1. Bright Beginnings: An Activity of Project Blossom Kimberlee Wyche-Etheridge, MD, MPH Nashville, TN CityMatCH Conference

2. The Rationale Women who start PNC early in pregnancy are more likely to: –Increase their chances of having a healthy pregnancy –Increase their chances of keeping their infants healthy

3. The Rationale Prenatal care (PNC) forms the cornerstone of services offered to pregnant women Traditionally PNC includes 3 Parts - Risk assessment - Medical treatment - Health education

4. The Data In Nashville: –84.6% of pregnant women entered prenatal care during the first trimester –74.8% of young women10-19 entered prenatal care during the first trimester Health Department, 2001

5. The Data In Nashville: –59 babies were born for every 1,000 females 15-19 52 for Whites 80 for African Americans Health Nashville 2000

6. The Data In Nashville: –11% of babies born to teens 15-19 were low birth weight 10.2 for whites 12.3 for African Americans –12.9% were born premature 9.7% for whites 16.6% for African Americans TN State Dept of Health 2000

7. The Data PPOR taught us: –The major contributors to the overall feto-infant mortality rate in Nashville are deaths among VLBW babies (Maternal Health/Prematurity) and postneonatal deaths (Infant Health) –Younger mothers with less education are at higher risk for poor birth outcomes –African American women of all ages and education levels are at higher risk for poor birth outcomes PPOR Report 2003

8. Project Blossom Mission: To optimize maternal and infant outcomes in Davidson County Goals 1.To decrease Infant Mortality and Eliminate Perinatal Disparities 2.Make MCH a Community Priority 3.Improve the health of reproductive aged women

9. The Response: Bright Beginnings Goals: To increase 1 st trimester prenatal care for young women 15-19 who are health department clients with a (+) pregnancy test to 90% To maximize birth outcomes among clients in the program To decrease unintended pregnancies among teen Health Department clients with a prior (-) pregnancy test by 20%

10. The Response: Bright Beginnings Components: –Separate teen pregnancy tests from the traditional family planning clinic and have them performed by BB staff –All positive (+) tests receive the following services Risk screening WIC application paperwork completed TennCare application completed for those eligible Referral to in school pregnancy program Referral to home bound services 1 St prenatal appointment made

11. The Response: Bright Beginnings Components: –High Risk Screening Referred for full assessment and either referred into traditional home visiting program like Healthy Start if (+) Followed as a “Generic” until third trimester –Low Risk Screening Referred into Bright Beginnings for case management Followed monthly Partnership with school and obstetrician to assure wrap around care is received

12. The Response: Bright Beginnings Components: –All negative (-) Pregnancy tests receive the following services: Pre-conceptual health education, including folic acid Family planning labs and paperwork completed Appointment made to return during menses Emergency contraception (EC) A follow up phone call if appointment missed

13. The Response: Bright Beginnings Components: *** Future –All negative (-) Pregnancy tests continued Invitation to attend a pregnancy prevention class worth ½ school credit if completed Involve the partners in education

14. The Response: Bright Beginnings Components: *** Future –All negative (-) Pregnancy tests continued Invitation to attend a pregnancy prevention class worth ½ school credit if completed Involve the partners in education

15. 1 st Quarter Results 133 pregnancy tests done –57% positive test results Age breakdown –0% <14 –8% 14-15 –29% 16-17 –63% 18-19 Race –65% African American –35% white

16. 1 st Quarter Results 60% scored (+) on the risk assessment 95% were referred to WIC –54% completed the application process 38% received presumptive TennCare 60% received prenatal vitamins (PNV), the rest were given a prescription

17. 1 st Quarter Results For those clients that had (+) screenings: N=45 –20% went on to have a (+) assessment and were referred to traditional HV program –Only 2% refused HV services For clients who entered into case management: N=30 –100% kept their 1 st prenatal visit

18. Lessons Learned Teens in general are very interested in having a healthy baby, and are willing to work towards that goal Most pregnant teens have already dropped out of school Family planning clinics are a great place to start pre-conceptional health agendas

19. Questions ?