2003 Model Practice Application (Public)

BRIDGE

Elyria City Health Department

BRIDGE (Birthing Readiness: Individualized Development and Growth through Education) offers a home-based visitation program utilizing a prenatal care experienced public health nurse to provide individualized education in a family-centered model. The program is designed for pregnant teens, and focuses on "bridging the gap" between education typically offered in the clinic setting and childbirth preparation classes. The program follows a specific curriculum individualized to meet the client’s own self-defined needs, and is implemented through a series of three home visits, scheduled during the second and third trimesters of pregnancy. This approach allows the client to seek information at her own pace and comprehension level, thereby increasing her sense of autonomy and encouraging her active participation. Clients are encouraged to include the identified supportive persons (usually the father of the baby, sometimes parents) as desired. In 24 months, 138 teen women received 311 BRIDGE visits.

The primary need to be addressed is the knowledge deficit among expectant teen parents. As they experience their first pregnancy, teen mothers often lack the education, life experiences and support systems necessary to complete the pregnancy in a positive way especially given the circumstances of their lives such as a lack of consistent support, ignorance of the pregnancy and birthing process, and vague ideas about parenting.

The program is innovative in that it takes the education to the teen's home, develops a relationship between the teen and the PHN, and provides a link between clinic care and the teen’s individual reality.

The Elyria City Health Department proposed this program, developed the curriculum and sought initial funding for its implementation. The March of Dimes of Ohio funded the program for two years, providing not only financial support but also the recognition of the program as being of value.

The PHN worked with the GRADS instructors within the public schools to assist the teen clients to continue their educational activities while pregnant and parenting. The PHN initiated contact with the teachers, developing a positive relationship with community organization.

The program was funded by the March of Dimes for $10,000 annually for two years. The PHN was a part-time employee of the ECHD who added additional hours to be able to accommodate the program. The cost of a visit was $68. The ECHD did not charge the project any overhead. Costs included the PHN salary, benefits and mileage. The clients were given a $10 gift certificate at the completion of the third visit in an effort to encourage ongoing participation.

At this point, the project has been incorporated into the MCH prenatal clinic project. They are struggling to continue to provide the visits to the teens. It is anticipated that the MCH Child and Family Services grant through the Ohio Department of Health will allow this continuation. Funding will always be a problem especially since there is so little available for public health nursing visits. However, the Board of Health is supportive and encourages creative planning to be able to continue the program.

Statistics after two years of implementation substantiate the hypothesis that as the client’s knowledge base increased, she is empowered to act as her own advocate on behalf of herself and her infant, measurable outcomes such as birth outcomes and willingness to participate in self-care would increase. BRIDGE clients demonstrated 88.6% rate of kept clinic appointments as compared to 67% rate among the total clinic population. 4.7% of BRIDGE clients delivered babies weighing less than 2500 grams or less than 37 weeks gestation as compared to 13% of the general clinic population. These two outcomes demonstrate impact on this at-risk population. Post-program evaluations by participants include "The BRIDGE nurse … was very helpful … could relate to me … was easy to talk to … gave good/clear explanations … explained what really happens during labor … taught me things I didn’t know … talked about my concerns and fears … came when I was available … answered questions in detail … I felt I could ask her ANYTHING!" Comments from the labor and delivery staff noted that the teens were better prepared for delivery.

It is very important to assign this project to the right person. The PHN was excited about the project, was very knowledgeable about pregnancy, had home visiting experience with other agency programs, and was willing to be very flexible with her schedule (i.e. after hours, Saturdays, appointments at school).

Funding is always a challenge, but the program will continue to seek third party reimbursement for this program, and would encourage others to do the same. The investment/success ratio has been positive and should make financial sense to providers.

A key element of the program is staff who are both innovative and creative in addressing issues and who are willing to try something new. As previously mentioned, a staff member who is excited about the possibilities of such an approach to teen pregnancies is essential. The program needs the ability to absorb the indirect costs as well as the Board and Administration’s commitment to assure continuation.