September is Infant Mortality Awareness Month

September is National Infant Mortality Awareness Month. Preterm birth— before 37 weeks gestation– is the leading cause of infant death in the first month of life. Babies born prematurely are at higher risk of mortality and morbidity, as well as developmental delay.

In 2017, Florida ranked 29th among states with an infant mortality rate of 6.1 deaths for every 1,000 live births. The infant death rates in the state have decreased 14% in the last decade but significant disparities persist for black babies compared to white babies.

Home visiting programs funded by FL MIECHV address infant mortality and preterm birth by focusing on key risk factors associated with prematurity and other poor birth outcomes. These risk factors include perinatal depression, intimate partner violence (IPV) and tobacco use during pregnancy. Performance on these measures by sites implementing one of three FL MIECHV-funded evidence-based home visiting models (NFP, HFF or PAT) is tracked annually and reported to HRSA.

Local Healthy Start Coalitions will join with community partners during September to raise awareness and promote strategies for ensuring every baby gets the best possible start in life.

 

Legisbrief Focuses on Home Visiting

A new brief by the National Conference of State Legislatures (NCSL) provides an overview of state and federal efforts to support home visiting, noting the strategy “enjoys mostly bipartisan support… due, in part, to the evidence behind the programs and the return on investment.”

Home Visiting: Improving Children’s and Families’ Well-Being describes home visiting as “a voluntary, two-generation (e.g., whole family) model that addresses issues such as health, child development, parenting, education and family violence.”

The brief reports that states have taken a leadership role in supporting the implementation of home visiting. “States have historically led public investment in home visiting. States started funding home visiting in the 1980s and continue to pass legislation to expand programming and increase accountability.”

According to the report, about 40% of counties in the U.S. had an evidence-based home visiting program in 2016.

The National Home Visiting Resource Center has identified Florida implementation sites for the following evidence-based home visiting programs: Child First, Early Head Start, Family Check-Up, Healthy Families America, Home Instruction for Parents of Preschool Youngsters, Minding the Baby, Nurse-Family Partnership, and Parents as Teachers. Statewide, 102 local agencies operated at least one of these models, and provided more than 154,000 home visits to 15,000 families and young children in 2016. Healthy Families Florida is the only program available statewide. Home visiting programs are funded by federal, state and local sources, including FL MIECHV.

Triplets! Home Visiting Supports Breastfeeding Success

August is National Breastfeeding Month! Nearly 90% of families participating in FL MIECHV supported home visiting programs during pregnancy  in 2017 initiated breastfeeding and more than one-third continued for six months or more. Here’s a great success story on how home visiting encourages and supports breastfeeding families!

Amy and Daniel Vaknin and their 2-year-old daughter, Skylar welcomed triplets, Ava, Avi and Ari into their family on April 28, 2015. Amy was very intentional about making breastfeeding a priority.

The Vaknin family today (left to right) Mom Amy; triplets Avi, Ari & Ava; big sister Skylar, and Dad David.

While While still pregnant, Amy committed to breastfeeding her triplets as long as possible. They enrolled in the Alachua MIECHV program on July 16th, 2015. Parent Educator, Shannon Brandt was very impressed with how committed Amy was to breast feeding her sweet babies. 

“She was very organized with her feeding schedules and documented everything on a spread sheet.” “Her husband, friends and family were a wonderful support system for her.” Shannon supported Amy’s goal to breastfeed as long as possible, often completing home visits while mom was rotating the babies on her breasts or pumping.

Alachua PAT participant Amy Vaknin breastfeeding two of her three newborns in 2015.

“Many mothers struggle with the undertaking of breast-feeding a single child for 12 months, Amy succeeded at breastfeeding her triplets for 15 months!”   

Shannon continued working with the family for the next three years. She was instrumental in tracking their development through the Ages and Stages Questionnaire and linked the family to services through Early Steps when it was identified that additional interventions were needed. It was a bitter sweet moment when the family successfully graduated from the PAT program. Shannon was thrilled to be able to re-connect with them to document this story.

August is National Breastfeeding Month

August is National Breastfeeding Month! The U.S. Breastfeeding Committee (USBC) is coordinating a social media advocacy and outreach campaign to build support for the policy and practice changes needed to build a “landscape of breastfeeding support.”  The group has adopted a theme for each week: Policy Pulse (Week 1), Special Circumstances & Emergency Preparedness (Week 2), Call to Action (Week 3) and Black Breastfeeding Week (Week 4).

These activities build on the observation of World Breastfeeding Week (WBW), celebrated every year from August 1-7 to encourage breastfeeding and improve the health of babies around the world. It commemorates the Innocenti Declaration signed in August 1990 by government policymakers, WHO, UNICEF and other organizations to protect, promote and support breastfeeding. This year’s theme is Breastfeeding: Foundation of Life, highlighting breastfeeding as a universal strategy that levels the playing field, giving everyone a fair start in life.

Breastfeeding has been a performance measure for MIECHV since the inception of the initiative. Performance Measure 2 tracks the success of home visiting programs in supporting mothers—who enroll as participants during pregnancy—in breastfeeding their infants during the first six months following birth.

In 2017, nearly 90% of new mothers participating in FL MIECHV-supported home visiting programs initiated breastfeeding after delivery, and 34% continued for six months or more.

FL MIECHV supports professional development for home visitors to build their skills in supporting breastfeeding mothers. Resources for home visiting staff include a 20-hour Breastfeeding Counselor Course. In 2017 more than 100 home visitors, nurses and community partner staff completed the training. Continuing education is also available through recorded webinars on the MIECHV Learning Management System (LMS) portal.

The American Academy of Pediatrics (AAP)  recommends exclusive breastfeeding for the first six months of a baby’s life, followed by breastfeeding with the introduction of complementary foods until at least 12 months of age, and continuation of breastfeeding for as long as mutually desired by mother and baby.

According to AAP, this recommendation is supported by the health outcomes of exclusively breastfed compared to outcomes for infants and infants who never or only partially breastfed. Breastfeeding provides a protective effect against respiratory illnesses, ear infections, gastrointestinal diseases, and allergies including asthma, eczema and atopic dermatitis. The rate of sudden infant death syndrome (SIDS) is reduced by over a third in breastfed babies, and there is a 15 percent to 30 percent reduction in adolescent and adult obesity in breastfed vs. non-breastfed infants.

Breastfeeding also provides health benefits for mothers. Mothers who breastfeed are at reduced risk for breast and ovarian cancer, type 2 diabetes, retention of pregnancy weight, and possibly hip fractures and osteoporosis in the postmenopausal period.

CI&R Pilot Recognized As Promising Practice

Efforts by FL MIECHV to pilot Coordinated Intake & Referral (CI&R) using the state’s universal prenatal and infant screening process were recognized recently as a Promising Practice by the Association of Maternal and Child Health Programs (AMCHP).

The national organization, which represents state Title V programs, reviewed CI&R pilot activities and evaluation results, and approved the project for inclusion in its Innovation Station database for potential replication by other states.

The CI&R pilot was launched in 2015 as part of systems building activities included in a competitive grant awarded to FL MIECHV by HRSA. Eight Healthy Start Coalitions – serving ten counties – participated in the Action Learning Collaborative (ALC) and worked to develop effective local systems for identifying at-risk families and connecting them with programs that best met both their needs and preferences.

Coalitions included Bay, Franklin, Gulf (Bay County); Jefferson, Madison, Taylor; Northeast Florida (Duval County); North Central Florida (Alachua County); Flagler-Volusia; Orange (Orange, Osceola & Seminole); Hillsborough, and Manatee.

Participating coalitions formed multi-agency teams and participated in monthly calls, webinars, and in-person statewide learning collaborative sessions. The project also incorporated Continuous Quality Improvement (CQI) principles and processes, including Plan, Do, Study, Act (PDSA) cycles and using data to drive system improvement at the community-level.

Each team developed decision trees that focused on areas of identifying families who may qualify for services, improving coordinated systems for referrals, effective engagement and enrollment of families, and providing services that align with families’ needs and preferences. The decision trees laid the foundation for focused areas to improve upon and ensure a more effective CI&R process. Community teams met regularly to review CI&R test results and refine their approaches as needed. Information was shared with state stakeholders, including Title V and home visiting model developers.

To facilitate engagement and involvement of these stakeholders, Florida MIECHV partnered with CityMatCH to design and implement an Action Learning Collaborative (ALC) framework to this pilot group. Community teams assessed the landscape and needs of the community. Coalitions were provided with resources to support their work, including a planning period for partnership development and discussion of and consideration for how key CI&R components work in their community. The evaluation was conducted by the Chiles Center at the University of South Florida.

Based on pilot results, CI&R is being scaled and implemented statewide in FY 2018-19 through Healthy Start Coalitions as part of their contracts with the Florida Department of Health, the state Title V agency.

2018 Florida County Child Well-Being Index Ranks Counties on Key Indicators

Nearly one-third of counties served by FL MIECHV are in the lowest quartile of Florida counties ranked on key measures of child health and well-being in the 2018 Florida County Child Well-Being Index.

The report, released today by Florida Kids Count, examines progress between 2011 and 2016 by the state and counties on 16 indicators. The index includes profiles of each of Florida’s 67 counties, as well as a county-by-county ranking. The report demonstrates that while many indicators have improved statewide, there is significant variation among counties.

Based on the national Kids Count Databook, an annual ranking of states published by the Annie E. Casey Foundation, the report offers both good and bad news for Florida kids. For the state overall, there have been improvements in the Economic domain.  Still 1 in 5 of Florida’s children lives in poverty.   In Education, there were improvements in math proficiency and graduation rates, but work remains in getting children enrolled in quality early childhood educational programs and in reading and language arts proficiency.  Among the Health indicators, there is continued progress in getting children insured and reducing alcohol and substance use among teens, but there has been no progress in helping youngsters achieve healthy weights or in the percent of low birthweight babies.  In the Family and Community domain, the rates of verified abuse and neglect have fallen over the past five years, as have contacts with the Juvenile Justice system. However, there are more children living in single parent households, an indicator of economic stability, and more children living in areas of concentrated poverty.

New Report Updates National Home Visiting Picture, Need

The National Home Visiting Resource Center recently released a new Data Supplement to the 2017 Home Visiting Yearbook providing updated data on early childhood home visiting, a proven service delivery strategy that helps children and families thrive.

The Data Supplement builds on an inaugural Yearbook, released last summer, which painted a first-of-its-kind picture of home visiting using the best available data from 2015. The National Home Visiting Resource Center examined publicly available data and collected new data—this time from 2016—to present a more complete and up-to-date look at home visiting in action. The supplement’s robust data reflect advancements in data collection. For example, the supplement includes service information from 14 evidence-based home visiting models, up from 7 in the 2017 Home Visiting Yearbook.

Among the highlights:

  • More than 300,000 families received evidence-based home visiting services in 2016 over the course of more than 3.8 million home visits.
  • About 18 million pregnant women and families (including more than 23 million children) could benefit from home visiting but were not being reached in 2016.
  • Evidence-based home visiting was implemented in all 50 states, the District of Columbia, 5 territories, 24 tribal communities, and 47 percent of U.S. counties in 2016.
  • From 2010 to 2017, the federal Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) strengthened home visiting by supporting services, research, and local infrastructure. MIECHV expired in September 2017 but was reauthorized in February 2018 for 5 more years.
  • In 2016, MIECHV helped fund services for 83,841 families in states, territories, and tribal organizations—a portion of the total families served by home visiting that year.
  • States supported home visiting by combining funds from tobacco settlements and taxes, lotteries, and budget line items in 2016. With limited resources, states are continually working to expand the reach of home visiting to serve as many families as they can in ways that make sense at the local level.

Florida’s updated state profile reports more than 15,500 families – including 15,200 children – received more than 154,500 home visits in 2016 from more than 102 agencies. Models implemented in the state included Child First, Early Head Start, Family Check-Up, Healthy Families America, Home Instruction for Parents of Preschool Youngsters, Minding the Baby, Nurse-Family Partnership, and Parents as Teachers. The report notes more than 980,000 families in the state with children under age six could benefit from home visiting programs. Detailed information on families and services provided through FL MIECHV is available in the 2017 FL MIECHV Demographics and Utilization Report.