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2013 Model Practices (Public)Application Name: 2013 Model Practices (Public) : Kent County Health Department : Kent County Interconception Care Program Applicant Name: Jim Smedes Application Title: Kent County Interconception Care Program Please enter email addresses you would like your confirmation to be sent to. Practice Title Kent County Interconception Care Program Submitting LHD/Agency/Organization Kent County Health Department Head of LHD/Agency/Organization Cathy Raevsky Street Address 700 Fuller Ave NE Practice Contact Person Bill Anstey Title Deputy Administrative Health Officer Bill.Anstey@kentcountymi.gov Submitting LHD/Agency/Organization Web Address (if applicable) www.accesskent.com/Health/HealthDepartment Provide a brief summary of the practice in this section. This overview will be used to introduce the model or promising practice in the Model Practices Database. Although this section is not judged, the judges use it to get an overall idea about your practice. You must include answers to the following questions in your response:
• Size of population in your health department’s jurisdiction
• Who is your target population/audience, what is the size of your intended population/audience for this practice and what percent of your target population did you reach?
•Provide the demographics of your target population (i.e. age, gender, race/ethnicity, socio-economic status)
• Describe the nature and gravity of the public health issue addressed
• List the goal’s and objective(s) of the practice and clearly link them to the problem or issue the practice is addressing.
• Describe the potential public health impact of the practice, and the likely effectiveness of the practice being implemented as intended, and the ease of adoption of the practice by other LHDs.
In your description, also address the following
• When (month and year) the practice was implemented.
• Briefly describe how the practice was implemented, what were major activities, and any start-up and in-kind costs and funding services.
• Outcomes of practice (list process milestones and intended/actual outcomes and impacts.
• Were all of the objectives met?
• What specific factors led to the success of this practice? The Kent County Health Department (KCHD), established in 1931, provides services to a population of 603,219 (2010). The Kent County Interconception Care (IC) Program was implemented in 2005 in response to the high rate of African American infant mortality and adverse pregnancy outcomes. The focus of the IC program is to provide enhanced case management services for high-risk women during the interconception period to ensure their optimal preconception health. IC services are provided by community health nurses and other health professionals that provide home visits, client program incentives, as well as referrals for dental care, wellness support and family planning services. The program targets, but is not limited to, African American women served through the area’s Maternal Infant Health Program (MIHP) and Strong Beginnings, a Federal Healthy Start program. IC funding has been targeted to reach a minimum of 25 high-risk African Americans annually. The program has exceeded its targeted caseload, and since inception has enrolled more than 200 women.
The program reports client demographics for race/ethnicity—58% African American, 26% White, 13% Hispanic; marital status—80% unmarried, 20% married; education—74% high school or less, 26% with education beyond high school, and; age—22% less than 20 years, 56% 20-29, and 22% are 30 years or older.
The IC Program began in the spring of 2005, when KCHD received a start-up grant of $130,000 from the Michigan Department of Community Health (MDCH). The grant funded the development of an infant mortality coalition, a community action plan to reduce infant mortality, particularly for African Americans, and implementation of evidence-based interconception services. Kent County was one of 11 Michigan counties who received funding based on high disparities between African American and White infant survival. The Kent County IC Program is modeled after two demonstration projects: 1) The Interconception Health Promotion Initiative in Denver, and 2) The Interpregnancy Care Program at Grady Memorial Hospital in Atlanta.
The African American infant mortality rate in Kent County from 2008-2010, the most recent period for which data is available, was 13.8 deaths per 1,000 live births. This was more than three times the infant mortality rate among White infants for this period (5.0/1,000). The area’s disparity between African Americans and Whites in the rate of low and very-low/extremely-low weight births is also stark. In 2010, the most recent year for which data is available, 10.5% of Kent County African American infants were low-weight births compared to 5.4% of White births and 5.3% of Hispanic births. African American infants were also nearly four times as likely to be born very-low or extremely-low weight compared to White and Hispanic infants.
To address this disparity, the IC Program has set the following broad goals:
• Reduced minority infant mortality
• Fewer preterm births (a birth that takes place before 37 weeks gestation)
• Fewer low birth weight babies (an infant weighing less than 2500 grams)
• More planned pregnancies
• More pregnancies with a 12-18 month pregnancy interval
• Improve oral health care, thereby improving birth outcomes
• Improve maternal health and wellness
Overflow: Please finish the response to the question above by using this text area. Please be mindful of the word limits. The IC Program has provided impressive outcomes. Data comparing selected birth outcomes for the clients who have had a birth since enrollment in the program indicates that of those clients discharged from the program due to a pregnancy, 63% had achieved ideal birth spacing of at least 18 months post delivery. Data for the pregnancies subsequent to participation in the program also shows a statistically significant increase in mean birth weight, from 1,920 grams to 2,914 grams. There was also a statistically significant increase in mean gestational age among IC clients, from 31.5 weeks during their eligible pregnancy outcome to 37 weeks during clients’ subsequent births. Community partnerships have been key to this success. Working through MIHP provides access to women with adverse pregnancy outcomes who have already experienced a relationship of trust with their case manager. You may provide no more than two supplement materials to support your application. These may include but are not limited to graphs, images, photos, newspaper articles, etc. Describe the public health issue that this practice addresses. (350 word limit) The IC Program was implemented in response to the high rate of African American infant mortality, disparities in other adverse pregnancy outcomes and state data for Kent County from the Perinatal Periods of Risk (PPOR) study. An adverse pregnancy outcome is defined as a preterm birth, low birth weight baby, infant death, stillbirth or miscarriage after the fourth month of pregnancy. PPOR is used as a model by MDCH to analyze infant deaths and identify target intervention areas. The PPOR data for Kent County indicated the priority to address deficiencies in the areas of maternal health issues and preterm births.
The African American infant mortality rate in Kent County from 2008-2010, the most recent period for which data is available, was 13.8 deaths per 1,000 live births. This was more than three times the infant mortality rate among White infants for this period (5.0/1,000). The area’s disparity between African Americans and Whites in the rate of low and very-low/extremely-low weight births is also stark. In 2010, the most recent year for which data is available, 10.5% of Kent County African American infants were low-weight births compared to 5.4% of White births and 5.3% of Hispanic births. African American infants were also nearly four times as likely to be born very-low or extremely-low weight compared to White and Hispanic infants
Pregnancy outcomes are important indicators of child survival and maternal health. They also have a significant impact throughout one’s life. Low birth weight infants are at increased risk of long-term disability and impaired development, and are more likely than normal weight infants to experience delayed motor and social development. Lower birth weight also increases a child’s likelihood of having a school-age learning disability, being enrolled in special education classes, having a lower IQ, and dropping out of high school. Recent studies have also pointed to low-weight births as a strong predictor of adult health. Children born less than normal weight (>2500 grams) are significantly more likely as adults to suffer hypertension, type II diabetes, coronary heart disease, and have shortened lives.
What process was used to determine the relevancy of the public health issue to the community? (350 word limit) Directing KCHD and community resources toward alleviating the disparity in infant deaths and poor birth outcomes in the African American community has been a KCHD priority objective since 2000. In 2001 KCHD convened the Taskforce on Healthcare for People of Color. An important exercise of the taskforce work was to engage the community in looking at infant mortality and other health disparities, their causes and potential solutions. Several Community Conversations, key informant interviews, and focus groups took place in predominantly African American neighborhoods to allow women to share their health issues and experiences with the healthcare system. Participants identified racism and poverty as key barriers to health and contributing factors of poor birth outcomes. This process has helped inform the need for and direction of the IC Program.
Disparities in infant mortality and adverse pregnancy outcomes were, and are, an issue in many other Michigan communities, and an issue that MDCH has worked hard to address. Initial MDCH funding for interconception care and the credibility given this issue at the state level also helped make interconception care relevant locally.
How does the practice address the issue? (350 word limit) The IC program addresses maternal and infant disparities by providing enhanced case management and referral services to enrolled clients. Public health nurses (PHN) visit IC clients from six to nine times prior to becoming pregnant to assist them toward optimal preconception health. In addition to case management, the program includes wellness, oral health, and family planning services. The program’s overall goal is to impact the following outcome areas:
• Reduced minority infant mortality
• Fewer preterm births (a birth that takes place before 37 weeks gestation)
• Fewer low birth weight babies (an infant weighing less than 2500 grams)
• More planned pregnancies
• More pregnancies with a 12-18 month pregnancy interval
• Improve oral health care, thereby improving birth outcomes
• Improve maternal health and wellness
• Improve client linkages to community resources related to the social determinants of health (e.g., access to healthy food, access to transportation, safe affordable housing).
IC services include family planning services and follow-up on compliance with clients’ contraception plan; dental treatments to restore clients to oral health, including reduction or elimination of periodontal disease, and; a wellness program and biometric screenings.
What is significant about the IC Program is the case management focus on the social factors impacting clients’ interconception health. PHNs serve as the program’s case managers. They take time to talk with clients about their life experiences, with special attention to social and mental/emotional factors affecting pregnancy and child rearing. Besides an assessment of key medical, behavioral and social risk factors, provision of IC education, interventions, and counseling related to pregnancy risk, clients and PHNs also discuss how stable housing, meeting basic needs, maintaining healthy relationships, and abstinence from tobacco, alcohol and other drugs can significantly decrease risks for having another premature and/or low-weight birth. The PHN also stresses the importance of nutrition, exercise, sleep, medical conditions, dental problems, infections, and stress in increasing risks of having another premature birth. The need to space pregnancies at least 18 months apart is emphasized and clients are given a $20 family planning incentive every three months to help them achieve proper child spacing.
Please list any evidence based strategies used in developing this practice. (Provide links or other materials for support) In 2005, MDCH provided funding for health departments in 11 Michigan communities with high infant mortality rates to develop action plans in their communities to reduce infant mortality. PPOR community data analysis provided guidance in this decision as it indicated that the primary causes of infant mortality were related to maternal health issues and preterm births. From their research, staff of the Michigan Infant Mortality Coalition encouraged the selected communities to assemble Infant Mortality Coalitions. Local IC interventions were intended by MDCH to 1) improve birth outcomes, 2) be sustainable, and 3) be transferable with other ongoing resources. The primary resource for reaching IC eligible clients has been through MIHP, the state’s Medicaid home visiting program for mothers and infants. The impetus for delivering the IC Program is also supported by the Centers for Disease Control and Prevention (CDC) Recommendations to Improve Preconception Health and Health Care , which includes interconception care. (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5506a1.htm) Is the practice new to the field of public health? If so, answer the following questions. No What process was used to determine that the practice is new to the field of public health? Please provide any supporting evidence you may have, e.g. literature review. While interconception programming is not new to public health, the KCHD program includes a focus on oral health care for clients. Periodontal disease has been linked as a factor in low-weight and pre-term births. Most IC clients are covered through Medicaid insurance, yet the majority of clients receiving dental care have not had a dental visit in several years. Reducing the impact of periodontal disease on pregnancy outcomes is seem as a very cost-effective preventative measure to reduce the high future costs of care of low-weight and/or premature infants. How does this practice differ from other approaches used to address the public health issue? The primary difference between the IC approach at KCHD and other interventions to address disparities in poor birth outcomes is the attention given to clients in addressing and alleviating social factors and life stressors impacting maternal health and pregnancy, as well as providing oral healthcare services, in recognition that oral health impacts pregnancy health. Is the practice a creative use of an existing tool or practice? If so, answer the following questions. Yes What process was used to determine that the practice is a creative use of an existing tool or practice? Please provide any supporting evidence you may have, for example, literature review. Interconception care is an approach, or collection of tools, promoted by MDCH and the CDC to reduce disparities in infant mortality. KHCD is actively involved in the IC network with other Michigan counties participating in the Practices to Reduce Infant Mortality through Equity (PRIME) Local Learning Collaborative. The collaborative's work occurs in the context of promoting the understanding of practices that support racism and developing an approach that challenges staff to develop individual and corporate strategies to incorporate social determinants of health in addressing health disparities. What tool or practice (e.g., APC development tool, The Guide to Community Preventive Services, HP 2020, MAPP, PACE EH, etc.); did you use in a creative way to create your practice? (if applicable) (300 word limit total)
a. Is it in NACCHO’s Toolbox; (if not, have you uploaded it in the Toolbox)?
b. If you used a tool or practice to implement your practice, how was your approach to implementing the tool unique and innovative for your target area/population? The innovations incorporated into the IC tools and protocols include cultural competency trainings (Creating Inclusive Healthcare Environments) and a two-day Health Equity, Social Justice Dialogue workshop targeting all nurses, managers, and community partners involved in the IC Program. A grant also allowed KCHD to provide the Health Equity, Social Justice Dialogues to all KCHD employees. IC Program staff strive to enhance services through the social determinants of health framework, identifying community resources and linking clients to essential needs, including, but not limited to: access to healthy foods, transportation, family planning and dental services, and social support. Each IC community partner and PHN case manager receives a Health Equity Toolkit: Framing the Relationship between Race and Health http://www.accesskent.com/Health/HealthDepartment/HealthEquity/. How does this practice differ from other approaches used to address the public health issue? The primary difference between the IC approach at KCHD and other interventions to address disparities in poor birth outcomes is the attention given to clients in addressing and alleviating social factors and life stressors impacting maternal health and pregnancy, as well as providing oral healthcare services, in recognition that oral health impacts pregnancy health. The KCHD IC Program shares common elements of other models in the Maternal and Child Health section of the Model Practices database. The Suffolk County Department of Health Services’ Interconception Care Collaboration is similar to the IC Program in that it offers family planning (FP) services. KCHD’s FP services includes 12 months of follow-up assessments of enrolled women to monitor effectiveness and continuation of and experience with family planning methods.
KCHD’s interconception services are supported through the work of the Healthy Kent 2020’s Infant Health Implementation Team and its Responding to Racism (R2R) Action Team. This collaborative approach to addressing maternal and infant health disparities and the IC Program’s work to engage KCHD and other healthcare agency employees in dialogue sessions on their experiences and perceptions of health equity and social justice seems akin to the Los Angeles County Department of Health Services' Mommy and Baby Project, especially their Preconception Health Collaborative and its work with racism.
Who were the primary stakeholders in the practice? Interconception Care stakeholders include the families participating in the IC Program, the IC case managers, dental providers, family planning staff and other ancillary service providers. Three partner agencies as well as KCHD’s Maternal Infant Health Program staff provide most of the services to clients. Two of the contracted agencies provide the family planning and dental services components of the program, while the third, Cherry Street Health Services (CSHS), allows for IC services expansion through their prenatal and MIHP programs.
It has also been important to maintain the support of county administration, including the Kent County Board of Commissioners, as there are significant county General Funds allocated to this program. The state Department of Community Health has been an important partner and the initial funder of IC interventions. The Infant Health I Team and its subcommittee, the Maternal Infant Health Program Provider Network, have served as the advisory board for the IC program.
What is the LHD's role in this practice? KCHD’s role includes program coordination and service delivery. A KCHD Health Educator coordinates implementation of all IC Program services. Eligible clients are recruited into the program by KCHD’s and Cherry Street Health Services’ Maternal Infant Health Programs. Women receive enhanced case management services from a PHN for up to 18 months post partum. KCHD also utilizes General Funds and grant monies to provide contracted dental and FP services to clients. What is the role of stakeholders/partners in the planning and implementation of the practice? Stakeholders/partners provide in depth insight into the planning of the IC Program. At the program outset, a planning workshop fostered valuable insight for the program from the Healthy Kent 2020 Infant Health Implementation Team and the KCHD Community Nursing staff. What does the LHD do to foster collaboration with community shareholders?
Describe the relationship(s) and how it furthers the practice's goals. IC Program case management and services are provided to clients of KCHD and two partner organizations. These service providers participate on the Infant Health Implementation Team, and its subcommittees (Responding to Racism Action Team and the Maternal Infant Health Program Provider Network) provide valuable support to the IC Program. Describe lessons learned and barriers to developing collaborations. Lack of community commitment by dentists willing to serve the uninsured or Medicaid-insured is a barrier. Client dental services are provided by volunteer dentists with the Baxter Holistic Health Center, which can only serve a limited number of IC Program clients per year due to the needs of their own patients. Evaluation assesses the value of the practice and the potential worth it has to other LHDs and the populations they serve. It is also an effective means to assess the credibility of the practice. Evaluation helps public health practice maintain standards and improves practice.
Two types of evaluation are process and outcome. Process evaluation assesses the effectiveness of the steps taken to achieve the desired practice outcomes. Outcome evaluation summarizes the results of the practice efforts. Results may be long-term, such as an improvement in health status, or short-term, such as an improvement in knowledge/awareness, a policy change, an increase in numbers reached, etc. Results may be quantitative (empirical data such as percentages or numerical counts) and/or qualitative (e.g., focus group results, in-depth interviews, or anecdotal evidence).
List up to three primary objectives for the practice. For each objective, provide the following information: (750 word limit per objective)
• Performance measures used to evaluate the practice: List the performance measures used in your evaluation. Depending on the type of evaluation conducted, these might be measures of processes (e.g., number of meetings held, number of partners contacted), program outputs (e.g., number of clients served, number of informational flyers distributed), or program outcomes (e.g., policy change, change in knowledge or attitude, change in a health indicator)
• Data: List secondary and primary data sources used for the evaluation. Describe what primary data, if any were collected for each performance measure, who collected them, and how.
• Evaluation results: Summarize what the LHD learned from the process and/or outcome evaluation. To what extent did the LHD successfully implement the activities that supported that objective? To what extent was the objective achieved?
• Feedback: List who received the evaluation results, what lessons were learned, and what modifications, if any, were made to the practice as a result of the data findings.
The KCHD Interconception Care Program has established the following outcome objectives for evaluating program impact on reducing infant deaths and improving pregnancy outcomes of clients.
• Performance measures used to evaluate the practice: List the performance measures used in your evaluation. Depending on the type of evaluation conducted, these might be measures of processes (e.g., number of meetings held, number of partners contacted), program outputs (e.g., number of clients served, number of informational flyers distributed), or program outcomes (e.g., policy change, change in knowledge or attitude, change in a health indicator)
• Data: List secondary and primary data sources used for the evaluation. Describe what primary data, if any were collected for each performance measure, who collected them, and how.
• Evaluation results: Summarize what the LHD learned from the process and/or outcome evaluation. To what extent did the LHD successfully implement the activities that supported that objective? To what extent was the objective achieved?
• Feedback: List who received the evaluation results, what lessons were learned, and what modifications, if any, were made to the practice as a result of the data findings.
Objective #1: Increase birth spacing among IC clients to 18 months by completing IC case management services to clients through up to 9 home visits by a public health nurse.
Data: KCHD epidemiology staff captures clients’ subsequent birth outcome information from vital birth records. In conducting the analysis of subsequent birth outcomes, KCHD relies solely on variables available in the birth certificate registry (i.e. Medicaid status, number of prenatal care visits).
Evaluation results: In the first three and half years of services, subsequent birth data was available for 103 clients discharged from the program for various reasons. Fifty percent of these clients had pregnancies subsequent to enrollment. Of those 51 clients, 32, or 63%, were discharged because they had achieved ideal birth spacing of at least 18 months post delivery. These results are very positive considering that most of the clients are very transient and 76% had a previous unplanned pregnancy.
Feedback: The IC Program staff compiles an annual report of IC Program highlights and outcomes. This report is posted on the health department’s web site as well as distributed to Infant Health Implementation Team partner agencies.
Overflow (Objective 1): Please finish the response to the question above by using this text area. Please be mindful of the word limits. Objective #2: Increase birth weights and gestational age of births to IC Program clients. Increasing birth spacing and intervening in women’s lives to improve their pre-pregnancy emotional and physical health should lead to these improved birth outcomes.
Data: Data on birth weights and gestational age is also available through the vital records of Kent County births.
Evaluation results: Birth weight and gestational age information was available for clients at enrollment and for those giving birth following their IC Program participation. There was a statistically significant increase (p<0.05) in mean birth weight, from 1,920 grams to 2,914 grams for clients with birth subsequent to program enrollment, and a statistically significant increase (p <0.05) in mean gestational age among IC clients from, 31.5 weeks during their eligible pregnancy outcome to 37 weeks during their subsequent birth.
Feedback: The IC Program annual report also highlights data on this objective.
Overflow (Objective 2): Please finish the response to the question above by using this text area. Please be mindful of the word limits. Objective 3: Objective #3: Complete dental care for 60% of IC clients including provision of cleanings, periodontal and gingivitis prevention and care, dental x-rays, restorations, and extractions, follow-up visits for education and monitoring. Promote and encourage regular brushing and flossing among clients.
Data: Reports on the number and type of dental services provided to IC clients and the progress in treating periodontal disease among clients, indicating improvement in level of severity at initiation and completion of services.
Evaluation results: One hundred IC Program clients have received dental services. Of the women who enrolled in the program, 73% completed the preventive and treatment portions of the program. There were 148 prophylaxis and education appointments, 269 restorations, 61 extractions, 8 root canals, and 12 early childhood check-ups for 7-24 month old children. Pregnant clients comprised 35% of participants and 34% of clients were in the interconceptional period. Pregnancy status was not available for the remaining clients.
Feedback: The IC Program annual report.
Overflow (Objective 3): Please finish the response to the question above by using this text area. Please be mindful of the word limits. What are the specific tasks taken that achieve each goal and objective of the practice? Objective #1: Increase birth spacing among IC clients:
Strategies for this objective include:
1. Assist IC staff to identify medical and basic needs of clients and work to build partnerships with agencies to meet client needs.
2. Promote and encourage IC clients to enroll into family planning services. Provide a quarterly incentive for participation and cab vouchers to encourage and facilitate use of family planning services.
3. Extend recruitment of at-risk women through area hospitals’ neonatal intensive care units.
Objective #2: Increase birth weights and gestational age of clients’ subsequent births.
Strategies for this objective include:
The IC Program’s wellness component encourages healthy eating and physical activity and increases women’s access to fresh fruits and vegetables. Research indicates that maternal obesity contributes to poor infant survival and health.
1. Women in the wellness program receive a pedometer and learn to track their daily steps and to encourage physical activity.
2. Women also receive coupons for purchases at the South East Area Farmer’s Market and recipes that feature market produce.
3. They are encouraged to log their daily fruit and vegetable consumption and to participate in the biometric screenings offered free at the KCHD clinic.
4. IC clients receive education and encouragement from their case manager as well as an incentive for completing their steps and fruit/vegetable logs.
5. Data on Body Mass Index (BMI) is collected on all IC clients during enrollment.
Objective #3: Complete dental care to 60% of IC clients.
Strategies for this objective include:
The IC Program addresses the importance of dental care through the Brush Up for Baby (BUFB) Program.
1. KCHD contracts with the Baxter Holistic Health Center Dental Clinic to provide IC clients with dental cleanings, extractions, restorations and root canals. Clients receive one-on-one attention from a dental hygienist focused on the importance of caring for their teeth and gums. Prior to receiving BUFB services, 80% of the clients had not been to the dentist in five years, despite having Medicaid coverage.
2. Conduct evaluation/satisfaction survey for clients that receive dental services.
What was the timeframe for carrying out these tasks? IC case management is provided to clients until 18 months from the date of the birth that made them eligible for IC services. Contracted IC family planning and dental services are generally renewed at the beginning of the health department’s fiscal year and are provided to clients until funds are expended. This usually allows clients to complete the course of treatment/services. Please provide a succinct outline of some basic steps taken in implementing your practice. I Research evidence based models
II Develop IC Program protocols
III Train maternal/child home visiting staff on the importance of interconception, dental care and family planning at half-day training
IV Execute contracts with IC service providers
V Enroll IC Program clients and begin IC service delivery
VI Provide bi-annual meetings for providers to share updates/feedback/quality improvement
VII Monitor subsequent birth data from Birth Certificate Registry data
What were some lessons learned as a part of your program's implementation process? • How to use the experiences of African American women shared through focus groups to modify IC Program protocols to fit local circumstances.
• The importance of developing a communications and marketing plan to identify and enroll women in need of interconception care.
• The value and need for establishing partnerships and MOUs with local systems of care, specifically hospitals with neonatal intensive care units (NICU), for identification and referral to the IC Program. A key lesson learned is identifying and sustaining a NICU liaison to identify and enroll women into IC within the first two weeks of delivery.
• Identifying opportunities to work with other programs within KCHD. The program was initiated with KCHD’s Maternal Infant Health Program, and has added provision of IC services to women that experience an infant loss, with referrals through KCHD’s Infant Loss and Grief Support Team. Discussions have begun on the possibility of working with KCHD’s Children's Special Health Care Services to enroll women with infants with congenital abnormalities into the IC Program.
Provide a breakdown of the overall cost of implementation, including start-up and in-kind costs and funding services. Costs for the IC Program are provided as per client reimbursements for providing case management, family planning, and dental services. The total cost per client is $952. This includes $365 for enrollment/case management, $135 for health items and FP incentives, $75 for wellness program expenses (including farmers' market coupons, blood pressure/ cholesterol screening and incentives); $200 (average per client) for contract dental services (provided by volunteer dentists), and $177 for a comprehensive FP exam and birth control for 12 months.
The IC Program is administered through KCHD’s Health Education and Promotion division. Primary staff responsibilities are managed by a .5 FTE program coordinator.
Is there sufficient stakeholder commitment to sustain the practice? Describe how this commitment is ensured. There has been a strong institutional commitment to providing IC Program services for eligible women. In 2000, KCHD designated reducing African American infant mortality as a priority department goal, and since then Kent County has allocated General Fund revenue to help sustain IC Program services for KCHD clients. IC Program staff and health department administration have also been successful in obtaining significant grant funding for the program from three funding agencies. The funding has allowed the program to expand in number as well as increase the breadth of services offered.
A second factor supporting sustainability of the IC Program is the presence and strength of other community partnerships committed to addressing African American infant mortality and other racial/ethnic health disparities. This includes the ongoing supportive work of the Infant Health Implementation Team , the Maternal Infant Health Program Provider Network, and the Responding to Racism (R2R) Action Team. Another important IHIT partner in this work is Strong Beginnings, a local provider of federally funded Healthy Start services. Strong Beginnings has teams of community health workers, nurses, and social workers who recruit and engage high risk mothers.
The goals of the Interconception Care Program are also shared by community partners of the Kent County Working Together for a Healthy Tomorrow Coalition’s Community Health Improvement Plan (CHIP). Among the CHIP objectives of the work plan, to be completed by 2015, are:
• Increasing by 10% the proportion of pregnancies that are intended;
• Increasing community awareness and perceived importance of early and adequate prenatal care by 10%, and;
• Reducing by 5% the disparity between African American and white women in Kent County in adequacy of prenatal care.
Describe plans to sustain the practice over time and leverage resources. The underlying goal of the IC Program is to integrate IC protocols as a standard of care in home visiting programs for women during periods of interconception. As a greater number of KCHD and other agencies’ nursing staff participate in the IC Program, IC protocols will increasingly be adopted by local Maternal Infant Health Programs, thereby ensuring women receive enhanced services and increased likelihood of optimal preconception health. This organizational commitment will eventually lead to the routinization of the IC Program’s most important services among KCHD maternal/child health programs. This entails development of MIHP program policies that lead to routine MIHP assessment and referral to support services for risk factors associated with poor pregnancy outcomes. The Kent County MIHP Provider Network will also continue to advocate at the state level for integration of interconception care in the state’s redesign of MIHP.
Program sustainability will also be bolstered through effective monitoring and evaluation of the IC Program to produce favorable results. KCHD’s Epidemiology staff will provide necessary support for program evaluation. By demonstrating program effectiveness through subsequent healthy birth outcomes, and data to support program benefits that justify program costs, the likelihood of securing other IC program funding will be enhanced.
Thus far, KCHD has observed compelling reasons to continue to fund IC interventions. In fact, KCHD is the sole agency among the 11 originally supported by MDCH in 2005 to maintain an IC program. Hopefully, these results will also continue to compel public and private funders to continue outside support for these services.
Practice Category Choice 1: Maternal and Child Health (Teen pregnancy, Mother to Child transmission of HIV and AIDS) Practice Category Choice 2: Practice Category Choice 3: Check all that apply. NACCHO Web Site Are you a previous applicant? No |
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