For Assistance: Please contact phanson@amchp.org Brief Notes about - - PowerPoint PPT Presentation

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For Assistance: Please contact phanson@amchp.org Brief Notes about - - PowerPoint PPT Presentation

May 08, 2023 492 likes •935 views

For Assistance: Please contact phanson@amchp.org Brief Notes about Technology Audio Audio is available through your computer. For assistance, contact phanson@amchp.org To submit questions throughout the call, type your question in

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For Assistance: Please contact phanson@amchp.org

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Brief Notes about Technology

Audio

  • Audio is available through your computer.
  • For assistance, contact phanson@amchp.org
  • To submit questions throughout the call, type

your question in the chat box at the lower left-hand side of your screen.

– Send questions to the Chairperson (AMCHP) – Be sure to include to which presenter/s you are addressing your question.

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Technology Notes Cont.

Recording

  • Today’s webinar will be recorded
  • The recording will be available on the AMCHP website at

www.amchp.org

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Objectives

  • Describe the importance of post-disaster reproductive

health assessments and the rationale for the creation of the Reproductive Health Assessment after Disaster (RHAD) Toolkit

  • Describe state (MS) level experience trying to capture

post-disaster reproductive health data for their MCH program following a disaster (Hurricane Katrina)

  • Guide participants through the RHAD Toolkit
  • Identify successes, challenges, and lessons learned from

the pilots that can be applied in other states

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Featuring:

  • Amy Williams, MPH

Consultant, Division of Reproductive Health/CDC

  • Juanita Graham, MSN, RN

Mississippi State Department of Health

  • Jennifer Horney, PhD, MPH, CPH

Director, University of North Carolina Center for Public Health Preparedness

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Disaster and the United States

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Disaster and Pregnant Women

 Classified as ‘at-risk individuals’  Post-event data often not collected  Few studies examined associations of US disasters

and birth outcomes

  • Exposure associated with poor birth outcomes
  • Showed increases in maternal risk factors
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Disaster and Women of Reproductive Age (WRA): What we do not know

Inconsistent changes in birth rate after disaster

  • Increases after Hurricane Hugo and OK City bombing
  • Decreases after Hurricane Katrina and 1997 ND Red River Flood

Little known about disaster effects on WRA in US

  • No routine surveillance of disaster-affected WRA
  • Inconsistent reports of intimate partner violence
  • Inadequate studies on contraceptive use, access to medical and

social services, risk behaviors, etc.

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Disaster and the Division of Reproductive Health (DRH), CDC

Hurricane Katrina

  • DRH received requests from states for technical assistance with

reproductive health needs assessments

  • Assisted health departments in LA and MS in creating survey

tools & conducting assessments

Lessons Learned

  • Need for refined assessment tools and sampling methodologies
  • Need for easy-to-use sampling guidance
  • Need for an easily adaptable guide with ready to use tools for

reproductive health assessments in disaster affected communities

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Post-Disaster Assessment:

Reproductive Health Needs of Women Affected by Natural Disaster Juanita Graham DNPc MSN RN

Chief Nurse, Health Services , MSDH

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26 miles of complete devastation along the Mississippi Coastline

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FEMA/ARC Estimates

(45 days post disaster)

  • ~ 180,000 people displaced
  • ~ 120,000 went to shelters
  • ~ 70,000 infants and children
  • ~ 40,000 women
  • ~ 500,000 registered FEMA applicants
  • ~ 3,200 LA & MS Gulf Coast students

enrolled to other schools

  • ~ 1,169 no vaccination compliance form
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One year post disaster

100K MS residents living in transitional housing due to extensive housing damage

  • 68,729 destroyed, 65,237 mjr dmg, 100,318 mnr dmg (Source: ARC, MSEMA.org)
  • Large mobilized population

– MS & LA residents

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  • Contacted by CDC, DRH
  • Develop tool set to assess RH needs of

disaster-affected women

  • Data to evaluate services available &

identify service needs

  • Support funding requests
  • Particularly, emergent post-disaster

period

Maternal Child Health

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Study plan

  • Collaboration

– UM SON Faculty, TA per DRH-CDC

  • Areas of interest

– Hancock, Harrison, Pearl River Counties – Most damage – Most mobilized population

  • Women of reproductive age excluding

minors (18-44)

  • Experiencing perm/temp displacement
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Sampling Barriers

  • Where are they now?
  • Where were they before?
  • Unfunded project

– Ø incentives, data collectors, travel support

  • Limited resources

– Most focused on recovery & planning with little time for data collection

  • Participant recruitment
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Sampling Barriers

  • IRB – University of MS Medical Center
  • Vulnerable population issues

– Surfacing of suppressed emotions brought about by reflection on Katrina – Confined population – similar to institutionalized but refugee as opposed to incarceration or commitment – Required invitation-based recruitment

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Overcoming Barriers

  • DRH-CDC identified small unobligated

funding source to support piloting of tool

  • Further partnering

– UMC-SON Accelerated BSN program – FQCHC – Family Coastal CHC – Theta Beta Chapter of STTI

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Overcoming Barriers

  • DRH-CDC identified small unobligated

funding source to support piloting of tool

  • Funding was reimbursement based
  • Sponsored by Theta Beta Chapter
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Overcoming Barriers

  • UMMC IRB required “invitation-based”

recruitment

  • No support from Agencies supervising

transitional housing & FEMA trailer parks

  • No mechanism for neighborhood invitation
  • Partnered with FQCHC –

– Family Coastal CHC – Waiting room recruitment

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Overcoming Barriers

  • IRB approved, funded, invited
  • Recruitment & data collection
  • Partnered with UMC-SON new

Accelerated BSN program

– Needed a community project – Eligible for practicum, clinical hours

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Experience

  • Students very open to learning opportunity
  • Students well received by target

population

  • Women eager to participate, chance to tell

their story, regardless of incentive

  • Met quota within an hour of recruitment

initiation at nearly all clinics

  • Insight on expectations of future survey
  • pportunities
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Findings

  • Obvious weaknesses & limitations
  • Clinic site – Access? Quality? Timing?
  • Timing an issue

– 40% of respondents indicated usually get family planning services at emergent care center

  • Further study needed

– Result of recovery efforts or occurring in other underserved areas?

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Presentation Outline

  • Background of RHAD Toolkit
  • Overview of the RHAD Toolkit
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BACKGROUND

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Disaster & Women of Reproductive Age (WRA)

  • WRA = ages 15—44
  • Inconsistent changes in birth rate after disaster

– Increases after Hurricane Hugo & OK City bombing – Decreases after Hurricane Katrina & 1997 ND Red River Flood

  • Little known about disaster effects on WRA in US

– No routine surveillance of disaster-affected WRA – Inconsistent reports of intimate partner violence – Inadequate studies on contraceptive use, access to medical and social services, risk behaviors, etc.

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Disaster & Pregnant Women

  • An at-risk population
  • Post-disaster data often not collected or used
  • Associations in US post-disaster studies (n=12)

– Increases in medical risks among women giving birth – Infant Intrauterine Growth Restriction – Infant low birth weight & length – Decrease in infant head circumference – Increase in polycyclic aromatic hydrocarbons in cord blood after World Trade Center attack

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Disaster and Division of Reproductive Health (DRH)

  • After Hurricane Katrina DRH received requests from states

for technical assistance with RH needs assessments

– Assisted health departments in LA & MS in creating survey tools & conducting pilots

  • DRH realized the need for refined assessment tools &

sampling methodologies for locating WRA & pregnant/postpartum women

– CASPER instructions are not sufficient for sampling subgroups such as women of reproductive age or pregnant women

  • DRH acknowledged health department’s need for easy-to-

use sampling guidance and easily adaptable guides for assessment in disaster affected communities

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Creation of the RHAD Toolkit

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OVERVIEW OF THE RHAD TOOLKIT

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RHAD Toolkit Website

http://cphp.sph.unc.edu/reproductivehealth

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RHAD Toolkit Content

  • Information about the toolkit
  • Seven main content areas

– Questionnaires – Planning – Sampling – Training – Implementation – Analysis – Data Use

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What have we learned from pilot testing?

  • Modified two-stage cluster sampling with

referral

  • Alternate sampling patterns can be used in

areas with sparse populations (i.e. 40x5 instead of 30x7)

  • The amount of time elapsed since the

disaster matters

  • Put time into constructing the most

effective interview teams

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Pilot Findings

  • Bertie County, NC

– 731 homes approached by a survey team; 202 had WRA home – 71% (n=144) completed the survey; 25 (17%) were PP – PP women reported more post-disaster stressors than overall sample mean (WRA=1.37; PP=2.11 [p<0.005]) – WRA reporting home damage had more stressors than with no damage (no damage= 0.97; damage= 2.27 [p<0.005])

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QUESTIONS?