Perinatal/Infant Health – Annual Report, October 1, 2021 – September 30, 2022

 

Priority Need: Prevent Infant Mortality

 

Perinatal services are focused on the health of women and infants before, during, and after birth. DPH aims to assure pregnant women in Georgia have every opportunity to access comprehensive perinatal health care services appropriate to meet their individual needs. DPH is committed to improving the quality of perinatal care provided throughout the state.

 

Disorders related to preterm and low birth weight is the number one cause of infant mortality in Georgia. In 2020, the Infant Mortality Rate for Georgia was 6.3 per 1,000 live births, with a 9.6 infant mortality rate among Black, non-Hispanic infants. This rate is two times higher than White, non-Hispanic (5.1) or Hispanic infants (4.1). Research indicates that maternal and infant morbidity and mortality can be reduced if high-risk pregnant women and newborns receive risk-appropriate care.

 

Infant mortality is a priority for DPH, stakeholders, and partners. As a priority for many agencies and partners, it is important for DPH staff to create synergy around strategies to reduce maternal and infant mortality.

 

NPM 3: Risk Appropriate Perinatal Care

 

Regional Perinatal System

The Regional Perinatal System is a collaborative system of hospitals and providers working to ensure risk appropriate care for pregnant and postpartum patients and infants to improve birth outcomes. Georgia has six Regional Perinatal Centers (RPCs) located in Albany, Atlanta, Augusta, Columbus, Macon, and Savannah. The RPCs provide the most advanced care for high-risk mothers and infants in their perinatal region. Each RPC has a Maternal and Neonatal Medical Director and a Maternal and Neonatal Outreach Educator that work to provide consultations and coordinate transfers to ensure care is provided at a risk-appropriate hospital. Outreach Educators also work with regional hospitals to implement quality improvement activities.

 

During the reporting period, Women’s Health continued to strengthen the system of regionalization by facilitating communication among the RPCs. Women’s Health staff hosted and attended quarterly meetings with the RPC Medical Directors and quarterly meetings with the RPC Outreach Educators. Finance and data coordinator meetings were scheduled as needed. An annual site visit was held virtually with each RPC.

Women’s Health also partnered with the RPCs and Outreach Educators to implement statewide quality improvement initiatives throughout their respective regions.

 

Current Year:

Women’s Health continues to coordinate and align maternal and neonatal work with the RPCs across the state. Women’s Health is holding regular meetings with RPC Medical Directors, Outreach Educators, finance staff, data coordinators and stakeholders. Each RPC rotates hosting the quarterly meetings and the Women’s Health team attends and is responsible for a meeting summary. Staff are currently planning for the Medical Director’s annual meeting that will occur in August 2023 in-person. The annual meeting will provide an opportunity to discuss trends identified across the state, best practices, and areas of improvement. These regular meetings facilitate communication and provide opportunities for collaboration.

 

Site visits for this year were conducted with each RPC and three were held virtually and three in-person. Next year, Women’s Health plans to alternate the in-person site visits and travel to the other three centers. Following each site visit, Women’s Health developed a summary and shared that with each center.

 

The RPCs are continuing campaigns and developing interventions to effectively reduce infant mortality. Neonatal Outreach Educators and Medical Directors from each RPC are working collaboratively with Women’s Health staff on planning for a statewide quality improvement project, implementation of the Hammersmith Infant Neurological Examination (HINE) Tool. When implemented, utilization of HINE can identify neurological disorders sooner, allowing for increased potential for early intervention.      

 

Levels of Neonatal Care

Women’s Health implements the levels of neonatal care program. Through the program, hospitals may voluntarily apply for a designation to verify that they are operating at their level of care authorized through their Certificate of Need to provide perinatal services. To achieve a designation, hospitals must complete a site survey with the American Academy of Pediatrics (AAP) based on the AAP national standards for levels of neonatal care. Women’s Health contracts with AAP to provide funding to reduce the cost of the survey.

 

In the reporting year, DPH revised regulations to allow for a Level IV designation, which was previously not available to hospitals. The regulations were also revised to align standards with those set forth by the AAP.

 

The Women’s Health program continued to contract with the AAP to implement the AAP NICU Verification Program. One hospital completed the process during the reporting year and was designated as a Level III NICU in the spring of 2022. Further applications were put on hold until the release of the AAP national standards.

 

Current Year:

Women’s Health has continued to work with AAP to designate hospitals according to their level of neonatal care. Applications with AAP were on hold until the publication of the national standards, which occurred in May 2023. Currently, eight hospitals are completing the application process with the AAP. Women’s Health hosted webinars for hospital staff to promote the program. Women’s Health works closely with hospital staff to facilitate participation, enable hospitals to become ready to apply, and provide technical assistance throughout the application process.

 

NPM 4: Breastfeeding

 

Breastfeeding

Georgia 5-STAR aims to promote breastfeeding as the community norm for infant feeding in Georgia exclusively for six months and up to at least the first year of life, ensure that hospitals and health care facilities implement an infant feeding policy; and make lactation accommodation a reality for working women. In the reporting year, a contract with the Georgia Chapter of the American Academy of Pediatrics (GA-AAP) expanded capacity to provide practical assistance, support, and clinical training to participating Georgia 5-STAR hospitals. Many Georgia hospitals have expressed renewed interest in achieving Georgia 5-STAR status following the various challenges experienced during the COVID-19 pandemic. Education and training opportunities on the Ten Steps to Successful Breastfeeding, the broad framework of the Baby-Friendly Hospital Initiative, are provided through the First Latch-Breast Feeding Hospital Initiative (BFHI) online training module with practical assistance through the GA-AAP. During this period, GA-AAP provided 59 hours of technical assistance and subject matter expertise to participating birthing hospitals that are working towards completing the Ten Steps to Successful Breastfeeding. Practical assistance includes monthly phone and email support and policy reviews as requested by the birthing hospitals. Through these efforts, 19 hospitals have been awarded 5 Stars and 10 hospitals are in process of earning stars. Hospitals are recognized for completing steps towards the implementation of the Ten Steps to Successful Breastfeeding. A commemorating plaque is presented to hospitals that successfully complete a minimum of six steps.  

 

Women’s Health worked with GA-AAP to deliver the Educating Physicians in their Communities (EPIC) breastfeeding program and distribute information to hospital staff on accessing lactation support services in the community to further patient education. Seventy EPIC trainings are provided annually.  

 

In collaboration with the Georgia Perinatal Quality Collaborative (GaPQC), Women’s Health provided opportunities for hospital teams to join educational webinars to increase the breastfeeding knowledge base of participating hospital staff. The series included topics to promote breastfeeding initiation within the first hour after birth and promote lactation support in the community for continuation and exclusivity through six months. These educational webinars aligned with the implementation of the GaPQC Optimizing Nutrition for Georgia Newborn statewide quality improvement initiative.

 

Working through the lens of health equity, Women’s Health continued to explore opportunities to support hospitals in incorporating aspects of health equity into their policies and procedures to support breastfeeding and to assess facilitators and barriers to improve breastfeeding practices and outcomes. Birthing hospitals were invited to participate in the Institute for Perinatal Quality Improvement SPEAK UP trainings offered twice a year in 2021 and 2022. 

 

Current Year:

The Georgia 5-STAR Hospital Initiative aims to promote breastfeeding as the community norm for infant feeding in Georgia exclusively for six months and up to at least the first year of life, ensure that hospitals and health care facilities implement an infant feeding policy, and make lactation accommodation a reality for working women. In the current year, Women’s Health is continuing the Georgia 5-STAR Hospital Initiative to address the need to support in-hospital breastfeeding education and increase breastfeeding initiation rates. Women’s Health continues to contract with GA-AAP to provide practical assistance, support, and clinical training to participating hospitals to increase the number of hospital staff and providers trained on the Ten Steps to Successful Breastfeeding. From the start of the period through May 30, 2023, GA-AAP provided 41 hours of practical assistance. The EPIC breastfeeding program is being delivered by GA-AAP as part of the ongoing collaboration and contract has been successful to reach clinical teams and distribute information on how to access lactation support services in the community for patient education. Seventy EPIC trainings are provided annually with a focus on reaching under resourced counties in Georgia. The EPIC program offers a pre-and post-presentation survey to assess changes in knowledge, planned practice changes, and program content. Results are compiled quarterly and reviewed for continuous quality improvement.  

 

Women’s Health supports the Athens and Waycross public health districts in implementing their breastfeeding support and continuation plan. The nationwide infant formula shortage highlighted the critical importance of these programs to promote breastfeeding to ensure better health for infants and children and reduce low food security. Breastfeeding promotion and support programs provide education about breastfeeding and necessary support to women and linkages to care such as family planning and WIC throughout pre-and post-natal care.

 

Georgia Perinatal Quality Collaborative (GaPQC) Neonatal Initiative

Optimizing Newborn Nutrition (ONN) is a two-year hospital-based quality improvement initiative focused on increasing the percent of newborns with human milk (maternal or donor) as the first feeding, decreasing the provision of formula, and mother breastfeeding or expression within six hours of birth. All hospitals in Georgia with Mother/Baby units or NICUs are eligible and encouraged to join the initiative. Educational webinars and self-paced microlessons started June 2022 and will continue through the two-year initiative. Each month featured an hour-long webinar with four associated foundational micro-lessons. The webinars provided opportunities to translate education into practice and feature expert faculty. The webinars and microlessons began with supporting the normal course of lactation for the healthy, term dyad and then expanded into NICU-specific education. Webinars focused on quality improvement topics will also be offered quarterly. 

 

Current Year:

GaPQC successfully launched the ONN Initiative in June 2022 and has been providing Mother/Baby units and Neonatal Intensive Care Units (NICUs) with educational webinars and self-paced microlessons featuring an hour-long webinar with associated foundational micro-lessons each month. Starting in July 2022, hospitals enrolled in active improvement submit minimal hospital data monthly for a random sample of ten infants. Quarterly, GaPQC provides active improvement hospital teams with quarterly reports that show how they are doing in the three main indicators (human milk as first feeding, provision of formula, and mother pumping or expressing in the first 6 hours after birth) in the unit and compared to the collaborative. Hospital teams use these reports to determine a SMART aim specific to their units’ needs and build a driver diagram to guide their improvement work. 

 

Related legislation: House Bill 825 passed in April 2022, which provides Medicaid coverage for donor human milk prescribed for an infant when ordered as medically necessary by a physician or physician assistant; the infant is younger than six months of age; the infant is medically or physically unable to receive maternal breast milk or participate in breastfeeding; the infant's caregiver is medically or physically unable to produce breast milk at all or in sufficient quantities; is unable to participate in breastfeeding despite optimal lactation support or has a contraindication to breastfeeding.

 

NPM 5: Safe Sleep

 

Safe Infant Sleep Program

The Safe Infant Sleep program leads the Georgia Safe to Sleep Campaign and implements evidence-based interventions to reduce the number of preventable cases of sudden unexpected infant deaths (SUID). Efforts are focused on ensuring accurate and consistent education provided to both professionals and caregivers, researching ways to address health inequities, and providing tools for families to practice Safe Infant Sleep.

 

In the reporting year, hospitals provided education and safe sleep education materials. However, the ability to initiate new work with hospitals on safe sleep stalled due to capacity issues. The program prepared a training for NICU nurses based off the 2021 Technical Report issued by the American Academy of Pediatrics to reinvigorate participation. The second cohort for the guided rapid-cycle continuous quality improvement initiative was offered to assist participants with assessing their hospital-based safe sleep programs and to make changes where needed. These two projects were placed on hold temporarily due to the release of the 2022 American Academy of Pediatrics recommendations on safe infant sleep. The program focused on updated training materials, provider aides and parent education.

 

The Safe Infant Sleep program manager joined the national Anti-racism and Health Equity working group offered through Safe States Alliance, a non-profit organization and professional association whose mission is to strengthen the practice of injury and violence prevention. The program also re-joined their second Children’s Safety Learning Collaborative and partnered with DPH Chronic Disease’s Tobacco Cessation program to focus on tobacco cessation for expectant mothers.  

 

The program hosted monthly “Train the Trainer” sessions to build local capacity to teach safe sleep education within communities and ensure that safe sleep education remains accessible, accurate, and consistent. The first session had 129 participants with interest for additional sessions. The recruitment for booster sessions occurred with the assistance of Safe Kids Columbus, a community coalition providing car-seat checkups and safety workshops to help parents and caregivers prevent childhood injuries. 

 

Georgia State University provided Geographic Information System Mapping (GIS) for SUID data from the Georgia Child Fatality Review. Results showed interesting overlays, such as the number of SUID that occur in families with multiple people living in the home, resulting in overcrowding. The number of SUID where the infant or other siblings have been removed from the family home at some point prior to the infant death will also be investigated.

 

The Safe Infant Sleep program had its seventh article accepted for publication. “Incident and Racial Discrepancies in News Media Reporting of Sudden Unexpected Infant Death” was a collaboration between Children’s Healthcare of Atlanta’s, Dr. Sarah Lazarus, DPH Injury Prevention, and the Safe Infant Sleep program. The article was published in Injury Epidemiology.  

 

The program’s contract for portable cribs had an unexpected 77 percent increase in cost per item. This increase will undoubtedly impact the ability to provide safe sleep environments to families in need by both the Safe Infant Sleep program and others within the community.

 

Current Year:

In the current year, hospitals continue to provide education and safe sleep education materials. However, the ability to initiate new work with hospitals on safe sleep has stalled due to capacity issues at the hospitals. 

 

The program continues to offer “Sleep Baby Safe & Snug” books and has engaged with the hospitals to offer a training on the 2022 American Academy of Pediatrics updates on safe infant sleep which has 1.25 CEU’s available for nurses. This training includes expanded education around tobacco cessation which was the goal of participating in the Children’s Safety Learning Collaborative and partnering with DPH Chronic Disease’s Tobacco Cessation program. Previous education did not include information on the Georgia Quit Line and how professionals can refer clients to receive free assistance in tobacco cessation. Evaluation showed that over 93% of participants (N=173) felt confident discussing tobacco cessation options after the training. 

 

The program also updated educational materials to reflect the 2022 American Academy of Pediatrics updates on safe infant sleep. These materials include the “What is Safe Sleep for Babies” educational flipbook which has been offered to sites around the state.

 

The program continues to evaluate safe sleep education and is exploring what information is helpful for families to support safe infant sleep after baby is born. The program follows up with willing participants when their infant is 3 to 5 weeks old and provides a brief educational session. Participants are also interviewed to elucidate what is easy or difficult when it comes to following safe sleep recommendation. The recruitment for booster sessions is on-going with the assistance of Safe Kids Columbus, a community coalition providing car-seat checkups and safety workshops to help parents and caregivers prevent childhood injuries as well as a local birthing hospital.  

 

The program assisted in the development of a grant application which was awarded to a local non-profit. The program is a part of the multi-disciplinary team tasked with guiding the research meant to address racial disparities in SUID.  

 

The program also launched the “Shelter Program” which works with shelters for unhoused or underhoused families as well as survivors of interpersonal violence. The program currently has 42 participating programs and recently expanded to include a program that works with substance exposed infants and their parents after release from the NICU. Families with infants under 6 months of age are eligible to receive a portable crib and a care package that includes a wearable blanket and a “this side up” onesie and other educational materials. The shelters could also apply to receive portable cribs to use in their facility to ensure that room sharing without bed sharing could be practiced and encouraged. 

 

SPM 1: Percent of Congenital Syphilis Averted

 

Congenital Syphilis

The Sexually Transmitted Diseases (STD) Office’s mission is to prevent STDs by providing quality intervention strategies, programmatic support, and education. With a focus on Congenital Syphilis, the STD team works to promote first and third trimester testing for Human Immunodeficiency Virus (HIV) and Syphilis, as well as improve the data quality of Congenital Syphilis cases. The STD Office works to improve the identification of pregnant females with Syphilis to ensure timely and appropriate treatment. The promotion of first and third trimester testing for HIV and Syphilis continued and efforts to provide education through trainings, community outreach, provider outreach, and district STD staff continued to be a priority.

 

The STD Office continued to work to prevent STDs by providing quality intervention strategies, programmatic support, and education throughout the state. To increase awareness, the STD office worked collaboratively with internal and external partners, which included Division of Women, Children and Nursing Services, to plan and develop a Congenital Syphilis Screening and Treatment Awareness Campaign and provider groups to promote congenital syphilis prevention messaging. Campaign channels included newsletter publications, provider presentations, social media messaging, and conference presentations. The STD Office worked collaboratively with the Office of Quality, Performance and Accreditation to identify Congenital Syphilis outcome measures for the DPH Strategic Plan. The STD office expanded its program staff specifically to support Congenital Syphilis prevention efforts. A Congenital Syphilis specialist was hired in January 2022. The STD Office worked closely with the health districts to prioritize investigations for females with syphilis for timely treatment. STD Office website enhancement efforts included Congenital Syphilis messaging during STD Awareness Week in April 2022, infographics, and data release. To help improve data quality, district and state Congenital Syphilis monthly reports and technical assistance were provided to each health district to ensure improvements in data collection through data matching and medical record extraction. The STD Office also held a Congenital Syphilis Prevention Training in August 2022 for district staff.

 

Current Year:

The STD Office is continuing to promote first and third trimester testing for Human Immunodeficiency Virus (HIV) and Syphilis, as well as improve the data quality of Congenital Syphilis cases. The STD Office is working to improve the identification of pregnant females with Syphilis to ensure timely and appropriate treatment. The program produces district and state Congenital Syphilis monthly reports and provide technical assistance to each health district to ensure improvements in data collection through data matching and medical record extraction. The Office of Women’s Health, Office of Nursing, and Office of STD are collaborating to address the increase in congenital syphilis cases in Georgia. An ECHO session targeting OB providers was held during November to increase awareness about the importance of screening early in the third trimester of pregnancy to provide adequate time for treatment before delivery. The program was promoted collaboratively with the GA Ob/Gyn Society and 99 participants, including physicians and midlevel providers, joined the session. A recording of the session is available on the agency website. Efforts are underway to leverage OB partners and communication channels to increase knowledge about testing, interpretation of test results, and treatment guidance and resources.

 

SPM 2: Reduce Infant Mortality in the Black Population

 

The Infant Mortality Community Toolkit was developed to empower community members, leaders, and organizations with the information and resources necessary to promote infant health and reduce infant mortality in their communities. The Toolkit slide deck was presented to the Georgia Family Connections Regional Managers for external review and feedback.

 

As part of the Georgia Perinatal Quality Collaborative’s (GaPQC’s) focus on health equity, the maternal and neonatal committees continued the two phased approach to address racism and improve health equity. Phase one was to build capacity among hospital teams from Georgia’s birthing hospitals. This remained a focus through the reporting period and beyond as turnover at the hospital level highlighted the need for ongoing training. A strong partnership with the Institute for Perinatal Quality Improvement (IPQI) allowed multiple offerings of the SPEAK UP Against Racism training during this period. During the training, participating clinicians became Speak Up Champions and created an action plans to support their hospital specific equity projects.

 

Current Year:

During the current year, GaPQC offered additional SPEAK UP health equity trainings in partnership with IPQI and moved into phase two of the health equity work. Phase two involves supporting hospital teams to implement their hospital specific action plans to strengthen their initiatives with a focus on equity. Sixty five percent (65%) of GaPQC hospitals attended the SPEAK UP training and are in various stages of working to improve their hospitals’ quality improvement initiatives. GaPQC is supporting the SPEAK UP Champions in partnership with the Georgia OBGyn Society by hosting an ‘office hours’ type meeting for Champions to have a space to discuss their equity QI initiatives and how the implementation is going.

 

Other Perinatal/Infant Health Programs

 

Neonatal Abstinence Syndrome

Neonatal Abstinence Syndrome (NAS) is a notifiable condition in Georgia as of January 1, 2016. DPH requires notice and reporting of incidents of NAS by a health care provider, coroner, medical examiner, or any other person who has knowledge of diagnosis or health outcomes related, directly or indirectly, to NAS. GaPQC led the statewide QI initiative to reduce length of stay among newborns diagnosed with NAS with forty-six participating birthing hospitals. Through the QI initiative, 17 GaPQC hospitals had a greater than 10 percent reduction in length of stay from 16.3 days to 14.7 days. Sixteen hospitals achieved Center of Excellence status. A total of 16,063 lessons were completed with 1,971 participating staff members. The NAS initiative moved into sustainability in September of 2021. In the sustainability phase, GaPQC continued to provide support to hospitals enrolled in the initiative to embed their progress into the day-to-day functions of their hospital. Hospitals are still statutorily required to report incidents of NAS.

 

Current Year:

Hospitals continue to report cases of NAS for ongoing surveillance. GaPQC continues to support hospitals in sustaining the improvements made through the NAS Quality Improvement initiative. 

 

Newborn Screening

Newborn Screening (NBS) is a life-saving public health service offered universally to infants born in Georgia. At the federal level, the Advisory Committee on Heritable Disorders in Newborns and Children (ACHDNC) conducts thorough evidence reviews to determine if a condition should be added to the Federally Recommended Uniform Screening Panel (RUSP). Georgia’s condition review process is similar to that at the federal level and Georgia typically adheres to RUSP.

 

In the current year, NBS continues to identify and provide early treatment for 35 selected inherited disorders that otherwise would cause significant morbidity or death. The team provides education for parents and health care providers, universal testing of all newborns, follow-up including rapid retrieval and referral of the screen-positive newborns, confirmation of a normal or abnormal screening test result by a private physician or tertiary treatment center, rapid implementation and long-term planning of therapy, and validation of testing procedures. NBS facilitates communication between practitioners, birth hospitals, the laboratory personnel, and the follow-up teams to provide ongoing education for practitioners.

 

The Medical Nutrition Therapy for Prevention (MNT4P) program provided ongoing services to individuals with conditions identified through NBS. The MNT4P continues working to improve health outcomes and the quality of life for individuals with IMDs by increasing access to medical nutrition therapies necessary for treatment and maintenance of these metabolic disorders.

 

NBS and NBS follow-up continue to adhere to protocols established due to COVID-19. NBS follow-up teams continue to conduct conference calls with subspecialists to whom they typically refer infants that require further testing or are diagnosed with an NBS condition. Teams discuss the effectiveness of processes to keep children safe during appointments. Specialists maintain 24/7 call lines to support pediatricians who provide services to infants and children with an NBS condition.

 

The NBS team developed an unsatisfactory specimen process improvement map and action plan. The poster, “Prioritizing Newborn Screening Education: Engaging Hospitals to Improve NBS Quality and Reduce Unsatisfactory Rates in Newborn Screen Blood Specimens” was presented during a virtual panel at the Association of Public Health Laboratories (APHL) Continuous Quality Improvement annual national meeting in October 2021. 

 

Current Year:

The NBS program is continuing efforts to ensure that every newborn is screened for heritable disorders with prompt identification and treatment. The NBS program continues to be responsible for the administration of the NBS system, which includes 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. Contracts with Emory University, Augusta University, and Children’s Healthcare of Atlanta continue 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. This helps ensure that all diagnosed cases are referred to Children 1st, leading to an assessment to determine the newborn’s eligibility for Individuals with Disabilities Education Act (IDEA) Part C, Babies Can’t Wait (BCW), children and youth with special health care needs (CYSHCN), and Children’s Medical Services (CMS).

 

The NBS program provides education to parents and providers. The program partners with organizations that engage providers, such as the GA-AAP and the Georgia Academy of Family Physicians, to participate in webinars, blast fax communications, professional development conferences, and grand rounds. On-site and telephone technical assistance to birthing hospitals will continue as needed.

 

DPH and the NBS program continue to collaborate to improve electronic transmission of results to providers to increase access to electronic results and reduce the number of paper NBS results that are mailed to providers. This allows providers that were not listed as the provider of record on the NBS card easier access patients’ NBS results. The NBS program continues to make improvements to the NBS database through SendSS by having frequent meetings with internal SendSS informational technology and epidemiology staff to discuss needed enhancements, build new requirements, and monitor the progress of any changes. 

 

Child Health Home Visiting Program

The Child Health Home Visiting Program was established to strengthen Georgia’s capacity for addressing the overall health, safety, and wellbeing of families and children through the implementation of Evidence-Based Home Visiting (EBHV) services and the enhanced coordination of services for at-risk families. The program is guided by a state-level infrastructure designed to support project implementation and evaluation via the provision of technical assistance and trainings. Data collection allows for performance monitoring and continuous quality improvement. The MIECHV program is the primary funding stream for home visiting. Other funding streams include Title V, Child Abuse and Neglect Prevention (CANP), Healthy Start, and other state dollars. Child Health Home Visiting provides EBHV program models as they are proven to improve outcomes in several domains including (1) maternal and child health, (2) positive parenting practices, (3) child development and school readiness, (4) reductions in child maltreatment, (5) family economic self-sufficiency, and (6) linkages and referrals to community resources and supports.

 

In the reporting year, the program continued the commitment to implement evidence-based, comprehensive, and community-based maternal and early childhood programs, including Healthy Families Georgia, Nurse Family Partnership, Parents as Teachers, and Maternal and Early Childhood Sustained Home Visiting. In-home, face-to-face home visiting services resumed on March 1, 2022, with required use of face masks. Each of the local implementing agencies (LIAs) received the 2022 Continuity of Operations Plan (COOP) that provides COVID-19 State of Georgia Guidelines for Re-Initiation of In-Home Home Visits. The COOP included guidance on social distancing, increased health practices and a decision tree originated by Washington State University to assist individuals and sites with safely returning to in-person visits. Clients enrolled in the home visiting program could choose to receive in-person home visits or continue with virtual visits.  

 

Child Health Home Visiting continued to facilitate the Georgia Healthy Start Collaborative for the six Georgia Healthy State grantees and the Healthy Start National Project Officer to foster collaboration and team building and identified opportunities to leverage resources for successful partnerships. The collaborative continued to work together to meet the Healthy Start benchmarks and Title V performance measures.  

 

Child Health Home Visiting provided monthly check-in calls with LIAs to provide support and guidance and allow sites to share strengths, challenges, and ideas regarding the impact of COVID-19 on service delivery, staff and families served. As a result of the monthly calls, the program successfully met its goal to have most of its sites maintain program capacity of at least 85 percent during the reporting period.  

 

The Georgia Strong Families Program (GSFP) successfully recruited, enrolled, and retained families. Virtual visits were completed using DPH telehealth platforms Cisco WebEx and Cisco Telepresence. Virtual visits allowed Child Health Home Visiting to meet the goals to optimize child development through screening, early detection, and connection to appropriated services, enhance parenting skills and resilience through delivering approved EBHV models with fidelity, and safeguard maternal and infant health through education and linkage to community resources. 

 

Healthy Start Professional Development Staff training opportunities aimed to increase their knowledge in family and community engagement included: 

 

Connections Matter - This training provided participants knowledge about ACEs and provided a better understanding of the connection between trauma, brain development, resilience, and health. 

 

Becoming Grief-Informed: Helping Parents Cope with the Loss of a Child - This training introduced the five stages of grief model and the three techniques used throughout the grief process. The session also provided practical strategies for supporting grieving parents. 

 

Executive Function Skills: Leading from the Inside Out - This training introduced the importance of executive function skills and how they are used in everyday life. Participants completed a self-assessment to develop a plan of action to increase their executive function skills. 

 

GSFP Retreat - The University of Georgia Fanning Institute for Leadership Development conducted a professional development retreat for GSFP team and Community Action Network (CAN) partners. 

 

Meeting of the Minds: Emergenetics - Emergenetics is an assessment based in the concept that one’s personality is the emergence of behavior, genetic makeup, and life experiences. The assessment provides an in-depth insight into understanding one’s individual identity. This assessment was conducted and used to equip GSFP staff with strategies and resources to enhance their personal effectiveness in communication and collaboration. 

 

Leadership Practices and Principles - This session provided GSFP staff with an understanding of effective leadership principles that can be applied in their daily interactions with team members, community partners, and families.   

 

Selfcare during COVID-19 for helping professionals - This session provided GSFP team tools to improve selfcare and reduce stress and provided instructions on how to avoid burnout and compassion fatigue while managing the needs of the families they serve. 

 

Child Abuse and Neglect: Reporting and Responding while Strengthening Families - This session increased participants’ knowledge, awareness and attitudes about child protective behaviors. Participants learned to define and recognize the four types of abuse and neglect, identify physical and behavioral indicators of legally recognized types of abuse and neglect, and provided knowledge on their role as mandated reporters. 

 

Community Action Network Retreat - These interactive working sessions included a detailed overview of the collective impact process. The UGA Fanning team assisted the Valdosta and Columbus teams in developing their collective action plans and developing shared measurement strategies. 

 

Current Year:

The Child Health Home Visiting program continues to strengthen its services and maintain its proven track record to positively impact the wellbeing of families, communities, and the state. The program continues to focus on diversifying funding to sustain and expand home visiting throughout the state, strengthening the workforce through assessment, and training and improving maternal mental health. The program has made maternal mental health a priority, as approximately ten percent of pregnant women worldwide and 13 percent of women who have recently given birth experience a mental disorder, primarily depression. Child Health Home Visiting is training staff and identifying community partners for direct linkage. 

 

The Healthy Start Georgia Strong Families Program (GSFP), managed by DPH, is providing healthcare coordination, home visitation, and case management services to 700 participants in the reporting year including pregnant women, new mothers, infants, and fathers. Child Health Home Visiting program staff facilitate the coordination of community service delivery systems, as well as the promotion and improvement of health equity.