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CROSS-CUTTING/SYSTEMS BUILDING DOMAIN SUMMARY/OVERVIEW FY23 ANNUAL REPORT

 

DOMAIN CONTRIBUTORS

 

Adolescent Health Program– Division of Child and Family Health - Repro Health Unit

Newborn Screening Program - Division of Child and Family Health

Local Health Districts

 

DOMAIN OVERVIEW

 

YOUTH ADVISORS:  Adolescent Health Program’s Youth Advisors provide expertise, guidance and feedback on current and future public health initiatives. 

 

NEWBORN SCREENING PROGRAM:  The Virginia Newborn Screening Program includes the Dried Blood Spot (DBS) Newborn Screening, Early Hearing Detection and Intervention (EHDI), and the Virginia Congenital Anomalies Reporting and Education System (VaCARES) Birth Defects Surveillance (BDS) programs.  The Critical Congenital Heart Disease (CCHD) pulse oximetry screening program is under the BDS program.  Special revenue funds from the Division of Consolidated Laboratory Services (DCLS) sustain the DBS program. Other programs receive CDC and HRSA funding.  Title V funds provide partial salary and special project support.

 

LOCAL HEALTH DISTRICTS:   The Commonwealth is divided into 35 Local Health Districts (LHD) which provide direct and population-based services and support tailored to the specific community needs. 

 

STATE ACTION PLAN UPDATES

 

	PRIORITY 1   Community, Family, & Youth Leadership:  Provide dedicated space, technical assistance, and financial resources to advance community leadership in state and local maternal and child health initiatives
OBJECTIVE	By 2025, increase equity in VDH’s public health initiatives by incorporating youth voice in the development, planning, and management of public health initiatives that impact young people
PERFORMANCE MEASURE	SPM 2: Cross-Cutting (Youth Leadership): Develop and sustain the Virginia Department of Health Youth Advisor Program

 

 

Strategy 1: Maintain paid Youth Advisor roles at VDH to provide expertise, guidance, and feedback on current and future public health initiatives across all MCH populations.; Fund a statewide Youth Advisory Council (YAC) that incorporates diverse youth voices into public health in Virginia

 

VDH created two paid, part-time positions called Youth Advisors who spearhead youth initiatives within the agency. VDH’s Youth Advisory Council was created as part of a departmental initiative to give youth across the state a stronger voice within public health. In addition to convening the council, Youth Advisors work as Subject Matter Experts. VDH employees who desire the perspective of young people on the projects they're working on may complete a project request form soliciting feedback. Through this mechanism, youth input is provided on multiple brochures and other public-facing content. The mission of the VDH’s Youth Advisory Council is to create a safe and consistent environment for youth to plan, implement, and advise on meaningful projects that will improve the health of Virginia youth. The Youth Advisory Council provides the opportunity to learn about public health topics and share feedback with VDH about issues affecting adolescents in Virginia.

 

VDH’s Youth Advisors were tasked to convene a statewide group of young folks for our Youth Advisory Council (YAC).

 

The YAC is comprised of youth ages 14-21 representing over 20 counties throughout Virginia. The Youth Advisory Council will provides the opportunity to be active in public health topics and share feedback with VDH about issues affecting youth in Virginia. VDH's Youth Advisory Council is guided by the following four core components : Be youth-led, with adult mentorship, Maintain consistent, structured virtual meetings, Foster community building, Offer a safe space for youth to share their opinions on health-related matters.

 

The first YAC cohort ended in May 2022, with the next Youth Advisors joining the team in the summer of 2023. During this time, the two Youth Advisors worked to relaunch the Youth Advisory Council, creating new materials and additionally adding three sub-committees: Community Health, Policy and Advocacy, and Mental Health. To recruit members, they worked strategically utilizing contacts with school superintendents as well as community-based organizations. This cohort of the YAC meets monthly for general body meetings where they discuss public health topics, policy, and other relevant issues. In addition to regular meetings, YAC members are invited to participate in advocacy days, outreach projects, and other forms of community engagement.

 

 

                                 

 

	PRIORITY 2   Racism as a root cause:  Explore and eliminate drivers of structural and institutional racism within OFHS programs, policies, and practices to improve maternal and child health
OBJECTIVE	By 2025, provide dedicated space, technical assistance, and learning opportunities that advance racial equity across MCH workforce
PERFORMANCE MEASURE	SPM 3:  MCH Workforce Development:  Develop and strengthen MCH partnerships that address racial equity

 

Strategy 1:  Engage with Urban Baby Beginnings in AMCHP’s Healthy Beginnings with Title V:  Advancing Anti-Racism in Preterm Birth Prevention – Learning and Practice Cohort

 

From July 2021 through January 2023, AMCHP facilitated an 18-month capacity building project that brought teams from six states together as a cohort to learn about and practice dismantling racism in state health department policies and practices.  The goal of this project was to build transformational partnerships between state MCH/Title programs and CBO’s. Virginia was one of six state teams selected to participate in this learning and practice cohort, alongside Urban Baby Beginnings, Virginia’s leading non-profit that provides outstanding community support services specifically for pregnant and parenting families in Virginia. 

 

Five MCH Team members participated in the cohort alongside the Executive Director of Urban Baby Beginnings – OFHS Director, Title V Director, Resource Mothers/State Doula Certification Coordinator, MCIEHV Director, and the Maternal Mortality Programs Manager.

 

The monthly learning and practice cohort meetings and Mural Board activities stepped each team through a decision making process designed to direct each team towards a strategic area on which to focus for the remainder of the cohort. Virginia’s team chose:  Restructure Title V funding requirements to support community-based organizations and interdisciplinary perinatal providers with an anti-racist, equity-centered, reproductive justice framework.   Through this strategy, Virginia’s team further identified that workforce development for Virginia’s doula community was critical, especially in light of the recent Medicaid doula benefit.

 

To ensure advancement of this collaboration beyond the January 2023 end of the AMCHP Learning Journey, the Executive Director of Urban Baby Beginnings and the Resource Mothers/State Doula Certification Coordinator, both of whom attend the legislative-mandated Doula Task Force, will continue to address workforce development efforts through the Task Force.

 

Strategy 2:  Partner with Blue Ridge Health District and Birth Sisters of Charlottesville in CityMatCH Alignment for Action Learning Collaborative

 

The Blue Ridge Health District and Birth Sisters of Charlottesville, a doula collective supporting BIPOC mothers, is one of eight teams selected national for the CityMatCH Alignment for Action Learning Collaborative (AAC), a two-year initiative, which began in March 2021 and continued through March 2023.  Title V leadership team provided onsultation and partnering to assist in their strategic planning of community-led efforts to address racism and implicit bias in the Charlottesville maternal and child health care community, including OB/GYN, Family Medicine, Pediatric providers and healthcare organizations. This dynamic team is composed of three Title V/MCH Team members, two Blue Ridge health district team members, two Birth Sisters of Charlottesville members, a UVA Sociology PhD candidate and a UVA student intern.

 

This Team met weekly and received monthly TA support from CityMatCH. The Team worked across three domains:

• Create a method by which the black woman’s birthing experience is shared back to the medical community to evoke process/systems change
• Explore methods by which Black medical providers, including nurses, midwives, pediatricians and OB/GYN providers, who train at University of Virginia will remain and serve the Black birthing community or methods by which new Black providers can be recruited and retained
• Serve as a clearinghouse for information and awareness regarding black maternal mortality

 

From the onset of the Learning Collaborative Team, one strategy centered around planning, preparing, and launching a virtual event called “Listening to the Living: Centering Black Women’s Birth Experiences”.  In celebration of Black Maternal Health Week, the event was held on April 12, 2022.  The 2-1/2 hour agenda featured Dr. Arthur James, a National Leader in birth equity, as the Keynote Speaker.  Patrice Wright, a Sociology PhD Candidate at University of Virginia, shared her research findings regarding race, culture, and inequality in reproductive health.  A panel of Charlottesville care providers, including the Executive Director of Birth Sisters of Charlottesville.  The most significant piece to this event, however, were the shared stories from three Black Women, all residents of Charlottesville, who were willing to share their birth story.  The event ended with a call to action by the Executive Director of Birth Sisters of Charlottesville.

 

 

 

                            

 

The event was intended to focus on the Charlottesville/Blue Ridge Health District maternity care community – however, registration was opened to VDH teams across all 35 health districts.  There were a total of 185 registrants with 119 attendants, 110 of whom stayed for the entirety of the 2-1/2 hour virtual event.  A total of 28 people completed the post-event survey, with a number of tangible take-aways, satisfying the Team’s overall goal of drawing consensus and evoking action regarding the poor birth outcomes for Black Women. 

 

A recording of the event remains available at www.listeningtotheliving.org.  The recording has been shared widely across the Charlottesville maternity care community, and across Virginia’s MCH community through collaborative networks including the local health districts and through the Virginia Neonatal Perinatal Collaborative.  The recording continues to be shared and watched in a variety of contexts, including reported views in UVA’s medical school and other classrooms, trainings for doulas entering the Birth Sisters of Charlottesville doula collaborative, and new local health district staff.

 

Additional work by the Learning Collaborative Team included the ongoing development of a black birth plan, networking and building stronger foundations and influence in the Charlottesville maternity care community and exploring ways to bring Black maternity care providers into the community.

 

At the end of the Learning Collaborative in March 2023, the Collaborative Team found great value in the strong supportive relationships developed through the collaborative, and all were in agreement to continue working together, both informally and formally.  Meetings were transitioned to monthly. Continued collaboration across FY23 included:

• Data support by VDH MCH Epi Team regarding Birth Sisters of Charlottesville applications for external funding and organizational strategic planning
• Exploration of methods by which community partners can implement MMRT recommendations
• Feedback loop from community to state leadership for potential upstream strategies and policy work
• Participation of Birth Sisters of Charlottesville in the Perinatal Hubs Study Group required by 2023 Senate Bill 1531.
• Title V sponsorship of Birth Sisters of Charlottesville Community event in August 2023

 

 

 

                      

 

 

 

Strategy 3:  Local Health District (LHD) Strategy: Increase opportunities for workforce development for LHDs to align with MCH leadership competencies

 

Beginning Fall FY23, the Local Health Districts were given the opportunity to participate in the MCHsmart asynchronous learning environment available through the MCH Navigator, housed within The National Center for Education in Maternal and Child Health (NCEMCH). MCHsmart contains 12 modules, one for each MCH leadership competency, with a pre- and post-test regarding each module.  Twelve of the 35 districts selected this activity for their MCH Teams to focus on during FY23. An initial TA call was held with the districts and leadership from NCEMCH, and participants were given a special passcode to use at registration, so that Virginia participant information could be aggregated.  The districts will have continued access to engage with the learning environment and complete the modules during FY23.

 

In total, 40 LHD MCH professionals participated in some aspect of the course and 16 completed the full curriculum, giving insight into levels and changes in knowledge as measured by preand post-tests as well as trends in knowledge, skills, and perceived efficacy as measured through self-reflection questions. (NOTE:  District participation in MCHsmart is aligned into Virginia’s State Action Plan as a cross-cutting/systems building strategy, with the following objective:  By 2025, provide dedicated space, technical assistance, and learning opportunities that advance racial equity across MCH workforce.  This is measured through SPM3:  MCH workforce development (racial equity).

 

 

 

 

Trend #1: Learners consistently scored higher on post-tests than on pre-tests in all competencies with an overall increase of 7.7%. However, self-reported knowledge and skills for Competency 1 (MCH knowledge base and public health context) actually decreased by the end of the curriculum. This could be attributed to the Dunning-Kruger Effect, in which individuals overestimate their initial knowledge of a topic before learning more in that area. As one user reported, “I didn’t know that there was so much to MCH that I wasn’t aware of.” However, balancing this trend, self-perceived efficacy for Competency 1 increased from 1.5 to 2.5 (on a scale of 3.0) over the course of the curriculum.

 

 

 

Trend #2: For other competencies related to “self” (Competencies 2-4), there were negligible or small gains in knowledge, while larger gains in knowledge were observed in competencies related to those involving others (Competencies 5-10) and the wider community (Competencies 11-12). This could indicate a need for increased learning opportunities in these “advanced” competency areas.

 

 

 

Trend #3: The largest increases across all competencies were related to self-perceived efficacy. An explanation of this dramatic increase is that the act of completing the online course and acquiring new knowledge boosted individual's self confidence. They may feel more empowered, capable, and self-assured in their understanding of topic areas, leading to a higher level of self-reported efficacy. Another theory is that learners become more aware of their progress and growth. Through the online course, they may have gained a clearer perspective on their strengths and weaknesses, allowing them to assess their own abilities more accurately.

 

 

 

MCHsmart continued efforts in FY24 & FY25: Recognizing the importance of ongoing MCH Leadership development, pleased with the participation in MCHsmart in FY23, and capitalizing on the excellent partnership with the MCH Navigator team at NCEMCH, MCHsmart will remain an available activity on the District work plans for FY24.  Those districts whose team members did not complete the learning competencies can continue, and districts that did not participate last year can engage across FY24 & FY25.  The MCH Navigator Team will once again provide TA to all districts once selections are made.  Additionally, staff in the CYSHCN programs and home visiting programs, including MCIEHV and Resource Mothers, will be invited to participate in these modules in FY24.  Lastly, Title V Leadership Team plans to review the data from MCHsmart, and incorporate competency-building information into all Title V-led trainings going forward.

 

	PRIORITY 3   MCH data capacity:  Maintain and expand state MCH data capacity, to include ongoing needs assessment activities, program evaluation, and modernized data visualization and integration
OBJECTIVE	Maintain 100% referral rate and improve/streamline processes by which all infants with confirmed newborn screening disorders are referred to CYSHCN care coordination services
PERFORMANCE MEASURE	SPM 1:  Cross-Cutting (early and continuous screening):  Percent of infants diagnosed with a newborn screening disorder who are referred to care coordination services in the CYSHCN program

 

The Virginia Newborn Screening Programs (VNSP) include the Virginia Newborn Bloodspot Screening Program (VNBSP), the Early Hearing Detection and Intervention Program (EHDI), and the Critical Congenital Heart Disease Screening Program (CCHD). The program also provides staff support to the Virginia Rare Disease Council (RDC) and partners with the Birth Defects Surveillance Program. The overarching goal for the VNSP is to strive for optimal outcomes of Virginia’s affected infants through early diagnosis, referral, and intervention by identification with newborn screening. All newborns born in the Commonwealth of Virginia are required to receive a newborn screening within 24-48 hours after birth (NBSP and CCHD) or prior to discharge from the hospital (EHDI). The NBSP and EHDI programs monitor the newborn screening results of all babies born within the Commonwealth of Virginia, as well as request follow-up and diagnostic testing for up to 6 months (NBSP) and 36 months (EHDI). The NBSP is currently establishing a long-term follow-up program for monitoring newborn bloodspot screening disorder outcomes. 

 

Virginia currently screens for 35 of the 37 targeted disorders on the national recommended universal screening program (RUSP) as well as a targeted congenital Cytomegalovirus (cCMV) screening program for any infant who fails the hearing screen at birth to be screened for cCMV before hospital discharge. The NBSP is planning a disorder review workgroup for FY25 for consideration of the addition of the two RUSP disorders not currently screened, Guanidinoacetate Methyltransferase Deficiency (GAMT) and Mucopolysaccharidosis type-II (MPS-II). The CCHD program focus is on quality assurance and passive surveillance. All infants identified with a confirmed newborn screening disorder, including positive CCHD newborn screens, are referred to CYSHCN care coordination services. Infants identified with hearing loss through the EHDI program are automatically referred to Early Intervention for care coordination services. The VNSP maintains a 100% referral rate for care coordination services, unless a healthcare provider notes that a referral is not indicated, or the infant has already been referred for services. 

 

In 2022, Virginia had a total of 95,887 births. A total of 93,658 (97.7%) of infants born were screened for hearing, with 92,225 infants passing overall. Of the infants who received a hearing screen, 4,542 passed with risk and 3,104 infants did not pass the initial hearing screening. Of the infants who did not pass the initial hearing screening, 130 were diagnosed with permanent hearing loss, of which 125 (96.2%) of these infants were referred to Part C Early Intervention services. A total of 94,531 (98.59%) of infants born received a bloodspot newborn screen. Of the infants that received a bloodspot newborn screen, 9,212 (9.74%) had an out-of-range result (abnormal) requiring follow-up services or diagnostic testing. Of these infants, 945 (1.03%) had a critical (presumptive positive) newborn bloodspot screening result with 827 confirmed diagnosed cases referred for care coordination. A total of 60,968 (63.4%) of all infants born were reported to have a CCHD screen. A total of 30,867 (32.2%) infants did not have record of screening reported, and 4,112 (4.3%) infants were not screened due to prenatal diagnosis, parent refusal, NICU admission, or other reasons. Of the infants screened, 77 (0.12%) had an out-of-range positive (fail) screen reported, however, this number is falsely inflated due to documentation errors from the reporting facilities. There was a total of 126 confirmed CCHD cases, which is defined as the total number of infants born in 2022 with a positive (fail) pulse oximetry screening result reported to Vital Records or a CCHD diagnosis reported into VaCARES, and the CCHD diagnosis confirmed by a provider or hospital. Infants reported as expired at the time of CCHD follow-up are not included in this number, as no follow-up is completed to confirm diagnosis. Of the confirmed cases, 89 infants were referred to Care Connection for Children (CCC) as a direct result of CCHD follow-up. Infants already referred to CCC from their provider are not included in this number. Due to errors in reporting, the CCHD program is planning education initiatives to improve QA/QI of CCHD newborn screens conducted. Challenges in staffing for all programs resulted in delays in follow-up reporting and case closures. 

 

Strategy 1:   Maintain the VaCARES Registry and expand capacity to document and track referrals of infants from the Newborn Screening Program to CYSHCN programs  

 

The Virginia Newborn Screening Programs, healthcare providers, and hospitals report confirmed cases into the Virginia Congenital Anomalies Reporting and Education System (VaCARES) until two years of age. The Birth Defects Surveillance Program (BDS) is a passive surveillance tool and serves as a data repository for birth defects to be reported for the first 2 years of life. The birth defects data informs stakeholders regarding the prevalence of birth defects in Virginia and potential impact of those affected with rare diseases. All infants identified with a disorder on Virginia’s newborn screening panel are referred for care coordination services in the CYSHCN program. 

 

The maintenance and ongoing support of the VaCARES Registry is provided by the VDH Office of Information Management to allow stakeholders to document birth defects. It also provides programmatic staff the ability to query the prevalence of a certain birth defect affecting those in Virginia up to age 2 years. The CCHD NBS program has a manual process for documentation that enables the program to track the number of infants referred and who accepted services to CYSHCN programs. A future process improvement would be to automate documentation to track number of infants referred and who accepted services to CYSHCN programs. DCFH partnered with internal agency teams to identify needs, gaps and future direction of the current birth defects surveillance system.

 

Future plans include enhancing the active surveillance of the BDS program to provide quality assurance to hospitals. By ensuring compliance of reporting, the program will have a better understanding of the impact of birth defects on Virginia’s population. 

 

Strategy 2:   Partner with NYMAC (New York-Mid-Atlantic Regional Genetics Network) to assess and respond to state needs related to genetic services 

 

Programmatic leadership, Christen Crews, MSN, RN, and Virginia’s Family Delegate, Dana Yarborough, continued to serve as a co-leaders on a project to collaborate with NYMAC (New York - Mid-Atlantic Regional Genetics Network) to assess and respond to state needs related to genetic services. This project is ongoing and includes a diverse team of stakeholders from across the Commonwealth. A current product of this collaboration is the development of a “Genetic Navigator” training toolkit to assist community health workers, case managers, social workers, etc. help bridge the gap and ensure those who need genetic services have a better understanding for the need to be seen by the specialist. The product has been launched and the Virginia NYMAC team has incorporated feedback for continued development and improvements. The Center for Family Involvement (CFI) at Virginia Commonwealth University trained Genetic Navigators are parents of children with genetic diagnoses and provide parent to parent support with their own personal experiences using genetic services (https://nymacgenetics.org/virginia/).

 

 

	PRIORITY 4   Upstream/Cross-sector strategic planning:  Eliminate health inequities arising from social, political, economic, and environmental conditions through strategic, nontraditional partnerships
OBJECTIVE	Maintain 100% referral rate and improve/streamline processes by which all infants with confirmed newborn screening disorders are referred to CYSHCN care coordination services
PERFORMANCE MEASURE	SPM 1:  Cross-Cutting (early and continuous screening):  Percent of infants diagnosed with a newborn screening disorder who are referred to care coordination services in the CYSHCN program

 

Strategy 1:  Maintain and expand family engagement on state NBS Advisory Committee

 

The Newborn Bloodspot and the EHDI Programs both have advisory committees with family representatives serving on the board. The Rare Disease Council includes representation from, and engages with, individuals diagnosed with rare diseases, caregivers, patient organization representatives, healthcare providers, researchers, insurance and biotechnology companies, and other community partners to identify health inequities for individuals affected by rare diseases in order to advise the Governor and the General Assembly about potential policy improvements. The programs have public comment periods during their advisory committees and invite parent speakers to share their stories. The VA EHDI team continues to provide support to families with newly diagnosed children with hearing loss and congenital Cytomegalovirus (cCMV). A follow-up specialist will discuss referral to family support services and to Care Connection for Children (CCC) for case management services if requested. Additionally, referral to the Infant and Toddler Connection in Virginia for early intervention services is made for all children with confirmed diagnosis. VA EHDI mails resources and materials to families of newly diagnosed children to include information on hearing loss and cCMV, language and communication modalities, and amplification options. Resources from family support organizations and upcoming events are also shared with families at diagnosis.

 The VA EHDI Program planned and hosted the first VA EHDI Conference in February 2023 and May 2024 to contribute to stakeholder engagement, education, collaboration between providers and families and data dissemination efforts. VA EHDI staff and stakeholders presented on topics regarding EHDI systems of care, protocols and policies for hearing screening, cCMV screening and audiological evaluations. The conference highlighted the importance of collaboration across a wide range of stakeholders who may not interact regularly across specialties, including hospital staff, audiologists, early interventionists, and members of the deaf and hard of hearing community. Responses from post-conference evaluation revealed that the conference gave stakeholders a deeper understanding of the EHDI process and the importance of timely reporting and follow-up, as well as the details of how EHDI-IS facilitates automated referrals and follow-up measures.  

 

One major change included the development of a plan is to collaborate with the Blood Spot Screening program in Virginia to increase prenatal outreach regarding the newborn screening programs. The NBSP and VA EHDI collaborated in FY22-23 on a Prenatal Outreach initiative to consolidate and disseminate educational materials and community resources to expecting parents and prenatal health care providers. The aim of this collaboration was to increase understanding of newborn screening in addition to improving health literacy relating to the newborn period for both infants and their caregivers. Additionally, prenatal and postnatal education are important aspects of increasing awareness of newborn screening prior to birth and to allow families to be prepared with next steps for outpatient follow up and testing if necessary. This project includes the development of four short videos and educational materials including brochures and posters to describe different aspects of preparing for birth including information on newborn screening processes.

 

 

The VNBSP is currently collaborating with the Department of Consolidated Laboratory Services (DCLS) on a Primary Care Provider Outreach initiative to improve timeless of newborn bloodspot screening follow-up. The aim of this collaboration is to provide training and education to primary care providers offering pediatric services to encourage collections of repeat newborn bloodspot screens in office, rather than outpatient laboratory settings. This initiative will also focus on improving communication between the programs and healthcare providers in support of the overarching mission of the VNBSP. This collaboration is ongoing with plans for future joint outreach. 

 

Strategy 2: Sustain Early Hearing Detection & Intervention Program, to include support for paid 1-3-6 Family Educators

 

EHDI Staff continue their work with VCU’s Center for Family Involvement to provide family to family support. They also will continue recruiting children and families who are deaf and or hard of hearing for advisory committee participation. VA EHDI will continue to strengthen follow up activities to newly diagnosed children and children who are older. Overall, VA EHDI will continue to implement technological enhancements to achieve program goals and objectives. The Virginia EHDI program partners with the Center for Family Involvement at Virginia Commonwealth University, and Family Educators continue to provide family-to-family support. VA EHDI in collaboration with CFI to host a family engagement day in May 2024 for families of children with hearing loss and cCMV. Families had the opportunity to engage with professionals and other parents and obtain resources and information. VA EHDI hopes to continue opportunities to support families in the Commonwealth.

 

The Virginia Early Hearing Detection and Intervention (VA EHDI) program continues efforts to create technological and system enhancements to educate families, providers, and stakeholders and decrease loss to follow-up and lost to documentation within the EHDI system. Additionally, VA EHDI continues to evaluate the Virginia Infant Screening & Infant Tracking System (VISITS), which is the EHDI Information System (EHDI-IS), for accuracy and efficacy. Implementation of new program elements, such as the automated follow-up efforts via VISITS and an enhanced follow up plan, have helped to ensure improved and timely communication efforts with stakeholders and families. The enhancements in VISITS include updates to the texting platform with automated texts to families and on-demand text messaging, implementation of an Interactive Voice Response system for incoming calls, robocalls, outgoing calls through VISITS, as well as continued updates to the VA EHDI website. In 2022, Primary Care Providers were provided access to VISITS as a new user group; to date, there are 172 PCPs currently registered as VISITS users. These advancements aid in decreasing loss to follow-up, as well as meeting the Centers for Disease Control (CDC) 1-3-6 guidelines. VISITS is continually being enhanced to improve usability and user experience for the VA EHDI team and all user groups with access.

 

Quality improvement activities are conducted regularly, with stakeholder input, to improve and update program materials and resources. VA EHDI also began incorporating technical assistance activities, with a designated Technical Assistance Specialist, to assist stakeholders with VISITS user issues and facilitate navigation of the system, as well as track and identify gaps for the EHDI staff to inform training and education needs.