Purpose

Opening Doors seeks to mitigate the impact of risk factors on healthy birth weights; remove obstacles to family stability; and support the success of parents and the health and well-being of their babies.

Description

With low-income, uninsured, and at-risk pregnant women experiencing less than 50% healthy births in Washington County, Community Action (CA) developed the Opening Doors Program in partnership with the health care community as a strategic response to this critical issue.  Most of these pregnant women presented at hospital emergency rooms to give birth without benefit of any prenatal care.  In this scenario, mother and baby often experienced complications, some resulting in long-term health issues.  Today, more than 95% of those served by Opening Doors achieve healthy birth weights.

Adequate prenatal care has been identified as a basic need for all pregnant women in Oregon.  Low-income and uninsured women are less likely to receive adequate prenatal care, putting them at greater risk for poor birth outcomes.  Other risk factors often include teen pregnancy and parenting, alcohol and/or drug addiction, mental health issues, low education level, domestic violence, and language barriers.

Connecting low-income, pregnant women with the resources they need for a healthy birth and providing families with the tools for successful parenting, Opening Doors consists of three strategic components: Intake and Referral; Maternal Outreach and Support; and Parenting Support.  Through collaborative partnerships with health care providers and other pregnancy resources, Community Action currently serves almost 50% of low-income women giving birth in Washington County.  The program is designated as an Oregon MothersCare site and is identified through calls to Oregon SafeNet at 1-800-SafeNet.

Intake and Referral

Low-income, pregnant women in Washington County come to Opening Doors to access prenatal care, to enroll in the Oregon Health Plan (OHP) or other health care programs, and to obtain referrals for needed social services.  The goal of the Intake and Referral component is to reduce barriers that prevent women from getting the care they need early in pregnancy.

Maternal Outreach and Support

Opening Doors utilizes grassroots outreach to engage low-income, pregnant women, including those who may be unlikely to connect with services on their own.  The program seeks out women who are not receiving prenatal care and motivates them to access care by providing the needed information, referral and advocacy to enable them to do so.  Outreach activities include door-to-door canvassing, networking with medical providers and social service agencies, and employing targeted marketing strategies directed at the highest at-risk population of pregnant women.  Women who have multiple risk factors are assigned an Outreach Worker to provide support and education throughout their pregnancy.  Together, the client and Outreach Worker develop an individualized plan of information sharing, referral, and advocacy that works in tandem with the client’s medical treatment plan.  The client is also linked with needed resources such as housing, emergency food supplies, domestic violence education, and substance abuse counseling.

Parenting Support

Opening Doors provides support through two months postpartum to ensure a successful transition into parenting.  In addition to individual support, this component has expanded to include sessions of the Make Parenting A Pleasure parent education curriculum.  “Make Parenting A Pleasure” is a tested, proven, curriculum that focuses on effectively supporting parents facing multiple stressors.  In addition to skill building, the group format decreases isolation for low-income parents and allows for the establishment of informal support networks.

As part of a county wide parenting support collaboration between the Washington County Commission on Children and Families and four non-profit agencies that provide services, Community Action Opening Doors is also authorized to provide the Healthy Start Program.  This model offers parent education and comprehensive case management for first time parents identified with multiple risk factors.  A needs assessment using the Kemp Assessment Tool is conducted with each participant.  The results of the assessment are used in developing a client specific plan of information sharing, referral and advocacy.  Family Support Workers utilize home visits as an opportunity to build strong relationships with each family and model appropriate adult-child interactions.  Access is facilitated to other services such as housing, transportation, child care and counseling.  Involvement with Early Head Start is also encouraged to promote a continuum of services.  This long-term, comprehensive approach increases parental skill levels and decreases the likelihood of child abuse.

Funding

Program funding has been obtained from various sources:

• Area hospitals, insurance companies and health care partners (annual amounts range from $5,000-$30,000)
• Private foundation support (variable)
• Oregon Community Foundation ($50,000 over 2 years for Make Parenting A Pleasure)
• Oregon State Health Department (MothersCare Program)
• Contract with Washington County Health Department; Commission on Children and Families, Healthy Start

Outcomes

Specific program outcome targets and results shown in parenthesis for FY ’09 are:

Goal A: To enhance the probability of healthy birth outcomes for low-income residents through outreach, advocacy and education

• 75% of Opening Doors clients will enter the program before their third trimester of pregnancy (08-09 Outcome 88%)
• 50% of clients will be identified through grassroots outreach efforts: (08-09 Outcome 44%) and 50% through referrals from the health care and social service community: (08-09 Outcome 31%)
• 90% of clients who complete the program will have healthy births, as indicated by birth weights of at least 2,500 grams (5 lb. 4 oz.) or more: (08-09 Outcome 99%)
• 95% of babies born to program clients will achieve a birth weight of 1,500 grams (3 lbs. 2 oz.) or more: (08-9 Outcome 100%)
• 95% of clients (babies) will be insured by the time they exit the program: (08-09 Outcome 100%)

Goal B: To have a system of care that assures the availability of high quality, comprehensive and appropriate maternity care for program clients

• 75% of clients presenting for care in their first or second trimester will receive their first prenatal visit within two weeks of their entry into the program, regardless of their payer status: (08-09 Outcome 53%)
• The number and percentage of clients that are involved with on-going services at exit from the program will be reported (92% reported baby having a pediatrician; 59% reported baby enrolled in WIC)