Transcript City Match Urban Maternal And Child Health Leadership

'Medical Home' for MCH
Populations:
A Way to Realize the Life Course
Perspective
and Address Social Determinants of
Health
March 24, 2009
Making the “Life Course
Perspective” Real for Harlem’s
Disparate Families: From
Birth Outcomes to Adult Chronic
Illness
Boston University
Mario Drummonds, MS, LCSW, MBA
CEO, Northern Manhattan Perinatal
Partnership, Inc.
Life Course Theoretical Assumptions
& Implication to MCH Practice
• Diminished Role & Impact of Prenatal Care
• Maternal Health Prior to Pregnancy is Key
• It will Take More Than One Generation to Equalize Birth
Disparities
• Calls for Clinical & Public Health Interventions that are
more Longitudinally and Contextually Integrated
• Transition Must be Made from Strictly Clinical Approaches
to Practice to Integrate a Social Determinants of Health
Focus to Practice
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Traditional Perinatal Care
Continuum
Preconception
Primary Care Counseling
Preconception antepartum
Period
Prenatal Care
Labor
and
Delivery
Care
throughout
labor and
delivery
Postpartum
Care
postpartum Interconceptional
period
Well Child Care
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New MCH Life Course Continuum
Axis 1
Birth
Early
Childhood
PreTeen
Teen
Young Women Senior
Adult
>35 Citizens
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MCH Life Course Organization
Social Determinants to Health Axis 2
Public Policy
Initiatives
Community
Environmental
Impact
Organizational
Impact
Group/
Interpersonal
Impact
Individual
Impact
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Social Determinants of Health MCH
(Strategies)
Public Health Zonal Strategies
• Harlem Children’s Zone
• NMPP’s Take Over of the St. Nicholas
Houses
• NYCDOH’s Local Public Offices
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Building Public Health Social
Movement
• To Change the Health Seeking Behaviors
of Women of Childbearing Age as well as
Change Political and Health Systems to
Develop the Political Will to Invest in
Infant Mortality Reduction Interventions
Citywide Coalition to End Infant Mortality
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Perfecting MCH Direct Practice
Interventions (Strategies)
• Prenatal Care, Centering Pregnancy,
Case Management & Home Visiting
Services, Health Education, Outreach,
Internatal Care, Fatherhood Services,
Children with Special Healthcare Needs,
etc.
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Developing Anti Poverty/Economic
Development Strategies
• Empowerment Zone
• Harlem Works
• Developing Financial Assets & Savings
• Developing New Industries to Employ the
Poor & Working Class
• Developing Affordable Housing Initiatives
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Developing Reproductive Social Capital
(Social Support Interventions)
• Baby Mama’s Group -Depression
Screening & Treatment, Sister Chat,
Consumer Involvement Organization,
Collard Greens for the Ghetto Soul Book
& Video Productions
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Curriculum Guide
Developed by
Northern Manhattan
Perinatal Partnership’s
Social Health
Marketing Group
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MCH Interventions in Early
Childhood Services
• Early Head Start
• Head Start
• UPK
• Grade School
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Integrating MCH and Child
Welfare Systems of Care
• Nurse Family Partnership
• Healthy Start
• Healthy Families America Home
Visiting Programs
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Selected Child Welfare Trends, Central Harlem 2002-2005
2002
2003
2004
2005
Abuse/Neglect Reports
1574
1354
1200
1208
Number of Children In
Reports
2478
2032
1855
1846
45.0%
39.4%
37.9%
45.9%
Number of Children in
Indicated Reports
973
649
745
885
Victimization Rates *
32.8
21.9
19.4
24.7
Number of Placements
Number of Children
Placed
449
447
285
279
228
220
192
192
Number of Families
Placed
288
198
161
146
Placement Rate **
15.1
9.6
7.4
6.5
Year
Abuse/Neglect Indication
Rates
Source: NYC Administration for
Children’s Services: Office of
Management Analysis
•Victimization Rate is the number of children with indicated abuse/neglect per
thousand youth 17 and under in the population.
•** Placement rate is the number of children placed into foster care per 100o
youth 17 and under in the population.
MCH Chronic Disease Strategy
• Obesity
• Diabetes
• Asthma
• High Blood Pressure
• Depression
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MCH Life Course Organization Clinical
Practice Service Mix
• Birthing Center/Labor & Delivery Ward
• Perinatal Case Management
• Interconceptional Care Program
• Maternal Depression Individual/Group Program
• Early Head Start
• Head Start
• Child Welfare Preventive
• After-School
• Adolescent Pregnancy Prevention Program
• Chronic Disease Management Programs
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NMPP Direct & Group Practice Assets:
• Central Harlem Healthy Start Program
• Nurse Family Partnership,
• Community Health Worker Program
• Harlem Hospital Birthing Center
• St. Nicholas Child Welfare Preventive Program
• Mankind Fatherhood Case Management Program
• Centering Pregnancy/Adolescent Pregnancy Prevention Team
• Baby Steps Home Visiting Program
• Baby Mama’s Club/Circulo de Mamas Depression Groups
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NMPP Direct & Group Practice Assets:
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Asthma Case Management Team
Harlem Weight Watchers Program
Start Right Immunization Team
Center for Preschool & Family Learning Head Start152nd St.
Center for Preschool & Family Learning Head Start155th St.
Universal Pre-K Program-152nd St.
Universal Pre-K Program-155th St.
Managed Care/Healthcare Enrollment Program 23
NMPP Coalitional & Public Health
Upstream Organizational Assets on the
Ground
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Harlem Choir Academy Middle School
CHHS Consortium
CHHS’s Consumer Involvement Organization
NYC Male Involvement Consortium
Harlem Weight Watchers Program
Comprehensive Prenatal/Perinatal Network
Manhattan Regional Perinatal Forum
NMPP’s Harlem Works Job Readiness Program
St. Nicholas Houses Community Organizing Project
Harlem Child Welfare Network
Casey Powerful Families Training Program
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NMPP’s Community/Environment Assets on the Ground
“Place & Race Matters”
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Harlem Food & Fitness Consortium
NMPP’s BBKH Diabetes Coalition
NYC Breastfeeding Alliance
Federation of County Networks
Harlem Health Promotion Center
Harlem Strategic Action Committee
Citywide Coalition to End Infant Mortality
ABC Asthma Coalition
Sisterlink Coalition
Start-Right Immunization Coalition
NYC Male Involvement Consortium
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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
1. Harlem Hospital Recently Designated as a “Baby
Friendly” Hospital (Aug 2008)
2. Passed Mental Health Parity Legislation Timothy’s
Law (2007)
3. Trained over 800 women and placed them in full time
jobs!
4. Reduced Child & Abuse & Neglect Rates in Harlem
5. Repealed “Medicaid Neutrality” Law in NYS
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Public Policy & Systems Change
Achievements
1. Increased Medicaid Mental Health Reimbursement
Rates
2. NYC Mayor Has $7.5 Billion Dollar Plan to Build
165,000 Units of Affordable Housing by 2013Eighty-Two Thousand units built to date!
1. Mayoral $10 million dollar Plan to train 400 Harlem
residents to become RN’s and LPN’s
2. Congressman Rangel’s Harlem Empowerment Zone
3. Legislation to move from a minimum wage to a livable
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wage policy
Public Policy & Systems Change
Achievements
•
Moving Harlem Residents into Union Jobs
•
Created More Micro-Lending Programs to Spur
Business Ownership by Poor & Working Class
Women in Harlem
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Spectrum of Work for MCH Life Course Organization
Building Public Health Social Movement
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
Housing
•Home Ownership
•Affordable Housing
•Base Building- St. Nicks
Legislative Agenda
•Reauthorize Healthy Start
•SCHIP
•Minimum Wage Legislation
•Women’s Health Financing
Health System
‾Case Management
- Title V Funds
‾Health Education
- Regionalization
‾Outreach
-Harlem Hospital
‾Perinatal Mood Disorders-Birthing Center
‾Interconceptional Care
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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Characteristics of a MCH Life Course
Organization
1. Builds Programmatic Capacity Within the
Agency at Each Stage of a Woman’s Life
Course to Manage her Health Over the
Life Course
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Characteristics of a MCH Life Course
Organization
• 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
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Characteristics of a MCH Life Course
Organization
1. Can See Around the Corner to Respond to
Trends Before They Have an Impact on
the Target Population- e.g. Diabetes,
Women Over 35
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Characteristics of a MCH Life Course
Organization
• Swims Up-Stream from Individual
Interventions & Design Strategies and
Actions at the Group, Organizational,
Community and Policy Levels to
Transform Social Determinants to
Poor Health
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Characteristics of a MCH Life Course
Organization
5. Unlike Healthy Start Programs that Only Seek to
Influence the Health System by Developing &
Executing a Local Health Systems Action Plan, a
MCHLCO Seeks to Influence and Lead their Local
& Regional Economic, Political, Housing, Child
Welfare, Early Childhood and Middle School
Systems of Care
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Characteristics of a MCH Life Course
Organization
1. The MCH Life Course Organization is
Decentralized
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Characteristics of a MCH Life Course
Organization
1. Leaders and Managers are Allowed to Run
their Programs like Businesses
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Ties that Bind:
MCH’s Role in
Preventing Chronic
Diseases
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Problem Analysis:
• Close to 1 million New Yorkers are Diabetics
• Over 40,000 women in NYC have Gestational
Diabetes
• 10 to 15% of the Adult Population in Harlem &
South Bronx Diabetic & Obese
• Death Rate due to Diabetes in NYC is three times
higher for African Americans and two times
higher for Latinos
• Recent NYCDOH Study Revealed that 43% of
NYC’s School Children are Overweight
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MCH/Chronic Disease
Solutions
• Restructured all Six MCH Home Visiting
Programs Pregnancy Care to Interconceptional
Care (2004)
• Partnered with Weight Watchers to Organize
First Program in Harlem (2004)
• Partnered with Mailman School of Public Health
to conduct a Study that Explored the
Relationship between Maternal Weight- Obesity
& Low Birth Weight (2005-2007)
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MCH/Chronic Disease
Solutions
• Formed BBKH Diabetes Coalition with NY
Presbyterian Hospital (2004)
• BBKH Goal: By 2012 Build a Public Health Social
Movement to Reduce Growth of Diabetes by 5% in
Harlem & South Bronx
• Secured Five-Year Funding Commitment from
NYSDOH (2006)
• Implemented Spectrum of Care Strategy to Achieve
Public Health Goal
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Strengthen Individual
Knowledge and Skills
• Manage the Diabetic Care of 1,000
diabetic patients using CHWs
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Promote Community
Education
• Diabetes Jazz Sundays-Medical
Moments
• Kitchens of Faith
• Day of Hope
• Social Marketing Campaign: Leaning
on Culture…Colliding with Faith
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Educating Health Providers
• Improving Culture Competency
Skills of Hundreds Medical Staff
Caring for Patients
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Fostering Partnership and NetworksDeveloping Diabetes Health Disparities
Task Force
• Built with NYCDOH Harlem Food &
Fitness Consortium-Super Network
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Changing Organizational
Practices
• Helped to Make Business Case for
Affinity Health Plan & Community
Premier Plus to Hire and Use
Community Health Workers
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Influencing Policy/Legislation
• Leading Force in Passing Green Cart Legislation in 2008
• Worked with NYC City Planning Agency to Place Moratorium
on Closing Supermarkets in Harlem & South Bronx
• Working with NYC City Council to Develop Zonal Legislation
on Curbing Growth of Fast Food Restaurants in Poor
Communities
• Working with Gov. Paterson to Pass Law to Institute Soda Tax
• Worked with NYC Board of Health & Health Commissioner to
Pass Trans Fat & Anti-Smoking Policies
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Discipline
Consistency
Patience
Faith
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• Put Simply, Transformations in how MCH
Services are Organized within an Agency
and how they are Managed, Deployed and
Executed Can Bring about Measurable
Changes in Organizational Performance
thus Producing Better Birth Outcomes
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• Building the MCH Life Course Organization
calls for Establishing a Strategic Leadership
Team that has Excellent Program
Development/Sustainability Competencies
Among Team Members. The Lead Agency must
Possess the Ability to Manage and lead a
Complex Organization Structure of Services,
Coalitions and Programs like a Business!
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NMPP believes that Leadership is the
self-defined capacity to communicate
vision and values while providing
programs, structures and core services
that satisfy human needs and aspirations
while transforming people, your
organization and society in the process!
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Reducing Infant Mortality Throughout the USA by: Building
a Social Movement, Investing in Ideas, Executing Tasks,
Returning Results!
Linking Women to Health, Power and Love Across the Life Span
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For more Information Contact:
Mario Drummonds, MS, LCSW, MBA
Executive Director/CEO
Northern Manhattan Perinatal Partnership
127 W. 127th Street
New York, NY 10027
(347)489-4769
[email protected]
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