Priority need: Women’s access to care

NPM-Well-Woman Visit: Percent of women, ages 18 through 44, with a preventive medical visit in the past year.

Annual plan FY25:

During FY25, the Maternal and Infant Health Program (MIHP) will continue to work to understand the knowledge, attitudes, and behaviors of women of reproductive age regarding the well-woman visit. Now that two years of data are available from the Behavioral Risk Factor Surveillance Survey (BRFSS) on this topic, staff will analyze the data to understand contributing factors to attending well-woman visits and plan educational activities accordingly.
 

Currently (calendar year 2024), the BRFSS includes the optional family planning module that asks what birth control method females younger than 49 years of age currently utilize. In addition to this module, a state-added question asks women where they obtained their current method of birth control. During FY25, staff will use the data obtained from this question to understand where Utahns are getting their birth control, recognize unmet needs, and provide education, as contraceptive counseling is an important aspect of the well-woman visit.

During FY25, the Utah Birth Defect Network (UBDN) will continue surveillance of birth defects and critical congenital heart disease in Utah, which includes analyzing folic acid use data collected from birth certificates within the Office of Vital Records and Statistics. Adequate folic acid access and uptake are essential to promoting a healthy pregnancy and reducing the risk of birth defects. By further examining folic acid uptake trends and identifying populations that have lower use of folic acid, UBDN can assist with targeted education and intervention, including during well-woman visits.

Staff will continue to attend community events to meet community members and educate our target population on the importance of the well-woman visit.
 

The MIHP website is an effective tool to provide education and during FY25, staff will also continue to monitor and update the website as needed, including the Power Your Life website.

Proposed activities:

• Staff will analyze data from the BRFSS to understand where women of reproductive age obtain their chosen method of birth control and publish a report detailing findings.
• Staff will attend a variety of community events throughout the year to meet community members and educate them on preconception health and the importance of the well-woman visit.
• Staff will review, revise, and update the Power Your Life website to educate the public about the annual well-woman visit.
  

Logic model for NPM – Well-Woman Visit

State priority area: Perinatal mood and anxiety disorders

SPM-1 (Prenatal and postnatal depression screening): Percent of mothers that report a doctor, nurse or other health care worker asked if they were feeling down or depressed during prenatal and postpartum care.

Annual plan FY25:

In addition to continuing all activities currently ongoing in our program (ongoing training of providers, creating new collaborations, social media education, etc.), we will be finalizing and expanding some services to better serve the providers and population in Utah. Building on the success of the Telemental Health Project, we will be working with all local health departments (LHDs) across the state to establish and support their perinatal depression screening and referral process. This online screening tool is vital for rural and frontier LHDs that are under-staffed and need more time to hold full screenings. Using the score online screener, referrals can be made for those who might need help before they attend the appointment. Through our new partnership with the DHHS Office of Substance Use and Mental Health, our outreach and education efforts will expand into other state agencies and DHHS offices and programs, such as the Division of Child and Family Services, Medicaid, Office of Population Health, and Office of Early Childhood. This year we will expand our messaging to better serve the diverse populations within Salt Lake City through culturally tailored fact sheets and presentations.

Promoting the Maternal Mental Health Toolkit which includes statewide screening and referral protocols, created by the Utah Women and Newborns Quality Collaborative (UWNQC), will continue to be a top priority. We will focus our promotion efforts on social media, networking events, presentations, and inclusion in the AIM Perinatal Mental Health Conditions Safety Bundle implementation. We will be translating the toolkit into Spanish and implementing the same promotion activities for our Spanish-speaking providers and community organizations.

UWNQC's Maternal Mental Health Subcommittee will focus their work on two main priorities: the unhoused pregnant and postpartum population and maternal suicide. The unhoused workgroup will focus on provider and public education about unhoused pregnant individuals and resources and complete a focus group with people with lived experiences to determine population needs. The suicide workgroup will focus on provider and public education about maternal suicide and state resources, and work with the crisis intervention team at the Office of Substance Use and Mental Health to make sure crisis workers are sufficiently trained in caring for the maternal population.

There are plans to train at least two more obstetricians, midwives, psychotherapists, pediatricians, or TriCare providers on perinatal mental health, looking for people who speak Spanish as we are boosting our provider knowledge base on the maternal mental health referral network. We will be prioritizing funding to make sure those who serve Medicaid recipients are trained. We will also provide funding for community health workers, doulas, and peer support specialists to obtain training in maternal mental health.

We will also be implementing a five-year contract that serves the Hispanic/Latino maternal community. This contract supports Comunidad Materna en Utah, a local non-profit association serving the Spanish-speaking maternal population through doula services, parenting education, support groups, breastfeeding peer counselors, and community health workers to connect low-income, underrepresented, and uninsured individuals to services. In 2022, Comunidad Materna served 155 participants through 45 workshops, 37 support groups, 20 breastfeeding groups, and 8 birth workers. Through this contract, Comunidad Materna en Utah will create a virtual support group for fathers, support their playgroups in Utah and Salt Lake Counties, create a parenting school that explores topics for newborn care, parenting, and child development, and host two outreach events centered on maternal mental health.

We will be collaborating with UWNQC, providers, patient advocates, and community organizations to evaluate current health care resources and protocols for those who experienced birth trauma. The main activity of this birth trauma workgroup will be conducting a needs assessment for patients who self-identify as experiencing birth or postpartum trauma and provide a baseline understanding. This information will be obtained through patient and clinician key informant interviews. The data from the interviews will help inform ways to provide resources to patients and clinicians serving maternal patients who have experienced birth and postpartum trauma. The project also aims to understand current provider knowledge and treatment or referral protocols to address the emotional and mental health impacts of birth and postpartum trauma. 

We will also continue to use social media platforms to encourage women to seek screening and care from providers. Social media is where we connect with the public and providers across the state and nationally.

Proposed activities:

• Promote Utah’s Maternal Mental Health Toolkit for the Utah Women and Newborns Quality Collaborative, translate the toolkit into Spanish, and assess the toolkit for improvements.
• Train at least two more obstetricians, midwives, psychotherapists, pediatricians, or TriCare (Veteran population) providers on perinatal mental health, and seek out providers who speak Spanish to include on the referral network.
• Expand the use of online screening to other health departments.
• Implement a project to address maternal mental health in Hispanic/Latino individuals.
• Continue to use social media platforms to encourage women to seek screening and care from providers.
• Train community health workers, doulas, and peer support specialists in maternal mental health.

Logic model for SPM 1 - Prenatal and postnatal depression screening