III.E.2.b.v.c. State Action Plan Narrative by Domain

Women and Maternal Health Domain Narrative
 

Overview

The women’s and maternal health program at DOH are within the Perinatal Health unit of the Community Health Improvement Linkages section of the Office of Family and Community Health Improvement in the Division of Prevention and Community Health. Key activities of the unit include promoting, influencing, adopting, and revising policies and processes to improve the health and well-being of women and families. This section also includes the Sexual and Reproductive Health Unit, which supports the Title X Program in Washington. This program supports a network of 16 contracted partners that operate 94 clinics across Washington state. They offer direct clinical services and education around family planning, contraception and interconception health, pregnancy testing with nondirective counseling, and the testing and treatment for sexually transmitted infections.

 

The Perinatal program has a long history of supporting the DOH’s our vision of equity and optimal health for all through working with others to improve the health of all people in Washington State, especially those that are pregnant and parenting. The work done by DOH and our partners is based on the perspective of the life course health development, which explains how individual health develops over a lifetime and is impacted by the cumulative effect of multiple drivers of health in all areas of life. This approach recognizes that we can promote the health of all individuals by positively impacting the health of women and pregnant people. We are actively working to ensure the health of all Washingtonians through our work in this area.

 

In support of this vision, and based on the perspective of life course health development, we offer educational materials and resources to the public on a wide range of topics, including healthy eating, physical activity, vitamins and nutrients, oral health, genetic illness, mental health and depression, safe relationships, family planning, pregnancy, sexually transmitted illnesses, and substance use on our website. Materials are also available in a variety of languages.

 

Much of our work is informed by the recommendations developed by the Maternal Mortality Review Panel (MMRP/Panel), established into law in 2016 and made permanent in Washington in 2019. The Panel reviews maternal deaths that occur during pregnancy or one year postpartum. Based on this review, the Panel develops recommendations to policymakers, state agencies, and health care providers to help improve perinatal health and prevent future maternal deaths and reduce maternal morbidity. This ensures our programs are data-informed and based on the input of multiple statewide experts.

 

In 2021, an estimated 1.5 million women of reproductive age (15 to 44) in Washington made up about one-fifth of the total population. The following data on racial breakdowns are from 2020, the most recent year for which estimates are available. White non-Hispanic women comprised 62% of women of reproductive age in 2011; this decreased to 57% in 2020, an 8% decline. The population of American Indian/Alaska Native women also decreased over this period, decreasing from 1.6% to 1.3%. Groups whose populations of women of reproductive age increased include Hispanic, 20%; Asian, 11%; Black/African American; 5%, Native Hawaiian/Pacific Islander 1.6 %, and individuals identifying as more than one race (multiracial), 35%. The largest population increases from 2011 to 2020 were to Native Hawaiian/Pacific Islander, with a 47% increase, multiracial, by 35%, and Asian by 21%.

 

In 2021, 63% of individuals of childbearing age in Washington received a medical check-up the previous year, compared to 66% in the general adult population. About 10% of women in Washington aged 18-44 reported poor or fair physical health. 34% of women 18-44 reported having been diagnosed with depression. This is higher than the % of depression reported in the general population of adults in Washington, at 23%. (BRFSS)

 

Between 2012 and 2021, the total birth rate among people of childbearing age in Washington decreased by 14%. This drop is most pronounced among individuals ages 15 to 17 (65% decrease), ages 18 to 19 (52% decrease), and ages 20 to 24 (36% decrease). During the same time, birth rates among individuals ages 35 to 39 (12% increase) and ages 40 to 44 (25% increase), suggesting a shift in age among pregnant people giving birth. Trends in births and pregnancies are not identical across racial and ethnic groups. The total pregnancy rate, which includes births, fetal deaths, and abortions, decreased from 78 to 66 pregnancies per thousand pregnant people from 2012 to 2021.

 

In 2021, receipt of first-trimester prenatal care varied by insurance coverage and by race and Hispanic ethnicity. Persons with Medicaid-funded deliveries started PNC later than persons with non-Medicaid-funded deliveries, 67% vs. 79%. NHOPI, Black/African American and American Indian/Alaska Native pregnant people were less likely to begin prenatal care in the first trimester than individuals in other racial/ethnic groups. NHOPI individuals were far more likely to receive no prenatal care or start care in the 3rd Trimester than all other groups. (see graph) (WA Birth Certificate).

Women and pregnant individuals are also choosing to give birth differently. From 2012 to 2021, deliveries by a Doctor of Medicine or a Doctor of Osteopathic Medicine decreased by 11%, while deliveries by licensed midwives increased by 23%. Deliveries in birthing centers increased by 49%, and home births increased by 24%.

 

Symptoms consistent with postpartum depression were reported by 12% of individuals in 2021. This does not represent a significant change from 10% reporting symptoms in 2012. 17% of respondents with Medicaid coverage reported symptoms consistent with depression, compared with 10% of respondents who did not have Medicaid. In 2012, 14% of respondents with Medicaid coverage and 7% of respondents not receiving Medicaid reported such symptoms. Neither represents a significant change. (PRAMS)

 

Diabetes during pregnancy increased by 68% from 2012 to 2021, including a 71% increase in gestational diabetes. Among all pregnancies, about 13% of expectant individuals experienced some form of diabetes, either gestational or pre-existing. Hypertension during pregnancy increased 81% over this same period, impacting, as with diabetes, approximately 13% of pregnancies. Greater than recommended weight gain during pregnancy, as defined by the 2009 Institute of Medicine recommendations, has increased significantly over the past decade, from 47% of individuals in 2012 to 54% in 2021.

 

National Performance Measure 1 – Well-Woman Visit

Percent of women, ages 18 through 44, with a preventive medical visit in the past year.

 

In 2021, 63% of women received a preventive medical visit within the past year. This was slightly less than the target of 67.2%. The percentage remained relatively steady between 2009 and 2017, but the survey data from those years are not comparable to 2018 and 2019 due to a change in a survey question. Since 2018 the rate has fallen from 70% to 63%, a statistically significant decrease (BRFSS).

 

Perinatal Health unit staff continued monitoring issues related to the recommended prevention services and worked with the Office of Insurance Commissioner and Health Care Authority (HCA), the state’s Medicaid administrative agency, when appropriate to ensure access to these benefits.

 

The DOH needs assessment found that many individuals lacked Medicaid coverage after pregnancy, preventing them from accessing services like behavioral health to address postpartum depression. In 2021, Washington state policymakers cited the MMRP’s report in Senate Bill 5068 to extend Medicaid coverage to 12 months postpartum. This bill was passed and signed by the governor in 2021. In 2021, Medicaid expanded postpartum coverage to be automated and extended to 12 months after the end of pregnancy. Starting July 2022, this coverage became permanent in Washington and includes obstetric/postpartum care and all healthcare services covered by Medicaid. The After Pregnancy Coverage has been announced, and the related information is available to the public on the HCA’s website. DOH has worked with HCA to promote awareness of this coverage by sharing information and training opportunities with our provider and local health networks.

 

In addition to Medicaid coverage, there is a need to provide sustainable access to community birth worker support like doulas and lactation specialists. In 2021, legislation was passed to create a credentialing system for doulas. While no current legislation enables doulas to reimburse Medicaid, HCA is working on developing potential payment options, which will expand on the newly developed credentialing system.

 

State Performance Measure 1 - Substance use during pregnancy

In 2021 16% of respondents indicated they had used an intoxicating substance during their most recent pregnancy. Some of the substances identified, such as cannabis, are legal in Washington State, while others, such as cocaine or off prescription use of opioids, are not. Cannabis was the most commonly reported substance used. (PRAMS)

 

State Performance Measure 2: Provider screening of pregnant women for depression

In 2021 87% of respondents indicated they had been screened by a provider for symptoms and/or signs of depression during their most recent pregnancy. (PRAMS)

 

We have developed 2 state performance measures to track work related to behavioral health and pregnancy.

 

Key partnerships in this work are HCA/Medicaid, the Washington State Hospital Association (WSHA), the March of Dimes (MOD), and Swedish Addiction Services in Seattle. These partnerships encourage an increase in the number of providers offering trauma and harm-reduction-informed care for pregnant and parenting people. This work is also informed by elements of the Washington State Opioid Response Plan that addresses the specific needs of pregnant and parenting people, children and families. Specific strategies include addressing bias and inequities, improved access to safe and affordable housing, quality medical services for mothers at delivery and during the prenatal and postpartum periods, group prenatal care for individuals with substance use disorder, and hospital policies. It also includes partnerships with the Child Protective Services programs to address the needs of pregnant and parenting people, children and families.

 

Alliance for Innovation on Maternal Health (AIM) – Birthing Hospital Quality Improvement DOH and WSHA continue collaborating on AIM implementation efforts. In 2021, we created the Perinatal Substance Use Disorder Learning Collaborative. This collaborative worked with 13 hospitals to pilot test the Obstetric Care for Women with Opioid Use Disorder patient safety bundle. In 2022, this bundle was expanded to include training and support for all substances, not just opioids.

The Perinatal Substance Use Disorder Learning Collaborative now supports over 80% of birthing hospitals in Washington by providing monthly educational webinars and peer-coaching calls. It also helps hospitals become certified as a Center of Excellence for Perinatal Substance Use. This certificate awards and recognizes hospitals that follow best practices when caring for people and infants impacted by substance use.

In addition to AIM, DOH is working on several interagency initiatives to address the maternal/child/family impact of the opioid epidemic:

 

We have partnered with the Division of Behavioral Health and Recovery (DBHR) at the HCA; WSHA; MOD; the Department of Children, Youth, and Families (DCYF); and other organizations to form a workgroup of the state opioid taskforce. DOH leads the state opioid response team, which provides urgent assistance to local communities who experience a drug-related public health event, and Title V staff leads the workgroup that addresses the perinatal child impact. This workgroup intends to address the needs of women, transgender, gender fluid, pregnant, and parenting people impacted by substance use.

The workgroup has several areas of focus, including:

• Decreasing stigma
• Addressing clinician bias
• Improving perinatal care and ease of access to care
• Linking pregnant and postpartum women to clinical and community resources
• Conducting a community-level gap analysis
• Expanding access to medication-assisted treatment (MAT)
• Expanding wraparound services
• Working with birthing hospitals to develop rooming-in policies for mothers and babies with withdrawal to stay in the same room, and transition to using the “Eat, Sleep, Console” tool
• Working with DCYF to increase consistency in child welfare decisions
• Supporting evidence-informed breast/chestfeeding guidelines
• Decreasing addiction to opiates, and increasing recovery for women, birth parents, and their families

 

Support for families with infants exposed to substances

In partnership with DCYF, we have worked to clarify and expand state policy related to the federal 2016 Child Abuse Prevention and Treatment Act (CAPTA) regulations that require states to report aggregate data on all infants born substance exposed and create a program so infants born exposed to substances without any safety risks can receive voluntary wraparound services through an outside agency (WithinReach) without a report being filed with Child Protective Services. DCYF provided training through the AIM perinatal substance use initiative. WithinReach has begun meeting with birthing hospital staff to initiate trainings with clinicians and to support hospitals in updating their policy/guidance for the notification or report of infants who are born substance exposed.
 

The HCA launched new billing codes to support birthing hospitals to implement the eat/sleep/console model of care for infants being monitored and treated for withdrawal. The model centers mothers and birth parents as the most essential elements of care and initiates nonpharmacological supports as the first line of treatment. The billing codes allow the hospital to bill for an administration day rate to provide mothers/birth parents with a room and meals while caring for their babies. Hospitals can also bill separately for any medication(s) mothers/birth parents need, e.g., not leaving the hospital to get their methadone from a methadone clinic when that medication is prescribed.

 

Overdose Campaign

To respond to the overdose crisis being experienced nationally and in Washington state, DOH launched a communication campaign for overdose awareness and prevention during pregnancy. The campaign provided education on harm reduction strategies to prevent overdose, fentanyl education, connection to substance use services during pregnancy, and access to naloxone. The campaign generated:

• 31.4 million impressions
• 5.5 million completed video views
• 33k clicks back to the landing page

• The social ads had 3,291 engagements, 198 shares, and 24 saves

• Reached 1,094,166 people, an average of 11.5x

• Digital Video #1 - Video received just under 7 million impressions and 5.6 million completed views (613k for the Spanish version)
• Display Banners - Our display banners received 12 million (1.3 million for Spanish) impressions and 13,224 clicks (1,659 Spanish).
• Facebook/Instagram - The social ads generated over 12.5 million (more than 4.6 million Spanish) impressions and 9,893 clicks (2,926 Spanish). 

 

State Summit

The workgroup also coordinated our 3rd state summit providing training and networking for clinical and community substance use providers, child welfare workers, and court attorneys. The training was offered virtually and in person, with 564 people registered to attend the training.

 

Provider Training and Engagement

DOH funded 5 community mini grants to increase the providers’ knowledge and skills about the patients’ and their families’ behavioral health conditions during and after pregnancy and the available treatment and resources. These projects support maternal Medication Assisted Treatment (MAT) programs and increase perinatal peer support groups and services.

 

DOH partnered with the University of Washington (UW) to launch a pilot program to train and support members of primary care clinics to address perinatal suicide risk and substance use overdose. Aspects of this suicide risk reduction care include screening for suicide risk (identifying risk factors and the use of screening tools), evaluating the severity of identified risks, preparing a risk mitigation plan, and initiating a team-based care approach within the care setting or in conjunction with community resources to address this risk. The UW team will recruit participating facilities to receive training to develop and carry out their own site-specific perinatal suicide risk improvement component with and measuring and reporting clinic screening and care rates.

 

Additional Work Supporting Women’s/Maternal Health

Maternal Mortality Review Panel

Background

In March 2016 (amended in 2019), the Legislature passed Engrossed Second Substitute Senate Bill 6534 (codified at RCW 70.54.450), creating the Maternal Mortality Review Panel (MMRP) to conduct a multidisciplinary review of all maternal deaths in Washington. The law sets out to identify factors associated with maternal deaths and make recommendations for system changes to improve perinatal health care services in the state. It requires a report outlining the findings of the review and panel recommendations to be submitted to the health care committees of the Washington State House of Representatives and Senate every 3 years.

 

The MMRP is a diverse and multidisciplinary group of over 80 people across the state. This group includes clinicians and non-clinicians, physicians, midwives, social workers, behavioral health experts, health equity experts, pathologists, advocates for people affected by intimate partner violence, doulas, community health workers, Indigenous/Tribal health representatives, patients, and patient advocates. With staffing and support provided by DOH, the MMRP reviews pregnancy-associated deaths (death of a person during pregnancy or within 365 days after pregnancy from any cause). It distinguishes which of those deaths were pregnancy-related (a subset of the above deaths that occurred from a cause complicated by pregnancy, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiological effects of pregnancy). Among pregnancy-related deaths, the MMRP identifies which deaths were preventable, meaning some change to clinical, social, or equity-related factors at any stage might have been able to prevent the death. The MMRP then identifies factors that contributed to preventable pregnancy-related deaths and makes recommendations for changes at the patient, provider, facility, community, or systems level to prevent similar deaths in the future. Recommendations also include ways to address bias and discrimination in cases where the MMRP identifies these factors as playing a role.

 

Report Findings

By September 2022, the MMRP and DOH staff had completed an early draft of its 3rd report of findings and recommendations from the MMRP (later published in February 2023). The MMRP completed a review of those cases in March 2022 and began focusing on prioritizing recommendations for the upcoming report.  

 

In June 2022, the MMRP held meetings to prioritize among its many recommendations based on 2017–2020 deaths. It organized recommendations into 6 topic areas which became the following categories: (1) addressing racism, discrimination, bias, and stigma in perinatal care; (2) increasing access to mental health and substance use disorder prevention, screening, and treatment for pregnant and parenting people; (3) expanding equitable and high-quality health care access by improving care integration, expanding telehealth services, and increasing reimbursement; (4) strengthening the quality and availability of perinatal clinical and emergency care that is comprehensive, coordinated, culturally appropriate, and adequately staffed; (5) meeting basic needs of pregnant and parenting people by prioritizing access to housing, nutrition, income, transportation, child care, care navigation, and culturally relevant support services; and (6) preventing violence in the perinatal period through survivor-centered and culturally appropriate coordinated services.

 

The MMRP and DOH staff completed data analysis for the 2014–2020 deaths report, preparing to publish these findings in the upcoming report. The analysis found that 80% of pregnancy-related deaths were preventable, reflecting the MMRP’s growing understanding of preventability as inclusive of social factors rather than primarily or exclusively clinical factors. Trend data showed that overall pregnancy-associated mortality in Washington state has remained relatively stable in recent years and did not increase in 2014–2020. However, disparities persist—particularly for American Indian/Alaska Native, Black and African American, Native Hawaiian or Pacific Islander, rural communities, and people covered by Medicaid. Leading underlying causes of pregnancy-related deaths were behavioral health conditions (predominantly by suicide and overdose), hemorrhage, and infection.

 

 

 

Tribal Collaboration

In 2021 and 2022, we continued supporting and building on a collaboration with the American Indian Health Commission that grew out of a presentation about the findings from our December 2019 report. The commission works on behalf of the 29 federally recognized tribes and two Urban Indian Health Organizations in Washington to improve health outcomes for American Indian and Alaska Native communities and people.

 

We supported the commission in coordinating a series of listening sessions with tribal and urban Indian health leaders and communities. The purpose of the listening sessions, as defined by the commission, was:

1) To hold gatherings in Tribal and Urban Indian Communities to hear concerns about the health of Native pregnant, birthing, and postpartum people in a safe, non-judgmental, and confidential space, where the words, concerns, fears, and hopes of participants are heard and honored.

2) To update Tribal and Urban Indian Health leaders on the issues of Native maternal mortality and morbidity, including concerns from their communities, to inform their recommendations for the 2023 Maternal Mortality Review Panel Report to the Legislature.

3) To reduce maternal mortality disparities in American Indian and Alaska Native (AI/AN) people in Washington State until they are eliminated.

 

By September 2022, after holding multiple listening sessions, the commission began drafting an addendum to the maternal mortality report, later published as a part of that report in February 2023. DOH Perinatal Unit staff provided support and consultation throughout and met with the commission monthly.

 

Second-Generation MMRP

Completing reviews of 2020 cases in March of 2022 and completing the meetings to prioritize recommendations in the summer of 2022 marked the end of the second MMRP’s service period. By September 2022, DOH staff and lead MMRP members began developing an application process for the 3rd MMRP. Applications opened later in fall 2022. Goals included increasing representation from tribal and urban Indian communities and communities disproportionately impacted by maternal mortality and morbidity and increasing other specific expertise areas on the MMRP.

 

Health Equity

We continue to center health equity in our maternal mortality review process and the work we produce. We ensured that equity and social determinants of health-focused perspectives were valued when facilitating MMRP case review meetings. We asked whether interpersonal or systemic discrimination and bias played a role and whether a death was preventable from an equity and social determinants of health perspective. We prioritized equity with a strong focus on antiracism in our process of narrowing down recommendations for selection in the report.  While planning for the recruitment of MMRP’s 3rd iteration, we developed outreach plans to focus on organizations and networks whose work centers communities experiencing disproportionate burdens of maternal mortality and morbidity, racism, and inequities.

 

Expanded Scope of Review

In addition to adding a review of deaths related to suicide and accidental overdose, we have continued expanding the scope of the overall review. We have included deaths from homicide where domestic violence and/or behavioral health conditions were also involved and deaths that occurred to Washington residents out of state. This expansion was based on feedback from the MMRP, CDC, and our partners and constituents. We now review all these maternal deaths to determine if they are pregnancy-related and preventable. We have been recruiting additional subject matter experts in domestic violence and law enforcement to assist us with reviewing homicide deaths.

 

The new MMRP has successfully reviewed maternal deaths from 2017 and 2020 and deaths that occurred out of state from 2014-2020. Our most recent report was published in early 2023 and included data on 2017-2020 maternal deaths. Information and recommendations related to the impact of COVID-19 on maternal deaths (based on the maternal mortality review findings) were also included.

 

Funding

Funding for basic infrastructure and staffing for the maternal mortality review and report was largely provided by state funding and MCHBG in 2020. In 2019, DOH was awarded $375,000 annually for 5 years as part of the CDC’s Preventing Maternal Deaths Grant, Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM). These funds have been used to enhance the review process to identify deaths in a timely way and increase activities for implementing the MMRP’s recommendations as outlined in reports. These activities included hiring a program coordinator, prioritizing which recommendations to focus on for the next year, planning a stigma and bias training for perinatal care providers, and continuing work on a Centers of Excellence for Perinatal Substance Use certification program.

 

DOH manages contracts with 4 regional perinatal centers in Washington to coordinate and implement state and regional quality improvement projects to improve pregnancy and newborn outcomes.

 

WithinReach Parent Support Hotline

WithinReach is an MCHBG contracted provider. This private, not-for-profit organization serves as our state’s central access point to the many resources a family needs to be healthy. They connect Washington families to health and food resources; promote awareness and education about specific health issues; provide insurance information; and make connections in person, online, and over the phone. They provide eligibility screening and referrals to Medicaid; the Women, Infants and Children Nutrition Program (WIC); and other services. They offer referrals and health education information about pregnancy, prenatal care, maternity support, childbirth, immunizations, and family planning.

 

WithinReach’s ParentHelp123.org resource website had 29,992 page views with 23,245 total unique page views in calendar year 2022.

 

WithinReach's Help Me Grow Washington (HMG-WA) Hotline is the state's maternal and child health hotline. During federal fiscal year (FFY) 2022, the hotline received and responded to 13,506 calls. Questions relating to food and nutrition resources generated the greatest number of inbound calls and resulted in 5,163 food assistance referrals and 5,715 referrals to WIC. Additional referrals were made for pregnancy-related services and determinants of health, including 654 referrals for housing assistance.

 

WithinReach provides health information in multiple languages for people whose first language is not English. During FFY 2022, the HMG-WA hotline received 1,186 phone calls in Spanish. The hotline averaged 365 non-English calls per quarter. Nearly all call center staff are bilingual, and nearly 99% of Spanish-language calls are completed without a third-person interpreter.

 

Local Health Jurisdictions Women and Maternal Health Work

Many of the LHJs chose to work on efforts to collaborate with local community Maternal Child Health coalitions, hospitals, managed care organizations, and provider groups serving pregnant/postpartum women and infants to increase referrals and ensure eligible women and individuals have access to breast/chestfeeding information, mental and behavioral health, and necessary counseling and referrals.

 

Seven LHJs selected activities to support this goal this program year. These included Benton-Franklin, Klickitat, Okanogan, Skagit, Tacoma-Pierce, Whatcom, and Yakima. Work with the breast/chestfeeding, including the Breast/chestfeeding coalitions, is listed in the Perinatal/Infant Health Domain. Breast/chestfeeding efforts include collaborating with community resources to serve pregnant and post-partum people to increase capacity for and access to lactation support. The following examples articulate county efforts related to this strategy that support the Women/Maternal Health Domain:

 

The majority of LHJs working on this strategy facilitated a variety of coalition meetings. Benton-Franklin conducted meetings with community partners, including Planned Parenthood, Catholic Youth and Family Services, Domestic Violence Services, and the Women’s Mission to gauge interest in developing a workgroup focused on birth outcomes/perinatal health. This LHJ also worked with Performance Management and the CYSHCN Coordinator to identify the impacts and referral sources for postpartum people and infants diagnosed with Neonatal Abstinence Syndrome or Substance Exposed Newborns.

 

Klickitat held approximately 20 - 25 meetings with local partners to share and discuss approaches, concerns, and data related to the mental health needs of pregnant/postpartum individuals. Meeting attendees included OBGYNs, pediatricians, home health workers, behavioral health providers, peer counselors, health dept nurses, and community members with lived experience. These meetings helped LHJ staff build partnerships, gather, and share needed data to develop a consistent community approach to address the mental health needs of pregnant/postpartum individuals.

 

In Okanogan, the LHJ staff participated in Perinatal Task force meetings and focused on increasing access to mental health and substance use disorder counseling and referrals. In Skagit, the focus has been on providing support for pregnant people and ensuring access to breast/chestfeeding information. The staff arranged for their Promotora to join a new WIC Breastfeeding Peer Counselor training to build relationships and acquaint them with ways to support infant feeding needs in their work, particularly with agricultural workers. The LHJ is planning to offer CMEs for health care providers during Breastfeeding Month in partnership with DOH Lactation and Infant Friendly Feeding Environments campaign.

 

For Tacoma-Pierce, the focus was on staffing and supporting the efforts of the Perinatal Collaborative of Pierce County (PCPC). The PCPC supports professional practice improvement and improvements in systems of perinatal health care. Services addressed by PCPC include prenatal education, breastfeeding support, nutrition, safety, and behavioral health. The LHJ staff collaborated with the PCPC Board of Directors to convene quarterly PCPC meetings to promote interagency communication and cooperation.

 

The LHJ serving Whatcom County chose to develop a local community standard of care around perinatal and infant mental health. This standard of care intends to increase community awareness of perinatal mood and anxiety disorders and normalize seeking support and skill-building during the transition to parenthood, expand and facilitate access to culturally responsive peer support for parents prenatal to 5 years postpartum. It will also help increase community capacity to therapeutically identify, refer, and treat families experiencing perinatal mood and anxiety disorders by providing training and consultation opportunities for different providers, including for health care, mental health, early learning and home visiting providers. This LHJ employed multiple means to address these activities, including providing training to community members, health care providers, and service providers, convening focus groups, and attending meetings of coalitions and other community serving organizations.

 

Yakima chose to identify existing community resources and find service and resource gaps. They worked with community partners serving pregnant and postpartum people to promote community resources and education, participated in local workgroup/meetings promoting the importance of perinatal and postpartum support services, to develop a pathway for breast/chestfeeding that assists the transition from hospital/home to assure all birthing individuals can receive breast/chestfeeding assistance if needed. They participated in local and statewide meetings to identify ways to support the coalitions and create local resources so that breast/chestfeeding assistance/education are equitable for all mothers. This LHJ also identified behavioral/mental health services available for all perinatal people and used the information to create a perinatal resource and referral handout. Finally, Yakima worked to identify who is receiving the Perinatal Mood and Anxiety Disorder screening and when they are receiving it. They also identified the tools that providers are using for the PMAD screening.

 

Identify strategies to improve access to affordable, quality health care, regardless of location, language spoken, gender identity, race, sexual orientation, or insurance status.

Mason county selected this strategy as one of their bodies of work. The LHJ connected with community providers to identify gaps and plan for serving the family planning and nutrition needs in their community after the loss of WIC and Planned Parenthood. The staff of this LHJ also worked on identifying and promoting supports for Spanish and Latin American indigenous language (Mam from Guatemala and Qʼanjobʼal from Guatemala and Mexico) speakers in their service population.

 

Other LHJs chose to work on increasing connection to support services for parents, implementing and promoting fatherhood inclusion opportunities and support resources and promoting inclusion of additional people taking parenting roles, such as foster parents, grandparents, kinship care.

 

The LHJ serving Cowlitz chose to achieve this strategy by gathering information about community resources for fathers, attending Cowlitz Café Fatherhood Council Meeting, and sharing information about the importance of providing information to fathers. For example, LHJ staff attended the “Perinatal Mental Health Screening and Referrals for Moms and Dads in Cowlitz County” training. This training provided an opportunity to learn skills to make effective referrals for mothers and fathers who might be experiencing perinatal mood and/or anxiety disorders. Staff reported that the training was inclusive of fathers and highlighted their unique needs and the available resources that can be incorporated into future work with fathers.

 

Snohomish LHJ also chose to promote fatherhood inclusion opportunities with community partners. Their staff worked on exploring county groups already working with people in parenting roles (such as foster parents, grandparents) to identify ways to partner with them on CYSHCN issues.

 

In Spokane, the LHJ staff collaborated with Community Minded Enterprises (Help Me Grow lead) to assess existing referral practices of medical providers into community-based programming. Staff identified strengths, challenges, and opportunities to develop an integrated health and social services system to meet the needs of parents/caregivers of young children (ages birth-5). The LHJ disseminated findings and recommendations among community partners. Their staff promoted the use of home visiting services and the importance of creating social connections with other parents and trusted adults by using the existing peer support groups and community cafes. They also shared linkages to services that meet unique client or subpopulation gaps in care to address the impact of ‘pair of ACEs’ on equitable health outcomes. Staff implemented and promoted fatherhood inclusion opportunities and support resources.

 

Another focus for this LHJ was to develop and provide information on community-based parenting enrichment activities to cross-sector health and social services providers to increase the connectivity of parents/caregivers to services. Staff promoted including additional people in parenting roles, such as foster parents, grandparents, and kinship care providers. This LHJ also worked to identify and engage representatives from local home visiting programs to assess and compile information about each program’s participation referral criteria. They developed an intra-agency referral process, centering the client’s needs, and used a strengths-based approach to match them with the most appropriate program offerings.