Crossing Borders: Promotoras and Advanced Practice Registered Nurses Meet Prenatal Needs of Underserved Latinas Rosa Bustamante-Forest, APRN, MPH Program Director March of Dimes Mom & Baby Mobile Health Center Daughters of Charity Services of New Orleans March 15, 2008

Historical Perspective Injustices: Part I

The Community Responds: A Commitment to Caring for the Vulnerable and Underserved

Creating a future different from the past: CenteringPregnancy® Model of Group Prenatal Care: Why it works  Evidence-based: ↓ risk of PTB  Client-centered: care meets women’ needs  Bilingual staff: APRNs, Promotora  Culturally acceptable  Responsive to needs and values of each participant  Groups: support, sense of community  Time honoring: group care starts and ends on time  Sessions conducted in a circle – 8 to 12 women in group; Respect for each woman’s story, expertise, voice  Socialization: Relationship-building  Facilitative leadership – equal partnerships and equitable care (all get same quality care); non- hierarchical group interactions (all get same quality care); non- hierarchical group interactions  Provider access - over 20 hours (10 sessionsx2h) (10 sessionsx2h)  Facilitator/Provider Consistency  Advocacy –right to have interpreter  Empowerment - shared knowledge  Education and written materials– in woman’s preferred language; use discussion format  Care is demystified: women participate in own care; have copy of medical record; prenatal passport

Injustices: Part II Our Lived Experiences Slow response to Latino health care needs by our partnering h.c.orgs and providers.  #1 Language Barrier: deters access to care and decreases quality of care.  The CLAS (Culturally and Linguistically Appropriate Services) mandates not consistently met, contributing to health disparities in this population –Women referred to other health care services report receiving inadequate info about their care, instructions, medications, and diagnosis –Women report feeling pressured to sign papers or d/c instructions they don’t understand because they are in English and were not translated (Lack of forms and other documents in Spanish) –Women told after waiting for hours, to re-schedule appt for another day b/c no staff available (that day) who speaks Spanish

Injustices: Part II Our Lived Experiences –Women told they have to bring/pay for their own translator –Available ATT language line service, but not used (b/c Cost? Time consuming? Holds up clinic? Unaware service is available?) –Inappropriate use of family members or cab driver/janitor who speaks Spanish to do medical translation CLAS mandates (fed requirements for all recipients of fed funds): Standard #4 – h.c.org must provide language assistance services and interpreter services at no cost to each patient at all points of contact in a timely manner during all hours of operation

The Good News: Progress and Outcomes  We have completed 1 year of program: Kenner and New Orleans  ~150 immigrant Latina women have received CenteringPregnancy® group prenatal care through innovative partnership between APRNs and Promotora  Promotora brings strong personal and community skills making her a valuable member of the h c team: assists clients with accessing medical and non-medical services; provides culturally appropriate health education; and is a source of social support to the women  Preliminary data (Dec 07): PTB rate of 5.4%; 85% BF at D/C from hospital, but high rate of formula supp at 6 wks (50%); 100% of the women were satisfied with group care; 98% reported being well prepared for labor and birth; 96% reported being well prepared to care for their baby.