DOCUMENT RESUME ED 471 711 SP 041 294 AUTHOR Fitzgerald, Maureen, Ed.; McIntosh, Kelly, Ed. Lessons Learned, 2001: Profiles of Leading Urban Health TITLE Department Initiatives in Maternal and Child Health. From the CityMatCH Urban MCH Leadership Conference (12th, Nashville, Tennessee, August 26-29, 2001). INSTITUTION CityMatCH, Omaha, NE. SPONS AGENCY Health Resources and Services Administration (DHHS/PHS), Washington, DC. Maternal and Child Health Bureau. PUB DATE 2002-00-00 NOTE 182p. CONTRACT 5U93MC00120-10 AVAILABLE FROM CityMatCH, University of Nebraska Medical Center, 982170 Nebraska Medical Center, Omaha, NE 68198-2170. Tel: 402 -561- 7500; Fax: 402-561-7525; e-mail: [email protected]; Web site: http://www.citymatch.org. PUB TYPE Collected Works General (020) Reference Materials Directories /Catalogs (132) -- Reports Descriptive (141) EDRS PRICE EDRS Price MF01/PC08 Plus Postage. DESCRIPTORS *Child Health; Public Policy; *Urban Areas IDENTIFIERS *Maternal and Child Health Services ABSTRACT This publication provides tools, local contacts, and ideas for program and policy initiatives in urban maternal and child health (MCH). Each CityMatCH member health department attending an August 2001 urban leadership conference submitted a profile of current MCH efforts. Section one, "Summing Up," examines lessons learned (e.g., local health departments are focusing energy on creative, effective ways to inform and educate the public about key MCH issues, and breathing new life into existing programs can lead to more convenient, direct services and increased access for consumers). Section two, "About Lessons Learned," explains how to use profiles, presents a listing of leading urban health department initiatives in MCH, offers a sample profile form, and includes two profile indexes (target populations and approaches and essential MCH program functions. Section three, which comprises the bulk of the document, presents CityMatCH profiles of leading urban health department initiatives in MCH. Each profile presents name, address, telephone, fax, and e-mail information, then lists essential MCH functions and MCH initiatives and offers information on: project description, objectives, barriers encountered, strategies to overcome barriers, funding source, role of the health department, accomplishments, and lessons learned. Two appendixes include CityMatCH membership listing and publications listing. (SM) Reproductions supplied by EDRS are the best that can be made from the original document. Leon am Le 5 20 og (foDcp agt_ffiD [70,Lf7o@V., 1-161E,Jaw[ii.)30 ari-ig @1 7111:u fc Ci D U.S. DEPARTMENT OF EDUCATION Office of Educational Research and Improvement EDUCATIONAL RESOURCES INFORMATION CENTER (ERIC) O This document has been reproduced as received from the person or organization originating it. CI Minor changes have been made to improve reproduction quality. Points of view or opinions stated in this document do not necessarily represent official OERI position or policy. PION) thie,.__Mi GIVAMON lirtan -UCH Latdisrrship MAW-was Healt.1 Center, Stagg NOM' Oleg 3111 AVVISi ny-249 SCA BEST COPY AVAILABLE Lessons Learned 2001: Profiles of Leading Urban Health Department Initiatives in Maternal and Child Health From the CityMatCH Urban MCH Leadership Conference Nashville, Tennessee August 2001 Editors Maureen Fitzgerald, MPA Kelly McIntosh Produced, prepared and published by CityMatCH at the University of Nebraska Medical Center Omaha, Nebraska 0 3 Cite as: Fitzgerald M., McIntosh K. (2001). Lessons Learned 2001: Profiles of Leading Urban Health Department Initiatives in Maternal and Child Health. From the 2001 CityMatCH Urban MCH Leadership Conference. Omaha, NE: CityMatCH at the University of Nebraska Medical Center. Lessons Learned 2001 is not copyrighted. Readers are free to duplicate and use all or part of the information contained in this publication. In accordance with accepted publishing standards, CityMatCH requests acknowledgment, in print, of any information reproduced in another publication. Inclusion of a work in this publication does not imply agreement or endorsement of the principles or ideas presented. This disclaimer is on behalf of CityMatCH and the Maternal and Child Health Bureau. CityMatCH is a national organization of urban maternal and child health programs and leaders. CityMatCH was initiated in 1988 to address the need for increased communication and collaboration among urban maternal and child health programs for the purpose of improving the planning, delivery, and evaluation of maternal and child health services at the local level. CityMatCH, through its network of urban health department maternal and child health leaders, provides a forum for the exchange of ideas and strategies for addressing the health concerns of urban families and children. CityMatCH also has developed a centralized information base about the current status of maternal and child health programs and leaders in major urban health departments in the United States. For more information about CityMatCH, contact Dr. Magda Peck, CityMatCH Executive Director/CEO, Department of Pediatrics, University of Nebraska Medical Center, 982170 Nebraska Medical Center, Omaha, NE 68198-2170, Phone: (402) 561-7500 or visit us at our website http://www.citymatch.org. CityMatCH at the Published by: University of Nebraska Medical Center Department of Pediatrics 982170 Nebraska Medical Center Omaha, NE 68198-2170 (402) 561-7500 (phone) (402) 561-7525 (fax) E-mail: [email protected] Lessons Learned 2001: Profiles of Leading Urban Health Department Initiatives in Maternal and Child Health was supported by grant number 5U93MC00120-10 from the Maternal and Children Health Bureau, Health Resources and Services Administration, Public Health Service, U.S. Department of Health and Human Services. To obtain a copy of Lessons Learned 2001, please contact us at the address listed above or you can fax/mail us the order form located at the back of this publication. The cost for a single copy is $15.00. 4 Acknowledgements Lessons Learned 2001: Profiles of Leading Urban Health 2001-2002 Department Initiatives in Maternal and Child Health is the fifth in CityMatCH this general publication series from CityMatCH, the national organization Board of Directors committed to improving the health and well-being of urban women, children and families by strengthening the public health organizations Chair: Carole A. Douglas, RN, MPH and leaders in their communities. The intent of this compendium is to Lincoln, NE facilitate easy access to selected urban public health practices aimed at improving the health of women, children and families. Highlighted are Past-Chair: address approaches and which practices replicable innovative Betty Thompson, RN, MSN Nashville, TN contemporary public health problems facing children and families in America's cities. Executive Committee: Carole A. Douglas, RN, MPH Readers seek advice on moving from "project" to scale and on Lincoln, NE Zenobia Harris, MPH, BSN developing creative collaborations to overcome the barriers to program Little Rock, AR effectiveness. They need effective methods to obtain and sustain LJamara Padro Milano, BSN, RNC resources. Lessons Learned 2001 provides ideas, tools, local contacts, Syracuse, NY and ideas for program and policy initiatives in urban maternal and child Magda G. Peck, ScD Omaha, NE health (MCH). Many of the MCH initiatives described have not been Betty Thompson, RN, MSN formally evaluated, their value lies in the initial research, groundwork Nashville, TN and concepts they offer for the development or enhancement of future Board Members: local, urban health projects. Vicki Alexander, MD, MPH Berkeley, CA Each CityMatCH member health department attending the August 2001 Lisa Belanger, BSN, MSN Urban MCH Leadership Conference submitted a profile of a current MCH Portland, ME effort as part of their active participation. These health departments Virginia Bowman, BSN, MPH Pittsburgh, PA deserve special recognition for passing on valuable lessons and for Kandi Buck land, RN, BS striving to better the lives of children and their families in urban Colorado Springs, CO communities. Kudos to Conference co-chairs: Gayle Bridges Harris Kathy Carson, RN, BSN (Durham, NC) and Llamara Padro Milano (Syracuse, NY), for steering a Seattle, WA Claude M. Dharamraj, MD successful conference experience. St. Petersburg, FL Linda Hook, RN, MSHP Producing Lessons Learned is a labor-intensive task, skillfully San Antonio, TX executed by co-editors Maureen Fitzgerald and Kelly McIntosh. Agatha Lowe, RN, PhD Chicago, IL Additional special thanks to Deanna Bartee, Michelle Coe, Diana Peter Morris, MD, MPH Fisaga, Jeanette Leaper, Jeff Rabey, Janet Rogers, Joan Rostermundt Raleigh, NC Patrick Simpson and Jennifer Skala at CityMatCH and Kevin Gamble Gary Oxman, MD, MPH at the University of Nebraska Medical Center's Printing Services for Portland, OR Lawrence Sands, DO, MPH helping to construct this user-friendly tool. The Maternal and Child Phoenix, AZ Health Bureau, HRSA, provides essential funding to allow CityMatCH to continue to serve as a partner for information and communication; CEO/Executive Director: we thank them for their ongoing support. Magda G. Peck, ScD Omaha, NE We hope Lessons Learned 2001 will spark action and change for local efforts to improve the health of women, children and families. Please let us know if and how this tool has proven most useful to you. Sincerely yours, G'671/. Magda G. Peck, ScD CEO/Executive Director, CityMatCH Table of Contents Summing Up: What Lessons Have We Learned? i Spot Light Award Winners vi About Lessons Learned: How to Use Profiles 1 Listing of Leading Urban Health Department Initiatives in Maternal & Child Health 5 Sample Profile Form 6 Profile Index I: Target Populations and Approaches 10 Profile Index II: Essential MCH Program Functions 16 2001 CityMatCH Profiles of Leading Urban Health Department Initiatives in Maternal and Child Health: 2001 CityMatCH Profiles 24 Appendices: CityMatCH Membership Listing 165 CityMatCH Publications Listing 181 6 7-1 ISORTING IT OUT: WHAT LESSONS HAVE WE LEARNED? The 12th annual Urban MCH Leadership Conference was held in Nashville, Tennessee in late August 2001. Among those in attendance were more than seventy designated maternal and child health leaders from CityMatCH member city/county public health departments. Each of these leaders, emissaries of health departments in major urban areas, whose jurisdictions include one or more cities with populations of over 100,000 or greater, submitted a "profile" outlining a current, local, urban MCH effort as a requisite for their federally subsidized attendance. Profiles submitted described a given activity, following a profile questionnaire which delineates budget, funding, expected outcomes, evaluation efforts, accomplishments, barriers to programmatic success, efforts to overcome challenges, key partners and overall lessons learned. Every profile included in this compendium has been reviewed for content, edited, updated where possible, reviewed and indexed. From the submitted profiles, CityMatCH extracted data to create two profile indices. The first index describes each profile by the type of initiative and the second index delineates them by the Essential MCH Functions, as described by Grason and Guyer in "Public MCH Program Functions Framework: Essential Public Health Services to Promote Maternal and Child Health in America." The mission of CityMatCH, the nationally recognized membership organization of city and county health departments' maternal and child health (MCH) programs and leaders representing urban communities in the United States, is to improve the health and well-being of urban women, children and families by strengthening the public health organizations and leaders in their communities. CityMatCH provides a peer-based support system for those striving to upgrade and enhance MCH practice and policy at the community, state and national level. In the years since the inception of CityMatCH, the organization has become a national resource center for data, policy and capacitybuilding on urban MCH. In 1996, CityMatCH recognized a unique opportunity to share local "best practices" and "models that "Lessons Learned: Profiles of Urban Health Department Initiatives in Urban Maternal work" and launched this series, and Child Health." As has been the case since 1996, the final question of the profile asks participants some variant of "What is the greatest lesson your health department has learned and can share with others about this activity?" Each year, a number of themes repeat themselves in some variation and each year a few new thoughts emerge. Not all the answers are found in reading responses to the last question. A number of themes emerged from the descriptions of barriers health departments encountered when undertaking their projects, and from the strategies health departments used to overcome them. Still others came from the project descriptions and the project accomplishments. Here are Lessons Learned 2001: the main themes that emerged from the review of 1. LOCAL. HEALTH DEPARTMENTS ARE FOCUSING ENERGY ON CREATIVE, EFFECTIVE WAYS To INFORM AND EDUCATE THE. PUBLIC ABOUT KEY MCH ISSUES.- "Community assessment of gaps in services often provides new opportunities for-- health education and prevention activities. "Knoxville, TN Many profiles in 2001 outlined unusual ways to create a more informed public. The 'Folic Acid Man' of Wilmington, DE, and Nashville's 'Tooth Fairy' all support the concept that learning should be a fun and easy activity. Wilmington also "Simple messages are best: dear visuals with verbal interaction are key." provided a formula for maximum impact: The City of Hartford (CT) Health Department, utilizing city vehicles, developed an educational awareness campaign with messages placed on the sides of Department of Public Works Sanitation Trucks. This clever collaborative effort of the city departments of Health, Public Works, and Housing and Community Development clearly met its stated objective to redefine how educational and awareness messages are provided to the public. Another clever mechanism for getting word out was offered by the Oklahoma City-County Health Department. After a series of focus groups were held, staff developed and implemented a plan to get health-related information printed onto dividers and placed into binders that were then given to high school suppliers. High school students assisted in both the development and the format of these materials, and the health department found that by printing health information on needed materials, they had increased the chances that it would be read and accessible. Vanderburgh County (IN) realized that they needed to do more to promote their services through the course of their project. "Through this initiative, we have also learned that we need to advertise our existence and services to FIMR the community in order that all residents have a source of obtaining health information if they don't receive it from CityMatCH Lessons Learned 2001 i 3357 COPY AVELA their physician." Lessons learned come to us in many different vehicles, and recognizing a need is the first baby step toward change. Measuring success (and failure) is an important aspect of promotional campaigns. Not all submissions to Lessons Learned have been through formal or informal evaluations, although some describe fairly sophisticated evaluation procedures. San Diego, CA presented a media awareness campaign which generated over 1, 000 uninsured families seeking health insurance within just ten weeks! Some promotional messages were designed to create awareness of a particular health issue, others were designed to advertise and alert consumers to programs and services. Still other health departments reported receiving the benefits of increased news coverage regarding health issues of the day. Clearly, health departments realize that they must communicate effectively to the different populations they serve or organizations with whom they collaborate. 2. COMMUNITY PARTNERSHIPS BETWEEN HEALTH DEPARTMENTS, POL/CYMAKERS OTHER-HEALTH-CARE.PROVIDERSi:FAMILIES, 'AND:INTERESTED OTHERS ENHANCE-;;, -LOCAL PUBLIC HEALTH IMPACT ON MATERNAL:AND CHILD HEALTH: . "Collaboration with community paitners,contributes to a more comprehensive program." Knoxville; TN Mobilizing community partnerships is an essential MCH function, carrying with it a host of unique issues and concerns. The development of collaborations can lead to positive outcomes for MCH, but requires significant effort. To carry out many projects successfully, local Health Departments need to elicit strong commitment from unrelated entities. Tacoma-Pierce (WA) County Health Department's acknowledged that, as with any effort that requires disparate people to cooperate, "Collaborations between public and private agencies take a lot of education and trust building before they can be successfully implemented. "Their Newborn Referral project was born out of a coalition of concerned businessmen, educators and human service providers, seeking to prevent abuse and neglect of children and promote health outcomes in families through the provision of family support services. Finding the right partners to provide the right services is paramount, yet sometimes determining who should be at the table is simple. The Long Beach Department of Health and Human Services developed their own collaboration between seven agencies, each of which considered improving the quality of life for children a priority. "Collaborative partners were easy to identify and included the local community college, the City's Library Department, a local community clinic with a long history of providing outreach and education and collaboration, the local school district Head Start program, a community-based agency specializing in outreach to Southeast Asian populations, and a local child care agency." In other instances, the choice of partners is not so intuitive. Health Departments consistently demonstrate creativity and take innovative approaches to assembling coalitions. They most often, however, look to the community for input. "The community knows what will and will not work for them. Agencies can provide a better service if the community is involved in the planning, decision-making and implementation. This kind of partnering takes time, but the outcome is more rewarding for both. "(Modesto, CA) Health Services Agency, for their Teen Life Challenge, a community project to reduce teen pregnancy. Improving health outcomes for women, children, families and youth is the overarching goal. 3. ROLES PERFORMED BY. THE LOCAL PUBLIC HEALTH DEPARTMENT ARE CRUCIAL, BUT... THEY AREN'T ALWAYS THE SAME AND THEY SOMETIMES DEFY EASY DESCRIPTION.: "Portland Public Health Division has planned and implemented this program in partnership with the school system and the hospital and has the responsibility for the on-going evaluation and management. "Portland, ME One question included in the profile questionnaire asks what role(s) the health department played in the project submitted. Answers were often complex, and ran the gamut from idea generation to research and data gathering, to convener of collaborations, to direct services to evaluation and back again. Health departments identify and assess problems, creating the spark that draws together community groups and other partners with disparate ideologies, agendas and funding streams, to create change. Spokane (WA) Regional Health District described the health department's role in their WIC Check Express program as, "catalyst, convener and facilitator in working with our community partners."Without question, the essential MCH function of "providing leadership for priority setting, CityMatCH Lessons Learned 2001 ii ,S12@rfr COPY AVAILA planning and policy development to support community efforts to assure the health of women, children, youth and their families, "is clearly at play in health department roles outlined in Lessons Learned 2001. Other profiles describe a more traditional public health model of start-to-finish involvement and direct service provision. The Philadelphia Department of Public Health's Osteoporosis Screening Program was fully under their auspices, as they "assumed NI responsibility for planning, and implementing this initiative, including training health center staff and providing education materials. All projects included elements of either catalyst or autonomous project direction. 4. BREATHING NEW LIFE INTO EXISTING PROGRAMS CAN LEAD TO MORE CONVENIENT, DIRECT .SERVICES AND INCREASED ACCESS FOR CONSUMERS. "Education and access are the most important needs of our citizens." Little Rock, AR "Access to Health Care" is one of the Leading Health Indicators set forth in Healthy People 2010, the prevention agenda for our nation. Many profiles in this year's Lessons Learned outline the overhaul and/or expansion of existing programs to increase consumer access. Some streamline multiple services into one location, others expanded existing services into different, more convenient locations, or augmented hours of service, or increased home visits or added neighborhood clinics. All have the same goal in mind: to provide increased access to services for the populations they serve, and thereby impact health outcomes. As one reads the profiles, it is evident that public health departments work in consultation with consumer, to bring them needed products and services in more appropriate ways. Winnebago County Health Department in Rockford, IL spent the last year expanding and at the same time, streamlining services targeted to provide support, education and assistance to at-risk populations, especially teen moms and moms receiving TANF. After initial staff resistance to change which is common no matter the endeavor; a shift slowly occurred. Arduous groundwork began to spark staff interest and earn their commitment. This shift, combined with the perception that clients now felt more motivated to participate, is crucial, as the health department struggles to meet the unique needs of consumers. "Implementing an old program in a new way can breath life into the program, "said the profile submitted by Rockford, IL The Pinellas County (FL) Health Department (PCHD) reviewed problems with its existing WIC program to determine how to make it more efficient and helpful to consumers. Administrative staff got together with consumers and brainstormed ways to break down barriers to service and to increase participation. They separated the two types of WIC appointments into different locations in one building so that those arriving simply to pick up checks no longer had prolonged wait time. They commented that, "It is important to listen to consumers and act on the information they provide about service delivery. PCHD and the consumers worked together to identify and solve a problem and improve services." This leads us to the next prevailing theme found in the 2001 submissions for Lessons Learned: SERVE, ANDTAILORTHEIR 5. SUCCESSFUL INITIATIVES RECOGNIZE THEINDIVIDUALITY. OF. THE-POPULATIONS THEY UNDERTAKINGS: TO TAKE THOSE UNIQUE. CHARACTERISTICS INTO ACCOUNT mentionedbyteen.S.can.havea.-; "Ask teens what is missingfrom health education. Many non-tradidOnal. issues the infOrmation you prOVide.','.. direct impact on their health and attitudes toward health. Addressthese issues in Oklahoma City, OK While the stated objective for the Salinas (CA) project was to reduce teen pregnancy, one of the strategies involved staff getting inside the world of the clients they were serving, and coming to an understanding of how these girls saw their potential life script. From that different vantage point, staff were then able to craft opportunities designed to enable the girls to find a new way of looking at their own possibilities. Because of this empathetic approach, staff were able to craft events upon which the girls could build an entirely new set of dreams. "It was surprising to the staff how narrow the world is for these girls and young women. There were surprises as the girls were taken to the State Capitol, Stanford University and the University of California, Davis. This was a new world for them and the mentors saw a new world in their eyes." Salinas, CA The lesson learned here is that unless you take the time to know what your population thinks, feels, and believes, you cannot speak to them in a way that is meaningful. The Madison (WI) Department of Health took this lesson to heart as they developed a program to combat the a common misperception that oral health is not an essential part of a person's general health, "The only way we have found to deal with this barrier is to inform and educate in a manner that respects the perspective and opinions of others." CityMatCH Lessons Learned 2001 iii 9 6. NEVER EVER UNDERESTIMATE THE USE OF DATA As A POWERFUL TOOL FOR CHANGE. "Tell the story. Tell the right story. Tell the right story right. "Portland, ME The effective use of data has emerged over the years as one of the more powerful tools that health departments can use. Used properly, data can explain not only what and where the problems are, but can be used to measure change, and to inform the public and key policymakers in a compelling fashion. Said the Tacoma-Pierce County (WA) Health Department, "By collecting this data, we hope to address these barriers and make prenatal care more readily accessible. In addition, a collaborative effort has been formed between local public health and the hospitals and high-risk families who were missed during the pregnancy are now being identified and linked to early intervention/prevention services." Marion County (OR) Health Department began a major focus to reduce teen pregnancy in 1997, when they found the rate to be at an all-time high. They needed to increase community awareness of the problem, and reduce the rate to at or below the state average of 18 percent. Thus began a program involving continuous monitoring of community health related data and of bringing relevant information to policy makers, commissioners, schools, churches and public agencies. The health department watched this strategy help unify their community to work toward the end objective of reducing teen pregnancy. They stated, "Data is crucial to proving the significance of a health issue with long ranging effects." The Minneapolis (MN) Department of Health and Family Support brought this caveat forward to all who gather and analyze data in MCH: "Communities want action, not simply more research." And so the gentle reminder to health departments: gather the data, by all means, but make effective use of it. Data should be gathered and utilized as a tool for change, and not to be bound into another report gathering dust on a shelf, a lesson not lost on CityMatCH member representatives. 7. PROGRAM EVALUATION IS A KEY STRATEGY FOR ENHANCING PROGRAKEFFECTIVENESSir.,.. . GARNERING. NEEDED SUPPORT AND RECOMMENDING PROGRAM REPLICATION. "Multnomah County Health 'Department seeks to invoive'c-ommunitypartners at all stages of planning,. implementation, and evaluation. "Portland, OR, Doubtless, not all of the profiles submitted to Lessons Learned have been formally evaluated. Projects span a continuum from new initiatives still in the rollout phase all the way through established programs with formal evaluation mechanisms. Several profiles illustrate how evaluation processes led them to programmatic 'tweaking" for enhanced outcomes. Others used outcome measurements as a tool to garner ongoing support from policymakers, city councils, foundations and grantmakers. Some discovered through implementing the project, the great need for evaluating program effectiveness. The key lesson learned submitted in one profile was this: "We need a tracking system to evaluate how effective the training was and how the materials were utiliZed." Knowledge is power. The Black Infant Health Project of the Los Angeles County MCAH Program is addressing health disparities in birth outcomes of African-Americans compared to other racial/ethnic groups. They are able to have a very concise picture of project impact because of the excellent feedback from San Diego State University, who serves are the official evaluator of the Statewide Black Infant Health Programs. Evaluation is an indispensable tool for Onondaga County (NY) Health Department developed the Syracuse Health Start Registry. For them, "the essential element of evaluation as an ongoing tool in quality improvement activities has resulted in new policies and procedures relevant to the practice of preventive MCH, increasing the frequency of home visitation, improving the documentation of interventions and getting women into care earlier. Evaluation has also encouraged the refinement of data collection and improved the tracking and monitoring of registry patticiPants." Good programs are meant to be shared. Collegial sharing and support is a hallmark of CityMatCH. Peoria (IL) City- County Health Department commented in their profile that, "as evaluation data is collected, the agency's "best practices"will be identified and profiled for possible replication. "They further describe sharing their local success and methodologies with pilot site colleagues and presenting it to State Level Department of Health staff. CityMatCH Lessons Learned 2001 iv 10 CO1FY AVAILA 111