A. Program Overview

The Title V Maternal and Child Health Services Block Grant is the Nation’s oldest Federal-State partnership to ensure the health of mothers, children, and youth, including Children and Youth with Special Health Care Needs and their families. Administered by the federal Health Resources and Services Administration (HRSA) Maternal and Child Health Bureau, Title V Maternal and Child Health Services Block Grant provides core funding to states for Maternal and Child Health public health activities. Each year, states submit a Title V annual report (for the previous year) and application (for the upcoming year) in accordance with Maternal and Child Health Bureau guidance.

New York’s Title V priorities and 5-year State Action Plan for 2021-2025 were developed based on a comprehensive Needs Assessment designed to assess the state’s Maternal and Child Health needs, strengths, capacity, and partnerships. The full Needs Assessment summary was submitted with our FY21 application. This Needs Assessment synthesized data and information from a wide range of sources including community listening forums, population health surveys and data systems, surveys of providers and the public, stakeholder meetings, and an inventory of Maternal and Child Health programs.  The Needs Assessment identified ten cross-cutting themes voiced by families and community members. These themes related to social determinants of health including poverty, transportation, housing, biases in health care, environmental and neighborhood safety, family support, social cohesion, and more. Subsequent FY22 and FY23 Needs Assessment updates reinforced the initial ten priorities and highlighted the impact of the COVID-19 pandemic on NY’s maternal and child populations and service systems.

This year’s Needs Assessment update reflects the continued impact of the pandemic alongside other persistent and emerging themes for Maternal and Child populations. It also demonstrates our continued leadership and commitment to protect and promote the health of people of reproductive age, pregnant and birthing people, parents, infants, children, youth, and families, within the context of a changing health care landscape, the continued adoption of a life course perspective, a focus on data-driven, evidence-based public health interventions, and a dedication to centering the voices of people and communities we serve as an essential step toward health equity and justice. Building on last year’s application, this year’s application reflects the many ways in which the NYS Title V Program has continued to lead and meet its Maternal and Child Health commitments for the state.

Our action plan for the FY24 represents our ongoing commitment to address the objectives, strategies, and performance measures for our 2021-25 State Action Plan priorities across five Maternal and Child Health population health domains: women’s and maternal health (WMH), perinatal and infant health (PIH), child health (CH), adolescent health (AH), and children and youth with special health care needs. NY’s application continues to reflect significant input from families, providers, and other key stakeholders across the state, and remains centered on the issues that have been voiced by communities that impact family and community health and well-being. It emphasizes understanding and addressing cross-cutting social determinants of health to reduce health disparities and promote health equity. It also reflects dedication to building a more comprehensive and inclusive system of supports for Children and Youth with Special Health Care Needs and their families.

Within NYSDOH, Title V Maternal and Child Health Services Block Grant activities are led by the Division of Family Health. As the Title V program home, Division of Family Health provides NYSDOH-wide leadership on Maternal and Child Health topics, directly oversees many Maternal and Child Health programs and initiatives, and collaborates with other key Maternal and Child Health programs outside the Division of Family Health. In addition to directly funding programs, NY’s Title V program plays a critical role in representing and ensuring that the Maternal and Child Health needs are addressed through key policy initiatives both within and beyond the Division of Family Health, as reflected throughout this application.

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Under Title V Maternal and Child Health Services Block Grant leadership, NY continued to build on its previous work to supplement and further refine its 2021-25 Needs Assessment (NA) and State Action Plan. As detailed in our Needs Assessment Update for this year, this includes continued engagement of stakeholders to provide input and feedback on Maternal and Child Health outcomes in the state, ongoing data collection and analysis, and facilitating opportunities for community member input.

Recognizing the collaborative and cross-programmatic nature of our work, Division of Family Health has continued to utilize an innovative structure and process to achieve our Title V objectives throughout the year. In this approach, Title V staff from across Division of Family Health are assigned to work on cross-disciplinary teams centered around each of the five Maternal and Child Health domains. Leaders for each team were identified based on their primary area of focus in their daily work, and then tasked with ensuring that work and activities for their respective domain, as outlined in the most recent Title V application, were completed. Despite the many unique and transformative challenges for the NYS Title V program over the past three years as we moved through the COVID-19 pandemic, domain teams have continued this approach through virtual meetings and expanded use of an online platform (Microsoft Teams). Teams share information, work on shared documents, and regularly meet virtually. This platform and structure have helped to foster increased collaboration between team members, including team members who work outside of Division of Family Health and outside of the Capital District region, and continues to be essential as staff have transitioned to hybrid remote and in-office work arrangements.

Below are the NY National Performance Measures (NPM) and State Performance Measures (SPM) with the cross-cutting, community and data-informed Title V Maternal and Child Health Services Block Grant priorities.

Title V State Maternal and Child Health Priorities and National and State Performance Measures (NPM/SPM), 2021-2025

The FFY 21 Maternal and Child Health Needs Assessment Summary and the five-year State Action Plan were developed based on community input and analysis of Maternal and Child Health performance measures and investments. Below is a summary by domain of the key findings and priorities identified in our full five-year Needs Assessment Summary.

Domain 1 – Women’s and Maternal Health (WMH)

The preventive medical visit measure was selected for this domain because preventive medical visits for individuals of reproductive age are foundational to health throughout the life course; population health data demonstrate a need for its continued improvement; and it relates directly to priorities voiced by women and families through community listening forums - including awareness of community resources, transportation, social support, and health care access and quality. In addition to preventive medical visits, strategies address a continuum of primary and preventive care and support that includes preconception, reproductive and sexual health, family planning, prenatal and postpartum care, and a full spectrum of medical care, mental/behavioral health, oral health, and other supports and services. NY’s State Action Plan reflects continued efforts to address access to comprehensive, high quality, and equitable health care services to people of reproductive age and a continued commitment to reduce maternal mortality and morbidity.

“We used to have a village and today it’s gone.”

“Doctors don’t respect us because they don’t value us.”

Domain 2 – Perinatal and Infant Health (PIH)

Measuring appropriateness of perinatal care was selected for this domain because of its relevance to quality and systems of care for high-risk and vulnerable infants. While site of delivery for very low birth weight infants is one critical indicator of care, NY’s Title V Maternal and Child Health Services Block Grant program views this indicator as part of a continuum of supports, services, and systems of care for infants, mothers, families, and service providers. This broader approach aligns with several priorities voiced by families in NY’s Needs Assessment, including awareness of community resources and services, enhancing supports for families, improving people’s health care experiences, ensuring access to transportation, and fostering community engagement and empowerment. Strategies include promoting early prenatal care and increasing awareness of community resources, supports, and services through Title V Maternal and Child Health Services Block Grant funded programs.

"I encourage people to enroll into whatever program is offered because through that you can be connected to other services that might be available in the community."

Domain 3 – Child Health (CH) 

The physical activity measure was selected for this domain, because it is responsive to concerns voiced directly by families in NY and reinforced by state-specific population health data. NY families identified the availability and accessibility of amenities that support children’s safe, active play and access to healthy foods as top priority needs, alongside priorities for community and environmental safety for children and community transportation. Supporting healthy, active play and recreation for children and youth of all ages is critical to promoting healthy weight as well as general physical and mental health during childhood and throughout the life course. Strategies under the Child Health domain focus on promoting environments that support physical activity among children of all ages and abilities and support overall well-being.

"I had concerns with my daughter gaining weight and the doctor said it was fine. Then when her 4-year check-up came she said it was a concern. She didn't listen to me."

 "I want a community where they can grow up and know that they're safe and can go anywhere they want to go and trust the adults in their community. Right now, I am scared for my kids…"

Domain 4 – Adolescent Health (AH) 

Measuring adolescent well visits was selected for this domain because it aligns with both population health data indicators and concerns voiced directly by adolescents in NY. Preventive medical visits are one part of overall wellness, based on community input and population data, need to include social-emotional wellbeing and preparation for taking on the responsibilities of adulthood. Adolescence is often a very challenging stage in a person’s life, during which there is immense physical, cognitive, social-emotional, and sexual development. Supporting adolescents’ health and development and helping them prepare for their futures can have a lasting impact throughout the life course. Adolescent Health strategies focus on promoting routine care related to reproductive, oral, and behavioral health, and resources needed to successfully transition to adulthood.

“Everybody needs to talk even for one second or ten minutes. Even boys.”

"I feel like we should have more African American counselors. Because the counselors that are there, I feel like the students don't feel comfortable talking to them."

Domain 4 – Children and Youth with Special Health Care Needs (CYSHCN) 

Measuring transitions to adult health care was selected because it was voiced as a key priority by youth with special health care needs and their families, reinforced by state-specific population health data. Families reported that only 15% of Children and Youth with Special Health Care Needs receive care in a well-functioning system, and less than 18% of youth age 12-17 with special health care needs received services necessary to make transitions to adult health care. This is consistent with experiences described by YSCHN and their families throughout the state. Children and Youth with Special Health Care Needs strategies include engaging youth with special health care needs and their families in our efforts to improve systems and practices supporting this population, including care coordination and transition support.

“[There should be] easier access to those resources so I do not have to be on a computer for 6 hours doing research.”