1. THE ROLE OF ORGANIZATIONS AND INTERORGANIZATIONAL RELATIONSHIPS IN REDUCING DISPARITIES IN INFANT MORTALITY Shannon Sparks, PhD Human Development & Family Studies, UW-Madison Brian Christens, PhD Interdisciplinary Studies in Human Ecology, UW-Madison

2. State Rankings Black Infant Mortality Rates (BIMR), 2005-7 US13.4 RankStateBIMRRankStateBIMRRankStateBIMR 1Washington7.814Maryland12.827Missouri14.4 2Oregon8.915Florida12.928Louisiana14.5 3Massachusetts10.016Nevada13.029Mississippi15.1 4Iowa10.417Arizona13.130N. Carolina15.2 5Minnesota10.518Colorado13.531Ohio15.3 6California11.219Illinois13.832Tennessee15.3 7New York11.220Connecticut13.933West Virginia15.3 8New Jersey11.721Delaware13.934Michigan15.4 9Rhode Island11.722Oklahoma13.9 35Wisconsin15.5 10Nebraska12.323Arkansas14.036Kansas15.7 11Texas12.324S. Carolina14.037Indiana16.0 12Kentucky12.525Alabama14.138DC18.6 13Georgia12.726Virginia14.239Hawaii21.1

3. Black Infant Mortality Rates Achieve Parity Dane County, 1990-2007

4. Extremely Premature Births By Race Dane County, 1989-2008

5. Disparities in Birth Outcomes  Current research suggests the need to look beyond individual risk factors and individual-level interventions to family, community and institutional systems  While prenatal care is important, it alone is not enough to prevent the premature births that are the prime contributor to black infant mortality  Service coordination and integration have been posited as critical elements in improving birth outcomes for African- American women  Integration of care and embedded community partnerships may be a key to improving birth outcomes  Pre and interconception access to integrated systems of health care and social services may improve birth outcomes by addressing the cumulative negative social, economic, and environmental insults that disproportionately impact certain racial/ethnic minority groups  Such systems may assist by not only dismantling system-level barriers to access, but enhancing trust and the quality of patient- provider relationships

6. Current Study  Seeks to understand the impacts of changes in organizational programs and policies and changing relationships between organizations as they impact mothers’ ability to access health services, information, social services, and other resources of importance for assuring positive birth outcomes  Investigating interorganizational networks operative in Dane County during this 20-year period of change to understand how they succeeded in engaging the African American community and working effectively among themselves  Hypothesis  Innovative community outreach and effective, multi- disciplinary/multi-agency preconception/prenatal coordination and care were the key drivers of improved African American birth outcomes

7. Phase I (2010-2011) 1) Compilation of the population of organizations (nonprofit, public and private) in Dane County involved in health care delivery and social services of particular relevance to expecting women and new mothers 2) Semi-structured interviews with representatives of these organizations to elicit information about the organization’s history and perceived role in the systems of care that impact birth outcomes

8. Next Steps: Phase II (2011-2012) 1) An inter-organizational network analysis of organizations in Dane County using a survey designed to capture relational transactions between organizations (e.g., collaboration/competition, information sharing, patient referrals, etc.) 2) Focus groups and individual interviews with selected mothers (e.g., African-American and White mothers who have given birth during different time periods; African- American mothers who live in different parts of Dane County; African-American mothers who have given birth both in Dane County and elsewhere) to understand their differential experiences with and understanding/trust of the local health care and social service system

9. Since 2008 – Disparity Returns Dane County

10. Thank you!  Project Partners  Public Health-Madison & Dane County  UW Center for Nonprofits  Project Funders  UW-ICTR  UW-Madison Fall Competition  Project Supporters  Dane County Human Services  ABC for Health  Access Community Health Centers  Wisconsin Primary Health Care Association