Healthy StartMoves Toward a Healthier

Maternal Weight National Summit on Preconception Health

and Health Care

June 13, 2011

Lisa R. King, MADepartment of Health and Human Services

Health Resources and Services Administration

Maternal and Child Health Bureau

Overview of Presentation

• Overview of Goals and Rationale for the Healthy Start Interconception Care Learning Community

• Structure and Framework of the ICC LC

• Healthy Weight Initiatives

• Conclusions and Results to Date

Goals and Rationale for the Healthy Start Interconception Care Learning Community

(ICC LC)

Project Goals

• The Healthy Start Interconception Care Learning Community (ICC LC) was developed by MCHB to engage all Healthy Start grantees in learning.

• ICC LC project goals are to:• Advance the quality and efficacy of

Healthy Start interconception care (ICC) components;

• Address identified gaps in the provision of ICC in Healthy Start; and

• Develop a toolkit to guide maternal and child health programs with their ICC activities.

Project Leaders

• Learning community members• All Healthy Start grantee teams

(~100)• MCHB-HRSA Healthy Start staff• Expert Work Group (20 members)• Abt Associates and Johnson Group

Consulting• Healthy Start Grantee Teams

• Core is Healthy Start ICC staff leadership

• Include other Healthy Start staff, community consortia, and consumers

• Add partners from primary care, mental health, public health, WIC, family planning, etc.

Why interconception care focus?

• In Healthy Start, interconception period is 24 months after one pregnancy for high-risk women.

• ICC is a required component for all Healthy Start projects.

• Evidence-based practices can be implemented or promoted by Healthy Start grantees.

• Content of ICC had not been operationalized for women in Healthy Start.

• Work with infants and toddlers is better defined.

• This is a chance for grantees to apply new evidence.

What’s new about ICC LC?

Implementing a quality improvement (QI) “learning collaborative” model in all Healthy Start projects

Applying a QI model to improve non-clinical, community-based services

Translating ICC research to practice

Structure and Framework of the

Interconception Care Learning

Community

Learning Community and Learning

Collaborative Structure for ICC LC

MCHB Project Officer

Project Team

Liaison

ICC LCLearning

Collaborative

Team C Team ETeam A Team DTeam B

Framework for ICC LC Change

Core Content Areas:

Strengthen linkages and partnerships

Advance use of evidence-based tools and data collection

Improve Healthy Start staff skills and protocols

Case Management

Primary Care

Maternal Depression

Healthy Weight X X X

Family Planning

Screening and Assessment

ICC LC Process

• Each Healthy Start program chose a topic area and a change concept• Fit with Healthy Start grantee capacity and

readiness• Doable and measurable in a 9-month time period

• Teams with similar kinds of change projects grouped together into Learning Collaboratives• 15 Learning Collaboratives in Learning Community• Learning Collaboratives meet bimonthly to discuss

the process and share information

• Web-based tools and telephone conference calls facilitate exchange of information

Modalities for Learning

• Face-to-face learning through ICC LC meetings among the 104 teams

• Action periods (9 mos.) between meetings• Teams work at home on change project and PDSA

• Learning Collaborative• 5-8 teams working on same topic & change concept• Meet by telephone (bimonthly)

• Technical assistance and support through web-based communication tools

Healthy Weight Initiatives in theICC LC (Cycle 2)

Topic: Healthy Weight Change concept: Strengthen partnerships and linkages

• AIM: Assure that Healthy Start ICC participant women in need of achieving or maintaining healthy weight postpartum are referred to organizations and providers who are responsive to their needs.

• CHANGE: Develop strong working relationships with one or more local campaigns and organizations within the community that are focused on promoting healthy weight.

Healthy Weight Change Projects

Change concept: Strengthen partnerships and linkages

Participate in regional coalitions or consortia dedicated to health promotion for women

Collaborate with variety of organizations:

• Health departments, government agencies, universities, cooperative extensions, non-profit organizations, faith-based organizations

Prepare MOA/MOUs with local partners who accept Healthy Start client referrals

Develop manual of community resources

Example: Indianapolis Healthy

Start Partnership with WIC to obtain accurate

height and weight data to document body mass index.

Partnership with Take Charge Life and EFNEP to increase referrals for overweight/obese clients.

Partnership with Marion County Health Dept. to provide monthly nutrition education classes.

Goal: By May 2011, 100% of ICC clients will have accurate BMI recorded. All determined to be at risk will be referred for services; 50% of these will enroll in a program to improve weight status.

Topic: Healthy Weight Change concept: Advance use of

evidence-based tools

• AIM: Measure BMI and assess related risks for all Healthy Start ICC participant women using an evidence-based method.

• CHANGE: Identify, adopt, and consistently use a standardized, objective tool to measure BMI and assess related risk for Healthy Start ICC participant women.

Topic: Healthy Weight Change concept: Advance use of

evidence-based tools

• AIM: Assure that Healthy Start ICC participants receive/benefit from evidence-based health promotion and counseling about the importance of achieving and maintaining a healthy weight.

• CHANGE: Identify, adopt, and use a consistent, evidence-based approach for informing, educating, and counseling ICC participants about healthy weight during the interconception care period.

Healthy Weight Change ProjectsChange concept: Advance use of evidence-based tools

Develop or adopt standardized protocol to measure height & weight, calculate BMI

Educate women as to the meaning of their BMI number and associated health risks

Refer those ≥ 25 to appropriate services

Implement electronic data collection systems

Healthy Weight Change Projects (continued)

Provide nutrition education materials and classes, in-house or through partnerships

Increase opportunities for physical activity

Administer pre- and post-tests to assess changes in knowledge and/or behaviors

Conduct focus groups with clients and staff to obtain feedback for program improvement

Example: Music City Healthy Start

Comprehensive MicroFit health assessment:

Height, weight, biceps strength, back flexibility, cardiovascular endurance (by personal trainer)

Weekly nutrition classes, workout schedule

Pre- and post-tests to measure change

Qualitative data - participant focus groups

Topic: Healthy WeightChange concept: Improve HS staff

skills and protocols

• AIM: Provide Healthy Start staff with the skills necessary to deliver evidence-based, culturally competent health education and promotion messages related to healthy weight during interconception care.

• CHANGE: Strengthen Healthy Start staff skills in delivery of effective health education and promotion messages related to healthy weight in a way that is both evidence-based and culturally competent.

Healthy Weight Change ProjectsChange concept: Improve HS staff skills and protocols

Select evidence-based, culturally competent nutrition and physical activity curriculum

Educate staff on the importance of healthy weight and BMI through series of classes

Administer pre- and post-tests to assess changes in knowledge and/or behaviors

Train home-visiting nurses and CHWs to deliver similar messages to ICC clients

Example: Detroit Healthy Start

We Can! Curriculum (U.S. DHHS – NHLBI)

Six weekly, 90-minute sessions for HS staff

Mandatory for nurses, social workers, nutritionists, and outreach workers

Pre- and post-tests to measure change

Conclusions and Results to Date for the Interconception Care Learning Community

Results from the ICC LC first action cycle

• Each team identified a change project in one of six topic areas and progressed using PDSA cycle.

• Peer-to-peer learning accelerated over 9 months.

• With adaptations, the Model for Improvement can be implemented on a large scale with case management-oriented public health organizations.

Challenges Encountered

Staff turnover

Limited resources• Within the project to follow through with the

PDSA plans• Outside of the project (health center

partners, providers, etc)

“Buy-in” of staff & clients

Transportation

Learning curve for technologies used as foundation for learning community

Challenges Encountered,

continued

Limits on data systems and lack of control that would enable changes (e.g., contractor developed data system) 

Having an adequate number of women to complete the change project on schedule

Competing demands between ICC and PDSA tasks and other Project work

Lessons Learned

QI with PDSA can help improve Healthy Start services

Staff and participants were previously less than satisfied with project processes; through ICC LC unidentified and unmet needs discovered and tools to take action were shared and implemented

Evidence-based and strengths-based items exist for use within a variety of areas of ICC care

QI study/PDSA is different than evaluation and performance monitoring

Lessons Learned, continued

Focusing intently on making one change at a time within a topic has allowed projects to accomplish more

PDSA processes helped projects be systematic and consistent in applying the change

Projects have shared protocols, instruments, tools, data, and methods with each other, allowing them to be more efficient and effective

Contact Information

Lisa R. King, MAWomen’s Health Specialist

Lking@hrsa.govwww.HRSA.gov