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Maternal Health Innovations Grant

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MAHEC has convened a learning collaborative with the vision to support a Statewide Provider Support Network (SPSN) leveraging the expertise of Family Medicine champions to strengthen the quality of care for people in the pregnant, postpartum and interconception periods. The learning collaborative’ s goal is to increase awareness and engage inter-professional collaboration in the provision of maternal health/well-woman care. The learning collaborative is primarily comprised of Family Medicine, Obstetrics & Gynecology, and Pediatric clinicians, as well as related providers from across the 6 perinatal care regions in North Carolina. To operationalize our efforts for sharing best practices and improving communication between obstetrical and primary care providers we are offering a series of continuing education opportunities, as well as technical assistance to bridge the gap between theory and practice to advance family and community health.

Objectives

  • Examine upstream social determinants, socially structured systems, and their impact on health and health care for people in the pregnant, postpartum, and interconception periods.
  • Analyze the systemic inequities that restrict the provision of quality reproductive health care for all by centering the experiences of those affected.
  • Apply evidence-based strategies for the prevention of maternal morbidity and mortality in the inpatient and outpatient settings.
  • Illustrate equitable quality improvement strategies to improve access, provision, and continuity of maternal health and well-woman care.
  • Demonstrate knowledge, skills, self-efficacy, and intent to use evidence-based practices that are applicable to the delivery of reproductive health services.
  • Practice inclusive leadership, communication, and interprofessional collaboration to improve perinatal care experiences especially for people with high risk pregnancy outcomes and chronic diseases complicating pregnancy.

Audience

  • Clinicians with the following specialties were the central audience: Family Medicine, Obstetrics and Gynecology, and Pediatrics.
  • Physician Assistants, Nurse Practitioners, Certified Nurse Midwives, Pharmacists, Lactation Consultants, Behavioral Health Specialists, Public Health Practitioners, and related fields were also invited.

Doing Better Together to Equitably & Innovatively Advance Reproductive Health and Healthcare with a Focus on Human Rights, Quality Improvement, and Interprofessional Collaboration, February 2022 – August 2022

Attachment in a Lifespan: How Adult Attachment Styles Influence Parenting, Adult Relationships, and Mental Health

Andrea Diaz Stransky, MD-BHSc and Heather Craige, MSW

Beyond the infant-caregiver relationship, attachment styles and processes influence adult relationships across the lifespan. In this presentation, participants will learn about the different attachment styles and how they evolve over the lifespan, how attachment styles impact adult relationships and mental health, and how healthcare providers can use their understanding of attachment to better serve their patients.

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Improving Perinatal and Interconception Care for People with Incarceration Histories

Andrea Knittel, MD, PhD, FACOG

People who have experienced incarceration may face unique challenges during pregnancy, after birth, and between pregnancies. Join this webinar to learn more about the criminal legal system and pregnancy, health disparities related to perinatal incarceration, and best practices for community and academic partners who provide perinatal and interconception care for people who have experienced incarceration.

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Intersex Experiences - Patient and Personal Stories

Alyssa Ball & Jessica Buch

The presenters, two individuals with CAIS (Complete Androgen Insensitivity Syndrome), shared their personal stories of growing up feeling different from their peers, and how they handled their genetic conditions. They talked about their interactions with health care providers, many of whom had little to no experience with CAIS and other genetic differences. They gave the audience advice on working with patients with intersex conditions, based on their own experiences with providers.

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Leveraging Policy to Improve Maternal Health Outcomes

Alyson Northrup, MS

Where do policy changes occur? How can you influence policy change to improve maternal health and advance equitable maternal health outcomes? The presenter will discuss opportunities for engaging in policy change at multiple levels as well as recent trends in policies to improve maternal health. Participants will have ample time to ask questions and discuss policy engagement strategies.

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Supporting Queer and Trans Clients

Ivy Hill and Wynston Sanders

This is an interactive, engaging, introductory level session centered around the basics of supporting trans and queer clients. Participants will gain a deeper understanding of appropriate terminology, discuss the unique barriers facing trans and queer people in the South, and prepare to better serve trans and queer clients.

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The Cost of Infant Death, Preventing Stillbirth, and Stigma

Kathryn Hyde-Hensley, LCMHC-A, LCAS-A

The Cost of Infant Death, Preventing Stillbirth and Stigma will address the prevalence of Stillbirth in NC, the use of evidence-based prevention care bundles, and the relationship-based approach parents want in bereavement care. The goal is to enhance awareness of the cost of loss, interventions for prevention and the bereavement skills needed to enhance the patient’s social-emotional and physical ability to recover from perinatal/neonatal death.

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Doing Better Together to Equitably & Innovatively Advance Reproductive Health and Healthcare with a Focus on Human Rights, Quality Improvement, and Interprofessional Collaboration, October 2020 - September 2021

Caring for Individuals with Developmental Disabilities-Challenges and Opportunities for Improvement

Andrea Currens, MD, FACOG

In this 90-minute session we will use case studies and sample conversations to discuss best practices for caring for individuals with developmental disabilities. We will dispel myths and discuss sexuality and contraception as it applies to this population. We will address barriers to care and best practices for transitions of care especially as adolescents transition to adult providers.

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Empowerment, Support, and Partnership to Improve Maternal Health in a Neurodiverse World

Mikaila Mills

As humans, we all learn, communicate and process information differently. However, most of our health care systems and policies are not set up for a neurodiverse population, especially for people with intellectual and developmental disabilities (I/DD). People with I/DD also have different needs for health and healthcare. These medical needs may represent barriers to successfully accessing appropriate health care in our current system. As professionals, we must be aware of barriers to positive maternal health for people with I/DD such as communication preference, learning differences, and lack of community care access. We must also adapt our implementation and delivery of services by taking a collaborative approach which maintains linkage to resources to support people with I/DD.

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IMPLICIT Model for Interconception Care at Well Child Visits

Heidi Knoll, MD and Julie Shelton, MPH, CPHQ, CCEP

The IMPLICIT Network is a family medicine maternal child health learning collaborative across the Eastern U.S. focused on improving birth outcomes and promoting the health of women, infants, and families through innovative models of care, quality improvement and professional development for current and future physicians and health care providers. The IMPLICIT Interconception Care model uses the child’s well visit as an opportunity to screen accompanying mothers for health risks. Where opportunities are identified, brief interventions are offered to promote the mother’s health in addition to the child’s health. With planning and strategy, implementation of the IMPLICIT model in Primary Care can be a seamless process. The speakers will discuss best practices and previous implementation strategies, as well as continuous quality improvement efforts after implementation.

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Interconception Care for the Pandemic and Beyond

Katie Wouk,PhD, IBCLC and Jacquana Smith, MPH, IBCLC

This session will address innovative models of interconception care with a focus on collaboration with stakeholders serving families to provide holistic, equitable, evidence-based care. We will share interdisciplinary approaches to providing lactation, doula, and dyad-focused support in any context, with adaptations for reaching families during the pandemic.

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Perinatal Mood Disorders, Bonding, and Attachment

Mary Kimmel, MD and Andrea Diaz-Stransky, MD-BHSc

When pregnant and postpartum people suffer from depression and/or anxiety, they can struggle to connect with their babies in healthy ways. This can lead to difficulties with bonding and attachment. Insecure attachment in mother-child dyads can lead to increased anxiety and emotional problems for the mother, as well as emotional and developmental problems in the child. In this presentation, Drs. Kimmel and Diaz Stransky will discuss the importance of secure attachment in the mother-child dyad, explain how perinatal mood disorders can affect the mother’s ability to bond with her fetus/newborn, and share tools to use in your practice to both assess quality of attachment and provide avenues of support for mom and baby.

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Placing Culture at the Center: Practical Approaches and Strategies for Culturally Responsive Care with Latinx Communities

Juan Prandoni, PhD, HSP-PA, LPA

We are often told to be "culturally competent" or "conscious" in our care. However, in our busy workspaces, culture can sometimes become more of an after-thought instead of a central pillar of the way in which we diagnose and care for individuals. In this webinar, participants will gain exposure to a general overview of cultural values that impact mental health of women in Latinx communities, understand how these values change through the process of acculturation, and gain practical evidence-based tools for addressing issues of culture, immigration, and acculturation in a culturally responsive and nuanced manner.

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Postpartum Depression in African American Women: Signs, Symptoms and Barriers to Diagnosis

Donya Wallace, PhD., NCC, LPC

In this presentation participants will explore the barriers to detecting and diagnosing postpartum depression among African American women, examine the culturally embedded schemas that preclude professional help seeking and treatment, and develop culturally relevant skills for diagnosing and encouraging treatment compliance in affected patients.

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Public Policy Strategies for Improving Maternal and Child Health Outcomes

Tina Sherman,BA and Beth Messersmith, BA-MPA

"Lack of workplace supports for families results in an increase in infant mortality and maternal morbidity and cost North Carolinians more than $450,000,000 each year. We will discuss why investing in workplace policies such as accommodations for pregnant and breastfeeding people, earned sick days and paid family and medical leave can help decrease health disparities, improve maternal and child outcomes, strengthen our children and families, and the economy.

In this session we will review each of these public policies and learn how participants and their organizations can be involved in winning policy change.

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Rights-Based Approaches to Maternity Care

Benjamin Meier, JD, LLM, PhD and Caitlin Williams, MSPH

Based on the ideal that all people are equal in dignity, human rights offer a framework for advancing justice in health. This webinar will outline how human rights can guide efforts to improve maternity care, and provide practical recommendations for clinicians to get involved in human rights advocacy to ensure maternal health.

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The Birthweight of a Nation: Racism & Population Health in the Trump Era

Carmen Gutierrez, PhD

A growing body of evidence finds increased levels of psychosocial stress and anxiety in the US population since Trump launched his 2016 US presidential campaign, especially among immigrant groups from Latin America and Middle Eastern/North African (MENA) countries. Few studies to date, however, have evaluated the population health implications of the Trump era for foreign-born Latina and MENA women and their children. With restricted-use natality files from the National Center for Health Statistics (NCHS), this project investigates whether periods following Trump’s 2016 presidential campaign, election, and administration were associated with changes in the risk of low birth weight (LBW) among US-born infants.

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When One Patient is Actually Two

Ami Goldstein,CNM, MSN, FNP

Many times in the first months of life, a young family's care is siloed between pediatric and parental health care providers. It is important to widen the vision to include the family as a whole, since health issues can impact both parents and infants. This session will look at how to identify, care or refer for concerns affecting young families.

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Doing Better Together to Equitably Advance Reproductive Health and Wellness Webinar Series with a Focus on Innovation, Quality Improvement, and Interprofessional Collaboration, February 2020 - September 2020

A Practical Introduction to Improvement and Implementation

Caitlin Williams, MSPH, MSW

This webinar dives into the importance of equitably improving outcomes for moms and babies through implementation science as well as having a thorough understanding of structural and social determinants of health. The stages of implementation are discussed as well as the Plan-Do-Study-Act cycles as an example of a quality improvement tool.

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Best Practices for Perinatal Substance Use Disorder Treatment: A Discussion with Project CARA, UNC Horizons and TIDES

Elizabeth Johnson, PhD, FNP-BC + Melinda Ramage, MSN, FNP-BC, CARN-AP and Skip Johnstone, MBA, MD, JD

Project CARA, UNC Horizons, and TIDES collaborated to discuss the best practices for perinatal substance use disorder treatment, such as perinatal substance use screening, transitions of care, and harm reduction techniques. The presenters debunked several myths surrounding perinatal substance use disorder and discussed how to best provide proper care during the COVID-19 pandemic.

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Childbirth Educators, Doulas and Providers - The Importance of Collaboration

Daijah Davis, MPH

This webinar focuses on the value and importance of doulas and childbirth educators and the collaboration between clinical workers and birth workers. The collaboration between clinical and birth workers follows the “Golden Rule” of mutual professional respect which embraces shared decision-making and Plan-Do-Study-Act cycles for implementation.

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Culturally Appropriate Birthing Education

Janalynn Beste, MD

Dr. Janalynn Beste presents the importance of practicing cultural humility as a clinician. Finding equity through structural competency, quality improvement tools, and interprofessional collaboration are all thoroughly discussed.

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Ensuring Positive Pregnancy and Birth Experiences for All

Caitlin Williams, MSPH, MSW

Understanding the importance of a positive birthing experience for all regardless of the unexpected challenges that may arise is imperative in improving maternal health outcomes. Obstetric mistreatment can be avoided by listening to birthing people, understanding the role of doulas and birth companions, abiding by the respectful maternity care charter, and implementing Plan-Do-Study-Act quality improvement tools.

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Family Support for Reaching Lactation Goals: Supporting the Dyad in Emergency Situations

Georganna Cogburn, MSHE, RD, LDN, IBCLC, RLC

Breastfeeding is widely recommended from different professional organizations, yet the decision to breastfeed is influenced by a wide variety of factors. Because breastfeeding is one of the most effective interventions in ensuring child health and survival, it is essential to provide support in order to reach lactation goals, especially in emergency situations.

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IMPLICIT ICC: Improving Birth Outcomes through Interconception Care at Well Child Visits

Lisa Schlar, MD

The IMPLICIT Network is a learning collaborative focused on minimizing preterm and low birth weight infants through continuous improvement techniques. The IMPLICIT model focuses on interventions for smoking, depression, family planning, birth spacing, and multivitamin with folic acid use as a means to achieve better health outcomes for infants and birthing people.

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Improving Counseling, Initiation and Access to Post-Partum Contraception

Brigid Wilson, MD

This webinar focuses on the importance of counseling, available contraception options, potential barriers to postpartum contraception, and the resources clinicians and patients can use to increase access. This informative session will help guide clinicians in their role as an advocate for postpartum contraception.

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Improving health by transforming care through Centering® groups

Carmen Strickland, MD and Victoria Jackson, MPH

The Centering Group Model through the Centering Healthcare Institute aims to improve health, transform care, and disrupt inequitable systems. Centering is a patient-centered framework for providing healthcare in a group format by replacing individual appointments with group appointments in an attempt to engage patients in their own care and connect them to other patients and support services.

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Maternal Health in Immigrant and Refugee Communities: Supporting Optimal Outcomes

Narges Farahi, MD

This presentation focuses on different barriers and techniques used to provide optimal maternal health outcomes in immigrant and refugee communities. Specific recommendations are provided to aid clinicians in giving the best care.

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MIND THE GAP: Top 5 Holes NC Providers Miss Delivering Interpregnancy Care

Keyona Oni, MD

If physicians are suited to understand the top five gaps in delivering interpregnancy care, birthing people may experience better health and health care outcomes. Dr. Oni shares different strategies for providing optimal interpregnancy care for all.

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Strengthening Parent and Child Health Outcomes through Policy Advocacy

Vikki Crouse, MSW

On behalf of NC Child, Vikki Crouse shares the importance and value of policy advocacy in improving parent and child health outcomes throughout the lifecourse. Various strategies for engaging in policy advocacy are provided as well as examples of how to apply the strategies to common scenarios.

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Systems Change for Advance Reproductive Health and Wellness

Dan Frayne, MD

To improve maternal health outcomes, it is essential to recognize the problem of poor maternal and child health results in North Carolina and focus on state and local initiatives to achieve a healthier population. Dr. Dan Frayne shares his theory of improving population health through a proposed metaphor where the three main practices are preconception and intergenerational focus of health and healthcare, transformation of healthcare delivery, and dismantling racism. This webinar also dives into the many different resources and initiatives found across the state for clinicians to implement as a means to improve maternal and child health outcomes.

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The Essential Role of the Physician Advocate in Improving Maternal Health

Toni Malhorta, MD and Rebecca Abbott,BA

Physicians can play a pivotal role in improving maternal and child health outcomes through advocacy. The importance of advocacy, tools for effective advocacy, and direct results of physician advocacy are discussed.

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The Role of Pregnancy Medical Home In the Covid Era

Arthur Ollendorf, MD, FACOG

The North Carolina Pregnancy Medical Home Program (NCPMH) serves as a resource to improve the quality of pregnancy care for Medicaid recipients by focusing on preterm birth prevention and reducing the amount of cesarean deliveries. While the COVID-19 pandemic has provided unprecedented challenges for healthcare providers and patients, the NCPMH Program has given recommendations for clinicians on how to ensure a proper standard of care for health equity, educational resources, equitable access to quality care and protection of human rights, and beyond.

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Transitions of Care in the Post-Partum Period: a Model for Interdisciplinary Collaboration

Amy Santin, MD + Suzanne Dixon, MD and Katlyn Moss, BSN

Understanding recommendations from different professional societies regarding postpartum care can prevent some of the common causes of preventable maternal mortality in the postpartum period. The presenters share best strategies for better communication between obstetric and primary care providers, best practices for clinical management, and the importance of advocacy.

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This project was made possible thanks to the funding, guidance, and support from North Carolina Department of Health and Human Services - Division of Public Health - Maternal Health Branch-Women, Infant, and Community Wellness Section. This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $10,216,885 with 0% financed with nongovernmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, HRSA, HHS, or the U.S. Government.

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