2025 Step Up Together Action Collaborative Application

Transfer Improvement Action Collaborative Application

Applications accepted on a rolling basis. Final deadline 9/12/2025
Thank you for your interest in our 2025 Step Up Together Community Birth Transfer Improvement Action Collaborative. This program is designed specifically for interdisciplinary teams from both community and hospital settings who are jointly invested in improving their collaboration, emergency preparedness, and transfer process. This year's Action Collaborative will have 2 cohorts:
- A birth center cohort, for teams preparing to run a Full Transfer Drill scenario originating in a freestanding birth center.
- A home birth cohort, for teams preparing to run a Full Transfer Drill scenario originating in a home birth.
Thanks to generous funding from the Skyline Foundation and a partnership between Primary Maternity Care and the National Association of Certified Professional Midwives, funding is available for 12 teams in each cohort to participate at no cost. Each team is comprised of representatives from:
- community birth practice (e.g. lead midwife and/or lead birth assistant)
- hospital unit (e.g. nurse manager or education coordinator)
- EMS or transport partner (e.g. education coordiator or medical director)
These interdisciplinary team leads will participate in the webinars, receive program communications, and work together to plan and execute the drill in their community.

We ask that one individual from either the community birth practice or the hospital complete this application. The application should include a letter of intent from the other partner and, if available, from the EMS or transport partner.

If you have questions, please reference the Frequently Asked Questions section of the Action Collaborative website, and feel free to reach out to the Step Up Together faculty at info@stepuptogether.com.
Applicant and Team Information
Name of person completing this application*

First NameLast Name
Credentials*
e.g. CPM, CM, CNM, RN, MD, DO,...
Email*
example@example.com
Phone Number
Please enter a valid phone number.
What type of Full Transfer Drill are you intending to run?*

Home birth to hospitalFreestanding birth center to hospitalUndecidedOther
How did you hear about this Action Collaborative? (Check all that apply)*

NACPM newsletter or announcementanother listserv or newslettera colleaguesocial mediaconference presentation or webinar about Step Up TogetherI have previously participated in a Step Up Together program or drillOther
Name of referral source
Name of newsletter/listserv, colleague, or other referral source
Birth Center Information

for teams planning a birth center to hospital transfer drill
Name of Birth Center*
Location of Birth Center*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name(s) and title(s) of proposed birth center participants in the Action Collaborative*
Up to 2 participants from the birth center, typically Lead Midwife, Lead Birth Assistant, and/or other clinical leader responsible for conducting emergency drills.
The following questions relate to types of providers and licensure and accreditation status. There are no requirements for staffing model or licensure/accreditation status to participate in Step Up Together.
Which types of providers attend births in your center? (Choose all that apply. There is no required staffing model for participation.)*

Certified Professional Midwives (CPMs)Licensed Midwives (LMs)Certified Midwives (CMs)Direct Entry Midwife (DEM)Certified Nurse Midwives (CNMs)Other
Is the birth center accredited by CABC?*

YesNo, but the center is in the pre-accreditation processNo, and the center is not currently pursuing accreditation
Is the birth center licensed by the state?*

YesNo, but the center is in the licensure processNo, and the center is not currently pursuing licensureThere is no mechanism for licensure in the state where the birth center is located
What is the distance in miles between the birth center and the collaborating hospital?*
distance in miles
Home Birth Practice Information

for teams planning a home birth to hospital transfer drill
Name of home birth practice or collective*
Location and service area of practice*
Name(s) and title(s) of proposed home birth participants in the Action Collaborative*
Up to 2 participants from the practice, typically Lead Midwife, Lead Birth Assistant, and/or other clinical leader responsible for conducting emergency drills.
Which types of providers attend births in your practice? (Choose all that apply. There is no required staffing model for participation.)*

Certified Professional Midwives (CPMs)Licensed Midwives (LMs)Direct Entry Midwife (DEM)Certified Midwives (CMs)Certified Nurse Midwives (CNMs)Other
Hospital Information
Name of Collaborating Hospital*
Location of Hospital*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name(s) and title(s) of proposed hospital participants in the Action Collaborative*
Up to 2 participants from the hospital who are responsible for conducting emergency drills.
What level of neonatal care is available at this hospital?*

Level 1 - well newborn nurseryLevel 2 - special care nurseryLevel 3 - NICULevel 4 - Regional NICU
Does the hospital have the following services? Check all that apply.*

Midwife-attended birthsFamily physician attended birthsLaborist or obstetric hospitalist programDedicated obstetric anesthesia on site 24/7In-house doula programOB-Gyn residency programFamily practice residency programNone of the above
Integration and Collaboration Model
What types of integration do the birth center and hospital have in place? Check all that apply.*

Midwives who maintain delivery privileges at both the birth center and the hospitalInterdisciplinary drills, simulations, or other training with birth center team and hospital-based teamWritten transfer agreement between the two facilitiesRegular joint review of transfersDirect admission to L&D for transfers (e.g. bypass emergency department or triage)Direct admission to NICU for transfers (e.g. bypass emergency department)Integrated electronic health record systems across birth center and hospitalOther structured process for transferring records and summarizing key prenatal, intrapartum, and neonatal dataWritten agreement with emergency transport serviceA neonatal transport team that will dispatch to the birth centerAccess to health system liability insurance for the birth center and/or providersPartial or total ownership of the birth center facility by the hospital or health systemOther (non-ownership) financial agreement between birth center and hospital or health systemOther (please explain)
What types of integration do the home birth midwives and hospital have in place? Check all that apply.*

Midwives who do home birth who also maintain delivery privileges at the hospitalInterdisciplinary drills, simulations, or other training with home birth team and hospital-based teamWritten transfer agreementRegular joint review of transfersDirect admission to L&D for transfers (e.g. bypass emergency department or triage)Direct admission to NICU for transfers (e.g. bypass emergency department)Integrated electronic health record systems across community and hospitalOther structured process for transferring records and summarizing key prenatal, intrapartum, and neonatal dataWritten agreement with emergency transport serviceA neonatal transport team that will dispatch to the homeAccess to health system liability insurance for the home birth providerPartial or total ownership of the home birth practice by the hospital or health systemOther (non-ownership) financial agreement between practice and hospital or health systemOther (please explain)
Briefly describe any strengths of the relationship between the community birth practice (home birth and/or birth center) and hospital. (Max 100 words)*

0/100
Briefly describe any challenges of the relationship. (Max 100 words)*

0/100
Have you identified an EMS or other transport partner to participate in the Full Transfer Drill?*

Yes, and they will participate in the Action Collaborative zoom sessions as well.Yes, but they will not also participate in the Action Collaborative zoom sessionsNo, we have not yet identified a transport partner willing to participate in a drill.
EMS or Transport Service
Name of Emergency Transport Service*
Location and service area of EMS*
Briefly describe how the EMS service is structured, and how EMS has so far been engaged in community birth integration efforts.*
Name(s) and title(s) of proposed EMS participants in the Action Collaborative*
Up to 2 participants from the hospital who are responsible for conducting emergency drills.
Action Collaborative Participation
Why do you want to participate in this Step Up Together Action Collaborative? (Max 300 words)*

0/300
All participants in the Action Collaborative are expected to:
- Attend 7 live, 1-1.5 hour sessions or view recordings (between September 22 and January 21)
- Review background materials provided before program launch and prior to each session
- Work together to use the tools and coaching from the program to plan, conduct, and debrief:
  - Partial Transfer Drills in the community setting and in the hospital setting
  - a Full Transfer Drill that begins in the community, moves by emergency transport, and resolves in the hospital setting.
  - (Learn more about Partial Transfer Drills and Full Transfer Drills)
Please indicate your team's understanding of these expectations, and share any reservations you have about committing to this initiative.*
Please upload a Letter of Support from your partner facility or practice. (i.e., if a hospital is submitting the application, please provide a letter of support from the collaborating birth center or home birth practice, and vice versa.) The letter can be brief and must simply confirm intent to participate and overall support for the application. All teams MUST have a community practice (birth center or home) and a hospital represented on the team. *

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Please upload a Letter of Support from your EMS partner, if available. The letter can be brief and must simply confirm intent to participate and overall support for the application. An EMS Letter of Support is not required for your application, but indicates EMS engagement. Teams without an EMS partner will receive additional support to reach out and engage EMS.

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Transfer Improvement Action Collaborative Application

Applicant and Team Information

Birth Center Information

Home Birth Practice Information

Hospital Information

Integration and Collaboration Model

EMS or Transport Service

Action Collaborative Participation