1. Sustainability in Tight Times: Local Efforts Building and maintaining an infrastructure of care for women, infants, children, and families. Supported in part by project H49MC00138 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).

2. Overview a Local community history a How interdepartmental teamwork and community collaboration enhances program development and capacity a How local partnership efforts support and effect change in systems and services a Continued sustainability strategies.

3. Healthy Babies/Healthy Moms Coalition a 1986 a Poor birth outcomes in Marion County

4. Childrens Defense Fund Announcement a 1987 a Indianapolis had the highest Black infant mortality rate (24) of any U.S. city with a population of 500,000 or more people.

5. Community-Based Approach 1989 Business, political, and community leaders unite to form a public and private partnership, develop a work plan, and mobilize the communities resources to reduce the countys infant mortality rate.

6. Indianapolis Campaign for Healthy Babies a 1989 ICHB formed and was active through 1992. a New health centers a Expansion of existing health centers a Care Coordination Services was introduced to pregnant women a WIC services expanded

7. Sustaining IHBC Efforts a 1993, Health and Hospital Corporation of Marion County (HHC) assumed responsibility for the campaign under Healthy Babies Initiatives a New services initiated: l Prenatal outreach l Prenatal substance abuse l Male responsibility l Community awareness

8. Fetal and Infant Mortality Review a 1995 - Marion County Health Department (MCHD) establishes the Indianapolis Healthy Babies Consortium to administer a Fetal and Infant Mortality Review (FIMR) Project. a 1999 - Healthy Babies of the New Millenium was released. m The final volume in a series of reports prepared by FIMR

9. Indianapolis Healthy Start a 1997 - MCHD receives a Health Resources and Services Administration grant -PhaseII l $3.6 million over four years a 2001 – 2005 a Healthy Start Grant: Eliminating Perinatal Disparities l $3.6 million over four years l Approved for third funding cycle 2005-2009

10. Rebuilding Community Infrastructure a In 2002: l MCHD reconvenes the IHBC l MCHD restarts the FIMR Program l Consumer Connection Consortium established a In 2003: l PPOR Workshop

11. Rebuilding Community Infrastrucure a In 2004: l PPOR Team identified- Technical Assistance provided through CityMatCH l FIMR-PPOR Workshop l Launching of the FIMR Chart Review Team l Healthy Start community assessment of MCH high-risk population and identification of catchment area

12. Marion County Demographics a Population: 1,607,486 a Median Age: 34.6 a Sex: l Male: 49% l Female: 51% a Race: l White: 82% l Black: 13.9% l Hispanic: 2.7% a Median Income: $41,964 a Source: U.S. Census Bureau 2005 American Community Survey

13. Marion County Demographics a Smoking during pregnancy: l Marion County: 17% l Indiana: 27.3% (Rank 49) a Obesity: l Marion County: 24% m 1 in 4 adults is obese l Indiana: 27.2% (Rank 41) a Adequacy of prenatal care: l Marion County: 77% l Indiana: 73.2% (Rank 32) a Infant mortality: l Marion County: 10 l Indiana: 8 (Rank 40) Source: U.S. Health Foundation, 2006.

14. Marion County Demographics a Infant mortality rate: l Marion County total: 10 m White: 8 m Black: 14 m Hispanic: 10 Source: HHC, Epidemiology, 2006. a Occupations: l Marion County: 8.4% m Professional, scientific, management, administrative and waste management services l Nationwide: 9.9% a Poverty level: l Marion County: 14.8% l Indiana: 12.2% l Nationwide: 12.6% Source: U.S. Census Bureau, 2005. American Community Survey.

15. Resources for Program Development and Sustainability a 2004-Present: l FIMR- Title V GAP grant assists with funding a MCH epidemiologist position. a 2005-2006: l FIMR- Title V Gap Grant assisted with funding a MCH nurse abstractor. a FIMR Abstractor: contract funded by MCH budget. a Americorps nurse volunteer 2007 -FIMR

16. Resources for Program Development and Sustainability a 2005-2007: l Title V GAP Grant Preconception/Interconception Health Project. l Assisted with funding a MCH nurse specialist position. a MCH Staff augment IHS staff with in-kind FIMR, Consortium and Project Director positions ($132,405 match).

17. Resources for Program Development and Sustainability a 2006: IHS Centering Pregnancy Program a Site-Indiana University Medical Group Health Center (Facility is the property of HHC) a March of Dimes funding of local group prenatal care programs

18. Community Assets a Healthy Start a Indiana Access national pilot site a Indiana State Department of Health a Indiana Perinatal Network state coalition, state advisory board a Fetal and Infant Mortality Review a Indianapolis Healthy Babies Consortia a March of Dimes a Child Fatality Review Committee

19. Community Assets a WIC a Breastfeeding peer counselors a Breastfeeding Coalition a MCHD Nutrition Service a Prenatal care coordination a PPOR Team a Community Council on Infant Health and Survival a Leading Ladies a Food & Nutrition Extension Program a Local universities

20. Community Challenges a Persistent leading causes of infant mortality: l Prematurity and low birth weight l Lack of community preconception and interconception protocols l High incidence of unintended (mistimed) pregnancy l Prevalence of obesity l Prevalence of STDs

21. Community Challenges a Access to mental health services a Lack of community awareness of preventable causes of infant mortality a Lack of consumer understanding of safe sleep messages a Lack of policies for safe sleep practices in local hospitals a Low breastfeeding rates

22. Local Partnership Efforts to Address Challenges a Indiana Perinatal Networks Indiana Access: l Medicaid waiver l Unplanned (mis-timed) pregnancy data l Technical assistance Excess Deaths Birth Cohort Data, Marion County, IN 1999-2003

23. Infant Fatalities a 1999, 2000, 2003 Indiana was ranked first in the nation for: l Injury-related fatalities for infants l Unintentional injury-related fatalities for infants a Leading cause of injury related fatalities was suffocation a Leading cause of intentional injury-related fatalities was physical abuse/beatings

24. Local Partnership Efforts to Address Challenges a Indiana Perinatal Network a Safe Sleep Conference, Oct. 4, 2006 a Call to Action: l Best Intentions l Unplanned pregnancies and the well being of Indiana families a March of Dimes a Grants a Brochures a Preconception Care: l Dr. Karla Damus, Oct. 10, 2006

25. Local Partnership Efforts to Address Challenges FIMR Preterm labor14 (45%) Smoking at time of delivery 13 (40.6%) Infection9 (29%)* Inappropriate weight gain 8 (25.8%)* Drug use6 (16.1%) Decreased fetal movement 4 (12.9%) Top Six Pregnancy Risk Factors

26. Local Partnership Efforts to Address Challenges June 2006-November 2006 FIMR Pre-existing Risk FactorsN=31 Obesity16 (50%) Previous poor birth outcomes 9 (28%) Less than 18 months between deliveries 6 (18.7%) Diabetes4 (12.5%) Hypertension2 (6.2%) Pre-existing Risk Factors

27. Local Partnership Efforts to Address Challenges a Indianapolis Healthy Babies Consortium l Serves as a venue for equipping the community to effect change based on evidenced-based practice and enhancing members knowledge and skills through presentations from local/national experts. l Six workgroups: m Access to care m Education m Nutrition m Domestic violence m Smoking elimination m Substance abuse.

28. Efforts to Improve Screening, Referral, and Access to Mental Health Services for Pregnant and Post-Partum Women

29. Marion County WIC Clinic Locations

30. Local Efforts

32. Sustainability Strategies a Sustained federal funding for Healthy Start a Sustained Title V funding a Other activities: Advocate for funding Blend Funding Pursue Grants Insist on accurate data Share data Use data to guide program development Monitor outcomes in MCH programs

33. Sustainability Strategies a Maintain collaboration with local universities,and hospital systems a Keep local, state, and national legislators apprised of the MCH issues We will embrace all opportunities to think out of the box.

34. Final Thought The problem of infant mortality is one of the great social and economic problems of our day. A nation may waste its forest, its water power, its mines and to some degree even its land, but if it is to hold its own…its children must be conserved at any cost. On the physical, intellectual and moral strength of the children of today, the future depends. Julia Lathrop, MD, first Director, Federal Childrens Bureau, 1913

35. Indianapolis Healthy Start Grantee Organization Marion County Health Department 3838 North Rural Street Indianapolis, Indiana 46205 Contact Persons: Yvonne Beasley, MN, RN, CNAA Director of Maternal and Child Health Project Director, Indianapolis Healthy Start Telephone: (317) 221-2347 Fax: (317) 221-2472 E-Mail: ybeasley@hhcorp.org