Cross-Cutting/Systems Building - Application Year
Illinois’ priorities for the Cross-Cutting Domains are:
- Strengthen workforce capacity and infrastructure to screen for, assess, and treat mental health conditions and substance use disorders. (Priority #8)
- Support an intergenerational and life course approach to oral health promotion and prevention. (Priority #9)
- Strengthen MCH epidemiology capacity and data systems. (Priority #10)
Priority #8 – Mental Health and Substance Use
During FY24, Title V will utilize the following strategies to strengthen workforce capacity and infrastructure to screen for, assess, and treat mental health conditions and substance use disorders:
8-A. Partner with the Illinois Children’s Mental Health Partnership to develop and to implement a model for children’s mental health consultations for local health departments and other public and private providers in the public health and health care delivery system.
IDPH and Title V staff will continue to participate on the Illinois Children's Mental Health Partnership. The OWHFS deputy director will continue to serve as a member of the executive committee with Title V staff serving on the various subcommittees. Title V will continue to leverage its relationship with the partnership and identify opportunities to develop new initiatives addressing child and adolescent mental health.
8-B. Partner with the Illinois Department of Corrections and Logan Correction Center on health promotion activities for incarcerated women focused on substance use recovery and trauma health education.
This strategy is similar to strategy 1-B. Information about this activity is available in the narrative for the Women’s and Maternal Health Domain.
8-C. Partner with UIC Center for Research on Women and Gender to implement a program at two clinic sites to expand the capacity of health care providers to screen, to assess, to refer, and to treat pregnant and postpartum women for depression and related behavioral health disorders.
This is the same as strategy 1-D. Information about this activity is available in the narrative for the Women’s and Maternal Health Domain.
8-D. Convene and facilitate state Maternal Mortality Review committees (MMRC and MMRC-V) to review pregnancy-associated deaths and develop recommendations to improve quality of maternal care as well as reduce disparities and address social determinants of health.
This is the same as strategy 2-A. Information about this activity is available in the narrative for the Women’s and Maternal Health Domain.
8-E. Support the Perinatal Mental Health Program that includes a 24-hour telephone consultation for crisis intervention for women suffering from perinatal depression.
This is the same as strategy 2-J. Information about this activity is available in the narrative for the Women’s and Maternal Health Domain.
8-F. Support the Illinois Perinatal Quality Collaborative (ILPQC) in its implementation of obstetric and neonatal quality improvement initiatives in birthing hospitals.
8-G. Collaborate with other state and national initiatives to address opioids and substance use disorder among women of reproductive age, pregnant persons, and families.
During FY24, Title V will identify ways to support state and continue support state and national initiatives to address substance use disorder (SUD) among women of reproductive age, pregnant persons, and families. We will continue to support ILPQC’s efforts promote universal substance use disorder screening prenatally and at the delivery hospitalization, as well as initiation of SUD treatment in obstetric and emergency care settings. ILPQC also continues to expand availability and provision of naloxone at the point of care
In addition to working with ILPQC, Title V continues to explore opportunities with other key stakeholders and include other state agencies, to address the gaps in mental health and SUD services for women and pregnant persons. In FY23, Title V staff joined a multi-agency workgroup on Illinois’ implementation of plans of safe care for infants prenatally exposed to substances. This workgroup is being led by the Illinois Department of Child and Family Services (DCFS) to meet federal child welfare policy requirements. We will continue to participate in this workgroup during FY24.
8-H. Identify gaps in mental health programs and resources for Illinois children, develop partnerships with and within organizations focused on improving mental health among children and adolescents, and support the implementation of mental wellness programs that facilitate system level improvements as well as address social determinants of health.
This is the same as strategy 4-D. Information about this activity is available in the narrative for the Child Health Domain.
8-I. Participate on and collaborate with statewide Adolescent Suicide Prevention Ad Hoc Committee to develop a strategic plan to reduce suicide ideation and behavior among youth.
8-J. Collaborate with organizations and programs to address the impact of adverse childhood experiences (ACE) and toxic stress on mental and physical health in children and adolescents.
This is the same as strategies 4-F and 5-F. Information about this activity is available in the narratives for the Child Health Domain and the Adolescent Health Domain.
8-K. Convene and partner with key stakeholders to identify gaps in mental health and substance use services for women that include difficulties encountered in balancing multiple roles, self-care, and parenting after childbirth, and leverage expertise to develop recommendations for system level improvements for Title V consideration and implementation.
This is the same as strategy 2-G. Information about this activity is available in the narrative for the Women’s and Maternal Health Domain.
Priority #9 – Oral Health
During FY24, Illinois Title V will utilize the following strategies to support an intergenerational and life course approach to oral health promotion and prevention:
9-A. Partner with IDPH Oral Health Section (OHS) to expand oral health outreach to the most at-risk maternal populations by engaging local programs and organizations.
During Fy 24, the OHPP grants will primarily reach low-income vulnerable families with a focus on early prevention to reduce oral disease burdens and help people obtain timely oral health care services. The information and resources are directed to school nurses, WIC staff, local health department staff, and personnel who then share with those they interact with school children, WIC participants, pregnant persons, and others through direct and video, web, or social media hits/views.
Throughout FY 24, OHS expects this program to reach about 50,000 individuals which are the target population of the Title V Block Grant.
During FY24, OHS will continue to work directly with pregnant women through WIC. Through this effort, OHS hopes to bring a greater awareness of the oral systemic link between low birth weight and pre-term labor. Working directly with WIC programs allows OHS to serve the most at-risk maternal population. Recent studies indicate an association between poor oral health in pregnant individuals with adverse pregnancy outcomes such as preterm birth and low birth weight. (Han, 2011) This is a surveillance activity rather than a research study and as such, it is anticipated that low-income pregnant individuals will have more diseases and lack of access to care than higher-income pregnant individuals. Results from this survey will help allocate appropriate resources and education efforts where most needed. Efforts will help new and future parents gain knowledge about chronic diseases that can be prevented with healthy food, appropriate beverage consumption, and good dental hygiene habits for them and their children. The assessment will allow the Illinois Department of Public Health, state agencies, and other organizations to plan and develop policies and programs to improve the health status of Illinoisans. Ultimately, it will enhance the development of subsequent interventions to address disease processes. Region-specific data will add granular information and show how many individuals experience oral health problems during pregnancy.
Assessing Oral Health During Pregnancy Survey (AOHDPS) is the first individual-level, primary data assessment of the oral health status of pregnant individuals in the state of Illinois. Information will be collected using a convenience sample of Women Infant Children (WIC) program sites. It is an important surveillance effort to better understand the health status of pregnant people. Outcome and findings will improve understanding and allow IDPH to further improve oral health and overall general health during pregnancy, of new parents and newborn babies. This effort will allow for continued collaboration of resources to raise awareness that oral health and general health go hand in hand. A WIC office-based setting provides the best opportunity to obtain this data. The survey also allows for comparisons of oral health status, access to preventative services, and other variables with similar counties, with states currently conducting this surveillance, and the nation.
9-B. Partner with OHS to support and to assist MCH populations and key stakeholders, which include women of reproductive age, school personnel, and families, to access oral health education, dental sealants, fluoride varnish, Illinois All Kids (Medicaid) enrollment, dental home referrals, and to comply with Illinois’ mandatory school dental examinations for children in kindergarten, second, sixth, and ninth grades.
Title V will continue to support OHS during FY24 in several activities to meet this strategy. First, OHS will continue implementing the Oral Health Promotion Program (OHPP), which focuses on the development and implementation of innovative community-level programs. These programs are expected to have an intergenerational and life course approach that address the oral health needs of children and families. Second, OHS will conduct its Healthy Smiles Healthy Growth Survey of Illinois third grade children. This survey is administered every five years. OHS will launch the next survey cycle during the 2023-2024 school year.
9-C. Collaborate with OHS to design and implement the first Basic Screening Survey (BSS) for Pregnant Women that will assess the burden of oral diseases and barriers to access care.
Using established methodology, the first Basic Screening Survey (BSS) for Pregnant Persons in Illinois is planned for the FY23 funding period and will be implemented to assess the burden of oral diseases and barriers to access care. Data will be collected, validated, cleaned, and results will be compiled. A comprehensive and detailed report of the findings will be completed and disseminated to stakeholders.
9-D. Participate in the “Implementation of Quality Indicators to Improve the Oral Health of the Maternal and Child Health Population” Pilot Project with OHS to pilot a series of measures to inform the creation of a national set of indicators.
During FY24, OHS will continue to implement the Illinois Oral Health Surveillance Plan, which was originally published in FY21. In addition, OHS will provide annual update of key oral health access and status measures using Illinois Oral Health Surveillance System and Plan for all ages and populations.
9-E. Participate in the Partnership for Integrating Oral Health Care into Primary Care project with OHS and local health departments to integrate the interprofessional oral health core clinical competencies into primary care practice, particularly for pregnant women and adolescents.
OHS will explore opportunities to participate in the Partnership for Integrating Oral Health Care into Primary Care Project or other similar projects and continue to provide educational resources for Title V.
Emerging Issues
Support the Oral Health Needs Assessment and Plan (OHNAP) I or II grantee in a high oral disease-burdened area in Illinois.
The Oral Health Needs Assessment Program (OHNAP) is a program for communities to explore oral health needs and determine a plan to address oral health needs. The Illinois OHNAP is modified from the Association of State and Territorial Dental Directors (ASTDD) 7-step OHNAP. This program allows a specific community or local health department to go through a planned process to understand the level of oral health needs in their area and design a plan to address this need within the Community. The project cycle consists of forming a diverse advisory committee, formulating goals for the community needs assessment, developing the needs assessment, surveying the availability of existing data, identifying perceived community needs, and coming up with an action plan. During FY 24, OWHFS will support OHS’ efforts.
Support OHS (with community partners) will begin planning to conduct the 2023-2024 Healthy Smiles Healthy Growth Survey of Illinois third-grade children.
Smiles Healthy Growth (HSHG) is an oral health and BMI assessment of third-grade children in Illinois. Oral health status, height, and weight measurements are collected on a statewide sample that is randomized and broken down by urbanicity: metro, collar, urban, and rural. Very important health issues affecting children will be better understood through this surveillance effort - oral health and overall health. This allows for the collaboration of resources that raise awareness that oral health and general health are interrelated. A school‐based setting provides a singular opportunity to obtain this data. The survey also allows the opportunity to compare oral health status, access to prevention treatments, and other variables with similar counties, surrounding states, and the nation.
Children's overall health, capacity to eat and speech development are all correlated with their dental health (Bagramian et al., 2009). Thus, for children's development, general health, and well-being, having good oral health at an early age is crucial (Selwitz et al., 2007). Problems with oral health in school‐age children can result in increased absenteeism, frequent hospital visits, poor concentration, lack of sleep, an inability to eat properly, undernutrition, decreased school performance, poor self-esteem, increased burden of healthcare cost on parents, social relationship issues, later life depression and anxiety, and overall low quality of life. Obesity is one of the leading causes of chronic diseases such as hypertension, diabetes, asthma, anxiety, and depression. More so, obesity in childhood is associated with obesity in adulthood, Venn, A.J., Thomson, R. J., Schmidt, M. D., Cleland, V. J., & Curry, B. A., Gennat, H. C., & Dwyer, T. (2007), with numerous elements of a child's physical and mental health being impacted by childhood obesity. Kumar, S. &Kelly, A. S. (2017). Obesity can be prevented with proper diet, beverage consumption habits, and regular physical activity.
This HSHG assessment will allow the Illinois Department of Public Health (Department), state agencies, and other organizations to develop policies and programs to improve children’s health status. Ultimately, the development of subsequent interventions to address these disease processes can be developed. Statewide normative data for children and adolescents ages 6‐17 regarding body weight, specifically body mass index (BMI), is a health indicator. This metric is included in the Healthy People 2030 to reduce the proportion of children and adolescents with obesity. Compiling this type of information is critical to tracking health trends in this age population, especially for obesity, diabetes, and asthma.
Previous HSHG assessments reported that some improvements were being made in the oral health status of Illinois’ third-grade children, including a 6% increase in third grades with sealants since the 2013-2014 HSHG assessment. Region-specific data provided additional granular information. Also noted was that many children in Illinois continue to experience dental problems, with significant racial disparities noted. Furthermore, in the wake of the COVID-19 pandemic, HSHG can provide information on the well-being of Illinois children to identify changes in oral health prevention and caries management.
The HSHG 2023-2024 project will add to this body of health status knowledge by also providing a statewide snapshot of body weight and height among third graders. This is the fifth assessment conducted, thus adding to twenty years of Healthy Smiles data. Reports from the previous four surveys are posted on the Department’s webpage at https://dph.illinois.gov/topics-services/prevention-wellness/oral-health/oral-health-data.html. The statewide assessment measures inform Illinois Oral Health Surveillance System Plan, oral health objectives for national Healthy People 2030 goals (HP 2030) and contribute data to the National Oral Health Surveillance System (NOHSS) that is maintained by the U.S. Centers for Disease Control and Prevention (CDC).
Priority #10- Strengthen MCH epidemiology capacity and data systems
During FY24, IL Title V will utilize the following strategies to address Priority #10 - Strengthen capacity and systems for data collection, linkage, analysis, and dissemination:
10-A. Enhance staff capacity for data management, analysis, and translation through training and workforce development.
Training opportunities will continue to be offered to Title V staff members as they are available and feasible. Staff are encouraged to attend at least one national epidemiology conference each year as a way of learning about best practices in the field, networking with other epidemiologists, and obtaining training on new methods or data sources.
Within the office, the Title V program plans to complete a training on health equity or social determinants of health every year. This training will be offered to all office staff and will focus on a specific topic area within health equity or SDoH, emerging research, or health equity data analysis or visualization. Following the training, staff will discuss the training and how it may be implemented within the scope of Title V program activities.
As the need arises, Title V epidemiology staff may provide data-focused trainings to other IDPH staff members, such as providing overviews of program evaluation, needs assessment processes, data interpretation, or other relevant topics.
Through support from Title V, CDPH is exploring training opportunities for staff involved in their nurse home visiting program, Family Connects Chicago. During FY 24, they plan to offer trainings in mental health and substance use disorders, and strategies for increasing male partner involvement to the nurses completing home visits.
Illinois Title V will continue to be dedicated to developing young professionals through epidemiology internships and fellowships. During FY24, we will host graduate epidemiology students for internships, such as students from local universities (e.g., UIC CoE-MCH and DePaul University) and/or through national internship programs, such as the Graduate Student Epidemiology Program and Title V internships.
Illinois will continue to host CSTE applied epidemiology fellow, Jelena Debelnogich, for her MCH epidemiology fellowship until August 2023. Cara Bergo (Maternal Morbidity and Mortality Analyst) will continue to serve as her primary mentor and Amanda Bennett (CDC MCH epidemiology field assignee) will continue to serve as her secondary mentor. The Title V epidemiology team will also host a new CSTE Fellow who will start in July 2023 and continue the fellowship through summer 2025.
B. Improve data infrastructure and systems, including initiatives to improve accuracy, timeliness, and quality of data
Linkage of data systems has long been identified as a need to improve MCH surveillance, and Illinois Title V will continue to prioritize linkage of MCH data sources. Epidemiology staff will continue to implement probabilistic matching to improve the linkage rate and quality for the infant birth and death certificates, and across multiple sources to identify pregnancy-associated deaths. Additionally, the epidemiology team will continue the process of linking hospital discharge and birth certificate data.
During FY24, Title V will continue a perinatal data system to collect quality and outcome data from the perinatal hospitals. As needed, updates and improvements to this data system will be made to ensure that the data are useful and of high quality.
Illinois will maintain use of the CDC-hosted MMRIA system during FY24 to record information about all pregnancy-associated deaths and to share this information with the CDC.
DSCC will continue to work on further development of Power BI reports into FFY24. A committee of care coordination team members was created to develop the performance measures that would be in the new DSCC Scorecard. This committee worked closely with the IT team to build the new scorecard into Microsoft Power BI. The scorecard will go-live to all staff in June of 2023 with the measures that have been properly vetted. The plan will be to continue to build performance measures into the scorecard on a quarterly basis, until it is fully complete.
The Title V team began receiving coroner reports for SUID deaths during FY22. Presenting, staff are in the process of developing an electronic data system to collect to record information from the coroner reports and match the coroner reports to death certificates. The new CSTE Fellow starting in summer 2023 will evaluate the data quality of this system and develop recommendations for improvements for the required surveillance evaluation project. During FY24, we anticipated being able to implement changes that will improve the process of collecting coroner reports and subsequently improve data quality and usefulness.
C. Analyze data, translate findings, and disseminate epidemiologic evidence to support MCH decision-making
Generating and disseminating epidemiologic evidence are vital steps in supporting evidence-based programs and policies for the state of Illinois. Data products and reports will continue to be developed for a variety of audiences based on emerging topics of interest. These products may include fact sheets, infographics, data briefs, or longer data reports. Data products anticipated during FY24 include:
- A data brief on substance use disorders identified on delivery records
- A manuscript on the impact of the COVID-19 pandemic on racial inequities in birth outcomes
- A manuscript on infant safe sleep behavior patterns
- A data brief on pediatric hospital encounters for mental health and substance use disorders before and during the COVID-19 pandemic
- An updated maternal morbidity and mortality report including deaths through 2020 with updated recommendations and specific analyses of trends and emergency department use among maternal deaths for 2015-2020.
Conference attendance and presentations will continue to be a priority as a means for disseminating the work of the IL Title V epidemiology team. Staff members will prepare scientific abstracts to submit to conferences during FY24, such as the annual conferences of the Association of Maternal and Child Health Programs (AMCHP), CityMatCH, and the Council of State and Territorial Epidemiologists.
As appropriate, Title V staff will also contribute to the development of manuscripts that will be submitted to peer-reviewed journals. This may include leading the development of papers based on studies involving Title V data or programs, or contributing as a co-author on papers led by external partner organizations or by trainees/interns working with Title V.
The Title V program staff participate in several efforts to improve the performance of the programs we support. During FY24, the Title V staff will continue to participate in perinatal advisory committee and statewide quality council projects, and the Illinois Perinatal Quality Collaborative projects, including projects on mothers and newborns affected by opioids, promoting vaginal birth, neonatal antibiotic stewardship, neonatal equity, and safe sleep.
In addition to ongoing utilization of the Power BI reports, DSCC will employ several strategies for performance management and program evaluation. A second strategy used by UIC-DSCC involves surveying families to assess their satisfaction with care coordination services. Brief questionnaires are distributed after enrolling in a DSCC program, various intervals of program participation (e.g., one year after enrollment), at key milestones (such as reaching transition age), and at program exit. A Power BI report provides real time data resulting from family surveys completed, including requests for additional follow up.
UIC-DSCC also holds Quarterly Quality meetings with senior leadership to review key performance metrics for all care coordination programs and quality improvement initiatives, such as results on record reviews, family surveys, incident reporting and quality champion improvement activities. Information presented during these meetings allows UIC-DSCC leadership to review performance over time, including trends and discuss possible actions for improvement, when needed.
D. Forge partnerships that will increase the availability, analysis, and dissemination of relevant and timely MCH data
Illinois has hosted a CDC MCH Epidemiology Program field assignee since 2014 and plans to continue this valuable partnership during FY24.
The MCH Epidemiology interagency agreement (IGA) work order with the UIC School of Public Health, CoE-MCH was renewed during FY23 and will continue through June 30, 2025. Work completed during FY24 will mainly focus on the planning and implementation of the 2025 Title V needs assessment, as well as finalizing the data products from past projects.
Illinois Title V has a second IGA work order with a faculty member form UIC-SPH who specializes in health economics in place through FY24. This agreement covers faculty time and a graduate assistant to conduct analyses related to obstetric hospital closures and maternity care shortage areas.
During FY24, the UIC-DSCC and the UIC CoE-MCH will continue to collaborate on data-related projects that inform services for CSHCN in Illinois. Specific projects will be developed in response to the future needs of the program.
During FY24, the Title V program hopes to gain access to Medicaid claims data for pregnant and postpartum people in Illinois. This valuable relationship with the state Medicaid agency would increase the capacity of the Title V programs to assess the care and outcomes of Medicaid-insured pregnant people in inpatient and outpatient care settings.
During FY24, the Title V epidemiology team will continue to provide technical assistance to various partners on data projects. This will include collaboration with HFS (Medicaid agency), Illinois Perinatal Quality Collaborative, state advisory committees (e.g., Perinatal Advisory Committee, Statewide Quality Council), Healthy Start programs, the Illinois Maternal Health Innovation Grant Program (I-PROMOTE), and various other state projects.
Additionally, Title V will maintain and build upon relationships with other internal IDPH data staff (e.g., PRAMS, BRFSS, vital records, hospital discharge data) through collaborative data sharing agreements. Specifically, Title V and PRAMS will continue to actively partner to ensure high-quality data collection during FY24. These activities will include providing training to PRAMs staff on recently added questions on adverse childhood experiences, participating on the Illinois PRAMS Advisory Committee, continuing to fund gift card rewards for survey respondents, analyzing data, and collaborating on phase 9 survey revisions. Participation in these processes will ensure that PRAMS survey questions and analyses support Title V priorities.
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