Improving Prenatal and Pediatric Care through Integrative Programs

Thrive by Three

Ellen Timberlake, Executive Director of the County of Santa Cruz Human Services Department, presented the Thrive by Three (TbT) Fund which was approved by the County Board of Supervisors in January of 2017. Thrive by Three aims to decrease child abuse, decrease parental distress during infancy, increase prenatal care for young mothers, improve healthy parenting practices, and increase access to quality care and education for children and parents. This $350,000 fund is focused on establishing a system of care centered on values and evidence based practices with an emphasis on positive interventions for vulnerable children and parents. The community-based system would have multiple entry points and promote the importance of screening and assessment. The funding will be allocated to three areas: expanding direct services, enhancing coordination between entities, and building a strong foundation for the system to be successful. Increasing capacity to provide intensive care coordination to high-risk families will be done through home visiting programs. Leveraging child care subsidies for high quality child care will be done through the implementation of Early Learning Scholarships (ELS) which uses local dollars to enhance care for vulnerable children. A home visiting learning collaborative has also formed with significant participation of leadership and staff of all local home visiting programs. Elisa Orona, Executive Director of HIP, explained that HIP will play an active role in Thrive by Three by aligning the intent of the initiative to create a coordinated entry system model for early childhood care support services such as home visiting and child care with development of the Health Information Exchange (HIE) to support care coordination for health care providers and beyond. On behalf of the TbT Initiative, Applied Survey Research will evaluate and track community outcomes. Overall, the goal of TbT is to improve outcomes for Santa Cruz County’s youngest and most vulnerable children, prenatal through age 3, and their families.

Live Oak Cradle to Career

Allison Guevara, Social Impact Consultant for Santa Cruz County Health Centers, presented the Live Oak Cradle to Career initiative (C2C). Supervisor John Leopold spoke about the challenges of tracking the success of families within the Live Oak community and the need for a family-driven and family-centered program. C2C aims to meet this need and find a middle ground between developing a community driven model and staying committed to results and evidence. By asking the parents “what are your hopes and dreams for your children,” the C2C team has developed core strategies committed to improving education, health, and character. Strategies include family engagement and leadership development, including parents in steering committees and board meetings, leveraging resources to support families, and improving elementary school clinic efficacy through the collaboration of a Community Care Team in partnership with Santa Cruz Community Health Centers. The C2C program looks to impact individual student achievement, track family satisfaction, organize sustainable funding, and improve data sharing systems. This community-based, family-driven program gathers parents, teachers, healthcare professionals, and social service leaders together to ensure that the children of Live Oak have an opportunity to reach their full potential.

Nurse-Family Partnership

Jennifer Herrera RN, Health Services Manager and Maternal, Child and Adolescent Health Division (MCAH) Coordinator, at the Santa Cruz County Department of Public Health, presented on the Nurse Family Partnership (NFP). The NFP is a nationally accredited program recently launched in Santa Cruz County to support low-income, first time mothers of any age in the community through arranged home-visits and personalized case management overseen by specially trained public health nurses. The national organization approved the implementation of the Santa Cruz County NFP program in February of 2017. The NFP aims to improve pregnancy outcomes, child development, and families’ economic self-sufficiency during the first two years of the child’s life. Substantial evidence has been gathered from three randomized control trials done in New York, Tennessee, and Colorado which found that outcomes of this program were the most successful when delivered by nurses. After NFP intervention, studies of participants from the original cohorts showed increased academic achievement, increased birth spacing, decreased hospitalizations, and decreased welfare assistance. Credentialed nurses possess a bachelor’s degree, a public health certification, and are required to attend a special, week-long training in Denver as a part of the national program. NFP nurses provide weekly and biweekly home visits to families and become an integral part of the mother’s life. Not only do these nurses provide health and development education, but they also serve as mentors and role models for first time mothers. Since its implementation, the NFP has successfully accepted referrals, enrolled clients, and set up an electronic health record to access data. Of the 159 currently received referrals, from prenatal services programs, schools, and NFP clinics, 95 were eligible and subsequently enrolled into the program with an 82% conversion rate from referral to enrollment.

Salud Perinatal Update

Devon Francis, Director of Pediatrics at Salud Para La Gente, presented a perinatal update and highlighted recent activities within their Obstetrics (OB) program, lactation services, and pediatric services. One of the currently active programs is the Salud Diabetes and Pregnancy Program (SDP). This program standardizes the way OB providers treat pregnant patients with diabetes by systemizing screening methods and timing, nurse involvement, patient education, and data tracking. Salud is working to integrate these services into the clinic’s fabric and culture in a more efficient way by involving collaborative management between managers, HR, nurses, billing, and medical assistants. Salud is implementing the 9 Steps to Breastfeeding Friendly algorithm developed by the California Department of Public Health to create a breast-feeding friendly clinic. The guidelines intend to assist clinic staff and implement practices that protect, promote and support breastfeeding. Step 9, for example, explains the importance of having electronic health records that show how breast-feeding outcomes affect infant growth. This informs health care teams about future program planning, determines next steps, and is shared with local agencies. Compared to state data, Santa Cruz County showed the highest rates of breast feeding initiation in data collected from Dominican Hospital, Sutter Maternity and Surgery Center, and Watsonville Community Hospital. Dr. Francis also shared The Healthy Beginnings Pilot Clinic, an ongoing pediatric services project at Salud. This program offers a multidisciplinary clinic where patients can see a pediatric nurse, a lactation consultant, and a pediatrician in one visit. Additionally, Salud’s Moving Health Care Upstream approach encourages healthcare professionals to co-manage with community partners to address social determinants of health beyond medical care, including financial and legal support services. This year, Salud linked its OB patients to the Watsonville Law Center to address questions or issues about documentation status and MediCal coverage. Salud Para La Gente continues to collaborate extensively with community members and healthcare providers to promote accessible perinatal and pediatric care for families with a special focus in South county.