Sustainability in Tight Times: Local Efforts Building and maintaining an infrastructure of care for women, infants, children, and families. Supported in part by project H49MC00138
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Transcript Sustainability in Tight Times: Local Efforts Building and maintaining an infrastructure of care for women, infants, children, and families. Supported in part by project H49MC00138
Sustainability in Tight Times:
Local Efforts
Building and maintaining an
infrastructure of care for women,
infants, children, and families.
Supported in part by project H49MC00138 from the U. S. Department of Health
and Human Services, Health Resources and Services Administration, Maternal
and Child Health Bureau (Title V, Social Security Act).
Overview
Local community history
How interdepartmental
teamwork and community
collaboration enhances
program development and
capacity
How local partnership efforts
support and effect change in
systems and services
Continued sustainability
strategies.
Healthy Babies/Healthy
Moms Coalition
1986
Poor
birth outcomes in
Marion County
Children’s Defense Fund
Announcement
1987
Indianapolis
had the
highest Black infant
mortality rate (24) of
any U.S. city with a
population of 500,000
or more people.
Community-Based Approach
1989
Business, political, and
community leaders unite
to form a public and
private partnership,
develop a work plan, and
mobilize the communities
resources to reduce the
county’s infant mortality
rate.
Indianapolis Campaign for
Healthy Babies
1989
ICHB formed and
was active through 1992.
New health centers
Expansion of existing
health centers
Care Coordination
Services was introduced
to pregnant women
WIC services expanded
Sustaining IHBC Efforts
1993,
Health and Hospital
Corporation of Marion County
(HHC) assumed responsibility
for the campaign under
“Healthy Babies Initiatives”
New
services initiated:
Prenatal outreach
Prenatal substance abuse
Male responsibility
Community awareness
Fetal and Infant Mortality Review
1995
- Marion County Health
Department (MCHD)
establishes the Indianapolis
Healthy Babies Consortium to
administer a Fetal and Infant
Mortality Review (FIMR)
Project.
1999
- Healthy Babies of the
New Millenium was released.
The final volume in a series of
reports prepared by FIMR
Indianapolis Healthy Start
1997
- MCHD receives a
Health Resources and
Services Administration
grant -PhaseII
$3.6 million over four years
– 2005
Healthy Start Grant:
Eliminating Perinatal
Disparities
2001
$3.6 million over four years
Approved for third funding
cycle 2005-2009
Rebuilding Community
Infrastructure
In
In
2002:
MCHD reconvenes the IHBC
MCHD restarts the FIMR
Program
Consumer Connection
Consortium established
2003:
PPOR Workshop
Rebuilding Community
Infrastrucure
In
2004:
PPOR Team identifiedTechnical Assistance
provided through CityMatCH
FIMR-PPOR Workshop
Launching of the FIMR Chart
Review Team
Healthy Start community
assessment of MCH high-risk
population and identification
of catchment area
Marion County
Demographics
Population:
Median
1,607,486
Age: 34.6
Sex:
Male: 49%
Female: 51%
Race:
White: 82%
Black: 13.9%
Hispanic: 2.7%
Median
Income: $41,964
Source: U.S. Census Bureau 2005 American
Community Survey
Marion County
Demographics
Smoking
during pregnancy:
Marion County: 17%
Indiana: 27.3% (Rank 49)
Obesity:
Marion County: 24%
1 in 4 adults is obese
Indiana: 27.2% (Rank 41)
Adequacy
Marion County: 77%
Indiana: 73.2% (Rank 32)
Infant
of prenatal care:
mortality:
Marion County: 10
Indiana: 8 (Rank 40)
Source: U.S. Health Foundation, 2006.
Marion County
Demographics
Infant
mortality rate:
Marion County total: 10
White: 8
Black: 14
Hispanic: 10
Source: HHC, Epidemiology, 2006.
Occupations:
Marion County: 8.4%
Professional, scientific,
management, administrative
and waste management
services
Nationwide: 9.9%
Poverty
level:
Marion County: 14.8%
Indiana: 12.2%
Nationwide: 12.6%
Source: U.S. Census Bureau, 2005. American Community
Survey.
Resources for Program
Development and Sustainability
2004-Present:
2005-2006:
FIMR- Title V GAP grant assists
with funding a MCH epidemiologist
position.
FIMR- Title V Gap Grant assisted
with funding a MCH nurse
abstractor.
FIMR Abstractor: contract
funded by MCH budget.
Americorps nurse volunteer
2007 -FIMR
Resources for Program
Development and Sustainability
2005-2007:
Title V GAP Grant
Preconception/Interconception
Health Project.
Assisted with funding a MCH
nurse specialist position.
MCH
Staff augment IHS staff
with in-kind FIMR, Consortium
and Project Director positions
($132,405 match).
Resources for Program
Development and Sustainability
2006:
IHS Centering
Pregnancy Program
Site-Indiana University
Medical Group Health Center
(Facility is the property of
HHC)
March of Dimes funding of
local group prenatal care
programs
Community Assets
Healthy
Start
Indiana Access national pilot site
Indiana State Department of
Health
Indiana Perinatal Network state
coalition, state advisory board
Fetal and Infant Mortality Review
Indianapolis Healthy Babies
Consortia
March of Dimes
Child Fatality Review Committee
Community Assets
WIC
Breastfeeding
peer counselors
Breastfeeding Coalition
MCHD Nutrition Service
Prenatal care coordination
PPOR Team
Community Council on Infant
Health and Survival
Leading Ladies
Food & Nutrition Extension
Program
Local universities
Community Challenges
Persistent
leading causes of
infant mortality:
Prematurity and low birth weight
Lack of community preconception
and interconception protocols
High incidence of unintended
(mistimed) pregnancy
Prevalence of obesity
Prevalence of STD’s
Community Challenges
Access
to mental health
services
Lack of community
awareness of preventable
causes of infant mortality
Lack of consumer
understanding of safe sleep
messages
Lack of policies for safe
sleep practices in local
hospitals
Low breastfeeding rates
Local Partnership Efforts to
Address Challenges
Excess Deaths
Birth Cohort Data, Marion County, IN 1999-2003
All Marion County
Marion County
Excess compared to Internal Group
Excess compared to External Group
Maternal
Health
Prematurity
Maternal
Care
Newborn
Care
Infant
Health
Overall
Excess
Deaths
(273 deaths)
137
117
(147 deaths)
76
40
(100 deaths)
19
20
(163 deaths)
97
92
(683 deaths)
330
268
Indiana
Perinatal Networks Indiana
Access:
Medicaid waiver
Unplanned (mis-timed) pregnancy data
Technical assistance
Infant Fatalities
1999,
2000, 2003 Indiana was
ranked first in the nation for:
Injury-related fatalities for infants
Unintentional injury-related
fatalities for infants
Leading
cause of injury
related fatalities was
suffocation
Leading cause of intentional
injury-related fatalities was
physical abuse/beatings
Local Partnership Efforts to
Address Challenges
Indiana
Perinatal Network
Safe Sleep Conference,
Oct. 4, 2006
Call to Action:
Best Intentions
Unplanned pregnancies and the
well being of Indiana families
March
of Dimes
Grants
Brochures
Preconception
Care:
Dr. Karla Damus, Oct. 10, 2006
Local Partnership Efforts to
Address Challenges
FIMR
Top Six Pregnancy Risk Factors
Preterm labor
14 (45%)
Smoking at time of
delivery
13 (40.6%)
Infection
9 (29%)*
Inappropriate weight
gain
8 (25.8%)*
Drug use
6 (16.1%)
Decreased fetal
movement
4 (12.9%)
Local Partnership Efforts to
Address Challenges
FIMR
Pre-existing Risk Factors
Pre-existing Risk Factors
N=31
Obesity
16 (50%)
Previous poor birth
outcomes
9 (28%)
Less than 18 months
between deliveries
6 (18.7%)
Diabetes
4 (12.5%)
Hypertension
2 (6.2%)
June 2006-November 2006
Local Partnership Efforts to
Address Challenges
Indianapolis
Healthy Babies
Consortium
Serves as a venue for equipping the
community to effect change based on
evidenced-based practice and enhancing
members knowledge and skills through
presentations from local/national experts.
Six workgroups:
Access to care
Education
Nutrition
Domestic violence
Smoking elimination
Substance abuse.
Efforts to Improve Screening, Referral,
and Access to Mental Health Services
for Pregnant and Post-Partum Women
Marion County
WIC Clinic
Locations
Local Efforts
Local Efforts
IHS Case Management Client Social and
Behavioral Risk Factors
100%
72% of clients with
Percentage of IHS Clients
90%
80%
90% of all IHS clients
70%
have at least one of
these risk factors.
60%
these risk factors
receive counseling or
assistance from IHS
Case Managers or
affiliated provider.
56%
46%
50%
39%
40%
34%
28%
30%
16%
20%
10%
0%
Mental Health
/Depression
Smoking
Lack of
Transportation
Domestic
Violence
Alcohol/
Drug Use
Poor/No
Housing
Sustainability Strategies
Sustained
federal funding for
Healthy Start
Sustained Title V funding
Other activities:
Advocate for funding
Blend Funding
Pursue Grants
Insist on accurate data
Share data
Use data to guide program
development
Monitor outcomes in MCH
programs
Sustainability Strategies
Maintain
collaboration with
local universities,and
hospital systems
Keep local, state, and
national legislators apprised
of the MCH issues
We will embrace all
opportunities to think out of
the box.
Final Thought
The problem of infant mortality
is one of the great social and
economic problems of our day. A
nation may waste its forest, its
water power, its mines and to
some degree even its land, but if
it is to hold its own…its children
must be conserved at any cost.
On the physical, intellectual and
moral strength of the children of
today, the future depends.
Julia Lathrop, MD, first Director,
Federal Children’s Bureau, 1913
Indianapolis Healthy Start Grantee
Organization
Marion County Health Department
3838 North Rural Street
Indianapolis, Indiana 46205
Contact Persons:
Yvonne Beasley, MN, RN, CNAA
Director of Maternal and Child Health
Project Director, Indianapolis Healthy Start
Telephone: (317) 221-2347
Fax:
(317) 221-2472
E-Mail:
[email protected]