Arkansas Title V Maternal and Child Health Services Block Grant

2023 Report and 2025 Application

 

III.E.2.c.  State Action Plan Narrative by Domain

Women and Maternal Health 2023 Annual Report

The Arkansas Department of Health (ADH) Women’s Health program provides direct healthcare, referral services, preconception, inter-conception counseling, and preventive screenings for women of reproductive age in all 75 counties in Arkansas. Each of Arkansas’s 75 counties has at least one local health unit (LHU) that provides clinical family planning and preventive health services. ADH also provides education, screening, and referral for smoking cessation to women of childbearing age to reduce smoking among pregnant women. LHUs serve the state’s most vulnerable and hard-to-reach populations, especially those in rural areas where access to medical care is limited. The ADH’s Women’s Health program support the provision of direct health care and referral services to address the perinatal, reproductive health, well woman, and other preventive service needs for women across the state. The ADH currently offers maternity services in 54 LHUs covering 50 counties including:

• Prenatal assessments, including risk assessments, history, physical, laboratory tests, gestational age, and fetal assessments.
• Management of abnormal prenatal findings.
• Case management.
• Prenatal counseling and education.
• Vitamins and mineral supplements.
• Post-partum services.
• Women, Infants and Children (WIC) program.

 

Service Area:  Statewide

 

Priority Need:  Well Woman Care

NPM WWV (formerly NPM 1):  By December 31, 2025, increase the percent of women, ages 18 through 44 with a preventive medical visit in the past year to 77%.

• 2023 Objective: 77.0/Indicator 73.9 Not Achieved

 

Performance Trends:

• 2020 Objective:  77/Indic. 76.2 Not Achieved
• 2021 Objective:  77/Indic. 73.1 Not Achieved
• 2022 Objective:  77/Indic. 75.5 Not Achieved
• 2023 Objective:  77/Indic. 73.9 Not Achieved

 

For Data Source Years 2018-2019, the Federally Available Data (FAD) indicated the percent of Well Woman Visit (WWV) was 74.8% in 2018 and 76.2% in 2019 for an average of 75.5% for the two-year period.

 

For Data Source Years 2020-2021, the FAD indicated the percent of WWV was 73.1% in 2020 and 75.5% in 2021 for an average of 74.3% for the two-year period.

 

For Data Source Year of 2022, the FAD indicated the percent of WWV was 73.9%, a significant decrease from 75.5% in year 2021.  

 

Strategies:

1. Continue to work with the ADH’s Hometown Health Coalition in each public health region to partner with local churches, schools, and civic organizations to provide community-based educational programs and activities.
2. Continue community-level grassroots outreach activities led by ADH women's health clinic nurses in the local health units, such as health fairs, engagement with local organizations and business partners, and women’s shelters.
3. Partner with the Arkansas Home Visiting Network to educate expectant and new mothers about the importance of annual preventive checkups.

 

Priority Need:  Oral Health

NPM PDV-Pregnancy (formerly NPM 13.1): By December 31, 2025, increase the percent of women who had preventive dental visit during pregnancy to 44%.

• 2023 Objective: 44/Indicator 41.3 Not Achieved

 

Strategies:

1. Work with the ADH Office of Oral Health to develop collaborations with obstetricians and gynecologists in the state to encourage women to continue their regular dental visits during their pregnancy through the Paint a Smile (PAS) program.
2. Distribute educational materials for pregnant women to maternal and dental healthcare providers through partnerships with ADH Office of Oral health.
3. Provide dental health education and counseling at initial or subsequent maternity visits to women attending ADH maternity clinics.

Strategies:

Family Planning and Well Woman patients at LHUs receive education and counseling on recommended preventive screenings to optimize health. Educational topics include sexually transmitted infection screening, Pap tests, mammogram referrals, hemoglobin testing, sickle cell screening, total cholesterol or cholesterol screening referrals, wet mount, pregnancy testing, and fecal occult blood testing. The client is also screened for immunization status, smoking, alcohol use, illicit drug use or abuse, human trafficking, and intimate partner violence.

 

Educate health care providers about the importance of oral health during pregnancy. The ADH Office of Oral Health (OOH) works with LHU nurses to provide oral screenings, risk assessments, fluoride varnish applications, oral health education to caregivers and assistance in locating a dental home if needed.

 

In November 2023, the ADH OOH collaborated with the Arkansas Oral Health Coalition to host the 2023 Oral Health Summit. The summit’s theme was “Mom’s Teeth Matter: Prioritizing Maternal Oral Health” and was sponsored by Delta Dental of Arkansas; Liberty Dental Plan; Arkansas Medical Dental & Pharmaceutical Association (MCNA Dental - Arkansas); and CareQuest Institute for Oral Health. The summit brought together dental and medical health care professionals to discuss the current recommendations for pregnant women to receive dental care. The meeting covered numerous maternal oral health topics including “Prioritizing Maternal Oral Health” (main speaker Dr. Kay Chandler, Arkansas Surgeon General and obstetrician/gynecologist), “Maternal & Infant Oral Health”, and “Dental Treatment in Pregnancy”. Other speakers included a pediatrician, family dentists, Medicaid, and Arkansas Center for Health Improvement’s (ACHI) Policy Director. The summit reached approximately 150 people.

 

In addition, the January/February 2024 edition of the Healthcare Journal of Little Rock featured an article from the ADH Director Dr. Jennifer Dillaha describing the current recommendations and best practices for oral health care during pregnancy. The estimated circulation for this publication is 10,000 people, primarily health care professionals.

 

Throughout the project period, ADH continued to maintain and strengthen partnerships and impact systems of care to address the health care needs of Arkansans. The development of partnerships with local community-based health and social service providers through local Hometown Health Coalition efforts has been helpful in establishing a community network of services. The ADH’s Well Woman services are available statewide. The program provides a resource for adult women and adolescents to obtain the recommended age and developmentally appropriate preventive services and referrals to improve the quality of the overall health of the individual.

 

Beginning in November 2018, the ADH launched Be Well Arkansas to provide Arkansans with resources to improve their health and well-being. With Be Well Arkansas, Tobacco Prevention and Cessation Program staff are operating a call center to connect callers to tobacco and nicotine cessation services and wellness counseling and services for diabetes and blood pressure control. These wellness services are accessible by calling 833-283-WELL phone number, or online at the Be Well Arkansas website. In addition, the number 1-800-QUIT-NOW for tobacco cessation, will route callers to the Be Well Call Center. The link to the Be Well Arkansas Website is: https://www.bewellarkansas.org

 

The ADH’s Women’s Health Section continues to work with the ADH’s Hometown Health Coalition in each region to partner with local churches, schools, and civic organizations to provide community-based educational programs and activities. Family planning promotional activities continue to be facilitated through:

1. Providing approved literature and resources at local health fairs, beauty salons, fast food restaurants and local colleges
2. Providing appropriate literacy-level materials to clients
3. Personal visits to health and medical clinics
4. Distribution of periodic electronic and print media articles.

During the reporting period of April 1, 2023 – March 31, 2024, a total of 1,871 external community outreach programs promotional activities were conducted with a total attendance of 88,058: 21,411 adult and 66,647 youth aged 19 and under.

 

Achievements:

Regional scheduling standards are used to maximize patient access and improve patient flow for a more efficient experience for all patients. To access patient satisfaction, ADH utilizes automated satisfaction surveys via email or text that are sent to patients after a visit is completed. Confidential patients are exempt from receiving automated surveys. The statewide 2023 report indicated overall client satisfaction with services provided at the LHUs. A total of five hundred eight (508) Family Planning clients responded to the survey. Four hundred sixty-four (464) of those respondents described their overall family planning visit as excellent or good. Four hundred eighty-four (484) respondents indicated they would use the health unit again for services.

 

Challenges/Barriers:

The agreement for the Count the Kicks campaign expired in October 2023. After discussions with the Family Health Medical Director, it was decided to extend the agreement with Healthy Birth Day, Inc. through 2024. Delta Dental of Arkansas and the ADH Office of Oral Health declined to participate in the Count the Kicks Campaign due to not a large enough impact versus the expense. The University of Arkansas for Medical Science (UAMS) opted not to renew the agreement with the ADH and Happy Birth Day, Inc. citing competing budget priorities. A new agreement was executed in February 2024.

 

Another challenge to the Women’s Health program has been finding ways to raise male awareness of how they can protect their own health and utilize family planning services. Of the 7,556 unduplicated clients aged 19 and under five (5) were males. The ADH Family Planning Title X program will utilize the Reproductive Health National Training Center (RHNTC) for assistance to improve the patient experience and increase access to family planning services for males.

 

Solutions:

Provide referrals to community resources for identified risk factors or medical procedures unavailable at the local health unit. In 2023, Family Planning and Well Woman programs referred patients for a total of 6,910 health-related services identified by the agency’s electronic health record not provided by ADH. The services include laboratory tests, radiology, mammography, colposcopy, social services, dental services, tobacco cessation, and referrals to other medical providers. The Family Planning program also made 3,221 referrals to the Special Supplemental Nutrition Program (SNAP) for the WIC program in 2023.

 

The postpartum period is an important time for maternal health and well-being. Untreated chronic conditions and pregnancy-related complications increase the risk of adverse health outcomes in the weeks and months following delivery. Data from Maternal Mortality Review Committees in 36 states suggest that more than half of pregnancy-related deaths occur from 7 to 365 days postpartum.

A comprehensive postpartum visit is an opportunity to improve maternal health by providing recommended clinical services, including screening, counseling, and management of health issues.

Screening for mental health conditions and contraceptive counseling are key components of postpartum care that are recommended by national quality standards and professional organizations. The American College of Obstetricians and Gynecologists (ACOG) recommends that all women have contact with their obstetrician-gynecologists or other obstetric providers within the first three weeks postpartum followed by a comprehensive postpartum visit within 12 weeks after birth.

Other Programmatic Activities:

Count the Kicks Campaign: The Count the Kicks Campaign is a stillbirth prevention public health campaign through Healthy Birth Day, Inc (HBD). HBD printed Count the Kicks educational materials with the ADH logo, including brochures, posters, and app reminder cards in English and Spanish for all maternal health professionals and birthing hospitals in Arkansas. Beginning in 2022 the ADH Women’s Health Section partnered with UAMS to launch Count the Kicks. In 2023, UAMS opted not to participate in Count the Kicks, citing budget concerns. The ADH Office of Oral Health declined to participate in the Count the Kicks campaign, citing campaign cost and limited impact. The ADH Women’s Health Section continued participation with HBD with the Count the Kicks campaign. For the period of October 1, 2022, through September 30, 2023, 99 medical and community professionals attended the initial Count the Kicks webinar and there were 5,406 website visits. There were 97 orders placed for a total of 29,085 pieces of Count the Kicks materials sent out. The app was downloaded 379 times. The agreement between Women’s Health and Healthy Birth Day, Inc. expired on September 30, 2023. A new agreement went into effect in February 2024.

Appointment Show Rate: In 2016, the ADH implemented an appointment reminder program for patients using the Vital Interaction software with Greenway PrimeSUITE patient data. The patient receives three reminders: a text reminder is sent five days prior to the appointment with a requested Y/N confirmation response, a voice call reminder is sent 72 hours prior to the appointment if the patient does not respond to the text and a text reminder is sent with no requested confirmation 24 hours prior to the appointment. The appointment show had notably increased from 65.6% during program implementation in March 2016. The show rate for March 2017 to February 2018 was 68.8%, an increase of 3.2 percentage points. From March 2018 to February 2019, the show rate was 69.7% an increase of 4.1 percentage points. From March 2019 to February 2020, the show rate was 69.8% an increase of 4.2. From March 2020 to February 2021, the show rate was 74.2%. From January 2022 to April 2023, the show rate was 79.6%. From April 2023 to April 2024 the well woman follow-up visit was 84.6% and the no-show rate was 15.4%. The follow-up with BreastCare was 81.3% and the no-show rate was 18.7%. The grand total was 81.8% for well woman visits, an increase of approximately 16% since implementation.

Nurse-Family Partnership: The Family Health Branch partners with Arkansas’s Nurse-Family Partnership (NFP) home visiting program to improve pregnancy outcomes by helping women be involved in good preventive health practices. The Nurse-Family Partnership Program gives first-time moms first-rate help, right from the start. This free, evidenced-based program partners first-time moms who meet low-income requirements with specially trained Registered Nurses. Through home-based visits, these nurses educate moms on prenatal and newborn care and teach them how to help their children develop emotionally, physically, and mentally. NFP helps moms prepare for birth and gives both mother and child the support to reach their goals. During home visits, NFP nurses answer questions about pregnancy, childbirth, and how to care for a newborn. Nurses help moms set personal and family goals, then link them with resources in the community so they can achieve them. Nurse-Family Partnership/Arkansas Home Visiting Network (https://www.arhomevisiting.org). See Perinatal and Infant Health 2023 Annual Narrative of the Application for additional information.

Promote Maternal Health: Arkansas Maternal Mortality Review Committee (AMMRC) works to quantify and understand pregnancy-associated deaths to create actionable and comprehensive recommendations to prevent future deaths. This is accomplished through epidemiological surveillance and multidisciplinary case review led by committee members. In late 2024, the maternal mortality internal workgroup will begin working with ADH Office of Communications to launch a media campaign to continue efforts to improve education about urgent maternal warning signs for pregnant and postpartum women and their families. The campaign will be promoted through major social media platforms and roadside billboards to reach the target population who are pregnant women, women who have given birth within the last year (postpartum), and their support network (including partners, family, and friends). The primary objectives are to raise awareness of urgent maternal warning signs during and after pregnancy, improve communication between patients and their healthcare providers, empower pregnant and postpartum women to speak up and raise concerns, and provide tools for pregnant and postpartum women and healthcare professionals to better engage in life-saving conversations.

 

SET-NET, the pioneering program in Arkansas dedicated to gathering vital data on the intersection of pregnancy and infectious diseases, notably COVID-19, has broadened its scope to tackle the alarming rise of syphilis and hepatitis C cases in pregnant individuals. Through meticulous research and analysis, SET-NET identified gaps in addressing congenital syphilis cases, prompting a proactive response. A pivotal move was the convening of a provider summit across central and northwest Arkansas, engaging approximately 130 healthcare providers and educators. This initiative not only raised awareness but also fostered collaboration to address the pressing challenges posed by syphilis in pregnancy.

 

Collaboration lies at the heart of SET-NET's strategy. By forging partnerships with diverse stakeholders, including substance use facilities and homeless shelters, SET-NET has initiated a multifaceted approach to combat the syphilis crisis in Arkansas. Recognizing the urgency of the situation, SET-NET collaborated closely with the infectious disease branch, leading to the development of a targeted syphilis outreach campaign. This comprehensive effort reflects SET-NET's commitment to leveraging resources and expertise to confront public health threats head-on.

 

Looking ahead, SET-NET remains steadfast in its mission to safeguard maternal and fetal health. In 2025, SET-NET will join forces with other Arkansas state partners to implement a congenital syphilis initiative, aiming to mitigate the impact of this preventable disease. Securing continued funding underscores SET-NET's dedication to sustaining and expanding its impactful work. By sharing insights and best practices with national stakeholders, including the Centers for Disease Control and Prevention (CDC), SET-NET continues to be a beacon of innovation and collaboration in the fight against infectious diseases in pregnancy.

 

Congenital Syphilis Testing, Prevention, and Treatment: Every region in Arkansas is seeing an increase in the number of syphilis cases, especially among women. From 2017 to 2022 there was a 159% increase (from 562 to 1,457) overall in early syphilis cases and a 277% increase (from 155 to 584) among women of reproductive ages (15 – 44 years). Syphilis among pregnant women is especially a concern due to the potential of congenital syphilis, which happens when a mother with syphilis passes the infection to her baby during pregnancy. Untreated syphilis during pregnancy can lead to stillbirth, preterm delivery, and other congenital abnormalities. Congenital syphilis is preventable by early detection of maternal infection and appropriate treatment prior to delivery. The State of Arkansas requires testing of all pregnant women at the first prenatal care visit and 3rd trimester (between 28 – 32 weeks gestation). Furthermore, testing at delivery is required if not done during the pregnancy.

 

Local health units across the state provide syphilis testing and treatment for free or at low-cost according to income verification. The definition of visit encounter is the total number of visits of maternity patients with syphilis. The patient encounter is the total number of pregnant women seen at local health units in the region. The following table lists the region name, visit type, visit count, and patient count for FY 2023 (7/1/2022 - 6/30/23).

 

 

Unintended Pregnancy: The ADH continues to partner with Arkansas Medicaid, Arkansas Foundation for Medical Care (AFMC), and the Department of Higher Education to implement strategies and distribute educational materials designed to address unintended pregnancies.

 

The MCH epidemiologist worked with an MCH/MPH student to update the Teen Pregnancy Data Deck, a compilation of data graphs, tables, and maps describing teen pregnancy, outcomes, and risk factors in the state. See the MCH Data Capacity portion of this grant application/annual report for more information.

 

High Risk Pregnancy Program: The ADH Women’s Health Section has a professional services contract with the UAMS Women and Infant Health Service Line (WISL) to facilitate the delivery of comprehensive and risk-appropriate maternity care to low-income women throughout Arkansas. It also supports the ADH in providing outpatient services to ADH high-risk maternity patients. In addition to telemedicine, the contract supports the provision of nursing services, laboratory services, physician services and the liaison/consultation services of a certified nurse midwife for the ADH’s Lay Midwife Program.

 

HPV Prevention: The HPV Summit was held in May 2023. The HPV Summit creates a platform for collaboration among medical and dental professionals to increase awareness about the benefits of the HPV (human papillomavirus) vaccine and cancer prevention as well as to increase acceptance of the vaccine. ADH partnered with the Arkansas Immunizations Action Coalition to provide education on efforts to improve Arkansans’ health through immunizations.

 

Long-Acting Reversible Contraceptives (LARC): LARC is an important service provided by ADH Family Planning Title X program. The Women/Maternal Health Domain work closely with the Title X staff to expand knowledge of, and access to, all forms of contraception, especially LARC services. In calendar year 2023, 3,821 LARC insertions including Nexplanon and Intrauterine Device (IUD) were performed.

 

Maternal Regionalization Site Visits: It is the goal of the Family Health Medical Director to begin making site visits to Arkansas’s birthing hospitals by the end of 2024. The objective is to invite members of a Maternal Mortality Committee from another state to teach members of the Arkansas Maternal Mortality Committee how to conduct site visits and develop the necessary processes.