NY State Community Health Partnership Milbank Memorial Fund
Partners in Community Health:
Working Together for a Healthy New York 1998

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Healthy Births, Children, Youth


Community Health Education Day 1997, Bronx Perinatal Consortium
Cortland County ZAP Program
Healthy Schenectady Families
Healthy Schools Initiative, Little Falls
Maternal Infant Network of the Capital Region
Nassau County Teenage Parenting Program
Planned Parenthood of Broome and Chenango Counties Co-location Programs with United Health Services Hospital and Chenango Memorial Hospital
Puerto Rican Youth Development and Resource Center, Rochester
The Lactation Center, Buffalo
Vytra Health Plans Medicaid Prenatal Care Program, Nassau and Suffolk Counties




COMMUNITY HEALTH EDUCATION DAY 1997
BRONX PERINATAL CONSORTIUM




Mission/Purpose

The purpose of Community Health Education Day 1997 was to increase awareness among target audiences of good nutrition and related issues; to increase the awareness of Bronx residents regarding health and community resources available to them for optimal nutrition; and to increase awareness among target audiences that the Bronx Perinatal Consortium (BPC) and its members are important sources of information and resources on health issues related to maternal, child, and family health.

On Community Health Education Day, each participating organization hosts an activity such as a health fair, workshop, video viewing, puppet show, or theater presentation at its site and distributes information on the selected theme. Organizations are encouraged to develop an activity that reflects their agency mission and objectives and to tailor their events to the availability of their hours of operation, staff involvement, resources and the needs of their program participants.

For the eleventh consecutive year, the Bronx Perinatal Consortium, Inc. coordinated and sponsored a Bronx-wide Community Health Education Day. The theme for the event is selected each year by the Outreach & Education Committee (OEC) of the Consortium. The OEC is composed of health and social service providers from a wide range of community-based organizations, hospitals, and schools. Nutrition was chosen as the 1997 topic after the OEC reviewed the public health priority areas identified in the New York State Public Health Council report Communities Working Together for a Healthier New York: Opportunities to Improve the Health of New Yorkers (September 1996).

The members decided that nutrition was a topic that affected the entire life cycle and would be relevant to all members of the community. Furthermore, this topic enabled participants to design a wide variety of activities that allowed more creativity and innovation in educating the diverse communities of the Bronx. The Outreach & Education Committee provided assistance in the development of project materials used in reaching out to organizations, both in the private and public sectors, to recruit their participation. The members met on a monthly basis to provide additional recommendations and insight to further coordinate this tremendous education effort.

In support of this event, the Bronx Perinatal Consortium (BPC) supplied and delivered to the registered participants, free of charge, health education literature and promotional materials. Through the Health Services Division of BPC, project participants were given extensive technical assistance in the development of materials, activities, outreach, and event promotion.

The Outreach & Education Committee views a healthy community as one that can identify, access, and obtain necessary health, social, and mental health services within the community in order to achieve a healthy self-sufficiency for the entire family. It is a part of the committeeís belief that health education plays a major role in preventive medicine and that in this era of change in health care delivery, it is essential to develop collaborations with existing entities to enhance partnerships in order to deliver effective services to the community.

The committee recognizes the growing changes and challenges in the public health field and is committed to educating and providing accurate information to community residents to enable them to make knowledgeable choices regarding their health care and social services needs.

In addition, whereas the original committee focused primarily on maternal health issues, the present committee acknowledged the necessity of including a wider spectrum of topics, including domestic violence, teen pregnancy prevention, alcohol, tobacco, and other drugs.


Leadership Role

The Outreach & Education Committee started in 1985 and remains a steadfast governing committee of BPC. The committee initially consisted mainly of outreach workers, but over the years it has grown to include a diverse group of health care and social service providers, health educators, school teachers, substance abuse providers, executives, administrators, mid-management, nurses, and frontline workers, all of whom bring vital information and resources to the table and are committed to improving the delivery of health care and social services.

The Outreach & Education Committee meets on the first Tuesday of each month at the offices of Bronx Perinatal Consortium to collectively develop strategies to conduct effective outreach and education and provide enhancement and support to projects, services, and programs of the Consortium members.

The Outreach & Education Committee promotes and encourages all members to provide information on their respective agencies in order to develop its extensive resources through its network. As a result, there is a consolidated effort between members to enhance member agenciesí objectives and share resources that provide a bridge between services gaps.

At each meeting, a resource packet on a specific subject is developed by the Health Services Division of BPC. The topics of the resource packets are determined through a voting process by the members. The members also identify speakers on pertinent public health and social issues who are invited to present at an OEC meeting. This enables the Outreach & Education Committee members to receive up-to-date information that may be otherwise unavailable.

Since the members provide services in the various communities of the Bronx, they serve as an effective conduit to disseminate information to various audiences: administrative, frontline personnel, and their program participants.

With respect to Community Health Education Day 1997, the OEC assisted in the development and implementation of the work plan to target community-based organizations, the food industry, worksites, health care providers, media, schools, libraries, and churches.

The OEC provided assistance in the development of the following: development of the work plan, compilation of mailing list, design of mailing materials, development of resources, development of a media campaign, identification of appropriate materials and incentives, and technical assistance during the stages of implementation of the work plan.

Recommendations obtained during an OEC planning meeting included contacting the New York Public Library to invite all Bronx branches to participate by distributing educational literature on good nutrition, and the initiation of a mailing campaign to distribute information on folic acid to Bronx WIC program sites. It was further recommended that, since all the New York Public Libraries have Internet access, a special resource kit be developed for the libraries to include Internet listings related to nutrition.

The committee strove to develop activities and events that would incorporate the positive aspects of the many cultures in the Bronx. It was important to the members to develop strategies that would focus on and promote good nutrition in a positive manner. Examples of the activities that took place during this event included presentations on folic acid for parent groups from four public high schools, District 9 Conference on Nutrition and Academic Achievement, lunchroom presentations on nutrition and diabetes, and workshops.


Key Partners

Longstanding members who provided guidance and leadership in the development of Community Health Education Day 1997 included:

Each member presented the project information to their respective organizations in order to develop and coordinate the events at their sites. As in the past 11 events, there was a 100 percent participation of member organizations in 1997. Many of the registered participants reached out to staff, local supermarkets, and vendors to solicit contributions of food for recipes and items for gift baskets.

In reviewing the 1996 Community Health Education Day, it was reported by numerous participants that the supply of educational materials was inadequate for their events. The budget for educational materials for the 1997 Community Health Education Day was $7,000, which was insufficient to purchase the quantity of materials needed by the anticipated numbers of participants.

In an effort to obtain additional materials, the committee collectively identified free and low-cost resources distributed by national and local food-related companies and organizations. The Health Services Division of the Consortium drafted a letter and initiated a mailing campaign to request free educational materials and incentives. This letter indicated the purpose of the event and the collaborative efforts of the committee and Bronx Perinatal Consortium to bring important information to the community on good nutrition and healthy living choices. The members also sent letters from their own organizations, soliciting additional materials for members to use.

All educational materials included in the resource kit were developed by the Health Services Division and evaluated and edited by the committeeís members to ensure accuracy and appropriate content for the intended population. The educational materials were available in English and Spanish.

Impact/Effectiveness

Community Health Education Day 1997 surpassed expectations. Through a collaborative partnership between the Bronx Perinatal Consortium and the Outreach & Education Committee, an estimated 43,519 Bronx residents were reached, a 187 percent increase over the number of participants for Community Health Education Day 1996.

In 1996 there was a total of 110 participants in comparison to 1997ís total of 172 participants, resulting in a 56 percent increase. There was an involvement of a broader range of participants: In 1997 free nutrition materials and incentives were solicited from 119 food-related companies and organizations, both national and local. Fifty of the organizations (42 percent) donated items, resulting in a greater and more varied supply of materials available to registered participants. Materials included videos, posters, game sheets, tape measures, recipes, cookbooks, and educational literature.

After reviewing the materials provided, the Bronx office of the New York Public Library approved participation of all Bronx branches of the library system. Each branch received a mailing consisting of educational materials on nutrition and a listing of Web sites that provide information on nutrition, health, or fitness. Including the branch libraries in Community Health Education Day extended the event to every zip code area, making it a truly Bronx-wide event.

The variety of activities developed generated a higher level of interest, reaching a broader audience. Activities included workshops, street fairs, poster and essay contests, conferences, raffles, cooking demonstrations, and tabling at two farmersí markets. In addition, the farmers welcomed the opportunity to participate by providing educational literature at their stands and donating baskets of fresh fruits and vegetables for raffles.

In response to a press release promoting the event, Community Health Education Day was featured on the Channel 5/FOX program Good Day New York on Wednesday, October 29, 1997. An estimated 231,000 persons viewed the program and were informed about the purpose of the annual event, the reason nutrition was chosen as the focus, locations of events, participants, and a contact for additional information.

The evaluation forms received by the Bronx Perinatal Consortium indicated an overwhelmingly positive response by both the participating organizations and the community. Members indicated that their audience welcomed the idea of repeating Community Health Education Day 1997. Since nutrition was the topic, community residents of all ages and backgrounds were able to obtain information that was applicable to their lifestyles and dietary needs.

Contact: Janet Albrecht, Coordinator of Health Services, Bronx Perinatal Consortium, Inc., 685 Morris Park Avenue, Bronx, NY 10462. Telephone: (718) 792-6551, extension 323. Fax: (718) 822-1959.

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CORTLAND COUNTY ZAP PROGRAM




Mission/Purpose

Cortland County (population 48,000) has a history of high teen pregnancy rates. In 1987 and 1988 Cortland Countyís repeat teen pregnancy percentages were higher than those in New York City; enough children were born to Cortland teens in 1990 to fill three kindergarten classrooms in 1995. ZAP (Zero Adolescent Pregnancy), a primary teen pregnancy prevention program, was created in 1990 through a partnership between the county health departmentís Jacobus Center for Reproductive Health and local Catholic Charities. Today the Jacobus Center works with the City of Cortland Youth Bureau and the local YWCA.

ZAPís goal is to decrease teen pregnancies in Cortland County by one-third by the year 2000. Behavioral objectives are to help teens postpone sexual intercourse, to promote the use of contraception among those who become sexually active, and to create broader life options for young people other than parenthood.

Over the years, ZAP has developed programs in:

Additional programs are developed as community members make their needs known. For example, the health teacher at one local school district recently became aware of the fact that a number of eighth-grade girls were being pushed to engage in oral sexual contact with older, high school boys. The health teacher called ZAP, which arranged for a public health educator to come out to the school to talk with eighth-graders and parents about the issue, offering factual information about disease transmission and refusal and resistance skills. ZAP is frequently asked to develop new programming based on the changing needs of the Cortland community.

Committees (including Media, Public Relations, School, Faith Communities, Business and Industry, and Youth) meet on an as-needed basis. Frequent press coverage allows the community access to information on program offerings. A recent community luncheon is an example of the continuous involvement of the community in the ZAP initiative. The luncheon, held to make community members aware of new teen pregnancy prevention strategies in Cortland County, was attended by a large number of school officials, religious leaders, business people, and social services agency personnel.


Leadership Role

From the beginning, Andrea Rankin, as the director of the Jacobus Center for Reproductive Health, has been the driving force behind ZAPís success. Her motto is, ìThereís no such thing as a dead horse!î She has worked to include as many community leaders as possible in the ZAP collaboration and regularly consults with school health teachers, parents, teens, business leaders, youth program and social services personnel, and other service providers to ensure that programs meet the needs of the community. In addition, the County Health Department recently created a part-time program coordinator position to help administer the program. The staff person filling this position spends much of her time coordinating grant activities and meeting with interested and involved community members.

ZAP frequently leads important, new teen pregnancy prevention initiatives. An example of this can be seen in 1998 Teen Pregnancy Prevention Month activities. Meetings were attended by members of the health and faith communities, county hospital staff, service agency personnel, business leaders, members of the school community, and area teens. Their efforts resulted in Teen Pregnancy Prevention Month activities that include:


Key Partners/Stakeholders

ZAPís principal partners are the Cortland County Health Departmentís Jacobus Center for Reproductive Health, the City of Cortland Youth Bureau (which sponsors the ZAP-PEERS program and Zapella), and the Cortland YWCA (which helps facilitate funding for some of ZAP programs and houses some of its activities, like the recent ìOh Boy Babiesî initiative).

Local school districts also work very closely with the ZAP program: Two recent projects involved offering health teacher training and research follow-up of the Postponing Sexual Involvement (PSI) and Reducing the Risk (RTR) sexual education curricula. Health teachers were trained and offered follow-up support as they prepared to implement the curricula. ZAP then distributed pre- and post-curriculum surveys to gauge the impact of the curricula in delaying sexual activity among their students. School health teachers also work to recruit ZAP-PEERS, ZAPís peer educators, and use these teens for educational programs and other health-related activities.

ZAP has an honorary board consisting of community leaders, state and local government officials, and service agency personnel. An ad hoc steering committee (consisting of Andrea Rankin, the ZAP program coordinator, the executive director of the Cortland YWCA, and the Youth Services supervisor of the City of Cortland Youth Bureau) meets regularly to be sure that all program activities are adequately supervised and maintained and that program content is relevant to the needs of the community.

In her role as ZAP point person in the community, Andrea also sits on many local boards, offering her additional access to information that helps in ZAP program decision making and content enhancement. She is a member of the Management Team of the local APPPS consortium, meets regularly with the County and City Youth Bureaus, and sits on the Resource Allocation Committee for TANF implementation. Andrea recently worked with the area School-to-Work Committee to help create a jobs-for-youth initiative in support of ZAPís objective to create greater life options for young people. In addition, Andrea served on the Prevention Subcommittee of the Governorís Task Force on Out of Wedlock Pregnancy and Poverty. As part of her work there, Andrea organized ten focus groups that provided information to the task force on the ìstreet realitiesî of teen pregnancy and prevention. These focus groups consisted of teens, preteens, teen parents, and parents of teens and proved to be an excellent source of information on the reasons teens become pregnant.

The programís collaboration with Cortland Catholic Charities, which administers the local APPPS Consortium, offered ZAP a good start. When Catholic Charities could no longer continue its formal association with ZAP, the Cortland YWCA and the City of Cortland Youth Bureau were eager to step in. Even though Catholic Charities is no longer a formal member of the collaboration, the local chapter still works very closely with ZAP. The two groups often work together, offering joint programs and sharing resources and responsibilities on various activities.

The YWCA and the City Youth Bureau work closely with the Jacobus Center to support or help administer certain aspects of the ZAP program. An example of how closely this team works together can be found in one of ZAPís newest initiatives, the creation of Zapella, Cortlandís newest superhero. Focusing her message on youth in grades K-6, Zapella is a high-energy, can-do female role model whose mission is to talk to youngsters about respect for their bodies and other self-esteem issues, making them more capable of fending off invitations to drug and alcohol abuse and sexual activity when they become older. She makes appearances in classrooms, on playgrounds, and at area events throughout Cortland County and is also included as a comic strip in the Cortland Youth Bureauís newsletter to area elementary school children. Zapella works closely with the Cortland Youth Bureau, which coordinates the comic strip and Zapella appearances. Her activities are presently being funded by the Cortland YWCA, proof positive that ownership of ZAP program components is shared.

Teens are among ZAPís most important players, and one of the programís greatest strengths comes from the involvement of ZAPís peer educators, called ZAP-PEERS. ZAP never speaks publicly without the ZAP-PEERSóa group of teens who make panel presentations at local schools and other area venues. They receive training in abstinence, birth control, sexually transmitted infections (STIs), HIV/AIDS, and listening and resistance skills. Their participation is crucial to ZAPís success, especially in the eyes of other area teenagers. They have made presentations throughout New York State showcasing ZAP as a model for community involvement.


Impact/Effectiveness

Since ZAPís inception, teen pregnancy rates in Cortland County have declined significantly. In fact, the program recently announced Cortlandís lowest teen pregnancy numbers in history! In addition, the community at large is more aware of teen pregnancy as a problem that must be addressed, and more and more members of the community are working to combat the problem. A recent ZAP-sponsored parent-child communications course elicited this response from a participant: ìMy only complaint about the class is that it was too short! I will use this information to talk with my children about all kinds of things, not just about sex. Thanks!î

All members of the ZAP partnership benefit from the coordination of efforts around teen pregnancy prevention. Meeting on ZAP issues encourages discussion about other issues, allowing for collaboration on many other matters; again, local efforts for Teen Pregnancy Prevention Month are an example of this. In addition, many of these same players will come together in October to promote Letís Talk Month. And making sure that teens are a part of the process offers them the opportunity to take leadership roles and create positive change in the community. They realize that they can have an impact.

Fiscally, the ZAP program has had its ups and downs. Funding has always been an issue; in fact, Cortland County no longer qualifies for needs-based funding sources because of the steep decline in its teen pregnancy rates. In early 1997 the program almost closed due to a lack of funding. That changed through some aggressive grants requests and private foundation support as well as help from the New York State Health Departmentís Bureau of Womenís Health. The program, however, is still dependent upon tenuous financial funding sources and one-time grants funds for its existence. Andreaís adage is, ìWe could fund ZAP well with all the money we are saving the county Department of Social Servicesóteen pregnancy prevention is cost-effective!î

Political problems and community conflicts, fortunately, are not common. Members of the ZAP partnership were saddened in 1994 when Catholic Charities felt that they had to discontinue their formal participation in ZAP because of the objections of several conservative members of the Catholic community. Although members of the ZAP team were disappointed with their decision, it has not kept Catholic Charities and ZAP from working together in less formal ways, to the benefit of all concerned.

ZAP has received state and national recognition for its efforts. It has been highlighted numerous times by the National Campaign to Prevent Teen Pregnancy as a program that works, an honor that can be directly attributed to Andreaís initiative: When she read about the campaign and noticed that its goal was to reduce teen pregnancy by one-third by the year 2005, she called them immediately to say, "Hey, we have the same goal as you, but weíve got a five-year jump on you!" That prompted a site visit, numerous calls, and a fruitful relationship between the two organizations. In fact, the National Campaign has asked ZAP to author a chapter of an upcoming publication, A Guide for States and Communities Working to Prevent Teen Pregnancy.

The true test of ZAPís achievement, however, may be to come. This year ZAP was honored with a private foundation grant in the amount of $30,000 to help five New York State communities replicate its success. Members of the ZAP team will try to help those communities participating in this demonstration project to tailor aspects of the ZAP program to their own locales, hopefully allowing them to experience a similar drop in teen pregnancy rates.

Contact: Lisa Hoeschele, ZAP Program Coordinator, Jacobus Center for Reproductive Health, Cortland County Health Department, 60 Central Avenue, Cortland, NY 13045. Telephone: 607-753-5026 or 607-756-2212.

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HEALTHY SCHENECTADY FAMILIES




Mission/Purpose

The mission of Healthy Schenectady Families is to change the world one child at a timeóa lofty goal indeed. Margaret Mead has been quoted as saying: ìNever doubt that a small group of thoughtful, committed people can change the world. Indeed, it is the only thing that ever has.î This quotation, along with its motto, ìEvery child is worth it,î is the driving force behind its efforts.

Healthy Schenectady Families is a family support program designed to provide home visiting services to families, starting with the pregnancy and continuing through the first three years of the childís life. It has become a vehicle for many disparate community agencies and service providers to find common ground and purpose in order to facilitate early childhood and family development. The ultimate goal is to support the development of resilient children who are better able to avoid psychological problems, high-risk behaviors, and violence, as well as resilient families that donít abuse or neglect their children.

Schenectady County is one of three counties that compose the capital region of New York State. It is geographically small (206 square miles) and predominantly urban (89 percent).

Schenectady averages 2,000 births per year, approximately 800 born to first-time mothers and 250 of those to adolescents. As with other capital region counties, there is a rise in the rate of children born into poverty and in the rate of teen pregnancies. (The 12307 zip code rate is nearly 25 percent.) Teen pregnancies are known to be at a higher risk for low birth weights and other factors associated with poor pregnancy outcomes. Schenectady County received and investigated 1,848 reports of child abuse and neglect during 1996. It serves more than 1,390 children through its probation system.

In 1995 a proposal from the Schenectady County Public Health Services and the county managerís office was submitted to the state to begin a Healthy Families program. New York State was developing sites for a home visiting program based on the Healthy Families America (HFA) model. Ten grant proposals were accepted; however, Schenectady County was not among those recipients. In spite of the fact that the program remained unfunded, the idea remained strong in the minds of several agencies and people who prepared the proposal.

At the same time, local pediatrician Dr. Kevin Karpowicz became interested in instituting a Healthy Families-type program. He was inspired after viewing I Am Your Child, a nationally televised program developed by the Rob Reiner Foundation. The program described the impact of such a program on a community like Schenectady. Dr. Karpowicz is the only pediatrician in the Hamilton Hill/Vale area of Schenectady Countyóthe area with the greatest concentration of people living in poverty and disadvantage. He has worked in Schenectady since 1980, caring for the highest-risk children.

Dr. Karpowicz realized that an analysis of the underlying research was the key to the program, not only in its development but also its ultimate effect. He evaluated the research in order to understand how such programs succeed and what approaches were necessary to achieve the best possible outcomes. Then he began to convince others of the need for this program. The research is very clear: Early brain development, emotional development, and attachment theory are critical elements in all future development. An approach focused on strengthening these elements could have a major impact upon many of the problems that have worsened in our society in recent yearsóchildhood behavior problems, high-risk adolescent behaviors, and youth violence. With the basic underlying research in hand, Dr. Karpowicz cast a net into the community. In April 1997 he wrote a brief summary of the programís concept, along with a ìcall to action,î and mailed it to physicians, schools, and numerous community agencies that work with children and families. In addition, due to his affiliation with St. Clareís Hospital and its mission of helping the community, Dr. Karpowicz wrote to and met with various hospital administrators. Wendy Bender, C.S.W., of the hospitalís Patient and Family Services Department became a strong partner in the promulgation of the concept.

With the sponsorship of St. Clareís Hospital, a series of community-based forums were held in July and September 1997 to present the concept of a family support program. At the first forum, basic research was presented to demonstrate how this family support approach could become a new standard for delivery of services. The data also revealed that this service could have a dramatic, long lasting effect upon not only the direct participants but the community as a whole.

In addition to the efforts of Dr. Karpowicz and St. Clareís Hospital, the Schenectady county manager and his office had for many years believed in this early family support approach to mitigating the myriad problems experienced later by the community due to dysfunctional families. There was a confluence of commitment to the healthy families concept, and community collaboration was realized. Community forums on healthy families were well attended and received. State representatives also attended these meetings. At one point, when Representative Paul Tonko commented on the level of agency collaboration, an official from the County Department of Social Services replied, ìI worked for this agency for 18 years and have never been in a room with this many agencies working toward a mutual goal.î

There was clearly a consensus that this was the right program for this community; it was where community efforts ought to be directed; it was people-driven and was going to happen regardless of funding opportunities.

The common vision of a healthy community that emerged was this: In ten years, all children born in Schenectady County would have available to them the benefits of a family support program that remains true to its roots in basic research and theory found in the ìTop Tenî list.

10. When a child is born into a family that is able to attend to the childís basic needs in a responsive and sensitive manner, along with providing enriched experiences, the childís brain will develop to its fullest potential.
9. Brain research indicates that the early care a child receives directly affects the actual formation of the brain. Brain development correlates with emotional development, and when growth proceeds in an optimal manner, the end result will be an emotionally healthy, permanently resilient and secure child.
8. A child who is resilient and secure will be able to succeed in school, be socially and emotionally healthy and be able to resist high-risk adolescent behaviors, such as substance abuse, sexually transmitted diseases, and teen pregnancy.
7. While continuing to be sensitive and responsive, a healthy family learns how to adapt to the changing developmental needs of their child at each stage of the childís development. No child will be maltreated in healthy families.
6. A healthy family can learn how to become a healthy family by acquiring those skills and knowledge that it requires to raise a healthy, resilient child. No family can become a healthy family without some degree of support. The support needed will vary depending upon the life history of the family members.
5. All families have individual goals and fears for their child, but common to all families is the desire to raise a child who will succeed in school and resist the high-risk behaviors of adolescence to become a secure, healthy, and responsible adult.
4. All families are part of a community, which can either support them or devalue them. Healthy children and healthy families require a community and society that addresses the developmental needs of a child and family. When a family requires out-of-home child care, that care must be geared toward the needs of the child. No child shall be maltreated due to community standards.
3. Healthy Schenectady Families will strengthen families by helping them acquire these skills and knowledge necessary to raise a healthy, secure, and resilient child. Where appropriate, if any other need of the family arises that could have a negative impact upon the health of the family, Healthy Schenectady Families will address that need to ensure the health of the child and family.
2. By realizing the importance of the first three years of life in terms of brain and emotional development, one child at a time we will create a village in which we all assist in the raising of healthy children and strengthening the family.
1. Every child is worth it!


Leadership Role

As a result of the community forums sponsored by St. Clareís, true dialogue and collaboration between community agencies began to occur. Individuals from various agencies met together and began to develop a working plan to create a program that would fit the needs of the community.

Training and assessment became initial priorities. Recognizing the need for a broad- based level of community involvement, Wendy Bender of St. Clareís Hospital organized a committee to develop the referral and assessment process and Dr. Karpowicz began to research training needs.

Wendy Bender led this assessment committee, which represented numerous agencies (local clinics, the three local hospitals, and other providers of services to pregnant and parenting women and families). Assessment and referral materials provided by Healthy Families America were received, and consideration was given to how they could be incorporated into the existing structure of agencies in this community.

Dr. Karpowicz developed a training course based on extensive research. It consisted of a series of eight two-hour classes that presented the underlying theories, research, and information to home visiting workers. This training assures that all home visitors will begin with a strong theoretical base and will be able to provide pertinent, up-to-date information to families. The class focuses on early brain development, emotional development, attachment theory, childhood resilience, practical interventions of home visiting, attachment parenting, and a specific curriculum for home visitors to follow. The training program has been offered free to all interested persons. The first series of classes began six months after the nationally televised airing of I Am Your Child.

Schenectady County Public Health Services also played a key role in the development of the program and was identified as the most appropriate central coordinating agency. Catholic Charities of Schenectady County was the contract agency for the county and became another key player in this collaborative community program.

As discussion proceeded, it became clear that all parties were committed to the same purposeóthe future of the children. What started as separate cooperative agencies evolved into a group of committed individuals working collaboratively to make this program happen for the benefit of the entire community. Throughout the initial stages of development, commitment and determination guided the process. Unlike the home visiting programs in other counties in New York State, there were no initial grant or startup funds. The entire program was conceived, fully researched, organized, and initiated in the absence of outside funding.

Once the preliminary planning had generated a structured model, the detail work began in earnest. The principal providersóCatholic Charities of Schenectady County, Schenectady County Public Health Services, St. Clareís Hospital, and Dr. Karpowiczódefined the roles and responsibilities of each of the program partners. There was an open recognition that each principal brought different aspects of knowledge, experience, and resources. The absolute commitment to collaboration was maintained, and a structure was developed that offered a unique and innovative delivery model.

While New York State does not currently contribute funds to this program, the state has provided a considerable amount of support and technical assistance. This assistance includes utilization of training resources, forms, and curriculum, in addition to the inclusion of the program in the state data system.

Significant support has also come from the National Committee to Prevent Child Abuse and from other New York State home visiting programs that have provided information and inclusion in regional training efforts.

The support and assistance of St. Clareís Hospital has been invaluable and unprecedented. With strong backing by the hospitalís CEO, Paul Chodkowski, the hospitalís foundation board took on a financial commitment to support the development of a home visiting site. The development of an Advisory Board, with representatives from over 20 separate community agencies will assume the task of maintaining the communityís focus and connection in addition to keeping the program growing toward its long-term goals of a healthy community.

Schenectady County has also committed significant funds to this program.


Key Partners/Stakeholders

The principal partners through the planning and inception of the project include Dr. Kevin Karpowicz, local pediatrician; Stephanie Scuderi, Peggy Grot, and Peggy Sheehan, Schenectady County Public Health Services; Trudy Brunelle, Catholic Charities of Schenectady County; and Wendy Bender, St. Clareís Hospital.

Each agency has assumed responsibility for certain aspects of the program. Schenectady County Public Health Services serves as the central coordinating agency for intake/referral and assessment. It provides the family assessment workers and a supervisor. In addition, regularly scheduled home visits by a community health nurse are included in the services offered to each family participating in the program. The agency also provides the site and connection to the New York State Home Visiting Program data system. Catholic Charities, under contract with Schenectady County, serves as a home visiting site and provides family support workers and a supervisor. St. Clareís Hospital serves as a home visiting site, provides family support workers, volunteer home visitors (each volunteer works with one family), and a supervisor. St. Clareís also sponsors the programís Advisory Board.

Weekly admission meetings are held, during which assessments are reviewed and equitable distribution of cases occurs. This is followed by weekly case reviews. At weekly planning meetings, policies and procedures, outreach, training, and other programmatic issues are coordinated. Each agency involved is included in all planning sessions. All tasks and assignments are divided, and each agency contributes and participates in decision making and planning.

It was recognized from the outset that in order to reach the lofty goal of universal coverage (the screen for risk/burden of all pregnant women in Schenectady County), it would be necessary to have the commitment and contribution of all individuals and agencies that had contact with this population. Built into the structure of the model were numerous measures to ensure meaningful participation and commitment from the community. An open invitation has been issued to encourage agencies to develop separate home visiting sites that would join the overall program. These sites would become full partners with the same expectations, roles, and responsibilities defined by the original partners. Details are currently being worked out to incorporate Parsonís Child and Family Centerówhich recently received a federal Early Head Start Grantóas the next home visiting site of Healthy Schenectady Families.

Creative and ongoing outreach efforts have been undertaken to ensure the efficiency of the referral process and to maintain a visible connection to the community. Efforts have been made to work with referral sources to help them establish a smooth and efficient process of administering the screening tool in order to identify potential referrals. The Advisory Board, which meets monthly, has provided its assistance and support in enhancing this creative outreach. These efforts have been very productive, and intimate working relationships are being established. An Outreach Breakfast was held in early May to thank participants and keep everyone updated on the programís process.


Impact/Effectiveness

As a result of this extraordinary community collaboration, Healthy Schenectady Families opened and began accepting referrals in January 1998. This was only nine months from the original inception of the idea. Considerable efforts have been made to identify potential referral sources and to work closely with them to streamline the referral process. Referrals have been received from fourteen separate sources. The data system is operational and being utilized with a defined schedule of required data collection. It provides a tool with which to measure health and social indicators and to generate ongoing measurement of efforts. Specific health outcomes include healthy pregnancy indicators, consistent use of primary medical providers, child immunizations, lead screens, and so on. Specific social outcomes include improved parental self-efficacy, enhanced parent-child interaction, and more effective parenting. The mutual benefits to all of the community agencies involved in this program are numerous. There has been an unprecedented sharing of expertise and resources in the development, training, and program delivery phases. There has been a commitment to coordinate and complement efforts to prevent duplication and assure the best use of time, effort, and resources. Other agencies benefit from the appropriate referrals that will be made to their programs (for example, counseling, domestic violence services, substance abuse programs).

On April 14, 1998, Dr. Karpowicz began the fourth series of training classes with 15 new trainees; the number of individuals completing the course now total 37. This course has also been offered to other agencies working with young children and families and serves as a vehicle to disseminate information to the community about the importance of the first three years of life.

As of July 1998, 15 individuals have taken the course in order to become volunteers. The volunteer home visitor, who is called a ìvillager,î will be assigned to a family that has been assessed as at a lower level of risk. The volunteer undertakes the training with the full understanding that he or she will be assigned to one family and will continue to work with that family from the prenatal period through the childís third birthday. The plan is to continue to offer the course four times per year to interested individuals at no cost. Including a corps of volunteers as part of the program provides for some element of insulation from funding dependency and, more important, provides another outlet for community involvement.

Healthy Schenectady Families offers myriad benefits to each partner and to the community as a whole. There has been an extraordinary sharing of resources and expertise within the community in the development of this program, and there exists a strong promise and commitment for this to continue throughout the programís delivery. Efforts are coordinated to avoid duplication. It is expected that outcome measures will demonstrate savings to the county in Medicaid costs, improved immunization rates, lower child abuse and neglect rates, better utilization of primary medical services versus emergency visits, and a coordination with county job training efforts.

Financial commitments have come from the Schenectady County budget, including state aid for public health, and St. Clareís Hospital Foundation. The addition of Parsonís Child and Family Center will bring financial resources from a federal Early Head Start grant. Current available funding allows for program managers, family support workers, family assessment workers, and volunteers, who will provide assessment and intensive home visiting activities at three locations. Provisions have been made for initial and ongoing training, materials, and support and for ongoing supervision of staff and volunteers. It is projected that the program will be servicing over 100 families at full capacity.

The level of support and interest from the community is unprecedented. Local funding sources have offered new grant applications requiring that bidders on Requests for Proposals (RFPs) integrate their activities into Healthy Schenectady Families. Numerous formal and informal presentations have been made throughout the county. The program was recently invited to present at a statewide conference of the National Committee to Prevent Child AbuseóNew York State.

The planning phase of this program went very quickly and the collaborative venture worked extremely well. The first set of workers (one family assessment worker, two family support workers, and three supervisors) was trained in December 1997. The next set of workers took this state-sponsored training in May 1998. As of August 1998, the program had received more than 75 referrals (including several self-referrals resulting from word-of-mouth connections) from more than a dozen separate sources.

The program anticipates that future sites provided by additional agencies will be welcomed into the existing structure. The determination to maintain close community connections will assure that the program will be able to overcome any unforeseen future stumbling blocks.

The initial funding appears to be adequate to address the developing needs of this program; however, requests will continue to be made for its inclusion as a funded New York State home visiting program. Other private and public funding sources will continue to be pursued to ensure the programís long-term existence and to enable it to demonstrate the highest level of achievement.

Healthy Schenectady Families believes that a ìsmall group of thoughtful, committed people can change the world,î and that ìEvery child is worth it.î

Contact: Stephanie L. Scuderi, Director of Prevention & Patient Services, Schenectady County Public Health Services, 107 Nott Terrace, Suite 304, Schenectady, New York 12308. Telephone: (518) 386-2824.

Email: stephs@health.co.schenectady.ny.us

A brochure is available upon request.

See map, C9





HEALTHY SCHOOLS INITIATIVE
LITTLE FALLS




Mission/Purpose

The purpose of the Healthy Schools Initiative is to promote the awareness of health and safety, to ensure childrenís access to health care providers, and to provide health education to school personnel.

The partnership with the service areaís 14 school districts began in 1993 with the inception of the Health Education and Safety Awareness Day program. From an initial offering of 16 topics, the program currently has a selection of over 40 topics and earned a New York State Health Department ìMeritorious Health Education Programmingî award in 1996. In addition to hospital staff, the following community agencies participate on a regular basis: the public health department; American Red Cross; YWCA; local fire, police, and ambulance departments; area social workers; Catholic Charities; Rape Crisis; New York State Police Department; and the county sheriffís office.

From the inception of the Health Education and Safety Awareness Day program, school health care service providers began to recognize that school-age children often were not receiving the quality of health care warranted by their symptoms.

Data from 1992 indicated that 21 percent of Herkimer Countyís children lived at poverty level. Many parents in this rural, low socioeconomic area have little or no insurance or are employed in shift work and are unable to take the time from work to take their child to a health care provider. Many ill children were only being seen by the school nurse, and although the nurse contacted the parents, follow-up care frequently did not occur.

In addition, Little Falls Hospital nursing personnel noted that school nurses are often in need of support and assistance in accessing health care providers for their students. They frequently found themselves frustrated with futile attempts to intervene on behalf of an ill child. Intervention on behalf of hospital staff has alleviated many of the these concerns, and efforts have been made to provide continuing education to health care personnel on a regular basis.

At the initiation of Little Falls Hospital staff, Herkimer County Public Health staff members are attending local kindergarten registrations, discussing health care coverage with parents, and enrolling eligible children in the stateís Child Health Plus program.

A healthy community is one in which comprehensive health and safety education programs are offered without charge to the public and health care is accessible to all, without regard to ability to pay for services.


Leadership Role

The Healthy Schools Initiative is guided and governed by the Little Falls Hospital administrator and staff, local school administrators and school health care providers, and area pediatricians and family practitioners. Little Falls Hospital staff has taken the role of lead agency in coordinating the efforts of the Public Health Department with the needs of the local school districts in enrolling eligible children in Child Health Plus and is scheduled to educate school personnel in this enrollment process. Little Falls Hospital staff also maintains leadership in planning and coordinating the Health Education and Safety Awareness Day program for the districts.

In a pilot program with the Ilion Central School District, area pediatricians and family practitioners have committed to ensuring that health care is available to all of Ilionís students and that consultation with the schoolís health care providers is provided in a timely manner. The physicians have agreed to accept new patients without regard to ability to pay for services and are supportive of covering eligible children through Child Health Plus. It is intended that this aspect, physician availability, of the Healthy Schools Initiative be made available to all of Herkimer Countyís schools by 2002.

As continuing education and support meetings with school health care providers are held, there is great potential for enlisting the expertise of other county agencies involved with health and social issues.


Key Partners/Stakeholders

The Health Education and Safety Awareness Day program is coordinated by the director and assistant director of the hospitalís Community Services and Fund Development Department. These individuals contact the local school nurses to schedule programs for their schools.

The continuing education programming for the school nurses is planned by the hospitalís director and associate director of nursing, in conjunction with the school nurses. At the request of the hospitalís staff, the countyís Public Health Department staff has been instrumental in conducting Child Health Plus enrollment sessions during area schoolsí kindergarten registrations.

The Ilion Central School District pilot program is led by the hospitalís administrator, assistant administrator, director of nurses, school nurses, school superintendent, and one area pediatrician who represents the physicians committed to the project. This group serves as the decision-making body for this project.

It is projected that the current pilot project in Ilion will be available to all 14 districts within the hospitalís service area by the year 2002.

Currently, several agencies participate in the Health Education and Safety Awareness Day program by providing information about a requested topic to the districtsí students. In order to tailor the program to address the needs identified by school personnel, hospital staff must seek the participation of area agencies with expertise in various specialized health and social issues.

Because the program is designed to offer an overview of a variety of health and social issues, frequently a presenter is asked to return for a more in-depth discussion of a particular topic. Some of these topics include suicide prevention, conflict resolution, teen pregnancy, sexuality, communication, separation and divorce, and domestic violence. Students as well as school personnel are thereby introduced to community agencies and gain an understanding of the services provided by each. The name of a contact person is also provided should it become necessary.

The Healthy Schools Initiative relies on the enterprising nature of school officials, hospital leaders, and community agency leaders to work together in promoting the health and well-being of children. It is very common for these leaders to spontaneously share ideas. Students within this service area are fortunate that such a comfortable association exists among the schools, community agencies, and hospital.


Impact/Effectiveness

The success of the Healthy Schools Initiative will be determined by its ability to meet the following goals:

Little Falls Hospital will benefit from the collaboration of area agencies and the expertise of their staffs in sharing of a variety of topics and concerns. Contacts will be made to promote hospital-sponsored community health education presentations. This effort will serve to increase the number of potential patients seeking quality local health care. The general public will come to rely and depend on Little Falls Hospital to meet all health care concerns and needs or be assured that appropriate referrals will be made when necessary. The Healthy Schools Initiative can only serve to strengthen ties with current patients while attracting new ones.

The Healthy Schools Initiative will ensure that all students in the Ilion Central School District have access to health care and that school health care personnel are able to seek the advice of a physician on behalf of their students 24 hours a day, 7 days a week.

All 14 school districts are now able to host a Health Education and Safety Awareness Day program introducing a variety of health and social issues to their students. This program further provides students and staff with contacts to obtain further information and guidance about a particular subject. The topics typically concern issues related to state health curriculum requirements.

Area school nurses will have the opportunity to meet with their colleagues to share ideas and concerns, learn from one another, and gain knowledge through continuing health education presented by Little Falls Hospital. The school nurses will have direct influence over the topics presented to their colleagues at their meetings since hospital staff tailor programming to their requests and needs.

The Ilion district has submitted a proposal to the local community foundation to assist in the funding of their pilot project. Initial costs are estimated at $64,590 for the first year and $23,550 for the second and will continue to diminish if, as anticipated, state aid funding is maximized. It is hoped that the program will reach a break-even point in the third year as state aid figures become stable and the maximum number of students are enrolled in some type of insurance coverage.

It is expected that the Ilion pilot program will be the model for all other area school districts.

The continuing education programóunless its participants eventually request Continuing Education Unitsóand the Health Education and Safety Awareness Day program are and will remain cost-free to those they serve. Little Falls Hospital will continue its commitment to health education, utilizing current staff.

As the Healthy Schools Initiative grows, it is anticipated that the community will look to Little Falls Hospital, surrounding community agencies, and its school districts to provide health and social services to area residents as needed.

Contact: Kathy Eisenhut, Director of Community Services, Little Falls Hospital, 140 Burwell Street, Little Falls, NY 13365. Telephone: (315) 823-5326. Fax: (315) 823-5395.

A brochure is available upon request.

See map, B4





MATERNAL INFANT NETWORK OF THE CAPITAL REGION




Mission/Purpose

By its very nature, as envisioned by the New York State Department of Health (NYSDOH), Comprehensive Prenatal Perinatal Services Networks (CPPSN) is an example of Communities Working Together. Comprehensive Prenatal Perinatal Services Networks contract with NYSDOH, Bureau of Womenís Health, to provide community health education and foster collaboration between health and human service providers in promoting the health of women and their families. The Maternal Infant Network of the Capital Region (MINCR) is locally based and governed. As described below, activities are based on needs identified in the Comprehensive Needs Assessment and also as determined by the board of directors. There are 14 CPPSNs in New York State, and each is separately incorporated under 501(c)(3).

The mission of the Maternal Infant Network of the Capital Region is to facilitate collaboration among health, education, government, and community services to promote the best health for women, mothers, and infants in Albany, Rensselaer, and Schenectady counties and surrounding areas.

The above mission statement also identifies MINCRís primary activity. MINCR is a network and that term identifies its primary activityófacilitating collaboration. MINCR stands among other players in health, education, government, and community services. From this position, it can serve an interstitial functionóidentifying community-wide issues and trends, supporting coordination of services, and promoting collaboration among organizations and services toward common goals. It provides direction and support to agencies and actors in the area it serves so they can work independentlyóbut also togetheróto provide the best care to women, mothers, and infants who will then have the best opportunity for optimal health.

MINCR fulfills its mission through the following activities:

Assessment: The Comprehensive Needs Assessment completed last year continues to be a valuable resource for assessing the status of maternal and child health in the Capital Region. Updates have been generated in order to look at sickle cell anemia and teen pregnancy. MINCR is looking forward to assessing the Regional Perinatal Data System for real-time data with which to assess the status of maternal and child health in Albany, Schenectady, and Rensselaer Counties and the surrounding areas. The director of special projects presents local MCH data to community groups on healthy births and teen pregnancy. Each issue of its newsletter also presents a local data update, including zip code data. As a result of these highly visible efforts, MINCR has experienced a dramatic increase in requests from community agencies and area college students for customized data runs, particularly by zip code. These are filled within a few days of the request, if not the same day.

Communication and Education: Its quarterly newsletter, The Networker, reaches 900 individuals from approximately 400 organizations. The goal of this publication is to highlight community programs and Network activities, disseminate local MCH data, and inform readers of events and resources both locally and nationally. This year a feature article was added to each issue to take an in-depth look at a particular topic. The first feature article was a two-part series on HIV. Part I focused on HIV in pregnancy and contained contributions from Dr. RenÈe Samelson and Cathy Valentini of Albany Medical Centerís Maternal and Child Coordinated Care Program. Part II presented the policy on the Newborn HIV Screening Program.

WEB Page: This page provides current information on maternal and child health resources and the organization, in addition to links to relevant state and national resources. The Web site (www.crisny.org/not-for-profit/mincr) also contains a community calendar of local, state, and national events.

Parent Resource Directory: Through collaboration with the Parenting Education Network and the Albany Cooperative Extension, MINCR developed, printed, and distributed 10,000 Parent Resource Directories.

Conference Attendance: Funded attendance of 17 at the 13th Annual Conference of the New York State Perinatal Association held in Albany. Many of these individuals are frontline community workers who would not otherwise have been able to attend this fine educational opportunity.

Telephone Requests: Approximately twenty calls per month are received from both professionals and consumers requesting information as varied as the availability of support groups, baby care items, and information on fetal alcohol syndrome.

Mini Grants: This year $12,000 was allocated to local activities that make a positive contribution to the maternal and child community. The recipients included Albany Girls Club, for a program to educate young women attending the Adult Learning Center on ways to stay healthy; Albany Citizens Council on Alcoholism and Other Chemical Dependencies, for expanding Grow Girl! Program, an education program offered to middle school girls on good decision making and self-esteem; New York Coalition for Alternatives to Pesticides, for printing of a brochure ìPesticides and Pregnancyî; Planned Parenthood Health Services of NENY, for training on detection and intervention with domestic violence; and Albany United Methodist Society and Hunger Action Network, for a joint project providing outreach to pregnant women in the Arbor Hill area of Albany.

Outreach to Promote Early Entry to Care: This outreach is conducted in conjunction with outreach on Child Health Plus. At every community event that MINCR attends, prenatal care materials are distributed and discussed, as well as the availability of Prenatal Care Assistance Programs (PCAP), free prenatal care for Medicaid-eligible women. MINCR developed a brochure on PCAP and sites in the Capital Region which is widely distributed. The Network also purchased baby care items such as thermometers, medicine dispensers, and personal care items that are distributed by outreach workers and case managers who work directly with high-risk mothers.

Child Health Plus Outreach: MINCR, in addition to the other 13 Comprehensive Prenatal Perinatal Services Networks in the state, has a three-year subcontract with the HMO Council to promote Child Health Plus (New Yorkís expanded health insurance program for children). As a result of these outreach efforts, enrollment in Albany, Rensselaer, and Schenectady Counties has increased by 32 percent, and in Fulton, Montgomery, Columbia, Greene, and Schoharie, 52 percent. Efforts are currently underway to expand activities in light of the expansion of the Child Health Plus program.

Substance Use in Pregnancy: Preliminary work is completed on the development of a directory of substance abuse treatment and related services for women in the Capital Region. MINCR continues to distribute the ìGuidelines for Counseling Pregnant Women Who Smokeî manual.

Community Collaboration: Staff collaboration consists of participation in the efforts and activities of many other community-based organizations, including United Wayís Success by Six, Parenting Education Network, Albany Teen Providers, Schenectady Teen Providers, Albany County Teen Needs Assessment Committee, Schenectady Health Priorities Consortium, Rensselaer Countyís Family Living for Teens Program, Northeastern NY HIV Care Network, Albany Traffic Safety Committee, New York State Perinatal Association, Parenting Education Network, New York State Bureau of Womenís Health Perinatal Redesignation Work Group, and many others.

Board Development and Infrastructure: As with any nonprofit organization, governing board development and participation is vital. The strategic planning committee, made up of board members, has completed an environmental scan, made recommendations for the future of MINCR, and made revisions to the mission statement. It has set five-year goals and action steps. Revisions to the bylaws are also being made.

Medicaid Managed Care: The Network obtained an add-on to its contract with the NYSDOH Office of Medicaid Managed Care to look at the impact of managed care on maternal and child health. Given MINCRís mission, as well as its concern regarding access to prenatal care and the transition to managed care for pregnant Medicaid-eligible clients, exploration under this initiative focused on the interfacing of Medicaid, managed mare, and the Medicaid presumptive eligibility (PE) determination process at state-supported programs for Medicaid-eligible consumers. Interviews were conducted with providers at Prenatal Care Assistance Programs (PCAP) and Medical Obstetrical and Maternal Services (MOMS) programs to gain a better understanding of the process of consumer education about Medicaid managed care and the issues providers face in relaying that information. More than 50 consumers were interviewed about their experiences with and opinions about Medicaid managed care in this area.

Project funds were used to sponsor a free conference on June 24, 1998, entitled ìMedicaid & Managed Care: Focus on Women and Familiesî. The conference took place in Albany and showcased the ìbest practicesî report of the project. More than 150 people attended the conference to hear presentations by professionals from the NYSDOH and all three county managed care coordinators. Representatives from area Medicaid managed care plans were available to answer participantsí questions. A summary of the afternoon roundtable discussions was mailed to all conference participants.

Volunteers: In addition to the volunteer board of directors, members from the Retired Senior Volunteer Programs donate their hand-knitted baby items, which are then distributed to providers who work with Medicaid-eligible families. A volunteer also provides about four hours a week of office support.

MINCR Executive Committee Members: Myron Gordon, M.D., Chairman; Steven Flavell, Vice Chairman; Robins Chaisson, Treasurer; Janet Perloff, Ph.D., Secretary. Staff: Catherine Burch, Executive Director; LuAnn McCormick, Ph.D., Director of Special Projects; Peggy Gleason, Program Assistant.

Contact: Catherine Burch R.N., M.S., Executive Director, Maternal Infant Network of the Capital Region, 307 Hamilton Street, Albany, NY 12210. Telephone: (518) 426-1153. Fax: (518) 426-1237. E-mail: mincr@crisny.org

Web page: www.crisny.org/not-for-profit/mincr

See map, C9-11





NASSAU COUNTY TEENAGE PARENTING PROGRAM




Introduction

The poor health of those pregnant and parenting teenagers who do not receive early and consistent health care frequently results in premature births, infant mortality, low birth weight babies, toxemia, anemia in both mothers and babies, infections, poor nutrition, neural tube defects, poor dentition, and delays in leading a productive life.

Teenage pregnancy and the resultant poor maternal and infant health are a major concern in Nassau County. Recently, the Nassau BOCES Teenage Parenting Program (TAP) coordinated a Teenage Pregnancy Prevention Conference that was attended by over 168 participants representing Nassau County School Districts and over 75 community agencies. This attendance reflects the growing concern in Nassau County for young pregnant and parenting teenagers and their babies.

Progress is easily measured because pregnant teenagers remain in constant contact with collaborative partners. Teenage mothers who deliver at the Nassau County Medical Center are followed up with a home visit by the TAP nurse and return to the TAP school with their babies six weeks after delivery. The poor health attributed to teenage mothers and their babies is significantly reduced as a result of these collaborative efforts.


Mission/Purpose

The mission of the collaborative partnership is to provide pregnant and parenting teenagers with the support of professional staff of the Board of Cooperative Educational Services (BOCES) of Nassau County Teenage Parenting Program (TAP) and Prenatal Care Assistance Program (PCAP) at Nassau County Medical Center (NCMC) and Nassau County Medical Centerís Department of Obstetrics and Gynecology Perinatal Parenting Educational Program. The collaborative provides an inclusive, safe, nurturing environment for over 106 pregnant and parenting teenagers and their babies in Nassau County, regardless of race, creed, citizenship status, or financial resources.

The TAP Program is a full-time alternative high school program that helps pregnant and parenting teenagers earn high school diplomas, master parenting skills, and improve their employability. Six on-site nurseries currently provide child care to 74 babies, ages six weeks to three years old. The nursery capacity is 80 children. The consequences of teenage pregnancy are very serious: poor maternal and infant health, limited education, lower earnings, and high poverty rates. Researchers consistently find two broad factors that predict early sexual activity, adolescent pregnancy, and nonmarital childbearing among teens: early school failure and poverty. The future does not hold great promise for a teenage mother and her child. Two out of three pregnant teenagers drop out of school. With her education cut short, the teenage mother may lack job skills. The income of teen mothers is half that of women who first give birth in their twenties. The teenage mother may become financially dependent on welfare. Eighty-seven of the 106 TAP students are eligible for and participate in the federal governmentís free breakfast and lunch program and receive Medicaid services for themselves and their babies. During the 1997ñ98 school year, TAP received a VATEA grant from the New York State Education Department on Quality Child Care for All Children: Inclusion of Special Needs Children.

The goal of the Prenatal Care Assistance Program at Nassau County Medical Center is to provide early and continued prenatal care to all women. PCAP began in 1994. Each year, PCAP serves approximately 500 women in Nassau County. Participation in PCAP includes the following services: prenatal medical testing, clinic visits and examinations, education, follow-up care, family planning services, HIV counseling and testing, social work intervention, nutritional counseling (dietitian), WIC, and Medicaid processing. These services are offered multilingually.

The NCMC Perinatal Parenting Education Program of the Department of Obstetrics and Gynecology provides women with prepared childbirth classes. This program offers the following inpatient educational services: prenatal care, baby care, postpartum care, lactation instruction from a certified lactation specialist, and family planning services prior to discharge. This program serves approximately 2,200 patients per year.

The purpose of joining together in this collaborative venture is to provide early and continued high-quality health services and care to more than 106 students enrolled in the TAP program each year.

Students, because of difficulties they encounter and their youth, do not always know about the services available in the community. Simply informing them of these services does not guarantee that they will follow through and obtain needed help. In conjunction with the collaborative, TAPís nursing staff physically introduces the students to the perinatal service providers available at NCMC. TAP buses students to NCMC. TAPís goal is to educate young pregnant and parenting adolescents on how to access quality medical care for themselves and their babies. This is an ongoing process that provides them with the capability of learning the value of good health care for themselves and their families.

This project has been in existence for the past six years. The initial efforts of this collaboration, although fruitful, did not encompass all of the needs of the pregnant and parenting teenage population. With the advent of the PCAP program and the realization that quality health care should encompass many areas extending beyond the studentsí immediate pregnancies, the collaborative became more united. More formal guidelines were established, in addition to more frequent communication. The PCAP and perinatal nurses participated in conferences at TAP and in TAPís Career Day Program and Open Houses. They also visited nurseries and met with mothers and babies who were recipients of their services. PCAP and perinatal nurses refer pregnant and parenting teens to TAP. The TAP program is committed to providing a thorough and complete parenting education program. In order to prevent duplication of services, TAP has identified NCMC as a quality care provider. TAP enrolls students in prepared childbirth classes at NCMC. Students are bussed to NCMC for tours of its Maternity Unit, including the Neonatal Intensive Care Unit. TAP students become familiar with the care providers in the Obstetric Department and familiarize themselves with the physical layout of the unit and the process of admission, hospital stay, routines, and discharge. The students are informed that the labor and delivery services acts as an emergency room for pregnant women when necessary. The information and education offered during these visits cannot be duplicated at TAP. The Nassau County Medical Center recognizes the pregnant teen as a unique and high-risk patient and, therefore, provides care in a separate and distinct Teenage Pregnancy Clinic.

Students enrolled in TAP are assigned to nurseries, where they receive an informal education through instruction and modeling. Nursery issues are also addressed in formal child development classes at TAP, which are taught by a licensed health education teacher. Pregnant students rotate throughout TAPís six nurseries. After students deliver and complete a six-week maternity leave, they return to school. Their babies are placed in the newborn infant TAP nursery, and as they develop, they move ahead into one of the five developmentally appropriate nurseries. During nursery periods social, medical, and spiritual issues are discussed. Through these discussions, specific needs of the teens are identified.

Teenage pregnancy is a local as well as a national concern. The consensus of service providers, the public, key policymakers, and the business and faith communities is that with a high school education, job training, quality medical care, parenting skills, and access to other social programs, the cycle of teenage pregnancy can be broken. This collaboration is an effort to bring this to fruition.

Each agency that participates in this collaborative receives public funding. The nursing staff of these agencies identified the needs of young teenage mothers who sought their services, identified the available resources, and proposed this project. The project was approved and the results have been very satisfactory.

Participants are the projectís best spokespersons. They have mobilized community interest and involvement in the project. The partnership collaborators also speak before civic organizations such as the local chapters of the American Association of University Women and the Lions Club. A panel of specially trained teenage parents give presentations at local high schools, colleges, and at the Mother-Child National Symposiums.

Seventy healthy babies are born each year at Nassau County Medical Center as a result of this collaborative.

Resource constraints are of a financial nature.

The collaborativeís vision of a healthy community is one in which all individuals are spiritually, mentally, socially, emotionally, and physically well.


Leadership Role

The leadership and design of this project was established through Nursing Networking between the Nassau BOCES-TAP, PCAP, and Parenting Education of NCMC. In-service programs at TAP have enhanced the partnershipís effectiveness.

The collaborative partnership has received the support of administrative officers of Nassau BOCES and NCMC. The team meets regularly on-site at the TAP program and at the Nassau County Medical Center. The school leadership acknowledges the needs and poor health of pregnant and parenting teenagers and their infants and coordinates schoolwork to accommodate health issues and clinic visits.


Key Partners/Stakeholders

The principal partners in the collaborative are: Patricia McCabe, R.N., Board of Cooperative Educational Services of Nassau County, Teenage Parenting Program; Rose Galla, R.N., Principal, Board of Cooperative Educational Services of Nassau County, Teenage Parenting Program; Donna Duffy, R.N. Nassau County Medical Center, Perinatal Services; Susan Hutton, R.N., Nassau County Medical Center, PCAP; Barbara Frazer, R.N.,Nassau County Medical Center, PCAP.

Members of the collaborative meet regularly to discuss and refine the projectís processes. Community representatives from health and social service agencies are invited to keep us up-to-date on the needs of identified pregnant and parenting teenagers. Mary McNulty, supervisor of Teenage Parent Services at the Nassau County Department of Social Services, meets with the collaborative on a regular basis. Referrals to the department are made by the collaborative for any necessary services. The department also makes referrals to the collaborative.

The partnership is open to additional stakeholders. Any enhancements or suggestions to better serve the needs of participants are gladly welcomed.

The following mechanisms are aimed at gaining meaningful participation from the targeted population. Nassau County Medical Center is an identified PCAP provider and a WIC center. NCMC has a Medicaid processing center and family planning unit. NCMC advertises its services on local television and radio networks. It also sponsors Womenís Health Fairs and conducts Open Houses. The Nassau BOCES TAP program conducts Open Houses and operates an arm of the 56 school districts in Nassau County. TAP receives referrals from the local schools, coordinates an annual Teenage Pregnancy Prevention Conference, and conducts monthly Parent Teacher Student Association Meetings and Fathers Groups.


Impact/Effectiveness

The mutual benefit to the partners is a greater resource base. The benefit to participants is the availability of complete services in a user-friendly environment with follow-up and continuity. The TAP program provides a strong, full-day academic high school program leading to a high school diploma. TAP has many wonderful services to offer to pregnant and parenting teens. However, it realizes that the same services are better provided in other environments and has identified the Nassau County Medical Center as an excellent provider of these servicesófor example, on-site WIC, counseling services, and family planning services. Conversely, the Medical Center recognizes the need for pregnant and parenting teens to attend a specialized high school program that leads to a high school diploma, provides parenting education, role modeling in parenting skills, and a peer support group for this specialized population.

The expected outcome is the delivery of a healthy baby and a healthy, maturing mother who is prepared to meet the challenges of parenthood and become a contributing member of society.

Contact: Patricia McCabe, R.N., Teenage Parenting Program, 2165 Seaford Avenue, Seaford, NY 11783. Telephone: (516) 826-1528. Fax: (516) 826-6178.

See map, D9





PLANNED PARENTHOOD OF BROOME AND CHENANGO COUNTIES CO-LOCATION PROGRAMS WITH UNITED HEALTH SERVICES HOSPITAL AND CHENANGO MEMORIAL HOSPITAL




Mission/Purpose

The success of the ìEnhancing Patient Access Through Co-locationsî project is attributable to a common vision and mission by Planned Parenthood of Broome and Chenango Counties (PPBCC); Chenango Memorial Hospital (CMH), a member of United Health Services; and United Health Services Hospitals (UHSH), also a member of the United Health Services Health Care System. The uniqueness of the co-location programs is that the working relationships among the three organizations demonstrate how an organization (PPBCC) located within two counties can effectively work within a comprehensive health care system to meet a continuum of health care needs in diverse communities.

The common vision of each agency is to improve the functional life span and to reduce health disparities among the residents in the target service areas.

The common mission is to serve the people of our region through programs designed to improve or maintain health and to provide patient-centered health services in a caring, competent, compassionate, and convenient manner. Each agency strives to provide services that are affordable and well organized and to meet the needs of patients and their families either directly or indirectly through collaboration with other agencies. Each program embraces a philosophy of removing barriers of access to care through co-location to achieve a healthier community. It was determined that co-location of services would result in the most cost-effective care to the community. All agencies involved guarantee access to care regardless of a clientís ability to pay.

Each agency has developed strong partnerships with health care providers, community organizations (e.g., Mothers and Babies Perinatal Network; NY-PENN Health Systems Agency; Chenango Health Network; Adolescent Pregnancy Prevention Coalition; Community Health Status Teams; Broome County Infant Mortality Team; and the Healthy Womenís Partnership, which provides access to services for breast, cervical, and colorectal/prostate cancer screening and education), local and state health departments, and through feedback from community residents. Additionally, PPBCC, CMH, and UHSH participated in the New York State Department of Healthís regional meetings entitled ìCommunities Working Together For a Healthier New York.î PPBCC, CMH and UHSH have incorporated NYSDOH and community partnership recommendations into strategies to address cases of poor health and to enhance health status through the development and implementation of two unique, collaborative co-location programs.

Program #1: Primary Care at Planned Parenthood
During the latter part of 1994, PPBCC and UHSH identified a community need to provide comprehensive primary and preventive health care and prenatal care to patients being seen at PPBCCís downtown Binghamton location. Planned Parenthood concluded, and UHSH concurred, that it would not be cost effective to independently provide a full range of primary care.

When discussions began relative to meeting these needs, the service areaís census tracts were identified as being federally underserved. There were no primary care providers in the target area, and 60 percent of PPBCCís Binghamton patients and their families did not have access to on-site comprehensive primary and preventive care and prenatal care services.

An action plan was developed in 1995 and implemented in August 1996 to include the provision of primary and preventive care and prenatal care services to all age groups and both genders. The provision of on-site services removed the barriers to access to care associated with lack of transportation and patient reluctance to receive care from multiple providers in multiple locations.

Program # 2: Reproductive Health Care Services at Chenango Memorial Hospital Family Care Sites
Planned Parenthood of Broome and Chenango Counties and Chenango Memorial Hospital entered in to an arrangement in 1997 that allows PPBCC to provide reproductive health care services on-site at two of CMHís Family Care Centers located in Greene and Bainbridge, New York.

Through this collaborative effort, PPBCC provides reproductive health care services at rural sites for women who would otherwise have to travel long distances to obtain care. By accessing services at PPBCC, women who are uninsured or underinsured can obtain services at an affordable cost, either on a sliding fee scale or at no charge.


Leadership Role

A matrix leadership structure existed during the design and implementation phase of the two projects, with each agency having representation from administrative, clinical, operational, and financial departments. Throughout the development of the project, staff from both parties worked in a very collaborative manner. In both scenarios it was determined that Planned Parenthood should provide the primary leadership and that each partner would have equal status in joint decision-making issues. Each agency agreed to adhere to joint standards of care and to reference each otherís policies and procedures in the administration of the respective programs. A collaborative relationship exists relative to the ongoing evaluation and programmatic enhancements of the services provided.


Key Partners/Stakeholders

Two distinct partnerships exist. The first is between PPBCC and UHSH, and the second is between PPBCC and CMH. An annual assessment is done to determine if programmatic changes need to be made and/or the partnership needs to be expanded to meet the needs of the clients.


Program #1: Primary Care at Planned Parenthood

The decision for PPBCC and UHSH to become partners in the provision of comprehensive primary and preventive care and prenatal care services was based on the common vision and mission of each organization as aforementioned.

Program needs are addressed on a continual basis through monthly joint leadership and staff meetings. Feedback is elicited from the providers and patients through personalized communication and satisfaction surveys. This feedback is then incorporated into program redesign. Several examples of this occurred during the first and second year of the program and include, but are not limited to the following:


The roles and responsibilities of each partner are identified in a Letter of Agreement as follows:

Program #2: Reproductive Health Care Services at Chenango Memorial Hospital
The primary roles of each organization include:


Impact/Effectiveness

Program #1: Primary Care at Planned Parenthood
The expected outcomes of the UHSH Primary Care program at PPBCC Binghamton location were to:

The impact on healthy birth outcomes was first monitored in the fourth quarter of 1997 through the Binghamton-based Perinatal Network and United Health Services Hospitals. Data will be forthcoming.

The program also supports other state and local initiatives to improve the communityís health status through improved nutrition, earlier intervention for mental health issues, and education on the incidence of poor health due to chronic diseases such as asthma and diabetes.

Program #2: Reproductive Health Care Services at Tenneco Memorial Hospital
The expected outcomes for the PPBCC reproductive health care services at CMH rural sites were to:

The impact on healthy birth outcomes was initially monitored in the fourth quarter of 1997 through the Binghamton-based Prenatal Network and United Health Services Hospitals. Data will be forthcoming.

The program also supports other state and local initiatives to improve the communityís health status through improved nutrition, earlier intervention for mental health issues, and education on the incidence of poor health due to chronic diseases such as asthma and diabetes.

The three agencies will continue to collaborate to bring accessible services to the residents of the two counties served by these cooperative arrangements. Through client feedback, community networking, and continuous internal quality improvement, we are confident that the strategies will result in further comprehensive integrated services that maximize availability of services and meet local, regional, and New York State objectives for healthier communities.

Contact: James B. OíHora, A.C.S.W., C.S.W., President and CEO, Planned Parenthood of Broome and Chenango Counties, Inc., 168 Water Street, Binghamton, NY 13901. Telephone: (607) 723-5130. Fax: (607) 723-4087. E-mail: JBOCEO@aol.com

See map, B10,13





PUERTO RICAN YOUTH DEVELOPMENT AND RESOURCE CENTER
ROCHESTER




Mission/Purpose

The mission of the Puerto Rican Youth Development and Resource Center, Inc., (PRYD) is to advocate for and enhance the quality of life of Hispanic children, youth, and their families and thereby help build a better community in the Monroe County area. This is achieved by providing services in the areas of education, health, leadership development, cultural enrichment, and employment, and by providing positive role models. The agencyís special emphasis is on youth who face socioeconomic challenges.

PRYD has taken an active role in working to improve the health and wellness of Rochesterís Hispanic community through collaboration with area health care providers, community-based organizations, and the Rochester City School District. Some examples of programming are the following:

Wellness Centers and Student Support Centers
PRYD is the lead agency at the Edison Technical High School Student Support Center. The agency is also a founding member of and the only Latino agency in the Jefferson and Charlotte Middle School Wellness Centers. PRYD also participates in on-site collaboratives at East High School, Franklin High School, Dr. Freddie Thomas Learning Center, and Frederick Douglass Middle School. These collaboratives consist of partnerships among community-based organizations, the public schools, health care providers, and other neighborhood service providers to deliver comprehensive and coordinated services to Rochester City School District pupils, their families, and, in some instances, neighborhood residents. These include physical, mental health, and dental services; counseling; case management; advocacy; and crisis intervention. PRYDís special role is to provide culturally and linguistically appropriate counseling, case management, and crisis intervention services to Hispanic youth at risk for or showing signs of substance abuse and those with behavioral, relationship, and academic problems. The goal of the collaboratives is to provide the services necessary to produce children and families that are healthy, self-sufficient, fully prepared for work and post-secondary education, and, ultimately, active contributors to an improved community.

PRYD was a forerunner in providing services on-site in local schools. Before the formation of any of the wellness or student support centers, the agency had counselors with office hours at several schools. PRYD is also the only agency providing these types of services to Hispanic middle school and high school youth. PRYDís experience and expertise made it a likely candidate to become a founding member of several of the collaboratives, serve as the lead agency at Edison Technical High School, and serve on several policy committees. The agencyís input and guidance are encouraged and appreciated.

These projects were initiated by CHANGE, a collaboration between the city of Rochester, Monroe County, Rochester City School District, and United Way. In 1993 a needs assessment was conducted in the neighborhood surrounding the Jefferson Middle School, including the input of a representative mix of neighborhood residents.

An analysis resulted in the selection of services to be provided and in the invitation of local health agencies and community-based organizations, including PRYD, to participate. Several organizational meetings were held with members of the CHANGE Collaborative, school personnel, and agency personnel to coordinate the effort. In the fall of 1994, this pilot initiative was implemented in a wing of the school known as the Jefferson Wellness Center. A similar process was undertaken in the formation of each subsequent school collaborative.

This is truly a comprehensive cooperative effort across all sectors in the city of Rochester. It involves intense cooperation among diverse service providers, the school district, neighborhood residents, and funders including the United Way, Department of Social Services, and the Youth Bureau. The centers were developed with full input of all parties.


AIDS Case Management and Prevention Programs
PRYD provides effective case management and service coordination for Hispanic persons affected by or infected with HIV/AIDS. The agency maintains membership in RATFA (Rochester Area Task Force on AIDS), and staff sits on the service subcommittee. Additionally, 1997 saw the inception of Proyecto PrevenciÛn, a new HIV/AIDS prevention program that provides educational workshops to Rochester youth and families and incarcerated Hispanics of limited English proficiency. In this way, the agency is able to provide a full continuum of HIV/AIDS services, from prevention to case management, counseling, and service coordination. These programs serve a vital need, given the increasing prevalence of AIDS among Hispanics. In New York State, Hispanics are diagnosed with AIDS at seven times the rate of non-Hispanics. PRYD provides vitally necessary HIV/AIDS services to the Hispanic population in a culturally competent and linguistically appropriate manner.

Proyecto Ayuda Outreach (PA-O) Program (Substance Abuse and Intervention) PA-O counselors provide counseling, case management, and crisis intervention to Hispanic youth at risk for or showing early signs of substance abuse on-site at Rochester City Schools wellness centers and collaboratives. The counselors also provide educational workshops and outreach for youth and parents in conjunction with the schools and several community-based organizations. Furthermore, the counselors provide cultural sensitivity workshops to the staff of other agencies serving the Hispanic community in an effort to facilitate better communication with their clients.

The HIV/AIDS Case Management Program provides case management, counseling, and service coordination services to Hispanics. It is a Ryan White program funded through the AIDS Institute in response to the increasingly high number of Hispanics with HIV/AIDS in the Rochester area. The case manager provides culturally sensitive services. Over 75 percent of clients are of limited English proficiency and are therefore counseled in Spanish. These individuals are unable to access the services they need without help. The case manager represents the needs of the Hispanic community on RATFA. The agency has several memoranda of agreement with different health care facilities and community organizations to better serve the needs of its clients.

Proyecto PrevenciÛn was formulated in response to a federal announcement of funds from the Centers for Disease Control for community-based HIV Prevention Programs. PRYDís analysis of state and local epidemiology profiles and local services indicated a need to provide culturally and linguistically appropriate prevention services to two groups: limited-English-proficient Hispanic youth within the family context and limited-English-proficient incarcerated Hispanics. Interactive workshop series were designed, based on behavioral science and other research, to assist in the delivery of effective prevention services. The pilot workshop series for incarcerated individuals began in April 1998; a similar program for Hispanic youth began in May. This exciting new program is still evolving. Currently, the program collaborates with local correctional facilities and state and local health departments in providing services.

Proyecto Ayuda Outreach has been in existence for over ten years. The purpose of the program is to provide culturally relevant services to Latino youth and families, including prevention, early case management, substance abuse counseling, youth awareness workshops, parent awareness workshops to address risks of drug use, distribution of outreach materials, and cultural sensitivity workshops for service providers working with Hispanic youth and families. The program addresses gaps in services identified by the ìComprehensive Alcohol and Drug Services for the Hispanic Communityî study, providing bilingual and bicultural staff, culturally appropriate services, and outreach and intervention services specifically designed for and targeted to Hispanic youth and families.

PRYD has a history of working with a variety of public and private institutions. The agency is the recognized leader in this community in providing effective substance abuse and HIV/AIDS services to the Hispanic community. PRYDís ability to provide competent multicultural services helps the agency to build the consensus necessary to support its programming efforts.

PRYDís vision of a healthy community is one in which all members have access to a variety of services and supports to ensure healthy, productive lives. These services and supports are not limited to physical and mental health treatment but also include prevention services, those designed to enhance youth and individual development, educational services, vocational services, and so on. A healthy community is one in which all segments contribute to the setting of priorities and policies for the fulfillment of community needs. All members have access to culturally relevant services. PRYD serves as a bridge linking consumers with providers of much-needed resources.


Leadership Role

Wellness Centers and Student Support Centers
The Wellness Centers are overseen by the CHANGE Collaborative; the Student Support Centers are overseen by the Youth Services Quality Council (YSQC) Collaborations Workteam, which consists of representatives of CHANGE and lead agency staff. These entities deal with the larger issues affecting the collaboratives across the board. Each collaborative, with the exception of Jefferson, is also run by a lead agency that sees to the day-to-day operations. Most have policy committees that meet on a monthly basis. PRYD is the lead agency at the Edison Technical High School Collaborative, coordinating services there. PRYDís executive staff actively participates on the policy committees of the Rochester City School Districtís wellness centers and collaboratives, ensuring that the needs of Hispanic students are recognized and met. Additionally, PRYD is a member of the YSQC Collaborations Work team.

Each year, CHANGE and the funders invested in the collaboratives offer several training opportunities in family worker skills, adolescent development, asset building, facilitation skills, and supervisory skills in an effort to build the skills of the direct service and management personnel involved.


HIV/AIDS Programs and Proyecto Ayuda Outreach
These programs operate out of PRYD. Proyecto Ayuda Outreach staff is supervised and directed by the executive director and director of programs who, in turn, are directed by the board. The board is a representative mix of individuals with experience in law, human services delivery, education, and law enforcement, and includes a former participant in the agencyís substance abuse program. Final decisions on program policy and operation rest with the board and executive director, but the expertise of program staff and input from consumers on program evaluation forms are fully considered and incorporated whenever possible.

PRYD has offered several intensive staff development opportunities to all program staff, including those in the HIV/AIDS and substance abuse programs. Program staff have attended several training opportunities and conferences; staff members also participate on several committees, including RATFA and other substance abuse and HIV/AIDS-related committees, to enhance interagency cooperation and sharing of program methods and service delivery strategies.


Key Partners/Stakeholders

Wellness Centers and Student Support Centers
Partners providing on-site services include several health care providers (including Eastman Dental Center, Threshold, Rochester Mental Health, Park Ridge Chemical Dependency, and Planned Parenthood) and several human services agencies (including Baden Street Settlement House, Urban League, Hillside Childrenís Center, Center for Youth Services, and Action for a Better Community) as well as counselors, teachers, and administrative staff of the host schools.

As described above, these collaboratives were formed as a result of cross-sector cooperation among several Rochester organizations, agencies, and entities, including CHANGE, the school district, neighborhood residents, and nonprofit organizations.

As these collaboratives have evolved, each site has identified additional needs not addressed by existing partners. In these cases, the policy or management team has identified providers that can fill the gaps and has invited them to join. The memorandum of understanding is amended to add the new partners. CHANGE and the YSQC Collaborations Workteam have identified a need for additional mental health services in the collaboratives and are currently negotiating with several providers to meet that need.

Each collaborative has its own structure. In general, most have a policy and/or management team that meets monthly or every few months. Edison has a management team that deals with day-to-day issues such as arranging coverage, assigning cases, and coordinating services. This team is made up of agency and school direct service personnel who provide on-site services to the collaborative. An advisory committee consisting of school and agency management personnel looks at policy issues pertinent to the collaborative.

There are two types of partners involved: on-site and linked. On-site providers assign direct service staff to the collaborative at regularly scheduled time periods. These providers offer services directly at the school. Linked providers do not offer coverage but may come in for special purposes, such as running a short-term support group or doing a crisis intervention.


HIV/AIDS and Proyecto Ayuda Outreach
These programs operate out of PRYD. The AIDS/HIV programs have memoranda of understanding with Strong Memorial Hospital, the Jordan Health Center, and other providers to enhance service delivery and coordination. These programs also maintain linkages with the local correctional facilities and county and state health departments for delivery of prevention services and the coordination of HIV testing and other services. Proyecto Ayuda Outreach and other PRYD programs are included in the memoranda of agreement with schools and other service providers in the on-site school wellness centers and student support centers for provision of services.

The input of PRYD consumers with respect to program delivery is solicited through the evaluation forms completed after program services have been obtained. A former Proyecto Ayuda Outreach client serves on the board of directors and informs policy. Staff members participate on a variety of community committees and task forces, thus ensuring the exchange of ideas and strategies for program delivery.


Impact/Effectiveness

Wellness Centers and Student Support Centers
The expected result of this project is that Rochesterís youth and families will have access to comprehensive, coordinated servicesóeasily accessible through their neighborhood schoolóthat accommodate their needs. The Center for Governmental Research is currently evaluating the effectiveness of the collaboratives. Additionally, each collaborative prepares a year-end report that summarizes data on the individuals served, services received, partners through which services are obtained, and the results of those services.

The schools themselves do not have all the resources necessary to deal with the personal, family, and health problems that affect their studentsí academic success and school behavior; they are now able to easily access these services through the on-site providers. These agencies are provided direct access to a large number of clients and are able to easily coordinate services with other on-site providers to accommodate students and families with multiple needs.

Although some special grant money has supported construction, renovation, and limited initiatives, the majority of resources are drawn from existing budgets. Agencies, schools, and health organizations take personnel already funded and onboard for programs and reassign or partially reassign them to the collaboratives.

Centers are now established at several area high schools and middle schools. The Center for Governmental Research and the funders are now conducting studies to evaluate the effectiveness and outcomes of these efforts.


HIV/AIDS Programs and Proyecto Ayuda Outreach
Project objectives for each program are negotiated with the funders concerning the number of persons served, type of services provided, and expected outcomes. PRYD tracks progress toward these objectives by collecting data such as pre- and post- test results, evaluation forms, case management outcomes, and so on. This data is reported to funders on a monthly or quarterly basis and in annual reports. Funders monitor the programs through analysis of these reports and annual or biannual site visits. During 1997 OASAS (Office of Alcoholism and Substance Abuse Services) did extensive evaluation of Proyecto Ayuda Outreachís services. This evaluation resulted in a three-year recertification, the longest term possible.

Consumers of substance abuse and HIV/AIDS services are provided with culturally appropriate prevention, counseling, and case management services that meet their needs. Many of the health care providers and agencies that collaborate with PRYD have praised its ability to enhance their own resources by providing training, service coordination, and improved access by Hispanic clientele.

The HIV/AIDS Case Management Program is funded through Ryan White and staffed by a full-time counselor. Proyecto PrevenciÛn is funded through the Centers for Disease Control and staffed by a full-time Prevention Educator, part-time manager, and part-time secretary. Proyecto Ayuda Outreach is funded by the Office of Alcoholism and Substance Abuse Services and United Way and staffed by two counselors.

These programs are well respected in the community and are seen as a valuable resource for the Hispanic community.

During 1997 the HIV/AIDS case management program served 56 clients. Proyecto Ayuda Outreach provided outreach materials to 7,369 individuals. Educational workshops were presented to 85 parents and 188 youth, and cultural sensitivity workshops were offered to 121 professionals. Thirty-eight youth received prevention case management services. Seventy-seven percent of the youth and 79 percent of the parents who attended workshops reported having increased their knowledge of drug and alcohol abuse; 84 percent of the youth stated that they would continue to be abstinent or no longer use substances. In the case management component, 80 percent of case closures indicated progress.

Proyecto PrevenciÛn is still in the pilot phase. Its goal is to present the health education and risk reduction workshop series to 200 Hispanic adolescents, 100 parents, and 60 incarcerated Hispanic individuals. PRYD anticipates that 75 percent of participants will increase their knowledge of HIV and AIDS transmission and prevention, and that 75 percent will report implementing at least one risk reduction behavior or continuing all risk reduction behaviors.

Two additional projects are briefly summarized here.

Neighborhood Fair PRYD hosts an Annual Neighborhood fair, at which over 20 agencies that provide health and other important services to Hispanic youth and agencies hold outreach and education activities. PRYDís event was the first health fair of its kind in this area. The Fair has improved access of the Hispanic community to a variety of health services. A representative sampling of agencies that attend includes AIDS Rochester, Cancer Action, Monroe County STD/HIV Clinic, Westside Health Services, and Community Health Network.

Hispanic Health Focus Group The executive director of PRYD, along with other Hispanic leaders, sits on a focus group that examines the health needs of Hispanics and networks with local health care providers to advocate remedies. The Hispanic Health Focus Group includes representatives from Ibero American Action League, Action for a Better Community, and Rochester City School District. The Hispanic Health Focus Group has been instrumental in getting area health care providers to actively recruit Hispanic staff, resulting in an increase in the number of Hispanics hired at several area hospitals.

Contacts: Nancy A. Padilla, Executive Director, Puerto Rican Youth Development and Resource Center, Inc., 997 North Clinton Avenue, Rochester, NY 14621.

Telephone: (716) 325-3570. Fax: (716) 325-3767.

E-Mail: PRYD@frontiernet.net Web Page: www.frontiernet.net/~pryd

See map, A9





THE LACTATION CENTER
BUFFALO




Mission/Purpose

Breast milk is the Gold Standard, the optimal nutrition for infants. Breastfeeding has proven benefits to the mother, baby, family, and society. Breastfeeding promotes healthier infants and healthier adults. Studies have shown that breastfed babies have fewer upper respiratory infections, allergies, and digestive problems than their formula-fed counterparts. New research is focusing on the possible link between breast milk and the prevention of many childhood diseases. Breastfeeding promotes a trusting one-to-one relationship, a sense of security and trust between mother and baby. However, as natural as breast milk is, breastfeeding is a learned skill.

In 1997 Sisters Hospital and the Erie County Health Department Women, Infants, and Childrenís Program (WIC) developed and implemented a Lactation Center to benefit all breastfeeding women in western New York. There are approximately 10,000 births per year within western New York, 3,000 of which are delivered at Sisters Hospital. Many of these women also participate in the WIC Program. There is an increased need for lactation services to help these women breastfeed their babies.

In keeping with Sisters Hospitalís commitment to the community, the purpose of the Lactation Center at Sisters Hospital is to provide a wide range of medical and health care services to all prenatal and postpartum women residing within metropolitan Buffalo, regardless of socioeconomic status, and to increase professional awareness of the importance of breast milk for infants.

The goal is to raise breastfeeding initiation rates to at least 75 percent at hospital discharge by the year 2000 and to achieve a sustained breastfeeding rate of 50 percent at six monthsí end to meet or exceed the goals set forth by the Surgeon General, World Health Organization/Unicef Baby Friendly Initiative, and the American Academy of Pediatrics, also by the year 2000. The formation of an interdisciplinary core group within Sisters Hospital would facilitate the implementation and completion of the ìTen Stepsî to becoming baby friendly by the year 2000.

The Baby Friendly Hospital Initiative is a global program sponsored by the World Health Organization and the United Nations Childrenís Fund to encourage and recognize hospitals and birthing centers that offer optimal levels of lactation care. The immediate goal of the Sisters Hospital/WIC project is to establish an enterprising retail store and breast pump rental station within the hospital to service all breastfeeding women with quality and affordable breastfeeding supplies.

Sisters Hospital saw as immediate priorities education, support, availability, and promotion. In October 1995 Sisters Hospital invited the Erie County Health Department WIC Program to come into the hospital on a regular basis to augment their existing lactation program by providing breastfeeding services to WIC participants and WIC-eligible mothers. Throughout the following year, it was noted both by WIC and the hospital in follow-up telephone surveys that an increased percentage of women receiving the additional lactation assistance during their stay continued to breastfeed beyond hospital discharge. In May 1997 a full-time lactation coordinator position was offered to Margaret Furlong, R.N., IBCLC, who, along with the WIC lactation consultants and McAuley-Seton Home Health (an affiliate of Sisters Hospital), saw the commitment of the hospital to improve lactation services and the potential for a collaborative effort between Sisters Hospital, McAuley-Seton, and the WIC Program. The plan was to increase the scope and services to the community at large by merging the Sisters Hospital Lactation Service with the WIC Breastfeeding Program to form the Lactation Center at Sisters Hospital. Most of the Buffalo area hospitals recognize the need for lactation consultants, but Sisters Hospital remains at this time the only hospital willing to make the long-term commitment to lactation services and outreach to the community. The lactation principals looked to the priority list to develop a plan of growth for the Lactation Center. It was determined that without education of both the mother and the hospital and WIC staff, the support component might not be achieved.

The principals developed a 40-hour Lactation Educators Course (LEC) for health professionals and through Dr. Mary Finnick at Millard Fillmore College, submitted a proposal to the State University of New York at Buffalo (SUNYAB) School of Nursing, requesting that it be offered at the university as part of its curriculum. The pilot class was offered October 10-16, 1997, on campus and included six registered nurses from Sisters Hospital, two McAuley-Seton home care nurses, two nutritionists from Erie County WIC, as well as a WIC peer counselor, and two private physician nurses. Sessions were taught by Margaret Furlong, Susan Leisner, and two physicians from the community who strongly encourage breastfeeding in their practices. Of the 13 students in the initial class, eight will sit the 1998 exam for lactation certification (IBCLE).

It is believed that by increasing the knowledge of the professionals working with the breastfeeding families both in-hospital and through follow-up, a solid support system would be created for these women to refer to when needed. Subsequently, the university was impressed with the LEC and absorbed it into the Millard Fillmore College curriculum as a three-credit SUNY course, making it one of less than ten university-affiliated lactation education courses in the U.S. and the only one in the eastern U.S. A second offering was taught in October 1997 and included nine registered nurses: two from Sisters Hospital, two from Childrenís Hospital of Buffalo, one from Buffalo General Hospital, one from South Buffalo Mercy Hospital, one from a local HMO, one from a private physicianís office, and one from the only retail breastfeeding store in Metro Buffalo. Following the second class, a core group of lactation specialists was established, forming a network that was capable of meeting the needs of any woman in western New York prenatally and throughout her entire breastfeeding experience. Additionally, monthly prenatal breastfeeding classes were being held at the hospital and at six other locations through WIC. They were open to anyone wishing to attend; a postpartum class was established biweekly at Sisters for moms 4-6 weeks following delivery.

In conjunction with the Lactation Educators Course, extensive in-servicing was being offered to the staff nurses at Sisters Hospital and at various WIC sites. These in-services offered current and accurate information regarding breastfeeding, which would be given to patients within the community. This created positive attitudes toward breastfeeding within the hospital and WIC. Physicians inquired about the lactation services being given to their patients, encouraging one-to-one in-servicing of the physicians.

Support was a logical conclusion to the education component due to the professional network that had been set up through the LEC. The support factor was key to the success of this program. Every new or potential breastfeeding mother who delivers at Sisters Hospital receives a visit from a lactation consultant/certified lactation educator. This consult includes individual lactation education as well as a clinical evaluation of breastfeeding techniques. If an immediate problem exists at discharge, the patient may be referred to a McAuley-Seton Home Care lactation consultant or a lactation consultant in a private office or agency. The support continues for these mothers and infants with a follow-up phone call 48 hours after discharge. Many new mothers are often apprehensive about breastfeeding; this call supports the mothers who are doing well and intervenes with mothers who are having difficulty. Patients are also given written information on breastfeeding and a phone number where they can reach a lactation consultant with questions or concerns. The Lactation Center phone line is available 24 hours a day. There is a lactation consultant in-house every day. Incoming calls during the evening or at night are triaged in the nursery and then referred to a lactation consultant on-call or to the lactation consultant in the morning. With the opening of the Lactation Center, women could be seen within hours of calling anyone in the professional network, if necessary. The hospital also supports employees who are breastfeeding. A Medela electric pump is located within the Lactation Center for use by staff when they are separated from their babies while at work.

Promotion is an immediate priority. Efforts have been undertaken to inform the community of the commitment that Sisters Hospital and Erie County WIC have made to breastfeeding and healthy families. An information letter regarding the Lactation Center and its services was sent to all obstetric and pediatric physicians in February, and referrals are increasing. Articles have been published promoting the Lactation Center in-house and throughout the community.

Announcements for the LEC have been printed in Medelaís Rental Round-Up, a national newsletter sent to hospitals and medical professionals. Most important, calls have been steady due to word-of-mouth by breastfeeding women who have taken advantage of Center services.

At this time, consensus of providers has not been formally measured due to the infancy of this project. However, positive feedback has been noted from patients, physicians, and community agencies. The director of Womenís Services, Jenny Bagen, and the director of the WIC Program, Robert E. Major, have witnessed the immense growth of the Lactation Center in a short period of time. They continue their support in helping to achieve the goals of the Initiative.

A community that offers the maximum opportunities to all its children, including the best quality health care, is one that guarantees a healthy future for the community. Our vision is to achieve the goals outlined by the World Health Organization/UNICEF Baby Friendly Initiative and to become the first baby friendly hospital in New York State. Currently, Sisters Hospital meets eight of the ten objectives set forth by Baby Friendly USA and UNICEF. To date, only eleven U.S. hospitals have been designated as baby friendly. However, globally, more than 13,000 hospitals have received this award. Provision of a baby-friendly environment will enhance the community by providing education to families, health providers, community leaders, and the community at large.


Leadership Role

Lactation services at Sisters Hospital are overseen by Margaret Furlong, R.N., IBCLC, and through WIC by Susan M. Leisner, R.D., C.D.N., IBCLC. The Lactation Center design and implementation has been a joint venture between Sisters Hospital and the Erie County Health Department WIC Program since its inception. This project is unique to New York State in that it merges preexisting private and public health programs to increase overall community service. The program is managed by Margaret Furlong and Susan Leisner and coordinates efforts through Sisters Hospital and WIC to provide education, follow-up, community referrals, and promotion. Additionally, Sisters Hospital has provided the physical space for the Lactation Center as well as financial assistance, public relations, and encouragement. SUNY at Buffalo made possible the education of the original team members from Sisters, WIC, and McCauley-Seton Home Health. The newly created Catholic Health System will allow for the expansion of lactation services throughout its agencies. The referral network already in place will assure the continued growth of the project. However, the potential does exist for expanding the partnership with SUNY at Buffalo to include student experiences through the various medical programs.

Decisions are a collaboration of Sisters Hospital and the Erie County Health Department WIC Program. Input is solicited from the core group, clientele, and staff of both Sisters and WIC. Sisters Hospital is responsible for supplying and maintaining the physical center, screening all postpartum patients for WIC eligibility, and providing consistent lactation care to all women who deliver at the hospital. WIC is responsible for providing lactation and nutrition consult services to patients for a specified number of hours per week. In addition, the WIC lactation consultant coordinates all WIC generated breastfeeding referrals to the Lactation Center at Sisters Hospital. Educational and clerical duties are shared by both principals. Any outside agency breastfeeding referrals to WIC are also directed to the Lactation Center.


Key Partners

The principal partners are Sisters Hospital and the Erie County Health Department WIC Program.

The process used to ensure and promote participation within the community is governed by the open-door policy of the Lactation Center. Any breastfeeding postpartum woman in western New York, regardless of the hospital at which she gave birth or her ability to pay, is eligible for services through the Lactation Center at Sisters Hospital. In addition to the physicians previously noted, any agency that is affiliated or that refers to these organizations can also refer to the Lactation Center. The expansion of the core group beyond Sisters Hospital and the ECHD WIC Program promotes professional awareness of these services so that the program becomes accessible to all socio-economic groups.


Impact/Effectiveness

The outcome of this project will be measured against the goalsódefined by the Baby Friendly Initiative and the surgeon generalóof 75 percent breastfeeding initiation rate at hospital discharge and a sustained breastfeeding rate of 50 percent at six months postpartum. Statistical evaluation will be an ongoing activity of the Lactation Center at Sisters Hospital, and protocol for such statistical collection must be set up soon. Success will also be reflected in the actual growth of the Lactation Center and an increase in referrals and positive outcomes.

Both Sisters Hospital and the ECHD WIC Program stand to benefit in the following ways: Both organizations have demonstrated a commitment to improved health for women and infants through breastfeeding education and assistance. Additionally, with the increase in referrals and the institution of some form of payment for services, be it third-party reimbursement or self-pay on a sliding scale, both programs will be able to realize a reduction in budgetary allocations for breastfeeding costs. That income will be reabsorbed into the Center in the form of breastfeeding supplies and donated care for cases of financial need. The Lactation Center, as well as its principal institutions, will be able to increase public and professional awareness of the benefits of breast milk for newborns by educating and increasing the number of women it supports. This project, unique to western New York, offers a tangible example to the community that collaboration results in the sharing of expertise and the expansion of services, thereby benefiting everyone. Establishing the Center at Sisters Hospital, which is centrally located and easily accessible by both private and public transportation, has enabled clientele to receive quality care in a comfortable setting whenever needed.

The Lactation Center at Sisters Hospital is experiencing community support in the form of increased referrals for service as well as increased patient-initiated contact. As promotion continues within the medical community, an unprecedented interest in lactation support as an adjunct to many local medical practices is being seen. Some physicians are hiring in-house breastfeeding specialists; others are using the Lactation Center as their lactation source. Many physicians are sending staff to the Sisters/WIC Lactation Educators Course at SUNYAB for training. Interest in this course is also coming from Pennsylvania, Ohio, and New York State. Whatever the method, the result is that more nursing women are being helped when experiencing difficulty. This will become apparent as sustained breastfeeding rates increase in western New York.


Significant Milestones:

Change in any institution is difficult when barriersósuch as a perceived threat to the status quoóexist. Nurses and other medical professionals need to accept the changing environment with respect to infant health and the benefits of breastfeeding. One of the significant political problems is change. Community conflict arises when a society looks to its leaders for commitment to issues that affect their health and well-being but find no strength in the commitment. The current environment in health care today is increasingly territorial. Therefore, financial resources are being divided among many small areas, losing sight of the overall health needs of the community. The Lactation Center at Sisters Hospital brings the needs of the patient to the forefront by utilizing existing services and joining forces to enhance the quality of care for the health and well-being of its citizens.

Contacts:

Susan M. Leisner, R.D., C.D.N., IBCLC, Breastfeeding Coordinator, Erie County Health Department WIC Program, 120 West Eagle Street, Buffalo, NY 14202. Telephone: (716)-858-7989.

Robert E. Major, Director, Erie County Health Department WIC Program, 120 West Eagle Street, Buffalo, NY 14202. Telephone: (716) 858-7989. Fax: (716) 858-8121

Jenny Bagen, Sisters Hospital, Director of Womenís Services, and Margaret Furlong, R.N., IBCLC, Sisters Hospital, Lactation Coordinator. Sisters of Charity Hospital, 2157 Main Street, Buffalo, NY 14214. Telephone: (716) 862-1939. Fax: (716) 862-1436

See map, A4





VYTRA HEALTH PLANS MEDICAID PRENATAL CARE PROGRAM
NASSAU AND SUFFOLK COUNTIES




Mission/Purpose

Vytra Health Plans, a not-for-profit health maintenance organization, initiated a Medicaid product in 1992 as part of its mission to provide comprehensive, regional health care to the Long Island community. There were unique challenges inherent in serving recipients of Medicaid on Long Island. The region spans approximately 118 miles in length and contains urban, suburban, and very rural areas. Access to Long Island private physicians had been traditionally problematic for this population. The Vytra Medicaid program fostered access to over 2,000 private physicians located throughout the Long Island community. Initial growth of the Vytra Medicaid program was slow, allowing for systematic analysis of population needs over time.

In 1994, with two years of experience serving indigent Long Islanders, Vytra identified a disparity between the low birth weight rates of its commercial and Medicaid members. Vytra members enrolled commercially were delivering low birth weight babies at a rate of 4.4 percentóa rate below the national average. Vytra members enrolled through the Medicaid program, however, were delivering low birth weight babies at a rate of 9.09 percent, higher than both the national and Long Island averages.

Within the health care industry and the community at large, a health planís low birth weight rate is one accepted measure of a health planís ability to provide quality care to its members. Decreasing the incidence of low birth weight is vitally important to the overall health and welfare of the community because of the negative impact low birth weight can have on the quality of life of the infant and the family, the enormous health care costs associated with caring for a low-birth-weight infant, and the mortality associated with low birth weight newborns. These infants are 40 times more likely to die by age four weeks than normal weight babies. The cost of neonatal intensive care stays can exceed one hundred thousand dollars, and low birth weight babies can experience lifelong health problems. In Healthy People 2000, the federal government has identified the national priority of decreasing the incidence of low birth weight to no more than 5 percent of all live births.

Following the identification of the Vytra Medicaid low birth weight rate as exceeding the national average, an investigation into its causes ensued. Since the obstetrical care providers of the two populations were the same, and the providers were blind to the payor source of each group, it was hypothesized that the source of the disparity must lie beyond the traditional explanations of inferior access to prenatal care and discrimination based on financial means. After a review of the academic literature and numerous discussions among a multidisciplinary group of Vytra physicians, administrators, nurses, and social workers, Vytra initiated program design discussions with the Suffolk County Public Health Nursing Division.

This county government agency was identified as a resource because of its long history of public health service delivery to the indigent population currently served by Vytra Health Plans. They had also made a commitment to decrease the incidence of low birth weight infants among indigent county residents to address the regionís rising infant mortality rate. Long Island had been identified as a community with an infant mortality rate higher than the national average.

This partnership was unique from its inception. With Medicaid Managed Care penetration growing slowly, no local health departments in Vytraís service area had worked with a managed care plan on a community problem before. This partnership has evolved as a model of collaboration between local health departments in New York and managed health care plans.

With collaboration of the Suffolk County Public Health Nursing Division and Vytra Health Plans, a model prenatal program was designed. The program sought to decrease the incidence of low birth weight rates through the identification of pregnant members, assessment of their risk for delivery of low birth weight infants, and the implementation of specialized case management services delivered by a public health nurse, a Vytra staff nurse, or a Vytra Health Plan representative.

The program design is unique in several ways. Because low birth weight is not easily predicted, the assessment was designed to include both medical and psychosocial risk factors. In addition, all pregnant members, both those with and without risk factors, receive education on identifying preterm labor. Vytra was able to work with Suffolk County to update and expand low literacy educational materials that are used in the program. Another unique feature of this program is its ability to provide at-home case management services to women who exhibit identified medical and psychosocial risk factors.


Program Evaluation

The Vytra Health Plans Prenatal Program has been in operation for more than three years. Each calendar year several measures are analyzed. Since the primary mission of the program is to decrease the low birth weight rate, that remains the primary indicator of success. However, Vytra also measures its ability to identify women within the plan at risk of delivering low birth weight babies. Nationally, the most widely used criteria for prediction of low birth weight predicts only 50 percent of the low birth weight deliveries. Vytraís specialized risk assessment tool has proven to be a more consistent predictor. Finally, the level of program participation is measured to reflect Vytraís ability to promote and retain members in the program. The Medicaid Prenatal Program statistics for Nassau and Suffolk Counties are as follows:

Year

Number of Participants Low Birth Weight Rate Risk Identification Participation Rate Success
1994 No program 9.09 percent No risk No program identification
1995 127 3.9 percent 60 percent 80 percent
1996 156 5.8 percent* 73 percent 85 percent
1997 142 3.5 percent 99 percent 90.5 percent
*In 1996 there were two sets of twins delivered.
Vytra Health Plans took full responsibility for the financial cost of the program.

Following the initial implementation of the program, Vytra expanded into Nassau County. The model developed with the Suffolk County Public Health Nursing Division was replicated with the Nassau County Public Health Nursing Division. Both county agencies have since initiated similar contracts with other managed care plans.


Program Recognition

The success of the program has been recognized by the community. Whereas the Nassau/Suffolk low birth weight rate had been measured at 6.5 percent for all deliveries in 1995 and 6.4 percent in 1996, the Vytra Prenatal Program yielded an average rate of 4.4 percent for all deliveries by economically disadvantaged women enrolled in the Vytra Medicaid program over a three-year period (1995ñ1997). The Suffolk County Department of Health has since instructed all of its divisions to follow this model when initiating partnerships with other managed care plans.

The Vytra Medicaid Prenatal Program has also been recognized nationally by the Association of Maternal, Obstetric, and Perinatal Nurses. A representative from Vytra and the Suffolk County Public Health Nursing Division presented a scholarly paper at the Associationís annual conference in June 1998.

Vytra also improved the number of Medicaid women entering prenatal care in the first trimester from 46 percent in 1995 to 67 percent in 1996, which exceeded the New York State average of 54 percent. In both 1995 and 1996, the number of pregnant Vytra Medicaid women receiving the expected number of prenatal care visits was also above the New York State average. Data for 1996 revealed a rate of 79 percent of Vytra Medicaid women as compared to 63 percent of Medicaid women statewide.

Contacts:

Anne M. Weeks/Dara Cerwonka, Vytra Health Plans, 395 North Service Road, Melville, New York 11747. Telephone: (516) 577-5100. Fax: (516) 249-6620.

Mary Lou Boyle/Jane Corrarino, Suffolk County Public Health Nursing Division, Bureau of Public Health Nursing, Suffolk County Department of Health Services, 225 Rabro Drive, Hauppague, New York 11788. Telephone: (516) 853-3068.

See map, D9,10



 


 
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