Perinatal/Infant Health - Annual Report

 

Illinois’ priority for the Perinatal and Infant Health Domain is:

 

• Support healthy pregnancies to improve birth and infant outcomes (Priority #3).

 

Outcomes in the infant health domain have shown mixed progress over the last several years in Illinois. A deluge of obstetric hospital closures and persistent disparities in race/ethnicity and geographic location have been challenges that contribute to the slowing of progress.

 

In 2020, the overall infant mortality rate (NOM #9.1) remained under 6.0, (a milestone for Illinois reached last year), however the IMR decreased by less than 4% (as opposed to 14% reduction from 2018 to 2019). Similarly, perinatal mortality (NOM #8), preterm-related infant mortality (NOM #9.4) and SUID mortality (NOM #9.5) decreased by 5% or less from 2019 to 2020. Neonatal mortality (NOM #9.2) increased slightly in 2020 – this was the only infant mortality measure with an undesired shift. Neonatal mortality was also an area that contributed greatly to previous years’ overall improvement in infant health. Some of this slowed momentum was offset by positive changes in post-neonatal deaths (NOM #9.3: decreased by 16%) from 2019-2020.

 

Additionally, inequities by race/ethnicity remain some of the largest in the nation. Compared to white infants, black infants are 2.8 times as likely to die during the first year of life. They are 2.4 times as likely to die during the neonatal period, 3.5 times as likely to die during the post-neonatal period, 3.2 times as likely to die from preterm-related causes, and 4.3 times as likely to die from Sudden Unexpected Infant Death (SUID). The disparity in SUID deaths (3 year average) by race/ethnicity has been increasing dramatically and continues to be a topic of focus for Illinois.

 

Last year, Illinois added NPM #5 to our selection of national performance measures because of the need to better address sleep-related deaths to achieve racial equity in infant mortality. While most (84.5%) infants are placed on their back to sleep (NPM #5A), this is substantially lower among non-Hispanic Black infants (~73%) compared to non-Hispanic White infants (~90%), Hispanic infants (~80%) and Asian infants (~84%). Furthermore, only about half of infants are placed in a safe sleep environment without loose bedding (NPM #5C) and just over one third of infants are placed on a separate sleep surface (NPM #5B), with non-Hispanic Black infants having substantially lower rates of these sleep practices than non-Hispanic White infants. Illinois will analyze more data on sleep-related behaviors using a health equity lens and will support new strategies to improve infant safe sleep in FY22 and the years to come. 

 

On the other hand, rates of low birth weight (NOM #4) and preterm birth (NOM #5)

have shown a slight, overall net increase since 2015. This trend is in line with both Region 5 and US states overall. For both outcomes, there are persistent inequities by race/ethnicity (Black infants more than twice as likely to experience the outcome), educational attainment, insurance status, and socioeconomic status. 

 

Furthermore, Illinois women are more likely than ever to deliver in a risk-appropriate care setting; for the last 3 years nearly 86% of Illinois’ very low birth weight infants were born in a hospital with a level III NICU (NPM #3). When Illinois first selected this national performance measure in 2010, the rate was only 77.6%. Success in this measure has come through persistent hard work of the administrative perinatal centers and coordination of our state’s regionalized perinatal system. Unlike most maternal and child health services and outcomes, risk-appropriate care rates are similar for non-Hispanic Black, White, and Hispanic women across Illinois.  However, there are wide differences in receipt of risk-appropriate care by geographic area. Illinois has seen a marked improvement in this area in rural counties that have historically had much lower rates of risk apropriate care utilization than hospitals in Chicago and cook county. In 2020, the rate of receiving risk-appropriate care was only 66% for residents of rural counties in Illinois (compared to over 90% for Chicago residents). In 2021 risk appropriate care utilization increased to 82.5% for other urban and 73% for rural counties. The trend in utilization for other urban and rural counties remains unsteady however; Illinois will continue to monitor this measure for the potential impact of obstetric hospital closures and to implement strategies to improve care in maternity care desert areas.  

 

There has also been substantial progress in breastfeeding in Illinois during recent years. The breastfeeding initiation rate (NPM #4A) increased from 71% in 2008 to nearly 85% in 2019, meeting the Healthy People 2020 objective. During the same time period, the rate of exclusive breastfeeding at six months more than doubled from approximately 12% to 28% (NPM #4B). However, breastfeeding rates remain lower for infants born to non-Hispanic Black mothers, young mothers, and residents of rural areas. Illinois has worked hard to improve the structures and supports to improve breastfeeding. One of these steady improvements has been an increase in Baby-Friendly hospitals (ESM#4.1) . In 2015, there were only 6 Baby-Friendly hospitals in Illinois, which served approximately 4% of the state’s births.  Currently there are 27 baby friendly hospitals in Illinois, serving approximately 16% of the state’s births. However, this is the first time since Illinois began reporting this measure that the number of baby friendly hospitals has declined compared to the previous years.

 

The MCH Epidemiology team has begun an in-depth analysis of infant mortality that includes updated trend analyses and updated perinatal periods of risk analysis to assess the impact of different types of infant deaths most contributing to overall mortality and IM disparities. The team plans to publish a data report for public use in the coming year. Preliminary PPOR analyses show that maternal health/prematurity and post-neonatal deaths continue to be the periods of risk that caused most of the black-white infant mortality disparity. This suggests that focusing on prematurity prevention, overall maternal health before and during pregnancy, social determinants of health, breastfeeding, and safe sleep promotion are the interventions that could most support achieving health equity for Illinois infants. 

 

Title V utilized the following strategies to address the Infant and Perinatal Health Domain priority:

 

3-A. Maintain a strong system of regionalized perinatal care by supporting perinatal network administrators and outreach/education coordinators and identifying opportunities for improving the state system.

 

Illinois had two perinatal nurses (one in the northern region of the state and one in the southern region) to cover the approximately 101 hospitals in Illinois that have perinatal units. One of the perinatal nurses moved to the school health program in late 2021 leaving only one nurse to cover the entire state. The second nurse position remained vacant through FY23. The perinatal nurses work in conjunction with the 10 administrative perinatal centers. Each administrative perinatal center has a perinatal nurse administrator, a neonatal nurse educator, an obstetric nurse educator, a maternal fetal medicine co-director, and a neonatology co-director. The administrative perinatal centers and the perinatal nurses conduct site visits at each perinatal hospital in Illinois to assess the hospital’s compliance with the Illinois Perinatal Code 640.

 

The IDPH perinatal nurses are fully funded by Title V and function as nursing consultants in maternal and child health issues by doing the following:

• Providing nursing expertise and leadership in the development, interpretation, and enforcement of regulations and program contract specifications related to programs impacting women throughout the reproductive cycle and infants working with other divisions at IDPH and external stakeholders, such as the CDC and U.S. Food and Drug Administration (FDA), to provide expertise and support for perinatal related needs.
• Coordinating and monitoring assigned maternal and child health program activities.
• Attending various state and local committee meetings (e.g., Perinatal Advisory Committee) to identify opportunities for collaboration and alignment between programs.
• Supporting hospitals statewide with education and technical assistance.

 

Designate and maintain perinatal levels of care and support administrative perinatal centers.

 

Illinois Perinatal Code 640 requires hospitals to undergo a site visit every three years. These visits include one perinatal nurse, one representative from the Perinatal Advisory Committee, and the administrative perinatal center team, which includes one perinatal nurse administrator, one neonatal nurse educator, one obstetric nurse educator, one maternal fetal medicine director, and one neonatology director. The purpose for the perinatal site visit is to assess if a perinatal hospital is following the State’s Perinatal Code 640 according to the hospital’s designated level of care. Standards for perinatal care and resource requirements are reviewed for each hospital as related to the hospital’s perinatal level. The levels are I, II, II with Extended Neonatal Capabilities (II-E), and III.

 

The IDPH perinatal nurses attend morbidity and mortality reviews at hospitals to keep abreast of emerging best practices and trends in the field. Quality improvement technical assistance site visits are also provided as requested. Multiple quality assurance and technical assistance was provided virtually, via phone, and onsite as needed for cases, including temporary and/or permanent OB closures due to COVID-19 census in hospitals.

 

Illinois has a regionalized perinatal health care program that provides the infrastructure and support for Illinois’ birthing and non-birthing hospitals. Ten highly resourced hospitals are contracted as administrative perinatal centers (APCs) and charged with engaging and supporting a network of hospitals. Each birthing hospital has a perinatal level of care designation based on its resources and ability to care for neonates. The goal of the program is to improve birth outcomes through training, technical assistance, consultation on cases with complex health issues, and providing transportation to a higher level of care when appropriate. Title V provides grants to the 10 APCs annually.

 

Develop, designate, and maintain maternal levels of care.

 

In FY22, the Perinatal Advisory Committee (PAC) continued the extensive process of developing regulations to create a Maternal Levels of Care designation system authorized under PA 101-0447. It is anticipated that this system will complement the existing Illinois perinatal designations; but focus on a hospital’s abilities and resources to care for the mother or birthing person. PAC has determined that the levels of care will be based on the levels developed by the American College of Obstetricians and Gynecologists (ACOG). Once these regulations are in place, a birthing hospital will have both a separate maternal and perinatal designation based on their staffing, resources, and capabilities. IDPH and PAC continue to employ a thoughtful and transparent process in creating these designations. This process continues to include ample time for stakeholder review and feedback. Key partners, such as the staff of the Illinois Hospital Association (IHA) plays a role in the process. IHA’s active engagement will help to ensure that the designation process considers the regional differences of the state.  After IDPH gained stakeholder interest in the Maternal Levels of Care and the PAC identified chairs for a committee, IDPH worked with the chairs to invite said stakeholders to create a committee to review and assist in the creation of Maternal Levels of Care. In August of 2021, the workgroup was created and met monthly through the rest of FY22 and into FY23. By the end of FY22 the workgroup was finished with most of the recommendations to IDPH.

 

Highlights of the APCs’ key activities

 

University of Chicago Perinatal Network

• University of Chicago participated in the Emergency Department Toolkit program. The program will reach the patient population who arrive at the ED for care.
• Began to introduce Social Determinants of Health (SDoH) into discussions during perinatal case reviews. This also began expanded linkage to services and making sure a Social Worker is always involved.
• Provided 1009 contact hours to Illinois nurses and 14 simulations events to 7 of network hospitals in their units.
• Their safe sleep quality initiative wrapped up in early 2022 with 6 out of 11 hospitals completing the Cribs for Kids certification.

 

Stroger Hospital’s Perinatal Network

• The Stroger APC added a series of behavioral health education to the Regional Quality Committee meetings and to the Stroger M&M Conferences presented by Illinois DocAssist.  The series included Screening of the Pregnant Patient, Substance Use and Abuse of the Pregnant Patient and Identifying and Treating Behavioral Issues in the Pregnant Patient.     The addition of behavioral education and intervention to our program has supported the needs of the network hospitals experiencing new or increased challenges for the maternal patient presenting to the emergency department for immediate care.
• Provided specific education and in-services related to maternal disparities.  Providing the healthcare team education by content experts giving the framework to identify and make the necessary changes to properly develop a system of healthcare services to address the needs of the individual.

 

Northwestern Perinatal Network

• Northwestern APC provided nine train-the-trainer education sessions to ED staff and providers (37 providers and nurses) at the network’s five non-birthing (level 0) hospitals and at two birthing hospitals. The education sessions included general information on the Illinois Regionalized Perinatal Program, IDPH mandatory reporting for maternal and fetal/neonatal deaths, perinatal hemorrhage, perinatal severe hypertension, Mothers and Newborns Affected by Opioids (MNO) initiative, perinatal anxiety and mood disorders, neonatal resuscitation, perinatal HIV, domestic violence/intimate partner violence, a review of onsite equipment and supplies and medications and policies, and review of their perinatal needs assessment.
• In response to their network needs assessment, Dr. Paloma Toledo, MD, MPH, Department of Anesthesiology at the Northwestern University Feinberg School of Medicine lectured on “Embolic Events and Malignant Hyperthermia: Recognition, Preparedness, and Response” during one of their network Leadership and Regional Quality Council meetings. The lecture was well received, and several hospitals utilized the content to incorporate Amniotic Fluid Embolism and Malignant Hypothermia emergencies into their annual perinatal simulation training. A perinatal educator from one network hospital commented “This has been such a great sim to create and run to help get our nurses get as comfortable as possible to coding a pregnant mom”.
• Northwestern saw an increase of violent pregnant-associated deaths, noting that homicide by their significant other/intimate partner accounted for 58% of those deaths. Northwestern APC staff attended Grand Rounds on Illinois laws surrounding domestic violence and whether they help or hurt victims. Following the Grand Rounds, the APC staff  decided that holding a conference on domestic violence would empower our network hospitals to help improve the statistics of homicide maternal deaths. They surveyed their network hospitals to ascertain interest in attending a conference focused on domestic violence and if the education would be beneficial to their staff and providers to change clinical practice and decrease homicides among pregnant and postpartum people.

 

University of Illinois at Chicago Perinatal Network

• Provided five simulations on hypertension and hemorrhage (including level 0 hospitals) and completed 33 morbidity and mortality reviews (M&Ms)
• The UIC Administrative Perinatal Center offered 177 educational opportunities. Offerings included 88 fetal monitoring classes (basic, intermediate, and advanced) and obstetrical patient safety classes. UIC Administrative Perinatal Center also offered 36 classes specifically focused on the neonate (STABLE, NRP and newborn assessment).
• In order to educate providers on disparities that impact maternal and neonatal patients, UIC Administrative Perinatal Center held a conference entitled Neonatal Equity Born Unequal: Narrowing the Gap on May 11, 2022.  Providers not only learned how NICUs are disproportionately populated by non-Hispanic black infants because of high preterm birth rates among black women, but also strategies that can be implemented to narrow the gaps between black and white patients.

 

Loyola University Medical Center (LUMC) Perinatal Network

• Each of the birthing hospitals in Loyola’s network began including Social Determinants of Health (SDoH) in their abstracts for case reviews at the Morbidity and Mortality meetings, which are included in the case presentation. Social work services were required to attend each of the birthing hospital case reviews to address those SDoH as active participants to share what support was provided and identify missed opportunities. Because of these reviews, practice changes occurred such as a hospital creating a specific house wide code for perinatal emergencies to expedite access to internal resources, collaboration with emergency departments, implementation of guidelines to meet the recommendations for provider evaluation in the triage setting, and an increase in consultations to assure the patient is receiving the right level of care.
• Presented 35 continuing education offerings throughout the region.
• Provided an annual report of recognitions and recommendations from de-identified morbidity and mortality case reviews to the perinatal network hospitals for them to self-select an area of quality improvement to support healthy pregnancies to improve birth and infant outcomes. Time was dedicated during each Regional Quality Council to discuss current successes and barriers to implementing ILPQC initiatives.

Rush University Medical Center (RUMC) Perinatal Network

• Provided continuous quality improvement (CQI) support for both network and ILPQC projects that promote healthy pregnancies and better maternal and newborn outcomes.
• Provided support and guidance to all network hospitals during M&M reviews, incorporating updated research materials, educational programs, and supporting hospitals through a virtual platform.
• Rush identified an increased number of patients being readmitted for severe range blood pressures.  They attribute this to the discharge teaching done by their Network hospitals as part of the ILPQC Hypertension project.  Due to the readmissions, blood pressure cuffs were then purchased and distributed throughout the Network hospitals to disperse to patients with Health Equity issues.

Javon Bea Hospital Perinatal Network

• 32 M&Ms were conducted.  In addition to case reviews of maternal/neonatal In-bound and Out-bound transport cases and cases that were reviewed for the educational benefit the review provided, they reviewed a total of 80 Perinatal Mortality Reviews (53 in the M&M setting and 27 internally by the APC staff only); 8 Maternal Mortality Reviews (3 in the M&M setting and 5 internally by the APC staff only); 26 Severe Maternal Morbidity reviews; and, 14 newborns that were transported or in-born that received Whole Body Cooling therapy
• Due to the growing number of hospitals closing their maternity services in their network, Javon Bea initiated a Regional Quality Council meeting for the ED staff of non-maternity hospitals.  This serves to improve the outcomes of pregnant women and newborns that might be seen in rural hospitals that do not have OB services by providing the ED staff the information and education regarding the statewide initiatives.  The intent was to increase the capabilities to provide for pregnant women that have limited access to maternity services through the use of educated ED staff supports the Health Equity initiative
• Provided Stork education for the Level 0 ED providers and staff of non-maternity hospitals provides knowledge and skills to manage maternal patients that present to their EDs; and then apply appropriate delivery and stabilization management of the newborn should the maternal patient deliver in the ED.  This serves to improve the outcomes of pregnant women and newborns that might be seen in rural hospitals that do not have OB services.

OSF St. Francis Medical Center Perinatal Network

• Conducted 28 virtual M&M meeting. Case narratives included discussions regarding potential implicit bias, mental health, and identified social determinants of health.
• Have 100% of their hospitals participating in ILPQC initiatives.
• During their Regional Quality Council meeting gave education and presentations on Birth Equity, Mapping of Social Determinants of Health, and Implicit Bias.
• Moved their meetings for Case Reviews and Regional Quality Council to virtual and have seen an increase in attendance and participation.

South Central Illinois/St. John’s Children’s Hospital Perinatal Network

• Offered 15 educational programs to network hospitals, emergency medical services (EMS), and fire departments. Course topics included OB hemorrhage, electronic fetal heart monitoring, and CQI oversight.
• St. John’s continues to provide maternal and neonatal care educations at two women’s prisons in central Illinois.
• Attempting to improve outcomes by supplying EMS, Fire Departments, and Department of Correction with Hypothermia Prevention Kits. The kits contain a gel warming mattress, a neo-wrap plastic, blankets, and a newborn hat. A package with instruction cards used to teach the pre-hospital providers how to use during pre-hospital emergency child birth educational offering.

 

Cardinal Glennon Perinatal Network

• The program facilitated a total of 17 morbidity and mortality reviews with nine network birthing hospitals, reviewing a total of 185 perinatal cases and providing education for 521 healthcare providers. Provided education called ‘Emergency Childbirth Workshop’ and Perinatal Support Visits to ten Level 0 facilities in our network, reaching a total of 193 healthcare providers. Provided consultative services to all 29 Level 0 hospitals in their network for a total of 328 phone calls offering clinical guidance on pregnant or postpartum women.
• Birthing hospitals all participated in ILPQC’s Promoting Vaginal Birth (PVB) initiative and are below the goal of 24.7% NTSV cesarean section rate, achieving the best overall rate of the entire state as a region. 100% of all hospitals in their network participated in ILPQC’s Birth Equity strategies including stigma and implicit bias training for all staff and had a minimum of two individuals attend Speak Up training in November 2021 and January 2022.
• Worked to determine which delivery modality would be best for their program activities. Their program invested in Microsoft Teams and became proficient in providing virtual education if that was deemed optimal and desirable for all parties. In person learning, with the opportunity for collaborative discussion and real-time interaction, was offered when at all possible. Locations and delivery modes were rotated to increase accessibility to their activities. They added a Special Care Nursery series to their course catalog, as well as stigma and implicit bias training.

 

3-B. Implement surveillance systems to assess the impact of COVID-19 on pregnant women and neonates, including use of CDC’s Surveillance of Emerging Threats to Mothers and Newborns (SET-NET) system and development of system to track universal testing of pregnant women admitted for labor and delivery.

 

In FY22, Title V continued to support data collection processes for Illinois’ participation in the CDC’s Surveillance of Emerging Threats to Mothers and Newborns (SET-NET) surveillance system for COVID-19 during pregnancy. The CDC MCH Epidemiology Assignee oversaw Illinois’ CDC SET-NET cooperative agreement and implementation of CDC’s COVID-19 pregnancy module for confirmed cases among pregnant persons. She linked data from birth certificates, fetal death certificates, and Illinois’ National Electronic Disease Surveillance System (INEDSS) to identify more than 9,000 pregnant cases of SARS-CoV-2 infection were confirmed with positive specimens during calendar year 2020. Data extracts for these cases were cleaned and uploaded to a REDCap database that was shared with the Adverse Pregnancy Outcomes Reporting System (APORS) and Chicago Department of Public Health (CDPH) staff for medical record abstraction. APORS staff abstracted medical records for a 60% sample of cases with deliveries occurring in Illinois hospitals not located in Chicago. CDPH abstracted medical records for all cases with deliveries occurring in Chicago hospitals. Mom and baby records were both abstracted and linked in the REDCap database to allow examination of both maternal and infant outcomes related to prenatal SARS-CoV-2 infection. On a quarterly basis, data were exported from REDCap, cleaned/prepared according to CDC protocols, and submitted to CDC SET-NET in timely manner. Data files specific to Chicago residents and Chicago occurrent births were shared with CDPH.

 

Through this SET-NET work, Illinois collaborated with other states on two scientific manuscripts that were published in 2022. (Illinois author in bold)

 

• Manning SE, Bennett AC, Ellington S, Goyal S, Harvey E, Sizemore L, Wingate H (2022). Sensitivity of pregnancy status on the COVID-19 case report form among pregnancies completed through December 31, 2020 — Illinois and Tennessee. Maternal and Child Health Journal, 26: 217-223.

 

In March 2023, Illinois completed the medical record abstraction for pregnant cases of SARS-CoV-2 infection were confirmed with positive specimens during calendar year 2020, marking the end point of data submission to CDC for this project. Now that data collection is complete, future activities will involve analyzing these data for the impact on Illinois birthing persons and infants.  

 

3-C. Support the Fetal and Infant Mortality Review (FIMR) program to identify factors that contribute to fetal and neonatal loss and subsequent adverse pregnancy outcomes and develop recommendations to improve quality care as well as address social determinants of health.

 

During FY22, FIMR continued to examine and to identify the significant health, social, economic, cultural, safety, and education systems factors (non-medical) that are associated with fetal and infant mortality through review of individual cases. FIMR identifies fetal deaths (infants born dead after the 20th week of gestation) and neonatal deaths (any live born infant regardless of gestational age and weight) who die within the first 28 days of life. Through interviews with families who recently experienced a fetal loss, several challenges were identified, including inconsistent medical advice regarding inter-conceptual care and community changes impacting health (increase in community violence, gentrification in some communities, decreased rates of employment opportunities, and closing of local schools).

 

University of Chicago FIMR

 

The University of Chicago is responsible for administering the FIMR program and reviews deaths occurring within the city of Chicago. In FY20, the University of Chicago and IDPH successfully applied for the CDC and Harvard T.H. Chan School of Public Health (HSPH) Program Evaluation Practicum to do a process evaluation. Students in the practicum provided insight on how to standardize the collection of FIMR data to facilitate its synthesis into action item, to create a Community Action Team (CAT) able to interact with services in need of improvement or facilitate creation of services needed, and to develop ways to identify the impact of community actions. The University of Chicago developed an action plan to recommence reviews in FY21. This plan included collaborating with other FIMR agencies; securing Institutional Review Board (IRB) approval; hiring a full-time community action manager to develop, to plan, and to oversee the FIMR CAT; recruiting members to serve on the CAT; updating and revising program forms; creating outreach and marketing materials; and establishing a calendar for meetings.

 

University of Chicago developed an IRB approved FIMR program guided by the National Center for Fatality Review and Prevention that helps provide the community perspective on needs and supports that could make a difference in the health of communities. The data captured by this program helps identify interventions, needed programs and policy advocacy avenues that pinpoint opportunities for health improvement strategies.

 

The University of Chicago FIMR team extended services to 90 individuals in FY22. The program worked on expanding its footprint in getting name recognition for program support. FY 22 saw the launch of a FIMR Chicago website that is aimed at better educating bereaved families, providers and community members on the capacity and opportunities to contribute to FIMR. FIMR has continued to refine its program with the support and collaboration of the National Center for Fatality Review and Prevention. Community outreach was expanded in FY22 as it was important for FIMR to reach out to support systems outside of MCH in the hopes of creating a more wide-reaching supported network. In the hopes of better capturing the evolving needs of families, FIMR worked at expanding the network of support and representation of the Case review Team.

 

In late 2021 the FIMR Community Action Team formed three subcommittees to take on each of the recommendations coming at the end for FY21 case reviews. These groups aimed to address issues surrounding transportation, implicit bias and peer support. The Transportation Committee started working on a Medicaid Benefits toolkit and also helped hold a MCH focus group leading to families voices included on a transportation platform developed to help inform the 2023 city of Chicago elections. The peer support committee started developing a peer support group in communities of need in the city of Chicago, being led by community members. The Implicit bias committee was developing a Community Conversation series on implicit bias with the hopes of bringing in the community voice on the topic and with their input create strategies to address the issue.

 

Southern Illinois Healthcare Foundation FIMR

 

A second FIMR team was established in southern Illinois by the Southern Illinois Healthcare Foundation (SIHF). SIHF implemented the first FIMR program in St. Clair County, identified local factors that associated with fetal loss and infant deaths and developed recommendations to address factors, distributed face masks to pregnant/postpartum and parenting women (COVID-19 prevention), participated in and collaborated with the Illinois Task Force on Infant and Maternal Mortality Among African Americans, participated in and collaborated with I-Promote to develop statewide maternal health strategies, and, in collaboration with local health departments, developed a five-year action plan to reduce infant mortality. During FY22, this program strengthened its community partnerships and hired more staff directly for the program.  The program is also continuing to work on a Community Action Plan for Safe Sleep, facilitated infant safety and safe sleep environment education, conducted Safe Sleep Champion Training for health care providers, and conducted a Safe Sleep Education Workshop for parents and care givers, case managers, and home visitors. 

 

3-D. Support the Illinois Perinatal Quality Collaborative (ILPQC) in its implementation of obstetric and neonatal quality improvement initiatives in birthing hospitals.

 

Babies Antibiotic Stewardship Improvement Collaborative Initiative

 

ILPQC continued its Babies Antibiotic Stewardship Improvement Collaborative (BASIC) initiative to work with hospital teams to implement system changes for Early Onset Sepsis (EOS) risk assessment, identification, and response, and clinical culture change using neonatal/pediatric provider and nursing education, clinical debriefs of newborns receiving antibiotics to improve care, and regular data review to improve care for all newborns at risk for EOS. ILPQC recruited 82 birthing hospitals/children’s hospitals to participate in the BASIC initiative and officially launched in December 2020 with 200 participants attending the first meeting. In FY22, ILPQC BASIC consistently engaged in the initiative demonstrated through (1) strong attendance (100+ attendees) on monthly collaborative learning teams calls; (2) entering data into the ILPQC data system (75-80% of teams per month); and (3) participating in QI support (50 hospital teams reached out to).

In FY22, ILPQC built a dashboard in the BASIC monthly patient-level data reports where hospital teams can view monthly graphs on key measures for the initiative disaggregated by race and ethnicity. ILPQC held webinars for the teams to help them understand how to view their data by race and ethnicity and implement strategies to address the disparities.

ILPQC is sharing these strategies and resources with hospital teams to help reduce bias through implementation of standardized processes to provide optimal clinical care to all newborns who receive antibiotics and to equitably engage all parents/families. ILPQC also reorganized the BASIC toolkit to support team efforts to locate key resources for implementation of strategies. Resources and updates can be viewed on ILPQC’s BASIC webpage: https://ilpqc.org/basic2021/.  

 

ILPQC hospitals teams provided feedback that it was important to have family-centered education available to help counsel families when babies receive antibiotics. ILPQC reviewed state and national resources to develop a video and accompanying handout made with feedback on the script and visualizations from our patient and family advisors. These materials are being implemented at hospitals as part of their strategies to standardize respectful and family-centered education and include: (1) ILPQC BASIC Family Education Handout with QR Code to video: Educational handout for parents whose newborns are receiving antibiotics (Spanish Version) and ILPQC Family Education Video (English and Spanish).

 

By the end of FY22, 85% of BASIC teams had a standardized process to provide standardized family education and anticipatory guidance with a focus on equitable care to families on antibiotics, early onset sepsis, and treatment plan for newborn antibiotics and early onset sepsis compared to 57% at baseline (2020). By May 2022, over 80% of families were receiving education on EOS and the treatment plan for their newborn receiving antibiotics.

See Women’s/Maternal Health Domain strategy 2-I narrative for additional activities.

 

3-E. Collaborate with partners to support statewide efforts to improve breastfeeding outcomes and reduce disparities.

 

ISPAN and IDPH OWHFS

The OWHFS continues to participate on a collaborative project known as the Illinois State Physical Activity and Nutrition Program (ISPAN) that began in early 2019. This project aims to build on the accomplishments made already in physical activity and nutrition policy, systems, and environmental change. The purpose of this collaborative program is to reduce chronic disease and to increase the health and well-being of Illinoisans by reducing disparities. This work focuses on equitable and just opportunities for people to practice healthy eating habits and to be physically active. Specific to OWHFS is the work that aims to increase the number of places (e.g., pediatric/ family practices, WIC sites) that implement supportive breastfeeding interventions. During FY22 Title V collaborated with the Bureau of Home Visiting (BHV) within the Illinois Department of Human Services Division of Early Childhood (IDHS-DEC) to advance this work. For several years, BHV has enjoyed a strong partnership with the ISPAN program, with the shared goal of improving breastfeeding outcomes for home visiting families. During FFY2022, IPHI and BHV planned two professional development opportunities specifically for home visitors. IPHI contracted with the Michigan Breastfeeding Network to develop a live, interactive virtual training titled “Chest, Breast, and Body-Feeding: Equity-Centered, Practice-based Strategies for Illinois Home Visitors” offered to BHV-funded home visitors in November 2022. In addition, IPHI created a learning cohort specifically for home visiting programs called “Delivering Chest/Breastfeeding Equity in Home Visiting,” which began in October 2022. The support of the Illinois Title V program made these professional development opportunities possible.

 

Enhancing and Expanding Breastfeeding Program

 

During FY22 Title V continued to support the Illinois Public Health Institute (IPHI) that administered the Enhancing and Expanding Breastfeeding – Illinois (EEB) program. This program launched in July 2021. The program sought to promote the positive state trends of increasing breast/chest feeding initiation and exclusive breast/chest feeding at six months rate. The specific objectives of the EEB program included improving the continuity of care and support for breast/chest feeding throughout Illinois, enhancing workforce development through training and the creation of tools for health care professionals who provide services to pregnant individuals, and developing and implementing programs that promote health equity in lactation support. To ensure community and provider engagement IPHI developed and implemented a learning collaborative with various institutions including home visiting programs, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) sites and/or task forces, obstetric practices, community health centers or community-specific regional breastfeeding partners to improve breastfeeding support, continuity of care and equity in their communities.

 

IPHI developed four teams led by appointed primary organizations to collaborate in peer learning meetings throughout FY22.  These learning meetings focused on discussing the importance and involvement of community engagement, equity and continuity of care.  During FY22, the teams also submitted final drafts of their action plans for improving breast/chest feeding continuity of care via sustainable changes which will be reviewed in FY23.

 

Additionally, during FY22, IPHI worked with the four teams to develop an online training module for early care and education providers and directors/owners on breast/chest feeding-friendly policies and environments to be integrated into the Gateways Professional Development System for childcare providers.   IPHI drafted a one-page description of the pilot and ordered a preliminary set of materials to be printed. A pediatrician and an OB team completed their pilots in FY22. The pediatrician team distributed 40 provider resources and 95 family focused resources to engage with patients who were pregnant or breast/chest feeding. The OB team utilized 400 family focused resources and 45 of both provider focused documents to distribute amongst providers and their pregnant or chest/breastfeeding patients. Both teams collected feedback on the tools from the providers who used them and to the families that received them. The OB team reported that 102 patients completed a post-use survey and 91 of them reported that they felt more confident in their ability to breastfeeding after their visit. After completion of the pilot, the feedback was incorporated into the resources via the original designer and the creator, Nekisha Killings MPH IBCLC. 3000 new family resources and 500 each of the provider resources have been ordered for print and will be distributed during FY23.

   

In FY22, IPHI hosted the free BreastSide® Manner Training®: A Culturally Humble Care Approach to Supporting Breast/ Chest feeding Families.  The training focused on empathic patient centered care, culturally competent breastfeeding communication, and recognizing implicit bias with patients and how to combat it. Training topics included equity/cultural competence, respectful bedside manner and basic breastfeeding topics clinicians can cover during prenatal and postpartum office visits, and some ideas for where providers can refer families for additional support. The training was held online and was recorded and posted on the State WIC training site. The training provided CEUs to those who attended the entire time and 142 individuals (of which 81 were health care providers) were reached with this training. IPHI also partnered with ICAAP to launch a continuing medical education (CME) planning committee to create a breastfeeding basics training that addresses implicit bias, culturally competent bedside manner and more and 119 people registered for the training for FY 23.

IPHI created a Breastfeeding “Digest” to be sent out monthly to our breastfeeding partner listservs during this report year. This digest is a combination of resources, partner highlights and other opportunities to advance equity in lactation support. We also received confirmation from the IPHI communications team that Google Analytics was added to the IPHI website, including the breastfeeding resources page. In FY22, the breastfeeding resource site has seen 511 views from 354 users. 312 of those users were new users (e.g., never been to the website before).

 

A key EEB program objective was to identify and map practicing International Board-Certified Lactation Consultants (IBCLCs) of color in Illinois as well as where clinical hours for those interested in becoming an IBCLC can be obtained. During FY 22, IPHI surveyed current IBCLCs across the state to identity those who identify as people of color, map them, and analyze the gaps in both geographic reach and by availability for providing clinical hours to future IBCLCs (of color).  The survey will help identify and map IBCLCs of color in Illinois and identify gaps in geographic reach and availability for providing clinical mentoring hours to future IBCLCs. The survey was created and sent out in June FY22 to partners and IBCLC listservs to help spread the word to over 12,000 individuals in the lactation space.  IPHI will utilize the survey responses to create a visual map of IBCLCs in Illinois and draft a gap analysis report for FY23.

 

IPHI and MIECHV

 

The Maternal Infant and Early Childhood Home Visiting (MIECHV) program which is housed in DHS’s Division of Early Childhood (IDHS-DEC), also partners with IPHI on various breastfeeding initiatives. In FY22, IPHI helped to create another survey of MIECHV home visitors to gather information on their baseline knowledge related to breastfeeding/lactation support and to help us understand what type of training would best meet their needs. The survey was sent to home visitors in different programs to help determine knowledge gaps and content needs for the training. Results were collected from 59 home visitors in March 2022.

 

 

3-F.  Partner with the Illinois Department of Corrections (DOC) and two state women’s correctional centers to support ongoing health promotion activities for incarcerated women and staff training, and to ensure women and babies receive Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) services while residing in DOC facilities.

 

See Women’s/Maternal Health Domain strategy 1-B narrative for details.

 

3-G. Support and collaborate with the Illinois Task Force on Infant and Maternal Mortality Among African Americans to assess the impact of overt and covert racism on pregnancy related outcomes, identify best practices and effective interventions, address social determinants of health, and develop an annual report with recommendations to improve outcomes for African American women and infants.

 

See Women’s/Maternal Health Domain strategy 2-D narrative for details.

 

3-H. Provide support to pregnant women at risk for poor birth outcomes through an array of case management and home visiting programs by the Illinois Department of Human Services (DHS) Maternal, Infant and Early Childhood Home Visiting (MIECHV) program, and ensure these DHS programs align with Title V priorities.

 

Home Visiting

 

The Illinois MIECHV program supports the delivery of coordinated, comprehensive, high quality, and voluntary, early childhood evidence-based home visiting services to eligible families in at-risk communities. Illinois MIECHV targets priority populations and aims to improve child and family outcomes by implementing evidence-based home visiting (HV) models in 11 at-risk communities across the state: (1) Cicero (Cook County); (2) Southside Cluster in the City of Chicago (ie, Englewood, West Englewood and Greater Grand Crossing neighborhoods); (3) East St Louis (St. Clair County); (4) Lake County; (5) Elgin (Kane County); (6) City of Rockford (Winnebago County); (7) Stephenson County; (8) Peoria County; (9) Kankakee County; (10) Macon County; and (11) Vermilion County. Target populations include families experiencing homelessness, pregnant and parenting youth in child welfare care, and families at risk for maternal depression. The Illinois MIECHV program 2,615 individuals during FFY2022.

 

Title V continues to connect MIECHV and home visiting programs to other partners for collaboration and support (e.g., Task Force on Infant and Maternal Mortality Among African Americans). While the CDPH Nursing and Support Services under the mini-Title V grant are largely focused on maternal and infant health, CDPH’s home visiting nurses provide support, guidance, and referrals for families who need assistance and services for older children. Examples include referrals for day care and pre-K programs, pediatricians, early intervention, and benefit programs like Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and the Supplemental Nutrition Assistance Program (SNAP).

 

Specific Title V and MIECHV Activities

 

While Title V does not provide any direct funding to MIECHV, the two programs continue to collaborate to align common strategies and participate in each other’s initiatives. In FY22, MIECHV’s project director served as member of the CDPH Family Connects Chicago community advisory board, which supported planning and expansion of this universal newborn service model. MIECHV funds Family Connects in two other at-risk communities (See strategy 3-I for more detail on Family Connects).

Another Title V initiative that benefits from the participation of MIECHV is the Task Force on Infant and Maternal Mortality Amongst African Americans (IMMT) (See strategy 2-E for more detail on IMMT). MIECHV’s MCH nurse consultant serves as a co-lead for the IMMT Systems subcommittee and the MIECHV BHV was an active member of the Programs and Best Practices subcommittee.

 

Additionally, in FY22, the Title V Director serves on the Health and Home Visiting Committee of the Illinois Early Learning Council. Formerly known as the Home Visiting Task Force, the committee consists of individuals representing state agencies and private sector health, early childhood, and child welfare organizations, as well as providers, researchers, and advocates. The committee’s charge is to advise on the development of systems that promote health and wellness and achieve equitable access and outcomes for families with young children by promoting seamless connections between robust home visiting, health care, mental health, and early education and care to provide a continuum of support prenatal through kindergarten for parents and all care givers (grandparents, guardians, foster parents), babies, and young children, and to serve as the advisory body to the MIECHV program and to home visiting programs overall. 

 

In addition to participating jointly in the above cross-sector meetings, BHV and the Title V program began scheduling quarterly check-in meetings at the end of FFY2022 to maximize opportunities for alignment and collaboration which continued throughout FY23.

 

Illinois MIECHV also collaborates with the Illinois’ HRSA-funded State Maternal Health Innovation Grant, I PROMOTE-IL, led by the University of Illinois at Chicago. Leadership participated on the project’s Maternal Health Task Force and contributed to the development of its strategic plan which called for examining and expanding maternal health training for home visitors. Based on the collaborative key informant interviews completed in FY21 with select MIECHV sites, it was determined that home visitors wanted more training on maternal health warning signs and chronic conditions that affect maternal health. I PROMOTE-IL developed the training with input from MIECHV and contracted with Start Early to create the training as part of the state’s home visiting professional development system. In addition, the curriculum was completed in FY2022, was piloted in November 2022, and is rolling out in calendar 2023 to all MIECHV-funded home visiting programs.

 

Illinois - Early Childhood Comprehensive Services (IL-ECCS) grant

 

DHS has received an Early Childhood Comprehensive Services (ECCS) grant from HRSA. IL Title V serves as a critical partner to DHS in its implementation of the IL-ECCS. The IL-ECCS project will build upon Illinois’ early childhood system and create structures and pathways to better coordinate and build the State’s maternal-child health infrastructure. This collaboration on the ECCS project will focus on the integration, alignment, and financing of programs within and across all state prenatal-to-3 systems while increasing the capacity of the health system to interface and collaborate with early childhood and MCH.

DHS and its partners seek to:

1. Enhance the P-3 statewide maternal and early childhood system of care by establishing a Universal Newborn Supports System (UNSS) that better connects moms and babies to programs and services.
2. Work across state agencies to establish a clearly aligned and sustainable infrastructure to support a stronger and more efficient and effective P-3 system.
3. Align policy, data, and financing mechanisms to support and to sustain a coordinated comprehensive P-3 system.

 

During FY22, IL Title V continued to support the ECCS grant in representation on the Illinois Maternal Health Task Force Care Coordination and Case Management Committee (CCCMC).  The CCCMC serves as the advisory committee for the implementation of ECCS by providing advice on the project and recommending strategic directions, policy, and financing changes. This committee will continue to provide advice on the project and recommend strategic directions, policy, and financing changes.

 

Other DHS perinatal/infant activities supporting Title V

 

Better Birth Outcomes. DHS contracts with local health departments, community-based agencies, and FQHCs to provide intensive prenatal case management services, known as the Better Birth Outcomes (BBO) program, to high-risk pregnant women in defined geographic areas of the state with higher-than-average Medicaid costs associated with poor birth outcomes and higher than average numbers of women delivering premature infants. Staff reassessed birth data to ensure the program is continuing to be offered in the areas of highest need. Title V funding for this program ended in FY19.

 

Family Case Management. Family Case Management (FCM) is a statewide program administered by DHS that provides comprehensive service coordination to improve the health, social, educational, and developmental needs of pregnant women, and infants (0–12 months) from low-income families in the communities of Illinois. Assistance in obtaining health and human services which promote healthy growth and development are provided to low-income families and high-risk infants as mandated in the Illinois Family Case Management Act and Maternal and Child Health Services Code. Agencies contracted with DHS to perform FCM activities perform assessments of client needs, provide linkage with Medicaid and primary medical care, refer clients for assistance with identified social needs, and coordinate care through face-to-face contacts and home visits at regular intervals throughout pregnancy and the infant’s first year of life.

 

DHS High-Risk Infant Follow-up Program. The High-Risk Infant Follow-up Program is a case management program administered by DHS. Based on eligibility established by the Adverse Pregnancy Outcome Reporting System (APORS), the Illinois birth defect registry housed in IDPH’s Division of Epidemiologic Studies, public health nurses in local health departments provide follow-up home visiting services. There is a direct connection between high-risk follow-up and numerous programs, such as WIC, Primary Care, Early Intervention, Perinatal Follow-up, and others depending on the needs of the family. Infants are followed until 24 months of age unless a complete assessment and the professional judgment of the nurse case manager indicate that services are no longer needed.

 

3-I. Support the Chicago Department of Public Health (CDPH) in implementation of Family Connects Chicago to ensure nurse home visits for all babies and parents immediately following birth and linkage to a network of community supports to assist with longer term, family identified needs.

 

Title V has continued to support universal home visiting. Initially, a pilot for universal newborn home visiting (Universal Newborn Support System Pilot) was coordinated by the Ounce of Prevention Fund (now known as Start Early) and was championed by former Illinois first lady Diana Rauner, who co-chaired the home visiting committee of the Early Learning Council (ELC). The pilot included two working pilot sites in Illinois where every woman receives a home visit to assess maternal and child health and well-being after a baby is born. One site was in Stephenson County and the other was in Peoria. This pilot morphed into the Illinois Family Connects program.

 

Family Connects is a community-based, universal program for parents of newborns, regardless of income or socioeconomic status. The support provided by the program includes physical assessments of the birthing person and the baby as well as screening for social determinants of health to help identify and to connect with supportive resources from which any new family may benefit. As part of its mini grant from Title V, CDPH developed and implemented a Family Connects pilot program in FY19. Activities included designing the community alignment function of Family Connects, building relationships with partner hospitals, training a nursing team on the model, and engaging an evaluation team to measure impact and to conduct an implementation study to inform plans to bring the pilot to scale. Families that participated were linked to care and provided parenting support, support for a safe home, and education, tools, and resources about maternal and infant health.

 

During FY22, Title V continued to support CDPH in the implementation of its Family Connects pilot at specific Chicago hospitals. As part of continued efforts to scale FCC citywide, by the end of FY22, CDPH had successfully worked with four partner birthing hospitals are currently implementing FCC services. As of the close of FY22, CDPH and partner hospitals reached 47% of eligible families. Of those, 2,179 families or 56% accepted services.

 

In addition, Title V continued to support CDPH’s efforts to convene the Family Connects Citywide Advisory Board (CAB) to review data, discuss implementation, and evaluation of the model. CDPH has supported implementation of four of six regional CABs to ensure coordination of local services and resources for families.

Title V funding supports CDPH efforts to regularly engage community partners and stakeholders to actively participate in the development of public health promotional campaigns, ensuring they are targeted broadly and inclusively across the service area to focus on equity in service. The FCC program promotes health equity through its universal approach. Services were offered to all persons who gave birth in participating pilot hospitals regardless of income or insurance factors. Research has shown that when services are focused on the specific needs of each family rather than targeted to certain socioeconomic groups, participation is more robust. FCC’s community alignment aspect identifies gaps in resources in communities with the most need. The six citywide CABs help CDPH and hospital providers to tailor services referrals and resources to meet the individual needs of each family to ensure equity in support.

 

During FY22, Title V supported the efforts of CDPH to redesign, rebrand, and launch the One Chi Fam website. One Chi Fam connects new parents and families with resources and support to help them live healthy and happy lives. Through resources such as the One Chi Fam website, CDPH strives to help create equity among diverse communities to ensure all parents have access to resources, environments, and opportunities that promote health and well-being.

The Safe Sleep Campaign launched in the fall of 2022 to provide access to information on safe infant sleep practices and more information will be available in the FY23 Report.

 

During FY22, the Title V utilized the following NEW activities:

3-J.  Partner with the University of Illinois at Chicago, School of Public Health, Division of Health Policy and Administration (UIC-HPA) to explore the influence of healthcare provider access and the casual effects of events or policies on this access.

 

This is the same as strategy 2-L. Information about this activity is available in the narrative for the Women’s/Maternal Health Domain.

 

Emerging Issue

3-K.  Partner with the University of Illinois at Chicago (UIC) through the Center for Research on Women and Gender (UIC-CRWG) enhance all emergency departments (EDs) understanding and ability to recognize and provide care for pregnant and postpartum birthing person.

 

This is the same as strategy 2-M. Information about this activity is available in the narrative for the Women’s/Maternal Health Domain.

 

Another noteworthy strategy to address the Infant and Perinatal Health Domain priority:

 

IDPH’s Newborn Screening section ensures population-based metabolic and hearing screening for Illinois newborns

 

Universal newborn blood spot screening is offered through the IDPH Newborn Screening Laboratory and Follow-up Sections (NBS).  All Core RUSP conditions are included in the Illinois newborn screening panel. This includes mucopolysaccharidosis type II (MPS 2). Newborns diagnosed through newborn screening are followed annually through fifteen years of age with staff of the Newborn Screening Program contacting the pediatric sub-specialist to verify compliance with treatment and to monitor growth and developmental milestones. If needed, cases are referred to a local public health nurse to provide family assistance.

 

The IDPH Early Hearing Detection and Intervention (EHDI) Program provides tracking, monitoring, and referrals for Universal Newborn Hearing Screening for infants born in Illinois. All newborns identified with atypical hearing are referred to Part C/ Early Intervention services and to the state Children with Special Health Care Needs Program (through UIC-DSCC) that offers ongoing follow-up services.

 

During FY22, the IDPH Newborn Screening Section through EDHI continued activities with the business agreement collaboration with Illinois Hands and Voices, Guide by Your Side. Additionally, continued work for the launching a rebuild of the illinoissoundbeginning.org website also took place during this report period. Continuous Quality Improvement (CQI) methodology is ongoing and was used to improve screening, diagnosis, intervention, and parent support.