Perinatal Disparities: Finding Solutions to Heal Our Communities A Call to Action

Perinatal Disparities: Finding Perinatal Disparities: Finding Solutions to Heal Our CommunitiesSolutions to Heal Our Communities

A Call to ActionA Call to Action

Translating Lessons Translating Lessons Learned in Central Learned in Central Harlem to Indiana: Harlem to Indiana:

Building the MCH Life Building the MCH Life Course OrganizationCourse Organization

September 17, 2008

Mario Drummonds, MS, LCSW, MBA

CEO, Northern Manhattan Perinatal Partnership, Inc.

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Presentation Objectives Presentation Objectives

• Document the Public Health Crisis in Harlem in Document the Public Health Crisis in Harlem in 1990 and how it was resolved by 20051990 and how it was resolved by 2005

• Reveal Direct Practice & System Changes Reveal Direct Practice & System Changes Instituted that Brought About Dramatic Changes Instituted that Brought About Dramatic Changes in Maternal and Birth Outcomes on the Ground in Maternal and Birth Outcomes on the Ground in Harlem by 2005in Harlem by 2005

• Define and describe the MCH Lifespan Define and describe the MCH Lifespan OrganizationOrganization

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The Northern Manhattan Perinatal Partnership, The Northern Manhattan Perinatal Partnership, Inc. (NMPP) is a not-for-profit organization Inc. (NMPP) is a not-for-profit organization comprised of a network of public and private comprised of a network of public and private agencies, community residents, health agencies, community residents, health organizations and local businesses. NMPP organizations and local businesses. NMPP provides crucial services to women and children provides crucial services to women and children in Central, West and East Harlem and in Central, West and East Harlem and Washington HeightsWashington Heights

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NMPP’s mission is to save babies and help NMPP’s mission is to save babies and help women take charge of their reproductive, social women take charge of their reproductive, social and economic lives. We achieve this mission by and economic lives. We achieve this mission by offering a number of programs that help reduce offering a number of programs that help reduce the infant mortality rate and increase the self-the infant mortality rate and increase the self-sufficiency of poor and working class women sufficiency of poor and working class women throughout the above communitiesthroughout the above communities

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NMPP 1995NMPP 1995

External EnvironmentExternal Environment

Funders, Business, Providers, & ConsumersFunders, Business, Providers, & Consumers

Central Harlem Healthy Start Program Central Harlem Healthy Start Program (18)(18)

Fiscal Consultant Fiscal Consultant

NORTHERN MANHATTAN PERINATAL PARTNERSHIP, INC.NORTHERN MANHATTAN PERINATAL PARTNERSHIP, INC.

MANAGERIAL/PROGRAM CHART for 1995MANAGERIAL/PROGRAM CHART for 1995

SUSTAINABILITY as ORGANIZATIONAL STRATEGIC INTENTSUSTAINABILITY as ORGANIZATIONAL STRATEGIC INTENT

NYSDOH/Perinatal Network NYSDOH/Perinatal Network (5)(5)

Board of DirectorsBoard of Directors

Mario DrummondsMario Drummonds

Executive Director/CEOExecutive Director/CEO

NYSDOH/Community Health Worker Program NYSDOH/Community Health Worker Program (5)(5)

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NMPP 2008NMPP 2008

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Central Harlem Central Harlem Infant Mortality RateInfant Mortality Rate

0

5

10

15

20

25

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1990 1992 1994 1996 1998 2000 2002

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002September 13, 2006Bureau of Vital StatisticsNew York City Department of Health and Mental Hygiene

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Infant Deaths and Infant Mortality Rate by Infant Deaths and Infant Mortality Rate by Health Center District of ResidenceHealth Center District of Residence

New York City, 2001-2005New York City, 2001-2005

Health Health Center Center DistrictDistrict

20012001

IMRIMR

20022002

IMRIMR

20032003

IMRIMR

20042004

IMRIMR

20052005

IMRIMR

New York New York CityCity

6.16.1 6.06.0 6.56.5 6.16.1 6.06.0

Central Central HarlemHarlem

13.113.1 6.26.2 7.37.3 5.15.1 7.47.4

East East HarlemHarlem

7.87.8 8.38.3 5.05.0 5.55.5 3.63.6

Washington Washington HeightsHeights

5.55.5 4.24.2 7.37.3 5.95.9 4.54.5

September 13, 2006Bureau of Vital StatisticsNew York City Department of Health and Mental Hygiene

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1990: Central Harlem Public 1990: Central Harlem Public Health CrisisHealth Crisis

• Border Baby Crisis Due to Crack EpidemicBorder Baby Crisis Due to Crack Epidemic

• 321 Newborns were Infected with the HIV 321 Newborns were Infected with the HIV VirusVirus

• 1990 Infant Mortality Rate 27.7 Deaths per 1990 Infant Mortality Rate 27.7 Deaths per 1,000 Live Births 1,000 Live Births

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1990: Central Harlem Public 1990: Central Harlem Public Health CrisisHealth Crisis

• Low Birth Weight Rates Hovered Around Low Birth Weight Rates Hovered Around 20% for Central Harlem in Early 1990’s 20% for Central Harlem in Early 1990’s

• 25% of the Women Entered Prenatal Care 25% of the Women Entered Prenatal Care In First Trimester! In First Trimester!

• Local Health System Fragmented, Access to Local Health System Fragmented, Access to Care Issues, No Plan or Political Will to Care Issues, No Plan or Political Will to Address the CrisisAddress the Crisis

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Central Harlem 2006: Central Harlem 2006: A New DayA New Day

• Infant Mortality Rate 7.4 Deaths per 1000 Infant Mortality Rate 7.4 Deaths per 1000 live birthslive births

• By 2003, Only Five Babies Born with the By 2003, Only Five Babies Born with the HIV VirusHIV Virus

• Low Birth Weight Rate at 11.3% Low Birth Weight Rate at 11.3%

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Central Harlem 2006: Central Harlem 2006: A New DayA New Day

• 92% of Central Harlem Women Accessed 92% of Central Harlem Women Accessed Prenatal Care during First Trimester Prenatal Care during First Trimester

• New Birthing Center Built at Harlem New Birthing Center Built at Harlem Hospital Hospital

• Social Movement Built Where Entire Social Movement Built Where Entire Community Takes Responsibility for Infant Community Takes Responsibility for Infant & Maternity Care& Maternity Care

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How Did We Do IT?How Did We Do IT?

1.1. ““Outcome” Case Managed 8,000 High-Outcome” Case Managed 8,000 High-Risk Women from 1990-2006Risk Women from 1990-2006

2.2. Launched an Intensive Air War Using Launched an Intensive Air War Using Private Sector Marketing Tactics to:Private Sector Marketing Tactics to:a. Recruit Thousands of Women into our a. Recruit Thousands of Women into our Case Management ProgramsCase Management Programsb. Foster health behavior change on the b. Foster health behavior change on the individual, group and mass media levelindividual, group and mass media level

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3.3. Transformed Local Health System through Transformed Local Health System through Regionalization of Perinatal Care/Opening Regionalization of Perinatal Care/Opening up Access/Building New Birthing Center at up Access/Building New Birthing Center at Harlem HospitalHarlem Hospital

4.4. Built a Healthcare Mass Movement Where Built a Healthcare Mass Movement Where Infant Mortality Reduction Became the Infant Mortality Reduction Became the Number One Public Health & Political Number One Public Health & Political Issue Throughout NYC DEVELOPED Issue Throughout NYC DEVELOPED THE POLITICAL WILL TO CHANGE THE POLITICAL WILL TO CHANGE COURSE!COURSE!

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5. 5. Raised Over $60 Million Dollars to Raised Over $60 Million Dollars to Supplement Healthy Start Dollars from Supplement Healthy Start Dollars from 2000-2007 NYC Using Tax Levy Dollars2000-2007 NYC Using Tax Levy Dollars

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System Transformation StrategiesSystem Transformation Strategies

1.1. Base Building at St. NicholasBase Building at St. Nicholas

2.2. Building Harlem Birthing CenterBuilding Harlem Birthing Center

3.3. Regionalization of Perinatal CareRegionalization of Perinatal Care

4.4. Integrating MCH/Child Welfare/Early Integrating MCH/Child Welfare/Early Childhood Systems of CareChildhood Systems of Care

5.5. Developing an MCH Poverty StrategyDeveloping an MCH Poverty Strategy

6.6. Developing a Public Health Social Developing a Public Health Social MovementMovement

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POURING THE FOUNDATION FOR CHANGE: POURING THE FOUNDATION FOR CHANGE: BASE BUILDING WITHIN BASE BUILDING WITHIN

ST. NICHOLAS HOUSING DEVELOPMENTST. NICHOLAS HOUSING DEVELOPMENT

• CHILD WELFARE & INFANT DEATH CHILD WELFARE & INFANT DEATH DATA REVIEW: ZIP CODE 10027 DATA REVIEW: ZIP CODE 10027

• HARLEM CARVE OUT HARLEM CARVE OUT

• DIRECT MAIL CAMPAIGNDIRECT MAIL CAMPAIGN

• DOOR-TO-DOOR CAMPAIGN DOOR-TO-DOOR CAMPAIGN • PHONE-FOLLOW-UP WORKPHONE-FOLLOW-UP WORK

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BUILT BIRTHING CENTER BUILT BIRTHING CENTER AT HARLEM HOSPITAL AT HARLEM HOSPITAL

LINKING WOMEN TO HEALTH CARELINKING WOMEN TO HEALTH CARE

PROBLEM FORMULATION: PROBLEM FORMULATION:

HARLEM HOSPITAL’S DELIVERES DECLINED HARLEM HOSPITAL’S DELIVERES DECLINED FROM 4,000 IN 1992 TO 1,104 BY 2002. 0B FROM 4,000 IN 1992 TO 1,104 BY 2002. 0B DEPARTMENT ON DEATH BED DEPARTMENT ON DEATH BED

POOR HISTORY & PERCEPTION OF QUALITY POOR HISTORY & PERCEPTION OF QUALITY CARE AMONG MCH POPULATION-VOTED WITH CARE AMONG MCH POPULATION-VOTED WITH THEIR FEETTHEIR FEET

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HOSPITAL HAS BEEN OPERATING AT A HOSPITAL HAS BEEN OPERATING AT A DEFICIT FOR A NUMBER OF YEARS. PAST DEFICIT FOR A NUMBER OF YEARS. PAST MAYORS MADE PLANS TO CLOSE MAYORS MADE PLANS TO CLOSE FACILITYFACILITY

HOSPITAL FAILED TO RESPOND TO HOSPITAL FAILED TO RESPOND TO COMPETITIVE FORCES IN THE LOCAL COMPETITIVE FORCES IN THE LOCAL HEALTHCARE MARKET HEALTHCARE MARKET

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SOLUTION: SOLUTION:

BEGAN PLANNING PROCESS FOR NEW BEGAN PLANNING PROCESS FOR NEW BIRTHING CENTER IN 1998: FINANCIALS BIRTHING CENTER IN 1998: FINANCIALS & CONCEPT PAPER FOR FREE-STANDING & CONCEPT PAPER FOR FREE-STANDING CENTER CENTER

APPROACHED NYC HEALTH & HOSPITAL APPROACHED NYC HEALTH & HOSPITAL CORPORATION/HARLEM HOSPITAL AND CORPORATION/HARLEM HOSPITAL AND BUILT PARTNERSHIP 2001BUILT PARTNERSHIP 2001

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DELIVERIES HAVE INCREASED BY 25% DELIVERIES HAVE INCREASED BY 25%

MAYOR BLOOMBERG REWARDED OUR TEAM MAYOR BLOOMBERG REWARDED OUR TEAM BY ALLOCATING 250 MILLION DOLLARS IN 2005 BY ALLOCATING 250 MILLION DOLLARS IN 2005 TO BUILD A NEW HOSPITAL THAT WILL COME TO BUILD A NEW HOSPITAL THAT WILL COME ON-LINE BY 2011 ON-LINE BY 2011

WE OPENED UP ACCESS TO IMMIGRANT WE OPENED UP ACCESS TO IMMIGRANT WOMEN, SAVED OB AND WE ARE CURRENTLY WOMEN, SAVED OB AND WE ARE CURRENTLY BUILDING A NEW HOSPITALBUILDING A NEW HOSPITAL

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REGIONALIZATION OF PERINATAL CARE IN NYS--- REGIONALIZATION OF PERINATAL CARE IN NYS---

IMPROVING QUALITY OF PERINATAL PRACTICEIMPROVING QUALITY OF PERINATAL PRACTICE

147 MATERNITY HOSPITALS HAD NOT BE 147 MATERNITY HOSPITALS HAD NOT BE DESIGNATED FOR OVER FIFTEEN YEARS BY DESIGNATED FOR OVER FIFTEEN YEARS BY THE NYSDOH THE NYSDOH

INCREASED FRAGMENTATION OF CARE, LACK INCREASED FRAGMENTATION OF CARE, LACK OF SUPERVISION OF HOSPITALS WHO CARED OF SUPERVISION OF HOSPITALS WHO CARED FOR SICK BABIES THROUGHOUT THE STATE, FOR SICK BABIES THROUGHOUT THE STATE, TRANSFERS WERE UNPLANNEDTRANSFERS WERE UNPLANNED

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REGIONALIZATION OF PERINATAL CARE IN NYS--- REGIONALIZATION OF PERINATAL CARE IN NYS--- IMPROVING QUALITY OF PERINATAL PRACTICEIMPROVING QUALITY OF PERINATAL PRACTICE

BY 2001, THE BUREAU OF WOMENS BY 2001, THE BUREAU OF WOMENS HEALTH/NYSDOH DECIDED TO SURVEY ALL OF HEALTH/NYSDOH DECIDED TO SURVEY ALL OF THE 147 MATERNITY HOSPITALS ACROSS THE THE 147 MATERNITY HOSPITALS ACROSS THE STATE AND REDESIGNATE THEM AND PLACE STATE AND REDESIGNATE THEM AND PLACE THEM WITHIN A LOCAL NETWORK OF CARE THEM WITHIN A LOCAL NETWORK OF CARE

BY 2004, SURVEY WORK WAS COMPLETE AND BY 2004, SURVEY WORK WAS COMPLETE AND NYSDOH ANNOUNCED EACH DESIGNATION NYSDOH ANNOUNCED EACH DESIGNATION

LEVEL FOUR HOSPITAL: REGIONAL PERINATAL LEVEL FOUR HOSPITAL: REGIONAL PERINATAL CENTER CENTER

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*COORDINATE MATERNAL-FETAL AND *COORDINATE MATERNAL-FETAL AND NEW BORN TRANSFERS OF HIGH-RISK NEW BORN TRANSFERS OF HIGH-RISK PATIENTS FROM THE AFFILIATE PATIENTS FROM THE AFFILIATE HOSPITALS TO THE RPCHOSPITALS TO THE RPC

*RESPONSIBLE FOR SUPPORT, *RESPONSIBLE FOR SUPPORT, EDUCATION, CONSULTATION AND EDUCATION, CONSULTATION AND IMPROVEMENT IN THE QUALITY OF IMPROVEMENT IN THE QUALITY OF CARE IN THE AFFILIATE HOPSITALS CARE IN THE AFFILIATE HOPSITALS WITHIN THE REGIONWITHIN THE REGION

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RESPONSIBLE FOR REVIEWING AFFILIATE RESPONSIBLE FOR REVIEWING AFFILIATE HOSPITALS DATA COLLECTION METHODS AND HOSPITALS DATA COLLECTION METHODS AND SUPERVISING THEIR QUALITY ASSURANCE SUPERVISING THEIR QUALITY ASSURANCE POLICIES IN THE NICUPOLICIES IN THE NICU

LEVEL 1 HOSPITALS PROVIDE CARE TO LEVEL 1 HOSPITALS PROVIDE CARE TO NORMAL AND LOW RISK PREGNANT WOMEN NORMAL AND LOW RISK PREGNANT WOMEN AND NEWBORNS BUT DO NOT OPERATE AND NEWBORNS BUT DO NOT OPERATE NEONATAL INTENSIVE CARE UNITS NEONATAL INTENSIVE CARE UNITS

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LEVEL 2 HOSPITALS PROVIDE CARE TO WOMEN LEVEL 2 HOSPITALS PROVIDE CARE TO WOMEN AND NEWBORNS AT MODERATE RISK AND DO AND NEWBORNS AT MODERATE RISK AND DO OPERATE NICUs OPERATE NICUs

LEVEL 3 HOSPITALS CARE FOR PATIENTS LEVEL 3 HOSPITALS CARE FOR PATIENTS REQUIRING INCREASINGLY COMPLEX CARE REQUIRING INCREASINGLY COMPLEX CARE AND OPERATE NICUs AND OPERATE NICUs

STATEWIDE PERINATAL DATA BASE STATEWIDE PERINATAL DATA BASE CONSTRUCTED CLINICAL DATA UPLOADED CONSTRUCTED CLINICAL DATA UPLOADED EVERY TWO DAYS EVERY TWO DAYS

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HOSPITAL REIMBURSEMENT FOR HOSPITAL REIMBURSEMENT FOR MATERNITY CARE RELATED TO LEVEL MATERNITY CARE RELATED TO LEVEL AND QUALITY OF PERFORMANCE AND QUALITY OF PERFORMANCE

NYSDOH MANDATES FORMING REGIONAL NYSDOH MANDATES FORMING REGIONAL PERINATAL FORUMSPERINATAL FORUMS

BOROUGH OF MANHATTAN HAS FIVE BOROUGH OF MANHATTAN HAS FIVE RPCS AND OVER TWENTY-FIVE RPCS AND OVER TWENTY-FIVE AFFILIATE HOSPITALSAFFILIATE HOSPITALS

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RESULT: INCREASED SURVIVAL RESULT: INCREASED SURVIVAL RATES FOR SICK BABIES AND RATES FOR SICK BABIES AND MOTHERS THROUGHOUT NYS AND MOTHERS THROUGHOUT NYS AND HARLEM NY THUS REDUCING HARLEM NY THUS REDUCING INFANT MORTALITYINFANT MORTALITY

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INTEGRATING MCH/CHILD WELFARE/EARLY INTEGRATING MCH/CHILD WELFARE/EARLY

CHILDHOOD SYSTEMS OF CARE TO SAVE LIVES!CHILDHOOD SYSTEMS OF CARE TO SAVE LIVES!

PROBLEMS/ISSUES:PROBLEMS/ISSUES:

*NYC’S & HARLEM’S CHILD WELFARE SYSTEM *NYC’S & HARLEM’S CHILD WELFARE SYSTEM HISTORY HISTORY

*CHILD WELFARE SYSTEM & MCH SYSTEM *CHILD WELFARE SYSTEM & MCH SYSTEM NEVER COMMUNICATED DESPITE SERVING NEVER COMMUNICATED DESPITE SERVING SIMILAR CASE POPULATIONS SIMILAR CASE POPULATIONS

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INTEGRATING MCH/CHILD WELFARE/EARLY INTEGRATING MCH/CHILD WELFARE/EARLY CHILDHOOD SYSTEMS OF CARE TO SAVE LIVES!CHILDHOOD SYSTEMS OF CARE TO SAVE LIVES!

RESULTS: RESULTS:

*TWO SENIOR STAFF MEETINGS WERE *TWO SENIOR STAFF MEETINGS WERE PLANNED BETWEEN BOTH AGENCIES TO PLANNED BETWEEN BOTH AGENCIES TO EXPLORE WAYS TO WORK TOGETHER EXPLORE WAYS TO WORK TOGETHER

*AS A RESULT OF OUR BRIDGE WORK, ACS *AS A RESULT OF OUR BRIDGE WORK, ACS AGREED TO ALLOW THE MCH COMMUNITY’S AGREED TO ALLOW THE MCH COMMUNITY’S HEALTHY START, HEALTHY FAMILY HEALTHY START, HEALTHY FAMILY AMERICA’S HOME VISITING AND NURSE AMERICA’S HOME VISITING AND NURSE FAMILY PARTNERSHIP PROGRAMS TO MANAGE FAMILY PARTNERSHIP PROGRAMS TO MANAGE THE CASES OF BIOLOGICAL MOMS WHO HAD THE CASES OF BIOLOGICAL MOMS WHO HAD CHILDREN IN CARE 0-5CHILDREN IN CARE 0-5

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INTEGRATING MCH/CHILD WELFARE/EARLY INTEGRATING MCH/CHILD WELFARE/EARLY CHILDHOOD SYSTEMS OF CARE TO SAVE LIVES!CHILDHOOD SYSTEMS OF CARE TO SAVE LIVES!

*A COPS WAIVER WAS SUBMITED TO OUR NYS *A COPS WAIVER WAS SUBMITED TO OUR NYS OFFICE OF CHILDREN & FAMILIES AGENCY OFFICE OF CHILDREN & FAMILIES AGENCY THAT RAISED OVER TEN MILLION DOLLARS TO THAT RAISED OVER TEN MILLION DOLLARS TO FUND THE COLLABORATION FUND THE COLLABORATION

*NYCDOH/MH AGREED TO MAKE TWO VISITS *NYCDOH/MH AGREED TO MAKE TWO VISITS TO ALL BIOLOGICAL PARENTS OF CHILDREN 0-TO ALL BIOLOGICAL PARENTS OF CHILDREN 0-5 WHO WERE EITHER IN OUR FOSTER 5 WHO WERE EITHER IN OUR FOSTER BOARDING HOME OR PREVENTIVE SYSTEMS BOARDING HOME OR PREVENTIVE SYSTEMS THROUGH THEIR NEW BORN HOME VISITING THROUGH THEIR NEW BORN HOME VISITING MODELMODEL

YearYear 20022002 20032003 20042004 20052005

Abuse/Neglect ReportsAbuse/Neglect Reports 15741574 13541354 12001200 12081208Number of Children In Number of Children In ReportsReports 24782478 20322032 18551855 18461846

Abuse/Neglect Indication Abuse/Neglect Indication RatesRates 45.0%45.0% 39.4%39.4% 37.9%37.9% 45.9%45.9%Number of Children in Number of Children in Indicated ReportsIndicated Reports 973973 649649 745745 885885

Victimization Rates *Victimization Rates * 32.832.8 21.921.9 19.419.4 24.724.7

Number of PlacementsNumber of Placements 449449 285285 228228 192192Number of Children Number of Children PlacedPlaced 447447 279279 220220 192192

Number of Families Number of Families PlacedPlaced 288288 198198 161161 146146Placement Rate **Placement Rate ** 15.115.1 9.69.6 7.47.4 6.56.5

Selected Child Welfare Trends, Central Harlem 2002-2005

•Victimization Rate is the number of children with indicated abuse/neglect per thousand youth 17 and under in the population.

•** Placement rate is the number of children placed into foster care per 100o youth 17 and under in the population.

Source: NYC Administration for Children’s Services: Office of Management Analysis

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EARLY CHILDHOOD SYSTEMS EARLY CHILDHOOD SYSTEMS INTEGRATIONINTEGRATION

ON THE EARLY CHILDHOOD FRONT, ON THE EARLY CHILDHOOD FRONT, NMPP’S BOARD DECIDED EARLY ON THAT NMPP’S BOARD DECIDED EARLY ON THAT THE AGENCY WOULD GET INTO THE THE AGENCY WOULD GET INTO THE EARLY CHILDHOOD BUSINESS, WHY? EARLY CHILDHOOD BUSINESS, WHY?

THE BOARD BELIEVED THAT THE BEST THE BOARD BELIEVED THAT THE BEST WAY TO MANAGE A WOMAN’S HEALTH WAY TO MANAGE A WOMAN’S HEALTH AFTER PREGNANCY WAS TO INVOLVE AFTER PREGNANCY WAS TO INVOLVE THE AGENCY IN THE CHILD CARE THE AGENCY IN THE CHILD CARE BUSINESSBUSINESS

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EARLY CHILDHOOD SYSTEMS EARLY CHILDHOOD SYSTEMS INTEGRATIONINTEGRATION

IN 2000 WE SECURED A CONTRACT FROM IN 2000 WE SECURED A CONTRACT FROM ACS TO DELIVER CENTER-BASED HEAD ACS TO DELIVER CENTER-BASED HEAD START SERVICESSTART SERVICES

BY 2003, WE SECURED A CONTRACT TO BY 2003, WE SECURED A CONTRACT TO DELIVER EARLY HEAD START SERVICESDELIVER EARLY HEAD START SERVICES

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POVERTY REDUCTION POVERTY REDUCTION STRATEGYSTRATEGY

CREATING A VISION BEYOND CREATING A VISION BEYOND WELFARE, DEVELOPING WORKING WELFARE, DEVELOPING WORKING

CLASS HEROES-MOVING WOMEN CLASS HEROES-MOVING WOMEN INTO THE MIDDLE CLASSINTO THE MIDDLE CLASS

BEING POOR IS HAZARDOUS TO A BEING POOR IS HAZARDOUS TO A WOMAN’S HEALTHWOMAN’S HEALTH

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Case Level Interventions:Case Level Interventions:

Harlem Works Job Readiness Program -Harlem Works Job Readiness Program -1997 & Beyond 1997 & Beyond

Powerful Families Financial Literacy/Assets Powerful Families Financial Literacy/Assets Building Program –Casey Family Programs Building Program –Casey Family Programs fundedfunded

NMPP’s Education Strategy Extended at NMPP’s Education Strategy Extended at Harlem Choir AcademyHarlem Choir Academy

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NYC Level Interventions:NYC Level Interventions:

NYC Mayor Bloomberg’s Poverty Campaign:NYC Mayor Bloomberg’s Poverty Campaign: Center for Economic Opportunity-Last Year Center for Economic Opportunity-Last Year Our Mayor Declared War On Poverty and Our Mayor Declared War On Poverty and Allocated 150 million a Year to Develop Allocated 150 million a Year to Develop Internal Agency-Public-Private Solutions to Internal Agency-Public-Private Solutions to Spur Economic Opportunities and Financial Spur Economic Opportunities and Financial Independence Independence

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THE MAYOR CHARGED EVERY THE MAYOR CHARGED EVERY COMMISSIONER TO TAKE 5% OF THEIR COMMISSIONER TO TAKE 5% OF THEIR ANNUAL BUDGET AND ALLOCATE TO THE ANNUAL BUDGET AND ALLOCATE TO THE ANTI-POVERTY STRATEGYANTI-POVERTY STRATEGY

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CONDITIONAL CASH TRANSFER CONDITIONAL CASH TRANSFER PROGRAM:PROGRAM:

Mayor’s Affordable Housing Strategy-Mayor’s Affordable Housing Strategy- 7.5 Billion 7.5 Billion Allocated to Preserve and Build 165,000 units of Allocated to Preserve and Build 165,000 units of affordable housing by 2013 in poor communities affordable housing by 2013 in poor communities like Harlem, the South Bronx & Bedford like Harlem, the South Bronx & Bedford Stuyvesant –Fifty Thousand Unit Built to Date Stuyvesant –Fifty Thousand Unit Built to Date

Moving Participants into Union JobsMoving Participants into Union Jobs

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Registered Nurse & LPN Career Ladder Registered Nurse & LPN Career Ladder Training Program- Training Program- Train 400 poor and working Train 400 poor and working class New Yorkers to become nurses! Ten class New Yorkers to become nurses! Ten Million Dollars Allocated to Fund this Program-Million Dollars Allocated to Fund this Program-Guaranteed Placement at HHC Facility Making Guaranteed Placement at HHC Facility Making up to 37,000 for LPN or $62,000 for an RN up to 37,000 for LPN or $62,000 for an RN

Micro-Lending Program Spurs Business Micro-Lending Program Spurs Business OwnershipOwnership

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State & National Policy State & National Policy Initiatives:Initiatives:

Congress Rangel’s Harlem Empowerment Congress Rangel’s Harlem Empowerment Zone/Enterprise Community ImpactZone/Enterprise Community Impact

Moving from a Minimum Wage to a Moving from a Minimum Wage to a Livable Wage Policy 1997-$5.15 TO 7.25 Livable Wage Policy 1997-$5.15 TO 7.25 TO 10.25 per HourTO 10.25 per Hour

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PUBLIC POLICY & SYSTEMS PUBLIC POLICY & SYSTEMS CHANGE ACHIEVEMENTSCHANGE ACHIEVEMENTS

1.1. Regionalization of Perinatal Care Throughout NYS Regionalization of Perinatal Care Throughout NYS

2.2. Secured Over $60 Million Dollars from NYC Mayor Secured Over $60 Million Dollars from NYC Mayor

3.3. Integrated MCH & Child Welfare Systems of Care Integrated MCH & Child Welfare Systems of Care

4.4. Financed & Staffed Up Birthing Center at Harlem Financed & Staffed Up Birthing Center at Harlem Hospital Hospital

5.5. Secured $250 Million Dollars to Build a New Harlem Secured $250 Million Dollars to Build a New Harlem HospitalHospital

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6.6. Harlem Hospital Recently Designated as a “Baby Harlem Hospital Recently Designated as a “Baby Friendly” HospitalFriendly” Hospital

7.7. Passed Mental Health Parity Legislation Timothy’s Passed Mental Health Parity Legislation Timothy’s Law Law

8.8. Trained over 800 women and placed them in full time Trained over 800 women and placed them in full time jobs! jobs!

9.9. Reduced Child & Abuse & Neglect Rates in Harlem Reduced Child & Abuse & Neglect Rates in Harlem 10.10. Repealed “Medicaid Neutrality” Law in NYS Repealed “Medicaid Neutrality” Law in NYS

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11.11. Increased Medicaid Mental Health Reimbursement Increased Medicaid Mental Health Reimbursement Rates Rates

12.12. NYC Mayor Has $7.5 Billion Dollar Plan to Build NYC Mayor Has $7.5 Billion Dollar Plan to Build 165,000 Units of Affordable Housing by 2013-165,000 Units of Affordable Housing by 2013-Fifty Thousand units built to date! Fifty Thousand units built to date!

13.13. Mayoral $10 million dollar Plan to train 400 Harlem Mayoral $10 million dollar Plan to train 400 Harlem residents to become RN’s and LPN’s residents to become RN’s and LPN’s

14.14. Congressman Rangel’s Harlem Empowerment Zone Congressman Rangel’s Harlem Empowerment Zone 15.15. Legislation to move from a minimum wage to a livable Legislation to move from a minimum wage to a livable

wage policywage policy

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16.16. Moving Harlem Residents into Union Jobs Moving Harlem Residents into Union Jobs

17.17. Created More Micro-Lending Program to Spur Created More Micro-Lending Program to Spur Business Ownership by Poor & Working Class Business Ownership by Poor & Working Class Women in HarlemWomen in Harlem

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Traditional Perinatal Care Traditional Perinatal Care Continuum Continuum

Preconception Period

antepartum postpartumInterconceptional period

Labor and

Delivery

Primary CarePreconception

Counseling

Prenatal Care

Care throughout labor and delivery

Well Child Care

Postpartum Care

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A MCH Life Course OrganizationA MCH Life Course Organization is an entity is an entity (local/state) that develops the capacity over time to (local/state) that develops the capacity over time to Deliver integrated, continuous and comprehensive Deliver integrated, continuous and comprehensive health and social services and support to women and health and social services and support to women and their family members from the womb to the tomb. their family members from the womb to the tomb. MCH services are delivered from clinical and group MCH services are delivered from clinical and group care interventions all the way upstream to care interventions all the way upstream to community and policy change interventions to community and policy change interventions to reduce racial disparities in birth outcomes. reduce racial disparities in birth outcomes.

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New MCH Life Course Continuum New MCH Life Course Continuum Axis 1 Axis 1

BirthBirth Early Early Child-Child-hoodhood

Pre-Pre-TeenTeen

TeenTeen Young Young AdultAdult

WomenWomen>35>35

Senior Senior CitizensCitizens

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CHARACTERISTICS OF A MCH LIFE CHARACTERISTICS OF A MCH LIFE COURSE ORGANIZATIONCOURSE ORGANIZATION

1.1. BUILDS PROGRAMATIC CAPACITY BUILDS PROGRAMATIC CAPACITY WITHIN THE AGENCY AT EACH STAGE WITHIN THE AGENCY AT EACH STAGE OF A WOMEN’S LIFE SPAN TO MANAGE OF A WOMEN’S LIFE SPAN TO MANAGE HER HEALTH OVER THE LIFE COURSEHER HEALTH OVER THE LIFE COURSE

2.2. IF UNABLE TO BUILD INTERNAL IF UNABLE TO BUILD INTERNAL CAPACITY COLLABORATES WITH CAPACITY COLLABORATES WITH OUTSIDE AGENCIES AND SYSTEMS TO OUTSIDE AGENCIES AND SYSTEMS TO CREATE AN INTEGRATED SYSTEM OF CREATE AN INTEGRATED SYSTEM OF CARE TO MANAGE A WOMAN’S HEALTHCARE TO MANAGE A WOMAN’S HEALTH

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3.3. CAN SEE AROUND THE CORNER TO RESPOND CAN SEE AROUND THE CORNER TO RESPOND TO TRENDS BEFORE THEY HAVE AN IMPACT TO TRENDS BEFORE THEY HAVE AN IMPACT ON THE TARGET POPULATION- E.G. DIABETES, ON THE TARGET POPULATION- E.G. DIABETES, WOMEN OVER 35 WOMEN OVER 35

4.4. SWIMS UP-STREAM FROM INDIVIDUAL SWIMS UP-STREAM FROM INDIVIDUAL INTERVENTIONS AND DESIGNS STRATEGIES INTERVENTIONS AND DESIGNS STRATEGIES AND ACTIONS AT THE GROUP, AND ACTIONS AT THE GROUP, ORGANIZATIONAL, COMMUNITY AND POLICY ORGANIZATIONAL, COMMUNITY AND POLICY LEVELS TO TRANSFORM SOCIAL LEVELS TO TRANSFORM SOCIAL DETERMINANTS TO POOR HEALTH. DETERMINANTS TO POOR HEALTH.

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5.5. UNLIKE HEALTHY START PROGRAMS WHO ONLY SEEK TO INFLUENCE THE HEALTH SYSTEM BY DEVELOPING AND EXECUTING A LOCAL HEALTH SYSTEMS ACTION PLAN, A MCHLCO SEEKS TO INFLUENCE AND LEAD THEIR LOCAL AND REGIONAL ECONOMIC, POLITICAL, HOUSING, CHILD WELFARE, EARLY CHILDHOOD AND MIDDLE SCHOOL SYSTEMS OF CARE.

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6. THEY COMPLETE THIS ASSIGNMENT BY SLOWLY ORGANIZING A PUBLIC HEALTH SOCIAL MOVEMENT IN THEIR TOWN THAT MOBILIZES ALL CORE CONSTITUENCIES TO IMPROVE THE HEALTH OF MOTHERS AND BABIES OVER THEIR LIFE COURSE.

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CHARACTERISTICS OF A MCH CHARACTERISTICS OF A MCH LIFE COURSE ORGANIZATIONLIFE COURSE ORGANIZATION

7. THE MCH LIFE COURSE ORGANIZATION IS DECENTRALIZED ALLOWING MAXIMUM FLEXIBILITY FOR LEADERS TO EXPERIMENT PROGRAMMATICALLY AMONG DEPARTMENTS INTERNALLY AND EXTERNALLY WITH OUTSIDE AGENCIES TO PRODUCE NEW BEHAVIORAL OUTCOMES FOR MOTHERS AND BABIES.

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8. LEADERS AND MANAGERS ARE ALLOWED TO RUN THEIR PROGRAMS LIKE BUSINESSES IN CHARGE OF FINANCIALS, MARKETING, AND PROGRAM DEVELOPMENT TASKS WHILE STILL BENEFITING FROM THE POLITICAL AND FUNDING CONTACTS, HUMAN RESOURCES INFRASTRUCTURE, FINANCE CAPITAL AND STRATEGIC LEADERSHIP OF THE CORPORATE STRUCTURE.

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Spectrum of Work for MCH Life Course OrganizationSpectrum of Work for MCH Life Course OrganizationBuilding Public Health Social MovementBuilding Public Health Social Movement

Economic Opportunities•Harlem Works•Financial Literacy•LPN RN Training Program•Union Employment•Micro Lending Savings•Empowerment Zone

Economic Opportunities•Harlem Works•Financial Literacy•LPN RN Training Program•Union Employment•Micro Lending Savings•Empowerment Zone

Early Childhood•Early Head Start•Head Start•UPK•Choir Academy

Early Childhood•Early Head Start•Head Start•UPK•Choir Academy

Child Welfare•Preventive Services•Foster Care Services•Parenting Workshops•Newborn Home VisitingCOPS Waiver

Child Welfare•Preventive Services•Foster Care Services•Parenting Workshops•Newborn Home VisitingCOPS Waiver

Legislative Agenda•Reauthorize Healthy Start•SCHIP•Minimum Wage Legislation•Women’s Health Financing

Legislative Agenda•Reauthorize Healthy Start•SCHIP•Minimum Wage Legislation•Women’s Health Financing

Housing•Home Ownership•Affordable Housing•Base Building- St. Nicks

Housing•Home Ownership•Affordable Housing•Base Building- St. Nicks

Health System‾Case Management - Title V Funds‾Health Education - Regionalization‾Outreach -Harlem Hospital ‾Perinatal Mood Disorders-Birthing Center‾Interconceptional Care

Health System‾Case Management - Title V Funds‾Health Education - Regionalization‾Outreach -Harlem Hospital ‾Perinatal Mood Disorders-Birthing Center‾Interconceptional Care

Birth Young Adult

Pre-teen TeenEarly Childhood

Women over 35

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SUMMARY:SUMMARY:

NMPP believes that Leadership is the NMPP believes that Leadership is the self-defined capacity to communicate self-defined capacity to communicate vision and values while providing vision and values while providing programs, structures and core services programs, structures and core services that satisfy human needs and that satisfy human needs and aspirations while transforming people, aspirations while transforming people, your organization and society in the your organization and society in the process!process!

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Reducing Infant Mortality Throughout the STATE of Indiana: Reducing Infant Mortality Throughout the STATE of Indiana: BBuilding a Social Movement, Investing in Ideas, Executing uilding a Social Movement, Investing in Ideas, Executing

Tasks, Returning Results!Tasks, Returning Results!

Linking Women to Health, Power and Love Across the Life Span

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Individual Level:

Outreach, Individual & Family Risk & Asset Assessments, Case Management, Interconceptional Care, Health Beliefs & Behaviors, Medical, Maternal Depression Screening& Treatment

Early Head Start, Child Abuse Prevention, Extending Inter-Pregnancy Intervals,Family Planning, Substance Abuse Treatment, Reproductive Life Plan

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Group & Interpersonal Level:

Centering Pregnancy, Parenting Classes, Male Involvement Group, Depression Group Work

Women Telling Their Pregnancy/Racism Stories, Baby Mama’s Club, Consumer Involvement

Organization

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Organizational Level:

Consortium, PTA/ Block Tenant Organization, Faith Institution, Union Shop, CBO Strategy,Citizens Power Councils-CPC, Tenant Organizing/Tenant Organizations

FinancialLiteracy/Investment/Savings Clubs, People’s Leadership School, Developing Women’sReproductive Capital, Harlem Works Jobs Center

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Community Environment Level:

Healthy Food & Fitness Organizing, Public Safety, Exercise/Play Areas, ResidentialSegregation, Physical Environment, Community Assets, Political Power

Cultural/HealthRelated Norms, Curbing Gentrification, Sustainable Community Capacity Building, PublicSchool Reform, Charter School Organizing

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Society/Public Policy Level:

Transforming Race & Class, Health Policy & Financing, Influencing the Media, EconomicPolicy, Livable Wage, National Urban/Rural Agenda, Empowerment Zones, Health Equity

Local, State & National Politics, SCHIP: Healthcare Access, Reauthorize Healthy Start, BuildingMCH Mass Movement; Sustainability, Local Health Systems Action Plan

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For more information contact:For more information contact:

Mario Drummonds, MS, LCSW, MBAMario Drummonds, MS, LCSW, MBAExecutive Director/CEOExecutive Director/CEO

Northern Manhattan Perinatal PartnershipNorthern Manhattan Perinatal Partnership

127 W. 127127 W. 127thth Street Street

New York, NY 10027New York, NY 10027

(347)489-4769(347)489-4769

[email protected]@msn.com

Perinatal Disparities: Finding Solutions to Heal Our Communities A Call to Action

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