Rhode Island - 2020 - III.E.2.c. State Action Plan - Cross-Cutting/Systems Building

RI understands that reducing poor outcomes and promoting health promotion is not limited to focusing on one segment of the MCH population. Good public health practice in the MCH population requires cross-cutting strategies that encourage systems-building. RI developed the following cross-cutting priorities: improve system coordination in communities and statewide to facilitate improved health outcomes; improve behavioral/mental health across the life course; and adopt social determinants of health in public health planning and practice to improve health equity.

Behavioral Mental Health

In Rhode Island, 2017 PRAMS data show that 18.1% of mothers with infants reported that they were diagnosed with depression during and/or after pregnancy. The NSCH 2016/17 reports that only 59.0% of children ages 3 through 17 diagnosed with a mental/behavioral health condition received treatment or counseling. Suicide ideation is also an important issue that the MCH Program monitors for teen behavioral health. YRBS 2017 data report that trends for high school teens who seriously considered committing suicide increased from 12.1% in 2007 to 15.9% in 2017. YRBS 2013-2017 data show that bisexual teens were more likely to experience depression, frequent mental stress, and inadequate support. YRBS data in 2017 also shows that gender-expansive youth are 3 times more likely to miss school because they felt unsafe, 2.5 time more likely to attempt suicide, and 2 times more likely to be bullied compared to cisgender youth. Behavioral/mental health issues are also evident among the CSHCN population. NSCH 2016/17 data show that 84.0% of CSHCN were bullied, picked on, or excluded by other children compared to 58.7% of non-CSHCN. In addition, NSCH 2016/17 also reports that 60.2% of CSHCN do not live in supportive neighborhoods compared to 45.9% of non-CSHCN.

Adequate Insurance

Insurance coverage is critical or determining child health outcomes. Adequacy of insurance is defined by NSCH as “ 1) having continuous insurance in the past 12 months, and/or 2) having current insurance which is adequate for the child’s healthcare needs”. NSCH 2016/17 data show that 74.8% of RI children have adequate insurance, significantly higher compared to 68.4% nationwide. RI children with the lowest adequate insurance prevalence are found among the 100-199% Federal Poverty Level group.

Social Determinants of Health

Through collaboration among participating state agencies, RI has adopted 15 Health Equity Indicators as statewide measures to address health equity in the state. These indicators span across five domains (integrated healthcare, community, physical environment, socio-economics, and community trauma), which are further broken down in measuring key determinants of health that can be reported by city/town and race/ethnicity and monitored annually using various state agency, census, and survey data. The MCH Program is interested in incorporating these measures to address social determinants of health that are related to the MCH populations.

Focusing healthcare access as a determinant of health, BRFSS 2016 data show that 24.1% of Hispanics report not seeking medical care due to costs compared to 7.2% of Non-Hispanic Whites. The community resilience indicator measures Health in All Policy by calculating the percentage of low- and moderate-income housing. This indicator shows that cities such as Woonsocket (15.9%), Providence (14.9%), and Central Falls (11.2%) in 2016 had a higher percentage of low- and moderate-income housing than the statewide estimate (8.2%). Housing burden, a socioeconomic indicator, is calculated by identifying the percentage of cost-burdened renters and owners for RI cities and towns. This composite metric from 2016 HousingWorks RI data show that the communities with the highest total burden are Narragansett (58.6%), Central Falls (57.3%), and Providence (46.3%). The social determinant of health measuring education from 2016 Rhode Island Department of Education data shows that 75.5% of RI Hispanic students have graduated in 4 years compared to 86.4% of non-Hispanic White students. This disparity is more evident in some RI cities such as North Kingstown, where only 60.0% of Hispanic students graduate in 4 years compared to 88.4% of non-Hispanic White students. Incarceration is defined as the number of non-violent offenders under RI probation and parole per 1,000 residents ages 18 and over. This indicator reports that in 2017, the incarcerations rates were highest among Central Falls (12.5 per 1,000), Providence (11.6 per 1,000), and Woonsocket (10.9 per 1,000) compare to the lowest incarceration rates of Barrington (1.2 per 1,000) Jamestown (2.3 per 1,000).

Continue implement and support of Health Equity Zone (HEZ) Initiative.

The MCH Program is committed to addressing health disparities and improving population health in underserved communities. One promising initiative is the Rhode Island’s Health Equity Zones. With a mission to “encourage and equip neighbors and community partners to collaborate to create healthy places for people to live, learn, work, and play” the Health Equity Zones have directed more than $10.4 million in public health funding towards community-led projects, increasing the impact and productivity of efforts to build healthier and more resilient communities. The MCH Program has invested in maternal and child health initiatives in 9 Health Healthy Zones throughout the state over the past four years.

HEZs are contiguous geographic areas, that are small enough to have a significant impact on improving health outcomes, reducing health disparities and improving the social and environmental conditions of the neighborhood, yet large enough to impact a significant number of people. HEZs can be defined by political boundaries (e.g., cities, wards) or by less defined boundaries (e.g., neighborhoods). The geographically-defined HEZ community must have a target a population of at least 5,000 people, demonstrate economic disadvantage, and demonstrate poor health outcomes. The HEZ are administered by a “Backbone Agency” which may be a municipality or a public not-for-profit community-based organization. Backbone Agencies must be supported by a HEZ Collaborative to achieve project goals. Existing Health Equity Zone Collaboratives include residents, diverse community-based organizations, youth-serving organizations, educators, business leaders, health professionals, transportation experts, and people in many other fields who are coming together to address the most pressing health concerns in their neighborhoods.

In June 2019, RIDOH announced that it is expanding support and funding to three new communities to establish Health Equity Zones. The communities were chosen through a competitive process that drew nearly 20 applicants from communities across the state. These new communities will share approximately $1.4 million in funding with seven existing Health Equity Zones receiving support to continue their work in local communities.

Develop certification process & core competencies for MCH workforce statewide through Community Health Worker workforce development initiatives.

RI has benefited from a Certification Program for Community Health Workers since 2016. To date, there are 284 Certified Community Health Workers in RI, each with demonstrated competency in the following domains:

Domains

Engagement Methods and Strategies
Individual and Community Assessment
Culturally and Linguistically Appropriate Responsiveness
Promote Health and Well-Being
Care Coordination and System Navigation
Public Health Concepts and Approaches
Advocacy and Community Capacity Building
Safety and Self-Care
Ethical Responsibilities and Professional Skills

Standards

1. Experience: Six months or 1000 hours of paid or volunteer work experience within five years

2. Supervision: 50 hours specific to the domains

3. Education: 70 hours relevant to the domains

4. Portfolio: Demonstrated competency through approved portfolio. The portfolio is a collection of personal and professional activities and achievements. This part of the requirement for the Community Health Worker is highly personalized and no two applicants will submit the same documentation. Components of the portfolio include documentation and requirements of at least three of these categories: Community Experience & Involvement; Research Activities; College Level Courses / Advanced or Specialized Training; Community Publications; Presentations & Projects; Statement of Professional Experience; Achievements / Awards; Resume / Curriculum Vitae (CV); Performance Evaluation

Training and Development - RI MCH Program partners with the following training entities for CHW education and preparation:

Community Health Innovations of RI provides ongoing training and apprenticeship opportunities especially for CHWs based in the community through health Equity Zones;
Rhode Island College Healthy Jobs offers ongoing CHW courses at Central Falls Parent College, Rhode Island College campus in Providence throughout the academic term, and in a centralized Warwick location;
RIDOH Chronic Disease Programs offers core community health worker training and modules specific to patient navigators working in chronic disease.
Dorcas International Institute offers a training for CHW working with refugees through funding by RI Foundation;
Rhode Island Parent Information Network provides ongoing training opportunities for Resource Specialist including parents of children with special healthcare needs;
Clinica Esperanza sponsors ongoing Navagante trainings for Bilingual / Bicultural CHWs.

All of these training programs have aligned their curriculum with Rhode Island’s Certified Community Health Worker standards meeting the certification requirements.

RI MCH Program also partners with the Department of Labor & Training in supporting the Community Health Worker Association of Rhode Island (CHWARI) at the Rhode Island College. CHWARI is an organization to provide CHWs resources around trainings and other professional development opportunities. The Community Health Worker Association of Rhode Island (CHWARI) actively supports frontline healthcare workers who work in underserved communities to improve high quality healthcare access for people in need. CHWARI envisions a state in which all Rhode Island communities receive high quality, equitable health and social services in order for all individuals to realize their optimal state of health and well-being. The mission of CHWARI is to Increase the power of Rhode Island’s Community Health Workers to promote health equity through increasing access to quality healthcare and social services and conducting advocacy.

Facilitate Interdepartmental, interagency, and statewide discussion to improve the health care delivery system.

EOHHS - RI MCH Leadership plans for and conducts a monthly stakeholder engagement meeting with the Executive Office of Health and Human Services (EOHHS) called the EOHHS Partnership meeting. This meeting draws between 50-75 advocates, consumers, providers, and state agency representatives to review Medicaid policy and program, grant opportunities, Medicaid re-design initiatives, barriers to coordinated care, Medicaid budget and spending, and Medicaid legislative proposals. Many of these topics affect MCH populations, especially children and youth with special needs.

Children’s Cabinet - The RI Children’s Cabinet provides overarching leadership and a comprehensive, strategic approach necessary to improve the well-being of RI’s children and youth. Its members engage in shared planning and decision making, interagency agreements to implement policy or programs and appropriate data-sharing to improve services and outcomes for children and youth. The Cabinet is comprised of the Secretary of the Executive Office of Health and Human Services, the Commissioner of Elementary & Secondary Education, the Director of the Dept. of Health, the Child Advocate, the Director of the Dept. of Human Services, the Director of the Dept. of Administration, Director of the Dept. of Labor and Training, the Director of the Dept. of Children, Youth & Families, the Director of Dept. of Behavioral Healthcare, Developmental Disabilities & Hospitals, and the Commissioner of Post-Secondary Education.

The overall goals of the Cabinet are to:

Improve the health, education, and well-being of all children and youth in RI.
Increase the efficacy, efficiency, and coordination of service delivery.
Improve data-driven, evidence-based decision-making through strengthened data sharing capacities among agencies and research partners, while adequately protecting the privacy rights of children.

Patient Centered Medical Home-Kids (PCMH-Kids) - PCMH-Kids is an initiative of the Care Transformation Collaborative of Rhode Island (CTC-RI) which is a statewide multi-payer patient centered medical home initiative. CTC-RI is co-convened by the Executive Office of Health and Human Services and the Office of Health Insurance Commissioner. RIDOH MCH leadership participates PCMH-Kids leadership planning activities, committee meetings, and work groups. PCMH-Kids was founded in 2015 as a pediatric primary care patient-centered medical home initiative that is driven by data, quality care and collaboration. Practices receive financial support and technical assistance to achieve NCQA recognition as a patient-centered medical home, meet state established clinical quality measures, and participate in quality improvement activities on important child and youth health topics. Cohorts of practices enroll for three years. In January 2019, the third cohort of pediatric practices signed on. Currently there are 37 pediatric and family medicine practices participating in the PCMH-Kids initiative, including 260 primary care providers and trainees, covering over 110,000 lives, and representing more than 80% of the state’s pediatric Medicaid population. PCMH-Kids successes include:

Improved developmental screening of all children age 9-30 months from a baseline of 41% screened to 85.9% screened which is fundamental to the Governor’s Children’s Cabinet third grade reading readiness initiative
Improved obesity screening and counseling from a baseline of 55% to 85.8%
Developed and implemented a pediatric specific high-risk framework to identify children and families that would benefit from care coordination services
Reduced Emergency Department usage by 2.5% compared with non-PCMH practices

Practices have also embraced a pediatric vision of care coordination and integrated behavioral health, using a model that includes practice-based social workers as care coordinators. Accomplishments in integrating behavioral health services into primary care include:

ADHD screening, diagnosis and treatment plans
Maternal post-partum depression screening: baseline of 22% to 87% with implementation of referral protocols for intervention
Screening, Brief Intervention, Referral, and Treatment (SBIRT) in the adolescents with 75 providers with a total pediatric population of ~34,000

RIDOH MCH programs work closely with PCMH-Kids to support medical home efforts. KIDSNET, the state’s integrated child health information system, works with providers to create reports that practices can use for patients care. Practices can utilize this centralized database to identify children in need of newborn hearing screening, immunizations, lead screening, developmental screening, Kindergarten readiness screening as well as participation in other early childhood programs such as WIC, Family Home Visiting Programs, and Early Intervention. KIDSNET is currently working with PCMH-Kids to develop a new practice report to identify newborns and young children with medical and family risk factors that would benefit from care coordination and referrals for supports. In March 2019, the RIDOH Family Home Visiting program and PCMH-Kids collaborated in applying for a Healthy Tomorrows Partnership for Children grant to improve communication between primary care and home visiting programs and implement a process for integrated care coordination. Funds will be awarded in March 2020 for this five-year project.

Aligning MCH research to impact system development - To support Rhode Island in achieving its goal that 75% of 3rd graders will read at grade level by 2025, the Rhode Island Department of Health (RIDOH), in collaboration with the Executive Office of Health and Human Services (EOHHS), leveraged the RIDOH Academic Center, a partnership between the Department and the academic colleges/universities throughout Rhode Island. To foster research driven approach to improving early childhood health to support the third grade reading goal, Rhode Island can capitalize on its small geography, high-level interagency coordination efforts (e.g., Children’s Cabinet), and research strengths (e.g., Brown University and University of Rhode Island) to understand and address the causes of poor outcomes, and improve the health and education outcomes for children. RIDOH supports the following areas of work:

Investing in Knowledge – Hassenfeld Birth Cohort Study funded by Hassenfeld Foundation

This project will serve as a pilot for collecting, analyzing, and evaluating data associated with this prenatal, maternal and child health population. Doing so will provide the state with lessons learned for any other related projects or potential scale-ups of existing projects.

Investing in Practice – Working Across Sectors to Accelerate the Delivery of Evidence-Based Programs

To accelerate near-term implementation of action steps, RIDOH proposes to dedicate efforts and energy to address already known recommendations within and between existing child- and family-serving programs. This will involve an array of service provision efforts – both “scaling up” current evidence-based efforts and introducing new approaches for families between birth and 3rd grade. For example, implement the action steps for school readiness in FY20: increase referrals to Child Outreach Screens for at-risk children, including DCYF-connected children and other children receiving home-visiting services.

RI State Innovation Model Grant - RI was fortunate to receive a five-year grant from CMS from 2014 until 2019. The RIDOH MCH Program Medical Director participated on the RI SIM interagency team that identified state priorities to promote health care system improvement. RI SIM is a public/private partnership whose steering committee includes state agency leaders as well as health care sector professionals, community organization leaders, and patient advocates. The steering committee identified strategies, programs, and activities to be funded and provides high level oversite of implementation. The SIM Grant activities focused on MCH populations were aligned with the state’s Title V block grant priorities. Key MCH activities supported through RI SIM efforts include:

Funding for the PCMH-Kids statewide medical home initiative explained above.
Funding for the establishment of a pediatric psychiatric teleconsultation program called Pedi-PRN (Psychiatry Resource Network) and staff support for the application for HRSA funding to expand the Pedi-PRN program.
Completion of a data project bringing together multiple stakeholders and utilizing several data sources to better define child and adolescent obesity rates in RI.
Interagency braided funding model to create enhanced community health teams specializing in support for pregnant and postpartum women, and children and youth, and families affected by substance use disorder. These new community health teams will be an extension of the prenatal care or primary care medical home and will begin serving clients in the summer and fall of 2019.
Funding for work by the state’s Office of the Health Insurance Commissioner to analyze barriers to implementing integrated behavioral health in primary care.
Established a forum for annual meetings on the states clinical quality “Aligned Measure Set” where stakeholders provide input on clinical quality measures that are mandated through insurer contracts with health care providers, hospitals, and Accountable Care Organizations.

Engage community members, CHWs, and consumers in all areas of program, policy, and systems change.

Commission for Health Advocacy and Equity – RIDOH, Health Equity Institute convenes the Commission for Health Advocacy and Equity (CHAE). The CHAE is a legislatively mandated commission created to address the social determinates of health and eliminate health disparities. There are currently 20 members from the community who represent the diversity of RI as individuals of or representing racial / ethnic minorities (Latino, Native American, and Black), persons with disabilities, LGBTTQQ, and people with limited English proficiency. The members also represent a variety of disciplines including consumers / residents, academia, housing, substance use, advocacy, medicine, public health, business, child welfare, local government, community development, planning, commerce, transportation, and social services. CHAE often invites and welcomes representatives from RI's state agency.

The Commission is required to complete a Disparities Impact and Evaluation legislative report every two years. The first report was published in January 2015 and it identified disparities in 5 areas (nutrition and physical activity, asthma, infant mortality, chronic illnesses and oral health) that needed to be addressed. In addition to the five focus areas, the report identified global recommendations for addressing health disparities in RI. The second report released in December 2017, established definitions of equity terminology including health, health equity, determinants of health, and health disparities; and identified 2 priority areas that the Commission's work will focus on for the next two years. These priority areas are (1) increase minimum wage to $15 per hour, and (2) increase high school graduation rates. The Commission actively engages with community organizations, members of the public, and legislators to impact these two priority areas. The plan for the upcoming report due December 2019 is to roll out RI’s Statewide Health Equity Indicators and report on the disparities identified in RI’s 23 Population Health Goals.

To date, CHAE has issued three letters of support for legislation, co-sponsored legislation on minimum wage, joined state-level policy workgroups, conducted a press briefing on Health In All Policies, hosted a health equity/minority health celebration event, sponsored a "Hill Day" for Health Equity Zone collaborative members to engage with legislators, issued their Disparity Report, aligned priorities with RI's SIM initiative, joined the RI PolicyLink Delegation, trained 2 commission members on conducting Health Impact Assessments, and co-sponsored the RI Health Equity Summit. Plans for 2019-2020, include increased collaboration with RIDOH health equity initiatives including minority youth mentoring programs addressing high school graduation, the community health worker association, and actively raising the awareness and resources required to achieve equity in RI.

Health Equity Institute – Special Needs - A main tenant of the MCH Program is supporting, empowering, training, hiring, and promoting parents and family partners at all levels of decision making, policy development, service provision, and community development. RIDOH partners with the RI Parent Information Network, Parent Support Network, Sherlock Center on Disabilities (RI's UCEDD), the Autism Project of RI, and other disease specific family organizations. Parent leaders are cultivated and supported to lead policy initiatives, make systems improvements and champion principles of parent-professional partnerships. Parent support groups are organized throughout the state. RIDOH has contracted with RIPIN (Family Voices) to maintain a calendar of support groups based on topic, age, and language. Through the Family Voices Leadership Team, RIDOH has addressed systems barriers and developed a parent policy team to provide peer-to-peer support in addressing statewide policy, especially health reform. Throughout RI over 1850 parents have been trained in navigating the special needs service delivery system such as basic rights, college success for students with disabilities, options for medical assistance, and transition planning.

Peer Resource Specialists – Peer Resource Specialists are culturally diverse family members with experience accessing MCH services and are assigned to various RIDOH programs based on the program's need for parent and consumer participation. Peer resource specialists are full partners in policymaking, outreach, and program quality assurance and evaluation. Currently, resource specialists are assigned to WIC, Immunization, Birth Defects, Diabetes Prevention, Wise Woman, Integrated Chronic Disease, Health Communications, Family Visiting, EDHI, Emergency Preparedness, and the Health Equity Institute.

Youth Resource Specialists - Since 2014, the Health Equity Institute has invested in hiring and supporting Youth Resource Specialists. Their input into the transition process and generation of self-determination resources has been invaluable. Youth Resource Specialists are engaged in planning and leading the Dare to Dream Student Leadership event, represent RI at national youth forums, and promote inclusion in RI’s youth serving organizations. In 2018-2019, youth resource specialists led a monthly Youth Advisory Council where an average of 30 students with disabilities served as advisors to RIDOH programs and policies; presented at the national AMCHP Conference; organized the Dare to Dream conference attended by 480 students; and presented at the Turn Up Rhode Island Conference featuring career exploration for 300 students of color.

Health Equity Zones (HEZ) – Each of the 10 funded Health Equity Zones has a lead organization (local government or local non-profit entity), that acts as a backbone on behalf of the coalition of key community stakeholders and residents in the proposed geographic area. One of the key requirements of HEZ funding is heavy stakeholder and resident engagement. This ensures that individuals who are experiencing poor health outcomes and health disparities are represented and are included in the decision-making process.

RI Asthma Control Program - The RI Asthma Control Program (RIACP) is working closely with families and seeking to develop family leadership in multiple areas including but limited to: improving indoor air quality at home and in schools; asthma and chronic disease self-management skills; healthy housing policies; and training and support for development of advocacy skills. The RI Asthma Control Coalition, in partnership with RI Parent Information Network, helped RIACP initiate “Asthma Advocates in Action,” to help people with asthma and their caregivers build advocacy and leadership skills.

Increase the number of programs implemented in Rhode Island that support healthy social/emotional development and address behavioral health issues.

RI has as a goal, to move toward implementing evidence-based programs to address issues that result in poor outcomes for families. Over the several years, RIDOH has continued to fund expanded behavioral health interventions across the life course.

Maternal Psychiatry Resource Network (MomsPRN) - The MomsPRN Program is a new statewide initiative at the RI Department of Health, funded by HRSA-18-101 Screening and Treatment for Maternal Depression and Related Behavioral Disorders Program, that seeks to assist obstetrical, adult primary care, pediatric, and adult psychiatric providers in optimizing behavioral health care for pregnant and post-partum women. To achieve this end, a psychiatry consult line that is staffed by perinatal experts at the Center for Women’s Behavioral Health at Women and Infants Hospital is available to help answer clinical and referral questions among calling providers caring for pregnant and postpartum women. Additional individualized quality improvement coaching will be provided to prenatal care practices seeking to implement maternal behavioral health screening, referral and treatment into their workflow. Ongoing continuing education and evaluation efforts will be used to enhance care, identify improvements, share best practices, and measure outcomes.

Pediatric psychiatry Resource Network (PediPRN) - Rhode Island’s children and adolescents face significant challenges in accessing timely and affordable mental health care. In response to this need, the RIDOH is working in conjunction with the Emma Pendleton Bradley Hospital to expand its existing child psychiatry access program, the Pediatric Psychiatry Resource Network (PediPRN). The project’s mission is to improve access to behavioral health care for Rhode Island children and adolescents by integrating psychiatry into the state’s pediatric primary care practices. To achieve its mission, PediPRN uses a telephonic integrated care model to improve access to quality behavioral health expertise. This service is free and provides all Rhode Island pediatric primary care providers assistance with the mild to moderate mental health care needs of their patients. Activities include prompt telephonic consultations, including recommendations for medical prescribing; face to face psychiatric evaluations, as needed, with return to the treating primary care practitioner for medication management; phone availability for ongoing collaboration; referral to other mental health services and programs, and short-term therapy to bridge children awaiting the appropriate behavioral health services. In addition, PediPRN offers educational activities focusing on creating a culture of empowerment for pediatric primary care providers. Through CME opportunities, educational e-blasts and the PediPRN Intensive Program (PIP), the project offers training and educational support.

Emotional Regulation Intervention Project –The Rhode Island Department of Health Violence and Injury Prevention Program in conjunction with the Rhode Island Student Assistance Program (SAP) aim to provide a wide range of prevention and early intervention services to high risk adolescents. The intervention will be implemented by master's-level counselors who will provide a Prevention Education Series (PES); individual and group counseling for students enrolled in; and referral to community-based social service and mental health agencies. The intervention was piloted during the ’17-’18 school year in which SAP counselors were trained in Project TRAC, a developmentally tailored emotion regulation training program designed for middle school students. The focus of the program is to help students 1) become aware of the connection between emotions and behaviors (especially risk behaviors), 2) improve recognition of when one is having a strong emotion, and 3) learn strategies for managing emotions in moments when they are making decisions.

The 2018 Title V MCH Venture Capital Funding allowed the Violence and Injury Prevention Program (VIPP) to scale up the implementation of the Emotional Regulation Intervention Project from two to five schools. During the 18-19 school year the SAP hosted a two-day emotional regulation intervention training for five counselors returning and new who showed interest in the Emotional Regulation Intervention Project. The Emotional Regulation Intervention Project implemented five 12 session workshops in five different school districts in Rhode Island. The number of students who participated varied between three and eight students per group. The Emotional Regulation Intervention Project served 31 students but the pre and post surveys were only completed by students who received parental approval before the start of the workshop. The evaluator will analyze the pre-post survey data and develop a report by September 2019. In efforts to sustain the intervention the VIPP will work with the Emotional regulation consultant to adapt the 12-session workshop into strategies that can be implemented by teachers in the classroom. In addition, the VIPP was able to obtain additional funding through the Rape Prevention Education grant to implement seven workshops in the 19-20 school year.

Mental Health Consultation within early care and education: Three communities were supported to implement this strategy in one early care and education setting per community. Expected outcomes include, higher classroom functioning, better capacity of teachers to support children, early identification and referral for mental/behavioral health issues, reduced child behavioral problems and reduced rates of expulsion of children for behavioral problems.

Mental Health Consultation primary care settings: Three communities were supported to implement this strategy in 5 primary care practices. Expected outcome include increasing the capacity of primary care providers to address behavioral health issues, early identification and referral for mental/behavioral health issues, increase enrollment of children in services that support positive behavioral health.

Parent education and support for children and their families: Three communities were supported to implement Incredible Years groups for families in the communities. Anticipated outcomes include, improved parenting, increased social emotional competence, and decreased behavior problems. In the longer term, RI expects to see improved school readiness, improved social-emotional functioning, and healthier families.

Offer training to support providers who may be caring for families who may be experiencing toxic stress.

RI continued to make progress toward developing systems and strategies of recognition and response for families with young children who are experiencing, or at risk of experiencing, toxic stress and/or trauma. Over the past year RI focused on continuing to support First Connections home visiting to implement the Experience Screen to identify Toxic Stress as well as to offering training to providers who are caring for children and families who experience toxic Stress and/or trauma. RI is currently conducting research with the Experience Screen to ascertain if risk for Toxic Stress can be determined at birth.

The Family Visiting Program will continue to use the experience screen in First Connections home visiting programs. RI will also continue to focus efforts around ensuring that the highest risk children and their families are linked to comprehensives services. RI will also pursue targeted funding streams to increase the capacity to mitigate toxic stress. Ri will also continue to offer training to groups of multi-disciplinary providers on caring for children and families who experience toxic stress and/or trauma. Three trainings are planned for the coming year. RI will also continue to try to encourage primary care providers to screen for toxic stress. Finally, RI will begin to re-design its First connections screening and response home visiting program so that different levels of intensive outreach and services can be embedded with the goal of reaching families with greater challenges and engaging them in services.

Develop and implement a model of mental health consultation to the Family Home Visiting Program.

The Family Visiting Program will continue to support its’ 12 family visiting agencies with access to mental health consultation and similar supportive resources. With support from national experts, TA and local mental health consultants, RI has developed a tiered framework to support mental health consultation within family visiting so that family visitors, supervisors and program managers have levels of support while working with complicated families. One level is mental health consultation to family visitors. The Family Visiting Program provided each family visiting agency with dedicated funding in the agency’s contract last year that may be used for mental health consultation and supportive services. The Family Visiting Program will continue to do so in future contracts.

In addition to providing funding to each family visiting agency, the Family Visiting Program has partnered with the RI Association for Infant Mental Health (RIAIMH) to provide additional support to the family visiting workforce. The Family Visiting Program will continue to work with RIAIMH on training and support related to infant mental health. The Family Visiting Program is also supporting family visiting staff by supporting the process of Endorsement for Culturally Sensitive, Relationship-Focused Practice Promoting Infant Mental Health® (RI-IMH-Endorsement®). This endorsement process ensures that family visiting staff have the competencies and skills to support the parent-child relationship and promote positive parenting practices that address the needs of infants.

Implement suicide prevention programs

The Rhode Island Youth Suicide Prevention Project (RIYSPP) - works with a broad range of partners to implement a combination of strategies aligned with the 2012 National Strategy for Suicide Prevention that are focused on lowering youth (10-24) suicide death and attempt rates. The three primary interventions associated with this project are: 1. Training youth and adults across the State in evidence-based gatekeeper training programs, 2. Training counselors/school crisis team members from schools across the state in a novel streamlined crisis evaluation assessment tool/protocol and connecting them to clinicians (via the Kids’ Link line at Bradley Hospital) who can help them triage and connect students in crisis with a local mental health provider, and 3. Implementing RI’s first systemic linkage of non-health organizations with mental health using various strategies in order to coordinate and share resources for the assessment, referral, treatment, and provision of follow-up care with wrap around services for at-risk youth, including sharing de-identified data. Also, the project maintains a statewide Youth Suicide Prevention Coalition with representation from all priority populations and funded/non-funded partners and works to promote suicide prevention principles to all Rhode Island residents. VIPP has implemented the SPI Youth Suicide Prevention work to some degree in every town in Washington County. The VIPP has also implemented the Emotional Regulation program in on SCHEZ middle school (Westerly). The VIPP has also participated in the HRSA funded Collaborative Office Rounds grant the HEZ has received and is targeted to local pediatricians. The Program also held a training with local pediatricians and the Bradley Hospital Pedi PRN. PediPRN is a State Innovation Model grant funded initiative providing tele-psychiatry access to pediatricians for medication management and other consultative services. The VIPP also participates with the Bristol Health Equity Zone through their suicide prevention subcommittee.

Statewide Plan for Improving Behavioral Health - The Governor signed an executive order (Executive Order 18-03) which charges state agencies with “develop[ing] an action plan to guide improvements to RI’s adult and pediatric behavioral healthcare systems” and reporting back to the Governor by November 30, 2018. To do this work, the Governor’s Office has asked to convene a small group of liaisons from RI State agencies to develop this action plan, in collaboration with their agencies, agency directors, and the Governor’s Office.

PCHM-Kids SBIRT Learning Collaborative- The MCH Medical Director was involved with this initiative that was designed to train groups of pediatric primary care providers and trainees in SBIRT and integrate substance use and abuse screening and brief intervention into practices through a pediatric learning collaborative. Combining efforts and resources with RI PCMH-kids, the RI State Innovation Model primary care initiative, eleven pediatric practices representing a heterogeneous mix of patients throughout the state joined the learning collaborative. The practices worked regularly with experts in adolescent substance use who coached pediatricians and helped them develop referral networks. Practice workflow was also addressed. Specific educational sessions both didactic and simulation were held to cover specific topics including; confidentiality issues when caring for adolescents with substance abuse, opioid use in adolescents, and intervention techniques when managing concerning adolescent substance use A substance abuse referral resource guide for pediatric practice is being developed by medical students as part of a collaborative initiative with the intent to distribute the resource to all pediatric providers in the region. All of the 11 practices involved in the initiative enhanced their knowledge about the role and impact of recreational substance use in the lives of their adolescent patients and about adolescent decision making related to substance use. All of the participating pediatric providers found the initiative beneficial and successfully integrated substance use screening into their practices. They reported and demonstrated increased knowledge of motivational techniques to discuss substance use with adolescents and were more comfortable assessing and managing adolescents with substance use and abuse. They all exceeded their initial screening goals and established ongoing quality metrics that will be sustained in practices. They expressed needs for ongoing assistance with sustainment as they navigate increasing screening in practices and also start to address how to provide early intervention to patients with risks for substance use disorder and in particular opioid abuse and chronic cannabis use. They identified gaps in services and designed specifically for youth and expressed need for local resources for referral. The practices will continue to make progress and grow during the 2019 sustainment period when they will receive additional coaching to help them further integrate SBIRT into their practices.

Healthy Transitions Grant – RIDOH assisted the Department of Behavioral Health, Developmental Disabilities, and Hospitals (BHDDH), with the implementation of the Healthy Transitions (HT) Grant, a grant program funded by the Substance Abuse and Mental Health Services Administration (SAMHSA). The goal being to improve life trajectories for youth and young adults with, or at risk for, serious mental health conditions. Through this work, a Youth MOVE chapter (a behavioral health youth leadership group) was established within the Parent Support Network of RI. The RIDOH Youth Advisory Council collaborated with BHDDH to represent the voice of youth with complex medical and/or behavioral health conditions. In 2018, the RIDOH advised BHDDH on the development a transition resource for youth involved with the child welfare system entitled “Take Charge of Your Behavioral Health: A Guide for Young Adults in Rhode Island’s Behavioral Health System”.

Governor’s Commission on Behavioral Health - The RIDOH Adolescent Transition Program provided on-going technical assistance to the BHDDH and the Healthy Transitions Statewide Advisory Council (SAC) in the implementation of the “Now is the Time” Healthy Transitions: Improving Life Trajectories for Youth and Young Adults with, or at Risk for, Serious Mental Health Conditions, a Substance Abuse and Mental Health Services Administration (SAMHSA) grant to develop and sustain a system of services for youth and young adults ages 16-25 who have serious mental health conditions and co-occurring disorders. The RIDOH Transition Program provided best practice and guidance regarding the process and scope of transition and transfer of youth and young adults to augment the knowledge of BHDDH staff and sub-contracted organizations.

Drug Overdose Prevention Program - The mission of the Drug Overdose Prevention Program is to decrease drug overuse, misuse and abuse and to decrease nonfatal and fatal drug overdoses in RI. The PDO PfS Program educates prescribers and pharmacists on the responsible prescribing of opioids, connects people struggling with substance use disorder (SUD) to community health navigator services, evaluates public health polices relevant to drug overdose prevention, improves access to drug overdose data, and engages diverse stakeholders to facilitate multi-agency collaboration and partnerships. The Program works very closely with and supports the Governor’s Task Force on Overdose Prevention and is responsible for overseeing the Prescription Drug Monitoring Program (PDMP).

Overdose Prevention Task Force - The Governor’s Task Force on Overdose Prevention and Intervention was created by executive order in August 2015. It is co-chaired by the Director of the Rhode Island Department of Health (RIDOH) and the Director of BHDDH (the state substance abuse agency). The task force meets on a monthly basis and includes state police, local police, healthcare providers, Emergency Medical Services (EMS), the Department of Corrections, the PDMP, recovery and treatment community centers, CBOs, and individuals in active recovery. In November 2015, the Task Force published a Strategic Plan and in May 2016, the Task Force released an Action Plan that outlines how the Strategic Plan will be implemented. The Strategic Plan includes four strategic initiatives: (1) expanding access to medication assisted treatment (MAT), (2) saturating high risk populations with naloxone, (3) preventing high risk prescribing of opioids, and (4) increasing access to peer-based recovery services. Each strategy has a statewide working group committed to development, implementation, and evaluation of the respective strategy. The plan is a rapid response to the overdose epidemic in RI and commits to reducing the number of overdose death by one-third within three years. This is a multi‐agency, volunteer-based approach that leverages existing resources and partnerships to stop the overdose epidemic in RI.

Peer Recovery Specialists - RIDOH partners with the Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals (the state substance abuse services authority) to fund Peer Recovery Coaches in three settings; Emergency Rooms, the Department of Corrections, and through targeted street outreach. A certified peer recovery specialist helps individuals navigate treatment and recovery resources, provides education on overdose prevention, and the use of naloxone, and acts as a contact for additional recovery support. RIDOH has also hosted trainings for individuals to be trained as Perinatal Peer Recovery Specialists.

Continue to implement & support the Health Equity Zone (HEZ) Initiative

RI’s Health Equity Zone initiative is an innovative, place-based approach that brings communities together to build the infrastructure needed to achieve healthy, systemic changes at the local level. Health Equity Zones are geographic areas where existing opportunities emerge and investments are made to address differences in health outcomes. Through a collaborative, community-led process, each Health Equity Zone conducts a needs assessment and implements a data-driven plan of action to address the unique social, economic, and environmental factors that are preventing people from being as healthy as possible. Our approach recognizes that communities have different needs and assets to build upon. By aligning strategic investments with existing resources across sectors, each community can address their unique needs, reduce disparities, and stimulate economic growth. Listed below is a description of MCH activities that took place in each HEZ this past year. Additional projects have also been included in specific domains reports as well.

Bristol

In the Bristol Health Equity Zone, an Engagement Navigator at Mt. Hope High School offered one-on-one counseling to students with immediate need for a variety of support services, including housing resources, food access, and more. This position offers students and families immediate assistance and prescreening services, and referrals to a variety of wrap around programs. The long-term goal of this effort is to decrease the number of students and families accessing emergency rooms for mental health support services.

This year, the Bristol HEZ also continued the Parents As Teachers program, which offers free family visiting to any family with a child between prenatal and kindergarten entry. This program provides knowledge for parents regarding age-appropriate skills and activities to promote school readiness, and increases families’ connections to various education, employment, family, and physical and mental health resources in the community. This year, 54 families, including 68 children, received a total of 335 visits, and 9 group sessions were offered. Boys Town also offered one Common Sense Parenting program at a local elementary school to help parents communicate effectively with their children.

A group of residents and community stakeholders, including representatives from the School Department, the Bristol Police Department, Bayside YMCA, Roger Williams University, and the National Alliance on Mental Illness, and more, meet monthly toward a community-wide suicide prevention plan. This group initiated the Kindness Rocks campaign to spread kindness and compassion and increase the sense of community connectedness.

Finally, the Courageous Kids: Stand up to Stand Out program, a weeklong character-building summer program, was offered to help children learn to make healthy choices and strengthen their self-esteem, while also highlighting people in the community, like police, firefighters, and teachers, who can support the children. This program includes daily speakers, free dinners donated by local restaurants, free backpacks with school supplies to all children, and a community family movie night at the end of the week. Next year, the program will be expanded to be offered to up to 125 youth in Bristol.

Newport

The Newport Health Equity Zone currently hosts a breastfeeding support group for women of color to offer a safe space for women of color to gather for support, to share their challenges and victories, and to obtain education and resources related to breastfeeding. This year, a representative from the Newport HEZ attended the Black Mamas Matter Maternal Health Conference and Training Institute in Atlanta, Georgia. This conference assembled Black women, clinicians, professionals, advocates, and other stakeholders working to improve maternal health, and fostered learning and rich discussion, using the birth justice, reproductive justice, and human rights frameworks.

The Newport HEZ also hosted its second annual Community Baby Shower, in collaboration with Newport Hospital, Planned Parenthood, and community volunteers. This event offered free items and resources for expecting parents and families with children under five in the Newport community. Over 1,500 diapers were donated, along with clothing, furniture, and other essentials for babies and new parents.

A Community Health Worker Fellow in the Newport HEZ was certified through a Maternal Child Health Specialist training and certification program. This program is offered to health navigators, community health workers, outreach personnel, care coordinators, home visitors, doulas, childbirth educators, lactation educators, nurses, midwives, and physicians, and it provides ways to navigate through systems that provide perinatal health care for women at risk for poor obstetric outcomes.

The Newport HEZ also sent a Community Health Worker and a Community Health Worker Fellow to the Rhode Island Breastfeeding Coalition’s Pearls of Wisdom Breastfeeding Conference. This conference provided information and education on breastfeeding, best practices in other countries, and highlights of baby-friendly hospitals. Lastly, the Rhode Island Department of Health hosted a 5-day training to become a Certified Lactation Counselor. The Newport HEZ was able to certify a Community Health Worker through this training, who now works as a Certified Lactation Consultant with the HEZ’s breastfeeding group for women of color.

Pawtucket/Central Falls

In the Pawtucket Central Falls HEZ, the Blackstone Valley Community Action Program (BVCAP) worked to promote breastfeeding education and resources through their network. BVCAP’s breastfeeding counselor works closely with expectant and new mothers to provide lactation consultants, support groups, and educational resources on breastfeeding. The Community Health Worker at BVCAP connects new and expectant mothers to available resources and BVCAP’s breastfeeding counselor provided lactation consultations to 40 women, and resources and peer support to another 30 women.

The Childhood Lead Action Project (CLAP) continued to provide lead poisoning prevention and education to the Pawtucket and Central Falls communities. In the Pawtucket Central Falls HEZ, CLAP conducted community outreach at six locations, including housing authorities, health fairs, and a summer food program. CLAP also facilitated six lead poisoning prevention workshops and provided education to 115 families, landlords, and tenants throughout the HEZ. There have been 150+ Notice of Violations issued, and 170 homes have been made lead-safe due to the work of CLAP. These efforts have resulted in a 44% decrease in childhood lead poisoning in Pawtucket.

Washington County

Maternal and child health is a primary focus of South County Health Bodies Health Minds (HBHM), which serves as the backbone for the Washington County Health Equity Zone. HBHM implements 5-2-1-0 to prevent childhood obesity and promote healthy habits, by encouraging families to be more physically active and eat healthier, while engaging community partners to create healthier environments for children. The 5-2-1-0 program promotes eating 5 fruits and vegetables, engaging in no more than 2 hours of recreational screen time, getting 1 hour of exercise, and drinking 0 sugary drinks per day. This year, 13 new cites joined the county-wide efforts that engage schools, preschool/child care organizations, public libraries, parks and recreation departments, food pantries, community health centers, healthcare providers, local businesses, and two local hospitals. Almost 40 policy, systems, and environmental changes have been implemented, including elimination sugary foods and drinks from menu offerings, making water and fruit more available, and improving the appearance of healthier foods in cafeterias.

Through Project LAUNCH (Linking Actions for Unmet Needs in Children’s Health), the Washington County HEZ implemented 3 key prevention and promotion strategies : (1) conducting Incredible Beginnings training with 19 early care & education providers, including home visitors (2) partnering with schools and Head Start to conduct 4 Incredible Years Parenting groups (to promote family strengthening and positive parenting skills), and (3) integrating behavioral health services into primary care settings by providing mental health consultation in 4 small pediatric practices. This year, a total of 76 families were engaged in the Incredible Years Parenting program with almost half (n=34) participating in all 22 weeks.

West Warwick

This year, the West Warwick Health Equity Zone hosted a multitude of physical activity and nutrition classes (Zumba, Yoga, Fitness, EFNEP) for women, children and families at their HEZ Hub community space. Classes were free and inclusive of LGBTQ+ families, and sponsored 4 classes specifically for those who are transgender/gender non-conforming and their families or guests. The HUB increased their offerings from 9 classes up to 14 classes, and more than doubled participation. The University of Rhode Island’ Expanded Food and Nutrition Education Program (EFNEP) offered 2 summer classes with a piloted childcare component, which resulted in a 50-200% increase in sign-up and maintained attendance over each 9-week course. The West Warwick HEZ is also collaborating with the Town of West Warwick to install the youth portion of a multi-generational fitness space in River Point Park.

To address food insecurity for West Warwick families and Children, the West Warwick HEZ continues to promote Farm Fresh RI’s ‘double your SNAP value’ at farmer’s markets. The weekly Summer Farmers Market and three WIC focused pop-up farmer’s markets experienced a 38.7% increase in SNAP sales, and a 117% increase in customers. The West Warwick Library’s and Sodexo’s Summer Meals program for young people under 18 saw a 9% increase this year, after a 17% increase the previous year.

West Warwick Public Schools Implemented a 3-tier trauma-informed high school initiative and trained 80% of their high school staff on the first tier and a group of 15 for the second tier. The West Warwick HEZ provided a training for 15 foster and kinship caretakers called “How Trauma Shows Up for Kids” by Family Service of Rhode Island’s Trauma and Loss experts, and the event was livestreamed and is now available on the WWHEZ Facebook page. West Warwick has the highest rate of foster and kinship care in the state, which led a West Warwick resident and HEZ ambassador establish the Grands Flourish program to support the experience of grandparents raising grandchildren due to the opioid epidemic and other trauma. Grands Flourish piloted a peer-to-peer grandparent support and resource group at the West Warwick HEZ Hub, and West Bay CAP implemented a part-time case manager solely dedicated to supporting grandparents raising grandchildren in West Warwick.

Thundermist has continued to implement healthy vending machines and expanded worksite wellness activities, and has initiated Size-Inclusive Best Practices, to provide the highest quality of care for everybody, with a focus on non-biased, equitable treatment. This practice recognizes that weight stigma is a social determinant of health that impacts the health of patients, leads to avoidance of healthcare appointments and screenings, and is a driver to the development of eating disorders, depression, anxiety, body dissatisfaction, malnutrition, and other health conditions independent of a person’s size.

Woonsocket

In the Woonsocket HEZ, Thundermist expanded physical activities specifically for those who are transgender/gender non-conforming and their families and guests. The library held Zumba classes, and the YMCA facilitated healthy kids’ days and healthier communities’ initiatives, including access to healthy foods and physical activity. The Connecting Children and Families program continued to provide school-age programs including cooking and karate.

The Woonsocket HEZ continued to promote Farm Fresh RI’s ‘double your SNAP value’ at farmers markets. Due to lack of attendance, the weekly winter farmer’s market was discontinued and replaced with monthly winter farmer’s markets near the Woonsocket WIC office inside the Thundermist clinic, which averaged 40-50 customers.

The Teen Health Chairs engaged Youth in Action to guide the workgroup in engaging youth to amplify the voice of teens with lived experience. Riverside youth is developing a peer-to-peer outreach campaign for teens. Thundermist continued to ask the One Key Question and worked to increase yearly primary care visits for adolescent patients. Woonsocket has seen over a 30% decrease in unplanned births to teens over the past 4 years.

The Teen Health Group embedded a Family Planner and Sexuality Educator in Woonsocket High School and implemented an inclusive, medically accurate, comprehensive, and evidence-based health curriculum for all 9th grade students. The school-based health center reported an increase of first-year students who have received services.

Thundermist Wellness Committee implemented healthy vending machines and expanded worksite wellness activities and continued to offer incentives for staff to engage in physical activities or spend at farmers markets. Thundermist has initiated Size-inclusive Health Best Practices, to provide the highest quality of care for every body, with a focus on non-biased and equitable treatment. This practice recognizes that weight-stigma, especially for women and girls, is a social determinant of health, and leads to avoidance of health care appointments and screenings and is linked to the development of eating disorders, depression, anxiety, body dissatisfaction, malnutrition, and other physical and psychological health conditions independent of a person’s size.

Providence

The Providence Health Equity Zone continued to bicycle education throughout the city, ana plans to expand the Recycle-a-Bike’s Pedal Power programs at recreation centers. Promotion of farmer’s market incentives for SNAP/EBT recipients contributed to a 34% increase this past year. The HEZ facilitated youth-led training on equity in outdoor spaces and recreation to Providence Public Schools teachers, with the goal of expanding these trainings on youth access to parks and natural spaces in the future. The Providence HEZ also engaged youth in a community gardening program, and led workshops on topics such as healthy relationships, healthy eating, and nutrition. The HEZ also continued the Summer Food Service Program and free dinners in all Providence recreation centers.

Olneyville

The Olneyville Health Equity Zone continued its efforts to improve housing throughout the HEZ. ONE Neighborhood Builders, the HEZ’s backbone agency, has provided safe, healthy, affordable housing to low-income Olneyville residents, leading to an improvement in overall neighborhood safety. The Olneyville HEZ also hosted their annual “Fall Festival” and continued summer youth programming from the YMCA and Woonasquatucket River Watershed Council. The walking school bus program to and from William D’Abate Elementary school continued to flourish, providing regular activity for the children who participate, and paid employment/volunteer hours for Onleyville residents. The HEZ also supports a mindfulness program at William D’Abate Elementary school taught by instructors from the Center for Resilience.

Develop certification process & core competencies for the MCH workforce statewide through a Community Health Worker workforce development initiative.

Domains

Engagement Methods and Strategies
Individual and Community Assessment
Culturally and Linguistically Appropriate Responsiveness
Promote Health and Well-Being
Care Coordination and System Navigation
Public Health Concepts and Approaches
Advocacy and Community Capacity Building
Safety and Self-Care
Ethical Responsibilities and Professional Skills

Standards

1. Experience: Six months or 1000 hours of paid or volunteer work experience within five years

2. Supervision: 50 hours specific to the domains

3. Education: 70 hours relevant to the domains

Training and Development - RI MCH Program partners with the following training entities for CHW education and preparation:

Community Health Innovations of RI provides ongoing training and apprenticeship opportunities especially for CHWs based in the community through health Equity Zones;
Rhode Island College Healthy Jobs offers ongoing CHW courses at Central Falls Parent College, Rhode Island College campus in Providence throughout the academic term, and in a centralized Warwick location;
RIDOH Chronic Disease Programs offers core community health worker training and modules specific to patient navigators working in chronic disease.
Dorcas International Institute offers a training for CHW working with refugees through funding by RI Foundation;
Rhode Island Parent Information Network provides ongoing training opportunities for Resource Specialist including parents of children with special healthcare needs;
Clinica Esperanza sponsors ongoing Navagante trainings for Bilingual / Bicultural CHWs.

All of these training programs have aligned their curriculum with Rhode Island’s Certified Community Health Worker standards meeting the certification requirements.

Continue to support a comprehensive system of engagement & leadership development for vulnerable populations.

Health Equity Institute –Health Equity Institute (HEI) was created by Director Nicole Alexander-Scott, MD, MPH in 2016 as a strategy to promote RIDOH’s three leading priorities. The priorities include: 1) addressing the social and environmental determinants of health; 2) eliminating the disparities of health and promote health equity; and 3) ensuring access to quality health services for Rhode Islanders, including our vulnerable populations. The mission of the HEI is to address systemic inequities so that all Rhode Islanders achieve their ideal life outcome regardless of their race, geography, disability status, education, gender identity, sexual orientation, religion, language, age, or economic status. HEI recognizes that achieving health equity requires action, leadership, inclusion, cross-sectoral collaboration and shared responsibility throughout RIDOH, and communities across the state. HEI has substantial expertise in providing communities and policy-makers with data, technical assistance, and evidence-based programs to address health disparities in vulnerable populations. Several large programs are housed within the HEI, including: Disability & Health, Minority Health, Refugee Health, Maternal and Child Health and the Health Equity Zones (HEZ). HEI also provides collaborative support to all of RIDOH’s equity initiatives including: the Social Justice Roundtable, Sexual Orientation and Gender Identity Workgroup, Vulnerable Populations Data Collection Workgroup, Disparities in Population Health Goals, Social Determinants of Health Workgroup, Community Health Assessment Group, Commission for Health Advocacy & Equity, Community Health Resiliency Project, and the Kresge Initiative.

Healthy Equity Communication Training - RIDOH recently received a grant from the Kresge Foundation’s Emerging Leaders in Public Health (ELPH) initiative to support agency transformation that helps us better integrate social justice approaches into our work. As part of this work, RIDOH is partnering with The Praxis Project and Berkeley Media Studies Group (BMSG) to host a one-day intensive training to help us communicate more effectively about issues and topics related to social justice and health equity. This professional development opportunity has value for every Division, Center, and Program at RIDOH, as we apply a health equity lens to work conducted across the Department.

The objectives of the training are to build capacity across RIDOH Divisions for:

Social impact communications – using communications science to influence perceptions, behaviors, and policy outcomes to advance social justice and health equity
Public health policy advocacy and message framing
Strategic storytelling
Social media and digital communications advocacy and outreach

The Praxis Project is a national non-profit working toward health justice for all. https://www.thepraxisproject.org/ [thepraxisproject.org] BMSG is a nonprofit organization dedicated to expanding advocates' ability to improve the systems and structures that determine health. http://bmsg.org/ [bmsg.org]

Refugee Health Program (RHP) - The responsibilities of the RI-RHP include tracking new refugees who enter the state via the Centers for Disease Control and Prevention’s (CDC) Electronic Disease Notification (EDN), assuring that all new refugees receive an initial health assessment within 30 days (in compliance with ORR State Letter 12-09 guidelines), tracking refugee health status through the completion of the Rhode Island version of the refugee health screening form, holding refugee network stakeholder meetings to connect stakeholders, sharing information with community agencies and health care providers, and assisting in the completion of the I-693 report of medical examination and vaccination form, which accompanies refugee green card applications. The ORR Refugee Health Promotion Program Grant enables the RI-RHP to assist refugee resettlement agencies and health clinics in building on their health promotion activities for refugees who are recent arrivals. Rhode Island arrivals largely came from the following countries: Burundi, United Republic of Tanzania, Democratic Republic of Congo, Ukraine, Somalia, Syria, and Colombia, and Eritrea. The mean age of refugees is 21 years old with a range of 3 to 65 years. Approximately 41% of arrivals are under the age of 18 and 59% are 18 years or older.

All newly arrives adult refugees attend community orientation that covers a multitude of topics geared to helping the newly arrived refugees adjust to their new environment. The major areas of focus include the following: Medical and Health issues, Rights and Responsibilities of Refugees, Employment Counseling, Housing, Financial Literacy, Social Guidelines, School Registration, Education, and Cultural Adjustment. Within this framework, more detailed discussions are dedicated to topics that are immediately relevant to the lives of each family. All the newly arrived refugees are connected to the local healthcare providers for medical screenings and vaccinations. The medical case management services include navigation of the health care system beyond primary care providers to include pharmacies, dentists, ophthalmologists, immunologists, audiologists, obstetricians, imaging specialists, insurance providers, billing offices, and others. Newly arrived refugees attend four sessions within the first 3 weeks after arrival. Interpreters are provided as needed.

Culturally Linguistic Appropriate Services (CLAS) – The Rhode Island Health Equity Institute (HEI) has been actively developing and implementing CLAS throughout Rhode Island through a multi-faceted approach.

CLAS Trainings - RIDOH conducts CLAS trainings for RIDOH staff as well as community partners to enhance the implementation of culturally and linguistically appropriate services. These trainings include practical ways of improving language access and creating an environment that is welcoming of diverse cultural backgrounds. Examples of community partners that have received training include: college students, refugee service providers, case workers for child protective services, state agencies and more.
CLAS Materials - In addition to the CLAS trainings for community partners, RIDOH distributes “I Speak Cards” which are durable, bilingual wallet-sized resources that educate the public about their rights regarding language access. There are efforts underway to evaluate the use of these cards.
CLAS Complaints - RIDOH has revamped the process for tracking and handling CLAS related complaints. CLAS related complaints are now handled through the centralized customer service line, and there has been an improvement in the coordination between the customer service staff, health facilities regulation staff, and the Health Equity Institute regarding addressing complaints.
Facilitating Training of Bilingual Staff - RIDOH is working to compile a repository of state and web-based programs that enable staff of RIDOH and any other facility to become a certified interpreter/translator. This initiative is designed to rectify the common practice in the community of non-certified bilingual staff serving as translators or interpreters.
CLAS Champion Program - RIDOH runs a CLAS Champion elective for physicians who are working under a J1 Visa. Doctors working under a J1 Visa are required to engage in one of three options of meaningful public service-oriented work one of which is becoming a CLAS champion. This involves undergoing CLAS training and championing CLAS at their respective institutions thereafter. In 2019 RIDOH had 27 doctors in the J1 Visa program complete CLAS training. There are efforts to better engage the CLAS champions regularly and better understand how they are serving as ambassadors for CLAS at their respective institutions.

Sexual Orientation and Gender Identity (SOGI) workgroup - The Rhode Island Department of Health (RIDOH) has formed a large, multidisciplinary team which is working to improve LGBTTQQ (Lesbian, Gay, Bisexual, Trans, Two-Spirit, Queer and Questioning) public health policies, systems, and environmental change. LGBTTQQ individuals often face a variety of healthcare challenges, including identifying and accessing providers knowledgeable about their health risks and behaviors and who provide culturally affirming care. LGBTTQQ health is also intersectional — sexual orientation and gender identity/expression are important parts of a person’s identity, but there are often other demographic factors influencing access to care. The group is working to ensure that our health surveillance systems include questions about sexual orientation and gender identity, offer training to staff to improve our ability to respond to LGBTTQQ health inquiries, and build relationships with other organizations to improve LGBTTQQ health equity statewide. Current initiatives include:

Data and Surveillance - In 2016, RIDOH began including the Centers for Disease Control and Prevention (CDC) optional module on Sexual Orientation and Gender Identity in RI’s adult Behavioral Risk Factor Surveillance System (BRFSS) survey. RIDOH also began including a gender identity question in RI’s high school Youth Risk Behavior Survey (YRBS) in 2017. RIDOH is currently analyzing findings from these surveys related to gender identity, with the goal of releasing these data later this year.
H 7765 – An Act Relating to Health and Safety – Vital Records - RIDOH Director Nicole Alexander-Scott, MD, MPH submitted a letter of support for H 7765, legislation which aims to ensure that gender markers on death certificates are correctly aligned with the decedent’s identified gender if it does not correlate with sex assigned at birth. RIDOH has also been working with GLBTQ Legal Advocates & Defenders (GLAD) on an amendment to include “any additional document as authorized by the Rhode Island Department of Health” to the list of qualifying documents that can be presented to memorialize a decedent’s identified gender.
LGBTTQQ+ Health Resources - RIDOH has developed a list of resources that RI LGBTTQQ+ community members may find helpful in accessing culturally proficient healthcare. To view these resources, visit www.health.ri.gov/lgbt.
RI Pride Sponsorship RIDOH has been a proud sponsor of RI’s Pride Festival since 2016, distributing public health resources and standing with LGBTTQQ+ Rhode Islanders to celebrate their many contributions to our wider community.
Listening Forum on Health and Public Safety - RIDOH held a listening forum with the City of Providence in 2016 to learn more about ways to improve health and public safety for LGBTTQQ+ community members. RIDOH is planning to hold another listening forum later this year.
All-Access Restroom at RIDOH’s Cannon Building - As part of planned renovations to modernize its public restrooms, RIDOH is installing an all-access bathroom on the lower level of the Cannon Building. These facilities will ensure a more welcoming and private space for gender non-conforming visitors and staff, as well as families, caregivers, individuals with disabilities, individuals with atypical bodies and physical presentations, and others.

RI Department of Health Information Line - The RIDOH Information Line (HIL) is the Department of Health's single point of entry for telephone inquiries. The HIL answers an average of 4300 calls per month on behalf of the Department's programs and the Director's office. The office hours on the HIL are from 8:30-4:30pm, Monday through Friday. There are at least two individuals on the phone line at all times. The telephone system used by the HIL is a Uniform Call Distribution (UCD) system. This system allows all calls coming into RIDOH, to come in to a single number. From there HIL staff will answer the calls and route them to the appropriate program/division, if they cannot be answered by staff. The HIL phone number is 401-222-5960. The HIL maintains a call database. All staff have access to the database through their own computer with a personal login. Once a call is received, it is logged into the HIL call database. There is a Database Input Sheet that is used when logging in calls. There are currently 38 programs listed on the input sheet, for which calls are taken. The HIL maintains three voicemail boxes; an English voicemail, a Spanish voicemail and an emergency voicemail. There is also a central e-mail account for anyone wishing to contact RIDOH with questions, which is also answered by HIL staff.

Family to Family Health Information Center - Family-to-Family Health Information Centers (F2FHICs) are non-profit, family staffed organizations that help families of children and youth with special health care needs (CYSHCN) and the professionals who serve them. Family-to-Family Health Information Centers aid in a variety of ways, including support and referral, training workshops, advocacy, and sharing information via websites, newsletters, and other publications. The Health Resources and Services Administration (HRSA) provides the primary funding and supports F2FHICs in all states and the District of Columbia. In RI, the F2FHIC is housed within Family Voices (FV) at the RI Parent Information Network (RIPIN). Family Voices, through the National Center for Family and Professional Partnerships, provides technical assistance, training, and connections to other F2FHICs. Data is collected in order to demonstrate the need for providing assistance to help the F2FHICs meet their accountability requirements. During the last grant period, the RI Department of Health (RIDOH) partnered with FV to support utilization of the F2FHIC in facilitate improved system coordination in communities and statewide for CYSHCN and their families.

RIREACH - RIREACH is an initiative under the RI Parent Information Network (RIPIN) umbrella that works in partnership with the Office of the Health Insurance Commissioner (OHIC) and HealthSource RI. RIREACH helps Rhode Islanders with any type of health insurance including: Medicaid, Medicare, commercial coverage (provided by an employer or purchased through HealthSource, RI) and the uninsured. Using a diverse team of advocates through a peer to peer support model, RIREACH provides assistance on the phone or in person in both consumer’s homes or multi-program expertise that is critical to their ability to solve complex issues. Together with RI Family Voices, RIREACH provides valuable information and support to families of CYSHCN and transitioning youth in navigating and utilizing health insurance.

Develop “data-to-action” initiatives to build internal and interagency support and action.

Statewide Health Equity Indicators – Over the past two years, the Health Equity Institute (HEI) went through an extensive community engagement process where the Community Health Assessment Group examined more than 180 potential indicators to measure Rhode Island's progress in advancing health equity. This process led to the selection, in 2018, of a core set of 15 health equity indicators in 5 domains: integrated healthcare, community resiliency, physical environment, socioeconomics, and community trauma. Data comes from various sources. When possible, data are reported by geographic location, race/ethnicity, disability status, income level, or other demographic characteristics. The selected measures are intended to help communities assess the impact of health equity initiatives, such as RI's Health Equity Zones, by providing baseline data and supporting outcomes evaluation. They also provide a way to measure our shared progress. A complete list of Rhode Island’s Statewide Health Equity Indicators can be found in the Appendix.

MCH Data Dashboard - The SSDI Program developed an MCH data “dashboard” that is available internally to MCH program management on a shared computer drive. The dashboard is an Excel spreadsheet that includes all state and federal Title V outcome, performance and evidence-based strategy measures, as well as the SSDI minimum and core data set, with separate tabs for each. Definitions and descriptions of the numerator and denominators for each measure are presented, along with historical data up to 10 years back and future targets through the year 2023. Where relevant, national averages and Healthy People 2020 objectives are presented for comparison. These data can be used to inform program planning, policy decisions, needs assessment and grant writing. Next steps include connecting the dashboard, using Power BI software, to the RIDOH website to display selected MCH data measures for the public.

KIDSNET - is a population-based integrated child health information system that facilitates the collection and appropriate sharing of preventive health services data for the provision of timely and appropriate follow-up. KIDSNET began in 1997 with funding from a Robert Wood Johnson Foundation All Kids Count grant and has continued to grow since that time. It contains information on children’s preventive health services for all RI children born on or after January 1, 1997. KIDSNET also serves as Rhode Island’s childhood immunization registry for children up to age 19. Currently it links data related to the following: newborn screening (bloodspot, hearing and developmental screening), vital records, family visiting, immunization, lead screening, WIC, Early Intervention, early childhood developmental screening, Asthma (Breathe Easy at Home), Cedar (Medicaid Care Coordination), Head Start, and insurance as well as having connections to birth defects and foster care data. State-wide data systems for Child Outreach and Dental Sealant programs are built into KIDSNET. Also collected are enrollment data from major health insurers (including all Medicaid Managed Care plans), as well as developmental screening from participating primary care providers. Data collection of Head Start and Cedar Family Centers enrollment data has begun and will be rolled out to all agencies as soon as possible. Because of the integrated nature of KIDSNET and easy on-line access, medical homes, child health programs, Early Intervention (Part C), specialty care providers, Head Start, School Nurse Teachers, home visitors, and other authorized users can access information necessary for case management, care coordination, and tracking of children with who are missing or need follow-up from various preventive health services such as newborn hearing screening, lead screening, and immunization. KIDSNET data managers support MCH programs by responding to numerous data requests for program development, quality assurance, and quality improvement activities. For example, the Newborn Hearing Screening and Early Childhood Programs are working with the Early Intervention (EI) Program to reduce the number of families who do not consent to share data in KIDSNET and to reduce the number of children where consent is missing. These programs use KIDSNET to identify when children are enrolled in EI so complete data are important. Another example is KIDSNET is working with WIC, Family Visiting, Cedar, Head Start, and Early Intervention to promote the running of reports to assure clients receive preventive services and follow-up.

RITRACK migration to KIDSNET - The newborn hearing screening database (RITRACK) was developed in the early 1990’s as a stand-alone system. At the time, it met the needs of the newborn hearing screening program. Over time, data transfer between RITRACK and KIDSNET has improved its functionality but it is inefficient and no longer meets the needs of the program, requires Women & Infant IT department support and is unavailable to RIDOH staff. This project will migrate the functionality of RITRACK directly into KIDSNET to resolve these issues. Once completed, all newborn hearing screening data functions will be integrated into KIDSNET. Title V funding was blended with other sources to cover the overall project costs. This project improves the efficiency of data management and reduces the time for data to become available to partners serving children and families. These partners assist RIDOH to ensure that all infants (approximately 11,000 per year) receive newborn hearing screen and appropriate follow-up. The data system provides PCPs, audiologists, Early Intervention, home visitors, WIC, and other community partners access to run reports on their patients/clients to help reduce loss to follow-up from newborn hearing screening. The project will be complete, or near complete, by September 30, 2019.

PRAMS data & infant safe sleep recommendations - The RI Safe Sleep Work Group aims to reduce infant sleep-related deaths in the state. Two-thirds of RI infant sleep-related deaths from 2012-2017 have occurred while an infant was sharing a bed or other surface with another person. PRAMS data from 2012-2015 reveals that 57% of new mothers report that their baby sleeps in the same bed with someone else and 19% report that this occurs always or often. The Interagency Safe Sleep Work Group designed a two-hour training program for early childhood professionals to learn about the American Academy of Pediatrics Updated 2016 Recommendations for a Safe Infant Sleeping Environment and strategies for effective conversations about safe sleep. The trainings include infant sleep-related PRAMS data which highlights that bedsharing with infants is not uncommon and that early childhood professionals are important messengers of safe sleep recommendations including the key message, Share a room, not a bed. Since January 2017, 430 early childhood professionals in WIC, Early Intervention, and Family Home Visiting have been trained. Additionally, nearly 300 DCYF employees have been trained. Of the professionals trained, 57.8% reported feeling an increase in their confidence to provide guidance on SIDS and safe sleep to their families after the training session. RIDOH is including PRAMS infant sleep data in other high-profile presentations to leadership and policy groups throughout the state and in media interviews and articles. The Safe Sleep Work Group will continue to monitor trends in PRAMS responses which will inform future professional education activities and public health communications promoting infant safe sleep recommendations.

PRAMS data & maternal depression – RI KIDS COUNT used PRAMS data to produce an Issue Brief on maternal depression in RI and release it at a Policy Roundtable on January 22, 2018. Cross-departmental recommendations were developed through this process including recommendations to improve 1) health insurance coverage and policies for maternal depression screening and treatment, including payment for dyadic therapy; 2) public health activities to help prenatal and pediatric health care providers deliver universal, routine maternal depression screening and to ensure all pregnant and parenting mothers who screen positive are connected to resources for further evaluation, diagnosis and treatment, 3) integrating maternal depression screening/treatment into large early childhood systems that serve mothers with newborns and young children, including Early Intervention (Part C of IDEA) and Family Home Visiting; 4) professional development on maternal depression for health care providers and early childhood professionals, 5) public awareness through a statewide campaign, and 6) strategies to reduce risk factors that contribute to maternal depression (poverty, unintended pregnancy, domestic violence, untreated mental health problems, etc.)

Since the release of the Issue Brief, new collaborative activities are underway to improve the identification and treatment of maternal depression including: the development of a Rhode Island Think Babies policy campaign, drafting maternal depression legislation, and a federal grant was secured to address maternal depression.

Behavioral Risk Factor Surveillance System (BRFSS) – BRFSS is an annual state-based telephone survey assessing the health status and behavioral risk factors of the non-institutionalized adult population 18 years of age and older. The BRFSS survey provides valuable information on health trends, chronic disease risks, and data for monitoring the effectiveness of policies, programs, and interventions. Subject areas include self-reported health status, access to health care, health awareness, use of preventive services, as well as knowledge and attitudes of health care and health care practices.

In 2019, 166 questions were asked on the survey. Of these, 86 are part of the national survey and 80 were recommended by the Rhode Island Department of Health. BRFSS data collection, analysis and reporting is a critical component of the 5-year needs assessment, and BRFSS results are used by the MCH program, other RIDOH programs, state agencies, academic institutions, non-profit organizations and others to develop and evaluate programs that promote the health of Rhode Island residents. Several examples of how this data were used in the past year include:

BRFSS data were used to inform or support legislative proposals and policy decisions. The Oral Health Program developed a proposal for the Medicaid Adult dental benefit to be expanded in the Medicaid budget initiatives; BRFSS data were highlighted and shared with the Governor's Office. The Tobacco Control Program included in BRFSS data in written testimony when supporting RI TCP legislative priorities including increasing the tobacco sale age to 21, smoke free policies for state and college campuses, and increasing tax on tobacco products including electronic cigarettes. Fact sheets were also developed from the written testimony to include key data points to be provided to state legislators.
The Health Equity Institute used BRFSS data to assess progress toward meeting state health objectives or performance measures. Health disparities were identified in key metrics of the Population Health goals (obesity, physical activity, smoking, cancer screening). Data are expected to be included in a disparities report by the Health Equity Institute with anticipated completion at the end of 2019.
The WISEWOMAN program shared BRFSS data with the CDC regarding the prevalence of hypertension and related risk factors along with diet and physical activity as one activity to evaluate disease prevention programs.
Maternal and Child Health Program/Title V created a MCH Dashboard of National and state performance/outcome measures using BRFSS data for program planning purposes. The Center for HIV, Hepatitis, STDs and TB Epidemiology (CHHSTE) also used BRFSS data for program decision-making. The information collected from the BRFSS has been influential in allowing CHHSTE to estimate the number of people who may be at risk for HIV and have never been tested for HIV. It was included in the jurisdictional plan that was created in conjunction with EOHHS. It allows programs to estimate the size of the populations that may be most at risk, as well as to determine if those who are at highest risk receive adequate testing.
The Office of Immunization monitors BRFSS adult influenza vaccination coverage rates, and the survey results are used to support policy decision making for RI's adult vaccine program. BRFSS data are disseminated to vaccine policy makers through varied presentations.

The Youth Risk Behavior Survey (YRBS) - is a collaboration between CDC, RIDOH, RIDE, and BHDDH. The survey, which is administered every two years, is implemented through anonymous questionnaires in a random sample of Rhode Island public high schools and middle schools. The YRBS was administered from January-May 2019, but the most recent data available are from 2017. The data are used to help policy makers, school administrators, social service workers, and public health professionals understand trends in the health behaviors of young people across the state and to create health-related policies that will impact those behaviors. At RIDOH, data from the Youth Risk Behavior Survey are used to develop health programs for adolescents throughout Rhode Island and to understand how students are disproportionately affected by different health issues. Understanding these disparities allows an opportunity to address the factors at the community-level that affect students' decisions and behaviors. 2017 YRBS programmatic data applications include:

2017 YRBS data were presented in a recent school official report. To communicate YRBS data in a way that is meaningful to school officials, the report was aligned with Social and Emotional Learning (SEL) competencies. Topics addressed on the YRBS align with three of the five SEL core competencies: self-management, relationship skills, and responsible decision making. Skills that support these three competencies include recognizing and managing emotions, making responsible decisions, establishing positive relationships, and handling challenging situations effectively. School administrators can use YRBS data to promote social and emotional learning and promote students’ well-being. Developing social and emotional skills is directly related to academic achievement and healthy behavior. Students with high social and emotional competencies are more likely to be active and successful learners and are less likely to engage in substance use, sexual activity, and have mental health problems.
The MCH Program supports the administration of YRBS and advocates for several state-added questions be included on the high school and middle school surveys. Disability and drinking water questions address MCH state priority needs. Questions on social support, community connectedness, and homelessness will help address issues regarding measuring social determinants of health.
The Oral Health Program and Youth Suicide Prevention Program analyzed 2017 YRBS data to examine the association between oral and mental health status. The goal was to determine if oral health could potentially be an indicator for mental health concerns, as youth that are feeling self-conscious or embarrassed by one’s teeth or mouth may be associated with poor mental health. 2017 data suggest an association and the two programs are collaborating on possible interventions such as integrating mental health screening into the medical risk assessment performed by dental providers to identify young people who would benefit from resources and services pertaining to mental health.
The YRBS program and the Tobacco Control Program (RITCP) partnered with RI KIDSCount to update 3 Issue Briefs related trends in Youth Tobacco Use: E-Cigarettes and Vaping, Factors Influencing Youth Use, and State and School Tobacco Policies.
STD and HIV Prevention Programs: YRBS data on sexual activity and condom usage are used to track trends of high-risk sexual behavior among adolescents over time. This information is then used to inform policy and to implement relevant interventions to improve adolescent sexual health. Furthermore, by asking about gender identity and gender expression, RIDOH programs can measure health disparities among gender minority populations.
Rhode Island Department of Behavioral Health, Developmental Disabilities and Hospitals (BHDDH): Programs at BHDDH partner with RIYRBS to include questions about misuse of prescription drugs and over the counter drug use to inform the Governor’s Overdose Task Force and obtain Rhode Island specific data to apply for grant opportunities to address teen substance use.

Rhode Island Department of Health (RIDOH) Academic Center - was created in 2015 to enhance RIDOH’s capacity to integrate scholarly activities into public health policy and practice by establishing and facilitating collaborations with academic and research colleagues across the state, and building upon internal and external partnerships and synergy to establish the RIDOH Culture of Learning at the department. The RIDOH Academic Center supports two areas of engagement to achieve these goals: the Public Health Education and Research Academy (PHERA), and the Workforce and Career Development Network (WCDN).

Public Health Education and Research Academy - Through the work of the RIDOH Academic Center, RIDOH has become an Academic Health Department that looks forward to having formal affiliations with all of Rhode Island’s colleges and universities. Formal affiliations currently exist with: Brown University School of Public Health, Community College of Rhode Island, Johnson and Wales University, Rhode Island College, Roger Williams University, University of Rhode Island. Collaboration between RIDOH programs and academic faculty is encouraged based on RIDOH’s public health policy and practice, and similar research and teaching interests of academic faculty. These partnerships drive development of collaborative research ideas that create experiential learning opportunities for RIDOH Public Health Scholars, who are undergraduate, graduate, professional or clinical students currently enrolled in courses of study that relate to public health.

RIDOH’s utilization of a health equity lens for public health program planning and policy development provides multidisciplinary opportunities for collaboration with faculty and students in programs of study such as public health, healthcare, communications, graphic design, technology, housing, finance, law, urban planning, architecture, etc.

The RIDOH Academic Center’s PHERA also facilitates forums for collaborative state-academic partnerships to enhance statewide research and outcomes in public health-related topic areas. These research-based groups include multiple researchers from various academic institutions as well as state agencies and community partners.

Between June 2017 – June 2018, RIDOH staff helped author the following MCH related journal articles:

1. :

State Unintentional Drug Overdose Reporting Surveillance: Opioid Overdose Deaths and Characteristics in Rhode Island. Jiang Y, McDonald JV, Goldschmidt A, Koziol J, McCormick M, Viner-Brown S, Alexander-Scott N. R I Med J (2013). 2018 Sep 4;101(7):25-30.

MEASURING REFLECTIVE SUPERVISION WITHIN HOME VISITING: CHANGES IN SUPERVISORS' SELF-PERCEPTION OVER TIME. Low CM, Newland R, Silver RB, Parade S, Remington S, Aguiar S, Campagna K. Infant Ment Health J. 2018 Sep;39(5):608-617.

Oral Health Concerns and Connections to Mental Health among Rhode Island High School Students, 2017. Pellegrino A, Vendetti T, Jackson T, Zwetchkenbaum S. R I Med J (2013). 2018 Oct 1;101(8):56-59.

Disparities in Health Risk Behaviors and Health Conditions Among Rhode Island Sexual Minority and Unsure High School Students. Jiang Y, Reilly-Chammat R, Cooper T, Viner-Brown S. J Sch Health. 2018 Nov;88(11):803-812.

The Cost and Cost-utility of Three Public Health HIV Case-finding Strategies: Evidence from Rhode Island, 2012-2014. Li XC, Kusi L, Marak T, Bertrand T, Chan PA, Galárraga O. AIDS Behav. 2018 Nov;22(11):3726-3733.

Assessing Educational, Developmental, and Parent Support Services Received by Families of Children with Craniofacial Birth Defects. St John K, Houle DL, Viner-Brown S. R I Med J (2013). 2018 Nov 1;101(9):41-43.

Action-focused, plain language communication for overdose prevention: A qualitative analysis of Rhode Island's overdose surveillance and information dashboard. Waye KM, Yedinak JL, Koziol J, Marshall BDL. Int J Drug Policy. 2018 Dec; 62:86-93.

Increasing Syphilis in Rhode Island: Return of an Old Foe. Junco-Fernández A, Montgomery MC, Crowley C, Bertrand T, Marak TP, Maynard MA, Gummo C, Flanigan TP, Chan PA. R I Med J (2013). 2019 Feb 1;102(1):50-54.

Childhood Cancer in Rhode Island. Muhlbauer N, Oh J, Renaud T, Welch J. R I Med J (2013). 2019 Feb 1;102(1):46-49.

Can Statewide Emergency Department, Hospital Discharge, and Violent Death Reporting System Data Be Used to Monitor Burden of Firearm-Related Injury and Death in Rhode Island? Jiang Y, Ranney ML, Sullivan B, Hilliard D, Viner-Brown S, Alexander-Scott N. J Public Health Manag Pract. 2019 Mar/Apr;25(2):137-146.

Increased overdose mortality during the first week of the month: Revisiting the "check effect" through a spatial lens. Goedel WC, Green TC, Viner-Brown S, Rich JD, Marshall BDL. Drug Alcohol Depend. 2019 Apr 1;197:49-55.

Community-Led Initiatives: The Key to Healthy and Resilient Communities. Amobi A, Plescia M, Alexander-Scott N. J Public Health Manag Pract. 2019 May/Jun;25(3):291-293.

Tobacco Product Availability Following Point-of-Sale Policy Implementation in Rhode Island. Arnold J, Pearlman DN, Orr M, Guardino G. R I Med J (2013). 2019 Jun 4;102(5):53-56.

AMCHP Data Communications E-Learning Collaborative - From April to November 2018, RIDOH staff including the MCH Data Manager, MCH Epi, MCH Program Manager and an RIDOH Communications Specialist, participated in the AMCHP Data Communications E-Learning Collaborative. The goal of the collaborative was to develop a communications product highlighting the importance of an MCH issue. AMCHP provided technical assistance to translate analytic data into communications products, such as infographics, stories, or briefs for non-scientific audiences including program staff, policymakers, and community partners. Rhode Island chose to develop a maternal mortality and morbidity data brief. The document has been reviewed by the RIDOH MCH Policy Team and the Disparities in infant Mortality Advisory Board. Feedback and recommendations will be incorporated before the data brief is finalized.

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III.E.2.c. State Action Plan - Cross-Cutting/Systems Building - Annual Report - Rhode Island

III.E.2.c. State Action Plan - Cross-Cutting/Systems Building - Annual Report - Rhode Island