Can Preconception Health be Enhanced through Existing Public Health Programs? Dana Edelman, MPH, CHES Peyton Mason-Marti, MPH Vicki Lombardo, MSN, RN March of Dimes, California Chapter

Preconception/ Interconception Health (PCH/ICH) in CA Every Woman, Every Time Preconception Health Council of CA March of Dimes PCH/ICH Funded Projects Interconception Care Project of CA Demonstration Projects

CA Preconception Care Initiative Launched Every Woman, Every Time provider & patient packet Developed through March of Dimes grant to Sutter Medical Center, Sacramento Guidelines for integrating PCH into primary care, family planning and women’s health visits Patient education handouts

1.CLINICAL GUIDELINES & TOOLS 2.CONSUMER INFORMATION 3.PUBLIC HEALTH PROGRAMS AND STRATEGIES 4.MONITORING & SURVEILLANCE 5.RESEARCH AGENDA 6.PUBLIC POLICY AND FINANCE 7.PROFESSIONAL EDUCATION AND TRAINING 8.BEST PRACTICES: Develop a catalogue of promising practices; Share promising practices; Maintain Internet web portals; Convene a national meeting in DEMONSTRATION PROJECTS 10.STATE & LOCAL INITIATIVES CDC’s Preconception Call to Action- Strategies for Implementation

Preconception Health Council of California (PHCC) March of Dimes California Chapter ACOG, District IX (CA) California Department of Public Health MCAH Division

Preconception Health Council of California (PHCC) The mission of the PHCC is to engage individuals, communities and policymakers to optimize the health and well-being of women and their partners, leading to healthier infants and families

Preconception Health Council of California Support from CDC Membership reflects state diversity –Public Health programs –Health care providers and hospital health care systems –Community-based organizations –Government agencies

Key Accomplishments: Clinical/ Research Hosted the Second National Summit on Preconception Health and Health Care in Oakland in 2007 in collaboration with the CDC Participated in CDC Clinical Guidelines (Grey Journal) Produced lecture templates on preconception health care Supports the Interconception Care Project of CA

Key Accomplishments: Public Health/Consumer Production of EveryWomanCalifornia.org –Comprehensive preconception health promotion website –Provides consumers with resources and networking opportunities for health care professionals

Spanish Language Website

Interconception Care Project of California March of Dimes funded cooperative partnership with ACOG, District IX (CA) Goal: develop interconception care guidelines to maximize the postpartum visit & improve subsequent pregnancy outcomes Created 21 algorithms with screening, risk- reduction counseling, treatment & referral guidelines, along with patient handouts Plan to distribute state-wide by end of 2010

Demonstration Projects Background In response to the 2006 CDC report on preconception health recommendations and their call to action to invest in demonstration projects, the March of Dimes, CA Chapter released a request for preconception/interconception project proposals

Criteria for Selection  Multi-year project that addressed PC/IC health  Potential to be replicated across the state and nation  Enhance education and support services for women at high-risk of poor pregnancy outcomes  Agencies had to be able to design, implement and evaluate the project and reach the priority population and show measurable outcomes

Grantees  The California Family Health Council's Preconception Care Integration Project  PHFE-WIC’s (WIC Offers Wellness) Program  Sutter Medical Center Sacramento’s Teen Care Project

CA Family Health Council’s Preconception Care Integration Project Goals were to: –assess current level of PC/IC care integration in Title X family planning clinics in 3 counties –develop training for clinical staff –assess knowledge and behavior change resulting from training and care expansion

Activities 300 clinicians were trained to integrate PC/IC care into family planning visits 1,500 women received PC/IC care during family planning visits

Outcomes Integrating PC messages into practice was doable and took an additional 3-5 minutes Physicians requested additional training, culturally/linguistically appropriate educational materials and protocol samples Patients strongly agreed that the PC information they received was important and they were interested in making at least one health behavior change

PHFE-WIC’s WOW (WIC Offers Wellness) Program Goals were to: Improve the health status of women who recently had a preterm and/or low birthweight baby Increase pregnancy spacing Increase rates of planned/intended pregnancies Reduce the incidence of repeat preterm/LBW babies

Activities The intervention included staff trainings, group preconception health activities, folic acid education and screenings assessing 6-week postpartum appointment status, nutrition, exercise, healthy weight and depression status Individual counseling, phone and peer support group meetings were provided for the intervention group.

Results  Program showed a significant impact on multivitamin/folic acid and birth control use  Of moms with a subsequent pregnancy during the project period, WOW moms had better birth outcomes* *Data reflects a small number of births

Impact Several of the materials and best practices developed through this project have been adopted for future utilization including:  Preconception health assessment forms  Six-week postpartum checklist Additionally, PHFE-WIC has incorporated preconception staff training, client screening and education into all of their sites

Sutter Medical Center Sacramento’s Teen Care Project This project delivered case management services to 650 pregnant and parenting teens in Sacramento County The goals of the project were to: Decrease adverse birth outcomes Positively impact health behaviors

Activities The intervention included: Interconception risk assessment (web based) Home visitation Health education events Life Plan (Individual Reproductive Life Plan)

Outcomes Health Risk Assessment data revealed that teens were concerned about: Nutrition and weight Exercise Birth control Chronic conditions such as asthma Inherited risk of chronic conditions

Outcomes Over 300 Life Plans were distributed Life Plans could be used as road maps for the teen and her case manager Participants felt that the Life Plan helped them to think about a healthy future Online assessments engaged teens and offered more in-depth information to providers There was an increase in birth control use among clients who completed a Life Plan

Demonstration Project Outcomes The March of Dimes’ Demonstration Project Review Committee conducted site visits, reviewed reports and made recommendations The PHCC monitored activities, outcomes and lessons learned and have been disseminating best practices throughout their networks Program resources, tools and findings have been featured on:

Promising Outcomes Projects were successful in showing measurable outcomes and reaching the target population PC/IC health activities can be integrated into programs Concepts and activities can be replicated Projects have produced and/or tested valuable tools that can be utilized in screenings, case management and programs Information has shed light on factors that affect reproductive health behavior

In Conclusion Preconception health can creatively be integrated into existing programs and when supported by adequate workforce preparation and tools can show measurable results for both patients and clinicians

Questions? Thank You !