Michelle Eglovitch
Program Analyst, Women’s and Infant Health; AMCHP

Andria Cornell
Senior Program Manager, Women’s Health; AMCHP

A Shared Urgency and Focus

Woman-centered care for women across the lifespan, irrespective of life stage or pregnancy intention, is necessary to protect and promote the health and wellness of this population. Preventive health visits, including the well-woman visit or “annual examination,” provide opportunities for women to receive recommended clinical preventive services. Title V programs clearly embrace this concept: Last year, 50 states/jurisdictions selected National Performance Measure (NPM) #1 – the percent of women 18-44 with a past year preventive medical visit – as a priority for their block grant activities.

Given this consensus across most Title V programs, AMCHP saw an opportunity to convene states around common interests and technical assistance needs for carrying out this measure. However, a challenge in doing so is that Title V programs vary significantly in their approaches to addressing NPM #1: Some jurisdictions focus on specific content of preventive health care (e.g., family planning and reproductive health services, mental health screenings); others concentrate on timing of delivery of quality care (e.g., preconception/interconception, prenatal, postpartum); and still others focus strategies on engagement of specific health professionals or environments (e.g., Title X-funded clinics, home visitors, WIC).

The one commonality is that at the root of NPM #1 is the goal to improve access to care. Title V programs have unique strengths in ensuring access to vital services, not just within traditional health care environments but also to overcome barriers to care experienced by all women to promote true woman-centered care.

Creating a Common Language

To craft a common agenda, AMCHP staff and partners from national initiatives that promote preventive health care convened a breakout session at the annual conference on how Title V programs are implementing strategies to overcome barriers to care experienced by women. We wanted to create a shared vision for a Community of Practice on preventive health care for women, facilitated by AMCHP in the months following the AMCHP conference.

AMCHP was particularly excited to partner with the Women’s Preventive Services Initiative team, given the timeliness of the recent release of recommendations to update the Women’s Preventive Services Guidelines and the role of Title V in supporting implementation of the guidelines. To inform the discussion, Regan Johnson from the University of Illinois-Chicago/CityMatCH Well-Woman Project gave a presentation on project findings regarding barriers women experience while attempting to access care.

Breakout session participants then split into five discussion groups, each with an expert discussant from a national partner organization: mental health/substance use, contraception/family planning, preconception health, postpartum visit and health insurance/Medicaid. Because well-woman care is a broad, encompassing concept that is subject to different strategies, we envisioned the break-out topics as an opportunity for states with similar strategies to delve into in-depth, specific discussion about barriers, challenges and resources. Participants answered the following questions:

• What of these barriers surprised you? How do these barriers resonate with you?
• How does your program or strategy address these barriers to care?
• How would you adapt or change your program to address these barriers?
• Where are you feeling the most urgency or need in your efforts to address National Performance Measure #1?

Lesson Learned: ‘Access’ Connects Us

What we learned, however, was that dividing the subject of well-woman care into content areas was not essential for states/jurisdictions to connect on common interests. Report-outs from the topic tables revealed that each area was having similar experiences in regard to strategies to improve access to preventive health care for women. Needs that emerged from various topical tables included transportation, family and social supports, complexities and fragmentation of care across the lifespan, and patient-provider relationships as continuing barriers to accessing care. When the discussion shifted to successes or existing resources, many attendees mentioned utilizing technology, via telemedicine, Skype and other avenues, to increase access.

Clearly, barriers, challenges and resources resonate across strategies, irrespective of timing, content or context of delivery of well-woman care, and provide salient opportunities to align initiatives along the lifespan of women.

Experts from multiple national initiatives attended the session to facilitate discussion and share partner resources. These organizations included:

• Women’s Preventive Services Initiative, represented by the American College of Obstetricians and Gynecologists and National Association of Nurse Practitioners in Women’s Health
• Bright Futures, represented by the American Academy of Pediatrics and Vermont Child Health Improvement Program
• National Preconception Health and Health Care Initiative
• The Well Woman Project, represented by CityMatCH
• Division of Healthy Start and Perinatal Services, Maternal and Child Health Bureau, HRSA, HHS

These experts shared resources and how they could be of assistance as Title V programs advance their strategies.

Next Steps

Participants called  for a simple one-stop-shop or guide that described each national or regional initiative for easy reference and access to technical assistance. The AMCHP staff has begun compiling this resource and will make it available in the coming weeks. As state strategies and partner resources around well-woman care and Title V continue to evolve, AMCHP is excited to address the need for a shared space to work together: the NPM #1 Community of Practice.

The participants requested the CoP be a space to simply share resources and connect with each other in an open, loosely-structured environment, to be driven by the members of the CoP. The CoP will minimize conference calls or webinars, recognizing that time is a limited resource for Title V programs, and AMCHP can best help by responding to immediate, pressing needs via resources and tools. More information about the CoP will be available in the coming weeks through Member Briefs, social media and other avenues to ensure that our members have the information needed to join this vital community.

If you are Title V program staff interested in joining the CoP or if you would like more information, please contact Michelle Eglovitch, program analyst for women’s and infant health, at meglovitch@amchp.org.