1. CityMatCH Promising Practice Preconception Health August 26, 2007 Small Change

2. Patricia Handel, MSN Kathy Hill, M.Ed., LSW Margaret Shank, MSN

3. Background/Purpose Ohio Department of Health, Regional Perinatal Centers, Perinatal Data Use Consortiums PPOR data analysis led us to preterm births Identified gap in services Home Visitor survey Results

4. Data into Action Develop objectives based on data Preterm birth needs improvement Survey results indicate need and interest by home visitors

5. Objectives Community-wide knowledge of prematurity and its consequences Decrease Ohio Perinatal Region I’s (Cincinnati) rate of subsequent preterm births Develop doable program with current resources (subcommittee’s time and skills) to reach the most at-risk women

6. Ohio’s Perinatal Regions Region I 8 counties Region II 17 counties Region III 11 counties Region IV 33 counties Region V 5 counties Region VI 14 counties

7. Program-specific objectives Home visitors are educated about prematurity and its consequences Home visitors adapt this knowledge to individual client needs/situations The client incorporates small changes in behavior to achieve a healthier lifestyle

8. Small Change Program name Curriculum Evaluation/documenta tion tool Resource sheet Brochures Small Change envelopes

9. Curriculum – Part I Prematurity is a serious problem Likelihood of repeat preterm pregnancy A Small Change can make a difference Identifying and decreasing stress Nutrition & exercise Tobacco cessation Substance use/abuse Adequate birth spacing African-Americans are at the greatest risk

10. Curriculum – Part II Motivational Interviewing Packets Small Change envelopes Resources Documentation http://www.motivationalinterview.org/

11. Small Change (Previous Preterm Birth Education) Name Date of Visit TopicDNVDNVDNVDNVDNVDNV Prematurity is a serious problem Likelihood of repeat preterm pregnancy African-Americans at much higher risk Small change may make a difference Stress – Abuse, low income, racism, social support Grief Nutrition/Exercise Tobacco Substance use/abuse Adequate birth spacing Interconception Health

12. Client’s Name __________________________ DOB_________________________________ Number of live births ____________________ Number of losses _______________________ Date of last birth _______________________ Gestation _____________________________ Birth weight ___________________________ Subsequent pregnancy due date_____________ D= Discussed (Discussed with client) N = Named (Client could name, when asked) V = Volunteered (Client volunteered that she had worked on this.) Visit Date & Comments: _________________________________________ _________________________________________ ______________________________________ ____________________________ Initials______ Visit Date & Comments: _________________________________________ _________________________________________ ______________________________________ ____________________________ Initials______ Visit Date & Comments: _________________________________________ _________________________________________ ______________________________________ _____________________________Initials______ Visit Date & Comments: _________________________________________ _________________________________________ ______________________________________ ______________________________Initials_____ Visit Date & Comments: _________________________________________ _________________________________________ ______________________________________ ______________________________Initials_____ Visit Date & Comments: _________________________________________ _________________________________________ ____________________________Initials_____ First Visit – Info from mom’s perspective. Set tone. Few points. Stress/grief. Second Visit – More specific. Additional history/info: ________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________

13. Implementation Part I presentation to four agencies Part II presentation to two agencies Follow-up meetings with the two agencies Documentation changes Additional materials

14. Results Presentation(s) received high marks. Enthusiasm, interest, questions and answers Not implementing Focus as much on community message as individual message “Share this information with your sister, friend, neighbor.” Agency-specific documentation Revisions

15. Barriers Documentation form = “another piece of paperwork” Difficult to attribute outcomes to interventions. Time to do trainings Lack of funding for giveaways.

16. It Appears..... Home Visiting Programs want this training as future funding agencies may require such.

17. Still Ahead Seek grant funding Info sheets on each topic Training for other Help Me Grow programs, GRADS teachers, Public Health Clinics, etc.

18. Infant Deaths Lifelong Handicaps Morbidity and/or Cost Prematurely, Congenital Malformations, SIDS, Injury, Pregnancy Complications, Infection, etc. High Risk Births All Births Infant Mortality Iceberg Ed Donovan, MD High Risk pregnant women All Pregnant Women All WCBA (social status, social & human capital) The public’s health Social & economic, community-oriented and public health policy Public Health Implications Pat Handel, RN, MSN Kathy Hill, LSW, M.Ed. Lisa Holloway, BS, MBA Margaret Shank, RN, MSN

19. If interested in a copy of the survey, documentation tool, or Small Change presentations, please contact: Kathy Hill (513) 636-8225 Kathy.hill@cchmc.org

20. Funded by: Cincinnati Children’s Hospital Medical Center City of Cincinnati Health Department Health Improvement Collaborative of Greater Cincinnati March of Dimes Greater Cincinnati Division Ohio Department of Health/Federal Government; Bureau: Child & Family Health Services; Program: Regional Perinatal Centers Program

21. Small Change