007 are not yet available. The estimate for 2007 is provisionally set at the 2006 rate
until data become available in the Fall of 2008.
Notes - 2006
Data for 2006 are not yet available. The estimate for 2006 is provisionally set at the 2005 rate
until data become available in the Fall of 2007.
a. Last Year's Accomplishments
The Health Start Program is a preventative health program that provides case management in
high risk communities with a focus on early access to prenatal care and improving birth
outcomes. The Health Start Program educated pregnant and postpartum women about prenatal
care, nutrition, the benefits of breastfeeding, danger signs of pregnancy, home safety,
immunizations, insurance and many other health and behavioral health topics during and
between pregnancies. The Program utilized Community Health Workers to identify pregnant
and/or parenting women within their community and facilitate early entry into prenatal care. The
Community Health Workers provided home and/or office visits and follow-up visits with the clients
to verify that they and their children up to age two are attending medical appointments and
receiving needed services. In 2008, Health Start provided educational services to 2,180
unduplicated enrolled clients. The program provided a total of 11,313 home and/or office visits.
The program increased outreach to the most vulnerable populations, Native Americans and
African Americans, in targeted communities to focus on new prenatal enrollments. Approximately
64% of Health Start clients entered the program in their first trimester of pregnancy. A Health
Start 2008 Evaluation concluded that babies of Health Start mothers had higher gestational ages
and/or full term when compared to non-Health Start mothers. Babies of Health Start mothers also
had higher birth weights when compared to babies whose mothers were not in the program. The
proportion of very low birth weight infants born to Health Start clients was approximately 1%.
The Office of Oral Health (OOH) provided information to educate health professionals on oral
health before, during and after pregnancy, to improve access to oral care during pregnancy and
thus improve oral health of infants and toddlers and promoted low cost clinics for oral care during
pregnancy. OOH encouraged the AHCCCS Dental Director and Health Plans to develop policies
regarding oral care during pregnancy and provided technical assistance to community-based
organizations on the relationship of oral health and pregnancy and early childhood tooth decay.
During 2008, the County Prenatal Block Grant provided 3,987 pregnant women in all 15 counties
with a range of prenatal services and classes focusing on early prenatal care, smoking, nutrition
and exercise, oral health, labor and delivery, premature births, and basic health issues and its
impact on birth outcome.
The ADHS Midwife Licensing Program reviewed data from 633 quarterly reports turned into the
Department by midwifes with notation of any who began care after the first trimester to determine
what the reasons were and why the mother had delayed care. The program reviewed this with
the licensee to see if this is a pattern and review potential corrective action needed. The program
completed enforcement action against the midwifery community who failed to turn in
documentation that is required with 10 licensed midwives. These individuals were required to
complete plans of correction to prevent a reoccurrence of the deficient practice in the future.
The BWCH Hotlines screened pregnant women for eligibility into Baby Arizona. Baby Arizona is
a presumptive eligibility program consisting of perinatal providers who agree to see pregnant
women while their eligibility into AHCCCS, Arizona's Medicaid, is being determined. These
providers agree to provide a payment plan if the woman does not qualify for AHCCCS. If
prescreening showed a woman was not eligible for AHCCCS, the Hotlines were able to refer
them to other providers in their area who offer prenatal care for a sliding scale fee. The Hotline
took 1,034 Baby Arizona calls in 2008.
The Arizona WIC program continued to screen pregnant women and refer them to prenatal

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services.
The state mandated Pregnancy Services Program provided funding to 13 agencies whose
primary function was to serve pregnant women seeking alternatives to abortion. The funds paid
for options counseling, prenatal vitamins, and education on a number of topics related to maternal
and child health. In 2008 the contractors provided the following education sessions; prenatal care
- 1,998, preconception care -809, childhood immunization- 154, and parenting skills- 1,212. A
total of 3,843 options counseling sessions were provided. This program was eliminated on June
30, 2008, due to state budget cuts.

Table 4a, National Performance Measures Summary Sheet
Activities
1. Office of Oral Health educated health professionals on
relationship of oral health and pregnancy risks.
2. Office of Oral Health provided support to affect AHCCCS
policies regarding oral care during pregnancy.
3. Health Start Community Health Workers educated pregnant
and postpartum women.
4. Health Start Community Health Workers ensured clients and
children attended
medical appointments.
5. County Prenatal Block Grant stressed the importance of
preconception health and early prenatal care.
6. Bilingual Hotline staff prescreened callers for Baby Arizona.
7. Bilingual Hotline staff referred to providers offering sliding
scale rates for prenatal care for pregnant women who would not
quality for Medicaid.
8. The Bureau of USDA Nutrition referred pregnant WIC
participants for prenatal care.
9.
10.

Pyramid Level of Service
DHC ES
PBS
IB
X
X
X
X
X
X
X

X

b. Current Activities
The Office of Oral Health (OOH) provides education to dentists on treatment protocols during
pregnancy.
The Health Start Program educates pregnant and postpartum women about prenatal care,
nutrition, the benefits of breastfeeding, danger signs of pregnancy, and home safety. The
Program utilizes Community Health Workers to identify pregnant and/or parenting women within
their community and facilitate early entry into prenatal care.
During the first three quarters of the state fiscal year, the County Prenatal Block Grant program
provided education and supportive services and classes related to early prenatal care and its
impact on birth outcome.
The BWCH Pregnancy and Breastfeeding Hotlines continue to screen pregnant women for
eligibility into Baby Arizona. The March of Dimes provided the Bureau of Women's & Children's
Health with funding to do new promotion of the Baby Arizona Hotline. Staff are working with
March of Dimes to target organizations in neighborhoods most in need of outreach for early entry
into prenatal care.
Bureau of USDA Nutrition promotes the benefits of early entry into prenatal care. WIC
participants are referred and tracked, and WIC staff are trained to refer pregnant women for early

117

prenatal care.

c. Plan for the Coming Year
Office of Oral Health will continue to enhance dental provider knowledge on women's oral health
and pregnancy issues to increase referrals for dental care and offer technical assistance
regarding dental treatment during pregnancy. The Office of Oral Health will also increase efforts
to encourage AHCCCS to develop policies on oral care during pregnancy.
The Health Start Community Health Workers will continue to provide education and assist clients
in obtaining prenatal care. The Community Health Workers will continue to follow-up with the
clients to verify that they are attending prenatal care medical appointments and are complying
with the physician's instructions. They will make referrals to community resources as appropriate,
such as smoking cessation programs and alcohol/ substance abuse prevention and treatment
programs in their community. They will continue to distribute the Arizona Resource Guides in
English and Spanish to enrolled clients.
The County Prenatal Block Grant is a likely to be discontinued due to state budget reductions.
Without funding, there will be no further services related to prenatal services through this
program.
The BWCH Pregnancy and Breastfeeding Hotlines will continue to screen pregnant women for
eligibility into Baby Arizona. Baby Arizona is a presumptive eligibility program consisting of
perinatal providers who agree to see pregnant women while their eligibility into AHCCCS,
Arizona's Medicaid, is being determined. These providers agree to provide a payment plan if the
woman does not qualify for AHCCCS. If prescreening shows a woman is not eligible for
AHCCCS, the Hotlines will continue to refer them to other providers in their area who offer
prenatal care for a sliding scale fee. The Hotline will continue to maintain and update a database
of participating providers and providers offering reduced rates and sliding scale rates. BWCH will
continue to work with March of Dimes, AHCCCS, and other partners to promote awareness of
Baby Arizona. BWCH will implement an evaluation of the new promotion of Baby Arizona to
determine whether there was an increase in calls to the Hotline and which targeted locations for
the promotion were most effective.
Arizona WIC participants will continue to be referred and tracked for access to prenatal services,
and new WIC staff will be trained to refer pregnant women for early prenatal care. WIC staff will
continue to regularly meet with AHCCCS coordinators.

D. State Performance Measures
State Performance Measure 1: Proportion of low-income women who receive reproductive
health/family planning services.
Tracking Performance Measures
[Secs 485 (2)(2)(B)(iii) and 486 (a)(2)(A)(iii)]

Annual Objective and
Performance Data
Annual Performance Objective
Annual Indicator
Numerator
Denominator

2004

2005

2006

2007

2008

17.9
49.2
126442
256879

11
49.2

50
49.2

50
49.2

51
47.4
129616
273417

118

Data Source
Is the Data Provisional or Final?
Annual Performance Objective

2009
51

2010
51

2011
51

Final
2012
51

AZ Family Planning Council
survey
Final
2013
51

Notes - 2007
Starting with the 2004 data point, the numerator is women at or below 200% FPL who received
family planning services through Title V, TItle X, Title XIX, or 330/340 Federally Funded
Community Health Centers. The denominator is women at or below 200% FPL who are fertile.
Data for this measure is from the Arizona Family Planning Council's Comprehensive Family
Planning Report, which is usually conducted annually. However, this report was not produced in
2007. Therefore, the 2005-2007 rates are provisionally set at the 2004 rate the new report is
issued in the fall of 2008.
Notes - 2006
Starting with the 2004 data point, the numerator is women at or below 200% FPL who received
family planning services through Title V, TItle X, Title XIX, or 330/340 Federally Funded
Community Health Centers. The denominator is women at or below 200% FPL who are fertile.
Data for this measure is from the Arizona Family Planning Council's Comprehensive Family
Planning Report, which is usually conducted annually. However, this report was not created for
2005. Therefore, the 2005 and 2006 rate is provisionally set at the 2004 rate the new report is
issued in the fall of 2007.
a. Last Year's Accomplishments
Through the Reproductive Health/Family Planning Program (RHFP), 11 out of the 15 County
Health Departments and Maricopa Integrated Health Services received intergovernmental
agreements (IGA's) to provide reproductive health/family planning services that focused on
women at or below 150% of the federal poverty level. In 2008, the program added a new
contractor, Gila County Health Department, in order to reach populations in Globe and Payson
who lack adequate access to services. Of the 4,279 women who received an initial or annual
exam in 2008, 98% were at or below 150% of the federal poverty level and received services at
no charge. The Reproductive Health/Family Planning Program focused on making services
available to sexually active teens in an effort to reduce teen pregnancy rates. In 2008, 54% of
clients served were under 24 years old. The RHFP collaborated with the Title X and Arizona
Family Planning Council (AFPC) to share data to analyze trends and outcomes of family planning
services among this group.
In order to increase the target population's access to preconception care, the program also
provided technical support and materials to contractors.

Table 4b, State Performance Measures Summary Sheet
Activities
1. The Reproductive Health/Family Planning Program (RHFP)
funds IGA's to sustain and increase the number of low income
women receiving reproductive health services.
2. The RHFP program works with other agencies sharing
resources and data for trend and outcome analyses.
3.
4.

Pyramid Level of Service
DHC ES
PBS
IB
X

X

119

5.
6.
7.
8.
9.
10.
b. Current Activities
The RHFP contractors continue to receive level funding in the unit reimbursement for providing
the required services of the program. The Reproductive Health/Family Planning Program works
with contractors to improve access for low income clients to preconception care within family
planning. The program also continues to focus on providing reproductive health/family planning
services to sexually active teens.

c. Plan for the Coming Year
The Reproductive Health/Family Planning Program (RHFP) will continue to provide funding to
county health departments and Maricopa Integrated Health Systems to provide services to
underserved populations. The program will continue to focus on women at or below 150% of the
federal poverty level. The program will continue to seek out locations where underserved clients
can be reached.
Newly developed preconception care materials will be distributed to the Family Planning
contractors.
The Bureau of Women's & Children's Health is working with a Masters in Public Health student to
conduct a study of perceived barriers to birth control and accessibility to reproductive health
services. The study will include assessing knowledge about preconception health and whether
the respondent has a reproductive life plan.

State Performance Measure 2: The percent of high school students who are overweight or
at-risk for overweight.
Tracking Performance Measures
[Secs 485 (2)(2)(B)(iii) and 486 (a)(2)(A)(iii)]

Annual Objective and
Performance Data
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Data Source

2004

2005

2006

2007

2008

25.1

25.5

25
25.5

25
25.9

24.5
25.9

Final
2012
24

Arizona Youth Risk Behavior
Survey
Final
2013
24

Is the Data Provisional or Final?
Annual Performance Objective

2009
24.5

2010
24

2011
24

Notes - 2008
The YRBS report already provides the calculated percentage. The percent at risk was added to
the percent overweight to get the total at-risk +overweight.
The YRBS report is done every two years. The next report available will be for 2009, and the

120

indicator will be changed to indicate the percentage of high school students who are overweight
and obese.
Notes - 2007
The YRBS report already provides the calculated percentage. The percent at risk was added to
the percent overweight to get the total at-risk +overweight.
The YRBS report is done every two years. The next report available will be for 2009.
Notes - 2006
The YRBS report already provides the calculated percentage. The percent at risk was added to
the percent overweight to get the total at-risk +overweight.
The YRBS report is done every two years. Therefore, the 2006 rate is set at the 2005 rate. The
next report available will be for 2007.
a. Last Year's Accomplishments
Former Governor Napolitano reestablished the Commission on Women's and Children' Health
(GCWCH) in April 2008. The Commission was charged with identifying priorities and advising the
Governor on effective policies and practices to improve health and wellness of women and
children. The Commission was also required to support and empower women and their families to
take control of and manage their health through a strong prevention model. The Bureau of
Women's & Children's Health provided Title V funding to support the staffing of the Commission
in the Governor's Office of Children, Youth, and Families.
As required by Executive Order 2008-18, the Commission assessed the health status of Arizona's
women and children, using key indicator data provided by the Arizona Department of Health
Services. After review of the data, the Commission established criteria for selecting a primary
focal area to concentrate efforts. The Commission decided to focus primarily on the promotion of
nutrition and physical activity for a healthy weight. The Commission's proposed actions are
focused on policy and environmental change that will promote improved nutrition and increased
physical activity where Arizonans learn, live, and work and can be implemented with limited
resources by the Commission and its partners.
One of the Title V Community Health Grant (CHG) contractors has taken a comprehensive
approach to reducing childhood obesity and overweight. Part of their approach was to develop a
local speakers' bureau comprised of interested community partners. Eight new speakers were
trained and conducted 14 presentations for various local organizations. During 2008, their
website had 27,743 hits and a total of 1,381 visitors. Fifty-five community courses focusing on
healthy eating and physical activity were given to families. Their coalition of community partners
was expanded, and has worked to promote healthy policy changes within the community and
local organizations. Coalition partners attended three trainings on advocacy. The contractor is a
community health center whose physicians are now utilizing a structured approach to manage
overweight and obesity. This contractor has also developed self-management plans for children
who are overweight or at risk for overweight. The project enrolled 278 children in the pediatric
weight management program for children who are overweight or at risk for overweight. Surveys
were implemented to assess their pediatric management program, followed by strategies to
increase the health care providers' perception of efficacy.
A total of 1,463 children and women of childbearing age, including high school students,
participated in educational programs that addressed the problem of obesity and overweight for
themselves and their families. All of the multi-week classes contained a physical activity
component suitable for each local community. Many classes served women of color including
Hispanic, Native American, and Black women.

121

Table 4b, State Performance Measures Summary Sheet
Activities
1. Governor’s Commission on Women’s & Children’s Health
developed priorities for addressing healthy weight and nutritionat
the workplace and educational institutions in Arizona.
2. Title V Community Health Grants provided culturally sensitive
information on obesity and overweight for women of childbearing
age.
3. Title V Community Health Grants provided age-appropriate
obesity and overweight education specifically designed for
children.
4. Title V Community Health Grants promoted physical activity to
achieve and maintain a healthy weight.
5.
6.
7.
8.
9.
10.

Pyramid Level of Service
DHC ES
PBS
IB
X

X

X

X

b. Current Activities
Governor's Commission on Women's & Children's Health activities aimed at decreasing the
number of overweight or at-risk overweight high school students include the Women's Health
Expo that focused on physical activity, nutrition and overall prevention of disease. The
Commission is working in conjunction with ADHS on a policy forum that will focus on combating
obesity and prevention in the youth of Arizona.
One of the Title V Community Health Grant contractors has taken a comprehensive approach to
reducing childhood obesity and overweight. They are providing community courses focusing on
healthy eating and physical activity. Their coalition of community partners is continuing to
expand, and is working to promote healthy policy changes within the community and local
organizations. The community health center will continue utilizing self-management plans for
children who are overweight or at risk for overweight. In 2007, this contractor created an
evaluation tool to establish a baseline of knowledge and perception about the problem of obesity
among community residents. Since then, they have continued a nutrition and physical activity
campaign for children.
The Title V funded Nurse Family Partnership program in Yavapai County provides education and
support related to reducing obesity and overweight in participants and their children. Topics
include nutrition, portion size, reading food labels, and the importance of regular physical activity.

c. Plan for the Coming Year
The Governor's Commission on Women's & Children's Health plans to begin workgroups
regarding community and school-based wellness in the future. High school students will be an
important demographic targeted through the policy and education work of these groups. ADHS
and the Commission will determine how to move forward based on the outcomes of the policy
forum to be held in the fall of 2009.
The Title V Community Health Grant program will continue nutrition and physical activity
education, including healthy lifestyle choices, to reduce obesity and overweight among women
and children. Grants are funded through December 2010.

122

ADHS Public Health Prevention Services bureaus will be working together on implementation of a
plan to improve integration of strategies related to physical activity, nutrition, and tobacco
prevention within existing health department programs. Bureaus involved in this integration
initiative include: Bureau of Women's & Children's Health, Bureau of Health Systems
Development (primary care), Bureau of USDA Nutrition Programs (WIC), and Bureau of Tobacco
and Chronic Disease Prevention.

State Performance Measure 3: The percent of preventable fetal and infant deaths out of all
fetal and infant deaths.
Tracking Performance Measures
[Secs 485 (2)(2)(B)(iii) and 486 (a)(2)(A)(iii)]

Annual Objective and Performance Data
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Data Source
Is the Data Provisional or Final?
Annual Performance Objective

2004

2005
33.2
251
756

2006
33
25.8
191
739

2007
32.5
25.0
188
753

33.9
248
732

2009
31.5

2010
31

2011
31

Final
2012
31

2008
32
29.0
238
821
AZ Vital Records data
Final
2013
31

Notes - 2008
Data provided is for the 2006 birth cohort, which is the most recent data available.
Notes - 2007
Data provided is for the 2005 birth cohort, which is the most recent data available.
Notes - 2006
Data provided is for the 2004 birth cohort, which is the most recent data available.
a. Last Year's Accomplishments
The Child Fatality Review Program provided the Infant Death Investigation Checklist for all
investigations of unexpected infant deaths and a protocol for investigating these deaths to law
enforcement agencies throughout Arizona. Law enforcement, in turn, submitted completed forms
to the Medical Examiners' offices so forensic pathologists could accurately assess cause of
death. These forms provide critical information regarding circumstances surrounding unexpected
infant deaths.
In 2008, Child Fatality Review teams reviewed 100% of deaths for all children in Arizona,
including infant deaths. These teams examined and identified the circumstances surrounding the
deaths that could have been prevented. The data were analyzed for public policy and prevention
campaigns and reports were provided to the public for research, media reports, and public health
campaigns. Recommendations regarding prevention of infant deaths included implementation of
an infant safe sleep campaign, establishing Cribs for Kids programs, and implementation of the
CDC recommendations to improve preconception health care.
The Unexplained Infant Death Council is staffed by the Child Fatality Review Program and utilizes
volunteers who advise the department, legislature and the Governor on issues relating to
unexpected infant deaths and all fetal deaths. The Office of Assessment and Evaluation produced
the 4th annual report on the incidence and reported causes of stillbirths. This report was
presented to the Unexplained Infant Death Council.

123

The Arizona Birth Defects Monitoring Program participated in three health fairs in 2008 to
promote the adequate intake of folic acid by women of childbearing age. The Program also
conducts statewide, population-based surveillance for 32 major categories of birth defects. The
rate of neural tube defects (spina bifida and anencephaly) for 2005-2007 was 2.73 per 10,000
(preliminary data).
The ADHS Center for Health Disparities, the Bureau of USDA Nutrition Programs, and the
Bureau of Women's & Children's Health partnered together to implement a new folic acid
campaign targeting young Latinas in Arizona. Public service announcements were created and a
new website was established: www.takemultivitamins.com The campaign was funded in part by
Title V and the March of Dimes.
The ADHS Folic Acid Education and Distribution Program provided multivitamins to low-income
women of childbearing age through the local health departments. Participants in the program
received a year's supply of multivitamins with 400 micrograms of folic acid. Participants also
learned about the importance of taking folic acid and how it can prevent serious birth defects.
The transport component of the High Risk Perinatal Program (HRPP) ensured the immediate
transport of any critically ill neonate or pregnant woman at risk of premature delivery to the
appropriate level of perinatal care. By serving as payor of last resort the program was able to
facilitate transport without concern of the payor source.
The Bureau of Women's & Children's Health used Title V funding to help fund a Community
Health Grant for the Nurse Family Partnership Program in Yavapai County. The project served
149 low-income new moms with 110 babies under the age of two, pregnant women, and pregnant
teens. The Nurse Family Partnership program is an evidence-based program that provides
education and support for first time mothers through regular home visits from a public health
nurse. Each participant received education and support about the importance of prenatal,
primary and infant care; breastfeeding; reducing the incidence of obesity and overweight in
themselves and their children; post partum mood disorders; infant safety; immunizations; and
parenting. Ninety-five percent of the babies born to the Nurse Family Partnership had birth
weights greater than 2500 grams. This contractor also conducted four trainings related to
interconception health for their nurse home visitors. Women received classroom instruction on
preconception health, and received folic acid supplements. One hundred three women received
preconception health educational material.
The BWCH was awarded the HRSA First Time Motherhood/New Parents Initiative grant to
develop a social marketing campaign targeting African American men and women ages 18-30 to
increase awareness about preconception health and the life course perspective.

Table 4b, State Performance Measures Summary Sheet
Activities
1. Child Fatality Review Program distributed Infant Death
Investigation checklist.
2. Unexplained Infant Death Council and Bureau of Women’s &
Children’s Health produced the annual report on stillbirth.
3. Child Fatality Review Program produced annual report on
infant and child deaths, including recommendations for
prevention.
4. Arizona Birth Defects Monitoring Program conducted
statewide, active, population-based birth defect surveillance for
neural tube defects.
5. High Risk Perinatal Program facilitated transport of premature
or critically ill neonate to appropriate level of care.

Pyramid Level of Service
DHC ES
PBS
IB
X
X
X

X

X

124

6. High Risk Perinatal Program transported gravid woman in
imminent risk of premature or complicated delivery.
7. ADHS programs promoted use of folic acid and multivitamins.
8. Title V Community Health Grants provided education for
women of childbearing age about preconception care.
9. Title V Community Health Grants provides in-home training
and support for new mothers about reducing infant mortality.
10.

X
X
X
X

b. Current Activities
The Unexplained Infant Death Council is revising the Infant Death Checklist to promote ease of
use and comply with national trends in data reporting. Local Child Fatality Review Teams are
collaborating with community organizations to provide cribs to families who cannot afford them.
The Injury Prevention Advisory Council held its annual injury symposium on the topic of safe
sleeping. Staff are working with partners to promote safe sleeping.
ADHS programs continue to promote folic acid consumption. The Arizona Birth Defects
Monitoring Program is continuing to conduct statewide surveillance on neural tube defects.
The High Risk Perinatal Program continues to ensure the immediate transport of any critically ill
neonate or pregnant woman at risk of premature delivery to the appropriate level of perinatal
care.
The Office of Women's Health convened a taskforce to review preconception health materials
developed by Healthy Woman Florida to make them specific to Arizona. Draft materials were
distributed at a Minority Health Month event. The new materials will be shared with the state's
Medicaid health plans, posted on the web, and distributed to partners. The Office is also working
on implementation of the First Time Motherhood social marketing campaign. A marketing firm is
conducting key stakeholder interviews and developing a presentation for educational sessions in
African American churches and other organizations serving this population.

c. Plan for the Coming Year
The Child Fatality Review Program will continue to review infant and fetal deaths, and compile the
results in an annual report. The Child Fatality Review Program will continue to promote the use of
the Infant Death Investigation Checklist and expects to further strengthen its ties with local
coalitions and organizations, which include: Sudden Unexpected Infant Death Investigation Task
Force, Safe Kids, Injury Free Coalition for Kids, Governor's Traffic Safety Advisory Council, Never
Shake a Baby Arizona, Inter-Tribal Council of Arizona, Maricopa Association of Governments,
and others. The Child Fatality Review Program will enhance the usability of its annual reports by
incorporating the spectrum of prevention, in addition to incorporating guidelines for writing
effective recommendations, which include problem statements, best practices, capacity,
accountability, outcomes, and impacts.
The Bureau of Women's & Children's Health will continue to work with partners, such as the
Unexplained Infant Death Council and the First Things First Board, to promote evidence-based
safe sleeping practices.
The Arizona Birth Defects Monitoring Program will continue to work with other ADHS programs to
encourage all women of childbearing age to consume adequate amounts of folic acid daily for
neural tube defect prevention. The program will continue to participate in three or four health fairs
a year where information will be provided to the public about the importance of folic acid for birth
defect prevention. The Program will also continue to conduct statewide surveillance on neural

125

tube defects to provide feedback on the effectiveness of prevention programs in the state. By the
end of 2010, the program will have complete neural tube defect data for 2008 births.
Assuming funding remains available, the transport component of the HRPP will continue to
ensure the transport of any critically ill neonate or pregnant woman at risk of premature delivery
to the appropriate level of perinatal care. By serving as payor of last resort the program will
continue to be able to facilitate transport without concern of the payor source.
The Title V Community Health Grant program will continue to educate clients about preventing
fetal and infant deaths, and to expand the scope of information available to clients about
preconception care. Grants are funded through 2010.
The Office of Women's Health will refine the website to feature preconception health materials.
The office will begin evaluation of the First Time Motherhood social marketing campaign,
community based education sessions, and the health professional education sessions. Staff will
work on identifying other funding opportunities to sustain activities initiated under the First Time
Motherhood grant and assess the possibility of convening a preconception health council to
develop a state wide strategic plan regarding the promotion and integration of preconception care
and the life course perspective.

State Performance Measure 4: Emergency department visits for unintentional injuries per
100,000 children age 1-14.
Tracking Performance Measures
[Secs 485 (2)(2)(B)(iii) and 486 (a)(2)(A)(iii)]

Annual Objective and
Performance Data
Annual Performance
Objective
Annual Indicator
Numerator
Denominator
Data Source

2004

7,478.6
90739
1213314

2005

7,174.4
90201
1257269

2006

2007

2008

7478

7477

7477

6,902.9
89255
1293014

6,681.6
92588
1385725

6681.6

Is the Data Provisional or
Final?
Annual Performance
Objective

2009
7476

2010
7476

2011
7476

Final

AZ Hospital
Discharge data
Provisional

2012
7476

2013
7476

Notes - 2008
Data for 2008 are not yet available. The estimate for 2008 is provisionally set at the 2007 rate
until data become available in the Fall of 2009.
Notes - 2007
Data for 2007 are not yet available. The estimate for 2007 is provisionally set at the 2006 rate
until data become available in the Fall of 2008.
Notes - 2006
Data for 2006 are not yet available. The estimate for 2006 is provisionally set at the 2005 rate
until data become available in the Fall of 2007.
a. Last Year's Accomplishments
The Arizona Department of Health Services was awarded more than $4.5 million to improve child
health and wellness in Phoenix's South Mountain community. The award, received through the

126

Substance Abuse and Mental Health Services Administration's Project LAUNCH (Linking Actions
for Unmet Needs in Children's Health), will be distributed in increments of $900,000 each year for
five years.
Safe Kids established a coalition for the southern halves of Apache and Navajo counties. The
Safe Kids Navajo Nation serves the northern portion of those counties. The Arizona Safe Kids
Program created child injury fact sheets for the six Arizona Safe Kids Coalitions. The Safe Kids
program manager provided certification child passenger safety training to four communities in
Arizona, two in tribal communities in partnership with local coalitions, Banner Health or and the
Governor's Office of Highway Safety. The program provided support materials to the 30 Child
Passenger Safety Instructors in Arizona. The program collaborated on two continuing educational
programs with local coalitions or the Governor's Office of Highway Safety. The program provides
a data needs assessment to for each coalition.
In 2008, Arizona's Emergency Medical Services for Children Program began work on establishing
a pediatric designation system for hospital emergency departments. This system will identify
minimum training and equipment a hospital should have to care for a pediatric patient. In
addition, the program is updating treatment guidelines for the paraprofessional caregiver in
schools.
In 2008, the Injury Prevention program provided county specific injury fact sheets and county
child fatality fact sheets for county health departments.
The High Risk Perinatal Program (HRPP) Community Health Nurses and the Health Start
Promotoras conducted environmental risk assessments on every home visit. These assessments
helped to identify potentially hazardous situations in the home. Once identified, the Community
Health Nurse or the Promotora worked with the family to correct the situation, thereby reducing
risk and the potential for preventable emergency room visits.
Through the Title V Community Health Grants, 407 bicycle helmets were distributed, along with
helmet safety education. One contractor partnered in the coordination of a Safe Routes/Walk
Safe to school day for a local school district. A large bike rodeo was held in Navajo County. The
rodeo focused on gun safety, sun safety, bicycle and helmet safety, car seat safety, and other
safety and health related education. Two community events reaching 500 teens promoted CPR
awareness and prevention of drowning. The program also provided 1,795 youth and their
families education on wheeled sports safety and traffic safety.
Title V Community Health Grants supported 24 presentations that were given to students on fire
prevention, helmet use, and calling 911. This was conducted in conjunction with the Flagstaff
Fire Department, Guardian Medical Transport, and 12 elementary schools. Thirteen injury
prevention classes were provided to fourth grade students and 11 injury prevention classes were
provided to sixth grade students. An additional 887 high school students attended safety classes.
The Title V Community Health Grants program also funded "Safe Dates", a co-educational injury
prevention course for adolescents 12 to 18 years of age. The project provided 935 participants
with information about healthy and abusive dating relationships.
The 15th Annual Arizona Child Fatality Review Report highlighted specific areas of concern
related to unintentional injuries. These included poisonings from prescription medications,
injuries due to children not being properly restrained in motor vehicles, and injury deaths involving
All Terrain Vehicle (ATV) usage. The recommendations in the report included:
First Things First Board fund culturally competent injury prevention programs that target injuries
among children five years of age and younger;
Educational materials be developed for parents regarding the safe storage and disposal of
prescription medications;
State legislation be passed to require the use of booster seats for children between five and nine

127

years of age;
Public information and education for parents be developed regarding dangers associated with
children riding or driving ATVs;
New class be developed for ATV registration.

Table 4b, State Performance Measures Summary Sheet
Activities
1. HRPP Community Health Nurses conduct environmental
assessments.
2. Safe Kids provided certified child passenger safety training.
3. Safe Kids conducted needs assessments for the 6 Safe Kids
Coalitions.
4. EMSC is establishing and implementing pediatric designation
criteria.
5. Title V Community Health Grants provided bicycle helmet
distribution with safety education for children.
6. Title V Community Health Grants provided injury prevention
education to children.
7. State Child Fatality Review Team made recommendations for
prevention of unintentional injuries.
8.
9.
10.

Pyramid Level of Service
DHC ES
PBS
IB
X
X
X
X
X
X
X

b. Current Activities
Project LAUNCH seeks to reduce violence within the home and help to mediate the family and
community conditions in South Phoenix, including economic and family instability, incarceration,
involvement with Child Protective Services, patterns of anti-social behavior and criminality, and
educational deficits that put children at extreme risk. Interventions will improve parenting
practices and prevent child abuse and neglect.
Community Health Nurses conduct environmental risk assessments on every home visit. These
assessments help to identify potentially hazardous situations in the home. Once identified, the
Community Health Nurse work with the family to correct the situation, thereby reducing risk and
the potential for injuries.
The Safe Kids program will establish a community car seat coalition for southern Arizona. The
program will conduct five certification trainings of which three are tribal communities. The
program works with the Governor's Office of Highway Safety and local coalitions to provide
continuing education for technician recertification.
For 2009, the Emergency Medical Services for Children is completing the school guidelines for
emergency treatment and continue working toward the creation of a pediatric designation system
for emergency departments.
The Injury Prevention Program created a factsheet about ATV safety, which has been featured on
the ADHS website. Staff have conducted interviews with the media related to water safety,
choking, ATV and bike safety.

c. Plan for the Coming Year

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By FFY 2010, Project LAUNCH will have placed four Extension Family Life Educators in four
neighborhood agencies within zip codes 85040 and 85041, and will have trained two home
visitors. The home visitors will be working with caseloads of 20-30 families. The Extension
Family Life Educators will serve as case managers for participating families and will refer families
into the appropriate intervention based on an assessment of needs and assets. The program
intends to serve 100 families as part of the Strengthening Multi-Ethnic Families and Communities
program. The Extension Family Life Educators will use the Parenting Wisely curriculum with
families, as appropriate.
Assuming funding is available for the High Risk Perinatal Program, Community Health Nurses will
continue to conduct environmental risk assessments on every home visit. These assessments
help to identify potentially hazardous situations in the home. Once identified, the Community
Health Nurse will work with the family to correct the situation, thereby reducing risk and the
potential for preventable ER visits.
The EMS Children program will begin implementation of a voluntary pediatric designation process
for hospital emergency departments.
The Injury Prevention Program will work with the Governor's Office of Highway Safety to map
Arizona child passenger safety infrastructure to determine where training should be directed.
The Injury Prevention Program plans to identify gaps in training and messaging for Safe
Sleep/Unintentional suffocation with infants. This work is in collaboration with partners identified
for a Safe Sleep symposium.
The Injury Prevention Program, in partnership with Indian Health Services, will be conducting
Indian Health Service's Level I and II Injury Prevention Training.
All Terrain Vehicle injuries to children are a concern to ADHS partners and were highlighted as an
area of concern in the last annual Child Fatality Review Report. The Injury Prevention Program
will be collaborating with the Arizona Department of Game and Fish to explore opportunities to
increase community education and enforcement of current laws.
The Title V Community Health Grants will continue to identify and address community needs to
reduce the rate of injuries among children. Community grants are funded through 2010.
Health Start Promotoras will continue to conduct environmental risk assessments and educate
parents on eliminating potential injury risks.

State Performance Measure 5: The percent of women entering prenatal care during their
first trimester in underserved primary care areas.
Tracking Performance Measures
[Secs 485 (2)(2)(B)(iii) and 486 (a)(2)(A)(iii)]

Annual Objective and Performance Data
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Data Source
Is the Data Provisional or Final?
Annual Performance Objective

2004

2005

49.6
62
125

47.2
60
127

2009
47

2010
46

2006
48
50.0
62
124

2007
48
50.4
63
125

2011
46

Final
2012
45

2008
47
50.4

AZ Birth Certificates
Provisional
2013
45

Notes - 2008

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Data for 2008 are not yet available. The estimate for 2008 is provisionally set at the 2007 rate
until data become available in the Fall of 2009. The numerator is the number of Primary Care
Area's (PCA's) with less than 74% of women giving birth receiving prenatal care in the first
trimester. The denominator is the total number of PCA's in Arizona. For 2007 the percent of
women giving birth in a Arizona Medically Underserved Area (AzMUA) who received prenatal
care in the first trimester was 74.2%.
Notes - 2007
Data for 2007 are not yet available. The estimate for 2007 is provisionally set at the 2006 rate
until data become available in the Fall of 2008. The numerator is the number of Primary Care
Area's (PCA's) with less than 74% of women giving birth receiving prenatal care in the first
trimester. The denominator is the total number of PCA's in Arizona. For 2006 the percent of
women giving birth in a Arizona Medically Underserved Area (AzMUA) who received prenatal
care in the first trimester was 73.8%.
Notes - 2006
Data for 2006 are not yet available. The estimate for 2006 is provisionally set at the 2005 rate
until data become available in the Fall of 2007.
a. Last Year's Accomplishments
Women were provided prenatal services in the rural/medically underserved areas through
the County Prenatal Block Grant Program. Rural counties utilized mobile clinics for women who
had no or minimal transportation, provided immunization clinics to attract women who were at risk
of getting pregnant, and contacted high schools to develop teen pregnancy programs and teen
mazes. The County Prenatal Block Program also provided incentives for women who completed
prenatal classes, and provided free pregnancy tests.
The Health Start program educated pregnant women about prenatal care, nutrition and danger
signs of pregnancy. The Community Lay Health Workers followed-up with the clients to verify that
they were attending prenatal care medical appointments and were complying with the physician's
instructions. All contracted agencies serve communities that are designated as primary care
areas. Of those categorized as primary care areas a large portion are also designated as
medically underserved areas. One Fetal Alcohol Spectrum Disorders screening and brief
intervention training was conducted in July 2008. Approximately 64% of Health Start clients
entered the program in their first trimester of pregnancy. A Health Start 2008 Report concluded
that babies of Health Start mothers had higher gestational ages and/or full term when compared
to non-Health Start mothers. Babies of Health Start mothers also had higher birth weights when
compared to babies whose mothers were not in the program.
The Pregnancy and Breastfeeding/Baby Arizona Hotline assisted pregnant women throughout the
state in finding a prenatal care provider and helping them apply for Medicaid. Baby Arizona is a
presumptive eligibility program consisting of perinatal providers who agree to see pregnant
women while their eligibility into AHCCCS, Arizona's Medicaid, is being determined. These
providers agree to provide a payment plan if the woman does not qualify for AHCCCS. If
prescreening showed a woman was not eligible for AHCCCS, the Hotlines were able to refer
them to other providers in their area who offer prenatal care for a sliding scale fee. The Hotline
assisted 1,034 callers with Baby Arizona in 2008.
The Bureau of Women's and Children's Health (BWCH) participates in the March of Dimes
Program Services Committee. Last year, the committee identified a need to help BWCH promote
the Baby Arizona hotline. Baby Arizona provides information to uninsured or underinsured
pregnant women on where they can receive prenatal care and assists them with enrolling in the
state Medicaid program. March of Dimes provided BWCH with a small grant to provide new
promotional materials for Baby Arizona.
The Bureau of Women's and Children's Health assisted with the development of the Arizona

130

Rural Women's Health Network. The Network defined itself as a "statewide network that
coordinates and improves health outcomes for rural and underserved women in Arizona." The
Network determined its focus to be to: assess needs of rural women in Arizona; increase
awareness and advocate for needs of rural women in Arizona; gather and disseminate
information on resources and services available for rural women in Arizona; and provide
networking opportunities among organizations that provide services for rural women in Arizona.
Core network members include Community Health Centers, Arizona Health Education Centers,
Bureau of Health Systems Development, Arizona State Office of Rural Health, and BWCH.

Table 4b, State Performance Measures Summary Sheet
Activities
1. Health Start Community Health Workers assisted clients by
arranging transportation to medical services.
2. Health Start educated low-income women about the benefits
of early prenatal care.
3. The County Prenatal Block Grant program provided funding
for rural areas to help increase access to prenatal care services.
4. Pregnancy and Breastfeed/Baby Arizona Hotline linked
pregnant women to prenatal care providers throughout Arizona.
5.
6.
7.
8.
9.
10.

Pyramid Level of Service
DHC ES
PBS
IB
X
X
X
X

b. Current Activities
The Governor's Commission on Women's and Children's Health coordinated statewide events
during Women's Health Week, and planned and implemented the annual Arizona Women's
Health Expo and Conference. The Women's Health Expo targeted the general public and
provided free screenings and information to Arizona families in need. To focus on underserved
communities, the Commission has worked closely with Arizona Women's Rural Health Network to
create essential health programming in rural communities throughout the state.
The Bureau of Women's and Children's Health continues to collaborate with the Arizona Rural
Women's Health Network in order to ensure that the voice of rural Arizona is represented in
assessment, planning, and evaluation of women's health efforts. The Bureau assisted the
Network director in introducing the Network to Medicaid health plans and provided data related to
rural women's health to Network partners.
The Health Start Program provides education to Community Health Workers on interconception
care and provides new educational materials so that they can convey the information to clients on
the importance of prenatal care and ensure access to prenatal care to clients.
Funding for the County Prenatal Block Grant was discontinued in March 2009 as the result of
state budget cuts.
BWCH is working with the March of Dimes to target community organizations for dissemination of
Baby Arizona information.

131

c. Plan for the Coming Year
Health Start Program will continue to provide educational opportunities to the Community Health
Workers on prenatal care topics so that they can provide the most current information to their
clients on the importance of prenatal care, increase access to prenatal care and the need to take
multivitamins during pregnancy.
BWCH will work with March of Dimes and AHCCCS, the state's Medicaid agency, to continue to
disseminate information regarding Baby Arizona. BWCH, AHCCCS, and Department of
Economic Security (which conducts Medicaid eligibility) will continue to meet regularly to work out
any issues related to Baby Arizona.
Future funding for the state-funded County Prenatal Block Grant remains in doubt at this time.
Prenatal education and enabling services that were funded through this program are unlikely to
continue unless counties are able to secure other funding sources. The program had also
required each county health department to conduct a local needs assessment and establish a
local plan for maternal and child needs, as well as have a local MCH advisory council. This
infrastructure for local MCH will no longer be in place with the loss of the County Prenatal Block
Grant.
BWCH will continue to participate in the Arizona Rural Women's Health Network as it works to
expand its membership and implement collaborative strategies. The Network will assist with the
dissemination of Baby Arizona materials to promote access to prenatal care in rural Arizona. The
Network will also participate in the Title V needs assessment process.

State Performance Measure 6: Percent of Medicaid enrollees age 1-18 who received at least
one preventive dental service within the last year.
Tracking Performance Measures
[Secs 485 (2)(2)(B)(iii) and 486 (a)(2)(A)(iii)]

Annual Objective and
Performance Data
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Data Source

2004

2005

2006

2007

2008

42.6

42.6
255983
600379

43
30.9
170018
550768

43.5
34.0
189423
556516

2009
44.5

2010
44.5

2011
44.5

Final
2012
44.5

44
37.9
224227
592298
AZ Medicaid
(AHCCCS)
Final
2013
44.5

Is the Data Provisional or Final?
Annual Performance Objective

a. Last Year's Accomplishments
The Office of Oral Health (OOH) funded Navajo County's oral health coalition and continued to
lend support to the existing oral health coalition in Pima County as well as to the State Oral
Health Coalition. Continued support for our partners in addressing access to care issues has
been a strategy to improve oral health.
The Office of Oral Health continued the dental trailer loan program for communities and non-profit
organizations in underserved areas. Dental care is provided while the organizations seek funding
and establish permanent dental clinics. Typically, communities lease the trailers for a period of
five years. Dental students are involved in one of the current sites, providing them with
experience in delivering services to underserved and low income populations. Through this
program, nine dental clinics for underserved populations have been established throughout the
state.

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The Office of Oral Health facilitated and conducted training of approximately 450 staff members
of childcare facilities, Head Start staff, and WIC programs on early childhood oral health and
provided education on early intervention, screening and referral to approximately 100 physician
assistants and other medical providers. The Office of Oral Health maintained Intergovernmental
Agreements with counties to provide school-based dental screenings, referrals and sealants to
children in low-income schools.
A media campaign promoting the establishment of a dental home by age one was targeted at
medical and dental providers as well as the general public. Medical and dental providers
received information on the recommendation that children have a first dental visit by age on and
techniques for performing an exam or screening on this age group. This information was
approved by the Arizona Academy of Pediatrics and Arizona Dental Association and is timely
because the most recent AHCCCS periodicity schedule recommends dental referrals at 12
months rather than three years.
Through a HRSA Workforce grant, the Office of Oral Health established one pilot teledental site in
rural Arizona and continued to work toward establishing four additional pilot sites.
Through the County Prenatal Block Grant, in state fiscal year 2008 several counties focused on
oral health and birth outcome as well as importance of oral health on toddlers at the earliest age
possible. A total of 1,411 individuals received oral health related services. Children received oral
health assessments, varnish, and sealants; pregnant women received oral health education.

Table 4b, State Performance Measures Summary Sheet
Activities
1. The Office of Oral Health provided support to communities in
addressing access to care issues.
2. The Office of Oral Health provided training for childcare
providers and early childhood teachers.
3. The Office of Oral Health provided education to health care
providers.
4. County Prenatal Block Grant provided sealants and varnish for
young children.
5. County Prenatal Block Grant educated pregnant women and
new mothers on the importance of oral health.
6.
7.
8.
9.
10.

Pyramid Level of Service
DHC ES
PBS
IB
X
X
X
X
X

b. Current Activities
The Office of Oral Health continues to monitor AHCCCS Health Plans on policies for dental care
and case management, collaborates with school-based dental clinics, and partners with private
organizations and foundations to enhance preventive activities. Through a HRSA Workforce
Grant, the Office is establishing four additional pilot sites for teledentistry. Sites include the
Northern Arizona University School of Dental Hygiene, ATStill University School of Dental and
Oral Health, Northern Arizona Council of Governments Head Start, North Country Community
Health Center and two school-based clinics, one of which is on the Hopi Reservation. The sites
will be operating by August 2009 and represent diverse ways to enhance the oral health
workforce and increase access to services in underserved populations.

133

The Office continues to work with the Arizona Dental Association and Arizona Dental Hygiene
Association in an effort to improve the number of providers for the underserved. The OOH
provided continuing education credits for dentists and hygienists at the Western Regional Dental
Conference. The dental sealant program continues to provide oral screenings, referrals and
sealants to underserved children and has expanded to two additional counties this year.
Funding for the County Prenatal Block Grant program ceased in 2009. During the first three
quarters of the state fiscal year, children continued to receive oral health assessments as well as
varnish and sealants.

c. Plan for the Coming Year
Tracking of AHCCCS utilization for care will continue, as will collaboration with other agencies
and organization to promote oral health education and early intervention by dental professionals
and early dental referrals by medical professionals. The Office of Oral Health will continue
promoting a dental home by age one and training those who provide services to young children in
childcare, learning and health care environments.
The dental sealant program will continue the current Intergovernmental Agreements with the
counties and seek to increase the number of children served.
Pending receipt of a HRSA Workforce Grant, teledentistry sites will continue to expand and utilize
Affiliated Practice hygienists in underserved areas. Additionally regional coalitions will be formed
to support training for both providers and community stakeholders.
The Office of Oral Health will work with other MCH programs in the Bureau of Women's Health to
enhance integration of oral health strategies into existing programs, such as Health Start. The
Office of Oral Health will be actively participating with other BWCH programs in the Title V needs
assessment process and setting new state priorities in 2010.

State Performance Measure 8: Percent of children and youth with special health care needs
who have access to service.
Tracking Performance Measures
[Secs 485 (2)(2)(B)(iii) and 486 (a)(2)(A)(iii)]

Annual Objective and Performance
Data
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Data Source

2004

2005

2006

14.0
32631
232545

Is the Data Provisional or Final?
Annual Performance Objective

2007

2009
0.2

2010
0.2

2011
0.3

Final
2012
0.3

2008
0.1
12.8
31141
243314
OCSHCN program
reports
Final
2013
0.2

Notes - 2008
The population estimate for all residents of Arizona under age 21 is 1,946,515. SLAITS
estimates that 12.5 percent of children under age 18 have a special health care need. This
percentage was applied to the population up to age 21, as the best estimate of the proportion for

134

that population subgroup. The number of children and youth with special health care needs
under age 21 living in Arizona is estimated as 1,946,515 X 0.125 = 243,314.
Notes - 2007
The population estimate for all residents of Arizona under age 21 is 1,860,359. SLAITS
estimates that 12.5 percent of children under age 18 have a special health care need. This
percentage was applied to the population up to age 21, as the best estimate of the proportion for
that population subgroup. The number of children and youth with special health care needs
under age 21 living in Arizona is estimated as 1,860,359 X 0.125 = 232,545.
a. Last Year's Accomplishments
OCSHCN has several systems in place to link families to available services for CYSHCN.
OCSHCN and the Arizona Department of Health Services Birth Defects Registry developed a
letter to send to all families of children born with spina bifida and cleft lip/cleft palate informing
them of coverage available through the Children's Rehabilitative Services (CRS) Program. 64
children were identified, 43 were enrolled in CRS, the remaining 21 received information about
state and community resources and received a follow up call. 4 newborns diagnosed with Sickle
Cell disorders were referred to the CRS program. OCSHCN and NBS worked together to develop
NBS notification letters that are more family friendly and provide families with information about
care and services. OCSHCN educated pediatric specialists contracted by the NBS Program on
resources and how to get newborns with positive screens into health care. Upon the onset of the
new CRS contract effective 10/1/08, the contractor identified CRS members who had previous
AHCCCS eligibility and facilitated their reenrollment in AHCCCS. Enrollment in AHCCCS
provided coverage for their primary care needs.
OCSHCN worked with the Social Security Administration to review SSI applications and provide
referral information to families. In 2008, the SSI Project sent 405 letters that provided insurance
information, information on state and local services and programs, and helped connect families to
other agencies. 402 children received service coordination through the Family Resource
Coordination Program (FRC). FRC also provided outreach and training on program services to
5,755 family members, agency and tribal representatives, health care providers and child serving
agencies. OCSHCN responded to over 614 family calls and directed families to services. In 2008
two additional staff were trained to provide resource information to callers and SSI applicants.
OCSHCN supported the Bureau of Women's and Children's Health (BWCH) Children's
Information Services (CIS) Hotline to educate families on CRS, AHCCCS, insurance information,
and other services for CYSHCN. OCSHCN provided education to the Hot Line staff on services
and programs for CYSHCN. OCSHCN worked with RSK-F2FHIC and BWCH Community Nursing
to provide resource information and support to families with a child with special health care
needs.
OCSHCN participated on annual school nurse conference planning committees to include
information on services for CYSHCN. OCSHCN exhibited at school nurse conferences and
distributed a questionnaire asking the nurses if they were interested in on-line training. 121
responded they would be interested in training on Systems of Care for CYSHCN, TBI and SCI,
CRS, and transition to adulthood. OCSHCN and RSK-F2FHIC developed two e-learning training
modules for families on how to navigate Arizona's system of care and to revamp parent youth
leadership training to meet the needs of RSK volunteers. State budget cuts created changes to
eligibility and program requirements for several of the systems of care. OCSHCN has delayed
deploying this training until the budget for the next fiscal year is finalized.
Five new questions were added to the CRS Family Satisfaction survey to reflect member
awareness of the transition to the new contractor, Arizona Physicians IPA (APIPA). 84% were
aware of the contractor change. Of these respondents, 94% were satisfied or very satisfied with
the change. The new contract also allowed for the expansion of pharmacy locations. Over half of
the respondents, 59% were aware of this change. Two additional questions were included in the

135

survey relating to awareness of who to call if families have a problem with CRS. 66% knew they
could call APIPA-CRS Member Services 24 hours a day, 7 days a week and 58% knew they
could call OCSHCN if they had a problem with CRS. Two questions about internet and email
access were also added to the survey. 61% had internet access and 86% had an email account.

Table 4b, State Performance Measures Summary Sheet
Activities
1. OCSHCN links families to services for CYSHCN.
2. The Family Satisfaction survey asked respondents if they
were aware of CRS Program changes and the addition of
services.
3. Education and technical assistance are provided to other
ADHS offices, state agencies and community partners on
services for CYSHCN.
4. OCSHCN participates on the Smooth Way Home grant
workgroup to provide technical assistance to families of CSHCN
who are transitioning from the NICU to home.
5.
6.
7.
8.
9.
10.

Pyramid Level of Service
DHC ES
PBS
IB
X
X
X
X

X

X

X

X

b. Current Activities
FRC provides information, referral and education on accessing services to families, providers and
the community. The Information and Referral Project refers callers to services, provides an
overview of systems of care, provides information on eligibility and application processes, and
provides information on financial aid and behavioral health services. The SSI Project reviews
applications, sends letters to applicants informing them of insurance options, services, programs
and responds to calls that the letters generate.
OCSHCN collaborates with BWCH to provide resource information to Community Nursing on
children ineligible for other care and at risk for developmental delay, supports the CIS Hotline,
and educates staff about services. OCSHCN and the ADHS Birth Defects Registry inform families
of children with spina bifida and cleft lip/cleft palate about CRS eligibility. CRS identifies new
members who are eligible for AHCCCS. OCSHCN works with NBS notifying families of care and
services and educates pediatric specialists about services for CSHCN.
OCSHCN works with RSK to develop and distribute information on eligibility requirements for
health care services. OCSHCN participates on a Smooth Way Home grant workgroup to explore
and pilot ways to improve how babies and families transition from the NICU to home and access
community services. OCSHCN works with state school nurse organizations and AzEIP to provide
information on how to access care and services for CYSHCN.

136

c. Plan for the Coming Year
OCSHCN will develop resources and offer education to providers, families and community
partners about best practices and services for CYSHCN. OCSHCN will remain a liaison to AzEIP
providing education about AzEIP service and eligibility guidelines. The School Health Project will
partner with the Arizona Department of Education, state school nurse organizations, and the
Arizona Collaborative for Adolescent Health to provide technical assistance on best practices for
youth with special health care needs.
Bi-lingual Information and Referral Project staff will refer callers to services, provide an overview
of systems of care, provide information on eligibility and application processes and provide
information on financial aid and behavioral health services. Project staff will track barriers
identified by families in gaining access to the services and information will be shared with the
responsible agency. The Information and Referral Project will review SSI applications; send
letters to applicants informing them of insurance options, services and programs; and respond to
calls that the letters generate.
OCSHCN will work with other ADHS offices to identify resources for families regarding early
childhood development. As a member of the First Things First Health Advisory Committee,
OCSHCN will participate in the strategic planning process for Linking Actions for Unmet Needs in
Children's Health to promote the behavioral, emotional, social and physical wellness of children
0-8. OCSHCN will work with BWCH Community Nursing to identify children who may be eligible
for CRS, AzEIP, and other programs for CYSHCN and will train CIS hotline staff. OCSHCN and
the ADHS Birth Defects Registry will mail letters to families of children with spina bifida and cleft
lip/cleft palate to inform them about CRS eligibility and other services. OCSHCN will explore
adding AzEIP information to the Birth Defects Registry letters. OCSHCN and NBS will notify
families of care and services for newborns identified with a disorder and educate pediatric
specialists about services for CSHCN.
OCSHCN will partner with community organizations to get information to families. OCSHCN will
work with RSK F2FHIC to develop and distribute information on eligibility requirements for
services. OCSHCN and RSK-F2FHIC will work together to convert the Arizona Health Care
Systems Workshop into an on-line interactive class. OSCHCN's on line training Navigating
Systems of Care will be available to provide education on accessing Arizona's network of care
and services.
OCSHCN will continue on the Smooth Way Home grant workgroup providing input on services for
families with CSHCN who are transitioning from the NICU to home. The APIPA Electronic
Medical Record platform will provide a way for CRS members to receive health issue specific
information. OCSHCN will explore developing on-line training about health and wellness for
CYSHCN on topics such as adaptive recreation, specialty diets and socialization.

State Performance Measure 9: Percentage of state MCH programs that formally incorporate
screening for behavioral health issues.
Tracking Performance Measures
[Secs 485 (2)(2)(B)(iii) and 486 (a)(2)(A)(iii)]

Annual Objective and Performance
Data
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Data Source

2004

2005

2006

2007

2008

33.3
6
18

40
36.8
7
19
BWCH and OCSHCN

137

Is the Data Provisional or Final?
Annual Performance Objective

2009
40

2010
45

2011
45

Final
2012
50

data.
Final
2013
50

Notes - 2008
The programs included in this measure were; the Health Start Program, High Risk Perinatal
Program, Teen Pregnancy Prevention program, Family Planning Program, Project Launch,
Sexual Violence Prevention and Education Program, County Prenatal Block Grant program,
Community Health Services Grant, Early Childhood Health Consultation, Rural Safe Home
Network, Office of Children with Special Health Care Needs programs, and Dental Sealant and
Early Childhood Carries programs (Office of Oral Health).
Notes - 2007
The programs included in this measure were; the Health Start Program, High Risk Perinatal
Program, Teen Pregnancy Prevention program, Family Planning Program, Sexual Violence
Prevention and Education Program, County Prenatal Block Grant program, Community Health
Services Grant, early childhood health consultation, Rural Safe Home Network, Office of Children
with Special Health Care Needs programs, and Dental Sealant and Early Childhood Carries
programs (Office of Oral Health).
a. Last Year's Accomplishments
The High Risk Perinatal Program (HRPP) Community Health Nurses screened all mothers of
infants enrolled in the Newborn Intensive Care Program for postpartum depression using the
Edinburgh Postnatal Depression Scale.
The Bureau of Women's and Children's Health began implementation of a Fetal Alcohol
Spectrum Disorders Subcontract. The prevention project integrates alcohol screening, brief
intervention, and referrals for treatment into the existing Health Start Program. During state fiscal
year 2009, the project screened 287 pregnant women for alcohol use. Out of those, 70 women
screened positive for alcohol use and were provided a brief intervention. The Health Start
Program has also encouraged contractors to screen for post-partum depression utilizing the
Edinburgh Screening Tool.
The Project LAUNCH grant is being achieved through the creation of a family-centered system of
care for young children and their families; expansion of system capacity and coordination at the
State and local level; implementation of five evidence-based programs at the local level, including
Healthy Steps; access to appropriate mental health and wellness services; integration of routine
developmental screening across a range of settings; and parent education, referral and support.
During state fiscal year 2008, several counties provided behavioral health screening and
treatment for 6,509 prenatal and postpartum women through the County Prenatal Block Grant.
The County Prenatal Block Grant built infrastructure by identifying and training additional
physicians, doulas, support groups, and therapists to provide services related to post partum
depression.
Six Title V Community Health Grant contractors conducted community activities to decrease
stress. Women and children of childbearing age participated in educational programs that
addressed healthy eating and physical activity. Many of the classes conducted pre and post tests
which included questions related to stress levels and offered stress management techniques.
Many classes served women of color including Hispanic, Native American, and Black women.
CRS covers some behavioral health needs, including therapeutic trials of medications, for
conditions that relate to a member's CRS condition. When needs are identified that go beyond
the CRS covered scope of services, members are referred to and care is coordinated with
appropriate other agencies or providers.

138

Table 4b, State Performance Measures Summary Sheet
Activities
1. Community Health Nurses screened for post-partum
depression.
2. Health Start integrated screening, brief intervention, and
referrals for alcohol abuse into the program.
3. County Prenatal Block Grant provided the Edinburgh
Screening tool to all pregnant women seen in local clinics.
4. County Prenatal Block Grant educated private physicians on
signs, symptoms and resources for women who were identified
as depressed.
5. Title V Community Health Grant program supported and
maintained postpartum mood disorder support groups.
6. Title V Community Health Grant provided education on stress
reduction.
7. OCSHCN's CRS Program screens for behavioral health
issues and provides services and referrals as needed.
8.
9.
10.

Pyramid Level of Service
DHC ES
PBS
IB
X
X
X
X

X
X
X

b. Current Activities
Project LAUNCH is implementing an evidence-based intervention, Healthy Steps, for children
birth to age three and their families. Project LAUNCH has partnered with Phoenix Children's
Hospital to implement the Healthy Steps program in South Phoenix (zip codes 85040 and 85041).
The addition of a Healthy Steps Specialist to the pediatric team will lead to enhanced well-child
visits and more time to explore salient developmental, behavioral, or psychological issues.
Family health check-ups will also attempt to identify parental depression, family violence, and
drug and alcohol use.
As a result of state budget cuts, funding for the County Prenatal Block Grant ceased at the end of
the third quarter. During the first three quarters of the state fiscal year, several counties
continued to screen and identify women who had postpartum depression. They also provided
follow up care by a trained doula.
Six Title V Community Health Grant contractors are conducting community activities to decrease
stress. All of the contractors include physical activity that is suitable for their local community.
Many classes are conducing pre post assessments which include questions related to stress
levels and offer stress management techniques.
Health Start continues to build infrastructure to expand integration of screening, brief intervention,
and referrals for alcohol abuse into additional sites.
OCSHCN's CRS and FRC Programs incorporate behavioral health screening for members.

c. Plan for the Coming Year
By FFY 2010, Project LAUNCH collaborative work will be completed with Phoenix Children's
Hospital to implement the Healthy Steps program in South Phoenix.
Health Start will integrate alcohol screening, brief intervention, and referrals into all Health Start
sites. Evaluation of the program will be conducted.

139

Due to Arizona's state budget crisis, it is likely that the County Prenatal Block Grant will be
discontinued. Without funding, there will be no further services related to post-partum depression
through this program.
Depending on future funding of the High Risk Perinatal Program, Community Health Nurses will
continue to conduct post partum depression screening on moms in the program. Additional
screenings related to internatal care/preconception health are expected to be added as a
component of the program.
Six Title V Community Health Grant contractors will conduct community activities to decrease
stress. All of the contractors will include physical activity that is suitable for their local community.
Many of the classes will conduct a pre post assessment which will include questions related to
stress levels and offer stress management techniques. Many classes will serve women of color
including Hispanic, Native American, and Black women. These grants will continue through
December 2010.
OCSHCN CRS program will continue to screen for behavioral health issues and provide services
and referrals as needed.

E. Health Status Indicators
Introduction
/2010/ Most single outcome Health Status Indicators showed no significant change
between 2004 and 2007. Year to year fluctuations in data were observed across HSI 01A,
01B, 02A, 02B, 03A, and 03B. Health Status Indicators reflecting nonfatal injury continued
to show improvement in Arizona from 2004 to 2007. Compared to 2004 there were
significantly fewer total nonfatal injuries for children 14 years and younger, and nonfatal
injuries due to motor vehicle crashes for children and youth 15 through 24 years in 2007.
However, rates of Chlamydia among female adolescents and adults continued to rise. This
in part may be due to increased access to and promotion of testing for Chlamydia rather
than a true rate increase among the populations at-risk.
Population data is beginning to show the effects of the current economic recession. Total
births fell over 3 percent in 2008, and among Hispanic or Latinos, significantly fewer
infants were estimated to be living in Arizona in 2008 compared to 2007. The 2010 Census
will further illuminate the rapidly changing composition of Arizona's maternal and child
health population. //2010//

Health Status Indicators 01A: The percent of live births weighing less than 2,500 grams.
Health Status Indicators Forms for HSI 01 through 05 - Multi-Year Data
Annual Objective and Performance Data
2004
2005
2006
Annual Indicator
7.2
6.9
7.1
Numerator
6704
6640
7266
Denominator
93396 95798 102042
Check this box if you cannot report the
numerator because
1.There are fewer than 5 events over the last
year, and
2.The average number of events over the last
3 years is fewer than 5 and therefore a 3-year

2007
7.1
7285
102687

2008
7.1

140

moving average cannot be applied.
Is the Data Provisional or Final?
Final
Provisional
Notes - 2008
Data for 2008 is not yet available. The estimate for 2008 is provisionally set at the 2007 rate until
the data becomes available in the Fall of 2009.
Notes - 2007
Data for 2007 is not yet available. The estimate for 2007 is provisionally set at the 2006 rate until
the data becomes available in the Fall of 2008.
Notes - 2006
Data for 2006 not yet available. Estimates for 2006 are provisionally set at the 2005 rate until
data becomes available in the Fall of 2007.

Narrative:
/2010/ The data show no significant change in the proportion of low birth weight infants
from 2004-2007. The percent of infants born at low birth weight in Arizona remained above
the Healthy People 2010 goal of 5.0 percent. If Arizona had met the Healthy People 2010
goal with the 2007 birth cohort, 2,150 fewer infants would have been born at low birth
weight. There has been an ongoing disparity in the proportion of Black or African
American infants born at low birth weight for in Arizona. Although Hispanic/Latina and
American Indian/Alaskan Native infants had a lower percentage of low birth weight infants
than White non-Hispanics (6.6 percent compared to 7.1 percent), the percentage of low
birth weight among Black or African American infants (12.8 percent) was significantly
higher than for White non-Hispanics. The only racial/ethnic group to witness an increase
in the percentage of low birth weight since 2004 was Black or African American. All data
for low birth weight infants were obtained through the Arizona Vital Statistics Birth
Certificate Database.
Preconception, pregnancy and post-partum care are embedded in multiple Arizona
Department of Health Services' (ADHS) programs that serve women at-risk for delivering a
low birth weight infant. The Bureau of Women's and Children's Health (BWCH) Pregnancy
and Breastfeeding Hotline refers women of reproductive age to smoking cessation
programs within the ADHS Tobacco Prevention and Education Program. According to the
Arizona Behavioral Risk Factor Survey, the smoking rate among adults improved from
19.7 percent in 2007 to 15.7 percent in 2008. In addition to the positive effect of ADHS
smoking cessation programs, legislation banning smoking in most public places and a
substantial increase in the tobacco tax also had a positive effect on the prevalence of
smoking. The reduction in smoking prevalence may have a positive impact on the
proportion of low birth weight infants in the 2008 birth cohort.
With funding from Northrop Grumman Information Technology, Inc., the Health Start
Program adopted the Alcohol Screening and Brief Intervention Services program to
identify and support pregnant women at risk of using alcohol. By lowering the prevalence
of alcohol use among health start clients, this best practices intervention model lowers the
risk for low birth weight deliveries. A BWCH evaluation of Health Start participants in SFY
2007 found that those who participated in Health Start were less likely to have a low birth
weight delivery or premature birth when compared to women of similar socio-economic
status who did not participate in Arizona Health Start.
Reductions in state funding will affect the ability of ADHS programs to positively affect
this indicator. The County Prenatal Block Grant funded prenatal services and the
distribution of prenatal care vitamins to clients in rural counties. However, budget
reductions for SFY 2010 resulted in the elimination of CPBG services to rural counties.
//2010//

141

Health Status Indicators 01B: The percent of live singleton births weighing less than 2,500
grams.
Health Status Indicators Forms for HSI 01 through 05 - Multi-Year Data
Annual Objective and Performance Data
2004
2005
2006
2007
2008
Annual Indicator
5.6
5.5
5.7
5.6
5.6
Numerator
5112
5162
5632
5599
Denominator
90732 93173 99216 99889
Check this box if you cannot report the
numerator because
1.There are fewer than 5 events over the last
year, and
2.The average number of events over the last 3
years is fewer than 5 and therefore a 3-year
moving average cannot be applied.
Is the Data Provisional or Final?
Final
Provisional
Notes - 2008
The data for 2008 is not yet available. The estimate for 2008 is provisionally set at the 2007 rate
until data becomes available in the Fall of 2009.
Notes - 2007
The data for 2007 is not yet available. The estimate for 2007 is provisionally set at the 2006 rate
until data becomes available in the Fall of 2008.
Notes - 2006
Data for 2006 not yet available. Estimates for 2006 are provisionally set at the 2005 rate until
data becomes available in the Fall of 2007.

Narrative:
/2010/ The data show no significant change in the proportion of low birth weight singleton
infants from 2004-2007. The percentage of singleton births weighing less than 2,500 grams
in Arizona remained above the Healthy People 2010 goal of 5.0 percent for all deliveries. If
Arizona had met the Healthy People 2010 goal with the 2007 birth cohort, 604 fewer
singleton infants would have been born at low birth weight. All data for low birth weight
infants were obtained through the Arizona Vital Statistics Birth Certificate Database.
Preconception, pregnancy and post-partum care are embedded in multiple Arizona
Department of Health Services'(ADHS) programs that serve women at-risk for delivering a
low birth weight infant. The Bureau of Women's and Children's Health (BWCH) Pregnancy
and Breastfeeding Hotline refers women of reproductive age to smoking cessation
programs within the ADHS Tobacco Prevention and Education Program. According to the
Arizona Behavioral Risk Factor Survey, the smoking rate among adults improved from
19.7 percent in 2007 to 15.7 percent in 2008. In addition to the positive effect of ADHS
smoking cessation programs, legislation banning smoking in most public places and a
substantial increase in the tobacco tax also had a positive effect on the prevalence of
smoking. The reduction in smoking prevalence may have a positive impact on the
proportion of low birth weight infants in the 2008 birth cohort.
With funding from Northrop Grumman Information Technology, Inc., the Health Start
Program adopted the Alcohol Screening and Brief Intervention Services program to
identify and support pregnant women at risk of using alcohol. By lowering the prevalence
of alcohol use among health start clients, this best practices intervention model lowers the

142

risk for low birth weight deliveries. A BWCH evaluation of Health Start participants in SFY
2007 found that those who participated in Health Start were less likely to have a low birth
weight delivery or premature birth when compared to women of similar socio-economic
status who did not participate in Arizona Health Start.
Reductions in state funding will affect the ability of ADHS programs to positively affect
this indicator. The County Prenatal Block Grant (CPBG) funded prenatal services and the
distribution of prenatal care vitamins to clients in rural counties. However, budget
reductions for SFY 2010 are likely to result in the elimination of CPBG services to rural
counties.
Implementation of the 1st Time Motherhood Grant will produce preconception health
marketing, and community and provider eduction for African American women in 2009 or
2010. Every Woman Arizona Preconception Health materials were produced in July 2009
and posted on the web. //2010//

Health Status Indicators 02A: The percent of live births weighing less than 1,500 grams.
Health Status Indicators Forms for HSI 01 through 05 - Multi-Year Data
Annual Objective and Performance Data
2004
2005
2006
2007
2008
Annual Indicator
1.2
1.2
1.2
1.2
1.2
Numerator
1100
1119
1229
1223
Denominator
93396 95798 102042 102687
Check this box if you cannot report the
numerator because
1.There are fewer than 5 events over the last
year, and
2.The average number of events over the last
3 years is fewer than 5 and therefore a 3-year
moving average cannot be applied.
Is the Data Provisional or Final?
Final
Provisional
Notes - 2008
The data for 2008 is not yet available. The estimate for 2008 is provisionally set at the 2007 rate
until data becomes available in the Fall of 2009.
Notes - 2007
The data for 2007 is not yet available. The estimate for 2007 is provisionally set at the 2006 rate
until data becomes available in the Fall of 2008.
Notes - 2006
Data for 2006 not yet available. Estimates for 2006 are provisionally set at the 2005 rate until
data becomes available in the Fall of 2007.

Narrative:
/2010/ The data show no significant change in the proportion of very low birth weight
infants from 2004-2007. The percent of infants born at very low birth weight in Arizona
remains above the Healthy People 2010 goal of 0.9 percent. If Arizona had met the Healthy
People 2010 goal with the 2007 birth cohort, nearly 300 fewer infants would have been
born at very low birth weight. There has been an ongoing disparity in the percentage of
very low birth weight for Black or African American infants in Arizona. Although
Hispanic/Latina and American Indian/Alaskan Native infants had similar proportions of low
birth weight infants than White non-Hispanics (1.2 percent and 1.0 percent compared to
1.1 percent), the percentage of very low birth weight among Black or African American

143

infants (2.6 percent) was higher than for White non-Hispanics. All data for very low birth
weight infants were obtained through the Arizona Vital Statistics Birth Certificate
Database.
Preconception, pregnancy and post-partum care are embedded in multiple Arizona
Department of Health Services'(ADHS) programs that serve women at-risk for delivering a
very low birth weight infant. The Bureau of Women's and Children's Health (BWCH)
Pregnancy and Breastfeeding Hotline refers women of reproductive age to smoking
cessation programs within the ADHS Tobacco Prevention and Education Program.
According to the Arizona Behavioral Risk Factor Survey, the smoking rate among adults
improved from 19.7 percent in 2007 to 15.7 percent in 2008. In addition to the positive
effect of ADHS smoking cessation programs, legislation banning smoking in most public
places and a substantial increase in the tobacco tax also had a positive effect on the
prevalence of smoking. The reduction in smoking prevalence may have a positive impact
on the proportion of low birth weight infants in the 2008 birth cohort.
With funding from Northrop Grumman Information Technology, Inc., the Health Start
Program adopted the Alcohol Screening and Brief Intervention Services program to
identify and support pregnant women at risk of using alcohol. By lowering the prevalence
of alcohol use among health start clients, this best practices intervention model lowers the
risk for low birth weight deliveries. A BWCH evaluation of Health Start participants in SFY
2007 found that those who participated in Health Start were less likely to have a low birth
weight delivery or premature birth when compared to women of similar socio-economic
status who did not participate in Arizona Health Start.
Reductions in state funding will affect the ability of ADHS programs to positively affect
this indicator. The County Prenatal Block Grant (CPBG) funded prenatal care and the
distribution of prenatal care vitamins to clients in rural counties. However, budget
reductions for SFY 2010 resulted in the elimination of CPBG services to rural counties.
//2010//

Health Status Indicators 02B: The percent of live singleton births weighing less than 1,500
grams.
Health Status Indicators Forms for HSI 01 through 05 - Multi-Year Data
Annual Objective and Performance Data
2004
2005
2006
2007
2008
Annual Indicator
0.9
0.9
0.9
0.9
0.9
Numerator
860
856
882
902
Denominator
90732 93173 99216 99889
Check this box if you cannot report the
numerator because
1.There are fewer than 5 events over the last
year, and
2.The average number of events over the last 3
years is fewer than 5 and therefore a 3-year
moving average cannot be applied.
Is the Data Provisional or Final?
Final
Provisional
Notes - 2008
Data for 2008 not yet available. Estimates for 2008 are provisionally set at the 2007 rate until
data becomes available in the Fall of 2009.
Notes - 2007
Data for 2007 not yet available. Estimates for 2007 are provisionally set at the 2006 rate until
data becomes available in the Fall of 2008.

144

Notes - 2006
Data for 2006 not yet available. Estimates for 2006 are provisionally set at the 2005 rate until
data becomes available in the Fall of 2007.

Narrative:
/2010/ The data show no significant change in the proportion of very low birth weight
singleton infants from 2004-2007. The percentage of singleton births weighing less than
1,500 grams in Arizona met the Healthy People 2010 goal of 0.9 percent for all deliveries.
All data for very low birth weight infants were obtained through the Arizona Vital Statistics
Birth Certificate Database.
Preconception, pregnancy and post-partum care are embedded in multiple Arizona
Department of Health Services'(ADHS) programs that serve women at-risk for delivering a
very low birth weight infant. The Bureau of Women's and Children's Health (BWCH)
Pregnancy and Breastfeeding Hotline refers women of reproductive age to smoking
cessation programs within the ADHS Tobacco Prevention and Education Program.
According to the Arizona Behavioral Risk Factor Survey, the smoking rate among adults
improved from 19.7 percent in 2007 to 15.7 percent in 2008. In addition to the positive
effect of ADHS smoking cessation programs, legislation banning smoking in most public
places and a substantial increase in the tobacco tax also had a positive effect on the
prevalence of smoking. The reduction in smoking prevalence may have a positive impact
on the proportion of low birth weight infants in the 2008 birth cohort.
With funding from Northrop Grumman Information Technology, Inc., the Health Start
Program adopted the Alcohol Screening and Brief Intervention Services program to
identify and support pregnant women at risk of using alcohol. By lowering the prevalence
of alcohol use among health start clients, this best practices intervention model lowers the
risk for low birth weight deliveries. A BWCH evaluation of Health Start participants in SFY
2007 found that those who participated in Health Start were less likely to have a low birth
weight delivery or premature birth when compared to women of similar socio-economic
status who did not participate in Arizona Health Start.
Reductions in state funding will affect the ability of ADHS programs to positively affect
this indicator. The County Prenatal Block Grant (CPBG) funded prenatal services and the
distribution of prenatal care vitamins to clients in rural counties. However, budget
reductions for SFY 2010 are likely to result in the elimination of CPBG services to rural
counties. //2010//

Health Status Indicators 03A: The death rate per 100,000 due to unintentional injuries
among children aged 14 years and younger.
Health Status Indicators Forms for HSI 01 through 05 - Multi-Year Data
Annual Objective and Performance
2004
2005
2006
Data
Annual Indicator
9.0
10.1
8.6
Numerator
117
136
119
Denominator
1300444 1347557 1390127
Check this box if you cannot report the
numerator because
1.There are fewer than 5 events over
the last year, and
2.The average number of events over

2007

2008

8.9
126
1412725

8.9

145

the last 3 years is fewer than 5 and
therefore a 3-year moving average
cannot be applied.
Is the Data Provisional or Final?
Final
Provisional
Notes - 2008
Data for 2008 not yet available. Estimates for 2008 are provisionally set at the 2007 rate until
data becomes available in the Fall of 2009.
Notes - 2007
Data for 2007 not yet available. Estimates for 2007 are provisionally set at the 2006 rate until
data becomes available in the Fall of 2008.
Notes - 2006
Data for 2006 not yet available. Estimates for 2006 are provisionally set at the 2005 rate until
data becomes available in the Fall of 2007.

Narrative:
/2010/ No significant change was demonstrated by the unintentional injury death rate for
this age cohort of children. According to the 2009 Arizona Child Fatality Review, 20
percent of all child deaths (17 years and younger) in 2007 were due to unintentional
injuries. In 2007, more than half of all deaths among children ages one through 14 years
could have been prevented, but only 18 percent of deaths among infants were preventable.
According to Arizona Vital Statistics, 4.1 per 100,000 children aged one through 14 years
died from a motor vehicle accident, making this the most common cause of unintentional
death among this age cohort in 2007. For infants, 23 per 100,000 unintentional injury
deaths were attributed to suffocation in 2007.
The Injury Prevention Program adopted the 2006-2010 Arizona Injury and Surveillance
Plan. The purpose of the Injury Plan is to expand and improve efforts to control injury
through coordination, communication, and cooperation among the various programs in
ADHS and outside agencies. Within this Injury Plan, data-based surveillance guides the
process for determining which actions and strategies will be most effective in reducing
injury. The Child Fatality Review (CFR) Program collects, analyzes and disseminates data
for every child death in Arizona. The State Child Fatality Review Team makes specific
recommendations for legislation and education to prevent unintentional injuries among
children. In 2006 and 2007, the State Child Fatality Review Team recommended an
increase in pool safety education and strengthening of local pool barrier ordinances.
These efforts, combined with the work of the Drowning Prevention Coalition of Central
Arizona, may have contributed to the decline in child drowning deaths observed in 2007
(from 31 in 2006 to 23 in 2007). In the 2006 there was a recommendation to increase
education regarding the proper storage of firearms. The Arizonans for Gun Safety
Coalition and the Arizona Firearm Injury Prevention Coalition have strengthened efforts to
educate children and parents on firearm-related injury prevention. The Child Fatality
Review Program observed a decline in firearm-related deaths among children in 2007. The
CFR Program recommended that the Arizona Local Child Fatality Review Teams work with
local community organizations to assist their communities in establishing Cribs for Kids
Programs (or other similar programs), which provide cribs for families who cannot afford
them. A lack of funding available at the local level to implement injury prevention
programs is a barrier to implementation of all injury prevention programs in Arizona.
Safety in the home has been a focus of BWCH programs. As part of Health Start,
Community Health Workers receive training in conducting safe home inspections for
children of all clients. High Risk Perinatal Program Community Health Nurses conduct
environmental risk assessments during every home visit in order to reduce the risk of
injury/death.//2010//

146

Health Status Indicators 03B: The death rate per 100,000 for unintentional injuries among
children aged 14 years and younger due to motor vehicle crashes.
Health Status Indicators Forms for HSI 01 through 05 - Multi-Year Data
Annual Objective and Performance
2004
2005
2006
2007
2008
Data
Annual Indicator
4.5
4.3
4.0
4.0
4
Numerator
58
58
56
57
Denominator
1300444 1347557 1390127 1412725
Check this box if you cannot report the
numerator because
1.There are fewer than 5 events over
the last year, and
2.The average number of events over
the last 3 years is fewer than 5 and
therefore a 3-year moving average
cannot be applied.
Is the Data Provisional or Final?
Final
Provisional
Notes - 2008
Estimates for 2001 on reflect motor vehicle death rates for all children ages 0-14. Prior to 2001,
estimates were based on ages 1-14. Data for 2006 not yet available. Data for 2008 not yet
available. Estimates for 2008 are provisionally set at the 2007 rate until data becomes available
in the Fall of 2009.
Notes - 2007
Estimates for 2001 on reflect motor vehicle death rates for all children ages 0-14. Prior to 2001,
estimates were based on ages 1-14. Data for 2006 not yet available. Data for 2007 not yet
available. Estimates for 2007 are provisionally set at the 2006 rate until data becomes available
in the Fall of 2008.
Notes - 2006
Estimates for 2001 on reflect motor vehicle death rates for all children ages 0-14. Prior to 2001,
estimates were based on ages 1-14. Data for 2006 not yet available. Data for 2006 not yet
available. Estimates for 2006 are provisionally set at the 2005 rate until data becomes available
in the Fall of 2007.

Narrative:
/2010/ Although the rate declined from 4.5 to 4.0 per 100,000 children, there was no
significant decrease in deaths from unintentional injuries within this age cohort. Arizona's
rate of unintentional MVC deaths for children is below the Healthy People 2010 goal of 4.4
per 100,000 children aged 14 years and younger. Mortality data was obtained from the
Arizona Vital Statistics Death Certificate Database.
The BWCH has multiple programs that attempt to reduce the mortality rate from motor
vehicle crashes among children. The Community Health Grant (CHG) program funds
contractors to train car and booster seat technicians as will as purchase and distribute
those safety seats. In addition, the CHG program funds contractors that conduct
education in high schools for teen parents about proper use of restraint seats. For
premature infants, the High Risk Perinatal Program Community Health Nurses monitored
car seat usage with every home visit and continued to educate the families on the
importance of car seat usage.

147

Arizona Safe Kids is a state-wide program dedicated to the prevention of unintentional
injury for Arizona's children under 15 years of age. Arizona Safe Kids is a member of the
National Safe Kids Campaign. Local Safe Kids Coalitions throughout Arizona receive
leadership and technical assistance from Arizona Safe Kids. There are five local Safe Kids
Coalitions, one local chapter, and the Arizona State Coalition. Educational materials,
assistance in creating new coalitions, and other injury prevention strategies for
communities are available from the Arizona Safe Kids Coalition. Local Coalition
accomplishments include regular car seat testing events, a permanent car seat testing
site, child passenger safety (CPS) technician certification and development of resource
materials for public education. During the past year Safe Kids established a coalition in
southern Apache and Navajo counties to address the safety needs of rural Arizonans.
Emergency Medical Services for Children (EMSC) addresses this measure at the
infrastructure level. Through a partnership demonstration grant from National Emergency
Medical Services for Children, the Pediatric Emergencies for Pre-hospital Professionals
(PEPP) Distance Learning Project was completed. In 2008, the Emergency Medical
Services for Children began working on establishing a pediatric designation system for
hospital emergency departments. This system will identify minimum training and
equipment a hospital should have to care for a pediatric patient. In addition, the program
is updating treatment guidelines for the paraprofessional care giver in schools.
Barriers to improving Arizona's performance across this measure include cuts in funding
to the County Prenatal Block Grant which provided funding for county health departments
to distribute car seats and provide education for new parents. The Arizona legislature has
not passed booster seat legislation that could safeguard the lives of older children.
//2010//

Health Status Indicators 03C: The death rate per 100,000 from unintentional injuries due to
motor vehicle crashes among youth aged 15 through 24 years.
Health Status Indicators Forms for HSI 01 through 05 - Multi-Year Data
Annual Objective and Performance Data
2004
2005
2006
2007
2008
Annual Indicator
30.6
29.8
32.4
26.7
26.7
Numerator
254
256
287
237
Denominator
829790 859454 885751 889177
Check this box if you cannot report the
numerator because
1.There are fewer than 5 events over the
last year, and
2.The average number of events over the
last 3 years is fewer than 5 and therefore a
3-year moving average cannot be applied.
Is the Data Provisional or Final?
Final
Provisional
Notes - 2008
Data for 2008 not yet available. Estimates for 2008 are provisionally set at the 2007 rate until
data becomes available in the Fall of 2009.
Notes - 2007
Data for 2007 not yet available. Estimates for 2007 are provisionally set at the 2006 rate until
data becomes available in the Fall of 2008.
Notes - 2006
Data for 2006 not yet available. Estimates for 2006 are provisionally set at the 2005 rate until
data becomes available in the Fall of 2007.

148

Narrative:
/2010/ Although the rate declined from 30.6 to 26.7 per 100,000 youth, there was no
significant decrease in the death rate from unintentional injuries within this age cohort.
The death rate among Arizona's youth remains above the 1998 baseline national death rate
of 26.4 per 100,000 youth. The rate remains nearly three-times greater than the overall
Healthy People 2010 population goal of 9.2 per 100,000 people of all ages.
The Arizona legislature approved a graduated driver license law that requires teens aged
15 years and 6 months old to have an adult at least 21 years of age seated in the front seat
at all times, a driving curfew and supervised training for youth 16 years of age, and limits
on the number of passengers under 18 years of age. This is a best-practice infrastructure
building model that will positively affect the rate of MVC deaths for youth in Arizona. The
Child Fatality Review Program will analyze any trends observed due to the enactment of
graduated driving license restrictions for teen drivers.
The Arizona Injury Prevention Advisory Council, in conjunction with Arizona Automobile
Association implemented a two-year trial safety belt educational program for Arizona high
schools called Battle of the Belt. The schools participated in a year long program to
increase safety belt usage among students, thereby saving lives. Students observed seat
belt usage and developed appropriate intervention strategies to improve student seat belt
use at their schools. The Automobile Association of America provided monetary prizes to
schools with the highest overall safety belt use and most improved safety belt use rates.
The tool kit for implementing a Battle of the Belt program is being made available to high
schools throughout Arizona in 2009-2010.
The Community Health Grant (CHG) program funds contractors that implement education
in high schools about driving while under the influence of alcohol.
The Arizona Legislature has not passed legislation to make the use of seatbelts a primary
enforcement law. Such a measure would reduce the incidence of fatal and non-fatal
injuries among this age cohort due to motor vehicle crashes.
With the assistance of Title V funding, Coconino County Health Department (CCHD) has
addressed teen and tween safety issues in new and innovative ways. The CCHD teach
distracted driver awareness and the dangers of drinking and driving by collaborating with
local law enforcement and judges, emergency room nurses, Citizens Against Substance
Abuse, and affected families. //2010//

Health Status Indicators 04A: The rate per 100,000 of all nonfatal injuries among children
aged 14 years and younger.
Health Status Indicators Forms for HSI 01 through 05 - Multi-Year Data
Annual Objective and Performance
2004
2005
2006
Data
Annual Indicator
263.4
251.6
190.0
Numerator
3425
3391
2641
Denominator
1300444 1347557 1390127
Check this box if you cannot report the
numerator because
1.There are fewer than 5 events over
the last year, and
2.The average number of events over

2007

2008

177.2
2504
1412725

177.2

149

the last 3 years is fewer than 5 and
therefore a 3-year moving average
cannot be applied.
Is the Data Provisional or Final?
Final
Provisional
Notes - 2008
Data for 2008 not yet available. Estimates for 2008 are provisionally set at the 2007 rate until
data becomes available in the Fall of 2009.
Notes - 2007
Data for 2007 not yet available. Estimates for 2007 are provisionally set at the 2006 rate until
data becomes available in the Fall of 2008.
Notes - 2006
Data for 2006 not yet available. Estimates for 2006 are provisionally set at the 2005 rate until
data becomes available in the Fall of 2007.

Narrative:
/2010/ Compared to the 2004 rate of 263.4 per 100,000, there a significant decrease in the
2007 rate (177.2) of nonfatal injuries among children aged 14 years and younger (p<0.0001;
CI 74.9 - 97.4). Falls were the largest contributing cause of non-fatal injury among this age
cohort. The data was obtained through analysis of appropriate e-codes in the Arizona
Hospital Discharge Database.
The Injury Prevention Program adopted the 2006-2010 Arizona Injury and Surveillance
Plan. The purpose of the Injury Plan is to expand and improve efforts to control injury
through coordination, communication, and cooperation among the various programs in
ADHS and outside agencies. Within this Injury Plan, data-based surveillance guides the
process for determining which actions and strategies will be most effective in reducing
injury. Unintentional falls are the leading cause of non-fatal injury for children ages 0-14 in
Arizona.
Safety in the home has been a focus of multiple BWCH programs. As part of Health Start,
Community Health Workers receive training in conducting safe home inspections for
children of all clients. The High Risk Perinatal Program (HRPP) Community Health Nurses
also conduct environmental risk assessments during every home visit in order to reduce
the risk of infant injury and death. The Nurse Family Partnership program is an evidencebased national program that provides education and support for first time mothers
through regular home visits from a public health nurse. Each of the mothers is taught
about home and transportation safety for themselves and their children. Topics include
the use of car seats, seatbelts, and use of substances including alcohol and tobacco while
driving.
Proper helmet use during pedal bike riding can reduce injury rates among this cohort. The
Community Health Grant program funding has been used to purchase bicycle helmets and
implement bicycle riding education programs throughout Arizona. A large Bike Rodeo was
held in Navajo County. The rodeo focused on gun safety, sun safety, bicycle and helmet
safety, car seat safety, and other safety and health related education.
Arizona Safe Kids is a state-wide program dedicated to the prevention of unintentional
injury for Arizona's children under 15 years of age. Arizona Safe Kids is a member of the
National Safe Kids Campaign. Local Safe Kids Coalitions throughout Arizona receive
leadership and technical assistance from Arizona Safe Kids. There are five local Safe Kids
Coalitions, one local chapter, and the Arizona State Coalition. Educational materials,
assistance in creating new coalitions, and other injury prevention strategies for
communities are available from the Arizona Safe Kids Coalition.

150

Funding for the Arizona Poison Centers is at risk due to possible state budget cuts in SFY
2010. //2010//

Health Status Indicators 04B: The rate per 100,000 of nonfatal injuries due to motor vehicle
crashes among children aged 14 years and younger.
Health Status Indicators Forms for HSI 01 through 05 - Multi-Year Data
Annual Objective and Performance
2004
2005
2006
2007
2008
Data
Annual Indicator
66.6
56.5
50.7
45.3
45.3
Numerator
866
762
705
640
Denominator
1300444 1347557 1390127 1412725
Check this box if you cannot report the
numerator because
1.There are fewer than 5 events over
the last year, and
2.The average number of events over
the last 3 years is fewer than 5 and
therefore a 3-year moving average
cannot be applied.
Is the Data Provisional or Final?
Final
Provisional
Notes - 2008
Data for 2008 not yet available. Estimates for 2008 are provisionally set at the 2007 rate until
data becomes available in the Fall of 2009.
Notes - 2007
Data for 2007 not yet available. Estimates for 2007 are provisionally set at the 2006 rate until
data becomes available in the Fall of 2008.
Notes - 2006
Data for 2006 not yet available. Estimates for 2006 are provisionally set at the 2005 rate until
data becomes available in the Fall of 2007.

Narrative:
/2010/ Compared to the 2004 rate of 66.6 per 100,000, there was a significant decrease in
the 2007 rate (45.3) of nonfatal injuries due to motor vehicle crashes among children aged
14 years and younger (p<0.0001; CI 15.6 - 26.9). The data was obtained through analysis
of appropriate e-codes in the Arizona Hospital Discharge Database.
The Arizona Safe Kids Coalition. Local Coalition accomplishments include regular car seat
testing events, a permanent car seat testing site, child passenger safety (CPS) technician
certification and development of resource materials for public education. During the past
year Safe Kids established a coalition in southern Apache and Navajo counties to address
the safety needs of rural Arizonans.
In 2008, the Community Health Grants funded four car seat safety projects throughout the
state. Through these programs, car safety seats were installed with accompanying
education including self-installation of the child car seat by the caregiver/parent. Also, car
seats were checked for proper installation, wear, damage, or product recalls.
For premature infants, the HRPP Community Health Nurses monitored car seat usage with
every home visit and continued to educate the families on the importance of car seat

151

usage.
Barriers to improving Arizona's performance across this measure include cuts in funding
to the County Prenatal Block Grant which provided funding through county health
departments for car seat distribution and installation training for new parents. The Child
Fatality Review annual report was used to support legislation introduced in the 2008
session including a proposed enactment of booster seat legislation for children who are
between five and nine years of age and are less than four feet, nine inches in height.
However, the Arizona legislature has not passed booster seat legislation. In addition, the
legislature has not passed legislation to make the use of seatbelts a primary enforcement
law. Both measures would reduce the incidence of fatal and non-fatal injuries among older
children due to motor vehicle crashes.
With the assistance of Title V funding, Coconino County Health Department (CCHD) has
the only two nationally certified Child Passenger Safety Instructors in northern Arizona
(one Spanish speaking). In addition, CCHD has the only two "Special Needs
Transportation" certified staff in northern Arizona. This allows the county to meet the
needs of children with special healthcare needs and their families (i.e., premature babies,
children with neurological impairment, obese toddlers, etc). //2010//

Health Status Indicators 04C: The rate per 100,000 of nonfatal injuries due to motor vehicle
crashes among youth aged 15 through 24 years.
Health Status Indicators Forms for HSI 01 through 05 - Multi-Year Data
Annual Objective and Performance Data
2004
2005
2006
2007
2008
Annual Indicator
240.8
232.2
211.2
206.6
206.6
Numerator
1998
1996
1871
1837
Denominator
829790 859454 885751 889177
Check this box if you cannot report the
numerator because
1.There are fewer than 5 events over the
last year, and
2.The average number of events over the
last 3 years is fewer than 5 and therefore a
3-year moving average cannot be applied.
Is the Data Provisional or Final?
Final
Provisional
Notes - 2008
Data for 2008 not yet available. Estimates for 2008 are provisionally set at the 2007 rate until
data becomes available in the Fall of 2009.
Notes - 2007
Data for 2007 not yet available. Estimates for 2007 are provisionally set at the 2006 rate until
data becomes available in the Fall of 2008.
Notes - 2006
Data for 2006 not yet available. Estimates for 2006 are provisionally set at the 2005 rate until
data becomes available in the Fall of 2007.

Narrative:
/2010/ Compared to the 2004 rate of 240.8 per 100,000, there was a significant decrease in
the 2007 rate (206.6) of nonfatal injuries due to motor vehicle crashes among youth aged
15 through 24 years (p<0.0001; CI 6.0 - 23.2). Although there is no age specific rate goal in
Healthy People 2010, the rate in Arizona is nearly five-times lower than the goal of 933

152

motor vehicle injuries per 100,000 people of all ages. The data was obtained through
analysis of appropriate e-codes in the Arizona Hospital Discharge Database.
The Arizona legislature approved a graduated driver license law that requires teens aged
15 years and 6 months old to have an adult at least 21 years of age seated in the front seat
at all times, a driving curfew and supervised training for youth 16 years of age, and limits
on the number of passengers under 18 years of age. This is a best-practice infrastructure
building model that will positively affect the rate of MVC injuries for youth in Arizona. The
Child Fatality Review Program will analyze any trends observed due to the enactment of
graduated driving license restrictions for teen drivers.
The Arizona Injury Prevention Advisory Council, in conjunction with Arizona Automobile
Association implemented a two-year trial safety belt educational program for Arizona high
schools called Battle of the Belt. The schools participated in a year long program to
increase safety belt usage among students, thereby saving lives. Students observed seat
belt usage and developed appropriate intervention strategies to improve student seat belt
use at their schools. The Automobile Association of America provided monetary prizes to
schools with the highest overall safety belt use and most improved safety belt use rates.
The tool kit for implementing a Battle of the Belt program is being made available to high
schools throughout Arizona in 2009-2010.
The Community Health Grant (CHG) program funds contractors that implement education
in high schools about driving while under the influence of alcohol.
The Arizona Legislature has not passed legislation to make the use of seatbelts a primary
enforcement law. Such a measure would reduce the incidence of fatal and non-fatal
injuries among this age cohort due to motor vehicle crashes. //2010//

Health Status Indicators 05A: The rate per 1,000 women aged 15 through 19 years with a
reported case of chlamydia.
Health Status Indicators Forms for HSI 01 through 05 - Multi-Year Data
Annual Objective and Performance Data
2004
2005
2006
2007
2008
Annual Indicator
21.9
26.2
29.0
30.7
30.7
Numerator
4400
5451
6188
6600
Denominator
200686 208105 213698 215079
Check this box if you cannot report the
numerator because
1.There are fewer than 5 events over the
last year, and
2.The average number of events over the
last 3 years is fewer than 5 and therefore a
3-year moving average cannot be applied.
Is the Data Provisional or Final?
Final
Provisional
Notes - 2008
Data for 2008 not yet available. Estimates for 2008 are provisionally set at the 2007 rate until
data becomes available in the Fall of 2009.
Notes - 2007
Data for 2007 not yet available. Estimates for 2007 are provisionally set at the 2006 rate until
data becomes available in the Fall of 2008.
Notes - 2006

153

Data for 2006 not yet available. Estimates for 2006 are provisionally set at the 2005 rate until
data becomes available in the Fall of 2007.

Narrative:
/2010/ The rate of diagnosed Chlamydia per 1,000 women aged 15 though 19 years
increased steadily from 2004 through 2007. There was a significant difference in the 2004
rate (21.9 per 1,000) and the 2007 rate (30.7 per 1,000) (Chi square 328.63 (1), p<0.0001). As
a result of concerted Chlamydia screening activities, the number of cases identified in
Arizona increased through 2007. Although better case finding may account for the
increased rates, it is likely that the incidence of Chlamydia has grown as well. Arizona
Chlamydia case rates have tended to be three to four times higher in females than in
males. Over the period 2002 to 2006, race-specific rates were generally much lower among
non-Hispanic whites when compared to other racial/ethnic groups. The Chlamydia case
rate among Asians for this time period remained similar to or below the rate for whites.
The rate among Native Americans represented the highest race-specific rate in the state
through 2006. This may have been in part due to the aggressive and comprehensive
Chlamydia testing conducted by Indian Health Services in the state. The rising rate of
Chlamydia among blacks from through 2007, however, probably suggested a true increase
in morbidity, especially since expanded screening efforts were not identified.
The Arizona STD Program collaborated with the Arizona Family Planning Council, the
Maricopa County Public Health Laboratory, and the state health laboratories in Flagstaff
and Tucson to facilitate Chlamydia-screening activities in Arizona. Due in part to this
collaboration, Chlamydia screening efforts have expanded in family planning clinics, STD
clinics, and correctional health facilities through the Infertility Prevention Project (IPP).
The Program also receives funding from the Centers for Disease Control and Prevention to
provide test kits to public health clinics throughout Arizona. All teens who report being
sexually active are provided screening for Chlamydia and other STDs. Arizona law permits
minors to seek treatment for sexually transmitted diseases without parental or guardian
consent.
As of April, 2008 new statutory language makes legal the practice of Expedited Partner
Therapy (EPT) for STDs. Specifically, medical providers can dispense an extra dose(s) of
an antimicrobial medication to their patient to deliver to their partner or provide a
prescription for the partner. This practice is currently supported for the treatment of
partners of patients with Chlamydia and/or gonorrhea.
In 2008 the Arizona state laboratory located in Flagstaff was closed. In early 2009, Arizona
also announced the impending closure of the Tucson state laboratory, and the program is
currently in the process of arranging for the transfer of the labs that had previously been
run in Tucson to the only remaining state laboratory located in Phoenix.
The Office of Women's Health is participating in a work group that is examining STD
prevention strategies for Black women. //2010//

Health Status Indicators 05B: The rate per 1,000 women aged 20 through 44 years with a
reported case of chlamydia.
Health Status Indicators Forms for HSI 01 through 05 - Multi-Year Data
Annual Objective and Performance
2004
2005
2006
Data
Annual Indicator
8.0
9.6
11.2
Numerator
8243
10329
11849
Denominator
1033343 1075048 1061924

2007

2008

10.7
11652
1085698

10.7

154

Check this box if you cannot report the
numerator because
1.There are fewer than 5 events over
the last year, and
2.The average number of events over
the last 3 years is fewer than 5 and
therefore a 3-year moving average
cannot be applied.
Is the Data Provisional or Final?
Final
Provisional
Notes - 2008
Data for 2008 not yet available. Estimates for 2008 are provisionally set at the 2007 rate until
data becomes available in the Fall of 2009.
Notes - 2007
Data for 2007 not yet available. Estimates for 2007 are provisionally set at the 2006 rate until
data becomes available in the Fall of 2008.
Notes - 2006
Data for 2006 not yet available. Estimates for 2006 are provisionally set at the 2005 rate until
data becomes available in the Fall of 2007.

Narrative:
/2010/ Although the rate declined slightly from 2006 to 2007, there was a significant
increase in the 2007 rate of Chlamydia among women aged 20 through 44 years (10.7 per
1,000) compared to the 2004 rate (8.0 per 1,000) (p<0.0001; CI 2.4 - 3.0). Low rates of
testing among adult women mask the true rate of Chlamydia in this cohort. Arizona
Chlamydia case rates have tended to be three to four times higher in females than in
males. Over the period 2002 to 2006, race-specific rates were generally lower among nonHispanic whites when compared to other racial/ethnic groups. The Chlamydia rate among
Asians for this time period remained similar to or below the rate for whites. The rate
among Native Americans represented the highest race-specific rate in the state through
2006. This may have been in part due to the aggressive and comprehensive Chlamydia
testing conducted by Indian Health Services in the state. However, the increasing rate of
Chlamydia among blacks from through 2007 probably suggested a true increase in
morbidity, especially since expanded screening efforts were not identified.
The Arizona STD Program collaborated with the Arizona Family Planning Council, the
Maricopa County Public Health Laboratory, and the state health laboratories in Flagstaff
and Tucson to facilitate Chlamydia-screening activities in Arizona. Chlamydia screening
efforts have expanded in family planning clinics, STD clinics, and correctional health
facilities through the Infertility Prevention Project (IPP). The Program also receives
funding from the Centers for Disease Control and Prevention to provide test kits to public
health clinics throughout Arizona. All teens who report being sexually active are offered
screening for Chlamydia and other STDs. Arizona law permits minors to seek treatment for
sexually transmitted diseases without parental or guardian consent.
As of April, 2008 new statutory language makes legal the practice of Expedited Partner
Therapy (EPT) for STDs. Specifically, medical providers can dispense an extra dose(s) of
an antimicrobial medication to their patient to deliver to their partner or provide a
prescription for the partner. This practice is currently supported for the treatment of
partners of patients with Chlamydia and/or gonorrhea.
The Office of Women's Health is participating in a work group that is examining STD
prevention strategies for Black women. The largest newspaper serving the African
American community in Arizona is sponsoring a new section on health issues of concern.

155

The Office of Women's Health will be contributing articles to the newspaper.
Screening analysis capacity is being reduced in Arizona. In 2008 the Arizona state
laboratory located in Flagstaff closed. In early 2009, Arizona also announced the
impending closure of the Tucson state laboratory, and the program is currently in the
process of arranging for the transfer of the labs to the only remaining state laboratory
located in Phoenix. //2010//

Health Status Indicators 06A: Infants and children aged 0 through 24 years enumerated by
sub-populations of age group and race. (Demographics)
HSI #06A - Demographics (TOTAL POPULATION)
White
Black or
American
CATEGORY
Total
African
Indian or
All
TOTAL
American Native
POPULATION Races
Alaskan
BY RACE
Infants 0 to 1
98995
84900
4299
6366
Children 1
402486
348504
18938
24008
through 4
Children 5
465088
399109
23380
30481
through 9
Children 10
462890
393413
23854
34085
through 14
Children 15
451910
381887
22188
36662
through 19
Children 20
451886
388075
20197
31309
through 24
Children 0
2333255 1995888 112856 162911
through 24

Native
Hawaiian
or Other
Pacific
Islander

More
than
one
race
reported

Other
and
Unknown

3430

0

0

0

11036

0

0

0

12118

0

0

0

11538

0

0

0

11173

0

0

0

12305

0

0

0

61600

0

0

0

Asian

Notes - 2010
Narrative:
/2010/ The 2008 population denominators assume that Arizona grew by 1.6 percent from
6,432,007 total residents in 2007 to 6,534,921 in 2008. Arizona's youth population grew 1.4
percent from 2007 to 2008. White Hispanic and non-Hispanic infants and children make up
the vast majority (85.5 percent) of Arizona's youth. American Indian or Alaskan Native (7
percent) and Black or African American (5 percent) represent the largest racial minorities
among youth.
The slowest rate of population growth since 1990 was combined with an unprecedented
decrease of 3.4 percent in the number of resident births (the only decrease since 1991).
The percentage of White infants declined from 4.8 percent and Native American or Alaskan
Natives declined 2.1 percent from 2007 to 2008. Arizona Health Status and Vital Statistics
estimates take into account the decrease in the number of resident births and its impact
on the estimated size of the population <1 year of age. In addition, the 2008 estimates are
based on the assumption that factors affecting the population growth such as the number
of illegal residents who had been driven out of the state, the decline in construction jobs,
the number of foreclosures, the number of built but vacant homes, the decline in the
number of resident births, etc., all apply primarily to metropolitan, not rural, counties. Our
estimates of the total population of Apache, Cochise, Coconino, Gila, Graham, Greenlee,
La Paz, Navajo, Santa Cruz, and Yuma counties agree with the 2008 population estimates
developed by Population Statistics Unit in the Arizona Department of Commerce. Arizona

156

Health Status and Vital Statistics estimates for Maricopa, Mohave, Pima, Pinal, and
Yavapai counties are lower than the estimates of the Population Statistics Unit. The
estimated total of 6,534,921 residents of Arizona in 2008 is similar to the latest estimate
from the U.S. Census Bureau (6,500,180) but it is substantially lower than the Population
Statistics Unit estimate of 6,629,455.
ADHS programs (described in detail elsewhere in the grant application) utilize culturally
and linguistically appropriate interventions to meet the health needs of Arizona's diverse
maternal and child population. //2010//

Health Status Indicators 06B: Infants and children aged 0 through 24 years enumerated by
sub-populations of age group and Hispanic ethnicity. (Demographics)
HSI #06B - Demographics (TOTAL POPULATION)
CATEGORY
Total NOT Hispanic
or Latino
TOTAL POPULATION BY
HISPANIC ETHNICITY
Infants 0 to 1
56841
Children 1 through 4
228790
Children 5 through 9
278085
Children 10 through 14
290448
Children 15 through 19
300586
Children 20 through 24
302301
Children 0 through 24
1457051

Total Hispanic
or Latino
42154
173696
187003
172442
151324
149585
876204

Ethnicity Not
Reported
0
0
0
0
0
0
0

Notes - 2010
Narrative:
/2010/ Hispanics or Latinos represent 37.5 percent of the total population of youth aged 024 years in Arizona. However, Hispanics or Latinos experienced a dramatic 7.0 percent
decrease in the number of infants enumerated in 2008 compared to 2007, while nonHispanic infants declined less than 1.0 percent. No other cohort of Hispanic or Latino
youth experienced a decline in population. Arizona Health Status and Vital Statistics
estimates take into account the decrease in the number of resident births and its impact
on the estimated size of the population <1 year of age. In addition, the 2008 estimates are
based on the assumption that factors affecting the population growth such as the number
of illegal residents who had been driven out of the state and/or did not immigrate into
Arizona at similar rates, the decline in construction jobs, the number of foreclosures, the
number of built but vacant homes, the decline in the number of resident births, etc., all
apply primarily to metropolitan, not rural, counties. Arizona Health Status and Vital
Statistics estimates of the total population of Apache, Cochise, Coconino, Gila, Graham,
Greenlee, La Paz, Navajo, Santa Cruz, and Yuma counties agree with the 2008 population
estimates developed by Population Statistics Unit in the Arizona Department of
Commerce. Our estimates for Maricopa, Mohave, Pima, Pinal, and Yavapai counties are
lower than the estimates of the Population Statistics Unit.
ADHS programs (described in detail elsewhere in the grant application) utilize culturally
and linguistically appropriate interventions to meet the health needs of Arizona's diverse
maternal and child population. //2010//

157

Health Status Indicators 07A: Live births to women (of all ages) enumerated by maternal
age and race. (Demographics)
HSI #07A - Demographics (Total live births)
White
Black or
CATEGORY Total
African
All
Total live
American
Races
births
Women < 15
Women 15
through 17
Women 18
through 19
Women 20
through 34
Women 35
or older
Women of all
ages

American
Indian or
Native
Alaskan

Asian

Native
Hawaiian
or Other
Pacific
Islander

More
than one
race
reported

Other and
Unknown

161

126

12

22

1

0

0

0

4151

3493

203

408

23

3

0

21

7849

6542

441

755

81

5

0

25

74898

64111

3201

4621

2531

53

0

381

12156

10292

444

556

722

7

0

135

99215

84564

4301

6362

3358

68

0

562

Notes - 2010
Narrative:
/2010/ According to Arizona Health Status and Vital Statistics estimates the proportion of
total births born to adolescents aged 19 and younger declined slightly from 12.6 percent to
12.3 percent of total births. The birth rate per 1,000 females 19 years and younger fell from
29.7 in 2007 to 27.4 in 2008, a 7.7 percent reduction. Females aged 18-19 years assumed
the highest birth rate at 96.3 per 1,000 in 2008. However, this was still an 8.6 percent
reduction in the birth rate for this age cohort compared to 2007 (105 per 1,000).
The White (Hispanic and non-Hispanic) birth rate for teens aged 15-19 years fell from 59.0
to 54.3 per 1,000 females, a nearly 8 percent reduction. American Indian or Alaskan Native
also saw a significant reduction in teen births from 70.4 to 64.1 per 1,000 females aged 1519 years. However, the birth rate for Black of African American teens rose from 60.8 in
2007 to 63.3 per 1,000 females aged 15-19 years in 2008. Among older women aged 35-44
years of age, the birth rate remained steady in 2008 at slightly more than 27 births per
1,000 women.
The Reproductive Health/Family Planning Program focused on making services available
to sexually active teens in an effort to reduce teen pregnancy rates. In 2008, 54% of clients
served were under 24 years old. The RHFP collaborated with the Title X and Arizona
Family Planning Council (AFPC) to share data to analyze trends and outcomes of family
planning services among this group. The RHFP will also continue to focus on providing
reproductive health/family planning services to sexually active teens. BWCH received a
grant from the National Campaign to Prevent Teen and Unplanned Pregnancy to focus on
women in their 20's. The RHFP intends to collaborate with this new program once it
begins.
Fourteen of the fifteen counties were funded to provide Teen Pregnancy Prevention
programming to youth and parents. Partnerships were developed with the county juvenile
probation in order to encourage participation in program from youth on probation, this has
been very successful. Three pilot programs were funded through the Division of
Behavioral Health to integrate teen pregnancy prevention messages into current
programming, these programs were cancelled due to budget cuts. //2010//

158

Health Status Indicators 07B: Live births to women (of all ages) enumerated by maternal
age and Hispanic ethnicity. (Demographics)
HSI #07B - Demographics (Total live births)
Total NOT Hispanic or
CATEGORY
Latino
Total live births
Women < 15
50
Women 15 through
1406
17
Women 18 through
3491
19
Women 20 through
43224
34
Women 35 or older
7842
Women of all ages
56013

Total Hispanic or
Latino
111

Ethnicity Not
Reported
0

2724

21

4333

25

31292

381

4179
42639

135
562

Notes - 2010
Narrative:
/2010/ According to Arizona Health Status and Vital Statistics estimates Hispanic or Latina
females have the highest birth rate among their age cohort in Arizona. Among Hispanic or
Latina females aged 15-19 years 96.7 per 1,000 delivered a birth in 2008. For 18-19 year old
Hispanic or Latina females, the birth rate was 163.1 per 1,000. These rates were
significantly greater than those rates found among non-Hispanic females (17.1 for 15-19
year olds and 63.5 for 18-19 year olds). However, it is important to note that the rate of
births for Hispanic or Latina teens declined 9.3 percent (15-19 year olds) and 10.7 percent
(18-19 year olds) from the 2007 rates.
Declines in the birth rates for Hispanic or Latinas were also seen among adult women.
Birth rates for Hispanic or Latina females declined from 157.9 per 1,000 women aged 20
through 34 in 2007, to 142.4 per 1,000 in 2008. The 9.8 percent decline in the birth rate
among this cohort contrasts sharply with the increase in the birth rate among nonHispanic or Latinas in 2008. //2010//

Health Status Indicators 08A: Deaths of infants and children aged 0 through 24 years
enumerated by age subgroup and race. (Demographics)
HSI #08A - Demographics (Total deaths)
White Black or
CATEGORY Total
African
All
Total deaths
American
Races
Infants 0 to 1
Children 1
through 4
Children 5
through 9
Children 10
through 14
Children 15
through 19

American
Indian or
Native
Alaskan

Asian

Native
Hawaiian
or Other
Pacific
Islander

More than
one race
reported

Other and
Unknown

625

466

76

52

26

1

0

4

128

96

10

15

4

0

0

3

66

49

10

7

0

0

0

0

68

56

6

4

2

0

0

0

297

231

19

41

4

0

0

2

159

Children 20
through 24
Children 0
through 24

458

357

31

64

4

0

0

2

1642

1255

152

183

40

1

0

11

Notes - 2010
Narrative:
/2010/ Total infant mortality decreased from 705 deaths in 2007 to 625 in 2008, a reduction
of 11 percent. Although the infant mortality rate declined from 6.8 to 6.3 per 1,000 live born
infants from 2007 to 2008, no consistent reduction has been seen in infant mortality in
Arizona during the past six years. In 2008 the Arizona infant mortality rate remained
similar to the national rate of 6.7 per 1,000 live births (2006). The data for infant mortality is
found in advanced analysis of 2008 Arizona Vital Health and Statistics.
Racial disparities in infant and youth mortality remain persistent in Arizona. Although
Whites (Hispanic and non-Hispanic) had the most total infant deaths, Black or African
American infant mortality (17.7 per 1,000 live born infants) was more than three times as
great at the rate for Whites (5.5 per 1,000 live born infants), and two-times as great as the
rate found in American Indian or Alaskan Native infants (8.2 per 1,000 live born infants).
Among older youth aged 15 through 19, there was a 13 percent decrease in the total
number of deaths in 2008 (297) compared to 2007 (341). Racial disparities were less
apparent in the mortality rates for older youth. The mortality rate for White youth (1.5 per
1,000 residents aged 15 through 19), Black or African American youth (1.4), and American
Indian or Alaskan Native youth (1.7) were similar in 2008. The population denominator was
based on population projections that are less precise than birth certificates. Thus, the
rates are estimates of mortality across this age cohort.
In 2008, Child Fatality Review teams reviewed 100 percent of deaths for all children in
Arizona, including infant deaths. These teams examined and identified the circumstances
surrounding the deaths that could have been prevented. The data were analyzed for public
policy and prevention campaigns and reports were provided to the public for research,
media reports, and public health campaigns.
In September 2008 the Office of Newborn Screening merged with the Bureau of State
Laboratory Services and is now able to provide transparent continuity of care for all
newborn screens. Services, beginning with the receipt of a blood spot card, through case
management follow up services, demographics entry, and up to diagnosis, are completed
in the same location.
The transport component of the High Risk Perinatal Program continues to ensure the
immediate transport of any critically ill neonate or pregnant woman at risk of premature
delivery to the appropriate level of perinatal care.
The Community Health Grant program continues to educate clients about preventing fetal
and infant deaths, and to expand the scope of information available to clients about
preconception care.
Funding for the County Prenatal Block Grant has been discontinued. Prenatal education
and enabling services that were funded through the CPBG have sought other funding or
been discontinued. //2010//

160

Health Status Indicators 08B: Deaths of infants and children aged 0 through 24 years
enumerated by age subgroup and Hispanic ethnicity. (Demographics)
HSI #08B - Demographics (Total deaths)
CATEGORY
Total NOT Hispanic or
Latino
Total deaths
Infants 0 to 1
348
Children 1 through 4
63
Children 5 through 9
40
Children 10 through
37
14
Children 15 through
171
19
Children 20 through
312
24
Children 0 through
971
24

Total Hispanic or
Latino
275
62
26

Ethnicity Not
Reported
2
3
0

31

0

125

1

143

3

662

9

Notes - 2010
There was a correction for 2006 mortality data by ethnicity among infants. The 2006 data should
read:

Infants 0 to 1

Not Hispanic/Latino Hispanic/Latino
365
338
2

Not reported

There was a correction for 2006 mortality data by ethnicity among children 15 through 19. The
2006 data should read:
Not Hispanic/Latino
Children 15-19 216
125

Hispanic/Latino

Not reported
0

Narrative:
/2010/ There was a 19 percent decline in the number of Hispanic or Latino infant deaths
between 2007 and 2008 (see footnote in data). The overall infant mortality rate for Hispanic
or Latino declined from 7.4 percent to 6.4 percent, nearly equal to the non-Hispanic or
Latino rate of 6.2 per 1,000 live births. The dramatic decline in births attributed to Hispanic
or Latinos in 2008 compared to 2007 resulted in a highly variable infant mortality rate
change that was not found across other age groups. For instance, in the 15-19 age cohort
the same number of Hispanic or Latino youth died in 2007 and 2008 (125) resulting in
nearly the same mortality rate (.8 of 1,000 youth aged 15-19 years). Population counts of
Hispanic or Latino youth are estimates and therefore, mortality rates for this cohort are
less precise than for infants which rely on counts of annual birth certificates. In addition
the population counts are of residents which do not take into account for the substantial
number of non-resident Hispanic or Latinos in Arizona.
The Health Start Program is a preventative health program that provides case
management in high risk communities with a focus on improving birth outcomes and the
health of children. The 2008 study of AZ Health Start concluded that babies of Health Start
mothers had higher gestational ages and/or full term when compared to non-Health Start
mothers. Babies of Health Start mothers also had higher birth weights when compared to
babies whose mothers were not in the program. The proportion of very low birth weight
infants born to Health Start clients was approximately 1%. The majority of infants in the

161

study were of Hispanic or Latino ethnicity. //2010//

Health Status Indicators 09A: Infants and children aged 0 through 19 years in miscellaneous
situations or enrolled in various State programs enumerated by race. (Demographics)
HSI #09A - Demographics (Miscellaneous Data)
CATEGORY
Misc Data
BY RACE

All children
0 through 19
Percent in
household
headed by
single
parent
Percent in
TANF
(Grant)
families
Number
enrolled in
Medicaid
Number
enrolled in
SCHIP
Number
living in
foster home
care
Number
enrolled in
food stamp
program
Number
enrolled in
WIC
Rate (per
100,000) of
juvenile
crime
arrests
Percentage
of high
school dropouts (grade
9 through
12)

Black or
African
American

American
Indian or
Native
Alaskan

Asian

Native
Hawaiian
or Other
Pacific
Islander

More
than
one
race
reported

Other
and
Unknown

Specific
Reporting
Year

1607813

92659

131602

49295

0

0

0

2008

23.1

21.1

42.8

31.0

13.3

24.0

27.3

25.2

2008

3.4

3.0

8.2

5.6

0.9

0.0

0.0

0.0

2008

657340

517327

44042

74937

9860

0

0

11174

2008

63688

53084

1677

4686

1101

0

0

3140

2008

20024

15127

2694

1449

178

0

0

576

2008

365396

285090

29900

45413

2324

1136

0

1533

2008

258824

234916

14901

5249

2611

1147

0

0

2008

5046.9

4993.1

8203.1

3427.5

1484.3

0.0

0.0

0.0

2008

4.8

5.3

5.6

11.3

2.2

0.0

0.0

0.0

2007

Total
All
Races

White

1881369

Notes - 2010
Narrative:
/2010/ The number of children aged 0 through 19 in Arizona increased by 1.2 percent
according to state population estimates. The largest increase was estimated to be among
Black or African American (1.7 percent) and Whites (1.2 percent). Although the percent of
this age cohort in families on TANF (Temporary Assistance to Needy Families) remained
basically the same in 2008, the effects of the economic recession were seen in other
categories. For instance, there were substantial increases in the number of children in this
age cohort enrolled in Medicaid (11.1 percent), receiving food stamps (14.8 percent), and

162

infants enrolled in WIC (5.9 percent) in 2008. All racial groups saw increased enrollment in
these social service programs beyond estimated population growth. These increases may
reflect a combination of changes in program eligibility, program outreach, and the
deleterious effects of the economic recession on Arizona's most vulnerable children.

Although the Arizona MCH Title V program does not fund most of these programs, Title V
funding is used to support the maternal and child health needs of populations that utilize
these programs. For instance, the Office of Oral Health continues to maintain dental
trailers on loan to communities or non-profit organizations to provide care in underserved
areas. Training was provided to approximately 450 staff members of child care facilities,
Head Start staff, and WIC programs on early oral health issues and early intervention. The
Dental Sealant program reaches children in underserved and low-income areas and
through a HRSA Work Force grant piloted tele-dental sites in rural Arizona. A media
campaign promoting the establishment of a dental home was targeted at medical and
dental providers as well as the general public.
The Teen Pregnancy Prevention Program (TPP) actively works with juvenile detention
facilities and the Department of Economic Security to provide education on teen
pregnancy prevention to incarcerated youth and those in foster care. Inter-agency
collaboration has enabled a Title V funded program such as the TPP to reach a cohort of
youth that would otherwise be missed with traditional outreach in public schools.
Many of the various state programs listed above have experienced or will experience
substantial cuts in service capacity due to the economic recession. Particularly hard hit is
the Department of Economic Security which supports TANF, food stamps, foster care
programs, and child abuse prevention. Service capacity is not expected to keep up with
the need for these services among this age cohort in 2009. //2010//

Health Status Indicators 09B: Infants and children aged 0 through 19 years in miscellaneous
situations or enrolled in various State programs enumerated by Hispanic ethnicity.
(Demographics)
HSI #09B - Demographics (Miscellaneous Data)
CATEGORY
Total NOT
Total
Hispanic or
Hispanic or
Miscellaneous Data BY
Latino
Latino
HISPANIC ETHNICITY
All children 0 through 19
Percent in household headed
by single parent
Percent in TANF (Grant)
families
Number enrolled in Medicaid
Number enrolled in SCHIP
Number living in foster home
care
Number enrolled in food stamp
program
Number enrolled in WIC
Rate (per 100,000) of juvenile
crime arrests
Percentage of high school dropouts (grade 9 through 12)

Ethnicity Not
Reported

Specific
Reporting
Year

1154158

727211

0

2008

24.8

23.5

0.0

2008

2.6

4.6

0.0

2008

314866
25260

331300
38893

11174
3140

2008
2008

12913

7111

576

2008

158341

207055

0

2007

79660

179164

0

2008

4745.8

5565.3

0.0

2008

4.6

7.3

0.0

2007

Notes - 2010

163

Narrative:
/2010/ The number of Hispanic or Latino children aged 0 through 19 in Arizona increased
by 1.1 percent according to state population estimates. There were substantial increases
in the number of Hispanic or Latino children in this age cohort enrolled in Medicaid (9.4
percent), receiving food stamps (15.8 percent), enrolled in foster care (4.9 percent), and
infants enrolled in WIC (4.8 percent) in 2008. It is important to note that residency status of
Hispanic or Latino youth impacts access to state programs. Therefore, the increase in
enrollment in these programs may not reflect the true magnitude of need among all
Hispanic or Latino youth living in Arizona regardless of residency. Kids Care (SCHIP) is a
federal and state program administered by Arizona Medicaid to provide health care
services for children under the age of 19 living in families with a gross income at or below
200 percent of the Federal Poverty Level (FPL). In 2008 enrollment in Kids Care dropped
2.3 percent despite the eligibility requirements remaining the same. The decrease was
among those of Hispanic or Latino ethnicity (3.6 percent) while non-Hispanic or Latinos
witnessed a large increase in Kids Care enrollment (16.9 percent). Decline in Hispanic or
Latino immigration to Arizona is a possible explanation for the reduction in Kids Care
enrollment among this ethnic group. //2010//

Health Status Indicators 10: Geographic living area for all children aged 0 through 19 years.
HSI #10 - Demographics (Geographic Living Area)
Geographic Living Area
Living in metropolitan areas
Living in urban areas
Living in rural areas
Living in frontier areas
Total - all children 0 through 19

Total
1865245
1422546
427368
31455
1881369

Notes - 2010
The proportions living in metropolitan areas from the 2000 Census were applied to the total
Arizona Department of Economic Security population estimates for 2008 to estimate the numbers
living in metropolitan areas.

Narrative:
/2010/ The percentage of children aged 0 through 19 years living in metropolitan areas and
urban areas increased by 1.3 and 2.8 percent respectively in 2008. Revisions in the
methodology used to estimate the number of children reported living in rural and frontier
areas in 2008 made comparisons with previous year data unreliable. //2010//

Health Status Indicators 11: Percent of the State population at various levels of the federal
poverty level.
HSI #11 - Demographics (Poverty Levels)
Poverty Levels
Total Population
Percent Below: 50% of poverty
100% of poverty
200% of poverty

Total
6500180.0
5.2
12.5
30.5

Notes - 2010

164

Narrative:
/2010/ The total population of Arizona was estimated to have increased by 2.5 percent
according to U.S. Census Current Population Survey. According to the 2007 U.S. Current
Population Survey, more than 12.5 percent of Arizonan's were living at or below 100
percent of the federal poverty level, and 30.5 percent were living at or below 200 percent of
the poverty level. More than 5.2 percent of Arizonans were classified as severely poor
during this time period. All poverty categories decreased slightly from previously reported
estimates across this measure which relied on the 2000 U.S. Census proportions. The full
effect of the economic recession in Arizona is likely to result in increased proportions of
Arizonans at all levels of poverty in 2009.
The percent of federal poverty level for eligibility in the State's SCHIP program for infants,
children and pregnant women remains 200 percent. However, the poverty level for
eligibility in State Medicaid programs is lower; 140 percent for infants, 133 percent for
children one through five years old, 100 percent for children six through 18 years old, and
150 percent for pregnant women. //2010//

Health Status Indicators 12: Percent of the State population aged 0 through 19 years at
various levels of the federal poverty level.
HSI #12 - Demographics (Poverty Levels)
Poverty Levels
Children 0 through 19 years old
Percent Below: 50% of poverty
100% of poverty
200% of poverty

Total
1881369.0
10.4
20.0
45.4

Notes - 2010
Narrative:
/2010/ According to the 2008 U.S. Census Current Population Survey (data collected in
2007), an estimated 20 percent of zero through 19 year olds were living at or below the
federal poverty line. This figure is similar to the proportion of youth estimated to be living
in poverty during the previous three years (21 percent). There were, however, more youth
living from 100 to 200 percent of the poverty level (45.4 oercent) compared to previous
estimates. Because of the small sample size of this survey, none of these differences were
significant. However, we anticipate that the proportion of zero through 19 year olds that
are below each level of poverty will increase over the 2008 and 2009 surveys due to the
effects of the economic recession in Arizona.
The percent of federal poverty level for eligibility in the State's SCHIP program for infants,
children and pregnant women remains 200 percent. However, the poverty level for
eligibility in State Medicaid programs is lower; 140 percent for infants, 133 percent for
children one through five years old, 100 percent for children six through 18 years old, and
150 percent for pregnant women. //2010//

F. Other Program Activities

165

Toll-Free Hotlines. OWCH operates two toll-free hotlines: the Children's Information Center (CIC)
and the Pregnancy and Breastfeeding Hotline. The CIC is a statewide, bilingual/bicultural toll-free
number (TDD available for the hearing-impaired in Maricopa County) that provides information,
referral, support, education and advocacy to family care givers and health care professionals
throughout Arizona. Follow-up is provided to all those who call the number. The Pregnancy and
Breastfeeding Hotline is a bilingual/bicultural hotline that facilitates entry of pregnant women into
prenatal care services. Although the service is available to any caller, the target population is lowincome women and those with culturally diverse needs. It provides advocacy, education,
information and support to disadvantaged women and their families. Follow-up calls are provided
to all those who use the number. The OWCH Hotline staff has assumed responsibility for the WIC
Hotline and WIC provides training and technical assistance for the Hotline staff. A decision was
made to reinstitute Baby Arizona, which is a presumptive eligibility process which guarantees
physicians who see pregnant women that their first prenatal care visit will be covered by
AHCCCS, even before the woman is determined to be eligible for AHCCCS services. Hotline
staff will assist in referring women to Baby Arizona.
/2007/The State Systems Development Initiative (SSDI) will convene stakeholders to identify
unmet program information needs. SSDI will collect feedback regarding if data is accessible,
yields information that identifies and monitors trends, supports strategic planning, coordinates,
integrates, and directs resources. SSDI will prioritize needs and will develop a plan based on
unmet priority-need areas.//2007//
State Early Childhood Comprehensive Systems Grant (SECCS). The Office of Women's and
Children's Health worked in partnership with the Governor's Office to submit the application for
the SECCS to work with stakeholders to develop strategies to better integrate early childhood
services and to develop a statewide Early Childhood Systems Plan. ADHS was awarded
$100,000 per year for two years beginning July 1, 2003. Funds were used to provide support to
the Governor's School Readiness Board. Many people from ADHS, including OWCH staff,
participated on subcommittees of the School Readiness Board. Staff will provide support to
SECCS planning process as needed. The Board provided its recommendations to the Governor
in the fall of 2003, and an implementation plan was released in 2005.
One of the recommendations of the Governor's School Readiness Action Plan recommends
developing a health and safety consultation system for childcare providers. The Office of
Women's and Children's Health, in conjunction with the Arizona Center for Community Pediatrics,
sponsored a telephone survey to evaluate health and safety issues that childcare providers deal
with on a regular basis. This survey, which was conducted in 2004, assessed the need for
technical support and training in licensed childcare for children five years old and younger.
Results of the survey are summarized in the five-year needs assessment document (in the
section on Children and Adolescents) accompanying this application.
/2007/Hearing screening is mandated for all Arizona schools. The Program collaborated with the
University of Arizona to create a draft curriculum outline for Vision Screening training. The
Program monitors the number of children in Arizona schools who receive hearing screening and
vision screening. The Program trains hearing screening trainers and monitors the training for
hearing screeners to determine their compliance with Arizona Hearing Screening Rules. The
Program loans audiometers to schools to provide hearing screening to children. The Program will
continue development of a vision-screening curriculum and will begin developing a Train the
Trainer Program in Vision Screening.
The Early Childhood Health Consultation Project in Pima County conducted a variety of activities,
some of which are discussed under other sections of this application. In addition to those
activities, the program worked closely with the Governor's School Readiness Board on initial
steps to develop a statewide health consultation system. This work is being done in conjunction
with the State Early Childhood Comprehensive Systems Grant. The Project responds to requests
from childcare programs, collaborates with county partners in the development of resources for

166

childcare programs, and promotes best practices related to health and safety of childcare centers.
The Project will update the communicable disease flipchart used by childcare providers, will
provide training for health professionals utilizing the National Training Institute for Child Care
Health Consultants as a guide. The Project will also work with the United Way of Southern
Arizona to complete the Quality Rating system for childcare centers that has been developed and
piloted.//2007//
Cultural competence:
/2007/Cultural competency will be addressed in other sections of this application for those
programs that are discussed under specific performance measures and health systems capacity
indicators.//2007// In addition to the information provided in those sections, OWCH programs take
measures to ensure that services are linguistically and culturally appropriate, and family centered.
The following are just a few examples: Community grants were set up specifically to address
cultural competence by putting program design into the hands of the community to ensure that
they will reflect the unique circumstances and cultural characteristics of each community. Each
year OWCH sponsors the statewide Family Centered Practice Conference which supports family
involvement and improves families' ability to access and utilize community services. OWCH is
currently working with the Governor's Minority Advisory Council to develop specific strategies to
address disparities, including health issues. Meetings focus attention on issues affecting each
minority group to examine relationships between the group's social and cultural characteristics
and their health status. Health disparity information is shared with community leaders who
provide context to statistics, and who can mobilize support.
/2009/OCSHCN staff and CRS contractors participate in an annual cultural competence selfassessment. Results are used to establish a baseline regarding staff perceptions, develop plans
that address changes in policy and procedure, and identify training opportunities. OCSHCN
facilitates a monthly cultural competency committee meeting. The committee includes OCSHCN
staff, BHS staff, CRS contractors and outside agencies. The committee has discussed
information and resources about immigration and has reviewed tools for organizational cultural
competency self-assessments. OCSHCN's practices, policies and training stress the need for
providers to recognize the cultural, racial, ethnic, geographic, social, spiritual and economic
diversity and individuality of families. OCSHCN requires contractors to provide culturally
competent service, requires them to use language assistance services and monitors them for
compliance. Family satisfaction surveys are conducted in English and Spanish and results are
tabulated by race, ethnicity and the need for translation services.//2009//
2010/ The OCSHCN Cultural Competency committee meets quarterly. OCSHCN uses the weekly
e-letter OCSHCN Currents to provide education on CLAS standards, use of the language line and
other information about cultural awareness and sensitivity. Cultural competency training is part of
monthly staff meetings//2010//
E-Learning
/2009/ OCSHCN's e-learning program added 46 new courses to the learning management
system (LMS), expanded registration to 490 external partners, partnered with AHCCCS to include
their e-learning domain on the LMS, and partnered with BHS and RSK - F2FHIC to develop
courses. OCSHCN's website is used to offer information to families, providers and the community
and to seek public input on programs and services. Information on cultural competency is
available on the website.//2009//

G. Technical Assistance
Only one request is being made for technical assistance, and it is related to collecting data for
National Performance Measure 15, the percent of women who smoke in the last three months of
pregnancy. The State of Arizona does not participate in PRAMS and we are unaware of any
other data source for this measure.

167

/2008/For the 2008 application year, Arizona is requesting technical assistance to assist with one
of our state defined priorities. The Bureau of Women's and Children's Health would like
assistance with identifying models for integrating behavioral health with MCH programs. Related
to the priority of preventable infant mortality, BWCH also request assistance with identifying a
preconception health self assessment tool and training and tools to integrate life course
perspectives into public health programs; strategies for funding preconception care; and framing
preconception health message among different populations. Related to the state priorities of
overweight and obesity among women and children, the Bureau also requests assistance related
to best practices and tools for addressing obesity/overweight in the MCH population. /2008//
/2010/ The Bureau of Women's and Children's Health is requesting technical assistance to
complete a Phase I Perinatal Periods of Risk Analysis. Specifically, the Bureau would like
examples of SAS code used to manage the multiple data sets used in PPOR analyses, and
code used to conduct the analyses. //2010//

168

V. Budget Narrative
A. Expenditures
The state's match and overmatch continues to exceed the 1989 maintenance of effort.
The budgeted amounts are based on previous year's projections and do not correlate well with
the actual budgeted amount because of the unpredictability of the actual award amount and
program changes that occur.
/2007/There are no updates for this year//2007//
/2008/There are no updates for this year//2008//
/2009/There are no updates for this year//2009//
/2010/There are no updates for this year//2010//

B. Budget
In 1998, the Arizona Department of Health made the decision to transition the MCH budgeting
cycle from a federal fiscal year to a calendar fiscal year. Consequently, the annual reporting of
budgeted, encumbered, and expended monies through September 30th is misleading in that we
actually have another three months remaining in our calendar year budget cycle so expenditures
will appear less than they should be while remaining money will appear greater.
The estimated Title V allocation for Arizona: For FFY2006 $7,769,858. More than 32%
($2,512,683) will be allocated for preventative and primary care needs for children and
adolescents; 30% ($2,330,957) for children with special health care needs; less than 28%
($2,149,233) for women, mothers and infants and 10% ($776,985) for administrative
costs/2007/For FFY2007 $7,512,293. More than 30% ($2,286,514) for preventative and primary
care needs for children and adolescents; 30% ($2,253,688) for children with special health care
needs; less than 30% ($2,220,862) for women, mothers and infants and 10% ($751,229) for
administrative costs.//2007// /2008/For FFY2008 $7,255,120. More than 30% ($2,242,127) for
preventative and primary care needs for children and adolescents; 30% ($2,176,536) for children
with special health care needs; less than 30% ($2,110,945) for women, mothers and infants and
10% ($725,512) for administrative costs.//2008// /2009/For FFY2009 $7,028,756. More than 30%
($2,212,595) for preventative and primary care needs for children and adolescents; 30%
($2,108,627) for children with special health care needs; less than 30% ($2,004,659) for women,
mothers and infants and 10% ($702,876) for administrative costs//2009// /2010/The estimated
Title V allocation for Arizona, FFY2010, is $7,035,771. For FFY 2010, 33.5% ($2,357,127) of
the Title V Block grant will be allocated for preventative and primary care needs for
children and adolescents; 30% ($2,110,730) will be allocated to children with special health
care needs; 26.5% ($1,864,337) will be allocated for women, mothers and infants and no
more than 10% ($703,577) will be budgeted for administrative costs.//2010//
We have another three months remaining in our calendar year budget cycle, so our remaining
money will appear greater. Projected carryover from our FFY2005 grant is $2,848,328:
$1,170,788 for pregnant women, mothers and infants; $943,360 for preventative and primary care
needs for children and adolescents; and $734,180 for children with special health care
needs./2007/Projected carryover from our FFY2006 grant is $2,861,375: $517,867 for pregnant
women, mothers and infants; $467,312 for preventative and primary care needs for children and
adolescents; and $1,876,196 for children with special health care needs.//2007// /2008/Projected
carryover from our FFY2007 grant is $1,618,200: $341,000 for pregnant women, mothers and
infants; $402,000 for preventative and primary care needs for children and adolescents; and
$875,200 for children with special health care needs.//2008// /2009/It is projected that there will

169

be $394,791 unobligated funds from our FFY2008 block grant. The Office for Children with
Special Health Care Needs expends their funds on a state fiscal year (7/1 - 6/30) and does not
begin using the funds awarded 10/1 until 7/1 the following year//2009// /2010/It is projected that
there will be $1,166,773 unobligated funds from our FY2009 block grant. The Office for
Children with Special Health Care Needs expends their funds on a state fiscal year (7/1 6/30) and does not begin using the funds awarded 10/1 until 7/1 the following year.//2010//
The state's match and maintenance of effort: For FFY2006, the $12,036,000 in state general
funds include High Risk Perinatal Services, a perinatal service grant to all fifteen counties,
Children's Rehabilitation Services, Adult Cystic Fibrosis, Sickle Cell Anemia, Child Fatality
Review; Prenatal Outreach and Newborn Screening Programs. An additional $1,226,434 in state
general funds is allocated to the Public Health Prevention Bureau and supports half of our
personnel located in the Offices of the Bureau Chief, Women's and Children Health, Children with
Special Health Care Needs and Oral Health and supplements above-the-line activities. Our
state's FFY2006 match and overmatch of $13,262,434 continues to exceed the maintenance of
effort amount of FFY1989's $12,056,360./2007/For FFY2007, the $12,232,200 in state general
funds includes High Risk Perinatal Services, a perinatal service grant to all fifteen counties,
Children's Rehabilitation Services, Adult Cystic Fibrosis, Sickle Cell Anemia, Child Fatality
Review and Newborn Screening Programs. An additional $700,129 in state general funds is
allocated to the Public Health Prevention Bureau and supports half of our personnel located in the
Offices of the Bureau Chief, Women's and Children Health, Children with Special Health Care
Needs and Oral Health and supplements above-the-line activities. Our state's FFY2007 match
and overmatch of $13,032,329 continues to exceed the maintenance of effort amount of
FFY1989's $12,056,360.//2007// /2008/For FFY2008, the $16,002,096 in state general funds
include High Risk Perinatal Services, a perinatal service grant to all fifteen counties, Children's
Rehabilitation Services, Adult Cystic Fibrosis, Sickle Cell Anemia Child Fatality Review, and
Newborn Screening Programs. An additional $877,064 in state general funds is allocated to the
Public Health Prevention Bureau and supports half of our personnel located in the Offices of the
Bureau Chief, Women's and Children Health, Children with Special Health Care Needs and Oral
Health and supplements above-the-line activities. Our state's FFY2008 match and overmatch of
$16,879,160 continues to exceed the maintenance of effort amount of FFY1989's
$12,056,360.//2008// /2009/For FFY2009, the $16,755,300 in state general funds include High
Risk Perinatal Services, a perinatal service grant to all fifteen counties, Children's Rehabilitation
Services, Adult Cystic Fibrosis, Sickle Cell Anemia, Child Fatality Review and Newborn
Screening Programs. An additional $1,137,253 in state general funds is allocated to Public Health
Prevention Services supports half of our personnel located in the Offices of the Bureau Chief,
Women's and Children Health, Children with Special Health Care Needs and Oral Health and
supplements above-the-line activities. Our state's FFY2009 match and overmatch of $17,892,553
continues to exceed the maintenance of effort amount of FFY1989's $12,056,360//2009//
/2010/For FFY 2010, the state's match and maintenance of effort includes State General,
Lottery, Dental Sealant, and donation funds. The $6,063,683 in State General funds
include High Risk Perinatal Services, Children's Rehabilitation Services (CRS), Child
Fatality Review Program, and operating funds allocated to the Public Health Prevention
Division and, in part, supports half of our personnel located in the Offices of the Women's
and Children Health, Children with Special Health Care Needs and Oral Health. The
$6,412,400 in Lottery funds includes the Teen Pregnancy Prevention and Prenatal
Outreach (Health Start) Programs. The $128,056 in donation funds are for the Children's
Rehabilitation Services Program and $250,000 is from fees generated by the Dental
Sealant Program. Our state's FY2010 match and overmatch of $12,854,139 continues to
exceed the maintenance of effort amount of FY1989's $12,056,360.//2010//
We receive additional state and local funding as a result of our collaboration with other state
government agencies and charitable foundations: For FFY2006, the total of $20,187,058 is
designated for Children's Rehabilitative Services, Teen Pregnancy Prevention and Abstinence
Services, and the Prenatal Outreach Program/2007/For FFY2007, the total of $22,721,775 is
designated for Children's Rehabilitative Services, Teen Pregnancy Prevention and Abstinence

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Services, and the Prenatal Outreach Program//2007// /2008/For FFY2008, the total of
$28,991,313 is designated for Children's Rehabilitative Services, Teen Pregnancy Prevention and
Abstinence Services, Pregnancy Services and the Prenatal Outreach Program//2008// /2009/For
FFY2009, the total of $34,243,753 is designated for Children's Rehabilitative Services, Teen
Pregnancy Prevention, and the Prenatal Outreach Program//2009//
Other federal funds: For FFY2006, $57,926,638 represent matching funds from Title XIX and Title
XXI for Children's Rehabilitative Services. Additional federal monies will contribute another
$86,348,660 toward MCH initiatives, which include the WIC food grant, Universal Newborn
Hearing, Rape Prevention and Education, Family Violence Prevention, SSDI Primary Care,
Abstinence Education, Kids Care, Arizona Early Intervention, Child Fatality Review, Early
Childhood Comprehensive Systems, and the Preventive Health and Health Services Block Grant.
/2007/For FFY2007, $43,307,910 represent matching funds from Title XIX and Title XXI for
Children's Rehabilitative Services. Additional federal monies will contribute another $84,785,126
toward MCH initiatives which include the WIC food grant, Universal Newborn Hearing, Rape
Prevention and Education, Family Violence Prevention, Core State Injury Surveillance and
Program Development, Emergency Medical Service for Children, SSDI Primary Care, Abstinence
Education, Kids Care, Spinal Head Injury, Arizona Early Intervention, Child Fatality Review, Early
Childhood Comprehensive Systems and the Preventive Health and Health Services Block
Grant.//2007// /2008/For FFY2008, $49,574,056 represent matching funds from Title XIX and Title
XXI for Children's Rehabilitative Services. Additional federal monies will contribute another
$76,113,790 toward MCH initiatives which include the WIC food grant, Universal Newborn
Hearing, Rape Prevention and Education, Family Violence Prevention, Core State Injury
Surveillance and Program Development, Emergency Medical Service for Children, SSDI Primary
Care, Kids Care, Spinal Head Injury, Integrated Community Systems implementation, Child
Fatality Review, Early Childhood Comprehensive Systems and the Preventive Health and Health
Services Block Grant.//2008// /2009/For FFY2009, $61,143,652 represent matching funds from
Title XIX and Title XXI for Children's Rehabilitative Services. Additional federal monies will
contribute another $97,993,807 toward MCH initiatives which include the WIC food grant,
Universal Newborn Hearing, Rape Prevention and Education, Family Violence Prevention, Core
State Injury Surveillance and Program Development, Emergency Medical Service for Children,
SSDI Primary Care, Kids Care, Spinal Head Injury, NGIT Fetal Alcohol Spectrum Disorders, Child
Fatality Review, Early Childhood Comprehensive Systems and the Preventive Health and Health
Services Block Grant//2009// /2010/Other federal funds administered by the MCH Chief and
CSHCN Chief besides the MCH Title V Block Grant Program include matching funds from
Title XIX and Title XXI for Children's Rehabilitative Services, Rape Prevention and
Education, Family Violence Prevention, Core State Injury Surveillance and Program
Development, Emergency Medical Service for Children, State Systems Development
Initiative, Kids Care, Spinal Head Injury, NGIT Fetal Alcohol Spectrum Disorders, 1st Time
Motherhood, and Project Launch. In the past, WIC, Preventive Health Services Block
Grant, and the Universal Newborn Hearing Screening grants were listed as federal
partners, however these grants are not actually under the control of the person
responsible for the Title V grant. We removed these grants from the other federal funds
column, but we continue to work in close partnership with all of these grants.//2010//
Core Public Health Infrastructure: For FFY2006, Office of Women's and Children's Health (Part A
& B): $1,981,971 will support the Department's birth defect registry; administrative initiatives;
information technology automation; the Deputy Assistant Director's Office for special projects;
assessment, evaluation and epidemiologic analysis; Nutrition consultant; women's health
initiatives; Community Grants; Child Health Primary Care; Healthy Mothers/Health Babies
contract with Banner Health Foundation of Arizona; the Early Childhood Program; and Midwife
Licensing. Office of Children with Special Health Care Needs (Part C): $2,130,957 will support
administrative initiatives; Community Development; Quality Assurance and Utilization Review for
the Children's Rehabilitation Services program; epidemiological support; and Child Fatality
support /2007/For FFY2007, Office of Women's and Children's Health (Part A & B): $1,853,507
will support the Department's Office of Birth Defects; administrative initiatives; information

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technology automation; the Deputy Assistant Director's Office for special projects; assessment,
evaluation and epidemiologic analysis; Nutrition consultant; women's health initiatives;
Community Grants; the Early Childhood Program; and Midwife Licensing. Office of Children with
Special Health Care Needs (Part C): $2,070,688 will support administrative initiatives; Community
Development; Quality Assurance and Utilization Review for the Children's Rehabilitation Services
program; epidemiological support; and Child Fatality support//2007// /2008/For FFY2008, Office
of Women's and Children's Health (Part A & B): $2,051,218 will support the Department's Office
of Birth Defects; administrative initiatives; information technology automation; the Deputy
Assistant Director's Office for special projects; assessment, evaluation and epidemiologic
analysis; Nutrition consultant; women's health initiatives; Community Grants; the Early Childhood
Program; and Midwife Licensing. Office of Children with Special Health Care Needs (Part C):
$1,988,536 will support administrative initiatives; Community Development; and Quality
Assurance and Utilization Review for the Children's Rehabilitation Services program//2008//
/2009/For FFY2009, Bureau of Women's and Children's Health (Part A & B): $1,769,624 will
support the Department's Office of Birth Defects; administrative initiatives; information technology
automation; the Assistant Director's Office for special projects; assessment, evaluation and
epidemiologic analysis; Nutrition consultant; women's health initiatives; Community Grants; Early
Childhood Program; Child Fatality services; and Midwife Licensing. Office of Children with Special
Health Care Needs (Part C): $1,921,627 will support administrative initiatives; CRS Direct
Services; Service Coordination and Early Intervention; Education, Training and Support Services
and Advocacy, Outreach and Member Services//2009// /2010/For FFY2010, Bureau of
Women's and Children's Health (Part A & B): $1,294,947 will support the Department's
birth defect registry, management service, information technology automation,
assessment, evaluation and epidemiologic analysis, Nutrition support, Child Fatality
services, Midwife Licensing, and the Early Childhood Program. Office of Children with
Special Health Care Needs (Part C): $1,925,730 will support administrative initiatives, CRS
Direct Services, Service Coordination, Early Intervention, Education, Training, Support
Services and Advocacy, Outreach and Member Services.//2010//
Population-Based Services: $724,252 is budgeted for the Sensory Program; Community grants;
the Pregnancy and Breastfeeding Hotline Program; High Risk Perinatal Services; and
Immunizations /2007/$741,799 is budgeted for the Sensory Program; Community grants; the
Pregnancy and Breastfeeding Hotline Program; High Risk Perinatal Services; and
Immunizations//2007// /2008/$593,128 is budgeted for the Sensory Program; Community grants;
the Pregnancy and Breastfeeding Hotline Program; High Risk Perinatal Services; and
Immunizations//2008// /2009/$621,818 is budgeted for the Sensory Program; Community grants;
the Pregnancy and Breastfeeding Hotline Program; High Risk Perinatal Services; and
Immunizations//2009// /2010/Population-Based Services: $1,058,570 is budgeted for
children's health initiatives that include the Sensory Program, Community Health Grants,
Pregnancy and Breastfeeding Hotline, High Risk Perinatal Services, Immunizations and
oral health services for children.//2010//
Enabling and Non-Health Support: $403,391 will support the Child Health Program's contract with
Arizona Academy of Pediatrics and Community grants./2007/$386,304 will support the Medical
Home Project and Community grants//2007// /2008/$308,150 will support Medical Home Project
and Community grants.//2008// /2009/$379,095 will support the Medical Home Project and
Community grants//2009// /2010/Enabling and Non-Health Support: $667,947 will support
planning, education and partnership initiatives that include the Medical Home Project and
Community Health Grants.//2010//
Direct Health Care Service: $1,752,302 will support community nursing services for high-risk
infants; oral health services for children; Reproductive Health Program and Community
grants./2007/$1,708,766 will support community nursing services for high-risk infants; oral health
services for children; the Reproductive Health Program and Community grants//2007//
/2008/$1,588,576 will support community nursing services for high-risk infants; oral health
services for children; and the Reproductive Health Program//2008// /2009/$1,633,717 will support

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community nursing services for high-risk infants; oral health services for children; and the
Reproductive Health Program//2009// /2010/Direct Health Care Service: $1,385,000 will
support community nursing services for high-risk infants and Reproductive Health
services for women.//2010//
Indirect Administrative Costs: $776,985 /2007/$751,229//2007// /2008/$725,512//2008//
/2009/$702,875//2009// /2010/Indirect Administrative Costs: $703,577//2010//

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VI. Reporting Forms-General Information
Please refer to Forms 2-21, completed by the state as part of its online application.

VII. Performance and Outcome Measure Detail Sheets
For the National Performance Measures, detail sheets are provided as a part of the Guidance.
States create one detail sheet for each state performance measure; to view these detail sheets
please refer to Form 16 in the Forms section of the online application.

VIII. Glossary
A standard glossary is provided as a part of the Guidance; if the state has also provided a statespecific glossary, it will appear as an attachment to this section.

IX. Technical Note
Please refer to Section IX of the Guidance.

X. Appendices and State Supporting documents
A. Needs Assessment
Please refer to Section II attachments, if provided.

B. All Reporting Forms
Please refer to Forms 2-21 completed as part of the online application.

C. Organizational Charts and All Other State Supporting Documents
Please refer to Section III, C "Organizational Structure".

D. Annual Report Data
This requirement is fulfilled by the completion of the online narrative and forms; please refer to
those sections.

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