Newborn Home Visiting program-Shelter Based Initiative NYC Department of Health and Mental Hygiene Newborn Home Visiting program-Shelter Based Initiative Beyond Housing 2016 Conference January 15, 2016 Ericka Moore, MPH,CLC Bureau of Maternal, Infant and Reproductive Health

NYC Department of Health & Mental Hygiene Agency Mission To protect and promote the health of all New Yorkers. Program Mission The Newborn Home Visiting Program (NHVP) seeks to provide mothers with the tools needed to raise a healthy child in a safe home environment. In the context of the Agency mission to promote and protect the health of all New Yorker; Our Program however, has a more narrow mission of supporting the health and well-being of our ‘Littliest New Yorkers.” The Newborn Home Visiting Program’s mission is to provide mothers with the tools and access to resources that will enable her to raise a healthy child in a safe home environment.

Program Rationale Giving birth is a period of vulnerability and offers an opportunity to address health and social issues Infancy and new motherhood are periods when education and support can have lasting effects The Health Department has unique access to this population and can assist families in accessing information and resources to support increases in health equity

Newborn Home Visiting Program (NVHP) The Newborn Home Visiting Program (NHVP) is an agency initiative which offers post-discharge support to families with a new infant; the Program provides topic specific education, assessments and identifies health and social issues that require referral to community-based services. NHVP is voluntary and free to the client. Infancy and new motherhood or becoming the mother to another child is a period when education and social supports can have a lasting effect. The DOMHH has unique access to this population and can assist families in obtaining information and resources that will increase their opportunity to experience better health and social outcomes. It important to understand that Home Visiting is an evidence-based public health practice; these visits are conducted by trained public health professionals who work as public health advisors with the Agency. What is the Newborn Home Visiting Program?

NHVP Program Goals ↑ Knowledge and utilization of safe infant practices ↑ Knowledge and breastfeeding practices among women ↓ Environmental hazards in the living environment ↑ Awareness and utilization of community-based services → Early Childhood Development/Language Development → Identify social and mental health needs of families and connect to appropriate services What are we trying to accomplish with the women, babies and families? Through this engagement – which consists of two visits and a follow-up phone call, we want to impact… Inform Mom of appropriate practices in caring for a new infant Some Moms know what they are doing and may only need reminders/current information about such practices Ensure that Moms who are breastfeeding get the often needed support to continue; and education others on the value and benefit of breastfeeding. Staff complete an environment assessment to ensure issues like: peeling paint and missing window guards are addressed. Additionally, issue like leaking pipes, mold and holes in the wall are identified and communicated to landlords, HPD and NYCHA. Many new moms are unaware of the services and resources in the community that they can access at no cost. When interviews are conducted home visitors can assess additional needs that the family may have based on a conversation, even when Mom has not indicated a specific need. The Newborn Program assesses other children in the home to determine need or eligibility for early intervention services, developmental monitoring, childcare services and UPK. We also provide families with children’s books and encourage the family to read, sing and talk to their babies to support early learning and language development. Current research clearly indicates that children in under-resourced environments enter school less ready than their better resourced communities. This type of engagement also support bonding, as does breastfeeding. Home Visitors also assess for social needs for moms, babies and other family members and work to make the connection to needed services. THESES GOALS REALLY OUTLINE THE ESSENCE OF THE NEWBORN HOME VISTING PROGRAM

Key Health Messages Infant feeding, breastfeeding education and assessment Safe Sleep and Injury Prevention Early Childhood Development Early Intervention assessments and referrals Immunization and Health Insurance enrollment Environmental assessments Community resource connection

NVHP Service Area NHVP in DPHO service areas: Bronx (Central/South) Community Districts: 1-6 Manhattan (East & Central Harlem) Community Districts: 10-11 Brooklyn (Bed-Stuy, Brownsville, Bushwick & East New York) Community Districts: 3, 4, 5 and 16 Newborn’s current services areas are geographically located in the District Public Health Office (DPHO) neighborhoods. Health data tells us that these areas have some of the worst health outcomes in the City and need additional resources to address those issues. We offer visits to women in the following CDs represented on the map. The Program has partnerships with (7) hospitals in these neighborhood where we recruit clients—at bedside—for participation in the Program. Manhattan: Harlem and Metropolitan Hospitals Bronx: Lincoln Hospital Brooklyn: Woodhull, Wycoff, Brookdale and Brooklyn Hospital Center Eligibility for the Program requires that women give birth in a partner hospital, live within the CD and have an intention to breastfeed (in Bronx and Brooklyn); In Harlem, women who give birth in a partner hospital, live within the CD and whether she breastfeeds or not is eligible for this Program.

Measuring Success Families Successfully Visited in 2013: 2,023 DHS Families Successfully Visited: 38

DOHMH – DHS Collaboration NHVP/DHS Citywide Shelter Initiative Goals Strengthen support provided to women giving birth in shelters Improve health of mothers and their infants through education on key maternal and infant health topics Increase access to support services through linkages and referrals to governmental and community-based programs Provide coordinated services to eligible DHS families The reason we are here today is because our Agencies: DOHMH and DHS initiated a conversation about how to better service women and families in shelter and felt this Program would be a good match for addressing some very specific types of supports that aren’t often obtained when a woman is living in shelter and has an infant. For women, pregnancy and childbirth are incredibly wonder and challenging periods in her life. The added pressure of living in an unstable home environment can have a negative affect on Mom and baby’s birth and health outcomes. Earlier this year, DOHMH began discussions with DHS leaders to address the need for and benefit of home visiting services for women and babies who live in shelters throughout New York City. From those discussions a set overarching dual-agency goals were developed, that include… Strengthening support provided to women giving birth in shelters Improving health of mothers and their infants: HOW? Through education on key maternal and infant health topics Increasing access to support services by connecting to governmental and community-based programs The idea is to align our efforts to improve coordination of services to eligible families living in shelter (primarily women and children) And as Shelter Providers, you are key to our success in reaching women/families with the supportive services provided by the Newborn Program. You will be our first point of contact for women and their babies.

DOHMH-DHS Initiative Eligibility Criteria Who Will We Serve? Women who reside in shelter or present to shelter with a baby 0-2 months of age. The Newborn DHS Shelter Initiative will focus on this population..

DOHMH/DHS LAUNCH TIMELINE Program Implementation PHASE I- November 2015 Brooklyn Queens Staten Island PHASE II- April 2016 Manhattan Bronx There will be one team stationed in Brooklyn to support PHASE I of the initiative and their catchment will be Brooklyn, Queen and Staten Island. Two Teams will be stationed in the Bronx and will be responsible for coverage in the Bronx and Manhattan.

NHVP Shelter Initiative Service Area NHVP Serving Families in NYC Shelters Citywide PHASE I Brooklyn, Queens, Staten Island PHASE II Bronx, Manhattan Visual to support the prior slide…

NHVP Shelter Initiative Staffing Model Initiatives Manager Team Supervisors Public Health Advisors Public Health Assistants Social Workers Public Health Nurses City Research Scientist Community Coordinator Admin Support Staff We are charged with hiring 28 new staff to support the Shelter Initiative and this slide outlines titles we’re hiring. We have identified 16 candidates and continue to interview to try and meet the target. The public health advisors and public health assistants will be the primary home visitors; social workers and nurses will offer added support for cases present with challenges or are complex and are beyond the scope of practice for the home visitor.

NHVP Shelter Initiative VISIT STRUCTURE Visit Timeline Visit I Occurs within 1st week of life Visit II Occurs within 2nd week of life Visit III Occurs in weeks 4-6 of baby’s life Follow-Up phone call week 7 or 8 of baby’s life Visit Content Comprehensive maternal and infant health education Safe sleep education and assessment/Environmental screening Infant feeding education; breastfeeding support Developmental milestone screening/education Medical Home assessment Resource review and referrals initiated Modeling ECD/language development best practices Breastfeeding support if needed Follow up on referrals with client and/or DHS social service staff Prep for upcoming medical appointments Maternal depression screening using PHQ 9 Reinforce key health messages Prep for upcoming medical appointments Follow-up on outcome of medical appointments Reinforce key health messages and referral follow up Positive affirmation As outlined here… there will be three separate visits at within specific timeframes as part of the Shelter Initiative model. The educational topics are divided between the visits. The goal is to cover all topics relevant to the families expressed need. Quick review of each

Progress to Date Establishment of DOHMH/DHS Working Group Launched Phase I of Initiative in November 2015 NHVP model revisions Two visits offered to all clients referred via shelter based clients Facilitated Listening sessions DHS Path and Shelter tours DHS Provider staff NHVP and Nurse Family Partnership Listening Sessions To Date… We have met and continue to meet bi-weekly to establish/build the foundation for this initiative. What we’ve termed Memorandum of Understanding (MOU) is actually a data use agreement between Agencies. Reiterate – definition of collaboration – We’ve done the work of becoming informed about families in shelter –specifically women and children in shelter and how their health can be impacted based on living in non-permanent residence, stress and uncertainty has on health outcomes through literature reviews. We’ve completed several rounds of listening sessions with internal staff (NHVP and NFP) as well as Shelter Provider staff. We’ve also complete a tour of PATH and several shelters. Again, our goal is to assist Moms and babies while in shelter. Strengthening support provided to women and babies in shelters Improving health of mothers and their infants Increasing access to support services by aligning our efforts to improve coordination of services --primarily women and children KEY TO MEETING THESE GOALS IS THE SHELTER PROVIDER –WHO WILL SERVE AS OUR 1ST POINT OF CONTACT

Next Steps DHS Client Listening Sessions Additional listening Sessions with Shelter Providers NHVP Model Enhancements Program Evaluation As the implementation of this initiative moves forward, we will continue to work between agencies to inform the Program model through what we’re calling listening sessions. These sessions are designed to assist DOHMH staff in understanding how to best focus the engagement with families and ensure there is real benefit for the families in meeting their identified needs around health issues. And we will, for the first time, evaluate the Newborn Home Visiting Program based on this initiative.

NVHP Program Materials

Thank You – Question??? Libby Carter-Otuya, MPA NYC Department of Health & Mental Hygiene Director, Newborn Home Visiting Program lcarter@health.nyc.gov Ericka Moore, MPH Director, Maternal Child Health Unit emoore@health.nyc.gov