Rhode Island - 2021 - III.E.2.c. State Action Plan - Cross-Cutting/Systems Building

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.

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 expanded 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. Throughout July 2019 to June 2020, the 3 new Health Equity Zones conducted comprehensive community needs assessments and developed action plans based on their findings. At the same time, the 7 existing HEZs reassessed their communities’ needs to ensure their action plans aligned with emerging needs in their communities. In March 2020, when the COVID-19 pandemic reached Rhode Island, the Health Equity Zones worked to rapidly identify and respond to emergent needs in their community. For example, HEZs coordinated food delivery, distribution of PPE, and social and educational supports for families with children. During COVID-19, HEZs have been an essential factor in response efforts, serving as a liaison between the community and the Department of Health, and coordinating resources and services at the community level.

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:

1. Improve the health, education, and well-being of all children and youth in RI.

2. Increase the efficacy, efficiency, and coordination of service delivery.

3. 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.

In 2019, RIDOH worked with the Children’s Cabinet to write a competitive grant for Preschool Development Funding. This grant was received and RIDOH received funding for two primary scopes of work. 1) to fund Health Equity Zones to implement evidence-based parent education and support programs and to imbed family navigators into early childhood programs. The goal of the navigators is to help families understand and access services that they need. The second scope of work was to expand the parents as Teachers program, RIDOH is in the process of funding new agencies to expand PAT by 300 slots.

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
In 2020, RIDOH will continue collaborating with the CTC to support PCMH-Kids practices in integrating Family Home Visiting within the Medical Home and doing joint care coordination for families facing adversity.

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 recently worked 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.

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

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 third report was published in January 2020 and highlighted 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.

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 2019, youth resource specialists led a monthly Youth Advisory Council where an average of 35 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 450 students; and presented at the Turn Up Rhode Island Conference featuring career exploration for 300 students of color. Unfortunately, youth conferences expected to take place in the Spring of 2020 were cancelled due to Covid.

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 Rhode Island Department of Health (RIDOH) is one of seven states to receive funding from the Health Resources and Services Administration’s Screening and Treatment for Maternal Depression and Related Behavioral Disorders Program, which seeks to assist obstetrical, adult primary care, pediatric, and psychiatric providers in optimizing behavioral health care for pregnant and post-partum women. To achieve this end, the RIDOH has partnered with the Center for Women’s Behavioral Health at Women and Infants Hospital (CWBH) to establish a free statewide psychiatry telephone consultation service for healthcare providers treating pregnant and postpartum women, especially those in rural and medical underserved communities. The RIDOH has also partnered with the Care Transformation Collaborative of Rhode Island (CTC) to provide intensive quality improvement coaching about behavioral health screening, treatment, and referral to contracted prenatal care practices.

The RI MomsPRN teleconsultation line is staffed by perinatal experts at the CWBH and is modeled after Rhode Island’s successful Pediatric Psychiatry Resource Network (PediPRN) program. The goal of the RI MomsPRN psychiatry teleconsultation line is to empower providers in effectively managing their perinatal patients’ behavioral health and substance use concerns, by initially providing treatment guidance from RI MomsPRN perinatal psychiatric specialists, and/or offering information and referral for additional supports and services in their patients’ geographic area. Since its launch in September 2019, the RI MomsPRN teleconsultation line has fielded 226 teleconsultation calls, with 50 coming directly from patients and the remaining 176 calls coming from 128 unique providers (25 OBGYNs, 16 therapists, 14 midwives, 10 family visitors, 10 OBGYN nurse practitioners, 9 psychiatric nurse practitioners, 8 pediatricians, 8 family medicine doctors, 6 psychiatrists, 5 social workers, 3 OBGYN residents, 2 family medicine nurse practitioners, 1 primary care provider, 1 primary care nurse practitioners, and 10 other types of providers). In total, 176 women (including 57 pregnant women) were helped as result of their healthcare provider or RIDOH family home visitor accessing the RI MomsPRN teleconsultation line. Most of these perinatal patients have a provisional diagnosis of depression (124), anxiety (96), bipolar disorder (17), substance use disorder (15) or PTSD (14). Calling providers are increasingly looking for support with identifying individual therapy referrals (98), connecting patients to the CWBH for diagnostic evaluations (35), referrals to the CWBH’s partial hospitalization program (31), medical consultations with the RI MomsPRN attending psychiatrist (30), help identifying support groups (23), or psychopharmacology guidance (12). Through a partnership with CTC, the RI MomsPRN program is also able to provide intensive quality improvement and practice transformation services to prenatal care practices seeking to implement, optimize, or spread perinatal behavioral health screening, treatment, and referral workflows and protocols. Upon soliciting and reviewing competitive applications in the fall of 2019, 4 prenatal care practices (Center for Women’s Health, the Women & Infants Obstetrics and Gynecology Care Center (OGCC), Women’s Care, and Women’s Medicine Collaborative) were selected to join the first cohort of the RI MomsPRN perinatal behavioral health quality improvement initiative. Taken together, these 4 practices manage 32% of all RI births, serve both rural and medical underserved populations, and are affiliated with differing hospital/healthcare entities, (Care New England (OGCC and Women’s Care), Lifespan (Women’s Medicine Collaborative), and South County Health (Center for Women’s Health)). Individual practice quality improvement teams meet monthly with CTC practice facilitators and all contracted practices jointly attend quarterly learning sessions facilitated by CTC that includes clinical advisement from CWBH staff to help them address common workflow issues and/or share promising practices. To monitor progress, RIDOH collects de-identified aggregate screening data among contracted practices. In January 2020, contracted practices began implementing perinatal behavioral health screening protocols and the latest collected screening data show that 48% of perinatal patients have been screened for depression, 6% have been screened for anxiety, and 2% have been screened for substance use disorder at least once in January or February 2020. Practices have the remainder of the 2020 calendar year to ensure that every perinatal patient is screened at least once for depression, anxiety, and substance use disorder, which is aligned with numerous evidence-based clinical recommendations and committee opinions.

In addition to providing perinatal behavioral health teleconsultation and practice transformation services for healthcare providers, the RI MomsPRN program also collaborated with RIDOH’s Family Home Visiting Program and the Women, Infants and Children (WIC) Program to create, distribute, and promote a public service campaign about perinatal depression and anxiety and the importance of seeking help by connecting with a healthcare provider. The 30 second spot featured a patient testimonial and was aired on a local news station in June 2020. To help further amplify this campaign, the RIDOH created a new mental health resource page for new moms and featured the campaign on its various digital platforms.

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. PediPRN focusses on creating a culture of empowerment for pediatric primary care providers. The clinical team works closely with providers offering CME opportunities, educational e-blasts, an updated website with assessment and educational resources on pediatric behavioral health topics, and ongoing support during telephonic consultations. In addition, PediPRN implemented the delivery of training, mentoring and education to PPCPs in the PediPRN Intensive Program (PIP) with the goal of creating a group of practitioners embedded in each of their home practices who will serve as local experts on various behavioral health topics. The PIP program has completed it’s first year and a second cohort of physicians has begun in 2020. Additionally, PediPRN has expanded its capacity as a resource to providers during COVID-19 an has started hosting “office hours” to physicians via zoom. Providers can speak with a staff psychiatrist, or with each other, about topics to support behavioral health treatment in their practices. This additional resource is meant to provide additional support to providers during these unprecedented times.

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- Through a partnership with DHS, child focused mental health consultation is available statewide. RIDOH is currently working with DHS to sustain its program focused mental health consultation to childcare as well. In 2020, several mental health professionals from Bradley Early Childhood Research Center, who are also early childhood mental health consultants, developed and delivered a training on how to become a child care mental health consultant with the goal of expanding the capacity of the system overall.

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 conducting ongoing 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 Home Visiting Program will continue to support its 14 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. Two levels provide for mental health consultation to family visitors and the other with families. The Family Home Visiting Program provided each family home visiting agency with dedicated funding in the agency’s contract for the past few years that may be used for mental health consultation and supportive services. The Family Visiting Program will continue to do so in future contracts. There is also funding in the Preschool Development Block grant also providers funding to support mental health consultation that will begin in Fall 2020.

In addition to providing funding to each family home visiting agency, the Family Home Visiting Program has partnered with the RI Association for Infant Mental Health (RIAIMH) to provide additional support to the family home visiting workforce. The Family Home Visiting Program works with RIAIMH on training and support related to infant mental health. The Family Home 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 home visiting staff have the competencies and skills to support the parent-child relationship and promote positive parenting practices that address the needs of infants. The family home visiting program has worked with the providers of the reflective practice and supervision trainings and groups to align the their training with the competencies for Endorsement and the training and monthly group supports now support a family visitor that is working on Endorsement.

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 is currently working to rollout the SPI Youth Suicide Prevention work to every public-school district in the state. The VIPP has also implemented the Emotional Regulation program in one Health Equity Zone middle school (Westerly). The VIPP has also participated in the HRSA funded Collaborative Office Rounds grant, whereby the HEZ has received the funding and training is targeted to local pediatricians. 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.

Last 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. Last year, 54 families, including 68 children, received a total of 335 visits, and 9 group sessions were offered.

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.

Central Providence

In 2019, the Olneyville Health Equity Zone expanded its efforts to additional adjacent neighborhoods in Providence to create the Central Providence Health Equity Zone. With the addition of new areas of the community, the Central Providence HEZ conducted a needs assessment in those areas to determine what the HEZs action plan should be for those neighborhoods. Lack of affordable childcare was identified as a community need, and the HEZ developed a plan for establishing a new resident-led childcare center and for improving existing childcare centers in the area.

The Central Providence HEZ’s main focus is on economic opportunity, and those efforts included the development of internship opportunities for teens, and a computer science skill-building program for middle school girls. The HEZ also utilizes community health workers to connect residents to social services and to keep a pulse on the needs of the community. Community Health Workers also work with families to increase enrollment in Family Home Visiting programs. The CP HEZ’s CHWs have been an integral part of their response to COVID-19, by allowing efficient communication of residents’ needs to the HEZ, which was able to leverage its relationship with RIDOH and other agencies to direct resources to families with urgent needs during COVID-19.

East Providence

As a new HEZ, East Providence conducted a comprehensive community assessment this year, which included a youth focused survey that received almost 200 responses. In response to the findings of their needs assessment, the EP HEZ plans to establish a Youth Health and Wellness focus group, hire a Family Navigator to engage families in Home Visiting programs, and to develop a program for families using the evidence based Parents As Teachers (PAT) model.

Newport

In addition to continuing to support ongoing maternal and child health work throughout their community, the Newport HEZ began focusing on key target populations most in need of health equity work. For example, they are working with community partners and healthcare providers to improve healthcare access and improve healthcare experiences for LGBTQ+ teens.

The Newport HEZ has also focused intensively on racial equity and racial justice. One of the Newport HEZ’s leading priorities is to eliminate disparities in black maternal and child health outcomes. In efforts to improve racial equity, the HEZ participated in and hosted several racial equity trainings throughout the year, reaching hundreds of attendees in the Newport community and beyond. The Newport HEZ conducts all of their work through a resident-centered, racial justice lens.

Pawtucket/Central Falls

The Childhood Lead Action Project (CLAP) continued to provide lead poisoning prevention and education to the Pawtucket and Central Falls communities. CLAP facilitated five lead poisoning prevention workshops at local schools. In previous years, the HEZ’s partnership with CLAP has contributed to achieving a 44% decrease in childhood lead poisoning in Pawtucket, and the HEZ continues to support work to decrease childhood lead poisoning throughout the community.

The Pawtucket Central Falls HEZ also developed an Opioid Action Plan this year, which includes plans for substance use education for youth, and the creation of positive social opportunities and employment opportunities for youth and young adults. The PCF HEZ’s substance use education programs reached 216 students at local schools this year, and they plan to continue these efforts in the future. In a post-presentation survey of those students, 91% reported that the presentation helped them understand how opioids affect the boy, and 92% reported feeling very or somewhat confident that they would be able to help someone in the case of an overdose.

Through their partnership with the Boys and Girls Club, the PCF HEZ engaged families and youth in a family swim program, anti-bullying and conflict resolution programming, and fitness and wellness classes. The Boys and Girls Club also helped serve 60 families with groceries, gift cards, and activities for youth during COVID-19. Another HEZ partner, Progreso Latino, provided over 100 individuals with birth control options and information regarding pre-natal and post-natal care.

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. To date, the Washington County HEZ has reached over 11,000 children and adolescents with their 5-2-1-0 programming. Ten K-12 schools implemented policy, systems, or environmental changes including offering a new grab-n-go breakfast option, eliminating chocolate milk for breakfast, and starting advisory committees for students to work with food service providers to give input on school nutrition.

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. To date, 337 children have received developmental screenings, and 101 children have received mental health consultations through Project LAUNCH.

West Elmwood

As a new HEZ, West Elmwood spent most of the year conducting a comprehensive community assessment. Part of their assessment focused specifically on teens, including a teen survey. The HEZ identified chronic absenteeism, lack of after school and extracurricular activities, and lack of resources to attain post-secondary education as key issues facing teens in their community. In response, they developed an action plan to address these issues, as well as additional community needs, which will be implemented over the next several years.

West Warwick

West Warwick Public Schools Implemented a 3-tier trauma-informed high school initiative and trained teachers and staff throughout the school department. This year, the West Warwick school department became the state’s first trauma-informed school district. 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. Throughout the year, the West Warwick HEZ continued to support these efforts and others to support families with children impacted by substance use.

Woonsocket

Teen Health continues to be a key focus area of the Woonsocket HEZ. Throughout the year, The HEZ continued to support a Family Planner and Sexuality Educator in Woonsocket High School and continued to implement an inclusive, medically accurate, comprehensive, and evidence-based health curriculum for high school students. Since baseline in 2014, the HEZ’s work has contributed to a 30% reduction in birth to teens in Woonsocket.

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.

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 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 equity and social justice. Funding and support made available through this initiative 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. With this assistance, RIDOH held an initial training in July 2018 for staff in its Center for Public Health Communication and additional staff from Centers and Divisions across the Department. This training helped build staff capacity to apply a health equity and social justice lens to their work and included hands-on practice to develop communications strategies and messages to drive narrative change and effect related changes in policies, systems, and environments affecting health. In March 2019, RIDOH held a follow-up training with the same expert consultants, this time for a more focused group of communications staff and other staff dedicated to health equity initiatives. This second in-person training was supplemented by a series of conference calls to dig into specific questions raised by RIDOH staff and help staff immediately apply new principles to their work.

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 has started a regular health equity series in its employee newsletter, called “Health Equity Now,” and has created 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.

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.

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. The CHAE is represented by 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. 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 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 third report was published in January 2020 and highlighted 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.

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 in 209 totaled 89 with refugees largely 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. 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 6800 calls per month on behalf of the Department's programs and the Director's office. When there is a Health emergency within the Department or the State (e.g. COVID-19) the HIL will setup a separate line for the specific emergency. (since March 2, 2020 – July 20, 2020 we have received 73,192 calls just for COVID-19 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 into 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. The HIL also manages the complaint intake for Health Professionals and Facilities Regulation. The complaints are received via telephone, e-mail, e-fax or walk-in. They are processed and forwarded to the respective programs. RIDOH also has the ability to stand up an Emergency Information Line (EIL) as needed to respond to a high volume of calls during emergencies and other crisis response scenarios. RIDOH is currently utilizing the EIL to respond to inquiries from the public related to the Coronavirus Disease 2019 (COVID-19) response.

Family to Family Health Information Center - RIPIN is also the Rhode Island’s HRSA funded F2FHIC, which is housed within Family Voices. This program provides families of CSHCNs with support, resource referral, training workshops, advocacy, and relevant information via newsletters/publications/websites. The National Center of Leadership for Family and Professional Partnerships provides technical assistance, training, and connections to F2FHICs. Title V dollars are utilized to provide staffing support.

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 and Cedar Family Centers. Three of seven Head Start agencies provide enrollment data, with a fourth planning to begin sending data soon.. 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 work 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. This has become even more critical as there is a state-wide effort to reverse the declines in lead screening and immunization associated with the COVID-19 pandemic. Expansion of the immunization registry component of KIDSNET to include all ages is underway, and in the future will provide data on the immunization status of pregnant womxn.

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. Programming has been completed and is being tested prior to release into production when 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

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.

RIDOH has benefited from an increased use of RI PRAMS for public health action and from students providing preliminary analyses for Rhode Island’s MCH strategic objectives, many of which have been published as RIDOH Issue Briefs, presented to practitioners locally and nationally, and published in peer-reviewed journals. Since its inception in 2016, the collaboration received national recognition with the CDC PRAMS 2018 1st place award for Unique Partnerships and Collaborations. More recently the Brown School of Public Health applied for a Health Resource and Services Administration (HRSA) grant to establish a MCH Centers of Excellence with the purpose to: 1) strengthen and expand the MCH workforce, both in Rhode Island as well as nationally, by training graduate and post-graduate public health students in MCH and 2) advance MCH science, research, practice, and policy through a well-trained MCH public health workforce that has benefited from a “learning public health by doing public health” approach to education.

This past year, RI PRAMS program and the Brown University School of Public Health continued to strengthen the partnership to use RI PRAMS data in the biostatistics and data analysis education of Brown University Master of Public Health students. In each year that this has been a part of the introductory biostatistics course sequence more students have applied to be a part of the collaboration than there are spots available. Based on these successes, the collaboration expanded in 2019 to include additional databases and issues from the RIDOH.

During the academic year 2019/2020 six students worked with RI PRAMS 2016 – 2018 dataset. Students meet monthly in a small group setting, led by Karine Monteiro, the RI PRAMS Coordinator and two to three times with identified RIDOH program staff. Issue brief analysis topics are aligned with ongoing RIDOH initiatives from brainstorming sessions held with the MCH Policy group and the PRAMS Steering Committee members. The issues focused on during the academic year 2019/2020 include adverse childhood experiences (ACEs), nicotine substance use, preterm birth, maternal depression, physical activity during pregnancy, and safe sleep. The partnership will continue in academic year 2020/2021 through distance learning due to the COVID-19 pandemic.

PRAMS data & maternal depression – The Rhode Island Maternal Psychiatry Resource Network (RI MomsPRN) Program continues to actively collaborate with RIDOH’s Center for Health Data, Analysis, and Public Health Informatics Unit to collect and analyze related maternal depression and behavioral health data within the PRAMS survey. This past year staff from both units collaborated to create a report and related poster for the RI Prematurity Task Force Summit that explored the connection between maternal mental health and preterm birth. Both the publication and related poster were distributed and highlighted to 125 attending prenatal care staff on 11/14/19. The Summit also featured a panel discussion that included RI MomsPRN clinical staff and a related keynote address by Dr. Jennifer Payne, Director of the Women’s Mood Disorder Center from Johns Hopkins School of Medicine that further reinforced and explored findings in the PRAMS data report. In addition, the two RIDOH units continue to analyze related phase 8 PRAMS data (2016-2018) and are actively partnering with a Brown University Public Health School Graduate Student to create a maternal depression during pregnancy report. Covid staff re-assignment at RIDOH has delayed the finalization of this brief, but it will be completed in the near future as RIDOH staff return to their normal job functions. This partnership also resulted PRAMS behavioral health data being included in a new Title V perinatal mental health factsheet, which is being used to guide stakeholder strategic discussions. Finally, RI MomsPRN funds continue to support the administration of the RI PRAMS survey and the fielding of substance use disorder related modules and questions that will be reportable in the near future.

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.

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. About one half of the questions asked on the 2020 survey were recommended by the Rhode Island Department of Health.

BRFSS collects data related to 17 of the 23 Population Health Goals of RIDOH's Strategic Framework, including:

Reduce obesity in children, teens, and adults

Reduce chronic illnesses, such as diabetes, heart disease, asthma, and cancer

Promote the health of mothers and their children

Promote senior health to support independent living

Promote behavioral health and wellness among all Rhode Islanders

Support Rhode Islanders in ongoing recovery and rehabilitation for all aspects of health

Increase access to safe, affordable, healthy food

Reduce environmental toxic substances, such as tobacco and lead

Improve access to care including physical health, oral health, and behavioral health systems

Expand models of care delivery and healthcare payment focused on improved outcomes

Increase patients’ and caregivers’ engagement within care systems

Reduce communicable diseases, such as HIV and Hepatitis C

Reduce substance use disorders

Minimize exposure to traumatic experiences, such as bullying, violence, and neglect

Ensure that quality public health data are collected consistently using current technology

Analyze public health data to monitor trends, identify emerging problems, and determine populations at risk

Provide public health data to support program planning, policy development, and surveillance needs

BRFSS also provides data to inform some of RIDOH's Health Equity Indicators, which addresses RIDOH's three leading priorities:

Integrated Healthcare - Healthcare Access (percentage of adults who reported not seeking medical care or dental care due to cost
Community Trauma - Discrimination (percentage of adults reporting racial discrimination in healthcare settings)

The Youth Risk Behavior Survey (YRBS) - i

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. Rhode Island is currently designing the 2021 high school survey in collaboration with the RI YRBS Advisory Committee. The survey will be fielded between February – May 2021 and will include state added questions related to the following topics: prescription drugs, maternal and child health priorities, oral health, homelessness, food insecurity, transportation safety, gender expression, transgender status, and assets. 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. Covid – 19 staff re-assignment at RIDOH has delayed YRBS data products planned for 2020. Despite these barriers we have been able to accomplish the following:

The 2019 YRBS data are available for analysis and summary tables are posted on the Rhode Island Department of Health (RIDOH) website.
A Health by Number article entitled “Sleep Deprivation among Rhode Island High School Students” published in the March 2020 issue of the Rhode Island Medical Journal.

The YRBS Survey Coordinator gave an oral presentation at the RI Conference on Youth Sexual Education in May 2019, and to orient community health educators about the questions on the Rhode Island High School Youth Risk Behavior Survey that pertain to sexual identity, gender identity and gender expression, and provide results of the prevalence of health-related behaviors by sex, race ethnicity, sexual identity, gender expression and disability.
The MCH Program continues to support 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 YRBS Survey Coordinator also participated in the All Students Count Coalition (ASCC), webinar entitled, Measuring What Matters: Leveraging YRBSS Data to Improve the Health & Well-Being of Transgender & Nonbinary Students.
Work is ongoing to review and update YRBS/Profiles 5-year Communication Plan and develop analysis plans for 2019 data.
Partnerships with a variety of stakeholders continue to be integral component of the YRBS project. For the 2019 YRBS survey, three new partners were identified to provide input. The partners included RIDOH Health Equity Institute’s Girls Empowerment Mentoring Support Program and Princes to Kings Program, RIDE Title 1 Homelessness Program and the RI Department of Transportation.

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 build upon internal and external partnerships and synergy to establish the RIDOH Culture of Learning at the department. The RIDOH Academic Institute supports three areas of engagement to achieve these goals: Public Health Education and Research, Workforce and Career Development, and Research Integrity and Accreditation.

Public Health Education and Research

Through the work of the RIDOH Academic Institute, 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, New England Institute of Technology, Providence College, Rhode Island College, Roger Williams University, and 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.

Collaborative state-academic forums and partnerships are developed 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.

Workforce and Career Development

The knowledge, skills and abilities of RIDOH staff and healthcare and health-related professionals across Rhode Island are enhanced through assessment of career planning and continuing education needs, thoughtful engagement, and development of initiatives to address Rhode Island’s health workforce needs utilizing collaborative and innovative methods.

Research Integrity and Accreditation

To facilitate appropriate use of RIDOH data, public health research is reviewed by the RIDOH Institutional Review Board to ensure ethical use of human subject research in compliance with federal laws. Additionally, RIDOH’s quality and performance is advanced through measurement and comparison with nationally recognized, practice-focused, evidence-based standards to improve and protect the public’s health.

Between June 2019 – June 2020, RIDOH staff authored the following MCH related journal articles:

Money EB, Williams J, Zelek M, Amobi A. Engaging the Power of Communities for Better Health. N C Med J. 2020 May-Jun;81(3):195-197.

Brousseau EC, Clarke JG, Dumont D, Stein LAR, Roberts M, van den Berg J. Computer-assisted motivational interviewing for contraceptive use in women leaving prison: A randomized controlled trial. Contraception. 2020 May;101(5):327-332.

Werner EF, Schlichting LE, Grobman WA, Viner-Brown S, Clark M, Vivier PM. Association of Term Labor Induction vs Expectant Management With Child Academic Outcomes. JAMA Netw Open. 2020 Apr 1;3(4):e202503.

Jackson TL, Cooper T. Sleep Deprivation among Rhode Island High School Students. R I Med J (2013). 2020 Mar 2;103(2):49-52.

Orr M, Rajotte J, Jackson T, Cooper T, Clyne A. E-cigarette Use and Rhode Island High School Students: What Providers Need to Know about the Characteristics of Initiation of E-cigarettes and Related Risk Behaviors. R I Med J (2013). 2020 Feb 3;103(1):51-54.

Monteiro K, Kim HH, Arias W, High P. How Many Parents are Reading with their Young Infants in Rhode Island? R I Med J (2013). 2019 Dec 2;102(10):57-60.

Sheldrick RC, Schlichting LE, Berger B, Clyne A, Ni P, Perrin EC, Vivier PM. Establishing New Norms for Developmental Milestones. Pediatrics. 2019 Dec;144(6):e20190374.

Zheng T, Zhu C, Bassig BA, Liu S, Buka S, Zhang X, Truong A, Oh J, Fulton J, Dai M, Li N, Shi K, Qian Z, Boyle P. The long-term rapid increase in incidence of adenocarcinoma of the kidney in the USA, especially among younger ages. Int J Epidemiol. 2019 Dec 1;48(6):1886-1896.

Amobi A, Plescia M, Alexander-Scott N. The Business Case for Investing in Place-Based Public Health Initiatives. J Public Health Manag Pract. 2019 Nov/Dec;25(6):612-615.

Clements E, Schlichting LE, Clyne A, Vivier PM. Underlying Causes and Distribution of Infant Mortality in a Statewide Assessment from 2005 to 2016 by Infant, Maternal, and Neighborhood Characteristics. R I Med J (2013). 2019 Nov 1;102(9):15-22.

Amobi A, Lewis M, Novais A, Alexander-Scott N. ASTHO President's Challenge: Core Principles for Building Community Resilience. Am J Public Health. 2019 Sep;109(S4):S277-S278.

St John K, Viner-Brown S. Maternal Obesity and Birth Defects in Rhode Island. R I Med J (2013). 2019 Aug 1;102(6):50-52.

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

RIDOH and the MCH Program will continue to have a leadership role in system, interdepartmental, and interagency coordination to improve the overall healthcare delivery system across the state for MCH populations. Through involvement in the Executive Office of Health and Human Service, RIDOH will continue to represent MCH policy direction and leadership on the state's population health plan and participate in the following initiatives: State Improvement Model (SIM); Patient Centered Medical Home-Kids (PCMH-K); Care Transformation Collaborative (CTC); and interdepartmental advisory groups. Specific MCH SIM initiatives include the Rhode Island Child Psychiatry Access Program (RICPAP) and the RI Screening, Brief Intervention, and Referral to Treatment Project (SBIRT). RIDOH will also continue to be heavily involved in the Children’s Cabinet and Governor’s Taskforce on 3rd grade reading. RIDOH will continue to assist on implementing the Global Compact Medicaid Waiver with CMS and State Medicaid.

Over the coming year the Children’s cabinet will continue to focus on supporting activities that will improve RI’s 3rd grade reading proficiency. This is a multi-state agency effort which also includes community partners and focuses on supporting children and their families beginning at birth to be proficient readers by 3rd grade. There is a state agency staff level Governor’s Taskforce on 3rd Grade Reading, that was convened in 2016 to ensure that specific activities to improve 3rd grade reading are implemented. The Cabinet is also focused on interagency collaboration activities that will both support families to reduce involvement in the child welfare agency as well as improve outcomes for children who are currently involved with the child welfare agency.

RIDOH and the MCH Program will continue to implement and support the 10 Health Equity Zones throughout RI. This includes utilizing Title V block grant funding to support MCH work in the HEZ, as long as it aligns with MCH State Priorities. The Program will work collaboratively with each HEZ to provide support and guidance, ensure fidelity to evidence-based programs, and create alignment and synergy at the local level. This will be achieved through attendance at monthly HEZ Collaborative meetings, reviewing quarterly reports, regular communication, and an annual site visit. MCH staff will continue to serve on the HEZ policy team will participate in collective impact evaluation of the HEZ.

Community Health Workers (CHW) are frontline public health workers who liaise between health, social services, and the community to facilitate access to services and improve the quality and cultural competence of service delivery. RIDOH is advancing the CHW profession through facilitating a certification process, building the research base, and developing reimbursement pathways. The use of CHWs in health prevention programs has been associated with improved healthcare access, prenatal care, pregnancy and birth outcomes, client health status, health-seeking behaviors, and reduced health care costs. RIDOH will continue to develop and support peer CHWs through the RI Parent Information Network, Pediatric Practice Enhancement Project, and RIREACH Program. RIDOH will continue to engage community members, CHWs, and consumers in all areas of program, policy and systems change through existing advisory boards, consumer groups, Health Equity Zones, and community contracts.

RIDOH will continue to implement evidence based program to address mental and behavioral including MomsPRN and PediPRN. RI will continue to be involved with statewide initials that support mental and behavioral health. RI will also collect and analyze data on gaps in services particularly as its related to mental/behavioral health.

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. The program will continue to track the positive responses to questions on the experience screen. There are clear income disparities in who experiences toxic stress. The experience of toxic stress is strongly related to poverty and therefore is correlated with a myriad of health disparities. RI’s work around toxic stress is focused on linking families to community based programs that meet their needs, and to make systems changes among systems that serve children at high risk for toxic stress such as those involved in the child welfare system, or infant born with Neonatal Abstinence Syndrome and their families. RI’s work is also focused on ensuring that all family members are connected to necessary services.

RIDOH will continue to implement suicide prevention programs. In the coming year, the RI Youth Suicide Prevention Programs (RIYSPP) plans to continue rolling out the Suicide Prevention Initiative (SPI) protocol and training adults and students in additional RI school districts. High-risk districts (those with higher reported youth suicide completions/attempts) are prioritized first, but if they decline the program staff will quickly move to establish partnerships with other school districts. In addition to the work done in schools, RIYSPP will continue to work with partners (South County Health Equity Zone, Washington County Coalition for Children, etc.) to train local community leaders (faith leaders, youth leaders, community organizers, etc.) in suicide prevention principles. RIYSPP staff will also continue to provide technical assistance to schools who have implemented the SPI protocol. Lastly the RIYSPP will work to provide suicide prevention resources/services to the 18-24 years old population group in RI through the various colleges/institutions of higher learning located throughout the State.

Overdose prevention will be supported by maintaining a leadership role in the Overdose Prevention Task Force, the Neonatal Abstinence Syndrome Task Force, and funding a network of Peer Recovery Coaches.

RIDOH aims to achieve health equity for all MCH populations by eliminating health disparities, assuring healthy child development, preventing and controlling disease and disability, and working to make the environment healthy. RI will continue to support health equity as the social determinants of health are adopted into public health planning and practice. RIDOH will do this by continuing to use a comprehensive, integrated approach to supporting health. RIDOH will continue to focus on improving outcomes for its most vulnerable populations, taking a life course approach through systems that support identification of risk and response at the earliest possible point. It is through taking this approach that RI will support all of its citizens to achieve optimal health.

RIDOH will continue to represent and provide advocacy for vulnerable populations. The Health Equity Institute (HEI) will continue to provide programmatic support concerning the best practice in eliminating health disparities in RIDOH programs through addressing the social determinants of health including transportation (providing bus passes for consumer engagement), interpreting (access to language bank for assistance), housing (providing technical assistance concerning Medicaid home stabilization and Home Locator services), engage community partners (Green and Healthy Housing Initiative, Healthy Communities, Health Food at School, Dare to Dream, Social Justice Workgroup, Employment First, Project SEARCH) and implementation of the Health Equity Zones. HEI will continue to provide education and technical assistance on Culturally Linguistic Appropriate Services (CLAS) standards to advance health equity, improve quality and helps to eliminate health disparities. It will also continue to convene the LGBTQ workgroup and the social justice roundtable.

The MCH Program will continue to actively participate in committees and workgroups that address the social and environmental determinants of health such as the Commission for Health Advocacy and Equity, the LGBT workgroup. Community Assessment Group, the Social Justice Roundtable among others. RIDOH will continue to collect, analyze and disseminate data to build internal and interagency support for MCH issues. The MCH Program will maintain its involvement in the PRAMS, BRFSS and YRBS advisory boards to ensure that the data needs of the Program are represented. For example, the MCH Program is advocating for the addition of a race and discrimination module in the PRAMS survey.

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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