Milwaukee Community Strategic Partnership Meeting
Tactics, Strategies & Critical Elements to Build a Mass Movement to Reduce Infant Mortality in the City
of Milwaukee
October 20th 2006
Mario Drummonds, MS, LCSW, MBA Principal Investigator, Central Harlem Healthy
Start CEO, Northern Manhattan Perinatal Partnership,
Inc.
WORKING DEFINITION OF PUBLIC HEALTH SOCIAL MOVEMENT/COMMUNITY MOBILIZATION:
PUBLIC HEALTH MASS MOVEMENTS ARE DEFINED AS A CAPACITY-BUILDING PROCESS THROUGH WHICH COMMUNITY INDIVIDUALS, GROUPS, OR ORGANIZATIONS PLAN, CARRY OUT, AND EVALUATE ACTIVITIES ON A PARTICIPATORY AND SUSTAINED BASIS TO IMPROVE THEIR HEALTH, TRANSFORM THE HEALTH DELIVERY SYSTEM AND ADDRESS OTHER NEEDS, EITHER ON THEIR OWN INITIATIVE OR STIMULATED BY OTHERS. AT THE END OF THE PROCESS, MOVEMENT PARTICIPANTS POSSESS MORE SKILLS AND SOCIETAL AND PUBLIC HEALTH CHANGES CAN BE MEASURED.
Critical Element # 1: Build the Infrastructure for Strategic Action!
Action Item 1: *Review Rationale for Building a Citywide Movement & Structure *Quickly Review & Discuss Problem Analysis*Review Current Political Climate and the Political Will to Build a Mass Movement in Milwaukee!
Action Item 2: Naming the Structure: Suggestions Milwaukee Strategic Action Movement to End Infant Mortality Milwaukee Mothers & Babies Movement for Change * ? * ? * ?
Action Item 3: Deciding on Leadership Structure:
Leadership Council: Representation from Community-Based MCH Entities/
Milwaukee City Government/Health Commissioner/Consumer & Faith-based Leaders/Private Sector Leaders
Committee Structure-Suggestions/ Co-Chairs- Discussion:Policy & Legislative ActionProgram Review, Planning & Deployment Evaluation & Data Male Involvement Social Marketing Social Networking/Community MobilizationSystems Integration Sustainability • Action Item 4: Deciding on Movement Mission & Smart
Goals • Possible Mission: Reduce the infant mortality rate in the city
of Milwaukee by ___by December 31, ___
• DECLARE AND ESTABLISH A STATE OF EMERGENCY IN MILWAUKEE CONCERNING THE HISTORICALLY HIGH INFANT MORTALITY RATES OVER THE PAST FIVE YEARS BY APRIL 31, 2007.
• SECURE TWO MILLION DOLLARS TO STRENGTHEN & EXPAND THE MCH SYSTEM OF CARE TO REDUCE INFANT MORTALITY IN THE CITY OF MILWAUKEE BY JANUARY 1, 2008.
• BUILD A MASS MOVEMENT OF THE POOR AND WORKING CLASS SEGMENTS OF MILWAUKEE WHO WILL WORK TO TRANSFORM THEIR OWN REPRODUCTIVE BEHAVIORS AS WELL AS ATTEMPT TO TRANSFORM THE POLITICAL CLIMATE AND HOLD ACCOUNTABLE THE GOVERNMENT, PRIVATE AND PUBLIC SECTORS TO ASSIST IN REDUCING RACIAL DISPARITIES IN BIRTH OUTCOMES IN THE CITY OF MILWAUKEE.
• DEMYSTIFY THE CONCEPT OF INFANT MORTALITY TO CONSUMERS, ELECTED OFFICIALS AND THE MEDIA SO ALL STAKEHOLDERS WILL KNOW THEIR SPECIFIC ROLE TO COMBAT THIS PROBLEM BY JUNE 30, 2007.
• MAGNIFY THE HIGH IMR IN MILWAUKEE TO LEVERAGE AN EXTRA 10 MILLION DOLLARS FROM THE PRIVATE SECTOR, STATE AND THE FEDERAL GOVERNMENT BY JANUARY 1, 2009.
Action Item 5: Discuss the Feasibility of Hiring a Full-time Organizer/Field General/Administrator for the movement and a consulting public relations
expert.
Critical Element 2: Declare and Establish a State of Emergency in the City of Milwaukee Regarding Infant Deaths
Declaring a State of Emergency Begins to Transform the Political Climate of Hopelessness, Lack of Political Will & Highlights the Racial Disparities in Birth Outcomes in the City of Milwaukee!
Establishing a State of Emergency Also Asks the Community, City Government, Private & Public Sector-What is Your Role in Resolving This Crisis?
Objective: Make the Infant Mortality Crisis and the Tasks Ahead to Resolve the Crisis the Number One Political & Public Health Issue in the City of Milwaukee!
Work Plan:
1. Develop the Message-Define Message Elements 2. Transform Message into various forms: Fact Sheet,
PSA, Manifesto, Press Release, Position Papers, Talking Points
3. Compile Media Database. 4. Organize Press Conference on Steps of City Hall. 5. Make sure key stakeholders are on the program
stage. 6. Send PSA to print & electronic media. 7. Plan for post-publicity articles in local newspaper,
radio, television and Internet news shows. 8. Stay on message!9. Ask the media to contact key elected officials,
private sector types and community & church leaders to find out what should be done to address the problem.
10. Distribute 100,000 fact sheets throughout the city.
11.Continue to organize & educate more press contacts. 12 Develop public interest stories highlighting individual family situations combating infant mortality. 13 Organize infant death town meetings in different sections of the city focusing on broadcasting the message! 14 Hit the talk radio circuit communicating message. 15 Develop and send a letter to every women of childbearing age in the city about what they can do prevent infant deaths. Could be distributed through utility bills!16 Secure editorial space in main city newspapers highlighting the message. 17 Set up informational meetings with block association leadership, churches, business associations, beauty shop owners, to pitch the message and recruit more ground troops for the movement. 18 Hold the Mayor of your town accountable by asking the press to interview this official and get his/her response to the issue. 19 Don’t stop until the problem of infant mortality becomes the number one political issue in Milwaukee! 19 Utilize the Internet, email and blogs to create an on-line community interested in learning more about and combating infant mortality.
• Critical Element 3: Securing Strategic Champions for the Movement:
• Objective: Secure two to three champions in the legislative, celebrity, faith-based, or private sector that can amplify the movement’s message to all sectors of civil society. The champion can speed up the movement achieving its political climate change, financial, legislative, mobilization and clinical objectives.
Action Items:
1. Get planning committee members to recommend various movement champions.
2. Position this work within one of the above committee structures.
3. Prioritize the targets and assign planning committee members to work the list, contacting each target.
4. Ascertain if a planning committee member knows the champion and could make a personal pitch to join the movement.
5. Develop a mock direct mail letter signed by one of the members within the Leadership Council and set date when mailing will take place. Complete focused phone follow-up work!
6. When meeting is set up with target, make sure a tight agenda is agreed to and movement forces agree on the specific role and task the potential champion will play in pushing forward the movement’s agenda and message.
7. Activate the champion and coordinate champion activities with other tactics in the campaign to build a mass movement to end infant mortality in the City of Milwaukee.
8. Redeploy, monitor and evaluate the champion as needed to highlight different aspects of the campaign as the movement gets closer to victory.
Critical Element 4: Program Review/Program Planning/Program Re-deployment
The movement to end infant mortality in Milwaukee will not be taken seriously unless the major MCH and healthcare operators seriously examine how MCH services have been delivered to the target population. This critical element calls for the MCH industry to complete a self-assessment of how outreach, case management, perinatal depression, preconceptional care, outreach, home visiting, teen pregnancy, male involvement, child welfare, community health center services and early childhood services have been delivered. The strengths and weaknesses related to service delivery must be documented and the sector’s weaknesses must be transformed into strengths.
Action Items: Program Review
Utilize recent HRSA OPR individual grantee reviews to assess the effectiveness of MCH assets on the ground in Milwaukee.
Request and secure individual self-assessments of the Healthy Start program, community health centers, home visiting programs, children’s hospital, medical college, primary care grantees, healthcare for the homeless program, AIDS Resource Center, Ryan White CARE Early Intervention Services, etc.
Evaluation & Data Committee members along with HRSA OPR staff will review the above data and monitor corrective action plans quarterly to see if practice has improved.
Committee members will make site visits to speak with staff and administrators and review documentation. Team will develop and administer a short client satisfaction survey. A random sample of the above grantee’s clients will be surveyed to secure data on culturally competent care, wait time ratios, the quality of clinical services delivered and how the customer was treated at different stages of the treatment process.
Data from the above program review processes will be used to drive the program planning phase of the work.
Action Items: Program Planning
1. Team will secure a large physical map of Milwaukee and begin to plot the geographical service areas where key strategic assets are deployed. Zip codes and specific communities where needs assessment data is available will be targeted first. The task will be finalized by utilizing mapping software. Information will be collected on the number of health centers, individual clinicians practicing, hospital in-patient/outpatient capacity, teen pregnancy prevention slot capacity and perinatal case management/ home visiting program slot capacity and availability. This data on asset capacity will then be matched up to needs of the MCH population in the staging area. Data on the number and type of women of childbearing age will be matched against the MCH assets on the ground.
2. Team members will identify gaps in the mix between assets and need. For example one of the high-need zip codes areas might have more than 7,000 teenage girls living in the area. Team will catalogue closures of clinical levels of care in high needs areas of Milwaukee.
3. Data collected during the program review stage will be overlaid onto the asset map to determine the quality and strength of the forces deployed throughout the central city.
4. Once the mapping exercise is completed, data will be collected on service gaps and which program service assets need to be strengthened or which services should be redeployed.
5. The committee should make critical decisions about
concentration of the right mix of MCH assets in an area to bring about the best birth outcomes.
6. Gap-budget needs will be developed that will be sent over to the sustainability and legislative action committee that should help develop the case for budget needs of the movement. Once resources are secured, the program planning entity will make resource allocation decisions based on the analysis developed above.
Action Item: Program Re-Deployment & Program Action The movement, after a period of retooling must now return to the field and test our theories about reducing racial disparities in birth outcomes through the crucible of practice! Assets identified at an earlier stage of this process will be charged with new responsibilities and deliverables. One provider should be assigned to be lead provider for the sector and coordinate the revised approach to practice in an assigned service area.
I argue that the City of Milwaukee be divided into three to six critical staging areas based on birth outcome needs data and assets on the ground. One provider should serve as the lead entity responsible for infant mortality decline in the staging area. Providers should coordinate strategies for outreach, case management, interconceptional care, health education, perinatal depression screening and treatment, pregnancy testing/prenatal care delivery, teen pregnancy prevention work, etc., in each staging area. The lead agency in each staging area should attempt to take advantage of economies of scale and resource sharing between providers to achieve the best results.
The Milwaukee Strategic Action Movement to End Infant Mortality should work with the providers in each staging area to set clear, measurable and realistic outcomes for infant mortality decline and process indicators. Each staging area group of providers will need to be held accountable for results on a year-to-year basis! The program committee should determine the need to deploy the following programs and resources to help the MCH assets in each staging area achieve their yearly birth outcome goals. The following capacity building assets could be deployed in the future when resources are secured by other sectors of the movement:
Male Involvement Initiative Breastfeeding Initiative Social Marketing Initiative Infant Mortality/Maternal Mortality Case Review Committees Nurse Family PartnershipPerinatal Periods of Risk Centering Pregnancy Intervention Community Action for Prenatal Care Coalition/CDC Health Fair Organizing Title V Collaboration Local Health Systems Action Planning Baby Mama’s Group Intervention Build New Clinic Capacity Job Training/Welfare to Work Services Early Childhood Services-Head Start/UPK/Daycare Birthing Center Construction? Women’s Health Programming Health Insurance Access Assets & Wealth Building Initiative Birthing Project/Doula Program
Besides the direct practice work delivered by providers in the field, program action can also take place within committee structures. Here are a few examples of how committees can structure their program action and deliverables:
Policy & Legislative Action Committee: Co-Chair Selection Process
Agreeing to a Policy & Legislative Agenda
Develop a Committee Operating Budget
Develop a Committee Deliverable-based Work Plan
During the first couple of years of operations, this committee will attempt to create political space on the local, statewide and national levels that could free up new financial and human resources to be allocated to the City of Milwaukee to combat the infant mortality crisis.
Possible City Legislative Agenda:
1. Secure up to five million dollars in the Mayor’s budget to be
allocated to the forces in the field combating infant mortality.
2. Implement the work plan outlined earlier to declare a state of emergency in the City of Milwaukee concerning infant mortality thus transforming the political climate and making it ripe for legislative and resource allocation action.
3. Develop policy proposals that support integration and development of a tight MCH system of care in the areas of case management, home visiting, perinatal depression clinic capacity/quality and outreach & health education. Policy work should foster consolidation of data systems and data mining, joint case conferencing, and coordinated surveillance of public health trends taking place on the streets.
Possible State Legislative Agenda: 1. Policy agenda should focus on how more State Title V MCH Block
Grant dollars can be allocated to the City of Milwaukee. Policy activists, consumers and administrators should testify at next Title V hearing to make the case for increase funding to city entities.
2. Make contact with HRSA/MCHB to target the local message nationally to influence how Block Grant funds are allocated throughout the state of Wisconsin.
3. Develop plan to access Medicaid or TANF funds to supplement nurse-led and lay-model perinatal case management teams in the field.
4. Work with your State Office of Children & Family Services to access the Community Optional Preventive Services (COPS) tool to redistribute funds back to the city. Local entities will have to come up with a 35% match and they will be able to bring down 65% of new funding into the district. To receive funding under COPS, a local district must submit a plan to the state OCFS which describes services to be provided, the persons or community that would receive the services, projected costs of the services, identification of any requirements for which a waiver is requested.
Possible Federal Legislative Agenda:
1. Support National Healthy Start Association Reauthorization and Appropriation Campaigns on the Hill each year.
2. Join national forces that are supporting Senator Christopher S. Bond (MO) Education Begins at Home Act that will establish a federal funding stream of $400 million dollars a year for a three year period to states to start or expand existing home visiting programming.
3. Join with the March of Dimes and Congressman Upton’s PREEMIE Bill (H.R. 2861). The bill seeks to reduce preterm labor and delivery and the risk of pregnancy-related deaths and complications due to pregnancy, and to reduce infant mortality caused by prematurity. The bill directs CDC and other federal agencies to allocate funds to conduct more research relating to preterm labor and delivery. Funds will also be allocated to public health care provider and support services.
• Committee members and Leadership Council member should examine Senate Majority Leader Bill Frist’s Minority Health Bill that seeks to reduce racial disparities in health by allocating $500 million to reduce disease rates among racial and ethnic minorities and some poor rural whites. Democratic sponsors are Senator Edward Kennedy of Massachusetts, Senator Barack Obama of Illinois and Jeff Bingaman of New Mexico.
5. U.S. Senator Dick Durbin of Illinois made an appropriation request in the FY
2007 federal budget for designation of the community-based doula (Birthing Project) model as a Special Project of Regional and National Significance (SPRANS) priority within the Maternal and Child Health (MCH) block grant. More than 1.5 million of the FY2007 federal SPRANS funding is recommended to be used for a first-time motherhood program. The programs will focus on the community-based doula model in urban settings, and on breastfeeding initiation and retention in rural settings.
Social Marketing Action Committee:
Co-Chair Selection Process Develop a Committee Operating
Budget Develop a Committee Social
Marketing Agenda Develop a Committee Deliverable-
based Work Plan
Action Plan:
1. Decide on MCH issue the committee will focus on over the next year. Message development could be in the area of increasing breastfeeding rates, a broad infant mortality reduction campaign, reducing smoking behavior of first time moms during pregnancy, importance of women’s health before pregnancy, getting women to enter prenatal care in the first trimester, supporting state of emergency message, etc.
2. Once a theme is selected the committee will organize focus groups to gather qualitative data that could help shape the final campaign message. Interview schedules should be developed, secure a group leader, secure space to conduct the groups, and develop an outreach flyer to recruit respondents.
3. A final report should be published revealing the major findings and trends on an issue and a local creative team should be secured to take the lessons learned in the report and develop a mock message board that will include headlines, body copy, graphics and take home themes for the campaign.
4. These drafts should be reviewed by the committee and the entire coalition to make adjustments and provide input. The team should then select two story boards and blow them up to poster board size to be reviewed by a random sample of the target audience so that the message can be tested. The goal is to determine if the message persuades the target audience to move to the next phase of the stage of change model.
5. Once the book is tested, it should be made ready for mass production and distribution in all or some of the defined staging areas in Milwaukee. Posters should be placed in public settings where the target audience frequents and at public transportation sites.
Social marketing helps set up the working environment for change. It supplements the actions on the ground by public health professionals who work with women of childbearing age to slowly change their reproductive behaviors. Social marketing campaigns are air wars that soften up the target community with key public health messages that reinforce the daily work of nurses, doulas, social workers, community health workers, doctors, midwives who I consider our ground troops.
Evaluation & Data Committee Male Involvement Committee
Social Networking/Community Mobilization Committee
Systems Integration Committee
Sustainability Committee
Critical Element 5: Demystify Infant Mortality as a Concept Among Key Sectors of Civil Society in Milwaukee
There will be no mass movement built in the City of Milwaukee unless thousands of consumers, community members, the media, elected officials, public and private sector leaders understand what infant mortality is and why they must join the movement to combat it. What I have found traveling around the country is that the above stakeholders view infant mortality as an abstraction and do not understand the social and public health significance of infant deaths.
Action Steps:
1. Decide which committee will be responsible for addressing this challenge. It could be a combination of social marketing and community mobilization.
2. Develop a simple survey instrument with five to seven questions related to the meaning of infant mortality and administer the instrument to representatives from the above social sectors to measure their knowledge of the concept.
3. Use results of the survey to develop individualized fact sheets, poster concepts, direct mail letters and other communication tactics to explain what infant mortality is and its impact on community development.
4. Committee members should decided what each community sector should be responsible for as it relates to combating infant mortality.
5. Committee members should take walking tours through the neighborhoods talking informally with community residents at beauty shops, grocery stores, churches and block association meeting. The infant mortality fact sheet should be distributed and obtain feedback from the community on what they want to do to address this problem.
6. Committee members should organize Deliver Me Sunday Sermons throughout the faith-based community where once a month on Saturdays or Sundays, the faith leader’s sermon focuses on the problem of infant death and what the congregation can do to combat the problem.
7. Committee members should develop public service announcements and send them to all print and electronic media outlets including Internet sites to explain the concept of infant mortality and concrete solutions mothers-to-be and the community can take to resolve the problem.
9. An infant mortality reduction mascot (like the crime fighting dog) should be created so that when the public views this creature; they know that she is connected with curbing the growth of dead babies in the city of Milwaukee. Several community vans should be secured and a loud speaker should be mounted on the vans, along with your infant mortality posters and educational messages. Movement members will broadcast throughout each staging area community talking about the crisis of infant deaths in Milwaukee and what folks can do to address the problem.
10. An infant mortality rap contest should be organized among Milwaukee teens and the teen that created the selected song should receive gift certificates and a monetary prize. The committee should encourage the local radio stations to play the tune and have one of the committee organizers on the stations to reveal the movement message concerning infant deaths.
11 Elderly “Pregnancy Watchers” should be recruited to alert movement clinical providers when they hear or see a
woman who might be pregnant so that she can be escorted either
for a pregnancy test or to her prenatal care visit during the
first trimester. An incentive program should be organized to recruit, train and deploy the “Pregnancy Watchers.”
12 Utilize champions and sports and entertainment celebrities to
talk about the problem of infant mortality in general terms and use the force of their personality to mobilize the community toward action.
Critical Element 6: Hold Various Sectors of the Movement Accountable for Measurable Results
Public health mass movements die when the leaders cannot show any incremental or significant change in conditions among the target population. Therefore it is imperative to hold all committee structures, governmental agencies, clinical providers, legislative staff and the consumers themselves accountable. Your theory of community and public health change has to be made real in the lives of your customers.
Action Steps:
1. The Evaluation & Data Committee must select its leaders and be charged to evaluate the results of each entity deployed to combat infant mortality in Milwaukee.
2. A movement logic model draft should be completed and submitted to the entire movement for review, comment, and edit.
3. Once the logic model has been approved, it will
be used to monitor program implementation at different stages of the campaign. If conditions change on the ground the logic model can be adjusted.
4. Committee chairs will collect deliverables and projected outcomes for each working committee for the Leadership Council of the movement. Deliverables and strategies to achieve deliverables will also be studied for each one of the program action staging areas throughout the City of Milwaukee.
5. Every two months, committee chairs, MCH program leaders in the field, legislative leaders will need to come before the Leadership Council and report on the status of their interventions, results achieved-process & outcomes, roadblocks to achieving results, plans to overcome obstacles, and resource allocation needs for the next phase of the work (Health Stat Meetings).
6. Every quarter the Leadership Council will complete a political climate analysis to monitor the transformation in public opinion and political will concerning infant deaths in the City of Milwaukee. Future political and program actions will be influenced by the results within the political climate report.
7. Committee members will review quarterly (with health department assistance) birth and death data and monitor vital statistics yearly to observe any new trends that movement activists should be aware of as they go about their work in the communities.
8. Every six months, town meetings should be organized to update the community, press, private sector, university sector, elected officials about the status of the work in the staging areas, difficulties experienced and immediate plans for the future.
9. The Milwaukee City Health Department should work with committee members to develop a citywide process and outcome MCH evaluation plan that could begin to measure the effectiveness or failure of various perinatal interventions deployed through the City of Milwaukee. Programs that fail to achieve their deliverables must be restructured or closed. Programs that are evidenced-based should be continued and replicated in other staging areas. Due to a shortage of financial resources, the movement should only allocate resources to interventions that achieve results!
SUMMARY:
SUCCESSFUL COMMUNITY MOBILIZATION CAMPAIGNS DEMAND FOCUSED AND DETERMINED LEADERSHIP!
I DEFINE LEADERSHIP AS THE SELF-CONSCIOUS CAPACITY TO PROVIDE VISION AND VALUES AND PRODUCE STRUCTURES, PROGRAMS AND PRACTICE THAT SATISFIES HUMAN NEEDS AND ASPIRATIONS WHILE TRANSFORMING PEOPLE AND SOCIETY IN THE PROCESS.
THE ESSENCE OF LEADERSHIP IS SIMPLY TO TAKE THE ASSETS YOU ARE GIVEN (PEOPLE, STRUCTURES AND PROGRAM) TODAY AND MAKE THEM MORE VALUABLE TOMORROW!
WHILE POLITICS IS THE ART OF THE POSSIBLE, LEADERSHIP IS THE ART OF MAKING THE IMPOSSIBLE COME TRUE.
I WOULD LIKE TO THANK THE STAFF FROM HRSA’S CHICAGO OPR FOR INVITING ME TO YOUR CITY. I AM COMMITTED TO YOUR CAUSE AND YOU’RE DREAMS. NOW LET US GET TO WORK TO MAKE THE DREAMS COME TRUE!
LEAD FROM THE FRONT, DRIVE CHANGE, CREATE THE FUTURE, DON’T LOOK BACK!
