Guide for Reading Mississippi’s MCH Block Grant Narrative

The following section contains a report on the accomplishments and challenges of the previous year as (FFY19) and a description of strategies and activities for the upcoming year (FFY20). One person does not write the MCH Block Grant Application for Mississippi. Multiple programs (with MCH teams) submit narrative to provide a landscape for MCH activities in the state of Mississippi. This section is organized by the five MCH population domains. The information within each domain is organized as follows:

1.  Introduction to MCH Priority area

1. Priority
2. National Performance Measure or State Performance Measure (NPM or SPM)
3. Program purpose and summary

2.  Annual Report (FFY2019) (Accomplishments and Challenges)

1. Statement of Priority Area
2. Objective selected to address NPM and or SPM
3. Strategy(s) selected to accomplish objective
4. Rational for selected strategy
5. Strategies and Activities reporting information
6. Evidenced Based Measure (ESM) reporting
7. Emerging issues
8. Other programmatic narrative/activities
9. Success stories

3. Plan for the Application Year (FFY2020)

1. Statement of Priority Area
2. Objective selected to address NPM and or SPM
3. Strategy(s) selected to accomplish objective
4. Rational for selected strategy
5. Planned Strategies and Activities
6. Evidenced Based Measure (ESM) planning

 

***= continued from previous year- programs may opt to carry strategies, activities and objectives over from the previous year.

Women/Maternal Health Annual Summary (Office of Women’s Health)

Priority:

1. Reduce low birth weight and premature birth
2. Increase access to early prenatal care

NPM 1: Well-woman visit (% of women with a past year preventive medical visit)

SPM 1: Percentage of women who smoke in the last three month of a pregnancy

Program Purpose and Summary

The Office of Women’s Health partners with internal and external providers to serve the uninsured and underinsured in Mississippi.  The goal is to provide women access to comprehensive health services to ensure healthier women, mothers and infants.  These services are provided in house, contracted out or through partnerships developed across the state.   Under the Office of Women’s Health Office, there are a two bureaus.

The Breast and Cervical Cancer program (BCCP) is a screening program for the medically underserved women in the state. According to the American Cancer Society, there will be an estimated 2,370 new cases of breast cancer in Mississippi during 2019 and only 67.7% of women ages 40 years and older received a mammography during 2016.  The United States was at 72.4% in 2016.  The BCCP provides outreach education, promotion awareness, screening and case management services.   Cervical screening services are available for uninsured or underinsured women between the ages of 40 and 64 and mammography screenings to uninsured or underinsured women between 50 and 64 years of age.  Special exceptions are available for those women between the ages of 18-39.  There are special funds from other organizations which are available for women ages 40-49 to receive a screening mammogram.  Diagnostic procedures and case management services are provided to women with abnormal findings.  Referrals are made to the Mississippi Division of Medicaid for treatment coverage, if a woman is diagnosed with a malignancy or pre-cancerous condition.   The BCCP has contractual partnerships with 297 facilities throughout the state.  There is a coordinated effort between the BCCP and Comprehensive Reproductive Health program to ensure that women who qualify for the Family Planning Waiver receive appropriate referrals.

The Perinatal High Risk Management/Infant Services System (PHRM/ISS) is a case management program for Medicaid eligible, medically high risk pregnant and post-partum women and Medicaid eligible, medically high risk infants up to one year of age.  PHRM/ISS case managers have the flexibility to provide individualize the health care, nutritional and psychosocial support, home visits, and health education to meet the individual health needs of the pregnant and post-partum woman and infants as seen by an individualized care plan.  In addition, the PHRM/ISS program is able to enhance services above the “Traditional PHRM/ISS” in order to add in components to meet the patient’s needs.  Through the addition of the Expectant and Parenting Teen project, funding from the Pregnant Assistance Fund, the needs of 17-19 year old pregnant and parenting women who would otherwise not qualify for the “Traditional PHRM/ISS” are being served. The incorporation of telehealth within the PHRM/ISS program is multi-faceted.  The partnership with UMMC Center for Telehealth provided the opportunity for the PHRM/ISS program to use the Health Harmony portal/services in order to accomplish this purpose via remote patient monitoring and mobile communications.   MSDH clinic to clinic technology is being used to fill the gaps of a declining workforce.  These projects are to identify if the use of the equipment will increase the number of visits by overcoming the barrier of transportation and remoteness in such a rural state and working with family schedules for appointments. 

Given the high burden of chronic disease among Mississippi’s adult population, and the importance of preconception/ inter-conception health on birth outcomes, a focus on preventive care for women of childbearing age is a priority for Mississippi. Preventive care encompasses a number of components, including physical exams, screening tests (including labs), and counseling. NPM 1 measures the percentage of women with a past year preventive visit. According to the 2015-2016 BRFSS, the percentage of women ages 14-44 who received a well-woman visit is 71.8%.  Per the 2016 BRFSS, 85.3% of women between the ages of 21-44 received a cervical cancer screen.  Per the 2016 BRFSS, percentage of females age 13 to 17 receiving the HPV immunization was 34.4%.  Increasing the percentage of women who complete preventive visits should improve not only the health of a mother (and thus reduce the chronic disease burden) but also improve birth outcomes by improving a mother’s preconception/ inter-conception health.

 

Per the Mississippi State Department of Health’s Infant Mortality Report 2018, during 2017 the Mississippi Infant Mortality Rate was 8.72 deaths per 1,000 live infants born. This represents a 1.7% rate increase from 2016 rate of 8.57.  Racial disparities are seen in the infant mortality rates, as evidenced by the black infant mortality rate at 11.9 deaths per 1,000 live births compared to the white rate of 6.2 deaths per 1,000 live births.  Infant mortality may be impacted by several factors such as the mother's health before and during the pregnancy, complications of pregnancy, and environmental and social factors. The mother's health before or during pregnancy may be influenced by exposure to tobacco, alcohol and/or other drugs, her chronic illnesses such as obesity, hypertension, and/or diabetes, and whether or not the pregnancy was planned.  The leading causes of infant mortality continue to be preterm birth, sudden unexpected infant deaths related to unsafe sleeping environments and birth defects.  https://msdh.ms.gov/msdhsite/_static/resources/8015.pdf  There are various protective efforts utilized to address the infant mortality rates in Mississippi looking at providing information on improving the women's health, sleeping environments, and infant health. 

 

Through the family planning waiver, women are provided a means to preconception and inter-conception health care, where without this they may not receive these services.  Increasing the percentage of women who receive health visits with education regarding effective forms of birth control to help improve their health before becoming pregnant, referrals for tobacco, alcohol, and/or drug services, and inter-conception care, assist in improving birth outcomes. This action plan describes how MSDH will address low birth weight and premature birth through preconception/interconception health. Our focus is to address the woman's preconception/ interconception health across the life span via a well woman visit. 

 

The strategies and activities are to engage a variety of partners to address the needs of uninsured, underinsured and high risk women throughout Mississippi.  The purpose of PHRM/ISS is to help reduce the infant mortality rate and to help reduce the rates of low and very low birth weight infants in Mississippi.  The case management program addresses this by direct services to women and infants.  Through committees, boards, and community presentations, the program is able to increase networking opportunities, engage partners to broaden the reach of the program, and share knowledge and skills to benefit the participants. 

 

As people more and more turn to various social media use for knowledge, use of social media to promote preventive visits became an opportunity. In following the philosophy of “meeting the patient where they are at” the Office of Women’s Health turned to social media as a platform to promote preventive health knowledge and encourage preventive health medical visits.  Some studies reflect that social media helps to empower patients regarding health care and compliments the information provided by providers not replace the providers. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5000484/   The purpose of the social media postings are to provide accurate information for patients to read, think about scheduling a screening appointment with their provider and use the information to start talking with their provider. In joining with other programs and organizations, the goal is to promote the same message and avoid providing any mixed messages around the same topic.

The narrative below describes the rationale for why Mississippi selected certain measures and provides detailed narrative to link the selected NPM’s, SPM’s with Mississippi’s identified state priorities.

 

Women’s/Maternal Health Annual Report (Office of Women’s Health)

 

Accomplishments and Challenges

Priority Area: Reduce low birth weight and premature birth

Objective 1: Increase awareness about PHRM/ISS Case Management by participating on community advisory boards and take part in vendor exhibits booths at professional organizations.  By September 2019, increase the total number of activities from 38 to 50.

Strategy 1: The Office of Women's Health Director, PHRM/ISS Director, Fatherhood Coordinator, and Promoter will work with internal MSDH and External MSDH partners to identify opportunities for collaboration.

Rationale Strategy 1: The PHRM/ISS program is working on transforming from a program where the majority of the referrals come from within the MSDH structure to reaching out to external partners in order to increase the referral base. With the Fatherhood Coordinator participating in the advisory boards, there is the potential of helping to engage and broaden the community’s knowledge about the population served in the PHRM/ISS program.  His role also serves as an advocate for the males in the communities, the fathers of the babies.  In addition, the PHRM/ISS program is working with a private funder, who has hired a promoter for the PHRM/ISS Telehealth project in the Hinds, Madison, and Rankin county areas.  The promoter will focus on the medical community and professional organizations in order to educate them about the benefits of the PHRM/ISS program and the use of telehealth within PHRM/ISS.  The two staff members will begin working together to broaden the external knowledge about PHRM/ISS.

 

Activity 1a:  Fatherhood Coordinator and Promoter will identify three additional external partners in order to obtain "a seat at their table" to promote PHRM/ISS and learn about their resources for partnerships/collaborations.

Report Activity 1a:

One of the roles of the Fatherhood Coordinator is to promote the PHRM/ISS program and other MCH programs reaching out to traditional and non-traditional public health partners.  He does this through participation in various external and internal boards and committees.  A portion of his schedule during the reporting period has been committed to outreach and educational activities. The Fatherhood Coordinator has been able to extend his reach while attending various meetings over the past year, which included external partners such as, Vicksburg Health Network, Indianola Excel by 5 Coalition meeting, and Nfusion Metro Governance Council; and internal MSDH partners.  Over the fiscal year, the Fatherhood Coordinator has been able to participate in 52 events.  While the Promoter has resigned from MSDH in March 2019, during her six months in the PHRM/ISS program, she was able to outreach to 23 different provider facilities regarding referrals to the PHRM/ISS program.  She was successful in identifying new referral sources for the program.  In addition, the PHRM/ISS Director worked with the Personal Responsibility Education Program (PREP) Director to ensure language in 20 MOUs between the MSDH PREP Program and existing school districts across the state was updated to encourage referrals of expectant and parenting teens to resources, such as PHRM/ISS.

Activity 1b:  Fatherhood Coordinator will continue to identify external conferences and professional meetings where he may promote PHRM/ISS via vendor exhibit booths.  

Report Activity 1b:

The Fatherhood Coordinator continues to engage in efforts to identify community organizations, agencies, and providers throughout the in order to promote the services provided through the PHRM/ISS program.  He has participated as an exhibitor in college events, state conferences, the Mississippi Perinatal Quality Collaborative, and community events to outreach to professionals and residents of Mississippi.  The Promoter worked with an advertising agency to develop PHRM/ISS brochures specifically for pregnant and parenting women and flyers for medical providers regarding the PHRM/ISS program. 

 Activity 1c:  The Promoter will identify external medical conferences and professional meetings where she may promote PHRM/ISS via vendor exhibit booths and/or presentations.

Report Activity 1c:

The Promoter resigned from the program after seven months.  While she was not able to attend medical conferences and professional meetings where she promoted PHRM/ISS via vendor exhibit booths and/or presentations, she was able to build and enhance relationships with 23 new individual provider for the PHRM/ISS program.  She provided the referring providers with an updated list of their referrals and the disposition of each referral.

 

Objective 2: By October 2019, increase the number of patients in PHRM/ISS case management by 10%.

Strategy 2: The PHRM/ISS program will continue to incorporate telehealth into the case management structure to address barriers to transportation and staff shortages.  

Rationale Strategy 2: As the health department transitioned and staff has decided to retire or move to other opportunities, the PHRM/ISS program numbers declined during FY18. The idea of incorporating telehealth components into the PHRM/ISS program was to eliminate barriers such as staff shortages, cost of staff traveling, and transportation issues for patients.  This strategy was chosen due to telehealth is new for the health department and new for the PHRM/ISS program.

Activity 2a: Review policies and forms necessary for use of the different telehealth projects and incorporate new policies and forms as these projects continue to evolve.

Report Activity 2a:

Since October 2018, considerable work has been directed towards transformation the PHRM/ISS program.  The leadership has been systematically reviewing the workflow of the project, adjusting one component at a time, in order to identify if each adjustment enhances the program.  Along with various adjustments, policies have been created to align with the adjustments and are continually being reviewed with programmatic staff for practical task function. 

Activity 2b: Review auditing procedures for the different telehealth projects and incorporate new policies and forms as these projects continue to evolve.

Report Activity 2b:

See report of Activity 2a.

Activity 2c:  Compare the baseline data for the traditional PHRM/ISS to the MSDH clinic to clinic telehealth for differences in case load numbers.

Report Activity 2c:

Telehealth services were incorporated into PHRM/ISS to provide assessments to patients, allow for remote case conferencing, and to overcome the shortage of staff around the state.  Since April 2018 when telehealth services began state wide, the PHRM/ISS case load has grown by 14%, outstanding nutritional assessments decreased by 25%.

The PHRM/ISS program worked with the Office of Communications to conduct several focus groups to assess the satisfaction of PHRM/ISS services for families enrolled.  Six focus groups occurred: Gulfport, Greenville, and Meridian.  

The findings from the focus groups will be utilized to guide upcoming programmatic activities, forms, and trainings.  Through the Pregnant Assistance Fund project, there were three focus groups conducted with providers in Jackson, Greenville, and Oxford.  The results and information gained from the focus groups will determine the top 3-5 training needs for providers of services to expectant and parenting teens. 

 

Activity 2d: Compare the baseline data for the traditional PHRM/ISS to the UMMC Health Harmony telehealth for differences in case load numbers. 

Report Activity 2d:

Since the transition of the PHRM/ISS program began, there has been an increase of 53% patients enrolling in the UMMC Health Harmony telehealth project. Reviewing the caseloads within the targeted counties shows a 49% increase in overall caseloads. 

Preliminary findings of the first report include: a total of 29 reports were reviewed, beginning November 2018 to March 31, 2019.  Of those, 14 (48.3%) were mothers and 15 (52.7%) were infants.  Of which 154 contacts were made; 69 (44.8%) were with mothers and 85 (55.2%) were with infants.  Approximately 454 different activities were reported as part of the 154 contacts. 

Activity 2e: Work on addressing the evaluation components of the telehealth portion of PHRM/ISS

Report Activity 2e: 

Monthly leadership meetings have included discussions of the process evaluation to ensure that this remains a focus.  The intent of the process evaluation is to: 1. Examine whether the PHRM/ISS UMMC Health Harmony telehealth pilot is being implemented as intended, 2. Assist MSDH in monitoring and reporting implementation of pilot, 3. Examine resources used to deliver services, 4. Identify barriers/facilitators to implementation, and 5. Capture ways in which problems are being resolved.  The evaluator, paid for by a private benefactor of the PHRM/ISS program, has been involved in weekly, monthly and quarterly meetings.  He has been instrumental in developing a tool to capture data and creating quarterly stakeholder reports. 

 

Activity 2f: The program will track compliance of the use of the pilot app for consideration of expanding use within the PHRM/ISS program.

Report Activity 2f: 

Due to shortages of staff, numerous transitions and working to provide training on current technology, this activity has been deferred until the next fiscal cycle.

Strategy 3: By September 2019, the PHRM/ISS case management program will increase the number of formal MOUs from 5 to 8 in order to increase the number of referral sources for PHRM/ISS.

Rationale Strategy 3:  As the PHRM/ISS program is working to expand their referral base from within MSDH to external partners, it is important to formalize these relationships.  PHRM/ISS has been identifying groups of high risk pregnant women and infants who are in need of case management services but may not qualify for other types of case management provided in the state.  These are the MOUs and relationships the program is seeking. Once the relationships are identified, the administrative staff will be providing training for the county level case managers to enhance their knowledge and skills for the population.

Activity 3a: Begin to identify additional specialized populations for specific referrals to PHRM/ISS.

Report Activity 3a: 

June 1, 2018, the PHRM/ISS program has entered into a Memorandum of Understanding (MOU) with the Mississippi Department of Child Protective Services regarding referrals to infants and their families identified as being affected by substance abuse or withdrawal symptoms resulting from prenatal drug exposure, or a Fetal Alcohol Spectrum Disorder for delivery of appropriate services.  The PHRM/ISS program is entering into their second year under this MOU with the Mississippi Department of Child Protection Services.  Through this MOU, 294 infants and their families were identified as being affected by substance abuse or withdrawal symptoms resulting from prenatal drug exposure or Fetal Alcohol Spectrum Disorder and referred to the program.  The PHRM/ISS Director collaborated with the Personal Responsibility Education Program (PREP) Director to ensure language in 20 MOUs between the MSDH PREP Program and existing school districts across the state was updated to encourage referrals of expectant and parenting teens to resources, such as PHRM/ISS.  In addition, the program has been working with the MSDH STD and HepB programs to develop protocol on referring high risk pregnant women and infants to PHRM/ISS.

Activity 3b: Incorporate the "Baby Station" model in 3 other areas around the state, as a model to distinguish the PHRM/ISS case management program from other case management programs - as a positive for other entities to enter into a joint MOU for referrals to PHRM/ISS.

Report Activity 3b: 

Three years ago, the PHRM/ISS program was awarded a Pregnancy Assistance Fund grant from the Office of Adolescent Health to address expectant and parenting teens.   The project created a Baby/Parenting Station which serves as an interactive area, where the case management team interacts one-on-one with the expectant and parenting teens to teach and demonstrate important parenting skills, infant care, and bonding techniques. Considerable work has been directed towards building the infrastructure and organizing the logistics of planting the 6 new baby/parenting stations proposed in the grant application. The stations will serve as interactive areas, where the case management teams interact one-on-one with expectant and parenting teens to teach and demonstrate important parenting skills and infant care and bonding techniques.  The health education and teaching delivered through the modules will be aligned with  the Partners for Healthy Baby curriculum and supported by additional medically accurate and evidence based materials vetted by larger federal entities, including CDC, HRSA, HHS, and NICHD.  Additionally, funding will be used to develop a reward/incentive opportunity for participants of the “baby/parenting stations” to assist with meeting basic physical, health, safety and other material needs.  Sites for the 6 new labs have been identified in existing county health departments throughout the state, including Coahoma, Pontotoc, Lauderdale, Adams, Harrison, and Hinds counties. The existing baby/parenting station in Jones County remains fully stocked and functional.

Activity 3c: The Promoter will work to formalize relationships with at least 4 medical providers in the Hinds, Madison, and Rankin area.

Report Activity 3c: 

The Promoter resigned from the program after seven months and her position has not been filled, she was able to build and enhance relationships with 23 new individual medical provider for the PHRM/ISS program.  These medical providers continue to refer patients to the program.

Objective 3: By September 2019, will increase the number of social media months from 4 months to 9 months for social media months with partnerships inside and outside MSDH.

Strategy 4: The Office of Women's Health will work identify National Health Observances related to women's preventive health, identify one health risk, work with internal MSDH and External MSDH partners to find social media messages for posting.

Rationale Strategy 4: The purpose of this strategy is to utilize a variety of programs’/organizations’ social media platforms inside and outside MSDH in order to reach a broader audience without sending mixed messages for different programs/ organizations.

Activity 4a:  Continue to pull the list of National Health Observances to identify months and events focused around women's preventive health services.

Report Activity 4a:

Throughout the year, the National Health Observance list was reviewed for potential activities surrounding a preventive health service for women. Such observance were breast cancer awareness, cervical cancer awareness, heart health, smoking, HPV, general women’s health visits during May. In addition to focusing on preventive health services for women, during the month of June, social media posts and MSDH website will be focus on awareness of men and their health issues.  There have been seven months with postings from October 2018 to June 2019. 

 

Activity 4b:  Continue to reach out to internal and external MSDH partners to develop joint messages for social media postings.

Report Activity 4b:

Informal discussion occurred with several programs regarding joint social media postings.  There were several months were postings sent joint messages surrounding health and regular check-ups with a medical provider.  The Office of Women’s Health, Fatherhood Coordinator and the BCCP Outreach Coordinator are currently working on a plan to identify external partners who are utilizing social media for postings; identifying the appropriate contact person and department to explore use of social media.

Activity 4c:  Reach out to the national and state organizations hosting the monthly National Observance in order to develop joint messages for social media postings.

Report Activity 4c:

At this time there have not been joint hosting between MSDH and other organizations.  Discussions have occurred with a few state organizational staff members, who are following up with their internal stakeholders about this process. 

Objective 4: By September 30, 2019, the Office of Women's Health will increase the number of users viewing the social media message delivered by MSDH social sites promoting women's preventive health services by 2% from the baseline obtained May 2018.

Strategy 5: The Office of Women's Health will work with internal MSDH and External MSDH partners to promote the social media posting by MSDH.

Rationale Strategy 5:  As the Office of Women's Health moves toward using social media and as social media changes, there is the need to monitor each type of social media for client engagement and use.  This is identified by a different means for each social media using the following:  Likes, views, impressions.  By monitoring the "likes, views, and impressions" will help to monitor where to invest time and resources for upcoming monthly observances and type of medium used such as video, links to webpages, or informational knowledge.

 

Activity 5a:  Identify new internal partners with similar messages who are willing to partner, create a consistent message, and post on multiple webpages and social media sites.

Report Activity 5a:

Throughout the year, several MSDH programs use social media in order to promote health messages.  Many of these messages are similar and promote health for women.  The Office of Women’s Health has been monitoring the type of social medial which MSDH is able to use and which types are engaging viewers.  This is identified by a different mean for each social medical using the following:  visitors, reaches, and impressions. 

Activity 5b:  Identify external MSDH partners with similar messages who are willing to partner, create a consistent message, and post on multiple MSDH webpages and social media sites.

Report Activity 5b:

The Office of Women’s Health, Fatherhood Coordinator and the BCCP Outreach Coordinator are currently working on a plan to identify external partners who are utilizing social media for postings; identifying the appropriate contact person and department to explore use of social media.  

 

Activity 5c:  Identify if an alternative social media site may need to be accessed that is currently not being used by MSDH Office of Communications, identify if using this alternative site is a viable option with another partner or could MSDH Office of Communication add this platform.

Report Activity 5c:

As the Office of Women’s Health moves towards using social media, there is the need to monitor the type of social medial which MSDH is able to use and which types are engaging viewers.  This is identified by a different mean for each social medical using the following:  visitors, reaches, and impressions. 

Social Media promotions throughout the year (excluding October 2018):

Facebook reaches: 109,145

Twitter impressions: 16,686

 

In conjunction with the Breast and Cervical Cancer program, the Office of Women’s Health provided social media during the month of October addressing women’s health and breast cancer awareness.

MSDH webpage visitors: 394

Facebook reach: 24,946

Twitter impressions: 8,486

 

During the month of June, there is a social media focus on Men’s Health and having preventive health visits

Facebook reach: 10,954

Twitter impressions: 4,447

 

In addition to monthly posts surrounding women’s health, MSDH Office of Communications created a new webpage “Become a Well Woman” https://msdh.ms.gov/msdhsite/_static/41,17609,225.html in order to provide knowledge about scheduling a Well-Woman visit, eating right, getting active, stress reduction and building healthy habits. 

Women/Maternal Health (Office of Women’s Health)

Evidenced Based Measure Reporting (ESM)

 

 

ESM 1:  # of social media message months promoting women's preventive health services.

ESM 1 Report: 

The strategy within this ESM is to provide a variety of information regarding well woman visits and preventive health services visits to meet the health care needs of women within Mississippi using Facebook and Twitter.  The goal is to work on providing social media tailored messages to meet the various preventive health services for women. There have been seven months with well woman visit and preventive health services visit postings between the months of October 2018 to June 2019.   

ESM 2: # of engaged users viewing social media messages delivered by MSDH social sites promoting women's preventive health services.

ESM 2 Report: 

The social media strategy is to encourage women to seek well woman and preventive health service visits to meet their health care needs. Preventive health screenings provide benefits to women throughout the life course.  From a well woman visit to immunizations, these preventive health care services assist with the identification, treatment and/or prevention of health issues and diseases.    The social media messages utilized cover a variety of topics to include some of the following: immunizations, hypertension, heart disease, breast cancer, cervical cancer, colorectal cancer, smoking, prenatal care, and STD/HIV.  Social media will continue to be used in order to increase awareness and education of women regarding the important of such preventive health services.

Social Media promotions throughout the year (excluding October 2018):

• Facebook reaches: 109,145
• Twitter impressions: 16,686

In conjunction with the Breast and Cervical Cancer program, the Office of Women’s Health provided social media during the month of October addressing women’s health and breast cancer awareness.

• MSDH webpage visitors: 394
• Facebook reach: 24,946
• Twitter impressions: 8,486

During the month of June, there is a social media focus on Men’s Health and having preventive health visits

• Facebook reach: 10,954
• Twitter impressions: 4,447

 

ESM 3: Attends and partners with a number of community group and activities (increase the total number of activities from May 2018 to October 2019 from 38 to 50).  Number of community group and activities program attends and partners with.ESM 3 Report:             

ESM 3 Report:

Program staff develop and sustain partnerships with community organizations and groups, in order to provide education about MSDH services and improve the health of women.  

With the Fatherhood Coordinator participating in 52 community activities which include advisory boards, presentations and conferences, there is the potential of broaden the community’s knowledge about the population served in the PHRM/ISS, BCCP and other health department programs. 

The Breast and Cervical Cancer Program continues to form partnerships with various organizations statewide. Some of these organizations include: the MS Department of Corrections, MS Network for Cancer Control, Fannie Lou Hamer Cancer Foundation, MS Comprehensive Cancer Control (MP3C), Office of Preventive Health, Families First, and the Adams County Sheriff’s Department.

 

ESM 4: # of MOUs with referrals sources for the PHRM/ISS case management program.             

ESM 4 Report:

The PHRM/ISS Director worked with the Personal Responsibility Education Program (PREP) Director to ensure language in 20 MOUs between the MSDH PREP Program and existing school districts across the state was updated to encourage referrals of expectant and parenting teens to resources, such as PHRM/ISS.

 

Women/Maternal Health Annual Report (Office of Tobacco Control)

SPM 1: Percentage of women who smoke in the last three month of a pregnancy

Program Summary and Purpose:

The Office of Tobacco Control (OTC) works to reduce secondhand smoke exposure, prevent youth tobacco use, increase adult cessation, and reduce tobacco-related disparities. Tobacco use is the leading preventable cause of death, disease and disability in Mississippi. We have 34 Tobacco-Free Coalitions that cover each county of the state. These coalitions focus on engaging those in the community to advocate for smoke-free spaces, educate on the dangers of tobacco use, and make community members aware of cessation services. The coalitions have been instrumental in advocating for smoke-free communities and adding vaping language to these ordinances.

We work with health systems across the state (clinics, hospitals, health organizations, etc.) to increase referrals to the Mississippi Tobacco Quitline. We have worked for over seven years with all 21 federally qualified health systems to make Quitline referrals, as well as to make comprehensive cessation services a standard of care. Electronic health referrals to the Quitline are also a priority. We have a bi-directional system in place with Coastal Family Health Center and are working to set one up with the University of MS Medical Center.

Mississippi Title V works to address the impact of tobacco use through the Office of Tobacco Control (OTC). Tobacco use is the leading cause of preventable death, disease, and disability across Mississippi and the United States. Approximately 5,400 Mississippians die each year from their own smoking. Direct costs to Mississippians for tobacco‐related illnesses include an estimated $1.23 billion in medical costs and $319 million in Medicaid payments. The Medicaid burden per household is $1,023 per year in federal and state taxes. Nationally, more than $1.8 billion annually is drained from the economy because of healthcare costs and lost productivity (Campaign for Tobacco-Free Kids, accessed 6/20/19).

According to the 2017 Behavior Risk Factor Surveillance Survey data, 22% of Mississippians smoke and 22% among females smoke. Smoking is more prevalent among white females than black females, 25.4 and 16.6, respectively. The percentage of Mississippi adults who reported current cigarette smoking was significantly higher among those with less than High School (HS) (37.8%) compared to other educational levels and higher among those with an annual household income of less than $15,000 (32.1%) compared to those with household incomes of $35,000 to 49,999, or $50,000 or more. To consistently address tobacco use for lower SES populations, we will continue to partner with health systems and organizations, such as the Health Center Association of MS, that serve these people. To address tobacco use among women of child-bearing age and pregnant women relative to infant mortality, SIDS, and secondhand smoke exposure, the Office of Tobacco Control (OTC) participates in COIIN (Collaborative Improvement and Innovation Network) and related infant health programs to coordinate strategies that educate women about tobacco use dangers before, during and after pregnancy.

OBJECTIVE 1: By September 18, 2019, reduce smoking prevalence among pregnant women and women of childbearing age by 3%.  (Medicaid Baseline Data, FY 16 - 722,261)

Strategy 1: The OTC, in collaboration with its partners, will work towards reducing the prevalence of tobacco/alternative tobacco products among women ages 18-44.

Rationale Strategy 1: Increase cessation among women of childbearing age to promote better birth weights and infant health.

Activity 1a:  Promote the availability of cessation treatment services and resources via the Mississippi Tobacco-Free Coalitions, state-wide partners, healthcare providers, and stakeholders to shape interventions and activities that address pregnancy and the implications of tobacco use during pregnancy.

Report Activity 1a:

Efforts to address infant mortality have included educating and informing healthcare providers on the value of tobacco cessation with pregnant women and women of child-bearing age.

The BABY & ME – Tobacco Free is a smoking cessation program created to reduce the burden of tobacco use on the pregnant and post-partum population. The program uses a cessation support design specific to pregnant women. This design is multi-pronged and successfully targets low socioeconomic groups by combining brief cessation counseling with biomarker feedback, while offering practical incentives (vouchers) as positive reinforcement to maintain smoking cessation.

Women who quit smoking are less likely to have premature and low-birth weight babies and reduce the damaging effect of second-hand smoke on their children. The program’s design has proven effective in decreasing the number of women who smoke during and after pregnancy. A Tennessee study found that pregnant smokers who attended >2 prenatal sessions: Consumed 63% fewer cigarettes per day during their last trimester compared to non-participants Reduced their chance of having a low birth weight birth by nearly 60% over non-participants.

Quit rate of 68% among those attending 3-4 sessions.

Nine (previously six) Federally Qualified Community Health Centers are enrolled in MS's pilot program—Aaron Henry, Coastal Family Health Center, GA Carmichael Family Health Center, Greater Meridian, Jackson Hinds, Jefferson Comprehensive, Mallory, and Southeast Rural Health Initiative  .

There are presently 84 participants (previously 20) in the program, 32 of which were enrolled in the Baby and ME program since October 2018. There have been 18 births in that time frame.  The average gestational period was 38.2 and an average birth weight of 7lbs.

www.babyandmetobaccofree.org

 

Activity 1b:  Ensure pregnant women have access to tobacco and drug counseling and educational services. (The OTC ensures access to treatment services for tobacco/alternative tobacco products; Other substances are excluded).

Report Activity 1b:

There is ongoing promotion with Federally Qualified Health Centers (FQHC), WIC clinics, and other health systems that serve low SES populations of pregnant women through our sub-grantees, partners, and networks.  See section 9 “Partnerships” for more details about collaborations with the Division of Medicaid.

Ongoing promotion with federally Qualified Health Center (FQHC) and other systems that service low SES populations of pregnant women is conducted via sub-grantees, partners, and networks.

 

Activity 1c:  Increase the number of referrals to the Tobacco Quit Line.

Report Activity 1c:

Ongoing promotion of the availability of Quitline services is shared via all sub-grantees, partners, and stakeholders;

The Mississippi Tobacco Quitline provides cessation treatment services for pregnant women via a specialized protocol to help them stop using tobacco products.

The Quitline administers a protocol for pregnant women that includes the same problem solving/skills training and supportive interventions as other  protocols with the addition of offering:

• Pregnancy-specific issues such as low birth weight babies and the developmental issues that are probable;
• Chemicals in tobacco and alternative tobacco products and how they also enter breast milk;
• Nicotine effects on the baby such as restlessness, vomiting, and diarrhea;
• Reduction in breast milk supply due to exposure in tobacco and alternative tobacco products;

 Pregnancy-specific self-help materials and follow-up are provided throughout pregnancy, including further encouragement of cessation if relapse occurs. When possible, partners are involved in the quit attempt through counseling. The dangers of second-hand smoke to the mother and newborn baby are addressed (SIDS). For pregnant women, physical and mental barriers are addressed, along with cravings and challenges specific to pregnancy. For this population, the counseling staff is trained to be aware of signs of depression, domestic violence, or other crisis and to refer the participant to appropriate resources and encouraged to speak with her health care provider.

Quitline challenges: The Quitline needed additional funding to hire staff for phone interviews.  The challenge was managed by providing additional funding for an automated phone system that calls clients to determine if they are motivated to quit smoking.  If ready, the system connects the person to a counselor. If not, the system allows the person to hear cessation tips or to call back when they are ready to quit and speak with a live counselor. This met the Quitline’ s needs and saved the program around $40,000.

 

Activity 1d:  Increase awareness of the health impact of second-hand smoke exposure

Report Activity 1d: 

Education and awareness regarding the health impact of second-hand smoke exposure is provided at the community level by the Mississippi Tobacco-Free Coalitions (MTFC) across Mississippi. The MTFCs work closely with local municipalities to provide technical assistance regarding local smoke free ordinances. Since September 2018, nine communities have adopted smoke-free ordinances, eight of which include vaping devices.

The Office of Tobacco Control has collaborated with the March of Dimes and the Health Center Association of Mississippi to pilot Baby and Me Tobacco Free in nine pilot sites (see 1a). We hope to grow this program as funds are available and by gaining buy-in with managed care organizations. The state of Tennessee had a similar outcome and we hope to mirror their progress.

We have sponsored state-wide media through television, social media and radio applications informing the public on the dangers of second-hand smoke and tobacco. Billboards promoting safe sleep (ABCs: Alone, on the Back, in a Crib, in a smoke-free environment) were placed in various areas throughout Jackson, MS as part of the Safe Sleep City initiative.

SCRIPT trainings were discontinued June 30, 2018 due to competing priorities and funding. Additionally, SCRIPT materials were cost-prohibitive for many clinics.From March of Dimes: SCRIPT® is an award-winning, evidence-based program shown to be effective in helping thousands of pregnant women quit smoking.

Strategy 2: Empower the MS Tobacco-Free Coalitions and other partners to provide education to local municipalities and counties on the importance of a smoke-free environment.

Rationale Strategy 2:  The OTC is working in collaboration with partners and sub grantees to continue efforts to educate and inform municipalities on the impact of and the benefits of Smoke-free policies to reduce tobacco use, increase cessation rates, and reduce secondhand smoke exposure.

The OTC and its partners has been recognized by the American's for Non-Smoker's Rights since 2010 as a 5-time first place recipient and 3-time second place recipient for the state passing the most local ordinances.

Activity 2a:  Engage with local officials at the Mississippi Municipal League (MML) Conference and the MS Annual Board of Supervisors Conference, annually, regarding the health and economic benefits of local comprehensive, smoke-free ordinances.

Report Activity 2a:

The OTC continues to partner with the Mississippi Municipal League and the MS Board of Supervisors to provide information to local municipalities during their annual conferences and throughout the year on the advantages of smoke-free/tobacco-free environments and to recognize cities who have passed local smoke free ordinances.

Activity 2b:  Provide education, awareness, and resources to municipalities regarding the importance of local ordinances to protect citizens from the dangers of second-hand smoke.

Report Activity 2b:

See 2a. We also provide stipends to communities to educate their citizens about the dangers of tobacco and the health advantages of smoke-free environments. Stipends range from $2,500 - $5,000 depending upon the needs of the community. With these stipends, communities hold town hall meetings to educate fellow citizens about the need for smoke-free spaces. Many communities pass smoke-free ordinances without these stipends, but for some communities, it can make a difference.

Activity 2c:  Award Technical Assistance Grants to municipalities to educate their communities on the importance of a smoke-free policy. 

Report Activity 2c:

The OTC continues to work through the Mississippi Tobacco-Free Coalitions to educate and empower local elected officials on the health and economic impact and the benefits of implementing smoke-free ordinances within their municipalities.

Women/Maternal Health Annual Report (Office of Tobacco Control)

Evidenced Based Measure Reporting  

 

ESM 1: # of women ages 18 - 44 who access the Quitline for cessation services (Baseline FY '17 1,114).

ESM 1 Report: 

1,171 females between the ages of 14-44 have accessed the Quitline this fiscal year (July 1, 2018-present).

ESM 2: # of Mississippi communities (cities, counties, etc.) with comprehensive smoke-free ordinances 

ESM 2 Report: 

There is a total of 155 smoke-free communities and five smoke-free counties.

Emerging Issues (Office of Women’s Health)

Opioid addiction:  Title V, Section 503, “Infant Plan of Safe Care,” of S. 524, “Comprehensive Addiction and Recovery Act of 2016” was signed into law (Public Law 114-198) on July 22, 2016. The bill amends the Child Abuse Prevention and Treatment Act (CAPTA) to address the health and substance use disorder treatment needs of the infant and affected family or caregiver; and to ensure the development and implementation by the State of monitoring systems regarding the implementation of plans to determine whether and in what manner local entities are providing, in accordance with State requirements, referrals to and delivery of appropriate services for the infant and affected family or caregiver. The collaborative response required under the CARA legislation has demanded the Mississippi State Department of Child Protective Services (MDCPS) to go beyond addressing immediate safety concerns of substance-exposed infants to addressing caregivers’ substance-use treatment and the infants’ well-being and developmental needs.

To support MDCPS in its mandate, effective late FY18, MSDH and the Mississippi Department of Child Protective Services (MDCPS) entered into a MOU between agencies to support a cross-system partnership for referrals of infants and their families to PHRM/ISS for outreach and delivery of appropriate services. The partnership follows the basic tenants ascribed by the Substance Abuse and Mental Health Services Administration (SAMSHA)’s: A Collaborative Approach to the Treatment of Pregnant Women with Opioid Use Disorders (2016). (Substance Abuse and Mental Health Services Administration (SAMSHA)’s: A Collaborative Approach to the Treatment of Pregnant Women with Opioid Use Disorders (2016).)

Referrals target infants identified as being affected by substance abuse or withdrawal symptoms resulting from prenatal drug exposure or a Fetal Alcohol Spectrum Disorder, who have been reported to MDCPS by medical providers under the CARA federal mandate. To ensure the success of this partnership, a licensed master level social worker (LMSW) at the MSDH Central Office provides primary oversight and initial outreach on all referrals received. Individuals interested and agreeable to participate in PHRM/ISS services are then referred to the county-level for enrollment.  Since the partnership launched on June 1, 2018, MSDH has received 363 referrals for infants identified as being affected by substance abuse or withdrawal symptoms resulting from prenatal drug exposure or a Fetal Alcohol Spectrum Disorder, the most of any single public or private-sector partner to MDCPS in this effort.

While this partnership has just completed its first year of implementation and data is still being analyzed, improved outcomes for families and infants referred to and served by PHRM/ISS have been anecdotally observed, as well as benefits to Mississippi’s already over-burdened child welfare system. Notably, many substance-exposed infants referred to MDCPS prior to the CARA mandate, would have been screened-in, opened, and investigated as child abuse or neglect reports, with the possible, very detrimental, outcome of being removed from the family of origin and placed in the foster care system.

 

 

Other Programmatic Activities (Office of Women’s Health)

Recognizing the need for improvement many months since 2017, discussion have been occurring within the MSDH Senior Leadership regarding evaluation and transformation of the PHRM/ISS program.  MSDH has engaged various stakeholders in order to being review of the current PHRM/ISS program.  One of the activities underway includes looking at specialized populations where the PHRM/ISS program is able to make an impact.  The program is working jointly with the MSDH HepB program to identify where the PHRM/ISS program is able to assist with women diagnosed with HepB and infants.  The PHRM/ISS program has been collaborating with the MSDH Office of STD/HIV to focus on the specialized needs of pregnant women diagnosed with an STD during pregnancy.  To support the partnership for referrals and to ensure the program staff were equipped with the knowledge base and skill set for managing patients with chlamydia, gonorrhea, and/or syphilis, the PHRM/ISS program requested specialized training in best practices for providing case management to high risk individuals affected by STDs.  Training related to best practices was held September 26, 2018 by a national level consultant from National Alliance of State and Territorial Directors and the National Coalition of STD Directors. The program is seeking external partners to increase outreach and services such as show in the relationship described in the MDCPS / MSDH PHRM/ISS referral project. There are several evaluation projects occurring which will guide the improvements and transformation of the program: a process evaluation and focus groups.     

 

MSDH partnered with the Mississippi Division of Medicaid, and Mississippi Department of Mental Health to apply for a competitive opportunity to support and advance innovative state-level policy initiatives that improve access to quality health care for the maternal child health population. Mississippi was recently selected as one of eight states by the National Academy for State Health Policy (NASHP) Maternal and Child Health Policy Innovations Program Policy Academy, to identify, promote, and advance innovative state-level policy initiatives in order improve access to care for Medicaid-eligible pregnant and parenting women with or at risk of substance use disorder (SUD) and/or mental health conditions through health care delivery system transformation. The Policy Academy will emphasize policy strategies that promote integration of care and systems; align with state initiatives to transform how care is provided and paid for (e.g., Medicaid managed care, accountable care organizations (ACOs), value-based payment, etc.); and ultimately, improve health outcomes for pregnant and parenting women.

 

The MSDH Office of Pharmacy has partnered with the Office of Women’s Health to have pharmacy students learn more about public health and women’s health.  Through this project, students are completing training modules surrounding STD and pregnancy, 17P, opioids and pregnancy, and NAS.  In addition, this partnership is reviewing the current Cancer Drug Program within the Office of Women’s Health, discussing ways to expand this program. 

 

The Breast and Cervical Cancer Program (BCCP) provides outreach activities/educational materials to promote awareness and public education through collaborations with community groups and organizations.  Conduct screening services, diagnostic services, referrals and case management through contracts with community health centers, health departments, private providers and hospitals.  The Breast and Cervical Cancer Program continues to form partnerships with various organizations statewide. Some of these organizations include: the MS Department of Corrections, MS Network for Cancer Control, Fannie Lou Hamer Cancer Foundation, MS Comprehensive Cancer Control (MP3C), Office of Preventive Health, Families First, and the Adams County Sheriff’s Department.

 

BCCP works closely with the Office of Women’s Health to ensure that women have access to quality care.  The Office of Women’s Health will continue to support and collaborate with the Breast and Cervical Cancer program and Office of Data Health and Research regarding the review and purchase of a needed program software to improve the processes within BCCP.   The Office of Women’s Health provides a Cancer Drug Program for women who are at or below 250% of the FPL.  Women diagnosed with a malignancy or pre-cancerous condition of the cervix may be referred to Medicaid for treatment coverage. 

 

The Breast and Cervical Cancer program is working with non-traditional partners in order to reach women underserved for breast and cervical screening opportunities.  The program partners with the MS Department of Corrections Restitution Center located in Flowood, MS.  The partnership allows the Breast and Cervical Cancer staff to conduct health educational seminars to the inmates, approximately 255 women.  Ladies who are released are often referred to transitional housing/halfway houses throughout MS.  Inmates who meet the age requirements for screening services through BCCP are provided with screening locations that will be nearest them upon release. A joint effort between the MS Collaborative Group, Alcorn State University, United Health Care, and Alpha Kappa Alpha Sorority focused on a Free Clinical Breast Exam Clinic held on the campus of Alcorn State University.  There were a total of 50 individuals who received information about the BCCP services and 26 women who received a clinic breast exam conducted by a health care professional. 

 

Pregnant and Parenting Teen Program

 

The existing PHRM/ISS case management model allows for a patient’s entry into the program only after a positive finding on a risk screening completed by an approved medical provider. The Mississippi Division of Medicaid reimburses MSDH for services provided to enrolled and eligible patients. Concerning pregnant and parenting teens, eligibility for PHRM/ISS is primarily determined by age and health status. Young women who are pregnant or parenting at age 16 years old or younger are automatically eligible for PHRM/ISS and can be served without restriction. Young women who are 17-19 years are not eligible based on age alone. This subset of young expectant women or infants born to women of these ages must have a medical risk factor in order to be eligible for the PHRM/ISS program. In Mississippi, the majority of teen pregnancies and repeat teen pregnancies occur in young women ages 17-19 years old. According to the NCSL: Mississippi: Teen Pregnancy, January 2015, “A closer look at births to teenagers in Mississippi finds that the majority – 70 percent – are to older teens (18-and 19-year-olds).  The rate among these young women was 3.6 times higher than that of younger teens – about 80 per 1,000 girls, compared to 22 among 15 to 17 year-olds in 2012 (State Update: NCSL: Mississippi: Teen Pregnancy January 2015, http://www.ncsl.org/documents/health/TPreMSJusttheFacts115.pdf).   As such, a considerable gap in services exists for this subset of the target population.

 

Under an existing Pregnancy Assistance Fund (PAF) Grant (FY2016-2020) awarded by the Office of Adolescent Health, the PHRM/ISS has directed resources to develop as existing case managers into “teen specialists” to serve teen-only caseloads in 15 county health departments and provide teen-focused consultation to other case management staff serving pregnant or parenting teens throughout the state. In the 15 grant-supported counties, expectant and parenting teens who do not qualify for the traditional Medicaid reimbursable services are enrolled under expanded eligibility supported by the PAF grant. The 15 counties selected for expanded eligibility, had repeat pregnancies and births to teens at or higher than the state average from 2014-2016. All services provided to the target population are equivalent to the services traditional PHRM/ISS participants receive; however, are tailored for the unique challenges pregnant and parenting teens’ experience.

As with any federal grant, there are expectations for program delivery and performance measures, for which data is collected on a monthly basis, analyzed, and reported on at least annually. As has been reported in every progress report since the baseline year of FY2016, the correlation between the services PHRM/ISS provides and the outcomes for pregnant and parenting teen participants continues to improve.

For example, data collected internally on program delivery and performance measures from FY2016-2018 reflects:

• Increased use of birth control methods in post-partum and parenting teens served;
• Increased use of LARCs in post-partum and parenting teens served;
• Decreased number of repeat pregnancy or births in parenting teens within one year of delivery;
• Increased father/male partner engagement in services provided to pregnant and parenting teens;
• Increased number of teens remaining in a school or educational program while pregnant and after delivery;
• Increased family engagement in services provided to pregnant and parenting teens;
• Increased referrals to resources addressing multiple social determinants of health (i.e., childcare, housing, school support, workforce support, mental health, etc.);
• Increased identification, referral to, and access to a medical home (maternity and pediatric).

 

MSDH's programming for expectant and parenting teens was recognized as an OAH Pregnancy Assistance Fund Program Successful Strategy via a publication it produced in September 2018. The data informing this publication was provided from FY2016 and FY2017 annual reporting and performance measure data. ( https://www.hhs.gov/ash/oah/grant-programs/pregnancy-assistance-fund/successful-strategies/mississippi-state-department-of-health/index.html)

 

May 2018 - MSDH case manager created the Baby/Parenting Station located in the Jones County Health Department.  The station is housed in a former clinic exam room of the Jones County Health Department. The case manager for the PHRM/ISS Expectant and Parenting Teen Program, had the idea in 2017 to develop an interactive area, where she and her partner case management staff, nurses and nutritionists, could interact one-on-one with expectant and parenting teens to teach and demonstrate important parenting skills, infant care routines, and bonding techniques. The station initially was housed in the case manager’s office and was assembled from items and equipment she had been given by other staff whose grandchildren were too old for or had outgrown. Seeing the advantage of hands-on instruction and the opportunity for expectant teens to practice skills before their babies arrives, the case manager advocated for the project to become a focus of the MSDH’s Pregnancy Assistance Fund (PAF) Grant work plan in FY2018.

 

The station houses several modules that teen participants are guided through, including safe sleep, bathing, car seat safety, diapering, feeding, developmental tasks and play, and life skills for young parents. Health education and teaching delivered through the modules is aligned with the Florida State University Partners for Healthy Baby curriculum and supported by additional medically accurate and evidence-based materials vetted by larger federal entities, including CDC, HRSA, HHS, and NICHD.  An incentives system was also developed for participants to earn materials that assist with basic physical, health, safety and other needs for themselves and their babies.

 

The case manager shared, “This station has allowed our teen participants to have hands-on experiences, that offer meaningful practice and support from staff before their infants are born that cannot be provided through a more traditional case management approach. We have been very successful in helping the participants enter parenthood, feeling prepared and confident in their emerging parenting skills. The station also allows teen parents and their infants to learn how to interact with one another through developmental tasks and play.”  During the current year, the program staff received additional funding to replicating this approach in six other areas of the state. 

 

Telehealth: The incorporation of technology and telehealth within the Perinatal High Risk Management/Infant Services System (PHRM/ISS) program is multi-faceted. The overarching goal in any portion of the PHRM/ISS program is to improve the quality of services provided and expand the reach.  The PHRM/ISS introduced the use of telehealth services for variety of components in the case management program, to overcome reduction of staff throughout the state, increase timeliness of assessments, and address transportation barriers within a rural state. 

 

One Telehealth module connects from one MSDH clinic to another MSDH clinic – not involving any patient’s personal devices or home interaction.  As of April 27, 2017, 67 staff members were trained, 100 cameras have been distributed state-wide. Patients benefit from this because they are able to have nutritional or psychosocial assessments completed while they are in the clinic for other services and provides access to a discipline which may not be housed in the clinic the day of their visit.    Technology services allow the case managers to connect with the three necessary disciplines (social worker, nurse, and nutritionist) for assessments, professional visits, and case conferencing regarding monthly activities and care plan development. 

 

The second telehealth module is a collaborative project between a private funder, the University of Mississippi Medical Center (UMMC) and MSDH PHRM/ISS program.  The partnership with UMMC Center for Telehealth provided the opportunity for the PHRM/ISS program to use the Health Harmony portal/services in order to accomplish this purpose via remote patient monitoring and mobile communications.  The blood pressure remote patient monitoring (RPM) has a goal of engaging patients in their own health care, provide access to nurses, and reduce admissions to emergency rooms. The use of the audio and video equipment via the tablet allowed for two-way, real time communication between the PHRM/ISS patient and the PHRM/ISS staff.  This visit was in no way to fully replace the home and/or clinic visits. This project was modeled after the UMMC RPM for chronic disease.  Peripherals send the data automatically via a secured internet connection to the PHRM/ISS RN at the Central Office to evaluate the blood pressure and weight remotely.  The PHRM/ISS nurse reviews the dashboard and will intervene or connect with another PHRM/ISS team member to follow up with the woman, as needed. Implementing this program will allow case managers to interact with maternity patients via remote technology, to engage them in follow-up, health education, and monitoring of their health status throughout the duration of their pregnancies and post-partum.

 

 

 

Other Programmatic Activities (Office of Tobacco Control)

We are collaborating with the MS Public Health Institute on their REACH grant (Racial and Ethnic Approaches to Community Health) that covers the three Mississippi Gulf Coast counties: Jackson, Harrison, and Hancock. This grant focuses on the following areas for African American women of childbearing age: enhance smoking cessation strategies, increase support for breastfeeding, and improve nutrition. Coastal Family Health Center is the regional FQHC in this area, and we have previously worked with them. Through the REACH grant collaboration, we added Coastal as a Baby & Me Tobacco Free site. Through REACH grant funds, Coastal hired a staff person to coordinate these efforts. As part of their scope, they promoted the Baby & Me Program to the Baby Cafes that have been established with the REACH grant to support breastfeeding mothers. My office also paid to run tobacco-free media in this region for part of the year, and the REACH grant will continue these efforts.

We have partnered with the Mississippi Public Health Institute and are utilizing a subject matter expert, Pamela Luckett, to engage the behavioral health community and healthcare systems around comprehensive tobacco cessation treatment service integration. These efforts aim to reduce smoking-related diseases and disabilities among persons with behavioral health and substance use disorders. This population uses much more tobacco than those in the general population not suffering from behavioral health and substance use disorders.  As the project’s senior behavioral health specialist, Luckett travels the state assessing policies and practices related to tobacco use and exposure at community mental health centers; identifying resources needed to facilitate changes in policy, practice, and cessation efforts; and providing technical assistance to help develop and implement policy changes aimed at creating smoke-free campuses. Luckett also provides information and tobacco dependency trainings to behavioral health and substance use disorder providers. “A major component of this project is education,” said Luckett. “We use evidence-based strategies to guarantee that staff and individuals receiving mental health center services are fully aware of the risks of tobacco use.” Luckett is dedicated to protecting those who suffer from mental health and substance abuse disorders from the dangers of tobacco use and secondhand smoke exposure. “The idea that quitting smoking can worsen symptoms of mental health disorders is a myth,” Luckett said. “With the right support, Mississippians who are using mental health facilities can quit, too. It’s essential that we ensure our mental health centers are informed and equipped to provide support and proper resources to help them make this change.” The work began with asking each substance abuse and behavioral health facility if they had a tobacco-free campus policy, if they wanted more information or training, and if their policy was being enforced. Once we received this information, we identified facilities we would work with. Because of Luckett’s background in working with substance use disorder patients and facilities, she was able to build relationships with staff and begin to dispel the myth that these patients could not successfully stop using tobacco products.  Since this work began in 2017, Luckett has provided training to seven of the facilities, and two of the facilities have gone tobacco-free. Through this work, we also have outreach materials specific to this population.

Success Stories (Office of Women’s Health)

The Central Region, Perinatal High Risk Management/Infant Services System (PHRM/ISS) program partnered with the University of Mississippi Medical Center to improve the care for high risk pregnant women in Humphreys County through the USDA DHCS Grant Program “Moving Our Delta’s Health Forward”.  According to the US Census, Humphreys county has a population of 8,257, 22.6% white, 75.6% black or African American, 31.7% do not have a high school degree and 38.4% live in poverty.  This collaborative provided education to the UMMC Belzoni Urgent Care Clinic staff regarding PHRM/ISS and how to make referrals.  Through the grant, the PHRM/ISS staff provide two educational baby shower events for 50 women in the community.  The women received a variety of education on: 1. Safe sleep environment, 2. How to safety proof their home regarding outlets, venetian blinds, stove safety, 3. Bathroom safety to prevent drownings, 4. Car seat safety including summer heat in a car with an infant, 5. Provided resources such as poison control number, 6. Nutritional support surrounding breastfeeding, not propping bottle, and 7. Positive coping mechanisms for new mothers.

The PHRM/ISS program entered a second year in a telehealth project collaborating with a private funder and the University of Mississippi Medical Center (UMMC) Center for Telehealth.  During the second year, the project has grown in staff, expanded to one additional county and added infant referrals.  The criteria for enrollment includes: Medicaid eligible, lives in pilot counties (Hinds, Madison, Rankin, and Yazoo), and has an ICD-10 risk factor.  In addition, the women are to be less than 18 weeks’ gestation and the infants are two months or less in age.  This module is comprised of two components.  The first includes monitoring a software dashboard for compliance with daily health education, requests for communication from the case manager, and blue toothed biometrics – blood pressures and weights.  The second includes the use of tablets for every other month case management services.  This year has show an increase of 53% patients enrolling in the UMMC Health Harmony telehealth project.   The project has added a process evaluation component.  Preliminary findings of the first report include: a total of 29 reports were reviewed, beginning November 2018 to March 31, 2019.  Of those, 14 (48.3%) were mothers and 15 (52.7%) were infants.  Of which 154 contacts were made; 69 (44.8%) were with mothers and 85 (55.2%) were with infants.  Approximately 454 different activities were reported as part of the 154 contacts. 

 Success Story (Office of Tobacco Control)

The Baby & Me Tobacco-Free pilot has been very successful. We are promoting these results, and through our partnership with the March of Dimes and the Community Health Center Association of MS, are engaging managed care organization to enlist their support and buy-in to sustain and grow these efforts.