The IDHS has developed a comprehensive maternal and child health (MCH) strategy for the reduction of infant mortality. This strategy integrates two large-scale programs, the Special Supplemental Nutrition Program for Women, Infants and Children, more commonly known as WIC, and the Family Case Management (FCM) program. The Department supplements these basic services with programs targeted to women who have a greater chance of giving birth prematurely. The Chicago Healthy Start Initiative (CHSI), Targeted Intensive Prenatal Case Management (TIPCM) and Closing the Gap projects serve areas of the state with high infant mortality rates or significant racial disparities in infant mortality. These programs work as an integrated whole to improve the health of women and infants.
The integration of these programs is supported and enhanced by the shared use of Cornerstone, the Department's maternal and child health management information system. This system collects and reports all of the information necessary for the operation of the WIC, FCM, Healthy Start and TIPCM programs, as well as other MCH services. Cornerstone provides an integrated record of the services provided to each participant and a service plan that identifies the services that the family requires. Cornerstone is also a distributed system, which means that much of the information collected by one MCH service provider can be retrieved by another service provider (with appropriate confidentiality safeguards). In this way, staff members within and among agencies have access to a comprehensive record of the services provided to participating families. This avoids the problem of duplicative data collection and recording. Cornerstone promotes the integration and streamlines the delivery of MCH services.
This comprehensive strategy also blends state and federal funds. WIC is supported entirely by funds from the United States Department of Agriculture (USDA). FCM and TIPCM are state-funded and these funds are used to leverage federal matching funds through the Medicaid program. CHSI and Closing the Gap are supported by discretionary grants from the federal Maternal and Child Health Bureau. Unfortunately, federal funding for Closing the Gap was discontinued as of June 30, 2007. The Department has been working with the Illinois Maternal and Child Health Coalition to identify alternative sources of funding.
The WIC program provides referrals, supplemental foods and nutrition counseling; FCM links families to health and other services.
A description of each of the above programs is presented below.
The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) seeks to improve the health of women, infants, and children; to reduce the incidence of infant mortality, premature births and low birth weight; to promote breastfeeding; and to aid in the growth and development of children. The program serves income-eligible pregnant, breastfeeding and postpartum women, and infants and children up to five years of age who have a medical or nutritional risk factor.
Participants receive food "prescriptions" based on their nutritional needs. WIC foods include milk, cheese, eggs, adult and infant cereal and juice, peanut butter, tuna, carrots, beans, and infant formula. Food-specific vouchers are printed on site at WIC clinics statewide. Participants obtain their WIC foods by redeeming the vouchers at program-approved grocery stores throughout the state and at WIC Food Centers in certain parts of Chicago.
The Department grants funds to 100 local agencies to provide WIC services, including local health departments, not-for-profit health care agencies and social service agencies.
Family Case Management is a statewide program that provides comprehensive service coordination to pregnant women, infants, and high-risk children. The Department funds 113 agencies, including local health departments, community-based organizations and Federally Qualified Health Centers, to conduct FCM activities. Assessments are conducted and care plans are developed to address a wide range of needs, including health care, mental health, educational, vocational, child care, transportation, psychosocial, nutritional, environmental, developmental, and other services. Contacts with clients include home and office visits at a frequency necessary to meet the client's needs. Most FCM providers are authorized to complete Medicaid Presumptive Eligibility applications for pregnant women and children and function as Application Agents for All Kids, Governor Blagojevich's health insurance program for children.
The WIC and FCM programs are the foundation of this integrated maternal and child health strategy for reducing infant mortality and improving child health. The targeted components of this strategy are described below.
The Department supplements WIC and FCM with intensive services for high-risk women.
The Chicago Healthy Start Initiative provides services through four Chicago Healthy Start Family Centers, which serve as "one-stop shopping centers" for intensive case management and linkage to prenatal care, pediatric primary care, family support, early intervention, substance abuse prevention, domestic violence prevention, and mental health counseling. The centers also provide two essential enabling services -- episodic child care and transportation -- to remove common barriers to care. CHSI targets the Near North Side, West Town, Near West Side, Near South Side, Douglas and Grand Boulevard Community Areas in the city of Chicago. This project is supported by a grant from the federal Maternal and Child Health Bureau.
Targeted Intensive Prenatal Case Management. This program's goal is to reduce the rates of premature birth and low birth weight. TIPCM enhances FCM by:
- Adding community-based outreach and retention strategies (including practical incentives for women),
- Lowering caseloads and increasing the frequency of contact between case managers and clients;
- Requiring case managers to be public health nurses or licensed social workers;
- Developing explicit linkages to medical care, substance abuse treatment, mental health care and smoking cessation services; and
- Adding access-related services such as transportation, interpreter services and child care.
The program serves the following communities in Chicago: Austin, Auburn-Gresham, Avalon Park, Burnside, Calumet City, Chicago Heights, East and West Garfield, Humboldt Park, Morgan Park, North Lawndale, South Chicago, South Shore, Roseland, Woodlawn, and Washington Heights. In West Suburban Cook County, the program serves the cities of Bellwood and Maywood. In Southern Cook County, the program serves the cities of Calumet City, Chicago Heights, County Club Hills, Harvey, Hazel Crest, Homewood and Riverdale.
Downstate the program serves Macon, Peoria, St. Clair, Vermilion, Winnebago, and Eastside Health District. In Will County, the project serves the following cities: Bolingbrook, Joliet, Mokena and Romeoville. These communities had higher-than-average Medicaid expenditures for health care services during the first year of life. This indicates that there was an unusually high number of infants in these communities were born prematurely.
Closing the Gap - Illinois is one of four states targeted by this federal initiative. The program addresses racial disparities in infant mortality by targeting four Chicago Community Areas with the highest number and rate of African American infant deaths in the state. The project focuses on reducing premature birth and deaths due to Sudden Infant Death Syndrome, the two leading causes of infant mortality in these communities. The communities of Austin, Englewood, West Englewood and Auburn Gresham have a wide array of health and human services funded by all levels of government. Rather than create another case management program, Closing the Gap has used several community-level interventions. A media campaign is being conducted for raising community awareness of the problems of premature birth and Sudden Infant Death Syndrome (see following page). Education programs on these topics are offered to community residents in a variety of settings. The knowledge base of human service providers is being enhanced through an on-going series of workshops. The Department is working with the IDHFS and the University of Illinois to improve the quality of medical care provided to pregnant women. Closing the Gap is supported by a grant from the federal Maternal and Child Health Bureau. Unfortunately, these funds were discontinued as of June 30, 2007. The Department has been working with the Illinois Maternal and Child Health Coalition to identify alternative sources of funding.