Illinois’ Title V has two priorities for the Women and Maternal Health Domain:
- Assure accessibility, availability, and quality of preventive and primary care for all women, particularly for women of reproductive age (Priority #1).
- Promote a comprehensive, cohesive, and informed system of care for all women to have a healthy pregnancy, labor and delivery, and first year postpartum (Priority #2).
1-A. Support the implementation, dissemination, evaluation, and improvement of the Illinois Healthy Choices, Healthy Future Perinatal Education Toolkit, which includes information and resources for consumers of women during preconception, prenatal, postpartum, and inter conception care.
For more about the IDPH and EverThrive Illinois work see Needs Assessment section III.C.1.b.iv. Family and Community Partnerships.
Illinois is home to two women’s correctional facilities: Logan Correctional Center (LCC) and Decatur Correctional Center (DCC). OWHFS’s Division of Population Health Management (DPHM) collaborates with the Illinois Department of Corrections (DOC) to support pregnant women and new mothers housed within the women’s prisons. These facilities housed more than 1,500 women and supported eight Mom and Baby joint housing units. Specifically, DPHM provided pregnancy education, breastfeeding education, and lactation support and counseling. DPHM also provided the facilities with new breast pumps, pumping kits, milk storage bags, and breast pads to support those women who were able to pump and provide milk for their baby. Before the end of FY24, a new program kicked off for those breastfeeding mothers who were not able to keep their baby with them as part of the moms and babies’ program. DPHM purchased breastmilk shipping coolers and ice packs, along with paying shipping costs to send breastmilk to babies who did not reside within DOC and lived more than two hours from the facility. This first of a kind program has been a pivotal factor in keeping mom and baby in close bond with such distance between them.
In the past, DPHM provided obstetrical and neonatal simulation training at the LCC and DCC for physicians, nurses, and other staff within the prisons. The goal of this training was to allow for staff to test their obstetrical and neonatal skills and prepare for any labor and/or delivery encounters at the facility. The training and education also afforded the staff the opportunity to debrief afterwards to identify other opportunities to improve the quality of care for pregnant women. The regional APC network administrator and the maternal-fetal medicine (MFM) physician APC co-director played a vital role in providing the education and answering the women and staff’s questions. The resurrection of this program is set for July in FY25. In addition to these trainings, the MFM has scheduled visits with the pregnant women at LCC to begin in FY25. The MFM will come to the facility to hold “Ask the Doctor” style lunch and learns to answer any questions the women may have surrounding delivery while incarcerated.
Helping Women Recover, Beyond Trauma, and Life Smart courses continued with in person services in FY24 and, over 200 women attended classes between both women’s correctional centers during FY24. Approximately ten pregnant women were reached through the Moms & Babies program during FY24 at Decatur Correctional Center.
1-C. Implement well-woman care mini grants to assist local entities in assessing their community needs and barriers; and, to develop and implement a plan to increase well-woman visits among women ages 18-44 years based on the completed assessment.
IL Title V launched its Increasing Well-Woman Visits program (well-woman care mini grants) in 2019. These planning grants were offered to initiate interest in expanding services and assisting local entities in assessing their community needs and barriers and due to the success of the Implementation Phase: Increasing Well-Woman Visits – Community (IWWV-C) Grant program launched as a two-year grant commencing July 2021.The grantees funded focused on four main objectives:
- Assist women 18-44 with accessing quality, comprehensive preventative care (e.g., mammogram, pap and pelvic exams, emotional well-being, tobacco and substance use, violence and injury prevention, sexual health and healthy relationships, and physical health and health promotion)
- Support evidence-informed guidance, to address behavioral, social, and environmental community health factors.
- Assist communities with assessing the barriers to women scheduling preventative care visits.
- Increase awareness of the importance of well-woman visits for at least 75% of staff at grantee organization.
A second planning phase of this grant was created in January 2022 to increase the reach of the program. Grantees who successfully complete the planning phase are eligible to continue the program with the Implementation phase and expanded scope when it began in FY24. Grantees of the program received extra funding to continue building and fostering their relationships and resources to move them successfully to the implementation phase of the grant.
During FY24, grantees focused on expanding awareness of the programs within the communities served through completing and improving relationships with providers, continuing to update surveying to have an understand of barriers to care, and providing toolkits to providers that cover barriers to care. They also focused on a variety of campaigns to increase knowledge of the program including social media campaigns, bus station advertisements, radio spots, digital signage, and provider education posters to be used in clinics. These campaigns are estimated to have reached thousands of women due to the variety of their reach. The grantees of this program reached approximately sixty-thousand women directly with well-woman education, community health factor surveys, and other services related to the program.
Grantees make sure that their community health workers are up to date with the latest education materials. All of the grantee’s screen for community health factors and tackle issues related to their findings. One grantee learned that digital literacy to help support them things like MyChart navigation. Another offers bus vouchers and distribute them through either direct contact or through their partners.
Some unique highlights of various grantees include creating cheat sheets for patient and provider well-woman education and vaccine information, a texting service supporting HPV prescribing, and rural grantees working with largest local businesses to do events and education,
One grantee, Cass County Health Department, held ‘Women’s Health Nights’ where they provided education on the importance of healthcare screenings and overall wellness combined with self-care. Another grantee, Mercer County Health Department, set up pop-up locations across various small towns to engage with harder to reach populations. These pop up’s took place in various businesses, including a convenience store, and offered educational materials and patient navigations.
All grantees were active in seeking feedback from their communities. One grantee, Calhoun County, has a ‘Well-Woman Board” which consists of community members that help advise on the direction of their outreach and programming. Another sought feedback through surveys, focus groups and open forums seeking input on mental health, accessibility of care, nutrition, fitness, and other barriers to care. Another grantee learned through their feedback that the inclusion of self-care was a strong desire amongst their community and started incorporating education in their outreach. Many of the programs also relied on their connections to the community, such as the YMCA, religious institutions, and other local strongholds, to learn and share with each other on some of the feedback practices and strategies.
Provider shortages especially in rural Illinois has been noted for continued challenges amongst grantees.
1-D. Partner with UIC to implement a program at two clinic sites to expand the capacity of health care providers to screen, to assess, to refer, and to treat pregnant and postpartum women for depression and related behavioral health disorders.
Completed in FY22, nothing new to report for FY24.
The University of Illinois at Chicago received Title V funding in FY20-22 to implement a pilot project to expand the capacity of perinatal health care providers in Illinois. The focus of this project was to screen, to assess, to refer, and to treat pregnant and postpartum women for depression and related behavioral health disorders. The scope of the project also included increasing awareness of, and access to, affordable and appropriate services to pregnant and postpartum women and their infants. The project targeted obstetricians, gynecologists, nurse midwives, pediatricians, psychiatric providers, mental health care providers, social workers, and primary care providers in geographical areas serving disadvantaged women, including Cook County/Chicago and Peoria County/Peoria.
The main objectives of the program were to: 1) provide in-person workshop training and resources on screening, diagnosis, and referral for maternal depression and related behavioral disorders to perinatal providers; 2) provide real-time psychiatric consultation and care coordination for providers; 3) screen women for depression, anxiety, suicide risk, and substance use during the perinatal period using Computerized Adaptive Testing (CAT); 4) increase access to depression prevention and treatment for medically underserved women using a telehealth intervention; 5) increase access to substance use treatment for pregnant women; and 6) plan for scale-up and sustainability to implement the project components statewide.
When this concluded in FY22, screenings continued at University Village with all providers. A total of 229 screens with the computerized adaptive testing for mental health (CAT-MH) were conducted during routine prenatal care at the clinics during FY22. Eleven screens were positive for major depressive disorder (4.8%), 13 positive screens for generalized anxiety disorder (5.68%), and four were at intermediate or high risk of substance use disorder (1.75%).
1-E. Support the Chicago Department of Public Health (CDPH) efforts to foster, partner, and collaborate with organizations and agencies providing male and partner involvement programs.
CDPH’s MICAH bureau staff collaborates with systemwide stakeholders to reduce negative health outcomes and improve birth and infant outcomes. This occurs through active participation in local, regional, and national MCH organizations and initiatives to ensure CDPH remains abreast of emerging research and best practices, policy conversations, and funding developments. Within the MICAH bureau, CDPH’s Family Connects Chicago (FCC) addresses the needs of post-partum women and their newborns, through in-home assessment and connections to needed services and care and improving health outcomes. FCC is an evidence-based, universal post-partum home visiting program for pregnant and postpartum women, their newborns, and families. The visits occur between 2 to 12 weeks after birth during which nurses assess the health of the mother and newborn, and provide education and resource referrals (e.g., referrals to healthcare providers or community-based ancillary services and supports) to address the individual needs of each family. All Chicago women who give birth at participating hospitals are eligible for participation, including families that adopt and those experience infant loss. FCC’s community alignment component engages community-based, local stakeholders routinely to review FCC service data to identify service gaps, promote program services to families in need in their communities, and identify appropriate solutions to address families’ needs for other resources and support.
CDPH’s departmentwide mission is to work with communities and partners to create a safe, resilient and Healthy Chicago and the vision is that everyone in Chicago thrives and achieves their optimal health and wellness. FCC promoted optimizing health outcomes by targeting outreach, marketing, and community engagement in communities with the greatest differences in MCH outcomes. FCC’s community alignment component engaged community-based, local stakeholders routinely to review FCC service data to identify service gaps, promote program services to families in need in their communities, and identify appropriate solutions to address families’ needs for other resources and support.
CDPH worked to expand and strengthen the network of maternal and child health services so that families have greater access to a range of resources, including those that promote male/partner involvement. FCC provides directs support to women during the post-partum period and builds connections within Chicago’s MCH system. FCC offers comprehensive visits to families after bringing home a newborn. Mothers and infants are assessed, and families are connected to needed services and resources that include those that are focused on partners and provide benefits to the whole family. Ultimately, it aims to strengthen the perinatal network of care and services and create a resilient system that protects against negative impacts and increased risk factors to maternal and child health, including promotion of male/partner engagement in supporting a healthy postpartum period.
During FY24, CDPH’s FCC program engaged in community outreach activities that explicitly engaged male partners. Community outreach activities included a series of events in collaboration with community partners that engaged local residents in infant safe sleep education and distributed related resources to families. Safe sleep education was inclusive of partner involvement. CDPH’s FCC and WIC programs also participated in the local Maternal Outcomes Matter Showers (MOMS) community baby shower that drew hundreds of Chicago residents and featured activities tailored to male partners. Male engagement programs presented resources to FCC nurses during case conferences. In addition, FCC made referrals to intensive, ongoing home visiting programs that promote male partner involvement, such as Early Head Start.
Community alignment is a key component of CDPH’s FCC model. It is a process that actively seeks local knowledge and expertise to inform program services. Community alignment functions include enhancing access to services for needs identified during home visits, improving family connections with providers, identifying system-level issues, and elevating policy issues. FCC’s six community alignment boards (CAB) consist of health and social service providers, early childhood providers, individual community members, advocates, and other maternal child health stakeholders. CABs assess unmet needs of families in their communities, identify appropriate resources and services to meet those needs, and advocate for support and resources to address persistent gaps. They review FCC service data on a regular basis and provide the program with direct feedback. They make connections between nurses and community-based resources to expand FCC’s referral network, advise on ways to improve reach, and participate in local events and outreach to promote FCC and other maternal child health resources.
- Priority #2- Promote a comprehensive, cohesive, and informed system of care for all women to have a healthy pregnancy, labor and delivery, and first year postpartum.
2-A. Convene and facilitate state Maternal Mortality Review Committees (MMRC and MMRC-V) to review pregnancy-associated deaths and develop recommendations to improve quality of maternal care as well as reduce barriers and address community health factors.
Illinois was one of the first states to implement maternal mortality review and created the state Maternal Mortality Review Committee (MMRC) in 2000. A second state committee, the Maternal Mortality Review Committee on Violent Deaths (MMRC-V), was formed in 2015. This second committee reviewed deaths of women who died within a year of pregnancy due to homicide, suicide, or drug related causes. These committees are structured as sub-committees of the state’s Perinatal Advisory Committee, with the purpose of providing expert recommendations to IDPH on how to improve maternal and infant health.
Since 2002, Illinois has followed the CDC recommendation to identify all pregnancy-associated deaths. Illinois used multiple methods simultaneously to ensure pregnancy-associated deaths are accurately identified and counted each year. The state database of death certificates is used to identify deaths that may be pregnancy-associated. A checkbox on the death certificate indicates whether a woman was pregnant at the time of death or pregnant within the last year. Additionally, some cause of death codes indicate that a death may have been related to pregnancy. Finally, death certificates for any woman aged 15 to 60 years are also checked against the databases of birth certificates and fetal death certificates to look for matching information. If there was a birth or fetal death record in the 12 months prior to a woman’s death, her death is flagged as a pregnancy-associated death.
In addition to the state data systems, there are other ways that maternal deaths are identified in Illinois. All Illinois hospitals are required by the state to report any known pregnancy-associated deaths to IDPH within 24 hours. IDPH completed regular searches of major newspapers to identify articles or obituaries that indicate the death of a woman while pregnant or within one year of pregnancy. For example, if an obituary mentions that a deceased woman has a surviving child who is less than 1 year old, the woman’s case is flagged as a potential pregnancy-associated death.
Though information from death certificates and other public health records may help identify counts of maternal deaths, these records cannot determine the preventability of deaths, or the factors involved in the death. Once the maternal deaths are identified, IDPH contacts the hospitals and health centers where the women received care to request records from the time of her most recent pregnancy to her death. These medical records provide details about the woman’s death and her medical history. For instance, records are routinely requested from the hospital where the woman died, the hospital where she gave birth, and the physician’s office or health center where she received prenatal care. When relevant, records are also requested from police departments, sheriff’s offices, and medical examiner or coroner’s offices. IDPH is constantly reviewing records to identify additional records that provide information on the case. Hospitals and medical providers are required to provide copies of all medical records related to maternal deaths within 30 days of IDPH’s request. IDPH compiles this information to confirm and accurately track the number of pregnancy-associated deaths in Illinois each year.
The CDC recommends review of maternal deaths by a multidisciplinary committee as a means of gathering additional information about if the death was related to pregnancy, what the underlying cause of death was, whether the death was preventable, and opportunities for preventing future maternal deaths. Over the past five years, IDPH has standardized the abstraction and review process to align with best practices promoted by the CDC. The goal was to improve several key components of the review process, including standardizing case abstraction, increasing review efficiency through structured meeting facilitation, and shifting to a population-health focus (instead of a purely clinical emphasis) to also consider how social and non-medical factors that may have contributed to a death. Overall, IDPH saw a need for more structured administrative and technical support to the committees, especially in terms of chart abstraction and data analysis. As a result, IDPH committed to taking a more active role in supporting the committee meetings, participating in reviews, and collecting and analyzing data. To align with national work, Illinois adopted the use of standard CDC data collection forms and resources. This ensured that the data collected by the Illinois MMRC and MMRC-V would be consistent with each other and with other review committees across the country.
During FY24, Illinois continued to implement the Maternal Mortality Review process for deaths potentially related to pregnancy. From October 2023 to September 2024, the MMRC held five meetings and reviewed 27 cases, and the MMRC-V held five meetings and reviewed 34 cases.
IDPH also continued other key activities, such as the IDPH and University of Illinois at Chicago (UIC) Center of Excellence in Maternal and Child Health (CoE-MCH) successfully applied for the HRSA Maternal Health Innovation Grant.
2-B. Partner with statewide Severe Maternal Morbidity (SMM) Review Subcommittee to develop recommendations for standardizing and improving hospital-level SMM case reviews across Illinois’ Regionalized Perinatal System.
According to the CDC, severe maternal morbidity (SMM) has increased more than 200% between 1993 and 2014. In 2017, Illinois began a collaboration with the 10 administrative perinatal centers and UIC. This SQC subcommittee became the Severe Maternal Morbidity (SMM) Surveillance and Review Project. In this project, all Illinois obstetrical hospitals identified and reported on SMM cases, defined as a pregnant or postpartum (up to 42 days) woman who was admitted to an intensive care unit (ICU) and/or transfused with four or more units of packed red blood cells.
CRWG developed a standardized SMM review form in partnership with the APCs. The form was used by APCs and their network hospitals to collect more information on the circumstances surrounding SMM events, preventability, and opportunities for intervention. APCs used the SMM review forms to report into the ePeriNet database, which allows for population-based analysis of SMM over time.
As the SMM Surveillance and Review Project continued, CRWG provided technical assistance to the hospitals and APCs as they conducted reviews and evaluated the quality of the data reported into ePeriNet. The statewide sub-committee meetings provided an opportunity for dialogue and collaboration between CRWG, the APC administrators, and the subcommittee members to discuss lessons learned and to identify ways to strengthen hospital level reviews. During FY21, the SMM Review Subcommittee was tasked with developing recommendations for standardizing and improving hospital-level SMM case reviews across Illinois’ Regionalized Perinatal System. Over the course of the year the committee identified key challenges and trends of preventability and what opportunities have been identified to barriers that exist. Much effort went into determining how to engage providers and to establish best practices for data collection.
The committee, after developing the above, had concluded their regular meetings in early 2022.
2-C. Participate in and collaborate with the Illinois Maternal Health Task Force established through the I PROMOTE-IL program (HRSA Maternal Health innovation Grant) to develop a statewide Illinois Maternal Health Strategic Plan to translate and build on findings and implement recommendations from the Illinois MMRC, MMRC-V, and SMM.
In FY24, the University of Illinois at Chicago (UIC) successfully applied for the HRSA Maternal Health Innovation Grant. The MHI program will assist the state in collaborating with maternal health experts and optimizing resources to implement state-specific actions that address differences in maternal health and improve maternal health outcomes. A key component of the grant is the Illinois Maternal Health Task Force.
During FY24, Title V representation on the task force is important as Title V is a leader for all maternal health activities in the state, including Maternal Mortality reviews. Thus, Title V’s ongoing participation and collaboration ensures that the task force is fully integrated into the existing maternal health infrastructure without duplication of efforts, assists in the tracking of maternal health legislation at the state and federal level to inform additional policy solutions, and addresses identified gaps outside of Title V’s efforts.
2-D. Support and collaborate with the state-mandated Illinois Task Force on Infant and Maternal Mortality Among African Americans to assess the impact of pregnancy related outcomes, identify best practices and effective interventions, address community health factors, and develop an annual report with recommendations to improve outcome for African American women and infants.
IDPH released its first Illinois Maternal Morbidity and Mortality Report in October 2018. Influenced by the report, the Illinois General Assembly passed Public Act 101-0038, which created the Illinois Task Force on Infant and Maternal Mortality among African Americans (IMMT). This task force focused on identifying best practices to decrease infant and maternal mortality within African American residents of Illinois. Three subcommittees were formed in to address distinct activities within the scope of work needed by IMMT: Community Engagement Subcommittee, Systems Subcommittee, and Programs and Best Practices Subcommittee.
- The Community Engagement Subcommittee (CE) was charged with reviewing research that substantiates the connections between a mother's health before, during, and between pregnancies, as well as that of her child across the life course; gathering research regarding women’s health before, during, and between pregnancies; reviewing data on social and environmental risk factors for Black/African American women and infants; and determining better assessments and analysis on the impact of toxic stress and pregnancy-related outcomes for Black/African American women and infants. In addition, the CE was charged with engaging the community to collect the voices of Black/African American women and families regarding maternal and infant health and presenting recommendations to the IMMT based on findings.
- The Systems Subcommittee was charged with reviewing data on social and environmental risk factors for Black/African American women and infants; studying nationwide/international data on maternal and infant deaths and complications, including data by race, geography, and socioeconomic status; identifying partners or key stakeholders in which the state should engage to address Black/African American maternal and infant mortality in a systematic way; and presenting recommendations to the IMMT based on findings.
- The Programs and Best Practices Subcommittee (P&BP) was charged with reviewing research that substantiates the connections between a mother's health before, during, and between pregnancies, as well as that of her child across the life course; reviewing research to identify best practices and effective interventions for improving the quality and safety of maternity care; reviewing research to identify best practices and effective interventions, as well as health outcomes before and during pregnancy, in order to address pre-disease pathways of adverse maternal and infant health; reviewing research to identify effective interventions for addressing community health factors in maternal and infant health outcomes; gathering data; and presenting recommendations to the IMMT based on findings.
The legislation required the task force to consist of 22 members representing various qualifications and clinical backgrounds. Members include state agency representatives, hospitals partners, pediatricians, obstetricians, maternal and child health advocates, neonatal professionals, public health experts, insurance industry representatives, and community members.
The task force is required to meet quarterly, a minimum of four times per year. In 2024, the Task Force has met a total of four times between January and December.
The committee deliberated on the program areas of focus for the taskforce and several options were Through a poll, the major priorities for the taskforce were identified as:
- Health Literacy – Assigned to the Community Engagement Committee
- Behavioral Health Support – Assigned to Programs and Best Practices
- Health Systems Accountability and Quality of Care – Assigned to Systems
In addition to the priority focus areas identified for each subcommittee, the taskforce is evaluating a strategic direction for the IMMT in 2024 towards 2025. To achieve this, the taskforce has commenced a cross walk of its developed tasks and responsibilities and the expectations of the legislative mandate in addition to a review of the Illinois 2022 Maternal Mortality and 2024 Infant Mortality reports. The taskforce has been engaged in a series of meetings in 2024 aimed at revisiting the strategic direction of the Taskforce. While the focus has primarily been on maternal health, future initiatives will address both maternal and infant health for Black/African American communities.
The taskforce will continue to collaborate with the Illinois Department of Public Health and other key maternal and child health partners within the state. In order to address the existing differences in health outcomes among Black mothers and infants, IMMT will continue to make recommendations for a sustained, multi-faceted approach that combines community insights, comprehensive evaluations, and coordinated efforts across all levels of care.
2-E. Facilitate the collaborative effort between the Illinois Maternal Health Task Force and the Illinois Task Force on Infant and Maternal Mortality Among African Americans to align their strategies and activities towards improving maternal health in Illinois.
The I PROMOTE-IL Illinois Maternal Health Task Force and the Task Force on Infant and Maternal Mortality Among African Americans (IMMT) were established in FY20. With similar goals and the Title V director holding a key role in both task forces, it was important to have the two task forces collaborate on strategies and align activities needed for improving maternal health in Illinois. In addition, the task forces share multiple members that facilitates constant communication between the two groups. This communication is especially important as both task forces have recommendations/strategies to address community based perinatal support (e.g., doulas, community health workers, lactation consultants), telehealth utilization especially in light of the changing health landscape, postpartum care reimbursement, and obstetric care deserts in Illinois.
2-F. Participate in state inter-agency committee efforts to improve Medicaid coverage and care coordination for pregnancy and postpartum women.
In April 2021, Illinois became the first state to receive federal Centers for Medicare & Medicaid Services (CMS) approval of its Continuity of Care & Administrative Simplification 1115 waiver application. The 1115 waiver extends Medicaid postpartum coverage from 60 days to 12 months. Specifically, the waiver allows Illinois to continue to receive federal match for postpartum Medicaid claims up to one year postpartum, including allowing women to enroll at any time during the first year postpartum if they become eligible at that time. Babies may be covered for the first year of their lives provided the mother was covered when the baby was born. Moms and Babies enrollees have no co-payments or premiums and must live in Illinois.
As a provision of the American Recovery and Prevention Act, states were allowed to file for a state plan amendment (SPA) for Medicaid extension to 12 months postpartum. This mechanism would allow state Medicaid agencies to receive approval for the extension of coverage and receipt of federal match funds for the coverage but has fewer ongoing administrative requirements than an 1115 waiver. Illinois applied for a SPA that went into effect April 2022, effectively replacing the 1115 waiver. The postpartum Medicaid SPA will be the authority that allows postpartum women to maintain continuous eligibility for Medicaid for 12 months after pregnancy.
Through the work initiated by the National Academy of State Health Policy (NASHP) Maternal and Child Health Policy Innovation Program (MCH PIP) [see strategy 2K], MCH staff from IDPH and HFS have begun to collaborate regularly on issues related to Medicaid policy, reimbursement, and innovations. The team meets bi-monthly to discuss various issues and to mutually inform the work of each agency. Legislation in 2021 required HFS to begin reimbursing for new non-clinical support services, such as doulas, lactation consultants, home visitors, and care coordinators (a recommendation from the maternal mortality review committees). HFS began by working on developing rules for implementing the doula, lactation support, and home visitor reimbursement benefit and convened partners to better understand covered services and fair payment rates. HFS worked with IDPH advisory groups to identify relevant partners to invite to these listening sessions. HFS and IDPH worked to finalize language on the doula and lactation support proposal through FY24, and both went live in FY25. In FY24, HFS, together with IDPH began the conversations regarding home visiting reimbursement, with that likely implementing in FY26.
2-G. Convene and partner with key stakeholders to identify gaps in mental health and substance abuse services for women that include difficulties encountered in balancing multiple roles, self-care, and parenting after childbirth; and leverage expertise to develop recommendations for system level improvements for Title V consideration and implementation.
Title V supported strategies to support universal substance use disorder/opioid use disorder (SUD/OUD) screening prenatally, linking women to treatment through MAR NOW and DocAssist and obstetricians’ ability to counsel for Narcan and offer a prescription in collaboration with DOPP and the Naloxone project including a March 2024 webinar on maternal substance use disorder. ILPQC leadership also contributed content to a training for emergency department providers on perinatal mental health and SUD/OUD screening and treatment.
2-H. Assess, quantify, and describe the impact of childcare on prenatal, intrapartum, and postpartum care in Illinois, and develop optional strategies and approaches that can be implemented in clinic and hospital settings.
Illinois participated in a three-year Collaborative, Improvement, and Innovation Network (CoIIN) that concluded in 2020. The CoIIN focused primarily on community health factors associated with infant mortality. Using surveys, focus groups, and informal discussions with health care providers and pregnant and postpartum women, the CoIIN team identified childcare, or lack thereof, during pregnancy, childbirth and postpartum, as a barrier to care that has the potential of negatively impacting children and family health outcomes. In July 2022, we submitted a ”notes from the field” manuscript to the Maternal and Child Health Journal that discussed our data collection processes and findings from the CoIIN project.
This program has concluded.
2-I. Support the Illinois Perinatal Quality Collaborative (ILPQC) in its implementation of obstetric and neonatal quality improvement initiatives in birthing hospitals.
The support of Illinois’s Title V program enables the Illinois Perinatal Quality Collaborative (ILPQC) to develop, implement, support, and sustain statewide quality improvement initiatives with nearly all of the birthing hospitals in the state in collaboration with IDPH, the State Quality Council, the Regionalized Perinatal System, and other state and national stakeholders. ILPQC provides collaborative learning opportunities, rapid-response data, and quality improvement (QI) support to build hospitals’ QI capacity to implement evidenced based practices and improve outcomes for mothers and newborns in Illinois related to its most pressing maternal and infant morbidity and mortality issues across hospitals.
Title V collaborates with ILPQC as it supports hospital teams in implementing strategies that facilitate quality improvement initiatives that address causes of maternal and infant morbidity and mortality through systems change and improved patient care.
Safe Sleep for Infants Initiative
Title V continued to enhance ILPQC’s Neonatal Safe Sleep/SUID QI initiative. ILPQC launched ESSI in November 2023. Over 80 Illinois birthing hospitals are participating. The initiative aimed that by December 2025, greater than 70% of Illinois birthing and children’s hospitals will address barriers to optimal care and promote neonatal health outcomes by actively participating in the initiative. Also, by December 2025, greater than 80% of infants will be discharged from ILPQC hospitals with a completed ESSI Bundle. The ESSI Bundle consists of three components: (1) Awareness: Parents or caregivers report an understanding of a safe sleep environment, (2) Readiness: Parents or caregivers are prepared for a transition to home, including community health factor screening and resource linkage and (3) Transfer of Care: ESSI Newborn Care Plan (Awareness and Readiness) is documented in the discharge summary.
Birth Outcomes Initiative
Title V collaborates with ILPQC as it supports 83 hospital teams in implementing strategies that facilitate change and improve patient care. The initiatives’ specific objectives include appropriate screening and linking of patients to resources that address community health factors, increasing the proportion of women reporting positive obstetric care experiences, and accurate recording of patient data. The goal is to achieve 75% or more teams implementing all key strategies by December 2024. Title V continued to collaborate with ILPQC as it supports hospital teams in implementing strategies that facilitate change and improve patient care. 48 hospital teams participating in the initiative achieved QI Excellence as of September 2024.
The focus of the Title V work for the initiative was on patient and community engagement. ILPQC hired a community coordinator to engage patients, community providers and community organizations to connect with birthing hospitals to address community health factors and improve birth outcomes. To engage patients and communities, ILPQC offered 1:1 and small group support to patient partners and outreach to community organizations especially those providing home visiting and doula services and created a guide for hospital teams to access these resources statewide. To engage outpatient community providers, ILPQC co-hosted with IDPH two webinars for providers including a March 2024 webinar on maternal substance use disorder and an October 2024 webinar on four vaccines recommended during pregnancy. The October webinar had 258 attendees and 85 identified as providers. ILPQC collaborative with the National Association of Community Health Centers to meet quarterly with Illinois community health centers to identify opportunities to collaborate on improvement work.
Community input via monthly community advisory board webinars:
ILPQC convened monthly both Obstetric and Neonatal Community Advisory Boards to engage community organizations, doulas, patients, parents and families in their OB and Neonatal initiative work. This provides a much-needed perspective to inform their initiative work and development and bridges the gaps between hospital and community.
In-person annual collaborative conference and face to face meetings:
ILPQC hosted 2 in-person collaborative learning meetings for ILPQC hospital teams. The 11th Annual Conference occurred in person in Lombard IL on November 2, 2023, and the OB and Neonatal Spring Face-to-Face Meetings occurred on May 22-23, 2024, in Springfield. ILPQC focused on developing conferences that focus on key strategies for hospitals to implement that address Title V priorities and develop relationships with public health, community organizations, and patients. Attendance at the Annual Conference was 481 and 398 for Face-to-Face Meeting across both days.
2-J. Support the Perinatal Mental Health Program that includes a 24-hour telephone consultation for crisis intervention for women suffering from perinatal depression.
Postpartum depression is an important public health issue and ongoing priority in Illinois. Almost 1 in 5 women who deliver a live birth in the state will experience postpartum depression. Roughly two thirds of those women will be diagnosed, but only 22% will receive some form of treatment. Perinatal women in Chicago who experience signs and symptoms of postpartum depression can access the hotline and speak to trained professionals in times of crisis.
In FY24, Title V continued to support the Perinatal Depression Program that is administered by the Northshore University Health System (Northshore). Northshore operates a 24/7 free, confidential perinatal depression hotline, 866-364-MOMS. Staffed by licensed mental health professionals, the MOMS Hotline provides perinatal depression crisis intervention, consultation, resources, and referrals to callers throughout Illinois.
Illinois Title V funding has been instrumental in sustaining and enhancing the Moms Hotline. It has allowed Northshore to:
- Maintain 24/7 operations with licensed clinicians, ensuring round-the-clock support.
- Hire 7 new clinicians.
- Provide training and supervision to hotline staff, increasing the quality of care.
- Expand community outreach and provider engagement, strengthening our referral networks.
These efforts have directly contributed to improving maternal mental health outcomes, reducing crisis situations, and ensuring that pregnant and postpartum women across Illinois have access to timely, compassionate support.
Northshore operates a no cost to callers’ service that provides high quality mental health triage and support to all callers regardless of income, location, identity, etc. The MOMS Line was shared with the Illinois Task Force on Infant and Maternal Mortality among African Americans (IMMT) work group in February and has followed up in communications with those team members on additional opportunities for collaboration.
Northshore listened to stakeholders and collaborators across their meetings with various statewide organizations. They implement feedback into their upcoming website redesign and marketing materials. They also report leaning into advertising in different markets to reach the current generation of pregnant and postpartum women (i.e., threads, Instagram). For more information, here is the link to the Northshore website Perinatal Depression Program | NorthShore
2-K. Partner with Department of Healthcare and Family Services (HFS) (Medicaid agency) in the National Academy for State Health Policy (NASHP) Maternal and Child Health Policy Innovation Program (MCH PIP).
In FY21, IDPH and HFS were accepted as one of eight states in the National Academy of State Health Policy (NASHP) Maternal and Child Health Policy Innovation Program (MCH PIP). This 2-year project ran from April 2021 through March 2023. The Illinois team’s action plan centered on improving access to care for Medicaid-eligible pregnant and postpartum women through health care system transformation.
Key accomplishments during this initiative included:
- Improving communication with Medicaid managed care organizations around maternal health and required each MCO to make maternal health the focus of one of their performance improvement plans. Discussed opportunities to improve care coordination processes for pregnant and postpartum women.
- Identification of potential quality metrics focused on maternal health that could be added to pay-for-performance or pay-for-reporting metrics requires of MCOs.
- Holding partner meetings to inform implementation of requirements for Medicaid reimbursement of new provider types, including doulas, lactation consultants, home visitors, and care coordinators.
- Improving data sharing between two agencies and obtaining legal approval to work on building a data mart that would enable IDPH staff to directly access Medicaid claims data.
The most important result of the NASHP MCH PIP is that IDPH and HFS staff began meeting bi-weekly to coordinate activities across our agencies and to mutually inform each other’s work. We have strengthened our collaborative partnership and now regularly consult each other on questions where we would like input and continue to meet every other week. Though the NASHP MCH PIP ended in March 2023, the ongoing partnership will ensure that our work in strategy 2F is stronger as we move ahead.
2-L. Partner with the University of Illinois at Chicago, School of Public Health, Division of Health Policy and Administration (UIC-HPA) to explore the influence of healthcare provider access and the casual effects of events or policies on this access.
During FY 22, Illinois continued to experience the closing of hospitals or the specific elimination of obstetrical services within hospitals. Title V is committed to ensuring timely access to appropriate levels of obstetrical care. In late FY22, Title V partnered with the University of Illinois at Chicago, School of Public Health, Division of Health Policy and Administration (UIC-HPA), to conduct an economic analysis exploring the influence of health care provider access and the casual effects of events or policies on this access. UIC-HPA will conduct this analysis by investigating the availability of maternal care (defined here as prenatal care, labor and delivery care, and postpartum care) and its effects on maternal and infant health related outcomes.
The analysis focus’ is on potential barriers or obstacles to accessing maternal care, including local geographic provider shortages and the configuration of Illinois’ regional perinatal network. Patients, patient-level associated information (e.g., residential ZIP code locations), and patient-level outcome measures will be defined based on available IDPH hospital discharge data and IDPH birth records data. The UIC-HPA research will bring its expertise in using large administrative health care claims datasets, developing models of individual and organizational behavior, and applying econometric and statistical methods.
There will be two components to this project. The first involves enhancing measures of maternity care deserts and access to maternity care. The second examines the effects of hospital closures and staffing changes in obstetrics.
Enhanced Maternity Care Access Measures
This component of the project will use a data-driven approach to define enhanced maternity care access definitions for smaller geographic areas (e.g., ZIP codes) and to consider access to OB providers across county borders. Measures of OB providers include birthing hospitals, Birth Centers, OB/GYNs, CNMs and a subset of family medicine physicians who provide OB services. This subproject could construct and compare additional definitions that consider access to OB providers with geodesic (“as the crow flies”) distance, approximate travel distance, and other travel cost/effort measures defined based on local population characteristics (e.g., estimated travel time, average vehicle access).
Effects of Hospital Closures and Staffing Changes in Obstetrics.
This component of the project will focus on the causal effects of hospital closures of birthing hospitals (i.e., hospitals with OB units), hospital OB unit closures, and potentially hospital OB-related staffing reductions on the provision of maternal care. More specifically, the UIC-HPA team will assess how hospital or hospital OB unit closures affect:
- Access to inpatient (labor and delivery) maternal care options;
- Labor and delivery, including in maternity care deserts and are the mothers more likely to have Caesarean sections;
- Maternal and infant health related outcomes.
The analysis for both components will be completed FY24.
2-M. Partner with the University of Illinois at Chicago (UIC) to enhance all emergency departments (EDs) understanding and ability to recognize and provide care for pregnant and postpartum women.
During FY24, this project transitioned from the pilot phase to full implementation. The main objectives were to: (i) implement the toolkit across all emergency departments (EDs) in Illinois, with a focus on Level 0 facilities, to provide education and resources for the timely identification of pregnant and postpartum women, recognition of potential maternal complications, and appropriate treatment and referral; (ii) assess toolkit implementation among ED staff in a variety of hospital settings, including urban and rural, birthing and non-birthing facilities; and (iii) evaluate behavior change within EDs through randomized data selection and analysis following implementation. UIC-CRWG coordinated with the Maternal Mortality Review Committees (MMRCs) and key stakeholders such as perinatal network administrators to support successful implementation.
Also, during FY24, Title V supported UIC-CRWG in updating training materials and toolkits for ED providers. Products developed included reports, fact sheets, presentations, and manuscripts. UIC, through UIC-CRWG, defined the content and format of these materials and interpreted and translated findings as needed. Toolkit implementation included processes to track consultations, treatments, and referrals for pregnant and postpartum women identified in the ED setting.
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