Women/Maternal Domain: Annual Report (October 1, 2021- September 2022)
Objective: Increase the proportion of women receiving a Well Women visit annually from 77.4% in 2021 to 85.4% by 2025. (BRFSS)
In 2021, South Dakota had 77.4% of women receiving a Well Women visit annually. The new 2022 annual target is 79.4%. South Dakota was ranked 2nd in the nation in 2021 and had a significantly higher percentage than the overall U.S. percentage of 69.7%.
Strategy 1.1 Develop partnerships with diverse, multisector stakeholders to promote preventative care for women of childbearing age
MCH Needs Assessment findings (2019-2020) indicated the importance of a yearly well women visit with a Primary Care Provider (PCP) as a care coordination and referral starting point for women of childbearing age. A well woman visit provides a comprehensive assessment of a women’s overall health including her mental health and substance use. Preventive care is important to stop diseases or conditions before they start. Mental health screenings are a component of a well women visit and can identify women who may be suffering needlessly. Throughout this grant year Title V continued to collaborate with Title X, the SD WIC program, and Bright Start Nurse Visiting to promote a medical home and annual Well Women check-up with their clients. All three programs are located within the Office of Child and Family Services and have representatives on the National Performance Measure (NPM) #1 workgroup making collaboration easier. The Well Woman Workgroup saw expansion with new members from the South Dakota chapter of Postpartum Support International and Sanford Health, executive director of children services. Other partnerships have included the MCH lead participating on the leadership of the North/South Dakota Perinatal Quality Collaborative and the South Dakota Perinatal Association conference planning committee. Cross participation in the NPM#5 workgroup- Infant domain has fostered collaboration in efforts to promote healthy moms and improved infant outcomes. Other engagement has been in person visitation to tribal leaders in women’s health throughout the state.
ESM: Number of messages posted promoting well women care
Media strategies the MCH team utilized to promote annual well women visits and well woman care included continuation of a social media campaign on For Baby’s Sake website and For Baby’s Sake Facebook /Instagram page. Social media was also expanded into other outlets including, Snapchat, and Google to improve reach. Posts related to well women and the mental health/substance misuse priorities are included on the social media metric table below. During the year we also transitioned from Hot Pink media services to an internal state-run communications team. We focused on our American Indian population in all our media content to represent our population with the most disparities. Information about well women visits (It Starts with You) and Perinatal Depression (You and Baby) can be found on the For Baby’s Sake website at For Baby's Sake | Healthier moms + Healthier babies (forbabysakesd.com). Print advertising in South Dakota Medicine Journal focused on the new 988 helpline and ads related to Syphilis screening and treatment as we saw our syphilis rates markedly increase across the state. As of spring 2023, syphilis cases have increased over 1713% above the five-year median. Congenital syphilis cases are also on the rise in South Dakota, increasing 2200% over the five-year median
988 Hotline
988 is more than a suicide hotline. It is for anyone in need of crisis support and can be used for those in emotional distress, including substance use crisis. If you or someone you know needs support now, call or text 988 or chat https://www.helplinecenter.org/9-8-8/
South Dakota Medicine Journal advertisement- target audience: providers
Radio advertisements
Following is an overview of the two media flights scheduled October 4 thru 29, 2021, and December 6 thru 31, 2021. The primary audience was American Indian women of childbearing age (18-34) and while the buy was essentially a statewide schedule, the emphasis was in and around reservations and counties with high American Indian populations and high need. There were over 105 spots per month running consistently throughout the month. Our placement strategy also allowed us to buy 10 stations deep (7 of the 10 stations are Native). Two 60-second American Indian voiced spots ran in rotation. The first focused on safe sleep with emphasis on putting babies to sleep on their backs, on a firm surface alone, room sharing, not bed sharing, and safe cribs. This ad pointed listeners to the website. The second ad discussed postpartum depression and encouraged listeners to reach out and to build a circle of support if they have symptoms. This spot included a call to action directing people to the Depression after Delivery Hotline and the For Baby’s Sake website.
For Baby’s Sake Postpartum Depression Awareness: 30 radio spots
A new baby brings joy and happiness – right? But sometimes new moms get the baby blues. With all these changes, it’s normal to feel sad or anxious. If you are having trouble getting through the day, feel overwhelmed, exhausted, or hopeless – reach out. Postpartum depression can be very serious but with support, you will get better. Call one eight hundred nine, four, four, four, seven, seven, three or visit For Baby’s Sake SD today.
Strategy 1.2 Create toolkit of resources on maternal mental health/substance misuse and health equity for OCFS field offices
Training on Motivational Interviewing (MI) was done to empower field staff to adequately screen and refer women. Field staff in 74 WIC/Community Health Offices were asked to complete 4 online interactive modules provided by JBS consultants.
- MI Modules- 84.5% completion rate across SD Office of Child and Family staff (nurses, dieticians, community health workers, and ancillary staff)
WIC staff and nurse team leads from each of the 4 public health regions were brought together to complete an in- person comprehensive Train-the-Trainer program on MI. Following training, a Teams channel was set up with resources to assist trainers in ongoing education of staff.
Continuing education on substance misuse was provided to all field staff. The first topic was on Cannabis from a MI focus. National experts provided the live virtual trainings. These trainings were recorded and added to the SD-TRAIN platform for future viewing by new staff and as refreshers. Ongoing training on other substances of misuse and lived experience are planned.
The women’s domain coordinator participated in the Quality Improvement Community of Learning (QICOL) sponsored by AIM and NICHQ. This was a 9-month course that reviewed the Model for Improvement in implementing the SUD AIM bundle. The work focused on structural measures or readiness within our OCFS field offices in anticipation of our Strategic Community Outreach and Outcomes plans (SCOOP) that addressed mental health/substance use.
Throughout this grant year, needs assessment plans and metrics were made. Development of a CQI tool to measure compliance with depression screening protocol and referral process was refined.
Strategy 1.3 Increase depression screening and referrals to primary care provider (PCP) among low-income women on the SD WIC program
According to the 2021 SD PRAMS data, 19.7% of postpartum women on the WIC program reported experiencing Postpartum Depression versus 8.6% of non-WIC mothers.
Beginning in October 2021, the DOH Community Health Offices WIC team was able to move data to action with depression screening using a validated tool, the PHQ9. The SD WIC team consists of RNs, LPNs, Licensed Dieticians, Nutrition Educators and Public Health Assistants (PHA) located in 74 Community Health Offices across the state. There are over 100 staff providing WIC services. Registered nurses are responsible for administering the PHQ9 and making referrals to PCP as needed.
To support understanding of depression in pregnancy, the South Dakota Perinatal Association (SDPA) annual conference hosted a talk on Depression in Pregnancy. Objectives of the talk provided by an obstetrician with an interest in pregnancy mental health focused on post-partum blues and depression, medication management, and services in the state.
ESM: Percentage of women with positive depression screen who are referred to their PCP within the OCFS offices
At the end of January 2022 an electronic health record (MyInsight) went live in the OCFS field offices. This allowed for the electronic documentation of the PHQ9 results as well as referrals made. The results are shown for the timeframe 1/31/22-10/31/22. Whooley Questions (PHQ2) are first asked as part of the Pregnancy or Postpartum WIC certification and any positive screens are referred to a nurse for a follow-up PHQ9 assessment.
Whooley Questions (PHQ2) timeframe = 1/31/2022-10/31/2022
3714 unique Whooley assessments done in WIC and MyInsight
- 70.2 % of ALL clients in WIC and Pregnancy Care were asked Whooley Questions
- 593 Positive screens (includes duplicate clients)
- 528 Unique positive screens (no duplication)
PHQ9 assessments timeframe = 01/31/2022 thru 10/31/2022
Overall:
700 PHQ9s completed
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190 positive PHQ9
- 27.1% positivity
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109 People Referred
- 57.4% of positive PHQ9s referred to their PCP or Community Mental Health Center
Strategy 1.4 Develop a policy recommendation with DSS to create a maternal medical home
Activities done to this point
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National Academy for State Health Policy MCH Policy Innovations Program Policy Academy (NASHP) is a two-year policy academy comprised of representatives from state Medicaid agencies, public health agencies, and other state stakeholders. The objectives for the academy include:
- Identify, develop, and implement policy changes or develop specific plans for policy changes and/or strategies necessary to build state capacity to address maternal mortality for Medicaid-eligible pregnant and parenting women, with the goal of improving access to quality care.
- Technical assistance to improve health care delivery systems and related supports for Medicaid-eligible pregnant and parenting women, with a particular focus on implementing policies or health system transformation that address racial disparities in maternal mortality
- Data from PRAMS and March of Dimes (MOD) to inform risk factors.
- The Association of State and Territorial Health Officials (ASTHO) links PRAMS data to Medicaid claims to understand the cost for risk factors identified in the payment model
- Stakeholder interviews with providers across the state were conducted to ascertain themes of needs, barriers, and views on the current state of maternal health care in their practices.
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Expansion of Bright Start
- Bright Start is the nurse visiting program implemented by the South Dakota Department of Health. In 2022, the program expanded statewide due to legislative approval of additional Medicaid and state general funds to support service delivery. The program uses the Nurse Family Partnership (NFP) model, and additionally offers support to families who do not fit NFP model criteria. The program enrolls pregnant women and families with children up to 6 weeks postpartum who are Medicaid enrolled or eligible. Families work with an assigned personal nurse until their child is two or three years old. Visits are held in the client’s home, another location of the family’s choosing, or by telehealth. Program goals are to improve pregnancy outcomes, improve child health and development and to improve the family’s economic self-sufficiency. Program components include education, referral linkages, and assessments of maternal depression, anxiety, intimate partner violence, child development and parent-child interaction. Nurse visitors support families in both meeting health and parenting goals, but also in addressing the social determinants of health that impact their lives.
- To identify pregnant women earlier who would benefit from the expanded services of Bright Start across the state an advertisement was placed in South Dakota Medicine. Information was also distributed through South Dakota Association of Healthcare Organizations (SDAHO), SD ACOG chapter, tribal healthcare, and hospital medical staff emails. To promote the expanded services, team leads from WIC and Bright Start presented at the SD Perinatal Association annual conference in a talk titled, Partnering with WIC and Bright Start.
Other MCH activities related to Women’s Domain
Maternal Mortality Review:
The SD Department of Health's Maternal Mortality Review Committee (MMRC) is a multidisciplinary expert panel with representation from public health, nursing, maternal and fetal medicine, mental health, substance use, pathology, obstetrics/gynecology, tribal health, and social work.
The MMRC reviews all deaths of SD residents that occur while pregnant or within one year of the end of pregnancy. The MMRC determines pregnancy-relatedness, preventability, and contributing factors to the death. The MMRC develops recommendations based on these factors to improve policies and practices and reduce preventable maternal deaths in SD.
The SD MMRC began reviewing cases in October 2021 and reviewed 20 cases in its first full year. These deaths occurred from 2018-2021. Preliminary findings from this review are represented below. An in-depth analysis including social determinants of health and themes of recommendations is underway. Recommendations from the MMRC will inform prevention to action to improve women’s health.
North Dakota-South Dakota Perinatal Quality Collaborative (NSD PQC): The NSDPQC has been awarded a five-year grant through the CDC for state based PQC capacity building. With these funds, the NSDPQC staff will be growing to include a Tribal Liaison and a Data and QI Specialist to better support participating hospitals in the QI work. Moving forward, the NSDPQC will continue to grow in name recognition and as a known source for science-based quality improvement and dissemination of best practices. We hope to enroll a larger portion of SD hospitals and affect change to a wider population. Currently, the NDSPQC participants cover less than 40% of SD births. Our goal is to cover over 70% of SD births in the coming initiatives.
Referrals for medical insurance coverage: Community Health Offices across the state promoted Medicaid and Marketplace enrollment for clients that initiated services and were uninsured. Staff utilized available translating services (Language Link or Lutheran Social Services translators) if a client ‘s primary language was other than English. Clients were referred to DSS Economic Assistance or Navigators if more assistance was needed to promote equity in accessing insurance.
Breastfeeding-Friendly Business Mini Grants: Over the last year, the MCH Program has partnered with the DOH Office of Disease Prevention programs on several initiatives to address public health needs. In 2022, the DOH Nutrition & Physical Activity Program released the Breastfeeding-Friendly Business Grant opportunity open to all South Dakota worksites. MCH funds support the state and federal breastfeeding law by providing worksites up to $2,000 to create a new lactation space, improve an existing space, and/or implement innovative, space-saving ideas to meet staff breastfeeding needs for employees including those who work outdoors and/or who frequently travel. Awarded grantees received assistance from the SD DOH on policy development, use of the Employer Breastfeeding Accommodation Form, and resource sharing based on need/request. Ten applications were received with eight applicants being awarded. Awardees will submit a final report of successes, challenges, and overall project outcomes in 2023.
Congenital Syphilis Awareness Media Campaign: In addition to SD Medicine Journal provider ads, the MCH Women’s Domain has partnered with the DOH Office of Disease Prevention to launch a media campaign to raise awareness of the congenital syphilis outbreak and direct the public to available resources. The campaign is geared toward both males and females aged 25-39, with an emphasis on women of child-bearing age. The campaign is statewide; however, increased focus has been placed on the counties with the highest numbers of cases and include a mix of social media, radio, and signage.
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