Women and Maternal Health Application Year 2026

The state priorities of improving mental health and decreasing substance use among pregnant and postpartum Vermonters and building safe and supported communities expand upon the work that Vermont has been engaged in over the last several years, while digging into the critical and emerging needs of women and their families. In addition to the universal postpartum visit measure, Vermont has selected two SPMs to further support the priority needs identified: 1) the percentage of pregnant Vermonters screened and connected to community-based resources for perinatal substance use; and 2) the number of FCH providers who received training on IPV universal education and response in the past.

The Postpartum Visit and Its Care Components

To support the reproductive health and perinatal workforce, VDH is partnering with Pregnancy Intention Initiative (PII) to coordinate a symposium to address emerging issues and realign efforts across programs. This event is an opportunity to support our new Women/Maternal Health Title V Measures. The universal postpartum visit measure includes contraceptive counseling, mental health, and substance use screening during the postpartum visit as care components. This event will fulfill our strategy measure: the number of Home Visiting Program staff, community partners, healthcare providers trained and equipped to provide postpartum care education, screening, referrals, and follow-up, with a focus on perinatal mental health and contraceptive use.

FCH leadership continues to serve on several statewide steering groups, including the Blueprint PII, which helps ensure that healthcare providers, Patient Centered Medical Homes, and community partners have the resources they need to support healthy pregnancies and build thriving families. The initiative focuses on several key domains, including best practice approaches to contraceptive counselling, substance use and mental health screening, brief intervention and referral, intimate partner violence screening and referral, and food insecurity. The coordination and collaboration with PII are critical as we continue to assess the impact of the pandemic on the healthcare service landscape, especially in rural communities. In the coming year, Vermont will continue to collaborate with the PII, especially related to identifying and training on best practice tools to support clinical and community providers' approaches to PMADS and SUD screening and referrals, and contraceptive use counselling.

There is program-level data through home visiting that will help inform our understanding of the current landscape. PQC-VT also has data available to assess efforts related to this EBSM. Some of the areas we plan to explore to help inform our baseline understanding include:

• The current landscape related to the timing of the postpartum visit.
• The current practices related to postpartum contraceptives. 
• Which models of contraceptive counseling are currently being used.

By the end of 2026, FCH will work with partners, such as PII, to host trainings for home visiting program staff, community partners, and healthcare providers related to postpartum care education, screening, referrals, and follow-up related to perinatal mental health and contraceptive use. Activities identified for 2026 include:

• Collaborate with PQC-VT and home visiting programs to establish a baseline understanding of current data and approaches to the postpartum visit and recommended care components.
• Collaborate with VCHIP to assess and monitor PMADS and SUD screening.
• Research and promote the use of evidence-based contraceptive counseling tools, such as Bedsider, SINC, etc.
• Identify and train home visiting program staff and community partners in current best practice approaches to the perinatal mental health and contraceptive use components of the postpartum care visit.
• Identify and train healthcare providers in current best practice approaches to the perinatal mental health and contraceptive use components of the postpartum care visit.

Perinatal Consultation Access Referral Education and Screening (CARES)

In June 2024, Vermont was awarded a four-year, four-month Maternal Mental Health and Substance Use Disorders (MMHSUD) cooperative agreement from HRSA, which is our second round of HRSA funding focusing on perinatal mood and anxiety disorders. In 2026, we plan to continue partnering with VCHIP’s Perinatal Quality Collaborative (PQC-VT) on a screening and referral project centered at Porter Hospital’s obstetric and pediatric practices. By 2026, the screening and referral project will be well underway, and we hope to have workflows articulated and to begin sharing our learning with other UVM Health Network practices across the state. We expect the electronic health record work to continue to progress and share that learning as well. In partnership with the Porter practices, VCHIP plans to collaborate with the Vermont Consultation and Psychiatry Access Program (VTCPAP) and Help Me Grow to continue to refine which referrals are appropriate for each service.

In 2025, we selected our two new community-based doula programs (CBDP) to bring the total to four. 2025 was a time of building infrastructure, training additional doulas, and working with the Office of Professional Regulation (OPR) on potential Medicaid reimbursement for CBDPs. In 2026, we plan to continue this work and hopefully provide additional doula services to perinatal Vermonters with health related social needs. We will continue to be a resource to OPR as the process for potential Medicaid reimbursement moves forward. Currently, the earliest CBDPs may be able to begin receiving Medicaid payments in summer 2027, but the final decision is up to the legislature and the Vermont Department of Health Access.

We will continue to explore and field training in partnership with our Maternal Health Innovation (MHI) cooperative agreement leadership at FCH and will continue to utilize the MHI needs assessment and strategic planning process to better understand provider education and training needs and preferences.

Vermont Consultation and Psychiatry Access Program (VTCPAP) Perinatal Service

In 2026, the VTCPAP will continue as a joint perinatal and pediatric program. We will continue our strategic planning and fiscal sustainability efforts. We intend to continue our training efforts related to perinatal mood and anxiety disorders (PMADs) both through subject matter experts in Vermont, including the perinatal psychiatrist, Dr Sarah Guth, and FCH Perinatal CARES leadership, and, if funding is available, national training opportunities such as with Postpartum Support International and on other topics in perinatal mental health.

We will continue our joint outreach efforts with the pediatric service and also outreach to providers across the state who care for perinatal people. Dr Guth offers lunch and learns, grand rounds sessions, and other learning opportunities to increase knowledge of the service and to entice providers to call for consultation. Two talks in 2025 that garnered quite a bit of interest were: Use of Stimulants in the Perinatal Population in June 2025 and lunch and learn sessions on Zuranolone, a novel treatment for PMADs.

Under the combined program, the perinatal service gained access to the liaison coordinators (LC), LICSW-trained clinicians who support practices in accessing resources and referrals for patients, including mental health clinicians with child and/or perinatal mental health expertise. As calls to the service increase with continued outreach, we intend to utilize Perinatal CARES funding to hire additional LC support for the program.

Substance Use in Pregnancy

To address the priority need of improving mental health and decreasing substance use among pregnant and perinatal Vermonters, the Title V SPM is the percentage of pregnant Vermonters screened and connected to community-based resources for perinatal substance use. The efforts outlined below highlight the primary activities to address this SPM in the application year.

Vermont’s high rates of substance use (SU) in pregnancy—including use of alcohol, tobacco, cannabis, and other substances —compared to other states, have forced us to look more deeply at our messaging and strategies to support perinatal providers, pregnant Vermonters, and their circles of support. FCH is supporting the integration of clinical and community-based care to coordinate approaches across clinical obstetrical care, Strong Families Vermont home visiting, WIC, community-based doulas, lactation resources, and other home visiting supports. Additionally, results of a qualitative study around the birthing experiences of perinatal Vermonters with substance use disorder and the participation of the PQC-VT Patient and Family Advisory Committee will guide the development of interventions and educational materials.   

FCH and the PQC-VT will work collaboratively with clinical, community, and state partners to address the widespread stigma and bias negatively impacting perinatal Vermonters with substance use disorders to increase comfort with disclosing use and accepting supports. The PQC-VT and FCH are supporting the implementation of the Alliance for Innovation in Maternal Health’s Care for Pregnant and Postpartum Vermonters with Substance Use Patient Safety Bundle to increase SU screening and referral. Updates to the Family Care Plan and a virtual platform will support the coordination of services between clinical obstetrical care and the SFV nurse home visiting program and other community resources. Additionally, the PQC-VT and the FCH division are updating guidance and implementing or supporting existing local interdisciplinary teaming for Vermonters with perinatal substance use through the CHARM/Community Response Team approach.   

The FCH program and communications staff continue to work jointly with the Division of Substance Use Prevention, and the tobacco control program (part of the Health Promotion and Disease Prevention Division) to help perinatal care providers in Vermont educate and support their patients to lower the rates of substance use in pregnancy through the  “One More Conversation,” campaign.

FCH staff, PII, and the Division of Substance Use continue to collaborate on reducing rates of maternal substance use and increasing access to community-based supports during pregnancy and postpartum periods.

Vermont Title V areas of focus for the coming year consist of:

• Aligning with the PQC-VT and AIMs maternal substance use projects (see Perinatal-Infant Action section)
• Developing and elevating the voices and experiences of birthing Vermonters with substance use disorder
• Aligning FCH and PQC-VT activities with the Maternal Mortality Review Panel perinatal substance use prevention recommendations
• Working with WIC, Strong Families Vermont (SFV) nurse home visiting, and community-based doula programs to ensure all clients have access to substance use resources/referrals through,
  • Distribution of educational and promotional materials for all WIC clients
  • Regular chart audits of WIC clients to assure appropriate referral and follow-up
  • Regular review of SFV MIECHV screening and referral metrics to assure appropriate screening, referral, and follow-up
  • Supporting community-based doulas to screen and refer for maternal substance use
  • Integrating PQC-VT maternal substance use educational modules into WIC, SFV, and doula training
• FCH staff working with clinical and community care partners, through the following:

• Regional FCH coalitions promote messaging around the risks of substance use during the perinatal period and resources.
  • Regional FCH Coordinators share One More Conversation materials with partners.

Quality Improvement Projects with Obstetric and Neonatal Providers

Through our partnership with VCHIP and the PQC-VT, we will improve perinatal care and quality by:

• Facilitating the receipt and submission of data from each hospital in the state for Alliance for Innovations in Maternal Health (AIM) related to the implementation and outcomes of the Postpartum Hemorrhage and Hypertension and Care for Pregnant and Postpartum Vermonters with Substance Use Patient Safety Bundles
• Exploring statewide severe maternal morbidity rates and benchmark information against nationwide data, and exploring obstetric interventions and outcomes at the University of Vermont (UVM) Medical Center and community hospitals
• Provide four educational webinars for obstetrical clinical and community-based providers on clinical practice updates and quality improvement.
• Engaging with the Maternal Mortality Review Panel (MMRP) to create recommendations for the prevention of maternal death. Collaborating with the MMRP, the PQC-VT has set perinatal substance use and mental health as key priorities informing all PQC-VT projects. 

Injury and Violence Prevention

Vermont supports a robust body of work to build safe and supported communities. Work in the injury and violence prevention space continues to expand in new and exciting ways, particularly for women and maternal health. This includes a new state performance measure to increase the number of FCH providers who receive training on intimate partner violence (IPV), universal education, and response. Our efforts in this area also include the Maternal Mortality Review Panel’s convening and legislative report.

Maternal Mortality Review Panel

VDH received CDC’s Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM) funding in 2023 to support the activities of the MMRP and engage in the use of the Maternal Mortality Review Information Application (MMRIA) to better collect, document, and disseminate perinatal mortality data. The Obstetrical Department at the University of Vermont Medical Center received HRSA AIMs funding in 2023 to support the planning, implementation, and maintenance of patient safety bundles.  The FCH division received Overdose Data to Action funding for prevention of perinatal substance use, which it has been using to support community-based organizations to enhance supports. Additionally, Vermont received the HRSA Maternal Health Innovations grant in 2024, with the goal of further integrating perinatal health policy, systems, and supports at the state and regional levels.

FCH has sustained a full MMRP team with a clinical abstractor, panel coordinator, and dedicated analyst in place. In the CDC five-year grant cycle, the MMRP will focus on incorporating the life stories of the deceased we review, using informant interviews to more fully allow the panel to understand the lives we review. Additionally, we will be developing and implementing a data dissemination plan for clinical and community partners as well as the public to gain an understanding of the picture of maternal death in Vermont, panel recommendations for prevention, and strategies for combating preventable perinatal death at the clinical, community, policy, and individual levels. And lastly, we are prioritizing broadening the voices of lived maternal morbidity and community-based organizations on the panel.  

Sexual and Domestic Violence Prevention

The efforts outlined below highlight the primary activities aimed at addressing this SPM in the application year. We will continue our systemic work to prevent domestic and sexual violence in partnership with home visitors, FCH Coordinators, and other agency and community partners. Efforts include:

• Sustain the Connected Parents, Connected Kids evidence-based training from Futures without Violence on domestic violence and home visiting. Additional work is needed to ensure that home visitors receive ongoing support and that all new home visitors can build this competency on an ongoing basis. See the Perinatal/Infant section for more info.
• Regional FCH Coordinators participate in local domestic sexual violence community response and/or prevention teams. In the application year, we will assess how this work is progressing and document what the current priorities include.
• FCH staff participates in the statewide Domestic Violence Fatality Review Commission, the Sexual Assault Nurse Examiners Board (SANE), the AHS Domestic and Sexual Violence Steering Committee, and the Vermont Council on Domestic Violence.
• FCH staff participate in workgroups, including the DCF Human Trafficking Workgroup and the SafeKids Vermont Firearm Safety Workgroup.
• Continue to advocate for domestic and sexual violence surveillance through the incorporation of questions into the Behavioral Risk Factor Surveillance System (BRFSS) and other statewide surveys.
• Continue to develop and foster community partnerships to enhance programming and resources related to built environment violence prevention strategies.
• Continue to develop and foster community and state agency partnerships to enhance services and resources for families impacted by the justice and carceral system.

Oral Health in Pregnancy

Oral health during pregnancy will continue to be an area in which FCH partners with HPDP and the Office of Local Health. Ongoing strategies include:

• Supporting the Oral Health team and the Public Health Dental Hygienist program
• Disseminating oral health materials through WIC and Strong Families Vermont
• Promoting expanded Medicaid benefits and best practices for women and infants

Please note: Only those strategies that link with national and state performance measures are identified in the Action Plan Table for this section.