Priority Need 1 – Improve Access to High Quality Integrated Health Care Services

 

Priorities, strategies, and measures for this domain have been reviewed, and there are minimal updates for FY25. One way of improving access to high quality integrated health care services is to ensure that infants and mothers are receiving care in a risk-appropriate level of care facility. In FY25, the Perinatal Nurse Champions will promote the development and implementation of collaborative systems within their respective perinatal care regions that promote the proactive integration of risk-appropriate antepartum, intrapartum, and postpartum care, which includes completing the CDC LOCATeSM with birthing facilities in each region that have not been assessed within the last two years. The Perinatal Nurse Champions will utilize regional data to make recommended improvements to the system of risk-appropriate maternal and neonatal care.

 

Adopting Uniform and Nationally Recognized Neonatal and Maternal Levels of Care Standards

 

One of the priority strategies of the PHSP is to adopt updated neonatal levels of care and develop maternal levels of care. Collaboration will continue within DHHS (DPH and DHSR) along with NC OB GYN Society, NC Pediatric Society, NC Healthcare Association, NCIOM, and individuals with lived experience will continue in order to finalize recommendations, draft language, and focus on fiscal impact related to levels of care.

 

Providing Behavioral Health Support to Maternal Health Providers

 

In FY25, the MATTERS program will launch the NC MATTERS Fellows program for 30 perinatal providers who care for pregnant, postpartum women, and new parent patients across the six perinatal care regions. The Fellows program is an intensive 6-month educational and technical assistance program and will introduce providers to topics related to screening, referral, and management of maternal mental health and substance use disorders through skills building, peer learning, and leadership development as well as how to incorporate the services of NC PAL into their practice. The Fellows will meet virtually once a month and attend an in-person one day workshop in August 2024. A second cohort of Fellows will be recruited in Spring 2025.

 

NC MATTERS will host at least three Stakeholders Group meetings in FY25. The NC MATTERS Stakeholders Group is representative of perinatal providers from across NC with an interest in advancing services addressing maternal mental health and substance use disorders. The Stakeholders Group will provide guidance and feedback to the NC MATTERS program to ensure that the program efforts are relevant and appropriate for what the perinatal providers need in their practice.

 

In FY25, the MHB LCSW will provide maternal mental health and substance use disorders education and support by convening a Community of Practice. The Community of Practice will provide opportunities for LHD staff to discuss ways to learn, improve, or address issues related to maternal mental health and substance use disorders. 

 

The MHB LCSW will also aim to coordinate training with LME/MCOs on mental health treatment considerations for the perinatal population. To strengthen the relationship with LMEs related to WICWS programs, the MHB LCSW will work with LME/MCOs and LHDs to consider opportunities for LHDs to contract with LME/MCOs to provide behavioral health services, such as outpatient psychotherapy, as well as to facilitate opportunities for educating LHDs, as needed, on how to access resources through or make appropriate referrals to the LME/MCO.

 

The NC MATTERS program will collaborate with the NCDHHS Office of Communications to develop a media campaign for the National Maternal Mental Health Hotline. The purpose of the media campaign will be to increase awareness of the national hotline among pregnant and postpartum individuals in North Carolina. The NCDHHS Office of Communications will incorporate the outreach and marketing products developed by the National Postpartum Support International and National Maternal Mental Health Hotline. The media plan will also include the development of additional Maternal Mental Health/Substance Use Disorders (MMH/SUD) messages to educate pregnant or postpartum women and their families about MMH/SUD, with an aim to reduce the stigma of seeking care. These additional media products will be used on various social media platforms. 

 

In FY25, educational opportunities will be developed based on needs identified during monitoring visits or technical assistance requests. The nurse consultants will ensure that the local agencies are collaborating with the CMHRP team to meet the needs of clients who have behavioral health concerns based on the pregnancy risk screening tool or assessments. The WICWS nurse consultants will provide TA to help local agencies integrate behavioral health tools into the electronic medical record as well as determine whether to incorporate Health Behavior Intervention Services.

 

The WICWS RSWCs will provide support to the CMHRP Care Managers on topics related to behavioral and mental health issues by developing an in-depth training on the newly implemented CMHRP Maternal Mental Health Pathway  which provides education on for Perinatal Mood Disorders and guidance on best-practice screening and follow-up This Pathway guides care managers in providing the most current, best practice interventions for patients identified with any level or type of perinatal mood disorder and the subsequent training provided will ensure that CMHRP care managers understand potential mental health issues and have the resources they need to appropriately screen and refer to applicable resources as well as follow up. Care management interventions from this Pathway will be highlighted in the monthly CMHRP program update. CMHRP Care Managers will be trained on various resources available through Postpartum Support International, which hosts the National Maternal Mental Health Hotline, and NC MATTERS, which incorporates NC-PAL, for providers. The CMHRP Program plans to partner with WICWS Matters staff members and the WICWS State LCSW to provide on-going mental health training to CMHRP Care Managers throughout the year.

 

Perinatal Oral Health

 

The Perinatal Oral Health Program will continue to offer perinatal oral health educational training to medical providers, dental providers and pregnancy support service professionals during FY25. The following items are included in the Program’s FY25 Action Plan:

• Program expansion to include pregnant individuals as a target audience.
• Develop and strengthen relationships with internal and external stakeholders (CMHRP, WIC).
• Medical Dental Educational Integration

 

Newborn Screening Follow-Up Team

 

In FY25, the NBS Follow-Up Team will continue to report NBSs with abnormal results in a timely manner, monitor follow-up testing, document final outcomes, provide technical assistance to LHDs and private providers about individual NBS results, and provide information for patients and their families. The NBS Follow-Up Team will work to develop follow-up protocols, educational and outreach materials relevant to new conditions being added to the NC Newborn Screening Panel in FY25 (Mucopolysaccharidosis Type II [MPS II] and Guanidinoacetate N-Methyltransferase [GAMT]). 

 

The NCSLPH NC Newborn Screening Program was awarded HRSA funding opportunity No. HRSA-23-065, State Newborn Screening System Priorities Program (NBS Propel) on June 9, 2023. The goals to be accomplished for FY25 include the following: 1) improving IT data systems and data collection through improvements to the existing laboratory information management system and by creating an infrastructure for the collection and reporting of timeliness indictors and long-term follow-up data; 2) enhancing laboratory and follow-up procedures by refining a continuity of operations plan, reviewing and updating screening algorithms and cut-offs, conducting quality improvement projects, and initiating the assay validation work to support the implementation of two new disorders (MPS II and GAMT) to the existing NC NBS panel; and 3) expanding follow-up and educational activities with providers, including clinicians and birthing facilities, and families to improve health equity. 

 

The team at UNC will continue to provide clinical genetic services, genetic counseling services, and genetic testing for approximately 2500 unduplicated patients in FY25. Metabolic services will be provided to newborns with a potential diagnosis for X-ALD, MPS-I and inborn errors of metabolism identified through MS/MS through the NCDHHS. UNC will continue to provide expertise and consultation to the SLPH on follow-up care for infants identified through NBS and consultation to referring healthcare providers regarding patient diagnosis, care, and management. The NBS Follow-Up Team at DCFW will provide initial notification abnormal Pompe disease results to the follow-up team at Duke and will work in conjunction with Duke to provide follow-up services to these infants. Duke will continue to provide expertise and consultation to the SLPH related to Pompe disease screening and follow-up care for infants identified through NBS. 

 

The NCBDMP will continue to work with the NC Healthcare Association and other partners to improve reporting of CCHD data into the statewide WCSWeb database by birthing hospitals, free-standing birthing centers, and other health care providers attending deliveries of newborns. NCBDMP staff will also continue to review screening results for case-finding, to compare results with cases identified within the registry to determine false positive and false negative results, and to link screening results with the registry to determine timing and method of diagnosis. DCFW/WCHS EHDI consultants will do outreach with staff while working with birthing hospitals about the CCHD reporting requirements. EHDI staff will continue to disseminate the prenatal information sheet, North Carolina’s Newborn Screening Program, to help with increasing awareness about several newborn screenings.  

 

The EHDI program will continue its activities in FY25. All hospitals/birthing facilities in NC will continue to provide newborn hearing screening and submit screening results through WCSWeb Hearing Link. The EHDI Regional Consultants will continue to provide ongoing technical assistance, consultation, education, and support to birthing facilities, physicians, audiologists, interventionists, and families. The EHDI program will improve service delivery by reaching out to more families of D/HH children across the state to improve early identification and quality intervention through the Spanish bilingual parent consultant and the continuation of the Parent Support Team. The EHDI program will finalize and distribute an updated on-line Residency Training Module to educate medical residents on EHDI 1-3-6 goals. The EHDI program was awarded a new five-year cycle for Funding Opportunity HRSA-24-036 in March 2024. During FY25, the program will conduct a needs assessment regarding our state’s infrastructure to coordinate services across the statewide EHDI system for DHH children to improve language acquisition outcomes. Areas to be assessed include, but are not limited to: 1) increasing data capacity and interoperability of data systems; 2) improving training and educating health care and other services providers; 3) building partnerships with other EHDI stakeholder organizations and entities that focus on early intervention; and 4) strengthening mechanisms to engage families, including those traditionally underserved by EHDI, in DHH adult-to-family supports and services. 

 

Priority Need 3 – Prevent Infant/Fetal Deaths and Premature Births

 

Work to reduce the infant mortality disparity ratio, which is the underlying framework of the PHSP, will continue in FY25 through a variety of methods. The PHSP’s adapted framework is designed to focus on equity and social determinants of health to address infant mortality, maternal health, and the health status of individuals of reproductive age. Upcoming PHEC meetings will include increased opportunities for collaborative partners to share their efforts in implementing the PHSP.

 

In addition, work to support the NC CFTF will continue. Specific priorities for FY25 will be established later this year, but they will likely include continuing to work on legislation to allow Medicaid reimbursement of doula services and legislation supporting Fetal and Infant Mortality Reviews (FIMR), along with paid family leave, youth suicide prevention, firearm safety, nicotine use prevention, and motor vehicle safety.

 

The WICWS will host a virtual Safe Sleep Summit in October 2024 in observance of Safe Sleep and Sudden Infant Death Syndrome month. The Summit will feature presentations and research on safe sleep interventions, current and new Safe Sleep efforts in NC. The Summit will convene safe sleep advocates from hospitals, childcare centers, LHDs, community health centers, and community-based organizations to discuss how NC can continue to promote safe sleep environments and resources to support birthing families. 

 

Infant Mortality Reduction Programs/Initiatives

 

In FY25, Healthy Beginnings expects to serve a minimum of 400 minority women during pregnancy, the postpartum period, and up to two years interconceptionally as described in the PIH Domain Annual Report. Healthy Beginnings will provide monthly care coordination services to all program participants to help improve birth outcomes.

The two Healthy Start sites-NC BLP and Southeastern NC Healthy Start (SENCHS) programs will continue to provide the services described earlier in the PIH Domain Annual Report, and the programs will continue its enhanced focus on mental health, breastfeeding, co-parenting, and improving self-sufficiency for FY25. NC BLP will continue to participate in community events and outreach where permitted and appropriate to increase awareness of enrollment in program services.

 

In FY25, five ICO4MCH sites representing nine counties will continue implementation of six evidence-based strategies (EBSs) to improve maternal health and infant birth outcomes.  The strategies include reproductive life planning and improving preconception and interconception health. Other strategies include 10 Successful Steps for Breastfeeding (with specific focus on Steps 3 and 10), tobacco cessation and prevention, Triple P and Family Connects newborn home visiting.

 

In FY25, the RIMC program will implement EBSs that are proven to be an effective means to improve birth outcomes through addressing pregnancy intendedness, preterm birth, and/or infant mortality. At least 50% of all program participants served will represent a minority population under each of the following EBSs: Breastfeeding Support Services, Centering Pregnancy, Doula Services, Infant Safe Sleep Services, and Preconception and Interconception Health Services. LHDs are required to incorporate partnerships with community-based organizations to help implement their chosen evidence-based strategies and reach individuals not being served at the LHD.

 

Strategic Plans Prioritizing Breast/Chest and Human Milk Feeding

 

As reported in the PIH Annual Report, multiple state strategic plans in NC have prioritized breast/chest and human milk feeding objectives, strategies, and action. Work to propel those plans forward will continue in FY25 under the leadership of the NC DPH/DCFW Breastfeeding Coordination Team.

 

WIC Breastfeeding Peer Counseling Program

 

The COVID-19 pandemic necessitated a shift in the structure of the WIC BFPC Program. While the model for providing prenatal and postpartum support to participants remained sustainable within pandemic safety protocols, there was a significant disruption in the recruitment of participants for the BFPC program. Recruitment was predominantly dependent on local WIC agencies through education by nutritionists or interactions with peer counselors during WIC certification appointments. During the pandemic, the adaptations made were considered temporary, which resulted in a lack of a long-term strategy for maintaining WIC participant enrollment in the BFPC program. This disruption in referrals extended beyond internal referral mechanisms to include external partners. The WIC LATCH aims to support local WIC agencies by evaluating their internal and external processes to enhance program enrollment, which has declined due to the pandemic. Establishing and maintaining referral processes that foster collaborative partnerships is a time-intensive endeavor that WIC LATCH will continue to work with each local WIC agency during FY25. Moreover, the BFPC program demands substantial effort in managing and tracking participant enrollment, necessary contacts, and completed interactions. This administrative workload detracts from efforts directly aimed at achieving the program’s goal of increasing breastfeeding rates. Consequently, for FY25, the NCDHHS aims to pursue updates to the management information system to alleviate the administrative burdens associated with the program.

 

Regional Lactation Training Centers

 

During FY25, the first grant cycle of the LATCH will be completed. This process will include an analysis to determine whether the grant deliverables achieved the desired outcomes, as well as the drafting, posting, and awarding of the subsequent grant period. The current organization, Eastern AHEC, is contracted through 2025 and will continue to fulfill its deliverables, including assisting with lactation orientation and continuing education training for our WIC Program staff. Additionally, it will work to strengthen connections between public health and private providers to improve continuity of care within the policies, systems, and environments in which WIC families operate. Furthermore, LATCH provides community continuing education sessions to medical providers to ensure consistent messaging about breastfeeding, which supports the primary goal of continuity in lactation support services for families.

 

Breastfeeding Friendly Designations

 

Competing priorities due to short staffing and the implementation of the multi-tiered training curriculum have previously delayed activities related to Breastfeeding Friendly Designations. Despite these challenges, it remains essential that the NC Maternity Center Breastfeeding Friendly Designation reflects the current guidance from the WHO and CDC. Therefore, updating the NC Maternity Center Breastfeeding Friendly Hospital Designation application to align with the WHO’s updated Ten Steps to Successful Breastfeeding and the revised Baby-Friendly, USA guideline evaluation criteria remains a goal for DCFW/CNSS for FY25. CNSS will coordinate the endorsement of the application with the NC Healthcare Association, NC Pediatric Society, NC Child Fatality Task Force, NCIOM, and other relevant professional organizations. Additionally, in FY25, DCFW/CNSS will collaborate with CCHCs and other childcare partners to develop a Making It Work tool specific to early care and education settings. Following its development, complementary trainings and the implementation of the NC Breastfeeding Friendly Child Care Designations will be prioritized.

 

Additional Breastfeeding Efforts by Infant Mortality Reduction Programs/Initiatives

 

Plans are underway to establish a 24/7 statewide Breastfeeding Hotline. Funds have recently been approved through Medicaid under CHIP authority. The RFP is being reviewed for approval and release. The goal is to have the Breastfeeding Hotline in place during FY25.

 

The RIMC program will provide Breastfeeding Support Services in four LHDs. In FY25, each LHD will provide prenatal and postpartum breastfeeding support services to at least 25 unduplicated individuals and provide Ready, Set, BABY education to at least 60 unduplicated pregnant individuals. Breastfeeding Support Services program staff received WIC Breastfeeding Peer Counselor Core training by the DCFW/CNSS, and Ready, Set, BABY training by the Carolina Global Breastfeeding Institute. In FY25, each LHD will conduct community education and advocacy work to increase the number of employers with breastfeeding-friendly policies and establish at least two new breastfeeding-friendly community spaces or workplaces/employers.

 

The Healthy Beginnings program will provide breastfeeding education and support to all pregnant and postpartum/interconception program participants. At least 35% of interconception program participants will initiate breastfeeding and maintain for at least six months. All Healthy Beginnings program staff received WIC Breastfeeding Peer Counselor Core training. In FY25, all breastfeeding program participants will receive monthly breastfeeding assessments and support to maintain breastfeeding for six months or longer.

 

To increase the percentage of participants who breastfeed in FY25, the NC BLP staff will maintain their relationships with WIC Breastfeeding Peer Educators within each health department. BLP staff will increase efforts to make early referrals to breastfeeding peer educators to strengthen the bond with participants prenatally. The goal of these efforts is to strengthen the connection during the prenatal period and build a network of support during the postpartum period. Familial support continues to be a critical component of breastfeeding initiation and impacts duration. Representatives of the NC BLP program will continue their participation in the Community Consortium (formerly known as Local Action Networks (LANs)) to elevate the community’s responsibility in supporting breastfeeding families. The Community Consortium will continue implementation of action plans to promote schools and businesses adopting policies to support breastfeeding families. Staff at the newly funded SENCHS site will engage in similar efforts to establish relationships and referral networks in the two-county rural catchment area so that client referrals can be made smoothly.  SENCHS staff will receive training emphasizing the importance and benefits of breastfeeding at least once annually.

 

ICO4MCH grantees will continue their focus on Steps 3 and 10 of the Ten Steps for Successful Breastfeeding. FY25 strategies for ICO4MCH continue to include: 1) provide education, consultation, and information to businesses/work to utilize resources for increasing breastfeeding-friendly businesses/work sites, such as, Making It Work Toolkit and the Businesses Leading the Way; 2) collaborate with communities in their services areas to increase the support for the breastfeeding family through the implementation of the Breastfeeding Friendly City Program; and 3) implement shared decision-making tools to assist patients to contemplate options, gather additional information, consult with provider and family to make an informed decision to breastfeed. During FY25, ICO4MCH projects will also continue their work with LHDs to establish public lactation rooms.

 

The MIECHV and non-MIECHV (NFP and HFA evidence-based models) Programs will continue to implement HFA and NFP models in NC in FY25 and support their ongoing strategies to promote breastfeeding. Almost all sites have at least one trained lactation consultant or counselor. When mothers are enrolled prenatally, breastfeeding discussions start early and continue throughout the pregnancy and after the infant is born. Other strategies include providing resources, incentives, and supplies to encourage breastfeeding, such as developing a breastfeeding success plan, and providing nursing pillows and pumping equipment. Breastfeeding educational materials are provided to families, and there are ongoing trainings for home visitors throughout each year.

 

The SCCNC will partner with the Carolina Global Breastfeeding Institute and the NC CCHSRC to offer Breastfeeding Friendly Child Care train the trainer opportunities to CCHCs and Birth-to-Three Specialists across the state to increase the number of trainers advocating, supporting, and promoting breastfeeding in child care settings.

 

Additional Strategies to Increase Breastfeeding Rates

 

Additional strategies to increase breastfeeding rates in FY25 include:

• Continuation of the DPH/DCFW Breastfeeding Coordination Team. This 20+ multidisciplinary team will meet on a quarterly basis (July, October, January, and April) and small workgroups will be formed to work on specific projects that may benefit the whole team. The PNC will continue to schedule those and work with volunteer meeting facilitators from the team to plan the agendas, etc.  

• Supporting the work of LHDs who are working toward or awarded the NC Breastfeeding Coalition’s Family Friendly (Breastfeeding) Clinic Award for outpatient healthcare clinics. This is primarily accomplished through the Child Health Agreement Addenda 351 as an optional activity for LHDs to choose and through CDC funding received by the CDIS for work in two branches that also focuses on increasing breastfeeding rates and improving other lifestyle behaviors. Continued promotion, TA, and coordination with the DPH/DCFW Breastfeeding Coordination Team will help to increase the total number of LHDs and other partners receiving this award.
• Training provided by the PNC and/or in coordination with DPH/DCFW Breastfeeding Coordination Team members for programs administered through DCFW and DPH. As interest and need is determined, additional trainings will be developed, administered, and evaluated.
• Working with the Office of Rural Health and the many partners involved in CHW training, explore if breast/chest/human milk-feeding information (and as feasible, food insecurity and other important nutrition topics) can be included in the training or contribute to specialization training for CHWs to increase their breast, chest and human milk feeding knowledge, skills and support.
• In FY25, the PNC and other members of the Breastfeeding Coordination Team will continue work with the NC Office of State Personnel to provide training and resources for state employees and HR personnel about the updated OSHR Lactation Policy. Proposed objectives to the training and resources include increasing knowledge of the policy, identifying the benefits to employers and lactating state employees, and identifying ways to implement the requirements of the policy for state employees. Some focus of this training will be to share information about the NC Making It Work toolkit and resources and to share additional resources like the www.BreastfeedNC.com site.

• Continuing dissemination and use of the NC Making It Work toolkit, including promotion of the North Carolina Worksite Breastfeeding Support in Action Webinar to help breastfeeding mothers return to work. Given the recent legislative actions in support of breastfeeding, the team is also in the beginning stages of reviewing the toolkit for updates to ensure the most relevant information is included.

• As noted above, work by DCFW to create an early childhood education specific Making It Work tool will be incorporated into the other Making It Work tools and promoted by the DPH/DCFW Breastfeeding Coordination team when available.

 

The Community and Clinical Connections for Prevention & Health Branch (CCCPH) was awarded funds through the Physical Activity and Nutrition (SPAN) grant from the CDC to implement a four-year phased plan to increase equitable access to human donor milk across NC. In FY25, the WICWS State Nutrition Consultant will work closely with the CCCPH team and the Wake Med Mothers’ Milk Bank to implement this project. During FY25, it is planned to expand the presence of donor milk dispensaries in designated pilot counties. The pilot counties include Cumberland, Durham, Jackson, Mecklenburg, and Pasquotank. In the pilot counties, outpatient dispensaries will be established to ensure equitable access to donor milk resources. 

 

The SCCNC will continue to participate in the DPH/DCFW Breastfeeding Coordination Team in FY25 to represent early educators and children in child care settings. Additionally, the Consultant will partner with the Carolina Global Breastfeeding Institute and the NC Child Care Health and Safety Resource Center to offer Breastfeeding Friendly Child Care train the trainer opportunities to CCHCs and Birth-to-Three Specialists across the state to increase the number of trainers advocating, supporting, and promoting breastfeeding in the child care settings.

 

Prenatal Tobacco Cessation Activities

 

Interventions by the CMHRP Care Managers to assist pregnant persons described in the PIH Annual Report will continue in FY25. The Tobacco Cessation Pathway, updated in partnership with You Quit, Two Quit/UNC CMIH, will continue to be utilized by CMHRP Care Managers to ensure the most current best practice, evidenced based information is available. WICWS Regional Social Work Consultants will look for ways to partner with Medicaid Managed Care Pre-paid Health plans on tobacco cessation efforts for pregnant people. Care manager training will be provided on the linkage between low-birth weight and preterm birth and tobacco usage. 

 

All Healthy Beginnings program staff are trained to provide evidence-based tobacco use screening and cessation counseling using the 5 A’s (Ask, Advise, Assess, Assist, Arrange) evidence-based intervention. In FY25, a minimum of 400 program participants will receive education and monthly tobacco use assessments and cessation counseling when needed during pregnancy and postpartum/interconception.

 

The PHW Program Manager will engage in the recruitment of prospective WATCH members in FY25. A brief survey will be developed and launched to assess member level of interest, determine availability and meeting frequency as well as identifying potential priority areas for WATCH to address. Also, a subset of WATCH members will be recruited to review  the Guide for Helping to Eliminate Tobacco Use and Exposure for Women to determine a plan for utilization in the future. The ICHB will continue to collaborate with the Tobacco Prevention and Control Branch to conduct statewide trainings to address individual tobacco use along with broader community policy implications. At least two trainings will be arranged in collaboration with the UNC CMIH and other WATCH partner organizations and provided to WICWS and DCFW staff and contracted partners on the 5As of tobacco cessation, women’s health, QuitlineNC, and e-cigarettes in FY25.