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Healthy Start Moves Toward a Healthier Maternal Weight

Healthy Start Moves Toward a Healthier Maternal Weight . National Summit on Preconception Health and Health Care June 13, 2011 Lisa R. King, MA Department of Health and Human Services Health Resources and Services Administration Maternal and Child Health Bureau.

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Healthy Start Moves Toward a Healthier Maternal Weight

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  1. Healthy StartMoves Toward a Healthier Maternal Weight National Summit on Preconception Health and Health Care June 13, 2011 Lisa R. King, MA Department of Health and Human Services Health Resources and Services Administration Maternal and Child Health Bureau

  2. 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 Overview of Presentation

  3. Goals and Rationale for the Healthy Start Interconception Care Learning Community (ICC LC)

  4. 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 Goals

  5. 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. Project Leaders

  6. 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. Why interconception care focus?

  7. 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 What’s new about ICC LC?

  8. Structure and Framework of the Interconception Care Learning Community

  9. ICC LC Learning Collaborative Learning Community and LearningCollaborative Structure for ICC LC Project Team Liaison MCHB Project Officer Team A Team B Team C Team D Team E

  10. Framework for ICC LC Change

  11. 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

  12. 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

  13. Healthy Weight Initiatives in the ICC LC (Cycle 2)

  14. CHANGE:Develop strong working relationships with one or more local campaigns and organizations within the community that are focused on promoting healthy weight. 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.

  15. Healthy Weight Change ProjectsChange 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

  16. 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.

  17. 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.

  18. 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.

  19. 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

  20. 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

  21. 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

  22. 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.

  23. 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

  24. 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

  25. Conclusions and Results to Date for the Interconception Care Learning Community

  26. 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.

  27. 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

  28. 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

  29. 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

  30. 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

  31. Contact Information Lisa R. King, MA Women’s Health Specialist Lking@hrsa.gov www.HRSA.gov

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