Ellie Bogue l St. Joseph Community Health Foundation Jackie Martinez, a case manager for Healthier Moms and Babies, shows a client how to set up a pack and play crib. A partnership with the Indiana State Department of Health and Cribs for Kids allows the agency to provide equipment for mothers who do not have a safe place for their infants to sleep.
babieslove.org The Babies Love website, created by McMillen Health, makes information about pregnancy testing and assistance for expectant mothers readily available on a smartphone.
Anchor Films The local chapter of Chi Eta Phi, an African-American nursing sorority, created this video promoting safe sleep habits. It is one of five videos aimed at preventing black infant mortality.
Saturday, February 25, 2017 10:01 pm
The BEST for BABY
In an article published here last April, Parkview neonatologist Sashi Kuppala pointed to a disturbing distinction: Allen County had the worst black infant mortality rate in the state, with 19.5 babies dying per 1,000 births. The statewide rate during the same four-year period was 12.9; the U.S. rate was 11.3.
"As a physician, I am alarmed by the number of infant deaths we see in our community," Kuppala wrote, "I share this information to raise awareness within the community."
Kuppala wasn’t the only one pointing to the troubling statistic. Indiana State Health Commissioner Jerome Adams began talking about the state’s 10th-worst in the nation infant mortality rate, noting the striking disparity between the rate for black and white infants. Indiana State Department of Health statistics pointed to two ZIP codes in Fort Wayne – 46806 and 46805 – where black infant mortality rates are among the highest in the state.
If the warnings raised alarm, it wasn’t apparent. No calls for community-wide task forces. No public forums to seek ideas for improvement. No marches to raise public awareness.
Fortunately, the medical community and public health professionals were already on it. More than 60 local agencies, as well as Lutheran Health Network and Parkview Health, collaborated on a proposal for a share of an $11 million state grant addressing infant mortality. In spite of the disturbing rate in this region, northeast Indiana lost out. But the urgency and interest in improving prospects for at-risk babies is strong among the players involved in the grant proposal. Here are a few of the initiatives they’ve tackled so far:
The alarming figures for black infant mortality, in particular, made it clear efforts need to target young black women. Parkview’s Community Health Improvement Program, guided by a health-needs assessment, made $50,000 available to groups for that purpose. Healthier Moms and Babies, which provides prenatal health education to women at risk for pre-term pregnancy, is at the forefront of helping expectant women who are Medicaid-eligible – a poverty indicator and at-risk factor for pre-term delivery.
The agency, with a staff of two nurses and two social workers, teaches mothers – generally beginning in the first trimester – about nutrition and exercise. Healthier Moms helps coordinate care with physicians and is available to answer questions busy doctors don’t have time to answer. The agency provides the support at-risk mothers need.
"There can be medical risk factors, but sometimes their social risk factors are even more of a detriment," said Paige Wilkins, executive director. "They can be homeless or on the edge of homelessness. No food, no transportation. We work with them to make sure they get what they need for a healthy pregnancy."
The program has impressive outcomes. There were 106 babies born last year to enrolled mothers, just two were admitted to intensive care for prematurity, which is a leading cause of infant mortality.
"A lot of times women don’t recognize the signs of pre-term labor, so we really drill that home with the women we serve at all of our home visits," Wilkins said.
To reach more young mothers who need the program’s services, Healthier Moms teamed up with McMillen Health to create a web-based information source. Babies Love is a new one-stop site for referral and information.
McMillen Health CEO Holli Seabury, who recently earned a doctoral degree in education technology, said the site was designed to target young women in the high-risk 46806 ZIP code area.
"We had a really specific goal of getting young women who are pregnant or think they are pregnant into the medical community," she said. "We wanted to create something really user friendly for young women."
Tapping her knowledge of young women and their communication habits, Seabury helped design a website easily navigated on a smartphone.
There are links to resources, but not so many as to be overwhelming. It is video-heavy, she explained, because research has shown teens prefer video to written content. The young woman who narrates is a local high school student.
"It was really important that the spokeswoman looked like someone you know around here – that she didn’t look like a super-model," Seabury said.
Information is aimed at young girls and is intentionally succinct.
"I would not assume they know what ‘prenatal care’ means," Seabury said. "We tend to give people all the information we can when the reality is we need to give them as little info as they need to get to where they need to be."
There’s a one-click link to contact someone for help. Since Babies Love went online earlier this month, Wilkins said two young mothers have sought help from Healthier Moms and Babies.
The right messengers
When local members of Chi Eta Phi, a national organization of African- American nurses, learned about the high incidence of black infant mortality here, they knew they had to do something, said chapter president Phyllis Bragg, nurse manager at the VA Northern Indiana Health Care System. The members identified focus areas – safe sleep, breastfeeding, early prenatal care, traumatic brain injury – and made members available to address each topic.
"We had to think about our intended audience and we realized young people are a lot more visual, so we decided to develop videos," Bragg said.
Again, with support from Parkview’s grant program, the sorority chose Anchor Films to produce five 30-second videos, with plans to make them available as public service announcements, on social media platforms and to show to community groups whenever possible.
Like the Babies Love website, the videos are expertly done and tailored to the target audience.
"We felt it was important to have people in the videos who looked like the audience we wanted to reach," said Chi Eta Phi’s Denise Jordan, an assistant professor at IPFW, who also appears in one of the videos. "We wanted people who looked like their sisters, their mothers, their aunts. Sometimes it takes the right messenger to get the message across. As women of color, we knew it was up to us to help share this message with the community."
Bragg, another of the video narrators, said Chi Eta Phi’s initial work showed awareness was needed in teaching the importance of prenatal health and infant care.
"I was a teenage mom myself," she said. "Breastfeeding was frowned upon. It’s not encouraged in our community. We have to talk about the benefits – the immunity it provides, the help with bonding."
She has been working to get the videos shown on local TV stations and at community events.
"It’s important to get the messages out not just to moms," Bragg said, "A lot of grandmothers are caring for babies in our community. They need to know about safe sleep. The guidelines have changed."
St. Joseph Community Health Foundation’s commitment to improving maternal and child health goes back decades.
It created Healthier Moms and Babies after the need became apparent with a Fetal Infant Mortality Review in 1994.
The foundation’s focus continues, most recently with launch of the Prenatal and Infant Care Network. With both Lutheran Health and Parkview Health serving as hosts, the network regularly pulls together more than80 professionals working in the field.
"These free, quarterly luncheons feature several local and statewide experts addressing continuing education to enable anyone in the community network of serving pregnant women, new families, participating in the delivery and or raising children in the first year to become well informed," explained foundation director Meg Distler in an email. "They use this to network and to also improve their ability to respond and refer. We have just begun to tape these presentations for those unable to make the luncheon and many agencies have reported they have shifted their programming to better utilize collaborative services."
The foundation also published a directory of low-cost, free and accessible prenatal services in the region. More than 6,800 copies have been distributed.
Getting to the cause of the community’s problem and determining how to address it is the aim of the Allen County Fetal Infant Mortality Review.
Professionals in various fields review individual cases of fetal or infant deaths, interviewing the mothers when possible.
"The parents are the real experts on their babies," according to Erin Norton, who heads up the review and is a clinical research nurse and program coordinator at Parkview Women’s and Children’s Hospital. "The cases are de-identified so names, dates, and other identifying information is removed prior to the review process. The team looks to see what community processes are working and where we need to improve. Our goal is to look for trends in how care and services are delivered to pregnant women and families and make recommendations for improvement."
The next step, according to Norton, is for a broader group of health, social service, faith, education, government and business professions to act on the recommendations.
"What is unique about the (review) process is that it is specific to our community," Norton wrote in an email. "Instead of looking at national or even state data, we are examining the problem at a local level. This allows us to hone in on Allen County, examine our strengths and weaknesses, and make changes that will have a direct impact on families here."
To that point, she adds this critical caveat:
"It is important to remember that infant mortality is a complex problem and there is not a simple solution to correct the infant mortality rates our community is seeing. We know that infant mortality is a marker of the overall health of a community. We must all find ways to make our community a healthier place to live."
Karen Francisco is editorial page editor for The Journal Gazette