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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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]