Welcome Click to edit Master text styles Second

Welcome! • Click to edit Master text styles – Second level • Third level – Fourth level » Fifth level Infant Mortality Strategic Planning Atlanta Perinatal Region Gainesville Civic Center May 3, 2017

About Healthy Mothers, Healthy Babies Since 1973, HMHB has worked to improve access to prenatal and preventive healthcare for thousands of women, children and families in Georgia through direct service, collaborative advocacy and community education. 2 ACCESS ADVOCACY EDUCATION HMHB operates the Maternal and Child Health Referral Line for the Department of Public Health, and the Prevent Child Abuse Georgia Helpline, to provide callers with appropriate referrals and resources across the State. In a non-partisan role, HMHB engages with legislators as well as medical, business and other community organizations to encourage fiscally responsible policies that promote access to care and improved health outcomes for women and children. HMHB provides prenatal and breastfeeding education across the State through collaboration with other community organizations and clinicians.

• • 31 GA L&D Units have closed over the last 21 years (19 in rural areas) GA has approx. 77 hospitals delivering babies out of more than 180 hospitals 46 of Georgia’s 159 counties have an L&D unit Of all the states, Georgia ranks: • 43 rd (2014) for premature births • 47 th (2014) for low birthweight babies • 45 th (2014) for infant mortality • 49 th (2006) for maternal mortality

• Six Perinatal Regions • HMHB one of Five Grantees

Infant Mortality Strategic Planning In the Atlanta Perinatal Region ROADMAP Partner Survey • Survey to gauge stakeholder perceptions • Partners identified • 70 survey invitations sent • 49 surveys started • 34 surveys completed Session I • Review available data on Infant Mortality pertinent to the Region (including state and national context) • Group prioritization of top factors driving IM in the region Session II • Summary of Session I • Presentation of needs, services and resources (categorized by identified priorities from Session I) • Group prioritization of needed resources Session III • Summary of Session II • Presentation of evidence-based interventions • Group prioritization of evidence-based interventions for the Region Draft Strategic Plan • Plan circulated to partners for open comment period

Hall County shows persistent disparities between 2005 and 2015 in infant mortality ratios among African American families when compared to white families (17. 0 and 5. 0 per 1, 000 live births respectively). Hall County

Atlanta Healthy Start Initiative — Children’s Healthcare of Atlanta — Amerigroup — GA Bureau of Investigation — Emory — Grady Health — Care. Source — Center for Black Women’s Wellness — Feminist Women’s Health Center — Georgia Breastfeeding Coalition — Georgia Chapter of the American Academy of Pediatrics — Stephanie V. Blank Center for Safe and Healthy Children — Prevent Child Abuse Georgia — Peach State Health Plan — Northside Hospital — March of Dimes Georgia — Kaiser Permanente Pediatric Medicaid — Well. Care —YWCA of Greater Atlanta — Georgia WIC Program — Georgia Department of Public Health — Centers for Disease Control and Prevention — Georgia OB/Gyn Society — Georgia Maternal & Infant Health Research Group — Georgia Health Foundation — Clayton County Perinatal & Infant Health Coalition — Department of Community Health — Piedmont Healthcare — De. Kalb Medical Center — Atlanta Medical Center — Well. Star — Gwinnett Medical Center — Georgia Perinatal Association — Northeast Georgia Medical Center — Reaching Our Sisters Everywhere (ROSE) — Division of Children and Family Services — Bartow County Health Department — Hall County Health Department — Floyd Medical Center — Fannin Regional Hospital — Gordon Hospital — Habersham County Medical Center — Hamilton Health Medical Center — Rockdale Medical Center — Southern Regional Medical Center — Stephens County Hospital — Union General Hospital & all Atlanta Perinatal Region Health Districts! Who’s missing?

Agenda I. II. • III. Welcome & Purpose Introductions Click to edit Master text styles Infant Mortality in the – Second level Atlanta Perinatal Region Third level Ø • Georgia’s Child Fatality – Fourth level Review Program (GCFR) Ø Data » Fifth level Ø Survey Responses IV. Identify & Prioritize Factors Facilitating Infant Mortality

GEORGIA HEALTH POLICY CENTER Integrating research, policy, and programs to advance health and well-being • A research center within the Andrew • Click to edit Master text styles Young School of Policy Studies at – Second level Georgia State University in Atlanta • Third level – Fourth level • Provides evidence-based research, » Fifth level program development, and policy guidance locally, statewide, and nationally • Working in more than 200 communities across the United States to achieve health improvement

INTRODUCTIONS & GREETINGS Lost at Sea You were on a flight traveling to a conference when your flight went down somewhere in the Atlantic Ocean. Your location is unclear because vital navigational and radio equipment have been damaged. Your best estimate is that you are many hundreds of miles from the nearest land. You and several other passengers have managed to save 15 items, undamaged and intact. • Third level In addition, you have salvaged a four man rubber life craft and a box of matches. • Click to edit Master text styles – Second level – Fourth level Using “Step 1” of the Lost at Sea Ranking Chart: » Fifth level • Take the next 8 minutes to individually rank (in order of importance) the items you have managed to salvage from the plane. When you are finished: Please use your smart phone to go to this address and reflect your individual responses: Poll. Ev. com/ghpc (raise your hand if you have difficulty)

INTRODUCTIONS & GREETINGS Split into two (2) groups at your table. Spend two minutes introducing yourself - name/title/organization. • Click to edit Master text styles Again using the “Step 2” of the Lost at Sea Ranking Chart: – Second level • Take the next 10 minutes as a table to discuss your individual • Third level choices and work together to agree on a collaborative list. – Fourth level » Fifth level When you are finished: Please use your smart phone to go to this address and reflect your individual responses: Poll. Ev. com/ghpc (Please raise your hand if you have difficulty)

INTRODUCTIONS & GREETINGS According to the experts, in this case the US Coastguard, the basic supplies needed when a person is stranded mid-ocean are articles to attract attention and aid survival until rescue arrives. A transatlantic trip takes roughly 20 days; significantly less with good winds and significantly more without them. • Click to edit Master text styles Articles for navigation are of little importance since even if a small life raft were capable – Second level of reaching land, it would be impossible to store enough food and water to survive for • Third level that amount of time. Without signaling devices, there is almost no chance of being spotted and rescued. – Fourth level » Fifth level So, the list on the next slide is the ranking order of the items according to their importance to your survival: What is the difference between your individual ranked order and the ranked order of the group (Steps 2 & 3)?

Item Rank Coastguard Reasoning INTRODUCTIONS & GREETINGS A sextant A shaving mirror A quantity of mosquito netting 15 Useless without the relevant tables and a chronometer. 1 The mirror is absolutely critical. It is the most powerful tool you have for communicating your presence. 14 There are NO mosquitoes in the middle of the Atlantic Ocean and the netting is useless for anything else. Vital to restore fluids lost to perspiration. 25 liters will supply water • Click to edit 3 Master text styles rations for your group for several days. 25 liter container of water 4 – Second level A case of army rations Maps of the Atlantic Ocean 13 • Third level 9 A floating seat cushion This is your basic food intake Worthless without navigation equipment. Useful as a life preserver if someone fell overboard. – Fourth level Critical item for signaling. The mixture will float on water and can be A 10 liter can of oil/gasoline 2 ignited using the matches. mixture » Fifth level A small transistor radio 12 You would be out of range of any radio station. 20 square feet of plastic sheeting 5 Can be used to collect rain water and shelter from wind and waves. A can of shark repellent 10 To repel sharks, of course! One bottle of 160% proof rum 11 Can be used as an antiseptic, otherwise of little value. 8 To prevent being washed overboard. There a variety of other uses, but none vital for survival. 6 Your reserve food supply 7 Ranked lower than chocolate - there is no guarantee you will catch fish. Could be used as a tent pole. 15 ft nylon rope 2 boxes of chocolate bars An ocean fishing kit with pole.

INFANT MORTALITY: STATE PLAN (20132016) Reducing Infant Mortality in Georgia (2013) Infant Mortality Task Force • • IMR improved in GA from 2007 -2011 (8. 4 to 7. 3 per 1, 000 live births) • Click to edit Master text styles * 6 Clusters of high IMR – Second level – – – • Fulton, Douglas, Cobb and Clayton Bibb, Twiggs, Houston and Jones • Third level Muscogee and Chattahoochee – Fourth level Lowndes » Fifth level Richmond Chatham Three objectives *Source: Georgia Department Of Public Health (2002 -2006) – Strengthen the regional perinatal system of care – Develop targeted educational campaigns on infant mortality related issues – Develop external collaborations to support infant mortality initiatives *Source: Georgia Department Of Public Health (2002 -2006) From Preconception To Infant Protection: A Regional Look At Periods Of Risk For Georgia’s Newborns

PLANNING PROCESS Each of the planning sessions will lead to a final strategic plan to reduce infant mortality in the • Click to edit Master text styles Atlanta Perinatal Region during a three to five year period. – Second level • Third level Planning Process: – Fourth level » Fifth level • Explore the state of infant mortality: National, State, and regional picture of drivers (Prioritize) • Explore available services and service gaps (Identify and prioritize objectives) • Explore evidence informed strategies (Identify and prioritize strategies)

INFANT MORTALITY: PARTNER SURVEY HMHB Partner Survey: • • • Surveys were administered online (3/20 -4/17) 49 surveys were submitted, 34 were complete Results include incomplete surveys when relevant (e. g. , EBP recommendations) 50% of respondents (17) represented all 39 counties in the Atlanta Perinatal Region Individual counties had no more than 6 respondents There were a variety of organization types represented: • Click to edit Master text styles – Second level – – • • Third level 74% represented non-profit/public health service providers (25) 15% represented professional associations (5) – Fourth level 6% represented for-profit health service providers (2) » Fifth level 6% represented research/education (2) The survey gathered respondent opinions and insight on the following: A. B. C. D. E. Opinions about the top factors facilitating infant mortality What more do mothers and babies need and why Respondent services offered, service area, and planned service expansions Intervention that have been effective in the past Recommendations about interventions that could be implemented and what are the challenges to implementation

INFANT MORTALITY: SECONDARY DATA Secondary Data Sources: The data included in this presentation were found using the following resources: • Click to edit Master text styles • • World Health Organization (WHO) - http: //www. who. int/en – Second level • Third level Kids Count Data Center – http: //datacenter. kidscount. org • – Fourth level » Fifth level OASIS - https: //oasis. state. ga. us • HMHB State of the State: Maternal & Infant Health in Georgia - https: //hmhbga. org • CDC NCHS Data Brief No. 279, March 2017 - https: //www. cdc. gov

INFANT MORTALITY Definition: • • Infant Mortality (IM) is the death of children under the age of one year. The measure of IM is the Infant Mortality Rate (IMR) (deaths per 1, 000 births). – Second level • Click to edit Master text styles Issue: • Third level – Fourth level In 2015: » Fifth level • GA ranked 47 th in the nation for our IMR • IMR was much higher in GA than the U. S. (7. 8 compared to 5. 9 per 1, 000 live births) • The Atlanta Perinatal Region County IMR was higher than the U. S. (6. 5 and 6. 0 per 1, 000 live births respectively) Source: CDC, National Vital Statistics System Sources: * World Health Organization (WHO) **Kids Count Data Center: Infant Mortality, Centers for Disease Control and Prevention, National Center for Health Statistics. ***OASIS: Department of Public Health, Office of Health Indicators for Planning (OHIP)

INFANT MORTALITY Georgia Child Fatality Review Panel https: //gbi. georgia. gov/CFR Georgia’s Child Fatality Review Program (GCFR) was established in 1990 by statute (Section 19 -15 -1 et seq. ). CFR is an independent program currently administered out of the Georgia Bureau of Investigation (GBI). The program is funded by state general funds. There are four state-level staff who are responsible for providing training and technical assistance to the local review committees. Local teams have no paid staff. • Click to edit Master text styles – Second level • Third level Reviews – Fourth level Local CFR committees review all injury, sleep-related, and unexpected/suspicious deaths to children who are less than 18 years old. Local committees submit their reviews using the National CDR Case Reporting » Fifth level System; the state Panel reviews selected case reports that have been completed by the local committees. Purpose The main purpose of Georgia’s CFR program is to prevent deaths. The mission of CFR is to serve Georgia’s children by promoting more accurate identification and reporting of child fatalities, evaluating the prevalence and circumstances of both child abuse cases and child fatality investigations, and monitoring the implementation and impact of the statewide child injury prevention plan in order to prevent and reduce incidents of child abuse and fatalities in the state.

INFANT MORTALITY (2005 -2015) Of the 39 Counties included in the Atlanta Perinatal Region: • • • There were 5885 deaths (6. 5 per 1, 000 live births) 31 counties decreased IMR, 9 counties saw increases in IMR 5 counties have higher IMR than GA (Reflected in Red cells on IMR county by county handout) 14 have higher IMR than the region (Reflected in orange cells on IMR county by county handout) 5 counties have higher IMR than the U. S. (Reflected in yellow cells on IMR county by county handout) • Click to edit Master text styles – Second level • Third level – Fourth level Since 2010: » Fifth level • 9 counties have seen increases – Indicated by the red text in the “ 20102015 Change” column • 30 counties have seen decreases – Indicated by the green text in the “ 2010 -2015 Change” column OASIS: Department of Public Health, Office of Health Indicators for Planning (OHIP)

INFANT MORTALITY: HEALTH INEQUITY • Infant Mortality Rate (per 1, 000) by race: • Click to edit Master text styles – Black: 13. 3 – White: 5. 5 – Hispanic: 4. 9 – Second level • Third level • Of the 1, 004 infant deaths in 2014: – Fourth level – 61% were African» Fifth level American – 31% were white – 6% were Hispanic • HMHB Partner Survey: – Absence of people of color in decision-making positions

INFANT MORTALITY: MEDICAL COMPLICATIONS Maternal hypertension (HTN) and diabetes increase risk to both mother and baby. • Women with a history of preeclampsia are at 2 x the risk of heart disease, stroke or thromboembolic event in the 5 -15 years following pregnancy • Click to edit Master text styles GA PRAMS data by race for HTN in pregnancy • Black 15. 1% • White 15% • Hispanic 6. 8% – Second level • Third level HMHB Partner Survey: What is needed: – Fourth level • Relevant health education for » Fifth level expecting mothers • Medical management • Additional training and awareness for first responders Why: • Culture • Poor compliance with follow-up directives Source: HMHB State of the State: Maternal & Infant Health in Georgia, PRAMS 2009 -2011 • Lack of access to care (transportation and provider location) • Lack of insurance

INFANT MORTALITY: SUBSTANCE ABUSE Georgia shows better rates than the nations for mothers’ use of alcohol and illicit drugs: - Alcohol consumption (GA- 6. 2% compared to U. S. 7. 5%) - Illicit drugs (GA compared to U. S. 3. 1 and 8. 2 per 1, 000 live births respectively) • Click to edit Master text styles – Second level Of the 1, 004 infant deaths in 2014: • 31 caregivers had a history of substance abuse • Third level • 11 under the influence at time of death – Fourth level • 52 (33%) had prenatal maternal tobacco exposure » Fifth level HMHB Partner Survey: Responses Related to Substance Abuse What is needed: • • • Smoking cessation resources for pregnant women Rehabilitation options (Maternal and infant programs) Foster care options Source: HMHB State of the State: Maternal & Infant Health in Georgia Why: • • Lack of resources in rural areas, in particular Lack of funding and limited reimbursement

INFANT MORTALITY: SMOKING Maternal Smoking is usually underreported and associated with increase risk of: Placental abruption, LBW babies, SGA babies, Nonsyndromic heart defects, Oral clefts, and Tourette syndrome • Click to edit Master text styles Of the 1, 004 infant deaths in 2014: – Second level • 52 (33%) had prenatal maternal tobacco exposure • Third level Birth certificates indicate that about 6% of GA mothers are smoking in – Fourth level pregnancy (7, 500+) » Fifth level • GA PRAMS maternal smoking by race (2009 -2012): – 10. 3% White – 3. 7% Black – 0. 9% Hispanic • Rome, GA (Floyd County) has one of the highest maternal smoking rates in GA. Source: HMHB State of the State: Maternal & Infant Health in Georgia

INFANT MORTALITY: PRECONCEPTION/INTERCONCEPTION HMHB Partner Survey: Responses Related to Preconception/Interconception Care and Secondary data related to IMR and top 10 IMR facilitators Counseling identified by survey respondents: What is needed: Why: • • • • Click to edit Master text styles Affordable doula services – Second level Appropriate spacing of pregnancies Postpartum check-ups at home • Third level Safe sleep training – Fourth level Breastfeeding training/education/support » Fifth level (IBCLC lactation services in the hospital and at home, training for breast pumps and how to maintain a mother's milk supply for all mothers undergoing any mother/baby separation, , etc. ) Care coordination for mother and baby Financial assistance for PPBTL for uninsured mothers • • • Lack of resources/reimbursement - Medicaid does not cover lactation care by an IBCLC (GA can choose to change) Not all communities/hospitals have access to lactation consultants (Habersham) Home visitors are not always trained to support breastfeeding Limited social support in the community for mothers breastfeeding Programs are not aware of a systemic way to coordinate care

INFANT MORTALITY: PRENATAL CARE Data regarding prenatal care is often outdated and incomplete in GA: Click to edit Master text styles • • Access to prenatal care in rural areas is a challenge • Babies born to mothers who received no prenatal care – Second level – Three times more likely to be born at low birthweight, and • Third level – Five times more likely to die, than those whose mothers received – Fourth level prenatal care. » Fifth level • DPH provided HMHB the latest data 2008 -2014: Source: HMHB State of the State: Maternal & Infant Health in Georgia

INFANT MORTALITY: PRENATAL CARE HMHB Partner Survey: Responses Related to Prenatal Care • Click to edit Master. Why: text styles What is needed: • Increased access/participation in – Second level prenatal care • In-home follow-up options • Third level • Affordable midwife services – Fourth level • Specific prenatal wrap around » Fifth level services for high risk populations • Prenatal oral health services • Prenatal classes • No programs in rural areas (e. g. , Polk and Chattooga) • Poor compliance with follow-up directives • Insurance eligibility after pregnant • Inequality • Transportation

INFANT MORTALITY: MOTHER UNINTENDED PREGNANCY • In 2010, 60% pregnancies were unintended (national average was • 45% in 2011) Click to edit Master text styles – Second level • Third level. AGE OF MOTHER – Fourth level Mothers <25 and >34 years old: » Fifth level • have higher rates of premature babies • have higher rates of LBW babies HMHB Partner Survey: What is needed: • Education for high-risk pregnancy Source: HMHB State of the State: Maternal & Infant Health in Georgia

INFANT MORTALITY: POVERTY HMHB Partner Survey: Responses Related to Poverty What is needed: Why: • Housing (stable, affordable, safe) • Employment opportunities/ – Second level • Job training /Educational • Third level opportunities for mothers – Fourth level • Safety » Fifth level • Financial support • Nutritional support (mother and baby) • • Click to edit Master • text styles Lack of resources Lack of programs/options Low awareness of what is available Systemic oppression Lack of buy-in from legislators Limited accountability for disparities No human rights framework

INFANT MORTALITY: STRESS AND LACK OF SUPPORT Untreated depression during pregnancy is associated with a 27% increased risk of preterm delivery compared to those whose depression was treated • Depression affects approximately 10 -15% of mothers • In GA, teen mothers are most at-risk for depression • Click to edit Master text styles HMHB Partner Survey: Responses Related to Stress and Lack of Support – Second level What is needed: • • Behavioral health services for pregnant and • Third level postpartum women – Fourth level Parent support/education (e. g. , nutrition, exercise, calm crying baby, child neglect/abuse, infant » Fifth level stimulation, child development, maternal bonding, stress reduction, safety, breastfeeding, language stimulation, etc. ) Maternity leave Paternal inclusion and support Screening and counseling for perinatal mood disorders (postpartum depression) Social Services for pregnant women (in-home parenting assessments) Presences of ACEs Source: HMHB State of the State: Maternal & Infant Health in Georgia Why: • • • • Lack of resources/reimbursement Transportation issues Lack of child care offered Illegal status Isolation Lack of programs/options Stigma/apathy Generational cycles Low awareness of what is available Poor attendance of existing programs Referral resources for positive screening Limited awareness of importance/value Inconsistent messaging and lack of information

INFANT MORTALITY: LOW BIRTHWEIGHT AND VERY LOW BIRTHWEIGHT • Low Birthweight (LBW): Babies weighing less than 2500 gms (5. 5 pounds) * • – Click to edit Master text styles ~ 9. 5% of GA births, but 70% of GA’s infant deaths ** • – Second level Very Low Birthweight (VLBW): Babies weighing less than 1. 5 kg * – ~ 2% of GA births, but 50% of GA’s infant deaths ** • Third level • – Fourth level Costs $27, 000 per pound to raise a baby to normal weight » Fifth level • Risk factors: small maternal stature, poor nutrition, smoking, illicit drug use, hypertension, and short inter-pregnancy interval (inadequate birth spacing) • For the last five years of data (as noted in the table below), consistently, babies born to mothers utilizing Medicaid have had lower rates of low birthweight than the overall state rate. ** Source: * World Health Organization (WHO) **HMHB State of the State: Maternal & Infant Health in Georgia OASIS: Department of Public Health, Office of Health Indicators for Planning (OHIP)

INFANT MORTALITY: LACK OF HEALTH INSURANCE Secondary data related to IMR and top 10 IMR facilitators HMHB Partner Survey: Responses Related to Lack of Health Insurance identified by survey respondents: Why: styles • Click to edit Master text • • Access to affordable health care coverage • Lack of Medicaid expansion in GA What is needed: • • – Second level for women of child bearing age before conception, postpartum, and between • Third level pregnancies – Fourth level Continuous insurance for infants » Fifth level (emergency Medicaid after birth, until age 2 years without reenrollment) • • Maternity units and hospitals have closed Institutional racism embedded in the health care system

INFANT MORTALITY: PRE-TERM BIRTHS Preterm is defined as babies born alive before 37 weeks of pregnancy are completed. • Click to edit Master text styles Beginning with 2014 birth data, the OB estimate of gestation on the birth – Second level certificate is now being used to calculate prematurity instead of the previous estimate using the LMP. This is a national change and is • Third level – Fourth level lowering prematurity rates by about 2% here in Georgia. » Fifth level • 2014 GA: 10. 8% (National average - 9. 57%) • GA currently ranks 38 th (perhaps 43 rd) • Risk factors: History of pre-term births, carrying multiples, uterus or cervix problems, maternal medical condition, certain infections during pregnancy, and substance use (including tobacco) Source: * World Health Organization (WHO) **HMHB State of the State: Maternal & Infant Health in Georgia

INFANT MORTALITY: SUDDEN INFANT DEATH SYNDROME (SIDS) Sudden death is non-violent, unexpected death occurring less than 24 hours from the onset of symptoms. • Click to edit Master text styles • From 2005 through 2014, the (national) IMR for sudden – Second level infant death syndrome declined 29% • Third level • Of the 1, 004 infant deaths in 2014, 158 (15%) were sleep related. – Fourth level » Fifth level Source: World Health Organization (WHO) CDC NCHS Data Brief No. 279, March 2017 HMHB State of the State: Maternal & Infant Health in Georgia OASIS: Department of Public Health, Office of Health Indicators for Planning (OHIP)

INFANT MORTALITY: GROUP POLL In the materials you received you will find a handout Take 8 -10 minutes to rank from 1 to 36 the factors that may • Click to edit Master text styles influence IMR in your area. – Second level Once you have finished the ranking on your worksheet please • Third level complete the next 5 poll questions using your laptop or smart – Fourth level phone. » Fifth level – Please provide only one response per question. – If texting your response: Please use the letter in parentheses to the left of your selection Please raise your hand if you have difficulty.

• Click to edit Master text styles – Second level • Third level – Fourth level » Fifth level

• Click to edit Master text styles – Second level • Third level – Fourth level » Fifth level

• Click to edit Master text styles – Second level • Third level – Fourth level » Fifth level

• Click to edit Master text styles – Second level • Third level – Fourth level » Fifth level

• Click to edit Master text styles – Second level • Third level – Fourth level » Fifth level

• Click to edit Master text styles – Second level • Third level BREAK – Fourth level » Fifth level

INFANT MORTALITY: PARTNER SURVEY HMHB Partner Survey: Top 10 Factors that impact IMR 1. Health inequity (15) 3. (12) –Substance Secondabuse level Medicalto complications (hypertension, etc. ) (13) • 2. Click edit Master textdiabetes, styles 4. Poor access to or inadequate use of prenatal care (12) • Third level 5. Poverty (12) 7. Stress and lack of support (8) 8. Absence of preconception/interconception care and counseling (7) 9. Lack of health insurance (7) – Fourth level 6. Unintended » pregnancy (10) Fifth level 10. Age of mother (35+ years) (6) How did your responses differ or align with survey responses?

INFANT MORTALITY: GROUP WORK Based on your input before the break, we will further prioritize the facilitating factors we discussed. • Click to edit Master styles What will text you do? – Second level Identify the five factors that your group believes should be the strategic focus over the next three to five years. • Third level – Fourth level Who will you work with? » Fifth level Your name tag should have a letter identifying your group for this activity. Others have the same letter as you. Your team. How long do you have? 45 minutes

INFANT MORTALITY: GROUP WORK How will you accomplish your work? q Take two or three minutes to introduce your selves and select a recorder and reporter q • The first task is discuss the facilitating factors listed on the slips you were Click to edit Master text styles provided. Are there any missing? Write what you believe is missing on individual blank slips. – Second level q Using the selection criteria sheet at your table: • Third level q q q List the priorities you have – Fourth level Are there any criteria missing from the selection criteria sheet? » Fifth level Rank each 1 to ? based on each of the criteria (with 1 being the best option) Total each factor and then rank them based on their scores. List on you easel pad the top five scores and discuss the reason for those. Do you agree? Why or why not? How will we know you did it? A. Your flip chart will list the top five priorities you selected B. Your reporter will offer a brief summary

PLANNING PROCESS: NEXT STEPS Each of the planning sessions will lead to a final strategic plan to reduce infant mortality in the Atlanta Perinatal Region during a three to five year period. • Click to edit Master text styles Planning Process: Next Steps – Second level ü Explore the state of infant mortality: National, State, and • Third level regional picture of drivers (Prioritize) – Fourth level » Fifth level • Explore available services and service gaps (Identify and prioritize objectives) – We will: – Revisit priorities – Review the service landscape and discuss gaps – Further narrow priorities and select specific objectives to address them

PLANNING MEETINGS Wednesday, May 31, 2017, 12 PM-4 PM Harry S. Downs Center for Continuing Education • Click to edit Master text styles Clayton State University – Second level 2000 Clayton State Boulevard • Third level Morrow, GA 30260 – Fourth level » Fifth level Wednesday, June 21, 2017, 12 PM-4 PM Chattahoochee Technical College – North Metro Campus Building B, Room 221 5198 Ross Road, Acworth, GA 30102

THANK YOU • Georgia Health Policy Center Georgia State University 404 -413 -0314 Click to edit Master text styles www. gsu. edu/ghpc Criss Sutton, Senior Research Associate – Second level • Third level chopson@gsu. edu – Fourth level Healthy Mothers, Healthy Babies Coalition of Georgia » Fifth level 770 -451 -0020 ext. 201 Elise Blasingame, Executive Director elise. blasingame@hmhbga. org