Transcript Project Blossom: Too Many Babies Die Before They Have the

Bright Beginnings:
An Activity of Project Blossom
Kimberlee Wyche-Etheridge, MD, MPH
Nashville, TN
CityMatCH Conference
The Rationale
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Women who start PNC early in
pregnancy are more likely to:
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Increase their chances of having a
healthy pregnancy
Increase their chances of keeping
their infants healthy
The Rationale
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Prenatal care (PNC) forms the
cornerstone of services offered to
pregnant women
Traditionally PNC includes 3 Parts
- Risk assessment
- Medical treatment
- Health education
The Data
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In Nashville:
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84.6% of pregnant women entered
prenatal care during the first trimester
74.8% of young women10-19 entered
prenatal care during the first trimester
Health Department, 2001
The Data
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In Nashville:
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59 babies were born for every 1,000
females 15-19
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52 for Whites
80 for African Americans
Health Nashville 2000
The Data
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In Nashville:
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11% of babies born to teens 15-19 were
low birth weight
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10.2 for whites
12.3 for African Americans
12.9% were born premature
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9.7% for whites
16.6% for African Americans
TN State Dept of Health 2000
The Data
• PPOR taught us:
– The major contributors to the overall feto-infant
mortality rate in Nashville are deaths among
VLBW babies (Maternal Health/Prematurity) and
postneonatal deaths (Infant Health)
– Younger mothers with less education are at higher
risk for poor birth outcomes
– African American women of all ages and
education levels are at higher risk for poor
birth outcomes
PPOR Report 2003
Project Blossom
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Mission: To optimize maternal and
infant outcomes in Davidson County
Goals
1. To decrease Infant Mortality and
Eliminate Perinatal Disparities
2. Make MCH a Community Priority
3. Improve the health of reproductive
aged women
The Response:
Bright Beginnings
Goals:
• To increase 1st trimester prenatal care for
young women 15-19 who are health
department clients with a (+) pregnancy test to
90%
• To maximize birth outcomes among
clients in the program
• To decrease unintended pregnancies
among teen Health Department clients
with a prior (-) pregnancy test by 20%
The Response:
Bright Beginnings
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Components:
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Separate teen pregnancy tests from the
traditional family planning clinic and have them
performed by BB staff
All positive (+) tests receive the following
services
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Risk screening
WIC application paperwork completed
TennCare application completed for those
eligible
Referral to in school pregnancy program
Referral to home bound services
1St prenatal appointment made
The Response:
Bright Beginnings
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Components:
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High Risk Screening
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Referred for full assessment and either referred into
traditional home visiting program like Healthy Start if
(+)
Followed as a “Generic” until third trimester
Low Risk Screening
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Referred into Bright Beginnings for case
management
Followed monthly
Partnership with school and obstetrician to
assure wrap around care is received
The Response:
Bright Beginnings
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Components:
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All negative (-) Pregnancy tests receive the
following services:
• Pre-conceptual health education, including
folic acid
• Family planning labs and paperwork
completed
• Appointment made to return during
menses
• Emergency contraception (EC)
• A follow up phone call if appointment
missed
The Response:
Bright Beginnings
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Components: *** Future
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All negative (-) Pregnancy tests continued
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Invitation to attend a pregnancy prevention
class worth ½ school credit if completed
Involve the partners in education
The Response:
Bright Beginnings
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Components: *** Future
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All negative (-) Pregnancy tests continued
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Invitation to attend a pregnancy prevention
class worth ½ school credit if completed
Involve the partners in education
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Quarter Results
• 133 pregnancy tests done
– 57% positive test results
• Age breakdown
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0% <14
8% 14-15
29% 16-17
63% 18-19
• Race
– 65% African American
– 35% white
st
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Quarter Results
• 60% scored (+) on the risk assessment
• 95% were referred to WIC
– 54% completed the application process
• 38% received presumptive TennCare
• 60% received prenatal vitamins
(PNV), the rest were given a
prescription
st
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Quarter Results
• For those clients that had (+) screenings:
N=45
– 20% went on to have a (+) assessment and were
referred to traditional HV program
– Only 2% refused HV services
• For clients who entered into case
management: N=30
– 100% kept their 1st prenatal visit
Lessons Learned
• Teens in general are very interested in having
a healthy baby, and are willing to work
towards that goal
• Most pregnant teens have already dropped
out of school
• Family planning clinics are a great
place to start pre-conceptional health
agendas
Questions ?