United Way Success By 6 Liberty City Outreach Initiative

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United Way Success By 6 Liberty City Outreach
Initiative
Funded by
Success By 6 Initiative
Presented by
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Overview of Healthy Start

• Implemented on April 1, 1992
• Reduce infant mortality, reduce the number of low
  birth weight and preterm babies and improve
  health and developmental outcomes.
• Offers universal prenatal and infant risk
  screening to identify pregnant women and infants
  at risk for adverse birth, health and
  developmental outcomes.
• Offers care coordination services that support
  families in reducing factors that place pregnant
  women and infants at risk for poor outcomes.

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Introduction

• Grant awarded in October 2002 to the Healthy
  Start Coalition of Miami-Dade in partnership with
  the Economic Opportunity Family Health Center,
  Teen Pregnancy Prevention Center, and the Health
  Council of South Florida.
• Funds are available from the United Way of
  Miami-Dade Success By 6 Program.
• Intermediate goal of the Initiative is to
  increase the number of completed Healthy Start
  prenatal screens by conducting intensive outreach
  to pregnant women and teens in zip codes 33147
  and 33142 (Liberty City).
• Long-term goal is to reduce the rate of preterm
  births in the targeted zip codes.

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Identified Needs in Liberty City

• Healthy Start Needs Assessment 2001 revealed
  12.8 babies were born preterm in Liberty City,
  3.2 more than Miami-Dade County 9.6.
• 67.7 of all babies in Liberty City were born to
  non-Hispanic Black mothers. Non-Hispanic Blacks
  and teenagers are more likely to experience
  preterm birth.
• Liberty city ranked within the top ten countywide
  for the following risk factors
• mothers receiving late or no prenatal care,
• low birth weight births,
• births to teens, and
• births to unwed mothers
• 30.6 and 31.1 of residents in zip codes 33147
  and 33142, respectively, under age 65 were
  uninsured more than the county-wide average of
  26.7 (Miami-Dade County Health Insurance Survey).

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Design

• Outreach and self-referrals in Liberty City

Increase Healthy Start prenatal risk screens
(Early detection of women who are identified at
risk for poor birth outcomes)
Provision of Healthy Start core services
Decrease preterm birth in Liberty City from 12.8
in 1999 to 10.6 in 2005
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Primary Strategies

• Marketing campaign in Liberty City

Street level outreach to pregnant women and teens
Development and dissemination of educational
materials
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Sample Billboard Ad
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Outreach Efforts Results2002 - 2005
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Zip Codes of Participation

• Liberty City falls within zip codes 33147 and
  33142.
• Historically known for poor health and
  socioeconomic status.

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Participants by Zip CodeOctober 2002 September
2005
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Age of Self-referred Women in Targeted Zip
Codes, 2002-2005
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Self-Referrals by Race Ethnicity October 2002
September 2005
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Healthy Start Awareness Among Liberty City
Participants
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Consent to Participate in Healthy Start Among
Liberty City Participants
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Achievements

• 24.8 of women from 33147 and 35 from 33142 were
  aware of Healthy Start, which is higher than that
  found in other/unknown zip codes (19.8).
• Number of Healthy Start prenatal screens
  processed in the target zip code 33147 (528) and
  33142 (625) in Year 3 were significantly higher
  than the baseline year 484 and 490,respectively.
  9.1 increase for 33147 and 27.6 increase for
  33142.
• 100 of women consented to be screened in the
  target areas compared to 76 in Miami-Dade County
  in Year 3.
• 100 of self-referred women from 33147 and 33142
  were assigned to Healthy Start providers.

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Healthy Start Prenatal Screens
Source Florida Department of Health HPE
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Healthy Start Prenatal Screens
Source Florida Department of Health HPE
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Live Births in Target Zip Codes
Source Resident Births from the Florida
Department of Health, Office of Vital Statistics.
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Self-Referral Results

• Based on the Self-Referral forms, the leading
  risk factors for referral to Healthy Start were
  unmarried (82.4) and Black race (60.5).
• Other reasons for referral were cited by 82.6
  of women. Most cited Other reason include
• participation in Healthy Start classes/services
  (25)
• stress/depression (unspecified,
  maternal/postpartum) (24.8)
• stress without mention of depression (22.7)
• 99.1 of women who were referred using the
  Self-Referral form consented to participate in
  Healthy Start.

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Long-Term Goal

• Long-term goal is to reduce the rate of preterm
  births in the targeted zip code.

Source Resident Births from the Florida
Department of Health, Office of Vital Statistics.
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Initiative Objectives

• Objective 1. Increase the number of Healthy Start
  prenatal risk screening rate in the target area
  from 54.2 to 65 by YR03.
• Measure/Indicator Number of prenatal risk
  screens processed.
• Baseline 54.2 in 1999 Year 1 66 Year 2
  71 Year 3 76
• Activities
• Intensive face-to-face outreach to pregnant women
  and teens
• Educational materials/incentives disseminated in
  the target zip code area.

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Initiative Objectives (cont)

• Objective 2. The estimated total number of
  unduplicated clients to be referred for Healthy
  Start services Year 1 1,000 Year 2 1,000 ,
  and Year 3 1,000 .
• Measure/Indicator Number of Self-referrals.
• Year 1 564 Year 2 707 Year 3 1,128
• Activities
• Intensive face-to-face outreach to pregnant women
  and teens
• Educational materials/incentives disseminated in
  the target zip code area.

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Initiative Objectives (cont)

• Objective 3. Increase knowledge of Healthy Start
  services and the Healthy Start risk screen by
  directly and indirectly educating and reaching
  1,500 pregnant women during Year 3.
• Measure/Indicator Number of women directly or
  indirectly reached.
• Year 1 1,348 Year 2 2,171 Year 3 8,946
• Activities
• Media and marketing campaign in Liberty City
  targeting pregnant women and teens to improve
  their knowledge and awareness of Healthy Start
  prenatal risk screen

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Initiative Objectives (cont)

• Objective 4. Increase awareness of Healthy Start
  services and the Healthy Start risk screen by 5
  each year in the 33147 and 33142 zip code areas.
• Measure/Indicator Healthy Start recognition
  among women in the targeted zip code area.
• Year 1 27 Year 2 27 Year 3 29.
• Activities
• Media and marketing campaign in Liberty City
  targeting pregnant women and teens to improve
  their knowledge and awareness of Healthy Start
  prenatal risk screen.

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Process Achievements/Limitations

• Outreach partners exceeded their goal for
  contacts (90 per month) 12,465 women were
  directly or indirectly reached.
• Direct outreach (i.e. street-level) was the most
  successful
• Follow-up procedures were perceived as labor
  intensive and unrealistic
• Each outreach partner adopted their own method of
  follow-up
• Outreach partners found that prescreened women
  came to expect a high level of interaction with
  Healthy Start case managers

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Process Achievements/Limitations

• Forms were changed on several occasions in Year 1
  and 2 to adequately document the outreach efforts
• At the conclusion of Year 1, the Coalition saw a
  need to expand the outreach activity zip code to
  include 33142
• Staff turnover
• Hurricane 2004-2005
• Lack of infrastructure or need for professional
  and technological capacity building among
  outreach partners

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Conclusions/Lessons Learned

• Community based organizations are essential in
  the provision of services to respective
  communities.
• Outreach partners were committed to the
  Initiative. Outreach partners feel that lack of
  adherence to protocol is related to their general
  concern about how changes will affect the
  community they serve and their ability to serve .
• Target area is socio-economically depressed that
  it is difficult for the population to focus on,
  obtain, or heed advice regarding health,
  pregnancy and outcome.
• Overall, the Initiative was successful,
  increasing awareness and utilization of Healthy
  Start services.

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Recommendations

• Changes in documentation should be limited to
  assure complete, accurate and continuous data and
  information
• Provide technical assistance in infrastructure
  development and capacity building
• Offer educational sessions related to pregnancy,
  womens health, infant health and adequate child
  care
• Substantial incentives including grocery gift
  certificates, infant car seats, diapers,
  strollers, cribs, baby clothing, etc.
• Provide formal structured training to outreach
  staff to include identification of appropriate
  outreach sites, capitalizing on activities and
  events, managing stress and burnout, using
  different methodologies and settings to increase
  numbers and participants reached.

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Contact Us

• Trecia Matthews Hosein
• Director of Quality Improvement Assurance
• Healthy Start Coalition of Miami-Dade
• 701 S.W. 27TH Avenue
• Miami, Florida 33135
• Phone [phone]
• Fax [phone]
• E-mail tmatthews_at_hscmd.org
• www.hscmd.org