Transportation: A vehicle for health equity in rural communities Allison Howland, PhD & Meagan Benetti, MS Center for Collaborative Systems Change Indiana Institute on Disability and Community
Learning Objectives Describe the components of successful care coordination for maternal and child health populations in rural communities Explain how transportation can expand opportunities for social support and access to health care services Apply the presented strategies to address transportation challenges in other rural communities
Indiana Institute on Disability and Community Our mission is to work with communities to welcome, value, and support the meaningful participation of people of all ages and abilities through research, education, and service.
Indiana Institute on Disability and Community Center for Collaborative Systems Change Center for Health Equity Center on Community Living and Careers Early Childhood Center Center on Education and Lifelong Learning Indiana Resource Center for Autism
Center for Collaborative Systems Change Connecting policy, research, and practice in partnership with communities to build local capacity that fosters lasting, sustainable change.
Areas of Study Mental Health Maternal and Child Health Substance Abuse Prevention Community Coalitions Groups of diverse stakeholders coming together to solve social problems Coalition development Strategic planning Social Service Organizations Program and policy implementation Evaluation and continuous quality improvement Capacity building
Community Based Participatory Research An orientation to research that focuses on relationships between academic and community partners, with principles of co-learning, mutual benefit, and long-term commitment that incorporates community theories, participation, and practices into the research efforts. (Wallerstein & Duran, 2015)
Indiana Health Stats 42 nd Infant Mortality CDC National Vital Statistics System (2014-2015)
Indiana Health Stats 46 th Maternal Mortality CDC National Vital Health Statistics System (2011-2015)
Indiana Health Stats 34 th Drug Overdose Deaths CDC National Vital Health Statistics System (2013-2015)
Safety PIN Protecting Indiana s Newborns Reduce rate of infant mortality across the state Improve overall health for women of child-bearing age Promote early and adequate prenatal care Decrease early elective deliveries before 39 weeks Decrease prenatal smoking and substance abuse Increase breastfeeding duration & exclusivity Support birth spacing & interconception wellness Promote safe sleep practices
Safety PIN Protecting Indiana s Newborns Overview Indiana State Department of Health grant to address opioid epidemic and its effect on infant mortality Southeast Indiana Target Area Awarded to provide services to new and expecting mothers including parenting classes and care coordination Partnership with Choices Care Coordination Solutions, a local system of care, & Center for Collaborative Systems Change
Safety PIN Description of Region Mostly rural No public transportation High rates of HepC & HIV High rates of smoking and excessive drinking Infant mortality related issues Prioritized unmet needs of catchment area Southeast Indiana Target Area Substance use Mental health Access to care (Health Collaborative, 2016)
Primary Care Provider Shortages Highest SE IN County - 2,970:1 Indiana - 1,500:1 Lowest SE IN County - 1,270:1 U.S. Top Performer - 1,030:1 Bureau of Health Workforce, Health Resources and Services Administration (HRSA), U.S. Department of Health & Human Services (2018)
Mental Health Provider Shortages Lowest SE IN County - 840:1 Highest SE IN County - 5,930:1 Indiana - 700:1 U.S. Top Perfo rmer - 330:1 Bureau of Health Workforce, Health Resources and Services Administration (HRSA), U.S. Department of Health & Human Services (2018)
Protecting Indiana s Newborns Addressing Multiple Needs Prenatal and Primary Care Mental Health Services DCS and Probation Involvement Substance Use Treatment Choices Care Coordination Choices Care Coordination Expecting or New Caregivers (infant > 1 year) Develop & Coordinate Individual Care Plans Screening & On-going Assessment Individual Support Incredible Years Baby Parenting Program Public Outreach and Awareness of Early Child Development and Safety
Choices Care Coordination Program Voluntary Eligibility Pregnant or has child under 1 year of age Lives in the 5-county catchment area Priority for moms with substance use issues Caseload ~ 15 per care coordinator Average length of services 200 days (6-7 months) Range: 1 to 422 days (~14 months)
Client Profile 81% 62 10% Caucasian/ White Clients Hispanic 98% 85% Female Met their Goals
Client Profile 64% 62 60% Transportation needs 37% Clients 39% Healthcare management needs Few ties to community Substance use issues
Care Coordination Referrals Child Welfare Hospital Pregnancy Resource Center Internal Social Service Agency Home Visiting Program WIC Mental Health Probation First Steps Parenting Program OB-GYN Self Referral Friend School 7% 5% 4% 2% 2% 2% 2% 2% 2% 2% 2% 1% 12% 19% 41%
Choices Care Coordination Model Meet with the client in their home or community setting Develop goals with family Conduct assessments: Informal family story Formal ANSA, CRAFFT, EPDS (At intake and every 6 months in program) Monthly family team meetings to plan steps towards their goals Connect family to community resources: WIC, parenting programs, pregnancy care centers, food pantries, mental health and substance abuse treatment, home visiting, First Steps, etc. Direct support for immediate needs
Transportation Policy & Practice Change Before Transportation provided to youth clients and families in emergency situations, only After Transportation provided to any Safety PIN client, when needed to meet individualized goals
Preliminary Transportation Data ~50% of clients received transportation Average # of rides 6.57 Range of 1 to 15 rides per client Successful completion rates (healthy birth & met goals) 85% overall 89% for those who received transportation
Going the extra mile Creative use of time during car rides Relationship building Skill building Assessments Support for life challenges Plans for future meetings/support Feedback from classes, appointments, & meetings
Going the extra mile Translation & Interpreter Services I would not be able to provide care for quite a few of my Spanish speaking patients, if it weren't for [the care coordinator]. I have always observed her in a professional manner, willing to go the extra mile for her clients. Her clients describe her as one of the family, kind and generous. OB/GYN Childcare If they have the kids with them, I m definitely going to be assisting on the child care as much as possible so the mom/parents can focus on the class, doctor, etc., to really be able to pay attention to what is going on and being said. Sometimes hands on assistance such as helping them learn how to best assist in holding their baby while they receive shots and then give guidance on comforting baby right after. Care Coordinator Advocacy I also find they often will tell me prior Don t let me forget to ask my doctors about xyz! so I m there to help give reminders on things they had questions on and to also help ensure they get scheduled again for their next visit and help give them a reminded when that next visit date comes up. Care Coordinator
Sustainability Across the Social Ecology Community Organizational Relational Leading transportation committee with regional Recovery Oriented System of Care initiative Advocacy for expansion of MediCab & other rural public transit options Creating policy to provide transportation in all care models Incorporating transportation into insurance/liability policies Improving data systems to better evidence transportation needs & services Providing social support and allyship with providers Building long-term relationships with clients Individual Care Coordinators helping clients: Obtain Driver s licenses Insurance enrollment Other basic needs assistance
References 1. Centers for Disease Control and Prevention. The HI-5 Initiative: Healthy Impact in Five Years. Atlanta (GA): Centers for Disease Control and Prevention; 2017. http://www.cdc.gov/sixeighteen/ 2. Health Research & Educational Trust. (2017, November). Social determinants of health series: Transportation and the role of hospitals. Chicago, IL: Health Research & Educational Trust. Accessed at www.aha.org/transportation 3. Bureau of Health Workforce, Health Resources and Services Administration (HRSA), U.S. Department of Health & Human Services, Designated Health Professional Shortage Areas Statistics: Designated HPSA Quarterly Summary, as of December 31, 2017. (2018) 4. Health Collaborative, (2016). Community Health Needs Assessment: A Regional Collaborative Report. Retrieved from http://healthcollab.org/wpcontent/uploads/2016/02/cincinnati-chna-report-2016-final.pdf
Questions? Contact us: ahowland@indiana.edu mbenetti@indiana.edu