Pre/Interconception Health – Application Year

Every Women Connecticut (EWCT) and the Every Woman Connecticut Learning Collaborative (EWCTLC) will be working toward addressing and increasing awareness around health equity, social drivers of health and social justice. A major vehicle for this work is the Reproductive Justice Alliance (RJA). The RJA, which was convened in March 2021, aims to expand and unify reproductive justice efforts in the state with a vision to better ensure individuals receive respectful maternity care.

The RJA will use the research findings from the RJA’s FGDs held in April-July 2023 to shape the development and focus of the questions that will be asked in interviews conducted with health care providers (anyone who interacts with birthing people) at facilities that offer prenatal, labor and delivery, postpartum care to birthing people.  Analyses of the FGDs and provider interviews will inform future RJA activities and prioritize efforts in the areas including but not limited to public information, advocacy, training, policy, and maternal and related service delivery systems.

Every Woman Connecticut & The Every Woman Connecticut Learning Collaborative (EWCTLC)

Preconception health counseling has been identified and endorsed by the Centers for Disease Control and Prevention as a strategy to improve maternal health and birth outcomes, as well as to reduce unplanned pregnancies. Starting in May 2016 under the auspices of the MCH Coalition and the March of Dimes, who provided the financial support, Every Women Connecticut (EWCT) and the Every Women Connecticut Learning Collaborative (EWCTLC) were established. The main goal of this initiative is to increase provider expertise and self-efficacy in implementing routine pregnancy intention screening and appropriate care, education, and services to ultimately improve birth spacing, increase pregnancy intentionality, as well as increase the proportion of Connecticut women who deliver a live birth and report discussing pre-/interconception health with a healthcare worker. 

EWCTLC is the major vehicle to increase provider expertise and self-efficacy in implementing routine pregnancy intention screening and appropriate care, education, and services to ultimately improve birth spacing, increase pregnancy intentionality, as well as increase proportion of Connecticut women who deliver a live birth and report discussing pre-/interconception health with a healthcare worker and to support implementers of OKQ. 

EWCT is exploring a partnership with Upstream to sponsor a One Key Question training that focuses on the organizational implementation of the screening tool. Upstream is a nationally recognized organization working in partnership with healthcare systems to strengthen reproductive care autonomy by increasing equitable access to the full range of contraceptive options.

EWCT is also working CCADV and the CT Hospital Association in the development of an IPV AIM bundle, which is a Community Care Initiative (CCCI) that focuses on the connections between hospitals and communities. EWCT’s role would focus on ensuring community involvement.

Currently there are over 350 EWCTLC members consisting of OKQ implementers and/or those who have attended an EWCT sponsored training.  EWCTLC members will receive at least quarterly Notes of Interest via e-mail. Opportunities for local networking and one-on-one meetings will also continue to be offered virtually.

EWCT will continue supporting other organizations and entities that share mutually supportive goals.  The specific groups are: 

The Medicaid Strategy Group (MSG)

MSG is a coalition of health advocates working together to improve and protect the quality and reach of HUSKY/Medicaid programs in Connecticut through administrative and legislative advocacy. 

Health Equity Solutions (HES)

HES was the lead advocate for passage of key doula legislation in the 2021 and 2022 legislative sessions: H.B. 5500, An Act Concerning the Department of Public Health's Recommendations included specific language which establishes a doula advisory committee at the Department of Public Health. A doula advisory committee will allow the profession to have autonomy in what, how, and why in building core standards to certify a doula. The Doula Advisory Committee will offer and ensure no doula be barred from this process. EWCT, in partnership with HES and other partners, will do administrative advocacy for the implementation of this legislation in the spirit it is intended. 

The CT Help Me Grow Advisory Committee 

The goal of this advisory group is to build, in partnership with families, a coordinated early childhood system that supports developmental screening, early identification and linkages to services and supports. The Advisory Committee consists of well-known and respected representatives within the early childhood field. It operates under the auspices of the Office of Early Childhood and 2-1-1 Child Development, a specialized call center of the CT United Way’s 2-1-1 system. The membership is diverse and includes both state level and community-based entities.

Postpartum Support International, CT

The PSI CT chapter provides direct peer support to families, trains professionals, and provides a bridge to connect them. PSI Volunteer Coordinators provide support, encouragement, and local resources on the phone and email to pregnant and postpartum moms, dads, and families. 

Connecticut Coalition Against Domestic Violence (CCADV)

CCADV has invited EWCT to introduce OKQ at staff meetings of residential staff and child and family advocates. If this introduction of OKQ leads to programs implementing this screening tool, EWCT will offer ongoing training and support to support successful implementation. These programs will also be part of the EWCTLC allowing additional support from other OKQ implementers. 

Participation in these groups expands partnership potential as it increases EWCT’s platform for addressing pre/interconception health care, health equity and racism from a comprehensive and holistic perspective. 

Consulting services will be provided by Marijane Carey of Carey Consulting and Alison Tyliszczak, MCH Consultant. Dependent on available funding, Marijane Carey and Alison Tyliszczak will manage the Advisory Committee, expand partnerships, respond to evaluation recommendations and engage members of EWCTLC in order to increase provider knowledge and self-efficacy in delivering, promising and evidence-based education, care, and services related to pregnancy intentionality, optimal birth spacing, and pre-/interconception health.

Reproductive Health Services

Reproductive health services are funded with State and Title V funds through a five-year contract with Planned Parenthood of Southern New England (PPSNE). The program provides services in those areas of Connecticut with high concentration of low-income women of "reproductive age," and with high rates of teen pregnancy. CT’s Medicaid program offers expanded reproductive health services, which affords presumptive Medicaid eligibility for those uninsured and under 250% of the FPL to receive reproductive health and STD services at no cost. Sliding-fee scale services are also offered and pregnancy testing, counseling visits, referrals for prenatal care, contraceptive service visits, breast and cervical cancer screenings, STD and HIV screenings and counseling, and other medical services visits are also provided as appropriate. The plan for this year is to continue to offer women the Expanded Medicaid Family Planning Limited Benefit and if they qualify, with presumptive eligibility if they are eligible. PPSNE also plans to work closely with Federally Qualified Health Centers (FQHCs) in implementing the Association of State and Territorial Health Officials (ASTHO’s) Learning Community goal of Increasing Access to Contraception for Medicaid clients. The reproductive health care services provided by PPSNE are in accordance with nationally recognized standards of care. Chlamydia and gonorrhea testing will be encouraged as a standard procedure for all patients between the ages of 15-25.

Planned Parenthood will continue to assure that all clients who receive a reproductive health exam participate in the development of a Reproductive Life Plan. The discussions are conducted by a licensed healthcare provider and the client.  The Program will also seek to decrease the prevalence of unintended pregnancies through health education.

Maternal Health Innovation Grant

Through the Maternal Health Innovation Grant funded by the Health Resources & Services Administration, Connecticut has been tasked with forming a state-led Maternal Health Task Force (Task Force) to engage multidisciplinary leaders, subject matter experts, and people with lived experience in developing statewide strategies to reduce maternal morbidity and mortality and address maternal health disparities. These strategies include quality services, a skilled workforce, enhanced data quality and capacity, and innovative programming.

The MHI team is receiving technical assistance from Race4Equity through University of North Carolina for establishing the Task Force and to assist with meeting facilitation. The team will be inviting Task Force members to meet several times to identify strategies to reduce maternal morbidity and mortality. These strategies will be drafted into a MHI strategic plan due in September 2024. The plan will serve as a living document until the final strategic plan due date of September 2025. Additionally, the MHI team is working on executing the contract for the Connecticut Women’s Consortium which will allow a MCH Consultant to lead the work of the Task Force.  The team will continue to work with the Connecticut Hospital Association Alliance for Innovation (AIM) Team to discuss contract deliverables involving surveillance activities with their member acute care hospitals.  Our Epi Staff continue to work on analyses around equity in maternal health, including severe maternal morbidity and mortality. Results from the analyses will be used to drive the MHI work.

Personal Responsibility Education Program

The Personal Responsibility Education Program (PREP) delivers evidence-based and evidence-informed prevention programs to high-risk youth ages 13 to 19 by trained facilitators.

For fiscal year 2024, PREP plans to expand services in current target areas and additional areas of high need, indicated by high teen pregnancy rates and STI rates above the state and national average. The program will continue to expand in target areas along with college freshman at the 4 State Colleges in Connecticut.  These colleges are Western, Eastern, Central and Southern State Universities. The Program is currently going through the RFP process and will recruit contractors. PREP administrators will continue to work with community partners to recruit additional school and community organizations to implement programming. 

PREP staff are also revamping training procedures to add in annual refresher trainings to ensure fidelity of program materials, as well as collaboration between facilitators to assist with facilitator retention within the school systems. Staff will also be revamping the DPH webpage with current information and informational resources for the public.

Pregnancy Risk Assessment and Monitoring System (PRAMS)

PRAMS data is used by DPH and other statewide partners by providing them with data to inform their work in addressing the strategies outlined in this section. PRAMS provides statewide data on a variety of topics that are not available from any other data source, including preconception health and education, pregnancy intention, contraception methods, perinatal depression, oral health, social support, postpartum maternal and infant care, discrimination, and father involvement. Since receiving our first weighted data set in late October 2015, 136 data requests from internal and external partners have been fulfilled; numerous publications and other products have been produced; and PRAMS staff have collaborated on various efforts to address state MCH priorities, as well as statewide plans, needs assessments, and initiatives to reduce low birth weight, infant mortality, and health disparities.

Currently, ten years of data (2013-2022) are available for analysis, including data from the 2019 opioid supplement, a COVID-19 supplement that was implemented between October 2020-June 2021, and our CT-developed supplement for cannabis surveillance. The cannabis supplement was created in response to 2021 State legislation legalizing adult use of cannabis products. The legislation includes the DPH’s role in surveillance, and PRAMS was one of three key data sources identified by the contractor for cannabis surveillance. The 2022 supplement data will be used for reporting to the legislature and other statewide partners. The new PRAMS Phase 9 survey implemented with the 2023 surveillance year will allow us to collect one question about cannabis use before, during, and after pregnancy for long-term surveillance.

Later this year, 2023 data from our new Phase 9 survey will become available. Some of the new content will allow DPH to measure several SDOH and expand the ability to measure and address disparities and equity in CT. Some of the new questions include content around a) discrimination while getting health care during pregnancy, at delivery, or at postpartum care based on 13 different dimensions (e.g., including race, ethnicity, or skin color; disability status; immigration status; age; weight; sex or gender; sexual orientation; religion). This question is similar to an existing question on our Phase 8 survey that we had planned to expand to include more dimensions; b) being treated unfairly due to race, ethnicity, or skin color in any of the following situations: job, housing, police, courts, school (self/child’s), getting medical care; c) different types of disabilities before pregnancy; d) other SDOHs (transportation to medical appts, work, errands; not enough food); e) addition of same-sex couple options to certain questions (e.g., why not taking birth control); and f) management of high blood pressure during pregnancy and receipt of information (and how) of “warning signs” to watch out for during and after pregnancy that require immediate medical attention (e.g., fever, frequent or severe headaches, or severe stomach pain).

The CT Reproductive Justice Alliance (RJA)

In the upcoming year, the RJA will use the findings from the focus group discussions (FGDs) to help inform future programs, practices and policies to improve the health and wellbeing of people who are pregnant or parenting in CT, with particular focus on individuals who are Black and/or Hispanic or Latina. Examples of future activities include, but are not limited to, developing a Know Your Rights campaign to increase public awareness about one’s rights during pregnancy and childbirth; establishing a process to improve accountability in the provision of health care; and educating health care providers on respectful maternity care.

The RJA will also continue working towards conducting in-depth interviews with staff working in maternity care settings. Results from the FGDs will inform question development. Ultimately, results from both the FGDs and in-depth interviews will be combined and shared with the Alliance and partners to better understand CT mothers’ experiences with disrespectful maternity care, identify issues with the delivery of care that might impact mother experiences and/or quality of care, and to help inform strategies and activities to improve respectful maternity care in CT.

Breast and Cervical Cancer

The CT Breast and Cervical Cancer Early Detection Program (CBCCEDP) is funded through the Centers for Disease Control & Prevention (CDC) and state of CT funds. The program provides comprehensive screening to Connecticut women ages 21 to 64 that are medically underserved, uninsured, and low income, all factors that are barriers to healthcare access. The primary objective of the program is to increase the number of women screened for breast and cervical cancer and referred for diagnostic testing and treatment. For the program year of 2023-2024, the WISEWOMAN Program (WWP) received CDC funding to provide cardiovascular screening services to women receiving breast and cervical cancer services. The WWP serves the same target population as CBCCEDP, specifically women between the ages of 35-64; Wellness checks are provided in the form of Body Mass Index (BMI), waist circumference, blood pressure monitoring, along with Cholesterol and Blood glucose monitoring for participants. Those found with at risk values in need of improvement can be supported by Health Coaching and specific Lifestyle Programs to better assist the participant in reaching their health and wellness goals. The Colorectal Cancer Program (CRC) received CDC funding to provide colorectal cancer screening, diagnostic, and treatment referral services for persons who qualify over the age of 45. Together the CBCCEDP, WWP, and CRC programs create the Connecticut Early Detection & Prevention Program (CEDPP), providing a whole-body approach to improving the health of CT Women. During this program period, CEDPP continued to provide services at 6 health care systems, consisting of 21 hospitals to reach more CT women. These hospitals sub-contracted with 15 FQHCs, 14 clinics and 15 Planned Parenthood clinics. CEDPP contracted health systems partnered with several organizations to provide Community Wellness Day events for women and families where services were provided where they live and work, and appointments were given for further follow-up visits. CEDPP collaborated with area CT Walmart Stores, CT Cosmetologists Association, and CT Physicians for Women to conduct outreach and more than 50 wellness days across the state, reaching over 1500 women.  CEDPP Wellness days provides, at a minimum, patient education, health assessment, clinical screening and clinical referral. CEDPP continued to collaborate with Knox Garden, Snap-Ed program, Sardili’s Produce, Joan Dauber Food Bank, and Women’s Empowerment Center to provide community garden opportunities to program participants and improve food security, healthy nutrition, and physical activities to reduce the risk of cancer and heart diseases to participants in the Hartford Community.

Oral Health

The Office of Oral Health (OOH) and its partners will continue to implement the State Oral Health Improvement Plan 2019 - 2024 (SOHIP). Focusing on prevention, access/utilization, medical and dental integration, and data collection and analyses.  The OOH is dedicated to ensuring access to oral health services for all residents regardless of race ethnicity, education, or class background. The SOHIP aims to decrease oral health disparities; promote a culturally competent oral health workforce, continue and increase community engagement of partners to establish practices; and improve the oral health literacy of CT residents.

The OOH program activities will continue to address oral health workforce gaps in dental health professional shortage areas (DHPSAs) and other underserved areas in CT and coordinate a continuum of oral health care for CT residents, with an emphasis on underserved populations. The OOH will continue implementation of the mobile medical dental integration project (MMDI) by providing contract management, technical assistance, data collection and analysis and rapid cycle quality improvement for Generations Family Health Center, Inc, the vendor selected to provide services through their newly launched Mobile Health Unit. The launch of the MHU aims to increase access and reduce barriers to oral health services and COVID-19 vaccination and testing in DHPSAs.

The OOH has selected a vendor to develop and execute a statewide media campaign to promote the safety and importance of preventive dental care and COVID-19 vaccination and a social media campaign to promote the utilization of MHUs in targeted DHPSAs. The social media campaign will also highlight the connection between oral health and overall health. The OOH will continue to provide support to the vendor in the design and dissemination strategies of the campaigns and support the launch of the campaigns by obtaining necessary agency approvals. The OOH will disseminate the Dentist and Dental Hygienist needs assessments to all registered Dentists and Hygienists in Connecticut to better understand how COVID-19 has impacted the dental workforce across the state. The surveys will also collect information on the support and training needs of the dental workforce. The OOH Epidemiologist will analyze the results of the surveys and the OOH will prepare a summary report which will be shared with key stakeholders and decision makers.

Community based prevention efforts continue with community water fluoridation and dental sealant programs. Action steps over the next year will include activities around increasing inter-professional collaboration across disciplines, including dental and primary medical care to develop best practices to improve service coordination and delivery.

The OOH and CT DPH Drinking Water Section (DWS) will continue to support certified water operators and public water systems to comply with the CT water fluoridation statute. Activities will include a water fluoridation principles and practice training, maintaining optimally fluoridated water levels in public water systems, and continuing to submit data to CDC WFRS on a timely basis.

The OOH will continue to implement the SEAL CT! Program in partnership with Hartford Public Schools and New Haven Public Schools which aims to increase access and utilization to preventative dental services for children in schools where 50% or more of the student population is eligible for the Free and Reduced Meals Program. The OOH will continue to facilitate the CT Dental Sealant Advisory. The OOH will also continue to implement the Medical Dental Integration Project (MDIP) in partnership with Community Health Center Inc. The MDIP Project focuses on screening for pre-diabetes in the dental setting and referring to medical services for confirmatory blood tests, nutrition counseling and enrollment in a Lifestyle Change Program for eligible individuals. The OOH will also continue to facilitate the Medical Dental Integration Advisory.

The OOH continues to promote and share bi-lingual oral health educational information, resources, social media postings, and public services announcements for the general public and MCH population. This is conducted via DPH’s social media, the OOH webpages, and through community partners.

Maternal Mortality Review Program (MMR)

In project period 2024, the DPH MMR will continue to support the Maternal Mortality Review Committee (MMCR) and perform case reviews to determine pregnancy-associated vs. pregnancy-related deaths of birthing persons through 365-days postpartum. The committee is a multidisciplinary team that is about 60% clinical and 40% non-clinical. The MMRC will finish the 2022 cases for review and begin the 2023 cases. The committee will provide a report to the commissioner no later than 90-days after the review. In the 2024 project period, the MMRC committee will use Maternal Mortality Review Information Application (MMRIA) data to make feasible recommendations for implementation.