Cross-Cutting/Systems Building Annual Report
Primary Care Office (PCO) Report
The Nevada Primary Care Office (PCO) improves health care access through its efforts to coordinate the federal shortage designation process, the J-1 Physician Visa Waiver Program, and other recruitment and retention programs. These efforts are supported by a strong collaboration between the PCO and Title V MCH, Area Health Education Centers, the Office of Rural Health, health care training programs, community health centers, rural health clinics, tribal clinics, rural hospitals, and other safety net health care sites. The PCO receives base funding from the federal Health Resources Services Administration (HRSA) to support its efforts. Because this work helps to improve health care access for maternal, child, and adolescent populations, the Title V MCH grant supports 0.25 FTE Health Resource Analyst in the PCO. Staff in the PCO continue to support Title V MCH initiatives through regular participation in Maternal and Child Health Advisory Board (MCHAB) meetings and through quarterly reports of PCO progress relating to MCH goals. The PCO is also regularly briefed by and collaborates with Title V MCH staff at quarterly Data Sharing Meetings hosted by the PCO.
PCO Shortage Designation
The PCO created health data reports for health needs assessments for Southern Nevada Health District and Washoe County Health District. The finalized Washoe County Health District report was completed and is published online at https://www.washoecounty.us/health/data-publications-and-reports.php. These reports included data and maps that outlined primary care, dental and mental health professional shortage areas (HPSAs), provider numbers, populations experiencing the shortages, and the numbers of providers needed to overcome these shortages.
The PCO submitted to HRSA 70 shortage designation applications to update all geographic and low-income HPSAs (20 primary care HPSAs, 22 dental HPSAs, 7 mental health, and 21 HPSAs supporting seven state correctional facilities) – all were approved. These updates to Nevada’s HPSAs are a result of months of work in collaboration with statewide partners to analyze all HPSAs throughout the state. As a result, primary care HPSA boundaries were expanded in urban Washoe and Clark counties, and in rural and frontier Humboldt and White Pine counties. Additionally, all of Clark County is now within a mental health HPSA. The PCO created and presented maps of the updated Health Professional Shortage Areas (HPSAs) in Nevada to the MCHAB and to other strategic partners. The Health Resource Analyst in the PCO was selected to be one of two state representatives in the country that participated in a federal auto-HPSA workgroup. Auto-HPSAs support Federally Qualified Health Centers, Indian Health Service and Tribal health care sites, and Rural Health Clinics throughout Nevada. The PCO strongly advocated for communication measures that support our state safety net clinics.
PCO National Health Service Corps and Nurse Corps Program Coordination
National Health Service Corps (NHSC) outreach activities during this year included 11 health clinic site visits, 14 webinars, and 12 outreach events. These activities increase awareness of the program and subsequent program participation, which leads to increased recruitment and retention of health providers for underserved maternal, pediatric and adolescent populations. The PCO also reviewed 34 NHSC site applications. These safety net health care sites serve all patients regardless of ability to pay and represent critical primary care, mental health, and dental access points for maternal, pediatric, and adolescent populations in Nevada.
PCO J-1 Visa Waiver Program
Fourteen applications were reviewed, public hearings held, and letters of support completed for primary care, mental health, and specialist physicians to participate in the J-1 Physician Visa Waiver program. These doctors will serve underserved populations in Las Vegas, Dayton, Carson City, North Las Vegas, and Sparks, including maternal, pediatric and adolescent populations. Additionally, five participant compliance site visits were completed to provide technical assistance and to assure compliance with program requirements.
The PCO Newsletter was published in March, June, and November and included multiple articles supporting maternal, child and adolescent health. Informational articles were included to support the Nevada Pregnancy Risk Assessment Monitoring System (PRAMS), a National Governors Association Learning Collaboration effort to increase access to insurance coverage and medical care for adolescents ages 15 to 18 years, and the Medical Home Portal for families with children with special needs. The newsletter also included stories and testimonials from Nevada providers about how the National Health Service Corps and the J-1 Visa Waiver program supports increased access to health care throughout the state. PCO shared MCAH information through provider listservs.
The PCO manager participated in the National Governor’s Association and the National College of State Legislatures workgroups to support health initiatives in Nevada. These workgroups include public health leaders and legislatures. The workgroups developed goals to support improvement of health care data collection and use in policy develop, and increased access to behavioral health services, especially in rural and frontier areas. Additionally, the groups worked on initiatives to increase the physician’s assistant, psychiatric nurse specialist, and community health worker pipeline into Nevada. These provider types are critical for expanding mental health care access in underserved areas.
The PCO Manager participated in the Elko Community Summit on Opioid Abuse. This event brought together the Nevada Office of Rural Health, local mental health care providers, local coalitions, law enforcement, state of Nevada public health leaders, and HRSA leadership for a community forum and discussion on the effect of the opioid epidemic on the community of Elko. This event was an important educational and networking opportunity to help in coordinating the effort to combat opioid abuse.
Adequately Insured Children Report
Carson City Health and Human Services (CCHHS) referred uninsured families to Nevada 2-1-1 to obtain health insurance benefits information and conducted two Nevada 2-1-1 Facebook campaigns with a reach of 5,620. Additionally, CCHHS distributed brochures outlining steps to access insurance to families of adolescents. CCHHS has a successful partnership with the Division of Welfare and Social Services (DWSS) for onsite, walk-in Medicaid application assistance. In-reach was conducted to uninsured clientele on options for health care coverage. The partnership assisted 526 families with onsite Medicaid applications.
Nursing personnel within DPBH Community Health Services provided information to uninsured people in the rural and frontier regions to insurance resources through Nevada Medicaid, Nevada Check Up (Nevada’s Children’s Health Insurance Program), and the Silver State Health Insurance Exchange (Nevada’s health insurance marketplace). Undocumented residents and those not eligible for Medicaid or other insurance were referred to Access to Healthcare Network (AHN).
PACE Coalition referred uninsured families to Nevada 2-1-1 to obtain health insurance benefits information, as well as distributed brochures outlining steps to access insurance to families of adolescents. The PACE Coalition’s Community Health Worker (CHW), through targeted work in Elko and nearby communities, assisted 59 Latinos and underserved individuals to access insurance/Medicaid, healthcare services, and other supports necessary to improve health. The CHW advocated for people with barriers to access healthcare services.
The Title V MCH Program developed a legislative factsheet educating providers and the public about the passage of Nevada Senate Bill (SB) 325 of the 79th Legislative Session. The bill authorizes Medicaid and Nevada Check Up to provide health coverage for children under 19 years of age and lawfully residing in the U.S. without a 5-year waiting period. The information was disseminated though the DPBH and MCH Coalition websites, partner agency listservs, e-newsletters and websites, as well as the Nevada School-Based Health Alliance and School-Based Health Centers (SBHC). The inclusion of newly eligible, lawfully residing, qualified, non-citizen children provides insurance opportunities to 7,484 previously ineligible children for fiscal years 2017-2018 and 2018-2019.
Title V MCH funded a 0.5 FTE position for Nevada’s Chronic Disease Prevention and Health Promotion (CDPHP) Section to support MCH activities to help ensure children are adequately insured. CDPHP was awarded the Connecting Kids to Coverage (CKC) grant which resulted in insurance enrollment for 372 parents and 490 children to access healthcare and support services. The CKC grant funding concluded June 30, 2018 and MCAH participated in technical assistance related to CHWs.
CDPHP efforts to increase the number of adequately insured children are conducted by the State Community Health Worker (CHW) Program by funding the Nevada Community Health Workers Association (NvCHWA). The association conducts trainings designed to build a CHW workforce to support health education and increase access to care. NvCHWA facilitated a Cardiovascular Health and Screening Module enhancing skills for 32 CHWs to help manage and prevent cardiovascular-related health problems. The training educated on the use of self-measure blood pressure monitoring with clinical support and engagement for non-physician team members in hypertension and cholesterol management, especially as they relate to women of childbearing age. The CHW Program and NvCHWA partner on several projects. Joint efforts trained 56 new CHWs and resulted in initiation of the first Nevada CHW Conference bringing in local and national speakers to educate 92 attendees on various topics. Title V MCH funding for these activities concluded September 30, 2018.
Office of Suicide Prevention and Hotline Report
Title V MCH funding helps support the Nevada Office of Suicide Prevention (OSP) through the provision of salary support to enable outreach and education, facilitated information-sharing, and consensus building among multiple constituent groups. New partnerships to enhance suicide prevention efforts were developed with the Nevada Physician Wellness Coalition, Nevada Advanced Practice Nurses Association, American Academy of Pediatrics - Nevada Chapter, and UNLV School of Medicine resident physician orientation.
OSP conducted several suicide education and prevention courses resulting in: 134 safeTALK trainings reaching 2,073 community members and/or school staff; 36 Applied Suicide Intervention Skills Trainings (ASIST) workshops reaching 493 providers and/or caregivers; 59 Nevada Gatekeeper trainings reaching 2,292 participants; and 96 veterans and/or service members receiving awareness or intervention training. The Reducing Access to Lethal Means program provided outreach to 20-gun shop owners and shooting range staff, as well as 521 first responders.
OSP expanded school-based mental health screening across the state through partnerships with community coalitions and organizations. The Project AWARE grant trained 569 community helpers to identify mental health risks in youth using Youth Mental Health First Aid (YMHFA) guidelines.
Nevada Oral Health Program Report
The Oral Health Program (OHP) compiled 5,000 bags of oral health supplies and educational materials for Nevada’s Women, Infant and Children (WIC) supplemental nutrition program enrollees. Bags were distributed among 45 WIC centers and resulted in an increased awareness on the importance of oral health. OHP oversaw the completion of a survey which included families of over 400 children enrolled in 16 Nevada Head Start Centers. The survey indicated a need for oral hygiene training, education and preventive services. Additionally, OHP visited Las Vegas’s Summit View Correctional Facility, and consulted with nurses and healthcare providers on the importance of oral health education. The Program provided 552 program enrollees with toothbrushes, toothpaste, floss, and Dental Service Directories.
In February 2018, the OHP Manager position was filled. OHP prepared for a rural pilot, to include: procuring supplies, creating intake forms, executing Memoranda of Understandings (MOUs) and hiring additional staff. During the spring and summer of 2018, OHP collaborated with the Southern Nevada Health District on “Medical Miles for Rural Smiles” trips. During April 9-11, 2018, OHP delivered 115 preventive dental sealants, 51 fluoride varnishes, 52 dental screenings, 33 immunizations, provided oral cancer screenings, distributed oral hygiene supplies and nutritional information, and offered Medicaid enrollment packets to all MCAH population attendees. During May 21-23, 2018, OHP delivered 22 preventive dental sealants, 11 fluoride varnishes, 11 dental screenings, oral cancer screenings, oral health, and nutritional information. OHP continued to educate and serve Nevada’s underserved/rural populations throughout the remainder of the federal fiscal year, including MCH and CYSHCN populations.
The OHP continues to educate Nevadans on the importance of oral health by collaborating with schools, universities, medical and dental providers, and coalitions to enhance standards of care. During 2017 and 2018, the Program hosted and actively participated in quarterly Advisory Committee on the State Program for Oral Health (AC4OH) meetings. Furthermore, the Program monitored, and continues to monitor, the City of Henderson and Southern Nevada Water Authority’s water fluoridation results and submits surveillance reports to the Centers for Disease Control and Prevention (CDC).
Tobacco Cessation Report
All Title V MCH funded programs promoted the Nevada Tobacco Quitline to pregnant women and women of child bearing age. CCHHS provided 638 smokers tobacco education, counseling, and/or referrals to the Nevada Tobacco Quitline. CCHHS promoted the Nevada Tobacco Quitline each month on the clinic digital signage, as well as conducted a Facebook campaign reaching 2,803. Nursing personnel within Community Health Services (CHS) counseled and referred 229 smokers to the Nevada Tobacco Quitline. Additionally, Partners Allied for Community Excellence (PACE) Coalition provided information on the importance of tobacco cessation to pregnant women and distributed Nevada Tobacco Quitline cards.
CCHHS and CHS utilized the Brief Tobacco Intervention developed by the Agency for Healthcare Research and Quality (AHRQ) to address tobacco use with clients. The five-step intervention is designed to be repeated at each visit. The practitioner asks about tobacco use, advises and encourages cessation, assesses if the individual is willing to quit, and then assists smokers interested in quitting and arranges for a follow-up session (in person or telephone) to determine the quit attempt outcome. The intervention, conducted in less than three minutes, is an effective means to screen and refer to the Nevada Tobacco Quitline.
The Tobacco Control Program Report
The Chronic Disease Prevention and Health Promotion (CDPHP) Tobacco Control Program (TCP) disseminates targeted Nevada Tobacco Quitline (NTQ) promotional material for pregnant and postpartum women who use tobacco via Nevada providers, Women, Infants, and Children (WIC) clinics, early childhood educators and Nevada Head Start sites. The NTQ continues to provide callers13 years and older with up to five scheduled personalized, culturally competent, coaching sessions, unlimited inbound calls, web and text support, and Nicotine Replacement Therapies (NRTs) free of charge to callers ages 18 and older, upon availability. The Pregnancy/Postpartum (PPP) program offered mothers in Nevada a designated, trained coach throughout each session along with incentivized gift cards for each completed counseling call. According to guidelines of the PPP program, each pregnant caller was enrolled before giving birth to ensure eligibility for both programs. This allows the mother to focus on her health, as well as the baby, creating longevity for both the baby and the mother. Comprehensive printed educational materials on benefits of quitting smoking during pregnancy and harmful effects on babies was provided upon each enrollment process.
The NTQ enrolled 1,063 callers during the program period which included three pregnant women. The NTQ offers a free program specializing in helping pregnant mothers quit smoking. The tailored treatment plan meets their needs by providing intensive behavioral support, including an increased number of coaching calls compared to the general population. As an incentive, reward gift cards for $5 and $10 are given after scheduled and completed counseling calls. For pregnant and new mothers who have quit, additional postpartum support is available to prevent relapse. NTQ uses evidence-based treatment practices to help pregnant smokers quit and remain tobacco free. Although the call volume was limited, outreach was expanded to Community Health Workers, women’s health care providers, WIC clinics, and events in the community. MCH opportunities to heighten NTQ awareness are being implemented, including promotion by all Title V MCH funded partners and the Chronic Disease Coalition monthly newsletters.
Partnerships continued to expand with the NTQ as listed: Medicaid Managed Care Organizations (MCOs), Division of Welfare and Social Services, Maternal, Child and Adolescent Health (MCAH), local tribal health departments, University Medical Center, Nevada Health Centers, Carson Tahoe Hospital, Lyon County Medical Center, Northern Nevada Health Centers, Access to Healthcare Network, and mental health clinics. Established relationships with providers created an opportunity for a health system change through a NTQ e-Referral process specific to patients interested in cessation.
Nevada tobacco use data indicates many Nevadans covered by Medicaid currently smoke. Additionally, Nevada Medicaid recipients are the highest percentage (approximately 30%) of callers to the Nevada Tobacco Quitline. From, January 1, 2018 to October 30, 2018, Nevada Medicaid recipients represent 19.3% of calls. The Nevada TCP partnership with Nevada Medicaid has ensured Medicaid’s MCOs provide comprehensive cessation coverage. Of Nevada’s three MCOs, two MCOs are utilizing services through the state quitline vendor to provide evidence-based tobacco cessation services. The third MCO contracts with the NTQ to triage their callers to their own cessation services provided to these recipients. The successes allow program funding to be directed to other necessary tobacco control projects statewide and to assist in building sustainability for tobacco cessation in Nevada. An extensive report is currently in its final stages detailing each MCO’s cessation benefits offered, quitline accessibility, NRT availability, and medication barriers. It will be distributed in the Spring of 2019.
Southern Nevada partners met with over 271 stakeholders to promote development of a comprehensive clean indoor air policy. The TCP has also continued to support its partners in expanding smoke-free housing in Nevada. Currently, northern Nevada has 4,525 smoke free units while southern Nevada has over 49,400 smoke-free units.
Nevada Tobacco Quitline Social Media Campaign Report
The Nevada Tobacco Quitline Social Media campaign was hosted by DP Video in June 2018. Messages were placed on Facebook, Instagram and Twitter on the Nevada Wellness social media sites. Messages represented multiple races and ethnicities, met National Culturally and Linguistically Appropriate (CLAS) standards, and were available in English and Spanish. Funding attribution was included in all messaging.
The goal of this campaign was to raise awareness of the importance of being tobacco free for a healthy pregnancy and to encourage pregnant women to use the Nevada Tobacco Quitline for help with tobacco cessation. This campaign also shared Centers for Disease Control and Prevention (CDC) messages describing the effects of smoking during pregnancy. The target audience included pregnant women in Nevada.
A variety of social media channels were chosen to ensure effective outreach and maximize coverage of our audience. The content for the campaigns was gathered from Nevada Wellness and the CDC.
A total of ten messages each in English and Spanish were chosen to be posted and used for sponsoring on the approved social media channels. Five of the messages, in both English and Spanish were animated into videos to maximize social media outreach.
Ten display ads on Twitter resulted in 92,080 media impressions; 15 display advertisements and seven video advertisements on Facebook and Instagram were sponsored with 61,969 video views, 96,607 media impressions, and 74,007 people reached (unique visitors).
The Tobacco Quitline Social Media campaign has reached almost 200,000 media impressions.
Sober Moms Healthy Babies Report
Title V MCH continued to fund and work with the Substance Abuse Prevention and Treatment Agency (SAPTA) list of SAPTA-funded treatment providers to update the SoberMomsHealthyBabies.org website to prevent substance use in pregnant women, as well as provide information to women of childbearing age, providers, and concerned family and friends. The website provides the substance use help line number, Nevada 2-1-1, Crisis Call Center, the Nevada Tobacco Quitline, and other resources. The website specifies the treatment priority status for pregnant women at SAPTA-funded agencies and the importance of women identifying they are pregnant. SAPTA-funded treatment centers must not deny treatment to persons unable to pay. All treatment centers listed on the website are SAPTA-funded.
For this funded period, the website had 13,068 sessions and 8,993 users. New users represented 69% of the total number of users and 31% were returning visitors. A total of 16,998 page views occurred. The number of sessions was up 7,102 from the previous year with an additional 5,985 page views. The majority of these sessions were accessed from Reno, Las Vegas, and Carson City.
The public awareness campaign uses radio and television public service announcements in English and Spanish throughout the state to promote the www.SoberMomsHealthyBabies.org website, in addition to the distribution of referral cards. The collaboration ensures substance use in pregnancy materials and resources will reach the targeted audience. The media campaign had a total of 11,873 total spots aired (2,280 radio advertisements and 9,593 television advertisements), promoting the SoberMomsHealthyBabies.org website and the importance of pregnant women receiving treatment and preventing substance use in women of childbearing age. All local health authorities and Title V MCH subgrantees promoted the SoberMomsHealthyBabies.org website and shared Sober Moms Healthy Babies referral cards.
In an effort to raise awareness on the priority admission of pregnant women at state funded treatment centers, Title V MCH designed a removable wall sticker promoting the SoberMomsHealthyBabies.org website and shared with non-traditional partners. Title V MCH is in contact with state agencies and local health authorities who have agreed to help with distribution and promotion. Partnerships with the Department of Taxation, Division of Health Care Finance and Policy (DHCFP), SAPTA, local hospitals and providers, March of Dimes, faith-based and MCH Coalitions, and other Division of Public and Behavioral Health programs will continue.
SoberMomsHealthyBabies.org Social Media Campaign Report
The SoberMomsHealthyBabies.org Social Media campaign was hosted by DP Video in September 2018. Appropriate messages were placed on Facebook, Instagram, and Twitter on the Nevada Wellness social media sites. Messages represented multiple races and ethnicities, met National Culturally and Linguistically Appropriate (CLAS) standards, and were available in English and Spanish. Funding attribution was included in all messaging.
The goal of this campaign was to raise awareness of the Substance Use During Pregnancy Provider toolkit, the SoberMomsHealthyBabies.org website, and priority admission for pregnant women at state-funded treatment centers. The target audience included pregnant women in Nevada and health care providers who work with pregnant women.
A total of ten messages each in English and Spanish were chosen to be posted and used for sponsoring on the approved social media channels. Five of the messages (both in English and Spanish) were animated into videos.
Ten sponsored ads on Twitter resulted in 19,423 media impressions. The ten posts and animations on Facebook and Instagram were sponsored with 56,268 video views; 139,520 media impressions, and a total of 84,239 people reached (unique visitors).
Marijuana Efforts Report
In response to Nevada’s legalization of medical and recreational marijuana, informational resources on pregnancy, breastfeeding and marijuana were developed by the Title V MCH program and disseminated by Title V MCH Program, the Department of Taxation, the Substance Abuse, Prevention and Treatment Agency (SAPTA), and funded and non-funded partners. The Title V MCH Program funds public service announcements (PSAs) promoting awareness of Pregnancy Risk Assessment Monitoring System (PRAMS) data which will inform program activities. Efforts to reduce substance misuse in pregnancy and improve inter-conception care are funded by the Title V MCH program and include promoting the SoberMomsHealthyBabies.org website and associated media campaign and focusing perinatal activities on reduction of neonatal abstinence syndrome (NAS). Title V MCH funded partners promote SoberMomsHealthyBabies.org through social media and print materials developed by Title V MCH, in addition to the Substance Use During Pregnancy Toolkit, marijuana warning posters during pregnancy, marijuana and childhood injury prevention warnings.
Title V MCH works closely with the Department of Taxation, the entity responsible for overseeing recreational marijuana and licensing for dispensaries in Nevada. Title V MCH shares all marijuana resources and provides feedback when asked on materials the Department of Taxation shares. Title V MCH marijuana awareness posters and SoberMomsHealthyBabies.org referral cards and removable wall stickers are provided to all dispensaries.
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