Our FY21 application presented a comprehensive five-year Needs Assessment (NA) summary of state’s MCH needs, strengths, capacity, and partnerships. The NA 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. Our subsequent FY22 NA update focused primarily on the impact of COVID-19. This year’s FY23 NA update reflects the continued impact of the pandemic, along with other persistent and emerging themes for our MCH populations and service systems.

 

Throughout this NA update, relevant Title V domains [WMH, PIH, CH, AH, CYSHCN] are referenced for selected examples. Please refer to the FY21 five-year NA summary for descriptions of MCH programs referenced in this update. 

 

Ongoing NA Activities:

 

This year Title V staff led a variety of activities that inform our ongoing assessment of MCH population and system needs. As noted last year, a combined approach of formal structured NA activities with more ad hoc ongoing open communication has proven essential throughout the public health emergency and continuing to present.

 

Population Health Data

 

In addition to monitoring Title V performance and outcome measures, we periodically review population data from a variety of sources to assess status, trends, and disparities for key MCH indicators. These data are shared with partners and are used to inform program strategies and allocation of funds. Examples from the past year include:

• In collaboration with the state’s multidisciplinary NYS Maternal Mortality Review Board (MMRB), DFH leads a comprehensive process to identify and review all maternal deaths. The focus is on describing the scope and distribution of maternal deaths and identifying key contributing factors and preventability. The first MMRB report for the 2018 cohort was released in April 2022 [WMH].
• Title V funds were allocated to conduct an over-sample of National Survey of Children’s Health (NSCH) data for NYS, with enhanced sampling of Black/African American, Hispanic, and CYSHCN. A project sampling plan was finalized this project period, to be implemented in 2022, with data available in 2023 [CH, AH, CYSHCN].
• Title V staff review data from relevant national surveys including Pregnancy Risk Assessment Monitoring System (PRAMS), Behavioral Risk Factor Surveillance System (BRFSS), NSCH, and Youth Risk Behavior Survey (YRBS) at least annually [All].
• In fall 2021, we updated the Adolescent Sexual Health Needs Index (ASHNI), which is a multi-dimensional ZIP code level indicator incorporating adolescent sexual health outcomes with demographic and community level predictive factors and which is used to prioritize available resources to the highest need communities. The updated ASHNI will be used for the 2022 Comprehensive Adolescent Pregnancy Prevention (CAPP) and Personal Responsibility Education Program (PREP) procurements [AH].

 

Program Utilization & Outcome Data

 

Data collection, management, and analysis is integrated across Title V-funded programs. In addition to supporting local program management, these data provide important insights to MCH population needs, service capacity/utilization, and selected outcomes. Examples from the past year include:

• A new PICHC data management information system (DMIS) for the Perinatal & Infant Community Health Collaborative (PICHC) was launched in April 2021, and a new five-year DMIS vendor contract will be awarded to begin September 2022 [WMH, PIH].
• The state’s Growing Up Healthy Hotline maintains data on information and resource needs based on calls received [WMH, PIH, CH].

• A new data system for the School-Based Health Center (SBHC) program is under development. It will allow for more streamlined and accurate reporting, including new performance measures related to physical activity and nutrition aligned with Title V priorities [CH, AH, CYSHCN].
• A web-based data system for local health department (LHD)-based CYSHCN programs was launched in October 2021 through the state’s Health Commerce System to streamline and improve the accuracy of data collection, analysis, and reporting.

Communication with Local Providers

 

As a fundamental requirement of grant funding, Title V-funded local providers are expected to engage with their communities and continuously assess community and client needs. Title V staff also communicate continuously with local partners through grant reports, regular scheduled provider calls, webinars, and ongoing ad hoc communication.  All of these are critical vehicles for learning about ongoing and emerging MCH needs, challenges, and successes. Examples of ongoing, continuous communication include:

• Review and discussion of quarterly or bi-annual contractor reports., regular monthly convene monthly or quarterly calls with local grantees to share information, review data and performance measures, ad hoc discussion to address emerging issues. [All].
• The Title V-funded Assets Coming Together (ACT) for Youth Center for Community Action (CCA) engages in continuous ongoing communication with local adolescent health grantee programs about their training and technical assistance (T&TA) needs. [AH, CYSHCN].

 

Quality Improvement & Evaluation Initiatives

 

Title V staff lead and participate in a range of special initiatives and projects to learn about service and system needs and effectiveness. These range from focused literature reviews to formal evaluation projects and to extensive continuous quality improvement (CQI) initiatives that integrate ongoing assessment of MCH outcomes and services with testing and implementation of specific improvement strategies matched to the issue. Examples from the past year include:

• The Newborn Screening Program is engaged in an ongoing CQI initiative to reduce collection and processing time for labs, improve blood spot specimen quality, reduce false positive screening results, and improve timeliness in screening for time-critical conditions [PIH, CYSCHCN].
• The NYS Perinatal Quality Collaborative is leading an interdisciplinary learning collaborative focused on implicit bias in birthing care, following the model of our numerous successful NYSPQC projects. [WMH, PIH].
• The Bureau of Women, Infants, and Adolescent Health (BWIAH) within DFH, with support from several Title V-funded MCH Catalyst Program graduate student interns, carried out special projects to strengthen engagement of families in MCH home visiting, enhance collaboration between MCH home visiting programs and birthing hospitals, and develop data collection instruments for evaluating sexual violence prevention programs [WMH, PIH, AH].

 

Enhanced Strategies for Assessing the Needs of CYSHCN & Their Families

 

Direct input from CYSHCN and their families is a special priority for NYS’s Title V Program. We have allocated Title V and other funds to support an array of NA activities, integrated within other family supportive services. These include:

 

• Regional Family Liaisons. DFH has allocated funding to support contracts with three Regional Support Centers (RSCs), which are HRSA designated University Centers of Excellence in Developmental Disabilities, to support families and provide T&TA to Local Health Department (LHD) CYSHCN programs. Each RSC is required to employ a Family Liaison (FL) as a requirement of the funding opportunity. The FL are parents of CYSHCN whose lived experience and knowledge informs RSC activities.
• Family Engagement Sessions. The regional FL are responsible for conducting family engagement sessions with CYSHCN families. These sessions use standardized questions to assess the needs of CYSHCN families, including questions about the impact of COVID-19. From 2019-2021, over 300 parents and caregivers of CYSHCN from 51 NYS counties participated in 63 small group sessions and 104 individual family interviews (primarily virtual).
• County Needs Assessment Surveys. RSCs also conduct surveys with each county to gather feedback and determine local gaps, barriers, resources, and T&TA needs. Counties are invited to develop tailored improvement and TA plans to help meet their community engagement goals with TA from the RSCs.
• County Family and Community Engagement Requirements. LHD CYSHCN programs are required to engage CYSHCN families in work groups, committees, task forces, and advisory committees to improve the system of care for CYSHCN. Families are engaged in local planning activities such as the county Community Health Assessment (CHA), and their input informs training and TA for the local programs.
• Other Surveillance and Program Data. Title V staff routinely review available public data sources to monitor trends and identify emerging needs for CYSHCN, including NSCH data and NYS Medicaid Health Home for Children data. In 2021, we issued the New York State Profile of Children and Youth with Special Health Care Needs, 2018-2019, an annual state report synthesizing demographic, health status, and service needs of NYS’s CYSHCN population.

 

Health Status & Needs of the State’s MCH population

 

Findings from Analysis of Population & Performance Data

 

Population health data and other specific performance measures collected from Title V-funded programs provide key information related to health status and needs of NYS’s MCH population and service systems. Notably, we may begin to see the early impact of COVID-19 in this year’s analysis, as the measures reported here are for the 2019-20 period.

 

Analysis of the most recently available data shows continued improvement in maternal mortality rates and stable rates for well-woman visits statewide. However, we observed declines in documented medical exams for women served in NYS Family Planning Program sites and development of birthing plans for pregnant clients served through the MICHC program, (the latter may reflect changes in data reporting) (WMH). Delivery of percent of very low birth weight (VLBW) infants in Level III+ birthing hospitals and timeliness of newborn bloodspot sample delivery were stable from the previous year’s analysis (PIH). The incidence of elevated blood lead levels among young increased (CYSHCN), and daily physical activity among children ages 6-11 declined from the previous year (CH), as did documentation of anticipatory guidance for physical activity and nutrition for children and youth enrolled in School-Based Health Centers (CH/AH). We observed continued improvement in the percentage of youth serving programs that engage youth in program planning and that provide training for youth on adult preparation topics, but preventive medical visits for adolescents decreased (AH). Provision of transition supports for youth with sickle cell disease (SCD) among SCD contractor programs improved, but the overall statewide percentage of youth with special health care needs who received services to support transitions to adult health care declined (CYSHCN).

 

Emerging & Persistent Themes

As emphasized in last year’s NA Update, the COVID-19 pandemic laid bare and exacerbated previous health and socioeconomic disparities, while also exposing and creating new needs for families and communities. The 10 crosscutting themes voiced by community members in our five-year NA summary remained salient over the last year, with selected themes described below emerging (or re-emerging) as prominent needs.

 

Improving the accessibility, quality, and equity of health care services continues to be a high priority for individuals and families in NYS. Telehealth services have emerged as a promising approach for strengthening capacity to provide services, tailored to the needs of urban and rural areas. We have expanded telehealth services for reproductive and family planning services, and as noted above we are working with Regional Perinatal Centers to assess and support needs for telehealth among birthing hospitals [WMH, PIH].

 

State and local partners have noted rising needs for mental health and substance use services, demonstrated by an increase in referrals for mental health services overall and specifically for referrals not completed because of limited provider capacity. These unmet needs may result from an inadequate number of providers as well as insufficient ability of existing providers to work with pregnant people and to provide Medication-Assisted Treatment (vs Abstinence-Based Treatment) for people with substance use needs [WMH].

 

Local partners report continued concerns about children falling behind on routine primary and preventive care [CH, AH]. They also note persistent vaccine hesitancy among pregnant people and parents in some communities, and a general distrust of government and public services for many undocumented people [All]. 

 

Families describe several key barriers to getting care for CYSHCN. Families in rural areas identified limited access to specialists and lack of high-quality health care facilities for CYSHCN, resulting in delayed diagnoses and lack of continuity for meeting children’s needs during key periods of development. Families in urban areas reported other challenges related to transportation and accessibility of services for CYSHCN. Statewide, CYSHCN families who do not speak English or who are Deaf or hearing impaired reported even more difficulties finding services for their children, including translation services and access to bilingual providers. In addition, families noted inadequate family-professional relationships including poor bedside manner, dismissiveness, and insensitivity from providers as frequent concerns [CYSHCN].

 

Families also continue to experience challenges in meeting their basic needs. Among the nearly 8,000 referrals for Title V-funded MICHC CHW clients last year, four of the top five referral categories were for basic needs including clothing and baby care items, housing assistance, food pantries, and WIC [WMH, PIH]. Partners report affordability and scarcity of “life supplies” including food and baby formula - due to rising prices, recalls, and supply chain issues - as major concerns for families [PIH]. Housing insecurity is also a major worry, as families report being priced out of their neighborhoods with gentrification, struggling to pay for housing due to rising costs and job loss, and rising concerns about eviction with the expiration of moratoriums [All domains].

 

Social-emotional and mental health continues to rise in prominence as key concerns raised by individuals, families, and service providers across the life course. Data demonstrate increasing rates and racial disparities for depression symptoms, and inadequate mental health services, for pregnant and postpartum people [WMH]. SBHC staff report growing concerns about mental health among students, resulting in a need for additional mental health staff [CH, AH, CYSHCN]. Youth-serving programs continue to report significant challenges in recruiting, engaging, and retaining youth in remote programming, describing a phenomenon of significant “screen-time burnout” and “Zoom Fatigue” that are taking a serious toll on young people’s social and emotional well-being [AH]. CYSHCN parents and providers report concerns about the impact of COVID-19 on children’s social and emotional development and well-being. In addition, parents of CYSHCN themselves report significant levels of stress and anxiety associated with caring and continuously needing to advocate for their children’s special health care needs, while foster and adoptive families of CYSHCN described additional challenges in meeting the behavioral and mental health support needs of children with trauma experiences [CYSHCN].

 

Title V Program & MCH Systems Capacity

 

Consistent with last year’s NA Update, the pandemic continues to have significant impact on the capacity of state and local MCH programs. At the state level, most staff deployments to assist with COVID-19 response have been completed. However there has been a great deal of staff turnover, with many staff retiring from public health or taking new positions outside the Division/Title V Program. Although DFH has been able to pursue recruitments to fill resulting vacancies and some new positions, recruitments have been challenging, and when new staff are hired there are significant extended needs for orientation and training. Current staff are often spread thin to cover existing and emerging work, in the context of significant losses in institutional memory. This dynamic of staffing losses, high turnover, and anticipated prolonged rebuilding of workforce capacity is a theme that spans across nearly all State level Title V units and programs.

 

A similar dynamic is occurring within local MCH organizations, which are also going through periods of major rebuilding. During the height of the pandemic, many programs experienced significant declines in services and clients because of school and other site closures, transportation limitations, and social distancing requirements. Most programs that discontinued services have now resumed operations, with varying limitations on in-person service delivery. Some programs that closed completely during the pandemic (e.g., one county CYSHCN program, two SBHC sites) are not expected to re-open. We have identified needs for training and re-training of local staff on program fundamentals, from contracting and work plans to specific program activities. We have also taken steps to address workforce equity within Title V-funded programs; as one example, the most recent PICHC RFA required a living wage for all staff. 

 

Two major initiatives have been pursued to help address these workforce challenges. First, NYS launched the New York State Public Health Corps (NYSPHC) to build public health capacity for current and future public health emergencies, bolster the state’s public health infrastructure, improve effective public communication and education around public health efforts, and strengthen community level connections and partnerships. In collaboration with community partners, NYSDOH will recruit and train up to 1,000 NYSPHC Fellows, who will serve in state and local agencies, including 9 fellows assigned specifically to DFH/Title V Programs. In addition, NYSDOH was allocated $16 million, which is from a larger $66M federal Public Health Crisis Workforce grant, to support hiring additional clinical staff at School-Based Health Centers for the period through June 2023, with the potential for further extension.

 

Despite these significant challenges, there have been many accomplishments related to capacity-building across NYS’s Title V Program during the past year. Selected examples include:

 

• Adaptation of services to virtual and hybrid environments. Going back to the first peak of the pandemic in NYS in spring 2020, MCH programs and providers have demonstrated tremendous creativity, resilience, and compassion for the communities and people they serve. As routine in-person programming came to an abrupt halt, programs developed strategies for engaging and supporting clients remotely. For example, MICHC and MIECHV replaced in-person home visits with remote visits, phone, and email communications [WMH, PIH]. Some SBHCs offered telemedicine services [CH, AH, CYSHCN] and the ACT CCA worked with local CAPP, PREP & Sexual Risk Avoidance Education (SRAE) programs to help them adapt and implement evidence-based programs with fidelity within the confines of a virtual environment [AH]. SBHCs are also using telehealth to supplement in-person mental health services, which has provided additional options for patient engagement, offers a better understanding of student’s home environments, and appears to be associated with a decrease in missed or canceled appointments [CH, AH, CYSHCN]. 

 

• New program data systems. As noted, in the past year we have invested in improved data management information systems for several key Title V-funded programs, including MICHC/PICHC [WMH, PIH], SBHCs [CH, AH, CYSHCN], and LHD CYSHCN programs [CYSHCN]. These systems will expand the scope of data collected from local providers while improving the quality, accuracy, and efficiency of data collection, management, and analysis.

 

• Quality Improvement Initiatives/ Learning Collaboratives. As described, we are leading a growing portfolio of quality improvement projects (See Ongoing NA Activities). In addition to enhancing our understanding of the needs and effectiveness of MCH services, these initiatives strengthen state and local organizational capacity for identifying, testing, disseminating, and institutionalizing best practices across a wide range of MCH service settings. [WMH, PIH].

 

• Prioritizing investments in Maternal, Perinatal & Infant Health programs. The recent PICHC RFA resulted in a net increase of three local providers, expanding both the geographic coverage and number of clients to be served through the program. Title V staff have provided significant subject matter expertise this year to support a home visiting pilot in four counties, as part of the state’s First 1000 days Medicaid initiative, through which managed care organizations support staffing Obstetrician and Pediatric offices with mental health social workers and peer navigators to engage, screen, and refer high-risk patients to home visiting services, which include partnerships with Title V PICHC programs. This year’s state budget included an increase in funding for RPCs, which will support a 38% increase in funding over the prior year, building on previously described work to enhance telehealth capacity across birthing hospitals [WMH, PIH]. 

 

• Expanding service capacity of SBHCs to meet the existing and emerging needs of children and youth. The Division recently received a new five-year HRSA grant to expand access to pediatric mental health care. The goal for NYS’s grant is to connect SBHCs with OMH’s Project TEACH, which is a statewide training, education, and consultation initiative that works to strengthen and support primary care providers’ ability to diagnose and manage mild-to-moderate mental health concerns. A Request for Applications (RFA) was completed this year (expected release later in 2022) to support the establishment of dental homes in SBHCs, which in turn will increase capacity for providing dental services and enhancing oral health promotion and prevention activities. [CH, AH].  

 

 

Title V Partnerships & Collaborations

 

Partnership and collaboration are core to the work of our Title V Program. Collaboration occurs at every level – across organizational units and programs within the Title V Program, with other MCH-serving state programs within NYSDOH and other state agencies, and with a wide array of stakeholders. We have selected one example for each domain to highlight as part of this year’s NA update:

 

• To strengthen collaboration across all DFH youth-serving programs, meetings to learn about the backgrounds and current work of staff in other programs were established. , In August 2021, staff from numerous youth-serving programs (CAPP, PREP, SRAE, SBHC, Family Planning, CYSHCN, and others) were invited to a series of ACT CCA-hosted webinars on youth mental health.
• Within the Title V Program, the Bureau of Child Health (DFH) is partnering with the Asthma Guidance Team (Division of Chronic Disease Prevention) and the American Lung Association to enhance SBHC engagement in an Asthma Self-Management Education Pilot project. [CH].
• Building on the longstanding partnership between our state Title V and Medicaid programs to support the development and implementation of Medicaid Children’s Health Homes (CHH), this year Title V staff joined a multidisciplinary NYS Medicaid Redesign Team focused on improving outcomes for people with Sickle Cell Disease (SCD). Based on the team’s recommendations, NYS pursued adding SCD as a single qualifying condition for enrollment in CHH, which would strengthen care coordination to promote effective treatment, reduce symptoms, prolong life, and improve well-being for children, youth, and young adults with SCD. [CYSHCN].
• Our Home Visiting Team includes staff from MICHC/PICHC (Community Health Staff from MICHC/PICHC) and MIECHV funded programs continued a collaboration with the WIC Program (NYSDOH Division of Nutrition) and Healthy Families NY (NYS Office of Children and Family Services) to improve referrals to home visiting programs from WIC local agencies. [PIH].
• Title V staff are collaborating with the NYS Office of Addiction Services and Supports (OASAS) to support a new OASAS overdose prevention grant that includes pregnant people, new parents, and survivors of sexual and domestic violence among its priority populations. In addition, we are engaging OASAS in meetings with Title V-funded programs/partners to strengthen those relationships [WMH]

 

 

Operationalizing Needs Assessment Activities & Findings

 

Our Title V Program continues multiple approaches to operationalize NA activities and findings. As demonstrated above, most of the methods we use to gather input and information are operationalized within routine program activities. These include:

• Reviewing existing population health surveys and surveillance systems annually.
• Developing, maintaining, and improving data management systems for local Title V-funded programs.
• Integrating requirements for routine data reporting in grant contracts for all Title V-funded programs.
• Integrating requirements for community engagement, including community listening forums, in our procurement processes.
• Supporting statewide and regional centers that assess needs of priority populations to inform ongoing statewide and program-specific T&TA activities.
• Applying findings from all these assessment activities to the design and ongoing improvement of MCH programs and initiatives.

 

Please refer to Ongoing NA Activities above for further detail on these approaches.

 

Organizational & Leadership Changes

 

Our Title V Program had several key leadership-level staffing changes this year:

• Kirsten Siegenthaler, PhD, was promoted to Director of the Division of Family Health and Title V Director, having served as the Associate Director for three years.
• Emily DeLorenzo, PhD, joined as Associate Director of the Division of Family Health, which was vacant following Dr. Siegenthaler’ s promotion to Division and Title V Director.
• Christopher Kus, MD, MPH, Associate Medical Director for the Division/Title V Program, retired from NYSDOH.
• Ann-Margret Foley, MSW, was appointed Director of the Bureau of Women, Infant, and Adolescent Health (BWIAH).
• Rae Ann Augliera, MS, was appointed Associate Director of BWIAH, following the retirement of Michael Acosta.
• Raymond Pierce was appointed Director of the Bureau of Early Intervention, following the retirement of Connie Donohue.
• Claire Rudolph was appointed Assistant Director of the Bureau of Child Health.