Women/Maternal Health - Application Year

 

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)
• Promote a comprehensive, cohesive, and informed system of care for all women to have a healthy pregnancy, labor and delivery, and first year postpartum. (Priority #2)

 

Access, Availability and Quality for Women (Priority #1)

 

During FY22, IL Title V will continue to utilize the following strategies to address Priority #1 - Assure accessibility, availability, and quality of preventive and primary care for all women, particularly for women of reproductive age:

 

1. Support the Illinois Healthy Choices, Healthy Future Perinatal Education Toolkit, which includes information and resources for providers of women during preconception, prenatal, postpartum, and interconception care.

 

During FY22, EverThrive Illinois will maintain the Illinois Healthy Choices, Healthy Futures Perinatal Education Toolkit, developed for clinical providers as well as promote, update, and maintain the toolkit’s new website: http://healthychoiceshealthyfutures.org/. Specifically, EverThrive Illinois will continue its promotional campaign with I PROMOTE-IL to expand the website reach to 500 views per quarter, utilizing new strategies (i.e., Facebook Live, new networks, and toolkit for partner promotion). In addition, it will promote the toolkit on social media four times per year, provide toolkit updates in a newsletter annually, present the toolkit at relevant partner meetings and events across the state, and conduct an evaluation of the toolkit. EverThrive will share data with the IDPH on the successes, areas of improvement and additional information regarding the utilization of the toolkit.

 

2. Partner with the Illinois Department of Corrections (IDOC) and two state women’s correctional centers to support ongoing health promotion activities for incarcerated women and staff training, and to ensure women and infants receive WIC services while residing in IDOC facilities.

 

For FY22, 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 program will implement the previously adopted evaluation plan, 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.

 

Additionally, OWHFS will continue to teach health education sessions using the Helping Women Recover, Beyond Trauma and Life Smart for Women curricula. Training opportunities for prison health care staff will focus on comprehensive care for their expectant mothers, trainings on trauma and adverse childhood experiences (ACEs), as well as better understanding of and specifically recognizing the unique health care needs of their LGBTQ population. An additional training programming will include 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 health care wing.

 

The IDPH southern perinatal nurse will continue to collaborate with the South Central Illinois Administrative Perinatal Center, other OWHFS staff, and correctional centers to assist in the process for women receiving maternal-fetal medicine consultations.

 

3. Implement well-woman care mini-grants to assist local entities in assessing their community needs and barriers; and develop and implement a plan to increase well-woman visits among women ages 18-44 years based on the completed assessment.

 

During FY19, IL Title V staff began planning for the well-woman care mini-grants with the goal to provide funding to local organizations who work with women ages 18-44 to develop and to implement a plan to positively impact the number of women seeking well-woman care. Using best-practice examples from other states, 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. For FY22, IL Title V will continue to support and to implement the well-woman care mini-grants. There are phases to this program: (1) Planning Phase – organizations required to develop a plan to increase well-woman visits in their community and (2) Implementation Phase – organizations are required to implement the plan they developed during the planning phase.

 

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

 

During FY22, IL Title V will continue to partner with the UIC-CRWG as it pilots a program at two clinic sites. The goals of the program are to increase the capacity of perinatal providers to screen, to assess, to refer, and to treat behavioral health disorders, and to increase awareness of and access to affordable and culturally appropriate services. Through these efforts, IL Title V and UIC-CRWG hope to improve the mental health and well-being of pregnant and postpartum women and their infants.

 

5. Support the Chicago Department of Public Health (CDPH) efforts to foster, partner, and collaborate with organizations and agencies providing male and partner involvement programs.

 

For FY22, CDPH will seek to engage male and partner involvement in its efforts to increase women’s early entry into prenatal care. These efforts will include leveraging relationships with organizations and agencies that target the same population. IL Title V will support CDPH’s efforts through the Title V mini-grant.

 

Comprehensive and Informed System (Priority #2)

 

During FY22, IL Title V will utilize the following strategies to address Priority #2 - Promote a comprehensive, cohesive, and informed system of care for all women to have a healthy pregnancy, labor and delivery, and first year postpartum:

 

1. Convene and facilitate state Maternal Mortality Review Committees (MMRC and MMRC-V) to review pregnancy-associated deaths and develop recommendations to improve quality of maternal care as well as reduce disparities and address social determinants of health.

 

Illinois continues its process for identifying pregnancy-associated deaths in Illinois and assuring reviews by the state’s two maternal mortality review committees. MMRC reviews every potentially pregnancy-related death and MMRC-V reviews 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, and will revise the process, as needed.

 

For FY22, it is expected that the MMRCs will complete its review of 2019 maternal mortality cases. These data along with data from 2018 will be included in the next Illinois Morbidity and Mortality Report. IDPH intends to publish all future reports on a bi-annual schedule over the course of the five-year Action Plan (2021-2025). All reports will include findings from the state reviews, such as demographic disparities, leading causes of death, factors contributing to deaths, preventability, and committee recommendations. IDPH will pursue multiple methods for disseminating the report and presenting the findings to relevant groups around the state and nation. The next Morbidity and Mortality Report is scheduled to be published in FY23.

 

Also in FY22, IL Title V staff will continue to implement interventions that address maternal mortality as a part of its CDC-funded grant entitled, Preventing Maternal Deaths: Supporting Maternal Mortality Review Committees. Activities under the grant include hosting a statewide maternal health summit and convening key stakeholders to create a multi-pronged strategic plan to improve maternal health based on the recommendations from the MMRCs.

 

2. Partner with the statewide Severe Maternal Morbidity (SMM) Review Subcommittee to develop recommendations for standardizing and improving hospital-level SMM case reviews across Illinois’ Regionalized Perinatal System.

 

The SMM Review Subcommittee will continue to focus on improving and standardizing hospital-level reviews. The subcommittee will make recommendations regarding training materials, templates, and resource manuals, as needed, to improve the quality of the local reviews within hospitals and APCs.

 

3. Participate in and collaborate with the Illinois Maternal Health Task Force established through the I PROMOTE-IL program (HRSA Maternal Health Innovation Grant) to translate findings and implement recommendations from the Illinois MMRC, MMRC-V, and SMM.

 

In FY19, the University of Illinois at Chicago (UIC) successfully applied for the HRSA Maternal Health Innovation Grant. The Innovations to ImPROve Maternal OuTcomEs in Illinois (I PROMOTE-IL) program will assist the state in collaborating with maternal health experts and optimizing resources to implement state-specific actions that address disparities in maternal health and improve maternal health outcomes. A key component of the I PROMOTE-IL grant is the Illinois Maternal Health Task Force. Illinois’ Title V director serves as co-chair of the taskforce. This development is important because OWHFS/Title V is the primary lead for all maternal health activities in the state, including Maternal Mortality and Severe Maternal Morbidity reviews. IL Title V’s participation and collaboration ensure that the task force is fully integrated into the existing maternal health infrastructure without duplication of efforts, assists in the tracking of maternal health legislation at the state and federal level to inform additional policy solutions, and addresses identified gaps outside of Title V’s efforts.

 

During FY22, IL Title V will continue to participate in and collaborate with the I-PROMOTE-IL program and its Illinois Maternal Health Task Force, and the Title V director will continue to serve as a co-chair for the task force.

 

4. Support and collaborate with the state-mandated Illinois Task Force on Infant and Maternal Mortality Among African Americans to assess the impact of overt and covert racism on pregnancy related outcomes, identify best practices and effective interventions, address social determinants of health, and develop an annual report with recommendations to improve outcomes for African American women and infants.

 

IDPH released its first Illinois Maternal Morbidity and Mortality Report in October 2018. Numerous state legislation influenced by the results of the report passed during the 2019 legislative session. The legislation included the Task Force on Infant and Maternal Mortality Among African Americans (IL Public Act 101-0038). The task force, under the purview of IDPH, is charged with establishing best practices to decrease infant and maternal mortality among African Americans.

 

In FY22, IL Title V will continue to support and collaborate with the Task Force on Infant and Maternal Mortality Among African Americans to review the impact of overt and covert racism on toxic stress and pregnancy related outcomes for African American women and infants. In addition, IL Title V will continue to support the development of the annual report that includes recommendations of best practices and interventions to improve quality and safe maternal and infant care for African Americans.

 

5. Facilitate the collaborative effort between the Illinois Maternal Health Task Force and the Illinois Task Force on Infant and Maternal Mortality Among African Americans to align their strategies and activities towards improving maternal health in Illinois.

 

During FY22, IL Title V will continue to facilitate collaboration between the Illinois Maternal Health Task Force and the Illinois Task Force on Infant and Maternal Mortality Among African Americans. It is expected collaboration will help to align both task forces’ strategies and activities as well as leverage each groups’ expertise regarding the improvement of maternal health.

 

6. Participate in state inter-agency committee efforts to improve Medicaid coverage and care coordination for pregnant and postpartum women by extending coverage from 60 days to 12 months postpartum, allowing managed care reinstatement within 90 days, and waiving hospital presumptive eligibility.

 

In April 2021, Illinois became the first state to receive federal Centers for Medicare & Medicaid Services (CMS) approval of its Continuity of Care & Administrative Simplification 1115 waiver application. The 1115 waiver extends Medicaid postpartum coverage from 60 days to 12 months. Specifically, the waiver allows Illinois to continue to receive federal match for postpartum Medicaid claims up to one year postpartum, including allowing women to enroll at any time during the first year postpartum if they become eligible at that time. Babies may be covered for the first year of their lives provided the mother was covered when the baby was born. Moms and Babies enrollees have no co-payments or premiums and must live in Illinois. The extended coverage authorized under the waiver will not go into effect until the continuous eligibility under the public health emergency ends.

 

During FY22, OWHFS and IL Title V will continue to participate on the state inter-agency committee as it develops implementation, monitoring, and evaluation plans regarding the extended coverage, continuous eligibility, reinstatement, and waiver of hospital presumptive eligibility (HPE).

 

Another activity in which IDPH and Title V will  engage is the Maternal and Child Health Policy Innovation Program (MCH PIP) through the National Academy of State Health Policy (NASHP). IDPH and HFS will work together to develop policy initiatives focused on improving access to care for Medicaid-eligible pregnant and parenting women with or at risk of substance use disorders and/or mental health conditions through health care system transformation. Specifically, the state team will seek to improve Medicaid managed care coordination processes for pregnant and postpartum Medicaid enrollees to address key drivers of adverse maternal morbidity and mortality outcomes, implement new prenatal and postpartum quality metrics to monitor and drive improvement in health outcomes for prenatal and postpartum Medicaid managed care enrollees, and enhance data sharing between the two agencies which will inform interventions and improvements in maternal health outcomes.

 

7. Convene and partner with key stakeholders to identify gaps in mental health and substance abuse services for women that include difficulties encountered in balancing multiple roles, self-care and parenting after childbirth; and leverage expertise to develop recommendations for system level improvements for Title V consideration and implementation.

 

During FY22, IL Title V will continue to partner with UIC-CRWG to improve the mental health and well-being of pregnant and postpartum women, and their infants, throughout the state. Activities will focus on expanding the capacity of perinatal health care providers to screen, to assess, to refer, and to treat pregnant and postpartum women for depression and related behavioral health disorders, and to increase awareness of, and access to, affordable and culturally-appropriate services to pregnant and postpartum women and their infants. Currently, the project targets obstetricians, gynecologists, nurse midwives, pediatricians, psychiatric providers, mental health care providers, social workers, and primary care providers in geographical areas serving disadvantaged women, including Cook County/ Chicago and Peoria County/Peoria. UIC-CRWG will continue to: (i) provide in-person workshop training and resources on screening, diagnosis, and referral for maternal depression and related behavioral disorders to providers; (ii) provide real-time psychiatric consultation and care coordination for providers; (iii) screen women for depression, anxiety, suicide risk, and substance use during the perinatal period using computerized adaptive testing (CAT); (iv) increase access to depression prevention and treatment for medically underserved women using a telehealth intervention; (v) increase access to substance use treatment for pregnant women; and (vi) develop recommendations for disseminating and implementing the project components statewide. UIC-CRWG will also coordinate with the Health Care Alternative Systems program at the DHS, which runs a perinatal depression screening and referral program, in an effort to reduce duplication and/or fragmentation of services.

 

8. Assess, quantify, and describe the impact of child care on prenatal, intrapartum and postpartum care in Illinois, and develop optional strategies and approaches that can be implemented in clinic and hospital settings.

 

Although the Social Determinants of Health Collaborative, Improvement, and Innovation Network (CoIIN) ended in FY20, IL Title V will continue to assess the 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. The assessment will include exploring opportunities to engage hospitals and FQHCs in developing and in implementing family friendly strategies to address child care needs.

 

9. Support the Illinois Perinatal Quality Collaborative (ILPQC) as it seeks to implement obstetric and neonatal quality improvement initiatives in birthing hospitals.

 

IL Title V continues to collaborate with ILPQC as it supports hospital teams in implementing strategies that facilitate culture change and improve patient care. In FY22, a key ILPQC initiative that Title V will support is ILPQC’s OB Birth Equity (BE) Initiative. This initiative focuses on hospitals’ capacity to facilitate systems and culture change to achieve birth equity through four key drivers: social determinants of health, data usage, patient and partner engagement, and provider engagement and education. The initiatives’ specific objectives include appropriate screening and linking of patients to resources that address social determinants of health, increasing the proportion of women reporting positive obstetric care experiences, and accurate recording of patient race and ethnicity data.

 

A second initiative that will be supported in FY22 is ILPQC’s Neonatal Babies Antibiotic Stewardship Improvement Collaborative (BASIC) QI Initiative. BASIC aims to decrease the number of newborns, born at ≥35 weeks who receive antibiotics and decrease the number of newborns with a negative blood culture who receive antibiotics for longer than 36 hours. It includes education for physicians, nurses, and parents/families. To achieve the goals of the initiative, ILPQC will utilize collaborative learning webinars, rapid-response data for hospital teams through the ILPQC Data System, and quality improvement support for hospital teams not achieving initiative goals.

 

10. Support the Perinatal Depression Program which provides 24-hour telephone consultation for crisis intervention for women suffering from perinatal depression.

 

During FY22, IL Title V will implement the MCH Perinatal Mental Health Program. This program seeks to provide perinatal depression crisis interventions, consultations, resources, and referrals for women who have screened positive for symptoms of perinatal depression. Objectives of the program include:

• Maintaining a 24-hour telephone consultation for crisis intervention.
• Providing resources for referrals and other health care services as needed.
• Increasing the awareness of perinatal mental health resources across the state. 
• Increasing the knowledge of health care providers and the public on perinatal mental health disorders.
• Partnering with other organizations that are working on initiatives in the field of perinatal mental health, to increase knowledge of resources and share best practices.
• Collecting and analyzing data on perinatal mental health for purposes of quality assurance, evaluation, dissemination, and informed decision-making.