Priority: Reduce infant mortality.
Interpretation of Performance Data on NOMs, NPMs, SPM and ESMs:
NPM 5a: Based on 2016 PRAMS data, 79.3 percent of Tennessee mothers surveyed reported placing their infant to sleep on their back. This number represents a slight decrease from our year 3 performance (83.0 percent) and is consistent with the performance for years 2 and 3 (78.0 percent). The year 4 performance fell slightly below the objective of 83 percent, but it did exceed the national percentage for the same year which was 78.0 percent.
NPM 5b: Based on 2016 PRAMS data, 32.0 percent of Tennessee mothers surveyed reported that their baby always or often sleeps alone, usually in a crib, bassinet, or pack and play, and not usually in a standard bed, couch, sofa, armchair, car seat, or swing. Because 2016 was the first year for which the PRAMS data included these questions, it is currently not possible to evaluate Tennessee’s trend over time. Tennessee’s performance was consistent with the 2016 national percentage for this measure (31.8 percent).
NPM 5c: Based on 2016 PRAMS data, 33.0 percent of Tennessee mothers surveyed reported that their baby does not usually sleep with blankets, toys, cushions, pillows, or crib bumper pads. Because 2016 was the first year for which the PRAMS data included these questions, it is currently not possible to evaluate Tennessee’s trend over time. Tennessee’s performance was lower than the 2016 national percentage for this measure (42.4 percent).
ESM 5.1: During year 4, Tennessee Department of Health distributed 311,629 safe sleep educational materials. This number is consistent with the performance for year 3 (317,334) and represents a substantial increase from the performance for years 1 and 2 (226,881 and 257,694, respectively). This significant increase reflects the strategy to connect with new parents and caregivers at multiple touchpoints, including in the Welcome Baby booklet mailed to all parents of newborns.
ESM 5.2: During year 4, 100 percent of eligible infant deaths were reviewed by the child fatality review teams. This percent has been stable for many years, as we have consistently met our objective of reviewing all infant deaths.
ESM 5.3: Based on birth data for state fiscal year 2019 (7/1/2018-6/30/2019), 84 percent of VLBW infants were delivered in Level III or IV birthing facilities. This percentage has remained highly consistent over the most recent four years. The year 4 performance was very slightly below the objective for this year (85 percent).
ESM 5.4: During year 4, 100 percent of newborns with a positive metabolic screen received follow-up to definitive diagnosis and clinical management. This number has remained steady over the past several years, as we have consistently met our objective to follow up with all newborns who have positive metabolic screens.
ESM 5.5: During year 4, 47,597 individuals were served by the TAPPP program, exceeding the objective of serving 46,500 individuals. Performance for this measure increased from year 1 to year 3, reaching a peak of 55,583 individuals in year 3.
Accomplishments and Challenges (based on FY2019 Action Plan)
Strategy 1: Educate parents and caregivers on safe sleep.
Activity 1a: Disseminate safe sleep flyers, door hangers, posters, educational flipcharts and Sleep Baby Safe and Snug board books to hospitals, daycares, Department of Children’s Services, Girl Scouts, Red Cross, generational caregivers and other agencies serving infants.
Report 1a: From October 1, 2018 through September 30, 2019, 311,629 safe sleep educational items were distributed to community partners and infant caregivers. This includes “Sleep Baby Safe and Snug” books to all births in the state, the Welcome Baby book that includes a page on infant safe sleep and all requested materials from community partners such as door hangers and flyers.
Activity 1b: Increase the number of educational materials distributed through the Direct On Scene Education (DOSE) program from 1600 to 1900 by September 30, 2019. Through this activity, first responder agencies and local housing authorities will be provided with packets of safe sleep information and access to portable cribs for families that do not have a safe sleep environment for their infant child.
Report 1b: A total of 2,010 DOSE kits have been distributed by first responder agencies and housing authorities since the inception of the program. Each of the participating agencies also received portable cribs and distributed 159 of them to families who were in need of a safe sleep environment for their infant.
Activity 1c. Increase the number of safe sleep floor talkers placed in stores, clinics, health departments, daycares and other agencies from 800 to 1000 by September 30th, 2019.
Report 1c: A total of 1,419 floor talkers have been placed at health departments, hospitals, child care centers, community centers, grocery stores, housing authorities, and universities.
Activity 1d: Increase the number of WIC parents completing the new safe sleep educational module from 500 to 800 by September 30, 2019.
Report 1d: From October 1, 2018 through September 30. 2019 717 WIC participants completed the online training module, “Help Your Baby Sleep Safe and Sound”. A total of 1,995 participants have completed the module since it was released. There have been 3 additional lessons that also include the infant safe sleep message, Feeding Your Newborn, Getting the Support You Need in baby’s First Weeks and Understanding Your Newborn: Sleep, Crying, and Cues.
Activity 1e: Increase the number of non-birthing hospitals providing safe sleep education from 3 to 10 by September 30th, 2019.
Report 1e: Currently there are 6 non-birthing hospitals disseminating materials.
Activity 1f: Disseminate Spanish and English safe sleep crib card to a minimum of 40 birthing hospitals by September 30th, 2019.
Report 1f: The crib card was offered to all 59 birthing facilities and 35,400 crib cards were distributed to 30 facilities in this FY. A total of 30 facilities are using the crib cards. To increase the number of hospitals using the card, it was modified to meet the needs of Baby Friendly hospitals.
Activity 1g: Engage at least 3 additional local fraternity and sorority chapters to participate in safe sleep education initiatives by September 30th, 2019.
Report 1g: A conference call was held with the founder of the Kappa Alpha Psi fraternity safe sleep initiative. The founder helped with facilitating a relationship with the health and wellness coordinator for the Tennessee state Kappa Alpha Psi. Fraternities and Sororities have been engaged at local universities in Shelby County and Knox County through their local FIMR Community Action Teams.
Activity 1h: Translate a minimum of two safe sleep materials into additional languages and make available on the safe sleep website by September 30th, 2019.
Report 1h: Safe sleep materials have been translated into Spanish, Arabic, Kurdish, Swahili, Somolia, Nepali, and Burmese. These are available at the following website: https://www.tn.gov/health/health-program-areas/fhw/vipp/safe-sleep/safe-sleep-campaign-materials.html
Strategy 2: Review infant deaths through multidisciplinary teams to enhance data collection.
Activity 2a: Provide necessary documents to 34 child fatality review (CFR) teams and 4 fetal and infant mortality review (FIMR) teams to review all infant deaths and collect data on circumstances surrounding these deaths.
Report 2a: The 34 CFR teams are provided with a monthly file of child deaths, and are able to request birth transcripts, death certificates, and autopsy reports to be able to complete reviews. The 4 FIMR teams are provided fetal death certificates to review deaths.
Activity 2b: Provide training to the local CFR teams through quarterly new member webinars and annual in-person education.
Report 2b: New Member orientation webinars are held quarterly October 2018, January 22, 2019, May 15 2019, and July 7, 2019. An in person meeting was held in April 2019 where teams developed prevention plans.
Activity 2c: Provide data quality reports to the local CFR teams to enhance the quality of data collected.
Report 2c: Data quality reports were sent to teams a minimum of monthly starting in March 2019.
Activity 2d: Provide death scene investigation training to first responders to educate on information to be gathered at the scene of an infant death. Training will be provided in-person and online for firefighters, police, EMS and medical examiners. If needed, agencies will be provided with a doll for doll reenactments.
Report 2d: Two trainings were held this year, one in Cookeville, TN and in Memphis, TN. The trainings had approximately 80 participants including law enforcement, fire fighters, EMS, and DCS. Dolls to assist with reenactment were provided to those who needed them.
Strategy 3: Support quality improvement and regionalization efforts to improve perinatal outcomes.
Activity 3a: Fund the statewide perinatal quality improvement collaborative to engage obstetrics, neonatal, and pediatric stakeholders in applying quality improvement methodologies related to perinatal outcomes.
Report 3a: The Department of Health continued to contract with Vanderbilt to coordinate the work of the Tennessee Initiative for Perinatal Quality Care (TIPQC). Under the direction of the Oversight Committee, hospital teams have created and implemented new quality improvement projects, continued with existing projects, collected data to track progress and outcomes, attended learning sessions, and participated in the annual educational conference. This year, TIPQC partnered with hospitals to implement its first ever dual-arm quality improvement project, addressing opioid use disorder in pregnancy and exposure in newborns.
Activity 3b: Provide technical assistance to the Regional Perinatal Centers. The five Regional Perinatal Centers will provide perinatal care for high- risk pregnant women and newborns if no other appropriate facility is available to manage significant high risk conditions. Funding from the state (Medicaid) is used to provide consultation and referral for facilities and health care providers within the respective perinatal region, professional education for hospital staff and for other health care providers within the region, and maternal-fetal and neonatal transport.
Report 3b: During the fiscal year, MCH staff have continued to work closely with the five Regional Perinatal Centers and the Perinatal Advisory Committee. In state fiscal year 2019, the five Centers provided direct care for 4,847 high-risk neonates and 15,606 high-risk maternal patients, and 4,847 hours of education and training were provided to staff at community hospitals to help them prepare for recognizing and treating complex medical conditions. Updates were made to the perinatal social workers educational objectives, regionalization and transportation guidelines, and a new document was created to prepare EMS and non-delivering hospital staff for providing care to high-risk pregnant women and newborns in emergent situations.
Activity 3c: Coordinate the Perinatal Advisory Committee meetings.
Report 3c: The Perinatal Advisory Committee met three times during the federal fiscal year (October 9, 2018, April 11, 2019, and July 11, 2019). Highlights for the year included: analysis of LOCATe survey responses and discussion of results, maternal mortality, pilot testing process to streamline requests to MCOs for back transport, update on implementation of the AIM OUD/OEN bundle, and newborn screening.
Strategy 4: Provide follow-up for abnormal newborn screening results.
Activity 4a: FHW staff will provide follow-up on all abnormal newborn screening results and unsatisfactory tests. Referrals are made to the genetics and sickle cell centers across the state. Access to genetic screening, diagnostic testing and counseling services is available at three comprehensive and two satellite Genetic Centers and two comprehensive and two satellite Sickle Cell Centers for individuals and families who have or who are at risk for genetic disorders.
Report 4a: All babies born in Tennessee are required to be screened for metabolic conditions, hearing, and CCHD by the birthing facility. All newborn screening test results which are abnormal or unsatisfactory are sent to the follow-up staff for action. Providers are contacted and referrals made to the tertiary centers across the state for confirmation testing, counseling, and long term follow-up. During this past year, the State approved adding Spinal Muscular Atrophy (SMA) to the newborn screening panel and monitored screening for X-ALD added the prior year. During the federal fiscal year, the education nurse held 2 BLS/Heart Saver classes, conducted 17 hospital site visits, 11 primary care physician trainings, 2 OB/GYN trainings, 4 local health department trainings, and 2 spinal muscular atrophy (SMA) hospital educational sessions.
Activity 4b: The newborn screening follow-up program will identify infants who did not have a metabolic screen by linking newborn screening data to birth certificate files. A report of those infants will be sent to the birthing hospital for review and follow-up.
Report 4b: Weekly, the program epidemiologist receives a raw birth file received from the Office of Vital Records (OVR) and matches the records to those in the Newborn Screening Database to identify any babies born in the state who did not have a dried blood spot screening test and generate lists of the babies by birthing hospitals. The quality improvement (QI) nurse sends these facilities a report on those babies and informs them of the need for a dried blood spot screening for those babies. Another monthly process is conducted by the program epidemiologist to link the provisional birth file cleaned up by the OVR, which is more complete but less timely in capturing birth events in Tennessee, with the newborn screening records and to identify infants who did not receive one or more of the three types of newborn screening – i.e., dried blood spot, hearing loss and critical congenital heart disease. The QI nurse sends a list of babies without a screening to the birthing facilities and asks for information on screening to be reported back to the state, and if not screened why, and these records are tracked to assure a response is received. In addition to the weekly and monthly lists of babies who missed screening, a summative report is sent to the birthing or collection hospitals on the indicators related to the completeness and timeliness of newborn screening for their facilities. Site visits were made to hospitals which requested training and/or assistance and to those with metrics not reaching the standard criteria for age at collection, unsatisfactory rate, or transit time to the Lab. TDH received a grant that will also facilitate the implementation of the OZ system to track in real time collection, transport, and reporting of results for TDH and birth hospitals.
Activity 4c: FHW staff will plan and facilitate three face-to-face meetings of the Genetics Advisory Committee.
Report 4c: The Genetics Advisory Committee met three times during this past federal fiscal year (November 28, 2019, April 25, 2019, and August 15, 2019). Much of the work centered on laboratory and follow-up procedures for adding SMA to the newborn screening panel, including creating procedures, validating tests, determining appropriate follow-up to prepare for implementation in January 2020.
Strategy 5: Reduce unintended pregnancies.
Activity 5a: The Family Planning Program will provide comprehensive family planning services, including medical examinations, laboratory tests, education and counseling, and contraceptive supplies.
Report 5a: The TFPP provides comprehensive services in 124 clinics across the state of TN. In CY2018 the program served 74,027 unduplicated clients (69,009 females and 1,683 males). The program provides clinical services in all 95 Tennessee counties, with emphasis on the adolescent, low income, medically underserved, and black populations. Services are targeted to those reproductive age persons who lack access to traditional medical care and for those who have no other financial resources for family planning and contraceptive supplies, which puts them at high risk of an unintended/unplanned pregnancy.
Activity 5b: Prevent adolescent pregnancies through a comprehensive, community-wide, collaborative effort that promotes abstinence, self-respect, constructive life options, and responsible decision-making about sexuality, healthy relationships and the future. These efforts are accomplished by: providing networking opportunities such as workshops and conferences for adults, professionals and parents; conducting community education and awareness activities for students, parents, and providers through classes in schools and community agencies; and disseminating pregnancy prevention material at clinics, malls, libraries, health fairs and community events.
Report 5b: The TN Adolescent Pregnancy Prevention Program (TAPPP) provided risk reduction and pregnancy prevention education to students, ages 10-19, in both during and after school settings. From July to September 2019, 322 TAPPP activities were done. 117 students attended sessions on abstinence, 58 attended self-respect, 81 positive youth development, 117 healthy relationships, , and 114 risky behaviors. 496 parents/guardians and 453 community professionals attended education and training sessions. There was 35,067 residents that attended community events, health fairs, and awareness education sessions.
Activity 5c: The abstinence education program will continue to encourage youth to participate in community service learning projects. The service learning experience improves the adolescent’s knowledge of global and local societal needs, encourages unity among participants, incorporates community activities that enhance personal growth and accomplishments and fosters asset building, positive self-worth and healthy decision making.
Report 5c: TAPPP encourages students to get involved in community initiatives as well as create innovative ways to bring impact. TAPPP provides funding to twelve community serving agencies that focus on sexual risk avoidance education (SRAE) via CDC funding. Each agency plans at least ten hours of service learning projects. The agencies reported 105 students active involvement in 356 hours of service. A few of the projects included: Reading Buddies, community clean-up, Meals on Wheels, holiday cards and care packages to nursing homes and first responders, National Day to Prevent Teen Pregnancy events, creation of posters for Sexual Assault Awareness month and suicide prevention, and participation in the statewide Red Sand Project highlighting human trafficking as a public health concern.
Activity 5d: The Tennessee Adolescent Pregnancy Prevention Program (TAPPP) will continue to utilize county and regional level health educators to provide school and community education. The program activities will cover topics such as community awareness of teen pregnancy, family life education, comprehensive sexuality education, professional training, abstinence education, healthy relationships, asset building in youth and adolescent growth and development.
Report 5d: TAPPP health educators are present in all 95 counties of the state. The educators planned and facilitated 58 community events and held 52 health council meetings and planning sessions. The educators were also responsible for providing 172 community/school education sessions, with 14 geared specifically to parents and 24 geared to professionals. These events all focused on a component of TAPPP and was designed to equip attendees with the tools necessary to make the most informed decision when placed in a situation that would place their loved one, child, student, or themselves at risk.
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