Sustainability in Tight Times: Local Efforts

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


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.


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


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).


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


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


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


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


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]

Documents

Sustainability in Tight Times: Local Efforts