MCAH and WIC MCAH and WIC An Ideal Partnership

How the collaboration between Tulare County WIC and MCAH is a win-win for

providers and clients alike.

Presented by Karen Pringle, RN

Tulare County Perinatal Service Coordinator

Tulare County Health and Human Services

Perinatal Wellness Program (PWP)A program of Maternal, Child, and Adolescent

Health PWP Seeks to:• Reduce the instance and/or severity of perinatal

mood and anxiety disorders (PMAD) experienced by perinatal women

• Increase positive later in life outcomes of infants• Increase services provided to unserved and

underserved populations• Increase community awareness of PMAD

Negative Effect on Bonding & Attachment

Noncompliance With Prenatal Care

Drug, Alcohol, Tobacco Use

Poor Self-Care, Nutrition, Sleep

Domestic Violence

Risks of Untreated

PMAD During Pregnancy

PMAD Effects During Pregnancy

Preterm birth and low birth weight

Decreased Bonding & Attachment

Newborns cry more often, difficult to console

Lower levels of dopamine and serotonin

in newborn

Low Apgar scores

Delayed fetal heart rate responsivity

Risks of Untreated PMAD for

Fetus/Newborn

PMAD Implications for Fetus and Newborn:

Long Term Implications:

• Impacts psychological, social, cognitive and behavioral development in children.

• Chronic maternal depression results in higher rates of anxiety, depression, and behavioral disorders in toddlerhood, preadolescence and adulthood.

Three Critical Components to PMAD Recovery:– Therapeutic Intervention

– Medical Intervention– Social Support

PWP Services Include:– Case management

• N.U.R.S.E. Model of Care

(Promoting Nutrition, Understanding, Rest, Support, Exercise)– Direct linkage to therapeutic services– Linkage to social and medical support services

• Additional MCAH Services:– Breastfeeding support– Basic health assessment and education– Linkage and/or referral – SASP (Safe A’sleep Program)

Distinct Services; Parallel Missions

MCAH’s Mission: To protect, improve and optimize the health and wellbeing of women,

infants, and children in Tulare County.

WIC’s Mission: To safeguard the health of low-income women, infants, and children up to age 5

who are at nutrition risk by providing nutritious foods to supplement diets, information on

healthy eating, and referrals to health care.

Client Base by Race/Ethnicity

African American White

Hispanic Asian

Native American, Pacific Islander, Alaskan Native Other/Unkown

PWPPWP WICWIC

Client Base by Age (Percentage of all clients served)

0

10

20

30

40

50

60

WIC PWP

<16

16-19 years

20-29 years

30-39 years

40+ years

The WIC & PWP PartnershipRecognition of similar clientele, aligned missions,

limited resources, and gaps in services.

• Partnership Structure:Partnership Structure:– PWP Nurse Case Manager on-site in WIC offices 1

day/week.– PWP Nurse: meets with referred clients for more detailed

nursing assessment, provides basic health education, connects clients to additional services.

– Video-conferencing capability with all 9 WIC offices.

Why it WorksBenefits for WIC:• Access to on-site education and support• Additional breastfeeding support available to clients• Additional nursing assessment and referral

Benefits for PWP:• Better client enrollment and retention• Increased assessment and referral rate

Mutual Benefits:• Simplified logistics for assessment and referral• Early intervention, particularly for clients in the most need • Improved communication between providers and a more effective

working relationship– Video conferencing improves communication over broad service area

• Shared knowledge and resources; more comprehensive and individualized service solutions

• Better outcomes for clients! Underserved clients are able to benefit from care they often didn’t know was available, and receive the information and support necessary to make well-informed choices about their care.

PWP Referral Sources

59%17%

13%

9% 2%31%

27%

20%

15%7%

TC WIC

HHSA (non-WIC)

Health Clinics and Hospitals

Family Resource Centers

Other

2010-2012: Current:

Challenges• Decreased Funding = Fewer Nurses

– Drive to use resources more effectively• Staff Training

– Training began with MCAH nurses, who could then act as resources for WIC staff

• Fear of change – New logistics and communication strategies for WIC and MCAH

staff who had never worked together before• Development of a trusting partnership

– Building trust takes time!

Everyone benefits from the solution – a structured, sustainable partnership that is supported by program leadership.