During FY22, the following programmatic strategies and activities have been identified as methods to advance and improve outcomes.

Doula Services: In order to advance the Doula Certification Program, VDH convened the Virginia Doula Task Force in FY21, with the ultimate goal to launch the program in FY22.  This task force, which meets quarterly, guides the Doula Certification and Medicaid Reimbursement.  The regulatory process for the certification of doulas is not finalized; however, it is anticipated to be finalized at the end of FY2021.  That would, in turn, provide DMAS the necessary information to complete the benefit for community doula providers.  Once completed by DMAS, the benefit would require CMS approval prior to full implementation.

Coordination and facilitation of bi-monthly MMRT Meeting:  Activities include case selection for each meeting, requesting records from health, social and community-based agencies that will be used in the review, review of those records, and determination of inclusion or exclusion in the review, as well as scanning the record for additional information that could be collected from other providers for use.  After each review team meeting, data from the review team meeting is entered into the MMRIA system by the Maternal Mortality Programs Manager and MMRT Research Associate.  The Program manager is also responsible for maintaining the recommendations from each review meeting, compiling and reviewing the recommendations quarterly for applicability and appropriateness based on the review topic and current data trends.

Maternal Health Collaborative (VDH, VNPC, VHHAF):  Through the use of cross-sector collaborations, Virginia Hospital and Health Care Association (VHHAF) aims to improve maternal health quality, care and access across the state of Virginia. As a principal convener of hospitals and healthcare systems statewide, VHHAF is uniquely positioned to support our state in building a collaborative-community based framework that minimizes rework, siloes and duplication, and optimizes financial resources to ultimately improve care for birthing people, and the overall community. The Collaborative’s aim, based on data, analytics and analysis, is for hospital systems to partner with community based organizations to improve health outcomes of Black maternal populations through the provision of mini grants. Each hospital system CBO goals and objectives will be unique to their own community. This is funded by a mix of general funds, Title V and Pew Charitable Trust Calling All Sectors Grant.

Virginia Neonatal Perinatal Collaborative (VNPC):  The vision of the VNPC is to ensure that every mother has the best possible perinatal care, and that every infant cared for in Virginia has the best possible start to life. The mission of the VNPC is to ensure an evidence-based, data-driven collaborative process that involves care providers for women, infants and families, as well as state and local leaders. The VNPC believes that working together now will create a stronger, healthier Virginia in the future, and is committed to including each of the 54 birth hospitals across the Commonwealth in the three initial quality improvement (QI) projects to focus on based on the Alliance for Innovation on Maternal Health (AIM) patient safety bundles:

• Reduce the use of inpatient intravenous antibiotics at hospital nurseries/NICU
• Decrease the rate of severe maternal morbidity attributable to obstetric hemorrhage
• Care coordination from delivery to the post-partum visit and then transition to annual women’s health, also known as the fourth trimester, where Virginia was one of three states to pilot this bundle which started in FY21.  In FY22, implementation and data collection will begin in hospitals that choose to participate. 

VNPC Sister Agency State Partners:  VNPC facilitates monthly meetings across state agencies, VDH, DMAS, DBHDS, OCME, VDSS), for common legislative initiatives, funding opportunities, agency updates and information sharing.

VNPC Strategic Planning: VNPC is utilizing The Spark Mill, a Richmond-based organization, to conduct strategic planning throughout FY20 to ensure unified goals and directives for the Collaborative.

Epidemiological surveillance:  Activities will include collection of comprehensive data using a MMRT data tool.  The tool will be developed by the Maternal Mortality Programs Manager and Maternal Mortality Research Associate using the Infant and Child Fatality and Domestic Violence tools available in the Division of Death Prevention as the model for the new tool.  The Research Associate will be responsible for collecting data using the tool and entering the data in the MMRT Surveillance Database.  The Research Associate will also work with the Programs Manager to identify data trends, conduct data analysis, and evaluate the tool and the data for quality assurance purposes.

In-depth data collection and analysis:  The addition of a MMRT Research Associate will allow for the expansion of the MMRT program to include a more in-depth data collection and analysis.  Current efforts of the MMRT only focus on the most current data available each year and/or the topic being reviewed.  Due to statutory regulations, data collection from 2015-2017 was halted so that the review team could focus on 2018 data and move forward with more current data.  Hiring an MMRT Research Associate will allow for a new tool to be developed so that the 2015-2017 data can be collected and allow for a more comprehensive database in future years.  Additionally, the addition of the MMRT Research Associate will give the Maternal Mortality Programs Manager more ability to focus efforts on data analysis, policy development, and data dissemination, as the Research Associate will be responsible for many of the current administrative tasks managed by the Programs Manager.

Stakeholder collaboration:  During FY22, VDH’s Reproductive Health Unit intends to continue its work supporting the Contraceptive Access Network and the Contraceptive Access Initiative.  The Contraceptive Access Initiative has grown tremendously since its inception – the program budget is now $4 million annually and all FDA-approved methods of contraception are covered.  Title V funds will continue to be used to support staff time administering the program, facilitating network meetings, and monitoring statewide data related to contraceptive utilization and access.  VDH aims to facilitate two contraceptive Access Network meetings during the upcoming fiscal year, and to enable the Contraceptive Access Initiative to support at least 7,000 contraceptive visits for eligible patients.

Pregnancy loss support:  VDH intends to launch a Pregnancy Loss Support program in FY22.  VDH plans to partner with community-based agencies to offer support services, including grief counseling, to families experiencing pregnancy loss.  VDH will released a Request for Proposals in the summer of 2020, with the goal of establishing 2-3 official partnerships with local agencies.  

Resource Mothers training: Title V funds will also continue to support professional development opportunities for Resource Mothers staff.  As new staff join the Resource Mothers Team, Growing Great Kids and AIM4TM trainings must be made available on a rolling basis.  VDH aims to offer at least one AIM4TM training in either the online or in-person format this year.

Strategy:  Maintain and expand existing MCH-focused dental education programs to improve oral health for individuals across the lifespan, to include advising on oral health integration in primary care settings, education for home visitors, school-aged oral health education, and emerging needs of adolescents.

New programming specifically aimed at advancing the oral health of adolescents began in FY20. Activities included updating the School-aged Oral Health Curriculum to include emerging topics for adolescents including vaping, and HPV exposure and vaccination and developing trainings and educational material related to these new topics of focus to highlight the importance of vape cessation and HPV prevention to combat oral cancer, as well as early detection of this disease in youth and young adults. Staff will continue this work and identify new partnerships to expand the reach of programming to include advising on oral health integration in primary care settings, education for home visitors, school-aged oral health education, and emerging needs of adolescents.  Staff will also continue to provide pertinent MCH related information to partners as a member of the Early Dental Home Workgroup and Project Immunize Virginia. The Early Dental Home Workgroup consists of partners from dentistry, early childhood education, and perinatal and pediatric health, as well as state agencies that offer social and health support services. The workgroup identifies promising practices and techniques to increase the number of young kids and pregnant women who access dental care. Project Immunize Virginia (PIV) is a team of energetic and innovative health professionals, business, and community members that believe every community in the Commonwealth can be free of vaccine-preventable disease by increasing immunizations across the lifespan. PIV achieves this by promoting partnerships and using effective strategies among its member organizations throughout the Commonwealth.

Strategy:  Sustain network of regional Oral Health Alliances to foster regional efforts and initiatives throughout the Commonwealth and distribute mini-grants for implementation of systems change and data-sharing initiatives to improve the oral health of all Virginians, with emphasis on pregnant women, and children and adolescents ages 1-17.

VDH will continue to partner with the VHC to foster regional efforts and initiatives throughout the Commonwealth.  Catalyst will work with the alliances to support development and implementation of regionally-identified projects, including projects from partners in far Southwest Virginia, through a micro-grant program; leverage Catalyst’s Clinical Advisory Board (CAB) and expert consultants to provide clinical guidance and education to the micro grantees;

assist micro grantees with developing an evaluation component for their projects; share regionally-specific data; enable information-sharing among state and local partners and regional alliance members to inform the plans and implementation of local and statewide activities; ensure alignment between regional and statewide initiatives, as applicable; and develop and disseminate communications to spur replication of promising practices, share data and 

surveillance information, and elevate issues related to oral health access and integration.

Strategy:  Convene statewide groups focused on targeted oral health issues and facilitate collaboration and work plan development, and provide leadership and oversight to guide initiatives

VDH will continue to partner with VHC to convene statewide groups to advance health equity, care coordination, and systems-change approaches that increase access to integrated, comprehensive care that includes oral health care for children under 17, pregnant women and their families.

VHC will convene a statewide workgroup focused on the future of oral health care delivery in Virginia following the COVID-19 pandemic and considering other environmental changes, trends in healthcare, and policy forecasts. The VHC will continue to engage a wide variety of partners to assemble participants including the Department of Medical Assistance Services, an MCO, maternal health providers, dental providers, and other community partners, while also leveraging the Catalyst’s Clinical Advisory Board (CAB) to provide expertise on the statewide future-focused workgroup. The VHC will also engage other clinical expertise, as needed, to offer additional technical assistance and guidance to the workgroup. HRSA Oral Health Workforce Grant funds will be leveraged to continue to implement a pilot program aimed at putting the workgroups ideas into action through a contract with a safety-net site to carry out future-focused projects including developing teledentistry capabilities to improve access to care.

VDH continues to partner with the VHC to convene a state-wide group focused on enhancing water equity in Virginia. The Water Equity Taskforce (WET) aims to enhance water equity across Virginia to ensure all residents have access to safe fluoridated tap water. In addition to DHP staff, WET engages a cross-sector of partners including representatives from the Office of Drinking Water, the Virginia Department of Forestry, the Virginia Department of Social Services, as well as rural and urban safety-net dental providers, professional dental and dental hygiene associations, and service organizations for health youth and low-income families. WET currently has two workgroups that were formed, one on access and affordability and the other on consumer literacy. A priority for the group is creation of a Virginia Water Equity Roadmap to serve as a framework for water equity information, priorities, and activities in Virginia. 

VHC will also continue convening the Early Dental Home (EDH) workgroup and collaborate with existing groups working on HPV to ensure oral health is integrated into their approach and goals. Additionally, the VHC will expand community engagement and provide trauma-informed care, oral health and systemic health, and health equity education to providers at the Virginia Oral Health Summit. Annually, the Summit reaches nearly 250 providers, public health stakeholders and caregivers, who attend to learn skills to improve the health and wellbeing of the individuals they serve. At this year’s Summit, Catalyst seeks to highlight the role of health equity and oral health in the COVID-19 pandemic, teledentistry (and telehealth more broadly), health policy at the state and federal level, and innovative community programs, so that attendees can work collectively to increase equitable access to quality health care, with a focus on oral health.

VHC will, for the second time, partner with a consulting team and Virginia Center for Inclusive Communities to provide twelve free racial equity trainings to partners across Virginia. These trainings will be virtual to allow partners from across Virginia to participate. The trainings will be offered in three bundles, and each bundle will be offered twice (six total bundles offered).

Task Force on Maternal Health Data and Quality Measures:  HB2111 requires the establishment of a Task Force on Maternal Health Data and Quality Measures for the purpose of evaluating maternal health data collection to guide policies in the Commonwealth to improve maternal care, quality, and outcomes for all birthing people in the Commonwealth. The provisions of the bill require the Task Force to monitor and evaluate relevant stakeholder data related to race, ethnicity, demographic and clinical outcomes to examine quality of care. The MCH Epidemiologist Lead will serve as a subject matter expert/member on this Task Force.