Transcript Cynthia Farkas, BSN, MS

CAAP
Community Antepartum
Alternative Program
Presented by:
Cynthia Farkas, RNC, FNP, MS
September 13, 2004
Jefferson County Department
of Health and Environment
Golden, Colorado
March of Dimes
Colorado Chapter
CAAP Program:
Supporting Pregnant Women in Need
• 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)
A Healthier Community
Each CAAP client receives:
- 3 antepartum home visits
- 1 postpartum/newborn
home visit
- Support, Education and
Referral
Support, Education, Referral
Home Visits Include:
• 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
Support, Education, Referral
Home Visits Include:
• Referral
– Community resources
– Medical resources
– Mental Health Nurse
Specialist at JCDHE
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
• Follow-up missed appointment
with three attempts to contact,
i.e. phone, drive-by, or mail
contact
Transient client base
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
• JCDHE Community resource
lists and referral to agencies
Socioeconomic
factors
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