NPM 5B - Percent of infants placed to sleep on a separate approved sleep surface,

NPM 5C - Percent of infants placed to sleep without soft objects or loose bedding

NPM 5A - Percent of infants placed to sleep on their backs

For the Perinatal/Infant Health domain, Hawaii selected NPM 5 Safe Sleep based on the 2020 Title V needs assessment findings. The 2025 Title V state objective is to increase the proportion of infants placed to sleep on their backs to 86.0%. Objectives were also set for NPMs 5B and 5C. The work plan highlights the three safe sleep strategies that are listed below.

Strategy 1: Increase awareness of the importance of Safe Sleep and provide safe sleep education through public service announcements and digital media

Media Campaign: Another Safe Sleep television and digital media campaign may be repeated in FY 2024. The campaign will likely be relaunched during October Safe Sleep and SIDS Awareness Month. Activities may also include a governor's proclamation signing and press release. The Safe Sleep Guide for Parents and The Parent Line will again be the central means to share information on AAP guidelines. The campaign will also coordinate with community-based programs that continue to support safe sleep efforts for Hawaii’s families.

Translation of Media Messaging: The television and digital media spots used in the media campaign will be translated into several languages to reach non-English speaking populations. The spots will be strategically aired and presented in ways to best reach more limited English-speaking households.

Strategy 2: Increasing reach of Safe Sleep Hawaii and connections to appropriate partners and stakeholders to promote health equity

This new strategy recently emerged from Safe Sleep Hawaii (SSH). The implementation activities for this strategy include the following:

• Increase membership and messaging connected with SSH
• Engage more diverse community partners and stakeholders throughout the state
• Ensure awareness of the availability of translated Safe Sleep guides in all offered languages
• Foster collaboration and partnership among community programs and stakeholders on safe sleep efforts and other maternal and child health issues
• Develop a new measure to monitor progress on this strategy that can be used for Title V reporting.

A contract executed with Healthy Mothers, Healthy Babies will ensure the coalition's ongoing work.

Implementation of Recommendations from the Statewide Assessment: The environmental scan and assessment of safe sleep activities in Hawaii will be completed in later FY 2023. The project includes conducting a focus group to learn how families get key information on safe sleep, what messaging they received to date, and perceived barriers to implementing safe sleep practices. The final report, results, and recommendations will be presented to SSH. It will help to inform future planning, including clarifying the role of SSH, identifying further evidence-based strategies to address disparities, and promoting health equity in safe sleep going forward.

Cribs for Kids. HMHB will meet with DOH to review program evaluation results and discuss plans, progress, tasks, and responsibilities.

Staff Vacancy. Once the SS coordinator position is filled, planning will resume for more SS activities, including the next Safe Sleep Summit.

SPM 2 – Number of participants in the WIC program in Hawaii

For the Perinatal/Infant domain, Hawaii added this state priority and performance measure during the COVID pandemic to address food insecurity issues, focusing on promoting WIC services/enrollment. Food insecurity emerged as a critical issue given the economic turmoil during COVID and subsequent inflationary trends.

The goal is that by July 2025, WIC participant numbers will increase in Hawaii to 30,000 pregnant women, infants, and children to provide greater supports and resources to Hawaii’s families most in need. The measure for this priority may change given improved WIC data analysis and capacity. The current strategies to address this SPM emerged from increased community and family collaboration during COVID.

The three strategies and plans presented below emerged from a Partnership for Children (PFC) grant, which was awarded in May 2021 and ended in 2022. A new grant award to improve WIC services may result in a change of strategies.

The proposed 2024 Title V grant guidance includes a national performance measure on child food insecurity. Hawaii may consider changing this state performance measure to the new NPM.

Strategy 1: Partner with agency and community programs to establish a working group that is committed to improving WIC utilization

The WIC Working Group convened for the PFC grant but has since stopped regular meetings. One of the Work Group recommendations included forming a more permanent WIC Advisory Group comprised of diverse stakeholders, including current and former WIC families. Resources to staff and implement the recommendation will need to be identified.

Strategy 2: Identify key barriers to WIC benefit utilization and enrollments

This strategy focuses on the primary data and research work to identify barriers and challenges experienced by the WIC program and its clients.

• The University of Hawaii Center on the Family will continue and expand its data analysis of the WIC dataset. The 2020 calendar year data will be added to the 4-year dataset that was analyzed.
• Additional qualitative data collection with WIC families, including focus groups and key informant interviews, is also being planned to address retention issues, targeting key population groups: Native Hawaiians, Pacific Islanders (Micronesians), and Filipinos.

Strategy 3: Develop recommendations for initiatives to pursue to improve WIC utilization.

As more data becomes available, the recommendations to improve WIC program planning will evolve.

The WIC Farmer's Market and Food Hub distribution pilot projects will be implemented in FY 2024. The pilot will be evaluated and modifications made if needed. Additional project sites will be identified.

Work on the WIC/SNAP data sharing MOA will continue through monthly meetings.

Title V Perinatal/Infant Health Programs

The Application narrative for that population domain provides a list of Women's/Maternal Health programs administered by the Hawaii Title V agency. The list of programs below focuses on infant/early childhood health programs administered by Hawaii Title V.

Newborn Hearing Screening: provides newborn hearing screening for babies as required by Hawaii state law to identify hearing loss early so that children can receive timely early intervention services.

Newborn Metabolic Screening: provides newborn blood spot testing for babies as required by Hawaii state law. The tests help detect rare disorders that can cause serious health, developmental problems and even death if not treated early.

Early Intervention Services (EIS): provides early intervention services for eligible children from birth to three years old with developmental delay or at biological risk, as mandated by Part C of the Individuals with Disabilities Education Act (IDEA). Services include care coordination; family training, counseling, home visiting; occupational therapy; physical therapy; psychology; social work; special instruction; and speech therapy. Parents/caregivers are coached on how to support the child's development within the child's daily routines and activities.

Early Childhood: focuses on systems-building to promote a comprehensive network of services and programs that helps promote children with special health needs and children who are at risk for chronic physical, developmental, behavioral, or emotional conditions to reach their optimal developmental health.

Birth Defects Surveillance: provides population-based surveillance and education for birth defects in Hawaii and monitors major structural and genetic birth defects that adversely affect health and development.

Women, Infants, and Children (WIC): Provides Hawaii residents with nourishing supplemental foods, nutrition education, breastfeeding promotion, and health and social service referrals through the federal Special Supplemental Nutrition Program for Women, Infants, and Children. The participants of WIC are either pregnant, breastfeeding, or postpartum women and infants and children under 5 years old who meet income guidelines and have a medical or nutritional risk.

Hawaii Home Visiting: Through the federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) grant, the Home Visiting Unit provides comprehensive early identification of high-risk families, including expectant families and families of newborns who may benefit from home visitation services to reduce health disparities by improving birth, health, and development outcomes through collaboration with and referral from birthing hospitals, physicians, WIC clinics, and community health centers.

Early Childhood Comprehensive Systems: This program uses the collective impact model to strengthen, align, and sustain family-centered systems at the state and community levels that are equitable, sustainable, and comprehensive, using the health system as a key partner. These programs focus on the prenatal-to-age-3 (P-3) period, a critical window of opportunity for prevention and intervention. Early childhood experiences that nurture positive health and development—starting prenatally—have lifelong impacts on overall health and well-being.