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WOMEN/MATERNAL HEALTH DOMAIN 

SUMMARY/OVERVIEW

FY21 ANNUAL REPORT

 

DOMAIN CONTRIBUTORS

 

Maternal and Infant Health (MIH) Consultant – Division of Child and Family Health

Reproductive Health Unit – Division of Child and Family Health

MCH Epidemiology – Division of Population Health Data

Division of Death Prevention – Office of the Chief Medical Examiner (OCME)

Dental Health Program – Division of Prevention and Health Promotion

VDH Local Health Districts

 

MATERNAL AND INFANT HEALTH (MIH) CONSULTANT: The MIH Consultant serves as subject matter expert housed at VDH’s Central Office who partners closely with an array of state and local partners, including the Virginia Neonatal Perinatal Collaborative (VNPC), the Maternal Mortality Review Team, and the recently-formed maternal mental health workgroup and Pathway to Coordinated Care for Infants and Families (PCC) workgroup. The MIH Consultant position was vacated in February 2020; however, a new consultant has been hired and will start in late August 2022.

 

REPRODUCTIVE HEALTH UNIT: This unit is led by the Reproductive Health Unit Supervisor, and includes the following programs and funding streams:

• Title X Family Planning (Title X): Clinical family planning programs consistent with Title X requirements and Quality Family Planning Services as defined by the CDC
• Contraceptive Access Initiative (TANF, Title V): Clinical contraceptive care for low-income patients without insurance
• Doula Certification Program and Task Force (Unfunded): State Program offering doulas the opportunity to earn state certification and to work together to promote doula services across the Commonwealth
• State Funding for Certain Abortions (General Funds): Abortion services for Medicaid members in cases of rape, incest, or incapacitating fetal anomaly
• Adolescent Health Program (Sexual Risk Avoidance Education, Title V): Positive youth development programs that build protective factors among participants that will make them less likely to initiate sexual activity
• Resource Mothers (TANF, Title V): Adolescent health program providing support services to pregnant and parenting teens and their families (Of note, the Adolescent Health Program and Resource Mothers Program are detailed in the Adolescent Health Domain)
• This unit works closely with the 35 LHDs to provide over $3.5 million in annual funds to support their local maternal and infant health programs and initiatives, providing quarterly recorded meetings via webinar platform for technical assistance and allow LHDs to share lessons learned across LHDs and programs. 

 

DIVISION OF DEATH PREVENTION:  The Division of Death Prevention, located in the Office of the Chief Medical Examiner, is responsible for several epidemiological surveillance and fatality review programs, including the Maternal Mortality Review and Child Fatality Review Teams. The MMRT is a multidisciplinary group with representatives from academic institutions, behavioral health agencies, hospital associations, state chapters of professional associations, state medical societies, and violence prevention agencies.  The MMRT collects data on and reviews the deaths of all Virginia residents who were pregnant within a year of their deaths regardless of the outcome of the pregnancy or the cause of death.  These deaths are termed “pregnancy-associated deaths”.  The MMRT is dedicated to the identification of all pregnancy-associated deaths in the Commonwealth and the development of recommendations for interventions in order to reduce preventable deaths.  Each case is reviewed by the MMRT to determine the community-related, patient-related, healthcare facility-related and/or healthcare provider-related factors that contributed to the woman’s death.  The MMRT also assesses and recommends needed changes in the care received that may have led to better outcomes.  Consensus decision-making is used to determine whether the death was preventable and/or related to the pregnancy.

MCH EPIDEMIOLOGY: The MCH Epidemiology and Evaluation Unit is a centralized epidemiology unit within the Division of Population Health Data headed by the MCH Epidemiology Supervisor who serves as the Lead Epidemiologist for Title V. The team has additional capacity available through a Reproductive and Perinatal Health (RPH) Epidemiologist and a Newborn Screening (NBS) Epidemiologist, a Dental Health Epidemiologist/Evaluator, and two program evaluators supporting MCH programs regarding home-visiting (i.e., Healthy Start, MIECHV), and child and adolescent health. Additional cross-cutting support is provided by the Injury and Violence Prevention Epidemiologist.

 

VDH LOCAL HEALTH DISTRICTS:  Each of VDH’s 35 local health districts (LHDs) receive Title V funds to drive and support maternal and child health programmatic initiatives at the local level.

 

DENTAL HEALTH PROGRAM: The DHP performs many duties including the provision of the following:  Educational activities and resources to a wide variety of partner groups to promote proper oral hygiene and support prevention services and access to dental care; direct clinical preventive services and assistance with establishing a dental home; quality assurance review to assure a competent public health oral health workforce; and, surveillance and evaluation activities to monitor and track dental disease rate and trends as part of program assessment for effectiveness and planning. 

 

STATE ACTION PLAN UPDATES

 

PRIORITY 1:  Maternal and Infant Mortality Disparity:  Eliminate the racial disparity in maternal and infant mortality rates by 2025

 

 

OBJECTIVE	By 2025, decrease the disparity in black-white maternal mortality disparity ratio from 2.1 (2017) to 1.2 (2025).
OUTCOME MEASURE	SOM 2:  Maternal Mortality Disparity: Black/White Maternal Mortality Ratio

 

Review of maternal mortality data from 2018 indicates that Virginia’s maternal mortality rate of 15.6 per 100,000 pregnancies largely mirrors the national mortality rate of 17.4 per 100,000; however, the maternal mortality rate of black women (47.2) is over two times higher than that for white women (18.1). PRAMS data from the same period indicated that Black women were more likely to report chronic conditions like hypertension and depression, and more likely to report experiencing discrimination or harassment due to their race/ethnicity or insurance or Medicaid status.   Additionally, the 2019 Maternal Mortality Review Team (MMRT) report showed that Black women with at least one chronic condition had a maternal mortality rate over twice that of their white counterparts (51.4 versus 25.1, respectively).  When combined with rising rates of pregnant women with substance use disorder, and an unplanned pregnancy rate of almost 50%, Virginia’s 2019 Maternal Health Strategic Plan (attached document) sets an ambitious yet imperative goal of eliminating the racial disparity in maternal mortality by 2025.  This plan outlines six specific focus areas with strategies and recommendations for achieving this goal.  The focus areas are:  Insurance coverage, healthcare environment, criminal justice and child welfare response, community-based services, contraception, and data collection.  Title V’s strategies in the Women/Maternal Health Domain complement and advance the recommendations made in the Maternal Health Strategic Plan.

 

Strategy 1:  Work with stakeholders to increase access to doula services among women of color

During the 2020 General Assembly Session, Virginia legislators tasked VDH with establishing a State Doula Certification Program in order to make doula services more accessible to all people, but specifically to Black women, who experience the highest maternal mortality rates of any population in Virginia.  In order to accomplish this, VDH’s Reproductive Health Unit convened stakeholders to develop state regulations that will guide the program.  Stakeholders included doulas, clinicians, advocates, and representatives from Department of Medical Assistance Services (DMAS), Virginia’s Medicaid Program.  VDH and DMAS worked in concert so that when the doula certification program is launched in FY22, certified doulas will then be able to apply to become a Medicaid provider.  Medicaid coverage for doulas will open access to low-income families and help to address the racial maternal mortality disparity in Virginia

An official Doula Task Force convened in FY21 to provide the opportunity for doulas, providers, consumers, and payers to provide continuous feedback to the State Doula Certification Program throughout program implementation. The purpose of this task force is to assist with the promulgation of regulations and the certification process of doulas, as well as to serve as an informational resource for policy-related matters for VDH.  The task force consists of fifteen members representing the following areas of expertise:

• Three individuals who are not doulas and who received doula services during their previous pregnancies
• Seven representatives who are doulas working independently, as part of a collective, or as part of a private or community-based provider organization
• Three representatives who are clinical providers, including at least one OB/GYN and one certified nurse midwife
• One representative of a professional organization for hospitals
• One legislative member with a demonstrated interest in maternal and child health
• VDH and DMAS representatives serve as ex-officio members

Strategy 2:  Maintain Title V representation on the Virginia Neonatal Perinatal Collaborative (VNPC) Steering and Executive committees, and Title V representation in selected workgroups.

Beginning February 2020, the Virginia Neonatal Perinatal Collaborative (VNPC) moved to Virginia Commonwealth University through a contract with VDH providing contract administration, epidemiological support, and is represented on all VNPC committees. In collaboration and coordination with Virginia’s 54 birth hospitals, VNPC is currently focusing on three quality improvement (QI) projects based on the Alliance for Innovation on Maternal Health (AIM) patient safety bundles : (1) reduce the use of inpatient intravenous antibiotics at hospital nurseries/NICUs; (2) decrease the rate of severe maternal morbidity attributable to obstetric hemorrhage; and in FY21, (3) care coordination from delivery to the post-partum visit and then transition to annual women’s health, also known as the fourth trimester.  Virginia is one of three states to pilot the 4th trimester bundle, with 51 birth hospitals currently participating in the bundle. Title V participates in VNPC’s Sister Agency Monthly call, alongside MCH representation from all state-level agencies. VNPC facilitates a perinatal cannabis workgroup, which formed in response to Virginia's July 2021 marijuana legalization legislation.  Title V is active in this workgroup, which is focusing on awareness and education at both the provider and community levels. VNPC offers a monthly webinar series for state perinatal stakeholders which are well attended each month.  VNPC also hosts two annual summits, both of which were virtual during FY21.  The 4th Annual VNPC Summit was held on October 4, 2020, themed around “respectful care”.  The Perinatal and Infant Mortality Summit occurred on March 2, 2021. Both summits had over 100 attendees from state, district and local community organizations.

 

Strategy 3:  Strengthen and expand MCH capacity at the local health district level

 

Thirteen of 35 local health districts prioritized maternal and infant mortality disparity in their annual work plans.  Local activities include:  Conducting local area environmental scans and gap analyses of maternal and infant mortality; strengthening community partnerships to increase referrals for the Black and Hispanic birthing population to home visiting programs; collaborating with community partners, including FQHCs, to develop stronger referral processes for appointments and care coordination of women with chronic medical conditions and those at risk of poor outcomes, including focuses on health literacy and health system navigation; partnering with local housing and food bank resources to strengthen community-centered support; strengthening of current educational resources provided to women who utilize current LHD clinics.

PRIORITY 2:  MCH data capacity:  Maintain and expand state MCH data capacity, to include ongoing needs assessment activities, program evaluation, and modernized data visualization and integration

 

OBJECTIVE	By 2025, decrease the disparity in black-white maternal mortality ratio from 2.1 (2017) to 1.2 (2025)
OUTCOME MEASURE	SOM2:  Maternal mortality disparity:  Black/white maternal mortality ratio

 

Strategy 1:  Sustain state maternal mortality and child fatality review programs, engaging with cross-sector partners and addressing social determinants of health in development of MMRT and CFRT recommendations

 

Activities of the Maternal Mortality Programs included the coordination and facilitation of bi-monthly Maternal Mortality Review Team meetings. These activities included case selection for each meeting, requesting records from health, social, and community based agencies that were used in the review, review of those records, and determination of inclusion or exclusion in the review, as well as scanning the record for additional information that could be collected from other providers for use. Due to COVID-19 restrictions, the Team successfully implemented virtual review team meetings. After each review team meeting, data from the review team meeting was entered into the MMRIA system by the Maternal Mortality Programs Manager and Maternal Mortality Research Assistant.  The Programs Manager also maintained and reviewed the recommendations from each review meeting for applicability and appropriateness based on the review topic and current data trends.

 

Additionally, in an effort to disseminate the findings and recommendations of the Maternal Mortality Review Team, Dr. Melanie Rouse participated in several dissemination activities. These activities include the following:

• Dr. Melanie Rouse was an invited speaker during a Virginia Children’s Health Insurance Program Advisory Committee meeting, December 2020.
• Dr. Rouse was the guest speaker and discussion facilitator regarding racial disparities in maternal mortality during a Grand Rounds on Maternal Mortality and Morbidity for OBGYN students at Virginia Commonwealth University, February 2021.
• Dr. Rouse was an invited speaker at the Virginia Neonatal Perinatal Collaborative Perinatal, Maternal and Infant Mortality Summit regarding maternal mortality and racial disparities in Virginia, March 2021.

The Maternal Mortality Programs Manager collaborated with the VNPC to develop a shared vision plan which aims to improve maternal and infant health across the Commonwealth through data-driven, evidenced based collaborative initiatives. The programs manager also engages in monthly VNPC-led Maternal & Infant Sister Agency Workgroup meetings to (1) identify shared goals, priorities, and strategies, (2) eliminate silos across state sister agency maternal and infant leads, and (3) meaningfully collaborate on shared deliverables of interest to improve maternal and infant health outcomes in Virginia.

Using data from the Maternal Mortality Surveillance Program, the OCME provided data to DPHD related to maternal health and health disparities for use in data briefs and other materials when requested.  The Maternal Mortality Surveillance Program is the hallmark data program for maternal mortality, which not only includes data collection, but also data analysis and subject matter expert input. The OCME also serves as a subject matter expert and will review data briefs and other materials as requested by DPHD once developed and before dissemination of materials.

The Maternal Mortality Review Team contributed to consumer and family engagement and partnership through the continued efforts in reducing maternal mortality.  The impacts of maternal mortality are far reaching, including links to reduce mental health and other socioeconomic disparities that greatly influence a person’s wellbeing.  Additionally, the work of the MMRT has identified key risk factors that affect maternal mortality and the higher the number of risk factors, the greater the likelihood of a fatal event.  Risk factors include:

• Chronic diseases
• Chronic mental illness
  • Depression
  • Anxiety

• Chronic substance use disorder
• Intimate partner violence

The addition of a MMRT Research Associate allowed for the expansion of the MMRT program to include more in-depth data collection and analysis. The hiring of this research associate also allowed for a new tool to be developed so that the 2015-2017 backlogged data could be collected and allow for a more comprehensive database in future years. Additionally, the addition of the MMRT Research Associate gave the Maternal Mortality Programs Manager more ability to focus efforts on data analysis, policy development, and data dissemination, as the research associate is responsible for many administrative tasks formerly managed by the Programs Manager.

Strategy 2:  Convene the Maternal Health Data and Quality Measures Task Force as mandated by HB2111 to evaluate maternal health data collection processes

Virginia House Bill 2111 (2021) established the Maternal Health Data and Quality Measures Task Force for the purpose of evaluating maternal health data collection to guide policies in the Commonwealth to improve maternal care, quality, and outcomes for all birthing people in the Commonwealth. With representation from multiple disciplines and organizations, the provisions of the bill require the Task Force to monitor and evaluate relevant stakeholder data, including third-party payer claims and mandated sources, to examine quality of care with regard to race, ethnicity, and demographic, as well as the impact of social determinants of health on outcomes. The first Task Force meeting was held in March 2022. The MCH Epidemiologist Lead serves as a subject matter expert/member on this Task Force, and the DPHD Director serves as an ex officio member.

PRIORITY 3:  Reproductive justice and support:  Promote equitable access to choice-centered reproduction-related services, including sex education, family planning, fertility/grief support, and parenting support

 

OBJECTIVE	By 2025, reduce the rate of mistimed pregnancies from 25.3% (PRAMS 2018) to 21.8%
PERFORMANCE MEASURE	SPM 4 – Pregnancy Intention: Mistimed or Unwanted pregnancy (wanted to become pregnant later or never)

 

Strategy 1:  Work with stakeholders to remove policy, financial, and training barriers to contraceptive access

VDH’s Reproductive Health Unit includes several programs dedicated to Title V populations and priorities, including the Contraceptive Access Network, the Virginia Contraceptive Access Initiative, the Title X Family Planning Program, the Adolescent Health Program, Resource Mothers, the Doula Certification Program and Task Force, and the Pregnancy Loss Services Initiative.

 

The Contraceptive Access Network is a group of agencies working to reduce unintended pregnancies among people of childbearing age and increase access to comprehensive, quality family planning services. This group was originally developed to address infant mortality, recognizing the role of contraceptive access on maternal and infant health. The group is facilitated by VDH, meets twice a year, and includes over 70 members from a variety of community-based health centers, governmental organizations, hospital systems, payers, and community members.

 

The Contraceptive Access Network collaborated to successfully advocate for the Virginia LARC Initiative, a two-year pilot program designed to increase access to hormonal LARCs (long acting reversible contraceptives) among uninsured, low-income patients that began in 2018. Funded through federal TANF funds allocated by the Virginia General Assembly, the LARC Initiative allowed VDH to contract with eighteen health providers to offer LARC insertions and removals to eligible patients. During its two year pilot period (October 2018-July 2020), the Virginia LARC Initiative provided approximately 3,986 no-cost visits to eligible patients. In July 2020, the Virginia General Assembly expanded the scope of the program to cover all-FDA approved methods of contraception, and thus the program’s name changed to the Virginia Contraceptive Access Initiative. During SFY 21 (July 1, 2020-June 30, 2021), the expanded program provided 6,785 no-cost visits to eligible patients, representing an enormous increase in patients served. Title V funds support VDH staff time spent administering this program.

 

VDH’s Title X Family Planning program provides comprehensive family planning services at approximately 140 clinical sites across the Commonwealth, including 34 local health districts and 3 federally qualified health centers. As the nation’s only federally funded family planning program, Title X provides structure, funding, and technical support to clinics providing family planning services according to CDC’s Quality Family Planning Services guidelines. The Title X Family Planning program is not directly supported by Title V funds, but Title X compliments Title V by supporting family planning services beyond those provided by the Virginia Contraceptive Access Initiative. 

 

PRIORITY 4:  Mental Health

 

 

OBJECTIVE	By 2025, reduce the percent of women who reported loss of interest or feeling depressed (postpartum depression) from 14.4% (PRAMS 2019) to 13.7%
PERFORMANCE MEASURE	SPM 6 - Promotion and strengthening of optimal mental health and well-being through partnerships and programs

 

Perinatal mental health (PMH) conditions, including perinatal mood and anxiety disorders or PMADS, are one of the most common complications in pregnancy, affecting 1 in 7 birthing individuals in the United States; however, PMH affects birthing individuals who are members of vulnerable groups, marginalized and underserved communities are affected at a much higher rate.  PMH conditions impact the mother-baby dyad in significant ways:  less engagement in medical care, preterm delivery, low birthweight and NICU stays, lactation challenges, bonding and attachment issues, cognitive and motor delays in the baby, and adverse partner relationships. We also know that 100% of pregnancy-related mental health deaths were preventable.  Before COVID-19, the CDC estimated that one in eight women experienced postpartum depression, and about five to seven percent experienced major depressive symptoms.  Two COVID-19 studies which collected survey data on maternal mental health and breastfeeding during the pandemic indicated that a third of women screened positive for depression and one-fifth for major depression.  One in five who screened positive for postpartum depression reported thoughts of harming themselves. In the state of Virginia, 11.77% of 2020 PRAMS respondents indicated that they “often” or “always” felt down, depressed, or hopeless or having little interest or little pleasure in doing things they usually enjoyed since delivery. 

 

Strategy 1:  Explore opportunities for providing support to families seeking fertility services and families experiencing miscarriage

 

During FY21, VDH laid the foundation for the Pregnancy Loss Services Initiative. The purpose of VDH's Pregnancy Loss Services Initiative is to build the capacity of community organizations to provide pregnancy loss support and education services to individuals and groups (including families) who have experienced pregnancy loss, including but not limited to miscarriage (including molar and ectopic pregnancy), termination for medical reasons, stillbirth and neonatal death, and sudden, unexpected death of an infant. While pregnancy loss is defined differently throughout the world, the World Health Organization (WHO) defines a miscarriage as a baby who dies before 28 weeks of pregnancy and a stillbirth as a baby who dies at or after 28 weeks. An estimated 10% to 20% of known pregnancies end in miscarriage, and an additional 1% end in stillbirth. Research suggests that even after the birth of a healthy child, some parents who have experienced pregnancy loss continue to grieve for much longer than previously thought by health care professionals. Pregnancy loss may affect future pregnancies, the ability of a parent to care for their other children, and may lead to the development of mental health issues (e.g. anxiety, depression, and post-traumatic stress disorders). By increasing access to pregnancy loss support services among Virginians, VDH aims to help individuals and families heal, thus resulting in positive health outcomes for children, adults, families, and communities. During this reporting period, VDH released a Request for Applications and recommended funding five community agencies to provide pregnancy loss services. Services were launched in FY22.

Strategy 2:  Strengthen and expand supportive capacity regarding perinatal mental health at the local health district level

Fifteen of 35 local health districts (LHDs) prioritized mental health in their annual work plans.  Local activities include: hiring a social worker with experience in mental health counseling to assess all mothers enrolling for prenatal or postpartum MCH services; strengthening the mental health skills of the LHD personnel through evidence-based trainings and continuing education; strengthening the internal screening, referral, and follow-up process; increasing connections with community providers.

PRIORITY 5:  Oral Health

 

 

OBJECTIVE	By 2025, increase the percent of women who had a dental visit during pregnancy from 49.9% (PRAMS 2018) to 52.4%.
PERFORMANCE MEASURE	NPM 13.1 – Percent of women who had a preventive dental visit during pregnancy
EVIDENCE-BASED or -INFORMED STRATEGY MEASURE	ESM 13.1.1 - Number of Regional Oral Health Collaborative Projects that implemented work to increase dental visits among pregnant women

 

The Dental Health Program (DHP) partners widely across both internal Virginia Department of Health programs as well as externally through the statewide oral health coalition now known as Virginia Health Catalyst (VHC).  VHC is a non-profit organization that serves as the only statewide oral health coalition in the Commonwealth.  It is a diverse group working to spark change so that all Virginians have equitable access to comprehensive health care that includes oral health, and to bring excellent oral health to all Virginians through policy change, public awareness and innovative programs.  The VHC works closely with VDH to implement grant objectives and has in-depth knowledge of the Virginia Oral Health Plan and the Virginia Oral Health Report Card, and other foundations that prioritize oral health activities statewide.   VHC has access to a diverse network of key statewide stakeholders, and the unique ability to share oral health information with both key partners and the public.  VHC staff understand the need to continue promotion of oral health at the local level, support local initiatives to affect meaningful change, and to evaluate efforts to ensure ongoing, comprehensive support for structural sustainability. 

 

Program activities aimed at increasing oral health care for pregnant women, infants, children and individuals with special healthcare needs (ISHCN) within the DHP are the Bright Smiles for Babies Fluoride Varnish Program, Dental Preventive Services Program, and Perinatal and Infant Oral Health Program. 

 

The Perinatal, Infant, and Adolescent Oral Health Program aims to improve access to oral health care for pregnant women, infants and adolescents who are most at risk for disease through integration of dental services and information into the primary care delivery system.  Additionally, this program allows for expansion of the existing Virginia Oral Health Surveillance System to include data collection, analysis, and reporting of indicators regarding pregnant women and infants.  In 2019, this program began to focus on HPV prevention and oral cancer education, and vaping concerns for the adolescent population. 

 

Strategy 1:  Maintain and expand existing MCH-focused dental education programs to improve oral health for individuals across the lifespan, to include advising on oral health integration in primary care settings, education for home visitors, school-aged oral health education, and emerging needs of adolescents

New programming specifically aimed at advancing the oral health of adolescents began in FY20. Activities included updating the School-aged Oral Health Curriculum to include emerging topics for adolescents including vaping, and HPV exposure and vaccination and developing trainings and educational material related to these new topics of focus to highlight the importance of vape cessation and HPV prevention to combat oral cancer, as well as early detection of this disease in youth and young adults. Staff continues this work and identifies new partnerships to expand the reach of programming to include advising on oral health integration in primary care settings, education for home visitors, school-aged oral health education, and emerging needs of adolescents.  Staff continues to provide pertinent MCH related information to partners as a member of the Early Dental Home Workgroup and Project Immunize Virginia. The Early Dental Home Workgroup consists of partners from dentistry, early childhood education, and perinatal and pediatric health, as well as state agencies that offer social and health support services. The workgroup identifies promising practices and techniques to increase the number of young kids and pregnant women who access dental care. Project Immunize Virginia (PIV) is a team of energetic and innovative health professionals, business, and community members that believe every community in the Commonwealth can be free of vaccine-preventable disease by increasing immunizations across the lifespan. PIV achieves this by promoting partnerships and using effective strategies among its member organizations throughout the Commonwealth.

 

Specific activities in FY21 (October 1, 2020 – September 30, 2021) include:
Recruit and hire an experienced oral health educator to focus on maternal, infant and adolescent oral health	Completed
Continue to provide education and trainings aimed at perinatal and infant oral health including education for home visitors and other family support workers	Ongoing
Review existing school-aged Oral Health Curriculum and revise as needed based on emerging issues (HPV, Vaping) and current standards of Learning (SOL) requirements	Completed
Using current information obtained through literature reviews regarding the need for oral health education for adolescents on emerging issues, assess the individual needs of schools in each of the 5 Health Planning Districts	Ongoing
Plan and implement educational initiatives and trainings including development of educational material and social media content related to adolescent oral health	Ongoing
Evaluate initiatives and trainings to ensure that goals are met	Ongoing

 

 

Strategy 2:  Continue to foster a network of 6 regional Oral Health Alliances to conduct regional needs assessments and implement systems change and data-sharing initiatives to improve the oral health of all Virginians, with emphasis on pregnant women, and children and adolescents ages 1-17

 VDH continues to partner with the Virginia Health Catalyst (VHC) to foster regional efforts and initiatives throughout the Commonwealth.  Catalyst will work with the alliances to support development and implementation of regionally-identified projects, including projects from partners in far Southwest Virginia, through a micro-grant program; leverage Catalyst’s Clinical Advisory Board (CAB) and expert consultants to provide clinical guidance and education to the micro grantees; assist micro grantees with developing an evaluation component for their projects; share regionally-specific data; enable information-sharing among state and local partners and regional alliance members to inform the plans and implementation of local and statewide activities; ensure alignment between regional and statewide initiatives, as applicable; and develop and disseminate communications to spur replication of promising practices, share data and surveillance information, and elevate issues related to oral health access and integration.

 

Specific activities in FY21 (October 1, 2020 – September 30, 2021) include:
Continue to conduct regional oral health assessments	Completed
Determine community-led strategies to improve oral health in their regions	Ongoing
Support development and implementation of project work plans to support regionally identified projects	Completed
Disseminate information to state level partners and other regional alliance members to inform statewide activities and planning	Completed
Disseminate micro grants to support alliance efforts	Completed

 

Strategy 3: Convene statewide groups focused on targeted oral health issues and facilitate collaboration and work plan development, and provide leadership and oversight to guide initiatives

VDH continues its partnership with VHC to convene statewide groups to advance health equity, care coordination, and systems-change approaches that increase access to integrated, comprehensive care that includes oral health care for children under 17, pregnant women and their families.

 

VHC convenes a statewide workgroup focused on the future of oral health care delivery in Virginia following the COVID-19 pandemic and considering other environmental changes, trends in healthcare, and policy forecasts. VHC continues to engage a wide variety of partners to assemble participants including the Department of Medical Assistance Services, an MCO, maternal health providers, dental providers, and other community partners, while also leveraging the Catalyst’s Clinical Advisory Board (CAB) to provide expertise on the statewide future-focused workgroup. VHC also engages other clinical expertise as needed, to offer additional technical assistance and guidance to the workgroup. HRSA Oral Health Workforce Grant funds are leveraged to continue to implement a pilot program aimed at putting the workgroups ideas into action through a contract with a safety-net site to carry out future-focused projects including developing teledentistry capabilities to improve access to care.

 

VDH continues to partner with VHC in convening a state-wide group focused on enhancing water equity in Virginia. The Water Equity Taskforce (WET) aims to enhance water equity across Virginia to ensure all residents have access to safe fluoridated tap water. In addition to DHP staff, WET engages a cross-sector of partners including representatives from the Office of Drinking Water, the Virginia Department of Forestry, the Virginia Department of Social Services, as well as rural and urban safety-net dental providers, professional dental and dental hygiene associations, and service organizations for health youth and low-income families. WET currently has formed two workgroups, one on access and affordability and the other on consumer literacy. A priority for the group is creation of a Virginia Water Equity Roadmap to serve as a framework for water equity information, priorities, and activities in Virginia. 

 

VHC also convenes the Early Dental Home (EDH) workgroup and collaborates with existing groups working on HPV to ensure oral health is integrated into their approach and goals. Additionally, the VHC has expanded community engagement and provides trauma-informed care, oral health and systemic health, and health equity education to providers at the Virginia Oral Health Summit. Annually, the Summit reaches nearly 250 providers, public health stakeholders and caregivers, who attend to learn skills to improve the health and wellbeing of the individuals they serve. At this year’s Summit, Catalyst seeks to highlight the role of health equity and oral health in the COVID-19 pandemic, teledentistry (and telehealth more broadly), health policy at the state and federal level, and innovative community programs, so that attendees can work collectively to increase equitable access to quality health care, with a focus on oral health.

 

VHC has, for the second time, partnered with a consulting team and Virginia Center for Inclusive Communities to provide twelve free racial equity trainings to partners across Virginia. These trainings will be virtual to allow partners from across Virginia to participate. The trainings will be offered in three bundles, and each bundle will be offered twice (six total bundles offered).

Specific activities in FY21 (October 1, 2020 – September 30, 2021) include:
Identify the appropriate statewide organizational and community partners to participate in a water equity workgroup	Completed
Convene a Water equality workgroup and host meetings at different localities across the state	Ongoing
Develop and implement a workplan to support identified goals around water equity in Virginia	Ongoing
Continue convening the EDH workgroup, including providing oversight regarding program direction, participating in discussions related to allocation and management of resources, and sharing responsibility for the identification and maximization of community ownership to sustain the EDH workgroup’s projects beyond the grant year	Ongoing
Identify existing groups working on HPV in Virginia and approach these groups about Virginia Health Catalyst participating as a collaborative member.	Ongoing
Ensure oral health initiatives are integrated into the workplans and projects conducted by existing HPV workgroups, with specific focus on dental visits and oral cancer education and screenings for children under 17, pregnant women, and their families	Ongoing
Convene the Virginia Oral Health Summit focused on community engagement to provide trauma-informed care, oral health and systemic health, and health equity to providers	Completed

 

 

EMERGING ISSUES

 

During the 2020 General Assembly session, Virginia legislators passed a law to allow pharmacists to dispense contraception to low-risk patients over 18 years of age.  VDH’s Reproductive Health Unit Supervisor worked with the Board of Pharmacy and other stakeholders to develop protocols for dispensing contraception, but pharmacists were tasked with COVID-19 vaccination activities and were unable to implement the new protocols.  VHD’s Reproductive Health Team intends to work with pharmacy partners during the upcoming reporting period to launch this program.  VDH anticipates that this policy change will ultimately lead to increased access for contraception to vulnerable communities, particularly people living in communities with few or no family planning providers.  While not funded by Title V, this work will complement the work done by both the Title V and Title X grants and help reduce unintended pregnancy rates in Virginia.