Baltimore County has launched a new initiative to combat infant mortality in low-income and minority communities in Cockeysville and Owings Mills.
The program, called Babies Born Healthy, will deploy community health workers and nurses to reach out to high-risk pregnant women and connect them with services to help them stay healthy through their pregnancies, health department officials said.
“It’s really looking at this holistically and wrapping around the social determinants of health,” said Dr. Teresa Messler, division chief of the county’s prenatal and early childhood programs.
The $200,000-per-year program is fully state funded for three years, Messler said.
Though birth outcomes are improving slightly across Maryland, infant mortality has remained high in Baltimore County in recent years.
The infant mortality rate in the county was 6.5 per 1,000 births in 2017 according to state statistics, higher than the previous year which saw a mortality rate of 5.9 per 1,000 births. Though the rate has declined slightly since 2008, Baltimore County maintains the second-highest infant mortality rate in the Baltimore metropolitan area, second only to Baltimore City, which has a mortality rate of 8.7 per 1,000 births.
Nationally the mortality rate is less than 6 per 1,000 births according to the Centers for Disease Control and Prevention.
Those poor birth outcomes are concentrated in communities of color, said Maura Dwyer, a senior administrator in the Maryland's maternal and child health bureau. Dwyer runs the statewide Babies Born Healthy program.
Infant mortality rates among black and Hispanic populations in Baltimore County were more than twice those of white infants, according to state statistics.
According to the program’s grant proposal, more than 12 percent of black babies are born with a low birth weight of less than 2,500 grams — nearly double the 6.6 percent for white babies.
“Although Baltimore County and Maryland rates are very similar, within Baltimore County there are multiple pockets of disparate birth outcomes by race and ethnicity,” the proposal said.
Two of the most concerning pockets are in Cockeysville and Owings Mills, officials said.
In Cockeysville, the proposal identified a census tract which includes apartment complexes around Cranbrook Road as an area in which infant mortality is increasing and which is “markedly underserved by existing support services.”
“These poor outcomes are often obscured in analyses by ZIP code because of the adjacent affluent communities,” the proposal said.
Women in these census tracts have high rates of hypertension, obesity and smoking, the proposal said, and “culturally appropriate” resources for pregnant women in these areas are scarce. Social services offices, health centers and Women, Infants and Children (WIC) offices are all based in other parts of the county, and the areas have “limited or no mental health services or substance use treatment facilities that accept public insurance or have a sliding fee scale,” the proposal said.
“There are a lot more resources in some of the areas where there are poor birth outcomes,” Messler said. “These communities don’t have the same access to the same resources.”
The Babies Born Healthy program is built to help fill that gap, she said.
The statewide Babies Born Healthy program started in 2009 and initially focused on getting women healthy before a planned pregnancy, Dwyer said. It operated in multiple counties including Baltimore County.
But because other programs already focus on family planning and women’s health, over the past year, state officials decided to refocus their efforts on at-risk women who are already pregnant, Dwyer said.
Starting in July, the county has revamped its own program, starting with hiring a public health nurse and community health worker, Messler said.
Instead of taking appointments at a centralized clinic, Messler said health workers make regular home visits and phone calls. Not only does that strategy overcome transportation barriers, but Messler said it is helpful to “assess that mom and the family in their environment.”
“There may be risks we don’t know about that they don’t know to tell us about that we can see,” she said, citing chipping or peeling lead paint and food insecurity as problems that may not come up in a doctor’s office.
Dwyer said an important element of the program is hiring health workers who are enmeshed in the communities in which they work, in order to engage the highest-risk women and earn their trust.
The state’s Office of Minority Health helped implement the new program, Dwyer said, providing cultural competency training and making sure hiring and organizational practices are promoting equity. The state is also asking program participants to collect data on race and ethnicity to “make sure they’re serving all populations.”
The health workers provide “care coordination and navigation” services. That means they connect women with doctors, educate them about issues like infant care and breastfeeding, and help them apply for social services like Medicaid and SNAP benefits.
The program is holistic because health is about more than just medical care, Messler said, adding that health also comes from being able "to get good nutrition, to have stable housing, and to reduce stress.”
“Pregnancy is in general … an opportune time to engage women who may be more reluctant to seek services,” Dwyer said.
Since July, the program in Baltimore County has had more than 25 patient referrals, Messler said. The program, she said, can handle up to 45, but if it receives referrals for more than that it will still connect patients with services. The program involves checking in with patients at least once a week and following them through pregnancy to at least six weeks postpartum.
Baltimore County Department of Health spokeswoman Elyn Garrett-Jones declined to set up an interview with a health worker in the program.
With so few patients so far, “any general information our workers could provide to you would be way too easy to identify the client,” Elyn Garrett-Jones said. "We are still in the beginning stages of building rapport and trust with the target population and would not want to do anything to stall that.”
The program serves women in ZIP codes 21030 and 21117. Anyone can refer a patient to the county’s free program, Messler said, and there are no financial requirements. There are incentives to remain in the program, she said, including a free Pack ’n Play portable crib for women who remain through their pregnancy. The phone number for referrals is 410-887-8768.