Transcript Slide 1

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
Lecture Objectives
1.
2.
3.
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
International Comparisons of Infant
Mortality Rates, 2005
Rank
1
2
7
14
25
26
28
30
Country
Rate
Singapore
2.1
Hong Kong
2.5
Czech Republic
3.4
Spain
4.1
Canada
5.4
United States, “White” 5.7
Cuba
6.2
Northern Ireland
6.3
United States
6.9
3
http://www.marchofdimes.com/peristats
Terminology

Interconception
◦ 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
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
6
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
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
HRSA Position
1.
2.
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.
9
Traditional Perinatal Care
Continuum
Labor and birth
Primary
care
Preconception
period
Antepartum Labor and birth
Postpartum
?
Interconceptional
period
Prenatal care
10
Lifespan Approach
Birth
Early childhood
Pre-teen
Teen Young adult Women 35≥ Seniors
11
New MCH Life Course Continuum Axis 1
Centering
Pregnancy
Child
Abuse
Prevention
Latch-Key Managing
Program
Relationships
Health
Policy
Activities
Reproductive
Social Capital
Internatal
Care
School
Readiness
Fitness &
Health
Activities
Pregnancy
Prevention
Women’s
Health
Protocol
Depression
Group Work
Women’s
Health
Protocol
Perinatal
Care
UPK
Beacon
School
College Prep
Perinatal
Care
Reproductive
Life Planning
Specialty
Care
Harlem
Birthing
Center
Early Head
Start/ Head
Start
Health/
Life
Stories
Telling
Preconception
Chronic
Disease
Chronic
Disease
Management
Chronic
Disease
Birth
Early
Childhood
PreTeen
Interconceptional
Care
Teen
Young
Adult
Women> Senior
35
Citizens
12
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
13
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
In obstetrics. . .
most of our outcomes or their
determinants are
already present before we ever
meet our patients
15
16
Goals of Interconceptional Care
1.
Increase access to women’s healthcare.
2.
Reduce low birth weight and infant
mortality.
3.
Reduce racial-ethnic disparities in
mother and infant health outcomes.
17
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
Pathways to Care
Assessment
Intake &
screening
Pregnant
Not Pregnant
Prenatal case
management
Interconceptional
case management
Interconceptional
case management
19
Pathways Protocol: Entry to Care
1.
New clients receive:
◦ Intake
◦ Screening
◦ Assessment
2.
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
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
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
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
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
Core Contents
Risk Assessment
Reproductive Life
Plan
Health
Promotion
Socioeconomic
Interventions
Psychological
Interventions
Clinical
Interventions
Male Involvement
Reassessment at
90 days
Update
Reproductive Life
Plan (as needed)
25
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
Risk Assessment: FINDS
Family violence
 Infections/Immunizations
 Nutrition
 Depression
 Stress

Lu, M.
27
Risk Assessment: FINDS
Family violence
 Infections/Immunizations

 Periodontal
 Chlamydia
 Other sexually transmitted or urogenital tract infections in
selected populations
Nutrition
 Depression
 Stress

Lu, M.
28
Risk Assessment: FINDS
Family violence
 Infections/Immunizations






Diptheria-tetanus toxoids booster
Hepatitis B vaccines
Measles and mumps
Rubella
Varicella
Nutrition
 Depression
 Stress

Lu, M.
29
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.

30
Health Promotion BBEEFF
Breastfeeding
 Back-to-sleep
 Exercise
 Exposures

◦
◦
◦
◦
Household molds and dust mites
Lead
Mercury
Dioxins
Folate
 Family planning

Lu, M.
31
Health Promotion BBEEFF
Breastfeeding
 Back-to-sleep
 Exercise
 Exposures
 Folate
 Family planning

◦ Reproductive life plan
◦ Contraceptive use
Lu, M.
32
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
◦ every 1-3 years
Clinical breast examination
◦ Every 3 year beginning at age 20
Screening mammography
◦ every 1-2 years beginning at age 40
Lu, M.
33
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.
34
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
35
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.
36
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
Encouraging a Reproductive Life Plan:
Example of Questions that could be in
RLP
1.
2.
3.
4.
5.
6.
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
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
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
Social Service
System
Physical
Environment
Health Care
System
Behaviors &
Lifestyle
Healthy
Women
Economic
Environment
Family & Social
Support
Community &
Culture
Schools
Used with permission of The Nemours Foundation, Division of Health and Prevention Services. Adapted from the
2005 Delaware Children’s Health Chartbook.
41
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
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) 489-4769
[email protected]
43