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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

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
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