REACH 2010 Grantee Spotlight: The Genesee County REACH Project
As we enter Women’s History Month, we would like to spotlight a REACH 2010 Grantee that worked on infant mortality, the Genesee County (GC) REACH Project. The Genesee County (GC) REACH Project concept began with a planning grant from the Center for Disease Control and Prevention (CDC) in 1999. The Community Action Plan (CAP) was developed using “new knowledge” a combination of bench (science) and trench (community). In October of 2000, the project was funded. With a mission to reduce racial disparities in health outcomes, and a particular focus on African Americans and infant mortality, a population-focused systemic and structural intervention that embody cultural understanding, sensitivity, and relevance was utilized. The CAP used an integrated style where everyone participates in the development of a coordinated system of care in Genesee County using a modified Socio -Ecological Model.
Approaches were multi-faceted, addressed the social determinants of health, and implemented simultaneously. Using Community-based Participatory Approaches (CBPA), it included: Community Engagement; History and Cultural Education; Enhanced Babycare (Medical) System; Undoing Racism; Addressing Social Determinants; and Policy/System Change. The project was governed by the Genesee County REACH Team using the three-legged stool model consisting of health department, academia, and community. The REACH team encompassed equity and inclusion through collaborative decision-making and shared resources. In October 2007, Genesee County was awarded as a Centers of Excellence in the Elimination of Disparities (CEED). REACH US provided the opportunity for the Genesee County REACH work to be shared and implemented in communities across the country.
As a result of practice-based activities implemented in Genesee County, a number of system changes occurred to improve perinatal health care and reduce disparities. This included: (a) Community Windshield Tours made mandatory for new medical residents, (exposure to this activity also inspired local provider practices to be more accommodating to patients); (b) institutionalization of infant safe sleep programs within Genesee County; (c) development of the Perinatal Risk Assessment Tool integrated into electronic medical records; (d) funding for Fetal Infant Mortality Reviews led to hiring of a forensic pathologist to accurately evaluate the causes of infant deaths; (e) mobilization of the medical community to address racial health disparities; and (e) community advocacy which helped to secure additional bus routes and stops in low-income neighborhoods that experienced high infant mortality rates. Correlated with these efforts, the infant mortality rate among African Americans showed a downward trend. The African American infant mortality rate in Genesee County declined from 22.8 in 2000 to 15.9 in 2005 to an all-time low of 7.9 in 2010. The corresponding Black/White disparity rate ratio was 2.7 in 2000 and 2005, and 1.6 in 2010.
The success of the GC REACH 2010/REACHUS on reducing racial disparities in infant mortality is attributed to the CBPA used to build bi-directional trust of institutional and community leaders; and leveraging the efforts of local initiatives. This bought investment from both sectors to the table. Efforts of the REACH Team built on empowering community by understanding their culture and history and addressing racism. The GC REACH Team laid the foundation for institutions and community to work in unison to address the community’s health/issues.