Women/Maternal Health, Application Year FY 2022

Within the women and maternal population domain key issues emerged from the 2020 needs assessment process and informed the selection of priorities to address maternal morbidity, mental health, and risk factors for preterm birth.

 

Maternal Morbidity

Severe maternal morbidity is more than 100 times as common as pregnancy-related mortality—affecting about 52,000 women annually—and it is estimated to have increased by 75 percent over the past decade. Rises in chronic conditions, including obesity, diabetes, hypertension, and cardiovascular disease, are likely to have contributed to this increase. Minority women and particularly non-Hispanic Black women have higher rates of severe maternal morbidity. Non-Hispanic Black, Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native women had 2.1, 1.3, 1.2, and 1.7 times, respectively, higher rates of severe morbidity compared with non-Hispanic white women (Federally Available Data Resource Document, 2019).

 

Preconception and Maternal Mental Health

Postpartum depression is common, affecting as many as 1 in 7 mothers. It occurs when brief “baby blue” symptoms of crying, sadness, and irritability become severe and result in depressed mood and loss of interest in activities for more than two weeks. Postpartum depression is associated with poor maternal-infant bonding and may negatively influence child development. Universal screening and treatment for pregnant and postpartum women is recommended by the American College of Obstetricians and Gynecologists (ACOG), the American Academy of Pediatrics (AAP), and the U.S. Preventive Services Task Force (Federally Available Data Resource Document, 2019).

 

Preterm Birth

Ohio continues to have high rates of infant mortality, with prematurity as the leading cause of infant death in Ohio. Maternal smoking is implicated in preterm birth and in 2017 Ohio’s rate of women who smoked cigarettes during pregnancy was two times higher than the U.S. rate. Moreover, 25.5% of pregnant women covered by Ohio Medicaid smoked during pregnancy in 2017, nearly twice the rate for Ohio overall. Smoking cessation before and during pregnancy improves infant outcomes.

 

Emerging Issues

Since the completion of the 2020 needs assessment, the COVID-19 pandemic has underscored the importance of the focus on mental health supports for women of reproductive age, as well as addressing the disparities in maternal morbidity and mortality.

 

Priority: Decrease risk factors contributing to maternal morbidity

 

Measures

• NOM 2: Rate of severe maternal morbidity per 10,000 delivery hospitalizations
• SOM: Disparity- Non-Hispanic Black rate of severe maternal morbidity per 10,000 delivery hospitalizations

• NPM 1: Percent of women (18-44) with a preventive medical visit in past year
• ESM: Percent of birthing hospitals that have implemented the AIM hypertension bundle.

 

To address the priority of maternal morbidity efforts must include improving the health outcomes for women before, during, and after pregnancy. The selected NPM relates to leveraging women’s well visits as key opportunities for health intervention and referrals. The SOM was established to measure the disparity in maternal morbidity outcomes. The ESM relates to the priority and efforts to improve safety related to maternal morbidity by standardizing assessment and responses for hypertension, which will contribute to addressing disparate outcomes.

 

Objective 1: By 2025, increase percent of women with a preventative medical visit by 5%.

Strategies:

1. Provide well-woman visits within Title X clinics following ACOG guidelines.
2. Community needs assessment on barriers to pre- and inter-conception care through MP subgrant.
3. Implement culturally relevant community, clinical, or community-based services to address unique pre- and inter-conception issues for women 18-44 through Maternal and Child Health Program (MP) subgrant.
4. Implement education and awareness for pre-conception and reproductive health targeting high-risk women through MP subgrant.
5. Find and review data on quality and comprehensiveness of preventive medical visits as well as feasibility and evidence-based practices for promoting standards (include mental health, health behaviors, dental, social determinants, referrals).
6. Work with partners to develop plan to increase coordination, referral, access, and uptake of high-quality services for at-risk women 18-44.
7. Distribute guidelines on managing oral health care during pregnancy to perinatal and dental care providers.
8. Integrate oral health education, assessment and referrals for dental care into community-based health care systems that serve women of reproductive age (e.g., FQHCs, WIC, Home Visiting).

 

The ODH Reproductive Health and Wellness Program (RHWP) will continue to promote the use of ACOG guidelines for well-women visits in Title X clinics over the next year. To date, the RHWP has included information on ACOG’s well-woman recommendations and articles for providers regarding action steps to help reduce fetal alcohol spectrum disorder in program newsletters, as well as updating and publishing the RHWP/Title X Clinical Services and Protocol manual. Additionally, the MCH Bureau Medical Consultant will deliver a presentation on the ACOG well-woman and postpartum exam recommendations, Fourth Trimester Project, and data from Pregnancy-Associated Mortality Review during the July 2021 planning call with the Title X clinics. RHWP will continue to track the number of well-woman visits following ACOG guidelines provided at Title X clinics over the year and identify additional strategies to increase uptake.

 

The Maternal and Child Health Program (MP) subgrantees are in the process of completing a community health needs assessment on pre- and inter-conception care. There are 19 subgrantees completing community health needs assessment in their respective counties. Findings from these needs assessments will be used to address strategies C-F (Implement culturally relevant community-based or clinical services to address unique pre- and inter-conception issues for women 18-44; Implement education and awareness for pre-conception and reproductive health targeting high-risk women; Find and review data on quality and comprehensiveness of preventative medical visits as well as feasibility and evidence-based practices for promoting standards; Work with partners to develop plan to increase coordination, referral, access, and uptake of high-quality services for at-risk women 18-44 by SFY 2023).

 

Guidelines for prenatal and dental care providers on managing oral health care during pregnancy have been integrated into the ODH Prenatal Care grant. The impact of the integration of these guidelines will be monitored by tracking the number of prenatal care providers who complete training on oral health and pregnancy, number of pregnant women with dental needs who are referred to dental care and the number of women who complete dental care. Additionally, funds have been awarded to 3 agencies/health care systems to provide oral health services to uninsured MCH population from low-income families, which will help to impact this strategy. A continuing education module for nurses and nutritionists is in the process of being developed on oral health and pregnancy and will be available to MCH programs, such as WIC and Home Visiting.

 

Objective 2: By 2025, reduce the rate of severe maternal morbidity by 12%.

Strategies:

1. Increase use of AIM safety bundles in healthcare systems for at-risk pregnant women.
2. Increase women’s health screenings during pediatric well visits.
3. Develop a statewide strategic maternal health plan through the Ohio Coalition to Address Maternal Health (OH-CAMH).
4. Increase the percent of pregnant and postpartum women who receive urgent maternal warning signs education in WIC, Home Visiting, and Healthy Start programs.
5. Continue Gestational Diabetes QI projects to improve postpartum visit and testing rates.
6. Train emergency department providers to recognize, triage, and treat obstetric emergencies.
7. Train maternal health care providers on how to conduct effective telehealth encounters.

 

The ODH Pregnancy-Associated Mortality Review (PAMR) program has implemented the AIM Hypertension patient safety bundle in 30 participating Wave 1 birthing hospitals sites to date. This patient safety bundle is being implemented by the Government Resource Center (GRC) using quality improvement science. Over 1,400 data submissions of patient encounters with women who have or are at risk for hypertension have been submitted to date and a health equity survey with over 350 hospital staff participating in Wave 1 has been completed. This patient safety bundle will be implemented in all birthing hospitals throughout the state by SFY 24. Additionally, the PAMR program with GRC is in the process of planning implementation of the AIM Hemorrhage patient safety bundle.

 

The PAMR program subcontracted with GRC to implement the IMPLICIT Network inter-conception care model implementing maternal health screenings for depression/anxiety, folic acid use, smoking/tobacco, and family planning during the pediatric well-visit through quality improvement science methodology. There are currently 9 pediatric sites and family practices enrolled in Wave 1 implementation. Additional pediatric and family practices will be onboarded in future waves of this initiative which will continue through SFY 24.

 

The Ohio Council to Advance Maternal Health (OH-CAMH) is the newly formed statewide maternal health task force. This group will use data from PAMR to develop and implement a statewide, maternal health strategic plan. OH-CAMH consists of over 80 external organizations and the purpose of OH-CAMH is to:

• Identify and fill gaps in addressing maternal health, both statewide and in local communities.
• Facilitate conversations among various stakeholders across the field, both in clinical and public health settings.
• Build on work already being done in Ohio.
• Collaborate to identify new areas to implement strategies and activities for addressing maternal health needs in Ohio.

 

To create the strategic plan, ODH PAMR staff spent over 55 hours talking with OH-CAMH members from across the state between June and August of 2020 to listen to the OH-CAMH members about what type of work they were currently involved with, what type of changes in maternal health they wanted to see in Ohio, and perceived challenges to maternal health. These one-on-one discussions were coded and analyzed to identify common themes.

 

A smaller subgroup of OH-CAMH members was convened in February 2021 to develop the first draft of OH-CAMH Strategic Plan. This group is referred to as the Strategic Plan Workgroup. The first draft of the statewide strategic maternal health plan will be completed and shared back to general OH-CAMH membership in June 2021. This strategic plan will be refined over the next SFY, and implementation teams will be formed to begin taking action to achieve the objectives set forth in this plan.

 

The ODH PAMR program subcontracted with GRC to implement urgent maternal warning signs education in public health settings. Over the past year, 27 WIC clinics across four counties in Ohio have been onboarded to this quality improvement initiative. Additional WIC sites across Ohio will be recruited and onboarded over the coming year. This program will continue implementation through SFY 24.

 

The first 5 waves of the Gestational Diabetes quality improvement project were focused on working with Primary Care, OB/GYN, and Family Medicine providers to improve postpartum follow-up and postpartum and long-term screening of Type 2 diabetes among women with Type 2 diabetes. The most recent wave of the project was implemented in 11 ODH Home Visiting sites. This wave resulted in more participants getting a postpartum visit, but not a postpartum glucose screen compared with a comparison group. The data collection for this wave will inform efforts to enhance the Home Visiting data system with GDM specific fields in future waves of implementation. The Gestational Diabetes QI project implementation will come to an end between Q2 and Q3 of SFY 22. A new QI project titled, “Women’s Behavioral Health Learning Collaborative” will use lessons learned from the Gestational Diabetes project will be initiated in SFY 22 and will be a new strategy ODH will utilize to, “Increase access, referral, and coordination of mental health services for pregnant and postpartum women 18-44" (Objective 2 under Increase mental health support for women of reproductive age Priority).

 

A needs assessment survey of delivery hospitals in Ohio revealed that though 98% of hospitals reported conducting simulation drills to prepare for obstetric emergencies, 100% involve labor and delivery or postpartum nursing staff, 80% involve physicians, but only 30% involved emergency department staff. Additionally, between 2008-2016 23% of pregnancy-related deaths in Ohio occurred in an outpatient or emergency department setting. The PAMR program has contracted with the Clinical Skills Education and Assessment Center at The Ohio State University to develop and deliver Obstetric Emergency Simulation Training for Emergency Medicine Provides. The goal of these trainings is to reduce preventable maternal morbidity & mortality in EDs and during maternal transports. Six trainings have been conducted to date with very positive feedback from participants and statistically significant improvement of pre- to post-test knowledge of recognizing, treating, and managing various obstetric emergencies. There is great demand of these trainings and every training to date has had a waitlist of registrants. There are 22 more trainings planned to occur between now and SFY 24.

 

The PAMR program has contracted with the Clinical Skills Education and Assessment Center at The Ohio State University to develop and deliver Telehealth Delivery Training for Women’s Health providers. The goal of the telehealth trainings is to train women’s health providers to provide sensitive and culturally competent care in a telehealth encounter and increase access to specialty care. These trainings have been offered to any type of care provider who reaches women at any point before, during, and after pregnancy (WIC providers, OBGYNs, residents, family med physicians, NPs, Providers, etc.). Five trainings have been conducted to date with positive participant reviews. Target populations most recently served include WIC health professionals, family medicine residency programs, and OB/GYN residency programs. Approximately 25 additionally trainings will take place between now and SFY 24.

 

Objective 3: By 2025, develop expanded maternal health surveillance to allow for adequate monitoring and tracking to inform programmatic interventions.

Strategies:

1. Expand data collections for COVID-19 for maternal population (SOARS, OPAS, ODRS linking to birth certificate).
2. Enhance surveillance for maternal morbidity through PAMR program.
3. Develop maternal substance use surveillance system and provide epidemiologic support for implementation of associated activities (CSTE fellowship).
4. Develop protocols for systemic data into action.

 

In FY 20, to leverage current BMCFH related surveillance activities to collect additional data on how COVID-19 is impacting Ohio’s MCH population, Ohio amended the 2020 Ohio Pregnancy Assessment Survey (OPAS; Ohio’s PRAMS-like survey) and the 2020 Ohio Study of Associated Risks of Stillbirth (SOARS) questionnaires to add supplemental questions related to COVID-19. By adding questions about diagnosis and impact of COVID-19 on pregnant women, additional analyses will be conducted on the prevalence of pandemic-induced financial difficulty, healthcare access issues, social issues, anxiety or depression, etc. among mothers who either recently delivered a live birth or experienced a stillbirth.

 

Additionally, the Data and Surveillance section initiated two additional projects regarding COVID-19 in pregnancy in FY 20. First, enhanced surveillance of pregnancies with SARS-CoV-2 infection was initiated. In April 2020, the CDC released a pregnancy module to the COVID-19 case report form (CRF) that is comprised of a Pregnant Case Form and a Neonate Form. The module includes surveillance questions for the mother on the clinical course of disease including severity of disease, treatments, mortality, timing of SARS-CoV-2 infection, presence of symptoms, and underlying risk factors; for delivery on adverse fetal and birth outcomes of infants born to mothers with SARS-CoV-2 infection; and for the neonate on frequency and risk factors for neonates testing positive for SARS-CoV-2 infection. ODH modified the Ohio Disease Reporting System (ODRS) for COVID-19 to capture all fields within the pregnancy module and create files for export to CDC’s Data Collation and Integration for Public Health Event Response (DCIPHER) platform. Data collection includes identification of pregnant COVID-19 cases within the existing surveillance system, following case-patients until due dates, identifying birth or fetal death certificates within the states vital records system, contacting clinicians for additional information, and abstracting relevant information. Both projects will continue through SFY 22.

 

BMCFH epidemiology staff are performing a retrospective data linkage using the Ohio Disease Reporting System (ODRS) and Vital Statistics (VS) data, including birth and death certificates. There are 2 objectives of this data linkage: First, to evaluate the quality of the pregnancy variable documented in the case report form mentioned in the first project (Enhanced Surveillance collaboration with the ODH Bureau of Infectious Diseases). Preliminary data show that the pregnancy variable is missing a value about 40% of the time. Thus, to confirm pregnancy status and improve surveillance accuracy, the gold standard for pregnancy status will be a live birth or fetal death documented within Ohio’s vital statistics. Through this linkage, BMCFH Epi staff can quantify the missingness, and accuracy (sensitivity, (predictive value positive and predictive value negative) of the pregnancy variable. Confirmation of pregnancy among confirmed COVID-19 cases will also allow for erroneous data to be corrected in ODRS and for identification of additional cases for which the pregnancy module could be completed. Second, using the linked ODRS and VS data, BMCFH Epidemiology staff will examine outcomes of pregnancies with confirmed SARS-CoV-2 infection. In addition to the ODRS data on infection, the birth and fetal death certificate data provide information such as birth weight, gestational age, abnormal conditions of the newborn, and characteristics of labor and delivery. BMCFH Epi staff will calculate frequency of adverse outcomes among women with confirmed or probable COVID-19 infection and will stratify analyses by race. Both projects will continue through SFY 22.

 

The Ohio Hospital Association (OHA) is the agency that collects maternal morbidity data from Ohio hospitals. ODH PAMR requests this data from OHA for analysis and has already created a data brief with this data. This data brief is currently being approved by ODH Communications and will be published for public viewing at some point in SFY 22.

 

ODH Data and Surveillance matched for a CSTE Applied Epidemiology Fellow for 2020 – 2022. Because current existing surveillance systems concerned with maternal and infant health are not designed to monitor opiate abuse or its health outcomes on women, children and young families, the fellow led 2 projects:

• The development of a new perinatal substance use surveillance system in Ohio that will take advantage of multiple existing data sources.
• Neonatal Abstinence Syndrome (NAS) Surveillance Evaluation - This evaluation will look at the data collected from The Ohio Connections for Children with Special Needs (OCCSN), Ohio’s birth defects surveillance system and compare it with the data from the Ohio Hospital Association, the 2 main data sources for NAS data in Ohio. The goal of this evaluation is to make sure that OCCSN is accurately capturing cases of NAS and referring those cases to the proper healthcare providers.

 

The CSTE Fellow accepted a full-time employment opportunity at the end of SFY 21. These two projects will be continued by other staff within the Data and Surveillance section throughout SFY 22.

 

Stakeholders across the Maternal, Child, and Family Health Bureau at ODH will develop a plan/process to routinely review program data within the Bureau and disseminate it internally at ODH to inform programming by the end of SFY 22. Key objectives of this process will be to set up an internal process to map the end results of surveys and to streamline data sharing and dissemination internally and externally. Implementation of this plan will occur in by SFY 25.

 

Priority: Increase mental health support for women of reproductive age

 

Measures

• NOM 24: Percent of women who experience postpartum depressive symptoms following recent live birth.
• SOM: Percent of women (18-44) with 14 or more mentally distressed days in past month (OMAS)

• SPM: Percent of women (18-44) with unmet mental health care or counseling services need in past year (OMAS)
• ESM: None developed at this time.

 

The need to address mental health for women of reproductive age, pregnant and postpartum is reflected in the selection of outcome and performance measures for both subsets of the population of women.

 

Objective 1: By 2022, develop plan to increase coordination, referral, and uptake of mental health services for women 18-44.

Strategies:

1. Develop plan in coordination with other state agencies to increase coordination, referral, and uptake of mental health services for women of reproductive age.
2. Continue to build trauma informed care into interventions in community-based settings for mental health.
3. Continue screenings for mental health/ substance abuse and provide referrals through Title X program.

 

There are currently several programs within ODH and outside of ODH already working toward improving coordination, referral, and uptake of mental health services for women of reproductive age but there is not a centralized place for this information to be stored or tracked. By the end of SFY 22, a small sub-committee from the larger the Women and Maternal Health Committee within the BMCFH will convene to inventory existing initiatives within ODH. This workgroup will review findings/data from ODH programs that are currently offering screening, referral, and coordination related to mental health services (e.g., MP Preconception Health, MP Peer Support, Reproductive Health, IMPLICIT project). After this comprehensive review is complete, a subcommittee of members will engage existing relationships with Ohio Mental Health and Addiction Services (OhioMHAS), Ohio Department of Medicaid (ODM), and others to look at existing work outside of ODH. Once a comprehensive overview of initiatives is developed, the workgroup will work with necessary stakeholders to develop a plan in coordination with other state agencies to increase coordination, referral, and uptake of mental health services for women of reproductive age.

 

The ODH Sexual Assault and Domestic Violence Prevention (SADVP) program is in the process of coordinating key stakeholders (e.g., Ohio Domestic Violence Network, Ohio Association of Community Health Centers) throughout the state to provide trainings for community health centers, on trauma-informed care, intimate partner violence and human trafficking. These trainings will continue to occur throughout SFY 22. To monitor progress toward this strategy, the SADVP program will monitor the number of trainings and number of people trained.

 

The ODH RHWP continues to implement best practices regarding screening for mental health and/or addiction issues (e.g., Edinburgh Screening tool, ASBI). Every client has a Reproductive Life Plan (RLP) and is screened for mental health needs. If needed, clients are referred for appropriate care. A process and outcomes tracking system has been developed to document and ensure monitoring and oversight of screening and referrals to providers. Over the coming year, Title X clinics will increase care coordination and quality assurance of linkages of women to care by developing a network of providers that will accept referrals for un/under-insured clients and tracking those referrals. Title X clinics will track progress toward this objective by continuing to track the number of clients screened and number of clients referred receiving treatment.

 

Objective 2: Increase access, referral, and coordination of mental health services for pregnant and postpartum women 18-44.

Strategies:

1. Implement culturally relevant peer support behavioral health services for high risk pregnant and postpartum women through MP subgrant.
2. Implement programs and strategies to decrease alcohol use during pregnancy.
3. Continue Practice and Policy Academy participation to inform implementations of plans of safe care.
4. Increase women’s postpartum depression/anxiety screening during pediatric well visits.

 

Six subgrantees of the MP grant are in the process of developing comprehensive plans to implement culturally relevant peer support behavioral health services for high risk pregnant and postpartum women. Grantees that receive a second year of funding from the MP grant will implement their approved plans starting in October of 2021 through September 2022. The purpose of these plans will be to:

• Increase the number of peer support personnel working with pregnant and postpartum women to improve their mental wellness.
• Increase the number of screenings for behavioral health to pregnant and postpartum women.
• Increase the number of referrals for pregnant and postpartum women to behavioral health services.
• Increase the behavioral health knowledge of personnel who work with pregnant and postpartum women by attending educational and training events.

 

The ODH Fetal Alcohol Spectrum Disorders (FASD) program will implement a multi-media campaign to increase awareness of the impact of alcohol-exposed pregnancies, collaborate with agencies to establish resources, coordinate interventions, and diagnostic services for families affected by FASD. The program plans to work to evaluate the impact of other relevant strategies identified in the FASD strategic plan for implementation in coming years.

 

There are currently two ODH staff participating in the Practice and Policy Academy that serve as liaisons and communicate information from the Academy to the ODH Home Visiting team and ODH Ohio Connections for Children with Special Needs (OCCSN, Birth Defects Surveillance program). In April 2021, ODH hosted a joint meeting with the Ohio Departments of Job and Family Services and Development Disabilities to train staff from each of our respective agencies. During this meeting, information on the Plans of Safe Care was provided.

 

All of our Home Visiting programs can serve families that have a Plan of Safe Care, there are no exclusions with any of our four models. The Plans of Safe Care work is currently being piloted in several communities throughout Ohio and they are being supported directly by the Practice and Policy Academy. This support includes technical assistance and information sharing about all of the different partners that may be involved with families in a community. Home Visiting could be one of those partners, depending on the needs of the families. There is no end date for implementation, the Plans of Safe Care work with be ongoing.

 

ODH PAMR program is working with GRC and the Ohio chapter of the American Academy of Pediatrics (AAP) to implement a statewide initiative based on a program developed by the Family Medicine Education Consortium IMPLICIT Network (Interventions to Minimize Preterm and Low birth weight Infants using Continuous quality Improvement Techniques). IMPLICIT Network is a framework that focuses on maternal health screenings at well-child visits. This is the first pediatric focused QI program to implement a nationally tested interconception care model in well-child visits for birth – 18 months. To date, 11 pediatric practices have confirmed participation in Wave 1 of implementation. Educational materials have been translated in 3 languages (Spanish, Arabic and Somali). Recruitment of wave 2 sites will continue over SFY 22 to increase the reach of women’s postpartum depression/anxiety screening during pediatric well visits.

 

 

Priority: Decrease risk factors associated with preterm birth

 

Measures

• NOM 5: Percent of preterm births (<37 weeks)

• SPM: Percent of women (18-44) smoking in reproductive age
• ESM: Percent increase in enrollment of high-risk populations in evidence-based home visiting programs

 

The risk factors associated with preterm birth include and extend beyond interventions for pregnant women. The selection of the SPM for smoking among reproductive age women aligns with the need to address smoking before women become pregnant to complement the existing efforts to identify and support pregnant women in quitting during pregnancy. Home visiting services targeted at high-risk pregnant women can improve birth outcomes and the ESM will measure efforts contributing to addressing the priority.

 

Objective 1: By 2025, reduce the proportion of women of reproductive age smoking by 15%.

Strategies:

1. Develop plan to re-engage partnerships and identify strategies for addressing smoking use among women of reproductive age (including 5 A’s strategies and provider training through RHWP, WIC, HV, TUPCP).
2. Improve cross-referrals among programs addressing tobacco use (e.g., Quit Line refer to Baby and Me Tobacco Free).
3. Identify and leverage cross promotional/marketing opportunities (media, partner, collaborations.
4. Continue to provide supports for pregnant women to quit smoking through Moms Quit for Two program.

 

The following programs will work together over SFY 22 to develop a plan to streamline strategies for addressing smoking among women of reproductive age and identify and leverage cross promotional/marketing opportunities:

• Asthma Program
• Home Visiting Program
• Oral Health
• Mom’s Quit for Two
• RHWP
• FASD
• MP
• Tobacco
• WIC
• Safe Sleep/Cribs for Kids

 

By the end of SFY 22, a smaller working group of the BMCFH Women and Maternal Health will convene to explore how cross-referrals among programs to address tobacco use currently occurs and how this process may be enhanced. Once this plan is developed, it will be implemented by SFY 25.

 

The ODH Perinatal Smoking Cessation program is a statewide project that provides information through media campaigns, technical assistance, and resources. The program also funds implementation of the evidence-based model Baby & Me Tobacco Free through the Moms Quit for Two subgrant. The subgrant currently funds 19 entities throughout Ohio to provide support and resources for pregnant women to quit smoking. This grant program will continue throughout SFY 22 with the goal of providing specific technical assistance to improve the retention rate of program participants from 70% in FY 21 to 94% in FY 22. ODH Perinatal Smoking Cessation partners with programs such as Tobacco Use and Cessation, infant safe sleep, Ohio Equity Institute, Infant Vitality Community Intensive Pilot Projects, and WIC.

 

Objective 2: By 2025, increase enrollment of high-risk populations in evidence-based home visiting programs by 10% each year.

Strategies:

1. Implement home visiting services for at risk pregnant and post-partum women.

 

The four Home Visiting models, Healthy Families America (HFA), Nurse Family Partnership (NFP), Parents as Teachers (PAT), and Moms & Babies First (MBF), all serve at-risk pregnant and post-partum women. In FY 21 ODH Home Visiting expanded into all 88 counties and continued to reach more women and families than in previous years.

 

We have engaged home visiting providers across the state in conversations around expanding to meet the needs in their communities, focusing attention where we know there are waitlists and/or many unserved, eligible women/infants. A number of specific efforts are underway that will result in further expansion of home visiting services for at risk pregnant and post-partum women in FY 22:

 

1. Revision of OAC Home Visiting rule that will expand eligibility and allow more women and families to be served.
2. Strengthened, streamlined referral process from Child Protective Services to HMG Home Visiting, allowing more high-risk families to be referred.
3. Nurse Family Partnership expanded eligibility in some programs to allow multiparous (more than one pregnancy) women, and women beyond the 28th week of pregnancy to enroll (traditional NFP enrolls first time pregnant women up through the 28th week).
4. Parents as Teachers expansion in Ohio to meet the need for increased home visiting capacity.

 

 

Other Efforts Supported by Title V MCH

The majority of MCH programs are represented within the application narrative above. Several program summaries are included below to highlight additional relevant programs and a complete list of programs serving the Women population is available in the Program Map (section V. Supporting Documents).

 

Ohio Equity Institute (OEI)

The Ohio Equity Institute: Working to Achieve Equity in Birth Outcomes is a grant-funded collaboration between the Ohio Department of Health and local partners in nine counties to address the racial inequities in birth outcomes. OEI addresses disparities in prenatal, infant, and maternal health through downstream (neighborhood navigators identify and connect priority prenatal population to clinical and social services) and upstream (facilitate development, adoption, or improvement of policies and practices that impact social determinants of health related to pre-term birth and low birth weight, including reducing barriers to accessing clinical social services by improving quality, availability, and cultural competence of service delivery, and working with local leadership who can adopt policies) strategies. The nine counties implementing OEI include: Butler, Cuyahoga, Franklin, Hamilton, Lucas, Mahoning, Montgomery, Stark, and Summit. Goals of this project include the reduction of low birth weight, very low birth weight, preterm birth and very preterm birth among Black women served in OEI counties.

 

Ohio Connections for Children with Special Needs (OCCSN)

Ohio Connections for Children with Special Needs (OCCSN) is Ohio’s statewide population-based birth defects surveillance program. The Ohio Revised Code 3705.30 authorizes the state director of health to require hospitals, physicians, and freestanding birthing centers to report children from birth to 5 years of age with certain reportable birth defects to the Ohio Department of Health (ODH). Collection of birth defect data is important for public health action, including facilitating referrals to services such as early intervention and targeting prevention strategies. The OCCSN program includes activities in four major areas: surveillance of birth defects, analysis of surveillance data, referrals to early intervention services, and awareness and prevention activities.

 

Comprehensive Genetics Services Program

The Genetics Services Program funds a network of eight genetic centers that provide comprehensive care and services to people affected with, or at risk for genetic disorders. The purpose of the program is to ensure availability of quality, comprehensive genetic services in Ohio. Genetic services include, but are not limited to genetic counseling, education, diagnosis and treatment for genetic conditions and congenital abnormalities. Persons in Ohio who would like genetic counseling, or other genetic treatment services, may contact one of the Comprehensive Genetic Centers (CGC), or may be referred by their primary care physician. The goals of the Comprehensive Genetic Centers (CGCs) are to ensure that children and adults with, or at risk for birth defects or genetic disorders and their families receive quality, comprehensive genetic services that are available, accessible, and culturally sensitive; and providers, the general public and policy makers are aware and knowledgeable about birth defects, genetic conditions, genetic disease related services in Ohio.