women/maternal health state action plan table...

Women/Maternal Health

State Action Plan Table (Missouri) - Women/Maternal Health - Entry 1

Priority Need

Improve pre-conception, prenatal and post-partum health care services for women of child bearing age.

NPM

Percent of women with a past year preventive medical visit

Objectives

By June 30, 2020, DHSS will develop/promote strategies to reduce maternal mortality by at least 10%, from 24 (baseline: CY 2013 Vital Statistics) to 21.5per 100,000 live births respectively.

By June 30, 2020, DHSS will develop/promote strategies to increase the percent of women with a preventive medical visit from 63.2% (baseline: 2013BRFSS) to 70%.

By June 30, 2020, DHSS will develop/promote strategies to increase the percent of African American women with adequate prenatal care from 62.5%(baseline: CY 2013 Vital Statistics) to 69%.

Strategies

The Newborn Health Program will continue to provide maternal and child health resources to women of child-bearing age and their families which includespreconception, prenatal and postpartum care, as well as smoking cessation, postpartum mood disorders and the importance of taking folic acid.

The TEL-LINK program will continue to provide information and referrals for preconception, prenatal and postpartum care services. Home visitingprograms will continue to encourage participants to obtain adequate preconception, prenatal, and postpartum health care services.

Home Visiting Programs will survey Local Implementing Agency (LIA) supervisors during monthly contractor conference calls for the existence oftransportation barriers and will refer reported issues to the Department of Social Services (DSS) Medicaid Specialist for investigation.

Home Visiting Programs will educate home visitors on the process for timely Medicaid enrollment for pregnant women and re-distribute the document toLIAs via email and at annual HV program conferences.

The Maternal Child Health Services Program will continue to partner with local public health agencies to ensure access to quality health care and providehealth care services to women of childbearing age during the preconception, prenatal, and postpartum periods.

The MO DHSS will continue to collaborate with the March of Dimes, Bootheel Babies & Families, FLOURISH St. Louis, and other prenatal care and infantwellness collaboratives to support initiatives to reduce infant morbidity and mortality.

The Show-Me Healthy Babies Program will continue to provide expanded access to health care services for pregnant women with incomes up to 300percent of the federal poverty level. This is no longer an active strategy.

The Office on Women’s Health will continue to provide education and resources to promote well woman care.

The Bureau of HIV, STD and Hepatitis will continue the promotion of Hepatitis B education, testing, and associated immunizations of pregnant women andtheir infants.

The Bureau of HIV, STD and Hepatitis will continue to collaborate with Ryan White Part D providers to provide access to preconception counseling andprenatal healthcare services for women living with HIV.

ESMs Status

ESM 1.1 - Percent of infants born to pregnant women receiving prenatal care beginning in the first trimester. Active

ESM 1.2 - The percent of women receiving postpartum follow-up health care services within the first four to six weeks afterdelivery.

Active

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NOMs

NOM 2 - Rate of severe maternal morbidity per 10,000 delivery hospitalizations

NOM 3 - Maternal mortality rate per 100,000 live births

NOM 4.1 - Percent of low birth weight deliveries (<2,500 grams)

NOM 4.2 - Percent of very low birth weight deliveries (<1,500 grams)

NOM 4.3 - Percent of moderately low birth weight deliveries (1,500-2,499 grams)

NOM 5.1 - Percent of preterm births (<37 weeks)

NOM 5.2 - Percent of early preterm births (<34 weeks)

NOM 5.3 - Percent of late preterm births (34-36 weeks)

NOM 6 - Percent of early term births (37, 38 weeks)

NOM 8 - Perinatal mortality rate per 1,000 live births plus fetal deaths

NOM 9.1 - Infant mortality rate per 1,000 live births

NOM 9.2 - Neonatal mortality rate per 1,000 live births

NOM 9.3 - Post neonatal mortality rate per 1,000 live births

NOM 9.4 - Preterm-related mortality rate per 100,000 live births

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State Action Plan Table (Missouri) - Women/Maternal Health - Entry 2

Priority Need

Improve maternal / newborn health by reducing cesarean deliveries among low-risk first births.

NPM

Percent of cesarean deliveries among low-risk first births

Objectives

By June 30, 2020, DHSS will increase the number of hospitals in Missouri that implement the Alliance for Innovation on Maternal Health (AIM) bundle “SafeReduction of Primary Cesarean Births” from 0 (baseline: 2016) to 20.

Strategies

The MO DHSS will collaborate with the Missouri Chapter of the March of Dimes and Missouri Hospital Association (MHA) to implement the bundle “SafeReduction of Primary Cesarean Births” in Missouri birthing hospitals.

The Healthy Births and Babies Unit will continue to educate women of reproductive age on the benefits of a full term pregnancy through various socialmedia (Text4baby) and by providing educational materials (brochures) through the Home Visiting Program.

The Healthy Births and Babies Unit will educate women of reproductive age on the risks of a cesarean birth through various social media (Text4baby) andeducational materials (brochures).

The MCH Services Program will partner with LPHAs to implement education programs for pregnant women, families, and providers on the benefits ofdelivery after 39 weeks gestation, the risks of preterm delivery, and the risk associated with a cesarean birth.

NOMs



ESMs Status

ESM 2.1 - Improve maternal/newborn health by increasing the number of hospitals that implement the Alliance for Innovation onMaternal Health (AIM) bundle “Safe Reduction of Primary Cesarean Births”.

Active

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Perinatal/Infant Health

State Action Plan Table (Missouri) - Perinatal/Infant Health - Entry 1

Priority Need

Ensure risk appropriate care for high risk infants to reduce infant mortality / morbidity.

NPM

Percent of very low birth weight (VLBW) infants born in a hospital with a Level III+ Neonatal Intensive Care Unit (NICU)

Objectives

By June 30, 2020, DHSS will increase the number of hospitals implementing the March of Dimes preterm labor toolkit from 0 (baseline: 2016) to 20.

Strategies

The MO DHSS will collaborate with the Missouri Hospital Association (MHA) to implement the Preterm Labor Assessment Toolkit (PLAT) in Missouri birthinghospitals.

The MO DHSS will continue to participate in the Infant Mortality Collaborative Improvement & Innovative Network (IM CoIIN) to learn best practices andstrategies for implementing risk appropriate care in Missouri.

The MO DHSS will continue to participate in the Prematurity & Infant Mortality Subcommittee to establish perinatal regionalization in Missouri.

The MO DHSS will collaborate with the Missouri Chapter of the March of Dimes to promote and educate providers and members of the public on theimportance and benefits of a regionalized perinatal system in Missouri.

The MO DHSS will continue to collaborate with local infant mortality initiatives in the Kansas City, St. Louis, and Bootheel regions to support efforts toreduce maternal and infant morbidity and mortality.

The MO DHSS will collaborate with the Missouri Chapter of the March of Dimes to increase the utilization of 17 Alpha-hydroxyprogesterone caproate (17P)for women with a prior spontaneous, singleton preterm birth.

The Healthy Births and Babies Unit will educate women of reproductive age on the benefits of 17 Alpha-hydroxyprogesterone caproate (17P) throughvarious social media (Text4baby) and by distributing March of Dimes educational materials through the Home Visiting Program.

The MCH Services Program will partner with Local Public Health Agencies (LPHA) to implement education programs for women of childbearing age,pregnant women, families, and providers on the benefits of 17 Alpha-hydroxyprogesterone caproate (17P), the risk of preterm delivery, and the need forrisk appropriate care for high risk infants.

NOMs





ESMs Status

ESM 3.1 - Ensure risk appropriate care for high risk infants by increasing the number of Missouri birthing hospitals implementingthe March of Dimes Preterm Labor Assessment Toolkit (PLAT) to reduce infant mortality/morbidity.

Active

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SPM

Improve health outcomes for Missouri mothers and infants by increasing breastfeeding initiation and duration rates.

Objectives

By June 30, 2020 Missouri will increase the number of hospitals participating in the Missouri “Show-Me 5” Hospital Initiative from 10 to 35.

By June 30, 2020 Missouri will increase the number of “Breastfeeding Friendly Worksites” from 259 to 600.

By June 30, 2020 Missouri will increase the number of “Breastfeeding Friendly Child Cares” from 30 to 100.

By June 30, 2020 increase the number of WIC agencies that are designated as “Breastfeeding Friendly” from 37 to 65.

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Strategies

Create partnerships by having existing “Show-Me 5” hospitals mentor other hospitals during the implementation phase. Contract with nurses andphysicians to provide training at hospitals on the “Show-Me 5” steps.

Provide a basic breastfeeding course, titled “Fundamentals of Breastfeeding: An 18 Hour Course,” 2-3 times per year for health care professionalsthroughout the state at no cost.

Partner with the Missouri Breastfeeding Coalition to offer a Perinatal Leadership Conference, the MotherBaby Summit, to educate hospital administratorson the importance of maternity care practices and how they relate to breastfeeding outcomes.

Increase the number of International Board Certified Lactation Consultants (IBCLCs) in the state by offering a 45 hour exam preparatory course at nocost, if funding allows.

Provide funding to local health departments through the Healthy Eating, Active Living (HEAL) grant and 1305 CDC grant to ensure local staff are availableto be a resource for employers.

Provide lactation room mini-grants to employers to increase interest in the Missouri Breastfeeding Friendly Worksite Program and to assist employers withproviding an adequate space for employees to express breast milk.

Work with the Missouri Chamber of Commerce and the Missouri Chapter of Society of Human Resource Managers to educate employers on theAffordable Care Act (ACA) provision for employers to provide workplace accommodations that enable breastfeeding employees to express breast milk.

The MCH Services Program will continue to partner with Local Public Health Agencies (LPHA) to promote employer/workplace support for breastfeeding.

Collaboration will continue with the Missouri Breastfeeding Coalition and local breastfeeding coalitions to promote the Breastfeeding Friendly WorksiteProgram.

Provide funding to local health departments through the Healthy Eating, Active Living (HEAL) grant to ensure local staff are available to provide educationand resources to child care providers.

Ensure that all training provided by the DHSS includes a breastfeeding component and promotes the “Breastfeeding Friendly Child Care” program.

Through the Child Care Health Consultation (CCHC) Program, LPHA Child Care Health Consultants will provide continuing education training,consultation, or technical assistance to child care providers that promote child care facilities as breastfeeding friendly both for parents of children enrolledwho are breastfeeding and as a breastfeeding friendly workplace for employees who are breastfeeding.

Collaboration will continue with the Missouri Breastfeeding Coalition and local breastfeeding coalitions to promote the Breastfeeding Friendly Child CareProgram.

Provide additional funding through the Breastfeeding Friendly WIC Clinic program to local WIC agencies that provide breastfeeding support beyond whatis federally required through the WIC program, which includes providing afterhours support, classes, support groups, breast pumps and working withother community partners to increase breastfeeding awareness.

Provide education to local WIC agencies and health department professionals on breastfeeding and increase the number of IBCLCs in these facilities.Increase the number of trained peer counselors that can provide mother-to-mother support and encourage partnerships with health care providers andother community organizations.

The Home Visiting Program will continue collaboration with the State Breastfeeding Coordinator and local breastfeeding coordinators and peer counselorsto support breastfeeding initiation and duration. The State Breastfeeding Coordinator’s contract information and other DHSS breastfeeding resources willbe shared during monthly contractor conference calls and in newsletters.

Partner with the University of Missouri on breastfeeding research to determine interventions that would decrease disparities in breastfeeding of women ofdifferent races, ethnicities and low socioeconomic status.

The MCH Services Program will continue to support a leadership role for LPHAs within coalitions and partnerships at the local level to build MCH systemsand expand the resources those systems use to promote breastfeeding.

The MCH Services Program will continue to partner with LPHAs to increase community access to breastfeeding education and information, to providebreastfeeding resources, and to make referrals to lactation experts through breast pump loan programs, billboard messages, prenatal case management,and home visiting programs.

Home Visiting Program will monitor and assess home visitors’ technical assistance needs and provide resources on the topic of breastfeeding. Duringmonthly contractor conference calls the Home Visiting Program will assess home visitors’ technical assistance needs and will provide resources toencourage initiation and duration of breastfeeding by enrolled participants through email, newsletters, and at annual HV program conferences.

Promote Breastfeeding through informational Resources. The Newborn Health Program will continue to promote breastfeeding through the use of thePregnancy and Beyond booklet, other print materials and electronic resources. The Newborn Health Program will continue to oversee and support theText4baby Program, through its contract with Voxiva, Inc., to provide customized Text4baby messages that refer Missouri participants directly to Missouri-specific breastfeeding resources.

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SPM

Percent of infants placed to sleep on their backs.

Objectives

By June 30, 2020, the rate of sleep related infant deaths will be reduced by 15% from 1.0 per 1,000 live births (baseline: 2014 Vital Statistics) to 0.85 per1,000 live births

By June 30, 2017, 100% of licensed child care facilities that provide care for children less than one year of age will have a written safe sleep policy inaccordance with the most recent safe sleep recommendations of the AAP. This objective has been achieved.

By July 1, 2020, implement an outreach and education campaign around safe sleep using a multimedia approach.

By June 30, 2019, improve caregivers’ safe sleep practices through culturally competent education.

Strategies

The Maternal and Child Health (MCH) Services Program will continue to partner with LPHAs to provide safe sleep education and safe crib distributionprograms and to build local MCH systems to promote safe sleep policies and practices.

The Center for Local Public Health Services (CLPHS), Safe Cribs for Missouri Program, and the MCH Services Program will continue to partner withLPHAs to promote safe sleep practices by providing safe sleep educational materials when issuing birth certificates for children less than one year of age.

The nine Safe Kids coalitions covering 47 counties will continue to provide cribs and safe sleep education and training to reduce the risk of injury anddeath of infants due to unsafe sleep environments.

The Safe Cribs for Missouri Program will continue to provide portable cribs and safe sleep education to eligible families who have no other resources forobtaining a safe crib.

Home visitors will continue to inform participants on how to obtain portable cribs and provide education on safe sleep environments.

The Newborn Health Program will provide customized Text4baby messages and other social media communication (e.g., Facebook campaigns, Twitter, et.)about safe sleep and other topics to all pregnant women, including high risk and minority populations.

Section for Child Care Regulation (SCCR) will continue to educate child care providers on safe sleep practices for infants.

SCCR will conduct inspections in licensed child care facilities to ensure compliance with Missouri statute and licensing rules related to safe sleep practicesfor infants. SCCR will continue to review and approve training for child care providers related to safe sleep practices for infants.

The Safe Cribs for Missouri Program will work with the State Safe Sleep Coalition to develop an outreach and education campaign around safe sleepusing a multimedia approach.

The Safe Cribs for Missouri Program will work with the 64 birthing hospitals to provide technical assistance to develop and implement safe sleep hospitalpolicies according to the AAP.

TEL-LINK will refer callers to Safe Cribs for Missouri Program providers.

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Child Health

State Action Plan Table (Missouri) - Child Health - Entry 1

Priority Need

Support adequate early childhood development and education.

NPM

Percent of children, ages 10 through 71 months, receiving a developmental screening using a parent-completed screening tool

Objectives

Increase the percentage of children, ages 10 months through 5 years, receiving a developmental screening using a parent completed screening tool from28.2% (baseline: 2011/12 NSCH) to 30.5% by 2020.

Increase the percentage of children with special needs', who have an actual developmental disability or a perceived developmental disability, ability toeither secure or maintain appropriate child care through inclusion services from 85% to 90%.

Strategies

Increase the number of WIC agencies that have incorporated the Learn the Signs. Act Early. (LTSAE) environmental graphics and developmentalmilestones checklists to 100% of agencies within the next five years.

Provide education and outreach on the importance of developmental screening through the dissemination of public awareness materials to DHSSprograms, stakeholders, and partners.

Research the feasibility of and funding opportunities for implementing a centralized reporting mechanism for developmental and social/emotionalscreening.

The Home Visiting Program will increase the percentage of children enrolled in all DHSS Home Visiting Programs, ages 1 year through 3 years, whoreceive a developmental screening using a validated parent-completed screening tool.

The Newborn Health Program will oversee and support the Text4baby Program, through its contract with Voxiva, Inc., to provide customized text messagesthat emphasize the importance of developmental screenings and refer parents to their physician or other resources.

DHSS will partner with the Department of Elementary and Secondary Education First Steps program to educate early childhood professionals whoregularly screen children for developmental and social/emotional delays on how to identify appropriate referrals for families.

The Maternal Child Health (MCH) Services Program will partner with LPHAs to provide and/or participate in infant and early childhood developmental andsocial-emotional screening and refer infants and children with potential developmental delay or failure to meet expected developmental milestones.

The Child Care Health Consultation (CCHC) Program will provide training and consultation to child care providers on social/emotional/physicaldevelopment.

Increase child care provider’s knowledge surrounding appropriate care for children with special needs through on-site consultation and face to facetraining to better prepare them for caring for children with a broad range of special needs.

ESMs Status

ESM 6.1 - Increase the percentage of eligible enrolled children, ages 1 year through 3 years, receiving a developmentalscreening using a validated parent-completed screening tool through MIECHV) and Healthy Families Missouri Home Visiting(HFMoHV) programs.

Active

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NOMs

NOM 13 - Percent of children meeting the criteria developed for school readiness (DEVELOPMENTAL)

NOM 19 - Percent of children in excellent or very good health

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State Action Plan Table (Missouri) - Child Health - Entry 2

Priority Need

Reduce intentional and unintentional injuries among children and adolescents.

NPM

Rate of hospitalization for non-fatal injury per 100,000 children ages 0 through 9 and adolescents 10 through 19

Objectives

By June 30th, 2020, Missouri will increase the number of schools that received training on evidence based suicide prevention programs from 0 to 100.

Strategies

Department will provide “Train the Trainer” training to LPHA District Nurse Consultants who will introduce the new Early Childhood Toolkits to LPHA in eachcounty in Missouri to increase access to resources for parents of children 0-5 years of age who have experienced a TBI. This strategy has beenachieved.

NOMs

NOM 15 - Child Mortality rate, ages 1 through 9 per 100,000

NOM 16.1 - Adolescent mortality rate ages 10 through 19 per 100,000

NOM 16.2 - Adolescent motor vehicle mortality rate, ages 15 through 19 per 100,000

NOM 16.3 - Adolescent suicide rate, ages 15 through 19 per 100,000

ESMs Status

ESM 7.1 - Increase the number of local public health agencies (LPHA) Child Care Health Consultants that are trained on EarlyChildhood Toolkits which will result in increased screening and referral for traumatic brain injury (TBI) in children ages 0 to 5.

Active

ESM 7.2 - Number of schools that received training on evidence based suicide prevention programs Active

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Adolescent Health

State Action Plan Table (Missouri) - Adolescent Health - Entry 1

Priority Need

Reduce intentional and unintentional injuries among children and adolescents.

NPM

Rate of hospitalization for non-fatal injury per 100,000 children ages 0 through 9 and adolescents 10 through 19

Objectives

By June 30, 2020, DHSS will reduce MO’ unintentional injury rate by 10 percent in children ages 0 to 9 years of age.

By June 30, 2020, DHSS will reduce MO’ unintentional injury rate by 10 percent in children ages 10 to 19 years of age.

By June 30, 2020, MO will reduce suicide deaths among youths (15-19 years) by at least 10% - from 8.9 (baseline: CY 2013 Vital Statistics) to 8.0 per100,000.

Strategies

The MCH services program will continue to support a leadership role for the LPHAs within coalitions and partnerships at the local level to build MCHsystems and expand the resources those systems use to promote safety and reduce intentional and unintentional injuries in children 0 to 9 and 10 to 19years of age.

DHSS will continue to partner with LPHAs, community stakeholders, and other state agencies to promote education and training to improve safety andprevent injury to promote the use of safety devices and injury prevention interventions and initiatives in child cares, schools, and places where childrenfrequent.

DHSS will continue to partner with LPHAs and community stakeholders to promote new legislation and policy changes to reduce injury and minimizeexposure to children to safety hazards.

DCPH will continue to partner with LPHAs to advocate for alterations/improvement in physical environments to promote home and community safety.

The CCHC Program will provide continuing education training, consultation, or technical assistance to child care providers on the variety of injuryprevention topics to promote safe child care environments and will provide health promotions to children enrolled in day cares on a variety of safety topics

DHSS will ensure any childcare facility identified with a communicable disease (CD) outbreak will receive an environmental health inspection within threeworking days of the special circumstance request to help lessen the spread of CD in the facility. This strategy has been achieved.

Continue to partner with 9 SAFE Kids Coalitions covering 47 counties to provide unintentional injury prevention services to children aged 0 to 9 and 10 to19 years of age.

DHSS will collaborate with community organizations serving large numbers of lesbian, gay, bisexual, and transgender (LGBT) youth to promoteimplementation of interventions to reduce LGBT youth suicide.

Department will provide “Train the Trainer” training to LPHA District Nurse Consultants who will introduce the new Early Childhood Toolkits to LPHA in eachcounty in Missouri to increase access to resources for parents of children 0-5 years of age who have experienced a TBI. This strategy has beenachieved.

Coordinate with the Missouri Injury and Violence Prevention Advisory Committee (MIVPAC) to reduce the morbidity and mortality of children aged 0 to 0and 10 to 19 years of age.

Collaborate with the Adolescent Health Program and the Department of Mental Health to provide and implement training on Improvement Network (CoIIN)to learn best strategies and approaches. Work through the Child Safety Collaborative Innovation and Improvement Network (CoIIN) to implement anddevelop strategies to improve child passenger safety, interpersonal violence and suicide and self-harm throughout the state.

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NOMs

NOM 15 - Child Mortality rate, ages 1 through 9 per 100,000

NOM 16.1 - Adolescent mortality rate ages 10 through 19 per 100,000

NOM 16.2 - Adolescent motor vehicle mortality rate, ages 15 through 19 per 100,000

NOM 16.3 - Adolescent suicide rate, ages 15 through 19 per 100,000

ESMs Status

ESM 7.1 - Increase the number of local public health agencies (LPHA) Child Care Health Consultants that are trained on EarlyChildhood Toolkits which will result in increased screening and referral for traumatic brain injury (TBI) in children ages 0 to 5.

Active

ESM 7.2 - Number of schools that received training on evidence based suicide prevention programs Active

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State Action Plan Table (Missouri) - Adolescent Health - Entry 2

SPM

Percent of children ages 6 through 11 and adolescents ages 12 through 17 years who are physically active at least 60 minutes per day.

Objectives

Increase the percentage of children ages 6 through 11, who are physically active at least 60 minutes per day by 5% from 44.0% (baseline: 2011/12 NSCH)to 46.2% by 2020.

Increase the percentage of adolescents who are physically active at least 60 minutes five days a week by 5% from 45.7% (baseline: YRBS 2015) to 48.0%by 2020.

Strategies

The Maternal and Child Health (MCH) Services Program and Bureau of Community Health and Wellness (CHW) will continue to partner with local publichealth agencies (LPHAs) to provide programs and services that increase physical activity, prevent obesity and promote policy, organizational andenvironmental changes that increase opportunities for children and adolescents to engage in physical activity.

The MCH Services Program and the Bureau of CHW will continue to collaborate and partner with LPHAs to implement a statewide healthy lifestyle initiativeutilizing the 12345 Fit-Tastic! framework to promote healthy lifestyles and healthy weight for all children.

CHW will continue to support schools to conduct the School Health Index (SHI) self-assessment and planning guide.

CHW will increase youth participation in local efforts to impact access to physical activity opportunities.

CHW will provide professional development to school staff on implementing comprehensive physical activity programs (CSPAP).

CHW will facilitate training and technical assistance opportunities for at least four local communities working to adopt policies supportive of activetransportation and access to physical activity.

DHSS will continue implementation of the MOve Smart Child Care program including training, technical assistance, and review of applications.

School Health Program will continue to promote resources and offer training for school nurses to work with families to address overweight/obesity.

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Children with Special Health Care Needs

State Action Plan Table (Missouri) - Children with Special Health Care Needs - Entry 1

Priority Need

Ensure coordinated, comprehensive and ongoing health care services for children with and without special health care needs.

NPM

Percent of children with and without special health care needs having a medical home

Objectives

By June 30, 2020, increase or maintain the current percentage (95%) of children with special health care needs participating in the Missouri Departmentof Health and Senior Services Bureau of Special Health Care Needs (SHCN) programs who report the health care they receive is consistent with therequirements of a medical home.

By June 30, 2020, the SHCN Family Partnership will ensure 95 percent of families of newly enrolled SHCN program participants will be aware of theimportance of a medical home for children with and without special health care needs.

By June 30, 2020, the School Health Program will increase the number of school districts assessing health insurance status from baseline to 80% throughtrainings to schools about Medicaid enrollment, and the medical home concept.

Strategies

Providing children and youth with special health care needs Service Coordination, including assessment of the child/family/caregiver’s needs, availabilityof healthcare services and the development of service plans (including emergency planning) is necessary to assure maximization of resources.

Culturally appropriate services are available to CYSHCN program participants and families, utilizing professional interpreters, translating educationalmaterials and providing opportunities for staff to participate in events to increase their knowledge of cultural diversity.

DHSS staff continues to collaborate with programs offered by other state departments as well as regional/community and faith-based organizations toassure children with and without special health care needs have coordinated, comprehensive healthcare services within a medical home.

The SHCN Family Partners will be trained to serve as experts on medical home and will provide information to families, stakeholders, and partnersregarding the importance of a medical home for children with and without special health care needs.

Provide education and outreach on the importance of medical home through the dissemination of public awareness materials to DHSS programs thatserve families with children in the household.

The Newborn Screening Program will add information about the importance of having a medical home to the Newborn Screening booklet. This strategyhas been competed.

The Newborn Screening Program will disseminate the Newborn Screening booklets, which include medical home information; the Program will ensure thatmedical home information continues to be included in future revisions of the booklet.

The Missouri Newborn Hearing Screening Program (MNHSP) will engage families of infants newly diagnosed with permanent hearing loss, the families’pediatricians, care coordinators, family mentors, and professionals with expertise in the unique needs of infants with hearing loss in learning communities(LCs). The LCs will address the importance of the patient/family-centered medical home in the care of the child who is deaf or hard of hearing.

ESMs Status

ESM 11.1 - Increase the percentage of families of newly enrolled Special Health Care Needs (SHCN) program participants whoare aware of the importance of a medical home for children with and without special health care needs.

Active

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NOMs

NOM 17.2 - Percent of children with special health care needs (CSHCN) receiving care in a well-functioning system


NOM 22.1 - Percent of children ages 19 through 35 months, who completed the combined 7-vaccine series (4:3:1:3*:3:1:4)

NOM 22.2 - Percent of children 6 months through 17 years who are vaccinated annually against seasonal influenza

NOM 22.3 - Percent of adolescents, ages 13 through 17, who have received at least one dose of the HPV vaccine

NOM 22.4 - Percent of adolescents, ages 13 through 17, who have received at least one dose of the Tdap vaccine

NOM 22.5 - Percent of adolescents, ages 13 through 17, who have received at least one dose of the meningococcal conjugate vaccine

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Cross-Cutting/Life Course

State Action Plan Table (Missouri) - Cross-Cutting/Life Course - Entry 1

Priority Need

Ensure adequate health insurance coverage and improve health care access for MCH populations.

NPM

Percent of children ages 0 through 17 who are adequately insured

Objectives

By June 30, 2020 DHSS will develop / promote strategies to reduce the percentage of uninsured children in Missouri by 10% from 6.4% (baseline: CPSASEC 2014) to 5.8%.

By June 30, 2020 DHSS will develop / promote strategies to increase the proportion of women receiving prenatal care beginning in the first trimester by5% from 74.5% (baseline: CY 2013 Vital Statistics) to 78.0%.

Strategies

SHCN will refer participants and families to MO HealthNet for determination of eligibility for services.

SHCN will provide services that improve access to care, including assisting participants and families in navigating health care systems.

TEL-LINK will refer callers to Medicaid/MO HealthNet services.

Customized Text4baby messages will refer Missouri participants directly to MO HealthNet for free or low-cost health care.

Pregnancy and Beyond, available in English and Spanish, will be distributed statewide and includes information about financial resources for pregnantwomen and children including MO HealthNet.

Home visitors through the Building Blocks (BB), Healthy Families Missouri Home Visiting (HFMoHV) and Maternal, Infant and Early Childhood Home Visiting(MIECHV) programs will continue to assist clients in accessing health care coverage through the Medicaid enrollment process or through the AffordableCare Act marketplace by linking clients to their nearest federally qualified health center to speak with a trained navigator in order to obtain eligibility andenrollment assistance.

LPHAs will continue to assess insurance coverage status on all MCH clients and refer noninsured and under-insured clients as indicated.

LPHAs will continue to assist pregnant women with the TEMP Medicaid application process.

School Health (SH) will continue their partnership with FQHCs, Health Care Plans, DSS and Missouri Foundation for Health to provide information toschool nurses about health care plans so that school nurses can be more knowledgeable of the health care system and more effectively work with parentsabout access to care.

The ODH will improve access to dental care through educating the oral health workforce, encouraging policymakers to retain the MO HealthNet Dentalbenefit, and by leveraging dental health care coordinators who can eliminate barriers to accessing dental care.

ESMs Status

ESM 15.1 - Percent of primary caregivers and children with health insurance at one year post enrollment among Missouri HomeVisiting program participants.

Active

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NOMs

NOM 17.2 - Percent of children with special health care needs (CSHCN) receiving care in a well-functioning system

NOM 21 - Percent of children without health insurance

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Priority Need

Prevent and reduce smoking among women of childbearing age, pregnant women and reduce childhood exposure to second hand smoke.

NPM

A) Percent of women who smoke during pregnancy and B) Percent of children who live in households where someone smokes

Objectives

By June 30, 2020, decrease the percentage of women who report they smoke during pregnancy from 17.5% (baseline: CY 2013 Vital Statistics) to 16.6%.

By June 30, 2020 decrease the percentage of children who live in households where someone smokes from 32.5% (baseline: 2011/12 NSCH) to 30.9%.

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Strategies

In collaboration with partners, maintain and increase non-federal funding to provide Missouri Tobacco Quitline services, to promote the Quitline, to expandnicotine replacement therapy (NRT) benefits to callers, and to allow Medicaid administrative claiming.

Work with MO HealthNet to promote its cessation benefit to providers and beneficiaries.

Use a variety of mass reach health communication interventions and media, including social media tobacco cessation messages to reach Missouritobacco users living in homes with women and children, pregnant women, women of reproductive age, and their healthcare providers.

The Bureau of Community Health and Wellness (CHW) will provide funding, support and technical assistance (TA) to Local Public Health Agencies(LPHA), in collaboration with partners, to mobilize and support community coalitions, connect trained youth with them and train adults and youth to bespokespersons for tobacco control with the main focus on comprehensive smokefree community policy, tobacco-free school districts and tobacco-freecolleges and universities.

CHW will enhance tobacco prevention and cessation information targeting pregnant women and women of reproductive age on the ComprehensiveTobacco Control Program’s web pages.

The Maternal Child Health (MCH) Services Program will continue to support a leadership role for local public health agencies (LPHAs) within coalitions andpartnerships at the local level to build MCH systems and expand the resources those systems use to prevent and reduce tobacco use and secondhandsmoke exposure.

The MCH Services Program will continue to partner with LPHAs to promote new legislation and policy changes to prevent and reduce tobacco use andsecondhand smoke exposure and reduce minors’ access to tobacco products.

Through the Child Care Health Consultation (CCHC) Program, LPHA Child Care Health Consultants will provide education to child care providers andparents on the hazards of exposing children to secondhand smoke and will provide health promotions to children to discourage them from initiatingsmoking later in life.

The Home Visiting Program will provide DHSS, American Cancer Society, the American Heart Association, the March of Dimes, and other organizations’smoking cessation resources and information on smoking cessation and exposure to secondhand smoke to home visitors during monthly contractorconference calls, in newsletters, and at annual program conferences.

Home visitors will continue to provide educational information and materials to families with small children participating in the Home Visiting Program ontopics such as safe sleep, car seat safety, poison control, firearm safety, fire prevention, water safety, and smoking cessation.

The Home Visiting Program will research and identify additional resources to assist home visitors in addressing barriers to smoking cessation by pregnantwomen and caregivers and the reduction of childhood exposure to secondhand smoke.

Through email, the Quality Outlook CQI electronic newsletter, and during monthly contractor conference calls, the Home Visiting Program will provideresources on topics including, but not limited to motivational interviewing techniques to assist home visitors in addressing barriers to smoking cessationand the reduction of childhood exposure to secondhand smoke.

The Safe Cribs for Missouri Program will continue to educate each crib recipient on smoking cessation, the consequences of smoking during pregnancyand childhood exposure to secondhand smoke. Additional resources such as Missouri Tobacco Quitline tip cards will be utilized.

The Newborn Health Program will continue to promote the Pregnancy and Beyond booklet, which provides information about smoking cessation duringpregnancy and the dangers of tobacco use and secondhand smoke.

The Text4baby Program will continue to provide free mobile text messages on the importance of not smoking during pregnancy, including Missouri-specificresources such as the Missouri Tobacco Quitline.

TEL-LINK will continue to connect callers directly to smoking cessation services including the Missouri Tobacco Quitline.

ESMs Status

ESM 14.1 - The number of Missouri communities (cities, towns, etc.) with comprehensive smoke-free ordinances. Active

ESM 14.2 - Annual number of callers to the Missouri Quitline that are women of child bearing age. Active

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NOMs



NOM 4.1 - Percent of low birth weight deliveries (<2,500 grams)

NOM 4.2 - Percent of very low birth weight deliveries (<1,500 grams)

NOM 4.3 - Percent of moderately low birth weight deliveries (1,500-2,499 grams)

NOM 5.1 - Percent of preterm births (<37 weeks)

NOM 5.2 - Percent of early preterm births (<34 weeks)

NOM 5.3 - Percent of late preterm births (34-36 weeks)

NOM 6 - Percent of early term births (37, 38 weeks)




NOM 9.3 - Post neonatal mortality rate per 1,000 live births


NOM 9.5 - Sleep-related Sudden Unexpected Infant Death (SUID) rate per 100,000 live births


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SPM

A) Percent of women with a recent live birth who reported frequent postpartum depressive symptoms. B) Percent of children age 2-17 with problemsrequiring counseling who received mental health care.

Objectives

1. Decrease the percentage of women with a recent live birth who reported frequent postpartum depressive symptoms from 12.5% (baseline: PRAMS2013) to 11.2% by 2020.

2. Increase the percentage of children age 2-17 with problems requiring counseling who received mental health care from 63.5% (baseline: 2011/12NSCH) to 69.9% by 2020. (10% increase consistent with HP2020).

Strategies

Continue to adopt strategies to increase awareness about postpartum depression, including distribution of messages about postpartum depressionthrough Text-4-Baby and in other resources.

Provide information on postpartum depression through home visiting programs and other outlets as identified (i.e., partnering with OB providers to reachpregnant women).

Encourage partnerships between schools and local mental health agencies to develop efficient referral and assessment processes through a process ofregional convening of stakeholders.

Participate and support the activities of the Coordinating Board for Early Childhood (CBEC) Early Childhood Mental Health (ECMH) Workgroup.

Continue partnership with DMH and Missouri Coalition for Community Behavioral Health Care to improve linkages between public and mental health.

Collaborate with DMH, DSS and DESE to assist schools to become trauma-informed.

Collaborate with DMH, DSS and DESE to assist schools that have designated safe spaces for LGBQT students.

At least 10 school districts will implement the TEAMS Framework and develop actions plans to improve school health services policies and practices.

Incorporate mental health issues, such as suicide prevention, trauma-informed schools into professional development opportunities for school staff.

Partner with Department of Mental Health (DMH) to promote Youth Mental Health First Aid (YMHFA) training for school faculty and staff. This strategy isincorporated into the strategy listed below.

Collaborate with the Adolescent Health Program and DMH to implement training on evidence-based suicide programs.

Address suicide prevention through participation in the Child Safety Collaborative Innovation & Improvement Network (CoIIN).

Incorporate education on childhood mental health conditions and warning signs into parenting programs offered through DHSS home visiting services.

Promote mental health screenings at all well-child annual visits.

The MCH Services Program will partner with LPHAs to provide education, screening, and referral for postpartum depression and child and adolescentmental health needs.

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SPM

A. Percent of women who had a preventive dental visit during pregnancy and B. Percent of children, ages 1 to 17 years, who had a preventive dental visitin the last year.

Objectives

By June 30, 2020, increase the percent of women who had a preventive dental visit during pregnancy from 48.6% (baseline: PRAMS 2013) to 52.0%.

By June 30, 2020, increase the percent of infants and children, ages 1 to 17 years, who had a preventive dental visit in the last year from 72.5% (baseline: 2011/12 NSCH) to 76.1%.

Strategies

Provide education to women about the importance of oral health for the mother’s overall health, during pregnancy and throughout her lifespan throughliterature developed by the Missouri Office of Dental Health (ODH). Literature is available on the DHSS website, at health fairs, and is distributed in dentalclinics, Federally Qualified Health Centers (FQHC), local health departments, Women, Infants, and Children (WIC) clinics and via the Home VisitingProgram.

Additional education on maternal and child oral health is distributed by the Missouri Primary Care Association, who can reach women in FederallyQualified Health Centers. This education is focused on the importance and safety of dental visits during pregnancy. Education also emphasizes theimportance of the mother’s oral health for their infant’s oral health and overall health.

Collaborate with the Missouri Dental Association to provide “Healthy Smiles from the Start” educational materials that are distributed to mothers at WICclinics and via the Home Visiting Program. These materials are provided along with a Prenatal Dental Health Education Kit to assist WIC and Home VisitingProgram employees to educate mothers about the importance of oral health during pregnancy, among their children, and throughout the lifespan. Thesematerials are tailored for mothers with small children and reinforce messages of the ODH in general regarding maternal and child oral health.

Educate children and their parents about the importance of dental visits at least annually for children to protect their oral health and overall health atoutreach events, via literature displayed at dental clinics, and via encounters with the WIC Program and the Home Visiting Program.

Educate children about the importance of dental visits within the educational component of the Preventive Services Program (PSP), an evidence-basedfluoride varnish and oral health education program administered by the ODH.

Provide referrals for children with a dental need (such as untreated tooth decay, rampant dental caries, early childhood caries, pain, abscess, infection, ormalocclusion) identified in PSP screenings. Referrals provide a link between children and local dental clinics, particularly those that serve children andtake Medicaid, within their community.

A special project conducted in a selection of Missouri schools that participate in PSP provides funding for schools to employ a care coordinator. The carecoordinator assists parents to understand the importance of oral health, links children with dental care, addresses barriers to dental services such astransportation, ability of parents to miss work, ability to pay, and knowledge of services available.

Educate caregivers, parents, and guardians about the importance of preventive dental visits for children with special needs via collaboration with theDepartment of Elementary and Secondary Education to implement PSP in every State School for the Severely Disabled.

Promote the use of dental sealants as a way to prevent dental caries on the biting surfaces of molar teeth. Dental sealants are provided by a dentalprofessional in either a clinical or school-base setting. Dental sealant initiatives are underway in Missouri, but are not funded by the MCH Block Grant.However, the use of dental sealants for preventing dental caries is a major message within educational materials and outreach conducted by ODH staffwho are funded by the MCH Block Grant.

Educate school nurses about oral health and the need for children to visit a dentist at least annually.

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women/maternal health state action plan table...

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