Cross-Cutting/Systems Building Annual Report
Primary Care Office (PCO) Report
The Nevada Primary Care Office (PCO) improves health care access through its efforts to coordinate the federal shortage designation process, the J-1 Physician Visa Waiver Program, and other recruitment and retention programs. These efforts are supported by a strong collaboration between the PCO and Title V MCH, Area Health Education Centers, the Office of Rural Health, health care training programs, community health centers, rural health clinics, tribal clinics, rural hospitals, and other safety net health care sites. The PCO receives base funding from the federal Health Resources Services Administration (HRSA) to support its efforts. Because this work helps to improve health care access for maternal, child, and adolescent populations, the Title V MCH grant supports 0.25 FTE Health Resource Analyst in the PCO. Staff in the PCO continue to support Title V MCH initiatives through regular participation in Maternal and Child Health Advisory Board (MCHAB) meetings and through quarterly reports of PCO progress relating to MCH goals. The PCO is also regularly briefed by and collaborates with Title V MCH staff at quarterly Data Sharing Meetings hosted by the PCO. The PCO shares provider-facing trainings and resources from Title V MCH staff in their newsletters and through their statewide provider lists for primary care physicians and specialists.
PCO Shortage Designation
The PCO recently completed a Health Professional Shortage Area designation update for all FQHCs, Rural Health Centers, and tribal clinics. Overall, there were 18 primary care, 13 dental health, and 9 mental health facilities whose designation score increased. This score increase will help facilities utilize federal recruitment and retention tools to recruit providers into the shortage areas. The Health Resource Analyst in the PCO was selected to be one of two state representatives in the country that participated in a federal auto-HPSA workgroup. Auto-HPSAs support Federally Qualified Health Centers, Indian Health Service and Tribal health care sites, and Rural Health Clinics throughout Nevada. The PCO strongly advocated for communication measures that support our state safety net clinics.
PCO National Health Service Corps and Nurse Corps Program Coordination
National Health Service Corps (NHSC) outreach activities during this year included 14 health clinic site visits, 14 webinars, and 6 outreach events. These activities increase awareness of the program and subsequent program participation, which leads to increased recruitment and retention of health providers for underserved maternal, pediatric and adolescent populations. The PCO also reviewed 19 NHSC site applications. These safety net health care sites serve all patients regardless of ability to pay and represent critical primary care, mental health, and dental access points for maternal, pediatric, and adolescent populations in Nevada.
PCO J-1 Visa Waiver Program
Twenty-three (23) applications were reviewed, public hearings were held, and letters of support were completed for primary care, mental health, and specialist physicians to participate in the J-1 Physician Visa Waiver program. These doctors will serve underserved populations in Las Vegas, Carson City, Reno/Sparks, including maternal, pediatric and adolescent populations. Additionally, 14 participant compliance site visits were completed to provide technical assistance and to assure compliance with program requirements.
Interorganizational Collaborations
The PCO Newsletter was published in October, February, May, and September and included multiple articles that support maternal, child and adolescent health. Informational articles included an announcement of the Bright Futures Tools and Resource Kits available, a new Family Medicine Residency Program in Elko, NV, Nevada Health Service Corps offering loan repayment to Licensed Alcohol and Drug Counselors, and a Suicide safeTALK alertness training for adolescents. They also included articles about resources to help 14 million children with special care needs, the Nevada's Congenital Syphilis Awareness Campaign Launch, and guides to help providers address patient sexual health. Lastly, they included articles on new resources for adolescent and school health, new funding opportunities for health centers, and an article on the Pediatrician’s Role in Public Health Systems for Children with Special Needs.
The PCO manager participated in the National Governor’s Association and the National College of State Legislatures workgroups to support health initiatives in Nevada. These workgroups include public health leaders and legislatures. The workgroups developed goals to support improvement of state-level capacity building best practices. This was a great opportunity for Nevada, including sessions on building behavioral health and dental health capacity, as well as model state-level health workforce data collection efforts across the county
The PCO attended a Primary Care Association annual conference on Growing, Improving and Nurturing Health in Nevada. The conference touched on the growing shortages of health providers throughout the state and how communities can collaborate to close the gaps.
The Title V MCH Program sought to increase the percent of children, ages 0 through 17, who are continuously and adequately insured (NPM 15). According to the NSCH 2017-2018 report, 63.4% of Nevadan children, ages 0 through 17, were continuously and adequately insured compared to 67.5% nationwide. To improve the percent of children who are adequately insured in Nevada, the Title V MCH Program utilized several strategies to accomplish this goal, including partnership and collaboration with other programs, agencies, and community organizations; drafting and distribution of informational brochures developed with a multi-agency workgroup convened by Title V MCH; and insurance application assistance and referrals.
The Title V MCH Program increased access to care by actively promoting Medicaid referral and enrollment, specifically annual open enrollment periods, Katie Beckett information, and essential health benefits; providing trainings on what Medicaid expansion means for MCH populations to provider and community-based partners and stakeholders; creating and widely promoting a one-sheet on Senate Bill 325 of the 79th Session of the Nevada Legislature in support of increasing Medicaid utilization for legally present youth under 19 years old on the DPBH MCH website; and including Medicaid information on the Nevada 211 MCH page, within the customized state text4baby messaging, on the Medical Home Portal, and through the CYSHCN statewide helpline.
The Title V MCH Program also participated in the National Governors Association (NGA) Learning Network to Improve Insurance Enrollment and Access to Health Care for Adolescents ages 15-18. The NGA Learning Network provided technical assistance for improving quality and access to care in MCH populations. A core group of state leaders from various governmental agencies committed to collaboration on activities to improve insurance enrollment.
Adequate Insurance – Partner Efforts
Family TIES of Nevada (FTON), Nevada’s Family Voices affiliate, awarded Title V funding, provided enabling resources and care coordination to families with CYSHCN statewide. FTON assisted clientele with insurance applications, disseminated informational health insurance brochures, including Katie Beckett waiver information, and referred families to applicable providers for needed services in southern and northern Nevada.
Carson City Health and Human Services (CCHHS), a local health authority in northern Nevada, awarded Title V funding disseminated brochures with information regarding insurance enrollment. CCHHS referred uninsured families to Nevada 211 to obtain health insurance benefits information and conducted Facebook campaigns promoting Nevada 211 and the Medical Home Portal, respectively reaching 5,084 and 2,124 users. CCHHS also partnered with the Division of Welfare and Supportive Services for on-site, Medicaid application assistance. Promotion of the services and resources to access insurance were displayed on the clinic digital signage.
Partners Allied for Community Excellence (PACE) Coalition, serving Elko and the nearby counties, was awarded Title V funds to strengthen the character and competencies of youth and families through the collaborative effort of members from every community sector to enhance proven protective factors encouraging youth to make healthy choices. The PACE Coalition’s Community Health Worker (CHW), enrolled 16 Hispanic and underserved individuals in Medicaid and assisted 35 people in accessing healthcare services, and other supports necessary to improve health. PACE referred families to Nevada 211 to obtain additional resources related to health insurance benefits and distributed health insurance brochures.
The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program within the MCAH Section exists to develop and promote a statewide coordinated system of evidence-based home visiting supporting healthy child development and ensures the safety of young children and family members. MIECHV works directly with families to facilitate completion of insurance enrollment referrals to increase adequate insurance coverage and is partly funded by Title V MCH.
Community Health Nurses (CHNs) are part of the Community Health Services (CHS) Program within DPBH and provide access to medical services in underserved areas including, but not limited to, family planning, outreach and education, and referral and navigation to care as needed. CHNs, awarded Title V funding, provided insurance resources and referrals to uninsured people in Nevada’s rural and frontier regions through Nevada Medicaid, Nevada Check Up (Nevada’s Children’s Health Insurance Program), and the Silver State Health Insurance Exchange (Nevada’s health insurance marketplace). Undocumented residents and those not eligible for Medicaid or other insurance were referred to the Access to Healthcare Network Medical Discount Plan.
The Title V MCH-funded Washoe County Fetal Infant Mortality Review (FIMR) studies a variety of factors affecting the health of the mother, fetus, and infant to learn more about how to reduce fetal and infant mortality. FIMR tracks insurance type (if any) the mother had during pregnancy and separates categories based on private, Medicaid or no insurance to identify insurer-specific opportunities to reduce infant mortality gaps and look for opportunities to expand care.
The Nevada Division of Health Care Financing and Policy; Medicaid), works in partnership with the Centers for Medicare & Medicaid Services to assist in providing quality medical care for eligible individuals and families with low incomes and limited resources. Services are provided through a combination of traditional fee-for-service provider networks and managed care. Medicaid partners with Title V MCH for informational and referral resources on the Katie Beckett waiver program, development of the one-sheet on Medicaid coverage for legally present children, and many other NPM 15-related efforts. MIHI efforts between DHCFP, DHHS and Title V MCH staff focused on increasing adequate prenatal care.
Office of Suicide Prevention and Hotline Report
Title V MCH funding helps support the Nevada Office of Suicide Prevention (OSP) through the provision of outreach and education, facilitated information-sharing, and consensus building among multiple constituent groups. New partnerships were created with the Nevada State Board of Pharmacy, hospitals across the state, and the University of Las Vegas School of Medicine Office of Continuing Medical Education.
OSP conducted several suicide education and prevention courses across the state. The safeTALK training, a suicide alertness course using the model Tell, Ask, Listen, and Keepsafe, reached 1,593 community members and/or school staff. The evidence-based Applied Suicide Intervention Skills Training (ASIST) teaching the Pathway for Assisting Life model intervention skill to 414 providers and/or caregivers. The Nevada Gatekeeper trainings providing information about suicide prevention, statistics, and what to look for and how to help reached 1,617 participants plus an additional 419 veterans and/or service members. The Reducing Access to Lethal Means program provided outreach to 108-gun shop owners and shooting range staff; 524 nurses and other healthcare providers, as well as 191 first responders.
OSP supported Youth Mental Health First Aid (YMHFA) and school-based suicide prevention programs which enables adults to better recognize and assist adolescents in need of intervention. Statewide, mental health literacy was enhanced by training 561 community helpers to identify youth mental health risks using the YMHFA model.
OSP worked with the Nevada Department of Education (NDE) Office of Safe and Respectful Learning Environments on a multi-tiered system of support to threat assessment teams and practicing of protocols across Nevada school districts. During the 80th (2019) Session of the Nevada Legislature, several school-based suicide prevention bills were passed. OSP provided technical assistance and resources to help school districts implement the new requirements.
Title V MCH funds supported the Crisis Support Services of Nevada (CCSN) phone and text lines which made 77,090 contacts. Detailed data reflecting all contacts made was available for quarters 1, 3, and 4. For those three quarters, the most common issue was mental health, reflecting 31.9% of calls. Other common issues included relationships, suicide, and abuse/violence, making up 28.3%, 14.4%, and 10.1% of calls respectively. Suicide related concerns represented 15.5% of users. Slightly more than 60% were female and less than 1% reported as transgender or gender fluid for contacts where gender was recorded. Most users were between ages 25-40 y.o. with 14% under age 18 y.o.
Nevada Oral Health Program Report
Title V MCH provided funding to the Oral Health Program in support of a pilot that included outreach to pregnant women and children, including mobile services and prescriptions of prenatal oral health care. Dr. Antonina Capurro, the State Dental Health Officer, and Ms. Shauna Tavcar, Social Services Program Specialist III with DHCFP, collaborated in reviewing and rewriting the Medicaid Services Manual 1000 Dental with the goal to increase preventive dental services while identifying areas to reduce redundancies and clarify the intent of the chapter. Dr. Capurro and Ms. Tavcar also collaborated with Dr. Amy Tongsiri, Nevada Dental Director of Liberty Dental Plan, to analyze the coverage, limitations and prior authorization requirements for the Nevada Medicaid and Nevada Check Up Dental Program. CPT codes and service limits are under review and the fiscal impact is under evaluation.
The Oral Health Program collaborated with Liberty Dental Plan and the University of Medical Center of Southern Nevada to redirect non-traumatic dental conditions within the emergency department and refer for definitive dental care. The project team provided a formal presentation to the April meeting of the Nevada Medical Care Advisory Committee.
The Oral Health Program also provided oral hygiene instruction, dental screening, and oral hygiene kits to Special Olympic athletes at the spring basketball game in Las Vegas on March 9, 2019. The Oral Health Program screened 101 Special Olympic athletes on May 31, 2019.
Tobacco Cessation Report
All Title V MCH funded programs promoted the Nevada Tobacco Quitline to pregnant women and women of childbearing age. WCHD, SNHD, CCHHS and CHS clinics provided smokers tobacco education and counseling. Referrals to the Nevada Tobacco Quitline were provided to 25 adolescents (ages 12-17 y.o) and 603 adults (ages 18-44 y.o.). CCHHS promoted the Nevada Tobacco Quitline each month on clinic digital signage, as well as conducted a Facebook campaign reaching 14,233 users. March of Dimes Smoking in Pregnancy brochures were widely distributed by the MIP Coordinator.
CCHHS and CHS utilized the Brief Tobacco Intervention developed by the Agency for Healthcare Research and Quality (AHRQ) to address tobacco use with clients. The five-step intervention is designed to be repeated at each visit. The practitioner asks about tobacco use, advises and encourages cessation, assesses if the individual is willing to quit, and then assists smokers interested in quitting and arranges for a follow-up session (in person or telephone) to determine the quit attempt outcome. The intervention, conducted in less than three minutes, is an effective means to screen and refer to the Nevada Tobacco Quitline.
The Tobacco Control Program Annual Report
The Chronic Disease Prevention and Health Promotion (CDPHP) Tobacco Control Program (TCP) disseminates Nevada Tobacco Quitline (NTQ) promotional material for pregnant and postpartum women who use tobacco via Nevada providers, Women, Infants, and Children (WIC) clinics, early childhood educators and Nevada Head Start sites. The NTQ continues to provide callers13 years and older with up to five scheduled personalized, culturally competent, coaching sessions, unlimited inbound calls, web and text support, and Nicotine Replacement Therapies (NRTs) free of charge to callers ages 18 and older, upon availability. The Pregnancy/Postpartum (PPP) program offered mothers in Nevada a designated, trained coach throughout each session along with incentivized gift cards for each completed counseling call. According to guidelines of the PPP program, each pregnant caller was enrolled before giving birth to ensure eligibility for both programs. This allows the mother to focus on her health, as well as the baby, creating longevity for both the baby and the mother. Comprehensive printed educational materials on benefits of quitting smoking during pregnancy and harmful effects on babies was provided upon each enrollment process.
The NTQ enrolled 1,326 callers during the program period which included 9 pregnant women. The NTQ offers a free program specializing in helping pregnant mothers quit smoking. The tailored treatment plan meets their needs by providing intensive behavioral support, including an increased number of coaching calls compared to the general population. As an incentive, reward gift cards for $5 and $10 are given after scheduled and completed counseling calls. For pregnant and new mothers who have quit, additional postpartum support is available to prevent relapse. NTQ uses evidence-based treatment practices to help pregnant smokers quit and remain tobacco free. Although the call volume was limited, outreach was expanded to Community Health Workers, women’s health care providers, WIC clinics, and events in the community. MCH opportunities to heighten NTQ awareness are being implemented, including promotion by all Title V MCH funded partners and the Chronic Disease Coalition monthly newsletters.
Partnerships continued to expand with the NTQ as listed: Medicaid Managed Care Organizations (MCOs), Division of Welfare and Social Services, Maternal, Child and Adolescent Health (MCAH), local tribal health departments, University Medical Center, Nevada Health Centers, Carson Tahoe Hospital, Lyon County Medical Center, Northern Nevada Health Centers, Access to Healthcare Network, and mental health clinics. Established relationships with providers created an opportunity for a health system change through a NTQ e-Referral process specific to patients interested in cessation.
Title V MCH continued to work with the Substance Abuse Prevention and Treatment Agency (SAPTA) list of SAPTA-funded treatment providers to update the SoberMomsHealthyBabies.org website to prevent substance use in pregnant women, as well as provide information to women of childbearing age, providers, and concerned family and friends. The website provides the substance use help line number, Nevada 211, Crisis Call Center, the Nevada Tobacco Quitline, and other resources. The website specifies the treatment priority status for pregnant women at SAPTA-funded agencies and the importance of women identifying they are pregnant. SAPTA-funded treatment centers must not deny treatment to persons unable to pay. All treatment centers listed on the website are SAPTA-funded.
The website had 2,474 sessions and 2,051 users. New users represented 82.5% of the total number of users and 17.5% were returning visitors. A total of 4,492-page views occurred. Most of these sessions were accessed from Reno, Carson City, and Las Vegas, with Sparks and Elko rounding out the top five.
The public awareness campaign uses radio and television public service announcements in English and Spanish throughout the state to promote the www.SoberMomsHealthyBabies.org website, in addition to the distribution of window clings and referral cards. The collaboration ensures substance use in pregnancy materials and resources will reach the targeted audience. The media campaign had a total of 10,367 total spots aired (8,2864 radio advertisements and 1,503 television advertisements), promoting the SoberMomsHealthyBabies.org website and the importance of pregnant women receiving treatment and preventing substance use in women of childbearing age. All local health authorities and MCH subgrantees promoted the SoberMomsHealthyBabies.org website and shared Sober Moms Healthy Babies referral cards.
To raise awareness on the priority admission of pregnant women at state-funded treatment centers, Title V MCH continued to disseminate removable wall stickers promoting the SoberMomsHealthyBabies.org website. Title V MCH is in contact with state agencies and local health authorities who have agreed to help with distribution and promotion. Partnerships with the Department of Taxation, Division of Health Care Finance and Policy (DHCFP), SAPTA, local hospitals and providers, March of Dimes, faith based and MCH Coalitions, and other DPBH programs continue.
All local health authorities participated in sharing substance use in pregnancy resource distribution. CCHHS, with Title V MCH funds, endorsed pregnant and postpartum women being substance free through their clinic digital signage and social media. Facebook messages with information about the SoberMomsHealthyBabies website reached 4,082 families.
Title V staff participated in CARA and neonatal abstinence syndrome focused efforts and serve as a core team member on the ASTHO OMNI Nevada Team and on numerous subcommittees focused on reduction of substance use in pregnancy and building systems of referral for families with substance exposed infants. LARC and Community Reproductive Engagement Committee MCH staff involvement also dovetailed with substance use prevention efforts, as did engagement on possible Title V Families First efforts.
Marijuana Efforts Annual Report
The Nevada Title V MCH Program has continued to disseminate Spanish and English marijuana awareness materials to partners statewide. These materials were developed in the last funding year in response to Nevada’s legalization of medical and recreational marijuana, and informational resources on pregnancy, breastfeeding and marijuana were developed by the Title V MCH program. The Title V MCH Program developed public service announcements (PSAs) promoting awareness, in addition to posters displayed in all dispensaries related to use in pregnancy and injury prevention and marijuana for children. Efforts to reduce substance misuse in pregnancy and improve inter-conception care are funded by the Title V MCH program and include promoting the SoberMomsHealthyBabies.org website and associated media campaigns and focusing perinatal activities on reduction of neonatal abstinence syndrome (NAS). Title V MCH funded partners promote SoberMomsHealthyBabies.org through social media and print materials developed by Title V MCH, in addition to the Substance Use During Pregnancy Toolkit, marijuana use and pregnancy information and posters, and marijuana and childhood injury prevention warnings.
Title V MCH worked closely with the Department of Taxation, the entity responsible for overseeing recreational marijuana and licensing for dispensaries in Nevada. Title V MCH shares all marijuana resources and provides feedback on materials from the Department of Taxation. Title V MCH marijuana awareness posters and SoberMomsHealthyBabies.org referral cards and removable wall stickers are provided to all dispensaries; informational sheets are distributed widely through FIMR and local health authorities.
Nevada Health Conference Report
The 2018 theme of the Nevada Health Conference, October 15-16, 2018, “Paving the Path for a Healthy Nevada” highlighted the importance of collaboration with other healthcare disciplines, addressed the health disparities, barriers, and challenges across the lifespan through an array of healthcare-related fields. Title V MCH provided significant funding to the conference, sponsoring scholarships and travel, sponsoring materials, and serving on the conference planning committee. DPBH staff, including MCH staff, presented at the conference and the CYSHCN Director and MIP Coordinator organized the substance exposure in pregnancy session, facilitated the session, and identified presenters. On October 15, a keynote speaker, Dr. Nathan Boonstra, and concurrent workshops featuring local and national field experts presenting on a variety of Immunization; Maternal, Child, and Adolescent Health; and Chronic Disease Prevention and Health Promotion topics related to the conference theme. A Roundtable allowing attendees to interact with one another on health-related topics included a presentation from Julia Peek, MHA, CPM, Deputy Administrator, DPBH, focused on updates and priorities, ACEs data, and Nevada’s preventive health foci. On October 16, the conference offered four intensive general session tracks focusing on niche areas of interest including: Immunization Clinic Best Practices; Maternal, Child, and Adolescent Health; and Chronic Disease Prevention and Health Promotion; and Increasing HPV Vaccination in Nevada. Conference exhibits were available.
Testimonials from some of the 235 attendees included:
“This conference provided a lot of helpful information for my line of work. I really appreciated the Substance Exposed Infants session”
“Information on resources that are already out there for us to use as public health workers. Often things are developed but it is difficult to know what is out there and how to find it, so I found that very useful.”
Continuing education credits were issued through the University of Nevada, Reno, for multiple healthcare related fields including:
- Certified Health Education Specialists (CHES)
- Certified Public Health
- Nursing
- Pharmacists
- Physicians (plus 1 hour of ethics/addiction care)
- Social Work
Each year the Nevada Health Conference awards scholarships to individuals who wish to attend the conference but may not otherwise be able to attend due to cost. MCH funds scholarships via Immunize Nevada, in addition to the Nevada Public Health Training Center, and the Nevada DPBH.
- Total number of Applicants Awarded: 44
- Total number of Recipients (people who accepted and/or didn’t cancel): 40 (local scholarships: 25; traveling scholarships 15)
- No-show(s): 1
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