12/03/13 LHJ: Sample Sacramento

Deliverable Form E – 5-Year Action Plans

(For further instructions see separate document titled “Action Plan Guidelines”)

MCAH SOW Goal 3_: Improve infant health
Problem Category / From Deliverable Form B of your Title V Needs Assessment - SIDS/SUID; Perinatal Substance Use
Problem Statement(s) / From Deliverable Form B of your Title V Needs Assessment -Black infants are having a higher rate of SIDS due to lack of knowledge about SIDS risks and unsafe sleep practices
Pregnant white women have an increased rate of Perinatal Substance Use (PSU) due to lack of knowledge about the harm to the fetus from alcohol use
Five Year Local Goal(s) / (Develop one or more five year local goal(s) that state the desired results of your interventions) - SIDS/SUID -Reduce the number of presumed unexpected infant deaths by promoting infant safe sleep and Sudden Infant Death Syndrome (SIDS) risk reduction education activities to the community with a focus on Black families
PSU - Increase the proportion of primary care providers who screen all pregnant and postpartum women for perinatal substance use; increase community knowledge regarding the harmful effects to the baby from PSU
Risk/Contributing Factors / (List LHJ-specific contributing factors using a problem analysis) – SIDS/SUID - Unsafe infant sleep environments, prone/side sleep positioning, exposure to substance use in utero or early infancy, lack of knowledge of SIDS, lack of regular prenatal care, prematurity, low birth weight
PSU -Lack of education on effects of substance use during pregnancy, stress (external/internal), unhealthy relationships, lack of social skills, poor health, domestic violence, mental health issues, low self-esteem, social acceptance of alcohol use
Best Practice Strategies/ Interventions / (List best practice strategies and/or interventions to address your problems) – SIDS/SUID - Educate parents, caregivers, and health care providers about ways to reduce the risk for SIDS and other sleep-related causes of infant death. Targeted outreach to MCAH population and other public health programs and providers. Increase knowledge of parents of newborns and childcare providers, especially for Black families
PSU - Integration of perinatal substance use screening into a range of clinical and community settings, such as Federally Qualified Health Centers, community clinics, managed care plans, health departments; community health education campaigns
Intervention Population(s) / (List the populations you will be focusing on for the next five years) – SIDS/SUID - MCAH and other public health programs and providers, childcare providers and parents of newborns, focusing especially on the Black community
PSU - Pregnant and postpartum women, primary care providers, Obstetric providers, local government departments, non-profit organizations serving women
Short and/or Intermediate Objective(s) / Inputs, including Community Partner involvement / Intervention Activities to Meet Objectives / Performance Measures
Short and/or Intermediate /
Process Description and Measure(s) including data source / Outcome Measure(s) including data source /
Fiscal Year 1- 2015-2016
SIDS/SUID
By June 30, 2016 [x/X] parents of newborns will demonstrate increased knowledge and intention to follow infant safe sleep practices and SIDS risk reduction in [number] birth hospitals, with a special focus on Black families
PSU – Infant health
By June 30, 2016, determine the number of primary care providers who screen for perinatal substance use (PSU) and, of those who screen, the number referring women who screen positive for follow-up care / ·  Birth hospital staff
·  Pediatric, obstetric (OB) and family practice providers
·  WIC pregnant clients
·  MCAH and public health department staff
·  Public health nurses
PSU– Infant health
·  CPSP providers
·  Primary Care Providers
·  PSCs
·  Behavioral Health
·  Social Services
·  Alcohol and Drug
Programs
·  Nonprofit/
community organizations addressing
PSU / ·  SIDS coordinator/public health professional outreaches to parents of newborns to provide infant safe sleep education and SIDS risk reduction in birth hospitals, focusing on Black families
·  Develop and administer evaluation tools to measure knowledge changes after education and intention to follow infant safe sleep practices and SIDS risk reduction
·  SIDS educational materials are located at the State web site: http://www.cdph.ca.gov/programs/SIDS/Pages/default.aspx
And the California SIDS Program web site:
http://californiasids.cdph.ca.gov
·  Develop and implement a Continuous Quality Improvement/Quality Assurance (CQI/QA) process to monitor implementation of policies/processes, a regular feedback mechanism to continually improve the process and evaluate the impact
·  Provide technical assistance as needed
PSU– Infant health
Perform the following activities:
·  Engage existing community partners/collaboratives
·  Develop and implement a survey of primary care providers to determine whether they screen none, all, or some pregnant and postpartum women for PSU, and refer women who screen positive for follow-up care. Include questions about policies implemented, referral processes, barriers/ challenges, and willingness to screen all pregnant and postpartum women
·  Identify the providers screening all or some pregnant and postpartum women and referring positive screens
·  Develop and implement a process to ensure a high rate of survey completion
·  Research and identify validated PSU screening tools. References include:
1) Local MCAH Jurisdiction Survey on Prenatal Substance Use Screening Data (Sept. 22, 2006), pp. 21-24 http://www.cdph.ca.gov/HealthInfo/healthyliving/childfamily/Documents/MO-PSU-LocalJurisdictionSurvey.pdf
2) Screening Instruments for Pregnant Women and Women of Childbearing Age: Substance Use, Mental Health and Intimate Partner Violence (VA Dept. of Behavioral Health and Developmental Services, 2012)
http://www.dbhds.virginia.gov/documents/scrn-Perinatal-InstrumentsChart.pdf
3) Perinatal Substance Use Screening in California (Chasnoff et al, 2008), p. 12
http://www.cdph.ca.gov/HealthInfo/healthyliving/childfamily/Documents/MO-ChasnoffPerinatalSubstanceUseScreeningReport-10-24-08.pdf / ·  Number of new parents outreached about the infant safe sleep practices and SIDS risk reduction
·  Number of new parents receiving education about the infant safe sleep practices and SIDS risk reduction
·  Briefly describe evaluation tool developed
·  Briefly describe barriers, challenges, and opportunities to improve infant safe sleep
·  Briefly describe the CQI/QA process developed
·  Brief description of technical assistance provided
PSU– Infant health
Briefly describe or report:
·  Collaborative relationships that support PSU screening all pregnant and postpartum women
·  Survey developed and implemented
·  Number of completed surveys/Number of surveys sent out
·  Total number of primary care providers caring for pregnant and postpartum women
·  Opportunities, barriers, and challenges to PSU screening and referral for follow-up / ·  [Number] of new parents demonstrating increased knowledge and intention to follow infant safe sleep practices and SIDS risk reduction/ the total number of new parents educated [X]
·  Briefly describe the results of evaluation
·  Describe the outcomes of the CQI/QA process including methods of measurements and results
PSU– Infant health
Measures include:
·  Number of providers who screen all pregnant and postpartum women for PSU and refer positive screens for follow-up/Number of providers who treat pregnant and postpartum women
·  Number of providers who screen some pregnant and postpartum women for PSU and refer positive screens for follow-up/Number of providers who treat pregnant and postpartum women
·  Number of providers with policies implemented for PSU screening
Fiscal Year 2 – 2016-2017
SIDS/SUID
By June 30, [20xx], [x/X] all homeless shelters will demonstrate increased knowledge and adopt infant safe sleep and SIDS risk reduction practices into
(this fiscal year the focus will be on homeless shelters; the second year the focus will be on faith-based organizations that are predominately attended by Black families)
PSU – Infant health
By June 30, 2017, [x/X] providers will screen all pregnant and postpartum women for Perinatal Substance Use (PSU) and refer women who screen positive for follow-up
(will conduct for 2 years to reach all providers) / ·  Homeless shelters
·  MCAH and public health department staff
·  Public health nurses
·  BIH Program
·  Loaves and Fishes
·  St. John’s Shelter
·  Family Promise of Sacramento
PSU – Infant health
·  CPSP providers
·  Primary Care Providers
·  PSCs
·  Behavioral Health
·  Social Services
·  Alcohol and Drug
Programs
·  Nonprofit/
community organizations addressing PSU / ·  SIDS Coordinators/Public Health Professional develop a relationship with homeless shelters
·  Provide infant safe sleep education and SIDS risk reduction and ongoing technical assistance
·  Observe safe sleep practices in shelters
·  Work with shelters to develop and implement policies to promote infant safe sleep and SIDS risk reduction practice
·  Evaluate safe sleep and SIDS risk reduction practices implemented
·  Develop and implement a Continuous Quality Improvement/Quality Assurance (CQI/QA) process
PSU – Infant health
Perform the following activities:
·  Assist providers to identify, develop protocols and implement the use of validated PSU screening tools (e.g., CPSP Initial Combined Assessment Form, 4 P’s, etc.).
·  Collaborate with other providers, community organizations, and support groups to establish a referral resource network
·  Develop and implement a Continuous Quality Improvement/Quality Assurance (CQI/QA)
·  Engage existing community partners/collaboratives / ·  Number of presentations given to homeless shelters
·  Briefly describe what was observed
·  Briefly describe the process to implement infant safe sleep and SIDS risk reduction practices in shelters
·  List technical assistance provided
·  Briefly describe the CQI/QA process developed.
PSU – Infant health
·  Number of primary care providers who have completed protocols /Number of providers who treat pregnant and postpartum women
·  Describe technical assistance provided
·  CQI/QA process developed / ·  [Number] of homeless shelters demonstrating increased knowledge of safe sleep practices and SIDS risk reduction /total number of shelters informed about infant safe sleep and SIDS risk reduction practice [X]
·  Number of shelters adopting infant safe sleep practices and SIDS risk reduction/ total number of shelters informed about infant safe sleep and SIDS risk reduction practice [X]
·  Briefly describe the results of evaluation
·  Describe the outcomes of the CQI/QA process
PSU – Infant health
·  [Number] of providers who have developed and implemented policies/procedures for PSU screening in their clinics/Number of providers who treat pregnant and postpartum women
·  Brief description of provider protocol
·  Brief description of
·  Brief description of referral resource network
·  Brief description of outcomes of the CQI/QA process
Fiscal Year 3 – 2017-2018
SIDS/SUID
By June 30, [20xx], [x/X] faith-based organizations that predominately serve Black families will demonstrate increased knowledge and adopt infant safe sleep and SIDS risk reduction practices into
(the focus will be on faith-based organizations that are predominately attended by Black families)
PSU – Infant health
By June 30, 2018, [x/X] providers will screen all pregnant and postpartum women for Perinatal Substance Use (PSU) and refer women who screen positive for follow-up
(second year of objective) / ·  Faith-based organizations that predominately serve Black families MCAH
·  Public health department staff
·  Public health nurses
·  BIH program
PSU – Infant health
·  CPSP providers
·  Primary Care Providers
·  PSCs
·  Behavioral Health
·  Social Services
·  Alcohol and Drug
Programs
·  Nonprofit/
community organizations addressing PSU / ·  SIDS Coordinators/Public Health Professional develop a relationship with faith-based organizations
·  Provide infant safe sleep education and SIDS risk reduction and ongoing technical assistance
·  Work with faith-based organizations to develop and implement educational programs to promote infant safe sleep and SIDS risk reduction practice
·  Develop a process to measure knowledge change and intent to implement SIDS information
·  Evaluate safe sleep and SIDS risk reduction programs implemented
·  Develop and implement a Continuous Quality Improvement/Quality Assurance (CQI/QA) process
PSU – Infant health
Perform the following activities:
·  Assist providers to identify, develop protocols and implement the use of validated PSU screening tools (e.g., CPSP Initial Combined Assessment Form, 4 P’s, etc.).
·  Collaborate with other providers, community organizations, and support groups to establish a referral resource network
·  Develop and implement a Continuous Quality Improvement/Quality Assurance (CQI/QA)
·  Engage existing community partners/collaboratives / ·  Number of presentations given to faith-based organizations
·  Briefly describe what was observed
·  Briefly describe the process to assist faith-based organizations to promote infant safe sleep and SIDS risk reduction practices
·  List technical assistance provided
·  Briefly describe the CQI/QA process developed.
PSU – Infant health
·  Number of primary care providers who have completed protocols /Number of providers who treat pregnant and postpartum women
·  Describe technical assistance provided
·  CQI/QA process developed / ·  [Number] of faith-based organizations demonstrating increased knowledge of safe sleep practices and SIDS risk reduction /total number of faith-based organizations informed about infant safe sleep and SIDS risk reduction practice [X]
·  Number of faith-based organizations providing education programs about infant safe sleep practices and SIDS risk reduction/ total number of faith-based organizations informed about infant safe sleep and SIDS risk reduction practice [X]
·  Briefly describe the results of evaluation
·  Describe the outcomes of the CQI/QA process
PSU – Infant health
·  [Number] of providers who have developed and implemented policies/procedures for PSU screening in their clinics/Number of providers who treat pregnant and postpartum women
·  Brief description of provider protocol
·  Brief description of
·  Brief description of referral resource network
·  Brief description of outcomes of the CQI/QA process
Fiscal Year 4 – 2018-2019
SIDS/SUID
By June 30, [20xx], [x/X] childcare providers will demonstrate increased knowledge and adopt infant safe sleep practice and SIDS risk reduction in the childcare center
PSU – Infant Health
By June 30, 2018, all pregnant and postpartum women in MCAH programs and presenting at the Public Health Department (PHD) will be screened for Perinatal Substance Use (PSU), and those who screen positive will be referred for appropriate follow-up care / ·  Childcare providers
·  Local social service department for licensing childcare providers