1 MCC is a well-established agency Good management practices - - PowerPoint PPT Presentation

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MCC is a well-established agency

• Good management practices
• Client focus
• Research informed
• Impressive home visits
• Discipline

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The Problem:

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Declining funding and demand for evidence

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Maternity Care Coalition’s Mission:

To improve maternal and child health and wellbeing through the collaborative efforts of individuals, families, providers and communities.

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Three tactics

• Direct Services
• Research
• Advocacy

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• Healthy Families America
• Early Head Start
• Healthy Start
• Safe Start
• HMO
• Riverside Prison
• Doula
• MOMobile Classic

In direct services, MCC uses eight different home visiting models

MCC’s Clients

• 5,000 low-income

women and families

• 88% pregnant at

registration

• 85% single

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MCC’s Clients

• 1/3 without a high

school diploma or GED

• 25% language not

English

• 55% identify as

African American; 28% Latina

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 Highest poverty rate of 10 largest cities:

 39% of children live below poverty  Two-thirds of births are Medicaid

 Alarming racial disparities:

 Black infant mortality rate 13.4 versus 7.7 White  Black maternal mortality rate 47.1 versus 11.9 for White  Maternal infection at birth: 13% Black and 5% White

City of Brotherly & Sisterly LOVE

MOMobile’s Toolkit

Integration with health care systems Connection to Public Benefits Emergency Supplies

Individualized referrals Parenting Education

Doula & Breastfeeding Services

Relationship

Case Management

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What is Success for an MCC program?

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MCC collects substantial information about clients for case management purposes

• Client information related to nutrition, smoking, prenatal care,

mental health care, breastfeeding, work and public benefits status, family planning

• Parenting Knowledge and HIV Knowledge Tests
• Periodic depression screening with a validated instrument,

beginning at intake

MCC was using Efforts To Outcomes database (ETO) to report activities, not outcomes

• To create a semi-annual report on client demographics,

enrollment and services provided across all MCC programs

• To meet ad hoc data requests about enrollment and activities

by funders, research collaborators and for new grant proposals

• Incomplete and low quality data
• No quality assurance system in place

• Breastfeeding – Initiation and Duration
• Safe sleep
• Back sleeping
• Co-sleeping
• Crib/No crib
• Cluttered/uncluttered crib
• Smoke exposure
• Reduced maternal smoking
• Reduced in home, in car smoke exposure for

mother and baby

• Increases in vegetables clients eat per week
• Having three meals a day
• Reduced frequency of fast food
• Use of family planning
• Increased connection to public benefits
• TANF
• SSI
• SNAP
• Improved parenting knowledge test scores
• Improved HIV knowledge test scores
• Increase postpartum bonding
• Reduction in maternal depression
• Connection to mental health services
• Improvement in housing, if needed
• Increase in social support
• Connection to child care
• Increase in employment or job training
• Increase in level of education achieved
• Health insurance
• Medical home for mother and baby
• Dental visit during pregnancy for mother
• Babies up to date on immunizations
• Attendance at prenatal visits
• Attendance at 6 wk postpartum visit
• Attendance at well baby visits
• Infant mortality rate
• Premature deliveries
• Low birth weight babies
• C-section rate
• Distribution of “stuff”: condoms, diapers,

formula, transit tokens, clothing

• Referrals to community services

Original Concept of Outcomes

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Convened leadership to focus evaluation

• Drastically limit the number
• Stick to what is important
• Stick to what we impact
• Use credible measures

From over 50 measures collected, selected three outcomes

• Maternal depression
• Breastfeeding

initiation

• Safe sleep practices

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Why Depression, Breastfeeding and Safe Sleep?

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Depression is both critical risk factor and one we expect to impact

–MCC is expert at providing emotional support –All programs focus on stressors and connect clients to behavioral health, as needed –MCC routinely screens all clients for depression using Edinburgh

Safe sleep and breastfeeding, rooted in MCC’s early mission, are also important top priorities

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RESULTS

The number of clients at risk for depression declines significantly over the course of MOMobile

A 68% reduction in clients at risk for depression!

RESULTS

Clients initiate breastfeeding and practice safe sleep more often

83% 94% 49% 65%

0% 20% 40% 60% 80% 100%

Breastfeeding Safe Sleep

Breastfeeding and Safe Sleep Practices

MOMobile Clients Community Benchmark

RESULTS

Consistent depression results across models

 Use of Community Health Workers  Staff supervision and training  Research informed curriculum  Standardized data collection and case management  Continuous program improvement

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RESULTS

Breastfeeding: Consistent results

 Use of Community Health Workers  Staff supervision and training  Research informed curriculum  Standardized data collection and case management  Continuous program improvement

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RESULTS

Safe sleep: Consistent results

 Use of Community Health Workers  Staff supervision and training  Research informed curriculum  Standardized data collection and case management  Continuous program improvement

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It works! What comes next?

We needed independent validation

• Who would validate pro bono?
• Also, how to reduce the quantity of missing data?

We partnered with academic researchers

• Cold-called researchers
• Searched for a research study opportunity
• MCC was ultimately recruited because of both

promising outcomes and data capacity

• Published validated results in leading journal:

Zero to Three in November, 2014.

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We significantly increased data discipline

– Began providing rapid feedback to staff about inaccurate data entry – Number of complete client records increased from 57% to 85% in one year

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Quality Assurance Process – an evolution

• Original QA Plan
• Check demographics, enrollment, contacts, and

assessments

• Query wizard used to create bi-monthly report in excel
• Challenges
• Limitations of Query Wizard
• Excess time and effort to create reports
• Lacked system for staff follow up
• Negative reception of QA report by staff
• Lacked buy-in on importance of data

Quality Assurance Process – an evolution

• Improvements to QA Plan
• ETO Results Reports
• Quicker report creation and distribution
• Focus on timely feedback
• Narrowed focus of QA reports to problems only

(exceptions report)

• Current System
• Monthly report to advocate
• One week turn around
• Personal follow up emails provided to staff, later copied to

supervisors if no response

Pre QA Post QA

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Wrapping up for Sustainability

Client

Aligning MCC’s outcomes with funders’ priorities

• Funders more interested in their own set of
• utcomes, than MCC’s validated three
• Necessary to show how MCC’s three outcomes

relate funder’s outcomes

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MCC included its client outcomes in all major grants it submitted in 2014, and was awarded every one

• For the first time, client outcomes provided validated

evidence of quality

• Outcomes also demonstrated MCC’s capacity to collect

and report data, enabling MCC to apply for a higher level

• f funding for the first time.

Previously declining revenues increased by 70% in one year

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Summary: Best Practices

• Stick to important, credible outcomes
• Ones you can impact
• Drastically limit the number
• Implement a data quality assurance process
• Partner with researchers for validation

Questions and Comments