Women/Maternal Health - Application Year

 

Illinois’ priority for the Women and Maternal Health Domain is:

 

• Assure accessibility, availability, and quality of preventive and primary care for all women, particularly for women of reproductive age (Priority #1)
• Promote a comprehensive, cohesive, and informed system of care for all women to have a healthy pregnancy, labor and delivery, and first year postpartum (Priority #2)

 

Access, Availability and Quality for Women (Priority #1)

 

During FY21, IL Title V will utilize the following strategies to address Priority #1 - Assure accessibility, availability, and quality of preventive and primary care for all women, particularly for women of reproductive age:

 

A. Support the implementation, dissemination, evaluation and improvement of the Illinois Healthy Choices, Healthy Future Perinatal Education Toolkit, which includes information and resources for consumers of women during Preconception, Prenatal, Postpartum, and Interconception Care.

 

During FY21, EverThrive Illinois will maintain the Illinois Healthy Choices, Healthy Futures Perinatal Education Toolkit, developed for clinical providers as well as promote, update, and maintain the toolkit’s new website: http://healthychoiceshealthyfutures.org/.

 

B. Partner with the Illinois Department of Corrections (DOC) and two state women’s correctional centers to support ongoing health promotion activities for incarcerated women and staff training, and to ensure women and infants receive WIC services while residing in DOC facilities.

 

For FY21, OWHFS will continue to partner with the Illinois Department of Corrections to offer health education to incarcerated women, provide training to corrections staff, help stock women’s health supplies (such as breast pumping supplies), and work closely with corrections staff to meet the health needs of women in Illinois prisons. The program will continue to implement the previously adopted evaluation plan which will demonstrate the value and impact of these efforts. Title V will specifically support this work by conducting the evaluation (epidemiology team), providing birth simulation training to prison staff, and providing information and support to corrections officers working with women who are pregnant, postpartum, or parenting. Future training programs are being formulated based on the feedback provided by the clinical staff at both correctional centers.

 

Additionally, OWHFS will continue to teach health education sessions using the Helping Women Recover, Beyond Trauma and Life Smart for Women curricula. Training opportunities for prison health care staff will continue to focus on comprehensive care for their expectant mothers, trainings on trauma and Adverse Childhood Experiences (ACEs), as well as better understanding of and specifically recognizing the unique health care needs of their LGBTQ population. An additional training programming will include a full simulation of a maternal transport team from the Level III Administrative Perinatal Center coming to pick up a patient in active labor. This simulation will allow corrections security to test the “lock-down” process for active labor patients while allowing EMS to enter and treat a woman and neonate in the pregnancy wing or health care wing.

 

The IDPH southern perinatal nurse will continue to collaborate with the Administrative Perinatal Center, South Central Illinois, other OWHFS staff, and correctional centers to assist in the process for women receiving maternal-fetal medicine consultations.

 

C. Implement well-woman care mini-grants to assist local entities in assessing their community needs and barriers; and develop and implement a plan to increase well-woman visits among women ages 18-44 years based on the completed assessment.

 

During FY19, IL Title V staff began planning for the well-woman care mini-grants, with the goal to provide funding to local organizations who work with women ages 18-44 to develop and implement a plan to positively impact the number of women seeking well-woman care. Using best-practice examples from other states, example activities were suggested, including using the CityMatCH Well-Woman Toolkit, providing education and training to women to increase health literacy, and developing local resource guides for where women could access care. For FY21, IL Title V will continue to support and implement the well-woman care mini-grants.

 

D. Partner with the University of Illinois at Chicago (UIC) Center for Research on Women and Gender to implement a program at two clinic sites to expand the capacity of Illinois health care providers to screen, assess, refer and treat pregnant and postpartum women for depression and related behavioral health disorders.

 

During FY21, IL Title V will continue to partner with the UIC-CRWG as it pilots a program at two clinic sites. The goals of the program are to increase the capacity of perinatal providers to screen, assess, refer, and treat behavioral health disorders, and to increase awareness of and access to affordable and culturally appropriate services. Through these efforts, IL Title V and UIC-CRWG hope to improve the mental health and well-being of pregnant and postpartum women and their infants in the State of Illinois.

 

E. Support the Chicago Department of Public Health (CDPH) efforts to foster, partner, and collaborate with organizations and agencies providing male and partner involvement programs.

 

For FY21, CDPH will seek to engage male and partner involvement in its efforts to increase women’s early entry into prenatal care. These efforts will include leveraging relationships with organizations and agencies that target the same population. IL Title V will support CDPH’s efforts through the Title V mini-grant.

 

Comprehensive and Informed System (Priority #2)

 

During FY21, IL Title V will utilize the following strategies to address Priority #2 -Promote a comprehensive, cohesive, and informed system of care for all women to have a healthy pregnancy, labor and delivery, and first year postpartum:

 

A. Convene and facilitate state Maternal Mortality Review Committees (MMRC and MMRC-V) to review pregnancy-associated deaths and develop recommendations to improve quality of maternal care as well as reduce disparities and address social determinants of health.

 

During FY21, Illinois will continue its process for identifying pregnancy-associated deaths in Illinois and assuring reviews by the state’s two maternal mortality review committees. MMRC will continue to review every potentially pregnancy-related death and MMRC-V will continue to review violent pregnancy-associated deaths due to suicide, homicide, or drug overdose. The revised processes developed during 2017 will continue to be implemented with an informal quality improvement lens applied; as IDPH continues to try new processes, small changes over time will be implemented and tested to ensure that the process is as smooth and effective as possible.

 

It is expected that OWHFS will publish its second Illinois Morbidity and Mortality Reports in FY21, with additional reports in subsequent years of the 5-year Action Plan (2021-2025). These reports will include findings from the state reviews, such as demographic disparities, leading causes of death, factors contributing to deaths, preventability, and committee recommendations. As was done in the past, IDPH will pursue multiple methods for disseminating the report and present the findings to relevant groups around the state and nation.

 

In FY20, OWHFS successfully applied for the CDC-RFA-DP19-1908 funding opportunity entitled Preventing Maternal Deaths: Supporting Maternal Mortality Review Committees. This is a five-year grant for the 2020-2024 cycle. During FY21, the IL Title V staff seeks to implement interventions to address maternal mortality that includes hosting a statewide maternal health summit, convening stakeholders, including community partners, to create a multi-pronged strategic plan to improve maternal health based on the recommendations from the MMRCs.

 

B. Partner with the statewide Severe Maternal Morbidity (SMM) Review sub-committee to develop recommendations for standardizing and improving hospital-level SMM case reviews across Illinois’ Regionalized Perinatal System.

 

The University of Illinois at Chicago’s Center for Research on Women and Gender (UIC-CRWG) will continue its existing intergovernmental agreement to assist with the Severe Maternal Morbidity quality improvement activities, such as monitoring the data completeness and quality of SMM review forms submitted to the state perinatal hospital database and providing technical assistance to administrative perinatal centers (APCs) and birthing hospitals on how to improve reviews. UIC-CRWG staff will also work with the data system developer to assure that data collection forms and indicators are clearly defined and to assure high quality data submission.

 

Additionally, the SMM Review Committee, which the UIC-CRWG helped establish help improve and standardize hospital-level reviews. It is expected that UIC-CRWG will continue to help facilitate the meetings, analyze decisions of the state-level committee, and take lead in helping the Committee create training materials, templates, and resource manuals, as needed, to improve the quality of the local reviews within hospitals and APCs.

 

C. Participate in and collaborate with the Illinois Maternal Health Task Force established through the I- PROMOTE-IL program (HRSA Maternal Health Innovation Grant) to develop a statewide IL Maternal Health Strategic Plan to translate and build on findings and implement recommendations from the Illinois MMRC, MMRC-V and SMM.

 

In FY19, The University of Illinois at Chicago (UIC) successfully applied for the HRSA Maternal Health Innovation Grant. The Innovations to ImPROve Maternal OuTcomEs in Illinois (I PROMOTE-IL) program will assist the State in collaborating with maternal health experts and optimizing resources to implement state-specific actions that address disparities in maternal health and improve maternal health outcomes. A key component of the I PROMOTE-IL grant is the Illinois Maternal Health Task Force. The Illinois Title V Director serves as co-Chair of the taskforce. This development is important because OWHFS/Title V is the primary lead for all maternal health activities in the state including Maternal Mortality and Severe Maternal Morbidity reviews. The participation and collaboration of the IL Title V ensures that the Task Force is fully integrated into the existing maternal health infrastructure in Illinois without duplication of efforts, as well as assist in the tracking of maternal health legislation at the state and federal level to inform additional policy solutions; and address identified gaps outside of Title V efforts.

 

During FY21, IL Title V will continue to participate in and collaborate with the I-PROMOTE-IL program and its Illinois Maternal Health Task Force, and the Title V Director will continue to serve as a co-chair for the Task Force.

 

D. Support and collaborate with the state-mandated Illinois Task Force on Infant and Maternal Mortality Among African Americans to assess the impact of overt and covert racism on pregnancy related outcomes, identify best practices and effective interventions, address social determinants of health, and develop an annual report with recommendations to improve outcomes for African American women and infants.

 

IDPH released its first Illinois Maternal Morbidity and Mortality Report in October 2018. Numerous state legislation influenced by the results of the report passed during the 2019 Legislative Session. This legislation includes the Task Force on Infant and Maternal Mortality Among African Americans (IL Public Act 101-0038). The task force, under the purview of the Illinois Dept. of Public Health (IDPH) is charged with establishing best practices to decrease infant and maternal mortality among African Americans in Illinois.

 

During FY21, IL Title V will support and collaborate with the Task Force on Infant and Maternal Mortality Among African Americans to review the impact of overt and covert racism on toxic stress and pregnancy related outcomes for African American women and infants in Illinois, and assist in the development of the annual report with recommendations of best practices and interventions to improve quality and safe maternal and infant care across Illinois.

 

E. Facilitate the collaborative effort between the Illinois Maternal Health Task Force and the Illinois Task Force on Infant and Maternal Mortality Among African Americans to align their strategies and activities towards improving maternal health in Illinois.

 

During FY21, IL Title V will facilitate collaboration between the Illinois Maternal Health Task Force and the Illinois Task Force on Infant and Maternal Mortality Among African Americans as they identify key activities that align with Title V priorities and improve quality and safe maternal and infant care across Illinois.

 

F. Participate in state inter-agency committee efforts to improve Medicaid coverage and care coordination for pregnant and postpartum women with the extension of coverage from 60 days to 12 months postpartum, allowing managed care reinstatement within 90 days, and waiving hospital presumptive eligibility.

 

The federal Centers for Medicare & Medicaid Services (CMS) is currently reviewing an Illinois Continuity of Care & Administrative Simplification 1115 waiver application. The 1115 waiver request includes extending Medicaid postpartum coverage from 60 days to 12 months, which was included in the state’s budget implementation bill and signed into law with a January 1, 2020 effective date.

 

During FY21, OWHFS and IL Title V will continue to participate on the state inter-agency committee as it develops implementation, monitoring and evaluation plans regarding the extended coverage, continuous eligibility, reinstatement and waiver of hospital presumptive eligibility (HPE).

 

G. Convene and partner with key stakeholders to identify gaps in mental health and substance abuse services for women that include difficulties encountered in balancing multiple roles, self-care and parenting after childbirth; and leverage expertise to develop recommendations for system level improvements for Title V consideration and implementation.

 

During FY21, IL Title V will continue to partner with UIC-CRWG to improve the mental health and well-being of pregnant and postpartum women, and their infants, throughout Illinois. Activities will continue to focus on expanding the capacity of perinatal health care providers in Illinois to screen, assess, refer, and treat pregnant and postpartum women for depression and related behavioral health disorders, and to increase awareness of, and access to, affordable and culturally-appropriate services to pregnant and postpartum women and their infants in Illinois. Currently, the project targets obstetricians, gynecologists, nurse midwives, pediatricians, psychiatric providers, mental health care providers, social workers, and primary care providers in geographical areas serving disadvantaged women, including Cook County/ Chicago and Peoria and surrounding communities in Peoria County (Providers). UIC-CRWG will continue to: (i) provide in-person workshop training and resources on screening, diagnosis, and referral for maternal depression and related behavioral disorders to Providers; (ii) provide real-time psychiatric consultation and care coordination for Providers; (iii) screen women for depression, anxiety, suicide risk, and substance use during the perinatal period using Computerized Adaptive Testing (CAT); (iv) increase access to depression prevention and treatment for medically underserved women using a telehealth intervention; (v) increase access to substance use treatment for pregnant women; and (vi) develop recommendations for disseminating and implementing the project components statewide. UIC-CRWG will also coordinate with the Health Care Alternative Systems program at the Illinois Department of Human Services, which runs a perinatal depression screening and referral program, in an effort to reduce duplication and/or fragmentation of services.

 

H. Assess, quantify and describe the impact of childcare on prenatal, intrapartum and postpartum care in Illinois, and develop optional strategies and approaches that can be implemented in clinic and hospital settings.

 

Although the Social Determinants of Health Collaborative, Improvement, and Innovation Network (CoIIN) will end in FY20, IL Title V will continue to assess the need for ‘emergency’ childcare in circumstances related to obtaining perinatal care (prenatal appointments, labor and delivery/hospitals) for women/parents and developing women/family-friendly childcare strategies for prenatal and perinatal providers.

 

I. Support the Illinois Perinatal Quality Collaborative (ILPQC) in implementation of as it seeks to implement obstetric and neonatal quality improvement projects initiatives in birthing hospitals.

 

During FY21, the regionalized perinatal program will continue to disseminate the toolkit and other related training materials to birthing hospitals throughout Illinois. Hospitals will be encouraged to provide annual training on obstetric hemorrhage to all hospital staff that interact with pregnant/postpartum women.

ILPQC will continue to support hospital implementation of Mothers and Newborns affected by Opioids (MNO) OB & Neonatal Sustainability. More specifically, ILPQC will provide support for hospital teams to implement strategies for culture change and improve patient care.

 

During FY21, IL Title will partner with ILPQC on two additional initiatives: (1) The OB Promoting Vaginal Birth (PVB) QI Initiative; and (2) the Neonatal Babies Antibiotic Stewardship Improvement Collaborative (BASIC) QI Initiative.

 

J. Support the Perinatal Depression Program that provides 24-hour telephone consultation for crisis intervention for women suffering from perinatal depression.

 

During FY21, IL Title V will continue to provide financial support and program monitoring to the Perinatal Depression Hotline, as it continues provide assistance to women and families across Illinois

 

Challenges and Emerging Issues

A development occurring in smaller urban or rural areas in other states, Illinois is beginning to experience a significant challenge in the closing of hospitals or the specific elimination of obstetrical services within hospitals. IDPH is in discussions with key partners to develop a study group to better understand the specific factors leading to the decisions to close these units and develop plans to prevent any further closures.