Promising Practice:

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Promising Practice A Successful Infant
Mortality Reduction Initiative
CityMatCH Urban Maternal and Child Health
Leadership Conference September 23, 2008
Shannon Brownlee, MPH Daniel Kruger, Ph.D.
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(No Transcript)
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Our Problem
Genesee County REACH 2010 Project 9/08
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Genesee County REACH 2010 Project 3/08
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REACH Partners

• FACED
• Flint Odyssey House/Health Awareness Center
• Genesee County Community Action Resource
  Department
• Genesee County
• Health Department
• U-M SPH/PRC

• Genesys Regional Medical Center
• Greater Flint Health Coalition
• Hurley Medical Center
• Mott Childrens Health Center
• PRIDE
• Priority Children
• U-M Flint

Genesee County REACH 2010 Project 9/08
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Our Community Action Plan

• Derives from two points of view
• Bench
• Trench

Genesee County REACH 2010 Project 9/08
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• Bench
• Racial disparities in infant mortality have
  persisted
• despite at least 2 decades of applied
  contributions
• from the clinical, scientific laboratory and
  legislative
• arenas to reduce racial disparities.
• Two explanations
• No single intervention is likely to eliminate
  racial disparities in infant mortality
• The period of pregnancy is simply too short to
  effectively address many risk factors important
  to infant health.

Genesee County REACH 2010 Project 9/08
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• Trench
• If you always do what youve always done, youll
  always get what youve always gotten. If you
  want something youve never had, you have got to
  do something youve never done.

Genesee County REACH 2010 Project 9/08
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Thinking Outside of the Box
A Different Approach to Address Infant Mortality
Genesee County REACH 2010 Project 9/08
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Socio-Ecological Model
Genesee County REACH 2010 Project 9/08
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Addressing Infant Mortality in Genesee County
Our Model
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Fostering Community Mobilization
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Community Dialogues

• Priority setting and problem-solving regarding
  infant mortality
• Two action groups organized
• Black Men for Social Change
• Women Taking Charge of Their Health Destiny
• Provide needed assistance to mothers
• Community empowerment education
• Health fairs

Genesee County REACH 2010 Project 9/08
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Community Media Campaign

• Billboards

• Radio spots
• TV commercial
• Posters, fans, T-shirts

Genesee County REACH 2010 Project 9/08
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Enhancing the Babycare System
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PRIDE Medical Services Committee

• Provider seminars and community roundtables
• Perinatal risk assessment tool
• Perinatal morbidity and mortality reviews
• Safe sleep campaign

Genesee County REACH 2010 Project 9/08
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Maternal/Infant Health Advocates

• Peer support
• System navigation
• Community windshield tours

Genesee County REACH 2010 Project 9/08
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University Cultural Competence in Health Care
Course

• Designed and offered at University of Michigan
  Flint
• Specialized training for client advocates
• Enhance culturally competent practice
• Improve patient-provider communication
• Patients more likely to keep prenatal care
  appointments

Genesee County REACH 2010 Project 9/08
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Reducing Racism
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Undoing Racism Workshops

• 2 ½ day facilitated event
• 24 workshops with over 880 participants
• Peoples Institute, New Orleans, Louisiana
• Impact
• Attitudes and beliefs towards culture and racism
• Diffusion of impact
• Follow-up working groups of community residents

Genesee County REACH 2010 Project 9/08
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African Culture Education Development Center

• History and culture lectures
• Middle Passage Experience
• Post-Traumatic Slavery Disorder Curriculum

Genesee County REACH 2010 Project 9/08
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Healthy Eating Curriculum

• Afrocentric
• Peer Trainers
• Harambee (pulling together) celebrations

Genesee County REACH 2010 Project 9/08
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SUCCESS!
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Annual Infant Mortality Rates by RaceGenesee
County, MI 1999-2006
Source Michigan Department of Community Health,
Vital Records Health Data Development Section.
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Infant Mortality Disparity RatioGenesee County,
Michigan 1999-2006
African American to White Disparity Ratios
Source Michigan Department of Community Health,
Vital Records Health Data Development Section.
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3-Year Moving Average Infant Death RatesGenesee
County and Michigan 1997-2006
Source Michigan Department of Community Health,
Vital Records Health Data Development Section.
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REACH Evaluation
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REACH Evaluation
Designed to assess Process Documentation of
activities Outcomes Changes in systems and
individuals Impact Changes in African
American infant mortality rate and
disparities with White
infant mortality rate
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REACH 2010 Logic Model
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REACH 2010 Logic Model
Vital Statistics
Racism and Health Disparities Survey
Process Evaluation
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Reduce/Undo Racism
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Enhance Baby Care System
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Mobilize Community
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Facilitating Policy Change
Graph Represents Institutional Policy Changes
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REACH 2010 Evaluation

• Racism and Health Disparities Survey
• Asses experiences of racism, responses to
  experiences of racism, perceptions of the health
  care system, relationships with partners, health
  and birth outcomes.
• Telephone interviews were conducted by the
  Michigan Public Health Institute in April and
  May, 2007
• Respondents included REACH Program participants,
  randomly selected community members aged 18-45 in
  the REACH focus ZIP Codes in Genesee County, and
  randomly selected community members aged 18-45 in
  demographically similar ZIP Codes in neighboring
  Saginaw County.

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Descriptives of Survey Sample
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Descriptives of Survey Sample
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Attitudes, Beliefs, and Knowledge regarding Racism
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I believe that racism exists in our society today
(Controlling for educational attainment)
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Even today Blacks feel the effects of slavery and
segregation
(Controlling for educational attainment)
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Experiences of racial discrimination
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Beliefs regarding racism in healthcare
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Blacks and Whites receive the same quality of
health care
(Controlling for educational attainment)
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Blacks and Whites are treated with the same level
of dignity and respect
(Controlling for educational attainment)
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Genesee County REACH
Vital Statistics Analyses
Part 1 Perinatal Health Behaviors
Data Source Michigan Department of Community
Healths vital statistics
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Month of Pregnancy when African American Mothers
entered Prenatal CareBy County
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Number of Prenatal Health CareVisits by African
American MothersBy County
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Kessner Index for adequacy of African American
pre-natal care(lower scores indicate greater
adequacy)
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Genesee County REACH
Vital Statistics Analyses
Part 2 Perinatal Health Outcomes
Data Source Michigan Department of Community
Healths vital statistics
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Percent of births that are premature among
African American Infants
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African American Infant Mortality Rate By County
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Genesee County REACH
Vital Statistics Analyses
Part 3 Socio-demographic trends
Data Sources Michigan Department of Community
Healths vital statistics and U.S. Census
American Community Survey
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Socio-demographic trends in the Michigan
Department of Community Healths vital statistics
and U.S. Census American Community Survey
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Percent of Births to Women Aged 15-19
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Percent of African American Births to Unmarried
Women
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Percent of African Americans with Income Below
the Poverty Line
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African American Mortality Rate, ages 5
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Socio-demographic trends American infant
mortality rates would be difficult to explain by
trends in the teen birth rate, percentage of
births to unmarried women, educational
attainment, household income, or poverty. No
other age group of African Americans (assessed in
5 year age groups) exhibited a decline in
mortality rates in 2004 and 2005 as African
American infants did.
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Conclusion
The reduction in infant mortality rates in
Genesee County, especially for African American
infants, encourages the continuation and
replication of activities in Genesee Countys
REACH 2010 program.These activities continue as
the Genesee County REACH partnership was selected
to be a Center of Excellence in the Elimination
of Disparities in the CDCs REACH US program.
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Contact Us
Shannon Brownlee, MPH Genesee County
Health Department [phone] sbrownlee_at_gchd.us

Daniel Kruger, PhD Prevention Research
Center University of Michigan School of Public
Health [phone] djk2012_at_gmail.com
www.gchd.us