III.E.2.b.v.c. State Action Plan Narrative by Domain

Women’s Health Domain Application Year for 10/01/2024-09/30/2025

 

Our maternal and women's health application focuses on reducing health disparities in birth outcomes and giving families the tools and time they need to parent their children, regardless of what they may have experienced during their life course. Washington’s Maternal Mortality Review findings have informed this work, especially in our last report, which found that one of the leading underlying causes of death among pregnancy-related deaths were behavioral health conditions, including suicide and overdose.  

A key activity to address this finding has been implementing hospital wide quality improvement protocols called ‘bundles’ through the Washington State Perinatal Collaborative. We have leveraged a strong relationship with the Washington State Hospital Association, Health Care Authority and other state agencies, perinatal regional coordinators embedded in four hospital systems, child protective services systems, researchers, and other changemakers to impact policy systems, delivery of care, payment of care to become a more trauma informed and patient centered system.

 

We are also working with community-based organizations on culturally appropriate and community-based care, and access to a more diverse range of birth workers. Through smaller, short terms grants we are supporting local organizations on projects to address perinatal mood and anxiety disorders. And through longer term grants, supporting the expansion of doula care, lactation specialists, and group prenatal care.

 

Priority Number 1

Promote mental wellness and resilience through increased access to behavioral health and other support services.

 

State Performance Measure

SPM 1: Substance use during pregnancy

 

SPM 2: Provider screening of pregnant women for depression

 

Strategies

• Build on efforts to identify scope of impacts of substance use, including inequities, at the local and state levels.

 

• Provide training for clinical staff providing care at birthing hospitals.

 

• Improve the care of infants with neonatal abstinence syndrome (NAS) and neonatal opioid withdrawal syndrome (NOWS).

 

• Support efforts to address and mitigate individual and community effects of substance use.

 

Objective 1

By September 30th, 2024, and in partnership with the Child Welfare Division at the Department of Children, Youth, and Families, Within Reach and the Washington State Hospital Association, implement the state’s new portal and policy for infants who are born substance exposed, including promotion of supports for the substance-affected mother/infant dyad.

 

This objective has been met.

 

Objective 2

Through September 2025, ensure 80 percent of birthing hospitals in Washington state have established processes to universally screen everyone giving birth for substance use disorders and perinatal mood and anxiety disorders as part of the Alliance for Innovation on Maternal Health (AIM) patient safety maternal mental health protocols.

 

Relevant Activities and Projects

Maternal morbidity and mortality rates have been increasing in the United States for the past 40 years, with marked disparities in the rates for women of color, women from low-income backgrounds, and women from rural areas. It is estimated that for every maternal death, 50 or more women are affected nationally by severe maternal morbidities each year. The CDC estimates that one in 8 women experience a depressive episode after pregnancy. Untreated maternal depression or other more extreme mood disorders can lead to significant morbidity and, in extreme situations, maternal suicide and infanticide.

 

In Washington state, all maternal deaths are reviewed by a panel of clinical and nonclinical perinatal experts and assessed for cause of death and underlying contributing factors. The panel found that in review of maternal deaths from 2014-2020, at least 80% of pregnancy-related deaths were preventable. The leading causes of pregnancy-related deaths were associated with behavioral health conditions, including suicide and accidental overdose. According to our Pregnancy Risk Assessment Monitoring System (PRAMS) data, in 2018, 11% of women interviewed expressed experiencing postpartum depression symptoms.

 

In October 2022, DOH was awarded a federal grant to enhance our Perinatal Quality Collaborative and our ability to implement perinatal quality improvement initiatives. Through this grant, the PQC will support AIM initiatives and other projects related to perinatal substance use.

 

Through the PQC, DOH and WSHA collaborate on AIM implementation efforts. In 2021, DOH and WSHA created the Perinatal Substance Use Disorder Learning Collaborative. This collaborative worked with 13 hospitals to pilot test the Obstetric Care for Women with Opioid Use Disorder patient safety bundle. In 2022, this bundle was expanded to include training and support for all substances, not just opioids.

 

The Perinatal Substance Use Disorder Learning Collaborative offers monthly educational webinars and peer-coaching calls to support hospitals in their effort in becoming a certified Center of Excellence for Perinatal Substance Use (COE).  This certificate awards and recognizes hospitals that follow best practices when caring for people and infants impacted by substance use. These criteria include verbally screening every person giving birth for substance use disorders and perinatal mood and anxiety disorders and implementing hospital policies and support for pregnant and parenting individuals who screen positive for a substance use disorder.

 

In July of 2024 the first three birthing hospitals received the first Center of Excellence for Perinatal Substance Use certification. The University of Washington Medical Center – Northwest, Providence Sacred Heart Medical Center of Spokane, and Providence Holy Family Hospital are the first birthing hospitals to receive this award. These three hospitals have met the eight criteria for addressing maternal behavioral health care and treatment. This includes screening all people giving birth for substance use disorder and perinatal mood and anxiety disorders, as well as providing resources for treatment and follow up care when needed.

 

During this year, the WSPC will implement a nurse-led consultation group for hospitals that are working towards becoming a Center of Excellence for Perinatal Substance Use. This will support additional hospitals successfully implement the criteria for certification. This initiative consists of three main tasks:

• Recruit member hospitals: The nurse consultant will support recruiting hospitals for this consultation group. We will identify and contact potential hospitals that serve communities disproportionately impacted by substance use, and who previously participated in the SUD Learning Collaborative.

 

• Establish and lead consultation group: The consultant will set up regular technical assistance (TA) sessions and tailored, individual TA sessions as needed for the member hospitals. We will create goals and focus of achievement for each hospital participant, based on their baseline assessment, needs, and readiness. We will also create a goal with each hospital about their plan to meet the criteria and apply to become a COE.

 

• The consultant will help determine the areas of perceived strength and obstacles to meeting COE criteria, such as staff engagement, organizational culture, or resource availability. They will also provide hospitals with any additional, or as needed, support, materials, and resources related to this work, such as educational webinars, toolkits, best practices, or peer learning opportunities.

 

• Project evaluation: The consultant will review the achievement of goals with each hospital, using data and feedback from the hospitals, the project team, and the WPSC. We will review the potential impact of the implementation methods, such as the changes in processes, outcomes, and satisfaction for the patients and the providers. The consultant will write a report on the project learnings, such as the successes, challenges, and lessons learned from the consultation group.

 

• They will also provide recommendations for future improvement and sustainability,   such as the areas for continued support, collaboration, or innovation

 

Objectives 3 and 4

Through September 30, 2025, building from the completion of the revised maternal mortality review panel report to the Washington State Legislature, DOH staff will share the findings widely with partners and community members around the state and participate in conversations about ways to involve community members in implementing recommendations. DOH will also include applying lessons learned from the AIHC listening sessions in our work to implement the report’s recommendations.  

 

By September 2025, we will continue to review cases of maternal mortality in Washington by facilitating meetings with the Maternal Mortality Review Panel. We will provide training opportunities for the panel on health equity and align our work with the CDC.

 

Relevant Activities and Projects

In 2016, the Washington State Legislature (RCW 70.54.450) mandated DOH to convene a multidisciplinary review panel to conduct comprehensive reviews of deaths that occur within a year of pregnancy, regardless of cause. The goal of the maternal mortality review panel (MMRP/Panel) is to understand the root cause of maternal mortality and morbidity and the inequities therein, so DOH and partners can identify and implement strategies and activities to prevent these tragic deaths and improve perinatal care for all people and families in the state. The MMRP comprises of clinical and non-clinical professionals from across Washington and from diverse racial/ethnic, geographic, and professional backgrounds. Members include perinatal psychiatrists, addiction medicine providers, perinatal social workers, community organizations, patients, and patient advocates.

 

To meet these goals, the department and MMRP work to identify all deaths that occur within a year of pregnancy, determine which of those deaths are preventable pregnancy-related deaths, determine underlying causes of preventable deaths, identify the issues and factors that contributed to them, and make recommendations to prevent such deaths in the future. The panel and the department use analyses of data and findings to prioritize evidence-based recommendations for health care and systems changes. The department submits those findings and recommendations to policymakers for consideration in a legislative report every 3 years.

 

To date, the Panel has reviewed maternal deaths from 2014-2020. This includes deaths from substance overdose, suicide, and domestic violence. The most recent report, published in February 2023, included findings from deaths through 2020. This report’s findings included:

 

From 2014–2020, 224 people died within one year of pregnancy. Of these deaths, 97 were determined to be pregnancy related. The Panel determined 80% of pregnancy-related deaths were preventable—a high percentage that reflects the Panel’s growing understanding of clinical, social, and systems factors that can be changed to help prevent pregnancy-related deaths.

 

There were 15.9 pregnancy-related deaths per 100,000 live births from 2014–2020 in Washington, lower than the U.S. rate of 18.6 pregnancy-related deaths per 100,000 live births in this timeframe. Leading underlying causes of pregnancy-related deaths were behavioral health conditions (32%), predominantly by suicide and overdose. Other common causes included hemorrhage (12%) and infection (9%).

 

Most pregnancy-related deaths occurred after the end of pregnancy:

• 27% occurred during pregnancy
• 11% occurred during delivery
• 31% occurred 2–42 days after pregnancy
• 31% occurred 43 days to one year after pregnancy

 

Disparities persisted, with communities of color, rural communities, and people with Medicaid coverage bearing a disproportionate burden of maternal mortality. The Panel identified discrimination, bias, and interpersonal or structural racism in 49% of preventable pregnancy-related deaths from 2017–2020. The rate of all pregnancy-associated deaths for non-Hispanic Black/African American people and non-Hispanic Native Hawaiian and Pacific Islander people was more than 2.5 times the rate of death among non-Hispanic White people. Among non-Hispanic American Indian and Alaska Native people, it was 8.5 times greater than the rate of death among non-Hispanic white people.

 

Factors identified by the MMRP to have contributed to preventable deaths from behavioral health conditions included:

 

• Gaps in clinical skills and quality of care contributed to the high percentage of preventable maternal deaths, including gaps in recognizing and responding to obstetric emergencies.

 

• Lack of screening or appropriate follow-up for risk factors such as behavioral health conditions, violence, and insufficient social support.

 

• Lack of care coordination or continuity of care.

 

• Lack of access to health care and behavioral health treatment.

 

• Issues of bias and discrimination affecting referrals and use of clinical standard procedures.

 

• Contributing factors were exacerbated by social and structural determinants of health, such as housing instability and systemic racism.

 

In the upcoming year, DOH will continue to disseminate findings from the 2023 report. There continues to be interest among the public and partners in the report findings. There is particular interest in the increased percentage of pregnancy-related deaths considered to be preventable, particularly in how this reflects an improved understanding of preventability and the opportunity to take action. DOH staff will participate in local, statewide, and national events to share findings from the report and about Washington’s maternal mortality review process.

 

Additionally, more work is needed to continually improve our understanding of how to create a systemic change that addresses the root causes of disparities, including racism, and to eliminate those disparities. It is essential to conduct comprehensive maternal mortality reviews of these types of deaths to continue supporting our implementation of recommendations and determine where interventions are needed most.

 

In the upcoming year, DOH will also be working on completing the next report to the legislature, due Fall of 2025. This report will include findings from 2021 and 2022 deaths. Completing this report will include:

• Convening the MMRP to review 2022 death cohort.
• Conducting qualitative and quantitative analysis on the 2021 and 2022 death cohort.
• Collaborating with implementing partners around the state on recommendations in the report.
• Collaborating with DOH policy and communications team on the content on the report.

 

In developing the new report, the MMRP will continue to center health equity in the maternal mortality review process and work. Some of the strategies we will implement over the next year include:

• Support the 2023–2025 MMRP cohort, which has increased health equity expertise, lived experience, and other expertise areas and affiliations. MMRP will be invited to attend the CDC Maternal Mortality Annual meeting, as well as other training opportunities.
• Provide monthly health equity related learning and other educational opportunities for the MMRP.

 

• Work with the CDC to align practices of identifying discrimination, racism, bias, and stigma in the deaths we review to make recommendations for change using data from the maternal mortality review work. This includes participating in monthly workgroups/meetings and collaborating with other states on successful strategies and practices that meet these goals.

 

• Work with the health equity and social justice experts on the MMRP to help us better identify evidence in the information we review and present it to the MMRP so they can make informed decisions.

 

• Continue to learn from and share information with other states’ maternal mortality review processes to improve our focus on health equity.

 

• Consult with agency health equity experts to implement and evaluate a health equity training/learning plan for all MMRP.

 

Prior to this period of performance, DOH will have contracted with a second state of listening sessions with the American Indian Health Commission (AIHC). Following these two rounds of listening sessions, DOH plans to collaborate with AIHC and other tribal partners on implementing recommendations or findings from the listening sessions.

 

Implementing MMRP recommendations: In 2023, DOH was awarded the HRSA Maternal Health Innovations (MHI) Grant to support strategic planning efforts and implementing recommendations from the Maternal Mortality Review report. Planned activities to implement recommendations from the MMRP report, in alignment with the MHI grant include:

 

Smooth Transitions: The Washington State Perinatal Collaborative supports the Smooth Transitions program through funding from the CDC. Smooth Transitions, a program of the Foundation for Health Care Quality, enhances the safety of hospital transfers and will bring together community midwives, hospital providers and staff, and EMS personnel to build a collaborative model of care. Smooth Transitions will launch protected case reviews related to transfers, pilot an EMS learning module simulation training, and develop resources for midwives, birth centers, and hospitals through our support.

 

Substance Use Disorder and Lactation Guidelines: DOH finalized Substance Use Disorder (SUD) Lactation Guidelines in May 2023. We will be collaborating with a tribal entity to develop tribal specific Substance Use Disorder and Lactation Guidelines.

 

Blue Band Initiative: DOH will evaluate and scale the Blue Band project, which addresses pre-eclampsia and postpartum post hypertension. Through the Washington State Perinatal Collaborative, DOH will build a resource website and assist hospitals in the implementation of the blue band project. In 2023, hospitals were provided funds to launch the program which we will evaluate during this upcoming year.

 

Rural Obstetric Provider Workgroup and provider simulation drills: DOH will convene a rural provider workgroup open to obstetricians and family practice providers. This group will work on strategies to address maternity care deserts in Washington and provide guidance to state agencies. DOH will also be contracting with WSHA to offer simulation training and drills with rural and critical access hospital obstetric and emergency services staff.

 

Hemorrhage Best Practices and Support: DOH will work with birthing hospitals and birthing centers to promote hospital specific best practices in preventing maternal hemorrhage including staff education, hemorrhage carts, and supplies to treat maternal hemorrhage. Support will be provided for facilities to maintain a hemorrhage cart and maintain obstetric or midwife hemorrhage emergency management plan.

 

TeamBirth: From 2023 through 2026, WSHA will implement TeamBirth throughout Washington’s birthing hospitals. According to WSHA, “TeamBirth aims to target poor maternal and newborn outcomes that occur as a result of those failures by providing a framework for shared decision making and amplifying the birthing person’s voice.” Over the next 3 years, Washington state birthing hospitals will participate in 1 of 4 cohorts. Each cohort will receive personalized training, support, and materials for implementation in their facility.

 

Priority Number 2

Optimize the health and well-being of adolescent girls and adult women, using holistic approaches that empower self-advocacy and engagement with health systems.

 

Performance Measures

National Performance Measure: NPM 1: Percent of women, ages 18 through 44, with a preventive medical visit in the past year.

 

In 2022, 69.1% of women received a preventative medical visit in the past year. This was sligthly higher than the target of 67.8%.

 

ESM ESM 1.1: Percent of women reporting in PRAMS that they had a preventive medical visit in the prior year.

 

In 2022, 67.2% of women surveyed in PRAMS reported they had a preventive medical visit in the prior year. This was just below the annual objective of 67.9% for this measure.

 

Percent of women who attended a postpartum checkup within 12 weeks of giving birth.

 

Strategies

• Support women during the “fourth trimester”; enhance postpartum care to allow providers to check in with mothers about their mental health and other medical issues.

 

• Promote standardized depression, anxiety, and substance use screening across the life course.

 

• Address the need for more services, support, providers, and insurance coverage, particularly in rural communities and remote areas.

 

• Support healthy pregnancies, births, and maternal recovery; address inequities and prevent maternal mortality and morbidity.

 

Objective 1 and 2

Through September 2025, collaborate with community birth experts from the doula, home visiting, nursing, and community health worker workforce, to identify a process for birth equity priorities and funds distribution and program development in line with anti-racist values.  

 

By September 2025 prepare an intervention design that will enable the full implementation of the universal PPV NPM in the next fiscal year to include identifying the scope of the intervention, responsible staff, and data sources that could be utilized to track the success of the intervention in coming years.

 

Relevant Activities and Projects

To address disparities in birth outcome among communities of color, particularly the Black/African American, and American Indian/Alaska Native community, DOH has committed to funding projects that directly support community birth worker projects serving those communities.

 

DOH conducted a series of listening sessions and worked closely with a community advisory board to identify investment areas. The listening sessions highlighted the systemic racism that birth workers and birthing families experience in Washington’s Western medical establishments. Themes from these listening sessions included:

• Racism creates barriers to care and prevents the delivery of culturally appropriate care.
• Racism negatively affects the physical, emotional, and spiritual health of birth workers and the families they serve.
• Our systems have undermined the credentials of birth workers and failed to recognize lived experience as an asset.
• There is a deep need for allyship, mentorship, and co-conspirators within the birth worker community.

 

Our community advisory board further defined birth equity as:

• Birthing people are healthy and can have a birth the way they want it.

 

• Birthing people are treated as experts in their own care, and their concerns are taken seriously.

 

• Birthing people have access to resources without fear of discrimination, violence, or deportation.

 

• Birthing people have access to care that incorporates both Western medicine and traditional practices.

 

• Birthing people have access to doulas and midwives.

 

• Based on this feedback, DOH has contracted with 8 community-based organizations that provide wraparound, culturally appropriate care for pregnant and parenting families. Throughout the next year, DOH will support these partners in implementing their projects.

 

• Contractors will work collaboratively with a DOH evaluator to create an evaluation plan and define what success will look like for their project.

 

• Host summits twice a year to encourage networking between grantees and sharing best practices.

 

• Identify areas for technical assistance to support grantee success.

 

• Support grantees in developing sustainability plans for their projects.

 

• Provide fiscal support to ensure timely payment for deliverables.

 

DOH will also continue to meet with the community advisory committee. The meetings will serve as an opportunity for community accountability and awareness of DOH investments and to provide feedback on other DOH projects.

 

In 2025, pending CMS approval, HCA will be launching a Medicaid benefit for doulas in the state of Washington. DOH plans to work closely with funded Birth Equity Project Partners to ensure that they have the resources and support needed to bill Medicaid funds. During 2025 and 2026 will be exploring what support is needed and collaborating with HCA and other technical assistance providers to support community doula organizations.

 

The funded partners are:

 

Ayan Maternity Health Care Support provides culturally relevant wraparound perinatal support services and professional development opportunities to East African immigrants and refugees in King County. Their project will include a 6-week perinatal class on pregnancy and wellness, labor and delivery, maternal mental health, and preparing for parenthood. They will use the grant funds to provide doula services, lactation support, childbirth education, and early parenting support to clients. Funds will also support annual workshops to build workforce capacity and educational opportunities for East African doulas.

 

BLKBRY offers culturally responsive, evidence and practice-based interventions to reduce the effects of structural racism for families in the Burien area. BLKBRY strives to fill the gaps of missing culturally responsive care and resources in Black/African American reproductive, perinatal, lactation support, and Black/African American infant and toddler health care. This grant funding will support no-cost classes for Black/African American pregnant and birthing people and access to Black/African American-owned reproductive and perinatal products. BLKBRY will use the funds to continue staff education, expand doula and lactation support to Black/African American pregnant and birthing families, and cultivate community spaces to support and share information about birthing work.

 

Center for Indigenous Midwifery is an Indigenous-led educational organization committed to strengthening community by honoring, supporting, and reclaiming Indigenous birth work and culturally centered family support. Their program offers virtual and in-person childbirth education, culturally relevant craft circles, and in-person celebrations such as Indigenous Milk Medicine Week. They support the training and mentorship of Indigenous doulas and childbirth educators around the state.

 

Nisqually Tribal Health and Wellness Center serves American Indian/Alaska Natives living in Thurston County and Nisqually Tribal Members and their families. They plan to expand their perinatal health services to include postpartum doula care, group prenatal care classes, lactation education, a dental program, and a Traditional Healing program. Their project will launch new initiatives, including training birth workers on Indigenous Lactation Counseling and developing a new perinatal mental health program.

 

Puyallup Tribe serves American Indian/Alaska Natives living in Puyallup and Puyallup Tribal Members and their families. Their goal is to make doulas and childbirth educators available to pregnant and parenting families, alongside their provider and nurses. Their program includes training for birth workers and linkages between clinic staff and community birth workers; weekly childbirth education classes; and developing and new workshop on culturally responsive infant feeding.

 

Shades of Motherhood serves Black/African American mothers, people of color, and their infants in Spokane. They support people in overcoming barriers to care and health equity. Shades of Motherhood centers Black/African American mothers and birthing people through education, empowerment, and community to reduce health inequities. Their program will expand access to peer support, childbirth education, lactation support, reproductive support, perinatal mental health support groups, and birthing and perinatal supplies. They will also host community outreach events to help connect Black/African American families to resources and promote birth equity awareness in the Spokane community.

 

Spokane Tribal Network is partnering with Həłmxiłp (Cedar Circle) Indigenous Birth Justice (HIBJ) to improve reproductive health in rural and urban areas in and around Spokane. The Spokane Tribal Network is a non-profit based on the Spokane Indian Reservation. HIBJ is a new Native-led non-profit with a vision to ensure all American Indian/Alaska Native people experience culturally responsive reproductive health without passing the burden of trauma from one generation to the next. Through this partnership, their project will support doula services to urban and rural families, ceremonial training, and birth advocacy. They will also offer prenatal and postpartum culture-based group care to pregnant American Indian/Alaska Native families. Grant funds will help support interested American Indian/Alaska Native community members to become doulas, birth advocates, and ceremonial mentors.

 

Global Perinatal Services has expanded their services for Black/African American birthing families in King County. These wraparound services include childbirth education classes, pre and postnatal lactation education, doula services, and parent support groups.

 

We are currently conducting a state-wide needs assessment that will provide the additional information necessary to design and implement an intervention designed to improve the percentage of women who attend a post-partum visit within 12 weeks of giving birth. We will work with our epidemiological team to design an intervention and data collection plan for this effort.

 

Objective 3

Through September 30, 2025, create training opportunities for perinatal care providers on mood disorders and suicide risk during and after pregnancy, and determine feasibility of modifying existing legislation requiring mandatory provider suicide training to include content on maternal suicide, risk factors, and interventions.  

 

Relevant Activities and Projects

To increase awareness and knowledge of suicide risk and pregnancy, DOH explored the feasibility of amending the law that outlines suicide training requirements for health care professionals in the state, RCW 43.70.442. Significant barriers made this amendment unfeasible at this time. The minimum standards within this law are general, and this proposed amendment would open the door for a change in the scope towards more specialized standards. It could take years to progress and have minimal impact on the reach of training materials.

 

DOH staff continue to explore opportunities to promote awareness around perinatal behavioral health and suicide prevention.

 

In spring 2021, DOH released a request for applications to fund projects that meet the MMRP’s recommendation to “increase knowledge and skill of providers, patients, and families about behavioral health conditions during and after pregnancy, and the treatment and resources that are available for support.” These projects aim to support maternal Medication Assisted Treatment (MAT) programs, increase perinatal peer support groups and services, and offer provider trainings to improve perinatal behavioral health skills. DOH will continue to support and offer TA for the community grants through August 2024. We will assess the success of the grants through monthly check-ins and quarterly reports that grantees will submit outlining their progress toward their goals and objectives.

 

In partnership with the University of Washington Department of Medicine, DOH will continue to offer the MMRP ECHO (Extension for Community Healthcare Outcomes) series for Washington State providers. The CME-accredited program addresses mortality risks and provides education to improve care for perinatal patients. They will include components that guide the evaluation of the severity of any identified risk, preparing a risk mitigation plan, and initiating a team-based care approach within the care setting. Participants will learn to address causes of maternal mortality as identified in the 2023 Maternal Mortality Review Panel report – with sessions focused on behavioral health, and suicide risk and accidental overdose.

 

 

 

Objective 4

Through September 2025, continue to collaborate with Tribal partners to meet the needs of Tribal communities impacted by maternal mortality through additional listening sessions and data quality improvement.

 

Relevant Activities and Projects

There is increased interest in and work around establishing a tribal review committee or subgroup of the existing MMRP that reviews tribal-related maternal deaths. As part of this work, DOH is exploring whether this endeavor is something tribal communities want and what resources and supports they need. Part of this exploration would be determining whether this would be a subgroup of the MMRP, an enhanced supplemental part of the existing MMRP process (but not distinct or separate), or a distinct process from the MMRP. 

 

We will work closely with our DOH tribal liaison and other tribal partners to plan what an exploration would entail. It may include a series of key informant interviews or focus groups with tribal leaders and health-related organizations to explore options, goals, and priorities of a tribal-led review. We would also identify the types of resources, funding, and technical assistance necessary to support such an effort and the potential challenges and barriers that would need to be addressed. 

 

Additionally, DOH has limited access to tribal clinic health records and tribal law enforcement records related to the death of a pregnant person within a year of their death. While this data is important for a comprehensive case review of maternal death, it raises questions about privacy and data sovereignty.  

 

To gather more information and context about what barriers exist to gathering tribal data and what factors impact whether tribes and urban Indian health organizations grant permission to DOH to request tribal records, we will engage in internal and external data consultation. This may include discussion with the DOH tribal liaison and initiating conversation with tribal leaders and members, as well as consulting with experts in the field of data collection and privacy. We will review and apply the guidance and recommendations found in the Addendum Report from the American Indian Health Commission to direct our consultative process. We will also use this project to better understand tribal perspectives on including interviews in our case narrative development process and how we would include the findings from these interviews in our case narratives. Ultimately, the decision about whether or how to collect this data should be guided by a commitment to transparency, data sovereignty, and respect for tribal nations and their unique cultural values and traditions. We are committed to respecting these rights and working collaboratively with tribal nations to develop data-sharing agreements or processes that reflect their priorities and values.  

 

Priority

Optimize the health and well-being of adolescent girls and adult women, using holistic approaches that empower self-advocacy and engagement with health systems.

 

 

NPM

NPM 1: Percent of women, ages 18 through 44, with a preventive medical visit in the past year

 

Strategies

• In collaboration with our clinical partners, assure access to prenatal genetic services in rural and/or underserved communities.

 

• Provide technical assistance by offering all prenatal genetics providers a paid subscription access to the Teratogen Information System Database (TERIS) to better assess risks of medications and exposures during pregnancy.

 

• Disseminate data and trends on service utilization of prenatal genetic services to stakeholders. 

 

• In collaboration with our clinical partners, disseminate printed published prenatal genetic resources to non-genetic clinicians ordering prenatal genetic tests.

 

• In collaboration with our clinical partners, create and publish new prenatal resources on topic areas of unmet need.

 

Objectives 1, 2, and 3

By September 2025, support access to prenatal genetic services. 

 

By September 2025, collect and analyze service utilization data on patients utilizing prenatal genetics services, and disseminate the information to our stakeholders.

 

By September 2025, convene the prenatal genetics work group to identify prenatal topics that need updated provider resources, and support dissemination of the existing published prenatal genetic resources.

 

Relevant Activities and Projects

The Genetics program works to serve those with or at risk for genetic and congenital conditions. The Genetics program does this by providing up-to-date and accurate information to individuals, families, and healthcare providers, helping families locate the nearest genetic service providers, monitoring the quality of genetic services in Washington and providing information and educational opportunities for health care providers.

 

Between October 2024 and September 2025, the Genetics Program will collaborate with partners and stakeholders to assure access to and the provision of genetic services to Washington’s residents.