A Promising Surveillance System to Monitor Perinatal/infant Health: Los Angeles Mommy and Baby (LAMB) Project

State: CA Type: Model Practice Year: 2009

Poor birth outcomes, such as infant and fetal deaths and low birth weight and preterm births, are a continuing public health challenge in Los Angeles County (LAC). The distributions of poor birth outcomes show significant racial/ethnic and geographic disparities. The precise reasons for these persistent disparities are mostly unknown. In 2004, the Department of Public Health Maternal, Child, and Adolescent Health (MCAH) programs established the Los Angeles Mommy and Baby (LAMB) project. This pilot project provided timely data on factors associated with increased rates of infant deaths in Antelope Valley (AV). The data from the survey proved to be extremely valuable in assisting the community stakeholders, such as area hospitals, community-based organizations, the Antelope Valley Service Planning Area, and Health District Officers, in designing program interventions to address the problem. Using data from the LAMB project, programs such as the Black Infant Health Program were expanded; and outreach, education, and prenatal care transportation projects were initiated to target women with high-risk pregnancies in the area. In 2005, the LAMB project was expanded to a bi-annual countywide survey. The LAMB survey provides comprehensive and groundbreaking perinatal data for public health professionals and community stakeholders in addressing disparities in poor birth outcomes in Los Angeles County. The goal of the LAMB project is to improve birth outcomes in LAC through a comprehensive surveillance system and to provide health-related service organizations with high quality population data to support a more action-oriented community collaboration to improve poor pregnancy outcomes. The specific objectives for LAMB are to: (1) establish a comprehensive surveillance system to monitor perinatal/infant health in LAC; (2) identify potential risk factors associated with poor birth outcomes; and (3) collaborate with the community stakeholders to develop strategies to improve birth outcomes based on findings from LAMB.
A community participatory process was used and will continue to be used to incorporate public health issues that are relevant to the community into the project. Since 2004, the MCAH programs have implemented the LAMB project as a surveillance system in LAC to allow MCAH programs, as well as community stakeholders, to regularly monitor each public health issue’s relevancy to mothers and infants in LAC. LAMB has also incorporated the community participatory process to facilitate the translation of LAMB findings into actions. Starting in 2009, the LAMB project began meeting with the collaborative and the new funder (First 5 LA) to review and revise the survey instruments for 2010 and 2012 to ensure survey questions addressing local needs are included. The LAMB project has addressed the issue of poor birth outcomes in LAC by meeting the need for a comprehensive data collection system—a population-based surveillance system. Using data from LAMB, MCAH has been able to calculate prevalence rates for selected health indicators and has been able to show that many of the mothers who experienced poor birth outcomes were at risk prior to their pregnancies. The findings from LAMB have also assisted MCAH in its efforts to reduce poor birth outcomes by focusing interventions on policy issues identified by the study, such as preconception health, perinatal mental health, racism, and healthy weight for pregnant women. The interventions implemented and justified in part due to the LAMB findings included establishing the following: The Los Angeles County Preconception Health Collaborative (LAC PHC), the Los Angeles County Perinatal Mental Health Task Force (LAC PMHTC), the LAC ALC on racism and FIM, and the Los Angeles County Healthy Weight for Women of Reproductive Age Action Learning Collaborative (LAC HW ALC). The project is unique and inventive in that it incorporates a participatory process engaging the community, which is usually not the norm for developing a data collection and surveillance system. In 2009 with the data strategic partnership grant from First 5 LA, LAMB entered into a new era wherein a strong public health and community partnership has been formed. Through this partnership, LAMB will work with key stakeholders and collaborators to obtain community input to identify the best sampling strategy. Furthermore, LAMB will review the existing survey instrument with community partners to capture and address data gaps and data needs of the community.
Agency Community RolesThe role of the LHD during the planning stage was to assist the community stakeholders and the county MCAH programs in reaching consensus regarding the importance of the project. Additionally, the LHD took input from all the stakeholders and subsequently designed the survey questionnaire. During the implementation stage, the LHD promoted the project to providers and the community, collected the data, analyzed data, disseminated findings, and worked closely with stakeholders and partners to translate findings into actions. These LHD activities are ongoing and critical in sustaining the project. At present the LHD actively supports four coalitions that have been implemented, in part, due to data from LAMB: The Los Angeles County Preconception Health Collaborative (LAC PHC), the Los Angeles County Perinatal Mental Health Task Force (LAC PMHTC), the LAC ALC on racism and FIM, and the Los Angeles County Healthy Weight for Women of Reproductive Age Action Learning Collaborative (LAC HW ALC). In summary, the main roles of the LHD have been to facilitate design, implementation, and data dissemination for the project. The role of stakeholders and partners during the planning stage was to work closely with the LHD to review and revise the survey and to support the LHD in conducting focus group meetings. During the implementation stage, the role of stakeholders and partners was to promote the project to providers and the community and to work closely with the LHD to translate findings into actions, such as the formation of the collaboratives noted above. The partners continue to provide expertise on survey topics and guidance to the project; they play an active role in identifying strategies to improve birth outcomes. The LAMB project provides detailed information and high quality data to assist policy makers, community stakeholders, and other essential strategic partners to monitor the health status of thousands of mothers and their newly delivered babies; identify strategies to address LAC perinatal issues; evaluate perinatal services to maximize the quality of health and human services for mothers, infants, and their families; and assess the environments in which families live and thrive. The following lists specific examples of MCAH stakeholders and community partners that have used LAMB data to inform decision-making and community action: March of Dimes, Greater Los Angeles Division; Healthy Weight for Women of Reproductive Age Action Learning Collaborative (HWALC); Los Angeles County Preconception Health Collaborative (LAC PHC); and Los Angeles Perinatal Mental Health Task Force (LAC PMHTC). In the future, MCAH will use LAMB data to inform quality improvement processes and initiatives within the individual LAC Service Planning Areas; assist in prioritizing MCAH issues during the MCAH five-year planning process; and provide information for children’s scorecards developed by the Children’s Council of Los Angeles County to prioritize county efforts for improving the well-being of children. Costs and ExpendituresThe overall annual budget to operate LAMB is $600,000. The 2007 LAMB was co-funded by the University of California in Los Angeles (UCLA, about $200,000) and the State MCH Grant (about $400,000). In 2009, the MCAH programs secured $1 million for five years, through a data strategic partnership with First 5 LA with in-kind matching for staffing support from MCAH programs for the 2010 and 2012 LAMB surveys. ImplementationTo achieve objective 1, we established a comprehensive surveillance system to monitor perinatal/infant health in LAC by forming a strategic partnership with community stakeholders to review data gaps and revise surveys to ensure the inclusion of issues that address the physical, psychosocial, economic, and emotional wellbeing of MCAH populations in Los Angeles County. We compiled input from the community regarding surveillance process and survey questions and designed and updated a relevant survey with understandable questions to ensure high quality data; and reviewed and revised the survey with input from all stakeholders. We used existing collaboratives to assist in implementing focus groups and/or key informant interviews. We maintained a high response rate (>50 percent) by following mailing protocol, sending a survey, a reminder card, a second survey, followed by a phone call, if necessary. We completed four waves of data collection per project year, and tracked responses, keeping the database current for proactively soliciting respondents. We provided gift certificates as an incentive for all mothers who complete the survey. We completed IRB application and followed all LAMB policies and procedures, and maintain a website and factsheets detailing the project. To achieve objective 2, we thoroughly cleaned data by identifying outlier responses and checking that skip patterns were followed to ensure high quality data. We ran basic frequencies on all health and demographic indicators to explore patterns in the data. We calculated the actual prevalences of all important indicators by adding sample weights to the analysis to accurately reflect trends in the LAC population. We performed all cross tabulations of interest to LAC MCAH REP and other community-based organizations to explore correlations. We conducted regression and trend analyses to determine the relative affects of different demographic and health indicators on birth outcomes. We generated a data LAMB data booklet for distribution and posting online, and included indicators selected by the partners. We informed communities by disseminating LAMB findings to local community stakeholders’ meetings and relevant conferences. We developed a customer satisfaction survey to ensure that partners are pleased with the surveillance procedures, collaborative processes, and results of data requests. We disseminated LAMB findings through professional and community-focused conferences. To achieve objective 3, we facilitated an action-oriented partnership with the affected communities to address issues identified from objective 2. We wrote and posted online health briefs, articles, and presentations based on data analyzed from LAMB. We conducted all data requests issued by local health departments, CBOs, and other stakeholders. We met in-person with CBOs, coalitions, collaboratives, and/or SPA-specific task forces. Annually, we share LAMB findings with the California State MCAH Program. We supported organizations implementing programs to improve birth outcomes. We provided data that can be used to improve risk-appropriate obstetrical care. We addressed the role of racism in the lives of mothers in LAC.
From previous years of LAMB experience, the project team needs to be vigilant in securing funding and resources, creating effective communications with executive management, fiscal, and county board of supervisor’s office to implement the project according to timeline. It is also important that the project team constantly review and modify LAMB project timeline, policies, and procedures. The project team modified the LAMB Web site and developed fact sheets and materials that promote the importance of the project.
The LAC MCAH program has formed collaborative relationships with researchers, epidemiologists, health educators, local county agencies, media, community organizations, leaders and elected officials to identify and implement strategies and interventions to improve birth outcomes in Los Angeles County. The community stakeholders have been long-term partners with the MCAH programs and have been supportive of the LAMB project since its inception. The collaborative nature of the project allows all participants to maximize their own resources and leverage external resources, resulting in more in-depth data analysis and comprehensive program formation and evaluation. The MCAH programs have secured additional funding, $1 million over five years, through a data strategic partnership with First 5 LA with in-kind matching for staffing support from MCAH programs for the 2010 and 2012 LAMB survey.