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Genesee County Healthy Start

Giving African American Babies a Healthier Start Genesee County Healthy Start Supported in part by project H49MC00148-05-00 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).

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Genesee County Healthy Start

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  1. Giving African American Babies a Healthier Start Genesee CountyHealthy Start Supported in part by project H49MC00148-05-00 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).

  2. Our Community

  3. Genesee County, Michigan

  4. Flint, Michigan • 4th largest city (120,000) • Manufacturing base • General Motors; UAW • 35% population decrease • Poverty, unemployment, violence • Racial health disparities • Community activism

  5. Genesee County, Michigan African American White City of Flint: 55.8% 39.3% County: 20.2% 75.4% • In the City of Flint… • 45% of children < 18 years live below poverty • 28% of all families live in poverty • 52% of female householder families live in poverty Population: 436,141 Source: U.S. Census Bureau, American Community Survey Fact Sheet, 2004 and 2005

  6. OB Care in Genesee County 2,768 births/year 35% Medicaid births 811 births/year 8% Medicaid births 2,721 births/year 57% Medicaid births Averages calculated using 1997-2005 live birth data

  7. Healthcare in Genesee County • 791 primary care physicians • 6 certified nurse midwives • 85 prenatal care providers at 49 sites • 3 perinatologists (2 high-risk clinics) • 1 NICU • 11 PNC provider offices located in IM zips

  8. In Genesee County…. 6,282 births per year (1998-2005 average) On average 69 infants die each year (2000-2006 Infant Deaths) Of the 69 infant deaths, 34 are black infants Black babies die 2-3 times more than other babies

  9. Number of Infant Deaths By RaceGenesee County, Michigan1999-2006 (2006 preliminary) Source: Genesee County Health Department, 1999-2006 Fetal-Infant Mortality Statistics

  10. Annual Infant Mortality Rates by RaceGenesee County, MI 1999-2005 Source: Michigan Department of Community Health, Vital Records & Health Data Development Section.

  11. Infant Mortality Disparity Ratio*Genesee County, Michigan 1999-2005 *African American to White Disparity Ratios Source: Michigan Department of Community Health, Vital Records & Health Data Development Section.

  12. Infant Cause of DeathGenesee County 2002-06(preliminary) N=339

  13. Healthy Start Supported in part by project H49MC00148-05-00 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).

  14. Purpose To reduce infant mortality, reduce perinatal depression, & improve neonatal outcomes among pregnant & post partum African American women and infants & children from birth to 2 years old.

  15. Genesee County, MIHealthy Start Logic Model Partners • Conditions • (City of Flint) • AA IM rate is 21.3* • Low Birth Weight among AA is12.4% • Very Low Birth Weight among AA is 3.7% • *Per 1,000 live births • Interventions • Outreach • Case Mgmt • Screening/Assmt • Home visits • Support Groups • Health Education • Consortium • Target Population • Pregnant AA women • AA/Bi-racial children (birth to 2) • Zip codes 48503,48504, 48458 Expected Outcomes >Access to PNC in 1st trimester >Babies >5 ½ lbs >Medical home >Full-term babies >ATOD >Breastfeeding > Immunizations >I.D. & refer for depression >self sufficiency >Reduce infant death rate

  16. Care Team Registered Nurse Social Worker Community Advocate Registered Dietician Program Coordinator

  17. The Service Process Referral Enrollment Interview Assessment Care Meetings (Case Conferences) Risk Assessment Scale Goal & Service Plan Quarterly Review Home Visits Support Referrals

  18. “Closing the Loop”

  19. Our Goals for the Process • Bring all partners “together” • Maintain ONE care plan • Stratify levels of care • Guide/organize work through the “chaos” of clients’ lives • More accurately reflect level of staff work & client progress (difficult to quantify)

  20. Healthy Start Program Participants2001-2006 • 1,008 Pregnant women • 639 Infants less than 1 year of age • 270 Children 1-2 years of age • 772 Births

  21. How Do We Know What We’re Doing is Working?

  22. Successes • Service Plans closed out at discharge • Improved documentation • Focus on identified issues • Consensus among Care Team members on discharge • Care Team members learn from one another • Compare/contrast individual staff assessments • Address issues with expertise from multiple disciplines

  23. % Low Birth Weight* Among African AmericansCity of Flint and Healthy Start, 2001-2006* *Low Birth Weight is between 1500 and 2499 grams; 2006 HS data is provisional Source City of Flint data: Michigan Department of Community Health, Vital Statistics

  24. % Very Low Birth Weight* Among African AmericansCity of Flint and Healthy Start, 2001-2006* *Very Low Birth Weight is less than 1500 grams; 2006 HS data is provisional Source City of Flint data: Michigan Department of Community Health, Vital Statistics

  25. Infant Mortality Among African AmericansCity of Flint and Healthy Start, 2001-05

  26. Factors Affecting Outcomes • Higher risk moms  more issues, harder to impact/affect change… • Entry into program  late trimester = no impact on current pg (but still count stats) • Entry into PNC  higher risk moms, harder to reach… how can we improve entry if can’t find them? • Documentation

  27. Marcia Franks Maternal/Infant Health & Mortality Programs Genesee County Health Department 630 S. Saginaw Street Flint, Michigan 48502 (810) 257-3202 mfranks@gchd.us Questions?

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