Enhancing Interconception Care for High Risk Women .


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Improving Interconception Care for High Risk Women. February 10, 2011 Low Country Healthy Start “Every Woman Southeast Initiative” Webinar. Virginia Berry White, LMSW vbwhite@lchealthystart.org. Interconception Care – Learning Community – MCHB, HRSA, Healthy Start Program.
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Enhancing Interconception Care for High Risk Women February 10, 2011 Low Country Healthy Start "Each Woman Southeast Initiative" Webinar Virginia Berry White, LMSW vbwhite@lchealthystart.org

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Interconception Care – Learning Community – MCHB, HRSA, Healthy Start Program Improve Health and Well-Being of Women Advance Quality & Effectiveness of Interconception Care Implementation of Evidenced-Based Practices Innovative Community-Driven Interventions Home Team and Traveling Team (Learning Sessions) Expert Work Group Abt Associates, Inc. furthermore, Johnson Group Consulting, Inc. 2

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Interconception Care – Learning Community – MCHB, HRSA, Healthy Start Program All Healthy Start Programs are required to take part CQI Process, utilizing Plan, Do, Study, Act standards Choices of Major Focus Area include: Family Planning & Reproductive Health Primary Care Services & Linkages Maternal Depression & Mental Health Healthy Weight Risk Screening Low Country Healthy Start (LCHS) picked Family Planning and Reproductive Health – emphatically connected with working with essential care suppliers 3

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Route to Get to: Strengthening associations and linkages among suppliers Taking prove based conventions and actualizing Improving staff preparing and conventions to enhance quality and consistency HS ICC-LC

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To get to changes and results is not a quick procedure; a lengthy, difficult experience to travel.

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About LCHS Part of the SC Office of Rural Health Service range is four provincial areas in the Low Country district of the state Allendale, Bamberg, Hampton and Orangeburg Six (6) destinations LCHS is staffed by experts arranged social laborers and lay home guests, called Client Navigators Home Visiting, Case Management, social work, effort and coordination program Target populace is African American ladies

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Description of Project Area Very poor, under-resourced regions Birthing Hospital in one and only of four regions High unemployment rates In 2008, there were 1,385 African American live births in the administration territory, 592 white births and 23 other In 2010, LCHS gave administrations to 1, 449 families - 380 pregnant ladies, 409 baby blues ladies and 660 babies LCHS program criteria, lady at hazard for poor pregnancy results and her infant Reduce the rate of Infant Mortality Eliminate differences in perinatal wellbeing

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Service Area IMR Data

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Barriers ( serving High Risk Women ) Lack of protection scope Women not knowing administrations that are accessible, i.e., Family Planning Waiver Access to care Woman\'s entrance to contraceptives of her decision Psychosocial and monetary issues Client maintenance amid the interconception (baby blues) period Coordination of care Shortage of suppliers

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Barriers ( serving High Risk Women ) Patient-Provider Communication/Relationship Time apportioned to guidance ladies amid office visits Inability for suppliers to pay for long haul techniques Few obstetric and pre-birth suppliers Women comprehension of what is required to build her odds of having a sound infant Women failure to secure access to chance fitting consideration Health of Women of Childbearing Age

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LCHS Interconception Care, Family Planning & Reproductive Health Increase the percent of expected pregnancies ▫Address Barriers ▫Partnership with Provider and LCHS program members Decrease unintended pregnancy ▫Family Planning Options/Link to FP Services ▫Pregnancy Spacing ▫Survey Family Planning Providers Decrease late pre-birth mind Decrease poor pregnancy results when ladies don\'t mean to be pregnant 12

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Model: Use of Multidisciplinary Teams (MDT) for Addressing Interconception Care for High Risk Women Partners Private obstetric practices Monthly Meetings Forge nearer association amongst LCHS and the perinatal suppliers Specific customer focused talks help in learning and educating, and also joint care arranging MDT gain from LCHS more about the customer\'s home circumstance and home/life push LCHS staff take in more about the clinical side of pre-birth, baby blues and interconception mind 13

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Successes/LCHS and Providers "Voice of the Providers" Certified Nurse Midwives including Obstetricians Tie LCHS work, Interconceptional Focus into Prematurity Prevention (starts before next pregnancy) Insight picked up into the necessities of ladies Centering Pregnancy – pre-birth & baby blues periods Home visits are critical, esp. to high hazard ladies with consequent pregnancies Find approaches to give family arranging administrations to poverty stricken customers Standing request through birthing clinic (ladies will leave the doctor\'s facility with a technique) 14

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Data System Client\'s Reproductive & Interconception Health start at pre-birth Risk Assessment Automated trigger updates – LCHS Data System Reminder about EDC & conveyance date, Family Planning alternative, Postpartum exam Automated alter reports – LCHS Data System - Specific data missing from customer\'s record - Examples: Did she leave doctor\'s facility after conveyance with a strategy? What is the baby blues visit date? Did she go? Conception prevention technique chose? Did she get? Following customer by technique chose and follow-up dates by kind of strategy. 15

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Implementing Changes - Steps LCHS staff were prepared on the significance of ladies comprehension anti-conception medication strategies, prepared on the viability and dangers of each and prepared to talk about techniques with ladies, helping them pick LCHS staff were prepared on program desires of when in the pre-birth period BC strategies will be examined, how to report, the desires for close development and documentation in the two years after conveyance Data accumulation instruments and logs were talked about, alongside obligation regarding finish Data are gathered, comes about dissected and imparted to the PPAG and Home Team.

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Success to Date LCHS built up a following log utilized by staff to gather and report information on every customer after she conveys. Enhancements have been archived in the quantity of ladies leaving the birthing healing center in the administration range with Depo Provera (or a changeless technique, for example, tubal ligation or hysterectomy). Results and advance are accounted for to accomplices, the Perinatal Provider Advisory Group, MDT individuals and LCHS Staff. The PPAG and MDT accomplices are counseled about the methodology, usage achievement and are as often as possible requested extra info.

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Success to Date Providers are currently straightforwardly talking about what must be done to help ladies access powerful durable contraceptives, especially the Mirena IUD. LCHS has met with the SC Primary Care Association, who then consented to shape a study gathering, to decide how the FQHCs can conquer saw hindrances to giving long acting, powerful conception prevention strategies for customers. LCHS has met with doctors and NP speaking to all FQHCs in the administration region to recognize issues and discover arrangements.

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Measuring Change # of accomplices (conveying suppliers) utilizing the convention to guarantee ladies are released from the healing facility, after conveyance, with a technique. LCHS will cooperate with 4; 1 for every district. # of essential care accomplices tolerating our referrals and helping customers to choose and utilize a successful preventative strategy. Arranged number is 8; 2 for each area. Helping customers with selecting and utilizing a powerful prophylactic strategy is characterized as LCHS or the customer securing an arrangement inside 2 weeks of arrangement demand. Installment for care is not a boundary which implies the customer has Medicaid, other protection or potentially the supplier has consented to acknowledge LCHS referrals for nothing, or minimal effort or utilizations a sliding expense scale . # of LCHS baby blues customers utilizing a contraception strategy adequately at 3, 6, 9, 12, 18, 24 months. Target is 75%.

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Where do we plan to go from here? Enhance information accumulation and information quality. Make information gathering more consistent, clear up what is required and why. Make information fit with information staff as of now report. Keep on working with the FQHCs and guarantee they work with ladies, endorse the technique ladies need and after that give the strategy. Work with Title V to figure out what should be possible to enhance access to Title X required administrations given the area wellbeing office staffing issues. Propose Title X sub-contract to different suppliers for administrations they can\'t give enough, suitably or convenient. Keep on working with the birthing doctor\'s facility and obstetric suppliers to keep the attention on interconception mind. Work with different healing centers, outside the administration region, to utilize the convention. Proceed to discover (and actualize) considerably more viable approaches to help ladies advocate for their own particular regenerative wellbeing yearnings, prerequisites and requirements.

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Low Country Healthy Start Post Office Box 2889 Orangeburg, SC 29116 803-531-8008 803-531-8007 – Fax Virginia Berry White, LMSW vbwhite@lchealthystart.org

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