Women

Babies

Families

Communities

The Baltimore City Healthy Start, Inc.The Baltimore City Healthy Start, Inc.

Overview and ImpactOverview and Impact

““Helping Mothers Have Healthy Babies”Helping Mothers Have Healthy Babies”

VisionVisionTo embrace our role as a leader in providing and coordinating services for pregnant, postpartum, interconceptional women and their babies living in vulnerable conditions in Baltimore City.

MissionMissionBaltimore City Healthy Start is committed to improving the health and well-being of pregnant, postpartum and interconceptional women, their babies, and families by providing comprehensive, supportive services in the communities where they live.

Baltimore City Healthy Start, Inc. Baltimore City Healthy Start, Inc. One of the original 15 Healthy Start projects created in 1991 to

address disparities in infant mortality (death of an infant before 1st birthday).

The only federally funded program of its kind in Maryland. Has served over 12,000 pregnant and postpartum women over its

17 years. The Lead Agency for the United Way of Central Maryland funded

Success By 6® Program. Baltimore’s Lead Agency on a NIH funded national community-

based participatory research study on the impact of stress and racism on birth outcomes.

Direct Service * Community Collaboration * Research * Public AwarenessDirect Service * Community Collaboration * Research * Public Awareness

Baltimore City Healthy Start, Inc. Board of Directors

Baltimore City Healthy Start, Inc. President & CEO

Executive Assistant

Chief Clinical Services and Q A Chief Financial Officer

Director Healthy Education & Marketing

Success By 6® Program

Belly Buddies

Evaluation Consultant

Finance Department

MIS Department

BSAS Care Coordination

Organizational Chart

HR Department

CRNPs & OB/GYN

Analyst

Director Special Populations

Director Life Planning Institute

Director Healthy Start

Guiding Light Program

Mobile Delivery System

Chrysalis House Healthy Start

Employment Support Program

& Computer Lab

CCHN

Healthy Start Programs

Forest Park/Walbrook

Dorchester/Ashburton

Morrell Park/Violetville

Allendale/Irvington/South Hilton

Healthy Start Program Success By 6® Initiative Healthy Babies Breastfeeding

Program Substance Abuse

Care Coordination Early Childhood Development In Home/In Center

Family Planning Program Life Planning Institute Belly Buddies Prenatal Program Chrysalis House

Healthy Start Program

Outreach and Recruitment Case Management and Home Visiting Pregnancy Testing Prenatal Groups Postpartum Care Breastfeeding Education and Classes Family Planning and Interconceptional Care Parenting Groups Early Childhood Development Services Healthy Relationship Counseling Emergency Food & Clothing Pantries Family Advocacy Visual Lead Inspection Workforce Development/Employment Readiness Drop-In Child Care STD Testing, Counseling and Treatment HIV Testing and Referral Mental Health Screening and Treatment Substance Abuse Screening and Referral Transportation

ProgramsPrograms ServicesServices

Service Area Current

Healthy Start, Inc.

Satellite Offices

• Home-Based

• Center-Based

• Mobile Delivery System*

Low Birth WeightLow Birth Weight

Very Low Birth WeightVery Low Birth Weight

Interconceptional CareInterconceptional Care

STDSTD

The Healthy Start Impact On:The Healthy Start Impact On:

Percent LBW (Maryland / Baltimore City / Healthy Start)

10.712.3

1110

11.5

8.9

11.712.8 12.9

8.5

13.612.6

0

2

4

6

8

10

12

14

16

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Per

cen

t L

BW

Maryland Baltimore Healthy Start HP 2010

Percentage LBW (Maryland/Baltimore City/Healthy Percentage LBW (Maryland/Baltimore City/Healthy Start)Start)

Source: HHS-HRSA Baltimore City Healthy Start, Inc. Performance Report 2006-07

VLBW (Maryland / Baltimore City / Healthy Start VLBW (Maryland / Baltimore City / Healthy Start Clients)Clients)

Source: HHS-HRSA Baltimore City Healthy Start, Inc. Performance Report 2006

VLBW (Maryland / Baltimore City / Healthy Start Clients)

1.6

2.6

1.8

3.3

4

1.4

2.6

3.3

2.2

0.70.9

2.4

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Per

cent V

LB

W

MD Baltimore City Healthy Start HP2010

Facts to know: 623 Infants died in Maryland in 2007Facts to know: 623 Infants died in Maryland in 2007

Low Birth WeightBirths-CY 2007

Infant DeathsCY2007

State of Maryland 9.1 8.0

Blacks in Maryland 13.9 14.0

Baltimore City 12.8 11.3

Blacks in Baltimore 15.1 15.5

Healthy Start * 8.5 5.3

*98% of Healthy Start Clients are African-American.Healthy Start clients accounted for 4% of Baltimore City births in 2007.

Interconception CareInterconception Care

Rates of inter-pregnancy interval greater than 12 months among Healthy Start pregnant-enrolled clients for calendar year 2007.

Pregnancy Outcome Condition Num Denom Percent

Live Birth >= 12 months 109 145 75.2%(Outcome = 4) >= 24 months 74 145 51.0%

>= 36 months 54 145 37.2%>= 48 months 37 145 25.5%>= 60 months 22 145 15.2%

Miscarriage >= 12 months 16 31 51.6%(Outcome = 1) >= 24 months 7 31 22.6%

>= 36 months 6 31 19.4%>= 48 months 4 31 12.9%>= 60 months 1 31 3.2%

Stillbirth >= 12 months 1 1 100.0%(Outcome = 2) >= 24 months 0 1 0.0%

>= 36 months 0 1 0.0%>= 48 months 0 1 0.0%>= 60 months 0 1 0.0%

Elective Abortion >= 12 months 10 29 34.5%(Outcome = 3) >= 24 months 6 29 20.7%

>= 36 months 5 29 17.2%>= 48 months 4 29 13.8%>= 60 months 1 29 3.4%

Impact on Sexually Transmitted Diseases Impact on Sexually Transmitted Diseases (STD)(STD) 1993 urine samples were collected and submitted

for Chlamydia Trachomatis (CT) and Neisseria Gonorrhoeae (GC) screening from September 1999 until March 2007.

The overall prevalence’s of CT and GC for the study period were 10.1% (201/1993) and 2.8% (55/1993) respectively.

The CT prevalence for 1999 was 18.2% with a decrease to 8.3% for 2006.

The prevalence of GC significantly decreased from a high of 9.1% in 1999 to a low of 1.3% in 2006.

Baltimore City Healthy Start has initiated a similar in-home screening for HIV/AIDS in October 2006.

Case Management ModelCase Management Model

Recruitment of Pregnant or Postpartum Client with Infant 6 months old or less

Participant Identification Form is completed (PIF)

Client is routed to interviewer

Interviewer completes Enrollment Packet and assigns client to Case Management team and to NHA (Neighborhood Health Advocate)

Interviewer submits enrollment packet to MIS

MIS data enters applicable data from interview packet

MIS submits enrollment packet to record’s clerk

Records clerk establishes a chart and notifies the assigned Case Management team of the new repeat or reactivated client

The Case Manager alerts the NHA of the new client. The NHA sends out an introductory letter

Case Management ModelCase Management Model

Within 10 days of the notification, the NHA conducts an orientation visit

Within 14 days of the orientation visit, the CM conducts a care plan visit

Home visits are conducted biweekly until client is exited from the program at 13 months old the family /infant is home visited once a month

HIV Testing, Growing Great Kids, Family Planning, Mental Health Services, etc.

Home visiting Checklists / Progress notes

Checklist or submitted to High Nurse Specialist / Submitted to MIS

High Risk Nurse Specialist submits reviewed checklist to MIS MIS enters applicable data and submits checklist, progress notes, etc. to the records

clerk for filing   Special procedures for the Certified Nurse Practitioner and ancillary staff are

outlined in the Case Management Protocol.

How We Measure Success How We Measure Success Baltimore City Healthy Start, Inc. Baltimore City Healthy Start, Inc.

Quality DashboardQuality Dashboard

Quality Management SystemQuality Management System

HR Services

Office of Finance MIS

Direct Services Centers

Satellites Mobile Unit

Data Application Process

Procedures/Protocols

EmployeesEmployees Funders Auditors/IRS

Software Hardware Data Entry Data Reporting

Customers Management of Employees

Baltimore City Healthy Start Baltimore City Healthy Start Quality Quality

DashboardDashboard

Infant Mortality Very Low Birth Weight Rate Low Birth Weight Rate Interconceptional Interval Perinatal Depression

Lead Levels Prenatal Care Rate Pediatric Medical Home Immunization Rate HIV/STD

Outstanding Clinical OutcomesOutstanding Clinical Outcomes

Efficient Procedural ProcessesEfficient Procedural Processes

CollaborationsCollaborations

Success By 6Success By 6®®

Historic East Baltimore Collaborative

Historic East Baltimore Collaborative

Greater West Baltimore Healthy Communities

Collaborative

Greater West Baltimore Healthy Communities

CollaborativeIn partnership with Parents, Community Representatives and

Martin Luther King, Jr. Early Head Start * Center for Urban Families * Lee’s Blessed Family Daycare Walter F. Perkins Daycare Center * JHU Injury Free Coalition for Kids

Coalition to End Childhood Lead Poisoning * Casey Family Services * The ARK Daycare Mercy Supportive Housing, Inc. * AMERIGROUP * Concord Baptist Church * Umoja Head Start Academy

Save Another Youth/Stop The Violence Coalition * Tuerk House, Inc. * East Baltimore Development Inc. Ames Shalom Community, Inc. * Community Building & Partnership

Enoch Pratt Free Library/North & Pennsylvania Avenues Branch ٠ Coppin Heights Community Development Corporation

Coalition of Advocates for Poverty and Healthcare Solutions

In partnership with Parents, Community Representatives and

Martin Luther King, Jr. Early Head Start * Center for Urban Families * Lee’s Blessed Family Daycare Walter F. Perkins Daycare Center * JHU Injury Free Coalition for Kids

Coalition to End Childhood Lead Poisoning * Casey Family Services * The ARK Daycare Mercy Supportive Housing, Inc. * AMERIGROUP * Concord Baptist Church * Umoja Head Start Academy

Save Another Youth/Stop The Violence Coalition * Tuerk House, Inc. * East Baltimore Development Inc. Ames Shalom Community, Inc. * Community Building & Partnership

Enoch Pratt Free Library/North & Pennsylvania Avenues Branch ٠ Coppin Heights Community Development Corporation

Coalition of Advocates for Poverty and Healthcare Solutions

Healthy Start Clients with MCO StatusHealthy Start Clients with MCO Status

AMERIGROUP

COVENTRY

HELIX

JAI

MD PHYS

PRIORITY PARTNERS

UNITED HEALTH CARE

OTHERS

23.8%

24.9%

17.3%

24%

4.6%

1.5%2.1%1.8%

Chrysalis House Healthy Start ProjectChrysalis House Healthy Start Project

Transitional Housing Transitional Housing for Pregnant Ex-for Pregnant Ex-

OffendersOffenders

Mobile Delivery SystemMobile Delivery System

West Baltimore ExpansionWest Baltimore Expansion

Healthy Start Satellite Office LocationsHealthy Start Satellite Office Locations

Allendale/Irvington/South Hilton Allendale/Irvington/South Hilton Sacred Zion Full Gospel Baptist Sacred Zion Full Gospel Baptist

ChurchChurch

Morrell Park/Violetville Morrell Park/Violetville St. Mark’s United Church Of St. Mark’s United Church Of

ChristChrist

Dorchester/Ashburton Dorchester/Ashburton

The IVY Family Support CenterThe IVY Family Support Center

Forest Park/Walbrook Forest Park/Walbrook Women Accepting ResponsibilityWomen Accepting Responsibility

Cradle of HopeCradle of HopeCampaignCampaign

The Cradle of Hope Campaign is Baltimore City The Cradle of Hope Campaign is Baltimore City Healthy Start’s public awareness initiative and Healthy Start’s public awareness initiative and fundraising program designed to inform and fundraising program designed to inform and

mobilize the citizens of our city, especially mobilize the citizens of our city, especially women, around the issues contributing to infant women, around the issues contributing to infant

mortality, low birth weight and premature births.mortality, low birth weight and premature births.

Project Project AwareAware

““He who has health has hope. He who He who has health has hope. He who has hope has everything.”has hope has everything.”

anonymous Arabic proverbanonymous Arabic proverb