United Way Success By 6 Liberty City Outreach Initiative

1. United Way Success By 6Liberty City Outreach Initiative Funded by Success By 6 Initiative Presented by

2. Overview of Healthy Start • Implemented on April 1, 1992 • Reduce infant mortality, reduce the number of low birth weight and preterm babies and improve health and developmental outcomes. • Offers universal prenatal and infant risk screening to identify pregnant women and infants at risk for adverse birth, health and developmental outcomes. • Offers care coordination services that support families in reducing factors that place pregnant women and infants at risk for poor outcomes.

3. Introduction • Grant awarded in October 2002 to the Healthy Start Coalition of Miami-Dade in partnership with the Economic Opportunity Family Health Center, Teen Pregnancy Prevention Center, and the Health Council of South Florida. • Funds are available from the United Way of Miami-Dade Success By 6 Program. • Intermediate goal of the Initiative is to increase the number of completed Healthy Start prenatal screens by conducting intensive outreach to pregnant women and teens in zip codes 33147 and 33142 (Liberty City). • Long-term goal is to reduce the rate of preterm births in the targeted zip codes.

4. Identified Needs in Liberty City • Healthy Start Needs Assessment 2001 revealed 12.8% babies were born preterm in Liberty City, 3.2% more than Miami-Dade County 9.6%. • 67.7% of all babies in Liberty City were born to non-Hispanic Black mothers. Non-Hispanic Blacks and teenagers are more likely to experience preterm birth. • Liberty city ranked within the top ten countywide for the following risk factors: • mothers receiving late or no prenatal care, • low birth weight births, • births to teens, and • births to unwed mothers • 30.6% and 31.1% of residents in zip codes 33147 and 33142, respectively, under age 65 were uninsured more than the county-wide average of 26.7% (Miami-Dade County Health Insurance Survey).

5. Design Outreach and self-referrals in Liberty City Increase Healthy Start prenatal risk screens (Early detection of women who are identified at risk for poor birth outcomes) Provision of Healthy Start core services Decrease preterm birth in Liberty City from 12.8% in 1999 to 10.6% in 2005

6. Primary Strategies Marketing campaign in Liberty City Street level outreach to pregnant women and teens Development and dissemination of educational materials

7. Sample Billboard Ad

8. Outreach Efforts Results2002 - 2005

9. Zip Codes of Participation • Liberty City falls within zip codes 33147 and 33142. • Historically known for poor health and socioeconomic status.

10. Participants by Zip CodeOctober 2002 – September 2005

11. Age of Self-referred Women in Targeted Zip Codes, 2002-2005

12. Self-Referrals by Race & Ethnicity October 2002 – September 2005

13. Healthy Start Awareness Among Liberty City Participants

14. Consent to Participate in Healthy Start Among Liberty City Participants

15. Achievements • 24.8% of women from 33147 and 35% from 33142 were aware of Healthy Start, which is higher than that found in other/unknown zip codes (19.8%). • Number of Healthy Start prenatal screens processed in the target zip code 33147 (528) and 33142 (625) in Year 3 were significantly higher than the baseline year 484 and 490,respectively. 9.1% increase for 33147 and 27.6% increase for 33142. • 100% of women consented to be screened in the target areas compared to 76% in Miami-Dade County in Year 3. • 100% of self-referred women from 33147 and 33142 were assigned to Healthy Start providers.

16. Healthy Start Prenatal Screens Source: Florida Department of Health HPE

17. Healthy Start Prenatal Screens Source: Florida Department of Health HPE

18. Live Births in Target Zip Codes Source: Resident Births from the Florida Department of Health, Office of Vital Statistics.

19. Self-Referral Results • Based on the Self-Referral forms, the leading risk factors for referral to Healthy Start were: unmarried (82.4%) and Black race (60.5%). • ‘Other’ reasons for referral were cited by 82.6% of women. Most cited ‘Other’ reason include: • participation in Healthy Start classes/services (25%) • stress/depression (unspecified, maternal/postpartum) (24.8%) • stress without mention of depression (22.7%) • 99.1% of women who were referred using the Self-Referral form consented to participate in Healthy Start.

20. Long-Term Goal Long-term goal is to reduce the rate of preterm births in the targeted zip code. Source: Resident Births from the Florida Department of Health, Office of Vital Statistics.

21. Initiative Objectives Objective 1. Increase the number of Healthy Start prenatal risk screening rate in the target area from 54.2% to 65% by YR03. • Measure/Indicator: Number of prenatal risk screens processed. • Baseline: 54.2% in 1999; Year 1: 66%; Year 2: 71%; Year 3:76% Activities: • Intensive face-to-face outreach to pregnant women and teens; • Educational materials/incentives disseminated in the target zip code area.

22. Initiative Objectives (con’t) Objective 2. The estimated total number of unduplicated clients to be referred for Healthy Start services: Year 1 1,000 Year 2 1,000 , and Year 3 1,000 . • Measure/Indicator: Number of Self-referrals. • Year 1: 564; Year 2: 707 ; Year 3: 1,128 Activities: • Intensive face-to-face outreach to pregnant women and teens; • Educational materials/incentives disseminated in the target zip code area.

23. Initiative Objectives (con’t) Objective 3. Increase knowledge of Healthy Start services and the Healthy Start risk screen by directly and indirectly educating and reaching 1,500 pregnant women during Year 3. • Measure/Indicator: Number of women directly or indirectly reached. • Year 1: 1,348; Year 2: 2,171; Year 3: 8,946 Activities • Media and marketing campaign in Liberty City targeting pregnant women and teens to improve their knowledge and awareness of Healthy Start prenatal risk screen;

24. Initiative Objectives (con’t) Objective 4. Increase awareness of Healthy Start services and the Healthy Start risk screen by 5% each year in the 33147 and 33142 zip code areas. • Measure/Indicator: Healthy Start recognition among women in the targeted zip code area. • Year 1: 27%;Year 2: 27%; Year 3: 29%. Activities • Media and marketing campaign in Liberty City targeting pregnant women and teens to improve their knowledge and awareness of Healthy Start prenatal risk screen.

25. Process Achievements/Limitations • Outreach partners exceeded their goal for contacts (90 per month); 12,465 women were directly or indirectly reached. • Direct outreach (i.e. street-level) was the most successful • Follow-up procedures were perceived as labor intensive and unrealistic • Each outreach partner adopted their own method of follow-up • Outreach partners found that prescreened women came to expect a high level of interaction with Healthy Start case managers

26. Process Achievements/Limitations • Forms were changed on several occasions in Year 1 and 2 to adequately document the outreach efforts • At the conclusion of Year 1, the Coalition saw a need to expand the outreach activity zip code to include 33142 • Staff turnover • Hurricane 2004-2005 • Lack of infrastructure or need for professional and technological capacity building among outreach partners

27. Conclusions/Lessons Learned • Community based organizations are essential in the provision of services to respective communities. • Outreach partners were committed to the Initiative. Outreach partners feel that lack of adherence to protocol is related to their general concern about how changes will affect the community they serve and their ability to serve . • Target area is socio-economically depressed that it is difficult for the population to focus on, obtain, or heed advice regarding health, pregnancy and outcome. • Overall, the Initiative was successful, increasing awareness and utilization of Healthy Start services.

28. Recommendations • Changes in documentation should be limited to assure complete, accurate and continuous data and information • Provide technical assistance in infrastructure development and capacity building • Offer educational sessions related to pregnancy, women’s health, infant health and adequate child care • Substantial incentives including grocery gift certificates, infant car seats, diapers, strollers, cribs, baby clothing, etc. • Provide formal structured training to outreach staff to include identification of appropriate outreach sites, capitalizing on activities and events, managing stress and burnout, using different methodologies and settings to increase numbers and participants reached.

29. Contact Us Trecia Matthews Hosein Director of Quality Improvement & Assurance Healthy Start Coalition of Miami-Dade 701 S.W. 27TH Avenue Miami, Florida 33135 Phone: (305) 541-0210 Fax: (305) 541-0213 E-mail: tmatthews@hscmd.org www.hscmd.org