Making the “Life Course Perspective” Real for Harlem’s Disparate Families: From

1. 'Medical Home' for MCH Populations:A Way to Realize the Life Course Perspectiveand Address Social Determinants of Health March 24, 2009 Making the “Life Course Perspective” Real for Harlem’s Disparate Families: From Birth Outcomes to Adult Chronic Illness Boston University Mario Drummonds, MS, LCSW, MBA CEO, Northern Manhattan Perinatal Partnership, Inc.

2. Life Course Theoretical Assumptions & Implication to MCH Practice • Diminished Role & Impact of Prenatal Care • Maternal Health Prior to Pregnancy is Key • It will Take More Than One Generation to Equalize Birth Disparities • Calls for Clinical & Public Health Interventions that are more Longitudinally and Contextually Integrated • Transition Must be Made from Strictly Clinical Approaches to Practice to Integrate a Social Determinants of Health Focus to Practice 2

3. Traditional Perinatal Care Continuum Preconception Counseling Primary Care Postpartum Care Labor and Delivery PreconceptionPeriod Interconceptional period antepartum postpartum Prenatal Care Care throughout labor and delivery Well Child Care 3

4. Birth Early Child-hood Pre-Teen Teen Young Adult Women>35 Senior Citizens New MCH Life Course Continuum Axis 1 4

5. Public Policy Initiatives Community Environmental Impact Organizational Impact Group/ Interpersonal Impact Individual Impact MCH Life Course Organization Social Determinants to Health Axis 2 5

6. Social Determinants of Health MCH (Strategies)‏ • Public Health Zonal Strategies • Harlem Children’s Zone • NMPP’s Take Over of the St. Nicholas Houses • NYCDOH’s Local Public Offices 6

7. 7

8. 8

9. Building Public Health Social Movement • To Change the Health Seeking Behaviors of Women of Childbearing Age as well as Change Political and Health Systems to Develop the Political Will to Invest in Infant Mortality Reduction Interventions Citywide Coalition to End Infant Mortality 9

10. Perfecting MCH Direct Practice Interventions (Strategies)‏ • Prenatal Care, Centering Pregnancy, Case Management & Home Visiting Services, Health Education, Outreach, Internatal Care, Fatherhood Services, Children with Special Healthcare Needs, etc. 10

11. Developing Anti Poverty/Economic Development Strategies • Empowerment Zone • Harlem Works • Developing Financial Assets & Savings • Developing New Industries to Employ the Poor & Working Class • Developing Affordable Housing Initiatives 11

12. Developing Reproductive Social Capital(Social Support Interventions) • Baby Mama’s Group -Depression Screening & Treatment, Sister Chat, Consumer Involvement Organization, Collard Greens for the Ghetto Soul Book & Video Productions 12

13. 13

14. 14

15. MCH Interventions in Early Childhood Services • Early Head Start • Head Start • UPK • Grade School 15

16. 16

17. Integrating MCH and Child Welfare Systems of Care • Nurse Family Partnership • Healthy Start • Healthy Families America Home Visiting Programs 17

19. Selected Child Welfare Trends, Central Harlem2002-2005 Year 2002 2003 2004 2005 Abuse/Neglect Reports 1574 1354 1200 1208 Number of Children In Reports 2478 2032 1855 1846 Abuse/Neglect Indication Rates 45.0% 39.4% 37.9% 45.9% Number of Children in Indicated Reports 973 649 745 885 Victimization Rates * 32.8 21.9 19.4 24.7 Number of Placements 449 285 228 192 Number of Children Placed 447 279 220 192 Number of Families Placed 288 198 161 146 Placement Rate ** 15.1 9.6 7.4 6.5 • Victimization Rate is the number of children with indicated abuse/neglect per thousand youth 17 and under in the population. • ** Placement rate is the number of children placed into foster care per 100o youth 17 and under in the population. Source: NYC Administration for Children’s Services: Office of Management Analysis

20. MCH Chronic Disease Strategy • Obesity • Diabetes • Asthma • High Blood Pressure • Depression 20

21. MCH Life Course Organization Clinical Practice Service Mix • Birthing Center/Labor & Delivery Ward • Perinatal Case Management • Interconceptional Care Program • Maternal Depression Individual/Group Program • Early Head Start • Head Start • Child Welfare Preventive • After-School • Adolescent Pregnancy Prevention Program • Chronic Disease Management Programs 21

22. NMPP Direct & Group Practice Assets: • Central Harlem Healthy Start Program • Nurse Family Partnership, • Community Health Worker Program • Harlem Hospital Birthing Center • St. Nicholas Child Welfare Preventive Program • Mankind Fatherhood Case Management Program • Centering Pregnancy/Adolescent Pregnancy Prevention Team • Baby Steps Home Visiting Program • Baby Mama’s Club/Circulo de Mamas Depression Groups 22

23. NMPP Direct & Group Practice Assets: • Asthma Case Management Team • Harlem Weight Watchers Program • Start Right Immunization Team • Center for Preschool & Family Learning Head Start-152nd St. • Center for Preschool & Family Learning Head Start-155th St. • Universal Pre-K Program-152nd St. • Universal Pre-K Program-155th St. • Managed Care/Healthcare Enrollment Program 23

24. NMPP Coalitional & Public Health Upstream Organizational Assets on the Ground • Harlem Choir Academy Middle School • CHHS Consortium • CHHS’s Consumer Involvement Organization • NYC Male Involvement Consortium • Harlem Weight Watchers Program • Comprehensive Prenatal/Perinatal Network • Manhattan Regional Perinatal Forum • NMPP’s Harlem Works Job Readiness Program • St. Nicholas Houses Community Organizing Project • Harlem Child Welfare Network • Casey Powerful Families Training Program 24

25. NMPP’s Community/Environment Assets on the Ground“Place & Race Matters” • Harlem Food & Fitness Consortium • NMPP’s BBKH Diabetes Coalition • NYC Breastfeeding Alliance • Federation of County Networks • Harlem Health Promotion Center • Harlem Strategic Action Committee • Citywide Coalition to End Infant Mortality • ABC Asthma Coalition • Sisterlink Coalition • Start-Right Immunization Coalition • NYC Male Involvement Consortium 25

26. Public Policy & Systems Change Achievements Regionalization of Perinatal Care Throughout NYS Secured Over $70 Million Dollars from NYC Mayor Integrated MCH & Child Welfare Systems of Care Financed & Staffed Up Birthing Center at Harlem Hospital Secured $250 Million Dollars to Build a New Harlem Hospital 26

27. Public Policy & Systems Change Achievements Harlem Hospital Recently Designated as a “Baby Friendly” Hospital (Aug 2008)‏ Passed Mental Health Parity Legislation Timothy’s Law (2007)‏ Trained over 800 women and placed them in full time jobs! Reduced Child & Abuse & Neglect Rates in Harlem Repealed “Medicaid Neutrality” Law in NYS 27

28. Public Policy & Systems Change Achievements Increased Medicaid Mental Health Reimbursement Rates NYC Mayor Has $7.5 Billion Dollar Plan to Build 165,000 Units of Affordable Housing by 2013- Eighty-Two Thousand units built to date! Mayoral $10 million dollar Plan to train 400 Harlem residents to become RN’s and LPN’s Congressman Rangel’s Harlem Empowerment Zone Legislation to move from a minimum wage to a livable wage policy 28

29. Public Policy & Systems Change Achievements • Moving Harlem Residents into Union Jobs • Created More Micro-Lending Programs to Spur Business Ownership by Poor & Working Class Women in Harlem 29

30. Housing • Home Ownership • Affordable Housing • Base Building- St. Nicks • Economic Opportunities • Harlem Works • Financial Literacy • LPN RN Training Program • Union Employment • Micro Lending Savings • Empowerment Zone • Legislative Agenda • Reauthorize Healthy Start • SCHIP • Minimum Wage Legislation • Women’s Health Financing • Health System • Case Management - Title V Funds • Health Education - Regionalization • Outreach -Harlem Hospital • Perinatal Mood Disorders-Birthing Center • Interconceptional Care • Child Welfare • Preventive Services • Foster Care Services • Parenting Workshops • Newborn Home • Visiting • COPS Waiver • Early Childhood • Early Head Start • Head Start • UPK • Choir Academy Spectrum of Work for MCH Life Course OrganizationBuilding Public Health Social Movement Early Childhood Young Adult Women over 35 Birth Pre-teen Teen 30

31. Characteristics of a MCH Life Course Organization Builds Programmatic Capacity Within the Agency at Each Stage of a Woman’s Life Course to Manage her Health Over the Life Course 31

32. Characteristics of a MCH Life Course Organization • If Unable to Build Internal Capacity, Collaborates with Outside Agencies and Systems to Create an Integrated System of Care to Manage a Woman’s Health 32

33. Characteristics of a MCH Life Course Organization Can See Around the Corner to Respond to Trends Before They Have an Impact on the Target Population- e.g. Diabetes, Women Over 35 33

34. Characteristics of a MCH Life Course Organization • Swims Up-Stream from Individual Interventions & Design Strategies and Actions at the Group, Organizational, Community and Policy Levels to Transform Social Determinants to Poor Health 34

35. Characteristics of a MCH Life Course Organization 5. Unlike Healthy Start Programs that Only Seek to Influence the Health System by Developing & Executing a Local Health Systems Action Plan, a MCHLCO Seeks to Influence and Lead their Local & Regional Economic, Political, Housing, Child Welfare, Early Childhood and Middle School Systems of Care 35

36. Characteristics of a MCH Life Course Organization The MCH Life Course Organization is Decentralized 36

37. Characteristics of a MCH Life Course Organization Leaders and Managers are Allowed to Run their Programs like Businesses 37

38. Ties that Bind: MCH’s Role in Preventing Chronic Diseases 38

39. Problem Analysis: • Close to 1 million New Yorkers are Diabetics • Over 40,000 women in NYC have Gestational Diabetes • 10 to 15% of the Adult Population in Harlem & South Bronx Diabetic & Obese • Death Rate due to Diabetes in NYC is three times higher for African Americans and two times higher for Latinos • Recent NYCDOH Study Revealed that 43% of NYC’s School Children are Overweight 39

40. MCH/Chronic Disease Solutions • Restructured all Six MCH Home Visiting Programs Pregnancy Care to Interconceptional Care (2004) • Partnered with Weight Watchers to Organize First Program in Harlem (2004) • Partnered with Mailman School of Public Health to conduct a Study that Explored the Relationship between Maternal Weight- Obesity & Low Birth Weight (2005-2007) 40

41. MCH/Chronic Disease Solutions • Formed BBKH Diabetes Coalition with NY Presbyterian Hospital (2004) • BBKH Goal: By 2012 Build a Public Health Social Movement to Reduce Growth of Diabetes by 5% in Harlem & South Bronx • Secured Five-Year Funding Commitment from NYSDOH (2006) • Implemented Spectrum of Care Strategy to Achieve Public Health Goal 41

42. Strengthen Individual Knowledge and Skills • Manage the Diabetic Care of 1,000 diabetic patients using CHWs 42

43. Promote Community Education • Diabetes Jazz Sundays-Medical Moments • Kitchens of Faith • Day of Hope • Social Marketing Campaign: Leaning on Culture…Colliding with Faith 43

44. Educating Health Providers • Improving Culture Competency Skills of Hundreds Medical Staff Caring for Patients 44

45. Fostering Partnership and Networks-Developing Diabetes Health Disparities Task Force • Built with NYCDOH Harlem Food & Fitness Consortium-Super Network 45

47. Changing Organizational Practices • Helped to Make Business Case for Affinity Health Plan & Community Premier Plus to Hire and Use Community Health Workers 47

48. Influencing Policy/Legislation • Leading Force in Passing Green Cart Legislation in 2008 • Worked with NYC City Planning Agency to Place Moratorium on Closing Supermarkets in Harlem & South Bronx • Working with NYC City Council to Develop Zonal Legislation on Curbing Growth of Fast Food Restaurants in Poor Communities • Working with Gov. Paterson to Pass Law to Institute Soda Tax • Worked with NYC Board of Health & Health Commissioner to Pass Trans Fat & Anti-Smoking Policies 48

50. Discipline Consistency Patience Faith 50