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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
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• 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
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A Healthier Community
Each CAAP client receives:
- 3 antepartum home visits
- 1 postpartum/newborn home visit
- Support, Education and Referral
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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:
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Support, Education, Referral
• Referral
– Community resources
– Medical resources
– Mental Health Nurse Specialist at JCDHE
Home Visits Include:
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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
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Process Evaluation:
• Referrals: 182
– 65 enrolled (36%)
– 37 of the 65 enrolled (57%) completed program with a postpartum home visit
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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%
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Risk Factors (n=65)
Smoking 28%
Drug/Alcohol 18%
Weight gain 35%
Late prenatal care 34%
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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.
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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
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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.
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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
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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
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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.
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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
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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.
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Client Stories