Title: Northeast Florida Healthy Start Coalition
1Northeast Florida Healthy Start Coalition
- 2009-2014 Healthy Start Service Delivery Plan
- Achieving healthy pregnancies
- through a life-course approach
2The Life-Course Model
- The health and socioeconomic status of one
generation directly affects the health status
and reproductive health capital of the next
one. - Interplay of biological, behavioral,
psychological and social protective and risk
factors contributes to health outcomes across the
span of a persons life - Examine cumulative effect of health status, life
events at different stages rather than risks,
behaviors and services once a woman becomes
pregnant
3Healthy Start The Life Course
- MISSION STATEMENT The Healthy Start Coalition
leads a cooperative community effort to reduce
infant mortality and improve the health of
children, childbearing women and their families
in Northeast Florida. - The life-course model broadens the focus of
maternal and child health to include both health
and social equity. - Key factors affecting health outcomes
- gt socioeconomic status gt race and racism
- gt health care gt health status
- gt stress gt nutrition and weight
- gt birth weight
42009-2014 Healthy Start Service Delivery Plan
- Tracks progress over the last five years in
addressing maternal and infant health needs
guides the development and funding of Healthy
Start services through 2014 - Life-course framework has both programmatic and
policy implications - Content of case management and related services
moves beyond health, e.g. addresses education and
poverty - Services organized and delivered in ways that
build resiliency and social capital, and reduce
dependency (e.g. group activities, self-care). - Requires inter-disciplinary, inter-agency
collaboration and cooperation to address the
complex needs of at-risk families.
5Strategies
- The Healthy Start program individual case
management and risk reduction services, not
directly responsible for addressing social
determinants. - Plan strategies developed on two levels
- What actions can be implemented through Healthy
Start? - What partnerships are needed between Healthy
Start and other organizations working to address
social equity? - Looks at four phases
- Infancy
- Childhood Adolescence
- Preconception
- Pregnancy Childbirth
6Infancy
19,268 babies were born in Northeast Florida in
2007, 8 of the births statewide
Health Status Services
- INFANT MORTALITY
- Declining, but still higher than state and
national rates - Black and other nonwhite babies die at 2X the
rate - Hispanic infant mortality rising
- HEALTHY START
- Infant Screening rates have declined
- More intensive, face-to-face services but fewer
served - Fewer substance-exposed newborns served (loss of
funding for Azalea Project)
- BREASTFEEDING Optimal start reduces child- and
adulthood obesity. Initiation has increased but
not duration. No hospitals in NEFL are
Baby-Friendly (WHO). - SAFE SLEEP Sudden Unexplained Infant Deaths
(SUIDS) leading cause of postneonatal (28-364
days) deaths most preventable. - LOW BIRTH WEIGHT Disparities in low and very low
birth weight place more minority children at risk
of life-long physical and development handicaps.
NICU stays and costs are rising.
7- Social Determinants
- LOW-INCOME MOTHERS More moms on Medicaid, fewer
graduate HS - 43 of moms on Medicaid in 2007 up from 33 in
2003 - 16 of babies born to white moms with no HS
education 20 of black moms - 25 of moms in Baker County lacked HS education
in 2007 - SINGLE MOTHERS Growing number, impact on family
income - 40 of babies born to single moms 60 of black
babies - Two-parent families earn more money
- Fathers info on 60 of birth certificates play
vital role in development, economic status
- ENVIRONMENTAL TOBACCO SMOKE (ETS) Risk factor
for SUIDS, asthma - 10 of babies born to mothers who smoked
during pregnancy higher than state - 9 exposed to second-hand smoke 1hr a day
- White moms smoke at higher rates
- Healthy Start smoking cessation
8Goals Strategies
- REDUCE Infant mortality, infant mortality
disparities, postneonatal mortality, LBW - INCREASE Breastfeeding initiation and duration
- HEALTHY START STRATEGIES
- Increase screening, initial contact rates.
- Provide more-focused education and support
- Include fathers in services.
- Improve continuity of care (NICU, other prenatal
high-risk moms). - CRITICAL PARTNERSHIPS
- Screening rates Area hospital council, Florida
OB/GYN Society (FOGS) - Fathers Jacksonville Childrens Commission,
Jacksonville Urban League, WorkSource, area
health departments, Healthy Families programs - Hispanic outcomes Council of Spanish Speaking
Organizations, Mayors Hispanic Advisory Council,
Spanish Association of North Florida Inc.,
Jacksonville Hispanic Lions Club, Hispanic media,
and Hispanic Chamber of Commerce - Breastfeeding NEF Breastfeeding Collaborative
- Poverty Family Foundations, WIC, Healthy People,
Healthy Communities
9Childhood Adolescence
About 329,000 children ages one-19 live in
Northeast Florida. Children in the region
comprise about 8 of children statewide
Health Status Services
- HEALTH INSURANCE Lower rates of Medicaid,
Florida KidCare in region - HEALTH CARE Wolfson Childrens Hospital had the
most ER visits Nemours provides specialty care - SCHOOL HEALTH SERVICES Funding higher but varies
greatly by county, as do health classes and nurses
- CHILD DEATHS
- Accidents are leading cause homicide is
second-leading cause for 15-19 year-olds (2X
state rate) - OVERWEIGHT
- 30 of 1st graders overweight or at-risk
- Insufficient physical activity
- CHILD ABUSE
- Regional rates higher than state rates
- Leads to future negative behaviors
- STIs HIV/AIDS
- High rate of teen STIs, especially Duval County
- Duval has one of highest rates of teen HIV/AIDS
cases - TEEN PREGNANCY
- Teen pregnancy and repeat births decreased
slightly - SUBSTANCE ABUSE
- Teen rates decreasing, more prevalent among whites
10- Social Determinants
- POVERTY 12 of families with children lt18, more
than 50 of families in Baker County with mom as
head of household and kids ltage 5 - SOCIAL SERVICES Food Stamp enrollment rising
cash assistance down - HOUSING Older in NEFL Duval has older housing,
higher lead poisoning rates, while almost 90 of
Baker County homes have septic tanks
High School Graduation Rate, NEFL Florida,
2006/2007 2007/2008
- SCHOOLS Students in NEFL fare worse than their
counterparts statewide
Source JCCI 2008 Quality of Life Report,
2006/2007-2007/2008
11Goals Strategies
- REDUCE Body Mass Index in 1st Graders, Teen STI
Rate, Repeat Teen Pregnancies - HEALTHY START Promote breastfeeding Address
poverty in case management (GED, EITC) Link teen
moms to prevention services Address murder
rate, health education through partnerships - CRITICAL PARTNERSHIPS
- Education School Board, Achievers for Life,
Learning to Finish, AWARE School for Teen
Parents, the Jacksonville Community Foundations
Quality Education for All, Jacksonville
Commitment. - Poverty The United Way, Real ense.
- School success Jacksonville Urban League (Head
Start), the Early Learning Coalitions, Episcopal
Childrens Services, Jax Childrens Commission. - Tobacco use County health departments, SWAT.
- Uninsured Department of Children and Families,
AHCA. - Crime, IM Jaguars Foundation, Media, JCCI.
- Teen pregnancy, STI rates Youth development
programs, local churches/faith-based
organizations, barbershops, salons. - Nutrition, obesity WIC
12Preconception
In 2007, there were 283,865 women of childbearing
age (15-44 years old) residing in Northeast
Florida. The number of women age 15-44 years old
is expected to reach nearly 300.000 by 2014
Health Status Services
BABY SPACING 25 had birth intervals lt18 months
- shows lack of contraceptive use, need for
family planning services, counseling FAMILY
PLANNING Medicaid waiver underutilized health
departments provide most services OVERWEIGHT 40
overweight or obese prior to pregnancy black
women impacted more ACCESS TO CARE One-third are
uninsured prior to pregnancy. FOLIC ACID Only
40 of women take a multi-vitamin with folic acid
daily but 77 know pre-pregnancy consumption
reduces birth defects
- PRE-PREGNANCY
- Maternal health and prematurity greatest
proportion of fetal infant deaths - Pre-existing conditions (diabetes and
hypertension STIs obesity and poor nutrition)
are factors - UNINTENDED PREGNANCIES
- More than half of pregnancies are unintended
- UNHEALTHY HABITS
- 20 smoked prior to pregnancy
- STI rates are 40 higher in NEF (pre-term birth,
other poor outcomes) - HIV/AIDS rates are high, especially for black
women
13Social Determinants
- DOMESTIC VIOLENCE Most victims are women.
- 60 higher rate of health problems
- NEFL consistently exceeds statewide rates
- Shelters in the region served 1,400 women and
children in 2007-08 - NEIGHBORHOOD CRIME VIOLENCE Homicide rate in
NEFL is 70 higher than state rate - Disproportionately impacts poor and minorities
-
14Goals Strategies
- REDUCE Preconception tobacco use, STI rate,
- INCREASE Preconception folic acid consumption,
interconceptional intervals of 18 months or
greater - HEALTHY START Promote multivitamin use
Increase interconceptional counseling, smoking
cessation services Promote use of
family-planning waiver Provide info on family
planning services for families, men. - CRITICAL PARTNERSHIPS
- Family planning, waiver OB/GYNs, State Agency
for Health Care Administration (AHCA). - Preconception health, folic acid info
Universities and private colleges (Flagler, JU),
community colleges, juvenile justice programs,
outward bound, half-way houses, the Tiger SHOP,
foster care group homes WIC March of Dimes. - Tobacco use Florida Quit Line, Area Health
Education Centers (AHECs). - Medical homes for uninsured Hospital Emergency
Room Alternatives Program (HERAP).
15Pregnancy Childbirth
There were more than 19,000 deliveries in
Northeast Florida in 2007. Fertility rates
(births to women age 15-44 years old) in the
region rose from 65.9 to 67.9 between 2005 and
2007
Health Status Services
- PREGNANCY
- More births to women age 20-24 and fewer to
mothers over age 35 - St. Johns most older mothers Baker Nassau
most age 17 and under - PRENATAL CARE
- 2x receive late or no prenatal care in NEF black
women have highest rates - Women on Medicaid more likely to receive no
prenatal care - Most care provided by private doctors
- C-SECTIONS
- Regional rates are higher than the state
- Shands Jacksonville has lowest rate in the state
Baptist Medical CenterNassau has one of the
highest
SUBSTANCE USE Impacts Fetal Alcohol Spectrum
Disorders, asthma Tobacco use high in
NEF INFECTIONS Associated with poor birth
outcomes PRE-TERM DELIVERIES Prematurity 2x
higher for blacks Late pre-term deliveries
rising. MATERNAL MORTALITY Consistently higher
than state rate, particularly high among
non-whites HEALTHY START Prenatal screening
rates low more intensive, face-to-face
services BIRTH CONTROL Post-partum birth control
use low Higher of women unable to pay for it
in NEF
16Social Determinants
- SINGLE MOTHERHOOD Higher rates of poverty,
reduced social support More than 40 of births
in the region were to unmarried mothers in
200733 white, 46 Hispanic and 62 of black
mothers. - FATHERS Feelings about pregnancy affects role in
pregnancy and childs life. - SOCIAL ENVIRONMENTAL FACTORS Arguing
excessively with partner, financial difficulties,
loss of partner or friend, maternal or paternal
incarceration, abuse - MATERNAL STRESS Linked to pre-term labor
- RACISM Creates disparate affect on black women
and contributes to their poor birth outcomes
17Goals Strategies
- REDUCE Proportion delivering with late or no
prenatal care, tobacco use during pregnancy,
maternal deaths, single mothers - HEALTHY START Implement outreach in hospital
ERs Promote simplified Medicaid enrollment
Promote breastfeeding Collaborate with chronic
disease prevention Provide info on consequences,
impact of single motherhood Increase screening
rates, initial contacts and intensive,
face-to-face services Provide group prenatal
care and case management - CRITICAL PARTNERSHIPS
- C-Section Rates Delivering hospitals and OBs
- Tobacco use American Lung Assn.
- Birth control Family planning providers in the
community - Medicaid eligibility, coverage and enrollment
process AHCA DCF - Healthy Start screening OBs, prenatal care
providers - Father involvement Jacksonville Urban League
Head Start, county health departments, other
community-based initiatives - Postpartum obesity WIC
- Chronic disease, maternal mortality Healthy
People, Healthy Communities
18Community Perspectives
- JCCI Town Hall meetings five diverse groups (60
participants) discussed causes and what to do
about black infant mortality - Focus groups what does community know?
- Common themes
- Need for education, information
- Impact of stress, lack of trust
- Impact of poverty
- Lack of awareness, concern among leaders
- Need for personal support, community involvement
19What does the plan tell us?
- Todays babies are tomorrows mothers and
fathers. - Significant improvements in infant mortality, low
birth-weight and other MCH indicators unlikely to
occur unless the health and social status of NEFL
residents is addressed across the life-course. - We can improve the effectiveness of Healthy Start
in impacting individual risks and behaviors in
and around pregnancy. -
- There are opportunities to focus and expand the
content of case management to address social
determinants. - Collaboration and partnerships are critical to
reducing social and environmental risks, building
resiliency and achieving health equity.
20Partnerships
- Collaboration essential to address complex needs
of families - Supports coalitions commitment to collaboration
and to addressing infant mortality within a
broader community context. - Builds on community engagement efforts
- Friendly Access
- Black Infant Health Practice Initiative
- Black Infant Health Community Council
- Magnolia, Azalea Projects
- St. Johns Infant Mortality Task Force
21Thanks!
- 2009 Planning Committee
- Thomas Bryant III, Chair
- Carolyn Arnister
- Karen Coleman
- Rev. Alton Coles
- Monica Floyd-Cox, RN
- Linda Hemphill
- Heather Huffman, RD, IBCLC
- Dave Malone
- Lisa Pelle