Women/Maternal Health - Application Year
Illinois’ priority for the Women and Maternal Health Domain is:
- Assure accessibility, availability, and quality of preventive and primary care for all women, particularly for women of reproductive age. (Priority #1)
- Promote a comprehensive, cohesive, and informed system of care for all women to have a healthy pregnancy, labor and delivery, and first year postpartum. (Priority #2)
Priority #1 – Assure Accessibility, Availability, and Quality
During FY24, Title V will continue to utilize the following strategies to assure accessibility, availability, and quality of preventive and primary care for all women, particularly for women of reproductive age:
1-A. Support the implementation, dissemination, evaluation, and improvement of the Illinois Healthy Choices, Healthy Future Perinatal Education Toolkit, which includes information and resources for consumers of women during preconception, prenatal, postpartum, and interconception care.
In FY24, EverThrive Illinois will continue to host, update, and promote the Healthy Choices, Healthy Futures Toolkit to build awareness and support healthy pregnancies statewide. It will partner with I PROMOTE-IL to implement an evaluation designed in 2020, focused on adapting content for social service providers.
OWHFS will continue to partner with DOC in FY24 to offer health education to incarcerated women, provide training to corrections staff, help stock women’s health supplies (such as breast pumping supplies), and work closely with corrections staff to meet the health needs of women in Illinois prisons. In addition, OWHFS will continue to teach health education sessions using the Helping Women Recover, Beyond Trauma, and Life Smart for Women curricula. Training opportunities for prison health care staff will focus on comprehensive care for expectant mothers, trainings on trauma and adverse childhood experiences (ACEs) and understanding and recognizing the unique health care needs of the LGBTQ+ prison population.
DOC health care staff will participate in simulation trainings. Specifically, the staff will participate in a full simulation of a maternal transport team from the Level III Administrative Perinatal Center coming to pick up a patient in active labor. This simulation allows correction security to test the “lock-down” process for active labor patients, while allowing EMS to enter and treat a woman and neonate in the housing unit or health care wing of the facilities.
OWHFS will continue to identify new and strengthen existing partnerships with outside agencies to improve and to support the work with DOC. These partnerships include collaborating with the IDPH southern perinatal nurse and the South-Central Illinois Administrative Perinatal Center to provide incarcerated women maternal-fetal medicine consultations.
Title V relaunched its well-woman care mini grants that initially began in FY19. The relaunch included two phases to the program: (1) Planning Phase – organizations required to develop a plan to increase well-woman visits in their community and (2) Implementation Phase – organizations are required to implement the plan they developed during the planning phase. During FY24, Title V will support the program in just the implementation phase and consider starting up another Planning phase cycle to reach more areas of the state during FY25.
I-D. Partner with UIC Center for Research on Women and Gender to implement a program at two clinic sites to expand the capacity of health care providers to screen, to assess, to refer, and to treat pregnant and postpartum women for depression and related behavioral health disorders.
This strategy was completed in FY22. There are no activities planned for FY24.
1-E. Support the Chicago Department of Public Health (CDPH) efforts to foster, partner, and collaborate with organizations and agencies providing male and partner involvement programs.
For FY24, CDPH will continue to partner with organizations providing male and partner involvement programming to increase women’s early entry into prenatal care. Title V will support CDPH’s efforts through the Title V mini grant.
Priority #2 – Comprehensive, Cohesive, and Informed System of Care
During FY24, Title V will utilize the following strategies to promote a comprehensive, cohesive, and informed system of care for all women to have a healthy pregnancy, labor and delivery, and first year postpartum:
2-A. Convene and facilitate state Maternal Mortality Review Committees (MMRC and MMRC-V) to review pregnancy-associated deaths and develop recommendations to improve quality of maternal care as well as reduce disparities and address social determinants of health.
Illinois continues its process for identifying pregnancy-associated deaths in Illinois and assuring reviews by the state’s two maternal mortality review committees. MMRC reviews every potentially pregnancy-related death and MMRC-V reviews violent pregnancy-associated deaths due to suicide, homicide, or drug related causes.
Additionally, Title V staff will continue to implement interventions that address maternal mortality as a part of its CDC-funded grant entitled, Preventing Maternal Deaths: Supporting Maternal Mortality Review Committees. Activities under the grant include hosting a statewide maternal health summit and convening key stakeholders to create a multi-pronged strategic plan to improve maternal health based on the recommendations from the MMRCs.
2-B. Partner with the statewide Severe Maternal Morbidity (SMM) Review Subcommittee to develop recommendations for standardizing and improving hospital-level SMM case reviews across Illinois’ Regionalized Perinatal System.
This strategy was completed in FY22. There are no activities planned for FY24.
2-C. Participate in and collaborate with the Illinois Maternal Health Task Force established through the I PROMOTE-IL program (HRSA Maternal Health Innovation Grant) to develop a statewide Illinois Maternal Health Strategic Plan to translate and build on findings and implement recommendations from the Illinois MMRC, MMRC-V, and SMM.
In FY19, the University of Illinois at Chicago (UIC) successfully applied for the HRSA Maternal Health Innovation Grant. The Innovations to ImPROve Maternal OuTcomEs in Illinois (I PROMOTE-IL) program will assist the state in collaborating with maternal health experts and optimizing resources to implement state-specific actions that address disparities in maternal health and improve maternal health outcomes. A key component of the I PROMOTE-IL grant is the Illinois Maternal Health Task Force. Illinois’ Title V director and other Title V staff serve on the task force and its various subcommittees. This relationship is important because OWHFS/Title V is the primary lead for maternal health activities in the state, including maternal mortality and severe maternal morbidity reviews. Title V’s participation ensures the task force is fully integrated into the existing maternal health infrastructure, avoids duplication of efforts, and assists in the tracking of maternal health legislation at the state and federal level to inform additional policy solutions.
During FY24, Title V will continue to participate in and collaborate with the I PROMOTE-IL program and its Illinois Maternal Health Task Force, and the Title V staff, including the director, will continue to serve on the task force and its subcommittees. Title V will continue to collaborate with DHS in the ECCS grant work to develop a plan for better pathways for providers/parents to understand referral process to programs.
2-D. Support and collaborate with the state-mandated Illinois Task Force on Infant and Maternal Mortality Among African Americans to assess the impact of overt and covert racism on pregnancy related outcomes, identify best practices and effective interventions, address social determinants of health, and develop an annual report with recommendations to improve outcomes for African American women and infants.
In FY24, Title V will continue to support and to collaborate with the Task Force on Infant and Maternal Mortality Among African Americans to review the impact of overt and covert racism on toxic stress and pregnancy related outcomes for African American women and infants. The priority topic that the IMMT would like to address in FY 24 is health literacy, as broadly defined as possible. In addition, Title V will support the development of reports that include recommendations of best practices and interventions to improve quality and safe maternal and infant care for African Americans.
Continuing in FY24, the subcommittees will be involved in various activities. The Community Engagement Subcommittee will collect the perspectives of birthing persons with “lived” experiences through listening sessions regarding their experiences before, during and after pregnancy (prenatal care, labor and delivery and post-partum care). These sessions will be conducted throughout the state with Black/African American community members. The task force will use the data to make additional recommendations to the General Assembly regarding interventions to improve Black/African American infant and maternal health outcomes. The Program and Best Practices Subcommittee will review programs and identify best practices and effective interventions for improving the quality and safety of maternal care, as well as health outcomes before and during pregnancy, to address pre-disease pathways of adverse maternal and infant health. The Systems Subcommittee will review data on social and environmental risk factors for Black/African American women and infants. They will identify key stakeholders the state should engage to address Black/African American maternal and infant mortality in a systematic way.
2-E. Facilitate the collaborative effort between the Illinois Maternal Health Task Force and the Illinois Task Force on Infant and Maternal Mortality Among African Americans to align their strategies and activities towards improving maternal health in Illinois.
During FY24, Title V will continue to facilitate collaboration between the Illinois Maternal Health Task Force and the Illinois Task Force on Infant and Maternal Mortality Among African Americans. The collaboration between both task forces will help to align their strategies and activities and leverage
each groups’ expertise regarding the improvement of Black/African American maternal health, and ultimately, all women across Illinois.
During FY24, OWHFS and Title V will continue to partner to improve Medicaid coverage and policy innovations. The relationships formed through the NASHP MCH PIP (strategy 2K) will continue as we continue to hold meetings at least monthly to discuss pressing issues and mutually inform each other’s work. We anticipate that in FY24, we may work together to develop the rules for implementing Medicaid benefits related to lactation consultants, home visitors, and care coordinators.
2-G. Convene and partner with key stakeholders to identify gaps in mental health and substance use disorder services for women that include difficulties encountered in balancing multiple roles, self-care, and parenting after childbirth; and leverage expertise to develop recommendations for system level improvements for Title V consideration and implementation.
During FY24, Title V will continue support ILPQC’s efforts to promote universal substance use disorder screening prenatally and at the delivery hospitalization, as well as initiation of SUD treatment in obstetric and emergency care settings. ILPQC also continues to expand availability and provision of naloxone at the point of care
In FY23, Title V staff joined a multi-agency workgroup on Illinois’ implementation of plans of safe care for infants prenatally exposed to substances. This workgroup is being led by the Illinois Department of Child and Family Services (DCFS) to meet federal child welfare policy requirements. We will continue to participate in this workgroup during FY24.
2-H. Assess, quantify, and describe the impact of childcare on prenatal, intrapartum, and postpartum care in Illinois, and develop optional strategies and approaches that can be implemented in clinic and hospital settings.
Title V continues to assess the need for ‘emergency’ childcare in circumstances related to obtaining perinatal care (prenatal appointments, labor and delivery/ hospitals) for women/parents and developing women/family-friendly childcare strategies for prenatal and perinatal providers. Title V continues to explore opportunities to engage hospitals and FQHCs in developing and implementing family friendly strategies to address childcare needs. Title V will explore leveraging the regional councils and family councils be organized through Birth to Five Illinois by the Illinois early childhood education and care system. These councils may be helpful resources because the enable residents to address the early childhood needs within their own communities.
2-I. Support the Illinois Perinatal Quality Collaborative (ILPQC) in its implementation of obstetric and neonatal quality improvement initiatives in birthing hospitals.
Title V will continue to collaborate with ILPQC as it supports 86 Birth Equity hospital teams in implementing strategies that facilitate culture change and improve patient care. In FY24, Title V will continue to support ILPQC’s OB Birth Equity (BE) Initiative. The initiatives’ specific objectives include appropriate screening and linking of patients to resources that address social determinants of health, increasing the proportion of women reporting positive obstetric care experiences, and accurate recording of patient race and ethnicity data. The goal for FY 24 is to achieve 75% or more teams implementing all key BE strategies by December 2023. Title V will continue to collaborate with ILPQC as it supports hospital teams in implementing strategies that facilitate culture change and improve patient care. In FY24, 
Title V will continue to support ILPQC’s neonatal safe sleep and equitable care initiative. This initiative will focus on hospitals’ capacity to facilitate systems and culture change to achieve newborn equitable care and improvement in safe sleep.
ILPQC will continue to host its annual conference and meetings. The 11th Annual Conference is scheduled for November 2, 2023, in Lombard and the OB and Neonatal Spring Face-to-Face Meetings are scheduled for May 2024 in Springfield. ILPQC works hard to develop conferences that focus on key strategies for hospitals to implement that address Title V priorities and develop relationships with public health, community organizations, and patients. Additionally, ILPQC will continue to hold Neonatal Community advisory board meetings quarterly to foster relationships with the group and receive input in the development and support of active and future statewide quality improvement initiatives. ILPQC will continue to hold OB Community advisory board meetings quarterly to foster relationships with the group and receive input in the development and support of active and future statewide quality improvement initiatives.
The ILPQC will transition the Mothers and Newborns Affected by Opioids Initiative (MNO) initiative with a focus on supporting hospital QI teams achieve initiative aims/measures/goals as well as other quality improvement initiatives.
2-J. Support the Perinatal Mental Health Program that includes a 24-hour telephone consultation for crisis intervention for women suffering from perinatal depression.
During FY24, Title V will continue supporting the MCH Perinatal Mental Health Program. This program seeks to provide perinatal depression crisis interventions, consultations, resources, and referrals for women who have screened positive for symptoms of perinatal depression. Through this program, NorthShore University HealthSystem will continue to provide a 24/7 hotline (MOMS Line) serving the perinatal population, with each caller receiving a psychosocial assessment by a mental health professional, psychoeducation about perinatal mood disorders and resources, and referrals if desired. It will also disseminate materials promoting awareness of perinatal mood and anxiety disorders in general and the MOMS Line specifically. In all of its efforts to address perinatal mental health and develop improved ways of capturing sociodemographic information from callers, NorthShore will draw from best practices of NorthShore University HealthSystem’s Health Equity and Inclusion Taskforce and the Lifeline4Moms Equity Incubator Group.
In FY24, Northshore plans to continue revamping its website to promote the awareness materials in a more active and engaging manner. It will also update its resource and referral database to make it more accessible and user-friendly and update the caller database and collect outcomes data on callers served.
Additionally during FY24, Title V plans to partner with Northshore on applying for a 5 year grant to improve perinatal provider mental health/substance use screening and referral. Title V will include in outreach efforts that the MOMS line is used as a resource providers can direct patients towards for immediate support.
2-K. Partner with Department of Healthcare and Family Services (HFS) (Medicaid agency) in the National Academy for State Health Policy (NASHP) Maternal and Child Health Policy Innovation Program (MCH PIP).
Though the official NASHP MCH PIP ended in March 2023, the collaborative partnership built between IDPH and HFS will continue. The most important result of the NASHP MCH PIP is that IDPH and HFS staff began meeting bi-weekly to coordinate activities across our agencies and to mutually inform each other’s work. We have strengthened our relationships between the MCH programs at each agency and now regularly consult each other on questions where we would like input. We will continue to hold monthly meetings between IDPH and HFS staff focused on maternal health, and to include each other in ongoing initiatives, such as advisory boards and workgroups.
2-L. Partner with the University of Illinois at Chicago, School of Public Health, Division of Health Policy and Administration (UIC-HPA) to explore the influence of healthcare provider access and the casual effects of events or policies on this access.
In late FY22, Title V partnered with the University of Illinois at Chicago, School of Public Health, Division of Health Policy and Administration (UIC-HPA), to conduct an economic analysis exploring the influence of health care provider access and the casual effects of events or policies on this access. UIC-HPA will conduct this analysis by investigating the availability of maternal care (defined here as prenatal care, labor and delivery care, and postpartum care) and its effects on maternal and infant health related outcomes.
During FY24 the UIC-HPA will finalize the analysis for both subprojects and prepare the findings for publication. The final report will provide a descriptive analysis on the following components:
Enhanced Maternity Care Access Measures
This component of the project will use a data-driven approach to define enhanced maternity care access definitions for smaller geographic areas (e.g., ZIP codes) and to consider access to OB providers across county borders. Measures of OB providers include birthing hospitals, Birth Centers, OB/GYNs, CNMs and a subset of family medicine physicians who provide OB services. This subproject could construct and compare additional definitions that consider access to OB providers with geodesic (“as the crow flies”) distance, approximate travel distance, and other travel cost/effort measures defined based on local population characteristics (e.g., estimated travel time, average vehicle access).
Effects of Hospital Closures and Staffing Changes in Obstetrics.
This component of the project will focus on the causal effects of hospital closures of birthing hospitals (i.e., hospitals with OB units), hospital OB unit closures, and potentially hospital OB-related staffing reductions on the provision of maternal care. More specifically, the UIC-HPA team will assess how hospital or hospital OB unit closures affect:
- Access to inpatient (labor and delivery) maternal care options;
- Labor and delivery, including in maternity care deserts and are the patients more likely to have Caesarean sections; and
- Maternal and infant health-related outcomes
2-M. Partner with the University of Illinois at Chicago (UIC) through the Center for Research on Women and Gender (UIC-CRWG) enhance all emergency departments (EDs) understanding and ability to recognize and provide care for pregnant and postpartum birthing person.
During FY 24, this project will be completed. The main objectives of this project are to: (i) implement a toolkit for six (6) EDs (varied by geography and level of care) that provides education and resources for the timely identification of pregnant and postpartum women, potential warning signs of maternal complications, and appropriate treatment and referral; (ii) assess the feasibility, acceptability, and best practices for the toolkit among providers and staff at pilot EDs in multiple hospital settings in Illinois (e.g., urban and rural, birthing and non-birthing); (iii) update training materials based on findings from pilot study; and (iv) develop plan for disseminating and implementing the project components statewide. UIC-CRWG will coordinate with the Maternal Mortality Review Committees (MMRCs) and other key stakeholders to develop and implement the toolkit.
During FY24, Title V will support the UIC-CRWG to develop training materials and toolkits for ED providers. Products developed may include reports, fact sheets, presentations, or manuscripts. UIC, through UIC-CRWG, will define content and format, and interpret and translate findings as appropriate. The implementation of the toolkits will include a process for tracking consultations, treatments, and referral activities for pregnant and postpartum birthing persons identified in the EDs
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