Case Study: Sewing up the Safety Net
Approaching Social Determinants at the Population Scale by “Sewing Up the Safety Net” — Collaborating with Competitors to Save Infant Lives
The CEOs of four major health systems serving Detroit (Henry Ford Health System, Detroit Medical Center, Oakwood Healthcare System, and St. John Providence Health System) committed their organizations to find enduring, collaborative solutions to reduce the city’s infant mortality – among the highest in the nation. In 2008, they commissioned the Detroit Regional Infant Mortality Reduction Task Force, under the leadership of Henry Ford’s Kimberlydawn Wisdom, MD, to develop an action plan.
A true public-private partnership, the Task Force represents a range of expertise and perspectives, from clinical to community, and from programmatic to policy, environment and behavior change. The health systems bring the strength and size of their provider networks, and their ability to reach women and families at multiple points across the clinical spectrum. Public health leaders from state and local health departments provide population-based perspectives and a focus on the social determinants of health – racism and its relentless cascade of socioeconomic factors influencing the life course. Agency members provide further policy expertise and links to organizations conducting synergistic work. An equally important cadre of community partners – neighborhood organizations and stakeholder groups – joined the Task Force in designing an innovative grassroots approach.
The result — the $2.6-million grant-funded Sew Up the Safety Net for Women & Children — demonstrates place-based population health management; innovative, sustainable service delivery models; high-tech/high touch social marketing; provider education on the health equity framework; and institutional alignment – even amongst competing health systems.
Sew Up the Safety Net is funded by the Robert Wood Johnson Foundation, The Kresge Foundation, W. K. Kellogg Foundation, PNC Foundation, University of Michigan School of Public Health, and the four health systems.
Infant mortality is known as a “sentinel” health indicator – the infant mortality rate correlates with the health status of the community. In Detroit, infant mortality hovered around 14.4/1000 for the past three years, or about 200 babies each year who do not survive their first birthday. Higher than some developing countries and over twice the U.S. rate, these statistics are even more painful when the racial health disparity of 15.9/1000 for black babies is compared to 5.6/1000 for white infants for the same period.
According to a 2009 survey conducted by the Detroit Regional Infant Mortality Reduction Task Force, many local programs and services to support women at risk for infant mortality were significantly underused. It was then that the Task Force conceived Sew Up the Safety Net, to tighten this loose web of disconnected medical, social, and community organizations into an accountable network of care.
The project works in three neighborhoods to connect women at risk for infant mortality with community health workers, known as Community & Neighborhood Navigators (“CNNs”), framed by three key objectives:
- The first objective centers on the CNN-participant relationship. Trained as community health workers by a specialist from the Detroit Department of Health & Wellness Promotion (Institute for Population Health) with additional education in maternal-child health, the CNNs mentor participants by helping them learn to navigate an array of socially and economically appropriate healthcare services, tailored neighborhood resources, and phone and Web-based information. Moreover, the CNNs provide the vital validation that says “I believe in you” amidst the oft-discouraging, lonely life journeys that many young women in poverty describe facing. In turn, participants become empowered to link their own social networks to similar resources for long-term success and improved health and well-being of women, families (including men), neighborhoods and communities. Over three years, 1,500 women – 375 pregnant and 1,125 nonpregnant women of childbearing age – will participate.
- The second objective is providing education on the health equity framework to 500 physicians and other healthcare professionals. Built on a tested, successful Henry Ford healthcare equity CME course, the interactive, challenging workshops are designed to improve awareness of health equity and racial disparities, resulting in increased understanding of how life’s difficult circumstances impact health. Resources such as MIBridges and United Way 2-1-1 are shared in a case study approach. A train-the-trainer course also is being offered to expand provider education reach.
- The third objective is to establish technologically relevant products to engage the broader community in promoting good health status prior to and during pregnancy. Social media, a program website and text messaging are being used to connect women to the program, link to related services, and provide a virtual “living room” for sharing and learning. Project planners learned in early focus groups that the name ”Sew Up the Safety Net” was not as relatable for the target population as for health professionals. A CNN proposed the new name, Women-Inspired Neighborhood Network Detroit (WIN Network Detroit) to very positive reception from program members, and it is now used.
At a neighborhood health fair, a CNN recruited “Sonya,” 27, a single mom pregnant with her second child. The CNN learned that Sonya and her 5-year-old son “Derek” are “couch-homeless” – living with various relatives for short periods. Sonya opened up to the CNN about the hardships and disappointments of moving her life from house to house whenever a family member was “tired of having them.” The CNN immediately referred Sonya and Derek to a shelter program that is assisting them with permanent housing. Sonya told her CNN that before her involvement with Sew Up the Safety Net, she felt lost and unsupported. Thanks to her CNN, she said she now “feels hope” and is making plans to become a registered nurse after her second child is born. Meanwhile, the CNN continues to mentor Sonya, connecting her with other needed resources including food, clothing, and a referral to a college counselor. In a sign of her growing sense of optimism and self-efficacy, Sonya has already enrolled in college classes.
While too early for reportable outcomes, as of February 2013, the project had enrolled more than 135 pregnant women and engaged hundreds of women who are pre-pregnancy or between pregnancies. Sew Up the Safety Net is measuring impact around three distinct yet interdependent metrics:
- no preventable infant deaths among participants – with measures including the effectiveness of community-based referrals, increased social support, and behavior change;
- knowledge and behavior change on equity-promoting strategies among the 500 healthcare professionals participating in health equity education; and
- knowledge and behavior change on prenatal care, preconception health, interconception health, and access to community services via the social media campaign.