Pre-/Interconception Health

Preconception health counseling has been identified and endorsed by the Centers for Disease Control and Prevention as a strategy to improve maternal health and birth outcomes, as well as to reduce unplanned pregnancies. Starting in May 2016 under the auspices of the MCH Coalition and the March of Dimes, who provided the financial support, Every Women Connecticut (EWCT) and the Every Women Connecticut Learning Collaborative (EWCTLC) were established. The main goal of this initiative is to increase provider expertise and self-efficacy in implementing routine pregnancy intention screening and appropriate care, education, and services to ultimately improve birth spacing, increase pregnancy intentionality, as well as the proportion of Connecticut women who deliver a live birth and report discussing pre-/interconception health with a healthcare worker.

EWCT, which established and manages the EWCTLC, now operates under the auspices and support of the Connecticut Women’s Consortium (CWC), which is a statewide policy, training, and advocacy organization specializing in women’s behavioral health. This, combined with the guidance of the EWCT Advisory Committee, has helped to stabilize the work of EWCT.

In order to strengthen relationships with new partners, representatives from the State Department of Mental Health and Addictions Services (DMHAS) and the Connecticut Coalition Against Domestic Violence (CCADV) have joined the EWCT Advisory Committee. This group of well-known and respected individuals representing partner organizations, including state agencies; the state’s Medicaid ASO; the state’s Medicaid dental and behavioral health carve-outs; state-level private non-profits; and direct service providers, continue to guide EWCT’s efforts in increasing a general awareness around pre/interconception care and specifically around the One Key Question (OKQ) screening tool and in addressing social determinants of health and health equity.

The EWCTLC has representatives from clinical and community-based providers in communities throughout the state and has expanded to include a cohort of the Department of Mental Health Addictions Services (DMHAS) providers.

The trainings done during this time frame continued the partnership with DMHAS, which is requiring the use of OKQ in their programs serving women and men in their childbearing years. Trainings for staff at DMHAS funded program were as follows: 

• On July 2, July 22, and September 16, 2019 EWCT and DMHAS co-sponsored and the CWC hosted a workshop entitled Pregnancy Intention Screening, Sexual Health, Optimal Birth Spacing, and Effective Contraceptive Counseling. This workshop was conducted by Dr. Jordana Frost, Co-Chair of EWCT and Sarah Gannon from Planned Parenthood of Southern New England (PPSNE). This training for implementers of OKQ focused on optimal birth spacing, an overview of different effective birth control methods, and ways in which staff can counsel women and their partners while ensuring a culturally sensitive and trauma-informed approach.

• In addition to the three trainings conducted by Dr. Frost and Sarah Gannon, another workshop, co-sponsored by EWCT and DMHAS and hosted by CWC, was a day-long session held in August 2019 on implicit bias and microaggressions. The trainer was Dr. Lisa Worcester Rozas from the UConn School of Social Work.

While these trainings were for DMHAS funded programs others, including Ashley Starr Frechette representing CCADV on the EWCT Advisory Committee, were also able to attend. CCADV is the membership organization of Connecticut’s 18 domestic violence service agencies that provide critical support to victims including counseling, support groups, emergency shelter, court advocacy, safety planning, and lethality assessment, among other services. Due to a major internal and external expansion of CCADV services the opportunity to present OKQ to the advocates and direct service staff of CCADV’s member agencies has been delayed.

EWCT supports the Department of Public Health’s State Health Improvement Plan (SHIP) through the participation of Jordana Frost and Marijane Carey on the SHIP Advisory Council. Jordana Frost is a member of the Advisory Council representing the March of Dimes and Marijane Carey attends and participates in Council meetings as the Co-Lead (along with Dr. Frost) of the Maternal, Infant and Child Action Team. Specific collaborative activities included advocating for Paid Family and Medical Leave (PFML) and supporting Judith Dicine, an attorney in the State’s Attorney Office and member of the SHIP’s Chronic Disease Action Team, in advocating for a statewide Uniform Property Maintenance Code. Note: After 7 years of educating on and advocating for PFML, PFML legislation was passed during the 2018 legislation and signed into law in June 2019.

Jordana Frost and Marijane Carey, Co-Chairs of Every Woman CT, presented a poster session at the annual AMCHP conference held in March 2019. In April Dr. Frost presented at the CWC-sponsored on Reproductive Health, Birth and Trauma.

Reproductive Health Services

Planned Parenthood of Southern New England provided reproductive healthcare services to 46,240 clients regardless of their ability to pay, of whom 90% were females and 10% males. Of those served, 15% were teens. The race and ethnicity breakdown of those served is as follows: 27% Hispanic, 37% White/Non-Hispanic, 26% Black/African American, and 2% Asian, and 7% Other, all of whom had incomes at or below 250% of the federal poverty level. The program provided pregnancy tests and options counseling to 1,841 program participants and translation services to 3,044 program participants, along with 1,422 Herpes tests, 38,537 Gonorrhea tests, 20,261 syphilis tests, 38,534 chlamydia tests, and 20,892 HIV tests. Seventy-two percent of program participants received reproductive health care services regardless of ability pay (over goal of 60%); fewer than one third of program participants were covered by commercial health insurance (55% Medicaid/Husky/public insurance, 28 % private insurance, 22% no insurance/self-pay). Ninety-eight percent of female program participants receiving a preventative reproductive health exam participated in the development of a Reproductive Life Plan (over goal of 90% and up from 97% last year); 79% of those between the ages of 15 and 25 received a screening for chlamydia/gonorrhea at their visit or within the last year (not meeting goal of 90%, but up from 76% last year), 98% received a Pap test or were current with their Pap screening schedule (over goal of 90% and up from 97% last year); 100% received a clinical breast exam (over goal of 90% and up from 96% last year), and 34% received an HIV test and referral for care as needed (not meeting goal of 65%).

Teen pregnancy and childbearing are at historic lows in CT. The teen birth rate in CT declined 77% between 1991 and 2016 and. Teen birth rates have fallen for all racial and ethnic groups, and in some cases the gap in teen birth rates by race/ethnicity has narrowed, but disparities remain.

Connecticut teen birth rates have been on a continuous decline since 2010. In 2014 the teen birth rate was 11.5 per 1,000 and decreased to 8.9 per 1,000 in 2018 in all race and ethnicities. Although overall teen birth rates have decreased, 2018 births to African American (13.2/1,000) and Hispanic teens (23.8/1,00 exceed the state rate of 8.9 per 1,000 births. The number of abortions among women under 20 has dropped even faster (67%) between 2006 and 2016.

The City of New Britain has the 2nd highest teen birth rate in the state at 44.2 per 1,000 women ages 15-19 and the highest repeat teen pregnancy rate in the state, and the family Planning Center that provided part-time reproductive health services closed. State funding was provided to expand an existing reproductive health and wellness clinic at the Hospital of Central CT to conduct outreach, provide education, referrals and linkages to preventative healthcare for New Britain teens.

Breast and Cervical Cancer

During the program period for fiscal year 2020 the Breast and Cervical Cancer Early Detection program enrolled and screened 4223 women while the WISEWOMAN program screened 961 women. The program continues to provide funding for 12 Community Health Workers (CHW) who navigated women to no-cost screening programs for cancer screening and cardiovascular screening. These CHWs also provide baseline cardiovascular services (blood pressure, blood glucose, cholesterol, height and weight) using a mobile equipment, connected participants with abnormal readings to providers and supported participants to improve their lifestyles to reduce their risk of cancer and heart diseases.

Genomics

The Genomics Office continued to increase public awareness of the importance of knowing their family health history and sharing this information with their family and healthcare practitioners, promoted the use of Family Health History collection by promoting the US Surgeon General’s “My Family Health Portrait” tool; continued partnering with CEDPP and the mandatory collection of patient and family B&C health history, provision of free patient information resources, and encouraging staff healthcare provider genomics education through online training on hereditary cancer syndromes such as Hereditary Breast and Ovarian Cancer (HBOC) and Lynch Syndrome, and the appropriate use of genetic services.

Oral Health

The OOH and its partners developed the State Oral Health Improvement Plan 2019-2024, which contains four overarching goals with 16 objectives and 18 strategies to improve the oral health of all Connecticut residents. The plan was developed utilizing an oral health equity framework and “healthy equity lens” to address oral health disparities. The four main goals focus on prevention, access and utilization, medical/dental integration and data collection and analysis. Each goal includes measurable objectives and strategies with identified potential community partners.

During the past year, the OOH, CTCOH, and its partners successfully collaborated to finalize the plan. During FY 2018, the OOH continued to partner with oral health stakeholders statewide, including dental and non-dental agencies and organizations with an interest in addressing the oral health and overall health of all CT residents across the lifespan. The OOH continues to collaborate with community partners to implement key strategies included in the State Oral Health Improvement Plan and to support long term sustainability and increasing efforts in inter-professional integration of health services.

The Perinatal and Infant Oral Health Workgroup (PIOHW) focused on the significance of women’s oral health as it related to birth outcomes and the oral health of their children, and served as the advisory committee for a HRSA funded Perinatal and Infant Oral Health Quality Improvement Project (PIOHQI). The CT Dental Health Partnership (CTDHP), the state’s dental Medicaid administrative organization continued to provide intensive outreach to encourage women to access dental care during pregnancy. The PIOHW serves as the advisory to the OOH for the HRSA workforce activities related to perinatal and infant oral health. The CTDHP and CT State Dental Association, both members of the PIOHW, worked collaboratively with the OOH to promote the importance of early childhood caries prevention and oral health for women during their childbearing years.

The OOH also served on the CT Maternal and Child Health Coalition (MCH) and attended quarterly meetings. The MCH Coalition is made up of key leaders involved with several statewide initiatives and organizations to promote maternal and child health. Inclusion on the Coalition provides an ideal forum to highlight and promote oral health for families through collaborative planning to implement the CT Plan to Improve Birth Outcomes and other statewide plans.

The OOH received two federal funding opportunities; one from the Center for Disease Control and Prevention (CDC) and one from the Health Resources and Services Administration (HRSA). OOH was awarded the CDC cooperative agreement State Actions to Improve Oral Health from 2018-2023 for a total of $2.85 million over the five-year period. The five-year funding will assist CT to decrease dental caries, oral health disparities, and other chronic diseases co-morbid with poor oral health through two components. Component One includes three strategies; 1) implement and expand school-based sealant programs, 2) support and increase access to community water fluoridation, and 3) conduct oral health surveillance. Component Two involves implementing a medical-dental integration strategy to integrate oral health and prediabetes and only five states were selected to receive this Component.

The HRSA Grants to States to Support Oral Health Workforce Activities also focuses on medical dental integration from 2018-2022 for a total of $1.6 million for the four-year period. The four-year funding will support CT’s efforts to develop and implement an innovative program to address the dental workforce needs of designated dental health professional shortage areas (HPSA) and increase oral health services accessibility and quality for populations living in dental HPSAs. The OOH will contract with selected federally qualified health centers to implement an innovative, systems level program to improve common risk factors for childhood obesity and dental caries by integrating nutrition screening, counseling, referral, and care coordination in the dental setting.

Personal Responsibility Education Program

The Personal Responsibility Education Program (PREP) replicates evidence-based personal responsibility education programs to high risk youth ages 13 to 21, with the intent to change behavior and delay sexual activity, increase condom or contraceptive use for those who are sexually active, and reduce unintended pregnancy. From 2018-2019 the program was delivered to 1,127 youth in a variety of settings including Bridgeport, East Hartford and Capitol Regional Education Council (CREC) high school health classes, Bridgeport middle schools, Bridgeport Juvenile Detention facility, child welfare residential and community-based settings and in the young adult mental health programs and in community programs of areas of high teen births. The program provides Facilitator training, the curriculum, educational materials, ongoing technical assistance, and training on trauma, gender and identity, birth control and motivational interviewing. The program sites are monitored for fidelity to assure that all program delivery is trauma informed, medically accurate, inclusive, age appropriate and implemented with fidelity. Participants complete voluntary entry and exit questionnaires, through which the effectiveness of the program is evaluated.