Women/Maternal Health

Annual Report - FY2023

 

The following section outlines strategies and activities implemented between 10/1/2022-9/30/2023 to meet the objectives and show improvement on the measures related to women’s and maternal health:

 

Activities in this domain were carried out by the following MSDH offices, bureaus, or programs during the reporting period:

• Breast and Cervical Cancer Program (BCCP)
• Family Planning/Comprehensive Reproductive Health (FP/CRH)
• Healthy Moms/Healthy Babies of Mississippi (HM/HB)
• Maternal and Infant Health Bureau (MIHB)
• Office of Oral Health (OOH)
• Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

 

PRIORITY: Improve Access to Care

 

NPMs, NOMs, SPM, and ESMs:

• Well-Woman Visit/NPM 1: Percent of women, ages 18 through 44, with a preventive medical visit in the past year
• SMM/NOM 2: Rate of severe maternal morbidity per 10,000 delivery hospitalizations
• MM/NOM 3: Maternal mortality rate per 100,000 live births
• LBW/NOM 4: Percent of low birth weight deliveries (<2,500 grams)
• PTB/NOM 5: Percent of preterm births (<37 weeks)
• ETB/NOM 6: Percent of early term births (37, 38 weeks)
• PNM/NOM 8: Perinatal mortality rate per 1,000 live births plus fetal deaths
• IM/NOM 9.1: Infant mortality rate per 1,000 live births
• IM-Neonatal/NOM 9.2: Neonatal mortality rate per 1,000 live births
• IM-Postneonatal/NOM 9.3: Post neonatal mortality rate per 1,000 live births
• IM-Preterm Related/NOM 9.4: Preterm-related mortality rate per 100,000 live births
• DP/NOM 10: Percent of women who drink alcohol in the last 3 months of pregnancy
• NAS/NOM 11: Rate of neonatal abstinence syndrome per 1,000 birth hospitalizations
• TB/NOM 23: Teen birth rate, ages 15 through 19, per 1,000 females
• PPD/NOM 24: Percent of women who experience postpartum depressive symptoms following a recent live birth
• WWV.5/ESM 1.5: Promote the use of the Mississippi Quitline and Baby and Me Tobacco Free to assist women in quitting smoking during pregnancy.

 

Objectives:

• By September 30, 2023, increase use of the family planning waiver by 5%
• By September 30, 2025, increase access and utilization of quality family planning services in 100% of MSDH county health departments
• By September 30, 2025, decrease the percent of women who report smoking during pregnancy by 1%

• By September 30, 2023, increase breast cancer screening rates by 10% among Hispanic, African American, American Indian, Asian, and other underserved, uninsured or underinsured women
• By September 30, 2023, increase cervical cancer screening rates by 10% among Hispanic, African American, American Indian, Asian, and other underserved, uninsured or underinsured women

 

New Strategy: Engage the support of external providers to increase access to care for pregnant women and new mothers.

 

Completed Activities:

During this project period, MCH programs engaged with multiple internal and external partners to increase access to care for pregnant women and new mothers. One of the partners with the Maternal and Infant Health Bureau (MIHB), Mom.me, conducted screenings for new mothers to assess their personal struggles with new motherhood, breastfeeding, mental health, domestic/interpersonal violence, and family/social support structures. Based on the results of the screenings, resources and referrals were given to new mothers who were impacted by any of the aforementioned issues.  During the reporting period, Mom.Me supported 75 women through wellness events, provided 15 referrals to medical providers, and enrolled 19 women in support groups. In addition, there were 33 women who participated in the Centering Pregnancy program. These types of programs bring together several women who are either pregnant and/or recently delivered to offer healthcare related services (e.g. mental health, physical health, etc.).

 

MIHB also partnered with the Mississippi Chapter of the National Council on Alcoholism and Drug Dependence (NCADD).  During the reporting period, NCADD screened 164 women who needed maternal and infant health resources. In addition, they hosted substance abuse and mental health workshops whereby 128 women attended. During the workshops, they distributed 28 pack n plays and 28 diapers/wipes bundles to low-income women who attended.

 

The Mississippi (MS) Breast and Cervical Cancer Program (BCCP) and the Office of Preventive Health, Heart Disease and Stroke Prevention Program (HDSPP) of the MSDH applied for and were awarded funding to offer the MS WISEWOMAN Program in 2023. The current funding cycle operates from September 30, 2023, through September 29, 2028. MSDH is accountable to the CDC for the appropriate use of these funds. The WISEWOMAN Program extends preventive health services to women already enrolled in the MS-BCCP, which include screenings and referrals for healthy behavior support services for cardiovascular disease, stroke risk, and diabetes. MSDH’s WISEWOMAN Program will be limited to only specific geographic areas of the state having the highest burden of cardiovascular disease and stroke-related mortality and stationed in already MS-BCCP contracted health systems, notably two FQHCs in the inaugural year. Plans to expand sites where WISEWOMAN will materialize is contingent upon funding, provider capacity, and data-driven decision making.

 

Under a partnership to seek funding which began in late 2022, MSDH was awarded a subgrant from Jackson State University (JSU) under the National Institute of Health's Centers of Excellence in Maternal Health program. This initiative targets reducing maternal morbidity and mortality in the Mississippi Delta region. The MSDH program, known as Time4Mom (T4M), has received a commitment for funding for the period August 1, 2023, to July 31, 2030, contingent upon funding from NIH. T4M focuses on enhancing maternal health outcomes by facilitating postpartum home visits provided by nurses and community heath workers, linking women with local health resources, referrals for mental health and lactation support, and providing educational support on postpartum health.

 

Though not funded until late in this reporting period, MSDH was awarded a 5-year grant from HRSA to develop an Enhanced Healthy Start program in Northeast Mississippi. This program aims to improve health outcomes before, during, and after pregnancy and reduce racial/ethnic differences in rates of infant death and adverse perinatal outcomes in NE Mississippi. The MSDH’s Healthy Start Program has two major focal areas: 1) providing direct and enabling services (e.g., screening and referrals, case management, care coordination, health and parenting education, and linkage to clinical care) to enrolled HSE participants; and 2) developing/convening Community Consortia to advise and inform healthy start activities, as well as to develop and implement action plans to improve perinatal outcomes within Northeast Mississippi. The period of funding is for 5 years (September 2023 – September 2028).

 

Starting in June 2023, various programs throughout Health Services partnered with the Mississippi Attorney General’s Office to carry out the legislative mandate under SB2781SG. This legislation charged the MS AGO to work with other state agencies, and private and faith-based partners, to create a one-stop-shop e-resource center for pregnant women and new mothers. Specifically, the legislation charged that the Mississippi Access to Maternal Assistance (MAMA) program website had to be active by October 1, 2023 and the MAMA mobile app by January 1, 2024. This partnership between MSDH and the MS AGO is overseen by the Office of Women’s Health Director. To view the MAMA website, visit: www.ago.state.ms.us/mama”

 

Strategy: Expand the use of One Key Question to promote pregnancy intent screening and targeted preconception and family planning counseling.

 

Completed Activities:

This exact strategy was not implemented by the HM/HB program due to competing priorities and trainings for staff.  However, as a standard of care, HM/HB staff discusses family planning through the Initial Comprehensive Assessment, closer to pregnant woman’s delivery, at postpartum visit, and at enrolment of infant.  Future trainings on family planning are forthcoming.

 

During the reporting period, nurses and clinicians who provide services to family planning (FP) clients, used the One Key Question (“Would you like to become pregnant in the next year?”) to understand client’s pregnancy intentions. This question is part of several included in the sexual history screening form in the Epic system used by the clinical staff to assess and document client’s information. A total number of 28,072 clients responded to this question during this period. The responses were categorized as follows; 25,192 clients did not want to become pregnant; 1,605 clients wanted to become pregnant, 913 clients were okay either way and 362 clients were unsure.

 

Nurses and clinicians counselled and educated clients based on their responses to the one key question. Client who did not want to become pregnant received counselling and education on birth control method including information and guidance on various contraceptive options, and safe sexual practices including education on how to prevent sexual transmitted infectious (STIs), HIV, and maintain sexual health. Clients who wanted to become pregnant, were provided counselling and education on preconception health, including the importance of smoking cessation for maternal and fetal health, risks associated with alcohol and drug use during pregnancy and the importance of abstaining, daily intake of folic acid and prenatal vitamins to prevent birth defects, management of pre-existing medical conditions to ensure they are under control before conception, and guidance on maintaining a balanced diet and a healthy weight to support pregnancy. Clients who were okay either way or unsure received comprehensive counselling and education covering both preconception health and contraceptives methods to allow clients to make informed decisions based on their changing preferences or circumstances, and on safe sexual practices to prevent STI and maintain overall sexual health.

 

Since early 2023, the OWH Director has provided the ongoing logistical support and facilitation of the Family Planning Transition Workgroup. This Workgroup is comprised of individuals representing various departments of the agency, including FP/CRH Program, Field Services, Clinical Operations, Legal, Internal Audit, Pharmacy, Revenue Cycle, Finance and Accounting, Health Data and Research, Communications, Clinical Technology Intergration, MCH Block Grant Leadership, and Senior Leadership. The primary task of the Workgroup has been to plan the transition of FP/CRH from being fully supported and funded by Title X to having no Title X funding and only relying on FP Waiver earnings and other revenue to sustain services. A major transition activity has been planning for a Special Rate Program, which would allow clients without insurance or who did not want to use their insurance to pay a reduced rate for FP services available through MSDH. The Special Rate Program is expected to launch in July 2024.

 

Strategy: Empower low-income users to make informed decisions about family planning and preventive health services.

 

Completed Activities:

The MSDH Family Planning Program continued to provide services to ensure access to affordable reproductive healthcare and a broad range of contraceptive supplies to women, men, adolescents, and teens throughout Mississippi. The program continued to provide Mississippi residents with access to information as a tool for making informed decisions that will produce a healthier lifestyle.  MSDH website continued to promote and provide education on family planning services to the number of clients who visit the site. The program collaborated with office of Medicaid to produce FPW fact sheet, adding MSDH logo, translate in other languages (Spanish and Vietnamese) and put on MSDH Family Planning web page. In the period of 4/1/2022 – 3/31/2023 family planning main page viewed times 6,110 from 3,954 users and family planning waivers viewed times 1,777 from 1,340 users. Family Planning (FP) staff continued to work with other Health Services program coordinators who organize community outreaches and health fairs to educate and distribute education materials to clients. In the period of 10/1/2022 – 9/30/2023 office of family planning mailed a total of 35,100 FP educational materials/brochures (English, Spanish, and Vietnamese) to MSDH districts and local health departments to distribute to the communities for education.

 

The Title X Family Planning Program continued to provide family planning services to all Title X clients and work on improving the overall management of and administration of the Family Planning Program under the No Cost Extension (NCE) funds until March 31, 2023. Following the end of NCE, MSDH continued to explore opportunities to partner with Converge, the current Mississippi Title X grantee to provide services and support patients who need enhanced services offered under Title X. Clients without health coverage, social security and minors (under 18 years old) who cannot let their parents/guardian sign consent for minors to receive family planning services except for pregnancy testing and STI services were referred to Title X clinics. County health departments continued to educate clients about changes including cost for family planning services and navigating them to pay source including Family Planning Waiver (FPW), Breast and Cervical Cancer Program BCCP) etc. County health departments continued to educate and encourage client’s men and women who do not have private plan or full benefit Medicaid coverage to apply for FPW to receive family planning and preventive health services through utilization of FPW.

 

In June 2022, MSDH started a project called “Operation Going Gold” which aimed at increasing access to and utilization of FPW among MSDH clients and continue to allow and promote the provision of family planning and some preventive health services to FPW clients state-wide. MSDH staff were trained to screen clients for FPW eligibility, educate clients on the benefits offered by FPW. Staff provided education, encouragement and one-on-one assistance to clients, men and women who do not have private plan or full benefit Medicaid coverage in completing FPW applications. Follow-up were made by sending reminders via calls, letters etc. to ensure patients are enrolled in the FPW and continue to utilize FPW to receive free family planning and preventive health services.   In the period of 10/1/2022 – 9/30/2023, a total number of 6,902 FPW application were submitted to the division of Medicaid where 28% (1,936) of submitted applications were approved

 

During this reporting period, family planning services were provided to approximately 16,926 clients male and female. A total of 4,420 clients received FP services from county health departments under the Family Planning Waiver (FPW), representing an increase of 21% (771 clients) from the previous program year.

 

County health departments continued to provide family planning and preventive health services including provision of contraceptives, pregnancy testing, annual medical exams, pap smear, clinical breast exam, and STI/HIV testing and treatment. Specialized services were performed by Obstetrics and Gynecology Consultant Dr. Prater for 44 clients at county health departments in North Mississippi (Grenada) and South Mississippi (Hattiesburg), including cervical abnormality treatment including Loop Electrical Excision Procedures (LEEPs), colposcopies with and without cervical biopsy, and cryosurgery. In addition, Dr. Prater proctored Nurse Practitioners in colposcopy procedures and trained them on IUD insertion and removal.

 

The FP/CRH program further collaborated with MSDH Pharmacy to ensure that an efficient inventory of a broad range of contraceptive options was available to all MSDH clinic sites. Regular meeting occurred with pharmacy staff related to contraceptive use and spending.

 

MSDH continued to make efforts in expanding access to family planning services, particularly in areas that are more likely to experience health disparities through telehealth visits. The agency continued to collaborate with UMMC to increase telehealth services, and with MSDH Information Technology and Health Informatics to improve telehealth infrastructure and broadband. The agency’s goal was to have all health department clinics utilize telehealth services by March 2024. The program collaborated with MSDH Pharmacy to ensure that an efficient inventory of a broad range of contraceptive options was available to all MSDH clinic sites. Regular meeting occurred with pharmacy staff related to contraceptive use and spending.

 

The FP/CRH program worked with consultants to review and update consent forms for colposcopies, Cryosurgery and LEEP, and procedures for following up on Pap Smear and Quick Start Algorithm as well as pap smear follow up guidance, quick start algorithm, FP trichomonas protocol, and a Telehealth Clinical pathway for MSDH.

 

The Family Planning central office and regional office MCH/FP coordinators continued to collaborate by holding thirty-minute weekly zoom meeting to discuss and review program challenges and policy/procedural updates regarding quality improvement and service provision. MSDH continued to provide staff training to ensure the provision of quality patient care. Three Nurse Practitioners (NP) completed Comprehensive Colposcopy Courses organized by American Society for Colposcopy and Cervical Pathology (ASCCP) during this period. Two nurse practitioners completed the courses online from January to March 2023, and one attended the in-person courses in Tampa Florida in March 2023. These NPs continue with their colposcopy practicum until signed off by the Women’s Health OB Consultant for independent practice. Program staff continued to provide technical assistance to ensure clinic staff receive appropriate program updates. Orientation for new clinic staff was managed at the district/regional clinic level.

 

Other MCH programs serving families also provide information about family planning and preventive health services. For example, the HM/HB staff discusses family planning through the Initial Comprehensive Assessment, closer to pregnant woman’s delivery, at postpartum visit, and at enrolment of infant.

 

To further support reproductive health services provided through the MSDH clinics, the MS-BCCP program initiated a Self-Breast Exam/Diagnostic Screening Push Card through the MSDH Office of Communications to be utilized as a teaching tool for women related to breast cancer screening and early detection. In September 2023, the Outreach Coordinator prepared a work request for a social media campaign to run through October 2023, which promoted breast cancer screening and early detection.

 

MS-BCCP Program Director/Program Compliance Monitor met virtually with (3) in attendance on August 2, 2023, with Magnolia Medical Foundation who support Latina/Hispanic women.

 

Lebanon Baptist Church District had six churches to participate in "PINK SUNDAY" the fourth Sunday in October 2022. Mt. Calvary had 30 people in attendance and the topic discussed was the importance of getting screened for breast cancer early and of the importance of screenings. Antioch had 70 people in attendance and the topic discussed was getting annual physicals, women, and men, for early detection of breast cancer. St. James had 25 people in attendance and the topic discussed was who's at risk for breast cancer and the resources available through MS-BCCP with the MSDH. Asia had 17 people in attendance and the topic discussed was the importance of early detection. Greater Nazareth had 30 people in attendance and the topic discussed was living as a breast cancer survival and the duties of a caretaker in the beginning and the outcome. The City of Tchula sponsored a Mayor's Health Council Fair and provided breast cancer screening information for 80 people in attendance.

 

The following activities were held for Breast Cancer Awareness Month, October 2022 and produced the following results:

• Collaborated with MSDH Communications Office on Facebook/Instagram/Twitter campaign specific to MS-BCCP content for Breast Cancer Awareness Month - Twitter: Reached 14,917 users and produced 11 website visits. Facebook/Instagram: Reached 110,373 users and produced 41 website visits.
• Pink Ribbon Honor/Memory Wall – 200+ ribbons were posted.
• Thursday All MSDH Men Wear Pink – 35 participants and the First Lady of Mississippi participated in a promotion and photo opportunity at MSDH.
• Pink Walk Around the Stadium – 100 participants.
• Screening & Early Detection Virtual Lunch & Learn – 41 participants.
• BCCP Breast Cancer Awareness Trivia - 556 quizzes completed by MSDH workforce.

 

With the support of the Office of Communications, a cervical cancer screening awareness social media campaign was carried out in January 2023. Promotional materials were provided to Boat People S.O.S. in February 2023 to support targeted outreach of Vietnamese American women in three Coastal Plains counties. In addition, the Outreach Coordinator and Nurse Consultants provided virtual training to Free Clinic/Primary Care Women’s Clinic with four people in attendance and an in-person meeting with the Governance Council with 11 in attendance. These efforts presented the MS-BCCP to community leaders to assist in the identification of any women in need of services and to outline the screening/enrollment process. Further, a virtual meeting was held with El Pueblo with five in attendance to discuss language barriers/disparities being noted with some Hispanic women enrolling in MS-BCCP through other MS-BCCP providers that they were referred to. A UMMC See, Test, and Treat event was held March 23, 2023. At this event, three of the 13-women screened and referred to MS-BCCP for further testing were enrolled in MS-BCCP.

 

One-time “rapid patient navigation” MS-BCCP subgrants were awarded to two already contracted health systems to temporarily support workforce capacity. This CDC funding supported the health systems in hiring or redirecting staff temporarily to catch up on any backlog of MS-BCCP-patient related work (i.e., patient re-enrollment, patient recalls for annual appointments, patient reminders, patient navigation from screening to diagnostic resolution, submission of required reporting to MS-BCCP, etc.) to assure women who were already due or needing screening in FY2020, FY2021, or FY2022, but did not receive it, were navigated back to care by close of FY2023. Staff positions that were supported with this funding included clerical/administrative, nurses, and clinicians who directly engaged in the practice of patient navigation related to MS-BCCP.

 

Delta Health Center was provided a subgrant and a list of 107 patients to outreach. Among them, 57 patients had obtained some type of insurance between their prior enrollment and the date of contact in CY2023, 27 patients were not able to be reached, 6 patients were determined to not need contact, 4 made appointments to re-enroll but did not show, and 8 were re-enrolled in BCCP by the close of FY2023. Family Health Care Clinic was also provided a subgrant and a list of 300 patients to outreach and did so via calls, letters, and text messaging. Among them, 132 patients were found to have completed a pap during the prior enrollment cycle, but the results had not been returned to BCCP. Those results were submitted to BCCP for entry and cycle closure, 64 patients were found to have had orders placed for screening mammograms during the prior cycle, but no appointments had been arranged. Patient navigators focused on returning those women to screening.

 

The need for a change in navigation processes was observed and a new procedure was established which required the screening mammogram appointment to be scheduled while the patient was in clinic on the day it was ordered. Delayed outreach to assist with appointment scheduling was shown to be successful only about 40% of the time. With the change to scheduling on the same day while the patient was in the clinic, appointment scheduling improved significantly, up to 98%, making it easier to navigate and track the patients. In addition, the number of mammogram referrals doubled. 44 women were re-enrolled in BCCP prior to the close of FY2023.

 

FHCC also conducted 15 outreach events where BCCP educational materials were distributed to 438 participants. The BCCP Champion as FHCC reported the following regarding quality improvement changes related to the project: “In identifying what occurred with the 300 patients with incomplete documentation, strengths and weaknesses in the process were identified. As changes were made in the process, reports were generated on a daily basis to show the staff during the morning huddles progress being made and corrections needed to be made. During the process, there were adjustments to the process. A strength was in the electronic health record that efficiently tracked orders and referrals. One of the weaknesses was standardizing the reason for the referrals. There were multiple ways routine mammogram was being described. An achievement was developing a method of identifying all of the mammograms and collating it to the mammogram orders. Tracking pap tests was simpler and easier because we performed the test on site. We could see that we needed to improve tracking of the referrals to the BCCP and tracking of the results from the referral to facility. We developed screen shot modules for making referrals and documenting the results while standardizing the verbiage.” From this project, of approx. 400 women were identified as “incomplete cycle” in a prior year during the height of the COVID-19 pandemic, most were successfully contacted by patient navigation support staff funded under the rapid navigation subgrants. Fifty-two (52) or 13% were re-enrolled in MS-BCCP to complete screening and navigation activities that had been derailed. Largely, this innovative project was a success. These two health systems were able to self-assess to determine what happened to the women, as well as what processes within their own structures needed improvement.

 

A review of Facebook social media posts during the reporting period showed that there were no posts exclusive to family planning. While some of the other MCH programs had some or frequent content posted to social media, there was a notable underutilization of the resources (i.e., Facebook, Twitter, Instagram) to promote messaging related to family planning decision making or services. It is important to note, however, that in a 5-month period (April 1, 2023, to August 30, 2023) there were nearly 1,500 visits to the Family Planning landing page of the MSDH website, generally ranking among the top 5 pages visited concerning women’s or child health issues. This suggests that there is a consumer-driven demand for information. A greater focus on utilizing the agency’s social media presence to promote family planning services will be prioritized for the next reporting period. Data for months prior to April 2023 was available; however, the methodology for calculations was different and meaningful comparisons between time periods could not be made.

 

Strategy: Partner with the Office of Tobacco Control and other state and community agencies to promote awareness of risks of nicotine use in all forms (e.g., cigarettes, cigars, e-cigarettes, vaping) during pregnancy, and promote resources for quitting.

 

Completed Activities:

HM/HB leadership made several attempts to connect with Federally Qualified Health Centers and the Tobacco Free Baby and Me National program, but the program was in transition at the time from providing in-person services to virtual services. Future trainings and collaboration with the MSDH Office of Tobacco Control concerning the Tobacco Free Baby and Me program are forthcoming. Training was provided after October 2023 and will be detailed in subsequent reports.

 

In the meantime, HM/HB staff continue to assess patients/caregivers’ tobacco use using the Initial Comprehensive Assessment as well as a tobacco use screening tool in EPIC. All HM/HB patients/caregivers are asked 9 questions at initial enrolment regarding Tobacco/Nicotine. When a patient screens positive for use, add to POC, refer to the OTC Quitline and Baby and Me Program, Moving forward, the HM/HB will implement processes to collect data on the number of referrals made to the resources for future reporting.

 

County health departments continued to offer pregnancy testing services to family planning clients and document these services in Epic. As part of the client assessment, those tested for pregnancy were also inquired about their use of tobacco or other substances. All clients who received positive pregnancy test results, were given education and counselling on the risks of smoking during pregnancy including potential complications like preterm birth, low birth weight, and developmental issues for the baby. Additionally, clients were provided with resources, including the Tobacco Quitline number and educational materials such as brochures and pamphlets to aid in quitting smoking. A total of 2,294 clients received positive pregnancy test during this reporting period. 

 

Strategy: Implement worksite wellness programs aimed to increase breast and cervical cancer screening.

 

Completed Activities:

Under CDC’s most recent funding period for NBCCEDP grantees, BCCP programs are no longer required to implement worksite wellness activities effective 7/1/2022. Therefore, no worksite wellness programs or activities were implemented by BCCP. The focus instead was to engage community-based partners to support increased breast and cervical cancer screening uptake among high priority populations.

 

Strategy: Engage the support of external providers to increase screening among high priority populations.

 

Completed Activities:

During the reporting period, MS-BCCP partnered with nine subgrantees, six health systems and three community-based partners selected from a competitive RFP process to execute specific activities for recruitment, referral, enrollment, increasing screening, and providing patient navigation to address SDOH’s of participants that reduce barriers to screening. These subgrantees included: Delta Health Center, El Pueblo, Family Health Care Clinic, Jackson Free Clinic, Jackson-Hinds Comprehensive Health Center, Mary Bird Perkins Cancer Center, North Sunflower Diagnostic Center, Southeast MS Rural health Initiative and Test Taking Solution.

 

Most of these subgrantees have completed their period of performance, which ran from January1, 2023 to December 31, 2023. Some, however, have had their project periods extended either 90 or 180 days to allow for completion of their activities. Collectively, among the 7 subgrantees with the ability to enroll participants directly (Delta Health Center, Family Health Care Clinic, Jackson Free Clinic, Jackson-Hinds Comprehensive Health Center, Mary Bird Perkins Cancer Center, North Sunflower Diagnostic Center and Southeast MS Rural Health Initiative), 1,296 participants were enrolled from January 1, 2023, to December 31, 2023. Further, among program enrollees, twenty-seven (27) were referred to a non-subgrantee enrolling provider by a community-based subgrantee partner (i.e., El Pueblo, Test-Taking Solutions). All subgrantees were provided orientation, quarterly progress reviews, and tailored TA throughout their periods of performance to assure they were leveraging their subgrant funding according to the prime grant expectations. TA included budget and work plan preparation assistance, resolving barriers to progress, data tracking and reporting, and announcements of other funding opportunities as available.

 

A new RFP to invite proposals among already contracted providers and new community partners to increase screening and provide patient navigation is in process and expected to be posted publicly by January 31, 2024, with the performance period of July1, 2024 thru June 30, 2025. Under its expanded authority granted in the NOA, MS-BCCP will use unobligated funding from PY1 and PY2 to support these activities aimed at increasing participation among target groups and screening activities.

 

Preliminary data for MS-BCCP's Program Year (PY) 1 (June 30, 2022 to June 29, 2023) indicates:

• 3,503 participants enrolled, 96% of projected end date total (n=3,651)
• 3,696 participants served or 95% of projected end date total (n= 3,908)
• 1,777 Black/African American, non-Hispanic women enrolled, 97% of projected end date total (n= 1,837)
• 1,891 Black/African American, non-Hispanic women served, 95% of projected end date total (n=1,985)
• 637 Hispanic, all races women enrolled, 115% of projected end date total (n= 555)
• 664 Hispanic, all races women served, 126% of projected end date total (n= 526)
• 19 Asian, non-Hispanic women enrolled, 66% of projected end date total (n=29)
• 21 Asian, non-Hispanic women served, 75% of projected end date total (n= 28)

 

PRIORITY: Reduce Maternal Morbidity and Mortality

 

NPMs, NOMs, SPM, and ESMs:

• SPM 10: Percent of severe maternal morbidity events related to hypertension
• SPM 16: Nulliparous, term singleton, vertex (NTSV) cesarean rate

 

Objectives:

• By September 30, 2023, reduce the primary cesarean deliveries among low-risk mothers (NTSV) rate by 10% among participating hospitals
• By September 30, 2023, hold 4 multidisciplinary maternal mortality case review committee meetings.
• By September 30, 2023, review, synthesize, and disseminate recommendations for maternal mortality prevention
• By September 30, 2023, reduce the percent of severe maternal mortality events related to hypertension by 5%

 

Strategy: Provide evidenced-based education, training, and/or technical assistance to internal and external partners to decrease risk factors for adverse outcomes, morbidity and mortality

 

Completed Activities:

This strategy was written in mid-year 2022 and submitted under the MCH Block Grant State Action Plan as a strategy to be accomplished between October 1, 2022, to September 30, 2023. However, the oversight of the Mississippi Perinatal Quality Collaborative (MSPQC) transitioned to being housed and administered by the MS Public Health Institute (MSPHI) in September 2022. Thus, many of the activities originally planned for the MSPQC when it was housed under MSDH could not be materialized or meaningfully tracked by MSDH. This change also coincided with an 80% turnover of key staff (4 of 5) in the Maternal Infant Health Bureau (MIHB). Without adequate staffing in the MIHB, this was not able to remain a priority during the reporting period. Since September 2022, MSPHI has received funding to support the MSPQC directly from the federal granting agency and does not have reporting obligations to MSDH. As staffing has stabilized in MIHB, by proximity and collaboration, MSDH is aware of and supports many of MSPQC’s continued and new activities. MSDH was an active participant at the MSPQC Annual Meeting held in Flowood, MS on June 2, 2023. At this meeting, topics centered around patient engagement, C-section overuse and labor culture, partnerships, healthy equity, implementation of AIM Safety Bundles, and optimizing post-partum transitions. The Office of Health Data and Research (OHDR) initially interfaced with members of the MSPQC in May 2023 and further discussed hospital points of contact and implementation of the CDC Levels of Care Assessment Tool (LOCATe) at the Annual MSPQC Meeting. In June 2023, OHDR administered the LOCATe survey. The survey was live from June 2023 to September 2023. During this time, OHDR continued to reach out to birthing hospitals via emails, letters, and phone calls to improve the participation rate to 56.8%. After responses slowed, OHDR exported the deidentified data and sent to the CDC LOCATe team for analysis. CDC finished the analysis and sent over results by November 2023. OHDR plans to send letters to each hospital that participated to explain their individual results. MSDH partners closely with MSPHI on multiple initiatives including the implementation of the Alliance for the Innovation on Maternal Health (AlM) patient safety bundles. The AIM Capacity Building grant was awarded to MSDH in October 2023. The overall mission of AIM is to support best practices that make birth safer, improve the quality of maternal health care and outcomes, and save lives. Maternal safety bundles address topics commonly associated with health complications or risks related to prenatal, labor and delivery, and postpartum care.  Ongoing AIM activities in Mississippi will include continuing to provide education and technical assistance to providers in relation to urgent maternal warning signs and bundle implementation. AIM grant is often a compliment to MSPQC funding, so deliberate and planned collaboration between MSPHI and MSDH is necessary to see all funding under both initiatives optimally used for non-duplicative work.

 

HMHB provided training on:

• March 2023 (2 trainings): procedures for receiving and processing high risk maternity and infant referrals and how to provide targeted case management services to those at risk of maternal and infant mortality and morbidity.
• March 2023: Perinatal/Congenital Syphilis and how to educate, treat and refer these patients.
• May 4, 2023: Postpartum Wellness Summit: Beyond the Baby Blues. This in-person educational opportunity was sponsored through the MS Department of Mental Health.

 

HM/HB onboarded two consultants to assist with education, training, and referrals.

• The HMHB Certified Nurse Midwife provides clinical consultation related to maternity and infant health to HMHB staff, she serves as a liaison between providers and HMHB, creates health education, leads Midwife Mondays – clinical updates and training to HMHB staff, such as family planning, gestational hypertension, maternal warning signs, maternal mental health, patient empowerment, and anticipating prenatal care visits.
• The HMHB Pharmacy Consultant provides medication management education, referrals, advocacy, health education, to patients with diabetes, gestational diabetes, hypertension, pregnancy induced hypertension, preeclampsia. Through a partnership with the MSDH MIHB, she also sends blood pressure cuffs to patients who need to self-monitor their hypertension in pregnancy and postpartum. Further, the HM/HB Pharmacy Consultant provides consultation to HMHB staff.

NOTE: These consultants began working with the program in the final quarter of this reporting period, so a more thorough description of their work will be included in the next annual report.

 

HM/HB program director and epidemiologists participated in CDC/Harvard Practicum in January 2023 and Summer 2023 which educated and provided assistance with program of developing an evaluation plan, smart goals, implementation of work plan and identifying outcomes.

 

Strategy: Provide guidance and evidenced-based trainings to participating Mississippi Perinatal Quality Collaborative (MSPQC) birthing hospitals and community partners to reduce severe maternal morbidity

 

Completed Activities:

The oversight of the Mississippi Perinatal Quality Collaborative (MSPQC) transitioned to being housed and administered by the MS Public Health Institute (MSPHI) in September 2022. Thus, many of the activities originally planned for the MSPQC when it was housed under MSDH could not be materialized or meaningfully tracked by MSDH. MSPHI receives its funding to support the MSPQC directly from the federal granting agency and does not have reporting obligations to MSDH. However, by proximity and collaboration, MSDH is aware of and supports many of MSPQC’s continued activities. MSDH partners closely with MSPHI on multiple initiatives including the implementation of the Alliance for the Innovation on Maternal Health (AlM) patient safety bundles. The AIM Capacity Building grant was awarded to MSDH in October 2023. The overall mission of AIM is to support best practices that make birth safer, improve the quality of maternal health care and outcomes, and save lives. Maternal safety bundles address topics commonly associated with health complications or risks related to prenatal, labor and delivery, and postpartum care.  Ongoing AIM activities in Mississippi will include continuing to provide education and technical assistance to providers in relation to urgent maternal warning signs and bundle implementation. Because this award’s start date coincides with the closing of the MCH Block Grant’s reporting period, detail on activities will be reported in the next iteration of this report.

 

Strategy: Provide leadership and technical assistance in the state on Alliance for Innovation on Maternal Health (AIM) initiatives and Maternal Mortality Review activities

 

Completed Activities:

The AIM Capacity Building grant was awarded to MSDH in October 2023. The overall mission of AIM is to support best practices that make birth safer, improve the quality of maternal health care and outcomes, and save lives. Maternal safety bundles address topics commonly associated with health complications or risks related to prenatal, labor and delivery, and postpartum care.  Ongoing AIM activities in Mississippi will include continuing to provide education and technical assistance to providers in relation to urgent maternal warning signs and bundle implementation. Because this award’s start date coincides with the closing of the MCH Block Grant’s reporting period, detail on activities will be reported in the next iteration of this report.

 

The MIHB’s Maternal Health Consultant, American College of Obstetricians and Gynecologists, and MIHB Director partnered to provide leadership and technical assistance to hospitals participating in the AIM initiative. The TA included (1) data reporting, (2) bundle implementation, and (3) overall support for implementation of related activities.  During the reporting period, 1 training (August 1, 2023) was conducted to introduce hospitals to a new bundle (Postpartum Transition Discharge) that will be adopted in Mississippi. This activity is ongoing.

 

The Maternal Mortality Review Committee (MMRC) activities included an orientation and training (April 2023) to discuss updates regarding committee decision forms and processes.  Of the 21 MMRC members, 16 attended the training. During the reporting period, the MMRC convened five (5) times to discuss 31 maternal deaths that occurred in 2020 (averaging 6 cases per meeting).  A state-level report was developed and submitted to the Mississippi Legislature January 2023. The report is accessible online at: https://msdh.ms.gov/page/resources/20200.pdf

 

Key findings from the MMRC report published January 2023 included the following:

• The maternal mortality ratio was 36.0 per 100,000 live births
• Black, non-Hispanic women had a maternal mortality rate 4 times higher than White, non-Hispanic women (65.1 versus 16.2) for the period.
• 57.5% of maternal deaths occurred during pregnancy or within the first 60 days after delivery, while 42.5% occurred more than 60 days but less than one year after delivery.
• Of the maternal deaths, 55% of women began prenatal care in the first trimester and an additional 20% began care in the second trimester.
• The majority of maternal deaths among Black, non-Hispanic mothers were due to cardiovascular conditions and cardiomyopathy while deaths among White, non-Hispanic mothers were distributed evenly among cardiovascular conditions, embolism, and cerebrovascular accidents.

 

Key recommendations from the MMRC membership included the following:

• Mississippi should make efforts to ensure insurance coverage before pregnancy and ensure patients receive options for ongoing insurance beyond the one-year postpartum period. 
• The State of Mississippi should extend Medicaid coverage from 60 days postpartum to at least one year.
• A coordinated response system is needed from the point of the 911 call about the fastest method of transport, the closest capable location, and needed expertise to support local providers.
• Perinatal social services should be seamlessly integrated in with clinical care in order to facilitate complex medical and social care coordination, provide psychosocial support, and minimize multiple referrals and additional visits for patients to obtain psychosocial support. A perinatal social worker could be embedded within clinical practices and hospitals and facilitate care coordination as well as provide at home support.
• Expectant mothers should be educated on the warning signs for obstetric complications including postpartum depression and make a follow up plan with medical providers for where to go and what to do if a postpartum complication arises.

 

Concurrent to supporting routine administrative operations of the MMRC, the MIHB staff spent a significant portion of time in researching other state’s policies and procedures for MMRC, Child Death Review Panels, and FIMRs. Over the course of a near 12-month period which began in July 2023, the MIHB developed 3 distinct policy manuals, 13 standard operating procedures for MIHB staff and committee members, and 31 appendix documents, including application forms, By-Laws, data dictionaries, confidentiality statements, consent forms, and interview guides. These documents are undergoing final draft approval before being memorialized in official agency policy. This was a critical activity for the succession of these committees under future MIHB leadership. Heretofore, there were no formalized, universal procedures that anchored operations.

 

Strategy: Provide guidance and technical assistance to birthing hospitals on reducing nulliparous, term singleton, vertex (NTSV) caesarean rate.

 

Completed Activities:

In September 2022, the oversight of the Mississippi Perinatal Quality Collaborative (MSPQC) transitioned from under MSDH to being housed and administered by the MS Public Health Institute (MSPHI). Thus, many of the activities originally planned for the MSPQC when it was housed under MSDH could not be meaningfully tracked by MSDH, including strategies to reducing C-Section births carried out under the MSPQC.

 

Further, the MSPHI receives its funding to support the MSPQC directly from the federal granting agency and does not have reporting obligations to MSDH. Thus, MSDH is unable to report on this strategy as it did not provide any specific work or effort towards it. However, in future reporting periods, the MSDH will ensure strategies are assigned, align with current stakeholder capacity, able to be carried out under the MIHB, and align closely with the work carried out by MSPHI/MSPQC relative to reducing C-Section births.

 

Strategy: Provide one-on-one technical assistance, knowledge sharing, and case review support to I-Support pilot hospitals.

 

Completed Activities:

In September 2022, the oversight of the Mississippi Perinatal Quality Collaborative (MSPQC) transitioned from under MSDH to being housed and administered by the MS Public Health Institute (MSPHI). Thus, many of the activities originally planned for the MSPQC when it was housed under MSDH could not be meaningfully tracked by MSDH, including strategies to increasing vaginal births carried out under the MSPQC.

 

Further, the MSPHI receives its funding to support the MSPQC directly from the federal granting agency and does not have reporting obligations to MSDH. Thus, MSDH is unable to report on this strategy as it did not provide any specific work or effort towards it. However, in future reporting periods, the MSDH will ensure strategies are assigned, align with current stakeholder capacity, able to be carried out under the MIHB, and align closely with the work carried out by MSPHI/MSPQC relative to increasing vaginal births.

 

PRIORITY: Improve Oral Health

 

NPMs, NOMs, SPM, and ESMs:

• Preventive Dental Visit/NPM 13.1 - Percent of women who had a preventive dental visit during pregnancy
• TDC/NOM 14 - Percent of children, ages 1 through 17, who have decayed teeth or cavities in the past year
• SOC/NOM 17.2 - Percent of children with special health care needs (CSHCN), ages 0 through 17, who receive care in a well-functioning system 
• CHS/NOM 19 - Percent of children, ages 0 through 17, in excellent or very good health
• PDV-Pregnancy.1/ESM 13.1.1 - Number of pregnant and postpartum women who received oral health education

 

Objective:

• By September 30, 2023, increase the percentage of women who have a preventive dental visit in pregnancy by 5%

 

Strategy: Provide education to women on the safety and importance of proper oral health during pregnancy and postpartum.

 

Completed Activities:

HM/HB developed a Comprehensive Assessment in June 2023 to be completed by the HM/HB Nurse Case Managers when enrolling a maternity or infant patient. The purpose of the initial enrollment and comprehensive assessment interview is to gather immediate information about the patient and family to identify urgent needs and barriers which may impact their short- and long-term health outcomes. The comprehensive assessment of the individual’s needs informs of any medical, educational, social, nutritional and or other services that are needed including the components of the Social Determinants of Health (SDOH).

 

Under the guidance of the Office of Oral Health (OOH), the comprehensive assessment also includes a section titled “Dental History” that includes 5 questions to determine if oral health education and/or referral to the MSDH OOH is to be made. All HM/HB patients/caregivers are asked these questions at time of enrollment. There is also an Oral Health Screening in EPIC that is recommended to be provided if the nurse case manager or extended service provider has identified any dental needs.

 

In July 2023, HM/HB collaborated with the OOH to provide a training which focused on educating and referring pregnant women and families for oral health assistance. All HM/HB staff, including approximately 60 nurses, nutritionists, and social workers participated in the training to review:

• Procedures for educating pregnant women on the importance of oral health care and the risks of not following up with a dental provider while pregnant.
• Procedures for educating caregivers on the importance of good oral health care in infants, as well as caregivers taking care of their own dental needs.
• Explanation of when, why, and how to refer an HM/HB patient and/or family member to the Office of Oral Health Regional Oral Health Consultants (ROHCs) to provide brief oral health education and/or refer to a dental provider closer to patient’s county of residence. 

In addition, the HMHB staff were given oral health education and toothbrush kits to distribute to their patients. 

 

During the 1st quarter after the training (October-December 2023), 15 patients were assessed as being in the urgency category I for pain and referred to the ROHCs for follow up. Further, over 500 hygiene and educational products were disseminated to HM/HB staff who then provided education and tools to families.

 

According to the National Institutes of Health (NIH), neglecting oral and dental health during pregnancy does not only cause problems such as tooth decay and tooth loss, but may also lead to problems such as premature birth, low birth weight infant, and pre-eclampsia. However, in Mississippi, once a pregnant mother has aged out of comprehensive dental coverage (age 20), she may only receive limited exams and extractions through the Division of Medicaid. Oral health assessment and education efforts are intended to document the gap between need and services for urgent dental care.

 

Oral care in pregnancy - PMC (nih.gov) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883753/#:~:text=It%20should%20also%20be%20kept,infant%2C%20and%20pre%2Declampsia.

 

Three Regional Oral Health Consultants (ROHC) provided 38 trainings to mothers participating in WIC programs in 21 counties: Forrest, Hancock, Hinds, Jasper, Jefferson Davis, Jones, Lauderdale, Leake, Lincoln, Neshoba, Newton, Rankin, Scott, Simpson, Smith, Washington, and Wayne Counties. A total of 1,671 women received oral health education and toothbrush kits which consist of a toothbrush, floss, and toothpaste from these in-person trainings. Additional oral health kits were donated to children and other adults attending the mother’s WIC appointments; however, these donations were not included in the calculations above

 

This is the first full reporting year in collaboration with the WIC department on oral health education and distribution of hygiene kits (toothbrush, toothpaste, and floss). These data are captured in the WIC SPIRIT management information system allowing the OOH to receive monthly reports and referrals from the WIC Program (see example of graph below). Based on these reports, between January and September 2023, 3,585 mothers received oral health education and oral health hygiene aids.