National Association of County and City Health Officials

NACCHO Preconception Care

Initiative: Support to Rural Local

Health Departments

Background

Goal: To improve the capacity of rural local health departments to address the preconception health and

health care needs of individuals in their community through coordination of existing health department

and community services. Project staff developed a request for applications to identify LHD

demonstration sites in rural jurisdictions. Applications were judged by MCH/BD Workgroup members.

Selected Demonstration Sites:

Hertford County (NC) Public Health Authority

Okanogan County (WA) Public Health

Uncas (CT) Health District.

Sites Received:

2 travel stipends to the Second National Summit on Preconception Health and Healthcare

2 travel stipends to a three-day training on Coalition Building and Group Facilitation Methods

Ongoing Peer to Peer Technical Assistance

Focus on Rural LHDs

Vision: The national voice of local public health.

Mission: NACCHO works to support efforts that protect and improve the health of all people and all communities by promoting national policy, developing resources and programs, seeking health equity and supporting effective local public health practice and systems.

•Rural LHDs often deliver many components of preconception care. With tight budgets and limited resources, there is a significant need for the coordinated delivery and promotion of preconception health and healthcare.

•Rural LHDs must overcome silos, take inventory of existing services, and strategize with community partners to strengthen human and financial resources.

Community Partners

–March of Dimes

–Local Schools

–Physicians

–Public Health

–Hospitals

–Family Planning

–Tribal Health Organizations

–Faith-Based Organizations

–Behavioral Health

–Social Services

–Home Visiting Services

–Community Health Centers

Hertford County

Located in rural Northeastern North Carolina

Population: 23, 864

Over 18% below poverty line

•75% of pregnancies are unplanned

•10.5% of babies weigh less than 2500 grams

•Infant mortality rate among highest in the state (15.2)

–Hertford County Public Health Authority Epidemiology Team has selected preconception health as the new approach to reduce the infant mortality rate. –Strategic priority of the Board of Health

Hertford County Goals

Community education being provided through the media and where women gather (churches, nail salons, beauty salons, health fairs, etc) about the importance of preconception health and preconception health care

Advocacy for increased public and private health insurance coverage for women with low incomes to improve access to preventive women’s health and pre/interconception care

Private primary care providers including intentional reproductive health planning during every encounter with men and women of child bearing age guided by protocols

Integrated preconception care services into

existing HCPHA services through structured

processes

Intensive case management of HCPHA clients

identified to be at high risk for poor pregnancy

outcomes

An active Hertford County Infant Mortality

Prevention Coalition that will include members

from the Preconception Health and Health

Care Planning Coalition

Hertford County Reflections

Success!

Action Plan Developed to Focus on Individual Responsibility Across the Lifespan

Identified and committed individuals will develop an education brochure, in-service education for staff, educate youth through existing organizations, mailing of brochures to clients, educate physicians, series of articles and implement a preconception education component into existing cosmetology class at local community college.

Hertford County Reflections

Challenges

“Each meeting brought new faces. We had to repeat and continually educate.”

Strengths

Having LHD as Lead for the Coalition

Representation from State Level- Preconception Health Consultant, March of Dimes

Executive Director, and Regional Consultants

Preconception focus in North Carolina

Hertford County Reflections

Next Steps

Coalition will continue to meet

HCPHA plans to apply for March of Dimes grant funding to assist with action plan initiatives

and hire a Preconception Coordinator

Okanogan County

Largest and one of the poorest counties in Washington state

Population: 39,600

Poverty and low educational attainment are significant health issues

Remote location- access to healthcare and medical homes significant problem

•Medicaid births: 71.1%, 5th highest in the state

•30.9% of births were to women with less than a 12 year education.

•Birth risk factors significantly exceed most state rates.

•Some of the most apparent include: preterm births, cesarean sections, breast

cancer screening and breast cancer fatalities.

Okanogan County Goals

Okanogan County Preconception Health Coalition Mission:

To use positive messages when educating the community about preconception

health issues, provide parents and community adults with information, tools, and

strategies to educate children in preconception health, and engage health care

providers and educators to implement and support preconception health in

Okanogan County.

Okanogan County Activities

•Working with clinics in making sports

physicals more comprehensive and

valuable for the patient

•Increasing public awareness of

preconception health with free and paid

advertising

•Collaboration with local college in

implementing a continuing education

class regarding contemporary social

issues in Okanogan County

•Training of stylists as a novel approach

to preconception health education and

information dissemination

•Support in the establishment of county

school-based clinics

•Develop data sharing agreements

among OCPH and Community Health

Centers

Okanogan County Reflections

Success!

“We have created a strong partnership with the Colville Confederated Tribes, who gave our

coalition $1080 for recording public service announcements to increase awareness of

preconception health and health issues in Okanogan County.”

Okanogan County Reflections

Challenges

•“It may have been beneficial to secure funding for projects prior to establishing a coalition.”

•“I am not convinced that this initiative has allowed us to leverage other resources (dollars)

at this time.”

•Difficult getting providers/physicians to the table

Strengths

Strong partnerships with key agencies and community representatives

Okanogan County Reflections

Next Steps

Coalition members continue to meet and believe preconception health is a worthwhile effort

Have contacted March of Dimes for supplemental educational material

Plan to apply for a grant through the Washington Health Foundation

Uncas Health District

One of three health departments in New London County, CT

Population: 65,000

Growing diversity- over 30 languages spoken

Physician shortage and medically underserved area with literally no maternal and

child health public health infrastructure

•County has highest prevalence of cardiovascular system birth defects in the state.

•Rates for central nervous system and chromosomal defects among highest in the

state- higher than all urban areas

Uncas Health District Goals

Those who provide health care to individuals of reproductive age will include

preconception health care as a standard of practice and as one strategy to promote

optimum birth outcomes and child well-being.

Uncas Health District Reflections

Success!

Community Grant from CT March of Dimes received ($8,000)

“The Health District was extended the opportunity to speak before the statewide advisory

committee on maternal and child health. It provided an opportunity for the listeners to learn

that the maternal and child health challenges can be the same or similar in the smaller more

rural regions of the state compared to those in the urban areas where resources to improve

outcomes are concentrated. I am positive that the data on birth defects prevalence in our

county caught their attention.”

Uncas Health District Reflections

Challenges

Lack of current locally relevant data

Difficult to maintain interest level in the implementation phase

Staying abreast of the current MCH literature

Strengths

Partnership with birthing center- gain access to hospital birth logs

Opportunities to attend the Preconception Summit and facilitation training

Coalition members committed to working together to benefit community- and increasing

their own awareness

Uncas Health District Reflections

Next Steps

MPH Intern will write guidelines on customs and beliefs surrounding pregnancy, childbirth

and infancy of the dominant new cultures. A handbook will be disseminated to local

providers.

Continue the coalition through the end of December when the March of Dimes grant

commitment expires, and with the intent or reapplying for a March of Dimes grant for

sustainability.

Lessons Learned

“To initiate a preconception coalition one has to realize that it is a labor intensive activity to assess the

community, identify the need, identify potential membership, lead and facilitate the group and the

process into a product, strategize for implementation and continuously evaluate along the way.”

“From the beginning, it was important to us to have the coalition members "own" the assessment

findings and develop an action plan according to what they chose to be priorities; our role was to provide

information and facilitate the process.”

“From a health department perspective, a challenge will be to stay abreast of the literature to identify

best practices related to population-based maternal and child health, to have adequate time to provide

the consultation and information sharing with the coalition, and generally to provide the continued

leadership when there is no compensation to the health department.”