2007 Model Practice Application (Public)

BabyFirst Solano

Solano County Health & Social Services

BabyFirst Solano targets pregnant and parenting teens, pregnant and parenting African American women, and pregnant women who are at risk for or using substances during pregnancy and addresses the issue of perinatal health disparities. The goals of the program include:

• Increase the number of infants that are born at optimal birth weight in at risk populations.
  
  
• Increase the number of women accessing early and adequate prenatal and postpartum care by adressing barriers to care.
  
  
• Create a collaborative of service providers to coordinate services for pregnant and parenting women.
  
  
• Identify and address prenatal substance use in the prenatal care setting--provide and link women to appropriate services.

BabyFirst Solano aims to increase the number of women entering early, adequate prenatal care and improve birth outcomes for high-risk populations. Less than half of pregnant women with Medi-Cal (CA's medicaid program) in Solano enter early prenatal care (44%). Nearly all pregnant and parenting moms in the program are enrolled in Medi-Cal (85%-90%). Through the extensive case management services, nearly two out of three pregnant moms (64%) receiving BabyFirst Solano case management services in Fiscal Years 2004-05 and 2005-06 entered early prenatal care, 20 percentage more than the overall Medi-Cal population. Additionally, nearly nine out of ten African American infants were born after 37 weeks of gestation (88%) and/or more than five pounds and eight ounces (87%). Finally, nearly all (96%) infants born to teens were connected to health insurance and a medical provider.

In Solano County, health outcomes for pregnant women and infants fall short of the national standards. For example, African American infants born in Solano are twice as likely to be born at low birth weight (5 pounds and 8 ounces or less) and more likely to die before their first birthday than their counterparts. In addition, Solano County's teen birth rates are the highest in the Bay Area. One out of four pregnant women in Solano does not access prenatal care in the first trimester, and only half of Medi-Cal women enter early prenatal care. In response, in 2000, First 5 Solano convened a year long community-wide task force to focus on these issues, which recommeded focusing on populations with the most health disparities. Consequently, in 2003, First 5 Solano funded BabyFirst Solano, a public and private partnership, committed to making sure all babies in Solano County are born healthy and live in a nurturing environment where they will thrive. BabyFirst Solano focuses on three target populations: pregnant and parenting teens; pregnant and parenting African American women and their families; and women at risk for or using substances during pregnancy.

BabyFirst Solano provides comprehensive case management services to an additional 350 pregnant and postpartum moms and their families. These services include a home visiting program by case managers, public health nurses, and social workers to provide optimal support to pregnant and postpartum moms and their families. Services also include client workshops and events to support and educate pregnant moms and families about different aspects of pregnancy and parenthood. In addition, BabyFirst Solano identifies and addresses barriers to care to increase the level of service and consequent outcomes for clients. Using collaboration to address public health issues has become more and more commonplace. While the exact make up of the large collaborative of public and private agencies is unique, the collaboration itself has built on practices that have been explored for years. The unique practice the collaborative employs is targeting services to those most at risk of perinatal health disparities to increase the health of the entire community.

Existing collaborative models (including some in the NACCHO model practice database) focus on women in living poverty or women without health insurance. While any pregnant woman can access BabyFirst Solano services for help obtaining health insurance, prenatal care, and referrals to other services, this program offers the additional services of comprehensive case management, home visiting, client workshops, and psychosocial and medical assessments to three target populations: pregnant teens, African American women, and women at risk of using substances during pregnancy. In this way, this program focuses on increasing birth outcomes for those women who are most at risk of adverse outcomes, rather than spreading limited resources across the entire population.

The Solano County Health and Social Services, Public Health Division, Maternal, Child and Adolescent Health Bureau acts as the lead agency in our collaborative. The Maternal, Child and Adolescent Health Bureau coordinates the collaborative structure, along with the data collection and evaluation of the programs. The Bureau also provides technical assistance and training to all of the collaborative partners. The community partners have been an intergral part of planning and developing the collaborative and its structure. Community partners include a large hospital, the local Medi-Cal managed care plan, and community-based organizations. The Policy Council includes directors from each of the funded partners, along representatives from mental health, child welfare, Board of Supervisors, and the court system. Each funded agency implements and operates their individual program within the scope of the collaborative. Agencies participate in interagency collaboration and provide input to the overall collaborative though many facets facilitated by the collaborative structure. In addition, each agency in the collaborative has shared measurable outcomes, generating a team approach to addressing common barriers.

Funding sources for this program include First 5 Solano and California Department of Health: Maternal, Child, and Adolescent Health Bureau through Federal Financial Participation. The operating costs for BabyFirst Solano are $2 million annually; the start-up costs for the project were $650,000; and $200,000 in-kind funds are provided to the project annually.

In 2000, First 5 Solano convened a year long community-wide task force to address perinatal health disparities in Solano. The task force recommended targeting services to the three populations: pregnant teens, pregnant African American women, and women who may be using substances during pregnancy. In response, in 2003, First 5 Solano funded BabyFirst Solano, a public and private partnership, committed to making sure all babies in Solano County are born healthy and live in a nurturing environment where they will thrive. Solano County Health & Social Services, Maternal, Child, and Adolescent Health Bureau acts as the lead agency in the partnership. Two Initiatives, the Teen and African American Prenatal Initiatives, were funded beginning in July 2004 and included expansion of the evidence based state funded Adolescent Family Life Program for pregnant and parenting teens and Black Infant Health Program for pregnant and parenting African American women. Additional programs for teens and African American women were funded focusing on specific sub-populations to address unique needs, such as pregnant women involved in the justice system, and pregnant Latino teens.

In 2005, the Prenatal Substance Use Initiative was funded. BabyFirst Solano contracted with Dr. Ira Chasnoff of NTI Upstream and Children's Research Triangle to assist in the implementation of this project. In May 2006, a Leadership Institute was held, and community leaders developed an action plan addressing prenatal substance use and substance exposed newborns in Solano. The “Leadership Team” consisted of policymakers, obstetric providers, local hospitals, Medi-Cal managed care leaders, a judge, and key Solano County Health & Social Services managers and deputy directors. The community plan guides the work of the Initiative and the Leadership Team meets periodically to update the plan. In June 2006, NorthBay Medical Center's ABC Prenatal Program began screening all women for risk of substance use using 4Ps Plus, an evidenced based screening and assessment tool developed with Dr. Chasnoff, modified for the specific needs of Solano County. The ABC Prenatal Program also provides substance use education and services along with tobacco cessation classes within the prenatal care setting.

The collaborative is led by a Policy Council that provides overall guidance to the project. Additional subcommittees address program level collaboration. Through shared outcomes, the overarching goal of the collaborative is to increase the number of women entering early and adequate prenatal and postpartum care and improve birth outcomes for high-risk populations. The partner agencies and organizations provide a continuum of care for pregnant and postpartum women and teens, as well as newborns. The collaborative includes inter-agency teams that address the needs of the high risk client. Creating changes in delivery of services through communication between partner agencies improves service referrals and decreases duplication of services. The success of the collaboration has improved the level of services provided to pregnant moms, new moms, babies and their families, and consequently outcomes.

BabyFirst Solano is currently funded by First 5 Solano and matching funds from the California Department of Health: Maternal, Child, & Adolescent Health Bureau though Federal Financial Participation. Initial funds from First 5 Solano were awarded for 3 years and the project is in the process of applying for future funding from First 5 Solano. A Sustainability Workgroup, made up of program directors, has been formed to address the long term funding of the project. It is projected that First 5 Solano funding will no longer be available beyond the year 2015 and may be significantly reduced in the years leading up to this point. The Sustainability Workgroup creating a long-term sustainability plan by identifying and leveraging available funds, and institutionalizing costs. Additionally, initial funding for the Prenatal Substance Use Initiative has been used to institute screening of all pregnant women for risk of substance use in the prenatal care setting. This is a large system change for the prenatal care sites with funding spent on training and coordinating services. However, once the system for screening women has been created, it can easily be sustained as part of the psychosocial assessments already taking place in the Comprehensive Perinatal Services Programs. (CPSP is a prenatal care program for women with Medi-Cal, enhancing traditional obstetric care with psychosocial assessment, health education, and nutrition services.)

The goal of the program is to improve perinatal health disparities for teens, African Americans, and women who may be using substances.

Objective 1: Women have early and adequate prenatal care.

Performance Measure: 40% of women in case management receive first trimester prenatal care and 60% of women will attend 60% or more of their prenatal care appointments.

Outcome: From Fiscal Years 2004-2006, 63.7% of women in our case management programs entered prenatal care in the first trimester. Less than half of Medi-Cal pregnant women in Solano enter early prenatal care and nearly all pregnant and parenting moms in our program are enrolled in Medi-Cal (85%-90%).

Objective 2: Infants are born of normal birth weight and gestational age.

Performance Measure: 60% of infant are born at normal birth weight and of normal gestational age.

Outcome: In fiscal year 2005-2006, the rate of preterm birth for teens in case management was 7.4%. Our rate of preterm birth for teens is lower than both the state and national rates, and is lower than the Healthy People 2010 objective of 7.6%. The rate of low birth weight infants for teens was 6.6%. The rate of preterm birth for African American women was 15.8% and the rate of low birth weight infants was 17.1%. However, 7.1 percent of the births were twin births. This rate is significantly higher than the statewide rate of 2.8 percent.

Objective 3: Women stop using ATOD by delivery.

Performance Measure: 60% of women receiving substance use services will be substance free by the birth of the infant.

Outcome: This objective has only been gathering data since July 2006, so does not have data to report at this time.

Lessons learned include:

• Many women come into case management after they enter prenatal care, so case management is not as effective in addressing early prenatal care. The program is changing the outreach message to stress the importance of early prenatal care.
  
  
• There was an extrememly high rate of multiple births in FY 05-06. This affected the rate of preterm and low birth weight infants. In the future, the program may separate birth weight and gestational age by singleton births from multiple births.
  
  
• It has taken longer than initially planned to institute screening and services for substance use in the prenatal care setting; therefore, the timeline has been revised to roll out services.