Maternal and Child Health (MCH) monitors emerging women’s and maternal health issues, integrates best practices, and incorporates community feedback into programming. In fiscal year fiscal year 2025 (FY25), Texas will focus on decreasing smoking during pregnancy, reducing maternal morbidity disparities, and improving women’s health status.

NPM 14.1: Percent of Women Who Smoke During Pregnancy 

In FY25, MCH will assess the current state of maternal tobacco use through various methods to identify needs, gaps, and opportunities to strengthen prenatal smoking prevention strategies including: 

• Studying maternal smoking rates, trends, and disparities
• Examining tobacco-related experiences and behaviors during and after pregnancy using the Pregnancy Risk Assessment Monitoring System (PRAMS) 
• Studying smoking and tobacco use knowledge, attitudes, and awareness among women of childbearing age using Texas’ Behavioral Risk Factor Surveillance System 
• Assessing maternal tobacco use as part of the Texas Maternal Mortality and Morbidity Review Committee’s (MMMRC) case review process 
• Monitoring progress toward Healthy People 2030 objectives to increase cigarette smoking and vaping abstinence among pregnant women and increase successful quit attempts in pregnant women who smoke
• Studying recommended strategies and best practices for focused, effective outreach methods to engage pregnant women in tobacco cessation

 

Throughout FY25, MCH will incorporate tobacco screening and referral into maternal health programs.  

 

As part of the High-Risk Maternal Care Coordination Services Pilot Program (HRMCCSPP), Northeast Texas Public HealthDistrict (NETHealth) Delivering Resources and Empowering All Mothers (DREAM) program community health workers (CHWs) will screen up to 60 clients by the end of FY25 using a CHW screening tool that includes questions about current tobacco and nicotine use. CHWs will develop client-centered action plans and provide health education, referrals, and support to clients to quit tobacco use.

By the end of FY25, the TexasAIM Obstetric Care for Women with Opioid and other Substance Use Disorders (OSUD) Innovation and Improvement Learning Collaborative (IILC)’s 8 participating hospitals will:

• Develop and maintain a set of referral resources and communication pathways between obstetric providers, community-based organizations, and state and public health agencies to enhance services and supports for pregnant and postpartum families for non-medical drivers of health, behavioral health supports, and substance use disorder (SUD) treatment
• Use validated self-reported tools and methodologies to screen all pregnant and postpartum obstetric patients during prenatal care and during the delivery admission for SUD including tobacco use disorder
• As part of screening, brief intervention, and referral to treatment (SBIRT) providers will educate their clients about tobacco use risks, motivate clients with a positive screen toward behavior change, and refer pregnant and postpartum patients with tobacco use disorder to cessation resources and programs including the Texas Tobacco Quitline (Quitline)

 

MCH will promote the TexasAIM On-Demand Continuing Education Platform to Wave 1 TexasAIM Plus OSUD hospital teams. Topics related to tobacco cessation include SBIRT and motivational interviewing.

 

In FY25, MCH will continue to distribute tobacco prevention resources to women of childbearing age, pregnant and postpartum women, health care providers, and other MCH populations. Resources include information about how tobacco, e-cigarettes, and other nicotine products are unsafe to use during pregnancy. Messaging will promote tobacco prevention best practices, educational resources, the Quitline, and smoking cessation as one of the most important ways to promote maternal and child health.

 

By the end of FY25, MCH will expand Safe Infant Sleep website content and resources for health care providers, public health partners, parents, and other infant caregivers. Website information will include tobacco cessation resources such as the Quitline and resources for health care providers, such as the TX Health Steps Infant Safe Sleep online provider education.

 

MCH will promote the Texas Health Steps (THSteps) online provider education SIS module to health care providers and public health partners statewide. The module highlights state tobacco cessation resources including the Quitline and promotes the importance of smoke-free environments. Providers can then disseminate this information to pregnant and postpartum women, fathers, and other infant caregivers to build awareness and reduce the risk of SIDS and other sleep-related deaths.

 

MCH will promote state tobacco cessation resources through the Healthy Texas Mothers and Babies (HTMB) Community Coalitions and encourage regional tobacco cessation coalition collaboration (where available) to build community capacity to support women and their families. In FY25, MCH will share at least 2 tobacco cessation resources in 2 virtual meetings with HTMB coalitions.

 

In FY25, public health regions (PHRs) will provide materials, communications, and programmatic activities to reduce women, children, and family tobacco exposure. Primary activities include education, prenatal and postpartum tobacco use screening and Quitline referrals for counseling and treatment among women, children, and families. Additional PHR activities include the following:

• Northwest Texas PHR will supply providers with an evidence-based resource Support Smoking Cessation During Pregnancy and offer tobacco cessation training and Quitline information to health care providers and agencies that provide services to pregnant women and their families.
• Piney Woods Texas PHR will conduct vaping and e-cigarette presentations for expectant mothers based on community requests and work closely with Nurse-Family Partnership to provide smoking cessation guidance and educational materials for expectant and new moms. In accordance with state law, this region also will continue to supply Housing and Urban Development (HUD) authorities with smoke-free policy guidance and information.  
• South Texas PHR MCH staff will collaborate with the PHR Tobacco Prevention regional coordinator to provide tobacco cessation information in conjunction with other maternal and infant health information at community events such as car seat safety, mental health and safe sleep resources, and Quitline information. Staff will provide technical support and Smoking Cessation and Reduction in Pregnancy Treatment materials for clinicians working with pregnant mothers.

 

In FY25, MCH will meet quarterly with the Texas Department of State Health Services (DSHS) Tobacco Prevention and Control Unit to coordinate efforts and identify shared goals and opportunities for cross-program collaboration. By the end of FY25, MCH will attend 4 meetings with the Tobacco Prevention Control Unit.

 

SPM5: Percent of Women of Childbearing Age Who Self-Rate Their Health Status as Excellent, Very Good, or Good.

The TexasAIM program is MCH’s partnership with the national Alliance for Innovation on Maternal Health (AIM) that uses the Institute for Healthcare Improvement’s (IHI) Breakthrough Series (BTS) model for collaborative learning, communication and teamwork training, and other methods to support hospitals implement AIM maternal patient safety bundles (PSBs). TexasAIM’s IHI BTS structured framework, peer-based learning, small tests of change, data-informed quality improvement methods, and data reporting accelerate maternal PSB adoption and implementation. Each maternal PSB includes a collection of best practices to improve condition-specific maternal health outcomes.

In FY25, MCH will support at least 75% of Texas birthing hospital teams to adopt and sustain AIM maternal patient safety improvement.  By August 2029, MCH expects to see a 5% reduction in the statewide severe maternal morbidity (SMM) rate (cases per 10,000 delivery hospitalizations).

 

In FY25, TexasAIM will:

• Partner with expert clinical and improvement science faculty and provide individualized coaching and mentorship to at least 40 TexasAIM hospital teams
• Engage patients through the Preeclampsia Foundation and Maternal Mortality and Morbidity Advocates (MoMMA’S) Voices partnership to educate hospital teams, hospital leadership, and stakeholders based on patients’ and their families’ lived experiences
• Host virtual and in-person collaborative learning to facilitate sharing and peer support about PSB implementation statewide
• Collect process, structure, and outcome measures and qualitative progress updates from hospital teams to inform current and future programming and guide technical support
• Support hospital teams through interactive web-based discussions, online-sharing platforms, coaching, and mentoring to help them learn from state and national experts, other hospital improvement teams, and Texas community partners
• Facilitate peer networking and resource sharing among hospital teams

• Continue engaging 8 Wave 1 birthing hospital teams in quality improvement through the TexasAIM Plus Wave 1 OSUD IILC

• Work with Wave 1 OSUD IILC teams to engage community partners that provide supportive services to pregnant and postpartum women, including women with OSUD
• Support 8 hospital teams (through data collection, analysis, and visualization) to use data to inform OSUD quality improvement efforts

• Hold 1 in-person celebration and harvest meeting for OSUD Wave 1 hospital teams in Fall 2024
• Collate and incorporate OSUD IILC lessons learned into future TexasAIM planning

• Hold the TexasAIM Plus summit in December 2024 to share lessons learned and engage stakeholders in the next collaborative phase. The biennial summit will conclude the Severe Hypertension in Pregnancy (HTN) Learning Collaborative and OSUD IILC and celebrate TexasAIM hospital teams successes, review outcomes, progress and lessons learned throughout the learning collaborative, engage stakeholders, partners and hospital leadership to commit to sustaining the achievements of the learning collaboratives, and launch new TexasAIM initiatives; Recruit, appoint and collaborate with a team of TexasAIM Plus Sepsis in Obstetric Care (SOC) Learning Collaborative faculty and coordinate to develop the TexasAIM SOC driver diagram, change package, charter, and family of measures core measurement strategy

• Develop data reporting forms, resources, dashboards, and tools for hospitals to report outcome, process, and structural measures related to sepsis in obstetric care

• Promote the SOC initiative and enroll at least 140 or more Texas birthing hospitals to participate in the TexasAIM Plus SOC Learning Collaborative
• Support participating SOC Learning Collaborative hospitals with establishing teams, conducting assessments, identifying measurement strategies, and completing learning session prework
• Convene participating SOC Learning Collaborative teams for SOC Learning Session 1 to share best practices, change ideas, and quality improvement methods and support teams with developing processes change ideas to test in their local settings using plan-do-study-act cycles
• During SOC Action Period 1, support SOC Learning Collaborative participating hospital teams through interactive web-based discussions, online sharing platforms, coaching, mentoring, and data reporting

By August 2025, at least 350 Texas health care professionals will complete 1 or more MCH-provided women’s maternal health continuing education (CE) opportunities. MCH will offer instructor-led and on-demand, self-paced courses and concepts and principles, concrete examples, and practical guidance training to support maternal patient safety and quality improvement implementation.

In FY25, MCH will prepare new TexasAIM On-Demand Continuing Education Platform courses and promote existing courses by:

• Developing CE course content-specific agendas in consultation with TexasAIM faculty and MCH subject matter experts
• Developing course content, recording presentations, and populating course content in the learning management system
• Working with DSHS CE Services and submitting CE documentation for CE courses
• Developing promotional communications and resources
• Promoting courses in TexasAIM newsletters, calls, and events

MCH will also support CE by:

• Developing, promoting, and providing TexasAIM hospital participants CE on topics such as obstetric hemorrhage, severe hypertension in pregnancy, obstetric care for women with SUD, interpersonal violence, maternal sepsis, congenital syphilis, maternal health disparities, simulation, communication and teamwork, maternal patient safety, and health care quality improvement
• Promoting women’s and maternal health THSteps online provider education including preconception, prenatal, and postpartum care and breastfeeding CE
• Promoting a course suite preparing CHWs to specialize in maternal high-risk care, informal counseling, and care coordination 
• Coordinating with DSHS Grand Rounds and other DSHS continuing education events to disseminate provider continuing education on women’s and maternal health
• Sponsoring the annual Texas Collaborative for Healthy Mothers and Babies (TCHMB) Summit and coordinating the summit CE contact hours award process

 

In FY25, at least 100 Texas birthing hospitals will engage in TCHMB maternal health activities.

 

MCH funds TCHMB as Texas’ perinatal quality collaborative. TCHMB’s mission is to advance health care quality and patient safety for all Texas mothers and babies through health and community stakeholder collaboration. Throughout FY25, MCH will continue to fund, provide technical assistance to, and partner with the University of Texas (UT) Health Houston School of Public Health in Austin to facilitate TCHMB. TCHMB will promote maternal health by:

• Coordinating Recognition and Response to Postpartum Preeclampsia in the Emergency Department (PPED) Project calls to sustain hospitals collaboration to improve identification and escalation of care for postpartum patients presenting to the emergency department with severe hypertension, preeclampsia, or eclampsia
• Partnering with DSHS to develop a congenital syphilis quality improvement toolkit for physicians and other providers
• Hosting the annual TCHMB Summit and engaging more than 300 participants in CE on maternal and infant health improvement topics
• Providing ancillary faculty staff support for the MCH TexasAIM program
• Collaborating with MCH to develop a TCHMB Obstetric Committee project that complements TexasAIM bundle implementation.

 

Throughout FY25, MCH will implement the HRMCCS to reduce maternal health care barriers for high-risk pregnant and postpartum women in Northeast Texas. MCH will work with NETHealth to:

• Maintain CHW and supervisory staffing necessary to provide the HRMCCS DREAM program in Smith County, Texas
• Provide assessment and screening to identify pregnant women at high risk for poor pregnancy, birth, or postpartum outcomes and provide necessary referrals to 80% of clients based on self-identified needs and
• Enroll and provide education, counseling, health care navigation support, and other high-risk maternal care coordination services to at least 60 pregnant and postpartum women

MCH will work with the UT Health Science Center Houston School of Public Health HRMCCS technical assistance and evaluation contractor to:

• Develop and refine HRMCCS program evaluation including process and impact assessment
• Facilitate incorporation of diverse CHW expertise into program planning, technical assistance, and evaluation support
• Routinely collect, analyze, and communicate with DSHS and NET Health about program implementation assessment findings
• Identify program needs, develop recommendations, and support process improvement implementation

By August 2025, MCH will partner with the DSHS CHW Training Program to promote the high-risk maternal care coordination CHW course suite and provide CE to at least 40 CHWs or CHW instructors.

In FY25, MCH will:

• Conduct a landscape assessment to identify Texas-based CHW programs that provide maternal health services
• Assess CHW learning needs related to maternal health care coordination
• Promote DSHS high risk maternal care coordination CHW course suite to CHWs, CHW supervisors, and CHW instructors
• Evaluate CHW suite of modules
• Identify outstanding CHW high risk maternal care coordination learning gaps that may be addressed with additional education or skills training

In FY24, MCH will coordinate with the DSHS Vital Statistics Section, DSHS Center for Health Statistics, Health and Human Services Commission Medicaid and CHIP Services, and other partners to identify data quality improvement opportunities to identify pregnancy-associated deaths and enhance case reviews. MCH partners with the University of North Texas Health Science Center to manage timely MMMRC case preparation and enter case information and committee decisions into the CDC Maternal Mortality Review Information Application (MMRIA) System. Through these partnerships, MCH supports the MMMRC to comprehensively study pregnancy-related mortality cases and SMM rates and trends.

As part of the current DSHS Strategic Plan to assure healthy mothers and babies by reducing disparities in maternal child health populations; facilitating access to maternal and child health services; and decrease maternal mortality and morbidity, by August 2029, MCH will aim to reduce the overall statewide rate of violent pregnancy-associated deaths by 5%.

 

In FY25, PHRs will provide materials, communications, and programmatic activities including:

• Northwest Texas PHR will promote education on Healthy Texas Women, regional & national crisis resources for intimate partner violence, the National Maternal Mental Health Hotline, the National Human Trafficking Hotline, March of Dimes, Special Supplemental Nutrition Program for Women, Infants and Children (WIC), and Hear Her Texas campaign materials to increase women’s access to family planning, preventative care, prenatal care in the first trimester, and interpersonal violence or other crisis supports
• Piney Woods Texas PHR will provide education and resources on sexual health, preconception health, and mental wellness to women of childbearing age, students, mothers, fathers, pregnant teen mothers pregnancy resource centers, historically Black colleges and universities, schools, churches, and community organizations, as requested
• Southeast Texas PHR will provide the 4-part, bilingual Mommy, Are You Ready? prenatal education program for expecting parents and their support systems. The program features topics like smoking cessation, safe sleep, infant safety, and breastfeeding. PHR staff will offer each of 4 lessons 4 times a year and include a pre-test and post-test to measure learner outcomes
• South Texas PHR will provide education to pregnant women and caregivers of children up to 1 year old through the March of Dimes Becoming a Mom/Comenzando Bien (BAM/CB) bilingual prenatal curriculum and gestational diabetes curriculum. Staff will educate participants on safe sleep, period of purple crying, car seat safety, breastfeeding, nutrition, physical activity, and secondhand smoke 

 

MCH will encourage HTMB Community Coalitions to amplify state maternal and infant health and safety programs, initiatives, and campaigns in their communities through social media and other awareness activities. These community-based programs engage health care providers, health, community systems, and other MCH stakeholders to improve awareness and capacity-building through education on breastfeeding, safe infant sleep, SIDS reduction, interpregnancy health, and other maternal health and safety topics.

In FY25, MCH will share state-based breastfeeding and maternal health and safety resources during at least 2 HTMB Community Coalition virtual meetings.

MCH’s statewide infant health and safety campaign will continue to raise awareness among employers, hospital staff, and community stakeholders about breastfeeding barriers in worksites, communities, and health care settings. The campaign will include sharing information about the Texas Mother-Friendly Worksite Program designation process and the fiscal year 2024 Right from the Start birthing hospital breastfeeding awareness campaign. For more information about the campaign, visit the Infant Health Plan, NPM 5 and SPM 3.

SPM 4: Maternal Morbidity Disparities: Ratio of Black to White Severe Maternal Morbidity Rate 

Nationally and in Texas black, indigenous, and Hispanic women are disproportionately impacted by severe maternal morbidity and mortality.

In FY25, MCH will support Texas birthing hospitals to implement the TexasAIM HTN, OSUD, and SOC PSBs and provide ongoing support for hospital data collection, analysis, reporting, and quality improvement.

MCH will support hospital teams engaging pregnant and postpartum women in multidisciplinary care teams, communicating with pregnant and postpartum women and their support networks on maternal health conditions, and aligning treatment plans with patients’ health literacy, culture, language, and accessibility needs.

MCH will support hospitals making respectful, equitable, and responsive, patient-centered care improvements and track hospital’s self-reported progress toward establishing processes for:

• Fostering cultures of respectful, equitable, and supportive health care with systems for reporting, response, and systems learning
• Providing referral resources, communication pathways, and a standardized discharge summary for pregnant and postpartum patients
• Using trauma-informed protocols
• Implementing ongoing all team member education on health disparities, patient-centered care, trauma-informed care, shared decision-making, and cognitive biases in clinical decision-making
• Conducting patient debriefs after a severe event
• Incorporating the patients’ and/or support networks’ perspective in regular clinical team formal debriefs after major complications cases
• Considering case review social and non-medical drivers of health
• Disaggregating process and outcome data by race/ethnicity and other demographic factors to pinpoint disparity improvement
• Incorporating patients, caregivers, and families with lived experiences with severe maternal morbidity in actively designing, delivering, and evaluating health services to improve maternal care quality
• Using patient-centered communication and shared decision-making  

 

MCH will monitor health care disparities in a culture of safety and improvement by disaggregating TexasAIM state collected measures data by race/ethnicity, payor (if available), and other key demographics and support hospital teams with strategies for collecting and reporting disaggregated process and outcome data.

 

In FY25, MCH will assess HRMCCSPP’s impact in Smith County, Texas with the goal of reducing SMM. MCH, through its contractor NETHealth, will continue implementing the DREAM model to deliver CHW-led high-risk maternal care coordination services. The model integrates person-centered concepts and diverse value, belief, and behavior systems to maintain healthy social support networks by:

• Staffing local community CHWs to address non-medical drivers that impact high-risk pregnant and postpartum women
• Supporting ongoing CHW training and capacity-building in high-risk maternal care including reducing access to care barriers and reducing care disparities
• Providing health education to high-risk pregnant and postpartum clients on factors that increase maternal risk
• Screening each potential client to identify experiences that could delay care or follow-up
• Providing ongoing CHW social support to improve health outcomes and help clients develop client-centered care plans to meet identified needs, coordinate care, and refer to needed services

By the end of FY25, NETHealth will screen at least 400 pregnant and postpartum women in Smith County, Texas using a CHW assessment tool to identify women who have risk factors that contribute to poor maternal health outcomes. CHWs will assess access barriers and educational needs and refer program beneficiaries to appropriate services to receive ongoing education and support. CHWs will recruit women identified as having risk factors for high-risk pregnancies to participate in the DREAM program. CHWs will provide clients with counseling and support to recognize risks, seek care, and self-advocate for their health. DSHS anticipates participants who complete the DREAM program will receive identification and management of maternal health issues, better participation in risk-appropriate prenatal care, better self-reported health status and—ultimately—lower incidence of poor health outcomes (e.g., SMM or injury) during pregnancy and in the year after.

In FY25, MCH will increase public awareness about Texas maternal morbidity disparities, pregnancy-related complications, and urgent maternal warning signs. The Hear Her Texas campaign strategies promote prevention, resources, and best-practice messaging among women of childbearing age, pregnant and postpartum women, health care providers and other MCH stakeholders. FY 25 campaign efforts include:

• Implementing an influencer campaign to expand campaign messaging reach
• Researching key stakeholders on effective strategies for incorporating messaging and maternal morbidity prevention strategies in existing state and local maternal health-oriented initiatives
• Enhancing the campaign website and refreshing social media to increase campaign engagement
• Implementing a comprehensive stakeholder outreach and engagement plan to engage health care providers and other stakeholders working with pregnant and postpartum women

 

To measure reach, MCH will analyze social media post engagements, impressions, webpage views, and document downloads. Additionally, MCH will produce a research report that includes:

• Process mapping to document maternal patient journey points of care pathways
• Successful labor and delivery and emergency department collaboration recommendations
• Provider job aids and educational materials
• Outreach strategies that effectively engage emergency departments in existing maternal health and safety programs

 

During FY25, MCH will produce a minimum of 2 provider job aids and analyze campaign material distribution and health care providers and stakeholders' engagement statewide.  

 

By December 2027, MCH will identify at least 95% of pregnancy-associated deaths statewide within 12 months of the date of death.

In FY25, the Texas Maternal Mortality and Morbidity Review Committee (MMMRC) will review pregnancy-related death cases and make recommendations to decrease maternal and mortality rates with special attention to mothers most affected in the state’s disparity ratios.

The MMMRC will use the Discrimination Assessment and Social Drivers of Health (DASH) Facilitated Discussion Tool to enhance data collection and understanding of the social and non-medical drivers that impact violent pregnancy-related deaths.

In FY25, MCH will study violent pregnancy death (VPD) and VPD review processes by conducting demographic and geographic disparity, rate, and trend analyses on maternal deaths due to violence using death certificate data from 2016-2021. DSHS will continue partnering with state agency and non-profit partners to identify opportunities for integrating and aligning VPD prevention strategies in state programs.

By the end of FY25, MCH will disseminate a state strategic action plan in collaboration with partners and stakeholders to improve health outcomes and reduce deaths among pregnant and postpartum women due to violence.

MCH will encourage HTMB Community Coalitions (HTMB CC) to use state and local data to identify key drivers of poor birth outcomes and will help support development of key interventions to address maternal health. HTMB CC will continue to include sustainability planning in their ongoing activities using collective impact to best improve health. In FY25, MCH will provide monthly technical assistance through virtual meetings and use an online shared platform where coalitions can collaborate to share best practices and highlight successes. MCH will fund at least 2 community-based health initiatives or events to improve pregnant and postpartum Black women’s health outcomes in communities with disparate outcomes.

MCH will continue to focus on breastfeeding support activities to reduce breastfeeding disparities and barriers. MCH will promote the Texas Mother-Friendly Worksite (TMFW) Program designation in low-wage Texas job sectors such as child care center and service industries. By the end of FY25, MCH will provide at least 2 webinars promoting TMFW designation to at least 15 outreach partners, focusing primarily on how to reach employers in low-wage job sectors.

Postpartum Visit Universal Measure

In FY25 MCH will continue all existing efforts that promote and support postpartum care and access and examine opportunities to address this universal measure. MCH is also planning to assess new strategies that increase both access and care in Texas.

Current efforts that address this measure include:

• Supporting statewide hospital teams in engaging pregnant and postpartum women with multidisciplinary care teams
• Communicating with pregnant and postpartum women and their support networks on maternal health conditions, and aligning treatment plans with patients’ health literacy, culture, language, and accessibility needs
• Promoting prevention, resources, and best-practice messaging among women of childbearing age, pregnant and postpartum women, health care providers and other MCH stakeholders through Hear Her Texas
• Educating PHR staff on the importance of postpartum care during one-on-one appointments with Texans including immunizations events, car seat inspections, and community events like health fairs and festivals and working to connect individuals with referrals and resources
• Provide health and safety information for mothers and infants in the Information for Parents of Newborns