sarah verbiest, drph, msw, mph center for maternal and infant health every woman southeast webinar...
DESCRIPTION
Target Population Mothers of medically fragile infants – from 25 counties across the state Recruitment UNC Newborn Critical Care Center – Regional Tertiary Care Center Intervention Immediate Care & IntensiveTRANSCRIPT
Sarah Verbiest, DrPH, MSW, MPHCenter for Maternal and Infant Health
Every Woman Southeast WebinarFebruary 10, 2011
Postpartum Plus Prevention Program (P4)
Program ObjectivesProvide high-risk mothers with the medical services, education, resources, and support they need to make positive improvements in their health and to implement a reproductive life plan.
Increase knowledge and understanding of the needs of this population and the best way to provide services to them.
Target PopulationMothers of medically fragile infants – from 25
counties across the stateRecruitment
UNC Newborn Critical Care Center – Regional Tertiary Care Center
InterventionImmediate Care & Intensive
Immediate Care• CNM available via pager
to assess and treat mothers of infants in the NICU.
• NICU Nurses most common referral source
• Previously these mothers were sent to the ER
• >400 patient service points
Intensive Care• Wellness Kit• Medical care and advice
– in NICU and beyond• Referrals • Psychosocial support• Telephone contact –
3,6,9,12 months• Available via pager or
email• Served 46 women
Immediate Postpartum Services
The CNM provided prescriptions during 40% of encounters and provided referrals for 10% of the
encounters.
Location of Services• 24% of the encounters were at the bedside • 76% were in the clinic
Duration of Services• 31% of the encounters were under 10 minutes• 49% were over 30 minutes (most well over an hour!)
Immediate Postpartum Health Issues
• Primary Care (41%)• Depression (20%)• Family Planning (15%)• Breastfeeding (13%)• Wound Check (11%)• Blood Pressure (8%)• Postpartum Visit (7%)
• Other Issues: Bereavement Domestic violence Health insurance Oral health Smoking
STIs
Intensive Postpartum Services
Spent a lot of time helping mothers navigate the health care system.
Location of Services• ~ 60% were via telephone• ~ 40% were in person via NICU, SICU or infant FU clinic
Duration of Services• Served mothers longer than planned (~18 mos)• No attrition• More frequent contact with mothers than expected
• Post Traumatic Stress Disorder• Family Planning• Reproductive Life Planning• Chronic Disease Management• Coping with Depression and Anxiety • Learning to Navigate the Health Care System• Setting Health Goals: lose weight (62%),
exercise more (47%), manage stress (20%), other goals (20%), no goals (16%)
Ongoing Postpartum Health Issues
• It is difficult to provide services to only some women in the NICU – programs need to serve everyone in some capacity.
• Program perceived favorably by NICU staff – seen as a valuable resource.
• The NICU setting is not an appropriate place to conduct wellness programs. Mothers’ needs are more immediate, basic and critical.
• Wellness messages need to be tailored to the woman’s current situation, including her baby’s health status. It really is all about the baby.
Lessons Learned
• Women still have significant challenges at 6-18 months postpartum.
• There are significant primary care and obstetric needs among this population – both while in the NICU and beyond.
• Some services, such as access to contraception, need to be immediately available in the NICU postpartum, but true RLP is difficult to initiate before 6 months.
Lessons Learned
• Recruiting from NICU doesn’t capture “near misses”.
• Many pathways to NICU admission.• Broken system of postpartum care for mothers. • Need stronger research data on impact of care
coordination.• Inadequate pediatric resources to support
parents of medically fragile infants.
Challenges
• Allocate adequate time and resources to allow for relationship building with mothers prior to program recruitment.
• Increase attention to and quality assurance of postpartum care to NICU moms (tobacco use).
• Offer some services at baby’s bedside.• Consider reaching women through services
provided to their infants.
Recommended Strategies
Additional Outreach
Integrative Approaches to Optimizing Mental and Physical Health among Adolescents & Women of Reproductive Age
7-Part Webinar Series launching on March 16, 2011
Webinars and related resources will be housed at Every Woman SE
Training grant funded by U.S. Health Resources and Services Administration’s Maternal and Child Health Bureau
Women’s Integrated Systems for HealthWISH
3rd National Summit on Preconception Health
June 12-14, 2011Tampa, Florida
Register at beforeandbeyond.org
Every Woman SE has been invited to be a
partner in convening this Summit!
