KY MCH has had many evidence based strategies to improve the health of women and mothers based upon the findings in the 2015/2020 needs assessment and in ongoing program level evaluations. These strategies include outreach to providers, birthing facilities, and community partners/stakeholders. MCH accomplishes this by promotion of best practice and provision of MCH Title V funds to LHDs for inclusion and support when using MCH packages. Based on community needs, LHDs have the opportunity to opt-in and select 2-5 packages with a requirement that at least one package chosen to address infant mortality.

 

MCH sets the allocations for LHDs based upon a formula using a base rate, number of children in poverty, and number of the MCH population served by Medicaid. LHDs are encouraged to use the package guidelines as a point of reference and to be innovative with initiatives to reach the MCH population. LHDs, stakeholders, and collaborative partners are engaged at both the local and state level, building an integrative strategic plan across all levels.

 

Women/Maternal Health Domain Annual Report

 

In 2015, MCH began, as part of the national effort to “Put the M back in MCH,” to intentionally evaluate ongoing maternal health efforts. In 2017, MCH became a catalyst in program change to incorporate new information from national resources and align data measurements, with national data sets. In 2019, MCH continued to promote best practice with local collaboration with an extensive group of partners both internally and externally to address issues related to women/maternal health. Three vital and successful partnerships with the KY Perinatal Association (KPA), KY Chapter of March of Dimes (MOD), and the Healthy Start Program in Louisville have created opportunity for MCH to work with grass roots organizations, collaboratives beyond the reach of the LHD or birthing hospitals.

 

In FY19, KY continued the work for NPM #2: Percent of cesarean deliveries among low-risk first births with a goal to reduce early elective cesareans by 10% by 2020. Per federally available data from the National Vital Statistics System, in 2009, 31.5% or about 6,425 of 20,391 were cesarean deliveries. This rate has slowly decreased to 27.8% or 4,752 of 17,108 cesarean deliveries in 2018. Rates were higher among privately insured women, non-Hispanic black women, and those occurring in non-metro areas. This rate continues to be higher than the Healthy People 2020 target of 23.9% and higher than the national rate of 25.9%.

 

Changing this outcome has been a slow process. KY preterm birth rates prior to 37 weeks gestation remain higher than national averages supporting efforts to reduce early elective deliveries and address maternal morbidities that may lead to a medically necessary early delivery. Efforts focused on dissemination of KY specific data, educational opportunities by webinar, or at regional meetings regarding reducing EEDs.

 

Prenatal Health:

 

With the advent of Public Health Transformation, LHDS have limited access and provide minimal screening to the pregnant woman. LHDs are assisting women in KY needing prenatal and postnatal care with family planning, pregnancy tests, referrals to obstetric providers, and wraparound services, including HANDS, WIC, and support for smoking cessation, dental care, interpersonal violence counseling and substance abuse treatment. Local health departments have established contracts or collaborations with service providers within the community to furnish care to lower income and high-risk women and their children.

 

During the 2020 needs assessment, improving the health of women of childbearing age was the highest scored concern for participants. Many comments related to obesity, tobacco usage, substance use, and morbidities that lead to early deliveries were discussed. One participant in a large urban area noted women who are not actively seeking family planning options may not have a well woman visit until pregnancy.

 

Available data from the Behavioral Risk Facto Survey System (BRFSS) has about 70.8% of KY women having an annual well woman exam. This visit is critical as an opportunity to counsel the woman on a healthy lifestyle to minimize health risks/outcomes across the life course. LHDs in KY are able to provide some screening activity, evaluation and ongoing health promotion activities, referral for specialty wrap-around services for smoking cessation, substance use treatment/harm reduction activities, or domestic violence referrals for safety.

 

With a heightened awareness regarding morbidity, referral, and improving the overall health of the woman, KY respondents felt KY should shift focus from NPM 2 to NPM 1 and the well woman visit with a goal to improve rates of visits and reduce morbidities in pregnancy.

 

Additional support will lie in the partnership with CHFS Division of Women’s Health, which has developed relationships with many federally qualified health centers (FQHCs) for family planning and collaborates with the LHDs and FQHCs for delivery of services for breast and cervical cancer screening, evaluation, referral and treatment.

 

PRAMS:

From the 2018 PRAMS cohort, KY was able to understand the beliefs, attitudes, and feelings of women regarding pregnancy. The survey asked questions about pregnancy, preconception care, prenatal care, oral health, Medicaid, and many other topics. Of interest, in regards to pregnancy intent:

• Three out of five PRAMS mothers were sexually active and not using contraceptives, with no intent to be pregnant at that time
• Three out of five mothers that never wanted to be pregnant were sexually active without using any contraceptives
• The majority of mothers that meet the definition of unintended pregnancy fall between the ages of 20-29

 

Title X Family Planning:

The Division of Women’s Health (DWH) continues to administrate the Title X Family Planning Program (FPP) with a priority to provide all citizens of KY, especially low-income citizens, with quality family planning services. Family planning services include contraceptive services, STD testing, pregnancy testing, preconception health services, basic infertility services, and related preventive care. Historically, Title X funding was provided directly to LHDs to provide family planning services with additional funding provided to two FQHCs and the UK Adolescent Medicine Clinic to increase access to care in the metropolitan areas of Louisville and Lexington. KY Public Health (PH) Transformation in 2019 has changed how the FPP is providing access to family planning across the state. PH Transformation removed family planning as a core public health service, defining it as a service based on local public health priorities. PH Transformation is a result of:

1. LHD fiscal instability, influenced by these factors:
   1. Decreased state and federal funding
   2. Decreased number of uninsured population requiring services. The impact of the Affordable Care Act (ACA) and Medicaid expansion in KY led to a significant decrease in uninsured clients and the number of clients seeking medical care at local health departments
   3. Increase in the number of Federally Qualified Health Centers (FQHCs) across the state where all citizens, insured and uninsured, may now have a medical home
   4. Pension costs
2. LHD services are not reflective of community needs
3. Legislative issues and shared governance

 

Each LHD, through a fiscal assessment, community needs assessment, and environmental scan chooses whether they will provide family planning services and at what level of services meets community need and LHD resources. After this review, 26 of the 62 LHDs chose to either decline Title X funding or receive limited funding to provide only STD testing and pregnancy testing. These 26 LHDs also declined all KY Women’s Cancer Screening Program (KWCSP) funding to provide breast and cervical cancer screening. This required the DWH to build partnerships with the FQHCs and look alike providers in all areas of the state where LHDs had limited services or no longer offered this service. As a result, contracts have been established with nine new partners, including 7 FQHCs, 1 university clinic, and 1 free clinic. Contracting with FQHCs and look-alike clinics will greatly increase access to KY citizens in need. FPP expects to increase by about 30% those served through the Title X program in CY 2020.

 

Healthy Babies Are Worth the Wait (HBWW):

KY’s prematurity prevention activities began through a pilot project to reduce preventable preterm birth with funding from the MOD and Johnson & Johnson Pediatric Institute. This community-based, multi-layer approach to prematurity prevention in three intervention communities with a range of health care settings was successful in showing that a partnership between hospitals, health departments, and communities could reduce preterm birth from EED which could also influence prematurity rates.

 

 

KY demonstrated success in the program early on, as results indicate a statistically significant 12 percent decline in the preterm birth rate in the intervention sites. However, in the past 3 years, interest in this practice has waned with only one local district health department and hospital continuing to have a strong relationship. The MOD, KPA, and MCH have worked in tandem to provide education and guidance for providers and hospitals. The focus of staff and leadership lies more with harm reduction activities and addressing the social determinants leading to women reaching delivery with minimal or no prenatal care.

 

Overall the rates for KY preterm births have been static and above the national rate. Data from the OVS birth certificate files show the percentage of births were higher for black infants (14.1%) than for white infants (11.2%). Preterm births were more likely in women age 35 or older and in women with less education, further reinforcing a need to continue health promotion and prevention activities to improve the health of the woman prior to conception and across the life course.

 

Data Dissemination:

During the 2019 MCH Conference, MCH collaborated with the KY MOD Chapter, KPA, and Healthy Start Louisville to address social determinants of health, provide data from many MCH programs, and present quantitative KY specific data. MOD materials and prematurity data briefs were distributed to nearly 400 people from LHDs, hospitals, childcare, and faith based community partners.

 

Prior to the opening presentation, MCH held the first Title V needs assessment focus group. During this meeting, the data briefs for woman and infant outcomes were available for review on the tables of the participants as a reference. Participants were from all local health departments and MCH specifically requested representatives who coordinated Title V programs and helped with community needs assessment.

 

In 2019, MCH provided ongoing presentations at the KPA annual meeting and in regional meetings. These opportunities allowed MCH to provide a variety of information to diverse groups about MCH concerns.

 

Hepatitis C:

A revision of KRS 214.160, in 2018, added language to include Hepatitis C screening for all pregnant women in KY rather than for those with risk factors. If a pregnant woman is positive for Hepatitis C virus antibodies or RNA, the child from that pregnancy should receive serologic testing for the presence of Hepatitis C antibodies at the 24-month well child check. While this statute became law in 2018, the infrastructure for electronic surveillance and provider education and promotion was not yet available. The KY Division of Epidemiology and Health Planning (DEHP) currently provides surveillance for Hepatitis C through reporting from OVS and reportable disease reports received from providers. The DEHP is building the Hepatitis C reporting page in the National Electronic Disease Surveillance System (NEDSS). The DEHP and DMCH have plans to message the changes to statute and distribute Hepatitis C information through ACOG, AWHONN, KPA, KHA, NBS, and other community partners. In 2019, leadership changes and a DPH response to a Hepatitis A outbreak limited the ability to impact reporting standards. In February 2020, a new immunization manager was hired, and MCH has met with Dr. Emily Messerli to begin planning for a collaborative effort to address this topic as capacity allows with the COVID-Covid-19 response.

 

Maternal Morbidity:

Despite all the advances in science, maternal morbidity and mortality has not decreased in recent years. In fact, as KY developed better analytics for the Maternal Mortality Review Committee (MMRC), it was evident there was growing concern for looking at all causation for maternal mortality. Drivers for morbidity became a topic of concern for the MMRC with a need to engage and continue development of the KY Perinatal Quality Collaborative (KPQC). Top concerns for stakeholders in the 2020 Needs Assessment in this domain were substance use, tobacco use, health problems related to pregnancy, and maternal obesity, all of which contribute to maternal morbidity. The long term impact these drivers have an on the rising maternal mortality rate, increased risk for preterm birth, and long-term effect on the newborn is significant.

 

The health care delivery system in KY has undergone significant changes in the past few years through Medicaid expansion and the implementation of components of the ACA. The number of individuals in KY without insurance has decreased dramatically. The women who have health care coverage are now able to access preconception and interconception care.

 

Other changes such as public health transformation reduced services through local health departments. LHDs continue to struggle with adapting to population health services for prevention and promotion. Successful LHD endeavors are ongoing assistance to apply for KY Medicaid and the wrap around services that create a safety net for clinical services for pregnant women. They assist with presumptive eligibility for Medicaid. LHDs provide assurance that women can access prenatal care in their community, whether by referral to local obstetricians or contracts with local providers.

 

Access to prenatal care is enhanced by presumptive eligibility (PE) for a short duration of time, 60 days, while eligibility for full Medicaid benefits is determined. While PE is very valuable, women who ultimately are denied benefits may not apply for PE until late in pregnancy to assure some form of coverage for the expensive cost of delivery. As local health departments move to PH Transformation, the safety net provided by LHDs may greatly decrease.

 

Title V grant funding may be used to support education, outreach, or enabling services for this population. Referrals to address smoking cessation, domestic violence, mental health services, and substance use disorders is standard service for each LHD. Many contract with a FQHC in the area. As to the SDoH, the rurality of KY has been a major barrier in regards to local access to women’s health providers, birthing hospitals, and referral for specialty services, available through travel of longer distances.

 

Preconception health counseling, including the distribution of folic acid/multivitamins, continue at LHDs and partner providers through MCH and Family Planning Programs. Women seen in the LHD or through contracted providers were provided preconception counseling and, when needed, a year’s supply of multivitamins. Clients, with positive pregnancy tests, received prenatal vitamins and counseling by the local health department staff, along with counseling on how to obtain prenatal care, apply for Medicaid, and referral for other services if noted during initial screening.

 

Substance use disorder creates further challenges in identifying and protecting the pregnant woman. Women have fears of removal of the infant at birth and do not readily seek out prenatal care. Treatment options across the state are varied, and social supports for these women are inherently limited. While the work and planning for a plan of safe care has progressed to piloting the Healing, Empowering, and Actively Recovering Together (HEART) Program, communities across the state are needed for expansion of this promising program. Establishing HEART requires time, workforce, funding, and a strong community collaborative team that has all stakeholders at the table with each entity actively supplying funds, staff, and knowledge to assure success.

 

In the spring of 2020, MCH joined DPH leadership and KY DMS in working to develop an analytics plan for review of maternal morbidity to inform MCH prevention efforts.

 

As MCH worked with providers for the needs assessment, reviewed mortality cases, and began the KPQC, other concerns were raised regarding domestic violence, depression, and use of alcohol or marijuana during pregnancy, and oral health. From the 2018 PRAMS data, MCH learned:

• One in five PRAMS mothers reported suffering with depression since giving birth.
• Marijuana is the predominant illegal drug used by mothers prior to and during pregnancy. This is mainly done among mothers within the age groups of 20-29.
• Four out of five mothers report having three or fewer drinks 3 months prior to conception.

• More than half of PRAMS mothers that cannot afford dental care report having dental insurance.
• One out of five mothers believed that it would be unsafe to receive dental care while pregnant.

 

Tobacco Use:

Reducing tobacco use among pregnant women in KY continues to have a high priority. Over the years, many efforts and programs were initiated with minimal success in reducing and engaging women to stop smoking prior to conception or during pregnancy.

 

 

While the percentage of women who smoke during pregnancy again declined in 2018 to 15.9%, it is well above the US rate of 7.2%. Smoking during pregnancy is more likely to occur in women with less than college education. Caucasian women were more likely to smoke in pregnancy than black women, and over 2/3 of those who smoked during pregnancy in 2018 had a high school education or less. Alarmingly, 78.3% of premature births occurred in pregnancies in which the mother reported smoking.

 

 

Geographical distribution of smoking during pregnancy continued to be highest in KY districts with the highest poverty rates and other social determinants of health impacting access to care, education, employment, and transportation. Tobacco use is a common factor in premature birth, birth defects, and it is a risk factor for sudden unexpected infant death. These outcomes have higher rates in the same areas of KY in which tobacco use and substance use rates are higher in pregnancy.

 

 

Quit Now KY has a pregnancy/postpartum protocol that is available to all KY residents 15 years of age or older who are currently pregnant. This protocol includes a designated female coach assigned to each pregnant woman. During pregnancy, each woman receives $5 per completed call for up to $25 and during postpartum each woman receives $10 per completed call up to $40.

 

From PRAMS, MCH learned:

• Roughly one in four mothers (24%) reported smoking at some point during pregnancy.
• Less than 1% of mothers report using electronic cigarettes before or during pregnancy, which may be restricted by sampling age.

 

In 2019, MCH explored the Tobacco Prevention and Cessation Program methods to improve outcomes for pregnant women who smoke. The following Prenatal Smoking Performance Improvement Plan (PIP), through an enhanced Obstetric Care Management model, continues to be refined in partnership with Medicaid MCOs and the Quality Improvement Branch. The suggested PIP template suggests the following areas:

• Develop a care management program to enhance reach to target the smoking subpopulation for smoking cessation outreach and follow-up.
• Tailor care coordination with care management to susceptible subpopulations as indicated by risk factors identified in focused study.
• Use Health Risk Assessments (HRAs) and develop new methods to identify smokers.
• Improve HRA response rates by collaborating with providers to complete HRAs for new members.
• Develop a MCO smoker registry to identify smokers for outreach, engagement in cessation counseling, and referral to the KY Quitline.
• Work to track members who contact the Quitline, receive services, and monitor quit status.

 

While KY has made some progress in decreasing the number of women who smoke during pregnancy, the rates of smoking during pregnancy in KY remain almost double that of the nation. KY is consistently one of the worst states on this indicator. Initial efforts to encourage participation of pregnant smokers in Quit Now KY have not been successful. In 2018, there were a total of 56 women enrolled in the pregnancy protocol and 24 women enrolled in the post-partum protocol.

 

Teen Birth:

Since 2008, KY has experienced a steady decline in teen birth rate of fifteen to nineteen year olds. The teen birth rate was 13.1% in 2008 and has steadily declined to 6.9.

 

 

MCH collaborates with the Division of Women’s Health (DWH) Adolescent Health Program on many adolescent health issues. The Adolescent Health Program continues to receive federal funding to prevent teen pregnancy and promote positive youth development through the Sexual Risk Avoidance Education (SRAE) grant and the Personal Responsibility Education Program (PREP) grant. The SRAE funds sub-awardees who provide age-appropriate sexual risk avoidance education to fifth through eighth graders in accordance with the KY Department of Education (KDE) program of studies for sexual health education. Approximately 24,000 students and up to 3,500 parents and other adults are educated each year with SRAE funding. The PREP grant provides the Reducing the Risk© or the Teen Outreach Program™ (TOP) to sub-awardees to provide personal responsibility education to middle and high school students. TOP primarily targets disengaged youth at high risk for poor healthy decision making, academic failure, and poor adulthood outcomes. Approximately 7,000 students participate in the PREP programing each year. In addition, Appalachian counties in KY continue to have higher rates of teen birth.

 

KY continues to struggle with high teen birth rates in comparison to the national rates. Historically, KY’s teen birth rate ranks 5th to 7th highest in the nation, depending on the year. While the overall teen birth rate is improving, a geographical view revealed areas in eastern Kentucky have teen births accounting for as much as 10.8%.

 

The teen birth rate is slightly higher in Blacks at 7.6% compared to 7.2% in Caucasians. Another alarming finding is the number of births to KY children less than age 15, reinforcing the need for intervention with child abuse and for education at younger ages regarding sexual intercourse. KY Youth Risk Behavior Survey data had data showing between 5.5-9.7% of middle school students reported having sexual intercourse in the past 3 years.

 

 

Maternal Mortality Review:

 

Maternal death is the worst outcome of pregnancy with one death being too many. Maternal deaths have significant repercussions, as women are crucial to a prosperous and healthy community. In KY, maternal mortality rapidly increased with some years double or triple the rate known prior to 2013. This prompted a deeper evaluation for cause and manner to attempt to understand the rise of cases. As in the figure below, the rate of maternal deaths in KY nearly doubled between 2013 and 2018. Other data during this time had increase in substance use, mental health concerns, and NAS.

 

 

While pregnancy-related causes of death comprised a large percentage of causes of death, the pregnancy-associated but not related causes such as accidental injury, suicide, and homicide, appear to be the precipitating cause of many deaths. During the MMRC reviews of 2017 cases, more detailed information became known about these deaths.  Factors affecting morbidity, such as tobacco use, obesity, socioeconomic disparities, depression, and substance use disorder increase the risk of mortality in Kentucky. Likewise, it is known social determinants of health, such as transportation, access to care, domestic violence, and a geographically rural state, limit early preventive care to reduce risk and address morbidities.

 

 

With a deeper review of only death certificate data, it became evident that many of the maternal deaths had influencing factors associated with substance use disorder.

Many had substance use involvement, mental health concerns, or other identifiable causes that if intervention had been taken could have potentially saved the life of the mother.  These includes seatbelt use, substance use treatment with care coordination, early referral and treatment and management of underlying health conditions such as diabetes, or infectious disease. 

 

.

 

Disparities in KY vary by geography, race, and access to care. Appalachian communities are unique and deserve special attention given the rural, resource-limited, socio-economically impoverished nature of families in this part of KY with an additional burden of low health literacy and limited access to care.

 

Nationally, African American women are estimated to be three to four times more likely to die from a pregnancy-related complication. The number of deaths of these women in KY is too small to provide a valid review of racial disparity. From review of death certificates, maternal deaths appear to be higher among black women in the two largest urban cities of Lexington and Louisville; however, providers and birthing hospitals are more readily available in these areas. Although providers and birthing hospitals are readily accessible, there are other factors such as lack of transportation, lack of insurance, and systems issues that may be a barrier when seeking prenatal care that may explain disparity in maternal mortality by race.

 

With an increasing rate, it became imperative for Maternal and Child Health (MCH) to understand the factors influencing this increase. A deeper review of the data revealed the number of maternal deaths from possible pregnancy-related causes (natural deaths) remained relatively unchanged while possible pregnancy-associated or pregnancy-associated but not related causes such as accident, homicide, or suicide, were rising. Further review of accidental deaths found over half had at least one ICD code related to substance use disorder or drug overdose.

 

The MMRC completed review of the 2017 cases finding that 26% were pregnancy related and 48% were pregnancy associated, not related. From the reviews, 31% had some type of substance use intoxication/overdose and 21% had clinical causes for death such as cardiovascular/coronary disorders (10%), embolism (8%), or aneurysm (3%). Substance use was a contributing factor in 48% of the cases after review. The MMRC determined that 81% of the maternal deaths in 2017 were preventable with 76% of the cases having either a good chance (26%) or some chance (52%) to have outcomes altered with some type of intervention.

 

With most maternal deaths determined to be preventable, it is imperative KY identify factors involved in maternal deaths and translate MMRC recommendations into prioritized strategies for primary, secondary, and tertiary prevention to reduce maternal mortality. Recommendations from the MMRC included warm handoffs, increasing Medicaid coverage postpartum for 1 year after birth, and education on maternal safety bundles addressing different clinical outcomes. A common concern found was the lack of care coordination in assuring the woman attended follow-up referrals or evaluations.

 

Kentucky Perinatal Quality Collaborative:

In November 2018, KY began exploring options to revive the KY Perinatal Quality Collaborative. This involved research with successful perinatal collaboratives in other states, research into the successes and barriers previously experienced in KY, and collaboration with the MOD, KPA, and the Association of State and Territorial Health Officials (ASTHO). The planning began with a federal ASTHO strategic meeting involving the DPH Commissioner, Chief Medical Director for KY DMS, MCH Division and Title V Block Grant Director, and the BHDID Director. From this meeting, a strategic plan was developed for the next 18 months that included development of a KPQC to address substance use in pregnancy and Neonatal Abstinence Syndrome plan of safe care.

 

This effort grew with the CDC grant award to the KIPRC for establishment of a KPQC to work on the program plan developed with ASTHO and a field agent housed in DPH from ASTHO. With this support, KY launched the first annual meeting for the KPQC in October 2018 and subsequently developed a website to host information and began building the infrastructure for a neonatal and OB/GYN branches of the KPQC.

 

MCH Best Practice Strategy Packages:

In SFY19, the MCH Prenatal Care Tracking Package was selected by 23 LHDs with 1,944 women receiving assistance in obtaining and continuing prenatal services. This strategy helped LHDs improve their internal process of tracking the initiation and continuity of prenatal care. Pregnant women receive referrals for services such as WIC, HANDS, breastfeeding peer counseling, and other services as appropriate. The specific strategies include coordinating care for pregnant women with local providers, ongoing contact with pregnant women, assistance with enrollment in Presumptive Eligibility (PE) and Medicaid, and referral of women denied Medicaid to providers for the Title V Public Health Prenatal Program. Through this package, LHDs are tracking these women to see if they initiate prenatal care within the first two weeks of a positive pregnancy test, thus increasing the chances of improved perinatal outcomes. While following up with patients about initiation of prenatal care, LHD staff may also assess for barriers to care such as a payor source and assist with the application process for Medicaid, PE, or the Public Health Prenatal Program. By assuring that women are obtaining early and ongoing prenatal care, there are many opportunities to educate these women about the risks associated with cesarean sections and EEDs.

 

In SFY19, four LHDs implemented the HBWW MCH Evidence Informed Strategy with 347 pregnant women, providers, and professionals reached. Activities included collaborative work with the MOD representative to educate health care providers and families on the importance of reducing EEDs. Additionally all LHDs participated by providing 17-OHP information and education for pregnant women with previous history of premature births. This project funded by the MOD reached over 10,000 pregnant women with educational materials across KY.

 

Other Programs Affecting Women and Maternal Health:

KY’s progress related to maternal morbidity continues through the Health Access Nurturing Development Services (HANDS) home visitation program. HANDS began in 1998 as KY’s voluntary home visitation program designed to assist overburdened expectant and first-time parents, prenatally through age 3. In 2011, HANDS expanded to serve multigravida families. HANDS focuses on fostering early childhood development, nurturing relationships, and learning which serves more than 12,000 families statewide. The paraprofessional and professional HANDS home visitors build relationships with the parents of young children and work on positive parenting and family self-sufficiency skills using a strengths-based curriculum. These protective factors build resilience and positive outcomes for both the child and parents. Previous outcomes studies report the infant mortality rate was 74% less likely among HANDS participants than statewide.

 

KY was a recipient of formula and competitive grant funds through the Maternal Infant Early Childhood Home Visiting (MIECHV) Program. At full implementation, 78 counties received expanded services (in addition to the core HANDS program, which is in every county). Due to changes in the federal MIECHV, currently only 29 of KY’s highest at risk counties receive support by MIECHV Formula funds. The benchmark results from this program found improvements in maternal and newborn health; school readiness and achievement; increased screening for domestic violence and referrals for victims of domestic violence; family economic self-sufficiency; referrals for other community resources; decreased mother and child visits to the Emergency Room; and decreased incidence of child injuries requiring medical attention.

 

During 2018, the state workforce for HANDS was dramatically reduced as veteran staff retired or found other state promotional opportunities. Regardless of this workforce transition, HANDS continued to meet federal standards of programming with local field representatives’ assistance and serve the women and children of KY.

 

 

Emergency Preparedness:

The purpose of the KY Emergency Operations Plan (KYEOP) is to define the general responsibilities of emergency response agencies, their partners, and the organizational structures required when activated to respond to emergencies, disasters, and technological incidents [all hazards] affecting the Commonwealth of KY and its citizens.

 

This plan is the all-hazards emergency plan as described and required in Kentucky Revised Statue (KRS) 39A and is activated upon order of the Governor of the Commonwealth of KY, the Director of KYEM, or their authorized representatives. Parts of this plan or the entire plan are automatically activated when:

• A general declaration of a disaster or an emergency by local, state, or federal authorities, or

• Required by the size and level of impact of a catastrophic event, or
• Required to implement actions necessary to place emergency personnel on active readiness levels for an impending incident or scheduled event.

 

This plan is the cornerstone document of the Commonwealth Comprehensive Emergency Management Program established to support an integrated emergency management system, providing for adequate assessment and mitigation of, preparation for, response to, and recovery from the threats to public safety and the harmful effects or destruction resulting from all major hazards.

 

Cabinet for Health and Family Services (CHFS) is the primary state agency responsible for coordinating and regulating health, medical, and social support services during emergencies or disaster events. During such circumstances, the Department for Public Health (DPH) is responsible for coordinating:

• Assessment of public health and medical needs
• Disease surveillance
• Mobilization of trained health and medical personnel and emergency medical supplies
• Provision of public health environmental sanitation services
• Food safety and security
• Disease and vector control
• Safety and security of drugs
• Biologics and medical devices distributed via the SNS program
• Establishment and staffing of special medical needs shelters and mass fatality management
• Handling, analysis, and identification of hazardous materials

 

MCH has specific Continuity of Operations Plans (COOP) in place to address nutrition for pregnant women and children through the WIC program, access to dieticians, and an outbreak plan through the Division of Epidemiology and Health Planning. During mass emergencies in other states, KDPH has assembled nursing strike teams to join Public Health efforts in other states. Two nurses from MCH have been part of these teams as KDPH strike team leaders in years past.

 

Beginning in March 2020, many operations were needed to respond to COVID-19.  MCH collaborated with OB/GYNs, MOD and others for rapid development of education opportunities, hospital guidelines, and webinars for caring for women with COVID-19 during pregnancy.  Dissemination occurred via the State Health Operations website, CHFS media system, and a multitude of distribution lists. MCH staff from across the division provided subject matter expertise and continue to support this effort to reduce negative outcomes in KY.