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Infant Mortality and Racial Equity

Infant Mortality and Racial Equity. Peggy Vander Meulen, RN, MSN Michigan Premier Public Health Conference October 12, 2011. Kent County Infant Mortality White, Black & Total - Three Year Averages. Infant Mortality Rate by Race Grand Rapids 2007-2009. Percent Low Birth Weight by Race

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Infant Mortality and Racial Equity

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  1. Infant Mortality and Racial Equity Peggy Vander Meulen, RN, MSN Michigan Premier Public Health Conference October 12, 2011

  2. Kent County Infant MortalityWhite, Black & Total - Three Year Averages

  3. Infant Mortality Rate by Race Grand Rapids 2007-2009 Percent Low Birth Weight by Race Grand Rapids 2009 (1,000 live births)

  4. Community Response

  5. Strong Beginnings Funded in 2004 by a federal Healthy Start grant, Strong Beginnings is a community-wide effort to lower infant mortality among the African-American population in Grand Rapids

  6. Cherry Street Health Services (St. Mary’s Health Care) Grand Rapids African American Health Institute Healthy Kent 2020 – Infant Health Implementation Team Kent County Health Department Metro Health Hospital Arbor Circle Spectrum Health MOMS The Salvation Army A Partnership of….

  7. Program Participants • African-American women • Pregnant • Mother of a child under 2 • Capacity to enroll 280 women at any one time • 1,800 families enrolled to date (80% high risk)

  8. Infant Health I-Team Structure • The I-team serves as the: • Community Coalition for Strong Beginnings • Community Action Team for FIMR • Advisory Board for Nurse-Family Partnership Healthy Kent 2020

  9. Strong Beginnings and IHIT Goals • Reduce overall infant mortality in Kent Co. • Low birth weight & premature delivery • SUID and sleep-related asphyxia • Eliminate racial disparities • Improve overall system of care

  10. Internalized Racism • Help women cope with the effects of internalized racism: • Poor self-image • Stress • Anger • Depression

  11. Internalized Racism • Frequent home visits by CHWs • Social support, education and goal-setting • “Finding the Gold Within” (self-worth, self-determination, hope for better future)

  12. Internalized Racism • Mental Health Services: • Crisis management • Individual counseling • Six-week therapeutic support groups on stress, depression & anger mgt • Healthy Minds & Bodies

  13. Internalized Racism • Parenting from an African American perspective (EBP) • Builds confidence in parenting skills • Develops pride in African American heritage • Helps raise strong, confident children

  14. Internalized Racism • Asked FIMR to add questions regarding women’s experience of discrimination • Measure participants’ satisfaction with cultural appropriateness of services and the treatment received from staff

  15. Individually-mediated Racism • Helped develop a Cultural Competency Curriculum for Health Care Professionals • Held 12 trainings (5 weeks) • Trained 7 facilitators • Reached >1200 professionals from 37 agencies • Made curriculum available statewide through MALPH

  16. Individually-mediated Racism • “Creating Inclusive Health Care Environment” workshops for 50 providers • Follow-up online survey on behavioral change

  17. Individually-mediated Racism • Community presentations on link between racism & racial disparities in birth outcomes, e.g.: • Unnatural Causes • 1-hour radio interview • Nursing & SW students • Family Practice Residents • Churches • Community Summit

  18. Institutional Racism • Created Health Care Sector for the Summit on Racism • Round-table discussions on recruitment & retention of employees of color in leadership • Staff attend 2 ½ days workshops

  19. Institutional Racism • Infant Mortality Summit in Grand Rapids,150 participants: 75 community residents and 75 agency reps. • One message: “Create a mechanism to report poor quality care and discrimination in health care based on race or ethnicity”

  20. Institutional Racism • Research and literature review • Focus Groups • Key Informant Interviews • Produced report and recommendations for developing an external reporting system

  21. Key Components of Reporting System

  22. Institutional Racism • GRACE – PRFC conducts assessments for orgs seeking racism-free credentialing (2008) • Documentation to meet criteria for 6 standards, e.g., leadership engagement, internal policies, contractor / vendor practices, external relations

  23. Institutional Racism • Teams meet with agency staff • Review documents • Deliberation team assigns status: • Not at this time, Provisional, Full, Credentialed • Make recommendations, develop action plan

  24. Institutional Racism • Three pilot agencies 2009 • Five organizations 2010-2011 • Five organizations starting 2011-2012

  25. Institutional Racism • Member PRIME workgroup • PEDIM ALC – to increase capacity at community, state & national levels to address impact of racism on birth outcomes & MCH

  26. Next Steps • R2R creating toolkits for providers & consumers: • Hidden bias tests • Organizational assessments • Local resources • Patient rights • Empowerment cards

  27. Next Steps • Continue offering ½ day workshops • Train new staff as assessors for PRFC • Increase number of organizations seeking racism-free credentialing

  28. Next Steps • Pursue mechanism for reporting discrimination • Create local action plan based on learnings from PEDIM-ALC experts & teams

  29. Next Steps • “Lines: The Lived Experience of Race” by Stephanie Sandberg • Video Clips & Facilitator guide to raise awareness & foster dialogue

  30. THANK YOU! Supported in part by project H49MC03591from the Maternal & Child Health Bureau (Title V, Social Security Act), Health Resources & Services Administration, Dept. of Health & Human Services

  31. Contact Information Peggy Vander Meulen Program Director Strong Beginnings (federally-funded Healthy Start) (616) 331-5838 peggy.vandermeulen@spectrumhealth.org Barb Hawkins-Palmer, BA Executive Director Healthy Kent 2020 (616) 632-7181 barb.hawkins-palmer@kentcountymi.gov

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