1. Interconception Education and Counseling: Strategies from Florida Presented by: Betsy Wood, BSN, MPH Infant, Maternal & Reproductive Health Unit Florida Department of Health

2. Florida 2005 Current Affairs 1 st Trimester entry into prenatal care decreased from 85.8% in 2003 to 81.0% in 2004. Healthy Start Prenatal Risk Screening to identify high risk women increased from 59.73% in 2004 to 66.53% in 2005. Infant Mortality Rate increased from 7.0 in 2000 to 7.5 in 2003, then decreased to 7.0 per 1000 live births in 2004.

3. Florida’s Pregnancy Associated Mortality Review (PAMR) “A review of cases where death of a woman has occurred, from any cause, while she is pregnant or within one year of termination of pregnancy, regardless of duration and site of the pregnancy.” CDC and ACOG definition of maternal mortality

4. PAMR 1999-2002 67.1% of women with pregnancy related deaths had a history of chronic disease or condition. Many had multiple chronic illnesses. Most common: –Obesity 11.8% –Hypertension 11.2%

5. PAMR 1999-2002 Showed higher mortality rates for: –Black women, –Women >35 years old, –Overweight and obese women. Women who are obese have odds of pregnancy related mortality that are 2 to 5 times higher than the odds for women of normal weight.

7. Perinatal Periods of Risk Data Categorizes feto-infant mortality according to gestation at death and birth weight at delivery: –Maternal Health & Prematurity –Maternal Care –Newborn Care –Infant Health

8. Maternal Health 3.47 Maternal Care 1.26 Newborn Care 0.59 Infant Health 1.72 Infant Health 1845 Maternal Health 4118 Maternal Care 2478 Newborn Care 1357 = 9798 Fetal-Infant Deaths Florida PPOR MAP 1998- 2002 Birth Cohort 1,008,318 Fetal Deaths and Live Births

9. Fetal Infant Mortality Review 12 local FIMR projects covering 30 Florida counties. Statewide FIMR Trends –Need for pregnancy planning –Poor Nutrition –Need for early prenatal care –Need for health awareness related to STD’s

10. Recommendation #8: Infuse and integrate components of preconception health into existing local public health and related programs. Florida’s Healthy Start Standards and Guidelines Chapter 21: Healthy Start Services Interconceptional Education and Counseling A collaborative initiative between Florida’s Department of Health and Local Healthy Start Coalitions

11. Healthy Start Interconceptional Counseling and Education Topics Access to Care Baby Spacing Nutrition Physical Activity Maternal Infections Substance Abuse Smoking Mental Health Concerns Environmental Risk Factors Chronic Health Problems http://www.doh.state.fl.us/family/mch/training/icc/icc.html

12. Key Implementation Components: Culturally Sensitive Considerate of client’s educational and literacy needs. Inclusive of father, family, and/or significant other. Tailored to the clients needs

13. Interconception Education Target Audience Women with previous poor birth outcome Women with behavioral or environmental issues contributing to poor birth outcomes that have not been resolved during pregnancy regardless of birth outcome

14. Implementation Coding Services can be provided to a Healthy Start mother or on behalf of a Healthy Start Infant, and are coded in 15 minute increments. Providers Providers are trained and qualified professionals and paraprofessionals.

15. Opportunities for Interconception Education Family Planning WIC Federal Primary Care Clinics Prenatal Care STD and HIV Clinics and Care Coordinators Children’s Medical Services Clinics and Care Coordinators Pediatric Care Child Care Facilities

16. Preconception Education Target Audience Women of childbearing age Families of women of childbearing age General public

17. Vitagrant Program Multivitamin settlement - $2 million Partnership between March of Dimes and Department of Health MOD staff housed at DOH Vitamin with folic acid distribution expanded to include preconception education

20. Integration of Preconception Education and Counseling Services Technical Assistance Guidelines were developed for use by all 67 County Health Departments (CHD) Education can be provided in any CHD setting where women are accessing care Mostly used in family planning clinics

21. Other Opportunities for Preconception Education Primary Care Clinics School Health Programs STD and HIV Clinics Care Coordinator interactions Health Fairs

22. Next Steps Children’s Medical Services: provided preconceptional brochures, resource lists, and information sheet to Early Steps for distribution at their statewide meeting will be providing a 1.5 hour inservice on interconceptional topics to CMS providers (therapists, MD's, mental health providers, case managers, etc) at their Bi-annual meeting in June, 2006. invited to join the March Healthy Start Interconceptional Education and Counseling webinar

23. Next Steps School Health provided preconceptional brochures and link to online training. scheduled to provide a 30 in-service on the School Health Meet Me Call on March 2, 2006 Doulas will be providing a training for the local Doula Program. training both Birth and Postpartum doulas focusing on ensuring providers are able to reinforce education about interconceptional issues when interacting with their clients

24. Next Steps WIC and Breastfeeding support paraprofessionals will be providing training with these groups. provided a link to our online training invited to join the March Healthy Start Interconceptional Education and Counseling webinar Community Colleges – contacting community college and university health centers to distribute preconceptional brochures starting a "Sticker Campaign" that would involve placing a sticker reminding women to take folic acid on all birth control pill packs dispensed from their pharmacies. (This is still in the planning stage.)

25. Questions?