Can Preconception Health be Enhanced through Existing Public Health Programs?

1. 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

2. 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

3. 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

4. CDC’s Preconception Call to Action-Strategies for Implementation

5. Preconception Health Council of California (PHCC) • March of Dimes California Chapter • ACOG, District IX (CA) • California Department of Public Health MCAH Division

6. 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

7. 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

8. 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

9. 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

11. Spanish Language Website

12. 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

13. 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

14. 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

15. 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

16. CA Family Health Council’s Preconception Care Integration Project Goals 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

17. 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

18. 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

19. PHFE-WIC’s WOW (WIC Offers Wellness) Program • Goals 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

20. 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.

21. 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

22. Impact • Several of the materials and best practices • developed through this project have been • adopted for future utilization including: • Preconception health assessment forms • Six-week postpartum checklist • Additionally, PHFE-WIC has incorporated • preconception staff training, client screening • and education into all of their sites

23. Sutter Medical Center Sacramento’s Teen Care Project • This project delivered case management • services to 650 pregnant and parenting teens • in Sacramento County • The goals of the project were to: • Decrease adverse birth outcomes • Positively impact health behaviors

24. Activities • The intervention included: • Interconception risk assessment (web based) • Home visitation • Health education events • Life Plan (Individual Reproductive Life Plan)

25. 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

26. 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

27. 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

28. 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

29. In Conclusion • Preconception 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

30. Questions? • Thank You !