United Way Success By 6 Liberty City Outreach Initiative Funded by Presented by Success By 6 Initiative.

United Way Success By 6 Liberty City Outreach Initiative

Funded by

Presented by

Success By 6 Initiative

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Overview of Healthy Start

Implemented on April 1, 1992

Reduce infant mortality, reduce the number of low birth weight and preterm babies and improve health and developmental outcomes.

Offers universal prenatal and infant risk screening to identify pregnant women and infants at risk for adverse birth, health and developmental outcomes.

Offers care coordination services that support families in reducing factors that place pregnant women and infants at risk for poor outcomes.

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Introduction

Grant awarded in October 2002 to the Healthy Start Coalition of Miami-Dade in partnership with the Economic Opportunity Family Health Center, Teen Pregnancy Prevention Center, and the Health Council of South Florida.

Funds are available from the United Way of Miami-Dade Success By 6 Program.

Intermediate goal of the Initiative is to increase the number of completed Healthy Start prenatal screens by conducting intensive outreach to pregnant women and teens in zip codes 33147 and 33142 (Liberty City).

Long-term goal is to reduce the rate of preterm births in the targeted zip codes.

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Identified Needs in Liberty City

Healthy Start Needs Assessment 2001 revealed 12.8% babies were born preterm in Liberty City, 3.2% more than Miami-Dade County 9.6%.

67.7% of all babies in Liberty City were born to non-Hispanic Black mothers. Non-Hispanic Blacks and teenagers are more likely to experience preterm birth.

Liberty city ranked within the top ten countywide for the following risk factors:

mothers receiving late or no prenatal care,

low birth weight births,

births to teens, and

births to unwed mothers

30.6% and 31.1% of residents in zip codes 33147 and 33142, respectively, under age 65 were uninsured more than the county-wide average of 26.7% (Miami-Dade County Health Insurance Survey).

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DesignOutreach and self-referrals in Liberty City

Increase Healthy Start prenatal risk screens (Early detection of women who are identified at risk for poor birth outcomes)

Provision of Healthy Start core services

Decrease preterm birth in Liberty City from 12.8% in 1999 to 10.6% in 2005

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Primary Strategies

Marketing campaign in Liberty City

Street level outreach to pregnant women and teens

Development and dissemination of educational materials

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Sample Billboard Ad

Outreach Efforts Results2002 - 2005

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Zip Codes of Participation

Liberty City falls within zip codes 33147 and 33142.

Historically known for poor health and socioeconomic status.

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Participants by Zip CodeOctober 2002 – September 2005

0

200

400

600

800

1000

1200

Nu

mb

er

of

Pa

rtic

ipa

nts

33142 99 111 157

33147 108 101 202

Other & Unknown 357 495 769

TOTAL 564 707 1128

Year 1 Year 2 Year 3

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Age of Self-referred Women in Targeted Zip Codes, 2002-2005

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

Under 18 20.2% 20.6%

Over 39 2.1% 1.0%

33142 33147

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Self-Referrals by Race & Ethnicity October 2002 – September 2005

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Non-Hispanic White 11.4% 8.8% 4.9%

Non-Hispanic Black 77.4% 59.7% 59.9%

Hispanic 6.8% 26.3% 30.1%

Other 2.7% 5.2% 5.1%

2002-03 2003-04 2004-05

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Healthy Start Awareness Among Liberty City Participants

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

Year 1 24.6% 27.1% 22.2% 32.3% 23.2%

Year 2 22.3% 26.9% 25.7% 27.9% 20.4%

Year 3 22.8% 29.2% 24.8% 35.0% 19.8%

Total Initiative Target Area 33147 33142 Other/Unknown

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Consent to Participate in Healthy Start Among Liberty City Participants

90.0%

92.0%

94.0%

96.0%

98.0%

100.0%

Year 1 95.2% 96.6% 96.3% 97.0% 94.4%

Year 2 96.5% 97.2% 99.0% 95.5% 96.2%

Year 3 99.1% 99.2% 99.5% 98.7% 99.1%

Total Initiative Target Area 33147 33142 Other/Unknown

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Achievements

24.8% of women from 33147 and 35% from 33142 were aware of Healthy Start, which is higher than that found in other/unknown zip codes (19.8%).

Number of Healthy Start prenatal screens processed in the target zip code 33147 (528) and 33142 (625) in Year 3 were significantly higher than the baseline year 484 and 490,respectively. 9.1% increase for 33147 and 27.6% increase for 33142.

100% of women consented to be screened in the target areas compared to 76% in Miami-Dade County in Year 3.

100% of self-referred women from 33147 and 33142 were assigned to Healthy Start providers.

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Healthy Start Prenatal ScreensNumber of Screens Processed by

Target Zipcode, 2001-2005

0

100

200

300

400

500

600

700

2001-02 2002-03 2003-04 2004-05

Nu

mb

er

of

Scre

en

s

33142

33147

Source: Florida Department of Health HPE

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Healthy Start Prenatal ScreensPercent HS Screens Processed

in Target Zip Codes and MDC, 2001-2005(Number of Screens Processed/Number of Live Births)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

2001 2002 2003 2004 2005

Perc

en

t S

cre

en

s P

rocessed

33142

33147

MDC

Source: Florida Department of Health HPE

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Live Births in Target Zip CodesNumber of Live Births in Target Zipcode

2001-2005

0

100

200

300

400

500

600

700

800

900

1000

2001 2002 2003 2004 2005

Nu

mb

er

of

Liv

e B

irth

s

33142

33147

Source: Resident Births from the Florida Department of Health, Office of Vital Statistics.

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Self-Referral ResultsBased on the Self-Referral forms, the leading risk factors for referral to Healthy Start were: unmarried (82.4%) and Black race (60.5%).

‘Other’ reasons for referral were cited by 82.6% of women. Most cited ‘Other’ reason include:

participation in Healthy Start classes/services (25%)stress/depression (unspecified, maternal/postpartum) (24.8%)stress without mention of depression (22.7%)

99.1% of women who were referred using the Self-Referral form consented to participate in Healthy Start.

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Long-Term GoalLong-term goal is to reduce the rate of preterm births in the

targeted zip code.

Preterm Births (<37 weeks Gestation)Targeted Zip Codes, 2001-2005

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

2001 2002 2003 2004 2005

Perc

en

t P

rete

rm B

irth

s

33142

33147

County

Source: Resident Births from the Florida Department of Health, Office of Vital Statistics.

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Initiative ObjectivesObjective 1. Increase the number of Healthy

Start prenatal risk screening rate in the target area from 54.2% to 65% by YR03. Measure/Indicator: Number of prenatal risk screens processed.Baseline: 54.2% in 1999; Year 1: 66%; Year 2: 71%; Year 3: 76%

Activities: Intensive face-to-face outreach to pregnant women and teens;Educational materials/incentives disseminated in the target zip code area.

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Initiative Objectives (con’t)

Objective 2. The estimated total number of unduplicated clients to be referred for Healthy Start services: Year 1 1,000 Year 2 1,000 , and Year 3 1,000 . Measure/Indicator: Number of Self-referrals.Year 1: 564; Year 2: 707 ; Year 3: 1,128

Activities:Intensive face-to-face outreach to pregnant women and teens;Educational materials/incentives disseminated in the target zip code area.

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Initiative Objectives (con’t)

Objective 3. Increase knowledge of Healthy Start services and the Healthy Start risk screen by directly and indirectly educating and reaching 1,500 pregnant women during Year 3.Measure/Indicator: Number of women directly or indirectly reached. Year 1: 1,348; Year 2: 2,171; Year 3: 8,946

ActivitiesMedia and marketing campaign in Liberty City targeting pregnant women and teens to improve their knowledge and awareness of Healthy Start prenatal risk screen;

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Initiative Objectives (con’t)

Objective 4. Increase awareness of Healthy Start services and the Healthy Start risk screen by 5% each year in the 33147 and 33142 zip code areas. Measure/Indicator: Healthy Start recognition among women in the targeted zip code area.Year 1: 27%; Year 2: 27%; Year 3: 29%.

ActivitiesMedia and marketing campaign in Liberty City targeting pregnant women and teens to improve their knowledge and awareness of Healthy Start prenatal risk screen.

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Process Achievements/LimitationsOutreach partners exceeded their goal for contacts (90 per month); 12,465 women were directly or indirectly reached.

Direct outreach (i.e. street-level) was the most successful

Follow-up procedures were perceived as labor intensive and unrealistic

Each outreach partner adopted their own method of follow-up

Outreach partners found that prescreened women came to expect a high level of interaction with Healthy Start case managers

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Process Achievements/Limitations

Forms were changed on several occasions in Year 1 and 2 to adequately document the outreach efforts

At the conclusion of Year 1, the Coalition saw a need to expand the outreach activity zip code to include 33142

Staff turnover

Hurricane 2004-2005

Lack of infrastructure or need for professional and technological capacity building among outreach partners

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Conclusions/Lessons Learned

Community based organizations are essential in the provision of services to respective communities.

Outreach partners were committed to the Initiative. Outreach partners feel that lack of adherence to protocol is related to their general concern about how changes will affect the community they serve and their ability to serve .

Target area is socio-economically depressed that it is difficult for the population to focus on, obtain, or heed advice regarding health, pregnancy and outcome.

Overall, the Initiative was successful, increasing awareness and utilization of Healthy Start services.

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RecommendationsChanges in documentation should be limited to assure complete, accurate and continuous data and information

Provide technical assistance in infrastructure development and capacity building

Offer educational sessions related to pregnancy, women’s health, infant health and adequate child care

Substantial incentives including grocery gift certificates, infant car seats, diapers, strollers, cribs, baby clothing, etc.

Provide formal structured training to outreach staff to include identification of appropriate outreach sites, capitalizing on activities and events, managing stress and burnout, using different methodologies and settings to increase numbers and participants reached.

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Contact UsTrecia Matthews Hosein

Director of Quality Improvement & Assurance

Healthy Start Coalition of Miami-Dade701 S.W. 27TH AvenueMiami, Florida 33135

Phone: (305) 541-0210Fax: (305) 541-0213

E-mail: [email protected]

www.hscmd.org