MCAH and WIC
An Ideal Partnership
How the collaboration between Tulare County WIC
and MCAH is a win-win for providers and clients alike.
Presented by Karen Pringle, RN
Tulare County Perinatal Service Coordinator
Tulare County Health and Human Services
Perinatal Wellness Program (PWP)
A program of Maternal, Child, and Adolescent Health
PWP Seeks to:
• Reduce the instance and/or severity of perinatal
mood and anxiety disorders (PMAD)
experienced by perinatal women
• Increase positive later in life outcomes of infants
• Increase services provided to unserved and
underserved populations
• Increase community awareness of PMAD
PMAD Effects During Pregnancy
Negative Effect
on Bonding &
Attachment
Noncompliance
With Prenatal Care
Risks of
Untreated
PMAD During
Pregnancy
Drug, Alcohol,
Tobacco Use
Domestic Violence
Poor Self-Care,
Nutrition, Sleep
PMAD Implications for Fetus and Newborn:
Preterm birth and
low birth weight
Decreased Bonding
& Attachment
Delayed fetal heart
rate responsivity
Risks of
Untreated
PMAD for
Fetus/
Newborn
Newborns cry more
often, difficult to console
Low Apgar scores
Lower levels of
dopamine and serotonin
in newborn
Long Term Implications:
• Impacts psychological, social, cognitive and behavioral development in children.
• Chronic maternal depression results in higher rates of anxiety, depression, and
behavioral disorders in toddlerhood, preadolescence and adulthood.
Three Critical Components to PMAD Recovery:
– Therapeutic Intervention
– Medical Intervention
– Social Support
PWP Services Include:
– Case management
• N.U.R.S.E. Model of Care
(Promoting Nutrition, Understanding, Rest, Support, Exercise)
– Direct linkage to therapeutic services
– Linkage to social and medical support services
• Additional MCAH Services:
– Breastfeeding support
– Basic health assessment and education
– Linkage and/or referral
– SASP (Safe A’sleep Program)
Distinct Services; Parallel Missions
MCAH’s Mission: To protect, improve and
optimize the health and wellbeing of women,
infants, and children in Tulare County.
WIC’s Mission: To safeguard the health of lowincome women, infants, and children up to age 5
who are at nutrition risk by providing nutritious
foods to supplement diets, information on
healthy eating, and referrals to health care.
Client Base by Race/Ethnicity
PWP
African American
Hispanic
Native American, Pacific Islander, Alaskan Native
WIC
White
Asian
Other/Unkown
Client Base by Age
(Percentage of all clients served)
60
50
40
<16
16-19 years
20-29 years
30-39 years
40+ years
30
20
10
0
WIC
PWP
The WIC & PWP Partnership
Recognition of similar clientele, aligned missions,
limited resources, and gaps in services.
• Partnership Structure:
– PWP Nurse Case Manager on-site in WIC offices 1
day/week.
– PWP Nurse: meets with referred clients for more detailed
nursing assessment, provides basic health education,
connects clients to additional services.
– Video-conferencing capability with all 9 WIC offices.
Why it Works
Benefits for WIC:
• Access to on-site education and support
• Additional breastfeeding support available to clients
• Additional nursing assessment and referral
Benefits for PWP:
• Better client enrollment and retention
• Increased assessment and referral rate
Mutual Benefits:
• Simplified logistics for assessment and referral
• Early intervention, particularly for clients in the most need
• Improved communication between providers and a more effective working
relationship
– Video conferencing improves communication over broad service area
• Shared knowledge and resources; more comprehensive and
individualized service solutions
• Better outcomes for clients! Underserved clients are able to benefit from
care they often didn’t know was available, and receive the information and
support necessary to make well-informed choices about their care.
PWP Referral Sources
2010-2012:
Current:
7%
9%
15%
31%
20%
13%
17%
27%
TC WIC
HHSA (non-WIC)
Health Clinics and Hospitals
Family Resource Centers
Other
2%
59%
Challenges
• Decreased Funding = Fewer Nurses
– Drive to use resources more effectively
• Staff Training
– Training began with MCAH nurses, who could then act as
resources for WIC staff
• Fear of change
– New logistics and communication strategies for WIC and
MCAH staff who had never worked together before
• Development of a trusting partnership
– Building trust takes time!
Everyone benefits from the solution – a structured,
sustainable partnership that is supported by program leadership.