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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
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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
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CA Preconception Care Initiative Launched - 2001
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
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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 2007
9. DEMONSTRATION PROJECTS
10. STATE & LOCAL INITIATIVES
CDC’s Preconception Call to Action-Strategies for Implementation
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Preconception Health Council of California (PHCC)• March of Dimes California
Chapter• ACOG, District IX (CA)• California Department of
Public Health MCAH Division
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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
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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
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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
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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
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Spanish Language Website
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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
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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
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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
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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
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CA Family Health Council’s Preconception Care Integration
ProjectGoals 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
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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
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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
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PHFE-WIC’s WOW (WIC Offers Wellness)
ProgramGoals 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
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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.
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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
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ImpactSeveral of the materials and best practicesdeveloped through this project have beenadopted for future utilization including: Preconception health assessment forms Six-week postpartum checklistAdditionally, PHFE-WIC has incorporatedpreconception staff training, client
screeningand education into all of their sites
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Sutter Medical Center Sacramento’s Teen Care
ProjectThis project delivered case managementservices to 650 pregnant and parenting teens in Sacramento CountyThe goals of the project were to:• Decrease adverse birth outcomes • Positively impact health behaviors
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Activities
The intervention included:• Interconception risk assessment
(web based)• Home visitation• Health education events• Life Plan (Individual Reproductive
Life Plan)
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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
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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
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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: www.EveryWomanCalifornia.org
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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
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In ConclusionPreconception 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
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Questions?
Thank You !