What is B’more for Healthy Babies?

• A new bold & exciting initiative in Baltimore

• Designed to decrease our high infant mortality rate

• Will work on different levels to affect change – policy, services, community and individual levels

A Public Health Crisis

In 2009, an estimated 123 infants died in Baltimore City – a rate of 12.3 per 1,000 live births … an average of over 10 babies per month African American: 14.3 per 1,000

(2008)

White: 7.3 per 1,000 (2008)

Baltimore City has the highest rate of infant death in Maryland and the 4th worst infant mortality rate in the U.S.

Baltimore City Health Department analysis of data from cases reviewed by the Baltimore City Child Fatality Review. 2009 data is still tentative.

Unexpected Infant Deaths that Occurred During Sleep 2002-2009

In 2009, 82% of deaths were African American, 18% White, 0% Hispanic

What is B’more for Healthy Babies?

Our vision is to ensure that all of Baltimore’s babies are born healthy weight, full term, and ready to thrive in healthy families.

This will be done by:

• mobilizing communities, families, and individuals around reducing the disparities of infant mortality

• improving access to and quality of medical and social services

• inspiring a collaborative spirit among policy advocates, health and social service organizations, and community members to actively reduce Baltimore’s infant mortality

Intended Outcomes

Reduce:

• Rate of pre-term births by at least 10% (283 fewer preterm babies)

• Rate of low birth weight infants by at least 10% (259 fewer low birth weight babies)

• Number of deaths from unsafe sleep by at least 30%

(12 infants)

Factors Affecting Poor Birth Outcomes

• Health of the mother and father before conception

• Medical and social support during pregnancy

• Access to critical knowledge and services after birth

Factors Affecting Poor Birth Outcomes

Stage Pre-Pregnancy Pregnancy Post-PregnancyCare Preconception Prenatal & Obstetric Postpartum & Neonatal

Modifiable Determinants of Adverse Outcomes

SmokingSubstance abuse

Poor nutrition/obesityPsychosocial stressDomestic violence

Infection/ Sexually Transmitted InfectionsUnderlying Chronic Illness

Lack of Health Insurance CoverageUnderlying Determinants of Poor Reproductive Health

Poverty Environmental exposures

Poor housingRacism

Genetic factors

Interventions Specific to Stages

Planned pregnancies: - Wanted & timed - Spaced Good nutrition - Adequate folate High quality primary care STD treatment

High quality prenatal care

Access to high-risk obstetrics

Home visiting for high-risk pregnancies

Breastfeeding Safe sleep Adequate nutrition Immunizations

High-Impact Service Areas

(1) Primary health care in a medical home

(7) Smoking cessation

(2) Obstetric care (8) Family planning

(3) Home visiting (9) Nutrition support

(4) Drug and alcohol treatment (10) Breastfeeding promotion

(5) Domestic violenceInterventions

(11) Safe sleep education

(6) Mental health care

Gaps in Current Efforts to Improve Birth Outcomes

• Individual initiatives are funded inadequately and separately

• Poor coordination of services

• Lack of adequate primary health care

• Lack of health insurance

• Lack of minimum standard of care

• Limited community mobilization to promote healthy behaviors prior to or between pregnancies

Professional Case Management for Selected Individuals at Risk

Paraprofessional Home/Community-Based Services for Selected Communities at Risk

Targeted Health Education and Support Services

Community Mobilization and Health Education

Support Continuum for Improved Birth

Outcomes

Refe

rral

s and

Coo

rdin

ation

Citywide Infrastructure and Education

High-Impact Service Areas

• Primary health care/ preconception

care

• Obstetric care

• Homevisiting

• Drug and alcohol treatment

• Intervention for domestic violence

• Mental health care

• Smoking cessation

• Family planning

• Nutrition support

• Breastfeeding promotion

• Safe sleep education

Excess Number of Infant Deaths by Census Tract, Baltimore City, 2002 - 2006

STEERING COMMITTEE

COMMUNITY ACTION TEAM

Core Implementation

Team

Neighborhood Action Team

SIBO Organizational System

Medicaid/MCOs

Ad Hoc Committees

Hospital Team(s)

State IM Plan

FQHCs

Donors

BabyStat

Fetal/Infant MortalityReview

Child Fatality Review

Neighborhood Action Team

Neighborhood Action Team

Implementation

• Timeline: 10 years (3 Years of initial funding)• 4 Results Areas: Policy, Services/Systems,

Communities, Families/Individuals• Entry Point: Pregnancy/Postpartum • 3 Phases of Communication: Healthy and Safe

Parenting, Healthy Pregnancies, Healthy Baltimore• 12 Communities – starting with 3

Implementation

Results Area 1: Policy/SystemsPolicy for coordinating risk assessment and referral

is in place• Citywide triage system for home visiting services and integrated

database• Prenatal Risk Assessments – making system more efficient• Linking families to community-based services and BHB messages at

discharge from labor and delivery• Fetal and Infant Mortality Review Team – Community Action Team

– Neighborhood Action Teams• Selecting home visiting models for the city

Implementation

Results Area 2: ServicesAgencies and partners providing services adhere to

policies and guidelines for risk assessment and referral with goal of increasing access

• Service Availability Profile—leading to agency work plans• Nurse home visiting adoption of Partners for a Healthy Baby

curriculum. • Cadre of trainers trained as change agents and disseminators

of BHB messages• Provider outreach on PRAs• Hospital outreach at postpartum (video)

Implementation

Results Area 3: CommunitiesCommunities know their role in supporting

improved birth outcomes and buy into strategy• Communities selected and funded• Introduction of Baby Basics and Mom’s groups• Text4Baby• Specific strategy for no prenatal care/unable to

locate under development

Upton/Druid Hts—University ofMaryland Medical System

Greenmount East – People’s Community Health Center

Patterson ParkNorth and East – Baltimore Medical System

Implementation

Results Area 4: Families and IndividualsFamilies and individuals at risk use available

services and practice behaviors that improve birth outcomes

• Branding/safe sleep focus groups• Home visiting programs• Provider outreach

Next Steps?

• Design and implement baseline evaluation for the strategy• Finalize citywide triage criteria• Work with State and hospitals to identify high risk women at

discharge from labor and delivery• Develop provider and community-based toolkit for high impact

areas• Implement phase I of citywide communications campaign:

Healthy and Safe Parenting: SAFE SLEEP• Develop website• Begin community program interventions

Imperative: A City-wide Coordinated Effort

• Citizens and leaders • Mayor’s Office• Health Department• The Family League of

Baltimore City, Inc.• Baltimore HealthCare Access,

Inc.• Baltimore Substance Abuse

Systems, Inc.• Managed Care

Organizations• Housing

• Dept of Social Services• Baltimore Mental Health Systems,

Inc.• Pediatricians/Adolescent

physicians/Obstetricians • Home visiting and community

outreach programs • Schools• Faith-based organizations• Businesses• Public Safety Departments• Hospitals