III.A.1. Program Overview

The Rhode Island Department of Health’s (RIDOH) Maternal and Child Health (MCH) Program supports and promotes the health of all mothers, children, and families to reduce inequities and improve outcomes. The MCH program is responsible for:

• Aligning and facilitating the coordination of efforts among RIDOH health topics and programs as it relates to maternal and child health.
• Focusing on key areas including women/maternal health, perinatal/infant health, child health, adolescent health, children with special healthcare needs, and social determinants of health
• Administering the Title V Maternal and Child Health Block Grant in Rhode Island.

MCH Structure

RI’s Title V Program is situated in the Division of Community Health & Equity (CHE), Associate Director’s Office. In this organizational structure, Title V acts as a convener, collaborator, and partner in addressing MCH issues within RIDOH and statewide. While the responsibility of Title V coordination and reporting falls on MCH staff, the larger Title V team includes staff from all RIDOH programs that touch MCH populations. This team approach allows Title V to be represented at virtually every MCH policy discussion, committee, or advisory group in the state.

MCH Framework

The Rhode Island Department of Health (RIDOH) Strategic Framework serves as the blueprint for the Rhode Island MCH program. RIDOH three leading priorities are to: 1) address the socioeconomic and environmental determinants of health, 2) eliminate health disparities and promote health equity, and 3) ensure access to quality health services for all Rhode Islanders, including the state’s vulnerable populations. Within that overarching blueprint, RI’s MCH program is guided by two primary frameworks: 1) social and environmental determinants of health and 2) a life course approach:

• Social Determinants of Health: The MCH program seeks to use a broad, community-wide understanding of the underlying social and economic conditions that perpetuate poor health at the community level to identify and make regulatory and policy changes that address root causes of health disparity.
• Lifecourse Approach: The Lifecourse Approach is a way of looking back across an individual’s (or a group's) life experiences to better understand current patterns of health and disease. It aims to identify the underlying biological and behavioral processes that operate across the lifespan. Currently, the RIDOH takes a life course approach when collecting, analyzing, and reporting health indicators.

MCH Priorities

Rhode Island performs better than the national average for most of the Title V National Performance Measures. This can be attributed to robust public health planning, integrated systems of care, and efforts focused on the state’s most vulnerable populations. Despite these positive trends, health disparities persist by age, race/ethnicity, geography, socioeconomic status, educational attainment, and health insurance coverage. In 2019-20, RIDOH completed an extensive MCH needs assessment that incorporated feedback from a wide array of stakeholders, including community organizations, clinical providers, advocates, and families. Information was gathered from more than 1000 individuals via surveys, facilitated discussions, large community meetings, and listening sessions. The resulting data were used to develop the following MCH priorities for 2020--2025:

• Reduce Maternal Mortality/Morbidity
• Reduce Perinatal Health Disparities
• Strengthen Caregiver’s Behavioral Health and Relationship with Child
• Support School Readiness
• Support Mental and Behavioral Health
• Provide Effective Care Coordination for CYSHCN
• Adopt Social Determinants of Health in MCH Planning and Practice to Improve Health Equity.

RIDOH’s MCH Program has appreciated the opportunity to develop workplans, evidence-based strategies, strategy measures, and disparity elimination plans for the above-mentioned MCH Priorities 2020-2025.

Program Evaluation Efforts and Recent Accomplishments

RIDOH’s MCH Program is pleased to report the following accomplishments in each domain:

Women’s/Maternal Health

Doula Legislation: In the 2020-2021 RI General Assembly Legislative session the Perinatal Doula Services Act passes. This Act provides for health care coverage by health insurance companies for perinatal doula services to take effect on July 1, 2022. This important legislation cited disparities in maternal morbidity, preventable pregnancy complications, the growing evidence that stress from racism and racial discrimination contribute to poor maternal health outcomes among black womxn, and the cost effectiveness of perinatal support services offered by doulas as evidence for its necessity.

Community Health Worker Legislation: In the 2020-2021 RI General Assembly Legislative session, the Medicaid Reform Act for Community Health Workers was passed that authorizes RI’s Medicaid program to improve health outcomes, increase access to care, and reduce healthcare costs, by providing medical assistance coverage and reimbursement to community health workers. RIDOH MCH participates in a CHW Sustainability Strategy Team to ensure implementation of the CHW Workforce, viability of the CHW Association of RI, and adherence to the CHW Certification Standards. It is important to note that parents of children with special needs have become certified as CHWs and will benefit from this legislative approval.

Rhode Island Pregnancy & Postpartum Death Review Committee (PPDRC): The PPDRC, a multidisciplinary committee that reviews deaths that have occurred during pregnancy or within one year of the end of pregnancy (replacing the Maternal Mortality Review Committee), was able to establish membership, conduct case abstractions, review 14 maternal deaths in 2022, and make comprehensive recommendations for the RI community.   The committee currently has ten members from the community reviewing and weighing in on cases during meetings including individuals and organizations that represent the populations that are most affected by pregnancy-related deaths or pregnancy-associated deaths and lack of access to maternal health care services.

Perinatal/Infant Health

Teleconsultation for behavioral mental health among caregivers: RIDOH completed its third year of a 5-year Health Resources and Services Administration (HRSA) grant to implement MomsPRN, a teleconsultant line to help obstetrical, adult primary care, pediatric, and psychiatric providers treating pregnant and postpartum patients screen and manage behavioral health disorders. This service is being implemented in partnership with the Center for Women’s Behavioral Health at Women and Infants Hospital (CWBH). In addition, the Care Transformation Collaborative of Rhode Island (CTC) is providing intensive quality improvement coaching about behavioral health screening, treatment, and referral to contracted prenatal care practices. During this reporting period (October 2021 – September 2022), the RI MomsPRN teleconsultation line fielded 679 initial encounter calls, with 7 coming directly from perinatal patients and the remaining 672 calls coming from 251 unique providers (60 prenatal, 38 family visitors, 35 primary care, 8 pediatric, 39 psychiatric, 20 other mental health providers, and 51 other providers) at 125 practices across the state. In total, 586 perinatal patients (including 209 pregnant women) were helped because their provider contacted the RI MomsPRN teleconsultation line during this reporting period. In addition to providing perinatal behavioral health teleconsultation and practice transformation services for healthcare providers, 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.

Child Health

Reach out and Read: RIDOH has continued to grow its partnership with Reach Out and Read Rhode Island, a research-supported program that provides children with books during pediatric checkups so that families can read to their children at home. Currently there are over 340 providers implementing the program at 65 medical practices, clinics, hospitals, and community health centers statewide. Over 35,000 children (50% of all children statewide) participate in the program and 73,000 books are provided annually at no cost to families.

Preschool Development Grant and HEZ School Readiness and Family Support Projects: RIDOH is collaborating with the state’s Preschool Development Initiative to improve system-, family-, provider-, and child-level outcomes for its most vulnerable populations. For the past 2 years, the Rhode Island Preschool Development Grant has funded the Health Equity Zones to implement school readiness and family support projects such as family navigators, Safe Sleep programs, and Incredible Years training for parents. These investments will continue for the next reporting year.

Adolescent Health

Rhode Island’s Children’s Behavioral Health System of Care Planning: The Executive Office of Health and Human Services works with other state agencies – the Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals, the Department of Children, Youth, and Families, the Office of the Health Insurance Commissioner, the Rhode Island Department of Education, and the Rhode Island Department of Health - on preliminary planning about Rhode Island’s Children’s Behavioral Health System of Care. The goal is to ensure a comprehensive, coordinated network of services that are effective and community-based. A wide range of stakeholders have been engaged to ensure extensive input and collaboration during the process to work on several areas of focus including: 1) the crisis continuum, development and access, screening and assessment; 2) care authorization, care coordination and care monitoring; 3) service array; 4) ensuring equity: race equity, family members, with IDD, and LGBTQ+ Families; 5) workforce transformation; 6) data systems for outcomes measurement and evaluation; and 7) community outreach and education

Children and Youth with Special HealthCare Needs (CYSHCN)

Medical Home Portal (MHP): RIDOH leveraged the Medical Home Portal during the pandemic to share vetted information on health insurance, safety guidelines, community supports, and tools to help families and professionals caring for CYSHCN. The portal is a web-based resource (www.ri.medicalhomeportal.org) that provides consumer-friendly information to help families to navigate the CYSHCN System of Care. The website provides a one-stop-shop for comprehensive diagnostic, education, specialty care, social service, and resource information to improve the system of care and health outcomes for CYSHCN. As of June 2022, the number of listings in the RI Service directory was 950. The past grant reporting period showed a dramatic increase in users among families and professional.

Cross-cutting Initiatives

Statewide Collaboration: In order to improve MCH systems of care, RIDOH’s MCH Program is working with a wide variety of internal and external partners. In the past few years, several collaborative projects have included the Governor’s Overdose Prevention and Intervention Task Force, the Task Force for Substance-Exposed Newborns, the Governor’s Initiative to improve Third Grade Reading, Plans of Safe Care, and a safe sleep campaign. Partners include: the Rhode Island Departments of Education; Children, Youth, and Families; Human Services; Corrections; and Behavioral Healthcare, Developmental Disabilities, and Hospitals; the Rhode Island Executive Office of Health and Human Services; Medicaid; and the Office of the Health Insurance Commissioner. RIDOH also has been an integral partner in the State Innovation Model (SIM) Grant planning and implementation. MCH Program staff have given valuable feedback to the SIM steering committee related to several SIM-funded MCH projects, including Patient-Centered Medical Homes for Children; the Pediatric Psychiatry Referral Network; Community Health Teams; Screening, Brief Intervention and Referral to Treatment; and a workforce development initiative.

Health Equity Zones (HEZs): RI’s Health Equity Zone initiative is an innovative, place-based approach that brings communities together to build the infrastructure needed to achieve system and policy changes at the local and statewide levels. 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”. Fifteen Health Equity Zones directed public health funding, during the reporting period, towards community-led projects, increasing the impact of efforts to build healthier and more resilient communities. The HEZ are administered by a “Backbone Agency” which may be a municipality or a public not-for-profit community-based organization which coordinates the efforts of 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 come together to address the most pressing health concerns in their neighborhoods. 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 reaching their optimal health.

Some of the 2022 activities completed by individual HEZs include:

1. At the end of the school year, Bristol and Warren HEZs partnered with local kindergarten teachers and Head Start preschool teachers to host a transition to Kindergarten event to support caregivers through the transition process,
2. Blackstone Valley Health Equity Zone worked with Lifespan Community Health Institute and Family Literacy Center in Manville to bring national program SafeSitter to youth at no cost. We chose this program after learning from Family Literacy Center staff that most of the youth they served also had brothers and sisters to look after at home, providing a class on first aid, CPR and other life skills would serve advantageous for the youth and their families, and creates employment opportunities for youth,
3. Central Providence HEZ, through family navigators, conducted SDOH screenings and provided navigation support and made referrals as needed. In total, 721 screenings conducted by CHWs, 24,786 masks distributed, 3,424 at home COVID-19 Testing distributed, and 131 food bags distributed,
4. OneCranston HEZ competed first year of operating the Huddle Community Center by serving families by running 65+ events with over 860 attendees,
5. Newport HEZ developed and is sustaining a Women of Color Collective that is focusing on prevention of suicide within the Newport women of color community,
6. Pawtucket and Central Falls HEZ, through a partnership with the Pawtucket Family YMCA, coordinated a Youth Equity Leaders group where youth ages 14-21 lead direct service and community engagement initiatives,
7.  TriCounty HEZ, in collaboration with the Woonasquatucket Watershed Council, educated over 390 youth about pollution and its impact on Woonasquatucket watershed, and
8. West Elmwood HEZ hosts community education efforts with American Lung Association and residents to inform them of air quality issues and to encourage advocacy.

Please reference annual and application sections for a thorough rendering of HEZ activities.