Breast and Cervical Cancer Program

 

Priority: Access to Care (Women, Children, Adolescents, and Families)

 

NPMs, NOMs, SPM, and ESMs:

 

• NPM 1: Percent of women, ages 18 through 44, with a preventive medical visit in the past year
• SPM 5: Percent of women 40-64 years screened for cervical cancer
• ESM 1: # of community groups and activities programs attended and worked with as partners
• ESM 2: # of engaged users viewing social media messages delivered by MSDH social sites promoting women's preventive health services
• ESM 3: # of social media message months promoting women's preventive health services
• ESM 4: # of expectant and parenting teens enrolled in PHRM/ISS program

 

Strategies and Activities (FY October 1, 2020 - September 30, 2021)

 

Objective 1: By June 30, 2022, establish a formal system with worksite wellness programs for breast and cervical cancer screenings

 

Strategy 1: MS-BCCP program staff will work with internal and external stakeholders to implement worksite wellness programs that aim to increase breast and cervical cancer screening uptake by women in Mississippi.

 

Activity 1a: Request invitation for the new Outreach Coordinator to join/serve on the MSDH Worksite Wellness Committee.

 

Due to changes brought on by the COVID-19 pandemic to the agency, external partners, and programs, all work plan activities, programmatic workflows, and day-to-day operations demanded continuous assessment and prioritization to assure the most critical and immediate services remained available, accessible, and were provided to the public. For MS-BCCP, the priority continuing into the fall of 2020 centered on ensuring a broad network of participating providers was available to provide cancer screening and diagnostic services throughout the state, that individuals in need were appropriately linked with those services, that data was collected according to CDC expectations, and that providers were consistently reimbursed for the services provided. Additionally, from October 2020 – February 2021, MS-BCCP’s Outreach Coordinator role was vacant. This limited the program’s ability to implement proposed activities until the new Outreach Coordinator started in March 2021. Shortly after starting, he learned the Worksite Wellness committee is not active within MSDH.

 

Central Mississippi Correctional Facility hosted a health fair May 4, 2021, in recognition of Correctional Officers Appreciation Week. The Outreach Coordinator participated in the event as an exhibitor and provided literature and discussion around the importance of screening with attendees.

 

Beginning late summer 2021, the MS-BCCP team began planning multiple worksite wellness activities to recognize October-Breast Cancer Awareness month within MSDH. Among the planned activities, a booth was to be setup every Wednesday during October 2021 in the MSDH main foyer where onsite employees could receive information about MS-BCCP, screening guidelines, and resources available for screenings.

 

Activity 1b: Research other state programs’ approach to worksite wellness activities. Identify 2-3 activities that could be considered for the MS-BCCP Program.

 

In the spring of 2021, the Outreach Coordinator researched and used success stories, one-pagers, and other available content from other states’ who had successfully implemented worksite wellness activities to garner ideas for MS-BCCP. The Program also received guidance and resources from the NBCCEDP Program Consultant to support improvement in the Environmental Approaches Strategy.

 

Activity 1c: Identify 10 potential large employers with regional or state-wide reach and research related to existing worksite wellness policies, activities, and interest in engagement (i.e., banking institutions, institutions of higher learning, food chains, grocery store chains, temp staffing companies, etc.).

 

By the close of the reporting period, the Outreach Coordinator had connected with 8 major employers in Mississippi, including three in the banking industry (Bank Plus, Bancorp South-Regions, and Trustmark), two in manufacturing (Toyota and Nissan), two in agribusiness (Simmons Catfish and Americas Catfish), and one in the staffing industry (Staffing Innovation) to assess existing employer policies concerning health and wellness promotion and activities. He corresponded with the employers, who did not have policies established but showed interest, to provide information (one-pagers, materials from NBCCEDP) and consultation for supporting their momentum. Additionally, one of MS-BCCP’s FY2021 subgrantees, Plan A Health - a mobile primary health clinic, partnered with a major employer in the MS Delta, Platte Chemical, on April 27, 2021 to offer an on-site wellness screening event in which the workers received primary care screenings, family planning services, STD testing, HIV testing, clinical breast exams, pelvic exams, pap smears, and referrals for mammograms. A total of 16 employees received care through the mobile unit. The success of those on-site events was well-received throughout the community where it was stationed. Later in the year, the Outreach Coordinator shared contact information with Plan A Health for key employers and community leaders in the MS Delta. Under its renewed subgrant for FY2022, Plan A Health had several events planned throughout the MS Delta in which the mobile clinic would offer services.

 

Activity 1d: Use research, a draft plan, and a schedule of activities to engage with 1 worksite or employer per month to inform and promote worksite wellness programs related to breast and cervical cancer.

 

Strategy 2: The MS-BCCP program staff will work with internal and external partners to identify opportunities for collaboration.

 

By the close of the reporting period, the Outreach Coordinator had connected with 8 major employers in Mississippi, including three in the banking industry (Bank Plus, Bancorp South-Regions, and Trustmark), two in manufacturing (Toyota and Nissan), two in agribusiness (Simmons Catfish and Americas Catfish), and one in the staffing industry (Staffing Innovation) to assess existing employer policies concerning health and wellness promotion and activities. He corresponded with the employers, who did not have policies established but showed interest, to provide information (one-pagers, materials from NBCCEDP) and consultation for supporting their momentum. Additionally, one of MS-BCCP’s FY2021 subgrantees, Plan A Health - a mobile primary health clinic, partnered with a major employer in the MS Delta, Platte Chemical, on April 27, 2021, to offer an on-site wellness screening event in which the workers received primary care screenings, family planning services, STD testing, HIV testing, clinical breast exams, pelvic exams, pap smears, and referrals for mammograms. A total of 16 employees received care through the mobile unit. The success of those on-site events was well-received throughout the community where it was stationed. Later in the year, the Outreach Coordinator shared contact information with Plan A Health for key employers and community leaders in the MS Delta. Under its renewed subgrant for FY2022, Plan A Health had several events planned throughout the MS Delta in which the mobile clinic would offer services.

 

 

Objective 2: By June 30, 2022, collaborate with community organizations and businesses to include educational programs in their community outreach activities aimed at reducing risk for breast and cervical cancer.

 

Activity 2a: Consult with leaders of partner organizations (i.e., Susan G. Komen, Mary Byrd Perkins Cancer Center, Institute of Minority Health, MP3C Coalition Chair, etc.) to determine historical and contemporary outreach efforts and activities facilitated through them. Seek invitation to partner on future events and activities.

 

Despite the limited availability of the Outreach Coordinator for several months during the reporting period, key partnerships with leadership of the MS Comprehensive Cancer Control Program (MCCCP) and MP3C Coalition were leveraged to extend the promotion of breast and cervical cancer screenings and BCCP services through various venues, virtual events, and other opportunities. The State MP3C Coalition Chair served as a guest presenter at multiple virtual events scheduled in October 2020, in which she provided education on the importance of breast and cervical cancer screenings, as well as referral information for the BCCP Program. These events included:

• October 12, 2020, “A Dose of Reality: Breast Cancer Awareness Forum” co-hosted by Jackson State University and The Black Girl Social Club.
• October 14, 2020, “Breast Cancer in African American Women” podcast hosted by Women for Progress Radio Network.
• October 26, 2020, “Breast Cancer 101: Emotional Aspects of a Breast Cancer Diagnosis” co-hosted by Hinds Community College Utica Campus and Phi Theta Kappa Honor Society.

 

On November 17, 2020, the American Cancer Society, Mississippi Cancer Action Network sponsored a virtual Policy Forum meeting, which drew approximately 90 participants representing the business community, healthcare providers and systems, advocacy groups, state agencies, pharmaceutical companies, and health insurers. The State MCCCP Director and State MP3C Coalition Chair were guest speakers and shared health promotion messages on screening, early detection, and cancer prevention, as well as contact information for the program(s). The Susan G. Komen (SGK) organization implemented major infrastructure and business model changes effective Spring 2021. These systemic changes resulted in the dissolution of the three local/state level SGK Chapters that had been partners to MS-BCCP for decades – both in providing non-federal grant funds and in referring women directly to enrolling providers. In May 2021, the Program Director met virtually with representatives from the National SGK office to craft a plan for women to be referred to MS-BCCP should they access the National SGK helpline. To support the training of helpline workers, MS-BCCP developed and sent a short slide deck, describing the MS-BCCP and the process of linkage discussed, along with the most recent list of providers.

 

Activity 2b: Identify 4-6 potential community-based organizations/partners to outreach per month. Request opportunities to share information with “gatekeepers” of or to the target population (i.e., community health workers, patient navigators, care coordinators, faith leaders, non-profit social service workers, philanthropic organizations, sororities/fraternities, etc.).

 

The importance of screening and early detection was further promoted by community health partners and participating providers. Many partners used their own internal and organic resources, such as business and organization social media outlets, to encourage uptake of screening services. Southeast Mississippi Rural Health Initiative, Inc., Aaron E. Henry Community Health Center, and North Sunflower Medical Center used Facebook as an outlet to bring awareness to the availability of free breast screening services in the month of October 2020. Some sponsored special activities, such as pumpkin decorating contests, “Bling-Your-Bra” contests, and self-care basket giveaways to increase interest and attention. The BCCP Program provided printed materials for smaller scale events/projects as requested and available. These included:

 

• Jackson Heart Study Community Engagement Center’s Health Fair/Screening held on October 21, 2020, whose target audience was Hinds County Sheriff’s Department employees.
• Jefferson Davis County School District, Human Resources Department, who requested material in electronic format that could be dispersed to employees through the month of October 2020.

 

The Program Director was an invited guest speaker for a community education webinar for January 25, 2021, hosted by the Office of Community Outreach and Engagement of O’Neal Comprehensive Cancer Center - The University of Alabama at Birmingham. Co-presenters from the Alabama BCCP program also joined. The presentation was targeted for community health workers and lay professionals and covered the basics of how one can access the services of the MS-BCCP program, eligibility, how to link women with an enrolling provider, and services provided for enrolled participants. The hosting organization partners with the Alabama Department of Health on a cervical cancer screening project. This project is geared to promote screenings (Pap testing/HPV) at the local health department in 13 counties in Alabama and 4 counties of Mississippi, including Bolivar, Humphreys, Yazoo, and Panola counties. Resources for obtaining cervical cancer screenings in Mississippi were emphasized. About 60 people participated in the webinar. Throughout the reporting period, MS-BCCP worked with contracted evaluator, Dr. Daniel Sarpong, and with Ms. Robyn Taylor, a Health Equity Consultant with the National Association of Chronic Disease Directors, to assess breast health disparities among Mississippi women with particular focus to the counties in which they reside. Using program data and that available from other sources (i.e., CDC, Susan G. Komen Mississippi State Health Profile, Robert Wood Johnson County Health Rankings, etc.), this team identified three (3) Mississippi counties (Prentiss, Claiborne, and Amite) with lower county health profile rankings for health and socioeconomic status and higher rates of late-stage breast cancer diagnosis, particularly among African American women. These same counties were also identified to be “under-referring” women to the MS-BCCP program to assist with access to and payment for breast health services based on program enrollment and claims data. To begin solution-finding for improving access to care, the team presented these findings in an inaugural community engagement meeting held virtually on July 9, 2021. The participants of the meeting included approximately 30 health care professionals in public and private institutions, faith-based institutions, community-based organizations, and members of the public, including cancer survivors from the 3 focus counties and more broadly. The content of the meeting included an overview of breast cancer nationally, in Mississippi, and in the 3 counties, the impact of disparities, the importance of early screening and detection, and invited discussion amongst participants for identify possible needs, barriers, and challenges as seen by community members and stakeholders. Information gained from the meeting assisted the BCCP program to identify possible strategies, opportunities, and solutions to improving BC screening. The program focused on provider engagement in August 2021 and offered six (6) opportunities for virtual training on MS-BCCP processes for enrolment and patient navigation. 175 unduplicated individuals were trained across the 6 trainings (77 external providers, 98 MSDH employees). The program leveraged the success of the August virtual trainings and continued its focus on provider education and engagement in September 2021. A Provider Reference Guide, frequently asked question supplement, and recording of the training were made available and broadcast to the MS-BCCP provider listserv. By the close of the reporting period and only one week after the training video link was live, it had been viewed 29 times. On August 31, 2021, the Outreach Coordinator provided a virtual presentation to Alpha Kappa Alpha Sorority, Inc., Rho Lambda Omega Chapter leadership and was invited to present to the Health and Wellness Committee of the Chapter virtually at their September 27, 2021, meeting – there were 27 participants.

 

Additionally, over the course of the reporting period, the Outreach Coordinator received many requests for outreach materials from new external “gatekeepers,” including:

• Clinton (MS) Alumnae Chapter of Delta Sigma Theta Sorority, Inc.
• Simmons Farm Raised Catfish, America’s Catch Catfish,
• Oak Grove Church of God (Meridian), St. Peter MB Church (Utica),
• Federal Bureau of Prisons (Yazoo City), New Jerusalem Church (Jackson),
• Le Fleur Haven Senior Retirement Housing (Jackson),
• Celebrity Hair Designs (Jackson),
• Southwest MS Community College – Career and Technical Education (Summit), Merit Health (Madison),
• Canton Public Library (Canton),
• Fredonia M.B. Church (Coldwater),
• Unity Health Services/Community Beauty Shops (Jackson),
• Indian Run Estates (Pearl),
• MSDH Office of Preventive Health
• Central MS Planning and Development District
• Women's Empowerment summit
• Temple Reconstruction Fitness
• Hinds Community College (Raymond)
• Oak Grove church of God
• St. Peter MB Church
• Federal Bureau of Prisons
• Spanish Congregation North Campus
• Celebrity Hair Designs
• Career-Technical Education and Horace Holmes Student Union
• Canton Public Library Community Beauty Shops
• Northwood Village Apartment
• Joe Prichard Holmes
• Pearl Street A.M.E Church

 

Activity 2c: Identify 3 potential sources for new enrollments within assigned area to outreach per month. Request opportunities to share information with direct care providers of breast and cervical services. Refer inquires for new fee-for-service contracts to Contracts/SG Coordinator.

 

This activity is an ongoing activity and is captured in reporting on other activities.

 

Activity 2d: Work with BCCP team to revise intake process to capture data element for how the enrollee or patient learned about BCCP (i.e., outreach event, gatekeeper referral, website, social media, medical provider, etc.) to allow for assessing effectiveness of outreach activities.

 

This activity was not initiated during the reporting period.

 

Activity 2e: Refer BCCP enrollees diagnosed with breast or cervical cancer to Medicaid within 7 days of receipt of pathology report and all other required documentation.

 

During the reporting period, 52 patients enrolled in the Breast and Cervical Cancer Program were referred to the Mississippi Division of Medicaid within 5-10 days of receiving the results of a pathology report positive for cancer.

 

Activity 2f: Refer BCCP enrollees diagnosed with breast or cervical cancer to the MS Comp Cancer Control Program within 7 days of receipt of pathology report and all other required documentation.

 

Due to staffing changes in the MCCCP program and prioritization of other tasks, this activity was not attempted during the reporting period.

 

Activity 2g: Submit work requests to the Office of Communications to promote CDC-approved messaging related to breast and cervical health, cancer prevention, detection, etc. Prepare social media post schedules and templates for Cervical Cancer Awareness Month (January) and Breast Cancer Awareness Month (October).

 

The MS-BCCP program initiated a cervical cancer awareness social media campaign through the MSDH Office of Communications to run through January 2021. In September 2021, the Outreach Coordinator prepared a work request for a social media campaign to run through October 2021, which promoted breast cancer screening and early detection. Total of 11 Facebook posts and 8 Twitter posts were observed. Analytics for reach and impressions were as follows. Facebook/Instagram: Reached 91,705 users and produced 302 website visits. Twitter: Reached 53,840 users and produced 42 website visits.

 

Activity 2h: Develop a trainer/speaker/presenter request form to be completed when outside partners or stakeholders request representation from BCCP for any program, event, or agenda involving interacting with the target population and/or potential referral sources. This will assist in maintaining a record of community engagement.

 

Strategy 3: MS-BCCP will engage the support of external providers to increase screenings among high priority populations.

 

This activity was not initiated during the reporting period.

 

 

Objective 3: By June 30, 2022, increase screening rates among the African American, Hispanic, Asian, and American Indian communities to identify never or rarely screen women and link them to services.

 

Activity 3a: Facilitate subgrant agreements with Health Systems Partners (JHCHC, FHCC) and Community-Clinical Linkage partners (Plan A, Singing River Health Systems, North Sunflower Health System) to support activities that increase screening rates among these underserved groups of women.

 

Starting in the fall 2020, the program worked with subgrantees to plan targeted, strategic interventions for increasing screenings of underserved women. The MS-BCCP executed subgrant agreements with six partners during the reporting period with funding support provided through June 30, 2021, which included Jackson Hinds Comprehensive Health Center, Family Health Care Clinic, Plan A Health, Mary Bird Perkins Cancer Center, Singing River Health Systems, and North Sunflower Health System to support activities that increase screening rates among high priority groups. A competitive RFP was developed to recruit subgrantee partners for FY2022 and was posted to the website in late August 2021. Seven applications were returned. Reviews were scheduled for early October 2021 and would lead to five competitive proposals being funded through June 30, 2022. The current subgrantees are located different areas of the state and are strategically positioned and working to reach underserved women. Some activities planned include expansion of patient navigator services to additional sites, addition of community health workers in under-reaching counties, and mobile screening and mobile mammography events in areas of the state with both low MS-BCCP enrollment, increased incidence for cancer, and higher vulnerability.

 

FY2021 MS-BCCP program data reflects that among 3,935 participants served, 58.2% were Black/African American women, 30% white women, 1.5% Indigenous/Native Alaskan, Asian, or Pacific Islander women, and 0.5% were two or more races. For 9.8% of participants, no race was indicated, representing a major area for programmatic improvement. Ten-point eight percent (10.8%) of enrollees indicated their ethnicity was Hispanic, 85.9% non-Hispanic, and for 3.3% no response was recorded. With the race of nearly 10% and ethnicity of over 3% of the participant population undetermined, the program cannot accurately determine its progress in achieving its targets for serving priority populations. However, based on available data, the program presently falls short of targets set in prior years.

 

Activity 3b: Continue contact with North MS Witness Project to assess progress and reach to date. Observe data for Northeast MS counties to determine enrollment and screening trends. Explore opportunities for more formal partnership through MOU.

 

There was no progress for this activity in the reporting period.

 

Activity 3c: Initiate contact with other MSDH programs on front line of COVID response, who have expert experience in reaching disparate communities. Leverage existing data, opportunities for joint messaging in health promotion, etc.

 

There was no progress for this activity in the reporting period.

 

Activity 3d Consult with Institute for the Advancement of Minority Health on strategies and best practices for engaging underserved populations. Explore opportunities for partnership.

 

A new partnership with the Institute for the Advancement of Minority Health was developed starting in September 2020. At the request of this partner agency, program staff provided consultation for organizing breast cancer screening promotion activities in October 2020, as well as more technical training for the Institute’s Community Health Worker (CHW) on linking women directly with BCCP. The BCCP Nurse Consultant provided the Institute’s CHW with the updated participating provider list, instruction on how to refer women for enrollment into the BCCP Program, and information related to navigation for diagnostic services. To bring awareness to the population served, the Institute developed a promotional graphic for posting on their website that encouraged women to make direct contact with the CHW for more info on free mammograms. The Program Director was an invited guest speaker for a Health Awareness webinar on January 25, 2021, hosted by the Institute for the Advancement of Minority Health. The presentation was targeted for community health workers with IAMH and covered the basics of how one can access the services of the MS-BCCP program, eligibility, how to link women with an enrolling provider, and services provided for enrolled participants. About 10 people participated in the webinar.

 

Activity 3e: Using e-blast list serv, send announcements to participating provider network of training and learning opportunities related to health equity, cultural sensitivity, and serving diverse populations.

 

Strategy 4: MS-BCCP will facilitate partnerships with institutions and sites that house women temporarily to promote awareness of breast and cervical cancer screening.

 

In May 2021, the Program Director developed a provider listserv to allow for timely announcements to the entire MS-BCCP provider network. The listserv has grown to more than 300 individual names and has been used routinely to broadcast targeted information to the MS-BCCP provider network. Throughout the year, the Program Director used the provider listserv to broadcast announcements of trainings, webinars, and online resources to support professional development targeting evidence-based interventions, health equity, health disparities, cultural competence, cultural responsiveness, etc. Materials shared were those from the CDC, American Cancer Society, Virtual National Health Equity Summit, Johns Hopkins Sidney Kimmel Comprehensive Breast Cancer Center, Black Breast Cancer Alliance, and other reputable agencies, organizations, and authorities.

 

 

Objective 4: By June 30, 2022, re-engage with the MS Department of Corrections (MDOC) to provide staff and incarcerated women with education on the importance of screenings and resources available.

 

Activity 4a: Initiate contact with Flowood Correctional Facility and other minimum-security settings, which house women for brief periods (6-18 months) to explore interest in providing virtual education to staff and inmate population on breast and cervical health and BCCP services. Plan logistics accordingly. Pursue MOU for sustainability.

 

On April 6, 2021, the Program Director and Outreach Coordinator provided a virtual presentation to the Women’s Program Director of the Central Mississippi Correctional Facility (CMCF). The focus of the presentation was how transition counselors and correctional case management staff can provide supportive help to link women with MS-BCCP providers as they approach their release dates. Throughout the year, the Outreach Coordinator stayed in contact with the Director to plan opportunities for him to meet with groups of women, who were scheduled to be released within 6 months or less, to provide direct information about accessing MS-BCCP. Visits to the facility were not possible due to ongoing COVID-related restrictions. However, this is still being explored for 2022.

 

Activity 4b: Initiate contact with other institutional case managers or community re-entry workers to provide information about BCCP resources and updates. Venues to target include transitional living facilities, community work programs, and probation/parole monitoring programs.

 

May 4, 2021, the Program Director and Outreach Coordinator provided a virtual presentation to the transition counselors of the Washington County Correctional Facility. The focus of the presentation was how transition counsellors and correctional case management staff can provide supportive help to link women with MS-BCCP providers as they approach their release dates.

 

Activity 4c: Work to ensure the BCCP Program is listed among services and resources in the Mississippi Re-entry Guide.

 

Strategy 5: MS-BCCP will initiate contact with former incarcerated women to promote awareness of the program and enrolling providers.

 

The Outreach Coordinator worked with contacts from the Foundation for the Mid-South and the Mississippi Reentry Council to have MS-BCCP listed among services and resources in the Mississippi Reentry Guide. The guide, available free of charge online and searchable by county and helps to connect ex-offenders with services and agencies that support successful transitions back to their communities. By close of June 2021, this task was successfully executed.

 

 

Objective 5: By June 30, 2022, upon release, link re-entry population to a medical home to increase breast and cervical cancer screenings

 

Activity 5a: Assess the list of 96 women who participated in the former Outreach Coordinator’s educational presentation and voluntarily requested more information. Review ages and release dates to prioritize a schedule of mail-outs encouraging follow-up with a local provider for breast and cervical services.

 

Upon her departure, the former Outreach Coordinator provided a list of the 96 women, inclusive of their names, ages, projected release date, county, and mailing address which were voluntarily provided by the women during the event. Because the women voluntarily offered this information, BCCP Program staff did not require additional support from the Restitution Center to make good on its plan to outreach these women. By the close of the reporting period, the Outreach Coordinator had identified 3 women from the list, who were already in MS-BCCP and had prioritized the “send-out” of brochures to the other women on the list. This is a staged and ongoing activity and has not been fully executed.

 

Activity 5b: Compare mail-out list to enrollee data to determine how many women were enrolled after they would have received a post card from BCCP.

 

Strategy 6: MS-BCCP will facilitate partnerships with agencies/organizations that house women temporarily to promote awareness of breast and cervical cancer screening.

 

See Activity 5a.

 

 

Objective 6: By June 30, 2022, establish partnerships with domestic violence shelter providers to assist in navigating women to medical homes, or health care systems to increase cancer screening, diagnostic, and treatment resources.

 

Activity 6a: Partner with Nursing Consultants and MSDH Social Services Director to make application for social work CE credit for a presentation specific to breast and cervical health, disparities preventing access to care, and resources available for social workers to refer women in need to for services.

 

By the close of the reporting period, the Outreach Coordinator had developed a draft presentation. The draft is pending review by other MS-BCCP staff and the Program Director. Plans to seek social work CE approval are not forecasted at this time.

 

Activity 6b: Initiate contact with MSDH Office Against Interpersonal Violence (OAIV) to determine opportunities to provide education to grantees (i.e., domestic violence shelters, victims service coordination sites, rape crisis centers, human trafficking programs, family violence prevention programs, etc.) as part of any annual or quarterly trainings. Plan logistics accordingly.

 

In March 2021, the Program Director and Outreach Coordinator met virtually with the Director of the Office Against Interpersonal Violence (OAIV) to begin strategizing how MS-BCCP could engage with domestic violence shelters throughout Mississippi. On April 28, 2021, and with the logistical assistance of OAIV, the Program Director and Outreach Coordinator provided a virtual presentation to the Mississippi Coalition Against Domestic Violence (MCADV) membership. The members in attendance were directors and leaders of women’s and family shelters across Mississippi. The focus of the presentation was how case managers and shelter staff can provide supportive help to link women with MS-BCCP providers. By close of summer 2021, the Outreach Coordinator had met virtually with both human trafficking navigators in Office Against Interpersonal Violence (OAIV) to share resources available through MS-BCCP.

 

Activity 6c: Initiate contact with MS Coalition Against Domestic Violence (MCADV) to determine opportunities to provide education to its shelter programs as part of any annual or quarterly trainings. Plan logistics accordingly.

 

See Activity 6b.

 

Activity 6d: Initiate contact with other social service agencies providing residential services or housing for women/families to offer information about BCCP resources and updates to staff. Venues to target include homeless shelters, housing authorities, substance abuse treatment programs, etc.

 

Strategy 7: MS-BCCP will engage external partners to recruit women for enrollment in BCCP.

 

This activity has not been fully accomplished and is a priority for the remaining half of FY2022.

 

 

Objective 7: By June 30, 2022, increase the breast and cervical cancer screenings for the uninsured and underinsured targeted population.

 

Activity 7a: Facilitate subgrant agreements with Health Systems Partners (JHCHC, FHCC) and Community-Clinical Linkage partners (Plan A, Singing River Health Systems, North Sunflower Health System) to support activities that increase screening rates among these underserved groups of women.

 

Duplicate activity, different measure of performance. Targets were not met for this activity. In FY2021, MS-BCCP enrolled 3,734 unduplicated women between 18 and 75 years across Mississippi. The enrollment numbers were 0.7% less than that of the previous year (n=3,762). There was a total of 9,598 breast and cervical screening activities performed on 3,774 unduplicated women, with an average of screening of three (3) procedures per woman. The breast (clinical breast exam and screening mammogram) and cervical screening (pelvic exam and pap smear) activities distribution was 62.4% (n=5,997) and 37.5% (n=3,601), respectively. Of the 3,774 women, 64.5% (n=2,436) had both breast and cervical cancer screening. Compared to the last performance period (n=3,722), there was a 1.4% increase in women screened for breast and cervical cancer. Additionally, there were 1.5% more screening activities in FY2021 than FY2020, in which 9,457 breast and cervical cancer screening activities were performed. A total of 2,329 detection (diagnostic) activities were performed among 1,256 unduplicated women. The breast (additional mam views, diagnostic mammogram, ultrasound, MRI, film comparison, biopsy, fine need aspiration, surgical consult, and other breast services) and cervical diagnostic (colposcopy, ECC, LEEP, cervical biopsy, and other cervical services) activities distribution was 88.4% (n=2,058) and 11.6% (n=271), respectively. Compared to the FY2020 (n=2,728), there was a 2.5% decrease in women who received diagnostics tests. Starting in the fall 2020, the program worked with subgrantees to plan targeted, strategic interventions for increasing screenings of underserved women. The MS-BCCP executed subgrant agreements with six partners during the reporting period with funding support provided through June 30, 2021, which included Jackson Hinds Comprehensive Health Center, Family Health Care Clinic, Plan A Health, Mary Bird Perkins Cancer Center, Singing River Health Systems, and North Sunflower Health System to support activities that increase screening rates among high priority groups. Collectively, these subgrantees enrolled 1,100 unduplicated women residing in 54% (n=44) counties in MS-BCCP in FY2021. These enrollees accounted for 30% of all women enrolled. Among subgrantee enrollees, 52% (n=571) were new (no prior enrollments in any year) to the program. Collectively, these women received a total of 3,652 breast and/or cervical cancer screening and/or diagnostic activities.

 

Activity 7b: Continue contact with North MS Witness Project to assess progress and reach. Observe data for Northeast MS counties to determine enrollment and screening trends. Explore opportunities for more formal partnership through MOU.

 

There was no progress for this activity.

 

Activity 7c: Partner with UMMC for annual See, Test, and Treat event. Assist with planning and pre-enrollment of patients.

 

Due to COVID-19 restrictions, See, Test, and Treat organizers were forced to again cancel the event scheduled for August 21, 2021, the third cancellation since the start of the COVID pandemic. All women who were initially given STT appointments were mailed a letter in August 2021 explaining the reason for the cancellation and future plans. Those women will be given priority scheduling when the next STT is scheduled in 2022. Women were also encouraged to contact the MS-BCCP should they need more immediate assistance in the interim

 

Activity 7d: Share information with providers on the use of social media campaigns and medically accurate messaging to increase awareness of the need for screenings and encourage uptake of BCCP services.

 

There was no progress for this activity.

 

Activity 7e: Establish contact with MS Insurance Commissioner’s Office to assure staff are aware of and know how to refer individuals to BCCP-supported services.

 

Strategy 8: MS-BCCP will use language, images, graphics, and messaging that is both responsive to diversity and health literacy.

 

There was no progress for this activity.

 

 

Objective 8: By June 30, 2022, continue collaboration with the Office of Policy Evaluation, Health Equity, and Government Relations to educate providers on promoting a culturally and linguistically appropriate healthcare setting.

 

Activity 8a: Collaborate with the Office of Health Equity and Office of Policy and Evaluation to develop material in accordance with health literacy guidelines for the program’s health literature disseminated at outreach events.

 

From April through June 2021, the MS-BCCP staff worked with the Office of Communications to redesign its outreach materials. By June 15, 2021, the brochure and poster were redesigned to reflect current eligibility requirements, provide better contact information and ways to connect with the BCCP program and providers, and reflect more diverse and accessible images and language. Both pieces were translated to Spanish. An online request process was designated for providers and partners to request materials and went live on June 15, 2021. By close of the reporting period, 112 requests for materials had been received since MS-BCCP implemented the online request process in mid-June 2021.

 

Activity 8b: Explore resources for translating program materials to Spanish, Vietnamese, and any other language needed to allow for improved accessibility of information.

 

New outreach materials and two MS-BCCP forms requiring patient signature were translated to Spanish through intra-agency resources.

 

Activity 8c: Initiate contact with other MSDH programs on front line of COVID response, who have expert experience in reaching disparate communities. Leverage existing data, opportunities for joint messaging in health promotion, etc.

 

There has been no progress for this activity.

 

Activity 8d: Consult with Institute for the Advancement of Minority Health on strategies and best practices for engaging underserved populations. Explore opportunities for partnership.

 

The Outreach Coordinator learned that the IAMH did not offer any specific services or programming for Asian, Hispanic, or Native American women during the reporting period.

 

Activity 8e: Using e-blast list serv, send announcements to participating provider network of training and learning opportunities related to health equity, cultural sensitivity, and serving diverse populations.

 

In May 2021, the Program Director developed a provider listserv to allow for timely announcements to the entire MS-BCCP provider network. The listserv has grown to more than 300 individual names and has been used routinely to broadcast targeted information to the MS-BCCP provider network. Throughout the year, the Program Director used the provider listserv to broadcast announcements of trainings, webinars, and online resources to support professional development targeting evidence-based interventions, health equity, health disparities, cultural competence, cultural responsiveness, etc. Materials shared were those from the CDC, American Cancer Society, Virtual National Health Equity Summit, Johns Hopkins Sidney Kimmel Comprehensive Breast Cancer Center, Black Breast Cancer Alliance, and other reputable agencies, organizations, and authorities.

 

Activity 8f: As recommended by CDC Program Consultant in site visit (July 2019), consult www.miyoworks.org for best practices and ideas on developing culturally sensitive and appropriate materials.

 

Strategy 9: MS-BCCP will partner with providers who are able to provide mobile breast and cervical cancer screening providers.

 

By the close of the reporting period, this website was no longer active. Neither the Outreach Coordinator nor the Program Director can sign in using credentials and have not received technical support despite requests.

 

 

Objective 9: By June 30, 2022, collaborate with other entities to promote/offer mobile mammography services in underserved areas of the state.

 

Activity 9a: Formalize partnership with Mary Byrd Perkins Cancer Center to recognize this organization as a legitimate BCCP enrollment site for women whose screening services are paid by other resources. Train the mobile unit’s patient navigator and clinical provider on BCCP enrollment processes.

 

In June 2021, two mobile primary care providers partnered with two mobile mammography screening units to host events in separate Mississippi cities allowing 31 women to gain access to breast and/or cervical cancer screening. To reach women “where they are” Plan A Health and the Mary Bird Perkins Cancer Center mobile clinics leveraged existing relationships with mobile mammography units local to the areas they served. Plan A Health, a mobile primary health clinic serving the lower MS Delta, partnered with MS Baptist Medical Center’s Mobile Mammography Unit of Jackson, MS. Mary Bird Perkins, a mobile cancer screening provider serving Southwest MS, partnered with Woman’s Hospital’s Mobile Mammography Unit of Baton Rouge, LA. On June 16, 2021, Mary Bird Perkins and Woman’s Hospital held a joint screening day in Natchez, MS (Adams County). Women were seen first by the Mary Bird Perkins mobile clinic staff to assess BCCP eligibility, enroll in BCCP, receive clinical breast exams, and screening or diagnostic mammogram orders. Those with screening orders were immediately seen by the Woman’s Hospital mobile unit for mammograms and received initial results. Because Woman’s Hospital is not a contracted MS-BCCP provider, Mary Bird Perkins leveraged its own grant funding to cover the screening mammograms for all women seen on the unit. Any women in need of diagnostic procedures were navigated by the Mary Bird Perkins clinic staff to an approved MS-BCCP provider local to their area, specifically River Park Imaging. All diagnostic procedures for enrolled women were covered by NBCCEDP funds. On June 18, 2021, Plan A Health and Baptist held a joint screening day in Louise, MS (Humphreys County). Women were seen first by the Plan A clinic staff to assess BCCP eligibility, enroll in BCCP, receive clinical breast exams, pap smears, and screening or diagnostic mammogram orders. Those with screening orders were immediately seen by the Baptist mobile unit for mammograms and received initial results. Any women in need of diagnostic procedures were navigated by the Plan A clinic staff. Screening mammograms for women ages 50-64 years old were covered by NBCCEDP funds. Screening mammograms for women 40-49 years old were covered by special non-federal funds, which MS-BCCP reserved in advance to eliminate the necessity of the routine pre-approval process (to prevent any delays in the women receiving the same-day mammograms). All diagnostic procedures for enrolled woman were covered by NBCCEDP funds. MS-BCCP provided small subgrants to Plan A Health and Mary Bird Perkins to support outreach and promotion of the events through small media, local newspapers, radio, and sponsored social media in days and weeks prior to the events and salary support for community health worker and patient navigator staff to assure BCCP deliverables were prioritized. From these two events, 31 women gained access to breast and/or cervical cancer screening. 31 women received clinical breast exams, 27 received screening mammograms, and 9 received pap smears. None of the 4 women ineligibles for BCCP enrollment required any diagnostic follow-up after their screenings.

 

Of the 27 women enrolled in MS-BCCP:

• 89% (n=24) were new to the program or Cycle 1 enrollees,
• 60% (n=16) were Black/African American women between 40-64 y/o, a high priority population for MS-BCCP,
• 23 women received screening mammograms with 8 requiring diagnostic follow-up,
• 5 women received pap smears with 1 requiring diagnostic follow-up,
• 18% (n=5) had received a mammogram 3 or more years ago,
• 30% (n=8) had never received a mammogram, and
• and none of these women were diagnosed with breast or cervical cancer.

 

The Mary Bird Perkins screening event drew women only from Natchez, MS (Adams County) showing effective targeted outreach local to that community in the days/weeks prior. The Plan A Health event drew women from 11 cities across 8 counties – the furthest 66 miles north of the screening location – showing effective outreach among several MS Delta towns and cities in the days/weeks prior. Given the ongoing and persistent demands to the healthcare system posed by the COVID-19 pandemic, MS-BCCP providers throughout the state have been challenged to keep breast and cervical cancer screening and BCCP enrollment a top priority. Through the direct outreach of these two mobile providers, these 31 women were able to receive timely screening and navigation that may otherwise have not been available or accessible to them for many additional weeks or months, if at all, in areas they were able to travel.

 

Both Plan A Health and Mary Bird Perkins will repeat these efforts in FY2022, offering additional joint screening events with their mobile mammography partners, expanding coverage to other areas. Plan A will be using MS-BCCP subgrant funding to expand its reach into Northeast MS into 4 counties with minimal to no BCCP enrollments for 2+ years. Mary Bird Perkins will use subgrant funding to expand its reach by 3 additional counties with underutilization of BCCP in Southwest MS. Both organizations, among others, have been selected as subgrantees under a competitive RFP. Internal program enrollment data, claims data, contracted provider locations, and other data sets (cancer incidence, social vulnerability, etc.) have been used to prioritize areas where MS-BCCP partners like Plan A and Mary Bird Perkins can focus their efforts to impact screening rates. The program will be monitoring performance and return-on-investment closely, providing support and technical assistance to assure these partners find success.

 

Activity 9b: Formalize partnership with MS Baptist Medical Center Mobile Mammography Unit to recognize this organization as a legitimate BCCP enrollment site for women whose screening services are paid by other resources. Train the mobile unit’s staff on BCCP enrollment processes.

 

This activity was not needed. MS Baptist Medical Center’s Mobile Mammography Unit is already recognized as a BCCP contracted provider, under its headquartered hospital in Jackson, MS. Pending some error corrections in enrollment documentation submitted directly from Plan A Health and MBPCC patient navis, all of the patients referred who were found eligible will be enrolled in BCCP.

 

Activity 9c: Assist with promotion of mobile mammography events hosted by these providers through e-blast distribution announcements, social media posts, etc.

 

Strategy 10: MS-BCCP will monitor the performance of contracted providers and subgrantees to assure eligible women receive the expected services within the guidelines of the program and in locations accessible to their county of residence.

 

These were small scale events with limited space. Promotion by Outreach Coordinator was not needed.

 

 

Objective 10: By June 30, 2022, continue implementation of continuous quality improvement strategies to assure high quality services are being provided to patients in partner sites and data quality is acceptable.

 

Activity 10a: Provide telephonic or web-conferencing technical assistance regarding BCCP policies, procedures, and protocols at least once annually or more often as needed to all provider sites.

 

The MS-BCCP staff provided virtual training to existing and orientation to newly onboarded providers as follows:

• Plan A Health – April 28, 2021 – 2 participants
• Family Health Care Clinic, Inc. – April 30, 2021 – 125 participants
• Open Arms Healthcare – May 25, 2021 – 5 participants
• Off Main Street Clinic – May 25, 2021 – 1 participant
• Mary Bird Perkins Cancer Center – June 2, 2021 – 5 participants

 

The program focused on provider engagement in August 2021 and offered six (6) opportunities for virtual training on MS-BCCP processes for enrolment and patient navigation. One hundred seventy-five (175) unduplicated individuals were trained across the 6 trainings (77 external providers, 98 MSDH employees). Participants represented 54% (n=76) of MS-BCCP’s contracted providers. The program leveraged the success of the August virtual trainings and continued its focus on provider education and engagement in September 2021. A Provider Reference Guide, frequently asked question supplement, and recording of the training were made available and broadcast to the MS-BCCP provider listserv. By the close of the reporting period and only one week after the training video link was live, it had been viewed 29 times.

 

Activity 10b: Review all new enrollment and other documentation received to determine missing information or errors. Return documentation in need of correction to providers for revision and updating within 3 business days. Provide visual or verbal instructions to guide corrections.

 

In May 2021, the Program Director assisted the MSDH East Central Public Health Direct nursing leadership and the Meridian Free Clinic to develop a protocol for referring patients to the local health departments for enrolment in MS-BCCP. The Meridian Free Clinic does not provide breast or cervical cancer screening services, thus is not eligible to become a MS-BCCP enrolling provider. However, this clinic does women from the MS-BCCP priority population and can serve as a community-clinical linkage partner. Throughout the reporting period, the nurse consultants provided ongoing, daily feedback to providers as enrollment documents were received. If corrections needed to be made, the forms were sent back immediately – rather than being held until the “batch” the forms were in were able to be keyed. This reduced the amount of time between enrollment and special funding approvals, as well as reduced the need for data and billing staff to track down the necessary information before keying a patient’s cycle and paying claims.

 

Activity 10c: Use queries produced by Data Manager to identify patients pending complete navigation. Follow-up with providers accordingly to assure follow-through.

 

MS-BCCP’s Data Manager role has been vacant from October 1, 2020, through present. Any data support has been provided through the Office of Health Data and Research. Queries to identify patients’ with incomplete navigation began in January 2021 continuing through the reporting period. As patients were identified, the nurse consultants reached out to providers to remind them the patient needed attention.

 

 

Office of Tobacco Control (OTC) - Annual Report

 

Priority: Maternal Morbidity and Mortality

 

NPMs, NOMs, SPM, and ESMs:

 

• NPM 1: Percent of women who smoke during pregnancy
• SPM 1: Percentage of women who smoke in the last three months of a pregnancy
• ESM 1: # of women ages 18 - 44 who access the Quitline for cessation services.
• ESM 2: # of Mississippi communities (cities, counties, etc.) with comprehensive smoke-free ordinances.

 

Strategies and Activities (FY October 1, 2020 - September 30, 2021)

 

Objective 1: By September 30, 2022, enroll at least 25 pregnant smokers in the Baby & Me Tobacco Free Program.

 

Strategy 1: The OTC, in collaboration with its partners, will continue to work to reduce the prevalence of tobacco / alternative tobacco products among women ages 18-44 years.

 

Activity 1a: Promote the availability of Baby & Me Tobacco-Free in the ten clinics that offer the program.

 

Provided technical assistance and training to participating Community Health Clinics. Increased awareness of Baby & Me Tobacco-Free through health fairs, table displays on site at CHCs, posting posters in targeted businesses in the community, community events (drive thru baby showers and by sharing program brochures/flyers with stakeholders, providers, and community partners such as Central MS Homeless Coalition Membership, MS ACA Stakeholders, MCH Coalition, Oak Hill Healthy Kids Parents Education Hour Live on Facebook, OTC State-wide Grantees, Institute of Minority Health, churches, DOM, legislators, community health workers. Promoted Baby & Me Tobacco-Free on billboards in targeted areas: 3/3/20 social media, June 15, 2021 - August 14, 2021 (billboards south Jackson). Baby & Me Tobacco-Free digital ads ran June 2021 – Aug 2021 state-wide – driving traffic to CHCs.

 

Activity 1b: Promote Baby & Me Tobacco-Free Telehealth services in the Northeast MS Baby & Me pilot.

 

Provided the Baby & Me Tobacco Free Program MS Telehealth Referral Training to Northeast MS telehealth counties: Chickasaw, Itawamba, Pontotoc, Calhoun, Monroe, Lee, Union, Benton, Marshall, Union, Tippah, Alcorn, Prentiss, Tishomingo, Lafayette.

 

Strategy 2: OTC will continue to empower the MS Tobacco-Free Coalitions and other partners to provide education to local municipalities and counties on the importance of a smoke-free environment.

 

The trainings conducted have focused on delivery of an evidence-based smoking cessation program with pregnant women to reduce the burden of tobacco on pregnant women and the unborn child. Clinical participants were provided a one-day training that equipped health center staff with the information, materials, and resources to successfully enroll participants in the Baby & Me telehealth program and implement program activities. The implementation phase includes prenatal counseling sessions for mother, carbon monoxide reading to confirm quit, and follow up for up to 12-months to ensure patients remain quit. There is also a referral component of the training that supports clinical telehealth implementation.

 

 

Objective 2: By September 30, 2022, increase the number of Mississippi smoke-free ordinances from 174 to 177.

 

Activity 2a: Provide education, awareness, and resources to municipalities regarding the importance of local ordinances to protect citizens from the dangers of second-hand smoke.

 

The MTFC disseminated educational materials to 188 events to include over 10,000 people.

 

Activity 2b: The OTC continues to work through the Mississippi Tobacco-Free Coalitions (MTFCs) to educate and empower local elected officials on the health and economic impact and the benefits of implementing smoke-free ordinances within their municipalities.

 

The MTFCs conducted over 200 events educating municipalities on the benefits of a smoke-free environment. The MTFC have presented to 62 municipalities to educate local officials on the importance of reducing exposure to second-hand smoke and the importance of including electronic nicotine devices to their current ordinance.

 

 

Family Planning

 

The Title X Family Planning Program promotes awareness and assures access to reproductive health benefits by encouraging individuals to make informed choices that provide opportunities for healthier lives. The program is currently working to improve the overall management and administration of the Family Planning Program. Areas of improvement include improving administrative functions, fiscal oversight and responsibility, contraceptive access, high quality family planning services, and increasing collaborations and partnerships.

 

The Title X network structure in Mississippi consists of 21 federally qualified health centers (FQHCs) facilities with 189 satellite centers and 203 rural health centers within the state. There are 35 rural health clinics (RHCs), some of which are also community health centers (CHCs). The health care organizations that partner with the Mississippi Title X Family Planning Program are generally open Monday through Friday from 8:00 am to 5:00 pm and accept walk-in appointments.

 

Efforts to improve the health of male, female, and adolescent clients during their reproductive years are tailored and integrated into every family planning encounter at the time of service. Client education also includes:

 

• Educating women on risk prevention before pregnancy (counseling).

 

• Sexual health assessment based on CDC guidelines: a sexual history is taken during a patient’s initial visit, during routine preventive exams, and when physicians see signs of STIs. The dialogue provides an opportunity for risk reduction counseling and sharing information about behaviors that may place a patient at risk of contracting STIs. A sexual history allows physicians to identify those individuals at risk for STIs, including HIV, and to identify appropriate anatomical sites for certain STI tests.

 

• Educating patients on the topic of exercise, obesity, nutrition, occupational hazards, family support, and financial issues related to pregnancy to better prepare patients for healthy outcomes (reproductive life planning).

 

• Promoting reproductive life planning as a tool in assisting individuals to set and achieve reproductive life goals (counseling).

 

• Providing clinical services that address the preconception health of women and men to promote positive pregnancy and birth outcomes (counseling).

 

• Educating females and males of reproductive age on the importance of preconception health (knowledge).

 

• Assistance with self-management approaches for avoiding adverse birth outcomes (behaviors).

 

• Providing information and encouragement on accessing community resources and health care for improved wellbeing (self-efficacy).

 

• Promoting the role of family planning in preconception care programs, including incorporating preconception care in the scope of work for clinics and sub-grantee agencies and monitor progress during site visits.

 

• Integrating reproductive life planning and core preconception messages in family planning visits, including information on provision of or referral for services regarding (1) folic acid intake; (2) rubella vaccination prior to pregnancy; (3) impact of diabetes on pregnancy; (4) impact of substance abuse during pregnancy; (5) healthy weight, nutrition, and exercise; (6) hepatitis B vaccination; and (7) impact of hypertension.

 

The Family Planning Program selected three strategies that have the highest return on assuring access to reproductive health benefits, including:

 

Strategy 1: Guarantee access to a broad range of family planning methods, including fertility methods and preventive health services.

 

• Coordinate with MSDH Pharmacy to provide contraceptive inventory to all clinics.

 

Strategy 2: Assure the delivery of the highest standard of evidence-based family planning and preventive health services to all Title X clinic users.

 

• Recertify with 340B Drug Pricing Program annually to access a broad range of family planning methods at a discounted rate.
• Provide funding to delegate agencies.
• Collaborate with MSDH regional and county wide staff to develop promotional strategies to increase family planning users.
• Assess the number of new clients served per clinic.
• Provide technical assistance to clinical staff on how to properly document family planning visits in EPIC.

 

Strategy 3: The Family Planning Program will develop materials, trainings, and protocols for the implementation of person-centered family planning telehealth services to all Title X clinics.

 

• Collaborate with the STD/HIV Office to ensure STD/HIV patients receive Title X services.
• Develop clinic protocols for person-centered family planning telehealth services.
• Develop telehealth workflows.
• Connect the protocol for real work cases and person-centered contraceptive care as a slide deck and or manual.
• Provide two webinars to Title X clinics on telehealth protocols.
• Provide technical assistance to Title X clinics on the implementation of telehealth protocols.