NPM 1 - Percent of women, ages 18 through 44, with a preventive medical visit in the past year
Objectives:
- Increase the percentage of primary care providers receiving education and support to assess and treat clients with perinatal mental health disorders to 25% of primary care providers within reach of dedicated programs by June 2020
- To prevent the onset of Type II diabetes for women with a history of GDM, increase the percentage of women in the University of New Mexico Hospital’s Maternal and Family Planning (M&FP) Clinics completing a post-partum visit and appropriate testing to 80% by June 2020.
Strategies:
- Provide training opportunities on the assessment, referral and/or treatment of women with perinatal mental health disorders to primary care providers in rural areas of the state.
- Work in a collaborative partnership to address the prevention of Type II Diabetes Mellitus by addressing barriers to postpartum visit completion.
- Design and implement a prenatal care resource application that will be used with women with a positive pregnancy test at three community-based sites in the US-Mexico border area.
Objective- Increase the percentage of primary care providers receiving education and support to assess and treat clients with perinatal mental health disorders, to 25% of primary care providers within reach of dedicated programs by June 2020.
During Fiscal Year 2018, the Maternal Health Program Manager worked with a committee of Human Services Department staff (Behavioral Health Division), Children, Youth and Families Department (CYFD) staff and other stakeholders to address the introduction of a new diagnostic coding system for infants and toddlers with mental health diagnoses. The system, called Diagnostic Coding 0-5 (DC 0-5), is widely accepted among infant mental health professionals as best practice. It directly addresses the social/emotional development milestones integral to infant mental health, while also acknowledging the needs of the infant caregiver (parents, or other) and their ties to the infant’s mental health. The CYFD Infant Mental Health Program leads this work with technical assistance from the national Zero to Three organization.
The goals are:
- To develop a continuum of behavioral and emotional health services in NM which are connected through referrals and patient information incorporating all existing services and new service opportunities from prenatal through 5 years old;
- To incorporate the DC 0 – 5 classification system into the continuum at all service sites, ages 0 – 5
Title V involvement is specific to the first goal through the creation of an inventory of network services that are accessible to referring providers and offer expanded maternal therapeutic support and potential substance use services that are beyond the dyadic therapy offered in the existing infant mental health network. Behavioral support services are limited in many parts of the state, so if a health provider needs to refer a family with a qualifying diagnosis, it is challenging to make an appropriate and accessible referral.
To address provider training needs, a new Project Echo is being launched in July 2019 called, ‘Child Behavioral Health ECHO Clinic’. This is a joint venture by two health care systems in Albuquerque using Project ECHO to provide virtual trainings for health providers outside the metro area and for those requiring diagnostic or treatment support. The goals of the project are for healthcare professionals to feel confident in diagnosing, treating and/or referring child and adolescent behavioral health disorders in addition to navigating the legal aspects of their healthcare. The ECHO clinic kicked off a symposium held in May 2019. It was attended by 34 clinical providers.
Several pediatric providers expressed a need to facilitate assessment and support for caregivers, especially during the pediatric visit. Future topics in this series will cover assessment of post-partum mental health and how it affects children. The sessions will provide case-based clinical discussions and brief didactics to support treatment or referral. The goal is to reach 100 healthcare professionals (doctors, advanced practice clinicians, nurses, counselors, home visiting staff, etc.) by May 2020.
Strategy- Work in a collaborative partnership to address the prevention of Type II Diabetes Mellitus by addressing barriers to postpartum visit completion.
MHP and MCH Epidemiology staff continued to work with the NMDOH Diabetes Prevention and Control Program (DPCP) and with the staff of an Albuquerque metro maternity/family planning clinic run by the University of New Mexico Hospital (UNMH) to implement a project to address the appropriate assessment and follow-up of women diagnosed with gestational diabetes (GDM) women at the post-partum visit.
This project was submitted to the MCH Workforce Development Center and accepted as a participating project for their 2018 Learning Institute Cohort. Staff from NMDOH MCH and staff from the UNMH Clinic attended the Learning Institute sessions in Chapel Hill, NC in March 2018. Through participation in the Development Center, the NM team was able to create a clear plan, divided into different phases, to move work forward. Phase one includes improving the post-partum visit follow up scheduling and to identify barriers in preventing women from getting the appropriate follow up blood testing. Phase two includes introducing an evidence-based education for managing diabetes risk for women post-GDM resolution following pregnancy. Phase three includes disseminating the education and methods to a wider-net of providers and phase four includes attempting to create incentive-based initiatives to assure sustainability as well as reach this population in clinics and other settings across the state.
One challenge for this program is using data to identify what barriers exist within the healthcare system itself. Some suspected barriers to attending post-partum visits (PPV) may be created by the healthcare system. For example, there is no clinical database that can easily identify a PPV scheduled at a site external to where the prenatal care took place. It has also been impossible, within the same healthcare system, to measure how many PPV’s were actually attended. Through the data that we have been able to pull, we identified inconsistency in appropriate glucose lab testing. This is used to evaluate Type 2 diabetes risk post-partum. Other limitations include the inability to achieve buy-in from all practitioners who could affect our intended outcomes.
In January 2019, a member of the MCH Epidemiology program attended the CDC/Harvard MCH Program Evaluation Practicum. Out of this partnership with the students, through guidance from the state program employees, we created an evaluation plan to further refine stakeholders, activities and outcomes of the initiative. We added a step to our proposed intervention in which we will provide GDM education to pregnant clients who had been identified as being at a higher risk for developing gestational diabetes. This change meant that we could provide health education at an earlier point, and not have to wait until the PPV. This helped to further identify courses of action that could be implemented, such as gathering feedback from the population of interest to guarantee a culturally competent diabetes health education curricula as well as the use of electronic devices to deliver the health education and utilize a survey to measure effectiveness. The evaluation plan was finalized in April 2019.
Objective- Increase prenatal care utilization in the first trimester. (Access to healthcare and adequate insurance)
New Mexico struggles with insurance coverage and access to care across all populations, which impacts pregnancy timing and intention, access to family planning and prenatal services, and ultimately affects birth outcomes. The prevalence of insured adults in NM changed positively with Affordable Care Act (ACA) expansion. Statistically significant increases in insurance coverage occurred among all adult women (10.5% increase) and among Hispanic adults (11.1%) from 2012 to 2015. The greatest increase by age was for those under 34 years (NM Behavioral Risk Factor Surveillance System: https://nmhealth.org/data/view/report/1932/). Among women of child-bearing age, this trend appears to have leveled off and while uninsured women (18-49 years) dropped from 24% to 12% in 2015, the prevalence was still 12% in 2017 (NM IBIS- BRFSS).
The existing barriers to insurance coverage for women of child-bearing age carry over to prenatal care where lack of pregnancy recognition, distance to care, and health professional shortages all contribute to delayed entry (NM PRAMS). These challenges impact women residing in border counties and in rural/frontier areas of our state disproportionately.
Border CoIIN- Improving first trimester prenatal care utilization in Dona Ana County
We built on strategic activities defined through the 2015 Title V 5-year needs assessment:
- Improve access to and navigation of health insurance coverage and resulting services and learn how ACA has impacted access and how navigation can be implemented;
- Increase prenatal utilization in the first trimester (and by adequacy of care index);
- Improve linkages and referrals between existing health services to optimize primary and specialty or behavioral health and wrap-around care; improve cross-border collaboration.
Title V programs partner with health organizations in the US-Mexico border region to identify and respond to barriers in access to healthcare, health insurance coverage, timely prenatal care and linkages between primary and behavioral/mental health care. There are unique challenges associated with border residence, including rural and urban disparities, geographic distances to routine healthcare, and high concentrations of poverty.
During FY18 Title V staff were challenged by staffing turnover and the termination of case management provided to over 300 families through Healthy Start perinatal case management at La Clinica de Familia in Las Cruces (Dona Ana County). Despite these challenges, we continued to design a web-based resource and app to inform women about community resources and insurance options, with variations depending on their personalized needs and questions. Working through the PCI Border CoIIN with CA, TX and AZ, we brought together Dona Ana County stakeholders to go through an intensive quality improvement innovation pilot.
Strategy- Design and implement a prenatal care resource application that will be used with women with a positive pregnancy test at three community-based sites in the border area.
In the Fall of 2017, Maternal Child Health Epidemiology and Maternal Health staff joined an infant mortality Collaborative Improvement Innovation Network (CoIIN) to improve prenatal care utilization among women residing in US-Mexico border counties. Project Concern International (PCI) received a grant through the Association of Maternal Child Health Programs (AMCHP) to work with CA, AZ, NM, and TX Healthy Start sites and provide technical assistance to Title V program staff across those states.
The 2018 activities included robust stakeholder input with PCI participation and leadership through our partners at La Clinica de Familia Healthy Start. Participants identified the community of Anthony, NM to receive the focus of intervention. Community members and MCH service providers held meetings to discuss barriers to prenatal care. LCDF Healthy Start staff led the project and worked with a website developer to begin the design process for web-based resources to assist women in their navigation of prenatal care entry. The proposed model of intervention was to:
1. Initiate introduction to a web-based application at the clinical encounter where women presented for pregnancy testing (at NMDOH public health clinics);
2. Coordinate follow up with a health promotions/promotora based in La Clinica de Familia and offer resources to women wanting support in insurance, payment or help getting to prenatal appointments, and
3. Verify prenatal care entry in LCDF clinics. With a goal of shortening the time between pregnancy testing/confirmation and clinical prenatal care entry to two weeks, we aimed to pilot the impact of offering the web-based resource application and access to a health promotions navigation support person.
Barriers to implementation
Several structural barriers presented themselves during the reporting period. First, La Clinica de Familia staff were informed that they would not be eligible for HRSA funding to continue Healthy Start services and that they would need to transition leadership of the CoIIN to another entity. Secondly, NMDOH staff were geographically and organizationally removed from the population targeted for intervention.
Other challenges were observed in the selection of Anthony, NM as the geographic focus of intervention. For example, input from women on their prenatal and delivery experiences indicated that it would be very challenging to track women’s entry to care if they received care in TX. Vital Records data confirmed that most Anthony residents left NM to obtain obstetric care and that there was a consumer preference for OB care offered in TX. The Title V and Healthy Start staff did not have capacity to work with TX clinical sites or to follow up with individual women opting for out of state care.
Finally, while states are offered a small contract to implement and evaluate a pilot project, it does not cover the costs required to conduct a robust evaluation of women receiving an intervention compared to those not receiving an intervention. The Title V staff can utilize population level data in Vital Records and PRAMS with birth certificate and survey information, but they do not have the resources required to conduct case control studies or even simulated data analysis required to evaluated interventions in a small geographic area. Staff transitioned work plans to reflect these barriers and will establish new goals for the FY2020 plans.
SPM 5 - Adequate Insurance
Objectives:
- Reduce the infant mortality disparity ratio between Black/African-American and White Infants by 25% by 2019.
- Improve health insurance coverage among NM women of reproductive age by 5% by 2020.
- Complete an economic impact study and community needs assessment of Paid Family Leave in NM by 2020.
Strategies:
- Organize with regional community health workers/promotoras, DOH case coordinators, and navigators to coordinate support for families trying to access insurance from the perinatal period through postpartum and inter-conception periods.
- Leverage participation in the Infant Mortality CoIINs to improve equity in birthing options and in healthcare utilization before during and after pregnancy.
- Coordinate multi-sector, State (DOH, HSD, CYFD) and tribal health entities, including Albuquerque Area Indian Health Board (AAIHB), Tribal Epidemiology Centers, and Medicaid Managed Care tribal liaisons to improve surveillance and health assessments.
Objective- Improve health insurance coverage among NM women of reproductive age by 5% by 2020.
Midwifery and Birth Worker Workforce Development
Title V staff seek to increase the adequacy and accessibility of timely maternal care by:
- improving components of the midwifery workforce licensure processes
- securing reimbursement for midwife services to allow birthing options in out-of-hospital settings, and
- expanding the quality and breadth of care to perinatal populations with perinatal mood disorders, gestational diabetes/post-partum care, and oral health needs.
The Title V Maternal Health Program licenses and provides support to midwives attending home births, which can be billed for Medicaid reimbursement. This is a way Title V makes birthing options available to lower-income families, and in conjunction with birth-worker retention funds (to cover malpractice insurance), helps assure that women opting for out of hospital deliveries have adequate insurance for maternity care. However, it is challenging for some midwives to sustain a Medicaid clientele because there are routine claim rejections, and MHP staff have actively helped problem solve this by providing training on billing code procedures. To facilitate better practice in Medicaid billing procedures and successful reimbursement, a training was conducted in conjunction with the Annual Conference of the New Mexico Midwives Association (the professional association for LMs in the state) in February 2018. Title V staff continue to support licensed midwives in this area and have worked with Medicaid leaders to request additional training and guidance for midwives.
Sustaining licensed midwifery as a profession in NM by providing continuing education, training, and living wage assessment are important pieces of Title V oversight, health equity and workforce development. MCH Epi staff work to evaluate and promote access to maternity care and birthing options among low-income, rural residing and minority women. NMDOH Title V Staff partner with statewide advocates and clinicians to broaden awareness about birthing options including access to perinatal doula care and home births.
Complementary work continues to broaden the access and professional development of doulas and midwives of color throughout New Mexico. The Birth Companion Project is a program at the University of New Mexico (UNM) to give Medicaid-covered or uninsured women a birth doula at no cost. The establishment of both the Birth Companion project and the NM Doula Association were important developments, and were led by partnering organizations, including Young Women United and UNM Hospital nurses. The NM Doula Association https://www.nmdoula.org/ was established to mitigate health disparities by increasing access to doula support for families, including rural, tribal, and other underserved communities. The aim is to increase racial, social and geographic diversity in the trained doula workforce.
The leadership from the Doula Association started training doulas in 2018 to prepare them for work in the Albuquerque Metro area in the Birth Companion Project and to train doulas throughout the state to address prenatal substance use and related behavioral or mental health referrals. NMDOH Title V staff reviewed literature and evidence from other states where Medicaid reimbursement for doula services is legislated and started plans to advance economic impact analysis, building on those state examples. To support training curriculum, MCH Epi staff provided PRAMS data on social context, healthcare utilization and preconception substance use.
Strategy- Coordinate multi-sector, State (DOH, HSD, CYFD) and tribal health entities, including Albuquerque Area Indian Health Board (AAIHB), Tribal Epidemiology Centers, and Medicaid Managed Care tribal liaisons to improve surveillance and health assessments.
Needs Assessments and Multi-Sector Alignment
Title V staff recognize the need for and support the cross-sector collaboration across government agencies, evaluation assessment and monitoring. As described in the Needs Assessment update, New Mexico Title V serves an important connecting role between clinicians, public health programs and academics. Collaborations include the NM Perinatal Collaborative, the Birth Equity Collaborative, NM March of Dimes, Office of the Medical Investigator, and early childhood programs including home visiting, Early Head Start and other state agencies.
The statewide Home Visiting Collaborative, NM Breastfeeding Task Force, and Tribal Epidemiology Centers partner to conduct community-level needs assessments; statewide population-specific assessments around maternal health, postpartum and child health, adolescent health, and children and youth with special needs or developmental risk; and pre-k school readiness. Title V objectives and strategies are coordinated and monitored with data from population surveys, community focus groups, and fatality review panels.
Maternal Mortality Review and Severe Maternal Morbidity
The Maternal Mortality review and analysis of maternal morbidity serve to inform both maternal, birth and infant health outcomes and potential strategies to reduce disparities. Throughout FY2018, the Maternal Mortality Review Committee (MMRC) convened to review 2015 deaths to establish a baseline cohort and build case registry capacity. Case review processes were refined during the reporting period, and the core planning group worked to address the complexity of defining preventable deaths.
Because the NM committee reviews all pregnancy-associated deaths up to one year after pregnancy, the nature of death review calls for multi-disciplinary collaboration. Pregnancy-related deaths, categorized by medical causes such as eclampsia, postpartum hemorrhage, or disseminated intravascular coagulation (DIC), are a fraction of the deaths, and the largest number of reviewed deaths are not directly related to medical circumstances but social or behavioral factors (figure 1.). They include motor vehicle accidents, violent deaths, overdose and suicide fatalities. To address the array of mortality causes, MMRC core members reviewed membership for appropriate expertise and discussed up-stream strategy contributors, such as home visiting, doula support and referrals for counseling or mental health treatment. More information on the definitions of pregnancy-related and pregnancy-associated deaths is available at the CDC Review to Action site: https://reviewtoaction.org/learn/definitions
DOH Title V staff attended CDC Maternal Mortality Review Information Application (MMRIA) database user trainings along with UNM committee members in 2017 and 2018, and two abstractors (OB-GYN and Nurse) have completed populating the case records for 2015. Currently, MMRC abstractors use a local version of MMRIA with no data sharing interface with the CDC. The CDC plans a national web-based platform release, and New Mexico plans to join that platform when the IT and confidentiality specifications are released and then approved by the Department of Health.
A maternal mortality bill was introduced in the 2019 legislative session and signed by the Governor to strengthen the confidentiality protections of the Committee’s proceedings, specifically protecting committee members from outside legal interference. The bill also institutionalizes and codifies MMRC proceedings so that they will be sustained through state government changes in leadership and resources over the years. A poster and a fact sheet were created to inform stakeholder agencies and legislators of the progress, proceedings and findings of the MMRC following the first year of its launch. These products were presented at the UNM Women’s Health Conference in February 2019, and they will be shared with other CDC maternal mortality review states for input.
Beyond immediate cause of death review, the MMRC and recent legislation included plans to review and to provide statistical analysis of severe maternal morbidity (SMM). MCH Epidemiology staff collaborated with UNM and NM Vital Records staff to analyze a linked birth certificate-hospitalization record file to assess the prevalence and patterns of severe maternal morbidity (SMM) in NM. Employing CDC definitions* of SMM we found that 144 per 100,000 hospitalizations for the 2015 birth cohort (n=27,263 singleton births) involved a severe morbidity between 2014-2016, and sharp disparities were observed by maternal race and ethnicity: The prevalence of severe maternal morbidity (n=439) was about twice as high for AI/AN women (2.69%) compared to non-Hispanic white women (1.35%). For Black women (1.86%) compared to non-Hispanic white women the prevalence was 1.37 times higher, and for Hispanic women (1.53%) it was 1.13 times higher. Work to address pathways to preventability for severe morbidity and mortality will require clinical but also non-medical and preconception/ well-woman interventions around risks such as hypertension, diabetes, obesity and stressful life events.*https://www.cdc.gov/reproductivehealth/maternalinfanthealth/smm/severe-morbidity-ICD.htm
As a first step in quality improvement for maternal health management, the New Mexico Perinatal Collaborative and NMDOH Title V applied to join an Alliance for Innovation in Maternal Health (AIM)- American College of Obstetricians and Gynecologists (ACOG) bundle to prevent postpartum hemorrhage. NMDOH Title V and NM Perinatal Collaborative members at UNM worked together to plan a launch of the bundle by presenting to hospitals and discussing with colleagues throughout the state. NMDOH staff attended AIM state calls and talked about baseline data and process measures to be used with each participating hospital. Staff planned to leverage the Project ECHO telehealth infrastructure to notify providers and solicit participation in the statewide effort. The ‘Improving Perinatal Health’ ECHO program uses a tele-mentoring framework in which maternal safety bundle components are presented through brief didactic presentations and reinforced through case-based learning that engages the entire network of participants in problem-solving and sharing of place-based clinical expertise. More about this platform and plans to collect process and outcome measures are found in the FY2020 application section of this report.
Maternal/Infant Title V-Tribal surveillance enhancements
State-Tribal health surveillance and assessment collaboration
Title V plans from the 2015 statewide needs assessment indicated a need to strengthen DOH-Tribal Epidemiology Center partnerships and institutionalize surveillance of maternal-infant health specific to Native American communities. NMDOH MCH Epi and Albuquerque Area Southwest Tribal Epidemiology Center (AASTEC), and Navajo Epidemiology Center (NEC) established a sampling plan with 26 New Mexico Tribes to conduct a parallel, tribe-specific PRAMS surveillance approved by the Institutional Review Board at New Mexico State University in 2017 and starting with 2018 birth data collection. Agreements and data sharing plans were signed with both Tribal Epidemiology Centers and the Department of Health to assure a long-term, collaborative surveillance plan to builds in capacity sharing, resource/cost sharing, and elements of community participatory research.
AASTEC and NMDOH share responsibility for the surveillance, and AASTEC has agreements in place with all participating tribes. Like the CDC-NM state PRAMS, women must agree to participate in the study, and it is voluntary, but it is important to establish approvals and data sharing agreements with tribes, as well. Tribes have authority over all data pertaining to participants from their communities, and tribe-specific data cannot be released without that agreement for any data request. AASTEC and NMDOH epidemiologists will collaborate to establish data validity at regions or tribal aggregations to provide stable data, when approved. Data will be used for program planning and evaluation for tribal WIC programs, home visiting programs, maternal child health and community health councils and health providers serving Native American women and infants.
In November 2018 the two Tribal Epidemiology Centers and Maternal Child Health Epidemiology staff held the first Tribal Maternal Child Health Symposium in New Mexico. AASTEC, NEC and MCH Epi/Title V presented state PRAMS data on Native American women and infants. Almost 200 participants attended from NM tribes, tribal-serving organizations and health organizations, and there are plans to hold a second symposium when Tribal PRAMS data are available to share.
Objective- Reduce the infant mortality disparity ratio between Black/African-American and White Infants by 25% by 2019.
Advancing multi-sector partnerships to address equitable birthing options and access to care
The Office of Health Equity and Family Health Bureau/Title V staff collaborate to assess the existing and potential applications of health equity principles in the objectives and strategies advanced through Title V Maternal Child Health partnerships. The broad goals are to reduce health disparities due to characteristics such as race/ethnicity, limited English proficiency, disabilities, sexual orientation, gender identity, economic status, and geographic location (rural v. urban, US-Mexico border, Tribal boundaries). New Mexico Title V team members approach the multi-factorial nature of healthcare access by addressing heath inequities related to social environment, determinants of health, and socioeconomic disadvantage.
Strategy- Leverage participation in the Infant Mortality CoIINs to improve equity in birthing options and in healthcare utilization before during and after pregnancy
New Mexico Birth Equity Collaborative
The NM Birth Equity Collaborative (BEC) was established in February 2018 following two years of community meetings and discussions held between Title V/MCH Epidemiology, Young Women United and the UNM Robert Woods Johnson Foundation Center on Health Equity. After conferencing on complex and historically rooted disparities, an opportunity for the Office of American Affairs and the NM March of Dimes to lead the birth equity work led to a solid and committed coalition of partners determined to change the course of poor maternal and infant outcomes for women of color. From 2015-2017 Black infants in NM were twice as likely to die in the first year of life compared to non-Hispanic White infants (10.5 v. 4.7 deaths per 1,000 live births). Using 5-year rolling averages, the infant mortality rate for black babies has not attenuated in any hopeful way since 1999 (NM IBIS). https://ibis.health.state.nm.us/query/result/infmort/InfMort/InfMortRate5Yr.html
Black women are more likely to experience hypertensive disorders and to report dissatisfaction with prenatal care compared to other NM women (NM PRAMS), and they are less likely to attend prenatal care in the first trimester compared to Hispanic and non-Hispanic White women (57.9% v. 62.7, 70.5% respectively) (NM IBIS, 2017 births).
https://ibis.health.state.nm.us/query/result/birth/BirthCntyPNC/PNCTri1.html
Because African American/Black women bear the highest burden of these health challenges, we came to a consensus that the work should focus on that population, and the concept of Centering Black Women was adopted. Indigenous women and other women of color are working to support this focus, bringing a range of community and medical expertise to the effort. The sustainability of the BEC has been facilitated by AMCHP Infant Mortality CoIIN efforts at the national local levels. Because NM was accepted to participate in two communities of practice, one focused on prenatal care utilization and the other on social determinants of health, we were able to leverage support to the BEC in the areas of provider bias training development and seed funding to make the trainings available within the next two years.
Young Women United, University of New Mexico, and partners including Black Health New Mexico, Office of African American Affairs, Tewa Women United, independent doulas, midwives, DOH Office of Health Equity, Medicaid Managed Care Organizations, and the March of Dimes were able to shift from identifying perinatal outcome disparities (low birthweight, preterm birth, late prenatal care) to focus and mobilize community-level clinical improvements through strategic planning. Strategies in 2018 developed around three primary areas:
Sister Circles and Story Collection
- The Sister Circles will be held in Santa Fe, hosted by the New Mexico Health Equity Partnership; in Albuquerque, hosted by Esperanza Dodge (Young Women United); and in Hobbs, hosted by Sabrina Curry (DOH). Additional circles may be offered if capacity and interest permit expansion.
- Circles will be held in four one-hour sessions, once a week for four consecutive weeks
- Sister Circle facilitators will be representative of the women participating, and along with the BEC hosts, ensure that those participating can give input and feedback on the process.
- We will offer a new, geographically-specific community resource at each session, i.e.: yoga, stress reduction techniques, community service resources/calendars.
BEC stakeholders received names of interested women by attending the NM Black Expo in June 2018. A short general survey was used to assess if women were interested in sharing their stories and to understand the usefulness of sister circles. The plans to launch sister circles in three regions of the state coincided with a very busy legislative session and new administration and Governor; however, plans to launch provider bias trainings for medical providers and medical students proceeded through NMDOH participation in an infant mortality collaborative improvement and innovation network (CoIIN) facilitated by the Association of Maternal Child Health Programs (AMCHP).
Provider Bias Trainings
Through a small funding opportunity with AMCHP, Title V staff, along with the DOH Office of Health Equity, March of Dimes and Black Health NM, set goals to offer trainings on provider bias. The over-arching goal is to improve health provider education in implicit bias and to minimize differential treatment based on perceived race or ethnic identity. Toward this goal, we established a small contract with Black Health and will describe FY20 plans in the application section of this report. The current goals that have been set include completing a timeline and audiences for training; identifying and convening presenters, national and local experts and clinicians in the process of curriculum development/adoption; and bringing together stakeholders to review existing plans and build consensus for a provider bias training plan in FY19-20.
The March of Dimes hosted a Birth Equity Summit in December 2018 to bring in health workers, clinicians, medical students and public health stakeholders to learn about how implicit bias and coercion can be identified and addressed in the implementation of birth equity principles. This was followed by a web-based training to support medical students and providers in their self-assessment for bias and inclusion of birth equity principles in their respective course of study or profession. The March of Dimes released birth equity principles and a Birth Equity for Moms and Babies Consensus Statement to help health systems and departments of health navigate tools and curricula on birth equity https://www.marchofdimes.org/professionals/Birth-Equity-for-Moms-and-Babies-Consensus-Statement.aspx Additional tools are available and being shared through the Black Mamas Matter Alliance and the National Birth Equity Collaborative.
Workforce Development
NM BEC stakeholders identified the cultivation of diverse (women of color, minority, women) students and clinical/community-based birth providers as a long-term goal. Investing in a representative workforce is a component of health equity requiring fiscal and intellectual investment. To operationalize this activity, NMDOH and UNM have established an agreement to offer women of color and young, parenting or disadvantaged students practica and internships in MCH Epidemiology, behavioral health and health promotion through the NMDOH, UNM, the Perinatal Collaborative, the March of Dimes and Tribal Epidemiology Centers.
Infant Mortality CoIIN- Paid Family Leave
Partnering with the Southwest Women’s Law Center, Title V staff and community organizations worked to develop potential policy and practice changes that would advance family-friendly workplace leave policies in New Mexico. Title V staff initially invited presenters from states that had already enacted paid family leave legislation to provide technical information and lessons on economic impact, if known. We convened multi-disciplinary stakeholders to view these webinar presentations and to create a literature repository which can be accessed by the Paid Family Leave policy workgroup, facilitated by the SW Women’s Law Center.
The primary NMDOH Title V objective was to support the completion of an economic impact study and community needs assessment related to paid family leave. While economists from the University of New Mexico did complete and deliver an economic impact analysis of implementing paid family leave, NMDOH staff did not receive direct communication in its development, and the report presented to the Paid Family Leave policy workgroup was not well understood nor communicated to state agencies or policy analysts. Ultimately, the bill did not pass because there were changes in leadership of the Paid Leave workgroup and because there was insufficient communication between stakeholder participants and UNM economists. Additionally, it became clear that there was not buy-in from the state agencies identified to manage the fiscal benefits proposed in the legislation. This was a key factor in the failure to pass a bill related to paid family leave. Although members successfully drafted and submitted legislation for paid family leave, it did not pass in 2019. Plans to address this failure and to follow up on community needs assessment are proposed in the 2020 submission of this report.
Figure 1. Causes of Maternal Deaths, 2011-2015, NM MMRC Case Review
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