1. Executive Summary
The Rhode Island Department of Health’s (RIDOH) Maternal and Child Health (MCH) Program supports and promotes the health of all womxn, children, and families. 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
- Improve Prenatal Health
- Strengthen Caregiver’s Behavioral Health and Relationship with Child
- Support School Readiness
- Support Mental and Behavioral Health
- Provide Effective Care Coordination for CSHCN
- Adopt Social Determinants of Health in MCH Planning and Practice to Improve Health Equity.
MCH Framework
RIDOH has three leading priorities and five strategies that guides all RIDOH work including MCH, with the goal of improving the health and well-being of all Rhode Islanders. Nestled within the RIDOH Health Equity Institute, RI’s MCH program seeks to address systemic inequities so that all Rhode Island families achieve their ideal life outcome regardless of their race, geography, disability status, education, gender identity, sexual orientation, religion, language, age, or economic status. Public health research and data show that generations-long social, economic, and environmental inequities, including structural racism and other forms of discrimination, have resulted in adverse health outcomes for several MCH populations.
MCH recognizes that achieving health equity requires action, leadership, inclusion, cross-sectoral collaboration and shared responsibility throughout RIDOH, and communities across the state. The MCH Program ensures that its work is coordinated by collaborating with and supporting a broad range of partners, including other State agencies, Medicaid, public and private insurers, family organizations, healthcare systems, clinical providers, community-based organizations, and other RIDOH programs. This work spans a variety of direct, enabling, and systems-level interventions.
In response to RI’s disparities and in an effort to achieve health equity, RIDOH has invested in Health Equity Zones (HEZ). Established in 2014, Rhode Island's Health Equity Zones initiative braids funds from several sources, including the state's Title V program. In the 6 years of the program, 10 HEZ across the state have been able to form strong collaboratives, define their unique needs, and address them with innovative solutions. In 2019, 3 additional communities were selected to become HEZ after a competitive selection process. In early 2020, 2 additional communities were added through COVID CARES funding as HEZ has demonstrated the ready-made infrastructure to support community-led investment to meet RI’s hardest hit by COVID communities. With the assistance of MCH, HEZ embodies four key components to successful and sustainable implementation, including (1) health equity-centered approach to prevention work that leverages (2) place-based, (3) community-led solutions to address the (4) social determinants of health (SDoH).
- Health equity-centered means that measuring and responding to population health disparities is the primary organizing principle to prevention.
- Place-based indicates that an equitable prevention approach should focus on providing resources to specific geographic areas, rather than funding all places equally. Any successful prevention effort must confront environmental factors that contribute to health inequities.
- Community-led signifies that the state or local department of health must share power with the community in a meaningful way and allow them to choose projects based on their own needs and priorities.
- The social determinants of health are the primary root causes of health inequities, besides the surrounding physical environment. SDoH include factors like access to education, quality job opportunities, safe housing, political participation, and healthy food.
RI’s Health Equity Zones are having a transformational impact on both the ability of the state's Title V program to align its goals with community-led initiatives and to improve the lives of the MCH population in RI’s most disparate communities.
Family-Centered Services
A long-standing tenet of RIDOH’s MCH Program is the representation and engagement of family, youth, children and youth with special healthcare needs (CYSHCN), and consumers at all levels of planning through implementation. RIDOH has partnered with the local chapter of Family Voices at the Rhode Island Parent Information Network to engage, train, and employ families of CYSHCN within the Rhode Island system of care. Family liaisons who are hired, trained, and certified as community health workers are supported in RIDOH’s CYSHCN, WIC, Newborn Screening, Birth Defects, Family Planning, Immunization, and Family Home Visiting Programs. RIDOH also convenes an active Youth Advisory Council that meets monthly, engages in policy development, and assists in the implementation of RIDOH programs. MCH strategic planning regularly includes families who have received services.
Partnerships
RIDOH is the sole public health entity in Rhode Island—there are no local health departments. As such, RIDOH relies heavily on partnerships to advance its work throughout the community. These partnerships include advocacy groups, colleges and universities, community-based organizations, federally qualified health centers, health insurers, Medicaid, professional organizations (Rhode Island Chapter of the American Academy of Pediatrics, Rhode Island Chapter of the American College of Obstetricians and Gynecologists, etc.), committees and coalitions, and other State agencies. During 2019-2020, RIDOH MCH staff convened or participated in more than 70 committees or advisory boards.
Recent Accomplishments
Women’s/Maternal Health
In this area, RIDOH focused on improving access to oral health services and improving preconception care and education. In 2018, the Family Home Visiting Program incorporated oral health screening and referral in its case management and data collection systems, the WIC Program added an oral health education model for WIC participants, and the RIDOH Childhood Lead Poisoning Prevention Program began distributing bilingual oral health materials in all of the certified lead centers across the state. Preconception health continues to be an area of focus because of its significance in affecting perinatal health outcomes. In the last several years, promotion of pregnancy intention screening, using the One Key Question model, has been used to encourage reproductive health counseling that empowers individuals to clarify their health needs in accordance with their personal goals. After reviewing and exploring existing data, RIDOH participated in an AMCHP communications technical assistance training and created an issue brief on maternal mortality and morbidity. Rhode Island recently formed the Pregnancy and Post-Partum Death Review Committee based on 2019 legislation.
Perinatal/Infant Health
Rhode Island is fortunate to have breastfeeding laws that support breastfeeding and lactating mothers. These laws allow womxn to breastfeed in all public spaces, require health insurance companies to cover breast pumps, and compel employers to provide a private, clean space for pumping. Currently, more than 95% of babies are born in certified baby-friendly facilities – four of five birthing centers. In 2018, breastfeeding materials were developed for dissemination at birthing hospitals, WIC offices, and through community partners that provide services to pregnant and parenting individuals. AMCHP selected these materials for inclusion in its Implementation Toolkit for National Performance Measure 4. RIDOH also oversees the implementation of four home visiting models throughout the state: First Connections, Nurse-Family Partnership, Healthy Families America, and Parents as Teachers. The Family Home Visiting Program at RIDOH continues to identify, enroll, and provide services for families most at-risk for poor health outcomes. From July 2019 to June 2020, the Program served 4,634 families and conducted 24,124 visits. Finally, upon recommendation by its advisory committee, RIDOH’s Newborn Screening Program added three conditions to the blood spot screening panel, effective October 1, 2018. RIDOH’s MCH Program has also been responsible for convening several groups focused on addressing perinatal health disparities: the Rhode Island Task Force on Premature Births, Disparities in Infant Mortality Work Group, Safe Sleep Interagency Work Group, and Task Force to Support Pregnant and Parenting Families with Substance-Exposed Newborns.
Child Health
Please note: It is premature to determine the full impact of the Covid 19 Pandemic on RI’s Child Health and Adolescent Health programs, so these accomplishments are based on previously realized successes. Rhode Island is a leader in several child health indicators, including healthcare coverage and immunization rates. High immunization rates can, in part, be attributed to the State’s universal vaccine policy that provides immunizations at no cost to medical providers for children, adolescents, and young adults. KIDSNET, an integrated birth to 18 child health and immunization registry, is used by public health professionals, medical providers, and several community-based providers (Early Intervention) to improve the health and well-being of children across the state. SEALRI!, a school-based dental sealant program, provides free dental exams and sealants to help prevent tooth decay among children who live in low-income communities throughout the state. In addition, beginning in late 2018, RIDOH’s Childhood Lead Poisoning Prevention Program pilot tested finger-stick lead screening at WIC sites for children identified in KIDSNET as needing screening. RIDOH supported passage of a school recess law by the state’s General Assembly. This law requires 20 consecutive minutes of unstructured free play each day in grades K – 6. RIDOH also participated in a statewide data project to collect overweight and obesity data and publish an issue brief.
Adolescent Health
Please note: It is premature to determine the full impact of the Covid 19 Pandemic on RI’s Child Health and Adolescent Health programs, so these accomplishments are based on previously realized successes. RIDOH completed an Adolescent Health Strategic Plan that utilizes the Healthy People 2020 and MCH Title V performance measures as a guide in identifying health priorities. Youth transition to adult healthcare services is an important area of work for RIDOH. For more than 10 years, RIDOH has also planned and sponsored the Dare to Dream Student Leadership Conference for high school students. While the conference was originally intended for youth with special healthcare needs, because of its overwhelming successes, it has been expanded to all youth. RIDOH also supports two minority youth leadership programs: Princes 2 Kings (P2K) and Girls Empowerment Mentoring Support (RI-GEMS). These programs provide learning and internship opportunities; pair youth with adult mentors; and address the unique academic, emotional, and environmental needs of the participants. Finally, RIDOH provides safety-net services for family planning and sexually transmitted infection (STI) screening and treatment through contracts with community clinical providers. The Teen Outreach Program, a pregnancy prevention program, has served more than 850 youth since 2013.
Children and Youth with Special HealthCare Needs (CYSHCN)
RIDOH has played a key role in the planning, development, and implementation of Patient-Centered Medical Homes for children (PCMH-Kids) throughout the state. Primary partners include Rhode Island’s four health insurers, the Rhode Island Chapter of the American Academy of Pediatrics, the State’s Executive Office of Health and Human Services, and the Care Transformation Collaborative. The primary goals of this project are to create pediatric medical homes and improve care coordination, especially for children with special healthcare needs. Currently there are 37 pediatric and family medicine practices participating in the PCMH-Kids initiative, including 260 primary care providers and trainees, covering more than 110,000 lives and representing more than 80% of the State’s pediatric Medicaid population. RI is also one of a few states that has established a medical home portal that provides comprehensive diagnostic, education, specialty care, social service, and resource information to improve the system of care and health outcomes for CYSHCN. Additionally, RIDOH contracts with the RIPIN for the provision of the Family to Family Health Information Line, support groups, resource development, peer resource specialists (community health workers), and advocacy for CYSHCN. RIDOH also oversees an internship program, recently designated by AMCHP as a Promising Practice, that provides workplace experience to CYSHCN and assists them with the transition to adulthood.
Cross-cutting Initiatives
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.
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