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First Year Cleveland MMIHS Conference 030518

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Disruptive Think: Using Data to Inform & Mobilize a Community Movement to Stop African American Babies from Dying - The Greater Cleveland Experience

Michigan Maternal-Infant
Health Statewide Conference:
A Strategic Approach To
Improving Maternal and
Infant Health

Bernadette Kerrigan
Elizabeth Littman
First Year Cleveland
Case Western Reserve University
Cleveland, Ohio

Infant Mortality Data

Published in: Health & Medicine
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First Year Cleveland MMIHS Conference 030518

  1. 1. Disruptive Think: Using Data to Inform & Mobilize a Community Movement to Stop African American Babies from Dying - The Greater Cleveland Experience Michigan Maternal-Infant Health Statewide Conference: A Strategic Approach To Improving Maternal and Infant Health Bernadette Kerrigan Elizabeth Littman First Year Cleveland Case Western Reserve University Cleveland, Ohio March 5, 2018
  2. 2. PRESENTATION TOPICS THE PROBLEM THE SOLUTION: CREATE A DATA-INFORMED COMMUNITY COLLABORATIVE FYC STRATEGIC PLAN VISION & MISSION 5 TAKEAWAYS 5 AREAS OF ACTIVITIES 3 PRIORITIES THROUGH 2020 FYC MOBILIZATION STRATEGY 2018-2020 FYC PROGRESS DISRUPTIVE THINK: YOU CAN ACT NOW BREAKOUT GROUPS + REPORT OUTS 2
  3. 3. THE PROBLEM High infant mortality rates in Ohio, the City of Cleveland and Cuyahoga County have been persistent for 50+ years. In 2015 ● Ohio ranked 45th among all states nationally - near bottom for IM ● City of Cleveland – 12.9 IMR was double the national average of 6.0 IMR ● Cuyahoga County - 10.5 IMR compared to national average of 6.0 IMR 3
  4. 4. THE PROBLEM 4 LOOKING AT 2015 LOCAL INFANT DEATHS - A DEEP DIVE
  5. 5. THE PROBLEM Most Significant Causes of Infant Deaths Extreme Prematurity Sleep-related Infant Deaths 5
  6. 6. THE PROBLEM OUR COMMUNITY’S #1 PROBLEM: RACIAL DISPARITIES ● For over 50 years, there has been a large racial disparities gap in Cuyahoga County between African American and White babies dying. ● Higher income and higher levels of education did not have better maternal and infant health outcomes for African Americans. ● 2015 Infant Death Data: ○ 38% of the all babies born in Cuyahoga County were African American ○ 65% of infant deaths were African American - 83 babies 6
  7. 7. THE PROBLEM OUR #1 PROBLEM: RACIAL DISPARITIES A local and state public health crisis. Ohio’s 2015 State Infant Mortality Rate by Race Source: ODH
  8. 8. Source: National Center for Health Statistics Data THERE IS A 40-YEAR SURVIVAL TIME LAG BETWEEN WHITE AND BLACK INFANT MORTALITY RATES 1975 Infant Mortality Rates ○ White: 14.3 ○ Black: 25.1 (in 1975 all non-White births were in one “Other” category) 2015 Infant Mortality Rates ○ White: 5.8 ○ Black: 15.2 THE PROBLEM
  9. 9. THINK ABOUT IT What if Ohio’s Black IMR had been the same as Ohio’s White IMR from 1990-2015? 5,914 Black babies would not have died. • Source: ODH data, HRSA evaluation THE PROBLEM
  10. 10. FYC SOLUTION: CREATE A DATA-INFORMED COMMUNITY COLLABORATIVE 10 • 13-Cuyahoga County civic leaders established First Year Cleveland in December 2015 • FYC Advisory Council includes over 300 community representatives from more than 70 organizations • FYC is a collaborative, grassroots effort with a bottom-up approach • FYC draws on the experience and wisdom of our community • Parents and grandparents • Neighbors • Frontline caregivers • Leaders from health systems, civic groups, volunteer organizations, and faith-based community Organizational Description
  11. 11. FYC SOLUTION: CREATE A DATA-INFORMED COMMUNITY COLLABORATIVE Structure Case Western Reserve University School of Medicine serves as First Year Cleveland's fiscal agent and provides in-kind support for executive staff leadership and operations, including space. 2016-2018 funders include: •Ohio Department of Medicaid •Ohio Department of Health including Cleveland-Cuyahoga County Ohio Equity Institute •Cuyahoga County, County Executive Armond Budish and Cuyahoga County Council •City of Cleveland, Cleveland Mayor Frank G. Jackson and Cleveland City Council 11
  12. 12. FYC STRATEGIC PLAN: VISION + MISSION Our Vision Every baby born in Cuyahoga County will celebrate a first birthday Our Mission To mobilize the community through partnerships and a unified strategy to reduce infant deaths including racial disparities 12
  13. 13. FYC STRATEGIC PLAN: 5 TAKEAWAYS 1. MISCONCEPTIONS PREVAIL 2. SYSTEMS-LEVEL INTERVENTIONS ARE REQUIRED 3. STRUCTURAL RACISM MATTERS 4. EVIDENCE-BASED SOLUTIONS MUST BE SCALABLE AND COORDINATED 5. INFANT SLEEP-RELATED DEATHS ARE PREVENTABLE AND REQUIRE A COMMUNITY MOVEMENT 13
  14. 14. TAKEAWAY 1: MISCONCEPTIONS PREVAIL Our community must have access to reliable, accurate, real-time infant death data on a regular basis so it has a common understanding of the problem and how to address it. 14 REALITY Babies are dying due to poor or no prenatal care. Cuyahoga County has the highest rate of prenatal care in the state and the worst IMR. Poor Black babies are dying, so poverty must be key. In 2015, 50% of African American babies who died from prematurity and birth defects were on Medicaid and 50% on private insurance. Babies who are dying are born to teen moms and/or moms who abuse drug and alcohol. In the past 10 years, less than 4% of all infant deaths were born to teen moms and/or moms with addiction or mental health issues. MISCONCEPTION
  15. 15. TAKEAWAY 2: SYSTEMS-LEVEL INTERVENTIONS ARE REQUIRED FYC must go beyond individual interventions and address systems that are negatively impacting maternal and child health outcomes. “While the mother is the environment of the developing fetus, the community is the environment of the mother.” - Dr. Lawrence Wallack, “Going Upstream for the Health of the Next Generation” "When a flower doesn't bloom, you fix the environment in which it grows, not the flower." Alexander Den Heijer (Quote used with permission from Mariela Uribe) • 15
  16. 16. Time Span Status Years % U.S. Experience 1619-1865 Slaves “Chattel” 246 62% 1865-1964 Jim Crow virtually no Citizenship rights 99 25.0% 1964-2017* “Equal” 53 13% 1619-2017 “Struggle” “Unfairness” 398 100% Source: Art James FYC STRATEGIC PLAN: STRUCTURAL RACISM MATTERS African American Citizenship Status: 1619-2017 87% of the United States history and experience has been under slavery and Jim Crow
  17. 17. TAKEAWAY 4: EVIDENCE-BASED SOLUTIONS MUST BE SCALABLE AND COORDINATED To affect change Community Providers, Medical Systems and Public Health interventions must be fully integrated and delivered in a seamless approach to Expectant Parents and New Parents Evidence-based Programs must be at scale: • Home Visiting (addressing housing, employment, education, mental health, parenting) • 17-P • CenteringPregnancy • Safe Sleep - ABCD • Fathers’ Programs • Birth Spacing • LARC (Long-Acting Reversible Contraceptives) 17
  18. 18. TAKEAWAY 5: SLEEP-RELATED INFANT DEATHS ARE PREVENTABLE AND REQUIRE A COMMUNITY MOVEMENT Over the last ten years, locally there were over 200 PREVENTABLE sleep-related infant deaths, with only one SIDS death. If proactive, we can save babies from sleep-related deaths. Activate the ENTIRE COMMUNITY to ensure all babies Sleep Alone On their Back In a Crib, Pack-n-Play or Baby Box and Don’t smoke near a baby 18
  19. 19. FYC STRATEGIC PLAN: 3 PRIORITIES THROUGH 2020 1. Reduce Racial Disparities 2. Address Extreme Prematurity 3. Eliminate Preventable Sleep-related Infant Deaths 19
  20. 20. FYC MOBILIZATION STRATEGY 2018-2020 For these 3 priorities, FYC’s Mobilization Strategy includes 5 activities that FYC is accountable for, evaluating measurable data. 1. Establish Shared Measurement Practices 2. Support Coordinated Activities 3. Build Public Will 4. Advance Public Policy 5. Secure Funding 20
  21. 21. FYC MOBILIZATION STRATEGY 2018-2020 21
  22. 22. FYC MOBILIZATION STRATEGY 2018-2020 22
  23. 23. FYC MOBILIZATION STRATEGY 2018-2020 23
  24. 24. FYC MOBILIZATION STRATEGY 2018-2020 24
  25. 25. FYC PROGRESS 25 2015 IMR = 10.4 2016 IMR = 8.7 2017 Preliminary IMR= 7.9 TOGETHER WE HAVE SAVED SEVERAL KINDERGARTEN CLASSES OF BABIES But we have a long way to go to get to 6.0 IMR by 2020
  26. 26. DISRUPTIVE THINK: YOU CAN ACT NOW • Launch a Systems-wide Structural Racism Initiative including biases testing and training for all level of employees in the systems that impact maternal and child health outcomes • Create a Community Movement for Safe Sleep and Activate Your Private Sector, School, Clubs, Faith-based Organizations... • Create a “No Wrong Door” Seamless Delivery System among community providers, healthcare systems and public health 26
  27. 27. BREAKOUT GROUPS + REPORT OUTS 27 Group 1 What are your keys to success in saving African American babies? Group 2 What interventions that FYC discussed would add value to your work? Group 3 What data are you currently measuring to help you understand the problem? QUESTIONS
  28. 28. THANK YOU & CONTACT INFORMATION 28 Erica Chambers Healthy Equity Senior Programs Director First Year Cleveland Erica.Chambers@case.edu Bernadette Kerrigan Executive Director First Year Cleveland Bernadette.Kerrigan@case.edu 216-368-6870 Elizabeth Littman Senior Director Government Relations and Strategic Initiatives Case Western Reserve University Amy Neumann Senior Director Marketing and Communications First Year Cleveland Amy.Neumann@case.edu 216-368-4837 FirstYearCleveland.org Case Western Reserve University School of Medicine 10900 Euclid Avenue, BRB109H Cleveland, Ohio 44106 Please text the word “BABY” to 66866 to get connected to First Year Cleveland

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