Northeast Florida Healthy Start Coalition

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Northeast Florida Healthy Start Coalition

• 2009-2014 Healthy Start Service Delivery Plan
• Achieving healthy pregnancies
• through a life-course approach

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The Life-Course Model

• The health and socioeconomic status of one
  generation directly affects the health status
  and reproductive health capital of the next
  one.
• Interplay of biological, behavioral,
  psychological and social protective and risk
  factors contributes to health outcomes across the
  span of a persons life
• Examine cumulative effect of health status, life
  events at different stages rather than risks,
  behaviors and services once a woman becomes
  pregnant

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Healthy Start The Life Course

• MISSION STATEMENT The Healthy Start Coalition
  leads a cooperative community effort to reduce
  infant mortality and improve the health of
  children, childbearing women and their families
  in Northeast Florida.
• The life-course model broadens the focus of
  maternal and child health to include both health
  and social equity.
• Key factors affecting health outcomes
• gt socioeconomic status gt race and racism
• gt health care gt health status
• gt stress gt nutrition and weight
• gt birth weight

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2009-2014 Healthy Start Service Delivery Plan

• Tracks progress over the last five years in
  addressing maternal and infant health needs
  guides the development and funding of Healthy
  Start services through 2014
• Life-course framework has both programmatic and
  policy implications
• Content of case management and related services
  moves beyond health, e.g. addresses education and
  poverty
• Services organized and delivered in ways that
  build resiliency and social capital, and reduce
  dependency (e.g. group activities, self-care).
• Requires inter-disciplinary, inter-agency
  collaboration and cooperation to address the
  complex needs of at-risk families.

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Strategies

• The Healthy Start program individual case
  management and risk reduction services, not
  directly responsible for addressing social
  determinants.
• Plan strategies developed on two levels
• What actions can be implemented through Healthy
  Start?
• What partnerships are needed between Healthy
  Start and other organizations working to address
  social equity?
• Looks at four phases
• Infancy
• Childhood Adolescence
• Preconception
• Pregnancy Childbirth

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Infancy
19,268 babies were born in Northeast Florida in
2007, 8 of the births statewide
Health Status Services

• INFANT MORTALITY
• Declining, but still higher than state and
  national rates
• Black and other nonwhite babies die at 2X the
  rate
• Hispanic infant mortality rising
• HEALTHY START
• Infant Screening rates have declined
• More intensive, face-to-face services but fewer
  served
• Fewer substance-exposed newborns served (loss of
  funding for Azalea Project)

• BREASTFEEDING Optimal start reduces child- and
  adulthood obesity. Initiation has increased but
  not duration. No hospitals in NEFL are
  Baby-Friendly (WHO).
• SAFE SLEEP Sudden Unexplained Infant Deaths
  (SUIDS) leading cause of postneonatal (28-364
  days) deaths most preventable.
• LOW BIRTH WEIGHT Disparities in low and very low
  birth weight place more minority children at risk
  of life-long physical and development handicaps.
  NICU stays and costs are rising.

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• Social Determinants
• LOW-INCOME MOTHERS More moms on Medicaid, fewer
  graduate HS
• 43 of moms on Medicaid in 2007 up from 33 in
  2003
• 16 of babies born to white moms with no HS
  education 20 of black moms
• 25 of moms in Baker County lacked HS education
  in 2007
• SINGLE MOTHERS Growing number, impact on family
  income
• 40 of babies born to single moms 60 of black
  babies
• Two-parent families earn more money
• Fathers info on 60 of birth certificates play
  vital role in development, economic status

• ENVIRONMENTAL TOBACCO SMOKE (ETS) Risk factor
  for SUIDS, asthma
• 10 of babies born to mothers who smoked
  during pregnancy higher than state
• 9 exposed to second-hand smoke 1hr a day
• White moms smoke at higher rates
• Healthy Start smoking cessation

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Goals Strategies

• REDUCE Infant mortality, infant mortality
  disparities, postneonatal mortality, LBW
• INCREASE Breastfeeding initiation and duration
• HEALTHY START STRATEGIES
• Increase screening, initial contact rates.
• Provide more-focused education and support
• Include fathers in services.
• Improve continuity of care (NICU, other prenatal
  high-risk moms).
• CRITICAL PARTNERSHIPS
• Screening rates Area hospital council, Florida
  OB/GYN Society (FOGS)
• Fathers Jacksonville Childrens Commission,
  Jacksonville Urban League, WorkSource, area
  health departments, Healthy Families programs
• Hispanic outcomes Council of Spanish Speaking
  Organizations, Mayors Hispanic Advisory Council,
  Spanish Association of North Florida Inc.,
  Jacksonville Hispanic Lions Club, Hispanic media,
  and Hispanic Chamber of Commerce
• Breastfeeding NEF Breastfeeding Collaborative
• Poverty Family Foundations, WIC, Healthy People,
  Healthy Communities

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Childhood Adolescence
About 329,000 children ages one-19 live in
Northeast Florida. Children in the region
comprise about 8 of children statewide
Health Status Services

• HEALTH INSURANCE Lower rates of Medicaid,
  Florida KidCare in region
• HEALTH CARE Wolfson Childrens Hospital had the
  most ER visits Nemours provides specialty care
• SCHOOL HEALTH SERVICES Funding higher but varies
  greatly by county, as do health classes and nurses

• CHILD DEATHS
• Accidents are leading cause homicide is
  second-leading cause for 15-19 year-olds (2X
  state rate)
• OVERWEIGHT
• 30 of 1st graders overweight or at-risk
• Insufficient physical activity
• CHILD ABUSE
• Regional rates higher than state rates
• Leads to future negative behaviors
• STIs HIV/AIDS
• High rate of teen STIs, especially Duval County
• Duval has one of highest rates of teen HIV/AIDS
  cases
• TEEN PREGNANCY
• Teen pregnancy and repeat births decreased
  slightly
• SUBSTANCE ABUSE
• Teen rates decreasing, more prevalent among whites

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• Social Determinants
• POVERTY 12 of families with children lt18, more
  than 50 of families in Baker County with mom as
  head of household and kids ltage 5
• SOCIAL SERVICES Food Stamp enrollment rising
  cash assistance down
• HOUSING Older in NEFL Duval has older housing,
  higher lead poisoning rates, while almost 90 of
  Baker County homes have septic tanks

High School Graduation Rate, NEFL Florida,
2006/2007 2007/2008

• SCHOOLS Students in NEFL fare worse than their
  counterparts statewide

Source JCCI 2008 Quality of Life Report,
2006/2007-2007/2008
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Goals Strategies

• REDUCE Body Mass Index in 1st Graders, Teen STI
  Rate, Repeat Teen Pregnancies
• HEALTHY START Promote breastfeeding Address
  poverty in case management (GED, EITC) Link teen
  moms to prevention services Address murder
  rate, health education through partnerships
• CRITICAL PARTNERSHIPS
• Education School Board, Achievers for Life,
  Learning to Finish, AWARE School for Teen
  Parents, the Jacksonville Community Foundations
  Quality Education for All, Jacksonville
  Commitment.
• Poverty The United Way, Real ense.
• School success Jacksonville Urban League (Head
  Start), the Early Learning Coalitions, Episcopal
  Childrens Services, Jax Childrens Commission.
• Tobacco use County health departments, SWAT.
• Uninsured Department of Children and Families,
  AHCA.
• Crime, IM Jaguars Foundation, Media, JCCI.
• Teen pregnancy, STI rates Youth development
  programs, local churches/faith-based
  organizations, barbershops, salons.
• Nutrition, obesity WIC

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Preconception
In 2007, there were 283,865 women of childbearing
age (15-44 years old) residing in Northeast
Florida. The number of women age 15-44 years old
is expected to reach nearly 300.000 by 2014
Health Status Services
BABY SPACING 25 had birth intervals lt18 months
- shows lack of contraceptive use, need for
family planning services, counseling FAMILY
PLANNING Medicaid waiver underutilized health
departments provide most services OVERWEIGHT 40
overweight or obese prior to pregnancy black
women impacted more ACCESS TO CARE One-third are
uninsured prior to pregnancy. FOLIC ACID Only
40 of women take a multi-vitamin with folic acid
daily but 77 know pre-pregnancy consumption
reduces birth defects

• PRE-PREGNANCY
• Maternal health and prematurity greatest
  proportion of fetal infant deaths
• Pre-existing conditions (diabetes and
  hypertension STIs obesity and poor nutrition)
  are factors
• UNINTENDED PREGNANCIES
• More than half of pregnancies are unintended
• UNHEALTHY HABITS
• 20 smoked prior to pregnancy
• STI rates are 40 higher in NEF (pre-term birth,
  other poor outcomes)
• HIV/AIDS rates are high, especially for black
  women

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Social Determinants

• DOMESTIC VIOLENCE Most victims are women.
• 60 higher rate of health problems
• NEFL consistently exceeds statewide rates
• Shelters in the region served 1,400 women and
  children in 2007-08
• NEIGHBORHOOD CRIME VIOLENCE Homicide rate in
  NEFL is 70 higher than state rate
• Disproportionately impacts poor and minorities

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Goals Strategies

• REDUCE Preconception tobacco use, STI rate,
• INCREASE Preconception folic acid consumption,
  interconceptional intervals of 18 months or
  greater
• HEALTHY START Promote multivitamin use
  Increase interconceptional counseling, smoking
  cessation services Promote use of
  family-planning waiver Provide info on family
  planning services for families, men.
• CRITICAL PARTNERSHIPS
• Family planning, waiver OB/GYNs, State Agency
  for Health Care Administration (AHCA).
• Preconception health, folic acid info
  Universities and private colleges (Flagler, JU),
  community colleges, juvenile justice programs,
  outward bound, half-way houses, the Tiger SHOP,
  foster care group homes WIC March of Dimes.
• Tobacco use Florida Quit Line, Area Health
  Education Centers (AHECs).
• Medical homes for uninsured Hospital Emergency
  Room Alternatives Program (HERAP).

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Pregnancy Childbirth
There were more than 19,000 deliveries in
Northeast Florida in 2007. Fertility rates
(births to women age 15-44 years old) in the
region rose from 65.9 to 67.9 between 2005 and
2007
Health Status Services

• PREGNANCY
• More births to women age 20-24 and fewer to
  mothers over age 35
• St. Johns most older mothers Baker Nassau
  most age 17 and under
• PRENATAL CARE
• 2x receive late or no prenatal care in NEF black
  women have highest rates
• Women on Medicaid more likely to receive no
  prenatal care
• Most care provided by private doctors
• C-SECTIONS
• Regional rates are higher than the state
• Shands Jacksonville has lowest rate in the state
  Baptist Medical CenterNassau has one of the
  highest

SUBSTANCE USE Impacts Fetal Alcohol Spectrum
Disorders, asthma Tobacco use high in
NEF INFECTIONS Associated with poor birth
outcomes PRE-TERM DELIVERIES Prematurity 2x
higher for blacks Late pre-term deliveries
rising. MATERNAL MORTALITY Consistently higher
than state rate, particularly high among
non-whites HEALTHY START Prenatal screening
rates low more intensive, face-to-face
services BIRTH CONTROL Post-partum birth control
use low Higher of women unable to pay for it
in NEF
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Social Determinants

• SINGLE MOTHERHOOD Higher rates of poverty,
  reduced social support More than 40 of births
  in the region were to unmarried mothers in
  200733 white, 46 Hispanic and 62 of black
  mothers.
• FATHERS Feelings about pregnancy affects role in
  pregnancy and childs life.
• SOCIAL ENVIRONMENTAL FACTORS Arguing
  excessively with partner, financial difficulties,
  loss of partner or friend, maternal or paternal
  incarceration, abuse
• MATERNAL STRESS Linked to pre-term labor
• RACISM Creates disparate affect on black women
  and contributes to their poor birth outcomes

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Goals Strategies

• REDUCE Proportion delivering with late or no
  prenatal care, tobacco use during pregnancy,
  maternal deaths, single mothers
• HEALTHY START Implement outreach in hospital
  ERs Promote simplified Medicaid enrollment
  Promote breastfeeding Collaborate with chronic
  disease prevention Provide info on consequences,
  impact of single motherhood Increase screening
  rates, initial contacts and intensive,
  face-to-face services Provide group prenatal
  care and case management
• CRITICAL PARTNERSHIPS
• C-Section Rates Delivering hospitals and OBs
• Tobacco use American Lung Assn.
• Birth control Family planning providers in the
  community
• Medicaid eligibility, coverage and enrollment
  process AHCA DCF
• Healthy Start screening OBs, prenatal care
  providers
• Father involvement Jacksonville Urban League
  Head Start, county health departments, other
  community-based initiatives
• Postpartum obesity WIC
• Chronic disease, maternal mortality Healthy
  People, Healthy Communities

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Community Perspectives

• JCCI Town Hall meetings five diverse groups (60
  participants) discussed causes and what to do
  about black infant mortality
• Focus groups what does community know?
• Common themes
• Need for education, information
• Impact of stress, lack of trust
• Impact of poverty
• Lack of awareness, concern among leaders
• Need for personal support, community involvement

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What does the plan tell us?

• Todays babies are tomorrows mothers and
  fathers.
• Significant improvements in infant mortality, low
  birth-weight and other MCH indicators unlikely to
  occur unless the health and social status of NEFL
  residents is addressed across the life-course.
• We can improve the effectiveness of Healthy Start
  in impacting individual risks and behaviors in
  and around pregnancy.
• There are opportunities to focus and expand the
  content of case management to address social
  determinants.
• Collaboration and partnerships are critical to
  reducing social and environmental risks, building
  resiliency and achieving health equity.

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Partnerships

• Collaboration essential to address complex needs
  of families
• Supports coalitions commitment to collaboration
  and to addressing infant mortality within a
  broader community context.
• Builds on community engagement efforts
• Friendly Access
• Black Infant Health Practice Initiative
• Black Infant Health Community Council
• Magnolia, Azalea Projects
• St. Johns Infant Mortality Task Force

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Thanks!

• 2009 Planning Committee
• Thomas Bryant III, Chair
• Carolyn Arnister
• Karen Coleman
• Rev. Alton Coles
• Monica Floyd-Cox, RN
• Linda Hemphill
• Heather Huffman, RD, IBCLC
• Dave Malone
• Lisa Pelle