Report for the application year: October 2023 - September 2024

The three priority needs for the women/maternal population were: 1) Increase connection to behavioral and mental health information, training and resources for parents and caregivers, and providers who serve women, adolescents, and children, 2) Improve social supports, with a focus on wellbeing and resilience, to prevent and reduce the impact of ACEs, and 3) Identify and mitigate non-medical factors affecting health. Alaska’s National Performance Measures for this domain are the Well-Woman Visit (WWV) and Postpartum Visit (PPV). Alignment with these performance measures is notated in parentheses after each strategy.

Collaborate with community-based partners to provide patient navigation and health education information about women’s health to disparate populations. (WWV 1)

The Alaska Breast + Cervical Screening Assistance Program (AK B+C), the State of Alaska’s CDC-funded breast and cervical cancer screening program located in WCFH, paid for cancer screening and diagnostic services for Alaskans ages 21-64 with incomes < 250% FPL. AK B+C maintained approximately 150 formal agreements with private and publicly funded screening and diagnostic providers to enroll and screen eligible Alaskans. The program coordinated closely with Alaska Medicaid to assure a seamless transition in coverage of costs for enrollees referred for cancer treatment. Over the past year, 25 patients were referred to Alaska Breast and Cervical Medicaid for treatment payment. To increase cervical cancer screening rates, AK B+C worked with community organizations and provided sponsorships to organizations such as the Anchorage Literacy Program, Enlaces, Pacific Communities of Alaska, and Deltas of Alaska to encourage members to get screened.

AK B+C maintained contracts for community outreach and screening navigation in four regions of the state that are population hubs with low screening rates. AK B+C regional outreach contractors are Mountain Pacific Quality Health, Southcentral Consulting, and Interior Community Health Center. These contractors provided educational opportunities to 1,337 people in addition to barrier relief (e.g., transportation, language assistance), and assistance with accessing appointments.

Through contractors and AK B+C, the program provided education to the public at several events each month with materials for cervical and breast cancer prevention and detection. The regional outreach contractors provided presentations to communities throughout the state on cervical and breast health, as well as how the program can help get people screened. The program develops educational materials throughout the year that correspond with various events, such as breast cancer awareness month and cervical cancer awareness month. AK B+C materials have been translated into 11 languages. AK B+C keeps in close contact with many community health organizations to ensure the program is up-to-date on which outreach methods are working effectively in the community. Finally, the program has a website and telephone assistance for anyone who wants to learn more about the program.

The program completed a Clear Communication Project in collaboration with the State of Alaska Comprehensive Cancer Program and Alaska Literacy Program’s Peer Health Navigators. The Peer Health Navigators are members of the immigrant community who are trained to provide health information to their fellow community members in linguistically appropriate ways. The product was a clear, simple one-page document on cancer screening. It was vetted by peer health navigators and translated into seven languages. The one-pager was so well received, the materials were adapted for a tri-fold poster board the peer health navigators use at community events.

In addition, AK B+C continued to support Public Health Nursing’s efforts to spread the word about this program throughout the state. One example of outreach completed by SOPHN is a campaign and health fair hosted by Ketchikan Public Health Center in partnership with Ketchikan Wellness Coalition (KWC). Ketchikan has a large Filipino population making up approximately 12% of the population. This demographic frequently reports being uninsured (data that was captured in Ketchikan’s 2019 Filipino Community Assessment). Because of this, a large amount of this population frequently forgoes preventative healthcare due to the financial burden. Ketchikan Public Health Center partnered with KWC to translate the health center’s reproductive health flier into Tagalog for reproductive health services, including enrollment into Alaska Breast and Cervical program. There was a campaign over the summer of 2024, and this flyer was shared widely with the community in both English and Tagalog. Ketchikan Public Health Center worked with KWC and PeaceHealth Medical to enroll patients in AK B&C and hosted a free mammogram clinic and continued to collaborate on connecting the community to affordable and accessible breast and cervical cancer screenings.

To support health care providers in their efforts to provide high-quality care, AK B+C developed a professional development and training opportunity on Motivational Interviewing for health care providers. Furthermore, AK B+C expanded their work with health care providers on quality improvement efforts to improve screening rates among patients seeking care at Alaska’s community health centers and private practices (see NPM 1.2 below). Finally, AK B+C continued to seek opportunities to engage with non-traditional partners. Supporting all this work was data analysis and visualization through GIS technology to track screening rates, changes based on geography, age, race, socio-economic status, and other relevant factors. AK B+C collaborated with 23 community-based organizations, cancer programs, other public health programs, and 122 screening providers.

AK B+C activities, which focused on increasing cervical cancer screening rates in Alaska, helped connect underserved and high-risk populations with health care providers who could then screen for and address other health concerns, including ACEs, substance use, and other risk and protective factors in the person’s life.

Identify and partner with public and private providers statewide to improve and expand their preventive health services through ongoing quality improvement models. (WWV 2)

WCFH continued to offer health systems interventions through a collaborative contract with Mountain Pacific Quality Health (MPQH, a quality improvement specialist) to improve women’s access to preventive health services. This included efforts to increase clinic-level screening rates for cervical cancer screening and well-woman exams.

The experience of one clinic was that over the reporting period, there was an increase in the number of women that received a screening overall but a slight decrease in percentage. The baseline screening rate was 249/497 50%, the annual was 255/519 49% of patients screened. The first intervention was focused on how to alleviate the check-in documentation burden and time, and to be able to take on more clients for annual wellness/preventative exams. The second intervention discussed was to look over the mapping and workflows of cervical cancer screening. The clinic did not utilize the eCQM's in the EMR, and the workflow to reflect screenings completed was not yet validated. Due to capacity issues, the clinic was not able to continue to participate in additional QI interventions at this time.

Another example includes a clinic that worked on increasing annual wellness visits with a focus on those coming due or overdue for a cervical screening from their patient population. The clinic had not been utilizing patient reminders; therefore, the first implementation strategy was to create a sustainable process for patient reminders for patients while also implementing a process to identify and track patients coming due or overdue for an annual wellness/cervical screening. Through this process, the technical assistance team assisted in creating a reminder that could be used as a physical mailer or electronically. The clinic created a flowsheet to track recent/historical pap results. The front office staff started noting visits as annual wellness visits in the EMR check-in process to be able to utilize their EMR reporting functionality to assist with identifying patients due for their annual visit. The clinic was tracking 40 patients who were overdue for an annual wellness visit. This clinic is in the process of monitoring and tracking this list to ensure the process is working and sustainable.

Another clinic worked on a project to improve annual wellness visit workflow and patient flow efficiencies. They wanted to increase the capacity to see more patients and decrease the time a patient is at the clinic with pre-visit documentation. The clinic set up pre-visit questionnaire to be sent out via text, and transitioned check-in paper forms to electronic. A direct quote from the clinic staff

"The introduction of Healow Check-In has provided our clients with more versatile options, enabling them to complete the check-in process remotely using their smartphones or laptops. This convenient feature allows them to answer our questionnaire in the privacy and comfort of their own space, contributing to a more seamless and efficient clinic visit. From our perspective, the integration of Healow Check-In has greatly streamlined our administrative processes. Clients now arrive at our clinic already checked-in, often ready to begin their appointments promptly upon arrival, leading to smoother transitions and optimized scheduling. We are exceptionally pleased with the positive feedback we've received from our clients regarding the new check-in process. They appreciate the added flexibility and the opportunity to expedite their appointments, ultimately enhancing their overall experience with our clinic."

This process was positively received by their patients and aided in the decrease in time patients are spending in the clinic completing their check-in documentation. Through the technical assistance the clinic was also showed how to utilize their quality reporting functionality to focus on different metrics and reviewed the cervical cancer screening eCQM to identify a baseline and discuss improvement opportunities and documentation accuracy.

Improving connectedness between providers and their patients on an ongoing, routine basis also helped preserve the continuity of health services. Maintaining this connectedness, as well as connecting more individuals with medical homes, helped practices more quickly integrate routine preventive services for their patient populations, as well as address any emergent health needs that occurred during the disaster response. See the “cross-cutting issues” section for more discussion.

Collect, analyze, and disseminate data on women’s preventive healthcare visits and other health issues among women of childbearing age (e.g. PRAMS and BRFSS). (WWV 3)

Annual preventive care visits with women of childbearing age are a chance to conduct critical screening, counseling, and referrals for behavioral health needs and provide other care to optimize the health of women before, between, and beyond potential pregnancies. In 2022, 70.3% of Alaskan women ages 18-44 said they had visited a doctor for a routine checkup in the past year. This information was included and updated on the “It Takes All of Us” campaign website, hosted by the Alaska Hospital and Healthcare Association. The Maternal Child Death Review (MCDR) program re-launched this campaign in summer 2024 as part of an ongoing effort to increase awareness of the importance of maternal health and wellbeing.

Alaska has begun its fourth decade of ongoing collection of PRAMS data. The Phase 9 PRAMS survey starting in Spring 2023 brought a more streamlined approach to the preventative health care pre-pregnancy question asked of all respondents than its Phase 8 counterpart. In addition, for the first time, data are being collected on disability among the perinatal population. This will allow Alaska to cross tabulate type of healthcare visits by disability status for maternal health. Both are core questions so comparisons with other PRAMS sites will be possible.  

The 2023 weighted PRAMS dataset is expected by December 2024. PRAMS launched an online response option in 2023, and staff conducted ongoing monitoring and evaluation of this mode of response and the impacts on response rates (RR). During this fiscal year, the PRAMS program implemented several strategies to turn the tide on our declining response rates, which in Fall 2023 had dropped below 40%, including several efforts to encourage participants to respond by web.  Response rates increased over several months. The average RR for the first half of the year was 40.5% and for the last half was 52.4%.  The PRAMS program is hopeful that the weighted response for 2023 will exceed 50%, after two years of failing to meet or exceed CDC’s threshold.

Using data from PRAMS, BRFSS, and other sources, the CSTE fellow drafted a women’s health fact sheet focusing on breast and cervical cancer screening visits among Alaskan women. The plan is that this publication will be the first in a series of publications focusing on women’s health. The purpose of the series is to increase provider and public awareness and understanding of key risk factors affecting women’s health in Alaska, and current practice recommendations for improving Alaska women’s health. Key data points of the first fact sheet include percent of women with a past year preventive health visit, breast and cervical cancer incidence and screening rates, and cancer mortality rates. These indicators are visualized over time, and where possible stratified by demographic categories, including region of residence, age, and race. Due to the retirement of the Adult Health Unit manager in spring 2024, the fact sheet had to be put on the back burner while the new Unit Manager was trained and oriented to her new tasks, however the goal is for the publication to be completed in early 2025.

Although the BRFSS program is in another Section of the Division of Public Health, Title V staff collaborate closely with BRFSS staff in numerous ways to support program improvements and share best practices for data collection, analysis, and dissemination. During FFY24, the MCH Epidemiology Unit Manager continued to serve on the BRFSS Advisory Committee, which reviews proposals for state-specific questions and makes recommendations on which questions to include on the survey each year.

In 2023, WCFH submitted a successful proposal to BRFSS to include the family planning module on the 2024 survey. The proposal was a joint effort of the Title X Family Planning Program Manager, the Title V MCH Director, PRAMS Coordinator, and MCH Epi Unit Manager. This was successfully re-submitted in 2024 with the goal of having two years of data which will allow for more sub-population (including regional) analyses. Having this module on the survey provides a unique opportunity to evaluate some of the early impacts of the postpartum Medicaid extension as well as access and utilization on a specific form of women’s healthcare.

Engage hospitals and birthing facilities in data-driven, collaborative quality improvement focused on reducing severe maternal morbidity in partnership with the Alaska Perinatal Quality Collaborative (AKPQC). (WWV 4)

In an ongoing effort to reduce severe maternal morbidity, hospitals and birthing facilities have been actively engaged in a data-driven, collaborative quality improvement initiatives. These efforts in partnership with the Alaska Perinatal Quality Collaborative (AKPQC) aim to improve maternal care outcomes through shared learning, best practices, and continuous engagement among healthcare providers, community midwives, and other stakeholders.

One of the central components of this collaborative work has been the Alaska Birth Transfer Initiative. Quarterly meetings provide a valuable opportunity for community members and healthcare professionals to come together and discuss ongoing quality improvement initiatives. AKPQC began inviting guest speakers to present on various topics to engage discussion in September 2023, with the first topic featuring an update from the Maternal and Child Death Review (MCDR) program, which provided insight into the trends and findings related to maternal mortality and morbidity. In January 2024, the Nurse-Midwife Site Director from Providence Alaska Medical Center presented on the hospital’s efforts around birth transfers. This included an overview of standardized transfer forms, client surveys, and best practices to ensure smooth transitions of care between birthing facilities. The Providence team is leveraging these discussions as an opportunity to engage with community midwives and strengthen relationships between the hospital and local midwifery practices.

In March, the focus was on postpartum hemorrhage, with an obstetrician from Southcentral Foundation (SCF) presenting on the ongoing work to reduce the incidence and improve management of this life-threatening condition. June’s meeting highlighted the Alaska Newborn Screening Programs. September 2024 focused on doula work around the state, with a guest speaker from the Alaska Birth Collective.  These meetings are important forums for sharing knowledge, receiving feedback, and fostering a sense of collective responsibility for improving maternal care. These efforts are seen as a crucial step in fostering greater collaboration between traditional healthcare providers and community-based care models.  Notably, these meetings have seen participation from three key communities, with additional groups regularly invited to join the conversation.

The Perinatal ECHO sessions, a series of virtual learning and consultation sessions, have been an integral part of efforts to improve perinatal care. During the reporting period, the Perinatal ECHO topics have been wide-ranging, reflecting the complex and varied challenges faced by healthcare providers. Notable topics included a two-part series on self-care presented by a behavioral health provider from Tribal health, as well as sessions on perinatal palliative care and perinatal loss, there were updates on congenital syphilis, RSV, and CMV. These ECHO sessions are a vital resource for expanding knowledge and offering support to healthcare providers as they work to improve care for mothers and babies.

The 2024 AKPQC and MCDR Summit was held in April 2024 and was a hybrid event.  Session topics included healing-centered approaches to exams, perinatal traumatic brain injury, substance use and breastfeeding, and state data presentations focused on violence and substance use. A total of 36 participants attended the activity on Zoom, and 32 attendees were in-person.  Learners were not required to stay the entire time, but they were required to select the sessions attended to receive continuing education credit. 18 attendees completed the course evaluation. All 18 participants rated the AKPQC & MCDR Joint Summit as good or excellent overall.  83% of respondents intend to share information and resources with colleagues who were unable to attend. This event was made possible through Title V Technical Assistance (TA) funds, which supported speaker fees and travel. Building on the momentum of this summit, planning has already begun for next year’s event in collaboration with MCDR, aiming to expand the reach and impact of these important conversations.

As the Substance Affected Pregnancies Initiative (SAPI) initiative transitioned to the sustainment phase, attention is shifting toward new priorities. A key focus will be on improving care for obstetric hemorrhage. Key providers were identified and invited to join the Faculty Team.  In August 2024, AKPQC and the Alaska Hospital and Healthcare Association (AHHA) distributed a survey related to obstetric hemorrhage to 18 hospitals and 10 birth centers with 16 hospitals and 5 birth centers responding. The data provided was used to inform the development of the Obstetric Hemorrhage QI Initiative. Using feedback provided by a faculty team and resources from AIM, the change package and data management plan for this initiative was also created. This next initiative will begin in January 2025.

A key development in the collaborative’s efforts to center community voices in quality improvement work has been working to establish a Patient Advisory Council (PAC). The AKPQC coordinator and Title V director met with MoMMA’s Voices, a maternal health patient advocates program, in June 2024 to discuss ways to proceed with PAC’s formation. To ensure that the council is representative and impactful, flyers were created and distributed in September 2024. That same month, an initial meeting with a potential patient representative took place. Stone Soup Group, a community organization, will provide stipends for PAC members, ensuring that those who serve on the council are compensated for their time and contributions. This council will reflect a commitment to engaging community members directly in the work of quality improvement and ensuring that maternal health efforts are aligned with the needs of those most affected.

The collaborative efforts to reduce severe maternal morbidity through data-driven, community-engaged quality improvement initiatives continue to make significant progress. With a strong foundation in place, the focus now shifts toward sustainability and deeper integration of best practices, particularly in areas such as obstetric hemorrhage and patient engagement. The ongoing work of the AKPQC, combined with the active participation of healthcare providers, community members, and stakeholders, ensures that the work will continue to evolve and positively impact maternal health outcomes. These collective efforts promise to strengthen the healthcare system and improve maternal care.

Disseminate information (e.g., PSAs, presentations, fact sheets, etc.) about risk and protective factors that support behavioral health and reduce the impact of ACEs among women of childbearing age. (WWV 5)

A major success for this strategy during the past year was the completion and publication of the Epidemiology of Adverse Childhood Experiences in Alaska Epidemiology R&R in December 2023. This report used multiple public health data sources to provide an overview of ACEs prevalence, documented differences, and assessed trends over time in Alaska. A unique contribution of this report was that it also broadly described the prevention infrastructure in Alaska. Multiple staff in the MCH Epidemiology Unit contributed to the report, which included data from PRAMS, CUBS, the National Survey of Children’s Health, BRFSS, and the Alaska Victimization Survey. The report was distributed through the DPH Epidemiology Bulletin Gov Delivery list, which reaches several thousand individuals including providers, media, and others, and was covered in an online news article with the Alaska Beacon.

Throughout the year, various staff in the MCH Epidemiology Unit presented information and data about factors associated with behavioral health and the impact of ACEs to assorted groups and partners. The following is a list of selected presentation titles and audiences:

• Jared Parrish, Preventing ACEs through pre-birth familial screening: Operationalizing public health data for clinical providers. Presented at the 2024 CSTE Annual Conference in Pittsburgh, PA. June 10, 2024.
• Jared Parrish, Preventing ACEs through pre-birth familial screening: Operationalizing public health data for clinical providers. Presented to partners and community members with Tanana Chiefs Conference in Fairbanks, AK. May 13, 2024.
• Richard Trantow, Navigating Alaska’s Substance Use Landscape: Insights into Breastfeeding and Substance Use. Presentation at the Annual Perinatal Quality Collaborative /Maternal Child Death Review (AKPQC-MCDR) Joint Summit. April 5, 2024.
• Melissa Bradley. Understanding Maternal Violence Through Data Analysis. Presentation at the Annual Perinatal Quality Collaborative/Maternal Child Death Review (AKPQC-MCDR) Joint Summit. April 5, 2024.
• Jared Parrish and Riley Fitting (former MCH Epi CSTE fellow). Hitting the central line of ACES prevention. Presentation at the All Alaska Pediatric Partnership Meeting. November 4, 2023.

The unit also received and responded to individual summary data requests relevant to this strategy. Below is a summary of some of these requests:

• PRAMS provided updated data on people who have 5 social supports during the postpartum period for a Scorecard of Key Issues Impacting Alaska Mental Health Trust Beneficiaries. The Scorecard provides evaluation measures for the Alaska Division of Behavioral Health’s Comprehensive Integrated Mental Health Program Plan 2020-24. Part of this plan is a focus on prevention and early intervention efforts that build resilience and address trauma in individuals who are at risk of developing disabling conditions. As stated in the Scorecard, “Research shows that social support is a major buffer of postpartum depression and can improve outcomes for infants, young children, and their families. The presence of social supports, as reported by mothers after giving birth, can help predict early childhood experiences and provide an opportunity to increase individual and community-level supports at a critical developmental period.” In 2021, 76.6% of postpartum Alaskans stated that they have access to all five social supports asked about on PRAMS, which included measures of financial support, physical support, and emotional support. The PRAMS Coordinator and other MCH Epi staff had worked closely with the Mental Health Trust to craft this measure, which is also now being used as one of Alaska’s Title V SPMs.
• MCDR provided data on maternal mortality and suicides to the Statewide Suicide Council
• PRAMS and CUBS data on maternal mental health and social supports were provided for inclusion in the infant and early childhood mental health needs assessment being conducted by the All Alaska Pediatric Partnership
• PRAMS data on life stressors and substance use was shared by request for a Cook Inlet Tribal Council community needs assessment
• PRAMS data on multiple postpartum and mental health topics by urban/rural residence and race were shared with a local provider writing an NIH grant on the impacts of displacement for birth among rural-residing Alaska Native women

Challenges experienced by the MCH Epidemiology Unit that impacted this strategy included the departure of the Survey Operations Manager for PRAMS and CUBS in April 2024 and the departure of the MCDR Research Analyst in May. These staff vacancies reduced the capacity of the Unit, in particular these programs, to proactively disseminate data and information and produce written data reports. Additionally, weighted PRAMS data for 2022 was received relatively late from CDC, after many publications that are annually updated with PRAMS data had gone to press.

Support the development of a comprehensive, healing-centered, community responsive workforce. (WWV 6)

The MCDR Maternal Mortality from Violence Prevention (MMVP) grant continued work to build a healing-centered and community responsive maternal health workforce in three ways: through development of a healing-centered and community-based birth helper/doula workforce, health care provider training, and the respectful handling of the MCDR process, data dissemination, and recommendation generation. An Alaskan-focused, community attuned birth helper/doula training curriculum was completed in November 2023 and distributed to additional doula organizations serving women. The pilot program offering training for doula was completed and evaluated by a research team from University of Alaska, Population Health Studies. The final report was received in June 2024 and based on the recommendations, an RFP for an Alaskan, healing-center birth helper/doula training and mentorship program was written and is in the procurement process. The MMVP grant sponsored an initial iteration of the planned training and mentorship program in the format of a 5-day hybrid birth helper/doula training September 2024 that reached 10 students, including 3 from rural communities and 2 RNs working in OB at the Alaska Native Medical Center.

The topics covered in the area of health care provider training was addressed in the previous section on the MCDR/PQC Joint Summit agenda.

 Staffing capacity was a significant challenge faced in efforts to address respectful data management and dissemination. The MCDR program staff experienced significant staff turnover, and the CEO of the community organization partnering with the MCDR in this was on sabbatical for much of the grant year. However, they contributed substantially to a presentation by the MCDR Program Manager and an Indigenous doula/member of the MCDR Committee on the MMVP grant initiatives at the Association of Maternal Child Health Programs in March 2024.

As mentioned in the Perinatal Health section, the AKPQC received funds for respectful maternity care training and plans for organizing that are underway. In September 2024, the PQC published flyers recruiting for members to build a Patient Advisory Council, offering compensation and training for interested individuals with lived experience to offer community responsive and holistic input on PQC initiatives.

Continue to partner with Medicaid and department leadership on extending postpartum coverage to one year. (PPV 1)

The postpartum Medicaid extension bill introduced by the Governor was signed into law July 19, 2023. These efforts represented a substantial achievement that have moved into successful implementation of this change. The extension went into effect February 1, 2024, and WCFH worked with Department of Public Assistance (DPA) and Medicaid staff on the press release and promotional materials. WCFH used channels such as the AKPQC listserv and connections with providers and community partners to widely share up-to-date information to educate all impacted groups about the extension and how it will be operationalized. Part of the operationalization was an updated and improved Medicaid and Birth Certificate linkage process to improve data on births, pregnancies, and infants covered by Medicaid.

When indicated, the MCH Epi Unit continued to include variables on Medicaid eligibility/enrollment, including when analyzing maternal health outcomes, PRAMS data on postpartum healthcare visits, and NPM performance. Findings were shared with Medicaid partners, providers, and others to provide information about the implementation of postpartum Medicaid extension and any observable impacts on maternal health. MCH Epi will continue to monitor data that can show a potential outcome of this expansion such as maternal mortality. It is likely that this will be asked during upcoming legislative sessions.

MCDR continued its recently implemented QA of maternal mortality case ascertainment using Medicaid data. In addition to identifying issues causing cases to be missed, this activity helped to ensure that all pregnancy-associated deaths among Medicaid beneficiaries received a multidisciplinary case review. When available, MCDR provided data about Medicaid access in maternal mortality cases and shared recommendations which supported or suggested improvements as relevant to the implementation of extended coverage.

Promote access to sexual and reproductive health services for all Alaskans in their communities. (WWV 7)

WCFH awarded Title X Family Planning Services Grant funds to two sub-recipient agencies. Kachemak Bay Family Planning Clinic (KBFPC) served the Central and Southern Kenai Peninsula, and Identity Health Clinic serves the greater Anchorage area. Both agencies provided comprehensive sexual and reproductive health and related preventive health services to patients within their respective service areas. They collaborated with other local health and social services providers and agencies to assure wrap-around care and reciprocal referrals to meet their clients’ specific needs, including behavioral/mental health support services, substance use screening and referral, and preventive and primary health care services. KBFPC continued to expand their reach via telehealth and offering services at three locations. Identity began to offer services in December 2023. They elected to leave the Title X program as of June 30, 2024.

In addition, the Title X program collaborated with Alaska Native Tribal Health Coalition’s I Know Mine program. They included Title X service locations in HIV self-test kits distributed to the public with the goal of sharing where low-cost family planning services can be found with people who received the test kits.

Related to the partnership with Medicaid on postpartum coverage, WCFH collaborated with Alaska Medicaid on a LARC carveout that started January 1, 2024. LARC was a standing topic at the monthly Medicaid meetings. WCFH is waiting for HCS to finish the promotional materials so they can be distributed to WCFH networks. Once more information is received from Medicaid, WCFH will share information about the LARC carveout at 2025 events.

MCDR’s OASH award for the prevention of maternal mortality from violence supported, evaluated, and made recommendations for future programming to promote and sustain the work of community attuned birth helper/doulas. The services they provided for birthing women extended throughout the perinatal period and included information and support to increase access to reproductive health, prenatal, birthing, and postpartum healthcare services. Community-based support has been shown to increase access for patients who have experienced medical trauma or other barriers to care. On-going plans for workforce development programs for community attuned birth helpers/doulas were also developed during this grant period.