Maine’s State Systems Development Initiative (SSDI) enhances Maine’s epidemiological capacity to improve and develop integrated data systems and assures that Maine’s Title V program can access policy and program relevant information and data to make informed decisions regarding the health of the maternal and child (MCH) population.

Contributions of the SSDI Grant in Building and Supporting Accessible, Timely and Linked MCH Data Systems

Maine’s SSDI program contributes to the growth of Maine’s Title V epidemiology capacity, allowing for more efficient processes to analyze MCH data and make it publicly accessible. For example, in the past year, we conducted analyses on multiple MCH indicators and exported these data into Tableau for data visualization. The data have been included in Maine’s Shared Community Health Assessment Dashboard, as well as a MCH birth outcomes dashboard. Many of these indicators are included in the MCH Block Grant annual report.

We continue to increase the timeliness of available MCH data. Maine MCH Epidemiologists receive provisional monthly data on births and infant deaths from the Maine Data, Research and Vital Statistics Program. Starting in 2022, we received permission to receive hospital discharge data on a quarterly basis. These data help Title V staff better track birth outcomes and maternal morbidity on a timely basis and improve reporting for the Title V Needs Assessment and annual reports. Our epidemiologists work collaboratively with Maine’s Maternal, Fetal, and Infant Mortality Review (MFIMR) Panel by providing the coordinator with timely monthly data for reviews and provide the MFIMR panel with a quarterly data sheet with updated infant mortality data. We also established a schedule for linking deaths among women of reproductive age, birth certificates, and fetal deaths to have more timely access to pregnancy-associated mortality data. MCH Epidemiologists also partnered with Maine’s Syndromic Surveillance staff to examine suicide-related emergency department visits among youth in real time. We have also started examining emergency department visits for mental health among youth.

Maine took several steps in recent years to overcome barriers to data linkage. In 2019, the contract for Maine’s linked data system that includes birth certificates, Maine Newborn Bloodspot Screening data, Maine Newborn Hearing data, and Maine Birth Defects Surveillance data went out to RFP and a new vendor, Nebulogic, received the award. They successfully created a new linked data system and migrated the older data into the new system. Maine’s MCH epidemiologists are able to access reports from this system and linked data upon request. Currently MCH epidemiologists are working with Nebulogic contractors and program staff to ensure the accuracy of the linked data.

In addition to this linkage, Maine’s MCH epidemiologists receive a linked birth-infant death certificate data file from Maine Center for Disease Control (Maine CDC) and Preventions Data, Research and Vital Statistics Program on a regular basis and access to this file became timelier in recent years. Maine is a Pregnancy Risk Assessment Monitoring System (PRAMS) state and since 1995 accessed linked PRAMS-birth certificate data.

As part of Maine’s Maternal, Infant, and Early Childhood Home Visiting (MIECHV) evaluation, Maine’s MCH epidemiologists successfully linked home visiting, birth certificate, and infant death data. We also initiated Data Use Agreements between the University of Southern Maine, Maine CDC, and Maine’s Office of Child and Family Services (OCFS) to link birth certificate data to home visiting and child maltreatment data, including drug affected infant reports. We completed a report on infants reported as drug affected involved in Maine’s home visiting program in February 2020. We recently linked child maltreatment data to home visiting and birth certificate data. We used the linked data to examine children with substantiated child maltreatment reports and their involvement in Maine’s home visiting program. Reports based on this linkage were completed in 2020, 2021, and 2022.

Our epidemiologists are also collaborating with staff from Maine’s Office of MaineCare Services, who are implementing Maine’s MOM (Maternal Opioid Misuse) grant to examine methods to conduct surveillance on substance exposure during pregnancy for women and infants. Maine’s Title V program has a Memorandum of Understanding with Maine’s Office of MaineCare Services that includes language around Title V access to MaineCare data and linking Medicaid data to birth certificate data. Maine’s Title V program received access to these data in Spring 2022. During the past year we conducted analyses examining the accuracy of the Medicaid checkbox on the birth certificate using the linked Medicaid/birth certificate data.

The Maine Health Data Organization (MHDO) maintains Maine’s hospital discharge, emergency department, and claims data. In 2021, MHDO received legislative permission to receive vital records data to link to their datasets. The linked dataset has recently become available and Maine’s Title V program is working on an application to request access.

Supporting MCH Five-Year Needs Assessment: Maine’s MCH epidemiologists work closely with staff at the Maine CDC to make data available to assist with selection of state priorities and the development of Maine’s State Performance Measures (SPMs). In spring 2018, Maine’s MCH epidemiologists created posters to inform stakeholders about MCH strengths and needs in Maine to assist with discussions of priorities. We distributed these posters and accompanying handouts at Maine’s Maternal and Child Health Symposium. In Fall 2019, our epidemiologists developed a set of data fact sheets for each MCH population domain. We distributed these fact sheets at MCH domain-specific discussion groups to help provide context to the discussions of potential MCH priorities. In Spring 2020, our epidemiologists developed a series of 24 data briefs on potential MCH priorities. These data briefs were used at a meeting to help stakeholders rank potential priorities.

In April 2019, a survey was conducted to gather stakeholder feedback on potential MCH priorities; almost 1,000 people responded. Analyses were conducted and results were included on fact sheets provided to stakeholders at the MCH prioritization meeting in January 2020. Results from the surveys that were completed by home visiting participants were analyzed separately in December 2019 and provided to the MIECHV needs assessment team for use in their needs assessment.

Maine’s SSDI grant also allows for ongoing needs assessment activities to inform current priorities and potential new priorities. For example, analyses of stressful life events around the time of pregnancy were conducted during Summer 2022 in anticipation of developing a MCH priority related to social determinants of health.

We are currently working to determine data needs for Maine’s 2025 MCH needs assessment.

Supporting MCH Priorities and Advancing Data Driven MCH Programming in 2022-2023:

• Maine’s MCH epidemiologists continue to use data from Maine’s PRAMS to better understand safe sleep practices among new parents in Maine. We updated an infographic to inform Maine’s safe sleep initiatives. Maine’s MCH epidemiologists also developed a survey, which was distributed to WIC participants, to ascertain the reach of the campaign and to gather information on safe sleep practices and barriers to safe sleep. Results from this survey were compiled into a report for WIC and Title V staff to inform the next launch of safe sleep messaging in June 2023.
• Analyses were conducted using birth certificate data to examine the impact of different methods for analyzing racial and ethnic disparities based on how race is categorized. Findings were presented at the Maine CDC’s Population Health Equity Data Group and have changed how Maine’s MCH epidemiology team presents data by race.
• An infographic on how mattering in one’s community is related to adolescent risk and protective factors was created using data from the Maine Integrated Youth Health Survey. The findings have been used by the Maine Resiliency Building Network to promote activities that engage youth in their communities.
• Analyses of stressful life events around the time of pregnancy were conducted using PRAMS data during Summer 2022. The results were presented to Maine’s Perinatal Leadership Council and at the MCH Domain Lead and Partners Meeting.
• Analyses on perinatal mental health were conducted using PRAMS data. Data from these analyses will inform Maine’s application for funding in this area and were presented at the Maine DHHS Commissioner’s Child Health Leadership April meeting.
• Analyses of neonatal abstinence syndrome and perinatal opioid use were conducted and a data brief was created and disseminated to inform efforts related to infant substance use exposure. The brief will also be used at Maine’s annual Perinatal Quality Collaborative for Maine (PQC4ME) in-person meeting in June 2023 to inform selection of Maine’s next perinatal quality improvement initiative.
• Maine’s MCH epidemiologists worked with a sub-group of Maine’s Substance Exposed Infant Taskforce to make recommendations for changes to the birth certificate to capture substance exposure during pregnancy. Initial changes went into effect in January 2022. Additional items were added in January 2023.
• A birth outcomes dashboard has been developed to examine trends and disparities related to key infant birth outcomes including infant mortality, low birth weight, prematurity, breastfeeding, and smoking during pregnancy. This dashboard was used to monitor birth outcomes throughout the COVID-19 pandemic.
• Infographics on pregnancy-associated deaths and fetal deaths were created to inform the work of the MFIMR Panel and other partners.
• A Substance Use Among Pregnant and Postpartum Individuals and Substance Exposed Infant dashboard was created through a collaboration between Title V, PRAMS, and Maine CDC’s Tobacco and Substance Use Prevention program. This dashboard is designed to provide substance use related data to the public, decision-makers, community leaders and providers: https://www.maineseow.com/pregnancy
• MCH epidemiologists analyzed indicators from the birth certificate, PRAMS, and linked birth-infant death data for inclusion in the Maine Shared Community Health Needs Assessment data dashboard. This dashboard is used by the Maine CDC, communities, and hospital systems to establish priorities: https://www.maine.gov/dhhs/mecdc/phdata/MaineCHNA/index.shtml
• Maine received three new grants in 2022, a Maternal Health Innovation Grant, a Perinatal Quality Improvement Grant, and a Maternal Mortality Review Grant. Surveillance and evaluation data were used to justify the need for this funding and are used to monitor progress on grant objectives on an ongoing basis.
• MCH epidemiologists sit on the steering committees of the Maine Integrated Youth Health Survey, Behavioral Risk Factor Surveillance System and PRAMS. Maine’s MCH epidemiologists are also part of Maine’s MFIMR Panel. By participating on these committees, Title V ensures that data needed to inform MCH priorities are collected from these key data sources. In the most recent year, Maine’s MCH epidemiologists played a critical role in question selection for Maine’s Phase 9 PRAMS survey and the 2023 Maine Integrated Youth Health Survey.