Transcript Infant Mortality can be Reduced: Implementing the Life

INFANT MORTALITY CAN BE
REDUCED: IMPLEMENTING THE
LIFE COURSE APPROACH
USING A PUBLIC HEALTH
SOCIAL MOVEMENT
3rd Annual
North Texas Health Forum
Reducing Infant Mortality in Tarrant
County: It's Time for Action
April 8 - 9, 2010
Tamara Wrenn, MA, CCE, CIMT
Senior Consultant, Practice Matters, a Subsidiary of
Northern Manhattan Perinatal Partnership, Inc.
Email: [email protected]
Objectives
 Define a Maternal Child Health Life Course
Organization.
 Define a public health social movement.
 Review the strategies and action steps to
build the movement.
MCH Life Course
Organization
Characteristics of a Life
Course Organization
 Builds programmatic capacity within the
agency at each stage of a woman’s life course
to manage her health over the life course
(Axis 1).
Characteristics of a Life
Course Organization Cont’d
 Swims up-stream from individual
interventions and designs strategies and
actions at the group, organizational,
community and policy levels to transform
social determinants to poor health (Axis 2).
Characteristics of a Life
Course Organization Cont’d
 If unable to build internal capacity
collaborates with outside agencies and
systems to create an integrated system of
care to manage a woman’s health.
Characteristics of a Life
Course Organization Cont’d
 Unlike many maternal and child health
programs that only seek to influence the
health system by developing and executing a
local health system action plan, a MCHLCO
seeks to influence and lead their local and
regional economic, political, housing, child
welfare, early childhood and middle school
systems of care.
LCO as a Business Entity
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Organizational structure
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Local entity 501 (c ) 3
Local/state government
Coalitions/consortiums
Leadership
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Strong leadership and management
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Cope with complexity
Build relationships
Sacrifice
Create a culture of leadership
Strategist
Capacity
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Order, consistency, quality
Internal
Collaborative
Integrated systems
Sustainability
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Funding
Coordination
Quality assurance
Community demand
Comprehensive strategy
Multilevel practice
Traditional Perinatal Care
Continuum
Labor and birth
Primary
care
Preconception
period
Antepartum Labor and birth Postpartum
?
Interconceptional
period
Prenatal care
Drummonds, M.
Life Course Perspective
 Suggests that a complex interplay of
biological, behavioral, psychological, and
social protective and risk factors contributes
to health outcomes across the span of a
person’s life.
 The life course perspective conceptualizes
birth outcomes as the end product of not only
the nine months of pregnancy, but the entire
life course of the mother leading up to the
pregnancy.
Longitudinal Approach
New MCH Life Course Continuum Axis 1
Centering
Pregnancy
Child
Abuse
Prevention
LatchKey
Program
Managing
Relationships
Health
Policy
Activities
Reproductive
Social Capital
Harlem
Weight
Watchers
Internatal
Care
School
Readiness
Fitness &
Health
Activities
Pregnancy
Prevention
Women’s
Health
Protocol
Depression
Group Work
Women’s
Health
Protocol
Perinatal
Care
UPK
Beacon
School
College Prep
Perinatal
Care
Reproductive
Life Planning
Specialty
Care
Harlem
Birthing
Center
Early Head
Start/
Head Start
Health/
Life
Stories
Telling
Preconception
Chronic
Disease
Chronic
Disease
Management
Chronic
Disease
Birth
Early
Childhood
PreTeen
Interconceptional
Care
Teen
Young
Adult
Women>35
Senior
Citizens
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Social Determinants of
Health
MCH Life Course Organization
Social Determinants of Health Axis 2
Public Policy
Initiatives
Economic
Empowerment
Zone
Supermarket
Zone
Expansion
Policy
NYC
Affordable
Housing
Policy
Community
Environmental
Impact
St. Nick Tenant Food & Fitness
Organizing
Coalition
Affordable
Housing
Organizing
Organizational
Impact
Healthy Start
Consortium
Diabetes
Prevention
Coalition
Harlem
Works Job
Readiness
Centering
Pregnancy
Baby Mama’s
Club
Consumer
Involvement
Organization
Group/
Interpersonal
Impact
Individual
Impact
OB/GYN
Case
Medical Homes Management
Depression
Screening &
Treatment
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Field of Dreams
“If you build it they will come”
Building an MCH life course organization requires
patience, commitment and sacrifice. The seeds we
plant today will require at least one generation
before we can see lasting changes. The knowledge
that the concept and standardization of prenatal
care is only 30 years old provides optimism in the
face of moving the life course perspective from
theory to practice.
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NMPP’s Individual/Clinical
Life Course Interventions
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Central Harlem Healthy Start Program
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Nurse Family Partnership, (NYCDOH/MH)
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Community Health Worker Program
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Harlem Hospital Birthing Center
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St. Nicholas Child Welfare Preventive Program
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Mankind Fatherhood Case Management Program
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TASA Cobra Case Management Program for Pregnant Teens
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Start Right Immunization Team
Center for Preschool & Family Learning Head Start-152nd St. and 155th St.
Universal Pre-K Program-152nd St. and 155th St.
Managed Care/Healthcare Enrollment Program
Asthma Case Management Team
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NMPP’s Group Life Course
Interpersonal Interventions
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Baby Mama’s Club/Circulo de Mamas Depression Groups
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Centering Pregnancy
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Adolescent Pregnancy Prevention Team
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Harlem Weight Watchers Program
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CHHS’s Consumer Involvement Organization
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NMPP’s Community Environmental
Life Course Interventions
 NMPP’s Harlem Works Job Readiness Program
 NYC Breastfeeding Alliance
 Harlem Strategic Action Committee
 ABC Asthma Coalition
 Start-Right Immunization Coalition
 St. Nicholas Houses Community Organizing Project
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NMPP’s Public Policy Life
Course Interventions
 Federation of County Networks
 Harlem Food & Fitness Consortium
 Citywide Coalition to End Infant Mortality
 Manhattan Regional Perinatal Forum
 NMPP’s BBKH Diabetes Coalition
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Public Policy & Systems Change
Achievements
1.
Regionalization of Perinatal Care Throughout NYS
2.
Secured Over $70 Million Dollars from NYC Mayor
3.
Integrated MCH & Child Welfare Systems of Care
4.
Financed & Staffed Up Birthing Center at Harlem Hospital
5.
Secured $250 Million Dollars to Build a New Harlem Hospital
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Public Policy & Systems Change
Achievements
6.
Harlem Hospital Recently Designated as a “Baby Friendly” Hospital
(Aug 2008)
7.
Passed Mental Health Parity Legislation Timothy’s Law (2007)
8.
Trained over 800 women and placed them in full time jobs!
9.
Reduced Child & Abuse & Neglect Rates in Harlem
10. Repealed “Medicaid Neutrality” Law in NYS
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Public Policy & Systems Change
Achievements
11. Increased Medicaid Mental Health Reimbursement Rates
12. NYC Mayor Has $7.5 Billion Dollar Plan to Build 165,000 Units of
Affordable Housing by 2013Eighty-Two Thousand units built to date!
13. Mayoral $10 million dollar Plan to train 400 Harlem residents to
become RN’s and LPN’s
14. Congressman Rangel’s Harlem Empowerment Zone
15. Legislation to move from a minimum wage to a livable wage policy
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Field of Dreams
“If you build it they will
come”
Building an MCH life course organization requires
patience, commitment and sacrifice. The seeds we
plant today will require at least one generation
before we can see lasting changes. The knowledge
that the concept and standardization of prenatal
care is only 30 years old provides optimism in the
face of moving the life course perspective from
theory to practice.
Spectrum of Work for MCH Life Course
Organization
Building Public Health Social Movement
Housing
•Home Ownership
•Affordable Housing
•Base Building- St. Nicks
Economic Opportunities
•Harlem Works
•Financial Literacy
•LPN RN Training Program
•Union Employment
•Micro Lending Savings
•Empowerment Zone
Early Childhood
•Early Head Start
•Head Start
•UPK
•Choir Academy
Birth
Early
Childhood
Health System
‾Case Management
- Title V Funds
‾Health Education
- Regionalization
‾Outreach
-Harlem Hospital
‾Perinatal Mood Disorders-Birthing Center
‾Interconceptional Care
Legislative Agenda
•Reauthorize Healthy Start
•SCHIP
•Minimum Wage Legislation
•Women’s Health Financing
Child Welfare
•Preventive Services
•Foster Care Services
•Parenting Workshops
•Newborn Home
Visiting
COPS Waiver
Pre-teen
Teen
Young Adult
Women
over 35
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BUILDING A PUBLIC HEALTH
SOCIAL MOVEMENT AROUND INFANT
HEALTH AND INFANT MORTALITY
HISTORY & PRINCIPLES OF MASS
MOVEMENTS
 SHARED PERCEPTION THAT A GROUP IS DENIED
RIGHTS, SAFTEY, OPPORTUNITY OR RESPECT
 THE ESSENCE OF MASS MOVEMENTS ARE THAT
THEY NARROW THE GAP BETWEEN IDEALS AND
THE CURRENT REALITY OF A GROUP
 PARTCIPANTS SHOULD BE THE AGENTS OF THEIR
OWN CHANGE!
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HISTORY & PRINCIPLES OF MASS
MOVEMENTS
 ONLY SINCE THE 1900’S HAVE MASS
MOVEMENTS BEEN USED AS AN
INTERVENTION TO ADDRESS BROAD
PUBLIC HEALTH CONCERNS IN LATIN
AMERICA, AFRICA AND THE UNITED
STATES
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Examples of Historical Social
Movements
 Civil rights
 Women’s Suffrage
 Feminism
 Black Power
 French Revolution
 Cultural and international revolutions
WORKING DEFINITION OF PUBLIC HEALTH
SOCIAL MOVEMENT/COMMUNITY MOBILIZATION
 Public health mass movements are defined as
a capacity-building process through which
community individuals, groups, or
organizations plan, carry out, and evaluate
activities on a participatory and sustained
basis to improve their health, transform the
health delivery system and address other
needs, either on their own initiative or
stimulated by others.
WORKING DEFINITION OF PUBLIC HEALTH
SOCIAL MOVEMENT/COMMUNITY MOBILIZATION
 At the end of the process, movement
participants possess more skills and
societal and public health changes can be
measured.
Strategies to Mobilizing & Organizing a
Public Health Social Movement
1. Build the organizational structure for Tarrant
2.
3.
4.
5.
6.
County’s public health social movement.
Declare and establish a state of emergency in
Tarrant County about infant health and infant
mortality.
Demystify the concept of infant mortality for the
common folk and key sectors of civil society in
Tarrant County.
Secure Tarrant County’s leadership team .
Secure strategic champions for Tarrant County’s
movement.
Include measurable results for accountability.
Strategies to Mobilizing & Organizing a
Public Health Social Movement
1. Build the organizational structure for Tarrant
County’s public health social movement.
Action steps
 Identify existing entities that support a MCHLCO
framework.
 Assess internal capacity of existing entities and
build internal capacity for new structures.
 Where capacity is weak form collaborations.
 Conduct program review/program
planning/program re-deployment.
Strategies to Mobilizing & Organizing a
Public Health Social Movement
2. Declare and establish a state of emergency in
Tarrant County about infant health and infant
mortality.
Action steps
 Develop the message.
 Develop a social marketing strategy.
 Get the message out. Work the media using mass
media campaigns including: PSA’s, press releases,
town hall meetings, talking points, press
conferences, and flyers.
 Use social networking tools at your disposal to keep
the message fresh and current, think viral.
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Strategies to Mobilizing & Organizing a
Public Health Social Movement
Demystify the concept of infant mortality for the common
folk and key sectors of civil society in Tarrant County.
Action steps
 Put a face(s) and name(s) to infant mortality versus it being
just another issue or cause.
 Use the social networking tools at your disposal to draw
more supporters (Facebook, Twitter, MySpace)
 Make the mass movement participatory allowing the
community to be agents of their own change.
 Approach block associations, churches, businesses, PTA’s,
home owner associations, barber/beauty shops.
3.
Strategies to Mobilizing &
Organizing a Public Health
Social
Movement
4. Secure Tarrant
County’s leadership team.
Action Steps
 Leadership team must include visionaries.
 Leaders that stretch their organizations
beyond their current capacity and structure
by challenging everyone to do what they
think is impossible.
 Form a Leadership council.
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Strategies to Mobilizing & Organizing a
Public Health Social Movement
5. Secure strategic champions for Tarrant
County’s movement.
Action Steps
 Secure personalities (celebrities, faith-based,
sports, private sector) to champion your
movement.
 Champions draw national attention to your
mass movement/message.
A Healthy Baby Begins with You
Campaign
Strategies to Mobilizing & Organizing a
Public Health Social Movement
Include measurable results for accountability.
Action Steps
 Working groups should include an evaluation & data
committee.
 Logic model should be used to document and evaluate the
movement.
 Evaluation of quantitative/qualitative changes over time.
 Legislative action and sustainability are part of the desired
outcomes/goals.
 Goals
6.
 Short-term
 Intermediate
 Long-term
Public Health Social Movement
Case Study
Citywide Coalition to End Infant Mortality
One City, One Customer, One Plan
Citywide Coalition to End Infant Mortality
Year One: 2000 - 2001
 Who?
 A group of clinicians, activists, Perinatal Networks, elected
officials and consumers/clients dedicated to ending infant
mortality.
 What?
 Approached the problem from the perspective that infant
mortality is a multifaceted issue that has medical, health care
access, economic and social determinants and solutions.
 Developed the Five-Point Program to answer the call.
 When?
 Movement began in August 2000 with focused media and
legislative campaigns. Fist formal community forum was held on
May 4, 2001.
Citywide Coalition to End Infant Mortality
Year One: 2000 – 2001 Cont’d
 Where?
 New York City’s five boroughs; New York, the Bronx,
Brooklyn, Queens and Staten Island
 Why?
 The catalyst:
 Decrease in Healthy Start funding
 Rise in infant mortality after experiencing a significant
decrease over a two year period
 How?
 City Council dedicated $5 million dollars starting December
1, 2001 to over 40 community-based social service and
health providers to start up case management, outreach,
health education and Doula programs to reduce infant
mortality.
Case Study
Build the organizational structure for a public health social movement.
1.

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Citywide Coalition to End Infant Mortality
Five Point Program
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Perinatal Networks
Immigrant/Ethnic Organizations
Building Borough Perinatal Tasks Forces
Community Health Centers
Declare and establish a state of emergency about infant health and
infant mortality.
2.
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Massive media campaign
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July 2000 Amsterdam News article
Sunday, January 21, 2001 NY Daily News Feature article
February 3, 2001 NY Post article
1010 WINS Radio News Broadcast February 3rd and 4th
All day coverage on IMR on New York One TV News and 1010 WINS Radio
Station
BET News provided national coverage of the story on 12/31/02
Case Study Cont’d
3. Demystify the concept of infant mortality for
the common folk and key sectors of civil
society .
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Consumer involvement Organization(CIO)
CIO leadership paid positions and committees
Human interest stories and interviews with
mothers
4. Secure leadership team
 Borough Perinatal Task Forces
Case Study Cont’d
5. Secure strategic champions for the
movement

Elected officials championed for funding for the
movement including: NYC Councilman Bill
Perkins (currently NYS Senator Bill Perkins)
6. Include measurable results for
accountability.

Comprehensive and standardized performance
objectives
Citywide Coalition to End Infant Mortality
Accomplishments to Date
1.
2.
3.
4.
5.
6.
Five Point Program– bought together five entities for a
common goal.
Massive media campaign
The coalition developed a comprehensive plan to end
infant mortality in high risk communities throughout NYC
by mobilizing and organizing key constituencies and public
health organizations from across the city.
A record $5 - $7 million dollars has been allocated yearly
since 2001 by the City Council towards achieving
objectives – over $70 million to date.
Legislative and advocacy strategies have been
instrumental in upstream policy changes.
One city, one customer, one plan!
Seize the moment
 Develop a working committee to scan the
external environment to research and then
select a variety of program development
funding opportunities to expand the service
offerings of the MCH Life Course
Organization.
Sample Funding Opportunities
 The Community Based Doula Program
 First Time Motherhood Initiative Grants
 March of Dimes Community Award
 March of Dimes Community Grant
 Bill & Melinda Gates Foundation
 Eileen Fisher Foundation
 http://mchb.hrsa.gov/training/grantee_resour
ces_alert.asp
“ The Future Belongs to Those Who Believe in
the Beauty of Their Dreams.”
Eleanor Roosevelt
MCH Life Course Organizations
Examples of Believing
Northern Manhattan Perinatal
Partnership, Inc. Sisterlink Initiative
• Harlem, New York
• Mario Drummonds, MS, LCSW, MBA
South Madison Health & Family Center Harambee
• Dane County, Wisconsin
• Paul Soglin
DC Developing Families Center
• Ward 5, District of Columbia
• Dr. Lubic & Dr. Randolph
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The Art of Leadership
 Tarrant County’s mass movement needs a
leader!
“Genuine leadership demands a sense, not of
glamour, but of responsibility. The true leader is
concerned not so much with the opinions of
others as with the truth, with getting a job done,
with inspiring others to join him/her in working
toward a worthy common goal.”
J. Donald Walters
Thank You for Your Time!
Tamara Wrenn
[email protected]