Project Description:
Maternal and Child Health Coalition of Greater Kansas City (MCHC), a MO 501(c)(3), proposes the Kansas City Healthy Start (KCHS) Initiative to eliminate perinatal health disparities by intervention with women and children at risk and city-wide programmatic and systemic change.
Institute faculty wrote the original grant(1997) and participated in the writing of competitive grants in 2000, 2005, 2009, and 2014. The most recent award was for 4 years 5 months (FY 2015-2019). IHD faculty members have provided technical support and have evaluated the project activities with participants and trainees since its inception. The most recently awarded grant requires primary linkage with the health care system and an emphasis on assisting families in establishing a medical home. This paradigm shift led to the decision to locate the supportive services in two federally qualified health centers (FQHCs).
Need. From 2007 to 2009, 146 infants died and infant mortality rate was 10.81 for the proposed bi-state area, which has a high prevalence of poverty, low education, and low health care access.
Populations to Be Served. KCHS will serve pregnant and interconception women and their children (0-2 years of age) from 6 ZIP codes in Wyandotte County, KS and 10 ZIP codes in Jackson County, MO with poor birth outcomes. Participants will be referred primarily by two Federally Qualified Health Centers: Samuel U. Rodgers Health Center (SURHC) and Swope Health Services (SHS). KCHS will then serve 800 participants per year (600 in Year 1): 50% pregnant women, 25% interconception women, and 25% children of interconception women. To extend the impact to the 5-county area, KCHS will also serve case managers, health care and other service providers, participants and members of their communities, and medical home administrators. Training and education venues will be coordinated for CAN members and provider and community networks to ensure workforce development to address benchmark objectives.
KCHS for Participants. KCHS will improve women's health through on-site linkage at SURHC and SHS with (a) Navigators for health coverage under ACA and (b) trained Community Health Workers (CHWs) who provide comprehensive case management services.
Quality services will be promoted through (a) care coordination and referral by CHWs in the medical home, and (b) support and training for CHWs in prevention and health promotion strategies. Family resilience will be enhanced by (a) CHW strategies to address toxic stress and provide trauma-informed care; (b) mental/behavioral health service coordination; (c) father
engagement opportunities (support groups, mentoring, life planning, and partner agencies resources, i.e., National Healthy Start Association and the National Fathering Initiative); and (d)
Parents as Teachers and Where Dads Matter curricula, the Born Learning website, and technological strategies to enhance parenting. The collective impact of work with KCHS participants at all sites will entail (a) shared measurement of participant and program data, (b) communication across sites about what is effective and how to improve, and (c) dialogue among partner agencies fostered by MCHC, with guidance from the Supporting Healthy Start Performance Program, to develop strategies that eliminate disparity in perinatal health. Accountability will occur by analyzing (a) alignment of participant services with needs, (b)
progress on benchmarks, and (c) family goal outcomes. Promising practices will be shared.
Programmatic and Systemic Change through KCHS. MCHC will achieve collective impact to improve perinatal outcomes in the 5-county metro area as a backbone organization by (a) building a perinatal health agenda, (b) instituting a shared measurement system, (c) fostering public awareness and dialogue, and (d) establishing a Community Action Network (CAN) of stakeholders. CAN subgroups will address needs for training, peer support, referral, access to
services, voice in health policies, data for decision-making, and models of best practice.
KCHS in 2009-2014.
KCHS Participants Served in 2009-2014:
* 907 total women served by KCHS program
* 485 women who enrolled when pregnant
* 422 women who enrolled after delivery
* Mean age of 24 years
* Predominantly African American (64%) or Hispanic (26%)
* Primary language of Spanish for 78% of Hispanic participants
* 864 children ages birth to 2 years were served
* Most participants had never been married (81%)
* Over half (51%) had at least a high school diploma/GED at enrollment
Goal Attainment in 2009-2014:
* KCHS infant mortality rate was 10.8 per 1,000 births
* 73% of pregnant enrollees accessed prenatal care in the first trimester
*8.2% of prenatal enrollees delivered an infant with low birth weight, and 1.2% delivered an infant with very low birth weight
Program Achievements in 2009-2014:
* Mothers who enrolled after the delivery of their infant (referred to as infant caregivers) were enrolled in the program an average of 56 weeks. Women who enrolled while pregnant (referred to as pregnant women) were enrolled in the program an average of 67 weeks.
* 86% of pregnant women had health insurance (with the majority enrolled in Medicaid) at intake.
* 69% of women and 78% of children had a medical home.
* 21% of mothers were breastfeeding their infants at the infant age of 6 months.
* KCHS referred 53% of participants to other community services, with 79% following through on the referrals.
* During 2009-2014, KCHS advocates had 5,938 face-to-face visits with 825 women in the program.
* During 2009-2014, these medical appointments were kept: 2,777 prenatal care visits, 369 postnatal visits, 738 healthy woman visits, and 30 adolescent visits, along with 886 family planning sessions and 3,273 well baby visits.
* KCHS provided outreach services to 993 women and their families, with 507 of the women eventually enrolling in Healthy Start.
* KCHS conducted over 150 training events, serving the health care community, the care coordinators, and the Healthy Start participants.
* KCHS disseminated information, shared resources, and recruited participants at 376 outreach events (e.g., health fairs). Over 39,364 people participated in the outreach events, and approximately 20,259 pieces of materials were disseminated.
