the role of public health nutrition in the new maternal, childhood, and early childhood home...
TRANSCRIPT
The Role of Public Health Nutrition in the new Maternal, Childhood, and Early
Childhood Home Visiting Program
Jeanne Blankenship, MS RD CLEVice President, Policy and Advocacy
American Dietetic Association
Objectives
• What the home visiting models must include• Examples of home visiting models• Examples of different roles for public health
nutritionists• How to advocate for the RD/public health
nutritionist in your state plan• Questions and discussion
Secretary Sebelius
“Through the Maternal, Infant, and Early Childhood Home Visiting Program, nurses, social workers, or other professionals meet with at-risk families in their homes, evaluate the families’ circumstances, and connect families to the kinds of help that can make a real difference in a child’s health, development, and ability to learn - such as health care, developmental services for children, early education, parenting skills, child abuse prevention, and nutrition education or assistance. ”
5 model programs identified
• Nurse Family Partnerships• Parents as Teachers • Healthy Families America • Parent Child Home Program• Home Instruction for Parents of Preschool
Youngsters
Major Themes: 5 Home Visiting Models
Target Population: • Low income• High risk• Currently pregnant or recently gave birth• First time mothers• Low education level
Major Themes: 5 Home Visiting Models
• Service Onset:– Pregnancy– 2 weeks old – 4 years
• Service Duration:– Until child is enrolled in school
(preschool/kindergarten)– 2 – 2 ½ years
Major Themes: 5 Home Visiting Models
• Visit Intensity (30-60 minute sessions):– Once a week– Monthly, bimonthly– Combination of home visits and group meetings– “Program year” considered a minimum of 23 visits
Major Themes: 5 Home Visiting Models
• Goals and Services Provided:– Role playing (curriculum)– Developmental screenings– Link to resources– Interaction (verbal, sensory, motor, connection
between child and parent)– Encompass 4 out of 6 benchmarks
Major Themes: 5 Home Visiting Models
• Staff Training:– Train-the-trainer approach– 4 – 5 day trainings with wrap-around and follow-
up trainings
Major Themes: 5 Home Visiting Models
• Evaluation:– Program plan which includes evaluation plan, site
development guide– Annual Program Report submitted with
recertification materials– Evaluate family outcomes, track progress– Online database (Home Visitor responsible to
impute data)– Site visits, technical and training support
The Role of the RD
• The evidence for inclusion of nutrition services– USPSTF “B” recommendation– Setting versus content– Abstract and summaries have been posted on the
website
The Role of the RD
• Program development and oversight– Defining protocols for delivery of care
• Provision of MNT and/or nutrition education– High risk indicators
• Training of professionals and paraprofessionals
• Development of nutrition education tools• Data analysis and interpretation– Ensures validity and reliability of data
RD’s Role in Positive Maternal/Child Health Outcomes
Nutrition Assessment:• Prenatal nutrition, reduce LBW risk • Infant and Pediatric Nutrition– School readiness (anemia, attention)– Physical growth, biochemical indices 1-6
– Feeding practices with infants and toddlers (feeding and elimination) 3, 7, 8
– Symptom/disease management 3, 9
– Resources, source of referrals 10, 11
RD’s Role with Direct Patient Contact in the Home
– Tube feeding of child– Special healthcare needs– Failure to thrive– Not showing up for prenatal appointments in clinic– Gestational diabetes; blood glucose monitoring– Excessive weight gain or weight loss– Preeclampsia– Pantry evaluation- especially for newly arrived immigrant
families with young children– All other maternal, infant, and child entities on a therapeutic
diet; knowledge of disease-specific nutrient requirements– Breastfeeding support– Preterm birth
Direct Referral Indicators
• Risk indicators defined in other programs• Increased acuity• Aggressive intervention opportunity• Direct involvement with primary care• Cross linkage with other programs when
stable
Example: Anemia• Pregnant women – Ferritin 6, Hgb 9 during first TM• Review– History and diagnoses– Labs– Diet (iron intake, inhibitors)– Supplementation
• Competitive nutrients• Compliance
– Medications– Clinical signs and symptoms of deficiency
• Hair, skin, nails, pagophagia, fatigue, decreased memory , concentration, tacchycardia, etc
Example: Anemia• Food resources and quality• Assessment and Diagnosis
– Altered nutrition related labs r/t xx as evidenced by xxx.• Intervention
– Supplementation– Behavioral – increased adherence– Nutrition education – high iron foods
• Monitoring and Evaluation– Lab improvement– Decreased clinical symptoms– Servings of high iron foods– Increased adherence
Training and Education
• Examples of training programs are available for several key areas
Nutrition Education Materials
• For use by– professionals– Paraprofessionals– RDs
– Integration of materials available by other collaborative programs
Accurate data analysis: 24 hour dietary recalls, food diaries, BMI charting, biochemical indices,
review of household food inventories
– Accurate interpretations and recommendations• Classification of available foods• Use of food resources and programs
– Portion sizes• Data for 24 hour recalls greatly influenced by method of
collection– Visual and verbal cues– Food environment
• Candy and other snack foods• Pantry and Refrigerator
– Physical environment • Resource allocation (ie TV’s in each room)• Lack of furniture and appliances
Example of Effective Program
• Colorado’s Prenatal Plus Program25
– Participants: high-risk childbearing and postpartum women on Medicaid
– Goals: reduce incidence LBW/improve nutritional health
– 5 nutrition contacts in the home with RD: assist in developing and maintaining healthy lifestyle & self-efficacy to appropriately use existing resources
Example of Effective Program
• n= 3567 Medicaid-eligible women• 80% of those who received full package of
services (All R.D., mental health, and care coordinator) decreased some or all risk factors for LBW vs. 68% who didn’t receive full package
• 6.7% LBW infants compared to 17.2% when inadequate weight gain was resolved
How to Advocate for RD Involvement in Your State
• Acknowledge scope of services and resources• Identify cost-effective strategies to address gaps
in services• Highlight evidence of home visits and of nutrition
intervention with similar populations• Take advantage of 25% of funding for new
programs• Work with local dietetic association in each state– ADA will provide a contact list for each state– ADA can assist with outcome measure development
for RDs
Questions and Discussion
Jeanne Blankenship, MS RDVice President, Policy Initiatives and
202-775-8507Ext. 6004