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WOMEN/MATERNAL HEALTH DOMAIN SUMMARY/OVERVIEW FY23 ANNUAL REPORT

 

DOMAIN CONTRIBUTORS

 

Maternal and Infant Health (MIH) Consultant – Division of Child and Family Health

Reproductive Health Unit – Division of Child and Family Health

MCH Epidemiology – Division of Population Health Data

Division of Death Prevention – Office of the Chief Medical Examiner (OCME)

Dental Health Program – Division of Prevention and Health Promotion

VDH Local Health Districts

 

DOMAIN OVERVIEW

 

MATERNAL INFANT HEALTH (MIH) CONSULTANT:   The MIH Consultant serves as subject matter expert who partners closely with an array of state and local partners. Statewide organizations such as the Virginia Hospital and Healthcare Association and Postpartum Support Virginia are key partners, and the MIH Consultant also supports work by March of Dimes in the Virginia-Maryland-DC region. The position works closely with the state Maternal Mortality Review Team, coordinates the Statewide Breastfeeding Friendly Hospital Designation Program and serves on the Board of Directors for the Virginia Neonatal Perinatal Collaborative (VNPC). The MIH Consultant facilitates the monthly Sister Agency meeting that includes representatives from Department of Medical Assistance Services (DMAS), Department of Behavioral Health and Developmental Services (DBHDS), and Department of Social Services (DSS), MMRT, and VPNC. This position also coordinates work for the state Substance-Exposed Infant Plan.

 

The MIH Consultant also supports the LHDs regarding perinatal health work and provides support where possible; particularly for LHDs working on becoming breastfeeding friendly health departments and districts focusing on maternal mental health. In addition, the MIH Consultant analyzes proposed maternal child health legislation and budget requests, and is responsible for resulting requirements upon passage such as work groups or task forces where appropriate. The MIH Consultant builds and sustains a variety of partnerships that serve Title V priorities and seeks out additional funding to expand the MCH work in Virginia.

 

REPRODUCTIVE HEALTH UNIT: This unit is led by the Reproductive Health Unit Supervisor, and includes the following programs and funding streams:

• Title X Family Planning (Title X): Clinical family planning programs consistent with Title X requirements and Quality Family Planning Services as defined by the CDC
• Contraceptive Access Initiative (TANF, Title V): Clinical contraceptive care for low-income patients without insurance
• Doula Certification Program and Task Force (Unfunded): State Program offering doulas the opportunity to earn state certification and to work together to promote doula services across the Commonwealth
• State Funding for Certain Abortions (General Funds): Abortion services for Medicaid members in cases of rape, incest, or incapacitating fetal anomaly
• Adolescent Health Program (Sexual Risk Avoidance Education, Title V): Positive youth development programs that build protective factors among participants that will make them less likely to initiate sexual activity
• Resource Mothers (TANF, Title V): Adolescent health program providing support services to pregnant and parenting teens and their families (Of note, the Adolescent Health Program and Resource Mothers Program are detailed in the Adolescent Health Domain)
• This unit works closely with the 35 LHDs to provide over $3.5 million in annual funds to support their local maternal and infant health programs and initiatives, providing quarterly recorded meetings via webinar platform for technical assistance and allow LHDs to share lessons learned across LHDs and programs. 

 

 

DIVISION OF DEATH PREVENTION:  The Division of Death Prevention, located in the Office of the Chief Medical Examiner, is responsible for several epidemiological surveillance and fatality review programs, including the Maternal Mortality Review and Child Fatality Review Teams. The MMRT is a multidisciplinary group with representatives from academic institutions, behavioral health agencies, hospital associations, state chapters of professional associations, state medical societies, and violence prevention agencies.  The MMRT collects data on and reviews the deaths of all Virginia residents who were pregnant within a year of their deaths regardless of the outcome of the pregnancy or the cause of death.  These deaths are termed “pregnancy-associated deaths”.  The MMRT is dedicated to the identification of all pregnancy-associated deaths in the Commonwealth and the development of recommendations for interventions in order to reduce preventable deaths.  Each case is reviewed by the MMRT to determine the community-related, patient-related, healthcare facility-related and/or healthcare provider-related factors that contributed to the woman’s death.  The MMRT also assesses and recommends needed changes in the care received that may have led to better outcomes.  Consensus decision-making is used to determine whether the death was preventable and/or related to the pregnancy.

 

MCH EPIDEMIOLOGY: The MCH Epidemiology and Evaluation Unit is a centralized epidemiology unit within the Division of Population Health Data (DPHD) headed by the MCH Epidemiology Supervisor who serves as the Lead Epidemiologist for Title V. The team has additional capacity available through a Women/Maternal Health Senior Epidemiologist, Infant/Child Health Senior Epidemiologist, Reproductive and Perinatal Health (RPH) Epidemiologist, a Newborn Screening (NBS) Epidemiologist, a Dental Health Epidemiologist/Evaluator, and two program evaluators supporting MCH programs regarding home-visiting (i.e., Healthy Start, MIECHV), and child and adolescent health. Additional cross-cutting support is provided by the Injury and Violence Prevention Senior Epidemiologist and Substance Use Prevention Epidemiologist in the Prevention and Health Promotion Evaluation Unit in the DPHD.

 

DENTAL HEALTH PROGRAM: The DHP performs many duties including the provision of the following:  Educational activities and resources to a wide variety of partner groups to promote proper oral hygiene and support prevention services and access to dental care; direct clinical preventive services and assistance with establishing a dental home; quality assurance review to assure a competent public health oral health workforce; and, surveillance and evaluation activities to monitor and track dental disease rate and trends as part of program assessment for effectiveness and planning. 

 

VDH LOCAL HEALTH DISTRICTS:  Each of VDH’s 35 local health districts (LHDs) receive Title V funds to drive and support maternal and child health programmatic initiatives at the local level.

STATE ACTION PLAN UPDATES

 

 

	PRIORITY 1   Maternal and Infant Mortality Disparity:  Eliminate the racial disparity in maternal and infant mortality rates by 2025
OBJECTIVE	By 2025, decrease the disparity in black-white maternal mortality disparity ratio from 2.1 (2017) to 1.2 (2025)
OUTCOME MEASURE	SOM 2:  Maternal Mortality Disparity: Black/White Maternal Mortality Disparity Ratio

 

 

 

 

National maternal mortality data from 2022 indicate that Virginia’s maternal mortality rate of 44.9 per 100,000 live births is over two times the national maternal mortality rate of 21.9 per 100,000 per livebirths (CDC Wonder); however, more recently, the 5-year (2018-2022) state maternal mortality rate of black women (61 per 100,000 livebirths) is over two and a half times higher than that for white women (26.3 per 100,000 livebirths). PRAMS data from 2022 indicated that during their most recent pregnancy, Black women were more likely to report chronic conditions like hypertension and gestational diabetes, and more likely to report experiencing discrimination or harassment due to their race/ethnicity or insurance or Medicaid status. Additionally, the 2023 Maternal Mortality Review Team (MMRT) report showed that Black women continue to have a pregnancy-associated mortality rate over twice that of their white counterparts (113.8 versus 54.8 per 100,000 live births, respectively). When combined with rising rates of pregnant women with substance use disorder, and an unplanned pregnancy rate of almost 50%, Virginia’s 2019 Maternal Health Strategic Plan (attached document) sets an ambitious yet imperative goal of eliminating the racial disparity in maternal mortality by 2025. This plan outlines six specific focus areas with strategies and recommendations for achieving this goal. The focus areas are: insurance coverage, healthcare environment, criminal justice and child welfare response, community-based services, contraception, and data collection.  Title V’s strategies in the Women/Maternal Health Domain complement and advance the recommendations made in the Maternal Health Strategic Plan.

 

Strategy 1:  Work with stakeholders to increase access to doula services among women of color

 

During the 2020 General Assembly Session, Virginia legislators tasked VDH with establishing a State Doula Certification Program in order to make doula services more accessible to all people, but specifically to Black women, who experience the highest maternal mortality rates of any population in Virginia. In order to accomplish this, VDH’s Reproductive Health Unit convened stakeholders to develop state regulations that will guide the program. Stakeholders included doulas, clinicians, advocates, and representatives from Department of Medical Assistance Services (DMAS), Virginia’s Medicaid Program. VDH and DMAS worked in concert so that when the doula certification program is launched in FY22, certified doulas will then be able to apply to become a Medicaid provider. Medicaid coverage for doulas will open access to low-income families and help to address the racial maternal mortality disparity in Virginia.

 

An official Doula Task Force convened in FY21 to provide the opportunity for doulas, providers, consumers, and payers to provide continuous feedback to the State Doula Certification Program throughout program implementation. The purpose of this task force is to assist with the promulgation of regulations and the certification process of doulas, as well as to serve as an informational resource for policy-related matters for VDH. 

 

The task force consists of fifteen members representing the following areas of expertise:

• Three individuals who are not doulas and who received doula services during their previous pregnancies
• Seven representatives who are doulas working independently, as part of a collective, or as part of a private or community-based provider organization
• Three representatives who are clinical providers, including at least one OB/GYN and one certified nurse midwife
• One representative of a professional organization for hospitals
• One legislative member with a demonstrated interest in maternal and child health
• VDH and DMAS representatives serve as ex-officio members

 

In 2022, the Virginia Board of Health finalized regulations to guide the State Doula Certification designation, triggering the launch of the State Doula Certification program and subsequent Medicaid billing process. To date, VDH has certified 152 community-based doulas, and DMAS has stewarded the majority of them in becoming Medicaid providers. With Virginia Medicaid covering one in three births in the Commonwealth, this represents a significant opportunity for vulnerable families to benefit from doula services. VDH and DMAS are collecting data about the certification process, service delivery, and maternal and infant health outcomes to understand the impact of these programs on the community. This work actively works to address the racial maternal and infant mortality disparities in Virginia, as Black birthing people are significantly more likely to experience poor outcomes than their White counterparts. VDH continued to provide administrative support the Doula Task Force, the purpose of which is to assist with the promulgation of regulations and the certification process of doulas, as well as to serve as an informational resource for policy-related matters for VDH. The Task Force is Chaired by Kenda Sutton-El (Birth in Color RVA) and Stephanie Spencer (Urban Baby Beginnings), and its membership includes doulas, consumers, providers, hospitals, legislators, DMAS, and VDH.

 

EQUITY CENTERING:  Community-based doulas are grounded in the communities they serve and offer culturally congruent care.  VDH’s State Doula Certification Program aims to help patients find a doula that meets their needs and support doulas in earning a living wage for their services. Per the bylaws, the Doula Task Force must include: at least three members of whom are not affiliated with a doula organization. This ensures that the patient experience is always central to any conversation.

 

CHALLENGES:  After offering the State Doula Certification Program for a year, VDH recognizes a need to increase the number of approved doula training entities.  VDH also sees an opportunity to build the capacity of community doulas to participate in the doula certification program and to connect with resources necessary to support their practice.  VDH intends to leverage its partnerships with the Doula Task Force, DMAS, and other stakeholders to explore these opportunities moving forward.

 

LOCAL HEALTH DISTRICT DOULA WORK GROUP: Across 2022, the Title V Director, State Doula Certification Program Coordinator, and MCH teams from three local health districts (Blue Ridge, Central Virginia, and Mount Rogers) participated in the Advancing Equity Learning Community through the National MCH Workforce Development Center. Virginia’s Team focus was to explore together opportunities to leverage the health department’s role in both recruiting and support new doulas to receive certification, as well as creating referral pathways for health department clients to community doulas. To gain stronger understanding of this, the work group developed a survey which was distributed to all 35 of the LHDs in October 2022. The full report is attached. According to the survey responses, respondents (local health district MCH Teams) indicated varying levels of knowledge on the benefits of doulas and services they provide, varying levels of knowledge regarding the presence of doulas in the community, and limited understanding of the utilization of doulas by the health care systems (OBs, hospitals) in their community. To continue this important work, the work group was reorganized in structure, expanding in size and purpose with a total of 11 District MCH teams participating, under the shared leadership of the State Doula Certification Program Coordinator and DMAS Doula Program Analyst, with the Title V Director serving as a participating member providing alignment of strategies to the State Action Plan. The work group will continue across FY25, with the main goal of identifying strategies and action items to be continued in the next five-year state action planning period.

 

SUCCESS STORY: Two testimonials from doulas who have achieved State Certification and become Medicaid Providers:

 

 

 

Strategy 2:  Maintain Title V representation on the Virginia Neonatal Perinatal Collaborative (VNPC) Steering and Executive committees, and Title V representation in selected workgroups.

 

The Virginia Department of Health Office of Family Health Services established the Virginia Neonatal Perinatal Collaborative (VNPC) in 2017 as the 42nd state perinatal quality collaborative to improve maternal and infant health outcomes for all pregnant and parenting people, their families, and their infants. In February 2020, the VNPC moved to Virginia Commonwealth University.

 

VNPC’s 2023 projects:

 

• Project LOCATe (Levels of Care Assessment Tool) is a web-based assessment tool developed by the CDC that helps states assess levels of maternal and neonatal care. data about birthing facilities’ levels of preparation and care provided. In 2023, 38 of 49 Virginia’s hospitals birth hospitals completed the LOCATe tool.
• Project EMBRACE (Equitable care for Mothers and Babies through Readiness, Access, and Community Expansion) works with birthing facilities to implement educational programming based on the needs of their facilities and populations. Birthing facilities select their educational focus based on the needs of their community. In 2023, 22 hospitals participated in Project EMBRACE, focusing on perinatal mental health, maternal health, prevention care and counseling, human milk feeding and reproductive health.
• Turn the Page uses storytelling to document the journeys across the perinatal period. In 2023, twelve stories were shared by VNPC across their social media platforms. The project was also awarded first place at the 2023 American College of Obstetricians and Gynecologists District IV annual District Meeting Film Festival.

 

VNPC offers a monthly webinar series for state perinatal stakeholders across the state. VNPC also hosts two annual summits. The 7th Annual VNPC Summit was held on October 22-23, 2023 in Williamsburg Virginia, and the Fourth Annual Day of Learning was held on March 20, 2023 in Richmond, VA.

 

The VNPC receives general funds through the Virginia Legislature, and the VDH Office of Family Health Services engaged and supported VNPC throughout 2023 in the following ways:

 

• Director of Division of Child and Family Health maintains contract administration, and met monthly with VNPC’s senior director
• MCH Epidemiologist Lead provided 10% FTE epidemiological support
• Maternal Infant Health Consultant assumed position on VNPC’s Executive Committee, attending meetings as scheduled, then transitioned to Board Member when VNPC restructured in early 2023
• Transitioned VNPC’s lead role on the statewide Sister Agency Monthly call back to VDH Maternal Infant Health Consultant (VNPC maintained this meeting while VDH position was vacant)
• Transitioned facilitation of Perinatal Cannabis Workgroup through VNPC to VDH’s Maternal Infant Health Consultant for strengthening and alignment with Title V’s action plan

 

Strategy 3:  Local Health Districts (LHD):  Develop, mobilize, and participate in strong interagency, multisector, and community partnerships to address disparities in maternal and infant mortality rates

 

Beginning State FY 23 (July 2022), Virginia’s LHDs were transitioned to a new work plan structure more closely aligned with the State Action Plan. Each district was required to select from a list of measurable activities, and then report quarterly to those activities.  Twenty-two of 35 local health districts prioritized maternal and infant mortality disparity in their annual work plans. 

 

Ten districts elected to focus on building out their districts’ engagement with Unite Us Virginia.  Unite Virginia is a coordinated care network consisting of healthcare, government, nonprofit, and other organizations. These network partners use Unite Us’ software to securely identify, deliver, and pay for services that address the needs of individuals within their communities. Unite Virginia is built in partnership with the Office of the Virginia Secretary of Health and Human Resources, the Virginia Department of Health, Optima Health, Partnering for a Healthy Virginia, Kaiser Permanente, Virginia Mental Health Access Program, Ballad Health, Virginia Department of Social Services, Virginia Hospital & Healthcare Association, STRONG Accountable Care Community, Virginia Premier,  Virginia Rural Health Association, VHC Health, and Inova.

 

District MCH Teams focused on ensuring that their community supportive programs were able to both receive referrals through the Unite Us network as well as engage with the program to make referrals for their clients to other community programs. District programs, such as WIC, community doula referrals, car seat programs, breastfeeding classes, BabyCare, Resource Mothers, and Reproductive Health Clinics.

 

	PRIORITY 2   MCH data capacity:  Maintain and expand state MCH data capacity, to include ongoing needs assessment activities, program evaluation, and modernized data visualization and integration
OBJECTIVE	By 2025, decrease the disparity in black-white maternal mortality ratio from 2.1 (2017) to 1.2 (2025)
OUTCOME MEASURE	SOM2:  Maternal mortality disparity:  Black/white maternal mortality disparity ratio

 

 

Strategy 1:  Sustain state maternal mortality and child fatality review programs, engaging with cross-sector partners and addressing social determinants of health in development of MMRT and CFRT recommendations

 

The Division of Death Prevention is led by Dr. Ryan Diduk-Smith (Director). The Division is responsible for several epidemiological surveillance and fatality review programs, including the Maternal Mortality Review Team and Child Fatality Review Team, local and regional overdose and domestic violence review teams, the National Violent Death Reporting System, Overdose Data to Action project, and the ERASE MM project. The division is 100% federal funded through grants and cooperative agreements through the Centers and Disease Control and Department of Justice.

Activities of the Maternal Mortality Programs included the coordination and facilitation of bi-monthly Maternal Mortality Review Team meetings. These activities included case selection for each meeting, requesting records from health, social, and community-based agencies that were used in the review, review of those records, and determination of inclusion or exclusion in the review, as well as scanning the record for additional information that could be collected from other providers for use. After each review team meeting, data from the review team meeting was entered into the MMRIA system by the Maternal Mortality Programs Manager and Maternal Mortality Research Assistant. The MMRT is currently reviewing maternal deaths that occurred in 2021 (n=64). The Programs Manager also maintained and reviewed the recommendations from each review meeting for applicability and appropriateness based on the review topic and current data trends. Final recommendations from the team are vetted with the target organizations/agencies.

The OCME continued to engage the community through multidisciplinary workgroups, review team meetings, and other activities where appropriate, through the MMRT. The MMRT consists of the following team members: the Chief Medical Examiner, the Director of the Office of Family Health of the Department of Health, the State Registrar of Vital Records, and the Commissioner of Behavioral Health and Developmental Services. Additional team members include: local law enforcement, local fire departments, local emergency medical services providers, local departments of social services, community services boards, attorneys for the Commonwealth, the Medical Society of Virginia, the Virginia Hospital and Healthcare Association, the Virginia College of Emergency Physicians, the Virginia Section of the American College of Obstetricians and Gynecologists, the Virginia Affiliate of the American College of Nurse-Midwives, the Virginia Chapter of the Association of Women's Health, Obstetric and Neonatal Nurses, the Virginia Neonatal Perinatal Collaborative, the Virginia Midwives Alliance, and the Virginia Academy of Nutrition and Dietetics. The Chief Medical Examiner and the Director of the Office of Family Health of the Department of Health serve as co-chairs of the Team and may appoint additional members of the Team as may be needed to complete maternal death reviews.

Additionally, Dr. Melanie Rouse, the Maternal Mortality Programs Manager, participated in several dissemination activities, including providing data to community-based organizations and local and state agencies, as well as presenting data and recommendations to prevent maternal deaths to a variety of audiences.

 

EQUITY CENTERING: Virginia's Maternal Mortality Review Team is committed to helping improve health equity among pregnant and post-partum persons in the Commonwealth. As such, a diverse, multidisciplinary review team conducts comprehensive reviews of each pregnancy-associated death in the Commonwealth. This includes addressing social determinants of health throughout the review process. The Team then makes recommendations for the development of interventions and the implementation of policy changes that support health equity, improve maternal outcomes and reduces racial disparities in pregnancy-associated deaths in the Commonwealth of Virginia.

 

 CONSUMER/FAMILY ENGAGEMENT & PARTNERSHIP: The Maternal Mortality Review Program continues to explore ways to include community-based organizations in the maternal mortality review and recommendation development process. We have also successfully developed and launched an informant interview protocol for the maternal mortality review program. This protocol will allow for family members of maternal death cases to provide information that will help to bolster the review of maternal death cases.

 

Strategy 2:  Convene the Maternal Health Data and Quality Measures Task Force as mandated by HB2111 to evaluate maternal health data collection processes

 

Virginia House Bill 2111 (2021) established the Maternal Health Data and Quality Measures Task Force for the purpose of evaluating maternal health data collection to guide policies in the Commonwealth to improve maternal care, quality, and outcomes for all birthing people in the Commonwealth. With representation from multiple disciplines and organizations, the provisions of the bill require the Task Force to monitor and evaluate relevant stakeholder data, including third-party payer claims and mandated sources, to examine quality of care with regard to race, ethnicity, and demographic, as well as the impact of social determinants of health on outcomes. The first Task Force meeting was held in March 2022 and continued through August 2023. The MCH Epidemiologist Lead and PRAMS Principal Investigator served as a subject matter experts/members on this Task Force. A final report was submitted to the General Assembly and released in January 2024. This report contained 22 recommendations across its seven charges, as outlined in the legislation, to be used by legislators and maternal health partners. Given the 2023 sunset date of the original task force, efforts are underway to re-establish the task force.

 

 

	PRIORITY 3   Reproductive justice and support:  Promote equitable access to choice-centered reproduction-related services, including sex education, family planning, fertility/grief support, and parenting support
OBJECTIVE	By 2025, reduce the rate of mistimed pregnancies from 25.3% (PRAMS 2018) to 21.8%
PERFORMANCE MEASURE	SPM 4 – Pregnancy Intention: Mistimed or Unwanted pregnancy (wanted to become pregnant later or never)

 

 

 

 

Strategy 1:  Work with stakeholders to remove policy, financial, and training barriers to contraceptive access

 

VDH's Reproductive Health Unit includes several programs dedicated to Title V populations and priorities, including the Virginia Contraceptive Access Initiative, the Title X Family Planning Program, the Adolescent Health Program, Resource Mothers, the State Doula Certification Program and Task Force, the Pregnancy Loss Services Initiative, and the State Funding of Certain Abortions Program. The Contraceptive Access Network was a group of agencies working to reduce unintended pregnancies among people of childbearing age and increase access to comprehensive, quality family planning services. This group was originally developed to address infant mortality, recognizing the role of contraceptive access on maternal and infant health. The group was facilitated by VDH, met twice a year, and included over 70 members from a variety of community-based health centers, governmental organizations, hospital systems, payers, and community members. The network stopped meeting officially in 2021, but informal collaboration continues among some members around specific projects. Two such projects include the Contraceptive Access Initiative and Prescribing Authority. The Contraceptive Access Network collaborated to successfully advocate for the Virginia LARC Initiative, a two-year pilot program designed to increase access to hormonal LARCs (long-acting reversible contraceptives) among uninsured, low-income patients that began in 2018. Funded through federal TANF funds allocated by the Virginia General Assembly, the LARC Initiative allowed VDH to contract with eighteen health providers to offer LARC insertions and removals to eligible patients. During its two-year pilot period (October 2018-July 2020), the Virginia LARC Initiative provided approximately 3,986 no-cost visits to eligible patients. In July 2020, the Virginia General Assembly expanded the scope of the program to cover all-FDA approved methods of contraception, and thus the program's name changed to the Virginia Contraceptive Access Initiative.

 

During SFY 21 (July 1, 2020-June 30, 2021), the expanded program provided 6,786 no-cost visits to eligible patients, representing an enormous increase in patients served. Patient volume has remained steady since then: in SFY 22 (July 1, 2021-June 30, 2022), the program provided 6,678 no-cost visits to eligible patients, and in SFY 23 (July 1, 2022-June 30, 2023), the program provided 6,238 no-cost visits. Title V funds support VDH staff time spent administering this program. VDH's Title X Family Planning program provides comprehensive family planning services at 108 clinical sites across the Commonwealth, including 25 local health districts and 3 federally qualified health centers. As the nation's only federally funded family planning program, Title X provides structure, funding, and technical support to clinics providing family planning services according to CDC's Quality Family Planning Services guidelines.

 

The Title X Family Planning program is not directly supported by Title V funds, but Title X compliments Title V by supporting family planning services beyond those provided by the Virginia Contraceptive Access Initiative. VDH partnered with Vanderbilt University to formally evaluate the impact of VDH's family planning efforts on unintended pregnancies in the Commonwealth, and the article is currently being considered for publication. The main findings were that a) areas with high saturation of CAI services experienced lower natality rates than the comparison areas, and b) Virginia's change in natality rates was smaller than the change experienced in other states who expanded access to contraception. This is due to Virginia having policies in place that supported contraceptive utilization before the program began, raising baseline rates. These policies include a robust Title X program with high utilization among patients, a Medicaid program that covers all methods of contraception, the federal Affordable Care Act (which required insurance to cover contraception at no copay), and then Medicaid expansion in 2019. During the 2020 General Assembly Session, Virginia legislators passed a law to allow pharmacists to dispense contraception to low-risk patients aged 18 or older. VDH and other stakeholders worked with the Board of Pharmacy to finalize protocols later that year, but pharmacists still have not taken advantage of this program in a significant way. The primary reason is tied to billing; until this year, Virginia Medicaid did not recognize pharmacists as medical providers, and therefore pharmacists could not be reimbursed for medical services they offered. In order to dispense contraception under the approved protocols, pharmacists must have a consultation with the patient to identify the appropriate contraceptive method and determine that the patient does not have any medical contraindications that would prevent her from safely taking hormonal methods. Because Virginia, until very recently, Virginia had no mechanism for compensating pharmacists for this consultation, commercial pharmacies did not have a financial incentive to offer this service. Now that DMAS recognizes pharmacists as providers, DMAS is actively conducting outreach and training for pharmacists on how to enroll as Medicaid providers. VDH's reproductive health unit works to promote DMAS' efforts and is collecting information about where this service is currently being offered in the Commonwealth.

 

During this reporting period, the FDA approved the first over-the-counter contraceptive pill, OPill. OPill became available at online and at major retailers during the following reporting period. The VDH Reproductive Health Team is exploring ways to make OPill more accessible to patients throughout the Commonwealth.

 

EQUITY CENTERING:  Countless programs have shown that when financial barriers to contraception are removed, more people use contraception consistently and correctly, and unintended pregnancy rates drop as a result. VDH's family planning programs, including those supported by Title V, intend to remove financial barriers for patients to allow them to use the method that is best for them, not just the method that is the most affordable. When the Contraceptive Access Initiative was launched, the Virginia General Assembly limited the program to hormonal LARCs. VDH believes that expanding the program to include all FDA- approved methods was an important step towards equity. While making some methods of contraception available at no cost, particularly the most expensive methods, can increase access, this approach has the potential of being coercive because a patient may feel pressured to choose the free method over the one that best meets their needs.

 

MCH WORKFORCE DEVELOPMENT CAPACITY:  During the previous reporting period, the MCH, reproductive health, and violence prevention teams partnered with the National MCH Workforce Development Center to meaningfully integrate the work of each of these respective teams into a unified maternal mental health strategy. During the current reporting period, the teams further strengthened relationships among one another and other teams in the office through a series of collaborative meetings and conversations. The MCH team has given the reproductive health team the opportunity to highlight the intersections of these fields through the pregnancy loss program.  Please see details regarding the Learning Community in the MCH Workforce Development Section of this grant report.

 

EMERGING ISSUES:  During the 2023 General Assembly session, Virginia legislators passed SB1538, which will require DMAS to reimburse pharmacists for medical services provided.  this bill directly addresses the main barrier to making contraception available under the Board of Pharmacy protocols finalized in 2020.  VDH anticipates that implementing SB1538 will take at least a year, but when the process is established, pharmacists will have a mechanism to bill Medicaid for contraceptive counseling provided when prescribing contraception to eligible patients. 

 

OPill, the first FDA-approved over-the-counter contraceptive pill in the United States, became available during this reporting period. OPill has no age restriction and the price ranges from $16 to $20 per pack. VDH is exploring ways to have OPill covered by insurance, and intends to research examples from other states and continue this conversation with NASHP, NFPRHA, and other national stakeholders.

 

 

 

 

 

 

	PRIORITY 4       Mental Health: Promote mental health across MCH populations, to include reducing suicide and substance use
OBJECTIVE	By 2025, reduce the percent of women who reported loss of interest or feeling depressed (postpartum depression) from 14.4% (PRAMS 2019) to 13.7%
PERFORMANCE MEASURE	SPM 6 - Promotion and strengthening of optimal mental health and well-being through partnerships and programs

 

 

 

 

Maternal mental health (MMH) conditions, including perinatal mood and anxiety disorders, are one of the most common complications in pregnancy, affecting 1 in 7 birthing individuals in the United States. MMH conditions also can often affect birthing individuals who are members of vulnerable groups and underserved communities at a much higher rate given a reduced access to screening and care, as well as other factors related to social determinants of health. If someone is experiencing MMH issues, there may be less engagement in medical care. This could lead to an increase in risk for things like preterm delivery or low birth weight, which can also increase the risk of admission to the NICU for baby following birth. MMH conditions impact the mother-baby dyad in a variety of significant ways; lactation challenges, bonding and attachment issues, the potential for cognitive and motor delays in the baby, and negative effects on partner relationships.

 

We also know that 100% of pregnancy-related mental health deaths are considered preventable. Before COVID-19, the CDC estimated that one in eight women experienced postpartum depression, and about five to seven percent experienced major depressive symptoms. Two COVID-19 studies which collected survey data on maternal mental health and breastfeeding during the pandemic indicated that a third of women screened positive for depression and one-fifth for major depression. One in five who screened positive for postpartum depression reported thoughts of harming themselves. In Virginia, 14.0% of 2022 PRAMS respondents indicated that they “often” or “always” felt down, depressed, or hopeless or having little interest or little pleasure in doing things they usually enjoyed since delivery. 

 

Strategy 1:  Explore opportunities for providing support to families seeking fertility services and families experiencing miscarriage

 

The purpose of VDH's Pregnancy Loss Services Initiative is to build the capacity of community organizations to provide pregnancy loss support to individuals and groups (including families) who have experienced pregnancy loss, including but not limited to miscarriage (including molar and ectopic pregnancy), abortion/termination for medical reasons, stillbirth and neonatal death, sudden, unexpected death of an infant, and pregnancy after loss. While pregnancy loss is defined differently throughout the world, the World Health Organization (WHO) defines a miscarriage as a baby who dies before 28 weeks of pregnancy and a stillbirth as a baby who dies at or after 28 weeks. An estimated 10% to 20% of known pregnancies end in miscarriage, and an additional 1% end in stillbirth. Research suggests that even after the birth of a healthy child, some parents who have experienced pregnancy loss continue to grieve for much longer than previously thought by health care professionals. Pregnancy loss may affect future pregnancies, the ability of a parent to care for their other children, and lead to the development of mental health issues (e.g. anxiety, depression, and post-traumatic stress disorders).

 

By increasing access to pregnancy loss support services among Virginians, VDH aims to help individuals and families heal, thus resulting in positive health outcomes for children, adults, families, and communities.

 

On January 1, 2022, VDH initiated contracts with the following organizations to offer pregnancy loss services:

• Birth in Color VA
• Full Circle Grief Center
• Kennedy's Angel Gowns
• Sisters in Loss
• VCU OB/GYN Department

 

These organizations achieved the following outputs during FY 23:

• Offered 94 grief groups to individuals who have experienced loss, with an average of 9 people attending each group
• Distributed material support ("angel boxes") to 111 families
• Hosted 11 community conversations/informational events

 

The VDH Reproductive Health Team is exploring additional ways to support individuals who have experienced loss, and during this reporting period, they have held numerous meetings with constituents, DMAS, and health providers to understand existing support systems and opportunities for improvement. Some of these opportunities for improvement include provider training, resources to help patients when they are experiencing the loss/actively miscarrying, and story sharing.

 

EQUITY CENTERING:  VDH’s Pregnancy Loss Initiative recognizes that Black women experience pregnancy loss at higher rates than White women, and as a result, aims to build the capacity of community-based organizations to support families of color. Three of the five participating agencies are led by Black women and have the ability to provide culturally specific care to Black families.

 

CHALLENGES/BARRIERS:  Stigma and misunderstanding around pregnancy loss, stillbirth, and abortion continues to be a challenge. During this reporting period, the General Assembly considered two bills that would have created a Stillbirth Support Program in Virginia. The patrons pulled both bills out of concern that the bills could be amended to restrict abortion access, and as a result, no funds were allocated to this issue. The team requested permission to apply for a Stillbirth Surveillance grant to allow the state to collect information about stillbirths, but the administration denied this request, stating that VDH had other maternal health issues that deserved our attention. In addition, health providers are not adequately trained on this issue, resulting in traumatic experiences at emergency departments and labor and delivery units. This lack of urgency and resistance to address this issue is leaving individuals and families without support. The VDH team is exploring opportunities to increase education and awareness about this important issue to providers and policy stakeholders alike.

 

SUCCESS STORY: Common feedback from pregnancy loss program participants was comfort in knowing they were not alone and gratitude for the opportunity to share their stories.

Quotes from pregnancy loss program participants:

 

 

 

 

 

When asked to note one topic they would like to have discussed, one participant wrote the following:

 

 

 

 

Strategy 2:  Local Health Districts (LHD): Strengthen early identification, supports, and referrals for mental and behavioral health needs of people of reproductive age

 

Beginning State FY 23 (July 2022), Virginia’s LHDs were transitioned to a new work plan structure more closely aligned with the State Action Plan. Each district was required to select from a list of measurable activities, and then report quarterly to those activities. Twenty-three of 35 local health districts (LHDs) prioritized mental health in their annual work plans. Local activities include: hiring a social worker with experience in mental health counseling to assess all mothers enrolling for prenatal or postpartum MCH services; strengthening the mental health skills of the LHD personnel through evidence-based trainings and continuing education; strengthening the internal screening, referral, and follow-up process; increasing connections with community providers.

Title V partnered with Postpartum Support Virginia to provide training to the district teams regarding screening and referrals, as well as to assist in the Districts’ ability to develop and sustain relationships with their community mental health providers. Twenty eight individuals attended the training. The evaluation data from the training was overwhelmingly positive, with most attendees indicating an increase in their knowledge of PMADs (Perinatal Mood and Anxiety Disorders) and resources.

Strategy 3:  Update the maternal guidelines for VDH’s five prenatal care clinics to include guidelines on maternal substance use and maternal mental health

Beginning FY23, the Maternal Infant Health Consultant participated in a workgroup led by the Director of Public Health Nursing and the Community Health Services Medical Director, and workgroup participants including representatives from all five of VDH’s prenatal clinics (Chickahominy, Chesterfield, Crater, Arlington, and Eastern Shore). The workgroup reviewed and updated current care guidelines, ensuring that they are useful, easy to follow for providers, and in alignment with recommendations from relevant professional organizations such as the American College for Obstetricians and Gynecologists. The Maternal Infant Health Consultant will provide subject matter expertise towards the creation of additional practice guidelines regarding maternal substance use and maternal mental health for clinical providers.

 

 

 

	PRIORITY 5   Oral Health: Maintain and expand access to oral health services across MCH populations
OBJECTIVE	By 2025, increase the percent of women who had a dental visit during pregnancy from 49.9% (PRAMS 2018) to 52.4%.
PERFORMANCE MEASURE	NPM 13.1 – Percent of women who had a preventive dental visit during pregnancy
EVIDENCE-BASED or -INFORMED STRATEGY MEASURE	ESM 13.1.1 - Number of Regional Oral Health Collaborative Projects that implemented work to increase dental visits among pregnant women

 

 

 

 

The Dental Health Program (DHP) partners widely across both internal Virginia Department of Health programs as well as externally through the statewide oral health coalition now known as Virginia Health Catalyst (VHC).  VHC is a non-profit organization that serves as the only statewide oral health coalition in the Commonwealth. It is a diverse group working to spark change so that all Virginians have equitable access to comprehensive health care that includes oral health, and to bring excellent oral health to all Virginians through policy change, public awareness and innovative programs. The VHC works closely with VDH to implement grant objectives and has in-depth knowledge of the Virginia Oral Health Plan and the Virginia Oral Health Report Card, and other foundations that prioritize oral health activities statewide. VHC has access to a diverse network of key statewide stakeholders, and the unique ability to share oral health information with both key partners and the public.  VHC staff understand the need to continue promotion of oral health at the local level, support local initiatives to affect meaningful change, and to evaluate efforts to ensure ongoing, comprehensive support for structural sustainability. 

 

Program activities aimed at increasing oral health care for pregnant women, infants, children and individuals with special healthcare needs (ISHCN) within the DHP are the Bright Smiles for Babies Fluoride Varnish Program, Dental Preventive Services Program, and Perinatal and Infant Oral Health Program. 

 

The Perinatal, Infant, and Adolescent Oral Health Program aims to improve access to oral health care for pregnant women, infants and adolescents who are most at risk for disease through integration of dental services and information into the primary care delivery system.  Additionally, this program allows for expansion of the existing Virginia Oral Health Surveillance System to include data collection, analysis, and reporting of indicators regarding pregnant women and infants. 

 

                                            

 

 

Strategy 1:  Maintain and expand existing MCH-focused dental education programs to improve oral health for individuals across the lifespan, to include advising on oral health integration in primary care settings, education for home visitors, school-aged oral health education, and emerging needs of adolescents

 

The VDH Dental Health Program (DHP) continues to provide education and trainings aimed at perinatal and infant oral health including education for home visitors, other family support workers, and medical/dental professionals. VDH offers an on-demand recorded "live" version of the Bright Smiles for Babies (BSB) training through an online server (TRAIN). Between October 31, 2022 and September 30, 2023, seven medical, dental, and lay health professionals completed the online BSB training. With the assistance of Catalyst staff, qualified oral health educators outside of VDH can be referred requests for BSB fluoride varnish in-person trainings. DHP also continues to collaborate with multiple partners to provide education and trainings aimed at oral health for people of all ages with disabilities or chronic conditions (PwD), including education for caregivers, direct support professionals, and medical/dental professionals. A continued partnership with the Virginia Department of Behavioral Health and Developmental Services (DBHDS) allowed for planning four additional direct support professional (DSP) virtual oral health trainings in FFY23, with a total of 119 in attendance. Contracts with Virginia Health Catalyst and the Virginia Dental Association Foundation promoted and supported three in-person dental provider trainings in FFY23 regarding oral health care for PwD. The 1.5 day (11 hour) dental provider courses in January, March, and June 2023 were attended by a total of 50 dental professionals.  In addition, a 30-minute virtual PwD course was given to nine private dental providers working with the Louisiana Health Department and planning to start a new school-based dental sealant program. A 30-minute virtual PwD CE course was provided to 25 Northern VA Community College second year dental hygiene students. At the request of the Virginia Department of Education (VDOE), a one-hour virtual course regarding dental care for PwD was provided for nine VDOE dental professionals. DHP continues to monitor and update the VDH Online Directory of Dental Providers willing to provide oral health care for very young children (under 3 years) and PwD, and partner with other Title V programs to promote the directory to families, as appropriate. As of September 30, 2023, the VDH online directory of dentists willing to see PwD and children under the age of three years included 2,341 active listings. This represents around 30% of all dentists licensed in the Commonwealth of Virginia. Approximately 1,965 of the dentists listed have selected at least some of the disability indicators as people they will see, which would represent approximately 25% of all Virginia-licensed dentists. October 1, 2022 September 30, 2023, three dentists added a new listing to the directory, and three made changes to their directory listing.

 

Strategy 2:  Continue to foster a network of 6 regional Oral Health Alliances to conduct regional needs assessments and implement systems change and data-sharing initiatives to improve the oral health of all Virginians, with emphasis on pregnant women, and children and adolescents ages 1-17

 

Strategy 3: Convene statewide groups focused on targeted oral health issues and facilitate collaboration and work plan development, and provide leadership and oversight to guide initiatives

 

 

All of Catalyst's strategies within the MCH program are designed to influence changes to the system that promote more equitable and easier access to oral health services for pregnant people and children and safe, trusted, fluoridated drinking water. Catalyst's Future of Public Oral Health (FPOH) workgroup was a collaborative project that implemented work plans to increase dental visits among pregnant people and children by focusing on technology and innovative, replicable quality improvement projects with safety net clinics. Our school-based oral health programs continued to bring together various partners who were previously unconnected to help school-age children get direct access to necessary oral health care. For example, Catalyst staff created two breastfeeding and water resources. One is specific to pregnant and post-partum patients about the importance of drinking water and how to know if your water is safe. The second is for health care providers and community organizations with the intent to educate them to discuss water with their patients and clients. Catalyst staff disseminated these resources to partners and micro-grantees to share with their community, providers, clients, and patients.  

 

Catalyst staff developed all activities to influence performance measures to increase dental visits among pregnant people and children through collaborative projects. Across the board, we positively influenced those measures through MCH-focused dental education programs like an "Oral Health for Pregnant Patients and New Parents: An Overview of Oral Hygiene in Babies and Breastfeeding" webinar, regional activities, and several active workgroups like FPOH, Water Equity Taskforce (WET) and the Early Dental Home (EDH) workgroup. 

 

Our partners across grassroots projects, alliances, and workgroups continued to identify barriers to accessing oral health care to implement work plans to address access issues at the community-level. There were eight strategic initiatives to implement work plans to increase dental visits among pregnant women including a community health center that during a scheduled medical appointment, the Assistant Dental Program Manager and Dental Assistant (DA) met with the OB patients through synchronous Teledentistry (TD) video calls to provide oral health information and education. At the time of the project, the dental and medical sites were at different locations several miles apart, with limited public transportation options to and from. During the reporting period, there were 14 Regional Oral Health Collaborative Projects that implemented work plans to increase dental visits among children (ages 0-11 years) and adolescents (ages 12-17 years). The work plans included school-based and school-linked oral health services to students in Title 1 schools across Virginia.

 

Catalyst staff partnered with four community-based organizations to implement innovative programs that support programs delivering vital services for MCH populations. This includes mothers, women, children, and youth from 0 to 17 years old (including children and youth with special health care needs) and their families. All projects have a community engagement component that benefits the community-based organization and provides crucial information to advance the work at Catalyst. Catalyst staff provided capacity-building and quality improvement support by targeting grassroots organizations that will help the communities served. The community will be empowered to take ownership of their health and access the available resources. One of the microgrants is Nurturing Amenities. The team shared that through their four self-care workshops involving 12 women, they identified five individuals who hadn't seen a dentist in over two years. They provided dental surveys and facilitated connections to dental resources for both these women and their families. Since receiving microgrant funding, they have distributed over 250 dental kits and 500 resources on tap water safety and breastfeeding within the community. The overall programmatic success and impact benefited by directly accessing individuals who can provide input regarding community needs related to oral and overall health, drinking water equity, and other issues important to the organization's mission. These collaborations across the Commonwealth advance efforts to ensure all Virginians have access to comprehensive health care, including oral health and equitable drinking water solutions.

 

As outlined in the monthly reports, many activities occurred during the reporting period. These activities included facilitating community outreach events to increase awareness of program services, training staff, and stakeholders on evidence-based practices, working with clinics to implement medical and dental integration, school-based oral health programs and services to improve access to care, and collaborating with community partners to enhance service delivery.

 

The Catalyst team recruiter presenter Tiffany L. Williams, DDS, MSD, Director of Student Recruitment, Admissions with Virginia Commonwealth University School of Dentistry for an "Oral Health for Pregnant Patients and New Parents: An Overview of Oral Hygiene in Babies and Breastfeeding" webinar on July 17 from 12-1 PM. Dr. Williams shared her knowledge about peri- and prenatal oral health care. She focuses on preventive oral care for the pediatric population and improving oral health outcomes for children locally and abroad. By the end of the session, participants understood the connection between parent and child oral health, were able to discuss the importance of pre-and perinatal oral health care and healthy home oral hygiene practices, demonstrated pre-dentate and dentate mouth cleaning, and explained the importance of drinking water while breastfeeding.

 

 

EQUITY CENTERING:  Catalyst's strategic plan includes a key priority to advance equity. During developing our current strategic plan, extensive discussion ensued between Catalyst's board and staff about whether to make "advance equity" a stand-alone priority or weave it throughout all priorities. Ultimately, we decided that positioning equity as its priority was necessary to make our commitment explicit and visible and hold ourselves accountable to accelerating our progress towards equitable health outcomes and racial equity. As such, we incorporate an equity lens in all of our work, and three goals specifically focus on advancing health and racial equity. Each of these goals also includes areas of focus that further outline Catalyst's strategies to advance equity. Virginia Health Catalyst's efforts promote health and racial equity by changing the systems that lead to these disparate outcomes. As an organization, we embrace a culture that values learning and partnership and recognize that changing systems necessitates a deep understanding of racism and related issues, including their context and history. For example, we have gained a wealth of knowledge about the history of racism and racial disparities regarding drinking water equity - from Black and Latino neighborhoods being denied access to plumbing and public water connections as cities grew to communities of color experiencing higher rates of drinking water violations. It is not surprising that an estimated 30-40% of people of color do not drink tap water compared to about 20% of Americans overall. This understanding and acknowledgment are front and center as we seek to improve trust and drinking water equity. As part of our water equity work and beyond, Catalyst recognizes that meaningful community engagement with both breadth and depth is essential in creating impactful strategies to advance health and racial equity. Consider the recent increase in federal funding for water infrastructure projects available through the Bipartisan Infrastructure Law. Without intentional community advocacy and participation in the decision-making process, these investments will likely continue to be out of reach for historically excluded communities. This demonstrates Catalyst's commitment to connecting our learning to actions that promote health and racial equity. 

 

PARTNERSHIPS, COLLABORATIONS, AND COORDINATION:

Virginia Health Catalyst collaborated with numerous partners during the grant period. Many of these partnerships supported strengthening Virginia's oral health workforce to meet the needs of all Virginians. Catalyst staff recruited many Future of Public Oral Health Taskforce (FPOH) members to participate in an FPOH Workforce Committee to develop and execute a shared vision for Virginia's oral health workforce. Participants include representatives from Virginia's community colleges, the Department of Health, safety net hospitals, federally qualified health centers, free and charitable clinics, health workforce agencies, and oral health professional societies. Committee members met regularly during the grant period to share information and better understand the challenges of the systematic oral health workforce. This work culminated in Committee members adopting an oral health workforce framework. This framework laid the foundation for the Committee's ongoing work to identify and execute specific policy and programmatic levers to ensure that Virginia has enough oral health professionals to meet the needs of all Virginians, no matter their location, race, ethnicity, income, etc. While the Committee members reviewed and adopted the oral health workforce framework, Virginia Health Catalyst staff began drafting an oral health workforce gap assessment to help policymakers and the public better understand the magnitude and consequences of Virginia's oral health workforce shortage. Staff gathered data and research from multiple sources into an accessible report that offered concrete recommendations to address the crisis. Catalyst staff conducted most of the research and writing during Summer 2023. Staff finalized, designed, and published the assessment in the Fall of 2023, just after the end of the grant period.

 

CONSUMER AND FAMILY PARTNERSHIPS:  Virginia Health Catalyst staff led several initiatives to strengthen partnerships during the grant period. In Virginia, dental hygienists may initially assess an individual in specific community settings without a dentist. A dentist must examine the patient or refer the patient to another dentist for examination within 90 days of the hygienist's initial assessment. This model is called dental hygiene remote supervision. The model effectively provides preventive oral health care and referrals to children in school-based settings. While supportive of the model's aims, many dentists and dental hygienists criticized it, partly because many patients first seen by a dental hygienist under remote supervision could not get an appointment to see a dentist within 90 days. Previous efforts to address the concerns were unsuccessful. During the grant period, Catalyst staff committed to bringing the appropriate partners together to tackle this challenge. Staff convened representatives from the Virginia Dental Association, Virginia Dental Hygienist Association, and dental directors from several safety net clinics. Through these meetings, Catalyst staff learned more about the challenges dentists and hygienists face in implementing the model. Catalyst helped build trust among these organizations and individuals. The partners agreed to pursue a policy change to allow dentists to examine a patient first seen under remote supervision from 90 days to 180 days, intending to strengthen access to underserved adults and children. Catalyst and the Virginia Community Health Workers Association (VACHWA) developed a partnership. This nonprofit organization provides a platform for Community Health Workers (CHWs) to connect, learn, and advocate personally and professionally. An increasingly robust body of research shows that CHW interventions improve health, particularly for underserved individuals and communities, while saving health systems and payers money. During the grant period, Catalyst staff partnered with VACHWA to strengthen CHWs' confidence and capacity to advocate on behalf of themselves, the communities they serve, and their profession. For instance, staff created educational materials for policymakers about the CHW profession and the benefits CHW interventions bring to underserved families. They provided regular policy updates to CHWs across Virginia, helping make Virginia's complex policymaking process more accessible. Catalyst staff also prepared and delivered a two-part advocacy training for Virginia's CHWs in partnership with the VACHWA (the training occurred one week after the grand period ended). Staff learned from CHWs about the challenges they face in helping their communities. Staff shared advocacy tips to build CHWs' confidence in their ability to advocate for themselves and the people they serve. The training culminated in an event where CHWs shared their background and work with state policymakers.

 

MCH WORKFORCE DEVELOPMENT: During the grant period, Catalyst staff began drafting an oral health workforce gap assessment to help policymakers and the public understand the magnitude and consequences of Virginia's oral health workforce shortage. Staff synthesized data from multiple sources to paint a detailed picture of Virginia's oral health workforce crisis at the locality level. The analysis found that many Virginia localities have less than one dentist or dental hygienist per 5,000 residents, and a handful do not have a single dentist or hygienist. The assessment also noted that only 27 percent of dentists treat Virginians enrolled in Medicaid or the Family Access to Medical Insurance Security program, which is a public insurance program for people who have low incomes or disabilities. Staff also began compiling concrete recommendations to address Virginia's oral health workforce crisis. These recommendations appear in the final assessment, which Catalyst staff released shortly after the grand period ended. The intent of these recommendations is to 1) ensure there is an adequate number of oral health professionals in all parts of the Commonwealth and 2) ensure all Virginians can access oral health care regardless of their race, ethnicity, or income.

 

CHALLENGES/BARRIERS: Virginia's safety-net clinics struggle to take on a growing number of patients. Provider burnout and healthcare professional shortages continue to create issues for safety-net providers to meet their patients' health needs. With the expansion of Medicaid in 2019 and the additional comprehensive adult dental benefit in Medicaid in 2021, more Medicaid members are seeking dental care. Still, there are not enough dental providers to meet their needs. As a result of delayed health care during the pandemic, kids present with more significant health care needs, including oral health, and usually require multiple visits. Emergency departments work to address the symptoms for patients who can't obtain an appointment and have emergent needs but provide short-term patient oral health-related relief with antibiotics or other prescriptions, and there is no follow-up to the patient's dental condition. Catalyst partners have begun pursuing and educating others on minimally-invasive preventive measures such as silver diamine fluoride. Additionally, Catalyst staff are working with clinics engaged in school-based work to discuss solutions, including diversifying insurance, obtaining additional funds elsewhere, and utilizing groups like PTA to secure monies for kids.

 

EMERGING ISSUES: Healthcare workforce capacity and provider burnout continue to be a growing challenge for patients and providers across the Commonwealth. Patients and clients report long wait times and a lack of providers that will see Medicaid, under, and uninsured patients. Medicaid expansion brought additional access to oral health care for over a million Virginians, but the workforce shortage has made it difficult for these patients to be seen. Care for pregnant people, older adults, and those within the ID/DID community increases the difficulty in finding care. Partners have expressed their difficulties in identifying and retaining providers and needing more resources around regulations that could help expand their staff scope of work, such as remote supervision of dental hygiene.