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. This NPM was selected because 1) Preventive medical visits for individuals of reproductive age are foundational to health throughout the life course, 2) it is supported by population health data demonstrating a need for continued improvement, and 3)   it relates directly to priorities voiced by women and families at community listening forums held across NYS. During the community listening sessions, women and families expressed priority needs including awareness and access of community resources, quality health care, transportation, and social support. This NPM also aligns directly with the NYS Prevention Agenda goal to increase 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 and encompasses a full spectrum of medical, mental/behavioral health, oral health, dietary/nutritional, and other supports and services.  

Increasing access to comprehensive, high quality, and equitable health care services has been identified 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 maternal mortality rate has been declining, racial disparities in maternal deaths are persistent, with maternal deaths being three to four times more common among Black women compared to White women. Severe maternal morbidity also fundamentally affects the lives of people who give birth, newborns, families, and health care provider teams. It 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, and is associated with an increased risk for maternal death. Perinatal depression is among the most common morbidities during pregnancy and postpartum periods, with significant implications for the health and well-being of the entire family. 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. (BRFSS)

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. (NVSS)

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. (HCUP-SID)

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 (PRAMS)

Four strategic public health approaches were identified to accomplish these objectives. These strategies are presented in the 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, 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 and 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 (MICHC) program, community health workers (CHWs) 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 needs of the individuals and families served. Assessments are completed at enrollment and updated throughout clients’ service periods and individualized care plans are developed based on the needs identified. CHWs 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. CHWs also connect clients and families to needed services and provide enhanced social support. CHWs 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. CHWs provided health information to increase clients’ knowledge and 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.

MICHC programs, which is being renamed to Perinatal and Infant Community Health Collaboratives (PICHC) to be more inclusive in language and reflect all people who are pregnant, coordinated outreach and engagement activities work with other home visiting programs serving the same communities including programs supported by New York’s funding from HRSA 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 MICHC and MIECHV programs coordinated outreach, referral, and assessment and intake processes, help identify, engage, and ensure pregnant and parenting families connect with home visiting programs and supportive services responsive to their needs. 

On July 28, 2021, a competitive request for applications (RFA) was released for the next iteration of MICHC, known as the Perinatal and Infant Community Health Collaborative (PICHC) initiative. A total of 26 awards were made for a five-year period beginning July 1, 2022 - June 30, 2027. The goal of the PICHC 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. 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 CHWs 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 RFA for a PICHC training and technical assistance provider was developed during the reporting period and released on December 14, 2021. Applications were received and scored in spring of 2022. The grant award package is pending review with the Office of the State Comptroller (OSC). Upon receiving OSC approval, a contractual agreement will be initiated for the five year period October 1, 2022 – September 30, 2027.

Current MICHC contracts were extended for 9-months through June 30, 2022, to prevent a gap in services while the new RFA was released, applications were received, and contracts were executed. During this extension period, MICHC programs received a one-time funding increase to support 1) salary increases for CHWs to ensure they are compensated equitably with a living wage according to the U.S. Department of Labor standards; 2) implementation of mandatory staff training focused on cultural humility, anti-racism, and equity in perinatal care which will better enable program staff to provide supportive services which improve health and behavioral outcomes especially for people who are pregnant or recently gave birth and are from communities disproportionally impacted by systemic barriers such as racism; and 3) subcontracts with community partners to address service gaps, in response to community input and needs assessments.

In addition, a new data management information system (DMIS) was launched April 1, 2021, to collect and monitor MICHC program data. The current DMIS vendor contract is in place through August 30, 2022. A competitive request for proposals (RFP) was developed and released on August 13, 2021. A new PICHC DMIS vendor contract will be awarded for a five-year period September 1, 2022 – August 30, 2027.

The NYS Family Planning Program (FPP) supports 34 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 over 150 family planning clinic sites across the state. Through these service sites, the FPP delivers 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; and appropriate referrals and health education.  Ensuring continued access to these core primary and preventive services is essential.

As reinforced by the MIECHV 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 Program for Women, Infants and Children (WIC), Medicaid, Family Planning, prenatal care, and the NYS Early Intervention Program. Social media and other emerging communication forums online 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 2020-21 reporting period:

• Across all programs, enhanced promotion of the NYS Growing Up Healthy Hotline (GUHH) to increase awareness of available community resources, supports, and services including WIC, Medicaid, family planning, prenatal care, and the NYS Early Intervention Program. In March-June 2021, an overview of GUHH was presented for multiple audiences: WIC local agencies, the statewide home visiting workgroup, local health departments, and other home visiting partners at the Home Visiting Coordination Initiative. A GUHH flyer for use by programs was translated into multiple languages and posted to the NYSDOH website in January 2021. The translations were prompted by an Executive Order (EO) directing all state agencies that provide direct public services to offer language assistance services (translation and interpretation) to people with limited English proficiency (LEP). While the GUHH flyer is not a vital document and falls outside the EO, Title V staff recognized the importance of translating this flyer to improve recruitment and engagement of MICHC and MIECHV priority populations.
• Through the Regional Perinatal Centers (RPCs) 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 will be tailored based on regional assessments of provider and affiliate hospital needs, to include routine prenatal and postpartum care and/or specialty care such as maternal-fetal medicine, radiology, and genetic counseling.
• Through the MICHC and MIECHV programs, successfully integrated use of 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 CHW 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-gong COVID-19 pandemic. CHWs continuously disseminated guidance on COVID-19 and perinatal health, as it became available.
• Through the MICHC program, supported CHWs to conduct outreach to find and engage high-risk pregnant and postpartum families in consistent, comprehensive preventive and primary care services, including preconception, prenatal, and postpartum care. From April 1, 2021, to March 31, 2022, a total of 4,688 clients were enrolled in the MICHC program. CHWs 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 April 1, 2021, to March 31, 2022, CHWs engaged 914 clients prenatally to create a birth plan. CHWs also issued a total of 17,011 referrals, with the top five referral categories being clothing/baby care items, housing assistance, SNAP, food pantry and WIC.
• Through the FPP, continued to support the delivery of comprehensive, confidential reproductive health services for women and men of reproductive age who are low-income and who are uninsured or underinsured. Addressing barriers to accessing reproductive health continues to be a priority of all FPP work. An example was the expansion in the availability of telehealth services, especially in response to the COVID-19 pandemic Including continued support to dispense a 12-month supply 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 (FPBP), and Family Planning Extension Program (FPEP).

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. MICHC 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 delivery of clinical care that can be tailored to the needs of each region and community, both urban and rural. Strengthening the connection between the MICHC providers and individual birthing hospitals will ensure 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:

• 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.
• Collaborated with MICHC, MIECHV, WIC, local health and social service programs, midwives, doulas, as well as state and national organizations such as the American College of Obstetricians and Gynecologists (ACOG), American Academy of Pediatrics (AAP), 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. A multimedia statewide campaign (in English and Spanish) was launched January 2021 through May 2021. Messaging was developed to address four key areas:
  • Emphasize the safety of and rebuild confidence in maternity care at all certified birthing facilities
  • Explain infection control practices in each type of birthing facility
  • Increase patient understanding of different levels of maternity care and types of birthing facilities as well as how to work with providers to select the appropriate patient-centered delivery
  • Support the mental health and wellbeing of pregnant and birthing people and their families.

Media outlets included digital, streaming video and radio, social media, and search optimization. Radio Public Service Announcements (PSA) were aired in New York City and major metropolitan areas in Upstate NY/Long Island. Print advertisement boards were placed in metropolitan community locations such as salons, laundromats, and corner stores. Throughout the campaign, advertisements and campaign materials were seen or heard over 35.6 million times, resulting in nearly 75,000 clicks to the Department’s website.

• Collaborated with NYS WIC to improve referrals from WIC local agencies to home visiting programs (MICHC, Nurse Family Partnership (NFP) and Healthy Families New York (HFNY). Both home visitors and WIC local agency staff were surveyed about referral patterns and barriers to referring to home visiting. Survey results indicated that home visiting agencies who are co-located with WIC, and those who have WIC on their community advisory board, reported the most referrals from WIC. Almost half of staff from WIC local agencies had not referred to home visiting in the past six months. WIC staff commonly indicated they lacked knowledge of home visiting programs and could benefit from a script to use with participants. These survey results were utilized to create a referral desk guide for WIC staff, which contained some scripting, and informed presentations on referrals given to home visiting programs and WIC local agencies. The home visiting team meets with NYS WIC to discuss bidirectional referral data quarterly to facilitate coordination and communication across the programs.
• The Regional Perinatal Centers (RPCs) and networks of affiliate birthing hospitals, continued to 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 were tailored based on regional assessments of provider and affiliate hospital needs, to include routine prenatal and postpartum care and/or specialty care such as maternal-fetal medicine, radiology, and genetic counseling. Each of the five upstate RPCs that serve a significant rural population identified needs and capacity.  Several of the RPCs 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. (See Strategy PIH-1 for more detail on Telehealth Services for Neonatal Services).
• As part of the effort to improve coordination and increase bilateral referrals between birthing hospitals and MICHC and MIECHV home visiting programs, Title V staff collaborated with the NYS Council on Children and Families (CCF) to develop a flyer for their new NYS Parent Portal, which includes information on childcare and home visiting options by county, to promote the website and increase awareness of home visiting services and supports available in NYS. In March 2021, this flyer was shared with NYS birthing hospitals and community-based programs serving pregnant and parenting families with the goal of directing more MICHC and MIECHV clients to the NYS Parent Portal. The flyer was also translated into the ten most common non-English languages spoken by Limited English Proficiency (LEP) individuals in NYS. As a result of this effort, CCF data (comparing March 2020 to March 2021) showed a 459% increase in number of clicks to the Childcare Locator (which includes the home visiting locator) and a 601% increase in number of clicks to the Parent Portal. Subsequent data comparing April 2020 to April 2021 showed a 442% increase in number of clicks to the Childcare Locator and a 154% increase in number of clicks to the Parent Portal.
• Title V staff also held multiple brainstorming sessions and developed a student internship project for the spring 2022 semester that will examine existing relationships between home visiting programs and birthing hospitals via a Survey Monkey questionnaire and evaluation of responses. The intern will also use current MICHC, NFP, and HFNY referral data and create a referral monitoring tool in Excel to track trends in referrals made. Best practices to improve referral relationships will be determined by survey analysis and evaluation of current data trends. Title V staff will share best practices with established home visiting-birthing hospital partnerships across the state to encourage and strengthen on-going collaboration.

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 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 (MMRB) 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 public health data and chart reviews. The cases are identified within one year of the date of the maternal death and the case reviews are completed within two years of the date of death. The 2018 maternal death cohort was completed by the end of calendar year 2020. The 2019 maternal death cohort review was initiated in 2019 and is on track for completion by the end of 2021.

During the reporting period, the MMRB met virtually six times (11/20, 12/20, 2/21, 5/21, 7/21 and 9/21) to perform the maternal death case reviews. The MMRB assessed the causes of deaths, factors leading to the deaths, and preventability for each maternal death reviewed. Staff has developed a written report of the findings and recommendations for the 2018 maternal death cohort that will be used to prevent future deaths and reduce the risk resulting from racial, economic, or other disparities. In September 2021, the findings of the 2018 maternal death case reviews and related recommendations were shared with the Maternal Mortality and Morbidity Advisory Council (MMMAC). The MMRB recommendations for preventability will be translated into action through collaboration with the MMMAC, ACOG District II) and other key stakeholders, including the development of issue briefs, webinars, and quality improvement projects through the New York State Perinatal Quality Collaborative (NYSPQC).

(See Strategy PIH- 2.4 for more detail on NYSPQC and equitable care.)

Analysis of NYSPQC project data provided by participating birthing hospitals helps to improve services and systems related to maternal health care. The NYSPQC, ACOG-NY, Healthcare Association of New York State (HANYS) and Greater New York Healthcare Association (GNYHA), with support from the National Institute for Children’s Health Quality (NICHQ), will continue to lead specific improvement projects related to opioid use disorder in pregnancy and birth equity, two important areas related to maternal mortality and morbidity. (See Strategy PIH- 4.1 for more detail on improvement projects.)

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 policy 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 NYSPQC projects, Title V staff have been collecting and doing 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 2020-21 reporting period:

• Summarized, shared, and discussed findings of the MMRB with key partners, including the MMMAC, to inform statewide prevention strategies as described above. Data from the 2018 maternal death cohort and findings from the MMRB case reviews was compiled and analyzed.
• A statewide report on maternal mortality with data and information to improve maternal outcomes was released in April 2022 and can be found at: maternal_mortality_review_2018.pdf (ny.gov).
• A planned Severe Maternal Morbidity (SMM) analysis was deferred while two analytic staff were deployed to assist in the COVID-19 pandemic efforts. Efforts of remaining analytic and program staff centered on continuing the MMRB meetings and writing the statewide report of the 2018 maternal death cohort. As time allows, staff will continue to identify cases of SMM 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 three-year NYS Obstetric Hemorrhage Project closed in June 2021. Through this project, the NYSPQC worked with birthing hospital teams to improve the assessment, identification, and management of maternal hemorrhage, one of the leading causes of maternal morbidity and mortality in NYS. A participating birthing hospital provided this feedback on the project, “It was a great support to be part of this collaborative and have our site make so many improvements during our engagement in the project.” During the coming reporting period, the NYSPQC will finalize and disseminate the NYS Obstetric Hemorrhage Project Toolkit, which contains presentations, tools and resources created by hospital teams, data forms, and other items to all NYS birthing hospitals. 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 for their use and information. The project website will continue to be available to project participants interested in referencing archived materials.
• The NYSPQC continued to work with birthing hospital teams and community-based organization through the NYS Opioid Use Disorder (OUD) in Pregnancy & Neonatal Abstinence Syndrome (NAS) 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 OUD during pregnancy, and improve the identification, standardization of therapy, and coordination of aftercare of infants with NAS. NYS participates in the national Alliance for Innovation on Maternal Health (AIM) through this project.
• Through the NYSPQC, with the support of collaborative partners, a new comprehensive interdisciplinary hospital quality improvement project, the New York State Birth Equity Improvement Project (NYSBEIP), 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 birthing people in the communities they serve. (See Strategy WMH-4 below for further detail.)

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’s and Maternal Health outcomes are impacted by the social determinants of health (SDOH), or the conditions in which people are born, live, work, play, learn, and age. SDOH 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 SDOH 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 SDOH. 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; the development of supports, opportunities and social norms that promote and facilitate healthy behaviors across the lifespan; involving community members in program implementation and policy; 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 Title V Program led the following specific program and policy activities to advance this strategy during the 2020-21 reporting period:

• Through the MICHC program, contracted staff including CHWs 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 1,500 community partners at more than 200 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. CHWs issued more than 12,610 health care and social support referrals to MICHC clients.

• Through the MICHC program, provided supports to individual clients and their families to address behavioral SDOH outcomes, including:
  • Provided 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.
  • Helped 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.
  • Provided professional development support for CHWs to delivery these services, 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.

• On a policy level through a contractual agreement, Title V staff worked to ensure CHWs are compensated with a living wage and afforded promotional opportunities. With the additional funds being provided in the nine-month extension period (10/1/2021-6/30/2021) as highlighted above, not only are CHW salaries intended to increase, but the requirements for the CHW Supervisor position have been updated to allow for a pathway for experienced CHWs to advance to a CHW supervisory role. To achieve this, MICHC programs that have identified a potential candidate must submit a staff development plan that includes the CHWs 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.
• Through the Enough is Enough (EiE) program, (which supports 48 projects across the state to work with local colleges and universities to support sexual violence prevention and education efforts) Title V funding supported costs associated with training EiE programs on the Safer Bars Curriculum to train bar proprietors and their staff on what is sexual violence, how to observe and assess situations for signs of sexual violence, bystander intervention skills building; policy change assistance, and environmental assessments. Trainings were initially scheduled for Fall 2020. However, due to the COVID-19 pandemic, NYSDOH collaborated with the training agency (Cicatelli Associates, Inc.) and the developer (Dr. Elise Lopez, University at Arizona) to modify the training-of-trainers to fit a virtual delivery model.  Trainings were provided in early 2021. Due to the COVID-19 pandemic and the impact on alcohol-serving establishments (closures and limited capacity once reopened), EIE programs with support from the NYSDOH decided to pause implementation of the Safer Bars programs until it was reasonable to resume.  As part of the 2021-2022 enacted state budget, the Department transferred the EiE program to the NYS Office for the Prevention of Domestic Violence (OPDV), effective April 1, 2021.  NYSDOH staff continue to collaborate with OPDV on the Safer Bars curriculum implementation.
• Title V staff continued to collaborate with partners, including but not limited to, the Office of Mental Health’s Project TEACH, American College of Obstetricians and Gynecologists (ACOG-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. Two maternal mental health training webinars were hosted during the reporting period. The first, in February 2021, focused on integrating maternal mental health into obstetrics and featured presentations by Mary D’Alton, MD, Chair of the Department of OB/Gyn and Catherine Monk, MD, Director of Women’s Mental Health Obstetrics and Gynecology at Columbia University Irving Medical Center. The second webinar took place on October 6, 2021, which focused on the impact of SDOH 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 MICHC Program Managers directly, as well as on the MICHC listserv. Recipients include but are not limited to MICHC program staff such as CHWs and CHW Supervisors, staff of Healthy Start home visiting programs, LHD staff, and NYSDOH staff located in Albany and in regional office.
• The Title V Program, in collaboration with its NYSPQC, began a comprehensive learning collaborative project, the NYS Birth Equity Improvement Project (BEIP) 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 participated 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 (PREM). The PREM, which was implemented in July 2021, is administered at project participating facilities to birthing people prior to their discharge.  As of October 6, 2021, more than 3,500 PREMs were submitted by people as they were being discharged from a participating hospital. The data collected through the PREM is analyzed by Title V staff and reported back to facilities.
• In 2020, NYS passed a law legalizing compensated gestational surrogacy. Title V staff, in partnership with other Department colleagues, worked to establish regulations, guidance documents and a Surrogates’ Bill of Rights to support the licensure of Gestational Surrogacy Programs (GSP). This comprehensive law (effective February 15, 2021) and regulations transformed NYS from one of the last states to allow gestational surrogacy to establishing the most comprehensive gestational surrogacy and ova donation program in the country. Gestational surrogacy provides New Yorkers’, including people who identify as LGBTQIA+, with the ability to start or expand their families. Title V staff developed and implemented internal policies and procedures to review GSP applications. Between February 15, 2021, and September 30, 2021, Title V staff reviewed 18 applications, approving 12 for licensure and requesting additional or clarifying information in alignment with GSP requirements. 
• Title V staff updated eligibility requirements of the Department’s Infertility Reimbursement Program (IRP), formerly known as the Infertility Demonstration Program, to align with new state insurance law effective January 1, 2020, which requires all large cap insurance plans to provide three cycles of in vitro fertilization (IVF), fertility preservation services (FPS) and adds 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, or other health conditions, or based on 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 has developed new criteria for patient and provider participation in the IRP, in consultation with expert stakeholders (ACOG and the Association of Reproductive Medicine), using the Centers for Disease Control and Prevention (CDC) Assisted Reproductive Technology (ART) Success Rate Report, to obtain objective performance data on provider eligibility. Patient participation will now include Medicaid recipients, making the program more accessible to individuals with limited income, the unemployed or those lacking insurance through their employer. Per the new criteria, NYSDOH has identified 24 infertility providers in NYS who meet provider eligibility requirements. NYSDOH released a solicitation of interest (SOI) for the IRP in early 2022. It is anticipated that contracts resulting from this SOI will be for a two-year period from 10/1/22-9/30/24.

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 MICHC program participants engaged prenatally who have created a birth plan during a visit with a CHW.

Data for this measure is obtained from monthly reports submitted by MICHC contractors. The baseline value for this measure, taken from 6-month program period of 10/1/19-3/31/20, is 52.7%. Since the baseline data collection period, a new web-based data management system was implemented on 4/1/2021. Uptake of the new data system impacted data completeness and quality, resulting in a value of 43.4% for the time period of 4/1/2021 to 3/31/2022. The program has set a one-year improvement target of 5%, to 45.6% of participants, for 2022.

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 FPP clinic visit record (CVR) data. Current FPP data for program year 2018 shows 25.6% of FPP clients had a documented comprehensive medical exam. The FPP program has set a one-year improvement target of 5%, to 26.9% of clients in 2022.