First Year Cleveland Community Action Council Meeting August 11, 2020 so far, and then transition to the new section of content.
Welcome and Update from First Year Cleveland
• Bernie Kerrigan
2 FYC • FYC Response to Two Pandemics: Update Racism and COVID-19 • Update on COVID-19 Activities Bernie Kerrigan • Update on the City Declaring Racism a Public Health Crisis • Update on FYC Action Teams and today you will hear from FYC Action Team 5 FYC Portion of Rapid Update Response funds used to promote message of COVID-19 safety and racial equity via WENZ, WZAK and WJMO FM so far, and then transition to the new section of content.
FYC 2021-2023 Strategic Planning Kickoff
• Chris Neumann • Sandy Chappelle
2 CENTER FOR ACHIEVING EQUITY First Year Cleveland Strategic Plan and Equity Assessment
August 11, 2020 Center for Achieving Equity (CAE) First Year Cleveland - Strategic Planning and Equity Assessment
• Who We Are - CAE Mission and Approach • Consulting Team Members: • Sandra Byrd Chappelle, Vedette Gavin, Corrina Wainwright • Our Work With First Year Cleveland • Your Role: Focus Groups, Interviews, Surveys so far, and then transition to the new section of content.
ODM Round #4 Funding Update
• Chris Neumann
2 so far, and then transition to the new section of content.
2020 Census
• Audrey Wynne
2 so far, and then transition to the new section of content.
Update on Unaudited Q2 2020 Infant Death and Premature Birth Data
• Richard Stacklin
3 11
RECENT INFANT MORTALITY & BIRTH OUTCOME DATA First Year Cleveland – Advisory Council Meeting August 10, 2020
Presenter: Richard Stacklin, M.Ed. Data Analyst Epidemiology, Surveillance & Informatics Cuyahoga County Board of Health 12
Outline
• Longitudinal Infant Mortality Trend
• 2020 Infant Mortality (IM) Data by Month
• Running 4 Quarters IM & Prematurity Data • 2nd-4th Quarter 2019 & 1st Quarter 2020
Data from Ohio Department of Health – Bureau of Vital Statistics • The Department specifically disclaims responsibility for any analyses, interpretations or conclusions. 13
2016-Prelim 2020 Infant Mortality 14
2016-2020 Infant Mortality Data:
20
16.1 16.3 15.5 15.3 16 15.0
12 10.7
8.68 8.5 8.65 8.61 7.84 8 6.9 8.11
3.9 3.8 4 4.5 3.8 1.8 3.0 2.4 0 2016 2017 2018 2019 2020 Overall Black Non-Hisp Hisp White Non-Hisp
Source: Ohio Department of Health - Bureau of Vital Statistics; 2019 & 2020 data are preliminary 2016-2020 Cuyahoga County Black-White Infant Death Inequity 8
7 6.71
6
5
4.17 4.12 4.02 4 3.31 White Inequity Ratio
- 3
Black 2
1
0 2016 2017 2018 2019* 2020*
*2019 & 2020 rates are preliminary 16
Prelim 2020 Data by Month 17
Total Infant Deaths by Month – 2020
14 13
12 11 10 10 9 8 7 6
5
Number of Deaths 4 4 2 Preliminary 2020 Infant Death Count = 59 0 Jan Feb Mar Apr May Jun Jul
2020 data are preliminary 18
Infant Deaths by Month by Sex – 2020
14
12
10
8
6
4
2
0 Jan Feb Mar Apr May Jun Jul Female (29) Male (30)
2020 data are preliminary 19
Infant Deaths by Month by Age – 2020
14
12
10
8
6
4
2
0 Jan Feb Mar Apr May Jun Jul Neonatal (36) Postneonatal (23)
2020 data are preliminary 20 Infant Deaths by Month by Ethnicity or Race – 2020 14
12
10
8
6
4
2
0 Jan Feb Mar Apr May Jun Jul Black non-Hispanic (44) Hispanic (1) White non-Hispanic (14)
2020 data are preliminary 21
Rolling 12 Months - Quarterly Data July 2019 - June 2020 22 Infant Mortality Rate by Ethnicity or Race 3rd-4th Quarter 2019 & 1st-2nd Quarter 2020 20 HealthyPeople 2020 Target = 6.0 per 1,000 live births
16 16.5 16.6 16.0 15.1
12
8.7 7.8 7.9 8.0 8
4.6 4.2 4.1 Infant Mortality Rate 4 3.5 2.7 3.1 0.0 0.0 0 3rd QTR '19 4th QTR '19 1st QTR '20 2nd QTR '20 Overall Black non-Hisp Hispanic White non-Hisp
Source: Ohio Department of Health - Bureau of Vital Statistics; 2019 & 2020 data are preliminary 23 Preterm Birth Rate by Ethnicity or Race 3rd-4th Quarter 2019 & 1st-2nd Quarter 2020 20% HealthyPeople 2020 Target = 9.4% or less
16.1% 15.9% 16% 15.2% 14.3% 13.3% 11.9% 12% 11.8% 11.5% 11.3% 9.5% 10.8% 8.8% 9.8% 8% 8.4% 8.5% 7.5%
4%
0% 3rd QTR '19 4th QTR '19 1st QTR '20 2nd QTR '20 Overall Black non-Hisp Hispanic White non-Hisp
Source: Ohio Department of Health - Bureau of Vital Statistics; 2019 & 2020 data are preliminary 24 Very Preterm Birth Rate by Ethnicity or Race 3rd-4th Quarter 2019 & 1st-2nd Quarter 2020 5% HealthyPeople 2020 Target = 1.5% or less
3.9% 4% 3.7%
3.2% 3.2% 3% 2.4% 2.4% 2.3% 2.1% 2% 1.8% 2.0% 1.6% 1.7% 1.7% 1% 1.3% 1.4%
0.6% 0% 3rd QTR '19 4th QTR '19 1st QTR '20 2nd QTR '20 Overall Black non-Hisp Hispanic White non-Hisp
Source: Ohio Department of Health - Bureau of Vital Statistics; 2019 & 2020 data are preliminary 25 Births 22 Weeks or less by Ethnicity or Race 3rd-4th Quarter 2019 & 1st-2nd Quarter 2020 10 Overall count = 41 8 8 8 7 6 6 5
4
2 2 1 1 0 0 0 0 0 3rd QTR '19 4th QTR '19 1st QTR '20 2nd QTR '20 Black non-Hisp Hispanic White non-Hisp
Source: Ohio Department of Health - Bureau of Vital Statistics; 2019 & 2020 data are preliminary 26
Summary
• Significant decrease in babies born 22 weeks or less
• Decrease in overall infant mortality and prematurity in 2020
• Inequity ratios still very high so far, and then transition to the new section of content.
Report from Local OEI Leadership on 2020 Efforts
• Lisa Matthews • Angela Newman-White • Marie Jones
6 Ohio Equity Institute
Identifying Opportunities to Improve Birth Outcomes
Lisa Matthews Angela Newman-White Marie Jones Cleveland-Cuyahoga Partnership
Led by Cuyahoga County Board of Health and City of Cleveland Department of Public Health Established county-wide partnership in 2014 Quarterly meetings to provide program and data presentations, networking opportunities, and strategic prioritization Past efforts include: CenteringPregnancy expansion Long Acting Reversible Contraception Cleveland-Cuyahoga Partnership
One Life, One Voice, One Community
Platform to provide community-friendly conference that focuses on education, advocacy, skill-building, and service connection in a relaxed, fun, family friendly atmosphere 3 events held (2015, 2017, 2019) engaging over 2,700 mothers, fathers, and community members Next event in 2021 pending Cleveland-Cuyahoga Partnership Coordination of annual county wide training for professionals who work with MCH population Provide most up to date education and resources that address supportive and risk factors for infant death Ensure consistent messaging across all home visiting programs Provide networking opportunities
Next training planned for late 2020/early 2021 Cleveland-Cuyahoga Partnership
Current strategy: Improve Breastfeeding rates among Black women Partnership with Black Mothers’ Breastfeeding Association to improve black breastfeeding outcomes 8 churches and 2 childcare centers awarded $500 mini grant to enhance or establish breastfeeding friendly spaces MomsFirst secured a Leading Lady Nursing Bra donation for World Breastfeeding Month (August) that will be disseminated to program participants in City of Cleveland Promotion of breastfeeding education and resources on the Momsfirst.org website, including the Ohio Breastfeeding Support Hotline Working with businesses to develop and implement breastfeeding policies OEI 2.0
Led by the Cuyahoga County Board of Health and Neighborhood Leadership Institute
Maternal and Child Health Epidemiologic capacity Social Determinants of Health Task Force Neighborhood Navigation Social Determinants of Health Task Force Multi-Sector Stakeholder Group formed to facilitate development and implementation of policy and systems changes that address social determinants of health
One Community groups comprised of individuals who live, work, learn, or worship in targeted communities that provide community voice to inform policy development Social Determinants of Health Task Force 2018 - identified labor and delivery dessert in county’s south east side 2019 - increased provider/patient communication; educated community through presentations and distribution of palm cards 2020 - Provided request to First Year Cleveland Executive Committee that included: 1. OB Triage at emergency rooms in zip codes with higher incidence of preterm birth and/or fetal/infant death 2. Improve access to patient medical records across systems (between the UH systems and Cleveland Clinic/Metro systems) 3. Training for EMS providers to include L&D destinations Social Determinants of Health Task Force 2019- identified transportation as area to be addressed Current landscape of labor and delivery hospitals required travel of at least 6 miles for residents in southeast quadrant 40% of women engaged in Navigation identified transportation as a barrier to care Managed Care Providers’ transportation support has limitations Partnership with GCRTA Ohio Department of Transportation released funding opportunity for transit agencies to address social determinants Data utilized to inform proposal for $400,000 to address communities of highest need Data analysis revealed a number of communities with high percentages of households without a vehicle
Key risk factors to identify target zip codes were: • % of households without vehicle • Infant Mortality Rate
Target Zip Codes: 44108, 44110, 44112
INFANT MORTALITY PER ZIP CODE All-HH HH-2Plus HH- Zip Code IMR IMR-Rank w/o vehicle Rank w/o vehicle HH2-Rank Black % 44110 26.88 2 30.05% 7 19.75% 8 82.27% 44112 16.95 3 31.40% 6 16.13% 9 90.32% 44108 14.75 6 28.35% 10 23.24% 5 90.36% County 8.48 13.22% 7.08% 29.61% Partnership with GCRTA Baby on Board Project scope: Providing vouchers to families who are able to access public transit Private transportation services (with carseat) for those with challenges accessing public transportation Improve infrastructure and safety at bus stop locations (seating, shelter, lighting, etc.)
Funding decision still pending Ensuring access to services Neighborhood Navigation
Neighborhood Navigation is the downstream strategy of the current Ohio Equity Institute.
Purpose is to identify pregnant residents in Cuyahoga county and provide connection to supportive services which includes home visiting support.
The team that does the direct service work includes NLI Healthy Communities staff, contracted Neighborhood Navigators, and our partner organizations.
The data is analyzed by Cuyahoga County Board of Health Epidemiologists. The dashboard of data which is being shared with you today was created by one of the CCBH epidemiologists, Taytana Khaled. Neighborhood Navigation
Needs Services Needs % Outreached Identified Screened Served Referred Needs Utilized ODH - OEI Identified Utilized Cuyahoga County Board of Health Meeting the Target Dashboard 73% Total Women 4,000 3,925 1,942 49% 7,706 1,271 1,244 933 99% African American
Age Causes of Stress Barriers to Attending Prenatal Care 350 Pregnancy Transporation 300 Work 250 Work Schedule Relationship 200 Housing Insurance Coverage 150 Health Concern Cost of Appointment 100 Lack of food, hunger 50 Childcare Parenting 0 Day to day activities Lack of Providers 15-19 20-24 25-29 30-34 35-39 40+
Count 0 100 200 300 400 500 600 700 0 50 100 150 200 250
Level of Completed Education Setting of Recruitment Actual Women Served 180 158 160 High School Diploma or Equivalent 639 SOCIAL MEDIA 134 140 117 120 107 95 Less than High School 161 MEDICAL OFFICE 100 86 80 72 69 60 48 44 Some college, no degree 109 All JFS Locations 40 20 Bachelor’s Degree or More 12 COMMUNITY EVENT 0
Associate's Degree 12 FAMILY REFERRAL
0 100 200 300 400 500 600 700 0 50 100 150 200 250 Served Goal of 106 What’s next? Continue advocacy to improve pregnancy related medical services for women in their communities. Continue to strengthen relationship with medical providers and systems to utilize navigation services Continue to connect women to services Continue to explore opportunities to ensure families are able to access goods and services Continue to utilize data in unique ways to push for polices and system changes Expansion of One Community into other areas One Community at a time so far, and then transition to the new section of content.
Report on Child Fatality/ Fetal Mortality
• Lorrie Considine
6 Child Fatality Review Fetal Infant Mortality Review Lorrie Considine, Erin Dodds August 2020 Topics
• Child Fatality Review Program (CFR) • Fetal Infant Mortality Review Program (FIMR) • Purpose • Process • Outcomes What is Child Fatality Review?
• A process to tell the story of a child’s death – one child, one death at a time • Look at the causal pathway • Identify risk factors and circumstances • Multiple sources • How to interrupt the pathway Child Fatality Review
• Ohio Revised Code • CFR in every county • Review deaths of all children under 18 years • Medical & medical examiner cases • Interdisciplinary committee • Collect data for local use & national database Purpose/Benefits of CFR
• Note trends • Racial disparity, types of deaths, risk factors, social determinants of health
• Identify gaps/barriers in service
• Encourage interagency communication & collaboration
• Advocate for change in policy or practice to improve health & safety of children
• Prevent deaths Outcomes for CFR
• Statewide safe sleep campaign • Hospital safe sleep education • Bumper pad ban • Agency policy changes • Multi-system, cross-sector stakeholder group What is FIMR?
§ Identifies local infant mortality issues
§ Multi-disciplinary and multi-agency
§ Confidential, Not fault finding
§ Utilizes the “Life Course Perspective”
§ Develops recommendations for system & policy changes
§ Implements the recommendations FIMR Process
- Family Interviews - Data Abstraction (Chart Reviews)
Data - Policy Change Gathering - Systems Change - Healthier Moms, Babies, and Families
Change Cycle of Case in Systems Improvement Review
- Case Review Team Community - Case Review Meetings - Community Action Team Action - Recommendations - Community Action Meetings - Act on Recommendations Fetal Deaths in Cuyahoga County (2015-2018) [n=439]
200
160 142 124 120 96 77 80
40
0 Fetal Deaths 2015 (n=142) 2016 (n=124) 2017 (n=96) 2018 (n=77) Gestational Age of Fetal Deaths Cuyahoga County (2015-2018) [n=439]
60 56 52 50 41 40 34
30 27 22 22 2120 18 20 16 15 14 12 13 12 1011 10 11 10 2
0 2015 (n=142) 2016 (n=124) 2017 (n=96) 2018 (n=77) 20-23 weeks 24-27 weeks 28-31 weeks 32-36 weeks 37+ weeks Unknown FIMR Family Interviews
- 35 interviews conducted to date - Free, offered to everyone - Mom, Dad, Grandparents… - Average 2-3 hours long - Qualitative Date - Confidential - Not fault finding - System support/ improvement focus 2019 Recommendations
• Promote good patient/provider communication including when to go to the hospital due to symptoms. • Improve access to Labor and Delivery Hospital Care for pregnant moms in the southeast part of Cuyahoga County (44125, 44128, 44137, 44139, & 44146 zip codes). Symptoms at Home
• I was worried I was bothering them.
• I didn’t know the signs of preterm labor.
• I was embarrassed that I’d be sent home for false labor.
• It seemed like my doctor would make excuses for my symptoms.
• I didn’t want to go to the hospital, be sent home, and feel like a bother.
• I called once and was told my symptoms were normal, so I was hesitant to call again.
• I noticed the baby wasn’t moving as much that night, but I waited to call until the next day. Previous Loss
• The doctor met with me and heard my previous experience.
• The OB is seeing me more often.
• The OB has a set birth plan and that feels good.
• I asked if I could be seen once a week and the doctor said yes.
• The doctor told me to stop by the office anytime I need to hear the heartbeat.
• The doctor gave me his/her cell phone number. Social Determinants of Health
• I was trying to find a way to the NICU before my baby died and the police stopped me. It’s because I’m an African American male – it happens all the time. I asked them if they could drive me there.
• I was upset when I saw (online) that the doctors had done a narcotics test on me and never told me. I felt judged and it hurt. The test was negative.
• I delivered my stillborn daughter by myself. I didn’t have any family there.
• My dad was murdered when I was 7, I lost my mom when I was 25. Then I moved back to Ohio with $200 in my pocket to get out of an abusive relationship. Outcomes
• Maternity hospital on southeast side • Emergency Department training • Grand rounds • Palm card Palm Card • Palm card available to patients in Cuyahoga County • Goals: • Address misuse of EMS services (emergency vs. non-emergency situations) • Educate women that not all hospitals have L&D services / need a plan for care • Encourage women to remain under one hospital system for ease of sharing patient records • Aid in facilitating communication between hospital systems
Jane Doe 12 12 20 Twins, preeclampsia Dr. John Smith at CCF Fairview Dr. John Smith 216 123 4567 Questions?
Closing •Upcoming meetings: Remarks Strategic Planning Discussion Dr. Jennifer Bailit September 22 • 8:30 a.m. Celina Cunanan Full Community Action Council Meeting November 10, 2020 • 2-4 p.m.
Thank you!