Transcript Crossing Borders: Promotoras and Advanced Practice Registered

Crossing Borders: Promotoras and
Advanced Practice Registered
Nurses Meet Prenatal Needs of
Underserved Latinas
Rosa Bustamante-Forest, APRN, MPH
Program Director
March of Dimes Mom & Baby Mobile Health Center
Daughters of Charity Services of New Orleans
March 15, 2008
Historical Perspective
Injustices: Part I
The Community Responds:
A Commitment to Caring for the Vulnerable and
Underserved
Creating a future different from the past:
CenteringPregnancy® Model of Group
Prenatal Care: Why it works










Evidence-based: ↓ risk of PTB
Client-centered: care meets women’
needs
Bilingual staff: APRNs, Promotora
Culturally acceptable
Responsive to needs and values of
each participant
Groups: support, sense of
community
Time honoring: group care starts and
ends on time
Sessions conducted in a circle – 8 to
12 women in group; Respect for each
woman’s story, expertise, voice






Socialization: Relationship-building
Facilitative leadership – equal
partnerships and equitable care
(all get same quality care); nonhierarchical group interactions
Provider access - over 20 hours
(10 sessionsx2h)
Facilitator/Provider Consistency
Advocacy –right to have interpreter
Empowerment - shared knowledge
Education and written materials– in
woman’s preferred language; use
discussion format
Care is demystified: women
participate in own care; have copy of
medical record; prenatal passport
Injustices: Part II
Our Lived Experiences
Slow response to Latino health care needs by our partnering h.c.orgs and
providers.
 #1 Language Barrier: deters access to care and decreases quality of
care.
 The CLAS (Culturally and Linguistically Appropriate Services)
mandates not consistently met, contributing to health disparities in
this population
– Women referred to other health care services report receiving
inadequate info about their care, instructions, medications, and
diagnosis
– Women report feeling pressured to sign papers or d/c instructions
they don’t understand because they are in English and were not
translated (Lack of forms and other documents in Spanish)
– Women told after waiting for hours, to re-schedule appt for
another day b/c no staff available (that day) who speaks Spanish
Injustices: Part II
Our Lived Experiences
– Women told they have to bring/pay for their own translator
– Available ATT language line service, but not used (b/c Cost? Time
consuming? Holds up clinic? Unaware service is available?)
– Inappropriate use of family members or cab driver/janitor who speaks
Spanish to do medical translation
CLAS mandates (fed requirements for all recipients of fed funds):
Standard #4 – h.c.org must provide language assistance services
and interpreter services at no cost to each patient at all points of
contact in a timely manner during all hours of operation
The Good News:
Progress and Outcomes
 We have completed 1 year of program: Kenner and New Orleans
 ~150 immigrant Latina women have received
CenteringPregnancy® group prenatal care through innovative
partnership between APRNs and Promotora
 Promotora brings strong personal and community skills making
her a valuable member of the h c team: assists clients with
accessing medical and non-medical services; provides culturally
appropriate health education; and is a source of social support to
the women
 Preliminary data (Dec 07): PTB rate of 5.4%; 85% BF at D/C from
hospital, but high rate of formula supp at 6 wks (50%); 100% of the
women were satisfied with group care; 98% reported being well
prepared for labor and birth; 96% reported being well prepared to
care for their baby.