As part of the Title V MCH Program, Maternal and Infant Health Program (MIP) staff provide technical assistance, resources and support to private and public agencies serving women, ages 18 through 44. The MIP Coordinator works closely with these agencies, as well as the Title V MCH Program Manager and MCH Director to improve the health outcomes of women of childbearing age. The Women/Maternal Health report demonstrates how collaboration between agencies, leadership and MIP staff are working to accomplish the state priority to improve the health of Nevada women. The population of women, ages 18 through 44 is demonstrated by Census tract in the map below.
The Title V MCH Program staff chose NPM 1 and NPM 14 to improve women and maternal health outcomes. Improving preconception and interconception health among women of childbearing age is a priority need in Nevada. Title V MCH partners with public and private partners to enhance efforts to meet this priority by increasing the percent of women, ages 18 through 44, with a preventive medical visit in the past year (NPM 1). Reducing substance use in women of childbearing age is another ongoing priority in Nevada. Public and private partners assist with these efforts to reduce the percent of women who smoke during pregnancy (NPM 14). All subawardees share information about the Nevada Tobacco Quitline as part of their scope of work. Program activities and successes related to these efforts are included in the body of the report.
Nevada Home Visiting Report
Title V MCH collaborates with the Nevada Maternal, Infant and Early Childhood Home Visiting (MIECHV) Program co-funding activities for the Sunrise Children’s Foundation expanded Home Instruction for Parents of Preschool Youngsters (HIPPY) program in Pahrump and the Children’s Cabinet developmental Parents as Teachers home visiting program in Elko. The design and delivery of the MIECHV-funded programs are to provide comprehensive, coordinated health and social service fostering continuous access to care for people who are pregnant or who have young children. The Nevada Home Visiting (NHV) Program focuses on many of the MCH priorities, including improving preconception and interconception health, breastfeeding promotion, increasing developmental screenings, reducing teen pregnancy, reducing substance use during pregnancy, and increasing adequate insurance coverage for families.
HIPPY programs (serving families with children aged three, four, and five) help parents engage with their children in daily learning activities to help promote literacy and school readiness. The program fosters language development, problem-solving, logical thinking, and perceptual skills in children. Parents as Teachers serves expectant mothers and families with children up to kindergarten entry providing child development education, health education, activities to build cognitive and motor skills in children, and parent-child interaction coaching. Both programs provide:
- Developmental and social development screening.
- Birth spacing education.
- Screening for insurance coverage.
- Depression screening (both post-partum and general).
- Screening for domestic violence.
- Screening for necessary needs (housing, food, clothing, and utilities).
- Substance misuse screening.
Referrals are provided for any screening showing need. Referrals are followed up, and assistance is given in making any appointments or any application follow through.
Agencies implementing home visiting programs for NHV pursue Continuous Quality Improvement (CQI) and conduct Plan Do Study Act (PDSA) cycles to test small changes to improve processes and outcomes. Significant improvements have been made to the Early Learning and Literacy benchmark through CQI. Benchmark data from MIECHV are shared with the Title V MCH Epidemiologist and other staff.
NHV staff and all implementing agencies are participating in a core competency certification program including self-paced courses as follows: ASQ-3, Basics of Home Visiting, Building Engaging Relationships, Challenges: Substance Abuse, Domestic Violence, Infant Mental Health, Pregnancy, Supervising Home Visitors, Trauma for Home Visitors, and Trauma for Supervisors. In addition to the self-paced courses, the certification also requires the following live webinars: Domestic Violence: Safety Planning, Exploring Values and Beliefs, Home Visiting Boundaries, Home Visiting Safety, Implementing Tools, Home Visiting Boundaries for Supervisors. Matching Resources, Partnering for Change, Motivational Interviewing, Reflective Supervision, Impact of Domestic Violence, Trauma in Communities, and Understanding Substance Abuse. Technical Assistance has been provided to agencies for data entry, CQI processes, and family engagement.
All home visiting models provide information to encourage well child and adult well visits, immunizations on schedule, child development topics, and safe home information. In addition to these topics, agencies serving expectant mothers and infants all have a certified lactation educator to provide breastfeeding education and support. NHV has provided each of those agencies with commercial grade and loaner breast pumps to encourage longer breastfeeding as mothers return to work.
NHV provides bilingual materials and agencies serving populations with bilingual home visitors who have bilingual staff. Families are also provided with Spanish language books for children to keep, and agencies maintain a resource library for check-out in Spanish and English. In addition, families are administered Spanish language screenings and learning materials. A total of 118 MIECHV families reported Spanish as their primary language in FFY2019.
- 519 households were served by the Nevada Home Visiting Program in FFY2019.
- 620 children were served by the Nevada Home Visiting Program in FFY2019.
- 21 parents less than 17 years of age were served in FY2019
- 149 pregnant persons were served
- 64 enrollees were pregnant and less than 21 years of age
All home visiting agencies transitioned to virtual visits in March 2020. Family retention and services remained steady in spite of the change in service delivery. AMCHP provided funding via the CARES act to provide laptops and hotspots with data plans for families needing those items to carry out virtual home visits, medical visits, mental health visits, and other critical needs.
The Nevada Statewide Maternal and Child Health (MCH) Coalition Report
Title V MCH fully funds the Statewide MCH Coalition. The Nevada Statewide MCH Coalition had a presence at the American Academy of Pediatrics (AAP) conference and hosted the 2020Mom Annual Forum statewide during the Spring. With the pandemic of COVID-19 in 2020, the Coalition opted for participation in many virtual webinars and web conferences to attend to respect safety measures across the community. This included the PMAD coordinators' annual attendance of the Post-partum International conference, which moved to a virtual platform. The Nevada Chapter of the American Academy of Pediatrics hosted their yearly conference online for the first time. Monthly coalition meetings in the North and South also moved on to online platforms such as Zoom and WebEx. Despite the different platforms and adjustments needed, the Coalition continued its involvement in the community and events. The Coalition demonstrated support for breastfeeding, pre-conception and inter-conception health, developmental screenings, anxiety and depression, safe sleep, marijuana use during pregnancy education, and other statewide resources. Coalition social Media outlets continued to grow, with Facebook totaling 417 "Likes" and Instagram totaling 291 "Followers." Social posts included awareness and support for the following programs: SMHB, Nevada 211, the MHP, Nevada Tobacco Quitline, Go Before You Show, breastfeeding, safe sleep facts, and lead poisoning information. Partner organizations and agencies in Nevada shared additional postings and daily "stories." The MCH website, Facebook and Instagram saw continued growth throughout the year.
The MCH website saw continued growth in total visitors throughout the year, as well as Facebook and Instagram, see chart below:
Statewide Maternal and Child Health Coalition Social Media – 2019-2020
The PMAD Coordinator attended nine (9) online or in-person PMAD related trainings through Maternal Mental Health NOW, Nevada Suicide Prevention Coalition, and 2020Mom. The Coordinator also conducted outreach to organizations that included OBGYN offices, therapists, doulas, Health Districts, WIC offices, and other local programs. Collaboration continues with HealthPlan of Nevada’s Behavioral Health Options in assisting PMAD families with available resources statewide in navigating care. Additionally, in partnership with UNLV School of Medicine, trainings were given to current and active pediatricians in Nevada. The PMAD coordinator attended the Postpartum Support International conference (300+ attendees).
Nevada MCH staff worked with statewide partnerships including SNHD, WCHD, CCHHS, Safe Kids, Southern and Northern NV Breastfeeding Coalition, Immunize Nevada, UNLV, UNR, Children’s Advocacy Alliance, Healthy Living Institute University Medical Center, Nevada 211, the Nevada State Oral Health Program, NICRP, and other statewide partners to continue the goal of building the capacity of the MCH Coalition partners. This effort helped promote statewide MCH messaging for improving the health of expectant parents, women of childbearing age, infants, children, CYSHCN, and their families.
Due to the stay-at-home orders in Nevada, the NV Statewide MCH Coalition did not hold its annual Fall Symposium to minimize a large gathering. Funding for the symposium was redirected for a media campaign for the Go Before You Show Campaign (GBYS). The campaign message of Go Before You Show is to help create public education effort for women and families to obtain prenatal care early on in their pregnancies. In Northern Nevada, the GBYS campaign included electronic billboards, vinyl billboards, and smart device impressions to redirect users back to the coalition website. In Southern Nevada, the GBYS campaign included bus shelters in areas that higher impacts of COVID19. The campaign ran for approximately four weeks in both the North and South.
The MCH Coalition Steering Committee is comprised of volunteer leadership members from both the Northern Nevada MCH Coalition and the Southern Nevada MCH Coalition and Title V MCH staff. Four (4) meetings are held each year to discuss proposed and current activities.
Title V MCH staff contributed ongoing content to the statewide MCH Coalition e-newsletter and encouraged membership growth, new partner linkages, and outreach to youth-serving agencies. Topics shared included MCH COVID information, state resources, CYSHCN-relevant information and trainings, child, medical, reproductive health, perinatal and infant resources, webinars, conferences, Project ECHO, teen health week, adolescent physical activity, adolescent-centered care, information briefs for parents, and materials to promote campaigns for suicide prevention, childhood obesity awareness, Sexual Assault Nurse Examiner regional training opportunities, and physical fitness and sports. Numerous Title V MCH funded partners participated in the MCH Coalitions; for example, Urban Lotus Project, serving youth in northern Nevada attended meetings to share the value of trauma-informed yoga no-cost courses to help young people cope with daily life stressors and the MCH-funded Washoe County FIMR uses the Northern Nevada MCH Coalition meeting to present recommendations as they function as the FIMR’s Community Action Team.
Women’s Health and Wellness Outcomes
Title V MCH staff will continue to participate in efforts to promote reproductive health, planning, and access. MCH staff work with AFP and Teen Pregnancy Prevention PREP and SRAE programs, and other key partners to promote informed reproductive choices and education to support reproductive life planning. Association of State and Territorial Health Officials (ASTHO) OMNI efforts and quality improvement of Infant Plan of Safe Care processes continued, as did efforts to create robust wrap around care and referrals for people who are pregnant and use substances. Efforts continue to try and get significant utilization of the Tobacco Quitline among pregnant people. PRAMS data to action exploration, pregnancy surveillance efforts, and programming based on surveillance resulted in initial PRAMS data use.
Nevada Alliance for Maternal Innovation (AIM) launched and MCAH staff worked on Nevada MMRC establishment pathways and data reporting working with the Office of Analytics to reduce preventable maternal mortality and severe maternal morbidity. Exploration of perinatal quality improvement efforts more broadly continued as a possible space to leverage efforts of substance use, LARC, and perinatal mortality review committees. Development of more robust maternal and perinatal data evaluation and applying for a CDC-MCH Assignee was completed and is pending in an effort to present timely key indicators of MCH health. Continuing to look for opportunities to expand NHV capacity to serve more families through additional funding streams and continued participation of MCH staff in early childhood support and systems building initiatives continue and focus on referral pathway supports and data integration.
Maternal-focused PSAs, websites, social media and print campaigns, and sponsoring conferences for information sharing and collaboration are ongoing. Staff training on equity, and programmatic efforts focused on disparity reduction are key areas of focus and include the IM-CoIIN and current partnerships with NOMHE, The Center, NGCDD, and the NCEDSV efforts to prevent sexual assault among CYSHCN with developmental disabilities.
Title V MCH provided funding for an Oral Health pilot which included focused education to expectant parents and children living in rural Nevada and Clark County. Mobile dental services provided in partnership between SNHD and the UNLV School of Dental Medicine, Nevada Oral Health Program afforded the opportunity to promote the importance of dental care during pregnancy and the connection between oral health and perinatal outcomes.
Title V MCH funded thirteen public health clinics to improve maternal and women’s health among those aged 18-44 years old (y.o.). These entities encompassed CCHHS, a LHA in Northern Nevada and 12 nursing clinics within DPBH CHS providing services in Nevada’s rural and frontier areas. Clinic assessments, education, reproductive education, and resources were based on nationally accepted standards of practice. Clients were screened for use of alcohol, tobacco/nicotine/vaping, recreational drugs, suicidal thoughts, and other risky behaviors utilizing a SBIRT approach. Education and referrals for care were provided for individuals in need of services. General preventive health education such as weight and nutrition, exercise, and preconception counseling were incorporated in the comprehensive patient teaching model.
All clinicians were mandatory reporters and educated in the recognition of patients at risk for human trafficking, neglect, and abuse. Staff were additionally trained in the delivery of culturally competent care. Age-appropriate education and counseling were conducted along with referrals, as needed. Education provided to avoid sexually transmitted infections and communicable diseases and treatment protocols followed CDC guidelines.
Through 13,070 clinic visits, CHS educated women of childbearing age (ages 18-44 y.o.) on wellness and the value of yearly visits. Reporting criteria to MCH varied. For CCHHS, of the 1,946 well-visits, education and referrals were made to 1,115 people using alcohol, 403 people using substances, 38 affected by intimate partner violence, and 281 experiencing depression. CCHHS reported race and ethnicity; however, 48% of the clientele declined to specify. Of those reporting, 46% identified as White and 49% identified as Hispanic. CHS provided 1,146 well care visits, 1,709 nutrition and weight management counseling sessions, and 14 referrals were made for women experiencing depression. CHS activities resulted in 719 identified sexually transmitted infections and 2,017 contraceptive visits (27 intrauterine and 16 implantable devices). CHS provided immunizations in clinic settings and through outreach events. 824 adult vaccinations were given to 714 individuals (ages 22 – 44 y.o.) in the clinic and at community point of dispensing sites during which Title V MCH funded education, resources, and referrals were provided. COVID-19 did not impact the number of individuals being referred for emotional and behavioral health concerns.
Clinic staff distributed diverse women’s health-related materials. Topics covered included the value of no-cost yearly checkups, reproductive health (including long-acting reversible contraception), sexually transmitted infections, healthy pregnancy outcomes, immunizations, depression, and intimate partner violence prevention. Resources provided by the MCH Program included information about Go Before You Show, Nevada Tobacco Quitline, sobermomshealthybabies.com, PRAMS, Text4Baby, Nevada 211, and the MHP.
CCHHS promoted the US Preventive Task Force Recommendations for women’s health annual checkups through community events, social media, and the clinic digital signage. CCHHS reached 2,254 individuals during outreach activities at three locations. Two Facebook posts promoting annual well women exams reached 6,608 users, and messages were displayed outside the clinic on the digital signage.
Partners Allied for Community Excellence (PACE) Coalition, an entity within the Nevada Statewide MCH Coalition, was awarded Title V MCH funding to employ a Community Health Worker (CHW) to participate in MCH activities in Elko County and nearby rural communities. The PACE Coalition ensures CHW collaborations with other community partners on key MCH objectives/priorities to improve health outcomes in women. The CHW distributed information on topics such as child health, pregnancy, diabetes, intimate partner violence assistance, tobacco/nicotine/vaping cessation, and suicide prevention. The staff participated in 17 community collaboration meetings promoting PACE’s programs to improve health among MCH populations. Additionally, the CHW taught one Mental Health First Aid (MHFA) class empowering community members to avert suicide attempts. During the pandemic, staff placed information on maternal and child coping tips into the agency website and sent content to their listserv. The intended award emphasis was to provide care coordination and increasing connections to resources and services for Hispanic and underserved populations; when bilingual staff were no longer hired by PACE Title V MCH staff discontinued funding.
COVID-19 Efforts
MCAH staff added COVID-19 MCH population-related content into the DPBH website http://dpbh.nv.gov/Programs/TitleV/TitleV-Home/. Materials contained Nevada’s response to the pandemic, as well as information and resources for women of childbearing age, in addition to all other populations served by the award. Identified links sent viewers to the CDC COVID-19 resources in American Sign Language via YouTube and Spanish language content. The CDC materials and placement of the links were shared widely with funded partners. The statewide MCH Coalition and PCO disseminated the materials through listservs. Clear mask were provided by MCH to teachers and children in schools statewide to support those who are living with deafness or hear of hearing and the Nevada Telehealth Project was done in response to COVID-19 related needs, as were numerous CARES related funding enabled projects in the MCAH Section.
In FFY 21, all Title V MCH funded partners promoted the Nevada Resilience Project helping families and individuals experiencing struggles and challenges due to COVID-19. Bilingual ambassadors provide education, information, counseling, and resource navigation over the phone, through text and video chat, and face-to-face while promoting resilience, healthy coping, and empowerment. Additionally, state staff shared the Nevada 211 mobile app launch to help Nevadans connect with needed resources in response to the pandemic.
Sober Moms Healthy Babies Annual Report
Title V MCH continued to work with the list of SAPTA-funded treatment providers to update the SoberMomsHealthyBabies.org website to prevent substance use in pregnant people, as well as provide information to women of childbearing age, providers, and concerned family and friends. The website provides the substance use help line number, Nevada 211, Crisis Call Center, the Nevada Tobacco Quitline, and other resources. The website specifies the treatment priority status for pregnant people at SAPTA-funded agencies and the importance of people identifying they are pregnant. SAPTA-funded treatment centers must not deny treatment to persons unable to pay. All treatment centers listed on the website are SAPTA-funded.
The public awareness campaign uses radio and television public service announcements in English and Spanish throughout the state to promote the www.SoberMomsHealthyBabies.org website, in addition to the distribution of window clings and referral cards. The collaboration ensures substance use in pregnancy materials and resources will reach the intended audience. The 2020 media campaign had a total of 10,742 total spots aired (9,118 radio advertisements and 1,624 television advertisements), promoting the SoberMomsHealthyBabies.org website and the importance of pregnant persons receiving treatment and preventing substance use in persons of childbearing age. All LHAs and MCH subgrantees promoted the SoberMomsHealthyBabies.org website and shared SMHB referral cards; OMNI partners also widely shared the site URL.
To raise awareness on the priority admission of pregnant people at state-funded treatment centers, Title V MCH continued to disseminate removable wall stickers promoting the SoberMomsHealthyBabies.org website. Title V MCH is in contact with state agencies and LHAs that have agreed to help with distribution and promotion. Partnerships with the Department of Taxation, Division of Health Care Finance and Policy (DHCFP), SAPTA, local hospitals and providers, March of Dimes, faith based and MCH Coalitions, and other DPBH programs continue.
All three LHAs participated in sharing substance use in pregnancy resource distribution. CCHHS used Title V MCH funds to endorse pregnant and postpartum persons being substance-free through their clinic digital signage and social media. Facebook messages with information about the sobermomshealthybabies.com website reached 5,814 families.
Title V staff participate in CARA and NAS focused efforts and serve as a core team member on the ASTHO OMNI and PRISM Nevada Team and on numerous subcommittees focused on reduction of substance use in pregnancy and building systems of referral for families with substance exposed infants. LARC and Community Reproductive Engagement Committee MCH staff involvement intersects with substance use prevention efforts, as does engagement on possible Title V Families First efforts.
Marijuana Efforts Annual Report
The Nevada Title V MCH Program has continued to disseminate Spanish and English marijuana awareness materials to partners statewide. These materials were developed in the last funding year in response to Nevada’s legalization of medical and recreational marijuana, and informational resources on pregnancy, breastfeeding and marijuana were developed by the Title V MCH program. The Title V MCH Program developed posters displayed in all dispensaries related to use in pregnancy and injury prevention and marijuana for children. Efforts to reduce substance misuse in pregnancy and improve inter-conception care are funded by the Title V MCH program and include promoting the SoberMomsHealthyBabies.org website and associated media campaigns and focusing perinatal activities on reduction of NAS. Title V MCH funded partners promote SoberMomsHealthyBabies.org through social media and print materials developed by Title V MCH, in addition to the CARA and OMNI resources, marijuana use and pregnancy information and posters, and marijuana and childhood injury prevention warnings; informational sheets are distributed widely through FIMR and the LHAs.
Tobacco Cessation Report
All Title V MCH funded programs promoted the Nevada Tobacco Quitline to pregnant persons and women of childbearing age. CCHHS and CHS clinics provided people who smoke tobacco education and counseling. Referrals to the Nevada Tobacco Quitline were supplied to 7,159 individuals of all ages. CCHHS promoted the Nevada Tobacco Quitline through paid and earned media that reached over 14,500 individuals. CCHHS collaborated with health care providers working in behavioral health settings and substance use treatment facilities to educate them on Nevada Tobacco Quitline. These collaborations are intended to help a disparate population (with behavioral health conditions and/or substance use issues) be connected to a Tobacco Quitline resource.
The Tobacco Control Program Annual Report
The CDPHP Tobacco Control Program (TCP) disseminates Nevada Tobacco Quitline (NTQ) promotional material to Nevada providers, WIC clinics, early childhood educators, and Nevada Head Start sites. The promotional materials are given to pregnant and postpartum women who use tobacco. The NTQ continues to provide callers 13 years and older with up to five scheduled personalized, culturally competent coaching sessions, unlimited inbound calls, web and text support, and Nicotine Replacement Therapies (NRTs) free of charge to callers ages 18 and older, upon availability. The Pregnancy/Postpartum Program (PPP) offered mothers in Nevada a designated trained coach throughout each session along with incentivized gift cards for each completed counseling call. According to the guidelines of the PPP program, each pregnant caller was enrolled before giving birth to ensure eligibility for both programs. PPP provides five (5) coaching sessions during pregnancy and four (4) coaching sessions postpartum, and the same coach administers each session. This allows the parent to focus on their health and the baby, creating longevity for both through cessation. Comprehensive printed educational materials on the benefits of quitting smoking during pregnancy and harmful effects on babies were provided upon each enrollment process.
The NTQ enrolled 1,828 callers during the program period, which included five (5) pregnant people. The NTQ offers a free program specializing in helping pregnant people quit smoking. The tailored treatment plan meets their needs by providing intensive behavioral support, including an increased number of coaching calls compared to the general population. As an incentive, reward gift cards for $5 and $10 are given after scheduled and completed counseling calls. For pregnant and new parents who have quit, additional postpartum support is available to prevent relapse. NTQ uses evidence-based treatment practices to help pregnant smokers quit and remain tobacco-free. Although the call volume was limited, outreach was expanded to CHWs, women’s health care providers, WIC clinics, and events in the community. MCH opportunities to heighten NTQ awareness are being implemented, including promotion by all Title V MCH funded partners and the Chronic Disease Coalition monthly newsletters.
Partnerships continued to expand with the NTQ as listed: Medicaid MCOs, Division of Welfare and Social Services, the MCAH Section, local Tribal health departments, University Medical Center, Nevada Health Centers, Carson Tahoe Hospital, Lyon County Medical Center, Northern Nevada Health Centers, AHN, and mental health clinics and behavioral health facilities. Established relationships with providers created an opportunity for a health system change through an NTQ e-Referral process specific to patients interested in cessation.
Nevada Health Conference Report
The 2019 theme of the MCH partially funded Nevada Health Conference, October 14-15, 2019, “Creating a Healthier Nevada through Community Collaboration and Change” highlighted the importance of collaboration with other healthcare disciplines, addressed the health disparities, barriers, and challenges across the lifespan through an array of healthcare-related fields. Title V MCH provided significant funding to the conference, sponsoring scholarships and travel, sponsoring materials, and serving on the conference planning committee.
A panel discussion included, Julia Peek, MHA, CPM, Deputy Administrator, DPBH, and other healthcare and legislative leaders to discuss current trends and topic relevant to the Silver State. The first day of the conference was concluded by Dr. Kenneth Hempstead from the Permanente Medical Group. His keynote topic was “Effective Communication without Confrontation.” Day two opened with Dr. Joel Amundson, Board Certified Pediatrician and Fellow of the American Academy of Pediatrics and President of Dr. Joel’s Clinic in Portland, Oregon, and President emeritus at Boost Oregon. Dr. Amundson spoke on Vaccine Hesitancy. The lunchtime program included Jamie Schanbaum who shared her emotional and empowering journey as Meningitis survivor and now Paralympic Cyclist. The conference also included a networking reception that encouraged students and professionals to exchange ideas and connect with the exhibitors.
Testimonials from some of the 215 attendees included:
“By far the best in-state health conference available to Nevada healthcare providers and public health and social services professionals. Thank you Immunize Nevada for coordinating and thank you to all the continuing sponsors.”
“Great experience! I came out with a whole new prospective on things. Great information provided and loved all the workshops I went to.”
“I find this conference to be one of the most valuable tools in continuing education.”
Continuing education credits were issued through the University of Nevada for multiple healthcare related fields included:
- Certified Health Education Specialists (CHES)
- Certified Public Health
- Nursing
- Pharmacists
- Physicians (plus 1 hour of ethics/addiction care)
- Social Work
Each year the Nevada Health Conference awards scholarships to individuals who wish to attend the conference but may not otherwise be able to attend due to cost. MCH funds scholarships via Immunize Nevada, in addition to the Nevada Public Health Training Center, and the Nevada DPBH.
- Total number of Applicants: 43
- Total number of Applicants Awarded: 39
- Total number of Recipients (people who accepted and/or didn’t cancel): 38 (local scholarships: 6; traveling scholarships 32)
- No-show(s): 1
Reality Works Report
Title V MCH provided partners with Reality Works figures (substance exposed, abusive head trauma, and fetal alcohol spectrum disorder infant sized figures) including the Nevada Public Health Foundation (NPHF) for their Supporting Teens Achieving Real-Life Success (STARS) workshop aimed at improving life skills and supporting pregnant and parenting teens and providing tools for self-sufficiency. Reality Works figures provided by Title V MCH were used to help reinforce the importance of abstaining from substances and alcohol use while pregnant. Other focus areas of the classes include reducing a repeat teen pregnancy with information on birth control, birth spacing, and continuing education. The overall goal was to support the pregnant and parenting teens and give them tools to reach their highest level of self-sufficiency. Items provided by the Title V MCH program included an infant oral health kit with tooth paste and toothbrushes, baby bath thermometers, text4baby water bottles and lunch bags, and informational handouts on various topics such as safe sleep, marijuana, WIC, and developmental screenings.
Rape Prevention and Education Program
RPE funded activities to support Active Bystander Intervention Training to increase participation in active bystander behavior through education and intervention techniques. Safe Embrace in Northern Nevada and The Rape Crisis Center (RCC) in Southern Nevada, collaborated with the Las Vegas Metropolitan Police Department to educate staff from 108 Reno and Las Vegas bars and clubs. The topics focused on the signs of predatory behavior and the dangers of drugs and alcohol in sexual violence. RCC assisted casino and club management in creating policies to avert potentially dangerous situations for staff and patrons.
In collaboration with UNLV, the Jean Nidetch Women’s Center, a CARE Peer Program 45-hour empowerment-based training curriculum was conducted virtually with students due to COVID-19. The interactive modules focused on increasing awareness of community and societal factors leading to sexual violence and harassment and increasing social norms that protect against violence. Following leadership preparation, new peer advocates delivered virtual trainings via Canvas, UNLV’s student portal, to the student body and self-identified campus groups. An Interpersonal Violence Collaborative Interest Group, consisting of administrative and educational faculty, convened quarterly to build campus infrastructure to establish best practices and evidence-based strategies for policy reform in response to interpersonal violence and harassment on the campus.
The NCEDSV hosted an Economic Justice Series as a part of their annual conference to support domestic and sexual violence statewide prevention efforts. NCEDSV held five virtual forums focusing on economic justice as a tool for sexual violence prevention in Nevada, hosting 185 individuals statewide. Each forum explored a specific economic justice priority, including and featured panelists with expertise in these areas. MCAH Program staff from SRAE, PREP, and RPE programs attended the conference to increase strategies for linking adolescent health to risks and protective factors related to sexual assault and intimate partner violence. NCEDSV continues to hold regional trainings to support domestic and sexual violence statewide prevention efforts.
Trauma-Informed Yoga Report
Title V MCH funding supported Urban Lotus Project yoga and mindfulness instruction to help adolescents ages 12-17 y.o. cope with stress. The program also served young adults. Young adults were served at five facilities with 87 yoga classes taught to 84 individuals comprised of pregnant and parenting young persons, and young people undergoing substance use and mental health treatment. Most students attended multiple yoga classes resulting in 452 pupil exposures. COVID-19 significantly impacted the ability for in-person courses and only one facility held on-site classes during this six-month period.
The collaboration with ULP and MCH resulted in two products inside the AMCHP Innovation Hub in hopes of replicating the success of this effort elsewhere, allowing women of childbearing age to reap the benefits of specialized yoga and mindfulness instruction. The promising practice is housed inside AMCHP’s MCH Innovations Database and showcased as one of the NPM 8 adolescent physical activity implementation toolkits. https://create.piktochart.com/output/44298021-npm-8-disseminating-tools-and-resources.
Nevada Maternal Mortality Review Committee
Nevada MMRC statute are codified in NRS 442.751 through 442.774, inclusive, and the Committee is required to: (1) review incidents of maternal mortality and severe maternal morbidity (SMM) in Nevada; (2) disseminate findings and recommendations concerning maternal mortality and SMM to providers of health care, medical facilities, other interested persons and the public; (3) publish timely reports consisting of data relating to maternal mortality and SMM, descriptions of incidents reviewed by the Committee, and recommendations to reduce maternal mortality and SMM in Nevada. Nevada’s MMRC convened for their first meeting in February 2020. This committee will continue to meet multiple times a year to review all incidences of maternal mortality in Nevada and address health disparities and to end preventable MM and SMM.
The Title V MCH Director and MCAH staff have worked with CDC for a number of years in efforts to bring a MMRC to Nevada and are involved in supporting the MMRC and in considering opportunities for implementing MMRC recommendations in MCH programmatic efforts for prevention, increased awareness of the existence and recommendations of the MMRC among the public, clinicians, and policy makers, and supporting dissemination of required reports and data-driven MMRC recommendations (e.g., evidence-based practices, screenings, and patient and provider education). Reporting produced by the MMRC support staff will be included in the Title V MCH Block Grant reporting, and health equity in birth outcomes and maternal domain population health maximization will be key areas of topical intersect in priorities of the MMRC, AIM, MCAH Section, SSDI Program, and Title V MCH Program.
Two contributing factors to maternal mortality at the systems level which could have a large impact in preventing maternal mortality were identified by MMRC members. First, the Committee identified the need to provide adequate drug treatment options to pregnant women. The Committee recommends educating providers on Nevada's substance use disorder treatment options which already exist for pregnant women and removing barriers to care. The second relates to substance use in pregnancy and the identified need as a society to address SDOH for all populations. At the provider level, the utility of recommending the use of a suicide screen in addition to the antepartum and postpartum depression screen was discussed. Finally, a recommendation for outreach promoting the importance of prenatal care and preventing delays in prenatal care was identified.
SSDI funds help to support MMRC case abstraction staff. MCAH staff have facilitated maternal mortality and severe maternal morbidity presentations to the MCHAB in concert with the Nevada DHHS Office of Analytics and the efforts of the Title V MCH-funded Biostatistician in the Office of Analytics.
Advanced Life Support in Obstetrics
In an effort to prevent maternal mortality and severe maternal morbidity, the Title V MCH Program initiated plans to fund Advanced Life Support in Obstetrics (ALSO) training for rural and frontier critical access hospital staff. ALSO is an evidence-based, interprofessional, and multidisciplinary training program that equips the entire maternity care team with skills to effectively manage obstetric emergencies. However, due to COVID-19, Title V MCH staff postponed the training.
Women/Maternal Domain Accomplishments
Despite challenges posed by the pandemic, funded partners could dedicate efforts to help women of childbearing age with education, resources, and referrals to improve their health outcomes. MCAH staff added COVID-19 MCH population-related content into the DPBH website and shared pandemic information and resources with partners pertinent to women of childbearing age and their families.
Highlights of maternal and women’s health efforts include robust substance use in pregnancy prevention efforts and internal and external stakeholder engagement, successful partnerships with NHV to improve dyad outcomes and reproductive health, strong relationships with the LHAs, support of statewide MCH Coalition networks, MMRC groundwork, funding statewide and local conferences for information sharing and workforce development, and support of novel trainings for sexual assault prevention with non-traditional partners in the bar and casino industries.
Women/Maternal Health Data
NPM 1- Percent of women, ages 18-44, with a preventive medical visit in the past year
According to BRFSS, the percent of women, ages 18 through 44, with a preventive medical visit in the past year in Nevada increased from 64.6% in 2018 to 65.6% in 2019. Nevada is significantly below the US national average of 72.8% for this metric and ranks 48th out of the 50 states and the District of Columbia (D.C.). Most women in Nevada with a preventive medical visit in 2019 were aged 35-44 years old (y.o.) (67.5%), followed by 25-34 y.o. (66.8%) and 18-24 y.o. (60.4%). When stratifying by race and ethnicity, Non-Hispanic Black women had the most preventive medical visits (68%), followed by Hispanic women (65.2%), and finally Non-Hispanic White women (59.7%).
NOM 1 - Percent of pregnant women who receive prenatal care beginning in the first trimester
Data from NVSS show a steady, significant increase for Nevada’s percent of pregnant women receiving prenatal care in the first trimester from 2015 to 2019 (72.6% to 75.4%). Nevada did not meet the Healthy People 2020 goal of 77.9%. For 2019 Nevada remains below the national average of 77.6%, and ranks 37th out of the 50 states and D.C. There are racial/ethnic disparities for timely prenatal care in Nevada. In 2019, non-Hispanic White (79.5%) women had the highest prenatal care coverage, followed by non-Hispanic Asian (79.0%), non-Hispanic Multiple Race (76.9%), Hispanic (72.7%) and Non-Hispanic Black (72.0%). Non-Hispanic Native Hawaiian/Other Pacific Islander (60.7%) and Non-Hispanic American Indian/Alaska Native (51.1%) had the lowest percent.
NOM 2 - Rate of severe maternal morbidity per 10,000 delivery hospitalizations
According to the HCUP - State Inpatient Databases (SID), the rate of severe maternal morbidity per 10,000 delivery hospitalizations in Nevada decreased from 73.1 in 2015 Q1-Q3 to 65.2 in 2018. Nevada is significantly below the 2018 national average of 77.5 per 10,000 delivery hospitalizations. Women aged greater than or equal to 35 y.o. had the highest rate (120.5) in 2018, while women aged 20-24 y.o had the lowest rate (24.7). By race/ethnicity, Non-Hispanic Black persons (102.9) had the highest rate, followed by Other (73.6), non-Hispanic Asian/Pacific Islander (62.2), Non-Hispanic White (58.3), and Hispanic (58.1).
NOM 3 - Maternal mortality rate per 100,000 live births
The 2015-2019 five-year estimates from NVSS indicate Nevada’s maternal mortality rate per 100,000 live births (14.5) is less than the national rate (17.8). This represents an increase from the 2014-2018 estimate of 9.5 per 100,000 live births for Nevada. Even with the five-year estimates, the data should be interpreted with caution, and no stratified data exists for Nevada.
NOM 4 – Percent of low birth weight deliveries (<2,500 grams)
Data from NVSS indicates the percent of low birth weight deliveries in Nevada remained in the 8% to 8.5% range from 2009 to 2016. There was an increase in 2017 to 9.1%, but it declined to 8.7 and 8.8% in 2018 and 2019 respectively. Nevada is above the US national average for this measure, as the US percent of low birth weight deliveries has remained in the 8.0% to 8.3% range since 2009 with a low of 7.99% (2012) and a high of 8.3% (2017, 2018, and 2019). Nevada ranks 36th out of 50 states and D.C. for percent of low birth weight deliveries. Racial/ethnic disparities are apparent. In 2019, Non-Hispanic Black (14%) women had the highest percent of low birth weight deliveries followed by Non-Hispanic Asian women (10.8%), Non-Hispanic Multiple Race (9.1%), and Non-Hispanic Native Hawaiian/Other Pacific Islander (8.9%). Hispanic (7.7%), Non-Hispanic White (7.6%), and Non-Hispanic American Indian/Alaskan Native (6.1%) women were below the Nevada average of 8.8%.
NOM 5 – Percent of preterm births (<37 weeks)
According to NVSS, the percent of preterm births has remained around 10% from 2009 to 2019 with a high of 10.9% (2010) and a low of 9.8% (2013). At the same time, the US percent of preterm births has remained lower with a high of 10.2% (2019) and lows of 9.6% (2013, 2014, and 2015). Nevada ranked 36th out of 50 states and D.C. for this metric in 2019. Racial/ethnic disparities are apparent. In 2019, Non-Hispanic Native Hawaiian/Other Pacific Islander (14.5%) had the highest percent of preterm births, followed by Non-Hispanic Black (14%), Non-Hispanic Multiple Race (11.5%), and Non-Hispanic Asian (11.3), and Non-Hispanic American Indian/Alaskan Native (11.2%). Hispanic (10.2%) and Non-Hispanic White (9.5%) women were below the 2019 Nevada average of 10.7%.
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