NPM #1 Well Women Care – Improve pre-conception, prenatal and postpartum health care services for women of childbearing age.
The health and well-being of a woman before, during, and after pregnancy is important not only for the woman but also for the newborn. Women who maintain a healthy lifestyle during the preconception period are less likely to experience adverse pregnancy and obstetric outcomes and are also more likely to experience better postpartum health that extends across their life span.
According to the 2022 Behavioral Risk Factor Surveillance System (BRFSS), 71.8% of Missouri women between 18 and 44 reported having a preventive health care visit within the past year. This is similar to the national proportion of 72.5% for 2022. There were racial differences in the proportion of women who had a preventive health care visit, with Missouri being similar to national levels and more non-Hispanic Black women (83.1%) than non-Hispanic White women (70.1%) receiving a preventive visit in the past year (Figure 1). A higher percentage of insured women (72.5%) than uninsured women (49.1%) received a preventive visit. A lower percentage of those with less than a high school education (50.5%) received a preventive visit in the past year than those with more than a high school education (72.9%). The proportion of Missouri women with more than a high school education who received a preventive medical visit in the past year was lower than the national level (74.1%). In Missouri, 69.1% of those with a household income less than $25,000 had a preventive visit in the past year, compared to 75.0% among those with a household income greater than $75,000. A slightly larger percentage of married women (75.1%) had a preventive visit in the past year than unmarried women (70.7%).
According to the 2022 Missouri Pregnancy Risk Assessment Monitoring System (PRAMS), 89.3% of Missouri women received a postpartum checkup. This proportion is similar to the 89.4% reported for 2021. Privately insured women had a higher rate of receiving a postpartum checkup (96.3%) than their Medicaid-insured counterparts (81.8%). Non-Hispanic Black women had lower rates of receiving a postpartum checkup (81.7%) compared to non-Hispanic White women (90.5%). Women with less than a high school diploma had lower rates of receiving a postpartum checkup (72.7%) than women with a high school diploma (81.4%), some college (92.2%), and a college degree or higher (98.1%).
Initiatives to Promote Women and Maternal Health
The Office on Women’s Health (OWH) continued to provide education and resources to promote well-woman care, including distributing the WOMEN: Take Charge of Your Health publication and the My Health Tracking Card and continuation of the Women’s Health Network listserv. The WOMEN: Take Charge of Your Health publication includes information on preventive health, preconception health, breastfeeding, postpartum depression, and obesity and disease prevention. It was updated to include new evidence-based information and recommendations from experts and leaders in women’s health. This resource is available in English and Spanish in print and online on the Department of Health and Senior Services (DHSS) website. The My Health Tracking Card helps women track blood pressure, cholesterol and weight measurements. Resources are provided to the public, local public health agencies (LPHAs), and others who contact OWH or visit the website. The Women’s Health Network listserv facilitates communication with organizations and individuals concerned with women’s health. The Network’s purpose is to provide timely information about current issues in women’s health, such as changes to services for women, changing technology in women’s health, available resources, training opportunities, events, and funding opportunities.
The Missouri Women’s Health Advisory Committee is comprised of thought leaders with expertise in women’s health and the broad range of factors that affect women and maternal health outcomes and wellbeing. Appointed by the Department Director, committee members reflect the geographic diversity of the state. The committee is charged with informing and advising the Department Director regarding women’s health risks, needs and concerns and recommending potential strategies, programs and legislative changes to improve the health and well-being of all women in Missouri. The Committee meets quarterly and consists of women from a variety of professions, including healthcare providers, researchers, healthcare administrators, social workers, and CEOs and executive directors of critical social services foundations serving women throughout Missouri. Several new members joined in 2023, bringing a variety of lived experiences. The committee also connects members with other state department leaders, such as the MO HealthNet team at the Department of Social Services (DSS) and women’s health services at the Department of Corrections.
The Office of Dental Health (ODH) continued to educate mothers and children about the importance of oral health for their overall health and well-being during pregnancy and throughout their lifespan, including the promotion of dental visits during pregnancy and the postpartum period. This information was shared through literature developed by ODH and the Missouri Dental Association. These materials were distributed to women via an ongoing collaboration with the Women, Infants, and Children (WIC) Program, Home Visiting Programs, and Federally Qualified Health Centers (FQHCs) across Missouri. Materials were also distributed via LPHAs, dental offices and community outreach events.
ODH utilized Title V funding to purchase items for approximately 10,000 “Brushing for Two” dental health kits. The kits contained a toothbrush, floss, and fluoridated toothpaste for the mother, along with a finger swab, a finger brush, an infant teething toothbrush, a child-sized toothbrush, and a timer, so parents and children know how long to brush their teeth. The kits also contained literature with QR codes to the Oral Health webpage and literature highlighting the importance of dental health. The literature includes information on tobacco cessation and lead poisoning prevention.
ODH also continued a program, started in October 2021, to fund three LPHAs to provide oral health education, oral health supplies, fluoride varnish, and a warm handoff to a dental provider through their WIC office. The LPHAs encouraged mothers to keep the appointments by emphasizing the importance of oral care during pregnancy. The LPHAs then tracked the mother’s dental visits to evaluate the effectiveness of the patient education. One of the LPHAs worked with a local FQHC to provide on-site mobile dental services to pregnant women. This allowed pregnant women to receive services in one location. In 2021, pregnant women covered by Medicaid received 531 dental procedures; in 2022, pregnant women covered by Medicaid received 16,639 dental procedures. Procedures included dental cleanings, extractions, fluoride varnish, crowns, and dentures.
The MCH Services Program continued to contract with LPHAs to support a leadership role for LPHAs at the community level to promote the health of mothers and infants by assuring prenatal, delivery, and postpartum care for low-income, at-risk pregnant women. Twenty LPHAs completed activities to improve pre-conception, prenatal, and postpartum healthcare services for women of childbearing age as their Priority Health Issue (PHI).
- The Miller County Health Center increased referrals to their Perinatal Program. The program helps pregnant women and new moms increase awareness and access to resources. The MCH Coordinator completes all pregnancy test services as requested and provides education and resources. Additionally, they assist women with enrollment into the Perinatal Program at the time of a positive pregnancy test result. In FFY 2023, of the 14 women who had positive pregnancy tests, eight women enrolled in the program. During the first perinatal appointment, the MCH Coordinator discussed safe sleep, safe travel, breastfeeding, prenatal vitamins, OB/GYN providers within a 50-mile radius, OB/GYN providers who accept Medicaid, applying for MO HealthNet for Pregnant Women, and additional resources as needed. The Health Center also partnered with Eldon Baby Grace, a local diaper bank, to provide diapers and wipes to those in need on the second Wednesday of every month. Eldon Baby Grace shared information regarding the Perinatal Program and other resources available at the health center with those they served.
One LPHA completed activities to prevent and reduce obesity among women of childbearing age as their PHI. Four LPHAs completed activities to prevent and reduce smoking among women of childbearing age and pregnant women as their PHI. These LPHAs continued to increase efforts to evaluate smoking status among women of childbearing age and offer smoking cessation resources and programs. Outreach efforts continued to engage community partners and providers to increase collaborative educational efforts, share resources and strengthen referral networks.
- The Chariton County Health Department increased tobacco screening and referrals among pregnant women and women of childbearing age; WIC staff used a tobacco screening and referral tool to refer women to the Smoking Cessation and Reduction in Pregnancy Treatment (SCRIPT) Program provided by the health department. Of the 128 women screened, four enrolled in the program. Of those four, one has decreased smoking frequency, and one has quit smoking.
- The Perry County Health Department increased tobacco screening and referrals among pregnant women by screening for smoking status when a woman presented to the health department for a pregnancy test; the pregnancy test consent form included questions for the woman to answer regarding smoking status and provided a referral option for the Baby & Me Tobacco Free Program. Of the 37 women screened, 13 were referred to smoking cessation resources, and one woman enrolled in the Baby & Me Tobacco Free Program.
- The Adair County Health Department increased screening and referrals among pregnant women who smoke; WIC staff screened all WIC participants and referred those eligible to the Baby & Me Tobacco Free Telehealth Program. All WIC participants were screened, six were referred, and three enrolled in the telehealth program. In addition, staff at A.T. Still University Gutensohn Clinic, Northeast Missouri Health Council, Lifeline Pregnancy Help Clinic, and the Adair County Ambulance District were trained by the MCH Coordinator on how to refer pregnant women. Lastly, the health department increased community awareness of smoking cessation services for pregnant women provided by the health department and its partners by developing Quit Kits that included smoking cessation education, information about the Baby & Me Tobacco Free Telehealth Program, and contact information for the health department. One hundred Quit Kits were distributed to prenatal care providers within the county. (Picture of Quit Kit below.)
Two LPHAs completed activities to decrease the number of women with a recent live birth who experience frequent postpartum depressive symptoms as their PHI, and one LPHA completed activities to improve mental health care services for women of childbearing age. These three LPHAs continued to work collaboratively to increase community awareness of postpartum depression, expand educational opportunities for providers and community members, and improve the understanding, adoption, and implementation of evidence-based postpartum depression screening tools.
- The Callaway County Health Department increased screening and referrals for postpartum depression by developing and implementing a policy to screen and refer all WIC participants at the initial prenatal and 6-month postpartum visit using the EPDS. 82 WIC participants were screened between October 2022 and September 2023; 20 were referred and received follow-up phone calls. Five were seen by a provider and received treatment. Of the 15 that did not follow up with a provider, six refused or were not interested in follow-up, and nine did not respond or LPHA staff could not make contact.
- The Springfield-Greene County Health Department increased referrals to the NEST Partnership. NEST stands for NUTURE, EMPOWER, SUPPORT, and TEACH. The Partnership provides nurse case management for at-risk prenatal and postpartum women and families with young children. Services are delivered in the home during scheduled visits for nurse assessment, intervention, education, and collaboration with healthcare providers. Community Health Workers (CHWs) were integrated within the WIC Program to make referrals to the NESY Partnership. 256 referrals were made, and 56 accepted NEST services (infant or prenatal visits). In addition, the NEST Partnership implemented an online HIPAA-compliant referral form that external agencies can use to refer participants directly. 104 referrals were received through the online referral form. Lastly, an internal policy was developed to use Language Line to reduce service barriers. Language Line provides language assistance to over 290 languages, 24 hours/day, seven days/week, and 365 days/year. This service was utilized 34 times.
Ten LPHAs completed activities to ensure women of childbearing age receive an annual preventive well-woman visit. Some activities resulted in organizational practices that include well-woman care as part of the services offered at the health department. In contrast, others collaborated with local FQHCs to screen and refer for services.
- The Madison County Health Department increased access to insurance coverage by surveying all women of childbearing age who presented to the health department for services. Those without insurance were referred to the MCH Coordinator and a CHW who have obtained certification to assist women in completing the Medicaid application process, specifically the Extended Women’s and Uninsured Women’s coverage. Since implementing this service in late FFY 2023, three women have received assistance in applying for insurance coverage. In addition, the health department has increased awareness of women’s health resources and insurance coverage by sending letters via postal mail to women who have had recent visits to the LPHA, offering assistance with enrollment into various programs provided by the health department. 61 women were mailed a letter. This program was implemented late in FFY 2023, and program impact has yet to be evaluated.
Two LPHAs completed activities to reduce disparities and ensure Black women of childbearing age receive preconception, prenatal, and postpartum health care services. These LPHAs continued to work closely with their internal and external partners, including but not limited to labor and delivery units at local hospitals and medical training programs at their local universities.
- The St. Louis County Department of Public Health developed a policy for screening pregnant women to determine the need for doula and home visiting nursing care to build trust in the healthcare system and improve birth outcomes. The MCH Lived Experience Advisory Board will be asked to review the proposed policy and provide feedback. To further inform policy development, the Health Department will collect data on birth outcomes during the prenatal and postpartum visits by adding screening questions to the electronic health record.
- The City of St. Louis Department of Health continued development of inclusive, culturally congruent care models and policies for clinical staff, including physicians and nurses, to implement as required annual training. The Health Department collaborated with Show-Me ECHO (Extension for Community Healthcare Outcomes) to enhance knowledge and practice recommendations to healthcare professionals to improve health outcomes of mothers and infants by increasing awareness and evidence-based management of preconception, antepartum, intrapartum, postpartum, and neonatal care, through collaboration among multiple disciplines and specialties. Show-Me ECHO learning sessions offer free continuing education to participating sites and individuals.
The MCH Services Program continued to support LPHA efforts to provide education on the importance of adequate dental care and overall oral health. LPHAs continued to collaborate with partners to offer screening, referral, and direct provision of preventive dental services and increase the number of women receiving preventive dental visits during pregnancy. LPHA and community partner efforts to implement education programs for pregnant women, families, and providers on the benefits of delivery after 39 weeks gestation, the risks of preterm delivery, and the risks associated with a cesarean birth continued to be supported.
The Newborn Health Program (NHP) continued to partner with various community health providers to raise awareness and educate the MCH population on resources for women of childbearing age and their families, including preconception, prenatal, and postpartum care, smoking cessation, postpartum mood disorders, and the importance of taking folic acid. The program accomplished this by distributing the Pregnancy and Beyond book and other educational materials at no cost. These resources contain information to improve pre-conception, prenatal, and postpartum health care services for women of childbearing age. The NHP tracked resource distribution and solicited partner feedback. on how they use the materials and ways to improve them. Materials are being updated to improve cultural competency and meet state health literacy standards. The Healthy Births and Babies (HBB) unit utilized and promoted an informal MCH internal work group, distributed educational materials through the Home Visiting Program and maximized outreach opportunities through conference exhibits, webinars, virtual baby showers, and health fairs. In July 2023, the NHP collaborated with Healthy Birth Day, Inc. to host a virtual baby shower that was promoted throughout the state and attended by more than 60 individuals. Attendees received information on counting kicks, labor and delivery, postpartum care of mom and baby, and other resources for pregnant women.
The Missouri Women, Infants, and Children (WIC) Program promoted the importance of depression screening by utilizing the Patient Health Questionnaire-2 (PHQ-2) for prenatal, breastfeeding, and non-breastfeeding women. The purpose of the PHQ-2 is not to establish a final diagnosis or to monitor depression severity but rather to screen for depression in a “first step” approach. WIC continued the referral system to the Home Visiting Program, TEL-LINK Program, the Missouri Primary Care Association, and other support programs. The Missouri WIC program held a two-part online training about perinatal substance use disorders on June 27 and 29, 2023, from 8:30 a.m. to noon. This recommended training provided counseling staff education aimed to increase comfort with foundational knowledge of substance use and perinatal health during pregnancy and breastfeeding; screening for substance use disorders and perinatal depression, brief educational intervention, and referral to support services. WIC also continued outreach efforts to enroll prenatal women in the WIC Program during their first trimester of pregnancy.
Home Visiting Programs continued to share information with all contracted local implementing agencies to help home visitors better understand the Affordable Care Act marketplace changes and uncertainties. Home visiting staff assisted enrolled clients in accessing insurance for prenatal, postnatal, and well-woman care through emails and weekly updates. Through a standard agenda topic on the monthly subrecipient monitoring and support calls with each contracted local implementing agency supervisor, Home Visiting Program Specialists addressed the need for updated resources for accessing a regular and ongoing source of healthcare, including current guidelines for accessing and maintaining insurance coverage. In FFY 2023, 74.3% of mothers enrolled in home visiting prenatally or within 30 days after delivery received a postpartum visit with a health care provider within eight weeks of delivery. This was a 29% increase from FFY 2022.
Additional Home Visiting Program Services included:
- Promoting smoking cessation for all primary caregivers who reported smoking at enrollment or the subsequent 6-month visit. In FFY 2023, 51.3% (41/80) of primary caregivers enrolled in home visiting who reported smoking, tobacco use, or other forms of nicotine delivery, including e-cigarettes, at enrollment were referred to tobacco cessation counseling or services within three months. This was a 21% increase from FFY 2022. In addition, home visitors provided tobacco cessation information and resources, such as the DHSS Tobacco Quitline, TEL-LINK, and the and the Baby and Me Tobacco Free Program.
- Providing information and resources to all enrolled pregnant women, promoting the benefits of continuing healthy pregnancies to the full 40 weeks. These resources included DHSS and March of Dimes educational materials. Home Visiting Program Specialists assessed the distribution and use of these resources during monthly subrecipient monitoring calls with contracted local implementing agencies.
- Screening all clients enrolled prenatally for symptoms of depression within three months of delivery. Primary caregivers not enrolled prenatally were screened within the first three months of enrollment. Home visitors utilized the Public Health Questionnaire 9 (PHQ-9) depression screening tool during these prescribed timeframes, and any time home visitors recognized potential symptoms of depression, individuals who screened positive were referred to appropriate services. In FFY 2023, 81.7% (343/420) of primary caregivers enrolled in home visiting were screened for depression, a slight increase from 80% in FFY 2022. Additionally, 12.3% (7/57) of primary caregivers who tested positive for depression were referred to services. Completed depression referrals decreased by 5% from FFY 2022. Resources on mental health were shared with contracting local implementing agencies through Weekly Updates.
- Collaborating with ODH to provide contracted home visitors with ordering information for oral health resources to share with enrolled primary caregivers, promoting the importance of receiving preventive dental care during pregnancy and at all stages of life for primary caregivers and their children.
- Facilitating discussions on performance measure data and clarifying accurate data collection during the review of FFY 2022-2023 data during the 2023 Leadership Academy, which all supervisors attended.
Pregnancy Associated Mortality Review (PAMR)
OWH continued to abstract and review all pregnancy-associated mortalities in Missouri. This is done to ensure information from all maternal deaths occurring within one year of pregnancy is captured. These reviews aid in the identification of strategies to prevent maternal mortality. DHSS reported findings from the Pregnancy-Associated Mortality Review (PAMR) and collaborated with partners and other key stakeholders to implement PAMR recommendations. Annual PAMR reports are accessible on the DHSS website.
With the support of Title V, DHSS was selected through a competitive grant process for a 5-year grant awarded through the Centers for Disease Control and Prevention’s (CDC) Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM) Program. This funding directly supports agencies and organizations that coordinate and manage Maternal Mortality Review Committees (MMRC) to identify, review, and characterize maternal deaths and identify prevention opportunities. OWH continued to improve internal processes to expedite maternal mortality case identification, abstraction, and review by working with the Bureau of Vital Records to use provisional death files. Furthermore, maternal mortality cases are grouped by date of death for abstraction and review. For example, deaths at the beginning of the year are abstracted first, if possible, and brought to the PAMR Board for review. In addition, a Patient Abstract System (PAS) linkage was developed during year two of the grant to identify additional hospitalizations/emergency room visits to aid in case abstraction. OWH contracted with the MHA through the ERASE MM grant to implement patient safety bundles in Missouri birthing facilities, clinics, and critical access hospitals. This work continued and included the implementation of the “Care for Pregnant and Postpartum People with Substance Use Disorder” bundle. Maternal overdoses were identified as a leading cause of death in the
Missouri Pregnancy Associated Mortality Review 2018-2020 Report published in June 2023. The OWH Maternal/Infant Mortality Coordinator worked closely with the PAMR Board and MCH leadership to implement the initiatives in this grant.
Other Activities to Promote Women and Maternal Health
OWH supported several initiatives to assist women of childbearing age. The Office supported the Uninsured Women’s Health Services Program. Through a collaboration with DSS, OWH reimbursed medical providers for women’s health services, such as providing approved methods of contraception and testing and treatment of sexually transmitted diseases. Women’s health services also included pap tests and pelvic exams; family planning, counseling and education on various methods of birth control; and drugs, supplies or devices related to the women’s health services described above when prescribed by a physician or advanced practice registered nurse. OWH maintained a public listing of information on pregnancy assistance and ultrasound providers. OWH sends an annual survey to develop a listing of private and public agencies in the state that help pregnant women. This listing is indexed geographically and available online. Typical services include food, clothing, supplies related to pregnancy, parenting skills, educational programs, and adoption assistance. OWH supported tobacco cessation services for pregnant and postpartum women through the Baby Me Tobacco Free Program. Finally, OWH supported the statewide Sexual Assault Nurse Examiner Telehealth Network. This network is in the beginning stages and will expand access to forensic exams across the state. By coordinating a statewide network of trained forensic nurses to provide consultative support to local emergency rooms, more survivors of sexual violence will have access to forensic exams.
The TEL-LINK Program provided over 3,000 healthcare referrals to increase access to care for any Missouri family needing assistance. TEL-LINK is Missouri’s toll-free MCH hotline, administered through a contract with ParentLink. The program was promoted through search engine campaigns to provide outreach to underserved populations through effective marketing strategies. The search engine strategy utilized geographic and demographic targeting, which directed individuals to TEL-LINK so operators could provide the closest resources. Starting in FFY 2023, TEL-LINK started providing resources by text message and searching an online directory. The program collaborated with DSS, the Department of Mental Health, the Missouri Hospital Association (MHA), LPHAs, ParentLink, and the Office of the Secretary of State to promote TEL-LINK’s new capabilities. Over 7,000 individuals clicked on the ad through this campaign to learn more about TEL-LINK's services. TEL-LINK collaborated with partners to provide access to resources on topics including smoking and substance use during pregnancy, prenatal care, safe sleep, WIC, home visiting, health insurance, housing, transportation, etc. Callers to TEL-LINK were referred to a variety of services, such as smoking cessation, dental care providers, safe crib providers, WIC clinics, audiologists, car seat providers, child care facilities, mental health treatment centers, health insurance providers, and many more.
Collaborative Efforts to Promote Women and Maternal Health
Missouri Maternal Health Action Network
Through participation in the Association of State and Territorial Health Officials (ASTHO) and the Association of Maternal and Child Health Programs (AMCHP) Promoting Innovation in State & Territorial MCH Policymaking (PRISM) Learning Community, DHSS contracted with the University of Missouri Kansas City Institute for Human Development (UMKC-IHD) to facilitate and continue to expand the statewide Missouri Maternal Multisector Action Network (the Network). The Action Network was established in 2022 and has over 220 individual stakeholders, 50 of whom are active participants.
Focused on a life course framework, the Maternal Health Action Network promotes a coordinated, multidisciplinary system of care for women of childbearing age and pregnant and parenting mothers and advances policy proposals to 1) address the impact of maternal substance use and mental health issues on the mother-infant dyad and 2) assure a comprehensive continuum of care, including prevention and treatment efforts, for women/mothers with mental health and substance use disorders (SUD) and their families. The Action Network used a landscape scan of State Policy Options for Perinatal Women with Substance Use Disorders provided by AMCHP to inform its priorities, goals, strategies, and future policy initiatives to address risk and protective factors that influence health disparities within families and communities. Two groups oversee the work of the Action Network: 1) the Moms’ Advocacy Network, comprised of mothers with lived experience, and 2) the Planning Committee, comprised of key MCH stakeholders. A diverse, multisectoral and representative group of MCH, public health, behavioral health, and social services stakeholders and community partners, including LPHAs, and women with lived experience with behavioral health conditions participated in Action Network efforts.
UMKC-IHD facilitated three Action Network meetings, two virtual meetings in January and April 2023, and one in-person summit in August 2023. To incorporate the lived experiences of mothers affected by substance use and mental health challenges, the Action Network promoted partnerships with individuals, families, and family-led organizations to ensure family engagement in decision-making, program planning, service delivery, and quality improvement activities. Action Network efforts explored practical ways to engage and partner with mothers with lived experiences. Through conversations with mothers, UMKC-IHD learned 1) mothers do not always feel safe being at the same table with the professionals; 2) mothers need a safe space to share their stories and provide feedback/input to the action plans tasked to the workgroups; and 3) mothers want to connect with those with similar experiences to build peer support. In response, UMKC-IHD began plans to launch a Moms’ Advocacy Network to provide leadership and self-advocacy training to equip mothers to share their stories and have an equal voice in decision-making.
As part of the dissemination efforts, UMKC-IHD presented a poster, titled “Collaborating for Collective Impact: Development of the Missouri Maternal Health Multi-Sector Action Network” at the 2023 AMCHP Conference held in New Orleans, LA In addition, the UMKC-IHD Communication and Dissemination team developed and continued to refine the Action Network website. The website features the Network's structure and function, participating organizations, testimonials from mothers with lived experience, announcements, resources, and upcoming events.
The Action Network’s first in-person Summit in August 2023. highlighted the voices of mothers with lived experiences. It included a story rewrite, updates from statewide programs (such as the DSS-Childrens Division’s plan to transform practices and service delivery), legislative updates, and a discussion on how to establish intentional collaboration for a coordinated statewide support system for mothers and children affected by substance use and mental health. Nine mothers from across the state attended the summit and participated in discussions. A few critical areas of discussion focus included: listening (to the voices of mothers with lived experiences) until we hear increasing communication across systems, coordinating care/services, providing stigma-free and trauma-informed services, and involving communities to provide wraparound services.
Maternal-Child Learning and Action Network
The Maternal-Child Learning Action Network offers assistance, facilitates the exchange of knowledge, and provides peer support for the creation of effective quality initiatives based on the Triple Aim principles of improving and evaluating perinatal quality and population-based programs. Soon after launching the Missouri Maternal-Child Learning and Action Network (MC-LAN) in 2018, DHSS and MHA partnered to join the American College of Obstetricians and Gynecologists (ACOG), as funded by the Health Resources and Services Administration, Alliance for Innovation on Maternal Health - AIM. Through this effort, MHA leads the implementation of maternal safety bundles in Missouri's birthing facilities. One example within the Severe Hypertension in Pregnancy initiative was the creation of an emergency department algorithm to assist providers in quickly responding to severe maternal hypertension. The MC LAN provided strategic guidance, focused on high-value opportunities to improve clinical, operational, and outcome performance, and developed collaborative partnerships to achieve these aims. In addition, the committee partnered with the communities they serve to achieve better communication and educate the public on quality and safety initiatives of the healthcare community. This committee met three times last year, with additional virtual meetings as needed. The MHA assisted birthing facilities with data submission to minimize the burden on the facilities, and DHSS worked with the MHA, leveraging key stakeholders to assist with implementing AIM bundles in interested facilities. As a result, 48 of the 59 birthing hospitals participated in at least one project.
Maternal Mortality Prevention Plan
Discussions with key partners identified the need for a comprehensive plan for maternal mortality prevention, with targeted funding and initiatives. DHSS leveraged Title V funding to propose a new state-funded budget initiative to implement a Maternal Mortality Prevention Plan. The Governor’s final approved state fiscal year 2024 budget included $4.35 million to implement the Plan and effect simultaneous transformation through five domains of action affecting maternal health, with the social determinants of health interwoven throughout all five domains. Implementation of the Plan, including a robust evaluation plan to monitor progress, measure success, ensure accountability, and inform ongoing maternal mortality prevention efforts, was launched through partnerships with internal and external maternal health partners. Improved maternal health data collection, standardization, harmonization, transparency, and support will enhance data quality and access, identify poor outcomes during pregnancy and make improvements to support healthy pregnancy, delivery, and postpartum outcomes. DHSS contracted with the University of Missouri to establish a collaborative hub and spoke model Maternal Health Access Project, inclusive of perinatal mental health, with a single point-of-entry system for referrals to prenatal care providers and community-based agencies, resources, programs, and services for prenatal women. Through a contract with the MHA, DHSS initiated implementation of three of the domains:
- Standardized, evidence-based maternal quality care protocols;
- Standardized maternal care provider trainings, using creative modalities, on trauma--responsive and culturally and linguistically appropriate care and screening, referral, and treatment of mental health conditions during and after pregnancy; SUD during and after pregnancy; cardiovascular disorders associated with pregnancy; and gestational diabetes and other endocrinology disorders associated with pregnancy.
- A Postpartum Plan of Care to plan for and optimize comprehensive postpartum care.
As the state’s chief maternal child health strategist, the state MCH Director continued to broaden the scope of MCH partnership beyond DHSS and other state agencies. As a convener of multidisciplinary, cross-sector collaborations and facilitator of meaningful and diverse partnerships, Title V brings MCH partners and programs together across programmatic silos and organizational boundaries to promote the health of the MCH population and address social drivers of health and health inequities. The MCH Director provided oversight for the new Maternal Mortality Prevention Plan and continued to be actively engaged in statewide collaborative efforts to promote the health of women of childbearing age, including but not limited to PAMR, the MC-LAN and Perinatal Quality Collaborative, the Women's Health Committee, Maternal-Infant Health efforts at MO HealthNet, the Maternal Health Action Network, the Uplift Connection, and many more.
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