AMCHP ALCs Focus on Birth Outcomes
By Piia Hanson
Program Manager, Women’s and Infant Health
With support from the W.K. Kellogg Foundation, AMCHP is working on multiple projects that provide capacity-building technical assistance to state MCH programs to ultimately improve birth outcomes. This includes the Optimizing Health Care Reform to Improve Birth Outcomes project and the Partnership to Eliminate Disparities in Infant Mortality project. As we are routinely seeking opportunities to share lessons learned from our member action learning collaboratives (ALCs) in an effort to help your work, we asked our project participants to share their success stories and offer valuable advice.
The Optimizing Health Care Reform to Improve Birth Outcomes project works with state MCH programs and their key partners (e.g., state Medicaid agencies, local health departments, community health centers) in selected states to increase their effectiveness and capacity to optimize implementation of the Affordable Care Act (ACA or "health care reform") to address preconception health, adolescent health and reproductive health. These teams include Florida, Oklahoma, Oregon, Michigan, Mississippi and New Mexico. The project focuses on key opportunities within health reform and other related national initiatives to promote preconception health throughout the life course for women and girls, and to ultimately improve birth outcomes.
The Partnership to Eliminate Disparities in Infant Mortality (PEDIM) project is a joint initiative with AMCHP, CityMatCH and the National Healthy Start Association (NHSA) that works with five state teams to increase capacity at community/local/state levels in order to address the impact of racism on birth outcomes and infant health. These teams include Fort Worth, TX; New Orleans, LA; Boston, MA; New Haven, CT; and various Healthy Start sites that comprise a Michigan team. This project focuses on increasing awareness and education about racism and its impact on birth outcomes.
Kris-Tena Albers, CNM, MN, Director, Infant, Maternal and Reproductive Health Unit at the Florida Department of Health is a member of the Florida Optimizing project team, which is comprised of the Florida Department of Health, the Agency for Health Care Administration (the Florida Medicaid Agency), the March of Dimes and the Florida Association of Healthy Start Coalitions. Kris-Tena shared that Florida recognizes preconception health as one of the key factors in improving the health of mothers and babies during and after pregnancy, and that their team goal for the project is: All women served by Medicaid will have access to preconception and interconception care. She also says that this project provides a forum to collaborate with other states, learn from each other and set dedicated time aside to work towards their goal of improving birth outcomes. The team thinks this work is important because one of the Florida Title V MCH priorities is preconception health and the related performance measure is to, "increase the number of women who have received PCH counseling within the year prior to becoming pregnant." Florida has been working on preconception health for many years and Kris-Tena shared that participating in the Optimizing project re-energized their activities in this area and created a renewed synergy among the partners on the team. She also says that, "our goal of improving the health of our women and their children can only be accomplished through collaborating with partners, internal and external to the state. Everyone is very busy but if you can weave a new initiative, such as this ALC, into activities your state is already doing it provides a renewed energy. Improving birth outcomes is a huge endeavor but you must start somewhere to make it happen and you cannot do it without your MCH partners so you must bring them to the table."
Sam B. Cooper III, LMSW-IPR, Director, Office of Title V & Family Health at the Texas Department of State Health Services, is a member of the Fort Worth, Texas PEDIM team. This team also includes travel members Reverend Ralph Emerson, of Rising Star Baptist Church, Dr. Richard Kurz of the University of North Texas (UNT), Lisa Boone-Reddick of Ft. Worth Healthy Start, Ann Salyer- Caldwell of Tarrant County Public Health Department (CityMatCH Member); the Texas ALC team also includes non-travel members: community leader, Loretta Burns, and Marcy Paul and Dr. Kathryn Cardarelli, both of UNT. Sam shared that as a participant in the second Infant Mortality and Racism ALC, the Texas team has developed a logic model and initial plans for addressing the infant mortality problem in high-risk areas of the city, and is currently using "concept mapping," a key tool from the ALC experience, to identify specific activities and interventions that will be developed and driven by the community in the future. The team originated from existing community partnerships and activities initiated by the Healthy Moms, Healthy Babies, Healthy Communities (H3) project that is targeting infant mortality in the city, specifically in zip codes 76105, 76112, 76119 and 76120. H3 is led by a Community Oversight Board including state, county and city legislators; clergy from the local faith community; service agencies; and members representing education, health and health care. The benefit of having an existing group of committed community members who already identified and understood key points regarding infant mortality was a great asset for the Texas ALC team. The team faced the initial challenge of how to incorporate the steps presented through the learning collaborative model into the preexisting work of H3. Only after team members clarified organizational relationships of the oversight board and the Texas ALC team, and then identified communication strategies that fit Ft. Worth best, did the true picture of possibilities began to emerge. "Lessons learned" or "relearned" by the Texas team at this stage of the ALC include: communication among team members is key; "Keep it Simple" – don’t get paralyzed by the details; and identify common ground and build on the strengths of all involved. In addition to the information and resources provided by AMCHP, CityMatCH and NHSA, the Texas team members have benefitted from the interaction with the other teams in the ALC project. The experiences of former and current participating teams have provided inspiration and energy to the Texas team.
Success Stories: Reducing Infant Mortality in Teen Pregnancies
The United States has made great strides in reducing teen pregnancy in the last number of years; however, the infant mortality rate for babies born to teen mothers is still shockingly high. Statistics tell us that this is due to babies being born prematurely and at low birth weight. But, the issue is complex; factors such as smoking, lack of adequate prenatal care, substance abuse, domestic violence and poor physical health among others contribute to poor birth outcomes. In 2006, the Centers for Disease Control and Prevention released Recommendations to Improve Preconception Health and Health Care – United States to provide a framework to more holistically address the problem of poor birth outcomes. Since then, most states have worked to integrate preconception health efforts into their maternal and child health efforts addressing women. Preconception health and adolescents: In 2009, six innovative states rose to the challenge of figuring out creative ways to integrate preconception health guidelines into their state adolescent and young adult health efforts. Take a look at their success stories!
Developing Recommendations on Preconception Health for Young Adults with Disabilities: Oregon Experience with an AMCHP ALC
By Lesa A. Dixon-Gray, MSW, MPH
Women’s Health Program Coordinator, Maternal and Child Health Section, Center for Prevention and Health Promotion, Oregon Health Authority
Current preconception health recommendations have not addressed the unique needs of young adults with disabilities. While young adults with disabilities are just as likely to be sexually active and less likely to use condoms, this group is often treated as if they were not sexual beings or would not become pregnant. Approximately one in five women in the United States has a disability (an estimated 16.8 to 28.6 million) and an increasing number of women with disabilities are becoming pregnant and report facing negative attitudes toward their pregnancies and difficulty receiving comprehensive prenatal care.
From 2009-2010, the state of Oregon Maternal and Child Health Section participated in an AMCHP Action Learning Collaborative (ALC) on preconception health for adolescents. The purpose the of ALC was to increase awareness and knowledge of the preconception health guidelines and promote the application of these guidelines for adolescent population. In Oregon, as a part of the ALC, an interdisciplinary team of professionals reviewed the Center for Disease Control and Prevention Mortality and Morbidity Weekly Review (MMWR) Preconception Health Recommendations and other published literature and identified that no specific recommendations concerning preconception health exist for young adults with disabilities. While the universal MMWR recommendations are relevant to this population, young adults with disabilities have other specific issues that deserve additional focus. Because the scope of preconception health interventions is so broad and numerous, the team decided to focus on recommendations around reproductive health and safety. The Oregon team developed a survey of young adults with disabilities and their opinions regarding sexual and preconception health. Oregon collected 115 survey responses from across the country and used the survey findings along with other research to develop recommendations.
Besides the benefit of having recommendations for preconception health work within a population that had little current attention, the Oregon team also experienced a wide benefit from the partnerships and collaborations required to complete the work of the ALC. Through their ALC participation, Oregon developed new partnerships, created opportunities for new collaborations with old partners, and enhanced partnerships between the Title V women’s health and children and youth with special health care needs programs.
To read the full Oregon report from the AMCHP Preconception Health and Adolescents Action Learning Collaborative, click here.