After completion of the 2020 needs assessment, KY continues the plan to reduce infant mortality with a focus on improving protective factors for breast feeding and for promotion of safe sleep activities. The following NPMs will continue for the next grant cycle:

• NPM # 4: A) Percent of infants who are ever breastfed, B) Percent of infants breastfed exclusively through six months
• NPM # 5: Percent of infants placed to sleep on their backs.

Infant Mortality:

MCH has participated in a variety of infant mortality CoIINs to develop strategies for reducing mortality. With the data known, MCH will continue to work with local hospitals, LHDs, and community partners to promote best practice initiatives. MCH is committed to reducing infant mortality from prematurity, birth defects, child abuse and neglect, as well as promoting safe sleep initiatives, breast feeding, and reduction of exposure to tobacco or other substances.

Breastfeeding:

Federally available data for KY show improvements in the percent of mothers initiating breastfeeding; however, recent information showed a dip in duration of breastfeeding at six months of age. KY will continue to build upon the work and efforts of the Nutrition Services Branch to promote the 10 steps to successful breastfeeding. Efforts to increase breastfeeding initiation and duration rates in the upcoming year will focus on the following activities:

• Supporting Regional Breastfeeding Coordinators to promote and support breastfeeding through public outreach, community events, health services planning, and organization of continuing education opportunities
• Providing breastfeeding education to WIC health professionals using the updated USDA required breastfeeding training
• Promoting the 10 Steps to Successful Breastfeeding with birthing hospitals while providing technical assistance as needed
• Providing breastfeeding education to pregnant and breastfeeding women through education materials and community events
• Promoting the WIC Breastfeeding Peer Counselor Program to WIC clients
• Offering breastfeeding education to health professionals and hospitals through conferences and trainings

Breastfeeding education materials and training (in-person and online) will be provided to LHD health professional staff, Regional Breastfeeding Coordinators, Breastfeeding Peer Counselors/Supervisors, birthing facility staff, and lactation specialists. The goals of the training are to increase breastfeeding knowledge of staff and of pregnant or breastfeeding women. By training in advance of delivery, pregnant women will be more prepared for breastfeeding best practices upon admission for the delivery.

Online education modules and educational materials on breastfeeding and nutrition will be developed for LHD staff training. Collaboration with the MCH Obesity Team and Partnership for a FIT KY will support the dissemination of educational materials to promote breastfeeding and nutrition through participation in health fairs and conferences. Likewise, other MCH programs promote this topic at local events as well as cross promote prevention activities related to childhood injury prevention, lead poisoning, and the linkage for prenatal services.

The MCH Nutrition Branch will continue supporting pregnant women and new parents of infants with nutritional education, WIC services per federal guidelines, and promotion of the WIC Farmer’s Market Program.

Healthy Start

In the next year, MCH and the Louisville Metro Healthy Start Program will continue to engage in efforts to make state and local systems level changes to improve the health of the population in Jefferson County. Healthy Start continues to organize plans to promote health equity, provide support and education to the women in Jefferson County with targeted outreach in Louisville with Louisville’s Stigma Intervention Project to provide a platform for women, who used substances during pregnancy, to share their experience with birthing hospitals. This partnership has been a vital opportunity for MCH and Healthy Start to make a vital impact on the vulnerable and diverse population of Jefferson County.

Social Determinants of Health

Ongoing participation in the Social Determinants of Health (SDOH) IM CoIIN has resulted in practice changes that recognize health equity as a function of the access to social factors that create good health. In addition to adding verbiage about the importance of social determinants to KDPH guidance documents for local health departments, KDPH has infused equity-focused trainings into Maternal and Child Health conferences and workshops. The March of Dimes’ “How Biased Am I” trainings were integrated into five regional MCH events, and the presentation was recorded for posting on KY TRAIN. Presentations at the 2018 and 2019 Kentucky MCH Conferences addressed SDoH from both rural and urban perspectives. Additionally, Title V MCH Needs Assessment questions asked responders to identify social factors in their communities that have the greatest influence on maternal and child health outcomes.

CoIIN team collaborations with Louisville Metro’s Healthy Start Program and the March of Dimes have strengthened working relationships and led to new equity-focused work such as Louisville’s Stigma Intervention Project, which shares the requests for perinatal care improvements from women who used substances during pregnancy with birthing hospitals. Learnings from Louisville Metro Healthy Start’s history of responding to the social determinants through both home visits and collective impact work will be presented at the virtual 2020 Kentucky Perinatal Association – Maternal and Child Health Conference.

Safe Sleep

The NPM # 5: Percent of infants placed to sleep on their backs and other safe sleep initiatives will continue to be a structural part of Title V work to reduce infant mortality. The Health Program Administrator will promote safe sleep on Facebook feed for local community partners and health departments. The program will continue to review all sudden unexpected infant deaths, collect and evaluate data on the sleep environments, and share the data with local teams to assist with prevention planning. A safe sleep assessment tool has been developed and will be shared with local health departments and other home visitors for use when discussing safe sleep with families. Trainings will be held for child care providers, home visitors, and other community partners on the ABCDs of safe sleep with a focus on how to assess safe sleep and provide safe sleep education during the Covid-19 pandemic. Prevent Child Abuse KY, the KY Hospital Association, and KDPH collaborated to create a comprehensive education video on safe sleep and AHT for new mothers to view prior to hospital discharge. The KDPH, KSPAN, KPRIC, and Northern KY Health Department plan to continue providing the high school PAHT and safe sleep curriculum. Lake Cumberland District Health Department plans to address this training in the high schools serving 10 KY counties.

Neonatal Abstinence Syndrome and Plan of Safe Care

Current work to address SPM #1: Reduce by 5% the rate of neonatal abstinence syndrome among Kentucky resident live births will continue. Although that goal was achieved as the rate decreased 26% from 2017 to 2018 (22.35 per 1,000 to 16.5 per 1,000), preliminary numbers for 2019 indicate that there is not a downward trend. For that reason, the existing SPM will continue until a 5% reduction in rate is sustained over multiple years.

MCH has an annual meeting and other regional programs planned for 2020, which have been changed to virtual learning opportunities available for the following year. These trainings will be promoted to schools of nursing, LHDs, and birthing hospitals. MCH continues to plan to replicate the HEART Program in other counties as Covid-19 restrictions and communities will allow.

HANDS and MIECHV

The home visitation program will continue efforts to address infant outcomes by providing prenatal education promoting a healthy lifestyle and encouraging prenatal follow-up with ongoing education after child birth. MIECHV will continue to screen families for a variety of concerns and refer to community providers and resources.

PRAMS

KY will continue with the PRAMS survey as described in the annual report. KY will continue to analyze and distribute the results annually. Topic specific reports have also been developed on breastfeeding, oral health, smoking and drug use, ACEs, and safe sleep. Because KY PRAMS survey addresses other areas of MCH population health, the data provides very pertinent information about the needs of the MCH population in KY. PRAMS could prove to be insightful for programming for the perinatal population in terms of mental health, care, and safe sleep outcomes. PRAMS data will continue to be shared at the annual MCH conference and regional conferences across the state.

MCH Evidence Informed Strategies at LHDs or Packages

KY plans to continue to offer MCH Evidence Informed Strategies through the MCH packages as described. The packages offered include Safe Sleep for Child Care Providers, Safe Sleep for Community Partners, Prevention of Abusive Head Trauma, and Cribs for Kids for Community Partners. Additionally, MCH has begun meeting with the Tobacco Cessation Program to develop a new strategy targeting pregnant woman and reduce the exposure of the infant in utero.

KPQC

Work begun in the initial year of the KPQC, with the neonatal and OB/GYN teams, will continue in the upcoming year. A virtual conference is planned for the fall of 2020, and surveys to assess hospital policy and protocols are being developed with targeted discussion about NAS and plan of safe care.

Newborn Screening

Newborn screening is an efficiently ran program. The goal for the upcoming year is to share KY data with stakeholders. The first presentation is planned for release by November 2020 as part of the overview of MCH data. This presentation is one of a 5-part perinatal series completed in partnership with KPA and KY Chapter of MOD.