This document provides details on a project by the Hollywood Health Loop Clinic in North Memphis to address high rates of infant mortality through prenatal education seminars. The clinic aims to educate minority pregnant women on the importance of prenatal care, as many do not seek care or do so late in their pregnancies. The pilot program saw success, with 96 women attending orientation and beginning care, a 43% increase from 2005. The project seeks to continue and expand the pilot by providing orientation sessions and monthly educational classes to further improve prenatal knowledge and care among high-risk patients in the community. The goal is for the program to become a best practice model for other clinics serving similar at-risk populations.

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II. PROJECT NARRATIVE
A. Project Abstract
There is no greater cost to a community than the life lost of a newborn baby. The
Hollywood Health Loop Clinic (HHLC) in North Memphis knows this all too well. That is why
in March 2006, they began a pilot project to educate the women in their community about the
importance of prenatal care and its link to the prevention of premature babies and infant
mortality. HHLC, part of the Regional Medical Center at Memphis network of community
healthcare centers, plans for the pilot to expand their services to pregnant women through
Prenatal Education Seminars. This initiative will address the on-going issue of pregnant women
not seeking prenatal care or seeking it late in their pregnancy. Memphis has one of the highest
Infant Mortality Rates in the nation. Premature birth is a known contributor to infant mortality.
Prenatal care and education on this issue play key roles in preventing premature births.
The Prenatal Education Seminars will focus on educating women, 97% minority, on the
importance of prenatal care through an Orientation session and additional educational classes in
order to improve the health of mothers and babies in their community. Many of the patients are
classified as high risk because of socio-economic factors or health issues, such as age or race.
The Orientation focuses on building trust with the patient through a team approach, education,
immediate care and access. The pilot program is a great success: 96 pregnant women attended
the Orientation and began seeking service by the clinic, a 43% increase in women served from
2005. The success of the program will continue as the clinic increases the number of women
seeking care and seeking care earlier in pregnancy. Overall success will be established when the
project becomes a Best Practice model for other Health Loop Clinics in the Memphis
community.

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B. Description
Funding Priority
The Hollywood Health Loop Clinic (HHLC), part of the Regional Medical Center at
Memphis (The Med) network of community-based healthcare centers, is expanding current
services to pregnant women in Memphis by educating women about the importance of prenatal
care and aftercare for their child through the Prenatal Education Seminars. The project is focused
on the March of Dimes priority area of Enhancing education and support services for high-risk
pregnant women. Through the Prenatal Education Seminars, HHLC will address the community
need for education for minority pregnant women who do not seek prenatal care or seek it far into
their pregnancy, thus compromising their health and the health of their babies. The program will
lead to an increased knowledge about the importance of prenatal care, an increase of pregnant
women seeking prenatal care, earlier prenatal care, reductions in no show rates, increased
knowledge of pregnancy, birth and newborn care and higher patient satisfaction. Funds will be
used to continue and expand the successful pilot program that began in March 2006. The grant
will purchase educational materials from March of Dimes, office supplies, brochures, mail-out
materials and incentives such as diapers and gift cards.
Community Need
The initiative will address the on-going issue of pregnant women not seeking prenatal
care. Often, these women have a high number of chronic conditions and health issues, yet do not
recognize pregnancy as a condition that justifies doctor visits. Other factors such as lack of
transportation, fear of others knowing of their pregnancy, and inability to pay contribute to
women not showing up for appointments or not making an appointment until the third trimester.
This can lead to a compromised health status of both the mother and the baby, often manifested

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in premature births and visits to the Emergency Room (ER) instead of the OB-GYN clinic. The
Commercial Appeal’s Special Report: Infant Mortality in Memphis (March 5, 2005) reported
Memphis’ Infant Mortality Rate (IMR) was twice that of the national average, with non-white
IMR at 19 deaths of every 1000 babies born. What is even more pressing for the HHLC is that
the area surrounding the clinic, which includes North Memphis' 38108 and the communities of
Douglass and Hollywood, “is deadlier for babies than Vietnam, El Salvador and Iran.” Premature
birth is a known contributor to infant mortality. Prenatal care and education can reduce the risk.
Impact on Community Health
Education on prenatal care and its importance are the key factors in the Hollywood
Health Loop’s project plan. The project will impact the mortality and premature birth rates
facing the clinic’s community. Additionally, the team plans for patients to be better informed
about their options for healthcare and community resources. Premature babies and high-risk
pregnancies put a significant strain on community health resources such as The Med where most
of the women in the program will have their babies. Regular visits to the clinic for prenatal care
will reduce emergency room visits thereby further reducing the strain on the resources of The
Med. Many of these women have little to no health insurance and may be relying on state funded
health programs or be self-pay. Even saving one admission to the Neonatal Intensive Care Unit
(NICU) would significantly reduce the financial burden to the community. In fiscal year 2006,
average length of stay for a baby in NICU was two weeks at a total average cost of $42,993.
Target Population
Almost 100% of the women who will attend these classes are from minority groups: 36%
Hispanic and 57% African-American. Approximately 75% range between 19 and 35 years of
age, but some are as young as 14 and as old as 46. Some have little to no formal education while

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others have high school to college education. Most of the Hispanic patients are from Mexico
where formal schooling for girls is required only up to the sixth grade. Patients come to the clinic
from all over the city, but three-fourths live nearby. They are classified as high risk because of
socio-economic factors, health issues, age, and race. The health issues may include previous
premature births, or chronic disease. Many are classified as low-income and require additional
services from other health agencies to meet the needs of their newborn babies. Over 42% do not
have insurance, while 51% rely on TennCare, the state-funded healthcare program. Many either
do not have a permanent living arrangement or live with many family members in small
apartments/homes.
Organizational Capacity
Dr. Linda Moses and the OB Team designed and implemented the pilot program in
March 2006. The OB Team includes an OB nurse, a medical assistant, an interpreter, a medical
social worker, community advocate, pediatric nurse and Dr. Moses, an OB-GYN physician.
They will provide the primary support for the program’s implementation with the help of Project
Manager and Community Program Coordinator, Patricia Hipps. Combined, they have over 51
years of experience dealing with high-risk pregnancies.
HHLC is a part of the Med’s network of community –based healthcare centers that began
in 1999. The centers provide independent and collaborative healthcare services within the Shelby
County Healthcare Network. The purpose of the clinic is to provide primary care that is
accessible, efficient and high quality to residents of Memphis and Shelby County. They offer a
sliding-scale fee for patients and varying services, including primary and episodic care for adults
and children and specialty services of obstetrics, gynecology and dentistry. Dr. Moses began the
Moses Community Coalition which helps the North Memphis neighborhood where she grew up.

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The coalition is made up of The March of Dimes, First Year Institute, Memphis City Schools,
The Memphis Fetal Alocohol Spectrum Support Network and several other organizations. The
clinic partners with the coalition, the Memphis/Shelby County Health Department, the Med and
other Health Loop clinics to provide better healthcare across all areas to disadvantaged residents
of their community.
Project Publicity and Dissemination
The clinic will develop a program brochure to distribute to patients, place at The
Birthplace, The Med’s birthing center, and share at regular meetings of social workers,
physicians and other organizations. The Med will handle additional publicity for the program
through their newsletter Resource, which is distributed to 2,500 employees. March of Dimes will
be acknowledged in any press release that is written and in the program brochure.
Information about upcoming classes will be presented to patients at Orientation. Mail-
outs will be used to follow-up which has been successful in previous clinic programs. The
patients are asked to give a permanent address where they can be reached for information
regarding their pregnancy. While many patients may be transient, they usually have a permanent
mailing address either through a relative or friend. In the past, if the patients could not be
reached by phone, many showed up for class with letter in hand. Phone calls are used, but are not
as reliable as the permanent address that patients give.
The HHLC expects the project to be a Best Practice model for the two other Health Loop
Clinics that offer OB services in the Memphis community. HHLC plans to communicate their
results through the Health Loop system at monthly manager’s meetings, provider’s meeting and
Health Loop Board meetings, and to similar organizations that serve the same populations.
C. Project Objectives, Activities and Methods

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Project Planning
The Prenatal Education Seminars began in March 2006 as a pilot program for the clinic.
The project is planned around four key components: a team approach, immediate care, education,
and access to care and resources. Services are delivered through weekly Orientation sessions for
up to 12 patients and monthly educational classes for up to 10 patients.
The first step in the process is the three-hour Orientation that is the initial prenatal visit
for each patient. During Orientation, the patients meet the entire OB Team focusing on building
trust with the patient, a central factor in its success. During this time, patients have many
opportunities to ask questions and interact with the team both corporately and individually as
they go through the morning activities. This ensures the women will return to receive additional
prenatal care provided by the OB-GYN physician. An appointment is made for them to be seen
by the OB-GYN physician based on their individual gestational stage of pregnancy.
The second focus is to provide immediate care. Before the Orientation, at least one-fourth
of patients waited until the third trimester to receive care and other clinics had waiting lists of
two to three months for appointments. With regular Orientation classes, the HHLC ensures they
will be able to see any woman who might need prenatal care in a timely fashion. The Orientation
also allows them to get their paperwork and the initial assessments finished, ensuring that the
first visit with the physician will be more effective. This increases the OB-GYN’s ability to see
additional patients. Receiving prenatal care from the clinic means the women have a continuous
connection with the clinic through The Med’s 24-hour call number or access to a member of the
OB Team.
The third component is education. During Orientation, the women are engaged in a
discussion with the OB nurse concerning danger signs of pregnancy, what medicines they can

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safely take, how their bodies change during pregnancy, and how to recognize normal changes, as
opposed to those that could put them at risk, including premature labor. The clinic’s nurses
perform blood work to check for any additional health issues and provide information to the
women. An interpreter is available for Spanish-speaking women. The interpreter is an integral
part of the process, from registering at the front desk to the meeting with the social worker.
During classes and group sessions, the interpreter uses the consecutive mode of interpreting:
what is spoken in English is followed by Spanish in phrases or sentences. Another major focus of
the program will be to provide information about dental care and to provide supplies for proper
dental hygiene such as toothpaste and toothbrushes. The clinic will work to collaborate with the
UT Dental program and other programs to receive the dental hygiene supplies. They also watch
informational videos in both English and Spanish on the importance of getting prenatal care,
folic acid, signs of preterm labor, 1st
, 2nd
, and 3rd
trimesters, labor and delivery, the first three
months of life, safe sleep, breastfeeding and other necessary topics. It is important that both the
videos and the materials give information about all three trimesters so that each patient receives
knowledge about her whole pregnancy. At the end of the Orientation seminar, they will receive a
“Baby Basics” book providing information on their pregnancy. Much of the grant funds will be
used to provide educational materials When appropriate, any handouts and materials are
provided in Spanish.
During the pilot Orientation sessions, the OB Nurse conducted an informal survey to
determine what type of classes most interested the patients. Based on their feedback, the
Aftercare for Moms and Babies and Labor & Delivery Classes were chosen. At the Orientation,
the social worker will explain to each patient about the classes and try to get them to sign-up for

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an upcoming class. After they have signed up for a specific class, then the Monday before the
class, the social worker sends a reminder letter about the upcoming class to the patient.
The classes are voluntary to the patients. Topics covered in Orientation and through the
classes are selected from the Baby Basics Book as deemed appropriate by the OB Nurse and Dr.
Moses from their experience dealing with high-risk pregnant women. The highlights in chapters
covering all three trimesters of pregnancy have been reorganized into a simpler format and are
presented in a way to encourage participation by patients. If an area is of interest to many of the
patients, then the topic is covered more fully by the staff. For topics not covered in depth,
handouts are provided for patients and they are instructed to call the OB staff if they have
questions.
The last focus of the project is access to resources. During the Orientation, the clinic’s
social worker assesses the women on their overall health, psychosocial well-being, financial
position, and health history. Through this process, she is able to make appropriate community
referrals depending on their needs. Some are referred to counseling programs, others referred to a
GED program. Still others are encouraged to enroll for the Special Supplemental Nutrition
Program for Women, Infants, and Children (WIC). Almost all of the women have some need that
is able to be addressed through this process. The community referral process is a significant
component as it ensures the longevity of life for the mother and the baby past pregnancy. A
young woman who receives her GED has more options for herself and her baby than before.
Patients also receive information on community resources and coupons from local stores and
restaurants. Incentives are offered including gift cards to Kroger and diapers to help meet some
of the needs of their newborns and to encourage further participation in prenatal visits and
classes by the patient.

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Project Goals & Objectives
The project will educate pregnant women about the issues involved in having a
successful pregnancy, provide earlier prenatal care for mothers and babies and teach the
appropriate use of community health resources.
Objective 1: To educate women about prenatal care
Activity 1: Hold 10 classes each per year in Labor & Delivery and Aftercare for Mother & Baby
Activity 2: Hold 40 Orientation sessions through-out the year for approximately 10 to 12
patients.
Objective 2: To provide improved access to prenatal care
Activity 2: Hold 40 Orientation sessions through-out the year for approximately 10 to 12 patients
Objective 3: To teach the appropriate use of community health resources
Activity 3: Education through the Orientation and classes on the appropriate use of community
resources including the clinic, OB Team, The Med, Emergency Rooms and other resources.
Project Management
The project is managed by Patricia Hipps, Coordinator of the Health Loop Community
Program. She will oversee the project and, with assistance from Dr. Moses, establish
measurement guidelines for when and how to measure the program goals. Data collection will be
done quarterly by the project manager to review progress. The instructor will administer
satisfaction surveys at the end of each Orientation and pre/post surveys during each class. The
results will be compiled quarterly by the project manager.
The Team will work closely together and have regular progress meetings related to the
overall service they provide. At these meetings, the team will adjust the program as needed and
will monitor any progress toward goals and objectives. As a member of the Shelby County

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Health Care Network, the clinic collaborates with other Health Loop clinics and The Med
through their programs.
D. Evaluation Plan
The evaluation plan will analyze and present the results of pre/post surveys as well as
other data to evaluate the success of the program. A pre/post survey administered by instructors
will compare what patients know at beginning of class and at end of class based on topics
covered for all three classes. A satisfaction survey administered by the instructor will gauge
patient’s opinions about each session and will be used to make needed changes to the process.
The project manager has developed the surveys with collaboration from The Health Loop’s
researcher, Dr. Diane Pace as well as clinic staff including Dr. Moses, the OB Nurse, the
pediatric nurse and the pediatrician. Data will be collected by the project manager on number of
pregnant women attending Orientation and classes, the trimester of pregnancy at initial visit, and
number of no-show for appointments. The data and survey results will be compiled by the
project manager and used to analyze the program with assistance from the Health Loop Reports
Analysis Compliance Manager. The project manager will then make recommendations, review
them with program staff and implement selected program improvements or changes.
Measurements
Objective 1: To educate women about prenatal care
Outcome 1.1: Increase knowledge regarding pregnancy, birth, and newborn care with 80 % of
patients scoring 90% or better on post test
Outcome 1.2: Measure patient satisfaction through maintaining an Overall Above Average
score on satisfaction survey (Level 4 out of 5)
Outcome 1.3: Educate 400 pregnant women in Orientation and 100 in classes

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Measurement 1: Pre/Post survey will measure education on pregnancy and prenatal care
and Satisfaction survey will measure patient satisfaction
Measurement 2: Data collection will be gathered on the following: a.) Number of OB
patients at clinic, b.) Number of pregnant women attending Orientation and c.) Number of
pregnant women attending classes
Objective 2: To provide improved access to prenatal care
Outcome 2.1: Increase patients served from 150 to 400 annually
Outcome 2.2: Encourage earlier prenatal care with 70% of patients attending Orientation
during 1st
trimester.
Measurement: Data collection will be gathered on the following: a.) Number of OB patients
at clinic and b.) Identification of trimester at initial visit
Objective 3: To teach the appropriate use of community health resources
Outcome 3.1: Reduction in no-show rate 20% (from 50% to 30% ) for prenatal visits
Measurement: Data collection will be gathered on number of no-shows
Successes & Challenges
The pilot program was a great success. During the pilot, 96 pregnant women attended the
Orientation, a 43% increase (from 67 patients to 96 patients) in the number of women seen by
the clinic during the same time in 2005. Additionally, the women seen during the pilot have
come in sooner in the pregnancy for prenatal visits. During 2005, only 45% (30 patients) of
women came during the first trimester. During the pilot period in 2006, 65% (62 patients) of
patients came during the first trimester. Even more significant is that during the pilot program
only 5% (5 patients) of patients were in the third trimester when first seeing the doctor, while in
2005, one-fourth (16 patients) of patients waited until the third trimester to visit the doctor.

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The Hollywood Health Loop Clinic plans for this project to be replicated will be one
measure of success. Success will also be achieved from increased education and higher numbers
of women served by the clinic. Another indicator of success will be healthier babies born to the
women who attend the clinic. One challenge is that women make appointments and then do not
show up. HHLC will educate the women on the importance of receiving adequate care and
maintaining consistency in appointments. Another challenge is that even if women do
everything right, there is still some chance of premature birth. Additionally, the program must
overcome education and economic barriers. Lack of education is one of the key factors which the
clinic plans to overcome by using material that is taught on a 6th
grade level as well as providing
hands-on and visual training. Furthermore, reaching women who really need the service is a
challenge the clinic must overcome. HHLC will encourage women to refer friends, family
members and acquaintances and promote the program to the community.
E. Project Impact
Anticipated Impact
The impact of the project will be seen through the increased knowledge of the patients
and earlier incidence of prenatal care. As mothers receive the proper prenatal care, their health
and their babies health will be better. The quality of life for their baby will be enhanced as they
learn to better take care of themselves and their baby through the classes. Often there is the fear
of the unknown especially for first-time mothers. Receiving support through prenatal care and
the classes will help them to be better prepared for changes that are occurring in their lives.
Sustainability
Hollywood Health Loop Clinic will establish the seminar as a best practice model.
Establishing the program model and building the prenatal program will help the Health Loop

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system to become Federally Qualified Health Center (FQHC) certified. Becoming FQHC
certified means more federal dollars for the center, allowing it to expand services to the
underserved in the urban community. If their success is proven, HHLC will seek to become a
preferred incentive provider for TLC for which 15-20% of current patients qualify. TLC is the
Family Care Health Care plan of the Memphis Managed Care Corporation that is sponsored by
the Med and UT Medical Group. Through TLC, HHLC will seek additional funding to continue
and expand the program.

14. Prenatal Education Seminars
Hollywood Health Loop Clinic
July 20, 2006
OBJECTIVE # 1 To educate women about prenatal care
OBJECTIVE # 2 To provide improved access to prenatal care
OBJECTIVE # 3 To teach the appropriate use of community health resources
1. Hold 10 classes each per year in Labor & Delivery and Aftercare for new-
borns
2. Hold 40 orientation sessions throughout the year for approximately 10 to
12 patients each time.
1. Education through the orientation and classes on the appropriate use of com-
munity resources including the clinic, OB Team, The Med, ER, etc.
1. Hold 40 orientation sessions throughout the year for approximately 10 to
12 patients each time.
OB Nurse & Pediatric
Nurse
OB Team
OB Team
OB Team
6/07-4/08
6/07-4/08
6/07-4/08
6/07-4/08