Perinatal/Infant Health Action Plan (October 1, 2021-September 30, 2022)

WIC:  WIC plans to launch its Online Prescreening Application to allow participants to upload required documents prior to appointment. This effort will decrease time in the clinic and reduce rescheduling of appointments. Expansion of self-checks for all WIC approved stores will be pursued during this time. Regional MOAs with First Steps will be established to focus on collaboration and retention of WIC participants. WIC will explore desktop/laptop texting companies. The program will explore adding senior breastfeeding peer counselors to each region for mentorship/training to enhance the breastfeeding program. Collaboration will continue to be a focus of the program, especially with the health care community. The program plans to update the Civil Rights and Customer Services modules for WIC staff and make them interactive. The program plans to expand CDC’s Learn the Signs, Act Early campaign statewide. 

Perinatal Regionalization: Major emphasis will be placed upon increasing capacity for maternal mortality and morbidity reviews.  There is a particular interest in implementing maternal levels of care which will likewise impact perinatal outcomes.  The impact of all of the mergers and acquisitions as well as the potential impacts of decreased numbers of birthing hospitals on access to care and patient outcomes will be studied during this time frame. As the number of hospitals adopting the MAiN (Managing Abstinence in Newborns) model of care continues to increase, DHEC will continue to provide training and support to ensure nurse home visitors have the skills and information needed to improve outcomes for infants with NAS/NOWS. MCH will continue contracts with the Regional Perinatal Centers to maintain the excellent perinatal regionalization system and will maintain active participation in the BOI.

Safe Sleep Coalition: The Safe Sleep Coalition will continue to engage with stakeholders statewide in efforts to align efforts within the state. During the month of October 2021, the Safe Sleep Initiative will work with partners to host a Safe Sleep Summit and Campaign to promote Safe Sleep Awareness Month. 

MCH staff will continue to work with the BOI Safe Sleep sub-committee to update the current brochure and create a new poster which reflects the updates. MCH staff will expand educational efforts through creation of more culturally appropriate materials with the help of our collaborating partners. Targeted messages will be developed for fathers and grandparents.   

Birth Outcomes Initiative: The CenteringPregnancy model of prenatal care is expected to continue to garner support, including support for monitoring BOI initiatives. A focus on LARC (inpatient and outpatient), access to progesterone for prevention of spontaneous preterm birth, support for Baby-Friendly hospital certification and breastfeeding continuance, and support of the Mother’s Milk Bank (http://www.scmilkbank.org/), will continue to be areas of focus for BOI.  Additionally, reducing health disparities in all areas of SC birth outcomes continues to be an area of focus for each of the BOI workgroups. 

Program replication for a unique treatment model to manage neonatal abstinence syndrome (NAS) is a new focus for BOI. The MAIN program, (Managing Abstinence in Newborns), provides multidisciplinary, coordinated care to families with newborns at risk for or diagnosed with NAS, in order to achieve a cost-effective, family-centered experience with best potential outcomes for mothers with substance dependence and their exposed and or treated infants.  Plans are to replicate the success of the original program at Greenville Health System at four other hospital systems during this time period. 

Another year of funding for mobile simulation training is earmarked, with focus on primary C-Section reduction and maternal/neonatal safety. As an added effort to improve maternal health, BOI has joined the national AIM Collaborative on Maternal Safety.

Experts in Safe Sleep and breastfeeding are expected to continue meeting as an ad-hoc seventh workgroup at BOI. Partners in the Safe Sleep efforts of the Baby Friendly workgroup are: Children’s Trust of SC; the SCFAC; the MCH Bureau; and hospital leaders. Through this creative interface, experts in the two areas, Safe Sleep and breastfeeding, will continue to interact and discuss initiatives that support both important areas.

The BOI has experienced staff changes over the past few months and is in a period of transition and reorganization.  Partners remain committed to the valuable work of BOI and monthly meetings will continue, open to all who want to work toward improving outcomes for mothers and infants in SC. 

The Care Line: The DHEC will continue to promote the Care Line and distribute material throughout the state of SC.  The Care Line will continue to provide resource information, referrals, assistance and support to the residents of SC to help them with access to health care and social services available.  The Care Line's goal along with agency partners is to continue to disseminate resources and referral information to at least 10 events (conferences, health fairs and community events) per year.

First Sound: First Sound will continue to collaborate with family support organizations to promote awareness of the First Sound program and the importance of early hearing detection and intervention. First Sound will resume work with the new AAP Chapter Champion to obtain additional opportunities to present at Grand Rounds in other areas of the state as well as large groups of pediatric practitioners. First Sound also plans to collaborate with The Care Project to host a parent retreat for parents of D/HH children. The First Sound program also plans to take steps to amend the state EHDI legislation to enable direct referrals to early intervention and parent support.  

Newborn Screening: Due to the COVID-19 pandemic, the APHL NewSTEPs QI grant was extended to August 31, 2022. Tasks will continue to expand lab courier, staff training, and timely lab reporting. 

NBS Advisory Committee and virtual ad-hoc medical specialists’ meetings will continue to assist the program. A pilot study to begin testing for X-ALD disorder will begin in October 2021. 

On October 7, 2020, the program initiated an electronic patient case management system to minimize patient paper case files. Projected completion date for this software project is February 2022.  

Text4baby: The National Text4baby program was relaunched in June 2021. The program has been updated with the latest prenatal and infant care guidelines and food allergy prevention and management information from FARE, the world’s leading non-governmental organization engaged in food allergy advocacy and the largest private funder of food allergy research.  DHEC will continue to promote Text4baby and distribute information on how the program works and how to sign up.  Text4baby material will be distributed throughout the state of SC with the help of agency partners. Through the Care Line program, Text4baby material will be distributed at conferences, health fairs and community events during the year. Text4baby material will also be distributed through other DHEC divisions and the regions.

Postpartum Newborn Home Visits:  During the summer of 2021 (prior to the start of FFY 2022), DHEC expects to resume provision of all the PPNBHV service components that were affected/curtailed by the COVID-19 pandemic. The close scrutiny of the “deep dive” programmatic analysis identified strategies for assuring the health of mothers and infants outside of a visit to the home; it is assumed that many of these outreach strategies will continue in the post-pandemic period. 

Work will resume to identify new families enrolled in the Nurse Family Partnership program who may now be eligible for the PPNBHV. MCH and Regions will collaborate to address staffing and outreach strategies to serve families of infants affected by Neonatal Abstinence Syndrome. 

The MCH Bureau and Regional Public Health Departments will continue to address issues of limited PPNBHV staff, as well as best stationing of staff to ensure access to this service, especially for priority mother-infant dyads in counties with limited resources. Based upon the positive reception of virtual visits, these will continue, with refinements in billing procedures, scope of visits, assessment techniques, and assurance of linkages to necessary services. 

DHEC will continue implementation of improved processes for receiving, prioritizing, assigning, and following up on PPNBHV referrals. Focus areas are: 1) efficiency (completed visits within fourteen days of hospital discharge); 2) efficacy (adequacy of documentation and preparation of nursing staff); and 3) the effect of visit content on health outcomes. Data markers tracked through DHEC’s CARES system (which will move to our electronic health record as it is implemented) include breastfeeding initiation, tobacco use, and other key health metrics. The Central Office Nurse Consultant is obtaining certification as a trainer on Fetal Alcohol Spectrum Disorders; this content will be incorporated int the next revision of the PPNBHV course and will be provided to other programs serving mothers and children. 

South Carolina Birth Defects Program: South Carolina Birth Defects Program: From October 1, 2021-September 30, 2022, the SCBDP will be working on continuing implementing activities identified in the SCBDP Strategic Plan and will focus on key areas of birth defects prevention, research, and referrals. 

The SCBDP Prevention activities will include a continuation of referrals to GGC for families impacted by a NTD.  A new strategic plan objective related to FASD will be operationalized during this time. The program will work closely with the Fetal Alcohol Syndrome Coalition to develop some measurable educational objectives related to FASD, and additional assessments related to surveillance will be conducted.  

The SCBDP will continue working with CDC SETNET to complete a perinatal Covid-19 surveillance project. The SCBDP has also applied for Epidemiology and Lab Capacity Project W funding through DHEC partners to implement syphilis and Hepatitis C surveillance among pregnant women for the first time. If this funding is awarded to SC, the program will adopt these conditions for surveillance and will work closely with the HIV/STD division to support women impacted by syphilis.  

Through funding awarded through the CDC CHD STAR study, the SCBDP will work with CDC NCBDDD to conduct surveillance of screening practices and results among all infants impacted with CHD from 2014 to present. Through an enhanced data system developed in 2021, the program will enter data from a retrospective medical chart review of all cases of critical congenital heart defects identified in SC since 2014. Through this same grant, the SCBDP will continue to expand surveillance of CHD and will work with the Office of Revenue and Fiscal Affairs to assess health outcomes of people impacted by CHD.  

The SCBDP was awarded as a grantee for a CDC NCBDDD grant entitled, “Advancing Population-Based Surveillance of Birth Defects”.  Through this opportunity, the SCBDP will work to improve operations in all areas of prevention, research, and referrals through enhanced surveillance and evaluation.  The SCBDP will continue working with Dr. Sonja Rasmussen and with enhanced staff capacity to assess and improve data quality. As a data quality enhancement, the SCBDP will work with NCBDDD to conduct an electronic health record readiness assessment in conjunction with other awarded states.  The program will also work to evaluate the efficacy of referrals to BabyNet through partnership with MCH experts. Additionally, the program will fully expand surveillance to outpatient OB-GYN and pediatrician clinics due to this funding. The program will continue monitoring the effect of adding data sources such as pediatric orthopedic hospitals and genetic institutions to case finding.  In addition to enhancing surveillance during this time, the SCBDP will evaluate progress made on its 2018-2023 Birth Defects Strategic Plan. 

Nurse Family Partnership: As Pay for Success study enrollment ended on March 31, 2020, NFP NSO significantly reduced the amount of financial support that was available to DHEC.  While Medicaid revenue has been higher than usual during the COVID-19 pandemic due to telehealth visits, income from all sources remains less than the agency’s current program expenditures. After much discussion and detailed financial analysis, it has become clear that the NFP program in its current state is not sustainable long-term within DHEC.   

On April 2, 2021, DHEC stopped enrolling new clients into the program.  In partnership with the DHHS, DHEC developed a 30 month phase out plan to ensure that all currently enrolled clients receive services until they complete the program.  DHEC will continue to provide quality customer service to the women and children enrolled into the program prior to April 2, 2021. DHEC will continue to collaborate with DHHS to ensure that funding is available to support the program through September of 2023.    

Infant Mortality SDoH CoIIN: The Bureau will continue to implement aspects of the IM SDoH CoIIN initiative to include the newly adopted health equity mission statement and continue to implement an equity lens across the Title V priority areas.  As of September 2020, the IM SDoH CoIIN initiative has ended.