Illinois’ priority for the Women and Maternal Health Domain is:

• Assure accessibility, availability and quality of preventive and primary care for all women, particularly for women of reproductive age (Priority # 1)

During FY20, Illinois Title V Program will utilize the following strategies to address the Women and Maternal Health Domain priority: 

A. Support dissemination of the Illinois Healthy Choices, Healthy Future Perinatal Education Toolkit, which includes resources about pre-/inter-conception health and the transition to postpartum care.

During FY2020, under the direction of IDPH, Everthrive Illinois will continue to serve as main facilitator of the Pre and Inter-Conception CoIIN workgroup.  In addition, EverThrive Illinois will lead an update of the Illinois Healthy Choices, Healthy Future Perinatal Education Toolkit, developed for clinical providers, as well as promote, update and maintain the toolkit’s new website: http://healthychoiceshealthyfutures.org/.

B. Partner with the Illinois Department of Corrections and two state women’s correctional centers to support ongoing health promotion activities for incarcerated women (including health education programs and lactation support) and prison staff training.

OWHFS will continue to partner with the Illinois Department of Corrections to offer health education to incarcerated women, provide training to corrections staff, help stock women’s health supplies (such as breast pumping supplies), and work closely with corrections staff to meet the health needs of women in Illinois prisons.  The evaluation plan that was developed during 2018 will continue to be implemented during 2020, which will demonstrate the value and impact of these efforts.  Title V will specifically support this work by conducting the evaluation (epidemiology team), providing birth simulation training to prison staff, and providing information and support to corrections officers working with women who are pregnant, postpartum, or parenting.  Future training programs are being formulated based on the feedback provided by the clinical staff at both correctional centers.             

OWHFS will continue to work with the women’s prisons within the Illinois Department of Corrections teaching health education sessions using the Helping Women Recover, Beyond Trauma and Life Smart for Women curricula.  Additional training opportunities for prison health care staff will also be planned to focus on more comprehensive care for their expectant mothers, trainings on trauma and Adverse Childhood Experiences (ACEs) as well as better understanding and specifically recognizing the unique healthcare needs of their LGBTQ population.  An additional training programming suggestion includes a full simulation of a maternal transport team from the Level III Administrative Perinatal Center coming to pick up a patient in active labor. This simulation will allow corrections security to test the “lock-down” process for active labor patients while allowing EMS to enter and treat a woman and neonate in the pregnancy wing or healthcare wing. Training programs for nursing staff surrounding fetal monitoring equipment and patient evaluation tools is on future programming agendas for both correctional centers. The IDPH southern perinatal nurse will continue to collaborate with the Administrative Perinatal Center, South Central Illinois, other OWHFS staff, and correctional centers to assist in the process for women receiving Maternal-Fetal Medicine consultations.

OWHFS will also continue to promote the Illinois Breast and Cervical Cancer Screening program to women upon their release.  Many of them meet the eligibility requirements for the program.  The Family Planning Title X program will also be heavily discussed in the upcoming reporting period.  While a woman may already be connected to a Family Planning agency in their area, ideally, she will leave the institution on a type of Family Planning method if her intention is to delay pregnancy.  This will be addressed in the upcoming months. 

C. Identify pregnancy-associated deaths and facilitate two state Maternal Mortality Review Committees (one focused on pregnancy-related deaths and one focused on violent deaths); generate statewide report that summarizes public health recommendations for preventing such deaths.

During FY20, Illinois will continue its process for identifying pregnancy-associated deaths in Illinois and assuring reviews by the state’s two maternal mortality review committees. MMRC will continue to review every potentially pregnancy-related death and MMRC-V will continue to review violent pregnancy-associated deaths due to suicide, homicide, or drug overdose.  The revised processes developed during 2017 will continue to be implemented with an informal quality improvement lens applied; as we continue to try new processes, small changes over time will be implemented and tested to ensure that the process is as smooth and effective as it can be. 

The first annual Illinois Morbidity and Mortality Report was published October 2018 for deaths occurring during 2015. It is intended for this report to be updated and published approximately annually, with the next edition of the report anticipated during the late fall of 2019. This report will include findings from the state reviews, such as demographic disparities, leading causes of death, factors contributing to deaths, preventability, and committee recommendations. As was done in the past, IDPH will pursue multiple methods for disseminating the report and present the findings to relevant groups around the state and nation. 

D. Conduct reviews of severe maternal morbidities (SMM) through the regional administrative perinatal centers to determine preventable causes and develop action plans; convene statewide SMM review sub-committee to develop recommendations for improving local reviews of SMM.             

The University of Illinois at Chicago’s Center for Research on Women and Gender (UIC-CRWG) will continue its existing intergovernmental agreement to assist with the Severe Maternal Morbidity quality improvement activities, such as monitoring the data completeness and quality of SMM review forms submitted to the state perinatal hospital database (ePerinet) and providing technical assistance to administrative perinatal centers (APCs) and birthing hospitals on how to improve reviews. UIC-CRWG staff will also work with the ePerinet data system developer to assure that data collection forms and indicators are clearly defined and to assure high quality data submission.

Additionally, in FY19 UIC-CRWG helped IDPH initiate a SMM Review Committee, which functions as a sub-committee of the Statewide Quality Council. The purpose of the SMM Review Committee is to review SMM case documents with the goal of improving and standardizing hospital level reviews. CRWG will continue to help facilitate these review meetings and will analyze decisions of the state-level committee. The information will inform the creation of training materials, templates, and/or resource manuals, as needed, to improve the quality of the local reviews within hospitals and APCs.

E.  Participate in ASTHO Long-Acting Reversible Contraceptives (LARC) State Learning Collaborative and advise state family planning program and contraceptive initiatives.

This activity was completed in FY16-FY18 and will not be continued in FY20.

Although the ASTHO Long-Acting Reversible Contraceptives LARC Learning Collaborative ended in FY18, Illinois will continue to work to increase education and support of health care providers and patients around the use of LARC. This includes working with the Illinois Department of Corrections to incorporate family planning into the two women’s prisons to offer family planning services to women prior to release, collaborating to expand the efforts of ILPQC’s immediate postpartum LARC initiative and integrating the Title X Family Planning Program with school-based health centers.

F. Collaborate with IDPH Division of Oral Health to convene stakeholders and develop a statewide strategic plan and resource manual for oral health during pregnancy and early childhood.

The Oral Health During Pregnancy and Early Childhood in Illinois resource manual will be finalized and published early FY20. IDPH Title V Program will work with IDPH Division of Oral Health to educate, promote and disseminate the completed manual to partners. This work will also be used to inform a new statewide oral health plan. In FY20, IDPH Division of Oral Health will formally convene stakeholders to participate on the Advisory and Steering Committee for the development of the Illinois' Oral Health Plan IV.  This plan was last updated during 2017. The goal is to reassess the oral health landscape, consider challenges, opportunities and update strategies that aim to improve oral health status, and decrease prevalence of oral diseases. The planned release of the Illinois' Oral Health Plan IV is the fall/winter of 2020.

G. Lead CoIIN- Social Determinants of Health workgroup to assess, quantify and describe the impact that child care has on prenatal, intrapartum and postpartum care in Illinois and develop optional strategies and approaches that could be implemented in clinic and hospital settings to address child care (started in FY18).

IDPH Title V Program staff will continue to participate in the Social Determinants of Health Collaborative, Improvement and Innovation Network (CoIIN) with two aims: assessing need for ‘emergency’ child care in circumstances related to obtaining perinatal care (prenatal appointments, labor and delivery/hospitals) for women/parents and developing women/family-friendly child care strategies for prenatal and perinatal providers. During Summer 2019, Title V interns are analyzing the results of the hospital and Federally Qualified Health Center surveys and developing a protocol and content for field testing of new PRAMS questions around child care to be piloted with Healthy Start clients. Once the interviews are completed, a data brief will be created and distributed to stakeholders who will meet to identify prenatal/perinatal health care system strengths, challenges, and current practices to suggest strategies to be piloted in three sites (one hospital, two prenatal/postpartum care providers) during early 2020.

H. Participate in Partnership for Integrating Oral Health Care into Primary Care project with IDPH Division of Oral Health and a local health department to integrate the interprofessional oral health core clinical competencies into primary care practice, particularly for pregnant women and adolescents (started in FY19).  

IDPH Title V Program will continue to partner with IDPH Division of Oral Health and the Champaign-Urbana Public Health District to participate in the Partnership for Integrating Oral Health Care into Primary Care Project” sponsored by Center for Oral Health Systems Integration and Improvement (COHSII) consortium beginning in FY19. Primary care providers at the local health department are being trained using the Smiles for Life curriculum and then subsequently providing oral health risk assessments, oral exams and fluoride varnish to adolescents and pregnant women recruited through their Women, Infants and Children (WIC) program. This pilot will be continued in FY20 through financial support of COHSII and the Illinois Title V Program to document need for these services in primary care settings and to collect data necessary to demonstrate success of pilot. For these oral health services to be sustainable in a primary care setting, reimbursement is needed. To maximize awareness of the pilot and lessons learned, the Division of Oral Health will continue to work with the Illinois Department of Health Care and Family Services (Medicaid) to promote and understand the reach of prevention and periodontal care received by Medicaid clients during pregnancy.  

I. Establish well-woman care mini grant program to assist local entities in assessing their community for need and barriers and developing a plan to increase well woman visits among women ages 18-44 (started in FY19).

During FY19, IDPH Title V Program Staff began planning for the well-woman care mini grants to provide to local organizations who work with women ages 18-44 to develop and implement a plan to positively impact the number of women seeking well-woman care.  Using best-practice examples from others states, example activities were suggested including using the CityMatCH Well-Woman Toolkit, providing education and training to women to increase health literacy, and developing local resource guides for where women could access care.  It is anticipated that 14 entities will receive funding in FY20 for planning and assessment and then a subset of funded entities will receive funding in FY21 to implement their developed plan.

J. Partner with UIC Center for Research on Women and Gender to implement a program at two clinic sites to expand the capacity of health care providers in the state of Illinois to screen, assess, refer and treat pregnant and postpartum women for depression and related behavioral health disorders (started in FY19).

The University of Illinois at Chicago's Center for Research on Women and Gender received Title V funding in FY19 to implement a program at two clinic sites to expand the capacity of health care providers in the state of Illinois to screen, assess, refer and treat pregnant and postpartum women for depression and related behavioral health disorders. The long-term goal of the project is to pilot a combination of strategies to increase the capacity of perinatal providers to screen, assess refer, and treat behavioral health disorders, and to increase awareness of and access to affordable and culturally-appropriate services to improve the mental health and well-being of pregnant and postpartum women and their infants in the state of Illinois. The main objectives of this project are: 1) Provide in-person workshop training and resources on screening, diagnosis, and referral for maternal depression and related behavioral disorders to perinatal providers; 2) Provide real-time psychiatric consultation and care coordination for providers; 3) Screen women for depression, anxiety, suicide risk and substance use during the perinatal period using Computerized Adaptive Testing (CAT); 4) Increase access to depression prevention and treatment for medically underserved women using a telehealth intervention; 5) Increase access to substance use treatment for pregnant women; 6) Plan for scale-up and sustainability to implement the project components statewide.

Challenges and Emerging Issues

A development occurring in smaller urban or rural areas in other states, Illinois is beginning to experience a significant challenge in the closing of hospitals or the specific elimination of obstetrical services within hospitals. Since 2014, Illinois has had eleven perinatal hospitals close obstetric services. Ensuring timely access to appropriate levels of obstetrical care is a key priority of Title V. IDPH is in discussions with key partners to develop a study group to better understand the specific factors leading to the decisions to close these units and develop plans to prevent any further closures.

Title V staff will also be looking to implement interventions to address maternal mortality. One such initiative is to host a statewide maternal health summit, convening stakeholders, including community partners, to create a multi-pronged strategic plan to improve maternal health based on the recommendations from the MMRCs. We have incorporated this strategy into the CDC-RFA-DP19-1908 funding opportunity entitled Preventing Maternal Deaths: Supporting Maternal Mortality Review Committees; IDPH was successfully awarded this five-year grant for the 2020-2024 funding cycle.