What is B’more for Healthy Babies? A new bold & exciting initiative in Baltimore Designed to...
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What is B’more for Healthy Babies?
• A new bold & exciting initiative in Baltimore
• Designed to decrease our high infant mortality rate
• Will work on different levels to affect change – policy, services, community and individual levels
A Public Health Crisis
In 2009, an estimated 123 infants died in Baltimore City – a rate of 12.3 per 1,000 live births … an average of over 10 babies per month African American: 14.3 per 1,000
(2008)
White: 7.3 per 1,000 (2008)
Baltimore City has the highest rate of infant death in Maryland and the 4th worst infant mortality rate in the U.S.
Baltimore City Health Department analysis of data from cases reviewed by the Baltimore City Child Fatality Review. 2009 data is still tentative.
Unexpected Infant Deaths that Occurred During Sleep 2002-2009
In 2009, 82% of deaths were African American, 18% White, 0% HispanicIn 2009, 82% of deaths were African American, 18% White, 0% Hispanic
What is B’more for Healthy Babies?
Our vision is to ensure that all of Baltimore’s babies are born healthy weight, full term, and ready to thrive in healthy families.
This will be done by:
• mobilizing communities, families, and individuals around reducing the disparities of infant mortality
• improving access to and quality of medical and social services
• inspiring a collaborative spirit among policy advocates, health and social service organizations, and community members to actively reduce Baltimore’s infant mortality
Intended Outcomes
Reduce:
• Rate of pre-term births by at least 10% (283 fewer preterm babies)
• Rate of low birth weight infants by at least 10% (259 fewer low birth weight babies)
• Number of deaths from unsafe sleep by at least 30%
(12 infants)
Factors Affecting Poor Birth Outcomes
• Health of the mother and father before conception
• Medical and social support during pregnancy
• Access to critical knowledge and services after birth
Factors Affecting Poor Birth Outcomes
Stage Pre-Pregnancy Pregnancy Post-PregnancyCare Preconception Prenatal & Obstetric Postpartum & Neonatal
Modifiable Determinants of Adverse Outcomes
SmokingSubstance abuse
Poor nutrition/obesityPsychosocial stressDomestic violence
Infection/ Sexually Transmitted InfectionsUnderlying Chronic Illness
Lack of Health Insurance CoverageUnderlying Determinants of Poor Reproductive Health
Poverty Environmental exposures
Poor housingRacism
Genetic factors
Interventions Specific to Stages
Planned pregnancies: - Wanted & timed - Spaced Good nutrition - Adequate folate High quality primary care STD treatment
High quality prenatal care
Access to high-risk obstetrics
Home visiting for high-risk pregnancies
Breastfeeding Safe sleep Adequate nutrition Immunizations
High-Impact Service Areas
(1) Primary health care in a medical home
(7) Smoking cessation
(2) Obstetric care (8) Family planning
(3) Home visiting (9) Nutrition support
(4) Drug and alcohol treatment (10) Breastfeeding promotion
(5) Domestic violenceInterventions
(11) Safe sleep education
(6) Mental health care
Gaps in Current Efforts to Improve Birth Outcomes
• Individual initiatives are funded inadequately and separately
• Poor coordination of services
• Lack of adequate primary health care
• Lack of health insurance
• Lack of minimum standard of care
• Limited community mobilization to promote healthy behaviors prior to or between pregnancies
Professional Case Management for Selected Individuals at Risk
Paraprofessional Home/Community-Based Services for Selected Communities at Risk
Targeted Health Education and Support Services
Community Mobilization and Health Education
Support Continuum for Improved Birth
Outcomes
Refe
rral
s an
d Co
ordi
natio
n
Citywide Infrastructure and Education
High-Impact Service Areas
• Primary health care/ preconception
care
• Obstetric care
• Homevisiting
• Drug and alcohol treatment
• Intervention for domestic violence
• Mental health care
• Smoking cessation
• Family planning
• Nutrition support
• Breastfeeding promotion
• Safe sleep education
Excess Number of Infant Deaths by Census Tract, Baltimore City, 2002 - 2006
STEERING COMMITTEE
COMMUNITY ACTION TEAM
Core Implementation
Team
Neighborhood Action Team
SIBO Organizational System
Medicaid/MCOs
Ad Hoc Committees
Hospital Team(s)
State IM Plan
FQHCs
Donors
BabyStat
Fetal/Infant MortalityReview
Child Fatality Review
Neighborhood Action Team
Neighborhood Action Team
Implementation
• Timeline: 10 years (3 Years of initial funding)• 4 Results Areas: Policy, Services/Systems,
Communities, Families/Individuals• Entry Point: Pregnancy/Postpartum • 3 Phases of Communication: Healthy and Safe
Parenting, Healthy Pregnancies, Healthy Baltimore• 12 Communities – starting with 3
Implementation
Results Area 1: Policy/SystemsPolicy for coordinating risk assessment and referral
is in place• Citywide triage system for home visiting services and integrated
database• Prenatal Risk Assessments – making system more efficient• Linking families to community-based services and BHB messages
at discharge from labor and delivery• Fetal and Infant Mortality Review Team – Community Action
Team – Neighborhood Action Teams• Selecting home visiting models for the city
Implementation
Results Area 2: ServicesAgencies and partners providing services adhere to
policies and guidelines for risk assessment and referral with goal of increasing access
• Service Availability Profile—leading to agency work plans• Nurse home visiting adoption of Partners for a Healthy Baby
curriculum. • Cadre of trainers trained as change agents and disseminators
of BHB messages• Provider outreach on PRAs• Hospital outreach at postpartum (video)
Implementation
Results Area 3: CommunitiesCommunities know their role in supporting
improved birth outcomes and buy into strategy• Communities selected and funded• Introduction of Baby Basics and Mom’s groups• Text4Baby• Specific strategy for no prenatal care/unable to
locate under development
Upton/Druid Hts—University ofMaryland Medical System
Greenmount East – People’s Community Health Center
Patterson ParkNorth and East – Baltimore Medical System
Implementation
Results Area 4: Families and IndividualsFamilies and individuals at risk use available
services and practice behaviors that improve birth outcomes
• Branding/safe sleep focus groups• Home visiting programs• Provider outreach
Next Steps?
• Design and implement baseline evaluation for the strategy• Finalize citywide triage criteria• Work with State and hospitals to identify high risk women at
discharge from labor and delivery• Develop provider and community-based toolkit for high impact
areas• Implement phase I of citywide communications campaign:
Healthy and Safe Parenting: SAFE SLEEP• Develop website• Begin community program interventions
Imperative: A City-wide Coordinated Effort
• Citizens and leaders • Mayor’s Office• Health Department• The Family League of
Baltimore City, Inc.• Baltimore HealthCare Access,
Inc.• Baltimore Substance Abuse
Systems, Inc.• Managed Care
Organizations• Housing
• Dept of Social Services• Baltimore Mental Health Systems,
Inc.• Pediatricians/Adolescent
physicians/Obstetricians • Home visiting and community
outreach programs • Schools• Faith-based organizations• Businesses• Public Safety Departments• Hospitals