Women/Maternal Health Report

The Women/Maternal Health report demonstrates how collaboration between agencies, partners, and the Title V MCH Maternal and Infant Health Program (MIP) improves the health of Nevada women. The population of women, ages 18 through 44 years old (y.o.) is demonstrated by the Census tract in the map below.

The Title V MCH Program chose NPM 1 and NPM 14 to improve women and maternal health outcomes. Improving preconception and interconception health among women of childbearing age is a priority need in Nevada. Title V MCH partners implement strategies to increase the percentage of women, ages 18 through 44 y.o., with a preventive medical visit in the past year (NPM 1), reduce the percentage of women who smoke during pregnancy (NPM 14), and reduce substance use in women of childbearing age. To address these priority needs all subawardees share information promoting Nevada 211, the Nevada Tobacco Quitline (NTQ), and the Medical Home Portal (MHP) as part of their scopes of work. Similarly, to support awareness and skills building, subawards include training in Diversity, Equity, and Inclusion (DEI) efforts. Specific program activities and successes related to these efforts are included below.

As part of the Title V MCH Program, MIP provides technical assistance, resources, and support to private and public agencies serving women ages 18 through 44 y.o. The MIP Coordinator works closely with these agencies, as well as the Title V MCH Program Manager, MCAH Section Manager, and MCH Director, to improve the health outcomes of women of childbearing age.

Nevada Home Visiting Report

The Nevada Home Visiting (NHV) Program supports agencies and organizations statewide in providing evidence-based home visiting services to pregnant people, mothers, fathers, and caregivers to improve maternal and newborn health, improve school readiness, and reduce child injuries, neglect, and abuse. NHV focuses on many MCH priorities, including improving preconception and interconception health, breastfeeding promotion, increasing developmental screenings, reducing teen pregnancy, reducing substance use during pregnancy, reducing infant mortality, and increasing adequate insurance coverage for families.

The Title V MCH Program collaborates with the  NHV Program by co-funding activities for the Sunrise Children’s Foundation expanded Home Instruction for Parents of Preschool Youngsters (HIPPY) program in Pahrump and the Children’s Cabinet developmental Parents as Teachers (PAT) home visiting program in Reno. The design and delivery of these programs are to provide comprehensive, coordinated health and social services; fostering continuous access to screenings and referrals for people who are pregnant or who have young children.

HIPPY programs (serving families with children aged 2-5 y.o.) help parents engage with their children in daily learning activities to help promote literacy and school readiness. The program fosters language development, problem-solving, logical thinking, and perceptual skills in children. PAT serves expectant mothers and families with children up to kindergarten entry providing child development education, health education, activities to build cognitive and motor skills in children, screenings, and parent-child interaction coaching. Both programs provide:

• Developmental and social development screening.
• Birth spacing education.
• Screening for insurance coverage.
• Depression screening (both post-partum and general).
• Screening for domestic violence.
• Screening for necessary needs (housing, food, clothing, and utilities).
• Substance misuse screening.

Referrals are provided for any screening demonstrating need. Referrals are then followed up on, and assistance is given in making appointments and completing assistance applications. Agencies implementing home visiting programs for NHV pursue Continuous Quality Improvement (CQI) by conducting Plan-Do-Study-Act (PDSA) cycles to test small changes to improve processes and outcomes. Benchmark data from MIECHV are shared with the Title V MCH Epidemiologist and other staff.

NHV and all implementing agencies are participating in a core competency certification program including self-paced courses as follows: ASQ-3, Basics of Home Visiting, Building Engaging Relationships, Challenges: Substance Abuse, Domestic Violence, Infant Mental Health, Pregnancy, Supervising Home Visitors, Trauma for Home Visitors, and Trauma for Supervisors. In addition to the self-paced courses the certification also requires the following live webinars: Domestic Violence: Safety Planning, Exploring Values and Beliefs, Home Visiting Boundaries, Home Visiting Safety, Implementing Tools, Home Visiting Boundaries for Supervisors. Matching Resources, Partnering for Change, Motivational Interviewing, Reflective Supervision, Impact of Domestic Violence, Trauma in Communities, and Understanding Substance Abuse. Technical Assistance has been provided to agencies for data entry, CQI processes, and family engagement.

All home visiting models provide information to encourage well-child and adult well visits, immunizations, child development topics, and safe home information. In addition to these topics, agencies serving expectant mothers and infants all have a certified lactation educator to provide breastfeeding education and support. NHV has provided each of those agencies with commercial-grade and loaner breast pumps to encourage longer breastfeeding as mothers return to work.

NHV provides bilingual materials to agencies serving populations with bilingual home visitors. Families are also provided with Spanish language books for children to keep, and agencies maintain a resource library for check-out in Spanish and English. In addition, families are administered Spanish language screenings and learning materials. A total of 77 MIECHV families reported Spanish as their primary language in FFY21.

There were 376 households served by the Nevada Home Visiting Program in FFY22, with a total of 393 children served. Twenty-one parents less than age 17 y.o. were served in FFY22. Additionally, 60 pregnant persons were served, with 41 under the age of 21.

Home Visiting has returned to in-person visits in some areas, although COVID-19 cases impacted in-person visits. Family retention improved during COVID, with families finding virtual visits easier to maintain. The Association of Maternal and Child Health Programs (AMCHP) provided funding via the Coronavirus Aid, Relief, and Economic Security (CARES) Act to provide laptops and hotspots with data plans for families needing those items to carry out virtual home visits, medical visits, mental health visits, and other critical needs. This project has been extended using American Rescue Plan (ARP) funding to purchase more data as needed. MCH partners in addition to NHV were served with CARES funding.

The Nevada Statewide Maternal and Child Health (MCH) Coalition Report

The Title V MCH Program funds the Statewide MCH Coalition which conducts community outreach and increases public awareness for Title V MCH priorities. The Coalition held virtual meetings and webinars to conduct outreach and continuing education on MCH priorities. In addition, many community partners held in-person resource fairs and events that coalition members attended. Monthly coalition meetings (14 in total between Northern and Southern Nevada) continued utilizing virtual platforms to conduct meetings and collaborate to discuss the ever-changing health climate during the pandemic. Northern NV MCH Coalition held a few hybrid meetings to get more involvement with hopes to increase in-person attendance within the new fiscal year.

The coalition conducted individual outreach in the community as well as holding collaborative events that demonstrated support for breastfeeding, preconception and interconception health, developmental screenings, anxiety and depression, safe sleep, marijuana use during pregnancy education, and promotion of other statewide resources.

Social Media outlets continued to grow with Facebook totaling 480 page “Likes”, and Instagram totaling 598 “Followers.” Social posts included awareness and support for the following programs: Sober Moms Healthy Babies, Nevada 211, Medical Home Portal, Nevada Tobacco Quitline, Go Before You Show, Count the Kicks, breastfeeding, safe sleep, lead poisoning information, and several community programs and events. The MCH website saw continued growth throughout the year, as well as Facebook, and Instagram, as displayed in the chart below: 

October 2021-September 2022	Facebook Likes	Facebook Followers	Instagram Following	Website Total Visitors
October	487	489	495	1750
November	489	492	507	1466
December	487	495	506	1269
January	494	501	528	1563
February	492	506	566	1803
March	494	582	619	2549
April	501	521	672	4777
May	501	501	692	1372
June	511	511	745	1429
July	513	551	776	1684
August	527	572	794	2491
September	542	598	824	3765
Total for Grant Period	542	598	824	25,918

 

In addition to social media outlets, the Coalition was able to promote MCH topics through digital billboards in both the North and the South for the Go Before You Show campaign, Perinatal mood and anxiety disorders (PMAD), safe sleep, and the annual Fall Symposium during the springtime. Later in the fall, radio spots with Nevada Broadcasters Association were utilized.  

In 2021, the Southern Nevada Maternal and Child Coalition launched the first direct service program by the Coalition. In collaboration with agencies serving prenatal and perinatal clients, New Mama Care Kits are distributed to women with low-income, providing them with after birth items including pads to manage flow, hemorrhoid wipes, sanitary wipes to keep stitches clean, hand sanitizer, and disposable undergarments. Information on how to care for stitches and after birth care, along with services available to growing families are included. A knitters group made baby blankets and burp cloths; Liberty Dental donated dental kits and family planning donations like condoms were received from University Medical Center (UMC's) Healthy Living Institute. This program was created especially for low-income families affected by the pandemic. Well after the community recovers from the economic disruption, the need for these items remains as clients regain self-sufficiency after homelessness, unemployment, underemployment, domestic abuse and teen pregnancy.

The New Mama Care Kits include:

• 14 individually wrapped maxi pads
• 14 individually wrapped moist towelettes (these can be heated in the microwave)
• 1 package of wipes
• 2 disposable underwear
• 2 purse size hand sanitizers
• Information about ‘What to Expect After Giving Birth’ and ‘How to Care for Stitches’
• Additional materials to recognize signs of postpartum depression and other relevant information for families with young children
• Small gifts for mother (determined per donations)
• Distributed in a reusable tote bag

Partner agencies for the New Mama Care Kits include: UMC's Healthy Living Institute, UNLV School of Medicine OB Clinic, Mobile Medical Clinic, Sunrise Hospital's Sunny Babies, Women’s Health Associates of Southern Nevada/Nevada Obstetrical Charity Clinic, Baby's Bounty, and WIC locations through the community, including St. Rose WIC and Urban League WIC.

This program functions off sponsorships, with the help of Anthem Medicaid, Molina Healthcare and Health Plan of Nevada. More recently, the Northern Nevada MCH Coalition received its first sponsorship from Health Plan of Nevada to launch the program in the North and Rurals.

In February, the Southern Nevada MCH Coalition worked with HealthPlan of Nevada (HPN) to secure a $5,000 sponsorship to provide New Mama Care Kits to low-income Black mothers in recognition of Black Maternal Health Week in April. The Southern Nevada MCH Coalition was able to stretch those funds to last until July. Included below is the distribution tracking of the care kits:

 

Keeping in mind the safety of the community, the Statewide MCH Coalition held an annual Fall Symposium virtually on the vFairs virtual event platform. Camp Creating Open-Hearted Peaceful Experiences (C.O.P.E.) had 76 attendees, 9 virtual booths and 10 sessions discussing topics including: Introduction to PMADs, How to Survive and Thrive When Sleep Deprived, Count the Kicks, How to find success in the Workplace & at Home, Reconnecting to Your Womb: A Journey through the Cycle, Safety in and Around Vehicles, PMADs and Attachment, the Power of Sharing your Story, a painting activity, and healthy trail mix demo.

Perinatal Mood and Anxiety Disorder (PMAD) and Maternal Mental Health

Title V MCH funding supports a PMAD Coordinator position through Dignity Health to enhance Statewide MCH Coalition efforts. This position works to educate healthcare professionals and MCH partners about recognizing, assessing, and referring persons to accessible services and resources for PMAD, and promoting emotional and psychological support services to persons diagnosed with PMAD to assist in recovery. The PMAD Coordinator held 23 PMAD trainings open to the public statewide. These trainings were held virtually and in-person. Attendees included UNLV Pediatric Residents, WIC, College of Southern Nevada’s Community Health Worker students, and interested community members. A PMAD facilitator training was held for partners with Molina Healthcare’s Community Outreach team. The coordinator also conducted outreach to organizations including OBGYN offices, therapists, doulas, the Southern Nevada Health District, WIC offices and other local programs. Collaboration continued with HPN’s Behavioral Health Options in assisting families with available resources statewide in navigating care for PMAD. Additionally in collaboration with UNLV School of Medicine, trainings were given to current and active pediatricians in Nevada.

Title V MCH continues to promote HRSA’s Maternal Mental Health Hotline through website postings and sharing with relevant partners.

Women’s Health and Wellness Outcomes

The Title V MCH Program continued to participate in efforts to promote reproductive health, planning, and access. Staff worked with the Account for Family Planning (AFP), Teen Pregnancy Prevention Personal Responsibility and Education Program (PREP) and Sexual Risk Avoidance Education (SRAE) programs, and other key partners to promote informed reproductive choices and education to support reproductive life planning. Association of State and Territorial Health Officials (ASTHO) Opioid Use Disorder, Maternal Outcomes, and Neonatal Abstinence Syndrome Initiative (OMNI) efforts and quality improvement of Infant Plan of Safe Care processes continued, as did efforts to create a robust wrap-around care and referrals for people who are pregnant and use substances. Efforts continue to try and get significant utilization of the Tobacco Quitline among pregnant people. PRAMS data to action exploration, pregnancy surveillance efforts, and programming based on surveillance resulted in initial PRAMS data use.

 

Nevada Alliance for Maternal Innovation (AIM) launched and MCAH worked on Nevada MMRC establishment pathways and data reporting working with the Office of Analytics to reduce preventable maternal mortality and severe maternal morbidity. Exploration of perinatal quality improvement efforts more broadly continued as a possible space to leverage efforts of perinatal groups. Development of more robust maternal and perinatal data evaluation is pending in order to present timely key indicators of MCH health. Continuing to look for opportunities to expand NHV capacity to serve more families through additional funding streams and continued participation of Title V MCH in early childhood support and systems building initiatives continue and focus on referral pathway supports and data integration.

Maternal-focused websites, social media and print campaigns, and sponsoring conferences for information sharing and collaboration are ongoing. Staff training on equity and programmatic efforts focused on disparity reduction are key areas of focus and include current partnerships with Nevada Office of Minority Health and Equity (NOMHE), The Center, Nevada Governor’s Council on Developmental Disabilities (NGCDD), and the Nevada Coalition to End Domestic and Sexual Violence (NCEDSV) efforts to prevent sexual assault among CYSHCN with developmental disabilities.

Public Health Clinic Wellness

The Title V MCH Program funded 12 public health clinics to improve maternal and women’s health among those aged 18-44 y.o. These entities included Carson City Health and Human Services (CCHHS), a local health authority in Northern Nevada, and 11 DPBH Community Health Services (CHS) nursing clinics providing services in Nevada’s rural areas. Clinic assessments, education, reproductive education, and resources were based on nationally accepted standards of practice. All nurses are mandatory reporters and educated in the recognition of patients at risk for human trafficking, neglect, and abuse. Staff are trained in the delivery of culturally competent care, inclusive language, and trauma-informed care.

Through community events and clinic visits, staff distributed women’s health-related materials. Topics encompassed the value of no-cost yearly checkups, reproductive and sexual health (including long-acting reversible contraception), healthy pregnancy outcomes, immunizations, depression, and intimate partner violence. Title V MCH Program provided resources distributed about Go Before You Show, Nevada Tobacco Quitline, Sober Moms, Healthy Babies, Pregnancy Risk Assessment Monitoring System (PRAMS), Text4Baby, Nevada 211, and Medical Home Portal.

During clinic visits, NPM 1 and NPM 12 were promoted. Individuals were educated on the value of an annual preventative medical to align with NPM 1. Those with adolescents were informed about the importance of helping their children transition from pediatric into the adult health care system to address NPM 12.

Individuals were screened and educated on use of alcohol, tobacco/nicotine, recreational drugs, depression issues or suicidal thoughts, and consequences of intimate partner violence. Referrals were provided for individuals needing services. CCHHS initiated CAGE, an evidence-based substance/alcohol use screening tool. The acronym is derived from the four questions of the tool: Cut, Annoyed, Guilty, and Eye.  Providers utilize the tool to learn the nature of one’s behaviors to determine referral needs. CAGE asks about (1) thoughts of cutting down, (2) annoying others or been criticized about their use, (3) feeling bad or guilty about using, and (4) drinking/using substances first thing in the morning to rid hangovers or steady nerves. Research shows individuals screened through CAGE are more willing to get help due to its focus on the effects one’s usage may have on their quality of life. CCHHS reported increased patient willingness to accept a treatment referral due to use of the evidence-based tool.

CCHHS provided wellness screenings and education to 1,680 women. Racial/ethnic groups served were primarily Hispanic (52%) followed by Non-Hispanic White (43%), and the remaining identifying as other racial groups (5%). Referrals were made to users of alcohol (16%), those experiencing depression (11%), users of nicotine/tobacco (7%) substances (3%), and women affected by intimate partner violence (2%).

Furthermore, CCHHS promoted health and wellness messages through community events, clinic digital signage, and social media campaigns. While COVID-19 still impacted outreach activities at the beginning of the report period, CCHHS reached over 450 families through several community events. Individuals driving by or walking into the building could view the promotional campaigns on the signage. Facebook messages promoting yearly well-visits reached 1,609 people with 89% engaged users. This unusually high percentage of engaged users resulted from a PDSA cycle testing the use of extra funding to boost messaging, video screens (rather than still images), postings during prime viewing hours.

 

CHS provided wellness screenings, preventive information, and referrals. Title V MCH Program funding supported purchases of sexual and reproductive health screenings and contraceptives. CDC guidelines were used for education to avoid sexually transmitted infections (STIs) and communicable diseases, as well as a treatment protocol. Referrals were made for persons experiencing depression, individuals using alcohol and substances, and those affected by intimate partner violence. Dependable data is not available for clinic visits since staff operated without an electronic health record (EHR) for several months and challenges presented with reliable reporting in the new system. CHS hired an Information and Technology (IT) contractor to improve EHR report capabilities for the next funded period.

CHS vaccination rates were reported through the Nevada WebIZ system. There were 977 vaccinations given to 812 people (69% female) in the clinic and at community point of dispensing sites during which Title V MCH Program funded education, resources, and referrals were provided.

Sober Moms Healthy Babies (SMHB) Annual Report

Title V MCH Program continued to work with Substance Abuse Prevention and Treatment Agency (SAPTA)-funded treatment providers to update the SoberMomsHealthyBabies.org website. The goal of the website is to prevent substance use in pregnant people, as well as provide information to women of childbearing age, providers, and concerned family and friends. The website provides the substance use helpline number, Nevada 211, Crisis Call Center, the Nevada Tobacco Quitline, and other resources. The website specifies the treatment priority status for pregnant people at SAPTA-funded agencies and the importance of people identifying they are pregnant. SAPTA-funded treatment centers must not deny treatment to persons unable to pay. All treatment centers listed on the website are SAPTA-funded.

The website had 4,816 total sessions with 3,353 users, of which 3,245 were new users. New users represent 77.6% of the total sessions and 22.4% were from returning visitors. A total of page views occurred. 22.78% of sessions came from Nevada, followed by Oregon, Virginia, and California.

Nevada Broadcasters Association conducted television and radio public service announcements in English and Spanish throughout the state to promote the SoberMomsHealthyBabies.org website, in addition to the distribution of outreach materials and referral cards. The 2022 media campaign had a total of 6,873 total spots aired (5,943 radio advertisements and 930 television advertisements), promoting the SoberMomsHealthyBabies.org website and the importance of pregnant persons receiving treatment and preventing substance use in persons of childbearing age. All LHAs and Title V MCH subgrantees promoted SoberMomsHealthyBabies.org and shared SMHB referral cards; OMNI partners also widely shared the site URL.

To raise awareness on the priority admission of pregnant people at state-funded treatment centers, Title V MCH Program disseminated outreach materials promoting the SoberMomsHealthyBabies.org website. The Title V MCH Program is in contact with state agencies and LHAs who have agreed to help with distribution and promotion. Partnerships include the Department of Taxation, Division of Health Care Finance and Policy (DHCFP), SAPTA, local hospitals and providers, March of Dimes, faith based and MCH Coalitions, and other DPBH programs.

All three LHAs participated in sharing substance use in pregnancy resource distribution. CCHHS used Title V MCH funds to endorse pregnant and postpartum persons being substance-free through their clinic’s digital signage and social media. These Facebook messages with information about SoberMomHealthyBabies.org reached 4,237 families with nine individuals clicking on the link for more information.

Title V MCH Program participate in Comprehensive Addiction and Recovery Act (CARA) and Neonatal Abstinence Syndrome (NAS) focused efforts and serve as a core team member on the ASTHO OMNI and Promoting Innovation in State and Territorial MCH Policymaking (PRISM) Nevada Team. Title V MCH Program also serve on numerous subcommittees focused on reduction of substance use in pregnancy and building systems of referral for families with substance exposed infants. LARC and Community Reproductive Engagement Committee Title V MCH Program involvement intersects with substance use prevention efforts, as does engagement on Families First efforts.

Mothers with Substance Use Disorders Focus Groups

Title V MCH funded and collaborated with the University of Nevada, Reno, to conduct a needs assessment of substance exposed maternal-infant dyads to help inform maternal and infant health priorities. Three focus groups were conducted between July-September 2022 and had a total of 27 participants. The purpose of these focus groups was to better understand the experiences of mothers with substance use disorders (SUDs) of accessing healthcare for themselves and for their children. Secondarily, participants were asked how they perceived their own health and their children’s health to better understand barriers and facilitators to healthcare access.

Overall, participants reported feeling healthier when they were not using substances. They reflected on how using while pregnant or while parenting may negatively impact their children and discussed their prenatal care experiences. Participants identified economic and domestic violence-related factors as barriers to both prenatal care and seeking substance use treatment and suggested increased case management as a facilitator to seeking healthcare and addiction treatment.

Potential next steps discussed include:

• Healthcare provider training on substance use disorders (SUD), with an emphasis on social determinants of health such as domestic violence.
• Continuing to understand statewide experiences of mothers with SUDs by expanding needs assessment to more counties.
• Better understanding the linkages between medication-assisted treatment, pregnancy and birth outcomes (and/or develop resources around this for MAT centers and healthcare providers)
• Supporting domestic and intimate partner violence prevention strategies, perhaps by targeting previously identified risk factors such as previous substance use

Marijuana Efforts Annual Report

The Nevada Title V MCH Program continued to disseminate Spanish and English marijuana awareness materials to partners statewide. These materials were developed in prior funding years in response to Nevada’s legalization of medical and recreational marijuana. The Title V MCH Program developed informational resources on marijuana use during pregnancy, breastfeeding, injury prevention, and the harmful effects for children. Efforts to reduce substance misuse in pregnancy and improve interconception care are funded by the Title V MCH program and include promoting the SoberMomsHealthyBabies.org website and associated media campaigns and focusing perinatal activities on the reduction of NAS. Title V MCH funded partners promote SoberMomsHealthyBabies.org through social media and print materials developed by Title V MCH, in addition to the CARA and OMNI resources (including provider guides and Screening, Brief Intervention and Referral to Treatment resources), marijuana use, and pregnancy information, posters, and marijuana and childhood injury prevention warnings. Informational sheets are distributed widely through Washoe County Health District’s Fetal Infant Mortality Review (FIMR) and the LHAs.

Title V MCH Program Tobacco Cessation Report

Title V MCH Program chose NPM 14 to focus on reducing the percentage of women who smoke during pregnancy. Thus, all Title V MCH Program funded agencies promoted the NTQ to pregnant individuals and women of childbearing age. CCHHS and CHS clinics provided education and counseling to users of tobacco. Referrals to the NTQ from CCHHS were supplied to 7.6% individuals screened of all ages. CCHHS promoted the NTQ through the outside digital clinic signage and a Facebook campaign reaching 2,716 individuals with 2.7% engaged users. CCHHS collaborated with health care providers working in behavioral health settings and substance use treatment facilities to educate about NTQ. These collaborations are intended to help a disparate population (with behavioral health conditions and/or substance use issues) be connected to a Tobacco Quitline resource.

Chronic Disease Prevention and Health Promotion (CDPHP) Tobacco Control Program Annual Report

The CDPHP Tobacco Control Program (TCP) disseminates NTQ promotional material to Nevada providers, WIC clinics, early childhood educators, and Nevada Head Start sites. The promotional materials are given to pregnant and postpartum persons who use tobacco. The NTQ continues to provide callers 13 years and older with up to five scheduled personalized, culturally competent coaching sessions, unlimited inbound calls, web and text support, and Nicotine Replacement Therapies (NRTs) free of charge to callers ages 18 and older, upon availability. The Pregnancy/Postpartum Program (PPP) offered mothers in Nevada a designated trained coach throughout each session along with incentivized gift cards for each completed counseling call. According to the guidelines of the PPP program, each pregnant caller was enrolled before giving birth to ensure eligibility for both programs. PPP provides five (5) coaching sessions during pregnancy and four (4) coaching sessions postpartum, and the same coach administers each session. This allows the parent to focus on their health and the baby, creating longevity for both through cessation. Comprehensive printed educational materials on the benefits of quitting smoking during pregnancy and harmful effects on babies were provided upon each enrollment process.

The NTQ enrolled 1,828 callers during the program period, which included five (5) pregnant people. The NTQ offers a free program specializing in helping pregnant people quit smoking. The tailored treatment plan meets their needs by providing intensive behavioral support, including an increased number of coaching calls compared to the general population. As an incentive, reward gift cards for $5 and $10 are given after scheduled and completed counseling calls. For pregnant and new parents who have quit, additional postpartum support is available to prevent relapse. NTQ uses evidence-based treatment practices to help pregnant smokers quit and remain tobacco-free. Although the call volume was limited, outreach was expanded to community health workers, women’s health care providers, WIC clinics, and events in the community. MCH opportunities to heighten NTQ awareness are being implemented, including promotion by all Title V MCH funded partners and the Chronic Disease Coalition monthly newsletters.

Partnerships continued to expand with the NTQ as listed: Medicaid Managed Care Organizations, Division of Welfare and Social Services, the MCAH Section, local Tribal health departments, University Medical Center, Nevada Health Centers, Carson Tahoe Hospital, Lyon County Medical Center, Northern Nevada Health Centers, Access to Healthcare Network, and mental health clinics and behavioral health facilities. Established relationships with providers created an opportunity for a health system change through an NTQ e-Referral process specific to patients interested in cessation.

Nevada Health Conference Report 

The 2022 Nevada Health Conference, hosted by Immunize Nevada, is an interdisciplinary conference for practitioners and community partners from different health professions including Chronic Disease Prevention and Health Promotion; Immunizations; and Maternal, Child, and Adolescent Health. Plenary sessions, panel discussions, and workshops offer cutting-edge information to help support the communities in which conference attendees live and work.

The 16th annual conference began May 24th, 2022, both virtually and in-person. Keynote speakers included Dr. Elizabeth Marnik, who presented on misinformation and how to compassionately and accurately communicate science, and Drs. Jessica Steier and Andrea Love of the Unibased Science podcast, who presented on vaccine-related content related to COVID and other diseases. Virtual exhibits were available to conference-goers throughout both days prior to the start of the general sessions, during breaks, and post-conference. Additionally, one-on-one virtual meetings were offered as an extra feature for attendees to connect with speakers and other attendees.

Continuing education credits were issued through the University of Nevada for multiple healthcare-related fields including:

• Certified Health Education Specialists (CHES)
• Certified Public Health
• Nursing
• Physicians (plus 1 hour of ethics/addiction care)
• Social Work

Each year the Nevada Health Conference awards scholarships to individuals who wish to attend the conference but may not otherwise be able to attend due to cost. The numbers below are included in the total attendee counts listed above.

• Total number of Applicants: 18

• Total number of Applicants Awarded: 18
• Total number of Recipients (people who accepted and/or didn’t cancel and additional state employees added after the application process): 22

The Cvent virtual platform provided a space for attendees, speakers, staff, sponsors, and exhibitors to connect and expand their knowledge.

Nevada Maternal Mortality Review Committee (MMRC)

Nevada MMRC statute are codified in NRS 442.751 through 442.774, inclusive, and the Committee is required to: (1) review incidents of maternal mortality and severe maternal morbidity (SMM) in Nevada; (2) disseminate findings and recommendations concerning maternal mortality and SMM to providers of health care, medical facilities, other interested persons and the public; (3) publish timely reports consisting of data relating to maternal mortality and SMM, descriptions of incidents reviewed by the Committee, and recommendations to reduce maternal mortality and SMM in Nevada. Nevada’s MMRC convened for their first meeting in February 2020 and met four times that year. This committee will continue to meet at least twice annually to review all incidences of maternal mortality in Nevada and address health disparities and to end preventable MM and SMM.

MCAH support the MMRC and report on MMRC recommendations for the public, clinicians, and policy makers on data-driven MMRC recommendations (e.g., evidence-based practices, screenings, and patient and provider education). The 2021 legislative session added a partnership between the MMRC and the NOMHE Advisory Board in relation to collaborating to provide an equity lens to the recommendations of the MMRC in the biennial report to the Nevada Legislature. Reporting produced by the MMRC support staff will be included in the Title V MCH Block Grant reporting, and health equity in birth outcomes and maternal domain population health maximization will be key areas of topical intersect in priorities of the MMRC, AIM, Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM), MCAH Section, SSDI Program, and Title V MCH Program. Title V MCH Program will look for opportunities to create sustained funding for the MMRC as it was passed into law without dedicated state funding. SSDI funds help support MMRC administrative support staff.

Two contributing factors to maternal mortality at the systems level which could have a large impact in preventing maternal mortality were identified by MMRC members. First, the Committee identified the need to provide adequate SUD treatment options to pregnant people. The Committee recommends educating providers on Nevada's substance use disorder treatment options which already exist for pregnant people and removing barriers to care. The second relates to substance use in pregnancy and the identified need as a society to address social determinants of health for all populations. At the provider level, the utility of recommending the use of a suicide screen in addition to the antepartum and postpartum depression screen was discussed. Finally, a recommendation for outreach promoting the importance of prenatal care and preventing delays in prenatal care was identified.

SSDI funds help to support MMRC case abstraction staff. MCAH has facilitated maternal mortality and severe maternal morbidity presentations to the Maternal Child Health Advisory Board (MCHAB) in concert with the Nevada DHHS Office of Analytics and the efforts of the Title V MCH-funded Biostatistician in the Office of Analytics.

Advanced Life Support in Obstetrics

To prevent maternal mortality and severe maternal morbidity, the Title V MCH Program initiated plans to fund Advanced Life Support in Obstetrics (ALSO) training for rural and frontier critical access hospital staff. ALSO is an evidence-based, interprofessional, and multidisciplinary training program which equips the entire maternity care team with skills to effectively manage obstetric emergencies. Due to COVID-19, Title V MCH staff postponed the training in previous years but has now re-initiated planning. MCHAB has been utilized as a platform to leverage support for this training.

Account for Family Planning 

The Nevada Account for Family Planning (AFP) uses state general funds to support reproductive health, vaccine, and contraceptive access statewide. These services include, but are not limited to:

• Provision of education concerning family planning
• Referrals for the purpose of family planning
• Distribution of contraceptives, installation of contraceptive devices, and the performance of contraceptive procedures approved by the United States Food and Drug Administration
• The provision of or referral of persons regarding preconception health services and assistance to achieve pregnancy
• The provision or or referral of persons for testing for and treatment of sexually transmitted infections
• The provision of any vaccinations recommended by the Advisory Committee on Immunization Practices of the CDC

While funding is focused on supporting reproductive health and access, AFP also allows for the use of funds for immunizations and STI screening and treatment. The LHAs, university, community, public health clinic, and county partners were awarded funds to implement the goals of AFP. The Reproductive Health Coordinator funded by AFP is situated within the MCAH Section and has worked closely with MCAH data and teen pregnancy prevention staff. 

 

Women/Maternal Domain Accomplishments

Highlights of maternal and women’s health efforts include robust substance use in pregnancy prevention efforts and internal and external partner engagement, successful partnerships with NHV to improve dyad outcomes and reproductive health, strong relationships with the LHAs, support of statewide MCH Coalition networks, MMRC groundwork, funding statewide and local conferences for information sharing and workforce development, and funding for focus groups to better understand the experiences of those experiencing substance use while pregnant.

CCHHS initiated the use of the evidence-based CAGE substance/alcohol use screening tool. Its usage resulted in an increased number of patients willingness to accept referrals for treatment.

Women/Maternal Health Data

NPM 1- Percent of women, ages 18-44, with a preventive medical visit in the past year

According to the Behavioral Risk Factor Surveillance System, the percent of women, ages 18 through 44, with a preventive medical visit in the past year in Nevada increased from 61.3% in 2020 to 66.8% in 2021. Nevada is below the US national average of 69.7% for this metric and ranks in the bottom 20%, at 41st place, among the 50 states and the District of Columbia (D.C.). Preventive medical visits for women in Nevada in 2021 varied across age groups, with those aged 35-44 years old y.o. having the highest usage (71.9%), followed by 18-24 y.o. (64.3%) and 25-34 y.o. (63.3%). When stratifying by race and ethnicity, Hispanic women had the most preventive medical visits (65.8%), a higher percentage than Non-Hispanic White women (60.4%). Data for other race and ethnicities was not available for this measure.

NPM 14.1- Percent of women who smoke during pregnancy

According to National Vital Statistics Survey (NVSS) data, the percent of women who smoke during pregnancy in Nevada has been steadily declining from 2012 to 2021, from 6.3% to 3.3%.  This is significantly lower than the 2021 U.S. national average of 4.6%. Nevada is in the top 20% among the 50 states and D.C., ranking 11th for this measure. When 2021 Nevada data is stratified by health insurance, 5.7% of women on Medicaid were found to smoke during pregnancy, compared to 2.1% of those who were Uninsured, 1.0% of those who had other public insurance, and 1.4% of those who had private insurance.

NOM 1 - Percent of pregnant women who receive prenatal care beginning in the first trimester

Data from NVSS show a steady, significant increase for Nevada’s percent of pregnant women receiving prenatal care in the first trimester from 2015 to 2021 (72.6% to 78.3%). Nevada met the Healthy People 2020 goal of 77.9% but is lower than the new Healthy People 2030 objective of 80.5%. For 2021 Nevada was equivalent to the national average, and falls in the lower half, at 28th place out of the 50 states and D.C. There are racial/ethnic disparities for timely prenatal care in Nevada. In 2020, Non-Hispanic Asian (83.1%) women had the highest prenatal care coverage, followed by Non-Hispanic White (81.3%), Non-Hispanic Multiple Race (80.3%), Hispanic (75.7%) and Non-Hispanic Black (69.7%). Non-Hispanic Native Hawaiian/Other Pacific Islander (63.2%) and Non-Hispanic American Indian/Alaska Native (58.1%) had the lowest percent.

NOM 2 - Rate of severe maternal morbidity per 10,000 delivery hospitalizations

According to the HCUP - State Inpatient Databases (SID), the rate of severe maternal morbidity per 10,000 delivery hospitalizations in Nevada decreased from 73.1 in 2015 Q1-Q3 to 65.2 in 2018. However, Nevada experienced a dramatic increase in 2019, with a rate of 84.4 per 10,000 delivery hospitalizations. This increase continued in 2021, to 89.1. Nevada is below average for this measure, ranking 34th compared to 12th in 2018. Nevada’s rate of severe maternal morbidity is higher than the 2020 national average of 88.3 per 10,000 delivery hospitalizations. Women aged greater than or equal to 35 y.o. had the highest rate (128.3) in 2020, while women aged 20-24 y.o had the lowest rate (64.4). By race/ethnicity, Non-Hispanic Black persons (130.5) had the highest rate, followed by Non-Hispanic Asian/Pacific Islander (98.2), Other (91.9), Hispanic (82.2), and Non-Hispanic White (79.4).

NOM 3 - Maternal mortality rate per 100,000 live births

The 2017-2021 five-year estimates from NVSS indicate Nevada’s maternal mortality rate per 100,000 live births (22.4) is equivalent to the national rate. Nevada ranks 22nd for this measure. This represents an increase from the 2016-2020 estimate of 19.3 per 100,000 live births for Nevada. Even with the five-year estimates, the data should be interpreted with caution, and only limited stratified data exists for Nevada.

NOM 4 – Percent of low birth weight deliveries (<2,500 grams)

Data from NVSS indicates the percent of low birth weight deliveries in Nevada remained in the 8% to 8.5% range from 2009 to 2016. There was an increase in 2017 to 9.1%, but it declined to 8.7 and 8.8% in 2018 and 2019 respectively. In 2020, the percent once again increased to 9%, and has significantly increased to 9.7% in 2021. Nevada has a significantly higher percent of low birth weight deliveries compared to the US national average, as the US percent has remained in the 8.0% to 8.3% range since 2009 with a low of 7.99% (2012) and a high of 8.5% (2021). Nevada ranks at the bottom for this measure, at 45th out of 50 states and D.C. Racial/ethnic disparities are apparent. In 2021, Non-Hispanic Black (16.0%) women had the highest percent of low birth weight deliveries followed by Non-Hispanic Asian (11.6%), Non-Hispanic American Indian/Alaskan Native (10%). Non-Hispanic Native Hawaiian/Other Pacific Islander (9.3%), Non-Hispanic Multiple Race (9.2%), Hispanic (9%), and Non-Hispanic White (7.6%) women were below the Nevada average of 9.7%.

NOM 5 – Percent of preterm births (<37 weeks)

According to NVSS, the percent of preterm births increased significantly from 10.7% in 2020 to 11.2% in 2021. This is significantly higher than the national average of 10.5% Nevada ranks near the bottom for this measure in 2021, at 39th out of 50 states and D.C. Racial/ethnic disparities are apparent. In 2021, Non-Hispanic Black (15.6%) had the highest percent of preterm births, followed by Non-Hispanic Native Hawaiian/Other Pacific Islander (13%), Non-Hispanic Asian (12.5%), Non-Hispanic American Indian/Alaskan Native (12.1%), and Non-Hispanic Multiple Race (12.0%). Hispanic (10.8%) and Non-Hispanic White (9.4%) women were below the 2021 Nevada average of 11.2%.