Alameda County Pubic Health Dept.MCAH

1
Alameda County, California Health Information
Team Pamela E. Brett, L.C.S.W. Perinatal
Services Coordinator Alameda County Health
Department Maternal, Child and Adolescent Health
Program
2
(No Transcript)
3
Alameda County, California
4
Alameda County, California
5
Description of Alameda County
Comprised of 20 cities, the largest being
Oakland. Nearly 1.5 million residents are
racially/ethnically diverse. Of the
approximately 22,00 births each year, nearly half
are to foreign-born mothers. About 25 funded
by Medicaid.
6
Target Population
Low income women and their families receiving WIC
services at 5 sites. Ethnicity Hispanic 42 Bla
ck 24 White 12 Asian 11 Pacific
Islander 4 American Indian 2 Other
3 Unknown 2
7
Health Information Team a.k.a. HIT Team

• Team of five Community Health Workers
• All are bi- or tri-lingual, speaking English,
  Spanish, Cantonese, Mandarin, and Mien.
• Two work full-time, the others half-time.
• One member has a medical degree from China.
• Two graduated this June from college two are
  enrolled in college courses.

8
Graduation Party for HIT Staff
9
Each member of the HIT team spends about 4/5 of
her job hours a week at a WIC site. The other
time is spent in compiling statistics, staff
meetings, on-going training and special projects.
10
She starts with an assessment of the clients
needs and interest in health education and
referrals.
11
(No Transcript)
12
Services are provided in the waiting room.
13
In WIC classes.
14
In private at her desk.
15
Health Information

• Family planning, including emergency
  contraception
• Dental health
• Pre-term labor prevention
• SIDS risk reduction
• Second hand smoke

16
Amanda Chan providing Second Hand Smoke
Information.
17
Referrals

• Health insurance
• Family planning
• Prenatal care
• Primary care
• Pediatric care
• Dental care

18
Seng Saechao helping client apply for health
insurance.
19
Referrals

• Substance abuse services
• Mental health programs
• Domestic violence resources
• Emergency food and food stamps
• Case management programs
• Housing

20
Yeny Moreno giving housing referrals.
21

• Tally Form
• 1. Have health insurance? ? No Yes ?
  Medi-Cal (adults___ ) (kids_____) ?
  Private/HMO___ ? Other
  __________________
• kids live with you _____ kids no
  insurance _______
• 2. ? emergency food, food stamps
• 3. ? tobacco/smoke free home/substance
  abuse4. ? SIDS prevention5. ? dental6.
  ? child care7. ? parenting tips/car
  seats/reading
•  
• 8. ? prenatal care
• Health Insurance Referral ? Medi-Cal (adults___
  ) (kids_____)
• ? Healthy Families ? CMSP (adults___ )
  (kids_____) ? Family PACT ? PE ? CHDP
  _____ ? AIM ? Other
• Substance Abuse Treatment Referrals
• Tobacco __________________ ? Other
  ___________________Age 17 or younger Women
  preg____ non-preg____ Other____
• 18 and over Women preg___
  non-preg____ Other_____
• Race White__ Hispanic__ Black__
  Asian__ Pac. Islander__
• Amer. Ind. __ Other__ Unknown__

22
Other Services

• Patient advocacy
• Child passenger safety teaching
• Breastfeeding promotion
• Earned Income Tax Credit promotion
• Utilities discounts for low-income households

23
Literacy Promotion Local Public Television
Station The First Book Program
24
Community Bulletin Boards
25
HIT Team Supervisory Staff

• Direct supervisor is a part-time Perinatal Health
  Educator with an MPH in Health Education.
• Provides ongoing training and program
  monitoring

26
HIT Team Guidelines

• 1.       Give a photo referral form to each
  client.
• 2.       Complete a half-page tally for each
  client.
• 3.       Use the script adapt if needed.
• 4.       Follow the HIT themes each month.
• 5.       When giving a referral for a provider,
  give
• at least 3.
• 6. Teach advocacy. Show how, but don't do
  it for them.
• 7. Confidentiality. We don't keep identifying
  information on clients.

27
HIT Team Guidelines

• 8. We don't personalize referrals from our own
  experience or get involved personally.
• 9. Keep WIC informed of our weekly schedule.
• 10. Keep WIC informed about our themes.
• 11. Update WIC staff about changes in our
  services.
• 12. Help WIC when short-staffed, once in a
  while, if available, up to a maximum of two
  15-minute sessions per day.

28
Other Members of the Alameda County Perinatal
Services Staff

• Perinatal Services Coordinator (Licensed Clinical
  Social Worker)
• Perinatal Nutritionist (RD)
• Perinatal Mental Health and Substance Abuse
  Coordinator (Marriage and Family Therapist)

29
Financing

• One position is funded by a 3-year grant from
  tobacco settlement funds for smoke-free homes.
• Money for health education materials and patient
  incentives for smoking cessation
• The other 4 are paid by county and Federal Title
  XIX funds.

30
Evaluation and/or Evidence of Success

• Keep statistics of
• Numbers and types of clients served
• Numbers and types of referrals
• Numbers and types of educational encounters

31
July 2004 through September 2004 Selected Topics

• Total number of clients served 2,506
•  
• Health insurance referrals 2,275
• Family Planning education and referrals 771
• Smoke-free homes and tobacco education 719
• Emergency contraception education 683
• Dental education and referrals 668
• Emergency food and/or food stamp referrals 656
• Prenatal care education and referrals 542
• Child care referrals 510
• SIDS prevention education 345

32
Work Load Each HIT staff see about 15-20
clients a day. Currently we have 3.5 full-time
equivalents. A full-time HIT staff sees about
271 clients each month, almost all are
unduplicated.
       
33
Other Evidence of Success

• Success is also evidenced by the number of
  clients who visit WIC to receive HIT services
  outside of their appointment time and those who
  refer their non-WIC friends, family members and
  neighbors.

34
Implications for Advancing Preconception Care
35
Low-income WIC clients are an ideal target
population for interconceptional care.
36
Implications for Advancing Preconception Care

• Roughly 3/4 are not currently pregnant.
• Many struggle to care for their families and
  neglect their own health needs putting them at
  higher risk for future poor pregnancy outcomes.
• The high volume of clients served by the WIC
  staff usually prevents them from addressing these
  client needs.

37
The HIT Team is Trained to

• Provide health education on important
  preconceptional topics such as folic acid, family
  planning/spacing
• Can make appropriate referrals for medical and
  dental care, substance abuse treatment, mental
  health and domestic violence services
• Assist a client to stop smoking

38
Potential for Application and/or Replication of
Strategies and Tools

• The HIT team could be easily replicated in other
  WIC sites throughout country.
• The lead was taken by county Department Public
  Health Maternal, Child and Adolescent Health
• Basic forms in your packet
• HIT staff introductory flyer
• Encounter tally form (2 clients per page)
• Sample monthly statistics
• HIT Guidelines

39
Lessons Learned Challenges

• Early challenges being co-located at WIC now the
  two staffs work collaboratively enhancing each
  others work.
• Each HIT staff faces daily challenges working in
  high stress situation with very needy clients and
  a lack of community resources.
• Three years of as needed employment as trainees.

40
Other Challenges

• Ongoing training, close supervision and mentoring
  are time-consuming for supervisory staff

41
Lessons Learned Successes

• High job satisfaction. Four out of five of the
  original HIT team celebrated their third
  anniversary.
• Part of the success is attributable to their
  ongoing training and supervision and flexible
  scheduling to enable members to attend college
  classes.
• Supervisor encourages creativity and initiative.

42
The Next Generation of Public Health Professionals
43
Contact Information Pamela E. Brett,
L.C.S.W. Perinatal Services Coordinator Alameda
County Health Department 1000 Broadway, Suite
500 Oakland, California 94607 Pamela.Brett_at_acgov.o
rg