III.E.2.c. Cross-Cutting/Systems Building: Annual Report (10/1/2021-9/30/2022)
State Priority Need:
Reduce Health Disparities and Inequities in internal programs, policies, and practices to improve maternal and child health.
State Performance Measure (2020 - 2025):
SPM: Reduce health disparities and inequities in internal programs, policies, and practices to improve maternal and child health.
One specific area that the MCH Division has worked to expand to better respond and reduce disparities is the maternal health team. During this reporting period, the Maternal Health Administrator led the effort to identify areas of maternal health to adequately represent the diverse pregnant and postpartum populations in Indiana. The existing maternal health team worked and discussed with internal and external partners, reviewed data sources including the previous Title V Needs Assessment, the Indiana collaborative-wide Alliance for Innovation on Maternal Health (AIM) data, and the Maternal Mortality Review reports to identify areas that affect and/or contribute to maternal health. Eight priorities were identified, with five that needed more concentrated programming and staff time to manage and provide the needs of the population. These areas included maternal mental health and substance use disorder, maternal health including maternal mortality due to violence, clinical maternal health data and quality management, paternal health and partner health promotion, and health equity within the maternal populations. In the next year, the maternal health team is set to expand with positions dedicated to these areas of need, identify funding opportunities, and foster new and existing partnerships for meaningful and sustainable change.
The newborn screening program continued to evaluate the policy for metabolic formula coverage. The program is required to cover metabolic formula for patients with a metabolic disorder on the newborn screening panel. The program must cover the cost based on a sliding-fee scale and be the payer of last resort. The sliding-fee scale was reevaluated to ensure equity within the coverage by ensuring individuals who need the most financial assistance received the most assistance. Since July 1, 2021, the newborn screening program required all patients who received financial assistance for metabolic formula to submit a financial form. Those financial forms allowed the program to collect data to continuously monitor and review the coverage for metabolic formula. During the summer of 2022, the decision was made to bring the program back in-house at IDOH. Continued evaluation is necessary to ensure equity in the program and coverage.
State Priority Need:
Engage Families and Youth with diverse life experiences to inform and improve MCH services.
State Performance Measure (2020 - 2025):
SPM: Engage families and youth with diverse life experiences to improve MCH services.
The Indiana Department of Health (IDOH) and the Division of Mental Health and Addiction (DMHA) have partnered to create Indiana’s first Indiana Youth Advisory Board (IYAB). State leaders are seeking input from youth across the state of Indiana who are passionate about shaping the future of public health services including suicide prevention programs. The Youth Advisory Board evaluates public health and suicide prevention services for Indiana youth and makes recommendations for improving the quality of life across Indiana. The current board launched on July 18, 2022, and will serve for one calendar year.
The Indiana YAB represents a diverse group of youth and young adults between the ages of 14 and 23; who come from 22 of Indiana's 92 counties. Of 229 applicants, these members earned their position as representatives for Indiana's youth by undergoing an interview process where they answered questions concerning health issues that they feel are most pressing in Indiana and recommended solutions for their selected issues. As mentioned, from March 1 – 31, 2022, 229 youth applied for the first round of applications and a little over half were asked back. For the second round of applications, youth were asked to create a short video to talk about themselves and their interest in public health and mental health. Upon review, 45 youth were selected to become a part of the first youth advisory board. Since the beginning youth have begun meeting to discuss a variety of topics such as mental health, sexual and reproductive health, minority health, and access to care.
Many joined us with lived experience; having faced hardships and sought care. They have also acted as support systems for their peers and look forward to advocating for others. The board held its first meeting in July 2022 and continues to meet each month. This is an unprecedented opportunity for youth and young adults to address health at the state level. By empowering youth to speak to their struggles and develop innovative solutions, the IYAB will see improved health outcomes across the state.
The Teen Pregnancy Prevention grant program engaged youth from across the state through a three-pronged approach Botvin LifeSkills, Be Strong Families Teen Cafés, and Adolescent Champion Model. These approaches reached youth at schools, in clubs, in the juvenile justice system, or in the clinic. The youth who participated in Teen Cafés were able to provide feedback on changes to the survey, topics for the café, and incentives that might be able to engage more youth. Youth are also able to give feedback on the Botvin LifeSkills post surveys. From the report, youth rated the program a 7.6 out of 10. Youth reported that one thing they learned from the program was either about drugs, money, communication, or healthy relationships.
It also reached community members and parents through after school events called Parent Cafés. Parents are also able to provide feedback on cafés they attended. Parents rated the cafés as 9.3 out of 10, with a rating of 3.5 out of 4 when it comes to understanding that they can use the protective factors to keep their family strong. Facilitators also asked for ideas on topics they wish would be covered to increase engagement in the program. Of the survey, parents rated that they felt safe sharing with others (3.8 out of 4) and more comfortable seeking community resources (3.5 out of 4).
State Priority Need:
Ensure Frequent Surveillance, Assessment and Evaluation of data drives funding, programming, and system change.
State Performance Measure (2020 - 2025):
SPM: MCH Data are analyzed and disseminated and used to inform Title V programming and funding allocations.
MCH continued to make relevant data easily accessible to partners statewide through our website. The MCH Epidemiology Team set out to improve data sharing through the development of presentations, fact sheets, reports, and dashboards. The Epi Team worked to build data capacity among internal and external partners and designed deliverables with their audience in mind.
Throughout the year, data presentations were routinely shared with our partners, both verbally and in written form. These presentations included PRAMS findings, AIM data, annual Indiana infant mortality and birth outcomes, Perinatal Substance Use (PSU) hospital collaborative quarterly data and many more. The PSU data were also combined with other sources such as IBDPR surveillance data, PRAMS, YRBS, maternal mortality review data, and suicide and overdose fatality review data and presented to our partners to provide a more complete picture of what substance use looks like in the state of Indiana.
The Maternal and Child Health Epidemiology Team supplied updated, annual data to several public-facing dashboards to allow users to access and stratify data as they need it for their programmatic and reporting needs. These dashboards included the Indiana Department of Health’s Stats Explorer website that contains content on county-level birth outcomes and infant mortality over time with options to view the data in tables or maps and the Governor’s Health Equity dashboard which shows infant mortality and key birth outcomes such as preterm births by race and ethnicity and emphasizes the continued need for equity in public health in Indiana.
The Epi team has also worked to build dashboards internally by utilizing Tableau. These dashboards enable users to explore and take advantage of available data to inform their work. One dashboard that the team has started constructing is based on metrics that will be used by Perinatal Centers and affiliate hospitals to inform quality improvement work at the hospital level. Once completed, this dashboard will give hospitals access to preliminary data on selected metrics such as C-sections, inductions, and NICU admissions, to support their work in improving clinical care across the state.
State Priority Need:
Strengthen Mental, Social, and Emotional Well-being through partnerships and programs that build capacity and reduce stigma.
State Performance Measure (2020 - 2025):
SPM: Strengthen mental, social, and emotional health and well-being through partnerships and programs that build capacity and reduce stigma.
Maternal Mental Health
The Indiana Department of Health (IDOH) and the Maternal Child Health (MCH) Division applied and were awarded the State Maternal Health Innovation (MHI) and Data Capacity grant from the Health Resources and Services Administration (HRSA). The purpose of Indiana’s Mental Health Innovation and Data Capacity Initiative is to increase the capacity and support for maternal mental health and postpartum care in Indiana, with a focus on reducing bias. The goal outlined above will be achieved through improving data and surveillance through collecting qualitative sate in a digital story platform, convening a Maternal Health Task Force (MHTF) and Community Advisory Committee (CAC), equity and workforce improvements, community mobilization efforts while building upon the work of Alliance for Innovation of Maternal Health (AIM) and employing innovative strategies by piloting the AIM safety bundle, Postpartum Discharge Transition, with a Stepped Care Model for mental health in five sites.
Indiana has recognized the immediate need to address maternal mental health, postpartum care, and equitable care as it relates to maternal mortality and SMM through emerging efforts in maternal health strategies across Indiana. IDOH’s Maternal Health Innovation and Data Capacity’s initiative is focused on a multi-level, intersectional, and systems-thinking approach to tackle a wicked problem. This approach will mobilize all levels of partners and community members to improve existing relationships and create new pathways for collecting, improving the quality of, and utilizing data related to maternal health. IDOH has proposed that more than 94% of the funding dollars be provided to pilot sites and consultants through 2027 to address preventable risk factors associated with maternal mortality and severe maternal morbidity through new AIM bundles within pregnant and postpartum populations that would otherwise continue to be unserved or underserved in their areas.
BeHappy
Indiana University School of Medicine was awarded a five-year grant from the Division of Mental Health and Addiction (DMHA) at the Family and Social Services Administration. The program aims to improve Hoosier families’ access to best practice pediatric behavioral health care across the state by supporting health care providers in their local communities with guidance from psychiatric specialists. Provider-to-provider consultation: Board-certified child and adolescent psychiatrists consult with community-based providers to help with assessment, diagnostic clarification, medication management, treatment, planning, and other pediatric mental health questions. Following a brief conversation with a coordinator, consulting psychiatrists are paged immediately and return calls within an hour or at a time requested by the caller. Community referrals: Staff assist with finding appropriate evidence-based treatment programs in the patients’ local community, when possible. Educational opportunities: staff offer in-service programming and free continuing education sessions on pediatric behavioral health topics. The MCH Division Director serves on the advisory board for BeHappy along with other leaders within state government and relevant professional organizations. In 2022, BeHappy completed 1168 consultation calls, 589 enrolled providers, and 62 out of 92 Indiana counties had providers enrolled.
Social Emotional Learning
The DNPA offered three Coordinated Approach to Child Health (CATCH) professional development training for PE teachers and before and after school professionals in north, central, and south regions of Indiana. They offered one training which focused on grades 6th-8th physical education, physical activity, and social emotional learning (SEL) activities and curriculum, and two trainings focused on grades K-5th physical education, physical activity, and SEL activities and curriculum. While these activity-based trainings consisted of mainly teaching easy ways to engage students and inspire movement and healthy lifestyle habits, they also included a component on SEL strategies that helped teach participants the skills and environments that can help advance students’ learning and development in various ways. CATCH trainers incorporated the SEL framework into each training by focusing on providing education and tools to participants to help their students apply the knowledge, skills, and attitudes to develop a healthy identity, manage emotions and achieve personal and shared goals, feel, and show empathy for others, establish, and maintain supportive relationships, and make responsible and caring decisions in their everyday lives.
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