OREGON FAMILY WELL-BEING ASSESSMENT
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:
1. To connect pregnant and parenting women with 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.
2. To use the data to understand the behavioral health 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. They may also invest in parent support services such as classes or counseling, and referral tools for 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.
Workflow: Most clinics are implementing the tool by building 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. 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.
Follow-up: Most clinics have a behavioral health staff person (social worker, psychologist, or in some cases a registered nurse) who review the assessment, note positive findings, and make any needed referrals to internal clinic resources 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. The Interviewer Guide gives suggestions for follow-up on these 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 is 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. 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.
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 domestic 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. We strongly urge each clinic to aggregate the data from the OFWBAs of pregnant women in order to better understand the behavioral health resource needs of your clinic or clinical system. The tool is designed with discreet answer options (multiple choice) to facilitate aggregation.
The committee also recognized that some topics on the OFWBA are already being addressed in routine maternity care (such as depression), but clinics and systems do not ask about those topics in a standardized way, and so the data cannot be aggregated. Our hope is that eventually most clinicians who care for pregnant women and young children will transition to the wording and answer options on this tool so that we can aggregate the data and have a better understanding of community needs. Eventually, data from this tool (or similar tools) will become part of the Oregon Maternal Data Center, where it can be used to better understand perinatal risks and quality of care.
Translations: A near-final draft of the tool is available in Spanish. Other translations are welcome as resources become available.
The OFWBA is administered by a Steward Council that meets a few times a year. Please go to the Oregon Perinatal Collaborative website (www.oregonperinatalcollaborative.com) to send us a note. We would be happy to answer any further questions or entertain suggestions regarding the tool.
Click here for a copy of the Well Being Assessment form and Interviewer Guide.