Promising Practice: Men in MCH

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Promising PracticeMen in MCH

• CityMatCH Conference 2008
• September 20-23, 2008
• Albuquerque, NM

Healthy Start, Inc. Pittsburgh/Allegheny County,
PA
Michael Caliguiri, M.S. Field Manager
Benjamin Davis Program Specialist
Healthy Start, Inc.  is supported in part by
Project No. CFDA 93.926E from the Healthy Start
Initiative, Division of Perinatal Systems
Womens Health, Maternal Child Health Bureau,
Health Resources Services Administration, and
Department of Health Human Services.
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The Problems (Pittsburgh/ Allegheny County)

• African American (AA) infants dies at almost 4
  times the rate of whites while representing just
  over 10 of the total births
• 80 of AA births are to unmarried women almost
  40 for whites
• 2xs as many LBW for African American as for
  Whites
• Teen birth rate (15-17yrs) for AA is 8 times
  higher than Whites (45/ 5.6)
• PA Dept. of Health EPIQMS (2003-05)

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The Mission

• The mission of Healthy Start, Inc. is to focus
  primarily on the reduction of infant mortality
  and low birth weight babies in Southwestern
  Pennsylvania in such a way as to make valuable
  use of its resources, preserve its flexibility
  and continue to offer seamless services with the
  intent of improving the quality of life of
  infants, toddlers, youths, siblings, parents, and
  grandparents.

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The Purpose

• To create and coordinate a comprehensive system
  that ensures infants are born healthy into homes
  where they will be nurtured and valued.
• To demonstrate innovative ways to reduce infant
  mortality in some of the areas with the highest
  infant mortality rate in the country.

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Men Need What Women Need Comprehensive Teams
and Services

• Care Coordination - Outreach Workers
• Health Screening Education - Nurses
• Depression Screening Referral - PHQ-9
  Assessment Tool by Pfizer, Inc.
• Targeted Case Management CACs
• Program Evaluation MIS
• Indigenous Personnel HR

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Successful Program Strategies

• Indigenous Employees
• Holistic in Approach
• Community-Based Culturally Sensitive
• Multi-Disciplinary
• Speak to Male-Specific Topics
• Collaborative Across Systems
• Outcomes-Oriented

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IMPACTS (-)

• Children who live absent their biological
  fathers are, on average, at least 2 to 3 times
  more likely to be poor, to use drugs, to
  experience educational, health, emotional and
  behavioral problems, to be victims of child
  abuse, and to engage in criminal behavior.

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IMPACTS ()

• Children with involved, loving fathers are
  significantly more likely to do well in school,
  have healthy self-esteem, exhibit empathy and
  pro-social behavior, and avoid high-risk
  behaviors such as drug use, truancy, and criminal
  activity.
• -NFI Father Facts, 4th Ed.

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Male Initiative Program (MIP)

• The purpose is to inform male partners and
  spouses of how influential they are to the
  outcome of a pregnancy and the ongoing health and
  well-being of their babies. 
• Fathers/ male caregivers receive identical
  services to those of enrolled women, while
  individualizing plans to meet male-specific
  needs.

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Male Initiative Program Case Management
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Core Services for Men The Basics

• Male Friendly Language, Literature Materials
• Male Role Models Examples
• Male Staff
• Activities Events
• Flexible Schedule
• Skill Enhancement Support

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Depression Screening Referral for Men

• PHQ-9 (Pfizer) Self Assessment Tool
• Specialized Training for Outreach Workers (Lay/
  Non-Professional) on
• Counseling Techniques of Dialectical Behavioral
  Therapy (DBT)
• Where to Turn for Community Services and Referral
  Procedures
• Administering and Scoring the PHQ-9

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Depression Screening Referral for Men

• Referral System
• Community based SW
• Health Start, Inc. SW
• DBT developed Marsha Linehan, M.D., Univ. of
  Washington
• DBT Training Developed in Conjunction with
  University of Pittsburgh, Western Psychiatric
  Institute Clinic, Katherine Wisner, M.D

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Build a Referral Network for Men!

• Local Health Providers
• Employment Training
• Housing Authorities City/County
• Local/ State Health Department
• Mental Health/ DA Treatment Centers and Systems
• Family Planning
• Child Protection Services

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Evaluation

• Participant Information Management System (PIMS)
• Referral Enrollment Database
• Case Management Forms

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Life Skills Groups

• FAMILY Focus Night
• Monthly education forums for fathers/ male
  caregivers as well as mothers, children, and
  support persons
• Promotes peer to peer (man to man) learning and
  discovery
• Increases empathy and understanding specific to
  gender roles and responsibilities

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Life Skills Groups

• Interactive Health Learning Mechanisms
• Roundtable Discussions

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Building Blocks for Programs

• Provide economic, social, and emotional support
  for parents
• Use screenings, assessments, and evaluations to
  monitor well-being and plan next steps
• Build on strengths of participants
• Educate staff and advocate for further research

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Linkage Across Services
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Promoting Responsible Fatherhood Grantee 2006-2011

• Three Primary Components
• Case Management/ Care Coordination for Fathers/
  Male Caregivers
• Healthy Marriage/ Cooperative Parenting
  Counseling
• Domestic Violence Counseling and Education

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Responsible Fatherhood Projected Impacts

• Increase case management/ care coordination
  service capacity by 350
• Expand eligibility and scope of participants
• Strengthen parental involvement for 300 couples
• Decrease in parental conflict via Prevention
  (education) and Intervention (counseling)

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Challenges

• Literacy
• Mentality
• Parenting
• Employment
• Depression
• Advocacy
• Sustainability

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Strategic Sustainability Planning

• Should be a written document with specific steps
  and outcomes
• Include evaluation as part of planning ( of
  months/ years)
• Identify resources large and small and of various
  systems (local/ federal philanthropic)
• Assure that outcomes meet the mission of the
  funding sources you approach
• Sustainability is just as much collaboration and
  partnership as much as financial

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Sustainability Evaluation(s)

• Quantitative Qualitative assessments to
  determine impact of male-based programs on MHC
  outcomes (see poster display!)
• National Healthy Start Association Dads Matter
  Cohort (Ken Scarborough)
• National Responsible Fatherhood Clearinghouse
• Low/ No Cost strategies, tools, approaches
• Timely submission of grant and other required
  reports
• Knowledge Dissemination across systems

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Sustainability Successes

• Grantee for federal PRF/HM
• Community Development Block Grant (5K)
  marketing
• Department of Community Economic Development
  (30K) personnel
• Heinz Foundation non-federal match and
  commitment to child health and development
  outcomes
• DV, FQHC, Faith-based Partnerships (collaborative
  agreement financial)
• Family Support/ Head Start Center in-kind support
  and shared program capacity

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Lessons Learned

• Strengthening entire families, especially
  fathers, are proven strategies associated with
  childhood success.
• Healthy Start has shown that local communities
  can, with support, develop and implement
  innovative approaches to reducing infant
  mortality

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Healthy Start, Inc.

• For more information about us,
• call the Healthy Start, Inc. Helpline at
• [phone]
• or
• [phone]
• or
• visit our website at
• www.healthystartpittsburgh.org

Healthy Start, Inc.  is supported in part by
Project No. CFDA 93.926E from the Healthy Start
Initiative, Division of Perinatal Systems
Womens Health, Maternal Child Health Bureau,
Health Resources Services Administration, and
Department of Health Human Services.