As part of the Title V MCH Program, the Maternal and Infant Health Program (MIP) provides technical assistance, resources and support to private and public agencies serving women, ages 18 through 44. The MIP Coordinator works closely with these agencies as well as the Title V MCH Program Manager and MCAH Section Manager to improve the health outcomes of women of childbearing age. The Women/Maternal Health report demonstrates how collaboration between agencies, leadership and MIP is working to accomplish the state priority to improve the health of Nevada women. The population of women, ages 18 through 44 is demonstrated by Census tract in the map below.
The Title V MCH Program staff chose NPM 1 and NPM 14 to improve women and maternal health outcomes. Improving preconception and interconception health among women of childbearing age is a priority need in Nevada. Title V MCH partners with public and private stakeholders to enhance efforts to meet this priority by increasing the percent of women, ages 18 through 44, with a preventive medical visit in the past year (NPM 1). Reducing substance use in women of childbearing age is another ongoing priority in Nevada. Public and private stakeholders assist with these efforts to reduce the percent of women who smoke during pregnancy (NPM 14). All subawardees share information about the Nevada Tobacco Quitline as part of their scope of work. Program activities and successes related to these efforts are included in the body of the report.
Nevada Home Visiting Report
Title V MCH collaborates with the Maternal, Infant and Early Childhood Home Visiting (MIECHV) Program; co-funding activities for the Sunrise Children’s Foundation expanded Home Instruction for Parents of Preschool Youngsters (HIPPY) program in Pahrump and the Northeastern Nevada Early Head Start home visiting program. The design and delivery of the MIECHV-funded program is to provide comprehensive, coordinated health and social service fostering continuous access to care for women who are pregnant or who have young children. The Nevada Home Visiting (NHV) Program focuses on many of the MCH priorities, including improving preconception and interconception health, breastfeeding promotion, increasing developmental screenings, reducing teen pregnancy, reducing substance use during pregnancy, and increasing adequate insurance coverage for families.
HIPPY programs (serving families with children aged three, four, and five) help parents engage with their children in daily learning activities to help promote literacy and school readiness. The program fosters language development, problem solving, logical thinking, and perceptual skills in children. Parents as Teachers serves expectant mothers and families with children up to kindergarten entry providing child development education, health education, activities to build cognitive and motor skills in children, and parent-child interaction coaching. Both programs provide developmental and social development screening, birth spacing education, screening for insurance coverage, depression screening (both post-partum and general), screening for domestic violence, necessary needs (housing, food, clothing, and utilities), and substance misuse. Referrals are provided for any screening showing need. Referrals are followed up and assistance is given in making any appointments or any application follow through.
Agencies implementing home visiting programs for NHV pursue Continuous Quality Improvement (CQI) and conduct Plan Do Study Act (PDSA) cycles to test small changes to improve processes and outcomes. Significant improvements have been made to the Early Learning and Literacy benchmark through CQI. Benchmark data from MIECHV are shared with Title V MCH Epidemiologist and other staff.
NHV staff and all implementing agencies are participating in a core competency certification program including self-paced courses as follows: ASQ-3, Basics of Home Visiting, Building Engaging Relationships, Challenges: Substance Abuse, Domestic Violence, Infant Mental Health, Pregnancy, Supervising Home Visitors, Trauma for Home Visitors, Trauma for Supervisors. In addition to the self-paced courses, the certification also requires the following live webinars: Domestic Violence: Safety Planning, Exploring Values and Beliefs, Home Visiting Boundaries, Home Visiting Safety, Implementing Tools, Home Visiting Boundaries for Supervisors. Matching Resources, Partnering for Change, Motivational Interviewing, Reflective Supervision, Impact of Domestic Violence, Trauma in Communities, and Understanding Substance Abuse. Technical Assistance has been provided to agencies for data entry, CQI processes and family engagement.
All home visiting models provide information to encourage well child and adult well visits, immunizations on schedule, child development topics, and safe home information. In addition to these topics, agencies serving expectant mothers and infants all have a certified lactation educator to provide breastfeeding education and support. NHV has provided each of those agencies with commercial grade, loaner breast pumps to encourage longer breastfeeding as mothers return to work.
NHV provides bilingual materials and agencies serving populations with the need for bilingual home visitors have bilingual staff. Families are also provided with Spanish language books for children to keep and agencies maintain a resource library for check-out in Spanish and English. In addition, families are administered Spanish language screenings and learning materials. A total of 102 MIECHV families reported Spanish as their primary language in 2018.
- 483 households were served by the Nevada Home Visiting Program in FFY2018.
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620 children were served by the Nevada Home Visiting Program in FFY2018.
- Intimate Partner Violence Screening; Percent of primary caregivers enrolled in home visiting who are screened for intimate partner violence (IPV) using a validated tool increased from 72% in FFY2017 to 80.1% in FFY2018.
- Developmental Screening; Percent of children enrolled in home visiting with a timely screen for developmental delays using a validated parent-completed tool increased from 82% in FFY2017 to 84.2% in FFY2018.
- Breast feeding; Percent of infants (among mothers who enrolled in home visiting prenatally) who were breastfed any amount at 6 months of age rose from 32.7% in FFY2017 to 50% in FFY2018.
- Tobacco Cessation Referrals; Percent of primary caregivers enrolled in home visiting who reported using tobacco or cigarettes at enrollment and were referred to tobacco cessation counseling or services within 3 months of enrollment increased from 28.1% in FFY2017 to 69.4% in FFY2018.
The Nevada Statewide Maternal and Child Health (MCH) Coalition Report
The Nevada Statewide MCH Coalition is largely funded by the Title V MCH Block Grant and state MCH staff provide extensive technical assistance. The Nevada Statewide MCH Coalition had a presence at the American Academy of Pediatrics (AAP) conference, the Nevada Health Conference, oversaw the implementation of the Fall Symposium in Reno, hosted the Climb Out of the Darkness postpartum depression prevention event - the first one ever held in Southern Nevada - promoted Global Big Latch On breastfeeding events statewide with five locations and over a hundred Latch On’s. These events/activities demonstrated support for breastfeeding, pre-conception and inter-conception health, developmental screenings, anxiety and depression, safe sleep, marijuana use during pregnancy education, and other statewide resources. Social media outlets included Instagram and Facebook with a total of three hundred and fifty-one “likes;” increased awareness and support for the following programs; Sober Moms Healthy Babies, Nevada 211, the Medical Home Portal, Nevada Tobacco Quit-line, Go Before You Show, breastfeeding, safe sleep facts, drowning prevention and lead poisoning information. The MCH website saw continued growth in total visitors throughout the year, as well as Facebook and Instagram, see chart below:
Statewide Maternal and Child Health Coalition Social Media – 2018-2019
In February 2019, the NV Statewide MCH Coalition hosted a live webcast of the 2020 Mom Forum, “Birth: An Intersection Between Maternity and Mental Health – Cost, Quality, Choice and Outcomes,” at four locations across Nevada: Las Vegas, Reno, Elko, and Hawthorne. The ninety-three participants included nurses, therapists, and statewide community organizations. The coalition’s Perinatal Mood and Anxiety Disorders (PMAD) Program held twelve trainings across Nevada for lactation staff, social workers, nurses, and pediatric residents with over a hundred and sixty attendees. The PMAD Coordinator attended twelve online/in-person PMAD related trainings through Maternal Mental Health NOW, Nevada Suicide Prevention Coalition, Gold Lactation Conference and 2020Mom, conducted outreach to thirty organizations that included OBGYN offices, therapists, doulas, Health Districts, WIC offices and other local programs. Collaboration continues with HealthPlan of Nevada’s Behavioral Health Options in assisting PMAD families with available resources statewide in navigating care. The PMAD Coordinator attended the Postpartum Support International conference (700+ attendees).
Nevada MCH staff worked with statewide partnerships including the Southern Nevada Health District (SNHD), Washoe County Health District (WCHD), Carson City Health and Human Services (CCHHS), Safe Kids, Southern and Northern NV Breastfeeding Coalition, Immunize Nevada, University of Nevada, Las Vegas (UNLV), University of Nevada, Reno (UNR), Children’s Advocacy Alliance, Healthy Living Institute University Medical Center, Nevada 211, Nevada State Oral Health Program, Nevada Institute for Children’s Research and Policy, and other statewide resources to continue the goal of building the capacity of the MCH Coalition partners. This helped to promote statewide MCH messaging for improving the health of pregnant women, women of childbearing age, infants, children, children and youth with special health care needs (CYSHCN), and their families.
Both the northern and southern MCH coalitions included leadership changes this year. In the south, Kim Amato accepted the position of co-chair from Baby’s Bounty, a 501(c)(3) nonprofit organization supplying essential items and baby gear to disadvantaged families with an infant six months of age or younger. In the north, Lora Carlson and Megan Schwarzrock accepted as chair and co-chair. Lora is the Manager of Nursing-Labor and Delivery at Renown Hospital. Megan is a pediatric nurse and Health Coordinator for the University of Nevada, Reno, Early Head Start Program. The Early Head Start Program is a comprehensive program serving pregnant women in poverty and families with children aged three or younger. The services included are home visiting and center-based childcare. Nikki Raffail joined as secretary with experience in challenges faced by pregnant and parenting teens issues with the Planned Parenthood Mar Monte Teen Success Program serving first time mothers, ages 14-19 years old (y.o.), to help them complete their high school education, learn social emotional skills, parenting education, and reproductive health education including birth spacing to reduce repeat teen births.
The MCH Coalition Steering Committee is comprised of volunteer leadership members from both the Northern Nevada MCH Coalition and the Southern Nevada MCH Coalition and Title V MCH staff. Four (4) meetings are held each year to discuss proposed and current activities. New members to the Steering Committee include Dr. Aimee Nussbaum, Laura Oslund, and Dr. Antonina Capurro. Aimee Nussbaum was the Maternal Child Health Program Director for both the Utah and Nevada markets of March of Dimes. Laura Oslund is the Executive Director of the PACE Coalition. The PACE Coalition's mission is to strengthen the character and competencies of youth and families in Elko, Eureka and White Pine counties through the collaborative effort of members from every community sector to reduce substance abuse and to enhance proven protective factors that encourage youth to make healthy choices. Nevada MCH Title V Program funds the PACE Coalition community health worker (CHW) to further assist in these efforts for that region. Dr. Capurro is the Nevada State Dental Health Officer with the Nevada Oral Health Program in Las Vegas and UNLV School of Dental Medicine, visiting assistant professor. Erick Lopez, Research Analyst with the Nevada Institute for Children’s Research and Policy, was nominated by Tara Phebus to replace her position. The MCH Steering Committee voted unanimously.
In September 2019 the NV Statewide MCH Coalition hosted the annual MCH Symposium in Reno, Nevada, with 100 attendees and a focus on PMAD. Speakers discussed PMAD, substance use during pregnancy, birth trauma, perinatal grief and breastfeeding. Vendors who attended this event included Quest Counseling, Anthem Blue Cross Blue Shield, March of Dimes, and Title V MCH (provided information on Medical Home Portal, PRAMS, Text4Baby and the MCH needs assessment).
Title V MCH staff contributed content to the statewide MCH Coalition e-newsletter and encouraged membership growth, new partner linkages, and outreach to youth-serving agencies. Topics shared included CYSHCN-relevant information and trainings, child, medical, reproductive health, perinatal and infant resources, webinars, conferences, Project ECHO, teen health week, adolescent physical activity, adolescent-centered care, information briefs for parents, and materials to promote campaigns for suicide prevention, childhood obesity awareness, Sexual Assault Nurse Examiner regional training opportunities, and physical fitness and sports. Numerous Title V MCH funded partners participated in the MCH Coalitions; for example, Urban Lotus Project, serving high-risk youth in northern Nevada attended meetings to share the value of trauma-informed yoga no-cost courses to help young people cope with daily life stressors and the MCH-funded Washoe County FIMR uses the Northern Nevada MCH Coalition meeting to present recommendations as they function as the FIMR’s Community Action Team.
Women’s Health and Wellness Outcomes
Title V MCH staff will continue to participate in efforts to promote reproductive health, planning, and access. MCH staff work with Teen Pregnancy Prevention PREP and SRAE programs, and other key stakeholders to promote informed reproductive choices and education to support reproductive life planning. Association of State and Territorial Health Officials (ASTHO) Opioid Use Disorder, Maternal Outcomes, and Neonatal Abstinence Syndrome Initiative (OMNI) efforts and quality improvement of Infant Plan of Safe Care processes continued, as did efforts to create robust wrap around care and referrals for women who are pregnant and use substances. Efforts continue to try and get significant utilization of the Tobacco Quitline among pregnant women. PRAMS data to action exploration, pregnancy surveillance efforts, and programming based on surveillance resulted in initial PRAMS data use.
The MCAH Section application for Alliance for Maternal Innovation (AIM) state status was completed and MCH staff worked on Nevada Maternal Mortality Review Committee establishment pathways and data reporting working with the Office of Analytics to reduce preventable maternal mortality and severe maternal morbidity. Exploration of perinatal quality improvement efforts more broadly continued as a possible space to leverage efforts of substance use, LARC, and perinatal mortality review committees. Development of more robust maternal and perinatal data evaluation and applying for a CDC-MCH Assignee was completed and is pending in an effort to present timely key indicators of MCH health. Continuing to look for opportunities to expand NHV capacity to serve more families through additional funding streams and continued participation of MCH staff in early childhood support and systems building initiatives continue and focus on referral pathway supports and data integration.
Maternal-focused PSAs, websites, social media and print campaigns, and sponsoring conferences for information sharing and collaboration are ongoing. Staff training on equity, and programmatic efforts focused on disparity reduction are key areas of focus and include the IM CoIIN and current partnerships with the Office of Minority Health and Equity, The Center, the Nevada Governor’s Council for Developmental Disabilities, and the Nevada Coalition to End Sexual and Domestic Violence efforts to prevent sexual assault among women and CYSHCN with developmental disabilities.
Title V MCH provided funding for an Oral Health pilot which included focused education to pregnant women and children in rural Nevada and Clark County. Mobile dental services provided in partnership between SNHD and the University of Nevada, Las Vegas, Oral Health Program afforded the opportunity to promote the importance of dental care during pregnancy and the connection between oral health and perinatal outcomes.
Fifteen public health clinics were awarded Title V MCH funding to improve maternal and women’s health among females aged 18-44 years old (y.o.). These entities included SNHD, WCHD, and CCHHS local health authorities and 12 DPBH Community Health Services (CHS) public nursing clinics providing services in Nevada’s rural and frontier areas. Clinic assessments, education, reproductive education and resources were based on nationally accepted standards of practice. Clients were screened for alcohol, tobacco, recreational drug use, vaping, suicidal thoughts, and other risky behaviors utilizing a Screening, Brief Intervention, and Referral to Treatment (SBIRT) approach with the provision of education and referrals. General preventive health education such as weight and nutrition, exercise, and preconception counseling were incorporated in the comprehensive patient teaching model.
All clinicians were mandatory reporters and educated in the recognition of patients at risk for human trafficking, neglect, and abuse. Staff were additionally trained in the delivery of culturally competent care, including the provision of services to those in non-traditional relationships. Age-appropriate education and counseling were conducted along with referrals, as needed. Education provided to avoid sexually transmitted infections and communicable diseases and treatment protocols follow Centers for Disease Control and Prevention (CDC) guidelines.
Through 13,518 clinic visits, women of childbearing age (ages 18-44 y.o.) were educated on wellness and the value of yearly visits. Reporting criteria to MCH varied. For CCHHS, the 1,992 well-visits, education and or referrals were made to 1,057 people using alcohol, 386 people using substances, 39 affected by intimate partner violence, and 276 experiencing depression. CHS provided 1,506 well care visits, 1,122 nutrition and weight management counseling sessions, and 10 referrals were made for depression. CHS activities resulted in 996 identified sexually transmitted infections, 2,287 contraceptive visits (54 intrauterine and seven implantable devices), and administration of 636 immunizations during which Title V MCH funded education, resources, and referrals were provided.
Clinic staff distributed diverse women’s health-related materials. Topics covered the value of no-cost yearly checkups, reproductive health (including long-acting reversible contraception), sexually transmitted infections, healthy pregnancy outcomes, immunizations, depression, and intimate partner violence prevention. Resources provided by the MCH Program included information about Go Before You Show, Nevada Tobacco Quitline, SoberMomsHealthyBabies website, PRAMS, Text4Baby, Nevada 211, and the Medical Home Portal.
CCHHS reached 571 people at community events promoting the US Preventive Task Force Recommendations for women’s health annual checkups. Two Facebook posts promoting the importance of an annual well women exam reached 3,808 users.
CCHHS promoted annual well women exams at three employer sites reaching 95 individuals.
Partners Allied for Community Excellence (PACE) Coalition, an entity within the Nevada Statewide MCH Coalition, was awarded Title V MCH funding to employ a Community Health Worker (CHW) to participate in MCH activities in Elko County and nearby rural communities. The PACE Coalition ensures CHW collaborations with other community partners on key MCH objectives/priorities to improve health outcomes in women. Emphasis was placed on care coordination and increasing connections to resources and services for Latina and underserved populations. The CHW distributed information on topics such as child health, pregnancy, diabetes, intimate partner violence assistance, tobacco cessation, and suicide prevention. The CHW raised awareness of intimate partner violence through several public service announcements informing community members to participate in the Walk A Mile in Her Shoes event. PACE partnered with other agencies to host a Family Safety Night educating about vaping hazards, internet safety for children, and mental health awareness. The CHW taught seven (7) suicide prevention classes (Suicide Alertness for Everyone or safeTALK) and Mental Health First Aid (MHFA) empowering 118 new community members to avert suicide attempts. Case management assisted 37 women (through 91 encounters) with health insurance, interpretation services, setting up medical appointments, transportation support for health visits, and basic social supports. Spanish translation was a critical job duty since 57% of those served were Hispanic and many people needed access to care assistance.
Sober Moms Healthy Babies Annual Report
Title V MCH continued to work with the Substance Abuse Prevention and Treatment Agency (SAPTA) list of SAPTA-funded treatment providers to update the SoberMomsHealthyBabies.org website to prevent substance use in pregnant women, as well as provide information to women of childbearing age, providers, and concerned family and friends. The website provides the substance use help line number, Nevada 211, Crisis Call Center, the Nevada Tobacco Quitline, and other resources. The website specifies the treatment priority status for pregnant women at SAPTA-funded agencies and the importance of women identifying they are pregnant. SAPTA-funded treatment centers must not deny treatment to persons unable to pay. All treatment centers listed on the website are SAPTA-funded.
The website had 2,474 sessions and 2,051 users. New users represented 82.5% of the total number of users and 17.5% were returning visitors. A total of 4,492-page views occurred. Most of these sessions were accessed from Reno, Carson City, and Las Vegas, with Sparks and Elko rounding out the top five.
The public awareness campaign uses radio and television public service announcements in English and Spanish throughout the state to promote the www.SoberMomsHealthyBabies.org website, in addition to the distribution of window clings and referral cards. The collaboration ensures substance use in pregnancy materials and resources will reach the targeted audience. The media campaign had a total of 10,367 total spots aired (8,2864 radio advertisements and 1,503 television advertisements), promoting the SoberMomsHealthyBabies.org website and the importance of pregnant women receiving treatment and preventing substance use in women of childbearing age. All local health authorities and MCH subgrantees promoted the SoberMomsHealthyBabies.org website and shared Sober Moms Healthy Babies referral cards.
To raise awareness on the priority admission of pregnant women at state-funded treatment centers, Title V MCH continued to disseminate removable wall stickers promoting the SoberMomsHealthyBabies.org website. Title V MCH is in contact with state agencies and local health authorities who have agreed to help with distribution and promotion. Partnerships with the Department of Taxation, Division of Health Care Finance and Policy (DHCFP), SAPTA, local hospitals and providers, March of Dimes, faith based and MCH Coalitions, and other DPBH programs continue.
All local health authorities participated in sharing substance use in pregnancy resource distribution. CCHHS, with Title V MCH funds, endorsed pregnant and postpartum women being substance free through their clinic digital signage and social media. Facebook messages with information about the SoberMomsHealthyBabies website reached 4,082 families.
Title V staff participated in the Comprehensive Addiction and Recovery Act (CARA) and neonatal abstinence syndrome focused efforts and serve as a core team member on the ASTHO OMNI Nevada Team and on numerous subcommittees focused on reduction of substance use in pregnancy and building systems of referral for families with substance exposed infants. LARC and Community Reproductive Engagement Committee MCH staff involvement also dovetailed with substance use prevention efforts, as did engagement on possible Title V Families First efforts.
Marijuana Efforts Annual Report
The Nevada Title V MCH Program has continued to disseminate Spanish and English marijuana awareness materials to partners statewide. These materials were developed in the last funding year in response to Nevada’s legalization of medical and recreational marijuana, and informational resources on pregnancy, breastfeeding and marijuana were developed by the Title V MCH program. The Title V MCH Program developed public service announcements (PSAs) promoting awareness, in addition to posters displayed in all dispensaries related to use in pregnancy and injury prevention and marijuana for children. Efforts to reduce substance misuse in pregnancy and improve inter-conception care are funded by the Title V MCH program and include promoting the SoberMomsHealthyBabies.org website and associated media campaigns and focusing perinatal activities on reduction of neonatal abstinence syndrome (NAS). Title V MCH funded partners promote SoberMomsHealthyBabies.org through social media and print materials developed by Title V MCH, in addition to the Substance Use During Pregnancy Toolkit, marijuana use and pregnancy information and posters, and marijuana and childhood injury prevention warnings.
Title V MCH worked closely with the Department of Taxation, the entity responsible for overseeing recreational marijuana and licensing for dispensaries in Nevada. Title V MCH shares all marijuana resources and provides feedback on materials from the Department of Taxation. Title V MCH marijuana awareness posters and SoberMomsHealthyBabies.org referral cards and removable wall stickers are provided to all dispensaries; informational sheets are distributed widely through FIMR and local health authorities.
Tobacco Cessation Report
All Title V MCH funded programs promoted the Nevada Tobacco Quitline to pregnant women and women of childbearing age. WCHD, SNHD, CCHHS and CHS clinics provided smokers tobacco education and counseling. Referrals to the Nevada Tobacco Quitline were provided to 25 adolescents (ages 12-17 y.o) and 603 adults (ages 18-44 y.o.). CCHHS promoted the Nevada Tobacco Quitline each month on clinic digital signage, as well as conducted a Facebook campaign reaching 14,233 users.
CCHHS and CHS utilized the Brief Tobacco Intervention developed by the Agency for Healthcare Research and Quality (AHRQ) to address tobacco use with clients. The five-step intervention is designed to be repeated at each visit. The practitioner asks about tobacco use, advises and encourages cessation, assesses if the individual is willing to quit, and then assists smokers interested in quitting and arranges for a follow-up session (in person or telephone) to determine the quit attempt outcome. The intervention, conducted in less than three minutes, is an effective means to screen and refer to the Nevada Tobacco Quitline. March of Dimes Pregnancy and Smoking brochures were distributed statewide through MCH partners, and PRAMS support by the Title V MCH Program is generating information on tobacco and nicotine use in pregnancy and early postpartum to inform future outreach strategies.
The Tobacco Control Program Annual Report
The Chronic Disease Prevention and Health Promotion (CDPHP) Tobacco Control Program (TCP) disseminates Nevada Tobacco Quitline (NTQ) promotional material for pregnant and postpartum women who use tobacco via Nevada providers, Women, Infants, and Children (WIC) clinics, early childhood educators and Nevada Head Start sites. The NTQ continues to provide callers 13 years and older with up to five scheduled personalized, culturally competent, coaching sessions, unlimited inbound calls, web and text support, and Nicotine Replacement Therapies (NRTs) free of charge to callers ages 18 and older, upon availability. The Pregnancy/Postpartum (PPP) program offered mothers in Nevada a designated, trained coach throughout each session along with incentivized gift cards for each completed counseling call. According to guidelines of the PPP program, each pregnant caller was enrolled before giving birth to ensure eligibility for both programs. This allows the mother to focus on her health, as well as that of the baby, benefitting the dyad. Comprehensive printed educational materials on benefits of quitting smoking during pregnancy and harmful effects on babies was provided upon each enrollment process.
The NTQ enrolled 1,326 callers during the program period which included 9 pregnant women. The NTQ offers a free program specializing in helping pregnant mothers quit smoking. The tailored treatment plan meets their needs by providing intensive behavioral support, including an increased number of coaching calls compared to the general population. As an incentive, reward gift cards for $5 and $10 are given after scheduled and completed counseling calls. For pregnant and new mothers who have quit, additional postpartum support is available to prevent relapse. NTQ uses evidence-based treatment practices to help pregnant smokers quit and remain tobacco free. Although the call volume was limited, outreach was expanded to Community Health Workers, women’s health care providers, WIC clinics, and events in the community. MCH opportunities to heighten NTQ awareness are being implemented, including promotion by all Title V MCH funded partners and the Chronic Disease Coalition monthly newsletters.
Partnerships continued to expand with the NTQ as listed: Medicaid Managed Care Organizations (MCOs), Division of Welfare and Social Services, Maternal, Child and Adolescent Health (MCAH), local tribal health departments, University Medical Center, Nevada Health Centers, Carson Tahoe Hospital, Lyon County Medical Center, Northern Nevada Health Centers, Access to Healthcare Network, and mental health clinics. Established relationships with providers created an opportunity for a health system change through a NTQ e-Referral process specific to patients interested in cessation.
Nevada Health Conference Report
The 2018 theme of the Nevada Health Conference, October 15-16, 2018, “Paving the Path for a Healthy Nevada” highlighted the importance of collaboration with other healthcare disciplines, addressed the health disparities, barriers, and challenges across the lifespan through an array of healthcare-related fields. Title V MCH provided significant funding to the conference, sponsoring scholarships and travel, sponsoring materials, and serving on the conference planning committee. DPBH staff, including MCH staff, presented at the conference and the CYSHCN Director and MIP Coordinator organized the substance exposure in pregnancy session, facilitated the session, and identified presenters. On October 15, a keynote speaker, Dr. Nathan Boonstra, and concurrent workshops featuring local and national field experts presenting on a variety of Immunization; Maternal, Child, and Adolescent Health; and Chronic Disease Prevention and Health Promotion topics related to the conference theme. A Roundtable allowing attendees to interact with one another on health-related topics included a presentation from Julia Peek, MHA, CPM, Deputy Administrator, DPBH, focused on updates and priorities, ACEs data, and Nevada’s preventive health foci. On October 16, the conference offered four intensive general session tracks focusing on niche areas of interest including: Immunization Clinic Best Practices; Maternal, Child, and Adolescent Health; and Chronic Disease Prevention and Health Promotion; and Increasing HPV Vaccination in Nevada. Conference exhibits were available.
Testimonials from some of the 235 attendees included:
“This conference provided a lot of helpful information for my line of work. I really appreciated the Substance Exposed Infants session”
“Information on resources that are already out there for us to use as public health workers. Often things are developed but it is difficult to know what is out there and how to find it, so I found that very useful.”
Continuing education credits were issued through the University of Nevada, Reno, for multiple healthcare related fields including:
- Certified Health Education Specialists (CHES)
- Certified Public Health
- Nursing
- Pharmacists
- Physicians (plus 1 hour of ethics/addiction care)
- Social Work
Each year the Nevada Health Conference awards scholarships to individuals who wish to attend the conference but may not otherwise be able to attend due to cost. MCH funds scholarships via Immunize Nevada, in addition to the Nevada Public Health Training Center, and the Nevada DPBH.
- Total number of Applicants Awarded: 44
- Total number of Recipients (people who accepted and/or didn’t cancel): 40 (local scholarships: 25; traveling scholarships 15)
- No-show(s): 1
Reality Works Report
Title V MCH provided partners with Reality Works figures (substance exposed, abusive head trauma, and fetal alcohol spectrum disorder infant sized figures) including the Nevada Public Health Foundation (NPHF) for their Supporting Teens Achieving Real-Life Success (STARS) workshop aimed at improving life skills and supporting pregnant and parenting teens and providing tools for self-sufficiency. Reality Works figures provided by Title V MCH were used to help reinforce the importance of abstaining from substances and alcohol use while pregnant. Other focus areas of the classes include reducing a repeat teen pregnancy with information on birth control, birth spacing, and continuing education. The overall goal was to support the pregnant and parenting teens and give them tools to reach their highest level of self-sufficiency. Items provided by the Title V MCH program included an infant oral health kit with tooth paste and toothbrushes, baby bath thermometers, text4baby water bottles and lunch bags, and informational handouts on various topics such as safe sleep, marijuana, WIC, and developmental screenings.
Rape Prevention and Education Program
The Nevada Rape Prevention and Education (RPE) Program implements prevention strategies to prevent sexual violence by using the public health approach to prevent first-time perpetration and victimization, reduce modifiable risk factors, and enhance protective factors associated with sexual violence. RPE primarily focuses on adolescents; however, the program also reaches young adults to reduce multiple forms of sexual and intimate partner violence. The RPE Program Coordinator is co-funded through Title V MCH Block Grant to create a full-time position dedicated to supporting sexual assault and violence prevention. Federally approved strategies reflected the expansion of previous RPE Program work preventing sexual violence through approaches impacting agency professionals, advocates, coaches and athletes, college campuses, and Las Vegas casino and bar personnel.
RPE funded activities to support Active Bystander Intervention Training to increase participation in active bystander behavior through education and intervention techniques. The Rape Crisis Center (RCC) collaborated with the Las Vegas Metropolitan Police Department to educate staff from 48 Las Vegas bars and clubs on the signs of predatory behavior and the dangers of drugs and alcohol in the perpetration and victimization of sexual violence. RCC assisted casino and club management in creating policies to avert potentially dangerous situations for staff and patrons.
In collaboration with the University of Nevada, Las Vegas, Jean Nidetch Women’s Center, a CARE Peer Program 45-hour empowerment-based training curriculum was conducted with 292 students. The interactive modules focused on increasing awareness of community and societal factors leading to sexual violence and harassment, as well as increasing social norms which protect against violence. Following leadership preparation, new peer advocates delivered trainings on campus to the student body and self-identified campus groups. An Interpersonal Violence Collaborative Interest Group, consisting of administrative and educational faculty, convened quarterly for the purpose of building campus infrastructure to establish best practices and evidence-based strategies for policy reform in response to interpersonal violence and harassment on the campus.
Title V MCH funding supported Urban Lotus Project yoga and mindfulness instruction to help adolescents cope with stress for adolescents ages 12-17 y.o and also served young adults. Young adults were served at five (5) facilities with 165 yoga classes taught to 102 individuals comprised of pregnant and parenting young women, and young people undergoing substance use and mental health treatment. Most students attended multiple yoga classes resulting in 821 pupil exposures. The collaboration with ULP and MCH resulted in an Innovation Station product for AMCHP in hopes of replicating the success of this effort elsewhere.
Nevada Maternal Mortality Review Committee (MMRC)
Nevada MMRC statute are codified in Nevada Revised Statues Statutes (NRS) 442.751 through 442.774, inclusive, and the Committee is required to: (1) review incidents of maternal mortality and severe maternal morbidity (SMM) in Nevada; (2) disseminate findings and recommendations concerning maternal mortality and SMM to providers of health care, medical facilities, other interested persons and the public; (3) publish timely reports consisting of data relating to maternal mortality and SMM, descriptions of incidents reviewed by the Committee, and recommendations to reduce maternal mortality and SMM in Nevada. Nevada’s MMRC convened for their first meeting in February 2020. This committee will continue to meet at a minimum of twice a year to review all incidences of maternal mortality in Nevada and address health disparities related to maternal mortality and SMM in efforts to end preventable MM and SMM.
Title V MCH Program staff have worked with CDC for a number of years in efforts to bring a MMRC to Nevada and will be involved in supporting the MMRC related meeting travel and ancillary costs, and in considering possible opportunities for implementing MMRC recommendations in MCH programmatic efforts for prevention, increased awareness of the existence and recommendations of the MMRC among the public, clinicians, and policy makers, and supporting dissemination of required reports and data-driven MMRC recommendations (e.g., evidence-based practices, screenings, and patient and provider education). Reporting produced by the MMRC support staff will be included in the Title V MCH Block Grant reporting, and health equity in birth outcomes and maternal domain population health maximization will be key areas of topical intersect in priorities of the MMRC, MCAH Section, SSDI Program, and Title V MCH Program. Title V MCH staff will look for opportunities to create sustained funding for the MMRC as it was passed into law without dedicated funding. SSDI funds help to support MMRC case abstraction staff. Title V MCH staff have facilitated maternal mortality and severe maternal morbidity presentations to the Maternal and Child Health Advisory Board in concert with the Department of Health and Human Services Office of Analytics and the efforts of the Title V MCH-funded Biostatistician in the Office of Analytics.
In response to state priorities regarding maternal mortality and morbidity prevention, the Title V MCH Program, in conjunction with Nevada Rural Hospital Partners (NRHP), plans to fund Advanced Life Support in Obstetrics (ALSO) training for rural and frontier critical access hospital staff. ALSO is an evidence-based, interprofessional, and multidisciplinary training program that equips the entire maternity care team with skills to effectively manage obstetric emergencies. This comprehensive training encourages a standardized team-based approach amongst physicians, residents, nurse midwives, registered nurses and other members of the maternity care team to improve patient safety and positively impact maternal outcomes.
Summary
Highlights of maternal and women’s health efforts include robust substance use in pregnancy prevention efforts and internal and external stakeholder engagement, successful partnerships with NHV to improve dyad outcomes and reproductive health, strong relationships with local health authorities, support of statewide MCH Coalition networks, MMRC groundwork, funding statewide and local conferences for information sharing and workforce development, and support of novel trainings for sexual assault prevention with non-traditional partners in the bar and casino industries.
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