Improving access to insurance coverage, preventing and reducing chronic health conditions, and promoting wellness significantly affect the lives of women of all ages. Because women represent the cornerstone of a family’s overall health, ensuring they have access to quality care can lead to improved health for children and families. With all of the responsibilities women have to deal with in their daily lives, well woman care can fall by the wayside.  In addition, ensuring that women receive prenatal care - regular check-ups with a provider that include screening for conditions such as gestational diabetes or birth defects, monitoring for potential complications, and education to encourage healthy behaviors such as smoking cessation and healthy eating - can reduce the risk of premature delivery, low birthweight and infant mortality. Infants of women who receive late or no prenatal care are twice as likely to have a low birthweight, compared to infants of women who receive prenatal care during the first trimester.

During our 2015 MCH Needs Assessment two state priority needs were identified that were inclusive of the women/maternal health population:

• Promote preconception/inter-conception health; and
• Promote oral health for all populations

Under the National Performance/Domain framework, one National Performance Measure was chosen and the objectives, strategies, activities are identified within the State Action Plan framework. In addition to the National Performance Measure activities there are other women/maternal health efforts that MCH team members support to assist in addressing women/maternal health priority needs.  Efforts included:

• Office of Child and Family Services’ (OCFS) offices (77 across the state) promoted Health Coverage Open Enrollment (November 1 – December 15, 2018) by dispersing Get Covered South Dakota’s pamphlets to client’s who did not have health coverage.  The pamphlet provides instructions on how to sign up for health insurance on the Marketplace, how to get help in signing up (location of Navigators) and the location of all Community Health Centers in South Dakota (SD) that have a sliding fee scale for services and are a part of the Community Healthcare Association of the Dakotas (CHAD).
• Department of Health (DOH) partnered with Delta Dental in SD to promote oral health for new moms:  Delta Dental distributed a SMILE kit to all new moms at birthing hospitals across the state.  Resources included: an adult size toothbrush and a handout Tips on Caring for Your Teeth.  Delta Dental distributed 10,861 Smile Kits in calendar year 2018.
• DOH’s Tobacco Disparities Coordinator provided information to OCFS field staff on the newest programs available to clients they serve:

• QuitLine services were made available to vaping clients
• Added Postpartum Relapse Prevention Services for pregnant women who are using tobacco/vaping during pregnancy but trying to quit or pregnant women who have quit using tobacco products during pregnancy and don’t want to relapse after they deliver.

• DOH’s Tobacco Program also promoted cessation services for pregnant and postpartum women by:

• Placing ads in SD Medical Journal (2,000 subscribers)
• Posting Facebook ads targeting women of childbearing age
• Mailing postcards to 4,000 postpartum women on Medicaid
• Developing and dispensing rack cards for healthcare providers to display in their clinics

• DOH had a display at the SD Annual Perinatal Conference to share information and resources available for doctors, Certified Nurse Practitioners and nurses who work in hospitals and clinics across the state.  Resources dispersed included:

• Posters on the harms of vaping
• Breastfeeding Friendly Business materials
• Posters for marketing the Pregnancy Risk Assessment Monitoring Survey (PRAMS)
• SD QuitLine information for providers
• Information on Bright Start home visiting and the National Family Partnership model
• Information on For Baby’s Sake website and Text4baby

At the end of this reporting period the MCH Impact Team workgroup members assigned to each National or State Performance Measure were asked to complete a data collection form.  The data collection form was a checklist of the strategies that the program was to address during the grant year. The workgroup members rated the degree to which the strategies were implemented, and the percentage of completion is included as the ESM for each measure.  In addition to this assessment for each measure, data was reported to provide a quantitative context for each strategy. This ESM process allowed us to better report progress to date on all strategies.  Data collection forms can be found at the link below: 

https://doh.sd.gov/documents/MCH/NPM1_2021DetailSheet_ESM.pdf

DOH Strategic Plan Goal 1: Improve the quality, accessibility, and effective use of health care.

National Performance Measure 1: Percent of women ages 18-44 with a past year preventive medical visit (data source: BRFSS)

Data Statement:

The routine checkup item question on BRFSS changed in 2018 and is not comparable to previous surveys. Due to this change, it is not possible to determine whether the target was reached or whether there was significant trend.  In 2018, South Dakota was ranked 8th in the nation with 77.6% of women having a preventive visit in the past year compared to a U.S. rate of 73.6%. 

The full-length South Dakota MCH Annual Data Summary can be found here:

https://doh.sd.gov/documents/MCH/2020_SD_MCH_DataSummary.pdf

State Objective:

By June 30, 2020, increase the percent of women, ages 18 through 24 years, who had a preventive medical visit in the past year from 59.3% (2016) to 66.2%. (data source: BRFSS)

State Objective Data Statement:

The routine checkup item question on BRFS changed in 2018 and is not comparable to previous surveys. Due to this change, it is not possible to determine whether the target was reached or whether there was significant trend.  In 2018, South Dakota was ranked 14th in the nation with 76.4% of women aged 18 through 24 years of age who had a preventive visit in the past year compared to a U.S. rate of 73.4%. 

Strategies:

1.         Partner with other agencies (state and other) to promote yearly preventive visits.

• Partnered with the SD Women, Infants, and Children’s (WIC) Program to promote Well Women visits:  the state WIC Breastfeeding Coordinator encouraged all WIC staff during a monthly WIC call to educate women on the importance of yearly preventive visits and to utilize the Well Women Visit referral in SD WIC-IT when making a referral.  Well Women visit referrals increased from 200 in FY18 to 317 in FY19.
• Partnered with the Bureau of Human Resources (BHR) to promote Well Women visits:  MCH team/BHR developed a letter to send to all SD state employees ages 18-39 reminding them to see their provider yearly for a preventive visit (evidence-based strategy).  The letters went out in February and March of 2019 and included a list of preventive services covered at 100%.  In FY19 (07/01/2018-06/30/2019) 30% of women between the ages of 18-24 submitted a claim for a preventive visit (CPT codes 99385 & 99395).
• Collaborated with the DOH Strategic Planning work group in promoting well visits for males, ages 18-34 for National Men’s Health month in June (2019) and females, ages 16-25 for National Women’s Health month in May (2019) using social media.
• MCH team continues to partner with the SD Family Planning program to promote Well Women visits:  SD Family Planning has 20 locations across the state each offering annual exams to clients on a sliding scale fee.
• The NPM #1(Well Women) Interagency team met in conjunction with the NPM #10 (Adolescent Well Visit) Interagency team in February 2019 to discuss ways to promote yearly well visits for adolescents and young women.  Agencies represented besides DOH were BHR, Department of Social Services (DSS) Medicaid, a DSS Medical Consultant, and a Medical Consultant (Pediatrician) from Urban Indian Health and the Avera Medical Systems.
• DOH’s Tobacco Program collaborates with Delta Dental to provide QuitLine information to families who have a smoker in the home.  Delta Dental’s Regional and Mobile clinics place a QuitLine sticker on a child’s take-home paperwork when the child reports that someone in their home smokes.  In 2018, Delta Dental staff saw 6,715 children for dental care and gave out a total of 564 stickers with QuitLine information.

Challenges: 

• The MCH program has limited outside partners in this arena.  We need to reach out to other medical groups such as the Community Healthcare Association of the Dakotas to help us promote preventive visits.

1.2.      Educate women on the importance of yearly preventive visits.

• BHR has a banner promoting well visits at every state employee health screening throughout the year.  One hundred twenty-two screenings were offered in 26 locations.  There are 26,822 employees on the SD Health Insurance Plan.
• MCH team worked with the SD WIC program to get a preconception (Well Women) message added to their Keeping Yourself and Your Family Healthy WIC pamphlet which is given to all women on the program.  SD WIC had an average of 3,943 pregnant or postpartum women enrolled in CY18.
• A Women’s Health data brief which included a section on Preconception Care was disseminated to 160 partner/stakeholders as part of the MCH Needs Assessment to encourage promotion of a Well Women visit.  Data relevant to Well Women visits (BRFSS) and SD 2016 PRAMS-like data on the percent of mothers participating in health-related actions prior to pregnancy were included.
• A Facebook post titled 11 Life Changing Reasons to Get Well Women Check-ups ran on For Baby’s Sake Facebook page from 5/9/19-6/30/19.  The post had a link to For Baby’s Sakes’ Scheduling Annual Well Women Check-ups and ACOG’s Well Women Exam infographic.  The post had a paid reach of 83,470 people.

Challenges:

• Finding an effective way to disseminate information that young women will read and act on.

1.3.    Implement training for Office of Child and Family Services staff related to preconception/inter-conception health.

• SD Family Planning developed a Power Point presentation to update OCFS field staff on the services that are offered to clients (including Well Women exams) in their clinics across the state.  The Power Point will be shared at the December of 2019 regional staff meetings.
• The SD Tobacco Program updated their Program and Resource Online Facilitator (PROF) content in February of 2019 for OCFS field staff to review.  Tobacco PROF includes training modules:

• The Toll of Tobacco on SD
• Priority Populations
• Talking Tobacco Techniques
• The SD QuitLine - Your Partner in Tobacco Cessation

• A Preconception Health training was presented by Dr. Jessica Rasmussen, Ob/Gyn to 56 OCFS field staff at their All Staff Conference in July of 2019.  Dr. Rasmussen’s presentation included a section on the risks of smoking and smoking cessation.
• NPM #1 workgroup facilitator is in the process of developing a training module for the All Women Count program so that OCFS field staff are aware of the services this program provides to low income women.

Challenges: 

• Meeting the training needs of all staff in a timely manner.
• Determining the most effective way to provide training with limited budget.

ESM: The degree to which the South Dakota Title V program has implemented evidence-based or informed strategies to assure that all women are aware of the importance of annual well women visits

 76% completion of identified strategies.