Annual Report Fiscal Year 2020:  This section provides a summary of Federal Fiscal Year 2020 (FFY20) activities, accomplishments, and challenges related to National Performance Measures (NPMs) and State Performance Measures (SPMs) (2016-2020) for the Perinatal/Infant Domain.

The American Academy of Pediatrics recommends exclusive breastfeeding for the infant’s first six months and encourages breastfeeding through at least the infant’s first birthday in order to maximize health benefits associated with breastfeeding. Breastfed infants are less likely to develop diabetes or obesity and mothers who breastfeed lower their risk of breast and ovarian cancer, diabetes, and heart disease.

Since  2015, when breastfeeding was declared as a priority in Wyoming, the prevalence of infants ever breastfeed in Wyoming, as well as though breastfeed exclusively through 6 months has remained higher than the U.S. prevalence.  In 2019, 90.0% of Wyoming infants were ever breastfed compared to 84.1% in the U.S., and 31.8% of Wyoming infants were breastfeed exclusively through 6 months compared to 25.6% in the U.S.

Due to Wyoming’s stellar performance in this priority, breastfeeding will no longer be seen as a top-level priority within the new Title V cycle; however, MCH Epidemiology will continue to monitor progress through interim needs assessment activities to identify reversing trends or emerging needs.

Strategy 1: Assure each county has one nurse who is a trained Certified Lactation Counselor (CLC); Strategy 2:  Promote breastfeeding within the Healthy Baby Home Visitation Program

To assure that mothers and their infants served by public health nurses (PHNs) through home visitation have access to breastfeeding support, the WIHPM provides financial support to train PHNs as CLCs. The goal is to have a CLC-trained nurse in all 23 Wyoming counties, and in FFY20, 100% of counties had a CLC-trained nurse. CLC-trained nurses are able to provide breastfeeding and lactation support, including assessing the latching and feeding process, providing corrective interventions, counseling mothers, and understanding and applying knowledge of milk production.

The WIHPM also assists the Wyoming Women, Infants and Children (WIC) Program with CLC certifications for their staff. Supporting breastfeeding programs in other public health programs is vital to maintaining Wyoming’s high breastfeeding rate.

Additional Strategies:

Develop a WDH Breastfeeding at Work Policy in Collaboration with Wyoming WIC

Despite the Wyoming Department of Health Leadership not approving the Breastfeeding at Work Policy the WIHPM and WIC team continued to work with leadership staff to ensure that when the Department of Health moved into new buildings a designated lactation space was put on each floor of the buildings. New chairs, refrigerators, and other necessary supplies were put in each lactation space of the new floor.

Due to Covid-19 the new lactation rooms have not been used to their full potential, because the Wyoming Department of Health began a full time work from home policy. However, when lactating people begin to return to work these new lactation spaces will be at their disposal as well as a google calendar so that women can schedule each room as needed.

The MCH Unit and WIC team continue to work together on this initiative and are glad we have found a way to ensure women employed by the Wyoming Department of Health feel like they can continue to work while also feeding their infant the way they want.

A baby at work policy was briefly discussed, but there was no traction to continue such a discussion under current leadership.

Risk-appropriate perinatal care is a key strategy for improving maternal and neonatal health outcomes. Studies conducted by the American College of Obstetrics and Gynecology (ACOG) as far back as the 1970s have demonstrated that access to risk-appropriate neonatal and obstetric care has the potential to decrease perinatal mortality and improve birth outcomes for both mothers and their infants. Risk-appropriate care is defined as access to care that matches both the mother’s and infant’s level of risk, including a full range of specialists available to help care for complex medical conditions.

Strategy 1: Distribute facility-specific reports on Levels of Care Assessment Tool (LOCATe) results

WY MCH and WY MCH Epidemiology piloted LOCATe in 2016 and provided facility reports in 2017, holding in-person meetings with some hospitals to review results. While a useful tool, no specific efforts related to LOCATe were implemented in FFY20. WY MCH may consider repeating the tool in the future if a plan for using the results to inform efforts is developed. The WYPQC will be a key partner in any future implementation of LOCATe activities.

Strategy 2: Support hospitals in implementation of Alliance for Innovation on Maternal Health (AIM) safety bundles (e.g. hypertension, opioids use during pregnancy, low-risk Cesarean delivery)

Wyoming partners with Utah in order to bring AIM safety bundle activities to the birthing hospitals in the state. Utah invited Wyoming birthing hospitals to participate in the in-person close-out of the hypertension bundle and help kick off the opioid use disorder (OUD) safety bundle. The meeting was held in Salt Lake City, UT in March 2020. The WIHPM put out a notice to all 21 birthing hospitals in the state notifying them that WY MCH would provide travel assistance for up to two staff members to attend the in-person safety bundle meeting. Staff from six hospitals (Memorial Hospital of Sweetwater County; St. John’s Health; Sheridan Memorial Hospital; Campbell County Health; Ivinson Memorial Hospital; Cheyenne Regional Medical Center) attended. These hospitals represent some of the largest birthing hospitals in each region of the state.

Shortly after the launch meeting, both states implemented travel restrictions due to Covid-19 and many of the participating Wyoming hospitals requested to put non Covid-19 work on hold. Utah honored this request and slowed down the pace of the work usually seen within the AIM safety bundles. Once the bundle began implementation again Wyoming birthing hospital staff requested that the AIM safety bundle focus on more than just OUD, because the rate of OUD in Wyoming is very low. Both Utah and Wyoming agreed to expand the safety bundle to discuss all substances, specifically methamphetamines and marijuana. Four of the six hospitals who attended the March 2020 launch meeting participated in at least one telehealth training session post-launch but sustained and active engagement was impeded by COVID-19.

Utah also partnered with the March of Dimes to host a virtual implicit bias training for Labor and Delivery staff from Wyoming and Utah. Utah bought enough licenses to allow Wyoming hospitals to participate in the implementation of this pilot training. Three Wyoming hospitals participated; Ivinson Memorial Hospital trained staff but did not hold a debrief session yet, Wyoming Medical Center trained and debriefed with over fourty participants, and Cheyenne Regional Medical Center trained staff and are scheduled to debrief in July 2021. Recruitment is ongoing for additional hospitals to participate.

Strategy 3: Develop a Wyoming Perinatal Quality Collaborative (WYPQC)

The WYPQC is still in its infancy and is continuing to reach out to new members and work towards improving its structure and policies. Due to the Covid-19 pandemic this work drastically slowed, with most members being tasked with Covid-19 duties. The WIHPM and WYPQC Chair made the decision to not host meetings during this time and to slow down the pace of newsletters and email alerts as members were feeling overwhelmed.

The WIHP released a Request for Applications for coordination of the WYPQC in late 2018, and in April 2019, a contract was awarded to Brenda Burnett, RN, MSN, PCMH CCE, of Brenda Burnett Clinical Consulting, LLC. Brenda brought with her a wealth of clinical expertise in perinatal issues, as well as project management and quality improvement experience. Brenda facilitated the WYPQC through meetings and project planning, coordinated communication and activities, developed toolkits and outreach materials for projects, and assured ongoing engagement and recruitment of project partners and stakeholders. Brenda maintained her contract through December 2019; when she chose to retire. The WIHPM released an RFA in early 2020 to attempt to rehire a coordinator but a candidate was not selected. The WIHPM plans to release a RFP in late FFY 21 in order to rehire for the position.

Prior to the pandemic, the WYPQC established subcommittees, but only recently selected a chair for each subcommittee. One of the five topical areas is the Infant Health Subcommittee, which has begun to work with the Substance Use Disorder Subcommittee on a state-level policy for a Plan of Safe Care. The other three subcommittees are: Hospital Systems; Infant Health; Maternal Morbidity and Mortality; and Maternal Mental Health. In Summer 2021, the WYPQC leadership team will receive short-term strategic planning consultation to revisit the vision/mission and develop a 12-month strategic plan to reset efforts post-pandemic.  WY MCH will also welcome a University of Washington MPH student to assist in logic model development and development of standard processes by which the WYPQC will review and act upon prioritized recommendations from the UT-WY maternal mortality review committee. 

Strategy 4: Implement Fetal and Infant Mortality Review (FIMR) in pilot community

Preventing infant mortality remains a Title V priority for the WIHPM in the 2021-2025 grant cycle and establishing infrastructure to implement FIMR at the state or local level remains a possible strategy.  Efforts to establish a maternal mortality review committee in partnership with the Utah Department of Health required significant staff time and effort during FFY20 and FFY21; therefore, efforts to implement FIMR have been put on hold until FFY22. Wyoming MCH will explore the idea of putting together a statewide FIMR instead of a community based review due to limited resources and capacity. This is also largely due to the low infant mortality rate we see in many counties and lessons learned from neighboring states like Montana, where some counties may not see a review for several years.

Training materials from the previous FIMR work led by WY MCH and community partners in Fremont County are still available to train potential future FIMR members and the National Center for Fatality Review and Prevention has offered technical assistance for this project. The CDC Epidemiology Assignee helped lead the pilot FIMR and is aware of and willing to assist in a reintroduction of a FIMR to Wyoming. Considerations for continuing this project include resources, staff capacity, local-level interest, data support capacity, legal authority and protections, and opportunities to coordinate efforts with other death reviews. 

Annual Report Fiscal Year 2020 Supplement:  This section provides an interim update for Federal Fiscal Year 2021 (FFY21) activities currently in process for the WIHP.

After the summer 2020 needs assessment, the WIHP decided to continue the prevention of infant mortality Title V priority for the perinatal/infant domain. New strategies include conducting virtual focus groups throughout the state in both English and Spanish to better understand families' knowledge of, and barriers to, safe sleep practices.

A Request for Proposal for focus groups was released in January 2021 and the OMNI Institute will complete this work by late 2021 to inform ongoing efforts in FFY22. The program selected NPM 5: A) % of infants placed to sleep on their backs; B) % of infants placed to sleep on a separate approved sleep surface; C) % of infants placed to sleep without soft objects or loose bedding to monitor progress over the five-year cycle.

Other Perinatal/Infant Activities:

Public Health Nursing Home Visiting

The Public Health Nursing Home Visiting Program officially began moving from the Bright Beginnings model to the Australian-based Maternal Early Childhood Sustained Home-Visiting (MECSH) model. This model is evidence-based, nurse-led, and can now be found in three states: Vermont, Minnesota, and Wyoming. The goal of the model is to enroll women and families while pregnant and follow the child, as needed, until the age of two. It focuses on the parent becoming self-sufficient sooner, building a positive relationship between the parent and child, and the parent beginning to rely on the community and others as part of the family network. Wyoming PHNs have begun training to switch to this model.

Plan of Safe Care

Wyoming does not currently have a Plan of Safe Care in Place and needs to comply with this federal mandate issued under CAPTA/CARA. The WIHPM sits on a Plan of Safe Care working group (comprised of public health nursing staff, DFS staff, and a nurse champion) that has utilized partnerships with the ASTHO OMNI Learning Community and the Utah AIM OUD safety bundle to not only understand what other states have done to roll out this policy, but to educate providers and nursing staff about Wyoming mandatory reporting laws, CAPTA/CARA laws, and what Wyoming hope to achieve from this plan.

Through this work the Plan of Safe Care working group has sought federal in depth technical assistance with the  National Center on Substance Abuse and Child Welfare. During the drafting of the federal application the working group lead and the possible federal lead presented to the WYPQC. The WIHPM facilitated the presentation and saw many great questions come through from WYPQC members. This presentation created further statewide buy in and interest in an alternative to ensure birthing people can receive the assistance they need and that the rate of infants placed in foster care decreases in Wyoming.

Newborn Screening

The Wyoming Newborn Screening (NBS) Program launched a de-identified, electronic Newborn Screening Report Card to improve quality assurance measures for the program and allow hospitals and consumers to easily obtain this data. By the fall of 2021, this information will be identifiable by hospital.

The NBS Program joined the Association of Maternal and Child Health Programs (AMCHP) Emergency Preparedness Learning Collaborative to create NBS emergency protocols. WY MCH identified this critical need after its then-NBS courier went bankrupt in December 2019, and after the southeast portion of Wyoming was shut down due to a spring blizzard. WY MCH’sCDC Public Health Associate Program (PHAP) assignee has taken on WY MCH’s work within this learning community and successfully brought together partners that had not previously worked together. The NBS video found on the WyomingNBS Program website has been an excellent driver in helping new partners understand why this program is so vital.