Perinatal/Infant Health, Application Year FY 25 

 

Based on preliminary data for 2022, 914 Ohio infants died before their first birthday. The number of non-Hispanic White infants who died was 519, an increase of 12 from 2021. Additionally, there were 273 non-Hispanic Black infant deaths in 2022, a decrease of 16 from 2021. In the Hispanic population, 55 infant deaths occurred in 2022 compared with 49 in 2021. Ohio’s infant mortality rate overall was 7.1 per 1,000 live births in 2022, compared with 7.0 in 2021. Non-Hispanic Black infants were more than 2.4 times more likely to die than non-Hispanic White infants.  The non-Hispanic Black infant mortality rate was 13.4 compared to a non-Hispanic White infant mortality rate of 5.7.  Additionally, Ohio’s Hispanic infant mortality rate was 6.1 per 1,000 live births.

Ohio’s neonatal mortality rate in 2022 was 4.6 per 1,000 live births.  A racial disparity exists with the non-Hispanic Black neonatal mortality rate being 7.6 compared to 3.9 for non-Hispanic White infants. The non-Hispanic Black neonatal mortality rate is lower than any time between 2013 and 2022. The Hispanic neonatal mortality rate was 4.9.  From 2013 through 2022, the overall neonatal mortality rate (NMR) decreased by an average of 1.5% per year. Additionally, the neonatal mortality rate for Non-Hispanic Black infants decreased an average of 2.8% per year. Ohio’s postneonatal mortality rate (PMR) in 2022 was 2.6 per 1,000 live births.  The non-Hispanic Black postneonatal mortality rate was 5.8 compared to 1.9 for non-Hispanic white infants. During the postneonatal period Non-Hispanic Black infants are three times more likely to die than Non-Hispanic White infants. The Hispanic postneonatal mortality was 1.2. From 2013 through 2022, Ohio’s overall and Non-Hispanic Black postneonatal mortality rate has increased an average of 1.7% and 4.5% per year, respectively. 

 

Priority: Support healthy pregnancies and improve birth and infant outcomes  

 

Measures  

The 2020 needs assessment process resulted in a strong and leading identification of infant mortality and birth outcomes as a priority health need. Addressing the disparity in birth and infant outcomes will be measured through the SOM. Both NPMs improve infant outcomes and the ESMs measure progress in improving both. 

• NOM 9.1: Infant mortality rate per 1,000 live births, NOM 9.2: Neonatal mortality rate per 1,000 live births, SOM: Black infant mortality rate per 1,000 live births 
• Ohio’s infant mortality rate overall was 7.1 per 1,000 live births in 2020, compared with 7.0 in 2021. This represents 914 infant deaths. 
• Ohio’s neonatal mortality rate was 4.6 per 1,000 live births in 2022, a decrease from 4.7 in 2020. 
• There were 273 non-Hispanic Black infant deaths in 2022 for a non-Hispanic Black infant mortality rate of 13.4 per 1,000 live births, down from 13.9 in 2021. The Black/white infant mortality ratio is 2.4, meaning non-Hispanic Black infants are about 2 and a half times more likely to die than non-Hispanic White infants.

 

Objective 1: By 2025, increase the percent of infants who are ever breastfed to 90.8% and percent of infants who are breastfeed exclusively through 6 months to 31.2%.  

 Strategies: 

1. Continue implementation and expand promotion of the statewide 24/7 breastfeeding hotline and virtual lactation consultants. 

2. Continue to build upon breastfeeding initiatives in hospitals, worksites, and childcare facilities. 

3. Improve breastfeeding continuity of care with statewide partners. 

4. Address disparities in lactation care and breastfeeding rates. 

 

In March 2021, Professional Data Analysts, Inc. (PDA) created two reports, Breastfeeding Experiences of Black or African American Women in Ohio and Breastfeeding Experiences of Appalachian Women in Ohio, based on quantitative and qualitative data from focus groups. PDA also identified future collaborations, topics for discussion, and strategies to improve breastfeeding initiation and duration, particularly focusing on African American and Appalachian women. ODH will continue to engage partners to identify new strategies and activities as well as improve and enhance current activities. In 2022, ODH released the competitive funding opportunity, Innovations to Advance Breastfeeding and Health Equity. Four organizations rooted in serving families facing breastfeeding disparities received initial funding: University Hospitals Cleveland Medical Center, Cincinnati Children’s Hospital, Columbus Neighborhood Health Center, and Breastfeeding Outreach for Our Beautiful Sisters. This opportunity will extend as a continuation through FY25.  

 

ODH continues to contract with Appalachian Breastfeeding Network to offer 24/7 breastfeeding support by phone and text. Interpreters are available in most languages, and texting is available in English and Spanish. An International Board-Certified Lactation Consultant and Mental Health Specialist are now available through the hotline as needed. Data will continue to be collected and reported monthly. 

 

The Ohio First Steps for Healthy Babies hospital initiative will continue the optional Father/Partner Engagement Designation. Hospitals that apply are recognized for their inclusion of fathers and partners as they implement the Ten Steps to Successful Breastfeeding. First Steps will continue with quarterly application reviews and recognition. Continuing education webinars will also be planned.  

  

ODH has received the five-year CDC State Physical Activity and Nutrition (SPAN) Cooperative Agreement. Proposed activities include continuing to fund 12 counties that are currently educating local businesses and assisting with development of lactation policies and accommodations, as well as expanding to other counties. Provider offices, schools, and hospitals will be specifically targeted for outreach and education. A yearly Certified Lactation Specialist (CLS) training opportunity will be made available to community partners to increase access to lactation education and care across the state. The Breastfeeding Friendly Workplace Award will continue and be promoted by the funded counties. 

  

The Breastfeeding Friendly Child Care Award remains available for Early Childhood Education (ECE) providers who complete a required training and application depicting their implementation of breastfeeding-friendly practices. Outreach to all licensed childcare centers and family providers will continue, with plans to create new ECE breastfeeding resources and materials. 

 

ODH will continue to improve breastfeeding continuity of care by reaching out to new statewide partners as well as enhancing collaboration with current partners. The Coffective initiative, with the WIC program, will continue to link local WIC projects with hospitals and community organizations. 

 

Objective 2: By 2025, increase the percent of infants placed to sleep on their back to 93%, alone on separate approved sleep surface to 53.1%, and without soft objects or loose bedding to 76.5%. 

Strategies: 

1. Continue implementation of the Cribs for Kids Program to provide safe sleep education and safety-approved cribs to families, including improved data collection by race. 

2. Continue implementation of the annual safe sleep campaign to provide consistent messaging on safe sleep practices to families.   
3. Revise safe sleep educational materials to reflect infant safe sleep recommendation updates, once released by the American Academy of Pediatrics. 

 

The Ohio Department of Children and Youth (DCY) will continue to provide funding to local organizations serving 71 counties to promote safe sleep practices and distribute safe sleep survival kits. These survival kits will continue to include a safety-approved portable crib, as well as supplemental items such as a fitted sheet and infant sleep sack. Survival kits will continue to be available to families at no cost. Safe sleep information will continue to be shared with families, including safe sleep recommendations from the American Academy of Pediatrics (AAP).

 

Ohio will continue to participate in the Child Injury Action Group (CIAG) Safe Sleep quarterly meetings. Ohio facilitates a quarterly Technical Assistance meeting for all Cribs for Kids/Safe Sleep partners.

 

Objective 3: By 2022, develop plan for enhancing coordination of pregnancy and post-partum supports and messaging. 

Strategies: 

1. Enhance partnerships with state agencies, local organizations, and stakeholders to improve coordination of pregnancy and post-partum services. 

2. Enhance partnerships with state agencies to improve coordination of state funding for local MCH activities. 

3. Explore coordination of safe sleep, breastfeeding, and smoking cessation messaging. 

 

The Ohio Council to Advance Maternal Health (OH-CAMH) is coordinating with 82 member organizations to implement a statewide strategic plan. Partner organizations include local organizations, state organizations, national organizations, Title V staff, and patients/families. In FY22, 11 implementation teams were formed to address each of the 11 strategies included within the OH-CAMH Strategic Plan. Volunteer implementation team leads worked to build their teams, assess membership gaps, and develop an implementation plan in September 2021. In FY25 OH-CAMH will finalize the draft Strategic Plan that is used to guide the work of implementation teams throughout the period of performance. This will be done through collaboration with the Ohio Title V  on their upcoming needs assessment and involvement in the development of the 2022-2028 State Health Improvement Plan. These collaborative efforts will assist OH-CAMH with identifying needed adjustments to the draft Strategic Plan and implementation team activities to better align with statewide goals and efforts. Additionally, OH-CAMH will continue to convene full OH-CAMH membership meetings and implementation teams to maintain efforts to carry out Strategic Plan-driven activities.

 

The Eliminating Racial Disparities in Infant Mortality Task Force (IMTF) continues to work with leaders from various state departments to implement the Eliminating Racial Disparities in Infant Mortality recommendations to achieve racial equity in outcomes for all infants by 2030. Representation is included from the following state agencies: Rehabilitation and Corrections, Health, Mental Health and Addiction Services, Job and Family Services, Development, Medicaid, Transportation, Education, Developmental Disabilities and the Department of Children and Youth. The Infant Mortality Task Force (IMTF) State Team will continue to prioritize the implementation of the recommendations to achieve the following goals: 1. Identify specific policies, practices, initiatives, and programs responsive to the recommendations of the Ohio Black Infant Mortality Task Force Report and 2. Develop practices for cross sector engagement, accountability and shared benefit to support cross departmental decision making, shared action and communication within the State Team. 

 

In addition, the IMTF will be returning to the 11 target counties to engage family participants who previously provided feedback and stories to inform the initial development of the recommendations. These listening sessions aim to provide continuous feedback regarding the design and implementation of IMTF recommendations. Community Sponsors will commit to recruiting families who previously participated in their listening session and other families who may have planned to but were unable to attend. The goal of the community conversations are to: 1. Provide input into and co-design efforts that advance infant vitality that are responsive to feedback from Black families. 2. Partner with Black communities and families to suggest modifications to Ohio’s existing programs, services, and initiatives to reach and benefit Black infants, Black mothers, fathers, and caregivers. 3. Confirm programs, policies, and practice efforts intended to advance infant vitality are tailored in state programs, services, and initiatives to advance the well-being of Black mothers, fathers, and caregivers.

 

In partnership with the Ohio Department of Medicaid (ODM) and their distribution of $26.8M to the ten Ohio Equity Initiative communities to support strategies that seek to improve equity in infant and maternal outcomes, DCY/ODH will continue to serve as primary support to ODM and their managed care plans in these investments. Local projects will begin implementation on July 1, 2022; projects include community health workers, doulas, home visiting, and locally designed strategies. During the design of this funding opportunity, ODM and ODH agreed all funded home-visiting projects would be transitioned to DCY/ODH for long-term service sustainability. This investment is an important opportunity to continue improving the quality and alignment of diverse funding streams to address racial inequities in maternal and infant outcomes. All three agencies continue to meet regularly to discuss further collaboration.

 

During the two-year long Ohio Family and Children First planning process managed by the Ohio Department of Job and Family Services (ODJFS), stakeholders were convened to discuss ways to prevent families from needing support and monitoring through the Child Welfare system. The process resulted in ODJFS identifying evidence-based practices known to support families and their collective growth and development. Two evidence-based home visiting programs, Healthy Families America and Parents as Teachers, were prioritized for implementation during the first phase of the work. ODH, DCY and ODJFS are partnering on this process to leverage the existing home visiting system infrastructure operated by ODH.  ODJFS is supporting the funding of home visiting in the following ways: 

•       Professional Development - Through the creation of the Center of Excellence, operated by Case Western Reserve University, approximately $95,000 is allocated to the Ohio Child Care Resource and Referral Association to support the quality and availability of professional development for home visiting staff. 
•       Expansion Grants- Through an Interagency Agreement, ODJFS will provide ODH $1,000,000 for existing home visiting providers' start-up funding to expand their teams and capacity.  Grants were awarded in June 2022. 
•       On-going Services- For families identified as needing “prevention services” by the local Public Children’s Services Agency (PSCA), ODJFS will reimburse ODH for 50% of the costs associated with the delivery of home visiting services.  All information will be documented in Home Visiting and Children Services systems to accurately report and track the families and the investments.  Reimbursement began SFY 23 and is expected to continue.  A data sharing agreement, critical to the implementation of the project, was just completed by the two agencies. 

 
ODH/DCY has been working with colleagues at ODM to design a system of funding to support Governor DeWine’s goal of expanding evidence-based home visiting. ODM will be offering reimbursement for nurse home visiting, aligned with the Nurse Family Partnership model, to address maternal and child health outcomes for Medicaid enrolled and eligible women. Funding should begin in October 2022.  In addition to standing up this sustainable source of funding, ODM through its partnership with the Managed Care Organizations, has supported providers in local Ohio Equity Initiative counties with expansion activities.   

 

During SFY24 and SFY25, 19 community- and faith-based organizations will be funded to provide services through the state supported Community and Faith-based Infant and Maternal Health Support Services Funding. This project provides funding with expanded access to community- and faith-based organizations to implement community-level projects to improve infant and maternal health outcomes. These dollars seek to strengthen the unique work of community- and faith-based organizations (CBOs) as trusted partners of Ohio’s pregnant women and new families. Funded organizations will reduce barriers to wellness for participants by providing physical and social supports that address gaps in existing maternal and infant systems and support pregnant women and newly parenting families (up to 12 months postpartum). These funds may support the establishment, expansion, or enhancement of programs and special projects for pregnant women and new families. The Governor announced the launch of a new pilot program called Family Connects serving 11 Ohio counties where every new mom will be eligible to receive a visit from a nurse about 3 weeks after delivering her baby. 
 

Objective 4: By 2025, reduce Black infant mortality rate to 6.0 per 1,000 live births. 

Strategies: 

1. Increase access to clinical and social services through outreach and identification of Black pregnant women. 

2. Increase use of social support services among high-risk Black pregnant women to address social determinants of health. 

3. Support local community-driven policy and practice change addressing social determinants of health that impact poor birth outcomes. 

4. Improve access to basic needs resources for pregnant and postpartum women (e.g., Cribs for Kids). 

5. Data to examine variations in cause of infant death by race and ethnicity to inform data to action. 

 

The Ohio Equity Initiative (OEI) will continue to support the facilitation of local upstream (policy change addressing social determinants of health that impact poor birth outcomes) and downstream (clinical and social resource navigation for Black pregnant people) strategies in the ten Ohio counties who carry the greatest burden of Black infant deaths and the greatest racial inequities in birth outcomes.  

  

In addition to the long-standing upstream and downstream OEI strategies, the DCY continue investing in building the internal organizational capacity of the ten subrecipients, all of which are local health departments, to engage in racial equity work effectively. Additional funding for a full-time health equity coordinator will continue to be provided to each local OEI team. The Health Equity Coordinators, in collaboration with their Racial Equity Core Teams, will continue to implement an action plan to normalize, organize, and operationalize organizational change to advance racial equity capacity of their local health department. The racial equity action plans are based on data collected through an organizational self-assessment process and include strategies around internal organizational policy and process change, as well as staff training, at a minimum. The Health Equity Coordinator and the local health departments will use a racial equity framework to develop organizational goals and objectives to address, reduce, and eliminate racial disparities and inequities.   

 

A third-party vendor will continue to provide coaching and technical assistance to OEI health equity coordinators and teams to support integration of racial equity in the foundation of entity policies and initiatives by building health equity core competencies of the OEI-funded health equity role. Examples of technical assistance provided by the vendor to the OEI subrecipients include topics such as training supports, organizational supports, policy development and strategy, communities of practice, and leadership, coaching and thought partnership. 

 

Queens Village was developed by Cradle Cincinnati as a way to engage and empower Black women to reduce infant mortality rates and decrease the racial disparities in local communities. The curriculum and training focus on engagement of Black women that encourages them to design and implement activities that promote the wellness and leadership opportunities within each community. This year-long cohort involves monthly virtual training, community building, individual coaching, fieldwork and self-directed planning, Cohort members learn tools and strategies to establish a Black women-led community advisory board, build their villages, become advocates, fundraise for their work, tell their story, and grow support. Funding will continue to be used in SFY24 and SFY25 to develop and scale a Queens Village approach to community building in eight of the ten Ohio Equity Initiative counties. Success will be defined as each of the eight chapters establishing a chapter advisory board with community members that inform and activate community-driven solutions to improve maternal and infant health outcomes in their communities.

To improve access to basic needs resources for pregnant and postpartum women, the Ohio Safe Sleep/Cribs for Kids program will continue to distribute cribs to prevent sleep-related deaths in Ohio’s 71 participating counties. Through a partnership with Cribs for Kids, Inc., Ohio will distribute 9,000 cribs. Approximately forty percent (40%) of families receiving cribs will be African American participants. 

  

The Disparities in Maternal Health Community Grant Program funds community-identified solutions addressing unmet needs through an equity-driven lens. From FY24-FY25, three grantees will implement initiatives to tackle racial/ethnic and geographic health disparities in Ohio: Birthing Beautiful Communities: Increasing outreach for behavioral health services and providing one-on-one counseling, a benevolence fund, and mental health sessions in Cuyahoga County. Summit County Public Health: Implementing a pilot program to improve early detection of hypertensive disorders in pregnant and postpartum women. Hospital Council of Northwest Ohio: Offering comprehensive care coordination and increasing access to doula care for underserved and socially vulnerable women in Lucas County.

 

Beginning in 2022, $2.25 million was awarded to improve birth outcomes and reduce infant mortality by providing stable housing for low-income families. Healthy Beginnings at Home offers rental assistance, housing stabilization, maternal and child health care, and social support to unstably housed pregnant individuals. The program provides 24 months of rental assistance and services to about 60 families in Akron and Columbus, aiming for long-term economic stability. An additional $2.5 million will fund expansion to Cleveland and Dayton in State Fiscal Year 25.

 

In addition, ODH has administered two youth homelessness grants since FY20, funded through the state General Revenue Fund (GRF).  Thirteen community agencies have been funded through the two grant programs to serve youth and pregnant youth ages 14-24 who are experiencing homelessness.  In addition to providing housing services, program deliverables include outreach, health or mental health services, education or employment services, and community or social connection.  In 2021, ODH contracted with the Coalition on Homelessness and Housing in Ohio (COHHIO) to data support and technical assistance to ODH and the 13 subrecipients to improve data collection in the program.  In addition, COHHIO will provide program recommendations based on the comprehensive data reports submitted to ODH during FY22.  SFY24 and SFY25 will be the third consecutive biennium that Ohio has allocated funds in the General Revenue Fund (GRF) budget to address youth homelessness.  In FY25, supporting this grant program will continue with a competitive solicitation process.

 

The Bureau of Health Improvement and Wellness will continue to implement the Produce Prescription (PRx) Program. Nutrition incentive programming is an evidence-based, nationally recognized model for impacts on increased food security, improved health outcomes, and strengthening of localized food systems.  

 

PRx connects patients with diet-related disease (diabetes, obesity, cardiovascular, etc.) to health care providers who write prescriptions for free fruits and vegetables. Patients are screened for food insecurity within their household, and providers issue monthly prescriptions to meet the family’s recommended daily servings of fruits and vegetables. Up to five family members are eligible to receive prescriptions. Women are eligible to participate during pregnancy and up to one year postpartum.

 

PRx programming will continue in participating OEI counties with a target population of at least 50% African American program participants.  

 

ODH/DCY continues to release an annual infant mortality report. This report highlights racial disparities, drivers of infant mortality, neonatal and postneonatal mortality rates, and causes of death.  A fetal mortality report with 2022 data has been drafted and we plan to make it available publicly in the near future. We are currently in the early stages of developing a Quarterly Infant Mortality Score Card on the Data Ohio portal (https://data.ohio.gov) which will provide the most current data available to stakeholders and the general public. We continue to look for outlets to share timely data related to infant and fetal mortality including presentations, social media, and fact sheets.

 

Contributing program scorecards for infant mortality have been created in Clear Impact. ODH has started implementation of Results Based Accountability (RBA) and use of Clear Impact with the State Health Improvement Plan (SHIP) indicators, which include infant mortality. Analysis of this data will be used to share data with program partners and the public and have conversations that drive change and improve outcomes. To ensure the scorecards are useful as we strive to eliminate the Black infant mortality disparity, programs have included disaggregated measures. 

 

Objective 5: By 2022, assess need for and explore opportunities to improve infant outcomes through enhancing screenings and education provided during well-baby visit.  

Strategies: 

1. Assess need for and explore opportunities to educate/train providers on enhanced screenings and education during well-baby visit (Bright Futures, including lead, hearing, vision, oral health, immunizations, safe sleep.) 

2. Explore cross-program support opportunities through partnership with ODH Immunizations program. 

 

The Title V team will continue to engage partners and collaborate on identifying gaps in screening and education. In collaboration with the Ohio Chapter- American Academy of Pediatrics a comprehensive resource linking providers to screening guidance by age to address developmental screening, social determinants of health/injury prevention, oral health and improving immunization rates will be developed. They will also conduct quarterly webinars based on emergent topics in child health.  ODH participates in the Healthy Mom, Healthy Family quality improvement project to impact maternal and infant health. It is designed for postpartum women and their children with a special emphasis on non-Hispanic Black women and women who are eligible for or enrolled in Medicaid or are uninsured. Healthy Mom, Healthy Family seeks to improve interconception care for women of reproductive age to reduce risk factors that might impact future pregnancies and the long-term health of mothers in Ohio. The interconception health of birth mothers of patients in participating pediatric sites is assessed through a series of interventions during well-child visits 0-18 months. Implementation of Healthy Mom, Healthy Family begins with the integration of the mother’s care with the baby’s well-child visit in a pediatric setting, if the accompanying caregiver is the biological mother.    

  

Ohio Title V coordinates with the Bureau of Infectious Diseases (BID) to promote immunizations.  The Title V director meets with the Vaccines for Children (VFC) Program Administrator at least quarterly, and the school nursing administrator meets with BID more frequently. Cross-collaboration between both bureaus will remain in effect to support existing and future work. 

 

Other Efforts Supported by Title V MCH 

Ohio Connection for Children with Special Needs – Birth Defects Surveillance Program    

One in 33 children is born with a birth defect. Birth defects, or congenital anomalies, are the second leading cause of infant mortality, accounting for approximately 18 percent of infant deaths in Ohio. For those who survive, birth defects are a major cause of morbidity and mortality throughout childhood. Ohio Connections for Children with Special Needs (OCCSN) is Ohio’s statewide population-based birth defects surveillance program. The Ohio Revised Code 3705.30 authorizes the Director of Health to require hospitals, physicians, and freestanding birthing centers to report children from birth to five years of age with certain reportable birth defects to the Ohio Department of Health (ODH).     

     

The OCCSN data system utilizes passive case ascertainment whereby hospitals report data to the online database after a child has an encounter at that facility. Genetic counselors at the eight state-funded genetic centers across the state conduct case reviews on selected birth defects to provide data validation. Approximately 130 hospitals, including birthing and children’s hospitals, report cases to ODH through the OCCSN data system. Contact information for children under the age of three years confirmed with certain birth defects is sent via automatic email to the Help Me Grow Central Intake & Referral Coordination for referral to early intervention services. The OCCSN program includes activities in four major areas: surveillance of birth defects, analysis of surveillance data, referrals to early intervention services, and awareness and prevention activities.    

    

Comprehensive Genetics Services Program    

The Genetics Services Program funds a network of eight genetic centers that provide comprehensive care and services to people affected with, or at risk for genetic disorders. The program aims to ensure availability of quality, comprehensive genetic services in Ohio. Genetic services include but are not limited to genetic counseling, education, diagnosis, and treatment for genetic conditions and congenital abnormalities. The goals of the Comprehensive Genetic Centers (CGCs) are to ensure that children and adults with, or at risk for birth defects or genetic disorders and their families receive quality, comprehensive genetic services that are available, accessible and culturally sensitive; and providers, the public and policymakers are aware and knowledgeable about birth defects, genetic conditions, genetic disease related services in Ohio.     

     

The Comprehensive Genetics Services Program also provides newborn screening follow up for bloodspot screening for genetic disorders. In SF23, a total of 45,979 encounters occurred for genetic counseling. A total of 1,070 were a result of newborn screening follow up. A total of 562 educational events were provided with 116 of those events focused on preconception and birth defects prevention topics, 88 on newborn screening, and 96 on the importance of family health history.    

    

Infant Hearing Program

The Ohio Department of Health Infant Hearing Program (IHP) is the state Early Hearing Detection and Intervention (EHDI) Program. The national EHDI guidelines provided by the Joint Committee on Infant Hearing (JCIH) recommend newborns receive screening for risk of hearing loss by one month of age, receive a diagnosis for suspected hearing loss by three months of age after a non-pass screening, and children identified through diagnosis begin provisions of early intervention by six months of age. National averages indicate approximately three infants per 1,000 births are identified with hearing loss. The IHP has several goals that align with the national EHDI principles. These include ensuring that all infants who do not pass their hospital hearing screening receive no more than two screenings before hospital discharge. The IHP also ensures that all newborns receive universal newborn hearing screenings in the hospital setting and before one month of age and that babies with non-pass screening results receive follow-up coordination for tracking and monitoring. In addition, the IHP refers families when a child is identified with hearing loss to home-based early intervention services to support the development of communication and language acquisition for infants and toddlers with hearing loss to establish essential communication skills through the early developmental stages of life. 

 

Newborn Screening for Critical Congenital Heart Disease    

Congenital heart defects are the leading cause of birth defect-associated infant illness and death in the United States. Critical congenital heart defects (CCHD) usually require surgery or other procedures in the first year of life. CCHD screening, using pulse oximetry, a painless test that measures the amount of oxygen in a baby’s blood, can lead to early diagnosis and treatment for critical congenital heart defects and may provide better health outcomes and save newborns’ lives. The Ohio Department of Health (ODH) CCHD program partners with Ohio hospitals and birthing centers to ensure newborns are screened for critical congenital heart disease and those that fail the screening receive timely and appropriate medical intervention.

    

Sickle Cell Services Program    

The Ohio Department of Health (ODH) funds two grant initiatives under the Sickle Cell Services Program related to sickle cell disease, sickle cell trait, and other hemoglobinopathies. These initiatives are the Sickle Cell Initiative and the Statewide Family Support Initiative. As a public health program, the Sickle Cell Services Program works to ensure and enhance the availability and accessibility of quality, comprehensive sickle cell services and care for newborns, children, and adults; promote public/patient/consumer/family/professional education to increase awareness and knowledge about sickle cell disease, sickle cell trait, and other hemoglobinopathies; and, increase strategies to maximize collaboration, coordination and utilization of all sickle cell-related services and resources in Ohio. The Sickle Cell program provides newborn screening follow-up for disease and trait cases as a result of newborn screening in the hospital setting. Families are provided counseling and education regarding sickle cell trait and sickle cell disease.    

  

Child Fatality Review (CFR)  

Child deaths are often regarded as indicators of the health of a community. While mortality data provide us with an overall picture of child deaths by number and cause, it is from a careful study of each child’s death that we can learn how best to prevent future deaths. Recognizing the need to better understand why children die, Governor Bob Taft signed a bill in July 2000 mandating CFR boards in each of Ohio’s counties to review the deaths of children under 18 years of age. For the complete law and administrative rules about CFR, refer to the Ohio Department of Health website at https://odh.ohio.gov/know-our-programs/child-fatality-review/resources/cfr-rules.   

   

To accomplish this, it is expected that local review teams will: promote cooperation, collaboration, and communication among all groups that serve families and children; maintain a database of all child deaths to develop an understanding of the causes and incidence of those deaths; recommend and develop plans for implementing local service and program changes, and advise ODH of data, trends, and patterns found in child deaths.  

   

CFR boards must meet at least once a year to review all deaths of child residents of that county. The basic review process includes the presentation of relevant information; the identification of contributing factors; and the development of data-driven recommendations. At the state level, we are re-establishing the CFR Advisory Board. The purpose of this advisory board will be to review Ohio’s child mortality and CFR data to identify trends in child deaths, identify system responses to child deaths in Ohio, to make recommendations in law, policy, and practice to prevent future child deaths in Ohio, and to review and provide input for the annual CFR report. The Advisory Board will meet 1-2 times per year with the possibility of establishing sub-committees to focus on specific issues.  

  

Fetal/Infant Mortality Review   

Fetal Infant Mortality Review (FIMR) is a multi-disciplinary, multi-agency, community-based program that identifies local infant mortality issues through the review of fetal and infant deaths and develops recommendations and initiatives to reduce infant deaths. Currently, there are active FIMR programs in all Ohio Equity Initiative (OEI) counties.   

   

The FIMR process includes:   

•       Identification of cases based on the infant mortality issues of the community.   

•       Collection of appropriate records from medical, social service, and other providers.   
•       Maternal interview.   
•       Abstraction of available records to produce a de-identified case summary.   
•       Presentation of de-identified case summary to review team.   
•       Development of data-driven recommendations.   

•       Implementation of recommendations to prevent future deaths.   
•       Case Review Team reviews case summaries and develops recommendations.   
•       Case Action Team reviews recommendations and develops a plan to implement interventions.   

   

Plans for the upcoming year include reviewing recommendations generated by Child Fatality Review and Fetal-Infant Mortality Review to determine areas of alignment for future prevention initiatives, increased data dissemination from the state to local CFR teams on issues related to CFR and emphasizing data quality through quarterly technical assistance webinars and newsletters. The ODH Child Fatality Review team has established regular meetings with DCY staff to discuss opportunities for collaboration related to the review of child deaths. DCY conducts reviews of child deaths due to abuse and neglect. We are exploring ways to work together to enhance our fatality prevention activities.

 

Infant Oral Health

The Oral Health Program (OHP) continues to distribute guidelines on managing oral health care during pregnancy and infant oral health to prenatal and dental care providers through the Integration of Oral Health into Prenatal Care Grant. This work will continue in FY25 and one additional subrecipient will be funded. Subrecipients have been provided educational resources to deliver to both providers and patients.

 

An online continuing education module for early education professionals, nurses, and nutritionists has been developed on oral health for infants and young children and is available to MCH programs, such as WIC and Home Visiting. This module is part of Help Me Smile—Ensuring the Oral Health of Young Children. The training is available on OhioTrain and is Ohio-approved through the Ohio Child Care Resource and Referral Association. Nursing and registered dietitian continuation education credits are available.