1. BIHCC Collaborative Learning Conference Call
Beyond Health Care Reform: The Role of Interconceptional Care in Reinventing Maternal and Child Health
BIHCC Collaborative Learning Conference Call
The State of Florida
Thursday, February 11, 2010
11:00 AM -12:00 PM
Presented by
Mario Drummonds MS, LCSW, MBA
Executive Director, Northern Manhattan Perinatal Partnership, Inc.
Linking Women to Health, Power and Love Across the Life Span

2. Lecture Objectives
Discuss 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 Rate
Singapore 2.1
Hong Kong
Czech Republic
Spain
Canada
United States, “White” 5.7
Cuba
Northern Ireland
United States 6.9

4. Terminology Interconception Internatal care Interpregnancy Interval
From the conception of one pregnancy to the conception of the next pregnancy.
Internatal care
From the birth of one child to the birth of the next child
Interpregnancy Interval
The 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 health
Goal 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 health 7

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 period
Goal 4: Reduce disparities in adverse pregnancy outcomes 8

9. HRSA Position
The 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. 9 9

10. Traditional Perinatal Care Continuum
Labor and birth ?
Primary care
Interconceptional period
Preconception period
Antepartum Labor and birth Postpartum
Well baby care
Prenatal care
Postpartum visit 10

11. Lifespan Approach
Birth Early childhood Pre-teen Teen Young adult Women 35≥ Seniors
Diminished role and impact of prenatal care. Maternal health prior to pregnancy is key. Explores and learns from history of poor birth outcomes
It will take more than one generation to equalize birth disparities 11

12. New MCH Life Course Continuum Axis 1
Centering Pregnancy
Child Abuse Prevention
Latch-Key Program
Managing Relationships
Health Policy Activities
Reproductive Social Capital
Internatal Care
School Readiness
Fitness & Health Activities
Pregnancy Prevention
Women’s Health Protocol
Depression Group Work
Perinatal Care
UPK
Beacon School
College Prep
Reproductive Life Planning
Specialty Care
Harlem Birthing Center
Early Head Start/ Head Start
Health/ Life Stories Telling
Preconception
Inter- conceptional Care
Chronic Disease
Chronic Disease Management
Birth
Early Child-hood
Pre-Teen
Teen
Young Adult
Women>35
Senior Citizens

13. MCH Life Course Organization Social Determinants to Health Axis 2
Public Policy Initiatives
Economic Empowerment Zone
Supermarket Zone Expansion Policy
NYC Affordable Housing Policy
Community Environmental Impact
St. Nick Tenant Organizing
Food & Fitness Coalition
Affording Housing Organizing
Organizational Impact
Healthy Start Consortium
Diabetes Prevention Coalition
Harlem Works Job Readiness
Group/
Interpersonal Impact
Centering Pregnancy
Baby Mama’s Club
Consumer Involvement Organization
Individual Impact
OB/GYN Medical Homes
Case Management
Depression Screening & Treatment

14. A Life Course or Integrative Model
Builds on a continuum
Emphasis is on health promotion throughout the lifespan (from “womb to tomb”)
Emphasis on primary and secondary disease prevention
Emphasis on woman, first, rather than her reproductive status 14

15. most of our outcomes or their already present before we ever
In obstetrics. . .
most of our outcomes or their
determinants are
already present before we ever
meet our patients 15

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 to
Woman’s lifelong health status
Potential impact on future pregnancies
Pregnancy is a “stress test” for life 18

19. Pathways to Care 19 screening Intake & Assessment Pregnant
Prenatal case management
Interconceptional case management
Not Pregnant 19

20. Pathways Protocol: Entry to Care
New clients receive:
Intake
Screening
Assessment
Existing 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 tool
Screening tool
Have these tools been evaluated for feasibility or effectiveness?
Sample tool 21

22. Existing Clients
Existing 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 Pregnancy
High risk pregnancy with pre-existing or pregnancy related medical conditions 22

23. Healthy/Normal Pregnancy
Basic newborn care
Back-to-sleep/safe sleep
Shaken baby syndrome
Early parenting skills (bathing, handling, bonding, attachment)
Breastfeeding
Preparing for your well baby visit
Preparing for your postpartum visit
Recognizing PMD 23

24. High Risk Pregnancy
Items 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 illness
Diabetes (pregestational and gestational)
Overweight/obesity
Prior stillbirth(s), LBW, prematurity, infant mortality 24

25. Core Contents 25 Risk Assessment Reproductive Life Plan
Health Promotion
Clinical Interventions
Psychological Interventions
Socioeconomic Interventions
Male Involvement
Reassessment at 90 days
Update Reproductive Life Plan (as needed) 25

26. Risk Assessment
The 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 tool
Has this tool been evaluated for feasibility or effectiveness?
Interventions are developed based on the findings from the risk assessment.
Sample tool 26

27. Risk Assessment: FINDS
Family violence
Infections/Immunizations
Nutrition
Depression
Stress
Go 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 violence
Infections/Immunizations
Periodontal
Chlamydia
Other sexually transmitted or urogenital tract infections in selected populations
Nutrition
Depression
Stress
Lu, M.

29. Risk Assessment: FINDS
Family violence
Infections/Immunizations
Diptheria-tetanus toxoids booster
Hepatitis B vaccines
Measles and mumps
Rubella
Varicella
Nutrition
Depression
Stress
Lu, M.

30. Highlights
F.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
Breastfeeding
Back-to-sleep
Exercise
Exposures
Household molds and dust mites
Lead
Mercury
Dioxins
Folate
Family planning
Lu, M.

32. Health Promotion BBEEFF
Breastfeeding
Back-to-sleep
Exercise
Exposures
Folate
Family planning
Reproductive life plan
Contraceptive use
Lu, M.

33. Clinical Interventions
Height and weight measurements
every 3-5 years
Blood pressure
every 2 years
Total skin examination
every 1-3 years
Papanicolau smear and pelvic examination
Clinical breast examination
Every 3 year beginning at age 20
Screening mammography
every 1-2 years beginning at age 40
Lu, M.

34. Psychosocial Interventions
Access to social support services
Public assistance
Childcare
Housing
Literacy programs
Professional clinical support
Mental health services
Services for intimate partner violence
Marital and sexual counseling
Parenting support
Mothers groups
Parenting classes
Fathers groups
Lu, M.

35. Socioeconomic Interventions
Access to socioeconomic interventions with multiple levels of impact
Job development
Financial literacy
Investment/savings clubs
Livable wage
Building political power
Transforming 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 driven
Empowers women (and men, if included in their care)
Reframes pregnancy from chance to choice
Encourages individualized counseling
(e.g. contraceptive options, interconceptional lengths, fertility considerations, etc)
May result in higher percentage of pregnancies identified as intended 37

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. Precautions
Reproductive 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 encounter
Addressing 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 encounters
Knowing a woman’s intentions can focus much of the rest of the encounter 40

41. Family & Social Support
Healthy Women
Physical
Social
Cognitive
Emotional
Social Service System
Health Care System
Economic Environment
Community & Culture
Schools
Family & Social Support
Physical Environment
Behaviors & Lifestyle
Used 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 Span 42 42

43. For more Information Contact:
Mario Drummonds, MS, LCSW, MBA
Executive Director/CEO
Northern Manhattan Perinatal Partnership
127 W. 127th Street
New York, NY 10027
(347) 43 43