Interconception Education and Counseling: Strategies from Florida

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Interconception Education and CounselingStrategi
es from Florida

• Presented by Betsy Wood, BSN, MPH
• Infant, Maternal Reproductive Health Unit
• Florida Department of Health

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Florida 2005 Current Affairs

• 1st Trimester entry into prenatal care decreased
  from 85.8 in 2003 to 81.0 in 2004.
• Healthy Start Prenatal Risk Screening to identify
  high risk women increased from 59.73 in 2004 to
  66.53 in 2005.
• Infant Mortality Rate increased from 7.0 in 2000
  to 7.5 in 2003, then decreased to 7.0 per 1000
  live births in 2004.

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Floridas Pregnancy Associated Mortality Review
(PAMR)

• A review of cases where death of a woman has
  occurred, from any cause, while she is pregnant
  or within one year of termination of pregnancy,
  regardless of duration and site of the
  pregnancy.
• CDC and ACOG definition of maternal mortality

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PAMR 1999-2002

• 67.1 of women with pregnancy related deaths had
  a history of chronic disease or condition.
• Many had multiple chronic illnesses.
• Most common
• Obesity 11.8
• Hypertension 11.2

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PAMR 1999-2002

• Showed higher mortality rates for
• Black women,
• Women gt35 years old,
• Overweight and obese women.
• Women who are obese have odds of pregnancy
  related mortality that are
• 2 to 5 times higher than the odds for women of
  normal weight.

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Perinatal Periods of Risk Data

• Categorizes feto-infant mortality according to
  gestation at death and birth weight at delivery
• Maternal Health Prematurity
• Maternal Care
• Newborn Care
• Infant Health

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Florida PPOR MAP 1998-2002 Birth
Cohort 1,008,318 Fetal Deaths and Live Births

Infant Health 1845
9798 Fetal-Infant Deaths
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Fetal Infant Mortality Review

• 12 local FIMR projects covering 30 Florida
  counties.
• Statewide FIMR Trends
• Need for pregnancy planning
• Poor Nutrition
• Need for early prenatal care
• Need for health awareness related to STDs

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Recommendation 8 Infuse and integrate
components of preconception health into existing
local public health and related programs.

• Floridas Healthy Start Standards and Guidelines
• Chapter 21 Healthy Start Services
• Interconceptional Education and Counseling
• A collaborative initiative between Floridas
  Department of
• Health and Local Healthy Start Coalitions

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Healthy StartInterconceptional Counseling and
Education Topics

• Substance Abuse
• Smoking
• Mental Health
• Concerns
• Environmental Risk
• Factors
• Chronic Health
• Problems

• Access to Care
• Baby Spacing
• Nutrition
• Physical Activity
• Maternal Infections

http//www.doh.state.fl.us/family/mch/training/icc
/icc.html
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Key Implementation Components

• Culturally Sensitive
• Considerate of clients educational and literacy
  needs.
• Inclusive of father, family, and/or significant
  other.
• Tailored to the clients needs

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Interconception Education Target Audience

• Women with previous poor birth outcome
• Women with behavioral or environmental issues
  contributing to poor birth outcomes that have not
  been resolved during pregnancy regardless of
  birth outcome

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Implementation

• Coding
• Services can be provided to a Healthy Start
  mother or on behalf of a Healthy Start Infant,
  and are coded in 15 minute increments.

• Providers
• Providers are trained and qualified professionals
  and paraprofessionals.

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Opportunities for Interconception Education

• Family Planning
• WIC
• Federal Primary Care Clinics
• Prenatal Care
• STD and HIV Clinics and Care Coordinators
• Childrens Medical Services Clinics and Care
  Coordinators
• Pediatric Care
• Child Care Facilities

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Preconception Education Target Audience

• Women of childbearing age
• Families of women of childbearing age
• General public

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Vitagrant Program

• Multivitamin settlement - 2 million
• Partnership between March of Dimes and Department
  of Health
• MOD staff housed at DOH
• Vitamin with folic acid distribution expanded to
  include preconception education

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Integration of Preconception Education and
Counseling Services

• Technical Assistance Guidelines were developed
  for use by all 67 County Health Departments (CHD)
• Education can be provided in any CHD setting
  where women are accessing care
• Mostly used in family planning clinics

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Other Opportunities for Preconception Education

• Primary Care Clinics
• School Health Programs
• STD and HIV Clinics
• Care Coordinator interactions
• Health Fairs

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Next Steps

• Childrens Medical Services
• provided preconceptional brochures, resource
  lists, and information sheet to Early Steps for
  distribution at their statewide meeting
• will be providing a 1.5 hour inservice on
  interconceptional topics to CMS providers
  (therapists, MD's, mental health providers, case
  managers, etc) at their Bi-annual meeting in
  June, 2006.
• invited to join the March Healthy Start
  Interconceptional Education and Counseling
  webinar

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Next Steps

• School Health
• provided preconceptional brochures and link to
  online training.
• scheduled to provide a 30 in-service on the
  School Health Meet Me Call on March 2, 2006
• Doulas
• will be providing a training for the local Doula
  Program.
• training both Birth and Postpartum doulas
• focusing on ensuring providers are able to
  reinforce education about interconceptional
  issues when interacting with their clients

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Next Steps

• WIC and Breastfeeding support paraprofessionals
• will be providing training with these groups.
• provided a link to our online training
• invited to join the March Healthy Start
  Interconceptional Education and Counseling
  webinar
• Community Colleges
• contacting community college and university
  health centers to distribute preconceptional
  brochures
• starting a "Sticker Campaign" that would involve
  placing a sticker reminding women to take folic
  acid on all birth control pill packs dispensed
  from their pharmacies. (This is still in the
  planning stage.)

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• Questions?