Priority Need: Promote routine well-woman visits to support the mental and physical health needs of women

NPM 1: Percent of women with a past year preventive medical visit

Objective 1: Increase well-woman visits by 10% by 2020.

Objective 2: Increase mental health screening at well-woman visits by 5% by 2020.

A. Promote importance of well-woman visits, including postpartum care, during family home visits

Minnesota’s family home visits (FHV) most often begin prenatally or immediately postpartum. Promoting well-women visits prenatally and postpartum are a regular element of family home visiting, which are often long-term intensive programs. In FFY 2020, several grantees receiving evidence-based home visiting (EBHV) grants will implement new or expanding programs to increase the number of families participating in evidence-based home visiting model services.

Providing universal depression screening is promoted as best practice during the perinatal period for caregivers served in all family home visiting programs. Screening and referral data for all caregivers enrolled in FHV will continue to be tracked by the MDH FHV Evaluation Unit.

B. Lead quality improvement projects and/or provide ongoing technical assistance to local programs to support improved universal screening and referral for perinatal or postpartum depression in clinic well child visits and during family home visits

The Family Home Visiting (FHV) program supports women’s mental health by conducting periodic caregiver depression screening routinely during home visits and by offering community of practice training about mental health during pregnancy.  Minnesota will continue to work with local public health agencies providing ongoing support and technical assistance to encourage continued quality improvement postpartum depression screening and referral among family home visitors.

C. Promote reproductive life plans and One Key Question

At reproductive health conferences, MCH staff will share information about reproductive life plans and One Key Question. In addition, the Family Planning Special Projects grant coordinator will continue to encourage grantees to use this tool with their clients. During the next grant year, staff will explore adding to the site visit report the grantees use of One Key Question and Reproductive Life Plans.

D. Promote the importance of well-woman visits to expectant and parenting high school and college students in the Minnesota Expectant and Parenting Student Program.

The Minnesota Expectant and Parenting Student Program will continue to support sub-grantees work to promote well-women visits through education of student parent clients on the importance of preventive care, assistance with applying for health insurance or Medicaid, and referrals to local health providers. These activities will be measured through the annual sub-grantee reporting.

ESM 1.2: Number of engaged users viewing social media messages delivered by the Title V agency promoting the well-woman visits and other healthy pregnancy/postpartum messages

A. Deliver social media messages promoting well woman visits and other health related topics

In conjunction with the National Women’s Health Week, staff will collaborate with the MDH Communications Division to use social media messages to promote women seek well-woman visits. Staff will track the number of engaged users viewing these social media messages.

Priority Need: Increase proportion of pregnancies that are intended

SPM 2: Percent of young women of reproductive age at risk of unintended pregnancy that adopt or continue use of Long-Acting Reversible Contraception (LARCs) in Minnesota Health Care Programs (MHCP)

Objective: Increase the percentage of young women of reproductive age at risk of unintended pregnancy that adopt or continue use of the most effective FDA-approved Long Acting Reversible Contraception by 15% by 2020

A. Educate providers on Long-Acting Reversible Contraception, particularly for adolescents, by distributing monthly or bimonthly e-newsletters on the latest research, reviewing progress with LARC use at state funded Family Planning grantee site visits, and partnering to present at the annual Reproductive & Sexual Health Update

Staff will educate and promote the use of Long-Acting Reversible Contraception (LARCS) by working directly with clinic directors, nurses, health educators and providers from these agencies. Staff will promote LARCs by discussing grantee LARC rates and strategies to increase those rates at the grantee annual site visit. Grantees are strongly encouraged to attend the annual Minnesota Reproductive and Sexual Health Update. Many grantees utilize a Reproductive Life Plan as part of their contraceptive counseling. Grantees are encouraged to continue to provide outreach and clinical services to underserved populations to reduce the disparities in unintended pregnancies among people of color.

B. Counsel individuals serviced by Family Planning Special Projects grantees on the range of contraceptive options, including Long-Acting Reversible Contraception

Staff will continue to offer training and technical assistance to family planning providers to promote the use of the most effective methods of contraceptives. Family planning grantees will report annually on the number of clients counseled on family planning.

Minnesota’s family planning program collects and monitors grantee data to assess progress in increasing LARC use rates. Twenty-seven agencies, including 33 sites were awarded family planning funding for the four and one-half year period beginning July 1, 2018. The new grantees will implement Long-Acting Reversible Contraception as the most effective family planning method.  During this funding period, providers will be reminded how Long-Acting Reversible Contraception may reduce the health disparities in the rate of unintended pregnancies.

C. Encourage local public health agencies and family home visitors to provide counseling and written information promoting the use of the most effective forms of birth control to all clients receiving postpartum visits

Minnesota’s family home visiting (FHV) nurse consultants and other staff will support and encourage home visitors to support families to make plans about child spacing and will provide education to women and families receiving a postpartum visit. Follow-up by home visitors may include discussion of child spacing, written information on birth control methods, referral to providers with follow-up, and other information based on family needs and interests.

Home visitors will provide evidence-based home visiting services to women and partners on birth control methods based on family need and interest. This is part of a set of activities linking a woman receiving FHV services to a medical home and encouraging women to access an array of preventative health services.

E. Work with the Minnesota Department of Human Services to increase the number of Medicaid enrolled women who receive hospital postpartum insertion of LARCs

Minnesota’s collaborative efforts working with the Minnesota Department of Human Services (DHS) to coordinate state policies to facilitate access to appropriate family planning services in a timely manner are ongoing. Expanded access to family planning services through the DHS administered Minnesota Family Planning program provides another state resource for access to family planning services for low-income women. In collaboration with the Perinatal Quality Collaborative, providing Medicaid-eligible women with access to long active reversible contraceptives at the time of delivery is being discussed.

F. Implement grant programs that use evidence-based or evidence-informed teen pregnancy prevention curriculums in the Sexual Risk Avoidance Education Grant Program and Eliminating Health Disparities Initiative grant program

Personal Responsibility Education Program’s (PREP), originating in 2018, has funded six community organizations and one alternative school through a competitive RFP process. Minnesota’s Sexual Risk Avoidance Education Grant Program (SRAE) has funded five grantees through 9/30/20.

MDH has a contract with the University of Minnesota Prevention Resource Center to provide training on five evidence-based curriculums for PREP grantees. Topics include adolescent development, healthy relationships, healthy life skills, and financial literacy. Technical assistance is provided to grantees at least quarterly.

G. Support School Based Clinics capacity to use LARCs in clinics through education and training of practitioners and patients

PREP funded (2018-2020) grantees serve youth in Hennepin, Ramsey and Beltrami counties. The three counties are among the top 25 counties in MN with the highest rates in teen pregnancies. One of the grantees is the Minneapolis Health Department School Based Clinics Program who have trained staff to provide LARC counseling and insertion. PREP funding will support ongoing training and technical assistance to the grantee in providing evidence-based Safer Sex Intervention (SSI) curriculum, which includes LARC education to Minneapolis’s most at risk female youth between ages 14-19. The Minnesota School Based Health Alliance convenes all School Based Health Staff from member clinics around the state annually for an education summit on different topics, networking and education opportunities.