CityMatCH Promising Practice CityMatCH Promising Practice Preconception HealthPreconception Health

August 26, 2007August 26, 2007

Small Change

Patricia Handel, MSN

Kathy Hill, M.Ed., LSW

Margaret Shank, MSN

Background/PurposeBackground/Purpose

Ohio Department of Health, Regional Perinatal Centers, Perinatal Data Use Consortiums

PPOR data analysis led us to preterm births

Identified gap in services Home Visitor survey Results

Data into ActionData into Action

Develop objectives based on data

Preterm birth needs improvement

Survey results indicate need and interest by home visitors

ObjectivesObjectives

Community-wide knowledge of prematurity and its consequences

Decrease Ohio Perinatal Region I’s (Cincinnati) rate of subsequent preterm births

Develop doable program with current resources (subcommittee’s time and skills) to reach the most at-risk women

LAND

LAND

ATHENS

BELMONT

CARROLL

COLUMBIANA

COSHOCTONDELAWARE

GALLIA

HARRISON

HOCKING

JACKSON

LAWRENCE

MEIGS

MONROE

MORGAN

MUSK-

NOBLEPERRY

PIKE

ROSS

SCIOTO

TUSCA-

VINTON

WASHINGTON

MONT

JEFFER-

SONRAWAS

INGUM

ADAMSBROWN

FAYETTE

HIGHLAND

GOMERY

HOLMES

GUERNSEY

OTTAWA

WILLIAMS FULTON LUCAS

ASH-

ASHTABULA

CRAWFORD

CUYAHOGA

HURON

LAKE

MAHONING

MEDINAPORTAGE

RICH-

SENECA

STARK

SUMMIT

TRUMBULL

WAYNEWYANDOT

HANCOCKPAULDINGPUTNAM

WOOD

GEAUGA

DEFIANCE ERIE LORAINSANDUSKYHENRY

FAIRFIELD

FRANKLIN

HARDIN

KNOX

LICKING

MARION

MORROW

PICKAWAY

MONT-

ALLEN

AUGLAIZE

BUTLER

CHAMPAIGN

CLARK

CLINTON

DARKE

GREENE

HAMILTON

LOGAN

MERCER

MIAMI

PREBLE

SHELBY UNION

VAN WERT

WARREN

CLER-

MADISON

I

II

III V

VI

IV

Ohio’s Perinatal Regions

Region I 8 counties

Region II 17 counties

Region III 11 counties

Region IV 33 counties

Region V 5 counties

Region VI 14 counties

Program-specific objectivesProgram-specific objectives

Home visitors are educated about prematurity and its consequences

Home visitors adapt this knowledge to individual client needs/situations

The client incorporates small changes in behavior to achieve a healthier lifestyle

Small ChangeSmall Change Program name Curriculum Evaluation/

documentation tool Resource sheet Brochures Small Change

envelopes

Curriculum – Part ICurriculum – Part I

Prematurity is a serious problem

Likelihood of repeat preterm pregnancy

A Small Change can make a difference

Identifying and decreasing stress

Nutrition & exercise Tobacco cessation Substance use/abuse Adequate birth

spacing African-Americans are

at the greatest risk

Curriculum – Part IICurriculum – Part II

Motivational Interviewing

Packets Small Change

envelopes Resources Documentation

http://www.motivationalinterview.org/

Small Change (Previous Preterm Birth Education) Name

Date of Visit 

Topic D N V D N V D N V D N V D N V D N V  

Prematurity is a serious problem  

Likelihood of repeat preterm pregnancy  

African-Americans at much higher risk  

Small change may make a difference  

Stress – Abuse, low income, racism, social support

 

Grief 

Nutrition/Exercise  

Tobacco 

Substance use/abuse 

Adequate birth spacing 

Interconception Health 

Client’s Name __________________________ DOB_________________________________Number of live births ____________________ Number of losses _______________________ Date of last birth _______________________Gestation _____________________________ Birth weight ___________________________Subsequent pregnancy due date_____________

D= Discussed (Discussed with client)N = Named (Client could name, when asked)V = Volunteered (Client volunteered that she had worked on this.)

Visit Date & Comments: ____________________________________________________________________________________________________________________________________________________ Initials______Visit Date & Comments: ____________________________________________________________________________________________________________________________________________________ Initials______Visit Date & Comments: _____________________________________________________________________________________________________________________________________________________Initials______Visit Date & Comments: ______________________________________________________________________________________________________________________________________________________Initials_____Visit Date & Comments: ______________________________________________________________________________________________________________________________________________________Initials_____Visit Date & Comments: ______________________________________________________________________________________________________________Initials_____

First Visit – Info from mom’s perspective. Set tone. Few points. Stress/grief.Second Visit – More specific.Additional history/info: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

ImplementationImplementation

Part I presentation to four agencies

Part II presentation to two agencies

Follow-up meetings with the two agencies

Documentation changes

Additional materials

ResultsResults

Presentation(s) received high marks.

Enthusiasm, interest, questions and answers

Not implementing

Focus as much on community message as individual message

“Share this information with your sister, friend, neighbor.”

Agency-specific documentation

Revisions

BarriersBarriers

Documentation form = “another piece of paperwork”

Difficult to attribute outcomes to interventions.

Time to do trainingsLack of funding for giveaways.

It Appears. . .. .It Appears. . .. .

Home Visiting Programs want this training as future funding agencies may require such.

Still AheadStill Ahead

Seek grant funding Info sheets on each

topic Training for other

Help Me Grow programs, GRADS teachers, Public Health Clinics, etc.

Infant Deaths

Lifelong

Handicaps

Morbidity and/or Cost

Prematurely, Congenital Malformations, SIDS, Injury, Pregnancy

Complications, Infection, etc.

High Risk Births

All Births

Infant Mortality IcebergEd Donovan, MD

High Risk pregnant women

All Pregnant Women

All WCBA (social status, social & human capital)

The public’s health

Social & economic, community-oriented and public health policy

Public Health Implications

Pat Handel, RN, MSNKathy Hill, LSW, M.Ed.

Lisa Holloway, BS, MBAMargaret Shank, RN, MSN

If interested in a copy of the survey, documentation tool, or Small Change presentations, please contact:

Kathy Hill

(513) 636-8225

Kathy.hill@cchmc.org

Funded by:Funded by:

Cincinnati Children’s Hospital Medical Center City of Cincinnati Health Department Health Improvement Collaborative of Greater

Cincinnati March of Dimes Greater Cincinnati Division Ohio Department of Health/Federal Government;

Bureau: Child & Family Health Services; Program: Regional Perinatal Centers Program

Small Small ChangeChange