Public Health Nurse Home Visiting Programs. Presented by Meredith Krugel, RN, LCSW Douglas County Public Health

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1 Public Health Nurse Home Visiting Programs Presented by Meredith Krugel, RN, LCSW Douglas County Public Health

2 Nurse Home Visiting Oregon currently has four different nurse home visiting programs: Maternity Case Management Babies First! CaCoon Nurse Family Partnership

3 Program Goals and Impacts Goal to improve health and developmental outcomes for children Positive impacts noted in the areas of: Improved attendance for prenatal care Increase in well child care Improved immunizations rates Increased access to WIC services Improved school readiness Coordinated care for complex needs

4 Target Population: Prenatal women with social or medical risks Children age 0-5 with social or medical risks Children up to age 18 with complex medical needs

5 Referrals To refer call the Public Health Department in your county Referrals come from many sources, including Primary Care, families, WIC, Child Welfare, Substance abuse Tx Would accept referrals from any source Services are all voluntary

6 How Services are Delivered Home visits by Public Health Nurses who provide a professional discipline founded on nursing theory, guided by standards and regulated by law - ORS Services are offered from weekly to monthly or bi-monthly, depending upon need Typical support includes relationship building, education, resource connection, problem solving, and case management

7 Assessment and Screening Home and safety assessment Intimate partner violence screening 9-P, 4-A s Substance abuse screening tools Pregnancy and post partum depression screen PHQ-9 Development screen ASQ, ASQ-SE Infant Motor Screen Hearing, vision, and dental screens

8 Maternity Case Management Assists pregnant women in improving birth outcomes for themselves and their babies. Evaluate strengths and challenges in making healthy lifestyle choices Identify pregnancy changes needing intervention; use motivational interviewing Screen and refer for substance abuse, intimate partner violence, and mental health needs

9 Maternity Case Management Services are offered in client s home or community setting Strength-based services Support begins anytime prenatally with the intention to continue after baby is born Indications: Identifiable risk factors- medical or social Mental health concerns Substance use, tobacco use Low income services covered by OHP for women up to 185% of federal poverty level

10 Babies First! Program for at-risk families with babies and children up to age 5. Visits done monthly or more often in the home or community setting Early identification of adverse health and developmental issues Walk with families as they navigate community resources

11 Babies First continued Health assessment and developmental screening which include: Monitoring of growth (height, weight, head) Screening of motor skills, language, adaptive behavior, personal/social skills and reflexes Monitoring of parent/child relationship development Hearing, vision, and dental screening Referral for services based upon screening and assessment results

12 CaCoon Care coordination for children from birth to age 21 with special health care needs and their families. CaCoon children have complex needs. About 27% of CaCoon children have multiple chronic medical diagnoses. Provide an ongoing relationship with families as they navigate complex systems, including education and health care

13 CaCoon Services Monitoring of child s growth and developmental progress to maximize child s development and to identify and prevent secondary complications Coordination and liaison between tertiary services, local providers and families Identification of specialty resources to meet child s needs (including financial and educational) Information and education regarding skills needed by families for caring for the child s special health needs and requirements

14 Nurse-Family Partnership Evidence-based nurse home visiting program for first-time, low-income moms and their babies. NFP clients receive weekly home visits Offered care and support they need to have a healthy pregnancy, provide responsible and competent care for their children, and become more economically self-sufficient

15 NFP Continued Women enrolled early in pregnancy (first home visit by 28 weeks gestation), and are served until the child turns 2. Evidenced based protocol Over 30 years of randomized controlled trial research proving its effectiveness -The RAND Corporation found that for every $1 invested in NFP to serve high risk families, communities can see up to $5.70 in return due to savings in social, medical and criminal justice expenditures.

16 NFP Outcomes Results from one or more randomized controlled trials demonstrated that NFP can result in: - 37% reduction in pregnancy-induced hypertension -79% reduction in preterm delivery among women who smoke -48% reduction in child abuse and neglect - 56% reduction in emergency room visits for accidents and poisonings -67% reduction in behavioral and intellectual problems at child age six

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