CAAP

1. CAAP Presented by: Cynthia Farkas, RNC, FNP, MS September 13, 2004 Community Antepartum Alternative Program Jefferson County Department of Health and Environment Golden, Colorado March of Dimes Colorado Chapter

2. CAAP Program: Supporting Pregnant Women in Need • CAAP provides support for pregnant women at risk, who may not qualify for existing home visitation programs. • Partnership between JCDHE and the Colorado Chapter of the March of Dimes. • Year One: $7,125 for .1 FTE Community Health Nurse (CHN) • Year Two: $12,000 for .2 FTE CHN plus a $1500 Community Award • Year Three: $20,175 for .3 FTE CHN (current)

3. A Healthier Community Each CAAP client receives: - 3 antepartum home visits - 1 postpartum/newborn home visit - Support, Education and Referral

4. Support Assistance in obtaining Medicaid Assistance in accessing prenatal care Self-assessment of support networks Education Health behaviors Guidance for early parenting and newborn care Benefits of consistent prenatal care Danger signs of pregnancy Sibling preparation Breastfeeding education and encouragement March of Dimes materials and videos Support, Education, Referral Home Visits Include:

5. Support, Education, Referral Home Visits Include: • Referral • Community resources • Medical resources • Mental Health Nurse Specialist at JCDHE

6. Program Objectives: • Objective I: 65 clients enrolled (25 first year and 40 in second year) • Objective II: 92% of delivered women enrolled in CAAP will have given birth to an infant weighing 5 pounds 8 ounces or more

7. Process Evaluation: • Referrals: 182 • 65 enrolled (36%) • 37 of the 65 enrolled (57%) completed program with a postpartum home visit

8. Demographics(n=65)

9. Risk Factors(n=65)

10. Birth Weight • 37 women completed the program with a postpartum visit. 26 (70%) delivered infants weighing over 5 pounds, 8 ounces. • Three sets of twins, two sets weighed over 5 pounds, 8 ounces.

11. Client Home Visit Satisfaction Survey 100% very satisfied or satisfied 100% found visits helpful: listening, support, answering questions, education, resources Client Health Behavior Survey Smoking: 9 of the 37 smoked – 7 (78%) quit or reduced their smoking Alcohol: All had no alcohol or less than one drink per day Drugs: All had quit drug use prior to pregnancy Outcome Evaluation(19 or 51% returned)

12. Outcome Evaluation cont… • Teaching Support • 17 (89%) were aware of community resources. • 14 (74%) had accessed community resources: WIC, Mental Health Specialist, CCAP, QuitLine, MOPS (Mothers of Preschoolers), TANF, etc. • 18 (95%) reported education regarding self-care or infant-care: breastfeeding, sibling rivalry, parenting, nutrition, smoking cessation, labor and delivery, birth control and gained confidence as a mother. • 18 (95%) were using a birth control method or had an appointment scheduled for a specific method: tubal, condoms, IUD, Depo, patch, or vasectomy.

13. Challenges

14. Challenges cont…

15. Benefits of CAAP • Individual attention from CHN in home. • Support for behavior change. • Health Education: danger signs of pregnancy, substance use, nutrition, dental, labor and delivery, breastfeeding infant and child care, safety, and family planning. • Access to medical/prenatal care and community resources.

16. Accomplishments • MOD grant funded for a third year • Poster presentation at Public Health in Colorado Annual Conference 2003 • Hired a .3 FTE CHN for the third grant year

17. Lessons Learned • Develop a database from which outcome data can be effectively analyzed, i.e. risk-reduction rates. • Low birth weight rate higher than expected in this multi-risk client population (small population sample). • Short-term nurse home visitation can positively increase client’s awareness of healthy behaviors and improve access to prenatal care and community resources.

18. Client Stories