Administration Initiatives and Interagency Collaboration
Reducing the Number of Newborns Exposed to Substances (CARA)
New Mexico has been tracking substance exposures in the perinatal period through self report, clinical screening, and through diagnosis in hospitalization data. Neonatal Abstinence Syndrome or neonatal opioid withdrawals rates have doubled over the last decade, and many more infants have a substance exposure indicated by a diagnosis code at delivery. While many states have taken punitive approaches to substance use in pregnancy, which have not proven effective, New Mexico is taking steps to ensure mothers and babies get the treatment and support they need.
The 2016 federal Comprehensive Addiction and Recovery Act (CARA) requires states to provide Plans of Care for all babies born exposed to substances. In response, DOH and CYFD convened an interagency working group, partnering with DOH and the J. Paul Taylor Task Force to pass a 2019 state law to connect families to the supports they need. This law was designed to ensure that babies born exposed to substances, and their families, receive everything they need to thrive without being stigmatized or punished.
Staff in CYFD, HSD and DOH have worked to implement CARA since 2020, traveling around the state and training hundreds of medical professionals, hospital employees, and care coordinators so they understand the intent of the law and what is required of them. Evaluation of the program is being led by DOH and data collection and analysis is ongoing.
A multi-agency team is currently assessing gaps in services, and each agency has provided resources to staff the program to improve services, outreach and follow up with families impacted by substance use in the perinatal period (DOH, CYFD, HSD and ECECD).
Safe Sleep for Infants
New Mexico holds an interagency safe sleep collaborative to improve education and awareness about safe sleep for infants. Led by the Department of Health with participation by programs with ECECD, CYFD, and partners including the NM Breastfeeding Task Force, Navajo Nation and the University of New Mexico Prevention Research Center. The collaborative participants work to reduce risks for sudden unexpected infant deaths (SUID) through messaging about safe sleep recommendations, including the use of cribs or bassinets with a firm mattress close to but not on the same surface as an adult. Additional media promote traditional sleep customs such as cradle boards, breastfeeding promotion and tobacco cessation among NM infant caregivers.
Maternal Health Program (DOH)
The Maternal Health Program (MHP) supports improved outcomes for birthing parents and newborns in multiple ways. Through oversight over midwifery practice, MHP works to integrate this evidence-based care model and the full spectrum of perinatal care providers into service delivery in NM communities. The Maternal Mortality Review Committee identifies contributing factors to deaths that occur during pregnancy and the following year and makes actionable recommendations to prevent such deaths from occurring in the future. As the maternal health domain lead for the Title V Program, MHP administers the High-Risk Fund to increase access to perinatal services before and after delivery for those lacking access to insurance coverage. Finally, MHP provides technical assistance to clinical sites across the state to implement perinatal quality improvement programming in support of improved outcomes.
Maternity Home (CYFD)
The Pregnant and Parenting Youth Home in Hobbs that was operated by the Guidance Center of Lea County closed their program in summer of 2023 due to lack of referrals. BHS has put out an RFA for Maternity Home programs twice over the last three years with no response. CYFD is currently reviewing the need for this program.
Infant Mental Health (IMH) Child-Parent Psychotherapy (CPP)
CYFD Infant Mental Health (IMH) Child-Parent Psychotherapy (CPP) has had an ongoing partnership with the CARA Navigator/Program Supervisor in order to support the efforts of both programs to improve the lives of infants in New Mexico. IMH facilitated the development of educational slides regarding the effects of substance exposure on child development which are now a part of the CARA Educational Modules used to train hospital staff who will oversee the development of the CARA Plans of Care. Additionally, IMH created a pamphlet with a brief description of the three IMH programs as well as a list of all IMH child parent psychotherapy providers by county, to facilitate the referral process. IMH is also providing IMH CPP providers’ contact information for the CARA representatives at their local hospitals. IMH’s intent is to encourage the establishment of partnerships between providers to ease the referral process for families.
Access to Reproductive Health Services
DOH holds an inter-agency work group to address increasing needs for comprehensive, full-spectrum reproductive health services throughout the state. Academic and community-based partners meet weekly to problem solve and strategize access and messaging about these services.
Evidence-based teen pregnancy prevention programs encompass service learning and positive youth development programs, parent training and adult-teen communication programs, comprehensive sex education programming, and community education and outreach activities. These include:
- Service learning and positive youth development programs (like the Teen Outreach Program [TOP] and Teen Connection Project [TCP]) promote positive outcomes for teens by providing meaningful service to develop and practice life skills, self-efficacy, and healthy behaviors.
- Adult-teen community programs (like From Playground to Prom) give adults information and skills to communicate effectively with young people about reducing risky sexual behavior.
- Comprehensive sex education programs (like TOP and TCP) provide youth with age-appropriate and medically accurate information to reduce the risk of sexually transmitted infections and unintended pregnancy.
Medicaid Extended to 12 Months Postpartum
A successful and developing collaboration between the Human Services Department and the Department of Health is the extension of Medicaid coverage to 12 months after pregnancy for anyone eligible for Medicaid during pregnancy. This went into effect in 2022, and the state agencies are working together to evaluate the impact of extending coverage for the postpartum population. Findings from the Maternal Mortality Review Committee suggest that many maternal deaths may be prevented by increasing opportunities for screening and support for mental health conditions, chronic disease, substance use disorder and general medical concerns up to one year after a pregnancy ends, and New Mexico has an important opportunity to prevent future deaths.
Children’s Oral Health Prevention Program (DOH)
Tooth decay is preventable yet remains the most common chronic disease among children. The Centers for Disease Control and Prevention estimates that over 51 million school hours are lost due to tooth decay. Untreated cavities can cause pain and infections that may lead to problems with eating, speaking, playing, and learning. Children with poor oral health often miss more school and receive lower grades than children who do not.
The Ofﬁce of Oral Health’s (OOH) mission is to prevent oral disease, contributing to a healthier New Mexico. Its vision is to promote oral health and overall health, improved oral health outcomes, and assure safety net services are available for the uninsured and low-income people in our communities. Chapter 24 of the New Mexico Health and Safety Code mandates that the Department of Health operate a dental program. OOH provides oral health information, conducts a school-linked prevention program focused on pre-school and elementary school aged children, and funds contractors to provide preventive and treatment services to the uninsured and low-income residents.
OOH works very closely with various organizations to promote the importance of children’s oral and overall health. Some of the local organizations are: the New Mexico Oral Health Coalition (consisting of over 20 local oral health advocates), the New Mexico Primary Care Association, Health Action New Mexico, Santa Fe County Head Start, Water Utility ofﬁces of Santa Fe and Bernalillo County, City of Albuquerque Head Start, YDI Head Start, New Mexico Children Youth and Family Department, St. Joseph’s CHI home visiting program, Villa Therese Catholic Clinic, Native American Professional Parent Resources, the New Mexico Human Services Department, and the Ofﬁce of School and Adolescent Health at DOH. The program is supported with $1.7 million in General Fund allocated each year in the state budget. About $1.4 million is spent providing school-based preventive services as well as preventive and treatment services for the uninsured or those who have low income. Estimated expenditures for the Children’s Oral Health Prevention Program are approximately $1.7 million.
Fitness and Nutrition
The Obesity, Nutrition, and Physical Activity (ONAPA) and Healthy Kids Healthy Communities (HKHC) programs build state and local partnerships to expand children’s and low-income adults’ opportunities for healthy eating and physical activity where they live, learn, play, work, eat, and shop. Healthy eating and physical activity are two major lifestyle behaviors that can help prevent obesity and subsequent chronic disease. Launched in October 2011, HKHC creates sustainable policy, systems, and environmental changes through multi-sector community-led coalitions to prevent childhood and adult obesity in 14 high-need (based on poverty and chronic disease burden) communities across New Mexico.
Key partners include: Public Education Department; Children, Youth and Families Department; Early Care and Education Department; Human Services Department; Department of Transportation; Women, Infants, and Children Program; New Mexico Department of Health (NMDOH) regional health promotion teams; Farm to Table New Mexico; University of New Mexico; New Mexico State University Cooperative Extension Service; schools and districts; state planning organizations; tribal and municipal governments; and parks and recreation.
In FY20, HKHC communities included: Chaves County, Cibola County, Colfax County, Curry County, Dona Ana County, Grant County, Guadalupe County, Hidalgo County, Roosevelt County, San Juan County, Socorro County, San Ildefonso Pueblo, Zuni Pueblo, and Ohkay Owingeh Pueblo. HKHC collects data on the number of increased healthy eating and/or physical activity opportunities in the school setting, built environment, and food system.
ONAPA also collects and reports on annual Body Mass Index (BMI) data on kindergarten and third grade students in randomly-selected public elementary schools across the state to monitor childhood obesity prevalence over time by grade, race/ethnicity, and gender.
Tobacco Cessation and Prevention Program
The State of New Mexico Indian Affairs Department (IAD) is focused on building tribal capacity to implement culturally appropriate tobacco cessation and prevention initiatives that recognize the unique ceremonial uses of tobacco while reducing the use of commercial tobacco use and its harmful effects. In FY23 IAD received a $249,300 appropriation from the New Mexico Legislature for Tobacco Cessation and Prevention Programs. This is funded out of the Tobacco Settlement Fund and is used for direct tobacco cessation and prevention campaigns in Native American communities. The three components are health, education, and community involvement.
The following organizations partnered with IAD to provide youth tobacco cessation activities:
- Pueblo of Pojoaque: Be Tough – Don’t Puff Part III aimed at tribal youth prevention and reduction efforts.
- Pueblo of Tesuque: Tobacco Cessation Prevention Program to encourage community to live healthier lifestyles.
- Keres Consulting: Nicotine Free Comic Series
- Albuquerque Indian Center: Promote cessation and prevention of commercial tobacco abuse in Native Communities with special emphasis on Native youth
- Capacity Builders: Provide Navajo community members, including youth, veterans, and pregnant women, with access to health education tobacco cessation and prevention media.
Leveraging Medicaid to Expand Dental Coverage
OOH was mandated by House Memorial 96 to convene a task force to study ways to expand Medicaid coverage to provide additional dental care for children. This task force comprises several oral health advocates representing the various dental associations, the University of New Mexico, the New Mexico Oral Health Coalition, Health Action New Mexico, Federal Qualiﬁed Health Center Dental Directors, Indian Health Services, and others. After several meetings, the committee developed a list of actions to increase access to care, and its recommendations were submitted to and accepted by the Legislative Health and Human Services (LHHS) Committee.
To date, the Human Services Department (HSD) has approved a provider reimbursement increase of 2% and has approved a reimbursement code for ﬂuoride varnish applications. The Department is currently developing a code for reimbursing the application silver diamide ﬂuoride varnish, which will reduce the number of ﬁllings as well as the pain associated with ﬁllings. OOH and HSD continue to work together to address the recommendations of the task force in order to improve the oral health status of Medicaid children.