# Presentation: 487602

## Approaches To Reducing Infant Mortality- Nutaqsiivik Program

- Southcentral Foundation
- Anchorage, Alaska

## Nutaqsiivik

- Developed based on FIMR analysis
- In depth chart review of selected ANMC infant deaths (included other family members in ANMC system)
- Obstetrical “social risk” system clearly defined

## Social Risk Referral Criteria

- _Prenatal Care_: none, onset in third trimester, or inconsistent/erratic care
- _Substance Use:_ + urine drug screen for mother or infant, maternal substance abuse during pregnancy or  risk for relapse postpartum
- _Recent or current:_ family violence or child protection system involvement

## Social Risk Referral Criteria

- _History of_: SIDS or childhood sexual abuse
- _Current:_ maternal psychiatric disorder or depression; maternal FAS/FAE or other cognitive impairment
- Homelessness

## Social Risk Referral Criteria

- Age 16 or under
- Worrisome parenting behaviors
- “Provider hunch”

**Notes:**
Using this tool, of about 450 Anch-based pregnant women, 1/3 were identified as being high risk so were stratified the 150 referrals into priority groups after doing in-home assessments.

## Program Development

- Collaboration ANMC and Southcentral Foundation – IHI collaborative 1993
- Flow charts of ‘system’ process and communication patterns
- No money- redirected existing resources

## Program Goals

- Promote safe home environments for high social risk infants
- Provide client-centered, risk-based interventions to support family’s move toward self-reliance
- Increase ANMC’s ‘system responsiveness’ for high risk families

## Program Goals

- Increase Anchorage community partnerships and awareness of program goals and activities
- Collect data and information to determine nature and extent of need among high risk Native families in Anch for program planning and evaluation

## Program Components

- One stop shopping clinic – prenatal, postpartum and infant up to 6 weeks
- PHN visits at prescribed and prn intervals (first week, 2 wk, 4wk, 6wk, 8wk, then monthly)
- Pre-clinic case conferences/planning & quarterly reviews

**Notes:**
Clinic CNM provider, PHN was nurse, CHR assisted and did referral follow-up/satisfaction surveys

## Improvement Process Built In 

- Program “designed” to change
- Client feedback, chart reviews, follow-up of referrals led to enhanced service connections
- Observations of risk and morbidity/mortality etiologies led to spin off programs

## Data evaluated

- Post-neonatal IM rates & etiologies
- Days Between Deaths run chart developed
- Maternal ‘risk factors’ tracked as identified by social risking tool
- Outpatient, inpatient, ER utilization rates
- Appointment ‘no show’ rates

**Notes:**
Case management system developed. Used for reminders, data analysis, comparison between pregnancies. In 1994 had a pre-program days between deaths of 55 days.....in 2000 that figure was 114 days....LONGER interval between deaths

## Data evaluated

- Prenatal care utilization
- Contraceptive utilization
- Time interval between pregnancies
- Immunization rates
- Breastfeeding rates
- Toddler and 3 year old conditions/diagnoses

**Notes:**
Current data- Lactation rates meet Healthy People 2010 goals and immunization rates 98%

## Hallmarks of Program

- Flexibility for clients – ‘meet them where they are at’
- Designed to change as ‘lessons learned’
- Clear goals
- Regular reports to ‘decision makers’ led to funding for 3 PHNs, a dedicated pediatric NP, clerical assistance (1999)

## Nutaqsiivik Today

- Home visits provided now to all ANMC postpartum women – 8 PHNs
- Recent expansion to Mat-Su area
- Changing trend re: 46% high risk , 800 referrals in 2006

**Notes:**
Once in home, PHN”s found that women who were ‘not high risk’ still had issues that required assistance/intervention.