2020 Application Year Report

SPM 2 - Percent of infants placed to sleep on their backs

Objectives:

- Leverage existing program partners to increase the number of home visitation and perinatal case management programs trained in Safe Sleep and Shaken Baby education from 5 to 15, statewide by 2020.

- Transition at least five NM birthing facilities to report standardized statistics for Shaken Baby Syndrome (SBS) Education to the NMDOH in 2020.

- Increase the number of NM birthing facilities trained by the NMDOH in safe sleep education protocols from 3 to 15 by 2020.

Strategies:

- Support the passage of legislation mandating hospitals to provide and support Safe Sleep certification for their birthing center staff.

- Develop and track a data collection protocol for Shaken Baby Education at NMDOH; tie use of protocol to certification to incentivize hospitals.

- Participate in an evaluation of Shaken Baby and Safe Sleep Education delivered by NMDOH.

- Draft and present a statewide, multi-sector Safe Sleep Strategy Plan to the Cabinet Secretaries of DOH and CYFD and the NM Children’s Cabinet.

Objective: Leverage existing program partners to increase the number of home visitation and perinatal case management programs trained in Safe Sleep and Shaken Baby education from 5 to 15, statewide by 2020.

For the upcoming year, 2020, we will continue to work with partners in DOH Office of Injury Prevention, Health Systems Bureau and at the Office of the Medical Investigator/Center for Disease Control (OMI/CDC) Sudden Unexpected Infant Death (SUID) registry, Tewa Women United, NM birthing facilities, Navajo Nation and Indian Health Service (IHS) health promotion and home visiting programs. The Child Health Program health educator, funded out of Title V, will continue to provide safe sleep and SBS trainings for parents, child care workers and home visitors statewide. 

Our work will continue to focus on promoting combined breastfeeding and safe sleep education for NM families, following national guidelines. In 2020 activities in New Mexico will include joining partners in conducting an environmental scan of program practice and policy across New Mexico. We will use this scan to further develop a Statewide Safe Sleep Strategic Plan and promote evaluation of statewide capacity around safe sleep education. From there, we will develop and share the resulting logic model and the plan to draft process measurements and tasks for team review. This process involves partnership with Children, Youth and Families Department (CYFD) home visiting programs, tribal home visiting sites, Families FIRST case management, Public Education Department (PED), Office of African American Affairs, Many Mothers, NM Graduation Reality and Dual Role Skills (GRADS) program, NM Hospital Association, March of Dimes (MOD), Indian Health Services providers, community doula programs, and the WIC breastfeeding counselor program.  It is our goal to use the Statewide Strategic Safe Sleep Plan to align and coordinate disparate safe sleep efforts in the state and promote consistent messaging. 

Another activity that will help us reach our new objective involves convening existing stakeholders from the Child Fatality Review (central OMI); University of NM; NMDOH; NM CYFD; Tribal Organizations; home visiting programs; NM Breastfeeding Task Force; Voices for Children; and the March of Dimes to begin the strategic planning process. Utilize quarterly inter-agency meetings (CYFD-DOH). In the upcoming year we will start holding quarterly interagency strategy and communication meetings between NMDOH and CYFD programs (to include CYFD Home Visiting staff), MOD, PED, clinicians and community health workers, and Human Service Department/Medicaid staff.

Through our partnerships, we also plan to combine child protective and calming techniques in trainings and evaluate cultural adaptability and suitability for different community settings. We will work with Tribal Epidemiology Centers, UNM and the NM Pediatric Society to assess approaches to safe sleep products and education and media-messaging. We also plan to work with Many Mothers, Young Women United, and Tewa Women United to evaluate Baby Box distribution and recommend next steps.

Preliminary plans will start with the development of regional messaging and cultural adaptability with consultants in Albuquerque and rural communities and specifically include breastfeeding promotion in messaging efforts with a focus on minority populations disproportionately impacted by SUID and lower breastfeeding rates (e.g. African-American and Native American families). We will simultaneously utilize Title V and partner participation in the Infant mortality CoIIN safe sleep strategy network, the social determinants of health/health equity CoIIN strategy network, and other partnerships to develop a transition from perinatal education to early childhood/infant health and safety collaboratives. In addition, reviewing current national campaign materials (National Institute of Child Health and Human Development - NICHD) to increase safe sleep awareness and media messaging on CYFD and DOH websites and community resources for families will enable us to keep up to date on current practices.      

Lastly, in order to get NM birthing facilities to report standardized statistics for SBS to NM DOH by 2020, we plan to expand the number of DOH and state agency Child Fatality Review participants and stakeholders. This will help to develop recommendations with actionable strategy items for families and regions most at risk for SUID/SBS.

Objective. Increase the number of NM birthing facilities trained by the NMDOH in safe sleep education protocols from 3 to 8 by 2020.

For the Title V program to be able to increase the number of programs and facilities with both SBS and Safe Sleep trained staff, our first strategy will be employing the results of the strategic plan and environmental scan, formative evaluation plans, logic model, and local engagement strategy plans. The work moving forward will be facilitated through multi-sector engagement with the March of Dimes program service committee in safe sleep strategies by communicating invitations to representatives from state agencies, NM Hospital Association, NM Voices for Children and Federal MIECHV and tribal home visiting sites. Inter-agency meetings will convene to implement the first phase of the strategy plan beginning in 2020 and will assess ways to integrate breastfeeding promotion with safe sleep curricula in different clinical and program service settings.

Other ways that we can advance this work is through supporting regional and local efforts (Child Protective Service (CPS) trainings and hospital protocols) to continue expanding e-learning modules in development with CPS. Expanding the e-learning offerings to Early Head Start, pre-school, daycare and home visiting programs will also serve this purpose as will working with the NM Hospital Association and NM Pediatric Society, Medicaid Managed Care Organizations, and NM Breastfeeding Task Force to consider an incentive program for hospitals and birthing centers successfully demonstrating both safe sleep and breastfeeding promotion with families. To incentivize hospital participation, the Title V funded Child Health Program in FHB is planning to purchase safe sleep books for hospitals to give to every baby born in NM in 2020. 

Objective. Transition at least five NM birthing facilities to report standardized statistics for Shaken Baby Syndrome (SBS) Education to the NMDOH in 2020.

To work towards completing this stated objective in the upcoming year, one step we can take is to combine legislative language already enacted for shaken baby education with introduction of safe sleep prevention at the same birthing facilities. The NM DOH Injury Prevention Bureau is responsible for promulgating rules around SBS education and data reporting, which will hopefully be complete in the next six months.  We will also incorporate data collection and reporting specifications in NMDOH rules to track numbers of families trained in both safe sleep and SBS prevention education. One of our specific goals is to report annually on statewide education occurring at birthing facilities. Additionally, we intend to contribute to the analysis of NM SUID registry data and publication as well as staff a full-time position in MCH Epidemiology or in the Office of Injury Prevention to support SBS and SUID analysis.

2020 Annual Plan Perinatal-Infant

NPM 4:  A) Percent of infants who are ever breastfed

   B) Percent of infants breastfed exclusively through six months

Objectives:

• Increase the proportion of birthing facilities with Baby-friendly designation and   corresponding self-reported experience in PRAMS by 50% by 2020.
• Increase the degree of cultural specificity and awareness in the breastfeeding         education/training with at least two home visiting programs by 2019.
• Increase the proportion of NM health providers reporting confidence in their    capacity to address at least three predictors of breastfeeding duration by 2020.

Strategies:

• Utilize PRAMS and the NM Toddler Study to measure the correspondence between self-reported experience and the facility identification as Baby-Friendly.
• Collaborate with the March of Dimes, Office of the Medical Investigator, Indigenous Women Rising or Young Women United to create or adapt culturally resonant language for breastfeeding-friendly, safe sleep education and messaging.
• Collaborate with the NM breastfeeding taskforce and the WIC breastfeeding program to monitor anticipated progress in breastfeeding initiation and duration at baby-friendly facilities in NM.
• Share data and combine analytic efforts with the UNM Pediatrics and Envision Community Advisory Board (CAB), the NM Breastfeeding Taskforce and NMDOH to document the quality improvement of breastfeeding support and breastfeeding-friendly workplace policies in NM.
• Execute agreements with at least two home visiting or doula program sites to integrate linguistically and culturally functional evidence-based, safe sleep and breastfeeding concepts in their education protocols in 2019.

Objective- Increase the proportion of NM health providers reporting confidence in their    capacity to address at least three predictors of breastfeeding duration by 2020.

Community Advisory Board, NM Breastfeeding Taskforce and NMDOH Title V Collaboration

The NM Breastfeeding ‘Community Advisory Board’ (CAB) assesses provider knowledge on breastfeeding competencies and confidence in educating women on key predictors and support services associated with longer breastfeeding duration. NMDOH Title V staff will continue to participate in and provide professional consultation to the NM Breastfeeding Community Advisory Board and collaborate with the New Mexico Breastfeeding Taskforce to improve provider competencies and increase support to women to achieve longer breastfeeding duration. FY20 plans fall into three programmatic areas:

1. Develop 2020 NM Telehealth web-based presentations and specialized subject matter presentations with the Envision NM, UNM Department of Pediatrics, Tewa Women United, the Navajo Breastfeeding Coalition and the NM Birth Equity Collaborative.  Appraise provider confidence through pre and post-test telehealth offerings by Envision NM and in two NMDOH-UNM collaborative projects, the Breastfeeding Evaluation Study and the Retrospective WIC Peer Counselor Study.
2. Expand the Breastfeeding Evaluation Study (bEST) data collection to two additional sites. The bEST study is an outpatient survey of women with a 6-week postpartum clinical visit to measure duration of breastfeeding, support received and barriers to continuation. We will present findings of the Breastfeeding Evaluation Study (bEST) to clinical staff in clinical Grand Rounds and develop strategies to address varying barriers to breastfeeding duration at one, two and six weeks, post-partum. Clinical provider training will be built from the results analyzed from 2017-2018 data collection.
3. Incorporate lactation support competency areas into the DOH Community Health Workers Program to expand the delivery of lactation trainings for Community Health Workers (CHWs) and home visiting staff seeking certification through the NM Department of Health. This expanded breastfeeding curriculum was developed and piloted with the NM WIC Peer Counselor Program, bilingual promotoras, Community Health Representatives and tribal home visiting staff. Expansion and acceptance of the curriculum requires additional stakeholder input and adaptation for different programs across the state.

Objective- Increase the degree of cultural specificity and awareness in the breastfeeding education/training with at least two home visiting programs by 2019.

Breastfeeding on the Border Project

The Breastfeeding on the Border Project (BBP) is a binational effort to increase breastfeeding rates in US/Mexico border communities, funded by the NM Office of Border Health. FY2020 goals of the BBP include increasing breastfeeding rates in three rural border communities in New Mexico through three objectives: 1) Build on the Hospital Baby-Friendly Initiative (BFHI) by providing a resource for referral for lactation support after hospital discharge (BFHI step 10); 2) Support the 2011 US Surgeon General’s Call to Action to Support Breastfeeding;  3) Bridge health and racial disparities along the US/Mexico border through forming binational partnerships and equipping partners and health promoters in basic lactation to increase accessibility to bilingual health services and resources. To meet the objective 3) the BPP will hold a community-wide event hosted in rural border communities (Anthony, Chaparral, Sunland Park) to introduce them to local breastfeeding coalitions and connect health organizations and family members, and then to offer a NMDOH Community Health Worker training, using the CDC Loving Support peer counselor 12-hour curriculum (English and Spanish). Once complete, the health workers can apply for a lactation consultant certificate with NMDOH.

The BBP will continue to partner with the Binational Breastfeeding Coalition https://www.borderbreastfeeding.org/ to provide the “Look Who’s Talking” Lactation Educational Series to regional health care professionals and families. This series will be offered to home visiting staff and will engage specifically with health promotions staff/ promotores and providers working across multiple systems of care. Cariño Home Visiting, serving predominantly Spanish-speaking families in Las Cruces and surrounding rural communities works with Ngage New Mexico, a non-profit which serves as a backbone organization for an early education initiative called SUCCESS! Partnership in Doña Ana County. This partnership uses a collective impact framework to support families through resource leveraging and continuity of services, and we are working through the statewide Home Visiting Collaborative to bring more health services support to these existing partnerships. In FY20 NM Title V staff and WIC staff will provide technical assistance and cultural bridging to offer bilingual lactation support training and resource alignment between cross-referring home visiting, nutrition services and perinatal case management partners.

Ben Archer Healthy Start, Families FIRST case management and WIC will continue to coordinate with local delivery hospitals (Mountainview and Memorial) to provide post-delivery, bilingual support and referrals to women who wish to continue breastfeeding their infants. Through WIC and Breastfeeding on the Border lactation support, women residing in areas outside Las Cruces are reached through home visits or community-based locations. For women participating in WIC, Healthy Start or Families FIRST perinatal case management, referrals are made to Breastfeeding ‘Sisters’ who are certified lactation heath workers to provide peer counseling support after delivery.

WIC peer counselors provide both breastfeeding and safe sleep assessment and education with their clients, however, individual home visiting programs practice different models of care. The Sisters on the Border approach builds on the WIC peer counselor structure with promotoras (lay health workers) to provide breastfeeding education and one-on-one support to women in rural communities where transportation, language and insurance access make it very challenging to access lactation, health or medical care services. FY20 plans focus on exclusive breastfeeding support because Black and Hispanic women have the highest rates of formula supplementation within two days of birth (Perez-Escamilla 2019 and  Chapman, Perez-Escamilla 2012 https://www.ncbi.nlm.nih.gov/pubmed/22332107). Efforts to change this pattern require collaboration and coordination across different sectors, and Sisters on the Border successfully models that in New Mexico communities. Exclusive breastfeeding is recommended for the first six months of life, and while NM enjoys high initiation rates, we struggle with duration and especially duration of exclusive breastfeeding. Women of color, low-income and monolingual Spanish-speaking women have lower access to healthcare, and the challenges they face in breastfeeding continuation are greater in magnitude compared to the aggregate birth population.

Food Sovereignty/First Foods

Navajo Breastfeeding Coalition and Zuni Breastfeeding Coalition are building unique and robust community-based spaces and policies to encourage and normalize and reclaim breastfeeding. Five Sandoval, Eight Northern Indian Pueblos and Santo Domingo WIC among other tribe-serving organizations have addressed breastfeeding promotion in innovative and self-determining ways. Because tribal nations have a colonial history of rationed and processed foods forced upon their people, breastfeeding promotion carries a reclaiming of feeding traditions and resistance to continued marketing and saturation of unhealthy or suboptimal nutrition products, such as infant formula. Tribal home visiting programs serving San Felipe Pueblo, Tiwa Babies Program (Taos) and Native American Parent Professional Resources (NAPPR) each has a unique approach to breastfeeding reclamation, and Title V partners support these communities upon request. We do not have an explicit Title V FY20 strategy plan for this work because it is not our role to lead. But, through the statewide Home Visiting Collaborative, MCH Epidemiology and the Title V Director participate in data provision, evaluation and policy development to support and share resources with home visiting programs. We will partner with the Albuquerque Area Southwest Tribal Epidemiology Center, Navajo Epidemiology Center and the LANL Pueblo Outreach Program to share research techniques and follow community-led and sovereign data collection processes.

Breastfeeding Friendly Workplace Development

Title V and the NM Breastfeeding Task Force will continue collaboration to promote family-friendly and breastfeeding-friendly workplace policy and practice in New Mexico. The areas of focus for FY20 are:

1. Promoting family-friendly workplace awards and recognition with Family Friendly NM and the Southwest Women’s Law Center Paid Family Medical Leave Coalition; support employer survey development, PRAMS maternal work leave analysis and evidence-based recommendations;
2. Research family-friendly and breastfeeding-friendly laws passed in other states and provide data briefs, economic impact summaries and recommendations to the NM Southwest Women’s Law Center Paid Family Leave Coalition;
3. Both Title V and the NMBFTF plan to support FY20 strategies with the NM Birth Equity Collaborative (NMBEC), Nuestra Salud, LLC and Envision New Mexico to incorporate health equity principles and training topics in hospital summits and web-based or provider education (implicit bias and social determinant medical coding) objectives. Building on existing telehealth offerings through the NM Breastfeeding Task Force and the NMBEC, this will strengthen inclusion of national experts including Jennie Joseph (The JJ Way®) in FY20. Joseph, a British-trained midwife is a nationally-recognized speaker and trainer on patient-centered care which places value on listening to mothers in care, creating perinatal safe spots (support circles and referral agency homes) and giving women tools and methods for self-advocacy in their care.

Objective- Increase the proportion of birthing facilities with Baby-Friendly designation and corresponding self-reported experience in PRAMS by 50% by 2020.

The New Mexico Breastfeeding Task Force (NMBTF) continues to expand efforts to increase the number of New Mexico hospitals births occurring in Baby-Friendly USA designated facilities. San Juan Regional Medical Center is the most recent NM hospital to achieve Baby-Friendly designation.  WIC staff support 20 community lactation support groups statewide and serve as a resource for hospitals seeking Baby-Friendly designation or refresher trainings.

Data collection and analysis

a. Comparison of Baby-Friendly designated hospitals or regions with prevalence of baby-friendly indicators in PRAMS.

Findings from these FY18 analyses indicate that while baby-friendly hospital staff are increasing their provision of breastfeeding-supportive practices, at least 50% of the birth population should be reporting these experiences, and we are under 30% prevalence as a state. To improve monitoring at the facility level, PRAMS began asking women where they delivered with the 2017 birth cohort, but analysis will require 2018 data to make any inferences. Findings will be used to drive more direct quality improvement in the next fiscal year. In FY20 we will be using a calculated variable to analyze breastfeeding data by Baby-Friendly v. Other hospital designation. This will not require individual hospital identification, and we will not publish facility-level data, but we will make those estimates available to facilities upon request.

b. Subpopulation analyses in PRAMS

NM PRAMS supported NM Breastfeeding Task Force goals to improve breastfeeding support to women whose infants were hospitalized in the Neonatal Intensive Care Unit (NICU). More analysis is planned to explore breastfeeding support with program partners working in home visiting and NICU referrals to infant mental health or maternal behavioral health and case management.  Dr. Peggy McLean, PhD, is a psychiatrist in the UNM Department of Pediatrics who directs the HATCH (Helping Families to Come Home) program. The program offers families of hospitalized newborns social support and transition to home visiting programs when their infant is released from the NICU. Because breastfeeding is one therapeutic approach to soothe premature (at appropriate gestational ages), low birth-weight and substance withdrawing infants, UNM has developed a program promote wrap around services and support for families of those infants. NMDOH case coordination and CYFD home visiting programs coordinate with HATCH to help identify early and ongoing social and medical needs for mothers, families and their infants. Title V/MCH Epidemiology staff will support this project with PRAMS and Toddler Survey data analysis and by soliciting input for the 5-year statewide needs assessment in FY20.

Title V will include in needs assessment and data analysis plans ways to evaluate doula service impact on breastfeeding initiation and duration. Because there are innovative and culturally-specific doula programs in NM, we will work with program staff to support their client, Vital Records and PRAMS aggregate analysis needs, one-on-one. The NM Birth Companion Project http://hscnews.unm.edu/news/laboring-together serves a large delivery volume urban hospital in Albuquerque with diverse, changing needs, and Tewa Women United’s  Yiya Vi Kagingdi Community Doula Training was developed through diverse communities in Northern New Mexico from years of doula programming and community/academic research. Breastfeeding is multi-factorial, personal and complex, and doula programs providing holistic services are crucial to understanding factors leading to success for each woman’s infant feeding choice.

MCH Epidemiology/Title V will host at least one MPH program epidemiology graduate student to explore more global (beyond baby-friendly) factors and risks for breastfeeding initiation and duration. This will build upon FY18-19 student work which included sub-population analyses for WIC recipients and for women who worked during pregnancy and had to make decisions about paid or unpaid family medical leave and how to support their families while they were out of work. The final paper (2019) will be synthesized for a Title V performance monitoring report, website, and data dashboard, which is in development.

c. Longitudinal data collection and data linkage improvement

We completed 2016 birth data collection for the longitudinal follow-up to PRAMS in the NM Toddler Study/PRAMS-2. We completed year three of the three-year WK Kellogg Foundation grant and will apply for a grant extension to assure that the data are properly weighted with statistical adjustments for the birth population, so we can publish valid estimates and release indicators over the next year. Provisional unweighted data indicate that in the 2016 birth cohort, 57.6% breastfed for at least 6 months (n=531) and that 32.6% breastfed exclusively for at least 6 months. Over 75 indicators for 2015-2016 births (with two-year old and maternal health results) are summarized for provisional, unweighted data, and the linked PRAMS-Toddler Study dataset will be ready for complex survey analysis in September 2019. 

Further development of the Toddler Study surveillance is a high priority for Title V and Maternal Child Health Epidemiology. We are seeking continued private foundation grants and increased our Medicaid revenue to support the surveillance. The PRAMS and Toddler Study Coordinator is in the process of revising the survey tool’s long-term objectives to measure the impact of baby-friendly experiences on early breastfeeding duration and their relationship to ongoing (after 10 weeks) breastfeeding duration.

Data Visualization and Dissemination

New Mexico Title V began feasibility exploration for Title V and Maternal Child Health data repositories and web-based data visualization. Over the years, faster, more easily accessible data have been in high demand. Birth registration and CDC statistical weighting of survey data are becoming more timely and will help us to meet the growing demand.  To keep up, the program has tested different software options and continues to consult with partnering academic and community organizations.

This is a priority area for FY20 to support all Title V domain areas, and we will employ two primary platforms to achieve this goal. We will utilize LiveStories, an e-reporting platform and Tableau (or similar) software for data dashboarding. We will house these and other Title V priority area products in a maternal child health website which allows staff to perform real-time updates, news briefs and information gathering over the next five years.