Preconception Care

1
Preconception Care

• Enhancement and Integration into
• MCAH/OFP Programs

2
Preconception Care has Challenges

• Time challenges
• California births diversity and our numbers
• Unintended pregnancies

3
Time Barrier Challenge

• Study of family practices, revealed 24 of
  patients were current on immunizations
• 9 were current with health-habit counseling
• USPSTF notebooks of preventive services are
  thicker and thicker over the years

4
California Births, 2003

• Total Births to California Resident
  Women 540,827

13.2 of US Total Births in 2003
5
MCAH/OFP Programs Enhancing/Integrating PIC

• Comprehensive Perinatal Services Program
• Black Infant Health
• Adolescent Family Life
• Family PACT (planning, access, care, and
  treatment
• Folic Acid Campaign
• Oral Health

6
MCAH/OFP Programs continued

• Domestic Violence
• California Diabetes and Pregnancy Program
• Adolescent Latino Diabetes Prevention Project

7
Comprehensive Perinatal Services Program

• Over 300,000 women served
• Clients served Medi-Cal eligible women
• Clients may crossover to Family PACT

8
Black Infant Health

• A case management program for high risk Black
  women
• July 1, 1996-June 30, 2003
• 34,365 First-Time Referrals

9
Adolescent Family Life

• Case management from transportation to medical
  referral needs.
• Preventing unintended pregnancy
• Preventing preterm births and low birthweight
• Decreasing school failure/dropouts

10
Adolescent Family Life

• Risk factors addressed
• Chronic health conditions asthma, DM
• Mental health issues
• Substance abuse/use

11
Office of Family Planning

• To increase the number of women who plan, and are
  prepared for pregnancy
• To optimize the womans health
• To minimize risks to her and the fetus and
  improve pregnancy outcome
• Provide information necessary to make informed
  decisions about future reproduction.

12
OFP

• In FY 02/03, family pact served 1.57 million
  women and men
• Scope of service
• Initiation and management of contraception
• Clinical preventive services
• Individual health education

13
Folic Acid Campaign

• All health care providers are urged to encourage
  women in the reproductive age group to consume
  400 mcg of folic acid daily.

14
Folic Acid Campaign

• California is targeting increase folic acid
  consumption among
• Young women (AFLP)
• Latinas(Spanish and English posters)
• Women of low socioeconomic status

15
What Is Domestic Violence?

• spectrum/pattern of behaviors that includes
  physical, sexual, verbal, emotional and
  psychological abuse and/or economic control used
  by adults or adolescents against their current or
  former intimate partners to power and authority,
  which has a destructive, harmful effect on
  individuals, the family and the community.

16
Funding for DV

• 22.8 M (FY 2003/04)
• - 97 direct service shelters
• - 32 prevention/planning grants
• - 15 unserved/underserved grants
• - 1 training technical assistance grant

17
The Adolescent Latino Diabetes Prevention
Collaborative

• Family centered
• Physical activity before and after school
  promote safe walking to school, picnics that
  combine activity with healthy food
• Nutrition simple nutritious food preparation
  portion size adjustment, cooking classes

18
Summary

• MCAH/OFP Programs contain these elements to
  enhance and integrate PIC
• Risk assessment
• Education
• Intervention or modification
• Counseling

19
MCAH/OFP ENHANCING AND INTEGRATING PIC

• Promotes PIC through its programs by
  disseminating reports, data, brochures
• Meets with the providers and directors of
  MCAH/OFP programs
• Coordinates information by linking web-sites with
  other CDHS programs

20
MCAH/OFP ENHANCING AND INTEGRATING PIC

• All MCAH/OFP programs have a set schedule of
  meetings for each fiscal year
• Introduction of topics are presented that
  influence PIC
• Speakers with expertise present pertinent new
  ideas
• Legislation and state programs are presented at
  each scheduled meeting

21
Time Barrier Challenge

• Preventive Medicine 2005 ACPM
• US Preventive Services Task Force (USPSTF) uses
  evidence base recommendations
• Recommendations classified A,B,C..etc

22
Oral Health

• Oral health related to pre-term labor
• MCAH contracts with the UCSF for a licensed
  dentist, DHS dental working group developed
• Oral health educational materials, brochure, and
  poster distributed

23
Adolescent Family Life

• Nutrition and Physical Activity Guidelines for
  Adolescents
• Body Image and Disordered eating
• Weight management (using CDC growth charts)

24
Pregnancy ComplicationsSignificantly Higher
w/IPV MIHA 2002

• Vaginal bleeding
• Cervix sewn shut
• Kidney or bladder infection
• Severe nausea or vomiting
• Some other health problem during pregnancy
• Low birth-weight baby

25
First-Time Referrals

• Breastfeeding
• Parenting Support
• Family Planning
• Parent Education
• Vocational/Jobs
• Immunizations

26
Latinos Diabetes Training in Fresno

• Provide update on the American Diabetes
  Associations guidelines for screening
• Improve understanding of dietary acculturation
  and the dietary changes that occur
• Provide a forum for discussion of regional
  collaborations on improving obesity and diabetes
  in Latinos

27
California our diversity and numbers

• In 2003 slightly over 540,000 births occurred in
  California
• In 2003 there were 8,605,732 women in the
  reproductive age group
• 49.9 of the births are to Latinas
• Greater than 40 of pregnancies are unintended