MCHB ALL GRANTEES MEETING

Solos to Symphonies: MCH Partners Working

October 4-7, 2004

SUNDAY GUSTIN: Okay, now we have to do--oh, that’s better. Testing again. Good morning. I’m Sunday Gustin. I’m the project director from--I’m a little bit nervous. Okay. I’m the project director for the Trenton Healthy Start Initiative. It’s also known in Trenton as Children’s Futures so we have a little identity crisis going on. But actually, it’s mostly known as Children’s Futures in Trenton . I’m excited to be here and you can tell I’m a little nervous, so I’ll calm down in a minute as I go along. Trenton is a relatively small city. We have about 85,000 people living in our city. We are predominantly African/American and we have a growing Hispanic community, and we have about 1,500 births per year just so you have some frame work and ours is a city-wide initiative. Our collaboration has about 15 core health and social service partners and we also have dozens of other organizations and programs across the city that are partnering with us to improve maternal and child health outcomes in Trenton. Thank you.

A collaboration of this enormity requires the inclusion of all sectors of the community, including the leadership of our public officials and that’s why we brought our mayor with us. Mayor Palmer has been a strong supporter and his energy and enthusiasm have really helped us to expand our collaboration and move it forward. And although challenging and difficult at times, the work of creating effective partnerships is definitely worth the effort. It really does make a difference for the families, the infants and children we serve. As a preliminary step, we began by taking a look at our existing strengths so this, you know, was before Children’s Futures came into town. And the resources that we had. We wanted to be sure if we were building a system of maternal and child health services that we integrated the pieces that were working well or that we needed to strengthen. In Trenton we have our Healthy Mother, Healthy Baby coalition. It’s been around since 1985 and through that forum that’s really where our front line clinical folks would come together on a regular basis and we, you know, we got to know each other and that was a good way of building trust and I know a lot of your communities have the same kind of a structure there.

Trenton also--we had five; we now have four prenatal clinics. A couple of them, you know, consolidated and those clinic partners now--those providers--served over 2/3 of our 1,500 births, and that was important to embrace those folks and to have their buy-in. We also had in place a small network of some community based services. Our public health nurses provided through my agency--through the local health department--we conducted maternal/child health home visits. We also had some pediatric, you know, well-baby clinical services in place and one of our community agencies had a small health families program and they provided some parenting support groups and other education and support pieces for families. And then we looked at what funding sources were in our community, and of course my local agency--we designated some municipal funding for maternal and child health services.

Our state department of health and senior services provided us with several small grants through our Title V MCH and Prevention Services. Our department of human services funded that very small--60 families--small healthy families program and then in 1996, the city of Trenton applied for and received a Healthy Tomorrow’s Partnership for Children program grant. And that five year grant, you know, it’s a small grant but it was really pivotal for us. It helped us to formalize those agreements--relationships--with our clinic providers and it also helped us begin to implement some small level of prenatal screening. Of course, we also needed to look at what barriers and gaps existed that we needed to build on and strengthen. We had those good relationships at the front line with our clinic folks. You know, we all got to know each other and we’d pick up the phone and call one another, but we knew that we needed more. We definitely needed top-level CEO level commitment to build and sustain a system’s change in our city, so that was one of our challenges.

We had no standard protocol for screening so we had little bits of--excuse me--little bits of screening going on and it was really at the providers discretion and you know how that goes. You know, it depends what you look like or how you behave or maybe some medical risk factors and that’s what would get a referral. So it was really important to standardize the screening process and in fact, you know, our goal is to screen all pregnant women. And then we were beginning to build that coordination between the clinic providers and the community services, but we were still at a very small scale. Our, you know, our 1,500 births we were maybe serving 300 pregnant women and in fact, the services that were there were becoming very over extended. Our public health nurses had huge caseloads of more than, you know, greater than 100 families that they were working with, and so as you all know, there’s no way to improve birth and pregnancy outcomes with large caseloads like that. And then finally, we knew that we were still missing some very important key partners--our substance abuse, mental health providers, domestic violence, fatherhood, and some linkages with infant and childcare providers. But the message here is to be ready. Certainly know your community, know what you have that’s working and, you know, start to formulate a plan because you never know what will happen, you know, new opportunities arise. And in 2000, we were very fortunate in Trenton to welcome a new private partner and that is Children’s Futures, the organization Children’s Futures. And this private organization was created with start up funding from the Robert Wood Johnson Foundation.

Rush will talk a little bit more about that in a few minutes. And their charge was to come into Trenton and undertake a broad citywide planning process. And so they brought in those partners that were missing--the mental health, fatherhood, childcare folks, whoever I’m leaving out but they also brought in the consumer voice. There were consumer focus groups, civic organizations became involved, our faith based community became more involved in being part of designing this initiative in the city. And the other part of the message is to be aggressive because as this, we were, kind of, just toward the end of the planning phase and HRSA had issued it to the RFP for the healthy start grant, and we were excited and motivated by this unique partnership with Children’s Futures and we said, “We’re going to apply,” and we were very, you know, thrilled and excited to be awarded our Healthy Start Grant in July of 2001. So we are the baby of the Healthy Start--one of the babies of the Healthy Start family. We’re in our fourth year of our first grant funding cycle. And then, you know, just good things kept happening.

The following month, Children’s Futures heard from the Robert Wood Johnson Foundation that they were awarded their full funding for the five year grant that they now brought in--we, kind of, brought in as a match to each other and so we were able to implement our full model which you’ll see in just a minute. And then one other thing happened. In early 2002, our state Juvenile Justice Commission, you know, we were surprised that there was a funding announcement from Juvenile Justice but they were looking at the nurse/family partnership as a best practice and we know we were ready to apply for that funding, we did so, and we were awarded a nurse/family partnership grant in Trenton . So we, you know, it was a great time. We had all these wonderful new funding sources and new partners coming to the table with us. And we’ve tried to, you know, take advantage of that good fortune and hard work and keep the coalition building going. So we had these new funding sources--these great new partners and it was, you know, very important for us to put a structure in place that would support the partnership and help to facilitate the system change.

So we have three lead administrative partners. That is my agency--the City of Trenton, Children’s Futures the organization, and of course our Trenton Healthy Mother, Healthy Baby Coalition and their lead agency, which is the Central New Jersey Maternal and Child Health Consortium. And they are our community coalition consortium from our project. And so just very briefly, these are some of the core interventions that we have. Our prenatal screening, which I just mentioned. We have a central intake point at the city of Trenton . We have our nurse family partnership program. That serves 125 first time pregnant women and families. We have four parent/child centers, one in each ward of our city and each of them have a new Healthy Families program and they each serve 60 families. So that’s 240 more families. We added our consultant services for behavioral health, for fatherhood, for childcare, and just recently we added our domestic violence agency as a formal partner in our collaboration. And I guess most importantly, we successfully integrated all of those pre-existing services into our model and here’s what it looks like.

Oh, the slides aren’t--oh, you can’t see our model. Are they coming up? Okay. You’re just listening to me talk. My God. Okay, here’s what the model looks like and after the interesting part, we have of course pregnancy is our entry point. Our prenatal clinics are doing universal screenings, so every pregnant woman that comes in through our clinic providers are being screened. We have adapted our Healthy Families screen and we have added the four piece plus, which as Dr. Irachanov’s screen for alcohol, tobacco, and other drug use, for depression and domestic violence. We also have done out reach to our private obstetrician offices and, you know, that takes a little bit longer so we’ve got to be able to build. Our goal is still universal screening but, you know, it’s a little tricky there. We definitely have interest from our private providers and then of course we have outreach activities going on, really through all of the partners of this collaboration.

Next. And then we have the central intake point which is through the city of Trenton . When women are screened, you know, this is a voluntary program so we ask for their consent to be referred for services from Children’s Futures. If we have that consent, then the screening information is collected at the central intake point and then families--women and families--are linked with services and that’s the next click. And then these are our partners that work with us in this initiative. And you can see where we’ve integrated the nurse/family partnership. Our four parent/child centers are north, south, east and west. They each have their own lead agency. We’ve integrated our pre-existing Healthy Families program. And then families are assessed at that point and they’re offered services based, you know, whether they qualify for intensive home visiting, or they may just want center bay services which are the next boxes, or they may just want occasional public health visits or--we have some other community programs. And then to the very right of that slide are our consultant services for behavioral health, fatherhood, domestic violence and childcare.

And then this is a picture of one of the parent/child centers where we do have--each parent/child center has home visiting services and center based activities and then click--and then of course we have the linkages with all of our other community based providers. And then next--we’re going to go quickly--and then these are some of the people and the partners that really bring our symphony to life. And I want to just, kind of, click through them. We have our Healthy Mother, Healthy Baby Coalition, Central Intake. These are our parent/child centers and as you can see I do want to point out because you might not know from looking at Rush and I representing our city but we have a very diverse group of partners and staff that work with us. We have those parent/child centers are bilingual. We have English and Spanish speaking staff and some of the centers where it’s appropriate we have staff that speak French Creole and one of our centers, we have an Eastern European community and so we’ve got language capability there. Thank you.