Member to Member

Member states that have participated in the MCHB Region IV and VI Infant Mortality Summit and COIN were asked:

What early achievements or successes have you seen? What lessons learned can you share with other states?

Bradley Planey, M.S., M.A.
Associate Branch Chief, Family Health Branch, Arkansas Department of Health

For several years, the Arkansas Department of Health has recognized the importance of reducing the state infant mortality rate (IMR) and it is one of our strategic goals. In 2009, 290 babies died in Arkansas before their first birthday, (an IMR of 7.3 deaths per 1000 live births), placing Arkansas in the top 10 for the highest IMR. The burden of infant death was not shared equally among Arkansas residents. Higher rates occurred in counties with rural, poor and minority populations, especially in the Mississippi Delta.

The Region IV and VI Infant Mortality Summits, as well as the associated COIN workgroups targeting a reduction in infant mortality, was a perfect fit for us. The meetings fostered a partnership that facilitated agreement on goals and strategies aimed at reducing infant mortality and we are now putting those in place. Below are some current and future activities:

  • Regionalization of perinatal care by defining levels of perinatal hospital care in state policy and designating hospitals by level
  • Through professional and public education, ensure appropriate use of labor inductions and cesarean sections to avoid unnecessary premature delivery
  • Increase the number of women receiving flu shots during pregnancy
  • Increase screening, consultation and referral of high-risk pregnant women and infants to appropriate perinatal services
  • Expanding community-based efforts for public awareness (i.e. Safe Sleep Campaign, "First Ride, Safe Ride Campaign," early prenatal care, teen pregnancy awareness and prevention, folic acid awareness, obesity prevention, tobacco cessation and prevention, enhanced pre/postnatal care using evidence-based home visiting care models

As the COIN workgroups and our state efforts continue, I look forward to watching our infant mortality rate drop.

Kris-Tena Albers, CNM, MN
Director, Infant, Maternal and Reproductive Health Unit, Florida Department of Health

Florida engaging with the MCHB Region IV and VI Infant Mortality Summit and Collaborative provides the state an opportunity to have ongoing communication with the multidisciplinary state team to work on the reduction of infant mortality and preterm births. Early Florida achievements/successes include: developing a Health Problem Analysis of SUIDS/SIDS and a logic model to guide the work of promoting safe sleep and preventing SUIDS; distributing Makena Rx pads to obstetrical providers, hoping to increase the usage of Makena for the appropriate at-risk population for preterm labor and birth; enhancing the relationship between the Florida Department of Health and the Medicaid agency to explore ways preconception and interconception care might be incorporated into future Medicaid managed care plans; identifying and receiving additional funding to sustain the Florida Perinatal Quality Collaborative; and announcing a request for proposals in July by the March of Dimes to award funding for demonstration projects to increase the number of women attending their postpartum visits.

Some recommendations to other states of lessons we have learned are:

  • Each of the summit Strategic Priority Areas has a lead person who facilitates the major actions/ activities needed to implement each strategy. Assigning a lead person is critical to accomplish the work that needs to be done.
  • The Florida Strategic Priority Areas team members participate in quarterly conference calls for the purpose of providing updates and soliciting input on the activities/strategies identified in January 2012. This helps to document progress, revise strategies if needed, and brainstorm new ideas.

Michael Warren, MD MPH FAAP
Director, Division of Family Health and Wellness, Tennessee Department of Health

On Sept. 20, the Tennessee Department of Health hosted a statewide infant mortality summit, "Tennesseans Teaming Up for Change." Forty two local community teams (made up of more than 200 individuals) attended the event. Welcoming remarks were provided by the Tennessee First Lady Crissy Haslam and Commissioner of Health, Dr. John Dreyzehner. Plenary sessions focused on national efforts related to infant mortality and included presentations by Dr. Michael Lu and Dr. Michael Fraser. Breakout sessions focused on specific topics, such as safe sleep and the impact of chronic disease on pregnancy, as well as capacity-building topics, such as using the PPOR process and marketing your message. At the end of the day, teams gathered to write individual "belief statements" and develop an initial team plan for addressing infant mortality in their communities, including at least one specific goal and associated strategies, objectives, and stakeholders.

We decided to make this conference "different" by making it a "team" event rather than having individual registrations. We wanted people to learn together, and then go back and do something, as a team, in their community. The response was overwhelmingly positive – registration filled within two weeks and every team turned in a Community Action Plan at the end of the day. One important recommendation is to consider existing resources and how they can help you with an event like this – we had great support from CityMatCH and AMCHP in planning and conducting some of the sessions – their cooperation saved us from having to "reinvent the wheel" and allowed us to hear directly from the experts! The other is to never fear challenging your communities to act – we now have 42 teams spread across the state that are ready to engage community stakeholders in efforts to improve birth outcomes.

Sam B. Cooper III, LMSW-IPR
Director, Office of Title V & Family Health, Family & Community Health Services Division, Texas Department of State Health Services

The earliest successes have been seen primarily in strengthened partnerships with stakeholders in our state systems and with local coalitions in Texas. We have improved communication among partners on critical areas that impact the health outcomes of pregnant women and infants. The Summit and COIN have provided additional opportunities to work with our peers in other states to see what is working and how we can take advantage of those successes. The national efforts have provided greater visibility of our existing state initiative and promoted interest among elected officials and leaders in agencies and organizations in Texas.

Our interactions with other states in the process have reinforced core ideas that can lead to success. Be clear who needs to participate from the beginning and be flexible in developing partnerships that can support the efforts. Recognize that there may be limits on individual organization’s involvement, but strategize how to make the most effective use of the combined efforts. Develop strategies that are holistic and include families, providers and community stakeholders from the state. Use any and all of the data tools available to measure success. Share the lessons learned often.