For Perinatal and Infant Health (PIH), New York’s Title V Program selected NPM 3: Percent of very low birth weight (VLBW) infants born in a hospital with a Level III+ NICU. This NPM was selected because of its relevance to quality and systems of care for infants who are at high risk for poor outcomes. While NPM 3 specifically measures site of delivery for very low birth weight infants as one critical indicator of care, NYS Title V Program views this indicator more broadly as part of a continuum of supports, services, and systems of care for infants, people who are pregnant, people who recently gave birth, parents/caregivers, families, and service providers. This broader approach aligns with several priorities voiced by families in NYS’s needs assessment, including awareness of community resources and services, enhancing supports for families, improving people’s health care experiences, and fostering community engagement and empowerment.

In addition, New York’s Title V Program established one SPM for this domain, state-wide improvement from 74.34% to greater than 85% of newborn bloodspot screening (NBS) samples received at the lab within 48 hours of collection. This SPM was developed to reflect the state’s continued commitment to ensure that every newborn in the state receives newborn bloodspot screening as a public health service, to identify and support infants with a wide range of medical conditions. As a population-based program, the NBS program is an integral part of NYS’s public health system for supporting the health and lifelong well-being of newborns and their families.

A focus on improving services and outcomes for infants is supported by other measures assessing the perinatal period. The proportions of low birth weight (8.2%) and preterm (9.2%) births in NYS have been stagnant for years, but racial and ethnic disparities continue. Non-Hispanic Black infants experience significantly more low birth weight births (13.3%) and preterm births (13.3%) than non-Hispanic white infants (6.3% and 7.7%, respectively). NYS has improved the proportion of pregnant people entering prenatal care during the first trimester to 80.6%, but again there are disparities with only 71.8 of non-Hispanic Black and 74.7% of Hispanic pregnant women beginning early prenatal care compared to 85.7% of non-Hispanic white pregnant women. In our community forums, community members expressed that they do not “feel heard” by their health care providers, that their concerns and treatment preferences are not taken seriously, and that providers do not care about them or understand what they are going through. They indicated people avoid seeking care and services because they feel judged or anticipate being treated poorly. Participants indicated that people would be more likely to visit a provider who shows compassion, has been trained about bias and cultural competence, and who is relatable (i.e., from the community and speaks their language).

During the forums, many families expressed the need to raise awareness about available community resources and services, especially for postpartum depression, and to increase the availability and scope of services to support families in the postpartum period, including postpartum doulas, home visitors, community health workers, and breastfeeding support. 
According to the 2020 Pregnancy Risk Assessment Monitoring System Report, 10.0% of NYS women reported experiencing depressive symptoms after giving birth.

NYS historically has been a leader in establishing systems of perinatal regionalization, with consistently high performance in this measure. Building on that success, the Title V Program is currently engaged in a multi-year effort to expand and update perinatal regionalization standards and designations for the state’s birthing hospitals and centers. As this work progresses, it is essential to closely monitor NPM3 and other related measures to ensure that quality of care and key health outcomes are maintained or improved.

Both NPM-3 and SPM-1 align with the NYS Prevention Agenda goal to reduce infant mortality and morbidity.

Three specific objectives were established to align with this performance measure:

Objective PIH-1: Increase or maintain the percent of very low birth weight infants born in a hospital with a Level III+ NICU by 2.4%, from the 2017 level of 91.2% to 93.4% by 2021. (NYS Vital Statistics Birth Data)

Objective PIH-2: Decrease the infant mortality rate by 2.6%, from 4.6 deaths per 1,000 live births in 2017 to 4.49 deaths per 1,000 live births in 2021 (NVSS).

Objective PIH-3: Improve the timeliness of Newborn Blood Spot samples received at the NYSDOH Wadsworth Laboratory from 74.34% to greater than 85% of samples received within 48 hours of collection by September 2023. (Newborn Blood Spot data)

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

Strategy PIH-1: Integrate specific activities across all relevant Title V programs to promote access to early prenatal care, access to birthing facilities appropriate to one’s needs, postpartum care, and infant care.

Consistent with a life course perspective, improving birth outcomes for infants requires attention to health and health care services for both babies, parents, and people of reproductive age (see the MWH Domain for additional discussion). New York State has made significant strides to reduce infant mortality and morbidities, but more work is still required. Timely and comprehensive prenatal and postpartum medical visits are essential to providing prevention education and anticipatory guidance, screening for risk factors and that may negatively affect the health of the neonate, managing chronic conditions and pregnancy complications, and connecting families with a wide array of community services and social supports to holistically address the health and wellness needs of pregnant people, neonates, and new families.  Several Title V programs, including Maternal & Infant Community Heath Collaboratives (MICHC), Newborn Bloodspot Screening (NBS), New York State Perinatal Quality Collaborative (NYSPQC), and Regional Perinatal Centers (RPCs), play a direct role in promoting comprehensive health and wellness of neonates through population-based systems, public health interventions, and delivering or linking people to health care services.

The Title V Program made progress or completed the following specific program and policy activities to advance this strategy throughout the 2020-21 year:

• PIH 1.1: The Department implemented a multimedia educational campaign that promoted the safety of birthing hospitals, maternity care options (levels of care and types of care providers), and infection control, and supported mental and emotional health of birthing people and families, to strengthen community awareness and advocacy for obtaining prenatal and postpartum care at appropriate level of care.
  • This campaign was informed by experts and community members in response to the COVID-19 Maternity Task Force recommendations (available at https://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/042920_CMTF_Recommendations.pdf). 
  • Campaign images and messages and ad placements were tailored to reach Black and Hispanic/Latinx pregnant people aged 15-50, an audience estimated at over 83,700 people (American Community Survey 2018, US Census Bureau).
  • In addition to messages on NYSDOH social media and partner agencies and providers, print media was placed in metropolitan markets while internet advertisements (banner ads, streaming video, and streaming and broadcast audio) and search optimization were statewide. Ads and audio were available in English and Spanish.
  • Over 35 million estimated impressions (the number of times the campaign was seen or heard) were delivered, resulting in nearly 75,000 clicks to the campaign website (not including broadcast/streaming radio and print media).
• PIH 1.2: Across all Title V programs, enhance promotion of the NYS Growing Up Healthy Hotline to increase awareness of available community resources, supports, and services including WIC, Medicaid, family planning, prenatal care, and the NYS Early Intervention Program.
• PIH 1.3: 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. (See Domain 1 WMH for additional details on obstetrical telehealth initiatives.)
  • The Title V-funded Rural Perinatal Telehealth Initiative provides funding to five upstate RPCs that serve rural communities. Starting in the 2019-20 program year and continuing through the current program year, RPCs were charged with conducting a technology, training, and interest-based Needs Assessment of rural affiliate birthing hospitals; community-based Obstetric, pediatric, and family medicine providers were also a potential partner. 
  • Based on identified needs, each RPC developed a telehealth service plan, determined the best approach to obtaining telehealth equipment (mobile carts, stethoscopes, etc.), and established formal relationships with affiliate partners to provide telehealth services.
  • Projects related to perinatal and infant health included increased access to real-time video-consultation with neonatologists and neonatal subspecialty providers; and increasing local access to neonatal ophthalmology to assess retinopathy of prematurity (with the goals of reducing patient/parent travel time and increasing timely clinical assessment).
  • Logistical issues, including global silicon chip shortages, high telehealth equipment demand, overtaxed hospital IT departments and legal/contractual delays, all five projects were extended beyond the initial 1/1/20-12/31/20 contract period, and are slated to end 12/31/21. Due to these issues, process and outcome measure data are not available at the time of reporting.
• PIH 1.4: Through the Maternal and Infant Community Health Collaboratives (MICHC) and Maternal, Infant, and Early Childhood Home Visiting (MIECHV) programs, integrate use of virtual home visiting services to increase acceptance and support of services for hard-to-reach families (See Domain 1 WMH for details).
• PIH 1.5: Through the MICHC and Maternal, Infant, and Early Childhood Home Visiting (MIECHV) programs, support community health workers (CHWs) to engage high-risk pregnant and postpartum families in consistent, comprehensive preventive and primary care services, including newborn care, screen and assist families in enrolling in health insurance, and provide families with social support to enhance health literacy and use of health care (See Domain 1 WMH for details).
• PIH 1.6: Through the American Indian Health Program (AIHP) and Migrant and Seasonal Farmworker (MSFW) Programs, continue to support direct health care and supporting services to ensure access to health care.
• PIH 1.7: Through the NYSPQC, provide educational opportunities and implement structured quality improvement projects with birthing hospitals and centers (See Strategy PIH-2 below for detail).

Additionally, a new strategy was identified and completed during the progress period.

• PIH 1.8: To increase public awareness of urgent maternal warning signs for pregnant and postpartum people, the Division of Family Health engaged in two activities:
  • The Division of Family Health launched a one-month, social media campaign, entitled the Hear Her campaign, to build public awareness of early urgent maternal warning signs for pregnant and recently pregnant people, as well as their support persons. Six social media messages linked back to the Department’s webpage for additional information and to a materials order form for print materials. Printed cards translated into the 10 most common languages spoken in NYS detail urgent maternal warning signs as a conversation starter for consumers with health care providers. With permission, NYS utilized the CDC’s Hear Her™ campaign materials and linked back to a NYS campaign landing page on the NYSDOH website.
  • The Division of Family Health also collaborated with the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) to distribute training licenses for the POST-BIRTH Warning Signs evidence-based initiative to all birthing hospitals, and to distribute take-home magnets for each birthing person who delivered at a birthing hospital. Each birthing hospital was offered a site license to train 10 nurses in obstetrics or other related fields on implementing the POST-BIRTH Warning Signs initiative. Additionally, the Department purchased and distributed POST-BIRTH Warning Signs magnets, to be provided for each birthing parent upon discharge as part of the program implementation. As of September 30, 2021, 68 birthing hospitals had registered for the program, distributing 720 licenses and over 142,000 magnets.

Strategy PIH-2: Implement updated perinatal regionalization standards, designations, and structured clinical quality improvement initiatives in birthing hospitals and centers.

NYS has been a longstanding national leader in implementing statewide systems of regionalized perinatal care. NYS’s regulations for perinatal regionalization and designation, as well as perinatal care services, were last updated in 2000 and 2005, respectively. It is imperative for NYS to ensure all perinatal hospitals are functioning in accordance with current standards of care for both maternal and infant outcomes. Since 2017, the Title V Program has worked to develop updates to these regulations to reflect current national standards of obstetrical and neonatal care and perinatal regionalization, changes in health care systems and reimbursements, as well as hospital restructuring and other corporate structural changes.  As part of the regulation development process, Title V Program staff conducted an extensive review of current standards, in consultation with a 49-member multi-disciplinary Expert Panel and other topical expert consultants. Additionally, the proposed regulations further integrate recently established midwifery birth centers, along with physician-led birth centers, into the perinatal regional system, and place a greater emphasis on quality care and patient safety, particularly for obstetrical patients. Current efforts to strengthen this public health system includes increased efforts to address maternal morbidity and mortality, integration of physician- and midwifery-led birth centers into the regional systems, and increased access to ancillary services such as alcohol and substance use and mental health services, directly and/or through referral and commensurate with the birthing facility’s level of care.

Working within this statewide system of perinatal regionalization, NYS’s Title V Program implements the NYSPQC. The NYSPQC aims to provide the best, safest, and most equitable care for individuals who are pregnant, giving birth and in the postpartum period and their infants.  This is achieved through collaboration with birthing hospitals and centers, perinatal care providers, and other key stakeholders to prevent and minimize harm through the translation of evidence-based guidelines to clinical practice. The NYSPQC has adapted the Institute for Healthcare Improvement (IHI) model for Idealized Perinatal Care and Breakthrough Series Methodology as a framework to guide improvement. Key NYSPQC activities include:

• Embedding evidence-based guidelines into practice
• Strengthening collaboration and communication within and among neonatal and obstetric providers, administrators, and organizations
• Fostering prepared and proactive care teams
• Assessing, conducting, and sharing surveillance and performance data on maternal and neonatal health indicators
• Continuously evaluating and measuring performance
• Setting priorities and implementing a comprehensive strategy for benchmarking and data driven quality improvement (QI) activities
• Providing topic-specific, intensive QI supportive activities, trainings and toolkits that are all-inclusive packages to facilitate improved clinical outcomes, excellent patient care and efficient resource allocation
• Researching best practices
• Continually reassessing outcomes of performance improvement interventions.

Specific priorities set by the NYSPQC are implemented by all participating NYS birthing hospitals and centers to improve outcomes of perinatal care. Analysis of NYSPQC project data provided by participating birthing hospitals and centers helps to improve services and systems related to perinatal health care.

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

• PIH-2.1: Strengthen the Perinatal Regionalization System through promulgating revised regulations for perinatal services, and subsequent assessment and re-designation of birthing hospitals and birthing centers to match new regulations.
  • In late 2020, DFH submitted a regulatory reform package designed to strengthen the perinatal regionalization system and update regulations related to hospital-based perinatal services, physician- and midwifery-led birth centers. 
  • In May 2021, a Midwifery Birth Center Accreditation bill passed both the NYS Senate and Assembly (S1414-A/A259-A). This bill has major potential implications on the midwifery birth center section of the proposed regulations. As such, approval was paused in June 2021. 
• PIH 2.2: Collaborated with other NYSDOH units to support the programmatic review to establish midwifery-led birthing centers, and support integration of these facilities into the regional perinatal system as a critical foundation for low-risk obstetrical and neonatal patients for childbirth.
  • Two physician-led birthing centers (PLBC) were approved in the 2019-20 program year under COVID-19 emergency authorization. These PLBCs applied for permanent authorization through the Department’s Certificate of Need (CON) process. One has received approval and is completing construction; the other applicant has had challenges with meeting architectural and life safety standards and continues to work with the Department.
  • During the 2020-21 program year, two applications for establishment of midwifery-led birth centers were received through the CON process. One applicant ultimately withdrew due to financial issues. The other applicant’s parent midwifery practice is the subject of an ongoing NYS State Education Department professional conduct investigation; as such, the CON application is paused until the outcomes are provided and reviewed.
• PIH 2.3: Collaborate with stakeholders to educate OB/GYN and family practice providers about changes to hospitals’ levels of perinatal care in their communities.
  • This activity is on hold pending regulations noted above.
• PIH 2.4: Led quality improvement projects through the NYSPQC, with birthing hospital and center teams and community-based organizations, to improve obstetric and neonatal outcomes in specific areas including:
  • Reducing maternal morbidity and mortality by improving the assessment, identification and management of obstetric hemorrhage (project completed in June 2021).
    • Between March 2018, and March 2021, hospital teams reported an improvement in the percent of maternity patients with a documented hemorrhage risk assessment, including:
      • A 26% improvement on admission to labor and delivery (75.5% to 94.7%)
      • A 106% improvement during the post-partum period (41.3% to 84.4%).
    • Adoption of quantitative measurement of blood loss (QBL) increased from 41% of participants in Q1 2019 to 90% in Q1 2021.
    • By the end of the project, participants reported:
      • 99% had a unit policy and procedure(s) on OB hemorrhage (updated in the last 2-3 years) in place
      • 100% had OB hemorrhage supplies readily available, typically in a cart or mobile box
      • 100% had STAT (immediate) access to hemorrhage medications.
  • Identifying and managing the care of pregnant and postpartum people with opiate use disorder (OUD) during pregnancy.
  • Improving the identification, standardization of therapy and coordination of aftercare of infants with neonatal abstinence syndrome (NAS).
  • Improving infant outcomes, with a focus on equity in the NICU (project under development).
  • Improving outcomes for all NYS birthing people by focusing on racial justice and birth equity.
• PIH 2.5: To improve coordination and increase bilateral referrals between birthing hospitals and home visiting programs, Title V staff will assist in connecting MICHC and MIECHV-funded home visiting 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.
  • Due to priorities related to COVID-19 and limited staff resources, this project was largely on hold during the reporting period. A new staff person (Public Health Program Nurse) was hired July 2021 and was assigned a leadership role for this project.  We anticipate major progress on this activity in the 2021-22 program year.

Strategy PIH-3: Maintain and strengthen a robust statewide population-based Newborn Screening Program.

New York’s Newborn Screening Program (NBS) is a population-based program and public health system that identifies infants who may have one of several rare, but treatable diseases through bloodspot screening shortly after birth. Within NYSDOH, the NBS Program is housed and administered by the Wadsworth Center, NYS’s public health laboratory, with direct support from Title V and several other state and federal funding sources. The program currently performs laboratory testing for 50 diseases, following national recommendations for NBS programs. The program ensures that every newborn in the state receives newborn bloodspot screening as a public health service, with no fee for testing. The program also performs follow-up case management to ensure newborns with a positive screening result receive appropriate diagnostic testing and treatment. Specialty Care Centers are certified and monitored to ensure newborns have access to specialty care for disease-specific testing and management. In addition, the NBS program receives separate funding from HRSA to support each of the state’s 10 Inherited Metabolic Disease (IMD) Specialty Care Centers to enroll patients with an IMD diagnosis identified by newborn screening for long-term follow-up in the NYS Newborn Screening Patient Registry. These IMD Specialty Care Centers are responsible for entering and tracking for consented patients annually, and for attending an annual meeting to discuss long-term follow-up data. Patients are monitored until age 18, when the individual must consent to continue participation until age 21. In 2020, the program screened 211,203 infants, 99.97% of all NYS resident infants born that year (See Form 4 for further details).

The NBS Program practices continuous quality improvement using LEAN principles, with a focus on improving overall efficiencies, reducing false positives, and improving timeliness in newborn screening for time-critical conditions. The program also strives to promote the growth of the field of NBS by promoting the development of its staff, participating in national committees, conducting pilot studies, and training other state newborn screening programs. The NBS program collaborates with other public health programs to support mutual goals. The NBS has identified a need for continued education for primary care providers and newborn coordinators on newborn screening and genetics.

PIH 3.1: The Title V Program collaborated with the Newborn Blood Spot Program on the following activities to advance this strategy during the 2020-21 program year:

• Provided comprehensive newborn bloodspot screening for every newborn born in NYS.
• Performed a quality improvement project to ensure hospitals are meeting benchmarks.
  • During the program year, nine (of 121) virtual hospital site visits were conducted, representing approximately 14% of total specimens submitted to the Newborn Screening Program. Site visits are intended to engage birthing hospital staff to improve compliance with five key performance measures:
    • Collection time (within 36 hours of life)
    • Turn-around time (received by lab within 48 hours of collection)
    • Overall specimen quality
    • Non-NICU specimen quality
    • Completeness of data (including demographic variables).
  • Baseline data are presented during the site visit for discussion. Although all five performance measures are addressed on site visits, focus is placed on turn-around time, as most NYS birthing hospitals struggle to improve this metric.
  • The NBS is developing a post-site visit monitoring plan with each hospital, to provide an updated hospital performance summary within 6-8 months post-site visit to evaluate improvement. For example, one hospital engaged with a private courier service to supplement UPS shipping, resulting in a 12.6% improvement in turn-around time and meeting a goal of 80% of specimens received within 48 hours of collection.
• Expanded the number of hospital site visits (conducted virtually) made by NYSDOH staff.
  • Due to the ongoing COVID-19 pandemic and priorities within NYSDOH and birthing hospitals, focus on expanding the number of hospital site visits was not feasible. Rather, the NBS implemented a post-site visit monitoring plan to further enhance the impact of virtual site visits, as described above.

Strategy PIH-4: Apply public health surveillance and data analysis findings to improve services and systems related to perinatal and infant health care.

Data-driven, evidence-based practice is essential to achieving public health goals for MCH. 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 MCH 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.

The Title V Program led the following specific program and policy activities to advance this strategy over the course of the 2020-21 year:

• PIH 4.1: Led quality improvement projects through the NYSPQC, with birthing hospital and center teams and community-based organizations, with a focus on reducing maternal morbidity and mortality by improving the assessment, identification, and management of obstetric hemorrhage; identifying and managing the care of pregnant and postpartum people with OUD during pregnancy, and improving the identification, standardization of therapy and coordination of aftercare of infants with NAS; and improving outcomes for all NYS birthing people by focusing on racial justice and birth equity.
  • The NYSPQC’s OUD-NAS project, which began as a pilot in 2018, was expanded to a statewide project in October 2020, bringing the total number of participating birthing hospitals to 45.
  • See Strategy WMH-3 for more detail on these projects.
• PIH 4.2: Summarize, share, and discuss findings of the Maternal Mortality Review Board (MMRB) with key stakeholders, including the Maternal Mortality and Morbidity Advisory Council (MMMAC) and ACOG-NY, to inform statewide prevention strategies to improve maternal outcomes. This includes the development of issue briefs, webinars, and quality improvement projects through the NYSPQC, and a maternal mortality report.
  • See Strategy WMH-3 for more detail on the MMRB and MMMAC.
• PIH 4.3: Establish a comprehensive perinatal data warehouse of perinatal outcomes to make data available in a timely way to birthing hospitals and support quality improvement activities. 
  • This project was placed on hold during the reporting period due to competing staff priorities and changes in staffing with collaborative partners.  Title V staff continue to engage with partners on this initiative and look forward to progressing in the 2021-22 reporting period.

Strategy PIH-5:  Address social determinants identified by community members that impact infant health and use of perinatal and infant health care and support services.

As noted in other domains, perinatal and infant 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 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.

Efforts to improve infant health outcomes must focus directly on addressing longstanding and persistent racial and ethnic disparities in infant health. This persistence of disparities in most of our major health indicators clearly shows that while evidence-based interventions can affect positive change, they alone are not enough to address the larger issues contributing to health inequities. NYS’s Title V Program thus seeks to combine the strength of data-driven, evidence-based programs and interventions with authentic community engagement opportunities across all Title V programs that address perinatal and infant health, including discussions and actions related to racial justice, as well as strengthening community-based and clinical/provider relationships, to increase equity in access to health care and social support services. Title V programs seek to engage and empower individuals, families, and communities by increasing awareness of available community resources and supports; working with community stakeholders to improve delivery of care and services; and enhancing social support, health literacy, and self-care and advocacy skills for pregnant and parenting families.

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

• PIH 5.1: Through the MICHC programs, Title V staff 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.
  • See Strategy WMH-4 for further details.
• PIH 5.2: Through the MICHC and MIECHV-funded programs, Title V staff provided supports to individual clients and their families to address behavioral social determinants of health outcomes. Programs provided information on community resources, screen and assist families in enrolling in health insurance and health care, worked directly with families to strengthen health literacy, self-care, and advocacy skills, and provided and enrolled families in enhanced social supports and educational opportunities.
  • See Strategy WMH-4 for further details.
• PIH 5.3: Through the NYSPQC, continue to lead a quality improvement project with birthing hospital teams and community-based organizations, to improve outcomes for all NYS birthing people and infants by focusing on racial justice and birth equity.
  • See Strategy WMH-3 for further details.
• PIH 5.4: Through the Infant Safe Sleep Initiative, the Department made safe sleep educational materials (brochures, posters, anatomical diagrams, mirror clings, etc.) that are translated into multiple languages available to hospitals and home visiting programs for distribution to infant caregivers. Additionally, 43 NYS-funded home visiting programs and Level 1 and 2 perinatal intensive care hospitals were provided books for distribution to infant caregivers that convey safe sleep messages in a story format. In 2021-2022, the DFH will continue implementation of this initiative by distributing pack-n-plays, sleep sacks, and onesies to NYS-funded home visiting programs so that infant caregivers have the resources that enable them to practice safe sleep.

The NYS Title V Program established two Evidence-Based Strategy Measure (ESM) to track the programmatic investments and inputs designed to impact NPM-3 and SPM-1:

ESM PIH-1: Percent of birthing hospitals with final level of perinatal care designation, in accordance with updated regulations and standards.

Data for this measure will come from hospital surveys and site visit reports from IPRO/NYSDOH staff. Due to delays described above, establishing a baseline for this measure is not yet complete. The baseline value for this measure will be determined after regulations are adopted. The program has set a goal to update designations for 50% of hospitals within the first year, and 100% within 5 years. 

ESM PIH-2: Increase the percentage of the birthing hospitals that received site visits from NYSDOH staff to evaluate the process of collecting and transmitting Newborn Blood Spot samples to ensure samples are received by the NYSDOH Wadsworth Laboratory within 48 hours of collection.

Data for this measure will come from the NYSDOH Newborn Screening Program. The baseline value for this measure will be determined in 2021. The program has set a goal to visit an additional 40 birthing hospitals by September 2023. This initiative is funded through non-Title V HRSA funding and a grant from the Association of Public Health Laboratories.