Priority Need: Prevent Infant Mortality
Perinatal services are focused on the health of women and infants before, during and after birth. The Georgia Perinatal-Infant Health program 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 providing access to high-quality perinatal care to Georgians and recognize that there is a direct relationship between perinatal birth outcomes and the quality of health care services.
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.
NPM 3: Risk-appropriate Perinatal Care
Perinatal Regionalization
Perinatal Regionalization is a collaborative system of hospitals and providers striving to ensure that deliveries occur in the hospital with the appropriate level of care for the mother and infant. The purpose of the RPCs is to coordinate access to optimal and appropriate maternal and infant health care. Regionalized systems assign hospitals risk-appropriate levels and ensure high-risk infants are born in facilities with appropriate technology and specialized health providers. The impact of appropriate level of care on maternal and perinatal health outcomes is great as low birth weight or premature infants born in risk-appropriate facilities are more likely to survive. Georgia has six RPCs which are designated to specific geographic regions to provide the most advanced care for high-risk mothers and infants. The Women’s Health program works to strengthen the system of regionalization through increased communication with RPC stakeholders, meetings with RPC medical directors and outreach educators, and conference calls with finance staff and data coordinators.
In the reporting year, the RPCs actively responded to the COVID-19 pandemic in addition to continuing to provide transportation and high-risk care to mothers and infants across the state. Maternal and Neonatal Outreach Educators continued to support clinical needs within their facilities, as well as provided education and training for clinical teams in their regions.
In the reporting year, DPH continued to plan the levels of care designation program. A fulltime program manager was hired and a contract with the American Academy of Pediatrics to conduct the site surveys for designations was executed.
SPM 4: Breastfeeding
Georgia 5-STAR
Georgia's 5-STAR Hospital Initiative was developed to recognize hospitals that have taken steps to promote, protect, and support breastfeeding in their hospital. A five-star system was developed to encourage maternity centers to promote and support breastfeeding one step at a time. Georgia 5-STAR awards one star for every two steps implemented of the Ten Steps to Successful Breastfeeding, as defined by the World Health Organization (WHO) and Baby-Friendly® USA. In the reporting year, the Georgia 5-STAR program reviewed the current Georgia 5-STAR program offerings and developed additional support materials to assist hospitals in evaluating their progress on the Ten Steps to Successful Breastfeeding and revised the training programs as suggested by the review.
The Women’s Health program provided skills fairs at Archbold Hospital, Augusta University, Colquitt Regional Medical Center, Northeast Georgia Health System- Gainesville and Braselton, and Upson Regional Medical Center. Hospital managers reported 75 to 90 percent of the staff attended the skills fairs. The successful training of hospital staff proved invaluable to the hospitals in helping them to accomplish clinical competency.
NPM 5: Safe Sleep
Safe Infant Sleep Program
In the reporting year, the Safe Infant Sleep program continued to lead the Georgia Safe to Sleep Campaign and implemented evidence-based interventions to reduce the number of preventable cases of SUID. Efforts focused on ensuring that accurate and consistent education was provided to both professionals and caregivers. The program researched opportunities to address health inequities and provided tools for families to practice Safe Infant Sleep. Most of Georgia’s birthing hospitals participated in the hospital-based initiative to ensure that Safe Infant Sleep education for staff and families was consistent with the American Academy of Pediatrics’ recommendations to prevent infant sleep-related deaths. The program empowered professionals in multiple disciplines to educate parents about safe sleep environments and ensured that families were modeled proper sleeping practices in hospitals. The program continued to work with participating birthing hospitals to meet the goals of the program and ensure continuous quality improvement. Thirteen hospitals participated in a separate, voluntary Quality Improvement Cohort led by DPH. This cohort worked to further strengthen safe sleep practices in the Neonatal Intensive Care Unit (NICU), Well Baby, and Pediatric Units.
The MCH Home Visiting program contracted the production of a Safe Infant Sleep educational training video for home visitors. The video includes how to involve fathers and partners into safe sleep practices, as well as provide advice on helping parents and caregivers find assistance with car seats. The effort was highlighted at the Safe States Annual conference in the “Addressing and Advancing Equity for Children” session. The program also presented education on Abusive Head Trauma to home visiting groups and provided information regarding how to include prevention education to families. The program provided a Frequently Asked Questions training to the statewide First Steps program, a home visiting program that initiates contact with families in the hospital following delivery.
The Safe Infant Sleep program became a host for a Project Imhotep intern. Project Imhotep, funded by CDC and in partnership with Morehouse College, was an 11-week summer internship program designed to increase the knowledge and skills of underrepresented minority students in biostatistics, epidemiology, and occupational safety and health. The Intern worked with the Safe Infant Sleep program to develop a faith-based safe sleep initiative.
Grant-in-aid was provided to two health districts with the highest rates of infant mortality due to Sudden Infant Death Syndrome (SIDS). The funds were utilized to encourage focused attention on Safe Infant Sleep within the public health districts. Training videos, like the MCH Home Visiting training video, were completed to provide on-demand access to safe sleep education for both professionals and caregivers. The program worked with Dr. Trina Salm Ward with the University of Wisconsin- Madison to develop a study protocol to evaluate materials used in a booster session. The booster session served to remind parents about safe sleep and answer questions, or address concerns the family has about infant care and sleep following the infant’s birth. Baby bundles, includes safe sleep literature, a “this side up” onesie, and a wearable blanket, were provided to participants of a faith-based initiative and a shelter initiative. The shelter initiative aims to provide portable cribs and baby bundles to families with infants that are under housed, unhoused or leaving violence within the home.
Through statewide partnerships and connections, the Safe Sleep Initiative was able to provide materials to various organizations that work with families and expectant parents. A partnership with the GaOBGYN resulted in 40,000 customed designed room sharing brochures to be distributed to expecting parents. More than 65,000 other items, such as educational handouts, safe sleep displays, “Sleep Baby Safe & Snug” books, and decals were also distributed. MCH continued to work with participating birthing hospitals to meet the goals of the program.
SPM 3: Rate of Congenital Syphilis
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 worked 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 following site visits and trainings were provided to public health district staff:
- Monthly Virtual TA Calls in lieu of site visits due to COVID-19
- Congenital Syphilis Annual Review Board Meeting (December 15, 2020)
- District Online Meeting (December 15, 2020)
- Two-Day STI Intensive (February 9-10, 2021)
In 2019, when compared to other states in the U.S., Georgia ranked eighth in reported primary and secondary syphilis and twelfth in reported Congenital Syphilis cases. A total of 1,757 cases of primary and secondary Syphilis were reported in Georgia in 2020. In 2020, there were 82 Congenital Syphilis cases out of 122,379 Georgia resident births. In comparison, there were 57 Congenital Syphilis cases out of 126,250 Georgia resident births in 2019. Georgia along with many other states throughout the nation continue to see a rise in Congenital Syphilis cases. The COVID pandemic impacted STD prevention, treatment, and service delivery and as a result Georgia and other states throughout the nation saw increases in all STDs in 2020.
SPM 2: Reduce Infant Mortality in the Black Population
Improving Birth Outcomes
The Improving Birth Outcomes Initiative was created to address infant mortality of all infants, particularly infants in the Black population, by developing strategies to empower community leaders, members, and organizations with information, resources, programs, and initiatives necessary to promote infant health and reduce infant mortality statewide.
In the reporting year, the Improving Birth Outcomes Working Group was convened to advise and work jointly with MCH through the development and implementation of innovative infant mortality prevention and community interventions. The working group helped determine impactful strategies and best practices to improve outcomes and reduce infant mortality. This was done by examining factors and identified research findings as affecting the mortality of infants, in particularly Black infants. Working group membership is comprised of research, medical, community and public health professionals and a person with lived experience. A Working Group member was appointed to the U.S. Department of Health and Human Services and March of Dimes Black Maternal Health Stakeholder Group.
The Working Group inaugural meeting was held in June 2021 and introduced members to the Improving Birth Outcomes Initiative, strategies, and infant mortality data. During the reporting year, quarterly meetings were held with topics, such as oral health, preterm birth prevention strategies, and the environmental scan of infant mortality in rural Georgia. The working group also reviewed the MCH Title V Block Grant State Performance Measure (SPM) 2 Goal and the 2030 Healthy People Goal- Rate of Infant Mortality (per 1,000 live births) in the Black population to determine the goal rate.
MCH continued the collaboration with Mercer University School of Medicine’s CRHHD to conduct a qualitative mixed-methods analysis in rural areas of the state with high infant mortality rates to understand the landscape of the community to better assess needs. Phase I of the environmental scan launched with plans to conduct virtual focus groups with people with lived experience in Clinch, Irwin, Seminole, and Wilcox counties. These counties were identified to be highly impacted with infant mortality rates that are either twice the 2018 state average or have a relative risk for Black babies of ten or higher, when compared White babies. The environmental scan aimed to explore the socio-economic determinants of health including poverty, education, rural attitudes and culture, psychosocial risk factors, access to healthcare, employment, transportation, insurance status, and other risk factors such as smoking rates, obesity, and safe sleep practices. The environmental scan will guide strategic planning and decision making to lead to evidence-based responses that will improve birth outcomes in rural communities. The CRHHD Director and the Title V Deputy Director provided participant recruitment and progress updates to community and partner groups.
A 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 introduces and highlights Georgia’s infant mortality rate, specifically in the Black infant population, discusses
the top causes of infant mortality, lists best practices to prevent infant mortality, and provides a call to action concerning how community members can help reduce infant mortality. During the reporting year, the toolkit was updated with the most current year infant mortality data and prepared for review.
MCH continued efforts to strengthen partnerships with HMHB and the GBI, while co-leading the Infant Mortality Working Group. The Health Equity and Evidence-Based Intervention subgroups met quarterly to identify needs and develop specific strategies to advance the working group goal to address existing disparities and reduce infant mortality rates to the Healthy People 2030 target (5 per 1,000) or below for each Georgia county and for each racial/ethnic group. The Health Equity Subgroup developed a strategic plan that include promoting health equity and inclusion training programs for pediatric and health care providers and incorporating data on disparities to reveal the conditions affecting Black babies in the state. The Evidence-Based Interventions subgroup established goals to identify, implement, and scale evidence-based interventions to ensure that more of Georgia’s babies see their first birthdays. The group planned to develop strategies to identify existing interventions in the state and assess their scalability to ensure that families are being referred to resources such as care coordination. The group reviewed related data plans to assess evidence-based or -informed interventions to mitigate contributing factors to infant mortality such as medical and social determinants of health.
Other Perinatal/Infant Health Programs
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.
In the reporting year, the Neonatal Subcommittee of the Georgia Perinatal Quality Collaborative (GaPQC) continued to implement the NAS initiative with the 46 (64%) participating birthing hospitals, including eight rural birthing hospitals who received a third year of funding to support their active participation in the maternal and neonatal initiatives to improve maternal and neonatal outcomes. The NAS initiative entered sustainability in September 2021. By the end of the initiative, there were 1,971 participating staff from 46 hospitals who completed 16,063 microlessons through the Vermont Oxford Network (VON). Sixteen hospitals achieved Center of Excellence by demonstrating a high level of engagement and completion of all quality improvement microlessons.
GaPQC supported hospital neonatal teams by hosting the monthly webinar series to facilitate education and collaboration to include specialized webinars on COVID-19 and health equity. The didactic presentations were designed to guide hospitals through implementing interventions listed in the key driver diagram. In the summer of 2020, GaPQC launched a Health Equity Learning Series to build capacity to improve health disparities in infant health. Addressing racial inequity is an ongoing focus and will move from learning to action in 2021 through the development of individual hospital action plans.
In December 2020, GaPQC developed and disseminated a statewide environmental scan survey to participating hospitals in partnership with the Georgia OBGYN Society. The assessment targeted maternal and neonatal hospital teams to identify improvement opportunities for all initiatives and future direction. The survey included questions about health equity and disparity reduction efforts at respective hospitals. GaPQC, along with all hospital teams and partners, actively responded to the current COVID-19 pandemic and prepared for ways that GaPQC can support hospital systems to continue to improve maternal and neonatal outcomes without further taxing the system. The Women’s Health program staff continued to offer technical assistance to hospitals as needed while dedicating time and resources to support DPH mass COVID-19 vaccination efforts.
The Microsoft Teams platform was utilized to maximize data sharing and as a webinar platform to host webinars and store recordings in a repository for on-demand viewing. This was a valuable tool during the pandemic to bring people together to encourage and support hospitals in improving maternal and neonatal outcomes through the GaPQC initiatives. GaPQC supported the maternal and neonatal teams by hosting a monthly webinar series to facilitate education, collaboration, and support for the process and structure measures for the AIM Obstetric Hemorrhage Bundle (HMG), the AIM Severe Hypertension in Pregnancy Bundle (HTN), and interventions for the NAS initiative. Webinars featured subject matter experts and hospital teams from Georgia and other states to share experience about implementing the interventions.
The GaPQC Leadership Council, Neonatal Committee, and hospital teams determined readiness and moved the NAS initiative into sustainability in September 2021.
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. During the reporting year, Georgia added and successfully implemented Krabbe disease to the Georgia Newborn Screening panel. The implementation process included a public hearing and comment period; targeted communication to families via the NBS brochure; targeted information sent directly to hospitals, public health districts, GA-AAP, GAFP, and physicians who routinely submit NBS specimen; and general updates on the process shared during the Newborn Screening Advisory Committee (NBSAC) stakeholder meetings. In response to the addition of Krabbe disease to the Georgia Newborn Screening panel, DPH implemented a pilot project that included Krabbe disease follow up to families of children with a positive Krabbe disease screening and developed a survey to assess the “Psychosocial Impact of Krabbe Disease on Families.”
DPH conducted another NBSAC recruitment cycle and selected a new co-chair, a pediatric pulmonologist with great interest in cystic fibrosis, along with a clinical, biochemical, and molecular geneticist. The NBSAC continues to meet bi-annually to provide a public forum for discussion and decision-making surrounding newborn screening in Georgia.
The NBS program finalized a QI project to improve the quality of specimen collection and to decrease the number of days the specimens are in transit to the DPH Laboratory. The project was designed for small cohorts of hospitals to be engaged over a six-month period. During the final QI project year, the NBS Program held a series of virtual educational trainings with hospital staff and continued to develop and disseminate educational materials that can be used to improve specimen collection and transit.
To highlight the benefits of NBS, the NBS program supported comprehensive strategies to enable the development of infants identified with a condition via NBS. For example, the sickle cell short-term follow-up and hematology program through Augusta University strengthen care coordination for infants and children with sickle cell, or other significant hemoglobinopathy and conducted outreach clinics in the rural southern parts of Georgia. Children and families who attended the clinics had access to medical care and case management services coordinated by a social worker. The social worker helped families address needs for transportation, social security appeals, school 504 plans, family leave request, and community resources. The social worker also conducted developmental screens on children who had not been screened by their primary care physician or for who the hematologist had concerns. Any child that showed signs of developmental delay was referred to their primary care provider for further follow up.
The Medical Nutrition Therapy for Prevention (MNT4P) Program provided ongoing services to individuals with conditions identified through NBS. Medical nutrition therapy is the primary and lifelong treatment for most of the inherited metabolic disorders (IMD) diagnosed through NBS. The MNT4P worked 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 metabolic disorders.
NBS and NBS follow-up was sustained during the COVID-19 pandemic. Adjustments were made to protocols to maintain the urgency of follow-up while minimizing risk of exposure to the virus. NBS follow-up teams conducted conference calls with subspecialists to whom they typically refer infants that require further testing or are diagnosed with an NBS condition. During the calls, the teams discussed safety processes in place to keep children safe during appointments and under what circumstances a child’s follow-up appointment may be postponed, avoiding unnecessary exposure to COVID-19. The follow-up teams included this new information in letters faxed to primary care providers when an infant screened positive for a NBS condition. Specialists maintained 24/7 call lines to support pediatricians providing services to infants and children with an NBS condition. The sickle cell follow-up teams provided supplementary guidance to pediatricians around initiating penicillin prophylaxis in cases where families were delayed in accessing follow-up or chose not to schedule an appointment with a hematologist during the pandemic. To maintain continuity of care, telephone visits were conducted for non-urgent patients.
Family and Community Support Services
The Georgia Home Visiting Program (GHVP) 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. GHVP 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.
GHVP provided appropriate home visiting services to eligible families who resided in at-risk communities and represented priority populations in 18 Georgia counties. Within the 18 counties served, DPH has contracts with 17 Local Implementing Agencies (LIAs) and utilized the following EBHV models: Early Head Start-Home Visiting (EHS-HV), Healthy Families Georgia (HFG), Parents as Teachers (PAT), and Nurse Family Partnership (NFP). In addition, GHVP helps to coordinate necessary services within and outside of home visiting programs to provide support and technical assistance to address needs of participants, which may include mental health, primary care, dental health, children with special needs, substance use, childhood injury prevention, child abuse and neglect/maltreatment, school readiness, employment training, and adult education programs.
During the reporting period, 23,135 home visits were completed statewide with 1,919 total families served in Bartow, Bibb, Brantley, Catoosa, Chatham, Clarke, Crist, DeKalb, Fulton, Gordon, Glynn, Houston, Liberty, Lowndes, Muscogee, Richmond, Rockdale, and Whitfield counties.
The Georgia Strong Families Program (GSFP) Healthy Start is implemented in two public health districts that are at-risk for poor birth outcomes. The two public health districts are (1) South Health District, located in Valdosta (GSFP-Valdosta) serving Brook, Echols, and Lowndes counties, and (2) West Central Health District located in Columbus (GSFP-Columbus) serving Muscogee County.
GSFP continued to focus on women at-risk for adverse perinatal health outcomes that utilized public health departments to access Presumptive Medicaid. Public health departments were designated as qualified providers to enroll eligible applicants in the Medicaid program through Medicaid Presumptive Eligibility. This process was initiated through the public health department’s PCM program, which aims to assure pregnant women in Georgia have an opportunity to access comprehensive perinatal health care services appropriate to meet their individual needs. The initial PCM assessments and the Healthy Start assessment provided an opportunity for early detection of high-risk pregnancies and allowed GSFP staff to connect women to timely coordinated prenatal care. Program participants with screenings and assessments with indicated areas of concern were connected to vital resources and community services. GSFP supported access to health insurance, facilitated Medicaid enrollment, and promoted access to services through the public health infrastructure. In addition, GSFP utilized local public health staff to provide enrollment assistance in the Planning for Healthy Babies® (P4HB®) waiver program for non-pregnant women which provides no-cost family planning services to eligible women in Georgia.
In the reporting year, the GHVP continued to provide virtual and telephonic visits based on EBHV model recommendations. The LIAs engaged families during the pandemic by organizing drive-by baby showers and virtual graduations. Statewide virtual Group Connection meetings continued and decreased client isolation by collaborating with partners and LIA’s to provide education and support to families. The Group Connection meetings were coordinated by the Georgia Home Visiting State Team and made available to families and staff throughout the state.
State Group Connection Topics and Dates included:
- Early Brian Development-Storytime- September 9, 2020
- Safe Sleep- October 13, 2020
- March of Dimes Program and Service Overview- November 10, 2020
- Strengthening Families Protective Factors- December 8, 2020
- Strengthening Families Protective Factors- March 9, 2021
GHVP developed a Safe Sleep Education and Training Video in collaboration with DPH’s Safe Infant Sleep Program Manager. MIECHV and Healthy Start Home Visiting staff participated in the making of the training video which launched in January 2021.
Certified Lactation Consultant (CLC) Training was offered during the reporting year to expand upon the success of existing CLCs with approximately 40 home visitors and program managers participating.
GHVP offered the Racial Equity Institute’s (REI) Groundwater Approach Presentation, Building a Practical Understanding of Structural Racism, as a training on May 11, 2021. The training was provided to home visitors and MCH staff with over 130 participants in attendance. The training provided stories and data to present a perspective that racism is fundamentally structural in nature. By examining characteristics of modern-day racial inequity, the training addressed the following concepts:
- Racial inequity looks the same across systems
- The socio-economic difference does not explain the racial inequity
- Inequities are caused by systems, regardless of people’s culture or behavior
Additional professional development trainings for Healthy Start Staff included:
- Lemonade for Life-Trauma Informed Care/ACEs Training
- Time Management
- Motivational Interviewing
- Stewards of Children (child sexual abuse prevention)
- Connections Matter (child advocacy)
- Self-care
To ensure continued quality improvement, GHVP staff prepared and distributed full-color two-page infographics to each LIA highlighting their fiscal year 2020 performance. Highlights included the number of families and children served, demographic indicators, and performance measure outcomes. In October 2020, the GHVP Leadership completed virtual annual site visits for all the DPH-managed MIECHV programs. The site visits included an overview of the performance and plans for the subsequent year.
Monthly GHVP Check-in Calls with LIAs were conducted. Support and guidance were provided to home visiting sites. In turn, the sites shared strengths, challenges, and ideas related to the impact of COVID-19 on service delivery, staff, and families.
Georgia assessed the impact of COVID-19 on Home Visiting in Georgia through a collaboration between Emory University, GHVP, and the Project Assessing the Impact of COVID-19 (AICHV). The project was designed to determine the essential and unmet needs of home visiting programs and clients during the COVID-19 pandemic, explore facilitators and barriers to the delivery of home visiting services since the start of the COVID-19 pandemic, and identify strategies for enhancing and adapting home visiting services during the COVID-19 pandemic.
The Georgia Home Visiting Institute
The eleventh annual Georgia Home Visiting Institute (HVI) was presented virtually as a series of four two-hour sessions on August 19, August 26, September 2, and September 9, 2021. The HVI was sponsored by DPH in partnership with United Way of Greater Atlanta. The Opening keynote, “When the Bough Breaks: Contextualized Stress, Support, and Resilience and the Pathway to Birth Equity,” was led by Fleda Mask Jackson, PhD. with 330 attending participants. Dr. Jackson explored the effects of contextualized stress on the mental and physical health of Black expectant and postpartum mothers. Daniel Charles and his home visiting team from the United Way of Central Georgia presented, “Ma-Con Families Stronger,” where they discussed how families are strengthened through their First Steps and Parents as Teachers home visiting programs. The third presentation, “Dear Parents: Discussing Discipline,” was led by Jyll Walsh, PhD., with Prevent Child Abuse Georgia (PCA) on August 26, 2021. In this session, the 271 participants learned the consequences and ineffectiveness of spanking and current beliefs and reasons for spanking, such as "I was spanked, and I turned out fine,” and “spanking is the only thing that seems to work" through practice scenarios. The final keynote presentation on September 9, 2021, was led by Robert Sege, PhD., from Tufts University. In “Healthy Outcomes from Positive Experiences (HOPE),” Dr. Sege covered the effects of ACEs on health outcomes and the mitigating effects of positive childhood experiences. The presentation also introduced ideas to incorporate the HOPE Framework into practice for 341 attendees.
DPH received HRSA American Rescue Plan (ARP) funding to support home visiting activities that address immediate needs of parents, children, and families related to the COVID-19 public health emergency. HRSA encouraged recipients to promote equity by allocating ARP funds to at-risk communities disproportionately impacted by COVID-19, including communities of color. DPH utilized the funding to provide needed technology, such as laptops, jetpack, and cell phones for families that were not able to participate in virtual home visiting and group activities because due to the lack of technology. Funds were used to provide needed families with emergency supplies, such as personal protective equipment, hand sanitizer, gloves, face masks, feminine products, baby items, food, and water. Through this funding MIECHV sites developed a partnership with diaper banks in the community to purchase diapers to provide for families in need. Several home visiting sites were faced with a significant reduction in their October 2022 contract when GHVP received a $500,000 reduction in their FY2022 MIECHV funding. However, ARP funding was approved to support the sustainability of those five sites. In addition, DPH was able to expand program services in two of the state’s at-risk counties, Muscogee and Dekalb. Muscogee will utilize its funding to provide home visiting services to pregnant teen mothers, while Dekalb will use funds to support Fasi/Dari/Pashto speaking families. Both sites will use the Parents as Teacher Curriculum.
Oral Health
The Oral Health Program provided Home Visitors a flipbook guide on oral health to help educate families on improving oral health behaviors. The flipbook was originally created by the Rhode Island state Oral Health Program and Oral Health Coalition with feedback from Home Visitors. The flipbook was adopted, with permission, and rebranded by Georgia DPH. Flipbooks were provided to all the Home Visitors in the state and provided to families through home visits.
Current Year: Oct 2021 – Sept 2022
Priority Need: Prevent Infant Mortality
NPM 3: Risk Appropriate Perinatal Care
Perinatal Regionalization
In the current year, infant mortality continues to be a priority for MCH, stakeholders, and partners. As a priority for many agencies and partners, it is important for MCH staff to create synergy around strategies to reduce maternal and infant mortality. Perinatal Regionalization continues to verify that all Georgia birthing hospitals are operating at the level of care designation authorized through the Department of Community Health Certificate of Need program. The Women’s Health program continues to develop campaigns, implement interventions, and increase collaboration with the Levels of Care committee in the implementation of hospital assessments to effectively reduce infant mortality.
NPM 4: Breastfeeding
Georgia 5-STAR
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 current year, the Georgia 5-STAR Hospital Initiative will continue to provide education and technical services to hospital providers. Many Georgia hospitals have expressed renewed interest in achieving Georgia 5-STAR status following the various challenges experienced during the COVID-19 pandemic. The Women’s Health program is committed to increasing the number of hospital staff and providers trained on the Ten Steps to Successful Breastfeeding, the broad framework of the Baby-Friendly Hospital Initiative. Education and training opportunities on the Ten Steps to Successful Breastfeeding will be provided through the First Latch-Breast Feeding Hospital Initiative (BFHI) online training module with technical assistance through the GA-AAP. 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.
The Women’s Health program is currently working 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 will be provided annually.
In collaboration with GaPQC, the Women’s Health program provides opportunities for hospital teams to join educational webinars to increase the breastfeeding knowledge base of participating hospital staff. The series will include 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.
Working through the lens of health equity, the Women’s Health program will continue to explore opportunities to determine the need for breastfeeding support for all birthing patients and to assess facilitators and barriers to improve breastfeeding practices.
Georgia Perinatal Quality Collaborative Neonatal Initiative
Optimizing Nutrition for Georgia Newborns 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 and breastfeeding or expression within six hours of birth. All hospitals in Georgia with Mother/Baby units or NICU 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 will feature an hour-long webinar with four associated foundational micro-lessons. The webinars will provide opportunities to translate education into practice and will feature expert faculty. The webinars and microlessons will begin with supporting the normal course of lactation for the healthy, term dyad and then expand into NICU-specific education.
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 continues to lead the Georgia Safe to Sleep Campaign and implement evidence-based interventions to reduce the number of preventable cases of 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 current year, hospitals continue to provide education and safe sleep education materials. However, the ability to initiative new work with hospitals on safe sleep have stalled due to capacity issues. The program is preparing 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 will also be offered to assist participants with assessing their hospital-based safe sleep programs and to make changes where they are needed.
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 is partnering with DPH Chronic Disease’s Tobacco Cessation program to focus on tobacco cessation for expectant mothers.
The program is hosting monthly “Train the Trainer” sessions to build local capacity to teach safe sleep education within communities. Providing local communities with presentations and guidance helps to 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 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.
Dr. Dajun Dai with Georgia State University provided Geographic Information System Mapping (GIS) for SUID data from the Georgia Child Fatality Review. Results show 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 will be 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.
SPM 1: Percent of Congenital Syphilis Averted
Congenital Syphilis
In the current year, the STD Office continues to work to prevent STDs by providing quality intervention strategies, programmatic support, and education throughout the state. To increase awareness, the STD office works collaboratively with internal and external partners, which will include provider groups, to plan and develop a Congenital Syphilis Screening and Treatment Awareness Campaign. Campaign channels include newsletter publications, provider presentations, social media messaging, and conference presentations. The STD office is expanding its program staff specifically to support Congenital Syphilis prevention efforts. A Congenital Syphilis specialist was hired in January 2022. The STD Office website enhancement efforts include 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 will be provided to each health district to ensure improvements in data collection through data matching and medical record extraction.
SPM 2: Reduce Infant Mortality in the Black Population
Improving Birth Outcomes
In the current year, MCH continues efforts to move ideas to action to reduce infant mortality. The Improving Birth Outcomes Working Group continues to meet quarterly to advise MCH’s infant mortality prevention efforts and community interventions. A Healthy Start program Nurse Practitioner, a Home Visitor and a person with lived experience were added to the Working Group’s membership. A Working Group member, Jacob Warren, PhD, MBA, CRA, was appointed to the U.S. Secretary of Health and Human Services Federal Advisory Committee on Infant and Maternal Mortality. Working Group meeting topics included the DPH Regional Perinatal Centers, DPH risk appropriate care, DPH levels of care, Emory Decatur Hospital’s Health Equity Initiative, CRHHD Health Equity Toolkit, MCH health equity, and Infant Mortality Environmental Scan updates. The Working Group finalized the SPM 2 Objective to reduce the rate of infant mortality in the Black population by 10 percent by 2030: 8.6 per 1,000 live births.
MCH continues the partnership with HMHB and GBI to collaboratively lead the Infant Mortality Working Group. In response to the group’s recommendation to provide implicit bias training to pediatricians and other health care professionals, DPH coordinated an implicit bias training and provided funding through the HRSA American Rescue Act. Terri McFadden, MD, FAAP, General Pediatrician and Professor in the Department of Pediatrics at the Emory University School of Medicine and member of Infant Mortality Working Group and the Improving Birth Outcomes Initiative, provided the training titled “Understanding the Impact of Bias as We Interact with Families” on May 25, 2022 to pediatricians, other health care professionals, and state and community organizations to teach family-serving professionals to use a reflective lens as they interact with clients. The session’s aim was to help participants develop an understand of the impact of implicit bias in daily work by sharing definitions of commonly used terms, addressing biases, and developing a better understanding of the reasons that biases exist and how biases manifest. The session closed with strategies to disarm microaggressions and break the mind’s natural habit of implicit bias.
MCH continues the collaboration with Mercer University School of Medicine’s CRHHD to conduct a qualitative mixed-methods analysis in rural areas of the state with high infant mortality rates. The CRHHD Director and Title V Deputy Director have presented infant mortality in rural Georgia data and scan recruitment needs to the MCH Advisory Council, DPH/HMHB/GBI Infant Mortality Working Group, Georgia Family Connections Regional Coordinator’s, and various partner and community organizations. The environmental scan is in Phase I, virtual focus groups. Focus group recruitment continues in Clinch, Irwin, Seminole, and Wilcox counties. Two focus groups have been completed to date. Phase II will launch in the current year and include in-depth interviews with community members, local public health, local healthcare, and community agencies in 17 counties. Status updates and findings are provided each month to the Director of Health Promotion and MCH Director in the DPH Mercer Partner meetings, as well as shared during the Improving Birth Outcomes Working Group and Infant Mortality Working Group meetings.
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.
Other Perinatal/Infant Health Programs
Neonatal Abstinence Syndrome
In the current year, 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.
Related legislation: O.C.G.A. §31-12-2 (2017) statutory reporting requirement for NAS.
Newborn Screening
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.
Family and Community Support Services
In the current year, the FACS program continues the commitment to implement evidence-based, comprehensive, and community-based maternal and early childhood programs, including HFG, NFP, and PAT. Family and Community Supports partner with the Georgia Maternal Mortality Review Committee (MMRC) and participates in their action-oriented processes to provide education and resources for women and infants through outreach activities in the community.
In-home, face-to-face home visiting services resumed on March 1, 2022, with required use of face masks. Each of the 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 includes 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 can choose to receive in-person home visits or continue with virtual visits.
The GHVP continues 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 identify opportunities to leverage resources for successful partnerships. The collaborative continues to work together to meet the Healthy Start benchmarks and Title V performance measures.
GHVP continues to provide 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, GHVP successfully met its program 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) continues to successfully recruit, enroll, and retain families. Virtual visits are completed using DPH telehealth platforms Cisco WebEx & Cisco Telepresence. Virtual visits allow GHVP 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
October 12 & 15, 2021
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
December 10, 2021
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
February 11, 2022
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.
- Child Abuse and Neglect: Reporting and Responding while Strengthening Families
March 11, 2022
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.
- 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
February 21, 2022
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
February 28, 2022
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.
- Community Action Network Retreat
March 28 & 31, 2022
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.
- Stephanie Hughes, LMFT, CAMS, CHT
Selfcare during COVID-19 for helping professionals
March 4, 2022
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.
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