Partners:

• Wayne County Health and Human Services
• Wayne County Department of Public Health
• Detroit-Wayne County Community Mental Health Agency
• Detroit-Wayne County Health Authority
• Michigan Department of Community Health
• Oakland University School University
• Oakwood Health System

Statement of Problems: 

Michigan currently ranks among the worst five states with regard to racial and ethnic disparities in Infant Mortality Rates (IMR).  In Wayne County Infant Mortality is more than twice as prevalent in African-American population as compared to whites (16/1,000 of live births versus 5.3/1,000 live births respectively).  While this disparity is largely due to higher low birth weights in the African-Americans as compared to Caucasians (14.4% versus 6.6%of live births) other factors such as health behaviors, socio-economic factors, environmental conditions, access to health care, availability of services where most needed, and mental health issues contribute to the disparity.  


Targeted Actions:

A multi-pronged approach is being taken to address the issue of high rates of infant mortality that exist in Wayne County.  All Infant Mortality reductions efforts are consolidated under the umbrella of Wayne County Babies.

• Using the Healthy Families Model, the Place Matters Team will work with its partners to provide home visits to vulnerable families, specifically African Americans, Hispanics, and new immigrant women until the child’s first birthday.  In order to address the social conditions, that impact health outcomes, the program will focus on appropriate prenatal and maternal care, enhancing parenting skills, assessing the families social and medical needs, and linking families to services based on the assessments.
• In addition, the Wayne Babies program activities will be integrated with the existing funded county programs that address physical and mental health needs of families and children.   Emphasis will be placed on infant mental health, early on, school based pregnancy prevention program, and supportive services for mothers and their children up to age one.  
• Advocate to obtain approval from the State of Michigan’s Medicaid department and the State’s legislature for creating “presumptive eligibility” for pregnant women applying for Medicaid.  This presumptive eligibility status would be granted upon submission of the application to DHS and would provide pregnant women in the State with immediate health coverage and access to prenatal care services within their first trimester.
• In order to promote pre-conception and inter-conception health, the team will engage and follow-up with African American women who have experienced fetal death, infant death, premature birth, or low birth rate of a period of two years.  This will reduce reproductive risks and improve pregnancy outcomes by incorporating elements of pre-conception and inter-conception care.  The program will raise awareness and offer support for women to have appropriate spacing between a fetal or infant loss and the next attempted conception.

Anticipated Results and Outcomes:

• Decrease infant mortality from 11/1,000 live births to 6/1,000 live births by the year 2012.
• 80% of women enrolled in Wayne County Babies program will be linked to a medical provider for family planning and well woman care.
• 95% of infants enrolled in the Wayne County Babies program will be linked to a medical provider after birth.
• 90% of infants enrolled in the Wayne County Babies program will be in full compliance with Well Baby Checks per EPSDT standards or equivalent.
• 90% of parents will be given ongoing information on child growth and development.
• Obtain presumptive eligibility from the State’s Medical Services Administration for “Presumptive Eligibility” status for pregnant women upon completion of application similar to what currently exists with the MICHILD Health Insurance Program by December 2008.
• The Team has contracted with the Detroit Wayne County Health Authority (DWCHA) to provide advocacy work around the issue of Medicaid approvals for pregnant women.  
• DWCHA is expected to:
• Help educate Medicaid Executives, State Legislators, and other key stakeholders on the importance of early prenatal care in preventing low birth weight deliveries that have the most impact survival in the first year of life.
• The team will work to increase enrollment at the State’s Plan First! Program through Medicaid and Medicare Services to provide family planning services (through submission of a waiver) to women who would not have medical coverage for these services.  Women 19-44 years of age with a family income of at or below 185% federal poverty level who meet Medicaid citizenship requirements will be eligible for services.  It is expected that enrollment in Plan First! is likely to impact the infant death disparity that exists by narrowing the gap in Infant Mortality Rates between Caucasians and African Americans.