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WOMEN/MATERNAL HEALTH DOMAIN SUMMARY/OVERVIEW FY22 ANNUAL REPORT

 

DOMAIN CONTRIBUTORS

 

Maternal and Infant Health (MIH) Consultant – Division of Child and Family Health

Reproductive Health Unit – Division of Child and Family Health

MCH Epidemiology – Division of Population Health Data

Division of Death Prevention – Office of the Chief Medical Examiner (OCME)

Dental Health Program – Division of Prevention and Health Promotion

VDH Local Health Districts

 

DOMAIN OVERVIEW

 

MATERNAL INFANT HEALTH (MIH) CONSULTANT: The MIH Consultant position was vacant from February 2020 through August 2022. The MIH Consultant serves as subject matter expert who partners closely with an array of state and local partners, including the Virginia Neonatal Perinatal Collaborative (VNPC), the Maternal Mortality Review Team, the state Child Fatality Review Team, and the Five-Star Breastfeeding Friendly Hospital Program. The MIH Consultant facilitates the monthly Sister Agency meeting that includes representatives from Department of Medical Assistance Services (DMAS), Department of Behavioral Health and Developmental Services (DBHDS), and Department of Social Services (DSS), MMRT, and VPNC. The MIH Consultant consults with LHDs regarding perinatal health work and provides support where possible. In addition, the MIH Consultant analyzes proposed maternal child health legislation and budget requests, and is responsible for resulting requirements upon passage such as work groups or task forces where appropriate. The MIH Consultant builds and sustains a variety of partnerships that serve Title V priorities and seeks out additional funding to expand the MCH work in Virginia.

 

REPRODUCTIVE HEALTH UNIT: This unit is led by the Reproductive Health Unit Supervisor, and includes the following programs and funding streams:

• Title X Family Planning (Title X): Clinical family planning programs consistent with Title X requirements and Quality Family Planning Services as defined by the CDC
• Contraceptive Access Initiative (TANF, Title V): Clinical contraceptive care for low-income patients without insurance
• Doula Certification Program and Task Force (Unfunded): State Program offering doulas the opportunity to earn state certification and to work together to promote doula services across the Commonwealth
• State Funding for Certain Abortions (General Funds): Abortion services for Medicaid members in cases of rape, incest, or incapacitating fetal anomaly
• Adolescent Health Program (Sexual Risk Avoidance Education, Title V): Positive youth development programs that build protective factors among participants that will make them less likely to initiate sexual activity
• Resource Mothers (TANF, Title V): Adolescent health program providing support services to pregnant and parenting teens and their families (Of note, the Adolescent Health Program and Resource Mothers Program are detailed in the Adolescent Health Domain)
• This unit works closely with the 35 LHDs to provide over $3.5 million in annual funds to support their local maternal and infant health programs and initiatives, providing quarterly recorded meetings via webinar platform for technical assistance and allow LHDs to share lessons learned across LHDs and programs. 

 

 

DIVISION OF DEATH PREVENTION:  The Division of Death Prevention, located in the Office of the Chief Medical Examiner, is responsible for several epidemiological surveillance and fatality review programs, including the Maternal Mortality Review and Child Fatality Review Teams. The MMRT is a multidisciplinary group with representatives from academic institutions, behavioral health agencies, hospital associations, state chapters of professional associations, state medical societies, and violence prevention agencies.  The MMRT collects data on and reviews the deaths of all Virginia residents who were pregnant within a year of their deaths regardless of the outcome of the pregnancy or the cause of death.  These deaths are termed “pregnancy-associated deaths”.  The MMRT is dedicated to the identification of all pregnancy-associated deaths in the Commonwealth and the development of recommendations for interventions in order to reduce preventable deaths.  Each case is reviewed by the MMRT to determine the community-related, patient-related, healthcare facility-related and/or healthcare provider-related factors that contributed to the woman’s death.  The MMRT also assesses and recommends needed changes in the care received that may have led to better outcomes.  Consensus decision-making is used to determine whether the death was preventable and/or related to the pregnancy.

 

MCH EPIDEMIOLOGY: The MCH Epidemiology and Evaluation Unit is a centralized epidemiology unit within the Division of Population Health Data headed by the MCH Epidemiology Supervisor who serves as the Lead Epidemiologist for Title V. The team has additional capacity available through a MCH Epidemiology Coordinator, Reproductive and Perinatal Health (RPH) Epidemiologist and a Newborn Screening (NBS) Epidemiologist, a Dental Health Epidemiologist/Evaluator, and two program evaluators supporting MCH programs regarding home-visiting (i.e., Healthy Start, MIECHV), and child and adolescent health. Additional cross-cutting support is provided by the Injury and Violence Prevention Epidemiologist.

 

DENTAL HEALTH PROGRAM: The DHP performs many duties including the provision of the following:  Educational activities and resources to a wide variety of partner groups to promote proper oral hygiene and support prevention services and access to dental care; direct clinical preventive services and assistance with establishing a dental home; quality assurance review to assure a competent public health oral health workforce; and, surveillance and evaluation activities to monitor and track dental disease rate and trends as part of program assessment for effectiveness and planning. 

 

VDH LOCAL HEALTH DISTRICTS:  Each of VDH’s 35 local health districts (LHDs) receive Title V funds to drive and support maternal and child health programmatic initiatives at the local level.

STATE ACTION PLAN UPDATES

 

 

	PRIORITY 1   Maternal and Infant Mortality Disparity:  Eliminate the racial disparity in maternal and infant mortality rates by 2025
OBJECTIVE	By 2025, decrease the disparity in black-white maternal mortality disparity ratio from 2.1 (2017) to 1.2 (2025)
OUTCOME MEASURE	SOM 2:  Maternal Mortality Disparity: Black/White Maternal Mortality Disparity Ratio

 

 

 

 

National maternal mortality data from 2018 indicate that Virginia’s maternal mortality rate of 16 per 100,000 livebirths largely mirrors the national mortality rate of 17.4 per 100,000 per livebirths; however, more recently, the 5-year (2017-2021) maternal mortality rate of black women (55 per 100,000 livebirths) is over two times higher than that for white women (24.6 per 100,000 livebirths). PRAMS data from 2021 indicated that Black women were more likely to report chronic conditions like hypertension and depression, and more likely to report experiencing discrimination or harassment due to their race/ethnicity or insurance or Medicaid status. Additionally, the 2019 Maternal Mortality Review Team (MMRT) report showed that Black women with at least one chronic condition had a pregnancy-associated mortality rate over twice that of their white counterparts (51.4 versus 25.1 per 100,000 live births, respectively).  When combined with rising rates of pregnant women with substance use disorder, and an unplanned pregnancy rate of almost 50%, Virginia’s 2019 Maternal Health Strategic Plan (attached document) sets an ambitious yet imperative goal of eliminating the racial disparity in maternal mortality by 2025.  This plan outlines six specific focus areas with strategies and recommendations for achieving this goal.  The focus areas are: Insurance coverage, healthcare environment, criminal justice and child welfare response, community-based services, contraception, and data collection.  Title V’s strategies in the Women/Maternal Health Domain complement and advance the recommendations made in the Maternal Health Strategic Plan.

 

Strategy 1:  Work with stakeholders to increase access to doula services among women of color

 

During the 2020 General Assembly Session, Virginia legislators tasked VDH with establishing a State Doula Certification Program in order to make doula services more accessible to all people, but specifically to Black women, who experience the highest maternal mortality rates of any population in Virginia.  In order to accomplish this, VDH’s Reproductive Health Unit convened stakeholders to develop state regulations that will guide the program.  Stakeholders included doulas, clinicians, advocates, and representatives from Department of Medical Assistance Services (DMAS), Virginia’s Medicaid Program.  VDH and DMAS worked in concert so that when the doula certification program is launched in FY22, certified doulas will then be able to apply to become a Medicaid provider.  Medicaid coverage for doulas will open access to low-income families and help to address the racial maternal mortality disparity in Virginia.

 

An official Doula Task Force convened in FY21 to provide the opportunity for doulas, providers, consumers, and payers to provide continuous feedback to the State Doula Certification Program throughout program implementation. The purpose of this task force is to assist with the promulgation of regulations and the certification process of doulas, as well as to serve as an informational resource for policy-related matters for VDH.  The task force consists of fifteen members representing the following areas of expertise:

• Three individuals who are not doulas and who received doula services during their previous pregnancies
• Seven representatives who are doulas working independently, as part of a collective, or as part of a private or community-based provider organization
• Three representatives who are clinical providers, including at least one OB/GYN and one certified nurse midwife
• One representative of a professional organization for hospitals
• One legislative member with a demonstrated interest in maternal and child health
• VDH and DMAS representatives serve as ex-officio members

 

During the current reporting period, the Virginia Board of Health finalized regulations to guide the State Doula Certification designation, triggering the launch of the State Doula Certification program and subsequent Medicaid billing process. To date, VDH has certified over 100 community-based doulas, and DMAS has stewarded the majority of them in becoming Medicaid providers. With Virginia Medicaid covering one in three births in the Commonwealth, this represents a significant opportunity for vulnerable families to benefit from doula services. VDH and DMAS are collecting data about the certification process, service delivery, and maternal and infant health outcomes to understand the impact of these programs on the community. This work actively works to address the racial maternal and infant mortality disparities in Virginia, as Black birthing people are significantly more likely to experience poor outcomes than their White counterparts. VDH continued to provide administrative support the Doula Task Force, the purpose of which is to assist with the promulgation of regulations and the certification process of doulas, as well as to serve as an informational resource for policy-related matters for VDH. The Task Force is Chaired by Kenda Sutton-El (Birth in Color RVA) and Stephanie Spencer (Urban Baby Beginnings), and its membership includes doulas, consumers, providers, hospitals, legislators, DMAS, and VDH.

 

EQUITY CENTERING:  Community-based doulas are grounded in the communities they serve and offer culturally congruent care.  VDH’s State Doula Certification Program aims to help patients find a doula that meets their needs and support doulas in earning a living wage for their services.

 

CHALLENGES:  After offering the State Doula Certification Program for a year, VDH recognizes a need to increase the number of approved doula training entities.  VDH also sees an opportunity to build the capacity of community doulas to participate in the doula certification program and to connect with resources necessary to support their practice.  VDH intends to leverage its partnerships with the Doula Task Force, DMAS, and other stakeholders to explore these opportunities moving forward.

 

SUCCESS STORY: Two testimonials from doulas who have achieved State Certification and become Medicaid Providers:

 

Strategy 2:  Maintain Title V representation on the Virginia Neonatal Perinatal Collaborative (VNPC) Steering and Executive committees, and Title V representation in selected workgroups.

 

Beginning February 2020, the Virginia Neonatal Perinatal Collaborative (VNPC) moved to Virginia Commonwealth University through a contract with VDH providing contract administration, epidemiological support, and is represented on all VNPC committees. In collaboration and coordination with Virginia’s 54 birth hospitals, VNPC is currently focusing on three quality improvement (QI) projects based on the Alliance for Innovation on Maternal Health (AIM) patient safety bundles : (1) reduce the use of inpatient intravenous antibiotics at hospital nurseries/NICUs; (2) decrease the rate of severe maternal morbidity attributable to obstetric hemorrhage; and in FY21, (3) care coordination from delivery to the post-partum visit and then transition to annual women’s health, also known as the fourth trimester.  Virginia is one of three states to pilot the 4th trimester bundle, with 51 birth hospitals currently participating in the bundle. Throughout FY22, VNPC continued to lead the statewide Sister Agency Monthly call, with Title V participation alongside MCH representation from all state-level agencies. In FY22, VNPC organized a perinatal cannabis workgroup, which formed in response to Virginia's July 2021 marijuana legalization legislation.  Title V is active in this workgroup, which is focusing on awareness and education at both the provider and community levels. VNPC offers a monthly webinar series for state perinatal stakeholders which are well attended each month.  VNPC also hosts two annual summits. The 5th Annual VNPC Summit was held virtually on October 29, 2021, themed “Fostering Community Partnerships to Improve Maternal and Infant Health Outcomes”.   The Perinatal and Infant Mortality Summit occurred on May 16, 2022, and was also virtual. Both summits had over 200 virtual attendees from state, district and local community organizations.

 

Strategy 3:  Local Health Districts (LHD):  Develop, mobilize, and participate in strong interagency, multisector, and community partnerships to address disparities in maternal and infant mortality rates

 

Beginning State FY 23 (July 2022), Virginia’s LHDs were transitioned to a new work plan structure more closely aligned with the State Action Plan. Each district was required to select from a list of measurable activities, and then report quarterly to those activities.  Twenty-two of 35 local health districts prioritized maternal and infant mortality disparity in their annual work plans.  Local activities include:  Conducting local area environmental scans and gap analyses of maternal and infant mortality; strengthening community partnerships to increase referrals for the Black and Hispanic birthing population to home visiting programs; collaborating with community partners, including FQHCs, to develop stronger referral processes for appointments and care coordination of women with chronic medical conditions and those at risk of poor outcomes, including focuses on health literacy and health system navigation; partnering with local housing and food bank resources to strengthen community-centered support; strengthening of current educational resources provided to women who utilize current LHD clinics. Detailed District reporting will occur in FY23 block grant report.  

 

	PRIORITY 2   MCH data capacity:  Maintain and expand state MCH data capacity, to include ongoing needs assessment activities, program evaluation, and modernized data visualization and integration
OBJECTIVE	By 2025, decrease the disparity in black-white maternal mortality ratio from 2.1 (2017) to 1.2 (2025)
OUTCOME MEASURE	SOM2:  Maternal mortality disparity:  Black/white maternal mortality disparity ratio

 

Strategy 1:  Sustain state maternal mortality and child fatality review programs, engaging with cross-sector partners and addressing social determinants of health in development of MMRT and CFRT recommendations

The Division of Death Prevention is led by Dr. Ryan Diduk-Smith (Director). The Division is responsible for several epidemiological surveillance and fatality review programs, including the Maternal Mortality Review Team and Child Fatality Review Team, local and regional overdose and domestic violence review teams, the National Violent Death Reporting System, Overdose Data to Action project, and the ERASE MM project. The division is 100% federal funded through grants and cooperative agreements through the Centers and Disease Control and Department of Justice.

The MMRT is current reviewing maternal deaths that occurred in 2021 (n=108). The 2023 triennial report was written and submitted to Virginia’s Secretary of Health and Human Resources, and at this time is in the final review stages. It is anticipated that this report will be published in the mid-late summer 2023. Through Plan-Do-Study-Act (PDSA) evaluations, it was determined that several changes needed to be made to the structure, operation, and facilitation of the MMRT and those changes are currently being discussed among OCME and OFHS. We anticipate a roll-out of updated procedures to assist with more timely review in September 2023.

Other activities included the MMRT coordination and facilitation of bi-monthly MMRT meetings: Activities under this activity include case selection for each meeting, requesting records from health, social, and community-based agencies that will be used in the review, review of those records, and determination of inclusion or exclusion in the review, as well as scanning the record for additional information that could be collected from other providers or agencies. After each review team meeting, data from the review team meeting are entered into the MMRIA database (funded and maintained by CDC under the ERASE MM cooperative agreement) by the MMRT staff. After each review meeting, the Programs Manager is also responsible for maintaining, compiling, and reviewing the recommendations quarterly for applicability and appropriateness based on the review topic and current trends. The OCME continued to engage the community through multidisciplinary workgroups, review team meetings, and other activities where appropriate, through the MMRT. The MMRT consists of the following team members: the Chief Medical Examiner, the Director of the Office of Family Health of the Department of Health, the State Registrar of Vital Records, and the Commissioner of Behavioral Health and Developmental Services. Additional team members include: local law enforcement, local fire departments, local emergency medical services providers, local departments of social services, community services boards, attorneys for the Commonwealth, the Medical Society of Virginia, the Virginia Hospital and Healthcare Association, the Virginia College of Emergency Physicians, the Virginia Section of the American College of Obstetricians and Gynecologists, the Virginia Affiliate of the American College of Nurse-Midwives, the Virginia Chapter of the Association of Women's Health, Obstetric and Neonatal Nurses, the Virginia Neonatal Perinatal Collaborative, the Virginia Midwives Alliance, and the Virginia Academy of Nutrition and Dietetics. The Chief Medical Examiner and the Director of the Office of Family Health of the Department of Health serve as co-chairs of the Team and may appoint additional members of the Team as may be needed to complete maternal death reviews.

The Maternal Mortality Programs Manager sits on numerous committees and boards including the Virginia Neonatal Perinatal Collaborative, the Maternal Health Data Quality Committee, and the Perinatal Cannabis Workgroup. They also provide data to community stakeholders and leaders as requested.

Strategy 2:  Convene the Maternal Health Data and Quality Measures Task Force as mandated by HB2111 to evaluate maternal health data collection processes

 

Virginia House Bill 2111 (2021) established the Maternal Health Data and Quality Measures Task Force for the purpose of evaluating maternal health data collection to guide policies in the Commonwealth to improve maternal care, quality, and outcomes for all birthing people in the Commonwealth. With representation from multiple disciplines and organizations, the provisions of the bill require the Task Force to monitor and evaluate relevant stakeholder data, including third-party payer claims and mandated sources, to examine quality of care with regard to race, ethnicity, and demographic, as well as the impact of social determinants of health on outcomes. The first Task Force meeting was held in March 2022. The MCH Epidemiologist Lead and PRAMS Principal Investigator serve as a subject matter experts/members on this Task Force. A final report is due to the General Assembly by December 1, 2023.

 

 

	PRIORITY 3   Reproductive justice and support:  Promote equitable access to choice-centered reproduction-related services, including sex education, family planning, fertility/grief support, and parenting support
OBJECTIVE	By 2025, reduce the rate of mistimed pregnancies from 25.3% (PRAMS 2018) to 21.8%
PERFORMANCE MEASURE	SPM 4 – Pregnancy Intention: Mistimed or Unwanted pregnancy (wanted to become pregnant later or never)

 

Strategy 1:  Work with stakeholders to remove policy, financial, and training barriers to contraceptive access

VDH’s Reproductive Health Unit includes several programs dedicated to Title V populations and priorities, including the Virginia Contraceptive Access Initiative, the Title X Family Planning Program, the Adolescent Health Program, Resource Mothers, the State Doula Certification Program and Task Force, the Pregnancy Loss Services Initiative, and the State Funding of Certain Abortions Program.

The Contraceptive Access Network was a group of agencies working to reduce unintended pregnancies among people of childbearing age and increase access to comprehensive, quality family planning services. This group was originally developed to address infant mortality, recognizing the role of contraceptive access on maternal and infant health. The group was facilitated by VDH, met twice a year, and included over 70 members from a variety of community-based health centers, governmental organizations, hospital systems, payers, and community members. The network stopped meeting officially in 2021, but informal collaboration continues among some members around specific projects. Two such projects include the Contraceptive Access Initiative and Prescribing Authority.

The Contraceptive Access Network collaborated to successfully advocate for the Virginia LARC Initiative, a two-year pilot program designed to increase access to hormonal LARCs (long-acting reversible contraceptives) among uninsured, low-income patients that began in 2018. Funded through federal TANF funds allocated by the Virginia General Assembly, the LARC Initiative allowed VDH to contract with eighteen health providers to offer LARC insertions and removals to eligible patients. During its two-year pilot period (October 2018-July 2020), the Virginia LARC Initiative provided approximately 3,986 no-cost visits to eligible patients. In July 2020, the Virginia General Assembly expanded the scope of the program to cover all-FDA approved methods of contraception, and thus the program’s name changed to the Virginia Contraceptive Access Initiative. During SFY 21 (July 1, 2020-June 30, 2021), the expanded program provided 6,785 no-cost visits to eligible patients, representing an enormous increase in patients served. During SFY 21 (July 1, 2021-June 30, 2022), the expanded program provided 6,678 no-cost visits to eligible patients. Title V funds support VDH staff time spent administering this program. VDH’s Title X Family Planning program provides comprehensive family planning services at 109 clinical sites across the Commonwealth, including 25 local health districts and 3 federally qualified health centers. As the nation’s only federally funded family planning program, Title X provides structure, funding, and technical support to clinics providing family planning services according to CDC’s Quality Family Planning Services guidelines. The Title X Family Planning program is not directly supported by Title V funds, but Title X compliments Title V by supporting family planning services beyond those provided by the Virginia Contraceptive Access Initiative. VDH is partnering with Vanderbilt University to formally evaluate the impact of VDH’s family planning efforts on unintended pregnancies in the Commonwealth, and the results are expected during the upcoming reporting period.

During the 2020 General Assembly Session, Virginia legislators passed a law to allow pharmacists to dispense contraception to low-risk patients aged 18 or older. VDH and other stakeholders worked with the Board of Pharmacy to finalize protocols later that year, but pharmacists still are not taking advantage of this program in a significant way. The primary reason is tied to billing; Virginia Medicaid does not recognize pharmacists as medical providers, and therefore pharmacists cannot be reimbursed for medical services they offer. In order to dispense contraception under the approved protocols, pharmacists must have a consultation with the patient to identify the appropriate contraceptive method and determine that the patient does not have any medical contraindications that would prevent her from safely taking hormonal methods. Because Virginia has no mechanism for compensating pharmacists for this consultation, commercial pharmacies do not have a financial incentive to offer this service. As a result, Safeway is the only commercial pharmacy prescribing contraception in Virginia. Safeway charges the patient $35 for the consultation, and its locations are only located in the northern part of the state. VDH is working with Safeway to learn best practices for implementing this program, but all acknowledge that the $35 consultation fee is a barrier for low-income patients. Based on VDH’s conversations with the Virginia Pharmacists Association and DMAS, until pharmacists are recognized as medical providers and compensated accordingly, pharmacies will not offer this service in a significant way.

EQUITY CENTERING:  Countless programs have shown that when financial barriers to contraception are removed, more people use contraception consistently and correctly, and unintended pregnancy rates drop as a result.  VDH’s famil planning programs, including those supported by Title V, intend to remove financial varriers for patients to allow them to use the method that is best for them, not just the method that is the most affordable. When the Contraceptive Access Initiative was launched, the Virginia General Assembly limited the program to hormonal LARCs.  VDH believes that expanding the program to include all FDA-approved methods was an important step towards equity.  While making some methods of contraception available at no cost, particularly the most expensive methods, can increase access, this approach has the potential of being coercive because a patient may feel pressured to choose the free method over the one that bes meets their needs.

 

 

	PRIORITY 4   Mental Health: Promote mental health across MCH populations, to include reducing suicide and substance use
OBJECTIVE	By 2025, reduce the percent of women who reported loss of interest or feeling depressed (postpartum depression) from 14.4% (PRAMS 2019) to 13.7%
PERFORMANCE MEASURE	SPM 6 - Promotion and strengthening of optimal mental health and well-being through partnerships and programs

 

 

 

Maternal mental health (MMH) conditions, including perinatal mood and anxiety disorders, are one of the most common complications in pregnancy, affecting 1 in 7 birthing individuals in the United States; however, MMH affects birthing individuals who are members of vulnerable groups, marginalized and underserved communities are affected at a much higher rate.  MMH conditions impact the mother-baby dyad in significant ways:  less engagement in medical care, preterm delivery, low birthweight and NICU stays, lactation challenges, bonding and attachment issues, cognitive and motor delays in the baby, and adverse partner relationships. We also know that 100% of pregnancy-related mental health deaths were preventable.  Before COVID-19, the CDC estimated that one in eight women experienced postpartum depression, and about five to seven percent experienced major depressive symptoms.  Two COVID-19 studies which collected survey data on maternal mental health and breastfeeding during the pandemic indicated that a third of women screened positive for depression and one-fifth for major depression.  One in five who screened positive for postpartum depression reported thoughts of harming themselves. In the state of Virginia, 11.2% of 2021 PRAMS respondents indicated that they “often” or “always” felt down, depressed, or hopeless or having little interest or little pleasure in doing things they usually enjoyed since delivery. 

 

Strategy 1:  Explore opportunities for providing support to families seeking fertility services and families experiencing miscarriage

 

The purpose of VDH's Pregnancy Loss Services Initiative is to build the capacity of community organizations to provide pregnancy loss support to individuals and groups (including families) who have experienced pregnancy loss, including but not limited to miscarriage (including molar and ectopic pregnancy), termination for medical reasons, stillbirth and neonatal death, sudden, unexpected death of an infant, and pregnancy after loss. While pregnancy loss is defined differently throughout the world, the World Health Organization (WHO) defines a miscarriage as a baby who dies before 28 weeks of pregnancy and a stillbirth as a baby who dies at or after 28 weeks. An estimated 10% to 20% of known pregnancies end in miscarriage, and an additional 1% end in stillbirth. Research suggests that even after the birth of a healthy child, some parents who have experienced pregnancy loss continue to grieve for much longer than previously thought by health care professionals. Pregnancy loss may affect future pregnancies, the ability of a parent to care for their other children, and lead to the development of mental health issues (e.g. anxiety, depression, and post-traumatic stress disorders). By increasing access to pregnancy loss support services among Virginians, VDH aims to help individuals and families heal, thus resulting in positive health outcomes for children, adults, families, and communities.

 

On January 1, 2022, VDH initiated contracts with the following organizations to offer pregnancy loss services:

• Birth in Color RVA
• Full Circle Grief Center
• Kennedy’s Angel Gowns
• Sisters in Loss
• VCU OBGYN Department

 

These organizations achieved the following outputs during the reporting period:

• Offered over 100 grief groups to individuals who have experienced loss, with an average of 4 people attending each group.
• Distributed material support (“angel boxes”) to 75 families
• Hosted 9 community conversations/informational events
• Create one public resource list and one informational video about pregnancy loss

 

In addition, VDH worked with partners to build capacity to meet the needs of families of color who have experienced loss and train future providers about this issue. Participant feedback about the program has been overwhelmingly positive, and VDH’s MCH team is partnering with the Reproductive Health team to more intentionally collect information about participant experience moving forward. During the current reporting period, VDH facilitated a workshop titled “Cultivating State Support for Pregnancy Loss” at the AMCHP conference and is working with the MCH Learning Institute to integrate these efforts into an overall maternal mental health strategy for Virginia.

 

EQUITY CENTERING:  VDH’s Pregnancy Loss Initiative recognizes that Black women experience pregnancy loss at higher rates than White women, and as a result, aims to build the capacity of community-based organizations to support families of color.

 

Strategy 2:  Local Health Districts (LHD): Strengthen early identification, supports, and referrals for mental and behavioral health needs of people of reproductive age

 

Beginning State FY 23 (July 2022), Virginia’s LHDs were transitioned to a new work plan structure more closely aligned with the State Action Plan. Each district was required to select from a list of measurable activities, and then report quarterly to those activities. Twenty-three of 35 local health districts (LHDs) prioritized mental health in their annual work plans.  Local activities include: hiring a social worker with experience in mental health counseling to assess all mothers enrolling for prenatal or postpartum MCH services; strengthening the mental health skills of the LHD personnel through evidence-based trainings and continuing education; strengthening the internal screening, referral, and follow-up process; increasing connections with community providers. Title V plans to partner very closely with Postpartum Support VA to provide training to the districts teams regarding screening and referrals, as well as to assist in the Districts’ ability to develop and sustain relationships with their community mental health providers. Detailed District reporting will occur in FY23 block grant report.  

 

	PRIORITY 5   Oral Health: Maintain and expand access to oral health services across MCH populations
OBJECTIVE	By 2025, increase the percent of women who had a dental visit during pregnancy from 49.9% (PRAMS 2018) to 52.4%.
PERFORMANCE MEASURE	NPM 13.1 – Percent of women who had a preventive dental visit during pregnancy
EVIDENCE-BASED or -INFORMED STRATEGY MEASURE	ESM 13.1.1 - Number of Regional Oral Health Collaborative Projects that implemented work to increase dental visits among pregnant women

 

 

 

The Dental Health Program (DHP) partners widely across both internal Virginia Department of Health programs as well as externally through the statewide oral health coalition now known as Virginia Health Catalyst (VHC).  VHC is a non-profit organization that serves as the only statewide oral health coalition in the Commonwealth.  It is a diverse group working to spark change so that all Virginians have equitable access to comprehensive health care that includes oral health, and to bring excellent oral health to all Virginians through policy change, public awareness and innovative programs.  The VHC works closely with VDH to implement grant objectives and has in-depth knowledge of the Virginia Oral Health Plan and the Virginia Oral Health Report Card, and other foundations that prioritize oral health activities statewide.   VHC has access to a diverse network of key statewide stakeholders, and the unique ability to share oral health information with both key partners and the public.  VHC staff understand the need to continue promotion of oral health at the local level, support local initiatives to affect meaningful change, and to evaluate efforts to ensure ongoing, comprehensive support for structural sustainability. 

 

Program activities aimed at increasing oral health care for pregnant women, infants, children and individuals with special healthcare needs (ISHCN) within the DHP are the Bright Smiles for Babies Fluoride Varnish Program, Dental Preventive Services Program, and Perinatal and Infant Oral Health Program. 

 

The Perinatal, Infant, and Adolescent Oral Health Program aims to improve access to oral health care for pregnant women, infants and adolescents who are most at risk for disease through integration of dental services and information into the primary care delivery system.  Additionally, this program allows for expansion of the existing Virginia Oral Health Surveillance System to include data collection, analysis, and reporting of indicators regarding pregnant women and infants.  In 2019, this program began to focus on HPV prevention and oral cancer education, and vaping concerns for the adolescent population. 

 

                                            

 

 

Strategy 1:  Maintain and expand existing MCH-focused dental education programs to improve oral health for individuals across the lifespan, to include advising on oral health integration in primary care settings, education for home visitors, school-aged oral health education, and emerging needs of adolescents

 

Birth in Color RVA is a non-profit organization dedicated to raising awareness about maternal health and reproductive justice. Through their comprehensive program, they provide training, mentorship, culturally-centered birth services, and support to Black pregnant individuals and their families while also offering racial bias training for healthcare professionals. With funding from the MCH block grant as a micrograntee, BIC educated doulas and birth workers about the importance of oral health and routine dental care for their clients. Additionally, BIC provided dental supplies, oral health education and referrals to participants of bi-monthly support groups.

 

Through this work, Birth in Color RVA contributed to the national performance measure (NPM) 13.1, which monitors the percentage of women who had a preventive dental visit during pregnancy. This initiative aligned with the organization's broader mission of promoting improved oral health and overall well-being for pregnant individuals and their children in the regions of Hampton Roads, Richmond, and Lynchburg.

 

Birth in Color RVA successfully integrated oral health education into their doula and birth worker training curriculum, empowering these providers to educate their clients effectively. By providing dental supplies, resources, and education to pregnant individuals and their families, the organization fostered awareness and prioritization of oral health during pregnancy. Through their comprehensive efforts, Birth in Color RVA contributed to the overall improvement of maternal health and reproductive justice in their target regions.

 

Strategy 2:  Continue to foster a network of 6 regional Oral Health Alliances to conduct regional needs assessments and implement systems change and data-sharing initiatives to improve the oral health of all Virginians, with emphasis on pregnant women, and children and adolescents ages 1-17

 

(See Below)

 

Strategy 3: Convene statewide groups focused on targeted oral health issues and facilitate collaboration and work plan development, and provide leadership and oversight to guide initiatives

 

All of Catalyst’s strategies within the MCH program are designed to influence changes to the system that promote more equitable and easier access to oral health services for pregnant people and children and safe, trusted, fluoridated drinking water. Catalyst’s Future of Public Oral Health (FPOH) workgroup was a collaborative project that implemented work plans to increase dental visits among pregnant people and children by focusing on technology and innovative, replicable quality improvement projects with safety net clinics. Our school-based oral health programs continued to bring together various partners who were previously unconnected to help school age children get direct access to necessary oral health care. For example, conversations spurred by Catalyst opened the door to continued collaborations that can provide medical care and vaccinations to the 6,000-plus children in the Harrisonburg school district and help replicate these partnership models across the state.

 

Many activities occurred during the reporting period as outlined in the monthly reports. In summary, these activities included conducting community outreach events to increase awareness of program services, training staff and stakeholders on evidence-based practices, working with clinics to implement telehealth services to improve access to care, and collaborating with community partners to enhance service delivery.

 

All activities were designed to influence performance measures to increase dental visits among pregnant people and children and collaborative projects. Across the board, we positively influenced those measures through MCH-focused dental education programs, regional activities, and several active workgroups like FPOH, Water Equity Taskforce (WET) and the Early Dental Home (EDH) workgroup. 

 

Our partners across grassroots projects, alliances, and workgroups continued to identify barriers to accessing oral health care including myriad COVID-related repercussions so that we could implement work plans to address access issues at the community-level. Our strategies to provide MCH-related education, foster regional programs, and convene statewide partners were all met through various activities like fluoride varnish and special needs dentistry trainings, completion of the 2022 Oral Health Report Card and Teledentistry Toolkit, and successful convenings for the FPOH, WET, and EDH workgroups.

 

In addition to the 2022 Oral Health Report Card and Teledentistry Toolkit, the program has produced various deliverables, including reports on program progress and service utilization, stakeholder meeting summaries, and additional training materials for staff and stakeholders. The program also provided technical assistance to partners and stakeholders, including training on evidence-based practices and implementation support for telehealth services. Additionally, Catalyst held the 11th Annual Summit, which brought health equity to the forefront and provided a forum for education and networking to hundreds of stakeholders.

 

The program has had several successes and impacts. For example, the program has increased community awareness of program services through high-touch technical support to increase care coordination, resulting in increased service utilization among community partners. The program has also trained staff and stakeholders on evidence-based practices, which has led to improved service quality and outcomes for program participants. Notably, Catalyst increased workgroup membership, adding new perspectives that have enhanced the work plans’ abilities to address topics like telehealth, health equity, and school-based oral health care. For example, a new FPOH technology workgroup member created a teledentistry workflow to share with school nurses so they can use teledentistry in their programs. Additionally, 90% of participants at Catalyst’s Annual Summit participants reported that the sessions were informative for their work; session topics covered the future of equitable public oral health care, improving care for Virginia’s LGBTQ community, leveraging social determinants of health, the history of racism in healthcare, and creating equitable policies in Virginia.

 

 

 

EMERGING ISSUES

 

During the 2023 General Assembly session, Virginia legislators passed SB1538, which will require DMAS to reimburse pharmacists for medical services provided.  this bill directly addresses the main barrier to making contraception available under the Board of Pharmacy protocols finalized in 2020.  VDH anticipates that implementing SB1538 will take at least a year, but when the process is established, pharmacists will have a mechanism to bill Medicaid for contraceptive counseling provided when prescribing contraception to eligible patients.