Joint Committee on Children, Youth and Families Babies Born Healthy Hearing: September 4, 2007

1. The Children’s Cabinet & The Governor’s Office for Children “Promoting the well-being of Maryland's children” Joint Committee on Children, Youth and Families Babies Born Healthy Hearing: September 4, 2007 Catherine J. Motz, Interim Executive Director (Chair), Governor’s Office for Children T. Eloise Foster, Secretary, Department of Budget & Management Catherine A. Raggio, Secretary, Department of Disabilities John M. Colmers, Secretary, Department of Health and Mental Hygiene Brenda Donald, Secretary, Department of Human Resources Donald W. DeVore, Secretary, Department of Juvenile Services Nancy S. Grasmick, State Superintendent of Schools, Maryland State Department of Education

2. The Children’s Cabinet & The Governor’s Office for Children“Promoting the well-being of Maryland's children” VISION • Children’s Cabinet: All Maryland’s children are successful in life. • Governor’s Office for Children: Maryland will achieve child well-being through interagency collaboration and state/local partnerships. MISSION The Children’s Cabinet, led by the Executive Director of the Governor’s Office for Children (GOC), will develop and implement coordinated State policies to improve the health and welfare of children and families. The Children’s Cabinet will work collaboratively to create an integrated, community-based service delivery system for Maryland’s children, youth and families. Our mission is to promote the well being of Maryland’s children.

3. What is our framework? • Three-Year Children’s Plan • Goal 1: Prevention • Goal 2: Transition Age Youth/Ready by 21tm • Goal 3: Build on Foundations • State and Local Partnerships • Results Accountability

4. Focusing on Results Results-based Accountability Decision-making: • What are we trying to achieve? • What does the data tell us? • What is the story behind the data? • What partners do we need? • What strategies work? • What is our action plan? Source: Mark Friedman, Trying Hard is Not Good Enough, Canada: Trafford (2005)

5. What Are We Trying to Achieve? Maryland’s Results for Child Well-Being Children Completing School Babies Born Healthy Children Safe in Their Families & Communities Healthy Children Stable & Economically Independent Families Children Enter School Ready To Learn Communities that Support Family Life Children Successful In School

6. Babies Born Healthy The Result Area “Babies Born Healthy” contains the following indicators: • Infant Mortality (the rate of deaths, per 1,000 live births, occurring to infants under one year of age); • Low Birth Weight (percentage of babies born at low birth weight, weighing less than 2,500 grams—about 5.5 pounds); and • Births to Adolescents (the rate of births to adolescents 15-19 years old)

7. Babies Born Healthy: Infant Mortality Rate: How is Maryland doing?

8. Babies Born Healthy: Low Birth Weight: How is Maryland doing?

9. Story Behind the Data Curve: Related Measures Contributing to Babies Born Healthy Leading Causes of Infant Mortality, 2005 • Complications related to premature birth and low birth weight (n=132, 24%) • Congenital abnormalities/Birth defects (n=80, 15%) • SIDS (n=55, 10%) • Maternal complications of pregnancy (n=46, 8%) • Respiratory distress of newborn (n=24, 4%) • Bacterial sepsis of newborn (n=19, 3.5%) • Newborn affected complications of placenta, cord, or membranes (n=19, 3.5%) • Diseases of the circulatory system (n=13, 2%) • Intrauterine hypoxia and birth asphyxia (n=13, 2%) • Necrotizing enterocolitis of newborn (n=11, 2%)

10. Story Behind the Curve: Related Measures Contributing to Babies Born Healthy Percentage of Unintended Pregnancy, Maryland 2001-2005 Data Source: Maryland PRAMS, 2001-2005

11. Story Behind the Curve: Related Measures Contributing to Babies Born Healthy

12. Story Behind the Curve: Related Measures Contributing to Babies Born Healthy Very Low Birth Weight (Less than 1,500 grams) 1994-1995 2004-2005

13. Story Behind the Curve: Related Measures Contributing to Babies Born Healthy • Because of the large disparity in the infant death rate between Black and White infants, it is imperative that this association be assessed. • There is no disparity between the numbers of the Hispanic, Asians, and Whites infant deaths.

14. High neonatal mortality and morbidity among newborns Lifelong family and social “costs” Lessened educational success Story Behind the Data: Low Birth Weight Why is birth weight important?

15. Story Behind the Data: Low Birth WeightRoot causes, correlates, and risk factors • Poor prenatal nutrition and healthcare • Cigarette smoking • Heredity • Low maternal pre-pregnancy weight and/or weight gain • Multiple births (i.e. twins, triplets) • Higher maternal age • Fetal Alcohol Syndrome • Race—African American infants are more likely to be born of low birth weight than white infants • Socioeconomic background and access to medical and emotional support for a healthy pregnancy

16. Story Behind the Data: Low Birth Weight Causes and forceshelping to improve low birth weight percentages: • Women, Infants and Children (WIC) Program • Maryland Pregnant Women and Infants Program • Maryland Family Planning Program

17. Story Behind the Data: Low Birth WeightContributing Factors • Causes and forces restraining improvement in the percentage of low birth weight babies: • Heredity--If the mother was a low birth weight infant, child is 4 times more likely to be LBW. If father was, child is 6 times more likely • Largest increase in number of low birth weight babies has been to mothers carrying one child and maternal age 24 – 34. • Declines in the number of mothers receiving prenatal care in the first trimester • Increases in the number of mothers receiving no or late prenatal care • Increasing numbers of preterm deliveries

18. What works: Babies Born Healthy Program Focus Areas The Babies Born Healthy Program works to strengthen the public health infrastructure through providing services that improve birth outcomes. The statewide approach enables access to quality services during four phases of a woman or child’s life: • Preconception/Interconception Health • Before/between births • Prenatal Care • During the pregnancy • Neonatal Safety • Immediately around the time of birth • Post-Neonatal Support • After birth/Infancy

19. What works: Preconception/Interconception Health • Reducing unintended pregnancy through creating new service entry points and strengthening the family planning infrastructure • Reducing the teen birth rate through enhanced clinical services and education • Reducing subsequent losses by supporting women with a previous loss through Heal Everyone After a Loss (HEAL) Program

20. What works: Prenatal Care • Increasing access to high-risk prenatal care services through a telemedicine program with the University of Maryland, Department of OB/GYN • Enhancing community support and education, as well as facilitating access to prenatal care through collaboration with the Baltimore City Healthy Start program

21. What works: Neonatal Safety • Initiating a Perinatal Collaborative to improve the safety and quality of obstetric and neonatal care provided in hospitals • Supporting the adoption and adherence to the Perinatal Standards

22. What works: Improving Birth OutcomesPost-neonatal Support • Encouraging Safe Sleep practices through parent and health care provider education • Promoting Breastfeeding-Friendly Workplaces to enhance working mothers’ ability to continue breastfeeding when returning to employment • Supporting the Early Hearing Detecting and Intervention Program

23. What works: Improving Birth OutcomesEarly Successes Baltimore City’s Baby Leadership in Action (LAP) is an opportunity for a diverse group of leaders to lead from the middle in implementing strategies that will turn the curve for birth outcomes

24. Births to Adolescents (Teen Pregnancy)Babies Born Healthy: How is Maryland doing?

25. Story Behind the Data: Births to AdolescentsRoot causes, correlates, and risk factors • Root Causes, Correlates, & Risk Factors: • Economic and Social Deprivation • Lack of Academic Opportunity • Peer Influence and Social Norms Favoring Early Sexual Involvement • Delinquent Behavior and Early Child Bearing

26. Story Behind the Data:Births to Adolescents: Causes and Forces • Contributing to Improved (declining) Rates of Births to Adolescents: • 86% of reduction due to increased access to Reproductive Health Services • Comprehensive health education • More use of contraceptives • Restraining Improvement in Decreasing the Rate of Births to Adolescents: • Mixed messages to adolescents regarding sexual behavior • Inconsistent access to family planning services • Lack of focus on positive youth development

27. What will it take to improve the current situation on births to adolescents? Make effective contraceptives widely available. Include additional data gathering tools Increase the use of evidence-based teen pregnancy prevention curricula in community and school-based settings. Increase youth development opportunities (especially for high risk youth), which includes safe and stable places, basic care and services (including health care and transportation) and high quality instruction and training. Family Support Centers and their strategies for working with at-risk youth. Support funding for after school and other community based programs that prevent teen pregnancy. Support increasing youth development opportunities in community-based settings (in particular for youth in more challenged communities). What Works & What is Maryland Doing? Reducing Births to Adolescents

28. What Works & What is Maryland Doing? Reducing Births to Adolescents • Support and Refine Existing Initiatives such as: • Healthy Teens Young Adults Program • Baltimore City Public Schools After School Program • Washington County Family Center- Alternative High School • Provide support for school-based programs • Support the implementation of the Ready by 21 Action Agenda • Continue to enhance and expand comprehensive adolescent reproductive health education and prevention services through the efforts of the interagency School-Based Health Policy Advisory Council • Continue to provide gender responsive programming through the Department of Juvenile Services • Continue to provide parent education, particularly to parents identified to be at-risk through their involvement with one of the Children's Cabinet Agencies

29. What Works & What is Maryland Doing? Reducing Births to Adolescents • Help reduce incidence of subsequent births to adolescents & support healthy families: • The Task Force to Study Incentives for Teen Parents (forthcoming recommendation) • The Young Fathers-Responsible Fathers Program • The Partners for Fragile Families Program • Family Preservation Programs, including Family Support Centers

30. Continue existing initiatives & partnerships to help Maryland move forward: • Maryland Health Improvement Plan/Healthy Maryland 2010 • Baltimore City Baby LAP (Leadership in Action) Program • Maternal and Child Health-Women, Infants and Children (WIC) Collaborative • Healthy Start • Youth Ready by 21: A 5-Year Action Agenda for Maryland • Perinatal Health Collaborative • Task Force to Study Incentives for Teen Parents • School-Based Healthy Policy Advisory Council • Healthy Teens Young Adults Program • Gender Responsive Programming • Parenting Education • DJS participation in Child Fatality Review Committee & Fetal Alcohol Spectrum Disorder • Maryland Infants and Toddlers Program

31. Recommendations for the Future • Enhance preconception health activities, especially teen pregnancy prevention • Strengthen the access to and quality of reproductive health services • Expand Baltimore City’s Baby Leadership in Action (LAP) to the rest of the state • Enhance availability of services through Infants and Toddlers programs • Modifications and updates to the Three-Year Children’s Plan to create an action agenda for Maryland

32. The Children’s Cabinet & The Governor’s Office for Children“Promoting the well-being of Maryland's children” * Local Management Boards ~ SCYFIS ~ Systems of Care Governor's Office for Children 301 W. Preston Street Baltimore, Md. 21201 410-767-4160 410-333-5248 (fax) www.goc.state.md.us