Bright beginnings an activity of project blossom
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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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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

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


The rationale1

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


The data

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


The data1

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


The data2

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


The data3

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


Project blossom

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


The response bright beginnings

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%


The response bright beginnings1

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


The response bright beginnings2

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


The response bright beginnings3

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


The response bright beginnings4

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


The response bright beginnings5

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


1 st quarter results

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


1 st quarter results1

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


1 st quarter results2

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


Lessons learned

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


Bright beginnings an activity of project blossom

Questions ?


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