Appendix D - Additional Tier 5 strategies supported by coalition members
Additional Tier 5 Strategies Supported by Members of the Coalition: Education and Counseling
D. Integrate Life Course education into Department of Education school health curriculum.
E. Engage in a broad effort to raise awareness of the important relationship between emotional and psychological wellbeing and physical wellbeing.
F. Raise consumer awareness about the midwifery model of care and available midwifery options.
Strategy 5D: Encourage local school districts to integrate life course education into school health curriculum.
As mentioned in previous sections of the plan, the Life Course perspective treats the health of individuals and communities as a collective experience over the span of life.125 Health and well-being happens over the life course, with different implications at different interconnected stages.125,126 School ages, birth to 19 years, comprise two critical stages of life, childhood and adolescence.126 According to the World Health Organization, these stages are considered sensitive developmental stages when different exposures can have a long-term effect on a person’s health potential. These stages also represent a time when social, cognitive and coping skills are formed, as well as behaviors and values.126
This presents a prime opportunity to educate students on positive health choices and behaviors that they will carry on into adulthood and older adulthood. Additionally, this will perpetuate the exchange of positive health messaging throughout generations. This becomes even more important when considering the impact of preconception health on future birth outcomes. If young women learn to make healthy choices early in life, this will have a positive impact on their preconception health which leads to healthy babies.
Integrating life course education into our local school health curricula will help to accomplish these aspirations by providing students the opportunity to understand how their environment, culture, behavior and other factors can impact their health throughout their life. Connecticut is already working to ensure proper health education in school curriculum. Currently, three state statutes mandate health and safety education for Grades K-12: 1) Connecticut General Statutes (CGS) section 10-16b77 requires a planned, ongoing and systematic program of study in health and safety including various health topics; 2) CGS section 10-19(a)77 requires instruction on the use of alcohol, nicotine, tobacco and drugs; and 3) CGS section 10-19(b)58 requires instruction on HIV/AIDS. Additionally, The Healthy and Balanced Living Curriculum Framework,78 developed by Connecticut Department of Education, is designed to help students develop and apply skills that will help them to lead a life of health and well-being. It focuses on a continuum of health education that builds upon itself beginning in pre-Kindergarten, continuing through Grade 12. Building upon these foundational efforts by adding life course education will only strengthen health education in schools. It will create an even more lasting understanding of health as a life-long concept, the different needs and priorities at different ages, and the impact the social and physical environment can play.
Listing of Organizations on the Connecticut Coalition to Improve Birth Outcomes
The Connecticut Coalition to Improve Birth Outcomes at Work: Using policy analysis tools to identify priorities and recommendations
Tier 1 - Addressing Socio-Economic Factors to Improve Birth Outcomes in Connecticut
Tier 2 - Changing the Context: Improving health outcomes by making healthy choices the easy choice
Tier 4 - Ongoing Clinical Interventions: Evidence-based interventions within clinical settings
Tier 5 - Education and Counseling: Individual or public educational messages and support
Strategy 5D: examples from the ground
Preconception Peer Educators Program
The Preconception Peer Educators Program is a component of the federal Office of Minority Health’s A Healthy Baby Begins with You campaign. The program enlists college students to complete training and become peer educators on college campuses and in the community. The trainings include key concepts on preconception health and how it relates to healthy birth outcomes.127 Connecticut local school districts may benefit from this example when thinking of ways to include a life course perspective in school health education.
North Carolina Preconception Health Campaign (Every Woman NC)
The North Carolina Preconception Health Campaign, a program of NC March of Dimes, has developed a preconception health curriculum called "Healthy Before Pregnancy" This curriculum was developed in response to poor birth outcomes, and used to capitalize on state legislation mandating abstinence-until-marriage and comprehensive sexuality education for Grades 7-9. The curriculum has 3 major goals: 1) Increase students’ knowledge of the various pathways that can lead to poor birth outcomes; 2) Increase students’ knowledge about how their current lifestyle and health choices can impact their future reproductive outcomes; and 3) Give students the knowledge and skills they need to plan their “healthy” reproductive lives. Connecticut schools may benefit from this example as a model because it is evidence-based, has proven success and aligns with state school health education mandates.128
Strategy 5E: Engage in a broad effort to raise awareness of the important relationship between emotional and psychological wellbeing and physical wellbeing.
Stigma whether real or perceived can be a paralyzing barrier for those struggling with mental health issues. Eliminating the stigma applied to mental illness requires a long term commitment and a comprehensive approach reflected in all aspects of society, including social, economic, educational, recreational, cultural and religious systems. Many organizations, groups and individuals have accepted the challenge to address the “mental health” stigma and are sharing their endeavors with others who wish to join the effort. Friends, family members, employers, teachers, and active citizens are contributing to a creating a socially inclusive society where those in recovery are able to actively participate and thrive in their communities. The following Examples from the Ground describe some of those efforts.
Strategy 5E: Examples from the Ground
The Connecticut Alliance for Perinatal Mental Health
The Connecticut Alliance for Perinatal Mental Health is a multidisciplinary collaborative formed in 2013 to address gaps in mental health supports and services for perinatal women and their families. The mission of the Connecticut Alliance for Perinatal Mental Health is to develop a safety net of supports and services for pregnant and postpartum mothers and their families to enhance family well-being and functioning. The goals of the Alliance are to:
1) Build capacity to offer perinatal mental health support groups statewide;
2) Identify and network mental health clinicians specializing in working with perinatal mothers by developing county-level resource and referral guides and engaging providers in coalition-building activities;
3) Identify professional training needs and coordinate training opportunities;
4) Expand Postpartum Support International in Connecticut;
5) Develop a cohesive coalition to address the ongoing needs of Connecticut’s mothers and
service delivery system; and
6) Develop public awareness including a legislative agenda.
Founded in neighboring Massachusetts, MotherWoman “supports and empowers mothers to create personal and social change by building community safety nets, impacting family policy and promoting the leadership and resilience of mothers.” Programs offered by MotherWoman include:
Mothers Support Groups - Led by trained facilitators, our groundbreaking support groups offer mothers a chance to talk openly about the challenges of parenting, to gain support and build community.
Facilitator Training – Comprehensive training that provides diverse community leaders and professionals with the skills needed to offer new MotherWoman Support Groups.
Professional Training – Teaches medical and social service providers about the complex mental health and socio-political factors involved in the crisis of postpartum emotional complications.
Postpartum Support Initiative – Builds comprehensive, multi-disciplinary safety nets for mothers in the four counties of Western MA by creating Perinatal Support Coalitions of professionals who serve mothers.
Policy and Advocacy – Nonpartisan advocacy program which raises awareness about social and economic justice issues, and organizes mothers, fathers and caregivers to take action on issues impacting families.
New Haven MOMS Partnership Project
The mission of the New Haven MOMS Partnership is to transform service delivery systems for mothers and children through community and neighborhood-based resources dedicated to wellness; thereby strengthening generations of families to flourish and succeed. The MOMS Partnership is a collaboration of agencies across the City of New Haven that work together to support the wellbeing of mothers and families living in the city.
Services offered by New Haven MOMS includes:
Stress Management Classes - An 8 week course that meets once per week. The class teaches mothers skills and technique needed for managing and coping with chronic and toxic stress.
Community Ambassadors are mothers from New Haven trained in mental health intervention, key principles to promote health, and development and achievement across generations. They act as referral sources to the MOMS Partnership and as care extenders. They are trained as outreach workers to promote health, development and achievement of moms and families.
M-POWER workshops are groups where mothers across the city are invited to come together to share, learn and discuss topics of importance to them as mothers.
National Alliance on Mental Illness (NAMI)
NAMI is the nation’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness. NAMI advocates for access to services, treatment, supports and research and is steadfast in its commitment to raise awareness and build a community for hope for all of those in need.
Postpartum Support International (PSI)
The purpose of PSI is to increase awareness among public and professional communities about the emotional changes that women experience during pregnancy and postpartum.
A website that offers support, education and local resource information.
A toll free Help Line in English and Spanish 800.944.4PPD (4773) that refers - callers to appropriate local resources including emergency services.
PSI Newsletter that gives up-to-date information on worldwide news, conferences, resources, research and events.
Area PSI Support Coordinators in all 50 U.S. states, Canada, and Mexico, and more than 36 other countries around the world. These support volunteers provide telephone and email support, information, and access to informed local resources.
Standardized Training and Education for hospitals, public health systems, clinical providers, support group leaders, social support volunteers, and others.
PSI Educational DVD for families and providers.
Free Phone "Chat with the Experts" First Mondays for Dads and every Wednesday for Moms, facilitated by PSI Professionals.
Resources for Women, Families, Students, and Professionals.
Strategy 5F: Raise consumer awareness about the midwifery model of care and available midwifery options.
There are approximately 15,000 midwives practicing in the United States, providing expert clinical care to women prenatally, as well as attending approximately 10% of all US births across all settings, including hospitals, birth centers, and home births. Research has repeatedly found that midwives are skilled and prepared to provide care for normal physiological birth, ensuring excellent outcomes for women experiencing low-risk pregnancies, and often resulting in health care savings tied to lower rates of interventions during labor and birth.
Women in Connecticut have choices when it comes to midwifery care, yet that choice often varies depending on insurance coverage. At the current moment, Husky-covered women wishing to be cared for by a midwife can do so only if the midwife is a Certified Nurse Midwife (CNM). This can pose an issue, if the woman desires a home birth, as most CNMs in the state of Connecticut only attend hospital births, with only a small number of CNMs attending homebirths in the state. As an alternative pregnant women in Connecticut may choose to give birth in the only free-standing birth center in the state which is located in Danbury, staffed by nurse midwives and accredited by the American Association of Birth Centers.
Women who are either covered by private insurance or have the means to self-pay for care, also have the option to choose homebirths attended by Certified Professional Midwives (CPMs) whose practice is legal and has been found to be distinct from that of nurse-midwifery.
While the midwifery model of care has been touted for its excellent outcomes, safety, reduced costs, increased savings, and increased consumer satisfaction, it still remains grossly underutilized by the vast majority of women whose pregnancies are considered to be low-risk and who could greatly benefit from such care.115 For this reason, the Coalition is recommending that strategies be employed to raise consumer awareness about the benefits of midwifery care, to increase utilization, and improve birth outcomes for low-risk pregnant women across all socio-economic levels.
Strategy 5F: Examples from the ground
“I am a midwife” campaign
The Midwives Alliance of North America has created a video-based campaign to help families learn more about midwifery care and the value that midwives bring to women, families, and communities.
“Our moment of truth” campaign
The purpose of Our Moment of Truth™ is to improve women’s health and maternity care in the United States by promoting a renewed understanding of midwives and midwifery care as important options for women’s health care services throughout their life course.
Citizens for Midwifery
A consumer-led organization aimed at increasing awareness about the midwifery care model, Citizens for Midwifery hosts a website with valuable information about midwifery care-related research, news, and resources.
Midwives Association of Washington State
An example of state-based organization focused on increasing consumer awareness about midwifery care, the Midwives Association of Washington State actively engages its midwifery community, consumers, professional allies, and supporters.