Perinatal/Infant Health - Annual Report FY19

 

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

 

• Support healthy pregnancies and improve birth and infant outcomes (Priority #2)

 

Illinois has worked hard to improve the health of infants and perinatal women over time.  There has been substantial progress on measures related to breastfeeding and infants’ sleep environments. The breastfeeding initiation rate increased from 71% in 2008 to 82% in 2016, meeting the Healthy People 2020 objective. During the same time period, the rate of exclusive breastfeeding at six months doubled from approximately 12% to 24%. In the last ten years, the percent of infants placed to sleep on their back increased from about 70% to about 84%. Illinois women are more likely than ever to deliver in a risk-appropriate care setting; more than 82% of Illinois’ very low birth weight infants are born in a hospital with a level III NICU (NPM #3), and non-Hispanic black, white, and Hispanic women are all similarly likely to have access to this care. There has also been modest, steady progress on infant mortality outcomes in Illinois.  Over the last five years, there has been a small reduction in perinatal mortality (NOM #8), infant mortality (NOM #9.1), neonatal mortality (NOM #9.2), post neonatal mortality (NOM #9.3) and preterm-related mortality (NOM #9.4). 

 

However, there is still much work to be done.  Non-Hispanic black infants still experience much worse outcomes than non-Hispanic white infants on all infants mortality measures. For example, black infants have more than two times than infant mortality rate than white infants, but this racial inequity is even higher for post-neonatal deaths and SUID deaths. For various infant mortality outcomes, Illinois continues to rank solidly in the middle of the 50 states; for example the Illinois rate of infant mortality is ranked 29th out of 50 states.

 

While most infant mortality rates have declined in Illinois, the SUID rate overall, and particularly among non-Hispanic Black infants displays the opposite pattern – a significant increase since 2009. While there is fairly high uptake of the “back to sleep” message, only about half of infants are placed in a safe sleep environment without loose bedding (NPM #5C) and only about one third of infants are placed on a separate sleep surface (NPM #5B). Among black infants, the prevalence of safe sleep practices are even lower, with only about 1 in 4 black infants being placed to sleep in a safe environment. A perinatal periods of risk assessment completed during 2020 revealed that post-neonatal deaths due to SUID are one of the top causes contributing to the black-white disparity in infant mortality.

 

Illinois’ mothers and children continue to experience adverse outcomes related to perinatal substance use.  The rates of both neonatal abstinence syndrome (NOM #11) and fetal alcohol exposure in the last three months of pregnancy (NOM #10) have been rising risen over the last five years. Non-Hispanic White infants are two times more likely than non-Hispanic Black infants and nearly four times more likely than Hispanic infants to experience NAS.  Compared to other states, Illinois has a fairly low rate of NAS, and a fairly high rate of fetal alcohol exposure. 

 

 

 

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

 

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

 

Illinois has two perinatal nurses (one northern region and one southern region) to cover all hospitals in Illinois that have perinatal units, approximately 120 facilities. The perinatal nurses work in conjunction with the 10 administrative perinatal centers. Each administrative perinatal center has one perinatal nurse administrator, two nurse educators, one maternal fetal medicine co-director, and one neonatology co-director. The administrative perinatal centers and the perinatal nurses perform site visits of the perinatal hospitals in Illinois to assess for compliance to the Illinois Perinatal Code 640.

 

The two perinatal nurses are fully funded by the IL Title V and function as nursing specialists in maternal, child, and adolescent health issues:

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

 

I. Utilize the Levels of Care Assessment Tool (LOCATe) to describe neonatal and maternal levels of care and inform improvements to the regionalized perinatal system.

 

Implementation of the Levels of Care Assessment Tool (LOCATe) to capture information about the neonatal and obstetric personnel, services, and resources available at every birthing hospital in Illinois was completed in FY18. Title V will continue to encourage the use of the tool and will monitor and assess data going forward.

 

II. Conduct a study of very preterm infants (<32 weeks) delivered outside Level III facilities to identify reasons for no maternal or neonatal transport and barriers to risk-appropriate care.

 

Illinois has implemented a special data collection process to gather information on very preterm (VPT) infants born outside Level III hospitals. Since 2015, OWHFS have implemented a data collection tool with six major sections: infant characteristics, maternal characteristics, information about the hospital admission and stay, reasons why mother was not transported to a Level III before delivery, outcome of the infant, and reasons why infant was not transported to a Level III after delivery. All Illinois hospitals that were not Level III facilities are required to complete the form for every instance of a live birth at 22-31 weeks gestation and to submit the form through the ePeriNet data system. These forms are linked to vital records files, enabling detailed analysis of patient characteristics and infant outcomes that are related to a lack of risk-appropriate care. Analysis of the very preterm review forms is ongoing in conjunction with the risk- appropriate care CoIIN workgroup.

 

Illinois will continue to collect the very preterm review form for all infants 22-31 weeks gestation born in non-Level III hospitals through the 2020 birth cohort. Data collection occurs through the ePeriNet online system. The Title V epidemiology team will continue to monitor form completion, follow-up on missing records, and analyze data to support the work of the risk- appropriate care CoIIN workgroup.

 

III. Convene Risk-Appropriate Care CoIIN workgroup to develop a quality improvement initiative to increase the percentage of very preterm infants (<32 weeks) delivered in Level III facilities.

 

In 2015, Illinois began a CoIIN workgroup focused on improving the percent of very preterm or very low birth weight infants receiving risk-appropriate care. The goal of the workgroup is to identify the barriers to risk-appropriate care and to develop quality improvement initiatives to overcome these barriers and ensure that more preterm infants are born in appropriate level hospitals.

 

This CoIIN team developed the concept for the very preterm review form and has worked closely with the Title V epidemiology team to interpret the data and develop evidence-based strategies. During 2018, the workgroup developed a grand rounds presentation that outlined some of the major findings and messages about risk-appropriate care. Analysis of risk-appropriate care data and the very preterm review forms is an ongoing process that is done in conjunction with the Risk-Appropriate Care CoIIN workgroup.

 

IV. Update state Obstetric Hemorrhage Toolkit based on information in the ACOG patient safety bundle and distribute updated materials to all Illinois hospitals.

 

The update of the hemorrhage toolkit was completed in FY18. The regionalized perinatal program will continue to disseminate the toolkit and other related training materials to birthing hospitals throughout Illinois. Hospitals will continue to be encouraged to provide annual training on obstetric hemorrhage to all hospital staff that interact with pregnant/postpartum women.

 

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

 

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

 

The IDPH perinatal nurses also attend morbidity and mortality reviews at hospitals to keep abreast of emerging best practices and trends in the field. Quality improvement technical assistance site visits are also provided as requested. During FY19, the northern perinatal nurse attended 25 perinatal site visits, 20 morbidity and mortality reviews at the hospitals, and 18 quality improvement/assurance or technical assistance visits. The southern perinatal nurse attended 20 perinatal site visits, 17 morbidity and mortality reviews at delivery hospitals, and 17 quality improvement/assurance or technical assistance visits.

 

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

 

Below are FY19 highlights from the 10 APCs:

 

1. University of Chicago completed 50 severe maternal mortality reviews within network, including University of Chicago; all level III network hospitals including University of Chicago transitioned to instrument generation 4 HIV testing, and all network hospitals put in place discharge planning and early blood pressure checks for patients with preeclampsia or chronic hypertension.
2. Stroger Hospital is working collaboratively with the Chicago Department of Public Health (CDPH) who is a key partner with IL Title V. Stroger Hospital is participating in the Severe HTN Initiative collaborative which includes  each network hospital demonstrating the integration of the HTN initiative into the process of providing care to the obstetrical patient presenting to the hospital for care; patients receiving scheduled 72 hour B/P checks prior to discharge from the facility; CDPH referrals for patients unable to return for follow up B/P checks; patients meeting the established criteria are discharged home wearing the Teal wristband; patients receiving their anti-hypertensive medication before leaving the unit; and severe HTN patients routinely reviewed internally and during the M&M conferences.
3. Northwestern performed a network needs assessment and identified additional education needs for Low-Risk Neonatal Certification prep (RNC-LRN) and High-Risk Neonatal Certification prep (RNC-NIC). Northwestern was able to utilize the IL Title V to offer both an RNC-LRN review course and an RNC-NIC review course for the network hospitals. Obtaining certification in neonatal nursing validate the nurses’ knowledge and allows nurses to demonstrate their specialty expertise.
4. University of Illinois at Chicago’s Perinatal Center is working with the University of Illinois (UI) Health Department of Psychiatry collaborated to implement a computer-based training program (CPT) to prevent and treat perinatal depression.  Per recommendations from the BETA testing conducted in FY19, the content was updated to reflect the lifestyles of an urban population.
5. Loyola University Medical Center collaborated with non-birthing network hospitals to establish relationships and resources, including having an annual non-birthing hospital network meeting. Other activities included: all non-birthing hospitals participated in skill stations for OB hemorrhage, maternal hypertension and newborn stabilization; network hospital presented a quality project to the council each quarter; and all delivering network hospitals are participating in IDPH/ILPQC programs to improve care.
6. Rush University implemented a Lunch and Learn program to enhance our ability to provide education in several different ways.  The APC utilized Network needs assessment to plan speakers. Education topics included STABLE, Basic Fetal Monitoring, AWHONN Intermediate Fetal Monitoring, AWHONN Advanced Fetal Monitoring, Ethical & Legal Considerations of FM, and Measles Isolation & Testing and Prevention of Perinatal Hepatitis B Transmission.
7. Javon Bea (formerly known as Rockford Memorial) successfully assisted the Perinatal Hospital in their move to their new open campus by providing the Stork education for all of the emergency department (ED) staff to help prepare the ED at the new campus in becoming a Non-delivering Hospital ED, assisted in the planning for the simulation drills and education for the staff moving to the new campus, organized and assisted with the simulation check-off to be witness by another APC  as required by IDPH, and assisted with the patient move process from the old campus location to the new campus location by performing the listed safety checks for each patient  to be transported at one of three exit bays at the old campus location.
8. OSF St. Francis Medical Center implemented a comprehensive perinatal quality improvement project in the North Central Perinatal Network, focused on improving outcomes in Very Low Birth Weight Newborns, delivered outside the Level III Perinatal Center.  The North Central Perinatal Network consists of one Level III Center and 14 regional maternity serve hospitals. The goal of the project is to increase survival without major morbidity from 50 to 55% in the Very Low Birth Weight Population born outside the Level III Center, by December 2020. This will involve standardizing care for all Very Low Birth Weight (VLBW) newborns delivered outside the Level III Center. The project team is composed of Maternal Fetal Medicine Specialists, Neonatologists, Neonatal Nurse Practitioners, NICU nursing staff, NICU Transport Team Members, and Respiratory Therapists.
9. South Central Illinois/St. John’s Children’s Hospital collaborated with Trauma Outreach Department to develop and present education specific to network area fire departments such as Trauma in the OB patient, Pre-hospital delivery, and Care and stabilization of the newborn. In addition, the APC collaborated with Department of Corrections providing education to pregnant inmates and the health care staff, including providing in-situ simulation events in the prison. Another notable activity of the APC was the provision of telemedicine services (MFM outpatient clinics, inpatient neonatology and newborn stabilization as needed) and establishing MFM telemedicine outpatient clinics throughout the South Central Perinatal Network
10. St. Mary’s Hospital in Saint Louis (Cardinal Glennon network) successfully moved into the sustainability phase of the Illinois Severe Maternal Hypertension project.  Each network birthing facility submitted a written plan on orientation of new staff and providers, and methods they will be utilizing to continue with the goals of early identification and treatment of severe maternal hypertension cases. The APC also held 21 M&M’s in which 210 cases were reviewed. Approximately, 33 cases involved severe maternal morbidity, 35 involved fetal deaths, 29 involved neonatal deaths and 2 involved maternal deaths. A total of 270 providers participated in the M&Ms and 432 other health professions (e.g., nurses, techs, social work, respiratory therapy) participated as well.

 

B. Collaborate with the Illinois Perinatal Quality Collaborative to implement quality improvement projects in birthing hospitals that will improve health outcomes.

 

1. Birth Certificate Accuracy Initiative (2014-2015)
2. Maternal Hypertension Project (2015-2017)
3. Mothers and Newborns Affected by Opioids (2017-2019)

 

The support of Illinois’s IL Title V enables the Illinois Perinatal Quality Collaborative (ILPQC) to develop, implement, support, and sustain statewide quality improvement initiatives with nearly all of the birthing hospitals in the state in collaboration with the Illinois Department of Public Health (IDPH), State Quality Council, and the Regionalized Perinatal System as well as other state and national stakeholders. The statewide quality improvement initiatives support improved outcomes for mothers and newborns in Illinois related to our most pressing maternal and infant morbidity and mortality issues across hospitals.

The Maternal Hypertension Project was formally completed in fall of 2017 and included the creation of a toolkit with resources for teams developed by ILPQC with national guidelines: http://ilpqc.org/?q=Hypertension. The efforts of the Maternal Hypertension Project were continued in FY19 by partnering with the Regional Perinatal Network administrators and educators that were facilitating hospital team development of sustainability plans (template developed by ILPQC), as well as perinatal network discussions of hypertension sustainability at regional quality meetings.

 

During FY18, the Mothers and Newborns affected by Opioids (MNO) Initiative (MNO) was developed and initiated with both obstetric and neonatal arms. Activities included recruiting clinical experts to develop aims, measures, and key driver diagrams based on national guidelines including the Alliance for Innovation on Maternal Health (AIM) bundle and resources from other Perinatal Quality Collaboratives. Member volunteers were convened to develop the MNO Quality Improvement Toolkit building upon the AIM bundle and examples from other Perinatal Quality Collaboratives. A link to the toolkit developed by ILPQC with national guidelines for Teams is available here: http://ilpqc.org/?q=MNO-OB. ILPQC worked with IDPH in their efforts to develop patient education tools for hospitals, including the identification of focus group participants and developing the material content.

 

• Prescription Pain Medicines and Pregnant Women Neonatal Abstinence Syndrome - You are the Treatment Neonatal Abstinence Syndrome: What You Need to Know

 

ILPQC recruited 33 hospitals to participate in Wave 1 of the initiative with at least two from each perinatal network, where hospitals reviewed and provided feedback on the data collection form and process prior to launching the initiative statewide in Wave 2. Once launched, the initiative included collaborative learning opportunities for participating hospitals and rapid response data collection. ILPQC served on IDPH NAS Advisory Committee and supported the development of evidence-based recommendations using information already gathered for the MNO toolkit.

 

ILPQC facilitated several in-person collaborative meetings. The ILPQC 5th Annual Conference (December 19, 2017) had 101 hospital teams in attendance, including 400 physicians, nurses, and public health professionals. The annual obstetric face-to-face meeting (May 30, 2018) had 327 attendees and the annual neonatal face-to-face meeting (May 31, 2018) had 231 attendees, with over 100 individuals attending both face-to-face meetings.

 

In FY2019, ILPQC hosted 10 collaborative learning webinars (monthly October 2018 – September 2019) completed with over 60 participants per call focused on helping hospitals implement key strategies for success for MNO-OB, including: (1) screening all pregnant women for Substance Use Disorder (SUD) with a universal self-reported validated screening tool prenatally and on Labor & Delivery; (2) creation and implementation of MNO-OB folders to engage the OB provider and with tools to activate the clinical care protocol for patients with OUD; (3) materials to facilitate an OB provider education campaign; and (4) implementation of a missed opportunity review/debrief with the clinical team for every patient diagnosed with OUD. ILPQC facilitated hospital team round-robins on the webinars where all teams had a chance to share their progress and barriers to implementing the key strategies.

 

Rapid response data included access to the ILPQC data and reporting system with approximately 70 teams entering and monitoring monthly data in the ILPQC data system with over 1,500 mothers with Opioid-Use Disorder represented. There are 23 MNO-OB & Neonatal patient-focused reports created for teams to track progress on key initiative AIMS and measures. In addition, teams have access to two reports focused on monthly samples of deliveries tracking screening with a universal self-reported validated screening tool. Over 15,000 charts are included in the screening data set. Teams also have access to track monthly progress on implementing 6 key structure measures for MNO-OB and 4 key structure measures for MNO-Neo. All 10 perinatal network administrators have access to the ILPQC data system reports and are able to view each hospital in their network’s progress on achieving the MNO initiatives. In addition, ILPQC staff provided cumulative comparative data for MNO-OB & Neo key initiative AIMs to hospital teams and perinatal network administrators.

 

QI support included 3 rounds of QI support to 36 hospitals in January 2019, about 30 in June 2019, and 29 in September 2019 to support hospitals working on implementing MNO Strategies including Screening, SBIRT, linking patients with OUD to MAT, implementing non-pharmacologic care, and coordinated discharge planning with the care team, family, and community pediatrician. ILPQC held 6 small group QI topic calls with 15-20 hospitals each during this period with QI Champions from hospitals sharing strategies for implementing Screening, SBIRT Protocol, Mapping Community Resources, the OUD/SBIRT Clinical Algorithm, OUD Clinical Care Checklist, and a monthly case review of all cases with OUD.

 

Key Resources developed to support efforts to engage OB Providers included:

• ILPQC SBIRT Pocket Card - resource for OB Provider to provide brief intervention, with SBIRT documentation and billing guidance
• OUD/SBIRT Clinical Algorithm - for pregnant/postpartum patients identified with Opioid Use Disorder
• Missed Opportunity Review / Debrief - tool to review monthly OUD cases to provide feedback to clinical teams
• ILPQC OUD Clinical Care Checklist - tool for OB providers to complete prenatally or by delivery for patients with OUD including Narcan counseling and prescription offer, Hepatitis C screening, peds/neonatal prenatal consult, etc.
• Narcan – Save a Life Poster; Key Counseling & Prescribing guidance for OB Providers
• Provider Poster (Mom & Baby) - key messaging for OB providers to link pregnant and postpartum women with OUD to MAT, provide Narcan Counseling, and link to recovery treatment programs
• Provider Poster (Provider & Patient) - key messaging every OB provider needs to know to save a mother's life
• Education Poster #1 - Importance of screening all pregnant patients for OUD with a validated screening tool
• Education Poster #2 - Key strategies for caring for pregnant/postpartum patients with OUD
• Words Matter eModule from ILPQC 2018 Annual Conference

 

C. Convene partners to support statewide efforts to improve breastfeeding outcomes and reduce disparities.

 

The OWHFS is participating on a collaborative project known as the Illinois State Physical Activity and Nutrition Program (ISPAN) which began in early 2019. This project aims to build on the significant accomplishments made already in physical activity and nutrition policy, systems, and environmental change. The purpose of this collaborative program is to reduce chronic disease and increase the health and well-being of Illinoisans by reducing disparities. This work focuses on equitable and just opportunities for Illinoisans to practice healthy eating habits and be physically active. Specific to OWHFS is the work that aims to increase the number of places (e.g., pediatric/ family practices, WIC sites) that implement supportive breastfeeding interventions. The future of this work includes convening a statewide learning collaborative as well as training and support for local health departments, such as scholarships for WIC staff to become certified lactation consultants.

 

D. Support hospital Baby-Friendly designation by assessing barriers to progress and provide resources to assist hospitals in overcoming these barriers.

 

This strategy was completed in FY17 – no activities to report for FY20.

 

Though no new activities are planned for this strategy, Illinois will continue to monitor the number of Baby-Friendly facilities and the proportion of births occurring in these facilities.

 

E. Partner with the Illinois Department of Corrections and two state women’s correctional centers to support ongoing health promotion activities for incarcerated women (including health education programs and lactation support) and prison staff training (same as strategy #1-B).

 

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

 

F. Provide support to pregnant women at risk for poor birth outcomes through an array of case management and home visiting programs through the Illinois Department of Human Services (DHS); Ensure DHS programs align with Title V priorities.

 

The three main DHS projects being supported by Title V in this grant period (2015-2020) are: Better Birth Outcomes, Fetal Infant Mortality Review (FIMR), and Perinatal Depression Hotline.

 

Better Birth Outcomes. DHS contracts with local public health departments, community-based agencies, and Federally Qualified Health Centers to provide intensive prenatal case management services, known as the Better Birth Outcomes (BBO) program, to high-risk pregnant women in defined geographic areas of the state of Illinois with higher-than-average Medicaid costs associated with poor birth outcomes and higher than average numbers of women delivering premature infants.

 

During FY19, 85% of women who participated in the BBO Program began prenatal care in their first trimester and 94% of the women were active in the Medicaid program as well. Approximately, 68% of the BBO participants received adequate prenatal care per the Kotelchuck Index and 66% received counseling on reproductive life planning. It is estimated that 60% of the participants in BBO received contacts monthly during their pregnancies and 44% received a home visit in each trimester. Thirty-eight percent (38%) of women in BBO initiated breastfeeding. Staff reassessed birth data to ensure the program is continuing to be offered in the areas of highest need in Illinois.

 

FIMR. FIMR continues to examine and identify the significant health, social, economic, cultural, safety, and education systems factors (non-medical) that are associated with fetal and infant mortality through review of individual cases. FIMR identifies fetal deaths (infants born dead after the 20th week of gestation) and neonatal deaths (any live born infant regardless of gestational age and weight) who die within the first 28 days of life. Through the interviews with families who recently experienced a fetal loss, several challenges were identified, including inconsistent medical advice regarding inter-conceptual care and community changes impacting health (increase in community violence, gentrification in some communities, decreased rates of employment opportunities, and closing of local schools). The University of Chicago is responsible for administering the FIMR program and reviews deaths occurring within the city of Chicago. During FY2019, 46 cases were reviewed.

 

Postpartum Depression Hotline. Postpartum women in Chicago who experience signs & symptoms of postpartum depression can access Healthcare Alternative Systems to utilize pertinent services to improve and support positive mental health. Postpartum depression is an important public health issue and ongoing priority in Illinois. Almost one in five Illinois-resident women who deliver a live birth in the state will experience postpartum depression. Roughly two thirds of those women will be diagnosed, and only 22% will receive some form of treatment. During FY19, 241 women were referred through different health facilities and treated for a duration of six to nine months. Some services that were utilized include Cognitive Behavior therapy (CBT), Psychodynamic therapy, and Rationale Emotive Behavior therapy (REBT).

 

G. Distribute information on topics related to health in pregnancy to women through service providers and social media. Utilize materials from IL CHIPRA and leverage existing public awareness campaigns, such as Text4Baby and Connect4Tots.

 

The bulk of these activities are resulting from the state’s Pre- and Inter-conception COIIN workgroup. The goal of this workgroup is to promote optimal women’s health before, after, and in between pregnancies as well as during postpartum visits and adolescent well visits. Beginning in FY18, the main facilitation of this workgroup was transferred to EverThrive Illinois through a grant agreement partially funded by Title V. In FY19, the created a logic model, refined an aim statement, outlined a plan for a gap analysis and gathered input on substantive updates for the Perinatal Education Toolkit.

Through their Title V Mini-Grant, the Chicago Department of Public Health (CDPH) continued the Know and Go campaign to encourage early entry into prenatal care. The campaign includes a location finder for those seeking prenatal care or any other perinatal resources and was shared over social media. CDPH continues to update and support www.HealthyChicagoBabies.org and the resource page. The website is tailored to both providers and Chicago residents.

 

H. Provide home visiting services to families with newborns identified in the Adverse Pregnancy Outcome Reporting System (APORS) through the DHS High-Risk Infant Follow-Up Program.

 

Surveillance of adverse pregnancy outcomes began in Illinois in 1986 with the establishment of the Adverse Pregnancy Outcome Reporting System (APORS) -- the Illinois birth defect registry -- housed in IDPH’s Division of Epidemiologic Studies. APORS has a two-fold purpose: 1) collection of adverse pregnancy outcomes for surveillance, policy development, and research; and 2) referral of high-risk newborns for community-based follow-up services. Hospitals are required to report babies meeting APORS case conditions within one week of their discharge from the hospital. Since 2002, APORS staff has been reviewing medical records to verify and further identify selected birth defects. To this end, hospitals make electronic medical records available through remote computer access or by providing the charts on paper or electronic media. Charts must be requested for most hospitals; most are available within two weeks, while a few can take up to two months. The chart of every baby reported with one of the selected birth defects, or with certain risk factors for one of the selected birth defects, is reviewed and every birth defect described in the chart is selected. The APORS program routinely uses birth and death certificates to identify APORS cases that may have been missed by hospital reporters. In addition, all cases are linked to birth certificates and, where applicable, death certificates.

 

The High-Risk Infant Follow-up Program is a case management program administered by the Illinois Department of Human Services. Based on eligibility established by APORS, public health nurses in local health departments provide follow-up home visiting services. There is a direct connection between high-risk follow-up and numerous programs such as WIC, Primary Care, Early Intervention, Perinatal Follow-up, and others depending on the needs of the family. Infants are followed until 24 months of age unless a complete assessment and the professional judgment of the nurse case manager indicate that services are no longer needed. In FY2019, 323 High-Risk Infant Follow-Up participants were active in a given quarter.

 

I. Support the Illinois Home Visiting Task Force in the design and implementation of Illinois Family Connects to offer universal home visiting to determine family support needs and refer them to appropriate services.

 

During FY19, the IL Title V supports home visiting in two ways. Firstly, the Title V Director served on the Illinois Home Visiting Task Force, which was coordinated by the Ounce of Prevention Fund and was a standing committee of Illinois’ Early Learning Council. This task force consisted of approximately 200 members representing state agencies and private sector health, early childhood, and child welfare organizations, as well as providers, researchers, and advocates. The task force worked with the Governor’s Office of Early Childhood Development to continue to advance the quality, quantity, and coordination of home visiting services across the funding streams and relevant departments and served as the strategic advisory body for the MIECHV grant.

 

Secondly, IL Title V continued to support a universal home visiting program. The Universal Newborn Support System Pilot was coordinated by the Ounce of Prevention Fund and was championed by former Illinois first lady Diana Rauner, who co-chaired the Illinois Home Visiting Task Force since 2009. The pilot included two working pilot sites in Illinois where every woman receives a home visit to assess maternal and child health and well-being after a baby is born. One was in Stephenson County (Memorial Hospital in Freeport, Illinois) and one was in Peoria.

 

This pilot morphed into the Illinois Family Connects program. The CDPH intends to implement a Family Connects Chicago. Planning activities included designing the community alignment function of Family Connects, building relationships with partner hospitals, training our nursing team on the model, and engaging an evaluation team to measure impact and conduct an implementation study to inform plans to bring the pilot to scale. Family Connects is a community-based, universal program for parents of newborns, regardless of income or socioeconomic status. The support provided by the program includes wellness checks for the baby and family and help to identify and connect with supportive resources from which any new family may benefit.

 

CDPH intends to implement a Family Connects program in the City of Chicago beginning in 2019. CDPH continued to work on the development of a blueprint for a plan to establish a coordinated, citywide, centralized intake system for all pregnant women and children zero to two years of age. This effort will work to connect families to appropriate services (including early childhood) and reduce duplication of services.

 

J. Through the CoIIN Safe Sleep workgroup, create a safe sleep toolkit that provides educational information to hospitals, home visiting agencies, childcares, and other organizations on developing evidence-based safe sleep policies.

 

The goal of this team is to improve safe sleep practices statewide. The Illinois Safe Sleep CoIIN Team has worked together to develop and distribute a statewide hospital survey to all birthing hospitals and pediatric hospitals that also care for infants under the age of one year in order to assess the implementation of a safe sleep policy. Work is underway reviewing safe sleep education for hospital emergency department staff in Illinois. In training hospital staff, the team works to put the burden of teaching infant safe sleep recommendations on the staff. The recommendations are based on those suggested by the AAP. Findings thus far are that while the teaching styles are different, the message stays consistent. The team is also currently working on the development of an educational safe sleep tool kit as well as programs for home visitors to teach safe sleep. The main facilitation of this workgroup was transferred to EverThrive Illinois through a grant agreement partially funded by Title V.

 

K. Participate in IDPH Zika Action Team to develop state readiness plan emphasizing needs of MCH populations. Ensure public messaging includes information related to pregnancy prevention, distribute educational materials to partners, and support APORS in enhancing microcephaly surveillance.

 

This strategy was completed in FY17 – there are no activities to report for FY18.

 

L. Collaborate with DPH Lead Prevention Program and other partners on the CoIIN Maternal and Child Environmental Health workgroup to update screening questionnaire, guidelines, and resources on lead exposure for pregnant women.

 

Illinois is participating in a cross-disciplinary Maternal and Child Environmental Health Collaborative, Improvement, and Innovation Network (CoIIN) to reduce infant mortality and morbidity by addressing lead exposure during pregnancy. The goal is for all pregnant women in Illinois to be assessed for lead exposure risk during pregnancy. IL Title V staff are working with IDPH’s Environmental Health and Lead Prevention Programs to create and update educational materials for pregnant women, revise the prenatal risk assessment and screening guidelines, and determine the prevalence of blood lead testing among pregnant women in Illinois. Ultimately, the CoIIN team will provide training to maternal care providers to raise awareness of these materials and increase completeness of blood lead testing to the state. During FY19, IL Title V staff participated in routine meetings for the CoIIN, provided clinical expertise in reviewing materials, assisted in the creation of a logic model for activities focused on increasing lead risk assessments/blood lead tests among pregnant women, and the development of a survey to OB/GYNs around knowledge and lead screening practices within two high-risk areas of the state for childhood lead exposure.

 

M. Ensure population- based metabolic and hearing screening for Illinois newborns.

 

Universal newborn blood spot screening is offered through the IDPH Newborn Screening Section (NBS).  All Core RUSP conditions are included in the Illinois newborn screening panel. There were 137,167 live births in Illinois in 2019. When including duplicate samples for babies requiring repeat screens and follow-up, a total of 138,041 newborn blood spot screening specimens were processed for 2019 births. Of the 138,041 screenings, 6,022 (4.36%) had a presumptive positive screening for at least one of the Core RUSP conditions and those babies were referred for further testing. Of those referred for testing, 438 (7.27%) were confirmed as having at least one Core RUSP condition and those babies were referred for treatment. Newborns diagnosed through newborn screening are followed annually through fifteen years of age with staff of the Newborn Screening Program contacting the pediatric sub-specialist to verify compliance with treatment and to monitor growth and developmental milestones. If needed, cases are referred to a local public health nurse to provide family assistance. Currently, no screening data or reports of diagnosed cases of newborns with a critical congenital heart defect are reported to the Newborn Screening Program, however families of all newborns with such a diagnosis are reported to the Adverse Pregnancy Outcomes Reporting System (state birth defects registry), which provides periodic follow-up by a public health nurse through two years of age.

 

The IDPH Early Hearing Detection and Intervention (EHDI) Program provides tracking, monitoring and referrals for Universal Newborn Hearing Screening for infants born in Illinois s. During 2019, 134,875 out of 137,167 (98.89%) infants reported to the EHDI program received inpatient hearing screening prior to hospital discharge, 502 (0.37%) died prior to testing, and 1790 (1.3%) were not screened prior to discharge. Of those screened, 4,388 (3.23%) referred for further testing. Of all infants tested and reported, 292 (incidence of 2.13/1000) were documented as having a permanent congenital atypical hearing status. All newborns identified with atypical hearing are referred to Early Intervention services and to the state Children with Special Health Care Needs Program (through UIC-DSCC) that offers ongoing follow-up services. (Data as of 9.2.2020 per the EHDI-information system at IDPH)

 

CDPH worked in partnership with the UIC-DSCC to provide nursing staff training on using OAE portable hearing screening machines. CDPH nurses will now do home visits and follow-up on children who failed their hearing screening upon discharge from the hospital at birth who did not return for follow-up.