Pregnancy_Peer_Support_Specifications_Sheet.final.pdf

Pregnancy Peer Support Services RFP-2023-0258 Specifications Sheet

Overview:

Maternal health and infant health are intricately tied together and critically important to families and communities. Despite advancements in health care, statistics at the national, state, and local level do not paint a positive picture for outcomes for birthing people and their babies, and there are widening disparities for communities of color. According to a recent report from the CDC, although it is estimated that 80% of pregnancy related deaths are preventable, the number of maternal deaths from 2018 to 2021 in the U.S. increased from 17.4 to 32.9 per 100,000 live births1. Even worse, the gap in disparities for communities of color has increased. The maternal mortality rate for Black women in 2018 was 37.3 per 100,000 live births, and this climbed to 69.9 deaths per 100,000 live births by 2021. This number is 2.6 times the rate of White women, who experienced a maternal mortality rate of 26.6 per 100,000 live births in 20212.

Infant mortality rates are also dismal and moving in the wrong direction. In 2019 the mortality rate for Black infants was 10.6 per 1,000 live births, compared to 4.5 for White infants. The top five leading causes of infant mortality in the U.S. in 2020 were due to: birth defects, preterm and low birth weight, sudden infant death syndrome, injuries, and maternal pregnancy complications3.

Nationally, the preterm birth rate has increased by 4%, inching up from 10.1% in 2020 to 10.5% in 2021. Disparities persist in this area too, with a preterm birth rate of 14.8% among Black women compared to 9.5% among White women in 20214.

The numbers at the state and local level are not any better. According to the March of Dimes, in 2021, 1 in 11 babies were born preterm and 1 in 14 babies were born low birthweight in California.

Specific to Sacramento County, 1 in 11 births was preterm, with the rate being highest for Black infants at 12.6%, compared to 7.9% for White infants5. 1 in 14 babies were born low birthweight in Sacramento County in 2021, with Black babies being two times as likely to be born low birthweight than White babies (12.2% vs. 5.4% respectively)6.

Although local efforts through partners in the Black Child Legacy Campaign (BCLC) have reduced African American child deaths by 30%, exceeding the goal of 10-20% by 2020, there is still much more work to be done. The top four causes for the disproportionate number of deaths due to:

perinatal conditions, infant safe sleep, child abuse and neglect, and third party homicide still exist.

The BCLC set a goal of a 23% reduction in perinatal condition deaths. When comparing the baseline of 2012-14 and the most recent data for 2018-20, there was a 4% reduction in perinatal condition deaths, and a 2% increase in the disparity gap7.

With all of this data in mind, and the impact of on-going disparities, this RFP is focused on reducing infant death due to perinatal conditions. Perinatal condition deaths occur when a child dies during pregnancy or within the four weeks after birth. These types of deaths can be attributed

1 Vital Signs: Maternity Care Experiences — United States, April 2023 | MMWR (cdc.gov) 2 Maternal Mortality Rates in the United States, 2021 (cdc.gov) 3 Infant Mortality | Maternal and Infant Health | Reproductive Health | CDC 4 Preterm Birth | Maternal and Infant Health | Reproductive Health | CDC 5 Distribution of gestational age categories: Sacramento county, 2021 | PeriStats | March of Dimes 6 Low birthweight: Sacramento county, 2011-2021 | PeriStats | March of Dimes 7 Reduction of African American Child Deaths - FY 2020-2021 Evaluation Report, with 3-Year Trends

(saccounty.gov) https://www.cdc.gov/mmwr/volumes/72/wr/mm7235e1.htm?s_cid=mm7235e1_w https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-mortality-rates-2021.htm https://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pretermbirth.htm https://www.marchofdimes.org/peristats/state-summaries/california?top=3&lev=1&stop=55&reg=99&sreg=06&creg=06067&obj=3&slev=6 https://www.marchofdimes.org/peristats/state-summaries/california?top=4&lev=1&stop=43&reg=99&sreg=06&creg=06067&obj=1&slev=6 https://first5sacramento.saccounty.gov/Results/Documents/RAACD_Report_2021-22.pdf https://first5sacramento.saccounty.gov/Results/Documents/RAACD_Report_2021-22.pdf to health issues such as prematurity, low birth weight, congenital defects, and chronic or infectious diseases in the mother.

The goal of this RFP is to fund community based activities to reduce risks for poor pregnancy and birth outcomes, including premature births, low birth weight births, and infant death.

Focus of Funding:

Proposers should review the Priority 2: Health & Well-Being Summary Sheet of the 2024 Implementation Plan. Specifically:

Strategy 2: Pregnancy Peer Support Regular and on-going education, support, accompaniment, and navigation services for pregnant African American people in Sacramento County provided by trained, community-based peer mentors. Assessments and screenings (including mental health) will be provided, as well as education and services relevant to a healthy pregnancy, birth, and infant. Services and supports will be provided up to 6 weeks postpartum.

Target Audience: Pregnant African American people in Sacramento County should be enrolled in the program as early as possible in their pregnancy, but no later than 30 weeks of pregnancy.

Include a focus on hard to reach pregnant people, those who are not seeking care, and those who are residing in the 7 hot spots for African American child deaths in Sacramento County:

Arden Arcade, Del Paso Heights/North Sacramento, Foothill Farms/North Highlands, Fruitridge and Stockton, Oak Park, Meadowview, Valley Hi.

Requirements:

Ensuring pregnant people have access to and regular use of quality, culturally responsive health care and related social services can be an important protective factor to their and their child’s overall health. Receiving regular social support, knowledge of healthy behaviors and risk factors, access to additional pregnancy supports, and help with advocacy and navigating critical services may also support a healthier pregnancy and positive birth outcomes.

The Commission is looking for programs that utilize best and promising practices, are located within the community, and work directly with the community to support pregnant African American people. Services at a minimum should address the following four categories and activities:

Support:

• Provide services in a one-on-one format that occur on a regular and consistent basis throughout the pregnancy and postpartum. In the proposal, please indicate the expected frequency of one-on-one meetings, dosage of time for each meeting, and what will generally occur in each meeting. Additional services in a group format may be considered, but should not replace the one-on-one work.

• Services should be easily accessible to pregnant people and can occur in their home or community location of their preference. Due to COVID-19 concerns, services may also occur virtually to maintain the health and safety of clients and staff. In the proposal please indicate your plan to build relationships with clients, bolster interactions, and support clients in the event of restrictions due to COVID-19.

• Utilize trained peers and community members to mentor and work with pregnant people.

Peer mentors should provide support, decrease stress, and help pregnant people feel that their needs and concerns during pregnancy and birth are being heard and considered.

These mentors should be individuals who understand the cultural values, beliefs, and practices of the community. The mentors may come from the community itself, and should be trusted conduits of information that act as an important bridge to the community and providers. These efforts will require meeting families where they are at and will include case management services; therefore, consider staffing levels and appropriate caseloads in your proposal.

• If they do not already have one, connect clients to a medical provider / OB/GYN and help establish a medical home for comprehensive prenatal and postpartum care. Encourage and support clients in attending all appointments and recommended activities (i.e. lab work, ultrasounds, vitamins, etc).

• Provide doula like services or connection to a doula or midwife for pregnant people requesting that support to prepare for and participate in the delivery of their baby.

• Enroll clients as early as possible in their pregnancy, but no later than 30 weeks of pregnancy. Support clients through at least 6 weeks postpartum, and up to the ‘fourth trimester’ (three months postpartum).

Education:

• Provide basic health education about pregnancy, healthy habits, risk factors to look for during the perinatal period, and childbirth.

• Provide additional education, where applicable and within the organization’s purview, on additional related topics or those that may be identified in client assessments.

Assessment:

• Individual assessments and on-going case management should occur throughout the pregnancy and in the postpartum period to assess and address physical health, mental health, and related social determinants of health.

• In the proposal, indicate how the information will be collected and used to develop a tailored plan for education and care to improve the well-being of the pregnant person/parent and their child.

• In the proposal, indicate how the program will either provide mental health assessments, or confirm provision of at least one prenatal and postpartum mental health assessment, the tool to be used, and how the results will be used.

Collaboration:

• It is assumed that the funded agency will not be able to provide all the services identified as needs through the assessments. The program should collaborate with other local organizations that can provide culturally responsive health and social services. The program will be expected to create partnerships, referral processes, and follow up to ensure client needs are met.

• A single agency may apply, or a consortium of agencies may apply, to ensure the variety of client needs are met.

Navigation and Advocacy:

• Provide the client with continued support and help with access to services including, but not limited to: maternal and infant health care, breastfeeding, safe sleep, and maternal mental health support.

• Help client reduce barriers to accessing care. This may include helping clients with setting up appointments, providing reminders of appointments, offering to attend appointments with the client, and more. If the client wishes, mentors may advocate for the client during appointments.

• Build relationships with health providers and clinics providing prenatal and postpartum care, as well as agencies providing other health and social services to pregnant/parenting people, to improve access to services and culturally responsive care. A CDC survey of experiences in maternity care indicated that 29% of respondents reported discrimination, with nearly 40% of Black, Hispanic, and multiracial respondents reporting discrimination8.

Peer mentors can help advocate for clients, while working with providers to increase awareness and build better connections with clients.

Parameters:

Amount of Funding Available: A maximum of $2,520,000 is available cumulatively over the three-year period. We strongly recommend that an equal budget amount is maintained across all three years as a means to plan for sustainability. However, we will allow reasonable increases in the budgets (not to exceed 2% per year) for years 2 and 3 if necessary and justified. Contractors are not allowed to front load costs in year 1 of the budget.

Note that consistent services should be provided throughout all three years.

Contract Term: 07/01/24 – 06/30/27

Eligibility to Apply:

Government entities, such as County, State, and Federal agencies are not eligible to apply for this funding. We are seeking community based organizations located in Sacramento County with experience working in the community on this issue and with relationships in the community. A single entity or consortium of entities in Sacramento County may apply.

Please note that while partnerships and subcontracts are allowed, organizations cannot apply for the funds and then re-grant the funds to other entities to provide the services.

8 Vital Signs: Maternity Care Experiences — United States, April 2023 | MMWR (cdc.gov) https://www.cdc.gov/mmwr/volumes/72/wr/mm7235e1.htm?s_cid=mm7235e1_w