Objective PI-1

By September 30, 2020, increase access to healthy foods and beverages (including breastfeeding) where people work, learn, live, play and worship.

 

Strategies PI-1.1 and 1.2

Increase the proportion of infants who are still being exclusively breastfed at six months of age.

 

Promote practices and policies that support breastfeeding in worksites, schools, institutions and health care settings.

 

• Continue to monitor the percent of breastfed six-month-old infants through the Women, Infants and Children Nutrition Program (WIC) and National Immunization Survey data. In federal fiscal year (FFY) 2018, 40.8 percent of babies born in the state received WIC assistance. WIC staff are trained to provide breastfeeding support and must address the client’s concerns about breastfeeding. When a client requests formula, WIC staff assess her goals for breastfeeding and supply only the amount of formula needed to support healthy growth of the infant while supporting continued breastfeeding. WIC provides breast pumps when needed and offers breastfeeding peer counseling services in 50 percent of clinic sites.

 

• Continue to coordinate the Breastfeeding Friendly Washington program with hospitals, birth centers, and clinics. The Breastfeeding Coordinator is working to further implement Breastfeeding Friendly Washington into other health care systems and supporting the community through technical assistance.

 

• The Child Profile Health Promotion System will continue to include breastfeeding information in mailings to families with young children.

 

• Local WIC agencies will continue to provide breastfeeding education and support.

 

• Maternity Support Services (MSS) will continue breastfeeding messaging and support.

 

• The WithinReach Family Health Hotline and ParentHelp123.org website, described in the Women/Maternal Health Annual Report, will provide information and referrals in response to breastfeeding questions.

 

• The Breastfeeding Coordinator will continue to coordinate agency activities around breastfeeding with the interagency Department of Health (DOH) Breastfeeding Workgroup, including reviewing applications for the Breastfeeding Friendly Washington program.

 

• DOH and its Children and Youth with Special Health Care Needs (CYSHCN) program will continue contract activities promoting and supporting breastfeeding in at-risk populations, including work with a CYSHCN nutritionist and the development of feeding teams that work with families with infants at risk for feeding difficulties.

 

• We will also continue work on policies related to coverage of breast pumps with the state’s Medicaid administrative agency, Health Care Authority (HCA); Medicaid-managed care plans; and Essential Health Benefits plans.

 

Status to Date on Objective PI-1

The Breastfeeding Workgroup met regularly during this reporting period and continued to find opportunities for cross-program collaboration. Title V staff continue to expand Breastfeeding Friendly Washington. As of June 2019, 34 hospitals, 8 outpatient birth centers, and 11 clinics were certified as Breastfeeding Friendly Washington facilities.

 

Objective PI-2

By September 30, 2020, promote and provide support to build capacity and availability of health care, education, resources and services.

 

Strategy PI-2.1

Promote community referral and linkages to quality pediatric services through partnerships with local health jurisdictions, parent support organizations, community health centers, etc.

 

• Title V staff will continue to provide technical support to the Washington State Hospital Association (WSHA) so the Safe Deliveries Roadmap can be updated to meet current hospital needs.

 

• Title V staff also continue to work with the American Indian Health Commission (AIHC) in implementing Healthy Communities: A Tribal Maternal and Infant Health Strategic Plan, which includes objectives and strategies for decreasing adverse birth outcomes. The Maternal and Infant Health (MIH) contract convenes a state-wide MIH Workgroup that includes HCA members, and the contract supports the annual Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Summit in collaboration with Department of Children, Youth, and Families (DCYF).

 

• We continue to support regional genetics clinics and compile service utilization data, monitoring trends in genetic services and clinic wait times for clients accessing services. In addition, staff continue to increase access to services through telemedicine. We anticipate Providence Sacred Heart Spokane will be expanding genetic services to Central Washington as well as Idaho.

 

• The Early Hearing-loss Detection, Diagnosis and Intervention (EHDDI) program works to ensure newborns are screened for hearing loss before hospital discharge or by one month of age. Follow-up is conducted by pediatric audiologists for infants who do not pass screening.

 

We will continue to work with Hands and Voices to offer unbiased support and resources to parents of infants suspected of having hearing loss or identified as deaf or hard of hearing (D/HH). The program will continue to encourage early intervention by six months of age for infants who are D/HH. Based on feedback we received from audiologists, we will work with our EHDDI-Information System (EHDDI-IS) vendor, Neometrics, to improve the EHDDI linkage with the Early Support for Infants and Toddlers (ESIT) program. Our goals are for Lead Family Resources Coordinators (FRCs) to consistently receive referrals from audiologists through EHDDI-IS, and for the system to send diagnostic results along with the FRC referral.

 

• Our newborn screening program is a population-based, preventive public health program. It enables early identification of infants affected with selected genetic disorders and birth defects and disorders that without detection and treatment can lead to permanent cognitive or physical damage, or death, in affected children.

 

• Washington currently screens infants for 29 conditions through dried blood spot specimen testing, as well as two point-of-care conditions: hearing and critical congenital heart disease (CCHD). The State Board of Health has recently approved the addition of X-linked adrenoleukodystrophy (X-ALD), mucopolysaccharidosis type I (MPS-I), glycogen storage disease type I (Pompe), and spinal muscular atrophy (SMA) to the newborn screening program. Staff routinely work with birthing providers, hospitals, four pediatric cardiology practices within the state, along with March of Dimes, the American Heart Association, WSHA, Washington Chapter of the American Academy of Pediatrics and the Midwives Association of Washington State to fulfill our goals.

 

Strategy PI-2.2

Collaborate with the Washington State Department of Children, Youth, and Families and the Washington State Health Care Authority to provide home visiting services to at-risk families with young children.

 

• DOH, DCYF and AIHC continue to discuss enhancing home visiting and maternal and infant health services for tribes, as they rely on each other for improved birth outcomes and family support. Title V staff also continue to build stronger linkages with other state agencies that oversee behavioral health and addiction services. Policy work will focus on ensuring that all women have access to mental health and chemical dependency treatment, as well as expanding evidence-based intensive case management and home visit programs in counties where they are available.

 

• The 2017 Washington State Home Visiting Needs Assessment will continue to be disseminated to partners and stakeholders. Staff are working on an update to meet the MIECHV needs assessment requirement, and will coordinate this work with the Title V Maternal and Child Health Needs Assessment.

 

Status to Date on Objective PI-2

To continue to increase the percentage of infants receiving needed EHDDI services, EHDDI program staff made regular site visits with birthing hospitals, free-standing birth centers, midwives and pediatric audiology clinics. We improved family engagement and leadership by working with Hands and Voices to provide regional meet-ups, leadership trainings, and parent-to-parent support.

 

Staff continue to compile and analyze data submitted by the pediatric surgical cardiologists in the state along with infant death records and the Comprehensive Hospital Abstract Reporting System (CHARS) data. We will work closely with the pediatric cardiologists to determine if additional data could or should be compiled to address the quality of hospital-based CCHD screening.

 

DOH, along with other state agencies, has been tracking neonatal abstinence syndrome (NAS) rates in our state, which seem to have stabilized since 2015. Many policies have been implemented since 2015 to address the impact of the drug epidemic. These include removal of prior authorization for opioid antagonist treatment and increasing the number of patients that can be seen for antagonist treatment by a single provider. Washington State has developed an Interagency Opioid Working Plan and resources available to the public and providers.

 

Objective PI-3

By September 30, 2020, increase social connectedness, healthy relationships, violence-free environments and community engagement across the life span.

 

Strategies PI-3.1 and 3.2

Support safe, stable and nurturing families to prevent child abuse and neglect.

 

Decrease the presence of risk factors that contribute to violence and increase the presence of resilience factors at the individual, family and community levels.

 

• Continue the Essentials for Childhood (EFC) initiative and other adverse childhood experiences (ACEs) related work. This work is described in detail in the Child Health Application Year Plan under Strategy CH-2.1.

 

• Continue to work with the Child Death Review (CDR) program, as described in the Child Health Application Year Plan under Strategy CH-2.1, to review infant deaths, including sleep-related deaths.

 

• Continue work to reduce infant mortality. Various programs at DOH will continue to take part in efforts to reduce Sudden Unexpected Infant Deaths (SUID) through participation in the national Child Safety Learning Collaborative. In addition, the Infant Mortality Reduction Report with strategies for prevention and reduction will continue to be available electronically.

 

Through our state performance measures (SPMs) on reducing the rates of Black and Native American infant mortality, we will continue to track disparities in these communities with the goal of ultimately eliminating infant mortality in all racial/ethnic and economic groups. The governor’s Results Washington initiative tracks infant mortality in Black and Non-Hispanic American Indian/Alaska Native populations.

 

Status to Date on Objective PI-3

See Child Health Application Year Plan, Status to Date on Objective CH-2 for a description of work accomplished through the EFC initiative that supports this objective.

 

Objective PI-4

By September 30, 2020, promote the cessation and prevention of maternal and adolescent tobacco use.

 

Maternal tobacco use in all its forms has significant impact on birth outcome and beyond. Consequences of youth smoking are reinforced by the fact that many young people who smoke regularly continue to smoke throughout adulthood.

Strategy PI-4.1

Work with the DOH Tobacco and Vapor Product Prevention and Control Program to refer pregnant women currently smoking to cessation counseling and other resources.

 

The Washington State Tobacco Quitline (1-800-QUIT-NOW) remains open to the uninsured and underinsured (those with an insurance plan that doesn’t cover tobacco cessation).

 

Alternatively, or in addition, people with smartphones can download the 2Morrow Health tobacco cessation app for free through doh.wa.gov/quit.

 

DOH also continues to provide educational resources to women about the potential risks associated with using tobacco and marijuana during pregnancy and while breastfeeding.

 

DOH funds the AIHC to help reduce tobacco-related disparities. Educational resources are provided at tribal wellness centers where pregnant women seek medical care.

 

Strategy PI-4.2

Address tobacco-related disparities.

 

According to DOH data, American Indians/Alaska Natives (AI/AN); non-Hispanic/Latino Blacks; and persons with low incomes and lower levels of educational attainment are more likely to smoke than other Washingtonians. The DOH Tobacco and Vapor Product Prevention and Control Program (TVPPCP) will continue to work with community groups, including the AIHC, to prevent chronic disease and improve the health of tribal and urban AI/AN residents by focusing on commercial tobacco-free living, healthy eating, active living and emotional wellness. DOH will also focus on the recruitment and training of peer leaders (community health workers) in underrepresented communities to connect clients with cessation resources and educate peers and community leaders on the impact of tobacco.

 

As mentioned in the Perinatal/Infant Health Annual Report, in an effort to be linguistically appropriate, the Washington State Tobacco Quitline provides services in more than 200 languages.

 

Status to Date on Objective PI-4

After four years of failed Tobacco 21 legislation, the Washington State Legislature passed House Bill 1074 to raise the minimum age of sale of tobacco and vapor products from 18 to 21. The new law takes effect January 1, 2020.

 

From August 2017 through July 2018, 2.4 percent of women who were served by the State Quitline and approximately 12 percent of women who downloaded the 2Morrow Health app were either pregnant, planning to become pregnant, or breastfeeding. Considering the apparent popularity of the smartphone app, TVPPCP is investing in the development of a custom 2Morrow Health app module tailored to the specific needs of pregnant women. A beta version is expected to be released in summer 2019.

 

DOH recently updated its popular pregnancy resource, Substance Free for Baby document, renaming it “For a healthier baby and a healthier you!” TVPPCP also promotes the CDC’s Substance Use During Pregnancy resources on the DOH website.

 

The DOH Tobacco Cessation Consultant has developed a slide deck for clinicians, Tobacco Use and Pregnancy, which was first presented to perinatal social workers at the University of Washington in February 2018.

 

In summary, Title V staff in the perinatal/infant health domain promote Breastfeeding Friendly Washington certification for hospitals and birth centers as well other stakeholders to increase six-month breastfeeding rates. We collaborate with community partners, including our contractors at the Black Infant Health Program and the AIHC, to find culturally appropriate methods and strategies to reduce and ultimately prevent infant mortality, as well as address disparities in infant mortality rates. We are working with other stakeholders to implement the Interagency Opioid Working Plan, which outlines both current efforts, as well as new proposed actions to scale up response. The plan will be regularly updated as the epidemic and response evolve over time. The work of the perinatal team is specifically focused on neonatal abstinence syndrome prevention through medication-assisted treatment for pregnant women and standardization of care for infants born withdrawing.