infant death related to teen mothers

Krystenn FowlerTracy Gregory

Nanci KleinElizabeth McManus

Janice Pappas

Infant Death Related to Teen Mothers

pappasj

This slide and the one before essentially say the same thing. Should we combined and make the info on one slide?

krystenn fowler

I thought the same thing. Will combined the two!

pappasj

Hi Group, just checking out the doc and getting a little familiar with the way it works

Tracy Gregory

Hi Janice. :)

krystenn fowler

Hi Tracy it is Krystenn... Just starting to throw things together on here... The only person who I think has not been able to access this document is Beth. I sent her the link again today. I am hoping it works.

krystenn fowler

I am going to post this to the discussion board as well. I reviewed the sample one from a previous class. Kind of just going off their slide set up...

Tracy Gregory

Great! I like the color choice Krystenn.

kleinn5

Hi everyonePlease take a look and feel free to tweak the added info. I'm not very good with excel so please improve the graph if this is an area you are better at. I added a problem statement slide but don't want to assume it's what we will use. I just wanted to move forward with the project.

pappasj

I am really, really trying to figure out this google docs stuff....itsfrustrating because I know PowerPoint pretty well. I cant even figure outhow to add a slide on this!! Im not even sure this is going to the wholegroup so I am sending email too.And BTW, the slides up there look fabulous!! Great job to those that figureit out, I thank you.My question is this...Are we going to post our contributions on thediscussion board first and then have the group comment or are we justpopping any and all info we each deem appropriate onto a slide? The laterseems inefficient, because we are placing items onto a slide beforediscussing it or tweaking it.I think we need to decide what our process as a group will be for addingeach members research or information. My personal thought is that we shouldpost information to the discussion board in threads, as a first step toadding information - this way the group can proceed to discuss whether thatinfo is pertinent, revise, edit and then approve for inclusion in thepresentation. This would also help with Beth's computer access issues andmy (old lady) issues in navigating google docs.I'm wondering if we should assign individual objectives/topics in our goalsto each member and then come together to pull them all together? Irecognize that we are supposed to be doing "all" of this together as agroup but I do not understand, nor do I appreciate the inefficiency in allof us researching the same aspects of this project. I thought posting theinfo on our primary analysis yielded a fairly good discussion and a nearcomplete problem statement. We can bring a topic of discussion to the groupvia the boards, each can provide ongoing analysis to the topic as theresearch is presented and then we can bring this all together.Can we discuss how to come up with some subjects for each of us to bringback to our discussion table? For example, I would like to add or clarifysome of the data that is already on one of the google docs slides but

krystenn fowler

Hi Janice. To use the google docs all of the tools to click on are directly under the title of the powerpoint : NURS 340 GROUP PROJECT. To add a new slide click on insert: second from the bottom is new slide. It is also under Slide-this is where you can add a slide move a slide change the background and the theme of the slide. The insert tool is where you go to add a text box and the format tool is where you go to change the font and things like that. I hope this helps a little! I have also posted some information on our discussion board. ThanksKrystenn

pappasj

Thanks Krystnn! I just watched a tutorial on using google docs so I think I can now navigate it a little better. I appreciate your willingness to help, I didn't want to fall behind the group so I figured I'd do the tutorials. Seems pretty straight forward. Thanks again, I gotta get into bed - work early in the am.JaniceSent from my iPhone

pappasj

The slide order seems out of sequence and not flowing well. I think the Kent County data should be presented before the problem statement. Followed by the proposed interventions

Teen Pregnancy & Infant Death Rates in the United States

Each year approximately 1 million adolescent females become pregnant, accounting for 13% of all births annually. (Harkness and

DeMarco, 2012)

In 2011 alone a total of 329,797 babies were born to women aged 15–19 years. (CDC, 2011)

This is a record low for U.S. teens in this age group, and a drop of 8% from 2010. (CDC, 2011)

Infant mortality 6.1 deaths per 1000 live births

Michigan Public Health Institute. (2012). Kent County 2012 community health improvement plan. Retrieved from http://www.kentcountychna.org/pdfs/KentCoCHNA_Final.pdf

Teen Pregnancy & Infant Death Rates in Michigan

Teen pregnancy rate 53.6/1000

Infant mortality rate 7.1 infant deaths per 1000 live births


Teen Pregnancy & Infant Death Rates in Kent County

Teen pregnancy rate is 61.5/1000

Rates in Kent County are higher than stateand national averages


Overview “Improving the well-being of mothers, infants and

children is an important public health goal for the United States. Their well-being determines the

health of the next generation and can help predict future public health challenges for families, communities, and the health-care system”

(Healthy People 2020, 2012, para. 1).

Maternal and Infant Health Program (MIHP): The Maternal and Infant Health Program is a program for all Michigan women with Medicaid health insurance who are pregnant and all infants with Medicaid.

MIHP Services Include:

Current Pregnancy Programs that Promote Prenatal Care in Kent

County

Maternal infant health and

psychosocial assessment.

Beneficiary care plans.

Home or office visits.

Transportation services.

Referrals made to local community

services

Referral to local childbirth

education or parenting classes.

pappasj

Yes!

Tracy Gregory

I like the look of this slide.

krystenn fowler

Thank you!

Healthy Women’s Resource GuideThis guide has been created in an effort to improve infant health in Kent County. This

guide includes information for women who:

Current Pregnancy Programs that Promote Prenatal Care in Kent

County

Are Pregnant

Might Be Pregnant

Trying to get pregnant Had a Baby

Link to the Healthy Women’s Resource Guide: http://www.accesskent.com/Health/Publications/pdfs/Healthy_Womens_Resource_Guide.pdf

http://www.accesskent.com/Health/Publications/pdfs/Healthy_Womens_Resource_Guide.pdf

Risk of infant mortality among infants born to adolescent mothers of Kent County,

Michigan related to lack of entry into first trimester

prenatal care.

Kent CountyCommunity Problem Statement

pappasj

Have we decided on this as our problem statement? I thought we were using the simpler version and using the others as a basis for our interventions?

kleinn5

Hi Janice,Sorry I hadn't been in to fix this. What do you think? For our demonstrated we could use the data on the next slide

pappasj

Good idea Nanci.

Kent CountyPrenatal Care in First Trimester

Benefits to Early Prenatal Care

Provide Necessary Education

Counsel on risky behaviors Information about physiological changes

Accurately determine gestational age Poor nutrition associated with preterm delivery

Reduces infant mortality rate Identify conditions associated with maternal and perinatal morbidity and mortality

Kirkham, C., Harris, S., & Grzybowski, S. (2005, April 1). Evidence-based prenatal care: part I. Generic prenatal care and counseling issues. American Family Physicians, 71(7), 1307-1316.

Improved Birth Rate

Decreased Preterm Labor

pappasj

Are these supposed to be upside down? You'd think I put them on here, LOL!

kleinn5

This would be the reason I pleaded for help :) All I did was paste them here from a slide I created on my computers excell power point. I can't figure out how to fix it. Told you I wasn't computer savvy!

krystenn fowler

There you go! :)

Healthy People 2020

Pregnancy Health and Behaviors

Increase the proportion of females delivering a live birth receiving prenatal care beginning in the first trimester from

70.8% to 77.9%. • MICH-10.1 Increase the proportion of pregnant women who

receive prenatal care beginning in first trimester

• MICH-10.2 Increase the proportion of pregnant women who receive early and adequate prenatal care

• Unaware of pregnancy until past 1st trimester• Hiding pregnancy - fear of disclosing pregnancy• Lack of knowledge of importance of prenatal care - belief

prenatal care is unnecessary• Fear of medical procedures• Lack of support - lack of a trusted adult figure• Availability of reproductive health care• Finances/money/insurance• Transportation issues• Clinic hours, long waits• Perceived discrimination - attitude of care providers r/t teen

pregnancy

Barriers to Care

pappasj

Rough list of some of the items we had in the discussion. Still need to refine this and reference it.

•Peer review studies reiterate early and regular prenatal care is a strategy to improve outcomes

•Pregnant women should be counseled early to identify and educate against high risk behaviors

•Allows for early and ongoing monitoring of maternal health

•Reduces the risk of adverse outcomes for mother and baby

•Early assessment identifies potential complications and allows treatment of underlying health issues

•Caregiver continuity is associated with reduced interventions during labor

Prenatal CareBest Practice

U.S. Department of Health and Human Services Health Resources and Service Administration. (n.d.). Prenatal-first trimester care access. Retrieved from http://www.hrsa.gov/quality/toolbox/508pdfs/prenatalmoduleaccess.pdfKirkham, C., Harris, S., & Grzybowski, S. (2005, April 1). Evidence-based prenatal care: part I. Generic prenatal care and counseling issues. American Family Physicians, 71(7), 1307-1316.

http://www.hrsa.gov/quality/toolbox/508pdfs/prenatalmoduleaccess.pdf

http://www.hrsa.gov/quality/toolbox/508pdfs/prenatalmoduleaccess.pdf

● Focuses on both population-level and individual-level determinants of health and interventions

● Considers issues that are community-based and not just individually focused

● Health is determined by influences at multiple levels (e.g., public policy, community, institutional, interpersonal, and intrapersonal factors

● Recognizes that examining the ecological niche - the family, the community, the political and social environments—in which the person lives is essential in helping to understand and prevent health problems

The Ecological Model (Harknss & DeMrco, 2012)

Harkness, G. A., & DeMarco, R. F. (2012). Community and public health nursing. Philadelphia, Pa: Wolters Kluwer Health- Lippincott Williams & Wilkins.

pappasj

Still tweaking this definition - work in progress

Ecological Model Adolescent Prenatal Care

Health care system. Education systems. Policy makers.

MicrosystemRelationships, Family, Peers

ExosystemFormal and Informal Social

Structures

MacrosystemAttitudes and ideologies of the culture

The direct environment, the setting in which we have direct social interactions with people in our lives.

The personal set of values and beliefs that shape and influence how events are interpreted

Female, adolescent, pregnantIndividualSex, Age, Health

The connections/interactions of family structure, family function, family adaptation, and school

MesosystemThe connection between the structures

of the microsystem

http://explorable.com/ecological-systems-theory#ixzz2jVJ3I0LP

pappasj

Not done yet, just starting a framework for the model discussion.

Ecological ModelThe Ecological Model applied to adolescent health is a product of the factors that are

occurring and interacting at individual, interpersonal, community and societal levels (Sword, 1999).

Individual Level ● biological and personal history factors; developmental stage

Interpersonal Level ● relationships with family, friends, and peers

Community Level ● where teens live, attend school, and work

Societal Level • social, economic, political and cultural systems

These relationships are multi-directional meaning each level is influencing the other levels at any given time.

Considering social determinants of health and the influences of where teens live, learn, work, and play will help to better understand the factors and underlying causes of why teens are not initiating early prenatal within the context of each community

(JSI, 2012).

pappasj

I am going crazy trying to get my stuff into this format. The reference is the notes section. Can on of you techy girls add it please.

pappasj

Feel free to do ANYTHING at all to fix ANY of my slides PLEASE!

WHEN

WHAT

WHO

HOW

WHY

WHERE

Pregnant Adolescent Students

Receive all routine prenatal care

After school clinic hours

School based health clinic

To ensure pregnant adolescents receive proper prenatal care and resources

Clinic nurse staff member will be assigned as OB case manager for each pregnant student

Kent County Goals/Objectives to Reduce Disparities in

Adequacy of Prenatal Care


● Ensure all women receive prenatal care in the first trimester

● Ensure pregnant women have referral and navigation support to get their first prenatal appointment right away

● Ensure all women receive an adequate number of prenatal care visits

● Educate community on the availability of prenatal care resources, insurance eligibility, and other support services

● Reduce disparities in the provision of prenatal care.

● Identify funding for a coordinated “early and often” prenatal care message and a social marketing campaign

● Promote planning for pregnancy and recognizing pregnancy early

● Ensure providers screen pregnant women for social determinants of health and provide referrals to appropriate resources and services

Description

Primary Intervention: Onsite Prenatal Care

Students can receive all routine prenatal care one designated Kent County school based health clinic. Students who need

additional services can receive assistance in coordinating and scheduling appointments and transportation.

S4. Strengthen and expand comprehensive school-based health

services, including primary care services where appropriate (i.e. school nurses,

school-based health centers).

S12. Expand the models of prenatal care that are available within Kent County, such

as Midwifery care and Centering

Kent County 2012 Objectives Addressed

Interventions Addressing Prenatal Care Best Practices by Increasing Prenatal Care Access in the First Trimester

Existing school based onsite health clinics will extend existing reproductive health care services to provide an obstetrics care coordination program that will provide comprehensive and culturally sensitive prenatal care,

education, support, and community resource referrals to pregnant students.

Goal S1. Promote planning for pregnancy and recognizing pregnancy early.

Goal S3. Ensure pregnant women have referral and navigation support to get their first prenatal appointment right away.

Goal S5. Educate community on availability of prenatal care resources, insurance eligibility, and other support services.

S8. Ensure pregnant women are screened for social determinants of health and provide referrals to appropriate resources and services.

pappasj

I will add the rest of the info later this week. I have some of the details on getting prenatal care visits coordinated a the school but I'm out of time. I have another paper due for another class. Are there other interventions you all are working on that can be coordinated through this school program as well? For example, the current push to expand the maternal home nurse visits...those can be initiated by the school nurse coordinator? Could we include the option of the initial visits right at the school to decrease absenteeism and avoid the fear of disclosure of the pregnancy to the family? This way could encourage the visit in the early part of the pregnancy?

krystenn fowler

I like the idea of having the initial visits right at the school! Nice job Janice!

Tracy Gregory

Yes, Janice this is a great intervention!

How It Works - OB Case ManagerUpon diagnosis or confirmation of pregnancy, a clinic nurse staff member

will be assigned as OB Case Manager for that student.

The OB Case Manager will:

● Meet with each student individually once or twice a month throughout the pregnancy to assess needs, coordinate services, and provide one -on-one education on a variety of topics related to pregnancy.

● Provide support and guidance for teens experiencing difficulty communicating with family members about the pregnancy.

● Ensure students questions are asked, answered, and understood.● Connect and refer to appropriate established resources within the

community, including MIHP a WIC, .● Coordinate visits and consults at the school whenever possible. ● Introduce and help transition the student into the existing school Teen

Parenting Program.

pappasj

Do you think I need a slide about how we need to get the local care providers/midwifes to come in to provide the care locally? I think that would take a lot of space about stakeholder?

Evaluation Participants enrolled in the program will be categorized using the Kotelchuck

Index to assess adequacy of prenatal care.

This index incorporates how early women enter prenatal care and the number of prenatal care visits they receive. The index categorizes adequacy of prenatal

care as follows:

• Adequate Plus Prenatal Care - Prenatal care begun by the 4th month and 110% or more of recommended prenatal visits were received

• Adequate Prenatal Care - Prenatal care begun by the 4th month and 80% to 109% of recommended prenatal visits were received

• Intermediate Prenatal Care - Prenatal care begun by the 4th month and 50% to 79% of recommended prenatal visits were received

• Inadequate Prenatal Care - Prenatal care begun after the 4th month or less than 50% of recommended prenatal visits were received

Eval (CONT)OB Case Managers will provide a synopsis on utilization of program

resources from their cases. This report will include assessment of currently identified social determinants, barriers, and coordination of care efforts,

challenges and successes.

Frequency of evaluation.Data will be obtained/compiled from the School-Based Health Clinics

during the school year at the following points:

● at students entrance the program● monthly during the pregnancy through OB Case Manage synopsis

reports● at the time of delivery

Harkness, G.A. & DeMarco, R.F. (2012). Community and Public Health Nursing Practice: Evidence for Practice. Wolters Kluwer/Lippincott, Williams & Wilkins: Philadelphia

Healthy Women’s Resource Guide (2008). What You Need to Know Before, During, and After Pregnancy. Retrieved from: http://www.accesskent.com/Health/Publications/pdfs/Healthy_Womens_Resource_Guide.pd

MDCH. Department of Community Health (2013). Maternal Infant Health Program (MIHP). Retrieved from http://www.michigan.gov/mdch/0,4612,7-132-2943_4672-106183--,00.html

Michigan Public Health Institute. (2012). Kent County 2012 Community Health Improvement Plan. Retrieved from http://www.kentcountychna.org/pdfs/KentCoCHNA_Final.pdf

Kirkham, C., Harris, S., & Grzybowski, S. (2005, April 1). Evidence-based prenatal care: part I. Generic prenatal care and counseling issues. American Family Physicians, 71(7), 1307-1316.

References

http://www.accesskent.com/Health/Publications/pdfs/Healthy_Womens_Resource_Guide.pdf

http://www.michigan.gov/mdch/0,4612,7-132-2943_4672-106183--,00.html

http://www.kentcountychna.org/pdfs/KentCoCHNA_Final.pdf

Tracy Gregory

Hi Ladies! The format looks great and what I have read so far looks amazing. There are a few blanks slides at the end. Do these need to be removed or are there interventions still to be added? Let me know when I can work on the narration? I think I can work on This Monday/Tuesday. I am working this weekend and writing a paper, but should have plenty of time Monday/Tuesday. I can email out a final copy to everyone once that is completed.

Tracy Gregory

Janice- Any more specific help on slides you wanted/needed? Let me know. :)

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infant death related to teen mothers

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