Bright Beginnings: An Activity of Project

BlossomKimberlee Wyche-Etheridge, MD,

MPHNashville, TN

CityMatCH Conference

The Rationale

• Women who start PNC early in pregnancy are more likely to:

– Increase their chances of having a healthy pregnancy

– Increase their chances of keeping their infants healthy

The Rationale

• 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

• In Nashville:– 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

• In Nashville:– 59 babies were born for every 1,000

females 15-19• 52 for Whites• 80 for African Americans

Health Nashville 2000

The Data

• In Nashville:– 11% of babies born to teens 15-19

were low birth weight• 10.2 for whites• 12.3 for African Americans

– 12.9% were born premature• 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

• Mission: To optimize maternal and infant outcomes in Davidson County

• Goals1. To decrease Infant Mortality and

Eliminate Perinatal Disparities2. Make MCH a Community Priority3. 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

• Components:– Separate teen pregnancy tests from the traditional

family planning clinic and have them performed by BB staff

– All positive (+) tests receive the following services• 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

• Components:– High Risk Screening

• 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• 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

• Components:– 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

• Components: *** Future– All negative (-) Pregnancy tests

continued• Invitation to attend a pregnancy

prevention class worth ½ school credit if completed

• Involve the partners in education

The Response:Bright Beginnings

• Components: *** Future– All negative (-) Pregnancy tests

continued• Invitation to attend a pregnancy

prevention class worth ½ school credit if completed

• Involve the partners in education

1st Quarter Results

• 133 pregnancy tests done – 57% positive test results

• Age breakdown– 0% <14– 8% 14-15– 29% 16-17– 63% 18-19

• Race– 65% African American– 35% white

1st 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

1st 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 ?