Building a Public-Private Partnership for Statewide

Action: The Preconception Health Council of California

Kiko Malin, MPH MSWPreconception Health Coordinator

Maternal Child and Adolescent Health Division

California Department of Public Health

• The California Landscape• Preconception Health and Title V• Preconception Health Council of California• Progress and Products to Date

Preconception Health Council of CaliforniaA Public-Private Partnership

California Demographics-2006

State Projected Total Population 37.4 million

Reproductive Age (Ages 18-44) Women 7.0 million

Data Sources: State of California, Department of Public Health, 2006 Birth Records; Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for 2005. Health E-Stats. Released November 21, 2006; State of California, Department of Finance, Race/Ethnic Population with Age and Sex Detail, 2000–2050. Sacramento, CA, July 2007.; Maternal and Infant Health Assessment (MIHA) Survey, 2005.

There were 562,157 Births to California Resident Women in 2006 – 13.3% of all 2005 US Births –

If we make a difference in maternal and infant outcomes in California, we will affect national statistics.

Preconception Health Status of California Women 18-44 – 2005

Health Status Measure Prevalence Overweight or Obese (BMI ≥ 25) 45%

Binge Drinking (5+ drinks on at least one occasion in past month)

12.5%

Folic Acid Consumption (daily) 34%

Frequent Mental Distress (14 or more “not good” days in last month)

13%

Preconception Health Status of California Women 18-44 – 2005

Health Status Measure Prevalence

Intimate Partner Physical Violence (in past 12 months)

6.5%

Diabetes (ever diagnosed with diabetes or GDM)

3.9%

Current Smoker 14%

Unintended Pregnancy(among those with a recent live birth)

41%

California Women’s Health Survey (CWHS) Data, 2005 and Maternal and Infant Health Assessment (MIHA) Data, 2005

Title V Implementation Plan California Title V Implementation Plan 2006-2010Priority Goal 1: Enhance preconception care and work toward

eliminating disparities in maternal and infant morbidity and mortality

• Objective 1.1: Develop and enhance systems to inform women and their health care providers about the importance of preconception and interconception health• Strategy 1.1: Collaborate with state groups and organizations

to develop a California plan for Preconception Health• Strategy 1.3: Integrate comprehensive preconception health

care promotion messages into all maternal and child health programs

• Objective 1.2: Determine methods for delivering preconception and interconception care to the MCAH/OFP population

Preconception Health Council of California (PHCC)

Purpose: • Forum for statewide planning and decision-making on issues and programs

related to preconception health and health care.

History:• Established after the release of CDC’s Select Panel Recommendations on

Preconception Care (MMWR April 21, 2006)• Organized by State MCAH and the March of Dimes California Chapter• Quarterly meetings since May 2006 and issue-specific work groups• Ongoing CDC participation and input

Composition:• Stakeholders and decision-makers in development of preconception care:

- Local MCAH Programs - Professional Associations (ACOG)- Community-based organizations - Academia (UCB, UCLA)- Health Plans - Hospitals/Health Systems- Advocacy Organizations - Funders

PHCC Activities• Research/Clinical Practice Workgroup

– Developing provider education tools, such as lecture templates and clinical care protocols

– Workgroup members have contributed to development of clinical guidelines by CDC

– Plan to create guidelines for optimizing the post-partum visit in California in 2009/2010

– Speakers bureau to be created

• Finance/Public Policy Workgroup– Educating the legislature about preconception care;– Advocacy for and expert input on bills that span the preconception,

prenatal and interconception periods. – Development of recommendations for the integration of preconception

health care services into proposed healthcare reform packages

PHCC Activities

• Public Health/Consumer Workgroup– Clarifying the role of MCAH programs in preconception health

promotion and developing curricula and messaging to support and expand these efforts

• MCAH Action Education Day and Assessment of PCH activities in LHJs• California Preconception Health Website

• Convener of the Second National Preconception Care Summit, October 2007 – Oakland, CA– In partnership with CDC, HRSA, March of Dimes, Sutter Health, Kaiser

Permanente, UC Berkeley, Alameda County Healthy Start Program and Los Angeles County Preconception Health Collaborative

– 600 attendees from the US and abroad; 25 California projects highlighted

Public Health WorkgroupMission Statement:• Public Health promotes healthy communities by supporting

reproductive life planning as an essential public health function.  Reproductive life planning presents a window of opportunity to ensure optimum health for all people across the lifespan.

Workgroup Priorities:• Integration of preconception health promotion messages into

existing MCAH programs (Strategy 1.1.3 from Title V Implementation Plan) – Healthy Body– Healthy Mind– Healthy Environment

• Coordination and communication of information statewide– Website

CA MCAH’s Preconception Health and Healthcare Initiative

Goal: Integrate preconception/interconception health promotion into existing MCAH/OFP Programs

MCAH Preconception Health Coordinator Provides training and technical assistance to interested local programs Member of PHCC and public health workgroup

Preconception health website to be launched in March 2009 Resources, tools, best practices On-line interactive forums Event calendars Consumer information

Folic Acid Campaign 2009

Participation on National Preconception Health Indicators Workgroup

Selected Preconception Health Measures Publication

everywomancalifornia.org

Maximizing the Post-partum Visit to Improve Interconception Health

• Joint March of Dimes and ACOG District IX Project with PHCC involvement

• Goal: Develop guidelines for health care providers that facilitate an assessment of adverse pregnancy outcomes within the context of the post-partum visit and the development of a plan for interconception health

• Falls under Objective 1.2 of Title V Implementation Plan

Maximizing the Post-partum Visit to Improve Interconception Health

Project Activities:• ICD-9 Code Research (February – April 2009)• Research Diagnoses, develop recommendations

(April – September 2009)• Review findings, reach consensus (September

2009)• Develop information for MDs and patients

(September 2009 – January 2010)• Stakeholder meeting to provide results/plan

dissemination (January 2010)

WIC Offers Wellness “WOW” Program

The WOW Program is a…– Prematurity prevention, – Interconception care,– MOD funded demonstration 3 yr

project

Focused on mothers and families with a premature or LBW baby

A PREMATURITYPREVENTIONPARTNERSHIP

WOW Project Objectives

• To improve the health status of high-risk women who recently delivered a preterm and/or low birthweight baby

• To increase pregnancy intervals • To increase the rates of planned/intended

pregnancies• And overall reduce the incidence of repeat

premature/LBW births to low-income women

The project is based at the Avenue 43 WIC Center in Los Angeles

WOW project activities are integrated directly into WIC services

Activities include screening, providing health promotion, education and counseling, and offering referrals

WOW Results – Family Planning

62%

36%

48%

39%

0%

10%

20%

30%

40%

50%

60%

70%

Baseline 6 Months

WOW Moms

Control Moms

After 6 months of the program, WOW moms showed a significant increase in birth control use. (p < .001)

0.2

0.3

0.4

0.5

0.6

0.7

0.8

WOW Moms Control Moms

Baseline

6 months

WOW Results - Mental HealthD

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After 6 months of the program, WOW moms showed improvement in their mental health outcomes and reported a significant decrease in negative feelings such as depression and helplessness (measured by CES-D-9 scale). (p = .05)

Questions?Kiko Malin

(916) 341-6333Kiko.Malin@cdph.ca.gov