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In December 2012, Connecticut was one of four states selected to participate in the National Governor’s Association (NGA) Learning Network on Improving Birth Outcomes. In the same year, Commissioner Jewel Mullen, on behalf of the Connecticut Department of Public Health (DPH) accepted the Association for State and Territorial Health Officials (ASTHO) President’s challenge to improve birth outcomes by reducing preterm birth (PTB) in Connecticut. The Commissioner also included a second challenge to reduce racial and ethnic disparities in early PTB.  Both of these events set the stage for DPH to establish the State Coalition to Improve Birth Outcomes (the Coalition) in March 2013. The Connecticut Plan to Improve Birth Outcomes is intended as a dynamic working document, and is the result of a highly participatory and systematic process that allowed over 80 Coalition members to come together and identify the recommendations and strategies believed to have the greatest potential for impact and feasibility. This Plan is intended as an initial roadmap to support the coordination and integration of cross-sectoral efforts needed to support a comprehensive and holistic effort to improve birth outcomes in our state.

CT Plan to 

Improve Birth Outcomes

Only by acting on reducing and ultimately eliminating health disparities,will we be able to significantly improve birth outcomes in our state.
Appendix A - Additional Tier 1 strategies supported by coalition members
  • Strategy 1D: Increase provider knowledge of community resources addressing social needs (housing, food, childcare, legal aid, and transportation.)
  • Strategy 1E: Identify and implement strategies aimed at reducing/eliminating institutionalized racism
  • Strategy 1F: Create supportive housing initiatives for pregnant women and their families
  • Strategy 1G: Integrate financial literacy into family planning and counseling services, as well as in other relevant programs serving MCH populations

Appendix B - Additional Tier 2 strategies supported by coalition members
  • Strategy 2D: Establish a statewide community health worker system similar to the one in Massachusetts: this can include models involving lay home visitors, community doulas, preconception peer educators, peer breastfeeding counselors, oral health, etc.
  • Strategy 2E: Engage in a broad effort to reduce maternal fear and stigma about the spectrum of emotional and psychological complications of pregnancy and childbirth by increasing provider- patient communications, including perinatal mental health in childbirth education programs, raising public awareness, and developing a coordinated system of treatment and care
  • Strategy 2F: Expand person-centered care model (PCCM) to include women’s health, including oral and mental health, with a lifecourse approach
  • Strategy 2G: Expand state Husky to undocumented women and their families

Appendix C - Additional Tier 4 strategies supported by coalition members
  • Additional Tier 4 Strategies Supported by Members of the Coalition: Ongoing Clinical Interventions
  • Strategy 4C: Increase access to midwifery care for all women considered low-risk (medically)
  • Strategy 4D: Increase access to childbirth and postpartum doula services (medicaid reimbursement; adding doula care to existing home visiting services)
 
Appendix D - Additional Tier 5 strategies supported by coalition members
  • Additional Tier 5 Strategies Supported by Members of the Coalition: Education and Counseling
  • Strategy 5D: Encourage local school districts to integrate life course education into school health curriculum
  • Strategy 5E: Engage in a broad effort to raise awareness of the important relationship between emotional and psychological wellbeing and physical wellbeing
  • Strategy 5F: Raise consumer awareness about the midwifery model of care and available midwifery options
 
References
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Long-lasting protections to individuals

 

Long lasting protective interventions have broad population impact, but do require outreach to individuals. Programs that take a lifecourse perspective incorporate a proactive, preventive approach to preconception wellness and healthy pregnancy.

Tier 3 - Protective, Long-Lasting Protection to Individuals
  • 3A: Support the provision of preconception health care throughout the childbearing years
  • 3B: Integrate life course education into provider training
Making healthy choices the easy choice

 

When we change the environment to promote and encourage healthy behaviors we not only impact individuals, we also improve the overall health of our communities. Interventions that change the environmental context to make healthy options the default choice, regardless of education, income, service provision, or other societal factors have the potential to greatly improve the health of expectant mothers, infants and families the most. The defining characteristics of these interventions are that individuals would have to expend significant effort not to benefit from them.

Tier 2 - Changing the Context: Improving Health Outcomes by Making Healthy Choices the Easy Choice
  • 2A: Establish and evaluate pilot projects involving holistic MCH medical home models
  • 2B: Integrate mental health, oral health and wellbeing into hospital-based perinatal education models, group prenatal care, as well as home visiting programs
  • 2C: Create trauma-informed environments for pregnant women, infants and their families
Evidence-based interventions in clinical settings

 

In addition to ensuring that women are healthier throughout their life course and within their communities, an effective maternity health care system should be adequately equipped with the tools and processes necessary to provide equitable access to evidence-based interventions within clinical settings.

 
Tier 4 - Ongoing Clinical Interventions: Evidence-Based Interventions Within Clinical Settings
  • 4A: Support the provision of behavioral health services and oral health care throughout the life course and during the perinatal period
  • 4B: Integrate into provider training mental health, social stressors, and trauma education relevant to infants and families
Individual and public educational messaging and support

 

Educational programs and innovative media outreach are important components for improving birth outcomes. By teaching women and men of childbearing age ways they can maintain good health, and meeting them "where they are at," we can encourage families to take a holistic view of physical and mental wellbeing.

Tier 5 - Education and Counseling: Individual or Public Educational Messages and Support
  • 5A: Scale up (or continue investing) in fatherhood initiatives to increase social support within the family and home environment
  • 5B: Integrate education about preconception and interconception health including mental and oral health, into hospital-based prenatal education models, group prenatal care, as well as home visiting programs
  • 5C: Encourage local school districts to integrate mental health and well-being into school health curriculum
Addressing socio-economic factors
 

Promoting a“whole person, whole family, whole-community systems approach” to improving birth outcomes, Coalition members recommend expanding efforts from traditional healthcare-centric approaches to multi-level cross-sector interventions and policies that aim to prevent health inequities by acting in the very community settings in which daily life occurs (i.e.schools, daycare centers, workplaces, WIC offices, parks and recreational facilities, churches, dining facilities, detention centers, courthouses, housing units, etc.) By addressing socio-economic conditions such as poverty, racism, education, housing, isolation, fractured families, food security, trauma and violence; legislators, providers, leaders, and community members can build upon protective factors and mitigate risk factors affecting the lifecourse of women, children, and their families, positively impacting birth outcomes and the health trajectory of generations to come.

Tier 1 - Addressing Socio-Economic Factors to Improve Birth Outcomes in Connecticut
  • 1A: Raise awareness among legislators, leaders, and administrators about social determinants of perinatal health and the life course perspective
  • 1B: Invest in preventing and mediating early life trauma and violence
  • 1C: Identify opportunities to reduce stressors affecting families in the inter-conception period