III.E.2.c Application Year: Cross/Cutting Systems Building

RI’s Cross Cutting Priority attempts to address health inequities that are systemic, avoidable, unfair, and unjust differences in health status across population groups. RIDOH recognizes that the conditions in which people are born, grow, live, learn, work, and play affect health in powerful ways. Public health research and data show that many adverse health outcomes have resulted from generations-long social, economic, and environmental inequities. These inequities include poverty, discrimination, racism, and their consequences. For example, segregation in housing and education and racist mortgage lending and zoning policies have affected communities differently and have had a greater influence on health outcomes than genetics, individual choices, or access to healthcare. Removing obstacles to health and improving access to good jobs with fair pay, quality education and housing, safe environments, and healthcare can help reduce health inequities and improve opportunities for every Rhode Islander.

The following priority for cross-cutting systems building emerged from Rhode Island’s 2019 Needs Assessment:

Adopt social determinants of health in MCH planning & practice to improve health equity

Priority: Adopt Social Determinants of Health in MCH Planning & Practice to Improve Health Equity

The Title V program aims to collaborate across the RIDOH and with other state and local stakeholders to adopt SDoH into MCH planning and practice to improve health equity. RI has adopted 15 Health Equity Indicators as statewide measures to overarchingly assess health equity in the state. These indicators span across five domains (integrated healthcare, community, physical environment, socioeconomics, and community trauma), which are further broken down in measuring key determinants of health that can be reported by city/town and race/ethnicity and monitored annually using various state agency, census, and survey data. The MCH Program is interested in incorporating these measures to address social determinants of health that are related to the MCH populations. Overall, the goal is to increase health equity and access across the entire state. Please reference the appendix for a comprehensive breakdown of health equity indicators.

RI has adopted 15 Health Equity Indicators as statewide measures to overarchingly assess health equity in the state. These indicators span across five domains (integrated healthcare, community, physical environment, socioeconomics, and community trauma), which are further broken down in measuring key determinants of health that can be reported by city/town and race/ethnicity and monitored annually using various state agency, census, and survey data. The MCH Program is interested in incorporating these measures to address social determinants of health that are related to the MCH populations.

The following strategies support RIDOH’s priority to improve system coordination:

Strategies supporting the adoption of social determinants of health in MCH planning and practice that will continue:

Ensure Health Equity Programming among Maternal Child Health Programs: Title V is continuing to grow its partnerships with community stakeholders, cultural groups, and networks, such as HEZ and SISTA FIRE, to address perinatal and birthing disparities within the birthing parent system of care. Through these partnerships, RIDOH administered programs, including family home visiting, family planning, oral health, and other preventative care, are seeking guidance on: 1) Translation & Interpretation, 2) Trauma Informed Care/Consent, 3) Patient Discrimination, 4) Community Resources, and 5) Workforce Diversity. This includes soliciting solutions to challenges from the community.

Assessing Womxn of Color and Indigenous Needs:

Presently the RIDOH is collaborating with SISTA Fire to implement community participatory research related to the economic needs of womxn of color in RI. This will be fed into our needs assessment. They completed a three-month community engagement process with over 200+ womxn of color about financial stability and economic needs.

Additionally, we are working with Narragansett elders to implement needs assessing activities of the Narragansett Tribal community and the Eastern Woodland tribes that are interconnected within RI. In particular, they are working to implement talking circles and disperse a survey to understand the needs of families. The circles and survey will not only ask the needs but understand what the potential solutions would be. Additionally, we understand there is a large urban indigenous community in RI that is not connected to a federally recognized tribe. As a result, we are supporting the Tribal Youth Empowerment Cooperation, to outreach and hold focus groups to understand the needs of urban indigenous families. The focus groups will center around the following questions:

1. What are activities and initiatives that are supporting families in RI,
2. What are the needs of urban indigenous families in RI, and
3. What are some solutions to those needs you referenced before.  

All groups will then write up and report back on their findings and they will be incorporated into our Title V needs assessment process.

Continue to Support the Development of a Doula Infrastructure: RIDOH MCH will continue efforts to engage stakeholders on finalizing a Medicaid State Plan Amendment, insurance reimbursement protocols, and assisting with implementation readiness. Title V, PDG, and PBG will collaboratively work with the Journ3i LLC. To continue training and mentoring upcoming doulas and providing established doulas with continuing educational avenues.

Amplify Family Voices and Input:

Promoting Indigenous voices within Title V activities and initiatives: RIDOH MCH Program will continue to invest in uplifting indigenous voices across RI. This will include continuing to integrate indigenous community members in our statewide taskforces and committees on maternal and child health and encouraging the growth of indigenous led initiatives and needs assessment activities. See the annual report section for a further rendering of our work with indigenous community members and organizations.  

The Family Visiting Advisory Council. The council are made up of parents/caregivers from across rural, suburban, and urban RI that at one point were recipients of Family Visiting services. The committee is convened regularly by RIDOH Family Visiting staff and participants are reimbursed for their time and provided food, refreshments, and childcare during meetings. The council advises on different topics such as: family engagement, family visiting marketing and outreach, family needs, and family visiting service asset and gaps. In the coming year, the committee will continue to meet and advise on the above topics.

Rhode Island Parent Information Network (RIPIN): RIPIN will continue its work in supporting families with children with special healthcare needs and empowering the voices and engagement of caregivers. For instance, the RI Department of Health (RIDOH) will continue to contract with the Rhode Island Parent Information Network (RIPIN) for Peer Professional Support Services to support the Title V Program in ensuring a quality system of health care for Children and Youth with Special Health Care Needs (CYSHCN). Through the employment of families of CYSHCN, RIPIN provides training to individuals who have actual life experience to assist other families of CYSHCN. Specific areas of Peer Resource Specialist support include the administration of a comprehensive resource, information, and referral system; training, education, peer support, and system navigation.

RIPIN has begun hosting focus groups in both English and Spanish to get periodic feedback from families and youth from diverse communities. Groups are focused on the following areas:

Healthcare technology

• FV is once again partnering with the RI Quality Institute (RIQI) to gather data from families with CYSHCN. This upcoming project will focus on health information technology and patient portal capabilities.

Special Education

• There is a strong need for early childhood support right now. RIPIN is partnering with the van Buren Charitable Foundation, Conexion Latina, RI KIDS COUNT, and Parents Leading Equity in Education (PLEE) to meeting with families and professionals across the state to gather data and develop policy recommendations for the state and providers.

Community Based Systems of Support

• Children with special needs, particularly those in underrepresented communities, do not have equal access to inclusive activities in their communities. RIPIN will be partnering with Newport Schools and Conexion Latina to help provide summer camp opportunities so children can engage with their peers.

Family Voices: The RI Department of Health (RIDOH) will continue to ensure the incorporation of family leadership through contractual support of the Family Voices (FV) program which is housed within the RI Parent Information Network (RIPIN). Family Voices is a national grassroots network of families representing Children and Youth with Special Health Care Needs (CYSNCN) with a designated affiliate office in each state and territory. The Family Voices program fulfills the Title V CYSHCN mandate to provide opportunities for parent engagement, leadership development, and policy advocacy to address the uninsured and underinsured CYSHCN. Family representation and/or input is incorporated into the following: task forces, advisories, and councils where policies and decisions are made that will impact CYSHCNs; communications development/distribution; parent/caregiver support groups; community outreach; and legislative policy development/advocacy. RIPIN FV is moving forward with promoting The Blueprint for Change to RI Systems of Care. We are working closely with RIDOH, AAP, RI’s Care Transformation Collaborative, and Medicaid to determine how to support families with children with medical complexity when they transition to adult care.

Family Voices Leadership Team: RIDOH will continue to contract with RIPIN to convene The Family Voices Leadership Team, an advisory body comprised of state agencies, healthcare providers, and community stakeholders, to provide expertise and input on a variety of issues affecting the system of care for CSHCN. The Family Voices Leadership Team is the perfect venue for us to continue to grow our professional contacts and share the wealth of knowledge and resources that RIPIN has to give. Our goal is to add new members to the team, but we start by inviting them to attend and present on their organization, program, and/or role. If we then see it as a good fit for the team, they are invited to join.

Family to Family Health Information Center (F2FHIC): RIPIN is also Rhode Island’s HRSA funded F2FHIC, which is housed within Family Voices. This program will continue to provide families of CSHCNs with support, resource referral, training workshops, advocacy, and relevant information via newsletters/publications/websites. RIPIN’s FV team has aligned with our communications department in setting goals to provide trainings to both families and professionals in both English and Spanish. We have committed to providing each of the five FV led workshops once in each language in the upcoming year.

• Enhancing Facilitation Skills Part 1 (based on Serving on Groups)
• Enhancing Facilitation Skills Part 2 (based on Leading by Convening)
• RI Medicaid Options for Families with CYSHCN
• Policy 101
• The Right Question ~ Health

In addition to these presentations being held either virtually or in-person, we will be recording short videos of Policy and Medicaid Options to highlight items that the community may find difficult or confusing to understand.

RIPIN Peer Resource Specialists: Through a contract with RIDOH, RIPIN will continue to employ Peer Resource Specialists to strengthen Rhode Island’s capacity to plan and deliver effective services to special needs, disability, and vulnerable populations. The Peer Resource Specialists bring the perspective of parents, youth, and consumers into the programs where they are placed. In addition to employment within the RIDOH, Peer Resource Specialists are employed throughout the CYSHCN service system, assisting healthcare professionals, community stakeholders, and policy leaders in providing support to CYSHCN and their families.

Parent Support Groups: RIPIN will continue to host a monthly Peer Support Group for families and caregivers of CYSHCN, in both English and Spanish, facilitated by RIPIN staff members, who are also parents of CYSHCN. The goal is to get the families together for an in-person celebration with wellness activities and promotion of self-care.

Support a Comprehensive System of Engagement & Leadership Development for Vulnerable Populations: RIDOH will continue to support a system of engagement and leadership development for vulnerable populations including but not limited to:

Support a Comprehensive System of Engagement and Leadership Development for Vulnerable Populations Through the Youth Advisory Council: This coming reporting year, the Youth Advisory Committee will offer a hybrid meeting structure where youth can choose to meet in-person (when resumed) or remotely accommodate the many youths with transportation challenges. The planned agenda for this period will include professional development and leadership training and social, emotional, and resilience workshops. The committee will also seek to expand its community youth engagement and RIDOH program support activities. During the Oct 1,2023-Sept 30, 2024, period, the RIDOH will continue to provide leadership development to youth with special needs, disabilities, and diverse learners through participation in the Youth Advisory Council (YAC). In accomplishment, the RIDOH will develop a hybrid program structure to include monthly meetings that provide youth with the option to meet in-person or remotely to accommodate transportation challenges. The RIDOH YAC Coordinator will develop a calendar year agenda that will include relevant topic education, leadership training, and professional development opportunities through collaboration with RIDOH Programs and partnerships with Community Agencies for Youth sponsored events.

Convene the MCH/HEZ Learning Classroom: The HEZ MCH Learning Classroom is an interactive educational space created to educate Health Equity Zones on Maternal Child Health issues across all six domains. The Maternal Child Health Program has put together a list of speakers from both the community and RIDOH to attend our bi-monthly meetings and educate the group on the initiatives they implement. 

Advance a Comprehensive System of Engagement and Leadership Development for Vulnerable Populations through the Health Equity Zones: This upcoming year, the HEZs will continue the important work they have started. This will include four new Health Equity Zones recently incorporated, which brings the total to 15 HEZs statewide. These include South Providence (02905), Warwick, Blackstone Valley, Warren, and Tri-County HEZs. 

EP HEZ plans to implement the evidence-based Parents as Teachers (PAT) model. They also plan to partner with the RI Philharmonic & Music School to implement music programming that supports early language acquisition for young children. EP HEZ will also offer a session on Safe Sleep and implement the evidence-based Incredible Years parenting education program. This and other PDG related work will continue through June 2023 with PDG funding, enabling the programming to positively impact the lives of children and families across the HEZ community.

The PCF HEZ’s substance use education programs plan to continue their efforts. PCF HEZ continues to leverage the expertise of state and community stakeholders and remain flexible in their approach as they empower youth in guiding the work. In addition, given that the PCF HEZ identified youth engagement as a priority focus, many priorities will be addressed through the lens of youth’s perspective and voice and choice. Currently, PCF HEZ is in the beginning stage of the implementation of their 3-year strategic plan; a response to recent assessment that includes diverse representation of HEZ youth, residents and members. PCF HEZ will continue to tap into the expertise of the youth as they identify and address disparities. To that end intentional opportunities for youth leadership and advancement has been prioritized. With the current round of PDG funds, the West Elmwood 02907 HEZ will be able to expand their efforts and connect an even greater number of families to vital supports that exist in their community.

West Warwick will continue peer to peer grandparent support to connect and establish relationships with community entities that serve this population, including DCYF, Senior Center, Schools, Community Health Center, Grands Flourish etc. West Warwick HEZ will continue efforts related to food insecurity and nutrition. In partnership with the local library, the free summer meal program will provide children ages 0-18 with consistent meals during the summer. Additionally, they are positioned to continue implementing their “pop up” farmers market for WIC and SNAP voucher recipients.

Woonsocket HEZ continues to engage community partners in building youth leadership, working towards the development of a Youth Ambassador group. In the 2023 State fiscal year, the Woonsocket HEZ will continue to utilize its PDG award to administer Conscious Discipline in Head Start classrooms and coaching local teachers and administrators.

Strategies delayed by COVID that will resume:

None

NEW strategies:

None

In addition, RIDOH will continue systems support for coordination and quality improvement of the following areas of work: oral health, mental health, patient centered medical homes, equity centered commissions and workgroups,