Perinatal/Infant Health – Application Year

 

Illinois’ priority for Infant and Perinatal Health Domain is:

 

• Support healthy pregnancies to improve birth and infant outcomes. (Priority #3)

 

During FY23, Title V will utilize the following strategies to support healthy pregnancies and improve birth and infant outcomes:

 

3-A. Maintain a strong system of regionalized perinatal care by supporting perinatal network administrators and outreach/education coordinators and identifying opportunities for improving the state system.

 

During FY23, IDPH and Title V will continue to administer the Illinois Administrative Perinatal Centers (APC) Grant Program. The 10 APCs supported by Title V through the APC program will continue to monitor and provide consultation to the birthing and non-birthing hospitals in their respective networks. This consultation will help to improve maternal, child, and infant health outcomes across Illinois. Key activities in which the APCs will engage include standardizing M&Ms case reviews, messaging on postpartum warning signs, educating EMS providers and non-birthing hospitals for emergency perinatal care to lower very pre-term birth deliveries outside a Level III facility, supporting ongoing simulations for obstetrical hemorrhage at birthing hospitals to prevent maternal morbidity and mortality, and providing neonatal resuscitation education to birthing hospital clinicians to assist with the understanding of stabilization for neonates. IDPH’s perinatal nurses will continue to provide site visits and attend morbidity and mortality reviews at the hospitals.

 

OWHFS, Title V and the Illinois Perinatal Advisory Committee (PAC) will draft the new administrative rules regarding the perinatal and maternal levels of care. Once the draft is completed, it will be shared with birthing hospitals and other key stakeholders for feedback that will be reviewed and incorporated as necessary. OWHFS hopes to submit a final version of the rules through the IDPH rulemaking process by early FY23.

 

3-B. Implement surveillance systems to assess the impact of COVID-19 on pregnant women and neonates, including use of CDC’s Surveillance of Emerging Threats to Mothers and Newborns (SET-NET) system and development of system to track universal testing of pregnant women admitted for labor and delivery.

 

During FY23, Title V will continue to support the CDC initiative, Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET). IDPH was funded to collect data on confirmed COVID-19 cases during pregnancy. This initiative involves the epidemiology team identifying cases through linkage of records from multiple sources. The medical charts are abstracted, and information entered into the CDC data collection form. Ultimately, this project will allow IDPH and CDC to monitor exposures of concern during pregnancy and collect follow-up data on affected infants over time.

 

3-C. Support the Fetal and Infant Mortality Review (FIMR) program that identifies factors that contribute to fetal and neonatal loss and subsequent adverse pregnancy outcomes and develops recommendations to improve quality care as well as address social determinants of health.

 

The Fetal Infant Mortality Review (FIMR) initiative is a nationwide systems strategy supported by the American College of Obstetricians and Gynecologists (ACOG) to identify non-medical factors that contribute to fetal and neonatal loss and subsequent adverse pregnancy outcomes. The goals include eliminating disparities in perinatal, infant, and maternal health; and directing resources and proposing interventions to improve access to, utilization of, and full participation in comprehensive perinatal and women’s health services, particularly for women at higher risk for poor health outcomes.

 

In FY23, Title V will support the two existing FIMRs and explore opportunities to support additional FIMRs.

 

3-D. Support the Illinois Perinatal Quality Collaborative (ILPQC) in its implementation of obstetric and neonatal quality improvement initiatives in birthing hospitals.

 

This is the same as strategy 2-I. Information about this activity is available in the narrative for the Women’s/ Maternal Health Domain.

 

3-E. Convene partners to support statewide efforts to improve breastfeeding outcomes and reduce disparities.

 

The OWHFS is participating on a collaborative project known as the Illinois State Physical Activity and Nutrition Program (ISPAN). This project, which began in 2019, aims to build on the significant accomplishments made in physical activity and nutrition policy, systems, and environmental change. The purpose of this collaborative program is to reduce chronic disease and increase the health and well-being of Illinoisans by reducing disparities. The collaborative projects most aligned with Title V activities focus on increasing the number of places (e.g., pediatric/ family practices, WIC sites) that implement supportive breastfeeding interventions. Title V will support future pending programs that focus on establishing a statewide learning collaborative and provide training and support for local health departments, which may include scholarships for WIC staff to become certified lactation consultants. DHS will continue to convene its learning collaborative utilizing seven regional breastfeeding task forces across the state. In addition, DHS will continue to provide scholarships for WIC staff to become certified lactation consultants or specialists. DHS will also continue to offer scholarship opportunities for community partners to attend these WIC breastfeeding trainings with the goal of increasing access to lactation support professionals (CLC/CLS/IBCLC) with similar lived experiences among rural, Black/African American, and Latina women.

 

Title V will continue to partner with organizations, such as ILPQC and the administrative perinatal centers, to explore opportunities to educate moms with opioid use disorder about safe breastfeeding practices, as well as education around pregnancy and opioid use. In addition, Title V will continue to track the number of Baby-Friendly facilities and the proportion of births occurring in these facilities.

 

Another notable activity in which Title V will support in FY23 is the recently launched breastfeeding initiative entitled, Enhancing and Expanding Breastfeeding – Illinois (EEB). This initiative seeks to bolster the substantial progress Illinois has made on measures related to breastfeeding over the past several years (e.g., increase in breastfeeding initiation rate). The specific objectives of the program include improving the continuity of care and support for breastfeeding throughout the state, enhancing workforce development through training and the creation of tools for health care professionals who provide services to pregnant individuals, and developing and implementing programs that promote health equity in lactation support.

 

In FY23, MIECHV’s will continue to collaboration with IPHI on breastfeeding initiatives. A key activity is the result of the two entities’ home visitors survey. As reported in FY21, this survey was administer to over 500 home visitors. It as determined that the home visitors needed additional trainings on breastfeeding, including guidance on becoming Certified Lactation Counselors or Specialists. MIECHV and IPHI identified a contractor to develop and implement a half-day live virtual training for home visitors. This training will take place in FY23 and will address such topics as milk supply issues, latch issues, shared decision-making in developing infant feeding plans and cultural humility in supporting/motivating families to breastfeed. The latter topic will use an equity framework that recognizes historic oppression of black, indigenous, and people of color (BIPOC) families.

 

Also, in FY23, the Illinois WIC program, which is housed at DHS, will support enhanced training for home visitors, Through the USDA Operational Adjustment grant, the WIC program will support approximately 40 MIECHV home visitors in obtaining a Certified Lactation Specialist certification.

 

3-F. Partner with the Illinois Department of Corrections (DOC) and two state women’s correctional centers to support ongoing health promotion activities for incarcerated women and staff training, and to ensure women and babies receive Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) services while residing in DOC facilities.

 

This is the same as strategy 1-B. Information about this activity is available in the narrative for the Women’s/ Maternal Health Domain.

 

3-G. Support and collaborate with the 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.

 

This is the same as strategy 2-D. Information about this activity is available in the narrative for the Women’s/Maternal Health Domain.

 

3-H. Provide support to pregnant women at risk for poor birth outcomes through an array of case management and home visiting programs by the Illinois Department of Human Services (DHS) Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program; and ensure DHS programs align with Title V priorities.

 

MIECHV

 

Title V will continue to support MIECHV in its effort to serve pregnant women at risk for poor birth outcomes through an array of case management and home visiting. Title V will also work with DHS to ensure alignment of priorities across both agencies.

 

IL-ECCS

 

Title V will also support DHS as it implements and executes its Early Childhood Comprehensive Services (ECCS) grant from the Health Resources and Services Administration (HRSA). IL-ECCS focuses on enhancing the P-3 statewide maternal and early childhood system of care by establishing a Universal Newborn Supports System (UNSS) that better connects moms and babies to programs and services; working across state agencies to establish a clearly aligned and sustainable infrastructure to support a stronger and more efficient and effective P-3 system; and aligning policy, data, and financing mechanisms to support and sustain a coordinated and comprehensive P-3 system. Title V will also participate on the IL-ECCS Cross Sector Advisory Committee/Care Coordination Committee to provide advice on the project and recommend strategic directions, policy, and financing changes.

 

3-I. Support the Chicago Department of Public Health (CDPH) in implementation of Family Connects Chicago to ensure nurse home visits for all babies and parents immediately following birth and linkage to a network of community supports to assist with longer term, family identified needs.

 

CDPH will continue to implement its Family Connects pilot at specific Chicago hospitals. The program establishes a system of coordinated perinatal referral that uses universal nurse home visiting to identify the needs of families with newborns and connect them to appropriate supports and services. Family Connects will not only engage with the birthing person and their partner, but also, consider services for the entire family, including the mother’s other children. These additional services may include, but are not limited to, providing families tools, resources, and support on health care, infant care, safe homes, and parent support. CDPH intends to engage all 15 maternity hospitals participating in Family Connects, the Community Alignment Boards, and the Family Connects Citywide Advisory Board to review data, discuss implementation, and evaluate the model.

 

Other CDPH activities that align with this Title V priority include its refinement of the Welcome Baby kits that contain educational booklet and supplies, promotion of the recently rebranded “OneChiFam” website (previously known as Healthy Chicago Babies), and dissemination of the infant mortality report for Chicago.

 

Additional Programs and Emerging Issues

 

Hospital Closures

 

Similar to smaller urban or rural areas in other states, Illinois is beginning to experience a significant challenge in the closing of hospitals or the specific elimination of obstetrical services within hospitals. Title V is committed to ensuring timely access to appropriate levels of obstetrical care. Thus, in FY23, Title V will partner with the University of Illinois at Chicago, School of Public Health, Division of Health Policy and Administration (UIC-HPA), to conduct an economic analysis exploring the influence of health care provider access and the casual effects of events or policies on this access. UIC-HPA will conduct this analysis by investigating the availability of maternal care (defined here as prenatal care, labor and delivery care, and postpartum care) and its effects on maternal and infant health related outcomes. The analysis will focus on potential barriers or obstacles to accessing maternal care, including local geographic provider shortages and the configuration of Illinois’ regional perinatal network. Patients, patient-level associated information (e.g., residential ZIP code locations), and patient-level outcome measures will be defined based on available IDPH hospital discharge data and IDPH birth records data. UIC-HPA will use a combination of natural experiments with exogenous or pseudo-random variation, control variables, and econometric methods. The UIC-HPA research will bring its expertise in using large administrative health care claims datasets, developing models of individual and organizational behavior, and applying econometric and statistical methods.

 

There will be two components to this project. The first involves enhancing measures of maternity care deserts and access to maternity care. The second examines the effects of hospital closures and staffing changes in obstetrics. This component will focus on the causal effects of hospital closures of birthing hospitals, hospital OB unit closures, and potentially hospital OB-related staffing reductions on the provision of maternal care.

 

Sudden Unexpected Infant Deaths

 

Sudden Unexpected Infant Deaths (SUID) are defined as deaths that occur suddenly and unexpectedly in infants less than 1 year of age, and whose cause of death are not immediately obvious. The cause of SUID may be due to suffocation, asphyxia, entrapment, infection, ingestions, metabolic diseases, cardiac arrhythmias, trauma (accidental or non-accidental), or sudden infant death syndrome (SIDS). SUID is the third leading cause of infant mortality in Illinois and the overall SUID rate in Illinois has remained steady since 2000. During 2020, 111 babies died from SUID before their first birthday. Infants born to non-Hispanic Black women are six times as likely to die from SUID as infants born to non-Hispanic White women; SUID is one of the largest contributors to the inequity in overall infant mortality between Black and White infants in Illinois. Furthermore, not only is SUID more common among Infants born to non-Hispanic Black women, but it is more common among residents of the city of Chicago and urban counties outside the Chicago metro area, infants born to women younger than 25 years of age, and infants born to women who have had at least one other child.

 

In FY23, Title V will launch a new program entitled Baby-ZZZ Safe Sleep Program to partner with maternal and child health community stakeholders to expand community-based promotion of safe sleep practices and employ a risk reduction approach to improve sleep environments for all Illinois infants. Specific program objectives include: leveraging the state’s campaign to promote consistent and inclusive safe sleep messaging; increasing awareness of infant safe sleep practices and providing risk reduction education and training for parents, caregivers, and early childhood professionals, such as home visitors, family case managers, and other health care providers; conducting trainings/education that include, but are not limited to, maternal stress, breastfeeding promotion, smoking cessation, and sleep environments; identifying social determinants of health and other barriers to safe sleep practices amongst families in the community and adopting culturally relevant resources/approaches to address these barriers (e.g., cribs, pack-n-plays); employing risk reduction approaches that acknowledge families’ existing practices and provide additional opportunities to improve sleep environment and other safe sleep practices; and understanding and identifying stressors that may contribute to unsafe sleep practices; and developing and implementing strategies to foster social and family supports and improve maternal mental health.

 

Title V will also work with the Illinois interagency team on Safe Sleep. DHS, CDPH, DCFS, and IDPH are collaborating to create a statewide safe sleep campaign. The campaign will include safe sleep awareness communication and messaging activities that are culturally accessible and focused on safe sleep practices, breastfeeding, and injury prevention. In addition, the campaign will have a component that focuses on resources, such as free cribs and safe sleep prevention kits.

 

Ensuring population-based metabolic and hearing screening for Illinois newborns

 

In FY23, the IDPH Newborn Screening Section will continue its various activities through EDHI. Such activities include:

• Continuing with the business agreement collaboration with Illinois Hands and Voices, Guide by Your Side.
• Launching a rebuild of the illinoissoundbeginning.org website with expanded parent materials and full translation into Spanish
• Continuing to utilize the Continuous Quality Improvement (CQI) methodology to improve screening, diagnosis, intervention, and parent support.
• Finalizing the Administrative Rules for the Newborn Screening Program.
• Working with the National Center for Hearing Assessment and Management to develop an out of hospital birth version of the Newborn Hearing Screening Training Curriculum. 

 

Outreach and disseminating information

 

IDPH will explore partnering with the Governor’s Office of Early Childhood Development (GOECD) to use the communication mechanisms within the Illinois early childhood education and care system to facilitate public awareness.

• Illinois Cares for Kids is an information hub where Illinois parents, grandparents, caretakers, teachers, and child care providers can access information related to early childhood in Illinois.  Information is provided by age, allowing for a focus on infants and toddlers.
• Ready4K, is a free research-based text messaging program for parents in Illinois. Ready4K helps support parents, increases children’s learning, and provides a method for the state to share customized early childhood messaging consistently with families. 
• The GOECD newsletter is distributed monthly to over 7000 early educators, caregivers, family members, researchers and other stakeholders and routinely includes health information.