Jefferson County Department of Health (JCDH) is located in Central Alabama and serves the residents of the most populated county with in the state of Alabama. Jefferson County has an estimated 659, 546 residents with a growth rate of -0.12% in the past year according to the most recent United States Census data. Jefferson County residents are 52.09% Caucasian, 42.58% African American, 1.54% Asian, .24% American Indian/Alaska Native, 0.03% Native Hawaiian/Other Pacific Islander, and 1.57% who are 2 or more races, 1.96% other race per the 2019 U. S. Census Bureau. JCDH has 3 locations within Jefferson County, Alabama strategically located in the Eastern, Western and Central areas of the county. JCDH provides adult primary care, pediatric primary care, family planning, international travel vaccinations, tuberculosis treatment, and adult immunization and STI/STD services to the community.
Quality primary health care has been shown to have a direct impact on maternal and infant health. The lack of access to early and adequate prenatal care is an established problem in Jefferson County with 16% of women not having prenatal care in the first trimester and 19% of women receiving inadequate care in 2013. In 2010, the infant mortality rate (IMR) in Jefferson County was higher than the state and national rates. More concerning, is the fact that the IMR for Non-Hispanic blacks in the same year was 16.1/1,000 live births versus 6.4/1,000 live births for Non-Hispanic whites. The IMR is an important marker of maternal and child health, and has also been called the most sensitive indicator of overall societal health. The Alabama Department of Public Health announced on December 11, 2019 that the state's IIMR rate was the lowest in Alabama history at a rate of 7.0 deaths per 1,000 live births in 2018. The 2018 was is an improvement over the state's previous decreasing rate in 2017 at 7.4 and 2016 rate of 9.1. A total of 405 infants born in Alabama died before reaching 1 year of age in 2018; 435 infants died in 2017 and 537 infants died in 2016. Alabama's overall rate remains higher than the U.S. 2018 provisional rate of 5.7. The infant mortality rate for black infants declined to 11.0 in 2018, and the infant mortality rate for white infants decreased to 5.1. Alabama is making improvements with increased funding and programming throughout the state but still has a states average that is about the national average. Nevertheless, a longstanding disparity between birth outcomes for black and white infants remain in Alabama. An estimated 26,710 women between the ages of 15-44 years with an income at or below the Federal Poverty Level who reside with in Jefferson County, Alabama. With an average pregnancy rate of 91.7 per 1,0000 women ages 15-44, the estimated number of pregnant women living in poverty in the county is 2, 455 women. Even though prior to 2018 Medicaid services were available for pregnant women in Jefferson County, Alabama, there were limited known single coordinated efforts that established rapport with expectant mothers early in pregnancy linking them to resources beyond delivery and through their child's first year of life. It is expected that tailoring intervention to meet identified needs will have a greater impact on the population served.
Jefferson County Department of Health (JCDH) established its From Day One” (FDO) Program in 2018 to make a direct impact in Jefferson County as it relates to improving birth outcomes and decreasing infant mortality through evidence based, methods of intervention. FDO is a comprehensive patient centered program designed to educate and support expectant mothers from the first trimester of pregnancy through their child's first year of life. FDO works specifically with pregnant mothers who are expecting at least their second child, who received prenatal care at UAB Maternity Clinics and deliver at University of Alabama Women and Infant Center. The target population served by FDO consists of pregnant women, fathers of the baby, and their infants with an emphasis on low resource, low income, underinsured, uninsured and minority patient populations.
The FDO program goal is to positively impact maternal and infant health outcomes in Jefferson County. The objectives of the FDO Program are: 1) Improve pregnancy and birth outcomes for women and infants in Jefferson County; 2) Improve access to and care coordination of health services; 3 Decrease the infant mortality rate 4) Provide strategic interventions throughout pregnancy and infancy; 5) Identify and address barriers to health and safety. These goal are being accomplished by intervention strategies for identifying barriers, improving access to care, providing continuous education, enhancing support networks and empowering women to set and meet good preventative health goals. FDO target measures include increasing the percentage of deliveries receiving a prenatal care visit in the first trimester or within 42 days of enrollment by 16%, to make an impact on public health by reducing the rate of infant mortality towards the national average of 6 per 1,000 live births in Jefferson County and increasing the rate of early entrance into prenatal care by year five.
The program staff includes medical providers (doctors, certified nurse practitioners and nurses); Community Providers (community health workers, mental health workers, educators and social workers); Referral Sources (Women Infants and Children (WIC) Program, University of Alabama, Birmingham (UAB) Maternity and Jefferson County Health Centers); Partners (Connection Health, area businesses, organizations and other healthcare resources).
In order to meet the goals of the FDO program and to be successful, JCDH partnered with Connection Health, a non-profit agency, to implement a Community Health Workers (CHW) model to address the high rates of infant mortality. The Community Health Workers are lay persons with a close understanding of the community they serve. They complete over 60 hours of training on topics such as effective communication, conflict resolution, stress management, child safety, infant care/safe sleep, pregnancy health, breastfeeding support and smoking cessation. Training and education is continuous in order to improve the skills of the community health workers to manage and assist their clients. The CHWs provides direct services, including baseline client assessments, infant safety assessment and education, home environmental assessments, medical adherence evaluations, health goal monitoring, primary health care visit appointment reminders, postpartum depression screenings, food insecurity screenings and health education to mothers living in poverty. Through educational enrichment and support parents are empowered to provide excellent infant care in a safe home environment.
FDO program has made a major impact in the Jefferson County Community. The objectives of the program are being met. Since the beginning of the program in February 2018, 154 active clients have been enrolled in the program with 32 who have graduated thus far when their infants turned one year of age. There is a 77% decrease in missed appointments for prenatal care with the clients; 100% smoking cessation with the client/family members who smoked; 77% initiation of breastfeeding rate, 100% report safe sleep practices. Clients have received transportation services for medical care through Kid One Transportation and other transportation services; education on safety and healthy living and barriers to healthcare are being addressed and eliminated. There have been 54 clients who received dental referrals in an effort to reduce dental related preterm birth and increase education on dental care for infants.
FDO continuously collects data throughout the program implementation and analyzes the data at incremental phases throughout the infant's first year of life. A twelve month survey at graduation and a six month post -graduation survey is given to the mother to evaluate if she has retained and utilized the education and incentives that were received throughout program participation.
JCDH and information about From Day One can be found at www.jcdh.org.