The Oregon Family Well-Being Assessment (FWBA) for pregnancy was developed by the Maternity Model of Care subcommittee of the Oregon Perinatal Collaborative. It was developed as a response to the need to integrate behavioral health, social determinants of health and awareness of Adverse Childhood Events (ACEs) into maternity care. The goals of the tool are:
- To connect pregnant and postpartum women with your local clinical and community resources they need to address mental health concerns, substance use disorders, domestic violence, basic resource needs and other support services. The purpose is to promote the health and well-being of women and their families, and to create more optimal environments for healthy parenting.
- To use the data to understand the behavioral health and social support resource needs of our clinics, clinical systems and communities in order to make strategic investments in the integration of behavioral health services and other supports into maternity care. Clinics may use data obtained from this assessment to consider adding mental health professionals, alcohol and drug counselors, behaviorists, case managers or patient navigators into clinics that care for pregnant women and families. Your organization may also choose to invest in parent support services such as classes or counseling, and referral tools for connecting with community organizations.
Using the Tool
The tool is intended to be used as early in pregnancy or early childhood for the purposes of connecting women and families to needed care as soon as possible. The original purpose was to deliver the tool as a part of routine prenatal care or in pediatric clinics during infant well child checks. However, it could also be considered for use in other clinical or community –based settings (provided confidentiality can be assured).
Suggested Workflow:
- Most clinics are implementing the tool by building it into a cloud-based application and then sending a link to the survey to their patients by email prior to a visit. The tool can also be completed by the patient on a tablet in the waiting room prior to an appointment.
- A paper version could also be mailed to a patient in advance of a visit, or given to a patient to fill out during a visit.
- In some cases, clinics build the assessment into their Electronic Health Records system. This has some advantages, in that referrals and populating the problem list can be automated. However, it also has some disadvantges in that it is a large amount of data, some of which does not have an obvious place in the EHR and some of which would be inappropriate or would compromise the safety of the patient if it was included in the EHR (such as information about interpersonal violence).
- Some patients will need to complete the survey in an interview format because of literacy or language issues, or because they were unable to do it in advance of the visits.
- Research demonstrates that people are more likely to respond accurately to sensitive questions when they answer those questions in private. If an interview is necessary, the interviewer should be as close to a peer to the patient as possible (Community Health Workers or medical assistants are often preferable to nurses or clinicians, although anyone conducting interviews should have training and support on how to respond to sensitive information).
Follow-up:
It is recommended that clinics have a behavioral health staff person (social worker, psychologist, or in some cases a registered nurse) to review the assessment, note positive findings, and make any needed referrals to clinical or community resources.
The OFWBA has an Interviewer Guide, which shows some answer options in red font, indicating that they need a response. The Interviewer Guide also has a Risk Assessment and suggested Next Steps at the end of each section to guide the staff in the follow-up strategy. Even if the tool is not being administered on paper, the Interviewer Guide can help your clinic develop its plan for follow up. We have also developed a Risk Scoring scheme to stratify patients into low, medium and high risk categories. That risk stratification could be used to develop resources or payment strategies as your organization sees fit.
The Interviewer Guide gives suggestions for follow-up on some positive questions, but each community and each clinical system may have its own resources and referral pathways that will be more appropriate than what is suggested here. 211info exist in multiple states as a statewide resource that can be of great assistance in connecting families to needed community resources, and we encourage clinics to work with 211info in their efforts to address positives on the FWBA. In Oregon, 211info has a great website and a new provider line to make it easy for clinic staff to connect to 211info during office hours for urgent community resource needs.
Collecting data:
Each clinic that chooses to use the OFWBA is responsible for managing the data it generates. The sensitive nature of the data collected here (especially related to interpersonal violence) warrants extra care and confidential handling.
As stated above, one of the two primary goals of the OFWBA is to understand the resource needs across systems and communities, so data aggregation is critical for system wide response. We strongly urge each clinic to aggregate the data collected in order to better understand the behavioral health resource and social support needs of your clinic or clinical system. The tool is designed with discreet answer options (multiple choice) to facilitate aggregation.
In Oregon, we are working to incorporate data from this tool (or similar tools) into the Oregon Maternal Data Center, where it can be used to better understand perinatal risks and improve quality of care.
Translations:
A version of the tool is available in Spanish. Translations to other languages are welcome. If you need it in another language, please contact us. In an effort to maintain the fidelity of the tool and ensure wide access to other versions, the OFWBA Stewardship Council will facilitate all translations. Currently we have no resources for translations, but we can work with you on funding options.
Feedback, comments, and questions:
The OFWBA is administered by a Stewardship Council that meets twice a year. We would be happy to answer any further questions or entertain suggestions regarding the tool.