The Friendly Access Infant Mortality Initiative (FAIMI) and its African American Family Resource Information Center and Network (AFRICAN) were two initiatives that grew out of the county’s Friendly Access Project.

With the overall goals of lowering infant mortality rates and improving pregnancy outcomes, the two programs sought to improve access to care, help women and children navigate the health system, connect patients with resources, raise awareness, and narrow the racial disparity in infant mortality exhibited by the area’s African American population.

FAIMI analyzed prenatal and perinatal care systems in the county to uncover unmet needs of mothers and infants while initiating a dialogue among various community stakeholders.

To address the gap between what is acknowledged to be good healthcare standards, and what is actually practiced in clinical settings, FAIMI utilized a multi-pronged approach. Efforts prioritized needed system changes, integrated and coordinated existing services to make them more responsive and enhanced cross-referral protocols and care planning.

The overall scope of FAIMI encompassed safe-sleep campaigns, pregnancy risk reduction programs, education efforts, evidence-based medicine protocols, and capacity-building initiatives throughout the county.

To what extent does our existing healthcare culture encourage or dissuade pregnant women from seeking early and continuing prenatal care? By changing the ethos of healthcare delivery systems in ways that increase consumer access, satisfaction, utilization, and outcomes, is it possible to erase disparities in the health of mothers and infants? Those were questions the National Friendly Access Project set out to answer.

In 2002, Genesee County was selected as one of twelve communities nationwide to submit proposals to the Lawton and Rhea Chiles Center for Healthy Mothers and Babies at the University of South Florida to become a “Friendly Access Community.” As the lead agent of the Project in Genesee County, the Coalition applied for a grant but initially did not receive funding from the Chiles Center. We did, however, obtain $300,000 from area foundations and organizations to launch the program locally. Acknowledging our independent efforts, the Chiles Center made our program a full demonstration project of the Friendly Access Project, with additional funding in subsequent years. Friendly Access became a collaboration project between the health services sector and community based organizations in Genesee County, and was a core project of the Prevention Research Center of Michigan at the University of Michigan’s School of Public Health.

Initial data collection and analysis of birth records revealed that while low-income women in our area (those covered by Medicaid or uninsured) had fewer complications or risks noted in their birth records, they experienced poor outcomes. An analysis with respect to race showed an even greater difference in the African-American population.

A further study of the mother’s ratings of the prenatal and perinatal healthcare system was conducted by interviewing 358 new mothers who gave birth at one of the three Flint area hospitals, and whose birth was covered by Medicaid or self-pay. Findings suggested many of the women did not receive early prenatal care, counseling in family planning, or assistance finding a pediatrician for their new baby.

In addition to study outcomes, throughout the project’s five years, participating healthcare providers, community leaders, and consumers attended training programs designed to gain a better understanding of what patients need, improve policies and procedures, and create a more efficient process for delivering quality care.

The lessons learned through our work with the Friendly Access Project laid the groundwork for future Coalition activities and the data gathered continues to inform leaders as they strive to reduce the infant mortality rate and eliminate the racial disparity that exists between European American babies and African American babies in Genesee County. The activities that follow have contributed to the wealth of work being done to improve health outcomes for mothers and babies in our community.

An outgrowth of the GFHC’s Health Improvement Committee, the Coalition’s Flint River Trail Committee was formed in 2004 and operated until 2008.

The Flint River Trail is a linear park that follows the Flint River from downtown Flint north to Bluebell Beach in the Genesee County Recreation Area. The
existing Flint River Trail is the spine of a developing Flint River Trail System that now includes a loop through Kearsley Park and the Flint Cultural Center. Currently, trail users can travel from the University of Michigan-Flint campus to Bluebell Beach, approximately a 12-mile round-trip. Future plans include the development of other connectors with the City of Flint, expansion west from downtown to Kettering University and Mott Park, and the completion of the Genesee County Park trail system around Mott Lake. Most of the trail is asphalt: however, there are a few “disconnects” along the route where trail users may need to use streets or sidewalks. A multi-year project is underway to eliminate and/or minimize these disconnects. Future plans for the Flint River Trail include the creation of more directional signs, improved crossing signs, identified trail entrances, and benches for relaxing.

The focus of activities for the Coalition’s Flint River Trail Committee was beautification of the Flint River Trail, health promotion to the residents of the City of Flint and Genesee County, and promotion of safe use of the Trail.

During that period, the Ruth Mott Foundation (RMF) funded two Flint River Trail focused grants:

• Flint River Trail Beautification & Expansion – Phase I
  Grant Period: April 1, 2005 – March 31, 2006
  Grant Amount: $93,500
  Focus Areas: beautification and clean-up; development of 3-5 year plan for trail improvements; development of brochures, maps, and marketing materials; neighborhood health promotion events; planning for historical wayside signage
• Flint River Trail Beautification & Expansion – Phase II
  Grant Period: January 1, 2006 – July 31, 2007
  Grant Amount: $96,100
  Focus Areas: community engagement via presentations, focus groups, community dialogues, & implementation of community liaison group; trail needs assessment & user-surveys; support and development of City of Flint five year recreation plan; development of health promotion and social marketing strategy; distribution of community engagement activity results; installation of historical wayside signage

From May 2005 to mid-2006, the GFHC’s Flint River Trail Committee was charged by the GFHC Board and leadership to discuss and address the lack of diversity of the Flint River Trail Committee, especially its need to involve African Americans – the majority population in the City of Flint. Community engagement was the major focus of the GFHC’s Phase II Flint River Trail grant. The outcomes of community engagement efforts from that grant are as follows:

Engagement Efforts / Volume of Contacts:

• 408 needs assessment surveys were administered & collected
• 196 user-intercept surveys were collected
• 332 community members participated in a community liaison group presentation
• Over 70 community members participated in focus groups
  • In total 258 community member names were collected as interested
• Community dialogue secessions were held where 27 community members participated over four sessions to understand the community’s concerns regarding the Trail and barriers to its use

Findings / Community Views of Trail:

• ~50% respondents were not aware there was a trail / did not know where it was
• Those aware of the trail saw it as unsafe
  • lack of police patrols
  • lack of lighting
  • lack of users
  • lack of safe access points
  • lack of amenities
  • lack of maintenance in spots

While the Ruth Mott Foundation has now reorganized all Flint River Trail activities under the auspices of Safe and Active Genesee For Everyone (SAGE), the GFHC remains engaged as a partner to address the outcomes of our previous community engagement efforts. To do so, a social marketing campaign has been designed to:

• Create awareness of the Flint River Trail while defining location and points of entry
• Educate county residents on health benefits of Trail use
• Address community concerns about safety and cleanliness
• Improve usage and build participation in organized Trail events

The GFHC’s Flint River Trail social marketing campaign in collaboration with SAGE occurred in the fall of 2009. For additional information, please click here.

The Diabetes Task Force’s vision was to improve the care and quality of life of individuals with diabetes by focusing on the awareness, behavior, education, and measurement of Hemoglobin A1c (HbA1c) testing for this population. Outcome options included development of a process to monitor and disseminate HbA1c testing frequency, aggregated across the community and to physicians on their patient base; development and implementation of physician and patient focused initiatives to increase compliance of HbA1c testing; and demonstration of increased compliance on HbA1c testing frequency.

With an estimated 10,000 undiagnosed diabetics living in Genesee County, it was appropriate that Flint was chosen as one of 10 communities to pilot a federal Health and Human Services program to screen and identify undiagnosed diabetics. Called “Diabetes Detection Initiative: Finding the Undiagnosed,” the project used a risk assessment tool to help determine a person’s likelihood of developing diabetes. Those who were identified as being at risk were referred for follow-up. The initiative kicked off in November 2003 with a high-profile news conference featuring both the United States and Michigan Surgeons General.

The Diabetes Detection Initiative was developed utilizing two components: (1) a broad-based community effort to encourage individuals to determine their risk for undiagnosed diabetes using a customized paper risk assessment tool (adapted from the American Diabetes Association) and if at high-risk, give them clear messages regarding referral to a health care site for appropriate blood testing; (2) a more intensive effort to identify and diagnose those with undetected diabetes.

Early detection and treatment of diabetes can make a critical difference in avoiding serious complications such as eye, kidney, and cardiovascular disease—yet people often live with diabetes for seven to ten years before being diagnosed. The Coalition is proud to have taken a lead role in organizing and implementing this important community health effort.

The vision of the Coalition’s Depression in Primary Care Partnership project was to build a community-wide system of care for mental health problems, focused on the primary care setting, with special emphasis on the treatment of
depression. Additionally, the partnership project sought to carry out translational research exploring the effectiveness of the mental health care system in Genesee County via a community-academic partnership between Genesee County stakeholders and partners from the University of Michigan Depression Center.

Specifically, the Depression in Primary Care (DPC) concept calls for an efficient and flexible program to support primary care clinicians’ management of their depressed patients. The program was designed at the University of Michigan Depression Center to follow the Chronic Care Model, and to be expandable to cover other chronic health problems. The Depression in Primary Care model includes the following core elements:

• Care management services (by a supervised MSW) matched to the level of depression severity;
• Ongoing disease monitoring (by a care manager) and clinician feedback at the individual patient level;
• Evidence-based treatment advice (from care manager and psychiatrist) to primary care clinicians;
• Patient education, activation, and self-management assistance;
  Clinical information system (CIS) to facilitate disease monitoring and clinical communication.

In May 2006, the model was presented to the Coalition’s Mental Health & Substance Use (MH/SU) Task Force by representatives from the University of Michigan Depression Center. The Task Force felt there was an opportunity to tailor a similar program to the landscape of mental health care services in Genesee County. In September 2006, these partners came together to form the Greater Flint Depression in Primary Care partnership, proposing to address depression in Genesee County by forming a community-academic partnership, building a community-wide system of care for mental health problems (focused on the primary care setting), and carrying out translational research exploring the effectiveness of this system of care in a real-world setting.

In 2007, the project received a two-year infrastructure building grant from the National Institute of Mental Health. Goals of this grant included an analysis of the places in which mental health care services are provided locally, analyzing how clinical data flows between providers and systems, and determining an appropriate set of measureable mental health metrics that could assess the quality of the local mental health care system as a whole.

In the grant period that followed, the project completed many accomplishments relating to planning for how to address the treatment of depression in primary care and mental health services in Genesee County. The accomplishments included:

• Construction of a community stakeholder coalition via the GFHC’s Depression in Primary Care Community Steering Committee;
• Consultation with content-area experts;
• Completion of stakeholder interviews conducted among primary care physicians, psychiatrists, specialty mental health providers, insurers, and patient/consumer advocates;
• Completion of community dialogue sessions and focus groups with more than 50 community members to identify common problems relative to depression treatment in the community;
• Development of a Mental Health Care Services Map;
• Development of a Mental Health Patient Pathway Map;
• Determination of an appropriate set of measurable mental health metrics;
• Developed the framework and business case for a local DPC Pilot Project to be instituted and tested if adequate local funding were secured.

Following the completion of these accomplishments, the partnership developed two intervention designs for possible implementation of the DPC project into the local community. The first design outlined a DPC Pilot Project which would serve approximately 300 patients and carry out research to determine the project’s effectiveness and suitability for scale expansion to a large patient base. The second design, which was to be implemented following the completion of the pilot project, was a depression in primary care community wide intervention which could serve up to 1,800 patients.

The project is currently on hiatus as alternative opportunities for partnership and funding are considered.

Cardiac catheterization is commonly used to assess the extent of artery blockage. The procedure involves injecting dye into a patient’s heart chambers through a tube inserted in a vein or artery in the leg, then using imaging equipment to track the dye’s flow. An invasive, expensive procedure, it is not without risk and should be undertaken with caution. In 1995, a study of area catheterization data showed that 52% of outpatient cardiac catheterizations did not meet the guidelines set forth by the American College of Cardiology.

From this study, the Coalition’s Cardiac Task Force developed an initiative to reduce the incidence of the procedure by developing a one-page outpatient pre-catheterization checklist. This initiative was implemented in May 1998 with the support and utilization of many area cardiologists. Following the intervention, a 1999 follow-up study indicated 82% of all outpatient catheterizations met the guidelines.

This effort was significant because it is believed to be the first time a community’s cardiologists collaborated across multiple hospitals to address an important issue. The Pre-Catheterization Initiative won praise from many members of the healthcare community—including providers, consumers, and insurers.

In 2002, the Coalition convened a Back Pain Management Task Force to address variations in spine care—and the unusually high numbers of spinal surgeries
within Genesee County. With a charge to assess the current system of treating back pain, identify causes, develop interventions, educate patients and employers, and implement best-practice guidelines, members of the task force went to work.

In 2003, the group released its Back Pain Management Report, which outlined a comprehensive strategy to address the problem. Highlights of the report included recommendations that physicians become familiar with Clinical Practice Guidelines and limit spinal surgery to those patients carefully screened and experiencing chronic spine pain.

The Back Pain Management Report received much attention locally as well as throughout Michigan. Requests were made to the Coalition to report these results to health care professionals across the state.