Cross-Cutting/Systems Building - Annual Report

 

Illinois’ priorities for the Cross-Cutting Domains are:

• Strengthen workforce capacity and infrastructure to screen for, assess, and treat mental health conditions and substance use disorders. (Priority #8)
• Support an intergenerational and life course approach to oral health promotion and prevention. (Priority #9)
• Strengthen MCH epidemiology capacity and data systems. (Priority #10)

 

Priority #8 - Mental Health and Substance Use

 

Illinois’ mothers and infants continue to experience adverse outcomes related to mental health disorders and substance use. Mental health and substance use disorders remain a common source of hospitalization among women of reproductive age (SOM #2), causing 144 hospitalizations per 10,000 population in 2021. This increase in hospitalizations since the previous year (135 per 10,000 births in 2020) occurred in all race and age categories, women 15-24 and non-Hispanic Black and Hispanic women had the sharpest rate increased. More than 1 in 10 Illinois women experience postpartum depression symptoms following a recent live birth (NOM #24). After remaining stagnant over the last 6 years,  this measure worsened slightly from 2020-2021. Illinois is still faring better than the national average (11.9% in IL compared to 12.7% in US), however it is concerning to see the measure worsening in Illinois while the national average shows some improvement. As a result. Illinois has dropped from 5th best among all states in 2020 to 14th best in 2021. The of neonatal abstinence syndrome (NAS; NOM #11) in Illinois has continued to decline since peaking in 2017. Non-Hispanic White infants continue to be nearly two times more likely than non-Hispanic Black infants to experience NAS. Notably, the rate of NAS among Hispanic infants doubled from 2019-2020 but is still less than non-Hispanic Black and non-Hispanic white infants. Overall, Illinois has the 5th lowest NAS rate among all states. 

 

Among Illinois children and adolescents, mental health is also a priority. Mental health services were especially difficult to access, with only 53.5% of children who needed treatment or counseling able to receive them in 2019-2020, a proportion that has been steady since 2018-2019 (NOM #18). This demonstrates difficulties with accessing the services that are needed. Alarmingly, the adolescent suicide rate (NOM #16.3) in Illinois has remained persistently high in recent years and is currently the eighth highest rate in the country.

In FY22, Title V utilized the following strategies to strengthen workforce capacity and infrastructure to screen for, assess, and treat mental health conditions and substance use disorders:

 

8-A. Partner with the Illinois Children’s Mental Health Partnership to develop and to implement a model for children’s mental health consultations for local health departments and other public and private providers in the public health and health care delivery system.

 

Infant and early childhood mental health consultation is a multi-level, proactive approach that partners multi-disciplinary infant early childhood mental health professionals with people who work with young children and their families. The pairing of these partners seeks to support and enhance children’s optimal social emotional development, health, and well-being. More specifically, the approach aims to build the capacity of public health programs to prevent, to identify, and to reduce the impact of mental health concerns among infants, young children, and their families. Title V partnered with the Illinois Children’s Mental Health Partnership (ICMHP) to integrate a model for infant and early childhood mental health consultation (IECMHC) into public health settings.

 

A comprehensive report of the pilot program was completed at the end of FY21 and included details on the evaluation completed, including impact and outcomes of the pilot, comprehensive list of resources required to be successful, and roles/responsibilities of key personnel. Title V has reviewed the report and discussing opportunities to leverage lessons learned with key stakeholders.

 

8-B. Partner with the Illinois Department of Corrections and Logan Correction Center on health promotion activities for incarcerated women focused on substance use recovery and trauma health education.

 

This strategy is similar to strategy 1-B. Information about this activity is available in the narrative for the Women’s and Maternal Health Domain.

 

8-C. Partner with UIC Center for Research on Women and Gender to implement a program at two clinic sites to expand the capacity of health care providers to screen, to assess, to refer, and to treat pregnant and postpartum women for depression and related behavioral health disorders.

 

This is the same as strategy 1-D. Information about this activity is available in the narrative for the Women’s and Maternal Health Domain.

 

8-D. Convene and facilitate state Maternal Mortality Review committees (MMRC and MMRC-V) to review pregnancy-associated deaths and develop recommendations to improve quality of maternal care as well as reduce disparities and address social determinants of health.

 

This is the same as strategy 2-A. Information about this activity is available in the narrative for the Women’s and Maternal Health Domain.

 

8-E. Support the Perinatal Mental Health Program that includes a 24-hour telephone consultation for crisis intervention for women suffering from perinatal depression.

 

This is the same as strategy 2-J. Information about this activity is available in the narrative for the Women’s and Maternal Health Domain.

 

8-F. Support the Illinois Perinatal Quality Collaborative (ILPQC) in its implementation of obstetric and neonatal quality improvement initiatives in birthing hospitals.

 

This is the same as strategy 2-I. Information about this activity is available in the narrative for the Women’s and Maternal Health Domain.

 

8-G. Collaborate with other state and national initiatives to address opioids and substance use disorder among women of reproductive age, pregnant persons, and families.

Of note, the ASTHO Opioid Use Disorder, Maternal Outcomes, Neonatal Abstinence Syndrome Initiative (OMNI) Learning Collaborative concluded during FY21 and no new activities were completed during FY22 for this specific project. See previous annual reports for information on the OMNI learning collaborative activities.

 

In FY22, the Title V team continued to collaborate with ILPQC as they worked to support hospital teams in sustainability of the Mothers and Newborns Affected by Opioids (MNO) initiative. This is the same as strategy 2-I. Information about this activity is available in the narrative for the Women’s and Maternal Health Domain.

 

8-H. Identify gaps in mental health programs and resources for Illinois children, develop partnerships with and within organizations focused on improving mental health among children and adolescents, and support the implementation of mental wellness programs that facilitate system level improvements as well as address social determinants of health.

 

This is the same as strategy 4-D. Information about this activity is available in the narrative for the Child Health Domain.

 

8-I. Participate on and collaborate with statewide Adolescent Suicide Prevention Ad Hoc Committee to develop a strategic plan to reduce suicide ideation and behavior among youth.

 

This is the same as strategy 5-C. Information about this activity is available in the narrative for the Adolescent Health Domain.

 

8-J. Collaborate with organizations and programs to address the impact of adverse childhood experiences (ACE) and toxic stress on mental and physical health in children and adolescents.

 

This is the same as strategies 4-F and 5-F. Information about this activity is available in the narratives for the Child Health Domain and the Adolescent Health Domain.

 

8-K. Convene and partner with key stakeholders to identify gaps in mental health and substance use services for women that include difficulties encountered in balancing multiple roles, self-care and parenting after childbirth, and leverage expertise to develop recommendations for system level improvements for Title V consideration and implementation.

 

This is the same as strategy 2-G. Information about this activity is available in the narrative for the Women’s and Maternal Health Domain.

 

Priority #9 - Oral Health

 

Access to dental healthcare is a priority and a challenge in Illinois. Although access to dental care during pregnancy showed improvement following a considerable drop in 2020, still only 46 % of Illinois’ pregnant persons received a preventative dental visit during pregnancy (NPM #13.1). This is a reassuring improvement after a sharp decrease in 2020, but not yet reaching the “pre-COVID” measure.

The percent receiving preventive dental care during pregnancy was even lower (less than 32%) for women with a high school degree or less, women who were Non-Hispanic Black, women on Medicaid and women participating in WIC. 

 

Many children also lack dental health services; approximately 74% of children received a preventive dental visit in 2020-2021 (NPM #13.2). This is a significant decline from the 2018-2019 estimates and may be due to disruptions in care from the COVID-19 pandemic. Among uninsured children, only 65% received a preventive dental visit, compared to nearly 80% of children with private insurance. Racial/ethnic disparities persist as well; non-Hispanic Black and Hispanic children were less likely to have a preventive dental visit than non-Hispanic White children. Among children ages 1-5, only 57.5% had received a preventive dental visit.  This may indicate need for additional parental education or for providers able to care for young children.  Dental care and dental health remain significant concerns for CYSHCN, who are more likely than non-CYSHCN to have tooth decay or cavities; in 2020-2021, 18.7% of parents of CYSHCN reported tooth decay or cavities in their children, compared to 11.3% of non-CYSHCN (NOM #14). 

 

During FY22, Title V utilized the following strategies to support an intergenerational and life course approach to oral health promotion and prevention:

 

Title V supports the Oral Health Section (OHS) in its various population health activities improving the oral health, and ultimately, the overall health of women, children, and families. It is important to note that OHS is housed in the Division of Community Health and Prevention.

 

9-A. Partner with IDPH Oral Health Section (OHS) to expand oral health outreach to the most at-risk maternal populations by engaging local programs and organizations.

 

During FY 22, OHS completed the Illinois Oral Health Resource Map.  It was requested and came up several times in the community conversations. This map includes dental clinics and practices, federally qualified health centers (FQHCs), local health departments, and hospitals in Illinois outside the Chicago metropolitan area that provide oral health services. The dental resource map provides basic contact and service information and designates which providers accept Medicaid and provides Spanish language accommodation.

OHS revamped the existing website and improved the quality and content. The website is now organized and has documents geared toward both dental professionals and the public. New sections highlight Illinois Oral Health Plan IV, oral health data, fast facts on oral health, where and how to access oral health care, and a complete collection of workforce resources that are easily accessible. Each of the OHS core programs is on the home page with tabs that provide additional details and resources. Forms and Publications are routinely updated and available for download and printing.

Public and oral health providers have both benefited from the new OHS website. The OHS team regularly fields phone calls and emails from Illinois citizens who need guidance with access to oral health care or have specific questions. The website contains an interactive map of the public dental clinics that are available within an address or zip code. School exam forms are routinely downloaded for printing.  The oral health data is invaluable for the stakeholders to seek additional funding from outside sources

 

See narrative for 9-B for more information on grant opportunities that aligned with the expansion of outreach efforts.

 

9-B. Partner with OHS to support and to assist MCH populations and key stakeholders, which include women of reproductive age, school personnel and families, to access oral health education, dental sealants, fluoride varnish, Illinois All Kids (Medicaid) enrollment, dental home referrals, and to comply with Illinois’ mandatory school dental examinations for children in kindergarten, second, sixth, and ninth grades.

 

The Oral Health Section (OHS) in the Division of Community Health and Assessment in the Office of Health Promotion. Assessment, policy development, and assurance are key OHS programs’ public health functions.  OHS also works with many partners and stakeholders to establish programs designed to improve access to population‐based interventions that prevent and reduce oral disease by promoting oral health as integral to health through organized community efforts. Oral health programs focus on community water fluoridation, school-based oral health, dental sealants, maternal and child oral health programs, community needs assessment, craniofacial anomalies, oral cancer prevention, oral health surveillance, oral health workforce initiatives to address shortage areas, and variety of educational and health education, communication programs, and plans designed to promote oral health as integral to health and meet the oral health needs of the Illinois population.

Oral Health Promotion Program Grant (OHPP) is a revamped population-based program where 14 statewide grantees were selected using an oral disease burden, data-informed strategy in granting resources to statewide applicants to do innovative work in this space.  During the FY22 OHPP funding opportunity, grantees developed and implemented innovative programs that addressed the local oral health needs of children and families.  The projects and strategies ranged widely and included high-quality education, integration into medical visits, and disease-mitigating prevention services all to address oral health disparity gaps.

 

During FY 22, the program’s primary reach continues to be low-income vulnerable families with a focus on early prevention to reduce oral disease burdens and to help people obtain timely oral health care services. OHPP is also designed to assist school personnel and families in accessing oral health education, fluoride varnish, All Kids enrollment, and care services through a dental home relationship.

 

The OHS will continue to reach out to local health departments to provide technical assistance and guidance for oral health programs. These programs include fluoride varnish trainings, medical dental integration, and referrals to care programs.

 

In FY22, 153,998 individual oral and health-promoting interactions occurred with the population of focus, women with children, children, and persons during pregnancy.  In addition, WIC, home visiting, nursing, school staff, teachers, and individual schools were collaborators and partners through which the 153,998 interactions occurred.

Another impact of the Title V funding resulted in local health departments and other grantees’ sustained work on oral health promotion and prevention programming in their counties and geographic areas which many grantees were able to expand programming to adjacent counties. 

 

9-C. Collaborate with OHS to design and implement the first Basic Screening Survey (BSS) for Pregnant Women that will assess the burden of oral diseases and barriers to access care.

 

Using established methodology, the first Basic Screening Survey (BSS) for Pregnant Women in Illinois will be implemented to assess the burden of oral diseases and barriers to access care. Data will be collected, validated, cleaned, and results will be compiled. A comprehensive and detailed report of the findings will be completed and disseminated to stakeholders.

 

In FY21 OHS found it necessary to pivot this initiative to the immediate needs associated with the COVID-19 pandemic. Nothing to report for FY 22.

 

9-D. Participate in the “Implementation of Quality Indicators to Improve the Oral Health of the Maternal and Child Health Population” Pilot Project with OHS to pilot a series of measures to inform the creation of a national set of indicators.

 

Illinois was one of five states selected to pilot the process of reporting on quality indicators. Pilot states were recruited from the pool of states that selected the Title V national performance measure for oral health. Each state was asked to form a team that included the MCH director, the oral health program director, a Medicaid oral health contact, information technology specialists and data analysts, and other state staff (e.g., epidemiologists, a representative from Medicaid managed care). Through this process, Illinois will learn how the indicators can enable assessments of current system performance and identify areas that can be targeted for improvement.

 

More information can be found here OHQI-overview.pdf (mchoralhealth.org)

 

During FY22, A user guide was developed to provide guidance on implementing quality indicators for the MCH population. The guide includes guidelines for data collection, preparation, and reporting as well as detailed technical specifications for how to calculate each indicator. This process allowed OHS to systematize data requests from Healthcare and Family Services and initiate the Illinois Oral Health Surveillance System Plan, an annual method of collecting and publishing oral health data.

 

9-E. Participate in the Partnership for Integrating Oral Health Care into Primary Care project with OHS and a local health department to integrate the interprofessional oral health core clinical competencies into primary care practice, particularly for pregnant women and adolescents.

 

During FY 22, the Oral Health Section has again been engaged in the Consortium for Oral Health Systems Integration and Improvement (COHSII) project. Nine states were selected to participate in a learning collaborative (LC) as part of the Integrating Oral Health Care and Primary Care Learning Collaborative: A State and Local Partnership project. The LC will include a state component and a local component as described below and will be implemented from January 2022 through March 2024. Illinois was one of the selected states.  We OHS received interest from six Illinois health centers and thus needed to select one health center through a brief application process. 

The selected FQHC will focus on integrating oral health care and primary care for pregnant women at the community health center (CHC) level. The FQHC site will need to provide prenatal care to pregnant women to participate in the LC. COHSII staff and consultants, including experts from the National Network for Oral Health Access (NNOHA), will provide TA to project teams to integrate the interprofessional oral health core clinical competencies into primary care practice. Project teams will have opportunities to share information to advance policy and practice to enhance the integration of oral health care and primary care. Data will be collected and presented to illustrate how the integration of oral health care and primary care can improve access to and utilization of oral health care. Each FQHC participating in the project will receive $30,000 (to be paid in three increments of $10,000 each over the 27-month project period).

OHS partnered with the Illinois Primary Health Care Association to work with federally qualified health centers (FQHCs) in this opportunity. In many respects, FQHCs are the ideal setting in which to carry out an oral health/primary care integration project as these depend on the ability to refer internally and share health information about individuals. FQHCs may also be better equipped with electronic health records and interest in meeting the health care needs of their patients. Through a competitive application process, OHS chose to partner with PCC Community Wellness Center, an FQHC with multiple locations in and around Chicago. The IDPH component of the COHSII project is to focus on assessing and improving systems-level capacity for integrating oral health care and primary care for pregnant women, infants, children, and adolescents.

More information on the program can be found at https://www.mchoralhealth.org/cohsii/index.php

During FY 22, which was Year 1 of the project, focused on assessing and improving systems-level capacity for integrating oral health care and primary care for pregnant women, infants, children, and adolescents within PCC Community Wellness Center.  OHS expect the impact to be improved oral health knowledge by midwives and medical assistants that will translate to oral health assessment and timely referrals to PCC’s oral health program for further individual-based oral health prevention and services.

Another notable activity in FY22 which IL Title V supported OHS is the Illinois Oral Health Plan IV: Eliminating Inequities in Oral Health. This plan represents a coordinated approach to lead oral health improvement, tackle barriers to health care, and use social determinants of health approach. Through the implementation of the plan, IDPH hopes to increase the health knowledge of the public, expand health promotion, strengthen primary prevention efforts, and improve access to timely professional services. It is equally important that local, county, and state stakeholders have regular updates on emerging concerns and disease burdens to act quickly in mitigating health issues.       

Established a process of an electronic newsletter to communicate with Illinois oral health stakeholders. The first two issues highlighted DOH programs, oral health data for providers, Oral Health Plan updates, oral health champions, and “news from the field”.

Priority # 10- MCH Data Capacity and Infrastructure:

 

The Illinois Title V program places a strong emphasis on improving data capacity and infrastructure to support maternal and child health (MCH) programs. Since 2010, Title V has dedicated one of its ten state priorities to improving data capacity and infrastructure. The 2020 Title V Needs Assessment demonstrated substantial growth in this area, but also affirmed the need for continued emphasis on strengthening the MCH epidemiology workforce in Illinois. As a result, Illinois chose to continue a state MCH priority centered on data for 2021-2025.This priority demonstrates the ongoing commitment of the Title V to ensuring evidence-based practice and data-driven decision-making.

 

Illinois developed SPM #5 to monitor data capacity over time. This measure considers 10 potential MCH data sources and whether the Title V epidemiology staff have direct access to these sources, whether the team conducted any specific analyses of these data files (beyond standard reporting requirements), and whether the findings were disseminated through presentations, reports, or other data products. A total score of 30 points is possible if all 10 data sources were available, analyzed, and had a related data product within one year.

During 2016-2020 when Illinois was building its internal data capacity, this SPM showed steady improvement over time, rising from 15/30 in 2016 to a high of 27/30 points in 2019 when 5-year needs assessment activities were underway. Since that time, the data capacity score has remained steady around 24-25 each year, indicating consistent access to, use, and dissemination of data from various sources.

 

During FY2022, the Title V MCH Epidemiology team included:

• Amanda Bennett, PhD, MPH: CDC MCH Epidemiology Program field assignee
• Cara Bergo, PhD, MPH: Maternal Mortality Analyst
• Ashley Horne, MSPH: Maternal and Infant Health Epidemiologist
• Julia Howland, PhD, MPH: Child and Adolescent Health Epidemiologist
• Bria Oden, MPH: CSTE Applied Epidemiology Fellow – completed fellowship April 2022
• Jelena Debelnogich, MPH: CSTE Applied Epidemiology Fellow

 

In 2022, the MCH data capacity score was 25/30 points, 9/10 points for data access, 9/10 points for analysis, and 7/10 points for dissemination. The Illinois Title V epidemiology team has maintained direct access to 9/10 target datasets, with Medicaid claims data being the one dataset not currently available to Title V epidemiology staff. However, we are actively working with the Illinois Department of Healthcare and Family Services as they build a maternal-infant data mart that would grants Title V staff direct access to electronic data on Medicaid eligibility, enrollment, and claims. During 2022, 9/10 high-priority datasets were used for customized analyses to inform Title V work and programs, which involved all datasets to which we have access (everything except Medicaid claims data). During 2022, data products were disseminated based on 7 of these datasets.

 

During FY22, IL Title V employed the following strategies to address Priority #10 - Strengthen capacity and systems for data collection, linkage, analysis, and dissemination:

 

10-A. Enhance staff capacity for data management, analysis, and translation through training and workforce development.

 

Throughout 2022, the Title V epidemiology team continued monthly meetings to provide opportunities for peer sharing, collaboration, coordination of work, and technical support. Of note, the Title V epidemiology staff began an epidemiology journal club during 2022. Monthly, the staff members meet to discuss a recent relevant article. Discussion centers around how the staff may apply the methodology in the article to our work. In recent months, the Title V staff has invited epidemiologists from partner offices to join the journal club, increasing opportunities for cross-office collaboration and learning.

 

Title V staff are encouraged to attend professional development activities and conferences to increase knowledge of best practices, become aware of emerging issues, and to develop professional and scientific skills. During FY2022, MCH epidemiology team members attended Illinois Perinatal Quality Collaborative Annual Conference (October 2021), the CityMatCH annual conference (December 2021), the Society for Pediatric and Perinatal Epidemiologic Research annual conference (June 2022), the Council of State and Territorial Epidemiologists (CSTE) annual conference (June 2022), and the CityMatCH/MCH Epidemiology Conference (September 2022).

 

Quality Champions continue to be an essential asset to DSCC’s quality improvement initiatives. A Quality Champion is a person who enjoys using information to celebrate success and help inspire change through focusing on solutions. The Quality Champion is a team member (not a manager) who would like to have an opportunity to utilize their leadership skills in a new way. Each regional office has a Quality Champion (or two) who takes the lead in facilitating the Quality Improvement Huddles each quarter. They help the team understand the quality measures, celebrate the team’s successes and support the team in developing an improvement plan. The Quality Champions meet on a quarterly basis with Quality Improvement team members for education on various topics pertaining to their quality role. Additionally, each Quality Champion is assigned a Quality Supporter from the QI team as an additional support. The Quality Champions utilize various reports to determine the teams progress towards performance measures, such as PowerBI reports. In 2023, the Quality Champions will be introduced to the new DSCC Scorecard that will provide them with performance measures at a team level for additional quality improvement opportunities.

 

The Illinois Title V epidemiology team strongly values mentoring of early career professionals in the MCH epidemiology field and supports numerous interns and fellows each year. During FY22, Illinois Title V hosted two Council of State and Territorial Epidemiologists (CSTE) Applied Epidemiology Fellows in MCH epidemiology, one intern from the Graduate Student Epidemiology Program, two interns from the Title V MCH internship program, one intern from the University of Illinois Chicago Maternal and Child Health Epidemiology program, and one intern from the DePaul Masters in Public Health program. These students completed projects on a wide variety of topics, including social determinants of health for children and youth with special healthcare needs, risk appropriate care for very preterm infants, maternal mortality by timing of prenatal care entry, and perinatal periods of risk for infant deaths.

 

 

Bria Oden, MPH, was placed with IDPH OWHFS for her CSTE fellowship in MCH from August 2020-April 2022. Her primary mentor was by Dr. Amanda Bennett (CDC MCH Epidemiology Program Assignee) and her secondary mentor was Dr. Jane Fornoff, epidemiologist and manager for the Adverse Pregnancy Outcomes Reporting System (APORS; state birth defects registry). Her projects during FY22 included: finalizing a youth suicide surveillance report and fact sheet, writing a scientific manuscript on an analysis of neonatal abstinence syndrome, evaluating the utility of syndromic surveillance data for pregnant persons, and analyzing data on pregnancy-associated homicides. Upon completion of the fellowship, she took a position as an MCH epidemiologist with the Ohio Department of Health.

 

Jelena Debelnogich, MPH, began her CSTE fellowship with Illinois Title V in August 2021 and continued throughout 2022, with an expected completion in August 2023. Her primary mentor is Dr. Cara Bergo (Maternal Mortality Epidemiologist) and her secondary mentor is Dr. Amanda Bennett (CDC MCH Epidemiology Program Assignee). The primary focus of Ms. Debelnogich’s fellowship is maternal health, and her projects focus on aspects of maternal morbidity and mortality. During FY22, her projects included: analyzing health insurance coverage around the time of pregnancy, evaluating maternal chronic conditions across maternal health data systems, analyzing mental health and substance use treatment among pregnancy-related deaths, and investigating community level factors as they relate to maternal mortality.

 

In addition to hosting interns, the Title V epidemiology staff received several trainings during FY 2022. Several trainings focused on data analysis and management skills, including trainings on data visualization and health equity trainings, forecasting, and SmartSheet trainings. The Title V program improved our health equity skills through trainings on racial health equity, infant health equity, and implicit bias. Other trainings pertained to the project and populations served by Title V including project management trainings, and opioid response training.

 

 

10-B. Improve data infrastructure and systems, including initiatives to improve accuracy, timeliness, and quality of data

 

Linkage of data systems has long been identified as a need to improve MCH surveillance, assessment, and evaluation. The Illinois Title V epidemiology team supports the data linkage needs of state programs but has limited capacity and prioritizes linkages based on the most urgent data needs. During FY22, the Illinois Title V epidemiology team successfully completed various matches using vital records data.

 

Deaths among women of reproductive age were matched to births and fetal death certificates to identify pregnancy-associated deaths, serving as a check to ensure all maternal deaths are identified using the primary, manual matching process. Correct identification of all pregnancy-associated deaths is crucial to Illinois’ maternal health efforts. During FY21, the maternal mortality epidemiologist performed a preliminary linkage of vital records data to identify pregnancy-associated deaths occurring during 2021. This linkage identified five deaths that were missed through other case ascertainment methods (e.g. searching vital records, newspapers, obituaries). She also identified 29 additional possible deaths of women of reproductive age where the death certificate checkbox was not marked as not pregnant. These additional deaths found through linkage and the death certificate check box partnered with ongoing case ascertainment methods ensures that we identify every pregnancy-associated death in Illinois.

In 2018, the Illinois Title V program gained access to identifiable hospital discharge files to link birth certificates and hospital discharge data for maternal and infant hospitalizations. Staff developed linkage protocols for matching infant birth hospitalizations to birth certificates and maternal delivery hospitalizations to birth certificates. In FY 2022, the Title V team completed maternal hospital discharge data to birth certificates for the 2018-2020 birth cohorts. This linked dataset allows for more complete capture of maternal health and demographic variables.

 

Infant and fetal death certificates were linked to records of COVID-19 positive specimens among women of reproductive age to identify COVID-19 cases occurring during a pregnancy. Due to high frequencies of missing or unknown values in the pregnancy field on the COVID-19 case reporting form, this linkage identified 50% more pregnant COVID-19 cases than the use of the infectious disease reporting system alone. The COVID-19 specimen data from Illinois’ National Electronic Disease Surveillance System (I-NEDSS) for lab tests during 2020 were matched to birth certificates from January 1, 2020-September 30, 2021. A total of 9,063 cases of SARS-CoV-2 infection during pregnancy were identified throughout the state. IDPH and the Chicago Department of Public Health abstracted medical records for these cases to report to the CDC Surveillance of Emerging Threats to Mothers and Newborns Network (SET-NET). The result is a robust data file that enables rich study of the impact of COVID-19 on pregnant persons and infants.

During FY22, Title V continued to support the implementation of the ePeriNet data system, which collects data to inform quality improvement work for the Illinois regionalized perinatal system. All birthing hospitals and administrative perinatal centers are required to enter information related to key maternal and infant quality and health outcomes, such as mortalities, transfers, and specific morbidities. For example, ePeriNet is the data system that collects the VPT review forms to track barriers to antenatal maternal transports. Due to contractual issues in Illinois, Title V was not able to make any major changes or enhancements to the ePeriNet system during 2022, but the system continues to be maintained.

 

Since late 2019, Illinois has used the CDC Maternal Mortality Review Information Application (MMRIA) system for storing data on pregnancy-associated deaths. Data from death certificates, birth certificates, and fetal death certificates are entered for all pregnancy-associated deaths since 2015. Cases that are reviewed by the MMRCs have additional forms entered, such as the committee decisions form and information from autopsies, prenatal care, mental health profiles, and social & environmental profile. During FY22, data in MMRIA were finalized for all deaths occurring during 2019 and 2020, and preliminary information for deaths during 2021 was entered.

Illinois PRAMS and OWHFS collaborate to improve survey response rates by using Title V funds to cover the cost of a reward for respondents. Until 2017, respondents received a small spiral bound note pad for completing the survey, but steadily declining response rates were beginning to threaten Illinois PRAMS ability to meet the CDC’s minimum response rate threshold. Innovative strategies were needed to stabilize the response rate and ensure validity of Illinois PRAMS data. In 2018, IL Title V began funding Illinois PRAMS to provide diaper gift card rewards for survey respondents and demonstrated increased response rates across all demographic groups after this reward was implemented. In FY22, Illinois PRAMS offered a $25 gift card reward and was able to maintain response rates above the CDC’s minimum response rate threshold (currently 50%).

During FFY 2022, UIC-DSCC completed 23 new Power BI reports. The implementation and use of these reports has continued to be helpful for monitoring care coordination activities at an individual and organizational level as well as monitoring performance on key indicators, including items related to the current CYSHCN statewide priorities.  

 

During 2022, Illinois continued to integrate Emory University and CDC's community vital signs dashboard in each case abstract packet for all maternal mortality reviews. The dashboard uses the woman’s last known residential address to generate a summary of county and community-level data on various health indicators such as health care providers per capita, housing stability, violence, segregation, transportation access and more. The dashboard helps the maternal mortality review committees recognize and evaluate community-level and systems-level factors that may have contributed to the woman’s death, and to identify potential recommendations to address these factors. This information helps supplement information already collected on the CDC MMRIA “social and environmental profile” and pushes the committee to identify factors and recommendations beyond the hospital and provider level. The MCH epidemiology team also used this data to investigate the association between pregnancy-related deaths per county and county-level indicators. County-level indicators such as poverty, food insecurity, and transportation were found to be associated with pregnancy-related mortality in Illinois.

 

During FY22, CDPH leveraged the FCC Regional Community Alignment Boards to survey community-based programs and initiatives that promote partner and male engagement. Regional CABs regularly local early childhood providers that offer Head Start and Early Head Start programs that specifically strive to include partner and male engagement as part of their service models. This includes strengthening proficiency to engage with families around such areas as health care connections for male/partner and health co-parenting skills.

 

 

10-C. Analyze data, translate findings, and disseminate epidemiologic evidence to support MCH decision-making

 

The MCH epidemiology team conducted many analytic projects to inform decision-making in the state, particularly as related to the Title V priorities. Some of the topics represented in the analyses and epidemiologic studies completed during 2022 are as follows:

• Relationship between pregnancy-related deaths and timing of prenatal care entry
• Emergency department visits among pregnancy-related deaths
• Mental health and substance use hospitalizations among women of reproductive age
• COVID-19 infection during pregnancy
• Impact of COVID-19 pandemic on variety of MCH health services and outcomes
• Stability of health insurance coverage and the association with prenatal care utilization, and with postpartum visits
• Chronic comorbidities and adverse perinatal outcomes among women with mental health and substance use disorders
• Suicidal behaviors and deaths among Illinois youth
• Characteristics of infants with NAS compared to other births
• Preterm birth rates during the COVID-19 pandemic in 2020 compared with 2017-2019

 

The MCH epidemiology team tracks products resulting from data analyses as one way of monitoring productivity and impact. Dissemination of findings through reports, presentations, fact sheet, manuscripts, and other mechanisms is important for informing MCH practice in the state and promoting evidence-based decision-making.

 

During 2022, the team produced a total of 21 data products:

• 8 oral presentations at conferences
• 1 poster presentation at a conference
• 6 manuscripts published, submitted, or under development
• 2 data reports
• 1 fact sheet
• 1 presentation at national, state or regional meetings
• 1 webinar
• 1 webpage developed

 

The IL Title V epidemiology staff represented the work of Illinois at various state and national meetings during 2022. MCH staff members presented two oral presentations and one poster presentation at the Council of State and Territorial Epidemiologists conference and five oral presentations and one poster presentation at the CityMatCH / Maternal and Child Health Epidemiology conference. The topics of these presentations included: mental health and substance use hospitalizations among women of reproductive age, pregnancy-related deaths, and the relationship between insurance coverage and prenatal care.

 

During 2022, Illinois Title V epidemiology staff were co-authors on several scientific manuscripts that were published, submitted for publication, or are in the process for development. (Illinois Title V staff bolded in citations):

 

• Published in 2022:
  • Neelam V, Reeves EL, Woodworth KR, Olsen EO, Reynolds M, Rende J, Wingate H, Manning S, Romitti P, Ojo KD, Silcox K, Barton JE, Mobley E, Longcore ND, Sokale A, Lush M, Delgado-López C, Diedhiou A, Mbotha D, Simon W, Reynolds B, Hamdan TS, Beauregard S, Ellis E, Seo JY, Bennett A, Ellington S, Hall AJ, Azziz-Baumgartner E, Tong VT, Gilboa G (2023). Pregnancy and Infant Outcomes by Trimester of SARS-CoV-2 Infection in Pregnancy – SET-NET, 22 Jurisdictions, January 25, 2020 - December 31, 2020. Birth Defects Research, 115(2): 145-159. [epub Sept 2022]
  • Goyal S, Gerardin J, Cobey S, Son C, McCarthy O, Dror A, Lightner S, Ezike NO, Duffas W, Bennett AC (2022). SARS-CoV-2 infection among pregnant people at labor and delivery and changes in infection rates for the general population: Lessons learned from Illinois. Public Health Reports, 137(4): 672-678.
  • Manning SE, Bennett AC, Ellington S, Goyal S, Harvey E, Sizemore L, Wingate H (2022). Sensitivity of pregnancy status on the COVID-19 case report form among pregnancies completed through December 31, 2020 — Illinois and Tennessee. Maternal and Child Health Journal, 26: 217-223.
• Submitted to journal in 2022 (awaiting decision):
  • Oden B, Fornoff J. Characteristics of Infants with NAS Compared to Other Births in Illinois, 2015-2016. Submitted to Journal of Substance Abuse and Treatment.
  • Holicky A, Anderson-Reeves T, Bennett A, Lightner S, McRae K, Handler A. Child Care as a Barrier to Perinatal Health Care in Illinois. Submitted to Maternal and Child Health Journal.
• Under Development in 2022:
  • Holicky A, Horne AA, Bennett AC. “Association of Social Support and Postpartum Depressive Symptoms among Postpartum Women, Illinois Pregnancy Risk Assessment Monitoring System, 2016-2020” (will be submitted to journal in 2023)

 

Another notable data product from 2022 was a data report on suicidal behaviors and deaths among Illinois youth. This data report utilized data from both the Youth Risk Behavior Surveillance System and vital records. The report examined the increase in suicidal behaviors, including self-harm and suicidal ideation among Illinois youth and demonstrated a rise in deaths from suicide among several groups, including youth of color and female adolescents. This report was important and concerning; suicide rates remain stable in many groups considered to be high risk, including non-Hispanic White youth and rural youth, and rose in groups previously considered to be lower risk including females and youth of color. This report was shared with program partners and academic audiences to broaden the reach of suicide prevention programming for youth.

 

CDPH collects and maintains current MCH-related data for residents of the city of Chicago. These data are published to the Chicago Health Atlas (https://chicagohealthatlas.org/). As new data become available, these resources are routinely updated. In FY22, there were 19 indicators in the “Maternal, Infant, Child and Adolescent Health” section of the Chicago Health Atlas.

 

Performance Management and Program Evaluation Activities

 

From the summer of 2020 through summer of 2021, UIC-DSCC had successfully implemented an organizational action plan related to care coordination performance called Connecting the Dots. This initiative resulted in a 33% increase in organizational compliance with completion of person-centered care plans for CYSHCN enrolled in DSCC care coordination. This initiative provided education on broad topics pertaining to care coordination.

Based off feedback from the care coordination team and the success of Connecting the Dots, in July 2021 UIC-DSCC kicked off an updated organizational initiative called Connecting the Dots – Planning Pathways. This new initiative included 15 topics and extended through September 2022. For this round the emphasis was on person-centered care planning. The initiative followed the theme of taking a journey to help keep it fun and engaging to the care coordination team. Each month had a different topic. The topic was introduced by a message from a member of DSCC leadership. The message was then followed up on by an educational module (using various techniques) for the care coordination team to complete. Regional managers were asked to then review the topic and discuss it as a team during their regularly scheduled team meetings. Success metrics were monitored, and results were shared quarterly with the broad DSCC team. The initiative demonstrated the following improvements:

• Completion of a person-centered care plan compliance was 71% at start of the initiative and was 87% at the end.
• Documentation of a monthly review of the person-centered care plan was 52% at the start of the initiative and was 68% at the end.

 

During FFY 2023 UIC-DSCC will again incorporate feedback incorporated by staffing during the Connecting the Dots – Planning Pathways initiative as a new organizational plan for continuing to improve care coordination quality. The next initiative will focus more on health promotion related topics and will begin in January 2023.

 

10-D. Forge partnerships that will increase the availability, analysis, and dissemination of relevant and timely MCH data

 

Illinois continued to serve as an assignment site for a CDC Maternal and Child Health Epidemiology Program (MCHEP) field assignee, Amanda Bennett, PhD, MPH. Dr. Bennett began her CDC assignment with IDPH in December 2014, after already working with Illinois Title V in various capacities since 2007. She provides technical assistance and scientific leadership to the Illinois MCH programs by conducting research and surveillance and building MCH epidemiology capacity. During FY22, she led the Title V epidemiology team, ensured timely reporting of Title V measures, designed and implemented epidemiologic studies, and mentored interns, fellows, and other IDPH epidemiology staff. She presented at national conferences and state meetings and provided technical assistance to various state advisory committees.

 

During FY22, Illinois Title V continued its partnership with the University of Illinois at Chicago (UIC) Center of Excellence in Maternal and Child Health. Through an Intergovernmental agreement (IGA) first enacted in 2013, UIC faculty, staff, and students conduct analytic projects on behalf of Title V. The CDC MCHEP assignee serves as the main coordinator and liaison for the collaborative projects between Title V and UIC. The MCH epidemiology team meets monthly with the UIC team to discuss project priorities, progress on activities, discussion of study findings, and feedback on analytic plans, methodology, and data products.

 

During FY22, UIC primarily focused on several analyses:

• Medicaid Evaluation: The UIC team analyzed baseline data for the evaluation of Illinois’ extension of Medicaid through 12-month postpartum. This evaluation plan uses population-based data sources, such as PRAMS and BRFSS, to examine changes over time in insurance coverage, stability, and MCH outcomes.
• COVID During Pregnancy: The UIC team used SET-NET data to examine outcomes related to maternal prenatal SARS-CoV-2 infection. The findings from this analyses were used in 2023 to develop a manuscript.
• Safe Sleep Patterns: The UIC team analyzing PRAMS data to look at patterns of infant safe sleep practices by race/ethnicity to inform risk reduction approaches.

 

During FY22, Title V maintained relationships with other internal IDPH data staff (e.g., PRAMS, BRFSS, vital records, hospital discharge data) through collaborative data sharing agreements. Through these agreements, Illinois Title V has access to population-based data to monitor the health of women, infants, children, and adolescents, and provide a mutual benefit in the analysis, data translation, and interpretation of findings.

 

Specifically, Title V and PRAMS continued to actively partner to ensure high-quality data collection during FY22. These activities include participating on the Illinois PRAMS Advisory Committee, continuing to fund gift card rewards for survey respondents, and advising the PRAMS director about the selection of questions for the Illinois PRAMS Phase 9 survey. The CDC MCHEP Assignee and PRAMS Director worked closely to ensure that the questions prioritized for the Phase 9 survey align with Title V priorities, performance measures, activities, and topics of interest for program/policy development in Illinois. The Phase 9 survey will be finalized and implemented in 2023.

 

During FY22, the Title V epidemiology team continued to provide technical assistance to various external partners on data projects. This includes: HFS (Medicaid agency), Illinois Perinatal Quality Collaborative, state advisory committees (e.g., Perinatal Advisory Committee, Statewide Quality Council), Healthy Start programs, the Illinois Maternal Health Innovations Grant Program (I-PROMOTE), and various other state projects. By participating in such workgroup and collaborating with these partners, Title V epidemiology staff meaningfully contribute by interpreting/translating data to inform decision-making and can influence plans for data collection and analysis. Title V epidemiology staff also analyze data to fulfill data requests from these partners that support program monitoring and evaluation purposes for these partners.