Can Preconception Health be Enhanced

through Existing Public Health

Programs? Dana Edelman, MPH, CHES  Peyton Mason-Marti, MPH  Vicki Lombardo, MSN, RN

March of Dimes, California Chapter

Preconception/ Interconception Health (PCH/ICH) in CA

• Every Woman, Every Time• Preconception Health Council of CA• March of Dimes PCH/ICH Funded

Projects• Interconception Care Project of CA• Demonstration Projects

CA Preconception Care Initiative Launched - 2001

Every Woman, Every Time provider & patient packet

•Developed through March of Dimes grant to Sutter Medical Center, Sacramento•Guidelines for integrating PCH into primary care, family planning and women’s health visits•Patient education handouts

1. CLINICAL GUIDELINES & TOOLS

2. CONSUMER INFORMATION

3. PUBLIC HEALTH PROGRAMS AND

STRATEGIES

4. MONITORING & SURVEILLANCE

5. RESEARCH AGENDA

6. PUBLIC POLICY AND FINANCE

7. PROFESSIONAL EDUCATION AND

TRAINING

8. BEST PRACTICES: Develop a

catalogue of promising practices;

Share promising practices; Maintain

Internet web portals; Convene a

national meeting in 2007

9. DEMONSTRATION PROJECTS

10. STATE & LOCAL INITIATIVES

CDC’s Preconception Call to Action-Strategies for Implementation

Preconception Health Council of California (PHCC)• March of Dimes California

Chapter• ACOG, District IX (CA)• California Department of

Public Health MCAH Division

Preconception Health Council of California (PHCC)•The mission of the PHCC is to

engage individuals, communities and policymakers to optimize the health and well-being of women and their partners, leading to healthier infants and families

Preconception Health Council of California• Support from CDC• Membership reflects state diversity

– Public Health programs– Health care providers and

hospital health care systems– Community-based

organizations – Government agencies

Key Accomplishments: Clinical/ Research• Hosted the Second National Summit on

Preconception Health and Health Care in Oakland in 2007 in collaboration with the CDC

• Participated in CDC Clinical Guidelines (Grey Journal)

• Produced lecture templates on preconception health care

• Supports the Interconception Care Project of CA

Key Accomplishments:Public Health/Consumer • Production of

EveryWomanCalifornia.org– Comprehensive preconception health

promotion website – Provides consumers with resources and

networking opportunities for health care professionals

Spanish Language Website

Interconception Care Project of California

• March of Dimes funded cooperative partnership with ACOG, District IX (CA)• Goal: develop interconception care

guidelines to maximize the postpartum visit & improve subsequent pregnancy outcomes

• Created 21 algorithms with screening, risk-reduction counseling, treatment & referral guidelines, along with patient handouts

• Plan to distribute state-wide by end of 2010

Demonstration Projects Background• In response to the 2006 CDC report

on preconception health recommendations and their call to action to invest in demonstration projects, the March of Dimes, CA Chapter released a request for preconception/interconception project proposals

Criteria for Selection

Multi-year project that addressed PC/IC health

Potential to be replicated across the state and nation

Enhance education and support services for women at high-risk of poor pregnancy outcomes

Agencies had to be able to design, implement and evaluate the project and reach the priority population and show measurable outcomes

Grantees

The California Family Health Council's Preconception Care Integration Project

PHFE-WIC’s (WIC Offers Wellness) Program

Sutter Medical Center Sacramento’s Teen Care Project

CA Family Health Council’s Preconception Care Integration

ProjectGoals were to:– assess current level of PC/IC care

integration in Title X family planning clinics in 3 counties

– develop training for clinical staff– assess knowledge and behavior

change resulting from training and care expansion

Activities

• 300 clinicians were trained to integrate PC/IC care into family planning visits

• 1,500 women received PC/IC care during family planning visits

Outcomes

• Integrating PC messages into practice was doable and took an additional 3-5 minutes

• Physicians requested additional training, culturally/linguistically appropriate educational materials and protocol samples

• Patients strongly agreed that the PC information they received was important and they were interested in making at least one health behavior change

PHFE-WIC’s WOW (WIC Offers Wellness)

ProgramGoals were to:• Improve the health status of

women who recently had a preterm and/or low birthweight baby

• Increase pregnancy spacing• Increase rates of planned/intended

pregnancies• Reduce the incidence of repeat

preterm/LBW babies

Activities

• The intervention included staff trainings, group preconception health activities, folic acid education and screenings assessing 6-week postpartum appointment status, nutrition, exercise, healthy weight and depression status

• Individual counseling, phone and peer support group meetings were provided for the intervention group.

Results Program showed a significant impact

on multivitamin/folic acid and birth control use

Of moms with a subsequent pregnancy during the project period, WOW moms had better birth outcomes*

*Data reflects a small number of births

ImpactSeveral of the materials and best practicesdeveloped through this project have beenadopted for future utilization including: Preconception health assessment forms Six-week postpartum checklistAdditionally, PHFE-WIC has incorporatedpreconception staff training, client

screeningand education into all of their sites

Sutter Medical Center Sacramento’s Teen Care

ProjectThis project delivered case managementservices to 650 pregnant and parenting teens in Sacramento CountyThe goals of the project were to:• Decrease adverse birth outcomes • Positively impact health behaviors

Activities

The intervention included:• Interconception risk assessment

(web based)• Home visitation• Health education events• Life Plan (Individual Reproductive

Life Plan)

Outcomes

Health Risk Assessment data revealed that teens

were concerned about:• Nutrition and weight• Exercise• Birth control• Chronic conditions such as asthma• Inherited risk of chronic conditions

Outcomes• Over 300 Life Plans were distributed• Life Plans could be used as road maps for

the teen and her case manager• Participants felt that the Life Plan helped

them to think about a healthy future• Online assessments engaged teens and

offered more in-depth information to providers

• There was an increase in birth control use among clients who completed a Life Plan

Demonstration Project Outcomes

• The March of Dimes’ Demonstration Project Review Committee conducted site visits, reviewed reports and made recommendations

• The PHCC monitored activities, outcomes and lessons learned and have been disseminating best practices throughout their networks

• Program resources, tools and findings have been featured on: www.EveryWomanCalifornia.org

Promising Outcomes• Projects were successful in showing measurable

outcomes and reaching the target population• PC/IC health activities can be integrated into

programs• Concepts and activities can be replicated• Projects have produced and/or tested valuable

tools that can be utilized in screenings, case management and programs

• Information has shed light on factors that affect reproductive health behavior

In ConclusionPreconception health can creatively be integrated into existing programs and when supported by adequate workforce preparation and tools can show measurable results for both patients and clinicians

Questions?

Thank You !