Joanne Roberts, PHN Perinatal Services Coordinator Los Angeles County November 8, 2012

1. Integrating Interconception Health into CPSP Joanne Roberts, PHN Perinatal Services Coordinator Los Angeles County November 8, 2012

2. Recommendations for The Postpartum Visit ACOG: Recommend four to sixweeks postpartum General assessment of physical and mental well-being Special emphasis on depression screening, breastfeeding, and contraception

3. Recommendations for the Post Partum Visit World Health Organization: Recommend contact with the health care system: “six hours, six days, six weeks and six months” post-delivery Improved postpartum care will not only improve the health and well being of the postpartum woman but will also improve outcomes of subsequent pregnancies

4. The Facts: Postpartum Visit & CPSP • Common belief: onepp visit at 4-6 weeks • Providers have minimum 3 ½ hours postpartum • Health education • Nutrition • Psychosocial services • Additionaltime (4 hours) Perinatal Education (Z6410) if not all used prenatally

5. The Postpartum Visit & CPSP • Perfect opportunity to discuss interconception care • Begin with review of prenatal medical records: OB and CPSP

6. The Postpartum Visit & CPSP Challenges: Delivery Record • Often missing from charts • Key to identifying potential risks for future pregnancies

7. Postpartum Visit Compliance • Patient • Provider • Systems

8. Addressing Compliance • Stress the importance of the postpartum visit: • Client Orientation • Initial Assessment • 2nd and 3rd Trimester Reassessments • Post-delivery contact • All team members – every opportunity

9. Los Angeles County Projects to Incorporate Interconception Care • Messages added to CPSP Training • ABCDE’S • Train the Trainer • ABCDE’S for CPSP Providers • CPSP Postpartum Project

10. ABCDE’S

11. CPSP Training

12. CPSP Training

13. CPSP Training

14. LA County CPSP Postpartum Project Training at provider office (1 hour): • Described PCC and ICC; ABCDE’S • Overlap of PCC/ICC with CPSP • Used sample Care Plan to identify the risks that have not resolved during pregnancy • Discussed CPSP billing codes that can be used for interconception care during postpartum

15. LA County CPSP Postpartum Project • Trained 12 sites:103 CPHWs • Reviewed 10 CPSP charts per site and documented postpartum services and billing on data collection tool • Follow-up 1-2 months post-training to review new postpartum charts • Compare pre- and post-training services and billing

16. CPSP Postpartum Project

18. 18% Improvement

19. Project Challenges • Difficult to schedule follow-up visits • Many providers don’t do CPSP postpartum • Difficult to measure results • How can we measure increase in ICC services? • Comparing number of postpartum services billed was not effective

20. RESOURCES • http://www.everywomancalifornia.org

21. RESOURCES www.cdph.ca.gov/programs/preconception

22. RESOURCES Visit ph.lacounty.gov/mch/ Select “Preconception Health”

23. Thank you! jroberts@ph.lacounty.gov