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Bright Beginnings: An Activity of Project Blossom

Bright Beginnings: An Activity of Project Blossom. Kimberlee Wyche-Etheridge, MD, MPH Nashville, TN CityMatCH Conference. The Rationale. Women who start PNC early in pregnancy are more likely to: Increase their chances of having a healthy pregnancy

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Bright Beginnings: An Activity of Project Blossom

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  1. Bright Beginnings: An Activity of Project Blossom Kimberlee Wyche-Etheridge, MD, MPH Nashville, TN CityMatCH Conference

  2. The Rationale • Women who start PNC early in pregnancy are more likely to: • Increase their chances of having a healthy pregnancy • Increase their chances of keeping their infants healthy

  3. The Rationale • Prenatal care (PNC) forms the cornerstone of services offered to pregnant women • Traditionally PNC includes 3 Parts - Risk assessment - Medical treatment - Health education

  4. The Data • In Nashville: • 84.6% of pregnant women entered prenatal care during the first trimester • 74.8% of young women10-19 entered prenatal care during the first trimester Health Department, 2001

  5. The Data • In Nashville: • 59 babies were born for every 1,000 females 15-19 • 52 for Whites • 80 for African Americans Health Nashville 2000

  6. The Data • In Nashville: • 11% of babies born to teens 15-19 were low birth weight • 10.2 for whites • 12.3 for African Americans • 12.9% were born premature • 9.7% for whites • 16.6% for African Americans TN State Dept of Health 2000

  7. The Data • PPOR taught us: • The major contributors to the overall feto-infant mortality rate in Nashville are deaths among VLBW babies (Maternal Health/Prematurity) and postneonatal deaths (Infant Health) • Younger mothers with less education are at higher risk for poor birth outcomes • African American women of all ages and education levels are at higher risk for poor birth outcomes PPOR Report 2003

  8. Project Blossom • Mission: To optimize maternal and infant outcomes in Davidson County • Goals • To decrease Infant Mortality and Eliminate Perinatal Disparities • Make MCH a Community Priority • Improve the health of reproductive aged women

  9. The Response:Bright Beginnings Goals: • To increase 1st trimester prenatal care for young women 15-19 who are health department clients with a (+) pregnancy test to 90% • To maximize birth outcomes among clients in the program • To decrease unintended pregnancies among teen Health Department clients with a prior (-) pregnancy test by 20%

  10. The Response:Bright Beginnings • Components: • Separate teen pregnancy tests from the traditional family planning clinic and have them performed by BB staff • All positive (+) tests receive the following services • Risk screening • WIC application paperwork completed • TennCare application completed for those eligible • Referral to in school pregnancy program • Referral to home bound services • 1St prenatal appointment made

  11. The Response:Bright Beginnings • Components: • High Risk Screening • Referred for full assessment and either referred into traditional home visiting program like Healthy Start if (+) • Followed as a “Generic” until third trimester • Low Risk Screening • Referred into Bright Beginnings for case management • Followed monthly • Partnership with school and obstetrician to assure wrap around care is received

  12. The Response:Bright Beginnings • Components: • All negative (-) Pregnancy tests receive the following services: • Pre-conceptual health education, including folic acid • Family planning labs and paperwork completed • Appointment made to return during menses • Emergency contraception (EC) • A follow up phone call if appointment missed

  13. The Response:Bright Beginnings • Components: *** Future • All negative (-) Pregnancy tests continued • Invitation to attend a pregnancy prevention class worth ½ school credit if completed • Involve the partners in education

  14. The Response:Bright Beginnings • Components: *** Future • All negative (-) Pregnancy tests continued • Invitation to attend a pregnancy prevention class worth ½ school credit if completed • Involve the partners in education

  15. 1st Quarter Results • 133 pregnancy tests done • 57% positive test results • Age breakdown • 0% <14 • 8% 14-15 • 29% 16-17 • 63% 18-19 • Race • 65% African American • 35% white

  16. 1st Quarter Results • 60% scored (+) on the risk assessment • 95% were referred to WIC • 54% completed the application process • 38% received presumptive TennCare • 60% received prenatal vitamins (PNV), the rest were given a prescription

  17. 1st Quarter Results • For those clients that had (+) screenings: N=45 • 20% went on to have a (+) assessment and were referred to traditional HV program • Only 2% refused HV services • For clients who entered into case management: N=30 • 100% kept their 1st prenatal visit

  18. Lessons Learned • Teens in general are very interested in having a healthy baby, and are willing to work towards that goal • Most pregnant teens have already dropped out of school • Family planning clinics are a great place to start pre-conceptional health agendas

  19. Questions ?

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