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MCC is a well-established agency • Good management practices • Client focus • Research informed • Impressive home visits • Discipline 3
The Problem: Declining funding and demand for evidence 4
Maternity Care Coalition’s Mission : To improve maternal and child health and wellbeing through the collaborative efforts of individuals, families, providers and communities . 5
Three tactics • Direct Services • Research • Advocacy 6
In direct services, MCC uses eight different home visiting models • Healthy Families America • Early Head Start • Healthy Start • Safe Start • HMO • Riverside Prison • Doula • MOMobile Classic 7
MCC’s Clients • 5,000 low-income women and families • 88% pregnant at registration • 85% single 8
MCC’s Clients • 1/3 without a high school diploma or GED • 25% language not English • 55% identify as African American; 28% Latina 9
City of Brotherly & Sisterly LOVE Highest poverty rate of 10 Alarming racial disparities: largest cities: 39% of children live Black infant mortality below poverty rate 13.4 versus 7.7 White Two-thirds of births are Medicaid Black maternal mortality rate 47.1 versus 11.9 for White Maternal infection at birth: 13% Black and 5% White 10
MOMobile’s Toolkit Relationship Connection to Parenting Public Education Benefits Integration Doula & with health Breastfeeding care systems Services Individualized Emergency Supplies referrals Case Management
What is Success for an MCC program? 12
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 13
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
Original Concept of Outcomes • Breastfeeding – Initiation and Duration • Reduction in maternal depression • Safe sleep • Connection to mental health services - Back sleeping • Improvement in housing, if needed - Co-sleeping • Increase in social support - Crib/No crib • Connection to child care - Cluttered/uncluttered crib • Increase in employment or job training - Smoke exposure • Increase in level of education achieved • Reduced maternal smoking • Health insurance • Reduced in home, in car smoke exposure for • Medical home for mother and baby mother and baby • Dental visit during pregnancy for mother • Increases in vegetables clients eat per week • Babies up to date on immunizations • Having three meals a day • Attendance at prenatal visits • Reduced frequency of fast food • Attendance at 6 wk postpartum visit • Use of family planning • Attendance at well baby visits • Increased connection to public benefits • Infant mortality rate - TANF • Premature deliveries - SSI • Low birth weight babies - SNAP • Improved parenting knowledge test scores • C-section rate • Improved HIV knowledge test scores • Distribution of “stuff”: condoms, diapers, • Increase postpartum bonding formula, transit tokens, clothing • Referrals to community services
Convened leadership to focus evaluation • Drastically limit the number • Stick to what is important • Stick to what we impact • Use credible measures 16
From over 50 measures collected, selected three outcomes • Maternal depression • Breastfeeding initiation • Safe sleep practices 17
Why Depression, Breastfeeding and Safe Sleep? 18
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 19
Safe sleep and breastfeeding, rooted in MCC’s early mission, are also important top priorities 20
The number of clients at risk for depression declines significantly over the course of MOMobile RESULTS A 68% reduction in clients at risk for depression!
Clients initiate breastfeeding and practice safe sleep more often RESULTS Breastfeeding and Safe Sleep Practices 100% 80% 60% 94% 83% 40% MOMobile 65% Clients 49% 20% Community 0% Benchmark Breastfeeding Safe Sleep
Consistent depression results across models RESULTS Use of Community Health Workers Staff supervision and training Research informed curriculum Standardized data collection and case management Continuous program improvement 23
Breastfeeding: Consistent results RESULTS Use of Community Health Workers Staff supervision and training Research informed curriculum Standardized data collection and case management Continuous program improvement 24
Safe sleep: Consistent results RESULTS Use of Community Health Workers Staff supervision and training Research informed curriculum Standardized data collection and case management Continuous program improvement 25
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. 28
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 29
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
Wrapping up for Sustainability Client 33
Aligning MCC’s outcomes with funders’ priorities • Funders more interested in their own set of outcomes, than MCC’s validated three • Necessary to show how MCC’s three outcomes relate funder’s outcomes 34
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 of funding for the first time.
Previously declining revenues increased by 70% in one year
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 37
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