Faculty Mentor Dr. Cynthia Barnes-Boyd

1. An Evaluation of a Case Management Programaimed to reduce Infant Mortality among African Americans: The Greater Englewood Healthy Start Initiative Faculty Mentor Dr. Cynthia Barnes-Boyd Angel Griffin SROP 2006 University of Illinois-Chicago

2. Problem Statement • Although infant mortality rates have declined during the past several decades in the U.S., disparities continue to exist between African American and White infants. African American infants are twice as likely to die, and are born with a lower birth weight as White infants.

3. National Statistics, 2002

4. Research Questions • What are some factors that contribute to this racial disparity in birth weight and infant survival between African American and White infants? • How do women in the Englewood community perceive their level of prenatal support and care? • How effective is a Case Management Program (CMP) in reducing the rate of infant mortality and low-birth weight in the Englewood community?

5. Review of Existing Literature • In the US only 17 % of all births were to African-American families, but 33 % of all low-birth weight babies were African-American. • Of all infant deaths in Chicago between 2000-2002, 61.4% were African American, 24.8% were Hispanic, 10.7% were White, and 3% were Asian. • In Austin and Englewood, two of the communities targeted by Healthy Start Initiatives, 1 out of every 6 babies dies before their first birthday .

6. Review of Existing Literature • A main predictor of infant mortality is low socio-economic status (SES). • Factors that might contribute to the disparity include racial differences in maternal medical conditions, stress, lack of social support, infection, previous preterm delivery, maternal smoking, delayed prenatal care, education and income. • In efforts to reduce this health disparity the Department of Health and Human Services established Healthy Start Initiatives in some of the highest-need communities in the US.

7. Healthy Start Program • The Healthy Start Program is a national community health program, dedicated to improving the birth outcomes of African American women. • Community Health Case Managers are assigned to women who are enrolled in the Program in order to: • Help access health care  • After a woman's child is born, her Case Manager helps her to follow up with: •     Immunizations

8. Description • The Greater Englewood Healthy Start Initiative, is a program implemented by the Chicago Department of Public Health (CDPH). • It is evaluated by the UIC Neighborhoods Initiative, Division of Community Health and targeted towards the Englewood community. • This three –year evaluation will result in a detailed look of the effectiveness of this Initiative, and help guide the program as it moves forward.

9. Purpose • The purpose of the evaluation is to identify best practices in case management • Identify access barriers • The evaluation engages the community into identifying solutions to it’s own problems • The evaluation is needed to justify funding and to secure funding to sustain the program

10. Profile of the Englewood Community • The Englewood community has a predominately African American population, 97.8%. • 41.2% of the residents are between 15-44 years of age. • The majority of the residents are economically disadvantaged • 43.8% live below the poverty level • 67.5% live 200% below the poverty level. • Overall this community exhibits an extremely high level of unhealthy lifestyle indicators such as: • Lack of insurance • Lack of cholesterol screening • Lack of exercise in the past month • Poor nutrition (non-daily fruit consumption)

11. Methodology • Revision of existing survey instrument by two research assistants, and head researcher • Research committee met to discuss the suggested revisions, and to finalize the questions that are used in the final protocol

12. Instrument Revision • Eliminated unnecessary section and questions • Allowed for space so that anecdotal information can be recorded • Assured that the language is on level that everyone can understand • Worded questions in a thoughtful and nonintrusive manner • Didn’t communicate our biases or expectations to the respondents in the questions • Assured Confidentiality before each sensitive section

13. Content Analysis • 114. What age will your baby be when you bring the baby in for his/her first doctor’s appointment or visit? • 01 When he/she is less than 2 weeks of age • 02 Between 2 weeks and one month of age • 03 Between 1 and 2 months old • 04 Between 2 and 4 months old • 05 Between 4 and 6 months old • 06 Between 6 and 12 months old • 07 After the baby's first birthday • 98 Don't Know • 99 Refused • 76. Assuming that your baby does not become sick, at what age will you bring your baby in for his or her first appointment or visit? I will read you several choices. Please select one. • 01 When he/she is less than one month of age • 02 At one month of age • 03 After 1 but before 2 months old • 04 After 2 but before 4 months old • 05 After 4 but before 6 months old • 06 After 6 but before 12 months old • 07 After the baby's first birthday • 98 Don't Know • 99 Prefer not to answer

14. Content Analysis • 123. From your Case Manager, did you get information or a referral for Medicaid, food stamps, WIC, or public aid? • 01 yes • 00 no • 02 I didn’t need these services • 98 Not sure/don’t know • 99 Refused • 85. Did your case manager help you connect to any of the following services: • 01 Medicaid, Kid Care or All Kids • 02 Food stamps • 03 WIC • 04 Social services • 05 Housing assistance • 06 Health services such as prenatal care, infant care or family planning • 07 Mental health services • 08 Smoking cessation program • 09 Substance use treatment program • 10 Education program such as GED or job training • 11 Any service I have not mentioned_____________________________ • 99 I did not require any assistance or services

15. Example of Questions Completely Eliminated • 140. Are you currently living with either a boyfriend, husband, or romantic partner? • 01 Yes • 00 No • 98 Don’t Know • 99 Refused • 142. Was the father of your baby involved with the criminal system (in jail) in the past year? • 01 Yes • 00 No • 98 Don’t Know • 99 Refused

16. Results • The results of this overall evaluation project are yet to be determined as it is still in its very early phases. • However, by continuing to provide education and outreach services it can be hypothesized that the CMP will be effective in its efforts to help identify and alleviate some factors contributing to this disparity based off findings from similar studies.

17. Discussion • Limitations and Assumptions • The study will reply on self-report of the subject, and therefore, this may introduce a misclassification bias. • We are limited by the subjects ability to recall all information accurately and truthfully respond to questions. • We can’t assume that this project can be generalized from the Englewood community and placed into another neighborhood with similar characteristics.

18. Acknowledgments • Thank you to: • My mentor Dr. Cynthia Barnes-Boyd • Beverly Washington • Nancy Tartt • Regina Ortiz • UIC Neighborhood Initiatives Community Health Division • SROP staff