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 capacity and systems for data collection, linkage, analysis, and dissemination (Priority #10)

 

Mental Health & Substance Use (Priority #8)

 

During FY21, IL Title V will utilize the following strategies to address Priority #8 - Strengthen workforce capacity and infrastructure to screen for, assess and treat mental health conditions and substance use disorders:

 

A. Partner with the Illinois Children’s Mental Health Partnership to develop and implement a model for children’s mental health consultations for local health departments and other public and private providers in the public health and healthcare delivery system.

 

During FY21, IL Title V will continue to support the IECMHC public health pilot program which provides 10-12 hours a month of reflective consultation by an infant/early childhood mental health consultant to the selected local departments of public health  pilot sites (Stephenson County, Winnebago County, Southern Seven, and East St. Louis) as well as monthly professional development and reflective supervision to promote fidelity to the IECMHC model. The consultation services provided to each site will increase the capacity of each pilot site to prevent, identify, and reduce the impact of mental health concerns among infants, young children, and their families as well as help facilitate connections made to appropriate systems and resources to assist with the needs identified by the public health staff (through the help of the consultants). This directly ties to Title V priority #3 (the consultant will help facilitate integration of and access to early childhood services and systems), #4 (consultants work with public health staff and families to help build the capacity of families to connect to the health and human services they require), and #8 (by providing consultation on infant and early childhood mental health, public staff will increase capacity to access and integrate mental health services).

 

B. Partner with the Illinois Department of Corrections and Logan Women’s Prison on health promotion activities for incarcerated women focused on substance use recovery and trauma health education.

 

This is the same as strategy 1-B. Information about this activity is available in the narrative for the Women’s and Maternal Health Domain.

 

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 in the state of Illinois to screen, assess, refer and treat pregnant and postpartum women for depression and related behavioral health disorders. (Same as strategy 1-E) 

 

This is the same as strategy 1-E. Information about this activity is available in the narrative for the Women’s and Maternal Health Domain.

 

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. (Same as strategy 2-A)

 

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.

 

E. Support the Perinatal Depression Program which provides 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.

 

F. Support the Illinois Perinatal Quality Collaborative (ILPQC) as it seeks to implement obstetric and neonatal quality improvement projects initiatives in birthing hospitals (Same as strategy 2-I).

 

This is the same as strategy 2-I. Information about this activity is available in the narrative for the Women’s and Maternal Health Domain.

 

G. Collaborate with other state and national initiatives to address opioids and substance use to ensure a focus on women of reproductive age, including participation in the ASTHO Opioid Use Disorder, Maternal Outcomes, Neonatal Abstinence Syndrome Initiative (OMNI) Learning Collaborative.

 

During FY21, IDPH will continue to serve as a member of the Illinois team invited to participate in the ASTHO Opioid Use Disorder, Maternal Outcomes, Neonatal Abstinence Syndrome Initiative (OMNI) Learning Collaborative. The Illinois team is comprised of representatives from IDPH, HFS (Medicaid), DHS, DCSF (child welfare), and the Illinois Perinatal Quality Collaborative. The team’s OMNI project focuses on Illinois having a “recovery-oriented system of care that enables women planning pregnancy, and pregnant and postpartum women to receive medication-assisted treatment (MAT) and needed support services to have healthy pregnancies and deliveries and be supported in the postpartum period for the development of healthy families.” The team identified several barriers to MAT for women with substance use disorder (SUD), including lack of providers, lack of provider awareness/training, lack of care coordination and fragmented system, lack of identification/ screening, reimbursement issues, prenatal care providers lacking experience and process to link women to MAT providers, stigma, and the social determinants of health (transportation, housing, child care). The goals of the project are:

 

         Expand access to MAT for pregnant women with SUD by increasing the number of providers trained to screen/diagnose SUD, administer MAT, and counsel patients;

         Develop a cross-system communication plan for the health care, Medicaid, substance use prevention/treatment, and child welfare systems that reduces stigma around substance use disorder and creates standardized systems of support for pregnant women with SUD and their infants; and

         Develop cross-system training for providers delivering prenatal care, labor/delivery staff in hospitals, and the child welfare system to establish standardized protocols and practices which would assure optimal care to infants born with Neonatal Abstinence Syndrome (NAS).

 

OWHFS and IL Title V will continue to work to increase education and support of health care providers and patients around the use of LARC. This includes working with the Illinois Department of Corrections to incorporate family planning into the two women’s prisons to offer family planning services to women prior to release, collaborating to expand the efforts of ILPQC’s immediate postpartum LARC initiative and integrating the Title X Family Planning Program with school-based health centers.

 

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. (Same as strategy 4-D)

 

This is the same as strategy 4-D. Information about this activity is available in the narrative for the Child Health Domain.

 

I. Participate on and collaborate with the statewide Adolescent Suicide Ad Hoc Committee to develop a Strategic Plan to reduce suicide ideation and behavior among youth in Illinois (Same as strategy 5-C).

 

This is the same as strategy 5-C. Information about this activity is available in the narrative for the Adolescent Health Domain.

 

J. Convene and partner with key stakeholders to identify gaps in mental health and substance abuse 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. (Same as strategy 2-G).

 

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.

 

Oral Health (Priority #9)

 

During 2021, IL Title V will utilize the following strategies to address Priority #9 - Support an intergenerational and life course approach to oral health promotion and prevention:

 

A. Partner with IDPH Division of Oral Health (DOH) to expand oral health outreach to the most at-risk maternal populations by engaging Woman, Infant and Children (WIC) programs.

 

During FY21, DOH will work directly with pregnant women through the Woman, Infant and Children (WIC) programs within local health departments providing assistance for the most at-risk maternal population.  This initiative will bring a greater awareness of the oral systemic link between low birth weight and pre-term labor.  By working directly with Woman, Infant and Children (WIC) programs within local health departments, DOH will be able to provide assistance for the most at-risk maternal populations. In addition, DOH will continue to reach out to Health Departments to provide technical assistance and guidance for oral health programs. These programs include the fluoride varnish trainings, medical dental integration and referrals to care programs.

 

B. Partner with the DOH to support and assist school personnel and families across Illinois to access:  oral health education, dental sealants, fluoride varnish, Illinois All Kids (Medicaid) enrollment, and dental home referrals; and, comply with Illinois’ mandatory school dental examinations for children in kindergarten, second, sixth and ninth grades.

 

During FY21, DOH will continue to partner with Illinois Title V to provide continued funding to local health departments for dental sealants for uninsured or underinsured children. In addition, DOH will continue to inform, educate, and empower others about oral health issues through such vehicles as providing oral health presentations for daycares and schools for children of all ages, and presentations and exhibiting at school nurses’ meetings and oral health screenings at local health fairs will continue to be a priority.

 

C. Collaborate with DOH to design and implement the first Basic Screening Survey (BSS) for Pregnant Women in Illinois that will assess the burden of oral diseases and barriers to access care.

 

In FY21, DOH will use established methodology to implement the Basic Screening Survey (BSS) for Pregnant Women with technical guidance from IL Title V epidemiologists, as needed. Results will be compiled in a comprehensive and detailed report of the findings for dissemination to stakeholders.

 

D. Participate in “Implementation of Quality Indicators to Improve the Oral Health of the Maternal and Child Health Population” Pilot Project with DOH to pilot a series of measures to inform the creation of a national set of indicators.

 

During FY21, IDPH Division of Oral Health will continue to work with HFS to promote and understand the reach of preventive and periodontal care received by women during pregnancy. DOH is developing a framework for an Illinois Oral Health Surveillance System which includes identifying and developing oral health data sets/measures for annual surveillance that inform partners state-wide, data extraction, testing and modifying (if needed) data transfer, and formatting content.  The first wave of data to be presented include non-traumatic use of the emergency department.  Data will be mapped by county, sex, age grouping including children (18 years old and younger). This set of data will help inform community partners to better understand needs and create plans to meet these needs. IL Title V epidemiologists and staff will continue to support this effort.

 

E. Participate in the Partnership for Integrating Oral Health Care into Primary Care project with DOH and a local health department to integrate the interprofessional oral health core clinical competencies into primary care practice, particularly for pregnant women and adolescents.

 

During FY21, IL Title V will continue to partner with DOH and the Champaign-Urbana Public Health District to participate in the Partnership for Integrating Oral Health Care into Primary Care Project sponsored by Center for Oral Health Systems Integration and Improvement (COHSII) consortium that began in FY19. Primary care providers at the local health department are being trained to use the Smiles for Life curriculum and then subsequently provide oral health risk assessments, oral exams, and fluoride varnish to adolescents and pregnant women recruited through their Women, Infants and Children (WIC) program. This pilot will be continued in FY21 through financial support of COHSII and the IL Title V. The pilot will continue to document the need for services in primary care settings.

 

In addition, IL Title V would like to highlight the upcoming Oral Health During Pregnancy and Early Childhood in Illinois resource manual which will be finalized and published early FY21. IL Title V will work with DOH to educate, promote, and disseminate the completed manual to partners.

 

Another notable activity for FY21 is Title V’s continued support for the development of a new statewide oral health plan. The last statewide plan was updated in FY17. DOH has started convening stakeholders to participate on the Advisory and Steering Committee for the development of the Illinois' Oral Health Plan IV. The goal is to reassess the oral health landscape, consider challenges, opportunities, and update strategies that aim to improve oral health status, and decrease prevalence of oral diseases.

 

MCH Epidemiology Capacity and Data Systems (Priority #10)

 

For the new Illinois MCH Action Plan for the years 2021-2025, the strategies have been condensed to better categorize and classify the work of the Title V epidemiology team.

 

During FY21, IL Title V will utilize the following strategies to address Priority #10 - Strengthen capacity and systems for data collection, linkage, analysis, and dissemination:

 

A. Enhance staff capacity for data management, analysis and translation through training and workforce development

 

Training Opportunities

 

Training opportunities will continue to be offered to Title V staff members as they are available and feasible. For example, new Title V epidemiologists may apply to participate in the weeklong MCH epidemiology training sponsored by MCHB in June 2021. Other opportunities, such as pre-conference trainings and the CDC/Harvard Program Evaluation practicum, will also be explored for their relevance to staff training needs. As the need arises, Title V epidemiology staff may provide data-focused trainings to other staff members, such as providing overviews of program evaluation, needs assessment processes, data interpretation, or other relevant topics.

 

Workforce Development for Interns, Fellows, and Early Career Professionals

 

Illinois Title V will continue to be dedicated to developing young professionals through epidemiology internships and fellowships. During FY21, we will host graduate epidemiology students for internships through agreements with local universities such as the UIC CoE-MCH and DePaul University.

 

Illinois will host a CSTE applied epidemiology fellow from August 2020 through August 2022. The CDC MCH Epidemiology field assignee will serve as the primary mentor for this fellow.

 

Illinois applied to be a host site for the CDC Public Health Associate Program (PHAP), which is a 2-year training program for early public health professionals. The proposed position would focus on emergency preparedness planning for MCH populations – a topic area that Illinois Title V would like to more actively engage and develop for the state.  The Title V Director would serve as the supervisor for this position. If selected as a host site, OWHFS will host the Public Health Associate from October 2020 – September 2022.

 

B. Improve data infrastructure and systems, including initiatives to improve accuracy, timeliness, and quality of data

 

Data Linkage

 

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. Additionally, while the process of linking hospitalization and birth certificate data was begun during FY18 by the CSTE Applied Epidemiology Fellow, this project was not completed prior to the end of her fellowship. Multiple demands upon staff time have made continued progress on this linkage slow. During FY19-FY20, a PhD level epidemiology student intern has assisted IDPH with the continued linkage of hospital discharge and birth certificate data. The hope is that the permanent Title V epidemiology staff will be able to take over this function in FY21.

 

Maintenance of Data Systems

 

During FY21, Title V will continue to maintain the ePeriNet data system as the primary reporting mechanism for quality and outcome data from the perinatal hospitals. As needed, updates and improvements to ePeriNet will be made to ensure that the data are useful and of high quality. For example, the addition of a COVID-19 module for maternal and infant outcomes is planned for late 2020 and will likely extend into 2021.

 

Illinois will maintain use of the CDC-hosted MMRIA system during FY21 to record information about all pregnancy-associated deaths and to share this information with the CDC.

 

C. Analyze data, translate findings, and disseminate epidemiologic evidence to support MCH decision-making

 

Generating and disseminating epidemiologic evidence remains at the heart of the state Title V priority on data. 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. Some specific data products that are anticipated for FY21 include:

• An annual update to the state report on maternal morbidity and mortality
• Data brief on mental health and substance use hospitalizations for women of reproductive age
• Data report on the state’s first in-depth analysis of fetal deaths
• Data report comparing maternal morbidity data across multiple data sources

 

Conference attendance and presentations will continue to be a priority as a means for disseminating the work of the Illinois Title V epidemiology team. Staff members will prepare scientific abstracts to submit to conferences during FY21, 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, as well as contributing as a co-author on papers led by external partner organizations or by trainees/interns working with Title V.

 

D. Forge partnerships that will increase the availability, analysis, and dissemination of relevant and timely MCH data

 

Partnerships to Increase Epidemiology Capacity of IL Title V

 

Illinois has hosted a CDC MCH epidemiology field assignee since 2014 and plans to continue this valuable partnership during FY21.

 

IDPH began hosting a CDC COVID-19 epidemiology field assignee in July 2020, and this position will continue through June 2020. Sonal Goyal, PharmD, MPH, is the COVID-19 epidemiology assignee, and her work with Illinois will focus on supporting maternal and child health related COVID-19 surveillance. Her state supervisor is the CDC MCH epidemiology field assignee.

 

The interagency agreement with the UIC School of Public Health, CoE-MCH is in the process of being renewed. The proposed new agreement would run through June 2022, thus continuing this vital partnership throughout 2021. This will enable Illinois Title V to continue to benefit from the epidemiologic technical assistance provided by UIC faculty, staff, and students. Projects may include detailed data analyses, program evaluations, and/or creation of fact sheets or other data products.

 

During FY21, 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.

 

Partnerships to Improve Access and Quality of MCH Data

 

During FY21, the Title V epidemiology team will continue to provide technical assistance to various partners on data projects. This will include collaboration with the Illinois Perinatal Quality Collaborative, state advisory committees (e.g. Perinatal Advisory Committee, Statewide Quality Council), and various other state agencies. 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.

 

Title V and PRAMS will continue to actively partner to ensure high-quality data collection during FY21. These activities will include: continuing to fund the incentives for survey respondents, supporting the implementation and analysis of a new PRAMS COVID-19 supplement, and collaborating on phase 9 survey development. Title V will ensure that questions representing Title V priorities, such as the social determinants of health, are included in consideration for new questions.

 

Title V will also continue the completion of the SDOH form for every maternal death case that will be reviewed by the MMRC/MMRC-V. The state MMRCs will also routinely use a community vital signs dashboard (developed by Emory University) as part of a pilot project to help state MMRCs apply a health equity framework to maternal mortality reviews.