Kansas Blue Ribbon Panel on Infant Mortality August 28, 2009 Susan E. Wilson, BGS Healthy Babies Program Director Ty Kane, MPH Community Health Analyst & IMR Coordinator

Improve birth outcomes among at- risk moms by reducing the incidence of premature and low birth weight births and infant deaths.

 Group Education  In-office Visits  Home Visits

 Nutrition/Healthy Weight  Labor & Delivery  Basic Baby Care  Breastfeeding  Infant Growth and Development  Parenting Skills  Relationships  Birth Spacing  Sexually Transmitted Diseases  Self-Esteem and Goal-Setting  Education, Employment and Budgeting

 Smoking  Depression  Domestic Violence  Drug and Alcohol Use  Lead Poisoning  Infant Development

 716 Incoming Referrals  8,500 Group, Home and Office Encounters  1,021 Moms & Babies

 Decrease the Infant Mortality Rate  Decrease the Premature Birth Rate  Reduce the Low Birth Weight (LBW) Rate  Increase Prenatal Care Entry  Increase Breastfeeding Rates (info from

 Annual budget ($1.78 million)  Additional one-time monies SFY2010 ($569K)  88% grant funded  31% of total funding is federal Healthy Start

 Northeast Wichita Healthy Start Initiative – referred to as NEWHSI  Funded since 1997  Targeted zip codes (67208, 67214, 67219)  Poor African American birth outcomes  Applications in 2007 and 2008 to extend targeted zips to 67203, 67210, and were approved by HRSA but unfunded due to budget constraints

 All races (all zips)16.72 deaths/1,000  African American (all zips)26.50 deaths/1,000  Up from for the three years ending 2000  All races (67214)21.07 deaths/1,000  African American (67214)26.12 deaths/1,000  Up from for the three years ending 2000 Data provided by KDHE

 0.00 infant deaths reported ( )  For clients residing in one of the three NEWHSI zip codes and enrolled in the Healthy Babies program  Two infant deaths reported (grant year 2008)  For all clients enrolled in the Healthy Babies program, all zip codes  Both unpreventable due to congenital anomalies Data provided by KDHE

Data provided by KDHE Bureau of Health Informatics

 Social marketing campaign targeting preconception care  Use Community Navigators to provide peer education among at-risk populations and increase referrals  Provide reproductive health education to middle and high school students in the Wichita Public Schools  Implement new software to increase ability to analyze and share birth outcome data with KDHE and local evaluator  Extend the Infant Mortality Review (IMR) Project to help determine the social factors associated with infant deaths in Sedgwick County

 Fall 2004 – Began dialogue with KDHE regarding data needs as related to the NEWHSI grant  Fall 2004 thru Fall 2007  Purchased zip-code specific data from KDHE  Nurtured partnership with KDHE Bureau of Health Informatics and the Kansas City Healthy Start (KCHS) Project via phone and in-person meetings to discuss grant objectives, program outcomes and target area stats  Fall 2007 – Partner with KCHS to fund KDHE research agreement to gain “greater understanding of the social and health issues related to pregnancy outcomes and infant mortality…”  Fall 2008 thru Spring 2009 – Chart Abstractions  June Convene Case Review Team (CRT)  February 2010 – Begin abstraction of 2010 charts

 Sedgwick County Health Department  Kansas City Healthy Start  Kansas Department of Health and Environment  Bureau of Health Informatics  Bureau of Local and Rural Health  Central Plains Regional Health Care Foundation  Medical Society of Sedgwick County  KUMC– Wichita, Office of Research  SIDS Network of Kansas

 Created as part of an on-going KDHE QA/QI project  Bureau of PHI authority allows abstraction of maternal and infant death records:  To verify hospital compliance with completing birth and infant death certificates  To collect data specific to infant deaths and stillbirths (No patient contact; Work by KDHE staff)  To allow comparison of birth outcome data between individuals served/not served by Healthy Babies (All work done in non-identifying manner)  KS Statute puts restrictions on a maternal interview

 To facilitate the bereavement process and provide appropriate referrals.  To learn about the mother’s experiences before and during pregnancy.  To learn about events during the infant’s life and around the time of death.  To identify community assets and deficits that affected the mother’s life during the pregnancy, birth and death of her infant.  To accurately summarize and convey the mother’s story of her encounters with local service systems and her loss to the community thru the FIMR case review.  To assess the family’s needs and provide culturally appropriate health and human service referrals as needed.

 95 Charts abstracted at Via Christi and Wesley  63 infant deaths  32 stillbirths  Non-Hispanic (82.1%)  Black (22.1%)  White (53.7%)  Other (6.3%)  Identified Payer Source (51.6%)  MCD (49.5%)  Private Insurance (2.1%)  Self-pay (36.8%) Data provided by KDHE

 Singleton Births (88.4%)  Prematurity (71.6%)  Very Preterm/<32 weeks (50.5%)  Moderate Preterm/32-33 weeks (11.6%)  Mother’s age <30 (72.7%)  <20 yrs. (24.2%)  yrs. (18.2%)  yrs. (30.3%)  Pre-pregnancy abnormal BMI (84.4%)  Underweight (14.7%)  Overweight (15.2%)  Obese (27.3%) Data provided by KDHE

Essential Steps for Initializing a FIMR Program Source: NFIMR, “A Guide for Communities, FIMR Manual, 2 nd Edition” * ASSURE COMMUNITY READINESS * Develop Programmatic Features Build Community Support and Collaboration Define the CommunityDetermine sponsoring agency Determine relationship to other review processes Build support from community services Identify costs and funding sources Identify FIMR team participants Identify and address legal and institutional issues Hold town hall meeting Set up procedures and policiesDevelop mission statement Reporting to community Administrative functions * INITIATE FIMR CASE REVIEWS *

Essential Steps for Initializing a FIMR Program Source: NFIMR, “A Guide for Communities, FIMR Manual, 2 nd Edition” * ASSURE COMMUNITY READINESS * Develop Programmatic Features NEWHSI Zip Codes versus other Sedgwick County zip codes Define the Community Determine relationship to other review processes Identify costs and funding sources Identify and address legal and institutional issues Set up procedures and policies Reporting to community Administrative functions * INITIATE FIMR CASE REVIEWS *

Essential Steps for Initializing a FIMR Program Source: NFIMR, “A Guide for Communities, FIMR Manual, 2 nd Edition” * ASSURE COMMUNITY READINESS * Develop Programmatic Features KS Child Death Review Board (CDRB) Has the statutory obligation to review the death of every child that is a KS resident or dies in KS. Examines trends and patterns that identify risk factors in the deaths of children, from birth through 17 years of age. ( Sedgwick County Infant Mortality Review Examine deaths of children between 20 weeks gestation and one year of age. The overall goal of a FIMR is to enhance the health and well being of women, infants and families by improving the community resources and service delivery systems available to them. Define the Community Determine relationship to other review processes Identify costs and funding sources Identify and address legal and institutional issues Set up procedures and policies Reporting to community Administrative functions * INITIATE FIMR CASE REVIEWS *

Essential Steps for Initializing a FIMR Program Source: NFIMR, “A Guide for Communities, FIMR Manual, 2 nd Edition” * ASSURE COMMUNITY READINESS * Develop Programmatic Features Sedgwick County IMR financial supporters: Central Plains Regional Health Care Foundation Healthy Babies Program NEWHSI grant CDC Safe Motherhood grant Define the Community Determine relationship to other review processes Identify costs and funding sources Identify and address legal and institutional issues Set up procedures and policies Reporting to community Administrative functions * INITIATE FIMR CASE REVIEWS *

Essential Steps for Initializing a FIMR Program Source: NFIMR, “A Guide for Communities, FIMR Manual, 2 nd Edition” * ASSURE COMMUNITY READINESS * Develop Programmatic Features Authority to perform abstraction activities and to review abstracted case summaries has been reviewed by KDHE and SCHD legal staff Define the Community Determine relationship to other review processes Identify costs and funding sources Identify and address legal and institutional issues Set up procedures and policies Reporting to community Administrative functions * INITIATE FIMR CASE REVIEWS *

Essential Steps for Initializing a FIMR Program Source: NFIMR, “A Guide for Communities, FIMR Manual, 2 nd Edition” * ASSURE COMMUNITY READINESS * Develop Programmatic Features Policies and procedures have been drafted and are in progress for: Project overview (Authority, Mission, Vision, Goals) Roles and Responsibilities Case Review Team (CRT) Community Action Team (CAT) Confidentiality Case Identification, etc. Define the Community Determine relationship to other review processes Identify costs and funding sources Identify and address legal and institutional issues Set up procedures and policies Reporting to community Administrative functions * INITIATE FIMR CASE REVIEWS *

Essential Steps for Initializing a FIMR Program Source: NFIMR, “A Guide for Communities, FIMR Manual, 2 nd Edition” * ASSURE COMMUNITY READINESS * Develop Programmatic Features NFIMR recommends: Media sub-committee Annual FIMR report Define the Community Determine relationship to other review processes Identify costs and funding sources Identify and address legal and institutional issues Set up procedures and policies Reporting to community Administrative functions * INITIATE FIMR CASE REVIEWS *

Essential Steps for Initializing a FIMR Program Source: NFIMR, “A Guide for Communities, FIMR Manual, 2 nd Edition” * ASSURE COMMUNITY READINESS * Develop Programmatic Features Currently managed by SCHD staff: Susan Wilson, Healthy Babies Program Manager Ty Kane, Community Health Analyst Define the Community Determine relationship to other review processes Identify costs and funding sources Identify and address legal and institutional issues Set up procedures and policies Reporting to community Administrative functions * INITIATE FIMR CASE REVIEWS *

Essential Steps for Initializing a FIMR Program Source: NFIMR, “A Guide for Communities, FIMR Manual, 2 nd Edition” * ASSURE COMMUNITY READINESS * From “The Evaluation of FIMR Programs Nationwide” -Women’s and Children’s Policy Center at Johns Hopkins University Where are FIMR’s housed? 65% LHD 12% Community organization 8% Healthy Start 7% Hospital 8% Other Build Community Support and Collaboration Determine the sponsoring agency Build support from community services Identify FIMR team participants Hold town hall meeting Develop mission statement * INITIATE FIMR CASE REVIEWS *

Essential Steps for Initializing a FIMR Program Source: NFIMR, “A Guide for Communities, FIMR Manual, 2 nd Edition” * ASSURE COMMUNITY READINESS * Current partners include: Center for Health and Wellness Hunter Health Clinic SIDS Network of Kansas African American Coalition Kansas Children’s Service League March of Dimes Catholic Charities Wichita Radiological Group Maternal-Fetal Associates COMCARE of SG County SG County Human Services Wichita Police Department USD 259, Wichita Public Schools Via Christi Wesley Medical Center Associates in Women’s Health Care Wichita Children’s Home Build Community Support and Collaboration Determine sponsoring agency Build support from community services Identify FIMR team participants Hold town hall meeting Develop mission statement * INITIATE FIMR CASE REVIEWS *

Essential Steps for Initializing a FIMR Program Source: NFIMR, “A Guide for Communities, FIMR Manual, 2 nd Edition” * ASSURE COMMUNITY READINESS * Recruit key community leaders, health care providers, public health providers, human service providers, consumer and advocacy groups CRT recruitment and initial informational meeting, mid CRT Training set for 9/30/09 CAT recruitment, late 2009 Build Community Support and Collaboration Determine sponsoring agency Build support from community services Identify FIMR team participants Hold town hall meeting Develop mission statement * INITIATE FIMR CASE REVIEWS *

Essential Steps for Initializing a FIMR Program Source: NFIMR, “A Guide for Communities, FIMR Manual, 2 nd Edition” * ASSURE COMMUNITY READINESS * Planning team will consider some type of kick-off or community engagement event Build Community Support and Collaboration Determine sponsoring agency Build support from community services Identify FIMR team participants Hold town hall meeting Develop mission statement * INITIATE FIMR CASE REVIEWS *

Essential Steps for Initializing a FIMR Program Source: NFIMR, “A Guide for Communities, FIMR Manual, 2 nd Edition” * ASSURE COMMUNITY READINESS * Yet to be finalized... will be guided by diversity, commitment and consumer participation. Build Community Support and Collaboration Determine sponsoring agency Build support from community services Identify FIMR team participants Hold town hall meeting Develop mission statement * INITIATE FIMR CASE REVIEWS *

 Enter into new agreement with KDHE to begin 2010 case abstractions.  Hire abstracter and hold “real-time” case reviews.  Further develop Community Action Team (CAT).  Use 2005 case review data as baseline to compare to 2010 data.  Sedgwick County  NEWHSI residents  NEWHSI residents served by Healthy Babies Program

Susan E. Wilson, BGS Program Director Healthy Babies Sedgwick County Health Department 434 N. Oliver, Suite 110 Wichita, KS Ty Kane, MPH Community Health Analyst & IMR Coordinator Sedgwick County Health Department 1530 S. Oliver, Suite 270 Wichita, KS