Women-Maternal Health – FY2024 Annual Report

October 1, 2023 – September 30, 2024

State Priority: Mental Health/Substance Misuse

NPM #1: Percent of women, ages 18-44, with a preventive medical visit in the past year.

Objective: Increase the percentage of women receiving a Well Woman visit annually from 77.3% in 2020 to 85% by 2025 (BRFSS).

Data Statement:

In 2022, 70.4% of South Dakota women attended a Well-Woman visit. This percentage increased in 2023 to 76.2%, surpassing the annual target of 75.3%. South Dakota’s national ranking improved significantly, rising from 39th in 2022 to 16th in 2023. In comparison, the 2023 Well-Woman visit attendance rate was 73% nationally and 70% across Region 8, placing South Dakota above both regional and national benchmarks.

The 2020 South Dakota Maternal Child Health Needs Assessment identified a need to focus on promoting yearly well woman visits with primary care providers (PCPs). These preventive visits serve as an entry point to care coordination and referrals for women of childbearing age. A comprehensive assessment of overall health allows for prevention, identification, and treatment to improve the health of women. A summary of South Dakota’s progress on the strategies over FY2024 for the well woman visit national performance measure can be found below.

Strategy 1.1. Develop partnerships with multisector stakeholders to promote preventive care for women of childbearing age.

Throughout the FY2024 grant year, South Dakota Title V collaborated with a variety of other Department of Health programs, including the Pregnancy Care Program, Bright Start Home Visiting Program, and South Dakota WIC. These programs play important roles in promoting annual well woman visits with their clients.

 

Activity: Expand the NPM #1 workgroup to include partners and community members who are committed to this work.

Other partnerships that Title V participated in or contributed to include the Well Women and Safe Sleep Workgroups, which met quarterly. The Title V Women and Infant Health Coordinator facilitates those workgroups. The Women and Infant Health Coordinator also served on the leadership team for the North and South Dakota Perinatal Quality Collaborative (NSD PQC). In FY2024, NSD PQC made the decision to split into a South Dakota-specific PQC in order to provide more targeted work for SD’s concerns.

Title V Well Women Workgroup

Throughout FY24, the Title V Well Women (NPM #1) Workgroup included members from SD Department of Health, SD Department of Social Services, and individuals from organizations and health systems across the state. In FY2024, the workgroup was expanded to include the President of SD Doulas, along with a certified doula trainer. SD DOH Prevention Services Manager, who coordinates Maternal Mortality Review Committee and Infant and Child Death Review, was added to the workgroup in FY24. A list of the workgroup members can be found below.

Women and Infant Domain Coordinator – SD DOH

Executive Director for Women’s and Children’s Hospital, Clinics, and Community Services at Sanford USD Medical Center

Health Coordinator of Sisseton Wahpeton Oyate - IHS

Public Health Office RN

SD PLAN (Family Planning)– SD DOH

STI Program Manager – SD DOH

Director of Behavioral Health – DSS

Prevention Services Manager – SD DOH

Substance Use Disorder Services Program Manager – SD DOH

SD Doulas – President

Program Director of Doula Program at Brookings Health System; SD Doulas Member; Certified Doula Trainer

Program Manager (Office of Treatment and Support Services)

SD Doulas Partnership

A partnership with SD Doulas, a 501c3 based in South Dakota, was formed with Title V to support the important roles that doulas play in maternal and infant health. SD Doulas continues to advance doula literacy and support doulas around the state. SD DOH, along with SD Department of Social Services and health care systems, collaborated with SD Doulas to get Medicaid coverage for doula services at births and during the postpartum period. The Women and Infant Health Coordinator collaborated with SD Doulas to create a toolkit of resources for their trainings, along with a brochure for each new doula that is trained. Multiple doulas were also active participants on the NPM #1 Well Woman Workgroup, and this collaboration will continue in the upcoming years.

SD’s Women and Infant domains supported SD DOH Prevention Services Manager and SD Doulas as they hosted a comprehensive birth and postpartum doula training and certification in September 2024. SD DOH and SD Doulas collaborated to offer 18 scholarships, which covered the cost of training, certification, and materials in exchange for enrolling as a Medicaid provider once SD made it available. This was aimed at encouraging individuals with unique experience to join the doula profession and make a meaningful impact in their communities, with emphasis on individuals seeking to serve communities with poor maternal and infant health outcomes.

 

Activity: Utilize social media to promote the importance of yearly well women visits.

ESM: # of messages developed promoting well woman care.

The Title V team used several media platforms in FY2024 to promote well woman care and other women’s health education materials throughout the state. This includes the SD DOH Facebook and Instagram pages, as well as Snapchat. The Title V team continued to work with the SD DOH Communications team to disseminate women's health and well woman visit education through Facebook, Instagram, and Snapchat. The For Baby’s Sake webpage and Facebook page was discontinued in March 2024 in preparation of SD DOH’s safe sleep campaign. Metrics of some of the well woman care posts for FY2024 can be found below.

Facebook/Instagram - For Baby’s Sake

Snapchat - For Baby’s Sake

Organic Posts 

                   

In addition to promoting well woman care, SD DOH posted about other important women’s health topics. Organic posts on Facebook, Instagram, and Snapchat from October 1, 2023-September 30, 2024, included topics of early prenatal care, healthy diets during pregnancy, high blood pressure during pregnancy, congenital syphilis, and early signs of pregnancy.   

Advertisements for South Dakota Medicine Journal

 

South Dakota Department of Health advertised in South Dakota Medicine Journal on a number of topics throughout FY2024. Title V Women and Infant Domains partnered with SD DOH’s STI Program in May 2024 to create and promote a congenital syphilis ad (shown to the left). The goal was to expand healthcare provider knowledge around congenital syphilis in SD through the estimated 2,000 SD providers that receive the magazine each month. The 54 congenital syphilis cases reported in 2023 represents a 1,250% increase from the 5-year median, emphasizing the need for continued education and priority.

 

Why Babies Cry Brochure

In September 2024, Title V assumed responsibility for the “Why Babies Cry” brochure from South Dakota WIC. The Women and Infant Health Coordinator worked with DOH Communications and partners to update the resource’s information and branding. This resource is used throughout the state in health systems, public health offices, and other organizations. It provides information on the reasons babies cry, stages of crying and what to expect, tips for coping, reminders on self care, and how to comfort a crying baby. The National Maternal Mental Health Hotline information is also included on the brochure. The brochure was made available in English and Spanish. View the brochure here: https://doh.sd.gov/topics/mch/infant-health/why-babies-cry/

 

Continuous Quality Improvement Project

The Women and Infant Health Coordinator co-led a Continuous Quality Improvement (CQI) project for MCH to enhance the usability and accessibility of the South Dakota MCH-related webpages. PDSA cycles and internal/external survey feedback was used to revise content, navigation, and accessibility. These updates support better access to key maternal and infant health resources, including safe sleep guidance, postpartum care information, and preventive health tools. This project remains active and is continuing into FY25.

Strategy 1.2. Create toolkit of resources on Maternal Mental Health/Substance Misuse for OCFS field offices.

Creation of this strategy’s toolkit of resources on Maternal Mental Health/Substance Misuse for public health offices was sidelined until FY25 because of the restructure within SD DOH Office of Child and Family Services. The initial restructure between public health nurses and WIC staff led to further splits throughout the Division of Family and Community Health (FCH). The three original FCH offices split into nine offices under three deputy division directors. The Office of Child and Family Services was phased out as the nine offices became active. This toolkit has been included in future planning for the women’s domain NPM postpartum visits, in collaboration with SD Perinatal Quality Collaborative (SD PQC). SD Perinatal Quality Collaborative plans to house the toolkit and it will be continuously updated with the latest information for SD. To prevent duplication of effort, SD PQC will lead the efforts and Title V Women’s Domain will provide support.

Throughout FY24, HRSA’s National Maternal Mental Health Hotline resources were distributed to staff in MCH, including magnets, wallet cards, and posters. These resources were also included in MCH Conference Boxes that attend statewide events related to maternal and child health.

 

Activity: Collaborate with multisector partners to identify a substance use screening tool for women of childbearing age.

The North and South Dakota Perinatal Quality Collaborative (NSD PQC) began work on the “Improving Care for the Maternal-Infant Dyad Affected by Substance Use Disorder” initiative in 2022. Implementation began in January 2023 with open enrollment and onboarding. The initiative targeted multiple outcomes: the percent of pregnant and postpartum patients with Opioid Use Disorder (OUD) who received or were referred Medication for Opioid Use Disorder (MOUD) and the percent of pregnant and postpartum patients with SUID referred to recovery treatment. Process measures included the proportion of pregnant and postpartum patients screened for SUD with a validated verbal screening tool, percent of pregnant and postpartum patients with OUD counseled on MOUD, and percent of pregnant and postpartum patients with SUD counseled on recovery treatment services. System-level measures tracked components such as resource mapping, validated verbal screening tools, and general and opioid use disorder pain management guidelines. 

In mid-2024, NSD PQC transitioned into two state-specific PQCs in order to take a refined, focused approached to meeting the needs of each individual state. Leadership of the former NSD PQC had been primarily based in North Dakota, so the establishment of the SD PQC enabled a more locally focused approach. During the transition, partners maintained momentum on AIM bundle implementation related to SUD while also increasing emphasis on provider and community education.  

Founded in August 2024 and housed at South Dakota State University’s Community Practice Innovation Center, the SD PQC is composed of stakeholders including nurses, doulas, mental health professionals, researchers, public health officials, higher education representatives, and healthcare providers. The Collaborative is actively working to include payers and community members to broaden engagement and representation. The South Dakota Perinatal Quality Collaborative is focused on the advancement of maternal care in South Dakota, with specific emphasis on perinatal mental health. Current SD PQC initiatives include participation in BIRTH-SD-AIM, with implementation of two AIM patient safety bundles at SD hospitals and birthing centers, and recent expansion to ambulatory sites: Care for Pregnant and Postpartum Patients with Substance Use Disorder and Perinatal Mental Health Conditions. The SD DOH continues to actively participate in SD PQC activities and support collaborative efforts.

 

Activity: Provide motivational interviewing training for OCFS staff through DSS SBIRT grant.

The motivational interviewing training for OCFS staff was completed to empower field staff to adequately screen and refer women for client services. Field staff in the WIC and Community Health offices were asked to complete four online interactive modules. Staff leads were provided training on how to continue the training in their teams. This activity was completed in FY2023.

Strategy 1.3. Increase depression screening and referrals to Primary Care Providers among low-income women within OCFS Community Health offices.

The Office of Child and Family Services (OCFS) separation of community health office staff into either public health nursing or WIC allows public health nurses the ability to focus attention and time on community health services like immunizations and pregnancy care support. This restructure led to further changes throughout Family and Community Health. Public health nurses now sit in the Office of Public Health Nursing Services (OPHNS) and WIC staff sits in the Office of Family Nutrition Services (OFNS).

 

Activity: Develop policy for screening postpartum Medicaid-eligible women for depression within OCFS Community Health Offices.

The policy for screening depression in South Dakota community health offices has been in place for over two years. At the end of January 2022, MyInsight became the Office of Child and Family Services field offices’ new electronic health record. Use of MyInsight has allowed for the electronic documentation of the PHQ9 results and referrals made following those PHQ9 results. Use of the PHQ9 screening tool for DOH community health offices began in October 2021. Following the restructure between public health nursing and WIC, WIC staff no longer complete PHQ9 screening. If they have a client who demonstrates need for a PHQ9 screening following the PHQ2 screening, they refer to a public health nurse for a PHQ9 assessment.

The Office of Child and Family Services’ Pregnancy Care Perinatal Services Program (Pregnancy Care Program) provides a risk assessment and subsequent modified case management for those found eligible for services. This includes monthly visits during pregnancy with a nurse, education about healthy pregnancies and healthy babies, and provides referrals to community resources. The risk assessment is comprised of chronic, and pregnancy-induced risk factors as well as community health factors. Modified case management involves registered nurses providing ongoing assessment, education, and support throughout the pregnancy and up to 3 months postpartum. Other services include screening for depression, safe sleep education, breastfeeding education, and referrals to community-based resources based on the mother’s identified risks and factors as they arise.

 

ESM: Percentage of women with positive depression screen who are referred to their PCP within OCFS Community Health offices.

WIC staff have continued to ask the Wooley Questions, also called PHQ2, as a part of their Pregnancy or Postpartum WIC assessments. Any positive screens to the Whooley questions are referred to a public health nurse for a follow-up PHQ9 assessment. During the FY22 annual report/FY24 plan for application review, there were recommendations to remove this ESM as it is not related to the NPM. Beginning in FY25, this ESM will be removed.

Number of PHQ9s administered (not including Bright Start Home Visiting): 675

Number of positive screenings: 170

Number of referred clients (to mental health provider or PCP): 137

 

25.2% of public health office clients had a positive screening when assessed with a PHQ9.

 

80.6% of public health office clients with positive PHQ9 screenings were referred to mental health provider or PCP.

 

WIC completed 6,519 Whooley screenings. For WIC, 682 screenings were positive, needing a referral to a public health nurse for the PHQ9 screening.

 

10.5% of WIC clients screened for depression with PHQ2 had positive screenings, requiring a follow-up PHQ9.

Strategy 1.4. Develop a policy recommendation with Department of Social Services (DSS) to create Maternal Medical Homes.

Activity: Conduct literature search and research other evidence-based programs related to pregnancy medical homes.

The literature search for pregnancy medical homes was completed prior to the start of the Maternal Medical Home planning process. This research contributed to the continued work to create the pregnancy medical homes.

Activity: Collaborate with DSS Medical Home Team to develop policies for Maternal Medical Home within the OCFS.

Policy recommendations to establish the Maternal Medical Homes are currently under development in collaboration with the Department of Social Services and Medicaid. Key considerations include participant enrollment processes, strategies to engage provider participation, and evaluating how the MMH model integrates with other maternal health services beyond Medicaid.

A soft launch of Medicaid’s new Pregnancy Medical Home occurred April 1, 2024, with the plan to officially launch at the start of 2025. At the time of this launch, 112 SD providers were enrolled for participation in this program, which intends to improve maternal health outcomes through enhanced care coordination, ensuring services are delivered according to clinical standards, and reducing barriers to care. Participating providers are eligible for enhanced reimbursement for care coordination and meeting prenatal care and postpartum care program objectives.

Other MCH Activities Related to Women-Maternal Health:

Maternal Mortality Review Committee (MMRC)

South Dakota’s MMRC began reviewing cases in October 2021 with a multidisciplinary expert panel with representation from public health, nursing. Maternal and fetal medicine, mental health, substance use, pathology, obstetrics/gynecology, and social work. The CDC’s Enhancing Reviews and surveillance to Eliminate Maternal Mortality (ERASE MM) Program funds South Dakota’s MMRC.

Within the last 10 years (2014-2023), 79 mothers in SD lost their lives due to a pregnancy-associated cause. The most common causes of pregnancy-associated deaths among American Indian women were related to unintentional injuries, while for White women they were related to pregnancy, childbirth, or the puerperium. Rates of pregnancy-associated deaths have continually increased over the past 10 years (2012-2021).

Before You Show Campaign

The Women and Infant Health Coordinator participated in the planning and creation of SD DOH’s Before You Show Campaign. This initiative aims to prioritize women’s health by raising awareness of early signs of pregnancy, encouraging timely pregnancy testing and early prenatal care, and ultimately improving maternal health outcomes in South Dakota. To help women recognize the importance of early prenatal care, this campaign discusses what there is to know “before you show” symptoms or a baby bump. This campaign was funded using CDC’s ERASE MM grant, which will be managed by the Title V Women’s Health Director moving forward.

Pregnancy Care Program

South Dakota Department of Health’s Pregnancy Care Program provides expectant mothers with a free nurse who answers questions and offers support/advice during pregnancy. Mothers of all income levels are eligible, and the nurse can also assist with connection to education, prenatal care, and community resources. Pregnancy Care nurses provide education on infant health, including safe sleep and breastfeeding support, and distribute safe sleep cribs to eligible families.

MIECHV Bright Start Home Visiting Program

SD DOH’s Office of Home Visiting (OHV) Bright Start Home Visiting Program supports expectant, first-time moms by connecting them with a free personal nurse that provides support throughout pregnancy and until the child’s second birthday. Bright Nurses support clients with accessing prenatal care and nutritional guidance, learn about child development, educate on safe sleep, breastfeeding, home and home safety; and connect to resources like healthcare, family planning, pediatric care, childcare, continuing education, and job training. The Bright Start team measures indicators including low birth weight, safe sleep, breastfeeding, and preterm birth to evaluate effectiveness of services.

In state fiscal year 2024, Bright Start served a total of 1,183 clients – including 664 mothers and 519 infants. During this time frame, a total of 6,846 visits were completed by the West, Central, and East Bright Start teams.

South Dakota Women, Infants, and Children (WIC)

SD WIC provides families with healthy eating and breastfeeding support, connection to other community programs, and provides healthy foods that meet the needs of the community. SD WIC supports women who have a child under the age of 5, are pregnant or had a baby within the last 6 months, or who are breastfeeding a baby under 1 year of age.

SD PLAN: Prepare, Learn, Advocate, Navigate

The South Dakota Title X Program, called SD PLAN, connects SD residents to safe and confidential services related to preventing pregnancy, achieving pregnancy, and assisting individuals with achieving their desired number and spacing of children. Clinics use a sliding fee scale to keep services affordable, and fees are based on family size and income. It also helps keep people healthy and protects their ability to have children in the future. Services include birth control, education and counseling, community education, pregnancy testing/planning/counseling, STI and HIV testing, basic infertility services, annual checkups, screenings for health issues like breast or cervical cancer, and follow-ups/referrals to specialists.

MARCH Avera Research Institute Summit

In March 2023, the Women and Infant Health Coordinator attended the first annual Avera Research Institute’s Maternal American Indian Rural Community Health (MARCH) Center of Excellence Summit. This event aimed to improve maternal health through collaboration, connection, and engagement.

SD MOMS Tour Event

Hosted by the HHS Partnership Center, U.S. Department of Health and Human Services, The M.O.M.S. Tour (Maternal Outcomes Matter Showers) brings education and resources to connect expectant and postpartum women onsite to prenatal services, Medicaid enrollment and healthcare coverage, mental health resources particularly around postpartum depression, and more to address the unacceptable high maternal mortality and morbidity rates in the U.S., especially among Black and American Indian/Alaska Native women. The M.O.M.S. Tour offers resources to expectant dads as well. The Women and Infant Health Coordinator, along with several other SD DOH staff, attended planning calls for this event to provide input. SD DOH staff attended the event and distributed education and resources around women, infant, and child health.

Lakota Lands Traveling Seminar

The 2024 Lakota Lands Traveling Seminar, sponsored by Monument Health, brought together educators, public health professionals, business leaders, healthcare providers, and other stakeholders to discuss the history, culture, and health status of Lakota communities in SD. This three-day event, from June 25-27, provided participants the opportunity to evaluate the complex relationship between people, histories, and environments, through both education and experience. This encouraged critical thinking about Lakota history, culture, and land, and the historical and contemporary relationships between American Indians and non-Indigenous populations. The Women and Infant Health Coordinator attended Day 3 of this event, where participants attended presentations about relevant topics. This also gave attendees the opportunity to discuss what was learned during the mobile classroom on days 1 and 2.

Avera Research Institute – SD DOH Meeting

In February 2024, SD DOH staff met with leaders from Avera Research Institute in Rapid City to discuss overlapping work and update on progress. This offered a chance to develop new partnerships and identify additional ways to collaborate on shared goals.