Print Version - Title V Information System (2024)

The Office participates in West Virginia’s civil service employment system that is governed by its Division of Personnel (DOP). DOP works with agencies to establish, criteria for personnel classifications, develop registers of qualified applicants and assures that agencies follow established policies and procedures. Recently, DOP has also been working with the Office to develop plans for the recruitment and retention of certain employment classifications including nurses and epidemiologists. While the Office recruits its workforce from throughout the United States, it is difficult to retain employees that are not from West Virginia because of lower than average salaries. In July 2019, salaries for all epidemiology classifications within BPH were increased in hopes of retaining existing staff and recruiting more easily for vacancies as they become open. Retention efforts focus on facilitating career goals, maintaining connections to family, and State benefits (including health insurance, generous leave policies, and an employer sponsored pension plan).

The Office provides ongoing support for staff to attend professional development opportunities both in-state and out-of- state to assure the understanding and knowledge of evidence-based practice. Opportunities include various national program specific meetings, annual conferences including Council of State and Territorial Epidemiologists (CSTE), CityMatCH, MCH Epi and AMCHP. Attendance to other national, state and local training programs available to enhance the epidemiology capacity is encouraged. OMCFH pays the yearly dues for all epi staff to be members of CSTE.

In addition to utilizing federal funds to maintain adequate staffing, the Office also embeds epidemiology personnel employed by its partners. For example, the Board of Pharmacy employs three epidemiologists housed in OMCFH, OEMS has an epidemiologist position that is supervised by OMCFH, and the Office of Drug Control Policy staffs an epidemiologist located in OMCFH. In some instances, this has even allowed former OMCFH personnel to be promoted to other positions in those agencies while they continue to function as OMCFH staff.

The majority of the epidemiology staff are funded through the program to which they staff while only a few are funded by Title V. All epidemiology staff have at a minimum master’s degree. Epidemiology staff tenure in OMCFH for currently filled positions is:

• 1-5 years = 7
• 5-10 years = 1
• 10-15 years = 2
• 25+ years = 1

The following chart depicts the structure of the MCH Epi Unit.

OMCFH Epidemiology Unit

The West Virginia Office of Maternal, Child and Family Health (OMCFH) within the Bureau for Public Health under the umbrella of the Department of Health and Human Resources operates in partnership with the federal and state governments and the state’s medical community including private practicing physicians, county health departments, community health centers and hospitals. The OMCFH is no stranger to forming public and private partnerships. Many of these collaborations have led to increasing the ability to leverage funding along with service provision. The OMCFH’s partnerships and collaborations, both public and private, are extensive and intertwined. These partnerships also participate on many of the OMCFH program advisory committees and offer input to Title V priorities. For example, for over 25 years the OMCFH has forged a relationship with West Virginia University Pediatrics Genetics to provide medical services to children with special needs and children identified with disorders through newborn screening. WVU Pediatrics provides six outreach clinics throughout the state to assist families with access to services. They also provide guidance and advice to the follow-up nurses and medical community on how to best treat many of the disorders identified through newborn screening. The Newborn Screening Program Advisory consists of the WVU Pediatrics personnel as well as specialists for Cystic Fibrosis, Hemoglobinopathies, and Endocrinology. There are other key informants involved as well such as the State Laboratory that performs the initial newborn screening testing. The Advisory makes recommendations on new disorders that should be included in the newborn screen panel of disorders and establishes cut-off values for indicating whether an infant is in critical need of a confirmatory result.

The partnership with Medicaid has been an important part of the OMCFH’s ability to improve the health care delivery system to the most vulnerable. Medicaid supports the Managed Care Organizations (MCOs) in providing care coordination to those women identified as high risk during their first prenatal visit. The OMCFH uses the results from the Prenatal Risk Screening Instrument (PRSI) that identifies a high-risk pregnancy and shares information with Medicaid to pass along to the coordinating MCO. Medicaid also supplies OMCFH data on pregnant eligible women and foster children to ensure services can be offered early for medical and home visitation support. Data from Medicaid claims is used to determine services that were rendered to assess utilization. Medicaid also financially supports Right From The Start, the State’s Medicaid Home Visitation Program and the EPSDT Program for children eligible for Medicaid, both housed in OMCFH.

In WV, both the Title V and Medicaid agencies reside in DHHR and are physically located in the same office building. OMCFH facilitates an annual review and renewal of the required Title V-Medicaid Inter-Agency Agreements (IAA). Medicaid has designated a formal point of contact for the Office to assure coordination and continuity of operations. This point of contact reaches out to the office via routine walk-throughs and check-ins assuring that they are informed of OMCFH issues and concerns. When ideas or issues are identified, they then facilitate follow-up with appropriate Medicaid staff in a timely manner.

This partnership extends to significant financial support of many OMCFH operations. Medicaid is a funder for Children with Special Health Care Needs, Birth to Three, HealthCheck, Right From The Start (the State’s Medicaid Home Visitation Program) and Breast and Cervical Cancer Screening. This allows the Office to leverage resources, but also assures additional coordination between the two agencies via program specific MOUs. This establishes a collaborative environment whereby the agencies work together to develop policy for service delivery which extends to other operations like oral health, maternity services, and newborn screening. On July 1, 2021, Medicaid increased coverage for postpartum care for up to one year. As a result, Right From the Start also increased home visitation services for up to one year. In 2020, WV CHIP increased coverage to include pregnant women up to 300% of the FPL. As a result, OMCFH increased the MCH Maternity Services Program eligibility up to 325% of the FPL based on family size, including the unborn child. The MCH Maternity Services Program also covers pregnant teens under age 19 with no other insurance and prenatal care, associated/prenatal lab work and OB provider delivery fee for non-US citizens. WV Medicaid has a special policy provision that may provide delivery and inpatient coverage.

The Office approaches outreach from a systems perspective. For example, the Social Security Administration routinely provides a list of children who have applied for social security. In turn, the Office reaches out with enrollment packages for Children with Special Health Care Needs services. The Office also works with the Health Statistics Center to use birth certificate information to complete a monthly mailing to new parents with targeted outreach information. HeathCheck staff routinely contact families enrolled in fee-for-service Medicaid to facilitate the administrative components of Early and Periodic Screening, Diagnosis and Treatment (EPSDT), including scheduling of well-child exams. Likewise, nine community based HealthCheck Regional Program Specialists serve to equip West Virginia's Medicaid providers with the necessary tools and knowledge to carry out EPSDT services consistent with the standard for pediatric preventive health care, i.e. Bright Futures, as well as provide ongoing technical assistance to enable EPSDT. In addition to these activities, staff often attend community baby showers, health fairs and other events to share information about the services provided by OMCFH and Medicaid.

Like many states, WV has commissioned managed care organizations (MCOs) to provide health services to its Medicaid members. The Bureau for Medical Services (BMS), Center for Managed Care, initiated a risk-based managed care program called Mountain Health Trust (MHT) in September 1996. Mountain Health Trust includes Medicaid and CHIP and provides managed care services to approximately 87% of the state’s Medicaid and CHIP membership. Populations covered under managed care include most adults and children, pregnant women, and members receiving Supplemental Security Income (SSI). The Bureau contracts with three Managed Care Organizations (MCOs) for the provision of Medicaid medically necessary services. Services carved out of managed care include point of sale pharmacy, long-term care, home and community-based waivers and non-emergency medical transportation services. On January 1, 2021 West Virginia Children's Health Insurance Program (WVCHIP) members were included in the MHT program.

Through the Pediatric Medical Advisory Board and HealthCheck Program, the Office has always set standards for the State’s EPSDT Program, this role has remained and, in some areas, expanded with the State’s utilization of MCOs. In 2020, children and youth in the foster care system and individuals receiving adoption assistance transitioned from a fee for service environment to Medicaid managed care. Aetna Better Health of West Virginia received the contract for this specialized managed care program. The Title V Director was involved in every aspect of this transition. Likewise, the Title V CSHCN Director and CSHCN Nursing Director continue to work with Aetna Better Health of West Virginia on a weekly basis to facilitate successful implementation of an electronic health record (EHR) system to include, at a minimum, the child/youth’s chronic health problems, allergies, medications, psychosocial and family histories, trauma history, developmental and immunization information, and shared plan of care that simplifies implementation of key functions of the medical home, including but not limited to, comprehensive care coordination, communication, and patient- and family-centered care. WV’s strong Title V-Medicaid partnership continues to bring about reduced fragmentation and to deliver needed support and services for this population in the most integrated, appropriate, and cost-effective way possible.

House Bill 2266, passed by the WV Legislature on April 10, 2021, amended and reenacted §9-5-12 of the Code of West Virginia to extend Medicaid coverage to pregnant women and their newborn infants up to 185% of the federal poverty level and to provide coverage up to 1 year postpartum, effective July 1, 2021. Said postpartum care may include the provision of care coordination services (targeted case management from Medicaid’s perspective) and health education to Medicaid eligible pregnant women via the Right from the Start Program administered by West Virginia’s Title V agency.

NPM - Percent of cesarean deliveries among low-risk first births (Low-Risk Cesarean Delivery, Formerly NPM 2) - LRC
Indicators and Annual Objectives

NPM - Percent of women who had a dental visit during pregnancy (Preventive Dental Visit - Pregnancy, Formerly NPM 13.1) - PDV-Pregnancy
Indicators and Annual Objectives

NPM - Percent of women who smoke during pregnancy (Smoking - Pregnancy, Formerly NPM 14.1) - SMK-Pregnancy
Indicators and Annual Objectives

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

Priority Need

Decrease preterm and low birthweight infants.

NPM

NPM - Percent of cesarean deliveries among low-risk first births (Low-Risk Cesarean Delivery, Formerly NPM 2) - LRC

Five-Year Objectives

Strategies

NOMs

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

Priority Need

Increase dental care specifically during pregnancy.

NPM

NPM - Percent of women who had a dental visit during pregnancy (Preventive Dental Visit - Pregnancy, Formerly NPM 13.1) - PDV-Pregnancy

Five-Year Objectives

Strategies

NOMs

State Action Plan Table (West Virginia) - Women/Maternal Health - Entry 3

Priority Need

Decrease smoking specifically among pregnant women and decrease smoke exposure among children in the household.

NPM

NPM - Percent of women who smoke during pregnancy (Smoking - Pregnancy, Formerly NPM 14.1) - SMK-Pregnancy

Five-Year Objectives

Strategies

NOMs

State Action Plan Table (West Virginia) - Women/Maternal Health - Entry 4

Priority Need

Address substance use in pregnancy and in youth/teens.

SPM

SPM 2 - Increase identification of pregnant women using substances during pregnancy.

Five-Year Objectives

Strategies

Decrease preterm and low birthweight infants

Provide evidence-based labor support education for nurses in birthing facilities.

For the second year, nursing shortages, burnout, staffing problems due to illness, and the limitations of in-seat presentations and drills have derailed some plans but Zoom meetings and webinars have been implemented with some success.

Evidence labor support was provided to 21 participants from five WV hospitals.

Provide Lamaze childbirth education.

Provided Lamaze childbirth education training through a combination of online courses with the final certification to occur in person in mid-June. Eleven people are participating in the course.

Promote childbirth education for first-time mothers statewide.

Two sessions of “Spinning Babies” is scheduled for Summer 2022.

Provide increased public awareness about risks of labor induction and cesarean section deliveries that are not medically indicated.

Completed two “Spinning Babies” courses in June with 25 people attending each session.

Conduct best practice updates for maternity care providers on the recommendations of the American College of Obstetrics and Gynecologists and the Society for Maternal Fetal Medicine.

Three training opportunities were provided at the Perinatal Summit, Improving Access to Doula Care, Leading Causes of Maternal and Infant Mortality and Racial Disparities, and Implicit Bias in Healthcare.

A 2-day course, Intermediate Fetal Monitoring (FM), was held. Two new Fetal Monitoring instructors are being supervised in order to receive AWHONN FM teaching certification.

Increase dental care specifically during pregnancy

Continue oral health surveillance of perinatal population through the Basic Screening Survey (BSS) to inform program and policy development.

The Oral Health Program completed the third grade BSS during the 2021-2022 school year and is currently working with the West Virginia Perinatal Partnership to determine the appropriate locations to conduct BSS for the perinatal population during 2022-2023. The Oral Health Program worked with the West Virginia University School of Dentistry (WVU SoD) to develop a pediatric residency program and continuing education opportunities for current oral health workforce and non-dental providers who work with the pediatric and perinatal populations. The continuing education includes pediatric and perinatal best practice. Education on these topics should increase the number of pregnant women who are referred for dental care during pregnancy and increase the number of pregnant women receiving dental services. To date, there have been three continuing education courses offered. These courses are offered by two board-certified pediatric dental faculty from WVU SoD via a virtual platform and are recorded for future use.

Establish a data sharing agreement with Medicaid and CHIP to monitor pregnant women use of available dental services.

Prior to January 1, 2021, West Virginia had an emergency only benefit for adults. The benefit expansion allows for all adults including the perinatal population to have comprehensive oral health services. Lack of adult oral health services in pregnant women results in premature delivery, low birth weight, gingival issues, as well as several other issues for mother and baby. Oral health may be considered an important part of prenatal care, given that poor oral health during pregnancy can lead to poor health outcomes for the mother and baby. We have a current agreement in place with Medicaid and CHIP to monitor pregnant women use of available dental services. The Oral Health Program will monitor claims data through the CMS 416 quarterly report to determine if pregnant women are utilizing these services.

Decrease smoking specifically among pregnant women and decrease smoke exposure among children in the household.

Offer evidence-based training to maternity care providers to promote tobacco cessation during each prenatal visit.

Three Help 2 Quit trainings were provided with 130 total participants completing the training. Two provider champions have been identified to promote tobacco cessation with the medical provider community.

Offer evidence-based cessation curriculums to pregnant women via home visitation services.

COVID impacted the use of CO monitors in the home for SCRIPT when home visiting programs transitioned from in person visits to virtual. Smoking cessation questions continued to be asked and the five A’s utilized with each client. Referrals were made based upon the woman’s request for referrals.

Over the next year home visiting programs as programs transition to a hybrid model of home visiting of both in person and virtual based upon the initial assessment triage process, the use of CO monitors in the home will be reinstated. Home visiting programs will develop a tiered incentive approach with women based upon the goals established for smoking cessation. The intent is to utilize multiple smoking cessation strategies and tiered incentives to increase the number of clients quitting or reducing smoking.

Continue to seek out innovative evidence-based strategies to support women in quitting tobacco products before, during and after pregnancy.

The Perinatal Partnership partnered with the WV Breast and Cervical Cancer Screening Program (BCCSP) and Mountains of Hope to develop patient education materials. The materials highlight the link between cervical cancer and smoking. There were three discrete pieces developed and all focused on the importance of quitting smoking and receiving preventive health care, including regular screenings.

Follow-up with maternity care providers after receipt of evidence-based training to assess increase of tobacco cessation with pregnant women.

Three Coalition for Tobacco Free meetings were held with a total of 138 participants. A DFMB Community Health Worker smoking cessation training was held with 25 in attendance.

Address substance use in pregnancy and in youth/teens

Use RFTS RLA to educate providers on accurate and complete submission of the PRSI form.

The training process was delayed due to COVID and restrictions with office visits, along with a “go live” start date. A detailed training plan was developed by the PRSI epidemiologist to be used with providers. Provider contact was ongoing and approximately 15 provider agencies have been added to the new PRSI system to enter forms. RCCs and the RFTS Coordinator are working closely with local providers on the transition.

Finalized the web based PRSI system in early 2021 and internal OMCFH office entry of PRSI forms started. The online implementation phase with providers was moved to summer/fall 2021 to ensure all providers received the appropriate training needed within offices for PRSI accuracy. A combined virtual and in person training plan has been developed for OB providers and RFTS, including use of the web-based system by a select group of OB providers.

Support transition from paper PRSI form to electronic data collection system.

Trained RCCs in the use of the on-line data system. Established an effective communication process between RFTS, the PRSI epidemiologist and Local Data Solutions. Providers were given a choice of an in-person training or virtual training on the use of the ePRSI system. It was a slow start getting providers engaged in the training. An increase in the number of providers being trained has occurred and some providers have started using the e-PRSI system. The production site for the ePRSI became live on April 1st, 2022. There are 19 providers offices who have requested for staff members to have accounts created to submit PRSIs on the site (some provider offices have multiple users). Currently 47 staff members have accounts. The first official ePRSI was submitted on May 18th, 2022. The overall submission of ePRSIs so far is 42. Only two provider offices have submitted any ePRSIs.An increase in the number of providers requesting access has increased significantly over the last two months.

Inform providers of compliance rate in submission of PRSI forms.

Due to the delay in getting providers trained and using the ePRSI system, reports have not been generated to providers yet. The reports have been designed and will be shared at the Maternal Risk Screening Advisory Board meeting in October 2022.

Decrease preterm and low birthweight infants

Provide evidence-based labor support education for nurses in birthing facilities.

As part of the SOW with the Perinatal Partnership the following will occur in coordination with OMCFH:

Provide 3 Lamaze Evidence-Based Labor Support (EBLS) training for intrapartum nurses and staff to reduce the rate of nulliparous, singleton, vertex, term babies born via cesarean delivery.

WVHVP will train 8 RFTS DCCs as doulas to work with women during their pregnancy on risk factors identified during the initial PRSI.

As part of a Managed Care Organization and private organization funding stream, 8 RFTS DCCs and home visitors are in the process of being trained and certified as doulas. The challenges faced are how to reimburse certified doulas in West Virginia and support newly trained doulas with insurance, marketing and hospital relationships. Discussions will be ongoing with Medicaid, the Perinatal Partnership, OMCFH and MCOs on how to implement effectively within the State.

Provide Lamaze childbirth education.

As part of the SOW with the Perinatal Partnership the following will occur in coordination with OMCFH:

Provide at least two Lamaze Childbirth Education Instructor training to support labor and reduce the rate of low-risk cesarean delivery to ensure adequate number of instructors.

Work with RFTS Regional Lead Agencies to have at least 1 Lamaze Childbirth Educator providing virtual sessions for women unable to attend in-person. RFTS will also increase the number of Designated Care Coordinators providing the Enhanced Service of childbirth education by 10 new trained Childbirth Educators.

Promote childbirth education for first-time mothers statewide.

As part of the SOW with the Perinatal Partnership the following will occur in coordination with OMCFH:

Provide two “Spinning Babies” one day workshop to train certified nurse midwives, nurses and childbirth educators on the use of positioning to facilitate birth.

WVHVP will increase the number of RFTS enhanced service providers that can provide childbirth education virtually to 10 providers Statewide.

WVHVP will provide childbirth education through RFTS enhanced service providers 100 women Statewide.

WVHVP will partner with three primary care centers to pilot enhanced services childbirth education at the primary care center.

WVHVP will develop a “Real WV Moms” social media campaign from women that have completed childbirth education, breastfed and utilized home visiting services to promote activities. This will personalize the messaging to moms from other moms and address real WV stigmas around pregnancy, postpartum mental and physical health concerns and importance of prenatal care.

RFTS will increase the number of certified childbirth educators across the State to include at least two in each of the eight regions. Childbirth educators will be trained to provide education virtually and in person.

RFTS is developing a birth plan training for new moms along with a resource kit that will help new moms better understand the birthing process, hospital preparation and the first few weeks at home with the new baby. This training will be provided to all home visitation programs and added to the new home visitor training.

Conduct best practice updates for maternity care providers on the recommendations of the American College of Obstetrics and Gynecologists and the Society for Maternal Fetal Medicine.

As part of the SOW with the Perinatal Partnership the following will occur in coordination with OMCFH:

Facilitate Grand Rounds on Implicit Bias in Racial and Impoverished Families in each of the obstetrics and gynecology residency training programs.

Continue the work with the obstetric and gynecology residency programs.

Facilitate Grand Rounds on Implicit Bias in Racial and Impoverished Families in pediatric residency training programs.

Provide fetal monitor instruction for clinicians to utilize standardized methods in the assessment of the fetal heart rate status, including interpretation, documentation using the National Institute of Child Health and Human Development (NICHD) terminology, and encouraging methods that promote freedom of movement. One Instructor course, one Advanced course and 2 Intermediate courses.

Continue the same activities with the goal of increasing the number of clinicians completing the course. Develop a process to survey participants six months and one year after completion to determine the impact of the training.

Increase dental care specifically during pregnancy

Continue oral health surveillance of perinatal population through the Basic Screening Survey (BSS) to inform program and policy development.

Due to Covid and guidance from the Center for Disease and Control (CDC), the Basic Screening Survey (BSS) has been postponed until further notice. We are continuing to have monthly calls with the CDC for updates and guidance. The Oral Health Program is working with the West Virginia University School of Dentistry (WVU SoD) to develop a pediatric residency program and continuing education opportunities for current oral health workforce and non-dental providers who work with the pediatric and perinatal populations. The continuing education will include pediatric and perinatal best practice. Education on these topics should increase the number of pregnant women who are referred for dental care during pregnancy and increase the number of pregnant women receiving dental services.

Establish a data sharing agreement with Medicaid and CHIP to monitor pregnant women use of available dental services.

As of January 1, 2021, all adults including the perinatal population will have access to comprehensive oral health services. Until now, West Virginia had an emergency only benefit for adults. Lack of adult oral health services in pregnant women results in premature delivery, low birth weight, gingival issues, as well as several other issues for mother and baby. Oral health may be considered an important part of prenatal care, given that poor oral health during pregnancy can lead to poor health outcomes for the mother and baby. We have a current agreement in place with Medicaid and CHIP to monitor pregnant women use of available dental services.

Decrease smoking specifically among pregnant women and decrease smoke exposure among children in the household.

As part of the SOW with the Perinatal Partnership the following will occur in coordination with OMCFH:

Will facilitate training for obstetrical and pediatric tobacco cessation champions, continue to identify, train, and support pediatric health care providers on best practice smoking /vaping cessation interventions to address second and third hand smoke exposure, coordinate tobacco cessation and prevention efforts with Our Babies Safe and Sound and other statewide groups to address clean air initiatives and participate on the Coalition for a Tobacco Free WV and other statewide group efforts.

RFTS will utilize SCRIPT with pregnant and postpartum women requesting to quit or reduce smoking.

WVHVP will coordinate referrals with WV Quitline and develop a quarterly referral/outcomes report with the WV Quitline indicating number of women referred and accepting services through the WV Quitline.

WVHVP will provide SCRIPT and smoking cessation training to all new home visitors within 30 days of hire to ensure home visitors provide the smoking cessation strategies tool kit to women requesting to quit or reduce smoking.

Increase education to families enrolled in home visiting on second-hand smoke and provide referrals as appropriate for family members within the household to quit or reduce smoking.

Continue to trainings and develop a process to survey participants six months and one year after completion to determine the impact of the training.

Offer evidence-based training to maternity care providers to promote tobacco cessation during each prenatal visit.

As part of the SOW with the Perinatal Partnership the following will occur in coordination with OMCFH:

Provide training and intervention programs specifically for obstetrical and pediatric providers to reduce smoking before, during, and after pregnancy. Continue to identify, train and support providers on best practice tobacco/nicotine cessation interventions during pregnancy, promote a consistent and unified message about cessation of smoking in pregnancy, provide training and technical assistance to healthcare and public health providers on helping women quit using tobacco before, during, and after pregnancy, advertise and connect with health care providers to attend trainings, develop a recognition plan for physician practices that participate in training as leaders addressing smoking before, during and after pregnancy. The Perinatal Partnership will also secure continuing education credits for participation in the workshops, provide technical assistance to providers and their practices receiving Help2Quit trainings, provide technical assistance to OMCFH home visitation programs on tobacco prevention and cessation strategies, coordinate with the WV Quitline to reduce barriers to enrollment and increase participation of pregnant and postpartum women.

Continue to trainings and develop a process to survey participants six months and one year after completion to determine the impact of the training.

Offer evidence-based cessation curriculums to pregnant women via home visitation services.

Home visitation programs will utilize evidence-based curriculums that align with each of the home visiting models (RFTS, Parents as Teachers, Healthy Families America, and Early Head Start Option) to 2000 pregnant women annually. Each model will utilize the approved handouts and activities addressing maternal mental health, prenatal care, referrals for community resources and supports, breastfeeding, safe sleep, and substance use. Targeted populations will be low income, pregnant women under 21 years of age, smokers, and women with substance use disorder. However, home visiting services will be available to any woman requesting home visiting. Each home visitor will be required to complete model specific curriculum training before adding women to their caseload.

Utilize evidence-based smoking cessation activities to provide a client tool kit for smoking cessation, including a tiered incentive program for women successfully meeting their goal to quit smoking.

Increase the number of home visitors trained and certified in tobacco cessation by 10 to ensure a tobacco cessation specialist is available regionally for any women enrolled in home visiting that requests a tobacco cessation specialist to assist with smoking cessation.

Continue to trainings and develop a process to survey participants six months and one year after completion to determine the impact of the training.

Continue to seek out innovative evidence-based strategies to support women in quitting tobacco products before, during and after pregnancy.

As part of the SOW with the Perinatal Partnership the following will occur in coordination with OMCFH:

Will facilitate the Tobacco Free Families Advisory Council and collaborate with the federal-state MOMS initiative, utilize the “Perinatal All Topics Workgroup” (workgroup of the WV Perinatal Partnership, Medicaid Managed Care Organizations and DHHR leadership) to continue to examine smoking cessation benefits for pregnant and postpartum women, and families with young children, develop Help2Quit program training schedule and deliver training, and explore opportunities with Right From the Start and other home visitation programs to implement evidence-based smoking cessation programs, such as Baby and Me Tobacco Free.

Identify, train, and support pediatric health care providers on best practice smoking /vaping cessation interventions to address second and third hand smoke exposure.

Promote a consistent and unified message about cessation of smoking in pregnancy.

Complete “Turning the Tables on Tobacco” presentations to pediatric providers, including residents from Cabell Huntington Hospital and CAMC Women and Children’s.

Collaborate between WV AAP and Our Babies Safe and Sound to get safe sleep materials to all the pediatric provider practices in the state, and the “this side up” onesie (infant t-shirt) campaign around National Safe Sleep month (October). The onesies will be distributed to all the delivering hospitals along with “Clean Air Zone” information postcard for parents. Per TFFAC Quitline info is to be included as well.

Develop stronger linkages with the MCOs and home visitation on incentives and activities to support pregnant and postpartum women requesting to quit or reduce smoking.

Follow-up with maternity care providers after receipt of evidence-based training to assess increase of tobacco cessation with pregnant women.

In order to assess the tobacco cessation efforts the number of obstetrical and pediatric providers who receive training and increased knowledge to provide best practice smoking cessation interventions to patients of childbearing age, pregnant patients, and new parents will be used, qualitative analysis/evaluation of the training program will be determined, quarterly meetings of the Tobacco Free Families Advisory Council meeting information, including agendas, participants and minutes will be recorded and quarterly updates of perinatal tobacco statistics and related data, including progress towards reduction of maternal smoking and 2nd hand exposure will be determined.

Continue to trainings and develop a process to survey participants six months and one year after completion to determine the impact of the training.

Address substance use in pregnancy and in youth/teens

Use RFTS RLA to educate providers on accurate and complete submission of the PRSI form.

The RFTS case management home visiting model will utilize the RCCs to conduct at least one site visit to each practicing obstetrical provider annually (at a minimum) in the assigned region to ensure obstetrical providers are completing the PRSI during initial examination of women. The RCC will provide technical assistance to practicing obstetrical providers to ensure proper completion and submission of the PRSI.

RCCs will provide training on the new PRSI system and completion of the PRSI form to practicing obstetrical providers. The number of practicing obstetrical providers in each region will be identified. A goal of 80% completion rate of visits to OB providers will be established for year one to establish a baseline. An increase of 10% each year for the next two years will be expected.

Support transition from paper PRSI form to electronic data collection system.

The RCCs will support physicians and help when needed to ensure successful completion of the on-line data system. The Epidemiologist assigned to the PRSI, will communicate with Local Data Solutions to ensure that any changes that need to occur with the electronic data system are communicated to the RCCs and providers.

Inform providers of compliance rate in submission of PRSI forms.

The epidemiologist assigned to the Maternal Risk Screening program will develop reports to inform providers of their number of submissions and error rates.

NPM - A) Percent of infants who are ever breastfed (Breastfeeding, Formerly NPM 4A) B) Percent of infants breastfed exclusively through 6 months (Breastfeeding, Formerly NPM 4B) - BF
Indicators and Annual Objectives

NPM - A) Percent of infants placed to sleep on their backs (Safe Sleep, Formerly NPM 5A) B) Percent of infants placed to sleep on a separate approved sleep surface (Safe Sleep, Formerly NPM 5B) C) Percent of infants placed to sleep without soft objects or loose bedding (Safe Sleep, Formerly NPM 5C) D) Percent of infants room-sharing with an adult during sleep (Safe Sleep) - SS
Indicators and Annual Objectives

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

Priority Need

Increase breastfeeding, both initiation and continuation.

NPM

NPM - A) Percent of infants who are ever breastfed (Breastfeeding, Formerly NPM 4A) B) Percent of infants breastfed exclusively through 6 months (Breastfeeding, Formerly NPM 4B) - BF

Five-Year Objectives

Strategies

NOMs

State Action Plan Table (West Virginia) - Perinatal/Infant Health - Entry 2

Priority Need

Decrease infant mortality with an emphasis on Sudden Unexplained Infant Death (SUID).

NPM

NPM - A) Percent of infants placed to sleep on their backs (Safe Sleep, Formerly NPM 5A) B) Percent of infants placed to sleep on a separate approved sleep surface (Safe Sleep, Formerly NPM 5B) C) Percent of infants placed to sleep without soft objects or loose bedding (Safe Sleep, Formerly NPM 5C) D) Percent of infants room-sharing with an adult during sleep (Safe Sleep) - SS

Five-Year Objectives

Strategies

NOMs

Increase Breastfeeding

Use evidence-based curriculums to promote breastfeeding, especially during home visits.

Six new home visitors were trained as lactation consultants and pending certification. Additional lactation consultant trainings will occur in mid Summer 2022 to assist in reaching the goal of 15 home visitors trained.

WVHVP focused on getting additional home visitors trained as breastfeeding champions and potential messaging. Due to most of the year being virtual visits and challenges with working with community partners on breastfeeding friendly designations, this activity will be a focus over the upcoming year.

WVHVP reviewed privacy policies with social media to ensure the appropriate measures will be in place to develop the peer-to-peer support groups. As the year progressed, the project was delayed due to staffing changes at two of the local implementing agencies to pilot the project. This will continue to be an activity for the upcoming year while also developing a hybrid breastfeeding peer to peer support group with both social media and in person opportunities for families enrolled in home visiting.

WVHVP had three home visitors begin the training and certification process to become a doula. The three home visitors should become certified in late June 2022. Research into funding options, marketing and enhancements to the home visiting programs using a doula was explored.

Due to a delay in training for the breastfeeding champion and lactation consultants, the project was pushed back to mid-summer 2022. The challenges of Zoom fatigue from all the online trainings became a barrier to have a lengthy online training.

Collaborate with WIC to assure that women receive evidence-based breastfeeding education.

The WVBA Director facilitated the WVBA Steering Committee and conducted quarterly virtual meetings with WVBA membership. The membership remained steady and quarterly virtual meetings were completed.

There was an improved facebook presence with increased numbers of followers for the West Virginia Breastfeeding Alliance (WVBA) page. Updates to the website and incorporating the WVBI were completed. A social media calendar is being developed to promote activities.

A new “WV Breastfeeding Discharge Resources” document is in the development stages. The intent is to distribute to all delivering facilities as well as Prenatal and Pediatric outpatient care providers.

During the WV Perinatal Partnership Spring conference, the WV School of Osteopathic Medicine and the WIC July conference, discharge resources were shared with participants. The WVPP continued to explore prenatal breastfeeding education options with efforts of hybrid training platforms. Two potential curriculums were identified, including the “Development of Prenatal “schedule” and guide for providers”. Continued planning on a webinar to promote the materials and train providers and staff.

A Spring Training was completed with the Outpatient Breastfeeding Champion Program with 35 participants. The participants included Registered nurses, OB clinic supervisors, pediatric clinic staff, WIC and home visitors.

As a result of the increased interest in the Certified Breastfeeding Specialist Training the number of available seats were increased to twenty. Free or reduced priced tuition was offered to participants in underserved areas of the State.

Offer evidence-based provider training

COVID continued to cause barriers on recruitment for Baby Friendly hospitals. Due to nursing shortages, limited in person training and meetings no additional hospitals were added during the year.

Provide support to hospitals working to become Baby Friendly

Started recruitment of WV birthing hospitals for EMPower Best Practices Initiative, a hospital-based quality improvement project aimed at improving evidence-based maternity care practices supportive of optimal infant nutrition through skills-based competency training and ongoing technical assistance.

Offer certified lactation training to WV providers to increase breastfeeding support after hospital discharge.

A directory of trained lactation support providers to improve breastfeeding education and support for pregnant and nursing mothers in the state is still being developed. Continuing education opportunities for lactation support providers complete with Lactation Continuing Education Recognition Points (LCERPs) is also still being developed.

An evidence-based feeding for hospital nursing staff webinar including newborn intensive care unit (NICU) Breastfeeding Course was completed. A survey was developed and distributed for hospital department managers, staff and clinic staff on training needs.

LCERP applications for WVPP Spring Conference and WV State WIC conference in July in process. The development of applicable lactation CE “Bundles” with Lactation Education Resources, Inc. at a low or no cost started in May 2022. The following presentations occurred:

• Drug Free Mother Baby Community Health Worker Training: Breastfeeding in the Substance Use Disorder Population Webinar (completed January 5, 2022)
• Hospital Breastfeeding Initiation Tips for Evidence Based Labor Support Workshop (March 28)
• WV Think Kids NAS Panel (April 22, 19 live participants)

Decrease infant mortality with an emphasis on Sudden Unexplained Infant Death (SUID)

Experienced barriers obtaining infant birth/death data from Vital Statistics. Continued discussion on a process to access records from out-of-state hospitals, out-of-state medical examiners, and WV law enforcement to complete comprehensive case reviews for all infant mortalities.

Continued use of remote access to electronic Health Information Management systems/medical records, in accordance with Memoranda of Understanding. Conducted comprehensive case ascertainment of birth and death certificates, medical records, Birth Score, Newborn Screening, Child Fatality Review summaries, and other documents relevant to the case. Working on recommendations to develop written procedural guidelines for the infant and maternal mortality review process, to assure standardization and continuity of a well-developed process.

Mail Back to Sleep materials to all families with a birth record.

The OMCFH mailed monthly “Safe to Sleep” materials to all families with a birth record. This mailing contained current information about risk factors such as co-sleeping/bed-sharing, early prenatal care, maternal smoking during pregnancy, infant exposure to second-hand smoke, and a safe sleeping environment. The OMCFH continued to provide current, relevant educational materials statewide to health care providers as well as parents, grandparents, and other caregivers of WV’s infants.

Offer evidence-based provider training.

Completed a Counts the Kick webinar in October with 31 participants. Promoted the www.CountTheKicks.org website and provided free materials to delivering hospitals and OB offices. The West Virginia Nurse journal published an article on the initiative in the Winter 2021 issue.

The community baby showers were delayed due to COVID and unable to provide in-person community baby showers. There were multiple virtual community events that RFTS participated in, however, in order to receive the full educational impact, the showers have been pushed back to summer 2022.

Activities continued to be delayed to COVID. Summer 2022 courses are planned to be offered if hospital staffing will enable adequate number of people to attend.

Utilize evidence-based curriculums to educate families on safe sleep environments.

At least 87% of home visitors completed the required annual competencies required for safe sleep education. The training transitioned to an online platform, including the annual competencies. Utilizing an online platform increased the number of people able to participate during one training and will continue to be utilized. Home visiting programs utilized an evidence-based curriculum with the appropriate handouts on safe sleep for every family enrolled.

Work with hospitals to develop safe sleep policies.

During the National Infant Safe Sleep month, a social media campaign reached over 8,000 people. 1,985 Sleep Baby Safe and Snug Board books were mailed to all hospital partners along with the new Safe Sleep Month Postcards and 1,054 Monthly Milestone Sticker Packets. A total of 7,247 hospital kits were sent to hospitals along with 11,220 safe sleep materials distributed.

Trainings provided to hospital and providers included Evidence Based Tools for Reducing Tobacco Exposure for Children and Families, Keeping WV Babies Safe, Infant Safe Sleep Education, and SUD and Stigma.

Increase Breastfeeding

Use evidence-based curriculums to promote breastfeeding, especially during home visits.

WVHVP will leverage the skills of home visitors and the use of evidence-based curriculum to provide breastfeeding support, increase access to lactation services and create sustainable community breastfeeding support. Breastfeeding education will be provided to all new home visitors within three months of hire. In addition, WVHVP will work with the WV Breastfeeding Alliance to develop trainings for more advanced home visitors to enhance their breastfeeding knowledge. The goal is for 15 home visitors trained to be lactation consultants.

Ensure that each home visiting agency (twenty-six) have a certified lactation consultant available for any mom requesting a lactation consultant during a virtual or in-person home visit.

Local home visiting programs will utilize their community relationships to increase the number of community partners that have breastfeeding friendly designation areas for women to breastfeed. WVHVP will work with community partners to follow the Ten Steps to Successful Breastfeeding as defined by the World Health Organization and Baby Friendly USA.

Work with breastfeeding partners on community base events spotlighting breastfeeding with a focus on education early in the pregnancy on breastfeeding and resources.

Home visiting programs will develop Breastfeeding Peer to Peer Support groups through private Facebook pages for women in their communities to encourage and empower moms to breastfeed.

Explore the use of a doula model for RFTS utilizing a partnership with the State’s Healthy Start grantee.

Provide a week-long series of Lunch and Learns for early childhood providers on breastfeeding. Each one-hour session will address a topic related to breastfeeding and will be provided during breastfeeding awareness month.

WVHVP will work with the Perinatal Partnership and trained lactation consultants to complete the week-long series of Lunch and Learns. Topics will include: breastfeeding and MAT, supporting moms that may not be able to breastfeed, exclusively breastfeed verses some breastfeeding.

Collaborate with WIC to assure that women receive evidence-based breastfeeding education.

The OMCFH and the Perinatal Partnership will coordinate with Office of Nutrition Services/WIC and Payors to improve breast pump, lactation services and donor milk coverage.

Will increase Prenatal Breastfeeding Education and Promotion by offering webinar for prenatal providers and toolkit of ACOG materials and encourage referrals to the WV WIC program for additional education and support.

• The WVBA Director will facilitate the WVBA Steering Committee and conduct quarterly virtual meetings with WVBA membership.
• Develop a robust website with resources for health care providers, parents, caregivers, businesses and communities.

Improve communication and social media to increase participation in statewide lactation efforts.

Coordinate with Office of Nutrition Services/WIC and Payors to improve breast pump, lactation services and donor milk coverage.

• Provide health care providers with current curriculum and materials for their patients.
• Train community-based providers on supporting breastfeeding through the Outpatient Breastfeeding Champion Program of IABLE (Institute for Breastfeeding and Lactation Education).
• Provide instruction and continuing education for all levels including:
  • Certified Lactation Counselor training or Certified Breastfeeding Specialist Training
  • Assistance with pathway to International Board Certified Lactation Consultant (IBCLC) designation
  • Provider training modules, and comprehensive course for clinical breastfeeding medicine scholarships

Assistance with pathway to International Board-Certified Lactation Consultant (IBCLC) designation.

Provider training modules, and comprehensive course for clinical Breastfeeding Medicine scholarships.

Maintain Lactation Support Directory through Zipmilk. Zipmilk, a website that helps mothers and providers locate breastfeeding support is based upon zip codes.

Offer evidence-based provider training

The Perinatal Partnership will coordinate with the WV Breastfeeding Alliance to update their website and social media pages to increase membership and participation in statewide lactation efforts and will provide essential updates, resources for training and best practices online.

Provide support to hospitals working to become baby friendly

Encourage hospitals to reach Baby-Friendly status with current educational information and presentations.

Facilitate recognition of hospitals that achieve Baby-Friendly designation at the Perinatal Summit and in news media sources.

Provide in-hospital (or online) training for providers and nurses as well as home educators.

• Proper tracking and reporting of breastfeeding intention and exclusivity at discharge by reporting information to Birthscore/Project Watch system.
• Assist with clinical portion of Baby Friendly required education hours.
• Assist with implementation of the 10 Steps to Successful Breastfeeding and how to improve mPINC scores.
• Publish Model Policy for Breastfeeding online.
• Improve rates of breastfeeding in the substance use disorder population.

Offer certified lactation training to WV providers to increase breastfeeding support after hospital discharge.

In partnership with the Perinatal Partnership, the OMCFH will facilitate a bi-annual WV Breastfeeding Conference bringing together providers, nursing staff and lactation support providers along with key stakeholders (would also serve as annual WV Breastfeeding Alliance membership meeting).

A directory of trained lactation support providers to improve breastfeeding education and support for pregnant and nursing mothers in the state will be developed and maintained. Continuing education opportunities for lactation support providers complete with Lactation Continuing Education Recognition Points (LCERPs) will be offered.

Provision of classes/meetings offering Lactation Continued Education Recognition Points (L-CERPs).

Decrease infant mortality with an emphasis on Sudden Unexplained Infant Death (SUID)

The OMCFH will utilize recommendations from the Infant and Maternal Mortality Review Panel to prevent future deaths when possible.

• Continue de-identified case review per established process to enable open discussion among panel members.
• Implement panel recommendations for post-review Quality Improvement of identified birthing hospitals, Emergency Departments, etc. in need of targeted outreach education/training as identified in the case review process. Develop best practice procedures to contact identified facilities with training needs.
• Expand existing perinatal outreach education by subrecipient grantee which most effectively allocates resources and prioritizes outreach education to facilities most in need.

Continue a strong collaboration with the safe sleep project, Our Babies: Safe and Sound to develop strong public awareness messages targeting parents and providers.

Mail Back to Sleep materials to all families with a birth record.

Within a month of delivery all women who deliver a live birth will receive back to sleep and safe sleep information in the mail. This mailing is generated from the Vital Statistics birth file.

Offer evidence-based provider training.

Vigorously market Count the Kicks as an outreach/educational strategy regarding the importance of tracking baby movements during the third trimester of pregnancy.

Work with early childhood programs (home visiting, head start, childcare) to promote with all pregnant women the CTK materials, website and app. Utilize parents enrolled as social media influencers on local agency social media platforms to promote the use.

Coordinate 8 community-based baby shower events sponsored by RFTS for pregnant women focusing on the third trimester of pregnancy and preparing for birth.

Facilitate stabilization of preterm or ill infants prior to transport to tertiary facility through STABLE (Sugar, Temperature, Airway, Blood pressure, Lab work, and Emotional support) infant stabilization program.

Facilitate stabilization of preterm or ill infants prior to transport to a tertiary facility through STABLE infant stabilization program. Provide STABLE workbooks and nurses to outlying delivering hospitals.

The Perinatal Partnership will provide safe sleep education to providers and encourage discussion with their clients.

Utilize evidence-based curriculums to educate families on safe sleep environments.

New home visitors will be required to complete the Say YES to Safe Sleep training modules before they begin adding families to their caseloads. Annual safe sleep competency trainings will be required for all home visitors. In addition, WVHVP will work with Our Baby Safe and Sound partners to develop more advanced level professional development regarding safe sleep for families impacted by substance use to ensure temporary caregivers are aware of safe sleep environments. Home visiting programs will utilize the Say Yes to Safe Sleep toolkit to continue and expand education with families enrolled and community partners. To better support nontraditional families enrolled, targeted messaging for grandparents, foster families and temporary caregivers will be updated to ensure cultural competency and sensitivity to the family. This will include reviewing and possible revisions to the Say YES to Safe Sleep Parent Brochure, Say Yes to Safe Sleep Grandparent brochure and Say YES to Safe Sleep Pledge Cards already being used.

Local home visiting programs will utilize their community relationships to increase the number of community partners that have Safe Sleep messaging displayed in their agencies. Community resources will be accessible for display upon completing the Say YES Educator Training Module developed by Our Baby Safe and Sound. This will include a description of initial, reinforcement and community education strategies to reach expectant parents and parents/caregivers of infants. Family Resource Networks, diaper pantries and food pantries will be targeted to include safe sleep messaging in materials provided to families.

Work with hospitals to develop safe sleep policies.

To ensure program fidelity and adherence to the latest American Academy of Pediatrics recommendations on Infant Safe Sleep, the Perinatal Partnership will sponsor the annual competency training for partners of the Say YES To Safe Sleep For Babies, including birthing hospitals, home visitation staff, and other community partners.

NPM - Percent of children, ages 6 through 11, who are physically active at least 60 minutes per day (Physical Activity, Formerly NPM 8.1) - PA-Child
Indicators and Annual Objectives

NPM - Percent of children, ages 1 through 17, who had a preventive dental visit in the past year (Preventive Dental Visit - Child, Formerly NPM 13.2) - PDV-Child
Indicators and Annual Objectives

NPM - Percent of children, ages 0 through 17, who live in households where someone smokes (Smoking - Household, Formerly NPM 14.2) - SMK-Household
Indicators and Annual Objectives

State Action Plan Table (West Virginia) - Child Health - Entry 1

Priority Need

Decrease smoking specifically among pregnant women and decrease smoke exposure among children in the household.

NPM

NPM - Percent of children, ages 0 through 17, who live in households where someone smokes (Smoking - Household, Formerly NPM 14.2) - SMK-Household

Five-Year Objectives

Strategies

NOMs

State Action Plan Table (West Virginia) - Child Health - Entry 2

Priority Need

Address substance use in pregnancy and in youth/teens.

SPM

SPM 3 - Increase the awareness of controlled substance use among children ages 5-17.

Five-Year Objectives

Strategies

State Action Plan Table (West Virginia) - Child Health - Entry 3

Priority Need

Decrease obesity among children.

SPM

SPM 4 - Percent of children, ages two to four, who are obese as defined as body mass index (BMI) at or above the 95th percentile on the CDC growth charts for age and sex.

Five-Year Objectives

Strategies

Offer evidence-based cessation curriculums to pregnant women, recently delivered women, mothers and other household members via home visiting services.

Home visitation programs continued to utilize evidence-based home visiting services for women that want to quit or reduce smoking. Smoking cessation referrals were made to the Quit Line. SCRIPT services continued to be challenged due to the home visits being virtual during the pandemic. The CO monitors were not able to be used to capture the most current CO values.

Provide evidence-based adolescent curriculum prevention programs in schools and tobacco/e-cigarette use prevention training for teachers.

It is well documented that smoking and the use of e-cigarettes are unsafe for kids, teens, and young adults. Nicotine can harm the developing adolescent brain, particularly the areas of the brain that control attention, learning, mood, and impulse control. Additionally, young people who use e-cigarettes may be more likely to smoke cigarettes in the future, including when they become pregnant and/or parents.

Research also suggests that adolescent smokers are less likely to quit if they become pregnant, compared to adult smokers. Smoking cessation interventions are recommended for this population to avoid the harmful effects of prenatal tobacco exposure (PTE) on the offspring of pregnant adolescents. This is particularly important because these mothers more likely become pregnant again and many will increase their level of tobacco use as they mature.

Prior to the COVID19 pandemic, the Adolescent Health Initiative (AHI) received an overwhelming number of requests for vaping information and prevention/cessation programs from nearly every high and middle school in the state. The AHI identified the curriculum program CATCH My Breath. CATCH My Breath is a best-practices youth E-cigarette and JUUL prevention program developed by The University of Texas Health Science Center at Houston (UTHealth) School of Public Health. The program provides up-to-date information to teachers, parents, and health professionals to equip students with the knowledge and skills they need to make informed decisions about the use of E-cigarettes, including JUUL devices. CATCH My Breath utilizes a peer-led teaching approach and meets National and State Health Education Standards. However, continual fluctuation of COVID19 rates and local outbreaks caused many counties to vary week to week between in-person and remote learning throughout 2021. This, in addition to the many social distancing and safety protocols, made it very difficult for schools to establish a routine, keep students on track with their core classes, and allow the AHCs entry to provide curriculum classes and presentations. However, the significant decrease in remote learning prevented virtual access to students. The pandemic also created an unprecedented level of stress and anxiety for students, parents, and school staff. Because of this, school priorities shifted and the AHCs devoted much of the school year providing mental health support, resources and trainings. Despite these numerous challenges, the AHCs were able to provide tobacco and vaping prevention education to over 1,400 students.

Disseminate prevention information, resources and materials to schools and the communities throughout the state including brochures, posters, social media posts, web site posts, YouTube, videos, etc.

Due to COVID19, school open houses, health fairs and community events were severely limited during much of 2021. However, there were a few events where the AHCs were able to distribute information including the Mason County Fair, the Lincoln County Recovery Event and Back to School Bashes in Cabell and Wood Counties, although attendance was very low at these events. The AHI was also able to facilitate a vaping prevention poster contest that had 75 participants. Ironically, the increase in in-person learning in 2021 made distributing printed information more difficult than in the height of the pandemic. Even though students were in class, no one except from school personnel was allowed in schools for much of the school year. When schools were remote learning, the AHI was able to utilize daily homework/assignment packets and daily lunch deliveries to distribute prevention materials. These avenues were no longer available in 2021 but school access remained severely restricted. Despite these barriers, the AHI distributed over 3,000 pieces of tobacco/vaping prevention and health related literature and shared 247 social media posts.

Substance use in youth/teens

Partner with medical providers to align with best practices in prescribing controlled substances to ensure optimum outcomes.

Alarming trends have been observed in West Virginia with regards to the prescribing of stimulants, a first-line pharmacological treatment for attention-deficit/hyperactivity disorder (ADHD). The 2019 estimated prevalence of ADHD in children 3-17 years of age in West Virginia was much higher than the national average at 13.2% versus 8.6% respectively. Moreover, in some counties in West Virginia up to one in four children within certain age groups were being prescribed a stimulant. While prescription stimulants may be first line therapy for ADHD where appropriate, the medications are controlled substances due to their risk for dependence, addictive properties, and potential for diversion. Likewise, these medications should only be prescribed where an appropriate corresponding diagnosis exists.

The initial plan was to develop an assessment, evaluation, and treatment guideline for ADHD in children and adolescents to be disseminated via academic detailing (educational outreach to medical providers) throughout the state. After additional analyses of stimulant prescribing trends in West Virginia, it has become evident that stimulant use in West Virginia is higher than national averages in children, adolescents, and adults. Harms are associated with the abuse potential of prescription stimulants without an appropriate diagnosis, and without appropriate assessment or follow-up; cardiac effects, growth impacts, and tic disorders may go unaddressed. Therefore, as a necessary preventive measure to ensure appropriate diagnoses are occurring and safe stimulant prescribing habits are implemented in the state with the highest rate of overdose deaths in the U.S., this educational effort was expanded to also target West Virginia’s adult population. Braided Title V and Centers for Disease Control and Prevention (CDC) now support this endeavor.

Facilitated by the West Virginia University School of Pharmacy with support from the OMCFH, a panel of experts from across the state first convened in November 2021 for the purpose of creating a statewide resource, i.e., treatment guideline, for managing attention-deficit/hyperactivity disorder (ADHD) in West Virginia. Comprising four practicing Psychiatrists, four practicing Licensed Psychologists, four practicing Pediatricians, three practicing Family Physicians, three practicing Pharmacists, three professional educators (two from the north and one from the southern part of the state), one Licensed Social Worker, the Medical Director and Pharmacy Director for West Virginia Medicaid, the West Virginia State Health Officer, the Executive Director of the West Virginia Board of Pharmacy (the state’s PDMP authority), and the OMCFH Director and Physician Director, this expert panel convened again in January, February and March 2022. To date, drafting of the West Virginia ADHD treatment guideline is approximately 80% complete.

Obesity among children

Implement the Key 2 a Healthy Start quality improvement initiative using the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) in 50 childcare centers each year.

WVBPH partners with KEYS4Healthy Kids (KEYS). KEYS is a partnership of community stakeholders that focus on creating policy, systems, and environmental (PSE) changes that support healthy eating, active living, and childhood obesity prevention. Key 2 a Healthy Start is a statewide initiative that was launched by KEYS.

In 2017, KEYS launched KEY 2 a Healthy Start, which involved 3 full-day trainings over the course of a year on nutrition, physical activity, and parent engagement. Centers completed a pre- and post- NAP SACC (Nutrition and Physical Activity Self-Assessment for Child Care), which is a quality improvement self-assessment. Centers who participated received site visits, one-on-one consultation, and became a part of the KEYS Peer Learning Network (PLN). Funding for KEY 2 a Healthy Start was provided by Claude Worthington Benedum (Benedum) Foundation and the WV Family Nutrition Program, which serves as WV’s SNAP-Ed Program.

Between October of 2020 and September of 2021, 55 NAP SACC Assessments were collected and 31 centers participated/received training.

These learning collaborative workshops are free to child care centers and participants receive WV STARS credits for professional development. In addition, participating sites receive physical activity equipment, MyPlate portion plates for each child 2-5 years of age in their center, indoor/outdoor garden elements (based on preference), and parent outreach materials.

Develop a Recognition Reward Program for Child Care Centers in nutrition and physical activity meeting 60% of Best Practices for nutrition and/or physical activity for sustainability of improved best practices.

The Earlier, the Better Initiative was launched in 2020 with funding provided by the Benedum Foundation. As part of this initiative, KEYS developed a recognition award for child care centers who demonstrated best practices (≥60%) in nutrition and physical activity.

In fall of 2020, KEYS opened applications for the 2021 Champion NAP SACC Award. During the first year, the applicants had to have previously completed KEY 2 a Healthy Start in order to be eligible. Applicants submitted a NAP SACC, and the top applicants’ scores were validated by a researcher CAMC Research Institute via EPAO (Environment and Policy Assessment and Observation). In April of 2021, 10 centers received the WV Champion NAP SACC Center Award (WVCNCA). The winners received a plaque, a promotional video featuring their center, and a monetary award of $3,000. The winners were announced at Celebrating Connections.

Applications for the 2022 WV Champion NAP SACC Center Award opened in October 2021 to all licensed child care centers in the state, regardless of whether they completed KEY 2 a Healthy Start. After following the same process from the previous year, 15 child care centers received the award. The winners were announced at the Celebrating Connections Conference.

In addition to the WV Champion NAP SACC Center Award, KEYS offered Healthy Environment Awards to centers. If selected, the center was awarded $1,000 to continue to enhance their learning environment. Applications were accepted in 3 different areas: Farm to Early Childhood Education (ECE); Natural Learning Environment; and Healthy Celebrations. In 2021, four centers were awarded.

Develop intensive training module for the best practices for breast feeding and infant feeding for STARS credit for all childcare centers in WV.

The Great Beginnings Infant/Toddler Conference was held in September of 2021, and many child care providers attended. Participants of the conference received STARS credit for professional development.

During the conference, participants were introduced to the WV Breastfeeding Friendly Child Care Designation (WVBFCCD), which was developed by the WVDHHR Infant/Toddler Division and supported by additional partners, including WV Perinatal Partnership, WV WIC, WV Breastfeeding Alliance, and KEYS 4 HealthyKids’ the Earlier, the Better Initiative. Presenters discussed the history of the initiative, the 10 Steps that were adapted for child care to increase breastfeeding duration, and training efforts and resources that are currently available.

Through collaboration and partnership, efforts are being made to increase the availability of training resources available to providers and other community partners; for example, the WV Breastfeeding Alliance and the Perinatal Partnership are working toward developing a WV Breastfeeding Institute. The Institute would offer trainings and resources, follow-up support programs, and certified breastfeeding specialist training. There are plans to offer scholarships to providers to take courses on breastfeeding and to eventually offer free or low-cost Continued Medical Education (CME). At this time, there has not been an established STARS training.

Develop social marketing campaign for Infant/Breast Feeding Friendly Child Care Centers and announce at Great Beginnings annual infant-toddler conference.

A social marketing campaign was developed in partnership with Division of Early Care and Education, West Virginia Supplemental Nutrition for Women, Infants and Children (WIC), KEYS, and the West Virginia Breastfeeding Alliance. This campaign is the West Virginia Breastfeeding Friendly Child Care Designation Initiative. The initiative provides support and education on breastfeeding to childcare centers. To obtain the designation, Child Care Centers must complete Ten Steps for Breast Feeding Friendly Child Care Centers. These steps were adapted from the Breastfeeding Hospital Initiative Ten Steps that were developed by World Health Organization (WHO) and United Nations Children’s Fund (UNICEF). After applying, centers are offered assistance and support along the way: Child Care Nurse Health Consultants, Child Care Health Educations and Infant/Toddler Specialists are available to lend their expertise and support. Training, educational materials and resources to create a breastfeeding space are made available.

This initiative was promoted and presented at the Great Beginnings Conference that was held virtually on September 23, 2021. The presentation described the components of the WVBFFD, including its history and purpose along with the training efforts and resources currently in use.

Develop a Recognition Reward Program for Infant/Breast Feeding Friendly Child Care Centers and announce at Great Beginnings annual infant-toddler conference.

A recognition reward program for child care providers has been developed and implemented. Upon the completion of the 10 Steps, providers receive a certificate of designation and a monetary award of up to $1,000. The first Breast Feeding Friendly Child Care Designation certificate was presented to a child care facility on September 2, 2021. Announcement was made at Great Beginnings Conference. Since the initiation of the designation 15 centers have applied and a total of 5 have been awarded the designation.

Each year, train at least 10 provider practices in an Obesity Prevention and Early Recognition training utilizing the American Academy of Pediatrics “5210 Pediatric Obesity Clinical Decision Support Chart.”

5210 is a set of recommendations for obesity prevention which stands for 5 servings of fruit and vegetables per day, 2 hours or less of screen time per day, 1 hours of physical activity per day, and 0 sugary beverages. A marketing and social media campaign was initiated this year. Keys4Healthy Kids has developed a music video featuring the message and offers a video that provides a tutorial for the dance.

In addition to the campaign for 5210, KEYS staff has been conducting trainings for healthcare providers on utilizing the American Academy of Pediatrics (AAP) “5210 Pediatric Obesity Clinical Decision Support Chart.” Dr. Jamie Jeffrey and team conducted a pre-workshop for 34 providers on 5210 Pediatric Obesity Clinical Decision Support Chart and prescription program (RX) during the WV AAP annual spring meeting held in April 2022. Each participant who attended the pre-workshop received a copy of the “5210 Pediatric Obesity Clinical Decision Support Chart” valued at $40.00. A Maintenance of Certification (MOC) II session was also offered on pediatric obesity and the “5210 Pediatric Obesity Clinical Decision Support Chart.”

Each year enroll at least five provider practices to participate in the 5210 Prescription (Rx) Initiative including “dispensing” produce, physical activity and drinking water “Rxs” with goal setting and tracking.

This is currently an ongoing initiative. The 5210 “Pediatric Obesity Clinical Decision Support chart” and the 5210 RX program in which providers write a prescription for physical activity, drinking water, or other healthy practices was presented during the Spring AAP annual meeting in April of 2022.

Through funding from WVBPH patients from provider practices have been able to participate KEYS cooking demonstrations virtually and in-person. From October of 2020 to September 2021, 24 cooking demonstrations have taken place with 188 participants.

With recent upgrades to WIC food package: Increase WIC participation rates-partner providers with local WIC office/staff; direct enrollment at birthing hospitals before discharge if WIC eligible and follow up by the one month EPSDT visit.

WV HealthCheck staff continued to provide WIC information on food packages as well as the eligibility guidelines to providers via virtual and face to face visits at routine intervals during the year. In addition to this, all new HealthCheck enrollees under the age of 5 that are not enrolled in managed care will be starting to receive WIC brochures in HealthCheck initial welcome packets in the upcoming year.

Increase CACFP participation and retention rates to that full utilization of federal CACFP funds are brought into WV: re-launch Leap of Taste standards with statewide training initiatives for OCN, QRIS quality specialist, health educators, nurse health care consultants and other resource and referral staff; including cook/kitchen staff “scratch” cooking training.

Currently this initiative has not been accomplished. The Leap of Taste Standards have not been re-launched and partnerships have not been able to be secured to move this initiative forward.

Incentivize Farm to ECE (same was done with farm to school but did not include childcare centers in ECE).

KEYS connects child care providers to local farmers through kids pop up markets. Between October 2020 and September of 2021, 61 kids pop up farmer’s markets were conducted. Kids were given vouchers to purchase fresh produce at the market. Approximately 500 kids were served at these markets and $13,395.00 in vouchers were redeemed. Child care centers are also offered leftover produce at discounted rates to encourage the center to cook and serve healthy meals to the children in their care.

Additionally, KEYS offers garden-based learning opportunities to child care centers. KEYS conducted 3 trainings this year – 2 virtually and one in-person. Each training is led by a garden coordinator that helps centers learn to garden and how to incorporate gardening into the curriculum. After the training, the garden coordinator visits each site to offer one-on-one support.

Furthermore, through the Earlier, the Better Initiative KEYS piloted the first Central Kitchen. Two centers in Marion County participated in the pilot. Central Kitchens receive fresh, local produce, prepare chef-led meals from scratch, and then finally distribute the meals to child care centers. The nutritional-density of these meals exceeds CACFP standards.

Improve ECE licensing standards for obesity prevention – According to “Achieving a State of Healthy Weight,” many of the 47 Caring for Our Children obesity prevention standards are either partially met or missing, and a few are contradictory. Licensing regulations will not be reviewed again until 2023.

Licensing regulations will not be reviewed again until 2023. Opportunity for review and improvements have not been formally discussed as of this year. Opportunity during the next year will be available via the WV Early Childhood Advisory Committee (ECAC) meetings which discusses many topics involving early childhood education included prevention of pediatric obesity through the KEYS program and the earlier the better initiative.

Offer evidence-based cessation curriculums to pregnant women, recently delivered women, mothers and other household members via home visiting services.

Develop a resource list for families on evidence-based smoking cessation strategies by region. Partner with the WV Quit Line and Tobacco Free Moms projects as a referral source. Incorporate the referral process into a new online resource/referral platform that will ease the referral process for both home visitors and families.

Add a smoking cessation training for all home visitors that is completed by a certified Smoking Cessation Specialist. Update the SCRIPT process with the most current handouts and “best practices” for pregnant women and utilize a tiered incentive process for women who successfully meet goal to reduce or quit smoking.

Provide evidence-based adolescent curriculum prevention programs in schools and tobacco/e-cigarette use prevention training for teachers.

Recognizing that a primary prevention approach is an effective way to avoid PTE and second-hand tobacco exposure for children, the AHI will implement evidence-based prevention and cessation strategies in schools and communities across the state. The 2018 WV School Health Profiles survey indicates that nearly all schools have a policy that prohibits the use of tobacco and vapor related products and most schools require students to take at least one tobacco prevention class. However, only 40% of the schools reported providing tobacco-use prevention information to the families of their students and only 30% of teachers reported receiving cessation training in the last 2 years. Nearly 60% of teachers stated they would like to receive additional training in tobacco use and vaping prevention. School staff members are struggling to identify vaping devices as they keep changing and look like other devices, such as thumb drives. Knowledge about nicotine addiction and vaping seems to be growing, however the AHCs have found many students and parents still believe vaping is safe. Many still view vaping as a “safe” alternative to smoking for teens and pregnant mothers. Schools are also reporting a significant increase in Tetrahydrocannabinol (THC) laced vaping devices. Prevention information and programming specific to THC vaping is very limited. The AHI will address these gaps in needed trainings and information by providing evidence-based curriculum programs in schools and professional development training for teachers, both in-person and virtually; while continually researching developing trends to provide the most current and accurate information.

Disseminate prevention information, resources and materials to schools and the communities throughout the state including brochures, posters, social media posts, web site posts, YouTube, videos, etc.

The social learning theory is also important in school- and community-based primary prevention. The AHI will utilize this strategy by disseminating prevention information, resources and materials throughout the state in schools, community centers, School-Based Health Centers and other youth-serving organizations. Recognizing that virtual programming will remain prevalent post-pandemic, the AHI will also implement a multi-media intervention utilizing web pages, social media and developing and/or distributing materials such as posters, social media posts, YouTube videos, etc. These items will contain brief messages that address educational goals such as a positive view of not smoking or vaping, a negative view of smoking or vaping, relevant health and statistical information, skills for refusing nicotine products and the perception that most people their age do not smoke or use vapor products. The AHI is also developing a new and improved website that will offer information and resources on many adolescent health related topics.

Substance use in youth/teens

Partner with medical providers to align with best practices in prescribing controlled substances to ensure optimum outcomes.

In partnership with the West Virginia University School of Pharmacy and in coordination with a panel of experts from across the state, the draft West Virginia ADHD treatment guideline will be finalized no later than the fall of 2022. Upon completion of the draft, various sections will be appraised by subject matter experts within the expert panel before posting in a shared location for all panel members to review and comment. Supplemental information and reference materials for use in the evaluation, diagnosis and treatment of ADHD in West Virginia will be included. The finalized West Virginia ADHD treatment guideline will be accessible via public website by the end of 2022. To promote uptake and increase dissemination of the finalized West Virginia ADHD treatment guideline, academic detailing will be initiated statewide via four full-time trained pharmacists no later than late-spring 2023. The intent of this effort is to facilitate prescribing behavioral changes to better align with evidenced-based, guideline-recommended, best practice. Initially, higher burden counties in West Virginia will be identified through public health surveillance of prescription drug monitoring program (PDMP) data to allow for a targeted academic detailing approach. As an incentive for providers to participate in academic detailing sessions, continuing education (CE) will be provided.

Lastly, a plan to assess impact of the West Virginia ADHD treatment guideline will be developed. The proposed evaluation plan will include survey administration to monitor provider impact and behavioral changes, evaluation of prescription stimulant prescribing trends in West Virginia, and analyzing and evaluating West Virginia Medicaid claims data for stimulant prescribing patterns when an ADHD diagnosis is not present.

Obesity among children

Develop intensive training module for the best practices for breast feeding and infant feeding for STARS credit for all childcare centers in WV.

WV HealthCheck will continue to participate and collaborate with WV Early Childhood Advisory Committee (ECAC) to support efforts put forward by the WV Breastfeeding Alliance to establish the WV Breastfeeding Institute. The WV HealthCheck program director will participate in ECAC meetings and support all efforts in planning and dissemination of training programs developed for Breast Feeding Institute to health care providers and childcare agencies that the OMCFH partner with to enhance knowledge among health care providers and community partners including childcare centers.

Train at least 10 provider practices in an Obesity Prevention and early Recognition training utilizing the American Academy of Pediatrics “5210 Pediatric Obesity Clinical Decision Support Chart.”

The OMCFH and WV HealthCheck will continue collaborating with KEYS4Healthy Kids to support training of at least 10 providers within the year on the “5210 Pediatric Obesity Clinical Decision Support Chart”. A meeting with medical director for KEYS4Health Kids will be established in the next 3 months to discuss HealthCheck and OMCFH support of initiative.

Each year enroll at least five provider practices to participate in the 5210 Prescription (Rx) Initiative including “dispensing” produce, physical activity and drinking water “Rx” with goal setting and tracking.

Within the next 3 months, WV HealthCheck director will establish a meeting with medical director for KEY4Healthy Kids to discuss the 5210 Prescription (Rx) Initiative. The discussion will allow HealthCheck staff and KEYS4Healthy Kids to develop an integrated work plan with expectations and roles. The overall goal at the end of the year will be that at least 5 provider practices are participating in prescribing produce, physical activity, or another healthy habit to children.

Improve ECE licensing standards for obesity prevention – According to “Achieving a State of Healthy Weight,” many of the 47 Caring for Our Children obesity prevention standards are either partially met or missing, and a few are contradictory. Licensing regulations will not be reviewed again until 2023.

Licensing regulations are to be reviewed in 2023. HealthCheck Director will attend WV ECAC meetings. WV ECAC has a subcommittee on policy that provides information and support on ECE licensing standards. WV HealthCheck and OMCFH will work to support initiatives to fullest extent regarding ECE licensing standards. Licensing standards will be discussed with KEYS4Healthy Kids medical director in upcoming meeting to be scheduled within next 3 months to discuss licensing standards and improvements that may be supported by the OMCFH.

Analyze statewide height, weight, and BMI data for WV HealthCheck/EPSDT population

In the upcoming year, WV HealthCheck will complete analysis of height, weight, and body mass index (BMI) data from a representative sample of HealthCheck/EPSDT visits for children ages 0 through 20 years of age. The information collected and analyzed by an OMCFH epidemiologist will serve to provide data driven decisions around childhood obesity rates of the Medicaid population. The information will be shared with BPH partners and medical providers and provide baseline data for quality improvement initiatives within the Office of Maternal, Child and Family Health. Height, weight, and BMI data was collected as a part of medical review of 2020 annual well-child visits.

WV HealthCheck will conduct a survey of at least 100 individual medical providers that provide EPSDT/HealthCheck services regarding childhood obesity, intervention/referral, and community resources.

Within the next year, WV HealthCheck director and epidemiologist will construct survey for medical providers to assist in determining each HealthCheck regions practices, interventions, and resources for clients who are diagnosed with childhood obesity. The survey will ask providers about what determines intervention, if referrals are made, and any community resources that they are aware of or utilize for children who have an elevated BMI. Based upon this survey, needs of WV HealthCheck providers will be evaluated and intervention developed to address needs.

WV HealthCheck will provide outreach during community events (ie. Health Fairs, Community events) and disseminate resources and provide education to at least 50 families on USDA MyPlate and 5210 recommendations.

WV HealthCheck will provide educational handouts and promotional materials to at least 50 families during community events to educate on healthy habits to prevent childhood obesity. This material will include information regarding 5-2-1-0 healthy habits and USDA MyPlate initiatives to encourage healthy lifestyle and nutrition habits among the pediatric population. WV HealthCheck Specialists attend numerous community events in which they meet families that may not have access to a primary caregiver or physician and have never received information on healthy nutrition practices.

Distribute WIC resources to families to upon initial HealthCheck enrollment of any child age 0-5 years of age to encourage increased WIC participation rates.

WV HealthCheck Program Specialists distribute WIC resources to health care providers every year. However, in the past HealthCheck has not distributed WIC resources with the emphasis on enrollees. Through the HealthCheck Outreach Specialists, who are responsible for effective informing of well-child visits for fee-for-service clients, WIC brochures will be offered in initial EPSDT/HealthCheck welcome letters for any child entering that is 0-5 years of age.

In addition to this, WV HealthCheck director will engage Managed Care Organizations (MCO) to inquire if WIC information is provided to children receiving the EPSDT benefit through the MCO.

Analyze extent to which Farm to ECE has an impact on healthy eating habits in children.

A research study was conducted by Dr. Jamie Jeffrey, KEYS4Healthy Kids medical director, to look at the effect of biweekly kids’ pop-up farmers markets on children’s eating habits in 2021. Results have not been finalized but are intended to be finalized within the year. The study includes 9 centers that participated in the intervention (pop-up markets biweekly) and 10 centers in the control group (did not receive any pop-up markets). Once finalized results are received, this will allow for data driven decisions and recommendations to be made on the effectiveness of Farm to ECE efforts.

NPM - Percent of adolescents, ages 12 through 17 who are physically active at least 60 minutes per day (Physical Activity - Adolescent, Formerly NPM 8.2) - PA-Adolescent
Indicators and Annual Objectives

NPM - Percent of adolescents, with and without special health care needs, ages 12 through 17, who are bullied or who bully others (Bullying, Formerly NPM 9) - BLY
Indicators and Annual Objectives

NPM - Percent of children, ages 1 through 17, who had a preventive dental visit in the past year (Preventive Dental Visit - Child, Formerly NPM 13.2) - PDV-Child
Indicators and Annual Objectives