services to pregnant women webinar.ppt

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Welcome to the Arizona Head Start Training and Technical Assistance Office 2010 Summer Webinar Series. Please remember to mute your phone (*6) in order to assure the clarity of the audio portion of the program. For those who attend today’s

webinar, a certificate of attendance will be emailed within 48 hours. For those who are viewing this webinar as a group, the email address signed on will be the recipient of the certificate and will be that person’s responsibility for forwarding the

certificate to other attendees. Our webinar today is entitled Home Visiting Part One. My name is Tina Sykes and I will be the facilitator of today’s session. I am the infant/toddler specialist of the T/TA office. I have many years of experience working in Early Head Start both as a Family Support Specialist/Home Visitor and as a

supervisor of home visitors. I am excited to share this time with you today

discussing Services to Pregnant Women and Families in Early Head Start.

Due to the nature of this webinar, if you have questions, please type them into the

question box on your screen and I will do my best to answer them if time permits. In

the event we run out of time, I will respond via e-mail to all webinar participants.

The objectives for today’s webinar are:

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So why does Early Head Start serve expectant families? Well, for several reasons.

According to the Centers for Disease Control and Prevention, there are certain activities a woman does during pregnancy that will directly affect the health and development of her newborn child.

For Example: 1) Cigarette smoking during pregnancy increases the chances of premature birth, certain birth defects, and infant death. Women who smoke during pregnancy are more likely than other women to have a miscarriage and to have a

baby born with a cleft lip or cleft palate--types of birth defects. Smoking is one of

the causes of problems with the placenta and can cause a baby to be born too

early and have low birth weight. Smoking is also one of the causes of Sudden Infant Death Syndrome (SIDS

2)Taking folic acid daily both before pregnancy and during the first few months

of pregnancy to reduce the risk of birth defects of the brain and spine. All women

who could possibly become pregnant should take a vitamin with folic acid, every day.

3) Legal drugs such as alcohol and caffeine are important issues for pregnant

women. There is no known safe amount of alcohol a woman can drink while pregnant. Fetal alcohol syndrome , a disorder characterized by growth retardation, facial abnormalities, and central nervous system dysfunction, is caused by a

woman's use of alcohol during pregnancy.

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There are developmental problems that occur pre-natally that can affect a child after birth. According to the Encyclopedia of Children’s Health, although 90 percent of

babies born in the United States are considered healthy, abnormalities may arise during prenatal development that are considered congenital (inherited or due to a genetic abnormality) or environmental. In other cases, problems may arise when a

fetus is born prematurely. Here are some examples of Genetic Problems :Down Syndrome – Also known as trisomy 21, Down syndrome is the most common

genetic anomaly during prenatal development. Down syndrome is caused by and

extra copy of the 21 chromosome (meaning there are three chromosomes instead of the usual two) and impacts approximately 1 out of every 1,000 infants. Typical

features of Down syndrome include flattened facial features, heart defects, and mental retardation. The risk of having a child with Down syndrome increases with

maternal age. Inherited diseases – A number of illnesses can be inherited if one

or both parents carries a gene for the disease. Examples include Sickle-cell anemia,

Cystic fibrosis, and Tay-Sachs disease. Genetic tests can often determine if a parent is a carrier of genes for a specific disease. Along with genetic issues, there

are also harmful environmental elements that can effects the fetus: Some examples of environmental issues are Maternal Drug Use – The use of substances by the

mother can have devastating consequences to the fetus.. Maternal Disease –

There are a number of maternal diseases that can negatively impact the fetus,

including herpes, rubella, and AIDS. Herpes virus is one of the most common

maternal diseases and can be transmitted in the fetus, leading to deafness, brain swelling, or mental retardation. Women with herpes virus are often encouraged to

deliver via cesarean to avoid transmission of the virus.

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Early and continuous are key words. EARLY: it doesn’t get much earlier in a child’s life than pre-natal. CONTINOUS: Early Head Start is a pregnancy to 3 program. It is

the intent of the HS Act (Section 645 A (b)(1)(2) that once a child is born to an enrolled pregnant woman, the EHS program will serve the child. EHS is a child development program for low income families and EHS services are intended to be

“continuous, intensive and comprehensive.”

Early Head Start programs are in a unique position to support pregnant women and

can offer this support through a combination of systems and services.

Now let’s take a look at eligibility and enrollment of expectant families…

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Early Head Start programs may elect to target their services to a particular population to best meet the unique needs of families and children in their

community.

A pregnant woman and her family should be informed prior to enrollment that EHS

is intended to serve the family prenatally and through the child’s first 3 years of life. Parents should also be informed of the program options in order to determine a match between the family needs and what EHS can offer after the child is born. Not

all pregnant women in the community are suitable candidates for Early Head Start programs. Pregnant women who do not anticipate a need for EHS services after

their children are born, are not appropriate candidates for EHS.

If you are unsure of the eligibility criteria for expectant families in your program, talk with your supervisor.

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Pregnant women enrolled in EHS are part of the EHS funded enrollment. However, pregnant women and their families are not enrolled in HS program options.

Therefore, regulations governing program options do not apply to pregnant women. Program staff have the flexibility to determine how services will be provided through the individualized Family Partnership Agreement Process. For example: although

many services to expectant families can be delivered via home visits, EHS staff members are NOT required to follow the frequency and duration of home visits that

are required in the home based program option for children.

Now let’s talk about eligibility…

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Family income is one key factor in determining eligibility. The federal poverty guidelines are used to evaluate family income.

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If the teen is not married, her own income determines eligibility regardless of her parent’s income. It is also very important to note the income of the baby’s father is

not used to determine income eligibility even if she lives with him.

It is important to consider factors in addition to income such as social supports

and/or access to resources when determining if a pregnant teen is an appropriate candidate for EHS.

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Pregnant women may come to EHS through many different routes and each one will have a slightly different enrollment process.

SO Let’s practice determining eligibility and enrolling some pregnant women in our community. I am going to read 4 scenarios to you of pregnant women who are

interested in enrolling in EHS. These scenarios include information that will help determine if the family is eligible for enrollment into EHS. Based on the information given, we will answer these four questions for each:

What is the family size?

Whose income needs to be used to determine income eligibility?

Is EHS a good fit for this family? Why or why not?

If so, which program option would appear to be the best fit for this family and why?

(Although you do not have a lot of information, base your decision on what you do know about all members of the household)

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What is the family size? 2: Anahi and her unborn child

Whose income needs to be used to determine income eligibility? Only Anahi’sbecause she is an unmarried teen

Is EHS a good fit for this family? Why or why not? Yes: Anahi and Esteban have

expressed a need for information, resources and support

If so, which program option would appear to be the best fit for this family and why? (Although you do not have a lot of information, base your decision on what you

do know about all members of the household) Center based due to Anahibeing enrolled full time in high school

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What is the family size? 4: LAYLA, JAMES, JADA (THE 15 MONTH OLD) AND THE UNBORN CHILD

Whose income needs to be used to determine income eligibility? LAYLA AND HER HUSBAND JAMES

Is EHS a good fit for this family? Why or why not? IT APPEARS SO: LAYLA HAD COMPLICATIONS IN HER FIRST PREGNANCY AND IS SEEKING INFORMATION AND RESOURCES REGARDING SIBLING ADJUSTMENT


do know about all members of the household) Since both parents work part-

time, either center based or home based could be appropriate for this

family


What is the family size? 6: Jasmine, Lou, their 7 year old, 5 year old, 30 month old and unborn child

Whose income needs to be used to determine income eligibility? Lou’s income

Is EHS a good fit for this family? Why or why not? It depends. If the family only

anticipates needing support and services during pregnancy, EHS is not a good fit

If so, which program option would appear to be the best fit for this family and why?

(Although you do not have a lot of information, base your decision on what you do know about all members of the household) home based or center based


What is the family size? 2: Rebecca and her unborn child

Whose income needs to be used to determine income eligibility? Only Rebecca’s. It is also important to note that we do not include the child support her mother receives for her as part of Rebecca’s income

Is EHS a good fit for this family? Why or why not? Yes based on her age.


do know about all members of the household) Possibly home based. Due to Rebecca’s previous struggles with getting to school, she may also

struggle with getting her child to center based services

Now that eligibility and enrollment have been determined, what services are Early Head Start programs required to provide? Let’s take a look at the Head Start

Performance Standards to find out…


The Performance Standards identify the major topics to be covered in prenatal education efforts. These include information about:

typical fetal development, including the risks of smoking and drinking alcohol; what to expect during labor and delivery; postpartum recovery, including maternal

depression and the benefits of breastfeeding

Prenatal education can take many forms: written materials, informal conversation, structured classes, videotapes, one-on-one instruction, or group meetings with other

expectant parents. The role of EHS staff is to serve as an advocate and liaison

between expectant parents and service providers2. EHS program activities may range from providing transportation to community-based prenatal classes, to

providing referrals to substance abuse treatment programs, or using written materials to explain the stages of fetal development.

Written or audiovisual materials are popular and useful tools for explaining many of

the physical changes that occur during pregnancy and child birth. It is a challenge for EHS staff to sift through the vast array of materials, identify the best resources,

and carefully select what will most effectively meet the individual and diverse needs

of participating families, as well as how the information should be delivered. The

needs and resources of participating families, the individual expertise of EHS staff

members, community partners, and the Health Services Advisory Committee are

critical links in planning an effective approach to prenatal education.


EHS program must assist expectant families in accessing

Comprehensive pre-natal health care: Pregnant women must be connected to health care providers, and ultimately a “medical home.” A medical home is a place where an individual will receive routine health care, and ideally, establish an ongoing

relationship with a familiar health care provider. A pregnant women will need a medical home to have her health monitored during pregnancy, to gather information on the status of her developing child, and where she will continue to receive medical

care following the delivery of her baby. Oral health and a regular source of dental care are equally important during pregnancy. The baby will also need a medical

home for well-baby checkups and immunizations.

Along with resources that allow EHS parents to access comprehensive health care, they must also receive information on good eating habits and proper diet.

Along with comprehensive health care, EHS programs must assist families in

access Postpartum Health Care: this care includes

Early and continuing risk assessments: includes assessment of nutritional status, nutritional counseling and food assistance as needed

Health promotion and treatment: medical and dental examinations on a schedule

deemed appropriate by attending health care providers as early in the pregnancy as

possible

Mental Health intervention: including substance abuse prevention and treatment

This sound like a lot, but don’t worry. Most of this all can be done through referrals

to community agencies. We will now look at the community assessment which will

help programs determine the resources available for pregnant women and families.

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EHS grantees must conducted community assessments within the service area once every 3 years

Grantees must review for changes every year.

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EHS grantees use this information to develop the specific services for the pregnant women in their community. The Community Assessment paints a picture of a

community at a point in time. It identifies community resources as well as needs or gaps in services. For example, a Community Assessment in a rural area might reveal that there is a shortage of obstetricians, and that pregnant women are not

receiving adequate prenatal care because they do not have transportation to medical facilities in neighboring towns. The EHS program might address this need

by assisting the EHS pregnant women in accessing transportation, or by developing

partnerships with other agencies that could bring qualified health care providers into

their community. Alternatively, a Community Assessment might reveal a high rate of

teenage pregnancy. In this case, the EHS program might collaborate with local

schools to offer supportive services that allow teens to remain in school while planning for the birth of their child and for the services they will need following

delivery.

A Community Assessment may also reveal that services to pregnant women are readily available in the community and women have access to them. Under such

circumstances a best practice in EHS might be to complement the services that are

already available by serving as a point of referral to the existing services or by developing collaborative agreements with agencies serving pregnant women.

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Creating community partnerships to support the growth and development of children and families to make their lives better [is a key focus in Head Start]. Without doubt,

your Head Start program is already involved in community partnerships of varying levels. Some of those partnerships may be at the communication or networking level, where staff exchange information about community programs and services.

Others may be at the coordination level, where staff work with other community agencies to avoid duplication of efforts or to fill gaps in services. Cooperation is yet

another level of community partnership where two or more programs conduct joint

activities to meet their individual goals.

Collaboration, however, is the most intense level of community partnership. It

involves programs working together toward common goals could not be achieved by

any program acting alone. Resources, information, and activities are shared by the collaborative partners to turn the goals into reality.

Collaboration with community partners is essential to the design and management

of a high-quality EHS program serving pregnant women. Some examples of potential community partners include: health clinics, transportation services,

counseling and other mental health programs, doula services, or translation

services for non-english speaking families.

Community partners are also some of the best resources for referrals. Formal as

well as informal relationships with service agencies that come into contact with

pregnant women increase the exposure of EHS in the community.

As you can see, community partnerships are important. Family partnerships are also essential to serving expectant families.

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Programs that serve expectant parents are challenged to meet the varied and complex needs of mothers and fathers during such an important time in the life of

the family. The needs of families vary based on family and cultural differences, personality and coping styles, health and medical status, stage of the pregnancy, and a host of other variables. There are many resources to help EHS staff

successfully meet this challenge. The key is individualizing the approach to fully engage parents, fulfill the requirements of the Performance Standards, and give

each baby the best possible start in life.

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Parents have the right to determine how much information they want to share and withwhom; when they are ready to set goals; how long it will take to achieve those goals; andhow to measure their success.

At the same time, staff members are expected to offer opportunities for goal-setting as acontinual part of their collaboration with families

Yet, the process of helping families identify their goals can offer them hope and a place to begin taking the steps they need to change the future.

It is also important to keep in mind that sharing goals is intimate work. Goals must be meaningful for families to feel motivated to move towards them, but it can be difficult for families to share these goals with staff when relationships are new. The supportive relationships that staff members create with families over time can open the door to allow families to share, sometimes for the first time, goals related to hard issues like substance abuse or depression. Allow families the time they need to get comfortable with you and the Early Head Start program.

You need to first establish a trusting relationship before you can expect family members to openly discuss their needs and challenges.

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This is the process of developing the Family Partnership Agreement

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A family partnership agreement is not a form that you fill out, or ask parents to fill out. It is the process through which you support families in Head Start. Thus, it is an interactive experience that happens over time and can include many different types of interactions. This process is not a one-time “event,” such as a formal meeting. There are many types of interactions that can be a part of the process, such as:

Helping families identify and reach their goals; identify and use their strengths and resources; and advocate for their children.

Offering opportunities for family members to enhance their skills or build new ones; Providing access to community resources, and

emergency or crisis assistance when needed; and Supporting any pre-existing family plans. In order to achieve this, a family partnership approach must be used.

(U. S. Department of Health and Human Services,Family Partnerships: A Continuous Process, 1999).

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The family partnership agreement process encompasses both how you approach family partnerships, and how families choose to be involved in your program. The family partnership agreement process is individualized and family driven. Thus, parents have the right to determine how much information they want to share and with whom; when they are ready to set goals; how long it will take to achieve those goals; and how to measure their success. At the same time, staff members are expected to offer opportunities for goal-setting as a continual part of their collaboration with families.

It is important to remember that setting goals and working toward them can be challenging for families under stress. Living in poverty can raise barriers and dampen optimism about the future. It can be difficult for families to see beyond their current crises or life circumstances, especially if they are struggling with additional stressors that go along with poverty, such as limited education, homelessness, substance abuse, or poor health.

Let’s take a look at some stressors I will call “special deliveries” that can be found in some expectant families.

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There are some pregnancies that are considered high risk due to the maternal factors such as age, disabilities, and delays. We must also face the fact that there

are also pregnancies that end in miscarriage or still birth. For the sake to this training, we will call these situations “Special Deliveries”.

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Some people feel that teens are hard to engage simply due to their age and maturity levels. Knowing that is important for pregnant teens to get information

regarding their pregnancy, what are some effective strategies you can use to engage pregnant and parenting teens?


Here are some strategies to use when partnering with teen parents

Persistence: often teens will test you to see if you really care enough to chase them down after they reject you. Be sure to drop by, send letters, call, text to show them that you are not just another adult trying to tell them what to do, but that you do care. Be positive, so instead of saying “you weren’t there”, try “Sorry I missed you.”

Creativity: If you can, get creativity in the way you complete paperwork. If it is possible to put off some of the paperwork for one visit, in order to do something fun and engaging. This shows the teen that EHS is much more than paperwork. Give the teen some of the responsibility for planning the visit. If the visit is centered around something the teen wants to do, they will be more likely to participate.

Teen teach: let the teen teach you something…their native language, pop culture, or what they are learning in school. This helps begin the process of the teen becoming their teacher of their child.

Listen: For some teens, having someone REALLY listen to them is unusual. Listening may be the most valuable service you provide and one of the things they’ll appreciate most about you.

Co-workers: when you get stuck, ask your co-workers what has worked for them. Sometimes the best ideas are accidental, and you’d never think to try them.

Try again: What works for one teen may not work for another. Use a variety of strategies and don’t give up.

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According to the 2000 Census, there were 3.9 million multigenerational family households in the United States, representing approximately 4% of all households

and socioeconomic statuses. Written: July 2006 © Copyright 2006, Generations United

Many pregnant and parenting teens are living in multigenerational households.

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Gain an understanding of the role each family member plays within the family: for example, it is important to know who is the decision maker, who is the parental authority, and what role the enrolled parent plays

in their home. You also must balance the various parenting styles that may be present in the home

Develop professional relationships with all members of the family: it is

important to developing a comfortable relationship with all family members who take an active role in parenting the EHS child.

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When partnering with expectant parents with disabilities, there are various types of disabilities to consider.

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Here are some strategies for partnering with expectant parents with disabilities

Knowledge of disability: research the disability and ask questions. It is important to know what the family is experiencing

Knowledge of challenges:. For example: For a blind "soon to be mother," some of the birthing material is in print only: child's ultrasound. Deaf women might need an interpreter when dealing with hospital staff.

Communication with family members and health care providers: for example: A diabetic who is also pregnant should take special precautions with their diet. All of these challenges can be discussed with a doctor. Doctors are pros at addressing the physical challenges that are associated with pregnancy.

Knowledge of Adaptive Equipment: research has shown that such equipment can have a positive impact on parent/infant interaction, in addition to reducing difficulty, pain, and fatigue. By reducing the physical demands of care-giving, the equipment can also be instrumental in preventing secondary disability complications.

Understanding that the disabled woman who is pregnant is quite similar to the able-bodied pregnant woman: She deserves all of the excited talk and expressions of encouragement, just as her able-bodied peers. Most likely, she has thought about many of the challenges and probably has found others who will help her overcome them. Make it a happy time for mother and baby.

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Miscarriage: According to the American Pregnancy Association, most miscarriages occur during the first 13 weeks of pregnancy. Pregnancy can be such an exciting

time, but with the great number of recognized miscarriages that occur, it is beneficial to be informed about miscarriage, in the unfortunate event that you find yourself working with a family faced with one.

Stillbirth: According to Share: Pregnancy and Infant Loss Support Inc, in about half of all stillbirths, a cause for the baby’s death can be discovered after evaluating

the baby. It is possible for the baby to have birth defects, or problems with the placenta or umbilical cord. Another cause can be found in maternal circumstances

such as an illness or recreational drug use. Unfortunately, for many stillbirths, the

cause for the baby’s death can remain undetermined.

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Unfortunately, miscarriage can affect anyone. Women are often left with unanswered questions regarding their physical recovery, their emotional recovery

and trying to conceive again. It is very important that women try to keep the lines of communication open with family, friends and health care providers during this time. Here are some strategies for partnering with parents experiencing miscarriage and

still birth

Give parents time: The parents of a baby who has died will need time to grieve.

The average intense grief period is 18 to 24 months. Parents will go through

ups and downs during that time. The future holds many milestones that will be missed like first steps, the first day of kindergarten, toothless grins, or a sweet

sixteen.

Acknowledge a parent’s grief and remember with them: although it may be

difficult to talk about, it is important that you acknowledge the loss. This can be done

by simply saying, “I’m here for you” or “I am sorry for your loss.” Communication:

Bereaved parents need a safe person and/ or place to talk about their baby and the feelings they are experiencing. They need to be heard without being judged or

receiving unwanted advice. Allow the parents talk openly about the pregnancy, the

birth, and any future plans or dreams they may be missing. Communicate with Health Care: It may also be necessary to get written permission to communicate

with health care providers to get a greater understanding of the situation and to help

the grieving parents and their family. Resources: The parents may have a lot of

questions or simply may be in a state of shock. Providing resources that can be

easily reached when the parent is ready is extremely important. Acknowledge your

own feelings: Your own personal experiences with loss may have an affect on how

you partner with a family experiencing miscarriage and still birth. It is important to

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This follow-up is critical for pregnant women. Tracking services to make sure appointments are kept, needed services are provided, and that problems (with

either the family or a community service provider) are identified and addressed early on are yet another way to ensure high-quality services.


Record keeping: Many of the services for pregnant women are delivered in partnership with community agencies. Up-to-date and comprehensive records are

necessary to ensure that these services are of high quality, delivered in a timely manner, and that any follow-up activities are carried out appropriately. Record keeping is also essential in documenting how services are meeting the Performance

Standards and other federal or state regulations; following the progress of individual families; and to identify the emergence or resolution of specific issues across the entire program.

Reporting: Formal, written reports of program progress for services to expectant parents provide governing bodies and staff with the information needed to

continually assess and improve the quality of program services.

Self-assessment and monitoring: High-quality services to expectant parents

require on-going review and reflection to remain responsive to families needs. Seek both formal and informal feedback on how program services are having an impact.

Use this information to build on program strengths and identify areas to improve.

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BEFORE SLIDE

I believe if we want to improve ourselves we must first examine ourselves. This is self reflection. So when you hang up the phone on this webinar, here are some

questions to consider…

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The Arizona Head Start Training and Technical Assistance Office and STG International thank you for joining our webinar today. Please contact Mary Kramer Reinwasser, at [email protected] for more information about

our 2010 Summer Webinar Series occurring every Tuesday and Thursday during the months of June and July at 3:00 Pacific Daylight Time.

ONLY SHOW SLIDE IF THERE IS TIME FOR QUESTIONS

services to pregnant women webinar.ppt

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