Delivering Prenatal Education through Community Collaboratives A Catalyst for Improved Maternity Services and Birth Outcomes Diane M. Daldrup State Director Program & Government Affairs November 19, 2014

Presenter Conflict of Interest Disclosure Diane M. Daldrup, State Director of Program and Government Affairs, March of Dimes Greater Kansas Chapter has no relationships to disclose.

Course Objectives At the conclusion of this workshop participants will: ● Know the leading issues impacting Kansas birth outcomes ● Learn about the Healthy Babies are Worth the Wait/Becoming A Mom program model ● Understand the community collaborative model and it’s role within the collective impact framework ● Understand the role of evaluation in program quality improvement

Birth Disparities in Kansas ● Infant Mortality - 6.3/1000 live births ● Birth defects, preterm birth/low birth weight, SUID leading causes ● Black infant mortality rate is more than double white ● Preterm Birth Rate – 10.8% ● 16.3% African American, 11.5 % Hispanic, 10.2% Caucasian ● Smoking 21.5% (women of childbearing age) ● Medicaid pays for 45% of all births ● Medicaid vs non-Medicaid disparity ● *2012 Data

Kansas Priorities ● Lower preterm birth rate 8% by 2020 (ASTHO Challenge) ● Lower infant mortality rate 10% by 2016 (CoIIN Blueprint) *************************************** ● Improve access and quality of prenatal care services ● Launch community collaboratives in high-need areas ● Statewide Expansion: ● Healthy Babies are Worth the Wait/Becoming a Mom ● Safe Sleep Campaign ● High Five for Baby ● Tobacco Quit Line

March of Dimes Response Strategic Mission Investment Targeted communities with demonstrated disparities Significant number of births Community collaborative backbone

Community Collaborative Model “Collaboration is a mutually beneficial relationship between two or more parties who work toward common goals by sharing responsibility, authority, and accountability for achieving results.“ (Collaborative Leadership; Chrislip & Larson, 1994)

Collaborative strategy is called for... where the need and intent is to change fundamentally the way services are designed and delivered "Collaboration establishes a give and take among stakeholders that is designed to produce solutions that none of them working independently could achieve.“ (Enhancing Transdisciplinary Research through Collaborative Leadership, Barbara Gray, 2006) Collaborative Strategy

CDC Health Promotion Model

Collaboration Benefits Permanent MCH Infrastructure developed Resources leveraged for greater benefit Care delivery paradigm changed Long-term program sustainability Emerging community needs identified early Collaborative becomes vehicle for change Magnet for new funding opportunities Shared risk, shared resources, shared rewards!

Healthy Babies are Worth the Wait Six Key Strategies ● Hospital Quality Improvement ● Community Intervention Programs ● Public Policy ● Consumer Awareness ● Provider Education ● Patient Education Healthy Babies are Worth the Wait is a March of Dimes Signature Program designed to decrease preventable preterm and early term births

Becoming A Mom - What is it?  Bilingual prenatal curriculum  Designed for use with pregnant women in a supportive group setting  Nine sessions Prenatal care Nutrition Stress Things to avoid during pregnancy Labor and birth Postpartum care Newborn care  Appendices with suggestions for adapting the curriculum for use with specific racial/ethnic groups

Incentive-based program Evidence-based curriculum Standardized delivery Standardized evaluation system Becoming A Mom in Kansas Two-fold focus – Clinical Services + Prenatal Education

Collective Impact in Action Growth Strategies ● State funds two priority replications ● Eight additional non-funded sites ● Regional models in the works ● KanCare providers coming on board ● Policy changes ● Presumptive Eligibility ● Title V Incentive ● CHW Waiver (fee for service $) ● Funding Magnet ● KS Health Foundation ($900,000) ● New Healthy Start Site ($3.5M) ● HRSA Rural Network Grant ($85,000) Community Collaboratives/Healthy Babies are Worth the Wait launched in eight additional communities

Program Evaluation Collaborative program evaluation led by researchers from two state universities Data from 2013 was collected from two levels: Participant-level (BAM Programs o self-reported knowledge (pre/post test) o health outcome data from medical charts Community-level data o self-reported implementation data through the Community Toolbox online system

Program Evaluation Core Components Universal class structure and delivery Standardized evaluation tools Data collectors trained at each site Technical assistance ad hoc Bi-annual grantee meeting for quality improvement Participation incentivized 79% of women (n=165) completed 4 or more classes Monthly data submission Bi-annual reports to each site Bi-annual aggregated reports

Data Tools: Community-Level Community toolbox – ctb.ku.edu Online tool to assist sites with documenting collaborative nature of model Includes approximately 20 questions related to collaborative actions and program implementation

Data Tools: Program-Level Becoming a Mom Evaluation First piloted in Kansas in 2012; modified in 2013 Pre/post knowledge survey (approx. 100 questions) Administered at 1 st and last prenatal education sessions Participation and program satisfaction included

Participant Level Data p=.004p=.0002 p<.0001

Improved Birth Outcomes Community health outcomes vs state averages Fewer preterm births - 9.5% compared to 11% (n=42) Low birth weight – 4% compared to 7.1% (n=68) Lower cesarean section rate – 26% versus 30% (n=87) Higher breastfeeding initiation - 81% versus 80% (n=85) Contributed to lower infant mortality rate Saline - 8.5/1000 ( ) to 6.4/1000 ( KDHE) Geary - 10/1000 ( ) to 8.3/1000 ( KDHE)

Create pilot programs for replication and the stakeholders and money will follow! Collaborative model works – but requires constant nurturing to keep stakeholders engaged Community customization increases impact and provides vehicle for identification of emergent issues Program standardization is essential for evaluation accuracy Evaluation accuracy will make or break a program – Get your data and evaluation experts on board up front! Lessons Learned

thank you