Nadine Peacock, PhD, Stephanie Townsell, Andrea McGlynn, L.Michele - - PowerPoint PPT Presentation

Arden Handler, DrPH, Kristin Rankin, PhD, Nadine Peacock, PhD, Stephanie Townsell, Andrea McGlynn, L.Michele Issel

 This study focused on barri

rier ers s to effective implementation of an Interco erconceptional nceptional Care e Pr Program gram (ICCP) P) implemented ented as part of the He Healthy thy Bi Births hs for He Healthy hy Communi uniti ties es in Chicago ago and a consideration of lessons learned with respect to overcoming these barriers

 Interconceptional Care Program (ICCP)

provided in 2 communities on Chicago’s West Side by two different health providers (Agenc gencies es A and B) B)

 Evaluation carried out by researchers at the

University of Illinois School of Public Health

 Longitudinal, multi-method approach

• Focu

cus s on success cess in achie ievi ving g ICCP CP program rogram

• bjectives as well as on women’s experiences in the

ICCP CP

• No comparison group

 Beginning in Dec. 2006, African-

American women with ad adve vers rse e pre regnancy gnancy outcom comes es (PTB, LBW, fetal loss) were invited to participate in ICCP by program staff at the two agencies

 Evaluation based on data collected

between Dec. 2006 and June 2010

 Servi

rvices ces delivered: vered: from database base designed for use by ICCP case-managers to document all services delivered to participants (n= 220)

 He

Health th Status, us, Goals, s, KAP: P: Pa Participant cipant questionnaire estionnaire completed face to face or via telephone (n=99; average week pp at time of the interview was 20 weeks)

• Questions based on established surveys (e.g.,

PRAMS, BRFSS)

 Key Inform

rman ant t Interviews rviews (n = 4) with ICCP staff at each site

 Focused on whether program objectives were met

and whether ICCP participants were able to establish self-management and reproductive goals as well as on their utilization of medical care, family planning, and the other social and health services provided

 For both services database and interview

information, simple frequencies were produced: ch chi-squa square e an and t-tests ests wer ere e used ed to co compare are ach chiev evement ement of object ctives ives and partici cipants pants at Agency cy A v versus us Agency cy B

 Key Inform

• rmant

nt intervi rview ews: key themes developed to highlight/extend/support quantitative findings

 ICCP focused on the integration of

soc

• cial

ial servic vices, es, fa family ily planning, nning, and nd medical cal care while fostering women’s empowerment

• ultimate aim: reducing future

adverse pregnancy outcomes

Figure 1: Healthy Births for Healthy Communities Interconceptional Care Program (ICCP) Program Guidelines SERVICE Where PROGRAM MONTH 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Case Finding C, Ho X Assessment C or H X X History & Physical Complete C X Reassessment C or H X Enrollment- HBHC ID in system C or H X Medical care home continuity – min. C X X X X X Specialty visits for chronic conditions C as needed → → → → → → Enrollment in medical insurance plan C X as needed → → → → → Patient /Care Team face-to-face mtg. C or H X X X X X X X X X X X X X X X X X X Care team case conf. w/ provider C X X X X X X X X X X X X X X X X X X Care team + provider conf. w/ patient C X X X Self mgmnt goals set & reassessed C or H X X X X X X X X X X X X X X X X X X Reproductive education delivered C or H X X Reproductive goals set C or H X X

• Repro. goals reviewed, as approp.

C or H X X X X X X X X X X X X X X X X X X Smoking cessation education C or H X X X Smoking cessation service as needed C or H X Substance abuse education C or H X X X and as needed → → → → Substance abuse service C or H X and as needed → → → → Substance abuse referral C as needed Depression screening completed C X X X X X Depression service as needed C X as needed → → → → Domestic violence screening C or H X X X Domestic violence counseling C as needed Friends & Family Network C or H A minimum of 3 sessions in first year Oral health service C as needed WIC enrollment C X

 ICCP participants were predominantly

young, poor, and had low educational attainment

 Very few were in the program for the

program target of 18 months (avg. length, 11.7 mos.)

 Most received the core intervention: a care

team in inclu ludi ding ng a ca case-ma manag nager er and medica ical l provid ider er

 Most interventions were delivered at

women’s homes

 Finding

ding: Even though participating women had experienced an adverse pregnancy

• utcome, a majo

jor focus s on medical al needs ds did not emerge because of women’s pressing social al and ec economic mic nee eeds ds

 Lesson:

sson: In future interconceptional care projects, women’s need to cope with crises in daily y livi ving g and SE SES S rel elated ed issues ues may take precedence over a series of planned interventions aimed at improving their health status

 Finding:

ding: Despite a high prevalence of a variety of acute and chronic health problems, the wo women consider dered ed themsel selve ves s healthy thy

 Les

esson: son: If preventive medical care is to be the anchor of interconception care, interconception care programs will need to focus on educating women about the importance rtance of seekin king g health th care eve ven if they y perceiv eive e themselves selves to be healthy thy

 Finding

ding: Despite participation in an interconceptional care program, many wo women repo ported rted use of less effecti tive ve birth th control l me metho hods ds and had notions ns of ef effec ective veness ness at va varian ance e wi with clinical knowl wledg edge

 Lesson:

sson: Po Postpartum partum contracep racepti tive ve use is a proce cess ss: it is necessary to me meet et wo wome men wh wher ere e they y are at and provide support to enable women to swi witch to more effective ive methods

• ds

as thei eir contracepti aceptive ve nee eeds ds change nge

 Finding:

ding: Although the ICCP program had

• bjectives related to ongoing contact

between the women and the case- management staff and a minimum um of 3 me medical cal vi visits during the first program year, it was difficult to reach these targets

 Lesson:

sson: It is important to recognize that low- income women with adverse pregnancy

• utcomes often have complicated lives and as

such, staff must remain n extremely mely flexibl ble e in ma maintaining taining the e clien ent-st staff aff connecti ection

• n

 Findi

ding: ng: The interaction of the case-management system with the medical system was not easily achieved; it was particula ularl rly y challenging ging to engage medical providers rs in preventi ntive ve care during ng the interconc

• ncept

eption ion period; ; many medical providers are used to meeting acute care needs

• r providing an annual checkup when women are

not pregnant

 Lesson:

n: Educati tion

• n of me

f medical providers rs in future interconceptional care programs will be essential; clear guidelines will be needed

 Lu et al. recommended that

interconception care include a multitude of interventions within the domains of cli linic ical al car are, , psy sycho hosocial social car are, , an and heal alth th pro romotio motion

• Healthy women should receive three

ee vi visi sits ts withi hin n the first rst six months ths, with additional visits for women with chronic conditions or prior preterm birth

 Despite reporting multiple health conditions,

women did not see medical care as a priority

 Likewise, even though the ICCP staff were

prepared to deliver a multitude of interventions based on women’s “health” needs, the delivery of these interventions was

• ften replaced by efforts to meet women’s

socioeconomic needs

 Finally, many medical providers did not

understand their role with respect to the delivery of interconception care

 These results suggest that:

• Organizations designing interconceptional care

programs should conduct needs s assessments ssments to more effectively target the women to be served

• Educati

cation

• n of both

h wome men n and me medical ical provi viders ders about the importance of medical care during the interconception period is essential

• Inter

ercon concepti ception n care e and d the AC ACA A associ ciated ated preven eventiv tive healt lth h vi visi sit t for women will not gain traction unless women are aware of its value and relevance to their lives

 No comparison group limited our ability to

compare ICCP participants to similar nonparticipants

 Interview information was based on self-report and

there was no access to medical records

 Interview data were not longitudinal; they were only

used to provide information about women’s experiences in the year after the adverse pregnancy

• utcome rather than to evaluate the effect of the

intervention

 Given data limitations, in effect, the majority of

lessons learned were based on the smaller group of women for whom we had both interview and services data

 Interconceptional care should not be

thought of so much as a pre rescriptio cription n but t ra rather r as as a c a complex plex pro roces cess s of f ma matching ching in inter ervention ventions s an and se serv rvices ices to meet women’s unique needs, including cluding their r socioecon ioeconomic

• mic needs

ds

 To access tools and instruments go to

http://healthybirths.wordpress.com