Introduction

The Connecticut Department of Public Health (DPH) has been awarded national accreditation by the Public Health Accreditation Board (PHAB). Earning a five-year accreditation status signifies that DPH has met or exceeded rigorous, nationally recognized, evidence-based public health standards, a distinction that only 31 other states have achieved. A strong public health infrastructure provides the capacity to prepare for and respond to emerging and ongoing threats to the public’s health. Key infrastructure components vary both in Connecticut as well as across the nation. These components include a capable and qualified workforce; up-to-date data and information systems; and the capability of assessing and responding to population health concerns. Accreditation through the national Public Health Accreditation Board (PHAB) provides an opportunity to strengthen the infrastructure and improve the quality and performance of governmental public health agencies. Quality standards address delivery of the 10 essential public health services, beginning with routine assessment of population health needs in our communities.

The DPH completed the 2020 update of the State Health Needs Assessment. The report was released as the State Health Improvement Plan (SHIP) coalition launched a series of planning workshops to update the health improvement plan. The DPH Public Health Systems and Equity (PHSE) team worked with partners across the state to design the Healthy CT 2025 State Health Improvement Plan framework. Although the COVID pandemic’s guidelines disrupted the planning process by requiring working remotely, the PHSE team completed the plan through multiple virtual meetings and webinars to discuss priority areas and cross-cutting themes. The plan’s strategies focus on policy, systems, and environmental changes to address upstream causes of poor health. The priorities under consideration include a) access to health services and primary healthcare, b) economic stability, particularly around issues of poverty and employment, c) access to healthy eating and issues of food security, d) housing quality and stability and e) community resilience as it relates to crime/violence and emergency preparedness. Cross-cutting priorities include education, transportation, and racial discrimination.

In addition to launching Healthy Connecticut 2025, DPH is undergoing preparations for its re-accreditation application due by the first quarter of 2022.  CT DPH received its first national public health accreditation in March 2017 and has submitted annual reports to the Public Health Accreditation Board (PHAB). The agency is now preparing documentation that demonstrates a culture of quality improvement and performance management. Additionally, DPH worked to maintain the capacity needed to provide the ten essential services of public health. The agency also worked on developing systems and programmatic functions to narrow gaps identified on an assessment of DPH’s current work based on the re-accreditation standards. MICH grant funding makes possible continued progress and allows the agency to conduct the accreditation work across the agency.  

The CT (Maternal and Child Health) MCH Coalition is a representative group of state agencies, providers, funders, and advocates working in concert with the state’s maternal and child health population. The Coalition has over 120 individuals representing 97 organizations.  It serves as a communication and networking vehicle for those working in the field of Maternal and Child Health by holding quarterly meetings and sending out Notes of Interest to Coalition members.  The Coalition represents the state’s maternal and child health priorities/interests in the State Health Improvement Plan (SHIP), which has established the following priority areas: access to health care; economic stability; healthy food and housing; and community strength and resilience. The Coalition also advocates for health equity and the elimination of racial and ethnic health disparities.  A Coalition advocacy initiative, being done in collaboration with the Every Woman CT Initiative and the March of Dimes, is the establishment of a Reproductive Workgroup. Modeled on the work being done in New York, this workgroup will be looking at the degree and types of disrespect and abuse experienced by women seeking pre/interconception as well as prenatal and postpartum health care. Based on the fact-finding results, the workgroup will propose recommendations to address identified areas of concern.

Key Initiatives

Women/Maternal Health

DPH participates in the Every Woman Connecticut (EWCT) Learning Collaborative, which seeks to increase expertise and self-efficacy in implementing routine pregnancy intention screening and appropriate care, education, and services to ultimately improve birth spacing, increase pregnancy intentionality, and the proportion of Connecticut women who deliver a live birth who report discussing preconception/interconception health with a healthcare worker.

Connecticut Legislation was passed in 2018 to establish a Maternal Mortality Review Committee and program within the department.  The Maternal Mortality Review Committee is comprised of both clinical and non-clinical subject matter experts that conduct a comprehensive, multidisciplinary review of each pregnancy-associated death that occurred within one year of the end of a pregnancy, regardless of the outcome. The comprehensive review includes medical records, medical examiner reports, death certificates, vital statistics infant birth, fetal and maternal death files, police reports, informant interviews, obituaries, social media, and other sources of information. The purpose of the Maternal Mortality Review Committee review is to identify contributing factors that may have contributed to the death, and to make recommendations to reduce pregnancy-related morbidity and mortality and disparities. The department’s Maternal Mortality Review Program is supported by CDC funding that supports program administration, data collection and analysis of maternal mortality data and an annual Maternal Mortality Evaluation Report. 

The Reproductive Health Program is administered by Planned Parenthood of Southern New England, Inc. (PPSNE) and is funded with State and Title V funds through a five-year contract. The program provides services in those areas of Connecticut with a high concentration of low-income women of reproductive age, and with high rates of teen pregnancy.

Perinatal/ Infant Health

The Department's State Physical Activity and Nutrition (SPAN) Program breastfeeding team, along with the State WIC Program staff, continues to partner with the CT Breastfeeding Coalition’s (CBC) Ten Step Collaborative to encourage implementation of evidenced-based maternity care and the 10 Steps for Successful Breastfeeding in CT hospitals. In 2020, the “It’s Worth It” media campaign that launched in late 2019, was again run in 2020, in targeted areas of the State aimed at increasing the awareness of the campaign’s community support message and also documenting stories of diverse populations. Additionally, DPH successfully launched the English version of Ready, Set, Baby (RSB) online website, in partnership with the Carolina Global Breastfeeding Institute in March 2020.  Translation of the RSB site into Spanish was completed in May of 2021, with a soft launch planned for July 2021.  The Arabic translation will be available in Fall 2021. In partnership with CBC, DPH launched a scholarship program for underrepresented populations in order to improve equity in community lactation support. In September 2020, CBC awarded six individuals (all women of color) funds to pursue their IBCLC.  To date, one candidate has taken the exam and the other five are working towards meeting the exam credentials.  We anticipate two additional awardees sitting for the exam in early 2022. DPH and CBC, with SPAN funds, plan to support these women through the process and have provided additional financial and moral support through 2021.  Four technical assistance sessions were held and an email group was created to facilitate communication among the awardees.  In addition, SPAN funded 12 individuals to attend the online Health Children Certified Lactation Counselor course and exam in 2020/2021, based on the scholarship applications.  

The Family Wellness Healthy Start (FWHS) program serves pregnant and parenting teens and include interconception services. The FWHS program works to eliminate disparities in infant mortality and adverse perinatal outcomes especially among the target population of African American and Hispanic women in Hartford and New Britain. The Department received a federal grant to expand services which previously included African American women in Hartford to now include African American and Hispanic women in Hartford and New Britain. Services include 1) improving women’s health, 2) promoting quality services, 3) strengthening family resilience, 4) achieving collective impact, and 5) increasing accountability through quality improvement, performance monitoring and evaluation.

Child Health

The DPH is working with primary care providers to incorporate parental education on developmental milestones and communicates benefits of standardized developmental monitoring and screening to parents and providers in primary care settings highlighting the CDC’s “Learn the Signs. Act Early” materials.  CT DPH staff coordinates the CT State Heath Improvement Plan Developmental Screening Workgroup to increase developmental screening through a developmental monitoring and screening education and awareness campaign; training community and healthcare providers to improve screening rates and coordination of referrals and linkage to services; and engaging in cross systems planning and coordination of activities around developmental screening.  

The Immunizations Program distributes vaccines to providers throughout the state, conducts surveillance for vaccine preventable diseases, conducts quality assurance reviews for vaccines for children programs, conducts educational programs for medical personnel and the public, works with providers using the immunization registry to assure that all children in their practices are fully immunized, promulgates rules and regulations related to vaccination requirements for day care, schools, colleges and universities. 

The DPH Nutrition, Physical Activity, and Obesity (NPAO) Program has been implementing the Go Nutrition and Physical Activity Self-Assessment for Child Care (Go NAPSACC) initiative with center and home-based early care and education programs (ECEs) to address childhood obesity. Go NAPSACC is an online system that helps ECEs create a healthier environment for the children they serve through a five-step improvement process.   

Adolescent Health

DPH supported 92 school health service sites in 27 communities. School health service sites support students in Pre-k through grade 12 and are in elementary, middle and high schools.  There are 80 School Based Health Centers (SBHC) that provide access to physical, mental health and limited dental services located throughout the state.  There were 12 were Expanded School Health (ESH) sites that provide mental health services. Services provided to students include: diagnosis and treatment of acute injuries and illnesses, managing and monitoring chronic disease, physical exams, administering immunizations, prescribing and dispensing medications, laboratory testing, health education, promotion and risk reduction activities, oral health (in some locations), referral and follow-up for specialty care, and linkages to community based providers.

Mental health services are a priority within the SBHCs and experienced adolescent health clinical staff provide a variety of services such as: assessment, diagnosis and treatment of psychological, social and emotional problems, crisis intervention, individual/group/family counseling, psycho-social education, advocacy and case management.

School-based health services serve as the principle vehicle for promotion of adolescent health services. SBHCs can provide a safe place to talk about sensitive issues such as depression, family problems, relationships and substance abuse. SBHC staff help students by addressing health problems that may interfere with learning, reducing absenteeism, help to keep students out of emergency rooms, and support families by allowing parents to stay at work. Care is delivered in accordance with nationally recognized medical/mental health and cultural and linguistically appropriate standards.

Children and Youth with Special Health Care Needs

The Children and Youth with Special Health Care Needs program’s CT Medical Home Initiative provides community- based medical home care coordination networks and collaboratives to support children with special health care needs. Services include a statewide point of intake, information and referral; provider and family outreach and parent-to-parent support. Care coordination services include linkage to specialists and to community resources, coordination with school-based services, and assistance with transition to adult health care and other services. Community Care Coordination Collaboratives support local medical home providers and care coordinators to access state and local resources, and work to resolve case specific and systemic problems (including reduction in duplicity of efforts). The program partners with Child Health and Development Institute of Connecticut, Inc. (CHDI) to conduct Educating Practices training modules on topics including Care Coordination in the Medical Home, Developmental Surveillance Screening and Help Me Grow, and Family Professional Partnership in the Medical Home.

Opioid Update

The Office of Injury and Violence Prevention (OIVP), Opioid and Drug Overdose Prevention Program is helping CT combat the ongoing opioid epidemic. As of March 2021, Connecticut state agency partners, the state Departments of Public Health and Mental Health and Addiction Services, have expanded their network across the state in the areas of real-time opioid and stimulant overdose surveillance, safe storage and disposal of controlled substances and OTC medications, harm reduction, naloxone access, and academic detailing for controlled substance prescriber education.  DPH and DMHAS combined elements of the LIVE LOUD (Live Life with Opioid Use Disorder) multi-media campaign with awareness of the high prevalence of fentanyl adulteration and with harm reduction messages.  DPH has also been working to improve the statewide spread of the CT Naloxone + Overdose Response App (NORAsaves.com) which has a variety of resources such as how to recognize an opioid overdose and how to administer naloxone. The Change the Script campaign, launched in 2018, is ongoing and all three awareness campaigns point people to 2-1-1 to seek assistance for treatment and to Connecticut's drugfreect.org landing page. CT values interagency collaboration and seeks to ensure sustained statewide, multi-agency education and awareness campaigns that align with the CT Opioid REsponse (CORE) Initiative, a strategic plan which lays out a series of actions designed to rapidly reduce opioid-related overdose deaths in CT. CT's campaigns include a variety of messages focused on prevention, harm reduction, treatment, and recovery and speak to the need to change public perception and thinking about substance use disorder and acknowledge it as a chronic brain disease. The campaigns also seek to address the stigma associated with drug use, which can prevent a person or their loved one from seeking help.

Conclusion

Connecticut has made significant progress in improving the health of residents across the life course. DPH has taken a prominent role in convening partners to address assessment, planning and implementation of activities directly contributing to this improvement.

The distribution of these health improvements, and persistent and new issues affecting maternal and child health are not equally distributed among subpopulations. Indeed, lower-income residents, Black non-Hispanics, and Hispanics generally have less favorable health and health behavior profiles than their counterparts. Additionally, some health patterns among maternal and child health populations vary by sex, town, sexual identity, and special health care need status. Initiatives and activities are planned to keep diverse populations in mind to begin to address these disparities with a strong emphasis in working to dismantle structural oppression.

These measures, developed through a participatory planning process, highlight areas of progress in maternal and child health in Connecticut, as well as health issues necessitating a public health approach to improve health outcomes.