Women’s Health refers to the health of women of child-bearing age, usually 15-44, although demographics show that this age range has been widening. Maternal health is the health of women during pregnancy, childbirth, and the postpartum period. It encompasses the health care dimensions of family planning, preconception, prenatal, and postnatal care. Preconception health is an area that focuses on women’s health before she becomes pregnant. Preconception care is important because it reduces unwanted and mistimed pregnancies and teen pregnancy. It also has been linked with better prenatal care engagement and birth outcomes. Preconception care was chosen as a priority need based on the 2015 needs assessment. Last year, RI also chose to move its priority around oral health - improve access to oral health services - into the women’s/maternal domain and selected NPM 13a (# of women who received a preventative dental visit during pregnancy).
Maternal Health Data
Preconception Health
PRAMS data indicate that 38.5% of women had an unintended pregnancy, a gradual decrease from 42.2% in 2012-2015. While trends have been improving for all populations, disparities exist with 33.1% of Non-Hispanic Whites, 45.6% of Hispanics 45.6%, and 61.9% Non-Hispanic Blacks reporting unintended pregnancies. The proportion of women who had a preconception discussion with a health care provider decreased from 27.7% in 2012 to 24.8% in 2015. Cigarette smoking before pregnancy has decreased from 2015 (11.6%) to 2018 (8.6%), although this trend may not account for the prevalence in electronic cigarette use. According to PRAMS, the percentage of women who used multivitamins daily was 37.4% between 2014-2017.
Access to Care
According to BRFSS, 79.7% of women received a past year preventive medical visit in 2017, a slight increase from 77.3% in 2016. Cost also appears to be a factor in access to care. Among women with a household income of $35,000-$49,999, 14.2% reported that they were unable to see a doctor because of cost, compared to 6.9 % of women with a household income $50,000 or greater.
In 2018, 82.7% of infants born to pregnant women received prenatal care beginning in the first trimester, a slight increase from 81.7% in 2017. Furthermore, 1.5% of infants were born to pregnant who received late or no prenatal care in 2018, a slight decrease from 1.6% in 2017. Adequate prenatal care is a calculation that measures the appropriate utilization of care during pregnancy using two dimensions: timing of prenatal care initiation and number of expected prenatal visits. In 2018, 63.3% infants were born to pregnant women who received adequate prenatal care, a statistically significant decrease from 75.2% in 2017. Hispanic (58.0%) and Non-Hispanic Black (57.5%) pregnant women had less adequate prenatal care than Non-Hispanic White pregnant women (67.0%) for 2018.
Health During Pregnancy
The percentage of short interpregnancy interval (< 18 months) among RI resident women in 2018 was 26.1%, which is a slight decrease from 26.8% I 2017. Birth data show that 2.3% of women who gave birth in 2018 reported having a previous preterm birth. Among RI-resident women who have birth in 2018, 7.6% had gestational diabetes, 8.1% had gestational hypertension/preeclampsia, and 5.4% smoked tobacco during pregnancy.
Delivery and Postpartum Health
In 2018, 27.2% of women had cesarean delivery with a low risk first birth. The percentage of non-medically indicated early elective deliveries for 2018 was 2%. This percentage represents a continued increasing trend from 2017 with 25.2%. Between 2014 - 2018 there were less than 10 maternal deaths in RI. The 2017 maternal morbidity rate was 239.6 per 10,000 delivery hospitalizations, which increased from 209.0 per 10,000 in 2016. Hospital discharge data from 2013-2017 show that non-Hispanic Black women (306.0 per 10,000 delivery hospitalizations) had a higher maternal morbidity rate than non-Hispanic White women (179.4 per 10,000 delivery hospitalizations). Lastly, 2016 PRAMS data show that percentage of women reporting symptoms of postpartum depression was 12.6%, a slight increase from 11.2% in 2015.
The Oral Health Program (OHP) works to achieve optimal oral health for all by eliminating oral health disparities in RI while also integrating oral health with overall health. The OHP focuses on prevention of oral disease through assurance of state-level oral health and public health leadership and enhancement of community efforts to prevent, control, and reduce oral diseases across the lifespan. In addition, the OHP works with dental providers, health professionals, community partners, and the RI Oral Health Commission to build and sustain community capacity for high-quality, culturally-sensitive oral health services. Highlights of effective ongoing interventions include the expansion of services for underserved adults through the creation of an Advanced Education in General Dentistry Residency Program, continued implementation of the school-based sealant program, Seal RI!, education to families and providers on the importance of the age one dental visit through TeethFirst!, provision of mobile dental programs serving Medicaid elders in nursing homes, licensure of public health hygienists, and training of providers through an annual dentistry mini-residency, academic detailing visits, and a Medicaid adult dental learning collaborative. Last year, the MCH priority of Improving Access to Oral Health Services was moved from the cross-cutting domain to the women/maternal health domain and the following strategies were developed:
- Provide guidelines and professional development for healthcare (infant and perinatal medical providers), dental, and service (MCHB, HRSA, and HHS funded programs) providers on the importance of oral health for pregnant women and infants.
In 2018, the RI Oral Health Program contracted with two physician consultants to conduct academic detailing visits to pediatrician, family practice, and OB/GYN offices. Dr. Lisa Littman, an OB/GYN, visited six OB/GYN offices to speak with staff on the importance of oral health during pregnancy and the need to make referrals to dental offices and then left additional materials for the providers. The materials included the National Consensus Statement on oral health during pregnancy (a combined brochure on oral health during pregnancy and the age one dental visit), an Rx pad to use as referral form and consent for the pregnant woman to receive dental care, and other relevant materials.
Dr. Jennifer Levy, a practicing family physician, performed academic detailing visits to pediatrician and family practice provider offices. Dr. Levy provided support incorporating oral health into well child visits and distributed tools including sample oral health risk assessments, the Smiles for Life curriculum and RI Age One Champion and Dental Safety Net lists. Dr. Levy discusses the benefits of fluoride varnish application, the benefits of prescribing fluoride, nutrition counselling and the importance of testing well water. In addition, Dr. Levy has clinical expertise in the development of TeethFirst! resources, the AAP Oral Health online toolkit. She has also presented at the “Dining with the Dentist” and the RI Primary Care Pediatric meeting on the importance of oral health for young children and pregnant women.
Carol Cote, a Public Health Dental Hygienist contracted by the Department of Health, also provided dental expertise in pediatric medical practices. Ms. Cote was able to visit 12 sites during her contract. At each site she delivered education about the importance of the Age One Dental Visit, where to purchase fluoride varnish, how to apply and properly code fluoride varnish, observed workflow, and helped each practice establish a caries risk assessment through quality improvement methods. Ms. Cote used quality improvement tools to create a driver diagram that could be used as a framework for each site. All these resources and sample caries risk assessments, QI tools, and resources containing information about fluoride have been compiled into a binder that Ms. Cote brings to each new medical practice.
- Pilot an electronic dental referral and data collection system between dental and medical providers.
Over the past year, The RI Oral Health Program has pursued the modification of the Project
LAUNCH system, a web-based development screening referral case management system used
by pediatricians and staff at RIDOH, to create an electronic referral system between
pediatricians and dental providers. The Rhode Island Department of Education is collaborating
in this multi-agency effort given their interest in empowering Pre-K educators to make various
referrals, including to dentists. Interagency weekly meetings were put on hold in the summer
due to a Department of Administration approval review process, the need to resolve United
Way 211 directory coding and interface issues, and to allow time for the IT build. Because of
this additional review process, monthly data collection about dental referrals is delayed. The RI
Oral Health Program anticipated testing this new system in September 2019.
- Incorporate dental referral functionality into electronic health record systems used by
perinatal medical providers and Federally Qualified Health Centers with OB/GYN services.
The RI Oral Health Program continues to work with FQHCs to discuss this possibility. Unfortunately, no FQHC has decided to digitize the existing oral health referral RX pad resource into electronic health record systems. The OB/GYN Rx referral resource, which was adopted from Connecticut, helps decrease any potential concerns among dentists in treating pregnant women by providing them with a signed form from a patient’s OB/GYN provider that states routine dental care may be given.
- Maintain and promote oral health related resources (bilingual brochures, patient education flipbooks, toothbrushes, etc.) and prompts (Efforts to Outcomes Family Visiting case management system) within Family Visiting programs, WIC program sites, medical providers, and dentists.
Building off a successful partnership in 2017, the RI Oral Health Program once again partnered with the Pawtucket Red Sox (AAA minor league baseball team located in city with high rates of child poverty) for oral health sponsorship and outreach opportunities throughout the 2018 baseball season. The RI Oral Health Program provided toothbrushes for events, had targeted messaging around sealants, brushing, and finding dental care as well as hosted the 2nd annual Oral Health Night.
Efforts to Outcomes is the case management database utilized by RI’s Maternal, Infant, and Early Childhood Home Visiting (MIECHV) programs. Staff from the RI Oral Health Program and the RIDOH MIECHV program continue to regularly pull and analyze oral health assessment and referral data from two of the three RIDOH MIECHV programs. For all of 2018, there were 85 referrals were made for infants and pregnant women and 275 dental referrals total have been made since August 2016.
While there were no direct trainings of RIDOH Home/Family Visitor front line staff in 2018, an oral health presentation was given to the Successful Start Steering Committee, an interagency birth to 3 stakeholder group. The mission of this body is to ensure the development of policies and approaches that help populations of vulnerable children. As a result of this presentation, RIDOH Home/Family Visiting programs were able to order additional TeethFirst! supplies and DCYF committed to disseminating Age 1 resources. Additional outreach locations included: Pawtucket Red Sox games, pride fest, state lead poisoning centers, Narragansett Indian tribal events, and the Warwick Mall.
- Promote oral health resources and communication about early dental visits and oral health care for pregnant women through the TeethFirst! bilingual campaign for parents and families, healthcare providers, dentists, and community organizations.
The RI Oral Health Program continues to maintain a partnership with RI KIDS COUNT and its TeethFirst! initiative, which is dedicated to educating families, providers, and community organizations about the age one dental visit. A mid-year contract modification allowed RI KIDS COUNT to produce additional copies of the TeethFirst! bilingual patient education flipbook, order more TeethFirst! branded toothbrushes and brochures, and conduct focus group research of dental hygienists about the age one dental visit and providing dental care to pregnant women. Through RI KIDS COUNT, the RI Oral Health Program purchased an additional 4,250 TeethFirst! Age 1 brochures, 4,250 TeethFirst! pregnant women and Age 1 combo brochures, 1,000 TeethFirst! toothbrushes, and 425 TeethFirst! flipbooks between April and July 2018. All toothbrushes were branded with the TeethFirst! Logo and will be distributed in a variety of locations where families may visit.
- Support family planning at Title X agencies.
RIDOH’s Family Planning Program supports twenty-eight family planning services sites, including twenty-three federally qualified community health center sites, three school-based health centers, a teen clinic operated by Planned Parenthood of Southeastern New England, and services at the RI Women’s Division of Corrections. The family planning service sites provide comprehensive, accessible, affordable, and confidential Title X family planning services to culturally diverse, primarily low-income women, men, and adolescents. Family planning services include contraceptive services, preconception care, reproductive life planning, reproductive health counseling, HIV screening and referral, STI testing and treatment, and related preventive health services. The confidentiality and affordability of Title X services provide a critical safety net, particularly for low-income, uninsured individuals and minors. Family planning services are often an entry point into the healthcare system. Title X family planning clinics provide referrals to other clinical specialties and community-based supports, including prenatal care and home visiting, as appropriate. In CY2018, Title X agencies provided family planning services to over 29,000 women, men, and adolescents. Among unduplicated Title X clients served in CY2018: 26% were less than 20 years of age; 21% were male; and 12% were uninsured.
To further support preconception care, the Family Planning Program partners with the Center for Health Data & Analysis (CHDA) to provide multivitamins with folic acid to women of reproductive age at Title X family planning clinics. Folic acid supplementation reduces the likelihood of neural tube birth defects.
- Promote routine pregnancy intention screening with the OKQ.
To promote reproductive health counseling that encourages planning and empowers individuals to clarify reproductive health needs and intentions, RIDOH Family Planning has provided training and technical assitance on pregnancy intention screening. The One Key Question® model (“Would you/and your partner like to become pregnant in the next year?”) encourages routine pregnancy intention screening. In preparation of OKQ implementation, all Title X family planning agencies received training on the OKQ model, as well as preconception care and reproductive life planning. Six of eight Title X have implemented routine pregnancy intention screening with the OKQ model; the other two Title X agencies are working on systematically scaling up screening. RIDOH Home Visiting programs have integrated pregnancy intention screening into their intake forms and developed protocols for routine screening.
RIDOH Family Planning has also engaged partners throughout the state and across sectors and specialties, including primary care, Head Start, Early Intervention, and substance use treatment providers, to consider integration of routine pregnancy intention screening in their practices. RIDOH Family Planning has presented on pregnancy intention screening at 2018 Reproductive Health Summit, the 2018 Neonatal Abstinence Syndrome Conference, and the 2018 Conference on Youth Sexual Health Education.
- Coordinate Preconception Health social marketing campaign.
RIDOH has developed social marketing materials to promote preconception care, including print ads, webpage banners, vinyl banners, and radio PSAs that includes messaging related to “Thinking about having a baby? Be healthy. Be ready.” Social marketing materials have been shared via Pawtucket Red Sox program book and game day radio announcements, RI Pride website and RI PrideFest activities, and at community outreach events throughout the state. RIDOH Family Planning and the Center for Center for HIV, Hepatitis, STD, and TB Epidemiology developed and released the Right Time app to provide sexual/reproductive health information, including where to find free condoms, family planning services, HIV/STI testing, and an “Ask the Expert” feature. As of May 2019, the Right Time has been downloaded by 2,500 users.
- Improve coordination of transition from OBGYN to primary care.
Medicaid coverage for pregnant women is terminated at 60-days postpartum, however RI’s Medicaid 1115 waiver provides additional coverage via the “Extended Family Planning Benefit” (EFP). For women with a Medicaid covered birth, the EFP provides coverage of family planning services for two years postpartum. Access to health insurance is critical to ensure continuity of care. Although the ACA requires all individuals to have health insurance and RI has expanded Medicaid, maintaining continuity of coverage can be a challenge and many people experience instability with gaps in coverage. The EFP provides a safety net for family planning services, particularly for women the eligibility threshold for Medicaid coverage of 138% FPL and the prenatal Medicaid eligibility of 250% FPL. RIDOH academic detailing activities with OB-GYN practices included questions regarding protocols for insurance enrollment services and referrals. RIDOH worked in collaboration with RI Prematurity Task Force to review communications sent by insurers to their pregnant members regarding continuity of insurance coverage and transition to primary care.
- Integrate preconception care into undergrad/graduate/continuing education and training for clinical providers and allied health professionals.
RIDOH partnered with the RI HIV & STI Prevention Coalition and the RI Prematurity Task Force to provide preconception health focused professional development opportunities with continuing education credits for physicians, nurses, social workers, and certified health education specialists.
- Promote reimbursement of Long-Acting Reversible Contraceptives (LARC) during post-partum period.
RIDOH and Prematurity Task Force conducted a Contraceptive Access Survey to RI clinical providers to assess providers’ perceptions of barriers to contraceptive access. With over 100 responses, RIDOH presented survey findings to Medical Directors of RI insurance companies to facilitate discussion of postpartum LARC reimbursement for commercial insurance plans. RIDOH has worked with the insurance companies to assess existing practices for LARC reimbursement to identify any potential barriers to access. RIDOH has worked in collaboration with the RI Governor’s Office to explore opportunities for funding and statewide professional development programs to promote access to contraception, including LARC methods.
Adult Immunization Registry – During the 2019 legislative sessions, RIDOH proposed legislation to expand the State’s childhood immunization registry to include adults. With passage of the bill, the Immunization Program and KIDSNET will move ahead to finalize development of the Rhode Island Child and Adult Immunization Registry and begin testing and implementation. Many adults receive vaccines at non-primary care sites such as pharmacies, workplace and community clinics. A vaccine registry facilitates the secure sharing of this information with the primary care and specialty care doctors who are coordinating care. A lifelong registry will help eliminate unnecessary re-vaccination that both saves health care costs and reduces inconvenience to patients. A registry is also a source of information for the public to easily obtain comprehensive immunization records that they may need for employment, education, travel, etc. A lifelong registry will further assist with the rapid collection of vaccination status and dissemination of that data is critical to disease prevention and containment during an outbreak. The infrastructure to monitor, track and communicate vaccination status must be in place and fully operational prior to the outbreak to appropriately target resources and contain disease spread. Lastly, to effectively achieve prevention of vaccine preventable diseases, a certain coverage level within the community must be maintained. This prevents the spread of disease seen in unvaccinated communities where the disease jumps from one unprotected individual to another. Having adults included in the registry allows RIDOH to monitor adults at the population level to identify communities/sub-populations at risk for spread of disease. A registry also allows targeted education and outreach to less well vaccinated populations and individuals.
Maternal Mortality Review Committee - The maternal mortality rate in RI for the five years 2013-2017 is 11.2 per 100,000 live births. During this five year period, there were 6 cases of maternal deaths (death within 42 days of giving birth). Given the state’s small size and small population, trends in mortality rates for certain subpopulations can be challenging to interpret and even more challenging to utilize to inform public health actions. With low numbers of cases, in depth case reviews can identify public health and other system changes that might prevent future deaths from similar causes. In addition, focusing on interventions to reduce maternal morbidity and address its root causes is important in addressing the drivers for maternal mortality that may not be gleaned from the small number of mortality case reviews.
In June 2018, the RI General Assembly passed an amendment to RIGL “An Act Relating to Health and Safety – Office of State Medical Examiners” which adds the multi-disciplinary maternal mortality review committee (MMRC) to the review of the office of the state medical examiner and extends immunities and confidentiality agreements to multidisciplinary teams. RI is plans to stand up a functioning MMRC by the end of 2019.
AMCHP Infant Mortaility Collaborative Improvement and Innovation Network (CoIIN) - is a multi-year national initiative supported by the Maternal and Child Health Bureau (MCHB) of the Health Resources and Service Administration (HRSA). CoIINs are multidisciplinary teams of federal, state, and local leaders working together to tackle a common problem. Using technology to remove geographic barriers, participants with a collective vision share ideas, best practices, and lessons learned, and track their progress toward similar benchmarks and shared goals. CoIIN provides a way for participants to self-organize, forge partnerships, and take coordinated action to address complex issues through structured collaborative learning, quality improvement, and innovative activities. For the last two years, RI has participated in the Social Determinants of Health Workgroup which holds monthly technical assistance calls, webinars, and an annual in person meetings. The Disparities in Infant Mortality Advisory Committee was formed as a result of participating in this CoIIN. Two policy initiatives are being pursued through this work: 1) increasing access to Doulas and 2) revising the current birth center regulations. Recently, AMCHP was successful in recruiting Dr. Joia Crear-Perry of the National Birth Equity Collaborative, to become RI’s team coach. RI is thrilled to be working with Dr. Crear-Perry and looks forward to learning from her during the remaining year of the project.
Disparities in Infant Mortality (DIM) Advisory Board - When undertaking the IM CoIIN project, RIDOH sought to convene a diversity of stakeholders in order to thoroughly assess the nuances of why certain gains made in supporting pregnancy and the perinatal period were not being felt by all segments of the population in the state. For the Disparities in Infant Mortality Advisory Board, RIDOH prioritized identifying women of color active in the perinatal health community at the community-level, as well as diverse stakeholders in perinatal health. Community-level stakeholders represented doula work and a parenting support and education agency. Other stakeholders included health care providers and public health. RIDOH invited public health representatives from the Center for Health Data and Analysis (CHDA), the Family Home Visiting Program (FHV), the Maternal and Child Health (MCH) program leadership, as well as the Health Equity Institute (HEI). In its first year the DIM group brought together 12 individuals representing 4 diverse stakeholder groups. Heading into the second year of the group, stakeholders representing policy and advocacy, as well as community organizing were added and membership increased to 16 individuals. The DIM advisory board meets monthly to discuss data, consider the perspectives of women of color in the community as shared by the advisory board members, and develop recommendations for the MCH leadership team. Seeking to follow in the footsteps of Oregon, Minnesota and most recently New York City, the DIM group considered how to put a strategy forward for doula reimbursement for Medicaid beneficiaries. During the first year of the group we found out that members of the nonprofit sector were putting forth a doula reimbursement bill with the state legislature. With the drafting of this bill, and the invitation to the DIM group of the policy analyst responsible for writing the bill- RIDOH saw an opportunity to inform regulatory revisions that could produce the intended results and increase the capacity of the state’s doula workforce, through appropriate reimbursement for time spent with clients and the services provided. The Doula Bill (H5609), introduced by RI state representative Marcia Ranglin-Vassell, introduced this legislative session, and have would mandated reimbursement for doula services by both private and public insurers, but referred to House Finance for analysis. The DIM advisory board and the MCH program will work with community advocates over the next year and continue to advise on different aspects of the bill.
Birth Centers Regulatory Advisory Committee - Seeking improved access to low-intervention models of care, the MCH Program saw an opportunity to help revise key facilities regulations through a process that mandated every state agency to re-open and revisit all of its regulatory processes. The Birth Centers Regulatory Advisory Committee (BCRAC) was a collaborative effort between the RIDOH MCH program and Health Facilities Regulations program. In response to requests for further discussion on revisions to the regulations, RIDOH established and convened the BCRAC, including representatives from the obstetrics/gynecology, midwifery, community health worker, and doula professions among its membership. The goal of the BCRAC was to draw together these various interested party groups, review/discuss the Regulations, receive detailed input on possible revisions to the regulations, and produce a report on the BCRAC’s findings for presentation to the Director of RIDOH. The BCRAC met 6 times during period of 5 months. The recommendations will then be implemented at the discretion of the RIDOH Director and the department’s facilities regulations team. This is the first advisory committee of its kind at the department of health focused on regulations. The MCH program was instrumental in recruiting a diverse cross-section of participants from the community to serve on the committee, which is a testament to its partnerships and collaborations in the community. The regulations are expected to go through the formal review process again this summer/fall before they are codified.
Maternal Psychiatry Resource Network (MomsPRN) Program - The MomsPRN Program is a new statewide initiative at the RI Department of Health, funded by HRSA-18-101 Screening and Treatment for Maternal Depression and Related Behavioral Disorders Program, that seeks to assist obstetrical, adult primary care, pediatric, and adult psychiatric providers in optimizing behavioral health care for pregnant and post-partum women. To achieve this end, a psychiatry consult line that is staffed by perinatal experts at the Center for Women’s Behavioral Health at Women and Infants Hospital is available to help answer clinical and referral questions among calling providers caring for pregnant and postpartum women. Additional individualized quality improvement coaching will be provided to prenatal care practices seeking to implement maternal behavioral health screening, referral and treatment into their workflow. Ongoing continuing education and evaluation efforts will be used to enhance care, identify improvements, share best practices, and measure outcomes.
Doula Workforce Study - RIDOH conducted a cross-sectional survey via Survey Monkey to collect information on doula demographic characteristics, doula training and practice, and doula client characteristics in RI. The survey was anonymous and voluntary. Thirty four 34 Doulas participated and twenty-six (26) completed the entire survey. The information will be used to inform the work of the MCH Program.
Community Health Network (CHN) is RI’s centralized referral system for all Evidence Based Lifestyle Change Program (EBLPs) that was created in 2012 in response to data collected in 2011 through Rhode Island’s Patient Centered Medical Homes Needs Assessment Survey. Since its inception, the CHN has provides a strong foundation for RI primary care practices as a referral mechanism for their patients to be able to effectively manage their chronic diseases. Managed by the Rhode Island Parent Information Network (RIPIN), the CHN utilizes Patient Navigators (PNs) to receive the referrals, contact the patients, provide program information, and place interested individuals into classes that best meet their healthcare needs. In 2017, 136 providers in 28 practice locations referred 921 to programs in the CHN. The programs currently housed under CHN are:
- Tools for Healthy Living - Chronic Disease Self-Management - This evidence-based education workshop teaches people how to manage symptoms and medications, communicate with family and doctors, relieve stress, eat well, exercise, and set attainable goals.
- Diabetes Prevention Program - This evidence-based education workshop teaches people how to lower their risk of getting Type 2 Diabetes by eating healthier, increasing physical activity and losing weight.
- Diabetes Self-Management - This evidence-based education workshop teaches people to deal with symptoms of diabetes, fatigue, pain, hyper/hypoglycemia, stress, and emotional problems such as depression, anger, fear, and frustration.
- Certified Diabetes Outpatient Education Program - CDOEs are Registered Nurses, Dietitians and Pharmacists who teach patients how to manage their glucose, blood pressure, cholesterol, medication, and nutrition.
- Enhance Fitness Program (YMCA) - Group exercise program that uses simple, easy to learn movements that motivate people with or without arthritis to stay active throughout their lives. The class is ideal for people who may be new to group exercise and want to have fun while exercising. People in the program experience improved physical strength, increased flexibility, better balance, enhanced cardiovascular fitness and reduced arthritic pain.
- RI Smoker’s Helpline – This Program provides tobacco cessation educational training for physicians and other healthcare providers, training and support on use of fax-referral system to the Smokers’ Helpline for patients who desire to quit smoking and follow up report on patient progress with Program.
- Walk w/ease - The Arthritis Foundation Walk with Ease program is designed to help people living with arthritis better manage their pain and is also ideal for people without arthritis who want to make walking a regular habit. Led by a certified leader, this program has been shown to reduce pain and increase balance and walking pace.
- Matter of Balance: Managing Concerns About Falls - Facilitated by Peer Leaders, these group workshops teach techniques to reduce fears of falling and increase activity levels among older adults.
- Chronic Pain Self-Management Program – This workshop provides you with the tools to manage medications, fatigue, frustration, proper nutrition, and communication skills, and teaches you to evaluate treatments and make an action plan.
- Powerful Tools for Caregivers: This workshop allows caregivers to develop a wealth of selfcare tolls to reduce personal stress, change negative self-talk, communicate their needs to family members and healthcare providers, communicate more effectively in challenging situations, recognize the messages in their emotions, deal with difficult feelings, and make touch care-giving decisions.
RI WISEWOMAN Program - The Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) Program focuses on reducing cardiovascular disease risk factors among high-risk women. Addressing risk factors such as high blood pressure, elevated cholesterol, obesity, inactivity, diabetes, and smoking greatly reduces a woman’s risk of CVD-related illness and death. The purpose of the WISEWOMAN program is to: 1) assure that cardiovascular screening is provided to women 30 and older who are eligible for the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) or RI Medicaid eligible between 30-64 years; 2) work with community-based organizations to provide evidence-based prevention services to those women in need (through individualized lifestyle coaching and/or agreements with organizations such as the YMCA, Weight Watchers, and those that provide Diabetes Primary Prevention Programs); 3) improve the management and control of hypertension by integrating innovative health system-based approaches and strengthening community-clinical linkages (such as team-based care, self-measured blood pressure monitoring, and pharmacy medication management programs); and 4) gather and reporting program related evaluation data, including impact measures.
The RI WISEWOMAN Program is offered at Federally Qualified Health Centers and free clinics.
An eligible WISEWOMAN member is given a heart health assessment/screening to determine their risk factors and willingness to change. This assessment is completed with the member, health risk factors for CVD are review. Screening questions responses, clinical measures, and risk reduction counseling is written into My Heart Health Booklet and given to the member. A referral(s) is made to the Community Health Network based on the members SMART Goals. The WISEWOMAN Program has enrolled 972 unique women from June 2014 through April 2018. Of the 972 women, 1392 Screenings, Re-Screening, and Follow-Up Assessments have been completed from June 2014 through April 2018. The WISEWOMAN Programs continues to partner with community resources throughout RI and offer free memberships to our WISEWOMAN members through the CHN Referral Program. This referral system enables WISEWOMAN members to choose a health behavior support services with their health care team at the WISEWOMAN sites. From 972 unique women, 1785 referrals were made through the CHN. Of the 1785 referrals made to the CHN, 208 unique women were referred to LSP and participated 511 times; 529 women were referred to gyms, Jazzercise, yoga, and smoking and participated 3910 times; 212 women were referred to HCP and participated 318 times.
Women’s Cancer Screening Program - The Women’s Cancer Screening Program (WCSP), RI Cancer Registry, and the Comprehensive Cancer Control Program implement a coordinated approach to inform policy, systems, and environmental change strategies to prevent and control cancer. The WCSP works to enhance the existing state-wide infrastructure with health systems to provide breast and cervical cancer screening services to uninsured and underinsured women and to implement key evidenced-based strategies to reduce structural barriers to screening within health systems. The WCSP works collaboratively with other RIDOH programs and a network of community-based partnerships that provide services to underserved women and focus on health care systems that provide essential primary care services to the most vulnerable populations in RI. The goal of the WCSP is to decrease breast and cervical cancer incidence, morbidity, and mortality by focusing on underserved populations in RI who have increased cancer risk. These outcomes are accomplished by implementing key evidence-based strategies to reduce structural barriers within health systems including increasing breast and cervical cancer screening services, eliminating barriers to accessing screening, and follow-up and referral for treatment. A large proportion of the work is spent partnering with the RI Federally Qualified Health Centers (FQHC) and Free Clinics to implement health systems change to drive and improve age appropriate cancer screening.
Over the past 20 years, the WCSP has provided breast and cervical cancer screening services to approximately 37,000 program eligible women including 53,404 mammograms, 47,955 Pap tests diagnosing 502 breast cancers and 39 invasive cervical cancers. Over 2,300 women have been navigated and enrolled into Medicaid through the WCSP to cover the cost of treatment related to a precancerous breast and/or cervical condition or to cover the cost of treatment needed for women with a diagnosis of breast or cervical cancer. The WCSP Program Manager (PM) has worked with the WCSP for the past 21 years and all WCSP staff have worked together with the program for over 13 years. The WCSP staff are seasoned staff serving as the backbone of the program. The staff provide ongoing support to all providers, clinicians and their office staff ensuring provider compliance with program requirements and policies.
To Top
Narrative Search