Healthy Babies – Recommendations

The Healthy Babies work group was formed in early 2015, and as part of its initial charge has worked to:

  • Identify and examine the impact of strategies to maintain and amplify the gains made to reduce rates of infant mortality, including efforts addressing racial disparities.
  • Identify and examine the impact of strategies and related policies to reduce the teen pregnancy rate, and further improve outcomes.

Baltimore’s Promise has joined together with B’More for Healthy Babies, whose vision is that “all of Baltimore’s babies are born at a healthy weight, full term, and ready to thrive in healthy families.” We have worked together to reinvigorate the B’More for Healthy Babies Steering Committee and have created a new table to explore sustainable funding options for this effort.

Recommendations

In 2015, the Healthy Babies work group, in partnership with B’more for Healthy Babies (BHB), put forth the below set of initial, strategic recommendations to move the needle on our key indicators for this outcome. The group monitored the following progress to date:

RECOMMENDATION 1

Propose an automatic cross-check system for all pregnant women who are uninsured or on Medicaid and visit a hospital emergency department to determine if they have a prenatal risk assessment filed with the City. This could be done through Maryland’s Health Information Exchange. The Baltimore City Health Department (BCHD) would then be able to reach out to women who are not in obstetrics care immediately, which in turn would set in motion the process of care and the risk assessment.

Progress to Date: A small group is piloting a PRA cross-check with women who visit hospital emergency rooms to test new protocols.

RECOMMENDATION 2

Work with Maryland’s Department of Health and Mental Hygiene (DHMH) to create, as soon as possible, an easy online path to generate Prenatal Risk Assessments (PRAs) through the state’s Health Information Exchange. The online path would include a feedback measure that would ensure that providers who fill out the PRA are aware of where women are in the process. The feedback measure would also provide data on the source of PRAs.

Progress to Date: The Baltimore City Health Department (BCHD) is leading efforts to develop an electronic PRA system. BCHD has assessed the current PRA processes in 10 clinics, and is considering cost, system compatibility, and impact as they proceed.

RECOMMENDATION 3

Propose a citywide policy that no granting agency, public or private, will make a grant for health to an organization that does not have a written policy on promoting smoking cessation. This policy should, at a minimum, prominently provide information on services available to Marylanders through the quitline. This should include all organizations that provide instructions in child safety seats.

Progress to Date: Efforts are underway to increase awareness and access to the Quitline, which provides cessation information on services available to Marylanders.

RECOMMENDATION 4

Request free airtime on local radio and TV stations for the B’More for Healthy Babies Safe Sleep Public Service Announcements. This request should be premised on the results of the campaign and the likelihood that further dissemination will save more lives.

Progress to Date: BHB launched a self-funded Safe Sleep campaign, including a new Sleep Safe video that was viewed 67,000 times in June 2016. Infant sleep-related deaths are at an all-time low thus far in 2016.

RECOMMENDATION 5

Propose that all substance use disorder treatment programs in the City screen patients for interest in family planning and have the capability to refer clients to receive family planning services.

Progress to Date: The Preventing Substance Exposed Pregnancies Coalition launched the Baltimore Reproductive Health Initiative Pilot Project to increase access to reproductive health services, including family planning for women receiving substance use disorder treatment in three sites. 

RECOMMENDATION 6

Write a letter of support, upon request, to BCHD and Baltimore City Public Schools (BCPS) in support of their proposed plan for improved reproductive health education.

Progress to Date: BCHD received a ve-year, $8.5 million award from the Of ce of Adolescent Health to support reproductive health education in all Baltimore City middle and high schools. All high schools are implementing Making Proud Choices: Out of Home Care and Title X clinics implementing Seventeen Days, a video-based intervention. Middle school implementation will begin in January 2017.

RECOMMENDATION 7

Endorse a proposal by B’More for Healthy Babies for expansion of Nurse-Family Partnership in the City within federally qualified health centers and embrace the concept of reaching all first-time teen parents with evidence-based home visiting.

Progress to Date: BCHD is working in partnership with the Family League of Baltimore (FLB), NFP, and other stakeholders to review how to set up an integrated system of home visits, public health, hospitals, managed care organizations, and clinic stakeholders with the goal of ensuring NFP nurses are housed at city clinics, and FLB is researching best practices for implementation.

RECOMMENDATION 8

In support of the intimate partner violence (IPV) project led by DHMH, write all hospitals, clinics, and emergency rooms in Baltimore City to request that validated routine IPV screenings are offered to all patients at every possible visit. The current three-question screen supported by DHMH should be included. The letter should be co-signed with the local and state health departments, which can offer trainings that provide compelling healthcare data related to the importance of IPV screening and mechanisms for referral.

Progress to Date: The development of action steps regarding this recommendation is ongoing.

RECOMMENDATION 9

Leadership from B’More for Healthy Babies was actively involved in the work group and strongly endorsed the following recommendations:

  • Endorse a separate process to explore the identification of sustainable funding opportunities to support B’More for Healthy Babies. This should include both a short-term goal to maintain and stabilize existing infrastructure and a long-term goal to sustain initiatives in the years to come. This process should identify all untapped opportunities for reimbursable services, engage with entities that will benefit financially as progress is made, and consider unique and dedicated funding sources.
  • Revamp the B’More for Healthy Babies Steering Committee to include participants from the Healthy Babies work group who are not already members. It is also recommended that moving forward, the B’More for Healthy Babies Steering Committee and the Healthy Babies work group become one and the same.

Progress to Date: In January 2016, The Healthy Babies work group and BHB Steering Committee merged with a focus on examining BHB’s operations and supporting efforts to close funding gaps.

The BHB Financial Sustainability action te
am collaborated with DHMH to explore opportunities to leverage federal Medicaid matching funds for care coordination and home visiting services. A Medicaid waiver was submitted with input from BHB to include home visiting as part of the state’s Medicaid plan.