For Women’s and Maternal Health (WMH), New York’s Title V Program selected National Performance Measure (NPM) 1: Percent of women, ages 18 through 44, with a preventive medical visit in the past year. This NPM was selected because it is foundational to women’s health throughout the life course, is supported by population health data demonstrating a need for continued improvement and relates directly to several priorities voiced by birthing people and their families through community listening forums, including awareness of community resources, transportation, social support, and health care access and quality. This NPM also aligns directly with the NYS Prevention Agenda goal to increase use of primary and preventive health care services among women of all ages, especially women of reproductive age.

 

While NPM 1 directly measures annual preventive medical visits, it should be viewed as part of a continuum of primary and preventive care that also includes preconception, reproductive and sexual health, family planning, prenatal, and postpartum care, and that includes a full spectrum of medical, mental, and behavioral health, oral health, dietary/nutritional and other supports and services.

 

As described above in the annual report, increasing access to comprehensive, high quality, and equitable health care services has been identified as a key element of efforts to eliminate the striking racial and ethnic disparities in mortality and morbidity outcomes.

 

The following specific objectives were established to align with this performance measure:

 

Objective WMH-1: Increase the percent of women, ages 18 through 44, with a preventive medical visit in the past year by 5%, from 79.6% in 2018 to 81.3% in 2022. (Behavioral Risk Factor Surveillance System)

 

Objective WMH-2: Reduce the maternal mortality rate by 10%, from 17.8 deaths per 100,000 live births in 2014-2018 to 17.7 deaths per 100,000 live births in 2016-2020. (National Vital Statistics System)

 

Objective WMH-3: Reduce the rate of severe maternal morbidity per 10,000 delivery hospitalizations by 1%, from 93.2 delivery hospitalizations with an indication of severe morbidity per 10,000 delivery hospitalizations in 2015 to 92.2 delivery hospitalizations with an indication of severe morbidity per 10,000 delivery hospitalizations in 2019. (Healthcare Cost and Utilization project-State Inpatient Database)

 

Objective WMH-4: Reduce the percent of women who have depressive symptoms after birth by 23%, from 13.0% in 2017 to 10.0% in 2020. (Pregnancy Risk Assessment Monitoring System)

 

Four strategic public health approaches were identified to accomplish these objectives. These are presented in the State Action Plan Table, and each is described in more detail here, with specific program and policy activities that will be implemented to advance the broader strategic approach in the upcoming year.

 

Strategy WMH-1: Integrate specific activities across all relevant Title V programs to promote the health and wellness of people of child-bearing age, including enrollment in health insurance, routine well visits, pregnancy planning and prevention, prenatal, and postpartum care.

 

Improving the health of people of child-bearing age requires a life course approach to be most effective. Preventive medical visits are a key opportunity for delivering health education and reinforcing health-promoting behaviors. Preventive visits help to identify chronic conditions, such as hypertension and diabetes, in child-bearing people that could contribute to maternal morbidity and mortality. Family planning and reproductive health visits ensure that people of child-bearing age have access to contraception for prevention of pregnancy, and counseling on reproductive life planning, appropriate birth spacing, and preconception health. Title V programs also provide enabling services, such as social support and referrals/linkages to a wide range of community services, to holistically address health and wellness, including mental health and social determinants of health, for people of child-bearing age. Incorporating specific activities across programs leverages the public health infrastructure and capacity supported through previous and ongoing Title V investments.

 

The goal of the Perinatal and Infant Community Health Collaboratives program (July 1, 2022 - June 30, 2027) is to improve perinatal health outcomes and eliminate racial, ethnic, and economic disparities in those outcomes. As the core individual-level strategy, Perinatal and Infant Community Health Collaborative programs will continue to utilize community health workers to conduct basic health and well-being assessments in the prenatal and postpartum periods, using standardized evidence-based and/or validated screening tools, to identify and prioritize needs of the individuals and families served. Assessments are completed at enrollment and updated throughout clients’ service periods and individualized care plans are developed based on the Perinatal and Infant Community Health Collaborative identified. Community Health Workers will continue to receive annual training from the Perinatal and Infant Community Health Collaborative Training and Technical Assistance provider, John Snow Inc. (JSI) on topics including, but not limited to how to talk with families about difficult topics like mental health and depression using a trauma-informed care approach, how to manage emergency situations; understanding what it means to be anti-racist, and how to support birth equity. Community Health Workers will continue to connect clients and families to needed services and provide enhanced social support. Community Health Workers will continue to help ensure early and consistent participation in preventive and primary health care services, including early prenatal care, particularly for those individuals not engaged in care and other supportive services, and postpartum care. Community Health Workers will also continue to provide health information to increase clients’ knowledge and ability to self-advocate and make informed health care decisions, with the goal of helping families achieve optimal health, self-sufficiency, and overall well-being.

 

Perinatal and Infant Community Health Collaborative programs will continue to coordinate outreach and engagement activities with other home visiting programs serving the same communities including programs supported by New York’s Maternal, Infant, and Early Childhood Home Visiting initiative. Perinatal and Infant Community Health Collaborative and Maternal, Infant, and Early Childhood Home Visiting programs coordinate outreach, referral, assessment, and intake processes to find and engage pregnant and parenting families and ensure they are engaged with home visiting programs and supportive services responsive to their needs.

 

The NYS Family Planning Program supports 37 health facilities that are regulated by NYSDOH under Article 28 of NYS Public Health Law (these include hospitals and clinics) that operate over 160 family planning service sites across the state. Through these service sites, the Family Planning Program delivers comprehensive, confidential reproductive health services for people of reproductive age who are low income and uninsured or underinsured. Services provided include contraceptive services; preconception planning and counseling services; pregnancy testing and related counseling; preventive services such as basic health screening, screening for sexually transmitted diseases, HIV counseling and testing, and breast and cervical cancer screening; and appropriate referrals and health education. Ensuring continued access to these core primary and preventive services is essential.

 

As reinforced by community forums, increasing awareness of available resources among both consumers and providers is critical. The use of social media messages enhances awareness of the state’s Growing Up Healthy Hotline service, which in turn provides callers with linkages to local community resources, supports, and services including Supplemental Nutrition Program for Women, Infants and Children (WIC), Medicaid, Family Planning, prenatal care, and the NYS Early Intervention Program. Social media and other emerging communication forums online have the potential to reach large and diverse populations. When messages are developed using science-based health messaging, social media can be a communication medium that can educate and influence health decision making.

 

The NYS Title V Program will lead the following specific program and policy activities to advance this strategy over the upcoming 2023-24 year:

 

• Activity WMH-1.1: Across all Title V programs, enhance promotion of the NYS Growing up Health Hotline to increase awareness of available community resources, supports, and services including Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC); Medicaid; family planning; and prenatal care.
  • Title V including Perinatal and Infant Community Health Collaborative and Maternal, Infant, and Early Childhood Home Visiting staff will continue to promote the Growing up Health Hotline through presentations to Title V programs and partners, broadly share the Growing up Health Hotline flyer available in multiple languages on the Department’s website and provide updates to the Growing up Health Hotline as available resources emerge or change. 

• Activity WMH-1.2: Through the Regional Perinatal Centers and networks of affiliate birthing hospitals, support and enhance capacity to provide high-quality perinatal telehealth services and perinatal subspecialty providers, particularly to rural communities and those with disproportionate access to such services.
  • Title V staff will continue to engage with these providers and other perinatal/neonatal telehealth initiative providers and support relevant collaborations across the Department to support telehealth initiatives, including the Department’s Office of Health Insurance Program’s maternity telehealth workgroup.
• Activity WMH-1.3: Through the Perinatal and Infant Community Health Collaborative and Maternal, Infant, and Early Childhood Home Visiting programs, integrate use of virtual home visiting services to increase acceptance and support of services for families that have been hard to reach.
  • Recent experience suggests that virtual home visits conducted in the context of the response to COVID-19 have helped to maintain communication and allow for essential Community Health Workers and home visiting services to continue including providing health information, support and referral and follow-up for preventive and prenatal care visits. As we enter into the endemic phase of COVID-19, and vaccinations are more widely available and accepted in some marginalized communities, home visiting programs have begun to slowly transition to modified in-person visits and continue to use the virtual option as needed to ensure at risk individuals and families continue to receive supportive services.
• Activity WMH-1.4: Through the Perinatal and Infant Community Health Collaborative program, continue to support Community Health Workers to conduct outreach to find and engage high-risk pregnant and postpartum families in consistent, comprehensive preventive and primary care services, including prenatal, interconception, and postpartum care.
  • Community Health Workers will routinely screen clients for health insurance enrollment and health care engagement, assist them in obtaining care if needed, provide ongoing social support and reinforcement for health care utilization, and provide clients with health information and social support to increase knowledge and ability to self-advocate and make informed health care decisions, including assistance to develop birth and postpartum plans. Community Health Workers will initiate (or coordinate with Obstetric providers) the development of a birth plan with all prenatal clients and monitor the number of birth plans initiated through the Perinatal and Infant Community Health Collaborative data management information system.
• Activity WMH-1.5: Through the NYS Family Planning Program, continue to support the delivery of comprehensive, confidential reproductive health services for individuals of reproductive age who are low income and uninsured or underinsured at our 160 family planning clinic locations across the state.
  • Barriers to accessing reproductive health care will remain a priority and be addressed through continued use of telehealth services and dispensing a 12-month supply of contraceptives. Family Planning providers will continue to implement sliding fee schedules to ensure cost is never a barrier to care, partner with and refer to other medical and social services to meet the needs of their patients, conduct outreach and education to ensure community members know where they can access comprehensive and affordable services and assist uninsured clients in enrolling in the most appropriate health insurance plans including Medicaid, Family Planning Benefit Program, and Family Planning Extension Program.
• Activity WMH-1.6: The Sexual Violence Prevention Unit will continue to support prevention and response services for sexual violence through three programs: Rape Prevention and Education; Rape Crisis; and Sexual Assault Forensic Examiners.
  • NYS’s Rape Prevention and Education program consists of six Regional Centers for Sexual Violence Prevention to implement evidence-based/informed primary prevention strategies in 17 counties across NYS with the highest average number of reported forcible rapes over a five-year period. To support survivors of sexual violence, 53 NYSDOH approved Rape Crisis Programs provide support and advocacy services. The Sexual Assault Forensic Examiners Program consists of 49 hospital programs, seven training programs, and 524 examiners to respond to survivors of sexual assault and collect forensic evidence.
• Activity WMH-1.7: Train Perinatal and Infant Community Health Collaborative and Maternal, Infant, and Early Childhood Home Visiting programs on CDC's Learn the Signs Act Early campaign. Collaborate with the NYS Council for Children and Families on the Early Childhood Comprehensive Systems grant, which supports dissemination of Learn the Signs Act Early materials.
  • A letter of agreement covering the period 10/1/21-9/30/24 is in place for this training.
• Activity WMH-1.8: Through the Maternal, Infant, and Early Childhood Home Visiting Initiative, direct American Rescue Plan Act (ARPA) funds to Healthy Families New York through a Memorandum of Understanding with the NYS Office for Children and Family Services which oversees the Healthy Families New York program, and through contracts with the Nurse Family Partnership programs overseen by NYSDOH. Per statute, ARPA funds can be utilized for emergency supplies for families, technology for families to support virtual home visits, home visitor staffing, home visitor training, prepaid grocery cards, diaper bank coordination, and/or hazard pay for staff. Round 1 ARPA funding expires 9/30/23 and Round 2 funding expires 9/30/24.
• Activity WMH-1.9: Through public awareness campaigns, promote messages about maternal warning signs to educate pregnant and postpartum women about when to seek help for untoward conditions associated with perinatal complications.
  • The Department’s webpage about the Hear Her Campaign promotes messages to consumers about urgent maternal warning signs. Hear Her. You Can Help Save Her Life. (ny.gov). Links on the webpage to print materials that providers may offer birthing people and their partners/families about urgent maternal warning signs will continue to be available.

 

Strategy WMH-2: Strengthen coordination between birthing hospitals, outpatient health care providers, and other community services to make support for birthing parents and their families more comprehensive and continuous.

 

Coordination between birthing hospitals, community providers, and community-based organizations that provide essential support to birthing persons and their families is critical to maintaining optimal health and well-being and ensuring continuity of care during a key life course period. Perinatal and Infant Community Health Collaborative programs routinely coordinate with a wide variety of community-based organizations that provide health and social support services to address needs related to both physical and mental health, and social determinants of health, including safe housing, transportation, poverty, nutrition, and other supports. Perinatal and Infant Community Health Collaborative programs will also continue to facilitate Community Action Boards/Networks within their communities, focused on issues affecting perinatal health, with memberships consisting of community members and diverse stakeholders, including representatives of birthing hospitals and other health care providers/networks. Birthing hospitals in NYS are required to provide similar referral services through support and social services. As noted above, telehealth services have emerged as a promising approach to delivery of clinical care that can be tailored to the needs of each region and community, both urban and rural. Strengthening the connection between the Perinatal and Infant Community Health Collaborative providers and individual birthing hospitals will ensure that pregnant New Yorkers, including those with high-risk pregnancies and chronic conditions, are connected to the highest quality of birthing services and support services, including timely postpartum care.

 

The Title V Program will lead the following specific program and policy activities to advance this strategy over the upcoming 2023-24 year:

 

• Activity WMH-2.1: Collaborate with birthing hospitals and Regional Perinatal Centers to support new regulatory requirements related to providing referral and support for ancillary services, including mental health, alcohol and substance use treatment and other services.
  • Title V staff will continue to coordinate NYSDOH’s response to public comments and adopt regulations related to perinatal services in hospitals, as well as the state’s regional perinatal network, including midwifery and physician-led birth centers as the first level of care. Following adoption of these regulations, work with Island Peer Review Organization (IPRO), which has a contract with NYSDOH to support this work, to develop and implement a redesignation survey based on the new regulations. Each birthing hospital will complete the survey of their intended level of care (which may mean hospitals requesting to increase or decrease a level of care). These surveys will be reviewed, and a portion of the applicants (20% of birth centers, Level 1 and Level 2 birthing hospitals, and all Level 3 and Regional Perinatal Center applicants) will have an on-site visit with IPRO staff and contracted neonatologists and/or maternal-fetal medicine specialists, to verify that the applicant meets the regulatory requirements and can provide appropriate care. Title V staff will also coordinate and support Regional Perinatal Centers as they work with their affiliate birthing facilities to meet the new regulatory requirements related to providing referral and support for ancillary services, including mental health, alcohol and substance use treatment, and other services which are not requirements under current regulations.

(See Activity PIH-2.1 for additional details.)

 

• Activity WMH-2.2: Improve coordination and increase bilateral referrals between birthing hospitals and home visiting programs. Title V staff will:
  • Continue to assist in connecting Perinatal and Infant Community Health Collaborative programs with their local birthing hospitals and support formal meetings where possible. Resources will be shared with programs and evaluation surveys conducted to determine use and effectiveness of resources. Perinatal and Infant Community Health Collaborative program data will also continue to be monitored to track incoming client referrals from birthing hospitals.
  • Share a promising and best practices document with input from established home visiting-birthing hospital partnerships across the state to encourage collaboration.
  • Collaborate with Perinatal and Infant Community Health Collaborative; Maternal, Infant, and Early Childhood Home Visiting; Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC); and the NYS Office of Children and Family Services on a WIC Referral Project and the State’s Maternal, Infant, and Early Childhood Home Visiting  continuous quality improvement project, to improve bi-directional referrals between local WIC sites and local Perinatal and Infant Community Health Collaborative and Maternal, Infant, and Early Childhood Home Visiting home visiting programs.

 

Strategy WMH-3: Apply public health surveillance and data analysis findings to improve services and systems related to maternal and women’s health care.

 

Data-driven, evidence-based practice is essential to achieving public health goals for the Title V program. Across all Title V programs, continuous effort is needed to enhance the collection, analysis, and sharing of data to inform the planning and implementation of Title V-funded programs and policy work. Sharing data with stakeholders, including providers and community members, is critical to raising awareness, empowering community action, and facilitating quality improvement efforts at all levels. 

 

In 2019, the NYS Task Force on Maternal Mortality and Disparate Outcomes released a report that detailed ten recommendations to better address maternal mortality and morbidity. Included in these recommendations was a call to establish in statute a statewide maternal mortality review board. Public Health Law 2509 authorized the establishment of a maternal mortality review board and allowed the Department to enter into an agreement with New York City to conduct reviews of maternal deaths occurring within the NYC. In 2019, the multidisciplinary NYS Maternal Mortality Review Board was established, and NYC continued to operate its Maternal Mortality and Morbidity Review Committee. PHL 2509 also authorized the establishment of an advisory council on maternal mortality and morbidity for the purpose of reviewing the findings of the state and city boards. The council, known as the Maternal Mortality and Morbidity Advisory Council, is authorized to develop recommendations on policies, best practices, and strategies to prevent maternal mortality and morbidity.

 

Title V staff will continue to implement a comprehensive review process with the multidisciplinary NYS Maternal Mortality Review Board for the purpose of reviewing maternal deaths and maternal morbidity. The Maternal Mortality and Morbidity Advisory Council will continue to meet virtually, about four to six times per year, to enable timely maternal death reviews. NYS has an established a public health surveillance process in place to identify and review cases of maternal death through multiple sources of public health data and chart reviews. The Maternal Mortality and Morbidity Advisory Council will assess the causes of deaths, factors leading to the deaths, preventability for each maternal death reviewed, and develop recommendations to reduce the risk of maternal mortality and morbidity, including risk resulting from racial, economic, or other disparities. Recommendations based on the review of the 2018 maternal death cohort have been presented to the Maternal Mortality and Morbidity Advisory Council. The Maternal Mortality and Morbidity Advisory Council is meeting to develop their own recommendations with anticipated release of those recommendations in the fall of 2023. The Maternal Mortality and Morbidity Advisory Council recommendations for preventability will be translated into action through collaboration with the Maternal Mortality and Morbidity Advisory Council, the American College of Obstetricians and Gynecologists District II NY, and other key stakeholders, including the development of issue briefs, webinars, and quality improvement projects through the NYS Perinatal Quality Collaborative. (See Strategy PIH-3 for additional details.)  

 

In 2023, the Department has been assessing the implementation of 2018 Maternal Mortality and Morbidity Advisory Council recommendations and will continue to direct its efforts at implementation of recommendations with partners through policy development and quality improvement work.

 

Based on analysis of qualitative data obtained from 2018 listening sessions that engaged over 200 women statewide, NYSDOH has also developed a comprehensive interdisciplinary hospital quality improvement project through the NYS Perinatal Quality Collaborative focused on birth equity and anti-racism. The New York State Birth Equity Improvement Project, which launched in January 2021, has engaged birthing facility staff from clinical, administrative, and executive levels to analyze facility policies and procedures that may contribute to bias and develop strategies to improve outcomes. As with all NYS Perinatal Quality Collaborative projects, Title V staff will continue to collect and analyze project data and share results with partners to influence policy and decision making.

 

Additional prevention efforts in the areas of congenital syphilis and sexual violence prevention will also be conducted. Efforts to address and eliminate congenital syphilis are currently in development and led by the NYSDOH AIDS Institute’s Office of Sexual Health and Epidemiology. Specific activities, and the role(s) of Title V staff, will be determined in collaboration with Office of Sexual Health and Epidemiology.

 

The Title V Program will lead the following specific program and policy activities to advance this strategy over the upcoming 2023-2024 year:

 

• Activity WMH-3.1: Summarize, share, and discuss findings of the Maternal Mortality and Morbidity Advisory Council with key partners, including the Maternal Mortality and Morbidity Advisory Council, to inform statewide prevention strategies as described above.
  • Title V staff will continue to meet with the Maternal Mortality and Morbidity Advisory Council at least twice annually to share and discuss findings of the Maternal Mortality and Morbidity Advisory Council and obtain Maternal Mortality and Morbidity Advisory Council recommendations on statewide prevention strategies. They will also continue to create and publish at least one issue brief annually on a key topic identified by the Maternal Mortality and Morbidity Advisory Council that can inform prevention strategies.
• Activity WMH-3.2: Issue and disseminate a maternal mortality report and an Executive summary to provide data and information that can be used to improve maternal outcomes.
  • Title V staff will conduct analysis of maternal mortality data for the 2018-2020 cohort. The anticipated publication date is 12/31/2023.
• Activity WMH-3.3: Identify cases of severe maternal morbidity through hospital discharge data to conduct an analysis assessing severe maternal morbidity trends, major causes, and disparities during the 2011-2021 period. 
  • Title V staff are in the process of developing a surveillance report of severe maternal morbidity, with a target publication date of 12/31/2023.
• Activity WMH-3.4: Through the NYS Perinatal Quality Collaborative, continue work on the NYS Birth Equity Improvement Project, a comprehensive interdisciplinary quality improvement project focused on implicit bias and birth equity (see Strategy WMH-4 below for further detail). 
• Activity WMH-3.5: Collaborate with NYSDOH AIDS Institute and the New York City Department of Health and Mental Hygiene on efforts to address significant increases in the number and rate of infectious (primary, secondary, and early latent syphilis among NYS females of childbearing age (See Activity PIH-3.5 for additional details and activities).

 

Strategy WMH-4: Apply a health equity lens to Title V activities to address social determinants of health and reduce disparities that impact women’s health and use of health care across the life course.

 

Women and Maternal Health outcomes are impacted by the social determinants of health, or the conditions in which people are born, live, work, play, learn, and age. The social determinants of health include factors like socioeconomic status, education, community environment, employment, social supports, and access to health care services. Systematic differences in the distribution of power and resources due to racism and other biases are root causes of inequities in access, availability of services, and quality of care. All ten priorities that emerged from community members' input during the Needs Assessment revolve around the social determinants of health and inequities. These factors and inequities impact the health outcomes of both individuals and entire communities.

 

The NYS Title V Program strives to contribute to broad-based efforts to address inequity and the social determinants of health. Strategies focus on 1) improving outreach to women, who have been disproportionally impacted by systemic barriers and are located in areas with limited access or have factors limiting their access to care, and their families to ensure they have health insurance and health care, have knowledge of available community resources and supports, receive high quality care and services, and have  supports, opportunities, and an environment that promote and facilitate healthy behaviors across the lifespan; 2) involving community members in program implementation and policy; and 3) promoting community engagement and mobilization to  proactively address bias and racism and other community and systems-level factors impacting racial and ethnic disparities.

 

 

The Title V Program will lead the following specific program and policy activities to advance this strategy over the upcoming 2023-24 year:

 

• Activity WMH-4.1: Through the Perinatal and Infant Community Health Collaborative programs, continue to work with diverse community stakeholders including community residents to identify and collaboratively address issues and barriers impacting perinatal and infant health outcomes at the community level, including to the following activities:

• Actively facilitate/participate in community advisory boards, consortiums, or coalitions to address issues impacting perinatal and infant health and identify effective strategies for addressing the social determinants impacting those outcomes.
• Engage and partner with diverse stakeholders from a wide array of community sectors including community residents, grassroots organizations, community-based service organizations, health care providers, local government, local foundations, and local businesses. 
• Work collaboratively to address relevant community issues such as safe housing, availability and accessibility of resources and services (e.g., health care, mental health, substance abuse services, home visiting, family support resources), social norms (e.g., related to use of preventive care services, breastfeeding, or personal health behaviors), and community mobilization to effectively identify and address community problems.

• Activity WMH-4.2: The Perinatal and Infant Community Health Collaborative programs’ Community Health Workers, as well as Maternal, Infant, and Early Childhood Home Visiting’s NYSDOH-led Nurse Family Partnership and NYS Office of Children and Family Services-led Healthy Families New York programs, continue to provide supports to individual clients and their families to address behavioral and social determinants of health outcomes, including the following specific program activities:
  • Provide information on available community resources for needs related to housing, food, employment and job training, transportation, and other basic needs. Perinatal and Infant Community Health Collaborative program policy was developed (per the recommendations of the NYS Expert Panel on Postpartum Care.) to support Perinatal and Infant Community Health Collaborative contractors to continue functioning as Stress-Free Zones (to the extent possible), creating a community in which birthing people have access to essential wraparound and care coordination services.
  • Routinely screen for health insurance enrollment, and assist clients with enrollment as needed, including referral to enrollment Navigators and Community Health Advocates.
  • Conduct screenings using standardized, evidence-based, or validated tools for domestic violence, substance use, smoking, and depression, and make referrals for follow-up as needed. Perinatal and Infant Community Health Collaborative, Nurse Family Partnership and Healthy Families New York program data will be collected and monitored via a web-based data management and information system.
  • Help families connect and use or enroll in enhanced social support resources and programs including parenting classes, peer support groups, childbirth education and resources, breastfeeding education, and directly support clients to develop birth and postpartum care plans.
  • To best support and empower the work of Community Health Workers, the Perinatal and Infant Community Health Collaborative program established policy to ensure Community Health Workers are fairly compensated with a salary comparable to a living wage. Title V staff will continue to assess the salary and ensure Community Health Workers have a livable wage in light of inflation and other factors.
  • Through a new Perinatal and Infant Community Health Collaborative training and technical assistance contractor, John Snow Inc. (JSI), effective 10/1/22, will provide professional development support for Community Health Workers to delivery these services, including annual training on how to talk with families about difficult topics like mental health and depression, using a trauma informed care approach, and how to manage emergency situations. Training and technical assistance will include assessing the training needs of funded grantees and providing appropriate technical assistance, developing/conducting web-based and in-person trainings, ensuring competencies of Community Health Workers and supervisors, standardization of best practice strategies, promoting/conducting Continuous Quality Improvement activities, and conducting an annual learning collaborative. JSI will also host a Perinatal and Infant Community Health Collaborative website/page, providing access to available trainings, resources, and opportunity for Perinatal and Infant Community Health Collaborative programs to communicate their training needs.

• Activity WMH-4.3: Collaborate with partners, including:

• Prevent Child Abuse New York, the NYS Office of Children and Family Services, and the Schuyler Center for Advocacy and Analysis (SCAA) Home Visiting Workgroup to integrate parent engagement and leadership into state level home visiting efforts. In 2024, Maternal, Infant, and Early Childhood Home Visiting staff have proposed to initiate and implement a statewide parent advisory committee, which will consist of parents who are current or former home visiting clients. Through parent engagement and leadership, the parent advisory committee will provide input on matters of interest to state agency partners and develop professional skills. Title V and Maternal, Infant, and Early Childhood Home Visiting staff will share lessons learned with Perinatal and Infant Community Health Collaborative programs to enhance their community member participation on Community Advisory Boards.
• NYS Office of Mental Health’s Project TEACH, American College of Obstetricians and Gynecologists District II NY, home visiting programs and other community-based organizations, will work together to continue to address mental health in pregnant and postpartum people by increasing screening and follow-up support.

• The NYS Perinatal Quality Collaborative has worked in collaboration with Project TEACH, and American College of Obstetricians and Gynecologists District II NY to host a series of five webinars to date focused on maternal mental health. Specifically, these webinars have focused on perinatal mood and anxiety disorders; developing an integrated maternal mental health/obstetrics practice; the integration of maternal mental health in obstetrics using an employee-based insurance model; maternal mental health disparities and steps for achieving equity; and the impact of social determinants of health on maternal mental health with an emphasis on Black and Latinx populations. The NYS Perinatal Quality Collaborative continues to meet with staff from Project TEACH and American College of Obstetricians and Gynecologists District II NY on a quarterly basis to plan for the development of new webinar topics.

• The Perinatal and Infant Community Health Collaborative program will be updating the data management information system to add an additional postpartum depression screening within three months of giving birth (in addition to at initial intake) for all birthing clients. Community Health Workers will continue to assist individuals with the development of a postpartum care plan and provide information, guidance, support, and referrals to needed services. Perinatal and Infant Community Health Collaborative program staff will be continuously trained and updated on postpartum care and available resources through the dedicated Perinatal and Infant Community Health Collaborative training website provided by JSI.

• Activity WMH-4.4: Collaborate with NYS Perinatal Quality Collaborative on the NYS Birth Equity Improvement Project.
  • The Title V Program, in collaboration with the NYS Perinatal Quality Collaborative, will continue the work of the NYS Birth Equity Improvement Project to assist birthing facilities in identifying how individual and systemic racism impacts birth outcomes at their organizations and to take action to improve both the experience of care and perinatal outcomes for Black people who give birth in the communities they serve. Monthly data collection and analysis for the project will continue through the application period. Participating facilities will continue to participate in educational opportunities focused on anti-racism and the impact of bias in perinatal health care as well as reducing primary cesarean births for low-risk birthing people (i.e., Nulliparous, Term, Singleton, Vertex, or NTSV, deliveries), develop new and/or improved existing policies related to birth equity to better meet the needs of their community, and work to ensure they are centering the experience of Black birthing people through the ongoing administration of the Patient Reported Experience Measure. 

• Activity WMH-4.5 Through the Infertility Reimbursement Program, provide reimbursement for out-of-pocket costs associated with in vitro fertilization (IVF) and fertility preservation services to individuals who meet eligibility criteria.
  • The Infertility Reimbursement Program was developed to align with NYS insurance law effective 1/1/2020, which requires all large cap insurance plans to provide three cycles of in vitro fertilization (IVF), fertility preservation services, and added requirements that prevent discrimination based on an individual’s expected length of life, present or predicted disability, degree of medical dependency, perceived quality of life, or other health conditions, or based on personal characteristics, including age, sex, sexual orientation, marital status, or gender identity. The new law also includes a state definition of infertility that is more equitable. Infertility Reimbursement Program patient participation is inclusive of Medicaid recipients, making the program more accessible to individuals with limited income, the unemployed, or those lacking health insurance through their employer. Title V staff will provide guidance, monitor activities, and collect data from six contractors awarded funding for a two-year period from 10/1/22-9/30/24. Staff will also monitor the program’s public mail log and respond to questions received about how to access infertility services in NYS.

• Activity WMH-4.6: Improve uptake of the COVID-19 vaccination among people who are pregnant, in the postpartum period and/or lactating, and of those people's families, with an emphasis on equity and those populations disproportionately affected by the COVID-19 pandemic. Title V staff will:

• Host educational webinars for perinatal care providers, assist NYS birthing facilities with the development and/or updating of their COVID-19 vaccination policies, and develop resources geared towards providers and/or patients
• Develop multi-media campaigns on vaccine hesitancy for individuals of reproductive age. In collaboration with the NYSDOH’s Bureau of Marketing and Creative Communications, NYS recently launched the COVID-19 and Pregnancy Media Campaign. Promotional materials were developed to increase vaccination uptake for pregnant and postpartum people and their families. Phase 1 of the campaign launched in Fall 2022 and focused on promoting COVID-19 vaccination during the perinatal period with the development and dissemination of promotional materials such as Facebook posts, bus flyers, and other social media. During December, Phase 2 of the campaign launched and focused on sharing testimonials from perinatal providers on their experience with COVID-19 vaccination during pregnancy. Two perinatal providers were identified who were interested in participating in the COVID-19 and Pregnancy Media Campaign. One of the providers identified was from the University of Rochester Medical Center and the other from Northwell Health. The providers’ testimonials included their experience with receiving the COVID-19 vaccination during pregnancy and the benefits of the vaccine. Title V staff will continue to promote these materials to partners.

•  Activity WMH-4.7: Update and improve the NYS Sexual Assault Victim's Bill of Rights.

• The Sexual Assault Victim's Bill of Rights was developed in 2019. The Bill of Rights will be updated to improve health literacy and translated into the 10 most common languages in NYS. The new Bill of Rights will include improved design features that make it easier for victims/survivors to understand the information and bring the document home safely. Most importantly, the new Bill of Rights will update necessary language on changes to Public Health Law since 2019 that improve access to HIV post-exposure prophylaxis for minors. 

• Activity WMH-4.8: Breastfeeding Support

• Title V staff will participate in the Breastfeeding Grand Rounds planning committee in collaboration with Division of Chronic Disease and Division of Nutrition. Breastfeeding Grand Rounds webcasts are created for public health and health care professionals and feature clinical experts paired with public health experts to provide education on current breastfeeding health issues with both clinical and public health significance.

• Activity WMH-4.9: Develop and deliver a health equity training to staff within the Bureau of Perinatal, Reproductive, and Sexual Health, and Division of Family Health staff who participate on the Racial Justice Workgroup.

• The Sexual Violence Prevention Unit’s Rape Prevention and Education Program has hired a consultant to develop and deliver a training series on Antiracist Health Equity for 50 internal Bureau of Perinatal, Reproductive, and Sexual Health staff. This training will be held in Fall 2023 and will consist of six live, two-hour virtual trainings. The consultant will also submit a final report of evaluations from each individual training and an aggregate assessment of the combined trainings with recommendations for potential future training and/or reinforcement of antiracism approaches within the Bureau.

• Activity WMH-4.10: Improve reproductive healthcare for the substance use population.

• The NYS Family Planning Program is collaborating with the AIDS Institute’s Office of Drug User Health to address disparities in family planning/reproductive health in the substance use population, creating partnerships and strong referrals between Family Planning Program and their Syringe Exchange Programs to strengthen reproductive healthcare and primary care.

• Activity WMH-4.11: Provide resources for Black birthing people to advocate and communicate effectively with healthcare providers.

• In 2018, the Department conducted seven community listening sessions with birthing people and other stakeholders. Poor communication with health care providers (e.g., feeling providers were not listening to them, that they were not given enough time with providers, and that few providers reflected their lived experience) was reported as a barrier to receiving optimal prenatal care. As one strategy to address this barrier, a communication guide for birthing people to promote effective communication with their health care provider is being developed and will be disseminated to partner organizations, including home visiting programs. Development plans for the draft guide, titled “My Voice Matters” was presented on 11/16/22 to an internal Department planning committee. The purpose of the guide is to improve birth outcomes by empowering and encouraging all birthing people and their advocates to speak up and participate in their antenatal care and decision-making and improve communication between providers and all birthing people. A planning subcommittee will meet monthly to develop the guide. The planning committee will supervise and provide feedback on the development of the guide to the subcommittee. The proposed timeline for release of the guide is January 2024.

 

• Activity WMH-4.12: Engage with Maternal, Infant, and Early Childhood Home Visiting (Healthy Families New York and Nurse Family Partnership) and Perinatal and Infant Community Health Collaborative providers to promote the availability of diapers through the NYCARES/Baby2Baby Diaper Bank.

• Title V staff will collaborate internally and with state partners at the Office of Temporary Disability and Assistance (OTDA) to coordinate access to free diapers for families served by NYS home visiting programs.

 

The NYS Title V Program established two Evidence-Based Strategy Measures (ESMs) to track the programmatic investments and inputs designed to impact NPM1:

 

ESM WMH-1: Percent of Perinatal and Infant Community Health Collaborative program participants engaged prenatally who have created a birth plan during a visit with a Community Health Worker.

 

Data for this measure will be obtained from monthly reports submitted by local Perinatal and Infant Community Health Collaborative contractors in the data management information system. The baseline value for this measure, taken from the 12-month program period of 4/1/21-3/31/22, is 43.4%. The Perinatal and Infant Community Health Collaborative program has set an objective of 64.1% of participants by 2024.

 

ESM WMH-2:  Percent of Family Planning Program clients with a documented comprehensive medical exam in the past year.

 

Data for this measure will be obtained from Family Planning Program clinic visit record data. For the program period 10/1/20-9/30/21, 32.8% of female Family Planning Program clients had a documented comprehensive medical exam. The Family Planning Program has set an objective of 38.2% in 2024.