Interconception Care Program Recruitment Strategies

1
Welcome
Interconception Care Program Recruitment
Strategies
2
Housekeeping

• There are over 100 registered participants for
  this call. Phones will be muted during the
  webinar.
• If you have a question, please post it via the
  chat function. Questions will be taken from chat.
  Submit questions as soon as they come to mind
  well keep track of them.
• Slides, speaker bios and speaker contact info are
  available at www.everywomansoutheast.org.

3
Acknowledgements

• March of Dimes
• Lori Reeves for TA with todays webinar.
• The W.K. Kellogg Foundation
• Every Woman Southeast Volunteers
• Our Speakers

4
What is Every Woman Southeast?

• A coalition of leaders in Alabama, Florida,
  Georgia, Kentucky, Louisiana, Mississippi, North
  Carolina, South Carolina and Tennessee to working
  together to build multi-state, multi-layered
  partnerships to improve the health of women and
  infants in the Southeast.

5
www.EveryWomanSoutheast.org
6
Our Blog
7
Monthly E-Newsletter
8
Join Your State Team

• We have 9 state teams one for each state.
• Find your team lead by clicking on your state
  webpage on our website.
• Contact the lead and connect. This is a great
  way to link up with the latest resources and
  opportunities on preconception health.

9
Todays Webinar

• Interconception Care Program Recruitment and
  Retention Strategies
• October 24, 2012

10
Why This Topic?

• Reducing risks indicated by a previous adverse
  pregnancy outcome is a top goal of the National
  Preconception Health and Health Care Initiative
• In the SE 3 states have demonstration projects
  to provide interconception care to high risk
  women
• Limited information about best practices in
  serving this population

11
Objectives

• Describe current efforts to promote
  interconception health care for high risk women
• Describe how to overcome at least one challenge
  to recruitment
• Describe at least two strategies that improved
  recruitment and retention
• Discuss ways that interested groups can continue
  to connect on this issue.

12
Speakers

• Sarah Verbiest, DrPH, MSW, MPH
• Dean Coonrod, MD, MPH
• Jennifer Culhane, PhD, MPH
• Anne Dunlop, MD, MPH
• Betsy Bledsoe-Mansori, PhD, Mphil, MSW
• Carol Brady, MPH

13
The Postpartum Plus Prevention Program in NC

• Sarah Verbiest, DrPH, MSW, MPH
• Executive Director
• UNC Center for Maternal and Infant Health
• Director
• Every Woman Southeast Coalition

14
The Postpartum Plus Prevention Program (P4)

• Designed to increase knowledge about how to
  provide health and wellness services to mothers
  of medically fragile infants.
• Services postpartum visit, a wellness kit at 3
  months, and contact with a nurse midwife at 3, 6,
  9, 12 and 18 months postpartum.
• P4 also provided onsite medical care to any woman
  in the NICU who requested help.

15
Enrollment

• Women were approached for enrollment by a nurse
  midwife while their infant was in the NICU. We
  didnt have anyone decline participation.
• A convenience sample of 44 mothers was recruited
  from the Newborn Intensive Care Unit at UNC.
• Nearly all (87) of the women had received a
  medical service from the nurse midwife prior to
  being recruited into the study.

16
What We Found

• Almost every mother (97) returned to UNC
  post-discharge for infant follow-up.
• Initial expectations were that mothers would only
  be reachable by phone but the majority of
  mothers also received in-person support.
• Mothers were open to talking with the nurse
  midwife during pediatric visits for their infant.

17
Contacts

• We anticipated about 220 total contacts with the
  women in the study. We had 645 contacts!
• The nurse midwife had an average of 15 contacts
  with each mother. The number of contacts per
  woman ranged from 6 to 42 the lowest number was
  still above our expectation.
• One third of the women went through a period of
  time where they had weekly contact with the nurse
  midwife usually due to a crisis in their babys
  health.

18
Content

• Almost all contacts began with a mother-led
  conversation about the infants health.
• The nurse midwife introduced wellness messages in
  the context of the impact of the mothers health
  on the well-being of her infant.
• Mothers needed support for nonmedical issues such
  as relationship with the infants father,
  poverty, employment, and loss/grieving.

19
Conclusions

• Mothers of medically fragile infants are
  receptive to tailored wellness messages when
  provided along with clinical care for themselves
  and their baby.
• The NICU provides a key opportunity for initial
  outreach to high-risk mothers.
• Telephonic support is a good option for providing
  services and support, especially when paired with
  in-person contact through pediatric services to
  the infant.

20
Conclusions

• Mothers capacity to attend to their own health
  and wellness needs is linked to the immediate
  health status of their infant.
• Easy access to health care services from a
  professional they trusted was very important.
• Innovative partnerships between OB/GYN and NICU
  follow-up clinics should be considered to best
  serve both high-risk mothers and infants.

21
Arizonas Internatal Clinic

• Dean V Coonrod, MD-MPH
• Chair, Department of Ob/Gyn
• Maricopa Integrated Health System / District
  Medical Group
• University of Arizona College of Medicine -
  Phoenix

22
Context
23
Preconception vs Interconception vs Internatal
Care


interconception
preconception care
pregnancy
no more kids!
internatal care
24
Program Eligibility

• Index pregnancy
• Preterm birth 35 weeks or less
• Early pregnancy loss 15 weeks and more
• Stillbirth
• Low birthweight
• Prolonged NICU stay
• Initially 3 days now 5 days
• Not permanently sterilized

25
Schedule of Visits

• 2 weeks
• Breastfeeding, review family planning
• 6 weeks
• Standard postpartum visit
• 6 months
• 12 months
• Yearly thereafter
• Preconception visit

26
Our Visits

• Seen by care coordinator
• Introduce program
• Edinburg Postpartum Depression scale
• 6-week intake form
• Go over education goals for nutrition,
  exercise, dental care, folate
• Psychosocial support, stress management

27
Our Visits

• Seen by physician
• Reason for visit
• Index pregnancy reviewed
• Neonatal status
• Breast feeding / back to sleep
• Prior ob history
• Reproductive life plan, contraception
• Gyn, STI history / screening
• PMH / PSH / Dental care

Underlined Done at all visits
28
Our Visits

• Infection / immunization
• TB, Rubella, Tdap (pertusis), varicela, influenza
• Nutrition / exercise
• Anemia, food security, BMI, folate, exercise
  (type / amount)
• Meds / allergies
• Habits / Social / Exposures
• Tobacco, alcohol, drugs, DV, work, environmental
  exposures
• Behavioral health
• EPDS, other mental health, eating disorders
• Physical exam
• Weight (BMI), BP etc
• Problem focused exam

29
Our Project Patients End of 2010

• 696 approached
• 142 had a visit
• 90 Latina
• 71 seen for clinical services in the last 6
  months and are considered active
• 71 have relocated or have been lost to follow up

30
Final Results (n102 women)

• In program for 12 to 18 months
• Of those pregnant at least 12 month interval
• Of those pregnant with first trimester care
• Of those pregnant, tob, ETOH, drug free
• Using contraception (if indicated)
• On folate
• Regular exercise (30 min 5 days a week)
• Normal BMI
• Those with oral health needs who have treatment
• Those with mental health needs who have treatment

• 64
• 40
• 87
• 100
• 88
• 61
• 23
• 26
• 20
• 100

31
Follow Up Data
Baseline 6-month 12-month
Health is Excellent 46 55 70
Regular Exercise 23 76 70
Very Interested in Getting Preconception Information 53 76 69
Alcohol Can Effect Fetus 73 83 94
Watchful About Eating Fish 48 77 88
32
Lessons Learned

• Care coordination key
• Mothers / families after a pregnancy ending in
  stillbirth very interested
• Patients with preterm birth have varying levels
  of interest
• No show rate a significant problem
• Interval of visits often dictated by family
  planning or other issues / mental health
• Usually more frequent than the idealized one
• TLC is always provided and likely of benefit

33
(No Transcript)
34
Thanks to our partners and funders

• March of Dimes
• Maricopa Dept of Public Health
• ADHS
• BHS
• Mercy Care Plan
• University Health Plan
• Az Public Health Association
• Mayo Clinic Family Medicine

• Maricopa Integrated Health System
• Ob/Gyn
• MFM
• Family Medicine
• Ambulatory
• Social Work
• Southwest Human Development
• St Lukes Health Initiatives
• AHCCCS

35
Questions?

• Dean_Coonrod_at_DMGAZ.org

36
The Philadelphia Collaborative Preterm
Prevention Project

• Jennifer F. Culhane MPH, PhD

37
The Study

• Before discharge from the post partum hospital
  stay
• Consent including access to medical records
• Conduct survey
• Randomization
• Smoking intervention begins
• Schedule 1st postpartum visit (1 month)

38
Postpartum Study Visits

• When 1, 6, 12, 18, and 24 months postpartum
• Or, at 20 weeks gestation of the subsequent
  pregnancy

39
Postpartum Study Visits

• Survey
• Periodontal exam (1, 12 and 24 months only)
• Vaginal fluid (self collection)
• Blood
• Urine
• Anthropometric measurements
• Blood pressure
• Transportation, flexible hours, childcare,
  barriers eliminated

40
Intervention Arm

• Evaluated and offered treatment for
• Depression
• Periodontal disease
• Urogenital tract infections
• Abnormal BMI
• Housing instability/inadequacy
• Smoking
• Literacy

41
Recruitment Rate
77.7
Figure 2. Webb, et al. BMC Medical Research
Methodology, 2010, 1088
42
Retention/Data Capture Rates for Study Population
Randomization Intervention Group Control Total
First Post Partum Assessment 83.5 76.0 80.0
Second Post Partum Assessment 67.6 57.5 64.6
Third Post Partum Assessment 60.0 48.9 54.4
Fourth Post Partum Assessment 54.2 46.3 50.3
Fifth Post Partum Assessment 47.3 40.8 43.6
43
Strategies to Improve Retentions

• Two full-time staff dedicated to cohort
  maintenance
• Provided transportation - either tokens or cab
  pick up
• Evening and weekend hours
• Child care and food provided
• If required visit conducted at participant's
  home
• Clinic had washing machines and dryers
• Staff required to be courteous and totally
  participant -focused
• Compensation for time

44
Risk Factor Prevalence, Acceptance Rates and
Rates of Minimal Participation in PCPP
Intervention Arms
45
Strategies to Improve Participation in
Interventions

• Phone medicine for depression care available
• Staff accompany participants to dentist
• Provide valium for dental visits
• Smoking intervention conducted in particpants
  home
• Medicines delivered to particpants home
• Food and caloric supplements delivered to
  participant's home

46
Selected Findings

• Exposures associated with adverse outcomes are
  moderately prevalent and co-occur.
• There is a wide range of participation across
  interventions- even with every traditional
  barrier to care addressed.
• Volunteering for treatment is MUCH different than
  random assignment to treatment- people who really
  need the intervention may not seek care

47
Important Research Questions

• Why dont some women avail themselves of care?
• Not just traditional barriers to care
• Complex decision making that may seem irrational
  to providers but may make perfect sense in
  certain contexts- what are those contexts?

48
Important Research Questions

• RHIME factors (Racism, Housing challenges,
  Insufficient resources, Multiple burdens and
  Emergencies) play a role in womens everyday
  lives and influence care participation
• We need to become aware of, document and address
  the ways various institutional structures, rules
  and ways of doing business create additional
  burdens for already stressed women

49
Summary

• Truly at risk women may not participate
• Even if an intervention works it may not be
  successfully implemented- what do we mean by
  works?
• More research needed to understand complex
  barriers to participation

50

• The Interpregnancy Care Program
• Overview of Engagement Strategy
• For Women Who Recently Delivered
• A Very-Low-Birthweight Infant
• Anne L. Dunlop, MD, MPH
• October 24, 2012

51
IPC Participants

• Eligibility African-American women who
  qualified for indigent care and delivered a VLBW
  infant at Grady Memorial Hospital (GMH) during
  the feasibility phase (11/2003 through 3/2004).
• Recruitment/Enrollment
• 29 women enrolled (of 38 eligible)
• 24-months of follow-up complete 3/2006.

52
IPC Intervention Package

• Definition of an individualized IPC plan to
  address 7 areas epidemiologically linked to low
  birth weight/preterm delivery
• Reproductive planning (assistance in achieving
  intendedness and spacing)
• Prevention, screening and treatment for
  sexually-transmitted infections
• Micronutrient supplementation
  screening/treatment for nutritional deficiencies
• Prevention, screening and treatment for
  periodontal disease
• Management of chronic disease
• Treatment and referral for substance abuse
• Screening and treatment for depression,
  psychosocial stressors, domestic violence
• Provision of health and dental services in
  accordance with the IPC plan for 24 months
• Community outreach via a trained Resource Mother.

53
Provision of IPC

• Contact with a multidisciplinary team
• Family nurse practitioner, family physician,
  periodontist, nurse case manager, social
  worker, and Resource Mother
• Initial contact with nurse case manager followed
  by Resource Mother during the delivery
  hospitalization.
• Primary care visits occurred every 1 -3 months
  (dependent upon extent of health problems) in a
  group setting with integration of group
  educational experiences according to the
  Centering Pregnancy Model of prenatal care
• Home visits and telephone contact by the Resource
  Mother monthly to address psychosocial issues.

54
Participation in IPC

• 21/29 (72) actively participated
• 8/29 (28) not actively participated
• 2 moved out of state
• 3 electively disenrolled (2 prior to 1st IPC
  visit 1 after single visit)
• 3 become lost to follow-up (2 prior to 1st IPC
  visit 1 after single visit).

55
Impact of IPC Social Outcomes (Education)

• Educational Attainment
• 18/21 (85.7) active participants without h.s
  diploma or GED at study entry
• Of those 18 without diploma or GED, 13/18 (72.2)
  were assisted in earning diploma or GED during
  the study
• 8/18 earned h.s. diploma or GED
• 5/18 enrolled in G.E.D. training program,
  but did not
  complete the program.

56
Impact of IPC Social Outcomes (Training)

• Other Training
• In addition to GED, 4 participants completed
  technical training (2 computer literacy, 2
  medical assistance)
• In addition to h.s. diploma, 1 participant
  completed Upward Bounds (college preparatory
  program)
• A participant with a h.s. diploma completed
  technical training (administrative assistance).

57
Impact of IPC Social Outcomes (Housing)

• Housing Acquisition
• 14/21 active participants with inadequate
  (crowded, dirty, unsafe) housing or homeless at
  study entry
• Of those 14 who were homeless or with inadequate
  housing, 11/14 assisted in finding adequate
  housing.

58
Cost of IPC per Participant Full 24 months

• Health care
• Mean charges 2,397 (median 2,104)
• Mean visits 7 (median 6)
• Mean cost per visit 342 (median 350)
• Resource mother outreach
• Estimated 1,800

Total Program Cost per Participant per 24-Months
4,197
59
Cost Analysis

• The 29 enrolled women received 24-months of IPC
  at 4,197 each, and delivered 1 LBW infant
  (initial hospitalization 55,576) conceived
  within 18-months of the index VLBW
• Cost of program 29 x 4,197 121,713
• Cost of LBW infant 55,576
• 
  177,289
• Based on the historical control cohort, we
  expected 5 LBW infants to be conceived within
  18-months of the index VLBW
• Cost of LBW infants 5 x 55,576 277,880
• Net savings 100,591

60
Translation of IPC

• Planning for Healthy Babies Georgia Medicaid
  Waiver, beginning January 2011, will expand
  Medicaid coverage for specific reproductive
  health services to Georgia women 200 FPL
• Family planning services (broadly) for all women
  of reproductive age
• Interconception primary care, case management,
  and resource mother support for all women who
  deliver a VLBW infant after Jan 1, 2011.
• Services to be delivered through the Georgia
  Medicaid CMOs
• Amerigroup, Peach State, WellCare
• Small trial of NICU-based engagement in 3 metro
  area NICUs

61
Engaging and Retaining Difficult to Reach
Mothers in Treatment Services Overview of a
Brief Intervention.Betsy (Sarah E.)
Bledsoe-Mansori, PhD, MPhil, MSWAssistant
Professor School of Social WorkUniversity of
North Carolina at Chapel HillOctober 24, 2012


62
Acknowledgements

• Pregnant women and adolescents from Pittsburgh,
  PA Seattle and King County, WA and Alamance and
  Wake Counties, NC who participated in the
  research studies supporting this work.
• Funding sources -- National Institute of Mental
  Health, National Institutes of Health, Horizons
  Foundation, Seattle, WA, Jane H. Pfouts Research
  Grant, Armfield-Reeves Innovation Fund,
  University of North Carolina Program on Ethnicity
  Culture and Health Outcomes, University of North
  Carolina
• Co-investigator s and collaborators Nancy
  Grote, PhD Holly Swartz, MD Allan Zuckoff, PhD
  Ellen Frank, PhD Katherine Wisner, MD Wayne
  Katon, MD Carol Anderson, PhD Sharon Geibel,
  MSW

63
An Ecological Model of Barriers to Treatment
Engagement and Retention
Distal Influences ----gt Proximal Influences
----gt Rx Adherence ----gt Rx
Outcomes  
Community Barriers Helping
System Barriers violence, safety concerns
bias or cultural insensitivity in
lack of support services
environment, procedures, providers unemployment
poverty lack of
evidence-based treatments lack of access to M.H.
services lack of diversity in clients
staff
provider overload and
burn-out
Social Network
Barriers Client Barriers
negative attitudes toward RX
practical- time, financial, transportation,
childcare social network strain
psychological - stigma, low
energy,
negative
RX experiences previous or current trauma

cultural womens view of
depression multiple stressors
culture of poverty
culture of race/ethnicity/nationality

 


64
Barriers to Care

• Practical Do I have time? Can I get there? Can
  I afford it?
• Psychological Can I trust my therapist? Can
  she/he really understand me and help me?
• Cultural Will treatment be relevant to my
  needs, goals, values, preferences and practices?

65
Practical Barriers to Care

• Costs
• 40 African Americans and 52 Hispanics lack
  health insurance in the US (US Census Bureau,
  2003)
• Access
• Inconvenient or inaccessible clinic locations
• Limited clinic hours
• Transportation problems
• Competing Obligations
• Child care and social network
• Loss of pay for missing work
• Time in dealing with chronic stressors

66
Psychological Barriers to Care

• STIGMA
• I dont want to be that person to get the
  medication and be called DEPRESSED my sister
  had to live with that label and everyone
  avoided her and treated her like it was her
  fault.
• NEGATIVE EXPERIENCES WITH SERVICE PROVIDERS
• I didnt want the therapist to report my
  depression to child protective services because
  they might take my baby away. I felt betrayed.
• CHILDHOOD TRAUMA AND LACK OF TRUST
• Greater risk of insecure attachment and lack of
  trusting others (Mickelson et al., 1997)
• Implications for seeking treatment go-it-alone
  attitude poor collaboration, missed
  appointments requires extensive outreach

67
Cultural Barriers to Care

• CULTURE OF POVERTY
• My therapist seemed overwhelmed by all my
  practical problems, so how could she help me?
• CULTURE OF RACE/ETHNICITY/NATIONALITY
• No it doesnt matter
• Sitting in front of a white therapist isnt
  necessarily like she thinks she is better than
  me, BUT there are some white people who think
  they can look down on you and show favoritism to
  people of their nature and culture and treat you
  any kind of way.

68
Development of an Engagement StrategyBefore
Treatment Begins

• To deal with practical, psychological, and
  cultural barriers to care and ambivalence about
  going for depression treatment
• Integration of two theoretical approaches
• Ethnographic interviewing
• Motivational interviewing

69
Ethnographic Interviewing (EI)

• A method of eliciting information designed to
  help the interviewer understand the ideas,
  values, and patterns of behavior of members of
  another culture without bias (Schensul, Schensul,
  LeCompte, 1999)
• Anthropological Uses
• Foreign cultures
• Sub-cultures

-
70
Motivational Interviewing (MI)

• Client-centered, goal-oriented method for
  enhancing a persons own motivation to change by
  working with and resolving ambivalence (Miller
  Rollnick, 2002)

71
Principles of Engagement (Grote, Zuckoff,
Swartz, Bledsoe, Geibel, 2007)

• 1) Work to understand the perspectives and values
  of the woman without bias or agenda
• 2) Adopt a one-down position as learner
• 3) Help the woman to feel safe to tell her story
  (whats bothering her) without fear of judgment
• 4) Find out how the depression or stress is
  interfering with what is important to her this
  primary motivator for change!

72
Principles of Engagement

• 5) Affirm the womans strengths and coping
  capacities (e.g., resilience, knowledge,
  spirituality, family)
• 6) Obtain permission before giving information or
  advice
• 7) Provide psychoeducation about the problem and
  effective treatments and elicit the womans
  reaction
• 8) Identify pros and cons about getting treatment
  (ambivalence) pull for the negatives
• 9) Express empathy, especially for the reasons
  against seeking treatment (as well as reasons for
  seeking treatment)

73
Principles of Engagement

• 10) Foster personal choice and control ( Its up
  to you!)
• 11) Problem-solve all the barriers with the woman
• 12) If the woman commits, collaborate with him or
  her to make the connection with mental health
  services
• 13) Offer hope, acceptance of ambivalence,
  affirmation
• 14) Leave the door open, if she does not commit

74
Engagement Session 5 components(Unpublished
manual, Zuckoff, Swartz, Grote, Bledsoe
Speilvogle)

• Total time 50-60 minutes -- These components can
  be used separately if time is limited or repeated
  as needed.
• 1) Getting the story
• 2) Past efforts at coping and attitudes toward
  treatment
• 3) Feedback and psychoeducation
• 4) Addressing barriers to care
• 5) Eliciting commitment and planning for
  treatment engagement

75
Engagement Component 1 The Story

• Introduce session
• During this time I would like to get to know you
  better how you see whats bothering you,
  whether you want help, and if so, what you would
  want out of treatment services.
• How have you been feeling lately and how is this
  interfering with whats important to you?
• Explore the Story
• A. Problem understanding of the womans
  view of her depression/stress how it is
  interfering with clients life
• B. Context social context of the problem
  acute stressors (stressful life events
  pregnancy) and chronic stressors (like poverty)
• C. Summary empathically summarize clients
  story highlight concerns and wishes identify
  and affirm strengths

76
Engagement Component 2Treatment History Hopes
for Treatment

• History of the problem ask about past or current
  efforts to cope with the problem (e.g. spiritual
  beliefs, family, inspirational people) identify
  and affirm strengths empathically summarize
• Treatment history ask about clients or family
  members experiences with or ideas about
  treatment get both positive and negative ask
  about experiences with social agencies/health
  care providers
• Treatment hopes/expectations
• What would you like to be doing if treatment
  worked?
• What do you want/not want in treatment or in a
  therapist?
• Does race/ethnicity matter?
• Empathically summarize hopes and fears for
  treatment, capturing the womans ambivalence
  while highlighting hope

77
Engagement Session Component 3Feedback and
Psychoeducation

• Feedback
• A. Elicit Would it be OK if I shared some of
  the results from the questionnaire you filled
  out? or my ideas about what youre struggling
  with?
• B. Provide symptom severity, consequences of
  depression/stress
• C. Elicit What do you make of this? How does
  this sound?
• Psychoeducation
• A. Elicit What is your view of depression?
  Would it be OK if I gave you some information
  about it and treatment options?
• B. Provide information about depression and
  treatment
• C. Elicit How does this sound to you? Does
  this make sense?

78
Engagement Session Component 4Problem-solving
the Barriers to Care

• Practical What might make it hard to come even
  if you wanted to? Transportation? Childcare?
  Scheduling? Finances?
• Psychological Beyond these practical concerns,
  what else might keep you from coming? Keep
  asking, What else?
• Negative attitudes about treatment? The burden
  of dealing with the symptoms of the problem?
  Guilt about taking time for self? Concerns that
  CPS might become involved? Doubts about whether
  treatment will help? Perceived stigma from
  family and friends?
• Cultural How is treatment viewed in your
  family or community?
• 1) How can treatment help me with getting a
  job, house, food, etc.?
• 2) Preferred community approaches for treatment
  (e.g., church)?
• 3) Therapist differences in race, class, gender,
  age, nationality?
• therapist would judge, not understand, act
  disrespectful, not care
• therapist does not know how to cope with clients
  problems no experience

79
Engagement Session Component 5
Elicit Commitment

• Grand Summary summarize womans story,
  ambivalence, barriers and solutions highlight
  her change talk I cant take this anymore.
• Change Plan outline next steps, e.g., scheduling
  an appointment, number of treatment sessions
• Elicit Commitment What would you like to do?
  Does this sound right for you?
• Leave Door Open Its fine if you want to think
  about it, you can give me a call.
• Instill Hope Affirm womans participation in the
  session and the strengths client brings to
  treatment express optimism about treatment

80
Randomized Study of Pregnant, Depressed Women
Rx Engagement and Retention (Grote, Zuckoff, et
al., 2007)
plt.001
plt.001
plt.001
Less than 1/3 of phone intakes attend 1 Rx
session in community mental settings Typical
number of Rx sessions attended in community
mental health 1
81
with Major Depression Diagnoses
92
79
42
30
5
0
Pre Post-Rx plt.05 Pre F/U plt.05
82
Feasibility Study of Depressed Pregnant
Adolescents (Bledsoe, Wike, Olarte, et al, 2010)
88 of eligible adolescents entered and 93
completed.
83
More Research on Engagement Session

• PREMIUM (Program for Effective Mental Health
  Interventions in Under-resourced Health Systems)
  in Goa, India funded by the Wellcome Trust, UK
  (Vikram Patel, PI)
• Patient Navigation for Depressed Mothers in Head
  Start in Boston, MA- An Engagement Strategy
  funded by NIMH (Michael Silverstein, PI)

84
Questions Answers

• Facilitated by
• Amy Mullenix
• Every Woman Southeast co-chair
• Please submit your questions via chat. Feel free
  to contact speakers after the webinar with any
  additional questions.

85
Join us!

• Join our listserv http//www.surveymonkey.com/s/FQ
  S2P3W
• Bookmark our website www.everywomansoutheast.org
• Follow the blog www.everywomansoutheast.com
• Like our Facebook page (Every Woman Southeast)
  and Pin our page!
• Contact Sarah at sarahv_at_med.unc.edu or
  919-843-7865

86
A woman's health is her capital. Harriet Beecher
Stowe