healthy start moves toward a healthier maternal weight healthy start moves toward a healthier...
TRANSCRIPT
Healthy StartMoves Toward a Healthier
Maternal Weight National Summit on Preconception Health
and Health Care
June 13, 2011
Lisa R. King, MADepartment of Health and Human Services
Health Resources and Services Administration
Maternal and Child Health Bureau
Overview of Presentation
• Overview of Goals and Rationale for the Healthy Start Interconception Care Learning Community
• Structure and Framework of the ICC LC
• Healthy Weight Initiatives
• Conclusions and Results to Date
Goals and Rationale for the Healthy Start Interconception Care Learning Community
(ICC LC)
Project Goals
• The Healthy Start Interconception Care Learning Community (ICC LC) was developed by MCHB to engage all Healthy Start grantees in learning.
• ICC LC project goals are to:• Advance the quality and efficacy of
Healthy Start interconception care (ICC) components;
• Address identified gaps in the provision of ICC in Healthy Start; and
• Develop a toolkit to guide maternal and child health programs with their ICC activities.
Project Leaders
• Learning community members• All Healthy Start grantee teams
(~100)• MCHB-HRSA Healthy Start staff• Expert Work Group (20 members)• Abt Associates and Johnson Group
Consulting• Healthy Start Grantee Teams
• Core is Healthy Start ICC staff leadership
• Include other Healthy Start staff, community consortia, and consumers
• Add partners from primary care, mental health, public health, WIC, family planning, etc.
Why interconception care focus?
• In Healthy Start, interconception period is 24 months after one pregnancy for high-risk women.
• ICC is a required component for all Healthy Start projects.
• Evidence-based practices can be implemented or promoted by Healthy Start grantees.
• Content of ICC had not been operationalized for women in Healthy Start.
• Work with infants and toddlers is better defined.
• This is a chance for grantees to apply new evidence.
What’s new about ICC LC?
Implementing a quality improvement (QI) “learning collaborative” model in all Healthy Start projects
Applying a QI model to improve non-clinical, community-based services
Translating ICC research to practice
Structure and Framework of the
Interconception Care Learning
Community
Learning Community and Learning
Collaborative Structure for ICC LC
MCHB Project Officer
Project Team
Liaison
ICC LCLearning
Collaborative
Team C Team ETeam A Team DTeam B
Framework for ICC LC Change
Core Content Areas:
Strengthen linkages and partnerships
Advance use of evidence-based tools and data collection
Improve Healthy Start staff skills and protocols
Case Management
Primary Care
Maternal Depression
Healthy Weight X X X
Family Planning
Screening and Assessment
ICC LC Process
• Each Healthy Start program chose a topic area and a change concept• Fit with Healthy Start grantee capacity and
readiness• Doable and measurable in a 9-month time period
• Teams with similar kinds of change projects grouped together into Learning Collaboratives• 15 Learning Collaboratives in Learning Community• Learning Collaboratives meet bimonthly to discuss
the process and share information
• Web-based tools and telephone conference calls facilitate exchange of information
Modalities for Learning
• Face-to-face learning through ICC LC meetings among the 104 teams
• Action periods (9 mos.) between meetings• Teams work at home on change project and PDSA
• Learning Collaborative• 5-8 teams working on same topic & change concept• Meet by telephone (bimonthly)
• Technical assistance and support through web-based communication tools
Healthy Weight Initiatives in theICC LC (Cycle 2)
Topic: Healthy Weight Change concept: Strengthen partnerships and linkages
• AIM: Assure that Healthy Start ICC participant women in need of achieving or maintaining healthy weight postpartum are referred to organizations and providers who are responsive to their needs.
• CHANGE: Develop strong working relationships with one or more local campaigns and organizations within the community that are focused on promoting healthy weight.
Healthy Weight Change Projects
Change concept: Strengthen partnerships and linkages
Participate in regional coalitions or consortia dedicated to health promotion for women
Collaborate with variety of organizations:
• Health departments, government agencies, universities, cooperative extensions, non-profit organizations, faith-based organizations
Prepare MOA/MOUs with local partners who accept Healthy Start client referrals
Develop manual of community resources
Example: Indianapolis Healthy
Start Partnership with WIC to obtain accurate
height and weight data to document body mass index.
Partnership with Take Charge Life and EFNEP to increase referrals for overweight/obese clients.
Partnership with Marion County Health Dept. to provide monthly nutrition education classes.
Goal: By May 2011, 100% of ICC clients will have accurate BMI recorded. All determined to be at risk will be referred for services; 50% of these will enroll in a program to improve weight status.
Topic: Healthy Weight Change concept: Advance use of
evidence-based tools
• AIM: Measure BMI and assess related risks for all Healthy Start ICC participant women using an evidence-based method.
• CHANGE: Identify, adopt, and consistently use a standardized, objective tool to measure BMI and assess related risk for Healthy Start ICC participant women.
Topic: Healthy Weight Change concept: Advance use of
evidence-based tools
• AIM: Assure that Healthy Start ICC participants receive/benefit from evidence-based health promotion and counseling about the importance of achieving and maintaining a healthy weight.
• CHANGE: Identify, adopt, and use a consistent, evidence-based approach for informing, educating, and counseling ICC participants about healthy weight during the interconception care period.
Healthy Weight Change ProjectsChange concept: Advance use of evidence-based tools
Develop or adopt standardized protocol to measure height & weight, calculate BMI
Educate women as to the meaning of their BMI number and associated health risks
Refer those ≥ 25 to appropriate services
Implement electronic data collection systems
Healthy Weight Change Projects (continued)
Provide nutrition education materials and classes, in-house or through partnerships
Increase opportunities for physical activity
Administer pre- and post-tests to assess changes in knowledge and/or behaviors
Conduct focus groups with clients and staff to obtain feedback for program improvement
Example: Music City Healthy Start
Comprehensive MicroFit health assessment:
Height, weight, biceps strength, back flexibility, cardiovascular endurance (by personal trainer)
Weekly nutrition classes, workout schedule
Pre- and post-tests to measure change
Qualitative data - participant focus groups
Topic: Healthy WeightChange concept: Improve HS staff
skills and protocols
• AIM: Provide Healthy Start staff with the skills necessary to deliver evidence-based, culturally competent health education and promotion messages related to healthy weight during interconception care.
• CHANGE: Strengthen Healthy Start staff skills in delivery of effective health education and promotion messages related to healthy weight in a way that is both evidence-based and culturally competent.
Healthy Weight Change ProjectsChange concept: Improve HS staff skills and protocols
Select evidence-based, culturally competent nutrition and physical activity curriculum
Educate staff on the importance of healthy weight and BMI through series of classes
Administer pre- and post-tests to assess changes in knowledge and/or behaviors
Train home-visiting nurses and CHWs to deliver similar messages to ICC clients
Example: Detroit Healthy Start
We Can! Curriculum (U.S. DHHS – NHLBI)
Six weekly, 90-minute sessions for HS staff
Mandatory for nurses, social workers, nutritionists, and outreach workers
Pre- and post-tests to measure change
Conclusions and Results to Date for the Interconception Care Learning Community
Results from the ICC LC first action cycle
• Each team identified a change project in one of six topic areas and progressed using PDSA cycle.
• Peer-to-peer learning accelerated over 9 months.
• With adaptations, the Model for Improvement can be implemented on a large scale with case management-oriented public health organizations.
Challenges Encountered
Staff turnover
Limited resources• Within the project to follow through with the
PDSA plans• Outside of the project (health center
partners, providers, etc)
“Buy-in” of staff & clients
Transportation
Learning curve for technologies used as foundation for learning community
Challenges Encountered,
continued
Limits on data systems and lack of control that would enable changes (e.g., contractor developed data system)
Having an adequate number of women to complete the change project on schedule
Competing demands between ICC and PDSA tasks and other Project work
Lessons Learned
QI with PDSA can help improve Healthy Start services
Staff and participants were previously less than satisfied with project processes; through ICC LC unidentified and unmet needs discovered and tools to take action were shared and implemented
Evidence-based and strengths-based items exist for use within a variety of areas of ICC care
QI study/PDSA is different than evaluation and performance monitoring
Lessons Learned, continued
Focusing intently on making one change at a time within a topic has allowed projects to accomplish more
PDSA processes helped projects be systematic and consistent in applying the change
Projects have shared protocols, instruments, tools, data, and methods with each other, allowing them to be more efficient and effective
Contact Information
Lisa R. King, MAWomen’s Health Specialist