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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. What is B’more for Healthy Babies?. A Public Health Crisis.

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What is B’more for Healthy Babies?

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  1. 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 What is B’more for Healthy Babies?

  2. 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.

  3. Unexpected Infant Deaths that Occurred During Sleep 2002-2009 Baltimore City Health Department analysis of data from cases reviewed by the Baltimore City Child Fatality Review. 2009 data is still tentative. In 2009, 82% of deaths were African American, 18% White, 0% Hispanic

  4. 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 What is B’more for Healthy Babies?

  5. 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)

  6. 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

  7. Factors Affecting Poor Birth Outcomes

  8. High-Impact Service Areas

  9. 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

  10. Support Continuum for Improved Birth Outcomes Professional Case Management for Selected Individuals at Risk • 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 Paraprofessional Home/Community-Based Services for Selected Communities at Risk Targeted Health Education and Support Services Referrals and Coordination Community Mobilization and Health Education Citywide Infrastructure and Education

  11. Excess Number of Infant Deaths by Census Tract, Baltimore City, 2002 - 2006

  12. SIBO Organizational System Donors STEERING COMMITTEE COMMUNITY ACTION TEAM State IM Plan BabyStat Medicaid/MCOs Hospital Team(s) Fetal/Infant Mortality Review Child Fatality Review FQHCs Core Implementation Team Ad Hoc Committees Neighborhood Action Team Neighborhood Action Team Neighborhood Action Team

  13. 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

  14. Implementation Results Area 1: Policy/Systems Policy 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

  15. Implementation Results Area 2: Services Agencies 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)

  16. Implementation Results Area 3: Communities Communities 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

  17. Upton/ Druid Hts— University of Maryland Medical System Greenmount East – People’s Community Health Center Patterson Park North and East – Baltimore Medical System

  18. Implementation Results Area 4: Families and Individuals Families and individuals at risk use available services and practice behaviors that improve birth outcomes • Branding/safe sleep focus groups • Home visiting programs • Provider outreach

  19. 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

  20. 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

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