Building a Public-Private Partnership for Statewide Action: The Preconception Health Council of California Kiko Malin, MPH MSW Preconception Health Coordinator Maternal Child and Adolescent Health Division California Department of Public Health

The California Landscape Preconception Health and Title V Preconception Health Council of California Progress and Products to Date Preconception Health Council of California A Public-Private Partnership

California Demographics-2006 State Projected Total Population37.4 million Reproductive Age (Ages 18-44) Women7.0 million Data Sources: State of California, Department of Public Health, 2006 Birth Records; Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for Health E-Stats. Released November 21, 2006; State of California, Department of Finance, Race/Ethnic Population with Age and Sex Detail, 2000–2050. Sacramento, CA, July 2007.; Maternal and Infant Health Assessment (MIHA) Survey, There were 562,157 Births to California Resident Women in 2006 – 13.3% of all 2005 US Births – If we make a difference in maternal and infant outcomes in California, we will affect national statistics.

Preconception Health Status of California Women – 2005 Health Status MeasurePrevalence Overweight or Obese (BMI 25)45% Binge Drinking (5+ drinks on at least one occasion in past month) 12.5% Folic Acid Consumption (daily)34% Frequent Mental Distress (14 or more not good days in last month) 13%

Preconception Health Status of California Women – 2005 Health Status MeasurePrevalence Intimate Partner Physical Violence (in past 12 months) 6.5% Diabetes (ever diagnosed with diabetes or GDM) 3.9% Current Smoker14% Unintended Pregnancy (among those with a recent live birth) 41% California Womens Health Survey (CWHS) Data, 2005 and Maternal and Infant Health Assessment (MIHA) Data, 2005

Title V Implementation Plan California Title V Implementation Plan Priority Goal 1: Enhance preconception care and work toward eliminating disparities in maternal and infant morbidity and mortality Objective 1.1: Develop and enhance systems to inform women and their health care providers about the importance of preconception and interconception health Strategy 1.1: Collaborate with state groups and organizations to develop a California plan for Preconception Health Strategy 1.3: Integrate comprehensive preconception health care promotion messages into all maternal and child health programs Objective 1.2: Determine methods for delivering preconception and interconception care to the MCAH/OFP population

Preconception Health Council of California (PHCC) Purpose: Forum for statewide planning and decision-making on issues and programs related to preconception health and health care. History: Established after the release of CDCs Select Panel Recommendations on Preconception Care (MMWR April 21, 2006) Organized by State MCAH and the March of Dimes California Chapter Quarterly meetings since May 2006 and issue-specific work groups Ongoing CDC participation and input Composition: Stakeholders and decision-makers in development of preconception care: - Local MCAH Programs - Professional Associations (ACOG) - Community-based organizations - Academia (UCB, UCLA) - Health Plans - Hospitals/Health Systems - Advocacy Organizations - Funders

PHCC Activities Research/Clinical Practice Workgroup –Developing provider education tools, such as lecture templates and clinical care protocols –Workgroup members have contributed to development of clinical guidelines by CDC –Plan to create guidelines for optimizing the post-partum visit in California in 2009/2010 –Speakers bureau to be created Finance/Public Policy Workgroup –Educating the legislature about preconception care; –Advocacy for and expert input on bills that span the preconception, prenatal and interconception periods. –Development of recommendations for the integration of preconception health care services into proposed healthcare reform packages

PHCC Activities Public Health/Consumer Workgroup –Clarifying the role of MCAH programs in preconception health promotion and developing curricula and messaging to support and expand these efforts MCAH Action Education Day and Assessment of PCH activities in LHJs California Preconception Health Website Convener of the Second National Preconception Care Summit, October 2007 – Oakland, CA –In partnership with CDC, HRSA, March of Dimes, Sutter Health, Kaiser Permanente, UC Berkeley, Alameda County Healthy Start Program and Los Angeles County Preconception Health Collaborative –600 attendees from the US and abroad; 25 California projects highlighted

Public Health Workgroup Mission Statement: Public Health promotes healthy communities by supporting reproductive life planning as an essential public health function. Reproductive life planning presents a window of opportunity to ensure optimum health for all people across the lifespan. Workgroup Priorities: Integration of preconception health promotion messages into existing MCAH programs (Strategy from Title V Implementation Plan) –Healthy Body –Healthy Mind –Healthy Environment Coordination and communication of information statewide –Website

CA MCAHs Preconception Health and Healthcare Initiative Goal: Integrate preconception/interconception health promotion into existing MCAH/OFP Programs MCAH Preconception Health Coordinator Provides training and technical assistance to interested local programs Member of PHCC and public health workgroup Preconception health website to be launched in March 2009 Resources, tools, best practices On-line interactive forums Event calendars Consumer information Folic Acid Campaign 2009 Participation on National Preconception Health Indicators Workgroup

Selected Preconception Health Measures Publication

everywomancalifornia.org

Maximizing the Post-partum Visit to Improve Interconception Health Joint March of Dimes and ACOG District IX Project with PHCC involvement Goal: Develop guidelines for health care providers that facilitate an assessment of adverse pregnancy outcomes within the context of the post-partum visit and the development of a plan for interconception health Falls under Objective 1.2 of Title V Implementation Plan

Maximizing the Post-partum Visit to Improve Interconception Health Project Activities: ICD-9 Code Research (February – April 2009) Research Diagnoses, develop recommendations (April – September 2009) Review findings, reach consensus (September 2009) Develop information for MDs and patients (September 2009 – January 2010) Stakeholder meeting to provide results/plan dissemination (January 2010)

WIC Offers Wellness WOW Program The WOW Program is a… –Prematurity prevention, –Interconception care, –MOD funded demonstration 3 yr project Focused on mothers and families with a premature or LBW baby A PREMATURITY PREVENTION PARTNERSHIP

WOW Project Objectives To improve the health status of high-risk women who recently delivered a preterm and/or low birthweight baby To increase pregnancy intervals To increase the rates of planned/intended pregnancies And overall reduce the incidence of repeat premature/LBW births to low-income women

The project is based at the Avenue 43 WIC Center in Los Angeles WOW project activities are integrated directly into WIC services Activities include screening, providing health promotion, education and counseling, and offering referrals

WOW Results – Family Planning After 6 months of the program, WOW moms showed a significant increase in birth control use. (p <.001)

WOW Results - Mental Health Depressive Symptoms After 6 months of the program, WOW moms showed improvement in their mental health outcomes and reported a significant decrease in negative feelings such as depression and helplessness (measured by CES-D-9 scale). (p =.05)

Questions? Kiko Malin (916)