Transcript Saint Paul – Ramsey County Department of Public Health

Healthy Outcomes
and
Self-Sufficiency
for
Pregnant and Parenting Teens
Receiving TANF Cash Assistance
in
Ramsey County, Minnesota
Minnesota’s Public
Health System
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Organized into 56 Community Health
Boards
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Nationally recognized because of
unique organization, State-Local
partnership, and innovations
Ramsey County
East side of the Minneapolis/St. Paul
Twin Cities
 Most densely populated county
 Pop. 525,000
 Increasing numbers of Hmong,
Somalian immigrants
 1 in 3 English as a Second Language
learners in St. Paul
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Saint Paul – Ramsey
County Department of
Public Health
301 employees
 Organized into “Sections”
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Administration
Correctional Health
Enviornmental Health
Healthy Communities
Epidemiology, Policy, Planning and Preparedness
Preventive Health
Screening and Case Mangement
WIC
Healthy Families
Healthy Families
Section
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Adolescent Parent Program
– Home visiting and case management for
pregnant and parenting teens under 17
yrs
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REACH Young Parents Program
– Home visiting and case management for
pregnant and parenting teens 17 – 19 yrs
who have not completed high school
Home Visits to
Pregnant/Parenting
Teens
In 2000, large influx of TANF $ from
feds, through MN Dept. of Health,
increased emphasis on self-sufficiency
of adolescents along with promotion of
healthy outcomes for families.
Teen
Home Visiting Staff
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Public Health Nurses (PHN)
– Minimum of 4 yr nursing degrees with public
health certification, some with masters degrees
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Social Workers –
– Licensed SW’s and LICSW
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Health Education Program Assistants
– Health para professionals with 2 year degrees
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Nutritionist
– 4 year degree
Home Visits to
Pregnant/Parenting
Teens
Services provided to both male and
female teen parents
 Information collected, nursing
diagnosis determined, individualized
plan of care developed
 Implement or refer for interventions
 Track outcomes
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Home Visiting Services
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Physical health assessment of mom,
dad(if present) and child(ren)
– Health histories, vital signs, and direct
observations
– Notify MD when needed for health concern
– Ensure all family members are hooked up with a
primary care clinic, dentist, and psychiatrist (if
needed)
– Ensure health insurance is active; all paperwork
processed
Home Visiting Services
con’t
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Mental health
– Assessments
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Past/present domestic violence
Past/present abuse/neglect
Past/present symptoms or diagnoses
Past/present self-mutilation
– Referrals for psych evals and medication
– Referrals for counseling and support groups
– Assist with obtaining county MH case manager
Home Visiting Services
con’t
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Child Health Assessments
– Assess for growth and development norms
established by national pediatric standards
– Nutritional assessment
– Past health history/dental history
– Daily living routines
– Elevated lead, PICA
– Past or current risk of abuse/neglect
– Parent/child attachment
Home Visiting Services
con’t
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Housing assessment and assistance
– Safety issues
 Home
Safety Checklist tool
– Financial situation, money management
– History or risk of homelessness
– Goals for living independent living
Home Visiting Services
con’t
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Cognition/educational needs
– Past or present learning difficulties
– Attitudes towards school
– Initiate special ed assessments
– Future educational/career goals
Home Visiting Services
con’t
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Pre-natal education, teaching and
monitoring
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Breastfeeding promotion and support
Previous pregnancy history
Current status
Feelings about pregnancy
Partner involvement
Nutrition, vital signs
Smoking or chemical use
Preparation for newborn
Meds or treatments ordered by MD
Home Visiting Services
con’t
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Post-partum education, teaching and
monitoring
– Assessment of physical status of mom
and baby
– Breastfeeding promotion and support
– Post-partum depression identification and
referral
Home Visiting Services
con’t
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Assess knowledge of community
resources and support
– Assist and support to access resources
– Referrals, as appropriate
Home Visiting Services
con’t
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Womens health
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Family health history
Personal health history
Previous pregnancy outcomes
Family planning
Chemical use
Mental/emotional/abuse history
Client’s assets
Medical care
Insurance
Dental care
WIC food program
Early Childhood years
Support Systems
Transportation
Home Visiting Services
con’t
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Caretaking and parenting
– Assess strengths and weaknesses
– Parenting practices of client’s parent(s)
– Risk of abuse/neglect to self or child
– Attachment and interaction
– Child’s behavior
– Current discipline practices
Home Visiting
Services, con’t
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Clinical medical record kept for each client
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For each category, client knowledge,
behavior and status(KBS) is assessed
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Interventions are implemented
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KBS ratings are tracked for improvement
Minnesota’s Program
for TANF Clients
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Called MFIP (pronounced m-fip)
Minnesota Family Investment Program
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Workforce Solutions, a Ramsey
County department, administers the
MFIP employment services
Teen Parents on MFIP
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More than 70% of teen parents end up on
welfare at some point in their lives
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More than 53% of MFIP families in
Minnesota began with a birth to a teen mom
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Only 41% of mothers who have children
before age 18 ever complete high school
Minnesota’s Program
for MFIP Clients
Each client assigned a job counselor to
provide Employment Services (ES)
– Assists clients in obtaining self-sufficiency
by developing “employment plan”
– Teens develop a “school plan” in place of
employment plan
– Ensures clients follow mandates
– Ability to sanction cash grant if out of
compliance
Public Health
Nurses(PHNs) as ES
Counselors
Because of our positive outcomes,
Workforce Solutions contracted with
Public Health for ES services to teens
 Prior to July ’03, home visiting program
was voluntary
 Only 1/3 of teens on MFIP received
home visiting services, now all are
mandated
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PHNs as ES Counselors
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Began July 2003
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Now have ability/responsibility to sanction
and approve child care payments
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ES chart added to clinical medical record
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PHNs have matched caseloads with
Financial Workers and Child Care Workers
in other county departments
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Unique collaboration with child support
enforcement department
Evaluation combining
PHN and ES Counselor
Roles
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Continue to track all outcomes including:
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Client satisfaction
Health status of families
Graduation rates
Positive attachment to children
Housing stability
Children will have:
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Well child exams
Health insurance
Up-to-date immunization
Normal growth and development
Reduction in unintentional injury
Evaluation combining
PHN and ES Counselor
Roles
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Additional study of mandatory vs.
voluntary participation and its effect on
health and self-sufficiency outcomes
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Saint Paul – Ramsey County
Department of Public Health selected
to be in CityMatch Data Institute to
study MFIP Teen Program
Year One Results
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MFIP Teens received more coordinated,
consistent, intensive, and comprehensive
services
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Developed a unique collaboration with
several county departments and the school
district
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Improved service delivery and efficiency of
services
Year One Results
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Increased communication between
service providers-a cross department
“team feeling” has occurred
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All MFIP teens received a
comprehensive assessment and
increased services
Lessons Learned
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It is a difficult balancing act between
the dual roles of public health home
visitor and MFIP enforcers
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Holding clients accountable to MFIP
rules(sanctioning) is difficult for staff
who have served in a service provider
role
Lessons Learned
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More up front training to PHNs on the rules
and regulations of MFIP was needed
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A sanction review team was implemented
for consultation, evaluation and consistency
of practice
– Nurses now tell clients that the committee made
the sanction decision rather than the individual
nurse who visits the home
Lessons Learned
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Even during the implementation
phase, continued emphasis needs to
be placed on public health practice
issues and support for staff
Implications for
Practice
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There may be safety concerns for home
visitors who have the responsibility to
sanction cash grants
Programs with mandatory
enrollment/service requirements affect
relationships
Continued emphasis on public health
practice (as well as learning the new
employment services counselor role) is vital
Implications for
Practice
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Matched caseloads among PHNs,
financial workers, and child care
workers are essential
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Have representatives from front line
public health staff involved in all
aspects of program design and
implementation
Implications for
Practice
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Successful public health strategies can be
adapted for use by agencies and
departments with differing missions
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Decreasing the number of county staff
involved with teens
– improves communication, coordination, quality,
and client satisfaction of services
– promotes healthier outcomes
Implications for
Practice
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Relationship based services that hold teens
accountable for the rules they need to follow
in order to receive MFIP cash assistance
promotes client responsibility
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Comprehensive services delivered by a
multi-disciplinary team increases positive
outcomes
Contacts
Sue Mitchell, MPH
651-266-2428
[email protected]
Linda Wagner, PHN, MPH
[email protected]
651-766-4063