KY MCH utilizes many strategies to address the identified needs and outcomes assessed in 2015. These strategies include data briefs and outreach to providers and birthing facilities. Primarily, MCH accomplishes this by promotion of best practice packages with funding from MCH Title V provided to LHDs for implementation of evidence informed strategies. Based on community needs, LHDs have the opportunity to opt-in and select 2-5 packages with a requirement that at least one package chosen to address infant mortality. MCH sets the allocations for LHDs based upon a formula using a base rate, number of children in poverty, and number of the MCH population served by Medicaid. LHDs are encouraged to use the package guidelines as a point of reference and to be innovative with initiatives to reach the MCH population. LHDs, stakeholders and collaborative partners are engaged at both local and state level building an integrative strategic plan across all levels.

Women/Maternal Health Domain Annual Report

MCH collaborates with an extensive group of partners both internally and externally to address issues related to women/maternal health. The Kentucky Perinatal Association, Kentucky Chapter of March of Dimes, and the Healthy Start Program in Louisville have been three strong partners during 2018. As stated for several years, the work completed for this effort began as part of the national effort to “Put the M back in MCH”. During the past year, many data measurements reviewed determined the impact for mothers and major issues and their impact for the health of mothers and women of childbearing age. For FY18, KY continued the work for NPM #2: Percent of cesarean deliveries among low-risk first births with a goal to reduce early elective cesareans by 10% by 2020.

Since 2009, based upon federally available data, the rate has decreased by 3.2%. Changing this outcome has been a slow process. Kentucky preterm birth rates prior to 37 weeks gestation remain higher than national averages supporting efforts to reduce early elective deliveries and address maternal morbidities that may lead to a medically necessary early delivery.

Healthy Babies Are Worth the Wait (HBWW):

KY’s prematurity prevention activities began through a pilot project to reduce preventable preterm birth with funding from the MOD and Johnson & Johnson Pediatric Institute. This community-based, multi-layer approach to prematurity prevention in three intervention communities with a range of health care settings was successful in showing that a partnership between hospitals, health departments, and communities could reduce preterm birth from EED.

KY demonstrated success in the program, as results indicate a statistically significant 12 percent decline in the preterm birth rate in the intervention sites. KY now has nine hospitals along with seven LHDs as members of the HBWW Collaborative. Partnerships involved in the Collaborative include the MOD, state and LHDs, hospitals, and community organizations. Creating the HBWW Collaborative made it possible for all hospitals and health departments in the state to participate, collectively working to reduce preterm births and EED. All sites participate on monthly calls to share information and strategies. The HBWW program requires five different components for success:

• Partnerships and Collaboratives
• Patient Support
• Provider Initiatives such as Grand Rounds and On-Going Education
• Public Engagement
• Progress Measures

In the past year, interest in the HBWW package and work in the community decreased as LHDs began pulling away from providing family planning and direct patient care services for the prenatal population. Previous partners on the calls waned. What this project learned was to reduce the rate of early elective deliveries; hospitals must adhere to a hard stop policy. The Advisory Board is extremely important, as this team ensures the program is data driven. Moreover, of equal importance, the site team at each individual hospital must monitor and actively enforce the hard stop policy. Educational resources from the MOD website are available for all collaborative partners to distribute to clients.

When the HBWW pilot project began, KY’s preterm birth rate was over 15%. This rate (see figure below) was slowly declining until the past 4 years, which has appeared to plateau with 2017 preterm rate for KY being 11.1%. KY’s rate continues to be above the US rates of 9.93% as reported by the MOD for 2017.

From a geographical perspective, the greatest rates of preterm birth were located in the more eastern and western areas of the state with some Area Development Districts (ADD) being as high as 13.8%.

Of interest, the LHDs and communities that elected to work on HBWW are located in the areas that have some of the lowest rates of EED. The Lake Cumberland District has a hard stop policy and committee review required prior to scheduling. They internally publish the EED rates for each provider and diligently adhere to policy.

In August of 2017, KY DMS clarified coverage for EED including non-medically necessary inductions and cesarean deliveries. Claims submitted for labor inductions or cesarean sections on or prior to 39 weeks gestation required documentation they were medically necessary and claims would be denied if documentation were not present. Practitioners are to complete the ACOG Patient Safety Checklist (or comparable form) when scheduling an induction of labor or cesarean section for deliveries less than 39 weeks gestation. Outcome data from DMS and MCOs for period since this rule began shows initially there was a decrease for EEDs. Some MCOs report the decrease has persisted while others report it may be rising. One MCO reported an increase of EEDs at 39 weeks gestation. Another MCO noted an increase in EEDs in the summer months.

PRAMS:

Pregnancy intent was part of the survey questions for the 2017 Cohort of PRAMS. From responses:

• One in four mothers were sexually active and not using contraceptives, but had no intent to be pregnant at that time.
• One in three mothers that never wanted to be pregnant were sexually active without using any contraceptives.

The reasons provided for not using contraceptives varied with the highest being concern about predicted side effects of contraceptives.

Data Dissemination:

During the 2018 MCH Conference, MCH collaborated with the KY MOD Chapter, KPA and Healthy Start Louisville to address social determinants of health, data from many MCH programs and survey for the Title V 5-year needs assessment. This conference was not held for several years and this became the official “reboot” of community engagement for MCH. Prematurity prevention was a highlighted topic. Distribution of MOD materials and prematurity data briefs to nearly 400 people from LHDs, hospitals, childcare, and faith based community partners occurred. Based upon 2017 PRAMS Cohort data, new data briefs are being developed for distribution to stakeholders in 2019-20.

DPH contracts with a university to provide an annual prenatal/postpartum training for new LHD nurses, as well as an annual update for all nurses working in-house prenatal clinics at LHDs. Due to the variance in new hires and turnover, the attendance at the trainings has varied from 4 to 25 staff in attendance over the past several years. With public transformation, this training program is discontinued for FY20. Every few years the sessions are taped to provide the most recent and updated information that aligns to the ACOG guidelines. The 2018 training was taped and is archived for LHD staff to view. Subject matter for this training includes fetal development, physiology of pregnancy, genetics, obstetrical complications, routine assessments, procedure and labs, perinatal nutrition, diabetes, prematurity, perinatal infections, breastfeeding, substance use, and domestic violence. The training and MOD materials provided to LHDs have emphasis on prevention of preterm births and EEDs.

In the past year, the data reports on cesarean sections and/or EEDs were made available at the MCH Conference and the Kentucky Perinatal Association conference for prenatal providers, as well as hospital and LHD nurses.

Hepatitis C:

A revision of KRS 214.160, in 2018, added language to include Hepatitis C screening for all pregnant women in KY rather than for those with risk factors. If a pregnant woman is positive for Hepatitis C virus antibodies or RNA, the child from that pregnancy, should receive serologic testing for the presence of Hepatitis C antibodies at the 24-month well child check. While this statute became law in 2018, the infrastructure for electronic surveillance and provider education and promotion was not yet available. The KY Division of Epidemiology and Health Planning (DEHP) currently provides surveillance for Hepatitis C through reporting from OVS and reportable disease reports received from providers. The DEHP is building the Hepatitis C reporting page in the National Electronic Disease Surveillance System (NEDSS). The DEHP and DMCH have plans to message the changes to statute and Hepatitis C information through ACOG, AWHONN, KPA, KHA, NBS and other community partners.

Maternal Morbidity:

Despite all the advances in science, maternal morbidity and mortality has not decreased in recent years. KY’s priority need in this domain was to address maternal morbidity. Top concerns for stakeholders in the 2015 Needs Assessment in this domain were substance abuse, health problems related to pregnancy, and maternal obesity, all of which contribute to maternal morbidity. These remain a concern for 2018 and future years, as these have an effect on the rising maternal mortality rate, increased risk for preterm birth and long-term effect on the newborn.

The health care delivery system in KY has undergone significant changes in the past few years through Medicaid expansion and the implementation of components of the ACA. The number of individuals in KY without insurance has decreased dramatically. The women who have health care coverage are now able to access preconception and interconception care. Should the 1115 Kentucky Health Waiver be authorized after appeal, the impact to benefits for this population will not change or be reduced.

As LHDs have moved to transformation to population health services, they have continued to provide a safety net for clinical services for uninsured pregnant women. They assist with presumptive eligibility for Medicaid. If denied coverage, many counties used local tax dollars or MCH agency funds to pay for services as a payor of last resort for services rendered by the local provider. LHDs not providing in-house prenatal services are required to provide assurance that women can access prenatal care in their community, whether by referral to local obstetricians or contracts with local providers. The number of women receiving maternity services through the LHDs has increased from 1,439 in 2017 to 2,900 in 2018.

Access to prenatal care is enhanced by presumptive eligibility (PE) for a short duration of time, 60 days, while eligibility for full Medicaid benefits is determined. While PE is very valuable, for women who ultimately are denied benefits they may not apply for PE until late in pregnancy to assure some form of coverage for the expensive cost of delivery. As local health departments move to PH Transformation, the safety net provided by LHDs may greatly decrease.

Title V grant funding may be used to support education, outreach, or enabling services for this population. Referrals to address smoking cessation, domestic violence, mental health services, and substance use disorders is standard service for each LHD. Many contract with a FQHC in the area. As to the SDoH, the rurality of KY has been a major barrier, in regards to local access to womens health providers, birthing hospitals, and referral for specialty services, available through travel of longer distances.

Preconception health counseling, including the distribution of folic acid/multivitamins, continue at LHDs and partner providers through MCH and Family Planning Programs. During FY18, 29,700 women seen in the LHD or through contracted providers were provided preconception counseling and, when needed, a year’s supply of multivitamins. Clients, with positive pregnancy tests, received prenatal vitamins and counseling by the local health department staff, along with counseling on how to obtain prenatal care, apply for Medicaid, and referral for other services if noted during initial screening.

Substance use disorder creates further challenges in identifying and protecting the pregnant woman. Women have fears of removal of the infant at birth, and do not readily seek out prenatal care. Treatment options across the state are varied, and social supports for these women are inherently limited. While the work and planning for a plan of safe care has progressed to piloting the Healing, Empowering, and Actively Recovering Together (HEART) Program, communities across the state are needed for expansion of this promising program. Establishing HEART requires time, workforce, funding, and a strong community collaborative team that has all stakeholders at the table with each entity actively supplying funds, staff, and knowledge to assure success.

Tobacco Use:

KY data shows a continued decline in smoking during pregnancy. While the percentage of women who smoke during pregnancy has fall from 16.9% in 2018, which is the lowest rate of the past eight years, this rate is still far above the US rate of 7.2%. From a geographical view, rates are considerably higher in rural eastern KY, with some rates as high as 32.5% of births in Kentucky River District.

Kentucky recently received the weighted PRAMS data for the 2017 Cohort. Of interest:

• Over one in four PRAMS mothers reported smoking at some point during pregnancy
• After giving birth, half of PRAMS mothers no longer allowed anyone to smoke in or around their home

Surveillance of OVS live birth  files data analysis was completed. Amidst those who smoke in pregnancy:

• KY Caucasian women were about 1/3 more likely to smoke than black women were.
• Two out of three women who reported smoking in pregnancy had a high school diploma or less than high school education
• Close to 50% were women less than 25 years of age.

Quit Now KY has a pregnancy/postpartum protocol that is available to all KY residents 15 years of age or older who are currently pregnant. This protocol includes a designated female coach assigned to each pregnant woman. During pregnancy, each woman receives $5 per completed call for up to $25 and during postpartum each woman receives $10 per completed call up to $40.

The Tobacco Prevention and Cessation Program has also been working with Medicaid MCOs and the Quality Improvement Branch on a Prenatal Smoking Performance Improvement Plan (PIP) through an enhanced Obstetric Care Management model. The suggested PIP template suggests the following areas:

• 1a) Develop a care management program to enhance reach to target the smoking subpopulation for smoking cessation outreach and follow-up
• 1b) Tailor care coordination with care management to susceptible subpopulations as indicated by risk factors identified in focused study
• 3a) Use Health Risk Assessments (HRAs) and develop new methods to identify smokers
• 3b) Improve HRA response rates by collaborating with providers to complete HRAs for new members
• 3c) Develop a MCO smoker registry to identify smokers for outreach, engagement in cessation counseling, and referral to the Kentucky Quitline
• 4a) Work to track members who contact the quitline, receive services, and monitor quit status

To date, the collaborative has worked with Audrey Darville, APRN, CTTS (Certified Tobacco Treatment Specialist) to provide tobacco cessation training for MCO care managers. The MCOs are working on developing a smoking registry. Those women who are identified as pregnant and smokers are referred to OB care management, where they are educated about smoking risks and encouraged to utilize Quitline services and Safelink/Vioxiva text messaging. Upon delivery, postpartum nicotine replacement therapy (NRT) is initiated for smokers, who had not quit or relapsed, to reduce exposure of secondhand smoke to the newborns.

A plan, provider, and member barrier analysis was conducted with the following results.

Plans:

• Do not systematically know if a member is pregnant and/or a smoker
• Do not know how many pregnant smokers are enrolled in care management
• Have inadequate staffing to support care management/care coordination for pregnant members for smoking cessation
• Care management team does not advise/assess member after enrollment if member declines help for cessation
• Unable to reach members to initiate postpartum NRT and/or determine quit status
• Erroneous member contact information

Providers:

• Lack of provider involvement in 5A’s (Ask, Advise, Assess, Assist, and Arrange)
• Lack of provider knowledge about MCO smoking cessation benefits and quitline resources

Members:

• Lack of knowledge about MCO smoking cessation benefits and quitline resources
• Lack of knowledge about tobacco risks to unborn child, need for prenatal care and screening
• Lack of willingness/readiness to quit
• Lack of family support
• Privacy concerns to Quitline referral

To address this need, LHDs could select a smoking cessation package targeted to pregnant women, Giving Infants and Families a Tobacco Free Start (GIFTS). GIFTS had minimal engagement reported by local health departments. For FY18, eight LHDs chose the program, with 369 pregnant women and 310 postpartum women reached by the program. After cessation of the program for FY19 (for whom only 15 engaged with the QUIT line in FY18), LHDs reported greater numbers of engagement.

While KY has made some progress in decreasing the number of women who smoke during pregnancy, the rates of smoking during pregnancy in KY remain almost double that of the nation. KY is consistently one of the worst states on this indicator. Initial efforts to encourage participation of pregnant smokers in Quit Now KY have not been successful. In 2018, there were a total of 56 women enrolled in the pregnancy protocol and 24 women enrolled in the post-partum protocol. Quit Now KY services are under utilized by pregnant women in KY. New strategies to engage this population will be identified and tested in the upcoming year.

Teen Birth:

Since 2008, Kentucky has experienced a steady decline in teen birth rate of fifteen to nineteen year olds. The teen birth rate was 13.1% in 2008 and is down to 7.3% in 2017.

While the overall teen birth rate is improving, a geographical view revealed areas in eastern Kentucky have teen births accounting for as much as 10.8%. The teen births rate is slightly higher in Blacks at 7.6% compared to 7.2% in Caucasians.

Maternal Mortality Review:

Maternal death is the worst outcome of pregnancy with one death being too many. Maternal deaths have significant repercussions, as women are crucial to a prosperous and healthy community. In Kentucky, the rate of maternal death has increased in the past five years. Historically, approximately 40 maternal deaths were reported annually through the Office of Vital Statistics (OVS) occurring within one year of the end of pregnancy. In 2016, this rate rose to 60 deaths and in 2018 preliminary data, 80 cases have already been identified for review.

 

While pregnancy-related causes of death comprised a large percentage of causes of death, the pregnancy-associated, but not related causes such as accidental injury, suicide, and homicide, appear to be the precipitating cause of many deaths. Factors affecting morbidity, such as tobacco use, obesity, socioeconomic disparities, depression, and substance use disorder increase the risk of mortality in Kentucky. Social determinants of health, such as transportation, access to care, domestic violence, and a geographically rural state, limit early preventive care to reduce risk and address morbidities. Many women in rural Kentucky have an hour or much longer for travel to birthing hospital, specialist or obstetrician. If a pregnancy is high risk, the expecting mother may need to travel greater distances to Lexington or Louisville, KY, for management of the pregnancy.

 

Disparities in Kentucky vary by geography, race, and access to care. Appalachian communities are unique and deserve special attention given the rural, resource-limited, socio-economically impoverished nature of families in this part of Kentucky with an additional burden of low health literacy and limited access to care. The following figure represents the maternal mortality rate per 100,000 live births for Kentucky for 2013-2017 based strictly upon reported fields on the Kentucky Certificate of Death represents these deaths further defined by manner of death.

 

 

Nationally, African American women are estimated to be three to four times more likely to die from a pregnancy-related complication. The number of deaths of these women in Kentucky is too small to provide a valid review of racial disparity. From review of death certificates, maternal deaths appear to be higher among black women in the two largest urban cities of Lexington and Louisville; however, providers and birthing hospitals are more readily available in these areas. Although providers and birthing hospitals are readily accessible, there are other factors such as lack of transportation, lack of insurance, and systems issues that may be a barrier when seeking prenatal care that may explain disparity in maternal mortality by race.

 

With an increasing rate, it became imperative for Maternal and Child Health (MCH) to understand the factors influencing this increase. A deeper review of the data revealed the number of maternal deaths from possible pregnancy-related causes (natural deaths) remained relatively unchanged. While, possible pregnancy-associated or pregnancy associated - but not related causes such as accident, homicide or suicide were rising. Further review of accidental deaths found over half had at least one ICD code related to substance use disorder or drug overdose.

 

Late in 2017, MCH began restructuring the MMR process with plans to be inclusive of all maternal deaths within one year of pregnancy. Key MCH staff consulted with the Centers for Disease Control and Prevention (CDC) technical assistant to assure case identification, review process, MMRC, and abstraction tools would meet best practice guidance provided and assure fidelity of the MMR program. MCH submitted a request for the Maternal Mortality Review Information Application (MMRIA) to ensure data and abstractions align with national reporting goals and processes.

 

In June 2018, an amendment to Kentucky Revised Statute (KRS) 211.684 authorized the Kentucky Department for Public Health (KDPH) to develop a multidisciplinary MMRC to conduct case reviews to inform public health policy, programming, and prevention activities and to assure case review details had protection from discoverability. Implementation included:

• June 2018: MCH presented the changes in scope to community stakeholders during the annual Kentucky Perinatal Association (KPA) meeting.
• August 2018:  Appointment of Dr. John Barton, a maternal-fetal medicine specialist and 30-year veteran ACOG member as MMRC chair. Invitations were sent to those who would comprise a 28-member MMRC with clinical and non-clinical backgrounds.
• October 2018: Inaugural MMRC meeting held. MMRC determined the new case review process would begin with 2017 cases.
• As of June 2019: This 28-member MMRC has met 3 times and reviewed 20 cases occurring in 2017. The multidisciplinary composition of the MMRC can be noted in the MMRC annual report included in the Supporting Documents section.

 

With more than 60% of pregnancy-related deaths estimated to be preventable, it is imperative Kentucky identify factors involved in maternal deaths and translate MMRC recommendations into prioritized strategies for primary, secondary, and tertiary prevention to reduce maternal mortality. Plans for next steps include further enhancement of the MMR process, partnerships with local birthing facilities or providers, and dissemination of recommendations.

 

MCH has applied for the CDC-RFA-DP19-1908 Preventing Maternal Deaths: Supporting Maternal Mortality Review Committees. This funding would support sustainability of the MMRC and subsequent increase in the MCH workforce to re-establish a Kentucky Perinatal Quality Collaborative (KPQC), and apply for the Alliance for Innovation on Maternal Health (AIM) to promote use of data-driven quality improvement strategies and align existing safety efforts to improve maternal outcomes. Strategic planning for a KPQC began in June 2019 with various community partners.

 

The KPQC will use information learned from a previous Perinatal Advisory Committee that began in 2015. This committee was suspended in 2017 secondary to lack of funding. Their recommendations regarding substance abuse during pregnancy and NAS remained a core concern for MCH. Much of the work MCH has completed or planned for began from the core recommendations from this committee. Ongoing work to establish the KPQC is planned to continue on these fundamental best practice recommendations.

 

The Perinatal Quality Committee recommendation for women with substance use during pregnancy was:

• Develop more comprehensive services for pregnant and parenting women with substance use disorder
  • In 2018, KY launched Find Help Now KY (findhelpnowky.org) website launched, developed in collaboration between KIPRC, UK College of Public Health, CDC, KY Cabinet for Justice and Public Safety, and multiple departments from the Cabinet for Health and Family Services.
  • Provider or an individual can use site to find up-to-date information on the current availability of accessible additional treatment services, both online and in real time

MCH Best Practice Strategy Packages:

In FY18, 23 LHDs selected the MCH Prenatal Care Tracking Package with 7,341 women receiving assistance in obtaining and continuing prenatal services. This strategy helped LHDs improve their internal process of tracking the initiation and continuity of prenatal care. Pregnant women receive referrals for services such as WIC, HANDS, breastfeeding peer counseling, and other services as appropriate. The specific strategies include coordinating care for pregnant women with local providers, ongoing contact with pregnant women, assistance with enrollment in Presumptive Eligibility (PE) and Medicaid, and referral of women denied Medicaid to providers for the Title V Public Health Prenatal Program. Through this package, LHDs are tracking these women to see if they initiate prenatal care within the first two weeks of a positive pregnancy test, thus increasing the chances of improved perinatal outcomes. While following up with patients about initiation of prenatal care, LHD staff may also assess for barriers to care such as a payor source and assist with the application process for Medicaid, PE, or the Public Health Prenatal Program. By assuring that women are obtaining early and ongoing prenatal care, there are many opportunities to educate these women about the risks associated with cesarean sections and EEDs.

Rates of EED continue to decrease since 2011. At that time, the percentage was 30.3%, which decreased to 27.2% in 2016 [National Vital Statistic System (NVSS)]. This reduction is likely due to many factors including the CoIIN EED team, HBWW, and KHA activities.

In FY18, five LHDs implemented the HBWW MCH Evidence Informed Strategy with 8,580 pregnant women, providers, and professionals reached. Activities included attendance at the National HBWW Conference, distributing HBWW material to communities and obstetric providers, newspaper articles, and TV interviews regarding preterm birth prevention. Implementation of this package promotes increased collaboration between LHDs, providers, and hospitals with a common goal of preventing EEDs. LHDs have provided HBWW presentations to pregnant women, WIC participants and obstetric providers. The Barren River District Health Department collaborated with the Medical Center at Bowling Green to organize a presentation for providers on “Preterm Labor Risk Factors and Strategies for Management”.

Other Programs Affecting Women and Maternal Health:

KY’s progress related to maternal morbidity continues through the Health Access Nurturing Development Services (HANDS) home visitation program. HANDS began in 1998 as KY’s voluntary home visitation program designed to assist overburdened expectant and first-time parents, prenatally through age 3. In 2011, HANDS expanded to serve multigravida families. HANDS focuses on fostering early childhood development, nurturing relationships, and learning which serves more than 12,000 families statewide. The paraprofessional and professional HANDS home visitors build relationships with the parents of young children and work on positive parenting and family self-sufficiency skills using a strengths-based curriculum. These protective factors build resilience and positive outcomes for both the child and parents. Previous outcomes studies report the infant mortality rate was 74% less likely among HANDS participants than statewide.

 

The HANDS program has also shown success in improving maternal and child outcomes with the latest data showing:

• 26% less premature births
• 46% less low birth weight births
• 47% less child abuse and neglect
• 14% more adequate prenatal care
• 49% less pregnancy-induced hypertension
• 40% less maternal complications during pregnancy

KY was a recipient of formula and competitive grant funds through the Maternal Infant Early Childhood Home Visiting (MIECHV) Program. At full implementation, 78 counties received expanded services (in addition to the core HANDS program, which is in every county). Due to changes in the federal MIECHV, currently only 29 of Kentucky’s highest at risk counties receive support by MIECHV Formula funds. The benchmark results from this program found improvements in maternal and newborn health; school readiness and achievement; increased screening for domestic violence and referrals for victims of domestic violence; family economic self-sufficiency; referrals for other community resources; decreased mother and child visits to the Emergency Room; and decreased incidence of child injuries requiring medical attention.

The MIECHV grant requires grantees to demonstrate improvement in performance measure outcomes. Based on the performance report data submitted in October 2017, KY’s MIECHV/HANDS demonstrated improvements with the following percentage of clients receiving:

• Screenings
  • Depression (73%)
  • Developmental (81%)
  • Behavioral (90%)
• Well Child Visits (70%)
• Depression Referrals (90%)
• Primary Caregiver’s Education
• Early Language and Literacy Activities
• Children with Health Insurance Coverage
• Completion of HANDS Healthy Kids Childproofing Checklist

Moving Beyond DepressionTM (MBD), a 15 session In-Home Cognitive Behavioral Therapy (IH-CBT) focused on alleviating symptoms of depression and increasing coping skills, ended on June 30, 2019. As a transition, MCH worked with the developer of MBD to design a tele-health approach to services, which is billable to Medicaid. KY’s MBD referrals by HANDS home visitors who see signs of depression in mothers and complete an Edinburgh screening will continue.

Changes to the Federal structure of the MIECHV program presented challenges for KY. Beginning July1, 2019 Medicaid will allow billing for HANDS multigravida services. This change will support sustainability of these services.

 

Oral Health:

 

In a previous reporting year, KY’s annual objective for NPM #13A (Percent of women who had a dental visit during pregnancy) was set at 33%, with the actual outcome being 11% per Medicaid data. Improvements for this measure are most likely the result of lack of engagement and treatment. Strategic planning was completed to determine activities to promote inclusion of oral health assessment and referral for treatment as a routine service for pregnant women. From the 2017 PRAMS cohort data, over half of PRAMS mothers never spoke with a health care worker or dentist about oral health during pregnancy.

 

Emergency Preparedness:

The purpose of the Kentucky Emergency Operations Plan (KYEOP) is to define the general responsibilities of emergency response agencies, their partners, and the organizational structures required when activated to respond to emergencies, disasters, and technological incidents [all hazards] affecting the Commonwealth of Kentucky and its citizens.

This plan is the all-hazards emergency plan as described and required in Kentucky Revised Statue (KRS) 39A and is activated upon order of the Governor of the Commonwealth of Kentucky, the Director of KYEM, or their authorized representatives. Parts of this plan or the entire plan are automatically activated when:

• A general declaration of a disaster or an emergency by local, state, or federal authorities, or
• Required by the size and level of impact of a catastrophic event, or
• Required to implement actions necessary to place emergency personnel on active readiness levels for an impending incident or scheduled event

This plan is the cornerstone document of the Commonwealth Comprehensive Emergency Management Program established to support an integrated emergency management system, providing for adequate assessment and mitigation of, preparation for, response to, and recovery from the threats to public safety and the harmful effects or destruction resulting from all major hazards.

Cabinet for Health and Family Services (CHFS) is the primary state agency responsible for coordinating and regulating health, medical, and social support services during emergencies or disaster events. During such circumstances, the Department for Public Health (DPH) is responsible for coordinating:

• Assessment of public health and medical needs
• Disease surveillance
• Mobilization of trained health and medical personnel and emergency medical supplies
• Provision of public health environmental sanitation services
• Food safety and security
• Disease and vector control
• Safety and security of drugs
• Biologics and medical devices distributed via the SNS program
• Establishment and staffing of special medical needs shelters and mass fatality management
• Handling, analysis and identification of hazardous materials.

MCH has specific Continuity of Operations Plans (COOP) in place to address nutrition for pregnant women and children through the WIC program, access to dieticians, and an outbreak plan through the Division of Epidemiology and Health Planning.  During mass emergencies in other states, KDPH has assembled nursing strike teams to join Public Health efforts in other states.  Two nurses from MCH have been part of these teams as KDPH strike team leaders in years past.