August 2009

Grant Results


The Family League of Baltimore City conducted the Babies Born Healthy Leadership in Action Program from November 2006 to November 2008 to try to improve birth outcomes in Baltimore. It helped actual and potential leaders in Baltimore develop leadership skills while working together on the problem of infant mortality.

The Problem
Adverse birth outcomes represent a stubborn public health challenge in Baltimore. According to the Baltimore City Health Department, when this grant began in 2006, Baltimore babies were at far greater risk of premature birth, low birthweight and death related to unsafe sleeping arrangements than were babies born elsewhere in Maryland and the United States. Department statistics showed the high infant mortality rates in Baltimore had remained relatively flat since 1997.

The Project
The Family League of Baltimore City is a planning organization whose mission is to improve the well-being of children and families by engaging communities and partnerships. In its Babies Born Healthy Leadership in Action Program, leaders from the state and city health departments; physician leaders from hospitals and large practices; parent, community and nonprofit leaders; and others participated to improve birth outcomes among Baltimore infants.

The Annie E. Casey Foundation developed the Leadership in Action model and applied it to social issues in several communities. With this project, the Robert Wood Johnson Foundation (RWJF) tested the model on a health problem.

The Family League of Baltimore City convened seven 2-day leadership meetings between November 2006 and April 2007. The 43 leaders who participated in the meetings made improvements in prenatal, obstetric and pediatric care in the short term; developed components of an action plan for the long term; and used a performance-tracking system to assess their sustained use of new leadership competencies.

Key Results

  • During the project period, participants reported several short-term accomplishments, including:
    • Collaboration between Baltimore City Health Department and Baltimore HealthCare Access—a quasi-public agency of the department—to visit pregnant women to identify environmental health threats in the home.
    • Provision of obstetric care by the University of Maryland Medical Center at Chrysalis House, a drug and alcohol treatment facility.
    • Modification of the prenatal risk assessment form used by managed care organizations to include information on language preference and mental health of expectant mothers.
    • Distribution of about 800 cribs to new mothers through Baltimore HealthCare Access and home-visiting programs.
    • Initial preparation for a multiyear public awareness campaign.
  • The Babies Born Healthy Leadership in Action Program laid the foundation for the following changes in Baltimore policies and systems:
    • In April 2009, the mayor of Baltimore and the commissioner of the Baltimore City Health Department released The Strategy to Improve Birth Outcomes in Baltimore City, which built on the work of this project. It outlined a comprehensive, coordinated citywide effort to achieve significant improvements in birth outcomes. (See the Appendix for a summary of the report.)
    • The Baltimore City Health Department assigned a bureau chief to advance the strategy.
    • The mayor's Office of Human and Community Development created a position of early care and learning at City Hall to help advance the agenda to improve birth outcomes and to ensure a healthy, successful early childhood.
    • Family League was one of four lead organizations involved in implementing the strategy, along with the mayor's office, the Baltimore City Health Department and CareFirst Blue Cross Blue Shield.

RWJF provided $396,549 to the Family League of Baltimore City for this project.

After the Grant
The strategy to improve birth outcomes became a major priority of the Family League of Baltimore City. Family League acted as the lead agency for the citywide education and communications campaign and for community-based outreach, education and referral programs in 12 of the city's designated high-risk areas.

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Implementing a leadership development program to improve the health of babies born in Baltimore


Family League of Baltimore City (Baltimore,  MD)

  • Amount: $ 396,549
    Dates: November 2006 to October 2008
    ID#:  058034


Rafael Lopez
(410) 662-5500

Web Site

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Appendix 1

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Brief Summary of The Strategy to Improve Birth Outcomes in Baltimore City

(Released by the Mayor of Baltimore and the Commissioner of the Baltimore City Health Department in April 2009)

The goals for the first three years of strategy implementation in Baltimore City are to reduce the three leading causes of excess infant death in Baltimore: pre-term birth, low birthweight, and unsafe sleep. Specifically, the goals are:

  • Reduce the number of infants born preterm by 283 (a 10 percent reduction).
  • Reduce the number of infants born at low birthweight by 259 (a 10 percent reduction).
  • Reduce the number of infants dying from unsafe sleep by 12 (a 30 percent reduction).

The 11 high-impact services most likely to affect these goals are the focus of the plan. They are:

  • Primary health care in a medical home
  • Obstetric care
  • Home visiting
  • Drug and alcohol treatment
  • Intervention for domestic violence
  • Mental health care
  • Smoking cessation
  • Family planning
  • Nutrition support
  • Breastfeeding promotion
  • Safe sleep education

The three elements of the plan are:

  1. Increase demand and utilization through citywide education and community-based programs.
    • Conduct a citywide education and communications campaign to inspire city residents to find a medical home, seek drug treatment when needed, quit smoking and use the high-impact services.
    • Conduct community-based programs of outreach, education and referral in 12 of the city's high-risk areas to generate demand for and utilization of each of the 11 high-impact services.
  2. Increase capacity through citywide coordination and aligned action.
    • Map deficiencies in primary and obstetric care and work with providers, hospitals, and the city and state health department to close the gaps.
    • Develop a strategy that includes home visits.
    • Report on the capacity of drug and alcohol treatment and ensure linkage of treatment services to programs targeting pregnant women.
    • Train staff in key messages related to positive behaviors surrounding pregnancy.
    • Assess resources available to pregnant women victimized by domestic violence and determine whether additional resources are needed. Train nurses in the city Maternal and Infant Care program to conduct outreach to pregnant women who screen positive for domestic violence.
    • Facilitate access to mental health services; increase utilization by providing education and technical assistance to home visiting and outreach programs on how to access Public Mental Health system services; provide individual case consultation as needed.
    • Convene a work group to promote mental health screening through outreach and home visiting programs; provide public education messages through various media.
    • Expand access to smoking-cessation services, increase opportunities for family planning, support improved nutrition, expand breast-feeding promotion and improve healthcare provider training on safe-sleep education.
  3. Improve quality of key services.
    • Convene a summit of experts to establish a quality standard of health services for all adolescents and young adults in the city.
    • Collaborate with the faculty of the two major medical schools in the city and other clinical experts to create toolkits for clinicians. The toolkits will offer up-to-date information on evidence-based clinical practices and will include a directory of resources relevant to each of the 11 high-impact service areas.
    • Enlist the obstetric community, in coordination with the Baltimore regional Perinatal Advisory Group, to develop a healthy mother checklist for completion at the first prenatal visit, at delivery and at the first post-partum visit. The checklists will include referral to available resources.

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Report prepared by: Nina Berlin
Reviewed by: Janet Heroux
Reviewed by: Molly McKaughan
Program Officer: Sallie Anne George