1. Using PPOR to Address Low Birthweight Bill Ulmer, MPH, MA Director, Community Health Chattanooga-Hamilton County Health Department

2. Where in the world is Chattanooga, TN?!

3. Hamilton Co: Urban and Rural Mix

4. Regional Health Plan 2002  Infant Mortality Rate: 9.8 Black rate 15.0 White rate 7.1  Low birth weight 11.4% of all live births. Blacks 16.4% Whites 8.8% For each race, LBW HIGHER than US, TN, or any other metropolitan area in TN

5. Organizational Developments  In November of 2002, the Regional Health Council made infant health a top priority and appointed a Task Force.  By January of 2003, the Task Force had organized under the leadership of Dave Adair, M.D., and selected the PPOR approach.  In March, the Task Force set a goal to reduce LBW births to 8.4% of live births by 2007.

6. PPOR Findings Overall Excess Mortality in Hamilton County: 7.2 Maternal Health/ Prematurity: 3.3 Maternal Care: 0.7 Newborn Care: 1.0 Infant Health: 1.9 13.0 Fetal-Infant Deaths Per 1000 Live Births + Fetal Deaths Due to rounding, numbers do not add to totals. Maternal Health/ Prematurity 5.5 Maternal Care 2.2 Newborn Care 2.0 Infant Health 3.1

7. So… time for action?!

8. First… A Message from our Sponsor A Framework for Assessing Community Readiness  Change is inherent in the PPOR approach.  5 components for community readiness for change:  Reasoning  Roles  Resources  Risks/Rewards  Results

9. Assessment of Community Readiness  PPOR Guidelines suggest conducting an internal assessment every six months.  A tool for assessing the five components of community readiness for change is provided.  The assessment instrument was easily modified to fit the needs of the Low Birth Weight Birth Task Force.

10. Modifying the Assessment Tool  We revised the very important 3 page assessment instrument.  For example:  From: We can communicate a clear, compelling case for doing PPOR at this time…  To: We can communicate a clear, compelling case for the work of the Task Force…

11. FINDINGS - Reasoning: Score 5  The first assessment was conducted at the May meeting of the Task Force.  Under the first item, Reasoning, The Task Force felt very confident about the Task Force’s underlying rationale.

12. Results: Score 4  There was discussion about the role of the Task Force: a planning body with no real authority to implement the strategies. The need to move from a very general goal to more specific objectives was discussed. Whether the Task Force has enough Prevention expertise to get the desired results was also questioned.

13. Roles: Score 3  Many felt that this may be the most difficult item. In particular, involving sponsors and targets, and developing their buy-in and championing of the work, seemed problematic. Politics and funding concerns were raised.

14. Risks and Rewards: Score 3  A lack of understanding, among everyone from parents to policy makers, of the health and economic consequences of low birth weight births and of the rewards to the community if this problem can be curtailed, was identified.

15. Resources: Score 4  It was thought that the community does have the resources to reduce low birth weight births.  Recent questions about existing services suggest the need for asset mapping.

16. Reasoning Roles Resources Risk/Reward s Resul ts 1 5 43 2 5 4 3 2 5 4 3 2 5 4 3 2 5 43 2 Not Quite Organized for Success!

17. Take Home Lessons  Prevention expertise is needed  Bringing all the players to the table is difficult  Asset mapping may be necessary and might begin early in the process.  Take time to make the case to the community about the importance of the work.  Moving from lack of awareness or defensiveness to “ownership” is challenging.  Reducing LBWB’s is everyone’s problem.

18. Recent Developments  Consumer Advisory Group (recently organized, no existing group in the county.)  Newsletter (sent in draft form to physicians)  Input from ‘similar’ communities (Aiken, SC; Nashville, TN)

19. We’ve got the skills… The PPOR approach brings: Analytic Confidence Organizational Ability