AMCHP 2006 ANNUAL CONFERENCE
EARLY CHILDHOOD: BUILDING THE FOUNDATION FOR LIFELONG HEALTH
March 4-8, 2006
JUSTINE DESMARAIS: For my part I'm fairly new to this office. Not new, I'm here on behalf of two of my colleagues who have done the majority of the groundwork from AMCHP side, that's Stephanie McDaniel, and Danielle Sellers. So I'd just want to acknowledge the hard work that they've done in keeping us involved.
So I'm just going to give a very quick overview of the state infant mortality initiative, and then turn things over to the real experts. But start by saying that as many of you know, the state infant mortality or the infant mortality in the United States and across several states in the nation has experienced a recent increase. And back in 2004, CDC basically commissioned AMCHP to take this issue on and work with states to help them investigate their state infant mortality rates, those that were relatively high, that hadn't changed in a long time, or were in fact increasing.
So we set out to do that with a number of partners, CDC is our primary partner and funder through the Division of Reproductive Health. We've also worked very closely with March of Dimes, and they've also been a funder of ours.
From the CDC side as well, I want to acknowledge that we've worked with different divisions and centers within that structure. Birth defects has also been involved, and HRSA MCHB as well has been a partner, along with the National Center for Health Statistics.
From the national organization side, we've had great participation from other organizations, including City MatCH, NCHO, and ASTHO. And universities, I mentioned University of Alabama, Birmingham. We've had participation from Johns Hopkins, Emery, UCLA, Boston University School of Public Health. It's a really wide range of academia, as well.
And then last but certainly not least, involvement from states, and their county and local partners.
So I mentioned that CDC had awarded us some funds back in 2004, and we were re-awarded last fall to continue this work. And basically, pulled together teams from five different states: Delaware, Hawaii, Louisiana, Missouri, and North Carolina.
These states -- there was an application that was sent out, it was fairly rigorous, we asked them for a lot of information ranging from a description of the infant mortality problem in their state, the statistics, kind of running that through some proposed methods to further investigate those. Kind of an inventory of what kind of resources they had available, including potential partners with whom they could work on this issue. And what they thought that they, as a state team, could contribute to this type of process. As well as what they hoped to get out of it.
On the teams we had representation and have representation from the Maternal Child Health side, as well as the data side, and planning. So again, kind of that triangle that a lot of us have seen and talked about of policy, data and planning. That was a very important component of the state team composition.
And they were selected, as you can see, based on the research, the statistics, their data capacity, integration of state level and community level support, the agency support that they had to be involved, and a number of other factors, including population characteristics, so racial and ethnic breakdown, geographic characteristics, and socioeconomic and health system characteristics, as well.
And these are some of the types of activities that AMCHP is engaged in with these -- with our partners, and with the state teams. We've had a couple of collaborative meetings so far. We have done and will continue to do informative sessions like this. There was a session also that some of you may have attended at the MCHFE conference in Miami in December. We're doing regular conference calls with the state teams and our partners to talk about progress, and to talk about research, and new approaches for addressing infant mortality.
There are plans to do some reports, and we hope at some point some peer review publications through the state teams. And a fairly large amount of effort has been put into developing a tool kit, an infant mortality tool kit. And Bill Sappenfield actually will be talking about that in quite a bit of detail, so I'll leave that for him to discuss.
You can see we do have a web page, so you can go there now actually and see a number of the resources and materials and discussions that we've had with that group in the past, and we'll continue to post things there.
So the collaborative meetings that I mentioned, these are just the objectives of those meetings, so you know kind of what we were trying to get out of them. One of the key things was really to share what we knew, nationally and statewide. And in the first meeting, also to think about why the data looked the way that it did. And Danielle informed me that out of that meeting came some 30 pages of potential hypotheses for what states were seeing in their data.
And each team also developed kind of an action plan for further exploration of their data, and beyond, kind of moving to what you do with that data, and how you act on it.
So a year out, we brought the teams back together and we also convened -- in addition to a number of our partners that were already in the collaborative, convened a number of experts to provide kind of on-site technical assistance to the teams. And these included people like Russell Kirby, Vajiya Hogan, Donna Peterson, Greg Alexander I had mentioned, he was there as well. Kind of try to tease out what some of the key issues were, and exploring some of the strategies.
And there was also quite a large focus on the toolkit at that time. Quite a bit of it had been drafted, so getting feedback from the teams on how useful that was.
So progress to date, you know, certainly this initiative is still in the early stages, given the issue that we're trying to grapple with. We did a survey in November, just to get a sense of where the state teams were. And the vast majority, about 90 percent of them, let us know that they did feel that their state team efforts were making a difference at the state level. And, you know, it's one thing to feel that, it's another thing to kind of show some proof of that. And I think it was telling in some of the successes and accomplishments that they also reported at that time. The development of a state infant mortality task force, getting -- building the state epidemiology capacity by getting new staff in to work on that, work on the MCH data, providing input to the governor for an infant mortality reduction plan, doing new and expanded types of data collection and analysis, working with providers, working on family planning waivers, and generally just trying to strengthen partnerships and build new ones where those were needed.
The challenges are enormous, and familiar, many of them. Money, time and staff, certainly were common across all the teams. And they were finding some limitations in the data. And this was in terms of numbers, as well as quality. And I think you'll hear a little bit more about that from our state team representatives. Certainly also some limitations in terms of analytic capacity within the state agencies.
And also trying to deal with disparities in the data. You know, you see what the data is telling you, now how do you address those issues. And within the profession, trying to really address this issue, infant mortality, and infant health, as something that needs to be addressed across the lifespan. Meaning look at the mother. So it's really going way back, and trying to figure out how to have a common understanding of the importance of that within the MCH profession.
So our immediate next step as an overall initiative, we in September will be disseminating kind of a preliminary report, and what we attempted, how the states are doing, some of the specifics on what they've tried, and some of the resources and preliminary recommendations that the collaborative has been able to develop.
In December, we will be convening a meeting of the state teams again, to share findings, progress, and kind of figure out where we go from here.
And I don't think it's been fully decided yet, but it's possible, we may try to do that in conjunction with the MCHFE meeting, which I think this year will be in San Diego. So --
UNKNOWN SPEAKER: Which meeting is that?
JUSTINE DESMARAIS: MCH epidemiology conference. Yeah. And we hope next year that we'll really be far enough along that we can at least get a toolkit, a state infant mortality toolkit out to a broad audience for use, an application, and look at some lessons learned and really try to disseminate what we've done and what we've learned through additional venues, and peer review publications and the like.
Beyond that, this is really kind of an exploratory year. We're talking with our collaborative partners, and certainly with CDC to figure out how we can continue to work on this area effectively. And hopefully make a difference.
Certainly would invite and encourage any of you to contact Danielle or me at any time by e-mail, or you can just call AMCHP, if you'd like more information. There is quite a bit already up on the website, so you can visit that as well for some of the meetings resources.
And I believe we're going to hold questions to the end, so I will turn things over to Bill.