During FY2020, the Bureau of Maternal and Child Health (MCH), at the South Carolina (SC) Department of Health and Environmental Control (DHEC), continued to work towards improving the health outcomes for women, children and their famlies.  National Performance Measures (NPMs) and State Performance Measures (SPMs) were selected to help achieve this goal, and information about DHEC’s activities is shared below:

Women’s/Maternal Health

Moving the needle: South Carolina has made strides to significantly increase the percent of women who receive first trimester prenatal care, reduce the percent of cesarean deliveries among low-risk first births, reduce the percent of women who smoke during pregnancy, and reduce the percent of women who experience postpartum depressive symptoms following a recent live birth. Improvements in women and maternal health have been achieved through partnerships with the South Carolina Birth Outcomes Initiative (BOI), a strong perinatal regionalization system that provides risk-appropriate care, coalitions and programs that focus on educating and training on safe sleep practices, “The Point” DHEC clinics, the state Adolescent Health Program, and other statewide efforts to decrease pregnancy in teens. Continued work is needed to address chronic conditions, health behaviors, and substance use disorders during preconception, postpartum, and intrapartum periods to see positive changes in severe maternal morbidity, neonatal abstinence syndrome, and other pregnancy and birth outcomes.

Population Needs: Despite these improvements, disparities persist among outcomes that disproportionately affect minority women and infants. DHEC will continue to work with partners like Healthy Start, Medicaid, and PASOs, who work with women in the community on this important issue. 

The Maternal Mortality and Morbidity Review Committee was formed and given legal permission to work by SC state law in 2016. The Committee has overcome several challenges to increase its case abstraction. Support from Title V and federal partners have assisted the Committee in increasing its review and staffing capacity. Despite the challenges of COVID, in 2021 the committee was able to complete the review of all in-state maternal mortality cases from the year 2018—a first since the committee’s establishment.

Accomplishments: NPM 1 was selected to help more women manage their reproductive health responsibly. Through partnerships with SC BOI, Fact Forward, and the New Morning Foundation, DHEC has been afforded the opportunity to increase access to Long Acting Reversible Contraceptives across the state and educate women about reproductive life planning.

Perinatal/Infant Health

Moving the needle: Infant mortality, postneonatal mortality, and the proportion of children without health insurance have all seen promising improvements. Infant breastfeeding, infant and child vaccinations, and children receiving developmental screening are also changing favorably. Improvements have been achieved through partnerships with the South Carolina Birth Outcomes Initiative, a strong perinatal regionalization system that provides risk-appropriate care, coalitions and programs that focus on educating and training on safe sleep practices, and the ongoing efforts of Baby-Friendly initiatives across state birthing hospitals, WIC, and other statewide efforts. Continued progress can be achieved through sustained partnerships with existing organizations and entities that promote access to risk-appropriate care and safe sleep practices and encourage protective factors such as breastfeeding.

Population Needs: While the 2017 rate of neonatal abstinence syndrome in South Carolina was 4.9 infants per 1,000 birth hospitalizations (NOM 11), NAS is likely being underreported in the hospital records. DHEC has completed a needs assessment in which a sample of obstetricians, neonatologists, and pediatricians around the state were interviewed to determine current practices, policies and protocols for screening and treatment of pregnant women and diagnosis and treatment for the infants. This information will be helpful and guide efforts to standardize NAS protocols statewide. 

Accomplishments: DHEC has partnerships with organizations and agencies across the state to improve outcomes in Perinatal and Infant Health. For example, the SC BOI brings together community partners to discuss issues that impact moms and babies. Workgroups of the SC BOI include: Access to Care Coordination; Baby-Friendly/Safe Sleep; Behavioral Health; Data; Quality and Patient Safety; and a new Birth Equity Workgroup. The work of the SC BOI’s Baby Friendly group directly addresses NPM 4.

South Carolina also continues to maintain a successful and robust perinatal regionalization system that addresses NPM 3.  Currently, there are four regional hospitals covering each of SC’s perinatal regions. As a part of this effort, DHEC has been very involved in a vaginal birth simulation project, SIMCoach. This project helps women to avoid C-sections that are not medically necessary and helps medical providers get the practice they need to help women during high-risk deliveries.

In 2019, the SC Birth Defects Program was selected as one of six sites to monitor heart defects through the CDC Congenital Health Defects Tracking and Research (CHD STAR) study. This important work will help to identify causes of heart defects and improve the health of those living with these conditions. Researching health issues and needs across the lifespan can help ensure people born with heart defects are getting needed care.

Child Health

Moving the needle: South Carolina has seen reductions in children without health insurance and an increase in both child vaccinations and developmental screenings. Conversely, fewer children with special health care needs have a medical home than in recent years. While South Carolina has already seen significant improvements in some measures of child health, additional years of data is warranted to see substantial improvements in other important measures such as bullying in young children. The Child Well-Being Coalition (CWBC), MD STARnet, State School Nurse Program, and Lead Screening Program as a collective seeks to strengthen the health, well-being, and resilience of our child population.

Population Needs: Although more people across SC want children to be screened for unhealthy development, the way children are being screened varies across the state. Only 38.4% of children received a developmental screening using a parent-completed screening tool according to survey results from the 2018-2019 NSCH.

Accomplishments: The Child Well-Being Coalition is prioritizing state and national performance measure as well as other key indicators across a child’s lifespan. The coalition is comprised of multidisciplinary workgroups covering five child well-being domains: health, family, education, economy, and community. In early 2017, the SC Birth Defects Program successfully began work with Help Me Grow SC to increase developmental screening across SC, impacting NPM 6.

Adolescent Health

Moving the Needle: Fewer children in South Carolina are uninsured, teen birth rates are steadily dropping, adolescent motor vehicle mortality has lowered, and adolescent vaccinations have risen. While South Carolina has already seen significant improvements in some measures of child health, adolescent suicide has increased significantly and fewer children without special health care needs have a medical home than in recent years. The Child Well-Being Coalition (CWBC), MD STARnet, State School Nurse Program, and Lead Screening Program as a collective seeks to strengthen the health, well-being, and resilience of our child population.

Population Needs: To help more young people get the exercise they need, DHEC is working with school boards and administrations. Educating leaders about the importance of exercise in youth and open-use agreement has been challenging. And although fewer teens are having babies, disparities persist among minority teens when compared to white teens.

Children and Youth with Special Health Care Needs

Moving the Needle: More than one (21.3%) in five children under the age of 18 identify as having a special health care need in South Carolina, and roughly half of children and youth with and without special health care needs have a medical home.

Population Needs: The percentage of infants identified through Newborn Screening with sickle cell disease who receive care coordination services through the CYSHCN program decreased in FFY20. This decrease illustrates a need to look at new activities to strengthen our approach in the upcoming year.  We know early intervention with care coordination can make a difference in outcomes for this vulnerable population and recognize the need to continue the successful partnership early intervention specialists and medical providers.

Accomplishments: CYSHCN has prioritized transition services, NPM 12. We have finalized our Transition Services policy, created trainings for staff development, partnered with our Family-to-Family agency to assist in training and development and created a transition workbook for individuals and families utilizing the “Got Transition” premise.

CYSHCN successfully provided and enhanced a virtual camp for our children with special health care needs, CBG n’ me. CYSHCN partnered with providers, community organizations, and staff to provide virtual sessions for all campers. Sessions included cooking classes, a talent show, and a host of other resources promoting the life skills for children and youth with special health care needs.