For Women’s and Maternal Health (WMH), New York’s Title V Program selected National Performance Measure (NPM) 1: Percent of women, ages 18 through 44, with a preventive medical visit in the past year. New York select this NPM because 1) preventive medical visits for individuals of reproductive age are foundational to health throughout the life course, 2) population health data demonstrate a need for continued improvement in this area, and 3) it relates directly to priorities voiced by women and families at community listening forums held across New York State (NYS). During the community listening sessions, women and families expressed priority needs that include increased awareness of and access to community resources, quality health care, transportation, and social support. This NPM also aligns directly with the NYS Prevention Agenda goal to increase the use of primary and preventive health care services among women of all ages, especially women of reproductive age.

 

While NPM 1 directly measures annual preventive medical visits, it should be viewed as part of a continuum of primary and preventive care that includes preconception, reproductive and sexual health, family planning, prenatal, and postpartum care, as well as encompassing a full spectrum of medical, mental/behavioral health, oral health, dietary/nutritional, and other supports and services.  

 

The New York State Maternal Mortality Review Board has identified increasing access to comprehensive, high quality, and equitable health care services as a key element of efforts to eliminate the striking racial and ethnic disparities in mortality and morbidity outcomes. NYS is ranked 15th in the nation for the rate of maternal mortality. While NYS’s overall maternal mortality rate has declined from its peak, racial disparities in maternal deaths persist, with maternal deaths being over 4 times more likely for Black women compared to White women during the 2018-2020 timeframe. Severe maternal morbidity also affects the lives of people who give birth, as well as their newborns, families, and health care provider teams, in profound and sometimes life-altering ways. Severe maternal morbidity can result in prolonged hospital stays, substantial medical costs, higher life-long burden of health problems, physical and emotional stress, and interference with maternal-newborn bonding. Additionally, severe maternal morbidity is associated with an increased risk for maternal death. Perinatal depression is among the most common morbidities during pregnancy and the postpartum period, with significant implications for the health and well-being of the entire family. During listening sessions, NYS women and families consistently highlighted maternal depression as a challenge requiring more attention and supports.

 

The following specific objectives were established to align with this national performance measure:

 

Objective WMH-1: Increase the percent of women, ages 18 through 44, with a preventive medical visit in the past year by 5%, from 79.6% in 2018 to 84.6% in 2022. (Behavioral Risk Factor Surveillance System)

 

Objective WMH-2: Reduce the maternal mortality rate by 10%, from 17.8 deaths per 100,000 live births in 2014-2018 to 16 deaths per 100,000 live births in 2018-2022. (National Vital Statistics System)

 

Objective WMH-3: Reduce the rate of severe maternal morbidity per 10,000 delivery hospitalizations by 5%, from 80 delivery hospitalizations with an indication of severe morbidity per 10,000 delivery hospitalizations in 2017 to 76 delivery hospitalizations with an indication of severe morbidity per 10,000 delivery hospitalizations in 2021. (Healthcare Cost and Utilization project-State Inpatient Database)

 

Objective WMH-4: Reduce the percent of women who have depressive symptoms after birth by 5%, from 13% in 2017 to 12.4% in 2021 (Pregnancy Risk Assessment Monitoring System)

 

Four strategic public health approaches were identified to accomplish these objectives. These strategies are presented in the State Action Plan Table, and each is described in more detail with specific program and policy activities that will be implemented to advance the broader strategic approach in the upcoming year.

 

Strategy WMH-1: Integrate specific activities across all relevant Title V programs to promote the health and wellness of people of child-bearing age, including enrollment in health insurance, routine well visits, pregnancy planning and prevention, and prenatal and postpartum care.

 

Improving the health of individuals of reproductive age requires a life course approach to be most effective. Preventive medical visits are a key opportunity for delivering health education and reinforcing health-promoting behaviors. Preventive visits for individuals of reproductive age help identify chronic conditions, such as hypertension and diabetes, which may contribute to maternal morbidity and mortality. Family planning and reproductive health visits ensure that individuals of reproductive age have access to contraception for pregnancy prevention, as well as counseling for reproductive life planning, appropriate birth spacing, and preconception health. Title V programs also provide enabling services, such as social support and referrals/linkages to a wide range of community services, to holistically address health and wellness, including mental health and social determinants of health for reproductive age individuals. Incorporating specific activities across programs leverages the public health infrastructure and capacity supported through previous and ongoing Title V investments.

 

Through the Perinatal and Infant Community Health Collaboratives (PICHC), community health workers conduct basic health and well-being assessments in the prenatal and postpartum periods using standardized evidence-based and/or validated screening tools to identify and prioritize the needs of the individuals and families they serve. Assessments are completed at enrollment and updated throughout clients’ service periods and individualized care plans are developed based on the needs identified. Community Health Workers receive annual training on 1) Communicating with families on difficult and sensitive topics such as mental health and depression, 2) Using a trauma-informed care approach, and 3) Managing emergency situations. Community Health Workers also connect clients and families to needed services and provide enhanced social support. Community Health Workers help ensure early and consistent participation in preventive and primary health care services, including early prenatal care, particularly for those individuals not engaged in care and other supportive services. Community Health Workers also provide health information to increase clients’ knowledge and their ability to self-advocate and make informed health care decisions with the goal of helping families achieve optimal health, self-sufficiency, and overall well-being.

 

PICHC programs coordinated outreach and engagement activities work with other home visiting programs serving the same communities including programs supported by New York’s funding from the Health Resources and Services Administration for the Maternal, Infant, and Early Childhood Home Visiting  (MIECHV) initiative. The MIECHV initiative provides funds to promote and improve the health, development and well-being of children and families, who are most impacted by systemic barriers and at risk for not receiving services, through evidence-based home visiting programs. The PICHC and MIECHV programs coordinated outreach, referral, assessment, and intake processes help identify and engage pregnant and parenting families to ensure they connect with home visiting programs and supportive services responsive to their needs. 

 

The goal of the PICHC initiative is to improve perinatal health outcomes and eliminate racial, ethnic, and economic disparities in those outcomes. 26 programs state-wide implement strategies to improve the health and well-being of individuals of reproductive age and their families with a focus on individuals in the prenatal, postpartum, and interconception periods. PICHC programs are required to implement individual-level strategies to address perinatal health behaviors, and community-level strategies to address the social determinants which impact health outcomes. The core individual-level strategy is the use of Community Health Workers to outreach and provide supports to high-need, low income, Medicaid-eligible individuals at risk for, or with a previous history of, adverse birth outcomes. Community-level strategies will involve collaboration with diverse community partners, including community residents, to mobilize community action to address the social determinants impacting perinatal health outcomes.

 

The Family Planning Program supports 37 health facilities that are regulated by the NYSDOH under Article 28 of NYS Public Health Law (these include hospitals, clinics, health departments, federal qualified health centers) that operate 164 family planning clinic sites across the state.

 

Services provided include contraceptive services; preconception planning and counseling services; pregnancy testing and related counseling; preventive services such as basic health screening, screening for sexually transmitted diseases, HIV counseling and testing, and breast and cervical cancer screening; appropriate referrals; and health education. To address barriers to receiving reproductive health care, the NYS Family Planning Program applied for and was awarded a one-year Telehealth grant (7/15/22-5/31/23) from the Office of Population Affairs to provide funds to rural Family Planning Program providers to support telehealth infrastructure, improve access to telehealth services, and support training and technical assistance for the Family Planning Program providers. Ensuring continued access to these core primary and preventive services is essential. The Family Planning Program submitted and was awarded a 12 month no cost extension (6/1/23-5/31/24) to finish the telehealth project, as well as approval for a change in scope for the project. The change in scope was to include downstate providers, as needs assessments showed that our non-rural providers were also in need of financial assistance to enhance their telehealth capabilities to reach those members who located in healthcare desserts.

 

Funding from this grant was also set aside to support the NYS Family Planning Training Center, managed by John Snow Research and Training Institute, Inc. With this funding they held one webinar for providers, developed a telehealth sustainability toolkit and a telehealth billing and coding guide to ensure providers have access to the latest telehealth best practices to ensure community members can access telehealth services during this reporting period. The Training Center during this reporting period also provided mini grants to 10 Family Planning Providers to support training and TA identified by the organization to assist them in providing high quality, patient centered care via telehealth.

 

As reinforced by the Needs Assessment community forums, increasing awareness of available resources among both consumers and providers is critical.   Home visiting programs are encouraged to promote use of the state’s Growing Up Healthy Hotline service which, in turn, provides callers with linkages to local community resources, supports, and services including Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC), Medicaid, Family Planning, prenatal care, and the NYS Early Intervention Program. Social media and other emerging communication platforms increase the potential to reach large and diverse populations. Title V staff incorporate a science-based health messaging approach when developing social media campaigns, with the goal of educating New Yorkers to positively influence their health care decision-making capabilities and improving overall health outcomes.

 

The NYS Title V Program led the following specific program and policy activities to advance this strategy during the 2021-22 reporting period:

 

WMH-1.1 Across all Title V programs, enhance promotion of the NYS Growing up Health Hotline to increase awareness of available community resources, supports, and services including the Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC), Medicaid, family planning, and prenatal care.

 

Staff promoted the Growing up Health Hotline across all these programs as well as the NYS Early Intervention Program. During FFY23, the Growing up Health Hotline handled nearly 13,000 calls, most of which resulted in a referral to local agencies that oversee the Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC). Other callers were referred to the NYS Marketplace for health insurance coverage or local departments of health for early intervention services. The Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) continues to promote the Growing up Health Hotline in brochures and via the online chat service “Wanda” when respondents are Spanish speaking.

 

For the 2023-2026 contract cycle, Growing Up Health Hotline services will include texting service that will provide the same information offered by the telephone service, and will be available 24 hours a day, seven days a week, 365 days per year. In consultation with Goodwill Vision Enterprises and other stakeholders, text message decision trees were developed for four of the top call categories received by the hotline: NYS Early Intervention Program, WIC, health insurance, and home visiting and parent support programs.

 

WMH-1.2 Through the Regional Perinatal Centers and networks of affiliate birthing hospitals, support and enhance capacity to provide high quality perinatal telehealth services and perinatal subspecialty providers, particularly to rural communities and communities with disproportionate access to such services.

 

Telehealth services are tailored based on regional assessments of provider and affiliate hospital needs, including routine prenatal and postpartum care and/or specialty care such as maternal-fetal medicine, radiology, and genetic counseling. Each of the five upstate Regional Perinatal Centers that serve a significant rural population identified needs and capacity.  Several of the Regional Perinatal Centers developed or expanded telehealth services to increase local access to maternal-fetal medicine specialists, including real-time video consultation and store-and-forward ultrasound reading with accompanied supplemental training for local ultrasonographers.  Data are not yet available to assess outcomes or delivery of services, as there were significant delays in project implementation due to COVID-19 and nationwide microchip and equipment shortages. Title V funding for these programs ended during the program year, and staff are working to summarize the processes and lessons learned from this program (See Strategy PIH-1.5 for more detail on Telehealth Services for Neonatal Services).

 

For the 22-23 grant year, the Department has collected information from the Regional Perinatal Centers regarding consultations to affiliate birth facilities via telemedicine regarding patient transfers and clinical management. The hospitals provide quarterly report submissions that include details on Obstetrical and Neonatal/Pediatric consultations and transfers and back transfers. Conversations with Regional Perinatal Centers and the Department regarding perinatal telehealth are ongoing.

 

WMH-1.3 Through the PICHC and MIECHV programs, integrate virtual home visiting services to increase acceptance and support of services for hard-to-reach families.

 

Virtual home visits conducted in the context of the response to COVID-19 have helped to maintain communication and allow for essential Community Health Worker and home visiting services to continue including providing health information, support and referral and follow-up for preventive and prenatal care visits. The use of virtual tools for home visiting, outreach, education, and further social supports continued to be integrated as a supplement to safe, in-person services during the on-going COVID-19 pandemic. During the reporting period, PICHC programs conducted 26,517 visits with clients, of which 52% (13,909) were virtual visits. Community Health Workers and home visitors continuously disseminated guidance from reputable sources, such as the NYSDOH, on COVID-19 and perinatal health as it became available.

 

WMH-1.4 Through the PICHC program, continue to support Community Health Workers to conduct outreach to find and engage high-risk pregnant and postpartum families in consistent, comprehensive preventive and primary care services, including prenatal, interconception, and postpartum care.

 

The PICHC programs supported Community Health Workers to conduct outreach to find and engage high-risk pregnant and postpartum families in consistent and comprehensive preventive and primary care services, including preconception, prenatal, and postpartum care. From October 1, 2022, to September 30, 2023, a total of 5,210 clients were enrolled in the PICHC programs. Community Health Workers routinely screened clients for health insurance enrollment and health care engagement, assisted them in getting care through referrals as needed, and provided ongoing social support and reinforcement for health care utilization. They also provided clients with health information and social support to increase their knowledge and ability to self-advocate and make informed health care decisions, including help developing birth plans. During this period from October 1, 2022, to September 30, 2023, Community Health Workers engaged 1,643 prenatal clients to create a birth plan. Community Health Workers also issued a total of 22,203 referrals, with the top five referral categories overall being clothing/baby care items, referrals to food pantry, Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC), transportation, and housing assistance.

 

WMH-1.5 Continue to provide training to Train PICHC and MIECHV programs on the Centers for Disease Control and Prevention’s (CDC) Learn the Signs Act Early campaign and collaborate with the NYS Council on Children and Families on the Early Childhood Comprehensive Systems grant, which supports dissemination of Learn the Signs Act Early materials.

 

In January 2022, Maternal and Infant Community Health Collaboratives and MIECHV-funded home visiting staff attended a webinar presented by NYS Early Intervention staff on what families can expect following a referral to their services. Related, in a February 2022 webinar for Maternal and Infant Community Health Collaboratives and Maternal, Infant, and Early Childhood Home Visiting-funded home visiting staff, developmental pediatrician and Learn the Signs Act Early ambassador, Dr. Romina Barros, provided updates on developmental monitoring materials which can be obtained without cost and provided to families.

 

WMH-1.6 Through the MIECHV Initiative, direct American Rescue Plan Act (ARPA) Act funds to MIECHV funded programs.

 

Staff allocated ARPA funds to Healthy Families New York programs via a new Memorandum of Understanding with the NYS Office for Children and Family Services, which oversees Healthy Families New York programs, and new contracts with Nurse Family Partnership programs, which are overseen by the New York State Department of Health (NYSDOH). In FFY22, contracts were created between the NYSDOH and Nurse Family Partnership programs, and the NYS Office of Children and Family Services’ Healthy Families New York programs, to allocate the ARPA funds to support families participating in home visiting by provision of internet-connected technology and met the emergency needs of clients by supplying prepaid grocery cards, diapers, and other infant supplies. Programs have also used funds to provide technology for home visitors to conduct virtual home visits and bolstered recruitment or retention of home visiting staff with incentive payments.

 

In January 2023, the monthly call with local implementing agencies (LIAs) centered around innovative uses for American Rescue Plan (ARP) funds. Two LIAs shared their experiences. Subsequently more LIAs began to spend the funds. Service delivery expanded in one county with an additional Nurse Home Visitor, and a mental health therapist was added to the staff at another LIA providing one-to-one therapy to all clients with a demonstrated need. Throughout the year, there was spending in all 7 categories. A wide variety of emergency supplies were provided to approximately 350 families each quarter including, essential baby care items, cleaning products, first aid supplies, and bus passes for transportation to medical appointments. Cell phones and tablets were provided to more than 150 families to facilitate virtual visits and staying connected to their family visitor. Hazard pay was used to supplement staff income at 10 LIAs to provide more competitive salaries and to reduce turnover. Nearly 500 families experiencing food insecurities were provided grocery gift cards. One LIA partnered with a diaper bank to provide over 3,000 diapers for families.

 

NYSDOH recently surveyed LIAs for their projected ARP expenditures, and to assess if they needed a no cost time extension (NCTE) to allow more time to spend the funds.  Four LIAs requested a NCTE, with three extending to 12/31/23 and one extending to 9/30/24.

 

WMH-1.7 Through the Family Planning Program, continue to support the delivery of comprehensive, confidential reproductive health services for low-income people of reproductive age who are uninsured or underinsured.

 

Addressing barriers to accessing reproductive health services continues to be a priority of all Family Planning Program work. An example of this is an additional one-time federal grant award which has now been extended through May 2024 to continue supporting telehealth services in rural service and downstate in healthcare desserts and those that serve a high volume of low income and underinsured individuals.as the NYS Family Planning Program continues to support dispensing 12-month supplies of contraceptives when appropriate. NYS Family Planning Program requires providers to submit a Schedule of Discounts (SOD) that aligns with the most current Federal Poverty Level (FPL) Guidelines and must ensure that Schedule of Discounts is reasonable, attainable, and fair with the goal of prioritizing services for low-income individuals who may be uninsured or underinsured. Cost should not be a barrier to any individual wishing to access family planning services.  The Schedule of Discounts ensure that no fees are charged for family planning clients at or below 100% of the FPL, and the sliding fee scale charges for the other FPL levels must be applied progressively, such that individuals with lower income levels pay a smaller portion of the total cost.  There are no charges for patients at or below 250% FPL for chlamydia testing, HIV testing and counseling, pregnancy testing and counseling, emergency contraception and condoms for patients, all common reasons why patients visit the family planning clinics. Family Planning Providers continue to assist uninsured clients in enrolling in the most appropriate health insurance plans including Medicaid, Family Planning Benefit Program, and Family Planning Extension Program.

 

WMH-1.8: Through public awareness campaigns, the NYSDOH promotes messages about maternal warning signs to educate pregnant and postpartum women on when to seek help for untoward conditions associated with perinatal complications.

 

NYSDOH conducted two statewide social media campaigns, utilizing the Centers for Disease Control and Prevention’s Hear Her Campaign, to build public awareness of the importance of recognizing early urgent maternal warning signs for pregnant and recently pregnant people. The simple message is that listening and acting quickly could save a life. The goals of the Hear Her Campaign are to raise awareness of potentially life-threatening warning signs during and after pregnancy and to improve communication between patients and their healthcare providers. The NYSDOH utilized social media platforms (Facebook, Instagram, and Snapchat) to convey information to pregnant people and their partners, friends, and family about pregnancy-related complications. The NYSDOH also employed two palm cards developed by CDC – one for pregnant and recently pregnant people and one for partners, friends, and family. These palm cards were co-branded, printed, and distributed to hospitals and home visiting programs in NYS to disseminate to their clients. The palm cards were translated into the ten languages most commonly-spoken in NYS and are available on the NYSDOH’s website at www.health.ny.gov/HearHer for downloading and printing, or they can be ordered from the Department’s distribution warehouse free of charge. In 2023, the NYSDOH added two new palm cards to the stockpile of Hear Her materials, which were specifically designed for American Indian and Alaskan Native pregnant people, as well as for their partners, friends, and family. These two new palm cards are available on the NYSDOH’s website.

 

In the fall of 2021, the NYSDOH conducted a public awareness campaign about Perinatal Mood and Anxiety Disorders to educate birthing people about this condition and to highlight the resources available for help. Following the campaign, the Department continued to make resources available through the Department’s website at Perinatal Mood and Anxiety Disorders (ny.gov).

 

In response to the Maternal Mortality Review’s recommendation for COVID-19 vaccination of pregnant women, NYSDOH issued a Health Advisory in December 2021 to facilities, providers, and stakeholders on the importance of COVID-19 vaccination for people who are pregnant, postpartum, breastfeeding, or who may become pregnant. Additionally, NYSDOH produced a brochure and a poster explaining the importance of COVID-19 vaccinations and affirming their safety. The brochure was translated into the 10 most common non-English languages spoken in NYS, and the poster was translated into Spanish.  All birthing hospitals in NYS were notified of these materials, which were made available for downloading and printing on the NYSDOH website at Pregnancy & COVID-19.

 

WMH-1.9: Continue to support prevention and response services for sexual violence through the Sexual Violence Prevention Unit.

 

Women’s health and reproductive health are significantly interconnected with sexual violence. Women between the ages of 12 and 34 are at the highest risk for sexual violence. In the short term, sexual assault can lead to unintended pregnancies, sexually transmitted diseases, and injuries. However, there are many more long-term health consequences from sexual assault that range from depression, anxiety, and suicide to obesity, cancer, high-blood pressure, fibromyalgia, fibroids, preterm labor, miscarriages, fetal growth issues, placental abruption, and frequent c-section (The Sexual Abuse to Maternal Mortality Pipeline, Black Women’s Blueprint). New York State’s Rape Prevention and Education program consists of six Regional Centers for Sexual Violence Prevention to implement evidence-based/informed primary prevention strategies in 17 counties across NYS with the highest average number of reported forcible rapes.  To support survivors of sexual violence, 55 NYSDOH approved Rape Crisis Programs provide support and advocacy services. Finally, the Sexual Assault Forensic Examiners (SAFE) Program consists of hospital programs, training programs, and examiners to respond to survivors of sexual assault and collect forensic evidence.

 

Strategy WMH-2: Strengthen coordination between birthing hospitals, outpatient health care providers, and other community services to make support for birthing parents and their families more comprehensive and continuous.

 

Coordination between birthing hospitals, community providers, and community-based organizations that provide essential support to birthing persons and their families is critical to maintaining optimal health and well-being and ensuring continuity of care during this period in a person’s life. PICHC programs routinely coordinated with a wide variety of community-based organizations that provide health and social support services to address needs related to both physical and mental health, and social determinants of health such as safe housing, transportation, poverty, and nutrition. Birthing hospitals in NYS are required to provide similar referral services through support and social services. As noted above, telehealth services have emerged as a promising approach to delivering clinical care that can be tailored to the needs of each region and community, both urban and rural. Strengthening the connection between the PICHC providers and individual birthing hospitals ensures that pregnant New Yorkers, including those with high-risk pregnancies and chronic conditions, are connected to the highest quality of birthing services and support services, including timely postpartum care.

 

The Title V Program led the following specific program and policy activities to advance this strategy during the 2020-21 reporting period:

 

WMH-2.1 Establish regulations to require birthing hospitals to provide referral and support for ancillary services, including mental health, alcohol and substance use treatment, and other services.

 

Submitted regulations for internal review prior to publication that require birthing hospitals to provide referral and support for ancillary services, including mental health, alcohol and substance use treatment, and other services, and collaborated with NYSDOH partners in response to pending legislation for midwifery-led birth centers. The Department continues to work on regulations to update and modernize the statewide perinatal regionalization system. This includes requirements for perinatal services within birthing hospitals, as well as freestanding and midwifery birth centers.  In May 2021, the Midwifery Birth Center Accreditation bill (S1414-A/A259-A) was passed by both houses of the legislature and was ultimately signed by Governor Kathy Hochul in December 2021. A chapter amendment was passed and signed, making technical revisions to the Midwifery Birth Center Accreditation bill (now an Act) in February 2022.  During this timeframe, the regulations package was paused until the final act language was available.  To comply with the Act, the Department engaged with midwifery stakeholders and advocates representing state and national chapters of the American Association of Birth Centers and the Commission for the Accreditation of Birth Centers, as well as key stakeholders from midwifery practices across the state.  This input received was incorporated into the draft regulations and were published for public comment on May 31, 2023.

 

The public comment period was closed at the end of July 2023. Around 100 comments were received from hospitals, community organizations, midwifery birth centers and individuals. The Department has been organizing comments into subtopics and drafting responses to be provided. At this time, no significant changes to the regulations are required and a second public comment period is anticipated.

 

WMH-2.2 Implement a Vaccine Hesitancy Media Campaign.

 

Staff from the Division of Family Health worked with the NYSDOH’s Bureau of Marketing and Creative Communications to launch Phase 1 of the COVID-19 and Pregnancy Media Campaign in October 2022. A workgroup consisting of staff from these areas met bi-weekly to develop promotional materials including Facebook posts and other social media to increase vaccination uptake for pregnant and postpartum women/people. The group also developed Phase 2 of the campaign which launched in December and focused on sharing testimonials from perinatal providers on their experience with receiving COVID-19 vaccination. The NYS Perinatal Quality Collaborative identified two perinatal providers who were recently pregnant and interested in promoting vaccination to the perinatal population. One of the providers is from University of Rochester Medical Center and the other from Northwell Health.  The providers reported their testimonials on receiving the COVID-19 vaccination during pregnancy and the benefits of the vaccine.

 

WMH-2.3 To improve coordination and increase bilateral referrals between birthing hospitals and home visiting programs, Title V staff will assist in connecting PICHC programs with their local birthing hospitals and support formal meetings. Additionally, Title V staff will share promising and best practices from established home visiting-birthing hospital partnerships across the state to encourage collaboration.

 

As part of the effort to increase referrals to PICHC and MIECHV-funded home visiting programs, MIECHVstaff collaborated with the NYS Office of Children and Family Services and the NYS Council on Children and Families to update language on the NYS Parent Portal from “home visiting” to “parenting support.” This change was supported by focus studies conducted in 2018 which found that home visiting-eligible parents tied the term “home visiting” to Child Protective Services and preferred terms like “parenting support.” The update was also prompted by plans for a Title V-funded media campaign to direct pregnant and newly parenting New Yorkers in counties with low home visiting program enrollment to the NYS Parent Portal for resources like daycare, home visiting, and afterschool programs in their county.  The media campaign ran August-October 2022 and led to over 100,000 clicks to the NYS Parent Portal. An evaluation to determine the impact on home visiting program enrollment is pending as of December 2022.

 

Title V staff previously mentored two master’s in public health student interns, one each in the Spring 2022 and Fall 2022 semesters. These interns examined existing relationships between home visiting programs and birthing hospitals via Survey Monkey questionnaires and evaluation of responses. The Spring 2022 intern used Maternal and Infant Community Health Collaboratives, Nurse Family Partnership programs, and Healthy Families New York referral data and created a referral monitoring tool in Excel to track trends in referrals made. With guidance from Title V staff, the intern ascertained best practices for improving referral relationships by survey analysis and evaluation of current data trends, and she presented on her findings to Maternal and Infant Community Health Collaboratives and Maternal, Infant, and Early Childhood Home Visiting-funded programs in April 2022. The Fall 2022 intern developed a survey for birthing hospitals, based on the previous questionnaire. The survey conducted in Fall of 2022 had a very low response rate which led to the proposal for a third master’s in public health student intern to recreate the birthing hospital survey and send out again.

 

The third student joined the Department in the Fall of 2023. She created a new survey for birthing hospitals that was informed by Home Visiting program responses in Spring 2022 and the work done on the survey from Fall 2022. The intern made the new survey more user-friendly and cut down completion time. Due to these updates, the response rate was much higher, and the intern was able to present these findings to the Regional Perinatal Centers on their first quarterly call of the year. The intern also created a promising practices tip sheet to be distributed to home visiting and birthing hospital staff.

 

Strategy WMH-3: Apply public health surveillance and data analysis findings to improve services and systems related to maternal and women’s health care.

 

Data-driven, evidence-based practice is essential to achieving public health goals for the Title V program. Across all Title V programs, continuous effort is needed to enhance the collection, analysis, and sharing of data to inform the planning and implementation of Title V-funded programs and related policy work. Sharing data with stakeholders, including providers and community members, is critical to raise awareness, empower community action, and facilitate quality improvement efforts at all levels. 

 

Title V staff have implemented a comprehensive review process with the multidisciplinary NYS Maternal Mortality Review Board for the purpose of reviewing maternal deaths and maternal morbidity. NYS has an established public health surveillance process in place to identify and review cases of maternal death through multiple sources of data and chart reviews. The cases are identified within one year of the date of death and the case reviews are completed within two years of the date of death. The 2019 maternal death cohort review was completed by the end of calendar year 2021. The 2020 maternal death cohort review was completed by the end of calendar year 2022.  The 2021 maternal death cohort review is expected to be completed by the end of calendar year 2023, except for one remaining case due to the availability of autopsy report.

 

Analysis of NYS Perinatal Quality Collaborative project data provided by participating birthing hospitals helps to improve services and systems related to maternal health care. The NYS Perinatal Quality Collaborative, American College of Obstetricians and Gynecologists District II of NY, Healthcare Association of New York State (HANYS) and Greater New York Hospital Association (GNYHA), with support from the National Institute for Children’s Health Quality (NICHQ), has led specific improvement projects related to opioid use disorder in pregnancy and birth equity, two important areas related to maternal mortality and morbidity.

 

The NYS Opioid Use Disorder (OUD) in Pregnancy & Neonatal Abstinence Syndrome (NAS) Project aimed to improve care for both birthing persons with OUD and infants with NAS. The project's pilot phase began in September 2018 with 15 participating birthing hospitals. In October 2020, the project was expanded to include an additional 26 NYS birthing hospitals. By the close of the project in June 2023, the 41 participating hospitals increased the percentage of pregnant people screened for substance use disorder with a standardized questionnaire on admission to labor and delivery 77% (from 35.8% first three months of the expansion phase to 63.5% last three months of the project); and increased the percentage of pregnant people with OUD referred to Medication-Assisted Treatment by nearly five times higher (from 2.9% to 13.7%).

 

Based on analysis of qualitative data obtained from the 2018 listening sessions that engaged over 200 women statewide, the Department has developed and implemented a comprehensive interdisciplinary hospital quality improvement project focused on birth equity and implicit bias. This learning collaborative, which launched in January 2020, has engaged birthing hospital and center staff from clinical, administrative, and executive levels to analyze hospital policies and procedures that may contribute to bias and develop strategies to improve outcomes. This project has included the development a comprehensive training curriculum that can be replicated at facilities to enable staff to better understand and mitigate bias. As with all NYS Perinatal Quality Collaborative projects, Title V staff have been collecting and performing analysis of project data throughout the project period.

 

The Title V Program led the following specific program and policy activities to advance this strategy during the 2022-23 reporting period:

 

WMH-3.1 Summarize, share, and discuss findings of the Maternal Mortality Review Board with key partners, including the Maternal Mortality and Morbidity Advisory Council, to inform statewide prevention strategies.

 

NYSDOH staff developed a fact sheet based on the New York State Report on Pregnancy-Associated Deaths in 2018 that summarized the main findings and recommendations for the 2018 maternal death cohort that was published in November 2022.  The Maternal Mortality Review Board published an issue brief in November 2022: “Spotlight on Perinatal Mental Health.”  An additional issue brief, “Spotlight on Perinatal Substance Use Disorder,” was nearing release at the close of the reporting period. Those publications can be found on the dedicated Maternal Mortality pages on the NYSDOH website developed by Title V staff: Maternal Mortality

 

The Maternal Mortality and Morbidity Advisory Council met seven times during the reporting period (10/22, 1/23, 2/23, 3/23, 5/23, 6/23, 10/23) and has written a report with their own recommendations for improving outcomes and reducing disparities, which  is currently in the executive review process for release in the next reporting period.

 

WMH-3.2: Issue a maternal mortality report to provide data and information that can be used to improve maternal outcomes. 

 

During the reporting period, the Maternal Mortality Review met six times (11/22, 1/23, 3/23, 5/23, 7/23, and 9/23) to perform the maternal death case reviews. The Maternal Mortality Review assessed the causes of death, factors leading to the death, and preventability for each maternal death reviewed.  

 

A statewide report on pregnancy-associated mortality for 2018-2020 deaths with data and recommendations to improve maternal outcomes has been developed and is currently in the executive review process.  The 2018-2020 report is expected to be released in the next reporting period (See Strategy PIH- 2.6 for more detail on NYS Perinatal Quality Collaborative and equitable care.)  A two-page factsheet presenting the highlights of the NYS Report on Pregnancy-Associated Deaths in 2018-2020 has also been developed during the reporting period and is expected to be released in the next reporting period.

 

The NYC Maternal Mortality and Morbidity Review Committee (M3RC) released the 2022 City Council annual report in January 2023, presented their findings internally to NYC DOHMH Bureau of Alcohol and Drug Use Prevention, Care and Treatment, Bureau of Maternal Health on Maternal Mental Health MMRC data, and Birth Equity workgroup on pregnancy-related deaths by cause of death & race/ethnicity, and provided data for external presentation at CAMBA event.

 

WMH-3.3: Identify cases of severe maternal morbidity through hospital discharge data and conduct an analysis using linked birth data and hospital discharge data to define the major causes of maternal morbidity.

 

Analytic staff examined 15 years of hospital discharge data (2008-2022) to monitor statewide and regional levels, trends, and disparities in severe maternal morbidity, with a primary focus on the surveillance period 2017-2022. Through these efforts, staff identified the top indicators of severe maternal morbidity, analyzed trends over time statewide and by key sub-populations, and examined severe maternal morbidity rates by maternal characteristics, geographic patterns, and facility context to identify priority areas for action to monitor, reduce, and eliminate inequities in severe maternal morbidity. Findings from this analysis have been summarized in a comprehensive statewide surveillance report on severe maternal morbidity. The report has been written and is currently undergoing internal review, with anticipated release in the next reporting period.      

 

WMH-3.4: Through the New York State Perinatal Quality Collaborative, NYS birthing hospitals and centers have been engaged in a comprehensive interdisciplinary hospital quality improvement project focused on implicit bias through the NYS Birth Equity Improvement Project

 

The NYS Birth Equity Improvement Project launched in January 2020. The project seeks to assist birthing hospitals and centers in identifying how individual and systemic racism impacts birth outcomes and in taking action to improve both the experience of care and perinatal outcomes for Black women/birthing people in the communities they serve. (See Strategy WMH-4 below for further detail)

 

WMH-3.5: Collaborate with NYSDOH AIDS Institute and the New York City Department of Health and Mental Hygiene on efforts to address significant increases in the number and rate of infectious (primary, secondary, and early latent) syphilis among NYS females of childbearing age.

 

Strategy WMH-4: Apply a health equity lens to Title V activities to address social determinants of health and reduce disparities that impact women’s health and use of health care across the life course.

 

Women and Maternal Health outcomes are impacted by the social determinants of health, or the conditions in which people are born, live, work, play, learn, and age. The social determinants of health include factors like socioeconomic status, education, community environment, employment, social supports, and access to health care services. Systematic differences in the distribution of power and resources due to racism and other biases are root causes of inequities in access, availability of services, and quality of clinical care. All ten priorities that emerged from community members' input during the needs assessment revolve around the social determinants of health and inequities. These factors and inequities impact the health outcomes of both individuals and entire communities.

 

The NYS Title V Program strives to contribute to broad-based efforts to address inequality and the social determinants of health. Strategies focus on improving outreach to find and engage high-need women and their families in health insurance and health care; increasing knowledge of available community resources and supports; working with community stakeholders to improve delivery of care and services; developing supports, opportunities and social norms that promote and facilitate healthy behaviors across the lifespan; involving community members in program implementation and policy development; and promoting community engagement and mobilization to proactively address bias and racism and other community and systems-level factors impacting racial and ethnic disparities.

 

The PICHC program incorporates a multi-faceted approach to ensuring health equity principles are embedded in the framework. The overall intended outcomes of PICHC programs are to help families achieve an optimal level of health, self-sufficiency, and overall well-being. The program activities are responsive to feedback received from community members during the Department’s 2018 statewide Commissioner’s listening sessions, and reflected in the Voice Your Vision Report: listening_session_report.pdf (ny.gov). The program also incorporated a recommendation from the Governor’s task force on maternal mortality to expand Community Health Worker services statewide: maternal_mortality_report.pdf (ny.gov), and also recommendations from the NYS Postpartum Workgroup to implement a stress free zone model of care: 2021-01_expert_panel_on_postpartum_care_final_report.pdf (ny.gov).

 

As part of the PICHC contractual agreement, Title V staff worked to ensure Community Health Workers are compensated with a living wage and afforded promotional opportunities. With additional funding from the state’s Reducing Maternal Mortality appropriation, not only have Community Health Workers’ salaries increased, but the requirements for the Community Health Worker Supervisor position have been updated to allow for a pathway for experienced Community Health Workers to advance to a Community Health Worker supervisory role. To achieve this, PICHC programs that have identified a potential candidate must submit a staff development plan that includes the Community Health Workers resume, a one-year probation period and additional training on Mental Health First-Aid, Case Management, Identification of Child Abuse and Maltreatment, Crisis Intervention, and Identification of Intimate Partner and Domestic Violence.

 

Community Health Workers conduct enhanced outreach, perform intake screening assessments using evidence-based tools, issue referrals and follow-up for needed services, work with clients to develop birth and postpartum plans, and connect or provide support groups for clients on topics related to breast/chest feeding, parenting/childbirth classes, Doula support, financial and health literacy resources, translation services and referral to English as a New Language (ENL) classes and grief support groups for families who have lost a parent or infant/child.

 

On a community-level, PICHC programs are required to conduct community mobilization, engagement and advocacy activities which include:

1. Start a new community action board if none exist in the catchment area (with 25% of the board consisting of community members) or participate in an existing community action board whose focus is improving perinatal and infant health.
   1. Identify gaps and barriers in the community and develop strategies for addressing social determinants impacting perinatal health outcomes.
   2. Develop a mechanism to include community input and report actions back to the community at large.
2. Promote civic engagement by training community members to participate on community action boards and other advocacy groups, and train 10-20 community members annually to develop leadership and advocacy skills.

 

The Title V Program led the following specific program and policy activities to advance this strategy during the 2021-22 reporting period:

 

WMH-4.1 Through the PICHC programs, contracted staff, including Community Health Workers, routinely worked with diverse community stakeholders, including community residents, to identify and collaboratively address issues and barriers impacting maternal and infant health outcomes at the community level, including:

• Actively participated in local community advisory boards, consortiums, or coalitions to address issues impacting perinatal and infant health and identify effective strategies for addressing the social determinants impacting those outcomes.
• Engaged and partnered with diverse stakeholders from a wide array of community sectors including community residents, grassroots organizations, community-based service organizations, health care providers, local government, local foundations, and local businesses. This included working with over 4,227 community partners at more than 1,057 coordinated outreach events.
• Worked collaboratively with community partners to address relevant community issues such as safe housing, availability and accessibility of resources and services (e.g., health care, mental health, substance abuse services, home visiting, family support resources), social norms (e.g., related to use of preventive care services, breastfeeding, or personal health behaviors), and community mobilization to effectively identify and address community problems. Community Health Workers issued more than 19,215 health care and social support referrals to PICHC clients.  The top five social support referrals are clothing and baby care items, the Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC); food pantry; housing assistance; and food stamps.

 

WMH-4.2 Through the PICHC programs, Community Health Workers were provided professional development, including annual training on how to talk with families about difficult topics like mental health and depression using a trauma-informed care approach; how to manage emergency situations; and cultural humility, anti-racism, and equity in perinatal care, and Community Health Workers provided supports to individual clients and their families to address behavioral and social determinants of health outcomes including:

• Information on available community resources for needs related to housing, food, employment and job training, transportation, and other basic needs, and guidance on how to access these resources, including remotely, as needed.
• Helping families connect and use/enroll in enhanced social support resources and programs including parenting classes, peer support groups, childbirth education and resources, breastfeeding education, and directly supported clients to develop birth plans.

 

WMH-4.3 Collaborate with partners, including but not limited to, the Office of Mental Health’s Project TEACH, American College of Obstetricians and Gynecologists District II NY, home visiting programs and other community-based organizations, to address mental health in pregnant and postpartum people by increasing screening and follow-up support.

• Project TEACH, American College of Obstetricians and Gynecologists District II NY, and NYSDOH's NYS Perinatal Quality Collaborative have been hosting webinars on the integration of maternal mental health into obstetric practices, including the private practice perspective, and a focus on maternal mental health disparities and steps for achieving equity.

• Integrating parent engagement and leadership into state-level home visiting programs.

 

Title V staff continued to collaborate with partners, including the NYS Office of Mental Health’s Project TEACH, the American College of Obstetricians and Gynecologists NY, home visiting programs, and other community-based organizations to address mental health in pregnant and postpartum people by increasing screening and follow-up support. A webinar was conducted on January 11, 2023, which focused on providing an overview of perinatal mood and anxiety disorders (PMADs) and understanding how Project TEACH can help NYS’ providers with caring for perinatal patients with PMADs.

 

WMH-4.4 Collaborate with NYS Perinatal Quality Collaborative on the NYS Birth Equity Improvement Project. Through a Learning Collaborative model, NYS will continue to assist birthing hospitals and centers: in identifying how individual and systemic racism impacts birth outcomes within their organizations; and in taking action to improve both the experience of care and perinatal outcomes for Black birthing people in the communities they serve.

 

Through a Learning Collaborative model, NYS will continue to assist birthing hospitals and centers: in identifying how individual and systemic racism impacts birth outcomes within their organizations; and in taking action to improve both the experience of care and perinatal outcomes for Black birthing people in the communities they serve.

 

The Title V Program, in collaboration with its NYS Perinatal Quality Collaborative, began a comprehensive learning collaborative project, the NYS Birth Equity Improvement Project in 2021 which will continue through May 2024. Seventy-three New York State birthing hospitals and centers have joined the project, which seeks to assist birthing facilities in identifying how individual and systemic racism impacts birth outcomes at their organizations and taking action to improve both the experience of care and perinatal outcomes for Black birthing people in the communities they serve. Monthly data collection and analysis for the project began in April 2021. Participating facilities have taken part in educational opportunities focused on anti-racism and the impact of bias in perinatal health care, developed new and/or improved existing policies related to birth equity to better meet the needs of their community, and worked to ensure they are centering the experience of Black people who are giving birth through the implementation of a Patient Reported Experience Measure. The Patient Reported Experience Measure, which was implemented in July 2021, is administered to birthing people prior to their discharge from participating hospitals.  As of September 30, 2023, more than 44,488 patient-reported surveys have been submitted. The data collected through the Patient Reported Experience Measure survey is stratified by race and ethnicity analyzed by Title V staff and reported back to facilities on a monthly basis.  Participating facilities use this experience data to improve equity of care.

 

WMH-4.5 Monitor Infertility Reimbursement Program contracts and provide guidance and ongoing support to contractors and the public.

 

NYSDOH awarded six contractors (one upstate and 5 downstate) to participate in the Department’s Infertility Reimbursement Program for the award period of 10/1/2022 – 9/30/2024. Title V staff updated eligibility requirements for the new program to align with new state insurance law, effective January 1, 2020, that requires all large cap insurance plans to provide three cycles of in vitro fertilization and fertility preservation services  as well as adding requirements that prevent discrimination based on an individual’s expected length of life, present or predicted disability, degree of medical dependency, perceived quality of life, other health conditions, or personal characteristics, including age, sex, sexual orientation, marital status, or gender identity. The new law also includes a new state definition of infertility.  Patient participation now includes Medicaid recipients, making the program more accessible to individuals with limited income, the unemployed, or those lacking insurance through their employer.

 

New WMH-4.6 Improve uptake of the COVID-19 vaccination among people who are pregnant, in the postpartum period and/or lactating, and of those people's families, with an emphasis on equity and those populations disproportionately affected by the COVID-19 pandemic.  This included hosting educational webinars for perinatal care providers, assisting NYS birthing facilities with the development and/or updating of their COVID-19 vaccination policies, and developing resources geared towards providers and/or patients.

 

Title V staff continued work to support the improved uptake of the COVID-19 vaccination among pregnant and parenting individuals and their families, with an emphasis on equity and those populations disproportionately affected by the COVID-19 pandemic.  A series of webinars were hosted on these topics, including one titled:  COVID-19 Vaccines for Black Birthing Women/People. The webinar enhanced participants’ knowledge and competence in relation to improving COVID-19 vaccination rates for people in the perinatal period with an emphasis on Black Birthing people and those disproportionately impacted by COVID-19. The webinar offered free continuing education (CE) credits and the recordings were archived on the NYS Perinatal Quality Collaborative webpage.

 

The staff at the Division of Family Health in collaboration with other bureaus within the NYSDOH launched the COVID-19 & Pregnancy Media Campaign. Promotional materials (i.e., commercial, Facebook posts, other social media) and creatives were developed for the COVID-19 and Pregnancy Media Campaign to increase vaccination uptake for pregnant and postpartum people, especially among those disproportionately impacted by COVID-19. Phase 1 of the campaign launched in Fall 2022 and focused on promoting COVID-19 vaccination during the perinatal period with the development and dissemination of promotional materials such as Facebook posts, bus flyers, radio spots, and other social media. Phase 2 of the campaign launched mid to late December and focused on sharing testimonials from perinatal providers on their experience with COVID-19 vaccination during pregnancy.

 

 

WMH-4.7 Improve the New York State Sexual Assault Victim's Bill of Rights. The Sexual Assault Victim's Bill of Rights was developed in 2019. The Bill of Rights will be updated to improve health literacy and translated into the 10 most common languages in New York State.

 

 The Sexual Violence Prevention Unit has formed an internal working group to begin updating the New York State Sexual Assault Victim’s Bill of Rights. This group has made significant progress this year by drafting the first revised document and soliciting feedback from dozens of stakeholders. The group has been able to successfully incorporate all recommendations received from stakeholders so far. A new draft has been developed and gaps in stakeholder feedback have been identified for additional review and feedback.  

 

WMH-4.8 Breastfeeding Support – Title V staff will participate in the Breastfeeding Grand Rounds planning committee in collaboration with Division of Chronic Disease and Division of Nutrition. The 2023 Breastfeeding Grand Rounds was held on November 14, 2023- Role of Legislation in Supporting Pregnant and Breastfeeding Employees in the Workplace.

 

 

WMH-4.9 The Rape Prevention and Education (RPE) Program has hired a Health Equity Consultant, Michelle M. Osborne, J.D. & Associates, LLC to conduct a health equity capacity assessment of the NYS RPE Program and develop and deliver a health equity training to staff within the Bureau of Perinatal, Reproductive, and Sexual Health.

 

Within this grant year, Michelle Osborne and Associates completed a health equity capacity assessment of the New York State Rape Prevention and Education Program. The purpose of the health equity capacity assessment was to determine the Rape Prevention and Education Program’s current capacity to enhance and expand health equity work, including an audit of Rape Prevention and Education program staff and materials; a review of current data availability and use of available data; and training and technical assistance on health equity. To conduct the assessment, Michelle Osborne and Associates met with the Rape Prevention and Education Program Director bi-weekly, delivered a survey to all funded and unfunded Rape Prevention and Education Program staff and partners, interviewed all Rape Prevention and Education Program staff within the NYSDOH and four other Rape Prevention and Education Program subrecipients, and completed a deep audit of many core program materials including the website, external and public documents, internal unpublished documents, federal documents, and contract information located on Basecamp (a platform for team collaboration and project management that fosters collaboration and sharing across groups).  

 

Michelle Osborne and Associates views antiracist health equity efforts as a continuous journey up and down the spectrum of Awareness, Accountability, Advocacy and Action.  Turning insights and findings into specific action is the hallmark of their approach. During the bi-weekly check-ins, Michelle Osborne and Associates has begun to community their findings and recommendations for action. A final report with an action plan was submitted in September.  This process has been critical to the RPE Program team and will guide strategic planning for the upcoming Center for Disease Control and Prevention Notice of Funding Opportunity and subsequent procurement for subgrantees.  

Additionally, Michelle Osborne and Associates has been preparing to deliver a 12-hour training series on ‘Antiracist Health Equity” to internal NYSDOH staff. This is designed as a virtual training that will be delivered in 6 2-hour sessions from October to December 2023.

• Session 1: Health Equity the Destination
• Session 2: Antiracism: The Vehicle
• Session 3: An Intersectional Journey
• Session 4: Locating Racist Power
• Session 5: Locating Antiracist Power
• Session 6:  Inside Out

 

WMH-4.10 Collaborate with the Office of Drug User Health to addressing disparities in family planning/reproductive health in the substance use population, creating partnerships between Family Planning Program and their Syringe Exchange Programs to strengthen reproductive healthcare and primary care.

 

The Family Planning Program continued work with the NYSDOH AIDS Institute Office of Drug User Health to address disparities in reproductive and sexual health care in the substance using population. This population is in high need of family planning services, and family planning clinics have the unique position to help de-stigmatize substance use disorders and address sexual and reproductive health needs from a harm reduction perspective. The goal of this work is to strengthen collaboration between Family Planning Programs and Syringe Exchange Programs to increase access to reproductive and primary healthcare A provider survey was sent out in mid-October 2022 and answers were collected/analyzed to gauge awareness of syringe exchange programs in counties that family planning clinics serve, their current partnership status with syringe exchange programs and their interest in strengthening partnerships with the syringe exchange programs. Based off the survey results, two regional meetings were convened. The first was a regional meeting with central/western NY providers, held on May 10, 2023 and the second with capital region/north country providers on September 20,2023. Both these meetings provided time for family planning clinics and syringe exchange programs to network and problem solve challenges they had faced when reaching out to each's respective client population. This work will continue with NYS Family Planning Providers attending Office of Drug User Health monthly workgroup meetings and including this topic in the NYS Family Planning Provider Meeting in May 2024.

 

In addition to the strategy updates above, the Department has taken great strides to incorporate health equity and racial justice throughout a wide variety of Title V activities, not limited to the activities within this strategy. In July 2022, the Department announced several reorganization efforts, including the creation of the Office of Health Equity and Human Rights. This new office is tasked with addressing health disparities and work to improve diversity, equity, and inclusion within the Department. The Office of Health Equity and Human Rights is a resource for programs across the Department as we work towards common goals of equitable health for all New Yorkers.

 

Within the Division of Family Health, a new Bureau of Health Equity and Community Engagement was created to address disparities highlighted in the COVID-19 pandemic and build a foundation for future epidemic responses. The bureau focuses on expanding and developing mitigation and prevention resources and services for pandemic response, improving data collection and reporting, and building infrastructure for cross-sector partnerships to align public health, healthcare, and social care interventions. The work of the new Bureau was highlighted in the Success Story and in Supporting Document #3. The Bureau has awarded 182 contracts of $49,999 each. These new contractors are non-traditional partners to the Department. There are over 50 contractors that focus specifically on supporting individuals from birth through reproductive age. Contractors include The Breasturant, Out Mommie Village, and Project Stork, as well as many more that support food security, health literacy, mental health, community empowerment, and more. These supports are critical for people to have knowledge, access, and availability to achieve health and well-being.

 

WMH-4.11 Guidance Document: Resources for Black Birthing People

In 2018, the NYSDOH organized seven community listening sessions with birthing people and other stakeholders. During these sessions, participants expressed that poor communication with healthcare providers was a significant barrier to receiving optimal prenatal care. Participants reported feeling unheard and needing more time with their providers and that few providers reflected on their lived experiences.

 

An internal ad hoc Department planning committee was formed in 2022 to develop a communication guide for Black birthing people, with a goal of helping pregnant and postpartum individuals to communicate more effectively with their healthcare providers – essentially bridging the communication gap between patients and their healthcare providers. The committee identified that better communication between providers and Black birthing people will be achieved by involving birthing people in their antenatal care and decision-making and that, in turn, will lead to better outcomes for all birthing people.

 

The planning committee consisted of subject matter experts in maternal and infant health from the Department’s Division of Family Health including physicians, health educators, home visiting program staff and an Empire State Fellow. The planning subcommittee met monthly to develop the guide, and the internal Department planning committee supervised and provided feedback on its development. The committee also consulted with the Department’s Bureau of Creative Communications on content, messaging, and dissemination.

 

The communication guide titled "My Voice Matters" aims to empower birthing people and ensure their voices are heard throughout pregnancy, childbirth, and post-partum care. The content is designed to help birthing people communicate effectively with their healthcare providers, understand respectful care practices, and access resources that can aid them in their prenatal and postnatal care. It provides strategies and tools for patients to confidently address their concerns and needs during antenatal care and decision-making.

 

The dissemination plan includes distribution to a wide range of partner organizations including birthing facilities, physicians, and home visiting programs. The guide will also be available on the Department's website, with an anticipated distribution date of March 2024. The guide will also be translated into the 12 most spoken non-English languages and designed with patient-centric language to ensure ease of comprehension and be available in print and digital formats, making it accessible to a broader audience statewide.

 

NEW WMH-4.12 Diaper Bank

 

In 2022, Title V staff in collaboration with other state agency partners, began to engage with MIECHV, PICHC and HFNY partners to promote the availability of diapers through the NYCARES/Baby2Baby Diaper Bank.

 

Title V staff surveyed PICHC and MIECHV programs in January 2023 to assess the programs need and capacity to store diaper pallets, and shared survey results with our state agency partners. Title V staff continue to work with programs to promote the availability of these items.

 

The NYS Title V Program established two Evidence-Based Strategy Measures (ESMs) to track the programmatic investments and inputs designed to impact NPM1:

 

ESM WMH-1: Percent of Maternal and Infant Community Health Collaboratives /PICHC program participants engaged prenatally who have created a birth plan during a visit with a Community Health Worker.

 

Data for this measure is obtained from monthly reports submitted by Maternal/PICHC contractors (note: Maternal and Infant Community Health Collaboratives transitioned to PICHC in 2022). The baseline value for this measure, taken from 6-month program period of 10/1/19-3/31/20, is 52.7%. For the time period of 10/1/2021 to 9/30/2022, there was a slight decline to 51.7%. We believe that the decline is due to the implementation of a new web-based data management system on 4/1/2021. Program uptake of the new data system impacted data completeness and quality. Title V staff are working closely with PICHC programs to ensure participants have a birth plan created.

 

ESM WMH-2: Percent of Family Planning Program clients with a documented comprehensive medical exam in the past year.

 

Data for this measure will come from Family Planning Program clinic visit record data. For the time period from 10/1/2022 to 9/30/23, 30.8% of Family Planning Program clients had a documented comprehensive medical exam. This is a decline from the 38.7% of Family Planning Program clients reported in the prior annual report. Providers indicate fewer clients coming for comprehensive annual exams, despite outreach. Changes in the guidance for the timing of pap smear tests from every year to every three years have been cited as a factor in lower annual visit numbers. Family Planning Providers continue to provide outreach and education to community members on the importance of annual medical exams.