Black Infant Health Program Transforming African American women - - PowerPoint PPT Presentation
Black Infant Health Program Transforming African American women & their communities to improve health Reggie Caldwell, LCSW Health Equity Analyst California Department of Public Health Maternal, Child and Adolescent Health Division
Transforming African American women & their communities to improve health
Reggie Caldwell, LCSW
Health Equity Analyst
California Department of Public Health Maternal, Child and Adolescent Health Division
California Department of Public Health Maternal, Child and Adolescent Health Division UCSF Center for Social Disparities in Health Steven Bavolek, Nurturing Parenting Tyan Parker-Dominguez, USC School of
Social Work
Local BIH Staff
Infant Mortality Rate= deaths per 1,000 live singleton births Data source: Birth Cohort Data 1960-2007. *Birth Cohort Data unavailable for 1998. Prepared by the California Department of Public Health, Maternal, Child and Adolescent Health Division
31.7 10.4 4.1 19.8 2.5 1.6 5 10 15 20 25 30 35
1 9 6 1 9 6 6 1 9 6 8 1 9 7 1 9 7 2 1 9 7 4 1 9 7 6 1 9 7 8 1 9 8 1 9 8 2 1 9 8 4 1 9 8 6 1 9 8 8 1 9 9 1 9 9 2 1 9 9 4 1 9 9 6 1 9 9 9 2 1 2 3 2 5 2 7
Year Infant Mortality Rate Deaths per 1,000 Live Births
Non-Hispanic African American Non-Hispanic White Ratio
*
mortality in California
access to prenatal care would lead to substantial reductions in infant mortality rates, especially among African Americans.
Black:White Comparison in California
The BIH Program spans 15 jurisdictions where
American live births
Source: California Birth Statistical Master Files, 2006- 2008, Non-Hispanic African American resident mothers, age 18 years or older, excluding foreign- born mothers. Analysis by CDPH MCAH EAPD.
More adverse birth outcomes among African American babies and mothers:
African American babies are ~1.5 to 2 times as
likely as White babies to have low birth weights
to die before their first birthdays
African American women are:
Nearly 4 times as likely to die from pregnancy
complications as White women, taking other factors into account
Less likely to survive to their first birthdays More likely to have delayed cognitive, behavioral
and physical development during childhood
More likely to suffer from chronic diseases like
hypertension, diabetes and heart disease as adults
Sources: Lu & Halfon, 2003; Behrman, 2007; Barker, 2004
BIH Clients African American Mothers in CA Source Unintended Pregnancy 80% 60% a, b Received Prenatal Care during First Trimester 72% 82% a, c Prenatal Care Paid by Medi-Cal 86% 50% a, c Single Marital Status 85% 64% a, d Education: High School Graduate or Less 63% 34% a, b Age (Average Years Old) 25 27 a, c
Sources: [a] BIH Management Information System, Calendar Year 2009, Current Pregnancy Report, Demographics Report., Trimester of Enrollment and Trimester of PNC Initiation Report; Data Set 20100419 [b] Maternal and Infant Health Assessment Survey (2006). California Department of Public Health. [c] California Birth Statistical Master File, 2006, analysis by MCAH staff. [d] Figure 5 (Never married, Separated, Divorced), California Current Population Survey, State of California (2006) Department of Finance, California Current Population Survey Report: March 2005. Sacramento, California. www.dof.ca.gov/HTML/DEMOGRAP/ReportsPapers/documents/CPS_Extended_3-05.pdf Prepared by the California Department of Public Health, Maternal, Child and Adolescent Health Division
birth outcomes are better among women with higher levels of income
between Blacks and Whites is greater among higher-income and more-educated women
Great work happening in sites, but was not
consistent across sites, but there was a lack of standardization
Science governing model was outdated Limited data collected Did not fully consider the other factors that
influence health seeking behavior
Recommended the development of a single core
model for all sites
Source: UCSF Center for Social Disparities Health Assessment Report
The birth outcome patterns suggest that social factors are involved. Prime suspects include:
racism and/or economic hardships
may directly improve health, affects health behaviors and buffers stress effects
plays key role in health behaviors; key to escaping poverty (lack of control at work strongly linked
Racism is a system of advantage based
me, but to impact me. Less access to capital Discriminatory hiring practices Inferior health care Over-representation in the criminal justice system Under-representation in the university system
Experiences of racial discrimination create chronic stress:
Overt incidents Subtle/ambiguous incidents Constant vigilance and self-doubt--“work
twice as hard to get half as far” Chronic stress negatively impacts our health and wellness Consider racism as a health issue Some studies have linked racism (generally, overt incidents) to adverse birth
I am generally in good health and in tune with my
pay attention. Tests were taken. And when the nurse returned, she said, “I’m sorry. You’re pregnant.” As if there was a problem. I asked her if there was something wrong. She seemed to hesitate and then repeated, “You’re pregnant.” To which I responded, “My husband will be so happy.” Seeming surprised, she said, “Oh you have a husband”……
Negative responses hit me hard. Not to mention I was feeling the pregnancy hormones. I felt negatively judged, often heard belittling comments, and felt eyes staring at my ring finger, with a “tisk, tisk” teeth smacking response. Birth outcomes are affected by the negative impact of racism over one’s lifetime, not just during pregnancy. A lifetime of exposures to racism can literally get inside the body and affect
No definitive scientific evidence The patterns of birth outcome disparities suggest that social factors are involved Strong theoretical basis for believing empowerment-focused group approaches are more effective than individual interactions, and empiric studies with pregnant/postpartum women support group approaches
Source: UCSF Center for Social Disparities Health Assessment Report
CRH
AFFECTS MULTIPLE ORGANS & SYSTEMS
STRESSOR
CORTISOL Hypothalamus Pituitary Gland Adrenal Glands ACTH
Source: Center on Social Disparities in Health, University of California San Francisco
Conception Birth Pregnancy Delivery Age 5 Puberty
Disparity at Birth Poor Birth Outcome Optimal Birth Outcome
Poverty No Social Support Mistimed Pregnancy Adverse Childhood Events Exposure to Toxins Poor Nutrition Obesity Unsafe Neighborhood Poor Education Lack of Health Care No Family Planning Tobacco/Alcohol Drugs Nutrition Healthy Relationships Social Support Exercise Education Health Care Family Planning Safe Neighborhood Healthy Relationships Financial Security Planned Pregnancy Excellent Health Poor Health
Protective Factors
Risk Factors
GOVERNING CONCEPTS
unique history and traditions of people of African descent.
recognizing that people have an inherent tendency to strive toward growth.
healthy decisions.
recognizing that problem solving is a goal-oriented process. [REV. 7/11]
LONG-TERM OBJECTIVE To improve African American maternal
health and infant health in California and decrease health disparities and social inequities among Black women and infants
Group intervention plus enhanced case management, designed to:
strengths and address their health and social needs and concerns
reduce isolation
(including stress management techniques)
medical, social, economic, & mental health services
community and providers BIH addresses the problem of poor birth
disparities affecting African American women and their infants. Empower women to reduce stress & build resilience Promote healthy behaviors & relationships Connect women with services Engage communities (awareness, action, change) BIH focuses on these contributing factors:
services
communities
The Black Infant Health Program (BIH)
Transforming African American women & their communities to improve health
PROGRAM FOCUS SHORT –TERM OBJECTIVES PROGRAM MODEL
Black Infant Health Program - Revised Model
Goal: Decrease disparities by improving African American infant and maternal health
Recruitment
Meets program requirements?
Yes
Program Completion
No
Intake
Standardized health promotion message & Refer out to appropriate agency
Case Management
that compliments the group sessions
Group Sessions 11-20 Group Sessions 1-10
Birth Postpartum Prenatal Core Intervention
Cultural competence
Culturally relevant information that is important to
African American women, and honors the unique history and traditions of people of African descent
Client-centered
All people have a tendency to strive toward growth
so clients’ needs and desires are at the core of any interaction
Strength-based
Builds upon client’s strengths to enrich them, their
families and their community by empowering them to make healthy decisions
Cognitive skills-building approaches
Solve problems through a goal-oriented process
Positive Psychology Multiple Intelligences Transtheoretical Model for Behavior Change Cognitive Behavioral Therapy Stages of Group Development Harm Reduction Facilitative Leadership/Adult Learning Theory
African American women have worse birth
BIH MIS indicates that clients have had more psychosocial issues and it is anticipated that the revised model will serve similar women Eligibility
Self-identified African American pregnant women
18 years of age or older Reside in LHJ Consent to actively participate in BIH
Group Sessions Provides social support in a safe & affirming environment Empowers participants to
Make good choices to have a
healthy pregnancy
Be a good role model to their
child
Materials and activities based on evidenced-based curriculum Skill-building activities
Stress reduction, personal goal
setting, nutrition, exercise
Case Management Governed by ICP Referrals to services Complements group sessions Works with clients to create a Life Plan Conducts assessments to determine changes/needs
Program assessments Home safety assessment Edinburgh Postnatal
Depression Scale
Research suggests that group-based interventions could be a more effective strategy for improving birth
Issues addressed are
common to all participants
Decreased isolation/
increased social support → improved health-seeking behaviors, more effective social skills, reducing harmful effects of stress
Participating in groups can help women:
Make better choices
about their health
Increase their sense of
control, which can improve health and wellness
Improve their coping skills Help others with their
knowledge and information
Black Infant Health is a Sistah Circle that helps us sistahs survive—a gathering, a lesson, a prayer to keep
single ,we are supported as queens. Motherhood is activism and we have accepted the challenge. This group constantly reminds me that we all have
African American heritage Stress and stress reduction Understanding how to meet our needs Self-advocacy Nutrition and exercise Infant and toddler parenting Preparing for the baby Safety Healthy relationships Planning for the future
Handout
Meaning
Attitude emotion Value Coping response Habit Personal trait
In religion
Give thanks to God, the father,
for everything (Eph 5:19-20)
If you are grateful, I will give you
more (Quran 14.7)
O Lord my God, I will give thanks
to you forever (Ps 30:12)
Gratitude and well-being (Frohle et al)
Significant increase in life
satisfaction and well-being
Gratitude and pain (Carson)
Improvement in physical pain
and psychological distress
Gratitude in relationships (Algoe)
Promote relationship
formation and maintenance
Oxygen plays a critical role in your circulatory and respiratory systems Most-efficient way for you to stimulate your parasympathetic nervous system which is the body's principle method for counteracting the effects of chronic stress Restores equilibrium--your heart rate decreases, your lungs expand and your muscles relax Your body is better able to rest, digest and heal
Source: University of South Florida College of Education
that you will practice next week?
Black Infant Health encourages and challenges us to be confident, educated, courageous and stylish having fun along the way. We must also have a vision and set goals for our lives so that we may live on purpose and remember that we are valuable and have a very important role.
(www.ppc.sas.upenn.edu)
Scientific study of the strengths and virtues that enable individuals and communities to thrive Founded on the belief that people want to lead meaningful and fulfilling lives, to cultivate what is best within themselves, and to enhance their experiences of love, work, and play Positive Psychology has three central concerns:
Positive emotions: contentment with the past, happiness
in the present, and hope for the future.
Positive individual traits: focusing on strengths and
virtues
Positive institutions: Strengths that foster better
communities, such as justice, responsibility, civility, parenting, nurturance, work ethic, leadership, teamwork, purpose, and tolerance.
HANDOUT Source: Positive Psychology Center
Logic/Mathematical Reasoning and problem solving Visual/Spatial Visually and organizing ideas spatially Body/Kinesthetic Interaction with one's environment Verbal/Linguistic Spoken and written word Musical/Rhythmic Patterns, rhythms and music Interpersonal Interactions with others Intrapersonal Feelings, values and attitudes Naturalist Recognizes, categorizes and draws upon features of the environment
HANDOUT
Barack Oama Alvin Poussaint Billy Strayhorn Maya Angelou Alvin Ailey Benjamin Banneker George Washington Carver Jacob Lawrence Handout
Developed by James Prochaska and colleagues at the University of Rhode Island in 1977 Assesses an individual's readiness to act on a new healthier behavior, and provides strategies, or processes of change For people to progress they need:
A growing awareness that the advantages (the “Pros”) of
changing outweigh the disadvantages (the “Cons”)
Confidence that they can make and maintain changes in
situations that tempt them to return to their old, unhealthy behavior
Strategies that can help them make and maintain change
has been met This infers:
That the facilitators fully trust the group process
A safe space has been created
Everyone is treated as equal
Actively seeks other ideas and opinions Encourages different viewpoints Teaches others how to solve problems Models the behavior she would like to see in others Encourages members to take responsibility Use members to reinforce behavior:
Encourage appropriate Discourage
inappropriate
Uses the group for decision-making
that you will practice tonight?
participant a compliment.
accept the compliment by saying “thank you.”
Bruce Tuckman published his model in 1965 adding adjourning in the 1970s Helpful explanation of group development and behavior Groups develop maturity and ability, and relationships establish Leader changes style
Beginning with a directing style Moving through coaching Participating Delegating and almost detached
At this point the team may produce leaders
HANDOUT
Based in Cognitive Behavioral Therapy which aims to solve problems through a goal-oriented, systematic procedure A perspective and a set of practical strategies to:
Reduce the negative consequences to the drug
use community
Incorporate a spectrum of strategies from safer
use to abstinence
Can be applied to other issues
Aims to reduce harm without necessarily requiring stopping the behavior Quality of life and well-being are criteria for measuring success not reduction in the behavior Any reduction in harm is a step in the right direction Encourages even the smallest accomplishment toward self-efficacy Validates the participant’s current attempts Views the participant as capable of taking a greater degree of control in their own lives
Exercise in the Notes