Project Grant H4953005

HEALTHY START INITIATIVE-ELIMINATING RACIAL/ETHNIC DISPARITIES - START CORPORATION PROPOSES TO BEGIN A HEALTHY START PROGRAM IN SOUTHERN LOUISIANA'S PUBLIC HEALTH REGION 3, WHICH INCLUDES 7 PARISHES DISPROPORTIONATELY AFFECTED BY MATERNAL AND INFANT MORTALITY COMPARED TO NATIONAL AVERAGES (ASSUMPTION, LAFOURCHE, ST. MARY, TERREBONNE, ST. JAMES, ST. JOHN, AND ST CHARLES PARISHES). THE GOAL OF THE PROJECT IS TO REDUCE INFANT AND MATERNAL MORTALITY THROUGH THE PROVISION OF DIRECT AND ENABLING SERVICES AND BY CONVENING A MULTISECTORAL CONSORTIA OF COMMUNITY MEMBERS DEDICATED TO REDUCING MATERNAL AND INFANT HEALTH DISPARITIES THAT AFFECT LOCAL RESIDENTS. THE TARGET POPULATION OF THE PROJECT WILL PRIMARILY BLACK BIRTH GIVERS, WHO EXPERIENCE MATERNAL AND INFANT MORTALITY AT RATES TWICE THE RATE OF WHITE BIRTH GIVERS IN THE SERVICE AREA. INTERVENTION STRATEGIES WILL INCLUDE CARE COORDINATION, MEDICAL AND NON-MEDICAL CASE MANAGEMENT, PROVISION OF PARENTING, NEWBORN CARE, AND BREASTFEEDING EDUCATION, GENERAL HEALTH EDUCATION AND LITERACY, AND THE PROVISION OF SUPPORTIVE SERVICES THAT ADDRESS SOCIAL DETERMINANTS OF HEALTH. START PROPOSES TO SERVE THE ENTIRETY OF EACH PARISH THROUGH ITS CENTRALLY LOCATED CLINIC IN HOUMA, LOUISIANA, AS WELL AS THROUGH MOBILE AND TELEHEALTH SERVICES. THE SERVICE AREA IS BOTH URBAN AND RURAL, WHICH PROVIDES START THE OPPORTUNITY TO SERVE HARD-TO REACH POPULATIONS THROUGH EXISTING CAPACITY SUCH AS ITS FLEET OF VANS THAT PROVIDE TRANSPORTATION. THIS PROJECT WILL BUILD UPON EXISTING CAPACITY OF ITS COMMUNITY HEALTH CENTER IN HOUMA, A CERTIFIED PATIENT-CENTERED MEDICAL HOME, TO CREATE A WOMEN'S HEALTH CLINIC THAT ATTENDS TO PRECONCEPTION, PRENATAL, POSTNATAL, AND PARENTING WOMEN USING A HOLISTIC, PERSON-CENTERED APPROACH. STRATEGIC HIRES WILL INCLUDE A WOMAN'S HEALTH ADVANCED PRACTICE PRACTITIONER TO PROVIDE CLINICALLY INDICATED PRENATAL CARE AND MONITOR CHRONIC CONDITIONS THAT CONTRIBUTE TO MATERNAL MORTALITY AND INFANT MORBIDITY/MORTALITY IN THE SERVICE AREA (PREGESTATIONAL DIABETES, UNCONTROLLED HYPERTENSION, CARDIOMYOPATHY) AS WELL AS LPNS AND A LCSW TO PROVIDE CARE COORDINATION WITHIN A CLINICAL SETTING. START WILL CONDUCT INTENSIVE OUTREACH AND RECRUIT PARTICIPANTS THROUGHOUT THE AREA TO INCREASE RATES OF EARLY ENTRY OF PRENATAL CARE. UPON INTAKE, ALL PARTICIPANTS WILL RECEIVE AN ASSESSMENT OF THEIR MENTAL AND PHYSICAL HEALTH AS WELL AS SOCIAL DETERMINANTS OF HEALTH AND SCREENING FOR DOMESTIC VIOLENCE USING VALIDATED ASSESSMENT TOOLS THAT ARE INTEGRATED INTO ITS EHR. ALSO INTEGRAL TO THE PROJECT DESIGN WILL BE THE HIRING OF FIVE FULL- TIME COMMUNITY-BASED DOULA SUPPORT SPECIALISTS, WHO WILL PROVIDE CULTURALLY AND LINGUISTICALLY RELEVANT EDUCATION AND SUPPORT TO MOTHERS AND THEIR FAMILIES AS WELL AS LINK THEM TO INDICATED SUPPORTIVE SERVICES AND LOCAL RESOURCES DURING HOME AND COMMUNITY-BASED VISITS. COMMUNITY-BASED DOULA SUPPORT SPECIALISTS WILL CONTINUE TO MEET WITH EACH FAMILY THROUGHOUT THE PRENATAL PERIOD AND AT LEAST 3 MONTHS POSTPARTUM TO ENSURE THAT MOTHERS AND BABIES CONTINUE TO THRIVE WELL BEYOND THE "FOURTH TRIMESTER," PROVIDING EDUCATION ON MATERNAL WARNING SIGNS AS WELL AS ASSESSING SLEEP ENVIRONMENT AND PROVIDING CONTINUED HEALTH EDUCATION AS INDICATED. EACH FAMILY MEMBER, INCLUDING THE BABY WHEN IT ARRIVES, WILL HAVE ACCESS TO START'S COMMUNITY HEALTH CENTER AS THEIR USUAL SOURCE OF MEDICAL CARE. THE INTENDED EFFECTS OF THESE INTERVENTION STRATEGIES-CARE COORDINATION, EDUCATION, AND INDIVIDUALIZED SUPPORTS - WILL HELP ADDRESS THE MAIN DRIVERS OF MORBIDITY AND MORTALITY IN THE AREA, WHICH MOST COMMONLY ARISE FROM CHRONIC HEALTH CONDITIONS THAT PERSIST DURING PREGNANCY. AS PART OF THIS INITIATIVE, START WILL ALSO CONVENE A CONSORTIA OF COMMUNITY MEMBERS, INCLUDING MEMBERS OF THE MEDICAL COMMUNITY, PUBLIC HEALTH AGENCIES, AND THOSE WITH LIVED EXPERIENCE, TO DETERMINE OTHER CAUSES OF MATERNAL AND INFANT MORTALITY/MORBIDITY IN THE SERVE AREA AND WORK COLLABORATIVELY TO DEVISE SYSTEMS-LEVEL SOLUTIONS THAT IMPROVE PERINATAL OUTCOMES.