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Sustainability in Tight Times: Local Efforts. Building and maintaining an infrastructure of care for women, infants, children, and families. - PowerPoint PPT Presentation
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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
2001 – 2005 Healthy Start Grant: Eliminating
Perinatal Disparities $3.6 million over four years Approved for third funding cycle 2005-2009
Rebuilding Community Infrastructure
In 2002: MCHD reconvenes the IHBC MCHD restarts the FIMR
Program Consumer Connection
Consortium established
In 2003: PPOR Workshop
Rebuilding Community Infrastrucure
In 2004: PPOR Team identified-
Technical 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: 1,607,486
Median 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 of prenatal care: Marion County: 77% Indiana: 73.2% (Rank 32)
Infant 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: FIMR- Title V GAP grant assists
with funding a MCH epidemiologist position.
2005-2006: 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
Indiana Perinatal Networks Indiana Access:
Medicaid waiver Unplanned (mis-timed) pregnancy data Technical assistance
Excess DeathsBirth Cohort Data, Marion County, IN 1999-2003
Maternal OverallAll Marion County Health Maternal Newborn Infant Excess
Prematurity Care Care Health DeathsMarion County (273 deaths) (147 deaths) (100 deaths) (163 deaths) (683 deaths)Excess compared to Internal Group 137 76 19 97 330Excess compared to External Group 117 40 20 92 268
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
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%)
Top Six Pregnancy Risk Factors
Local Partnership Efforts to Address Challenges
June 2006-November 2006
FIMR
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%)
Pre-existing Risk Factors
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
IHS Case Management Client Social and Behavioral Risk Factors
56%
46%39%
34%28%
16%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Mental Health/Depression
Smoking Lack of Transportation
Domestic Violence
Alcohol/Drug Use
Poor/No Housing
Perc
enta
ge o
f IH
S C
lient
s
72% of clients with these risk factors
receive counseling or assistance from IHS Case Managers or affiliated provider.
90% of all IHS clients have at least one of these risk factors.
Local Efforts
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 GranteeOrganizationMarion County Health Department3838 North Rural StreetIndianapolis, 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]