About Focus on the Fourth

Focus on the Fourth Targets Maternal Health Disparities in Central Texas

St. David’s Foundation launched the Focus on the Fourth initiative in 2018 to improve maternal health outcomes for Central Texas women, especially underserved women and women of color. The program awarded a total of $2 million in grant funding to support projects aimed at improving postpartum access and outcomes during the “fourth trimester,” the year following delivery.

“For all the modern medical advancements in the United States, a shocking fact remains: the U.S. is the leader in the developed world when it comes to maternal mortality.”

Elizabeth Krause,
former St. David’s Foundation Senior Program Officer
Photo by Casey Chapman-Ross, mural art by Kristen Gunn

“For all the modern medical advancements in the United States, a shocking fact remains: the U.S. is the leader in the developed world when it comes to maternal mortality,” noted former St. David’s Foundation Senior Program Officer Elizabeth Krause, who helped launch Focus on the Fourth.

Disparities and outcomes for underserved women and women of color are especially alarming. The Texas Maternal Mortality and Morbidity Task Force reported in 2018 that more than two-thirds of maternal deaths in Texas were among women who delivered on Medicaid. Additionally, Black mothers were found to be at 50 percent higher risk than their white counterparts.

Building capacity

St. David’s Foundation aimed to build capacity within community-based organizations tackling these issues. William Buster, Executive Vice President of Community Investments, explained, “Funding projects that build capacity within the organizations already engaged with this work is such a sound investment. The results are lasting, which in this case means more women and babies can stay healthy throughout the baby’s first year.”

William Buster,
Executive Vice President of Community Investments,
St. David’s Foundation
Photo by Casey Chapman-Ross, mural art by Kristen Gunn

The foundation granted Focus on the Fourth funding to 10 organizations in 2018 who are working to make a difference in the health of Central Texas women and their families.

Leading with Learning

The foundation recognizes the complexity of this issue will require a long-term commitment to learning with the community on what is working and what still needs to be done. In addition to providing grant funding, the foundation invited partners to learn from each other through semi-annual convenings focused on supporting connections and sharing experiences. The insights gained through Focus on the Fourth played a key role in designing the refined strategic direction of the foundation’s Women’s Health portfolio. 

We also recognize and believe in the power of collaboration and storytelling to further the goals we set out with Focus on the Fourth, and broader change that may happen in our region and nationwide. To that end, we welcome your questions, observations and reflections as you peruse these collections of stories and approaches to more effectively increasing access and improving outcomes for underserved mothers and babies in Central Texas.

2018 Focus on the Fourth Grant Recipients

CardeaBuilt capacity of Women, Infants and Children (“WIC”) and FQHC sites for opioid screening, intervention, and referral. Developed Toolkit for Supporting Substance Abuse Disorder Services Integration in Diverse Settings.$330,000
Hand to HoldTailored services to more effectively serve African-American NICU moms with attention to depression, breastfeeding, and peer support. Trained NICU staff on Unconscious Bias. Piloted counseling program for families.

Read Hand to Hold’s featured story here
Mama Sana Vibrant WomanInstituted structured postnatal program with home visiting, support groups, social support, and yoga for moms of color.

Read Mama Sana Vibrant Woman’s featured story here. 
Texans Care for ChildrenResearched maternal health challenges and community-based solutions in Central Texas and statewide, with a particular emphasis on mothers’ mental health and substance use challenges during the first year after childbirth. Disseminated findings through the Healthy Mothers Raising Healthy Babies report.$116,000
Austin RecoveryDeveloped and implemented action plan to provide postpartum care to high risk new moms in Family House residential treatment.$303,281
El Buen SamaritanoPiloted culturally and linguistically competent outreach to increase postpartum visit adherence among Latina moms.$125,000
Lone Star Circle of CareEmployed nurse care coordinator to engage patients and work across providers to improve outcomes. Implemented mother-baby registry, patient follow up including text message campaign, prenatal classes, and lactation support.$216,681
People’s Community ClinicConducted evaluation of patient experience with post-partum services and materials. Increased care coordination services for perinatal patients and evaluated impact of care delivery improvements. Developed online resource guide for new parents.$220,000
Texas State School of NursingDeveloped Networx, a virtual safety net to inform, educate, and connect underserved women in Hays County with services and information using an SMS text messaging and group chat platform. Conducted translational research to assess effectiveness of platform and tailor content.

Read Networx’s featured story here.
UT Steve Hicks School of Social Work – Black Mamas Community CollectiveEngaged African American women in community-based participatory research and strategic planning to tackle maternal mortality disparities. Launched Groundwater Analysis trainings, Sister Circles, and Sister Doula Program.

Read Black Mamas Community Collective’s featured story here.
$ 300,000
 Total Grants$2,170,000