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