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