III.C.1.a Needs Assessment Process Updates

 

NY’s Title program combines structured needs assessment (NA) activities and ongoing communication with providers, families, and other partners to assess the needs of MCH populations and systems, as detailed below.

 

Statewide MCH Data Collection & Analysis

 

We review statewide data to assess status, trends, and disparities for key MCH indicators, and share results to inform program strategies and allocation of funds. 

 

• Title V staff review national survey data including PRAMS, BRFSS, NSCH, and YRBSS annually. [All]
• In collaboration with the NYSDOH Office of Public Health Practice, DFH maintains a MCH data dashboard, updated in April 2024 [All]
• DFH collaborated with the NYSDOH Division of Chronic Disease Prevention to add Family Planning and Sexual Violence measures to BRFSS. [WMH]
• Title V leads a comprehensive maternal mortality and morbidity review process with the NYS Maternal Mortality Review Board (MMRB). This period we released a statewide report on pregnancy-associated deaths for 2018-20. A report on Severe Maternal Morbidity (SMM) is pending release. [WMH]
• A new report Infant Mortality in New York State, 2016-2019 was published in June 2023. [PIH]
• Title V funded an over-sample of National Survey of Children’s Health (NSCH) for NYS for Black, Hispanic, and CYSHCN. [CH, AH, CYSHCN]
• The Lead Poisoning Prevention Program manages a data system of children’s blood lead levels and produces data reports on lead testing rates and lead poisoning.
• The New York State Profile of CYSHCN is updated annually and shared with partners. [CYSHCN].

 

Input from Local MCH Programs & Service Providers

 

Data collection and reporting are required for all Title V-funded programs. Local providers are required to engage with communities to assess community and client needs, which informs local and state work.

 

• All Title V-funded local programs submit quarterly reports on program activities, capacity, outcomes, and training and technical assistance (T&TA) needs.[All]
• Title V program staff convene quarterly calls with grantees to share information, review performance data, and discuss needs, challenges, and solutions. [All]
• DFH contracts with statewide and regional centers that provide additional information from local family planning, maternal/perinatal and infant health, adolescent health, and CYSHCN programs [WMH, PIH, AH, CYSHCN]
• The state’s Growing up Health Hotline (GUHH) maintains data on information and resource needs based on calls received [WMH, PIH, CH]

• A new web-based data system for the SBHC and School-based Dental programs was rolled out in Fall 2023, with expanded race, ethnicity, and gender identity fields and enhanced data reporting functionality. [CH, AH, CYSHCN]
• The ACT Center for Community Action (CCA) communicates with local adolescent health (AH) grantees about their T&TA needs. AH programs conduct entry and exit surveys to monitor attendance, reach, and dosage of their curricula through the CCA’s system. [AH, CYSHCN]

• A web-based data system for local health department (LHD) CYSHCN programs launched in 2021 is now fully operational. LHD staff can review their own data in real time. Title V staff produce an annual report and are developing a new CYSHCN data dashboard. [CYSHCN]
• CYSHCN staff review Medicaid data to monitor enrollment in Health Home for Children. [CYSHCN]
• In 2023 CYSHCN staff collaborated with the NYS Association of County Officials (NYSACHO) to convene a statewide meeting and follow-up regional calls with local CSYCHN and Early Intervention programs.[CYSHCN]

 

Quality Improvement & Evaluation Initiatives

 

Title V staff lead a range of special projects to learn about specific service and system needs, capacity, and effectiveness.

 

• A Fall 2023 survey evaluated referrals between birthing hospitals and home visiting programs. Development of a statewide home visiting referral tracking tool is paused due to staffing vacancies. [WMH, PIH]
• NYSPQC led learning collaboratives with birthing hospitals on opioid use disorder and equity in birthing hospital and NICU care.  These projects include discharge surveys to better understand birthing and NICU care experiences. [WMH, PIH]
• The Family Planning Program (FPP) surveyed local providers to assess partnerships with Syringe Exchange Programs (SEPS), which informed formation of regional partnerships. [WMH]
• A new QI project focused on language capacity in home visiting programs is underway. Title V staff also participated a national QI project on staff recruitment and retention. [WMH, PIH]

• The Newborn Screening Program continues a CQI initiative to improve lab collection and processing times, blood spot specimen quality, false positive screening results, timeliness in screening, and data completeness. Monthly reports to hospitals are used to prioritize targeted virtual TA site visits. Based on this work, the program has expanded its training to  hospital IT staff, established a centralized hospital information portal, and offered a series of webinar trainings. [PIH, CYSCHCN]
• The Early Hearing Detection and Intervention (EHDI) program amended state regulations to improve newborn hearing screening and follow-up through a new two-tier inpatient newborn hearing screening protocol and companion standard for NICUs. [PIH, CYSHCN]
• DFH contracts with the Island Peer Review Organization (IPRO) to monitor FPP, Regional Perinatal Centers, SBHCs, and School-based Dental programs. In Fall 2023 Title V staff worked with IPRO to update monitoring tools, sampling methods, and review visits in response to provider feedback. [All]
• The CYSHCN Director is serving on the advisory group for a new study led by Cornell University and Bassett Health Care to compare health outcomes among students in district with and without SBHCs. [CH, AH, CYSHCN]
• A project to assess models and best practices for SBHCs is underway with support from an SPH student intern and FAPH physician fellow. [CH, AH, CYSHCN]
• Title V staff hosted and mentored two MPH interns to assess health equity in LHD CSYCHN programs and Sickle Cell program capacity statewide. [CYSHCN]

 

Advisory Groups

 

Title V staff convene and participate in many formal bodies that facilitate input from state and local partners including families and youth. 

 

• DFH convenes the NYS Title V Advisory Council. With representation from LHDs, CBOs, parent groups, and advocates, the council meets three times each year on a range of MCH issues and initiatives [All]

• A new FPP Clinical Advisory Group will begin in 2024. [WMH, AH]
• DFH is working to establish a Midwifery Workgroup to better understand the needs, challenges, and opportunities for further engagement and partnership with midwives. [WMH]
• As part of our new HRSA Maternal Health Innovation grant, DFH is establishing a Maternal Health Task Force to develop a strategic plan for improving maternal and pregnancy outcomes. [WMH]
• Title V staff are working to establish a statewide Home Visiting Parent Advisory Committee. Work on a formal procurement was paused due to staffing vacancies. [WMH, PIH]
• Perinatal Health and FPP staff are participating in a Congenital Syphilis Elimination Strategic Plan Workgroup led by the NYSDOH AIDS Institute. [WMH, PIH]
• The EHDI program convenes a state Advisory Group that meets quarterly with state partners including family members to provide guidance and feedback on relevant initiatives, including support for families of Deaf or Hard of Hearing children. [PIH, CYSHCN]
• Title V staff serve on the state Early Childhood Advisory Council (ECAC). Comprised of experts in education, health care, child welfare, and mental health from state agencies, CBOs, higher education, and others, the ECAC advises the Governor on early childhood issues. [PIH, CH, CYSHCN|
• Title V staff participate in an inter-agency workgroup on Adverse Childhood Experiences. [CH, AH, CYSHCN]
• NYSDOH convenes and staffs the Governor’s NYS Advisory Council on Lead Poisoning Prevention to provide input on the prevention and elimination of childhood lead poisoning. [CH, CYSHCN]
• Title V staff serve on the Advisory Committee for the NYS Governor’s Youth Council, a youth-run council  comprised of youth from all 62 counties to facilitate ongoing communication with policymakers. [AH]
• In collaboration with Families Together in NYS-Youth Power, DFH is establishing a new Youth Advisory Group (YAG) to incorporate authentic youth voices and lived experiences into our program and policy work. Beginning in 2024, diverse youth from across the state will meet directly with Title V program staff to provide input and feedback on our youth-serving programs. [AH, CYSHCN]
• Title V staff participate in several interagency groups to support CYSHCN, including the NYS Council on Developmental Disabilities, the Deputy Commissioners’ Cross-Systems Work Group, a new Pediatric & Obstetric Emergency Protocol Workgroup, and a new Pediatric Policy and Programs Cross-Agency Group. [CYSHCN]

 

Input from Families, Youth, & Community Members

 

Direct input from priority populations, especially families and youth, is a major emphasis for NY’s Title V Program. Examples of how we integrate this across our programs include:

 

• In collaboration with the NYS Office of Health Insurance Programs, Title V staff are enhancing engagement with doula providers to inform expanded access to doula services, including new state Medicaid coverage for doula services effective April 2024. [WMH, PIH]
• With support from the ERASE Maternal Mortality grant, Title V staff are working with PICHC contractors and CBOs to host six listening sessions in Spring 2024 related to birthing experiences of communities disproportionately affected by maternal morbidity and mortality. [WMH, PIH].
• Under the same ERASE grant, in May 2024 DFH engaged IPRO to conduct key informant interviews with family members who have experienced a pregnancy-related death of a loved one, and to incorporate that information in the case summaries reviewed by the MMRB. [WMH]
• In conjunction with Hands & Voices NY, the EHDI program gathers input and feedback from parents through a survey administered in conjunction with family engagement and support events across the state. [PIH, CYSHCN]
• In addition to the Governor’s Youth Council and new Youth Advisory Group mentioned above, local AH grantees engage youth in their programming and as paid advocates. [AH]

• DFH contracts with three Regional Support Centers (RSCs), which are required to employ parents of CYSYCN as Family Liaisons.  The RSCs work with all LHDs to develop and implement tailored improvement plans to meet their community engagement goals. LHD CYSHCN programs are required to engage CYSHCN families in work groups and other local planning activities and their input informs local and statewide T&TA. [CYSHCN]
• A parent representative from Parent to Parent of NYS serves on the Title V Advisory Council. The OCFS-led Commissioner’s Cross-Systems Work Group has begun holding periodic meetings with families. [CH, AH, CYSHCN]

 

 

III.C.1.b  FINDINGS

 

III.C.1.b.i MCH Population Health and Wellbeing

 

Women's and Maternal Health. Maternal mortality improved steadily from 2018-2020, but provisional data for 2021 show a potential increase.  The recently published statewide report confirmed that most cases of maternal mortality deaths are preventable. Moreover, stark racial disparities persist, and rural residents report poorer access to women’s healthcare services.   

The percentage of women with annual preventive visits continues to decline post COVID.  However, the percentages of PICHC clients who have developed birth plans and of FPP clients with documented medical exams both increased, though the latter has not recovered from COVID losses. An increasing number of individuals seeking services indicate a primary language other than English.

 

Hemorrhage, embolism, and mental health conditions remain the leading causes of maternal mortality, and PICHC and MIECHV providers are requesting more training on suicide prevention, emergency response, and self-care. New York State has also experienced a significant increase in Severe Maternal Mortality (SMM) over the last 15 years that has disproportionately impacted racial and ethnic minorities.

 

Perinatal Health. Perinatal health outcomes have remained largely stable over the five-year cycle. The percentage of VLBW infants born in a level 3+ NICU has remained consistently high. The percentage of Newborn Bloodspot screenings received within 48 hours of collection has also started to recover from its COVID-19 pandemic related decrease. Infant mortality rates continue to improve overall, but racial disparities persist, with Black non-Hispanic children having nearly twice the rate of white non-Hispanic infants, driven by disparities in housing, employment, income, transportation, food security, stress, quality of medical care, social supports, insurance, and other factors.

 

Through the Growing Up Healthy Hotline (GUHH), individuals and families have requested information about ta multitude of services including Medicaid, the Food and Nutrition Program (FAN), and the Extended Syringe Exchange Program (ESAP).  

 

Child Health. Outcome measures for children’s health continue to recover from pandemic losses.  SBHC providers report increased concerns about health care provider shortages, and the percentage of children enrolled in SBHCs who received anticipatory guidance on physical activity and nutrition has continued its negative trend.

 

Lifetime prevalence of asthma among children has decreased over the last year, but asthma-related ED visit rates for children have increased. The percentage of children who are obese continues to increase following a trend of fewer parents reporting that their children get 60 minutes of physical activity daily. Despite fewer children getting a preventive dental visit, the prevalence of tooth decay or cavities among children improved.

 

Adolescent Health. Indicators of adolescent health continue to reflect pandemic-related losses. Annual adolescent preventive health visit rates and HPV vaccination rates decreased throughout and after the pandemic. However, the percentage of youth programs that provide training on adult preparatory topics remaining consistently high, and the percentage of youth-serving programs that engage youth in program planning and implementation continues to increase to pre-pandemic levels.   

 

Adolescent pregnancy rates continue to decrease, although providers have encountered emerging resistance to expanding sexual education topics in some school districts. Providers continue to report mental health as an area needing more resources to meet current demand. Despite this, suicide among adolescents continues to decrease. The percentage of adolescents who are obese has remained consistent. However, fewer adolescents are reported to be exercising 60 minutes or more daily.

  

CYSHCN. New York State families of CYSHCN continue to navigate recovery from the pandemic. The percentage of children identified as having special health care needs decreased over the last year, which we will monitor as a potential reflection of decreased screening. CYSHCN reported experiencing a higher rate of adverse childhood experiences. The percentage of NYS adolescents with special health care needs with a transition plan to adult care services has recovered from COVID and continues to increase. The percent of youth with sickle cell disease (SCD) served through our funded SCD program with transition plans has increased.

 

With the infusion of increased funding, LHDs are increasing their focus on CYSHCN and their families including through the promotion of accessible community spaces. Additionally, LHDs report that their ability to provide services continues to be limited by their inability to recruit and retain therapy providers.

 

III.C.1.b.ii  Title V Program Capacity

 

III.C.1.b.ii.a. Organizational Structure

There have been no major changes to the Title V Program/ Division of Family Health organizational structure this year.

 

III.C.1.b.ii.b Title V Agency Capacity

As we continue the long recovery process from the COVID-19 pandemic, several changes this period positively affect state Title V capacity to provide and assure services for MCH populations:

• DFH contracts with statewide and regional centers that augment the agency’s capacity to monitor, support, and learn from the work of local funded programs. [WMH, PIH, AH, CYSHCN].  Following mutual termination of a contract with the former PICHC T&TA provider, DFH requested approval to establish a new contract to ensure continuity of support, anticipated to start 7/1/24. During this transition period, DFH staff have engaged other subject matter experts to provide training on suicide prevention and promoted other resources and training opportunities. [WMH, PIH].
• As noted, a new monitoring contract with IPRO for selected programs began Fall 2023. [All]
• DFH was awarded a new HRSA State Maternal Health Innovation grant (2024-28, $2M annually), to conduct a maternal health-related needs assessment, establish a statewide maternal health taskforce, develop a preliminary strategic plan, conduct data system enhancements and innovations, and plan and implement innovative approaches to addressing maternal health issues. The innovation projects include a universal postpartum virtual home visiting model to provide birthing families with virtual visits and referrals for support services. [WMH, PIH]
• Through our collaboration with the Syringe Exchange Program, several FPPs are engaging in partnerships to support and provide referrals for individuals who use drugs. [WMH]
• Our recent assessment of FPP grantee reports, described in last year’s NA Update, identified key themes related to staff retention and engagement, client experience, and reaching underserved populations.  These inform QI/QA and T&TA for the program. [WMH, AH]
• New guidance for home visiting programs on best practices for referrals is in development, and information from the recent assessment of referral relationships with birthing hospitals has been shared with providers. Additional feedback from home visiting projects identified a common challenge in supporting families with a primary language other than English. We are exploring resources to help programs better support these families. [WMH, PIH]
• Resources on opioid use and neonatal abstinence syndrome have been developed through the NYSPQC learning collaboratives, including tools and resources for provider and patient education. Toolkits from the birth and NICU equity projects are in development. [WMH, PIH]
• Amendments to state regulations effective April 2024 have resulted in enhanced standards for newborn hearing screening and follow-up in the state. [PIH, CYSHCN].
• PICHC and MIECHV programs requested support for training staff on suicide prevention, emergency response, and self-care. From this, programs engaged with the NYS Office of Mental Health (OMH) to provide Links to Hope training planned for 2024. [WMH, PIH]
• 33 of our 37 FPPs participated in a project to enhance delivery of telehealth for sexual and reproductive health appointments, which we expect will increase telehealth visits and improve access to contraceptive and STI services, counseling, and preventive care. [WMH, AH]
• A procurement for new School-Based Dental Home grants was completed with new contracts starting July 2023, replacing the former school-based dental sealant program. The enacted state budget for 2024-25 includes additional funding for school-based dental services. [CH]
• The Pediatric Mental Health Care Access (PMHCA) grant from HRSA (2021-2026) is increasing youth access to mental health services by connecting SBHCs to children’s mental health professionals through a partnership with the NYS Office of Mental Health’s Project TEACH , which provides clinical consultation, telehealth mental health services, T&TA for SBHC. A key component is engaging youth and their families together in the provision of mental health telehealth services. [CH, AH, CYSHCN]
• New state legislation, adopted in 2023 with anticipated implementation in 2025, will establish a statewide Rental Registry program to require proactive lead inspections in rental units in multifamily dwellings built before 1980 in high risk areas of the state.  [CH, CYSHCN]

• Several AH programs have reported resistance from school districts on delivering sexual health education, as part of wave of rising conservative advocacy with school boards. We are supporting providers to engage in relationship-building and education with school districts. [AH]

• As an outgrowth of our participation in a NYSDOH ACES workgroup, we continue to integrate work on trauma-informed practice and ACES across programs, trainings, and resources for local providers. [CH, AH, CYSHCN]
• There have been a series of CYSHCN program expansions. In 2022, we doubled grant funding for CYSHCN LHD programs, with a new requirement for minimum LHD CYSHCN staffing levels. In 2023 through a competitive procurement we increased the number of DOH-funded Sickle Cell programs from three to five, along with an increase in annual funding per program. Effective October 2024, a new statewide Center of Excellence for CYSHCN will replace the current three regional centers. This year the program also will conduct a competitive procurement to award a new state appropriation of $3 million for local CYSHCN work, with projects to begin in 2025. [CYSHCN]
• New state legislation signed by the Governor in December 2023 requires the state Health Equity Council to consider and issue recommendations to NYSDOH on promoting screening, education, and supportive services on sickle cell disease. [CYSHCN]
• The Blueprint for Change provides a framework to guide current and future work in support of CYSHCN and their families. All CYSHCN staff read the full Blueprint and each staff led a staff discussion of one article, including assessing how current work aligns with the Blueprint recommendations.  We are developing a crosswalk between the Blueprint and current and planned CYSHCN domain action plan activities. [CYSHCN].

 

 

III.C.1.b.ii.c Workforce Capacity and Workforce Development

 

The MCH workforce at both state and local levels has been heavily impacted by the COVID-19 pandemic, retirements, inflation, stagnant wages, and shortages in specific professions (e.g., skilled nurses).  Our Title V program is engaged in many approaches and initiatives to strengthen the capacity of the existing MCH workforce while continuing to invest in training the MCH workforce of tomorrow. We accomplish this through recruitment strategies, staff training and professional development, partnering with fellowship programs, and our innovative academic-practice partnership with the University at Albany School of Public Health’s MCH Program. Please see section III.E.2.b.i. MCH Workforce Development for more detail on this critical work.

 

III.C.1.b.ii.d. State Systems Development Initiative (SSDI)

 

Please see Systems Development Initiative (SSDI) Update.

 

 

III.C.1.b.ii.e. Other data capacity

 

In addition to the SSDI-specific updates provided in Section III.E.2.b.iii.b., we have strengthened our data capacity in other areas. Examples include:

• The new MHI grant funding, in conjunction with our NYSPQC AIM grant, will support capacity to conduct new data analyses, including deep dives in SMM, data matches between PRAMS and other administrative datasets, and deeper analysis of low-risk cesarean births. [WMH, PIH]
• The addition of CDC Family Planning and NYS-defined Sexual Violence measures to the BRFSS will provide additional insight to statewide health status and trends related to sexual health. [WMH]
• The regulatory changes for newborn hearing screening have improved documentation in the state EHDI Information System, which will help refine activities to promote timely screening and follow-up. [PIH, CYSHCN]
• The over-sample of National Survey of Children’s Health for NYS will provide more robust information on a wide range of health & well-being indicators and potential disparities for NY’s children and families, including CYSHCN.  Title V data staff are traveling to CDC for additional training to facilitate analysis of the data. [CH, AH, CYSHCN]
• New web-based data systems for SBHC, SB Dental, and CYSHCN Programs will greatly increase capacity for data analysis and reporting to support statewide and local program activities. [CH, AH, CYSHCN].
• New state legislation requiring the establishment of a statewide Rental Registry program to require proactive lead inspections in rental units in multifamily dwellings built before 1980 in high risk areas of the state will enhance both data capacity and childhood lead poisoning prevention efforts.  [CH, CYSHCN]

 

 

III.C.1.b.iii Title V Program Partnerships, Collaboration, and Coordination

 

Partnership and collaboration are core to our Title V work across all five domains and at every organizational level. We have selected a few examples to highlight the wide range of partnerships and collaborations our Title V program engaged in this year:

 

• The new federal Maternal Health Innovation (MHI) grant has led to new partnerships, with more expected as the project matures. NY Title V staff are engaging with other funded MHI programs to learn best practices from other states and have identified potential partner resources related to health equity. [WMH]
• Title V staff continue several key collaborations with the NYSDOH Division of Chronic Disease Prevention to promote children’s health. Several additional SBHCs have joined the American Lung Association (ALA) asthma self-management program, DFH staff are expanding collaboration with the Bureau of Tobacco Control to promote vaping prevention initiatives and engage SBHCs in that area, and a previous effort to connect SBHCs with DOH-funded Creating Healthy Schools and Communities (CHSC) grantees in their districts has been revitalized. As one example of the latter collaboration, SBHC and CHSC grantees in Syracuse are working together with a local food pantry to expand access to healthy meals and food items for students and families. [CH, AH, CYSCHN]
• SBHC staff are partnering with the NYS Office of Mental Health (OMH) to update a crosswalk between OMH-approved Article 31 school-based mental health clinics and DOH-approved Article 28 SBHCs. DFH also partners with the OMH-funded Project TEACH to facilitate mental health consultation and referral support for SBHCs.  [CH, AH, CYSHCN]
• Title V Adolescent Health staff have joined a NYSDOH Alcohol Surveillance Workgroup and an interagency Runaway Intervention Workgroup convened by the Division of Criminal Justice Services. [AH]
• The Lead Poisoning Prevention’s partnership with the National Center for Healthy Housing provides access to a wide range of evaluation and technical assistance tools that are shared with local health departments.  The program has also recently expanded its partnership with the Refugee Health Program, sharing data to better monitor health outcomes among refugee populations. [CH, CYSHCN]
• Title V CYSHCN staff continue to deepen and expand their collaboration with the NYS Office of Children and Family Services to support the OCFS-led HEARS Family Line, which provides families with resources and referrals to a variety of services and resources including food, clothing, housing, medical and behavioral health care services, parenting education, and child care, with messages available in 12 languages.  As an outcome of the Deputy Commissioners Cross-Systems meetings in which CYSHCN staff participate, OCFS has expanded HEARS this year, and shares summary data on call volume and themes with us. [CYSHCN].

 

 

III.C.1.b.iv. Family and Community Partnerships

 

The preceding sections highlight many examples of how our Title V program partners with families and communities to support MCH. Please refer to the sub-section Input from Families, Youth and Community Members within Section III.C.1.a Needs Assessment Process Updates.

 

We would like to highlight one example of a recent family and community partnership from the CYSHYN program. As noted, every local CYSHCN program develops and implements a family engagement plan with support from the Regional Support Centers. This year the Erie County CYSHCN program planned and hosted a “Spring into CYSHCN” Family Resource Fair at the Explore & More Children’s Museum in Buffalo, NY. The museum space is customized with visual, social, communicative, sensory, and behavioral supports for families with different needs, including a universal changing table, elevators, wheelchair ramps, and sensory friendly rooms.

 

For this event, the Erie County CYSHCN program provided free admission to the museum, transportation assistance, and a nutritious meal for families. The Erie County Project Coordinator, Evanna Ramos, assembled a resource fair of community organizations based on needs identified through conversations with local families. Twenty-five community and government organizations engaged with attendees and enrolled and connected families with local services and programs. Featured vendors included Erie County Social Services, Parent Network of Western New York (WNY), Help Me Grow WNY, Mental Health Advocates of WNY, Lead716, and the Neurodiversity Network of WNY.

 

III.C.1.c. Identifying Priority Needs and Linking to Performance Measures

 

We are incorporating measures related to postpartum care and medical home consistent with the new universal National Performance Measures. look ahead to our next five-year Needs Assessment we will focus our attention to these measures and appropriate strategies and activities.