Reducing Racial Disparities
addressing Extreme Prematurity
Eliminating Sleep-Related Deaths
In an effort to keep our stakeholders apprised of the work being done by First Year Cleveland and our many partners throughout Cuyahoga County, we have implemented a series of now bi-weekly updates. These updates will provide information about key initiatives being performed to address and eliminate racism as well as our collective FYC efforts to target and reduce the disparity in Cuyahoga County's African American infant mortality rate amidst the COVID-19 pandemic.
Infant Mortality and Premature Birth Data
As of July 10, 2020, the preliminary, unaudited infant mortality data provided by the Cuyahoga County Board of Health shows an overall infant mortality rate of 8.28, an increase compared to this time one month ago, with the majority of infant deaths in the Black non-Hispanic population. The Black to white disparity rate is 4.15 and the overall rate of premature births is 11.54%, both slight decreases from year- end 2019. There is a significant decrease in the number of infants born 22 weeks or less (n=16). The first half of 2020 is the lowest six-month total since data monitoring began in 2016. The rates of overall preterm births and very preterm births for the first six months of 2020 are the lowest rates in the last three years.
Racism and Infant Mortality
Cuyahoga County Council passed legislation declaring racism a public health crisis on July 7, 2020. A Citizens’ Advisory Council on Equity is being formed, subject to approval by County Council. This group will identify recommendations to reduce the disparity between Black and white people in:
FYC would like to thank Cradle Cincinnati for its webinar which offered insight into its recent annual and racial equity reports. We look forward to more opportunities like this to share what is working and identify strategies resulting in sustainable change.
Partner Agencies Working Together
Partner agencies have not only been focused on their own service delivery but are connecting and sharing information and resource knowledge with each other. Recently, Birthing Beautiful Communities donated eight iPads to area Labor and Delivery units and CenteringPregnancy® programs as part of a pilot to support equitable access to virtual care. Birthing Beautiful Communities will assess this pilot effort.
FYC is staying abreast of guidance from the Ohio Department of Health to home visiting programs related to the resumption of in-person visits. In addition to general guidance, it is possible there may be county-specific guidance related to each county’s COVID-19 Alert Level. According to the Ohio Department of Health Dashboard (July 12, 2020), one-half of positive cases in Cuyahoga County are affecting Black citizens.
FYC Safe Sleep Heroes launched a comprehensive, highly visible ABCDs of Safe Sleep campaign including large-scale, public advertising. This includes a billboard campaign (12 billboards for two months) and RTA interior bus cards which appeared on one-third of the fleet for four months, focusing on neighborhoods with the highest sleep-related infant deaths. Each route in those neighborhoods had daily exposure to the message. Local businesses are also hanging Safe Sleep posters, especially if they have lactation spaces or changing tables available.
Managed Care Plan Resources
Paramount Advantage has shared the following resources, which have been communicated to our partner agencies:
NEW-Transportation – We have always allowed our members to use their transportation benefit to get to emergency food banks. We have added grocery stores during the COVID pandemic. We have also added that trips can be used for grocery delivery, where only the groceries are being transported. Mom and baby both have their own transportation benefit (15 round trips or 30 one-way trips).
NEW-Cradle to Crib Program – Take your baby to at least six well-visits before they turn 15 months old and you can earn a $100 gift card.
NEW-Prenatal to Cradle (PTC) is our prenatal program and we have increased the amount of rewards mom can earn from $125 to $150. We also enter each mom who signs up for PTC into a drawing to win a four-week supply of diapers. Winners are selected monthly.
Cleveland Browns Healthy Rewards – We have a partnership with the Cleveland Browns where our members can be entered into a drawing for a chance to win hundreds of prizes. Paramount members who are 12 months of age or older need to get a wellness exam and then sign up for the program to be entered into the drawing. They can call member services, sign up online or mail in the brochure that we send to them.
The launch of FYC Action Team 2’s Our Wellness Network has generated media interest, with interviews conducted or underway with Freshwater, Spectrum News, WEWS, WKSU and WOVU which targets Cleveland’s Central and Kinsman neighborhoods. The media exposure will help ensure Black men and women who have experienced pregnancy and infant loss, or who need emotional support during and after pregnancy get the counseling and guidance they need. All media spots will be added to our website’s Newsroom as they become available.
FYC is pleased to begin a new partnership with Village of Healing (VOH), a nonprofit organization working to decrease racial disparities through healing and empowerment. Village of Healing will facilitate bi-monthly support group sessions for professional Black women in Cuyahoga County (30+ years old, with a bachelor’s degree or higher), to learn more about the ways in which racism and toxic stress affect Black women. FYC and VOH will design a community awareness campaign with the knowledge gained from these sessions, amplifying the voices of Black women and educating the community on how best to support them.
Infant Mortality and Premature Birth Data
As of June 10, 2020, the preliminary, unaudited infant mortality data provided by the Cuyahoga County Board of Health shows an overall infant mortality rate of 7.48, compared to an overall infant mortality rate of 9.13 at this time one year ago. The Black to White disparity rate is 3.70 and the overall rate of premature births is 11.58%. Our focus continues to be on decreasing the Black to White infant mortality disparity rate.
FYC's Action Team 4 has been studying premature births, the leading cause of infant deaths in Cuyahoga County, beginning with a review of aggregate baseline data for 2013-2017 from four health care systems. This data was discussed in learning circles where elements for further study were defined. Data collected on every 2018 birth that occurred at 26 weeks gestation or less, across four health care systems, resulted in three priority areas for intervention. Action Team 4 is actively communicating its findings and recommendations, highlighting the learning and change that is possible when systems come together to share and analyze data.
Racism and Infant Mortality
The Resolution Declaring Racism a Public Health Crisis was approved by Cleveland City Council on June 3, 2020. Cleveland is the ninth city in the country to pass such a resolution. FYC has been co-leading this work for over 12 months, and is one of five founders of the Resolution.
FYC is now participating in a coalition leading the creation and execution of a work plan for how the City and County will address racism. Efforts are underway to pass a City of Cleveland Ordinance on Racism as a Public Health Crisis, which would allow a budget to be assigned to future actions. Representatives from the Government Alliance on Race and Equity (GARE) and the cities of Milwaukee and Seattle are being invited to Cleveland this summer to share their experience and guidance. FYC commends the Cuyahoga County Executive Office and the Cuyahoga County Board of Health for their support of the Resolution. More than 60 Greater Cleveland organizations, including many corporations, have also pledged their support for the Resolution.
Based on feedback from expectant and new parents, particularly African American parents, FYC is leading the creation of a second video addressing COVID-19 concerns and guidance. Three hospital systems and several Federally Qualified Health Centers are contributing to this video, expected to be released in July. Also, FYC senior consultant Dr. Arthur James is working with HRSA and Region V leaders in launching a virtual conference in 2020 and an in-person conference in 2021, addressing why Region V has the highest African American IMR in the nation and what can be done to improve it. In addition, he is also working with the Association of Maternal & Child Health Programs (AMCHP) and other national maternal and child health membership organizations to develop a statement about addressing racism as a root-cause for the racial disparities experienced in maternal and child health.
FYC's Action Team 1 has led focus groups and individual interviews to learn from the experiences of African American, Latinx, and Caucasian expectant and new mothers as they navigated care. Using this knowledge, each health care system has initiated an awareness campaign to address how racial biases impact maternal and child health. Hundreds of OB/GYN department leaders and providers, human resources staff members, CenteringPregnancy staff members, and other clinicians have received training on unconscious bias in the work place. Action Team 1 continues to execute system awareness and employee training campaigns to address biases in the work place that negatively impact maternal and child health outcomes, expanding training to reach all staff within health care systems, evaluating the training's impact, and looking into system policies and practices.
FYC's Pregnancy and Infant Loss Committee (Action Team 2), who produced the movie Toxic, has established a network of African American mental health professionals and peer support specialists called Our Wellness Network (OWN). OWN is comprised of African American therapists, parents, and lay leaders, stressing the importance of mental health and providing services to African American families who have experienced a miscarriage, stillbirth, or an infant loss. OWN also offers emotional support during pregnancy and early parenting. The press release announcing Our Wellness Network is attached. For more information on how to access Toxic, visit https://toxicshortfilm.com/
Public Policy and Advocacy
FYC's Engagement and Public Policy Committee continues to be active in its advocacy related to infant mortality, most recently focusing on Ohio House Bill 11. On June 19, 2020, the Governor of Ohio signed House Bill 11 into law. House Bill 11 is focused on reducing infant mortality in Ohio through increased access for pregnant women to dental cleaning, smoking cessation, lead safety information, and group prenatal care services.
The Committee has identified three main issues as its priorities for 2020-2021: funding, equity, and access. Several initiatives fall within these priority areas and are grounded in equity and anti-racism actions. The Committee will closely follow anti-racism declarations and policy decisions across the state that will inform and impact its initiatives, including those focused on promotion of paid family and medical leave, recognition of doulas and perinatal support professionals as essential staff for women in labor and delivery, and the expansion of anti-racism training.
FYC is pleased to launch a new partnership with the Bright Cities Program of Healthy Babies Bright Futures. The Bright Cities Program will support practices that both reduce toxic exposures for infants and pregnant women and are models that can be adopted and transported for use in other cities. FYC will work with the Bright Cities Program, local partner agencies, and advocacy groups to educate expectant parents and new parents on how to reduce toxic exposures in their homes and use safe products in their environment.
Managed Care Plan Resources
Partner agencies are knowledgeable about CareSource resources including expanded transportation benefits and employment services. FYC is engaging in a Digital Connectivity Pilot with UnitedHealthcare Community Plan's Perinatal Health Services, providing 40 hot spot devices to families identified by community providers. In addition, UnitedHealthcare's national Moms Meals initiative has been a valued resource for high-risk expecting mothers.
Racism and Racial Disparities
First Year Cleveland, the YWCA of Greater Cleveland, Urban League of Greater Cleveland, NAACP Cleveland Chapter, Birthing Beautiful Communities, United Way of Greater Cleveland, and others, have been working on a City of Cleveland resolution Declaring Racism a Public Health Crisis. On June 1, 2020, the Cleveland City Council Health and Human Services Committee unanimously voted on a Resolution to Declare Racism a Public Health Crisis. Expert testimony on behalf of First Year Cleveland was presented by Chief Natoya Walker Minor and Dr. Arthur James, Senior Advisor to First Year Cleveland. The Resolution was approved by the full City Council on Wednesday, June 3, achieving a momentous milestone for the community. We are the ninth city in our country to activate this resolution. FYC has been co-leading this work for over 12 months. Click here to watch the full City Council hearing. Congratulations to our leaders and community residents for launching this important, collective work. Additional media coverage can be found here.
FYC commends Cuyahoga County Executive Office and Cuyahoga Board of Health for supporting Racism as a Public Health Crisis. Thank you Commissioner Terry Allan and Matt Carroll for your leadership. Learn more
In addition, please read this news release from the members of the Racism is a Public Health Crisis Working Group, a coalition of six nonprofits (Birthing Beautiful Communities, First Year Cleveland – a public/private coalition at Case Western Reserve University, National Association for the Advancement of Colored People – Cleveland Branch, United Way of Greater Cleveland, Urban League of Greater Cleveland and YWCA Greater Cleveland) who have worked together with Cleveland City Council for more than a year to advance the declaration of racism as a public health crisis in Cleveland, which commends the unanimous passage.
On June 5, 2020, a news conference was held at 2 p.m. on the steps of Cleveland City Hall with Councilmen Blaine Griffin, Basheer Jones and Council President Kevin Kelley, along with members of the Racism is a Public Health Crisis Working Group (including Christin Farmer of Birthing Beautiful Communities, Helen Forbes Fields of United Way of Greater Cleveland, Margaret Mitchell of YWCA; Marsha Mockabee of the Urban League and others), to discuss the new resolution and the way forward now.
FYC encourages everyone to use your voice and identify ways to help dismantle 400 years of racism. We have compiled a list of resources to help guide your efforts. These resources were distributed via FYC's social media networks and email list following the recent deaths of Ahmaud Arbery and George Floyd.
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 the impact of racism and bias on maternal and infant health outcomes, and will be provided to Greater Cleveland health system leaders, staff members, and clinicians
FYC's inaugural strategic plan is in its final months of execution and we are moving forward to secure a consulting firm to lead us through our next strategic planning process, with an emphasis on equity. An update will be provided in late June.
Infant Mortality Data
As of May 27, 2020, the preliminary, unaudited infant mortality data provided by the Cuyahoga County Board of Health shows an overall infant mortality rate of 7.32, with a Black to White disparity rate of 3.69. The overall rate of premature births is 11.72%. While the overall infant mortality and premature birth rates represent a decrease from the same time last year, our focus continues to be on decreasing the infant mortality Black to White disparity rate. Cuyahoga County data will be presented in more detail in late June.
Basic Needs Care Packages
FYC, on behalf of its partners, applied for and has received $100,000 in funding from the Greater Cleveland COVID-19 Rapid Response Fund. These funds will provide much needed blood pressure cuffs, doppler fetal monitors and body weight scales to COVID-19-positive pregnant women and those considered to be high risk due to other medical concerns. Funding will also provide iPads in labor and delivery rooms for connecting with significant others as well care packages. FYC’s ultimate goal is to return the local funds earmarked for blood pressure cuffs, doppler fetal monitors and body weight scales for pregnant women who are COVID-19 positive and at high risk for COVID-19. This will occur once FYC’s advocacy work is successful in having this prenatal care monitoring equipment provided by Medicaid Managed Care Plans to all pregnant women as a telehealth standard of care.
Public Policy and Advocacy
FYC’s Engagement & Public Policy Committee has updated and is launching a bold new 2020-2021 public policy agenda. Three priority areas include 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 on May 29, 2020 and was open to all FYC partners.
FYC continues to explore opportunities to provide devices and data plans to address the digital gap in the community. In addition to engaging in a Digital Connectivity Pilot with UnitedHealthcare Community Plan’s Perinatal Health Services, FYC is exploring funding available through CARES money available through the FCC.
Focus on Mental Health
FYC’s Pregnancy and Infant Loss Committee (FYC Action Team 2), is excited to launch a mental health support network called Our Wellness Network (OWN). The network provides emotional and mental health support to African American women and men who have experienced pregnancy and infant loss. OWN also offers emotional support during pregnancy and early parenting stages. The network consists of African American mental health professionals and peer support specialists, including parents, clergy, and health advocates. The Pregnancy and Infant Loss Committee will hold a virtual press conference in June to introduce OWN to the community.
ODM Grant of $4.8 Million to FYC
FYC continues to have frequent contact with all of our local ODM grantees who are offering services during the COVID-19 pandemic.
FYC Action Teams
All FYC Action Teams continue to meet and all services are being held, some remotely and some face to face. Home visiting and community-based programs are still serving remotely and are in the position to not only serve current clients but are beginning to enroll new consumers.
FYC kicked off a community fundraiser for care packages containing diapers, face masks, grocery gift cards and other essential items for new and expectant parents with or at high risk of contracting COVID-19. Ads are running on all FYC social media channels, Radio One urban stations and WCPN. Thank you to FYC Action Team 4, home visiting programs, community-based programs and all three health care institutions for leading in these efforts.
Infant Mortality Data
As of today, the preliminary, unaudited infant mortality data for Q1 2020, provided by the Cuyahoga County Board of Health, shows an overall infant mortality rate of 7.76, a decrease from the same time period last year. This data was presented by the Cuyahoga County Board of Health to FYC's Community Action Council on May 12, 2020. Also, at this meeting, FYC's Action Team 4 presented findings and quality improvement recommendations based on their multi-year study of local premature births. Their study of system processes will be integrated with the journey mapping of patient experiences led by Action Team 1 in order to identify additional opportunities for improvement.
FYC is engaging 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 will increase the engagement of UnitedHealthcare members in Telehealth services and will provide individual support for a period of nine months. In addition, this digital access will support other social determinants of health such as education and employment. As this work continues, FYC will provide more information to our Partner Agencies regarding the project and referral process.
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 places of residence. The streamlined process for becoming a proxy has contributed to the success of this effort. All home visiting and community-based program workers have the ability to act as proxies and pick up food through the Greater Cleveland Food Bank. Northeast Ohio Neighborhood Health Services Moms and Babies First program has thus far delivered food to 117 families per week for the last several weeks.
Mental Health Awareness Month
FYC has been focusing its social media and communications on mental health issues of expectant parents, new parents, and parents who have experienced pregnancy and infant loss who have been impacted by COVID-19. Our focus has highlighted the importance of good mental health and strategies to achieve it.
FYC, along with the YWCA of Greater Cleveland, Urban League of Greater Cleveland, NAACP, Birthing Beautiful Communities, and United Way of Greater Cleveland is continuing its work on a City of Cleveland Resolution Declaring Racism as a Public Health Crisis. City of Cleveland's HHS Virtual Hearing Date on this Resolution is set for Monday, June 1, at 9:30 a.m. The projected time frame of this resolution passing is Summer 2020. A webinar this week highlighted that last year Harvard created an index to measure the economic equity of cities of 21 metropolitan regions. Out of 21 cities, Cleveland came in as the 19th worst city for economic equity. The presentation slides can be viewed here.
Public Policy and Advocacy
In 2018, the FYC Engagement & Public Policy Committee created a public policy agenda with 13 items focused in four categories: Public Engagement, System Financing, Social Determinants of Health, and Maternal and Child Health. Next month, Marcia Egbert and Natoya Walker Minor will update the Executive Committee on FYC's 2020-2021 policy agenda priorities.
New and expectant parents are understandably concerned about the pandemic's impact on their pregnancy, delivery and new baby care. There are many moving pieces and we are learning every day about new ways to provide quality services that reduce maternal and infant deaths and keep expectant parents, new parents and providers safe. We recognize the herculean work done over the last several weeks to adjust every program and then execute significant policy and process changes within our nonprofit, faith-based, public and private sectors, including our health care systems. All programs are focused on effectively and efficiently providing virtual services or services within the social distancing guidelines to expectant and new parents, including housing, food, safety, prenatal care, home visiting, CenteringPregnancy® and other community-based interventions. All of our Ohio Department of Medicaid grant-funded programs have gone above and beyond to continue serving the community. With all of your help, and the help of so many other FYC partners, together over the last several weeks we have activated the following actions through a racial equity lens. Each of these requires your ongoing support and advocacy.
1. All Ohio Department of Medicaid grant-funded programs continue to serve their enrolled families. Some now have the capacity to continue enrolling new expectant parents.
Action: Continue to refer expectant and new parents who could benefit from home visiting and community-based programs to Bright Beginnings at (216) 930-3322 or (440) 389-3322 or online.
2. First Year Cleveland is expanding its communications to provide additional guidance and resource information to expectant and new parents. New radio ads regarding COVID-19 ran March through April on Radio One urban stations. In addition, six local healthcare providers worked together to create a short video for new and expectant parents regarding the pandemic. FYC is grateful to FYC Action Team 4 for creating and offering this video to their patients. COVID-19 information and resources are constantly being evaluated and added to FYC’s website, with input from the community.
Action: Listen to FYC’s radio spots, airing on Radio One urban stations WENZ, WZAK and WJMO, and use your networks and websites to share our video. Also, please link the FYC website to your website: www.FirstYearCleveland.org and follow us on FYC Facebook, Twitter, Instagram and LinkedIn.
3. First Year Cleveland is reaching out to the community through surveys, phone calls and Zoom meetings, listening to and acting on the expressed needs and resource gaps identified by expectant parents, new parents, and the providers that serve them. As of May 11th, FYC has responded to the following priority areas.
Other priorities over the next few weeks include addressing isolation, anxiety and fear among expectant and new parents. FYC must leverage our community partners to provide social, emotional, and mental health support. FYC is exploring the possibility of a neighborhood-led platform for this support, while leveraging FYC’s website and social media platforms.
It is so important that we hear from you now. What are you seeing and hearing that requires immediate attention to ensure healthy parents and healthy babies during this pandemic? What other needs are being expressed by your staff, patients, clients, and families? Please contact Bernie Kerrigan at Bernadette.Kerriogan@case.edu.
Thank you for all you are doing during this pandemic.
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