Conversations with the Division of Healthy Start & Perinatal Services

November 16, 2017

Webinar Agenda Topic Speaker

Housekeeping Megan Hiltner

Welcome Johannie Escarne

Division Updates - Women’s Health

- Behavioral Health and AStEPP - IM CoIIN

Kimberly Sherman

Dawn Levinson Vanessa Lee

HS CoIIN Update Kori Eberle

EPIC Center Update Megan Hiltner

HS Program Update Benita Baker Christina Lottie

HS National Evaluation Update Robert Windom

HS Data Reporting Chris Lim

Question & Answer All Participants

2

Please note the following:

• This session is being recorded, and will be archived for future

viewing.

• Members are encouraged to participate in the discussion by typing

your comment/asking questions using the chat box.

3

Meeting Logistics

Welcome

Johannie Escarne, Acting Deputy Director

4

Division Updates

Kimberly Sherman, Women’s Health Specialist Dawn Levinson, Behavioral Health Lead and AStEPP

Vanessa Lee, IM CoIIN Coordinator

5

6

AIM Collaboration

Maternal Health

Systems Level

Approach

(11+)

(8+)

AIM Participation: July 2017 AIM Impact Annual Births: 1,520,000+

AIM Hospital Networks Premier Trinity National Perinatal Information Center (NPIC)

Project Scope: 11 States+ State/Hospital Start Total Births 2015 Bundles Implemented System Date

Oklahoma 4/24/15 53,122 HEM; HTN

Florida 11/6/15 224,269 HEM; HTN; CS-starting

Illinois 12/1/15 158,116 HTN

Michigan 1/20/16 113,312 HEM; HTN

NPIC 5/15/16 HEM; HTN; CS; VTE

Maryland 6/1/16 73,616 CS

Mississippi 11/18/16 38,934 HEM

California 1/20/17 491,748 HEM; HTN; CS

New Jersey 1/23/17 103,127 HEM

Utah 3/23/17 50,778 HTN

Louisiana 8/9/17 64,692 HEM

North Carolina 9/13/17 120,843 HEM

Trinity 10/5/17 CS

Premier Variable HEM; HTN; CS; VTE

Women’s Health Initiative Update wellwomancare@hrsa.gov

1. Alliance for Innovation in Maternal Health (AIM) a. New Maternal Safety Bundle: Obstetric Care for Women with Opioid Use Disorder

b. Collaborative on Maternal Opioid Use Disorder: Launched November 2018

a. Participants: NM, TX, IL, TN, NY, OH, NJ, OK, VA, MA, MD, NNEPQIN b. Purpose: To identify current resources, gaps, and strategies to scale up programs concentrated on

addressing maternal opioid use disorder.

http://safehealthcareforeverywoman.org/aim-program/

9

Potential AIM Collective Impact 11 Current AIM States 1,520,000 Annual Births +21 ‘NEW’ AIM States 1,241,200 Annual Births 32 States 2,761,200 Annual Births

AIM Hospital Networks Premier Trinity National Perinatal Information Center (NPIC)

11

Women’s Preventive

Services Initiative

Women’s Health Initiative Update wellwomancare@hrsa.gov

1. Women’s Preventive Services Initiative (WPSI) a. Draft Recommendation Statements

i. Screening for Diabetes in Postpartum Period - Finalized ii. Screening for Urinary Incontinence – Fall Public Comment iii. Expanding the Well Woman Preventive Visit: October 2017

https://www.womenspreventivehealth.org/

2. Global Maternal Health Summit – June 2018 Promising Global Practices to Improve Maternal Health Outcomes in the U.S.

6 Countries to Share on Policy, Program, Research & Data

12

HRSA’s Maternal & Child Health Bureau: Our Role in Behavioral Health November 16, 2017

Maternal and Child Health Bureau (MCHB) Health Resources and Services Administration (HRSA)

Dawn Levinson, MSW | Behavioral Health Lead, Division of Healthy Start & Perinatal Services

14

MCHB’s Role in Addressing Behavioral Health

COLLABORATE WITH FEDERAL, STATE,

AND NATIONAL PARTNERS, AND GRANTEES, TO ENSURE

BEHAVIORAL HEALTH KNOWLEDGE, TOOLS, AND RESOURCES ARE INFUSED ACROSS ALL MCHB PROGRAMS.

15

We address behavioral health issues on multiple levels: the provider level, the policy level, and through workforce training and technical assistance.

16

GUIDING PRINCIPLES FOR MCH BEHAVIORAL HEALTH 1) PROMOTE: Promoting healthy mental, emotional, & behavioral development among infants, children & youth.

2) PREVENT: Preventing mental, emotional, & behavioral disorders, including substance use disorders, among maternal & child health (MCH) populations.

3) Building public awareness of the importance of social and emotional health for the well-being of infants, children, youth & their families.

4) SCREEN, INTERVENE, REFER, SUPPORT: Promoting evidence-based screening for mental, emotional, & behavioral disorders among MCH populations, & ensuring capacity for referral and linkage to comprehensive health, behavioral health, & wraparound social services for full assessment & evidence-based interventions.

5) Promoting evidence-based screening of MCH populations for the social & environmental determinants of health and adverse conditions of childhood that often precede or co-occur with mental, emotional, & behavioral disorders, & ensuring capacity for addressing these issues among health care, behavioral health, human services, public & environmental health, education, & legal systems.

17

• Training and Technical Assistance on Evidence-based Screening and Treatment Practices

• School mental health

• Advanced Leadership Training: neurodevelopmental disabilities, adolescent health, developmental/behavioral pediatrics

• Systems/Policy – preventive services for women’s health; health supervision guidelines (Bright Futures) for children/adolescents

MCHB’s Role in Addressing Behavioral Health

Thank you!

Contact Information Dawn Levinson, MSW Behavioral Health Lead, Division of Healthy Start and Perinatal Services Maternal and Child Health Bureau (MCHB) Health Resources and Services Administration (HRSA) Email: dlevinson@hrsa.gov Phone: 301-945-0879 Web: mchb.hrsa.gov Twitter: twitter.com/HRSAgov Facebook: facebook.com/HHS.HRSA

18

Alcohol and Substance Exposed Pregnancy Prevention Initiative

UPDATE

COMMUNITY TRAININGS/PROFESSIONAL DEVELOPMENT

WEBINARS/TECHNICAL ASSISTANCE

FOCUS: POPULATIONS AT RISK

STAKEHOLDER ENGAGEMENT: DISCUSSIONS/ADVISORY PANEL

Infant Mortality CoIIN Updates

• The national IM CoIIN and the cooperative agreement with NICHQ to support the 51 participating states/jurisdictions ended Sept. 29, 2017.

• Preliminary findings include: • 5% decline in IMR nationally • 81% of the states/jurisdictions for which data are

available experienced declines in their IMR • Of the 81% states/jurisdictions, 71% showed a decrease

of > 5% and 29% showed a decrease of >10%

• Highest % improvement in IMR by any state is 23%

21

Infant Mortality Prevention Toolkit

http://www.nichq.org/resource/infant-mortality-coiin-prevention-toolkit

• Interactive toolkit features change ideas, case studies, videos and key insights from teams who are working to reduce infant mortality throughout the country.

Quality Improvement 101 • A digital course that

explains the fundamentals of improvement, including: • Aim Statements • Plan-Do-Study-Act Cycles • Driver Diagrams

http://www.nichq.org/resource/quality-improvement-101

The fundamentals of changes that lead to improvement

Quality Improvement 102

• Learn how to use PDSA cycles iteratively to test improvement ideas to increase their impact and effectiveness

The next step in understanding how change leads to improvement

http://www.nichq.org/resource/quality-improvement-102

Essentials of Collaboration Course

• With information on breaking down silos, aligning activities and working productively together, this course provides a foundation for effective collaboration

http://www.nichq.org/resource/essentials-collaboration

New IM CoIIN Awards

• An FY17 IM CoIIN NOFO resulted in 4 new awards to backbone organizations and their CoIIN Teams • 3 year project period, start date is

Sept. 30, 2017 • Contact Vanessa Lee, Project Officer,

at VLee1@hrsa.gov with questions

26

FY17 IM CoIIN funding opportunity (HRSA-17-105)

Purpose: to reduce infant mortality in areas with high annual rates, as well as disparities in infant mortality and related perinatal outcomes, through support of 1) collaborative improvement, 2) collaborative innovation, and 3) the spread and scale of best practices to reduce infant mortality. Specific aims/objectives of IM CoIIN are to: 1) Achieve measurable improvements in specific aims…as defined by the CoIIN teams during the project period 2) Accelerate the development and/or discovery of innovations and new evidence to reduce infant mortality, as well as disparities in infant mortality and related perinatal outcomes 3) Support dissemination, spread and scale of best practices to reduce infant mortality as well as disparities to stakeholders in all states/jurisdictions

27

28

Awardee: Association for Maternal and Child Health Programs (AMCHP)

CoIIN Team States: FL, IL, KY, MA, NC, NM, NV, OH, OR, RI, SC, TX, WI (13)

CoIIN Team topic area/focus: social determinants of health (SDOH)

Awardee: National Institute for Children’s Health Quality (NICHQ)

CoIIN Team States: AR, MS, NY, TN (4)

CoIIN Team topic area/focus: SUID

Awardee: Project Concern International (PCI)

CoIIN Team States: AZ, CA, NM, TX (4)

CoIIN Team topic area/focus: early prenatal care & SDOH

Awardee: University of North Carolina-Chapel Hill

CoIIN Team States: CA, DE, NC, OK (4)

CoIIN Team topic area/focus: preconception health

Award Recipients: “Backbone Organization” to CoIIN team

Healthy Start Collaborative Improvement and Innovations Network (CoIIN) Update

November 2017 Conversations with the Division Webinar

Standardization: CoIIN Goal

Builds a stronger program that provides a consistent, predictable, & replicable experience for HS participants.

Standardization

Standardize Screening Tools and Processes:

Ensures comprehensive

and consistent assessment of

participants’ needs.

Standardize Data Collection and Reporting:

Supports monitoring and

evaluation to demonstrate program effectiveness

Standardize Care Coordination and Case

Management: Defines best practices to

improve the health of pregnant women and

young families

Overview of CoIIN Priorities (Adopted March 2015)

• Care Coordination/Case Management is the foundation of re-framing Healthy Start as a system of care to:

• ensure sustainability of the program in order to mobilize more communities to create more equity for our families in need; and

• assure care coordination and case management are rooted in the community, are multidisciplinary: address linkages and referrals; include a family centered approach; incorporate advocacy and a cultural focus.

Principles of the CoIIN’s Standardization Work

Jun 2016 Call

Brainstormed approach for CC/CM initiative

Jul 2016 Call

Brainstormed data collection needed

to inform CC/CM priority

Sept 2016 Meeting

Established guiding principles for CC/CM

standardization approach

Dec 2016 Call

Provided update on the CC/CM module of the CHW curriculum

Feb 2017 Call

Discussed how to leverage NHSA Core

Standards report

Mar 2017 Call

Conducted polls to determine readiness to

address CC/CM

Where Have We Been-What Have We Addressed?

• Finalized the CC/CM Planning Document.

• Identified focus areas for each work group.

• Finalized work group work plans.

• Continued to reinforce bridging the HS screening tools to the CC/CM initiative.

Progress to Date

• The initial step toward standardization is establishing a shared understanding of care coordination/case management across the HS CoIIN.

• Establish common definitions of care coordination and case management as a foundation for any other steps in standardization.

Defining Care Coordination and Case Management

CoIIN Care Coordination and Case Management Initiative Framework

Policies and Protocols Workgroup

Operationally define CM and CC, highlight distinctions if they exist, and identify alternative terms to guide the Literature Review and Data Sources Workgroups, and Members: Anna Gruver, Sara Kinsman (co-leads) Maxine Vance, Maria Lourdes Reyes, Julie DeClerque, and Kori Eberle

Literature Review Workgroup Review current literature to provide context to the findings of the Data Sources Workgroup. The outcome for the literature review will support current CC/CM HS best practices and address identified gaps. Members: Dianne Browne, Delores Passmore (co-leads) HSNO, Tara Schuler, Jada Shirriel , Lisa Matthews, and Meloney Baty

Current Practices Workgroup Begin documenting and describing common components and gaps in CC/CM across grantees through review of current grantee applications and currently available data sources to inform the development of any additional data needs and to provide guidance for the Literature Review Workgroup. Members: Lo Berry , Gwen Daniels (co-leads) JoAnn Smith, Megan Young, Rick Greene, Anna Colaner, and Risë Ratney

Establish best practices for CC/CM related to providing MCH services.

Policies and Protocols Current Practices Literature Review

Define terms. Document current HS program practices.

Compare the HS current practices to the literature.

Informs actions of Current Practices and Literature Review work groups.

Based on adopted definition of CC/CM, identify existing functions

across HS programs.

Document how the literature supports current HS practice.

Establish best practices for recommendation to Healthy Start.

Identify gaps. Identify how the literature can address identified gaps.

Inform the establishment of best practices by policy group.

Inform the establishment of best practices by policy group.

Each Work Group Focus Area

Work Group Suggested Timeline Suggested Communication with Grantees

Policies and Protocols Outcome: A common definition of understanding of care coordination/case management, and their components across CoIIN members.

Defines terms: overarching terms and any others that pertain October – November 2017 December 2017-solicit feedback to CC and/or CM Current Practices

Outcome: analysis of strengths and gaps of current HS programs’ CC/CM practices.

Prep (e.g., identify methods for gathering CC/CM practice October – November 2017 November 2017– check in info from grantees, sources, etc.)

Data collection (based on definition) December 2017 – January 2018 No check-in

Analysis February – March 2018 April 2018 – report findings

Literature Review Workgroup Outcome: Support current CC/CM HS best practices and address identified gaps.

Identify best practices in design and implementation of CM/CC: October – December 2017 No check-in risk levelling, staffing ratios, community risk vs. individual

risk, etc.)

Crosswalk with current practices March – April 2018 May 2018– report findings

All CoIIN members Establish best practices for recommendation to HS.

May – June 2018 July 2018 – final recommendations presented

Care Coordination and Case Management Task and Timelines

To emphasize:

• Healthy Start as promoting equity;

• Healthy Start as a standardized system of care; and

• Standardization as a strategy for sustainability.

Focus of HS CoIIN

EPIC Center Update

November 16, 2017 JSI/EPIC Center

Healthy Start Community Health Worker Course

500 users representing 86% of HS grantee programs

EXPECTED IN 2018

Certificates are

e-mailed within 48 hours of course

completion http://healthystartepic.org/training-

and-events/healthy-start-community-health-worker-course/

1) Number of CHWs Trained Goal: At least two direct service staff (i.e., Community Health Workers, Case Managers) from each grantee organization will successfully complete 3 out of the 5 CHW Phase 1 modules by December 31, 2017.

• Numerator: Number of grantees that have had two staff complete 3 out of the 5 CHW Phase 1 modules by December 31, 2017

• Denominator: Number of National Healthy Start Grantees (N=100) Data source: HS EPIC Center CHW Course Monitoring Spreadsheet

2) Number of Project Directors\Program Managers trained Goal: At least 80 Project Directors or Program Managers will successfully complete the Healthy Start 101 module by Dec 31, 2017.

• Numerator: Number of Project Directors or Program Managers that successfully complete the Healthy Start 101 module by December 31, 2017.

• Denominator: Number of National Healthy Start Grantees (N=100) Data source: HS EPIC Center CHW Course Monitoring Spreadsheet

CHW Reporting Goals

Health Living Initiative

Webinars Series and Webpage for staff and participants: • Taking a Landscape View of Healthy Living (June)

• Strategies to Support Healthy Eating (October)

• Supporting Physical Activity (November)

• Stress Reduction and Mindfulness (December 5, 2017)

http://healthystartepic.org/resources/healthy-living/

• No Annual Healthy Start Convention • National Healthy Start Association Conference • Community Trainings (Requests fulfilled) • MCH Journal articles being published! Congratulations to

authors! • CLC Scholarships • Crosswalk of Healthy Start Performance Measures and Screening Tools

Other EPIC Updates

Crosswalk

http://healthystartepic.org/wp-content/uploads/2016/12/CrosswalkofScreeningToolstoPerformanceMeasures7617.pdf

22 programs submitted for September

100 active users (screeners)

508 screenings total

399/109 initial screenings/rescreenings

488 participants

Electronic Screening Tool Updates

Scre

enin

gs p

er to

ol: Demographic form: 402

Pregnant: 408

Preconception: 14

Prenatal: 303

Postpartum: 123

Interconception: 282

To stay informed of training and TA opportunities and resources, sign up for e-News and Training Notices. Available to all Healthy Start grantees and their staff e-News (Sent out 3rd

Wednesday) Training Notice

(Sent out 4th Wednesday)

Stay connected!

For assistance: Contact Us:

http://www.healthystartepic.org healthystartepic@jsi.com 1-844-225-3713, toll-free.

Questions?

Healthy Start Program Update

Benita Baker, Branch Chief Christina Lottie, Public Health Analyst

50

Healthy Start Program Updates

Budget

HRSA operates under a Continuing Resolution through December 8, 2017

The "Continuing Appropriations Act, 2018 and Supplemental Appropriations for Disaster Relief Requirements Act, 2017" (Public Law 115-56) provides appropriations for HRSA through December 8, 2017.

•HRSA will issue non-competing grant awards at a level that is commensurate with the CR funding and guidance.

•Adjustments to award levels will depend on future CRs or after Fiscal Year 2018 appropriations are enacted.

April 1st Grantees

Progress Reports due Dec 1

Look at re-budgeting current year funds

November 1st Grantees

Release of funding- All Nov 1 starts should have received a NoA which includes the CR amount.

FFRs due January 30, 2018

Healthy Start Program Updates

Healthy Start Program Updates

NHSA Spring Conference

JSI is collaborating with NHSA to plan the meeting. There will be a planning committee with NHSA, JSI, DHSPS, and HS grantees. The Division will not have a separate day long grantee meeting, but instead will develop a plenary session for Division updates and other opportunities for meeting with grantees.

2019 NOFO Development

We have received and reviewed comments from grantees and are moving forward with drafting of NOFO .

Overall, 96% of Healthy Start grantees found the conference useful

CityMatCH Conference Evaluation

Not Useful

4%

Useful 96%

What was most valuable to you about this conference? - “Being able to hear about the research

and work happening across the U.S.” - “The wealth of information” - “Opportunity to network.”, “Making

partnerships.” - “Best CityMatCH I have ever been to.”

N=82

Healthy Start grantees gained knowledge and connections from the CityMatCH conference

CityMatCH Conference Evaluation

I established new relationships

The conference provided sufficient networkingopportunities

The content adressed needs or gaps inknowledge or skills

I expect to apply the knowledge and skills Igained

Strongly Agree Agree

96%

92%

80%

82%

N=82

Healthy Start National Evaluation Update

Robert Windom

56

Participant Consent for the National Evaluation

• Grantees should be using the IRB approved form to consent participants for the National Evaluation.

• Consent should be requested for all women with a known delivery in calendar year

2017 and all pregnant women with an expected delivery in 2017, as well as women with expected delivery through March of 2018, in the possible event of early delivery occurring in 2017.

Participant Consent…cont.

• If your organization started consenting participants later in the year, we ask that you attempt to go back to capture participants who already gave birth in 2017. Grantees are encouraged to consent participants during follow up encounters, such as home visits, WIC appointments, or other contact points.

Current Activity and Immediate Next Steps

• Finalizing Data Sharing/Use Agreements (Ongoing) • PRAMS Oversampling (Ongoing for 14 HS programs through June 2018) • Training and Technical Assistance for Data Linkage (Jan-Mar)

2018 • April:

• HS grantees provide individual participant identifiers to VROs for those with a known or expected delivery in CY 2017 through March 2018 (to capture any participants that may deliver prematurely).

• May: • VROs complete linkage and transfer 2017 linked HS participant

birth certificate data + non-participant control data in the same counties served by HS grantee to MCHB/HRSA

Timeline

Points of Contact

• Healthy Start Eval: HealthyStartEval@abtassoc.com • Robert Windom & Ansley Marcellus: rwindom@hrsa.gov, amarcellus@hrsa.gov • Your Project Officer

Healthy Start Data Reporting

Chris Lim

62

Healthy Start Monitoring & Evaluation Data (HSMED) Reporting

REMINDERS: • The Healthy Start Monitoring & Evaluation Data (HSMED) system, enabled for HS client-level

data uploading, can be accessed via the following URL: https://healthystartdata.hrsa.gov/

• Monthly client-level data upload - grantees are to upload monthly data into the HSMED, starting the 10th day of each month, consisting of data collected from the prior month.

• For example, starting on 5/10/2017, a grantee organization is to upload data collected on clients throughout the month of 04/2017.

NOTE: All organizations were to attempt uploads must by October 2017.

63

Healthy Start Monitoring & Evaluation Data (HSMED) Reporting (Cont’d)

REMINDERS (cont’d): • Uploads of previous months’ data – grantees are to upload data collected throughout the

previous months of the calendar year 2017. • For example, when submitting a first data upload on 11/10/2017, user should upload data

collected on clients throughout the months of 01/2017 through 09/2017, in addition to data collected in the previous month of 10/2017.

NOTE: Clearly name upload files with reported months. For example, files with data 01/2017 through 09/2017 could include “Jan – Sep2017”… within the naming convention.

• If your organization is not able to submit an initial data upload of previous months’ client-level data, for calendar year 2017, communicate to your assigned HRSA PO why, so he/she will discuss an acceptable reporting schedule.

64

Healthy Start Monitoring & Evaluation Data (HSMED) Reporting (Cont’d)

UPDATES: • Client-level data uploads, as of _10/30/2017_

• 89 grantees attempted HSMED client-level uploads • 11 grantees have not attempted uploads

• If your organization has yet to upload monthly data and/or initial data of previous calendar year 2017 months, you will have until December 2017 to attempt at a data upload. At minimum, the Demographic HS Screening Tool’s data must be loaded into the HSMED. Your assigned HRSA Project Officer (PO) will monitor for your upload attempt.

65

Healthy Start Aggregate-Level Data Reporting

REMINDERS: • On 05/03/2017, grantees received guidance that monthly Healthy Start aggregate-level data

will report to the Healthy Start Data Mailbox at HealthyStartData@hrsa.gov and the assigned HRSA PO, via completion of the CY2017 Healthy Start Aggregate Data Reporting Template – 04-24-2017.

• The CY2017 Healthy Start Aggregate Data Reporting Template, in the writeable MS Excel format, and the accompanying Healthy Start Aggregate Data Reporting Guide – v. 1.1 – 4/28/17, in the PDF form, are located on the Healthy Start EPIC Center website at http://healthystartepic.org/healthy-start-implementation/monitoring-data-and-evaluation/

• HS monthly aggregate reporting continues to occur on the 10th day of each month. • For example, on 11/10/2017, a grantee organization will complete an aggregate data

template with data for the previous month of 10/2017.

66

Healthy Start Aggregate-Level Data Reporting (Cont’d)

REMINDERS (cont’d): • Aggregate data reporting will continue through CY 2018, until the following factors exist:

• All 100 grantees are able to regularly upload client-level data into the HSMED • Uploaded client-level data is accurate and valid.

• Grantee call template data reporting continues. • NOTE: call reported data is used to validate aggregate data.

• Grantees who missed any previous month(s) of aggregate data reporting, throughout calendar year 2017, will work with assigned HRSA PO’s to discuss a submission schedule in December 2017.

67

List of Healthy Start Program Reports

Healthy Start Reporting Project Schedule

68

Reports Reporting Submission Due Dates

Noncompeting Continuation Progress Reports Prior to end of budget period

Performance Reports By the HRSA EHB’s generated due date, after NoA issuance

Monthly HS Aggregate-level Data Report to: HealthyStartData@hrsa.gov

Starting the 10th of each month, and by no later than the end of the month.

Monthly HS Client-level Data Report to the HSMED at https://healthystartdata.hrsa.gov/hslogin/admin/login.aspx

Starting the 10th of each month, and by no later than the end of the month.

Grantee Call Templates In the discretion of the assigned MCHB/DHSPS Project Officer

Open Discussion

Please type your questions into the chat box.

69

Contact Information Benita Baker and Maria Benke Branch Chiefs, Division of Healthy Start & Perinatal Services Maternal and Child Health Bureau (MCHB) Health Resources and Services Administration (HRSA) Email: bbaker@hrsa.gov, mbenke@hrsa.gov Phone: 301.443.1461, 301.443.0156 Web: mchb.hrsa.gov Twitter: twitter.com/HRSAgov Facebook: facebook.com/HHS.HRSA

70