Infant Mortality Can B e Reduced: Implementing the Life Course Approach Using a Public Health Social Movement

1. 3rd Annual North Texas Health Forum Reducing Infant Mortality in Tarrant County:  It's Time for Action       April 8 - 9, 2010 Tamara Wrenn, MA, CCE, CIMT Senior Consultant, Practice Matters, a Subsidiary of Northern Manhattan Perinatal Partnership, Inc. Email: Tamara.Wrenn@justuswomen.org Infant Mortality Can Be Reduced: Implementing the Life Course Approach Using a Public Health Social Movement

2. Objectives • Define a Maternal Child Health Life Course Organization. • Define a public health social movement. • Review the strategies and action steps to build the movement.

4. Characteristics of a Life Course Organization • Builds programmatic capacity within the agency at each stage of a woman’s life course to manage her health over the life course (Axis 1).

5. Characteristics of a Life Course Organization Cont’d • Swimsup-stream from individual interventions and designs strategies and actions at the group, organizational, community and policy levels to transform social determinants to poor health (Axis 2).

6. Characteristics of a Life Course Organization Cont’d • If unable to build internal capacity collaborates with outside agencies and systems to create an integrated system of care to manage a woman’s health.

7. Characteristics of a Life Course Organization Cont’d • Unlike many maternal and child health programs that only seek to influence the health system by developing and executing a local health system action plan, a MCHLCO seeks to influence and lead their local and regional economic, political, housing, child welfare, early childhood and middle school systems of care.

8. LCO as a Business Entity • Organizational structure • Local entity 501 (c ) 3 • Local/state government • Coalitions/consortiums • Leadership • Strong leadership and management • Order, consistency, quality • Cope with complexity • Build relationships • Sacrifice • Create a culture of leadership • Strategist • Capacity • Internal • Collaborative • Integrated systems • Sustainability • Funding • Coordination • Quality assurance • Community demand • Comprehensive strategy • Multilevel practice

9. Traditional Perinatal Care Continuum Labor and birth ? Primary care Interconceptionalperiod Preconception period Antepartum Labor and birth Postpartum Well baby care Postpartum visit Prenatal care Drummonds, M.

10. Life Course Perspective • Suggests that a complex interplay of biological, behavioral, psychological, and social protective and risk factors contributes to health outcomes across the span of a person’s life. • The life course perspective conceptualizes birth outcomes as the end product of not only the nine months of pregnancy, but the entire life course of the mother leading up to the pregnancy.

11. Longitudinal Approach

12. New MCH Life Course Continuum Axis 1

13. Social Determinants of Health

14. MCH Life Course Organization Social Determinants of Health Axis 2

15. Field of Dreams“If you build it they will come” Building an MCH life course organization requires patience, commitment and sacrifice. The seeds we plant today will require at least one generation before we can see lasting changes. The knowledge that the concept and standardization of prenatal care is only 30 years old provides optimism in the face of moving the life course perspective from theory to practice.

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17. NMPP’s Individual/Clinical Life Course Interventions • Central Harlem Healthy Start Program • Nurse Family Partnership, (NYCDOH/MH) • Community Health Worker Program • Harlem Hospital Birthing Center • St. Nicholas Child Welfare Preventive Program • Mankind Fatherhood Case Management Program • TASA Cobra Case Management Program for Pregnant Teens • Start Right Immunization Team • Center for Preschool & Family Learning Head Start-152nd St. and 155th St. • Universal Pre-K Program-152nd St. and 155th St. • Managed Care/Healthcare Enrollment Program • Asthma Case Management Team

18. NMPP’s Group Life Course Interpersonal Interventions • Baby Mama’s Club/Circulo de Mamas Depression Groups • Centering Pregnancy • Adolescent Pregnancy Prevention Team • Harlem Weight Watchers Program • CHHS’s Consumer Involvement Organization

20. NMPP’s Community Environmental Life Course Interventions • NMPP’s Harlem Works Job Readiness Program • NYC Breastfeeding Alliance • Harlem Strategic Action Committee • ABC Asthma Coalition • Start-Right Immunization Coalition • St. Nicholas Houses Community Organizing Project

22. NMPP’s Public Policy Life Course Interventions • Federation of County Networks • Harlem Food & Fitness Consortium • Citywide Coalition to End Infant Mortality • Manhattan Regional Perinatal Forum • NMPP’s BBKH Diabetes Coalition

23. Public Policy & Systems Change Achievements Regionalization of Perinatal Care Throughout NYS Secured Over $70 Million Dollars from NYC Mayor Integrated MCH & Child Welfare Systems of Care Financed & Staffed Up Birthing Center at Harlem Hospital Secured $250 Million Dollars to Build a New Harlem Hospital

24. Public Policy & Systems Change Achievements Harlem Hospital Recently Designated as a “Baby Friendly” Hospital (Aug 2008) Passed Mental Health Parity Legislation Timothy’s Law (2007) Trained over 800 women and placed them in full time jobs! Reduced Child & Abuse & Neglect Rates in Harlem Repealed “Medicaid Neutrality” Law in NYS

25. Public Policy & Systems Change Achievements Increased Medicaid Mental Health Reimbursement Rates NYC Mayor Has $7.5 Billion Dollar Plan to Build 165,000 Units of Affordable Housing by 2013- Eighty-Two Thousand units built to date! Mayoral $10 million dollar Plan to train 400 Harlem residents to become RN’s and LPN’s Congressman Rangel’s Harlem Empowerment Zone Legislation to move from a minimum wage to a livable wage policy

26. Field of Dreams“If you build it they will come” Building an MCH life course organization requires patience, commitment and sacrifice. The seeds we plant today will require at least one generation before we can see lasting changes. The knowledge that the concept and standardization of prenatal care is only 30 years old provides optimism in the face of moving the life course perspective from theory to practice.

27. Spectrum of Work for MCH Life Course OrganizationBuilding Public Health Social Movement Early Childhood Women over 35 Birth Pre-teen Teen Young Adult

28. Building a Public Health Social Movement Around Infant Health and Infant Mortality

29. HISTORY & PRINCIPLES OF MASS MOVEMENTS • SHARED PERCEPTION THAT A GROUP IS DENIED RIGHTS, SAFTEY, OPPORTUNITY OR RESPECT • THE ESSENCE OF MASS MOVEMENTS ARE THAT THEY NARROW THE GAP BETWEEN IDEALS AND THE CURRENT REALITY OF A GROUP • PARTCIPANTS SHOULD BE THE AGENTS OF THEIR OWN CHANGE!

30. HISTORY & PRINCIPLES OF MASS MOVEMENTS • ONLY SINCE THE 1900’S HAVE MASS MOVEMENTS BEEN USED AS AN INTERVENTION TO ADDRESS BROAD PUBLIC HEALTH CONCERNS IN LATIN AMERICA, AFRICA AND THE UNITED STATES

31. Examples of Historical Social Movements • Civil rights • Women’s Suffrage • Feminism • Black Power • French Revolution • Cultural and international revolutions

32. WORKING DEFINITION OF PUBLIC HEALTH SOCIAL MOVEMENT/COMMUNITY MOBILIZATION • Public health mass movements are defined as a capacity-building process through which community individuals, groups, or organizations plan, carry out, and evaluate activities on a participatory and sustained basis to improve their health, transform the health delivery system and address other needs, either on their own initiative or stimulated by others.

33. WORKING DEFINITION OF PUBLIC HEALTH SOCIAL MOVEMENT/COMMUNITY MOBILIZATION • At the end of the process, movement participants possess more skills and societal and public health changes can be measured.

34. Strategies to Mobilizing & Organizing a Public Health Social Movement • Build the organizational structure for Tarrant County’s public health social movement. • Declare and establish a state of emergency in Tarrant County about infant health and infant mortality. • Demystify the concept of infant mortality for the common folk and key sectors of civil society in Tarrant County. • Secure Tarrant County’s leadership team . • Secure strategic champions for Tarrant County’s movement. • Include measurable results for accountability.

35. Strategies to Mobilizing & Organizing a Public Health Social Movement • Build the organizational structure for Tarrant County’s public health social movement. Action steps • Identify existing entities that support a MCHLCO framework. • Assess internal capacity of existing entities and build internal capacity for new structures. • Where capacity is weak form collaborations. • Conduct program review/program planning/program re-deployment.

36. Strategies to Mobilizing & Organizing a Public Health Social Movement • Declare and establish a state of emergency in Tarrant County about infant health and infant mortality. Action steps • Develop the message. • Develop a social marketing strategy. • Get the message out. Work the media using mass media campaigns including: PSA’s, press releases, town hall meetings, talking points, press conferences, and flyers. • Use social networking tools at your disposal to keep the message fresh and current, think viral.

38. Strategies to Mobilizing & Organizing a Public Health Social Movement • Demystify the concept of infant mortality for the common folk and key sectors of civil society in Tarrant County. Action steps • Put a face(s) and name(s) to infant mortality versus it being just another issue or cause. • Use the social networking tools at your disposal to draw more supporters (Facebook, Twitter, MySpace) • Make the mass movement participatory allowing the community to be agents of their own change. • Approach block associations, churches, businesses, PTA’s, home owner associations, barber/beauty shops.

39. Strategies to Mobilizing & Organizing a Public Health Social Movement • Secure Tarrant County’s leadership team. Action Steps • Leadership team must include visionaries. • Leaders that stretch their organizations beyond their current capacity and structure by challenging everyone to do what they think is impossible. • Form a Leadership council.

41. Strategies to Mobilizing & Organizing a Public Health Social Movement • Secure strategic champions for Tarrant County’s movement. Action Steps • Secure personalities (celebrities, faith-based, sports, private sector) to champion your movement. • Champions draw national attention to your mass movement/message.

42. A Healthy Baby Begins with YouCampaign

43. Strategies to Mobilizing & Organizing a Public Health Social Movement • Include measurable results for accountability. Action Steps • Working groups should include an evaluation & data committee. • Logic model should be used to document and evaluate the movement. • Evaluation of quantitative/qualitative changes over time. • Legislative action and sustainability are part of the desired outcomes/goals. • Goals • Short-term • Intermediate • Long-term

44. Public Health Social Movement Case Study Citywide Coalition to End Infant Mortality One City, One Customer, One Plan

45. Citywide Coalition to End Infant MortalityYear One: 2000 - 2001 • Who? • A group of clinicians, activists, Perinatal Networks, elected officials and consumers/clients dedicated to ending infant mortality. • What? • Approached the problem from the perspective that infant mortality is a multifaceted issue that has medical, health care access, economic and social determinants and solutions. • Developed the Five-Point Program to answer the call. • When? • Movement began in August 2000 with focused media and legislative campaigns. Fist formal community forum was held on May 4, 2001.

46. Citywide Coalition to End Infant MortalityYear One: 2000 – 2001 Cont’d • Where? • New York City’s five boroughs; New York, the Bronx, Brooklyn, Queens and Staten Island • Why? • The catalyst: • Decrease in Healthy Start funding • Rise in infant mortality after experiencing a significant decrease over a two year period • How? • City Council dedicated $5 million dollars starting December 1, 2001 to over 40 community-based social service and health providers to start up case management, outreach, health education and Doula programs to reduce infant mortality.

47. Case Study • Build the organizational structure for a public health social movement. • Citywide Coalition to End Infant Mortality • Five Point Program • Perinatal Networks • Immigrant/Ethnic Organizations • Building Borough Perinatal Tasks Forces • Community Health Centers • Declare and establish a state of emergency about infant health and infant mortality. • Massive media campaign • July 2000 Amsterdam News article • Sunday, January 21, 2001 NY Daily News Feature article • February 3, 2001 NY Post article • 1010 WINS Radio News Broadcast February 3rd and 4th • All day coverage on IMR on New York One TV News and 1010 WINS Radio Station • BET News provided national coverage of the story on 12/31/02

48. Case Study Cont’d • Demystify the concept of infant mortality for the common folk and key sectors of civil society . • Consumer involvement Organization(CIO) • CIO leadership paid positions and committees • Human interest stories and interviews with mothers • Secure leadership team • Borough Perinatal Task Forces

49. Case Study Cont’d • Secure strategic champions for the movement • Elected officials championed for funding for the movement including: NYC Councilman Bill Perkins(currently NYS Senator Bill Perkins) • Include measurable results for accountability. • Comprehensive and standardized performance objectives

50. Citywide Coalition to End Infant Mortality Accomplishments to Date • Five Point Program– bought together five entities for a common goal. • Massive media campaign • The coalition developed a comprehensive plan to end infant mortality in high risk communities throughout NYC by mobilizing and organizing key constituencies and public health organizations from across the city. • A record $5 - $7 million dollars has been allocated yearly since 2001 by the City Council towards achieving objectives – over $70 million to date. • Legislative and advocacy strategies have been instrumental in upstream policy changes. • One city, one customer, one plan!