HomeMy WebLinkAboutMINUTES - 05101994 - S.1 TO: BOARD OF SUPERVISORS `'moi 'ti Contra
FROM: SUPERVISOR JEFF SMITH Costa
County
DATE: MAY 101 1994 S. 1
' 1
SUBJECT: Report reviewing progress by Contra Costa County on acheiving national
objectives for lowering infant mortality among African Americans .
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
RECOMMENDATION:
Accept report from Director of Health Services on progress by
Contra Costa County in the area of infant mortality in the African
American community.
FISCAL IMPACT:
None.
BACKGROUND:
In a report issued by the State of California, Contra Costa County
is recognized as the first and only County in the State to meet
federal goals in reducing infant mortality among African Americans .
Attached is a report by the Health Services Department which
discuss in detail the County's efforts and progress towards
improving African American -infant mortality rates .
CONTINUED ON ATTACHMENT: YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARDCO I
APPROVE OTHER
SIGNATURE(S):
ACTION OF BOARD ON - May 10, 1994 APPROVED AS RECOMMENDED X OTHER X
The Board REFERRED to the Education Committee to link with schools, Social
Services and Community Services Departments and families the aforesaid report from
the Health Services Director on progress by Contra Costa County in the area of
infant mortality in the African American community; and REQUESTED that a letter of
thanks be sent to institutions involved, along with a copy of the chart that was
presented today.
VOTE OF SUPERVISORS
I HEREBY CERTIFY THAT THIS IS A TRUE
_ X UNANIMOUS(ABSENT ) AND CORRECT COPY OF AN ACTION TAKEN
AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD
ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN.
CC: County Administrator ATTESTED May 10, 1994
Social Services PHIL BATCHELOR,CLERK OF THE BOARD OF
Community Services SUPERVISORS AND COUNTY ADMINISTRATOR
Health Services
M382 (10/88)
BY DEPUTY
SI
Contra Costa County
The Board of Supervisors HEALTH SERVICES DEPARTMENT OFFICE OF THE DIRECTOR
Tom Powers, 1st District Mark Finucane, Director
Jeff Smith,2nd District .............•.o
Gayle Bishop,3rd District __ 20 Allen Street
Sunne Wright McPeak,4th District -'_- Martinez,Cc;ifornia 94553-3191
Tom Torlakson,5th District ni (510)370-5003
County Administrator cas FAX(510)370-5098
Phil Batchelor `°s;•. `.��`
County Administrator
To: Supervisor Tom Powers, District 1
Supervisor Jeff Smith, District 2
Supervisor Gayle Bishop, District 3
Supervisor Mark DeS Hier, District 4
Supervis r Tom Torl on, District 5
From: Mark firrucane —
Health Services Director
Date: May 3, 1994
Subject: Reaching the National Objective for African American Infant Mortality
The enclosed report is prepared at the request of Supervisor Jeff Smith. It describes the
progress we have made in Contra Costa County toward reducing African American infant
mortality. The Department initiated this effort in the mid-1980's. Over the years we have
taken advantage of new funding sources and allocated local funds to create new County-run
programs and entered into partnerships with community organizations. In short, we have
focused consistent attention and resources toward addressing one of the most glaring
inequities in our society -- the high rate of infant death for African American families.
We are proud of the progress we have made, but we cannot rest until we close the gap
completely between white and black infant death rates. We pledge ourselves to continue
what has worked so well, to refine programs based on new data and to initiate strategies to
further reduce unnecessary suffering and death. Special attention needs to be given to
tobacco use,domestic violence,involving men in services and improving the economic health
of African American families.
Merrithew Memorial Hospital 8 Clinics Public Health Mental Health • Substance Abuse Environmental Health
Contra Costa Health Plan Emergency Medical Services • Home Health Agency Geriatrics
A-345 (2/93)
• Reaching the National Objective for
African American Infant Mortality
in
Contra Costa County
Contra Costa County is the first county in California to achieve (and surpass) the year
2000 objective for African American infant mortality of 11.0 deaths per 1000 live births.
African American infants nationwide die twice as often as white infants during the first year of
life. In contrast, in Contra Costa County, we have been steadily closing the gap in the rate of
infant deaths between black and white infants.
For 1989 through 1991, the .rate of African-American infant deaths in Contra Costa
County was 10.1 deaths per 1000 live births compared to white rate of 6.3 deaths per 1,000 live
births. For 1980 through 1982, the African American rate was 16.7 compared to a white rate
of 8.2. See Attachment 1.
How Did Contra Costa County Improve African American Infant Mortality Rates?
In the mid 1980's, the Health Services Department made a conscious decision to devote
its resources to improving the health of pregnant women and infants, with special attention to
African American families.
The first step was to recognize that a problem existed. Detailed analysis of birth and
infant death data revealed the areas of the county and the population groups most affected by
poor outcomes. Three inter-related strategies were adopted. See Attachment 2.
1. Improving Access to Prenatal Care and Hospital Services, including
• changing financial policies
• bringing hospital care closer to home
• creating caring relationships/making health care more personal
2. Improving the Content of Prenatal Care, including
• adding nutrition, health education and social support to the regular medical
visit
• creating substance abuse recovery services, especially for pregnant women
and new mothers
• training staff to counsel women about HIV infection and AIDS
3. Improving Our Understanding and Use of Prevention Opportunities, including
• taking a closer look at preventable deaths
• involving the most affected communities in changing the numbers
• training community health advocates
Reaching the National Objective for Page 2
African American Infant Mortality
in Contra Costa County
These strategies have been implemented by various Health Services programs and by
community based organizations. Our partnerships with each other have been essential to
success. No one program has made the difference. It is the combination of strategies and
services which has finally added up to make a critical mass for change. See Attachment 3.
In addition to local actions, the state and federal governments made available new sources
of funding to reduce infant mortality. MediCal began covering support and educational services
as part of prenatal care and then expanded coverage for women up to 200% of poverty,
including those without immigration papers. This reimbursement made a tremendous difference
in access to care and the comprehensiveness of care. Federal funds match state and local dollars
to support outreach, case management and program administration. One third of the Tobacco
Tax Health Education account has been allocated for perinatal community involvement programs
with special attention to neighborhoods with the most serious problems.
Actions to Improve Access
• Financial Policy
In 1985 the Health Services Department eliminated collection of a cash deposit for
prenatal visits and adopted a policy of enrolling pregnant women in prenatal care while their
applications for MediCal were pending. To date we are still the only provider of prenatal care
services in the County to do this. Delays in receiving MediCal eligibility often delay when a
woman begins care. Due to a recent State law, any prenatal care provider can now apply to
become a "Presumptive Eligibility" provider, a designation which reduces the financial risk of
enrolling patients whose MediCal applications are pending. Many prenatal practices in the
County are enrolling in the program which should help more women receive beneficial care
sooner than before.
• Adolescent Family Life Program
In 1985 the Adolescent Family Life Program, operated by the East Bay Perinatal
Council, began to serve pregnant and parenting adolescents in East and West County. Case
management services help reduce low birthweight and infant mortality, reduce school drop out
due to teen pregnancy and delay repeat pregnancy. Parenting skills training reduce the risk of
child abuse and neglect as a result of parenting too soon. Services are provided by the council
and by sub-contracting agencies including: Family Stress Center, Planned Parenthood and West
Contra Costa Youth Services Bureau.
j
Reaching the National Objective for Page 3
African American Infant Mortality
in Contra Costa County
• Regional Perinatal Health System
In 1986 the Regional Perinatal Health System for Alameda and Contra Costa Counties
was established. It is called the Perinatal Network of Alameda/Contra Costa and includes Health
Services staff on its governing board and working committees. This system is the formal
organization of perinatal service providers, related agencies and organizations to promote
optimal referral patterns, consultation among providers, resource sharing, joint planning and
staff training. Alta Bates Hospital is the maternal perinatal center and Children's Hospital of
Oakland is the newborn perinatal center in our region.
• Prenatal Care Guidance
Since beginning in 1989, the Prenatal Care Guidance Program has grown to provide
outreach and support services to at least 450 women annually, with over 95% of these women
giving birth to normal weight babies. This program continues to follow the women and their
newborns after delivery to insure they receive pediatric care.
•
Healthy Tomorrows
In 1990 the Healthy Tomorrows Program, operated by the East Bay Perinatal Council,
began outreach and ongoing support services, including substance abuse treatment and support
groups, for African-American women in West County who are at high risk for low birthweight
births and infant mortality. They also follow the families after birth.
• Joint Venture with Brookside Hospital
In February of 1991, the Department began a joint venture with Brookside Hospital to
deliver women receiving Healthy Start services at the Richmond Health Center using Merrithew
staff. We designed the joint venture to improve the accessibility of delivery care for West
County families and to improve continuity of services.
Improving Prenatal Care
•
Healthy Start
In May of 1988, the Health Services Department implemented Healthy Start, a
Comprehensive Perinatal Services Program (CPSP) that includes extensive health education,
nutrition and psychosocial services as part of regular prenatal care. The program now serves
2,200 pregnant women a year at the Richmond, Pittsburg and Martinez Health Centers.
Reaching the National Objective for Page 4
African American Infant Mortality
in Contra Costa County
• WIC
Since 1988, the Women, Infants and Children Supplemental Food Program has worked
closely with our Healthy Start clinics. The Healthy Start nutrition assessment includes collection
of all the information for enrollment in the WIC program. Explicit coordination with the WIC
program for enrollment and voucher distribution results in more effective use of patient and
provider time and coordinated service provision.
• Comprehensive Perinatal Services Program
In addition to Healthy Start, which was the first Comprehensive Perinatal Services
Program in Contra Costa County, five other prenatal care providers now provide comprehensive
perinatal services at eight locations. Another provider is in the application process. CPSP
requires that each pregnant woman receive individual assessments and extensive attention to her
medical, nutrition, psychosocial and health education needs during pregnancy Reimbursement
for services is through MediCal. We estimate that 58% of pregnant women on MediCal are
receiving CPSP care which increases their chances of having a healthy baby.
• Born Free
Beginning in 1989 and expanding to three sites in 1990, the Born Free Project has
implemented regular substance abuse assessment and intervention for all Healthy Start
participants, as well as women delivering at Merrithew Memorial Hospital. In addition, Born
Free's outpatient treatment program serves a minimum of 75 families a year.
• Options For Recovery
In December 1991, Options for Recovery opened its doors to provide intensive substance
abuse treatment, case management and foster care services(when necessary) to pregnant and
postpartum women in East and West County. The program has served approximately 350
mothers and their babies to date.
• HIV Policy and Training
In 1991, in response to the high prevalence rate of HIV infection in our perinatal
population, all pregnant women enrolling for prenatal care at Merrithew Memorial Hospital and
Clinics were offered an HIV antibody test, regardless of risk factors for HIV infection. In 1992,
we strengthened this policy by recommending the HIV antibody test for all pregnant women.
Comprehensive, culturally sensitive and frequent training supplements these policies. A
procedure for follow up care for HIV positive women in the system is also in place to ensure
that women, infants, and their families receive appropriate medical and support services.
Reaching the National Objective for Page 5
African American Infant Mortality
in Contra Costa County
• Exnanded Perinatal Substance Abuse Recovery Programs
In 1992, new funding from the State of California created the Perinatal Treatment
Expansion Program in the Community Substance Abuse Services Division of the Department.
Fund supports services provided by residential recovery services, substance abuse education, and
counseling to women in jail, childcare and support for children, and parenting skills trainings.
Tri-County Women's Recovery Services, the Born Free Project and East County Community
Detox.
Prevention Opportunities
• Fetal Infant Mortality Review
In 1992, the Health Services Department began working closely with the Fetal Infant
Mortality Review project of Alameda/Contra Costa Perinatal Network to examine fetal and infant
deaths as soon as they occur. The findings are helping us recognize gaps in services and design
more focused prevention and early intervention strategies.
• Comprehensive Perinatal Outreach
Starting in Richmond in March 1993 and expanding to Pittsburg in February 1994, the
Comprehensive Perinatal Outreach project, funded by Tobacco Taxes, is creating more
community awareness about prenatal care and family health issues and is training a network of
community health advocates who will keep the message going. This special effort is being
created and carried out by Community Leadership Development Institute in West County and
the Pittsburg Preschool Coordinating Council in East County.
What's Next?
We are proud of the progress this County has made, but a serious gap continues to exist
between black and white infant mortality. African American infants die 1.6 times more often
than Caucasian infants in Contra Costa County. Our goal for the coming years is to close the
gap completely.
By the year 2000 our goal is for the African American infant mortality rate to be the
same as the white rate. To achieve this goal we must maintain the efforts described above and
focus attention in the following new areas:
n
Reaching the National Objective for Page 6
African American Infant Mortality
in Contra Costa County
• reduce smoking by pregnant women'
• reduce exposure to second hand smoke for pregnant women and infants
• reduce domestic violence
• improve the economic health of African American families
• increase our involvement of men in perinatal and family health programs
Date: May 3, 1994
MF:jap
a:SusanYinfntmon.rep
'A 1992 prevalence study by the California Department of Alcohol and Drug Programs
revealed that 14.8% of all women giving birth in Contra Costa smoked, with a surprising 35.0%
of African American reporting smoking. Cigarette smoking is highly related to low birth weight
which in turn is a major factor in infant mortality.
INFANT DEATHS PER 1000 LIVE BIRTHS
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Attachment 3
Programs Contributing to Reducing African American Infant Mortality
We honor and thank the staff and administrators of these programs. Their consistent and caring
work has changed the lives of women, infants and their families in Contra Costa County. Thank
you outreach workers, nurses, social workers, nutritionists, dietitians, health educators,
physicians, epidemiologists, nurse practitioners, LVN's, clerks, public health aides,
comprehensive perinatal health workers, receptionists, financial counselors, substance abuse
counselors, public health nurses, program coordinators, child enrichment workers and program
administrators.
Alcohol, Drug Abuse and Perinatal Task Force
Adolescent Family Life Program
Alta Bates Perinatal High Risk Program
Born Free
Brookside Hospital
Child Health and Disability Prevention Program
Children's Hospital Genetics Screening
Childhood Injury Prevention Program/Childhood Injury Prevention Coalition
Community Substance Abuse Services
Community Development Leadership Institute/Joyce White Associates
Comprehensive Perinatal Services Program
Comprehensive Perinatal Outreach Program
East Bay Perinatal Council
East County Community Detox
Family Stress Center
Healthy Start/Merrithew Memorial Hospital and Clinics
Heritage Project Social Service Department
HIV/AIDS Program
Healthy Tomorrows
Infant Bond
Living Free
Options For Recovery
Perinatal Network of Alameda/Contra Costa
Pittsburg Pre-School Coordinating Council
Planned Parenthood - Shasta-Diablo
Prenatal Care Guidance
Private Comprehensive Perinatal Services Program Practices
Tobacco Prevention Program
Tri-County Women's Recovery Services
West Contra Costa Youth Services Bureau
Wollam House
Women, Infants and Children Supplemental Food Program
(File:SHM/aTROGIMR.LST)
Phil Batchelor
The Board of Supervisors Contra Clerk of the Board
and
County Administration BuildingCounty
0)Administrator
651 Pine Street, Room 106
Martinez,California 94553-1293 County
Tom Powers,1st District
Jeff Smith,2nd District �E......;�••,o„
Gayle Bishop,3rd District
Mark DeSaulnier,4th District /
Tom Torlakson,5th District V
Sra COUNT
August 2, 1994
Dear Colleague:
Contra Costa County is the first county in California to achieve (and surpass) the Year 2000
National Objective for African American infant mortality of 11.0 deaths per 1,000 live births.
On May 10, 1994, the Board of Supervisors officially recognized this achievement and honored
the Health Services Department and community based organizations that have been working
diligently for years to reach this goal. In addition, the Black Families Association of Central
Contra Costa County presented an award to the Health Services Department in June, 1994 in
appreciation of the progress made in improving the health of African American children.
The Board of Supervisors and the Health Services Department would like to extend to you a
personal acknowledgement of your vision and efforts which were instrumental in achieving this
objective. This achievement is the result of all programs working together, developing strategies
and providing quality, innovative services.
Although we are proud of the progress we have made together, we are committed to achieving
further improvements. We are counting on your continued dedication and participation.
Sincerely,
0-)AI
Tom Powers, Chair Mark Finucane, Director
Board of Supervisors Health Services Department