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Michigan Perinatal Quality Collaborative (MI PQC)
Michigan Perinatal Quality Collaborative (MI PQC)
Regional Perinatal Quality Collaboratives (RPQCs)
Recognizing the diverse geographic and demographic nature of the state, Michigan approached its structure of the PQC in a unique manner. The Michigan PQC (MI PQC) is comprised of nine (9) Regional Perinatal Quality Collaboratives (RPQC), representing the state’s ten (10) Prosperity Regions.
As an individual’s health outcomes are attributed to clinical care, as well as environment, socioeconomic factors, and health-related behaviors, the RPQCs utilize both community and clinical approaches by bringing together health care professionals, community partners, families, faith-based organizations, Great Start Collaboratives, home visiting agencies, and others in a unified, collaborative effort.
- Convene perinatal stakeholders and partners in regular meetings to address their respective region’s largest concerns with individualized attention
- Improve birth outcomes for birthing people, infants and families through data-driven quality improvement efforts that are tailored to the strengths and challenges of their respective region
- Authentically engage families/communities; garnering and utilizing the advisement of families statewide and within specific RPQC catchment areas
Regional Perinatal Quality Collaborative Efforts
♦ Partnering with Maternal Child Health Epidemiology to collect, analyze, and share data for equitable outcomes.
♦ Actively addressing health inequities, social determinants of health and disparate outcomes.
Implementing and expanding care for families affected by Perinatal Substance Use Disorder (PSUD)
♦ Continuing efforts to increase screening for mental and behavioral health concerns at prenatal and family planning clinics through utilization of an electronic screening tool including High Touch, High Tech (HT2).
♦ Increasing accessibility of Medication-Assisted Treatment (MAT) for pregnant & postpartum people, as well as coordination of prenatal care for pregnant people receiving MAT.
♦ Establishing rooming-in policies and procedures for babies born substance-exposed at participating birthing hospitals.
Expanding and improving access to care and support throughout the pregnancy and postpartum period
♦ Increasing referrals and enrollment to evidence-based home visiting programs through various interventions, including enhanced social media posts, warm hand-offs from trusted providers, referral hubs, etc.
♦ Bolstering virtual birthing and breastfeeding education and support.
Upper Peninsula Perinatal Quality Collaborative
Region 1 Perinatal Quality Collaborative was initiated in 2017 with a goal of ensuring mothers and babies are healthy and thriving across the Upper Peninsula. The predominantly rural Region covers 15-counties and is home to an extensive coastline on the Great Lakes, large tracts of state and national forests, about 4,300 inland lakes, and more than 150 waterfalls.
Geographic location - Region 1: Upper Peninsula
- 15-county region; 300 miles from west to east
- 6 local health departments
- 15 hospitals (11 CAHs): 7 birthing hospitals; 1 NICU
- 1 Medicaid health plan; Upper Peninsula Health Plan
Neonatal Abstinence Syndrome (NAS) and maternal opioid use continue to be key priority areas for our region, as the Upper Peninsula has the highest rate of NAS in Michigan.
Over the last year Region 1 built upon the planning and development that took place during the previous project periods and take action on the needs that emerged as a result of the needs assessment. The region will continue the following activities and anticipated measurable outcomes which align with Michigan’s goal of building a locally linked, coordinated network to support the highest standard of health for mothers and their babies in Michigan:
♦ Coordinate and provide resources for workforce development opportunities related to NAS and perinatal care
♦ Promote and expand the use of Long-Acting Reversible Contraceptives (LARCs)
♦ Implement and expand Smoking Cessation and Reduction in Pregnancy Treatment (SCRIPT)
♦ Convene a workgroup to improve coordination across care systems
♦ Minimize barriers for pregnant women with SUD by way of integrated care teams
♦ Implement High Touch, High Tech (HT2) electronic screening, brief intervention, and referral for treatment program (eSBIRT)
Maternal Opioid Misuse (MOM) Model
Upper Peninsula (UP) Maternal Opioid Misuse (MOM) Model Program: UPHCS recently received a grant award from the Health Resources and Services Administration to address maternal opioid misuse use region-wide. The goal of the program is to improve the quality of care for pregnant and postpartum Medicaid beneficiaries with opioid use disorder (OUD) residing in Baraga, Chippewa, Gogebic, Houghton, Keweenaw, Marquette, and Ontonagon Counties by implementing community health worker (CHW) centered care coordination strategies that focus on cross-system collaboration and improved health outcomes over the course of the three year performance period.
- Tyler LaPlaunt, Assistant Director, Upper Peninsula Health Care Solutions
- Andy Chosa, Grant Administrator, Upper Peninsula Health Care Solutions
- Katrina Keough, Project Director, Upper Peninsula Health Care Solutions
Region 2 & 3
Region 2 & 3: Northern Lower Michigan
Regions 2&3 Perinatal Quality Collaborative was the initial RPQC and was formed in 2011. Funding was initiated in 2015. The primarily rural region covers 21-counties near the northern shores of Lake Michigan and Lake Huron. Bordered by two of the Great Lakes, the Northern Lower Peninsula has glorious scenery everywhere you look, seemingly endless miles of outdoor adventures and some of the most picturesque spots in all of Michigan.
Geographic Location - Region 2: Northern Lower Peninsula
Perinatal Substance Use Disorder (PSUD) and Medication Assisted Treatment (MAT):
Implementing High Tech High Touch (HT2), electronic Screening, Brief Intervention, and Referral to Treatment (SBIRT)MI-AIM safety bundle planning/implementation in birthing hospitals.
Neonatal Abstinence Syndrome (NAS) training conducted for 8 birthing hospitals, and 50+ public health nurses. NAS hospital protocols aligned across the region with a gold standard developed from renowned evidenced based practices. Finnegan Scoring Training materials purchased and distributed to 8 birthing hospitals. Regional referral pathways documents completed for tobacco, alcohol, substance use, depression, and domestic violence. Behavioral Health Resource Guides developed for Region 2&3. Mom Power implementation in several locations across the north with expansion planned. Providers and RPQC continue to meet to assure and increase MAT/Counseling expansion. MAT/Counseling partnership between GT Women’s Clinic, Munson Behavioral Health and Munson Family Practice. Provided MAT training support to the Traverse Health Clinic to get MAT implemented. SCRIPT implementation grant received from March of Dimes. SCRIPT trained professionals in 7 local health departments are serving pregnant women with the SCRIPT smoking cessation curriculum. Ongoing work to formalize and support the perinatal relationships between agencies in the 21 counties. Alignment with MIHEIP and regional work involving: CHIR HUBS, family planning, trauma, and Adverse Childhood Experiences (ACES).
Healthy Future - Universal Home Visiting:
Services provided in all 21 counties, 7 local health departments & Munson hospital central Healthy Future office.
Trained public health nurses in new Healthy Futures family visiting model.
Region 2&3 Home Visiting Billing Guide developed, and is now utilized by Local Health Departments to bill private insurance for Healthy Future family visiting.
Birthing hospitals and Local Health Departments continue the Electronic Birth Certificate referral system for new mothers and infants who are eligible for MIHP services.
Advocacy over the years:
Increase in Home Visiting funding that resulted in a funded Healthy Families Northern Michigan program in 10 counties.
Advocacy/education around fewer Medicaid Health Plans in our northern region.
Supplemental funding to continue for our birthing hospitals in our rural region.
- Team Lead: Christi Nowak, MPH, MBA Community Health Manger, Munson Healthcare
- Grant Coordinator: Jenifer Murray, RN, MPH, JHM Consulting LLC
- Grant Support: Debbie Aldridge, RN Munson Medical Center & Benzie, Leelanau District Health Department
- Physician Support: Julia Riddle, DO, GT Women's Clinic
West Michigan Perinatal Quality Collaborative
Region 4 Perinatal Quality Collaborative was initiated in 2016. Most of the Region is along the Lake Michigan shoreline with miles and miles of soft-sand beaches and quiet rural towns. The Region is also home to destination urban cities full of unique Michigan attractions, adventure and entertainment.
Geographic location – Region 4 (Mason, Lake, Osceola, Oceana, Newaygo, Mecosta, Montcalm, Muskegon, Kent, Ottawa, Ionia, Allegan and Barry)
Regional Highlights, Challenges & Achievements
Region 4 has developed two workgroups to address infant mortality and morbidity. The first group is addressing the need to identify and refer women with active or at risk for substance use disorder (SUD). The second group is focused on increasing use of already existing evidence-based perinatal home visiting programs.
Home Visiting Workgroup
Our KCHD partners are piloting a project with DHS, to evaluate structured 'warm hand-offs' between a dedicated prenatal case manager and a home visitor in the Maternal Infant Health Program (MIHP). This evaluation will look at the process in hopes that it will increase referrals and enrollments in MIHP. The DHS Case Manager calls and talks with the client then places a three way call to the home visitor who then completes the enrollment. Home visitors are scheduled to take calls from the DHS Case Manager two days per week. After three weeks of the Pilot with DHS, enrollments have increased. This pilot would have been considered great in ‘normal’ times and has shown to be extraordinary during the COVID-19 chaos.
The clients have been receptive to working with MIHP via phone calls. The Region is interested in evaluating the numbers when visits can be face to face, in hopes for even greater improvement. But this evaluation has all of the partners at the table very pleased with such a great success during such a challenging time.
Substance Use Workgroup
The substance use workgroup will be working in collaboration with the team from mirecovery.org. This website provides a comprehensive set of options for recovery from substance use disorder and addiction. As part of this work the website will be adding a new section that focuses on pregnant and new mothers. The substance use workgroup is designing a quality improvement project to promote the website. The workgroup will help the mirecovery team develop promotional materials to share with pregnant women and providers to increase use of this resource. While the website is being developed, workgroup members are providing input and feedback on material/resources for the new section for pregnant and new mothers.
- Joann Hoganson, Kent County Health Department
- Marcus Cheathum, Mid-Michigan District Health Department
- Jill Montgomery Keast, Public Health Muskegon County
Regional 5 Perinatal Quality Collaborative
Region 5 Perinatal Quality Collaborative was initiated in 2018. The Region is home to the beautiful Saginaw Bay of Lake Huron, one of the largest coastal wetlands on the Great Lakes. The watershed has canopies of sheltering hardwoods on the edge of the marsh, miles of outdoor recreation trails, and parks. Along with outdoor adventure and calm rural scenery, the Region also has several small urban cities with their own unique attractions, and adventures.
Geographic location – Region 5 (Arenac, Bay, Clare, Isabella, Gladwin, Gratiot, Midland and Saginaw)
Health equity trainings offered at biannual RPQC 5 Summits.
Equity, Implicit Bias, and/or Stigma trainings will be offered at all future RPQC 5 Summits.
Mental, Emotional & Behavioral Well-Being
Region 5 has worked to expand Centering Pregnancy (a group prenatal care model) across the region and include curriculum focused on Perinatal Substance Use Disorder (PSUD). As a part of this work, Region 5 provided PSUD and Stigma Trainings to RNICU staff in collaboration with Peer 360.
Region 5 has continued to work on Smoking Cessation and Reduction in Pregnancy Treatment (SCRIPT) which has been implemented across the region. The collaborative hosted 2 SCRIPT trainings with attendees representing all Local Health Departments, CMU Health, Mid-Michigan Health, and Great Lakes Bay Health Centers. RPQC 5 Summit hosted speaker on pregnancy smoking cessation.
In collaboration with Saginaw Community Mental Health Authority, Region 5 has offered MyStrength (online behavioral health support app) to all residents in the Region.
- Colleen Sproul, Saginaw County Community Mental Health Authority (SCCMHA)
Region 6 Perinatal Quality Improvement Collaborative
Region 6 Perinatal Quality Collaborative was initiated in 2019. The thumb area is surrounded by the rolling sand dunes and sparkling blue waters of Lake Huron. The Region is full of rural countryside, beach-side beauty and small town charm. Region 6 is also home to Flint, Michigan a vibrant city full of exciting attractions, art, museums and outdoor adventure.
Geographic Location - Region 6: Thumb Area (Genesee, Huron, Lapeer, Sanilac, Shiawassee, St. Clair, Tuscola)
Engaging Community Members
Region 6 prioritizes engaging community members in the collaborative. The leadership values the experiences and expectations that caregivers bring to collaborative meetings. One approach the region has taken is reaching out to community members who are vested in maternal child health outcomes and asking them to bring their experience and knowledge to the collaborative. Region 6 has great community representation and has received positive feedback.
High Touch, High Tech (HT2)
Region 6 continues to partner with Dr. Steve Ondersma and his team on the High Touch High Tech (HT2) project. HT2 provides universal perinatal screening to identify SUD, mental health and trauma concerns as pregnant women start their prenatal care. Based on their screening, they also have the opportunity to watch a brief intervention and receive counseling / treatment referrals if they choose.
- Shannon Lijewski, Region 6 Perinatal Quality Collaborative Coordinator
- Kristi Suber, Tuscola County Health Department
Region 7 Perinatal Quality Collaborative
Region 7 Perinatal Quality Collaborative was initiated in 2019 with a goal of ensuring mothers and babies are healthy and thriving across Clinton, Eaton and Ingham Counties. The Region consists of both urban and suburban areas, along with gently rolling hills, beautiful rural farmland, and unique small towns. Region 7 is home to Michigan State University, and is the site of the Michigan State Capitol, the State Supreme Court, the Court of Appeals, a Federal Court, the Library of Michigan, Michigan's History Center and an array of outdoor nature parks, dining options and more.
Geographic location – Region 7 (Clinton, Eaton and Ingham)
Region 7 has launched their CenteringPregnancy project at Cedar Women’s Health Clinic within the Ingham County Health Department.
The region has worked diligently to increase opportunities for training, education and outreach related to health equity and maternal and infant health. This includes film screenings of the movie Toxic and WKAR's NOVA film, Twice as Likely. These opportunities highlight disparities in maternal and infant mortality and morbidity.
Virtual Parent Support groups
Region 7 conducted virtual parent support groups for pregnant women and new mothers throughout the pandemic. The content of the support groups covered wholistic wellness, pandemic specific concerns, guided meditation, seven tips for self care, signs of anxiety and depression, and mindfulness. A session specifically for women of color was offered, and this session had the highest attendance.
- Tammy Maidlow-Bresnahan, Ingham County Health Department
- Sally Meyer, Ingham County Health Department
Southwest Michigan Perinatal Quality Improvement Coalition (SWMPQIC)
Geographic location – Region 8 (Berrien, Branch, Calhoun, Cass, Kalamazoo, St. Joseph, and Van Buren)
The collaborative recognizes the importance of authentic community voice and the importance in influencing the direction of the collaborative work. To address potential barriers and show community members their time and expertise has significant value, a stipend was provided to each community member or parent who attended a quarterly collaborative meeting. The collaborative determined additional community member or parent engagement could be reached if there was a more concentrated effort to connect with community members. A flyer for the regional collaborative was created and disseminated at community events in the region, as well as a survey to gain more information from community members themselves. Stakeholders were also taking a more targeted approach at connecting and inviting community members to the collaborative. Due to these concentrated efforts, there was an increase in community member or parent engagement.
The regional collaborative also strives to increase stakeholder engagement at quarterly collaborative meetings which has ranged widely in attendance. In an effort to improve stakeholder engagement and returning collaborative members the collaborative now focuses on providing a professional or personal development opportunity and allows space for collaborative members to network with one another. Stakeholder attendance has improved at the quarterly collaborative meetings.
Health Equity & Bias
The collaborative hosted the Center for Health Equity Practice at MPHI to provide a workshop on applying systems thinking to advance health equity. Participants engaged in a root cause analysis of maternal and infant health outcomes, discuss health equity core concepts and strategies for change. The activity fostered critical systems thinking and innovative approaches for moving programs, policies or practices “upstream” and address the systematic causes for maternal and infant health disparities.
This collaborative also partnered with Denise Evans for a workshop on implicit biases. This workshop was interactive and aimed to help participants identify how unconscious biases impact our perceptions and decision making on a daily basis. The workshop started with self-awareness, examined a few of the most common forms of unconscious bias, explored cultural values, and examined a few ways to dismantle the biases we each hold.
- Alaina Dequaine, Michigan Public Health Institute
- Beth Washington, Bronson Methodist Hospital
- Danielle Persky, Van Buren Cass District Health Department
- Courtney Davis, Berrien County Health Department
Website – www.SWMPQIC.com
Region 9 Perinatal Quality Collaborative
Region 9 Perinatal Quality Collaborative was initiated in 2019 working to ensure healthy moms, and healthy babies. Region 9 aims to develop data-driven, innovative strategies that are tailored to the strengths and challenges of the region to address preterm birth, very low birth weight and low birth weight, as well as maternal and infant mortality. The Region is home to Ann Arbor, a college town wrapped tightly around the University of Michigan. The city and it's nearby neighbors are well-known for globally-inspired cultural offerings, renowned galleries, museums and arts. The area is home to unique small businesses and family owned dining options. The Region covers 6 counties and consists of Metropolitan cities which are mixed urban-suburban areas, along with beautiful rural farmland, and unique small towns.
Geographic location – Region 9 (Hillsdale, Jackson, Lenawee, Livingston, Monroe, Washtenaw)
Region 9 Conducted several surveys and focus groups to assess community needs, impacts of COVID-19, and gaps in care delivery regarding maternal infant health. They also hosted Beyond Implicit Bias: Transforming Systems of Care facilitated by Leseliey Welch.
MI AIM Partnership
To further foster the partnerships, MI AIM updates specific to Region 9 are shared at the Collaborative meetings. Region 9 plans to identify key MI AIM contacts at each Region 9 birthing hospital to encourage Collaborative participation.
Mom-Centric Workgroup is working to review and analyze the data collected via community outreach events & surveys, using this data to create a plan for project implementation in FY 21. This workgroup is also developing an infographic detailing what choices and rights birthing families have and empowering them make the choices that are best for them.
Trauma-Informed Care Workgroup hosted a group book club which reviewed Trauma Informed Care in the Perinatal Period by Seng and Taylor and met with Julia Seng to learn more about the Survivor Mom’s Companion. The group gathered survey data which indicated that 80% of participants wanted further education about trauma-informed care and a referral list of agencies that offer trauma specific services in Region 9.
Additionally, the workgroup developed the “Stress, Emotions, and Pregnancy” pocket guide for Region 9 organizations and agencies. The Collaborative anticipates that this tool will encourage communication between patients and providers and spread awareness about the impacts of trauma on pregnancy.
Home Visiting Workgroup is developing a resource list with specific outreach/referral contact information to better coordinate care and foster warm hand-offs. Additionally, they are pooling together a list of strategies/tools that agencies have independently piloted to increase referrals, increase referral conversion rates, promote program participation, etc. The Region hopes that compiling their collective knowledge will result in a more meaningful project launch.
Health Equity Advisory Group is currently working to ensure that all Collaborative work is equitable. The group will also help engage in conversations about healthy equity, implicit bias, and racial disparities in maternal infant health during Collaborative meetings, and explore various partnerships and other health equity initiatives. They will also share relevant resources, events, and information.
Community Engagement Advisory Group is currently creating a master list of all Region 9 organizations and agencies. The group is paying specific attention to the Social Determinants of Health and identifying key agencies that support multiple dimensions of health. The group will share resources, events, and information with Region 9, solicit feedback directly from community members, encourage community member participation and conduct specific outreach to underrepresented populations in Region 9.
Email – firstname.lastname@example.org?
Southeast Michigan Perinatal Quality Improvement Coalition (SEMPQIC)
Region 10 Perinatal Quality Collaborative was initiated in 2016. The goal of SEMPQIC is to create a coordinated, equitable and sustainable network for perinatal care based on best practices and evidence-based strategies that will result in improved birth outcomes for all babies born in southeast Michigan and narrow the disparity between black and white births including adverse maternal perinatal and infant outcomes, including infant mortality.
Geographic location - Region 10 (Wayne, Oakland and Macomb)
Healthy Baby at Home
SEMPQIC continues to work with Maternal Infant Health Program (MIHPs), prenatal clinics and hospitals to implement the Healthy Baby at Home (HB@H) initiative to increase utilization of evidence-based home visiting programs. The initiative has successfully created a model for referral protocols to home visiting services for prenatal clinics and hospital NICUs.
The team is also working to expand the work from Detroit into Oakland and Macomb counties. These expansion efforts have led the team to draft a Book of Knowledge that can be used by organizations implementing the model at their health care institution. The Book of Knowledge includes lessons learned during the pilot of the model and important considerations when doing this work.
Needs Assessment Survey
SEMPQIC surveyed organizations with respect to work on the six priorities in the Mother Infant Health & Equity Improvement Plan (MIHEIP) to identify service gaps and current strategies to achieve the MIHEIP goals. Survey results will be used to create a document to track progress for implemented strategies in Region 10. The team plans to monitor implementation of the strategies and continue to measure change over time. The leadership team is working with coalition members to determine how to address service gaps and create an action plan to move forward.
Respondents reported highest implementation of the MIHEIP recommendations: ensure women are connected to early comprehensive prenatal care and home visiting programs and educating women and families on the connection between tobacco use and unhealthy babies. Strategies implemented the least: assessing and improving how non-traditional institutions (i.e., housing, environment, education) utilize a health and equity lens in policies and procedures and ensuring that teen pregnancy prevention programs exist in schools and communities.
The pandemic disproportionately affected African Americans in Region 10, due to being overly represented in the essential workforce (e.g., grocery store workers, food service workers, etc.) and other social determinants of health. SEMPQIC met virtually to discuss the pandemic related to pregnant and postpartum women and how to address barriers to proper care. The conversations resulted in several recommendations which were shared with the State Coronavirus Task Force on Health Disparities. The coalition will continue to discuss the pandemic relative to pregnant and postpartum women, how the recommendations have been used and how SEMPQIC can continue to support the work of the Task Force.
Contact Information -