Project Title: LIFT Healthy Start Project Applicant Name: LIFT Community Action Agency, Inc. Address: 209 North 4th Street, Hugo, Oklahoma 74743 Project Director: Pam Waugh Contact Phone Numbers: Voice – (580) 326-3351 Fax – (580) 326-2305 E-Mail Address: pam.waugh@liftca.org Web Site Address: http://www.liftca.org As a current grantee, LIFT CAA is submitting a Competing Continuation Grant - Rural application in response to the Health Resources and Services Administration’s Funding Opportunity titled Healthy Start Initiative: Eliminating Disparities in Perinatal Health (HRSA-24-033). The purpose of LIFT CAA’s proposed Healthy Start Project will be to reduce the rate of and disparities in infant mortality and poor perinatal outcomes, as well as improve the health of women and their families within the project area of Atoka, Choctaw, Coal, Johnston, McCurtain, and Pushmataha Counties in rural southeast Oklahoma. Infant mortality exceeds the rate of 8.2 deaths per 1,000 live births (1.5 times the National average) in Oklahoma’s Atoka, Choctaw, Coal, Johnston, McCurtain, and Pushmataha Counties. The total number of live births in the target rural area from 2019 through 2021 was 3,322, with 31 infant deaths, for an overall Infant Mortality Rate of 9.3 per 1,000 live births. Thus, the target population for the LIFT Healthy Start Project will be pregnant women, women recently delivered, women of reproductive age, children up to 18 months of age, and the fathers/partners of program participants residing in the project area. The majority of services under this project will be directed to the target population. The project will address the needs of high-risk women and their families before, during, and after pregnancy. This will be achieved by placing emphasis on a community-based approach (medical neighborhood) to providing care coordination, health education, counseling and support to women who, because of the area where they live and other co-d
eterminants (smoking, poor health literacy, lack of social supports, etc.), are at more risk of poor birth outcomes during the pregnancy and preconceptual/ interconceptual (women’s health) periods. The anticipated benefit is the reduction of infant mortality, increased use of a primary medical home for mother and infant, and decreased co-factors (social determinants) which negatively impact pregnancy and the interconception period (smoking, drinking, substance use, domestic violence, and depression). Direct and enabling services can begin as early as the prenatal period for participants and follow the woman and child through 18 months after the end of the pregnancy, including the provision of group-based health and parenting education. The project will utilize a primary care model of delivery regarding the continuum of women’s health and prenatal care, including comprehensive services, continuity of care, health assessment/intervention, and community partnership. This will be supported through a patient-centered medical home (PCMH) model at targeted private practices, Choctaw Nation of Oklahoma Health Care facilities, and Federally-Qualified Health Centers, through clinic and home-based service delivery. Care coordination will provide access, education, and referral to health care and need-based client services, provided in part by various project partners. The PCMH will be supported through the electronic medical record as well as robust health information exchange technology deliverables and tools; the primary care model of delivery will ensure quality measures and improvement. Diverse community resources and integrated, patient-centered care within the medical neighborhood will work towards achieving collective impact. LIFT Healthy Start will direct the Community Consortium, facilitate the coordination of services, evaluation, and accountability required to assure fidelity.