CAAP Community Antepartum Alternative Program March of Dimes Colorado Chapter Jefferson County...

CAAPCommunity Antepartum

Alternative Program

March of DimesColorado Chapter

Jefferson County Department of Health and Environment

Golden, Colorado

Presented by:

Cynthia Farkas, RNC, FNP, MS

September 13, 2004

• 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

A Healthier Community

Each CAAP client receives:

- 3 antepartum home visits

- 1 postpartum/newborn home visit

- Support, Education and Referral

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:

Support, Education, Referral

• Referral

– Community resources

– Medical resources

– Mental Health Nurse Specialist at JCDHE

Home Visits Include:

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

Process Evaluation:

• Referrals: 182

– 65 enrolled (36%)

– 37 of the 65 enrolled (57%) completed program with a postpartum home visit

Demographics (n=65)

Single 95%

Teen 35%

Pregnant in 12 months 32%

Hx of preterm labor 18%

Hx of medical problems 38%

Low family support 43%

FOC not involved 74%

Hx of family violence 18%

Risk Factors (n=65)

Smoking 28%

Drug/Alcohol 18%

Weight gain 35%

Late prenatal care 34%

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.

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

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.

Challenges

Barriers Strategies 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

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

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.

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

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.

Client Stories