1. Secretary’s Advisory Committee on Infant Mortality (SACIM) Meeting
Infant Mortality Collaborative Improvement and Innovation Network (CoIIN) Update: Social Determinants of Health Learning Network
Secretary’s Advisory Committee on Infant Mortality (SACIM) Meeting
March 26-27, 2015
Vanessa Lee, MPH
IM CoIIN Coordinator
HRSA/MCHB
Lauren Smith, MD, MPH
Executive Project Director
NICHQ

2. Session Overview
Updates on Infant Mortality CoIIN initiative (Vanessa Lee)
National approach
IM CoIIN Structure
Overview of the Social Determinants of Health Learning Network (Lauren Smith)

3. Infant Mortality CoIIN Partnerships
The IM CoIIN Online Community is another tool designed to support continuous communication. If you are part of your state CoIIN team and have not received an invitation to join online community please Alex Martin at or come see me after the session. We realize that many of you are overextended as it is and that accessing yet another system to do this work may be the farthest from your interests or capability at this time. Please know though that the online community is designed to support your work, to facilitate communication and learnings, to accelerate change and innovation of ideas through knowledge sharing, so we encourage you to take a few minutes to see what resources and opportunities await you within the online community. We designed this online community specifically for the IM CoIIN and are constantly seeking feedback and input to improve the quality and usability of its features and functions, so please do not hesitate to share your comments and feedback with our team!
In addition to the above partners, we have convened national leaders & experts
3/16/2015

4. Questions or comments? Email CoIIN@NICHQ.org
National Infant Mortality CoIIN Common Agenda: More first (+++) birthdays
Dr. Lu to include message about multiple HRSA MCHB CoIINs
Home Visiting
Healthy Start
Obesity
Adolescent
Questions or comments?

5. Update on National Expansion
Infant Mortality Summits for Regions I-III, VII-X and the Pacific Basin were conducted last summer
Infant Mortality action plans
Key strategic priorities – Town Hall
CoIIN strategy team topic areas finalized
Integration of Regions IV, V and VI
The final list of IM CoIIN strategy topic areas (which will become CoIIN strategy teams) is below:
1.      SIDS/SUID/Safe Sleep
§  Primary focus is to improve safe sleep practices
2.      Smoking Cessation
§  Primary focus is to reduce smoking before, during and/or after pregnancy
3.      Preconception/Interconception Health
§  Primary focus is to promote healthy birth spacing and reduce unintended pregnancy, including focus on Postpartum Visits (content and frequency), Adolescent Well Visits (content and frequency), Long Acting Reversible Contraception (LARC)
4.      Social Determinants of Health
§  Primary focus is to incorporate evidence-based policies/programs and place-based strategies to improve social determinants of health and equity in birth outcomes
5.      Prevention of preterm and early term births
§  Primary focus is to increase appropriate utilization of 17 OH progesterone and/or reduce early elective deliveries. 
6.      Risk appropriate perinatal care  (perinatal regionalization)
§  Primary focus is to increase the delivery of higher risk infants and mothers at appropriate level facility.

6. National CoIIN Strategies
1. SIDS/SUID/Safe Sleep 2. Smoking Cessation 3. Preconception/Interconception Care 4. Prevention of preterm and early term births (EED and/or 17-P) 5. Risk appropriate perinatal care (perinatal regionalization) 6. Social Determinants of Health
The final list of IM CoIIN strategy topic areas (which will become CoIIN strategy teams) is below:
1.      SIDS/SUID/Safe Sleep
§  Primary focus is to improve safe sleep practices
2.      Smoking Cessation
§  Primary focus is to reduce smoking before, during and/or after pregnancy
3.      Preconception/Interconception Health
§  Primary focus is to promote healthy birth spacing and reduce unintended pregnancy, including focus on Postpartum Visits (content and frequency), Adolescent Well Visits (content and frequency), Long Acting Reversible Contraception (LARC)
4.      Social Determinants of Health
§  Primary focus is to incorporate evidence-based policies/programs and place-based strategies to improve social determinants of health and equity in birth outcomes
5.      Prevention of preterm and early term births
§  Primary focus is to increase appropriate utilization of 17 OH progesterone and/or reduce early elective deliveries. 
6.      Risk appropriate perinatal care  (perinatal regionalization)
§  Primary focus is to increase the delivery of higher risk infants and mothers at appropriate level facility.

7. CoIIN-Wide Aims CoIIN-Wide Aims Decrease Infant Mortality Rate
Decrease Neonatal Mortality Rate
Decrease Postneonatal Mortality Rate
Decrease Preterm-related mortality rate
Decrease SUID mortality rate
Decrease Preterm birth
VLee: yes, this is what I meant by “CoIIN-wide Aims”. I just need to confirm this is okay w/ Ashley, and we may need to clarify during webinar that the HP 2020 targets are not necessarily the COIIN targets (due to timeframe of CoIIN they may be unrealistic). FYI – Dr. Lu never set targets for the CoIIN wide aims in IV/VI CoIIN pilot.
Maria recommends adding a footnote regarding the denominator (i.e. per 10,000).
NOTE for follow-up after the call: I would think about adding early (<34) and late (34-36) preterm birth as aims (potentially early term birth too).
Data source: Provisional state vital statistics data reported quarterly (rolling averages)

8. State Strategy Selection (n= number of states)
Improve Safe Sleep Practices
(n = 38)
Reduce smoking before, during and/or after pregnancy
(n = 22)
Pre & Interconception Care
Promote optimal women’s health before, after and in between pregnancies during Postpartum Visits & Adolescent Well Visits
(n = 31)
Social Determinants of Health Incorporating evidence-based policies/programs & place-based strategies to improve equity in birth outcomes
(n = 25)
Prevent Pre and Early Term Births
(n = 21)
Risk Appropriate Perinatal Care (Perinatal Regionalization)
Increase the deliver of higher-risk infants and mothers at appropriate level facilities
(n = 14)

9. Collaborative Interest
National Infant Mortality CoIIN
Collaborative
Learning Network (6)
Who? Members commit to aims and measures in population health that are defined for the network. They are the main reservoir of CoIIN members.
Improve Safe Sleep Practices
Reduce Smoking
Pre / Interconceptional Care
Social Determinants of Health
Perinatal Regionalization
Reduce EED / Progestogen Use
Collaborative Interest
Network

10. Collaborative Interest
National Infant Mortality CoIIN
Collaborative
Innovation Network (COIN)
Who? Members of CoIIN create, test, and improve an innovation. There are multiple COINs that form and disband, not one network.
What is done? Members collaborate to develop promising concepts into the first improvised version that can be put into practice. New COINs form when a collective interest is identified. A COIN can disband when it produces the working prototype. New COINs can continually form to create solutions.
Collaborative
Learning Network (6)
Collaborative Interest
Network

11. Collaborative Interest
National Infant Mortality CoIIN
Collaborative
Innovation Network (COIN)
Modeling Safe Sleep practices in NICUs
Safe Sleep Board Books through EI sites
Discharge Boxes (Finland) to replace gift bags with formula
Safe Sleep
Collaborative
Learning
Network
Collaborative Interest
Network

12. Infant Mortality Collaborative Perinatal & Newborn Care
Interest Network
Safe Sleep
Learning Network
 _______________________________
BTS Model: Driver Diagram, Measurement Strategy, & Change Package.
Smoking Reduction
Learning Network
 _______________________________
BTS Model: Driver Diagram, Measurement Strategy, & Change Package.
Pre/Inter- conception Care
Learning Network
  _______________________________
BTS Model: Driver Diagram, Measurement Strategy, & Change Package (Adol. Well Visits, PPM Visit, & LARC)
Modeling in the NICU
(COIN)
Board Books
(COIN)
Virtual Patient Navigator (COIN)
Teen Phone App
(COIN)
Risk Appropriate
Perinatal & Newborn Care
Learning Network
_______________________________
Collaborative Learning Network
BTS Model: Driver Diagram, Measurement Strategy, & Change Package.
Social Determinants
of Health
Learning Network
_______________________________
Develop Improvement Structure: Include key documents and changes packages to support state efforts to integrate policies and evidence to address social determinants of health.
Reduce EED &
Progestogen Use
Learning Network
_______________________________
Collaborative Learning Network
BTS Model: Driver Diagram, Measurement Strategy, & Change Package (Progestogen, EED)
And this slide illustrates how each of the 6 strategies again are part of one national initiative in which activities are mutually reinforcing, not only across the 6 learning networks, but also in support of MCH Block grants and state efforts to develop evidence-informed and / or evidence-based strategy measures that address the National Performance Measures states have selected related to maternal health and infant health population domains.
Hospital Survey Tool
(COIN)
Smart Diaphragm (COIN)
Health Dept. Equity Score Card
(COIN)

13. State Selections HRSA Regions (N=50) Learning Networks I II III IV V
HRSA Regions (N=50)
Learning Networks I II
III IV V VI
VII
VIII IX X
Total # of States
SIDS/SUID Safe Sleep 5 1 7 2 3 38
Preconception/ Interconception Health 4 31
Social Determinants of Health 6 25
Smoking Cessation 22
Prevention of Preterm and Early Term Births (Progestogens & EED) 21
Risk Appropriate Perinatal Care (Perinatal Regionalization) 14

14. Virtual Learning Session 1 Dates
VLS1 DATES
LEARNING NETWORKS
February 25 – 26, 2015
Safe Sleep
March 11 – 12, 2015
Smoking Cessation
March 18 – 19, 2015
Preventing Pre & Early Term Birth
March 25 – 26, 2015
Pre & Interconception Care
April 1 – 2, 2015
VLee: be sure the framing includes clarifying that these are virtual MEETINGS of the states (similar to 2-day in-person meetings), not just a webinar, and that’s why they are so long (2 half days).
Risk Appropriate Perinatal Care
April 17, 2015
Social Determinants of Health

15. Social Determinants of Health n=25
LEGEND
Learning Network Chosen =
Puerto Rico

16. SIDS/SUIDS/Safe Sleep n=38
LEGEND
Learning Network Chosen =
Puerto Rico

17. Preconception/Interconception Health n=31
LEGEND
Learning Network Chosen =
Puerto Rico

18. Smoking Cessation n=22
LEGEND
Learning Network Chosen =
Puerto Rico

19. Prevention of Preterm & Early Term Births n=21 (Progestogens & EED)
LEGEND
Learning Network Chosen =
Puerto Rico

20. Perinatal Regionalization n=14
LEGEND
Learning Network Chosen =
Puerto Rico

21. Social Determinants of Health Aim Statement (Provisional)
Building from Region V work to date
This Learning Network aims to build state and local capacity, and test innovative strategies to shift the impact of social determinants of health and improve equity in birth outcomes.
VLee: open to feedback but my talking points might be –
Thank you to Region V states for their courage and leadership in taking on SDOH as part of their CoIIN work – we are in consultation with them as we prepare for the national Learning Network on SDOH to launch. This team will operate more like Peter Gloor’s CoIN with “one I” or a Collaboration Innovation Network because SDOH is less ripe for QI due to less of an evidence base, and more ripe for innovation. Dr. Lu sees this CoIN as an incubator that can help to spread what’s working/best practices in 2 focus areas: policies and place-based work.
Questions or comments? Contact

22. WHO Framework on SDOH
3/16/2015

23. Rating impact based on these criteria
Evidence of effectiveness available and/or identified by WHO, CDC, or other frameworks
Matters, having value to clients and families
Likely to reduce disparities by improving outcomes for vulnerable groups (e.g., low potential to improve only outcomes of non-minority populations)
Direct impact on social determinants of health
Supports diffusion of effective interventions / technology / practices to previously underserved populations
3/16/2015

24. Rating feasibility based on these criteria
Intervention can be readily advanced by CoIIN teams
Likelihood of improvement during 18 months
Potential to quickly develop needed supports, linkages, or partnerships
Impact can be measured directly or indirectly by CoIIN teams
Alignment or synergy with other initiatives or priorities
Supported by current political or social environment
3/16/2015

25. State level program and policy strategies
Strategy
IMPACT
FEASIBILITY
Use “health in all policies” approach
Use Region V CoIIN “score card”
Create flexible finance structures that support place-based work
CLAS training, tools, and measurement for state agencies and contractors
Expectations for CLAS standards compliance in procurement and contracts
Women’s health insurance initiatives
Policy for paid leave (parental, sick leave)
Policy on food and nutrition
Policies to improve maternal capacity (maternal education, job training, welfare time exemptions)
Home visiting program enhancements (e.g. universal welcome baby, maternal depression program funding)
Monitoring unequal treatment of clinical care
ACE questions added to state BRFSS and use data for action
Medical-Legal Partnerships
3/16/2015

26. Local, community, and place-based strategies
Strategy
Impact
Feasibility
Place-based, cross sector initiatives (eg BBZ)
Multi-sector leadership entities including non-traditional partners
Social enterprise models (e.g., mini-grants, micro-enterprise)
Job training / career paths for poor women (e.g. doulas, lactation aides, community health workers, outreach workers, child care staff)
Centering pregnancy, centering parenthood
Trauma informed, cross-system initiatives assessing and addressing ACEs, PTSD, etc. (embed in health, human services, child care, home visiting, nutrition, etc.)
CLAS and/or unequal treatment QI provider network projects
3/16/2015

27. Social networking, engagement, and empowerment strategies
Impact
Feasibility
Support groups or mother’s clubs for mothers, parents, families (e.g., Cincinnati Mothers Clubs, Birthing Project, LA Babies)
Create COINs made up of mothers, mentors, providers, and others
Social networking approaches (e.g., app, Facebook based, web space for sharing)
Public awareness campaigns focused on SDOH
Intensive, direct outreach and engagement campaigns (e.g., door-to-door)
3/16/2015

28. SDOH Tentative Timeline
What happens during the Learning Sessions?
Learning Session 1
April 17, 2015
12 – 3 pm ET
Get ideas
Get methods
Identify strategies and areas innovation
Get started!
Learning Session 2
Identify specific strategies
Start assessing capacity and readiness for change
Begin plan for action
Learning Session 3
Report on action plan
Get ready to advance strategies and innovations
Start measuring change
Learning Session 4
Learn from other state teams
Get better at methods
Report on initial measures of change
Project
End
Action Period 1
4-6 weeks
Action Period 2
4-6 weeks
Action Period 3
8-12 weeks
Additional learning
Action Periods 4 & 5
Defining the problem
Where are we now?
What are the gaps in performance for us to close?
What changes can we make to improve?
Clinical content
Ideas from experts, experience, excellent systems, creative thinking, sharing
How can we improve?
The science and techniques of improvement
Planning
Teams work to develop a concrete plan
During the first Learning Session, we will:
Define the challenge
Discuss changes we can make to improve
Introduce a framework for addressing SDOH
Provide time for teams to give input on strategies at state and local level
Action Periods:
Time for teams to take what they learned, identify areas for improvement, build connections, and start testing on a small scale

29. Upcoming Thematic Webinar (Optional Sessions / Open to All)
Online Community Office Hours
March 24, :00 – 2:00 p.m. EST
Provide team members with a live demonstration of the online community platform.
Control Charts
April 14, :00 – 2:00 p.m. EST
An introduction to running control charts, which is how we will look at data over time to assess progress.
How to Leverage Local Data to Impact Outcomes
April 16, :00 – 3:00 p.m. EST
Innovation Corner
May 7, :00 – 2:00 p.m. EST
Highlight work around resident driven project development and implementation through Educational Opportunity Initiatives.
Recordings are available for previously conducted calls.

30. Improving Equity in Birth Outcomes
One word to describe why you are committed to the work of reducing infant mortality (Town Hall 2014)

31. Questions?
Questions?