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Lift Every Voice (LEV) Lift Every Voice (LEV) ProgramProgram
Jeannie Cummings, MA
Itika Greene, NP, MPH
Suzzette C. Johnson, MSW, MPA
Family, Maternal and Child Health Programs: Contra Costa Health Services
American Correctional Health Services Association Conference
November 4, 2011
C h a n g i n g t h e
p r e s e n t i n t o a b e t t e r f u t u r e
L i f t E v e r y V o i c e
“See Them as Women, See Them as Mothers”
Lift Every Voice (LEV) Lift Every Voice (LEV) ProgramProgram
Today’s Intention1)“See them as women, see them as mothers”2)Address how women’s health affects the health
of herfamily and community.
Acknowledgements
C h a n g i n g t h e
p r e s e n t i n t o a b e t t e r f u t u r e
L i f t E v e r y V o i c e
LEV Presentation LEV Presentation ObjectivesObjectives
At the end of today’s presentation, participants will:
1)Learn how a public health program model can be integrated into the criminal justice system in order to better serve women.
2)Learn how health inequities impact health outcomes among African American and low socioeconomic populations.
3)Understand preconception health care recommendations to improve reproductive health care for women and improve perinatal outcomes.
LEV Mission & LEV Mission & BackgroundBackground
Mission
To inspire, motivate, and empower women to take constructive action to support their mental,
emotional, spiritual, and physical well-being.
Background Started in 2005
Contra Costa County Health Services/Public Health in Family, Maternal and Child Health Programs as part of Perinatal Services Coordination
Concentration in West County Detention Facility
LEV Program LEV Program DescriptionDescription
Home visiting, outreach and case management services
Links to prenatal care, psychosocial support services, and other home visiting programs
Psychosocial education, support, and advocacy
Engages and retains women until delivery of babies
Comprehensive and holistic, culturally sensitive, strength-based, gender-specific, trauma informed
Innovative public health approach within criminal justice system
Systems intervention
“Life Course” Perspective
Life Course PerspectiveLife Course Perspective
A way of looking at life not as disconnected stages, but as an integrated continuum
Suggests that a complex interplay of biological, behavioral, psychological, and social protective and risk factors contributes to health outcomes across the span of a person’s lifeMichael C. Lu, MD, MPH, 2011
What is “GOOD” What is “GOOD” Health?Health?
Health is a state of complete physical, mental, and
social well-being and not merely the absence ofdisease or infirmity.
World Health Organization (WHO)
What is “GOOD” What is “GOOD” Health?Health?
Health is a state of well-being with physical, emotional,
mental, and spiritual dimensions that serves as anessential foundation for human life with implications
forhow all other aspects of life are pursued and evolve.
It is also an essential resource to be valued byindividuals, families, communities, and our larger
globalcommunity. Health may vary in how it is defined,qualified, and pursued within diverse communities
andfor individuals.
Barbara C. Wallace, PhD (Toward Equity in Health, 2008)
“All members of a community are affected by the poor health status
of its least healthy members. Infectious diseases, for example,
know no social/ethnic or socioeconomic boundaries.”
“Unequal Treatment”, 2003
Health DisparitiesHealth Disparities
Health disparities refer to differences in healthoutcomes (death, illness, injury, and birth-relatedoutcomes).
“A difference in rates of illness, disease, or conditions among different populations.”Turning Point: Collaborating for a New Century in Public Health. The University of Washington School of Public Health and Community Medicine/Robert Wood Johnson Foundation/National Association of County and City Health Officials.
Health InequitiesHealth Inequities
“Health inequities refer to material, social, gender, racial, incomes, and other social and economic inequalities that are beyond the control of individuals and are therefore considered unfair and unjust.”Health Canada, Population & Public Health Branch
“Health inequities are differences in health status and mortality rates across population groups that are systemic, avoidable, unfair and unjust…” and arise from racial and class based inequities.Adapted from Margaret Whitehead and Unnatural Causes
Health EquityHealth Equity
Health equity means fairness and justice in efforts
to achieve the best possible health for everyone,
especially for those groups who have systematically faced greater obstacles to being
healthy through social disadvantage, discrimination, or marginalization.
Social Determinants of Social Determinants of HealthHealth
The social determinants of health are the conditions in which people are born, grow, live, work, and age, including their experience in and access to the health care system.
Circumstances are shaped by the distribution of money, power, and resources at global, national, and local levels, which are themselves influenced by policy choices.
World Health Organization (WHO)
Social Determinants of Social Determinants of Health:Health:
ExamplesExamplesSocio-economic statusStressEarly LifeSocial ExclusionWorkUnemploymentSocial SupportAddictionFood Transportation
World Health Organization (WHO)
LEV Approaches & LEV Approaches & PracticesPractices
Gender-specific treatment
Trauma-informed care
Motivational interviewing
Family-centered approach
Strength-based
Cultural humility
Eco map
C h a n g i n g t h e
p r e s e n t i n t o a b e t t e r f u t u r e
L i f t E v e r y V o i c e
A Typical LEV DayA Typical LEV Day
In West County Detention Facility (WCDF)
In the Community
In the Courts, Probation, and Parole
During a Home Visit
In the Hospital
In the FMCH Office
C h a n g i n g t h e
p r e s e n t i n t o a b e t t e r f u t u r e
L i f t E v e r y V o i c e
Who Are the Women Served Who Are the Women Served by LEV? by LEV?
Black/African American (44%) Average Age (23-29) Education (8-9th grade) Unstable intimate partners - FOB Partner abuse/domestic violence Sexual Abuse Alcohol, Tobacco and Other Drugs Use (2/3) Unintended pregnancy Pre-term labor Pre-existing medical conditions Unstable housing
Who Are the Women Served Who Are the Women Served by LEV?by LEV?
History of previous
incarceration
History of CPS/CFS
involvement
Poverty
Isolation
Mental Health Depression & Anxiety Disorders Bi-polar Disorder PTSD Trauma Personality Disorders
Behaviors Observed of the Behaviors Observed of the Women Served by LEV in Women Served by LEV in
WCDFWCDF Entitlement and privilege Aggression toward staff Excessive calls to triage “Getting even” with staff by refusing to take
prescribed medication Misplaced Anger Pressured and hurried attitude Lack of social skills “Child-like” behaviors Attention seeking behaviors Depression Excessive crying
LEV & Clients Work Together LEV & Clients Work Together in Developing an in Developing an
Individualized Care Plan Individualized Care Plan
Intake QuestionsWhere are the children?Who has custody of the children? Who are the main caregivers?Is there an open CFS case? Is there domestic violence?What is your plan for the baby?Previous or current AODS history?Are you on parole or probation?
Provider Challenges in Provider Challenges in Working with Working with
Incarcerated WomenIncarcerated WomenCompassion Fatigue
Vicarious Traumatization
Dealing with Women’s Anger
Lack of Understanding of Trauma and impact on the women
Lack of Provider Training
Medical Records Come after women have left WCDF
Provider Provider RecommendationsRecommendations
Redirect behaviors
Don’t personalize
Talk about the baby
Let the client lead (not too pushy or aggressive)
Empathetic Listening
All female inmates are not alike
Assume Good Will
Talk about healthy life-style changes
Lessons Learned Lessons Learned
Community partnership expansion and development
Jail health care a ‘window of opportunity’
Women shut down when feel being judged
Women are a ‘specialized’ population
What Can We Do To Make What Can We Do To Make Sure the Women Have Sure the Women Have
Healthy Babies?Healthy Babies?
Prenatal CarePrenatal Care
Prenatal care alone is not enough to improve birth outcomes.
In order to improve birth outcomes, interventions must address health equity and the social determinants of health.
Social determinants of health means that where women live, learn, work, and play contribute to their overall health status.
Contra Costa FIMR Program, 2010
Recommendations for Recommendations for Improving Preconception Improving Preconception
HealthHealth
1. Prevention Preventive visits: As a part of primary care
visits, provide risk assessment and counseling to all women of childbearing age to reduce risks related to the outcomes of pregnancy.
2. Interventions Interventions for identified risks: Increase
the proportion of women who receive interventions as follow up to preconception risk screening, focusing on high priority interventions.
Recommendations for Recommendations for Improving Preconception Improving Preconception
HealthHealth
1. Interconception Interconception care: Use the interconception
period to provide intensive interventions to women who have had a prior pregnancy ending in adverse outcome (e.g., infant death, low birthweight or preterm birth).
2. Pre-pregnancy Pre-pregnancy check ups: Offer, as a
component of maternity care, one pre-pregnancy visit for couples planning pregnancy.
Chronic Disease Chronic Disease Management Management
Examples (not limited to):
Diabetes
Hypertension
Obesity
Asthma
Folic Acid for Folic Acid for Men & WomenMen & Women
Men: A study published in Human Reproduction (2008) showed that men who take folic acid lower their risk of having abnormal sperm by 20-30 percent. So men eat foods high in folate, such as fruits & vegetables to help lower the chances of birth defects.
Current recommendation for women: Take folic acid before pregnancy to lower the chance of Neural Tube Defects.
Men & Women: Consume at least 400 micrograms of folic acid daily, in addition to foods high in folate.
Men & Women: Be physically active for at least 30 minutes a day.
Oral HealthOral Health
See a dentist and get teeth cleaned before/during pregnancy.
Pregnancy: dental care can improve the health of the baby.
All pregnant women have dental insurance through Medi-Cal. This includes 60 days postpartum.
Source: FMCH Children’s Oral Health Program brochure May 2011
Contraceptive Effectiveness Contraceptive Effectiveness and Continuation Ratesand Continuation Rates
Source: Hatcher, RA et al; Contraceptive Technology 19th Edition, 2007
Perfect Perfect UseUse
Typical Typical UseUse
Continuation Continuation raterate
Implant (Implanon)Implant (Implanon) 0.050.05 0.050.05 84%84%
Male sterilizationMale sterilization 0.100.10 0.150.15 100%100%
IUCIUCLNG-IUS (Mirena)LNG-IUS (Mirena)Cu-T 380 (ParaGard)Cu-T 380 (ParaGard)
0.20.20.60.6
0.20.20.80.8
80%80%78%78%
Female sterilizationFemale sterilization 0.50.5 0.50.5 100%100%
DMPADMPA 0.30.3 3.03.0 56%56%
OCs, Patch, RingOCs, Patch, Ring 0.30.3 8.08.0 68%68%
Every Woman CaliforniaEvery Woman California
www.everywomancalifornia.org
Information about health considerations for women and their partners before they become pregnant for the first time or between pregnancies (preconception health).
Links to resources and tools for health care providers and public health professionals.
Information for women and men who want to learn what they can do to be healthier for themselves and for their families.
Discrimination and Discrimination and Disparities in HealthDisparities in Health
Perceptions of discrimination have been shown to account for some of
the racial differences in birth outcomes in U. S. data. (Mustillo et
al. 2004)
Institute of Medicine’s Institute of Medicine’s Report: Report: Unequal Unequal
Treatment, June 2002Treatment, June 2002
The report showed that patient outcomes were affected by the way
providers and the system treated them and that people of color were treated differently, so people’s lives were at
stake.
Jeannie Cummings, MALEV Program Coordinator
(925) [email protected]
Itika Greene, NP, MPHFMCH Public Health Nurse Consultant
Suzzette C. Johnson, MSW, MPALEV Program Manager
Thank you for your tireless & enthusiastic energy, skills, & focus.