Crossing Borders: Promotoras and Crossing Borders: Promotoras and Advanced Practice Registered Advanced Practice Registered Nurses Meet Prenatal Needs of Nurses Meet Prenatal Needs of

Underserved LatinasUnderserved Latinas

Rosa Bustamante-Forest, APRN, MPHRosa Bustamante-Forest, APRN, MPH

Program DirectorProgram Director

March of Dimes Mom & Baby Mobile Health CenterMarch of Dimes Mom & Baby Mobile Health Center

Daughters of Charity Services of New OrleansDaughters of Charity Services of New Orleans

March 15, 2008March 15, 2008

Historical PerspectiveHistorical PerspectiveInjustices: Part IInjustices: Part I

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

UnderservedUnderserved

Creating a future different from the past: Creating a future different from the past: CenteringPregnancy® Model of Group CenteringPregnancy® Model of Group

Prenatal Care: Why it worksPrenatal Care: Why it works

Evidence-based: Evidence-based: ↓ risk of PTB↓ risk of PTB Client-centered: care meets women’ Client-centered: care meets women’

needsneeds Bilingual staff: APRNs, Promotora Bilingual staff: APRNs, Promotora Culturally acceptableCulturally acceptable Responsive to needs and values of Responsive to needs and values of

each participanteach participant Groups: support, sense of communityGroups: support, sense of community Time honoring: group care starts and Time honoring: group care starts and

ends on timeends on time Sessions conducted in a circle – 8 to Sessions conducted in a circle – 8 to

12 women in group; Respect for each 12 women in group; Respect for each woman’s story, expertise, voicewoman’s story, expertise, voice

Socialization: Relationship-buildingSocialization: Relationship-building Facilitative leadership – equal Facilitative leadership – equal

partnerships and equitable carepartnerships and equitable care (all get same quality care); non-(all get same quality care); non-

hierarchical group interactionshierarchical group interactions Provider access - over 20 hoursProvider access - over 20 hours (10 sessionsx2h)(10 sessionsx2h) Facilitator/Provider ConsistencyFacilitator/Provider Consistency Advocacy –right to have interpreterAdvocacy –right to have interpreter Empowerment - shared knowledgeEmpowerment - shared knowledge Education and written materials– in Education and written materials– in

woman’s preferred language; use woman’s preferred language; use discussion format discussion format

Care is demystified: women Care is demystified: women participate in own care; have copyparticipate in own care; have copy of of medical record; prenatal passport medical record; prenatal passport

Injustices: Part IIInjustices: Part II Our Lived Experiences Our Lived Experiences

Slow response to Latino health care needs by our partnering h.c.orgs and Slow response to Latino health care needs by our partnering h.c.orgs and providers.providers.

#1 Language Barrier: deters access to care #1 Language Barrier: deters access to care andand decreases quality of care. decreases quality of care. The CLAS (Culturally and Linguistically Appropriate Services) mandates not The CLAS (Culturally and Linguistically Appropriate Services) mandates not

consistently met, contributing to health disparities in this populationconsistently met, contributing to health disparities in this population

– Women referred to other health care services report receiving inadequate Women referred to other health care services report receiving inadequate info about their care, instructions, medications, and diagnosisinfo about their care, instructions, medications, and diagnosis

– Women report feeling pressured to sign papers or d/c instructions they Women report feeling pressured to sign papers or d/c instructions they don’t understand because they are in English and were not translated don’t understand because they are in English and were not translated (Lack of forms and other documents in Spanish) (Lack of forms and other documents in Spanish)

– Women told after waiting for hours, to re-schedule appt for another day Women told after waiting for hours, to re-schedule appt for another day b/c no staff available (that day) who speaks Spanishb/c no staff available (that day) who speaks Spanish

Injustices: Part IIInjustices: Part II Our Lived Experiences Our Lived Experiences

– Women told they have to bring/pay for their own translatorWomen told they have to bring/pay for their own translator

– Available ATT language line service, but not used (b/c Cost? Time Available ATT language line service, but not used (b/c Cost? Time consuming? Holds up clinic? Unaware service is available?)consuming? Holds up clinic? Unaware service is available?)

– Inappropriate use of family members or cab driver/janitor who speaks Inappropriate use of family members or cab driver/janitor who speaks Spanish to do medical translationSpanish to do medical translation

CLAS mandates (fed requirements for all recipients of fed funds): CLAS mandates (fed requirements for all recipients of fed funds): Standard #4 – h.c.org must provide language assistance services Standard #4 – h.c.org must provide language assistance services and interpreter services at no cost to each patient at all points of and interpreter services at no cost to each patient at all points of contact in a timely manner during all hours of operationcontact in a timely manner during all hours of operation

The Good News:The Good News:Progress and OutcomesProgress and Outcomes

We have completed 1 year of program: Kenner and New OrleansWe have completed 1 year of program: Kenner and New Orleans

~150 immigrant Latina women have received CenteringPregnancy® ~150 immigrant Latina women have received CenteringPregnancy® group prenatal care through innovative partnership between APRNs group prenatal care through innovative partnership between APRNs and Promotoraand Promotora

Promotora brings strong personal and community skills making her a Promotora brings strong personal and community skills making her a valuable member of the h c team: assists clients with accessing valuable member of the h c team: assists clients with accessing medical and non-medical services; provides culturally appropriate medical and non-medical services; provides culturally appropriate health education; and is a source of social support to the womenhealth 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 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 hospital, but high rate of formula supp at 6 wks (50%); 100% of the women were satisfied with group care; 98% reported being well women were satisfied with group care; 98% reported being well prepared for labor and birth; 96% reported being well prepared to care prepared for labor and birth; 96% reported being well prepared to care for their baby. for their baby.