community strategies to address infant mortality & improve birth outcomes it takes a village for...

Community Strategies to Address Infant Mortality & Improve Birth OutcomesIt takes a village for capacity building

©Professor Lynn Perry Wooten, May 2007

Ross School of Business, University of Michigan

Agenda

• Introduction of the Research Project

• Framing the Research Issues

• The Case Studies• Lessons Learned &

Reflections



The Public Health Problem

• According to "Health, United States, 2000," infant mortality rates are more than twice as high for African-Americans.

– Stillbirths– Low Birth Weight

(10% of African-American Infants)

– Pre-term Delivery (20% of African-American Infants)

~ Highest infant mortality rate In the developed world



In the Popular Press (Essence Magazine, November 2005; New York Times; April 22, 2007)

In Turnabout, Infant Deaths Climb in South



The NIH Roadmap is an integrated vision to deepen our understanding of biology, stimulate interdisciplinary research teams, and reshape clinical research to accelerate medical discovery and improve people's health.



'U' study seeks to close gaps in prenatal care (Michigan Daily, October 13, 2004)

• Closing the gap of disparities has become a major goal for many government agencies, researchers, healthcare organizations and community groups. Although in the past decade prenatal care utilization rates have risen, decreasing the overall infant mortality rate, disparities in infant mortality and other perinatal outcomes between various ethnic and socio-economic groups continue to widen. Moreover, researchers have yet to explain all of the differences in birth outcomes experienced by African-Americans compared to other groups.



The Grant’s Goals

• Interdisciplinary research infrastructure to solve public health problems.

• Develop testable hypotheses for new effective approaches to public health problems

• Provide an effective mechanism for communicating research-based information to policy leaders, providers, and patients.

• Three core areas: patients, providers and leaders

• The Research Team (17 departments represented at UM)~ OB/GYN~ Genetics~ Nursing~ Midwifery~ Public Health~ Social Work~ Engineering~ School of Information~ Business~ Sociology~ Anthropology~ Medical History



Why Interdisciplinary Research? – Various Viewpoints

• Traditional Viewpoints~ Socio-Economic Status~ Access to Healthcare~ Genetics~ Predisposed Health

Problems

• Contemporary Viewpoints• Stress & a Reactive

Immune System~ Gestational Diabetes~ Preeclampsia~ Bacteria Infections

• Racism• Segregation• Life-course• Quality of Healthcare

~ Approach~ Evidence-based

Medicine~ Cultural Competencies



Thinking Outside the Box: The University of Michigan Roadmap Team’s Interdisciplinary Model



The Sojourner Syndrome, Resilience & Reproductive Health (Mullins, 2002; 2005)

RaceClass

Gender

Survival Strategy

Pre-term LaborStillbirths

Lower Resistance to InfectionLow Birth Weight

Maternal or Child Health ComplicationsStress

Life Course



The Organizational Perspective – Research Questions

• What are “best” organizing routines for re-energizing the resilience of African-American women during their pregnancies and producing favorable birth outcomes?

• What are the capacity building activities and competencies associated with these organizing routines?

• How can other organizations learn from these positive organizing routines?



Research Methodology

• Case Study data collected from state health departments, nonprofit organizations, healthcare organizations and community coalitions.

• Transcribed and Coded into NVivo• Analyzed using a grounded theory

approach



Guiding Theories

• Organizational Routines~ Skills and capabilities of organizations and its members; the current

best practice in an industry; enable organizations to cope with complex problems (Nelson & Winter, 1982)

~ An executed capability for repeated performance that has been learned in response to selective pressures (Cohen, 1996).

• Positive Organizing (Dutton & Glynn, 2007)~ Enable organizational resourcefulness~ Enhance organizational strengths and capabilities~ Expand organizational action repertoires~ Collective behavior and relational mechanisms

• Capacity Building~ The development of core skills, management practices, strategies,

and systems to enhance an organization’s effectiveness, sustainability and ability to fulfill its mission (Connolly, 2001)



Capacity Building in Action:Case Studies of Best Practices

Model created by Connolly & Luka’s for the Fieldstone Alliance



Parkland Memorial Hospital (Dallas, Texas)

• Delivers approximately 17,000 babies a year; 4 out of every 1000 babies born in the Untied States

• For African American babies, infant mortality rate is roughly half the national average.

• Ninety-Five percent of women who deliver at Parkland are indigent.

• Capacity Building Focus: Internal Operations & Management~ Rigid, codified rules about

medical practices.~ Re-engineered the delivery

process for babies because of system overload; positive consequences for patient care.

~ Elaborate hierarchy with 14 different levels, from nurse’s aides (OB techs) to attending physicians with years of experience.

~ Team approach to directed by protocols for prenatal, care, labor and delivery.

~ The protocol serves as a “medicine cookbook” based on refining clinical research; gives the system a sense of order.



Black Infant Health (California)

• San Diego a Mission Driven Program~ Focuses on accessing

resources and services~ Targeted to certain zip

codes~ Social support~ On-staff nurse~ Monthly rap session for

clients~ Success attributed to

common vision and dedication of staff members

~ Reduction in infant mortality rate from 17.9 to 12.3

Started in 1989 by the California Department of Health in response data showing African American Babies death rate tripe of Caucasian babies



Every Child Succeeds(Cincinnati, Ohio)

• Adopted best practices in the industry: Every Child Succeeds uses two evidence-based, nationally-established home visitation models: Healthy Families America (HFA) and Nurse Family Partnership.

• A partnership between public and private organizations• Capacity Building Focus: The application of a corporate model

~ Inspired by former CEO of Proctor & Gamble~ Uses corporate tool “Continuous Quality Improvement” to

boost results~ Focused and directed programming – areas of highest need

and where the organization can make an impact~ Data intensive – Mothers complete 50 different forms~ Red/Green chart based on Japanese manufacturing

techniques that measures 17 quality indicators, such as staff training, immunization rates, breastfeeding rates, and client satisfaction



• Nurse-Family Partnership (the Olds Model) is an evidence-based nurse home visitation program that improves the health, well-being by focusing on three goals.

• Registered nurses visit weekly for the first month after enrollment and then every other week until the baby is born. Visits are weekly for the first six weeks after the baby is born, and then every other week through the child's first birthday. Visits continue on an every-other-week basis until the baby is 20 months. The last four visits are monthly until the child is two years old; Visits last 75 to 90 minutes

• Pregnancy and Birth Outcomes~ Fewer preterm deliveries~ Fewer low birth weight babies~ Fewer instances of pregnancy-induced hypertension



1. Improved Pregnancy Outcomes ~ Help clients obtain prenatal care from their physician ~ Help clients reduce their use of cigarettes, alcohol and illegal

drugs ~ Teach clients about healthy nutrition during pregnancy

2. Improved Child Health and Development~ Help parents provide more competent care of their children in

the first two years of life ~ Teach parents how to nurture their children ~ Teach parents safe and consistent practices of child discipline ~ Help parents get proper health care for their child

3. Improved Maternal Life Course Development

~ Teach young mothers to keep their lives on track and develop a vision for their own future

~ Help the mothers make reasoned choices about the partners, family and friends who are involved with their child

~ Help mothers plan future pregnancies ~ Help mothers continue their education, reach their educational

goals and find adequate employment



Northern New Jersey Maternal/Child Health Consortium: Black Infant Mortality Reduction Resource Center

• Approach: Strategic Relationships and Program Delivery ~ Warm-Line for the General Community Including

Professionals~ Outreach, Education, Training at Health Fairs and

other Community Events~ Inform Media Outlets of Latest BIMR Developments

in New Jersey~ Comprehensive Library including Evidence-based

Research & Updated Bibliographies~ Cultural Competency BIMR Education for Clinicians~ Annual Perinatal Disparities Conferences~ Technical Assistance to support Regional, State-wide

& National BIMR Efforts



Centering Pregnancy

• Centering Pregnancy: A group model of prenatal care – empowering clients & professionals.

• The Centering Pregnancy Program alters routine prenatal care by bringing women out of exam rooms and into groups for their care.

• Regular meeting of 8-12 women meet through early post-partum.



Centering Pregnancy

• Based on patient empowerment~ Control of their bodies~ Their pregnancies,~ Their families~ Self-care activities of weight, blood

pressure, estimation of gestation age Health care provider empowerment

~ Sharing their care-giving with their clients.



The Birthing Project USA: The Underground Railroad for New Life

• Capacity building embedded in visionary leadership, social support and grassroots community engagement.

• National training programs that focus on:~ Assessing community

needs and resources~ Strategic planning~ Building collaborative

partnerships~ Leadership

Development

• Signature Program: Sister to Sister which is designed to is to improve birth outcomes by matching trained volunteers with pregnant women in order to provide support and education.



South Carolina – Black Infants Better Survival

• Funded & Supported by:~ Government source~ WIC~ Healthy Start Program~ March of Dimes

• University of South Carolina received a grant• Focused on women of child-bearing age, fathers

and healthcare providers.• Focuses on education and dispelling myths.



Partnership with Faith Community• African Methodist Episcopal ministers’ wives and widows

alliance – Supporting Kids and Infants Into a New Generation

• Grant from March of Dimes to fund:~ Infant Mortality Curriculum~ “Vitamins for Brides” kits~ Baby Showers and Baskets for Expecting Parents~ Oral Health Initiative for Pregnant Women

OMH 2004

The Columbia Conference of theAAAfrican MMMethodist EEEpiscopal CCChurch

Disparity RatioColumbiaColumbia

ConferenceConference



Lessons Learned and Reflections

• Committed and collective leadership• Community Partnerships• The importance of collecting and analyzing data• Systematic, targeted, and structured programs

based on best practices and evaluation• The significance of nurses• The coordination of services• Empowering, educating, holistic, relationship-

centered and life-course approaches

community strategies to address infant mortality & improve birth outcomes it takes a village for...

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