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Fresno County Preterm Birth Collective Impact Initiative:
Introduction to the Common Agenda
September 2016
© FSG |
1 Background
2 Overview on preterm birth
3 Common Agenda
Meeting agenda
2
© FSG |
Background and today’s discussion
3
Background:
• This effort in Fresno County is supported by the University of California – San
Francisco’s Preterm Birth Initiative, a 10-year, philanthropic initiative working
across three counties in California, including Fresno
• During early 2015, a group of local leaders came together to create this initiative
to improve the health of women and babies in Fresno County, specifically
reducing the rate of preterm birth.
• These Fresno County leaders formed a Steering Committee, and have met
monthly since February 2015.
© FSG |
The draft Common Agenda was developed with
input from more than 150 people in Fresno County
4
© FSG |
The Steering Committee provides leadership and
guidance for the Fresno Preterm Birth Initiative
1. Andrea Powell, Community Member with Lived Experience
2. Kristi Hernandez, Community Member with Lived Experience
3. Niecia Harris, Community Member with Lived Experience
4. Yolanda Randles, West Fresno Family Resource Center
5. Artie Padilla, Every Neighborhood Partnership
6. Dr. Gail Newel, Retired UCSF-Fresno (Consultant)
7. President Joseph Castro, CSU, Fresno
8. Dr. Ken Bird, Fresno Dpt. of Public Health (Rose Mary Garrone – alternate)
9. John Capitman, PhD, Central Valley Health Policy Institute
10. Lynne Ashbeck, Community Medical Centers
11. Todd Suntrapak, Valley Children’s Hospital
12. Greg Hund, Cal Viva
13. Emilia Reyes, First Five Fresno
14. Dr. Kathryn Catania, Deputy Superintendent, Fresno County Office of Education
15. Dr. Larry Rand, Preterm Birth Initiative (Linda Franck – alternate)
16. Ruben Chavez, Clinica Sierra Vista
17. Davena Witcher, Executive Director of AMOR Foundation
18. Preston Prince, Executive Director of Fresno Housing Authority
19. Dawan Utect, Fresno County Director of Behavioral Health
5
© FSG |
The initiative is using a cross-sector, collaborative
approach called collective impact
Common
agenda
All participants share a vision for change that includes a
common understanding of the problem and a joint
approach to solving the problem through agreed-upon actions
1
Shared
measurement system
All participants agree on how to measure and report on
progress, with a short list of common indicators identified
and used to drive learning and improvement
2
Mutually
reinforcing activities
A diverse set of stakeholders, typically across sectors,
coordinate a set of differentiated activities through a
mutually reinforcing plan of action
3
Continuous
communication
All players engage in frequent and structured open
communication to build trust, assure mutual objectives, and
create common motivation
4
Backbone
support
An independent, dedicated staff (with funding!) guides
the initiative’s vision and strategy, supports aligned
activities, establishes shared measurement practices, builds
public will, advances policy, and mobilizes resources
5
There are five conditions to the collective impact approach:
© FSG |
What makes this initiative different?
• A focus on collaboration among institutions and organizations
across the County, even those who have not previously worked
together or who may not usually focus on health issues
• A combination of coordinating of what’s already working in the
community, as well as selectively introducing new and innovative
practices
• Long-term timeline and goal to drive change for the population of
Fresno County
• Close coordination and collaboration with the community
7
© FSG |
1 Background
2 Overview on preterm birth
3 Common Agenda
Meeting agenda
8
© FSG |
Among the ten most affected counties in the state,
Fresno has the most babies born preterm
9
Source: March of Dimes Final Summit Packet / 2013 Birth Statistical Master File
Note: Gestation based on Obstetric Estimate with LMP replacement when OE missing/out‐of‐range; Valid gestational age range 17‐47 weeks, excludes unknown
gestational age; Percents not shown for less than 10 events
Top 10 Counties in California by Preterm Birth Rate and Count (2013)
8 9 10 11 12 13
Glenn 10.3%
Colusa
12.1%
11.2%
Trinity
Kern 9.5%
San Benito
10.2%
9.8%
Lake 9.8%
Fresno 9.8%
Del Norte
CA PTB Rate: (8.4%)
San Joaquin 9.2%
Plumas 9.3%
Count
12
35
41
32
1,538
74
74
1,339
14
900
Rate
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All women in Fresno are at risk, but some races
and ethnicities are disproportionately affected
10
15%
10%
5%
0%
8.1%
Series
White
7.3%
Hispanic
7.9%
Asian
8.3%
African American
12.0%
Distribution of Preterm Births By Ethnicity, 2013
7.3% 11.9% 60% 17.4%
County Rate
Preterm Birth Rate (Singletons), 2013
% of all Preterm Births
• African American
women have a
much higher
preterm birth rate,
but constitute only
7.3% of all PTBs.
• Hispanic women
have a PTB rate
that was slightly
below county
average, but
constitute 60% of
all PTBs.
Key Takeaways
Source: California Summit on Preterm Birth (March 18, 2015), CADPH, March of Dimes
6.8% State Rate
10
© FSG |
Preterm births are concentrated in urban areas of
Fresno, but some rural areas have high rates also
11
Singleton Preterm Birth Rate by
Medical Service Study Area (2011-13)
Fresno South and West
Fresno West Central
Firebaugh / Mendota
Biola / Herndon
Fresno North Central
Auberry
Huron
Orange Cove
9.9%
Cantua Creek
Coalinga
Bowles
9.4%
Clovis West
Fresno Northwest
Fresno East Central
9.1%
6.1%
7.0%
7.4%
7.6%
8.0%
8.1%
8.1%
8.4%
8.8%
9.0%
6.0% 22
35
294
266
21
382
150
265
267
408
536
123
442
526
Number of Singleton PTBs by
Medical Service Study Area (2011-13)
Although Fresno’s preterm births are distributed across the county, certain
areas bear a disproportionately large burden.
MSSA Name
Source: California Summit on Preterm Birth (March 18, 2015), CADPH, March of Dimes
© FSG |
Preterm birth is a driver of negative outcomes for
the people and systems in Fresno County
• The health and developmental impacts of preterm birth
vary by severity – babies who are born earlier typically
face greater health problems
• Preterm birth is a leading cause of infant death before
the age of one
12
Source: Central Valley Health Policy Institute, Birth File Analysis; California Department of Education; Societal Cost of Preterm Birth, Preterm Birth: Causes,
Consequences, and Prevention, Behrman RE, Butler AS, March of Dimes Final Summit Packet.
Note: Disability data is for K-12 students, and is only listed for conditions associated with PTB
Health problems
for children
Challenges for
children’s
academic
achievement
High costs for
the healthcare
system and
families
• Preterm birth impedes academic achievement for many
children: in 2014, more than 7,000 students received
special education services in Fresno County due to
conditions that are associated with preterm birth
• Preterm birth is expensive for the health system:
conservative estimates show that caring for babies born
prematurely in Fresno costs the health system about
$78 million per year
© FSG |
Medical, social, and economic factors are
important drivers of preterm birth
While many of the causes of preterm birth are not well understood, we
know certain factors put women at risk:
13 Source: Central Valley Health Policy Institute, Birth File Analysis; Dahlgren and Whitehead (1991).
Poverty:
• Women on Medi-Cal are 1.3x
more likely to have a preterm
birth than women on private
insurance
Access to care and services:
• Women who receive prenatal
care late in their pregnancy or
none at all are at higher risk
• Women who receive WIC
benefits are less likely to have
a preterm birth
Poor health before pregnancy:
• Women who have
hypertension are 3x more
likely to have a preterm birth
Other socioeconomic and
environmental conditions:
• Factors such as domestic
abuse, stress, and air quality
can also negatively affect birth
outcomes
© FSG |
1 Background
2 Overview on preterm birth
3 Common Agenda
Meeting agenda
14
© FSG |
The guiding principles
We believe…
…that every child in Fresno County deserves a healthy start in life
…that every woman and her family in Fresno County deserves equitable access to life
opportunities
…that the health of mothers and babies is the shared responsibility of the entire
community
We seek…
…to engage all systems that directly affect women, infants, and families in Fresno to bring
about change, including policies, practices, and community norms, to support healthy,
happy mothers and babies
…to collaborate directly with and listen to women and their families, with a focus on
understanding experience, recognizing behavior patterns, and employing empathy
…to focus on approaches that are inclusive, equitable, innovative, and responsive to
women and their families
…to leverage and align the significant community assets, such as the rich cultural
diversity and the existing collaborative efforts
…to create change that will be adopted and sustained by the people and institutions in
Fresno County 15
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The challenge
16
Fresno County has one of California’s highest rates of babies born
prematurely: 1 out of every 9 babies. Being born too soon can cause
serious physical and mental disabilities or even death before the
baby’s first birthday. It has enormous human and financial costs for our
families and affects the overall health of our community. Conditions in
Fresno County must be changed so that more women can have
healthy pregnancies and healthy babies.
© FSG |
The vision and goal
We envision a future in which all women in Fresno County are in the
best health before, during, and after pregnancy so that more babies
are born healthy. We will work tirelessly to serve all women, babies,
and families in Fresno County, with particular focus on those who are
most at risk for premature birth. In Fresno County, everyone in the
community, including government, businesses, schools, universities,
community colleges, churches, nonprofit organizations, and healthcare
providers, has an important role in supporting the health of women and
babies.
By 2025, we strive to dramatically reduce the percentage of babies
born prematurely in Fresno County as a result of good health for all
women before, during, and after pregnancy.
*The percentage decline will be defined as part of shared measures in September 2016. 17
© FSG |
The focus areas
18
Deliver services and resources
to women in their communities
and neighborhoods to improve
birth outcomes, address
stress, and improve social and
emotional support during
pregnancy.
Improve the coordination and
integration of physical and
behavioral healthcare, social
services, and other support for
women before, during, and
after pregnancy
Care and Support for
Pregnant Women
Coordination of Care
for Women
Strategic focus areas:
Deliver primary, behavioral,
reproductive health services,
and health education to
empower women and men to
be healthy before having
children.
Health & Education
before Pregnancy
