Report for the application year: Oct 2023 - Sept 2024

Three priority needs for the 2023-2024 report period are addressed in the Cross-Cutting domain because they apply across all population domains. These priorities are: 1) Strengthen systems, services and partnerships to help families and health care providers respond to the impact of a collective emergency, disaster or other trauma, 2) Improve social supports, with a focus on well-being and resilience, to prevent and reduce the impact of ACEs, 3) Address non-medical factors affecting health. Alaska created three State Performance Measures to align with these priorities. These SPMs are: 1) Percent of mothers of 3-year-old children whose family has an emergency plan in case of disaster (SPM EP), 2) percent of women who recently delivered a live birth who have a strong social support system during the postpartum year (SPM SSS), and 3) infant mortality rate ratio of Alaska Native to White infants (per 1,000 live births) (SPM IM). Alignment with these performance measures is notated in parentheses after each bolded strategy.

Over the past four years, WCFH work to address these priorities more intentionally has included efforts to integrate these priorities across public health practice in all domains. It has also involved identifying and naming examples of work in these areas and being more intentional about reporting and advancing such activities. Accordingly, some of the activities included in this chapter may receive only a brief mention here due to more detailed discussion appearing in other population domain reports and vice versa. The writers have endeavored to provide cross-referencing whenever possible to reduce duplication.

Contribute to assessment of needs and dissemination of data and best practice information to support emergency response. (EP 1)

Congenital syphilis (CS) became a high priority for the Division after rates began to rapidly increase in the last few years, and the legislature passed a multimillion dollar increment to fund work in State Fiscal Year 2024 to address the topic. During 2023-2024, the MCDR (Maternal Child Death Review) Program Manager and MCH Epidemiology Unit Manager continued to provide technical assistance to the Sexually Transmitted Infections program team in the Section of Epidemiology on the creation and implementation of a congenital syphilis review board, building upon experience with MCDR. This included attending mock internal reviews, sharing MCDR materials and forms, and providing input on review processes.

Another infectious disease of importance to MCH that has increased in recent years is RSV. During the fall of 2023, there was a growing concern about the rising number of respiratory cases being seen in Alaska at a time when RSV season had not yet even begun. WCFH collaborated with the Section of Epidemiology and the Department of Health Staff Pediatrician to plan for a Perinatal ECHO session on Alaska recommendations for RSV intervention for children and during pregnancy. This took place in November 2023. In preparation for the upcoming respiratory virus season, the September 2024 Perinatal ECHO session focused on the impact of key respiratory illnesses—RSV, influenza, COVID-19, and pertussis—during pregnancy. This included how these conditions affect maternal health, fetal development, and neonatal outcomes and updated participants on current clinical guidelines for the prevention, diagnosis, and treatment of these respiratory illnesses in pregnant women. Special attention was given to the latest recommendations for influenza and COVID-19 vaccines, including optimal timing and safety considerations to ensure both maternal and fetal protection. There was also discussion on prevention strategies and boosting vaccination confidence. This included best practices for administering vaccines during pregnancy, with a focus on timing and effectiveness. Discussion also included strategies for effectively communicating with patients about the safety and importance of vaccines during pregnancy, addressing common concerns to improve vaccination rates, and overall maternal and neonatal health outcomes.

As part of the response to the COVID-19 pandemic, WCFH staff, in collaboration with the University of Alaska-Anchorage's Center for Human Development, launched an ECHO series for home visitors in early childhood. This initiative was supported through MIECHV funds and entered its third year of monthly Home Visiting ECHO sessions during this reporting period. The sessions were offered at no cost to home visitors across all program models, including Early Intervention/Part C, and provided opportunities for continuing education credits. The following topics were covered:

• Providing Support to Families Affected by Substance Use
• Supporting Families Affected by Fetal Alcohol Spectrum Disorders (FASD) and Navigating Difficult Conversations
• Engaging Fathers in Early Learning
• Reflective Supervision Practices
• Supporting Families Experiencing Multiple Risk Factors (3-part series)
• Exploring Family Structures and Effective Support Strategies

These sessions featured didactic presentations from both local Alaskan and national experts, as well as Alaskan with personal experiences with the topic. A total of 365 participants attended the 8-part series.

In partnership with emergency response agencies, promote and disseminate information to the public about policies being implemented and changes in availability of public health services during and in the wake of a significant traumatic event or emergency. (EP 2)

During this past reporting period, Title V worked more closely with staff in the Emergency Preparedness (EP) program. The Title V MCH Director and Council of State and Territorial Epidemiologists (CSTE) Fellow partnered with them on the Jurisdictional Risk Assessment (JRA). The goal of the JRA is to identify and evaluate jurisdiction-specific risks in Alaska associated with public health and hospital preparedness, ensuring enhanced emergency preparedness capacity and capabilities, and effective allocation and utilization of federal grants related to EP. The CSTE Fellow participated from a data collection and survey design perspective, and the MCH Director provided a maternal child health lens and linked this project with MCH providers and stakeholders. After Title V began assisting in getting the survey out via MCH networks to increase feedback from hospitals and providers, the response rate had a significant increase. The EP staff were grateful for this partnership. These were the top areas of concern noted by Alaska hospitals:

1. Behavioral Health Crisis (Suicide, Severe Depression, Anxiety Disorder)
2. Substance Abuse (Opioids, Alcohol Abuse)
3. Interpersonal Violence (Domestic, Child, and Elder Abuse)
4. Infectious Disease (Epidemics and Pandemics)
5. Supply Chain Shortage/Failure
6. Earthquake
7. Severe Weather (Typhoons, Blizzards, Heatwaves)
8. Wildland Fire and Community Fire
9. Communication Failure
10. Cyber Attack & Facility Failure (Water Disruption/Contamination, Utility Disruption, Sewer Failure)

Concerns regarding Behavioral Health and Substance Use also aligned with the most recent Title V Needs Assessments completed in 2020 and 2025.

The Title V MCH Director and Newborn Bloodspot Screening (NBS) Nurse Consultant also partnered with EP staff to create a continuity of operations (COOP) plan for the whole of the Division of Public Health. The MCH Director and Nurse Consultant first updated the current Section COOP plan and then used that information to add MCH relevant content to the Division Plan. The Division-wide plan was under leadership review and approval as of September 2024.

The EP program plans to conduct preparedness exercises for the top five concerns noted by statewide hospitals over the next year. WCFH will be able to participate in these exercises in partnership with the EP program.

Provide staff training in responding to ACEs/trauma and strengths-based approaches. (SSS 1)

All WCFH staff are encouraged to and given an opportunity to attend a 2-day Strengthening FamiliesTM training, which provides an Alaskan perspective on  trauma and the impact of ACEs, as well as practical training on everyday actions to promote the five Protective Factors: (1) Parental Resilience, (2) Social Connections, (3) Concrete Supports, (4) Knowledge of Parenting and Child Development and (5) Social and Emotional Competence of Children. The training is open to the public and engages groups of participants from many professions and backgrounds, lending an opportunity for public health professionals to connect with communities and other disciplines. This training had been in a virtual format due to pandemic safety measures but is now offered in person. Since the virtual approach has increased access to participants in rural regions, this option may also continue to be offered. Staff will be encouraged to attend whichever format is most beneficial for engagement with regional partners and/or their own telework status.

WCFH staff include many professionals who have experience working directly with various populations, including the CYSHCN Director who holds an LCSW, Child and Adolescent Health Unit staff with backgrounds in social work and/or working on youth violence prevention, and the MCDR Program Manager who has a social work and child welfare background. During this reporting period, the MCDR added a long-term, non-permanent Mental Health Clinician 3 position. This position helped to facilitate review committee meetings and assisted with provider and community outreach, including the three MCH Epidemiology visits to Kotzebue, Fairbanks, and Bethel. This position was approved to become permanent in fall 2024 and was in the recruitment process by the end of reporting period. The MCH Epidemiology Unit’s Senior Epidemiologist has a scientific research emphasis on ACEs and the impacts of trauma on MCH population health outcomes. Overall competency and familiarity with these topics are increasing throughout WCFH as these key staff members continue to provide consultation and leadership on this topic. These subject matter experts help to increase the reach and impact of these approaches through their involvement in workforce training.

As part of professional development, staff are also encouraged to attend the AK Blanket Exercise training provided by the Alaska Native Tribal Health Consortium. This training has been well-received by staff who have attended and covers the history of the Alaska Native people. ANTHC welcomes and encourages public health professionals to participate in this training activity, which recently returned to in-person delivery. All members of the WCFH leadership team had the opportunity to attend this training at Division’s leadership retreat in April 2024.

In April 2024, a session was included at the annual AKPQC & MCDR Joint Summit on “Trauma Informed Approaches to Exams," presented by a local provider. The session highlighted the pivotal role medical exams can play in patient care, emphasizing that for individuals with a history of trauma, these exams can often trigger feelings of vulnerability, fear, and distress. The presentation provided healthcare professionals with practical strategies to create safe, supportive, and empowering environments during medical exams. The local provider, drawing from her extensive experience, offered valuable insights into how to conduct exams with heightened sensitivity to patients' past experiences, ensuring that patients feel respected, in control, and fully supported throughout the process. Attendees learned how to adopt strengths-based approaches that foster trust, prioritize patient dignity, and promote healing, making medical exams a less intimidating and more collaborative experience. This session was an important step in building a healing-centered culture within our healthcare settings, ensuring that patients, regardless of their history, receive care that is compassionate, respectful, and empowering.

Promote or provide workforce training and support for self-care and responding to vicarious trauma exposures. (SSS 2)

The Alaska Perinatal ECHO series hosted two sessions regarding self-care.  The first session of the two-part series was in December 2023 and focused on Self-Care and Resiliency for Caregivers. The session aimed to examine special considerations for self-care; during the holidays, with grief, at work, and in recovery. This session also offered practical tools to help caregivers navigate the emotional and physical demands of their role.

Given the powerful response to the first session, the presenter was invited back to address a different group in the second session in January 2024. Expanding upon the insights gained from December's session, this follow-up session specifically targeted healthcare providers, delving deeper into the clinical nuances of self-care and resilience. The session focused on an in-depth exploration of advanced strategies introduced earlier, providing participants with tangible tools and actionable steps tailored to their clinical context. Through interactive exercises and focused discussions, the session aimed to cultivate a profound understanding of the challenges faced by caregivers, fostering a clinically supportive environment amidst the complexities of their work.

For both caregivers and healthcare providers, the series provided practical tools for managing stress, setting boundaries, and recognizing the importance of emotional well-being. At its heart, this two-part series emphasized that caregivers and healthcare providers must first ensure that they are prioritizing their needs alongside those they serve.

Conduct multidisciplinary reviews to identify factors in maternal and child mortality and make Alaska specific, actionable recommendations to reduce preventable mortality experienced by different populations. (IM 1)

The Maternal Child Death Review Program (MCDR) in the MCH Epidemiology Unit is partially funded by Title V and partially funded by two CDC grants to specifically support Sudden Unexplained Infant Death (SUID) and maternal mortality reviews. Since 1990, the MCDR committee has followed a systematic, evidence-based review model to identify causes and contributing factors to maternal, infant, and child deaths and develop recommendations aimed at preventing future deaths. In May 2024, MCDR applied for funding for another cycle of the CDC Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM) grant, which was awarded in September 2024.

The 2023-2024 year held many challenges for the MCDR program in terms of staff turnover, as well as programmatic changes resulting from updates to the state statute that governs review organizations in Alaska. With the dedicated funding for maternal and SUID reviews and limited capacity, the program prioritized reviews of these two types of death over the past year.

In the 2024 legislative session, both the Alaska House and Senate passed updates to the State statute that establishes public health review organizations in Alaska, including MCDR. One of the major changes made to the statute is the removal of the requirement that 75% of committee participants be health care providers. The bill went into law in August 2024. The MCDR program staff began reviewing the committee membership process to identify opportunities to make the committee more multidisciplinary and representative of communities disproportionately impacted by premature mortality, while also improving program effectiveness and efficiency. Throughout this process, the team also had ongoing conversations with other review organizations within DPH, in particular the Overdose Fatality Review team in the Section of Chronic Disease Prevention and Health Promotion, to collaborate on processes such as committee member approvals and records requests.

MCDR focused on addressing the backlog of SUID cases this year and conducted an internal staff-only review to categorize 41 cases. As a result, MCDR is now caught up with the current grant cycle for SUID cases. During this reporting period, the committee met three times to review nine SUID cases and develop recommendations. Additionally, the committee convened twice to review maternal deaths, examining a total of seven cases and formulating recommendations. MCDR also held one meeting to review child deaths involving suicide, where three cases were reviewed, and recommendations were developed.

The previous MCDR Epidemiologist who left in June 2024 initiated the development of an online visualization tool using R-Shiny to consolidate review recommendations into a searchable platform. While the tool still requires further development, it has the potential to become a valuable resource for MCDR to disseminate recommendations. Recommendations were also shared with the Alaska Hospital and Healthcare Association and at presentations to communities including Kotzebue, Fairbanks, and Bethel.

Engage with various contacts and audiences to increase awareness about maternal and child mortality and promote implementation of prevention recommendations. (IM 2)

During the final year of CDC funding under the Supporting Maternal Mortality Review Committees grant, Alaska received an increase in funding that doubled the previous annual amount. With this additional funding, the program was able to advocate for and receive a long-term, non-permanent Mental Health Clinician (MHC3) position to support community engagement in disseminating and promoting committee recommendations to prevent maternal deaths. A former rural mental health clinician with one of the Tribal health organizations was hired into this position in February 2024. While this position is funded primarily to support maternal mortality reviews, by being a part of the MCDR staff, it also has been able to speak to other components of the program when meeting with communities. The MHC3 traveled with other MCH Epi staff to Fairbanks as part of the “MCH Epi road show” described elsewhere in this report, and she, the MCDR Manager, and a WCFH Perinatal Nurse Consultant also traveled to a rural hub community in September to specifically reach out to MCDR partners on prevention opportunities. The purpose of these trips and future planned trips to communities outside of Anchorage is to conduct listening sessions to hear directly from community members about their concerns and questions related to maternal mortality and to learn what types of prevention recommendations resonate most strongly.

The new CDC maternal mortality review funding cycle includes additional focus over the next five years on community engagement, disseminating information about the program and findings, and receiving and acting on input from disproportionately impacted populations. Additionally, with this new five-year funding, the program successfully advocated to make the MCH3 position a permanent staff position, and the MCH Epi Unit Manager and MCDR Manager began working on the formal paperwork required to create a permanent position.

MCDR data was presented at the joint MCDR/Alaska Perinatal Quality Collaborative (AKPQC) Summit in April 2024 by the MCDR Epidemiologist in a presentation titled "Understanding Maternal Violence Through Data Analysis." This presentation reflected data collected from across Alaska, focusing on deaths related to intimate partner violence (IPV) and suicide.

During the reporting period, MCDR and the AKPQC continued partnering with the Alaska Hospital and Healthcare Association (AHHA) through a contract to support dissemination of recommendations and quality improvement initiatives to prevent maternal morbidity and mortality. A small portion of this contract to support activities related to severe maternal morbidity was funded with state Title V funding.

Collaborate with Medicaid to improve reimbursement and/or increase access to services. (IM 3)

The purpose of this strategy is to recognize that WCFH’s many partnerships with the Medicaid program are a deliberate component of Alaska’s overall Title V Strategic Plan across all Domain areas. However, most - if not all - of the work that WCFH does with Medicaid to improve reimbursement and/or increase access to services is also described in other sections of this report.

Notable collaborations during this report period included:

• Regular monthly meetings attended by the Title V Director and CYSHCN Directors, MCH Epidemiology Unit Manager, Child & Adolescent Health Unit Manager, MIECHV Program Manager, along with Medicaid staff including the Medical Director, EPSDT Manager, and CHIP Director.
• Partnership between Medicaid, the Chief Medical Officer, and the Commissioner’s Office on the implementation and promotion of extended postpartum coverage from 60 days to 12 months;
• CHIP Work Plan– Multiple Title V staff continue to collaborate with the CHIP Director and Medicaid team on the Alaska CHIP Work Plan and Core Measures;
• Participation in a workgroup with Medicaid centered on reimbursement for developmental screening;
• Collaboration and problem solving with Medicaid on the pediatric audiology capacity concerns in the state and the relationship between Medicaid reimbursement;
• Collaboration with Medicaid and the Commissioner’s Office on a federal grant application to support school-based services in Alaska

Provide staff training and development opportunities in respectful maternity care. (IM 4)

Throughout the reporting period, ongoing efforts to promote respectful care in perinatal care have focused on a critical area of need: ensuring treatment for individuals most impacted by substance use during pregnancy. A key component of this work has been the development of a training for perinatal providers aimed at fostering an environment of non-judgmental care for people who use drugs, particularly pregnant women. WCFH began the procurement process and issued a Request for Proposals (RFP) to identify a qualified organization or expert to design and implement this specialized training. This step represents a significant milestone in Title V commitment to promoting quality practice among perinatal healthcare providers.

The training will focus on the intersection of substance use and pregnancy, providing perinatal providers with tools to enhance communication and build trusting relationships with patients. The goal is to create a supportive, empathetic atmosphere where patients feel comfortable disclosing important information about their health. This approach will focus on improving communication and ultimately promoting better access to services. The training will be fully funded through supplemental finding received through the CDC Statewide Perinatal Quality Collaboratives Cooperative Agreement, allowing us to allocate the necessary resources to make this initiative accessible and impactful. In the coming months, continued efforts will be made to collaborate with key stakeholders to ensure the successful roll-out of this training.

As mentioned in the Women’s/Maternal Health domain, the MCDR Maternal Mortality from Violence Prevention (MMVP) grant continued work to build a healing-centered and Alaska focused maternal health workforce by ensuring the MCDR process and data dissemination is respectful, promoting access to community-based birth helper/doulas, and supporting health care provider training on maternal mortality. The MCDR Program Manager collaborated with an expert on Missing and Murdered Indigenous Women and Girls (MMIWG) and an Indigenous doula to present at the Association of Maternal Child Health Programs Annual Conference in March 2024.

Conduct ongoing assessment of non-medical factors impacting health related to Title V strategies across domains. (IM 5)

WCFH continued to conduct ongoing discussions during quarterly domain meetings about how to ensure that Alaska’s Title V strategies were centered on improving outcomes among populations most impacted without causing unintended consequences. These meetings, which include progress updates, team-based problem-solving and collaboration, were facilitated by the Title V Block Grant Coordinator, Title V MCH Director, and MCH Epidemiology Unit Manager.

Collect, analyze, and disseminate data and information on non-medical factors affecting health. (IM 7)

The MCH Epi Unit continued ongoing work collecting, analyzing, and disseminating data, as described elsewhere in this report. Some of the Unit’s work specifically related to data and information on non-medical factors affecting health is described below.

The CSTE fellow continued work on a project linking PRAMS data with Alaska’s web-based immunization information system, VacTrAK. This project looked at two vaccine series as the outcomes of interest, the childhood series and the kindergarten series, and included both PRAMS and birth certificate variables as independent predictors of these outcomes. He presented the preliminary results at the national CSTE conference in June 2024 as well as at numerous internal meetings of DPH staff and leadership, Tribal health organizations, and public health nurses. This ongoing project will provide information that can help Alaska’s immunization program improve services for Alaskan children and families by identifying pre-birth maternal factors that are associated with lower vaccination rates.

PRAMS continued collecting survey data from mothers who recently delivered a live birth, using the Phase 9 survey which started with 2023 births. This updated survey instrument included new questions related to food insecurity, barriers experienced while accessing services, and use of doula care. The PRAMS and CUBS program staff conducted multiple efforts throughout the year to increase survey response rates. These efforts are key to future MCH Epi Unit analysis projects because higher numbers of respondents overall will support the ability to examine differences in outcomes by demographic sub-populations. Additionally, since PRAMS serves as the foundation for both ALCANLink and CUBS, boosting the response rate to PRAMS was seen as critical to the success of these other programs as well as PRAMS.

WCFH hosted the 2024 AKPQC & MCDR Joint Summit in April 2024, that served as a powerful platform for sharing knowledge, examining complex health issues, and fostering collaborative solutions.

Session Highlights:

• Understanding Maternal Violence Through Data Analysis: Alaska, known for its stunning landscapes and rugged wilderness, also grapples with a less visible but deeply concerning issue: intimate partner violence (IPV). This session addressed the heart of this complex issue, utilizing comprehensive data analysis from MCDR and PRAMS. This session aimed to shed light on the multifaceted dimensions of violence in Alaska, with a particular focus on intimate partner violence. It explored trends, patterns, and contributing factors, providing invaluable insights into the prevalence, impact, and root causes of violence within the state. Attendees gained a deeper understanding of the challenges facing Alaskan communities, as well as the critical role that data-driven approaches play in addressing and mitigating these issues.

• Navigating Alaska's Substance Use Landscape: Insights and Data Analysis, Including Breastfeeding and Alcohol Use. Alaska's battle against substance use is multifaceted, requiring a comprehensive understanding of the data to drive effective interventions. This session delved into Alaska's substance use landscape, utilizing data-driven insights to inform policies and interventions. Moreover, the session explored the intersection of substance use with breastfeeding practices, alcohol consumption, and screening rates for substance-exposed newborns.  Through an in-depth analysis of statewide PRAMS and data from the Substance Exposed Newborns Initiative, this session illuminated the prevalence, patterns, and consequences of substance use within Alaska's communities. The session included substance use trends, geographic variations, and the impact on maternal and child health outcomes.

All presentations and recordings from the Summit are available to the public through the AKPQC website. By ensuring wide access to these materials, we hope to empower individuals and organizations to act on the information shared and continue the important work of serving families in our communities.