Women/Maternal Health, Application Year FY 2023

Within the women and maternal population domain key issues emerged from the 2020 needs assessment process and informed the selection of priorities to address maternal morbidity, mental health, and risk factors for preterm birth.

 

Maternal Morbidity

Severe maternal morbidity is more than 100 times as common as pregnancy-related mortality—affecting about 52,000 women annually—and it is estimated to have increased by 75 percent over the past decade. Rises in chronic conditions, including obesity, diabetes, hypertension, and cardiovascular disease, are likely to have contributed to this increase. Minority women and particularly non-Hispanic Black women have higher rates of severe maternal morbidity. Non-Hispanic Black, Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native women had 2.1, 1.3, 1.2, and 1.7 times, respectively, higher rates of severe morbidity compared with non-Hispanic white women (Federally Available Data Resource Document, 2019).

 

Preconception and Maternal Mental Health

Postpartum depression is common, affecting as many as 1 in 7 mothers. It occurs when brief “baby blue” symptoms of crying, sadness, and irritability become severe and result in depressed mood and loss of interest in activities for more than two weeks. Postpartum depression is associated with poor maternal-infant bonding and may negatively influence child development. Universal screening and treatment for pregnant and postpartum women is recommended by the American College of Obstetricians and Gynecologists (ACOG), the American Academy of Pediatrics (AAP), and the U.S. Preventive Services Task Force (Federally Available Data Resource Document, 2019).

 

Preterm Birth

Ohio continues to have high rates of infant mortality, with prematurity as the leading cause of infant death in Ohio. Maternal smoking is implicated in preterm birth and in 2017 Ohio’s rate of women who smoked cigarettes during pregnancy was two times higher than the U.S. rate. Moreover, 25.5% of pregnant women covered by Ohio Medicaid smoked during pregnancy in 2017, nearly twice the rate for Ohio overall. Smoking cessation before and during pregnancy improves infant outcomes.

 

Emerging Issues

Since the completion of the 2020 needs assessment, the COVID-19 pandemic has underscored the importance of the focus on mental health supports for women of reproductive age, as well as addressing the disparities in maternal morbidity and mortality.

 

Priority: Decrease risk factors contributing to maternal morbidity

 

Measures

• NOM 2: Rate of severe maternal morbidity per 10,000 delivery hospitalizations
• SOM: Disparity- Non-Hispanic Black rate of severe maternal morbidity per 10,000 delivery hospitalizations

• NPM 1: Percent of women (18-44) with a preventive medical visit in past year
• ESM: Percent of birthing hospitals that have implemented the AIM hypertension bundle.

 

To address the priority of maternal morbidity efforts must include improving the health outcomes for women before, during, and after pregnancy. The selected NPM relates to leveraging women’s well visits as key opportunities for health intervention and referrals. The SOM was established to measure the disparity in maternal morbidity outcomes. The ESM relates to the priority and efforts to improve safety related to maternal morbidity by standardizing assessment and responses for hypertension, which will contribute to addressing disparate outcomes.

 

Objective 1: By 2025, increase percent of women with a preventative medical visit by 5%.

Strategies:

1. Provide well-woman visits within Title X clinics following ACOG guidelines.
2. Community needs assessment on barriers to pre- and inter-conception care through MP subgrant.
3. Implement culturally relevant community, clinical, or community-based services to address unique pre- and inter-conception issues for women 18-44 through Maternal and Child Health Program (MP) subgrant.
4. Implement education and awareness for pre-conception and reproductive health targeting high-risk women through MP subgrant.
5. Find and review data on quality and comprehensiveness of preventive medical visits as well as feasibility and evidence-based practices for promoting standards (include mental health, health behaviors, dental, social determinants, referrals).
6. Work with partners to develop plan to increase coordination, referral, access, and uptake of high-quality services for at-risk women 18-44.
7. Distribute guidelines on managing oral health care during pregnancy to perinatal and dental care providers.
8. Integrate oral health education, assessment and referrals for dental care into community-based health care systems that serve women of reproductive age (e.g., FQHCs, WIC, Home Visiting).

 

The ODH Reproductive Health and Wellness Program (RHWP) will continue to promote the use of ACOG guidelines for well-women visits in Title X clinics over the next year. To date, the RHWP has included information on ACOG’s well-woman recommendations and articles for providers in program newsletters which is emailed to over 200 Title X staff, as well as updating and publishing the RHWP/Title X Clinical Services and Protocol manual. Additionally, the MCH Bureau Medical Consultant delivered a presentation to over 100 Title X physicians, nurse practitioners, nurses and program directors on the ACOG well-woman and postpartum exam recommendations, Fourth Trimester Project, and data from Pregnancy-Associated Mortality Review during the July 2021 project director meeting. RHWP will offer information on ACOG’s recommendations for postpartum exams during the Jul 2022 project director meeting, include information on ACOG’s well-woman recommendations and articles for providers in program newsletters to Title X staff, update and publish the RHWP/Title X Clinical Services and Protocol manual, and continue to track the number of well-woman visits following ACOG guidelines provided at Title X clinics over the year.

 

The Maternal and Child Health Program (MP) subgrantees are in the process of completing a community health needs assessment on pre- and inter-conception care. There are 18 subgrantees completing community health needs assessment in their respective counties and findings from these needs assessments will be used to address strategies C-F through SFY23 and beyond (Implement culturally relevant community-based or clinical services to address unique pre- and inter-conception issues for women 18-44; Implement education and awareness for pre-conception and reproductive health targeting high-risk women; Find and review data on quality and comprehensiveness of preventative medical visits as well as feasibility and evidence-based practices for promoting standards; Work with partners to develop plan to increase coordination, referral, access, and uptake of high-quality services for at-risk women 18-44). Preliminary findings from the community health needs assessments include services and education focused on the following topics: obesity prevention, healthy eating, active living, improving chronic disease management, improving mental health, community and clinical coordination, screening, and referral, and addressing social determinants of health.

 

During FY 23, the Title V epidemiologist position will be backfilled. The epidemiologist will work on finding and reviewing data on quality and comprehensiveness of preventive medical visits as well as feasibility and evidence-based practices for promoting standards (include mental health, health behaviors, dental, social determinants, referrals). Additional information about our plans to continue to use quality improvement science and partner to increase coordination, referral, access, and uptake of high-quality services for at-risk women 18-44 are also found in the following objectives and in Other Efforts Supported by Title V MCH.

 

The Oral Health Program continues to distribute guidelines on managing oral health care during pregnancy to prenatal and dental care providers through the Integration of Oral Health into Prenatal Care Grant in FY22 and will continue through FY23. The Oral Health Program requires that subrecipients of this grant complete the Pregnancy and Women's Oral Health module that is part of the Smiles for Life curriculum. Subrecipients have been provided educational resources to deliver to both providers and patients. Two agencies are currently being funded to provide oral health assessment, education, and referral and case management to their prenatal patients. Funding for this subgrant program will continue and the program will expand to include three agencies in FY23. Additionally, through another Oral Health subgrant program, funds have been awarded to 3 four agencies/health care systems to provide oral health services to uninsured MCH population from low-income families, which will help to impact this strategy. This subgrant program will continue through FY23. A continuing education module for nurses and nutritionists is in the process of being developed on oral health and pregnancy and will be available to MCH programs, such as WIC and Home Visiting. Oral Health Program staff are in the process of getting the training program uploaded onto the web-based training site, OhioTrain, and Ohio-Approved through OCCRRA by the end of FY22. The oral health and pregnancy continuing education module will be available in OhioTrain for MCH programs to access in FY23.

 

Objective 2: By 2025, reduce the rate of severe maternal morbidity by 12%.

Strategies:

1. Increase use of AIM safety bundles in healthcare systems for at-risk pregnant women.
2. Increase women’s health screenings during pediatric well visits.
3. Develop a statewide strategic maternal health plan through the Ohio Coalition to Address Maternal Health (OH-CAMH).
4. Increase the percent of pregnant and postpartum women who receive urgent maternal warning signs education in WIC, Home Visiting, and Healthy Start programs.
5. Train emergency department providers to recognize, triage, and treat obstetric emergencies.
6. Train maternal health care providers on how to conduct effective telehealth encounters.

 

The ODH Pregnancy-Associated Mortality Review (PAMR) program has implemented the AIM Hypertension has been implemented in 53 participating hospitals across waves 1 and 2. Wave 1 concluded in October of 2021, though wave 1 sites can continue to submit data, attend action period, and coaching calls. Over 840 data submissions of patient encounters with women who have or are at risk for hypertension have been submitted to date. Recruitment for wave 3 implementation of the AIM Hypertension bundle is underway with plans to kick off in summer 2022. The planning for implementation of the AIM Obstetric Hemorrhage bundle is also underway with plans to begin recruitment in late summer/early fall. Wave 3 of the AIM Hypertension bundle and wave 2 of the AIM Obstetric Hemorrhage bundle will continue FY23.

 

The PAMR program subcontracts with GRC to implement the IMPLICIT Network inter-conception care model implementing maternal health screenings for depression/anxiety, folic acid use, smoking/tobacco, and family planning during the pediatric well-visit through quality improvement science methodology. Wave 1 included 9 family and pediatric practices. Wave 1 concluded in early 2022 and has now entered a sustainability phase. Wave 2 kicked off with 20 participating sites in February of 2022 and has seen continued engagement with data collection, submission, and attendance of action period calls. Wave 3 of the IMPLICIT project will kick off in FY23, and wave 2 will enter a sustainability phase.

 

The Ohio Council to Advance Maternal Health (OH-CAMH) is the statewide maternal health task force. OH-CAMH consists of over 82 external organizations working together to implement the co-created OH-CAMH strategic plan. Partner organizations include local organizations, state organizations, national organizations, Title V staff, and patients/families. In FY22, 11 implementation teams were formed to address each of the 11 strategies included within the OH-CAMH Strategic Plan. Volunteer implementation team leads worked to build their teams, assess membership gaps, and develop an implementation plan in September 2021. Two quarterly OH-CAMH general membership meetings took place to continue making progress on OH-CAMH Strategic Plan implementation. Strategic plan implementation will continue throughout SFY23.

 

The ODH PAMR program subcontracts with GRC to implement urgent maternal warning signs education in public health settings. Wave 2 of this project spread to an additional 46 WIC sites, from the original 26 sites in wave 1 for a total of 72 participating WIC clinics. Educational webinars about urgent maternal warning signs, offered by region, were delivered to Wave 2 sites and were very well attended. The planning phase for wave 3 is occurring through the end of SFY 22, Wave 3 will include expanding implementation of this project into ODH Home Visiting sites. Wave 3 kick off in the fall of 2022, with two opportunities for home visitors to attend the UMWS educational webinars throughout FY 23.

 

The PAMR program continues to contract with the Clinical Skills Education and Assessment Center (CSEAC) at The Ohio State University to develop and deliver Obstetric Emergency Simulation Training for Emergency Medicine Provides. The goal of these trainings is to reduce preventable maternal morbidity & mortality in EDs and during maternal transports. Three trainings were conducted in FY22 with 3 more scheduled to occur by September have been conducted to date with very positive feedback from participants and statistically significant improvement of pre- to post-test knowledge of recognizing, treating, and managing various obstetric emergencies. Four abstracts on this project have been accepted by different professional associations at conferences to disseminate scholarly findings. In FY23, additional funds will be allocated to this program to increase the number of trainings that can be provided per year and expand trainings to reach to more providers in rural/Appalachian areas of Ohio. CSEAC will also assess feasibility and need to provide obstetric simulation trainings to first responders in FY23.

 

The PAMR program continues to contract with the CSEAC to develop and deliver Telehealth Delivery Training for Women’s Health providers. The goal of the telehealth trainings is to train women’s health providers to provide sensitive and culturally competent care in a telehealth encounter and increase access to specialty care. Two telehealth trainings have taken place so far in SFY22, with seven trainings targeting Title X providers and staff scheduled to take place from mid-May through the end of August. Pre/post test data from participants have shown a significant increase in knowledge related to using telehealth care and a significant increase self-efficacy related to the different aspects of conducting a telehealth visit with a patient. One abstract on this project has been accepted for presentation at a professional conference and a poster will be presented at the 2022 AMCHP conference. Due to decreased need and interest in these trainings, the telehealth contract will be ending at the end of FY22. Funds originally allocated to this project will be reallocated to the obstetric simulation project mentioned above.

 

Objective 3: By 2025, develop expanded maternal health surveillance to allow for adequate monitoring and tracking to inform programmatic interventions.

Strategies:

1. Expand data collections for COVID-19 for maternal population (SOARS, OPAS, ODRS linking to birth certificate).
2. Enhance surveillance for maternal morbidity through PAMR program.
3. Develop protocols for systemic data into action.

 

BMCFH continues to leverage related surveillance activities to collect additional data on how COVID-19 is impacting Ohio’s MCH population. These activities include continuing to utilize data from the amended the 2020 Ohio Pregnancy Assessment Survey (OPAS; Ohio’s PRAMS-like survey) and the 2020 Ohio Study of Associated Risks of Stillbirth (SOARS) questionnaires to add supplemental questions related to COVID-19. This work will continue through SFY23.

 

The Data and Surveillance section continued the two following projects regarding COVID-19 in pregnancy in FY22. Both projects will continue through FY23.

 

1. BMCFH epidemiology staff continued performing a retrospective data linkage using the Ohio Disease Reporting System (ODRS) and Vital Statistics (VS) data, including birth, fetal death, and pregnancy-associated death certificates and examine outcomes of pregnancies with confirmed SARS-CoV-2 infection. BMCFH Epi staff will calculate frequency of adverse outcomes among women with confirmed cases of COVID-19 infection and will stratify analyses by race.
2. ODH continues to utilize ODRS for COVID-19 to capture data and create files for export to CDC’s Surveillance for Emerging Threats to Mothers and Babies Network (SET NET). Data collection includes identification of pregnant COVID-19 cases within the existing surveillance system, following case-patients until due dates, identifying birth or fetal death certificates within the states vital records system, contacting clinicians for additional information on a random sample of cases, and abstracting relevant information.

 

The Ohio Hospital Association (OHA) is the agency that collects severe maternal morbidity (SMM) data from Ohio hospitals. ODH PAMR requests this data from OHA and performs analyses. The latest SMM data report was published on ODH’s website in FY22. The ODH PAMR program is in the process of requesting updated data from OHA and will plan to analyze and publish an updated data report in FY23.

 

Stakeholders across the Maternal, Child, and Family Health Bureau at ODH will develop a plan/process to routinely review program data within the Bureau and disseminate it internally at ODH to inform programming by the end of FY22. Key objectives of this process will be to set up an internal process to map the end results of surveys and to streamline data sharing and dissemination internally and externally. Implementation of this plan will occur in by SFY 25.

 

Priority: Increase mental health support for women of reproductive age

 

Measures

• NOM 24: Percent of women who experience postpartum depressive symptoms following recent live birth.
• SOM: Percent of women (18-44) with 14 or more mentally distressed days in past month (OMAS)

• SPM: Percent of women (18-44) with unmet mental health care or counseling services need in past year (OMAS)
• ESM: None developed at this time.

 

The need to address mental health for women of reproductive age, pregnant and postpartum is reflected in the selection of outcome and performance measures for both subsets of the population of women.

 

Objective 1: By 2022, develop plan to increase coordination, referral, and uptake of mental health services for women 18-44.

Strategies:

1. Develop plan in coordination with other state agencies to increase coordination, referral, and uptake of mental health services for women of reproductive age.
2. Continue to build trauma informed care into interventions in community-based settings for mental health.
3. Continue screenings for mental health/ substance abuse and provide referrals through Title X program.

 

The OH-CAMH Strategic Plan consists of 11 draft strategies to improve maternal health outcomes in Ohio. Strategy 8 within the OH-CAMH Strategic Plan is focused around maternal mental and behavioral health in Ohio and is co-lead by a BMCFH staff member who is partially funded by the Title V Block Grant. In FY22, OH-CAMH Strategy 8 continued to build a strong team of stakeholders from across Ohio to accomplish this objective. This team consists of individuals from the Ohio Hospitals Association, community-based organizations, the Ohio Practitioners' Network for Fathers and Families, advocacy organizations, the Ohio Children’s Trust Fund, and the Ohio Association of Community Health Centers. IN FY22, this team worked together to identify key action steps needed to improving coordination, referral, and uptake of mental health services for women of reproductive age throughout the state. In FY23, the Strategy 8 team will invite the Ohio Mental Health and Addiction Services (OhioMHAS) and Ohio Department of Medicaid (ODM) to join the team, and plan to explore leveraging an existing funding opportunity from OhioMHAS to support this work. Additionally, Strategy 8 co-leads to streamline and synergize work that comes from the new Maternal Mental Health Task Force OhioMHAS intends to initiate in FY23.

 

The ODH Sexual Assault and Domestic Violence Prevention (SADVP) program finished delivering trainings for community health centers, on trauma-informed care, intimate partner violence and human trafficking in partnership with key stakeholders (e.g., Ohio Domestic Violence Network, Ohio Association of Community Health Centers) throughout the state in FY22. To continue building trauma informed care into interventions in community-based and state agency settings for mental health, staff from the ODH SADVP program lead the OH-CAMH Strategy 7 team, which focuses on promoting organizational shifts in culture that support a trauma-informed approach to clinical and public health services. This group consists of external stakeholders throughout the state to accomplish this goal. The ODH SADVP program also convened the Adverse Childhood Experiences (ACEs) workgroup at ODH to provide technical assistance, training, and organizational development for ODH programs and employees. Both groups will continue to work together through FY23 to implement this work in community-based settings. 

 

The ODH RHWP continues to implement best practices regarding screening for mental health and/or addiction issues (e.g., Edinburgh Screening tool, ASBI). Every client has a Reproductive Life Plan (RLP) and is screened for mental health needs. If needed, clients are referred for appropriate care. A process and outcomes tracking system has been developed to document and ensure monitoring and oversight of screening and referrals to providers in the areas of substance abuse, children’s services, social services, domestic violence, mental health, primary care, and insurance enrollment assistance. To continue encouraging care coordination and quality assurance of linkages of women to care, all FY23 subrecipients will continue to be required to be co-located with a primary care provider or have formal agreements with a primary care provider.

 

Objective 2: Increase access, referral, and coordination of mental health services for pregnant and postpartum women 18-44.

Strategies:

1. Implement culturally relevant peer support behavioral health services for high risk pregnant and postpartum women through MP subgrant.
2. Implement programs and strategies to decrease alcohol use during pregnancy.
3. Continue Practice and Policy Academy participation to inform implementations of plans of safe care.
4. Increase women’s postpartum depression/anxiety screening during pediatric well visits.
5. Implement the Women’s Behavioral Health Support Learning Collaborative

 

Six subgrantees of the MP grant are in the process of implementing their approved comprehensive plans to accomplish the following:

• Increase the number of peer support personnel working with pregnant and postpartum women to improve their mental wellness.
• Increase the number of screenings for behavioral health to pregnant and postpartum women.
• Increase the number of referrals for pregnant and postpartum women to behavioral health services.
• Increase the behavioral health knowledge of personnel who work with pregnant and postpartum women by attending educational and training events.

 

This subgrant program will continue through the end of FY23.

 

The ODH Fetal Alcohol Spectrum Disorders (FASD) program will implement a multi-media campaign to increase awareness of the impact of alcohol-exposed pregnancies, collaborate with agencies to establish resources, coordinate interventions, and diagnostic services for families affected by FASD. A contract was established with the Ohio Hospital Association to receive data on the number of infants born with FASD in Ohio as indicated by ICD-10 codes. Over the coming year, the FASD program will evaluate this data and use it to inform future programming. Additionally. FASD Prevention brochures have been sent out to WIC clinics, Safe Sleep subgrantees, and Baby and Me Tobacco Free subgrantees. FASD prevention information has been shared with OEI, HMG, and adolescent health programs within the Bureau.

 

ODH Home Visiting staff and Birth Defects Surveillance Coordinator continue to be  members of the Practice and Policy Academy. Staff participated in a joint presentation to Plans of Safe Care county-level groups of over 150 people, focused on early childhood systems, and how home visiting can support families with a Plan of Safe Care. Additionally, ODH Home Visiting will continue to be a member of the Education Subcommittee of the Practice and Policy Academy who put together a professional guidance resource document for professionals in the field. The group is also working on developing a website with implementation resources for local communities. There is no end date for implementation, the Plans of Safe Care work with be ongoing.

 

For information about how ODH PAMR program is working to increase women’s postpartum depression/anxiety screening during pediatric well visits, please refer to Strategy B under Objective 2: By 2025, reduce the rate of severe maternal morbidity by 12%.

 

The Gestational Diabetes QIP implementation came to an end between Q2 and Q3 of SFY22 and a new QI project titled, “Women’s Behavioral Health Learning Collaborative” was initiated using lessons learned from the Gestational Diabetes project. The Women’s Behavioral Health Support Learning Collaborative project is a quality improvement project aimed at improving health outcomes for women of childbearing age by implementing best practice mental health interventions in a primary care setting with a specific focus on health equity. Project planning activities for this project continued through FY22, including developing onboarding materials, project curriculum, developing a data plan, hosted a kick-off call, and finalizing data use agreements with 23 participating sites. Project planning activities will continue through FY22 with implementation occurring in FY23.

 

Priority: Decrease risk factors associated with preterm birth

 

Measures

• NOM 5: Percent of preterm births (<37 weeks)

• SPM: Percent of women (18-44) smoking in reproductive age
• ESM: Percent increase in enrollment of high-risk populations in evidence-based home visiting programs

 

The risk factors associated with preterm birth include and extend beyond interventions for pregnant women. The selection of the SPM for smoking among reproductive age women aligns with the need to address smoking before women become pregnant to complement the existing efforts to identify and support pregnant women in quitting during pregnancy. Home visiting services targeted at high-risk pregnant women can improve birth outcomes and the ESM will measure efforts contributing to addressing the priority.

 

Objective 1: By 2025, reduce the proportion of women of reproductive age smoking by 15%.

Strategies:

1. Develop plan to re-engage partnerships and identify strategies for addressing smoking use among women of reproductive age (including 5 A’s strategies and provider training through RHWP, WIC, HV, TUPCP).
2. Improve cross-referrals among programs addressing tobacco use (e.g., Quit Line refer to Baby and Me Tobacco Free).
3. Identify and leverage cross promotional/marketing opportunities (media, partner, collaborations.
4. Continue to provide supports for pregnant women to quit smoking through Moms Quit for Two program.

 

The Tobacco Use Prevention and Cessation Program and BMCFH continued meeting bi-monthly to share programmatic updates and identify strategies for addressing smoking use among women of reproductive age. The following programs will continue to work together over FY23 to develop a plan to streamline strategies for addressing smoking among women of reproductive age and identify and leverage cross promotional/marketing opportunities:

• Asthma Program
• Home Visiting Program
• Oral Health
• Mom’s Quit for Two
• Reproductive Health and Wellness Program (RHWP)
• FASD
• MP (Maternal and Child Health Program)
• Tobacco
• WIC
• Safe Sleep/Cribs for Kids

 

By the end of SFY 22, a smaller working group of the BMCFH Women and Maternal Health will convene to explore how cross-referrals among programs to address tobacco use currently occurs and how this process may be enhanced. Once this plan is developed, it will be implemented by SFY 25.

 

The ODH Perinatal Smoking Cessation program is a statewide project that provides information through media campaigns, technical assistance, and resources. The program also funds implementation of the evidence-based model Baby & Me Tobacco Free through the Moms Quit for Two subgrant. The subgrant currently funds 18 entities throughout Ohio to provide support and resources for pregnant women to quit smoking. In FY22, one subgrantee withdrew from the program due to low recruitment. This grant program will continue throughout FY23 with modified deliverables aimed at increasing recruitment and enrollment into the program.  

 

Objective 2: By 2025, increase enrollment of high-risk populations in evidence-based home visiting programs by 10% each year.

Strategies:

1. Implement home visiting services for at risk pregnant and post-partum women.

 

The four Home Visiting models, Healthy Families America (HFA), Nurse Family Partnership (NFP), Parents as Teachers (PAT), and Moms & Babies First (MBF), all serve at-risk pregnant and post-partum women. In FY22, the Home Visiting program accomplished the following:

1. OAC Home Visiting rule went into effect for home visiting and major changes included:
   1. Expanded eligibility to 24 months and expanded services to 5 years.
   2. Added flexibility for home visiting workforce to align with home visiting model specifications.
   3. Removed risk factors for determining eligibility.
2. ODH completed a training, in collaboration with the Ohio Department of Job and Family Services (ODJFS) and the Ohio Department of Developmental Disabilities (DODD), on how and why families should be referred for Early Intervention and/or Home Visiting Services. In November 2021, ODH started a Continuous Quality Improvement Project in 5 counties working with the Public Children’s Services Agency (PCSA) and the Home Visiting Central intake and Referral vendor to increase the quality and volume of referrals sent from PCSAs.  Referrals from PCSAs have increased from a monthly average of 399 in SFY 21 to 527 so far in SFY 22; an increase of 24%. Nurse Family Partnership expanded eligibility in some programs to allow multiparous (more than one pregnancy) women, and women beyond the 28th week of pregnancy to enroll (traditional NFP enrolls first time pregnant women up through the 28th week).
3. ODH has supported the Nurse Family Partnership programs with the cost to expand their eligibility (NFP fees and training) through Help Me Grow Bright Beginnings (Dayton region), the Center for Family Safety and Healing (Columbus region) and through the Educational Service Center of Eastern Ohio (Mahoning region).  All teams had staff trained during the last nine months and are currently enrolling women under the new criteria.
4. Beginning in April 2021, ODH expanded Parents As Teachers services into several new counties.

 

In FY23, the Home Visiting program will design and implement expansion grant applications and funding to support local organizations will the start-up costs of implementing evidence-based home visiting services with the goal of adding 400 slots. The Home Visiting program will also begin leveraging federal Medicaid funding and Title IV-E Families First Funding to support evidence-based home visiting services. Additionally, the program will work to increase access to Nurse Family Partnership in 5 new counties

 

Other Efforts Supported by Title V MCH

The majority of MCH programs are represented within the application narrative above. Several program summaries are included below to highlight additional relevant programs and a complete list of programs serving the Women population is available in the Program Map (section V. Supporting Documents).

 

Ohio Equity Institute (OEI)

The Ohio Equity Institute: Working to Achieve Equity in Birth Outcomes is a grant-funded collaboration between the Ohio Department of Health and local partners in nine counties to address the racial inequities in birth outcomes. OEI addresses disparities in prenatal, infant, and maternal health through downstream (neighborhood navigators identify and connect priority prenatal population to clinical and social services) and upstream (facilitate development, adoption, or improvement of policies and practices that impact social determinants of health related to pre-term birth and low birth weight, including reducing barriers to accessing clinical social services by improving quality, availability, and cultural competence of service delivery, and working with local leadership who can adopt policies) strategies. The nine counties implementing OEI include: Butler, Cuyahoga, Franklin, Hamilton, Lucas, Mahoning, Montgomery, Stark, and Summit. Goals of this project include the reduction of low birth weight, very low birth weight, preterm birth and very preterm birth among Black women served in OEI counties.

 

Ohio Connections for Children with Special Needs (OCCSN)

Ohio Connections for Children with Special Needs (OCCSN) is Ohio’s statewide population-based birth defects surveillance program. The Ohio Revised Code 3705.30 authorizes the state director of health to require hospitals, physicians, and freestanding birthing centers to report children from birth to 5 years of age with certain reportable birth defects to the Ohio Department of Health (ODH). Collection of birth defect data is important for public health action, including facilitating referrals to services such as early intervention and targeting prevention strategies. The OCCSN program includes activities in four major areas: surveillance of birth defects, analysis of surveillance data, referrals to early intervention services, and awareness and prevention activities.

 

Comprehensive Genetics Services Program

The Genetics Services Program funds a network of eight genetic centers that provide comprehensive care and services to people affected with, or at risk for genetic disorders. The purpose of the program is to ensure availability of quality, comprehensive genetic services in Ohio. Genetic services include, but are not limited to genetic counseling, education, diagnosis and treatment for genetic conditions and congenital abnormalities. Persons in Ohio who would like genetic counseling, or other genetic treatment services, may contact one of the Comprehensive Genetic Centers (CGC), or may be referred by their primary care physician. The goals of the Comprehensive Genetic Centers (CGCs) are to ensure that children and adults with, or at risk for birth defects or genetic disorders and their families receive quality, comprehensive genetic services that are available, accessible, and culturally sensitive; and providers, the general public and policy makers are aware and knowledgeable about birth defects, genetic conditions, genetic disease related services in Ohio.