Federation of County Networks

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Federation of County Networks Feeling the
Strength of Our Own Spirit Developing a Plan to
Address Comprehensive Approaches to Perinatal
and Family Health Taking it to the Streets
Organizing, Planning-ACTION May 20th 2005
Mario Drummonds, MS, LCSW, MBA Board
Treasurer, Federation of County Networks, Inc.
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FCN MISSION The FCN mission is to reduce
fragmentation in the maternal, perinatal and
child health systems to improve outreach and
access to care for economically challenged women
who may be pregnant and parenting and their
families to enhance and ensure collaboration and
coordination among providers to provide training
and technical assistance to maternal and child
health providers and to assist in local health
systems planning.
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• Programmatic Activities
• Regional Program Coordination
• Local Health System Collaboration and
• Planning
• Technology Virtual Private Perinatal
• Network
• MCH Management Clinical Training
• Advocacy
• Policy Agenda/Direction
• Healthy Start Coordination

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EXTERNAL ENVIRONMENT SCAN
Opportunities 1. National, state and local
focus on reducing racial disparities in health
outcomes within the foundation, government and
private sectors 2. NYSDOH RFP focusing on
chronic disease management by making a six
million dollar investment across New York State.
States around the country are under increasing
fiscal pressure to develop disease management
programs that provide quality health care for
those most in need, while alleviating some of the
cost pressures facing Medicaid
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EXTERNAL ENVIRONMENT SCAN
3. National, state and local focus on fighting
childhood and adult obesity 4. NYC over the last
four years has invested 20 million dollars in
community-based solutions to IMR reduction
5. NIH recently released an eleven-year
multi-year RFA that focuses on research and
practice activities to reduce racial disparities
in health outcomes
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EXTERNAL ENVIRONMENT SCAN
6. National Patient Navigator Program legislation
moving fast through Congress that projects to
allocate 25 million dollars a year to address
structural and cultural barriers to healthcare
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EXTERNAL ENVIRONMENT SCAN
7. Renewed focus in Washington on utilizing
information technology to computerize medical
records. Health experts say that moving to
electronic records, which would reduce paper
handling and eliminate unnecessary or duplicative
tests, could cut 10 percent or more from the
nations 1.7 trillion a year health care
spending. A digital system should sharply reduce
medical errors, which are estimated to be
responsible for 45,000 to 98,000 deaths a year,
more than breast cancer, AIDS or motor vehicle
accidents, according to the Institute of Medicine
of the National Academy of Sciences
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EXTERNAL ENVIRONMENT SCAN
8. Large numbers of immigrant women from Mexico,
Dominican Republic, and West Africa have migrated
from their home communities and have developed
homes in Queens, Central East Harlem and the
South Bronx
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EXTERNAL ENVIRONMENT SCAN
9. ACS, NYC Department of Homeless Services, and
NYCDOH have begun to collaborate on several
projects to improve the care of pregnant and
parenting women throughout NYC 10. Former
President Clinton joins fight against childhood
obesity by launching a public service campaign
and funding new program models that show
potential for reducing the problem 11. Merck
Company Foundation has released a call for
proposals to develop a comprehensive campaign
against childhood asthma
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EXTERNAL ENVIRONMENT SCAN
12. Gov Patakis uncertainty about running for a
fourth term creates the conditions for a
Democratic Governor in Albany that could
support many of our MCH policy initiatives 13.
On April 21, 2005, Mayor Bloomberg announced the
Healthy Women/Healthy Babies Initiative to
reduce unintended pregnancies. Over 3 million
dollars will be invested in partnership with
community-based and health care organizations to
increase awareness and access to emergency
contraception and family planning and expand the
Nurse Family Partnership Program
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EXTERNAL ENVIRONMENT SCAN
14. Centers for Medicare Medicaid Services have
been experimenting with pay-for-performance
demonstration projects in 270 hospitals around
the country concluding financial incentives can
improve care. High-performing hospitals receive
bonuses totaling 7 million per year. Poorly
performing hospitals may face financial penalties
in the third year
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EXTERNAL ENVIRONMENT SCAN
15. A coalition of politicians and health
providers over the last year have pushed for the
passage of Timothys Law that calls for the
expansion of mental health services. The law
would eliminate discriminatory and unequal mental
health and substance abuse coverage by insurance
companies. The NYS Assembly has passed the
legislation. More work has to be done in the
Senate to pass the bill
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Threats
1. MCH community has not made any strides in
reducing low birth weight rates in high-risk
communities 2. Congress and the NYS governor
has attempted to cut the Medicaid budget 3. NYC
IMR rate increased from 6.0 to 6.5 between 2002
and 2003 4. NYC LBW rate remained constant
between 2002 and 2003
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Threats
5. Depressed pregnant women throughout NYC have
to wait over six weeks for an appointment with a
therapist 6. Fort Greene, Jamaica East and
Tremont have the highest IMR in NYC in 2003 7.
One in four New Yorkers do not exercise, one in
six is obese, and one in 13 has diabetes 8.
Black and Latina women in NYC have a life
expectancy almost 5 years shorter than white
woman.
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Threats
9. Black and Latina women in NYC are more than
twice as likely as white women to die from
pregnancy-related complications 10. Data
suggests that women are more obese than men. An
estimated 30 of black women, 26 of Latina
women, 15 of white women and 10 of Asian women
are obese. 11. Midwives and OBs are
unable to practice due to increases in
malpractice insurance that is closing
freestanding birthing centers
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Threats
12. NYS legislature has developed a commission
to examine the closing of hospitals throughout
NYS. Closing the wrong hospital could increase
barriers to care for poor and working women we
serve 13. The number of teens in foster care
who become pregnant is on the rise as well as
the quality of health and social services
delivered to teens in the foster care system is
poor (NYC Public Advocates Report May 2005)
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Threats
14. Reductions in affordable housing and the
development of a citywide gentrification movement
has forced poor and working class women and their
families to move from their traditional
neighborhoods to more affordable communities in
the South Bronx and Brownsville that will become
flashpoints for poverty and family dislocation
over the next five years
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Threats
15. African American women who report experiences
of discrimination based on their race or skin
color appear to have an increased risk of poor
pregnancy outcomes according Dr. Sarah Mustillo,
of Duke University School of Medicine, Durham
North Carolina. Black women are more likely than
white women to experience premature delivery and
to have low birth-weight babies, but the
discrepancy is not fully explained by factors
such as prenatal care, genetics and
socioeconomic factors. The study above reveals
evidence that chronic stress from racial
discrimination may play a role in poor birth
outcomes
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Threats
16. HIV infection and abusive relationships are
especially difficult for women based on the
finding of a new study showing increased risks
for depression and suicide attempts in women
afflicted with both of these problems according
to Andrea C. Gielen, deputy director of the
Center for Injury Research and Policy at Johns
Hopkins Bloomberg School of Public Health who
conducted the study and authored the report
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Threats
17. In 2003, more than 1 in 4 babies were born by
Cesarean section. The Cesarean section rate of
26.1 is the highest ever reported in the United
States. The World Health Organization states
that the Cesarean rate should be no more than
10-15. Studies have indicated that a woman is
4-7 times more likely to die as a result of
Cesarean surgery than vaginal birth. Studies also
show that babies born by Cesarean surgery are 5
times more likely to be admitted to an
intermediate or intensive care nursery. The
increasing Cesarean section rate is a major
public health concern for maternal and infant
health
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Threats
18. Research conducted by clinicians from
Columbia Universitys Mailman School of Public
Health and the Mount Sinai School of Medicine
found that pollutants in the air in Upper
Manhattan, the South Bronx and neighborhoods
surrounding the World Trade Center area have been
linked to lower birth weight babies and smaller
skulls in African American babies. High rates of
child asthma have been found in these same
communities as well as an increased risk of
cancer
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Threats
19. New Yorkers with diabetes are twice as likely
to experience depression, anxiety, schizophrenia,
and other disorders causing serious psychological
distress than those without diabetes according to
a NYCDOH/MH study published late last year in the
Center for Disease Controls Morbidity and
Mortality Weekly Report. The study also found
that individuals with co-occurring diabetes and
serious psychological distress are more likely
than those with diabetes only to experience poor
physical and mental health, live in poverty, and
lack access to health care and social support.
Diabetes is now the fourth leading cause of death
in New York City
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INTERNAL MCH SYSTEM REVIEW STRENGTHS
PEOPLE-CULTURE-PROCESS-STRUCTURE
1. NYC has some of the best and largest health
care facilities in the world 2. NYC has 3
Healthy Start grantees, 9 lay model home visiting
programs, 3 nurse family partnership programs and
5 CHWP operating in NYC 3. Two years ago
NYCDOH/MH built local public health offices in
Central Brooklyn, Central Harlem and the South
Bronx
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STRENGTHS PEOPLE-CULTURE-PROCESS-STRUCTURE
4. Through mandatory testing of newborns, care
management and counseling of high-risk mothers,
the HIV mother-to-child transmission rate has
decreased from 10 1993 to less than 2 in 2003.
In NYC, 321 newborns were infected with H.I.V. in
1990, the year the virus peaked among newborns in
the city. In 2003, five babies were born with
the virus
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STRENGTHS PEOPLE-CULTURE-PROCESS-STRUCTURE
5. More than half of the hospitals in NYS have
joined an effort to save 7,000 lives over
the next year or so by applying best
practices to improve quality of care (Daily
News 5/16/05) Healthcare Association of New
York State 6. As the general population ages,
more women over 35 are deciding to have a
child
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STRENGTHS PEOPLE-CULTURE-PROCESS-STRUCTURE
7. The Citywide Coalition to End Infant Morality
has over sixty community-based agencies
delivering various maternal and child health
services throughout NYC. This network of
providers is maturing and delivering better
results 8. Across New York State the
regionalization of perinatal care has started. In
NYC, the Citywide Regional Perinatal Forum and
local borough forums of hospitals and
community-based organizations have begun to
determine the MCH needs in their areas and
develop borough-specific action plans to address
identified needs. 9. The NYCDOH/MH has
developed plans to screen patients at all HHC
hospitals for depression and make it a routine
part of primary care, much like a blood pressure
test or a cholesterol reading.
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WEAKNESSES PEOPLE-CULTURE-PROCESS-STRUCTURE
1. MCH care system fragmented 2. Uninsured
population in downstate region over 2 million
3. 40 of NYC hospitals are operating in the
red 4. More New Yorkers die from medical
mistakes each year than from highway accidents,
breast cancer, or AIDS
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WEAKNESSES PEOPLE-CULTURE-PROCESS-STRUCTURE
5. Recently, Jacobi Hospital in the Bronx failed
to tell 307 women that they had abnormal
cancer-test results. These women did not receive
follow-up care 6. Racial disparities in care and
outcomes is prevalent even at some of the best
medical centers 7. Constant movement from one
provider to another characterizes the patient
base within the MCH system in NYC where a woman
might secure her prenatal care at one facility
and deliver at another. Continuity of care
suffers and patients move to the providers that
respect them and deliver quality care- HAVE
MEDICAID CARD WILL TRAVEL!
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WEAKNESSES PEOPLE-CULTURE-PROCESS-STRUCTURE
8. The maternal mental health provider network is
weak across NYC. There are not enough clinicians
who are trained to screen, diagnose or treat
various perinatal mood disorders 9. Nursing
shortage in NYC can be described as a health care
state of emergency that has negative consequences
to patient safety, the quality of patient care
and morale issues among existing nursing
staff 10. Medicaid poorly reimburses mental
health providers who manage the care of
pregnant, emotionally depressed women
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WEAKNESSES PEOPLE-CULTURE-PROCESS-STRUCTURE
11. The health and mental health care systems are
poorly integrated to meet the growing needs of
pregnant and parenting women
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Perinatal Depression Campaign Performance
Objectives

• By December 31, 2006, FCNs perinatal mood
  disorder social marketing poster campaign will
  have motivated at least 1,000 pregnant and
  parenting women to seek mental health care in NYC
  and every year until 2009
• By December 31, 2006, FCNs maternal mental
  health training program will have organized at
  least 50 grand round trainings of doctors,
  nurses, midwives, and social workers that will
  begin to standardize the expectations of practice
  to screen, diagnose, and treat various perinatal
  mood disorders

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Perinatal Depression Campaign Performance
Objectives

• By December 31, 2007, FCN will develop a citywide
  network of trained individual and group
  therapists that are willing and have the skills
  to screen, diagnose and treat various perinatal
  mood disorders
• By December 31, 2006, a statewide movement to
  address the funding, slot capacity, and practice
  development issues regarding perinatal mood
  disorders will be built mobilizing contacts
  throughout NYC and upstate New York where the
  Mayor of NYC and the Governor of New York State
  will support new funding and systems change
  proposals to strengthen the system of care to
  address this problem

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Perinatal Depression Campaign Performance
Objectives

• By May 31, 2009, two NYC schools of social work,
  one medical school and one psychology department
  will develop specialty programs to produce
  students trained to appropriately screen,
  diagnose and treat various perinatal mood
  disorders.

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Perinatal Depression Campaign Action Areas
Legislative Actions 1. Develop a brief narrative
that summarizes the clinical, waiting list/slot
capacity, provider training, and stigma-marketing
issues related to treating various perinatal mood
disorders in the down state region by 8/18/05.
The narrative should describe the problem and
point to solutions for each problem identified
2. Use the narrative to develop a legislative
fact sheet, legislative action letters and other
communication vehicles that will be used to bring
about reforms by 8/30/05
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Perinatal Depression Campaign Action Areas
3. Form Perinatal Depression Legislative Action
Team that is representative of all the networks,
Healthy Start and home visiting programs within
the downstate region that will be charged
with implementing this plan by 9/8/05 4. Action
Team should study Timothys Law and Assemblyman
James Brennans proposed bill (A. 2016) that
would force OMH to repeal the regulation
enforcing Medicaid Neutrality
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Perinatal Depression Campaign Action Areas
5. Begin setting up meetings in Albany with
targeted republican and democratic legislators in
the Senate and Assembly to persuade them to
support the above legislation 6. Set up a
meeting with the Commissioner of State OMH to
understand OMHs position on Timothys Law and
Medicaid Neutrality 7. Contact Speaker Silver
Senator Bruno to present our case concerning the
perinatal mood disorder problems and solutions
and win their support
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Perinatal Depression Campaign Action Areas
8. Set up meetings with Governor Patakis health
and social service representatives in Albany, Ms.
Renee Rider, Director of Human Services Programs,
State Capital, Room 253 and Mark Kissinger,
Executive Chamber, State Capital to make our case
and position our narrative as a campaign issue
that the governor must address. Show how the
issue relates to key constituencies that any
republican candidate for governor must develop an
informed response
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Perinatal Depression Campaign Action Areas
9. Meet with the democratic candidate for
governor, Attorney General Eliot Spitzer and
transform our case statement into a campaign
issue for him 10. Make contact with our friends
at 1199 Hospital Workers Union and see if
they can transmit our legislative
narrative into a print and electronic media
campaign during the election period and
right before the budget debate begins in
December 2005
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Perinatal Depression Campaign Action Areas
11. Begin letter writing and phone bank
activities to targeted legislators starting on
November 20, 2005 12. Action Team should
have at least three operatives completing
media work (letters to editor, story
development, press conference planning,
phone follow up work with health reporters,
etc.) to achieve the passage of the two
laws
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Perinatal Depression Campaign Action Areas
13. Attend September 2005 APN meeting to
communicate FCNs overall action plan and
secure commitments from the networks in
other parts of NYS to our political narrative
14. Set up a meeting with State Senator Jeff
Klein and his staff who sponsored
Timothys Law to target the coalition of
mental health parity activists who support
the legislation and join their movement
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Perinatal Depression Campaign Action Areas
15. Organize clergy across NYC and secure
their support for our PPD legislative
objectives by organizing Clergy Day to
Treat Perinatal Mood Disorders. Get major
clergy leaders and coalitions in NYC to
attend a press conference focused on our
core message/narrative
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Perinatal Depression Campaign Action Areas
Social Marketing Anti-Stigma Actions 1. Work
with NMPP and the NYCDOH/MH to review their
recent perinatal depression anti-stigma campaign
and obtain some of the unused proofs to develop a
citywide perinatal mood disorder poster campaign
by November 30th 2005 2. Secure NMPPs Social
Health Marketing Group to retouch some of the
photos, headlines and poster copy to produce
drafts for a FCN PPD citywide campaign 3.
Develop a mini proposal to the foundation
community to secure resources to mass produce the
campaign poster and secure 250,000 for citywide
dissemination
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Perinatal Depression Campaign Action Areas
4. Develop radio and television public service
announcements and work to get them placed as well
as secure free time within mainstream, local
print and electronic media throughout NYC 5.
Work the radio talk show circuit communicating
our core messages concerning the PPD problem and
fiscal, legislative and network development
solutions
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Perinatal Depression Campaign Action Areas
Provider Network Development Actions 1.
Study the network development work of MHRA, NMPP
and the Black Psychiatrists of Greater New York
who are developing a network of clinicians in
Harlem who treat maternal mental health
problems 2. Each Citywide Coalition to End
Infant Mortality Borough Coordinating Body will
take responsibility for organizing maternal
mental health networks throughout their borough
beginning on December 1, 2005 3. The FCN
executive director will computerize each borough
network database and distribute the list to all
perinatal networks, community health worker
programs, Healthy Start sites, etc
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Perinatal Depression Campaign Action Areas
4. Borough networks should meet quarterly to
determine the need for maternal mental health
services in the area, the status of the service
network (strengths weaknesses), network
training needs and develop an action plan for
network development by January 30th 2006 5. Each
borough network should develop clinical and
referral protocols and MOUs to formalize network
communications and to ensure each patient obtains
the best level of care to meet her needs 6.
Integrate grand rounds trainings with network
development activities to ensure that all
clinicians develop their knowledge base to
screen, diagnose, and treat various perinatal
psychiatric disorders
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Perinatal Depression Campaign Action Areas
7. By May 20, 2006, each borough network will
present a status report at the FCN
annual conference
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Perinatal Depression Campaign Action Areas
Workforce Training Actions 1. Set up
meetings with two medical school deans and one
school of social work dean to persuade the
decision makers to develop core curriculum and a
training practice area focused on producing
students with core skills to screen, diagnose and
treating perinatal mood disorders starting on
January 22, 2006 2. Connect media, legislative
and research work plan activities to create the
right conditions to positively influence
university leadership to adopt our workforce
training objectives
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Perinatal Depression Campaign Action Areas
3. Secure three of the top national maternal
mental health clinicians to practice in NYC
and complete the administrative and fund
development tasks to create a fellowship that
will attract medical and psychiatry students
to enroll and graduate with special
knowledge of treating perinatal psychiatric
disorders 4. Attend all of the schools of
social work in NYC and Long Island to
educate their deans and curriculum committee
chairs about the need to train and deploy
more social workers who have special skills
screening for, diagnosing and treating perinatal
mood disorders
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Perinatal Depression Campaign Action Areas
5. Develop concept paper on Centers of
Excellence on Maternal Mental Health and
develop a funding proposal that one or two of
the universities would manage to make New York
City or New York State the national
intellectual center for policy, research and
practice for treating various perinatal mood
disorders
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Perinatal Depression Campaign Action Areas
Organization Mobilization Actions To achieve
the objectives and tasks outlined above, FCN
must partner with the following entities and
persuade them to join our campaign MHRA,
Black Psychiatrists of Greater New York and
Associates (BPGNY), New York City Home Visiting
Council, COFFCA, New York State Mental Health
Association, Mailman School of Public Health,
APN, New York State March of Dimes, New York
State Perinatal Association, National Association
of Social Workers, National Association of Black
Social Workers, New York State Midwife
Association, New York State Nurses Association,
NYC Health Hospitals Corporation,
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Perinatal Depression Campaign Action Areas
Organization Mobilization Actions
1199 Hospital Workers Union, Greater New York
Hospital Association, NYSDOH Bureau of Womens
Health, New York State Office of Mental Health,
New York State Psychiatric Institute, ACOG, New
York State Nurses Association, PCAP Coordinators
Network, HRSA/MCHB
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Perinatal Depression Campaign Action Areas

• Research Action Steps
• Continue to submit proposals to NIH, CDC and the
  National Institute of Mental Health for specific
  grants that focus on womens mental health in
  pregnancy and the postpartum period. Current NIMH
  funding round closes on May 6, 2006.
• In February 2003, S450 and HR846 were introduced
  in the 108th Congress. The bills call for the
  Secretary of Health and Human Services, working
  through the Director of NIMH, to provide for
  basic, epidemiological, diagnostic, clinical, and
  intervention research on postpartum depression
  and psychosis. All FCN networks and research
  institutions should take advantage of the above
  funding streams to advance the theory and
  practice of treating perinatal mood disorders
  today!

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Perinatal Depression Campaign Action Areas
3. Support and disseminate MHRAs research to
develop a new screening tool called the MIC
Behavioral Risk Factor (BRF) Screen. Currently,
they are testing the instrument at all of their
MIC sites and will release an updated scale by
September 2005.
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Chronic Disease/Birth Outcome Campaign
Performance Objectives
By June 30th, 2006, a social marketing poster and
radio campaign will have been developed and
rolled out throughout NYC promoting family
exercise, proper nutrition, the development of
more fresh fruit vegetables coops entitled
Healthy Communities, Healthy Families/Healthy
Womens Movement By June 30th, 2007, an active
research and practice movement will have been
built to understand the relationship between
various chronic diseases (asthma, obesity,
diabetes, depression, high blood pressure) and
maternal, child and family health outcomes.
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Chronic Disease/Birth Outcome Campaign
Performance Objectives
By June 30th, 2008, the FCN working with its
citywide partners will help to strengthen and
rebuild an effective womens and family health
movement across NYC where NYCDOH/MH Vital
Statistics will document 9 declines in health
indicators in the areas of maternal and child
obesity, diabetes, asthma, maternal depression
and high blood pressure By June 30th, 2009, a
women family move your body movement will have
been built throughout NYC where families will
have access and use community exercise, Weight
Watchers, meditation, aerobics facilities to
combat and manage various chronic diseases
associated with poor health outcomes.
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Chronic Disease/Birth Outcome Campaign
Performance Objectives
Legislative Actions 1. FCN activists will begin
to work with the City Council, the Mayors Office
and the Commissioner for the NYCHA to obtain
authority to utilize the community rooms of
housing authority sites for exercise, Weight
Watcher sessions, and dance classes throughout
NYC 2. The Citywide Coalition to End Infant
Mortality will educate the City Council and the
Mayors Office and secure 10 million dollars that
will cover the costs of the chronic disease and
birth outcome focus to FCNs work. This work
hypothesizes to reduce the low birth weight rate
in high-risk NYC communities by 2 by 2009 can be
achieved by reducing prevalence of various
chronic diseases women of child bearing age
possess by 9 before, during and after the
pregnancy period.
57
Chronic Disease/Birth Outcome Campaign
Performance Objectives

• Social Marketing Actions
• The FCN executive director and board leadership
  will secure resources and hire a consultant to
  conduct focus groups to determine the content and
  means of delivering specific health messages that
  promotes womens and family healthy behaviors
  throughout NYC starting on September 1, 2005
• 2. The final copy of the focus group report and
  draft proofs of the radio and poster campaign
  will be presented before the FCN board for review
  and approval by January 1, 2006

58
Chronic Disease/Birth Outcome Campaign
Performance Objectives
3. The FCN executive director will secure
resources from the private sector or
government sector to produce 300,000 posters
and purchase over 150,000 in targeted radio
time to roll out the campaign in communities
where chronic diseases flourish by April 1,
2006 4. FCN board and executive leadership will
secure public service time at targeted radio
and television stations and tour the talk show
circuit promoting the Healthy Communities,
Healthy Families Healthy Women campaign to
NYC audiences beginning on June 1, 2006
59
Chronic Disease/Birth Outcome Campaign
Performance Objectives

• Provider Network Development Actions
• FCN leadership will meet with the directors of
  the NYC-based Healthy Start, CHWP, Home Visiting
  and Nurse Family Partnership programs to discuss
  their training needs concerning managing various
  chronic diseases and their relationship to infant
  mortality and low birth weight reductions
  starting on August 8, 2005
• 2. FCN leadership will meet with the DOHMH and
  HHC Chronic Disease Collaborative to obtain
  assistance to develop a case management and
  health education MCH protocol that will be
  implemented by the MCH program staff outlined
  above to better manage chronic diseases before,
  during and after the pregnancy period. The
  meeting will take place by September 28, 2005

60
Chronic Disease/Birth Outcome Campaign
Performance Objectives
Provider Network Development Actions
3. A special case management and health education
protocol will be developed to manage the
relationship between maternal diabetes/obesity
and maternal depression based on the November
2004 study findings by the NYCDOH/MH that
revealed a causal relationship. This protocol
will be developed by December 1, 2005 4.
NMPP will work with Weight Watchers of America
staff to expand the number of Weight Watcher
sites from Harlem to sites in the other boroughs
in poor and working class communities throughout
NYC starting November 2005 and ending by June
30th, 2006
61
Chronic Disease/Birth Outcome Campaign
Performance Objectives

• Workforce Training Actions
• FCN leadership will meet with the directors of
  the NYC-based Healthy Start, CHWP, Home Visiting
  and Nurse Family Partnership programs to discuss
  their training needs concerning managing various
  chronic diseases and their relationship to infant
  mortality and low birth weight reductions
  starting on August 8, 2005
• 2. Once the Chronic Disease/Birth Outcome Network
  is developed focused training sessions will begin
  starting on October 1, 2005 on diabetes, asthma,
  depression, high blood pressure and obesity at
  MCH training sites across NYC

62
Chronic Disease/Birth Outcome Campaign
Performance Objectives
Workforce Training Actions 3. By December 12,
2005, Dr. Lus presentation on Internatal Care
will be transformed into a case management and
health education program model to deliver womens
health services beyond the pregnancy period.
Healthy Start and Home Visiting contractors
should use the base proposal to secure funding
from local, state and federal funding streams to
build the infrastructure for this type of care
over the next five years throughout NYC
63
Chronic Disease/Birth Outcome Campaign
Performance Objectives
Workforce Training Actions 4. Program directors
and supervisors should monitor the results of
the above training to ascertain if practice and
knowledge saturation has been achieved by line
and supervisory staff. Administrative staff
should complete six-month chart reviews and
administer maternal satisfaction surveys to
monitor results of new learning on patient
care
64
Mobilization Actions To achieve the objectives
and tasks outlined above, FCN need to partner
with the following entities and persuade them to
join our campaign American Diabetes
Associations, Weight Watchers of America, MHRA,
Black Psychiatrists of Greater New York and
Associates (BPGNY), New York City Home Visiting
Council, COFFCA, New York State Mental Health
Association, Mailman School of Public Health,
APN, New York State March of Dimes, New York
State Perinatal Association, National Association
of Social Workers, National Association of Black
Social Workers, New York State Midwife
Association, New York State Nurses Association,
NYC Health Hospitals Corporation, 1199 Hospital
Workers Union, Greater New York Hospital
Association, NYSDOH Bureau of Womens Health, New
York State Office of Mental Health, New York
State Psychiatric Institute, ACOG, New York
State Nurses Association, PCAP Coordinators
Network
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• Research Action Steps
• NMPP has collaborated and submitted at least
  seven
• proposals with academic community partners
  over the last three months to reduce the
  incidence of adult and childhood obesity and
  managing diabetes (Type 1 Type 2) among
  community residents in Harlem. Most of these
  projects were submitted to CDC and NIH. When or
  if these projects are funded, they will add to
  the body of knowledge exploring the relationship
  between chronic disease management before, during
  and after the pregnancy period relationship to
  improving maternal and child health outcomes

66
Research Action Steps 2. Citywide Coalition to
End Infant Mortality borough coordinating bodies
starting on August 1, 2005, will begin to reach
out to their university partners to conduct
applied public health research to develop best
practice models to combat obesity, high blood
pressure, asthma, diabetes and depression 3. The
results of the above citywide research efforts
will be used to upgrade the knowledge possessed
by collaborative members who will utilize new
knowledge to improve practice
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Planning/Action Summary This plan is now in
your hands colleagues. If we implement the tasks
as planned, the MCH industry throughout New York
State will strengthen its infrastructure and new
knowledge and practice will be created that could
improve birth outcomes and the health of
mothers. By no means are we communicating that
the road ahead will be easy. However, if we stay
committed to confronting and transforming the
reality that is right before us, we will be able
to overcome the obstacles that could block the
achievement of our performance objectives.
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Planning/Action Summary This plan cannot be
achieved by just deploying downstate resources.
We will need to mobilize statewide resources and
organizations to help institutionalize our
advocacy agenda, research and practice findings
as permanent components of the MCH system of care
throughout New York State. This plan is FCNs
best effort to predict industry change within the
maternal and child health business. However, it
is not enough to see what might be happening
next, we must dedicate ourselves to executing the
actions steps above to be better positioned to
survive and thrive in the new industry climate
defined above.