Priority Need: Prevent Infant Mortality

 

NPM 3: Risk-appropriate Perinatal Care

 

Perinatal Regionalization

Perinatal services are focused on the health of women and babies before, during and after birth. The Georgia Perinatal-Infant Health program aims to assure pregnant women in Georgia every opportunity to access comprehensive perinatal health care services appropriate to meet their individual needs. DPH is committed to providing access to high-quality perinatal care to Georgians and recognize that there is a direct relationship between perinatal birth outcomes and the quality of health care services. Perinatal regionalization is a strategy to improve maternal and perinatal outcomes by establishing a network that supports patient transfers and increases the accessibility of perinatal specialty care. Perinatal regional systems assign hospitals a risk-appropriate level and support high-risk infants being born in facilities with higher levels of care.

 

The number one cause of infant mortality in Georgia are disorders related to preterm birth and low birth weight. In 2017, the Infant Mortality Rate for Georgia was 7.2 per 1,000 live births. Research indicates that ensuring that high-risk pregnant women and newborns receive risk-appropriate care can reduce maternal and infant morbidity and mortality.

 

Perinatal regionalization is a strategy to improve maternal and perinatal outcomes by establishing systems designating where infants are born or transferred according to the level of care they need at birth. Regionalized systems assign hospitals risk-appropriate levels and ensure high-risk infants are born in facilities with appropriate technology and specialized health providers. The impact of appropriate level of care on maternal/perinatal health outcomes is great as low birth weight or premature infants born in risk-appropriate facilities are more likely to survive.

 

During the reporting period, the Regionalized Perinatal Center (RPC) Clinic survey was completed to gain baseline knowledge of each RPC Developmental Clinic resources, processes and services. An initial conference call with all Developmental Clinic Medical Directors and staff was conducted with the purpose to assess operational needs, define outcome measures and create an action plan for the RPC Developmental Follow-Up Clinics.

 

SPM 4: Breastfeeding

 

Breastfeeding

Georgia 5-STAR Hospital Initiative is a program that was implemented to encourage hospitals to take steps toward becoming breastfeeding-friendly and achieving the “Baby Friendly” designation. In the reporting year, the Georgia 5-STAR program worked to review the current Georgia 5-STAR program offerings and past support provided to hospitals. Women’s Health developed more support materials to assist hospitals in evaluating their progress on the Ten Steps to Successful Breastfeeding-Georgia 5 STAR journey and revised the training programs as suggested by the review.

 

Support materials were developed to include: Policy Evaluation Tool, examples of Infant Feeding policies from some of Georgia’s designated Baby-friendly hospitals, Step 1 Policy Audit Tool, and Audit/Interview Tools for Steps 2 through 10.

 

In order to provide the training to more hospital staff, trainings were offered at the hospital to train a team of hospital staff who would then lead the Georgia 5-STAR journey at their hospital. Three levels of Technical Support Workshops (TSW) were identified:

 

TSW Level 1: Recommended for newly engaged or re-engaging hospitals needing to establish/re-establish a team to lead the Georgia 5-STAR Initiative. TSW Level 1 provides the 15 required Baby-Friendly sessions and provides Tran the Trainers training for attendees to lead the Georgia 5-STAR Initiative at their respected hospital.

 

TSW Level 2: Recommended for hospitals with an established team and actively working through the Ten Steps. Required Baby-Friendly sessions are provided for staff and teams are trained on the use of audit/interview tools. DPH interviews staff and patients.

 

TSW Level 3: Recommended for hospitals that have implemented the Ten Steps and desire third party assessment of Steps 2-10. A Mock Survey is conducted on site with staff and patient interviews are completed.

 

There are currently 16 Baby-Friendly hospitals in Georgia.

 

SPM 3: Rate of Congenital Syphilis

 

Congenital Syphilis

The STD Office’s mission is to prevent STDs by providing quality intervention strategies, programmatic support and education to all throughout the state of Georgia. With a focus on Congenital Syphilis, the STD team works to promote first and third trimester testing for HIV and Syphilis, as well as improve the data quality of congenital syphilis. The STD Office works to improve the identification of pregnant females with syphilis to ensure timely and appropriate treatment.

 

In 2017, a total of 1,489 cases of primary and secondary syphilis were reported in Georgia. This is a 139-case increase from the previous year. When compared to other states in the U.S. Georgia ranked 4th in reported primary and secondary syphilis. In the MCH population, there were 23 congenital syphilis cases out of 129,158 Georgia resident births. In 2018, there were 21 congenital syphilis cases out of 128,727 Georgia resident births.

 

The STD section provided the following activities to promote prenatal testing during the first and third trimesters:

District Education

• Congenital Syphilis All Day Training for district staff (Feb 15, 2018)
• August District Site Visit (Nov 28, 2017)
• Columbus District Site Visit (July 19,2018)
• Dalton District Site Visit (Sept 27, 2018)
• Dekalb District Site Visit (June 4, 2018)
• Dublin District Site Visit (May 16, 2018)
• Fulton District Site Visit (Sept 10, 2018)
• Lagrange District Site Visit (Sept 13, 2018)
• Lawrenceville District Site Visit (Aug 16, 2018)
• Macon District Site Visit (July 18, 2018)
• Rome District Site Visit (Sept 27, 2018)
• Congenital Syphilis Case Review Board (Feb 22, 2018)
• Congenital Syphilis Case Review Board (April 26, 2018)
• Congenital Syphilis Case Review Board (June 28, 2018)
• Congenital Syphilis Case Review Board (Aug 23, 2018)
• Rapid Syphilis Testing Training (July 13, 2018)

Community Outreach

• World Changers Health Fair (April 21, 2018)
• Center for Black Women’s Wellness Annual Health Fair (Nov 11, 2017)
• Fulton-Dekalb Health Summit (Oct 17, 2017)
• Latino Health Fair (Oct 14, 2017)
• Women's Empowerment Summit (June 19-24, 2018)

Provider Outreach

• Georgia Academy of Family Physicians Annual Meeting (Oct 25-28, 2017)
• Georgia Academy of Family Physicians Webinar on CS (April 25, 2018)
• Georgia Academy of Family Physicians Annual Scientific Assembly Meeting (June 14-17, 2018)
• Georgia Perinatal Association Annual Conference (Sept 18-21, 2018)

Other activities

• Developed a Congenital Syphilis Review Board Guidelines (April 2018)
• Congenital Syphilis Media Campaign (May 2018)
• Disseminated Dear Colleague Letter on CS signed by Commissioner (Feb/March 2018)
• District STD staff
• HIV Linkage Coordinators
• Georgia Academy of Family Physicians
• Georgia OBGyn Society

 

SPM 4: Neonatal Substance Abuse

 

Neonatal Abstinence Syndrome

NAS became in a reportable condition in Georgia in January 2016. In the reporting year, Women’s Health provided oversight and management of the NAS surveillance process in close collaboration with MCH Epidemiology and birthing hospital staff. Cases were verified by MCH Epidemiology staff through review and confirmation of case indicators. Georgia’s case criteria for a confirmed case of NAS is: (1) presence of one or more clinical symptoms of NAS and/or (2) a positive infant substance test result.

 

In January 2018, the Neonatal Subcommittee of the GaPQC began working on a quality initiative to impact the growing incidence of NAS. The committee developed a baseline survey for birthing hospitals to determine current practices around NAS diagnosis and treatment. The survey was piloted in four hospitals during March 2018 and was provided to all birthing hospitals in April 2018.

 

In 2017, 1,053 suspected NAS cases were reported with 762 determined to meet the case definition of NAS. Among the 762 cases, 59% were reported to have the signs/symptoms consistent with NAS (with or without positive toxicology screening results), while 41% had positive toxicology only.

 

Infants born to mothers who were 15-29 years of age, especially 25-29 (7.0 per 1,000 live births), and Non-Hispanic Whites (8.6 per 1,000 live births) had the highest rates of NAS. Small metropolitan, metropolitan and non-core counties had higher NAS rates than large and medium metropolitan counties (17.5-19.8 vs 9.9-13.0 per 1,000 live births, respectively). Hospital charges and length of stay increased substantially for infants with NAS compared with non-NAS newborns in the nursery. Charges and length of stay differed by $12,500 and nine days for infants with NAS.

 

The Oral Health Program helped lead the Georgia Oral Health Coalition meeting with about 30 attendees representing DPH Oral Health District Programs, CHOA, accredited Georgia Dental Hygiene Programs, child advocacy organizations such as Georgia Voices, The Council on Aging, Emory University, the Georgia Tobacco Program, and Medicaid payers. Updates were given from the various organizations. Dr. Karen Howell from the Emory Center for Maternal Substance Abuse and Child Development spoke about substance abuse during pregnancy and the effects on the developing fetus.

 

Other Perinatal/Infant Health Programs

 

Newborn Screening

Georgia Newborn Screening (NBS) is a six-part preventative health care system designed to identify and provide early treatment for 31 inherited disorders that would otherwise cause significant morbidity or death, including 29 disorders detectible through blood, hearing loss, and critical congenital heart disease (CCHD). The NBS systems is comprised of six major components to ensure every newborn in Georgia receives adequate screening for these 31 conditions and infants that screen positive for a condition receive appropriate and timely follow up. The six components of the system are: 

 

1.               Education: of parents and health care providers 

2.               Screening: universal testing of all newborns 

3.               Follow-up: rapid retrieval and referral of the screen-positive newborn 

4. Medical Diagnosis: confirmation of a normal or abnormal screening test result by a private physician or tertiary treatment center 

5.               Management: rapid implementation and long-term planning of therapy 

6. Evaluation: validation of testing procedures, efficiency of follow-up and intervention, and benefit to the patient, family, and society. This includes consideration of adding other tests to the system as indicated by appropriate research and scientific evidence. 

 

The NBS program is responsible for the administration of the NBS system, including educating families and practitioners about NBS, overseeing the follow up process for infants that screen positive for conditions identified via NBS, monitoring and evaluating the NBS system and reporting to state and federal officials and to the public.

 

Emory University, Augusta University, and Children’s Healthcare of Atlanta are contracted to conduct short-term follow-up on abnormal NBS results. NBS short-term follow-up encompasses the time between receiving an abnormal result to the confirmation of a diagnosis. Each contractor utilizes a database to track newborns during the short-term follow-up process which includes a minimum of twelve steps to locate and recall infants who screen positive for a condition identified by NBS. All diagnosed cases are referred to C1st, the single point of entry for public health services, which leads to an assessment to determine the newborn’s eligibility for IDEA Part C, BCW, CYSHN or CMS.

 

The NBS program provides education to both parents and health care providers. The program makes information available to parents in hospitals, providers’ offices, and health departments prior to the completion of NBS through informational brochures. The NBS program educates health care providers on the NBS system through the Georgia Newborn Screening Policy and Procedure Manual, which was provided in print to each birthing hospital and health district office and is also available electronically through the NBS website. The NBS Policy and Procedure Manual outlines the processes and regulations for specimen collection, submission, and reception of results. The NBS Clinical Coordinator also provides technical assistance related to specimen collection and submission to hospitals and birthing facilities through telephone consultations and in-person trainings as needed. 

 

The NBS program also maintains a database, State Electronic Notifiable Disease Surveillance System (SendSS), through which each hospital can access its NBS specimen report. The specimen report displays a list of unsatisfactory specimens and the reason(s) that each screen was declared unsatisfactory. The report includes statistical measures of the hospital’s performance as it relates to national benchmarks.

 

The NBS system included provision for children to receive therapies beyond the newborn period. In collaboration with Emory University, the NBS program provides medical foods and low-protein modified foods to children and adults who would otherwise be unable to access those treatment modalities due to cost. The NBS program also provides telehealth and outreach clinics for children and adults with sickle cell disease and other clinically significant hemoglobinopathies through a collaboration with Augusta University. The NBS program also supports the Comprehensive Sickle Cell Center at Grady Memorial Hospital, a 24/7 comprehensive primary care center for adults with hemoglobinopathies. Additionally, the NBS program contracts with The Sickle Cell Foundation of Georgia, Inc. to provide Community Partners, which are responsible for completing a needs assessment, a transition assessment if appropriate, identifying medical homes, and providing resource referrals to clients with clinically significant hemoglobinopathies. 

 

The Georgia Newborn Screening and Genetics Advisory Committee (NBSAC) is a multidisciplinary group of over 15 professional and consumer representatives with knowledge and expertise in NBS programs. In the reporting year, the NBSAC convened a meeting to discuss, among other agenda items, whether to recommend three disorders for inclusion on the Georgia NBS panel. These conditions were nominated during the previous NBSAC meeting held in September 2017. Spinal Muscular Atrophy (SMA), which was added to the national Recommended Uniform Screening Panel by the Secretary of the US Department of Health and Human Services was nominated to the Georgia NBS panel during the February 2018 NBSAC meeting as well. The NBSAC voted to recommend SMA for inclusion on the Georgia NBS panel. The NBSAC has established workgroups, including the long-term follow-up workgroup and the hemoglobin workgroup. The long-term follow-up workgroup met on October 3, 2017 and November 6, 2018. The hemoglobin workgroup met on November 17, 2017, February 2, 2018, April 27, 2018, and July 13, 2018. 

 

The NBS program worked with Emory University to hire a long-term follow-up coordinator for metabolic disorders. The long-term follow-up coordinator gathered input from internal and external stakeholders to create a subsection on the Emory NBS database to collect information on specific variables after a child is diagnosed with a NBS disorder to allow for longer-term tracking of NBS outcomes to enhance program evaluation and inform decision-making. The long-term follow-up workgroup, a subgroup of the NBSAC, discussed possible initiatives around this project during the meetings held on October 3, 2017 and November 6, 2018.

 

The NBS program has continued to collaborate with the  Georgia Public Health Laboratory (GPHL) to develop policies, procedures, budgets, data exchange, evaluation, and education. The GPHL completed a system update that allows hearing and CCHD results to be fully integrated into the existing data entry system. Hearing and CCHD data is now entered at the same time, on the same module, and by the same clerk as the rest of the information on the NBS card unifying and streamlining all NBS information. Since that time, the NBS program has conducted ongoing training and technical assistance to GPHL data entry staff as well as project evaluation to ensure accuracy and efficiency of hearing and CCHD results entered into the NBS database.

 

The NBS program has conducted several educational activities aimed at increasing awareness around the NBS system to providers as well as improving specimen collection techniques. The NBS program engaged pediatricians and their staff directly while exhibiting during GA AAP’s fall and spring meetings. GA AAP holds two meetings in the fall and spring of each year. The meetings target key staff within a pediatric practice including the pediatricians and the nurse managers. Each meeting provides NBS program staff at the state office an opportunity to interface with key members of a pediatric practice and tailor messaging to their role within the practice. NBS staff exhibited during fall meetings held on October 13, 2017, November 2, 2017, September 14, 2018 and the spring meeting held on April 20, 2018. The NBS program developed and mailed postcards to each birthing hospital and birthing center to report the number of babies each organization screened and identified in 2016. The NBS program also exhibited at the Georgia Academy of Family Physicians (GAFP) Annual Fall Meeting as well as the GAFP Summer CME meeting.

 

Zika Prevention

Arboviral

In July 2017, DPH’s Zika testing guidelines were changed to match CDC’s new recommendations. The changes made to the guidelines at that time are still in effect. Under these guidelines, only symptomatic patients are approved for Zika testing through GPHL. Exceptions include asymptomatic pregnant women who have a fetus with an anomaly and/or are uninsured. As a result of the change in guidelines, the number of patients approved for Zika testing at GPHL has significantly decreased. Since January 2016, Zika surveillance efforts in DPH epidemiology have identified 120 travel associated cases of Zika in Georgia citizens, with the last confirmed case identified in October 2017. To date, there has been no local transmission of Zika in the state of Georgia.

 

ZIKA

In the reporting year, the Zika Pregnancy Registry (ZPR) Coordinator managed the investigation of pregnant women and infants identified to have laboratory evidence of Zika virus through GPHL testing or commercial lab testing. Data was uploaded and reported monthly to the CDC US Zika Pregnancy Registry Team.

 

Potential cases were identified from three sources, including the ZAMS, and ZPR. Electronic birth certificates (eBCs) constituted the largest (73%) reporting source. However, birth defects reported on eBCs require confirmation through medical record review, per guidelines from CDC Zika Birth Defects Surveillance (CDC-ZBDS) and the National Birth Defects Prevention Network (NBDPN). Record requests involved mailing or faxing facilities, as well as calling facilities to ensure receipt of requests; determine which types of records are needed; and situate our efforts within the context of state and federal privacy laws. Through this effort, we have fostered relationships with these facilities, as well as drawn attention to the need for birth defects reporting, established a protocol for tracking records from initial requests through confirmation, referral to early intervention services, and reporting out to CDC.

 

The Zika Birth Defects epidemiologist (ZBDE) has been dedicated to this effort full-time since November 2016. The Zika Epidemiologist and the ZBDE have been collaborating to initiate medical record requests, review records for confirmation of reported birth defects, and abstract confirmed records since March 2017. In November 2017, an additional part-time epidemiologist was hired to conduct the record requests and build relationships with reporting facilities, as well as help review and abstract records. Once received, reviewed, and confirmed, the abstracted records were linked with confirmed cases from the Metropolitan Atlanta Congenital Defects Project (CDC-MACDP) and reported to CDC-ZBDS monthly.

 

Without these efforts, 299 infants with true birth defects, including 155 infants with Zika-associated birth defects, could have been missed. Zika birth defects surveillance has also given Georgia DPH the opportunity to develop a Birth Defects Registry. This registry will connect 17 reporting sources, including eBCs and ZAMS/ZPR; expedite referral of affected infants and their families to early intervention services; and facilitate standardized, timely, reporting and confirmation of birth defects statewide. Flexibility is inherent to the design of the registry and will greatly enhance Georgia’s capacity to respond to emerging teratogens.

 

Safe Sleep
The Georgia Safe to Sleep Hospital Initiative, as part of the Georgia Safe to Sleep Campaign, is a statewide initiative designed to raise awareness about sleep-related infant deaths and evidence-based sleep practices to prevent infant mortality. The hospital initiative was launched in May 2016 to prevent infant sleep-related deaths in Georgia, empower professionals in multiple disciplines to educate parents about safe sleep environments and ensure they see proper sleeping practices modeled in hospitals. The Georgia Safe to Sleep Campaign provided tools and resources that strengthened policy, provided consistent education to change infant sleep environments to prevent infant sleep-related deaths, empowered professionals to educate parents, empowered families to make informed decisions about infant sleep, and increased access to resources that support behaviors that protect infants from sleep-related deaths. MCH continued to work with participating birthing hospitals to meet the goals of the program.

 

Recognition of hospitals who completed all aspects of the program continued on a quarterly basis. In the reporting year, 100% of the 79 birthing hospitals throughout the State of Georgia participated in the Safe Sleep Hospital Initiative. The Safe to Sleep Program provided quarterly recognition of birthing hospitals that have completed all parts of the Safe to Sleep hospital program. Efforts to track hospital submissions of requirements and ongoing trainings and follow up for staff continued as well as the distribution of quarterly gown shipments, yearly safe sleep book shipments and twice a month bassinet shipments. MCH designed, developed and implemented the “floor talker” opportunity with 148 floor talkers sent to locations throughout Georgia with specific focus on the areas with the highest rates of sleep-related infant mortality from 2006-2016.

 

Family and Community Support Services

Georgia continues its commitment to implement comprehensive, community-based maternal and early childhood programs to include evidence-based home visiting (EBHV) programs in nineteen counties determined by the 2010 Needs Assessment (Bartow, Brooks, Catoosa, Chatham, Clarke, Clayton, Crisp, DeKalb, Dooly, Echols, Fulton, Flynn, Houston, Liberty, Lowndes, Muscogee, Richmond, Rockdale, and Whitfield). Since 2010, Georgia has instituted a comprehensive, high quality, community-based maternal and early childhood system, with EBHV as the major service strategy for improving child and family well-being. The framework seeks to assure the well-being of families with young children by identifying all expectant parents, children birth to five and their families, offering a comprehensive screening to determine strengths and needs, and linking families to community services and supports, including EBHV.

 

Extensive research has shown the effectiveness of EBHV in improving outcomes for maternal/child health, home and child safety, school readiness, family safety, family economic self-sufficiency, referrals and linkages to community resources. Through combined Title V and MIECHV service strategies the Family and Community Support Services program provides pregnant women and families, particularly those considered at-risk, necessary resources and skills to raise children who are physically, socially, and emotionally healthy and ready to learn.

 

EBHV programs available in Georgia are as follows: Early Head Start - Home Based Option (EHS-HBO), Healthy Families Georgia (HFG), Nurse-Family Partnership (NFP) and Parents as Teachers (PAT).

 

During the reporting period:

• 24,042- home visits were completed
• 2,016- families were served
• 984- new families were enrolled into Georgia Home Visiting

• 2,459 children completed the child development screening Ages and Stages Questionnaire (ASQ)
• 8, 291 First Step screens were completed
• 5,946 community referrals were made for services
• 824 maternal depression screenings were completed-181 screened positive (22%) and of those, 155 were receiving services or a referral was made.

 

Georgia completed the data system migration with Social Solutions to update the existing data system to the new ETO platform which is a robust system that provides the infrastructure and scalability needed to effectively manage the data, share information and track progress in a secure environment.

 

Home Visiting Institute: The Annual Georgia Home Visiting Institute (HVI) was held at the Wyndham Peachtree Hotel and Conference Center in Peachtree City, Georgia. The theme for this event was The Magic of Home Visiting. The event featured a plenary session speaker, Eric Anderson, six breakout sessions and vendors. Mr. Anderson, a magician and motivational speaker whose high-energy presentation entitled The Magic of Attitude combined illusions with a motivational speech about his rise to success after enduring a childhood filled with obstacles. Georgia Home Visiting Institute provided high quality training for 311 of Georgia’s home visitors, supervisors, community outreach staff and family support staff to develop and enhance core competencies critical to their work. The HVI addressed strategies to improve the quality and effectiveness of home visiting services, with an emphasis on supporting healthy infant/toddler development and parent-child relationships and developing skills necessary for establishing, building and enhancing relationships with families.

 

Continuous Quality Improvement: Continuous Quality Improvement (CQI) is beneficial for home visiting programs in many ways. CQI is a systematic approach to specifying the processes and outcomes of a program or set of practices through regular data collection and the application of changes that may lead to improvements in performance. The CQI approach helps home visiting programs to measure processes and outcomes; incorporates new knowledge and practices in a data-driven manner; highlights training and technical assistance needs; helps monitor fidelity of program implementation; provides rapid information on a small scale about how change occurs; helps identify key components of effective interventions; and empowers home visitors and program administrators to seek information about their own practices. CQI has the potential to be transformative for programs and is a terrific opportunity to improve upon everyday practices in small ways that result in large gains in program efficiency and service delivery. During this period focus was on family engagement. Family engagement is key to the success of home visiting programs. Family engagement is also a challenge for home visiting programs not just in Georgia but nationwide. Historically Georgia has seen a high number of families who enroll in home visiting but exit services after one home visit. CQI efforts focused on family engagement and four goals:

 

1. Increase the number of families who remain active in home visiting for greater than three months;
2. Increase the number of expected home visits received by families enrolled in home visiting;
3. Increase the number of families who receive a face-to-face contact within 14 days of referral to home visiting; and
4. Increase the number of families who remain active inhome visiting for greater than one month.

 

Program managers from all Healthy Families programs met monthly to discuss their progress on their projects and shared best practices with the support of Georgia’s CQI Lead. At a previous Home Visiting Institute, Local Implementing Agencies (LIA) participated in a poster session where all attendees had the opportunity to view their posters, learn about their CQI projects and innovations that resulted from their testing and utilize the examples of best practices for use in their own programs.

 

Current Year: Oct 2018 – Sept 2019

 

Priority Need: Prevent Maternal Mortality

 

NPM 3: Risk Appropriate Perinatal Care

 

Maternal and Neonatal Levels of Care

In the current year, House Bill 909-Creation of DPH Perinatal Facilities was signed into law to allow DPH to define and designate Perinatal Facilities in Georgia. The Bill’s goal is to improve perinatal outcomes by providing more structure to risk appropriate care. In July 2019, hospitals can request levels of care designation for maternal and/or neonatal. Maternal and/or neonatal designation will increase consistent application of national recommendations for levels of care and facilities recognition of their risk level capacity.

 

The Women’s Health team met with several states who have implemented levels of care verification programs and national organizations promoting levels of care to learn about best practices and lessons learned. The Neonatal Subcommittee and the Maternal Subcommittee completed their recommendations on the criteria for Levels I-III. The subcommittees used the recommendations from the American Academy of Pediatrics, the American College of Obstetrics and Gynecology and the Society for Maternal Fetal Medicine as a model. They also considered additional requirements put in place by other states. The recommendations are being drafted into regulations for the Advisory Committee to review.

 

The Maternal and Neonatal Advisory Council approved a final version of the requirements for each level of maternal and neonatal care. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists provided input into the document. This language was submitted to the General Counsel and will be posted for public comment in April 2019. A Site Visit Workgroup was established with ten people representing medical, nursing, and administration leadership in various birthing hospitals. The workgroup approved the site visitor requirements and application process, and the site visit agenda. The Georgia General Assembly appropriated $152,826 to pay for training costs and stipends for the site visitors.

 

Related legislation: In 2018, the Georgia General Assembly passed HB909 which authorizes DPH to designate hospitals for maternal and neonatal care. The legislation was signed into law and became effective July 1, 2018.

 

Challenges/barriers: DPH will need to receive an appropriation in the FY2020 state budget to fund the site visits. Hospital acquisition by large healthcare organizations and growing numbers of specialty level of care in the metro area provides challenges to the regional system.

 

Perinatal Regionalization
To strengthen the system of regionalization, there has been continued work on increasing communication with RPC stakeholders to include meetings with RPC medical directors and outreach educators as well as conference calls with finance staff and data coordinators.

 

During the current year, annual site visits were completed at Memorial Health University Medical Center (Savannah), Grady Memorial Hospital (Atlanta) Phoebe Putney Memorial Hospital (Albany), and Medical Center, Navicent Health (Macon). RPC Contract amendments were provided to Contractors and fully executed. Outreach Educator meetings were held each quarter with presentations on the following programs: Babies Can’t Wait, Children’s First and Children Medical Services provided. Educators will update the Hospital Assessment Checklist as their project for FY 2019. This checklist is completed by Outreach Educators when they conduct site visits with birthing hospitals within their region to ensure that they are complying with the standard of care as defined by their level of care designation. A combined Medical Director and Outreach Educator meeting was held and Levels of Care Updates, GaPQC updates and Developmental Clinic Performance Measures were discussed.

 

NPM 4: Breastfeeding

 

Breastfeeding

In the current year, MCH provided technical assistance to hospitals by phone, emails, and in person visits. Individualized Technical Support Workshops with hospitals that have submitted applications to the program were provided. These workshops are a platform to provide a more individualized approach to aid hospital staff in overcoming their specific barriers to implementing the ten steps in their facility.

 

In collaboration with the American Academy of Pediatrics- Georgia Chapter, DPH delivered the Educating Physicians in Their Communities (EPIC) breastfeeding program, a physician peer-to-peer training program that provides breastfeeding education to physician’s offices, hospitals and residency programs, and distributes information on how to access lactation support services in the community and free resources for patient education. During this reporting period, 29 EPIC breastfeeding programs were administered. MCH partnered with WIC to provide breastfeeding educational trainings to all DPH staff including nurses, peer counselors, breastfeeding coordinators, nutritionists, and administrative staff. The team hosted breastfeeding trainings on “How much milk does mom need to express for baby?” and “Maternal Mental Health and Breastfeeding”.

 

SPM 3: Rate of Congenital Syphilis

Congenital Syphilis

During the reporting year, Syphilis During Pregnancy was added to the Notifiable Disease List. The promotion of first and third trimester testing for HIV and syphilis continued. Efforts to provide education through trainings, community outreach, provider outreach, and district STD staff continue to be a priority.

 

The following outreach and education activities were provided:

Current Activities:

District Education

• Congenital Syphilis Case Review (Oct 25, 2018)
• Congenital Syphilis Prevention Training Session (Dec 19, 2018)
• Savannah District Site Visit (Oct 20, 2018)
• Waycross District Site Visit (Oct 29, 2018)
• Congenital Syphilis Case Review (Feb 21, 2019)

 

Community Outreach

• Healthy Mothers, Healthy Babies Conference (Oct 22-23, 2018)
• Center for Black Women’s Wellness (Nov 10, 2018)

 

Provider Outreach

• Georgia Medicaid Fair (Nov 7, 2018)
• Georgia Academy of Family Physicians Annual Scientific Assembly Meeting (Nov 7-10, 2018)
• Navicent Medical Center Grand Rounds (April 11, 2019)

 

Policy/Legislation

• Syphilis During Pregnancy was added to the Notifiable Disease List (2018)

 

Priority Need: Prevent Maternal Substance Use

 

SPM 4: Neonatal Substance Abuse

 

Neonatal Abstinence Syndrome

In the current year, MCH continued passive and active NAS surveillance and reporting which included the completion of the 2017 NAS Surveillance report. Preparation of the annual 2018 Surveillance Report began. MCH collaborated with the GaPQC to launch the NAS QI initiative statewide and participated in the Statewide Opioid Strategic Plan Work Group, specifically the Maternal Substance Use Work Group. Collaborations with professional organizations to increase awareness of NAS and reporting requirements, including those of Plan of Safe Care continued.

 

The VON NAS Universal Training Initiative was launched through GaPQC to standardize care given by interdisciplinary teams to infants with NAS, increase the quality of care provided, and decrease health care costs associated with unnecessary length of stay and pharmacological treatment. Forty-two hospitals enrolled in the initiative, including eight hospitals that are new to GaPQC. Hospitals have received their welcome packets and are currently working to complete participant agreements, IRB approval, and compile the list of individuals in their hospital who will need access to the VON Learning Management System.

 

Related legislation: O.C.G.A. §31-12-2 (2017) Statutory reporting requirement for NAS

 

Challenges/barriers: Lack of national standard definition for NAS potentially affects data quality and ability to set benchmarks.

 

Other Perinatal/Infant Health Programs

 

Newborn Screening

In the previous fiscal year, the former DPH Commissioner added three new conditions, Pompe Disease, Mucopolysaccharidosis Type I (MPS I), X-linked Adrenoleukodystrophy (X-ALD) to the state newborn screening panel. In December 2018, an additional condition, Spinal Muscular Atrophy, was added to the state universal screening panel based on the rigorous review of the condition by the Newborn Screening and Genetic Advisory Committee (NBSAC) and subsequent recommendation to include the condition on the state panel. During the legislative session, DPH requested and allocated funds to support the implementation of universal screening for four new conditions early in the next fiscal year. To educate hospitals and pediatricians about the new conditions, the newborn screening program will host a webinar through AAP on the new conditions included on the state panel. The program will also issue memos to hospitals, pediatric providers and public health staff.

 

In November 2018, The NBSAC held an ad hoc meeting during which Congenital Cytomegalovirus (cCMV) Screening was nominated to the state newborn screening panel. The NBSAC established a workgroup to review the condition and the implications of adding cCMV to the state panel. The work group included the parent of a child with a condition identified through newborn screening, a pediatric infectious disease physician, a pediatric neurologist, a cCMV laboratory expert, and Georgia newborn screening laboratory director, clinical coordinator, and lead follow-up nurse. The work group met monthly for a six-month period and reviewed cCMV based on standard criteria outlined in Rules and Regulations that guide the addition to new conditions to the state panel and criteria used by the Advisory Committee on Heritable Disorders in Newborns and Children within the Health Resources and Services Administration.

 

In February 2019, the NBSAC held a regularly scheduled semi-annual meeting. During the meeting, the Guanidinoacetate Methyltransferase (GAMT Deficiency) work group presented the outcomes of the extensive review they conducted regarding adding GAMT to the state newborn screening panel. The work group concluded that GAMT meets many of the criteria required for inclusion on the newborn screening panel including a clear benefit to detection and treatment in the newborn period. However, the work group noted that further inquiry into the best method to detect GAMT through blood spot screening and the implications for the newborn screening follow-up process is needed. The work group recommended a pilot study be conducted to further investigate the implications GAMT screening. The NBSAC voted in favor of this recommendation pending the availability of funding to support a pilot study.

 

Georgia Department of Public Health’s newborn screening program continues to develop and implement strategies to consistently engage birthing centers and hospitals around the importance of newborn screening and the impact of high-quality specimen collection. The Newborn Screening program developed and disseminated a brief instructional video reviewing necessary techniques for quality newborn screening specimen collection. The video is posted on the newborn screening website and all newborn screening specimen collectors were made aware of the video through blast communication. During the current year, newborn screening specimen quality for all birthing facilities is monitored by the Newborn Screening program.

 

The newborn screening program and laboratory staff are preparing for universal screening for the four new conditions recently added to the state NBS Panel - Pompe Disease, Mucopolysaccharidosis Type I, X-linked Adrenoleukodystrophy and Spinal Muscular Atrophy. Program staff are working on strategies to educate families and providers about the new conditions by updating web-based educational materials available to consumers and working with the Georgia chapter of the American Academy of Pediatrics to educate pediatricians, working through Emory University Department of Human Genetics to update and implement new follow-up protocols for infants that screen positive for the new conditions. The laboratory staff will procure supplies necessary for screening and validate screening tests to detect the new conditions.

 

Submitting newborns screening samples with zero errors received a letter from the MCH Director, recognizing the facilities’ success. Facilities with consecutive quarters of zero errors in their newborn screening samples received a certificate of achievement. To further bring awareness to techniques that result in proper newborn screening specimen collection, the newborn screening program created posters with quick tips for collecting newborn screening samples. The program also developed pocket guides with images of quality newborn screening sample to be used as a quick reference. The video, posters and pocket guides are all on-demand resources birthing facilities can use to improve the quality of their newborn screening samples. The Newborn Screening Clinic Coordinator will continue to monitor the overall rate of quality newborn screening samples and provide in-person technical assistance when needed.

 

DPH partners with the Sickle Cell Foundation of Georgia, Inc. (SCFGa) to provide CHW services for individuals of all ages with SCD in Georgia. CHWs aim to improve overall health outcomes for SCD by providing local families with resources to increase self-care management, self-efficacy, and successful transition from pediatric to adult care. Patient education and strategic partnerships are incorporated into the program to address this issue. The overall program provides a number of benefits to those living with sickle cell disease. CHWs served clients by linking them to medical homes, community-based programs and resources, public health services and healthcare transition planning with adolescents. Many primary care physicians that do not have specialized training in caring for patients with SCD are uncomfortable treating adults with SCD. Furthermore, individuals with SCD believing that they only need a hematologist to manage their care. As a result, fewer than half of adults with SCD have access to primary care. The partnership between Ga DPH and SCFGa is an innovative approach to strengthen the system of care for people with SCD by better linking social support services, medical care and public health services. This partnership signifies a ‘whole person approach’ to supporting individuals with SCD. The SCFGa has ongoing collaboration with renowned hematologist in the state to promote the benefit of the whole person approach. They have held joint presentations in Bibb, Emanuel and Chatham Counties and have presented this approach during a webinar hosted by the AAP.

 

The Newborn screening program employs various education and outreach strategies to families and providers. The program engaged directly with physicians and nurses at the Georgia Academy of Family Physician’s meeting in October 2018 as well as the Georgia Chapter of American Academy of Pediatrics meeting on November 2018. These meetings provide the program opportunities to interface directly with physicians and discuss the importance of newborn screening and reviewing newborn screening results with families during the newborn visit.

 

The newborn screening program also engaged families directly at two outreach events. In October 2018, the program exhibited at a Baby Expo in the Atlanta area where they educated over 200 families about newborn screening, the conditions on the panel and how to receive newborn screening results after their child is born. In February 2019, the NBS program participated in Kids at Heart Congenital Heart Disease (CHD) Awareness Celebration Event in Atlanta. The NBS program will continue the strategy of educating both providers and parents about the importance of newborn screening.

 

Related legislation:

 

Ga. Comp. R. & Regs. R. 511-5-5-.10 ; Authority: O.C.G.A. 31-2A-6, 31-12-5 through -7.

HB 241 (Cove’s Law): In May 2017, the Georgia state legislature passed a law to provide a pathway for parents to access Krabbe screening at the option and cost of the parent(s).

 

O.C.G.A. § 31-12-5: State-wide network for medical genetics services 

O.C.G.A. § 31-12-6: System for prevention of serious illness, severe physical or developmental disability, and death resulting from inherited metabolic and genetic disorders 

O.C.G.A. § 31-12-7: Rules and regulations regarding tests for sickle cell anemia, sickle cell trait, and other metabolic and genetic disorders; counseling; fees 

State Rules and Regulations 511-5-5: Testing for inherited disorders in the newborn 

 

Zika Prevention

In July 2017, DPH’s Zika testing guidelines were changed to match CDC’s new recommendations. The changes made to the guidelines at that time are still in effect. Under these guidelines, only symptomatic patients are approved for Zika testing through GPHL. Exceptions include asymptomatic pregnant women who have a fetus with an anomaly and/or are uninsured. As a result of the change in guidelines, the number of patients approved for Zika testing at GPHL has significantly decreased. Since January 2016, Zika surveillance efforts in DPH epidemiology have identified 121 travel associated cases of Zika in Georgia, with the last confirmed case identified in August 2018. To date, there has been no local transmission of Zika in the state of Georgia.

 

In the current year, 17 women/infant pairs are enrolled in Georgia’s Zika Pregnancy Registry. This included three transfer cases, and one fetal loss. To date, there are two live born infants with birth defects.

 

Currently, 668 potentially Zika-associated birth defects cases have been identified and 488 records have been reviewed for 2016–2017 Georgia birth cohort. Of these, 155 infants (32%) have confirmed Zika-associated birth defects and an additional 144 (30%) had other general birth defects of interest to the Georgia Birth Defects Registry.

 

As of May 2018, 119 medical records were still outstanding for Zika-associated birth defects confirmation. A number of facilities receive record requests and/or send out records via mail only, which increases the amount of time needed to receive and fulfill requests as compared to facilities that have a designated fax line for medical record requests. In addition, facilities have provided conflicting information regarding the modes of receiving and fulfilling medical record requests, which further delays the overall Zika-associated birth defects surveillance effort. Nuanced language is sometimes needed to communicate exactly what information is being requested from a facility (e.g., “chart” instead of “record”). The combination of these issues has significantly delayed the confirmation of approximately 15% of the suspected Zika-associated birth defects cases.

 

Several facilities have refused to fulfill record requests on the basis of well-established privacy laws. Efforts have been made to redraft the medical record request forms to state the HIPPA privacy rule explicitly, in addition to providing germane state legislation, without adding unnecessary protected health information to the request. This was done to demonstrate that the request of medical records falls under the legal purview of the Georgia Department of Public Health. Once this education is provided and a second medical record request is sent, facilities generally comply with the request.

 

When suspect cases are identified, state and/or local epidemiology collects information on demographics, travel, and clinical presentation for use by appropriate groups to implement control measures. Data is stored in the Zika Active Monitoring System (ZAMS, housed in SendSS) which is shared between state and district programs for efficient information sharing and follow up. Epidemiologists provide the patient and provider important prevention education (both mosquito avoidance and sexual transmission prevention messages) for all suspect cases.

 

If a positive is identified, then the physician and local health department are notified within an hour, then the physician or district epidemiologist contacts the patient the same day. The patient is given updated guidance and reiteration of the education and a case report form is completed using information gathered at the time of identification. Additionally, DPH state epidemiology notifies Environmental Health within 1 hour of report of the positive result. Environmental Health immediately notifies the Vector Surveillance Coordinator/entomologist assigned to the designated location to perform mosquito surveillance by evaluation of breeding sites and setting out mosquito traps. Mosquitoes collected from the traps were then identified to species and treatment (larviciding/adulticiding) is performed accordingly. The patient is also provided mosquito control and prevention education, including tip and toss and mosquito repellent use. Confirmed Zika cases are also reported to CDC in ArboNET, a national arboviral surveillance system managed by CDC and state health departments.

 

Challenges/Barriers: When the new Zika testing guidelines were adapted in July 2017, there was difficulty disseminating the information to state partners and healthcare providers. Although the DPH website was updated to reflect the new guidelines, many providers had a difficult time understanding the changes and why they were made.

 

Funding for Zika-specific projects was discontinued on August 1, 2018. Zika surveillance has since continued by being integrated into the ongoing activities of acute arboviral disease surveillance.

 

Pregnancy

The Zika Pregnancy Registry (ZPR) Coordinator was responsible for managing the investigation of pregnant women and infants identified to have laboratory evidence of Zika virus through Georgia Public Health Laboratory testing or commercial lab testing. Once case inclusion was confirmed, the ZPR coordinator collaborated with physicians, health care facilities, district epidemiologists, and patients to acquire complete detailed clinical information requested on the maternal health history, neonate assessment, and infant follow up case report forms. The Maternal Health History form’s variables include: travel history, underlying maternal illness, pregnancy information, and maternal prenatal imaging and diagnostics. Neonate assessment variables include: newborn physical examination, and neonate imaging and diagnostics. Infant follow up variables include: infant findings at examination, developmental milestones assessment, and any special studies since the last follow up. Infant follow-up information is collected for the designated follow up points: 2, 6, 12, 18, and 24 months. Data is uploaded and reported monthly to the CDC US Zika Pregnancy Registry Team. As of May 2019, 17 women/infant pairs are enrolled in Georgia’s Zika Pregnancy Registry. This included three transfer cases, and one fetal loss. To date, there are two live born infants with birth defects. Infant follow-up forms on 12 out of 14 infants has been completed for the 24-month period.

 

Due to uncertainty, as to whether the project would continue to be funded, the ZPR Coordinator resigned from her position. Nobody has since been hired to fill this position. Most of the duties have transitioned to the Arboviral Epidemiology Team and the Maternal and Child Health Epidemiology Unit.

 

Birth Defects

As of May 2018, 686 cases have been identified with suspected Zika-associated birth defects. Of these, five are waiting on medical records to be received and the other 681 have been dispositioned into one of three categories: confirmed Zika-associated birth defects (32%), confirmed general birth defects (31%), or non-case (36%).

 

Potential cases were identified from three sources, including the Zika Active Monitoring System (ZAMS) and the Zika Pregnancy Registry (ZPR). Electronic birth certificates (eBCs) constituted the largest (73%) reporting source. However, birth defects reported on eBCs require confirmation through medical record review, per guidelines from CDC Zika Birth Defects Surveillance (CDC-ZBDS) and the National Birth Defects Prevention Network (NBDPN). Record requests involved mailing or faxing facilities, as well as calling facilities to ensure receipt of requests; determine which types of records are needed; and situate our efforts within the context of state and federal privacy laws. Through this effort, we have fostered relationships with these facilities, as well as drawn attention to the need for birth defects reporting and established a protocol for tracking records from initial requests through confirmation, referral to early intervention services, and reporting out to CDC.

 

The Zika Birth Defects epidemiologist (ZBDE) was promoted to being the Newborn Surveillance Team Lead, which includes the activities of Zika-associated birth defects surveillance. Hence, her time spent on this effort has been significantly reduced. An Infant Epidemiologist was hired to focus on the surveillance of birth defects and Neonatal Abstinence Syndrome. Further, a part-time Medical Record Liaison was also hired as a contractor to assist in the requesting of medical records. The Infant Epidemiologist and Medical Record Liaison have been collaborating to initiate medical record requests, review records for confirmation of reported birth defects, and abstract confirmed records. Once received, reviewed, and confirmed, the abstracted records were linked with confirmed cases from the Metropolitan Atlanta Congenital Defects Project (CDC-MACDP) and reported to CDC-ZBDS on a monthly basis.

 

Zika birth defects surveillance has given Georgia DPH the opportunity to develop a Birth Defects Registry. This registry has integrated data from 13 reporting sources, including eBCs and ZAMS/ZPR; expedited referral of affected infants and their families to early intervention services; and facilitated standardized, timely, reporting and confirmation of birth defects statewide. Flexibility is inherent to the design of the registry and will greatly enhanced Georgia’s capacity to respond to emerging teratogens.

 

Related legislation: Birth defects are notifiable conditions in Georgia under the Official Code of Georgia, Title 31-12-2, wherein the Georgia Department of Public Health is given the authority to “…conduct studies, research, and training appropriate to prevention of diseases….” Under this legislation, all healthcare providers are required to report patients with any condition listed under the Notifiable Disease Reporting Requirements. On Georgia’s list of notifiable diseases, Zika infection falls under “all acute arboviral infections”, along with several other illnesses. As in the aforementioned statute, these infections are supposed to be reported to DPH immediately.

 

Challenges/barriers: If any

When the ZPR Coordinator resigned, the position was not filled due to the uncertainty surrounding future grant funding. Without that position being filled, multiple data collection time points were missed as part of the infant follow-up. However, for the final time point currently being requested of states (24-month), 12 of 14 infants have successfully had their data collected.

 

Safe Sleep
In the current year, all 79 Georgia birthing hospitals participate in the Safe Sleep Hospital Initiative. The following activities supported hospitals in their efforts to educate families about safe sleep practices.

• Distributed educational materials around the state, including: safe infant sleep educational flipcharts for educators, one-page handouts on the safe sleep environments, safe sleep brochures, crib cards, Spanish language materials and safe sleep books.
• Children’s Healthcare of Atlanta quality improvement project expanded to all three campuses to improve modeling of safe infant sleep.
• Designed, developed and implemented the “floor talker” opportunity. 148 floor talkers were sent to locations throughout Georgia with specific focus to the areas with the highest rates of sleep-related infant mortality from 2006-2016.
• Attend the GA Injury Prevention advisory council meetings.
• Expanded the previously designed, developed and implemented the “floor talker” opportunity to 250 additional sites.
• Attend & present at the Injury Prevention Research Center at Emory meetings.
• Attend GDPH Breastfeeding meetings.
• Published Article and Poster Presentation:

As Easy as ABC: Evaluation of Safe Sleep Initiative on Safe Sleep Compliance in a Freestanding Pediatric Hospital, S. Lazarus; T. McFadden; T. Miller

• Designed, developed and implemented the “Safe Infant Sleep Education and Crib Distribution” program and study. Currently 30+ sites throughout the State of Georgia are hosting safe infant sleep educational classes and distributing a play yard with bassinet to expectant mothers in or near their third trimester. A pre-and post-education survey is being administered and sent back to DPH. DPH is then following up with participants with another survey approximately ten weeks after the birth of the infant. Surveys are testing the change short and long-term knowledge and self-reported behavior change. University of Wisconsin-Madison is the principal investigator.
• Developed a train the trainer education to increase the number of safe infant sleep trainings that occur with consistent and accurate education. Applied for and received one CNE for nurses for the next two years.
• Began the process to conduct an outcome evaluation of the hospital-based safe infant sleep program with the 77 birthing hospitals. Kennesaw State University will be the principal investigator. Results expected by June 30, 2019.
• Began the process to conduct focus group testing of educational materials, newly created and currently utilized to ensure that messaging is effective. Georgia Southern University will be the principal investigator.

 

Family and Community Support Services

In the current year, the Family and Community Supports program continues its commitment to implement evidence-based, comprehensive and community-based maternal and early childhood programs in Bartow, Bill Chatham, Clarke, Crisp, DeKalb, Fulton, Glynn, Gordon, Houston, Liberty, Lowndes, McDuffie, Muscogee, Richmond, Rockdale, and Whitfield counties. Home Visiting programs currently include the Early Head Start-Home Based Option (EHS-HBO), Healthy Families Georgia (HFG), Nurse-Family Partnership (NFP) and Parents as Teachers (PAT).

 

Family and Community Supports is partnering with the MMRC and participating in their action committee to impact maternal and child health outcomes through systems improvements and other action-oriented processes providing education and resources for women and infants through outreach activities in the community.

 

To strengthen collaboration with the Healthy Start grantee sites and Title V, Family and Community Supports coordinate and conduct a quarterly call with the six Healthy Start Sites in Georgia to foster collaboration and team building and identify how resources and opportunities can be leveraged for successful partnerships.

 

Family and Community Supports was awarded a Healthy Start grant and will be implementing the Georgia Strong Families Program (GSFP) in Valdosta at the South Health District and Columbus at the West Central Health District. GSFP will provide services in Brooks, Echols, Lowndes and Muscogee counties to at least 700 pregnant women, new mothers, infants and fathers across the four counties. Program services include a wide range from care for women, children and families such as healthcare coordination, home visitation, case management, and linkages to community social services. In addition, the program will help build a more effective and efficient service-delivery system and promote and improve health equity across the local health districts and community partners.

 

Working with the MIECHV TA Center, Local Implementing Agencies (LIA), University of Georgia Center for Family and the DPH internal evaluation team the Annual MIECHV Client Satisfaction Survey was developed and piloted. Satisfaction surveys were administered at the Baby Luv and American Pathways Home Visiting Sites during the monthly Group Connection Meetings. There were 13 clients that participated in the pilot, eight from New American Pathways and eight from Baby Luv. The pilot was conducted to determine if the tool was user friendly. Based on the results, 80 percent felt that the survey was easy to read and understand, 92% felt that the length of the tool was good and 92 percent preferred that the tool be administered by paper and pen. As a result of the pilot, the survey will be administered with both a paper and pen and electronic options such as SurveyMonkey.

 

Innovation Award

Efforts continued to develop and increase the knowledge of the professional development needs of home visitors. A home visitor resource toolkit has been ordered that consists of a book and other materials that address autism, children with special needs, postpartum depression, infant mental health and toxic stress/ACES. These topics were identified by the home visitors as areas in which more training and resources are needed. Home Visitors will also receive safety kits filled with a first aid kit, personal alarm keychain with LED light, neon yellow drawstring backpack and breakaway lanyards. These items will be provided to help ensure home visitors protection and safety. Since February 2019, the project has made 61 college visit tours informing students about the field of Home Visiting, including eight presentations and four school career fairs reaching 256 students. The skills of current workforce was improved by developing a partnership with technical schools and colleges in the MIECHV service area and providing presentations and information to students and staff about the field of home visiting and opportunities about internships with local GHVP sites.

 

The Home Visiting Program has partnered with the UGA J.W. Fanning Leadership Institute to continue to provide professional development opportunities to home visiting leaders across Georgia to improve the leadership skills of the current workforce. Workshop topics include, Leadership Strategies, Innovation for All, Strengthening Teams and Partnerships, and Exploring and Leading Change.

 

Home Visiting Quarterly Calls: In the current year, the Georgia Home Visiting Quarterly Calls continue. The calls provide opportunities for the Georgia Home Visiting Programs (GHVP) to share information, create solutions, build relationships, and make decisions. As well as to inspire and encourage, as we strengthen program processes and services. This initial call included DPH updates and sites shared best practices related to client engagement and retention. A survey was developed to receive feedback regarding the Quarterly call. Based on the survey results of 17 people that participated:

• 94% thought that the call was informative
• 100% thought that the information provided on the call was relevant to their work
• 65% thought that the call provided new ideas on how to approach their work

 

Continuous Quality Improvement (CQI) Updates: CQI is beneficial for home visiting programs in many ways. CQI is a systematic approach to specifying the processes and outcomes of a program or set of practices through regular data collection and the application of changes that may lead to improvements in performance.

 

The CQI approach helps home visiting programs measure processes and outcomes; incorporates new knowledge and practices in a data-driven manner; highlights training and technical assistance needs; helps monitor fidelity of program implementation; provides rapid information on a small scale about how change occurs; helps identify key components of effective interventions; and empowers home visitors and program administrators to seek information about their own practices. CQI has the potential to be transformative for programs and is an opportunity to improve upon everyday practices in small ways that result in large gains in program efficiency and service delivery. CQI plans to address the following:

• Breastfeeding Continuation
• Parent Child Interaction
• Maternal Depression

 

The GHVP team will pivot from family engagement as the CQI topic to a menu of other topic areas in accordance with feedback from a variety of stakeholders about where improvements are most needed and where LIAs have capacity to make change.

 

 The Home Visiting Program Annual Site Visit: The Home Visiting team will begin annual site visits in June 2019 to all LIAs that receive Federal and State Funds managed by DPH. The purpose of the visits is to ensure program compliance, fidelity of the home visiting models, meet with staff and provide support and guidance.

 

Home Visiting Institute: Georgia Home Visiting Institute (HVI) provided high quality training for 311 of Georgia’s home visitors, supervisors, community outreach staff and family support staff to develop and enhance core competencies critical to their work. The HVI addressed strategies to improve the quality and effectiveness of home visiting services, with an emphasis on supporting healthy infant/toddler development and parent-child relationships and developing skills necessary for establishing, building and enhancing relationships with families. The 2019 Georgia Home Visiting Institute will be held in September 2019.