TM

1"The findings and conclusions in this presentation are those of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry"

Hani K. Atrash, MD, MPH hka1@cdc.gov Associate Director for Program Development National Center on Birth Defects and Developmental Disabilities And,

The CDC Select Panel on Preconception Care

The CDC/ATSDR Workgroup on Preconception Care, and

CDC’s Preconception Health and Health Care Initiative:History and An Update

2007 CityMatCH Urban MCH Leadership Conference August 26 - 28, 2007, Denver, Colorado

TM

2

The Preconception Care Team

Steering Committee:CDC, HRSA/MCHB, ACOG, MOD, AMCHP, CityMatCH, Consultants

Select Panel:Representatives of partner organizations, subject matter experts

CDC/ATSDR Workgroup:Representatives of 22 programs (80+ members)

Workgroups (Clinical, Public Health, Consumer, Policy and Finance):

Practitioners, members of select panel, members of CDC/ATSDR workgroup

Pilot Urban Practice Collaborative

TM

3

Why Preconception Care

1. Poor Pregnancy Outcomes Continue To Be At Un-acceptable Levels

2. Women Enter Pregnancy “At Risk” For Adverse Outcomes

3. There Is Consensus That We Must Act Before Pregnancy

4. Intervening Before Pregnancy Will Help Improve Outcomes

5. We currently intervene too late

TM

4

If you continueto do what you always did, You will continue to get What You always got Anonymous

TM

5

From Anticipation and Management to Health Promotion and Prevention

From Healthy Mothers Healthy Babies to Healthy Women Healthy Mothers Healthy Babies

Paradigm Shift

TM

6

Not a New Concept

Aristotle, Problemata, 384-322 BCE: Foolish, drunken, or harebrain women most often bring forth children like unto themselves

William Potts Dewees, first American textbook on Pediatrics 1825: “The physical treatment of children should begin as far as may be practicable, with the earliest formation of the embryo; it will, therefore, necessarily involve the conduct of the mother, even before her marriage, as well as during her pregnancy.”

Domestically, starting in 1979: Reference in government and professional reports

Internationally MCH and women’s health meeting reports starting in the 1960s

TM

7

Opportunities are missed

New strategies are needed

Facilitate collaboration

Develop recommendations

Identify and address obstacles and opportunities:

»Clinical, Public health, Consumer, Policy & Finance, Research

Why a CDC Preconception Health and Health Care Initiative?

TM

8

Challenges to Implementation (2004)

Absence of a national policy that supports implementation

Lack of National/State/Local Model programs

Lack of tools and practical guidelines for practice (Who does it, who gets it, how much, what is it, why do it, how to do it, where to do it, when to do it, etc?)

Inadequate education of providers and consumers Lack of demonstrated practicality, feasiblity and effectiveness of preconception “programs”

TM

9

The CDC PCC InitiativeInitial Plan

Make the scientific case; Solidify the scientific evidenceMake the business caseDevelop consensus within and outside CDCDevelop recommendations and national policyDevelop guidelines and tools for implementation Develop marketing strategies:

Implement recommendations Enhance knowledge and skills of providersEducate consumers

TM

10

The CDC PCC Initiative: Timeline

6/04CDC Workgroup

11/04Meeting with Partners

4/06Recommendations

6/05Select Panel

Meeting

6/051st Summit

5/06Clinical, PH, ConsumerWorkgroup Meetings

3/07Policy & Finance

Workgroup Meetings

5/072nd Select Panel

Meeting

10/072nd Summit

9/06Supplement

1/06Steering Committee

Meeting

TM

11

www.marchofdimes.com/california

TM

12

Partners

With CDC’s Environmental Health, Birth Defects and Developmental Disabilities, Chronic Disease, Infectious Diseases, National

Immunization Program, Health Marketing, Health Statistics, HIV, STD, and TB Prevention, Women’s Health, Genomics and Public Health

TM

13

Recommendations 1-5

Recommendation 1. Individual responsibility across the life span

Recommendation 2. Consumer awareness

Recommendation 3. Preventive visits

Recommendation 4. Interventions for identified risks

Recommendation 5. Interconception care

TM

14

Recommendations 6-10

Recommendation 6. Pre-pregnancy check ups Recommendation 7. Health coverage for low-income womenRecommendation 8. Public health programs and strategiesRecommendation 9. ResearchRecommendation 10. Monitoring improvements

TM

15

1.Define contents 2. Integrate existing guidelines3.Disseminate information 4.Demonstrate effectiveness 5.Explore means for financing 6.Monitor practice 7.Study association between women’s health and pregnancy outcomes7.Conduct a cost study

Steering Committee MeetingThe Road Ahead

TM

16

Implementation: The Goals

Changing consumerconsumer knowledge, attitudes, and practices

Changing clinical providers’ clinical providers’ knowledge, attitudes, and practices

Change public healthpublic health professionals’ knowledge, attitudes, and practices

TM

17

Strategies to Implement The Recommendations

Workgroup Meetings:June 27/28-2006:

oClinicaloPublic HealthoConsumer

March 2007:oPolicy and Finance

TM

18

1. Clinical guidelines and tools

2. Consumer information

3. Public health programs and strategies

4. Monitoring and surveillance

5. Research agenda

6. Public policy and finance

7. Professional education/training

8. Best practices

9. Demonstration projects

10. State and local initiatives

Strategies for Implementation

TM

19

1. CLINICAL GUIDELINES & TOOLSDevelop guidelines; Assess screening

tools; Disseminate products; Redesign postpartum visit; Implement demonstration / quality improvement / research projects

Strategies for Implementation

2. CONSUMER INFORMATIONDevelop consumer messages; Conduct

community participatory action research; Compile consumer self-assessment tools; Study effectiveness of bundled messages

TM

20

3. PUBLIC HEALTH PROGRAMS AND STRATEGIES

Encourage integration of PC practices; Develop, evaluate, and disseminate

integrated approaches; Analyze and evaluate Healthy Start PCC activities; Encourage action at the community; Support a Preconception Health Practice Collaborative

Strategies for Implementation

4. MONITORING & SURVEILLANCE Improve surveillance and monitoring;

Conduct needs / gaps assessment; Link to laboratory leadership; Link to prevention of birth defects

TM

21

5. RESEARCH AGENDADevelop a list of priority research projects;

Generate research project proposals

Strategies for Implementation

6. PUBLIC POLICY AND FINANCE

Develop a menu of public policy options; Develop Medicaid demonstration; Develop a private health plan finance pilot / demonstration project

7. PROFESSIONAL EDUCATION AND TRAINING

Promote education and training for public health and clinical care professionals; Review and disseminate existing and new training modules

TM

22

8. BEST PRACTICESDevelop a catalogue of promising

practices; Share promising practices; Maintain Internet web portals; Convene a national meeting in 2007

Strategies for Implementation

9. DEMONSTRATION PROJECTSEvaluate current projects; Initiate new projects;

Identify opportunities in public health settings

10. STATE & LOCAL INITIATIVES

Support state and local initiatives

TM

23

Clinical Workgroup

Developing a Curriculum for training clinical care providers

Developing a uniform set of guidelines

Developing a standard assessment tool

Delivering lectures at various meetings and conferences

Developing a clinical demonstration project and other research projects

TM

24

Public Health Workgroup

Assessing existing screening tools

Promoting education for public health students and workers

Modifying existing surveys to include questions on preconception health and health care

Evaluating preconception/interconception care activities under Healthy Start

Implementing Public Health Practice Collaboratives in Los Angeles, Nashville and Hartford

TM

25

Consumer Workgroup/Other

Consumer Workgroup: Developing consumer messages with market researchConducting participatory action research with women at risk

Other:Speakers’ Bureau with over 30 volunteers available to speak about preconception careCDC and March of Dimes updated their websites to include more information about preconception careMembers of the steering committee are supporting several states who started working on preconception care

TM

26

The CityMatCH Pilot Urban Practice Collaborative

Acts on CDC Recommendation 8: “Integrate components of preconception health into existing local public health and related programs, including emphasis on interconnection interventions for women with previous adverse outcomes”

Uses a “practice collaborative” model to promote adoption and integration of Preconception health recommendations among peers

Encourages more integrated preconception health practices and policies in public health programs in urban settings

TM

27

Led by the urban public health program (CityMatCH member is the health department)5-person teams with expertise in:

community assessment/engagementprevention programmingclinical practicepolicy development and systems integration of reproductive/women’s health

Each team has representatives from local March of Dimes, State MCH Director, & local community organizationsEach team will select a project to address preconception health in their community

CityMatCH Pilot Urban Practice Collaborative: Team Composition

TM

28

Team Hartford

Smaller racial/ethnically diverse urban area in the Northeast

Large Latina population

Project Focus: Integration of preconception health into existing MCH programs

TM

29

Team Los Angeles

Large urban center with 1 of 4 US births occurring in the county

Tremendous potential impact on maternal and infant health outcomes

Project Focus: Improve data and surveillance preconception health issues

TM

30

Team Nashville

Mid-size, traditional Southern urban area with large Black population

Project Focus: Target special populations to address preconception health concerns of childbearing age women including young women with sickle cell disease & trait

TM

31

Thank You!Questions??? hka1@cdc.gov

www.cdc.gov/ncbddd