Women’s/Maternal Health Domain

FY20 Application

 

 

The FY20 workplan for the Women’s/Maternal Health Domain includes the following performance measures:

 

1. Oral Health
2. Unintended Pregnancy
3. Maternal Mortality Disparity Ratio

 

Emily Yeatts, MSW, MPH (Reproductive Health Unit Supervisor) currently serves as the Title V Women’s/Maternal Health Domain Lead.

 

Leadership of Title V-funded efforts for women’s and maternal health will be shared by the Division of Prevention and Health Promotion’s Dental Health Program and the Division of Child and Family Health’s Reproductive Health Unit. These entities and their proposed activities for the upcoming grant period are detailed below.

 

 

Dental Health Program

The Division of Prevention and Health Promotion’s Dental Health Program is led by Tonya McRae Adiches, RDH (Dental Health Programs Manager).

 

Kami Piscitelli, BSDH, RDH, serves as the Special Needs Oral Health Coordinator.

 

 

Reproductive Health Unit

The Division of Child and Family Health’s Reproductive Health Unit is led by Emily Yeatts, MSW, MPH (Reproductive Health Unit Supervisor). The unit includes the following programs:

• Title X Family Planning (Title X);
• Adolescent Health (Abstinence Education Grant, Title V); and
• Resource Mothers (TANF, Title V).

 

The Adolescent Health Program is led by Madeline Kapur, MPH, MSW (Adolescent Health Coordinator). The Resource Mothers Program is led by Consuelo Staton, MEd. (State Resource Mothers Coordinator). These programs are detailed in the FY20 application for the Adolescent Health Domain.

 

Janelle Anthony, MSN, RN, PHNA-BC, serves as the Family Planning Quality Assurance Nurse Supervisor supporting Title X and the LARC Initiative.

 

 

 

 

Program Overview

 

The Division of Prevention and Health Promotion’s Dental Health Program (DHP) provides:

• Educational activities and resources to a wide variety of partner groups to promote proper oral hygiene and support prevention services and access to dental care;
• Direct clinical preventive services and assistance with establishing a dental home;
• Quality assurance reviews to assure a competent public health oral health workforce; and
• Surveillance and evaluation activities to monitor and track dental disease rates and trends and for Program assessment of effectiveness and planning.

 

The DHP collaborates with Title V to:

• Foster regional alliances and implement local initiatives to improve access to dental care for children and pregnant women;
• Promote medical and dental integration in safety-net settings;
• Increase public awareness and engagement around oral health by disseminating data, research, and promising practices; and
• Support workforce development and training for medical and dental providers, lay professionals, home visitors, and caregivers serving individuals with special health care needs (ISHCN).

 

The DHP has many internal partners including other VDH MCH programs and the statewide Virginia Oral Health Coalition (VaOHC). VaOHC is a non-profit organization that serves as the only statewide oral health coalition in the Commonwealth. It is a diverse group working to bring excellent oral health to all Virginians through policy change, public awareness and innovative programs. The Coalition works closely with VDH to implement grant objectives and has in-depth knowledge of the Virginia Oral Health Plan and the Virginia Oral Health Report Card, foundations that prioritizes oral health activities statewide. VaOHC has access to a diverse network of key, statewide stakeholders, and the unique ability to share oral health information with both key partners and the public. Coalition staffs understand the need to continually promote oral health at the local level, support local initiatives to affect meaningful change, and to evaluate efforts to ensure ongoing, comprehensive support for structural sustainability.

 

The Special Health Care Needs Oral Health Program aims to improve access to dental services for individuals with special health care needs (ISHCN) by expanding components of the Dental Health Program’s (DHP) oral health initiatives to include services focused on ISHCN. This is accomplished through educating medical/dental professionals, lay health workers, case workers, teachers, families, and individuals about oral health care for ISHCN through presentations, exhibit booths, and educational materials.  With Title V funds, staff provide oral health education materials and support for dental and medical provider courses regarding the care of very young children, pregnant women, and ISHCN, as well as, maintain a current web-based listing of 2,300 dental providers who report serving ISHCN and children under three years of age, representing approximately 41% of Virginia’s licensed dental providers residing in the Commonwealth of Virginia.

 

Program activities aimed at increasing oral health care for pregnant women, infants, children, and individuals with special healthcare needs winin the DHP are the Bright Smiles for Babies Fluoride Varnish Program, the Dental Preventive Services Program, and the Perinatal and Infant Oral Health Program.

 

Bright Smiles for Babies (BSB) is a prevention and education initiative to reduce the prevalence of early childhood caries (ECC) in infants and toddlers, aged 6 months – 3 years of age.  Children who are at high risk for ECC often experience barriers to accessing timely dental services.  The BSB program eases barriers to care by providing preventive services primarily in non-dental settings where parents of young children are seeking other services, e.g., doctors’ offices, Women, Infants, and Children. 

 

The Dental Preventive Services Program aim is to prevent dental decay for children in the most susceptible permanent teeth, in the most vulnerable populations in Virginia.  Low-income schoolchildren in targeted areas of the state receive dental services including oral health assessment, dental cleanings, dental sealants, fluoride varnish application, dental referral information, and oral health education.

 

The Perinatal and Infant Oral Health Program aims to improve access to oral health care for pregnant women and infants who are most at risk for disease through integration of dental services and information into the primary care delivery system.  Additionally, this program allows for expansion of the existing Virginia Oral Health Surveillance System to include data collection, analysis, and reporting of indicators regarding pregnant women and infants.

 

 

Snapshot of Program Accomplishments

 

• VDH completed an action plan for integrating oral health into MCH activities by identifying strategies and partners for addressing 3 MCH population oral health needs in Virginia -  women, infants, and children.  This includes providing support to the Virginia Oral Health Coalition (VaOHC) to facilitative leadership training to 6 Regional Oral Health Alliances.

 

• 204 dental providers participated in VDH-sponsored continuing education courses regarding the oral health care of ISHCN, early childhood, and/or perinatal/pregnant women. In addition, the ISHCN program coordinator provided various oral health education courses attended by 161 lay health workers/home visitors/family educators and 48 medical professionals.

 

• Through a partnership with the Care Connection for Children pediatric medical specialty clinics in three Southwestern Virginia counties, a VDH remote-supervised dental hygienist provided preventive services. ISHCN at these clinics had the opportunity to receive these services 12 days out of the year. The number of services provided include 112 oral screenings, 106 fluoride varnish applications, 75 dental referrals, and oral health education for 115 parents/caregivers.

 

 

FY20 Action Plan Overview

 

Strategy: Integrate targeted adolescent oral health messaging into existing MCH-focused dental education programs to improve oral health for individuals across the lifespan.

Domain: Women/Maternal, Child, Adolescent

 

 

During FY19, VDH worked to increase access to care for pregnant women and young children through the Federal Perinatal and Infant Oral Health Quality Improvement Grant.  While this work was impactful, there remains a need to continue successful activities related to perinatal oral health and to integrate educational initiatives into the program that also target adolescents.  During FY20, through the work of a dedicated MCH-funded Maternal, Infant, and Adolescent Oral Health Consultant, VDH will continue to rely on a proven remote supervision dental hygienist model to integrate dental services and education into primary care settings; to support home visitors, community health workers and other client support workers in educating their clients on the benefits of oral health and to coordinate oral care; to collaborate with key partners and local stakeholders to maximize reach and effectiveness of oral health messaging; and to training dental and non-dental professionals on the importance of oral health care for overall wellness with the goal of improving access to oral health care for pregnant women and infants who are most at risk for dental disease.  In addition, VDH will develop new programming specifically aimed at advancing the oral health of adolescents.  This will include updating the 2009 School-aged Oral Health Curriculum to include emerging topics for adolescents including vaping, and HPV exposure and vaccination. 

 

 

Strategy: Continue to foster a network of 6 regional Oral Health Alliances to conduct regional needs assessments and implement systems change and data-sharing initiatives to improve the oral health of all Virginians, with emphasis on pregnant women, and children and adolescents aged 1-17.

Domain: Women/Maternal, Child, Adolescent

 

 

VDH will partner with the VaOHC to provide backbone support and facilitative leadership training to 6 Regional Alliances (South Hampton Roads, Northern Virginia, Richmond/Petersburg, Southside, Central Virginia, and Southwest Virginia) to conduct regional oral health needs assessments, develop and implement regional project work plans, and share region-specific data among state and local partners. Staffs will also work together to develop and disseminate communications, to include white papers addressing MCH populations.

 

 

Strategy: Convene statewide groups focused on targeted oral health issues and facilitate collaboration and work plan development, and provide leadership and oversight to guide initiatives.

Domain: Women/Maternal, Child, Adolescent

 

 

VDH will also partner with the VAOHC to convene a state-wide group focused on enhancing water equity in Virginia, continue convening the Early Dental Home (EDH) workgroup, collaborate with existing groups working on HPV to ensure oral health is integrated into their approach and goals.  Additionally, the VaOHC will expand community engagement and provide trauma-informed care, oral health and systemic health, and health equity education to providers at the Virginia Oral Health Summit.  Annually, the Summit reaches over 200 caregivers, who attend to learn skills to improve the health and wellbeing of the individuals they serve.  In 2020, the summit seeks to highlight best practices and the expertise of state and national experts so that attendees can work collectively to increase equitable access to quality health care, with a focus on oral health.

 

Data-Informed Strategies

 

A survey of WIC clients completed as part of another grant program demonstrated that the number of pregnant women aware of the comprehensive Medicaid dental benefit decreased between 2017 and 2018. This informs a need to improve awareness among pregnant women and their caregivers about the comprehensive Medicaid pregnancy dental benefit. Furthermore, studies are demonstrating the health- and cost-savings in utilizing community health workers and home visiting models to route pregnant women and children to oral health care providers. Additionally, data from the Virginia Oral Health Report Card, which measures Virginia against the nation on nine oral health indicators, is leveraged to engage regional oral health alliance leadership around efforts to improve community health.  A literature review regarding oral health found that vaping and HPV are important topics to add to oral health education for adolescents and young adults.

 

A survey regarding the oral health of ISHCN will take place from June – August of 2019 to assess the level of oral health knowledge and current oral health status of these individuals.  Data obtained from the survey will be used to tailor trainings and initiatives for MCH populations.

 

Inclusion of Family Voices

 

Work plan activities included in Strategies 1 and 2 were partially predicated on information gained from surveys of caregivers and community health workers, who work one-on-one with the community, to lift up concerns and barriers that their loved ones and client families faced regarding oral health.  Regional oral health alliances also provide an opportunity for families, community health providers, and population groups leadership to lead changes in health improvement and awareness, with backbone support from the Virginia Oral Health Coalition.

 

Health Equity

 

Convening regional alliances across the state allows for the development of initiatives and activities that target the unique needs of communities and allow for equitable distribution of resources based on local level needs across all geographic locations in the state.  The provision of fluoride through community water fluoridation provides a means of delivering the benefits of a proven cavity reducing intervention to all people of a community regardless of race, income, educational attainment or other factor that affects equitable care. 

 

 

Other Programmatic Activities

 

Surveillance Plan: Virginia has been successful in maintaining a surveillance system that captures the oral health status of target populations. Findings are disseminated to inform program and policy decisions and to improve interventions. The system assesses the impact of existing strategies and informs the development of new strategies. The Basic Screening Survey (BSS), developed by the ASTDD, is the key tool used to capture data for the surveillance system. In addition, state added BRFSS oral health questions are included, as well as other oral health surveillance indicators collected at the state and local level. VDH will actively engage in monitoring these survey data throughout the grant period to address oral health and disparities related to oral health in Virginia.  Previously, VDH conducted the BSSs for third grade children, pregnant women, Head Start, and older adults. The BSSs have been used in assessing oral health status and access to preventive services in target populations across Virginia. VDH continues to conduct BSSs for targeted populations on a 5-year rotation schedule. VDH has been successful in collaborating with school districts, community clinics, nursing homes, senior centers, and Head Start centers to conduct these surveys. In FY19 the ISHCN BSS is being conducted, followed by the Commonwealth’s largest survey, the Third Grade BSS, in FY20. 

 

 

School-Based Clinical Dental Preventive Services Program: The purpose of the State General Fund-funded School–Based Dental Preventive Services Program is to prevent dental decay for children in the most susceptible permanent teeth, in the most vulnerable populations in Virginia.  The VDH remote supervision model refers to the dental regulations, initially passed as of July 1, 2012, which permits VDH licensed dental hygienists to provide preventive dental services without the general or direct supervision of a dentist. This remote protocol has improved access to preventive dental services for those at highest risk of dental disease, as well as reduced barriers and costs for dental care for low-income individuals.  Through this program low-income schoolchildren in targeted areas of the state can receive dental services including oral health assessment, dental sealants, dental cleanings, fluoride varnish application, dental referral information, and oral health education with parental consent. In several areas, a dental cleaning is offered to students as well.  The Program is offered to selected high-risk schools that have at least 50% of their students participating in the National School Lunch Program. Once a high-risk school is identified, all students in grades Pre-K to sixth grade are eligible for services. Sealants placed are evaluated the following school year for retention rates, with repairs as needed.  Parents receive a list of area dental practices/community clinics for referral for treatment needs and to assist in establishing a dental home. During the 2017-2018 school year: 38 Virginia school divisions participated in the program, 7,864 children were assessed, 2,518 children received dental sealants, 2,031 children received dental referrals, and 14,171 preventive dental services (sealants and fluoride varnish applications) were provided in the school setting

 

 

Bright Smiles for Babies (BSB) Program: VDH provides the BSB Program, a prevention and education initiative, to reduce the prevalence of early childhood caries (ECC), to infants and toddlers, aged 6 months – 3 years of age.  Children who are at high risk for ECC often experience barriers to accessing timely dental services.  The BSB program eases barriers to care by providing preventive services primarily in non-dental settings where parents of young children are seeking other services, e.g., doctors’ offices, Women, Infants, and Children (WIC).  Program Services include providing trainings to health professionals to raise their awareness of the need for early intervention, such as the recommended age one dental visit, and to equip them with the knowledge and skills necessary to provide clinical preventive services; providing oral health risk assessments and screenings, fluoride varnish applications, anticipatory guidance and dental referrals by medical and dental providers in traditional office settings, and public health dental hygienists and nurses in WIC and well-child clinics; and providing trainings to early childhood professionals (WIC, Resource Mothers, Healthy Start, Head Start) and VDH maternal providers (family planning and maternal nurses) to support oral health education efforts with staff, parents and children and promote the importance of oral health during pregnancy and inter-conceptual stages. In FY20, with General Fund support, this program trained 123 health professionals to provide preventive services and 173 early child professionals in early child oral health.  Additionally, clinical services in WIC and Head Start for Infants, Children 1-17, and CSHCN included 4,751 oral screenings, 4,310 fluoride varnish applications, 3,637 parent educational contacts, and 1,806 referrals.

 

 

Budget Update

 

In FY19, MCH funds supported the salary of the ISHCN Oral Health Coordinator, billing support for the Commonwealth’s clinical prevention programs, and the development of regional oral health alliances through the VaOHC.  Additionally, plans to reintegrate oral health educational activities into the MCH grant were completed.

 

For FY20, MCH funds will continue to support the salary and fringe for the ISHCN Coordinator, and the billing support specialist but will also include 100% salary support for the MIAOH Consultant and 25% of both a dental epidemiologist and evaluator to assist with surveillance and evaluation. Approximately $200,000 in funds will be allotted to the VaOHC to support grant-funded activities that they are uniquely qualified to carry out including supporting the regional oral health alliances and convening statewide stakeholders to impact systems change. 

 

 

Challenges & Barriers

 

Regional and grassroots leadership are vital to advance the grant goals and policy changes that increase access to oral health care for pregnant women, children, and families. Thus, VaOHC continues to engage community leaders through its regional oral health alliances; these alliances are provided backbone support to address the unique issues they face and a platform to ensure their efforts are heard among state leaders and align with statewide initiatives. 

 

Furthermore, fluoridation promotion efforts have demonstrated a broader need to improve water system infrastructure and public awareness and trust in public drinking water. Thus, the MCH funding will support formation of a statewide water task force and other necessary groups, as identified, to address public health equity concerns.

 

 

Consumer/Family Engagement & Partnership

 

ISHCN often rely on family support for care.  A survey regarding the oral health of ISHCN, which includes questions that involve the individual and their support system, will take place from June – August of 2019 to assess the level of oral health knowledge and current oral health status of these individuals.  Data obtained from the survey will be used to tailor trainings and initiatives for MCH populations.

 

The federal PIOHQIE grant required an advisory group made up of stakeholders interested in perinatal, infant and children’s oral health, who represented a variety of constituencies and clients.  The quarterly convening of this group provided a platform for information sharing and partnering to implement changes in oral health for these populations.  It was in this setting that sustaining the work of the PIOHQIE grant and adding strategies related to adolescent oral health was lifted up as a priority and the groundwork for the MIAOH consultant was laid. This group will continue to advise the work of this position.

 

VaOHC convenes groups who represent and serve families, youth, caregivers, and women through its regional alliances, Early Dental Home Workgroup, and trainings for home visitors. These partners conduct needs assessments and provide feedback on the issues that pregnant women, children, and families face when impacting oral health care. Of note, VaOHC is currently working with a home visiting organization to ensure they are able to help clients understand the Medicaid pregnancy dental benefit and find a provider who can provide them with dental care. The home visiting organization has a key role in VaOHC’s Early Dental Home Workgroup, which will continue to convene with support from MCH grant funding. Additionally, VaOHC is providing a forum for community partners to present at the annual Virginia Oral Health Summit about innovative projects that have increased access to oral health care in the communities they serve.

 

 

Emerging Issues

 

Medicaid Expansion: Medicaid expansion increased access to affordable health care and a limited dental benefit for more than 400,000 Virginians. Yet, adults enrolled in Virginia Medicaid do not have comprehensive dental coverage outside of pregnancy. It’s vital for women of child-bearing age to have access to dental care before and after her pregnancy to ensure optimal health. Additionally, WIC survey data compiled by the VDH shows that fewer women know about Medicaid’s comprehensive pregnancy dental coverage than in years past. VaOHC will work with state partners to advocate during the 2020 Virginia General Assembly session for a comprehensive adult dental benefit in Medicaid. While comprehensive dental benefits for all adults in Medicaid has always been a priority issue for VaOHC, the 2020 session presents the most promising opportunity in years, based on feedback from legislators and a pressing need to ensure Virginia’s expansion population is healthy and employable.

 

HPV: HPV-positive oropharyngeal cancer has surpassed cervical cancer as the most prevalent HPV cancer. Certain strains of HPV cause 70% of oropharyngeal cancers in the U.S., affecting about 11,600 people each year. Oral HPV has been detected in newborns when the mother has an HPV cervical infection, and research shows that 2.5% of adolescents have HPV.  The HPV vaccine provides protection from HPV related cancers but must be given prior to age 13 to achieve the best immune response.  Oral health professionals play a critical role in combating growing rates of HPV-positive oropharyngeal cancers, which affect the tonsils and the base of the tongue. Messaging to oral health professionals will focus on the promotion and recommendation of HPV vaccination to all age-eligible patients. Messaging to adolescents will focus on the importance of HPV vaccination and oral cancer exams to identify oral cancer in the earliest and most treatable stage.

 

 

 

 

Program Overview

 

The Division of Child and Family Health’s Reproductive Health Unit is led by Emily Yeatts, MSW, MPH (Reproductive Health Unit Supervisor). The unit includes the following programs:

• Title X Family Planning (Title X): Clinical family planning programs consistent with Title X requirements and Quality Family Planning Services as defined by the CDC;
• Adolescent Health (Abstinence Education Grant, Title V): Positive youth development programs that build protective factors among participants that will make them less likely to initiate sexual activity; and
• Resource Mothers (TANF, Title V): Adolescent health program providing support services to pregnant and parenting teens and their families.

 

The Adolescent Health Program is led by Madeline Kapur, MPH, MSW (Adolescent Health Coordinator). The Resource Mothers Program is led by Consuelo Staton, MEd. (State Resource Mothers Coordinator). These programs are detailed in the FY20 application for the Adolescent Health Domain.

 

Janelle Anthony, MSN, RN, PHNA-BC, serves as the Family Planning Quality Assurance Nurse Supervisor supporting Title X and the Virginia LARC Initiative.

 

The Reproductive Health Unit also administers the Virginia LARC Initiative. The LARC Stakeholder Workgroup is a network of agencies working towards reducing unintended pregnancies among women of childbearing age and increasing access to quality comprehensive family planning services. This workgroup was developed to increase access to the moderately and most effective contraceptive methods, including during the immediate post-partum period. This workgroup holds quarterly webinars and monthly calls, and includes over 70 members from a variety of community-based health centers, governmental organizations, hospital systems, payers, and community members.

 

 

Snapshot of Program Accomplishments

 

• During FFY18, the Resource Mothers Program started building capacity to offer evidence-based programs to participants. Resource Mothers staff were trained in AIM4TM, a positive youth development program designed to prevent rapid repeat unintended pregnancy among teen parents. Resource Mothers began offering this intervention during SFY19.

 

• During SFY18, the LARC Workgroup educated stakeholders about the public health importance of long acting reversible contraceptives (LARCs), and as a result, the Virginia General Assembly allocated $6 million in TANF funds to the Virginia LARC Initiative in SFY19. Anticipated outcomes of this initiative include reduced unintended pregnancies and improved maternal and child health outcomes.

 

 

FY20 Action Plan Overview

 

Strategy: Increase capacity of youth-serving agencies to implement AIM4TM, an evidence-based pregnancy prevention program designed for parenting teens.

Domain: Women/Maternal, Adolescent

 

 

During FY19, VDH worked to increase the capacity of the Resource Mothers Program to offer evidence-based programs to pregnant and parenting teens. Resource Mothers is a home-grown, community-based program designed to support teens during their pregnancy and until their child turns 1. By providing educational and practical support to these young clients, VDH aims to prevent rapid repeat unintended pregnancy, empower teen parents, and ultimately improve maternal and child health outcomes. All Resource Mothers staff received training on the AIM 4 Teen Moms (AIM4TM) curriculum, an evidence-based positive youth development program designed to increase protective factors and prevent pregnancy.  During FY20, VDH intends to continue this work through continuous quality improvement (CQI). VDH plans to monitor the data collection system and tools developed in FY19 to monitor program fidelity and effectiveness. This data will illustrate ways that AIM4TM is being implemented successfully with Virginia families, as well as opportunities for improvement. VDH intends to work with implementation sites to identify and address any challenges identified in the upcoming year. VDH will monitor sites to ensure that at least 80% of Resource Mothers clients receive the AIM4TM program as it was originally designed.

 

During FY20, VDH will implement a new evidence-based prenatal/postpartum curriculum delivered to teen parents of children birth to two years.  The program, Growing Great Kids, Inc. (GGK) is designed to promote healthy child development and strengthening protective factors for teen families in a home visiting setting.  GGK is a skill-driven curriculum that provides program staff with research-informed, strength-based, and solution-focused training that helps teen parents develop parenting, family strengthening, and essential life skills. GGK training builds staff competencies for nurturing parental resiliency; advancing individual and family functioning, nurturing parents’ problem-solving skills: enabling parents to construct protective barriers.  The GGK curriculum is culturally inclusive, while embracing family diversity.

 

All Resource Mothers staff will be trained in the GGK curriculum, which will complement the AIM4TM curriculum and will replace the current educational programming for the program. VDH will monitor sites to ensure that at least 80% of Resource Mothers Clients will receive GGK curriculum programming.

 

 

Strategy: Work with community stakeholders to remove policy, financial, and training barriers to LARC utilization.

Domain: Women/Maternal, Adolescent

 

 

The LARC Stakeholder Workgroup is a network of agencies working to reduce unintended pregnancies among women of childbearing age and increase access to quality comprehensive family planning services. This workgroup was specifically developed to increase access to the moderately and most effective contraceptive methods, including during the immediate post-partum period. This workgroup holds quarterly webinars and monthly calls, and includes over 70 members from a variety of community-based health centers, governmental organizations, hospital systems, payers, and community members. VDH intends to continue facilitating this network during FFY20, and work with partners to identify opportunities for provider trainings and public education. The workgroup also aims to start at least two immediate postpartum LARC programs at Virginia hospital systems.

 

During FY19, VDH launched the Virginia LARC Initiative, a $6 million pilot program designed to increase access to hormonal LARCs among low-income women. Given the positive public health impact of making family planning services available to patients regardless of ability to pay, VDH anticipates that the Virginia LARC Initiative will achieve positive health outcomes. To demonstrate this, VDH intends to monitor both patient-level and aggregate-level data as the program progresses and after it ends. VDH initiated contracts with twelve community agencies to offer LARC devices, insertions, and removals to qualifying patients, and then reimburses participating providers using TANF funds. As of April 30, 2019, VDH has provided funding for 651 patient encounters, including 518 insertions/reinsertions, 513 devices, and 133 removals. The majority of patients (63%) were 100% or below the federal poverty level. Given that 36% of patients identify as Hispanic/Latino and 21% identify as Black/African American, the LARC Initiative is also addressing the documented ethnic/racial disparities in accessing comprehensive family planning services.

 

Because TANF funds only support provider reimbursements for hormonal LARC devices, insertions, and removals, administrative support for the LARC Initiative is funded by VDH’s federal Title V Maternal and Child Health Block Grant. The VDH Reproductive Health Unit manages all programmatic components of the LARC Initiative, including reviewing subrecipient invoices, entering patient data into the REDCap system, administering contracts, and monitoring program impact and expenditures.

 

The Virginia LARC Initiative will conclude at the end of state fiscal year 2020 (June 30, 2020), with contracts officially ending on May 31, 2020. The full impact of this pilot program will not be apparent until well after its conclusion, given that unintended pregnancy, teen pregnancy, and abortion rates are released on a two-year delay. After the pilot program ends, VDH intends to continue monitoring this data through its Office of Information Management and Division of Population Health Data. VDH anticipates lower teen pregnancy and abortion rates among areas with a high concentration of patients served through the Virginia LARC Initiative. In the meantime, VDH intends to track and report the following information:

• Demographic information about patients served, including race, ethnicity, and income;

• Number of patients served with a substance use diagnosis;
• Geographic analysis of patient residence and provider zip codes; and
• Patient satisfaction.

 

 

Budget Update

 

MCH Block Grant funds will be used to provide administrative support to the Virginia LARC Initiative and the LARC Stakeholder Workgroup, as well as continued training and technical assistance for the Resource Mothers Program. By providing infrastructure support to VDH’s existing family planning programs and networks, the MCH Block Grant increases the impact of these initiatives. VDH’s MCH Block Grant also supports the professional development of Resource Mothers staff, empowering community health workers with the knowledge and skills necessary to make a positive impact on vulnerable families.

 

 

Challenges & Barriers

 

Virginia continues to face policy barriers to family planning access across the Commonwealth. First, private payers have not unbundled delivery codes to allow hospitals to be reimbursed for immediate postpartum LARCs. Three hospital systems have launched immediate postpartum LARC programs, but other hospital systems are resistant to changing their clinical practices only to accommodate patients with Medicaid, accounting for 30% of births. The LARC Stakeholder Workgroup will continue encouraging private providers to unbundle delivery codes in order to increase access to immediate postpartum LARCs across the state. Second, the Virginia LARC Initiative does not address the issue of upfront cost. State procurement policies only allow VDH to reimburse for services rendered, so agencies are still responsible for initially purchasing devices for patients at their practice. Lastly, family planning services continue to be a hotly debated topic that does not enjoy statewide support. In 2019, the Virginia General Assembly voted to profoundly change the way the Virginia LARC Initiative was administered and essentially end the program. The Governor saved the program with a veto, but nevertheless, the message is clear that LARC access is not supported by all stakeholders in Virginia.

 

 

Consumer/Family Engagement & Partnership

 

Title V funds provide administrative support to the Title X Information and Education (I&E) Advisory Committee, a group of nine community members that are broadly representative of VDH family planning patients. The purpose of the I&E Committee is to ensure that patient education materials are culturally appropriate, relevant, and effective for the patient population. Members of the Community Health Workers Association staff this group, and regularly provide feedback on any patient education materials used in VDH Title X family planning clinics, offering invaluable expertise.

 

 

Emerging Issues

 

The impact of Medicaid expansion on VDH’s safety net programs, including the Virginia LARC Initiative and the Title X Family Planning Program, remain to be seen. Medicaid expansion will give approximately 400,000 Virginians access to care that they otherwise would have been unable to access, profoundly impacting the health of the Commonwealth. At the same time, many patients may still rely on VDH for family planning services, depending on the availability of other providers in their region. VDH intends to continue offering services through the Virginia LARC Initiative and Title X Family Planning Program to patients regardless of ability to pay, and will monitor patient data to assess what impact, if any, Medicaid expansion will have on service provision.

 

 

 

 

Strategy: Develop and mobilize strong interagency, multisector, and community partnerships to address disparities in maternal and infant mortality rates.

Domain: Maternal, Perinatal/Infant

 

 

In light of the Title V leadership team’s commitment to a racial equity lens across all domains, infant mortality disparity has been included in the FY20 workplan and maternal mortality disparity has been added as a new state performance measure. Both measures aim to eliminate mortality rate disparities between black and white women by 2025. These measures mirror commitments from the Governor, State Health Commissioner, and Associate Commissioner to reduce racial disparities in maternal health by 2025. In addition to racial disparities in mortality rates, the Title V team will continually monitor disparities in morbidity indicators for each subpopulation.

 

The Title V Acting Director is currently working with the Division of Population Health Data to ensure the five-year needs assessment identifies not only drivers of maternal and infant mortality but also drivers of disparities. The needs assessment will help to inform a statewide 2021-2025 strategic plan.