Decrease preterm and low birthweight infants

The OMCFH will continue to participate in partnership with the West Virginia Perinatal Partnership (WVPP) in the Risk Appropriate Care (RAC), a quality improvement strategy that endeavors to assure that babies are born in a hospital with the appropriate level of nursery, and that mothers with high-risk conditions give birth in a facility that is best prepared to meet their needs.  OMCFH will continue to participate on the WVPP Quality Improvement Advisory Council to consider recommendations for implementing strategies based on Project Watch Data related to Pre-Term and Very Pre-Term Birth.

Promote low-dose aspirin use in pregnancy to prevent preterm birth related to hypertension.

The OMCFH will partner with the WVPP to develop a pilot project on low-dose aspirin use in high-risk pregnancies in two hospitals or provider groups.  The project will provide low-dose aspirin use education at the appropriate level for home visitors, doulas, pharmacists, providers, and anyone caring for pregnant patients to encourage expectant mothers to follow protocols.

The OMCFH is sponsoring a Special Topics in Women’s Health Conference in September 2024.  Attendees will include primary care providers, oncologists, women’s health providers, nurses, and behavioral health providers.  Sessions will include Reproductive Justice and a Decision Aid Tool for Sterilization to support informed consent for sterilization, onco-fertility and sexuality in women cancer survivors, and ethical issues related to in vitro fertilization.

Provide evidence-based labor support education for nurses in birthing facilities

Promote Doulas into Perinatal Care

The Doula Advisory Committee will continue to meet bi-monthly to operationally define the role of doulas and educate providers on how doulas can support their practices in addressing postpartum maternal mental health outcomes and health disparities, Plans include broadening membership to include representatives from the community (a parent and pregnant individual), Right From the Start (RFTS) direct care coordinator (DCC), peer recovery coach doula, Hospital Association, and agency Federally Qualified Health Centers (FQHCs).  The OMCFH will continue to participate on the Medicaid Payer Group to promote payment for doula services.

Eight Listening Sessions will be conducted with healthcare workers and families across the state to operationally define the role of doulas and educate providers on how doulas can support their practices in addressing postpartum maternal and mental health outcomes and health disparities.  These listening sessions are being held in July and August 2024.  Results from these sessions will be shared with the listening session participants and at the OMCFH Special Topics in Women’s Health Conference scheduled for September 17, 2024, Annual Home Visiting Conference, and with the Doula Advisory Committee.  Recommendations from these listening sessions and Hospital Lunch and Learns will be used to inform future goals related to Doula Initiatives.

Observing live births is a barrier for doulas obtaining DONA certification due to hospital limits on visitors in the labor and delivery rooms and lack of hospital policies for doulas.  To mitigate this challenge, the OMCFH is exploring implementing doula residency programs in WV birthing hospitals.  To obtain technical assistance, the OMCFH has scheduled a site visit with the Lived Experience Accessible Doula Program (LEADoula) in North Carolina in September 2024 at the University of North Carolina School of Medicine.  Braided funding through the WVPP has been allocated to provide payment hospital incentives to establish these residency programs. 

The OMCFH will continue to support maintenance of a doula directory for professionals and parents and will continue to collaborate with the WVPP to support doula education and training.  Doulas will also be listed on the WV Home Visitation Program (WVHVP) Childbirth Education Enhanced Services Directory.

Love Your Birth Control

The OMCFH will continue to collaborate with the WVPP to offer the Love Your Birth Control course to promote optimal spacing during pregnancy and improve individuals’ understanding of birth control options.  The Love Your Birth Control course will continue to be provided free to any healthcare facility or community group that requests training.  Additionally, starting June 2024, the course will be offered virtually.

Provide Lamaze childbirth education.

In collaboration with the WVPP, the OMCFH will continue to provide Lamaze Evidence-Based Labor Support (EBLS) training for intrapartum nurses and staff to reduce the rate of nulliparous, singleton, vertex, term babies born via cesarean delivery.  An evaluation component is added to this work to assess the impact of this training on the workforce over time.  RFTS will work to increase the number of clients enrolled in the enhanced services component for Lamaze childbirth education and provide a director of Lamaze trained DCCs to providers within each region.  The certified Lamaze Childbirth educators’ contact information will also be listed in the Childbirth Education Enhanced Services Directory developed by the WVHVP.

Promote childbirth education for first-time mothers statewide.

The WVHVP developed a Childbirth Education Enhanced Services Directory that will be provided to OB providers, hospitals and primary care providers with contact information listed by county.  The certified Lamaze Childbirth educators’ contact information will also be listed in the findhelp online resource referral platform.  The findhelp platform will provide a streamlined referral process for providers and self-referral options for birthing parents.  The resource directory will be incorporated in the HMG Coordinated Intake Process and providers listed will be encouraged to claim their site within the findhelp platform for easily managed referral/resource linkages.  A final review is occurring, and the directory will be released in early Fall 2024 with changes updated as needed based upon the contact information shared in the document.

The goal will continue to be add an additional 10 enhanced services providers statewide and to ensure the providers are strategically located within different regions to provide access to care.  RFTS will also develop the enhanced service component to a hybrid model to best meet the needs of birthing parents.  As the enhanced service component of childbirth education training continues, the intent is to train DCCs to provide education both virtually and in-person to better meet the birthing parents request for education.

Due to staffing changes within RFTS, the initial activity to incorporate the voice of the birthing parents into the enhanced services work has been delayed until Summer 2024.  A pre and post survey will be developed that can be completed by the participants.  The results will be evaluated and shared with the RFTS enhanced service providers to ensure the training meets the needs of the birthing parents enrolled.  The survey will be designed to measure both virtual and in person training to ensure training is equitable regardless of training mode.

As a result of the discussion on Real WV Moms, the topic advanced to more than just working with first time moms, but families overall.  The content will continue to be pregnancy, postpartum mental and physical health, and the importance of prenatal care.  The targeted population for the campaign has changed and the focus falls into both women’s and family health, adolescent and child health and workforce development.  West Virginia has a higher prevalence of adolescents identifying as transgender and grandparents raising grandchildren, which affects the changing landscape of families in the state.  Many of our materials for the State’s Home Visiting program are targeted to traditional families, creating a stronger divide in health equity.  To better identify targeted workforce training needs, public health input from key stakeholders is required.  Both behavioral health providers’ and maternal social support workforce’s strengths include conceptualizing how psychosocial issues affect a person’s quality of life.  However, this workforce may lack the basic knowledge about a person’s physical health concerns.  There is an overall need for targeted workforce development and training to address these inequities.  Listening sessions on Real WV Families are being conducted in July 2024, and the results will be presented at the Special Topics in Women’s Health Conference in September 2024.  Results from these listening sessions will inform future workforce needs and program development.

The OMCFH will collaborate with the WVPP to provide delivery hospitals and emergency departments with education on bereavement care to those families who experience the loss of a baby by miscarriage, fetal demise, stillbirth, and infant death.

In coordination with the WVPP, the OMCFH will update the annual competency training for partners of the Say YES To Safe Sleep for Babies, including birthing hospitals, home visitation staff, and other community partners.  This update will include shared decision making and a culturally sensitivity which also supports breastfeeding and mental health.

Count the Kicks will be promoted via literature, phone app, online resources, and continuing education webinars to nurses, physicians, midwives, and doulas to enhance knowledge related to fetal movements and how to instruct their patients to count fetal movements in utero.

Conduct best practice updates for maternity care providers on the recommendations of the American College of Obstetrics and Gynecologists and the Society for Maternal Fetal Medicine.

The OMCFH will continue to collaborate with the WVPP to facilitate Grand Rounds on Implicit Bias in Racial and Impoverished Families in each of the obstetrics and gynecology residency training programs.

Additionally, the collaboration will continue to provide fetal monitor instruction for clinicians to utilize standardized methods in the assessment of the fetal heart rate status, including interpretation, documentation using the National Institute of Child Health and Human Development (NICHD) terminology, and encouraging methods that promote freedom of movement.

Implement Nurse Family Partnership for first time moms in highest risk counties.

The WVHVP will support the implementation of Nurse Family Partnership which is an evidence-based, community health program with 45 years of research showing significant improvements in the health and lives of first-time teen moms and their children affected by social and economic inequality.  NFP has proven outcomes and the impact for teen prenatal and parents, especially those impacted by two-generational trauma and experiencing socio-economic inequality.  NFP will pair specially trained registered nurses with vulnerable teens who are pregnant with their first child, starting early in the pregnancy and continuing through the child’s second birthday.  During home visits, nurses will monitor and respond to symptoms of postpartum depression and postpartum psychosis/schizoaffective disorder.  NFP will also provide around care, referring women to social services, legal counsel, and group community outings.  Pregnant teens and their child will be provided with an initial assessment, case management and supportive counseling.

The initial implementation was planned for Spring 2024 but has been delayed pending final Model implementation approval.  As part of the HMG coordinated intake process, NFP will be available through limited capacity within Kanawha County.  Using a blended funding stream of MIECHV, Medicaid, state funds and Title V block grant, Kanawha County is the first county for services to be implemented.  The county was determined by the number of first-time moms and staffing capacity of registered nurses that are Bachelor degreed.  A subrecipient agreement will be effective in September 2024 for services to begin.

Increase dental care specifically during pregnancy

Continue oral health surveillance of perinatal population through the Basic Screening Survey (BSS) to inform program and policy development

The Oral Health Program (OHP) will continue partnerships with both the WVPP and the West Virginia Family Resource Networks (FRNs) to determine the appropriate event locations to access the perinatal population for 2024-2025.  Registered dental hygienists, staffed by the OHP, will continue to attend FRN sponsored Community Baby Showers statewide to provide oral health education and supplies to this population.  The OHP will continue working with the WVPP to strengthen medical/dental collaboration through providing oral health educational materials to providers.  The OHP also partners with other OMCFH programs to provide oral health education and materials to allow for consistent messaging among all programs regarding oral health initiatives.

Establish a data sharing agreement with Medicaid and CHIP to monitor pregnant women use of available dental services.

West Virginia’s current Adult Dental Benefit expansion allows for all adults including the perinatal population to have comprehensive oral health services.  Lack of adult oral health services in pregnant women results in premature delivery, low birth weight, gingival issues, as well as several other issues for mother and baby.  Oral health may be considered an important part of prenatal care, given that poor oral health during pregnancy can lead to poor health outcomes for the mother and baby.  We have a current agreement in place with Medicaid and CHIP to monitor pregnant women’s use of available dental services.  The Oral Health Program will monitor data through the CMS 416 quarterly report to determine if pregnant women are utilizing these services.

Decrease smoking specifically among pregnant women and decrease smoke exposure among children in the household.

The OMCFH and the WVPP will continue to facilitate training for obstetrical and pediatric tobacco cessation champions, continue to identify, training and support pediatric health care providers on best practice smoking/vaping cessation interventions to address second and third hand smoke exposure, coordinate tobacco cessation and prevention efforts with Our Babies Safe and Sound and other statewide groups to address clean air initiatives and participate on the Coalition for a Tobacco Free WV and other statewide group efforts.

Vaping has been indicated by many of the families enrolled, and as a result, WVHVP will add vaping educational materials to the list of items shared with families.  WVHVP will work with the States’s Division of Tobacco Prevention to utilize the materials developed in two reports:  WV Youth and Vaping a Dangerous Combination and Truth Initiative, a report on vaping in the workplace.  WVHVP staff will also work with the Smoking Cessation Epidemiologist to determine if materials in the new FDA Online Vaping Prevention and Education Resource Center are appropriate for use with families enrolled.

The focus of any training completed with providers and home visiting programs is to determine the effectiveness of the training and how the training content is being used in daily practice.  The WVHVP team will utilize their existing epi team and CQI team to implement a series of surveys through Google that will measure impact with home visitors and DCCs that completed training.

Offer evidence-based training to maternity care providers to promote tobacco cessation during each prenatal visit.

The OMCFH and the WVPP will continue to provide training and intervention programs specifically for obstetrical and pediatric providers to reduce smoking before, during, and after pregnancy.  In addition, efforts will continue to identify, train and support providers on best practice tobacco/nicotine cessation interventions during pregnancy and to promote a consistent and unified message about cessation of smoking in pregnancy.  The PP will provide training and technical assistance to healthcare and public health providers on helping women quit using tobacco before, during, and after pregnancy, advertise and connect with health care providers to attend trainings, and develop a recognition plan for physician practices that participate in training as leaders addressing smoking before, during and after pregnancy.  The WVPP will also secure continuing education credits for participation in the workshops, provide technical assistance to providers and their practices receiving Help2Quit trainings, provide technical assistance to OMCFH home visitation programs on tobacco prevention and cessation strategies, coordinate with the WV Quitline to reduce barriers to enrollment and increase participation of pregnant and postpartum women.  The Tobacco Free Families Advisory Council will continue to meet quarterly to provide relevant updates and information.

Offer evidence-based cessation curriculums to pregnant women via home visitation services.

Home visiting programs will continue to use evidence-based curriculums with all families served.  Two additional evidence-based models, Nurse Family Partnership and Maternal Health Outreach Worker (MIHOW) have been added to the list of models being used to ensure a coordinated intake system is in place that meets the need of any family enrolled based upon the initial assessment.

The smoking cessation epi will work with the WV Tobacco Prevention program, the WV Quitline, and the Tobacco Free Advisory Board to update the toolkit based upon recent recommendations and reports generated.  The toolkit will include materials on vaping.

RFTS will work with the DCCs trained as certified tobacco treatment specialist (CTTS) to provide hybrid smoking cessation services through enhanced services.  RFTS will provide an in-depth review of the counties with the highest rates of pregnant women to smoke to ensure there will be DCC coverage providing the service.

Continue to seek out innovative evidence-based strategies to support women in quitting tobacco products before, during and after pregnancy.

RFTS will share the value add-on elements provided by the MCOs to clients enrolled.  An exhibit will occur at the Perinatal Summit with RFTS to approximately 180 providers.  WVHVP will work with the MCOs to ensure exhibits at the community-based baby showers targeting pregnant women. 

OMCFH submitted a proposal through the preventive block grant for additional funding support to develop a workflow by which referrals for pregnant individuals identified as smoking during pregnancy by the PRSI can be referred to BMTFP.  These referrals will be a priority for referral and enrollment through this project.  The SMART objective for the project will be: “By September 30, 2025, increase the percentage of referrals from all sources that enroll in BMTFP by 5%.

Follow-up with maternity care providers after receipt of evidence-based training to assess increase of tobacco cessation with pregnant women.

RFTS will provide information to maternity care providers on the number of DCCs providing tobacco cessation training, including the number of pregnant women enrolled that indicate they want to quit or reduce smoking.  Data reports will be provided that indicate the number of women enrolled, the number of women that quit or reduced smoking.  The trained DCCs will work with maternity care providers to include smoking cessation as part of enhanced services available.  Regional reports will be developed to be shared with providers and community partners.  To streamline the process for referral, the tobacco cessation specialists will be listed on findhelp and referrals made through the resource/referral platform.

Address substance use in pregnancy and in youth/teens

WVHVP will work in the southern part of the State (Mingo, Boone, Mercer, and Fayette counties that works with foster children, adoption agencies and early childhood programs that provides services throughout four identified high-risk counties to support a NFP nurse and social worker, along with initial costs for an infant mental health consultant on a contractual basis.  For that combination of counties, the teen birth rates for the 15-19 age group are:

• Mingo with a birth rate of 41.4
• Boone with a birth rate of 40.6
• Mercer with a birth rate of 38.6
• Fayette with a birth rate of 34.4

The activities outlined with the WV PMHCA expansion funds will engage social service agencies and OB providers and pediatricians to refer teen moms impacted by substance use or behavioral concerns to a NFP team.  The team will consist of a registered nurse, social worker, mental health consultant and an early childhood specialist that will also focus on the child through age two.  The two-generational approach will assess social determinants of health, emotional well-being, domestic violence, and secondary trauma which will assist with developing a case plan.  

Use RFTS RLA to educate providers on accurate and complete submission of the PRSI form.

The RFTS case management home visiting model will continue to utilize the RCCs to conduct at least one site visit to each practicing obstetrical provider annually (at a minimum) in the assigned region to ensure obstetrical providers are completing the PRSI during initial examination of women.  The RCC will provide technical assistance to practicing obstetrical providers to ensure proper completion and submission of the PRSI.

Support transition from paper PRSI form to electronic data collection system.

The RCCs will continue to collaborate with the Division of Women’s and Family Health Quality Assurance Coordinator (QAC) on education needed with OB providers to encourage a higher completion rate of the PRSI form in the electronic database.  A survey is being developed for OB providers and front-line staff asking about the barriers related to PRSI submission.  The results of the survey will be shared with the Maternal Risk Screening Advisory Board to lead the work on revising the PRSI form and processes needed for successful electronic submission.

The Division of Women’s and Family Health Quality Assurance Coordinator (QAC) will engage obstetrical care providers and nursing/healthcare staff in a quality improvement initiative related to implementing the electronic PRSI into their healthcare practices, including interviews to identify challenges related to maternal risk screening, opportunities to streamline processes, and innovative ways to improve compliance.

The QAC will conduct a literature review to determine best practices for electronic maternal risk screening implementation in obstetrical offices.

Inform providers of compliance rate in submission of PRSI forms.

Reports will be developed and shared with providers on a regular basis.

Post Block Review Note: Activities to address postpartum visit measures will be included in the Plan for the Upcoming Year after further development.