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Maternal, Child and Adolescent Health (MCAH) Program Fiscal Year 2017-18 Annual Report

Agency: Fiscal Year: 2017-2018 Agreement Number:

1 2011-2015 Title V State Priorities 2 Title V Requirement

MCAH Annual Report, May. 2018 Pages 1 of 48

Complete this table referencing your fiscal year 2017-18 MCAH Scope of Work (SOW). When describing activities, accomplishments, barriers and solutions, use lists, bullets and very short narratives.

Submit the Annual Report(s) following these directions:

Document format: a. Submit all documents requiring an original signature in PDF format. b. Submit all other documents in Word format.

Naming convention: Title your reports with your LHJ name, the fiscal year, the program name, and the type of report, for example “Alameda 17-18 MCAH AR, where AR means “Annual Report”.

Email all components of the Annual Report(s) to the email box for the applicable program: a. Submit MCAH and FIMR reports to [email protected] b. Annual Reports are due by August 15, 2018

Goal 1: Increase access and utilization of health and social services (cross-cutting)

o Increase access to oral health services1

o Increase screening and referral for mental health and substance use services1

o Increase utilization of preventive health services1

o Target outreach services to identify pregnant women, women of reproductive age, infants, children and adolescents and their families who are eligible for Medi-Cal assistance or other publicly provided health care programs and assist them in applying for these benefits

2

o Provide developmental screening for all children1

Short and/or Intermediate Objective(s)

Place Evaluation/Performance Measures in the Two Columns Below

Process Measures Short and/or Intermediate Outcome Measures

1.1-1.6 All women of reproductive age, pregnant women, infants, children, adolescents and children with special health care needs (CSHCN) will have

Assessment – Briefly list or describe here: 1.1 This deliverable will be fulfilled by completing and submitting your

Community Profile with your Agreement Funding Application each year

NOTE: Do not enter anything here except for the date you shared

Although specific data is not required for this objective, the below speaks to the local MCAH Field Nursing Unit (FNU) Data: MCAH Field Nursing served 1455 unique individual families.

mailto:[email protected]








access to:

Needed and preventive medical, dental, mental health, substance use services, and social services

Early and comprehensive perinatal care

An environment that maximizes their health

your data with health department leadership. This objective will be fulfilled by completing and submitting your Community Profile with your Agreement Funding Application

4/5/18 Date data shared with the key health department

leadership. Briefly describe responses or outcomes received below, if significant. The Community Profile was shared with key Santa Barbara Public Health Department Leadership with the following responses:

1. Concerns around families accessing care and community resources given the recent change in presidential administrations as it relates to immigration. Staff was educated on immigration resources available within the community to share with clients. Staff was also instructed to educate and encourage clients to seek healthcare when needed as there is no relationship between healthcare, detention and deportation status.

2. Concerns about the future number and availability of pediatric providers in the Santa Maria area, which is the northern part of the County, given that region of the county has been growing in population and has the highest number of births in the County. The Health Department has been in discussions with CenCal, the County’s MediCal Managed Care, in looking at ways to increase the number and availability of pediatric providers in the Santa Maria area to accommodate the forecasted need.

3. Concerns about the reduction in AFLP funding. Though the number of teen births in the County has been on a downward trend, the need for programs such as AFLP are still critical to help build and provide teen mothers with the support and resources they need to succeed.

Santa Maria 659

Santa Barbara 500

Lompoc 296 Of the 1455 families, 54% (790) were postpartum mothers, referred by the SBC PHD Health Care Center OB departments, which had a home visit for case management services. Program Standard: See 75% of postpartum referrals within 5 working days of mother’s discharge date. Goal met = 87% (690/790) Program standard: See 85% of high risk referrals within 10 working days of referral date. Goal almost met = 84% (891/1055)

There were 1085 women, 13 years of age and older, seen by the Field Nursing Unit (FNU). Of the 1085 women, 86% (929) had Medi-Cal as their insurance source (124 women were missing data). Race & Ethnicity, as self-identified by these women over 12 years of age, served by the FNU are as follows (denominator 1065):

88% (940) Hispanic; Hispanic (791), Hispanic-mixed (7), Mexican/Mexican American/Chicano (139), Other Hispanic/Latino (3)

7% (78) White/Caucasian

2% (17) Other

1% (12) Asian; Asian (3), Chinese (2), Filipino (2), Filipino (2), Korean (2), Middle Eastern (2),








Supplemental data to previously submitted Community Profile: Race and Ethnicity of All Births in SBC, 2016 White 28.6% (1574/5501) Hispanic 64.5% (3548/5501) Black 0.78% (43/5501) American Indian 0.3% (15/5501) Asian 4.0% (220/5501) Asian Pacific Islander 0.0% (3/5501) Multi-race 1.8% (98/5501) Medi-Cal births by SBC Geographic Area (3207/5,501 births in 2016) show that 58.3% of births are to women on Medi-Cal county-wide. 77.2% of births in North County were to MediCal recipients.*

Region N %

North 2061/2670 77.2%

Central 493/1046 47.1%

South 646/1770 36.5%

15 births lacked zip code information; 7 of which were to MediCal delivered babies* Infants whose mothers received prenatal care in the first trimester in SBC by race and ethnicity in 2016 White: 87.0% = 1369/1574 (24.9% of SBC births) Hispanic: 74.1% = 2628/3548 (47.8% of SBC births) Multicultural: 94.4% =84/89 (1.5% of SBC births) African Americans: 72.1% = 31/43 (0.6% of SBC births) Asian: 88.6% = 195/220 (3.5% of SBC births) American Indian: 93.3% = 14/15 (0.3% of SBC births) Asian Pacific Islander: 66.7% = 2/3 (0.04% of SBC births) TOTAL: 78.6% = 4323/5501*

Vietnamese (1)

1% (13) Black; African (1), Black (10), Caribbean American (1), other Black/African American (1)

0% (2) American Indian

0% (2) Missing data 25 Pregnant High Risk Teens were served by the MCAH Field Nursing Program between 7/1/17-6/30/18:

Santa Maria – 2 females

Santa Barbara – 6 females

Lompoc – 17 females 213 Non-pregnant High Risk Teens Served by MCAH Field Nursing Program between 7/1/17-6/30/18: Countywide – 202 females and 11 males

Santa Maria – 123 females and 3 males

Santa Barbara – 40 females and 2 male

Lompoc – 39 females and 6 males 16,295 community-wide referral sources were discussed or referred to by the FNU.








In 2016, 5.8% (321/5501) of total births in SBC were to teens (defined as age of mother 15-19)** The teen birthrate decreased in 2016 to 16.8 births (in every 1000 teen women in SBC). This compares to a teen birthrate of 19.7 in 2015, 20.1 in 2014, 23.6 in 2013, and 25.3 in 2012** There were 321 births to teenage mothers/19,084 SBC teenage female population. This is equal to 16.8 births per 1000 population or one birth in every 59.5 teenage females compared to the most recent info for CA is a 2014-2016 three-year average of 18.8 births per 1000 teenage females or one birth in every 53.2 teenage females. ** 2016 data shows that 8.3% (294/3548) of births to Hispanic women were to teens in SBC (defined as 15-19 y.o) compared to 9.3% (346/3709) in 2015 and 9.2% (346/3761) in 2014 (of the 2016 births to SBC teenage mothers (N=321), 91.6% of the mothers were Hispanic.)* 2016 data shows that the proportion of teen births are higher in the North (Santa Maria/ Guadalupe Cities) and mid-county (Lompoc) than in the South County (Santa Barbara/Carpinteria): Guadalupe: 5.88% (8/136) Santa Maria: 8.07% (204/2527) Lompoc: 5.61% (47/838) Santa Barbara: 2.35% (29/1235) Carpinteria: 3.52% (7/199) 7.1% of live births in SBC (2016) weigh less than 2500 grams (5.5 lbs) compared to an average of 6.3% from 2014-2016 for CA.¥ *California Department of Public Health, Center for Health Statistics, Vital








Statistics Section, Birth Statistical Master Files. ** State of California, Department of Finance, State and County Population Projections by Race/Ethnicity, Detailed Age, and Gender, 2010-2060. Sacramento, California, January 2018. ¥https://www.cdph.ca.gov/Programs/CHSI/CDPH%20Document%20Library/CHSP-SANTABARBARA.pdf

1.2

11Report the total number of collaboratives with MCAH

staff active participation

Submit online Collaborative Surveys that document participation, objectives, activities and accomplishments of MCAH –related collaboratives. The Collaborative Survey is an on-line survey located at: Collaborative Form 2018

The MCAH Director is a member of the following community collaborative meetings:

– KIDS Network – survey completed – Child Abuse Prevention Council (CAPC) – survey completed – Children’s Oral Health Executive Committee (COHEC) which

transitioned to the Oral Health Advisory Committee (OHAC) to include adults – survey completed

– Santa Barbara Neighborhood Clinic (SBNC) and Child Abuse Listening Mediation (CALM) ACE Initiative – SB Resiliency Project – survey completed

– SBUSD Readiness Summit – survey completed

Briefly list or describe here:

1.2 List policies or products developed to improve infrastructure and address MCAH priorities.

SBC MCAH developed a training on the NEAR@Home curriculum in order to address ACEs in home visiting programs which was shared with local CBOs.

The following brochure was created by SBC MCAH and approved by State MCAH 6/19/18:

o “Caring for substance exposed babies”

The following brochures were created by SBC MCAH and as of 6/30/18 awaiting final approval by State MCAH:

o “Pregnant and Using” o “Maternal Mental Health”

The following brochure was updated by First 5 and other collaborative partners:

o First 5 “Healthy Teeth for Healthy Kids”

KIDS Network o Contributed to Children’s Scorecard

https://www.cdph.ca.gov/Programs/CHSI/CDPH%20Document%20Library/CHSP-SANTABARBARA.pdf

https://www.cdph.ca.gov/Programs/CHSI/CDPH%20Document%20Library/CHSP-SANTABARBARA.pdf

https://www.surveymonkey.com/r/LQ7KNB6








A Field Nursing Unit PHN attends:

– DART/CHART – Dental Access Resource Team and Children’s Health Resource Team – sub-committees of COHEC and CHISB. This information is incorporated as workgroups for the Children’s Oral Health Executive Committee COHEC/OHAC

– Santa Barbara County Breastfeeding Coalition – THRIVE Meetings

PSC/MCAH Coordinator attends:

– Perinatal Wellness Coalition (PWC) – Dignity Health Maternal Mental Health (MMH) Committee – survey

completed – Regional PMAD Collaborative – Early Childhood and Family Wellness Coalition (EC+FW) – survey

completed

(publication evaluating general well-being of children within the county). Publication released on 6/5/18

o Collaborative discussed, identified, and addressed existing and emerging needs for the community specifically related to children and families.

CAPC o ACES Science presentation developed for

medical providers

COHEC o Oral health month resolution o Applied for “Smiles Across America Early

Childhood Caries Prevention Project targeted at Headstart and Early Headstart oral health prevention.

SBNC and CALM ACE Initiative o Participated in advisory group to

implement pilot project based on Center for Youth and Wellness (CYW) framework to screen and address ACEs at a local Federally Qualified Healthcare Center (FQHC). Provided oversight and suggestions to process/policies for interventions when children screen greater than 2 on ACEs. Project group developed Clinical Care Model for Children Exposed to ACES and Clinic visit Script. Evaluation processes were developed by the project group with UCSB as the lead.

SBUSD Readiness Summit








o Communication strategies developed for schools re: ACEs

o Referral process for schools re: ACEs

Dignity Health MMH o MMH Provider Algorithm developed o 2-1-1 Resource guide developed o Provider and community trainings on

MMH 10/26-10/27/18

EC+FW o Began development of a brochure of

resources for child developmental sorted by protective factors– will be completed in FY 18/19.

Policy Development - Briefly list or describe here: 1.3

1. Efforts to develop policy and systems changes that facilitate access to Medi-Cal, Medi-Cal Access Program (MCAP), Covered CA, Child Health and Disability Prevention Program (CHDP), Women, Infants, and Children (WIC), California Children’s Services (CCS), Family PACT, Text4Baby, and other relevant programs.

2. List formal and informal agreements, including Memoranda of Understanding with Medi-Cal Managed Care (MCMC) plans or other organizations that address the needs of mothers and infants.

Assisted in facilitating MOU between CAC PYD clients and SBCPHD HCC to provide facility tour and establish processes to help establish MediCal services specific to the teen population.

Updated standardized procedure to facilitate easy access and scheduling

Briefly list or describe here: 1.3 The impact of policy and systems changes that

facilitate access to Medi-Cal, MCAP, Covered CA, CHDP, WIC, CCS, Family PACT, and other relevant programs.

Teens have additional resources to seek MediCal services related to teen health and family planning. Warm handoffs and improved communications regarding client needs were enhanced through clarity and trainings re: services offered Staff were able to standardize assessments and interventions related to MediCal, MediCal services, and other relevant programs.








related to PHD lactation services. MCAH has continued to outreach to Cen-Cal Health to facilitate an updated MOU for CPSP services. However, Cen-Cal health has had to focus many resources on the CCS carve-in which goes into effect 7/1/18. Both agencies agreed to continue MOU discussions in the next fiscal year. MCAH program identified policy needs to address standardization of home visits related to MediCal, MediCal related services, and other relevant programs. Policies were developed, documentation forms updated, and staff in-serviced on new policies. Policies include:

MCAH Home Visiting assessment

MCAH Home visiting assessment: Basic Needs/Housing/Physical Environment

MCAH home visiting assessment: community living needs/vocational-educational

MCAH home visiting assessment: Medical, Dental, Mental Health

MCAH home visiting assessment: Familial-Social Support/Social-Emotional

The SBC PHD remains a leader in the outreach and enrollment community in coordination with Department of Social Services, County Education Office and Behavioral Wellness. An Interagency Committee facilitated by the PHD meets monthly during the enrollment season and as needed during the remainder of the year. The PHD Health Care Centers (HCC) staff Covered California Certified Application Counselors (CACs) at all locations. The PHD ensures that enrollment and renewal services are available to anyone in the community. The PHD has established a Benefits and Referral Center (BRC) to assist with outreach and enrollment efforts and Medi-Cal renewal services

The PHD had 24 Certified Application Counselors (CACs) complete recertification training and currently has 24 CACs. To date the PHD has assisted over 5,596 community members with enrollment and renewal information. This included assisting clients with completion of applications for those enrolling. The PHD estimates that more than 1,851 people were enrolled into Medi-Cal or a Covered California health exchange plan. Over 3,745 individuals have been assisted with renewals.

CenCal Members Assigned FY17/18

Clinic Members

Carpinteria HCC

2,543

Franklin HCC

4,385

Santa Barbara HCC

6,773

Lompoc HCC

10,726

Santa Maria HCC

4,872








throughout the county. PHD has created, updated and continues to broadly distribute brochures and other language appropriate marketing materials to inform our community about ACA and its benefits. The PHD continues to participate in community events, including health fairs and farm worker events, to educate the community on health coverage benefits and enrollment options. The goal of the PHD is to continue to stay focused on our outreach and enrollment activities.

Briefly list or describe here: 1.4 Trainings attended or provided and numbers attending Staff development at MCAH staff meetings:

PHD Travel Claims Process 9/19/2017

MediCal/CalFresh/CalWORKS and CalLearn 9/19/2017

Community Resiliency Model (CRM) Training 11/8/17

NEAR@Home Training 1/16/2018

Neonatal Abstinence Syndrome Overview - Mary Richards (Marian) 4/10/2018

CRM Skills 6/13/2018

NEAR@Home Training Refresher Training 6/18/2018 Community Classes:

CRM Train the Trainer Course 8/22/17 - 8/25/17

California Infant Health Feeding Guide Webinar 8/29/2017

Cottage Hospital Child Abuse Prevention Symposium 9/8/2017

2017 SIDS Coordinator Meeting 10/5/2017

2017 Annual SIDS Conference 10/6/2017

Briefly list or describe here: 1.4 Outcomes of workforce development trainings in

MCAH and public health competencies, including but not limited to, knowledge or skills gained, practice changes or partnerships developed.

All MCAH Field Nursing Unit (FNU) staff either attended the classes or the information was reviewed after at staff meetings. All PHN’s in the FNU attended a blood borne pathogen class, disaster, and nursing skills training.

Attendance at educational opportunities has allowed staff to be better informed of available community resources which they have incorporated into their education of clients. Learnings from the various classes have also facilitated the following, but not limited to:

Improved capacity to address Adverse Childhood Experiences (ACEs), impact on health outcomes, resilience, and referrals for needed to MediCal services.








Bridges to Resilience 10/16/2017

CPSP In person Provider training 10/19/2017

Berkeley Media Group: Messaging for MCAH 10/25/2017

Dignity Health Maternal Mental Health 10/26/2017

Health Eating Active Living Summit 11/2/2017

Preparing for Recreational Cannabis 11/3/2017

CPSP Billing Training (FQHC) 11/28/2017

CPSP Billing Non FQHC 11/30/2017

Dr. Nadine Burke-Harris on ACEs at UCSB 4/16/2018

PSI PMAD Certificate Training 5/30/18 and 5/31/18

Sexual Orientation/Gender Identity Training 5/16/2018

Youth Thrive 6/15/2018 PHD Classes:

Civil Treatment Training 9/14/17

PHD Privacy and Security Training 9/8/2017

PHN/RN Privileging 9/18/2017

3rd Floor Disaster Training 9/22/2017

OCHIN PM Super user Training 9/26/17 - 9/27/17

SBCPHD Women's Case Conference 10/25/2017

PHD DOC Disaster Exercise 11/16/2017

OCHIN Practice Management Training 11/28/2017, 11/29/2017, 11/30/2017, 12/5/2017, and 12/6/2017

EMR End user training 1/9/2018

CPR 3/16/2018 Webinars:

Cannabis: California Laws & Public Health Implications Webinar 9/7/2017

Greater knowledge to educate and provide resources for clients on the impacts of cannabis in various special groups such as children, pregnant, and lactating women.

Improved ability to identify signs/symptoms, screening tools available, self-care and treatment options for women experiencing perinatal mood disorders.








Compliance Program and Fraud Waste Act Training - dates varied

Zika State Call 9/27/2017

MIHA Stakeholder meeting 10/17/2017

Intersectionality in Perinatal Mental Health 11/9/2017

Baby Teeth Matters: Oral Health Collaborative 11/7/2017

Caring for the provider 1/19/2018

Prenatal SIG webinar series 2018: Opioids in Pregnancy and Lactation 1/18/2018

An Overview of California's MMH Strategic Plan 2/14/2018

Understanding and Preventing Preterm Birth from a Public Health Perspective 5/3/2018

Briefly list or describe here: 1.5 Activities to facilitate referrals to health insurance and programs. Training session on Every Woman Counts (EWC) offerings and services was conducted during staff meeting. Discussed eligibility for EWC and relevancy to the population seen through MCAH home visitation.

DSS came to staff meeting to speak about Medi-Cal and state funded programs. Eligibility, benefits, and application processes were discussed

Outreach: PSC and other MCAH staff attended health fairs, some in collaboration with CHDP. Information was provided on access to care and health insurance as well as healthy messaging for pregnant women including nutrition, folic acid, perinatal mental health and substance use, well-baby care, and healthy living. PSC interfaced with the Medi-Cal population at the following health fairs/ community meetings with discussions on how to access Medi-Cal and Medi-Cal related services:

Complete the table below: 1.5 The number of referrals your local MCAH Program

made to Medi-Cal, MCAP, covered CA, CCS, or other no/low cost health insurance programs for health care coverage. (Insert numbers in the table).

Program

Name

Medi-Cal

MCAP CovCA

CCS *No/low cost health insurance

Number Referred

850 XXX XXX 27 XXX

*Identify the no/low cost health insurance programs here The data above is specific to Field Nursing Unit actual referrals and based on individual clients.








“A Safe City for You and Our Children” Panel – 8/21/17

Reiter Berry Farms Health Fair – 10/1/17 – 400 participants

Carpinteria Children's Project Family Resource Center Health Fair

– 10/10/17 – 212 participants

Cen-Cal Health Member Event – 1/20/18

MCAH Director and Coordinator provided a resource table on MCAH services during the “Bridges to Resilience Conference” on 10/16/17. Attendees included direct service providers for MCAH population.


1.6 Methods of communication, including the cultural and linguistic challenges and solutions, to linking the MCAH population to services

Most hotline calls are for information on prenatal care and access issues.

The one office professional (AOP) that answers the MCAH hotline is bicultural, speaks Spanish and is available M-F. This AOP has been oriented to referral systems and how to address specific needs of clients. She works in collaboration with the MCAH Director and Supervising PHNs. The AOP updated county-wide referral sources.

MCAH is listed in the directory for 211 which is a hotline that links residents of SBC to resources for social services. Staff within all three regions is bilingual and bicultural which help to meet the language and cultural needs of the community.

Report the following information: 1.6 Number of calls to the toll-free or “no cost to the calling

party” telephone information service

6 Number of toll free calls

2192 Number of web hits to the appropriate

local MCAH Program webpage








Provided materials to PHD Health Educator to promote campaigns and education through social media posts from the PHD. Promoted the following awareness campaigns via Twitter and PHD Facebook Home page:

- Jan: Safe sleep - Feb: National Children’s Dental Health Month - Feb: Preteen Vaccine Week - Apr: Child abuse prevention month - May: Maternal Mental Health - July: Pregnant Women and Zika Risk (Retweeted from CDPH) - Aug: World breastfeeding week (Utilized a graphic/message

from WIC) - Aug: National immunization awareness month - Aug: Look Before You Lock (Retweeted from CDPH) - Oct: SIDS - Nov: American diabetes month - Dec: National Influenza Vaccination Week

1.7 Increase the rate of:

Developmental screening

for children ages 0-5

years according to AAP

guidelines – 9 months, 16

months and 30 months

All children, including

CYSHCN, receive a

yearly preventive medical

visit

Briefly list or describe process measures to serve Children and Youth with Special Health Care Needs (CYSHCN) here: 1.7 Describe or report the following: Required to report on the following:

1. Activities to promote the yearly preventive medical visit 2. Describe protocols/policies to screen, refer and link all

children in MCAH programs 3. List QA process developed to ensure screening, referral and

linkage Report the following based on the optional activities you chose to

implement in the second column (Bold or highlight in yellow):

Briefly list or describe short and/or intermediate outcomes measures to serve CYSHCN here: 1.7 Outcomes of activities conducted to promote:

Required to report on the following:

1. Number of children, including CYSHCN, receiving

a yearly preventive medical visit

2. Number of children in local MCAH programs

receiving developmental screening

Number of children with positive screens that








1.7 SBC specific objective: By June 30

th, 2018, 75% of

children 0-17 in the MCAH Field Nursing Unit program with an identified developmental delay risk factor will have a developmental screen completed and followed recommended referrals.

4. Number of providers receiving information about Birth to 5 or other screening materials

5. Describe participation in HMG or HMG like programs 6. Describe barriers and strategies to increase screening, referral and

linkage

Number of HPs requiring screenings per AAP guidelines 7. List process or performance measures for other activities here

Briefly describe:

1. Protocols/policies to screen, refer and link all children in MCAH programs (SOW required 2)

The following MCAH policies were updated or newly created to address program standards for identifying children at risk for developmental delay: Updated: “Health Indicator” and “MCAH Nursing Documentation”

complete a follow-up visit with their primary

care provider

Number of children with positive screens

linked to services

Number of calls received for referrals and

linkages to services

3. Outcomes of protocols/policies and QA activities

to ensure screening, referral and linkage

Describe the following based on the optional activities

you chose to implement in the second column

(Bold or highlight in yellow):

4. See Column 3

5. Outcomes of participation in HMG or HMG like

programs. Describe results of work to implement HMG

core components

6. Outcomes of activities with HPs

7. List outcomes of other activities here

Briefly describe: 1. Briefly describe the policies developed to screen

children for high risk factors, follow-up as needed with a developmental screening tool, refer and link children who screen positive to a provider and services and promote well-child visits. (SOW required 3)

The Health Indicator policy addresses when and how the developmental screening should take place. The Nursing documentation policy addresses follow up/outcome of








Newly created: “MCAH Home Visit Assessment: Medical, Dental, Mental” and “Perinatal Mood and Anxiety Disorder Screening in MCAH”

2. Assessment, intervention, referral process, provider access, and barriers to obtaining resources for developmental delay risk.

All families in the MCAH Field Nursing Unit (FNU) are screened for high risk factors (ex: substance use, domestic violence, maternal positive Edinburgh, mental health issues, and other traumatic influences) during home visits. If a high risk factor is identified, FNU staff screen children 0-17 with a developmental screening tool such as the ASQ-3, ASQ-SE 2, or Ireton. FNU staff refers and links at risk children to referral resources for follow up. Identified children with special health care needs less than 18 years are offered and given referral resources. FNU staff promotes the yearly medical visit for children, including CYSHCN.

3. List QA process developed to ensure screening, referral and linkage (SOW required 3)

SPHN’s continuously monitor individual charts to ensure clients identified as having screened positive for developmental delay or special healthcare needs are referred appropriately. Case conferences are conducted within each region when challenges are identified. The Health Indicators and outcomes for “Well Child Visit: 0-18”, “Developmental Delay Risk”, and “Children with Special Health Care Need: 0-18” are reviewed on a monthly basis with the leadership team. Barriers and opportunities for improvement are discussed and brought back to staff for further discussion and implementation. PHN’s presented at PHD Women’s Health Case Conference highlighting challenges and process in linking clients to needed services based on

screening process relevant to the specific health indicator (Developmental delay risk). The MCAH Home visit assessment policy discusses developmental screening tools to use. The PMAD policy addresses that if a mother has a positive EPDS then child should be screened for developmental delay. 2. Outcomes of QA activities to ensure screening,

referral and linkage (SOW required 3) Measures include:

Number of children in the MCAH FNU, including CYSHCN, receiving a yearly preventive medical visit (SOW required 1) – see objective 1.9 for “Well Child Visit: 0-18” health indicator and outcomes.

Numerator: Number of children 0-17 in the MCAH FNU with an identified developmental delay risk factor who had a developmental screen completed and followed recommended referrals Denominator: All children 0-17 in the MCAH FNU with an identified developmental delay risk factor who had a developmental screen completed

95 / 100 = 95% Health Indicator - Developmental Delay Risk Health Indicator Outcome

-95% (95/100) Developmental Screen done: Referral








referral and screening outcomes.

4. Describe activities to promote the yearly preventive medical visit (SOW required 1)

Each client enrolled in the MCAH FNU is provided education on the importance of the yearly preventive medical visit. Staff ensures that an appointment is made or that client/guardian is aware of when to schedule.

resources received: followed recommended referral resource -3% (3/100) Developmental Screen done: Referral resources received: did not follow recommended referral resource -Developmental Screen done: Referrals refused -2% (2/100) Developmental Screen not done -Developmental Screen done - no referrals indicated at this time (SOW required 2)

Health Indicator – Child with Special Health Care need: under 18 yrs Health Indicator Outcome

-94% (60/64) Referral resources received: followed recommended referral resource -5% (3/64) Referral resources received: did not follow recommended referral resource -1% (1/64) Unable to locate for status of referral (SOW required 2)

1.8 By June 30, 2018, all

eligible children and adolescents ages 0-18 who are clients of the Field Nursing Unit (FNU) will be enrolled in health insurance


1.8 and 1.9

Describe policies implemented

The MCAH policy “MCAH Home Visit Assessment: Medical, Dental, Mental” addresses program standards for assessing all MCAH Home visiting clients and their children for insurance status and needed well-child appointments.

Describe rationale for interventions, recommendations and

Briefly list or describe here: 1.8

Numerator: Number of eligible children and adolescents who are clients of the FNU who enroll in health insurance Denominator: All eligible children and adolescents seen by FNU

857 / 926 = 93%








1.9

By June 30, 2018 all children and adolescents ages 0-18 who are clients of the FNU will have a scheduled appointment or are aware of the next well child visit based on Bright Futures periodicity schedule.

strategies/policies developed

Briefly describe referral process developed and implemented Each child, ages 0-18, is assessed to determine if they are enrolled in health insurance. Unenrolled but potentially eligible children are referred for application assistance or directly provided with application assistance for appropriate insurance type. Staff follow-up with referred children to determine if they have become enrolled. Families are educated on upcoming/next well child visit per Bright Futures Schedule.

Briefly describe the CQI/QA process developed

SPHN’s continuously monitor individual charts to ensure children are enrolled in insurance and have a well-child visit scheduled. Case conferences are conducted within each region when challenges are identified. The Health Indicators and outcomes for “Well Child Visit: 0-18”and “Insurance: 0-18” are reviewed on a monthly basis with the leadership team. Barriers and opportunities for improvement are discussed and brought back to staff for further discussion and implementation.

Describe access to care issues identified

Barriers identified included losing families at the follow-up appointments and mothers moving back to their native countries with their children.

Health Indicator – “Insurance: 0-18” and “Lack of Insurance: Infant/Child/Teen under 18 yrs” * Health Indicator outcomes

- 90% (829/926) Obtained Insurance within 2 months - 3% (28/926) Obtained insurance after 2 month - 4% (33/926) Insurance application in process - 3% (31/926) Unable to locate for status of referral - 1% (5/926) Insurance not obtained

1.9

Numerator: Number of children and adolescents who are clients of FNU with scheduled appointment or are aware of the next well child visit based on Bright Futures Denominator: All eligible children and adolescents seen by FNU

689 / 722 = 95% Health Indicator – “Well Child Visit: 0-18” ** Health Indicator outcomes

- 95% (689/722) Has scheduled appointment or is aware of the next well child visit

- 0% (3/722) Do not have a scheduled appointment or is not aware of the next well child visit

- 5% (30/722) Lost to follow-up

Describe the outcome of the CQI/QA process including methods of measurements and results








For the monthly leadership meetings to review the health indicators, the MCAH coordinator conducted drill-down to identify reasons why the outcomes of “unable locate for status of referral”, “Insurance not obtained”, and “application in process” were used. After chart review and analysis was done it was taken back to the leadership team to discuss with their staff. Access to care barriers were identified and addressed. It was also found that sometimes another outcome would have been more appropriate to use and staff were educated to correct this. * Health indicator “Lack of Insurance: Infant/child/Teen under 18 yrs” was used for clients referred before 7/1/17. Health Indicator “Insurance: 0-18” replaced it for referrals made 7/1/17 and after. ** Health Indicator “Well Child Visit: 0-18” was a new indicator that began for referrals made 7/1/17 and after.

1.10

By June 30, 2018 90% [900/1000] eligible children in the MCAH FNU will receive dental resources and information.


Description of outcomes of meeting(s), partnerships and strategies agreed upon.

List materials and resources that were created and/or identified for use in outreach

MCAH collaborated with First 5, OHEC, and DARTs to produce a media campaign for February’s National Children’s Dental Month. Social media messaging via Facebook were sent out once per week as well as a press release and BOS proclamation.


Numerator: Number of eligible children in the FNU receive dental resources and information Denominator: All eligible children seen by FNU

971 / 989 = 98% Health Indicator – “Dental Care < 21 yrs” Health Indicator Outcomes

- 82% (808/989) Referral resources and info received








The “Healthy Teeth for Health Kids” brochure was revised based on feedback from First 5 Santa Barbara, Children’s Oral Health Collaborative (COHC) and MCAH. OHEC continuously updates the regional Denti-Cal provider lists which are distributed to community partners and used by the MCAH FNU staff.

Description of Medi-Cal enrollment process

Briefly discuss process of anticipatory guidance, referrals, provider access and barriers to obtaining dental care and possible solutions

The policy “MCAH Home Visit Assessment: Medical, Dental, Mental” describes the program standards for assessment and referral for dental insurance and providers. All families with children 0-18 are given oral health anticipatory guidance during home visits. All family members are assessed for their current access to dental insurance and provided information on how to apply if needed. MCAH staff utilizes the First 5 Santa Barbara County “Healthy Teeth for Healthy Kids” brochure and has current lists of local dental providers that accept Medi-Cal broken down by the three county regions. STT handouts on the importance of dental health related to the fetus/child development are also reviewed with pregnant women.


SPHN’s continuously monitor individual charts to ensure clients receive dental education and those needing assistance with dental care access are referred appropriately. Case conferences are conducted within each region when challenges are identified.

Discuss documentation of health indicators

for dental care & verbalized understanding – Dental insurance obtained: Infant under 1 -14% (135/989) Referral resources and info received for dental care & verbalized understanding – dental insurance obtained: Ages 1-21 -2% (17/989) Resources and info on dental care received & verbalized understanding – Client/Family receiving services -2% (18/989) Referral and info not received for dental care -1% (11/989) Referral resources and info received & verbalized understanding of how to obtain dental services – dental insurance not obtained

Describe the outcomes of the CQI/QA process, including methods of measurements and results

For the monthly leadership meetings to review the health indicators, the MCAH coordinator conducted a drill-down to identify reasons why a family did not receive info on dental care. After chart review and analysis was done it was taken back to the leadership team to discuss with their staff. Typically the reason that dental resources were not received was that the family moved or was lost to follow-up.








The health Indicators and outcomes for “Dental Care <21” are reviewed on a monthly basis with the leadership team. Barriers and opportunities for improvement are discussed and brought back to staff for further discussion and implementation.

Ongoing PHD Field Nursing Measure 1.11 By June 30, 2018, all Medi-Cal eligible pregnant and postpartum women who are clients in the Field Nursing Unit (FNU) will be enrolled in Medi-Cal and have timely access* to care. *Timely access to care for:

Eligible pregnant women = Within 1 month from initial referral.

Eligible postpartum women = Within 2 months of obtaining insurance

Ongoing PHD Field Nursing Measure 1.11

Describe rationale for interventions, recommendations and strategies developed

The policy “MCAH Home Visit Assessment: Medical, Dental, Mental” describes the program standards for assessment and referral for Medi-cal. All clients are assessed for MediCal eligibility and enrollment status on initial visits. Assistance is provided on how to enroll. Follow up on status (including but not limited to assisting clients with making calls to DSS and/or MCMC, assist with form completion, and/or assist with transportation as needed) with enrollment is conducted through case closure.


Monthly CQI with SPHNs and MCAH Coordinator to review number of clients not meeting outcomes measure. Challenges and reasons for not meeting barriers were identified and addressed. Identified clarification for documentation by staff was needed to ensure accurate client enrollment status. SPHN’s clarified documentation process with PHN’s

Briefly describe barriers, challenges and solutions to enrollment in


• Numerator: Number of pregnant women in the MCAH FNU who are enrolled or are in the process of applying for Medi-Cal have a scheduled appointment with a provider within one month of the initial referral Denominator: All pregnant women in the MCAH FNU program eligible for Medi-Cal

94 / 99 – 95%

• Numerator: Number of postpartum women in the MCAH FNU who enrolled in Medi-Cal and have a scheduled appointment with a provider within 2 months of obtaining insurance Denominator: All pregnant women in the MCAH FNU program eligible for Medi-Cal

859 / 888 = 97% Health Indicator – “Pregnant all ages: Medi-Cal / timely access to care” Health Indicator Outcomes








Medi-Cal and follow-up to see a provider

Describe access to care issues identified Changes in the Federal Administration have resulted in families reluctant to access social services due to fear of deportation and undocumented status. Staff has had training on immigration rights and community resources by Immigrant HOPE, a local immigration rights organization. Staff received updates to community resources. Delay in MediCal to enrollment in MediCal and MCMC due to DSS staffing challenges requiring persistent f/u from PHN to escalate issues with MediCal Department Specialist.

- 95% (94/99) Has or obtained Medi-Cal; has scheduled apt within 1 month of referral - 5% (5/99) Unable to locate

Health Indicator – “Postpartum (within 2 months of delivery), all ages: Medi-Cal/timely access to care” Health Indicator Outcomes

- 97% (859/888) Has or obtained Medi-Cal; has scheduled appt within 2 months of obtaining Medi-Cal - 1% (6/888) Has or obtained Medi-Cal; no scheduled appt within 2 months of obtaining Medi-Cal - 0% (2/888) No Medi-Cal (self-pay); has scheduled appt - 2% (21/888) Unable to locate

Describe the outcomes of the CQI/QA process, including methods of measurements and results

Outcome of CQI process has led to having community resources re: Immigration rights present and educate staff at staff meetings to increase knowledge regarding immigration process and resident rights relative to healthcare access.





Goal 2: Improve preconception health by decreasing risk factors for adverse life course events among women of reproductive age

o Decrease unintended pregnancies1

o Decrease the burden of chronic disease1

o Decrease intimate partner violence1

o Assure that all pregnant women will have access to early, adequate, and high quality perinatal care with a special emphasis on low-income and Medi-

Cal eligible women 2



Process Short and/or Intermediate Outcome Measures

2.1-2.3 All women will have

access to quality maternal and early perinatal care, including CPSP services for Medi-Cal eligible women

Assurance - Briefly list or describe here: 2.1 1. Trainings received by staff on perinatal care

Neonatal Abstinence Syndrome Overview 4/10/2018

California Infant Health Feeding Guide Webinar 8/29/2017

CPSP In person Provider training 10/19/2017

Dignity - Maternal Mental Health 10/26/2017

Preparing for Recreational Cannabis 11/3/2017

CPSP Billing Training (FQHC) 11/28/2017

CPSP Billing Training (Non FQHC) 11/30/2017

Dr. Nadine Burke-Harris on ACEs at UCSB 4/16/2018

PSI PMAD Certificate Training 5/30/18 and 5/31/18

Cannabis: California Laws & Public Health Implications Webinar 9/7/2017

Intersectionality in Perinatal Mental Health 11/9/2017

Baby Teeth Matters: Oral Health Collaborative 11/7/2017

Prenatal SIG webinar series 2018: Opioids in Pregnancy and Lactation 1/18/2018

An Overview of California's MMH Strategic Plan 2/14/2018

Assurance - Briefly list or describe here: 2.1 Describe outcomes of the following: 1. Behavior or practice change following receipt of

training All MCAH FNU staff either attended the classes listed or the information was reviewed at staff meetings. The MCAH FNU staff has incorporated information regarding Neonatal Abstinence Syndrome, breastfeeding, CPSP, preterm birth, ACEs, perinatal mood disorders, and perinatal substance use into education provided to clients during home visits.








Understanding and Preventing Preterm Birth from a Public Health Perspective 5/3/2018

2. Activities implemented to increase access of women to early and

quality perinatal care, e.g., round table meetings, collaboratives MCAH/CPSP table at “A Safe City for You and Our Children” Panel in Santa Maria – 8/21/17 MCAH/CPSP table at Reiter Berry Farms Health Fair in Santa Maria – 10/1/17 – 400 participants MCAH/CPSP table at Carpinteria Thrive Health Fair on 10/10/17. 212 participants (91 adults and 121 children under age of 6) MCAH/CPSP table at “Bridges to Resiliency Conference” in Buellton– 10/16/17 (Direct service providers) MCAH/CPSP table at Goleta Valley Flu Clinic 11/1/17. 440+ participants. New Cuyama Family Resource Center Outreach Fair 11/4/17. EWC Health Educator spoke to 5 pregnant and PP women about MCAH field nursing program. MCAH/CPSP table at Cen-Cal Health Member Event at CAC Santa Maria– 1/20/18 For collaboratives related to increasing access to early and quality perinatal care see obj. 1.2, 2.4, and 3.4. PSC attends quarterly SAPA meetings and is chair of the Perinatal Wellness Coalition.

2. Activities implemented to increase access to and

improve the quality of perinatal care At the various health fairs, MCAH/CPSP education was provided on access to resources for OB services, dental, nutrition, health education, psychosocial support, and new car seat laws.








3. Barriers and opportunities to improve access to early and quality perinatal care

Barriers for successful recruitment of OB and CPSP providers remain centered on the limited number of M/C providers in the area. Barriers and opportunities lie in our MCMC encouraging OB providers to be CPSP providers.

4. Activities conducted in collaboration with your local Regional Perinatal

Programs of California (RPPC) Director Marian Regional Medical Center (Dignity Health) gathered various stakeholders from Santa Barbara and Ventura Counties to form a regional collaborative focused on PMAD. From November 2017-May 2018 this group met at various times in person and virtually to develop a proposal for the Dignity Health Social Innovations Grant program. SBC and Ventura County PSCs participated as well as PACLAC which was the lead agency on the grant. Unfortunately, funding was not granted. However, partnerships were strengthened and there are plans for continued regional work to take place.

3. Activities addressing the barriers to improve access to early and quality perinatal care

PSC and MCAH Director last met with Cen Cal (MCMC) staff to review draft CPSP MOU, discuss role of PSC, MCAH Priority Areas/SOW, outreach to non-CPSP Medi-Cal providers, and collaboration opportunities in 2017. Currently there is no signed MOU between MCAH and Cen-Cal. MCAH has attempted to contact Cen-Cal liaisons on multiple occasions to address this issue, however, Cen-Cal is focused on the carve-in of CCS. Discussions will continue into FY 18/19. Cen Cal and MCAH representatives sit on various collaboratives throughout the county and partnerships are formed when able to improve access to early and quality perinatal care.

Briefly list or describe here: 2.2 Describe the local network of perinatal providers, including CPSP

providers (e.g. concentration of Medi-Cal Managed Care, Fee-for Service, etc).

1. How many Medi-Cal obstetric providers did you provide enrollment

information about becoming a CPSP provider? __2___ 2. How many enrolled CPSP providers provided services in your

jurisdiction? __13__

Briefly list or describe here: 2.2 Do you have an adequate number and type of

perinatal providers to meet the needs of your maternal population? Yes _______ No ___X____ If No, describe issue here:








o Of these providers, how many were new to the CPSP program? __0___

3. List technical assistance activities provided to perinatal and CPSP providers (e.g. resources, referrals, tracking system for follow-up, assessments, interventions, infant care etc).

Extensive TA with PHD HCCs on transition of CPSP paper forms to

new OCHIN EHR system – ongoing throughout 2017 and 2018

Worked w/ a current CPSP provider on an additional CPSP

application for their high risk branch – 2017 – Will not submit

application, but changing names with Medi-Cal.

Assisted w/ updating Protocols to match assessment forms used by

a CPSP provider – July-August 2017

Assisted three CPSP providers w/ payment denials d/t Cen-Cal

CPSP code conversion which began July 1st, 2017. Worked with

Cen-Cal staff to review CPSP billing codes and max units. – July

2017

Scheduled training of MCAH staff on new CPSP Perinatal Food

Recall forms being used by HCCs– July 18th, 2017

Gave overview of CPSP documentation tips based off HCC site

reviews to MCAH staff – July 18th, 2017

Took lead on planning for joint CPSP/CHDP billing training –

Scheduled on Nov. 28th and 30

th 2017

Continued work to outreach to Cen-Cal rep to have a signed MOU

Met w/ new Santa Maria MCAH SPHN to give overview on CPSP

and documentation requirements – July 25, 2017

TA w/ a CPSP provider office support staff on various CPSP

documentation and basic billing questions – July 2017

The rate of OBGYN Providers/100K population is 19 in San Luis Obispo County, 18.9 in Ventura County and 17.7 in Santa Barbara County. San Luis Obispo and Ventura are neighbor counties.

Source: http://ahrf.hrsa.gov/arfdashboard/HRCT.aspx

For clients in MCMC, according to the 2018 HEDIS measure “Timeliness of Prenatal care”, Santa Barbara County (SBC) achieved 90.97% (comparison 93.11% in 2017 and 84.9% in 2015). With a benchmark of 91.67%, SBC ranked in the top 10% nationally. For the measure “Timeliness of Postpartum care”, Santa Barbara County (SBC) achieved 77.57%. With a benchmark of 73.67%, SBC ranked in top 5% nationally.

Source: https://www.cencalhealth.org/providers/quality-of-care/hedis/

List improvement/s in provider knowledge or practice following technical assistance on perinatal care access and quality of perinatal services. List outcomes of shared activities performed with the perinatal provider networks and/or local health plan in improving access to and quality of perinatal services.

Improved knowledge on CPSP especially regarding program requirements, documentation/HER, and billing

http://ahrf.hrsa.gov/arfdashboard/HRCT.aspx

https://www.cencalhealth.org/providers/quality-of-care/hedis/

https://www.cencalhealth.org/providers/quality-of-care/hedis/








Met w/ new Supervising RN of SBHCC to give overview on CPSP

and documentation requirements – 8/7/17

Assisted with DPA between lactation services/GDM and non-PHD

CPSP Provider – Signed on August 2017

Salinas Site Visit for OCHIN implementation – 9/15/17

Provided overview on CPSP and MCAH services to new CHDP

PHN – 10/13/17

Provided TA re: DPAs between PHD Lactation Services and two

SLO County CPSP Sites – 12/2017 - 3/2018

Provided TA re: DPAs between Dignity Clinics and outside

providers for high risk CPSP clients

Provided TA re: New Ownership and NPI for CPSP provider

including end-dating current CPSP application and applying under

new NPI

Provided TA re: a FQHC clinic system applying to be a CPSP

provider for off-site lactation services to be billed under CPSP

Provided extensive TA for CHCC clinics re: transition to new EHR

system

Sat on committee with State MCAH to revise CQI tools – began in

2018

** If above is not applicable to the local site, 4. Summarize shared activities performed with current provider networks

and/or local health plans to improve access to and quality of perinatal services including coordination and integration of care.

codes was gained by all providers from TA provided by PSC. Improvements include:

New EHR system was implemented in early 2018 which met CPSP standards for the PHD which includes 5 CPSP practices.

Updated CPSP Protocols for one provider office provided an opportunity to review and revise referral process for high risk clients.

PSC worked with local MCMC plan as they implemented a code conversion crosswalk for local CPSP codes to national HIPPA compliant codes. Discussions and trainings by Conduent rep helped to increase MCMC representative’s knowledge.

PSC provided documentation trainings to various CPSP support staff throughout the year. Improvements to documentation were noted during chart reviews at those sites.

CPSP DPAs between Santa Barbara County Lactation Services and non-public health department clinics were renewed or created in order to increase breastfeeding support and increase the number of breastfeeding women.









1. List the types of CPSP provider QA/QI activities conducted during site

visits, i.e., chart, administrative, protocol review

Chart Review and Administrative Review of all 13 CPSP providers

The Multi-chart review tool and Administrative Review tool generated by the State were utilized for all reviews

PSC invited to review policy/procedures and documentation of various CPSP providers to ensure quality and compliance

2 CPSP providers invited PSC back o office for a check-in on improvements on documentation based on feedback from annual site visit.

2. Identify your MCMC liaison contacts

Michael Harris and Theresa Scott

3. Report the number of actual site visit conducted with CPSP providers

PSC completed 12 site visits for the annual administrative and chart reviews. PSC made a total of 36 face-to-face visits among all CPSP providers for varying TA calls.

Briefly list or describe here: 2.3 The results of QI/QA activities that were conducted Chart review tools generated by the State continued to receive positive feedback from providers.

1-10 charts from each site were reviewed. There were 8 sites (2 different health care systems) that changed or are in the process of changing EHRs. Fewer charts were reviewed at those sites as extensive TA was provided on CPSP requirements for the new EHR system. Next year 10 charts (as customary) will be reviewed at these sites again.

Corrective Action Plans done on-site continued to enhance communication and efficiency during site visits.

Face to face interaction with Comprehensive Perinatal Health Worker (CPHWs) addressed documentation questions and enhanced compliance with program guidelines.

An updated SBC Resource list and dental provider list was given to all providers.

Information on Zika, Tdap/Pertussis, SIDS/Safe Sleeping, and STI/HIV testing were also provided during each site visit.








2.4 By July 30, 2018, prepare a resource directory of providers who will see women to assess, diagnose, and treat for Perinatal Mood and Anxiety Disorders (PMAD), directory will include type of payments/insurance accepted by each provider listed. 2.5 By July 30, 2018, determine the total number of mental health providers currently accepting MediCal Payment for Perinatal Mood and Anxiety Disorders


2.4 and 2.5

Planning meetings notes

Describe process to obtain and understand services provided and payment options of providers seeing women related to PMAD

CQI/CQA process developed Since 2016, MCAH has partnered with Marian Regional Medical Center (MRMC), a local Dignity Health Hospital and largest birthing hospital in the county, to address PMAD. Initially funding was secured through an Academy Health Grant. PSC participated on the Dignity Health Maternal Mood Disorders Project Committee with the following goals: 1) Increase patient, provider, and community awareness and communication about PMAD. 2) Decrease the number of women with unrecognized and untreated PMAD. The project objectives included assessing the community and provider landscape, creating a web based resource directory for providers and patients, begin to engage OB and Pediatric providers on PMAD and recommended use of screening tools, and create a tool-kit for other health care systems. The primary members were representatives from MRMC inpatient services, MRMC OB clinics, SBCEO, Behavioral Wellness, and MCAH.

Sub-committees were formed and met as needed. In 2017, PSC worked with MRMC and 211 representatives to create a resource guide in English and Spanish entitled “Maternal Emotional Wellness Resource Guide”. Community resources providing PMAD intervention/prevention services were engaged to be included in the guide. It was found that some organizations may provide mental health services, which could include care for PMAD, but they did not feel comfortable being labeled as providing services specific PMAD and did not want to be included in the guide. As the Academy Health funding has sunsetted, MCAH has volunteered to work


2.4

Resource Directory created

The 211 “Maternal Emotional Wellness Resource Guide” may be accessed in English and Spanish at the following web link: http://www.211santabarbaracounty.org/for-agencies/directories/

Resource Directory distributed – number of providers and community members

The resource directory was distributed to all 13 CPSP provider sites in Santa Barbara County as well as to community members/providers on multiple email lists which included, but not limited to: Perinatal Wellness Coalition of Santa Barbara County, Marian Maternal Health stakeholders, and MCAH staff. The guide was also on display at the Santa Barbara Public Library during the month of May to raise awareness on maternal mental health.

Number of providers added, updated, and deleted in resource directory

This was a newly created guide and included the following headings and number of providers per heading:

Crisis = 1

Professional Support = 5

Peer Support = 8

http://www.211santabarbaracounty.org/for-agencies/directories/

http://www.211santabarbaracounty.org/for-agencies/directories/








with 211 to keep the guide updated on an annual basis.

Home Visitation = 3 2.5

Number of providers accepting MediCal as a payment Source: There are 5 “Professional Support” providers listed in the resource guide that accept Medi-Cal as a payment source. It should be noted that Holman Group is listed as a resource for CenCal clients (MCMC plan). The Holman Group has a number of paneled providers.

2.6 By June 30, 2018, the number of CPSP providers that provide client education about PMAD as part of routine perinatal care will increase by 4 (from 14/21 to 18/21).

2.6

Describe the process for educating CPSP providers

Briefly describe the development process of the reference tool.

List of PMAD resource references used

Describe the survey process See obj. 2.4 for info on Marian PMAD partnership. PSC worked on a subcommittee of the Dignity Health Maternal Mood Disorders Project to create a “PMAD Screening and Care Pathway Guide” for local providers to use which included suggested screening intervals, care pathway depending on the score of the EPDS or PHQ-9, and local resources. PSC sent a letter to all CPSP providers in early January 2018 which included:

Results from the survey of CPSP providers on their screening practices for PMAD and knowledge of local resources conducted in 2017

Recommendations for screening

211 “Maternal Emotional Wellness Resource Guide”

CPSP STT Educational handouts on PMAD

2.6

Number of CPSP providers having received education

Number of providers received resource reference tool

All 30 CPSP providers at the 13 CPSP sites received education on PMAD screening recommendations, patient education, and local resource reference tool developed.

Numerator: number of CPSP providers that provide client education about PMAD as part of routine care Denominator: Number of CPSP Providers

15 / 17 (total survey respondents) = 88%








PMAD Screening and Care Pathway Guide PSC followed-up with in-person visits to each CPSP site by bringing hard copies of above information and to discuss current recommendations, guides, and resources. Marian Regional Medical center sponsored PMAD trainings in conjunction with Maternal Mental Health Now:

Thursday October 26th “Perinatal Mental Health: More than Just the

Blues” (41 attendees)

Thursday October 26th –Provider specific PMAD training (23

attendees total which included 4 SBC CPSP providers)

Friday October 27th “It Takes a Village: Creating Support Groups

for New Moms” (19 attendees) PSC installed a display at the Santa Barbara Public library on PMAD signs and symptoms and local resources which was on display for the month of May in honor of Maternal Mental Health Awareness Month. In late Spring 2018 PSC re-surveyed the CPSP providers to see if there was a change in practice regarding screening and educating clients on PMADs. Thirty CPSP providers at 13 CPSP sites received surveys. Of those 30 providers, 17 responded with a response rate of 57%. This was a lower response rate than in 2017 at 73% (21/29). The survey was voluntary, but PSC promoted the importance of the survey via email and in-person.








2.7 By June 30, 2018, collaborate with SB Healthcare Center (SBHCC) Gestational Diabetes Mellitus (GDM) champion provider to determine feasibility of a ‘Centering-like’ model for GDM clients seen at the SBHCC.

2.7

Planning meeting minutes

Describe options for CPSP documentation and billing MCAH Director and/or PSC met with Sansum Diabetes Research Institute (SDRI) team and WIC director as needed for planning sessions to develop a pilot project for a ‘Centering like’ model for GDM clients seen at SBHCC to facilitate bonding and efficient patient education. Meeting topics included CPSP requirements, documentation, billing, workflows, and curriculum development. Options discussed included using promotoras or medical assistants, who would qualify as CPHWs, to teach group classes with assistance from the RD and MD depending on the topics if needed. The MD would meet with each client in the group individually. Discussions occurred regarding when the individual sessions would occur (before group, after group, or pull out during).

2.7

Decision made re: feasibility of operationalizing GDM ‘Centering-like” model for GDM clients seen at the SBHCC based on:

o Staffing o Financials o Population served

Committee determined a pilot cohort is feasible using a combination of staff to include but not limited to HCC medical assistants, RD, promotoras, and MD. The HCC Medical Director is supportive of piloting the GDM cohort based on clients seen through the SB HCC. Pilot date to occur in FY 18/19.

Ongoing PHD Field Nursing Measure 2.8 By June 30, 2018 85% of clients with a risk factor/history of Domestic Violence (DV) and/or current DV receiving MCAH Field Nursing Unit (FNU) home visits will receive information, referral and follow-up care or assistance.

Ongoing PHD Field Nursing Measure 2.8 and 2.9 Briefly describe: • Assessment, intervention, referral process, provider access and barriers to obtaining domestic violence resources. Discuss documentation of health indicators • Field nursing assistance for safety planning and health indicators.

Field Nursing Unit (FNU) staff screen all clients seen for domestic violence

The FNU staff provides brief intervention/education and review/offer a list of resources on domestic violence.

The FNU staff review and/or provide a list of resources that was developed for each region in coordination with Perinatal Wellness Coalition– ‘Parent Links Healthy Coping’. The list of resources


Numerator: Number of clients with a risk factor/history/current DV receiving a brief intervention, referral and follow-up care or assistance. Denominator: Number of MCAH FNU home visiting clients with a risk factor/history of Domestic Violence (DV) and/or current DV

130 / 152 = 86%

2.9 Report the following:

Numerator: Number of clients with a risk








2.9 By June 30, 2018 35% of clients with a risk factor/history of Domestic Violence (DV) and/or current DV will have a verbal or written safety plan.

includes contacts for services ranging from DVS, Legal Aid, Victim Witness, mental health, Rape Crisis, etc.

Follow-up case management is provided to this population.

FNU staff enter information re: individual cases into the PHN Database under the health indicator status.

Referrals are frequently made to Domestic Violence Solutions, Victim Witness, Legal Aid, and CALM (Child Abuse Listening and Mediation).

CALM has multiple services for high risk women, including Healthy Families America, SafeCare, Psychiatrist services, Counseling and support groups in both English and Spanish.

Continued efforts for support services are needed in this community. The main community based organization that administers long-term case management, CALM, struggles with capacity from a resource and fiscal perspective resulting in long or closed waitlist at times.

Documentation of domestic violence support given by the FNU staff is assessed on individual chart reviews. This is an ongoing process and all documentation is reviewed by the Supervising PHNs. Case conferences are conducted within each region when challenges are identified.

2.9

Field Nursing Unit (FNU) staff provides assistance in safety planning to all clients that have a risk factor/history of domestic violence and/or have current domestic violence.

FNU staff enter information re: individual cases into the PHN Database under the health indicator status.

Documentation of domestic violence support given by the FNU staff is assessed on individual chart reviews. This is an ongoing process and all documentation is reviewed by the Supervising PHNs. Case conferences are conducted within each region when challenges are identified.

factor/history/current DV who have a verbal or written safety plan Denominator: Number of MCAH FNU home visiting clients with a risk factor/history of Domestic Violence (DV) and/or current DV

101 / 152 = 66% Health Indicator – “Domestic Violence” Health Indicator Outcomes

• 61% (93/152) Referral for DV Resources received and acknowledged – Verbalized Safety Plan • 15% (23/152) Referral for DV Resources received and acknowledged • 7% (11/152) Declined FNU Services • 7% (11/152) Not Found • 5% (8/152) Referral for DV Resources received: Clt/Family receiving services – Verbalized Safety Plan • 2% (3/152) Referral for DV Resources received: Clt/Family receiving services • 2% (3/152) Referral for DV Resources received: declined treatment referral








Discussed at Dept meeting on redirecting the education and asking client to help educate others and by doing so they are receiving DV resources and information.

SPHN reinforced with staff the importance of developing a safety plan for clients with current and history of DV.

Local resource, Domestic Violence, spoke at staff meeting to educate, discuss services offered, and referral process.

Ongoing PHD Field Nursing Measure 2.10 By June 30, 2018 100% of FNU clients seen in the antepartum and immediate (2mo) postpartum period that have a diagnosis of GDM will be given information on GDM and on the importance of self-care using the GDM PHN toolkit and will follow diet, monitoring and scheduled appointments as assessed by the PHN.

Ongoing PHD Field Nursing Measure 2.10 • Briefly describe the process of FNU home visitation to promote diet, weight and blood sugar utilizing the GDM PHN toolkit on clients seen with a diagnosis of GDM or Type II DM in the antepartum or postpartum period.

FNU staff utilizes the GDM PHN Toolkit for all pregnant and postpartum clients with a diagnosis of GDM or Type II Diabetes. The GDM PHN Toolkit addresses GDM, diet education, exercise and healthy lifestyle choices.

In addition to referring clients to their OB provider for GDM management

and follow up, FNU staff refers south and mid county Spanish speaking

clients to the William Sansum Diabetes Center for the Semillas de Cambio

program. Women are eligible for Semillas de Cambio if they have

experienced a high risk pregnancy (ex: obesity, gestational diabetes, type 2

diabetes.), are “between” pregnancies, and/or at risk for future high risk

pregnancy (ex: overweight/obese, pre-diabetic, type 2 diabetes).

FNU staff refers clients to the Alliance for Pharmaceutical Access if

assistance is needed for diabetic medication. The cost of diabetic

medication often is identified as a barrier for clients served in SBC.


Numerator: Number of clients seen in the antepartum and immediate (2 mo.) postpartum period that have a diagnosis of GDM that are given information on GDM and on the importance of self-care using the GDM PHN toolkit and following diet, monitoring, and scheduled appointments Denominator: Number of clients seen in the antepartum and immediate (2 mo.) postpartum period that have a diagnosis of GDM

110 / 117 = 94% Health Indicator – “Gestational Diabetes Mellitus” Health Indicator Outcomes

• 94% (110/117) Information received on importance of self-care r/t GDM – following diet, monitoring, and scheduled appointments • 3% (4/117) Number Unable to locate • 2% (2/117) Information received on importance








Documentation of GDM education provided by the FNU staff is evaluated through individual chart reviews. Evaluation is completed by the Supervising PHNs on an ongoing basis. Case conferences are conducted within each region when challenges are identified. MCAH Director and PSC met with a local CPSP GDM provider re: planning and possibility of having GDM centering like model for prenatal care at SBHCC (see obj. 2.7).

of self-care r/t GDM – not following medical recommendations • 1% (1/117) Information not received on importance of self-care r/t GDM – client declined





Goal 3: Reduce infant morbidity and mortality

o Reduce pre-term births and infant mortality1

o Increase safe sleep practices1

o Increase exclusive breastfeeding initiation and duration 1




3.1-3.2 All infants are

provided a safe sleep environment.

Assurance - Briefly list or describe here: There were 3 presumed SIDS/SUID cases with 8 parents/caregivers. One of the cases in which the death occurred at the childcare provider’s house, the childcare provider chose not to be contacted due to ongoing litigation.

3.1 Number of parents/caregivers who experienced a presumed SIDS death

8

Number of parents/caregivers who were contacted for grief and bereavement support services. Please briefly describe discrepancies in the numbers reported.

7

Briefly list or describe here: 3.2 Provide staff member name and date of attendance at SIDS Annual

Conference/training(s) and other conferences/trainings related to infant health.

SIDS Coordinator Meeting 10/5/17 Kelley Barragan

2017 Annual SIDS Conference 106/17 Kelley Barragan

Briefly list or describe here: 3.2 The results of staff trainings related to infant

health. Staff was trained in current SIDS theories, research, and risk reduction practices, roles of the first responder, coroner, and medical examiner, grief support, SIDS home visit, and community outreach.

SBC PHNs provide support and education services to families of all presumed SIDS, SUID, and undetermined cases. This approach is due to the varied use of different diagnoses for unexplained infant deaths that are sudden and unexpected.








SIDS Coordinator attends CDRT.

SIDS Coordinator attended CA SIDS Advisory Council and Southern CA SIDS Council meetings via teleconference as able. SIDS Coordinator partnered with newly formed Santa Barbara County Safe Kids Coalition to distribute a press release on safe sleep recommendations for January 2018’s Safe Sleep Month. Also collaborated to plan for obtaining and distributing pack-n-plays with Safe Kids funding. On 6/9/18 SIDS Coordinator provided a table on safe sleep at the Safe Kids Day Fair. Attendees were invited to play a game of “What’s Not Safe Here?” which allowed participants to identify unsafe items in a picture. Participants were then educated on safe sleep practices and provided educational handouts. There were 300 participants at the fair.

3.3 By June 30th, 2018 assess all CHDP providers knowledge, access to materials, and practices for distributing materials to parents on SIDS Risk Reduction for children <1 year of age.

Briefly list or describe here: 3.3 Briefly describe:

Planning efforts and interventions to develop and promote SIDS survey

Process to implement SIDS survey SIDS Coordinator wrote article for October 2017 Health Matter Newsletter for SIDS Awareness Month (history, SIDS risk reduction, and safe sleep recommendations) which was delivered to 1700+ individuals including local medical providers.


3.3

Number of surveys and interviews completed/brief description of survey results

Thirty-four CHDP provider offices were surveyed with a total of 15 respondents. Providers rated their knowledge of the AAP’s “SIDS And Other Sleep-Related Infant Deaths: Updated








Partnered with CHDP staff to write article for Winter 2017 CHDP Newsletter discussing safe sleep recommendations and announcing that a survey of CHDP providers would be conducted in Spring 2018. A 10 questions survey on SIDS/Safe sleep was sent to CHDP providers via survey monkey on 3/7/18. A reminder email was also sent and garnered more respondents. Survey included:

Rating of providers’ knowledge on SIDS and infant safe sleep recommendations

True and False questions related to AAP recommendations

If education is being provided to patients as part of routine care

Types of educational materials are provided

Barriers to providing education

2016 Recommendations On Safe Sleep Environments for Infants”: “Excellent” (14%), “Good” (43%), “Average” (14%), “Fair” (14%) and “Poor” (14%). Of the type of SIDS educational materials being provided to patients: 60% provide brochures, 13% provide videos/ DVDs, 6% provide a resource list, while 53% provide verbal education only.

List top 3 perceived barriers to care Reported barriers to providing education on SIDS risk reduction and safe sleep practices included: Language barrier (26%), No materials (6%), and Time constraints (6%). Seventy-three percent respondents reported no barriers to screening.

Numerator – Number of CHDP Providers who provide education and materials to parents on SIDS Risk Reduction Denominator – Number of CHDP providers surveyed

Respondents reported that they provide education on SIDS risk reduction and safe sleep practices to








caregivers of infants as part of routine care: “Always” (73%), “Most of the time” (13%) and “Sometimes" (13%).

3.4 By June 30, 2018, prepare a resource directory of providers who see women to assess, diagnose, and treat for perinatal substance use (PSU), and directory will include type of payments/insurance accepted by each provider.

3.5

By June 30, 2018, determine the total number of substance use providers currently accepting MediCal Payment for perinatal substance use education/counselling and prevention.

3.4 -3.5

Planning meetings notes

Describe process to obtain and understand services provided and payment options of providers seeing women related to perinatal substance use

CQI/CQA process developed The Perinatal Wellness Coalition (PWC) developed three regional “Parent Links” brochures which included local resources for substance use, mental health, basic needs, and other health and human services. During PWC meetings and other meetings when Parent Links was shared, PSC asked and received updates from community partners on services provided in the community. PSC also outreached to various providers. MCAH updates the Parent Links yearly and as needed. MCAH’s number is listed on the brochure with request to call if updates needed.

3.4

Resource Directory created Parent Links Healthy Coping (regional guides): https://www.countyofsb.org/phd/mcah/community-resources.sbc

Number of providers added, updated, and deleted in resource directory

Added: 3 Updated: 2 Deleted: 2

3.5

Number of providers accepting MediCal as a payment source.

There are 4 local organizations that have substance use services specific to the perinatal population. Those with an * accept Medi-Cal. All offer sliding scale/scholarships for some or all of their programs. -Coast Valley Substance Use Treatment Center* -Good Samaritan -Recovery Way/Turning Point (Mid County) and Project Preemie (North County) -CADA – Perinatal Program*

https://www.countyofsb.org/phd/mcah/community-resources.sbc

https://www.countyofsb.org/phd/mcah/community-resources.sbc








-Casa Serena

3.5-3.7 For FIMR LHJs only:

For FIMR LHJs Only: 3.5 Submit number of cases reviewed as specified in the Annual Report table:

Total # of cases in Annual Report period

Total # of cases with completed data collection

Total # of cases with completed maternal interview

Total # of cases reviewed with CRT

Total # of cases reviewed with completed maternal interview

Total # of cases

Number of fetal deaths

Number of infant deaths

For FIMR LHJs Only: 3.5 Submit periodic local summary report of findings

and recommendations (periodicity to be determined by consulting with MCAH).

3.6-3.7 Date of Local Health Officer Authority Letter: Submit FIMR Tracking Log and FIMR Committee Membership forms for CRT and CAT. Submit dates of trainings/meetings/teleconferences attended.

Are member mix and attendance meeting your local needs to address CRT/CAT goals?

Number of CRT Recommendations:

Describe three priority recommendations:

1.








2.

3.

For FIMR LHJs Only: 3.8 Copy locally developed

objectives addressing the development of interventions to prevent fetal, neonatal, and postneonatal deaths from Goal 3 of your MCAH SOW here.

For FIMR LHJs Only: 3.8 Copy and report on the process measures listed in the MCAH SOW 3

rd

column of locally developed interventions to prevent fetal, neonatal, and postneonatal deaths from Goal 3 here.

Number of interventions implemented:

Describe interventions, including objectives, key activities, timelines, evaluation components and barriers to implementation. Categorize the interventions by identifying whether these involved policy, systems, and/or community norm changes.

For FIMR LHJs Only: 3.8 Copy and report on the outcome measures listed

in the MCAH SOW 4th column to address locally

developed interventions to prevent fetal, neonatal, and postneonatal deaths .

Submit “Product Developed” form(s).

Provide web link(s) for any products and/or reports for posting on MCAH FIMR website.





Goal 4: Increase the proportion of children, adolescents and women of reproductive age who maintain a healthy weight

o Increase consumption of a healthy diet1

o Increase physical activity1








Ongoing PHD Field Nursing Measure

4.1 By June 30, 2018, 80% of MCAH FNU breastfeeding clients will continue to breastfeed at closure of case.

Ongoing PHD Field Nursing Measure Briefly list or describe here: 4.1

Briefly describe

Breastfeeding trends in Santa Barbara County Santa Barbara County local hospital data compared to CA breastfeeding data: SBC breastfeeding Initiation percentage during early postpartum in the area of: any breastfeeding – increased from 95.8% in 2015 to 95.9% in 2016. Compared to CA breastfeeding initiation percentage during early postpartum – any breastfeeding 94% for 2015 and 94% for 2016. HP 2020 Target – 81.9% SBC breastfeeding Initiation percentage during early postpartum in the area of: exclusive breastfeeding – decreased from 60.7% in 2015 to 58.3% in 2016. Compared to CA breastfeeding initiation percentage during early postpartum – exclusive breastfeeding 68.8% for 2015 and 69.4% for 2016. Source: https://www.cdph.ca.gov/Programs/CFH/DMCAH/CDPH%20Document%20Library/BFP/BFP-Data-InHospital-Hospitals-2016.pdf 79.9% of white women in 2016 compared to 76.0% in 2015 exclusively breastfeed upon discharge from hospital. Only 50.0% in 2016 compared to 53.7% in 2015 of Hispanic women exclusively breastfeed. This demonstrates a continued need for education and support for breastfeeding within the Hispanic community and collaborative work to address barriers. Source: https://www.cdph.ca.gov/Programs/CFH/DMCAH/CDPH%20Document%20Library/BFP/BFP-Data-InHospital-Residence-RaceEthnicity-2016.pdf

Ongoing PHD Field Nursing Measure Briefly list or describe here: 4.1

Numerator: Number of clients in the MCAH FNU who were breastfeeding at closure of case Denominator: Number of clients in the MCAH FNU who breastfed

671 / 809 = 83% Health Indicator – “Breastfeeding” Health Indicator Outcomes

• 32% (260/809) No problems – Breastfeeding adequate, no supplementation • 18% (144/809) No problems – Breastfeeding adequate with supplementation • 6% (46/809) No problems – No longer breastfeeding • 12% (98/809) Breastfeeding support – Breastfeeding adequate, no supplementation • 10% (81/809) Breastfeeding support – Breastfeeding adequate, supplementation • 5% (39/809) Breastfeeding support – No longer breastfeeding • 4% (36/809) Referral for breastfeeding consultation received – Breastfeeding adequate, no supplementation

• 6% (52/809) Referral for breastfeeding consultation received – Breastfeeding adequate, supplement

• 3% (23/809) Referral for breastfeeding consultation received –No longer breastfeeding

• 4% (29/809) Not Found

https://www.cdph.ca.gov/Programs/CFH/DMCAH/CDPH%20Document%20Library/BFP/BFP-Data-InHospital-Hospitals-2016.pdf

https://www.cdph.ca.gov/Programs/CFH/DMCAH/CDPH%20Document%20Library/BFP/BFP-Data-InHospital-Hospitals-2016.pdf

https://www.cdph.ca.gov/Programs/CFH/DMCAH/CDPH%20Document%20Library/BFP/BFP-Data-InHospital-Residence-RaceEthnicity-2016.pdf







The Public Health Department has a Lactation Services Program that is very successful and is utilized by the MCAH FNU and the public. There is a two-way texting program that Lactation Services developed that is quite popular.

Describe MCAH staff participation in the Breastfeeding Coalition.

A MCAH PHN attends Breastfeeding Coalition meetings and shares information at the FNU staff meetings and case conferences.

Describe breastfeeding training for Field Nursing Unit staff. MCAH FNU trainings related to breastfeeding include: -The Art of Breast Massage (9/16/16) - 20 hour breastfeeding course offered by SBC Nutrition/WIC Program (Feb-July 2017) - PHNs in serviced on breast pump and are now carrying in cars to bridge wait times to get breast pump from WIC

Describe Field Nursing Unit breastfeeding interventions and referrals to WIC and Lactation Services.

List three successful strategies used to sustain exclusive BF Collaborated with WIC/Nutrition Services Director on algorithm to facilitate timely lactation services for FNU clients. Worked with local hospitals and other nurse home visiting programs to ensure breast pumps are made available to families at all times. FNU staff intervention on postpartum home visits include: • Assessment of breastfeeding is done on all postpartum mothers. A majority of the PP referrals are received from the PHD Health Care Center OB department. • Support of breastfeeding and/or assistance is given as needed by FNU. • All pregnant and postpartum referrals are encouraged to exclusively breastfeed.





• Current information on breastfeeding is sent to staff. • Referral to WIC and Peer Counseling for breastfeeding problems not resolved with PHN intervention. • If client is seen in pregnancy, PHN will promote WIC and lactation services. • FNU staff inputted information re: individual cases into the PHN Database under health indicator status. • Documentation of breastfeeding support given by the FNU staff was assessed on individual chart reviews. This is an ongoing process and all documentation is reviewed by the Supervising PHNs. Case conferences are conducted within each region when challenges are identified. • Cottage Hospital became a Baby-Friendly Hospital in early 2018.

Describe barriers to BF Barriers to exclusive breastfeeding in SBC:

There is a cultural norm in the Hispanic community to supplement. The FNU and other home visitation agencies attempt to dispel these myths.

Formula companies send advertising and free formula samples to our clients.

Early return to work is also a barrier. Although there are free breast pumps through Lactation Services at the PHD and baby friendly companies. Many of our clients are farm workers that are paid by how much they pick as a crew (or) are in minimum wage jobs and do not feel comfortable or may not have adequate time to pump at the workplace.





Goal 5: Improve the cognitive, physical, and emotional development of all children

o Reduce unintentional injuries1

o Reduce child abuse and neglect1

o Provide developmental screening for all children1



Process Short and/or Intermediate Outcome

Measures

5.1

By June 30th, 2018 MCAH

FNU will address Adverse Childhood Events (ACEs) by incorporating the NEAR@Home framework into all home visits


Describe ACE screening and integration of NEAR@Home framework into home visitation

Describe the policy developed to support ACE screening and NEAR@home interventions during home visitation

To prepare for the NEAR@Home integration, the leadership team was trained on reflective supervision and case conferencing. The MCAH Coordinator became a trainer in the Community Resiliency Model (CRM). CRM is a model that helps us to notice the difference between sensations of stress and sensations of well-being so that we can learn to regulate our body to be “in our zone” where we are the best person we can be. There are six easy to use CRM Skills that can be used by people who have experienced trauma or as a wellness practice to help build resilience. Staff has had several CRM trainings. CRM skills have been incorporated into all staff and leadership meetings. A 6 hour staff training was developed based on the NEAR@home toolkit and provided to all MCAH staff 1/15/18. A 4 hour training was provided on 6/18/18 to both new staff and those needing a refresher. The “MCAH Field Nursing Documentation” and “Health Indicators” were updated to include protocols for NEAR@Home visits.

Briefly list or describe here: 5.1 Goal: 75% of clients seen during home visits will verbalize effect of ACEs on parenting and its role in health

Numerator: Number of clients in the MCAH FNU able to verbalize effect of ACEs on parenting and its role in health Denominator: Number of clients in the MCAH FNU who received NEAR@Home visit

94 / 118 = 80% Goal: Parents with ACE scores equal/greater than 4 referred to parenting classes and/or community support

Numerator: Number of parents with an ACE score equal/greater than 4 referred to parenting classes and/or community support Denominator: Number of parents with an ACE score equal/greater than 4








Measures

ACE screening is conducted on all HOH. Education on protective factors and resilience is provided during home visits. Referrals to needed resources are made based on assessment. Pre and post-test on family resilience is given to all families seen.

Describe the QA process Review of ACE screenings conducted by MCAH FNU reviewed during monthly meetings with SPHN. Discussion of NEAR@Home progress is conducted at each staff meeting.

Describe collaborations with CBOs that promote and educate clients on protective factors.

Training materials developed based on the NEAR@home toolkit were shared with CBOs at CAPC and EC&FWC meetings.

23 / 23 = 100% Health Indicator – “ACEs Screening” Health Indicator Outcomes

• 47% (55/118) ACES < 4: Parents verbalized effect of ACEs on parents and health • 2% (2/118) ACES < 4: Parents unable to verbalize effect of ACEs on parents and health • 1% (1/118) ACES > or = 4: Referred to resources/support; Parents unable to verbalize effect of ACEs on parents and health • 19% (22/118) ACES > or = 4: Referred to resources/support; Parents verbalized effect of ACEs on parents and health • 3% (4/118) ACES Screening declined: Parents unable to verbalize effect of ACEs on parents and health • 6% (7/118) ACES Screening declined; Parents verbalized effect of ACEs on parents and health

• 3% (4/118) ACES Screening not completed; parents unable to verbalize effect of ACEs on parents and health

• 8% (10/118) ACES Screening not completed: Parents verbalized effect of ACEs on parents and health • 11% (13/118) Lost to follow-up








Measures

Additional activities related to goal 5: Press release “Kids and Hot Cars turn into tragedy”





Goal 6: Increase conditions in adolescents that lead to the improved adolescent health

o Decrease teen pregnancies1

o Reduce teen dating violence, bullying and harassment1




Measures

6.1

Not addressed in this SOW.

MCAH Director collaborates with AFLP Manager

CalPREP. MOU with Teen Services grantee in North County for referrals.



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