Family health

The period of time from pre-conception through the child's eighth birthday is key in the growth and development which affect long term health and school success. Health can be measured in benchmarks related to access and utilization of health care. Women should have adequate and early prenatal care. Children should have a spacing of at least 24 months between births. Immunizations should be completed on time for children, and well child services should include physical, dental, and mental health.

Oklahoma ranks poorly in most indicators of maternal and infant health. In 2004, Oklahoma was the 8th highest state in the nation in the number of teen births for females ages 15-19 and ages 15-17 (2007). Oklahoma had the highest white infant mortality rate for l994 and l995 in the United States. The African-American infant mortality rate was twice as high as the white infant mortality rate. 70% of Oklahoma women identify their pregnancy as unintended or mistimed. (Oklahoma State Department of Health, Maternal Child Health, 2007)

The Tulsa County statistics are reflective of the State trends. Poverty plays a significant role in outcomes with 20% of all children in Tulsa County living in households that are at 100% of the poverty level or less. In 37 census tracts in Tulsa, the infant mortality rates exceed 13 deaths per 1,000 births. 33% of women give birth within 24 months of their previous birth. (Oklahoma State Department of Health, 2007)

Responding to the Need: the Family Health Coalition

The Tulsa Area Coalition on Perinatal Care (TACPC) was formed in early l987 in response to the relationship between lack of access to health care in the prenatal period and the number of infants with low birth weight, extreme low birth weight, and infant mortality. In 2000, the name was changed to the Family Health Coalition (FHC) as a result of the broadened mission to include children's and male family planning issues. The FHC develops strategies and implements those strategies through grants, task forces, community mobilization, social marketing, and advocacy which will reduce infant mortality and improve family health. The membership is comprised of over 160 representatives from over eighty public and private, health and human service organizations, business and consumers. The FHC mission is to work together through broad-based community representation to optimize the health and well being of women of childbearing age, infants, and families by establishing a system of universal and comprehensive quality support, education, prevention, and services.

New! Perinatal Continuum of Care and the Family Health Coalition, 2007 (PowerPoint presentation)

The FHC has been instrumental in developing and coordinating major components of the Tulsa perinatal system: (Insert link to perinatal system Powerpoint) Free Pregnancy Testing Program (l987), Babyline (l989), Planline (l990), Save Our Babies (l990), Margaret Hudson Program School-linked Expansion (l993), Tulsa Healthy Start (l997), Covering Kids (1998), state-wide conferences on infant mortality (1999-03), the maternal-infant and teen sexuality components of Turning Point (1999), Fetal Infant Mortality Review (1999), Kidsline (1999), Community Integrated Service Systems (2000), and HealthLink (2003). Volunteer leadership for the committee and task forces is from members of the community and agencies which make up the FHC.

FHC initiatives have resulted in a number of reports and projects, including regularly published quarterly statistical reports presenting service data collected from Babyline, Planline, Free Pregnancy Testing, and Tulsa Healthy Start programs. Copies of all reports may be obtained from the Community Service Council. The current publications include: Helping Mothers, Helping Babies: Improving Access to Prenatal Care in Tulsa County (l989), Patterns of Contraceptive Use Among Public Clinic Clients (l992), Public Family Planning Services and Utilization in Tulsa County (l994), the Tulsa County Profile (l995), the Analysis of Teen Births in Tulsa Oklahoma (2001), Update of the Analysis of Teen Birth in Tulsa Oklahoma for 2000 (2002), Pregnancy and Depression (2002), Review of Infant Mortality Using Linked Birth-Infant Death Data Set Tulsa County Oklahoma 1991-2000 (2004), A Review of Reproductive Indicators for Women of Minority Race and Ethnicity in Eastern Oklahoma (2005), and Babyline Trend Analysis 1990-2000 (2006). More data and reports

In 2006, over 15,000 low income and uninsured women, their babies and their families benefited from the work of the Coalition. Service providers, including hospitals, also benefited, as the Coalition's efforts helped promote greater efficiencies and reduced emergency room costs.

The FHC is the primary provider of planning and coordinating services in the public health system in the Tulsa area. The Tulsa Health Department, and the Oklahoma State Department of Health, Maternal Child Health (Title V) services participate on and implement programs of the Coalition.

Mission

The Family Health Coalition (Coalition) is committed to working together through broad-based community representation to optimize the health and well-being of individuals and families who are underinsured, uninsured and Medicaid enrolled women of childbearing age, infants and families by establishing a system of universal and comprehensive quality health education, prevention, services, and support.

The coalition does not discriminate in participation for service delivery to any person regardless of age, race color, creed, nationality, gender, religion, geography, socio-economic, sexual preference or veteran status. Every effort is made to engage participants from the consumers of services supported by the coalition.

Committees and Meetings

The Coalition meets every other month on the third Thursday at Noon. At this meeting, the various subcommittees address the activities of the previous month, conduct networking regarding program developments within the community, and promote the health interests of the community. Additional committees include:

Steering Committee: The Steering Committee represents the chairs of all committees, and at large members selected from the Coalition. The Committee develops the key issues and work plan for each year, organizes the Coalition meetings, and intervenes as needed between meetings of the Coalition to address burgeoning issues. The Committee meets the second Thursday of the month at 9:00 a.m.
2007 Key Issues, Family Health Coalition

Social Marketing: The Social Marketing Committee develops and conducts the social marketing and Training Institutes for the Coalition. Each year two social marketing campaigns are conducted to raise the awareness of consumers regarding the health and social issues surrounding family health.

The Committee meets the first Thursday of the month at 11:00 a.m.

Tulsa Hispanic Resource Association is an interagency committee of providers serving Spanish-speaking clients and interested in the welfare of the Latino community. The Association hosts an annual health fair, and Town Hall meetings addressing various issues of importance to the community. The Association has also published a community resource guide in Spanish. Tulsa Area Free Clinic Coalition Directory (April 2007) - in Spanish: Cover, Pages The Association meets the first Friday of the month at Noon.

Access Committee addresses various health care access issues and advocates for improved care for women and children. The Committee monitors the efforts of Babyline, Planline and Kidsline telephone services, and the Free Pregnancy Testing Program. The Committee meets on the 4^th Tuesday of the month at 9:00 a.m.
New! View the Babyline video

System Evaluation Committee monitors the data produced from the case management programs Healthy Start, Children First, and Great Beginnings. The group meets as needed as data sets are available. Meetings are called as needed.

CHAT (Community and Home Action Team) is direct service providers who conduct home-based services. The meetings provide an opportunity for networking and training. CHAT meets every other month on a sliding schedule of dates.

Tulsa Healthy Start Initiative

With federal funding, Tulsa launched Healthy Start, a major new community initiative designed to reduce the infant mortality rate by 50% within four years in the project's geographic area. The health of new babies and their mothers also was to be improved by increasing the rate of entry into first trimester prenatal care by 20%; decreasing the rate of unintended pregnancies by 5%; increasing the utilization of WIC (a nutrition program) for women by 23%, for infants by 25%, and for children by 47%; and increasing the rate of completed immunizations by children two years of age by 10%.

Before the program's inception in 1997, many factors indicated a need for Healthy Start in Tulsa.

- 26,847 women of childbearing age were among the 114,237 people living in the project's 37 census tracts,
in four distinct areas of Tulsa with diverse low-income households (Index years of 1991-1993)
- The average number of newborns was 1,991
- Over 130 of the births were to teens
- The average infant mortality rate was a disturbingly high 16.4, with an average of 32.7 infant deaths
- Nearly 100 women per year (98.3) received no prenatal care
- The average neonatal mortality rate was 9.5; the post-neonatal rate was 6.9
- The low birthweight rate was 8.1--6.5 for Whites, 12.9 for Blacks, and 7.2 for other races
- In 1994, only 67% of children under the age of 2 had received all necessary immunizations

Most of the high-risk women are young, low-income, and often members of ethnic or racial minorities. Changing at-risk behavior will require health education and training, and generating increased community support. High mobility, regularly changing payment and service delivery arrangements related to the initiation of Medicaid managed care, lack of awareness of where to get help and how to use it, and many other practical obstacles to care all create a great need for outreach, client recruitment, care coordination and case management.

Over the past ten years, Tulsa has made much progress toward building and coordinating a system of services to improve access to family planning, prenatal, postpartum, and health promotion opportunities, largely through sustained leadership and work by the Family Health Coalition (formerly the Tulsa Area Coalition on Perinatal Care) and its member agencies. Healthy Start continues to build on this foundation.

Healthy Start is being implemented jointly by the Community Service Council, Tulsa City-County Health Department, and the Family Health Coalition (formerly the Tulsa Area Coalition on Perinatal Care -- a consortium of agencies, sponsored by the Community Service Council). Some of the services are also being provided by staff in Healthy Start-funded positions at the Indian Health Care Resource Center, Margaret Hudson Program, Morton Comprehensive Health Services, Parent Child Center, Planned Parenthood, and Metropolitan Tulsa Urban League.

The Healthy Start Program works closely with the Family Health Coalition to provide outreach, health education, case management, and telephone access to high-risk pregnant women. The Community Service Council provides support through Babyline, Planline and Kidsline to enhance these activities, coordinates case management services, and provides analysis of program outcomes. Recipients of service are high-risk pregnant women, including teens, minorities, and women who have low income.

The main benefit sought by the program is for pregnant women, children, and adults to have improved access to health and social services. Progress is being made. Entry into prenatal care has improved over values of 10 years ago but recent changes in the SoonerCare system have made access to health care for uninsured and Medicaid eligible more difficult. Babyline now makes approximately 44.6% of all first prenatal appointments for resident births in Tulsa County. The System Evaluation Committee of the Family Health Coalition meets every two months and incorporates results of evaluation efforts into the improvement of Kidsline/Babyline/ Planline, Tulsa Healthy Start, and other perinatal projects.

Summary of Progress on Tulsa Healthy Start Performance Measures 2006

Clients served: Three hundred twelve (312) high-risk pregnant women received prenatal case management services and 170 received interconceptional care during 2006. Eighty-seven (87) infants less than 1 year and 166 1 to 2 years olds were served. Of these, 9 were special needs infants. On intake, THS pregnant clients are at the most risk for poor birth outcomes in the Tulsa community. In 2006, women's combined social and physical risk scores at admission assessment ranged from 49-101, out of a possible score of 34-102, with an average risk score of 64. All the premature, VBLW and LBW infants were born to mothers with initial risk scores over 60.

Medical homes and ongoing source of health care: Of all the participants 0-18 years of age (infants, children and pregnant teens), 314 of 348 had medical homes which is 90.2%, exceeding the annual performance objective of 90%. The percent of pregnant and interconceptional women who have an ongoing source of primary care was 482 of 482 which was 100% of the participants and exceeded the annual objective of 90%.

Birth indicators: Of the 109 births in 2006, 100 were singleton, 4 were very low birth weight which is 3.7% annual indicator compared to 1.5% annual performance measure. Of the 109 births, 11 were low birth weight. The 11% actual performance indicator exceeds the projected annual performance objective of 9.6%, but does show a steady progression downward from previous years. In 2006, there was 1 set of triplets and there were 3 sets of twins. The annual projected low birth weight indicator is still higher than the MCHB target of 8.9%, but the target population index years of 1999-2001 showed an infant mortality rate of 14.2. The infant mortality rate was 1 in 109 total births which is 9.2 per 1,000. This exceeds the annual performance indicator of 11.0 per 1,000 and is only one point higher to the total Tulsa county rate of 8.1 for 2005. THS high-risk women are performing at overall county rates. The THS 2005 infant mortality rate was 0 (0 of 95) with a 5.3% very low birth weight and an 11.6% low birth weight. Of these women giving birth, most had compounding risk factors of depression, family violence, smoking, alcohol and drug use before and during pregnancy.
Substance abuse and pregnancy, analysis

Depression screening: All women received depression screening at the initial intake on the weighted scale. All women received post-partum depression screening using the Beck Post Partum Depression Assessment. Two hundred six (206) women received screenings during the on-going case management services. Of these 206 women, 67 received risk prevention counseling and/or risk reduction counseling.

Interconceptional care: One hundred seventy (170) women received interconceptional care during 2006. Of these, 125 women received depression screening and 61 received risk prevention counseling and/or risk reduction counseling. Sixty (60) were screened for drugs, alcohol, and smoking with 23, 14, and 36 respectively receiving risk prevention counseling and/or risk reduction counseling.

Service contacts: Of the 482 women served in case management, 3,173 clinic or home contacts were made for an average of 6.5 contacts per year. In outreach services, Babyline served 4,220 callers seeking prenatal care, and the Free Pregnancy Test saw over 5,550 women of which 50% were pregnant. The community based case managers followed 481 moderate risk women in the interconceptional period with 170 women in interconceptional care by case managers. Transportation provided 228 units of transportation for urgent appointments where no other source was available, and 4 units of translation. The health educators provided 90 presentations or events to over 530 community and program participants. Nineteen training institutes and conferences were conducted to over 500 professionals and paraprofessionals.

The Community Service Council congratulates Jan Figart, winner of a Best of TCC Award!

Jan Figart, associate director and senior planner, maternal and child health, Community Service Council of Greater Tulsa, has associate degree in applied science from TCC. She has a bachelor of science degree in nursing from Langston University-Tulsa and master of science degree in nursing from University of Oklahoma. Figart is active in Children's Consortium, Community HealthNet, Family Health Coalition, Office of Child Abuse Prevention District 12 Task Force, and Healthy Start Initiative. She has served on boards of directors for Oklahoma Sickle Cell Anemia Research Foundation and Parkside Incorporated and on advisory or steering committees for American Red Cross, Northeast Area Health Education Center, Oklahoma State Department of Health, Osage Community Health Education Center, and Tulsa Technology Center. Listed in Who's Who for Executive Women, Figart has been recognized with awards from Indian Heath Care Resource Center, Margaret Hudson Program, Oklahoma Area Health Education Center, Sigma Theta Tau, Tulsa City-County Health Department, and University Center at Tulsa. "Over the past 25 years, I have worked with hundreds of Tulsa's most dedicated, capable professional and volunteers," said Phil Dessauer, Jr., executive director, Community Service Council; "Jan Figart ranks as one of the most successful. Jan's work ethic and commitment to persons in need are unmatched. Her contributions to improving the health and education of thousands of area residents have been outstanding."

For more information about any of these initiatives, please contact Jan Figart or Colleen Ayres-Griffin - 918-585-5551 - Community Service Council, 16 East 16th Street, Tulsa, Oklahoma 74119