Genesee County REACH
Contact Person: Tamara Brickey
Contact Information: firstname.lastname@example.org
Since 2000, the Genesee County REACH (Racial and Ethnic Approaches to Community Health) project has conducted a series of innovative interventions to reduce racial disparities in infant mortality, including: engagement and mobilization with the community to develop community-driven solutions to improve maternal and child health; activities with healthcare systems and professionals to optimize healthcare for high risk mothers and infants; and experiential, culturally-based interventions to promote awareness and improvement of social determinants that contribute to African American infant mortality, including racism. During the project, African American infant mortality rates in Genesee County decreased from a high of 23.5 to 15.2 deaths per 1,000 live births. Genesee County has been a national leader and Center of Excellence charged with translating and replicating evidence of its innovative practices to document the value of community-based participatory approaches to reduce infant health disparities with an emphasis on anti-racism intervention strategies.
Genesee County has partnered with the following organizations: Flint Odyssey House/Health Awareness Center, Genesee County Community Action Resource Department (GCCARD), Genesee County Health Department (Central Coordinating Agency), Greater Flint Health Coalition, Hurley Medical Center, Programs to Reduce Infant Deaths Effectively (PRIDE), Priority Children, University of Michigan/Prevention Research Center, and YOUR Center.
Activities & Objectives
The primary objective of Genesee County REACH is to reduce the disparity in infant mortality through multifaceted practice and evidence-based interventions in Genesee County, MI, using a three-theme approach of community mobilization, enhancing the babycare system, and reducing racism. More broadly, the goal is to reduce racial and ethnic health disparities through population focused and systemic structural interventions that embody community engagement and cultural relevance.
Activities to accomplish the above are explained in more detail in the following section.
1. Anti-racism awareness and education across multiple sectors
- A flagship component includes Undoing Racism™ Workshops
- There is justification for racism awareness and education as a crucial step to developing critical race consciousness, reducing prejudice, and implementing social and community change
- There are many documented examples of individual perspectives that have been fundamentally changed
- Participants describe that enhanced awareness and knowledge of racism has motivated actions to reduce health disparities; such revelations provide support for the value of anti-racism education as an intermediary step to improving African American general and infant health outcomes
- Anti-racism efforts must be sustained and institutionalized
2. Addressing the connections between racism and infant mortality from a historical and cultural perspective
- Using history and culture education as a venue to explain health disparities and the social determinants that fuel those disparities
- Highlights how historical and systemic racial inequities shape thinking and behaviors that harm health across generations
- Discussing issues from an African American perspective resonates well with focus populations that suffer the greatest inequities
- Has enlightened non-African American participants and health professionals as well and enhances understanding of disproportionate social and health disparities
- The Genesee County intervention is designed to challenge racial stereotypes and change the thinking, feelings, and behaviors of participants, including reducing internalized racism. The intervention also encourages participants to combat racial victimization through coping mechanisms such as positive racial identification, self-affirmation and empowerment, and community support.
- Participants have reported more pride in their heritage with enhanced self-esteem that translated into improved nutritional practices, stress-coping behaviors, educational and economic development, and academic performance among youth?these characteristics are supportive of healthier lifestyles and enhanced maternal health and birth outcomes
3. PRAT (Pregnancy Risk Assessment Tool)
- An original, enhanced perinatal assessment tool created for the Genesee County community
- Facilitates standardized perinatal assessment of high-risk women across institutions
- Incorporates evidence-based guidelines for perinatal care
- Emphasizes routine assessment, referral, and follow-up for both medical and social determinants of health
- Was precedent-setting for reinforcing mental and emotional well-being and safe sleep practices
- Incorporated into the electronic medical records of partner institutions
- Has utility for multiple communities addressing maternal and infant health disparities
4. Windshield Tours
- Bus tours through neighborhoods where many high-risk clients reside
- The objective of these tours is to help providers, administrators, and policymakers gain a better understanding of the social conditions of women and families at risk for birth outcomes with the hopes that they can implement policies to reduce barriers to health in disadvantaged communities and provide more compassionate and effective care.
- Increases awareness of the lived experiences and unique challenges encountered by clients served at varying institutions
- Highlights community assets as well that often go unrecognized and fosters a more holistic appraisal of 'at risk communities'
- Documented change in provider sensitivity/office practices as a result of the Windshield Tours
- Has resulted in clinic adaptations to better accommodate clients (e.g., more flexible clinic scheduling in recognition of barriers such as transportation challenges)
- Has prompted successful advocacy for structural changes such as the addition of new bus routes that provide more direct access to health services and grocery stores that are distant from the focus neighborhoods
5. Community Health Advocates
- An essential component of the health outreach team for pregnant and childrearing women and their families
- Community health advocates facilitate access to clinical care and community resources and also reinforce health promotion behaviors for pregnant and postpartum women
- Direct street outreach reaches clients who would not normally present to prenatal care. These 'invisible' clients are not represented among most in-house case management services that only reach clients who proactively come through their doors
- A large percentage of FIMR cases often reveal no evidence of community-based care coordination; thus, community health advocates help to fill an established need
- Effective community health advocates are often from the same communities as their focus population and have lived similar experiences
- The community health educator model has demonstrated fewer than expected adverse outcomes in relation to the higher risk status of participating moms and babies in Genesee County as well as improved birth outcomes in relation to the general population for some MI communities
6. Sustained Community Engagement and Mobilization
- Utilizes genuine community-based participatory approaches; not just conducting outreach or services within communities
- Takes services to the people and adapts approaches to community needs
- Focus community must be involved from the very beginning and in all phases of program planning, design, implementation, dissemination, and evaluation of what constitutes 'success'
- The approach has successfully engaged 'non-traditional' partners such as African American men as leaders for education, advocacy, and community support to promote infant mortality reduction
7. Media Campaigns (billboards, public service announcements, informational flyers, etc.)
- Heightened awareness among both the community and health professionals as to the scope of infant mortality disparities
- Most effective in coordination with specific calls to action and availability of resources to directly benefit stakeholders
Lessons, Challenges, & Recommendations
Lessons learned include:
- Embrace 'non-traditional' approaches to address public health issues for populations that have consistently demonstrated little benefit from conventional programs and approaches. Ensure sustained support over the long-term to show the benefit of innovative approaches which often involve significant changes in institutional and social norms.
- Community must be at core of health equity work?be involved from the very beginning in priority-setting, program planning, and intervention design and evaluation.
- Successful community outreach involves sustained engagement with residents and organizations embedded in the community with well-established relationships and trust.
- Develop unique approaches to addressing racism and health disparities based on the uniqueness and composition of the community.
- Improving health equity and social determinants of health should be a shared communitywide issue--not limited to public health or select populations only.
- Importance of multi-sector engagement to develop shared solutions.
- Engaging non-health sectors to propagate the social determinants of health perspective.
- Community engagement and health promotion goals with pregnant and childrearing women and families are not likely to be successful unless you address basic needs first (food, clothing, shelter).
- Create equitable social justice policies and exchanges by building on relationships and getting the commitment of influential leaders within agencies and organizations.
Although Community Based Public Health (CBPH), the method used by REACH, is becoming more widely accepted, it is not how public health is "traditionally" practiced. Some institutional policies and systems barriers have adversely impacted this partnership. CBPH partners and grassroots organizations face this challenge in moving forward as we work to prove the legitimacy of CBPH.
Please review this research (PDF) compiled in the Genesee REACH US project Acknowledging Racism as a Primary Cause of Infant Mortality Disparities.