Reducing Racial Disparities
addressing Extreme Prematurity
Eliminating Sleep-Related Deaths
Summarized below are highlights from 2019 through June 2020. Much collective work has been done to decrease infant deaths in Cuyahoga County, particularly Black infant deaths, and efforts in this area continue, despite the challenges presented by the COVID-19 pandemic. A separate summary of the work we’ve done to address the pandemic and its effects on our community’s families has also been developed and can be found here. Our thanks to all those who work alongside us to tackle issues, achieve our goals and save our babies!
Reductions in the number of Infant deaths throughout Cuyahoga County are being achieved. The information cited below is reflective of data gathered through July 10, 2020 and is provided by the Cuyahoga County Board of Health.
Infant deaths are being addressed with urgency through our FYC Action Teams. These FYC Action Teams are executing the activities outlined in their respective charters and work plans.
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 organizations, nonprofits, corporations, philanthropic organizations, 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.
On Monday, March 2, Cleveland City Council introduced a resolution declaring racism as a public health crisis. The resolution was passed by City Council on June 3. A similar resolution was approved by Cuyahoga County Council on July 7. The measure is currently being considered by the Ohio General Assembly. Since that time, a Citizens’ Advisory Council has been formed, which will be tasked with reviewing and providing recommendations to reduce racial disparities in areas ranging from health care to employment and transportation.
In mid-March 2020 FYC efficiently pivoted to meet the increased needs of new and expectant parents due to the COVID-19 pandemic, while maintaining remote day-to-day operations. Working collectively with our partners, we implemented key initiatives to target and reduce the disparity in health outcomes in the county’s Black communities. Details of these efforts can be found in a separate COVID-19 updates document.
FYC was the recipient of a $100,000 grant from the Cleveland Foundation’s Rapid Response fund which enabled us to provide equipment to labor and delivery units, including Doppler fetal monitors, BP cuffs and more, as well as care packages for new mothers with or at high risk of COVID-19.
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 expectant parents not served by these programs.
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 Centering® program experience a 41 percent reduction in premature births. The FYC Centering Coalition is now one of the largest and most active Centering® systems in the United States. FYC will strive to increase enrollment over the next five years.
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 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 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” on September 25, 2019. The film has been screened across Cuyahoga County, including within the three Cleveland health care systems for medical grand rounds. The film was also added to the “Focus 2020: Racial Equity Shorts” program of the Cleveland International Film Festival, which was conducted virtually due to the COVID-19 pandemic.
The PAIL Committee also launched Our Wellness Network (OWN) on June 18, 2020. OWN is comprised of Black mental health professionals, parents, clergy and community advocates who provide Black men and women with the support they need to manage pregnancy, parenting, infant loss and any other circumstances involving depression, anxiety, racism, and stress.
Ohio’s “Tobacco 21” Law took effect October 17, 2019, raising the age to purchase tobacco and vaping products to 21. Decreasing smoking rates among expectant parents and new parents, as well as decreasing second and third-hand exposure to smoke, will positively impact the number of infant deaths.
FYC has been able to scale best practice interventions, notably growing the number of Safe Sleep Heroes. More than 15,000 Safe Sleep Heroes have been recruited and trained as a sustainable community engagement effort to reduce preventable sleep-related infant deaths.
Fatherhood and faith-based programs have been integrated throughout home visiting programs, bringing value-add program components that are key to reducing infant deaths.
FYC 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 improve health care services to decrease maternal and infant deaths, specifically mothers and infants of color.
FYC and UH 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 throughout multiple systems 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 structural racism. FYC is also sponsoring and supporting racial equity training through the Racial Equity Institute.
FYC is working with the Cuyahoga County Metropolitan Housing Authority to secure important housing vouchers for high-risk pregnant women in need of stable housing.
FYC was the Primary Applicant to the Ohio Department of Medicaid Healthy Moms and Babies grant opportunity. This opportunity secured $4.8 million in November 2019 for county programs critical to improving birth outcomes and reducing disparities among Black people enrolled in Medicaid. The funds went directly to seven local, highly effective entities to expand nine programs that have a track record of reducing Black infant deaths.
FYC is leading efforts to impact state-wide policy and develop integrated and sustainable funding sources for best practice interventions through an aggressive three-year Community Engagement and Public Policy Strategic Plan, which began in June 2018. FYC is working with Advocacy & Communication Solutions and The Center
for Community Solutions to achieve Medicaid billing solutions so programs can have long-term financial sustainability rather than depending on limited grant funds. Also as a result of this partnership, House Bill 11 was passed in the Ohio House in June 2020. This bill expands tobacco cessation programs and increases lead education and prenatal support group programs, with the goal of improved maternal health and reduced infant illnesses and deaths. FYC has demonstrated its ability to advocate and secure critical state funds for local infant mortality efforts targeted at reducing Black infant deaths and will continue this work through 2020.
To target interventions, 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 and county-level data for end of year 2020 goals, and pursuing the role that managed care organizations could play in providing birth outcome results tied to specific programs.
FYC was one of the first infant mortality collaborations in the state to call out structural racism as a key factor in our local and state high infant death rates. FYC has committed to continuing to apply an equity lens to its work and urges all of our partners to do the same.
FYC is being called upon to present at local and national conferences and seminars, leading the discussion on reducing racial disparities, addressing structural racism, and Racism as a Public Health Crisis, and has presented at the Michigan Maternal-Infant Health Statewide Conference, National Grantmakers in Health Conference and the March of Dimes Prematurity Collaborative Conference, “Equity in Action: Moving from Theory to Practice Training,” in Orlando, Florida. In an effort to allow others to gain from FYC’s collective work, FYC is lending its expertise and technical assistance.
FYC has continued to operate with a lean staffing model dedicated to the success of the collective impact collaboration.
In June 2020, FYC began a six-month equity-based strategic planning process. Execution of the three-year plan will commence in the first quarter of 2021.
FYC has diversified its revenue stream, with funding from foundations, public sources, Executive Committee 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 and action in our work. We have noted progress in reducing infant deaths within each race but the needle is moving too slowly. We continue to see numbers fluctuate, and acceleration needs to occur on all levels. 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 achieve our goals, save our babies and eliminate racial inequities. Our goal is to have no racial inequities between Black and white babies by 2025. We appreciate all your efforts to ensure continued progress.
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