Delivering Prenatal
Education through
Community Collaboratives
A Catalyst for Improved Maternity Services
and Birth Outcomes
Diane M. Daldrup
State Director Program & Government Affairs
November 19, 2014
Presenter Conflict of Interest Disclosure
Diane M. Daldrup, State Director of Program and
Government Affairs, March of Dimes Greater
Kansas Chapter has no relationships to disclose.
Course Objectives
At the conclusion of this workshop participants will:
● Know the leading issues impacting Kansas birth outcomes
● Learn about the Healthy Babies are Worth the Wait/Becoming A
Mom program model
● Understand the community collaborative model and it’s role within
the collective impact framework
● Understand the role of evaluation in program quality improvement
Birth Disparities in Kansas
● Infant Mortality - 6.3/1000 live births
● Birth defects, preterm birth/low birth weight, SUID leading causes
● Black infant mortality rate is more than double white
● Preterm Birth Rate – 10.8%
● 16.3% African American, 11.5 % Hispanic, 10.2% Caucasian
● Smoking 21.5% (women of childbearing age)
● Medicaid pays for 45% of all births
● Medicaid vs non-Medicaid disparity
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*2012 Data
Kansas Priorities
● Lower preterm birth rate 8% by 2020 (ASTHO Challenge)
●Lower infant mortality rate 10% by 2016 (CoIIN Blueprint)
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● Improve access and quality of prenatal care services
● Launch community collaboratives in high-need areas
● Statewide Expansion:
●Healthy Babies are Worth the Wait/Becoming a Mom
● Safe Sleep Campaign
●High Five for Baby
●Tobacco Quit Line
March of Dimes Response
Strategic Mission Investment
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Targeted communities with
demonstrated disparities
Significant number of births
Community collaborative backbone
Community Collaborative Model
• “Collaboration is a mutually beneficial
relationship between two or more parties
who work toward common goals by sharing
responsibility, authority, and accountability
for achieving results.“
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(Collaborative Leadership; Chrislip & Larson, 1994)
Collaborative Strategy
Collaborative strategy is called for ... where
the need and intent is to change
fundamentally the way services are
designed and delivered
"Collaboration establishes a give and take
among stakeholders that is designed to
produce solutions that none of them
working independently could achieve.“
(Enhancing Transdisciplinary Research through Collaborative Leadership,
Barbara Gray, 2006)
CDC Health Promotion Model
Collaboration Benefits
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Permanent MCH Infrastructure developed
Resources leveraged for greater benefit
Care delivery paradigm changed
Long-term program sustainability
Emerging community needs identified early
Collaborative becomes vehicle for change
Magnet for new funding opportunities
Shared risk, shared resources, shared rewards!
Healthy Babies are Worth the Wait
Healthy Babies are Worth the Wait is a March of Dimes
Signature Program designed to decrease preventable
preterm and early term births
Six Key Strategies
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Hospital Quality Improvement
Community Intervention Programs
Public Policy
Consumer Awareness
Provider Education
Patient Education
Becoming A Mom - What is it?
 Bilingual prenatal curriculum
 Designed for use with pregnant
women in a supportive group setting
 Nine sessions
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Prenatal care
Nutrition
Stress
Things to avoid during pregnancy
Labor and birth
Postpartum care
Newborn care
 Appendices with suggestions for
adapting the curriculum for use with
specific racial/ethnic groups
Becoming A Mom in Kansas
Two-fold focus –
Clinical Services + Prenatal Education
Incentive-based program
Evidence-based curriculum
Standardized delivery
Standardized evaluation system
Collective Impact in Action
Community Collaboratives/Healthy Babies are Worth the
Wait launched in eight additional communities
Growth Strategies
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State funds two priority replications
Eight additional non-funded sites
Regional models in the works
KanCare providers coming on board
Policy changes
● Presumptive Eligibility
● Title V Incentive
● CHW Waiver (fee for service $)
● Funding Magnet
● KS Health Foundation ($900,000)
● New Healthy Start Site ($3.5M)
● HRSA Rural Network Grant ($85,000)
Program Evaluation
Collaborative program evaluation led by
researchers from two state universities
Data from 2013 was collected from two levels:
• Participant-level (BAM Programs
o self-reported knowledge (pre/post test)
o health outcome data from medical charts
• Community-level data
o self-reported implementation data through the
Community Toolbox online system
Program Evaluation Core Components
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Universal class structure and delivery
Standardized evaluation tools
Data collectors trained at each site
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Technical assistance ad hoc
Bi-annual grantee meeting for quality improvement
Participation incentivized
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79% of women (n=165) completed 4 or more classes
Monthly data submission
Bi-annual reports to each site
Bi-annual aggregated reports
Data Tools: Community-Level
• Community toolbox – ctb.ku.edu
• Online tool to assist sites with documenting
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collaborative nature of model
Includes approximately 20 questions related to
collaborative actions and program
implementation
Data Tools: Program-Level
Becoming a Mom Evaluation
• First piloted in Kansas in 2012; modified in 2013
• Pre/post knowledge survey (approx. 100 questions)
• Administered at 1st and last prenatal education sessions
• Participation and program satisfaction included
Participant Level Data
90%
98%
95%
100%
83%
81%
81%
80%
Pre
70%
60%
Post
49%
50%
40%
30%
20%
p=.004
p<.0001
p=.0002
10%
0%
Baby's brain growth Signs of Preterm Labor
and development
Safe Sleep Habits
Improved Birth Outcomes
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Community health outcomes vs state averages
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Fewer preterm births - 9.5% compared to 11% (n=42)
Low birth weight – 4% compared to 7.1% (n=68)
Lower cesarean section rate – 26% versus 30% (n=87)
Higher breastfeeding initiation - 81% versus 80% (n=85)
Contributed to lower infant mortality rate
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Saline - 8.5/1000 (2006-2010) to 6.4/1000 (2008-2012 KDHE)
Geary - 10/1000 (2006-2010) to 8.3/1000 (2008-2012 KDHE)
Lessons Learned
Create pilot programs for replication and the stakeholders and money will follow!
Collaborative model works – but requires constant nurturing to keep stakeholders
engaged
Community customization increases impact and provides vehicle for identification of
emergent issues
Program standardization is essential for evaluation accuracy
Evaluation accuracy will make or break a program – Get your data and evaluation
experts on board up front!