Steering Committee Meeting April 15, 2020
Acknowledgement The National Center is funded in part by Cooperative Agreement Numbers UG7MC28482 and UG7MC31831 from the US Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB) as part of an award totaling $1,099,997 annually with 0 percent financed with non-governmental sources. Its contents are solely the responsibility of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
Agenda 1. Highlights from the National Center 2. NFR-CRS Version 5.1 3. Update on Suicide Prevention Action Team 4. Update on Maternal Infant Health Equity Action Team 5. 2020 Meeting Dates
Program Highlights • Engaged states that have not received a site visit in more than five years • Completed a number of products including: – Parental Interview Guidance – Guidance for Engaging AI/AN in Fatality Review – Child Abuse and Neglect Quick Look for Infants • Embarking on prevention pilot with AAP • Welcomed new staff member Krisha Felzke
Data Highlights • Launched FIMR data quality initiative • Coauthored papers on U-shaped pillows, incidence of sudden death in children, and firearm suicides in young teens • A paper on fire play is currently being revised for resubmission • Set benchmarks for Data Dissemination
Response to COVID-19 • Revised NFR-CRS to include COVID-19 as a cause of death • Created guidance for teams on conducting virtual meeting and high volume reviews • Created guidance on reviewing direct and indirect COVID-19 deaths • Compiled self-assessment tools • Participated in national dialogue with key partners
NFR-CRS Version 5.1 • Version 5.1 will launch on April 27, 2020 – Expanded mental health and substance use/abuse (CDR) – Revised suicide and prevention sections – All variable data download – Health equity standardized report (FIMR) • Version 5.1 resources – Training modules – Webinars – Written products
Suicide Prevention Action Team
Suicide Action Team Charges Revise Review Suicide CRS Existing CRS section Data Review summary Key trends and CRS data gaps in data Prioritize Develop elements in new summary section Collaborate with Modified Delphi partners to finalize section
NFR-CRS Suicide Revision • New skip pattern to access suicide questions • Updated language to remove antiquated and harmful terms • Incorporated current research such as Warning Signs • Expanded questions about child’s history • Created Life Stressors section (for all children) • Updated Data Dictionary
New Skip Pattern for Risk Factor Questions • Created new skip pattern to make suicide risk factor questions available for deaths that are undetermined • National Center hopes it gives teams flexibility to access additional variables without contradicting death certificate
Revised Suicide Section
Life Stressors Section • Social/Economic • Relationships • School • Technology • Transitions • Trauma • Other
NFR-CRS Standardized Report • Child history – Maltreatment as a victim (history), open CPS case (at time of death), child placed outside of home, mental health (history), mental health (at time of death), substance use/abuse (history), delinquency, suicidal behaviors/attempts, communication of suicidal thoughts, showed warning signs and known crises • Incident – DSI performed and toxicology • Life stressors
Data Presentation for Standardized Report Manner of Death = G5 Checked Suicide History of mental health services Number Number Child was currently receiving mental health Number Number services History of substance use or abuse services Number Number Child experienced suicidal Number Number behaviors/attempts
Key Questions • What additional information do teams need to help with prevention? • What key pieces of data would you like to see in a national report on NFR-CRS suicide data?
Next Steps • Program standardized report • Finalize guidance and webinar • Begin data analysis for national report
Maternal Infant Health Equity Action Team
Key Question • We shifted the language from maternal interview guide to parental interview guide, does the action team need a new name? • We’ve recently been asked to standardize language around race. How does your organization handle this?
Parent Interview Guidance document • Draft reviewed by multiple MIHE/Steering Committee members (THANK YOU!) • Input from experts from the field, experienced maternal interviewers, including past contributors to the 2002 NFIMR/ACOG Guidance • HRSA Division of Healthy Start and Perinatal Services has reviewed • Document sent to the MPHI design team
Sections of the Parent Interview Guidance • Community Benefit • Conducting the interview • Benefit to Bereaved • Alternative methods Families – In-person • Challenges – Phone • Who does the interview – Survey • Locating and engaging • Bereavement support families for families • Confidentiality and • Self Care ethical concerns
FIMR Storytelling Project • Aims: This exploratory scope of work aims to adapt, apply and integrate the science and best practices of storytelling with existing community-based death review processes. • Principal Consultant: Dr. Magda Peck MP3 Health Group for the Public’s Health and Equity
Design Team Charge • To advise on strategies for strengthening FIMR teams’ abilities to use strategic storytelling to augment the death review process • To inform the design and implementation of a pilot program to orient and train selected FIMR Teams on harnessing the power of stories for social change with focus on improving perinatal outcomes • To assist in the evaluation of the pilot and make recommendations for continued investments in strategic storytelling strategies to enhance FIMR.
Progress • Representatives on the Design Team – MIHE action team – AMCHP, CityMatCH, NICHQ, MPHI’s Center for Health Equity Practice – Healthy Start, Fatherhood Initiative • Design Team has met virtually two times, 3/25/20 and 4/8/20 • Third meeting is planned for 4/29/20
FIMR Storytelling Project • Dr. Peck will plan, deliver and facilitate a day-long (hybrid) capacity-building workshop and design session, Storytelling for Social Change – Opportunities for FIMR , by early June 2020. • This workshop will be adapted from Dr. Peck’s work, Storytelling to Change the Narrative for Health, Equity, and Justice :
Progress • Case Statement: The “Why” . . . What is the value- add to FIMR of first person, individual stories and storytelling from parents and others who have experienced losses? • The Who: Who else’s voice needs to be added to the Design Team? • Design Principles: What core principles need to guide this work?
Anticipated Outcomes Short term: • Participating FIMR teams increase their knowledge and understanding about how to use and leverage powerful stories and strategic storytelling in their FIMR practices and processes for greater impact. • Participating FIMR teams enhance their individual and collective capacity to invite and incorporate strategic storytelling into their work to influence services and systems change.
Anticipated Outcomes Long Term: • Concurrent MCH-related sentinel event/fatality review processes – Maternal Mortality Review (MMR), Child Death Review (CDR), and FIMR – will utilize and align enhanced storytelling strategies to inform and influence policies and practices and systems change through joint leadership development, cross-cutting skills-building, and collaboration. • Health disparities in maternal, fetal, infant, and child mortality may be reduced, in part, through improvements in maternal, fetal, infant, child health review processes.
Next Steps
Building upon the Center’s Equity Work Opportunity to weave in the MIHE Action Team strategies with the Center’s current activities FIMR/CDR Health Disparities Work Group Fatality Review Health Equity Learning Collaborative
Discussion? Questions?
Future full Steering Committee meetings: Save the Date • July 28, 2020: full Steering Committee meeting, DC
National Center is on Social Media: @NationalCFRP
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