Recommendations at a glance

The AMCHP (Association of Maternal and Child Health Programs) Compendium identifies recommendations for improving birth outcomes in seven broad areas, and aligns them with the Frieden’s Health Impact Pyramid. This approach was taken in order to present a comprehensive, multi- level framework that states can use in their efforts to improve birth outcomes.4

In looking at the recommendations identified by the Coalition, there was clear symmetry in how they aligned with the AMCHP Compendium. The Coalition wanted to utilize a framework that would ensure a comprehensive approach that would impact different levels of community and multiple populations. To that end, the Coalition grouped its priority recommendations based on the different tiers and recommendations in the AMCHP Compendium. This also became a strategy for implementation as the Coalition will recommend the implementation of a multi-tiered approach tier to deliver a comprehensive initiative to improve birth outcomes in the state of Connecticut. Following is a complete listing of recommendations and strategies organized by tiers. Those that were selected for priority action are depicted in boxes and elaborated on in the main part of the Plan. The other ones are briefly elaborated on in the Appendices section of the Plan.

Tier I: Addressing Socio-Economic Factors to Improve Birth Outcomes Recommendations

1A: Raise awareness among legislators, leaders, and administrators about social determinant 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 during the interconception period

1D: Increase provider knowledge of community resources addressing social needs (housing, food, childcare, legal aid, and transportation)

1E: Identify and implement strategies aimed at reducing/eliminating institutionalized racism

1F: Create supportive housing initiatives for pregnant women and their families

1G: Integrate financial literacy into family planning and counseling services, as well as in other relevant programs serving MCH populations

Tier 2: Changing the Context: Improving Health Outcomes by Making Healthy Choices the Easy Choice

Recommendations

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

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.

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

2F: Expand person-centered care model (PCCM) to include women’s health, including oral and

mental health, with a Life Course approach

2G: Expand state Husky to undocumented women and families

Tier 3: Protective, Long-Lasting Protection to Individuals Recommendations

3A: Support the provision of preconception health care throughout the childbearing years.

3B: Integrate Life Course education into provider training.

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Tier 4: Ongoing Clinical Interventions: Evidence-Based Interventions within Clinical Settings

Recommendations

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

4C: Increase access to midwifery care for all women considered low-risk (medically)

4D: Increase access to childbirth and postpartum doula services (Medicaid reimbursement; adding doula care to existing home visiting services)

Tier 5: Education and Counseling: Individual or Public Educational Messages and Support

Recommendations

5A: Scale up (or continue investing) in fatherhood initiatives to increase social support within the family and home environment

5B: Integrate education and 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: Integrate mental health and well-being into the State Department of Education school health curriculum

5D: Integrate Life Course education into the State Department of Education school health curriculum

5E: Engage in a broad effort to raise awareness of the important relationship between emotional and psychological wellbeing and physical wellbeing

5F: Raise consumer awareness about the midwifery model of care and available midwifery options.