Inadequate prenatal care among African American teens

Meghan Brown, Caitlin Buren, Stefanie Lombard, charity McKinnon, Katie morell, Stephaine RyanInadequate Prenatal Care Among African American TeensAges 15-19 in Kent County

Welcome to our community change project addressing inadequate prenatal care among african american teens ages 15-19 in kent countyPresented to you by 1 Teen Birth RatesRace2012All Races29.4 /1,000Non-Hispanic White20.5/1,000Non-Hispanic Black43.9American Indian/Native Alaskan34.9Asian/Pacific Islander9.7Hispanic46.3

(Martin, Hamilton, Osterman, Mathews, 2013) US Birth Rates per 1,000 Live Births for Mothers 15-19 Michigan teen pregnancy rate 53.6

Kent County teen pregnancy rate 61.5(MPHI,2011)

Teen birth rates for the US MI and Kent County All birth rates are per 1,000 live births the Us all race rate is 29.4 per 1000 the us Non hispanic black rate is the second highest at 43.9 Michigans teen pregnancy rate including all races is higher than the national US rate at 53.6 and Kent County is higher than both US and MI rates at 61.5According to the MPHITeens are more likely than adult women to receive late or no prenatal care, deliver pre-term, and deliver a baby at low birth weight. This is important to note because the teen pregnancy rate in Kent County is higher than it is in MI overall.2Infant Mortality Rates (IMR)2010 Total US IMR 6.14 2010 US IMR for Non-Hispanic Blacks 11.46 (Mathews & MacDorman, 2013)

2010 Michigan IMR 7.1Michigans African American IMR is approximately three times greater than the white, non-Hispanic rate (MPHI, 2011).

Infant mortality rates per 1000 live births for the US and MI. The US IMR in 2010 was 6.14 overall. The us non hispanic black rate was nearly double at 11.46. Michigans IMR was greater than the US rate at 7.1 According to the MPHI The most tragic outcome that adequate prenatal care can help to prevent is death of an infant. Findings from a study of fetal deaths in Kent County indicated that African American babies in Kent County are significantly more likely to die before their first birthday than babies of any other race or ethnicity. This study also found that African American and Hispanic/Latino mothers who lost a baby were more likely to have had late entry into prenatal care and to report fear, distrust, or dissatisfaction with the healthcare received. 3Community Problem DiagnosisRisk of inadequate prenatal care among 15-19 year old African American females in Kent County related to cost and availability as evidence by higher than average infant mortality rates (IMR).

Based on the birth and infant death rates we have just provided our community change group has developed the problem diagnosis: risk of inadequate prenatal care among 15-19 year old african american females in kent county related to cost and availability as evidence by higher than average infant mortality rates.4Existing Services Available in Kent CountyThere are many existing centers available to help pregnant teens.Alphas Womens Center Paired with a MentorAttend classes on pregnancy, nutrition and parenting to earn pointsUse points to buy baby supplies (Alpha Womens Center , 2014)

Kent County Health DepartmentWICMedicaidNurse, Social Worker and Nutritionist available (KCHD, 2014)

Current existing Kent County services that provide assistance to at risk and pregnant teens include the Alpha womens center where teens are paired with a personal mentor. They attend classes on pregnancy nutrition and parenting. To encourage mothers to attend Each class allows participants to earn points that can be used to buy baby supplies. Kent county health department assists mothers to sign up for WIC and medicaid. The health department also provides education and counseling for mothers with nurses social workers and nutritionists.5Existing Services Available in Kent CountyGrand Rapids African American Health InstituteStrong BeginningsReferrals to prenatal careSupport and education for teens and their family (GRAAHI, 2013)

D.A. Blodgett- St. Johns CenterCounselingFood assistanceHelp signing up for Medicaid (D.A. Blodgett, nd)

The grand rapids african american health institue offers a strong beginnings program to expecting african american mothers. They provide referrals to prenatal care providers and offer support and education for teens and their familyThe DA Blodgett St. Johns Center provides counseling for pregnant teens as well as food assistance and help signing up for medicaid.6Existing Services Available in Kent CountyPlanned Parent Hood Irwin/Martin Health Center

Confidential services

Teens-only walk-in appointments accepted Tuesdays, 3:00pm-6:00pm

Pregnancy education, prenatal care, and family planning.

No insurance necessary. With or without insurance, you can always come to us for your health care (Planned Parenthood, 2014).

Planned Parenthood Irwin Martin health center in Kent County offers confidential services to teens. They have special teen only walk in appointments on Tuesday evenings. Pregnancy education, prenatal care and family planning is offered at this center. No insurance necessary. The planned parenthood web site states with or without insurance you can always come to us for your health care Planned Parenthoods Mission statement sates: Planned Parenthood believes in the fundamental right of each individual, throughout the world, to manage his or her fertility, regardless of the individual's income, marital status, race, ethnicity, sexual orientation, age, national origin, or residenceto provide comprehensive reproductive and complementary health care services in settings which preserve and protect the essential privacy and rights of each individual7Established Interventions Initiated by Kent CountyKent County intervention programs to reduce disparities

Reducing the Risk Kent County Health Education Programs Designed to reduce the rate of teen pregnancy and exposure to STDsSupplements existing health and sex education curriculum (County of Kent, 2014).

Kent County Infant Health Initiative Designed to reduce infant mortality and eliminate racial health disparities.Interconception care program Targets African American women with poor pregnancy outcomes.Brush up for BabyFamily Planning Services Financial Assistance Case managementHome visits with a community nurseRisk screening (Kent County Health Department, 2010).

Established interventions initiated in kent countyKent County has implemented intervention programs to reduce disparitiesReducing the Risk Kent County Health Education Programs Designed to reduce the rate of teen pregnancy and exposure to STDs by focusing on delaying or reducing frequency of intercourse and using contraception and condoms. Targets youth between ages of 14-18 and Supplements existing health and sex education curriculumThe Kent County Infant Health Initiative - Started in 2005 on a grant received from the Michigan Department of Community Health aimed at reducing infant mortality and eliminating racial health disparities.Their Interconception care program targets African American women with poor pregnancy outcomes. Interventions focus on creating Fewer preterm births Fewer low birth weight babies More planned pregnancies and More pregnancies with a 12-18 month pregnancy intervalBrush up for Baby aims to decrease African American infant mortality rates by reducing premature delivery and low birth weight associated with periodontal disease.They also offer Assistance in obtaining Family Planning Services, financial assistance through gift cards,Case management, in-home visits with a community nurse, and risk screening

8Established Interventions Initiated by Kent CountyMaternal Infant Health Program Perinatal and postpartum home visitsFree Service (Kent County, 2014).

Other strategies implemented by Kent County Early and Often prenatal care messagingEmergency Department prenatal scheduling before dischargeHealth disparity education for providersEnrollment assistance for :Healthy Kids Medicaid, MIChild, Maternity Outpatient Medical Services, and Plan First. (MPHI, 2012).

The Maternal Infant Health Program providesHome visits during pregnancy and after the infant is born by a public health nurse, nutritionist, and/or social worker.Services include health and parenting education, counseling, service coordination, and referrals. this is a Free service for pregnant women and families with infants. Other strategies being implemented by Kent County Include Designated Funding by the year 2015 to create early and often prenatal care messaging and social marketing campaigns Implementing a system for pregnant women presenting in the emergency department to be scheduled an appointment with a prenatal care provider before discharge.Educating providers on health disparities and the relationship between racism/discrimination and poor birth outcomes.The Kent County Health Department provides application and enrollment assistance for Healthy Kids Medicaid for pregnant women, infants and children; MIChild; Maternity Outpatient Medical Services and Plan First.

9What needs to change? An intervention that targets African American teens, age 15-19Partnership with schools and public health servicesOffers education and resources at little to no cost

Recognizing that teen populations respond to pregnancy prevention programs that are sensitive to their cultural backgrounds and varying lifestyles is crucial to developing and implementing successful programs (National Conference of State Legislatures, 2009).

After researching the services and interventions already available our community change group assessed what needs to change to improve Infant mortality rates among african american teens in Kent county by making prenatal care more accessible and affordable. We identified a the need to create interventions that targets african american teens. We want to create a partnership between the public school system and public health services to reach more at risk teens. And we want to offer education and resources at little to no cost. At the national conference of state legislatures the statement, recognising that teen populations respond to pregnancy prevention programs that are sensitive to their cultural backgrounds and varying lifestyles is crucial to developing and implementing successful programs was made. This statement provides the basis of our programs vision.10Proposed Primary InterventionTeen Pregnancy Resource CenterOffers on site and out reach programsProviders: Social Workers NursesPhysicians VolunteersMission & Vision

The resource center will allow high risk teens to develop relationships with healthcare providers and peers in a non-judgmental environment.

The resource center will provide high risk teens with education, emotional support, and the resources necessary for a healthy pregnancy.

Our proposed primary intervention is to Create a resource center for pregnant african american teenagers in Kent County ages 15-19. The center will offer on site and out reach programs. The out reach program will visit the four high schools in kent county with the highest amount of African American teen enrollment. This will allow the intervention to go to the teens eliminating the need for transportation and increasing the number of teens exposed. The resource center will consist of social workers, nurses, physicians, and volunteers to teach about health in pregnancy, infant care, and health in the post partum period. Our Mission and Vision Statements are: The resource center will allow high risk teens to develop relationships with healthcare providers and peers in a non-judgmental environment. The resource center will provide high risk teens with educaion, emotional support and the resources necessary for a healthy pregnancy

11Resource Center: On Site ServicesProvidersSocial WorkersCase management system Life skill education Strengthen social behavioral supportProvide continuing education Assist with workforce referrals (Patchen, et al., 2013).

NursesEducate teens within individual and group settings.Anonymous question/answer sessions

On site services will include social workers who act as a care coordinators with pregnant teens using a case management systemprovide life skill education with individuals and in group settings. work with the integrated team to identify and strengthen social-behavioral support. Assist with continuing education with the end result of completion of education. And Assist with workforce referrals. Nurses will Educate teens regarding health, child birth classes, breastfeeding and lactation support, and family planning within individual and group settings using mixed delivery methods. They will Provide handouts, videos, lecture, and role play. and allow teens to write down anonymous questions and provide answers in a non judgmental way.

12Resource Center On: Site ServicesPhysicians Primary Care ProvidersObstetricianPsychologistsMental Health Professionals

VolunteersCommunity members with:similar backgrounds similar life storiesable to relate on a personal level

On site physicians will provide prenatal assessments and referrals to PCP and OBs. They will screen for mental health issues such as depression. according to the american academy of child and adolescent psychiatry Pregnant teens need to meet with support systems that include a child and adolescent psychologist as needed throughout (pregnancy and post partum. The pregnant teen may need to be referred to a mental health professional. Education through school classes during and after the pregnancy will help teenage mothers to learn how to function as a parent and survive as adults Volunteers will allow the teens to develop theraputic peer realtionships with people from similar backgrounds and similar life stories.

13Resource Center: Out Reach ProgramThe Resource Center will assist the Kent County public high schools with the highest African American enrollment to provide a once a semester pregnancy prevention and education course during school hours.

Target High Schools

Kent County Public High SchoolTotal StudentsMinority %Majority Race of Minority PopulationCity Middle/High School68940%Black and HispanicCreston High School66083%BlackEast Kentwood High School198555%BlackKelloggsville High School57059%Black(publiceschoolreview.com, 2014)

The resource centers outreach program will offer a once a semester pregnancy prevention and education course during regular class hours at 4 kent county high schools with the highest african american enrollment. This will allow the program to reach up to 3900 teens in schools with a 40-83% african american population. In educating this population, teenagers will obtain resources for transportation to doctors visits, be referred to obstetrical physicians who will provide prenatal care, and have access to care coordinators for pregnancy resources.

14Desired OutcomesIncrease the amount of African American teens who recieve adequate prenatal care.

Decreased Kent County African American teen pregnancy rates.

Educate on the health disparity of teen pregnancy and increased infant mortality.

Improve cost and availability of prenatal care for African American teens through community and government funding.

The desired outcomes for this project are to increase the amount of african american teens who receive adequate prenatal care. Demonstrate by decreased kent county african american teen pregnancy rates. Provide an increased awareness of the health disparity of teen pregnancy and increased infant mortality through education. And improve the cost and availability of prenatal care for african american teens by having The Director of public health nursing and public policy for MI petition the governor for public health funding targeted at this health disparity

15Intervention EvaluationIncreased number of Kotelchuck Indexes* recorded in Kent County within the adequate prenatal care range. Kotelchuck Index : An index of adequacy of prenatal care based upon 1) month of entry, 2) number of prenatal visits and 3) gestational age of infant at birth. Uses ACOG standards for number of visits (IDPH, nd).

Decreased Kent County African American teen pregnancy rates on annual Michigan Department of Community Health reports.

Post course survey of teens enrolled in the out reach program.

Increased amount of annual community funding and governmental grants.

Our interventions will be evaluated by Kotelchuck indexes, teen pregnancy rates, post course surveys and total project funding. To meet our desires outcomes we will need to see 1 2 3 416Theory: Maternal Role Attainment: Becoming a MotherBecoming a mother: Research on Maternal Identity from Rubin to the Present

Author:Ramona T. Mercer PhD, RN, FAAN

The kind of help or care a woman receives during pregnancy and over the first year following birth can have long term effects for her and her child. Nurses in maternal child settings play a sizeable role in providing both care and information during this period (Tomey & Alligood, 2006, p. 611). Nursing care and intervention is extremely important in the model of maternal role attainment because according to Mercer, nurses are the health professionals having the most sustained and intense interaction with women in the maternity cycle Ramona T. Mercer explains in one of her many publications, Becoming a mother: Research on Maternal Identity from Rubin to the Present, that The kind of help or care a woman receives during pregnancy and over the first year following birth can have long term effects for her and her child. Nurses in maternal child settings play a sizeable role in providing both care and information during this period

17Theory: Maternal Role Attainment: Becoming a MotherThis theory encompasses the target population of African American females 15-19 years of age in Kent County.

This model can also be generalized to all women during pregnancy through the first year after birth, regardless of age, parity, or environment (Tomey & Alligood, 2006, p. 618).

This theory encompasses the target population of African American females 15-19 years of age in Kent County.This model can also be generalized to all women during pregnancy through the first year after birth, regardless of age, parity, or environment The nurse assesses and evaluates the patient situation-does she have support systems? Is the father involved? What is her financial status? Assessing aspects like these, along with community and societal factors will aid the nurse in planning care for the patient, therefore implementing with success the best outcome for mother and child (Tomey & Alligood, 2006).

18ReferencesAlpha Womens Center of Grand Rapids. (2014). Were here to help. Retrieved from http://www.optionsforyou.orgCenters for Disease Control. (2012). About teen pregnancy. Retrieved from http://www.cdc.gov/TeenPregnancy/AboutTeenPreg.htm.American Academy of Child & Adolescent Psychiatry. (2012). Facts for families: When children have children. Retrieved from: http://www.aacap.org/aacap/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/When_Children_Have_Children_31.aspxCounty of Kent. (2014). Health education programs. Retrieved from http://www.accesskent.com/Health/HealthPromo/ed_program.htm#rrCounty of Kent. (2014). Pregnancy & parenting support services. Retrieved from http://www.accesskent.com/Health/PregnancyParenting/default.htm.D.A. Blodgett- St. Johns. (n.d.). For pregnant women. Retrieved from http://www.dablodgettstjohns.org/what-we-do/therapy-supportive-services/pregnant-women.Grand Rapids African American Health Institute (GRAAHI). (2013). Strong beginnings. Retrieved from http://www.graahi.org/Advocacy/StrongBeginnings.aspx.ReferencesIowa Department of Public Health (IDPH). (nd). Definition of terms. Retrieved from: https://www.idph.state.ia.us/IdphDefinitions/List.aspx?term=Kotelchuck%20indexKent County Health Department(KCHD). (2010). Kent county infant health initiative: interconception care program final report 2009. Retrieved from http://www.accesskent.com/Health/HealthPromo/pdfs/KCIHI_2009_AnnualReport.pdf Kent County Health Department (KCHD). (2014). Pregnancy & parenting support services. Retrieved from http://www.accesskent.com/Health/PregnancyParenting/default.htm.Martin, J., Hamilton, B., Osterman, M. , Curtin, S., Mathews, T.J. (2013) Vital statistics reports. Births: Final data for 2012 (vol. 62 No. 9). Retrieved from: http://www.cdc.gov/nchs/data/nvsr/nvsr62/nvsr62_09.pdf#table01Mathews, T.J. & MacDorman, M. (2013)Vital statistics Reports. Infant mortality statistics from the 2010 period linked birth/infant death data set (Vol. 62 No.8). Retrieved from: http://www.cdc.gov/nchs/data/nvsr/nvsr62/nvsr62_08.pdf Michigan Department of Community Health (MDCH). (2012). Estimated teen pregnancy rates & population. Retrieved from http://www.mdch.state.mi.us/pha/osr/chi/births/teenpreg/PREGCO.asp?DxId=1&CoCode=41

ReferencesMichigan Public Health Institute (MPHI). (n.d.). Kent county 2012 health improvement plan. Retrieved from http://www.kentcountychna.org/pdfs/KentCoCHNA_Final.pdfNational Conference of State Legislatures (2009). Teen pregnancy prevention. Retrieved from: www.ncls.org/documents/health/teenpregnancy09.pdf Patchen,L., LeTourneau, K., & Berggren, E. (2013). Evaluation of an Integrated Services Program to Prevent Subsequent Pregnancy and Birth Among Urban Teen Mothers. Social Work in Health Care,52(7), 642-655. doi:10.1080/00981389.013.797538Planned Parenthood of West and Northern Michigan, Inc. (2014). Irwin/Martin Health Center - Grand Rapids, MI. Retrieved from: http://www.plannedparenthood.org/health-center/centerDetails.asp?f=3295Publicschoolsreview.com (2014). Kent County High Schools. Retrieved from: http://www.publicschoolreview.com/school_ov/school_id/41022Tomey, A. M., & Alligood, M. R. (2008). Nursing theorists and their work (6th ed.). St. Louis, MO : Mosbys

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