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Technology Notes Cont. Recording • Today’s webinar will be recorded • The recording will be available on the AMCHP website at www.amchp.org 3
Objectives • Describe the importance of post-disaster reproductive health assessments and the rationale for the creation of the Reproductive Health Assessment after Disaster (RHAD) Toolkit • Describe state (MS) level experience trying to capture post-disaster reproductive health data for their MCH program following a disaster (Hurricane Katrina) • Guide participants through the RHAD Toolkit • Identify successes, challenges, and lessons learned from the pilots that can be applied in other states
Featuring: • Amy Williams, MPH Consultant, Division of Reproductive Health/CDC • Juanita Graham, MSN, RN Mississippi State Department of Health • Jennifer Horney, PhD, MPH, CPH Director, University of North Carolina Center for Public Health Preparedness 5
Disaster and the United States
Disaster and Pregnant Women Classified as ‘at - risk individuals’ Post-event data often not collected Few studies examined associations of US disasters and birth outcomes Exposure associated with poor birth outcomes Showed increases in maternal risk factors
Disaster and Women of Reproductive Age (WRA): What we do not know Inconsistent changes in birth rate after disaster Increases after Hurricane Hugo and OK City bombing Decreases after Hurricane Katrina and 1997 ND Red River Flood Little known about disaster effects on WRA in US No routine surveillance of disaster-affected WRA Inconsistent reports of intimate partner violence Inadequate studies on contraceptive use, access to medical and social services, risk behaviors, etc.
Disaster and the Division of Reproductive Health (DRH), CDC Hurricane Katrina DRH received requests from states for technical assistance with reproductive health needs assessments Assisted health departments in LA and MS in creating survey tools & conducting assessments Lessons Learned Need for refined assessment tools and sampling methodologies Need for easy-to-use sampling guidance Need for an easily adaptable guide with ready to use tools for reproductive health assessments in disaster affected communities
Post-Disaster Assessment: Reproductive Health Needs of Women Affected by Natural Disaster Juanita Graham DNPc MSN RN Chief Nurse, Health Services , MSDH
26 miles of complete devastation along the Mississippi Coastline
FEMA/ARC Estimates (45 days post disaster) • ~ 180,000 people displaced • ~ 120,000 went to shelters • ~ 70,000 infants and children • ~ 40,000 women • ~ 500,000 registered FEMA applicants • ~ 3,200 LA & MS Gulf Coast students enrolled to other schools • ~ 1,169 no vaccination compliance form
One year post disaster 100K MS residents living in transitional housing due to extensive housing damage • 68,729 destroyed, 65,237 mjr dmg, 100,318 mnr dmg (Source: ARC, MSEMA.org) • Large mobilized population – MS & LA residents
Maternal Child Health • Contacted by CDC, DRH • Develop tool set to assess RH needs of disaster-affected women • Data to evaluate services available & identify service needs • Support funding requests • Particularly, emergent post-disaster period
Study plan • Collaboration – UM SON Faculty, TA per DRH-CDC • Areas of interest – Hancock, Harrison, Pearl River Counties – Most damage – Most mobilized population • Women of reproductive age excluding minors (18-44) • Experiencing perm/temp displacement
Sampling Barriers • Where are they now? • Where were they before? • Unfunded project – Ø incentives, data collectors, travel support • Limited resources – Most focused on recovery & planning with little time for data collection • Participant recruitment
Sampling Barriers • IRB – University of MS Medical Center • Vulnerable population issues – Surfacing of suppressed emotions brought about by reflection on Katrina – Confined population – similar to institutionalized but refugee as opposed to incarceration or commitment – Required invitation-based recruitment
Overcoming Barriers • DRH-CDC identified small unobligated funding source to support piloting of tool • Further partnering – UMC-SON Accelerated BSN program – FQCHC – Family Coastal CHC – Theta Beta Chapter of STTI
Overcoming Barriers • DRH-CDC identified small unobligated funding source to support piloting of tool • Funding was reimbursement based • Sponsored by Theta Beta Chapter
Overcoming Barriers • UMMC IRB required “invitation-based” recruitment • No support from Agencies supervising transitional housing & FEMA trailer parks • No mechanism for neighborhood invitation • Partnered with FQCHC – – Family Coastal CHC – Waiting room recruitment
Overcoming Barriers • IRB approved, funded, invited • Recruitment & data collection • Partnered with UMC-SON new Accelerated BSN program – Needed a community project – Eligible for practicum, clinical hours
Experience • Students very open to learning opportunity • Students well received by target population • Women eager to participate, chance to tell their story, regardless of incentive • Met quota within an hour of recruitment initiation at nearly all clinics • Insight on expectations of future survey opportunities
Findings • Obvious weaknesses & limitations • Clinic site – Access? Quality? Timing? • Timing an issue – 40% of respondents indicated usually get family planning services at emergent care center • Further study needed – Result of recovery efforts or occurring in other underserved areas?
Presentation Outline • Background of RHAD Toolkit • Overview of the RHAD Toolkit
BACKGROUND
Disaster & Women of Reproductive Age (WRA) WRA = ages 15—44 • Inconsistent changes in birth rate after disaster • Increases after Hurricane Hugo & OK City bombing – Decreases after Hurricane Katrina & 1997 ND Red River – Flood Little known about disaster effects on WRA in US • No routine surveillance of disaster-affected WRA – Inconsistent reports of intimate partner violence – Inadequate studies on contraceptive use, access to – medical and social services, risk behaviors, etc.
Disaster & Pregnant Women An at-risk population • Post-disaster data often not collected or used • Associations in US post-disaster studies (n=12) • Increases in medical risks among women giving birth – Infant Intrauterine Growth Restriction – Infant low birth weight & length – Decrease in infant head circumference – Increase in polycyclic aromatic hydrocarbons in cord – blood after World Trade Center attack
Disaster and Division of Reproductive Health (DRH) • After Hurricane Katrina DRH received requests from states for technical assistance with RH needs assessments – Assisted health departments in LA & MS in creating survey tools & conducting pilots • DRH realized the need for refined assessment tools & sampling methodologies for locating WRA & pregnant/postpartum women – CASPER instructions are not sufficient for sampling subgroups such as women of reproductive age or pregnant women • DRH acknowledged health department’s need for easy-to- use sampling guidance and easily adaptable guides for assessment in disaster affected communities
Creation of the RHAD Toolkit
OVERVIEW OF THE RHAD TOOLKIT
RHAD Toolkit Website http://cphp.sph.unc.edu/reproductivehealth
RHAD Toolkit Content • Information about the toolkit • Seven main content areas – Questionnaires – Planning – Sampling – Training – Implementation – Analysis – Data Use
What have we learned from pilot testing? • Modified two-stage cluster sampling with referral • Alternate sampling patterns can be used in areas with sparse populations (i.e. 40x5 instead of 30x7) • The amount of time elapsed since the disaster matters • Put time into constructing the most effective interview teams
Pilot Findings • Bertie County, NC – 731 homes approached by a survey team; 202 had WRA home – 71% (n=144) completed the survey; 25 (17%) were PP – PP women reported more post-disaster stressors than overall sample mean (WRA=1.37; PP=2.11 [p<0.005]) – WRA reporting home damage had more stressors than with no damage (no damage= 0.97; damage= 2.27 [p<0.005])
QUESTIONS?
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