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 and Substance Use (Priority #8)

 

During FY22, Illinois 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:

 

1. 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.

 

IL Title V supported 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 health department pilot sites (Stephenson County, Winnebago County, Southern Seven counties, and the city of East St. Louis) as well as monthly professional development and reflective supervision to promote fidelity to the IECMHC model. A comprehensive report of the pilot program was completed at the end of FY21 and included details on the evaluation completed, including impact and outcomes of the pilot, comprehensive list of resources required to be successful, and roles/responsibilities of key personnel. Title V is reviewing the report and continuing discussions with key stakeholders to leverage lessons learned and identify new opportunities.

 

In addition, IDPH and IL Title V program is participating in the IL Children's Mental Health Partnership's Strategic Planning process and exploring opportunities to leverage or develop new initiatives to address child and adolescent mental health.

 

2. 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.

 

3. 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 to screen, to assess, to refer, and to 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.

 

4. 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.

 

5. Support the Perinatal Depression Program that 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.

 

6. Support the Illinois Perinatal Quality Collaborative (ILPQC) as it seeks to implement obstetric and neonatal quality improvement 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.

 

7. 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 continued 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 was comprised of representatives from IDPH, HFS (Medicaid), DHS, DCSF (child welfare), and the Illinois Perinatal Quality Collaborative. The team’s OMNI project focused 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 a 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 were:

 

• 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.
• 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 that would assure optimal care to infants born with neonatal abstinence syndrome (NAS).

 

This project closed out in FY21 with an OMNI Virtual Summit where the state teams highlighted successes and identified innovative and sustainable solutions to address care for pregnant and postpartum women with opioid use disorder and infants prenatally exposed to opioids. State teams also discussed next steps to continue to improve access to care and to treatment for this population as well as capacity to prepare for new and emerging issues through state-to-state learning and federal partner presentations.

 

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 IDOC to incorporate family planning into 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.

 

8. 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.

 

9. Participate on and collaborate with statewide Adolescent Suicide Ad Hoc Committee to develop a strategic plan to reduce suicide ideation and behavior among youth. (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.

 

10. Collaborate with organizations and programs addressing the impact of adverse childhood experiences (ACE) and toxic stress on children and adolescents’ mental and physical health and throughout their life course. (Same as strategy 4-F and 5-F)

 

This is the same as strategy 4-F and 5-F. Information about this activity is available in the narratives for the Child Health Domain and the Adolescent Health Domain.

 

11. 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 FY22, Illinois Title V will utilize the following strategies to address Priority #9 - Support an intergenerational and life course approach to oral health promotion and prevention:

 

1. Partner with IDPH Division of Oral Health (DOH) to expand oral health outreach to the most at-risk maternal populations by engaging WIC programs within local health departments.

 

During FY22, DOH will work directly with pregnant women through WIC programs within local health departments providing assistance for the most at-risk maternal population.  This initiative will serve to bring a greater awareness of the oral systemic link between low birth weight and pre-term labor.  By working directly with WIC programs within local health departments, DOH will be able to aid with the most at-risk maternal population. In addition, DOH will continue to reach out to local 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.

 

Additionally, DOH will offer the second phase of its Oral Health Needs Assessment and Plan Program (OHNAP-2). In the first phase of this program, local health departments evaluated and determined the oral health status of their respective jurisdictions through a comprehensive community-based assessment. (HNAP-2 will continue to support local health departments to implement their action plans developed during Phase 1. Specifically, DOH will provide technical support for the development and implementation of an effective population-based oral health program that meet the needs of various age groups in the community.

 

2. Partner with the DOH to support and to assist school personnel and families across Illinois 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.

 

During FY22, DOH will implement a new program, Oral Health Promotion Program (OHPP), which seeks to develop and to implement innovative health promotion and prevention programs intended to have community-level impact. Programs are expected to have an intergenerational and life course approach and to address the oral health needs of children and families. Activities include identifying early opportunities to reduce tooth decay and other oral health conditions as well as assisting MCH populations in obtaining oral health care services as needed.

 

In addition, DOH will continue to inform, to educate, and to empower others about oral health issues through such vehicles as local, regional, and national conferences, and other key outreach events.

 

3. Collaborate with DOH 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.

 

In FY22, DOH will continue to administer 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.

 

4. 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 FY22, IDPH will support DOH as it revitalizes the Illinois Oral Health Surveillance System (IOHSS) with national and state indicators related to oral health. Additional Illinois indicators addressing Medicaid utilization, dental workforce, safety net dental clinics, the oral health of pregnant women, craniofacial anomaly, and data from the Behavioral Risk Factor Surveillance System (BRFSS) will be added to assist communities in reporting oral health needs in their grant applications, prioritizing programs, and expanding services to high-risk populations. IL Title V epidemiologists and staff will continue to support this effort.

 

5. Participate in 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.

 

In FY22, IL Title V  and DOH will explore opportunities to continue to participate in the Partnership for Integrating Oral Health Care into Primary Care Project or other similar projects. IDPH recognizes the importance of working with primary care providers at the local health department level on oral health issues.

 

DOH’s resource manual entitled “Oral Health During Pregnancy and Early Childhood in Illinois” will be a great resource for primary care providers. The manual will be finalized in FY22 and will serve as a resource for prenatal and primary care providers to educate, to assess, and to refer patients for oral health issues. Information included in the manual will help to improve health literacy, encourage routine self-care practices, promote prevention activities, and address access to treatment services. In addition, the manual establishes a care coordination protocol to close the communication loop between providers.

 

Another notable activity in which IL Title V will support DOH is the Illinois Oral Health Plan IV: Eliminating Inequities in Oral Health. This plan represents a coordinated approach to lead oral health improvement, tackle barriers to health care, and begin to use a social determinants of health approach. Through implementation of the plan, IDPH hopes to increase the health knowledge of the public, expand health promotion, strengthen primary prevention efforts, and improve access to timely professional services. It is equally important that local, county, and state stakeholders have regular updates of emerging concerns and disease burdens to act quickly in mitigating health issues.       

 

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 FY22, 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

 

In May 2021, Illinois Title V hired two epidemiologists to support state MCH programs:

• Maternal and Infant Health Epidemiologist Ashley Horne, MSPH
• Child and Adolescent Health Epidemiologist Julia Howland, MPH

These new epidemiologists will continue to be integrated into the Title V team and will be supported with professional development activities during 2022.

 

Training opportunities will continue to be offered to Title V staff members as they are available and feasible. For example, Title V epidemiologists may apply to participate in the week-long MCH epidemiology training sponsored by MCHB in June 2022. Other established training opportunities will be leveraged to meet staff needs, such as pre-conference trainings at the CityMatCH/MCH Epidemiology Conference in September 2022 (to be held in Chicago). 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.

 

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 FY22, we will host graduate epidemiology students for internships through agreements with local universities, such as the UIC CoE-MCH and DePaul University.

 

Illinois will continue to host CSTE applied epidemiology fellow, Bria Oden, for her MCH epidemiology fellowship until August 2022. Amanda Bennett (CDC MCH epidemiology field assignee) will continue to serve as her primary mentor.

 

Illinois will host a second CSTE applied epidemiology fellow, Jelena Debelnogich, for a maternal mortality-focused fellowship during 2022. Cara Bergo (Maternal Mortality analyst) will serve as her primary mentor and Amanda Bennett (CDC MCH epidemiology field assignee) will serve as her secondary mentor during the fellowship (2021-2023).

 

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 has been slowly completed during 2018-2020, there is not yet a consistent rhythm for ongoing implementation of this linkage. The addition of the two new Title V epidemiology staff in 2021 will increase overall epidemiology capacity and should enable this linkage to become more routine and consistent.

 

Maintenance and Improvement of Data Systems

 

During FY22, 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.

 

Illinois will maintain use of the CDC-hosted MMRIA system during FY22 to record information about all pregnancy-associated deaths and to share this information with the CDC.

 

DSCC has been working with a consultant on the ongoing development of reports in the Microsoft Power BI system. This work will continue into FFY22. The initial reports developed have been able to help care coordination teams prioritize their activities.  Additional reports are in development that report on various quality metrics, including metrics relevant to Title V block grant priorities # 6 and #7, such as the number of UIC-DSCC participants with transition-related goals in their plan of care. 

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 anticipated for FY22 include:

• Data brief on mental health and substance use hospitalizations for women of reproductive age.
• Data report comparing maternal morbidity data across multiple data sources.
• Multiple manuscripts on the effects of COVID-19 during pregnancy that will be submitted to peer-reviewed journals.
• Updated maternal morbidity and mortality report covering 2018-2019 deaths.

 

In FY22, UIC-DSCC will use data from completed reports to analyze how various social determinants of health impact participants and families in the program. Once the data are analyzed, UIC-DSCC will determine if certain care coordination interventions or other resource provisions can lead to improvements in care. 

 

In FY22, UIC-DSCC will conduct an in-depth needs assessment on transition to adulthood. Previously, DSCC received feedback that our needs assessment participation rates did not align well with the racial/ethnic makeup of the CYSCHN served. UIC-DSCC will work to ensure more data collection from diverse groups. 

 

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 FY22, such as the annual conferences of the Association of Maternal and Child Health Programs (AMCHP), CityMatCH/MCH Epidemiology Conference, 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 Program field assignee since 2014 and plans to continue this valuable partnership during FY22.

 

IDPH was able to negotiate the extension of the CDC COVID-19 epidemiology field assignee, Sonal Goyal, through June 2022 to support continued implementation of COVID-19 surveillance among pregnant persons. Amanda Bennett (CDC field assignee) serves as the site supervisor for this assignment. During 2022, it is anticipated that the COVID-19 pregnancy module will be completed for all sampled cases and final data will be shared with CDC.

 

The interagency agreement with the UIC School of Public Health, CoE-MCH has been renewed and will continue through 2022. 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. Anticipated projects during 2022 include analysis of data on COVID-19 during pregnancy and development/implementation of an evaluation plan for the Illinois Medicaid postpartum extension to 12 months.

 

During FY22, 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 FY22, 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 Innovations 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.

 

Title V and PRAMS will continue to actively partner to ensure high-quality data collection during FY22. These activities will include participating on the Illinois PRAMS Advisory Committee, continuing to fund gift card rewards for survey respondents, analyzing data from the COVID-19 supplement, and collaborating on phase 9 survey revisions. Title V will ensure that questions representing Title V priorities, such as the social determinants of health, are included in consideration for new questions in phase 9.

 

Title V will also continue to use the SDOH abstraction form and community vital signs dashboard for every maternal death case that will be reviewed by the MMRC/MMRC-V. These data are anticipated to improve the identification of contributing factors and recommendations related to community-level and systems-level issues affecting maternal mortality.