Reducing Racial Disparities
addressing Extreme Prematurity
Eliminating Sleep-Related Deaths
First Year Cleveland (FYC) is a collective impact organization with a community-wide network of more than 500 partners, across all sectors and including parents and individuals who have experienced infant loss — all committed to reducing infant deaths. FYC is executing a three-year public policy and engagement strategic plan, and our Action Teams are focused on reducing infant deaths, racial disparities, extreme premature births and preventable sleep-related infant deaths. Summarized below are highlights of our work from 2019 through December 2020. Our thanks to all those whowork alongside us to tackle issues, achieve our goals and save our babies.
While the overall number of infant deaths throughout Cuyahoga County is decreasing, there remains a high rate of inequity between the number of white and Black infant deaths, with Black infants dying at nearly four times the rate of white infants. FYC remains committed to reducing this inequity. The information cited below is reflective of data gathered through December 15, 2020 and is provided by the Cuyahoga County Board of Health.
Cuyahoga County’s overall infant mortality rate has decreased from 10.51 in 2015 to 8.61 in 2019, and 7.18 through November, 2020.*
The county’s infant mortality rate for the Black non-Hispanic population has decreased from 18.45 in 2015 to 16.33 in 2019 and 13.57 through November, 2020.*
Infant deaths are being addressed with urgency through our FYC Action Teams, who are executing their respective charters and work plans. After two years of FYC support, two Action Teams are working toward self-sustenance and will continue to report the outcomes of their work to FYC for another two years.
FYC has led and grown a community-wide network of nearly 500 participants and partners, including parents and prospective parents, individuals with a lived experience of infant loss, neighborhood initiatives, faith-based, nonprofit, and philanthropic organizations, corporations, health care providers, hospital systems, and government entities.
In November 2019 FYC sponsored, with the YWCA Greater Cleveland, “400 Years of Inequity: A Call to Action.” This national conference acknowledged the 400-year anniversary of slavery in this country and the specific, urgent action necessary to dismantle racism. Conference attendance exceeded 500, with several national experts presenting. As an outcome, strategies were executed to work with local government to declare racism a public health crisis.
FYC was one of the first infant mortality collaboratives in Ohio to highlight structural racism as a key factor contributing to Black infant deaths. Since our initial efforts, strategies were executed which led to Cleveland City Council and Cuyahoga County passing resolutions declaring racism a public health crisis. Advisory Councils, at both city and county levels, have been formed, tasked with reviewing and providing recommendations to reduce racial disparities in areas ranging from health care to employment and transportation.
FYC partnered with providers to meet the increased needs of new and expectant parents due to the COVID-19 pandemic. FYC received a $100,000 grant from the Greater Cleveland COVID-19 Rapid Response Fund which enabled our partners to provide care packages, food, doppler fetal monitors, blood pressure cuffs, and iPads to COVID-19 positive and high-risk expectant mothers and families.
FYC has been active in leading efforts to scale up effective programs serving Black expectant and new parents. As a result, the community has increased the number of home visiting and birth worker slots and has served 3,600 additional consumers over three years through Ohio Department of Medicaid grants to four highly effective agencies – MomsFirst, Birthing Beautiful Communities, Moms & Babies First, and Nurse Family Partnership. Ninety-eight percent of the additional slots served Black expectant parents and each of these high performing programs had a significantly lower infant mortality rate when compared to Cuyahoga County’s Black parents not served by these programs.
Fatherhood and faith-based programs have been integrated into home visiting programs, bringing valuable insights and interventions key to reducing infant deaths.
Over the last several years, FYC increased the number of CenteringPregnancy® slots by over 1,300. Eighty percent of the additional slots served Black expectant parents. National data show that Black expectant parents served in a CenteringPregnancy® program experience a 41 percent reduction in premature births. The FYC Centering Coalition is now one of the largest and most active Centering Pregnancy® coalitions in the United States.
Led by FYC’s Action Team 1, FYC was selected as one of 17 organizations in Ohio to pilot implicit bias training developed by the March of Dimes, in collaboration with Quality Interactions. The training, "Breaking Through Bias in Maternity Care," is focused on addressing racial bias in maternity care, improving maternal and infant health outcomes,
and building a culture of equity within health care systems. The training will be provided to Greater Cleveland health system leaders, staff members,
FYC’s Action Team 2, the Pregnancy and Infant Loss (PAIL) Committee, established the Pregnancy and Infant Loss Society, led by men and women who have experienced infant loss. The PAIL Society hosts an annual remembrance event, “Wave of Light,” each October to honor babies who have passed away due to miscarriage, stillbirth or infant death prior to one year of age.
The PAIL Committee, in partnership with the Healthy Neighborhoods Committee of Healthy Cleveland, held the premiere of their film “Toxic: A Black Woman’s Story” in September, 2019. The film has been screened across the United States, including within the three Cleveland health care systems. The film was also added to the “Focus 2020: Racial Equity Shorts” program of the Cleveland Inter-national Film Festival, and it was featured in an additional six national film festivals. The film is available for purchase.
Stressing the importance of good mental health, the PAIL Committee also launched Our Wellness Network (OWN) in June, 2020. OWN is comprised of Black mental health professionals, parents who experienced loss, clergy and community advocates who provide Black men and women with support to manage pregnancy, parenting, pregnancy and infant loss, depression, anxiety, the effects of racism, and stress.
FYC’s Action Team 4 spearheaded efforts to bring local hospitals’ OB and NICU clinical leaders together to review medical record data and participate in shared learning in order to decrease the rate of premature births and improve maternal and birth outcomes. The Action Team presented findings and quality improvement recommendations in the summer of 2020. These findings and recommendations have been presented to hospital providers and are being addressed within each system.
FYC’s Safe Sleep Action Team has grown the number of Safe Sleep Heroes in our community. More than 17,000 Safe Sleep Heroes have been recruited and trained as a sustainable community engagement effort to reduce preventable sleep-related infant deaths. The “heroes” teach the ABCDs of Safe Sleep: Alone, on their Back, in a Crib and Don't smoke.
In the summer of 2020, FYC's Safe Sleep Action Team launched a comprehensive and highly visible Safe Sleep campaign including large-scale public advertising, billboards, car wraps, and daily messaging inside RTA buses circulating in Cleveland's east and central neighborhoods. In addition, local restaurants, public spaces such as libraries, and some businesses are displaying Safe Sleep posters.
Ohio’s “Tobacco 21” Law took effect in October, 2019, raising the age to purchase tobacco and vaping products to 21. FYC’s Smoking Cessation Action Team focused on decreasing smoking rates among expectant parents and new parents, as well as decreasing the exposure of pregnant women and infants to second- and third-hand tobacco smoke.
FYC and University Hospitals received one of the only system-wide anti-bias infant mortality grants from the Ohio Department of Medicaid (ODM). FYC certified 28 local trainers throughout multiple local systems using a highly effective, evidence-based Cook Ross Workplace Bias curriculum. By the end of 2019, over 1,000 key employees completed this impactful bias training. This training, along with educational materials developed for health care institutions, is part of ongoing and strategic racial bias training and Human Resource transformation efforts to address systemwide bias. FYC also sponsored and supported racial equity training through the Racial Equity Institute.
FYC secured $4.8 million through the 2019 ODM Healthy Moms and Babies grant to coordinate a community-wide, data-driven initiative and target the disparity in the Black infant mortality rate in Cuyahoga County. The funds went directly to seven local, highly effective entities to expand nine programs that have a track record of reducing Black infant deaths.
In June, Ohio’s Governor signed House Bill 11 into law. HB11 is focused on reducing infant mortality through increased access for pregnant women to dental cleaning, smoking cessation, lead safety information, and group prenatal care services. FYC's Engagement and Public Policy Committee was integral to the passage of this bill.
The Engagement and Public Policy Committee identified three public policy priorities for 2020-2021: funding, equity, and access. The committee will closely follow policy decisions across the state that will inform and impact its initiatives, including those focused on paid family and medical leave, recognition of doulas and perinatal support professionals as essential staff in labor and delivery, and the expansion of anti-racism training.
As part of its strategic planning efforts, FYC is identifying opportunities to improve access to and the use of data, with efforts focused on greater access to data reported by programs, analyzing both City of Cleveland and Cuyahoga County data, and pursuing the role that managed care organizations could play in providing maternal and birth outcome data related to specific interventions.
FYC is presenting at conferences and seminars, leading discussions on reducing racial disparities and addressing structural racism. FYC’s executive director now serves on the NY State Department of Health Maternal and Child Equity Improvement Planning Team where strategies for improving equity in maternal and birth outcomes will be identified.
FYC is in the midst of an equity-based strategic planning process. This process will result in an equity assessment of FYC; a 2021-2023 strategic plan centered in equity; clearly defined priorities and goals; an implementation plan with measurable deliverables; and an evaluation process to ensure the plan contributes to reducing Cuyahoga County’s infant mortality rate, specifically the Black infant mortality rate.
Through a partnership with the Bright Cities Program of Healthy Babies Bright Futures, FYC is supporting education and practices that reduce toxic exposures for infants and pregnant women. FYC is working with the Bright Cities Program, local partner agencies, and advocacy groups to educate expectant parents and new parents on how to reduce toxic exposures, particularly exposure to lead, in their homes.
FYC and its partner agencies continue their collaboration with the Greater Cleveland Food Bank whereby providers can act as proxies for individuals, pick up food from area food pantries, and deliver food directly to residences. All home visiting and community-based partners have the ability to act as proxies and pick up food through the Greater Cleveland Food Bank.
FYC has diversified its revenue stream, with funding from foundations, public sources, governance members and individual donors.
FYC continues its effective and impactful relationship with Case Western Reserve University School of Medicine. CWRU serves as First Year Cleveland’s parent organization and provides in-kind resources including infrastructure to support day-to-day operations, such as accounting, human resources and technology services.
There is urgency to our work. We have made progress in reducing infant deaths for all races, but improvements are moving too slowly. We have the right road map and we must continue to work strategically and collectively in leading both system changes and scaling effective programs for Black parents and expectant parents to eliminate racial inequities. FYC is committed to eliminating the inequity rate for Black infant mortality by 2025. We appreciate all your efforts to ensure continued progress.
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