Delivering Prenatal Education through

Community Collaboratives

A Catalyst for Improved Maternity Services and Birth

Outcomes

Diane M. DaldrupState Director Program & Government Affairs

November 19, 2014

Presenter Conflict of Interest Disclosure

Diane M. Daldrup, State Director of Program and Government Affairs, March of Dimes Greater Kansas Chapter has no relationships to disclose.

Course Objectives

At the conclusion of this workshop participants will:

● Know the leading issues impacting Kansas birth outcomes

● Learn about the Healthy Babies are Worth the Wait/Becoming A Mom program model

● Understand the community collaborative model and it’s role within the collective impact framework

● Understand the role of evaluation in program quality improvement

Birth Disparities in Kansas

● Infant Mortality - 6.3/1000 live births● Birth defects, preterm birth/low birth weight, SUID leading

causes● Black infant mortality rate is more than double white

● Preterm Birth Rate – 10.8%● 16.3% African American, 11.5 % Hispanic, 10.2%

Caucasian

● Smoking 21.5% (women of childbearing age)

● Medicaid pays for 45% of all births● Medicaid vs non-Medicaid disparity

● *2012 Data

Kansas Priorities

● Lower preterm birth rate 8% by 2020 (ASTHO Challenge)●Lower infant mortality rate 10% by 2016 (CoIIN Blueprint)

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● Improve access and quality of prenatal care services● Launch community collaboratives in high-need areas● Statewide Expansion:

● Healthy Babies are Worth the Wait/Becoming a Mom● Safe Sleep Campaign● High Five for Baby● Tobacco Quit Line

March of Dimes Response

Strategic Mission Investment

• Targeted communities with demonstrated disparities

• Significant number of births

• Community collaborative backbone

Community Collaborative Model

• “Collaboration is a mutually beneficial relationship between two or more parties who work toward common goals by sharing responsibility, authority, and accountability for achieving results.“

• (Collaborative Leadership; Chrislip & Larson, 1994)

Collaborative strategy is called for ... where the need and intent is to change fundamentally the way services are designed and delivered

"Collaboration establishes a give and take among stakeholders that is designed to produce solutions that none of them working independently could achieve.“

(Enhancing Transdisciplinary Research through Collaborative Leadership, Barbara Gray, 2006)

Collaborative Strategy

CDC Health Promotion Model

Collaboration Benefits

• Permanent MCH Infrastructure developed

• Resources leveraged for greater benefit

• Care delivery paradigm changed• Long-term program sustainability• Emerging community needs identified

early• Collaborative becomes vehicle for

change• Magnet for new funding opportunitiesShared risk, shared resources, shared rewards!

Healthy Babies are Worth the Wait

Six Key Strategies● Hospital Quality Improvement● Community Intervention

Programs● Public Policy● Consumer Awareness● Provider Education● Patient Education

Healthy Babies are Worth the Wait is a March of Dimes Signature Program designed to decrease preventable preterm and early term births

Becoming A Mom - What is it? Bilingual prenatal curriculum

Designed for use with pregnant women in a supportive group setting

Nine sessions Prenatal care Nutrition Stress Things to avoid during pregnancy Labor and birth Postpartum care Newborn care

Appendices with suggestions for adapting the curriculum for use with specific racial/ethnic groups

Incentive-based programEvidence-based curriculumStandardized deliveryStandardized evaluation system

Becoming A Mom in Kansas

Two-fold focus – Clinical Services + Prenatal Education

Collective Impact in Action

Growth Strategies● State funds two priority

replications● Eight additional non-funded sites● Regional models in the works● KanCare providers coming on

board● Policy changes

● Presumptive Eligibility● Title V Incentive● CHW Waiver (fee for service $)

● Funding Magnet● KS Health Foundation ($900,000)● New Healthy Start Site ($3.5M)● HRSA Rural Network Grant ($85,000)

Community Collaboratives/Healthy Babies are Worth the Wait launched in eight additional

communities

Program Evaluation

Collaborative program evaluation led by researchers from two state universities

Data from 2013 was collected from two levels:

• Participant-level (BAM Programso self-reported knowledge (pre/post test)o health outcome data from medical

charts

• Community-level data o self-reported implementation data

through the Community Toolbox online system

Program Evaluation Core Components

• Universal class structure and delivery

• Standardized evaluation tools

• Data collectors trained at each site• Technical assistance ad hoc

• Bi-annual grantee meeting for quality improvement

• Participation incentivized• 79% of women (n=165) completed 4 or more

classes

• Monthly data submission

• Bi-annual reports to each site

• Bi-annual aggregated reports

Data Tools: Community-Level

• Community toolbox – ctb.ku.edu• Online tool to assist sites with

documenting collaborative nature of model

• Includes approximately 20 questions related to collaborative actions and program implementation

Data Tools: Program-LevelBecoming a Mom Evaluation

• First piloted in Kansas in 2012; modified in 2013

• Pre/post knowledge survey (approx. 100 questions)

• Administered at 1st and last prenatal education sessions

• Participation and program satisfaction included

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Baby's brain growthand development

Signs of Preterm Labor Safe Sleep Habits

81%

49%

81%

95%

83%

98%

Pre

Post

Participant Level Data

p=.004 p=.0002p<.0001

Improved Birth Outcomes

• Community health outcomes vs state averages• Fewer preterm births - 9.5% compared to 11% (n=42)• Low birth weight – 4% compared to 7.1% (n=68)• Lower cesarean section rate – 26% versus 30% (n=87)• Higher breastfeeding initiation - 81% versus 80% (n=85)

• Contributed to lower infant mortality rate• Saline - 8.5/1000 (2006-2010) to 6.4/1000 (2008-2012

KDHE)• Geary - 10/1000 (2006-2010) to 8.3/1000 (2008-2012

KDHE)

Create pilot programs for replication and the stakeholders and money will follow!

Collaborative model works – but requires constant nurturing to keep stakeholders engaged

Community customization increases impact and provides vehicle for identification of emergent issues

Program standardization is essential for evaluation accuracy

Evaluation accuracy will make or break a program – Get your data and evaluation experts on board up front!

Lessons Learned

thank you