See Them As Women, See Them As Mothers. Lift Every Voice (LEV) Program Jeannie Cummings, MA Itika Greene, NP, MPH Suzzette C. Johnson, MSW, MPA Family,

See Them As Women, See Them As Mothers

Lift Every Voice (LEV) Lift Every Voice (LEV) ProgramProgram

Jeannie Cummings, MA

Itika Greene, NP, MPH

Suzzette C. Johnson, MSW, MPA

Family, Maternal and Child Health Programs: Contra Costa Health Services

American Correctional Health Services Association Conference

November 4, 2011

C h a n g i n g t h e

p r e s e n t i n t o a b e t t e r f u t u r e

L i f t E v e r y V o i c e

“See Them as Women, See Them as Mothers”

Lift Every Voice (LEV) Lift Every Voice (LEV) ProgramProgram

Today’s Intention1)“See them as women, see them as mothers”2)Address how women’s health affects the health

of herfamily and community.

Acknowledgements




LEV Presentation LEV Presentation ObjectivesObjectives

At the end of today’s presentation, participants will:

1)Learn how a public health program model can be integrated into the criminal justice system in order to better serve women.

2)Learn how health inequities impact health outcomes among African American and low socioeconomic populations.

3)Understand preconception health care recommendations to improve reproductive health care for women and improve perinatal outcomes.

LEV Mission & LEV Mission & BackgroundBackground

Mission

To inspire, motivate, and empower women to take constructive action to support their mental,

emotional, spiritual, and physical well-being.

Background Started in 2005

Contra Costa County Health Services/Public Health in Family, Maternal and Child Health Programs as part of Perinatal Services Coordination

Concentration in West County Detention Facility

LEV Program LEV Program DescriptionDescription

Home visiting, outreach and case management services

Links to prenatal care, psychosocial support services, and other home visiting programs

Psychosocial education, support, and advocacy

Engages and retains women until delivery of babies

Comprehensive and holistic, culturally sensitive, strength-based, gender-specific, trauma informed

Innovative public health approach within criminal justice system

Systems intervention

“Life Course” Perspective

Life Course PerspectiveLife Course Perspective

A way of looking at life not as disconnected stages, but as an integrated continuum

Suggests that a complex interplay of biological, behavioral, psychological, and social protective and risk factors contributes to health outcomes across the span of a person’s lifeMichael C. Lu, MD, MPH, 2011

Life Course Model (Lu, Life Course Model (Lu, 2003)2003)

Protective factors

Risk factors

What is “GOOD” What is “GOOD” Health?Health?

Health is a state of complete physical, mental, and

social well-being and not merely the absence ofdisease or infirmity.

World Health Organization (WHO)

What is “GOOD” What is “GOOD” Health?Health?

Health is a state of well-being with physical, emotional,

mental, and spiritual dimensions that serves as anessential foundation for human life with implications

forhow all other aspects of life are pursued and evolve.

It is also an essential resource to be valued byindividuals, families, communities, and our larger

globalcommunity. Health may vary in how it is defined,qualified, and pursued within diverse communities

andfor individuals.

Barbara C. Wallace, PhD (Toward Equity in Health, 2008)

“All members of a community are affected by the poor health status

of its least healthy members. Infectious diseases, for example,

know no social/ethnic or socioeconomic boundaries.”

“Unequal Treatment”, 2003

Health DisparitiesHealth Disparities

Health disparities refer to differences in healthoutcomes (death, illness, injury, and birth-relatedoutcomes).

“A difference in rates of illness, disease, or conditions among different populations.”Turning Point: Collaborating for a New Century in Public Health. The University of Washington School of Public Health and Community Medicine/Robert Wood Johnson Foundation/National Association of County and City Health Officials.

Health InequitiesHealth Inequities

“Health inequities refer to material, social, gender, racial, incomes, and other social and economic inequalities that are beyond the control of individuals and are therefore considered unfair and unjust.”Health Canada, Population & Public Health Branch

“Health inequities are differences in health status and mortality rates across population groups that are systemic, avoidable, unfair and unjust…” and arise from racial and class based inequities.Adapted from Margaret Whitehead and Unnatural Causes

Health EquityHealth Equity

Health equity means fairness and justice in efforts

to achieve the best possible health for everyone,

especially for those groups who have systematically faced greater obstacles to being

healthy through social disadvantage, discrimination, or marginalization.

Social Determinants of Social Determinants of HealthHealth

The social determinants of health are the conditions in which people are born, grow, live, work, and age, including their experience in and access to the health care system.

Circumstances are shaped by the distribution of money, power, and resources at global, national, and local levels, which are themselves influenced by policy choices.


Social Determinants of Social Determinants of Health:Health:

ExamplesExamplesSocio-economic statusStressEarly LifeSocial ExclusionWorkUnemploymentSocial SupportAddictionFood Transportation


LEV Approaches & LEV Approaches & PracticesPractices

Gender-specific treatment

Trauma-informed care

Motivational interviewing

Family-centered approach

Strength-based

Cultural humility

Eco map




A Typical LEV DayA Typical LEV Day

In West County Detention Facility (WCDF)

In the Community

In the Courts, Probation, and Parole

During a Home Visit

In the Hospital

In the FMCH Office




Who Are the Women Served Who Are the Women Served by LEV? by LEV?

Black/African American (44%) Average Age (23-29) Education (8-9th grade) Unstable intimate partners - FOB Partner abuse/domestic violence Sexual Abuse Alcohol, Tobacco and Other Drugs Use (2/3) Unintended pregnancy Pre-term labor Pre-existing medical conditions Unstable housing

Who Are the Women Served Who Are the Women Served by LEV?by LEV?

History of previous

incarceration

History of CPS/CFS

involvement

Poverty

Isolation

Mental Health Depression & Anxiety Disorders Bi-polar Disorder PTSD Trauma Personality Disorders

Behaviors Observed of the Behaviors Observed of the Women Served by LEV in Women Served by LEV in

WCDFWCDF Entitlement and privilege Aggression toward staff Excessive calls to triage “Getting even” with staff by refusing to take

prescribed medication Misplaced Anger Pressured and hurried attitude Lack of social skills “Child-like” behaviors Attention seeking behaviors Depression Excessive crying

LEV & Clients Work Together LEV & Clients Work Together in Developing an in Developing an

Individualized Care Plan Individualized Care Plan

Intake QuestionsWhere are the children?Who has custody of the children? Who are the main caregivers?Is there an open CFS case? Is there domestic violence?What is your plan for the baby?Previous or current AODS history?Are you on parole or probation?

LEV DVD Part 1 LEV DVD Part 1

Provider Challenges in Provider Challenges in Working with Working with

Incarcerated WomenIncarcerated WomenCompassion Fatigue

Vicarious Traumatization

Dealing with Women’s Anger

Lack of Understanding of Trauma and impact on the women

Lack of Provider Training

Medical Records Come after women have left WCDF

Provider Provider RecommendationsRecommendations

Redirect behaviors

Don’t personalize

Talk about the baby

Let the client lead (not too pushy or aggressive)

Empathetic Listening

All female inmates are not alike

Assume Good Will

Talk about healthy life-style changes

Lessons Learned Lessons Learned

Community partnership expansion and development

Jail health care a ‘window of opportunity’

Women shut down when feel being judged

Women are a ‘specialized’ population

What Can We Do To Make What Can We Do To Make Sure the Women Have Sure the Women Have

Healthy Babies?Healthy Babies?

Prenatal CarePrenatal Care

Prenatal care alone is not enough to improve birth outcomes.

In order to improve birth outcomes, interventions must address health equity and the social determinants of health.

Social determinants of health means that where women live, learn, work, and play contribute to their overall health status.

Contra Costa FIMR Program, 2010

Recommendations for Recommendations for Improving Preconception Improving Preconception

HealthHealth

1. Prevention Preventive visits: As a part of primary care

visits, provide risk assessment and counseling to all women of childbearing age to reduce risks related to the outcomes of pregnancy.

2. Interventions Interventions for identified risks: Increase

the proportion of women who receive interventions as follow up to preconception risk screening, focusing on high priority interventions.

Recommendations for Recommendations for Improving Preconception Improving Preconception

HealthHealth

1. Interconception Interconception care: Use the interconception

period to provide intensive interventions to women who have had a prior pregnancy ending in adverse outcome (e.g., infant death, low birthweight or preterm birth).

2. Pre-pregnancy Pre-pregnancy check ups: Offer, as a

component of maternity care, one pre-pregnancy visit for couples planning pregnancy.

Chronic Disease Chronic Disease Management Management

Examples (not limited to):

Diabetes

Hypertension

Obesity

Asthma

Folic Acid for Folic Acid for Men & WomenMen & Women

Men: A study published in Human Reproduction (2008) showed that men who take folic acid lower their risk of having abnormal sperm by 20-30 percent. So men eat foods high in folate, such as fruits & vegetables to help lower the chances of birth defects.

Current recommendation for women: Take folic acid before pregnancy to lower the chance of Neural Tube Defects.

Men & Women: Consume at least 400 micrograms of folic acid daily, in addition to foods high in folate.

Men & Women: Be physically active for at least 30 minutes a day.

Oral HealthOral Health

See a dentist and get teeth cleaned before/during pregnancy.

Pregnancy: dental care can improve the health of the baby.

All pregnant women have dental insurance through Medi-Cal. This includes 60 days postpartum.

Source: FMCH Children’s Oral Health Program brochure May 2011

Birth SpacingBirth Spacing

Just us for 2 years

Contraceptive Effectiveness Contraceptive Effectiveness and Continuation Ratesand Continuation Rates

Source: Hatcher, RA et al; Contraceptive Technology 19th Edition, 2007

Perfect Perfect UseUse

Typical Typical UseUse

Continuation Continuation raterate

Implant (Implanon)Implant (Implanon) 0.050.05 0.050.05 84%84%

Male sterilizationMale sterilization 0.100.10 0.150.15 100%100%

IUCIUCLNG-IUS (Mirena)LNG-IUS (Mirena)Cu-T 380 (ParaGard)Cu-T 380 (ParaGard)

0.20.20.60.6

0.20.20.80.8

80%80%78%78%

Female sterilizationFemale sterilization 0.50.5 0.50.5 100%100%

DMPADMPA 0.30.3 3.03.0 56%56%

OCs, Patch, RingOCs, Patch, Ring 0.30.3 8.08.0 68%68%

Perinatal Depression &Perinatal Depression &AnxietyAnxiety

Every Woman CaliforniaEvery Woman California

www.everywomancalifornia.org

Information about health considerations for women and their partners before they become pregnant for the first time or between pregnancies (preconception health).

Links to resources and tools for health care providers and public health professionals.

Information for women and men who want to learn what they can do to be healthier for themselves and for their families.

Discrimination and Discrimination and Disparities in HealthDisparities in Health

Perceptions of discrimination have been shown to account for some of

the racial differences in birth outcomes in U. S. data. (Mustillo et

al. 2004)

Institute of Medicine’s Institute of Medicine’s Report: Report: Unequal Unequal

Treatment, June 2002Treatment, June 2002

The report showed that patient outcomes were affected by the way

providers and the system treated them and that people of color were treated differently, so people’s lives were at

stake.

LEV DVD Part 2 LEV DVD Part 2

Jeannie Cummings, MALEV Program Coordinator

(925) [email protected]

Itika Greene, NP, MPHFMCH Public Health Nurse Consultant

Suzzette C. Johnson, MSW, MPALEV Program Manager

Thank you for your tireless & enthusiastic energy, skills, & focus.

See Them As Women, See Them As Mothers

QUESTIONS & ANSWERS

Documents

See Them As Women, See Them As Mothers. Lift Every Voice (LEV) Program Jeannie Cummings, MA Itika Greene, NP, MPH Suzzette C. Johnson, MSW, MPA Family,