Women/Maternal Health-Annual Report

 

NPM #1 Well Women Care – Improve pre-conception, prenatal and postpartum health care services for women of childbearing age.

 

The health and wellbeing of the mother before, during, and after pregnancy is important not only for the woman but also for the newborn. Women who maintain a healthy lifestyle during the preconception period are less likely to experience adverse pregnancy and obstetric outcomes and are also more likely to experience better postpartum health that extends across their life span.

 

According to the 2020 Behavioral Risk Factor Surveillance System (BRFSS), 72.5% of Missouri women between 18-44 years reported having a preventive health care visit within the past year. This is higher than the national proportion of 71.3% for 2020.   There were racial differences in proportion of preventive health care visit, with Missouri being similar to national levels (Figure 1).  A higher percentage of insured women (77.7%) compared to uninsured women (49.5%) received a preventive visit. A lower percentage of those with less than a high school education (56.9%) received a preventive visit in the past year than those with more than a high school education (74.5%). The proportion of Missouri women with more than a high school education that received a preventive medical visit in the past year was also higher than at the national level (72.5%). In Missouri, 67.0% of those with a household income less than $25,000 had a preventive visit in the past year compared to 79.8% among those with a household income greater than $75,000. A larger percentage of married women (73.6%) had a preventive visit in the past year than unmarried women (71.5%).

 

 

Missouri Vital Statistics (MVS) data for 2020 indicate 73.4% of women began prenatal care in the first trimester, which is slightly lower than the 73.6% observed in 2019. First trimester initiation was also lower in Missouri compared to the national level (77.7%) in 2020. There is a racial gap in first trimester initiation in Missouri, but that gap has narrowed. MVS data for 2020 showed that 76.5% of White Missourians began prenatal care in the first trimester compared to 61.4% of Black Missourians. While first trimester prenatal care initiation increased for Black Missourians (61%) from 2019, it decreased for White Missourians (76.9%) during that same year.

 

According to 2020 MO PRAMS, 85.1% of Missouri women received a postpartum checkup. This proportion is lower than the 88.6% reported for 2019. Women without health insurance (31.3 %) had the lowest percentage of receiving a postpartum checkup compared to their counterparts who were privately insured (92.3%) and Medicaid-insured (77.9%). Non-Hispanic Black women (72.9%) had lower rates of receiving a postpartum checkup compared to non-Hispanic White women (87.3 %). Women with less than a high school diploma (70.1%) had lower rates of receiving a postpartum checkup than women with a high school diploma (80.6%), some college (84.2%), and a college degree or higher (92.8%).

 

The Office on Women’s Health (OWH) continued to provide education and resources to promote well woman care, including the distribution of WOMEN: Take Charge of Your Health publication and the My Health Tracking Card and the continuation of the Women’s Health Network listserv. The WOMEN: Take Charge of Your Health publication includes information on topics such as preventative health, preconception health, obesity prevention, breastfeeding, postpartum depression, and disease prevention. This resource is also available on the Department of Health and Senior Services (DHSS) website at www.health.mo.gov/womenshealth. The WOMEN: Take Charge of Your Health publication is now available in both English and Spanish online and in print. The My Health Tracking Card provides a means to track blood pressure, cholesterol, and weight, and is available on the DHSS website at https://health.mo.gov/living/families/womenshealth/pdf/my-health-tracking-card.pdf. Resources were provided to the general public, local public health agencies (LPHAs), and others who contact the OWH or visit the website. In FY21, the OWH partnered across the Department to share these resources with medical providers. This partnership helped educate women about the need for health screenings, including breast and cervical exams, blood pressure, cholesterol, and blood sugar monitoring. The Women’s Health Network listserv comprises organizations and individuals concerned with women’s health. The Network’s purpose is to provide timely information about current issues in women’s health, such as changes in services for women, changing technology in women’s health, available resources, training opportunities, events and funding opportunities. The OWH provides individuals with resources and updates weekly. In the annual survey of these providers, 97% of responses indicated that the listserv was helpful or very helpful in increasing their knowledge of women’s health issues.

 

The Missouri Women’s Health Council continued to meet quarterly. The Council is an advisory group comprised of thought leaders with expertise in women’s health and the broad range of factors that affect health outcomes and wellbeing. Council members are  appointed by the DHSS Director and reflect the geographic diversity of Missouri. The Council is charged with informing and advising the DHSS regarding women’s health risks, needs, and concerns and recommending potential strategies, programs, and legislative changes to improve the health and well-being of all women in Missouri. The council consists of women from a variety of professions, including health care providers, researchers, healthcare administrators, social workers, as well as, multiple directors of critical social services foundations serving women throughout Missouri. The Council developed a system for member nominations in FY21 to ensure current members could recommend peers to the DHSS Director and ensure continued diversity of profession, region, and expertise for future years. The Office of Dental Health (ODH) will continue to educate mothers and children about the importance of oral health for their overall health and well-being. This includes the promotion of dental visits during pregnancy. As quantities allow, ODH will supply infant toothbrushes and Healthy Smiles from the Start booklets to the St. Louis Safe Kids Coordinator for use during baby safety classes. The classes cover safe sleep habits, car seat safety, breast and bottle-feeding and oral care. The training reaches pregnant moms, new parents and grandparents and is presented  in both English and Spanish. For FY21, ODH did not receive requests for the booklets, as the classes were not held due to COVID-19.

 

The ODH continued to provide education to women about the importance of oral health for the mother’s overall health, during pregnancy and throughout her lifespan. This education took place through literature developed by the ODH and the Missouri Dental Association. The materials highlighted the importance of dental visits and were  distributed via an ongoing successful collaboration with the Women, Infants, and Children (WIC) Program and the Title V MCH funded Home Visiting Programs. Materials were also distributed via LPHAs, dental offices, and Federally Qualified Health Centers (FQHCs) and at community outreach events. 9,628 materials were distributed to promote the importance of oral health during pregnancy. To date, three versions of the materials have been translated into Spanish.

 

Community Health

 

The MCH Services Program continued to contract with LPHAs to support a leadership role for LPHAs at the community level to promote the health of mothers and infants by assuring prenatal, delivery, and postpartum care for low income, at-risk pregnant women:

• Nineteen LPHAs worked to improve pre-conception, prenatal, and postpartum health care services for women of childbearing age as their Priority Health Issue (PHI). LPHAs implemented women’s preventative health programs within their health departments, providing women with a low cost annual exam (to include breast and cervical screening) paired with women’s health education. The health education covered smoking cessation, self-care tips, and mental wellness resources. As a result, the number of women who received an annual preventative exam increased.
• Eight LPHAs worked to prevent and reduce obesity among women of childbearing age as their PHI. LPHAs used a variety of strategies to encourage and increase physical activity among women of childbearing age.
  • As the COVID-19 pandemic necessitated activities be socially distanced, the Phelps-Maries Health Department held a “virtual” Breastfeeding Walk. Participants were asked to register online, choose a start and end point to walk 3.1 miles, and submit a photo to a private Facebook event page showing they had completed the walk. Those who successfully completed the walk were given a reusable water bottle to increase water intake.
  • The Hickory County Health Department worked with local businesses and distributed a four-month activity calendar, encouraging women of childbearing age to participate in various physical activities each day. 75  calendars were distributed, and nine participants responded to a post-activity survey. The survey showed women of childbearing age reported an increase in physical activity.
  • The Nodaway County Health Department planted a community garden and made fruits and vegetables available to women of childbearing age along with recipe cards so they knew how to prepare a healthy meal with the produce. As a result, women of childbearing age reported an increase in knowledge regarding nutrition.  
  • The Pulaski County Health Department facilitated an AquaCize class in the summer months for women of childbearing age. The class was held at the local pool and encouraged women of childbearing age and families to be active.
• Nineteen LPHAs worked to prevent and reduce smoking among women of childbearing age and pregnant women as their PHI. These LPHAs have continued increased efforts to assess smoking in women of childbearing age and offer smoking cessation resources and programs. Outreach efforts have continued to engage community partners and providers to increase collaborative educational efforts and resource sharing, and strengthen referral networks. Many LPHAs used the Smoking Cessation and Reduction in Pregnancy Treatment Program (SCRIPT) and collaborated with WIC programs to identify women of childbearing age that were using tobacco. Using this strategy and program, LPHAs reported an increase in the number of women of childbearing age that were referred and received smoking cessation education as well as an increase in the number of women that quit smoking.
• Three LPHAs worked to decrease the number of women with a recent live birth who experience frequent postpartum depressive symptoms as their PHI. These three LPHAs continued to work collaboratively to increase community awareness of postpartum depression, increase educational opportunities to providers and community members, and increase the awareness, adoption, and implementation of evidence-based postpartum depression screening tools.
  • Callaway County Health Department implemented an internal policy to collaborate with the WIC program to screen postpartum women using the Edinburgh screening tool. This resulted in an increased number of women screened and referred for treatment.
  • Columbia-Boone County Health Department implemented a peer based support line for postpartum depression, leading to an increase in the number of women who reported feeling supported.

 

The MCH Services Program also supported LPHA efforts to provide education on the importance of adequate dental care and overall oral health. Activities included collaborating with partners to provide screening and increasing referral and direct provision of preventive dental services in an effort to increase the number of women receiving a preventive dental visit during pregnancy. This collaboration has resulted in an increase in the number of women receiving oral health services during pregnancy as well as an increase in organizations that understand the importance of integrating oral health care. LPHA and/or community partner efforts to implement education programs for pregnant women, families, and providers on the benefits of delivery after 39 weeks gestation, the risks of preterm delivery and cesarean births have also been supported.

 

The TEL-LINK Program helped improve maternal and child health by providing health care service referrals to increase access to care for any Missourian who needs assistance. The program promotes this service through search engine campaigns to provide outreach to the underserved population. TEL-LINK provided 2,952 referrals to a wide range of services such as smoking cessation, dental care providers, WIC clinics, food assistance, housing assistance, transportation, health insurance, and many more.

 

The Newborn Health Program continued to partner with a variety of community health providers to raise awareness/educate the MCH population on MCH resources for women of childbearing age and their families, which include preconception, prenatal, and postpartum care, as well as smoking cessation, postpartum mood disorders, and the importance of taking folic acid. The program accomplishes this through free distribution of the Pregnancy and Beyond books and a wide variety of educational materials. All of these resources contain information to improve pre-conception, prenatal, and postpartum health care services for women of childbearing age. The Program tracked the distribution of these materials and obtained feedback from partners on how they use the materials and ways to improve them. The Healthy Births and Babies (HBB) Unit continued to utilize and promote an informal MCH internal work group. Additionally, the HBB Unit maximized outreach opportunities at conference exhibits, webinars, health fairs, and through the Home Visiting Programs by distributing various educational materials.

 

The Missouri WIC Program promoted the importance of depression screening utilizing the Patient Health Questionnaire-2 (PHQ-2) for prenatal, breastfeeding, and non-breastfeeding woman. The purpose of the PHQ-2 is not to establish a final diagnosis or to monitor depression severity, but rather to screen for depression as a “first step” approach. 22 out of 115 LPHAs implemented the PHQ-2. WIC continued the referral system to the Home Visiting Program, TEL-LINK program, the Missouri Primary Care Association, and other support programs. WIC also continued outreach efforts to enroll prenatal women in the WIC Program in their first trimester.

 

Home Visiting

 

The Title V MCH funded Home Visiting Program and the Maternal, Infant and Early Childhood Home Visiting (MIECHV) funded home visiting services, managed under the Department of Elementary and Secondary Education’s (DESE) newly created Office of Childhood (OOC), were offered in 26 counties and served 1,008 families in FY21 through four evidence-based home visiting models:

• Nurse Family Partnership;
• Healthy Families America;
• Parents as Teachers; and
• Early Head Start Home Based Option.

 

Insurance coverage

The Home Visiting Program continued to share information with all contracted local implementing agencies to help home visitors better understand Affordable Care Act (ACA) Health Insurance Marketplace® changes and uncertainties in order to assist enrolled clients to access insurance for prenatal, postnatal, and well woman care. Home visitors accessed resources through email and postings within the Missouri Home Visiting Gateway resources and through weekly updates on the Home Visiting Program’s web-based data collection system platform. The Home Visiting Program recorded the continuity of insurance coverage and provided Marketplace open enrollment information to home visitors throughout the enrollment period. This information was utilized by home visitors to inform their clients of the opportunity and timeline for enrollment. In FY21, 64.8% (508/784) of primary caregivers with medical insurance coverage maintained it continuously for 6 months. Health Insurance Marketplace® open enrollment information was included in every edition of the Weekly Update, provided to all Title V MCH and MIECHV funded home visitors, from November 1, 2020 to December 15, 2020 and again during the Special Enrollment Period initiated due to COVID-19 from April 1, 2021 to May 15, 2021 and through the extension from May 16, 2021 to August 15, 2021. The Home Visiting Program held monthly subrecipient monitoring and support calls with each local implementing agency (LIA) Supervisor with a standing agenda topic of resources agencies need assistance with. When assistance with health coverage for enrolled pregnant and postpartum women is requested, the Home Visiting Program has a contact in the Department of Social Services (DSS) Family Support Division (FSD) User Assistance Team. The Home Visiting Program collected annual performance measure data on the percentage of mothers enrolled in home visiting prenatally or within 30 days after delivery who receive a postpartum visit with a health care provider within 8 weeks of delivery.

 

Prenatal care

Home Visitors provided information and resources that promote the benefits of pregnancy to the full 40 weeks to all contracted home visitors to share with clients. Resources included DHSS and March of Dimes materials. Title V MCH funded Home Visiting Program Specialists assessed the receipt and use of these resources during monthly subrecipient monitoring and support calls with contracted LIA Supervisors.

 

Postpartum visit

The Home Visiting Program specifically tracked the number of women enrolled during pregnancy or within 30 days postpartum who received a postpartum follow-up within 8 weeks of delivery. In FY21, 69.1% (132/191) of women received a postpartum follow-up visit.

 

Smoking Cessation

Home visitors promoted smoking cessation for all primary caregivers who reported smoking at enrollment and at subsequent 6-month time points during enrollment. The Home Visiting Program specifically tracked annual performance measure data on the percentage of primary caregivers who reported smoking and/or use of other tobacco or nicotine products, including e-cigarettes, at enrollment. Caregivers were then provided tobacco cessation referrals for counseling services within three months of enrollment. In addition, home visitors were provided with information and resources on tobacco cessation to share with enrolled participants, such as the DHSS Tobacco Quitline and TEL-LINK. In FY21, this percentage was 65.4% (93/142).

 

Depression Screening

The Home Visiting Program screened all prenatally enrolled clients within three months of delivery. Primary caregivers not enrolled prenatally were screened within three months of enrollment. Home visitors utilized the Public Health Questionnaire 9 (PHQ-9) depression screening tool at these prescribed time points and anytime they recognized potential symptoms of depression. Individuals who screened positive were provided support by home visitors through their model curriculums (i.e., Nurse Family Partnership and Early Head Start Home Based Option models) or training received in July 2021 (i.e., Parents as Teachers and Healthy Families America models) for the Mothers & Babies Mental Health Intervention developed by The Center for Community Health at Illinois Northwestern University, Institute for Public Health and Medicine. This intervention promoted healthy mood management by teaching pregnant women and new moms how to effectively respond to stress. When PHQ9 scores indicated, referrals were made to the appropriate services. The FY21 data showed that 83.6% (285/341) of enrolled clients meeting these criteria were screened. 31 individuals screened positive and 10 had completed referrals for appropriate services. Follow-ups were made to ensure completion of referrals by making a connection between client and referral source.

 

Oral Health

The Home Visiting Program provided ordering information for oral health resources from the Office of Dental Health (ODH) and the Missouri Primary Care Association (MPCA) via email to all MCH and MIECHV funded home visitors and supervisors, as well as links to materials, webinars, and other resources that highlight the importance of preventive annual dental care ahead of the virtual Title V/MCH and MIECHV specific home visiting summit held on March 10, 2021.

 

Environmental Health

 

Many persons are not aware that lead exposure can be a problem for women of childbearing age, a developing fetus and/or a nursing infant. The most serious effects of high levels of lead exposure during pregnancy are miscarriage and stillbirth. Other pregnancy problems such as gestational hypertension, low birth weight and premature delivery can also occur. Prenatal lead exposure impairs children’s neurodevelopment, placing them at increased risk for developmental delay, reduced IQ, hearing impairments, and learning and behavioral problems.

 

DHSS lead poisoning prevention staff continued the following activities to prevent or decrease blood lead poisoning in pregnant women and their babies:

• Provided community lead education via various outreach events such as health fairs, home shows, and public information sessions.
• Participated in updating outreach materials such as the “Pregnancy and Beyond” booklet and other pamphlets and brochures which are distributed to expectant and new parents.
• Made contact with pregnant women and their health care providers when they were known to have elevated blood lead levels (EBL) of 5 mcg/dL or higher (tracked by the ABLES staff), provided educational materials, and offered lead risk assessments.
• Provided lead education and resource materials to health care providers, LPHA and health plan lead case managers, as well as WIC program staff regarding the need to discuss lead poisoning prevention and lead testing with clients. This included providing LeadCare Analyzers and lead test kits to LPHAs that did not have the capacity to provide accurate lead screenings—allowing them to offer this service on a regular and ongoing basis.

 

The Prenatal Substance Use Prevention Program educated pregnant women on the importance of prenatal substance use prevention to promote healthy pregnancy and birth. The program utilized statewide community placement sites, which house substance exposed infant manikins to demonstrate the effects of drugs and alcohol exposure during pregnancy. Despite the challenges of COVID-19, the community placement sites were able to demonstrate the substance exposed manikins 137 times, educating 2,635 individuals. Educators reported that students were full of empathy for the infant manikins. Educators also noted that a women’s recovery group was in tears as the manikins hit very close to home. Participants reported that it’s different knowing what could happen and then seeing the side effects of drinking while pregnant. They had no idea alcohol could be so harmful to babies. Participants also demonstrated concern about the guilt a parent might feel if they were struggling with substance use.

 

In addition, the Prenatal Substance Use Prevention Program created awareness campaigns that were displayed to 1,822,430 individuals to promote healthy pregnancy and to educate women of childbearing age on the importance of avoiding all substance use before, during, and after pregnancy.

 

The Safe Cribs for Missouri Program continued to educate each crib recipient on smoking cessation and the consequences of smoking during pregnancy. Missouri Tobacco Quitline tip cards and MO HealthNet resources were utilized. The Safe Cribs Program Specialist continued to follow-up with contracting agencies to ensure they were providing health education. The Program Specialist was also available to provide resources as needed.

 

Maternal Mortality

 

The OWH continued to abstract and review all pregnancy-associated mortalities in Missouri. This was done to ensure that information from all maternal deaths occurring within one year of pregnancy termination was captured. These reviews aided in the identification of strategies to prevent maternal mortalities. DHSS reported findings from the Pregnancy-Associated Mortality Review (PAMR) by publishing the Missouri Pregnancy-Associated Mortality Review: 2018 Annual Report. The report was disseminated to a broad audience and made available on the PAMR web site at https://health.mo.gov/data/pamr/index.php. The Maternal/Infant Coordinator completed 15 presentations on PAMR data to various stakeholder groups.

 

The Maternal/Infant Mortality Coordinator and the MCH Director participated in the planning and sponsorship of the 2021 Virtual Convening for Maternal and Infant Health in Missouri. This event convened maternal and infant health providers, stakeholders, and invested community partners from all across the state to learn, share progress, and walk away with actionable insights. More than 300 people registered with approximately 170-180 participating that day. This event was a partnership between the Missouri Foundation for Health (MFFH), Missouri Hospital Association, and the DHSS and was provided free of charge to participants as a result of this partnership.

 

The DHSS was selected through a competitive grant process for a 5-year grant awarded through the Centers for Disease Control and Prevention’s (CDC) Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM) Program. This funding directly supports agencies and organizations that coordinate and manage Maternal Mortality Review Committees (MMRC) to identify, review and characterize maternal deaths and identify prevention opportunities. The Maternal/Infant Mortality Coordinator worked closely with the PAMR Board and the Title V MCH Block Grant Program to implement the strategies in this grant. The OWH improved internal processes to expedite maternal mortality case identification, abstraction and review by working with the Bureau of Vital Records to use provisional death files. Furthermore, maternal mortality cases were grouped by date of death for abstraction and review. For example, deaths that occur at the beginning of the year are abstracted first if at all possible and brought to the PAMR Board. These process improvements increased timely case identification from 45% (baseline) to 87%. In addition, the Patient Abstract System (PAS) linkage that was developed during year two of the grant to identify additional hospitalizations/emergency room visits has proved to be extremely beneficial for case abstraction. For example, the PAS linkages provided identification of medical care access that otherwise would have been missed. Additionally, through the ERASE MM grant, the OWH continued a contract with the Missouri Hospital Association (MHA) to implement the Severe Hypertension in Pregnancy (SHP) patient safety bundle in Missouri birthing facilities, clinics and critical access hospitals. Ultimately, 31 birthing centers, eight emergency rooms/critical care access hospitals and seven provider clinics participated. Multiple coaching calls, virtual office hours for collaborative team support, peer-to-peer meetings with physician faculty, and data support were offered to participants. Overall, there was a combined improvement (17.18%) in the rate of treatment of medication measure which ensures women who present with severe high blood pressure are treated in a timely manner. One reoccurring theme noted in the maternal mortality case reviews is poor follow up for patients diagnosed with hypertension in pregnancy. Participating entities in the collaborative reported that 76% of participants in the birthing unit track reported scheduling follow-up appointments for patients with a diagnosis of hypertension, preeclampsia or eclampsia within 7-14 days of discharge. Within the provider clinic track, 85% of participants reported patients adhered to the scheduled follow-up. The number of hospital births statewide covered by implementation of the AIM SHP bundle was 40,250, which equates to 59% of the total births in Missouri. The collaborative moved into the sustainability phase continuing to report data on a bi-monthly basis. The SHP collaborative resulted in these additional improvements:  bundle completion increased from an average of 59% to 91%, structure measure completion increased from an average of 81% to 90% and the team process improvement measure completion increased from an average of 81% to 93%. One of the more notable changes included provider education on severe hypertension including the unit-based protocol which increased from 49% (1st quarter) to 92% (4th quarter). Lastly, to ensure that efforts and improvements did not cease at the close of the collaborative, MHA created a sustainability plan for the organizations. The sustainability plan was implemented allowing organizations to continue to monitor their efforts. Missouri shared the sustainability plan with the AIM National Team as this is the first of such a plan to have been developed. Prior to the end of the SHP collaborative, planning work began on the implementation of the “Obstetric Care for Women with Opioid Use Disorder” bundle. Maternal overdoses were identified as a leading cause of death for PAMR in the report released in 2021.  

 

The DHSS and the Missouri Hospital Association continued to work together on the Maternal and Child Learning Action Network (MC-LAN) and the Alliance for Innovation on Maternal Health (AIM). The Maternal/Infant Mortality Coordinator and MCH Director participated in the Missouri Maternal-Child Learning and Action Network (MC LAN) by providing guidance, data, knowledge sharing and peer support in developing strategic quality initiatives based on the Triple AIM principles of improving and evaluating perinatal quality and population-based programs. The MC-LAN provides guidance, knowledge sharing and peer support in developing strategic quality initiatives based on the Triple Aim principles. The committee partners with the communities they serve to achieve better communication, and educate and impact the public on quality and safety initiatives of the health care community. AIM is a national data-driven maternal safety and quality improvement initiative, and Missouri was designated as an AIM state in 2018. As part of the current Obstetric Care for Women with Opioid Use Disorder AIM Bundle, the Missouri Neonatal Abstinence Syndrome Collaborative was formed to focus on developing improvements in care related to the care of substance-exposed newborns, including keeping the mother-infant dyad intact; incorporating the functional assessment model Eat, Sleep, Console into practice; and establishing Safe Plans of Care of the mother and the infant.

 

One example of a population-based program implemented during the time of the COVID-19 pandemic when most in-person office visits were ceased included The Cuff Kit™ Project. As a result of meetings between partners discussing the effect of the pandemic on the health and safety of pregnant women, several partners came together to apply for and fund The Cuff Kit Project. The Cuff Kit Project distributed comprehensive blood pressure cuff kits to pregnant women at high risk for or diagnosed with blood pressure-related issues. The cuff kits were also distributed to other vulnerable populations. Organizations participating in the Missouri AIM SHP Collaborative were given first priority to receive the kits. Additional opportunities were given primarily to FQHCs serving maternal patients in identified high-need regions of Missouri. In coordination with the Preeclampsia Foundation, blood pressure cuff kits were distributed to organizations able to accomplish the following:

• Utilize telehealth technologies to communicate with participating patients;
• Provide patients with the entire cuff kit package;
• Prioritize distribution to those at highest risk, especially vulnerable women with a lower ability to procure their own blood pressure cuff:
  • At-risk and vulnerable women include those with: chronic hypertension, history of preeclampsia and/or eclampsia, obesity, advanced maternal age, autoimmune disorders and other medical diagnoses, as well as those with population-level risk factors, such as race (Black, Native American), and/or live in a rural location;

• Conduct a brief survey to assess initiative impact and encourage patient feedback submission through an enclosed postage-paid postcard; and
• Provide outcome data and patient success stories.

 

Altogether 33 organizations participated in The Cuff Kit Project distributing kits to 2,935 women. This program was so well received that the Missouri Foundation for Health provided matching funds to enable additional kits to be distributed beyond the initial funding for 1,500 kits. Participants who received a cuff kit reported that, in a time where they felt extremely isolated, having the cuff kit at home enabled them to monitor their health safely and identify when they needed to seek medical attention.  

 

Other Title V Program Activities Related to the Women/Maternal Health Domain

 

The OWH supports several initiatives to assist women of childbearing age. First, the office supports the Uninsured Women’s Health Services Program. With the DSS, the OWH reimburses medical providers for women’s health services. These include: approved methods of contraception; sexually transmitted disease testing and treatment, including pap tests and pelvic exams; family planning, counseling, education on various methods of birth control; and drugs, supplies, or devices related to the women’s health services described above, when they are prescribed by a physician or advanced practice nurse. Second, the OWH maintains a public listing of pregnancy assistance information and ultrasound providers. The OWH sends a survey annually in order to develop a listing of private and public agencies available in the state to help pregnant women. This listing of assistance providers and ultrasound providers is indexed geographically and available online. Third, the OWH represents or supports the Department in several statewide task forces and commissions, including the Missouri Rights of Victims of Sexual Assault Task Force, the Combatting Human Trafficking and Domestic Violence Commission, and the Missouri Women’s Health Council. Finally, the OWH supports the statewide Sexual Assault Nurse Examiner Telehealth Network. This network is in the beginning stages and will expand access to forensic exams across the state.

 

The DHSS participated in the Association of State and Territorial Health Officials (ASTHO) and the Association of Maternal and Child Health Programs (AMCHP) Promoting Innovation in State & Territorial MCH Policymaking (PRISM) Learning Community. The Title V MCH Block Grant program formed a core team, including: the MCH Director as the team lead, behavioral health representation from the DSS, MO HealthNet Division and the Department of Mental Health, and members from the University of Missouri Kansas City Institute for Human Development and the Dallas County Health Department. The PRISM Learning Community provided technical assistance and capacity building to support and advance policy implementation within states and territories to equitably address substance misuse and addiction and mental health disorders in women, children, and families within the context of the COVID-19 pandemic. The core team created a state action plan to achieve the following goals:

• Goal #1: Leverage Missouri’s existing maternal-fetal-infant/neonatal abstinence syndrome (MFI/NAS) workgroups to organize a multisector action network, focused on a life course framework, to coordinate and collaborate on maternal mental health and substance use prevention and treatment efforts.
• Goal #2: Conduct a landscape analysis of existing state approaches for addressing maternal mental health and substance use disorders, to inform Missouri's future policy efforts.
• Goal #3: Create a policy proposal that advances maternal mental health and substance use prevention and treatment, using a sustainable funding approach.

AMCHP worked with the Georgia Health Policy Center at the Andrew Young School of Policy Studies to conduct a landscape scan of state policy options for perinatal women with substance use disorders for Missouri’s PRISM project. The DHSS contracted with the UMKC-Institute for Human Development to convene a Maternal Health Multisector Action Network to leverage Missouri’s existing maternal-fetal-infant/neonatal abstinence syndrome (MFI/NAS) work groups and coordinate and collaborate on maternal mental health and substance use prevention and treatment efforts.

 

As the state’s chief MCH strategist, the MCH Director worked to broaden the scope of Title V partnership beyond the DHSS and other state agencies. As a convener of multidisciplinary, cross-sector collaborations and facilitator of meaningful and diverse partnerships, Title V brought MCH partners and programs together across programmatic silos and organizational boundaries to promote the health of the MCH population and address social determinants of health and health inequities. For example, the MCH Director facilitated a statewide Healthy Start Collaborative with the two Healthy Start grantees (Nurture KC, and Missouri Bootheel Regional Consortium) and their partners to facilitate virtual sharing of information and resources, shared learning and identification of opportunities for alignment and collective impact. The MCH Director was actively engaged in statewide collaborative efforts to promote the health of women of childbearing age, including but not limited to PAMR, the MC-LAN, the Women's Health Council, the DSS-Maternal Fetal Infant Workgroup and Substance Use Disorder and Social Determinants of Health sub-workgroups, the Uplift Connection, the MFFH Maternal Mortality Stakeholder group, and the Kansas City Perinatal Recovery Collaborative.