1. MCAH and WIC MCAH and WIC An Ideal Partnership How the collaboration between Tulare County WIC and MCAH is a win-win for providers and clients alike. Presented by Karen Pringle, RN Tulare County Perinatal Service Coordinator

2. Tulare County Health and Human Services Perinatal Wellness Program (PWP) A program of Maternal, Child, and Adolescent Health PWP Seeks to: Reduce the instance and/or severity of perinatal mood and anxiety disorders (PMAD) experienced by perinatal women Increase positive later in life outcomes of infants Increase services provided to unserved and underserved populations Increase community awareness of PMAD

3. PMAD Effects During Pregnancy

4. PMAD Implications for Fetus and Newborn: Long Term Implications: Impacts psychological, social, cognitive and behavioral development in children. Chronic maternal depression results in higher rates of anxiety, depression, and behavioral disorders in toddlerhood, preadolescence and adulthood.

5. Three Critical Components to PMAD Recovery: –Therapeutic Intervention –Medical Intervention –Social Support PWP Services Include: –Case management N.U.R.S.E. Model of Care (Promoting Nutrition, Understanding, Rest, Support, Exercise) –Direct linkage to therapeutic services –Linkage to social and medical support services Additional MCAH Services: –Breastfeeding support –Basic health assessment and education –Linkage and/or referral –SASP (Safe A’sleep Program)

6. Distinct Services; Parallel Missions MCAH’s Mission: To protect, improve and optimize the health and wellbeing of women, infants, and children in Tulare County. WIC’s Mission: To safeguard the health of low- income women, infants, and children up to age 5 who are at nutrition risk by providing nutritious foods to supplement diets, information on healthy eating, and referrals to health care.

7. Client Base by Race/Ethnicity PWPWIC

8. Client Base by Age (Percentage of all clients served)

9. The WIC & PWP Partnership Recognition of similar clientele, aligned missions, limited resources, and gaps in services. Partnership Structure:Partnership Structure: –PWP Nurse Case Manager on-site in WIC offices 1 day/week. –PWP Nurse: meets with referred clients for more detailed nursing assessment, provides basic health education, connects clients to additional services. –Video-conferencing capability with all 9 WIC offices.

10. Why it Works Benefits for WIC: Access to on-site education and support Additional breastfeeding support available to clients Additional nursing assessment and referral Benefits for PWP: Better client enrollment and retention Increased assessment and referral rate Mutual Benefits: Simplified logistics for assessment and referral Early intervention, particularly for clients in the most need Improved communication between providers and a more effective working relationship –Video conferencing improves communication over broad service area Shared knowledge and resources; more comprehensive and individualized service solutions Better outcomes for clients! Underserved clients are able to benefit from care they often didn’t know was available, and receive the information and support necessary to make well-informed choices about their care.

11. PWP Referral Sources 2010-2012:Current:

12. Challenges Decreased Funding = Fewer Nurses –Drive to use resources more effectively Staff Training –Training began with MCAH nurses, who could then act as resources for WIC staff Fear of change –New logistics and communication strategies for WIC and MCAH staff who had never worked together before Development of a trusting partnership –Building trust takes time! Everyone benefits from the solution – a structured, sustainable partnership that is supported by program leadership.