3.A. Executive Summary
The mission of the NJ Department of Health (NJDOH), Division of Family Health Services (FHS) is to improve the health, safety, and well-being of families and communities in New Jersey (NJ). FHS works to promote and protect the health of mothers, children, adolescents, and at-risk populations, and to reduce disparities in health outcomes by ensuring access to quality comprehensive care. The Maternal and Child Health Block Grant Application and Annual Report that FHS submits each year to the Maternal Child Health Bureau (MCHB) provides an overview of initiatives, State-supported programs, and other State-based responses designed to address the maternal and child health (MCH) needs in NJ as identified through our continuous needs assessment process and in concert with the NJDOH’s strategic plan, the State’s Health Improvement Plan, Healthy NJ 2030, and the collaborative process with other MCH partners.
NJ is the most urbanized and densely populated state in the nation with 9.0 million residents; it is also one of the most racially and ethnically diverse states in the country. The racial and ethnic mix for NJ mothers, infants, and children is more diverse than the overall population composition. This growing diversity not only raises the importance of addressing disparities in health outcomes, but also of the need to ensure a culturally competent workforce and service delivery system. One of the three priority goals of the FHS Title V program is to increase the delivery of culturally competent services through a well-trained workforce. The other two goals are to improve access to health services through partnerships and collaboration and to reduce disparities in health outcomes.
The goals and State Priority Needs (SPNs) selected by FHS are consistent with the findings of the Five-Year Needs Assessment, built upon the work of prior MCH Block Grant Applications/Annual Reports and in alignment with NJDOH's and FHS' goals and objectives. The State Priority Needs (SPNs) are:
SPN 1-Increasing Equity in Healthy Births,
SPN 2-Reducing Black Maternal and Infant Mortality,
SPN 3-Improving Nutrition & Physical Activity,
SPN 4-Promoting Youth Development Programs,
SPN 5-Improving Access to Quality Care for CYSHCN,
SPN 6-Reducing Teen Pregnancy,
SPN 7-Improving & Integrating Information Systems, and
SPN 8-Smoking Prevention.
Title V services within FHS will continue to support enabling services, population-based preventive services, and infrastructure building to meet the health of all NJ's families.
NJ has selected the following nine of 15 possible National Performance Measures (NPMs) for programmatic emphasis over the next five-year reporting period:
NPM 1-Well Woman Care,
NPM 4-Breastfeeding,
NPM 5-Safe Sleep,
NPM 6-Developmental Screening,
NPM 9-Bullying,
NPM 11-Medical Home,
NPM 12-Transitioning to Adulthood,
NPM 13-Oral Health, and
NPM 14-Household Smoking.
Although the overall infant mortality rate in New Jersey is lower than the national rate, the disparity between white, non-Hispanic (NH), and black, NH, is significant and persistent. NJ’s NH Black women experience related mortality at nearly five times their White counterparts and greater severe maternal morbidity (SMM) burdens than all other groups. Regional focus groups with consumers and stakeholders identified some of the social determinants of health (SDOH), including lack of social support and timely access to care, that contribute to the persisting disparities. As a result, the Healthy Women, Healthy Families (HWHF) Initiative was implemented in July 2018 to improve maternal and infant health outcomes for women of childbearing age and their families, while reducing racial, ethnic and economic disparities in those outcomes through a collaborative coordinated community driven approach through the use of Community Health Workers and Central Intake Hubs.
New Jersey is taking a targeted approach to reducing black infant mortality (BIM) rates. Specific BIM reduction activities including breastfeeding support, fatherhood support, Centering and Doula programs, have been implemented in 8 municipalities found to have the highest rates of BIM (Atlantic City, Camden, East Orange, Irvington, Jersey City, Newark, Paterson, and Trenton). Statewide collaboration with traditional and non-traditional partners to address the SDOH is instrumental in moving the needle on Black Infant Mortality reduction. As a result, partners from the Departments of Labor and Workforce Development, Education, Transportation, Children and Families, Human Services, the Office of the Attorney General and the community, regularly collaborate to reduce BIM. FHS is working very closely with the Office of Population Health with the purpose of: (a) ensuring health in all policies, (b) leveraging resources and inter- and intra-departmental collaborations, and, (c) addressing health disparities using a multi-sectorial approach.
The State Health Improvement Plan (SHIP) identified Birth Outcomes as a priority health issue to be addressed by the NJ DOH, sister agencies, community-based stakeholders, and local public health agencies. The SHIP with its focus on health equity has identified several policy related strategies to improve birth outcomes. FHS and the Office of Population Health have successfully applied for several federal grants focused on maternal mortality and morbidity including the Maternal Mortality Review Committee Grant from the CDC and the State Maternal Health Innovation Program Grant from HRSA to fund the strategies of the SHIP.
The NJ Maternal Mortality Review Committee grant from the CDC ($450,000 per year for 5 years) will fund the NJ DOH to coordinate and manage the NJ Maternal Mortality Review Committee (NJ MMRC) to identify and characterize maternal deaths for identifying prevention opportunities. The strengthening of the NJ MMRC and the implementation of the strategies and activities outlined in the NJ MMRC grant will produce the short-term, intermediate, and long-term outcomes necessary to reduce preventable maternal deaths. NJ legislation (P.L.2019, c.75) provides the legal authority to convene and strengthen the MMRC.
HRSA funding for the State Maternal Health Innovation Program (SMHIP) Grant will support the NJDOH initiatives to enable New Jersey becomes the safest place in the United States to give birth. The SMHIP will leverage progress to-date, anchor multi-sector collaboration, establish sustainable mechanisms that will extend beyond the five-year period of performance and improve data infrastructure to complement activities in New Jersey’s Title V program.
Nurture NJ is the First Lady of NJ’s statewide awareness campaign that is committed to reducing infant and maternal mortality and morbidity and ensuring equitable maternal and infant care among women and children of all races and ethnicities. The campaign includes a multi-pronged, multi-agency approach to improve maternal and infant health among New Jersey women and children. Initiatives include an annual Black Maternal and Infant Health Leadership Summit; the First Lady’s Family Festival event series; quarterly interdepartmental maternal and infant health meetings; and a comprehensive, statewide strategic plan to reduce maternal mortality by 50% over five years and eliminate racial disparities in birth outcomes.
Another program augmenting efforts to reduce infant mortality, pre-term births, and maternal morbidity is the Maternal and Infant Early Child Home Visiting (MIECHV) Program which has expanded Home Visiting (HV) across all 21 NJ counties. The goal of the NJ MIECHV Program is to expand NJ’s existing system of home visiting services which provides evidence-based family support services to: improve family functioning; prevent child abuse and neglect; and promote child health, safety, development and school readiness.
Other initiatives contributing towards positive outcomes in addressing the State’s priority areas of reducing teen pregnancy, promoting youth development, and improving physical activity and nutrition are the Whole School, Whole Community, Whole Child (WSCC) School Health NJ Project, the NJ Personal Responsibility Education Program (PREP), and the NJ Sexual Risk Avoidance Education (SRAE) Program.
New Jersey's Title V Children and Youth with Special Health Care Needs (CYSHCN) program includes Newborn Screening Follow-up and Genetic Services (NSGS), the Birth Defects and Autism Registry (BDAR), the Early Hearing and Detection Program (EHDI), Family Centered Care Services (FCCS) and Early Intervention Services (EIS). Both NSGS and EIS are primarily funded by other sources but are co-located and coordinate with our HRSA-funded programs.
The NSGS Program ensures that all newborns and families affected by an abnormal screening result receives timely and appropriate follow-up services. NJ remains among the leading states in offering the most screenings, and by the end of 2020 will screen 60 disorders for newborns. In addition to disorders detected through heel stick, NJ’s newborns are also screened with pulse oximetry through the Critical Congenital Heart Defects (CCHD) screening program. This screening was instituted to ensure that babies who appeared healthy are identified before they are discharged. As of April 2020, NJDOH has received reports of 28 infants with previously unsuspected CCHDs detected through the screening program. In addition, the early hearing detection and intervention (EHDI) program continues to screen all newborns for hearing loss.
The BDAR ensures that all children 0 through five-year-old who have a congenital birth defect and all children 0 through 21 years old who have an Autism Spectrum Disorder (ASD) are registered. The BDAR provides valuable public surveillance data for needs assessment, service planning, and research. Most importantly, the BDAR links families to important resources through our Special Child Health Services Case Management Units (SCHS CMUs).
The Early Hearing Detection and Intervention Program (EHDI) monitors compliance with the NJ Universal Newborn Hearing Screening law, and measures NJ’s progress in achieving the national EHDI goals of ensuring that all infants receive a hearing screening by one month of age, that children who do not pass screening receive diagnostic testing by three months of age, and that children who are diagnosed with hearing loss receive family-centered, culturally competent Early Intervention Services by six months of age. Hospitals have been very successful in ensuring that newborns receive hearing screening prior to hospital discharge, ensuring that children who did not pass their initial screening receive timely and appropriate follow-up remains an area for continued efforts.
The FCCS program promotes access to care through early identification, referral to community-based culturally competent services and follow-up for CYSHCNs up to 21 years of age. These services and supports are provided through SCHS CMUs, Specialized Pediatric Services Providers (SPSP) which includes Child Evaluation Centers (CECs), Cleft Lip/Palate Craniofacial, and Tertiary Care Centers. Ryan White Part D is also housed within FCCS and provides direct care to women, infants, children, and youth who are infected or affected with HIV/AIDS. FCCS services support NJ’s efforts to address the six MCH Core Outcomes for CYSHCN. This safety net is supported by State and Title V funds administered via community health service grants, local support by the County Boards, reimbursement for direct service provision, and technical assistance to grantees. Through our Title V program partners, FHS continues to address families’ medical, and social conditions by providing, in addition to quality health care, referrals to support accessible services within state departments, and divisions as well as county and municipal agencies. Such referrals could include but not be limited to public health insurance options; legal services; food stamps; the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); employment; public assistance; and the Catastrophic Illness in Children’s Relief Fund. These service referrals have been shown to drastically improve health outcomes and decrease the need for additional medical interventions, improve quality of life, and reduce costs.
New Jersey Early Intervention Services (NJEIS) provides over 1.5 million services to over 30,000 children per year. In addition to state funds, Medicaid reimbursement, and family cost share funds, NJEIS receives federal funds as an IDEA Part C program. Located within our Special Child Health Services unit, they work collaboratively with the other programs. Our FCCS case managers refer children to NJEIS to ensure that eligible children receive important services in a timely manner, and as children age out of NJEIS and continue to need case management, these children move back to our county-based CMUs.
New Jersey’s Title V CYSHCN program diligently collaborates with intergovernmental and community-based partners to ensure that care through these multiple systems will be coordinated, family centered, community-based, and culturally competent. Communication across State agencies and timely training for State staffs, community-based organizations and families with CYSHCN remains a priority to ensure that families are adequately supported during the reorganization of these systems.
Additionally, family and youth input on multi-system access to care is obtained through the Community of Care Consortium, a coalition led by SPAN statewide Parent Advocacy Network (SPAN), a key partner to NJ’s Title V program and comprised of parents of CYSHCN and youth, State agency representatives, and community-based organizations.
The impact of COVID-19 on all areas of maternal and child health has been and continues to be significant. On March 9, 2020, Governor Murphy issued Executive Order 103, declaring the existence of a public health emergency. COVID-19 necessitated a rapid transition from in-person programs and services to those being administered remotely whenever possible. Title V staff as well as Title V grantees moved to operating remotely from home. Innovations in telehealth as well as Medicaid reimbursements were created. As the situation with COVID-19 continues to be rapidly evolving, Title V continues to collaborate with partners and families to deliver services and support.
New Jersey continues to support the work and mission of Title V and actively works on developing innovative ways to improve the health and well-being of New Jersey women, children, and families. As with addressing challenges to improve birth outcomes, reduce disparities, and operate within the public health COVID19 pandemic, NJDOH will work to further strengthen its partnerships with the MCH Bureau as well as families, providers, agencies, and other stakeholders.
To Top
Narrative Search