Strategic Planning Workshop 20052008 Service Delivery Plan

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Strategic Planning Workshop2005-2008 Service
Delivery Plan
Plan Development Committee Healthy Start Coalitio
n of Hillsborough County
September 23, 2004
Catherine S. Carroll, MA John C. Harris, MPA Lei
sa J. Stanley, PhD(c), MS

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Trends in MCH Indicators1998-2002
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Prenatal Care Trends1998-2002First Trimester
Care

• Slight overall increase of 0.5.
• The rate was 85.97 in 1998 and 86.38 in 2002.
• White rate increased 0.5.
• Black rate increased 7.7.
• Racial Disparity is 0.9.

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Prenatal Care Trends1998-2002Late or No
Prenatal Care

• 29.6 decrease.
• The rate was 2.70 in 1998 and 1.90 in 2002.
• White rate decreased 19.9.
• Black rate decreased 40.6
• Racial Disparity is 1.5down from 1.9 in 1998.

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Teen BirthsTrends 1998-2002

• Births to teens ages 15-17 decreased 32.3.
• The rate was 43.60 in 1998 and 29.53 in 2002.
• White rate decreased 28.2.
• Black rate decreased 34.2.
• Racial Disparity is 1.8.
• Births to teens less than 15 decreased 36.5.
• The rate was 1.86 in 1998 and 1.18 in 2002.
• White rate decreased 14.9.
• Black rate decreased 43.3 from 1998 to 2002, but
  actually increased from 2001 to 2002 (1.94 to
  2.89).
  
• Racial Disparity is 3.9down from 5.9 in 1998.

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Age of Mother Trends 1998-2002 Repeat Teen
Births

• Overall increase of 6.3 (12.7 in 1998 and 13.5
  in 2002).
  
• White rate actually decreased 8.8 with a 21.2
  decrease between 2001 and 2002.
  
• Black rate increased 34.9 with a large increase
  between 2001 and 2002 (13.6 to 19.7)
  
• Racial Disparity is 1.9.

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Low Birth Weight Trends 1998-2002

• Overall rate increased by 3.8.
• The rate was 8.19 in 1998 and 8.50 in 2002.
• White rate slightly increased 0.7.
• Black rate increased 10.1.
• Racial Disparity is 1.9.

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Low Birth Weight Trends 1998-2002Very Low
Birth Weight

• Increased 21 (1.54 in 1998 and 1.87 in 2002).
• White rate increased 6.9.
• Black rate increased 39.
• Racial Disparity is 2.2.

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Low Birth Weight Trends 1998-2002Preterm Low
Birth Weight

• Increased 7.7 from 5.87 in 1998 to 6.32 in
  2002.
  
• White rate increased 5.3.
• Black rate increased 15.4.
• Racial Disparity is 1.9.

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Contribution of Age of Mother to Low Birth
WeightTrends 1998-2002
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Plurality and Low Birth WeightTrends 1998-2002
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Fetal MortalityTrends 1998-2002

• Overall rate increased by 8.7 from 6.9 in 1998
  to 7.5 in 2002.
  
• White rate increased 5.3.
• Black rate increased 14.
• Racial disparity is 2.0.

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Infant MortalityTrends 1998-2002

• The overall rate increased 13.4 from 7.76 to
  8.80.
  
• White rate increased 11.6.
• Black rate increased 32.5 from 1998 to 2001 but
  decreased 16 from 2001 to 2002. The increase
  from 1998 is 9.
  
• Racial disparity is 1.98.

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Infant MortalityTrends 1998-2002Neonatal
Mortality

• Increased slightly by 1 (5.45 to 5.50)
• White rate increased by 5.5 (4.36 to 4.60)
• Black rate increased 3.5 from 1998 to 2001 but
  decreased 13.4 from 1998 to 2002.
  
• Racial disparity is 1.91.

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Infant MortalityTrends 1998-2002Post-Neonatal
Mortality

• Increased 42.2 (2.32 to 3.30).
• White rate increased 23.9.
• Black rate increased 57.4. It began to decrease
  from 7.1 in 2001 to 4.3 in 2003.
  
• Racial disparity is 2.1up from 1.4 in 1998.

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Cause of Death Trends 1998-2002
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• There was a net increase of 22 infant deaths from
  1998-2002
  
• 5 were in the neonatal period
• 17 were in the post-neonatal period
• Largest component of infant mortality is still
  Perinatal Conditions 4.97
  
• The rate has increased each year since 2000
• Birth defects increased from 1999-2001 then
  declined in 2002
  
• Homicides and Unintentional Injury are higher
  than expected
  

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Age of Mother Characteristics of Infant Deaths

• Neonatal deaths were highest among 18-19 year old
  and 35 year old mothers (82.6,76.5)
  
• The older the mother, the more likely she was to
  be White
  
• Birth Weight
• Very low birth weight infant deaths were highest
  in 18-19 year old and 35 mothers
  
• 2500 gram deaths were highest in teen mothers
  (57.1)

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• Gestation
• Teen mothers had the highest rate of deaths to
  term infants (71.4)
  
• 18-19 year old and 35 mothers had the highest
  rate of death for preterm infants
  
• Prenatal Care 1st Trimester Entry
• Teen mothers 66.7
• 18-19 YO 81.8
• 20-34 YO 78.3
• 35 YO 100

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• First Time Birth
• Teen Mothers 100
• 18-19 YO 70
• 20-34 YO 31.3
• 35 YO 65
• The older the mother, the more likely she is to
  be at least college educated
  
• All 19 and younger mothers were single
• Healthy Start Prenatal Screen
• 35 least likely to be screened (77)
• Teens 43 not screened
• 18-19 YO 40 not screened
• 20-34 YO 51 not screened

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• Plurality
• Multiple births higher in 18-19 year old and 35
  year old mothers (35, 30)
  
• 100 of teens were singleton

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Birth Weight Characteristics of Infant Deaths

• Cause of Death (Preliminary)
• VLBW Perinatal Conditions
• MLBW Birth Defects
• NBW Sudden Infant Death Syndrome, Unintentional
  Injuries
  
• Prenatal Care Entry in 1st Trimester
• 500-1499 g 84.8
• 1500-2499 g 87
• 2500 g 68.8

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• First Time Live Birth
• VLBW Evenly split with repeat births
• MLBW 60 were repeat
• NBW 65 were repeat
• 2500 g more likely to have mother who smoked
• Education
• NBW more likely to have lower education (40 HS)
  
• MLBW 60 HS or less
• VLBW 60 had HS or greater

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• Marital Status
• 2500 g 62 single
• Plurality
• Concentrated in 500-1499 g and 1500-2499 g
• 20 of all deaths were multiples
• VLBW least likely to be screened for HS (70)

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Perinatal Periods of Risk
CityMatCH
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Feto-Infant Mortality Hillsborough County, Florid
a
1999-2001
PostNeonatal
Neonatal
Fetal
Maternal Health 3.8 (n169) W2.9 B7.3 RR2.
5

500-1499 g
MaternalCare 2.6 (n116) W2.3B4.0 RR1.7
4

NewbornCare 1.5 (n66) W1.4B1.4 RR1.00
Infant Health 2.1 (n93) W1.7B4.0 RR2.4


1500 g
Total Feto-Infant Mortality Rate
10.0feto-infant deaths per 1,000 live births
fetal deaths (n444). White rate8.3 Black rate
16.6 RR2.0
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Excess Mortality Opportunity Gap
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PPOR Trends1998-2001

• Maternal Health declining from 8.0 to 7.3
• Disparity has increased by 9.6 due to faster
  rate of decline in white women
  
• Maternal Care declining 3.2 to 4.0
• Disparity has declined by 12.3
• Newborn Care declining 2.3 to 1.4
• Disparity has declined by 72
• Infant Care increasing 2.7 to 4.0
• Disparity has increased by 118 due to an 81
  increase in the rate for Black infants (2.6 to
  4.7)
  
• Post-Neonatal rate for Blacks began to decrease
  in 2001.
  

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Maternal Health Period of Risk Kitagawa Analyses
Results

• Excess Mortality Due to Birth Weight
  Distribution
  
• 49.4 of the excess mortality
• 55.6 in 500-750 gram weights
• 22.2 in 750-1249 gram weights
• 27.7 in 1599-2499 gram weights
• 86 of the excess mortality in the
  Prematurity/Maternal Health Period of Risk
  

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• Excess Mortality Due to Feto-Infant Mortality
  Rate
  
• 50.6 of the excess mortality
• 89.5 in 2500 gram weights
• 21 in 1500-2499 gram weights

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Trends in Infant Deaths by Birth Weight, 1998-2001
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Risk Factors by PPOR Domain
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Fetal Infant Mortality Review

• Infant mortality is the most sensitive index we
  possess of social welfare (Julia Lathrop,
  Childrens Bureau, 1913)

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FIMR Case ReviewsJanuary-April, 2004

• Total Cases Reviewed
• 20 Cases from 2002-2003
• Homicide Cases 7 out of 10
• 4 women screened in pregnancy
• 3 closed to No Further Services Needed
• 2 infants screened
• 5 had prior domestic violence incidents
• 2 had prior DCF reports
• 5 the perpetrator was the husband/boyfriend

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• SIDS/Suffocation Cases 13 out of 13
• Infant
• 11 were SIDS deaths
• 5 were breastfed only, 8 were on formula only
• 7 had a previous ER visit
• 4 were co-sleeping
• 7 had no crib available
• 7 were in the Healthy Start program

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• SIDS/Suffocation Cases 13 out of 13
• Mother
• 11 were single
• 11 were on Medicaid
• 7 were obese
• 6 were smokers
• 5 had a DCF history
• 5 were in the Healthy Start program

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Healthy Start System of Care
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Components of Healthy Start System

• Screening Infrastructure
• Prenatal Screens outreach by Community
  Liaisons
  
• Infant Screens outreach by Family Assessment
  Workers

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Prenatal and Infant Screening Rate Data

• Prenatal Screening Rates, since the 1992-1993
  contract year, have shown improvement. We reached
  a peak of 64 in March of 2004 when a new
  outreach system was put in place. After an
  initial falloff, rates have begun to climb back
  up.
• Prenatal Screening Rates are actually an
  Acceptance Rate. Most women are offered the
  screen at initial contact in their providers
  office but only those that accept the screening
  are included in the states percentage.
• Infant Screening Rates have shown an overall
  improvement to 80, a steady improvement since
  December of 2003
  
• Hospital Screening Rates vary, with Brandon
  Regional at the top of the scale, though all but
  University Hospital have shown improvement.

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• Triage Unit
• Screens with a 0-3 score
• Concentration of infant deaths
• Initial Contact Teams
• Screens with score of 4 or safety concerns
• Minimum contacts before closure 3 with one face
  to face
  

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• Care Coordination
• Public Health Nurses
• Social Service Coordinators
• Mental Health Counselors
• Health Educator (Addictions Specialist)
• Intensive Teen Unit (CBHC Funding)
• Linkages to Other Systems
• TOPWA link to prisons
• Family Support and Resource Centers
• Alpha House

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• Healthy Start Leveling System
• Level E
• Initial Level
• If not leveled higher, closed in one month
• Level I, one contact each six weeks
• Level II, one contact each month
• Level III, two contacts each month

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Healthy Start Services

• Executive Summary Reports
• Types of Services Provided
• Caseload Analysis

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Executive Summary ReportsPrenatal Clients

• Since the implementation of the Medicaid Waiver,
  face to face contacts have increased from 833 to
  1,503
  
• Total clients receiving care coordination
  services has declined from 6,893 in 10/95-9/96 to
  2,375 in 10/02-9/03.
  

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Infant Clients

• Since the implementation of the Medicaid Waiver,
  face to face contacts have increased from 536 to
  726.
  
• The number of clients receiving care coordination
  services has declined from 6,023 in 10/95-9/96 to
  1,130 in 10/02-9/03.
  

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• Overall, for both prenatal and infant clients
• Attempts to contact have increased
• Those receiving only an attempt to contract with
  other Healthy Start services has increased
  
• Unable to Locates have increased
• Clients receiving Care Coordination/Tracking Non
  Face to Face Services has decreased
  
• Clients receiving a Family Support Plan have
  decreased

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Direct Service Units

• Since the 1999-2000 Program Year Direct Service
  Units from the Health Department have declined
  from 224,310 to 116,998
  
• In the same period of time, Units have increased
  for the Child Abuse Council from 29,077 to 121,
  144

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Attempted Contacts

• Attempted Contact Units have also show decreases
  in the Health Department and significant
  increases in the Child Abuse Council

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Completed Contacts

• Completed Contact Units also showed increases
  within the Child Abuse Council and decreases in
  the Health Department

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Completed and Attempted

• When adding the Completions and Attempts together
  the trends seen in the independent graphs still
  hold true

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Yearly Change in Direct Service Units

• The Child Abuse Council has shown an increase in
  Direct Service Units every year, with a
  significant increase between 2000-2001 to
  2001-2002, due to staff increases. They have
  leveled off somewhat since, but still show slight
  increase each year.
• The Hillsborough County Health Department have
  shown yearly decreases during the same period,
  with each year decreasing a bit more than the
  last.

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Caseloads by SiteSeptember 17, 2004
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