Project Embrace:

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Project Embrace

• From Recommendations to Actions to Outcomes
• by Liane Montelius
• and Kelly Sanders

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Women and Childrens Health Network, Inc.

• History Greater Hartford Prenatal Care Continuum
  Provider Network, 1994
• Purpose To improve birth outcomes of Hartford
  women

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WCHN Mission

• A comprehensive system of high quality,
  culturally competent care for women and children
  will be enhanced and sustained through a citywide
  network of health care and social service
  providers.

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WCHN Members/ Key Partners

• Asylum Hill Family Practice
• Burgdorf/Fleet Health Center
• Charter Oak Family Health Center
• Community Health Services
• Connecticut Childrens Medical Center
• Hartford Hospital
• Hispanic Health Council
• City of Hartford Health Department
• St. Francis Hospital and Medical Center

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WCHN Model
Black Womens Health Council
Womens Health Team
WCHN Management Team
Perinatal Health Team
Childrens Health Team
Project Embrace
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WCHN Teams

• Goals
• Through collaboration each team
• Facilitates communication and coordination across
  institutions.
• Identifies barriers and develops systems,
  processes and intervention vehicles.
• Conducts research
• Develops and disseminates information
• Advocates for public and institutional policy

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Description of Issue

• WCHN has committed to
• Addressing the high infant mortality rate in
  Hartford.
• Developing and maintaining a project that would
  work with families to address medical and
  psychosocial needs relating to the loss of their
  baby
• Preventing repeat poor birth outcome

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Objectives

• Create and maintain a system to identify, link to
  services and track 50 Hartford women annually
  suffering a fetal or infant loss.
• 75 of Project Embrace participants will
  demonstrate improved grief resolution scores over
  intake scores.

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Objectives

• 75 of Project Embrace participants will
  demonstrate improved basic and preconception
  health care knowledge and infant health care
  knowledge
• Reduce the Hartford repeat poor birth outcome
  rate from a baseline of 19 through comprehensive
  health and social service linkage, and skill
  building activities.

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Intended Results

• Improve the overall health and well-being of the
  mother/family in order to reduce the incidence of
  repeat pattern of fetal and infant mortality.

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Methods

• Established system of referral in the Citys
  major hospitals, and within major prenatal care
  outreach clinics
• Implemented Edinburgh Depression Scale to track
  improved grief resolution
• Provide health education using a curriculum
  developed by local health care providers.

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Methods

• Bereavement Support
• Assistance in making funeral arrangements
• Referrals to bereavement support groups and
  bereavement counselors
• Limited financial assistance for funeral expenses

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Methods

• Case Management
• Assistance accessing basic needs such as food,
  clothing, shelter
• Link to other needed social services
• Assist families in achieving their personal goals
  using the Family Development Model from Cornell
  University

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Methods

• Care Coordination
• Postpartum appointment
• Explanation of medical aspects of loss, including
  autopsy
• Referral to risk reduction activities
• Assistance accessing services to address chronic
  health issues, mental health services, and family
  planning services.

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Role of WCHN

• Members volunteer to provide oversight for the
  Project as an advisory group.
• Members volunteer to participate on an
  interdisciplinary team to provide expertise in
  identifying issues related to a loss and
  developing a plan of action for each family
  served

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Approximate Annual Budget

• Braided Funding from
• CJ Foundation for SIDS
• CT Chapter March of Dimes
• Hartford Hospital
• St. Francis Hospital and Medical Center

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Results

• Question Thinking about your entire experience,
  was there any person or event that was
  particularly helpful for you?
• Response The social worker who told me about
  you (Project Embrace). I am very grateful for all
  your help and for the information about grief and
  health that I didnt know about. Its is nice to
  know that there are people that really care.
• (Participants of Project Embrace, 2003)

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Results

• Question What do you think needs to be done to
  help women and families who have experienced the
  death of their baby?
• Response This program (Project Embrace) was
  really helpful with making funeral arrangements,
  transportation and helping me get answers from my
  doctor about the reasons for my babys death.

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Results

• 23 women have received services through Project
  Embrace
• Project Embrace has established a system of
  referrals within the Citys major hospitals and
  has complete support of the hospital staff
• Project Embrace coordinator has created a
  bereavement support group specifically available
  to African, African American and West Indian
  Caribbean women

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Conclusions

• Lessons Learned
• Women/Families are often feel confused about the
  medical aspects relating a poor birth outcome.
• Women/Families are seeking to prevent repeat poor
  birth outcomes and are seeking the information
  needed to accomplish this.
• Black women/families in the Hartford area
  appreciate and use a bereavement support group
  that is available solely for Black families.

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Conclusions

• Greatest Barrier
• Sustaining the continuation of funding for the
  program
• Shifting the paradigm to encourage the health
  care community to view this program as a primary
  intervention for next pregnancy rather than a
  secondary intervention after a pregnancy loss.

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Public Health Implications

• Improving womens health by addressing medical
  and psychosocial issues prior to next pregnancy
  can lead to a reduction of poor birth outcome