Women and Maternal Domain Plan for FY2024

Priority:

Promote mental wellness and resilience through increased access to behavioral health and other support services.

 

State Performance Measures:

Substance use during pregnancy.

 

Provider screening of pregnant women for depression.

 

Objective:

By September 30, 2024, and in partnership with the Child Welfare Division at the Department of Children, Youth, and Families, WithinReach and the Washington State Hospital Association, implement the state’s new portal and policy for infants who are born substance exposed, including promotion of supports for the substance-affected mother/infant dyad.

 

Strategies:

• Provide training for clinical staff providing care at birthing hospitals.

 

• Support efforts to address and mitigate individual and community effects of substance use.

 

• Build on efforts to identify the scope of impacts of substance use, including inequities, at the local and state level.

 

• Improve the care of infants with neonatal abstinence syndrome (NAS) and neonatal opioid withdrawal syndrome (NOWS). 

 

In response to the Opioid Epidemic, Washington State created a state Opioid Taskforce and an Opioid and Overdose Response Plan (WA State - Opioid Response Plan). The Pregnant, Parenting, Children and Families (PPCF) workgroup is connected to the state's taskforce and works to address the impact of substance use on families. The MCHBG partially funds the coordination of this workgroup.

 

The workgroup's current initiatives intend to transform our systems of substance use care so parents can receive treatment without being separated from their children. During pregnancy/birth/postpartum, this means:

• Transforming prenatal care so anyone pregnant and using substances can easily get into prenatal care and substance use care, regardless of their ability to stop using substances or the stage of their pregnancy.
• Transform the provision of care at birth:
  • Make sure mothers/birth parents who are stable in recovery at birth room in with their babies and provide non-pharmacological supports for infant withdrawal.
  • Mothers/birth parents who aren’t stable in recovery at birth can receive MOUD/withdrawal support/substance use treatment at the birthing hospital with their baby and then be directly transferred to residential/outpatient treatment without being separated from their baby.
• Streamlined access to intensive outpatient treatment models that provide housing and/or residential treatment that allows parents to bring their children with them.
  • Residential treatment models need to be in more communities and be able to accommodate fathers/partners and more children.
• Housing access:
  • Residential treatment wait times are currently 4-6 weeks, parents and children need housing while they wait to go to treatment. (Some LHJs are reporting they are putting people in hotels while they wait for treatment beds.)
  • Direct transfer to permanent housing when discharging from outpatient treatment/residential treatment. Transitioning to dyadic or couplet care at birth.
• Expanding hospital inpatient days and creating Medicaid payment for services.
• Establishing best practices, including withdrawal/stabilization care for mothers/birthparents and eat/sleep/console for infants.
• Increasing collaboration and communication between child welfare, birthing hospitals, and parents, when families are child welfare involved.
• Connecting families to services.
• Educating families and providers on harm reduction strategies for substance use and what to do for an overdose.

Projects we are supporting as we work to implement these changes are:

• Partner with the Health Care Authority to create payment structures for withdrawal/stabilization care at birth for mothers and birth parents using substances.
• Provide training and TA support for care providers disseminating the best practice lactation with substance use guidelines that DOH published in June 2023.
• Convene housing experts to strategically plan and develop cost estimates for a housing program for families impacted by substance use.
• Cross-walk the policies identified through the PRISM workgroup with PPCF’s priorities.
• Convene the PPCF workgroup and maintaining the statewide website.
• Looking at policy changes needed to support birthing hospitals to dispense naloxone to all parents discharged after delivery.
• Resource WithinReach to build a self-referral portal, so mothers and birth parents who use substances during pregnancy can access a plan of safe care services during pregnancy.
• Support WithinReach and the Department of Children, Youth, and Families (DCYF) in training clinicians at birthing hospitals about Washington’s new policy and program for mandated reporters so they know if a notification or report is needed when an infant is born substance exposed.

 

 

Objective:

By February 1, 2023, submit a revised maternal mortality review panel report to the Washington State Legislature, covering the deaths that occurred to women during pregnancy or within one year of pregnancy, inclusive of deaths resulting from suicide, substance overdose, homicide, and deaths that occurred out of state, and covering data from 2014-2020. The report will include the identification of gaps and issues contributing to preventable, pregnancy-related deaths in the maternal behavioral health system and recommendations for improvement. Recommendations will address disparities and health equity improvements to reduce maternal mortality and include contributions from our tribal and Indigenous partners.

 

The report has been published, and we will continue to work on implementing its recommendations, as detailed below.

 

Objective:

Through September 30, 2025, building from the completion of the revised maternal mortality review panel report to the Washington State Legislature, DOH staff will share the findings widely with partners and community members around the state and participate in conversations about ways to involve community members in implementing recommendations. DOH will also include applying lessons learned from the AIHC listening sessions in our work to implement the report’s recommendations.   

 

Strategies:

• Support interventions to address suicide ideation among pregnant and parenting people.

 

• Support efforts to address and mitigate individual and community effects of substance use.

 

• Promote standardized depression, anxiety, and substance use screening across the life course.

 

• Build on efforts to identify the scope of impacts of substance use, including inequities at the local and state level.

 

• Increase and improve reimbursement for behavioral health care from preconception through all phases of pregnancy and the first year postpartum, including screening, treatment, monitoring, and support services.

 

• Take action to reduce stigma surrounding behavioral health conditions, treatment, and related challenges.

 

• Implement trauma-informed services into community services, health care systems, and the public sector.

 

• Explore implementation of Maternal Levels of Care in Washington state.

 

In 2016, the Washington State Legislature (RCW 70.54.450) mandated DOH to convene a multidisciplinary review panel to conduct comprehensive reviews of deaths that occur within a year of pregnancy, regardless of cause. The goal of the maternal mortality review panel (MMRP/Panel) is to understand the root cause of maternal mortality and morbidity and the inequities therein, so DOH and partners can identify and implement strategies and activities to prevent these tragic deaths and improve perinatal care for all people and families in the state. The MMRP comprises of clinical and non-clinical professionals from across Washington and from diverse racial/ethnic, geographic, and professional backgrounds. Members include perinatal psychiatrists, addiction medicine providers, perinatal social workers, community organizations, patients, and patient advocates.

 

To meet these goals, the department and MMRP work to identify all deaths that occur within a year of pregnancy, determine which of those deaths are preventable pregnancy-related deaths, determine underlying causes of preventable deaths, identify the issues and factors that contributed to them, and make recommendations to prevent such deaths in the future. The panel and the department use analyses of data and findings to prioritize evidence-based recommendations for health care and systems changes. The department submits those findings and recommendations to policymakers for consideration in a legislative report every 3 years.

 

To date, the Panel has reviewed maternal deaths from 2014-2020. This includes deaths from substance overdose, suicide, and domestic violence. The most recent report, published in February 2023, included findings from deaths through 2020. This report’s findings included:

 

From 2014–2020, 224 people died within one year of pregnancy. Of these deaths, 97 were determined to be pregnancy related. The Panel determined 80% of pregnancy-related deaths were preventable—a high percentage that reflects the Panel’s growing understanding of clinical, social, and systems factors that can be changed to help prevent pregnancy-related deaths.

 

There were 15.9 pregnancy-related deaths per 100,000 live births from 2014–2020 in Washington, lower than the U.S. rate of 18.6 pregnancy-related deaths per 100,000 live births in this timeframe. Leading underlying causes of pregnancy-related deaths were behavioral health conditions (32%), predominantly by suicide and overdose. Other common causes included hemorrhage (12%) and infection (9%).

Most pregnancy-related deaths occurred after the end of pregnancy:

• 27% occurred during pregnancy
• 11% occurred during delivery
• 31% occurred 2–42 days after pregnancy
• 31% occurred 43 days to one year after pregnancy

 

Disparities persisted, with communities of color, rural communities, and people with Medicaid coverage bearing a disproportionate burden of maternal mortality. The Panel identified discrimination, bias, and interpersonal or structural racism in 49% of preventable pregnancy-related deaths from 2017–2020. The rate of all pregnancy-associated deaths for non-Hispanic Black/African American people and non-Hispanic Native Hawaiian and Pacific Islander people was more than 2.5 times the rate of death among non-Hispanic White people. Among non-Hispanic American Indian and Alaska Native people, it was 8.5 times greater than the rate of death among non-Hispanic white people.

 

Factors identified by the MMRP to have contributed to preventable deaths from behavioral health conditions included:

 

• Gaps in clinical skills and quality of care contributed to the high percentage of preventable maternal deaths, including gaps in recognizing and responding to obstetric emergencies.

• Lack of screening or appropriate follow-up for risk factors such as behavioral health conditions, violence, and insufficient social support
• Lack of care coordination or continuity of care
• Lack of access to health care and behavioral health treatment
• Issues of bias and discrimination affecting referrals and use of clinical standard procedures

Contributing factors were exacerbated by social and structural determinants of health, such as housing instability and systemic racism.

 

Work has already begun to publicize the findings and recommendations of the report and spark conversations about implementing the recommendations based on these findings. However, this work has only recently started since the report was released in February 2023. There has been high interest among the public and partners in the increased percentage of pregnancy-related deaths considered to be preventable, particularly in how this reflects an improved understanding of preventability and the opportunity to take action.

 

Additionally, more work is needed to continually improve our understanding of how to create a systemic change that addresses the root causes of disparities, including racism, and to eliminate those disparities. It is essential to conduct comprehensive maternal mortality reviews of these types of deaths to continue supporting our implementation of recommendations and determine where interventions are needed most.

 

In the upcoming year, the MMRP will continue to center health equity in the maternal mortality review process and work. Some of the strategies we will implement over the next year include:

• Support the newly recruited 2023–2025 MMRP cohort, which has increased health equity expertise, lived experience, and other expertise areas and affiliations.
• Provide access to health equity and anti-racism learning and other educational opportunities for the MMRP.
• Work with the CDC to align practices of identifying discrimination, racism, bias, and stigma in the deaths we review to make recommendations for change using data from the maternal mortality review work. This includes participating in monthly workgroups/meetings and collaborating with other states on successful strategies and practices that meet these goals.
• Work with the health equity and social justice experts on the MMRP to help us better identify evidence in the information we review and present it to the MMRP so they can make informed decisions.
• Continue to learn from and share information with other states’ maternal mortality review processes to improve our focus on health equity.
• Consult with agency health equity experts to implement and evaluate a health equity training/learning plan for all MMRP.

 

Move forward with a next stage of the listening sessions with the American Indian Health Commission (AIHC) and hope to learn more about how to better collaborate with these partners. This includes supporting AIHC in helping entities (including the MMRP) apply the findings from the appendix AIHC provided in the 2023 MMRP report. DOH will also work with AIHC to conduct listening sessions with all of the Tribes around the state to discuss the results of the MMRP and to gather feedback on the report recommendations, discover what individual communities are already doing, and to gain an understanding of the interest of Tribal communities for a Tribally lead MMRP.
 

Now that the 2023 report has been released, DOH staff will share the findings widely with partners and community members around the state and participate in conversations about ways to involve community members in implementing recommendations. DOH will also include applying lessons learned from the AIHC listening sessions in our work to implement the report’s recommendations.

 

Implementing MMRP recommendations:

Planned activities to implement recommendations from the MMRP report:

 

Smooth Transitions: The Washington State Perinatal Collaborative supports the Smooth Transitions program through funding from the CDC. Smooth Transitions, a program of the Foundation for Health Care Quality, enhances the safety of hospital transfers and will bring together community midwives, hospital providers and staff, and EMS personnel to build a collaborative model of care. Smooth Transitions will begin work on protected case reviews related to transfers, pilot an EMS learning module simulation training, and develop resources for midwives, birth centers, and hospitals through our support.

 

Substance Use Disorder and Lactation Guidelines: DOH finalized Substance Use Disorder (SUD) Lactation Guidelines in May 2023. Once the guidelines are complete, we will work with the DOH communications team to develop and disseminate materials for providers and patients over the next year. We will distribute the guidelines to statewide partners and integrate them into the Perinatal SUD Learning Collaborative toolkit.

 

Blue Band Initiative: DOH will pilot test the Blue Band project, which addresses pre-eclampsia and postpartum post hypertension. Through the Washington State Perinatal Collaborative, DOH will build a resource website and assist hospitals in the implementation of the blue band project.

 

TeamBirth: In March 2023, WSHA will begin implementation of TeamBirth with its first cohort.  According to WSHA, “TeamBirth aims to target poor maternal and newborn outcomes that occur as a result of those failures by providing a framework for shared decision making and amplifying the birthing person’s voice”. Over the next 3 years, Washington state birthing hospitals will participate in 1 of 4 cohorts. Each cohort will receive personalized training, support, and materials for implementation in their facility.

 

Objective:

Through September 2025, ensure 80 percent of birthing hospitals in Washington state have established processes to universally screen everyone giving birth for substance use disorders and perinatal mood and anxiety disorders as part of the Alliance for Innovation on Maternal Health (AIM) patient safety maternal mental health protocols. 

 

Strategies:

• Promote standardized depression, anxiety, and substance use screening across the life course.

 

• Promote verbal screening for substance use for every person giving birth, using validated tools.

 

• Improve the care of infants with neonatal abstinence syndrome (NAS) and neonatal opioid withdrawal syndrome (NOWS).

 

• Support interventions to address suicide ideation among pregnant and parenting people.

 

Maternal morbidity and mortality rates have been increasing in the United States for the past 40 years, with marked disparities in the rates for women of color, women from low-income backgrounds, and women from rural areas.[1],[2] It is estimated that for every maternal death, 50 or more women are affected nationally by severe maternal morbidities each year.[3] The CDC estimates that one in 8 women experience a depressive episode after pregnancy.[4] Untreated maternal depression or other more extreme mood disorders can lead to significant morbidity and, in extreme situations, maternal suicide and infanticide.

 

In Washington state, all maternal deaths are reviewed by a panel of clinical and nonclinical perinatal experts and assessed for cause of death and underlying contributing factors. The panel found that in review of maternal deaths from 2014-2020, at least 80% of pregnancy-related deaths were preventable. The leading causes of pregnancy-related deaths were associated with behavioral health conditions, including suicide and accidental overdose. According to our Pregnancy Risk Assessment Monitoring System (PRAMS) data, in 2018, 11% of women interviewed expressed experiencing postpartum depression symptoms.

 

In October 2022, DOH was awarded a federal grant to enhance our Perinatal Quality Collaborative and our ability to implement perinatal quality improvement initiatives. Through this grant, the PQC will support AIM initiatives and other projects related to perinatal substance use.

 

Through the PQC, DOH and WSHA collaborate on AIM implementation efforts. In 2021, DOH and WSHA created the Perinatal Substance Use Disorder Learning Collaborative. This collaborative worked with 13 hospitals to pilot test the Obstetric Care for Women with Opioid Use Disorder patient safety bundle. In 2022, this bundle was expanded to include training and support for all substances, not just opioids.

The Perinatal Substance Use Disorder Learning Collaborative now supports over 80% of birthing hospitals in Washington by providing monthly educational webinars and peer-coaching calls. It also helps hospitals become certified as a Center of Excellence for Perinatal Substance Use. This certificate awards and recognizes hospitals that follow best practices when caring for people and infants impacted by substance use. These criteria will include verbally screening every person giving birth for substance use disorders and perinatal mood and anxiety disorders, and implementing hospital policies and support for pregnant and parenting individuals who screen positive for a substance use disorder. Additionally, WSHA and DOH launched a Perinatal Substance Use Learning Collaborative that offers monthly learning sessions and a toolkit of resources to support hospitals in implementing bundle components and becoming a Center of Excellence for Perinatal Substance Use.

 

Priority:

Optimize the health and well-being of adolescent girls and adult women, using holistic approaches that empower self-advocacy and engagement with health systems.

 

National Performance Measure:

Percent of women, ages 18 through 44, with a preventive medical visit in the past year.

 

Objective:

Through September 2025, collaborate with community birth experts from the doula, home visiting, nursing, and community health worker workforce, to identify a process for birth equity priorities and funds distribution and program development in line with anti-racist values.  

 

Strategies:

• Support active engagement by birthing hospitals, licensed birth centers, and perinatal providers in quality improvement efforts that reduce the leading causes of maternal mortality and morbidity.

 

• Support healthy pregnancies, births, and maternal recovery; address inequities and prevent maternal mortality and morbidity.

 

• Support women during the “fourth trimester”; enhance postpartum care to allow providers to check in with mothers about their mental health and other medical issues.

 

To address disparities in birth outcome among communities of color, particularly the Black/African American, and American Indian/Alaska Native community, DOH has committed to funding projects that directly support community birth worker projects serving those communities.

 

DOH conducted a series of listening sessions and worked closely with a community advisory board to identify investment areas. The listening sessions highlighted the systemic racism that birth workers and birthing families experience in Washington’s Western medical establishments. Themes from these listening sessions included:

• Racism creates barriers to care and prevents the delivery of culturally appropriate care.
• Racism negatively affects the physical, emotional, and spiritual health of birth workers and the families they serve.
• Our systems have undermined the credentials of birth workers and failed to recognize lived experience as an asset.
• There is a deep need for allyship, mentorship, and co-conspirators within the birth worker community.

Our community advisory board further defined birth equity as:

• Birthing people are healthy and can have a birth the way they want it.
• Birthing people are treated as experts in their own care, and their concerns are taken seriously.
• Birthing people have access to resources without fear of discrimination, violence, or deportation.
• Birthing people have access to care that incorporates both Western medicine and traditional practices.
• Birthing people have access to doulas and midwives.

Based on this feedback, DOH has contracted with 6 community-based organizations that provide wraparound, culturally appropriate care for pregnant and parenting families. Throughout the next year, DOH will support these partners in implementing their projects.

• Contractors will work collaboratively with a DOH evaluator to create an evaluation plan and define what success will look like for their project.
• Host summits twice a year to encourage networking between grantees and sharing best practices.
• Identify areas for technical assistance to support grantee success.
• Support grantees in developing sustainability plans for their projects.
• Provide fiscal support to ensure timely payment for deliverables.

 

DOH will also continue to meet with the community advisory committee. The meetings will serve as an opportunity for community accountability and awareness of DOH investments and to provide feedback on other DOH projects.

 

The funded partners are:

 

Ayan Maternity Health Care Support provides culturally relevant wraparound perinatal support services and professional development opportunities to East African immigrants and refugees in King County. Their project will include a 6-week perinatal class on pregnancy and wellness, labor and delivery, maternal mental health, and preparing for parenthood. They will use the grant funds to provide doula services, lactation support, childbirth education, and early parenting support to clients. Funds will also support annual workshops to build workforce capacity and educational opportunities for East African doulas.

 

BLKBRY offers culturally responsive, evidence and practice-based interventions to reduce the effects of structural racism for families in the Burien area. BLKBRY strives to fill the gaps of missing culturally responsive care and resources in Black/African American reproductive, perinatal, lactation support, and Black/African American infant and toddler health care. This grant funding will support no-cost classes for Black/African American pregnant and birthing people and access to Black/African American-owned reproductive and perinatal products. BLKBRY will use the funds to continue staff education, expand doula and lactation support to Black/African American pregnant and birthing families, and cultivate community spaces to support and share information about birthing work.

 

Nisqually Tribal Health and Wellness Center serves American Indian/Alaska Natives living in Thurston County and Nisqually Tribal Members and their families. They plan to expand their perinatal health services to include postpartum doula care, group prenatal care classes, lactation education, a dental program, and a Traditional Healing program. Their project will launch new initiatives, including training birth workers on Indigenous Lactation Counseling and developing a new perinatal mental health program.

 

Shades of Motherhood serves Black/African American mothers, people of color, and their infants in Spokane. They support people in overcoming barriers to care and health equity. Shades of Motherhood centers Black/African American mothers and birthing people through education, empowerment, and community to reduce health inequities. Their program will expand access to peer support, childbirth education, lactation support, reproductive support, perinatal mental health support groups, and birthing and perinatal supplies. They will also host community outreach events to help connect Black/African American families to resources and promote birth equity awareness in the Spokane community.

 

Spokane Tribal Network is partnering with Həłmxiłp (Cedar Circle) Indigenous Birth Justice (HIBJ) to improve reproductive health in rural and urban areas in and around Spokane. The Spokane Tribal Network is a non-profit based on the Spokane Indian Reservation. HIBJ is a new Native-led non-profit with a vision to ensure all American Indian/Alaska Native people experience culturally responsive reproductive health without passing the burden of trauma from one generation to the next. Through this partnership, their project will support doula services to urban and rural families, ceremonial training, and birth advocacy. They will also offer prenatal and postpartum culture-based group care to pregnant American Indian/Alaska Native families. Grant funds will help support interested American Indian/Alaska Native community members to become doulas, birth advocates, and ceremonial mentors.

 

Global Perinatal Services has expanded their services for Black/African American birthing families in King County. These wraparound services include childbirth education classes, pre and postnatal lactation education, doula services, and parent support groups.

 

Objective:

Through September 30, 2025, create training opportunities for perinatal care providers on mood disorders and suicide risk during and after pregnancy, and determine feasibility of modifying existing legislation requiring mandatory provider suicide training to include content on maternal suicide, risk factors, and interventions.  

 

Strategies:

• Take action to reduce stigma surrounding behavioral health conditions, treatment, and related challenges.

 

• Implement trauma-informed services into community services, health care systems, and the public sector.

 

• Promote standardized depression, anxiety, and substance use screening across the life course.

 

To increase awareness and knowledge of suicide risk and pregnancy, DOH explored the feasibility of amending the law that outlines suicide training requirements for health care professionals in the state, RCW 43.70.442. Significant barriers made this amendment unfeasible at this time. The minimum standards within this law are general, and this proposed amendment would open the door for a change in the scope towards more specialized standards. It could take years to progress and have minimal impact on the reach of training materials.

 

DOH staff continue to explore opportunities to promote awareness around perinatal behavioral health and suicide prevention.

 

In spring 2021, DOH released a request for applications to fund projects that meet the MMRP’s recommendation to “increase knowledge and skill of providers, patients, and families about behavioral health conditions during and after pregnancy, and the treatment and resources that are available for support.” These projects aim to support maternal Medication Assisted Treatment (MAT) programs, increase perinatal peer support groups and services, and offer provider trainings to improve perinatal behavioral health skills. DOH will continue to support and offer TA for the community grants through August 2024. We will assess the success of the grants through monthly check-ins and quarterly reports that grantees will submit outlining their progress toward their goals and objectives.

 

In partnership with the University of Washington Department of Medicine, DOH will continue to offer the MMRP ECHO (Extension for Community Healthcare Outcomes) series for Washington State providers. The CME-accredited program addresses mortality risks and provides education to improve care for perinatal patients. They will include components that guide the evaluation of the severity of any identified risk, preparing a risk mitigation plan, and initiating a team-based care approach within the care setting. Participants will learn to address causes of maternal mortality as identified in the 2023 Maternal Mortality Review Panel report – with sessions focused on behavioral health, and suicide risk and accidental overdose.

 

Objective:

By December 2025, continue to collaborate with tribal partners to meet the needs of Tribal communities impacted by maternal mortality through additional listening sessions and data quality improvement.

 

Strategies:

• Support interventions to address suicide ideation among pregnant and parenting people.

 

• Support efforts to address and mitigate individual and community effects of substance use.

 

• Promote standardized depression, anxiety and substance use screening across the life course.

 

• Build on efforts to identify scope of impacts of substance use, including inequities at the local and state levels.

 

• Increase and improve reimbursement for behavioral health care from preconception through all phases of pregnancy and the first year postpartum, including screening, treatment, monitoring, and support services.

 

• Take action to reduce stigma surrounding behavioral health conditions, treatment, and related challenges.

 

• Implement trauma-informed services into community services, health care systems, and the public sector.

 

There is increased interest in and work around establishing a tribal review committee or subgroup of the existing MMRP that reviews tribal-related maternal deaths. As part of this work, DOH is exploring whether this endeavor is something tribal communities want and what resources and supports they need. Part of this exploration would be determining whether this would be a subgroup of the MMRP, an enhanced supplemental part of the existing MMRP process (but not distinct or separate), or a distinct process from the MMRP. 

 

We will work closely with our DOH tribal liaison and other tribal partners to plan what an exploration would entail. It may include a series of key informant interviews or focus groups with tribal leaders and health-related organizations to explore options, goals, and priorities of a tribal-led review. We would also identify the types of resources, funding, and technical assistance necessary to support such an effort and the potential challenges and barriers that would need to be addressed. 

 

Additionally, DOH has limited access to tribal clinic health records and tribal law enforcement records related to the death of a pregnant person within a year of their death. While this data is important for a comprehensive case review of maternal death, it raises questions about privacy and data sovereignty.  

 

To gather more information and context about what barriers exist to gathering tribal data and what factors impact whether tribes and urban Indian health organizations grant permission to DOH to request tribal records, we will engage in internal and external data consultation. This may include discussion with the DOH tribal liaison and initiating conversation with tribal leaders and members, as well as consulting with experts in the field of data collection and privacy. We will review and apply the guidance and recommendations found in the Addendum Report from the American Indian Health Commission to direct our consultative process. We will also use this project to better understand tribal perspectives on including interviews in our case narrative development process and how we would include the findings from these interviews in our case narratives. Ultimately, the decision about whether or how to collect this data should be guided by a commitment to transparency, data sovereignty, and respect for tribal nations and their unique cultural values and traditions. We are committed to respecting these rights and working collaboratively with tribal nations to develop data-sharing agreements or processes that reflect their priorities and values.  

 

Objective:
By December 31st, 2023, support access to prenatal genetic services.
By December 2023, collect and analyze service utilization data on patients utilizing prenatal genetics services, and disseminate the information to our stakeholders.

 

• Strategy:
  In collaboration with our clinical partners, assure access to prenatal genetic services in rural and/or underserved communities.
   
• Provide technical assistance by offering all prenatal genetics providers a paid subscription access to the Teratogen Information System Database (TERIS) to better assess risks of medications and exposures during pregnancy.

 

• Disseminate data and trends on service utilization of prenatal genetic services to stakeholders.  

 

[1] Centers for Disease Control and Prevention. (2019). Pregnancy Mortality Surveillance System. Reproductive Health. Found at:
https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-mortality-surveillance-system.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Freproductivehealth%2Fmaternalinfanthealth%2Fpmss.html

[2] Singh GK. Maternal Mortality in the United States, 1935-2007: Substantial Racial/Ethnic, Socioeconomic, and Geographic Disparities Persist. A 75th Anniversary Publication. Health Resources and Services Administration, Maternal and Child Health Bureau. Rockville, Maryland: U.S. Department of Health and Human Services; 2010. Found at: https://www.hrsa.gov/sites/default/files/ourstories/mchb75th/mchb75maternalmortality.pdf

[3] Callaghan, W. M., MacKay, A. P., & Berg, C. J. (2008). Identification of severe maternal morbidity during delivery hospitalizations, United States, 1991-2003. American Journal of Obstetrics and Gynecology, 199(2), 133. Found at https://www.sciencedirect.com/science/article/abs/pii/S0002937807023320

[4] Centers for Disease Control (2020). Vital Signs: Postpartum Depressive Symptoms and Provider Discussions About Perinatal Depression – United States, 2018. Morbidity and Mortality Weekly Report, May 15, 2020/69(19);575-581. Found at: https://www.cdc.gov/mmwr/volumes/69/wr/mm6919a2.htm?s_cid=mm6919a2_w