Perinatal & Infant Health: Application Plan

FY 2021 Plan for Application Year

Based on outcomes from the 2020 Needs Assessment and stakeholder prioritization process, Idaho intends to continue with some of the same priorities, strategies, ESMs, and NPMs that were identified in the State Action Plan for the Perinatal/Infant Health domain in previous years. This includes improving breastfeeding rates (NPM 4), increasing the percent of infants placed to sleep on their backs (NPM 5), and injury prevention for children under 5 years of age (SPM 3).

Safe sleep education in rural areas and among Hispanic populations continues to be a priority based on the 2020 Needs Assessment and key informant interviews. While Idaho compares positively to the national percentage of infants placed to sleep on their back (84% to 79.5%), only 70% of Idaho infants were reported as sleeping alone between 2014-2018. To address this, Idaho MCH will continue the priority to support services, programs, and activities that promote safe and healthy family functioning. Strategies aligned with this priority include providing safe sleep education materials using a family-centered approach, training MIECHV home visitors, and implementing an Idaho-specific media campaign to assist with NPM 5 and the goal of reducing infant sleep-related deaths by September 2025.

Breastfeeding

For FY 2021, strategies discussed in the FY 2019 annual report for breastfeeding will be continued by Idaho Title V, WIC, and MIECHV. Key strategies include training for home visitors, sponsoring the Idaho Breastfeeding Summit, and WIC’s peer counselor program.

The Idaho MCH Program plans to build on the existing collaboration with the MIECHV and WIC Programs to deliver a training event focused on teaching best practices to home visitors to support breastfeeding moms. The training will be facilitated by WIC staff and the Idaho Breastfeeding Coalition and will focus on strategies for encouraging pregnant and new mothers to initiate breastfeeding, addressing hesitancy to breastfeed, supporting mothers to breastfeed for at least six to 12 months, and engaging fathers or male partners to support breastfeeding. Based on MIECHV’s FY 2020 projected caseload, approximately 425 families will benefit from home visitor education and support on breastfeeding.

The Idaho MCH Program will support and participate in the Idaho Breastfeeding Summit to be hosted in Boise, ID on October 8-9, 2020.

In FY 2021, the Idaho Breastfeeding Coalition will be building resource pages on their website in an effort to provide information to those who are breastfeeding and their families. Resources will include care providers, support groups, and breastfeeding friendly businesses.

MCH and WIC are working together to coordinate a breastfeeding education opportunity for the MIECHV Program. This training will provide education and tools the home visitors can use to assist the families they visit.

Safe and Healthy Family Functioning

Safe Sleep

For FY 2021, strategies to promote safe sleep education and practice will further cement Title V’s leadership role in implementation. Some strategies will continue as described in the Annual Report section.

In previous years, the MCH Program worked hard to shift safe sleep education and practices to allow Title V to lead efforts, rather than relying solely on community partners. Continuing the work started in 2019, the MCH Program continues to use SUIDs-related death and other Idaho-specific information, as well as data from the 5-year needs assessment, to inform decisions on which areas of the state need the most support and education related to safe sleep. The following activities are proposed and planned for FY 2021 to expand and bolster safe sleep awareness:

• Continue the partnership with MIECHV to provide risk reduction and safe sleep training in-person or via webinar to home visitors. The goal is to provide an overview of safe sleep recommendations and offer risk-reduction strategies when interacting with a family who is reluctant to adopt all the recommendations. Using a family-centered approach will be key to reaching families who may not be interested in safe sleep practices due to misinformation or cultural and personal preferences. This training was scheduled to occur in April 2020 but has been delayed to 2021 due to the COVID-19 pandemic.
• Partner with St. Luke’s Hospital to determine opportunities and deliver in-person or webinar-based safe sleep education.
• Translate the Infant Safe Sleep Brochure into Spanish and the remainder of safe sleep outreach and educational items as time and funding permits.  

For FY 2021, the MCH Program will continue to purchase Cribs for Kids® safe sleep products and cribs for distribution to the local home visiting programs and other partners, distribute Charlies Kids© “Sleep Baby Safe and Snug” board books through the PRATS survey which is mailed out to 4,200 new Idaho moms, and continue collaboration with the CFRT to share information and use recommendations to guide strategies to eliminate preventable deaths among children.

Injury and Disease Prevention

For FY 2021, strategies discussed in the FY 2019 annual report for injury and disease prevention will be continued by Idaho Title V. Key strategies include funding the Idaho Poison Control Center, funding the Epidemiology Program, funding and managing the Idaho Newborn Screening Program, distribution of CMV materials, and collaboration with the Child Fatality Review Team. New strategies and important changes are highlighted below.

The MCH Program will provide funding at a reduced level to the Epidemiology Program. Due to the lack of specific focus on MCH populations, funding for epidemiology subgrants with public health districts was discontinued at the end of FY 2018, and future funding has been significantly decreased with a focus on state-level systems support for vaccine-preventable and reportable diseases among newborns and children. To strengthen efforts in other priority areas, funding was shifted from epidemiology to the Child Health domain, with focus on reducing obesity in young children and supporting suicide prevention efforts for adolescents.

The Bureau of Communicable Disease Prevention, Epidemiology and Immunization Programs, will continue to partner to prevent perinatal hepatitis B infection.

Epidemiology surveillance staff will monitor incoming electronic laboratory reports (ELRs) daily to identify any laboratory result that indicates a positive hepatitis B virus result in a woman of childbearing age and notify epidemiologists in each of Idaho’s seven Public Health Districts for follow up to be conducted. Epidemiologists will conduct investigations to determine whether the hepatitis B-infected woman is currently pregnant, plans to become pregnant, or has children. If the woman is not currently pregnant, education will be provided regarding behaviors to reduce the risk of transmitting hepatitis B virus to household members, including children. If the woman is planning to become pregnant, additional education will be provided regarding the necessity of prenatal care and vaccination of the newborn with the HBV vaccine and HBIG after delivery and the woman will be referred for case management to the Immunization Perinatal Hepatitis B program. 

ELRs will also be monitored for pregnancy status, reason for testing, and ordering provider. If the pregnancy status indicates the patient was pregnant when the test was ordered, the reason for testing indicates prenatal or pregnancy care, or the ordering provider is an OB/GYN, the Immunization Perinatal Hepatitis B program will be notified as well as the Public Health District epidemiologist to ensure the woman is placed in case management if she has not already been referred for case management. 

Idaho will continue to implement Nationally Notifiable Disease Surveillance System (NNDSS) message-mapping guides for vaccine-preventable diseases (VPDs) to enable transmission of extended variables to the National Center for Immunization and Respiratory Diseases (NCIRD) in support of national surveillance for VPDs as the CDC NNDSS team is able to onboard states.

The Title V program and the Idaho Bureau of EMS and Preparedness previously shared the cost of poison control activities through a contract with the Nebraska Poison Center. This year, the contract costs will be split between the Title V MCH Program, the Idaho Bureau of EMS and Preparedness, and the Opioid Prevention Program. The Bureau of Community and Environmental Health (BCEH) will be primarily responsible for contract monitoring and providing public education on poison control topics in consultation with the programs providing funding.

The Idaho NBS Program will continue to meet on a quarterly basis with NBS stakeholders. The convening of this small group has been vital in the exploration of new public health NBS laboratories that will meet Idaho’s needs. The NBS Program plans to bolster this collaboration by inviting other medical providers and specialists to join the quarterly meetings to discuss newborn screening and genetic related topics, such as the addition of conditions to Idaho’s NBS panel.

Newborn screening specimen transit times continue to be a challenge for the NBS Program. The NBS Program currently incurs the cost of expedited shipping for all newborn screening dried blood spot specimen for all birthing facilities and midwives through a partnership with UPS Campus Ship, which is a web-based shipping system. While the roll out of this partnership did make enormous improvements in transit times, there is a gap in courier services on the weekends, as there is not pick-up available Saturday or Sunday. For FY 2021, the NBS Program will be working with FedEx for courier services for NBS specimen as an additional service for areas where UPS does not have weekend pick-ups.  

In addition to changing courier services, the NBS program will also be transitioning to a new laboratory for processing newborn screens. For many years, the program has utilizing the Oregon State Public Health Laboratory. In 2021, the program will work on development and implementation of a strategic communication plan to ensure a smooth transition from Oregon to another public health laboratory.

The program will continue to provide technical assistance and training on CCHD screening through in-service trainings to birthing facilities and midwives as well as web-based resources, when needed. The MCH Program will explore non-mandated, voluntary CCHD diagnosis reporting with physicians since there is currently no mechanism for collecting diagnosis data.

At the beginning of 2020, Idaho’s Governor requested state agencies cut 2% of their state funds and the MCH Program was informed Cytomegalovirus (CMV) funding would be a part of that reduction. Shortly following news of the budget cut, COVID-19 began to impact business operations, further altering plans for CMV outreach and education. Looking towards FY 2021, the MCH Program will begin to transition all CMV materials to an electronic platform and will focus on identifying paths to provide education and awareness online. The CMV workgroup will continue to work together by maintaining electronic communication and meeting in person as needed, to share current efforts and brainstorm additional, zero-cost avenues for outreach and education. As states reopen and conferences resume following the COVID-19 pandemic, the MCH Program will attend relevant conferences and events as an exhibitor to continue to provide education and increase visibility in the community. The program will display and provide educational materials developed for safe sleep, CMV, newborn screening, poison control, and CCHD.