Project Embrace: From Recommendations to Actions to Outcomes by Liane Montelius and Kelly Sanders

Women and Children’s Health Network, Inc. History: Greater Hartford Prenatal Care Continuum Provider Network, 1994 Purpose: To improve birth outcomes of Hartford women

WCHN Mission A comprehensive system of high quality, culturally competent care for women and children will be enhanced and sustained through a citywide network of health care and social service providers.

WCHN Members/ Key Partners Asylum Hill Family Practice Burgdorf/Fleet Health Center Charter Oak Family Health Center Community Health Services Connecticut Children’s Medical Center Hartford Hospital Hispanic Health Council City of Hartford Health Department St. Francis Hospital and Medical Center

WCHN Model Women’s Health Team Perinatal Health Team Children’s Health Team WCHN Management Team Black Women’s Health Council Project Embrace

WCHN Teams Goals Through collaboration each team : Facilitates communication and coordination across institutions. Identifies barriers and develops systems, processes and intervention vehicles. Conducts research Develops and disseminates information Advocates for public and institutional policy

Description of Issue WCHN has committed to: Addressing the high infant mortality rate in Hartford. Developing and maintaining a project that would work with families to address medical and psychosocial needs relating to the loss of their baby Preventing repeat poor birth outcome

Objectives Create and maintain a system to identify, link to services and track 50 Hartford women annually suffering a fetal or infant loss. 75% of Project Embrace participants will demonstrate improved grief resolution scores over intake scores.

Objectives 75% of Project Embrace participants will demonstrate improved basic and preconception health care knowledge and infant health care knowledge Reduce the Hartford repeat poor birth outcome rate from a baseline of 19% through comprehensive health and social service linkage, and skill building activities.

Intended Results Improve the overall health and well- being of the mother/family in order to reduce the incidence of repeat pattern of fetal and infant mortality.

Methods Established system of referral in the City’s major hospitals, and within major prenatal care outreach clinics Implemented Edinburgh Depression Scale to track improved grief resolution Provide health education using a curriculum developed by local health care providers.

Methods Bereavement Support Assistance in making funeral arrangements Referrals to bereavement support groups and bereavement counselors Limited financial assistance for funeral expenses

Methods Case Management: Assistance accessing basic needs such as food, clothing, shelter Link to other needed social services Assist families in achieving their personal goals using the Family Development Model from Cornell University

Methods Care Coordination: Postpartum appointment Explanation of medical aspects of loss, including autopsy Referral to risk reduction activities Assistance accessing services to address chronic health issues, mental health services, and family planning services.

Role of WCHN Members volunteer to provide oversight for the Project as an advisory group. Members volunteer to participate on an interdisciplinary team to provide expertise in identifying issues related to a loss and developing a plan of action for each family served

Approximate Annual Budget Braided Funding from: CJ Foundation for SIDS CT Chapter March of Dimes Hartford Hospital St. Francis Hospital and Medical Center

Results Question: “Thinking about your entire experience, was there any person or event that was particularly helpful for you?” Response: “The social worker who told me about you (Project Embrace). I am very grateful for all your help and for the information about grief and health that I didn’t know about. It’s is nice to know that there are people that really care”. (Participants of Project Embrace, 2003)

Results Question: “What do you think needs to be done to help women and families who have experienced the death of their baby?” Response: “This program (Project Embrace) was really helpful with making funeral arrangements, transportation and helping me get answers from my doctor about the reasons for my baby’s death.”

Results: 23 women have received services through Project Embrace Project Embrace has established a system of referrals within the City’s major hospitals and has complete support of the hospital staff Project Embrace coordinator has created a bereavement support group specifically available to African, African American and West Indian Caribbean women

Conclusions Lessons Learned: Women/Families are often feel confused about the medical aspects relating a poor birth outcome. Women/Families are seeking to prevent repeat poor birth outcomes and are seeking the information needed to accomplish this. Black women/families in the Hartford area appreciate and use a bereavement support group that is available solely for Black families.

Conclusions Greatest Barrier Sustaining the continuation of funding for the program Shifting the paradigm to encourage the health care community to view this program as a primary intervention for next pregnancy rather than a secondary intervention after a pregnancy loss.

Public Health Implications Improving women’s health by addressing medical and psychosocial issues prior to next pregnancy can lead to a reduction of poor birth outcome