universal well-being assessment for families
DESCRIPTION
Universal well-being assessment for families. A path to more coordination and better health outcomes Helen Bellanca, MD, MPH Maternal Child Family Program Manager Health Share of Oregon May 6, 2014. A little background. - PowerPoint PPT PresentationTRANSCRIPT
Universal well-being assessment for familiesA path to more coordination and better health outcomes
Helen Bellanca, MD, MPHMaternal Child Family Program ManagerHealth Share of OregonMay 6, 2014
A little background• Legacy midwifery clinic approached Health Share to ask for
help integrating mental health services into prenatal care
• We piloted a risk assessment to understand the problem and make a business case
Legacy midwifery data 2013Medicaid (59%)
Commercial (41%)
Can identify a PCP 29% 44%Entered care in the 1st trimester 79% 93%
“didn’t want to be pregnant” or “bad timing”
36% 24%
Worried about having enough foodsafe housing
11%16%
2%5%
Feel depressedFeel anxious
27%33%
12%14%
Domestic violence 8% 2%Binge drinking 8% 12%Used illegal drugs 28% 14%
Meanwhile, back at the ranch
• Multnomah, Washington and Clackamas counties began meeting to discuss a regional maternal child health strategy and relationship with Health Share
• Healthy Families program was expanded legislatively to include all families (not just first-time parents), but no increase in funding
• Early Learning Hubs began forming
• I was convening a subcommittee of the Oregon Perinatal Collaborative
What is the problem we are trying to solve?• The primary issues complicating
maternity care are mental health issues, substance use disorders, family violence, and poverty-related social problems
• Public health home visiting programs have limited capacity and need to connect with health care systems
• Early learning hubs and CCOs must work together
• Everyone agrees that addressing family risks as early as possible is key
Also…• Every public health program serving young families does some
sort of risk assessment
• Health care providers do not know how to assist families needing social services
• We as a community do not have a good sense of exactly what the needs of our population are, and whether we are meeting them or not
• Maternity providers were wondering what they should take on next after success of 39 weeks initiative
• BabyLink in Clackamas county has shown us a model
BabyLink
Resources for expecting and new parents and their families
Call (971) 400-7832 or text "baby" to this number and we'll call you back.
BabyLink
• Home Visiting Programs• Parent Education Classes• Medical and Dental Care Information• Insurance questions• Linking you to resources in your community
Single questionnaire to connect with any resources the families need.
What if…
We had a single universal family well-being tool that was used by:
• every clinic offering prenatal care
• every public health home visiting program
• all early childhood providers
We could use this tool to…
• Coordinate care among heath care providers, public health, early learning communities
• Aggregate the data by county, region, CCO and state-wide to understand family needs and how they are changing
• Understand each other’s worlds and operate more like a team
• Support health and well-being and not just service provision
What would we screen for?
• Strengths and assets (social supports, resources, PCP, dentist)• Food insecurity• Housing• Family violence• Depression and anxiety• Substance use disorders• Intendedness of pregnancy• Need for parenting support• Oral health
Alignment
• CCO metrics• Depression• SBIRT• Prenatal care
• Integration of public health home visiting programs into CCO global budget
• Early Learning Hubs’ need for coordination of services
How would it work?
Prenatal or pediatric clinician
Home visiting nurse or early
childhood program
Pregnant or child
under 1 yr
211
database
1Check if FWBA has been done in past year, if not, complete and send
2Refer if needed
1Check if FWBA has been done in past year, if not, complete and send
2Refer if needed
Oregon Perinatal Collaborative
Subcommittee on Maternity Model of Care
Goal:Community consensus about our next priorities regarding the quality and cost of maternity care in Oregon
Participation: WHA, OHSU, Legacy, Kaiser, midwives, public health, many individual practitioners
Maternity Model of Care
Prenatal care BIRTH First 30 days postpartum Healthy familyIntended
pregnancy
Address unintended pregnancy
January 17
Mental health integration with prenatal care
Address substance use disorders in pregnancy
Improve transition from maternity care to primary care
December 20 February 21 March 21
Prioritize, determine sequential phases, build learning collaboratives
Behavioral Health Integration with Maternity Care• Standardize risk assessment tool • Include strengths and assets• Food, housing, domestic violence, mental health and
substance abuse• Use to connect to services and discover unmet needs
• Explore collaborative partnerships versus integrated systems
• Psychiatric medication prescribing in maternity care