Approaches To Reducing Infant Mortality- Nutaqsiivik Program

1. Approaches To Reducing Infant Mortality- Nutaqsiivik Program Southcentral Foundation Anchorage, Alaska

2. Nutaqsiivik Developed based on FIMR analysis In depth chart review of selected ANMC infant deaths (included other family members in ANMC system) Obstetrical �social risk� system clearly defined

3. Social Risk Referral Criteria Prenatal Care: none, onset in third trimester, or inconsistent/erratic care Substance Use: + urine drug screen for mother or infant, maternal substance abuse during pregnancy or risk for relapse postpartum Recent or current: family violence or child protection system involvement

4. Social Risk Referral Criteria History of: SIDS or childhood sexual abuse Current: maternal psychiatric disorder or depression; maternal FAS/FAE or other cognitive impairment Homelessness

5. Social Risk Referral Criteria Age 16 or under Worrisome parenting behaviors �Provider hunch� Using this tool, of about 450 Anch-based pregnant women, 1/3 were identified as being high risk so were stratified the 150 referrals into priority groups after doing in-home assessments.Using this tool, of about 450 Anch-based pregnant women, 1/3 were identified as being high risk so were stratified the 150 referrals into priority groups after doing in-home assessments.

6. Program Development Collaboration ANMC and Southcentral Foundation � IHI collaborative 1993 Flow charts of �system� process and communication patterns No money- redirected existing resources

7. Program Goals Promote safe home environments for high social risk infants Provide client-centered, risk-based interventions to support family�s move toward self-reliance Increase ANMC�s �system responsiveness� for high risk families

8. Program Goals Increase Anchorage community partnerships and awareness of program goals and activities Collect data and information to determine nature and extent of need among high risk Native families in Anch for program planning and evaluation

9. Program Components One stop shopping clinic � prenatal, postpartum and infant up to 6 weeks PHN visits at prescribed and prn intervals (first week, 2 wk, 4wk, 6wk, 8wk, then monthly) Pre-clinic case conferences/planning & quarterly reviews Clinic CNM provider, PHN was nurse, CHR assisted and did referral follow-up/satisfaction surveysClinic CNM provider, PHN was nurse, CHR assisted and did referral follow-up/satisfaction surveys

10. Improvement Process Built In Program �designed� to change Client feedback, chart reviews, follow-up of referrals led to enhanced service connections Observations of risk and morbidity/mortality etiologies led to spin off programs

11. Data evaluated Post-neonatal IM rates & etiologies Days Between Deaths run chart developed Maternal �risk factors� tracked as identified by social risking tool Outpatient, inpatient, ER utilization rates Appointment �no show� rates Case management system developed. Used for reminders, data analysis, comparison between pregnancies. In 1994 had a pre-program days between deaths of 55 days�..in 2000 that figure was 114 days�.LONGER interval between deaths Case management system developed. Used for reminders, data analysis, comparison between pregnancies. In 1994 had a pre-program days between deaths of 55 days�..in 2000 that figure was 114 days�.LONGER interval between deaths

12. Data evaluated Prenatal care utilization Contraceptive utilization Time interval between pregnancies Immunization rates Breastfeeding rates Toddler and 3 year old conditions/diagnoses Current data- Lactation rates meet Healthy People 2010 goals and immunization rates 98%Current data- Lactation rates meet Healthy People 2010 goals and immunization rates 98%

13. Hallmarks of Program Flexibility for clients � �meet them where they are at� Designed to change as �lessons learned� Clear goals Regular reports to �decision makers� led to funding for 3 PHNs, a dedicated pediatric NP, clerical assistance (1999)

14. Nutaqsiivik Today Home visits provided now to all ANMC postpartum women � 8 PHNs Recent expansion to Mat-Su area Changing trend re: 46% high risk , 800 referrals in 2006 Once in home, PHN�s found that women who were �not high risk� still had issues that required assistance/intervention.Once in home, PHN�s found that women who were �not high risk� still had issues that required assistance/intervention.