In 1996, the culturally diverse community of Brockton, Mass., earned a ranking its flagship hospital was compelled to reverse. That year, the state department of health issued
a report that found Brockton had the state's second highest infant mortality and morbidity rates. While the statewide average of babies born with low birth weights was 6.4%,
Brockton's was 8%.
The report struck a chord with Brockton Hospital, prompting it to respond with Better Beginnings, a culturally focused outreach program.
The hospital found that many of the barriers to prenatal care, which ranged from language obstacles to transportation issues, could be broken down with specially trained
bilingual community advocates and multicultural marketing support.
These advocates, who speak English, Spanish, Portuguese, Creole and Cantonese, formed the backbone of the Better Beginnings program. They blanketed retail stores, churches,
social events and health fairs with literature on prenatal care and partnered with government agencies to provide prenatal counseling and education. They also knocked on doors to
urge at-risk moms to seek medical care. "It is important not to expect moms to come to the hospital for prenatal education but to take this information to them," says Suzanne
Baroni, coordinator of Better Beginnings.
This foot soldier approach is helping Brockton improve on its infant mortality and morbidity rates. So far, the program has reached 1,032 women in their first trimester and has
delivered 751 healthy babies. As of June 1999, babies with low-birth weights in the program averaged 3.75%, significantly lower than the state's average of 6.4%.
Earlier this year, Better Beginnings earned national recognition and was awarded a $22,000 grant from the Monroe E. Trout Premiere Cares Awards competition. The contest
recognizes innovative local efforts that reach medically underserved communities.
Best Intentions
Although Better Beginnings is achieving impressive results, it didn't get off to the best start. It relied on a handful of volunteers who worked a few hours a week on outreach
activities.
Their limited efforts couldn't put a dent the program's aggressive goals of building heightened cultural awareness of prenatal education, says Baroni, who lobbied hard for
full-time community advocates. "I told my boss, this program stinks!"
Baroni's candid criticism moved the hospital's administration to take action. In February 1997, the hospital began overhauling the program by hiring four full-time bilingual
advocates and has added staff according to community demand ever since.
Currently there are 11 full-time advocates. Boosting the number of advocates has helped the program achieve steady growth, says Baroni.
In 1997, the program reached 65 women. In 1998, it reached 300 women. And by June 1999, it had enrolled 755 women helping them deliver 426 healthy, full-term babies.
Another pivotal building block of the program was establishing a central clinic for advocates to help women receive pregnancy testing, fill out health insurance paperwork,
provide support for selecting physicians and scheduling prenatal appointments.
Before, women had to go to disparate places to get this comprehensive information, says Baroni.
Deferring to Advocacy
Because the financial priority of the program is funding the community advocates, the marketing costs are kept conservative, says Monique Aleman-Hikal, Brockton's director of
marketing and PR.
The marketing department kicks in by developing multicultural brochures and promoting the program via annual local cable, radio and print - the most efficient advertising
vehicles. It also spearheaded efforts to partner with a local bank system to be the drop-off site for donating items to Better Beginnings mothers for one month (December). So far,
more than 20 mothers have benefited from the items donated in this drive, which have included baby clothing, car seats, diapers and formula.
Corporate partnerships provide access to resources that are beyond the reach of the program, like housing assistance, postnatal support, employment guidance and long-term
emotional support, say Baroni. To get this support, it's important not to be too pushy, suggests Baroni, who approaches companies to partner with Better Beginnings on a trial
basis. "Although I have to be a little bit of saleswoman, [the test period] usually works; the companies become permanent partners."
(Brockton Hospital, Suzanne Baroni, Monique Aleman-Hikal, 508/941-7297)
Pounding the Pavement
From a marketing standpoint, the advocates are the heart and soul of the Better Beginnings program, says Monique Aleman-Hikal, Brockton's director of marketing and PR. They
promote culturally relevant prenatal education by:
- establishing a consistent program presence in government agencies and community centers;
- distributing informational brochures throughout the community, in stores, beauty salons, churches, etc.;
- encouraging pregnant women to schedule physician appointments as soon as possible.