ELIMINATING DISPARITIES IN BIRTH OUTCOMES Spectrum Health | Grand Rapids, Mich. MATERNAL HEALTH CASE STUDY Overview Impact Spectrum Health's Maternal Infant Health Program offers A seven-year study by Michigan State University revealed personalized services to help eligible mothers and families success, as defined by a significant reduction in preterm in Kent County, Mich., have a healthy pregnancy and a and very preterm birth rates and higher rates of adequate healthy baby. Augmented by the federally funded Strong prenatal care, completing postpartum exams and well- Beginnings program, which provides additional services child visits. The rolling infant mortality rate for program to eligible African American and Hispanic women in participants was 5.7 per thousand live births as of Grand Rapids, Spectrum assists with locating health care December 2019, just slightly higher than the white rate of services, finding transportation, and understanding the 4.4/1,000 in 2018. baby's growth and development. The infant mortality among African Americans in Kent Today's comprehensive support County fell by 46% in the past services began in 2000 when 12 years due in part to the hospital and community leaders Strong Beginnings community joined forces to address a Black collaborative. infant mortality rate that was up to five times higher than the This came in addition to the white rate. The result was the harder-to-measure impact that creation of the Infant Health Spectrum Health's programs Action Team. have had on individual lives, such as helping clients obtain housing, In 2003, the community was education and employment, further galvanized by new as well as navigating the legal data demonstrating that at system to regain custody of their 22.4 Black infant deaths per children. 1,000 live births, Grand Rapids had the highest Black infant The architects of Spectrum mortality rate in Michigan. In response, the Action Team Health's two-decade effort to eliminate disparities in birth successfully applied for a large, multi-year federal Healthy outcomes offer some takeaway lessons from their quest: Start grant, managed by Spectrum Health, which funded • Enlisting community health workers - local people new efforts to address health disparities in the African who in some cases were themselves Strong American - and later, Latinx - communities. Beginnings program participants - was vital to Over time, these collaborative efforts expanded to success. "They have a cultural sensitivity far in include home visits by nurses and social workers, excess that I will ever be able to exhibit that can the addition of community health workers, behavioral create almost instantaneous trust and help to health, a fatherhood initiative, community education and navigate these complex situations," said Kenneth breastfeeding support groups, among other services. All Fawcett Jr., M.D., vice president of Spectrum Health programs have a strong emphasis on promoting racial Healthier Communities Department. equity and anti-racism work. ©2020 American Hospital Association | October 2020 Page 1 | www.aha.org • Embrace the role of fathers. Participation in the reaching greater numbers of expectant mothers. It will Action Team has grown from the original 12 concentrate on using technology in new ways, such as members in 2000 to 85 people, including community creating a home visiting program without visiting the residents and program participants, working on home, relying on virtual connections and telephonic 12 different committees related to maternal- connections to distribute a "lighter" version of its child health. Leaders attribute the interest and programs to impact more people. commitment of the broader community in part to the program's embrace of the role of fathers, who Spectrum Health is interested in pursuing a Medicaid are often the forgotten piece in the maternal-child waiver that would allow women across all of Michigan to health equation. They have learned that fathers need benefit from similar programs, not only those that reside and want to be included, and fathers have indicated in Kent County. their support for maternal health programs that offer Finally, program organizers intend to train more facilitators them a defined role. in health equity and social justice issues, while reaching • Flexibility is key. By offering behavioral health the general community with the same messaging. services in the home, Fawcett is optimistic that in conjunction with the sense of community maternal health collaboration that has services, care attended the growth of its providers have been maternal health programs so able to overcome far will continue to sustain it barriers around in years to come. transportation and "We're all kicking the ball in stigma, achieving a the same direction. When 90% engagement you surround yourself with rate in mental like-minded people, it's health services, almost limitless what you thus improving birth can achieve," said Fawcett. outcomes. Spectrum "It's very impressive how Health leaders call innovative Spectrum Health flexibility regarding has been in improving where services are offered a "differentiator." the health not just of mothers and babies, but entire • Spectrum Health was the first in Michigan to communities through the Strong Beginnings program." utilize social impact bonds, or "SIBs," a funding mechanism that represents a unique blend between Contact investing and philanthropy. As an alternative to traditional grant funding, SIBs tie compensation to Ken Fawcett, M.D. actual, achieved outcomes, as opposed to being Vice President, Spectrum Health Healthier compensated for the number of activities that Communities Spectrum Health engages in. Fawcett said the ken.fawcett@spectrumhealth.org creation of sustainable funding is "really improving birth outcomes and starting kids on the proper Peggy Vander Meulen launch angle for successful lives." Program Director, Strong Beginnings – Healthy Start peggy.vandermeulen@spectrumhealth.org Future Goals Moving ahead, Spectrum Health will continue its work toward eliminating disparities in birth outcomes by ©2020 American Hospital Association | October 2020 Page 2 | www.aha.org