Joint Committee on Children, Youth and Families

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The Childrens Cabinet The Governors 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), Governors 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
•  

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The Childrens Cabinet The Governors Office
for ChildrenPromoting the well-being of
Maryland's children

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

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What is our framework?

• Three-Year Childrens Plan
• Goal 1 Prevention
• Goal 2 Transition Age Youth/Ready by 21tm
• Goal 3 Build on Foundations
• State and Local Partnerships
• Results Accountability

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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)
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What Are We Trying to Achieve?
Marylands Results for Child Well-Being
Children Completing School
Babies Born Healthy
Children Safe in Their Families Communities
Healthy Children
Stable Economically Independent Families
Children Enter School Ready To Learn
Communities that Support Family Life
Children Successful In School
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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
  gramsabout 5.5 pounds) and
• Births to Adolescents (the rate of births to
  adolescents 15-19 years old)

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Babies Born Healthy Infant Mortality Rate How
is Maryland doing?
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Babies Born Healthy Low Birth Weight How is
Maryland doing?
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Story Behind the Data Curve Related Measures
Contributing to Babies Born Healthy

• Leading Causes of Infant Mortality, 2005
• Complications related to premature birth and low
  birth weight (n132, 24)
• Congenital abnormalities/Birth defects (n80,
  15)
• SIDS (n55, 10)
• Maternal complications of pregnancy (n46, 8)
• Respiratory distress of newborn (n24, 4)
• Bacterial sepsis of newborn (n19, 3.5)
• Newborn affected complications of placenta, cord,
  or membranes (n19, 3.5)
• Diseases of the circulatory system (n13, 2)
• Intrauterine hypoxia and birth asphyxia (n13,
  2)
• Necrotizing enterocolitis of newborn (n11, 2)

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Story Behind the Curve Related Measures
Contributing to Babies Born Healthy
Percentage of Unintended Pregnancy, Maryland
2001-2005
Data Source Maryland PRAMS, 2001-2005
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Story Behind the Curve Related Measures
Contributing to Babies Born Healthy

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Story Behind the Curve Related Measures
Contributing to Babies Born Healthy
Very Low Birth Weight (Less than 1,500 grams)
1994-1995
2004-2005
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Story Behind the Curve Related Measures
Contributing to Babies Born Healthy

• 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.

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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

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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
• RaceAfrican 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

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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

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Story Behind the Data Low Birth
WeightContributing 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

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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 childs 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

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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

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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

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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

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What works Improving Birth OutcomesPost-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

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What works Improving Birth OutcomesEarly
Successes

• Baltimore Citys 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

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

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Story Behind the DataBirths 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

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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).

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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

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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

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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

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Recommendations for the Future

• Enhance preconception health activities,
  especially teen pregnancy prevention
• Strengthen the access to and quality of
  reproductive health services
• Expand Baltimore Citys 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
  Childrens Plan to create an action agenda for
  Maryland

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The Childrens Cabinet The Governors Office
for ChildrenPromoting 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 410-333-5
248 (fax) www.goc.state.md.us