Presentation on theme: "BIHCC Collaborative Learning Conference Call"— Presentation transcript:
1 BIHCC Collaborative Learning Conference Call Beyond Health Care Reform: The Role of Interconceptional Care in Reinventing Maternal and Child HealthBIHCC Collaborative Learning Conference CallThe State of FloridaThursday, February 11, 201011:00 AM -12:00 PMPresented byMario Drummonds MS, LCSW, MBAExecutive Director, Northern Manhattan Perinatal Partnership, Inc.Linking Women to Health, Power and Love Across the Life Span
2 Lecture ObjectivesDiscuss the concept of interconceptional care as aftercare.Describe how interconceptional care improves birth outcomes, particularly in preventing LBW and prematurity.Explain the rationale for changing the perinatal prevention paradigm to include an emphasis on preconceptional/ interconceptional health and link the rationale to CDC and MCH initiatives.2
3 International Comparisons of Infant Mortality Rates, 2005 Rank Country RateSingapore 2.1Hong KongCzech RepublicSpainCanadaUnited States, “White” 5.7CubaNorthern IrelandUnited States 6.9
4 Terminology Interconception Internatal care Interpregnancy Interval From the conception of one pregnancy to the conception of the next pregnancy.Internatal careFrom the birth of one child to the birth of the next childInterpregnancy IntervalThe time between the delivery and conception of two consecutive births.4
5 Interconceptional Care Interconceptional care is defined as a set of interventions that aim to identify and modify biomedical, behavioral, and social risks to a woman’s health or pregnancy outcome through prevention and management from conception of one pregnancy to the conception of the next pregnancy.5
7 Select Panel Goals for Improving Preconception Health Goal 1: Improve the knowledge, attitudes and behaviors of men and women related to preconception healthGoal 2: Assure that all US women of childbearing age receive preconception care services- screening, health promotion and interventions- that will enable them to enter pregnancy in optimal health7
8 Select Panel Goals for Improving Preconception Health Goal 3: To reduce risks indicated by a prior adverse pregnancy outcome through interventions in the interconception periodGoal 4: Reduce disparities in adverse pregnancy outcomes8
9 HRSA PositionThe interconceptional period is a critical time to address both medical and social issues that can increase the risk of infant mortality, and particularly those that contribute to disparities in infant mortality.The National Healthy Start program includes interconceptional care as one of its nine core components in recognition of its important role in eliminating disparities.Grantees were less likely to offer services that addressed medical risk factors, including hypertension follow-up (74 percent), diabetes follow-up (73 percent), and obesity reduction (71 percent). When these services were offered, grantees reported they were typically received by fewer than half of all interconceptional clients.99
10 Traditional Perinatal Care Continuum Labor and birth?Primary careInterconceptional periodPreconception periodAntepartum Labor and birth PostpartumWell baby carePrenatal carePostpartum visit10
11 Lifespan ApproachBirth Early childhood Pre-teen Teen Young adult Women 35≥ SeniorsDiminished role and impact of prenatal care. Maternal health prior to pregnancy is key. Explores and learns from history of poor birth outcomesIt will take more than one generation to equalize birth disparities11
12 New MCH Life Course Continuum Axis 1 Centering PregnancyChild Abuse PreventionLatch-Key ProgramManaging RelationshipsHealth Policy ActivitiesReproductive Social CapitalInternatal CareSchool ReadinessFitness & Health ActivitiesPregnancy PreventionWomen’s Health ProtocolDepression Group WorkPerinatal CareUPKBeacon SchoolCollege PrepReproductive Life PlanningSpecialty CareHarlem Birthing CenterEarly Head Start/ Head StartHealth/ Life Stories TellingPreconceptionInter- conceptional CareChronic DiseaseChronic Disease ManagementBirthEarly Child-hoodPre-TeenTeenYoung AdultWomen>35Senior Citizens
13 MCH Life Course Organization Social Determinants to Health Axis 2 Public Policy InitiativesEconomic Empowerment ZoneSupermarket Zone Expansion PolicyNYC Affordable Housing PolicyCommunity Environmental ImpactSt. Nick Tenant OrganizingFood & Fitness CoalitionAffording Housing OrganizingOrganizational ImpactHealthy Start ConsortiumDiabetes Prevention CoalitionHarlem Works Job ReadinessGroup/Interpersonal ImpactCentering PregnancyBaby Mama’s ClubConsumer Involvement OrganizationIndividual ImpactOB/GYN Medical HomesCase ManagementDepression Screening & Treatment
14 A Life Course or Integrative Model Builds on a continuumEmphasis is on health promotion throughout the lifespan (from “womb to tomb”)Emphasis on primary and secondary disease preventionEmphasis on woman, first, rather than her reproductive status14
15 most of our outcomes or their already present before we ever In obstetrics. . .most of our outcomes or theirdeterminants arealready present before we evermeet our patients15
17 Goals of Interconceptional Care Increase access to women’s healthcare.Reduce low birth weight and infant mortality.Reduce racial-ethnic disparities in mother and infant health outcomes.17
18 Interconceptional Period Provides an important opportunity to address risk factors identified in the last pregnancy relative toWoman’s lifelong health statusPotential impact on future pregnanciesPregnancy is a “stress test” for life18
19 Pathways to Care 19 screening Intake & Assessment Pregnant Prenatal case managementInterconceptional case managementNot Pregnant19
20 Pathways Protocol: Entry to Care New clients receive:IntakeScreeningAssessmentExisting clients transitioning to interconceptional aftercare receive:3rd trimester assessment which is used as a baseline to begin planning continuous interconceptional aftercare (adapted from NC Healthy Start).20
21 Intake & Screening (new clients) Initial contact with the prospect that includes gathering demographic information and enough data to determine if they meet program guidelines or would benefit from being referred to alternate resources.Key points:Intake toolScreening toolHave these tools been evaluated for feasibility or effectiveness?Sample tool21
22 Existing ClientsExisting prenatal clients can begin to transition into interconeptional aftercare prior to giving birth.In addition to the areas identified using the risk assessment what standard interconceptional care interventions can be applied for the following scenarios?Healthy/Normal PregnancyHigh risk pregnancy with pre-existing or pregnancy related medical conditions22
23 Healthy/Normal Pregnancy Basic newborn careBack-to-sleep/safe sleepShaken baby syndromeEarly parenting skills (bathing, handling, bonding, attachment)BreastfeedingPreparing for your well baby visitPreparing for your postpartum visitRecognizing PMD23
24 High Risk PregnancyItems covered in the healthy/normal pregnancy slide.Identify referrals for specialist care after birth to assure continuity of care.Health promotion and education related to high risk condition(s).Chronic illnessDiabetes (pregestational and gestational)Overweight/obesityPrior stillbirth(s), LBW, prematurity, infant mortality24
25 Core Contents 25 Risk Assessment Reproductive Life Plan Health PromotionClinical InterventionsPsychological InterventionsSocioeconomic InterventionsMale InvolvementReassessment at 90 daysUpdate Reproductive Life Plan (as needed)25
26 Risk AssessmentThe interconceptional risk assessment identifies areas where ongoing problems exist, including lack of resources, that need to be addressed in order to improve future birth outcomes.Key points:Risk assessment toolHas this tool been evaluated for feasibility or effectiveness?Interventions are developed based on the findings from the risk assessment.Sample tool26
27 Risk Assessment: FINDS Family violenceInfections/ImmunizationsNutritionDepressionStressGo back to the training from the LCC in August and revisit the tools that are being used to capture this data.Lu, M.
28 Risk Assessment: FINDS Family violenceInfections/ImmunizationsPeriodontalChlamydiaOther sexually transmitted or urogenital tract infections in selected populationsNutritionDepressionStressLu, M.
29 Risk Assessment: FINDS Family violenceInfections/ImmunizationsDiptheria-tetanus toxoids boosterHepatitis B vaccinesMeasles and mumpsRubellaVaricellaNutritionDepressionStressLu, M.
30 HighlightsF.I.N.D.S. should be used as part of a routine risk assessment after every pregnancy.For prenatal clients the 3rd trimester is an opportune time to create a baseline using F.I.N.D.S.Each clinical visit is also a perfect time to conduct F.I.N.D.S.
31 Health Promotion BBEEFF BreastfeedingBack-to-sleepExerciseExposuresHousehold molds and dust mitesLeadMercuryDioxinsFolateFamily planningLu, M.
32 Health Promotion BBEEFF BreastfeedingBack-to-sleepExerciseExposuresFolateFamily planningReproductive life planContraceptive useLu, M.
33 Clinical Interventions Height and weight measurementsevery 3-5 yearsBlood pressureevery 2 yearsTotal skin examinationevery 1-3 yearsPapanicolau smear and pelvic examinationClinical breast examinationEvery 3 year beginning at age 20Screening mammographyevery 1-2 years beginning at age 40Lu, M.
34 Psychosocial Interventions Access to social support servicesPublic assistanceChildcareHousingLiteracy programsProfessional clinical supportMental health servicesServices for intimate partner violenceMarital and sexual counselingParenting supportMothers groupsParenting classesFathers groupsLu, M.
35 Socioeconomic Interventions Access to socioeconomic interventions with multiple levels of impactJob developmentFinancial literacyInvestment/savings clubsLivable wageBuilding political powerTransforming race & class
36 Reproductive Life Plan A written tool created by men and women that outlines their personal goals around having children. It states how to achieve these goals including action steps and interventions. It also addresses those areas that research indicates impact adverse birth outcomes.
37 Potential Benefits of Including Reproductive Life Plan Assessments into Routine Care Starts a conversation that is patient centered and patient drivenEmpowers women (and men, if included in their care)Reframes pregnancy from chance to choiceEncourages individualized counseling(e.g. contraceptive options, interconceptional lengths, fertility considerations, etc)May result in higher percentage of pregnancies identified as intended37
38 Encouraging a Reproductive Life Plan: Example of Questions that could be in RLP Do you hope to have any (more) children?How many children do you hope to have?How long do you plan to wait until you (next) become pregnant?How much space do you plan to have between your pregnancies?What do you plan to do until you are ready to become pregnant?What can I do today to help you achieve your plan?38
39 PrecautionsReproductive life plans are never right or wrong: they are an approach for helping individuals plan, based on their own values and resources, how to achieve a set of personal goals about having children.Reproductive life plans are fluid—they should never be considered set in stone because “life happens”.39
40 Impacting on the rate of unintendedness is more complex than the content of a single health related encounterAddressing and facilitating intentional decision making around if and when to have children is an appropriate health promotion and disease prevention activity that should be built into all clinical and community health encountersKnowing a woman’s intentions can focus much of the rest of the encounter40
41 Family & Social Support Healthy WomenPhysicalSocialCognitiveEmotionalSocial Service SystemHealth Care SystemEconomic EnvironmentCommunity & CultureSchoolsFamily & Social SupportPhysical EnvironmentBehaviors & LifestyleUsed with permission of The Nemours Foundation, Division of Health and Prevention Services. Adapted from the Delaware Children’s Health Chartbook.
42 Linking Women to Health, Power and Love Across the Life Span Achieving Health Equity by: Building a Social Movement, Investing in Ideas, Executing Tasks, Returning Results!Linking Women to Health, Power and Love Across the Life Span4242
43 For more Information Contact: Mario Drummonds, MS, LCSW, MBAExecutive Director/CEONorthern Manhattan Perinatal Partnership127 W. 127th StreetNew York, NY 10027(347)4343