Title X Update

1
Title X Update

• National Title X Grantee Meeting
• Phoenix, AZ
• September 19-20, 2006
• Susan B. Moskosky, MS, RNC
• Director, Office of Family Planning
• Office of Population Affairs

2
Welcome!!!

• In 2002, the first National Title X Grantee
  Meeting (NGM) was held in Dallas, TX
• This was followed two years later (2004) with a
  second NGM held in Atlanta, GA
• Today, in September 2006, we have convened the
  third NGM here in Phoenix, AZ

3
Meeting Evolution

• In 2002 and 2004, the NGMs were focused primarily
  on policy and administrative issues
• We recognize that grantees and delegates are
  involved in innovative service and research
  activities that would be of interest to all
  grantees, so
• The 2006 meeting focuses on YOU as grantees, and
  your contribution to achieving the Title X
  mission, even in challenging times
• Welcome Title X Grantees!!

4

• A Quick Review
• As most of you know

5
The Beginning

• Title X was created in 1970 and funded in 1971
• Amended the Public Health Service Act to provide
  grants for family planning services. Also,
  provides grants for related research, training,
  and informational and educational materials
  this change is called the Family Planning
  Amendments of 1970
• Context was concern over population issues
• Title X is 35 years old and still GOING STRONG!

6
Mission of Title X

• To provide individuals with the educational,
  comprehensive medical, and social services
  necessary to aid in determining freely the number
  and spacing of their children.
• Title X projects do not include abortion as a
  method of family planning.

7
More Than Contraception

• Title X Family Planning includes preventive
  health services such as Pap smears, breast exams,
  HIV and STD tests, and other services related to
  reproductive health and family planning
• For many, Title X is the entry point into the
  health care system, and, for some, the only
  health care they receive

8

Times Change

• Since 1970, there have been many
  changes/transitions/challenges for the Title X
  program and in the environment in which we work
• Some positive changes, some not so positive, but
  throughout, the Title X National Family Planning
  Program has continued to provide needed services
  to women and men throughout the country, and best
  of all
• WERE STILL HERE PROVIDING SERVICES TO THOSE WHO
  NEED THEM!!

9
Program Priorities 2007

• Assuring ongoing high quality family planning and
  related preventive health services
• Assuring access to a broad range of acceptable
  and effective family planning methods and related
  preventive health services
• Assuring compliance with State laws requiring
  notification or the reporting of child abuse,
  child molestation, sexual abuse, rape, or
  incest

10
Program Priorities 2007

• Encouraging participation of families, parents,
  and/or legal guardians in the decision of minors
  to seek family planning services and providing
  counseling to minors on how to resist attempts to
  coerce minors into engaging in sexual activities
• Addressing the comprehensive family planning and
  other health needs of individuals, families, and
  communities through outreach to hard-to-reach
  and/or vulnerable populations, and partnering
  with other community-based health and social
  service providers

11
Key Issues Focus on Quality

• Efficiency and effectiveness
• Management and decision-making through
  performance measures and accountability for
  outcomes
• Linkages and partnerships
• The use of electronic technologies
• Data collection for monitoring performance
• Translation of research outcomes into practice
• Utilizing practice guidelines and
  recommendations, developed by recognized national
  professional organizations and Federal agencies

12
Ensure Quality FP Services

• From 2007 Services Announcement
• Evidence of a system for ensuring quality family
  planning services, including
• a. a process for ensuring compliance with
  program requirements, and
• b. a methodology for ensuring that health care
  practitioners have the knowledge and skills
  necessary
• including training of select health care
  practitioners by the clinical preceptor training
  program and utilizing clinical training
  opportunities through the Regional Training
  Centers

13
2006 HHS Organizational Chart
14
US Department of Health Human Services
Secretary Mike Leavitt
Assistant Secretary - Dr. John O. Agwunobi, MD,
MPH, MBA
Office of Public Health and Science (OPHS)
Programs

• Office of Minority Health Office of HIV/AIDS
  Policy
• Office of Population Affairs Office of
  Research Integrity
• Office of Womens Health National Vaccine
  Program
• Office of Regional Health Administrators
• Presidents Council on Physical Fitness
• Office of the Surgeon General
• Office of Military Liaison and Veterans Affairs
• Office of Disease Prevention and Health
  Promotion

15
Office of Population Affairs
Evelyn Kappeler Acting Director, Office of
Population Affairs Johanna Nestor Acting Deputy
Director
Immediate Office Inyang Isong, MD Evelyn
Kappeler Susan Dunnell Medical
Officer Senior Policy Analyst Management
Analyst Brad Hendrick Jeannine Nielsen
Vacant Policy Analyst Public Affairs Specialist
Staff Assistant
Office of Family Planning Susan Moskosky, M.S.,
R.N.C. Director
Office of Adolescent Pregnancy Programs Johanna
Nestor Acting Director
Office of Research Evaluation Patricia
Thompson, Ph.D. Director
Vacant Charon Flowers Staff Assistant
Health Education Specialist Jule
Hallerdin David Johnson Nurse Consultant
Public Health Advisor George Jones
Elizabeth Phillips Program Development
Program Analyst Specialist Kathleen
Woodall Public Health Analyst
Barbara Cohen Statistician Eugenia
Eckard Statistician Pankaja Panda Public Health
Analyst
Laquinta Bruster Jacqueline Crump-McCain Staff
Assistant Program Analyst JoAnne Jensen
Johanna Nestor Medical Education Program
Analyst Specialist Alicia Richmond-Scott
Allison Roper Program Analyst Project
Officer Tarsha Wilson Leslie
Ranieri Project Officer Project Officer
16
Funding

• Title X is part of the Labor/ HHS Appropriations
• Operationally, OPA/OFP is part of the Office of
  the Secretary of Health and Human Services,
  Office of the Assistant Secretary, OPHS
• Although Title X is NOT a HRSA (Health Resources
  and Services Administration) program, the budget
  line is in the HRSA budget

17
Funding History Key Years

• 1971 6,000,000 (enactment of Title X)
• 1975 100,625,000
• 1980 162,000,000
• 1985 142,500,000
• 1990 139,135,000
• 1995 193,000,000
• 2000 238,000,000
• 2005 285,977,000
• 2006 283,103,000
• adjusted to show funding amount after
  across-the-board rescissions

18
A Word About the Money

• Budget for 2006 283,103,000
• After 1 across the board rescission
• Before any evaluation tap or other rescission
• Priority is maintenance of family planning
  clinical services

19
A Word About the Money

• Expect level or reduced funding for the
  foreseeable future Projected 2007 budget is
  level funding before across-the-board rescissions
• Expect a continuing resolution (CR) to continue
  operations for the beginning of the 2007 budget
  year

20
Title X Clients

• Although funding has had ups and downs, Title X
  projects continue to serve large numbers of
  clients
• 5,002,961 total users
• 4,740,168 female (95)
• 262,793 male (5)
• 58 24 yrs. or younger
• 25 racial minority
• 23 Hispanic/Latino
• 66 lt 100 FPL
• 90 lt 200 FPL
• Unpublished 2005 Family Planning Annual Report
  (FPAR) data
• 2004 FPAR data published July 2005

21
Many Assessments

• Assistant Secretary for Administration and
  Management (ASAM) FY 2005 review of Grants
  Management Practices focus on Title X
• Positive findings minimal modifications required
  
• Program Review Tool identified as a Best Practice

22
Many Assessments

• Office of the Inspector General (OIG) FY 2005
  independent review of how information is provided
  to grantees regarding their obligations to
  address State requirements regarding child abuse,
  child molestation, sexual abuse, rape and incest.
  
• Positive findings OPA informs grantees in
  various ways and includes assessment in Program
  Reviews and Site Visits

23
Many Assessments

• Program Assessment Rating Tool (PART) -
  comprehensive review of all Federal programs
• Links actions to outcomes
• Identifies strengths and weaknesses
• Performance Objectives will become part of the
  2007 Title X GPRA Plan
• Title X Program reviewed in 2005 for the 2007
  Budget year
• Received a Moderately Effective Rating
• Title X Evaluation Activities and Assessment of
  Current Needs (1) project presentation later
  in the meeting

24
Family Planning Annual Report (FPAR)

• Revised. Implemented in 2005.
• First Report from the new data collection tool
  will be published soon
• Informs assessment of Title X Performance
  Objectives identified in the PART assessment and
  GPRA Plan
• Provides information for program management

25

Preliminary FPAR Results 2005

• Pap Tests
• 2,447,498 unduplicated users tested
• 52 of female family planning users received a
  pap test
• 2,644,413 tests performed
• 9 ASC or higher
• Clinical Breast Exams (CBE)
• 2,510,861 unduplicated users who obtained a CBE
• 53 of family planning users received a CBE
• 2 referred for evaluation of abnormal findings

26

Preliminary FPAR Results 2005

• Chlamydia
• 2,310,640 tests performed (94.5 Female 5.5
  Male)
• 50 of total female family planning users 15-24
  were tested for Chlamydia
• HIV
• 607,974 confidential HIV tests performed
• 13,349 anonymous HIV tests performed
• 1,114 positive HIV tests (confidential)

27
HIV

• 62 projects (down one from 2005)
• In 2006, over 9,389,000 invested in HIV projects
  (Total MAI and Title X)
• Since 2001, Projects have counseled 572,854
  individuals and provided 265,779 HIV tests
• Remains a major focus for Title X

28
HIV

• OFP invited to participate in CDC consultation
  regarding new HIV testing recommendations
• More information later in the meeting
• CDC collaborating with OFP to provide Rapid
  Testing Train the Trainer sessions for RTCs
• Technical Assistance meeting in Atlanta in
  February 2006
• Train the Trainer to be held in Atlanta in
  November 2006
• OFP and RTCs have been involved in 4 TC
  activities
• Training centers from CDC, HRSA, SAMHSA, and OPA
• Meeting to be held in October

29
Male Activities

• 15 grants Managed from the OFP Central Office
• Entering 4th year of a 5-year project period
• Includes Cross-Site Evaluation of 7 participating
  grantees
• Many Male Projects Managed by OFP Regional
  Offices
• Competitive
• Usually 3-year project periods
• Male Training Center
• Male Meetings
• Grantee Meeting/Grantee and Projects Meeting
• Male Health Educator Training Institute (for male
  health educators)
• Male Health Institute (for managers)

30
HOT Off The Press

• Clinical Training Cooperative Agreement 2
  Components
• Will provide training for Health Care
  Practitioners working in Title X projects to act
  in the role of clinical preceptors
• Will conduct a National Clinical Training Meeting
  every other year of the project beginning in the
  second year of the project
• Six Applicants Close competition
• Grantee has been chosen
• Curators of the University of Missouri

31
NEW!

• HPV vaccine on the market
• In early stages of review
• Implications for Title X projects
• Open communication with CDC - keeping us informed
  of newest developments
• More from CDC later in this meeting

32
Reminders

• Appropriations Language Continues
• Certification that family participation in the
  decision of minors to seek family planning
  services is encouraged
• Provision of counseling to minors on how to
  resist attempts to coerce minors into engaging in
  sexual activities
• No provider is exempt from any State law
  requiring notification or reporting of child
  abuse, child molestation, sexual abuse, rape, or
  incest

33
Challenges

• 3 Cs
• Competition
• Consistency
• Consolidation
• Cost of Contraceptives
• Administrative/Management Issues
• Will address these Challenges this afternoon

34

• Looking Forward to an Interesting and Informative
  Meeting!