Pre-/Interconception Health

 

Every Woman Connecticut

 

Preconception health counseling has been identified and endorsed by the Centers for Disease Control and Prevention as a strategy to improve maternal health and birth outcomes, as well as to reduce unplanned pregnancies. Starting in May 2016 under the auspices of the MCH Coalition and the March of Dimes, who provided the financial support, Every Women Connecticut (EWCT) and the Every Women Connecticut Learning Collaborative (EWCTLC) were established. The main goal of this initiative is to increase provider expertise and self-efficacy in implementing routine pregnancy intention screening and appropriate care, education, and services to ultimately improve birth spacing, increase pregnancy intentionality, as well as increase the proportion of Connecticut women who deliver a live birth and report discussing pre-/interconception health with a healthcare worker. 

 

The EWCT Advisory Committee is a group of well-known and respected individuals representing partner organizations, including state agencies; the state’s Medicaid ASO; the state’s Medicaid dental and behavioral health carve-outs; state-level private non-profits; and direct service providers, continue to guide EWCT’s efforts in increasing a general awareness around pre/interconception care and specifically around the One Key Question (OKQ) screening tool and in addressing social determinants of health and health equity. 

 

The EWCTLC has representatives from clinical and community-based providers in communities throughout the state and has expanded to include Department of Mental Health Addictions Services (DMHAS) providers.

 

The training done during this time frame continued the partnership with DMHAS, which requires the use of OKQ in their programs serving women and men in their childbearing years.

Trainings for staff at DMHAS funded program were as follows:  

 

On March 24 and September 14, 2022, EWCT provided One Key Question Implementation training for a DMHAS-sponsored workshop entitled Pregnancy Intention Screening, Sexual Health, Optimal Birth Spacing, and Effective Contraceptive Counseling. This workshop was conducted by Alison Tyliszczak, LCSW, Co-Chair of EWCT and Planned Parenthood of Southern New England (PPSNE). This training for implementers of OKQ focused on optimal birth spacing, an overview of different effective birth control methods, and ways in which staff can counsel women and their partners while ensuring a culturally sensitive and trauma-informed approach.

 

In addition to the trainings done in partnership with DMHAS, on October 12, 2021, EWCT held an OKQ orientation session for Zero to Three’s Baby Court Community Providers and a follow up debrief session on December 14, 2022.

 

EWCT continues to partner with the following other state level entities that share mutually supportive goals.

 

The Medicaid Strategy Group (MSG)

MSG is a coalition of health advocates working together to improve and protect the quality and reach of HUSKY/Medicaid programs in Connecticut through administrative and legislative advocacy. An example of this partnership is the collaboration, along with the Department of Social Services, in sharing information with both providers and birthing people on the HUSKY/Medicaid prenatal care coverage extended to undocumented pregnant people. 

 

Health Equity Solutions (HES)

HES was the lead advocate for passage of key doula legislation in the 2021 and 2022 legislative sessions. H.B. 5500, An Act Concerning the Department of Public Health's Recommendations included specific language which establishes a doula advisory committee at the Department of Public Health. This advisory committee is ensuring that doulas have input in the establishment of core standards to certify a doula. EWCT, in partnership with HES and other partners, will do administrative advocacy for the implementation of this legislation in the spirit it is intended.  In March 2022 EWCT submitted testimony in support of doulas.

 

The CT Help Me Grow Advisory (HMG) Committee 

The goal of this advisory group is to build, in partnership with families, a coordinated early childhood system that supports developmental screening, early identification and linkages to services and supports. The Advisory Committee consists of well-known and respected representatives within the early childhood field. It operates under the auspices of the Office of Early Childhood and 2-1-1 Child Development, a specialized call center of the CT United Way’s 2-1-1 system. The membership is diverse and includes both state level and community-based entities. The CT HMG Advisory Committee offers a natural link between maternal and early childhood touchpoints.  At the May 23, 2022, Help Me Grow Advisory Committee meeting, the Co-Chairs of Every Woman CT presented on the Reproductive Justice Alliance.

 

Postpartum Support International, CT

The PSI CT chapter provides direct peer support to families, trains professionals, and provides a bridge to connect them. PSI Volunteer Coordinators provide support, encouragement, and local resources on the phone and email to pregnant and postpartum moms, dads, and families.  At the March 2, 2022, CT Chapter of the Postpartum Support International (PSI) Lunch & Learn, the Co-Chairs of Every Woman CT presented on the Reproductive Justice Alliance.

 

Connecticut Coalition Against Domestic Violence (CCADV)

CCADV is the voice against domestic violence across CT through a statewide network that focuses on advocacy, outreach, and education. CCADV and EWCT’s overlapping networks create pre/interconception care touchpoints that can serve as a safe conduit for offering support and resources for those in, or at risk of being in, an abusive situation. In support of this relationship, in August, a presentation on OKQ was held for CCADV’s Residential Directors (8/18/21) followed by session for CCADV’s Child and Family Advocates (8/25/21).

 

Participation in these groups expands partnership potential as it increases EWCT’s platform for addressing pre/interconception health care, health equity and racism from a comprehensive and holistic perspective. 

 

EWCT contributes to the Department of Public Health’s State Health Improvement Plan (SHIP) through the participation of Alison Tyliszczak and Marijane Carey, as the MCH experts, on the SHIP Advisory Council.  

 

The CT Reproductive Justice Alliance (RJA)

 

The Connecticut (CT) Reproductive Justice Alliance (RJA) is a group that was formed by the CT Department of Public Health, March of Dimes, EWCT, Maternal and Child Health Coalition and other organizations and individuals in 2021 to improve maternal and reproductive health in CT. The RJA is a group of community-based and state-level organizations and partners who work to address maternal health inequities in CT. The RJA is comprised of 30+ members who work to ensure that people who are pregnant or parenting, particularly those who are Black and/or Hispanic or Latino, receive access to quality care that is safe and respectful. Alliance members supports and guides the Leadership Team, which meets weekly, in working toward realizing RJA goals, which are to improve:

 

• Access to respectful, quality maternity care;

• Respectful interactions between patients, providers and staff;

• Health care systems, resources, and policies related to maternal health; and 

• Accountability of health care systems by centering patients’ voices.

 

During this reporting period, the RJA worked on planning activities to hold regionally based Focus Group Discussions (FGDs) to better understand the experiences of individuals who are Black and/or Hispanic or Latino during pregnancy, childbirth and the postpartum period. The FGDs are being done as community collaborative research, which requires oversight by the Department’s Human Investigation Committee (HIC) to ensure the protection of participants. This created the need to balance partnering with local communities with HIC protocols and requirements.

 

Simultaneously occurring activities included a) forming an ad hoc group of RJA members to provide guidance on the FGD topics and questions. The full RJA reviewed and approved the topics and questions, and assisted with identifying CBOs and promotion activities; b) piloting the questions with a small group of individuals from the community and making some refinements; c) seeking HIC approval for the FGDs; and outreach to key CBOs throughout the state (including identifying facilitators and FGD participants). Through DPH’s CDC Designee and member of the RJA Leadership Team, the RJA had two CDC summer interns who researched and designed the state level e-resource guide that will be distributed to all focus group participants. This planning resulted in developing a calendar from April to July 2023 for FGDS to be held in English and Spanish in the following counties: New Haven, Hartford, Fairfield, Windham, New London, and Litchfield. FGD participants are receiving $50 gift cards and a statewide e-resource guide.

 

The RJA will use the findings from the FGDs to help inform future programs, practices and policies to improve the health and wellbeing of people who are pregnant or parenting in CT, with particular focus on individuals who are Black and/or Hispanic or Latino. Examples of future activities include, but are not limited to, developing a Know Your Rights campaign to increase public awareness about one’s rights during pregnancy and childbirth; establishing a process to improve accountability in the provision of health care; and educating health care providers on respectful maternity care.

 

The RJA was included in a compendium of birth equity work that is being done throughout the country. The compendium is a joint project between the March of Dimes and Pritzker and will aid birth equity workers, researchers, and others in National projects that advance health equity for persons in their childbearing years.  

 

Pregnancy Risk Assessment and Monitoring System (PRAMS)

 

PRAMS has significantly increased perinatal data capacity in CT, providing ongoing statewide data on a variety of topics that are not available from any other statewide data source, including preconception health and education, pregnancy intention, perinatal anxiety and depression, oral health, social support, postpartum maternal and infant care, safe sleep, discrimination, and father involvement. During this reporting period, eight years of data (2013-2020) were available for analysis. PRAMS staff completed and disseminated several publications, including fact sheets and data reports. CT PRAMS supported DPH and other statewide programs by providing them with data to inform their work addressing the strategies outlined in this section. Staff fulfilled 20 data requests from internal and external partners throughout the course of the year, including presenting data at external meetings. In addition to ad hoc requests, a 2019-2020 Medicaid data report was produced for our partners at the Department of Social Services, which was followed by an extensive follow-up data request; these data were integral into informing their new Medicaid Maternity Care Bundle (discussed below). PRAMS also supplied data to the CT Title V program for the MCHBG Application/Annual Report, including updates to the Needs Assessment. PRAMS is also used to report on numerous state and national measures annually, including providing Federally Available Data on 6 NPM/NOMs.

 

PRAMS data have been integrated into efforts to address state MCH priorities, as well as statewide plans and initiatives to reduce low birth weight, infant mortality, and health disparities. Some recent examples of how PRAMS data has been translated into public health policy or practice include:

 

• The Connecticut Department of Social Services (DSS) administers CT’s Medicaid program, HUSKY Health. Rates of adverse maternal outcomes, overall C-sections, and NICU utilization have been increasing among HUSKY Health members since 2017. DSS has a strong commitment to remedying historical disparities in maternity care and, as such, equity is at the center of their work developing a new maternity bundle. The Maternity Bundled Payment program would shift from a HUSKY fee-for-service payment model to maternity care to bundled payments, which is part of the agency’s overarching goal to move toward paying for equitable care in a value-based way. Although DSS has certain clinical data items through payor claims data via the Community Health Network of CT, the Administrative Service Organization (ASO) for Medicaid’s provision of health care, there was still critical information about their population that was missing, including patient experiences and other data by race/ethnicity that was not available via vital records or administrative data.

 

PRAMS provided an extensive Medicaid-specific data report to DSS, as well as the results of follow-up analysis to support DSS’s work.  As a result of the data provided to DSS partners, PRAMS informed the development of the Medicaid Maternity Bundled Payment Program and will continue to serve as a data source for some measures that will be tracked over time. PRAMS data will be used to monitor trends in numerous outcomes of interest and assist DSS in evaluating the performance of their Maternity Bundled Payment Program over time. If the goals of this new program are realized, not only will we see improved health equity among a group of individuals who have already been marginalized (i.e., Medicaid members), but also further reductions in racial and ethnic disparities and improvements in health outcomes.

 

• The Connecticut Coalition Against Domestic Violence (CCADV) is the state’s leading voice for victims of domestic violence and those organizations that serve them. For more than 20 years, CCADV has provided affordable, high-quality training to individuals who are committed to strengthening Connecticut’s response to victims of domestic violence. To expand capacity to present information, the CCADV Training Institute was opened in 2011. The Training Institute is dedicated to assisting people with obtaining the education they need to become valuable members of the domestic violence response and care coordination in Connecticut. Trainings are comprised of basic and advanced workshops to best accommodate the varying degrees of professional experience held by those who serve anyone impacted by domestic violence. Topics are tailored to the needs of the audiences whether they are domestic violence advocates, law enforcement, prevention specialists, State agencies, attorneys, community-based service providers, or medical professionals. CCADV also runs the state’s Health Professional Outreach program which aims to increase outreach, education and support for health and community providers. Through this program over 1,500 health professionals and community providers are trained each year.

 

PRAMS provided a comprehensive data report examining violence before and during pregnancy to CCADV. This was the first time they had state-specific data to support their work which resulted in several programmatic enhancements. According to CCADV, prior to the PRAMS data on intimate partner violence (IPV) and pregnancy, information on healthy relationships tends to be a topic that is not highly regarded by health professionals as something that is worth the time. The lack of disclosures around IPV tends to make health professionals believe that IPV is not prevalent. However, the PRAMS data was eye-opening for many, and it underscores the important role providers play in keeping their patients healthy. Through continued CCADV Training Institute programs, CT PRAMS data will be able to demonstrate that IPV is a serious public health concern, one that very commonly affects pregnant and postpartum individuals, as well as those in the preconception time period.

 

• In June 2021, SB 1201, An Act Concerning Responsible and Equitable Regulation of Adult-Use Cannabis, legalized the possession and consumption of cannabis in Connecticut for individuals 21 years old or older starting July 1, 2021, and sales will become legal August 1, 2022. The legislation includes the Department of Public Health’s role in collecting, abstracting, and disseminating timely public health information on the impact of cannabis use. PRAMS was one of three key data sources for cannabis surveillance identified by the Governor’s Office’s national consultant on cannabis legalization.

 

Except for data collected in the PRAMS Opioid supplement in 2019, Connecticut had no other statewide data on marijuana or cannabis use during pregnancy. In order to fulfill the needs of both legislative reporting and MCH programs and professionals statewide, the CT PRAMS program had to formulate both short- and long-term plans to meet these new data needs. CT PRAMS developed a survey supplement uniquely tailored to Connecticut’s needs that was implemented at the start of the 2022 surveillance year. In 2023, the new PRAMS Phase 9 survey will be implemented that will retain one question on marijuana use before, during, and after pregnancy for long-term surveillance. Determining cannabis utilization before, during, and after pregnancy is important as new cannabis-related policies are adapted. This data can be used to inform providers, pregnant people, clinical guidance, and public health programs to support evidence-based approaches to addressing substance use during pregnancy.

 

• In March 2019, CT implemented a statewide Child Abuse Prevention and Treatment Act (CAPTA) response that requires hospitals to identify infants exposed in utero to a range of legal and illegal substances (including alcohol), infants showing withdrawal symptoms, or those diagnosed with FASD and notify the CT Department of Children and Family’s (DCF) new CAPTA portal. In Fall 2021, an evaluator for DCF approached CT PRAMS to see if data from the 2019 PRAMS opioid supplement could be used to help evaluate data captured in the newly implemented CAPTA notification system. Our results suggest that CAPTA is accurately identifying certain types of substance use for certain individuals, but there are areas should be examined further to better understand hospital practices and implement quality improvement efforts. For example, despite State policy guidance that any alcohol use in pregnancy should result in a notification, CAPTA appears to be capturing more frequent alcohol use only. In addition, it appears that the current screening/testing practices may be under-identifying substance use and/or resulting in differential CAPTA notifications in pregnancy among all race/ethnic groups except non-Hispanic Black individuals. However, it’s important to note that one limitation in CAPTA is that the data was missing race/ethnicity data for 10% of records which may have influenced the rates of detected substance use across racial/ethnic groups. This highlights an opportunity for training with hospitals to improve data quality and completeness.

 

• Supporting DPH’s State Health Assessment (SHA) which establishes the health status of the state and will inform the prioritization and development of the next Healthy Connecticut 2025 State Health Improvement Plan (SHIP). This plan will serve as a 5-year roadmap for promoting and advancing population health in CT and provides a framework for health promotion and disease prevention in the current decade, with overarching themes of health equity and social determinants of health. Maternal, Infant and Child Health was one of several domains addressed by the SHA and the SHIP. Data from CT PRAMS was provided to support the development of the SHA and will be used for the upcoming SHIP. Moving forward, CT PRAMS will be a data source for several SHA and SHIP measures.

 

Nationally, CDC PRAMS provided data to HRSA MCHB on safe sleep, fetal alcohol exposure during pregnancy, postpartum depressive symptoms, and teeth cleaning during pregnancy to support the federally available data (FAD) for the MCHBG. Numerous requests for the PRAMS Analytic Research File are made from researchers annually, allowing them to analyze data from multiple states or nationwide, thus contributing to the overall MCH knowledge base. This file is maintained and disseminated by CDC staff.

 

Reproductive Health Services

 

Despite the continuing challenges of COVID-19, Planned Parenthood of Southern New England (PPSNE) exceeded all its clinical service goals except number of teens served. PPSNE provided family planning/reproductive health services to 41,164 women, men and teens (goal of 35,000). Of these, 30,050 (73%) were low income (goal of 14,000); 22,935 were women of color (goal of 9,100) and 5,431 (13%) were teens (goal of 5,800). We were below our goal for teens by just 369 individuals; of note is that 9,903, or 24%, of this year’s patients were age 21 or under.

 

Of all patients, 35% were white non-Hispanic/Latinx; 29% were Hispanic/Latinx; 26% were Black/African American non-Hispanic/Latinx; 2% were Asian; and 8% were “other” (Native American, mixed race, unknown/declined, etc.). The majority of patients (87%) were female. More than half (55%) were between the ages of 22 and 34; 13% were teens, and 11% were ages 20-21. Fifty percent of DPH family planning participants were covered by Medicaid; 28% were covered at least partially by private insurance; and 22% were uninsured and were charged according to PPSNE’s income-based sliding fee scale.

 

The program provided 18,000 pregnancy tests with options counseling, 1,305 Herpes tests, 53,534 chlamydia tests, 53,518 gonorrhea tests, 21,955 syphilis tests, and 22,793 HIV tests. PPSNE exceeded all its outcome measure goals except two: chlamydia and HIV screening. Seventy three percent of PPSNE’s DPH family planning patients received reproductive health care services regardless of ability to pay (goal, 60%). Ninety seven percent of female patients receiving a comprehensive reproductive health exam received a Pap test or were current with their Pap screening schedule (goal, 90%); 99% received a clinical breast exam (goal, 90%); and 100% discussed reproductive life plan with clinic staff (goal, 90%). Seventy three percent of patients ages 15-25 received a screening for chlamydia and gonorrhea in the last year. This is short of our goal of 90%, but still well above national screening rates. Forty nine percent of patients received an HIV test and referral for care as indicated (goal, 65%).

 

Between 86% and 92% of those not receiving an HIV test were offered but refused one. Work continues to provide more patients with HIV tests with an ‘opt-out’ service model and by trying to normalize HIV testing both in the clinical setting and through outreach and social media advertising. HIV testing numbers at PPSNE overall are going up—along with the provision of PrEP/PEP.

 

PPSNE’s education and training department reached 589 people, 488 of whom were teens with outreach and education in a variety of settings and venues, including in multi-session workshops to at-risk teens. Utilization of PPSNE education and training programs was greatly affected by COVID-19 social distancing requirements and lack of in-person educational opportunities.

 

Starting in April and May, PPSNE’s Education staff began transitioning from in-person programming to virtual programming, focusing initially on the STARS peer education program, Teen Clinic, and the healthy relationship series for the Department of Developmental Services. Other virtual activities included sex ed "game nights,"--Quarantrivia: All Things Sex (with New Haven Pride Center) and Sex Ed Loteria (bilingual) -- and release of a Sex During COVID coloring book.

 

During the summer, the Education team revised the STARS curriculum using a reproductive justice lens. In September, PPSNE piloted a new, virtual sexuality education program, "Birds & Bees: Not Your Typical Sex Ed," to replace the in-person, "Teen Life. Real Talk." program.  Educators then reworked the monthly in-person Teen Clinics to incorporate virtual education workshops for teens facilitated by teens.  In the online version, participants receive a voucher for a free visit to a PPSNE health center.

 

In 2018, Connecticut’s teen birth rate was 8.3 births per 1,000 females aged 15-19 and marked the thirteenth year in a row that the state rate reached its lowest level. The 2017-2021 annual overall teen birth rates in Connecticut averaged 8.0 (range = 7.3 – 8.9, reported as live births per 1,000 women aged 15-19) and continued long-term declines over the previous two decades that ranged between 1.3 and 10.8% annual decline.  2021-updated trend analysis shows an annual rate of decline for 2017-2021 of 5.2%. Declines across all three major race-ethnicity groups are also evident for the period 2017-2021, with annual rates of declines in teen birth rates in the non-Hispanic White, non-Hispanic Black/African American, and Hispanic populations during this period averaging 11.8%, 4.9%, and 6.1% per year, respectively. In the presence of these significant declines across all three major race-ethnicity groups in Connecticut, however, disparities by race and ethnicity nonetheless exist.

 

The City of New Britain had the 2nd highest teen birth rate in the state at 24.2 per 1,000 women ages 15-19 in 2015-2019.  There were 355 births to mothers aged 15-19 out of a female (aged 15-19 years) population of 14,660.

 

The Family Wellness Healthy Start Program used this data to expand services in New Britain when the grant renewed in 2019 and continues to serve the New Britain pregnant women population.  The New Britain pregnant teen population is being served by a new intensive teen intervention and prevention program, the Reproductive Education and Comprehensive Health (REACH) program.

 

Personal Responsibility Education Program

 

The Personal Responsibility Education Program (PREP) delivered evidence-based and evidence-informed prevention programs to high-risk youth ages 13 to 19 by trained facilitators in Capitol Regional Education Council (CREC) an alternative high school, City of Bridgeport high school, Klingberg Family Centers in programs funded by Department of Children and Families (DCF), and in Greater Bridgeport Area Prevention Program in one middle school. The Be Proud! Be Responsible!, Making Proud Choices, and Reducing the Risk programs have been showed through rigorous evaluation to reduce risk-taking behavior, delay sexual activity, increase condom or contraceptive use for those who are sexually active, and reduce unintended pregnancy, and range in length from 6 to 16 hours. “Streetwise to Sexwise” is a three-hour evidence informed program delivered to youth in the Detention Center. From 2020-2021 the PREP programming was delivered to 275 youth and young adults.

 

PREP staff are also revamping training procedures to add in annual refresher trainings to ensure fidelity of program materials, as well as collaboration between facilitators to assist with facilitator retention within the school systems. Staff will also be revamping the DPH webpage with current information and informational resources for the public.

 

Breast and Cervical Cancer

 

During the program period for fiscal year 2022 the Breast and Cervical Cancer Early Detection program enrolled and screened 4385 women while the WISEWOMAN program screened 700 women while continuing to experience decreased appointment availability due to the COVID-19 Safety protocols and procedures. The CEDPP continues to include Colorectal Cancer Screening Program (CRC) as part of its integrated services. The program continues to provide funding for 15 Community Health Workers (CHW) who navigated women to no-cost screening programs for cancer screening and cardiovascular screening. These CHWs provide baseline cardiovascular services (blood pressure, blood glucose, cholesterol, height and weight) using a mobile equipment, connected participants with abnormal readings to providers and supported participants to improve their lifestyles to reduce their risk of cancer and heart diseases.

 

Genomics

 

The Genomics Office continued to increase public awareness of the importance of knowing their family health history and sharing this information with their family and healthcare practitioners, promoted the use of Family Health History collection by promoting the US Surgeon General’s “My Family Health Portrait” tool; continued partnering with CEDPP and the mandatory collection of patient and family B&C health history, provision of free patient information resources, and encouraging staff healthcare provider genomics education through online training on hereditary cancer syndromes such as Hereditary Breast and Ovarian Cancer (HBOC) and Lynch Syndrome, and the appropriate use of genetic services.

 

Oral Health

 

The OOH continued to be a member on the CT Maternal and Child Health Coalition (MCH) to ensure oral health is represented as a critic function of overall wellness.

 

The OOH continued implementing two federal awards, 1) a Centers for Disease Control and Prevention (CDC) cooperative agreement, and 2) a Health Resources and Services Administration (HRSA) grant. The two grants support CT’s efforts to improve oral health outcomes, reduce oral health disparities, and conduct ongoing surveillance of oral health. The CDC grant includes two components:

 

Component One (3 strategies)

 

Implement and expand school-based sealant programs -

 

Hartford Public Schools and New Haven Public Schools continued to provide dental sealants to students through the SEAL CT! Program. OOH worked with the SEAL CT! contractors and a vendor to develop two educational videos for parents and the community. One focused on dental sealants and the second on how to prevent cavities. Both videos were distributed to the SEAL CT! programs, the CT Dental Sealant Advisory and are on the DPH OOH website. The CT Dental Sealant Advisory continued to meet on a quarterly basis, but meetings were shifted to virtual instead of in person.

 

Support and increase access to community water fluoridation –

 

The OOH along with the DPH Drinking Water Section (DWS) conducted the annual Community Water Fluoridation: Principles and Practices training in June 2022. The training was given virtually, and certified water operators were eligible to receive free CEUs if they received a passing score of 70% or better on the post-assessment. Presenters included a CDC Division of Oral Health fluoridation engineer, a dental hygienist from DPH’s Office of Oral Health, a sanitary engineer from DPH’s DWS Section, and a managing certified water operator from a CT public water system (Metropolitan District Commission). The OOH continued to work with DWS to ensure timely and accurate submission of fluoridation data into CDC’s Water Fluoridation Reporting System (WFRS).

 

Conduct oral health surveillance –

 

The OOH conducted the 2021-2022 Every Smile Counts survey for children between September 2021 and April 2022. Every Smile Counts surveyed a randomized sample of kindergarten and 3rd grade students across the state. This survey was conducted in collaboration with the CT State Depart of Education (SDE), the CT Oral Health Initiative and the Association of State and Territorial Dental Directors (ASTDD). In April, the OOH began conducting the Every Smile Counts for older adults in long-term care facilities and congregate meal sites across the state.  

 

Component Two

The OOH has continued to implement the prediabetes component of the Medical Dental Integration Project (MDIP) in collaboration with Community Health Center, Inc. (CHCI), a federally qualified health center. This component continued to identify adult patients with prediabetes in dental settings and is being implemented at two sites.

 

HRSA Grant

Through the HRSA grant the OOH also continued to implement the nutrition component of the MDIP project by addressing common modifiable risk factors for childhood obesity and dental caries in pediatric patients. This component was being implemented at five sites and concluded August 2022. Both components utilize provider toolkits to identify at risk patients, including motivational interviewing training for medical and dental providers, and includes system level change to incorporate bidirectional referrals and care coordination. The Medical Dental Integration Advisory has continued to meet on a quarterly basis virtually.