II.B. Overview of State

Rhode Island Demographics, Geography, Economy, and Urbanization

In 2020[1], Rhode Island had a population of just over 1M (1,097,379) people with a median age of 40 and a median household income of $63,296. Children under 5 years of age represent 5.1% of RI’s population and 19.3% of the population is under the age of 18. In addition, individuals aged 65 and older constitute 17.7% of the population and 9.8% of the population are disabled individuals under the age of 65.

The state of Rhode Island (RI) is a small, coastal area that measures just 48 miles from north to south, and 37 miles from east to west, with a total area of 1,214 square miles and over 400 miles of coastline. Rhode Island encompasses urban, suburban, and rural topography. Generally, it takes approximately an hour to travel from one side of the state to the other. The City of Providence, the state capital, holds the largest estimated residential community of 178,335 persons. The other core cities are Pawtucket, Central Falls, and Woonsocket. In addition, six smaller cities, fourteen suburban areas and fifteen rural towns surround the state’s core cities.

Municipality Organizational Structure

RI is unique as it has organized its government and distribution of services differently than any other state or territory in the country. Since Rhode Island has no county level of government, its 39 cities and towns provide services commonly performed by county governments in other states such as primary and secondary education, subdivision of land and zoning, and housing code enforcement in their local community. The state's cities and towns may adopt one of four forms of government: council–manager, mayor–council, town council–town meeting, or administrator–council. All of the core cities have a mayor-council structure whereas in the suburban areas a council -manager structure is more common.

Racial and Ethnic Diversity

The 2020 U.S census data indicate that residents are 71.3% White, not Hispanic; and 18.7% Hispanic or Latinx. The racial distribution in Rhode Island is White 71.3%, 5.7% Black or African American, 3.6% Asian, 9.3% Multiracial, and 0.7% Native American, and Alaskan Native. It is estimated that 13% of Rhode Island Residents are immigrants. In 2018, the largest share of the foreign-born population in RI was from the Dominican Republic (19% of immigrants), Portugal (7%), Guatemala (10%), Cape Verde (7%), and India (4%)[2]. Among RI residents over 5 years of age, 22.1% speak a language other than English at home, and Spanish is the most common of those languages.

Communities of color are growing rapidly throughout many areas of Rhode Island, and most of Rhode Island’s population growth over the last few decades is attributable to people of color. Between 2000 and 2010, the Latinx population experienced the most growth (44%), followed by Asian population (29%), and the Black, non-Latinx population (28%). This trend is expected to continue well into the future, as people of color are projected to represent 41% of the population by 2040[3]. Interestingly, this growth has occurred even as the state’s overall birth rate has decreased, in 2018, to 50.5 per 1,000 women ages 15-44. The largest communities of color are found in Providence, Pawtucket, Central Falls, Cranston, Woonsocket, and East Providence. It is also estimated that about 32,000 undocumented individuals live in RI and approximately 8,000 of these individuals are parents of U.S. born children.

Gender Inclusivity

RIDOH seeks to recognize the breadth of gender identities among the Maternal Child Health Populations. This includes individuals who are trans, non-binary, and intersex. However, there are limitations on population-based data reported among these individuals. Throughout this annual report, data are presented as they were originally collected and reported for gender, age, race, and ethnicity. RIDOH recognizes that these categories may not reflect how people and communities define themselves. We acknowledge these limits and strive to use language that is welcoming and inclusive of every Rhode Islander whenever possible such as womxn, womxn of color, and Latinx.

Structural Racism & Inequity

From the early days of Rhode Island’s colonization and the subsequent reliance on Black slaves for both labor and trade, through widespread displacement and asset-stripping through eminent domain via the Federal Housing Act, and the use of redlining to perpetuate racial segregation in the 20th Century, Black Rhode Islanders have been dealt an unfair hand. The historical legacy of centuries of unequal treatment manifests today across many socio-economic indicators which will be discussed later in this document.[4] In addition, new immigrants to Rhode Island from Liberia, Nigeria, other African nations and the Caribbean may have different experiences than native-born African Americans, yet still be subject to the similar prejudices and barriers that have held back the native-born population.

Similarly, structural racism and inequity has impacted indigenous people present in RI. From 1635 to the present day, the Narragansett tribe has endured, persevered, and challenged a variety of social injustices and interferences from colonists and the state. This includes but is not limited to “pressure to abandon the traditional ways and adopt Waumpeshau (white man) ideas of civilization”, slavery, slaughter, forced indebtedness, land seizures, a depletion of hunting and farming lands, discrimination and racism, and illegal state detribalization attempts.[5]

Sparked by the national social justice movement and accelerated by RI’s disparate COVID infections, RI is challenging its racial past and working to achieve racial equity. RI’s racial equity charge is the just and fair inclusion of all people, immaterial of their race or ethnicity, into a society where they can participate, prosper, and reach their full potential. This requires eliminating unjust policies, practices, attitudes and cultural messages that reinforce differential outcomes by race.[6] Racial Equity is best achieved through a social justice lens that understands both past and present social injustices and how these inequities have led to poor outcomes for communities of color. Today, RI is still grappling with its historical ties to colonialism and racial injustice, most notably the current political movement to drop Providence Plantations as a part of RI's official legal name.

Income Landscape

Rhode Island sees income gaps among various genders, races, and ethnicities.

RI An income gap also exists between men and women. In 2019, men earned 1.2 times
more than women. [7]

 

 

 

From 2015-2019, the median family income of white families ($92,986) was higher than that of Asian ($85,378), Black ($49,980), Hispanic ($40,624), Native American ($36,447), other race ($42,193) and Multiracial ($56,527) families. Generally, 10.8% of individuals in the state live in poverty. From 2015-2019, nearly one in six (17%) children in RI (a total of 34,766 children) lived in poverty. Specifically, 55% of Native American, 33% of Hispanic, and 27% of Black children endure poverty within the state. There is also a large percentage of the population with incomes above the poverty level who have a difficult time meeting the high costs of housing, utilities, food, childcare, and health care in RI. [11]

Within the four “core” cities, the poverty rate is 32.9% and nearly twice the poverty rate of the entire state (17%). Between 2015 and 2019, nearly two thirds of Rhode Island's children (22,516) living in poverty lived in the four “core” cities of Providence, Central Falls, Pawtucket, and Woonsocket. 72% of children living in poverty live in unmarried parent families. This is in comparison to 25% of children who are in poverty while living in married-couple families. The four core cities also had substantial numbers of children living in extreme poverty, defined as families with incomes below 50% of the federal poverty threshold, or $10,116 for a family of three with two children and $12,733 for a family of four with two children. The overall state had a lower percentage of children living in extreme poverty (7%) compared to Central Falls (12.4%), Pawtucket (7.6%), Providence (14.8%), and Woonsocket (16.7%). During the 2019-2020 school year, RI public school personnel identified 1550 children as homeless. Of these children, 66% lived with other families ("doubled up"), 23% lived in shelters, 9% lived in hotels or motels, and 2% were unsheltered. Within each of RI’s cities and towns, there are communities that are affected by poverty and attain extremely low wages. [8]

Children with Special Needs

In the state, 21% of children have at least one healthcare need. [12] 66% of CSHCNs have multiple diagnoses and chronic conditions. [11]

In addition, as of June 30, 2020, 2,224 children were provided appropriate Early Intervention services as required by the Individuals with Disabilities Education Act (IDEA) Part C and 2,904 children between ages three and five who received preschool special education services. In addition, 21,660 students ages 6 to 21 receive special education services through RI public schools, the majority of whom are White, identify as boys and are not low-income. Thirty-six percent of these students had a learning disability. The demographic profile of students receiving special education services indicate that some children may not be getting access to special education services due to their economic, racial, or other characteristics. [11]

Roles, Priorities, and Interests of the RI Department of Health

RIDOH Role and Structure

RIDOH is the lead RI agency responsible for addressing the maternal and child health needs throughout the state. Section 23-13 of the RI General Laws gives RIDOH broad authority for administering and overseeing Title V MCH services. RIDOH is located within the state's Executive Office of Health and Human Services (EOHHS), a cabinet agency that reports directly to the Governor. (See Appendix for organizational charts). Further, the RI MCH (Title V) Program is a part of the newly created Health Equity Institute (HEI). HEI was created by Director Nicole Alexander-Scott, MD, MPH in 2016 as a strategy to promote RIDOH’s three leading priorities including:

1) addressing the social and environmental determinants of health

2) eliminating the disparities of health and promote health equity

3) ensuring access to quality health services for Rhode Islanders, including our vulnerable populations.

These priorities are the foundation that guides all RIDOH work supporting the goal of improving the health and well-being of all Rhode Islanders.

Health Equity Institute (HEI)

The mission of the HEI is to address systemic inequities so that all Rhode Islanders has a fair and just opportunity to be healthier regardless of their race, geography, disability status, education, gender identity, sexual orientation, religion, language, age, or economic status. This requires removing obstacles to health such as poverty, discrimination, and their consequences. Consequences of health obstacles include powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and healthcare.

HEI recognizes that achieving health equity requires action, leadership, inclusion, cross-sectoral collaboration and shared responsibility throughout RIDOH, and communities across the state. HEI has substantial expertise in providing communities and policy-makers with data, technical assistance, and evidence-based programs to address health disparities in vulnerable populations. HEI systematically addresses health disparities across the Department by providing guidance on data analysis, the development of joint work plans, and technical assistance. The HEI is strategically located in the Office of the Director, who provides leadership, vision, communication, and direction across all RIDOH divisions and programs.

HEI Structure

Several large programs are housed within the HEI, including: Disability & Health, Minority Health, Refugee Health, Maternal and Child Health and the Health Equity Zones (HEZ). HEI also provides collaborative support to all of RIDOH’s equity initiatives including:

1) The Social Justice Roundtable

2) Sexual Orientation and Gender Identity Workgroup

3) Social Determinants of Health Workgroup,

4) Community Health Assessment Group,

5) Commission for Health Advocacy & Equity,

6) Kresge Initiative

Health Equity Indicators

The identification of health disparities is critical to identifying and describing vulnerable populations in RI so that these groups can be prioritized in public health interventions.  HEI currently uses both absolute and relative measures for rates and proportions to measure health disparities. Current disparity data can be found in each domain update.

Notably, over the past two years the Health Equity Institute (HEI) went through an extensive community engagement process where the Community Health Assessment Group developed a core set of 15 indicators in five domains that affect health equity: integrated healthcare, community resiliency, physical environment, socioeconomics, and community trauma. The data for these indicators comes from various sources. When possible, data are reported by geographic location, race/ethnicity, disability status, income level, or other demographic characteristics. A complete list of Rhode Island’s Statewide Health Equity Indicators can be found in the Appendix.

Please reference the following website for up to date information and statistics on health equity indicators: https://health.ri.gov/data/healthequity/.

Interagency Initiatives

It is the responsibility of the RI Title V Program to assure that MCH initiatives, within RIDOH and throughout the state, work together to ensure a continuous system of care for mothers, children, CSHCN, and families that is coordinated, comprehensive, and community-based. Various RIDOH programs take the lead on different MCH strategies. All RIDOH’s programs work together to ensure a statewide system of services. This complex work is pursued utilizing a variety of strategies that engage other state agencies, policy makers, community-based agencies, clinical and social service providers, and target populations including:

The Rhode Island Children’s Cabinet: Governor’s Children’s Cabinet is authorized to engage in interagency agreements and appropriate data-sharing to improve services and outcomes for children and youth. The general goals of the organization are to improve the health, education, and well-being of all children and youth, increase the efficacy, efficiency, and coordination of service delivery, and improve data-driven, evidence-based decision-making through strengthened data sharing capacities among agencies and research partners, while adequately protecting the privacy rights of children.

Early Intervention Interagency Coordination Council (ICC): ICC is composed of representatives from organizations that serve the Early Childhood population and parents of children who are currently or formerly enrolled in Early Intervention. The ICC is an advisory council to assist EOHHS with program implementation. ICC is a venue for information sharing and we encourage programs to work together on initiatives that are being implemented across the state. The ICC also acts as a sounding board for families and providers to discuss challenges and successes in their Early Intervention experiences.

Task Force to Support Pregnant and Parenting Families with Substance-Exposed Newborns (SEN): The SEN Task Force is composed of medical professionals, substance use treatment providers, peer recovery coaches, early intervention/family home visiting professionals, educators and representatives from the key Health Cabinet agencies. Their aim is to work through interagency collaboration to reduce the number of substance exposed newborns and provide adequate support for affected families and children. This complements the work of the broader Overdose Prevention and Intervention Taskforce.

Successful Start: This is an advisory board composed of representatives from state and local agencies. The board works to advise on Healthy Families America, Project Launch, Project Autism, and DCYF related programming. A parent advisory board gives feedback on these programs and discusses any relevant issues affecting them and their communities.

Community Agency Partners: RIDOH also highly values and works with the community as a core partner in MCH and works with the state's 39 cities and towns to assure that equity in maternal and child health becomes a reality. The following types of roles community agencies take on in the state. The community agencies take on a variety of different roles within RI including advocacy and policy work, direct services, and clinical services.

Strengths and Challenges that Impact Maternal and Child Health

RI’s small size is an advantage for the state to be at the forefront of developing and testing innovative statewide health care policies that work to improve the health and well-being of the state's maternal and child health (MCH) populations. In RI, all public health services are managed by the RIDOH, there are no local health departments. The centralization of RI’s public health services to a single agency helps simplify the management and implementation of statewide strategic plans, programs, and initiatives, including those that address maternal and child health. The RIDOH upholds strong partnerships with many community organizations, hospitals, healthcare providers, and academic institutions. Through these partnerships, various initiatives, programs, and population health priorities can be integrated at all levels of public health service and health care delivery throughout the state. Community, healthcare, and academic partners also help assess the health needs of all Rhode Islanders. From place-based community health evaluations to hospitals, they provide data that may highlight emerging issues, diseases, or inequities.

Racial and ethnic populations, disparities still exist for several maternal and infant health outcomes in Rhode Island. Minority women are more likely than White women to receive delayed or no prenatal care and to have preterm births. Black, Hispanic, and Asian women have higher rates of maternal morbidity than that of White women. Black children are more likely to die in infancy than White, Hispanic, or Asian children. Hispanic, Native American, and Black youth have a higher teen pregnancy rate than White and Asian youth. Black and Hispanic children in RI are more likely to be hospitalized as a result of asthma than White children. Racial and ethnic differences in asthma are connected to issues such as poverty, exposure to indoor and outdoor air pollution, stress and access to healthcare. A more comprehensive review of the strengths and challenges of the state can be referenced in the Needs Assessment. [12]

Maternal Child Health Administrative Structure

Various state agencies are responsible for independently and collaboratively working together and with community partners to care for birthing parents and their children. It is important to note that these departments are centralized at the state level and serve every city and town in the state. Some of the agencies listed below are particularly created and proposed for serving this subset of the population. Other generalist agencies have fashioned programs and units that serve the needs of birthing parents and children.

Principal Health and Human Services Agency

Executive Office of Health & Human Services & Hazard building (EOHHS): (EOHHS) serves as “the principal agency of the executive branch of state government” (R.I.G.L. §42-7.2-2) responsible for overseeing the organization, finance and delivery of publicly funded health and human services. In this capacity, the EOHHS administers the state’s Medicaid program and provides strategic direction to Rhode Island’s four health and human services agencies: Department of Health (DOH); Human Services (DHS); Children, Youth, and Families (DCYF); and Behavioral Healthcare, Developmental Disabilities, and Hospitals (BHDDH).

Child Welfare Agencies

Department of Children, Youth, & Family Services (DCYF): DCYF is the sole child welfare agency for the state of Rhode Island. They consist of numerous departments including but not limited to, Child Protective Services, Licensing, the Family Service Unit, Developmental Disability Unit, Child Support Unit, Juvenile Corrections, Juvenile Probation, Legal Department, Intake Unit, Monitoring Unit, Central Referral Unit, Children’s Behavioral Health Unit and the Contract Compliance Unit. In short, DCYF is the state child welfare, children's mental health and juvenile corrections services agency which promotes safety, permanence, and well-being of children through partnerships with family, community, and government.

Office of the Child Advocate (OCA): The OCA serves as the oversight agency to DCYF and monitors each child open to DCYF. OCA is responsible for monitoring the operation of each unit within the Department and must ensure best practices for child welfare and general compliance with internal policies and protocols, state law and federal law.

Health Centered Agencies

The Office of the Health Insurance Commissioner (OHIC): The OHIC makes sure that insurance companies selling policies in the state follow Rhode Island and federal law. OHIC issues recommendations, orders, and/or penalties to protect Rhode Islanders in the case where state or federal law is not followed. OHIC also creates new regulations and updates current regulations as needed. Consumer protection is at the core of all of the work in the agency as it oversees and researches the appropriateness of any insurance premium increases.

Department of Behavioral Healthcare, Development Disabilities, and Hospitals (BHDDH): BHDDH has three major operational divisions: Behavioral Healthcare, Developmental Disabilities, and Eleanor Slater Hospital. BHDDH serves over 50,000 Rhode Islanders who have intellectual and/or developmental disabilities or need Long- Term Acute Care in the state hospital system, known as the Eleanor Slater Hospital. The Department works to create safe, accessible, high quality and integrated services for all Rhode Islanders, while collaborating with community partners for those in need of assistance.

Housing Centered Agencies

Office of Housing & Community Development (OHCD): OHCD provides opportunities for healthy and affordable housing through production, lead hazard mitigation, and the coordination of the homeless system and implementation of the State’s plan to end homelessness. OHCD provides financial and operational support for all housing programs administered by the Housing Resources Commission (HRC), including a rental assistance program, which will provide housing to homeless individuals and families by non-profit homeless service providers. OHCD’s Community Development branch administers the federal Community Development Block (CDBG) program, and related programs.

Education Agencies

Department of Education (RIDE): RIDE administratively oversees all primary and secondary schooling within the state. The agency also oversees the educational services in which special needs children and youth receive in their schooling.

Disability Agencies

Commission on Deaf & Hard of Hearing (RICDHH): RICDHH is an advocacy, coordination, and service providing entity committed to promoting an environment in which deaf and hard of hearing individuals in Rhode Island are afforded equal opportunity in all aspects of their lives. The RICDHH develops policy; initiates and lobbies for favorable legislation; fosters cooperation and awareness among state agencies and community organizations; and educates and advises consumers, state agencies, and employers about the Americans with Disabilities Act (ADA) rights to equal access.

Governor’s Commission on Disabilities: A governor organized commission that believes that all people with disabilities should have the opportunity to exercise all the rights and responsibilities given to citizens of this state. They believe each person with a disability should be able to reach his/her maximum potential in independence, human development, productivity and self-sufficiency. Developmental Disabilities Council There are 24 governor-appointed Rhode Islanders serving on the Council who are proponents of legislative and systems changes that account for obstacles in education, employment, transportation, housing, recreation, and health care that confront people with disabilities throughout their lives.

Components of Systems of Care

Insurance in the System of Care

Public health insurance is insurance that is either offered by or in part subsidized by the U.S federal, state, or local government. For instance, RIte Care is RI’s Medicaid managed care program for families and children, pregnant individuals, children under the age of 19. It is important to explain the Medicaid Managed Care Organizations delivery system structured to manage cost, utilization, and quality of healthcare services. Medicaid managed care allows recipients to receive Medicaid health benefits and additional services via contracted arrangements between the state Medicaid agencies and managed care organizations (MCOs). These MCOs allow for a set per member per month (capitation) payment for these services. Eligible individuals can choose from three of the following insurance plans: 1) Tufts Health Plan, 2) Neighborhood Health Plan of RI, and 3) United Healthcare Community Plan.

Private health insurance is insurance that is marketed to individual consumers or employers who buy private companies not in affiliation or subsidization with the government. Some private health insurance companies in the state include Blue Cross Blue Shields, Aetna, etc. A person may choose to buy their own insurance, but many do receive it as a benefit from their employers. It can be noted that there are quasi-public insurance companies that are generally private sector companies that are supported in some way by the government and charged with providing insurance.

HealthSource RI is the state's health insurance marketplace. HealthSource RI enrolls customers for both commercial health insurance and the state's Medicaid program. HealthSource RI held its fifth open enrollment period between November 1, 2017, and December 31, 2017. During that time, the Healthsource RI Open Enrollment 2018 Report, 30,637 total customers were enrolled in private plans through the state marketplace (and paid their first month's premium). Of those, 22,603 were renewing customers and 8,034 were new customers. Recently released data from the 2019 open enrollment period show that 32,486 customers enrolled, which is an increase of 1,849 customers from the previous year. During state fiscal year 2017, Rhode Island’s Medicaid Program served an average of 305,000 enrollees with full Medicaid benefits and another 17,6000 average enrollees received partial benefits. Children and families represent 51% of the enrollment (165,894) and children with special health care need represent 4% of all enrolled (12,060). [9]

Insurance Oversight

The Office of the Health Insurance Commissioner (OHIC) provides the state oversight on healthcare insurance providers within the state. OHIC is responsible for: Guarding the solvency of health insurers; Protecting the interests of consumers; Encouraging policies and developments that improve the quality and efficiency of health care service delivery and outcomes; and viewing the health care system as a comprehensive entity that encourages and directs insurers towards policies that advance the welfare of the public through overall efficiency, improved health care quality, and appropriate access. Consumer protection is at the core of the work of the Office of the Health Insurance Commissioner. OHIC helps consumers understand the healthcare system and protects Rhode Island consumers by making sure federal and state laws are followed.

RIDOH participates in the standards development and implementation of Accountable Entities (AE) which is Medicaid’s version of an Accountable Care Organization (ACO) where a provider organization is accountable for quality health care, outcomes and the total cost of care of its population. Rhode Island launched its first pilot AE in the spring of 2016. Six (6) organizations participated in the AE pilot and five (5) became certified AEs when standards were released in 2018. Guiding Principles of Rhode Island’s AEs reflect several MCH priorities and include:

• Promoting and supporting multi-disciplinary capacity, a strong foundation in primary care, effective behavioral health integration
• Having the ability to manage the full continuum of care, including “social determinants”
• Having analytic capacity to support data driven decision-making and real time interventions.
• Focusing on high utilizers- Medicaid beneficiaries with complex needs or high costs

Birthing Parent System of Care

It is important to lay out the system of care birthing parents receive as they enter antepartum and intrapartum. For reference, antepartum is referred to as the pregnancy and intrapartum spans from the onset of labor to the delivery of placenta. There is a network of support for birthing parents as they journey through the conception and gestation process. Primary care providers and obstetrician-gynecologists (OB-GYNs) are generally the first providers that interact with a person’s sexual health before and during pregnancy. During visits with practitioners, many individuals are educated on and gain access to family planning options. Family planning promotes reproductive health by helping people prevent unplanned pregnancy or achieve intended pregnancy. This is an important option for individuals as, in 2018, one in three women had an unintended pregnancy.

Title X Family Planning Clinics are funded by the federal Title X grant and provide individuals with comprehensive family planning and related preventive health services. It is important to note some past Title X Grant recipients such as Planned Parenthood have foregone this funding stream with the release of recent mandates concerning family planning methods. In 2018, approximately 6 out of 10 individuals served at Title X clinics use a family planning method defined as most to moderately effective, such as an IUD or hormonal injections.[10]

During antepartum, Title X clinics, OB-GYNs, midwives, doulas, and primary care providers become important to ensuring the health of a pregnant individual and developing fetus. Recent estimates show that there are a total of 30 prenatal care practices in the state. From 2015-2019 17% of RI pregnant women had a delayed prenatal visit during their first trimester. Black (23.5%), American Indian and Alaska Native (21.3%), Hispanic (19%), and Asian women (17.8%) were more likely to have delayed prenatal care than white women (13.1%). Additionally women who did not graduate from high school were more likely to have delayed prenatal care (25.5%) than women with more than a high school education (12.9%) Additionally, Family Home Visiting programming, such as Nurse Family Partnership, supports and helps prepare pregnant individuals for parenthood.

During intrapartum, pregnant people can choose to access hospital, midwifery, and doula services. Women and Infants Hospital, part of the Care New England system, specializes in care of womxn and newborns, and is the 9th largest stand-alone obstetrical service in the US. In 2019, over 80% of newborns in RI are delivered at Women and Infants Hospital. There are four additional birthing hospitals located throughout the state that split the remaining birth. Within many of these hospitals, their respective Obstetric and Labor and Delivery Units not only birth babies but perform fetal surgery, examine placenta and products of conception, and perform neonatal postpartum exams.

Perinatal/Infant System of Care

RI Birthing Hospitals contain postpartum and Neonatal Intensive Care (NICU) units that assess and care for delivered babies. During Postpartum, RI birthing hospitals are legally required to coordinate with the Office of Newborn Screening and Follow up to screen all newborns in Rhode Island for metabolic, endocrine, hemoglobin, hearing, and developmental risk factors. All babies are tested, because babies with these disorders often appear healthy at birth. Serious problems, including death, can be prevented if the disorders are discovered early.

Generally, the Office Newborn Screening and Follow-Up work to support systems and services that screen newborns. In total, the program provides universal newborn screening for 33 core blood disorders, Critical Congenital Heart Disease, and a Hearing and Developmental Risk Assessment. Their goal is to screen 100% of newborns annually and thoroughly monitor the number of follow-up forms completed by diagnostic clinics in KIDSNET. The Office encompasses the Newborn Hearing Screening Program that works to screen, evaluate, refer, and provide resources and educational supports to newborns with hearing loss.

It is important to note the support a birthing parent receives in the initial phases of parenthood. For instance, consultation on breastfeeding is available to birthing parents both inside the hospital and in the community. There are Certified Lactation Counselors (CLCs) and International Board-Certified Lactations Consultants (IBCLCs) that can help birthing parents through the breastfeeding process. Both IBCLCs and CLCs are tasked with assessing, advocating, educating, and consulting birthing parents. RIDOH plays a role in monitoring IBCLCs and CLCs, digitally listing all certified practitioners in the state, and examining any consumer complaints. Additionally, Family Home Visiting Programs are influential in supporting the lives of parents with newborns and young children and connecting them to pertinent resources.

Childhood & Adolescent System of Care

There are a variety of care options for children and youth in the state. For instance, there are 60 pediatric practices in the state that serve children and youth. Additionally, Hasbro Children’s Hospital, the pediatric division of Rhode Island Hospital, is RI’s primary dedicated children’s hospital. Hasbro has RI’s only pediatric emergency department, Level 1 Trauma Center, and pediatric critical care teams. Hasbro is part of the Lifespan health system and is affiliated with the Warren Alpert Medical School of Brown University. Children and youth also have access to programming either structured through the state or through community agencies.

 

Children and Youth with Special Healthcare Needs Services

There are a variety of developmental resources that are tailored in supporting children with special healthcare needs (CSHCNs). Medical Assistance benefits for children and adults with a disability, include federal Supplemental Security Income Program and the Katie Beckett Program, a Medicaid coverage category that is given to eligible CSHCNs. Additionally, home visiting programs and community agencies in the state play a supportive and active role in the lives of many special healthcare needs children.

In addition, there are various educational resources provided to special needs children including Early Intervention and Special Education.  There are nine certified EI provider agencies.  Preschool special education services are provided through the public school districts. In addition, all school districts coordinate with the Child Outreach program to screen all enrolled children ages three to five years old which has been instrumental in helping to identify children who need additional resources to learn and thrive.

Federally Funded Assistance Programs

 

RI offers various federally funded assistance programs and services to underserved and vulnerable populations:

 

Supplemental Nutrition Assistance Program (SNAP): SNAP is available to households with a gross monthly income below 185% of the federal poverty level ($40,626 for a family of three in 2021). SNAP, usually through electronic benefit transfers (EBT), distributes monthly monetary funds to help families buy non hot food items. Hot foods are referred to as food that is sold for on-premises consumption. In October 2020, 43,660 children and 93,422 adults were enrolled in SNAP. [11]

 

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC): WIC serves pregnant, postpartum, and breastfeeding womxn, infants, and children under five years of age living in households with incomes below 185% of the federal poverty level. Any individual who participates in SNAP, RIte Care, Medicaid, or RI Works is automatically income-eligible for WIC. Participants must also have a specified nutritional risk, such as anemia, abnormal growth, or high-risk pregnancy. In June 2020, 19,507 women, infants, and children were enrolled in WIC in Rhode Island. In 2019, only 48% of those eligible for the program were enrolled. [11]

 

Rhode Island Works (RIW): RIW program assists qualifying families through various methods including temporary cash assistance, job training and job search assistance, and transportation costs in preparation for employment. As of December 2019, 4,298 children were enrolled in RI Works.

 

Child Care Assistance Program (CCAP): CCAP is meant to subsidize the cost of childcare for eligible RI families with children under the age 13 and are families that are either US citizens or legal residents. The program and parent usually share in the costs of the child care expenses. The share in expenses is calculated based upon a family’s income and size, and amount of children already receiving child care subsidies.

 

State Regulations and Statutes Impacting MCH Population

RI has several regulations and statutes that have an impact on MCH and CSHCN Programs.  A full description can be found in the Appendix.

 

Conclusion

Rhode Island is a small but diverse state that offers a variety of services for birthing parents, children, and youth. The state is always pushing the needle on how to more adequately serve its constituents and help them towards a healthy and prosperous life. The MCH program builds upon the comprehensive health care and social service system to prioritize the state’s most disparate populations with a racial / health equity lens. MCH works to expose that social, economic, and environmental inequities have resulted in adverse health outcomes and have a greater impact than individual choices for mothers, children, and families in RI. The sections to follow will outline the priorities that Title V MCH will focus on to further increase maternal and child health outcomes.

Endnotes

[1] https://www.census.gov/quickfacts/fact/table/RI/PST045219

[2] 2020, August 06). Immigrants in Rhode Island. Retrieved September 08, 2020, from https://www.americanimmigrationcouncil.org/research/immigrants-in-rhodeisland

[3] H. (2018). Healthsource RI Open Enrollment 2018 Report (Rep.). RI. https://healthsourceri.com/wp-content/uploads/2018HSRI_OE5Report_02182019.pdf

[4] Economic Progress Institute. The State of Black families report http://www.economicprogressri.org/wp-content/uploads/2017/05/SOBRI2017_Final_digital.pdf

[5] Official Website of the Narragansett Indian Tribe. http://narragansettindiannation.org/

[6] Adapted from PolicyLink and FSG: The Competitive Advantage of Racial Equity. Published October 2017. http://www.policylink.org/resource/competitiveadvantage-racial-equity and W. K. Kellogg Foundation Racial Equity Resource Guide Glossary. http://www.racialequityresourceguide.org/about/glossary

[7] Data USA. https://datausa.io/profile/geo/rhode-island

[8] RI Kids Count Factbook, 2020 http://www.rikidscount.org/Portals/0/Uploads/Documents/Factbook%202020/RIKCFactbook2020.pdf?ver=2020-04-03-124327-163

[9] H. (2018). Healthsource RI Open Enrollment 2018 Report (Rep.). RI. https://healthsourceri.com/wp-content/uploads/2018HSRI_OE5Report_02182019.pdf

[10] Rhode Island Title X Database

[11] National Vital Statistics System

[12] RIPIN & Family Voices. Issue Brief. https://ripin.org/ripin/wp-content/uploads/2019/09/RIPIN_FV_Policy-Brief-2019-Access-FINAL.pdf