N.C. Perinatal Health Strategic Plan: 2016-2020

Goal 1: Improving Health Care for Women and Men

Multi-Ethnic Family

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 Point 1. Provide interconception care to women with prior adverse pregnancy outcomes

- 1A. Support healthy pregnancy intervals through access to effective methods of contraception, including increased access to Long-Acting Reversible Contraception (LARC)

  1. Provide payment for postpartum placement of LARC in hospital setting by addressing the billing issue
  2. Expand training opportunities for clinicians on LARC provision specifically for family medicine and pediatricians, Nurse Practitioners, Certified Nurse Midwives, and other specialists
  3. Expand LARC education opportunities related to counseling and referring patients for LARC for providers who do not provide
  4. Use shared decision-making model, also known as interactive counseling, to educate patients about available contraception including the benefits and barriers of LARC.

- 1B. Provide care coordination / case management / home visiting services that includes promotion of resiliency, mental health screening, substance use intervention, tobacco cessation and prevention, reproductive life planning, chronic disease management and access to health care

  1. Add prior adverse pregnancy outcomes as a risk factor for Medicaid, Tri-care and state health plan case management Expand to include other private insurance.
  2. Improve access to community services for case management programs by providing orientation for clinicians in order to increase awareness of services and referral mechanisms.
  3. Increase opportunities for insurance reimbursement for services offered through case management / home visiting programs
  4. Provide evidence-based coverage for tobacco cessation treatment and counseling for all tobacco users who want to quit, including populations at greater risk for tobacco use (e.g., populations with mental health and/or substance use problems, low income and educational attainment, homeless, and those in the criminal justice system)

- 1C. Assure women are transitioned from different points of care and have access to postpartum / primary / well woman care including access to ongoing health insurance coverage and a medical home

  1. Increase utilization of the postpartum clinic visit by offering dual appointment scheduling for mom and baby and/or dual home visit for mom and baby
  2. Develop a plan to increase postpartum home visits
  3. Improve mechanisms for maternity care providers to refer patients to medical homes by developing a patient handout (on-line/print) with medical home providers
  4. Provide access to evidence-based tobacco cessation and treatment and tobacco free living to help tobacco users quit and stay quit in the postpartum period and when leaving tobacco free environments (e.g., hospitals, prisons, behavioral health facilities, and group homes)

- 1D. Provide outreach to all providers who care for children (pediatric and family practice clinics, community settings, etc.) to ensure women are receiving interconception care services

  1. Increase outreach to substance use treatment programs with interconception care and family planning services
  2. Conduct outreach to pediatric clinics pertaining to interconception care. Educate providers on timing and methods of introduction of interconception care with the pediatric population and their families.
  3. Incorporate interconception care into routine well-child care
  4. Engage pediatric providers to provide evidence based tobacco treatment services, including education on a tobacco free living environments, remaining tobacco free in the postpartum period and protection from secondhand and thirdhand
  5. Work with public and private decision-makers to make multi-unit housing, government buildings, grounds, child care facilities, and public places smoke-free / tobacco-free.
  6. Engage community stakeholders and educate on the benefits of interconception care and its impact on the community by hosting town halls or town Utilize methods identified during town summits to implement educational sessions and efforts.

- 1E. Increase quality and frequency of risk assessment at the postpartum clinic visit

  1. Continue development and implementation of Pregnancy Medical Home Care Pathway: Postpartum Care and Transition to Well-Woman Care as the recommended check-list for risk assessment
  2. Ensure providers have access to referral services if needs are identified during risk assessment

 Point 2. Increase access to preconception health and health care to women and men

- 2A. Expand the college-based Preconception Peer Education (PPE) Program to reach additional women and men in colleges, universities, graduate schools, community colleges and adult learning programs

  1. Increase the number of new PPE program sites by 5 per year by procuring start-up funds through sorority and fraternity alumnae chapters
  2. Implement the PPE program model through minority-based student-led groups at five NC community colleges
  3. Obtain lessons learned from other states that have implemented the PPE program within non-African American populations to determine program design, successes, challenges, and barriers for possible adaptation in NC
  4. Partner with other public health programs that have experience working within colleges, community colleges, and community settings that reach young adults in order to deliver the PPE program in 2 new institutions
  5. Work with all tobacco control partners and colleges in NC to go 100% tobacco-free, as is allowed by law, and to provide evidence-based tobacco treatment services to all tobacco users
  6. Obtain funding to expand March of Dimes free folic acid distribution program to colleges and universities via the PPE program and social media messages

- 2B. Integrate preconception health (PCH) care and messages into primary care for people of reproductive age.

  1. Design, administer, and analyze survey for primary care providers to assess what PCH care and education they are currently Use existing professional networks and conferences to administer the survey.
  2. Disseminate PCH interventions and messaging through professional organizations on how to implement these messages in a 10-minute primary care visit
  3. Identify and disseminate effective PCH social media messages (e.g. Show Your Love campaign, Tobacco-free living messages) that are targeted throughout the life course via ongoing and newly established PCH health campaigns
  4. Provide PCH messaging through intergenerational conversations facilitated by ongoing family-centered, community-based programs
  5. Provide reproductive life planning counseling and ensure that people have a reproductive life plan in place, particularly those women identified with medical conditions that put them at risk for maternal mortality / morbidity

- 2C. Integrate the use of evidence-based and evidence-informed curricula with adolescent and young adult populations in educational and community settings.

  1. Implement evidence-informed preconception / reproductive life planning curricula in GED and workforce development programs by expanding pre-existing PCH trainings
  2. Ensure compliance with the Healthy Youth Act and facilitate its full implementation via monitoring, reporting and general oversight
  3. Implement Healthy Before Pregnancy curriculum in charter schools
  4. Integrate PCH education into school-based health centers
  5. Incorporate breastfeeding positive messaging into PCH trainings for high-school students
  6. Educate young people about the dangers of all tobacco products, including menthol, and new and emerging electronic nicotine delivery systems with youth-attractive flavorings and promotional messages. Empower young people to carry out effective peer educational campaigns.

- 2D. Implement the North Carolina Preconception Health Strategic Plan and Supplement.

  1. Identify key stakeholders and electronically distribute plan and supplement
  2. Identify champions who can share plan and supplement
  3. Identify other health promotion / educational campaigns that can integrate plan and supplement


 Point 3. Improve the quality of maternal care (includes prenatal, labor, delivery and postpartum care)

- 3A. Expand the use of evidence-based models of prenatal care

  1. Establish 6 additional CenteringPregnancy® sites by procuring start-up funds and providing training. Focus on expanding this model to populations who are at higher risk for poor birth outcomes.
  2. Evaluate outcomes for CenteringPregnancy® patients in North Carolina by developing evaluation measures
  3. Increase continuity of care by promoting that the same provider sees the prenatal patient on a consistent basis
  4. Use shared decision-making model to provide patient education on contraception during the third trimester of prenatal care

- 3B. Provide evidence-based clinical standards in prenatal care (e.g., early elective deliveries, cesarean rate, 17P, tobacco cessation, hypertensive disorders, gestational diabetes, mental health, substance abuse, intimate partner violence, perinatal mood disorders, etc.)

  1. Continue development and implementation of Pregnancy Medical Home Pathways through utilization of flow sheet/checklist of required (or recommended) clinical elements for prenatal care
  2. Increase health care clinician training (public and private) on recommended clinical standards
  3. Track specific measurements related to provision of recommended clinical care including data on maternal mortality and severe maternal morbidity by race & ethnicity
  4. Implement maternity safety bundle (i.e. OB hemorrhage, hypertension management and prevention of thromboembolism for in-patient care; OB clinical checklist for providers)
  5. Offer Pregnancy Medical Home providers training and / or technical assistance regarding the use of SBIRT (Screening, Brief Intervention, and Referral to Treatment) to identify, intervene, and refer pregnant women for substance use
  6. Ensure all pregnant women with substance use who contact the local management entities-managed care organizations (LME-MCO) Access Line are considered emergent (within 2 hours) referrals
  7. Implement You Quit, Two Quit to improve quality of tobacco cessation and prevention efforts among providers
  8. Ensure all pregnant women receive appropriate gestational weight gain guidance

- 3C. Improve access to and utilization of first trimester prenatal care

  1. Allow private providers to complete Medicaid pregnancy presumptive eligibility determination forms
  2. Ensure that each health department is providing pregnancy testing and completion of Medicaid presumptive eligibility at the same visit
  3. Decrease length of time for approving Medicaid for Pregnant Women (MPW) applications
  4. Increase the number of private providers who will accept women with presumptive eligibility for Medicaid and with MPW
  5. Improve first trimester access to care for undocumented pregnant women by using open access scheduling

- 3D. Provide care coordination / case management / home visiting services that includes promotion of resiliency, mental health screening, substance use intervention, tobacco cessation and prevention, reproductive life planning, chronic disease management, perinatal mood disorders, and access to health care

  1. Improve access to community services for case management programs by providing orientation and ongoing technical assistance for providers in order to increase awareness of services and referral mechanisms
  2. Provide care coordination for pregnant women with substance use disorder and/or mental health disorder through LME-MCO

- 3E. Ensure that all pregnant women and high-risk infants have access to the appropriate level of care through a well-established regional perinatal system

  1. Decrease the percent of Very Low Birthweight (VLBW) and high-risk babies who are born at Level 1 and Level 2hospitals
  2. Define, identify and promote centers of excellence for VBAC (vaginal birth after cesarean)
  3. Assess the levels of neonatal and maternity care services for hospitals using the consensus recommendations of the American Academy of Pediatrics (AAP), the American College of Obstetricians and Gynecologists (ACOG), and the Society for Maternal-Fetal Medicine (SMFM)

- 3F. Promote access to comprehensive breastfeeding support services including medical lactation services

  1. Expand breastfeeding peer counseling program to all counties in NC
  2. Increase the number of International Board Certified Lactation Consultants (IBCLCs) per live birth, especially people of color, by increasing educational support (including mentoring) and financial support
  3. Reimburse for the provision of medical lactation services by IBCLCs, MDs, CNMs, and NPs
  4. Increase the number of facilities participating in NC Maternity Center Breastfeeding Friendly Designation or NC Breastfeeding-Friendly Child Care Designation Program or achieving a Baby Friendly Hospital Designation
  5. Reduce infant formula utilization by increasing the initiation, duration, and exclusivity of breastfeeding

- 3G. Provide evidence-based culturally competent patient education and anticipatory guidance

  1. Provide evidence-informed childbirth education information to expectant families that includes:
    • Letting labor begin on its own
    • Walking, moving and changing position in labor
    • Have continuous labor support
    • No routine intervention in labor
    • Upright position for pushing
    • Immediate skin-to-skin: skin-to-skin for the first hour or until the first feed (this is for all babies for thermal regulation)
    • Keep baby with you, it's good for breastfeeding "rooming in"
    • * adapted from Lamaze International Six Healthy Birth Practices
  2. Increase perinatal health literacy by ensuring that families are provided with appropriate educational resources and support
  3. Increase the availability of continuing education for individuals providing patient education to ensure most current evidenced based practices are presented to patients and ensure that individuals are able to maintain certification
  4. Increase community awareness and comprehension of reproductive health literacy
  5. Convene community focus groups to test existing patient education materials and find out the best routes for accessing information by integrating focus groups with pre-existing forums
  6. Educate clinicians on the latest, evidence-based information and guidance through continuing education, conferences, and graduate curricula updates. Utilize inter-professional techniques to effectively integrate and facilitate team learning.

 Point 4. Expand healthcare access over the life course for all

- 4A. Promote access to and utilization of the adolescent well visit

  1. Increase enrollment of adolescents in Health Check/Health Choice by working with community-based organizations
  2. Educate adolescents and parents/caregivers about the importance of the adolescent well visit, health benefits, and perceived barriers through social media campaigns
  3. Increase school-based healthcare access through legislative action and increased funding

- 4B. Promote access to and utilization of evidence-based preventive health services

  1. Educate clinicians about evidence-based strategies through continuing education, conferences, and graduate curricula updates
  2. Educate consumers about benefits of the Affordable Care Act (ACA) and evidence-based strategies through social media

- 4C. Increase access to and utilization of medical homes

  1. Educate population about the concept of a medical home and services provided

- 4D. Provide affordable, comprehensive insurance coverage

  1. Close the health care insurance gap for low income populations
  2. Increase accessibility of health care services through safety net providers

- 4E. Promote access to and utilization of immunizations according to the American Committee on Immunization Practice guidelines

  1. Launch a social media campaign on immunization benefits for people of reproductive age via pre-existing marketing channels
  2. Assess current inventory and supply management needs for vaccines amongst safety net providers
  3. Address immunization data gap for adults by monitoring immunization rates through statewide registry

- 4F. Provide evidence-based culturally competent patient education and anticipatory guidance

  1. Compile evidence-based education for priority patient populations, e.g. African Americans, American Indians, LGBTQ, etc.
  2. Compile evidence-based education for men
  3. Convene community focus groups to test existing patient education materials and find out the best routes for accessing information by integrating focus groups with pre-existing forums
  4. Educate clinicians on the latest, evidence-based information and guidance through continuing education, conferences, and graduate curricula updates

Perinatal Health Strategic Plan

Last Modified: February 20, 2019