WATCH OWCH
Office of Women’s and Children’s Health
150 N. 18th Avenue, Suite 320 Phoenix, AZ 85007-3242
Telephone: (602) 364-1400

Fall 2006

COMMUNITY HEALTH GRANTS
The Office of Women’s and Children’s Health, Community Health
Services Program released a new
Request for Grant Application
(RFGA) on October 6, 2006. The
RFGA process will provide more
flexibility to the grant recipient regarding the services provided to the
various communities throughout the
state of Arizona. The scope of work
can be molded to better fit the needs
of the community and will have the
freedom of being more easily adjusted as community needs change.
In addition, the RFGA allows for
greater communication between the

Offeror and the Grantor during the
negotiation process. All applications
will be expected to follow the Arizona
Logic Model as a measurable way of
providing the chosen health outcomes.
The three priority areas addressed
by this RFGA are to: reduce obesity
and overweight among women and
children; reduce preventable infant
mortality; and reduce the rate of injuries, both intentional and unintentional. The first one-year funding
cycle will begin on January 1, 2007.

It is anticipated that approximately
$1,500,000 will be available each
year over the next four years to fund
programs that fit within these three
broad priority areas.
The RFGA proposals are due on
November 17,2006. You may review
the RFGA at the Arizona Department
of Health Services, Procurement
Office website,
azdhs.gov/procurement/grants.htm
or contact the Arizona Department of
Health Services, Procurement
Office.

CORD BLOOD COLLECTION
A new bill (HB 2286) passed by the
Arizona State House of Representatives requires health professionals to
inform patients about their options
regarding umbilical cord blood. This
blood, which is usually discarded
along with the placenta and umbilical
cord itself, contains stem cells
unique to the baby and its family.
Cord blood banking provides a
unique biological safeguard, which
can come in handy later in life. Additionally, there is little to no risk to the
baby or the mother during the collection process, the blood can be collected after a vaginal or cesarean
birth, and the procedure is quick and
painless.
After delivery, a woman’s options are
to either discard the stem cells, donate them to a public umbilical cord
blood bank, store the cells in a family
umbilical cord blood bank for use by
immediate and extended family
members, or store them for family
use through a family or sibling donor

banking program that provides free
service where there is a medical
need.

• Current and potential medical uses
to the biological family
• Current and potential medical uses
to biologically unrelated people
• Costs incurred by collection
• Options for ownership and future
use of collected material

The blood is stored in cryogenic
freezers, where it is ready to be used
as soon as needed. Unlike other
transplants, stem cells are much
more primitive than those in bone See parentsguidecordblood.org for
marrow or peripheral blood, and more information about cord blood.
have a lower risk of causing graft
versus host disease. This means
1 Inside this issue
that transplants to biologically unrelated patients do not require a perfect match.
Community Health Grants ............ 1
As part of the new legislation, the Cord Blood Collection...................1
Arizona Department of Health Serv- Stalking & Domestic Violence ......2
ices is now responsible for creating Perinatal Periods of Risk.............. 3
an informational pamphlet detailing Preconception Care ...................... 4
the following:
Injury Prevention Plan...................4
Community Health Nursing.......... 5
• Process involved in collecting um- New Employees ............................. 5
bilical cord blood.
• Any medical risks

Page 2

Watch OWCH

Fall 2006

STALKING AND DOMESTIC VIOLENCE
When someone decides to leave an
abusive partner, the relationship
does not necessarily end. The estranged partner may begin stalking
him/her–a behavior that is unsettling
at the least, and can be terrifying.
The consequences can be dangerous, even fatal. Arizona statue (ARS
§13-2921) defines stalking as “conduct directed at a specific person
which would cause a reasonable
person to be seriously alarmed, annoyed or harassed and the conduct
in fact seriously alarms, annoys or
harasses the person.” Violation of
the statute is a class one misdemeanor.
Here are some things to consider
when working with a stalking victim:
Stalking relies on intimidation, fear,
and isolation. Encourage victims not
to handle the situation alone. A
stalker may depend on the victim's
reluctance to ask for help. Ask the
family to involve everyone they can
think of, starting with the police.
Have them contact neighbors and
ask them to keep an eye out. Tell
the neighbors to contact the police
immediately if they observe any suspicious activity around the victim's
home.
If victims have children in
school, have them ask school personnel to report stalking behavior.
Talk with other family members and

enlist their help. Encourage open
discussion with employers, have
calls screened at work, and report
any stalking behavior involving the
place of work.
If you or someone you know is
a victim of domestic violence
and/or stalking, please call your
local domestic violence shelter
for help.
Maricopa County
Contacts Shelter Hotline
(Provides bed availability information)
(602) 263-8900
(800)-799-7739
Outside Maricopa County
Arizona Coalition Against
Domestic Violence (AzCADV)
(602) 279-2900
(800) 782-6400
(800) 787-3224 (TDD)

victims should keep the order of
protection with them at all times and
make copies for their employer and
children’s school(s).
Stress the importance of documenting everything! This means keeping
a log of the date, time, and type of
incident. If the victim has the ability,
they should record telephone conversations and take pictures and
videos. Stalking is very hard to
prove. The more documentation a
victim has, the easier it will be to
convince law enforcement and the
courts.
Develop a safety plan. Part of that
safety plan might include an alternative place to live for a short period of
time. Keep emergency numbers upto-date and easily accessible. Include numbers to local domestic violence shelters.

National 24-Hour Hotline
(800) 799-7233
(800) 787-3224 (TDD) for help
locating the nearest shelter

Remind victims that they are not
alone! Domestic violence affects
many people.
National statistics
show that one in three women has
been, will be, or is currently involved
in a violent relationship. There are
Explore the option of an order of pro- many programs available that offer
tection (or harassment injunction). counseling, support groups, shelter,
While it is only a piece of paper, it is legal advocacy, and other needed
documentation that will help the legal services.
system work for the victim. Stalking

Online Resources
endabuse.org
ncadv.org
nwnetwork.org
elderabusecenter.org
cpsdv.org

Health, domestic violence, and battered immigrant issues
Links page to many web sites and resources nationally
Gay, lesbian, bisexual, and transgender population
Elder abuse issues
Sexual assault and domestic violence; focus on religious
response to domestic violence

October is Domestic Violence Awareness Month

Page 3

Watch OWCH

Fall 2006

PERINATAL PERIODS OF RISK
The Perinatal Periods of Risk
(PPOR) analysis is an innovative
tool for identifying excess fetal-infant
mortality or potentially preventable
deaths among population groups.
PPOR results guide further investigations and target interventions.
PPOR categorizes fetal and infant
deaths into four periods of risk based
on the age at death and birth weight.
The figure below shows each of the
four periods of risk with corresponding risk factors and areas to focus
prevention efforts.

PPOR identifies excess feto-infant
deaths by comparing death rates
among subgroups to a reference
group known to have good birth outcomes.
For the Arizona PPOR
2000-2003 analysis, the reference
group is defined as White, nonHispanic women age 20 or older with
13 or more years of education.

total of 3,001 feto-infant
deaths and an overall fetoinfant death rate of 8.6 per
1,000 live births and fetal
deaths.
This compares
with a death rate of 5.9
deaths per 1,000 for the
reference group. The excess death rate was 2.7
per 1,000 or 953 potentially preventable deaths.
Overall, 32 percent of fetal
and infant deaths in Arizona were excess (953/
3001).

Arizona Feto-Infant Deaths (n=3,001)

The upper-right figure shows the
breakdown of both expected and
excess deaths for the 2000-2003
birth cohort by periods of risk. The
maternal health/prematurity period
stands out as having the highest
number of combined expected and
excess deaths. However, there were
three periods that had very similar
numbers of estimated excess or preventable deaths, which were the maternal health/prematurity, maternal
care and infant health periods.

The figure below illustrates the percent of feto-infant deaths for the
2000-2003 birth cohort that were
excess by subpopulation. African
Americans had the highest percentage of excess feto-infant deaths (62
percent) compared to other racial
groups. For women age 36 and
The following is a summary of the older, 50 percent of deaths were exresults from the Arizona PPOR cess. Women with 12 or less years
2000-2003 analysis.
Among the of education had a higher percent2000-2003 birth cohort, there were a age of excess feto-infant deaths (40

percent) than women with 13 or
more years of education (9 percent).
The PPOR analysis indicated that
there were three important periods of
risk to focus on in preventing fetoinfant mortality in Arizona. To reduce
excess deaths in the maternal
health/prematurity period, interventions should be focused on preconceptional health, health behaviors
before pregnancy, and perinatal
care. Strategies for interventions in
the maternal care period should include prenatal care, health behaviors
during pregnancy, and obstetric
care. Intervention areas for the infant health period should include
injury prevention, sleep position, and
breastfeeding.
For comprehensive results and a
detailed description of the PPOR
methodology, please refer to the full
PPOR report on the OWCH website
at www.azdhs.gov.

Estimates of Percent Excess Feto-Infant Deaths, Arizona 2000-2003

Page 4

Watch OWCH

Fall 2006

PRECONCEPTION CARE
Most people are unaware of the importance preconception care has on
improving birth outcomes. The Centers for Disease Control and Prevention (CDC) defines preconception
care as “a set of interventions that
identify and modify biomedical, behavioral, and social risks to a
woman’s health and future pregnancies”. Preconception care activities
include the prevention and management of risk factors such as substance use, smoking, and poor nutrition. Spacing pregnancies and family planning are also key components
of preconception care.
The Perinatal Periods of Risk analysis underscores the importance of
preconception care in reducing premature births and infant deaths.
Preconception care is important to
all women of childbearing age for
several reasons; 1) almost half of all
pregnancies in the United States are
unintended 2) a number of women
may not realize they are pregnant
during the first 10 weeks of pregnancy when the fetus is most vulnerable to developing a variety of
problems 3) prenatal care typically
begins at week 11-12 of gestation
which is too late to prevent several
health problems that can affect the
mother and her baby.

ception care into the health care
system. The recommendations are
extensive and encompass consumer
awareness, individual reproductive
health plans, interventions when
risks are identified, preventative visits, research of promising practices

and risk assessment tools from other
states and collaborating with our
partners to strategize on how can
implement the CDC preconception
recommendations and action steps.

Online Resources
Centers for Disease Control and Prevention
cdc.gov/ncbddd/preconception/default.htm
USA Today Article
usatoday.com/news/health/2006-05-08-preconception-care_x.htm

Association of State and Territorial Health Officials
astho.org/pubs/FactSheet-PreconceptionCare-FINAL.pdf

and integrating preconception care
into current public health programs.
The Office of Women’s and Children’s Health has taken several
steps to promote preconception care
in Arizona including; providing time
limited funding to the Phoenix Chapter of the Black Nurses Association
(BNA) to increase awareness of preconception care among African
The Centers for Disease Control and Americans; incorporating preconcepPrevention convened a summit of tion care into the Women’s and Chilexperts in June 2005 to develop rec- dren’s Community Health Grants
ommendations for preconception convening an internal workgroup to
care. These recommendations were develop action steps for integrating
issued in the April 21, 2006 issue of preconception care into existing prothe Morbidity and Mortality Weekly grams such as Health Start, ComReport. The report includes four munity Health Nursing, Family Plangoals and ten recommendations with ning, and the County Prenatal Block
specific action steps that lay out a Grant; gathering information regardstrategic plan for integrating precon- ing preconception care programs

Research now recognizes that while
early and consistent prenatal care is
critical to identifying and managing
perinatal complications, improving a
woman’s health prior to becoming
pregnant is a primary prevention
strategy for avoiding poor birth outcomes. The only way any benefit
will arise from this research is to
make the term preconception care
and its definition as familiar to the
entire medical profession and general public as “vitamins” and “immunizations”. It will take time and a
concerted effort by everyone in the
health care field to integrate preconception care into all appropriate venues but the end result, a decrease in
prematurity and infant deaths, make
it worth the investment.

IN OTHER NEWS...
The Injury Surveillance and Prevention Plan for the State of Arizona 2006-2010 is now available online:

azdhs.gov/phs/owch/pdf/injury_plan_06-10.pdf

Page 5
œ

Watch OWCH

Fall 2006

COMMUNITY HEALTH NURSING

The High Risk Perinatal Program
(HRPP) recently received an increase in funding from the Arizona
Legislature. A significant portion of
these funds are committed to the
Community Health Nursing (CHN)
component of HRPP; for the minimum provision of four annual home
visits to “at-risk” children enrolled in
the program.
The HRPP has
amended CHN contracts statewide
as all have demonstrated the ability
to provide these increased services.
Community Nursing Services facilitates the transition of the developmentally “at-risk” child and family
from the newborn intensive care unit
to their home and community. Periodic monitoring of the child’s medical

and developmental needs identifies
infants who would benefit from referral to early intervention programs.
Through these home visits, the family receives support and education
as well as referrals to appropriate
community resources.
Additional funds will be utilized in
providing a statewide perinatal system evaluation. This evaluation will
look at the services currently being
provided throughout Arizona and
make recommendations for program
enhancement.
The HRPP will be working closely
with Arizona pediatricians to promote
the usage of Parents Evaluation of
Developmental Status (PEDS), an in

office developmental screening tool
that can be completed by families
and reviewed during their regular
doctor visit. Physicians have long
been interested in providing this
service in a manner that is beneficial
for families and physician’s practices.
The HRPP will be creating a Developmental Resource Guide.
This
guide is to be utilized by healthcare
professionals who have determined
a child in their practice would benefit
from additional developmental services. The guide will allow them to
locate the services available in the
family’s community.

NEW EMPLOYEES SINCE OUR LAST EDITION

Tia Davis
Data Manager
Assessment and Evaluation

Michael Whyte
Program Manager
Community Health Program

Megan Raymond
Administrative Assistant
Assessment and Evaluation

John McElligott
Follow Up Specialist
Newborn Screening

Erika Garcia
Administrative Assistant
Community Health Services