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					            The Children’s Cabinet &
        The Governor’s Office for Children
                   “Promoting the well-being of Maryland's children”

           Joint Committee on Children, Youth and Families
            Babies Born Healthy Hearing: September 4, 2007


Catherine J. Motz, Interim Executive Director (Chair), Governor’s Office for Children

          T. Eloise Foster, Secretary, Department of Budget & Management

             Catherine A. Raggio, Secretary, Department of Disabilities

       John M. Colmers, Secretary, Department of Health and Mental Hygiene

            Brenda Donald, Secretary, Department of Human Resources

           Donald W. DeVore, Secretary, Department of Juvenile Services

                Nancy S. Grasmick, State Superintendent of Schools,
                    Maryland State Department of Education
                                                                                  1
                   The Children’s Cabinet &
               The Governor’s Office for Children
                    “Promoting the well-being of Maryland's children”



                                      VISION
 Children’s Cabinet: All Maryland’s children are successful in life.
 Governor’s Office for Children: Maryland will achieve child well-being
  through interagency collaboration and state/local partnerships.
                                    MISSION
   The Children’s Cabinet, led by the Executive Director of the Governor’s
   Office for Children (GOC), will develop and implement coordinated State
   policies to improve the health and welfare of children and families. The
   Children’s Cabinet will work collaboratively to create an integrated,
   community-based service delivery system for Maryland’s children, youth and
   families. Our mission is to promote the well being of Maryland’s children.


                                                                           2
       What is our framework?

 Three-Year Children’s Plan
   Goal 1: Prevention
   Goal 2: Transition Age Youth/Ready by 21tm
   Goal 3: Build on Foundations


 State and Local Partnerships

 Results Accountability
                                                 3
             Focusing on Results
       Results-based Accountability Decision-making:
 What are we trying to achieve?
 What does the data tell us?
 What is the story behind the data?
 What partners do we need?
 What strategies work?
 What is our action plan?



            Source: Mark Friedman, Trying Hard is Not Good Enough, Canada: Trafford (2005)   4
What Are We Trying to Achieve?

Maryland’s Results for Child Well-Being
                               Children
           Babies Born        Completing
             Healthy            School
                             Children Safe in
            Healthy          Their Families &
            Children          Communities
                                  Stable &
          Children Enter       Economically
          School Ready          Independent
                                  Families
            To Learn
            Children          Communities
           Successful         that Support
           In School          Family Life




                                                5
         Babies Born Healthy
The Result Area ―Babies Born Healthy‖ contains the
 following indicators:
 Infant Mortality (the rate of deaths, per 1,000 live births,
  occurring to infants under one year of age);
 Low Birth Weight (percentage of babies born at low birth
  weight, weighing less than 2,500 grams—about 5.5 pounds);
  and
 Births to Adolescents (the rate of births to adolescents 15-19
  years old)




                                                                   6
                               Babies Born Healthy:
                   Infant Mortality Rate: How is Maryland doing?

                                                    Infant Mortality Rate by Race, Maryland, 1997-2006
   Infant Mortality Rate per 1,000 live




                                              20.0

                                              15.0
                  births




                                              10.0


                                                  5.0

                                                  0.0
                                                        1997   1998   1999   2000   2001     2002   2003   2004   2005   2006
                                          All Races     8.6    8.6    8.3    7.4     8.0     7.6    8.1    8.5    7.3    7.9
                                          White         5.3    5.5    5.1    4.7     5.5     5.4    5.4    5.6    4.7    5.7
                                          Black         16.1   15.4   14.7   13.0   13.6     12.7   14.7   14.9   12.7   12.7
                                          Hispanic                           5.1     6.2     5.3    6.0    5.3    4.6    3.0
Data Sources: MD DHMH, Vital Statistics Administration                              Calendar Year
* 2006 data is preliminary




                                                                                                                                7
           Babies Born Healthy:
 Low Birth Weight: How is Maryland doing?

                            Percentage of Low Birth Weight (<2500g) Infants, Maryland, 1997-2006

                                            16.0
                                            14.0
    % Low Birth Weight




                                            12.0
                                            10.0
                                             8.0
                                             6.0
                                             4.0
                                             2.0
                                             0.0
                                                     1997   1998   1999   2000    2001   2002    2003   2004   2005   2006
                         All Races                   8.8    8.7    9.1    8.7      9.0   9.0     9.1    9.4    9.2    9.4
                         White                       6.3    6.4    6.7    6.4      7.0   7.0     7.1    7.4    7.1    7.4
                         Black                       13.7   13.1   13.7   12.9    13.0   13.3    13.1   13.2   13.2   13.4
                         Hispanic                                         6.5      6.9   6.9     7.0    7.3    7.2    6.8
                         United States (All Races)   7.5    7.6    7.6    7.6      7.7   7.8     7.9    8.1
Data Sources: MD DHMH, Vital Statistics Administration,
                                                                                 Calendar Year
NCHS, National Vital Statistics System
* 2006 data is preliminary




                                                                                                                             8
                  Story Behind the Data Curve:
       Related Measures Contributing to Babies Born Healthy

Leading Causes of Infant Mortality, 2005
1.   Complications related to premature birth and low birth weight (n=132,
     24%)
2.   Congenital abnormalities/Birth defects (n=80, 15%)
3.   SIDS (n=55, 10%)
4.   Maternal complications of pregnancy (n=46, 8%)
5.   Respiratory distress of newborn (n=24, 4%)
6.   Bacterial sepsis of newborn (n=19, 3.5%)
7.   Newborn affected complications of placenta, cord, or membranes
        (n=19, 3.5%)
8.   Diseases of the circulatory system (n=13, 2%)
9.   Intrauterine hypoxia and birth asphyxia (n=13, 2%)
10. Necrotizing enterocolitis of newborn (n=11, 2%)


                                                                             9
               Story Behind the Curve:
 Related Measures Contributing to Babies Born Healthy



Percentage of Unintended Pregnancy, Maryland 2001-2005




                  Data Source: Maryland PRAMS, 2001-2005




                                                           10
                        Story Behind the Curve:
          Related Measures Contributing to Babies Born Healthy

                              Percentage of Women with Late or No Prenatal Care,
                                         Maryland and US, 1997-2006

                 4.5


                 4.0


                 3.5
Percent




                                                                                             Maryland
                                                                                             US
                 3.0


                 2.5


                 2.0
                       1997   1998   1999   2000   2001   2002   2003   2004   2005   2006
            Maryland   2.6     2.9   3.1    3.1    3.7    3.6    3.8    3.9    4.3    4.3
            US         3.9     3.9   3.8    3.9    3.8    3.6    3.5    3.6
                                                     Years




                                                                                                        11
                                            Story Behind the Curve:
                              Related Measures Contributing to Babies Born Healthy


                                   Very Low Birth Weight (Less than 1,500 grams)
                                   1994-1995                                                                                                   2004-2005
                       Birthweight-adjusted neonatal mortality rates by hospital                                            Birthweight-adjusted neonatal mortality rates by hospital of
                      of birth for Maryland resident infants with birth weights of                                          birth for Maryland resident infants with birth weights of 500-
                      500-1499 grams born in Maryland III/IV hospitals, 1994-1995                                              1499 grams born in Maryland III/IV hospitals, 2004-2005
                                                                                                                      ALL                       112.5
                    ALL                               142.2
                                                                                                                       Y                                          176.5
                      Z                                                          257.5
                                                                                                                       C1                                    156.4
                                                                                                                       G1                                  148.8
                     K1                                                        249.8
                                                                                                                       K1                                140.1
                                                                              241.1




                                                                                                  Hospital of birth
                      T
Hospital of birth




                                                                                                                       F1                        115.7
                     X                                                209.3                                            J1                        114.8
                     F1                                       178.6                                                    Z                         114.7
                     D1                                 147                                                            E1                         112
                     G1                          134.3                                                                 H1                     104.4
                     H1                         130.2                                                                  B1                     103.1
                     C1                       121.3                                                                    A1                    102.9
                     A1                       117.7                                                                    W                        99
                     B1                89.6                                                                            V                   87.8
                     E1         63.5                                                                                   D1              73.4
                                                                                                                       X               70.6
                          0     50            100         150          200            250   300
                                                                                                                            0        50         100            150        200      250       300
                                 Neonatal mortality rate per 1000 live births
                                                                                                                                     Neonatal mortality rate per 1000 live births

                                                                                                                                                                                                   12
              Story Behind the Curve:
Related Measures Contributing to Babies Born Healthy


                                            Infant Death Rate by Race and Maternal Education,
                                                           Maryland 2002-2004

                                      16
 Death Rate per 1,000 Live Births




                                      14
                                      12
                                      10
                                       8
                                       6
                                       4
                                       2
                                       0
                                            <12 yrs            12 yr           13-15 yrs        16+yrs
                                    Black     15.2             14.4              12.1            9.9
                                    White     6.4               5.3               4.5            3.8
                                                            Years of Education Completed


• Because of the large disparity in the infant death rate between Black and White infants,
it is imperative that this association be assessed.
•There is no disparity between the numbers of the Hispanic, Asians, and Whites infant
deaths.


                                                                                                         13
     Story Behind the Data: Low Birth Weight
     Why is birth weight important?


 High neonatal mortality and morbidity among newborns

 Lifelong family and social ―costs‖

 Lessened educational success




                                                         14
Story Behind the Data: Low Birth Weight
 Root causes, correlates, and risk factors
   Poor prenatal nutrition and healthcare
   Cigarette smoking
   Heredity
   Low maternal pre-pregnancy weight and/or weight gain
   Multiple births (i.e. twins, triplets)
   Higher maternal age
   Fetal Alcohol Syndrome
   Race—African American infants are more likely to be born of
    low birth weight than white infants
   Socioeconomic background and access to medical and
    emotional support for a healthy pregnancy


                                                                  15
  Story Behind the Data: Low Birth Weight
Causes and forces helping to improve low birth
             weight percentages:


 Women, Infants and Children (WIC) Program

 Maryland Pregnant Women and Infants Program

 Maryland Family Planning Program




                                                 16
  Story Behind the Data: Low Birth Weight
            Contributing Factors
 Causes and forces restraining improvement in the percentage of
  low birth weight babies:
   Heredity--If the mother was a low birth weight infant, child
     is 4 times more likely to be LBW. If father was, child is 6
     times more likely
   Largest increase in number of low birth weight babies has
     been to mothers carrying one child and maternal age 24 – 34.
   Declines in the number of mothers receiving prenatal care in
     the first trimester
   Increases in the number of mothers receiving no or late
     prenatal care
   Increasing numbers of preterm deliveries


                                                                    17
  What works: Babies Born Healthy Program
                Focus Areas
The Babies Born Healthy Program works to strengthen the public
 health infrastructure through providing services that improve birth
 outcomes. The statewide approach enables access to quality services
 during four phases of a woman or child’s life:

    Preconception/Interconception Health
      Before/between births
    Prenatal Care
      During the pregnancy
    Neonatal Safety
      Immediately around the time of birth
    Post-Neonatal Support
      After birth/Infancy



                                                                       18
              What works:
  Preconception/Interconception Health

 Reducing unintended pregnancy through creating
  new service entry points and strengthening the family
  planning infrastructure

 Reducing the teen birth rate through enhanced
  clinical services and education

 Reducing subsequent losses by supporting women
  with a previous loss through Heal Everyone After a
  Loss (HEAL) Program


                                                          19
                  What works:
                  Prenatal Care

 Increasing access to high-risk prenatal care services
  through a telemedicine program with the University
  of Maryland, Department of OB/GYN

 Enhancing community support and education, as well
  as facilitating access to prenatal care through
  collaboration with the Baltimore City Healthy Start
  program


                                                          20
                   What works:
                  Neonatal Safety

 Initiating a Perinatal Collaborative to improve the
  safety and quality of obstetric and neonatal care
  provided in hospitals

 Supporting the adoption and adherence to the Perinatal
  Standards




                                                           21
   What works: Improving Birth Outcomes
          Post-neonatal Support

 Encouraging Safe Sleep practices through parent and
  health care provider education

 Promoting Breastfeeding-Friendly Workplaces to
  enhance working mothers’ ability to continue
  breastfeeding when returning to employment

 Supporting the Early Hearing Detecting and
  Intervention Program



                                                        22
  What works: Improving Birth Outcomes
            Early Successes


Baltimore City’s Baby Leadership in Action
(LAP) is an opportunity for a diverse group of
leaders to lead from the middle in implementing
strategies that will turn the curve for birth
outcomes




                                                  23
                                          Births to Adolescents (Teen Pregnancy)
                                                   Babies Born Healthy:
                                                  How is Maryland doing?


                                                                     Birth Rate Among Adolescents (15-19 years),
                                                                                 Maryland, 1997-2006
              Rate per 1,000 population




                                              100

                                                  80

                                                  60

                                                  40

                                                  20

                                                  0
                                                       1997   1998    1999   2000   2001     2002   2003   2004   2005   2006
                                          All Races    43.9    43     42.5   41.2   37.8     35.4   33.3   32.3   31.8   33.6
                                          White        28.1   27.8    28.4   29.2   26.4     24.5   22.7   23.7   24.2   26.4
                                          Black        74.1   72.6    71.9   67.5    61      57.6    53    49.9    48    50.7
                                          Hispanic                           63.9   72.6     74.1    81    77.5   87.2   91.6

Data Source: MD DHMH, Vital Statistics Administration                               Calendar Year
* Note - 2006 Data is Preliminary




                                                                                                                                24
Story Behind the Data: Births to Adolescents
Root causes, correlates, and risk factors
 Root Causes, Correlates, & Risk
  Factors:
   Economic and Social Deprivation
   Lack of Academic Opportunity
   Peer Influence and Social Norms
    Favoring Early Sexual Involvement
   Delinquent Behavior and Early Child
    Bearing


                                               25
            Story Behind the Data:
  Births to Adolescents: Causes and Forces

 Contributing to Improved (declining) Rates of Births to Adolescents:
       86% of reduction due to increased access to Reproductive Health Services
       Comprehensive health education
       More use of contraceptives

 Restraining Improvement in Decreasing the Rate of Births to
  Adolescents:
       Mixed messages to adolescents regarding sexual behavior
       Inconsistent access to family planning services
       Lack of focus on positive youth development




                                                                                   26
          What Works & What is Maryland Doing?
              Reducing Births to Adolescents

   What will it take to improve the current situation on births to adolescents?

       Make effective contraceptives widely available.
       Include additional data gathering tools
       Increase the use of evidence-based teen pregnancy prevention curricula in
        community and school-based settings.
       Increase youth development opportunities (especially for high risk youth),
        which includes safe and stable places, basic care and services (including health
        care and transportation) and high quality instruction and training.
       Family Support Centers and their strategies for working with at-risk youth.
       Support funding for after school and other community based programs that
        prevent teen pregnancy.
       Support increasing youth development opportunities in community-based
        settings (in particular for youth in more challenged communities).



                                                                                           27
    What Works & What is Maryland Doing?
        Reducing Births to Adolescents
    Support and Refine Existing Initiatives such as:
      Healthy Teens Young Adults Program
      Baltimore City Public Schools After School Program
      Washington County Family Center- Alternative High School
      Provide support for school-based programs
      Support the implementation of the Ready by 21 Action Agenda
      Continue to enhance and expand comprehensive adolescent
       reproductive health education and prevention services through the
       efforts of the interagency School-Based Health Policy Advisory
       Council
      Continue to provide gender responsive programming through the
       Department of Juvenile Services
      Continue to provide parent education, particularly to parents
       identified to be at-risk through their involvement with one of the
       Children's Cabinet Agencies

                                                                            28
 What Works & What is Maryland Doing?
     Reducing Births to Adolescents
 Help reduce incidence of subsequent births to
  adolescents & support healthy families:
   The Task Force to Study Incentives for Teen
     Parents (forthcoming recommendation)
   The Young Fathers-Responsible Fathers Program
   The Partners for Fragile Families Program
   Family Preservation Programs, including Family
     Support Centers



                                                     29
Continue existing initiatives & partnerships to
       help Maryland move forward:

   Maryland Health Improvement Plan/Healthy Maryland 2010
   Baltimore City Baby LAP (Leadership in Action) Program
   Maternal and Child Health-Women, Infants and Children (WIC)
    Collaborative
   Healthy Start
   Youth Ready by 21: A 5-Year Action Agenda for Maryland
   Perinatal Health Collaborative
   Task Force to Study Incentives for Teen Parents
   School-Based Healthy Policy Advisory Council
   Healthy Teens Young Adults Program
   Gender Responsive Programming
   Parenting Education
   DJS participation in Child Fatality Review Committee & Fetal Alcohol
    Spectrum Disorder
   Maryland Infants and Toddlers Program



                                                                           30
         Recommendations for the Future
 Enhance preconception health activities, especially teen pregnancy
  prevention

 Strengthen the access to and quality of reproductive health services

 Expand Baltimore City’s Baby Leadership in Action (LAP) to the rest
  of the state

 Enhance availability of services through Infants and Toddlers programs

 Modifications and updates to the Three-Year Children’s Plan to create
  an action agenda for Maryland



                                                                           31
                        The Children’s Cabinet &
                    The Governor’s Office for Children
“Promoting the well-being of Maryland's children” * Local Management Boards ~ SCYFIS ~ Systems of Care




                                  Governor's Office for Children
                                      301 W. Preston Street
                                     Baltimore, Md. 21201
                                          410-767-4160
                                       410-333-5248 (fax)
                                      www.goc.state.md.us

                                                                                                         32

				
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