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 the pilot project Healthy Births for Healthy Communities (HBHC) 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. It is 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 supported by state-funds as well as federal funds including those from Titles V and XX and matching funds through the Medicaid program. CHSI is supported by discretionary grants from the federal Maternal and Child Health Bureau. HBHC is supported by a private foundation (Steans) and state funds. These programs are described below.
Special Supplemental Nutrition Program for Women, Infants and Children (WIC)
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 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, salmon, whole grains, 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
Family Case Management is a statewide program that provides comprehensive service coordination to pregnant women, infants, and high-risk children. The Department funds 116 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, Illinois' health insurance program for children.
Chicago Healthy Start Initiative
The Chicago Healthy Start Initiative provides services through four Chicago Healthy Start Family Centers that 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 Hermosa, Near West Side, Near South Side, Douglas, Grand Boulevard, Washington Park and Greater Grand Crossing 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 (TIPCM)
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 childcare.
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, and Winnebago Counties. The Eastside Health District of East St. Louis also is served. In Will County, the project serves the following cities: Bolingbrook, Joliet, Mokena and Romeoville.
Healthy Births for Healthy Communities
The IDHS, IDHFS, and the Steans Family Foundation implemented the Healthy Births for Healthy Communities initiative on July 1, 2006. The initiative is using a performance-based reimbursement strategy to pay for outreach activities in two Chicago Community Areas (Austin and North Lawndale). Two community-based organizations are conducting grassroots outreach efforts to engage multiparous women who are at increased risk of delivering a very low birth weight infant in WIC, FCM, Healthy Start or TIPCM. The IDHFS is matching the funds provided by the foundation and transferring these funds to IDHS. The Title V program, in turn, is managing the grants to the community-based organizations. Since its inception, Healthy Births for Healthy Communities initiative reported 380 women participants. The women enrolled are a high-risk group: 67 percent report having medically high-risk conditions such as chronic disease, previous pre-term birth, and less than 12-month interpregnancy intervals. The others have social risk factors such as homelessness and domestic violence. The project is measuring the effort it takes to find these high-risk women.