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Initiative for Infants: Task Force Working to Reduce High Death Rate

Posted on: Sunday, 21 May 2006, 06:08 CDT

By Chris Vaughn, Fort Worth Star-Telegram, Texas

May 21--FORT WORTH -- Community leaders trying to lower Tarrant County's high infant-mortality rate are working to establish a medical review team that would allow them to interview women to research the precise reasons their babies died.

Called fetal and infant mortality review teams, they are widely used in many parts of the country, including Houston and San Antonio, to improve medical and social services for pregnant women, particularly those at high risk for premature births.

Local leaders of a task force, who are working on legislation to improve legal protection for their teams, are proceeding for now, with the best version they have.

"The first step would be to have a nurse review the cases of all fetal/infant deaths," said Lou Brewer, director of the Tarrant County Public Health Department. "We can translate that into information for the task force, so we can be looking for trends and repeated problem areas."

But like most of the task force's ideas to reduce infant mortality, establishing a fetal and infant mortality review is not free; and so far, no question looms larger than how it would be funded.

Money has turned out to be the task force's primary impediment to action. Established in 2002, the task force has researched the problem and proposed remedies, yet few have been implemented because of a lack of money.

"In the 1980s, the mayor's office put together a big group of people to improve infant mortality, and the initiative died," said Barbara Greer, director of the neonatal intensive care unit at Cook Children's Medical Center. "Here we are 20 years later, doing the same thing. We need to carry this through. We need to because it's pay now or pay later."

City and county officials, in speeches to civic groups, are increasingly highlighting the economic costs of the problem, hoping that idea will be more effective than talking about public health.

A baby born prematurely who is treated in the neonatal intensive care unit at Cook's stays for an average of 20 days at $3,000 a day, and much of that cost is paid for by the state or absorbed by the hospital.

Some expenses for premature babies can reach up to $200,000.

Officials also contend that infant-mortality statistics are used by corporate relocation firms to measure the health of an area.

Tarrant County has, for decades, registered a higher infant-mortality rate than the state's other urban counties, including Dallas, Harris and Travis counties.

The numbers are most grim for black babies, but Tarrant County's rates are also higher among Anglos and Hispanics. The problem is most severe in southeast and east Fort Worth and central Arlington.

Money matters

The 36-agency task force that met to address the problem is a mixture of government, such as the Fort Worth and Tarrant County public health departments, JPS Health Network and the Fort Worth school district; and nonprofits, such as Catholic Charities, Cook Children's, March of Dimes and Alliance for Infant Survival.

After more than two years of study, leaders compiled a wish list of options in 2005 that would cost about $300,000. But little money has resulted from that plan.

Instead, many of the agencies have contributed so-called in-kind services, whether in conducting research, providing lunches for meetings or freeing people for duties.

The main donor has been Catholic Charities, which has used federal money for a staff member and a part-time consultant to coordinate the task force.

But Catholic Charities' financial support for other task force needs must be reduced, said Samantha Cheatham, the agency's director of development.

"We're needing to put that money toward direct client services," Cheatham said.

Relying on in-kind donations limits how much the task force can do, leaders said.

"People have been awesome about giving of their time, but we need substantial dollars," Greer said.

Fundraising has been difficult, leaders said, because few have had the time to write grants or make fundraising pitches and because each of the nonprofits already taps the existing pool of wealthy residents and large foundations.

It doesn't help that the task force is not asking for money for a building or something else concrete, said Tarrant County Commissioner Roy Brooks, who has been involved in the task force.

"What we need is a piece of capital infrastructure that is not a building," he said. "It is a system. But it is no less real and no less vital than a building."

But Brewer isn't worried yet about the lack of money. She and Brooks both said the task force's primary purpose is to raise awareness and coordinate a response.

"I really want to try to do as much in-kind as possible, to get some tangible activities going and start tracking them," Brewer said. "Then it makes a more compelling argument to go to traditional funding sources and say, 'We've come this far on our own. This is what we need to notch it up to make a bigger impact.' "

New approach

The task force had hoped for one of its biggest initiatives to be a marketing campaign in southeast Fort Worth, but its leaders have thus far tried other methods because of the campaign's significant price tag.

Instead, they're working to to reach black pastors and church leaders who have strong influences on families.

"The group of women that we as providers are trying to reach hasn't responded to any of the conventional methods -- not the clinics or the branches, not public-service announcements or brochures," said Jerry Roberson, a consultant to the task force. "We've tried all that, and it still hasn't closed the gap. We have to deal with the social and behavioral factors."

If a fetal and infant mortality review team can get started, it most likely would be under the direction of the Tarrant County medical examiner's office, which already has the legal authority to convene a child-fatality team.

The hope for that review team is that interviewing women who lost babies and poring over their medical records will reveal causes and allow specific fixes to those problems.

The JPS Health Network, the county hospital system, is also starting a program for women to act as mentors and advocates for pregnant women, ensuring that they get prenatal care.

It is not a task force initiative, Brooks said, but it is complementary.

"We believe it is only through that kind of approach that you're going to make any substantive progress on the issue," he said.

Infant mortality rates

Tarrant County

Anglos: 7.0 deaths per 1,000 live births

Blacks: 16.1

Hispanics: 5.5

All races: 7.5

Texas

Anglos: 5.8

Blacks: 13.8

Hispanics: 5.7

All races: 6.6

SOURCE: Texas Department of Health, based on 2003 numbers

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Chris Vaughn, (817) 390-7547 cvaughn@star-telegram.com

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Copyright (c) 2006, Fort Worth Star-Telegram, Texas

Distributed by Knight Ridder/Tribune Business News.

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Source: Fort Worth Star-Telegram (Fort Worth, Texas)

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