Ohio Equity Institute
to Improve Birth Outcomes
Cuyahoga Cleveland Partnership
Meeting Objectives
 Why are we here?
 Progress since last meeting
 Survey results
 Upstream and downstream strategy discussion
What happened in October
 Discussion of Perinatal Periods of Risk
 Discussion of potential strategies
 Discussion around additional data sources
Progress since last meeting
 Sent out FIMR webinar for group to view
 2 technical assistance calls with CityMatch
 Sent out survey monkey for group
Aligning with Hip-C
 Attending Eliminating Racism as social determinant of health
committee
Survey Results
 Survey was sent out early December
 21 people responded
Ranking Strategies
 Chronic Stress (5.71)
 Perinatal Care (5.43)
 Unintended Pregnancies (4.67)
 Safe Sleep (4.29)
Thinking about Chronic Stress and its impact on birth outcomes, please select the
upstream strategy you feel would be most effective to address infant mortality:
Answer Choices –
Responses –
Identify and implement Best Baby Zone in
high need communities
52.38%
Improve equitable distribution of resources
in high need communities
38.10%
Improve community cohesiveness
Work with county and city officials to
improve access to quality education in all
communities
0%
14.29%
Work with county and city officials to ensure 4.76%
safe and affordable housing for all families
Total Respondents: 21
Comments(0)
Thinking about Unintended Pregnancy and its impact on birth outcomes, please select
the upstream strategy you feel would be most effective to address infant mortality:
Answer Choices –
Ensure all clinical and social service
organizations work with men and women of
child bearing age to discuss the
Reproductive Life Plan
Ensure all women are offered long term
reversible birth control
Ensure all clinical and social service
organizations maintain policies related to
Title X services in Cuyahoga County
Total Respondents: 21
Responses –
57.14%
28.57%
19.05%
Thinking about Perinatal Care and its impact on birth outcomes, please select the
upstream strategy you feel would be most effective to address infant mortality:
Answer Choices –
Ensure all clinical systems in Cuyahoga
County offer Centering Pregnancy for
pregnant patients
Ensure all clinical and social service
organizations are familiar with the Medicaid
Waiver
Ensure there are policies in clinical settings
to educate, screen, and offer progesterone
injections for women who experienced
previous preterm birth and/or have a
shortened cervix
Educate all clinical providers on social
determinants of health and its impact on
their patients
Ensure all clinical and social service
agencies adopt health literacy principles
Responses –
42.86%
19.05%
28.57%
28.57%
14.29%
Thinking about Safe Sleep and its impact on birth outcomes, please select the upstream
strategy you feel would be most effective to address infant mortality:
Answer Choices –
Responses –
Ensure all clinical and social service
85%
organizations adopt the Ohio Department of
Health's Safe Sleep policies
Work with political offices on developing
policy to eliminate the sale of bumper pads
20%
In summary
 PPOR analysis found that the areas of greatest need for
Cuyahoga County were Maternal Care and Infant Care
 Maternal Care
 Top Three: Chronic Stress, Perinatal Care, and Unintended Pregnancies
 Infant Care:
 Safe Sleep
Chronic Stress: Upstream Strategy
 Best Baby Zones
Best Baby Zones
Every baby is born healthy, into communities that
enable them to thrive and reach their full potential.
 Best Babies Zone communities promote good health from
one generation to the next. Positive life experiences and
increased opportunities where we live, work, learn and play,
such as early childhood education, affordable housing and a
vibrant local economy will help everyone thrive and be
healthy
Methodology
Cuyahoga County, Ohio. Bivariate Thematic Map. 2009-2011 Low Birth Weight and Preterm Births
by Census Tract with Greater Than Twenty-Nine (29) Live Births
Vital Statistics Data
.
Why Place Really Does Matter
Why Place Really Does Matter
Perinatal Care :Upstream Strategy
 Centering Pregnancy as standard of Care in Hospital settings
Centering Pregnancy
 “Centering is a model of group health care, changing how
people experience their care. When a group of people come
together for a common purpose of health and well-being to
share information and learn together, a transformation
happens at both the personal and collective level that brings
about better understanding, greater engagement, and selfconfidence. “
 Sites in Cuyahoga County:
 University Hospitals
 Neighborhood Family Practice
 NorthEast Ohio Neighborhood Health Services
Unintended Pregnancies: Upstream
Strategy
 Policies for clinical and social service organizations to receive
training and provide Reproductive Life Plan with men and
women of child bearing age
Unintended Pregnancies
 Lack of planning for pregnancy and pregnancy spacing,
management of health conditions, environmental risk factors,
and negative health behaviors that affect pregnancy outcomes
leads to:







unintended pregnancies
increased risk for preterm births
increased risk for low birth weight births
increased rates of birth defects
poorer health status for women
increased health disparities
increased risk of infant mortality
What is a RLP?
 A reproductive life plan is a set of personal goals about
having or not having children, as well as the number and
spacing of children if and when you choose to have them.
 Everyone (men and women) is encouraged to make a
reproductive life plan based on their own values, goals, and
resources.
Infant health: Upstream Strategy
 Ensure all clinical and social service providers adopt ODH
safe sleep policy
Sleep related deaths: City of Cleveland
Sleep related deaths: Cuyahoga County
Group Work
Best Baby Zones
2. Centering Pregnancy as standard of care
3. Policy to support provision of Reproductive Life Plan
4. Ensure all clinical and social service providers adopt ODH
safe sleep policy
1.
Group Work
 Do you think this is an effective strategy to improve infant
mortality? Why or why not?
 Do you feel this should be a county-wide or neighborhood
based approach? Why or why not?
 What are some potential activities to support
implementation of this strategy?
 What are the assets and limitations to implementing this
strategy?
Next Steps
 Identify roles of each organization for identified strategies
 Create Logic Model
 Next meeting February 14, 2014