First Year Cleveland (FYC) is a collective impact organization with a community-wide network of more than 500 partners, across all sectors and including expectant parents, new parents and parents and individuals who have experienced infant loss — all committed to reducing infant deaths. Throughout 2020, FYC executed its final activities outlined in its inaugural 2017-2020 strategic plan along with its three-year public policy and engagement strategic plan. We applaud all our Action Teams and partners who are focused on reducing infant deaths, racial disparities, extreme premature births and preventable sleep-related infant deaths. Summarized below are highlights of our collective work from January 2019 through December 2020. (All 2020 data are preliminary and unaudited.)
EFFORTS TO REDUCE INFANT DEATHS
Due to our community-wide, collective effort, Cuyahoga County’s progress in reducing the local Infant Mortality Rate (IMR) is historic. It is now time for FYC and all of our partners to double down on our collective commitment to eliminate racial disparities in birth outcomes and reduce infant deaths. The information cited below is reflective of data gathered through June 16, 2021 and is provided by the Cuyahoga County Board of Health. Using 2015 data as a baseline, over the subsequent five years the following reductions are noted:
- Cuyahoga County’s overall infant mortality rate (IMR) has decreased from 10.51 in 2015 to 7.57 through December, 2020. This is the lowest IMR recorded in Cuyahoga County and represents a 28% reduction over five years.
- The county’s infant mortality rate for the Black non-Hispanic population has decreased from 18.45 in 2015 to 14.60 through December, 2020. This is the lowest Black IMR since the inception of FYC and represents a 21% reduction over five years.
- The Black to white infant mortality inequity ratio in Cuyahoga County was 6.7 in 2017 – when FYC began recording the benchmark index – and is now 4.1 through December, 2020, a 38% decrease.
- The county’s overall preterm birth rate has decreased from 12.14% in 2015 to 11.37% through December, 2020. This is the lowest preterm birth rate in Cuyahoga County in the last 20 years. During this same period of time, the national preterm birth rate increased.
- There were 27 sleep-related infant deaths in Cuyahoga County in 2015. The number of sleep-related infant deaths in 2020 was 23.
Fatherhood and faith-based programs, led by Rev. Knuckles, have been integrated into home visiting programs, bringing valuable insights and interventions key to reducing infant deaths.
FYC ACTION TEAM ACTIVITIES
Infant deaths are being addressed with urgency through the 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.
Priority Area: Reducing Racial Disparities
- Following nine focus groups held to learn about the impact of racial bias in healthcare, FYC Action Team 1 (led by University Hospitals, CWRU, and Cleveland City Council) implemented an awareness campaign in Cuyahoga County’s three major healthcare systems to call attention to inequities in care received by Black women receiving prenatal, birth care and postnatal services. The campaign includes a series of interactive posters and videos, informs staff on how personal biases negatively impact maternal and child health, and provides interventions that address these biases.
- With funding from the Ohio Department of Medicaid, FYC Action Team 1 also arranged for the training of several individuals from multiple healthcare systems, preparing them to deliver Cook Ross-designed Everyday Bias for Healthcare Professionals workshops. Several hundred department leaders, HR departments, CenteringPregnancy® staff members, OB/GYN providers, and other clinicians participated in these workshops to recognize their own biases and discover how biases impact maternal and infant health outcomes.
- In 2020, FYC, led by FYC Action Team 1, was selected as the only organization in Ohio to pilot implicit bias training developed by the March of Dimes and funded by Anthem and FYC. 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 healthcare systems. The training will be provided to Greater Cleveland health system leaders, staff members, and clinicians.
- FYC Action Team 2, the Pregnancy and Infant Loss (PAIL) Committee, (led by Cuyahoga County and MetroHealth) established the Pregnancy and Infant Loss Society, led by women and men who have experienced pregnancy and 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 healthcare systems. The film was also added to the “Focus 2020: Racial Equity Shorts” program of the Cleveland International Film Festival, and it was featured in six additional national film festivals. The film is available for purchase at https://toxicshortfilm.com/purchase. Proceeds from film sales will benefit the PAIL Society and is an example of FYC Action Team 2’s efforts to establish sustainability.
- 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. Learn more at http://OurWellnessNetwork.org.
- FYC Action Team 3 (led by Birthing Beautiful Communities and Kent State University) conducted doula-led “sister collectives” with nearly 60 Black expectant women. The collectives are an intervention that use culturally competent tools to help women learn to reduce race-related stress and cope with relationship stress in meaningful and productive ways. Hair samples collected from participants at the beginning of the group sessions were found to have cortisol levels associated with anxiety and Post-Traumatic Stress Disorder. Feedback from husbands, partners and other members of their sister collective indicated positive changes were observed in members following their participation in the collective.
Priority Area: Addressing Extreme Prematurity
- FYC Action Team 4 (led by Better Health Partnership) brought together four health systems who normally compete to achieve a shared goal. The team spearheaded data collection efforts to assess modifiable interventions related to prenatal care, the delivery of the baby and the NICU stay. The team then analyzed and prioritized findings through monthly learning circles and determined quality improvement interventions. These findings were communicated to the larger health systems, FYC, Better Health Partnership membership and national OB/GYN providers, who then began implementation of quality improvement interventions.
QI interventions across health systems currently underway include:
- Improving reliability and consistency with ultrasounds/cervical length screenings for early assessment of premature birth risk.
- Improving care coordination and connection to prenatal care for pregnant women who visit Emergency Rooms.
- Improving early establishment of gestational age, pregnancy viability, and determination of pregnancy risk.
- Recommending protocols to EMS to transport pregnant women to emergency rooms where labor and delivery services are available in the hospital.
- Each health system is conducting diversity, equity, inclusion training and education to improve the patient experience and reduce racial bias in care delivery.
- These interventions are undergoing continuous improvement.
- FYC Action Team 5 (led by Cuyahoga-Cleveland Ohio Equity Institute) coordinated advocacy efforts to support equitable access to pregnancy-related services in Emergency Rooms in the county’s southeast quadrant and created a palm card to educate families on where to seek emergency room services. This team also conducted Home Visiting Training, held a resource fair for expectant and new parents, and connected more than 700 pregnant women to supportive services.
- FYC Action Team 5 also worked with the Greater Cleveland Regional Transit Authority to pilot a program aimed at reducing infant mortality rates by providing free rides to new and expectant mothers. The “Baby on Board” program provides free monthly bus passes to eligible pregnant women and new moms living In ZIP codes with very high rates of infant mortality because transportation is often cited as a primary reason for missing medical appointments.
- FYC Action Team 6 (led by the Center for Community Solutions and March of Dimes) was formed to work with healthcare providers to increase public awareness of birth spacing guidelines, implement One Key Question (OKQ), and improve access to long-acting reversible contraceptives. The OKQ pilot with home visitors in the Parents as Teachers (PAT) program (Cuyahoga County Bright Beginnings) was completed in November, with the final booster training of the home visitors. The booster revisited the OKQ intervention and provided additional support for conversations on contraception, identified by the cohort as a need. The intervention is ongoing with the PAT program, and data is being collected on when the question is asked, the responses, and related referrals.
- FYC Action Team 7 (led by Cuyahoga County CenteringPregnancy® Coalition) leads the CenteringPregnancy® program effort, with programming provided by University Hospitals, Cleveland Clinic, The MetroHealth System, Care Alliance Health Center, and Northeast Ohio Neighborhood Health Services. An enrollment goal of 1,881 pregnant and postpartum women was established for the period Jan. 1, 2020 through Dec. 31, 2021. In 2020, CenteringPregnancy® programs enrolled 408 pregnant and postpartum women, achieving about 22% of their overall goal, with in-person group sessions significantly impacted for all providers by COVID-19. Ongoing attempts at virtual only group sessions were not well received over the timespan of a pregnancy, with the initial engagement wearing off over time. With a resurgence in OB visits in October 2020, the program began to see an increase in the numbers enrolling in group prenatal care and has since resumed in-person sessions. National data show that Black expectant parents served in a CenteringPregnancy® program experience a 41% reduction in premature births.
- FYC Action Team 8 (led by Invest in Children, Bright Beginnings, ODH and ODM) coordinated services for more than 3,000 pregnant women and caregivers with new babies annually in results-driven interventions that address housing insecurity, employment, education, nutrition, and early access to prenatal and postnatal care.
Priority Area: Eliminating Sleep-Related Deaths
- FYC Action Team 9 (led by MetroHealth) has recruited and trained nearly 18,000 Safe Sleep Heroes 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. They have also hired parents and grandparents who have experienced a sleep-related loss to drive the ABCD messaging and lead safe sleep training.
- In the summer of 2020, FYC's Action Team 9 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; 25,000 pharmacy bags printed with safe sleep information were distributed; and more than 150,000 postcards with safe sleep and breastfeeding information were distributed through area Popeye’s restaurants.
- FYC Action Team 10 (led by the Cuyahoga County Board of Health) focused on reducing tobacco use among expectant parents and new parents through implementation of Tobacco 21 policies in Greater Cleveland communities and increasing access to the Ohio Quit Line by pregnant women, noting that all pregnant women who receive Medicaid are eligible for free services, including incentives and nicotine replacement therapy. This initiative also worked to decrease the exposure of pregnant women and infants to second- and third-hand tobacco smoke.
- FYC’s Action Team 10 was instrumental in Ohio’s “Tobacco 21” Law which took effect in October 2019, raising the age to purchase tobacco and vaping products to 21.
In November 2019 FYC co-sponsored, with 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. As an outcome, strategies were executed to work with local government to declare racism a public health crisis and to raise national attention to the fact that Region V of the USA (OH, MI, IN, IL, WI, MN) has the highest Black infant mortality rate in the nation. As a result of FYC leadership, HRSA (Health Resources and Services Administration) will host a series of monthly webinars for Region V states beginning February, 2021 designed to address this concern.
FYC was one of the first infant mortality collaboratives in Ohio to highlight structural racism as a key factor contributing to Black infant deaths and the most substantial contributor to the racial inequity in birth outcomes. Since our initial efforts, strategies were executed which led to Cleveland City Council and Cuyahoga County passing resolutions declaring racism a public health crisis. An advisory council at the county level, and a working group at the city level – including representatives from First Year Cleveland – have been formed, tasked with reviewing and providing recommendations to reduce racial disparities in areas ranging from healthcare to employment and transportation. A status report produced by Cuyahoga County’s Citizens’ Advisory Council on Equity and released in January 2021, presented preliminary findings and recommendations, and may be viewed here.
FYC participated in a number of symposiums, panel discussions, myriad groups and coalitions, grand rounds, conferences and more to discuss systemic racism as a driver of health inequities and work toward solutions. (Additional information can be found under “Presentations” below.)
PUBLIC POLICY AND ENGAGEMENT
- FYC’s Public Policy & Engagement Committee updated an aggressive public policy agenda. Three priority areas were identified: equity and access, securing resources to address social determinants of health, and improving expectant and new parents’ access to technology and the internet. In support of this work, advocacy training was held in May 2020 and was open to all FYC partners.
- This committee was integral to the June 2020 passage of House Bill 11. 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.
- 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.
- FYC senior advisor Dr. Arthur James worked with HRSA and Region V leaders to develop webinars addressing why Region V has the highest African American IMR in the nation and what can be done to improve it. The webinars launched in spring 2021.
- FYC’s senior advisor also serves as a member of the Ohio Commission on Infant Mortality, Ohio’s Eliminating Racial Disparities in Infant Mortality Task Force, the March of Dimes National Leadership team for its Mom and Baby Action Network, and a member of the leadership team of NICHQ (National Institute for Children’s Health Equity).
COVID-19 PANDEMIC RESPONSE
- The Greater Cleveland COVID-19 Rapid Response Fund awarded FYC $100,000 to support expectant and new mothers who were COVID-19 positive, suspected of having the virus, or were determined to be at high risk for contracting the virus. Four community partners worked with FYC and the Greater Cleveland Food Bank to purchase food and non-food items from the Food Bank. In addition, four healthcare partners and FYC created care packages and purchased iPads and doppler fetal monitors to support virtual prenatal obstetrical visits and participation in group prenatal care.
- FYC and its partner agencies established and continue their collaboration with the Greater Cleveland Food Bank whereby all home visiting and community-based program workers now have the ability to act as proxies for individuals, pick up food from area food pantries, and deliver food directly to places of residence.
- FYC engaged in a Digital Connectivity Pilot with UnitedHealthcare Community Plan's Perinatal Health Services, using digital connectivity devices provided by PCs for People. This pilot project aimed to increase the engagement of UnitedHealthcare members in telehealth services for a period of nine months. The digital access also supported other needs, such as education and employment.
- FYC provided COVID-19 resource information to expectant and new parents through a dedicated page on our website, social media posts and our monthly e-newsletter. Radio spots featuring COVID-19 information ran in the spring and summer of 2020 on Radio One urban stations WENZ, WZAK and WJMO. FYC also partnered with WOVU radio to discuss COVID’s effect on mental health and local resources for therapy and counseling.
- At the onset of the pandemic local healthcare providers participating on FYC Action Team 4 collaborated to create a short video for new and expectant parents with tips for staying safe during the pandemic. A second video addressing COVID-19 and providing answers and reassurance for pregnant women was also created. The videos were shared through FYC social media channels as well as our partners’ social media channels and continue to be available on FYC’s YouTube page.
OHIO DEPARTMENT OF MEDICAID
- FYC secured $4.8 million through the 2019 ODM Healthy Moms and Babies grant to coordinate a community-wide, data-driven initiative to 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 total, the community has been awarded $14,367,405 from the Ohio Department of Medicaid since 2016. The current award of $4.8 million is for years 2020 and 2021.
- 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 women served through home visiting and perinatal support specialists over three years through Ohio Department of Medicaid grants to four highly effective agencies – Birthing Beautiful Communities, Moms & Babies First, MomsFirst, and Nurse Family Partnership. In 2020, 81 percent of those served through this grant were Black expectant women and their families.
- FYC and University Hospitals received one of the only system-wide anti-bias infant mortality grants from the Ohio Department of Medicaid. 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 system-wide bias. FYC also sponsored and supported racial equity training through the Racial Equity Institute.
- Bernadette Kerrigan, FYC Executive Director, is serving on the New York State Department of Health Maternal and Child Equity Improvement Planning Team, working to develop strategies for improving equity in maternal and birth outcomes. This partnership was facilitated by the National Institute for Children’s Health Quality.
- FYC launched a new partnership with the Bright Cities Program of Healthy Babies Bright Futures. The Bright Cities Program will support 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 has also partnered with Village of Healing to amplify and elevate the voices of Black professional women who have experienced pregnancy or infant loss, as well as stress and anxiety related to racism and/or sexism. Videos featuring participants as well as their quotes pertaining to experiences of racism, infant loss, stress and mental health were featured on the social media pages of FYC and Village of Healing.
FYC is presenting at conferences and seminars locally and nationwide, leading discussions on reducing racial disparities and addressing structural racism.
- In October 2019, First Year Cleveland's Senior Advisor, Dr. Arthur James, joined YWCA President and CEO Margaret Mitchell and Birthing Beautiful Communities’ President and CEO Christin Farmer at the City Club of Cleveland to discuss systemic racism as a driver of health inequities, especially for women and children, as a prelude to the November event, “400 Years of Inequity: A Call to Action.”
- In April 2020, Dr. James again joined Margaret Mitchell as well as Councilman Blaine Griffin on WCPN's Sound of Ideas to discuss racial disparities in infant mortality and COVID-19 and our efforts to declare racism a public health crisis in Cleveland.
- In July 2020, Dr. James and Katrice Cain, FYC’s Racial Disparities & Health Equity Program Director, presented to over 3,000 Walgreen’s International leaders on racism’s impact on maternal and child health outcomes. They also presented in the CWRU Racial Disparities, Social Justice and the Opioid Crisis Series in September 2020.
- Katrice Cain discussed racism as part of the national panel at the 2020 CityMatCH Leadership and MCH Epidemiologist Conference held in September 2020. Ms. Cain and Jazmin Long, President and CEO of Birthing Beautiful Communities, were panel members at the Ohio Black Women’s Virtual Health Symposium, hosted by U.S. Senator Sherrod Brown in October 2020.
- The Cleveland International Film Festival selected Toxic: A Black Woman’s Story to be included in the Racial Equity Shorts program in 2020. The film was also shown at the Greater Cleveland Urban Film Festival in September 2020. The October 2020 American Public Health Association Annual Meeting Public Health Film Festival Opening kickoff event featured the film. Katrice Cain and Frances Mills, Director of the Cleveland Office of Minority Health, participated in the panel discussion.
- Dr. James spoke about racism as a public health crisis and racial disparities in birth outcomes to national, regional and local organizations in the fall of 2020. These included presentations to the American Academy of Pediatrics, Women of Influence Coalition of Marion County, National WIC Association, Baldwin Wallace University BSN program, Cleveland Clinic and University Hospitals OB/GYN grand rounds, Walgreens events, the CityMatCH Leadership and MCH Epidemiology Conference, the local organization of United Methodist Women, Berea Kiwanis, and the OSU Hospital Medicine and Med-Peds Symposium.
- FYC established a strong digital presence, beginning with the launch of a new enhanced website in June 2019 and accelerated communications via email and social media. On average, our social media followers and engagement increased by more than 50 percent across all channels and continues to grow, and our newsletter subscriber base grew by 46 percent. We also earned a vast amount of media coverage (view stories here), educating the community about our important work to reduce infant deaths and racial inequities in birth outcomes.
- At the onset of the pandemic, a COVID-19 resource page was quickly developed for the FYC website. The page contained information on testing, symptoms, resources, face masks, COVID during pregnancy, and much more, and was updated frequently. More than 16,000 individuals have visited the page.
- WOVU 95.9 FM is a community radio station operating out of Burten, Bell, Carr Community Development Inc. The station serves Cleveland’s Central and Kinsman neighborhoods, where we often see high concentrations of infant deaths. FYC teamed up with the station’s “Our Voices Today” program to spread the messages of safe sleep practices, Our Wellness Network, and FYC’s efforts to declare racism a public health crisis.
- In the fall of 2020, FYC began a 2021-2023 strategic planning process. This highly engaged and equity-centered process included FYC staff, Executive Committee, Action Teams, partner organizations, key stakeholders, service providers, and families who have experienced pregnancy and infant loss. A culturally diverse 19-member Design Team, representing FYC’s funders, the Executive Committee, partner organizations, and Action Teams, proposed recommendations to addressing root causes of inequities in birth outcomes and developing a strategic plan to reduce Cuyahoga County’s Black infant mortality rate. The strategic planning process was completed in first quarter 2021.
- 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.