The Ohio Department of Health’s (ODH) mission is to advance the health and well-being of all Ohioans by transforming the state’s public health system through unique partnerships and funding streams; addressing the community conditions and inequities that lead to disparities in health outcomes; and implementing data-driven, evidence-based solutions.  ODH’s strategic agenda is informed by a State Health Assessment (SHA) and a State Health Improvement Plan (SHIP), which include maternal and infant health priority focus areas.

The Ohio Title V Maternal and Child Health (MCH) program is an organized effort to eliminate health disparities, improve birth outcomes, and improve the health status of women of childbearing age, infants, children, youth, including children and youth with special health care needs (CYSHCN), and families in Ohio. MCH utilizes a life course approach to develop strategies for improving factors impacting social determinants of health and creating systems that are equitable for all Ohioans.

To identify Ohio’s MCH priority focus areas for 2021-2025, MCH led a collaborative and comprehensive needs assessment process with internal and external MCH experts, agency partners, families, and consumers in alignment with the SHA, SHIP, and Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Needs Assessment. Since completion of the 2020 needs assessment, the COVID-19 pandemic has underscored the importance of the resulting priorities:

• Decrease risk factors contributing to maternal morbidity.
• Increase mental health support for women of reproductive age.
• Decrease risk factors associated with preterm births.
• Support healthy pregnancies and improve birth and infant outcomes.
• Improve nutrition, physical activity, and overall wellness of children.
• Increase developmental approaches and improve systems to reduce adolescent and young adult suicide rate.
• Increase protective factors and improve systems to reduce risk factors associated with the prevalence of adolescent substance use.
• Increase prevalence of children with special health care needs receiving integrated physical, behavioral, developmental, and mental health services.
• Prevent and mitigate the effects of adverse childhood experiences.
• Improve health equity by addressing community and social conditions and reduce environmental hazards that impact infant and child health outcomes.

A Five-Year Action Plan drives the development and implementation of strategies and activities aligning the National Performance Measures, National Outcome Measures, Evidence-Based Strategy Measures, and state MCH priorities within six population health domains.  The Ohio MCH program uses a Population Domain Group structure to manage MCH priorities and implement strategies from the five-year plan. Population Domain Groups are comprised of staff, stakeholders, and consumers including representatives from state agencies, local health departments, health care organizations, managed care organizations, insurance, consumers, parent, and family groups representing CYSHCNs, universities, and community agencies. Also included in the collaborative efforts are families, youth, and consumers, whose voices lend vital understanding of the unique needs of Ohio’s MCH population.  All these partnerships are critical because no single agency or system has the resources or capacity to accomplish this goal alone.

The Domain Groups update the Five-year Action Plan, assess performance measure outcomes, implement, and monitor strategies to impact the performance and outcome measures, and create or identify an evaluation plan to assess whether the interventions have been successful. In addition to the Domain Groups, MCH program administrators utilize data collection, program evaluation, and surveys to solicit feedback and monitor program outcomes.

A summary of each domain and strategies from the 2021-2025 Action Plan are included below. The descriptions represent key initiatives but do not reflect the entirety of work being implemented across the state and in collaboration with stakeholders.

Women/Maternal Health

The priorities reflect an ongoing need to address maternal morbidity, mental health for women of reproductive age, and risk factors associated with pre-term births. To address all three priorities, the Domain Group will continue to work with multiple partners to improve the outcomes for women before, during, and after pregnancy.

While the rate of severe maternal morbidity in Ohio is lower than the U.S. rate, the rate for Hispanic, non-Hispanic Asian/Pacific Islander, and non-Hispanic Black women is higher than the rate for non-Hispanic white women. Preconception care continues to be prioritized as a prevention strategy for maternal morbidity, and an opportunity to improve overall women’s health. Title X clinics implement Reproductive Life Plans for clients of child-bearing age and offer contraception as requested to assist clients in achieving their reproductive goals.  Preconception health efforts also include community assessments to identify pre- and interconception issues and barriers to inform strategies to implement culturally relevant community, clinical, or community-based services. The Oral Health Program is increasing the integration of oral health education, assessment, and referral into prenatal care. The Pregnancy Associated Mortality Review (PAMR) program leads multiple initiatives to address maternal morbidity, including AIM safety bundles, urgent maternal warning signs education, telehealth and obstetric emergency training, and the Ohio Council to Advance Maternal Health (OH-CAMH). OH-CAMH will focus the efforts of over 80 stakeholder organizations to improve maternal health outcomes, address gaps, and implement strategies that translate knowledge and recommendations into action.

Women in Ohio experience unmet mental health needs and more Ohio women experience postpartum depression compared to the U.S. national rate.  Preliminary evidence indicates that the COVID-19 pandemic has further increased mental health needs for women while also decreasing opportunities to screen and access services. The Domain Group is focused on addressing mental health for all women, including through screening and referral of women of child-bearing age through Title X, increasing trauma-informed care in community-based health and mental health settings, providing culturally relevant peer supported behavioral health services for high risk pregnant and postpartum women, and postpartum depression/anxiety screening during pediatric well visits. The Fetal Alcohol Spectrum Disorders (FASD) Steering Committee updates a strategic plan annually and conducts trainings on FASD prevention, screening for FASD, and treatment.

Pre-term birth continues to be one of the leading causes of infant mortality in Ohio.  Ohio’s rate of women who smoked cigarettes during pregnancy has decreased but remains two times higher than the rate for the overall U.S. Over 20% of infants who died in Ohio in 2019 were born to a mother who reported smoking in 3 months prior to pregnancy or during the first 3 months of pregnancy. Ohio aims to reducing smoking and substance use among pregnant women, including through the Moms Quit for Two program and Practice and Policy Academy participation to inform plans of safe care.

Perinatal/Infant Health

The highest priority is to support healthy pregnancies and improve birth and infant outcomes. The Domain Group will continue to focus on breastfeeding and safe sleep as key methods for improving infant health outcomes, as well as advancing initiatives to address Black infant mortality.

While the number of infants who died before their first birthday has decreased in the last ten years, the disparity continues with Black infants dying at nearly three times the rate of white infants. In December 2020, Governor Mike DeWine announced the formation of the Eliminating Racial Disparities in Infant Mortality Task Force, with members charged to work with local, state, and national leaders to identify needed changes to reduce infant mortality and eliminate racial disparities by 2030. To address the complex issues and systems, Ohio implements several large, data-driven initiatives employing evidence-based strategies. These include implementing the Ohio Equity Institute: Working to Achieve Equity in Birth Outcomes program in ten targeted high-risk metro areas; increasing evidence-based home visiting; increasing screening and referral via the integrated Pregnancy Risk Assessment Form in partnership with the Ohio Department of Medicaid; and enhancements in newborn screenings focusing on system linkages to increase and improve identification and referrals. Ohio ensures newborns receive appropriate screening, diagnostic testing, referral, and intervention through programs including newborn screening for Critical Congenital Heart Disease, Comprehensive Genetic Services Program, Sickle Cell Services, Infant Hearing, and Ohio Connection for Children with Special Needs Birth Defects Surveillance program.

Over the past five years, Ohio made significant improvements in performance measures for breastfeeding and safe sleep. Title V Breastfeeding and Ohio First Steps for Healthy Babies support breastfeeding in hospitals, worksites, and childcare facilities, improve breastfeeding continuity of care, and provide women direct support through a 24/7 breastfeeding hotline and virtual lactation consultants. Focus groups conducted with African American and Appalachian mothers will guide efforts to improve strategies aimed at increasing breastfeeding initiation and duration. MCH coordinates safe sleep education and crib distribution to remove barriers and assist families with safe sleep environments for their babies. Each year, nearly 99% of families receive safe sleep education during their maternity stay in Ohio’s hospitals, over 6,400 families receive a crib and safe sleep education through a Cribs for Kids partner, and safe sleep campaigns deliver over 57 million impressions to parents and grandparents in areas of Ohio with high infant mortality.

Child Health

The MCH priority for children represents a comprehensive approach to children’s health: improve nutrition, physical activity, and overall wellness of children. To address the priority of improving overall child health, efforts address a broad range of issues impacting children. Pediatric primary care visits represent a key opportunity for monitoring and addressing the comprehensive needs of children’s health, including the critical role of developmental screening.  The Domain Group continues to implement strategies to ensure all components of the well-child visit, including important screenings (Bright Futures, developmental, lead, hearing, vision, oral health, immunizations, BMI, social determinants of health, and ACEs), are included for every child. Ohio has rates comparable to the U.S. for developmental screening but has not seen an improvement in this outcome overall; however, the Home Visiting program has improved the rates of developmental screening among children served. The Early Childhood Health and Ohio Healthy programs continue to improve obesity efforts in childcare settings.  Compared to the U.S., Ohio has a lower rate of obesity among 2-4-year-olds, but a higher rate among ages 10-17 with lower income children experiencing disparities. Ohio performs similarly to the U.S. on several metrics related to nutrition and physical activity: fruit and vegetable consumption, access to exercise opportunities, and physical activity among children.

Adolescent Health

The MCH priorities: Increase developmental approaches and improve systems to reduce adolescent and young adult suicide rate; and increase protective factors and improve systems to reduce risk factors associated with the prevalence of adolescent substance use. The Domain Group is coordinating initiatives across both priorities with partners to support adolescent health.

Adolescent and young adult suicide has increased by more than half since 2009. The rate of adolescents with a major depressive episode in the past year has increased since 2011 and the percent of adolescents who bully others and who report being bullied is higher in Ohio than the U.S. MCH is working with partners to support implementation of the Ohio Suicide Prevention Plan among the youth population. Multiple MCH programs support adolescent resiliency through grant-funded community specific projects, coordination on prevention workgroups and coalitions including anti-Harassment Intimidation and Bullying and supporting professionals and communities in preventing violence and identifying/responding to victims of violence. The Domain Group continues to focus on adolescent preventive medical visits, which provide key opportunities for screening, education, and referral on numerous topics including mental health and substance use. Ohio’s rates of adolescent well-visits compare with the national rates, and improvements have been observed with nearly 80% of adolescents obtaining a well-visit, although data shows that well child visits/immunizations, and particularly adolescent well child visits/immunizations declined during the COVID pandemic.  BMCFH worked collaboratively with the Immunization Program at ODH on social media campaigns to increase well child visits where providers could also promote immunizations with parents.  Other efforts include training to pediatricians and school nurses, School Based Health Center initiatives, and cross-program prevention opportunities.

Children with Special Health Care Needs (CYSHCN)

The MCH priority to increase the prevalence of children with special health care needs receiving integrated physical, behavioral, developmental, and mental health services, is being implemented using a transition focus to ensure CYSHCN are prepared to actively participate in their care as adults.

Ohio's Title V efforts to address CYSHCN includes Ohio Revised Code 3701.023 requiring ODH to review eligibility for medically handicapped children (CMH) that are submitted to the department by city and general health districts and physician providers approved in accordance with the code. The eligibility will be extended from age 21 to age 22 in SFY 22 and age 23 in SFY 23. MCH convenes a state-wide workgroup comprised of representatives from ODH, the Ohio Department of Medicaid, clinicians specializing in treatment of CYSHCN, parents of CYSHCN, hospitals, condition-specific advocacy groups, and members of the ODH CMH Parent Advisory Committee. The CMH program works directly with more than 40,000 families of CYSHCN annually. In Ohio, CYSHCN have a similar rate of receiving care in a well-functioning system and a higher rate of receiving care in a medical home compared to the U.S. The Domain Group continues to focus on coordinating with partners to improve clinical and non-clinical service delivery systems, including hospital-based service coordination, parent-to-parent mentoring, and emergency preparedness for CYSHCN.

Ohio adolescents ages 12-17, with and without special health care needs, are less likely than U.S. peers to receive the services necessary to transition to the adult healthcare system. The Domain Group is working to increase adult and pediatric provider capacity, family and teen knowledge and support, and planning that identifies and addresses social determinant barriers to medical transition. The group is also committed to identifying opportunities to support transitions to adulthood outside of health care for CYSHCN.

Cross-cutting

Ohio continues to experience significant disparities in health outcomes. The priorities established to support all Ohioans in achieving their full health potential focus on adverse childhood experiences (ACEs) and health equity. These priorities are incorporated into each population domain and addressed from a systems-level. MCH is coordinating with partners to advance ACEs prevention and mitigation through the lens of shared risk and protective factors. The Health Equity Committee (now re-named to the Health Equity Action Team – HEAT) is advancing health equity in internal MCH organization/staff and in policy, program, grant, and contract administration.