Priority: Strengthen the capacity of the health system to promote mental health and emotional well-being.

 

Objective 1. Increase to 92% from baseline (89.5%, PRAMS 2018) the percent of birthing people who have moderate or high social support following the birth of their baby. 

When 2021 data become available, MDPH will examine the changes in moderate or high social support comparing 2016-2018 and 2019-2021 with a difference-in-differences analysis for pre-COVID-19 and COVID-19 periods. PRAMS staff will examine the characteristics of people with a lower score of social/emotional connectedness, and the association of frequent postpartum depressive symptoms with this social connectedness question. This analysis will help to identify vulnerable populations and guide efforts to promote mental health and emotional well-being.

 

Perinatal Mental Health Data Analysis Plan 

The Perinatal Mental Health Data Analysis Plan was finalized in FY21 and submitted to the Postpartum Legislative Commission, the Racial Inequities in Maternal Health Special Legislative Commission, and other key stakeholders. MDPH is seeking funds to implement the plan.

 

Perinatal Mental Health Training and Technical Assistance 

In FY23, MDPH will continue to provide training and technical assistance on perinatal mental health (including maternal mental health and co-morbidities such as substance use and interpersonal violence) to state agencies (such as the Departments of Children and Families and Early Education and Care), providers (including home visiting programs and community health centers), and health plans. This training and technical assistance will contribute to increasing awareness and reducing stigma of perinatal mental health issues and will support continued implementation of the Postpartum Depression regulations. 

 

Doula Initiative

In FY22, the MDPH Doula Initiative was established to support and expand a strong doula workforce that includes the development of a certification pathway, enhancing ongoing professional development opportunities and establishing a pathway to sustainable financing.  Doulas are trained non-medical professionals who provide perinatal emotional, physical, and educational support and patient-advocacy. Doula care is associated with improved birth outcomes (including reduced cesarean births, decreased preterm births, and decreased low birthweight infants) and cost savings. Community-based doulas of color play a critical role in promoting racial equity. Community-based doulas come from the communities they serve and are largely hired by members of their own communities based on shared cultures, values, languages, and/or lived experiences. Evidence suggests that doulas may help mitigate health inequities people of color, especially Black birthing people, face. Research found that Black birthing people who engaged community-based doulas had a 49% greater reduction in preterm births and 41% greater reduction in low birthweight infants compared to their peers who did not engage community-based doulas.[1] Additionally, compared to their White peers, Black birthing people are 1.8 times more like to want a doula, but lack access to a doula.[2]

 

Currently, doulas are not licensed or certified in Massachusetts and there is no single national or statewide accrediting body for doulas. Creating a certification pathway would help to professionalize doulas, help ensure quality of care, allow consumers to select doulas who have been vetted by a trusted state agency, legitimatize broader funding opportunities of doula care, and set up a means through which funders may eventually reimburse doulas. As Massachusetts birthing people and families pursue hiring a doula, either out-of-pocket or through their insurance provider, certification from MDPH would help consumers validate the skills and knowledge of the doula.  

 

Using Title V funds, in FY22 BFHN hired a Maternal Health Coordinator to develop, implement, and coordinate a doula certification process. The Coordinator will also provide programmatic support to other maternal and infant health programs including perinatal mental health and maternal mortality and morbidity.

 

In FY23, BFHN will host monthly Doula Stakeholder Advisory Group meetings with the goal of drafting recommendations for doula certification. The Advisory Group will include doulas, a certified nurse midwife, and representatives from the American College of Obstetricians and Gynecologists, MassHealth, and the Commonwealth Care Alliance. MDPH will offer monthly stipends to 10 doulas for their participation. In addition, BFHN staff will work with the MDPH legal and government affairs offices to begin the process of drafting legislation that will allow MDPH to promulgate regulations allowing MDPH the authority to certify doulas.

 

MA MIECHV

Home visitors will continue to screen participants for depression prenatally and postpartum and provide education, brief intervention, and referrals to mental health supports (e.g., support groups, therapy) to people identified with depression. Additional FY23 activities include data collection and analysis on completed participant depression screens to assess progress on a MIECHV performance measure assessing the percent of primary caregivers enrolled in home visiting who are screened for depression using a validated tool. Data will also be collected and analyzed to report on an outcome measure assessing the percent of primary caregivers referred to services for a positive screen for depression who receive one or more service contacts. Programs will continue to support families in accessing mental health services as needed and offer ongoing social connections in the form of group services. MA MIECHV will continue to support innovative staff positions within home visiting programs – such as case workers or outreach coordinators – who can liaise with mental health and other services and facilitate successful connections to supports.

 

Welcome Family

Based on the Learning Collaborative cycle described in the FY21 Annual Report, MDPH and the contracted programs jointly agreed that there would be no change in the process for screening for depression and social connectedness during the home visit. Important lessons learned through this Learning Collaborative project will be applied to program practice moving forward, such as the understanding that no screening tool is diagnostic, and Welcome Family nurses can either connect parents to someone who can diagnose or offer support without a diagnosis. In addition, the program will use a family-driven and culturally appropriate approach when considering the types of referrals being made, recognizing that many families find value in informal supports, such as doulas and peer-to-peer support groups, compared to mental health counseling or medication.

 

As a result of the COVID-19 pandemic, MDPH is planning for a longer-term hybrid (virtual and in-person) model of Welcome Family service delivery. For contracts beginning July 1, 2022, MDPH has stated that if a visit is conducted by telehealth, the Welcome Family nurse may offer a follow up visit in person based on his or her clinical judgment (e.g., to respond to acute mental health concerns). MDPH will develop further guidance to contracted agencies on when and how to conduct a second visit.

 

F.O.R Families

In FY23, F.O.R. Families will continue engaging families transitioning from homelessness to stable housing who are at high risk for stress, depression, violence, and substance use. Visiting this population in the home helps promote a strong foundation for family resilience and emotional wellness. Home visitors will monitor clients for symptoms of depression and provide education, supportive counseling, and referrals to mental health services. Staff have been successful in building community relationships with their local mental health resources and services to ensure a smooth referral process for families. They also use staff meetings and case conferences with shelter providers as a method of technical support and education to their shelter colleagues about symptoms of depression and tips on family engagement. In FY23, home visitors will continue to assess families’ needs, define goals, develop plans, and connect with community support services.

 

Priority: Prevent the use of substances, including alcohol, tobacco, marijuana and opioids, among youth and pregnant people.

 

Objective 1 (NPM 14). By 2025, reduce the percentage of people who report smoking during pregnancy from the baseline of 4.3% in 2018 (PRAMS) to 3.0%.

PRAMS

CDC and MA PRAMS have started the Phase 9 survey revision for the 2023 survey; MA PRAMS will add questions including cigarettes/e-cigarettes (vaping) in the first and second trimesters of pregnancy; the current Phase 8 survey asks about smoking during the three months before pregnancy and the third trimester of pregnancy. MDPH will examine data from 2023 in FY25. MDPH will use PRAMS data to report on nicotine use during pregnancy and validate reporting of cigarette smoking on the birth certificate.

 

Perinatal-Neonatal Quality Improvement Network (PNQIN)

In FY23, MDPH will share PRAMS data at PNQIN statewide summits to foster collaboration and support quality improvement cycles to reduce nicotine, marijuana, and alcohol use during pregnancy (also tied to Objective 2 below). PNQIN has heard from several hospitals that they have improved systematic screening for use of these substances, with referrals as necessary. For tobacco and marijuana, responsibility mostly remains with the obstetricians to provide counseling and offer alternatives like nicotine patches or gum in the case of tobacco, and counseling about potential effects of marijuana on the developing fetus. PNQIN will support hospital teams that have strong screening and referral processes in place and to engage additional hospitals, with the goal of increasing screening and referral to existing statewide support services such as the MDPH Tobacco Cessation and Prevention Program.

 

MA Tobacco Cessation and Prevention Program (MTCP)

In FY23, MTCP will use the findings from surveys and key informant interviews of family support providers and substance use treatment facility providers to implement trainings that address gaps in knowledge and confidence in addressing tobacco/nicotine use among pregnant and parenting people. MTCP will also use the findings to promote the Quitline services, especially the pregnant and postpartum protocol, as a resource for providers to use with their clients.

 

MTCP will engage with a vendor to develop and implement focus groups (hopefully using the TIER Community Evaluator model or similar community-based participatory research model) with pregnant and parenting people (including fathers) across the state. MTCP aims to learn about existing tobacco/nicotine cessation services, the ways in which pregnant and parenting subpopulations (e.g., MassHealth members, families with mental health and substance use disorder) access and experience these services, and how services could be adapted for these populations. MTCP hopes these findings will increase the quality of existing programs, develop harm reduction and trauma-informed messaging that includes vaping, and more effectively promote quitting resources by using racial equity and intersectionality frameworks.

 

MA MIECHV

In FY23, MA MIECHV will continue to provide training on substance use, NAS, substance use screening, and trauma-informed practice, and home visitors will routinely screen participants for substance use. Data on tobacco cessation referrals will be collected and analyzed to assess progress on a MIECHV performance measure assessing percent of primary caregivers enrolled in home visiting who reported using tobacco or cigarettes at enrollment and were referred to tobacco cessation counseling or services within three months of enrollment. In addition, MA MIECHV will explore the use of a validated substance use screen to support home visitors in assessing risk for substance use and identification of appropriate referrals to treatment services.

 

Objective 2. By 2022, improve measurement of marijuana use among pregnant people by adding specific questions to the PRAMS survey.

Objective 3. By 2023, improve measurement of alcohol consumption among pregnant people by adding specific questions to the PRAMS survey. 

PRAMS

MA PRAMS will continue to use the current opioid supplement to collect marijuana use during pregnancy. The 2021 PRAMS data collection is ongoing and will be completed by July 31, 2022. Data from 2021 will be examined in FY23. MDPH will present the PRAMS findings to prenatal and other providers at the PNQIN summits in spring 2023 and develop a fact sheet that can be posted on the MDPH and PNQIN websites.

 

CDC and MA PRAMS have begun the Phase 9 survey revision for the 2023 survey, MA PRAMS will add questions about alcohol consumption in all three trimesters of pregnancy; the current Phase 8 survey asks about alcohol consumption in the past two years and during the three months before pregnancy. MDPH will examine data from 2023 in FY25.

 

Center for Birth Defects Research and Prevention

In FY23, CBDRP will continue the Birth Defects Study to Evaluate Pregnancy exposures (BD-STEPS) and the Stillbirth Study. Data from these studies are released on a regular basis and CBDRP anticipates having MA data available by early 2023. This population-level data will allow MDPH to better understand the prevalence use of marijuana in pregnancy, as well as the frequency of use, route of use (e.g., smoke, vape, eat, consume drinks, dab) and reason for use (e.g., recreationally or to relieve nausea, anxiety, pain, symptoms of a chronic condition).

 

FASD Task Force

The previous Statewide FASD Coordinator, funded by MDPH through a contract with the Institute for Health and Recovery, will retire in FY23. Two new staff, both parents of children with FASD, were hired to take over the role. They are committed to supporting the FASD Task Force by continuing to engage families through support groups, meetings, and linking to the center at William James College that provides diagnosis for families with children suspected of having FASD. A particular focus in the coming year is to reach out to programs serving pregnant and parenting families in recovery to offer support to birth parents of children with FASD and connect them earlier to diagnostic and support services to address parenting a child with FASD from birth.

 

In FY23, the FASD Task Force will increase training opportunities geared towards services for families caring for individuals with FASD (such as school systems, direct therapy and social work agencies, DCF Foster/Adoptive Care, and Children’s Behavioral Health Initiative providers), and research further opportunities to directly support families caring for individuals with FASD.

 

Additional activities to prevent the use of substances among youth and pregnant people

Additional efforts to address this priority that do not directly relate to the performance measure or other objectives are described below.

 

PNQIN

In FY23, Title V will continue to support PNQIN initiatives and statewide summits, which convene almost all birth hospitals in the state to share best practices for the care of substance exposed newborns and their families. PNQIN will continue to focus on addressing perinatal opioid use during pregnancy, at delivery, and during the first year of life.

 

Moms Do Care 

In FY23, MDC will continue to implement peer led, seamlessly integrated, trauma informed continuums of wraparound care for pregnant, postpartum, and parenting people with opioid use disorders. The MDC technical assistance team will provide support and training in implementing the program and assist the MDC health care systems to plan for ways to sustain the wraparound services as well as collaborative, multidisciplinary networks of support established by the program. MDC will also continue to work with the health care systems and their regional partners to build and maintain the organizational system change initiatives and collaborate with Medicaid and public health stakeholders to bring this direct service and system change model to a statewide reimbursable scale. MDPH anticipates onboarding 2-3 additional sites in 2023.

 

Plans of Safe Care

In FY23, MDPH will provide training and technical assistance to support MA residents and providers to develop and use Plans of Safe Care for substance affected families. The trainings will be conducted within all levels of care in the state’s public substance use treatment system. MDPH will explore partnering with PNQIN to enlist hospitals in the development of Plans of Safe Care, with FIRST Steps Together providing training and technical assistance to hospitals and MA MIECHV programs as needed. A new online training module will be developed and will be widely available to providers throughout the state working with pregnant people with SUD.

 

FIRST Steps Together

In addition to direct service provision, the program will continue to create mechanisms to implement Plans of Safe Care, expand and refine the perinatal and parenting peer recovery workforce, expand perinatal collaboratives, increase referrals to Early Intervention and develop and disseminate best practices.

 

In FY23, FIRST Steps Together will continue to build capacity in the state to implement Mothering from the Inside Out, an evidence-based intervention to increase reflective capacity among parents with substance use disorders, through the training of two new cohorts of clinicians, and implementing a learning collaborative for peer staff. In FY23, MDPH will complete and disseminate an extensive FIRST Steps Together implementation toolkit and create online training modules related to a range of relevant topics. In addition, MDPH will add 1-2 new sites, and eligibility will expand to include parents of children up to age 11.

 

In FY23, there will be a continued expansion of the Group Peer Support model throughout the substance use treatment system. This is a trauma-responsive support group model based on evidence-informed modalities that was developed initially to combat perinatal mood disorders. 

 

MA MIECHV

In FY23, MA MIECHV will continue to pilot an overlay of a Peer Recovery Coach within the PAT program. In FY23, using the MIECHV American Rescue Plan award, MA MIECHV will expand the Berkshire Recovery Coach Pilot by one peer recovery staff. Through this pilot, home visitors attend the Recovery Coaching and Ethical Considerations trainings required for Recovery Coach Certification. Supervisors attend the Recovery Coach Supervisor training to build their capacity to supervise recovery coaches. The home visitor/recovery coach positions will also have access to specialized training provided through FIRST Steps Together and to the peer learning collaborative, thus integrating State Opioid Response and MA MIECHV resources.  

 

Priority: Reduce rates of and eliminate inequities in maternal morbidity and mortality.

 

Objective 1 (SPM 1). By 2025, the MMMRC will increase the percent of pregnancy-associated deaths that are reviewed within two years of occurrence from 0% to 50%.

Objective 2. By 2025, develop a structure for community input to the review process that is authentic and addresses the power dynamics between medical providers and community stakeholders. 

Maternal Mortality and Morbidity Review Committee

In FY23, data will continue to be collected and abstracted into MMRIA. Once recent deaths have been entered, records will be checked for completeness and provided to the MMMRC to review and make recommendations.

 

BFHN has submitted a legislative proposal that will align Massachusetts with national trends toward strengthening MMMRCs to improve state-level efforts to provide healthcare providers and systems with the necessary information to improve services and practices to prevent maternal mortality and severe maternal morbidity, along with addressing persistent racial inequities. The proposal seeks to establish in statute the authority needed for the MMMRC to collect the information necessary to conduct thorough and complete reviews of every maternal death in Massachusetts and to increase MDPH’s capacity to review deaths in a timely manner and provide crucial information to healthcare providers and health systems to prevent maternal mortality and severe maternal morbidity.

 

Learnings from the Lean Six Sigma quality improvement training completed in FY21/22 will be used in FY23 to plan rapid cycle tests of change to improve the timeliness and efficiency of the process. The team also will also pilot the Racial Equity Data Road Map, which provides guidance and resources for programs to improve the use of data to eliminate racial and ethnic inequities (see MCH Data Capacity Efforts or the Crosscutting domain for more information about the Road Map). The team will use the tools and resources from the Road Map to monitor MMMRC performance measures with a racial equity lens and engage community stakeholders in identifying strategies to address inequities in maternal health outcomes.

 

Objective 3. By 2025, leverage collaborative partnerships to inform practice and policy changes and disseminate findings including MMMRC recommendations.

Maternal Mortality and Morbidity Review Committee

MDPH epidemiologists will analyze data from MMRIA to provide information to the public, clinicians, and policy makers. Descriptive reports will include information on burden, causes, and distribution by age, race, ethnicity, and geographic area. These data will also be used to produce briefs that identify trends or highlight a particular issue, such as racial inequities or deaths related to hypertension. The data will be analyzed using a racial equity frame to better contextualize the findings in the setting of the broader historical and current policy and system factors that affect people’s health, such as structural racism. This will help the MMMRC to identify solutions more effectively to address root causes of the inequities.

 

PNQIN

In FY23, PNQIN will continue to support the implementation of the Alliance for Innovation on Maternal Health (AIM) collaborative QI project and serve as a liaison between the AIM national office and participating hospitals, providing guidance, education, and technical assistance to hospitals. Implementation strategies are based on the Institute for Healthcare Improvement model for improvement and the AIM program implementation toolkit. Between July 2021 and March 2022, PNQIN implemented the AIM Obstetric Hemorrhage and Severe Hypertension maternal safety bundles with 22 hospitals; this effort is ongoing with the Hypertension bundle running through June 2022 and the Equity bundle launching in September 2022. PNQIN has worked with MDPH and the Betsy Lehman Center to prepare and distribute data reports via webinars on SMM for all 40 birthing hospitals in Massachusetts using data from 2016-2020. In FY23, PNQIN will conduct at least eight SMM webinars with hospitals to review their data reports, answer questions, solve coding issues, and encourage participation in the AIM Initiative.

 

PNQIN will also explore the implementation of on-site assessments of hospitals for designation of level of care, explore linkage of LOCATe results with process and outcome indicators, and operationalize the levels of care designations, ensuring equity and access to the appropriate level of care centers. PNQIN anticipates weaving the Levels of Maternal Care (LoMC) concept into ongoing PNQIN initiatives to not only ensure its longevity but to safeguard the quality improvement-oriented approach. In addition, PNQIN and partners from the Betsy Lehman Center is participating in a multistate Learning Community convened by CDC and ASTHO with an overarching goal of leveraging technical assistance and peer-to-peer learning to improve equitable risk appropriate care practices in participating states by translating LOCATe data into policy and programmatic action. The Learning Community will focus on five key areas related to LoMC: 1) data and evaluation, 2) monitoring and verification, 3) financing and reimbursement, 4) provision of quality services, and 5) coordination and access to quality services.

 

Objective 4. By 2025, reduce inequities in rates of COVID-19 infection among birthing and lactating people of color by improving their vaccination coverage during pregnancy from 21.6% for Hispanic individuals, 21.5% for non-Hispanic Black individuals and 14.0% for non-Hispanic American Indian/Alaska Native/Other individuals to above 50.0% for these groups.

Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET)

In FY23, CBDRP will continue to conduct COVID-19 surveillance on pregnant people and their infants as part of SET-NET, and routinely share data with CDC. In addition, CBDRP will more actively assist in the Hepatitis C surveillance for SET-NET, by linking Hepatitis C data from the infectious disease database to vital records and conducting medical record abstractions for identified cases. CBDRP will continue to build upon their established collaboration with the MDPH Bureau of Infectious Diseases and Laboratory Sciences by having quarterly meetings to discuss the intersection of MCH populations and infectious diseases. Through this partnership, both will work to bolster preparedness efforts to ensure that the public health response to emerging infections meets the needs of MCH populations.

 

In addition, MA SET-NET will continue contributing to national-level studies and analyze their state-level data, carrying out their multistate study examining the risk of stillbirth associated with SARS-CoV-2 infection during pregnancy and an analysis examining the association between newborn hearing loss and SARS-CoV-2 infection during pregnancy. All analyses, both currently underway and yet to be designed, will be conducted using a racial equity lens, stratifying analyses by race/ethnicity and exploring structural factors that contribute to any observed inequities.

 

MA SET-NET has linked birth certificate data with COVID-19 vaccination data from the Massachusetts Immunization Information System (MIIS). Through this linkage, staff examined COVID-19 vaccination uptake among pregnant and recently postpartum people and found this population was vaccinated against COVID-19 at a much lower rate (40% of those who delivered in October 2021) than the general population (78% of total MA population as of October 2021). There were also differences in uptake by race/ethnicity among those who delivered between May 2021-October 2021, with Black (16%), Hispanic (17%), and American Indian/Alaska Native (20%) pregnant people receiving vaccination during pregnancy at much lower rates than White (42%) and Asian (46%) pregnant people. Data were broken down by race/ethnicity and other sociodemographic characteristics including age, preferred spoken language, nativity status, education level, insurance type, and adequacy of prenatal care. In addition to providing estimates for broad race/ethnicity categories, data were disaggregated into more granular racial/ethnic subgroups to make within-group comparisons and reveal the heterogeneity within these broad groupings. These data were disseminated through several presentations with groups internal and external to MDPH, and a slide deck with the data and tailored information for healthcare providers was posted on mass.gov.  

 

In FY23, MA SET-NET will continue to share these data with various collaborators including PNQIN, the MA League of Community Health Centers, tribal partners, and MA doula networks to promote data-informed clinical decision-making and guidance related to COVID-19 vaccination during pregnancy. Staff will build upon their existing collaboration with the Vaccine Equity Initiative and continue to provide updated data on COVID-19 vaccination uptake during pregnancy broken down by specific communities of interest. 

 

There have been capacity challenges hindering the ability to routinely link data to identify COVID-19 vaccination uptake among pregnant and recently postpartum people. MA SET-NET has worked to establish a linkage timeline for FY23 with the Massachusetts Immunization Information System (MIIS) that balances timeliness with these capacity challenges. In FY23, MA SET-NET will also onboard two new medical record abstractors to build capacity and support the infant follow-up portion of the surveillance.

 

Community Evaluators

MDPH contracted with Tufts Interdisciplinary Evaluation Research (TIER) to conduct a series of community-based evaluation projects with funding from the CDC National Initiative to Address COVID-19 Health Disparities Award. For this project, TIER will hire and train a cohort of Community Evaluators in community-based participatory research to help design and implement evaluation projects and translate findings into program and policy recommendations. The projects are focused on understanding and addressing the effects of COVID-19 on Massachusetts residents, and on making sure that people directly affected by COVID-19 are part of both the evaluation process and public health response. 

 

Three initial projects have been selected and will be executed in FY23. These projects include holding focus groups with pregnant people and parents of children under age five from communities with lower COVID-19 vaccination uptake to understand barriers and facilitators to COVID-19 vaccination; evaluating community acceptance of a new telehealth kiosk being used to provide a safe, easily-accessible, and confidential space for community members to access health and other social services; and informing the development of the second iteration of MA’s Community COVID-19 Impact Survey by supplementing the previous quantitative findings with qualitative research.

 

Another cohort of projects will be identified later in FY23 and will continue to help MDPH understand the effects of COVID-19 on MA residents, especially those disproportionately impacted by the pandemic including Black, Indigenous, and other People of Color, pregnant and parenting people, essential workers, people who live in rural communities, LGBTQ people, people with disabilities, people over age 65, immigrants and refugees, people affected by mental health, domestic violence, substance use or homelessness, people living in congregate care settings, veterans, and essential workers.

 

PRAMS

Both COVID-19 and COVID-19 vaccine supplemental data collection is ongoing. While MDPH initiated COVID-19 data analysis based on seven months of 2020 data, staff will conduct additional analysis using 2021 data in FY23 (data will be available in fall of 2022). For information about PRAMS for Dads, funded through the CDC COVID-19 Disparities Grant, see the Crosscutting domain under the family engagement priority.

 

PNQIN

PNQIN is supporting MDPH’s Vaccine Equity Initiative (VEI) with a focus on improving COVID-19 vaccination among pregnant people and improving equity in the 20 communities identified by MDPH as the hardest hit by COVID-19. In FY22, PNQIN attended 27 community vaccination events, bringing clinical speakers such as OB/GYNs, pediatricians, and infectious diseases specialists to share information about the vaccine. This support is ongoing and will continue as needed through FY23.

 

PNQIN will compile and expand upon recommendations from CDC, the American College of Obstetricians and Gynecologists, and the Society for Maternal Fetal Medicine to develop a guide for providers. This guide will include centralized guidance and best practices surrounding health equity and vaccine administration and counseling. The guide will also include helpful tips for providers and a list of trusted resources that provide additional information.

 

Vaccine Equity Initiative

In FY22, VEI established a Pediatric and Family Vaccine Workgroup, led by Title V staff in BFHN. The workgroup aims to carry out VEI goals (related to increasing trust in the vaccine, ensuring vaccines are easily accessible, and reducing inequities in vaccination rates) with a specific focus on young children and their families, including pregnant and breastfeeding people. Data from a survey conducted in December 2021 about parent attitudes toward COVID-19 vaccinations for children and youth ages 5-17 illustrated that parents who are vaccinated tend to vaccinate their children, and parents who are not vaccinated are much less interested in vaccinating their children. This reinforces the need to consider the whole family when designing strategies to increase COVID-19 vaccination of children.

 

The VEI workgroup works closely with PNQIN on the initiatives described previously and is leveraging partnerships with community-based MCH partners such as Early Intervention, libraries, and YMCAs, to engage them in hosting vaccine clinics, organizing community conversations, and distributing educational materials. For example, in FY22 a town hall about COVID-19 vaccination for CYSHN was held through collaboration with the MDPH Division for Children and Youth with Special Health Needs, PNQIN, and the Federation for Children with Special Needs.

 

In FY23, this workgroup will continue these efforts, with an anticipated shift to including infants and children ages 6 months-4 years, pending authorization of a COVID-19 vaccine for this age group. One area of focus will be building capacity of community-based organizations and providers serving families with young children – such as home visiting, WIC, schools, and early education and care settings – to discuss the COVID-19 vaccine with the families they serve. MDPH is planning a series of trainings, in partnership with the MA Chapter of the Academy of Pediatrics, titled How to Become a Vaccine Champion: Strategies to Improve Confidence in COVID-19 Vaccines. The trainings will cover evidence-based strategies, including motivational interviewing, to help improve COVID-19 vaccine conversations with families with young children, and include time for questions and answer. Two sessions will be held in late FY22, and MDPH will assess the need to offer additional sessions in FY23 based on interest and demand. In addition, the workgroup will explore avenues to support Child Life Specialists to volunteer at community-based clinics. Child Life Specialists can help with managing cognitive fears, provide comfort goals and distractions, and promote coping among children and families to ensure a trauma-informed approach.

[1] Thomas, M.-P., Ammann, G., Brazier, E., Noyes, P., & Maybank, A. (2017). Doula Services Within a Healthy Start Program: Increasing Access for an Underserved Population. Maternal and Child Health Journal, 21(1), 59–64. https://doi.org/10.1007/s10995-017-2402-0

[2] Kozhimannil, Katy B., Attanasio, L. B., Jou, J., Joarnt, L. K., Johnson, P. J., & Gjerdingen, D. K. (2014). Potential benefits of increased access to doula support during childbirth. The American Journal of Managed Care, 20(8), e340–e352.