Public Health Committee
JOINT FAVORABLE REPORT
AN ACT PROVIDING FUNDS FOR THE CONTINUED OPERATION OF LOCAL AND REGIONAL FETAL AND INFANT MORTALITY REVIEW PROGRAMS.
Joint Favorable Change of Reference to Appropriations
SPONSORS OF BILL:
Public Health Committee
REASONS FOR BILL:
To require continued funding for five existing FIMR programs, provide funds for the establishment of an additional five such programs.
RESPONSE FROM ADMINISTRATION/AGENCY:
NATURE AND SOURCES OF SUPPORT:
Maria Damiani, Director of Women's Health, New Haven Health Department.
Fetal and Infant Mortality Review Project (FIMR) is an ongoing community process for assessing, planning, improving and monitoring the service system and community resources that support and promote the health and well-being of women, infants, and their families. This program goes beyond traditional review of infant or fetal death to focus more on the identification of the social, economic, and system factors unique to each community.
FIMR is locally coordinated by a community committee of volunteers. In New Haven we were able to start a community conversation about the unpleasant topic of fetal and child mortality.
Last year, DPH informed us that they would no longer financially support our community-based programs. This will likely result in the dissolution of the teams of community volunteers. The modest investment in FIMR (approximately $35,000 per year annually per program), has brought together key providers, consumers, and community leaders to facilitate positive changes in the service delivery system. Without the State's support, it is unlikely that this vital public health function will continue.
Eugene Ciccone, MD, Director, City of New Britain Health Department,
FIMR plays an important role in monitoring and improving our local service delivery systems for women and families. FIMR has been the catalyst for the following:
• Establishment of a protocol for scheduling postpartum visiting nurse home visits for all mothers following an infant or fetal loss
• Establishment of a community fund to cover fetal burial costs for indigent families
• Bereavement support services for Spanish-speaking families
• Grand Rounds on periodontal disease and pre-term birth attended by OB-Gyns and pediatricians;
• Addressing the need to improve birth certificate reporting of adequacy of prenatal care
• Grand Rounds on prenatal screening for STDs and obstetric infections (receiving funding from the March of Dimes)
• Linkage with oral Health Collaborative to raise awareness of the need for dental services for pregnant women and their children.
I would ask that the bill specify continuation of the five existing FIMR programs in Greater New Haven, Hartford, Manchester-Vernon, New Britain, and Windham. I would also ask that the bill specify establishment of a new FIMR programs in 3 additional Connecticut communities, to be determined based on need.
Beth E. Cheney, Women's Health Coordinator, Windham Hospital,
The Windham region has a high percentage (18.4% vs. 7.8% statewide average) of teenage pregnancies with over 15.8% (13.4% State average) of pregnant women in this region receiving inadequate prenatal care and 19.3% (10.6% State average) receiving late or no prenatal care. Ninety-five percent of the women seen at the Prenatal Clinic are monolingual Spanish and all are uninsured.
Based on Connecticut State Department of Health date, the Windham region has a high percentage of low birth weight babies, very low birth weight babies and preterm births. These factors affect the rate of fetal and infant mortality and morbidity. Fifty percent of our clients are under the age of 19 and 80% are under the age of 25. Over 90% of our clients have a high school education or less. Approximately 66% of this population is first time mothers. A high proportion of the Prenatal Clinic population does not attend prepared childbirth educational classes and other related educational services held in the community. Poor educational outcomes can lead to poor birth outcomes which can affect the community at large.
Pati Long, FIMR Committee Member, Windham Hospital,
Windham is a community with significant social, economic and health challenges. A suspension of the FIMR initiative will undoubtedly result in a reversal of the progress made over the last eight years.
Roberta Schwane, RN Case Manager, Windham Hospital,
Submitted similar testimony to the previous two speakers.
Beth Murana, Center Coordinator, Planned Parenthood,
The intrinsic value of a successful program that functions with minimal funding cannot be overstated.
Some of the successful program outcomes that have been implemented:
• Addressed issues and system protocols regarding maternal substance abuse, hepatitis, mental health issues, statutory rape, teens and the law, teen pregnancy, DCF referral process, Chorioamnionitis, and provided community trainings and Windham Hospital for providers
• Coordinated and developed a system to ensure VNA postpartum referrals from hospital to VNA
• Developed universal pregnancy screening tool to be utilized by all community services to ensure referral to prenatal care
• Addressed lack of Spanish speaking outreach workers in the community.
• Coordinated and developed system to address lack of maternal 6-week follow-up postpartum visits
• Distributed STD information to providers and addressed issues of partner testing
• Addressed and reviewed York Correctional Institute protocols for follow-up upon the release of pregnant women to the community
• Developed and distributed list of bereavement resources for grieving parents, and/or a faith based list for parents
• Secured 2 years of funding from the March of Dimes for implementation of Outreach in the Windham area. Further funding was secured to continue this successful program.
Mary Alice Lee, Advocates for Connecticut's Children and Youth,
FIMR is an important public health strategy for identifying risk factors for perinatal morbidity and mortality and for developing information that can be used to design community interventions to improve the health of women and infants.
Major indicators of infant health show that perinatal morbidity and mortality are not a whole lot better in Connecticut than elsewhere in the US. In Connecticut as in the rest of the country the infant death rate varies based on race and ethnicity.
The FIMR programs aim to identify community-level factors that can be addressed to reduce these differences in infant mortality. We support the continued funding of FIMR at the level the programs were funded in previous years ($35,000 per program vs. $25,000 current funding).
Brian Karsif, Coordinator, Greater New Haven Regional FIMR Project,
The goal of FIMR is to enhance the health and well-being of women, infants and families by improving the community resources and service delivery systems available to them. There are over 200 FIMR programs nationally.
The FIMR coordinator presents cases of fetal and infant deaths to a Case Review Team (CRT) comprised of local and regional volunteers. The function of the CRT is to review the cases presented by the Coordinator and after careful consideration, provide recommendations for local, regional, or perhaps statewide interventions to a Community Action Team (CAT). The FIMR projects are not adequately funded to impact birth rates but as several functions:
• Date collections and analysis
• Client services and access
• Quality improvement for system of care
• Partnerships and collaboration
• Populations advocacy and policy development
• Enhancement of the labor force
3 components of the FIMR process are especially valuable:
• The diverse coalition/community partnership building component of the process
• Inclusion of the voice of local families who have lost their babies,
• FIMR actions based on decisions pertaining to the whole community and the families who live there
FIMR works to accomplish the 9 goals stated in the “Perinatal Health Plan”
Without the FIMR infrastructure, identifying women at the highest risk for a subsequent loss or other poor birth outcome will be a major barrier to intervention. One goal of the DPH Health Plan for Connecticut is to “reduce perinatal health disparities, particularly preterm/low birth weight births and infant and fetal mortality between and among racial and ethnic groups. This will be very difficult to achieve if we discontinue FIMR.
Michael Berman, Clinical Professor of Obstetrics,
Submitted similar testimony to previous speakers.
Susan Phillips Plese, Member of the Community Action Team (CAT) for the Manchester/Vernon FIMR,
FIMR promotes prenatal care, smoking cessation, treatment for maternal depression, high blood pressure and obesity, the cause of many premature deaths. FIMR in Manchester/Vernon alone has a volunteer staff of more than 30 medical specialists and activists coordinated by one woman who is granted just $25,000 a year to administer the entire program.
Lynda Stein, Windham FIMR Coordinator,
Offered similar testimony to previous speakers and added successful program outcomes:
• Addressing the issue of lack of smoke detector alarms in certain sections of town.
• Researched culturally sensitive nutrition information for pregnant Hispanic women and distributed it to members of the CRT for their patients.
• The FIMR coordinator is working with the Dental Director at Generations and other key community people to address the unmet dental needs of pregnant women/children.
• A community baby shower was held June 2006, information on all aspects of a healthy pregnancy was addressed.
• CAT/CRT members reviewed FIMR statistics and noted that drugs/smoking were top priorities.
• Our CRT recommended education about SIDS, especially in our Hispanic Community.
• Addressed issues and system protocols regarding maternal substance use/abuse, hepatitis, mental health issues, statutory rape, tenns and the law, teen pregnancy, DCF referral process and provided community training at Windham Hospital for providers.
• Coordinated and developed a system to ensure VNA postpartum referrals from Hospital to VNA.
• Developed universal pregnancy screening tool to be utilized by all community services to ensure referral to prenatal care.
• Addressed issues of lack of Spanish speaking outreach workers in the community.
• Coordinated and developed systems to address lack of maternal six-week follow-up postpartum visits to the provider.
• Distributed STD information.
• Secured 2 grants to continue implementation of outreach programs to address issues of safe pregnancies.
Candy Parker, Manchester/Vernon FIMR Coordinator,
The Manchester/Vernon FIMR program has offered a variety of educational and awareness programs since 2001.
The following Recommended changes to the bill were made:
1.) Continuation of the five existing FIRM programs.
2.) Establishment of the new FIMR programs in at least three additional Connecticut communities, to be determined based on need.
Jane Palley, Coordinator of the New Britain FIMR program,
Offered similar testimony to previous speakers but stressed the importance of localized FIMR programs instead of a state-wide FIMR program.
NATURE AND SOURCES OF OPPOSITION:
Reported by: Joe Goldman