III.E.2.c Annual Report: Perinatal/ Infant Health

The perinatal period refers to the period immediately before and after birth. Perinatal and maternal health are closely linked. Infant health refers to the period before a child's first birthday, a very critical period in growth and development. The RI MCH Program strives to ensure that all pregnant womxn receive appropriate prenatal care, which can affect both maternal and infant birth outcomes. The program is focusing on the caregiver relationship between the mother and infant. Emphasis is placed on identifying pregnant and parenting families who are at high risk of negative outcomes and linking them to appropriate services, including addressing stagnant or worsening trends in racial/ethnic disparities.

 

Rhode Island had the following priorities for perinatal and infant health:

1. Strengthen caregiver’s behavioral health and relationship with child

Priority: Strengthen Caregiver’s Behavioral Health and Relationship with Child

Title V aims to support a caregiver’s behavioral health and relationship with their child. This includes supporting bonding methods between caregiver and child and assessing the behavioral health of the caregiver and referring them to appropriate and supportive services. The following needs assessment data show an increasing need to support caregivers’ behavioral health and their relationship with their child:

 

Interactions with Children: In 2022-23, home visitors observed 73.4% of caregivers interacting with their children, an increasing trend from previous years.  However, those caregivers who were never married (66.1%) were still less likely to be observed interacting with their children than caregivers who were married (83.1%) or caregivers who aren’t married but living with a partner (76.1%).

 

Ability to Handle Day-to-Day Demands of Caring for Children: Furthermore, 59.0% of caregivers are able to handle the day-to-day demands of raising children very well in 2021-22, which is a slight decrease from 58.0% in 2020-21. 

 

Breastfeeding: 2018 NIS data shows that 82.8% of RI infants breastfed at some point and time (an increase from 78.8% in 2017) but that only 22.7% of RI infants were breastfed exclusively through 6 months.

 

Mental and Emotional Health: In 2021-22, the percentage of mothers who reported having excellent or very good mental and emotional health was 71.0%, which is only a slight increase from 70.4% in 2020-21. In 2021-22, 63.2% of mothers with a household income of 100-199% Federal Poverty Level (FPL) reported having excellent or very good mental and emotional health compared to 79.1% of mothers with a household income of 400% FPL or greater.  

 

In addition, the RIDOH community survey showed that participants chose mental health (e.g., postnatal depression or anxiety (29%) and culturally responsive pregnancy/postpartum education and care (12%) as the top issues related to pregnancy and birth that the DOH should focus on to support families. Similarly, the RIDOH & SISTA FIRE Womxn of Color survey found that participants ranked the following as the three most important things to be addressed to improve the wellbeing of newborns/infants: 1) Support new moms in caring for their infant (social, emotional, & financial); 2) Screening newborns for health conditions and diseases; and 3) Bonding and attachment. Women of color responses for promoting the wellbeing of children (1-4 years old) were closely aligned as well. The top three answers were:1) Parent/Caregiver Support (social, emotional, financial) (70%); 2) Affordable & Quality Child Care (60%); and 3) Healthy check-ups & immunizations (56%). Overall, these three surveys show a statewide need for more comprehensive caregiver and baby support, especially in the arena of mental and emotional health.

 

Birth defects program data, in 2021, showed that 76 newborns were discharged with neonatal abstinence syndrome. This represents a rate of 72.7 per 10,000 live births, a decrease from the NAS rate of 89.4 per 10,000 in 2019. There was also a decline in the number of substance exposed newborns from 538 in 2019 to 470 in 2020. However, in both HEZ SUD reports and SISTA FIRE Key Learnings, parents of SENs report being stigmatized and judged by medical care providers and hospital staff. SISTA FIRE interviewee shared, “My girlfriend delivered our son, who was delivered on methadone. He had to stay in the hospital for a few days so they could wean him off the methadone. We left the hospital, but when we went home, he was having signs of detox, so we brought him back to the hospital. About two days after we brought him back...a social worker from DCF came in, and we were wondering why...A nurse had reported that she found a syringe in the bathroom of the hospital...The baby got taken from our custody. It was an agonizing year because he didn’t return home for a year, It was because they said they found a syringe in the bathroom...which was not true. I believe the nurse because we was on methadone, they felt we wasn’t worthy of having a baby.”

 

To respond to these disparities and support this new priority, RIDOH will resume, continue and add strategies as follows:

 

Grow Behavioral Health Teleconsultation Resources for Caregivers and Children:  Thanks to HRSA funding, RIDOH continues to implement statewide psychiatry resource networks (PRN) for both pregnant and postpartum patients (RI MomsPRN) and children and adolescents (PediPRN) to help healthcare providers treating pregnant, postpartum, or pediatric patients screen and manage behavioral health disorders. Since 2018, funding for both PRN programs were provided by two federal grants awarded to the Rhode Island Department of Health (RIDOH). However, RIDOH grant funding for these services changed in September 2023. Only the PediPRN program was awarded continued federal funding for the next three years, while the RI MomsPRN program was not.  The RI MomsPRN 2023 federal grant application was highly competitive and funded states had large populations, widespread geographies, or vast access issues comparable to our relatively resource-rich, small state.

RI MomsPRN Program: With remaining federal funding, RIDOH continued to implement the RI Maternal Psychiatry Resource Network (RI MomsPRN) Program to help obstetrical, adult primary care, pediatric, and psychiatric providers, as well as other community-based staff caring for pregnant and postpartum individuals screen and address behavioral health disorders and concerns. RIDOH continued to partner with the Center for Women’s Behavioral Health at Women and Infants Hospital (CWBH) for statewide behavioral health teleconsultation services for calling providers, including resource and referral, and the Care Transformation Collaborative of Rhode Island (CTC) for learning collaborative facilitation services to help practices optimize and enact behavioral health screening, treatment, and referral protocols among their perinatal patients.

 

The RI MomsPRN teleconsultation line is staffed by clinicians with perinatal expertise at the CWBH and is modeled after Rhode Island’s successful Pediatric Psychiatry Resource Network (PediPRN) program (see next subsection for more information). The goal of the RI MomsPRN psychiatry teleconsultation line is to empower providers in effectively managing their perinatal patients’ mental health and substance use concerns, by initially providing diagnosis, treatment, and medication guidance from RI MomsPRN perinatal psychiatrists, and/or by resource and referral support to various services, including those that are community based. Non-prescribing health care providers, such as Family Visitors, WIC nutritionists, and doulas, continue to be able to access resource and referral support through the RI MomsPRN teleconsultation line and are offered professional education sessions. Program staff also continue to strengthen connections with the Substance Use and Mental Health Leadership Council of RI and the RI Substance Exposed Newborn Taskforce to better support and engage behavioral health treatment and recovery providers with program services, especially those serving perinatal patients. 

During this reporting period (October 2022 – September 2023), the RI MomsPRN teleconsultation line fielded 846 initial encounter calls, with 9 coming directly from perinatal patients and the remaining 837 calls coming from 292 unique providers (71 prenatal, 47 adult primary care, 46 psychiatric, 25 other mental health providers, 6 pediatric, and 97 community-based professionals, including family visitors, doulas, social workers, WIC nutritionists, and Early Intervention staff) at 130 practices across the state. Referrals and services requested by RI MomsPRN calling providers varied, with 52.6% seeking outpatient treatments (442 calls), 24.5% seeking an evaluation with perinatal specialist (206), 14.8% seeking medication teleconsultation (124), 4.5% seeking care coordination support (38), 2.1% seeking intensive treatments (e.g., inpatient, partial hospitalization, and crisis consult) (18), and 1.4% needing substance use disorder (SUD) treatments (12). Highlights of call outcomes include 125 medical consultations, and/or 1,037 resources/referrals offered. Clinical concerns reported by providers included depression (586 calls), anxiety (448), PTSD (59), SUD (58), ADHD (44), Bipolar (41), or some other mental condition (50).

In total, 719 perinatal patients (including 240 pregnant women) were helped because their provider contacted the RI MomsPRN teleconsultation line during this reporting period. These perinatal patients vary in:

• age (19 and under (2.6%), 20-29 (32.3%), 30-44 (46.2%), 45+ (0.3%), or unknown (18.6%)), 
• race (American Indian or Alaska Native (1.1%), Asian (1.4%), Black or African American (14.5%), Native Hawaiian or Other Pacific Islander (1.1%), White (47.8%), multiple race/other (7.6%), or unknown (26.4%)), 
• ethnicity (Hispanic (22.1%), non-Hispanic (53.1%), or unknown (24.8%)), 
• health coverage (public (49.9%), commercial/other (35.9%), uninsured (0.6%), or unknown (13.6%)), 
• primary language spoken (English, Spanish, African languages, Portuguese, and French Creole)

The RI MomsPRN Program also continued to organize perinatal behavioral health learning collaborative cohorts that help practices caring for perinatal patients optimize their screening, treatment, and referral workflows for depression, anxiety, and substance use disorder using validated screening tools of their choosing. The goal is to have each practice universally screen all attributed perinatal patients at least once for each domain and respond with appropriate treatment/referral. Practices are recruited through a statewide call for applications that are objectively scored and reviewed by a committee. Selected practices each form a quality improvement team that includes a practice champion, leader, and IT staff member among others that meet monthly with CTC-RI practice facilitation staff along with CWBH clinicians and RIDOH staff to discuss and monitor workflow changes. All practice staff are welcome to attend cohort-wide learning sessions and/or just in-time practice specific trainings and can call the RI MomsPRN teleconsultation line for patient specific clinical advisement and/or resource/referral support. 

During this reporting period, a third learning collaborative that was comprised of 4 new practices and 5 continuation practices from the second cohort was completed in the summer of 2023. In total, these 9 practices had 129 providers that cared for 1,978 attributed perinatal patients (12.7% of all the estimated perinatal population in RI). Practice perinatal patients varied in age (19 and under (2.9%), 20-30 (36.1%), 30-44 (60.1%), or 45+ (0.9%), race (American Indian or Alaska Native (1.1%), Asian (2.7%), Black or African American (15.8%), Native Hawaiian or Other Pacific Islander (1.4%), White (52.6%), multiple race/other (11.8%), or unknown (14.7%)), ethnicity (Hispanic (29.7%), non-Hispanic (48.3%), or unknown (22.0%)), and health coverage (Medicaid (61.3%), commercia/private (36.0%), no insurance (1.6%) or unknown (1.0%)). Finalized screening data showed that 66.1% of attributed perinatal patients were screened for depression (1,308), 65.9% were screened for anxiety (1,303), and 41.6% were screened for SUD (818) at least once using a validated tool during relevant performance periods. This is an increase from reported baseline data. Among those perinatal patients screened, 11.7% screened positive for depression (153), 17.0% screened positive for anxiety (221), and 23.1% screened positive for SUD (189).

In addition to providing perinatal behavioral health teleconsultation and practice transformation services at this time, the RI MomsPRN program also engaged with 1,823 providers who collectively attended 85 program sessions (46 professional education sessions and 39 outreach sessions) to obtain training relating to various perinatal behavioral health topics and/or program information about teleconsultation supports. Please note this provider count is not deduplicated and are session specific totals that are summed that are inclusive of learning collaborative sessions. This provider count is in addition to and complimentary of ongoing clinical advisement provided to local providers who called the teleconsultation line during this time. RI MomsPRN program staff also were featured 6 times by local news outlets, authored 5 peer reviewed research articles, issued 3 RIDOH state agency health professional advisories, and developed new provider outreach materials and informational reports.

RI MomsPRN program staff also continued to collaborate with the PediPRN program to jointly promote teleconsultation services when appropriate, coordinate communication and clinical efforts, and enact program sustainability efforts. Like the prior year, PRN program staff were also successful in getting legislation introduced in both chambers of the RI General Assembly during the 2023 session, with bill proposing sustained funded through a health plan assessment being passed by the full Senate and held for further study by the House Finance Committee.

Postpartum Depression Screening: The RI MomsPRN program also continues to actively support RIDOH family visiting programs, both short-term (First Connections) and long-term MIECHV services as well as WIC staff across the state given requirements to regularly screen for maternal depression and refer impacted clients to care. Additionally, doulas, early intervention staff, and community health workers, among other community-based staff continue to be made aware of program supports and are welcome to call the RI MomsPRN teleconsultation for resource and referral support. During this time, 133 calls from 37 community-based staff (doulas, family visitors, early intervention, and WIC staff) across the state were made to the RI MomsPRN line that helped 130 perinatal clients obtain support mostly for maternal depression. In addition, the RI MomsPRN program conducted a qualitative evaluation among these critically trusted community-based professionals to better understand the perception of need, related workflows/responsibilities, and equity related to maternal mental health as well as assess any desired professional education and resource/referral supports and to solicit their recommendations on statewide policy and practice. In total, 61 affiliated professionals completed a comprehensive assessment survey, and 20 participated in focus group sessions. Findings informed RIDOH’s grant application that was submitted to HRSA for continued federal funding, which was not awarded, and for overall program quality improvement and planning of statewide program supports and services going forward.

PediPRN Program: PediPRN serves providers treating children and adolescents in partnership with Bradley Hospital. The project’s mission is to improve access to behavioral health care for Rhode Island children and adolescents by integrating psychiatry into the state’s pediatric primary care practices. PediPRN uses a telephonic integrated care model to improve access to quality behavioral health expertise to achieve its mission. This service, funded by a 5-year HRSA grant, is free and provides all Rhode Island pediatric primary care providers assistance with their patients' mild to moderate mental health care needs. PediPRN focuses on creating a culture of empowerment for pediatric primary care providers. The clinical team works closely with providers offering CME opportunities, educational e-blasts, an updated website with assessment and educational resources on pediatric behavioral health topics, and ongoing support during telephonic consultations.

During the reporting period, PediPRN served 107 children, participated in 129 consultations, and facilitated approximately 15 office hours sessions. Practice-based office hours have been a successful strategy to provide training, consultation, and support to specific practices. Office hours have also been an excellent opportunity to learn more about the mental health needs of particular practices across the State and establish program champions to support programming and sustainability efforts. The modality for practice-based office hours is Zoom and the frequency is monthly for one hour for each practice. During this time, PPCPs ask for support with specific cases and general mental health questions, share mental health-related challenges within their practices, and provide feedback regarding service needs in these discussions. We have also shared PediPRN sustainability efforts and inquired about PPCP's comfort with supporting these efforts via advocacy. Practitioners have utilized general/open “drop-in” office hours less frequently, so we have decided to pause on continuing these open office hours and are considering alternative strategies.

PediPRN also initiated the 4th cohort of its intensive program with 20 providers enrolled. The goal of the PIP is to increase PPCPs knowledge about and comfort with diagnosing and treating mild to moderate mental health conditions in their patients. Each session is 1.5 hours long and includes didactic training, case presentations, and interactive discussion. Presenters are experts in the specific mental health condition they present. The moderator provides continuity across the sessions and facilitates discussion on cases and the burden that impacts practitioners when treating mental health conditions. Presentation slides and additional materials are available via google classroom. In addition, PediPRN sends out periodic electronic education via e-blasts and newsletters to provide up-to-date information regarding mental health resources, mental health screening and treatment training, and PediPRN services.  Evaluation of both PIP graduates and highly engaged providers show that these providers have:

• Higher rates of mental health-focused visits
• Fewer psychiatric hospitalizations per year
• Increased knowledge and comfort with assessing safety, evaluating, and managing non-suicidal self- injury, and awareness of available mental health care.

We continued to develop our partnership with RI Mom’s PRN which led to joint marketing and outreach, joint education/webinars, local news media coverage, and joint legislative efforts. In addition, PediPRN and MomsPRN pursued legislation that would generate 100% of the funding for the PRN lines from healthcare payers (like the model used for the Rhode Island Vaccine Assessment Program and the Children’s Health Account – Rhode Island) and developed a value proposition supported by both qualitative and quantitative data.  The proposed approach to sustaining the PRN lines has been fully implemented in Washington and Massachusetts.  Both programs use a formula that equitably distributes costs among payers based on the number of covered lives.  Over the past 2 years, the programs have collaborated to build buy-in for this sustainability strategy.  For the spring 2023 legislative session, Care New England engaged a lobbyist to bring the legislation forward for the second year.  The legislation was introduced for the second time in spring 2023, with slight revisions to the language. For a second time, it passed in the RI Senate and was tabled for further study by the House Finance Committee. There were no formal objections to the legislation and Blue Cross Blue Shield (among others) issued a public letter of support. 
 

Continue to use evidence-based screening tools to identify family needs and make appropriate referrals to necessary services that support positive health outcomes for all family members: The Family Visiting program continues to use evidence-based screening tools with families.  These tools have been chosen from a list of approved tools that HRSA provided for the MIECHV Performance Measures.  The screenings assist in guiding visits, prioritizing family needs, and planning visits around those needs. The screenings begin during the first two visits/enrollment period with a family and continue periodically throughout a family’s participation in family visiting. Caregivers are screened for prenatal and postpartum depression, alcohol and substance use disorder, interpersonal violence and quality of the parent/caregiver child relationship.  One evidence-based model also screens for anxiety.

Families are offered referrals and are linked to care based on screening results. Children are also screened for developmental milestones as well as physical, social, and emotional health. Based on screening results, children are referred to supportive services, such as Early Intervention. Families are also screened for the quality of the caregiver-child relationship. With consent, family visitors also share concerns with medical providers including obstetricians and pediatricians.  One family visiting agency, with two evidence-based programs participated in a CQI initiative on health equity.  This started in March 2023.

Screening Tools and Linkages to Care: The MomsPRN line supports family visitors that are working with caregivers with postpartum and perinatal depression and families experiencing substance use disorder.  Family visitors can access and receive support from the MomsPRN line, just as physicians and other health care providers are. Family visiting agencies from all four programs are able to access the line.  Multiple trainings are scheduled to educate new family visiting staff on the MomsPRN line and how to access the line. The Family Visiting Program Manager also receives data on how many family visitors access the MomsPRN line. RIDOH’s Substance-Exposed Newborn Coordinator is able to assist the line in understanding resources that are available in communities. Family visitors are also able access the line to find substance and alcohol use treatment resources.

Finally, all family visiting programs screen children using the Ages and Stages developmental screening tool and the Ages and Stages screening tool for social emotional development.  Based on screening results, families may be offered an array of supports, including activities to do at home with a child, referrals to Early Intervention, sharing results with a family’s pediatrician and ongoing monitoring and screening. 

 

Identify, Engage, and Retain more Families at risk for Poor Outcomes: The family visiting program worked with the Family Visiting Parent/Caregiver Advisory Council and a marketing company to re-launch the Love that Baby campaign to more effectively reach more high needs families and communities.   This included the use of family visiting social media ads and reworking language and images on marketing materials.  The family visiting program must continue to do better in engaging and retaining some families and communities identified in the 2020 Maternal, Infant and Early Childhood Home Visiting Needs Assessment.   This includes fathers/male caregivers and families in specific communities.

The relaunch of the campaign was tested and approved by the Parent/Caregiver Advisory Council.  Marketing on social media will be a component of the campaign. The family visiting program has begun looking at data that looks at engagement in the communities identified in the 2020 MIECHV Needs Assessment.  The Family Visiting program will continue to try to engage a broad base of referral sources to de-stigmatize family visiting.   

Improve the Professional Development System that is based on National Core Competencies for Family Visiting Staff, including Standardized Orientation for all new staff and supervisors, including Title V Priorities: The Family Visiting Program continues to refine its professional development system and the number and quality of its professional development offerings.   They will continue to support its 11 family visiting agencies with access to mental health consultation and similar supportive resources. With support from national experts, TA and local mental health consultants, RI has developed a tiered framework to support mental health consultation within family visiting so that family visitors, supervisors and program managers have levels of support while working with complicated families. Two levels provide for mental health consultation to family visitors and to families.

The Family Visiting Program provided each family home visiting agency with dedicated funding in the agency’s contract for the past few years. That funding may be used for mental health consultation and supportive services. The Family Visiting Program will continue to provide that dedicated funding in future contracts.

In addition to providing funding to each family visiting agency, the Family Home Visiting Program has partnered with the RI Association for Infant Mental Health (RIAIMH) to provide additional support to the family visiting workforce. The Family Home Visiting Program works with RIAIMH on training and support related to infant mental health. The Family Home Visiting Program is also supporting family visiting staff by funding home visitors engaged in the process of Endorsement for Culturally Sensitive, Relationship-Focused Practice Promoting Infant Mental Health® (RI-IMH Endorsement®).              

This endorsement process ensures that family home visiting staff have the competencies and skills to support the parent-child relationship and promote positive parenting practices that address the needs of infants. The family visiting program has worked with training providers of the reflective practice and supervision to align their training curriculum with the competencies for Endorsement so that their reflection practice and supervision training and group sessions support a family visitor that is working on Endorsement.  The family visiting program will continue encourage family visitors to get endorsed and has been sharing information on the new Endorsement level with family visitors.

In March 2023, the Family Visiting program adapted an existing RIDOH Learning Management System (LMS) specifically for use by family visitors.  The new LMS provides family visiting staff the ability to print certificates/proof of attendance after each training and create a professional development transcript for each individual.  It also provides the RIDOH Family Visiting team data on training frequency and participation. The family visiting program overhauled its New Hire Orientation for family visitors.  The New Hire Orientation is more streamlined and spread out across multiple weeks, with a mix of in-person and virtual options, to ensure that family visitors have enough time to provide visits each day.  The training topics also respond to current trends and areas for improvement within the family visiting program.  Family Visitors are also able to suggest training topic ideas and at least one professional development offering is held each month.  Some trainings are also recorded so that new family visitors can access the trainings in between New Hire Orientation trainings. 

Increase WIC Caseload: RIDOH had approved federal waivers throughout the COVID-19 pandemic to provide WIC services remotely. Services include assessments, nutrition education, referrals and food prescriptions to support healthy growth and development in young children and those in a WIC category (pregnant, breastfeeding, or postpartum people, infants, and children to age five years old). The goal is to increase accessibility for current and potential clients. As the WIC Program winds down from the formula crisis, the caseload and participation has begun to increase. The WIC Program allows for remote services, during situations that will cause a hardship for participants and expects local program to have a minimum of one on-site visit per certification period.  Allowances for medical, work schedules, illnesses are individually allowed.  Remote issuance of food benefits, follow up appointments and food prescriptions are approved.  If a participant prefers to be physically present, the WIC site must have appointments available and provide them in that manner.

RIDOH actively participates in state food access working groups, such as the Interagency Food and Nutrition Policy Advisory Council and the Hunger Elimination Taskforce to build relationships, promote WIC program participation, and share WIC updates and promotions with newsletters (i.e., World BF week, Farmers Market). Collaborations for referring WIC participants to appropriate and available services are another goal of participating with these groups. RIDOH WIC Program continues to work with SNAP and Food access committees to jointly encourage families to apply for both programs. The innovative shopping experience has given WIC the opportunity to offer families the option to order WIC shopping on-line. The program is preparing the documents to explore this option. RI may work with other NERO states to share costs, data, and expense.

RIDOH collaborated with RIDHS to cross promote WIC, SNAP, Medicaid, and childcare to eligible families in Rhode Island. For instance, WIC representatives met with DHS staff in October 2023 to provide how to refer to the WIC program and that ay SNAP,and Medicaid recipients are adjunctively eligible based on income, for those in a WIC category (P,B,N,C,I).  Presently, the following are updates on this collaboration:

• SNAP and WIC are able to compare data looking at eligibility.
• RI has received a federal funding and is partnering with Brown University to improve WIC awareness, access, and retention on the WIC Program. Incorporated in this, is a strong community piece to help shape program design and outreach opportunities that will work.  There are two Community Action Boards who are providing feedback and direction for social media and other campaigns.
• Also, in-housework is being done with an on-line application for the community to schedule appointments, see if they are eligible for services and soon to grow into a “No Wrong Door”, to those needed more service.  This is planned to be available in July 2024.
• The WIC program worked with our video production vendor, Steer, to produce high-quality interviews of local WIC staff in both English and Spanish. These interviews have been uploaded to the RIDOH social media channels, such as YouTube, Facebook, and Instagram, and are being further distributed in Soapboxx, a video publishing platform aimed at increasing two-way communication with agencies and their stakeholders.

 

Resume efforts to increase the number of IBCLCs and CLCs of color to address disparities in infant breastfeeding rates: RIDOH WIC and Family Home Visiting programs offered in October 2021 The Healthy Children’s Project Certified Lactation Counselor (CLC) virtual training to 20 staff.  The self-paced 52-hour course consisted of informational videos and materials, self-check questions, and competency verification. In its entirety, the course covered the core competencies staff needed to pass the CLC examination administered by the Academy of Lactation Policy and Practice. Currently, all breastfeeding peer counselors are certified lactation counselors serving and supporting breastfeeding clients. In addition to the CLC training, RIDOH’s State WIC Program implemented USDA’s new WIC Breastfeeding Curriculum Training which is a comprehensive platform of training resources for training all levels of WIC staff. RIDOH contracted with Cathy Carothers, IBCLC, Every Mother Inc., the organization that developed the curriculum, to facilitate 10 sessions of 4-hour trainings, which were recorded for future use. 100 WIC staff completed the assigned levels of training. The curriculum uses the innovative, visual design approach and is structured in tiered levels to address the varied roles among WIC staff.  

 

Additionally, RIDOH and Ready Set Latch Go (RSLG) LLC. is collaborating with RIDOH and the Department of Labor and Training (DLT) to implement training for up to 40 individuals to be trained and certified as Certified Lactation Counselors. Apart of the training will be the org providing mentorship and support to cohort participants that will be implementing online training course modules for Academy for Lactation Policy and Practice (ALPP). At the moment, RIDOH is drafting contract documents with RSLG and further sketching out the shape the program in further detail.

 

Expanding Lactation Licensure and Applying for IBCLC and CLC Workforce Training Grant: Over the last few years, the RIDOH has collaborated on the development of the lactation workforce supports available to diverse perinatal community members. Most recently, this year RIDOH supported the shaping and passage of a community led legislation labeled, Lactation Counselors Practice Act of 2014. This bill allows for the licensing of Certified Lactation Counselors (CLCs) and Advanced Lactation Consultants (ALCs) by RIDOH. It was passed by both legislative chambers and signed by the governor on June 25, 2024. The legislation was supported by a multiplicity of stakeholders and the legislation was written with input from content experts with lived experiences. Please reference the legislation at the following link: https://legiscan.com/RI/text/H7882/2024

The Academy of Lactation Policy and Practice defines CLCs as “a clinical lactation care provider who has demonstrated the necessary skills, knowledge, and attitudes to provide clinical support and management to families who are thinking about breastfeeding or who have questions or problems during the course of breastfeeding/lactation. CLC candidates undergo rigorous competency verification before they are able to sit for the certification examination with ALPP.” CLCS and IBCLCs can earn an “advanced certification in lactation management by completing 95 hours of advanced level education. The Advanced Lactation Consultant possesses the insight, knowledge, and skills essential to the development and implementation of management strategies for complex problems related to breastfeeding and human lactation. ALC candidates undergo rigorous competency verification before they are able to sit for the certification examination with ALPP.”

RIDOH’s MCH Program’s collaboration on the bill comes out of our following Preconception, Pregnancy, and Postpartum and Perinatal/Infant priorities: 1) Improve prenatal health by reducing perinatal health disparities and 2) Strengthen caregiver’s behavioral health and relationship with child. Within RI, Black and Hispanic women breastfeed at lower rates in relation to White women. From research and community input, we realized increasing diverse and culturally congruent perinatal lactation supports available to the community may reduce these apparent disparities. This legislation is a vivid step forward in our following strategy of supporting efforts to expand breastfeeding services and supports. This year RIDOH was awarded an approximate $175,000.00 grant to implement a training program from the Department of Labor and Training for the implementation of a CLC training program. Our collaboration will be with a local organization: Ready Set Latch Go LLC. To implement the training and mentorship project.

 

 

Support Efforts to Expand Breastfeeding Services and Supports: RIDOH has worked collaboratively to cross promote breastfeeding services at WIC, birthing hospitals, provider offices, community health centers and community breastfeeding support groups. RIDOH provided educational outreach materials to providers, conducted regular conference calls with birthing hospitals and shared information on social media. In 2021, Rhode Island Governor Dan McKee signed RI Doula Reimbursement Act into law. The RI Doula Reimbursement Act ensures that doula services are reimbursable by every Rhode Island based private and public insurance plan. Many doulas serve postpartum clients and can provide baseline educational support to clients on how to breastfeed their babies and refer them to appropriate lactation resources. The Doula Reimbursement bill went into full effect on July 1, 2022. Please reference RI Certification board for a list of certified doulas: Credential Search | Rhode Island Certification Board (ricertboard.org)

 

Continue to support breastfeeding awareness through the Health Equity Zone (HEZ) initiative: RIDOH’s State WIC Breastfeeding Coordinator provided technical assistance to the HEZ initiative by reviewing current federal and state laws and protections in place for breastfeeding individuals. HEZs were not aware of the break time accommodations protections that are in place. As such, they were able to share this information with their communities to promote breastfeeding when going back to work and/or school.  State WIC program staff attended HEZ Collaborative Learning Sessions to inform and prov ide WIC outreach information to the communities in RI. 

 

Continue the work of the Rhode Island Task Force to Support Pregnant and Parenting Families with Substance-Exposed Newborns (SEN Task Force): SEN Task Force reports to the RI Children’s Cabinet and is one of 10 workgroups that report to the Governor’s Overdose Prevention and Intervention Task Force. Chaired by the Chief of the Substance Exposed Newborns Program, the SEN Task Force represents a dynamic partnership across state agencies, stakeholders, and community-based providers in the arenas of MCH, treatment and recovery, and perinatal health. SEN Task Force members share a vested and common interest in the health and well-being of families affected by prenatal substance exposure. This interdisciplinary collaboration provides RIDOH with a strong and stable foundation to support a coordinated and thoughtful cross-sector response to the problem of prenatal substance exposure. The SEN Task Force meets the second Tuesday of every month. SEN Task Force activities during the above-mentioned time frame include:  

• Activities continue to be informed by the four pillars of the SEN Task Force’s strategic plan: (1) education and workforce development; (2) interdisciplinary, family-centered care coordination; (3) access to treatment and recovery; and, (4) data-informed activities, data alignment/improvement
• 203 people attended the 2023 SEN Conference at the Crown Plaza Hotel in Warwick, RI. The conference was sponsored by the RI Department of Health; Parent Support Network of Rhode Island; Women & Infants Hospital; Thundermist Health Center; United Healthcare; the Rhode Island Department of Behavioral Health, Developmental Disabilities and Hospitals; the Rhode Island Executive Office of Health and Human Services; Hands in Harmony; and the Addiction Technology Transfer Center at Brown School of Public Health. The keynote speaker was Daniel Sumrok, a noted Family Medicine physician with an expertise in addiction and trauma. Other topics included emerging issue updates on cannabis and xylazine; congenital syphilis; and keeping families together in the face of prenatal substance use. A peer recovery specialist and her client shared their story.
• The online Plan of Safe Care application launched in KIDSNET, RI’s secure database for children’s health information. Postnatal plans can be data entered at the hospitals and prenatal plans can be entered by peer recovery specialists. There is reporting capability through the administrative dashboard.
• The SEN Surveillance database was being designed and built during this time period. 
• The SEN data entry tool in RIVERS was being designed and built during this time period. 
• A community-based SEN Peer Services project began during this time period. 
• SEN began planning for a community-based Women’s Health Street Outreach project
• First Connections Family Visiting continued to provide intensive and intentional care coordination to families affected by prenatal substance exposure. 
• Long-term family visiting programs began planning to provide services and support for families affected by prenatal substance exposure. 
• Bi-weekly case conferences continued to take place between DCYF and RIDOH to support preventive referrals for pregnant and parenting women open to DCYF.

 

Plan of Safe Care

• Plan of Safe Care is a federal mandate under the Child Abuse Prevention and Treatment Act (CAPTA) and the Comprehensive Addiction Recovery Act (CARA). Plan of Safe Care is a care coordination form offered at the birthing hospital that documents new and current biopsychosocial referrals for substance exposed newborns and their adult caregivers. 
• The Chief of the SEN Program manages Plan of Safe Care for Rhode Island
• About 25% of RI substance exposed newborns received a Plan of Safe Care
• Types of supports and services substance exposed newborns and their adult caregivers may be referred to include: parent support groups, fostering support groups, Family Visiting, mental health counseling, substance use counseling, Peer Recovery Coaches, Medication Assisted Treatment, basic needs, pediatric care, skilled nursing, Early Intervention, WIC, and others.
• Plans of Safe Care are implemented at Rhode Island’s five birthing hospitals: Kent Hospital, Landmark Hospital, Newport Hospital, South County Hospital, Women & Infants Hospital. Most substance exposed newborns are delivered at Women & Infants Hospital.  
• All substance exposed newborns receive priority referrals to Home Visiting Substance Exposed Newborns Teams.  
• All substance exposed newborns with a neonatal abstinence syndrome (NAS) diagnosis receive priority referrals to Family Visiting and Early Intervention.   
• Annual hospital site visits review Plan of Safe Care data and recommendations for improvement. 
• A Community Health Worker began offering Plans of Safe Care to non-opioid affected SENs and their families at Women & Infants Hospital. 
• A Plan of Safe Care brochure for families is being developed.

 

Perinatal/ Infant Health and Health Equity Zones:

Continue HEZ Parent Support Services: HEZs are committed to supporting the health and well-being of pregnant/postpartum individuals, and infants. For instance, Family navigation services provided families with more knowledge of statewide resources and increased their ability to connect and access them. HEZs that received funding to support Family Navigators include Pawtucket and Central Falls, West Elmwood 02907, Newport, Cranston, Central Providence, West Warwick, and East Providence HEZs. PDG funds for HEZ Family Navigators resulted in over 900 families being supported over 2022-2023. Please see below for other activities HEZs are implementing to support these demographics:

West Warwick HEZ: West Warwick continued peer to peer grandparent support to connect and establish relationships with community entities that serve this population, including DCYF, senior centers, schools, community health centers, Grands Flourish etc.  West Warwick HEZ continued efforts related to food insecurity and nutrition. In partnership with the local library the free summer meal program provided children ages 0-18 with consistent meals during the summer. Additionally, they are positioned to continue implementing their “pop up” farmers market for WIC and SNAP voucher recipients.

 

Pawtucket and Central Falls HEZ: The Pawtucket Central Falls HEZ developed an Opioid Action Plan, informed by the Opioid needs assessment. Target population included young adults, families with a loved one who has a substance use disorder, and pregnant women and mothers with substance use disorder (or in recovery). Needs assessment participants also included staff of organizations in the community who work with young adults or people with a substance use disorder. 

 Central Providence HEZ: Central Providence HEZ continued with awarded funding to support a Family Navigator to provide navigation services to parents and families in the HEZ community, working with a total of 161 families. Family navigation services provided through PDG funding, supporting families across the HEZ community. Additionally, a Family Learning Academy will focus on providing child-centered family programming, adult basic education for parents, along with case management services. 

East Providence HEZ: The East Providence HEZ conducted a comprehensive community assessment, which included a youth focused survey. The youth survey was distributed to youth at the East Providence Boys and Girls Club and EBCAP’s Youth Center. Based on the findings from the EP HEZ Community Needs Assessment, the HEZ continues with five preliminary action areas, one of which being Supporting Health & Wellness Across the Lifespan. This focus area was addressed by hiring a Family Navigator to engage families with young children/expectant families to participate in the array of evidence-based maternal/early childhood home visiting programs, and to support families to secure the social and health resources they need.

Newport HEZ: Newport HEZ aims to engage in ongoing maternal and child health work throughout their community. The Newport HEZ also focused intensively on racial equity and racial justice. One of the Newport HEZ’s leading priorities was to eliminate disparities in Black maternal and child health outcomes. In efforts to improve racial equity, the HEZ participated in and hosted several racial equity trainings throughout the reporting year, reaching hundreds of attendees in the Newport community and beyond. The Newport HEZ conducted all their work through a resident-centered, racial justice lens. The Newport HEZ partner Conexion Latina provided rent relief and gift-cards to support families in accessing basic necessities.

 

Other Programs/Projects Related to Perinatal/Infant Health

Support the Implementation of the Family Visiting Program:  RIDOH has successfully administered evidence-based family (home) visiting programs since 2012. Rhode Island supports the implementation of three evidence-based models: Healthy Families America, Nurse-Family Partnership® and Parents as Teachers. In addition, RIDOH has supported First Connections, a RI specific, short-term family home visiting program, for over 20 years. First Connections is a short-term risk assessment and referral program that often makes referrals to one of the evidence-based programs. Prioritized populations for the evidence-based models, as designated by HRSA/MCHB, include:

• Low-income eligible families;
• families that include a pregnant woman who is younger than age 21;
• families that have a history of child abuse or neglect or have had interactions with child welfare services;
• families that have a history of substance abuse or need substance abuse treatment;
• families that have users of tobacco products in the home;
• families that have children with low student achievement;
• families with children who have developmental delays or disabilities; and
• families that include individuals who are serving or formerly served in the Armed Forces, including families that have members of the Armed Forces who have had multiple deployments outside of the United States.

Strong collaborations support RIDOH implementation of evidence-based family visiting programs. Many of the community and state partners sit on the Family Visiting Governance Council, Governor’s Children’s Cabinet, Title V Maternal and Child Health Management Team, RI’s Early Learning Council, RI’s Early Intervention Interagency Coordinating Council, Successful Start Steering Committee, as well as others. The Family Visiting Program also continuously builds and maintains relationships with community-based social service providers, medical homes, behavioral health providers, substance use treatment providers and Health Equity Zone partners. Furthermore, the Family Visiting Program collaborates with multiple programs within RIDOH including:

• WIC: WIC identifies and refers pregnant womxn for services. WIC staff provide professional development training on infant feeding, nutrition, and breastfeeding to family visitors. WIC and family visiting work together to increase breastfeeding initiation and duration. The programs worked together to co-host a Certified Lactation Consultant training for WIC and family visiting staff.
• MomsPRN: MomsPRN partners with the MomsPRN program to support family visitors that are working with caregivers who have postpartum depression. Family visitors are now able to access and receive support from the MomsPRN line, just as physicians and other health care providers can. 

 

• Newborn Screening: The Family Visiting programs receive referrals from the Newborn Screening program for infants that need time-sensitive follow up for their newborn bloodspot screening.  Family Visiting also received referrals from the Newborn Hearing Screening program for children that are lost to follow up and/or need to engage in additional hearing support services.

 

• Safe Sleep: The Safe Sleep program provides comprehensive training on safe sleep to family visitors.  The evidence-based programs and First Connections collect information on infant safe sleep and provide safe sleep education to families.  All Family Visiting agencies were able to provide families safe sleep sacks if a family needed one.  First Connections is able to provide a cribette at no cost to a family if a family does not have a safe sleep environment and cannot afford to provide one.

 

• Substance-Exposed Newborns: The Family Visiting programs have a close relationship with RIDOH’s substance-exposed newborn program. Staff at RI’s largest birthing hospital work with Peer Recovery Specialists and family visiting programs to provide a comprehensive set of supports to families and children affected by substance-use disorder.  First Connections providers often meet with new parents that have delivered a substance-exposed newborn, prior to hospital discharge and support the goals and activities in the family’s Plans of Safe Care.  At the end of September 2023, plans were finalized to have Family Visiting’s Family Engagement Specialist return to Women & Infants Hospital to engage families in family visiting services prior to hospital discharge.  She will also offer to complete a Plan of Safe Care for families that have delivered a marijuana-exposed newborn.  The Family Engagement Specialist had not been able to be at the hospital since the COVID-19 pandemic began.
   

Identify, engage, and retain more families at risk for poor outcomes: As of September 24, 2023, the evidence-based programs were at 64% of contracted capacity for all funding streams. The Family Visiting program remains committed to working with RI’s most vulnerable families and providing support at critical points during the life course. By working with community partners such as the birthing hospitals, healthcare providers, substance use providers, and the Department for Children, Youth and Families (DCYF), family visiting is able to engage pregnant womxn that may be at risk for poor outcomes. Through the Newborn Developmental Assessment done for every mother and baby at time of birth, 60-65% of newborns and their families are automatically referred to First Connections at birth. First Connections works with families to refer and engage vulnerable families in long term, evidence-based family visiting.

 

The family visiting program also works closely with DCYF to identify and refer families that are involved with the child welfare system. DCYF has also increased referrals for families that are being investigated for child abuse but may not have an indicated case open to DCYF for further services.  Policies and procedures put in place by RIDOH’s Family Visiting program provide clear guidelines for consistent efforts to engage and retain families, as does ongoing sub monitoring of program implementation. Family visiting agencies are encouraged to use continuous quality improvement to test strategies to support both initial engagement and retention in services.

 

Family Visiting also began participating in Rhode Island’s new Coordinated Intake System, Unite Us.  Unite Us is used by healthcare and social service providers to refer families, with their consent, to other social service and healthcare providers.  The Family Visiting program has had the program’s referral form built into the platform.  A large federally qualified health center is RI is using Unite Us to refer pregnant people to family visiting.

 

Sustain and expand the Family Visiting Program by finding additional revenue streams: Currently, with MIECHV funding, RIDOH’s current capacity for evidence-based family visiting is 1,559 families statewide. Some of those family visiting slots are funded by time-limited Preschool Development Block grant funds.  Data shows more vulnerable families could benefit from long term, evidence-based family visiting. While RIDOH has successfully maintained its federal funding, additional resources are needed to support the program.

 

In 2018, RIDOH worked with RI Medicaid to include Healthy Families America and Nurse-Family Partnership Home Visiting Programs in RI’s 115 Medicaid Demonstration Waiver. Approval by CMS was granted in December 2018. RIDOH worked closely with the Governor’s office to secure state funding in 2021. In 2023, Parents as Teachers, was added to the State Plan Amendment.  All evidence-based family visiting programs were able to start billing Medicaid for visits with pregnant people and children.  RIDOH continues to work with state partners to identify opportunities for braided and blended funding. As RIDOH works to identify and engage more families in family visiting there is a need to have more family visiting availability across Rhode Island.

 

In 2021, RIDOH began exploring multiple avenues of funding for the First Connections Program. First Connections provides confidential home visits to expectant parents, and to families with children up to age three. Services are based on family need and may include health education and connections with healthcare services, social services and community resources. First Connections (FC) also conducts child wellness screenings. EOHHS, through a temporarily increased First Connections Medicaid reimbursement rates by over 200% from July 1, 2022, to June 30th, 2023, and work was underway to sustain those rates.  The rate increase was the first increase in over 20 years.

Newborn Screening Program: The Newborn Screening Program provides universal newborn screening for 33 core blood disorders, Critical Congenital Heart Disease, and Hearing and Developmental Risk Assessments. The Newborn Screening Program assures screening and diagnosis for all infants born in the state. Abnormal results are tracked by the Newborn Screening Coordinator until resolved or a diagnosis is confirmed. Rhode Island’s six specialty clinics (endocrine, metabolic, hemoglobin, cystic fibrosis, neurology, and immunology) are responsible for reporting the diagnosis and treatment plan for all infants identified with a positive screen.

 

In 2022, 99.7% of eligible infants received a newborn blood spot screening and 99.5% were screened or evaluated for Critical Congenital Heart Disease (CCHD). The Newborn Screening Program and the Birth Defects Program continue to collaborate to track and identify cases of CCHD. The Newborn Screening Advisory Committee, which advises the Newborn Screening Program on strategic planning, policies and procedures, new conditions to be added to the RI newborn screening panel, and associated services, continues to meet on a quarterly basis. Members include health care providers, public health experts, and people involved in delivering services, follow-up, and treatment in the state.

 

The Newborn Screening Program continues to train Fellows and Family Visitors to allow them to better educate parents on the urgency of newborn screening. The Newborn Screening Program will continue to work to educate more obstetrics/prenatal providers about newborn screening and increase the distribution of Newborn Screening brochures to these providers.

The Newborn Screening Program received a 5-year grant, the State Newborn Screening Systems Priorities Program (NBS Propel) from the Health Resources Services Administration that began on 7/1/23. The purpose of NBS Propel is to support Rhode Island’s Newborn Screening in addressing state-specific challenges; to expand the state’s follow-up program to include long-term follow-up; to improve on newborn screening timeliness; to support implementation of new conditions added to the Recommended Uniform Screening Panel; and increase access to treatment and follow-up activities for individuals and their families with conditions identified through NBS.

 

Rhode Island Newborn Hearing Program (RI-NBHS): RI’s NBHS program is also known as RI’s Early Hearing Detection and Intervention (RI-EHDI) program. The RIEHDI’s program goal is to ensure that children who are DHH are identified through newborn, infant, and early childhood hearing screening and receive diagnosis and appropriate early intervention to optimize language, literacy, cognitive, social, and emotional development, to reach their full potential.

 

The RI-EHDI program is integrated into the state’s system of early childhood services; this has ensured that the program is coordinated at the state and community levels with other early childhood systems. The RI-EHDI integration also supports RI in achieving high rates of follow-up for children who do not pass a newborn hearing screen. However, due to recent challenges such as reduced capacity of audiologists, changes in hospital procedures and insurance co-pays and deductibles, and expanding income disparities in the state, RI is seeing a greater need to support families of newborns and infants who do not pass a newborn hearing screen. The RI-EHDI program works to ensure those families are able to access appropriate evaluation and intervention follow-up at the earliest possible point, consistent with the Joint Committee on Infant Hearing (JCIH) 1:3:6 guidelines: screening by 1 month of age, evaluation by 3 months of age, and intervention by 6 months of age.

 

In 2022, Rhode Island reported, to the Centers for Disease Control and Prevention (CDC), screening 99% of all infants born in the state. Of those babies screened, 95% were screened by 1 month of age. The JCIH goals are that 85% of infants who need an evaluation receive it by 3 months of age, and that 80% of children diagnosed with hearing loss are enrolled in early intervention services by 6 months of age. Unfortunately, RI did not meet these goals. In 2022, 178 (64.5%) received their evaluation and were diagnosed by 3 months of age and 3 (12.5%) of those diagnosed with hearing loss were enrolled in early intervention services by 6 months of age. In 2022, there were 24 confirmed cases of permanent hearing loss. Despite infants not meeting the JCIH best practice guidelines for EI enrollment, of the total number of confirmed cases of permanent hearing loss, 20 (83.3%) of infants have been referred and enrolled in EI (Part C) services.

 

The RI-EHDI program faced many challenges during 2022. Universal newborn hearing screening may have reduced completion of screening due to both early hospital discharge and shortage of staff. Due to this, RI has seen an increased number of infants lost to diagnostic follow-up, particularly for those who were seen once but did not yet have a conclusive diagnosis. Additionally, the COVID-19 pandemic may have reduced completion of screening due to both early hospital discharge and policies which prevented screening of infants whose mothers were COVID positive. RI has seen an increased number of infants lost to diagnostic follow-up, particularly for those who were seen once but did not yet have a conclusive diagnosis. It was also a year of transition for the RI-EHDI program.

 

 The RI-EHDI program continues to make multiple attempts to engage families. If an infant needs follow-up, the hearing screening database automatically generates a follow-up letter, which is mailed to the family; it instructs the family about next steps. The family’s pediatrician also receives that same letter to ensure that the pediatrician is aware of the child’s referral and to encourage the physician to engage the family in follow-up. Ongoing follow-ups consist of multiple phone calls made to families, primary care providers, and other support services such as WIC to ensure follow-up is completed. Once all these attempts have been exhausted, families are referred to First Connections, one of RI’s family visiting programs. The goal of this referral is for a First Connections home visitor to assist the family with scheduling hearing screening follow-up. The RI-EHDI program conducts outreach and education to health professionals and service providers in the EHDI system about the 1-3-6 recommendations and the importance of timely screening, diagnosis, referral, and enrollment into EI services. Emphasis has been made on the need for hearing screening up to age 3 to identify, diagnose, and enroll into EI those infants who pass a newborn screen but later develop hearing loss also known as (late onset hearing loss).

The program has assessed and reviewed all educational materials for accuracy, appropriate reading-level, and up-to-date and evidence-based information. The RI-EHDI program has improved coordination of care and services for families and children who are deaf or hard of hearing (DHH) through the development of formal communication. A memorandum of agreement between RI-EHDI and EI (Part C), has been developed and implemented. The RI Department of Health (RIDOH) has worked for decades and continues to develop and maintain a high-quality system of newborn hearing screening and follow-up based on the understanding that early support for children and their families plays a significant role in mitigating negative outcomes that can be associated with hearing loss.

The Special Supplemental Nutrition Education for Women, Infants and Children (WIC): The mission of WIC is to ensure healthy pregnancies, positive birth outcomes and healthy growth and development for infants and children up to age five who are at nutritional risk. The WIC Program refers to healthcare and critical social services as well as to an array of agencies to meet the needs identified by participants/guardians; gives participants the opportunity to make informed decisions on healthy food choices, optimum feeding options and knowledge of food safety by providing nutrition education and breastfeeding promotion and support; offers access to nutrition professionals for questions and assistance; and prescribes tailored food package options to meet individual needs for optimal growth and development. The program serves roughly 18,500 women, infants and young children throughout Rhode Island. Approximately 53% of the births in the state of R are eligible for the WIC Program, however WIC serves approximately 50% of the eligible population. 

Overall, the WIC program serves approximately 49% of the total WIC eligible population in Rhode Island, based on the 2020 WIC State Plan. The reduction in the eligible population served in 2020 was due to the pandemic, which closed clinics to the public and provided telework appointments. The state was mandated to transition to eWIC and to transfer to a new MIS system, Crossroads, as the eligibility system in RI. These factors created confusion for WIC participants, including issues with reporting and limited staff availability, leading to a drop in WIC caseload. A nutritionist, with a BS, LDN or RD, will provide client centered counselling, referrals and food prescriptions based on individual needs. A care plan will be developed with the participant and follow up will occur at least every quarter, sometimes more frequently depending on the needs of the WIC participant.

 

Prenatal women on WIC are provided education on breastfeeding and are introduced to a WIC Breastfeeding Peer Counselor (BFPC). The BFPC builds rapport with the participants, provides ongoing education, and promotes and supports breastfeeding. Any issues that exceed the ability of the BFPC are referred to an International Board- Certified Lactation Consultant (IBCLC). WIC IBCLC’s round at the three largest hospitals in the state, provide BF education, help with latch and any other issues, and see only WIC participants or WIC eligible patients. The IBCLC will send their notes to the BFPC so the BFPC can follow up either at the clinic or while the client is home.

The WIC Program provides referrals and opportunities that help positively impact the health of womxn and children. WIC collaborates with the RI Breastfeeding Coalition working on many topics from licensing IBCLCs to the Baby Café in Providence RI. WIC also collaborates with the following RIDOH Programs: Healthy Homes (to address exposure to lead) ; PRAMS (to increase response rates) ; Diabetes Prevention program; Oral Health; Health Equity Zones (farmer’s markets, breastfeeding promotion and support) ; Center for Emergency Preparedness and Reponses (community resilience) ; Family Home Visiting; Safe Sleep; Drug exposed Newborns; and Tobacco cessation.

The WIC Program will continue with current services with a focus on increasing caseload, referrals and collaborations with new partners (i.e. Brown University Hassenfeld collaboration), assessing strategies to improve caseloads, and offering innovative opportunities (i.e. working with the Council on the Arts). Nationally, WIC is due to be reauthorized and receive ARPA funds for innovations that will offer possible changes in the program to reduce barriers and streamline services.

 

Rhode Island’s Perinatal Hepatitis Prevention Program (PHBPP): The Perinatal Hepatitis B Prevention Program (PHBPP) coordinates with healthcare providers and birthing hospitals to prevent perinatal mother-to-child hepatitis B virus (HBV) transmission in routine preventive services before, during, and after labor and delivery. The program recommends testing all pregnant womxn for HBsAg during an early prenatal visit (e.g., first trimester) in each pregnancy, even if they have been previously vaccinated or tested. Healthcare providers are required to report all HBsAg positive pregnant womxn to the RIDOH. During the COVID-19 pandemic, the program was not interrupted and providers must continue to ensure that HBsAg-positive pregnant women are able to advocate for the proper care of their HBV exposed infants in case labor and delivery occurs at an unplanned facility or is attended by staffs that are not knowledgeable about managing HBV exposed infants (e.g., providing education and supplying documentation to HBsAg-positive pregnant womxn).

The program also recommends identification of HBVs of all womxn presenting for delivery. If a woman’s HBsAg status is positive or HBsAg status is unknown, post-exposure prophylaxis (PEP) - single antigen hepatitis B vaccine and HBIG (Hepatitis B Immune Globulin) should be administered to her infant within 12 hours of birth per ACIP recommendations and provide the birth dose of hepatitis B vaccine to all other newborns within 24 hours of birth to prevent horizontal hepatitis B virus transmission from household or other close contacts. The program works with the mother and infant’s immunization provider to ensure HBV-exposed infants complete the hepatitis B vaccine series and post-vaccination serology testing (PVST). This follow-up ensures PEP and vaccinations were effective in protecting against disease transmission and that the infant developed immunity to hepatitis B. If PVST was delayed beyond 6 months after the hepatitis B series is completed during the COVID-19 pandemic, it was recommended that the provider consider administering a “booster” dose of single antigen hepatitis B vaccine and then ordering post vaccination serologic testing (HBsAg & antibody to HBsAg [anti-HBs]) 1-2 months after the “booster” dose per ACIP recommendations.

Safe Sleep Program:

• The mission of the Safe Sleep Program is to decrease preventable sleep-related morbidity and mortality in Rhode Island through education, training, and concrete resources. 
• The Safe Sleep Program procures cribettes, sleep sacks, and swaddlers for community based First Connections, Parents as Teachers, and Healthy Families America family visiting programs.
• The Interagency Safe Sleep Communications Workgroup developed a Safe Sleep toolkit for community partners.  
• The Office of the State Medical Examiner (OSME) reports all infant sleep-related deaths to RIDOH. Upon each repot, a case conference is held between the Safe Sleep Program, RI Family Visiting Program, and RI WIC to gain a deeper understanding on the families’ engagement with community programs. 
• The Chief of the Safe Sleep Program serves on the RI Child Death Review Team and contributes to recommendations related to preventable infant sleep related deaths. 
• There was an increase in infant sleep-related deaths from calendar year 2022 to calendar year 2023. Bedsharing remained the overwhelming risk factor in both the previous and current reporting years. 
• 7 Safe Sleep trainings were conducted, and 119 individuals were trained. 
• The SS Program purchased safe sleep supplies including cribettes, sleepsacks, and swaddlers for Family Visiting agencies to distribute to families in need. 
• The interagency Safe Sleep Communications Workgroup launched an organic social media campaign called #SafeSleepStories which featured RI families talking candidly about the challenges and successes practicing safe sleep.
• RIDOH purchased over 13,000 Sleep Baby Safe and Snug books (English and Spanish) for Rhode Island birthing hospitals to distribute to families who deliver a newborn.
• RIDOH-branded NIH safe sleep handouts in English and Spanish are available at no cost to hospitals and the community through RIDOH’s Publication Center.