aIII.E.2.c Annual Report: Cross/Cutting Systems Building

Public health research and data show that generations-long social, economic, and environmental inequities, including structural racism and other forms of discrimination and their consequences, have resulted in adverse health outcomes. For example, segregation in housing and education and racist mortgage lending and zoning policies

have historically advantaged white Americans and disadvantaged communities of color. Together, these policies and practices have a greater influence on health outcomes than individual choices or access to healthcare. These inequities have been shaped by the distribution of power, money, and resources at the global, national, and local levels. Reducing health inequities through policies, practices, and organizational systems can help improve opportunities for every Rhode Islander.

 

Rhode Island had the following priorities for cross-cutting systems building:

1. Adopt social determinants of health in MCH planning and practice

 

Priority: Adopt social determinants of health in MCH planning and practice

The Title V program aims to collaborate across the RIDOH and with other state and local stakeholders to adopt SDoH into MCH planning and practice in order to improve health equity.

 

To respond to these disparities and support this priority, RIDOH will resume, continue, and add strategies as follows:

 

Ensure Health Equity Programming among Maternal Child Health Programs:

Title V is continuing to grow its partnerships with community stakeholders, cultural groups, and networks, such as HEZ and SISTA FIRE, to address perinatal and birthing disparities within the birthing parent system of care. Through these partnerships, RIDOH administered programs, including family home visiting, family planning, oral health, and other preventative care, are seeking guidance on 1) Translation & Interpretation, 2) Trauma Informed Care/Consent, 3) Cultural Bias, 4) Community Resources, and 5) Workforce Diversity. This includes soliciting solutions to challenges from the community.

 

For example, RIDOH’s MCH program supported efforts of community stakeholders to increase the availability of doula services and support to womxn in RI. From October 2021 to April 30th, 2022, One Neighborhood Builders, RI Department of Health Maternal Child Health Program, and Journ3i LLC. collaborated to increase perinatal workforce capacity to address the multi-cultural and multi-lingual needs of birthing people within RI. Over this seven-month period, 26 community members of color were trained, mentored, and received free one-year memberships to RI Birth Workers Cooperative, Doulas of Color Network, and RI Perinatal Doula Agency. Cohort members also received doula bags and had their required CPR/AED, food handling safety, and HIPPA Compliance courses covered. So far, 11 initiative participants have become certified perinatal doulas through the Rhode Island Certifying Board (RICB). Please reference the appendix for a complete write up of the project. Through Preschool Development Grant funding, the above project was extended by six months. Journ3i LLC. Implemented a mentoring program participant and implementing workshops covering the following topics:

• How to set up your doula business,
• How to sign up with insurance and submit claims,
• How to build your clientele base,
• How to balance work and life responsibilities, and
• How to troubleshoot common job issues.

 

During the summers of 2022-2023, Journ3i LLC. collaborated with MCH Program and PDG in order to further train and mentor 20 doulas of color and increase workforce development for existing doulas of color. Doulas, certified through the RI Certification Board, must complete continuing education credits to maintain their certification. As a result, educational opportunities, such as taking newborn care specialist courses through the newborn care training academy. Newborn care specialists are trained on caring for newborns in the first few months of life. They are trained on tenets of infant mental health, newborn developmental milestones, caring for multiples, bottle and breastfeeding practices, swaddling, sleep training, etc. In addition, funding was secured from the RI Prevention Block Grant to support Doulas of Color to be trained as Perinatal Mental Health Specialists. Perinatal Mental Health Specialists are trained in how to screen for and acknowledge symptoms perinatal mental health issues and how to provide group support among diverse communities.

 

In addition, Quatia Osorio, RIDOH’s perinatal community consultant, continued to serve as an advisor and thought partner to inform racial equity initiatives and assist in the development and implementation of the MCH racial equity action plan. This includes her supporting MCH leadership in the development and implementation of racial equity organizational initiatives, objectives, and strategies related to the advancement of racial equity. For example, Quatia is collaborating with our disparities specialist to complete an infant health and mortality workplan. The idea was to catalogue pressing infant health issues that lead to poor outcomes and develop strategies to address this. WIC increasing outreach and sustaining client involvement was a strategy to address child malnutrition and promote newborn overall development. As a part of WIC trying to increase outreach to diverse communities, they are currently contracted with a videography company, Steer Studio LLC., in order to create a video campaign to be shared on social media sites. Our current timeline for video completion would be by end of September 2023.

 

In 2021, SISTA Fire, a womxn of color network advocating for change within RI, continued its collaboration (funded by the MCH TA Grant) with Women and Infants Hospital to increase perinatal workforce diversity and address disparities of care present for pregnant people of color. SISTA Fire presented their birth justice demands to Women and Infants Hospital (WIH) based on their participatory action research findings showcased above. Over the course of the TA Grant, SISTA Fire repeatedly met with WIH to present and explore implementation avenues of their demands. There main demands are to be completed in the following areas:

• Culture and Approach,
• Translation and Interpretation,
• Workforce,
• Doula Engagement,
• Independent Community Review Board, and
• Community Resource Space.

WIH accepted a majority of the below demands and SISTA Fire has currently switched into monitoring WIH implementation progress. In the area of culture and approach, SISTA Fire demanded the following steps be taken by WIH.

 

Moving forward, in 2024, RIDOH MCH Program and Ready Set Latch Go LLC. Are receiving a Department of Labor and Training grant to support the training of diverse community members to become certified lactation counselors. This can also serve as an additional continuing educational credit for doulas to further expand their credentials and skills to serve their perinatal patients.

 

Recently, in 2023, RIDOH partnered with a local community doula, Susie Finnerty to develop perinatal childbirth educational programming for local diverse perinatal individuals. Her training was titled: “Rhode Island’s Roadmap to Well-being: Conception to the first Year of Pregnancy”. Susie held multiple sessions throughout the year that cumulatively garnered 23 participants. She is now working to place the training online for public consumption for a wider reach. Susie developed curriculum aimed at accomplishing the following objectives:

• Reviewing with participants the perinatal time period (conception, pregnancy, birth, first year postpartum)
• Demystifying for participants the maternal mortality crisis, specifically postpartum mood disorders
•  Focusing on prevention, community and clinical resources
• Identifying participant fears and creating individualized path to wellness
• Identify what is currently working in participant’s community, culture, life
• Participants leaving with confidence, action items and empowerment to have a safe and dignified pregnancy, birthing and parenting experience

Curriculum Outline topics that were covered included:

• Understanding maternal outcomes
• Healthcare options and resources in RI
• Power of peer support
• Movement and exercise
• Nutritional education
• Art and mental health

 

Continue to Support the Development of a Doula Infrastructure: MCHP partnered with Journ3i LLC. and the Early Childhood Comprehensive Systems (ECCS) Grant in order to implement an asset and gap analysis of the doula workforce. For instance, doulas gaining access to insurance reimbursement is an asset. However, the lack of provider knowledge of reimbursement processes and general provider confusion and frustration in navigating this landscape are ongoing gaps. Doulas, such as Journ3i LLC., are working with private and public insurances to troubleshoot and fix reimbursement technical issues. The RI Birth Worker’s Cooperative, an administrative doula billing organization, has been holding technical assistance sessions with members who need support with signing up with insurance, submitting claims, and receiving reimbursements. Other doula workforce gaps included:

•  a lack of in-state trainings available to community members interested in becoming doulas,
• a lack of diverse doulas serving diverse populations,
• a plethora of unaddressed financial barriers blocking individuals from entering the workforce, and
• a lack of connection and collaboration between doulas and other young family serving agencies.

The report also explored the established and emerging assets of the workforce which included:

• a newly established Birth workers Cooperative, a cooperative supporting doula in signing up with insurance and billing them. The organization provides HIPAA compliant software so doulas can store client information. They also supply billing support services that help doulas check client insurance eligibility, send in claims, and do claim denial/error follow up,
• a newly established Doulas of Color Network, a network that brings doulas of color together from across the state to connect, learn, and collaborate with each other,
• an established doula association, since 2011, named Doulas of Rhode Island (DoRI),
• new community and state collaborative efforts to bring national doula trainings to Rhode Island, and
• sustained perinatal population demand of doula services.

The next phase of the grant will be creating a workplan to address the gaps mentioned above.

 

 

Support CHW Training & Workforce Development: RIDOH’s CHW Initiatives have continued to cultivate learning opportunities for the MCH workforce through the CHW CORE trainings. These are administered through various partners across the state and through the certification process administered through the RI Certification Board. The CHW CORE trainings continue through the following training entities:

• Community Health Innovations of RI provides ongoing training and apprenticeship opportunities especially for CHWs based in the community through Health Equity Zones;
• The Community Health Worker Association of RI (CHWARI) also offers CORE training to prepare candidates for full CHW certification.
• Central Providence Health Equity Zone provides training and an apprenticeship program for its cohort of CHWs.
• RIDOH’s Diabetes, Heart Disease and Stroke Program offers a training program focused on type 2 diabetes, gestational diabetes, prediabetes, hypertension, and cardiovascular disease. This training program prepares candidates for full certification in CVD/Diabetes.
• Rhode Island Parent Information Network provides ongoing training opportunities for Resource Specialists including parents of children with special healthcare needs;
• Clinica Esperanza sponsors ongoing Navagante trainings for Bilingual / Bicultural CHWs. They also offer a wellness program, “Vida Sana” for patients living with chronic disease.

All of these training programs continue to align their curriculum with Rhode Island’s Certified Community Health Worker standards meeting the certification requirements.  The RI MCH Program continues to partner with Rhode Island College (RIC) in supporting the Community Health Worker Association of Rhode Island (CHWARI), which is housed at RIC. CHWARI is an organization which provides CHWs with resources such as trainings and other professional development opportunities. The CHWARI actively supports frontline healthcare workers who are employed 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. CHWARI also acts as an advocacy organization by promoting equity within the CHW workforce and through the promotion of CHW sustainability. Sustainability efforts underway include the potential for reimbursement of the CHW workforce through RI Medicaid, and CHWARI is a partner alongside RIDOH and RI Medicaid in this sustainability effort.

 

Support a Comprehensive System of Engagement and Leadership Development for Vulnerable Populations Through the Youth Advisory Council:  Support a Comprehensive System of Engagement and Leadership Development for Vulnerable Populations Through the Youth Advisory Council: The YAC has been instrumental in supporting vulnerable populations by providing a comprehensive system of engagement and leadership development. During the last Title V reporting period, the YAC addressed topics like strengths assessment, stress management, health equity, oral health, and healthy eating. They collaborated with the Southside Community Land Trust youth program, hosting a joint meeting where the 2 groups prepared a meal and learned about each other's programs. The YAC has played a significant role in shaping the RIDOH's health and wellness messaging and strategic plans, ensuring the youth voice is heard. Members have contributed to youth focus groups and had additional leadership opportunities each month.

 

The YAC sponsored a community-wide event, "How to Tell Your Tale,” with technical assistance from Rochelle Coleman, of the RI Black Storytellers organization. Transition-age youth of all abilities learned strategies to help guide what they wanted to share and what they wanted to keep private. The group also learned many tips on how to tell an effective story. 

In the coming year, the YAC will continue to offer a mixed meeting format, professional development, and focus on social-emotional resilience while expanding community engagement and support of RIDOH programs.

 

Amplify Family Voices and Input:

Promoting Indigenous voices within Title V activities and initiatives: RIDOH MCH Program has spent the last two years investing in uplifting indigenous voices across RI. This has included integrating indigenous community members in our statewide taskforces and committees on maternal and child health and encouraging the growth of indigenous led initiatives and needs assessment activities. See below for a rendering of our work with indigenous community members and organizations.

 

For the past two years the RI Department of Health has partnered with a new organization, Tribal Youth Empowerment Corporation (TYEC), to implement year-round programming and engagement for approximately 20-25 youth and their respective families. TYEC is an organization that provides urban and non-tribal federally recognized indigenous youth with the culturally appropriate tools they need to succeed in school, at work, and in the community. Their focus is on youth (ages 0 - 24), and they aim to address the overall needs of the individual indigenous youth they serve by offering life training skills, educational assistance, financial literacy, free tax services for both young adults and adults, and comprehensive and culturally appropriate support systems in a safe, caring, and welcoming environment. They partner with RIDOH’s immunization program for health and wellness educational sessions throughout the year for youth and their families to attend. Some sessions have included education related to vaccines, nutrition, etc. Regarding the needs assessment, TYEC will implement focus groups for urban indigenous communities regarding the health needs of their families and potential solutions regarding it. Particularly, through this partnership we aim to uplift the voices of urban indigenous families that are not apart of a federally recognized tribe in RI. The findings from these focus groups will be integrated into our overall needs assessment.

 

Title V has partnered with a Narragansett Tribal Elder, Wanda Hopkins to implement a couple of projects aimed at either assessing or promoting health and community connectedness of the Narragansett community. Presently, she is collaborating with RIDOH to implement an assessment of the needs of both Narragansett families and the Eastern Woodland Tribes interconnected within and around RI. She will be implementing talking circles, and surveying of the community in order to understand the needs of the community, and the potential solutions to those needs. These findings will be integrated into our upcoming Title V needs assessment process and report.

 

The Family Visiting Parent/Caregiver Advisory Council (P/CAC): The P/CAC is made up of parents/caregivers from across rural, suburban, and urban RI that at one point were recipients of Family Visiting services or currently receiving services. Parents and caregivers may have also been participants in Early Intervention or Early Head Start.  The committee is convened monthly by RIDOH Family Visiting and Newborn Screening program managers and participants are reimbursed for their time.  The members of the P/CAC were asked if they preferred in-person or virtual meetings, and the group chose to proceed with virtual meetings.  When meetings are in person, food, refreshments, and childcare is provided. The P/CAC advises on different topics such as: family engagement, family visiting marketing and outreach, family needs, and family visiting service asset and gaps. The group also elects parent/caregiver officers each year.  An in-person event at a local zoom was held for current and alumni members of the P/CAC and their families.  The same was done for Thanksgiving and a harvest dinner was held at one of the family visiting agencies for the P/CAC.   In the coming year, the committee will continue to meet and advise on the above topics.

 

Rhode Island Parent Information Network: The RI Department of Health (RIDOH) Title V Program contracts with RIPIN to engage Peer Professionals who are Parent and Community Leaders that provide expertise in systems of care for CYSHCN. RIPIN provides quality resources, education and training to families with CYSHCN and the professionals who serve them.

RIPIN held our 2nd Policy Forum on Access to Preschool Special Education. Due to the PHE, many children were not referred to Early Intervention within an appropriate time frame. Those who were referred were not able to be serviced as they had been previously due to isolation, therapies being offered virtually, and workforce challenges. Children fell further behind and created a backlog of children entering special education preschool services. RIPIN surveyed families and providers to gather needed data and information. We then interviewed key informants and reached out to families who identified that they would be interested in future advocacy opportunities. We then planned an event to bring everyone together to discuss the issues.  We had a panel of professionals that included a representative from the Governor’s office, a district Special Education Director, a representative from the Early Intervention training school, and a Head Start/Childcare provider. Families were able to share their experiences, or lack of experience, with accessing preschool special education. All involved broke bread together and brainstormed on how to help better support children who are in need of services. It was the beginning of an ongoing initiative that we are continuing to work on with partners, families, and policy makers.

RIPIN’s Call Center works in partnership with the Office of the Health Insurance Commissioner (OHIC) and HealthSource RI. The Call Center is the designated Consumer Assistance Program for 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, at both consumer’s homes and within the community, providing 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.

 

RIPIN is also the federally designated Family to Family (F2F) Health Information Center for the State of Rhode Island. RIPIN continues to grow in our commitment to the cause of promoting racial justice, both in our workplace and in our community. This year we worked on professional development to learn more about biases in the workplace and how to handle conflict resolution. We’ve enhanced the diversity of our professional development, created safe spaces for staff to talk about race, and improved data collection about the race, ethnicity, and language of those we serve. RIPIN is dedicated to addressing inequities in health care and education. Currently, 90 percent of RIPIN employees are certified or working toward Community Health Worker certification. We have also supported families from our networks to become certified CHWs.

 

Family Voices: The RI Department of Health (RIDOH) ensures the incorporation of family leadership through contractual support of the Family Voices (FV) program which is housed within RIPIN. Family Voices is a national grassroots network of families representing CYSHCN with a designated affiliate office in each state and territory. The Family Voices program fulfills the Title V CYSHCN mandate to provide opportunities for parent engagement, leadership development, and policy advocacy to address the uninsured and underinsured CYSHCN. Family representation and/or input is incorporated into the following: task forces, advisories, and councils where policies and decisions are made that will impact CYSHCNs; communications development/distribution; parent/caregiver support groups; community outreach; and legislative policy development/advocacy.
 

Family Voices Leadership Team: RIDOH contracts with RIPIN to convene The Family Voices Leadership Team, an advisory body comprised of state agencies, healthcare providers, and community stakeholders, to provide expertise and input on a variety of issues affecting the system of care for CSHCN. Current members include:

• The Autism Project
• Bradley Hospital - (Children’s Behavioral Health)
• The Governor’s Commission on Disabilities
• Parent Support Network of RI
• Protect our Health Care Coalition of RI
• RI Behavioral Health, Developmental Disabilities, and Hospitals
• RI Department of Health, Office of Special Needs, Birth Defects, and Traumatic Brain Injury
• RIPIN
• United Health Care
• United Way

 

Family to Family Health Information Center (F2FHIC): RIPIN is also Rhode Island’s HRSA funded F2FHIC, which is housed within Family Voices. This program provides families of CYSHCNs with support, resource referral, training, workshops, advocacy, and relevant information via newsletters/publications/websites. The Leadership in Family and Professional Partnerships program provides technical assistance, training, and connections among the F2FHICs in the states and territories. The RIPIN Family Voices Manager has been facilitating regional calls among the Region A FV and F2Fs for the last 8 years creating connections that increases our reach and enhances our service to families.

 

RIPIN Peer Resource Specialists: Through a contract with RIDOH, RIPIN employs Peer Resource Specialists to strengthen Rhode Island’s capacity to plan and deliver effective services to special needs, disability, and vulnerable populations. The Peer Resource Specialists bring the perspective of parents, youth, and consumers into the programs where they are placed. In addition to employment within the RIDOH, Peer Resource Specialists are employed throughout the CYSHCN service system, assisting healthcare professionals, community stakeholders, and  policy leaders in providing support to CYSHCN and their families. RIPIN has developed and registered an apprenticeship program with the RI Department of Labor and Training, to further support the development of certified community health workers (CCHWs) utilizing employed Peer Resource Specialists. RIPIN has aligned its professional development programming to the domains of the certification standards. RIPIN employees are expected to earn certification within their first 18 months of employment. During the last year, Peer Resource Specialists have worked with the following RIDOH programs: Special Needs, Birth Defects, Oral Health, Emergency Preparedness, Home Visiting, Health Information Line, Chronic Disease, WIC, and Immunization.

 

Parent Support Groups: Family Voices has seen tremendous growth in our Spanish Support Group. They allow for families from all over the state to attend by holding meetings virtually. The group has created a WhatsApp group with over 40 individuals who use the group to talk between support group meetings.  RIPIN will continue to host a monthly Peer Support Group for families and caregivers of CYSHCN, in both English and Spanish, facilitated by RIPIN staff members, who are also parents of CYSHCN. The goal of the support group is to foster guidance and support from peers who share their same experiences.

 

Convene the MCH/HEZ Learning Classroom: The HEZ MCH Learning Classroom is an interactive educational space created to educate Health Equity Zones on Maternal Child Health issues across all six domains. The Maternal Child Health Program has put together a list of speakers from both the community and RIDOH to attend our bi-monthly meetings and educate the group on the initiatives they implement. Each HEZ must send a representative to consistently attend the learning classroom meetings. These educational learning sessions are still taking place on a bi-monthly basis.

 

Advance a Comprehensive System of Engagement and Leadership Development for Vulnerable Populations through the Health Equity Zones: RIDOH’s supports a comprehensive system of engagement and leadership development for vulnerable populations through the following initiatives:

 

Health Equity Institute: Health Equity Institute (HEI) was created by Former 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 policymakers 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 Trainings: RIDOH received a Kresge Foundation Applied Learning Resource Grant through the Emerging Leaders in Public Health (ELPH) initiative to support agency transformation to integrate social justice into RIDOH’s practices and create a new role for public health to advocate for social and environmental justice policies. As part of this work, RIDOH partnered with The Praxis Project and Berkeley Media Studies Group (BMSG) to host two full-day trainings to help us communicate more effectively about social justice and health equity. The ELPH Initiative provided critical support that has helped RIDOH transform the way we communicate about health disparities enabled RIDOH to obtain technical assistance and training for staff across the department from leading experts in the health equity and health communications field, including The Praxis Project1 and Berkeley Media Studies Group2.

 

As a result of this training, RIDOH has developed new messaging to help make the case for advancing health equity and social justice, and garner support for specific health equity initiatives, like its Health Equity Zone model. RIDOH has also begun applying a stronger racial equity lens to its messaging, explicitly calling out racism as a barrier to health and advocating for approaches that advance racial equity. To encourage further engagement in health equity work across the Department, RIDOH continues the regular health equity series in its employee newsletter, called “Health Equity Now,” and maintains a page on its intranet to share health equity resources and training opportunities with employees. RIDOH is also exploring how to better highlight stories about how employees are advancing health equity in their work, and how the lived experiences of employees motivate them to do this work.

 

With funding from the Robert Wood Johnson Foundation (RWJF) and the Association of State and Territorial Health Officials (ASTHO), and in partnership with ChangeLab Solution, RIDOH published, updated, and maintains the Health Equity Zones: A Toolkit for building Healthy and Resilient Communities, which demonstrates how together, state and local health departments can all begin to guide our communities towards the goal of truly achieving health equity.  This toolkit explores what it means to establish Health Equity Zones, identifies the four key components of an HEZ-like initiative, and describes how RIDOH’s HEZ model and theory of change address the shortcomings of traditional public health prevention approaches.

In addition, with the support of ELPH project consultants Human Impact Partners and Berkeley Media Studies Group, RIDOH’s Health Equity Institute (HEI) created a guide, “Building a Shared Language around Health Equity,” to foster shared understanding about terms and concepts including social justice, institutional racism, and structural inequities.

Lastly, the HEZ initiative through RIDOH is working with Brown University to provide data training opportunities through a “Data Academy” for community members and HEZs to support the use and accessibility of data around social and environmental determinants of health.

 

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 determinants of health and eliminate health disparities. The CHAE membership reflects the diversity of RI, including individuals from or representing racial / ethnic minorities (Latino, Native American, and Black), persons with disabilities, LGBTTQQ, and people with limited English proficiency. 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.

 

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 identifies 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 identifies global recommendations for addressing health disparities in RI. The second report released in December 2017, establishes 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 third report was published in January 2020 and highlights RI’s Statewide Health Equity Indicators. This report provides data related to these measures to help educate the Rhode Island General Assembly, State agencies, and partner organizations on health inequities in Rhode Island. For each measure, the report also includes examples of programs and policies in Rhode Island and across the country that are showing promise for reducing inequities.

 

Statewide Health Equity Indicators: Over the past few 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.

 

HEZ MCH Activities Analysis Summary and Proposed Metrics:  An examination and analysis of the end of year reports of activities of each Health Equity Zone provided information to form a summary of activities by grouping MCH related activities by type of activity, social determinants of health addressed, and populations served. The Health Equity Zones (HEZs) provided MCH related activities and programs across the different HEZs to communities in several primary focus areas addressing Social Determinants of Health, as identified by the needs of the communities. These key areas of MCH activities across the HEZs include:

1. Family and parenting support/education (including infant safe sleep education);
2. Youth/teen engagement, education, academic and social-emotional support, mental health, health education, and sexual health education;
3. Quality/healthy child care, afterschool programming, preschool, and Kindergarten readiness;
4. Healthy lifestyles for youth and family, including healthy food access and availability, nutrition, breastfeeding support, and exercise;
5. Healthy homes, including lead and asthma correlates;

 

Given these primary areas of activities and reach, the following measures are proposed for tracking and evaluation over time of each of these areas as well as the overall impact of MCH activities within the HEZ areas and for the Health Equity Zone initiative overall as it relates to MCH activities:

1. Childhood obesity rates for different age groups ranging from infant to high school, and infant mortality rates (related to programs/activities of healthy lifestyles/nutrition and healthy food access/exercise/breastfeeding support);
2. Child maltreatment rates and infant mortality (related to family/parenting support/education);
3. High school graduation rates, school chronic absenteeism, and teen birth rates (related to youth engagement, academic and social-emotional support, and health and sexual education);
4. Preschool and childcare enrollment rates, and Kindergarten readiness scores (related to quality, healthy childcare and preschool access, and afterschool programming);
5. Incidence of high household lead, rates of childhood asthma/incidence of asthma related ER visits among children, tobacco use rates in homes with children (related to healthy homes).