Every Woman Connecticut

Every Women Connecticut (EWCT) and the Every Woman Connecticut Learning Collaborative (EWCTLC) will be addressing and responding to the impact of COVID-19 and the increased awareness around health equity, social justice, and social determinants of health. With guidance from EWCT Advisory Committee members and implementers of OKQ, lessons learned from providing clinical and non-clinical services during the perinatal period in a pandemic will be shared with EWCTLC, the MCH Coalition and the SHIP Advisory Council.

This work will be done under the auspices of the CT Women’s Consortium. 

Consulting services will continue to be provided by Marijane Carey of Carey Consulting. Carey Consulting will be charged with managing the Advisory Committee, expanding partnerships, responding to the evaluation recommendations and engaging members of EWCTLC to increase provider knowledge and self-efficacy in delivering , promising and evidence-based education, care, and services related to pregnancy intentionality, optimal birth spacing, and pre-/interconception health. Dr. Jordana Frost, the Co-Chair of EWCT since the inception of this initiative, has moved into a national position at the March of Dimes. Once her CT position is filled, the March of Dimes’ essential contribution to the work of EWCT will continue.

Based on the evaluation report prepared for the Advisory Committee by Dr. Megan Smith through Elevate, a policy lab at Yale School of Medicine, beginning this year evaluation recommendations will be addressed. The recommendations are: 1) clarifying EWCT’s mission and objectives; 2) clarifying the role of Advisory Committee members and other involved in EWCT’s work; 3) sustainability planning; and 4) measuring impact.

Internal work will also include updating the OKQ manual to include information and guidance on providing care during a pandemic and how federal and state legislation, The Child Abuse Prevention and Treatment Act (CAPTA) and the Comprehensive Addiction Recovery Act (CARA), impacts women who deliver an infant believed to have been substance exposed and/or displays withdrawal symptoms. The manual update will be informed by the information and resources presented in the two EWCT-sponsored workshops on CAPTA and CARA.   

Externally EWCT is strategically planning to maximize its reach by establishing relationships with other organizations and entities. The specific groups are:

• The Women’s Services Practice Improvement Collaborative (WSPIC)

WSPIC is co-sponsored by the Department of Mental Health and Addiction Services (DMHAS) and the CT Women’s Consortium. Collaborative members are the Department’s treatment programs for women. WSPIC is a conduit for a rapid response by EWCT to needs identified WSPIC members.

• The Women and Opioid Workgroup

This is another DMHAS sponsored group designed to communicate and coordinate services for women dealing with opioid use.

• The Medicaid Strategy Group (MSG)

MSG is a coalition of health advocates working together to improve and protect the quality and reach of HUSKY/Medicaid programs in Connecticut through administrative and legislative advocacy.

• Health Equity Solutions, COVID-19 Outreach

This on-going outreach effort is collecting information about the impact on COVID-19 on underserved communities to help center health equity in Connecticut’s response and recovery efforts. 

• The ACES Task Force

This Task Force was convened by the Women’s Consortium to support efforts to address racism in trauma.

Participation in these groups expands partnership potential as it increases EWCT’s platform for addressing pre/interconception health care, health equity and racism from a comprehensive and holistic perspective.

Participation in WSPIC and the Women and Opioids Workgroup supports and strengthens EWCT relationship with DMHAS, which includes the Department offering, for the past two years, EWCT-sponsored workshops on OKQ/human sexuality/reproductive health and on implicit bias as well as creating an on-line OKQ training module.

CT Coalition Against Domestic Violence’s (CCADV) representative on the EWCT Advisory Committee will help to facilitate opportunities to present OKQ to CCADV member agencies.

EWCT will use the EWCT Learning Collaborative (EWCTLC) has the major vehicle to increase provider expertise and self-efficacy in implementing routine pregnancy intention screening and appropriate care, education, and services to ultimately improve birth spacing, increase pregnancy intentionality, as well as the proportion of Connecticut women who deliver a live birth and report discussing pre-/interconception health with a healthcare worker and to support implementers of OKQ. Currently there are over 350 EWCTLC members consisting of OKQ implementers and/or those who have attended an EWCT sponsored training.  EWCTLC members will receive at least quarterly Notes of Interest through Constant Contact supported emails and at least two trainings on topics identified by EWCTLC members or through the groups identified above (WSPIC, the Women and Opioid Workgroup, Health Equity Solutions’ COVID-19 Outreach, and the ACEs Task Force). Opportunities for local networking and one on one meetings will also be offered virtually until it is safe to resume in person meetings.

Family Wellness Healthy Start Program (FWHS)

The Family Wellness Healthy Start Program (FWHS) will continue to provide services to Hartford and New Britain, Connecticut low-income pregnant and parenting teens, women, their infant, and other family members until that child reaches 18 months of age. The goal of all Federal Healthy Start Program is to eliminate racial and ethnic disparities in perinatal health outcomes such as low birth weight, premature birth and infant mortality among the target population of Hartford and New Britain’s African American/Hispanic female teenagers and women. Direct services are provided by Care Coordinators/ Case Managers at Community Health Services Inc., Charter Oak Health Center Inc., St. Francis Hospital and Medical Center, Women’s Clinic; the Hispanic Health Council; the City of Hartford Health and Human Services; and the Community Health Center, Inc. (CHC Inc). Outreach provided by Outreach Workers at the Urban League of Greater Hartford and CHC Inc. Fatherhood activities are provided by a Fatherhood Coordinator at Catholic Charities, Archdiocese of Hartford Family Centers in the Asylum Hill and Northeast areas of Hartford.  Nurse Practitioner services are also provided in the city of New Britain through a contract with CHC Inc.  In the upcoming grant year FWHS will provide services to at least 700 program participants including pregnant women, infants, preconception and interconception women.  The services will include case management; prenatal, inter-conception, depression and domestic violence screening referral and follow-up; fatherhood services;  health education about nutrition, breastfeeding, infant and child care and developmental milestones; and referral to resources such as HUSKY, WIC, food pantries, housing and shelters, education, employment, smoking cessation, child care, counseling and maternity needs.

Pregnancy Risk Assessment and Monitoring System (PRAMS)

PRAMS data is used by DPH and other statewide partners by providing them with data to inform their work in addressing the strategies outlined in this section. PRAMS provide statewide data on a variety of topics that are not available from any other data source, including preconception health and education, pregnancy intention, contraception methods, perinatal depression, oral health, social support, postpartum maternal and infant care, discrimination, and father involvement.

Currently, six years of data (2013-2018) are available for analysis, and the 2019 weighted data should be received in early Fall 2020. The 2019 data set will include opioid supplement data that we will analyze and disseminate to our statewide partners. CDC PRAMS was able to secure additional statisticians to reduce the time lag between states completing data collection for a surveillance year and receiving their weighted data. Given that data collection for any given surveillance year spans 14 months (ending in June of the following calendar year), receiving the 2019 weighted file only months after closing data collection is an incredible achievement. Since receiving our first weighted data set in late October 2015, 62 data requests from internal and external partners have been fulfilled; numerous publications and other products have been produced; and PRAMS staff have collaborated on various efforts to address state MCH priorities, as well as statewide plans and initiatives to reduce low birth weight, infant mortality, and health disparities. In the upcoming year, CT PRAMS and the Title V Director will be collaborating on two PRAMS Data to Action efforts with partners from the March of Dimes Connecticut Chapter, MCH Coalition, and Connecticut Perinatal Quality Collaborate around discrimination and respectful birth care, as well as mental health.

In addition to core operations, CT PRAMS elected to add a COVID-19 supplement to the survey. The questions were developed by CDC and are undergoing cognitive testing. Title V MCHBG funds are being used to fund this supplement as CDC PRAMS does not currently have funding for this. The supplement will begin with the October 2020 batch and run at least through the end of the 2020 surveillance year. However, depending on the course of the pandemic and available funds, we will explore the possibility of extending the supplement beyond March 2021.

These supplemental questions are an effort to begin collecting population-based data on how the lives of Connecticut’s mothers are being impacted by COVID-19 infection and the COVID-19 pandemic. The questions will allow us to describe the number of moms who feel that they may have been infected with COVID-19, whether or not that was confirmed by a test. We will also be able to divide women into groups that were not at all affected, somewhat affected, or greatly affected by the societal effects of the pandemic. Taken in conjunction with the rich information that PRAMS already gathers on the lives of women around pregnancy, we may be able to quantify the degree of disruption across many different life domains.

PRAMS is uniquely positioned to provide population-based data on maternal behaviors and experiences related to COVID-19 among recent postpartum women. PRAMS data will complement other CDC COVID-19 surveillance efforts by filling gaps in data, including interactions with health care providers in person and by telemedicine, testing and results exposure/infection, and economic/emotional hardship. Other relevant data from the non-supplemental portion of the PRAMS survey can also be provided to state and national partners, including contraceptive use, family planning, receipt of prenatal care, and more.

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and SPAN CDC 1807 Cooperative Agreement Initiatives

DPH will continue to partner with the CT Breastfeeding Coalition’s (CBC) Ten Step Collaborative to encourage implementation of evidenced-based maternity care and the 10 Steps for Successful Breastfeeding in CT hospitals. Focus this year is to enhance continue to promote the “It’s Worth It” (IWI) messages, related media campaign and materials in targeted communities and practices. Widely disseminate IWI Social Media toolkit to various organizations, partners and community groups.  Disseminate link to

https://www.readysetbabyonline.com/ developed in partnership with the Carolina Global Breastfeeding Institute (CGBI). By March 2021, webpage will be translated into Spanish and piloted.  Goal is to increase breastfeeding knowledge and access prior to delivery (Step 3).

DPH will continue to focus on improving access to culturally competent community lactation support through partnership with the CT Breastfeeding Coalition (CBC) to offer scholarships to diverse candidates to attend the Certified Lactation Counselor (CLC) training and/or pursue the International Board Certified Lactation Consultant (IBCLC) certification and exam (August 2021). Follow up with the 2020 awardees to ensure they have access to mentors and assistance as they pursue their career in lactation. Make needed modifications to application and scholarship targets based on feedback from applicants and community partners. Determine the best option to offer CLC training to qualified applicants in CT moving forward due to COVID-19 limitations.  Continue to support the Great Lakes Breastfeeding Webinars (GLBW) which offer free breastfeeding training and CEUs to individuals. Disseminate, via the IWI listserv, up to 2 e-newsletters that focus on state coordinated breastfeeding activities. 

CT-WIC will continue to participate in the quarterly meetings of the Connecticut Perinatal Quality Collaborative (CPQC) as appropriate based on their focus area.

UConn Health Center for Public Health and Health Policy training consultant to provide at least one training in targeted REACH communities or technical assistance to staff in at least one Federally Qualified Health Center (FQHC). Consultant may provide various peer support networks such as Community Health Network of Connecticut (CHN-CT), Nurturing Families, staff of DMHAS (Department of Mental Health and Addiction Services), Fatherhood Advocates or La Leche League access to the Secrets of Baby Behavior (SBB) training. By January 2021, update existing SBB evaluation forms to align more closely with the overall evaluation and Educating Practices evaluation.

Improve outreach to physicians’ offices and provide opportunities for breastfeeding training through the Educating Practices project. Explore alternative ways to deliver training content to practices considering COVID-19 and feedback from initial pilot sites and those practices trained in 2020.  Continue to refine the content to include information on implicit bias and institutional racism and impacts on breastfeeding support. The goal of CHDI's Educating Practices program is to improve the content and delivery of child health services by assisting providers in implementing best-practices that are supported by community and State resources. By August 2021, implement training in at least two additional sites. Sites will receive IWI materials, be encouraged to apply for the new CBC Breastfeeding Friendly Physician’s Office recognition, will be offered SBB training and provided resources that address racism and breastfeeding.

DPH will continue to support worksites' voluntary application to the CBC’s Breastfeeding Friendly Worksite Program. Working with the CBC worksite subcommittee, DPH, WIC and SNAP-Ed provide needed technical assistance on the Child Care Toolkit for providers and families. Worksite and childcare support for lactation is critical to improve Connecticut’s breastfeeding duration rates. This is especially important as women continue to make up an increasing percentage of the workforce. If possible, additional outreach efforts include networking at Connecticut Business and Industry Association events (CBIA), with schools, hospitals, child care centers through both SNAP-Ed outreach and the Go Nutrition and Physical Activity Child Care Self-Assessment (Go NAP SACC) obesity prevention initiative, the CT Department of Labor, and the Hartford and New Haven Racial and Ethnic Approaches to Health (REACH) communities about lactation accommodations and community support for breastfeeding mothers.

Early Hearing Detection & Intervention Program  

Effective January 1, 2016, Connecticut state law requires hospitals to screen newborns who do not pass newborn hearing screening for congenital Cytomegalovirus (CMV) and report the results to the Connecticut Department of Public Health (DPH). Congenital CMV is considered the leading cause of nonhereditary sensorineural hearing loss in children. Starting in July 2015, Connecticut began a CMV initiative which included birth facility education and technical assistance, resource development (including a re-designed brochure for parents of infants who do not pass newborn hearing screening, and fact sheets for pediatric healthcare and obstetric providers), continued database enhancements, and, as needed, collaboration with Infectious Diseases physicians and the Connecticut Chapter of the American Academy of Pediatricians.

With regards to CMV, in addition to our aggressive lost to follow-up tracking protocols, CT EHDI will also begin work on ensuring that all Connecticut-born infants who fail their newborn hearing screening be tested for CMV before 21 days of age. Enhancements will be made to the data system to better identify cases and facilities that need more training.