Kansas Blue Ribbon Panel on Infant Mortality August 28, 2009 Topeka, Kansas

Mother & Child Health Coalition Susan McLoughlin, MSN, RN, CPNP Executive Director Jean Craig, PhD Kansas City Healthy Start Project Director Mary Jean Brown, MS, RNC Kansas City FIMR Program Coordinator

Maternal & Child Health Coalition of Greater Kansas City, Inc.

Our Vision Every mother and child in greater Kansas City will be healthy.

The five county metropolitan area includes: The five county metropolitan area includes: Wyandotte and Johnson counties in Kansas Wyandotte and Johnson counties in Kansas Jackson, Clay and Platte counties in Missouri Jackson, Clay and Platte counties in Missouri

Our Mission

Every child deserves a healthy start. It is the best gift a community gives its children and itself. Every child deserves a healthy start. It is the best gift a community gives its children and itself.

Mother & Child Health Coalition works together with community partners and families to promote wellness and advocate excellence in health care. Mother & Child Health Coalition works together with community partners and families to promote wellness and advocate excellence in health care.

 History  Numerous organization partners and individuals  Organizational Chart Committees, Programs and Projects Committees, Programs and Projects

HEALTHY PEOPLE 2010

Process Goals Goal 1 Promote the involvement of multiple organizations in the delivery of health and prevention services; and Promote the involvement of multiple organizations in the delivery of health and prevention services; and facilitate a more comprehensive health care delivery system to women of childbearing age, infants and children, specifically targeting services to those women at risk of adverse pregnancy outcomes. facilitate a more comprehensive health care delivery system to women of childbearing age, infants and children, specifically targeting services to those women at risk of adverse pregnancy outcomes.

Goal 2 Increase the availability, ease of access, and utilization of health services for women of childbearing age and children; Increase the availability, ease of access, and utilization of health services for women of childbearing age and children; decrease health disparities between racial and/or socioeconomic groups; and decrease health disparities between racial and/or socioeconomic groups; and improve the quality of life for women, infants and children. improve the quality of life for women, infants and children.

Goal 3 Optimize maternal/child health outcomes through: Optimize maternal/child health outcomes through: health promotion and injury prevention services; health promotion and injury prevention services; responsible sexuality; responsible sexuality; medical care before, during and after pregnancy; medical care before, during and after pregnancy; educational and emotional preparation for parenting, including financial responsibility. educational and emotional preparation for parenting, including financial responsibility.

5 Priority Issue Areas  INFANT MORTALITY  IMMUNIZATIONS  INJURY PREVENTION  CHILDHOOD OBESITY  BREASTFEEDING

 Resource Sharing  Networking  Dissemination of Best Practices  Annual Report

Jean Craig, PhD Project Director Kansas City Healthy Start

KCHS Sites: Missouri & Kansas  15 ZIP Codes  Children’s Mercy Hospital – English/Hispanic  Truman Medical Center, Hospital Hill  Project EAGLE  Truman Behavioral Health

Components:  Outreach  Case Management  Health Education  Perinatal Depression Screening  Interconception Care  Fathering Initiative (BB Clinic/Workshop)

Leadership Support  Sista’ Talk (English/Spanish) – RAP Talk  Policy Council/Peer Group – Early Head Start (1x per mo/educational topics/taxes/WIC) (1x per mo/educational topics/taxes/WIC)  Business Meetings -Pres/VP/Sec  Gentlemen of The Round Table ( Maltbia/Jones)  Letters of Recommendation for Education/Employment  Bi-Monthly Consumer Training  Graduate Speaker Bureau

Partnerships:  Local Universities/Lincoln University Extension Program  Full Employment Council  Health Dept/Health Centers  Gentlemen of The Roundtable  The Clay Johnson Foundation  Nat’l Center for Fathering  StartRight Teen MOMs/DADs  Faith-Based Organizations

In-Kind:  Target  Kiwanis  Babies R Us  Community

Dedicated Dads  Male Involvement  Committee  StartRight Teens w/TMC  KC Magic Weekend (Workshop/BB Clinic)

Data Profile:  African American – 60%  Hispanic – 30%  Caucasian – 5%  Other – 5%

Performance Objective:  Prenatal Visits: CY 2005: 99/120 (82.5%) – Obj CY 2006: 81/97 (83.5%) – Obj CY 2007: 97/114 (85.1%) – Obj.85.0 CY 2008: 67/86 (83.7) – Obj.85.0

Performance Objective:  Very Low Birth Weight: CY 2005: 0/100 (0%) – Obj. 3.6% CY 2006: 1/58 (1.7%) – Obj. 2.5% CY 2007: 1/47 (2.1%) – Obj. 2.0% CY 2008: 1/67 (1.5%) – Obj. 1.5%)

Performance Objective:  Low Birth Weight CY 2005: 0/28 (0%) – Obj. 1.4% CY 2006: 7/28 (12.1%) – Obj. 1.4% CY 2007: 4/47 (8.5%) - Obj. 1.4% CY 2008: 6/59 (10.2%) - Obj. 1.4%

Performance Objectives:  IMR (# deaths x 1000 div. by # live births) CY 2005: 0/28 (0%) – Obj CY 2006: 1/58 (17.2%) – Obj CY 2007: 1/47 (21.3%) - Obj CY 2008: 1/67 (14.9%) - Obj. 15.0

Mary Jean Brown, MS, RNC Program Coordinator Greater Kansas City’s Fetal Infant Mortality Review Program

History of FIMR 1990  FIMR was a collaborative effort between  Federal Maternal and Child Health Bureau (MCHB) and  The American College of Obstetricians and Gynecologists (ACOG)  Created as a strategy to improve service systems and resources for women, infants and families.

Purpose of FIMR  To improve services systems and resources for women, infants and families  Address gaps in care  Understand how psychosocial and economic issues affect outcomes

FIMR Partners  Missouri Department of Health and Senior Services  Kansas City Missouri Health Department  March of Dimes  St. Luke’s Fetal Board  SIDS Resources  Mother and Child Health Coalition  Kansas City Healthy Start Program

FIMR Process  Death Occurs  Data Collected Death certificate, prenatal records, inpatient records, social work notes, maternal interview Death certificate, prenatal records, inpatient records, social work notes, maternal interview  Case Review Team reviews de-identified cases and makes recommendations to: cases and makes recommendations to:  Community Action Team Responsible for Interventions & System changes Responsible for Interventions & System changes  Improved Maternal and Infant Health

KC FIMR  Fetal and Infant deaths from 5 ZIP codes in Kansas City, MO are reviewed  Majority of births are at 3 inner city hospitals: Truman Medical Center Truman Medical Center St. Luke’s Hospital, Plaza Campus St. Luke’s Hospital, Plaza Campus Research Medical Center Research Medical Center  73 cases have been reviewed September 2004 to April 2009

Definitions  Fetal Mortality 20 weeks gestation or greater 20 weeks gestation or greater Or at least 350 gms Or at least 350 gms  Infant Mortality Death of live born infant before his or her first birthday Death of live born infant before his or her first birthday

KCFIMR Race/Ethnicity FIMR Kansas City, MO (n=73)(n=7,858) AA87.6%36.5% AA87.6%36.5% Hispanic 9.5%16.0% Hispanic 9.5%16.0% FIMR cases September ’04 to April ’09 Kansas City, MO live birth data, 2006

KC FIMR Age Distribution FIMR Kansas City, MO (n=73)(n=7,858) Age < % 12.6% Age < % 12.6% Age % 77.3% Age % 77.3% Age % 10.1% Age % 10.1% FIMR cases September ’04 to April ’09 Kansas City, MO live birth data, 2006

KC FIMR Prenatal Care FIMR Kansas City, MO (n=73) (n=7,858) Adequate26% 84.6% Marginal24.6% 12.3% Inadequate30.1% 3.10% FIMR cases September ’04 to April ’09 Kansas City, MO live birth data, 2006

KC FIMR BMI Category FIMR KCMO (n=73)(n=7,858) Normal Weight 30.1% 44.4% Underweight 2.7% 3.9% Overweight 26.0% 21.1% Obese32.8% 19.5%

KC FIMR Preexisting Disease FIMR Kansas City, MO (n=73) (n=7,858) Diabetes5.10%0.50% Hypertension12.3%0.90% Obesity32.8%19.5% Tobacco 35.6%12.5% Alcohol10.9%0.50% Drug use23.2%1.20% Asthma21.9%

 Limited or No Prenatal Care  Addiction to alcohol, tobacco, drugs  Obesity  Asthma KC FIMR Identified Trends

FIMR Community Action Team  CAT is part of the Kansas City Health Commission: Women’s Infant’s and Children’s Committee  CAT puts action steps to the recommendations from the CRT, based on identified trends.

CAT Activities Access to Care Issues Seeking to reduce barriers to early entry into care Identifying potential KC community partners Identifying potential KC community partners Seeking funding sources Seeking funding sources Found vendors to donate pregnancy tests Found vendors to donate pregnancy tests

Public Awareness of FIMR  Kansas City Gyn Society Meeting, 2009  David Mundy, MD, Perinatologist, TMC, Chair of CRT History and activities of FIMR History and activities of FIMR Data presentation Data presentation Invitation to join Community Action Team or Case Review Team Invitation to join Community Action Team or Case Review Team

Missouri-Kansas Partnership  KC Healthy Start Program contracted with Kansas Department of Health and Environment for a FIMR- like program  Wyandotte County, Kansas 44 Fetal and Infant deaths (2005) abstracted 44 Fetal and Infant deaths (2005) abstracted  Sedgwick County, Kansas (2005)

We appreciate all you do to help see that every child receives a Healthy Start! THANK YOU!