For the interim needs assessment update, NJ TVP compiled and synthesized statistics seeking to inform the current maternal and child health interventions that MCHBG is funding. The Team has compiled data from multiple sources, including but not limited to the American Community Survey, New Jersey Pregnancy Risk Assessment Monitoring System (PRAMS), World Health Organization (WHO), Centers for Disease Control (CDC), and more.

Other, local, needs assessments have been conducted in NJ to get a contemporary conceptualization of the characteristics and dynamics of communities served.  In 2022, the University Hospital (UH) in Newark examined both primary and secondary data to better understand the complex health issues facing patients from their core service areas (CSAs). Four, core focus areas guided the research, and included information on key characteristics of people who access services at UH, their health status, the interplay between community characteristics and health status, and the best ways that data can drive decision making in the UH system of care. The findings revealed correlations between social determinants of health (SDOH) and chronic diseases and recommendations for prevention and intervention efforts aimed at the most impoverished patients from the CSA.  In the same year, the Trenton Health Team conducted a needs assessment in Trenton to determine community health priorities. Using quantitative and qualitative data methodologies, the respondents reported that mental health issues, maternal and child health issues, equitable access to preventative clinical treatment and COVID-19 management.  These data also proved helpful in informing programmatic focus areas for the upcoming strategic planning cycle.

Maternal & Women's Health, Reproductive Health, & Perinatal/Infant Health

Maternal Mortality

According to the CDC’s Pregnancy Monitoring and Surveillance System (PMSS), the 2019 pregnancy-related mortality ratio (PRMR) in the US was 17.6 deaths per 100,000 live births in the US. When stratified by race/ethnicity, evident disparities persist. Native Hawaiian/Pacific Islander NH and Black NH women had PRMRs of 62.8 and 39.9 deaths per 100,000 live births, respectively, from 2017-2019. The Black NH PRMR was more than three times the rate for White NH women (12.8 deaths per 100,000 live births, Figure 11). Additionally, Hispanic women had the lowest PRMR among all races/ethnicities nationally, with a rate of 11.6 deaths per 100,000 live births. 

Figure 11. U.S. Pregnancy-Related Mortality Ratio by Race/Ethnicity, 2017-2019 (Pregnancy Mortality Surveillance System)

The NJ Maternal Mortality Review Committee (NJMMRC) reviews all pregnancy-related and pregnancy-associated deaths among NJ residents during pregnancy or within one year of the end of pregnancy. 2016-2018 data from the NJMMRC confirm persistent racial and ethnic disparities regarding maternal mortality. The NJMMRC identified 44 pregnancy-related deaths, of which 39/43 (91%) were determined to be preventable. The state-level pregnancy-related mortality ratio for 2016-2018 was 14.4 deaths per 100,000 live births; however, similarly to national PMSS data, disparities are evident among race/ethnicity. Figure 12 shows the PRMRs by race/ethnicity. The PRMR for Black NH women was 39.2 deaths per 100,000 live births, which was 6.6 times higher than the PRMR for White NH women, which was 5.9 deaths per 100,000 live births Hispanic women had a PRMR (20.6 deaths per 100,000 live births) 3.5 times higher than White NH women.

Figure 12: Pregnancy Related Mortality Ratio by Race, 2016-2018

 Based on the analysis conducted by the MMRC, the leading contributing factors for pregnancy-related deaths were lack of provider/patient knowledge, lack of continuity of care/care coordination, lack of standardized policies and procedures, substandard clinical skill/quality of care, and lack of assessment. While the leading contributing factors for pregnancy-associated but not related cases were lack of continuity of care/care coordination, complications of substance use disorder, complications of mental health conditions, lack of provider/patient knowledge and lack of standardized policies and procedures. The MMRC made an array of recommendations categorized into 5 themes by classes of maternal mortality, emphasizing actions that providers and facilities could take to identify and potentially address maternal mortality disparities. For each class, these were:

Pregnancy-related deaths: 

• Ensure high-quality care,
• Build patient knowledge,
• Address barriers to care,
• Implement a holistic approach to care and
• Share patient records and information about care provided.

 Pregnancy-associated but not related deaths:

• Implement a holistic approach to care,
• Ensure high-quality care,
• Address barriers to care, and
• Share patient records and information about care provided.

Severe Maternal Morbidity 

In 2022, New Jersey’s total SMM with transfusion rate was 227 per 10,000 delivery hospitalizations, and SMM without transfusion rate was 67 per 10,000 delivery hospitalizations. As with pregnancy-related mortality, racial and ethnic disparities are substantial and persistent in severe maternal morbidity. Black NH women giving birth in New Jersey suffered the greatest burden of preventable morbidity, with racial disparity in rates present and growing since 2011. In 2022, Black NH women suffered the highest SMM rates (385 per 10,000 delivery hospitalizations). The rate for White NH mothers is the lowest at 163 per 10,000 delivery hospitalizations (Figure 13).  The 2022 leading causes of severe maternal morbidity in New Jersey per 10,000 delivery hospitalizations were: acute renal failure (18.5 per 10,000 delivery hospitalizations), disseminated intravascular coagulation (19.9 per 10,000 delivery hospitalizations, and shock (8.4 per 10,000 delivery hospitalizations). 

Figure 13: Severe Maternal Morbidity by Race/Ethnicity, New Jersey, 2011-2022 

Infant Mortality

According to America's Health Rankings, as of 2021, New Jersey has the 3rd lowest overall infant mortality rate among the 50 states; however, similarly to the racial and ethnic disparities observed nationally, these disparities persist.

CDC data from the National Vital Statistics System identified that in 2021, racial and ethnic disparities in infant mortality continued to persist in the US among Black NH women, who had the highest IMR (10.6) per 1,000 live births, followed by Native Hawaiian or Other Pacific Islander NH (7.76), American Indian or Alaska Native NH (7.46), Hispanic (4.79), White NH (4.36), and Asian NH (3.69) (Figure 14).

In 2021, NJ's Black NH infant mortality rate (IMR) was 7.8 per 1,000 live births, while the IMR for White NH infants was 2.2 per 1,000 live births (Figure 14). The Hispanic IMR was also 3.7 per 1,000 live births. The Black NH IMR was nearly four times higher than the IMR for White NH infants, and the Hispanic IMR was nearly two times higher than the rate among White NH infants in NJ. Findings from the most recent 5-year needs assessment include the need to address NJ's maternal mortality crisis and disparities seen in both maternal and infant mortality rates These statistics warrant the need to continue implementing public health interventions that seek to address these racial and ethnic disparities and improve maternal and child health outcomes in NJ. 

Figure 14: Infant Mortality Rate by Race/Ethnicity, United States and New Jersey, 2021

Source: National Data (National Center for Health Statistics, National Vital Statistics System); New Jersey (Office of Vital Statistics and Registry) 

Key Demographics among Delivery Hospitalizations

According to a review of NJDOH’s Vital Statistics and Registry data:

• In 2022, 96,844 delivery hospitalizations occurred in New Jersey.
• 34,547 delivery hospitalizations during this time were considered NTSV-Cesarean births, where NTSV is defined as: nulliparous (first-time mother); term (37 weeks' gestation or above); singleton (one fetus); vertex (head-first presentation).

Among 2022 delivery hospitalizations, the following racial/ethnic stratifications were:

• White non-Hispanic (NH): 45%
• Hispanic women: 30%
• Black NH: 12%
• Asian NH: 10%
• Other/Multi-Race, NH: 3%

64% of delivery hospitalizations were financed through private insurance, 32% through Medicaid, 3.9% through either Self-Pay or Charity Care, and 0.1% other.

In 2022, 71% of all delivery hospitalizations were by women who initiated prenatal care during the first trimester; however, when stratified by race/ethnicity, first trimester prenatal care initiation was lowest among Hispanic (58%) and Black NH (59%) women, while it was highest among White NH women (81%). When assessing medical conditions at the time of delivery, 12.3% of New Jersey mothers had either chronic/gestational diabetes, while 9.9% had chronic/gestational hypertension, both of which are an increase from 2016, where diabetes prevalence was 9.8% and hypertension prevalence was 8.2%. When assessed by race ethnicity, diabetes prevalence was highest among Asian NH women (22.5%) and hypertension prevalence was highest among Black NH women (16.4%).

Preterm Birth

Preterm live births are defined as the birth of an infant before 37 weeks of gestation. Being born prematurely increases an infant’s risk of morbidity and mortality. Premature infants have a greater risk of dying in the first month of life, may require intensive care at birth, and are at higher risk of developmental disabilities and chronic illnesses throughout life. 

Nationally, in 2020, disorders related to preterm birth and low birth weight accounted for about 16% of infant deaths before their first birthday. Based on statistics provided by the CDC, 1 of every 10 infants in the US was born prematurely in 2021. An increase of 4% in the preterm birth rate was observed nationally from 2020 to 2021 (10.1% to 10.5%, respectively). In 2021, while an increase was observed nationally, NJ’s preterm birth rate dropped from 9.3% to 9.2%, respectively. An 8% dropped in preterm rate is observed in NJ from 2016 to 2021, while a 7 % increase is observed nationally for the same period. Although declining in New Jersey, these statistics on pre-term births warrant the need to continue implementing public health interventions to sustain or improve these maternal and child health outcomes.

Access to Care

The following data from the 2021 NJ Pregnancy Risk Assessment Monitoring System (PRAMS) address the access to care data deliverables for State Maternal Health Innovation Program (SMHIP). NJ PRAMS is a joint project between NJDOH, CDC, and the Rutgers University Bloustein School. Women as defined in this data set include mothers who are residents of New Jersey who delivered within New Jersey a live-born infant during the surveillance period (calendar year 2021). 

Percentage of women who receive an annual well-woman visit: 

65.7% of women reported having any health care visits with a doctor, nurse, or other health care worker (including a dental or mental health worker) in the 12 months before getting pregnant with their new baby. Among those women that reported having a health care visit in the 12 months prior to getting pregnant, 52.4% had a regular checkup at their family doctor’s office. 33.9% reported having a regular checkup at their OB/GYN’s office. 

Percentage of pregnant women who receive prenatal care: 

98.6% of women receive prenatal care as of 2021, however in 2017, according to birth certificate data 1,550 women delivered a newborn in NJ without receiving a single prenatal care visit. 83.4% percent of women received prenatal care in the first trimester, and 90.4% percent of women received a postpartum visit.

Among women screened for perinatal depression in 2021, during prenatal visits, 69.1% of women were asked if they were feeling down/depressed and during postpartum visits, 85.6% of women asked if feeling down/depressed.

Formative Evaluation Projects & Results

In the past few months, NJ TVP has led multiple projects to assess the needs of the MCH population in NJ.

Community Health Worker Evaluation

In collaboration with the Rutgers School of Public Health, NJ TVP developed an evaluation project that focuses on examining the adopted strategies used to train, deploy, and engage CHWs. The priority trainee populations include racial and ethnic minority groups, immigrants, those with limited English proficiency, the homebound, seniors, the homeless, disabled populations, migrant workers, pregnant and nursing mothers, the underinsured and uninsured, undocumented workers, and people with substance use disorder diagnoses. The evaluation found that CHWs overall are highly satisfied with the training they receive and their jobs; however, compensation and job security are potential areas of improvement for retaining CHWs over the long run.

The evaluation project aided NJ TVP in assessing the effectiveness of the CLG-CHWI and Rutgers Project ECHO training on increasing CHW competencies and improving curricula materials and instruction to address gaps in training. Based on the evaluation project results, NJ TVP is working on further updating the curricula and assessment materials to better equip CHWs with the skill needed to serve their clients adequately. NJ TVP and evaluation partners are also using results to assess progress and improve strategies for recruitment and deployment to optimize CHW integration into community organizations and to address and support the integration of CHWs within diverse organizations.  

Fetal Alcohol Syndrome Prevention and Postpartum Depression and Mood Disorders- Evaluation Project

In 2001 the Fetal Alcohol Syndrome Disorder (FASD) Taskforce comprised representatives from the NJ Department of Health (DOH) recommended steps to expand prevention programs and strengthen systems to alleviate the effects of prenatal alcohol exposure in NJ. The NJ DOH funded multiple grantees to implement FASD-related activities that seek to reduce the impact of prenatal exposure to substances in NJ communities.

The NJ Postpartum Depression and Mood Disorders Initiative was established by former Governor Codey in July 2005 to raise awareness about postpartum depression and to increase access to appropriate clinical services. Through this initiative, NJ TVP, through the grantees it funds, seeks to provide information about symptoms, screening, diagnosis, and treatment of postpartum depression to healthcare providers and New Jerseyans. PPD-MD grantees outreach to women and their families via a toll-free hotline, brochures, and online resources.

In 2023, over 20 years after the implementation of the FASD program and over 15 years after the implementation of the PPD-MD program, the NJ TVP Epidemiology Team designed and conducted an informative evaluation project to inform future programmatic and policy efforts. The evaluation projects had multiple phases corresponding to key project activities. Phase 1 involved compiling maternal and child health-related statistics, formulating the evaluation questions, selecting the methodological approach, designing the surveys, and the initial recruitment for the project. Phase 2 involved administering online surveys through the Novisurvey platform and hosting a listening session with the grantees. Phase 3 involved data analysis of survey responses, hosting one listening session, and the write-up of results and recommendations.

As a result of the formative evaluation project, NJ TVP Epidemiology Team generated a comprehensive list of culturally competent recommendations grouped into four categories:

1. System Level,
2. Programmatic Level,
3. Data-related, and
4. Material Development or Revision

The evaluation results led to a complete revision of the PPD-MD program goals and objectives and the launch of a new Request for Applications in Spring 2024. The FASD program will similarly be revised in SFY25.

Adolescent Health

The CAHP collects pre- and post-survey data for all students who participate in our programs (with parental consent). The following are data collected in the prior program year related to social-emotional learning and bullying prevention.

After completing a PREP evidence-based model (EBM), students reported the following:

• 82% indicated they were more/much more able to manage emotions in healthy ways
• 75% indicated they were more or much more able to resist or say no to peer pressure
• 77% indicated they were more or much more likely to talk with a trusted adult/person (for example parent, family member, teacher, counselor, etc.) if someone makes them feel uncomfortable, hurts them, or pressures them to do things they don’t want to do

After completing a SRAE EBM, students reported the following:

• 67% indicated they were more or much more able to manage their emotions in healthy ways
• 72% indicated they were more or much more able to resist or say no to peer pressure
• 69% talked to a trusted person/adult if someone makes me feel uncomfortable, hurts me or pressures me
• 81% felt respected as a person while participating in SRAE programming

After completing the Teen Outreach Program (TOP®) (specifically), students reported the following:

• 92% indicated they were able to make decisions to keep themselves healthy and safe (5% increase)
• 83% indicated they were able to come up with ways to solve problems (16% increase)
• 91% indicated they were able to understand how other people feel (9% increase)
• 85% indicated they were able to help make their community a better place (21% increase)
• 88% indicated they could handle the challenges that came their way (11% increase)

Students receive a pre- and post-survey provided by the funder (Family Youth Services Bureau) that covers all EBMs implemented. Students who participate in TOP® specifically receive an additional pre- and post-survey developed by the model developer. The above data shows how students who participated in our programs had increased skills and protective factors related to social-emotional learning and bullying prevention.

Children and Youth with Special Health Care Needs (CYSHCN)

A targeted Quality Assurance (QA) Audit initiative for all SPSP grantees commenced in 2023 and continued through February 2024. Grantees provided the DOH with patient and visit counts for SFY23, which were then deduplicated. The goal of this review is to better understand the utilization patterns and identify program overlap/potential gaps in services. SCHS SPSP staff ascertained that required quarterly Progress Reports have not been interpreted uniformly across grantees, despite detailed instructions. The QA shed light on the mediocre systems many grantees utilize to capture reported data, ranging from manual counting to pulling data from three internal systems and doing their best to synthesize the data. This information has spurred the SPSP team to further analyze the content of the progress reports and help grantees justify the need for improved data systems from their parent organizations.

In 2022, FCCS conducted a pilot satisfaction survey of families registered with SCHSCM for continuous quality improvement. The results showed that 79% of responders felt their SCHS case manager supports their family, and 77% said their CM meets the needs of their family. Additionally, over 65% of responders ranked the overall value of SCHSCM services as either excellent or very good. As a result, in 2023, SCHSCM staff has incorporated an acuity tool and SMS text messaging into the redesign of the electronic data system, that will be able to enhance communication with the families served by SCHSCM and conduct annual and exit satisfaction surveys. The data will help to continuously identify areas of improvement and guide policy and implementation of SCHSCM services across the State.

SCHSCM utilizes the Case Management Reporting System as its primary hub to document all case management activities. These include communication with affected families, individual service plans, case management actions, service delivery, deactivations, and more. Currently, CMRS is undergoing a major redesign that will enable the capturing of data to monitor and evaluate the services provided to CYSCHN populations. The redesign encompasses several modules of the system, including Individual Service Plan, Exceptional Events, Child Information, custom reports at the CMU level, the ability to conduct family surveys, and features that will better facilitate communication with families.

NJ’s Ongoing Needs Assessment Activities

NJ is currently engaging in the five-year grant cycle needs assessment process.  Several initiatives are occurring simultaneously to better understand how Title V funding is distributed throughout the state, while examining impact of activities and voids to be addressed. One initiative that has been organized is an internal Work Group that discussed data sources, presents on programmatic strengths and growing edges and proposes ways to move forward with program modifications.  Concomitantly, a Steering Committee of professional stakeholders from the clinical, governmental, non-profit and parent advocacy arenas has been created to offer feedback and liaise between service recipients and the TVP in gathering information regarding Title V programming in NJ.  During the summer of 2024, public health interns will be working with the TVP to facilitate focus groups with families and community members with lived experience, as well as conduct key informant interviews with clinical practitioners and other stakeholders, to further understand perspectives on the Title V programming in NJ.  As these feedback initiatives are occurring, TVP staff are discussing ways to implement best practices in performance monitoring and assessment of the activities.