Building Successful Community Collaborations Within a Public Health System Salina – Saline County Health Department MCH Program Prenatal Collaboration Project
Objectives • Identify one approach to collaborating with existing community programs/partners to better reach the community’s most at risk prenatal populations. • Identify how the March of Dimes’ Becoming a Mom / Comenzando bien curriculums can be adapted to meet the needs of your community’s prenatal population. • Identify potential road blocks when starting a community collaboration of this nature.
Background • Salina- Saline County Health Department’s (SSCHD) Maternal Child Health (MCH) program’s focus on providing education and social support to pregnant women, new mothers, and infants in Saline County • Routes of delivery of this education and support have changed over time, with change in other programs and services, change with technology, culture and population, etc. • Frustration with inability to reach targeted population
Background • Initiation of conversation with our FQHC about possibility of a prenatal collaboration • Exploration of options, i.e. “Centering Pregnancy”, March of Dimes’ Becoming a Mom / Comenzando bien • Shifted back to idea of “group” prenatal education as an enhancement to traditional prenatal care model, not a replacement for • Conversations and meetings with the March of Dimes; grant proposal solicited
Background • Began bringing in other community partners, i.e. childcare partner, Wal-Mart, Senior Center • Collaboration included SSCHD’s MCH staff facilitating monthly group prenatal education classes at SFHCC as a part of SFHCC’s routine prenatal care • Prenatal Group Education Collaboration Project officially started July 2010, after close to two years of conversations, brainstorming, bringing partners together, grant writing, etc.
Brief Summary of Project • Our MCH staff overseeing the project; working with a project manager at FQHC (and each additional site with expansion) • Our MCH staff facilitating group education sessions at the FQHC during the 3 rd week of the month • Residents, at the FQHC / KU Family Practice Residency Program, participate in group sessions
Brief Summary of Project • Ideally, “every" patient receiving prenatal care at SFHCC will attend a monthly prenatal education class in addition to routine appointment with physician • Part of routine prenatal care; not an optional class (ideal) • Program is incentive based • Group sessions once a month for a series of 6 sessions, then restart • Uses March of Dimes’ Becoming a Mom / Comezando bien curriculum as it’s core
Brief Summary of Project Topics for Sessions • Session 1 - You and Your Pregnancy / Prenatal Care – Content: getting to know you exercise; common discomforts of pregnancy and what you can do; why prenatal care is important; what to expect and prenatal tests; talking to your provider – Highlighted Agencies/Resources: Maternal and Infant Program (M&I); Pregnancy Service Center (PSC); OCCK transportation / G&B Enterprises; “Text -4- Baby” • Session 2 - Pregnancy Health – Content: healthy eating and what pregnant women need; shopping & cooking on a budget; what foods are not safe for consumption by pregnant women; why stress is a concern during pregnancy and how to control it; importance of exercise; importance of healthy relationships; partner abuse and where to get help; safe sex during pregnancy; things to avoid during pregnancy – smoking, alcohol, drugs; prescription and OTC meds.; how viruses and other infections affect the fetus; chemicals and work safety – Highlighted Agencies/Resources: WIC; Prairie Land; DVACK; SRS; OARS program; Substance Abuse programs; Ashby House; Housing Authority; Quitline
Brief Summary of Project Session 3 - Signs and Symptoms of Preterm Labor / Labor and Delivery – Content: knowing s/s of preterm labor, what to do, and when to see the Dr.; why the last few weeks count; inductions (medically needed vs. non-medically needed); preparation for the hospital; birthplan; s/s of labor and when to go to the hospital; what to expect at the hospital; three potential ways of having a baby; what to expect with a c-section and recovery; coping with pain – Highlighted Agencies/Resources: Expectant Parent Class (EPC); SRHC Childbirth Classes; SRHC registration form; s/s of preterm labor wallet card • Session 4 - Infant Feeding / Breastfeeding Basics – Content: safe feeding basics; recognizing early hunger cues; breastfeeding basics: you will not have milk at first, it will be colostrum; importance of colostrum and breastfeeding; importance of frequent feedings at breast; supply and demand; realistic expectations; positioning; common problems; where to get help – Highlighted Agencies/Resources: Saline County Breastfeeding Coalition (SCBC); La Leche League (LLL); WIC; SRHC Breastfeeding Class
Brief Summary of Project • Session 5 - Infant Care / Happiest Baby on the Block / Period of Purple Crying / SIDS – Content: bonding with your baby; diapering; bathing; normal bowel patterns; knowing that crying is normal and that it will likely peak at 2-3 months; how to deal with crying; techniques for soothing a crying baby (“Happiest Baby on the Block”); SIDS: what causes it / what it is; risk factors for and ways to reduce risk factors; safe sleep practices and environment; SIDS in childcare; immunizations – Highlighted Agencies/Resources: Heartland Healthy Families (HHF); Parents as Teachers (PAT); Child Advocacy and Parenting Services (CAPS), Parent Helpline; KCSL Tip Card; Car seat Expiration flyer; Car seat Inspection flyer • Session 6 - Postpartum Recovery / Interconception Health – Content: realistic expectations of the postpartum period; physical changes; emotional changes; baby blues and PPD; when to see your provider; relationships; returning to work; childcare; when to have another baby; family planning options and resources; taking care of yourself; returning to pre- pregnancy (or ideal) weight and blood sugar control; vaccinations; medications; smoking, alcohol and drug use; folic acid – Highlighted Agencies/Resources: Postpartum Resource Center of Kansas (PRC); Mental Health resources in Salina; Salina-Saline County Health Dept. (SSCHD) – Family Planning, Immunizations, Childcare resources; Childcare Resource and Referral Agency; ICD; Poison Control
Brief Summary of Project • Sessions in English and Spanish • Sessions designed so women can enter at any point in pregnancy: two different sessions each month, on different rotations • Sessions are two hours long, with snacks provided • Sessions incorporate social support piece / integration of community agencies & programs
Project Successes • Invaluable partnerships created: o CAPS – providing on-site childcare during sessions o OCCK – transportation o Wal-Mart – incentives “at - cost” o Senior Center / RSVP – swaddling blankets o Guest Presenters: Early Childhood Programs, Pregnancy Service Center, Mental Health Center, Highway Patrol
Project Successes • Level of support from community partners and the lack of barriers o Wal-Mart providing incentive items for the project at cost o Child Advocacy and Parenting Support (CAPS) program using United Way funding to provide quality childcare during class sessions (In first 6 mo., 72 total children – 63 Spanish, 9 English) o Buy-in and support from SFHCC faculty and staff o Support from SSCHD administrator and Board of Health; also KDHE MCH program o Interest, and commitment from, OB practices in community for partnership expansion in year two
Project Successes • Session discussions, sharing, and question asking leading to: o Patients talking to their physician and reporting concerns o Concerns being identified and treated, i.e. Pica, UTI, placenta previa o Participants learning from each other
Project Successes • Relationships being established: o Patients bringing sonogram pictures to share o Staying around after class to visit o Knowing staff at WIC appointments and Healthy Start Home Visits and voicing their appreciation for / excitement about the classes o Relationships between health care providers and community agencies
Project Successes • Knowledge gain: o Patients reporting they are learning “so much”, even experienced mothers and experienced breastfeeders o Evidenced by answers on pre and post tests o Patient not wanting to accept incentive, as “education was enough of a gift” o Patients bringing pregnant friends from other clinics as “support person” o Patient concern with transfer of care due to not wanting to miss out on classes
Project Successes • Behavior changes: o Report of behavior changes on Completion Surveys; i.e. personal health habits and contact with community agencies and resources o Report of a “developed connection with other pregnant women in the class, the class teacher, or other social supports” on Completion Surveys o Report of behavior change / increased support from “support person”
Project Successes • SFHCC (FQHC) Feedback: – In complete support of partnership and continued commitment to collaboration – See us as helping them do their job better – Patients who attend group have reported greater satisfaction with their prenatal care – Long term evaluation of project hoped to show improved birth outcomes
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