1. CAAP Community Antepartum Alternative Program March of Dimes Colorado Chapter Jefferson County Department of Health and Environment Golden, Colorado Presented by: Cynthia Farkas, RNC, FNP, MS September 13, 2004

2. CAAP provides support for pregnant women at risk, who may not qualify for existing home visitation programs. Partnership between JCDHE and the Colorado Chapter of the March of Dimes. Year One: $7,125 for.1 FTE Community Health Nurse (CHN) Year Two: $12,000 for.2 FTE CHN plus a $1500 Community Award Year Three: $20,175 for.3 FTE CHN (current) CAAP Program: Supporting Pregnant Women in Need

3. A Healthier Community Each CAAP client receives: - 3 antepartum home visits - 1 postpartum/newborn home visit - Support, Education and Referral

4. Support, Education, Referral Support –Assistance in obtaining Medicaid –Assistance in accessing prenatal care –Self-assessment of support networks Education –Health behaviors –Guidance for early parenting and newborn care –Benefits of consistent prenatal care –Danger signs of pregnancy –Sibling preparation –Breastfeeding education and encouragement –March of Dimes materials and videos Home Visits Include:

5. Support, Education, Referral Referral –Community resources –Medical resources –Mental Health Nurse Specialist at JCDHE Home Visits Include:

6. Program Objectives: Objective I: 65 clients enrolled (25 first year and 40 in second year) Objective II: 92% of delivered women enrolled in CAAP will have given birth to an infant weighing 5 pounds 8 ounces or more

7. Process Evaluation: Referrals: 182 –65 enrolled (36%) –37 of the 65 enrolled (57%) completed program with a postpartum home visit

8. Demographics (n=65) Single95% Teen35% Pregnant in 12 months32% Hx of preterm labor18% Hx of medical problems38% Low family support43% FOC not involved74% Hx of family violence18%

9. Risk Factors (n=65) Smoking28% Drug/Alcohol18% Weight gain35% Late prenatal care34%

10. Birth Weight 37 women completed the program with a postpartum visit. 26 (70%) delivered infants weighing over 5 pounds, 8 ounces. Three sets of twins, two sets weighed over 5 pounds, 8 ounces.

11. Outcome Evaluation (19 or 51% returned) Client Home Visit Satisfaction Survey –100% very satisfied or satisfied –100% found visits helpful: listening, support, answering questions, education, resources Client Health Behavior Survey –Smoking: 9 of the 37 smoked – 7 (78%) quit or reduced their smoking –Alcohol: All had no alcohol or less than one drink per day –Drugs: All had quit drug use prior to pregnancy

12. Outcome Evaluation cont… Teaching Support –17 (89%) were aware of community resources. –14 (74%) had accessed community resources: WIC, Mental Health Specialist, CCAP, QuitLine, MOPS (Mothers of Preschoolers), TANF, etc. –18 (95%) reported education regarding self-care or infant-care: breastfeeding, sibling rivalry, parenting, nutrition, smoking cessation, labor and delivery, birth control and gained confidence as a mother. –18 (95%) were using a birth control method or had an appointment scheduled for a specific method: tubal, condoms, IUD, Depo, patch, or vasectomy.

13. Challenges BarriersStrategies to Overcome Lack of interest in program CAAP brochures in PE and WIC clinics Contacting those with greatest risk factors Three attempts to contact following referral Transient client base Follow-up missed appointment with three attempts to contact, i.e. phone, drive-by, or mail contact

14. Challenges cont… Barriers Strategies to Overcome Unwillingness to resolve high risk behaviors, i.e. smoking Education on effects of smoking on fetus and risk of secondhand smoke Client-centered goals and counseling Smoking cessation resources Socioeconomic factors JCDHE Community resource lists and referral to agencies

15. Benefits of CAAP Individual attention from CHN in home. Support for behavior change. Health Education: danger signs of pregnancy, substance use, nutrition, dental, labor and delivery, breastfeeding infant and child care, safety, and family planning. Access to medical/prenatal care and community resources.

16. Accomplishments MOD grant funded for a third year Poster presentation at Public Health in Colorado Annual Conference 2003 Hired a.3 FTE CHN for the third grant year

17. Lessons Learned Develop a database from which outcome data can be effectively analyzed, i.e. risk-reduction rates. Low birth weight rate higher than expected in this multi-risk client population (small population sample). Short-term nurse home visitation can positively increase client’s awareness of healthy behaviors and improve access to prenatal care and community resources.

18. Client Stories