Genesee County Healthy Start

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Genesee CountyHealthy Start

• Giving African American
• Babies a Healthier Start

Supported in part by project H49MC00148-05-00
from the U.S. Department of Health and Human
Services, Health Resources and Services
Administration, Maternal and Child Health Bureau
(Title V, Social Security Act).
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Our Community
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Genesee County, Michigan
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Flint, Michigan

• 4th largest city (120,000)
• Manufacturing base
• General Motors UAW
• 35 population decrease

• Poverty, unemployment, violence
• Racial health disparities
• Community activism

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Genesee County, Michigan

• Population 436,141

African American White City of Flint 55.8
39.3 County 20.2 75.4

• In the City of Flint
• 45 of children lt 18 years live below poverty
• 28 of all families live in poverty
• 52 of female householder families live in
  poverty

Source U.S. Census Bureau, American Community
Survey Fact Sheet, 2004 and 2005
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OB Care in Genesee County
2,768 births/year 35 Medicaid births
2,721 births/year 57 Medicaid births

• 811 births/year
• 8 Medicaid births

Averages calculated using 1997-2005 live birth
data
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Healthcare in Genesee County

• 791 primary care physicians
• 6 certified nurse midwives
• 85 prenatal care providers at 49 sites
• 3 perinatologists (2 high-risk clinics)
• 1 NICU
• 11 PNC provider offices located in ?IM zips

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In Genesee County.
6,282 births per year (1998-2005 average)
On average 69 infants die each year (2000-2006
Infant Deaths)
Of the 69 infant deaths, 34 are black infants
Black babies die 2-3 times more than other babies
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Number of Infant Deaths By RaceGenesee County,
Michigan1999-2006 (2006 preliminary)
Source Genesee County Health Department,
1999-2006 Fetal-Infant Mortality Statistics
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Annual Infant Mortality Rates by RaceGenesee
County, MI 1999-2005
Source Michigan Department of Community Health,
Vital Records Health Data Development Section.
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Infant Mortality Disparity RatioGenesee County,
Michigan 1999-2005
African American to White Disparity Ratios
Source Michigan Department of Community Health,
Vital Records Health Data Development Section.
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Infant Cause of Death Genesee County 2002-06
(preliminary)
N339
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Supported in part by project H49MC00148-05-00
from the U.S. Department of Health and Human
Services, Health Resources and Services
Administration, Maternal and Child Health Bureau
(Title V, Social Security Act).
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To reduce infant mortality, reduce perinatal
depression, improve neonatal outcomes among
pregnant post partum African American women and
infants children from birth to 2 years old.
Purpose
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Genesee County, MIHealthy Start Logic Model
Partners

• Conditions
• (City of Flint)
• AA IM rate is 21.3
• Low Birth Weight among AA is12.4
• Very Low Birth Weight among AA is 3.7
• Per 1,000 live births

• Interventions
• Outreach
• Case Mgmt
• Screening/Assmt
• Home visits
• Support Groups
• Health Education
• Consortium

• Target Population
• Pregnant AA women
• AA/Bi-racial children (birth to 2)
• Zip codes 48503,48504, 48458

• Expected Outcomes
• gtAccess to PNC in 1st trimester
• gtBabies gt5 ½ lbs gtMedical home
• gtFull-term babies gt?ATOD
• gt?Breastfeeding gt ?Immunizations
• gtI.D. refer for depression
• gt? self sufficiency
• gtReduce infant death rate

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Care Team
Registered Nurse
Social Worker
Community Advocate
Registered Dietician
Program Coordinator
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The Service Process
Referral
Enrollment
Interview Assessment
Care Meetings (Case Conferences)
Risk Assessment Scale
Goal Service Plan
Quarterly Review
Home Visits Support Referrals
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Closing the Loop
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Our Goals for the Process

• Bring all partners together
• Maintain ONE care plan
• Stratify levels of care
• Guide/organize work through the chaos of
  clients lives
• More accurately reflect level of staff work
  client progress (difficult to quantify)

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Healthy Start Program Participants2001-2006

• 1,008 Pregnant women
• 639 Infants less than 1 year of age
• 270 Children 1-2 years of age
• 772 Births

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How Do We Know What Were Doing is Working?
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Successes

• Service Plans closed out at discharge
• Improved documentation
• Focus on identified issues
• Consensus among Care Team members on discharge
• Care Team members learn from one another
• Compare/contrast individual staff assessments
• Address issues with expertise from multiple
  disciplines

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Low Birth Weight Among African Americans City
of Flint and Healthy Start, 2001-2006
Low Birth Weight is between 1500 and 2499
grams 2006 HS data is provisional Source City of
Flint data Michigan Department of Community
Health, Vital Statistics
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Very Low Birth Weight Among African Americans
City of Flint and Healthy Start, 2001-2006
Very Low Birth Weight is less than 1500 grams
2006 HS data is provisional Source City of Flint
data Michigan Department of Community Health,
Vital Statistics
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Infant Mortality Among African AmericansCity of
Flint and Healthy Start, 2001-05
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Factors Affecting Outcomes

• Higher risk moms ? more issues, harder to
  impact/affect change
• Entry into program ? late trimester no impact
  on current pg (but still count stats)
• Entry into PNC ? higher risk moms, harder to
  reach how can we improve entry if cant find
  them?
• Documentation

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Questions?

• Marcia Franks
• Maternal/Infant Health Mortality Programs
• Genesee County Health Department
• 630 S. Saginaw Street
• Flint, Michigan 48502
• [phone]
• mfranks_at_gchd.us