7:00 a.m. Shuttles from Indianapolis Zoo begin
Light breakfast available
8:30 a.m. Welcome, David McCormick, Division Director, Immunization Division, ISDH
- Kris Box, MD, FACOG, Indiana State Health Commissioner
- Elliott Main, MD, Stanford Medical School, Medical Director and Executive Committee Chair of the California Maternal Quality
Care Collaborative (CMQCC), and Chair of the California Pregnancy-Associated Mortality Review Committee
- Charles S. Johnson, IV, 4Kira4Moms
10:15 a.m. 30 minute Break, visit Exhibitors & Sponsors
10:45 a.m. - Maria J. Small, MD, Maternal-Fetal Medicine Specialist, Duke Health
- Nolan Mikowski, ISDH – Liv pregnancy App, Friend of Liv
- Raymond “Paul” Miller, Division Chief of EMS, Crawfordsville Fire Department
- Hossain Marandi,MD MBA FACHE, President, Peyton Manning Children's Hospital @ St. Vincent
12 p.m. Plated Lunch
1:45-2:45 p.m. Concurrent Breakouts
The Strengths-Based Approach to Working with Mothers with Substance Abuse History
Room JW Grand 1
In response to Indiana’s high infant mortality rate, the Indiana State Department of Health developed Safety PIN. As part of this initiative, Choices Coordinated Care Solutions provides care coordination services to five counties in southeastern Indiana to help pregnant women, recent mothers (to children younger than 1 year old), and expecting fathers or recent fathers receive the care they need during the pregnancy and the first year of their child’s life.
Safety PIN integrates the social determinants of health through a wraparound model to support these women and their families to achieve a live birth without signs of chemical dependency for the mother or the infant. The program is client-driven and strengths-based so that goals are specific to the needs of the expecting/new mother. Staff members help clients meet needs that have been identified as social determinants of health more broadly (e.g., food, health care). Future goals include expanded access to transportation and housing.
In addition to learning about some of the needs of our population to achieve treatment goals, staff have learned valuable lessons about the differences in engagement of clients who are voluntarily participating versus those whose participation is mandatory. This session will feature some of those outcomes and insights.
Jodi Alexander, Choices Coordinated Care Solutions
Jennifer Tackitt-Dorfmeyer, Choices Coordinated Care Solutions
A New Model for Reducing Maternal Death
Room JW Grand 2
Approximately 700 women across the United States die each year as a result of pregnancy or pregnancy-related complications. From 2012 to 2016, 202 Indiana women died from pregnancy or pregnancy-related complications. According to the Centers for Disease Control and Prevention, nearly 50 percent of all maternal deaths were caused by hemorrhage, cardiovascular conditions or cardiomyopathy. While vital statistics can tell us about trends and disparities, maternal mortality reviews (MMR) are best positioned to comprehensively assess maternal deaths and identify prevention opportunities.
With a goal of reducing Indiana’s maternal mortality rate, Senate Enrolled Act (SEA) 142 allows the Indiana State Department of Health to create a MMR committee to study all identified maternal deaths in Indiana. Maternal deaths are identified using vital statistics data (death and birth records), case abstractions, review decisions, and data analysis using the Maternal Mortality Review Information Application (MMRIA) database.
Expected outcomes of MMR in Indiana include:
-Widespread adoption of patient safety policies that reflects highest standard of care for mothers;
-Elimination of preventable maternal deaths; and
-Improvement of population health for women of reproductive age in Indiana.
To turn the tide on maternal mortality in Indiana, we must build on current momentum and support the critical work of the MMR committee. The MMR committee can be the best tool for understanding why preventable maternal deaths continue to occur and to prioritize ways to effectively reduce maternal deaths. As more MMR committees collect and share data throughout the country, there will be greater understanding and specificity of potential high-impact recommendations.
Kolawole Ale, MPH, maternal mortality review coordinator/epidemiologist, ISDH
Kristen Moore, MSN, RNC-OB, C-EFM, chief nurse consultant, ISDH
Engaging Fathers in Infant Mortality Prevention
Room JW Grand 3
When fathers are involved during pregnancy, maternal negative health behaviors (e.g., tobacco, alcohol and substance use) diminish and risk of preterm birth and low birth weight is reduced. After pregnancy, a father’s absence contributes to infant mortality, in one study widening the black-white gap in infant mortality almost fourfold.
Few community-based infant mortality initiatives are explicitly designed for and administered to fathers. WeCare is a partnership of healthcare, public and community organizations developed to reduce infant mortality in Indiana’s Central and Eastern Regions through outreach, health coaching, community engagement and mobile health messaging technologies. Pregnant and parenting women enrolled in WeCare receive tailored health education focused on health behavior change, safe sleep and accessing social services within the community.
In 2017, WeCare expanded to target fathers, as well as women, for preventive services. Since then, 85 fathers have enrolled, most during their partner’s pregnancy.
This session will look at the needs expressed by enrolled fathers, including services focused on smoking cessation, food insecurity, transportation and housing instability. Fathers’ unique health and social service needs that are unique from mothers create an opportunity to engage them in preventive health initiatives traditionally developed for women and children.
Erika Cheng, PhD, MPA, Indiana University School of Medicine
Nancy Swigonski, MD, MBA, Indiana University School of Medicine
Debra K. Litzelman, MD, MA, Indiana University School of Medicine
Supporting and Strengthening Families through Home Visitation to Impact Infant Mortality
Room JW Grand 4
Infant Mortality for Region 10 has been an ongoing health care concern. Regional infant mortality rates have been as high as 11.4 per 1000 live births. The Vanderburgh County Health Department received a Safety Pin Grant through the Indiana State Department of Health to implement the Pre to 3 Program. This is a free home visiting program that follows women prenatally until the child is 3 years of age.
This program utilizes community health workers (CHW), registered nurses, a social worker, a certified lactation consultant, and a data coordinator. A CHW visits the home on a weekly basis to provide long-term, consistent, hands-on support for babies and families. These visits are completed using an evidence-based curriculum called Growing Great Kids, which is an interactive program that promotes empathic parenting, self-regulation, healthy living, and other topics.
The goals of the program are to reduce risk-factors associated with infant mortality, reduce Adverse Childhood Events, and improve health and wellness outcomes for mothers and babies. Specific factors addressed include early prenatal care, smoking cessation, safe sleep practices, and breastfeeding. Using several screening tools and forms, metrics are tracked such as client health, education, and socioeconomic information. These data are analyzed for the clients’ benefit and program evaluation. The upshot of the Pre to 3 Program is to increase family resiliency and to break the intergenerational cycle.
Lynn Herr, clinical and outreach director, Vanderburgh County Health Department (VCHD)
Sophie French, supervisor, Pre to 3 Program, VCHD
Shamirah Willis, community health worker, VCHD
Mark Healy, data coordinator, VCHD
Immunizations Mandatory Training
(Pre-registration is required to attend this session, 1:45-4:45 p.m.)
Room JW Grand 5-10
Part A-Maternal Influenza and Tdap Vaccination
Dr. Mary Pell Abernathy will explore the importance of influenza and Tdap vaccination for pregnant women, including a review of current immunization rates for this population, pertussis and influenza disease morbidity and mortality outcomes among pregnant mothers and their infants, and recommendations to improve vaccination practices and messaging.
Mary Pell Abernathy, MD, MBA, associate professor of clinical obstetrics and gynecology, Indiana University School of Medicine
Part B-Juvenile Recurrent Respiratory Papillomatosis (JRRP)
Katharina Lewman will describe the epidemiology of juvenile recurrent respiratory papillomatosis (JRRP) and the Advisory Committee on Immunization Practices (ACIP) vaccine recommendations for its prevention.
Katharina Lewman, MPH, education and outreach manager, Immunization Division, ISDH
Part C-Indiana Vaccines for Children (VFC) and Immunization Program Updates
David McCormick will examine Indiana’s immunization rates and address vaccination gaps, describe pertinent Vaccines for Children (VFC) program updates, and discuss ISDH Immunization Program initiatives to improve vaccination uptake among Hoosiers.
David McCormick, director, Immunization Division, ISDH
Pioneering Perinatal Navigation
The Central Southwest Region of Indiana is composed of nine counties that collectively hold one of the highest infant mortality rates in Indiana. To decrease the infant mortality rate in this region, the Perinatal Navigator Program was designed and implemented by Union Hospital (the region’s largest maternal and child services provider) in partnership with the ISDH Safety PIN grantee program. This program uses an evidence-based approach to evaluating and stratifying mothers and families who are at a high risk for experiencing an infant loss.
The program is founded on establishing relationships and connecting mothers to resources within our communities to ensure their needs are met and success is attainable. The navigators meet with many patients including high risk patients with whom they meet every trimester and four times in the post-partum period, three occur in the home. The navigators are trained to exchange evidence based lifestyle choices with patients to impact the health and safety of the family, specifically the mother and the baby. The mother’s health and lifestyle choices directly impact the health outcomes of the entire family, especially the infant. Making a difference in these choices has proven a difficult process. It is a journey that reaps many rewards and will impact the health of families into many future decades. Participants in this session will learn about the work done by navigators and the lessons they’ve learned in perinatal navigation.
Jaimee Goodman, RN, MSN, MBS, CNML, service line director: Women and Children Services, Union Hospital
Sarah Fagg, RN, MSN, perinatal navigator, Union Hospital
Shane Wilson-White, RN, BSN, perinatal navigator, Union Hospital
Dan Hardesty, MPA, research & project coordinator, Richard G. Lugar Center for Rural Health
Community Health Workers-Leaving a footprint in Allen County
Footprint Indiana is a 2017 Safety PIN funded program designed to educate, support, and connect women in Northeast Indiana to health and social services. The program utilizes certified Community Health Workers (CHWs). These CHWs are experts in their communities and are acting as a bridge between health and social services and the residents in neighborhoods most affected by infant mortality. They are serving at every level of the collective impact model from data collection, information sharing, prioritizing, initiative implementation, and outcome measures.
Our goal is to empower women to have healthy pregnancies, raise healthy babies, and improve their lives. At less than a year into the program, we want to share our lessons learned. Implementing the program came with many surprises and heartwarming stories. Our most impactful takeaway so far has been learning what great things can happen when we assume less and listen more. We are learning to support the community in ways that are meaningful to them.
Erin Norton, director community outreach, women’s and children’s, Parkview Health
Gwendolyn Carpenter, Safety PIN project manager, Parkview Health
Overview of Immediate Postpartum Long-Acting Reversible Contraception (LARC)
This session contains general information on LARC placement prior to a woman’s discharge after delivery. The session will be led by immediate postpartum (IPP) LARC clinical expert Dr. Jeffrey Peipert, who will explain the efficacy, safety, benefits and clinical considerations of immediate postpartum LARC and describe the IPP IUD insertion procedure. This session will highlight the need for postpartum contraception and the importance of shared medical decision-making for contraceptive counseling. Resources for practical guidance on how to incorporate IPP LARC into practice or institution will also be shared.
Jeffrey Peipert, MD, PhD, Indiana University School of Medicine
The Heart of the Matter: Cardiac Health During Pregnancy
This presentation will discuss pre-conceptual, antepartum, intra-partum and post-partum management of women considering pregnancy or who are pregnant with heart disease. Learn multidisciplinary approach to these complex patients.
Mary Walsh, MD, St. Vincent/Ascension
Changing the Tobacco Purchasing Experience
The way tobacco companies market their products has changed over time. As tobacco advertising has been restricted, tobacco companies have adapted and now spend most of their marketing dollars in stores where tobacco is sold, known as the point of sale.
Tobacco point-of-sale marketing is essentially marketing tobacco products to consumers where they buy tobacco, such as convenience stores or gas stations, grocery stores and pharmacies. Point-of-sale marketing includes price promotions or discounts on tobacco products, in-store tobacco product displays, product placement and retail advertising. This type of marketing is not random. Retailers often have contracts with tobacco companies that specify where tobacco products have to be placed, at what height, and what proportion of the display needs to be dedicated to particular products. It is an intentional form of marketing, and tobacco companies know that it works.
Exposure to point-of-sale marketing encourages youth to start using tobacco, makes quitting more difficult among established tobacco users, and disproportionately targets some communities. Targeted marketing to women continues the cycle of tobacco addiction among women and girls and presents challenges for future healthy moms and babies. This session share observational data collected at the point of sale in urban and rural parts of the state.
Brian Busching, director of tobacco cessation systems, Tobacco Prevention and Cessation Commission, ISDH
Katelin Rupp, director of program evaluation, Tobacco Prevention and Cessation Commission, ISDH
Healthy Beginnings Post-Discharge Clinic to Improve Maternal and Neonatal Outcomes
The Healthy Beginnings clinic was developed by nurse advocators and opened in April 2017. The goal is to bridge the gap between hospital discharge and the first doctor’s follow-up appointment for both mother and baby. The clinic helps the patient find a primary care provider if one has not already been established at the time of delivery and features a one-on-one visit by a highly experienced maternal-newborn registered nurse. Appointments are scheduled for patients through interdisciplinary management while the patient is still in the hospital to facilitate individualized care for the mother-baby dyad.
Newborn assessments are focused on heal sticks for bilirubin and newborn infant screens, vital signs, weight check, auscultation of heart, breath sounds and bowel sounds, Finnegan withdrawal screening for substance-exposed newborns, and feeding evaluations performed with feeding plans initiated if indicated. Maternal assessments focus on vital signs, fundal and lochia checks, perineum or incision exams, post-partum mood disorders, and breastfeeding concerns. Once assessed, the nurse reports to physicians to initiate early interventions and to schedule additional follow-up appointments as needed. Review has shown a significant increase in participation with the clinic, as well as multiple discoveries that have improved outcomes.
Lacy Hanmore, BSN, RN, CLC, St. Vincent, Evansville
Miranda Wahnsiedler, MSN, BS, AGCNS-BC, RNC-OB, St. Vincent, Evansville
2:45 p.m. Break for Exhibitors
3:15 p.m. Concurrent Breakouts
Straight Talk on Safe Sleep
Room JW Grand 1
The March 2018 Journal of Pediatrics reported a 184 percent increase in accidental suffocation/strangulation in bed for infants from 1995 to 2015 in the United States. To better inform prevention strategies, a paradigm shift is needed to reach at-risk populations. This shift involves gaining trust and credibility with families and engaging them to resolve issues that prevent a safe sleep environment.
Healthcare providers and social and outreach workers set the tone for successful patient education outcomes. Parents are the ultimate decision-makers of where and how their babies sleep and eat. The Straight Talk for Infant Safe Sleep (STISS) curriculum consists of a train-the-trainer section for professionals and a parent section for families. This approach supports enhanced communication skills to ensure professionals are equipped to "meet families where they are.”
STISS is evidence-based, designed to share American Academy of Pediatrics safe sleep recommendations, to explore potential personal biases and to involve families in creating their own best solutions. Curriculum is based on the Ajzen's Theory of Planned Behavior.
The train-the-trainer section uses self-reflection/role playing to gain understanding of how to create a two-way conversation with parents, identify and respect family practices and beliefs, provide accurate information about safe sleep and breastfeeding. Parent training is then enhanced by this skill set development.
Holly Wood, Safe Sleep Coordinator, ISDH
Recognizing and Managing Neonatal Abstinence Syndrome (NAS)
Room JW Grand 2
Four St. Vincent Indiana Health facilities joined Phase 2 of the Indiana Perinatal Quality Improvement Collaborative (IPQIC) Perinatal Substance Use pilot. In fall 2016, a multi-disciplinary task force was developed to focus on the implementation of the objectives proposed by IPQIC. The task force developed a system-wide policy and standardized approach to identify and care for mothers and babies affected by substance use in pregnancy. Education was developed and presented to staff focusing on the system policy, identifying newborns at risk for substance exposure, and providing evidence-based interventions to the newborns and families.
The methods used to identify at-risk newborns include the five P’s verbal screen, universal maternal toxicology screening, umbilical cord toxicology screening, and the scientifically validated Finnegan Neonatal Abstinence Screening Tool. Non-pharmacological and pharmacological interventions are provided to decrease length of stay and promote family bonding. In one St. Vincent facility, pre-pilot data over seven months showed on average a 24.3 percent umbilical cord testing rate, with 29.5 percent of the cords resulting positive, and 77 percent of the newborns that met criteria for umbilical cord testing not receiving withdrawal screening.
After education and policy implementation, current data trends over seven months show on average a 33.3 percent umbilical cord testing rate, with 25.6 percent of the cords tested resulting positive, and 31.7 percent of the newborns that meet criteria for umbilical cord testing not receiving withdrawal screening. There has not been an increase in Neonatal Intensive Care Unit admissions for NAS. Future work is aimed at evaluating verbal screening and improving withdrawal screening compliance.
Miranda Wahnsiedler, MSN, BS, AGCNS-BC, RNC-OB, St. Vincent, Evansville
Pacita Bassler, MSN, RNC-NIC, Ascension Health
Collaboratively Addressing Inclusion and Diversity for Hoosier Moms and Babies
Room JW Grand 3
Lake County community champions Franciscan Health, Mental Health America of Northwest Indiana (MHA), and Nurse-Family Partnership (NFP) join forces to recognize and address the social determinants of health that significantly impact infant mortality rates. As highlighted by data from ISDH Birth Outcomes Fact Sheets and KIDS Count Data, exclusive breastfeeding, safe sleep practices and the importance of diaper time contribute to the outcome of healthy, Hoosier moms and babies.
Learn how Lake County’s inclusive and diverse model can be used to prevent infant mortality and improve health outcomes. Presenters will share a brief overview of their organizations’ missions and services, as well as their efforts to combine the expertise of each. These three community stakeholders will explain how collectively working toward improving efficiencies increases likelihood of reaching more mothers and babies. Participants will then venture through past, present and future programming in Lake County that not only decreases infant mortality, but positively impacts socioeconomic barriers.
The session will conclude with a discussion on how collaborative efforts organized by the Prenatal Assistance Program, MHA’s Healthy Families, and NFP can bridge gaps in county resources and funding. Participants will be given tools to identify challenges of their own communities, as well as best practices to professionally and communally create their own Community Toolkit.
Joan Culver, Franciscan Alliance, Inc.
Victor Garcia, Mental Health America of Northwest Indiana
Tameka Warren, Nurse-Family Partnership
Rebecca Tilton, MPH, Franciscan Health, Northern Division
Danielle Magana, Franciscan Health, Hammond
Mama Matters: The Heart of The Issue
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To affect change in maternal health outcomes and reduce infant mortality, core issues such as socioeconomic, physical as well as behavioral health barriers must be addressed. Stakeholders cannot expect meaningful and sustainable results without intentional and strategic focus on the root issues facing the families we serve. Mothers in underserved minority communities face overwhelming disparities in health care, nutrition, educational programming and economic opportunity, resulting in disproportionate risks to their lives and the lives of their children. Providing mothers with a network of collaborative health initiatives focused on the whole woman can begin to change the landscape of maternal health.
Each organization that pledges to provide a service, resource or program with the intent of saving lives must be dedicated to serving the entire community, starting with the mother. The lack of adequate resources in predominately minority communities sheds light on the issues of systemic racism and epigenetics that threatens the lives of minority babies. The moment a woman receives a positive pregnancy test result, her life changes instantly and permanently. Her thought processes begin to change dramatically to include the future challenges and possibilities that motherhood offers. Coupled with the excitement and preparation are the fears and questions that are presented by the new set of responsibilities and the overwhelming barriers she faces. This session will focus on our responsibility to provide support and resources that change the culture of the community by focusing on the issues directly affecting maternal health.
Kelli Brien, Community Wellness Partners
Karl Nichols, Community Wellness Partners
Immunizations Mandatory Training, continued
Room JW Grand 5-10
Utilizing CBT to Improve Maternal Mental Health and Decrease Infant Mortality through Home Visiting and Group Sessions
The research shows that preterm birth, low birth weight and intrauterine growth restriction are leading causes of infant mortality. Recent studies have identified an increased risk for these factors when maternal depression is present.
Having listened to local healthcare providers, Mental Health America of Northwest Indiana determined that there was a gap in resources available to support mothers experiencing low to moderate depression symptoms. As a result, Mental Health America of Northwest Indiana
adopted a new evidence-based curriculum that can be used in home visiting as well as in group sessions that is rooted in Cognitive Behavioral Theory to positively impact maternal mental health.
This session will provide an overview on how maternal mental health impacts infant mortality, what CBT is and how it works, and a high level look at the implementation process with real world results.
Jodi Thielemann, MA, LCSW, Mental Health America of Northwest Indiana
Derek Blagojevic, Mental Health America of Northwest Indiana
Supporting Infants Born in the Midst of Crisis
Supporting Infants Born in the Midst of Crisis
Indianapolis Healthy Start (IHS) is an infant mortality reduction program that provides intensive case management services to Marion County women and their families. The program focuses on 10 ZIP codes that have been identified as having the highest infant mortality rates in Indiana. The implementation of standardized screening tools across national sectors is improving maternal and child health outcomes within the communities being served. Women and their families who are living in crisis and being enrolled into a program that provides support and resources helps them in overcoming social determinants of health. IHS plays a significant role in improving birth outcomes in Indiana. As violence, hunger and homelessness increase in our communities, learn what work can be done to protect Indiana’s infants.
Anita Adams, MA, LMFT, MDIV, Marion County Public Health Department
Maisha Wade, lead case manager, Marion County Public Health Department
Immediate Post-Placental IUD Placement Training
(pre-registration required to attend this training-attendees must be qualified to insert LARC)
This hands-on training session is designed for all providers authorized to insert a long-acting reversible contraceptive (LARC) device in a patient prior to discharge from the hospital after delivery. The immediate postpartum LARC clinical expert, Dr. Jeffrey Peipert, will demonstrate the immediate post placental IUD insertion for each group using MamaU models, which simulate an IPP uterus. Dr. Peipert will describe and demonstrate the insertion procedure and different insertion techniques. The attendees will practice inserting IUDs with the MamaU models with individualized technical assistance and feedback. Training attendees will have the opportunity to ask questions in the small group setting during this time.
Jeffrey Peipert, MD, PhD, Indiana University School of Medicine
The Role of Child Care Providers in Reducing Infant Mortality
Attendees will have the opportunity to hear how cross-sector collaborations with early childhood education partners, workforce development and other community development partners create a Best Baby Zone (BBZ). The BBZ participants interact to help reduce negative outcomes of social determinants of health for mothers and families, leading to a reduction in infant mortality.
The session will start with an overview of the state of infant mortality in Indiana. Next, participants will look at the cross-sector collaborations in the BBZ to address these social determinants of health, foster economic development and reduce infant mortality. Attendees will follow the journey of a mother and childcare provider toward economic development and overall better health outcomes through some of the local initiatives. Attendees will also have the opportunity to review some of the recent short-term outcomes and results from these local initiatives.
Presenters will share information on implementing cross-sector collaboration strategies with various partners in the community, lessons learned and the framework for spreading this work. Current metrics and available data will also be shared.
Whitley Wynns, Indiana University School of Medicine
Kara Casavan, Indiana University School of Medicine
Perinatal Safety Bundles: Is Your Facility Ready?
Learners will be updated on how Perinatal Safety Bundles can prepare your facility to deal with OB Hemorrhage, Hypertension and Maternal Venous Thromboembolism Prevention.
Anita Roesener, CNS, St. Vincent/Ascension
Clinton County’s One Stop Shop for Reducing Infant Mortality
Through this panel discussion, participants will learn how Healthy Communities of Clinton County (HCCC) has maintained a strong coalition that aspires to improve the overall health and well-being of women of child-bearing age in the Clinton County region. Through action, partnerships, and resources we strive to reduce infant mortality.
HCCC has set a plan in motion where an individual who enters the office can receive free help and assistance in multiple areas in one location. Some of these areas include pregnancy tests, prenatal vitamins, tobacco cessation, prenatal classes, opioid treatment and mental health resources, insurance navigation, safety items for the home, safe sleep education and car seat inspections. All are with bilingual services, which helps reach and serve an especially high Hispanic population in Clinton County. HCCC works to unite resources to provide services as a “one stop shop” to those of child- bearing age to reduce infant mortality in the region, and you can do it, too.
Kathy Martin, director of operations, Healthy Communities of Clinton County
Libbi Smith, prenatal coordinator, HCCC
Kacie McGill, Baby & Me-Tobacco Free facilitator, car seat technician, HCCC
Madison Balero, Covering Kids & Families insurance navigator, car seat technician, HCCC
4 p.m. Closing Session