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 23rd 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 4.6 times more likely for Black women compared to White women during the 2017-2019 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 Maternal and Infant Community Heath Collaboratives, which was renamed in 2022 to the Perinatal and Infant Community Health Collaboratives, 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.

 

Perinatal and Infant Community Health Collaborative 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 initiative. The Maternal, Infant, and Early Childhood Home Visiting 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 Perinatal and Infant Community Health Collaborative and Maternal, Infant, and Early Childhood Home Visiting 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 Maternal and Infant Community Health Collaboratives program formally ended June 30, 2022 and was replaced with the new Perinatal and Infant Community Health Collaborative initiative, whose name is more inclusive in language and reflects all people who are pregnant.  Through a competitive award process, a total of 26 awards were made for a five-year period beginning July 1, 2022-June 30, 2027.

 

The goal of the Perinatal and Infant Community Health Collaborative initiative is to improve perinatal health outcomes and eliminate racial, ethnic, and economic disparities in those outcomes. Funded programs will 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. Perinatal and Infant Community Health Collaborative 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. A companion competitive procurement for a Perinatal and Infant Community Health Collaborative training and technical assistance provider was released during the reporting period and awarded to John Snow Inc. (JSI) for a five-year period beginning October 1, 2022 – September 30, 2027. JSI will support Perinatal and Infant Community Health Collaborative programs on the implementation of best practice community-based strategies to improve perinatal and infant health outcomes through the provision of technical assistance, training, and quality improvement efforts, including development of core trainings for Community Health Workers and their Supervisors.

 

In addition, a new data management information system vendor contract was awarded to the Research Foundation of the State University of New York for a five-year period September 1, 2022 – August 30, 2027 to collect and monitor Perinatal and Infant Community Health Collaborative program data.

 

The NYS Family Planning Program awarded funds to three new Family Planning Program organizations in August of 2022. The Family Planning Program now supports 37 health facilities that are regulated by 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.

 

The NYS Family Planning Program reentered the Title X network in April 2022 and, as a result, all funded NYS Family Planning Program contracts re-entered the Title X network. With this influx of funding, the NYS Family Planning Program was able to expand their network to include the three new Family Planning Program organizations mentioned above and to announce additional funding for all NYS Family Planning Program providers to support comprehensive, confidential reproductive health services for low-income, uninsured, and underinsured women and men of reproductive age. 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.

 

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 FFY22, the Growing up Health Hotline handled nearly 14,000 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. During the formula shortage, the Growing up Health Hotline provided callers who participate in the Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) with the contact information for local agencies that oversee the Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) to assist with locating formula in their area. 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.

 

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).

 

WMH-1.3 Through the Perinatal and Infant Community Health Collaborative and Maternal, Infant, and Early Childhood Home Visiting 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, Perinatal and Infant Community Health Collaborative programs conducted 24,198 visits with clients, of which 59% (14,331) 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 Perinatal and Infant Community Health Collaborative 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 Perinatal and Infant Community Health Collaborative 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, 2021, to September 30, 2022, a total of 5,101 clients were enrolled in the Maternal/Perinatal and Infant Community Health Collaborative 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, 2021, to September 30, 2022, Community Health Workers engaged 1,303 prenatal clients to create a birth plan. Community Health Workers also issued a total of 19,215 referrals, with the top five referral categories overall being clothing/baby care items, referrals to Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC), food pantry, dental services, and housing assistance.

 

WMH-1.5 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 was an additional one-time federal grant award to continue supporting telehealth services in rural service areas beyond the COVID 19 pandemic, as well as continued support for dispensing 12-month supplies of contraceptives when appropriate. 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.

 

New WMH-1.6: 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 assault.

 

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 over a five-year period.  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.

 

New WMH-1.7 Continue to provide training to Train Perinatal and Infant Community Health Collaborative and Maternal, Infant, and Early Childhood Home Visiting 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 Maternal, Infant, and Early Childhood Home Visiting -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.

 

New WMH-1.8 Through the Maternal, Infant, and Early Childhood Home Visiting Initiative, direct American Rescue Plan Act (ARPA) Act funds to Maternal, Infant, and Early Childhood Home Visiting -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 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.

 

 

New WMH-1.9: Through public awareness campaigns, promote messages about maternal warning signs to educate pregnant and postpartum women about when to seek help for untoward conditions associated with perinatal complications.

 

NYSDOH implemented the Hear Her Campaign on media statewide 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 campaign ran twice (9/20/21 through 10/20/21 and 7/5/22 through 8/14/22). 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 persons and one for partners, friends, and family. These palm cards were co-branded, printed, and distributed to 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 website at NYS Hear Her Campaign (ny.gov) for downloading and printing, or they can be ordered from the NYSDOH distribution warehouse free of charge.

 

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.

 

 

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. Perinatal and Infant Community Health Collaborative 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 Perinatal and Infant Community Health Collaborative 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.

 

WMH-2.2 Collaborate with Perinatal and Infant Community Health Collaborative; Maternal, Infant, and Early Childhood Home Visiting; Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC); local health and social service programs; midwives; doulas; as well as state and national organizations such as American College of Obstetricians and Gynecologists, the Academy of Pediatrics, Society for Maternal-Fetal Medicine, hospital associations and the NYS Association of Licensed Midwives on messaging and strategies to promote birthing options appropriate for anticipated level of care, and safety of birthing hospitals, especially during health emergencies.

 

Title V funds will support a Perinatal Mood and Anxiety Disorder campaign and CDC Hear Her campaign. This work will continue in subsequent program years,

 

WMH-2.3 To improve coordination and increase bilateral referrals between birthing hospitals and home visiting programs, Title V staff will assist in connecting Perinatal and Infant Community Health Collaborative 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 Perinatal and Infant Community Health Collaborative and Maternal, Infant, and Early Childhood Home Visiting -funded home visiting programs, Maternal, Infant, and Early Childhood Home Visiting staff 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 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; their work was completed outside of this reporting period. Title V staff will continue to share best practices for established home visiting-birthing hospital partnerships with key provider groups across the state to encourage and strengthen ongoing collaboration.

 

New WMH-2.4 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.

 

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.

 

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.

 

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 2021-22 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.

 

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

 

New WMH-3.2a: Appoint a perinatal psychiatrist to the Maternal Mortality Review to enable recommendations and strategies to reduce maternal mortality related to mental health conditions in pregnant and postpartum women.

 

A perinatal psychiatrist was appointed to the Maternal Mortality Review to enable recommendations and strategies to reduce maternal mortality related to mental health conditions in pregnant and postpartum women.

 

During the reporting period, the Maternal Mortality Review met virtually six times (11/21, 1/22, 3/22, 5/22, 7/22, and 9/22) 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. Staff developed a written report of the findings and recommendations for the 2018 maternal death cohort to prevent future deaths and reduce the risk resulting from racial, economic, or other disparities. In April 2022, the findings of the 2018 maternal death case reviews and related recommendations were published in the New York State Report on Pregnancy-Associated Deaths in 2018.  The Maternal Mortality and Morbidity Advisory Council recommendations for preventability are in the process of being translated into action through collaboration with the Maternal Mortality and Morbidity Advisory Council, the American College of Obstetricians and Gynecologists District II NY, and other key stakeholders, including the development of issue briefs, factsheets, webinars, media campaigns, printed materials, and quality improvement projects through the NYS Perinatal Quality Collaborative. A statewide report on maternal mortality with data and recommendations to improve maternal outcomes was released in April 2022 and can be found at NYS Report on Pregnancy-Associated Deaths in 2018. During the reporting period, Maternal Mortality and Morbidity Advisory Council members also developed an issue brief on the Management of Behavioral Health Medications During Pregnancy. It was approved and will be published and posted on the NYSDOH website during the next reporting period. (See Strategy PIH- 2.6 for more detail on NYS Perinatal Quality Collaborative and equitable care.)

 

The NYC Maternal Mortality and Morbidity Review Committee (M3RC) published findings and recommendations from its 2016-2018 review of NYC maternal deaths and presented this information during a citywide webinar on October 28, 2021.

 

A two-page factsheet presenting the highlights of the NYS Report on Pregnancy-Associated Deaths in 2018 was developed during the reporting period. The fact sheet will be released and posted on the NYSDOH website near the start of the next reporting period.

 

Title V staff developed dedicated Maternal Mortality pages which were deployed to the NYSDOH website and can be found at Maternal Mortality (nys.gov).

 

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.

 

The planned severe maternal morbidity analysis that was deferred while two analytic staff were deployed to assist in the COVID-19 pandemic efforts is now underway. Analytic staff have been working to identify cases of severe maternal morbidity through hospital discharge data and to perform an analysis using linked birth data and hospital discharge data to define the major causes of maternal morbidity. This project will culminate in the development of a statewide report on severe maternal morbidity, spanning a decade of data.

 

WMH-3.4: Through the New York State Perinatal Quality Collaborative, continue work with birthing hospital teams and community-based organizations, through the NYS Opioid Use Disorder in Pregnancy and Neonatal Abstinence Syndrome (NAS) Project.  This learning collaborative, which kicked-off in September 2018, was initially conducted as a pilot with 14 NYS birthing hospitals participating.  The project was expanded in Fall 2020 to include a total of 39 NYS birthing hospitals. The project seeks to identify and manage the care of pregnant and birthing people with Opioid Use Disorder during pregnancy, and to improve the identification, standardization of therapy, and coordination of aftercare of infants with neonatal abstinence syndrome. NYS participates in the national Alliance for Innovation on Maternal Health (AIM) through this project

 

The NYS Perinatal Quality Collaborative continued to work with birthing hospitals and outpatient prenatal care clinics through the NYS Opioid Use Disorder in Pregnancy and Neonatal Abstinence Syndrome Project. This learning collaborative, which kicked-off in September 2018 with 14 birthing hospitals serving as pilot sites, expanded in the fall of 2020 to include a total of 43 birthing hospitals. The project seeks to identify and manage the care of people with Opioid Use Disorder during pregnancy, as well as to improve the identification, standardization of therapy, and coordination of aftercare of infants with neonatal abstinence syndrome. NYS participates in the national Alliance for Innovation on Maternal Health (AIM) through this project.

 

The NYS Perinatal Quality Collaborative produced two new brochures and a poster on Naloxone, the life-saving medication that can reverse opioid overdose, for people who are pregnant, people who recently gave birth, and their support persons that can be found at Opioid Overdose Prevention. The posters are available in English and Spanish, and the brochures are available in the top 11 languages spoken in NYS.

 

WMH-3.5: 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)

 

In addition, the NYS Perinatal Quality Collaborative finalized and disseminated the NYS Obstetric Hemorrhage Project Toolkit, which contains presentations, tools, resources, and data forms created by hospital teams. The toolkit will assist birthing hospitals that participated in the project with continued efforts and sustainability related to obstetric hemorrhage. It will also provide resources to non-participating hospitals. The project website will continue to be available to project participants interested in referencing archived materials.

 

New WMH-3.6: 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.

 

New WMH-3.7: The Rape Prevention and Education Program will create Regional Profiles to serve as living documents of publicly available data across the 17 counties covered by the six Regional Centers for Sexual Violence Prevention. These profiles will be used to assist the Regional Centers in making informed decisions when working with their communities utilizing various data sources such as the State Liquor Authority, New York State Education Department and the Census.

 

The Rape Prevention and Education Program created “Regional Profiles” to serve as living document of publicly available data across the 17 counties covered by the six Regional Centers for Sexual Violence Prevention in New York State. Four regional profiles were completed and shared with partner agencies on the Healthy Nightlife Initiative, the Healthy Schools Initiative, Health data, and census data. Each profile contains multiple data sources specific to each county served to make data-informed decisions for preventing sexual violence in their community. Training and technical assistance was provided to each regional centers to help describe the profile and how to use the data. 

 

In addition to the updates above, the Division of Family Health through the Title V program is advancing public health surveillance and data analysis to improve services and systems related to perinatal and infant health care. A new Bureau of Data Analytics, Research, and Evaluation was created to support research and data needs across the Division of Family Health. The consolidation of data and analytic staff into one Bureau under the direction of a new Bureau Director with a DrPH in Epidemiology will create efficiencies and cross training as well as provide professional development opportunities to further advance the use of data in Maternal and Child Health programs and policy decisions.

 

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 includes 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 Perinatal and Infant Community Health Collaborative program incorporates a multi-faceted approach to ensuring health equity principles are embedded in the framework. The overall intended outcomes of Perinatal and Infant Community Health Collaborative 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 Perinatal and Infant Community Health Collaborative 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, Perinatal and Infant Community Health Collaborative 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, Perinatal and Infant Community Health Collaborative 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 Perinatal and Infant Community Health Collaborative 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 Perinatal and Infant Community Health Collaborative 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 Perinatal and Infant Community Health Collaborative 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 a webinar series 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 October 6, 2021, which focused on the impact of social determinants of health on maternal mental health, and, specifically, a collaborative multidisciplinary approach to maternal mental health with a focus on Black and Latinx populations. The panelist of speakers included staff from NYS birthing hospitals and community-based organizations. Announcement of these webinar opportunities were shared with all NYS birthing facilities and Perinatal and Infant Community Health Collaborative Program Managers directly, as well as by email distribution. Recipients include Perinatal and Infant Community Health Collaborative program staff such as Community Health Workers and their Supervisors, staff of Healthy Start home visiting programs, local health department staff, and NYSDOH staff located in Albany and in Regional Offices.

 

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.

 

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 October 2022. 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, 2022, more than 25,000 patient-reported surveys have been submitted. The data collected through the Patient Reported Experience Measure survey is analyzed by Title V staff and reported back to facilities.

 

WMH-4.5 Support gestational surrogacy regulations, including licensure of and collaborations with gestational surrogacy programs.

 

Title V staff continued to review gestational surrogacy program application sections relevant to the Division of Family Health areas of expertise, including gestational surrogacy programs policies and procedures for screening of potential gestational surrogates (per NYSDOH guidelines), screening of intended parents (per American Society for Reproductive Medicine), appropriate use and monitoring of Surrogates' Bill of Rights, and appropriateness of Informed Consent related to above elements.

 

In 2020, NYS passed a law legalizing compensated gestational surrogacy. Title V staff, in partnership with other Department colleagues continue to review and approve new applicants, as well as review any updated guidance documents as agencies apply for their annual licensure renewal.  During the program year, the Department approved an additional 12 applicants, bringing the number of licensed surrogacy matching programs to 30.

 

New WMH-4.6 Monitor Infertility Reimbursement Program contracts and provide guidance and ongoing support to contractors and the public.

 

NYSDOH has awarded six contractors (one upstate and 5 downstate) to participate in the Department’s Infertility Reimbursement Program, formerly known as the Infertility Demonstration 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 (IVF) and fertility preservation services (FPS) 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. Based on these changes to the law, the Department developed new criteria for patient and provider participation in the Infertility Reimbursement Program, in consultation with expert stakeholders, including the American College of Obstetricians and Gynecologists and the Association of Reproductive Medicine, using the CDC’s Assisted Reproductive Technology Success Rate Report to obtain objective performance data on provider eligibility. 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-4.7 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 will include 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 two titled: COVID-19 Vaccination During the Perinatal Period and COVID-19 Vaccines for Black Birthing Women/People. These webinars offered free continuing education (CE) credits and the recordings were archived on the NYS Perinatal Quality Collaborative webpage. The NYS Perinatal Quality Collaborative project team led the development of a COVID-19 vaccination and pregnancy brochure and poster. The brochure and poster were created in collaboration with the NYSDOH’s Vaccine Confidence Workgroup and other bureaus within the NYSDOH to encourage and provide information to pregnant women/people about the COVID-19 vaccine.  A PDF copy of the brochure and poster have been uploaded on the NYSDOH website for public use and can be found here: https://health.ny.gov/publications/19647.pdf and here: https://health.ny.gov/publications/19656.pdf.

 

The brochure and poster in PDF version, as well as information for ordering hard copies, was also distributed to all NYS birthing facilities, all NYS Perinatal Quality Collaborative participating hospitals and centers, and to all Perinatal and Infant Community Health Collaborative programs.  The brochure was translated into 10 additional languages and is available to order from our distribution warehouse free of charge to all NYS providers. The poster was translated into Spanish and is also available to order at our distribution warehouse free of charge to all NYS providers. Resources on screening, treatment, referral, or other services related to COVID-19 and maternal mental health for providers were collected. The resources were collected from the American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine, CDC, and other states’ Perinatal Quality Collaboratives and organizations. The resources were posted on the NYS Perinatal Quality Collaborative webpage and shared with our birthing facilities and providers. and providers.

 

New WMH-4.8 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 New York State Sexual Assault Victim's Bill of Rights was developed in 2019. The plan was to update the Bill of Rights to improve health literacy and translate the Bill of Rights into the 10 most common languages in New York State. This work was delayed due to staffing vacancies. New staff members were onboarded within the Sexual Violence Prevention Unit in the fall of 2022 to oversee the Sexual Assault Forensic Examiner Program and the Rape Crisis Program. The work will be carried forward into the next program year.

 

New WMH-4.9 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. Spring 2023 regional meeting will be planned to strengthen relationships and referrals between Syringe Exchange Programs and Family Planning Programs.

 

The Family Planning Program has begun working 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 survey will be sent out in October 2022 to Family Planning Program providers outside of NYC to gauge their knowledge of Syringe Exchange Programs in counties that the Family Planning Program serves, their current partnership status, and their interest in strengthening partnerships with the Syringe Exchange Programs.

 

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 will address health disparities and work to improve diversity, equity, and inclusion within the Department. The Office of Health Equity and Human Rights will be 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. More information about this new bureau in future annual reports and applications for the 2022-23 program year.

 

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 /Perinatal and Infant Community Health Collaborative 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/Perinatal and Infant Community Health Collaborative contractors (note: Maternal and Infant Community Health Collaboratives transitioned to Perinatal and Infant Community Health Collaborative 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 Perinatal and Infant Community Health Collaborative 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 10/1/2021 to 9/30/22, 38.7% of Family Planning Program clients had a documented comprehensive medical exam. This is an improvement from the 25.6% of Family Planning Program clients reported in the prior annual report and exceeded the one year set goal of improving by 5%.