Distributing the Parenting Newslettters
Distributing the Parenting
Newsletters
B. COMMON PROBLEMS DISTRIBUTION PROBLEMS AND SOLUTIONS
1. Address label problem: “The
hospital (or health department) won't give us the address list because
of HIPAA issues.”
2. Difficult Partners
3. Partners want to give all 12 newsletters
at once
4. How can we reach families who speak Spanish?
5. How do you keep track of parents who change
addresses?
6. How do you keep track of parents who give
birth in neighboring counties or states?
7. How can we identify new parents who move
into our county or adopt?
8. Can we distribute the newsletters
electronically?
1. Address label problem:
“The hospital (or health
department) won't give us the address list because
of HIPAA issues.”
HIPAA refers to the Health Insurance Portability and Accountability
Act. Two primary objectives of HIPAA are: 1) to assure health insurance
portability so individuals with pre-existing medical conditions can
change jobs and still keep their health insurance; and 2) to guarantee
privacy of health information. Health care providers (including doctors,
nurses, hospitals, clinics and nursing homes) cannot share a person's
health information without the permission of the individual. For instance,
health information cannot be shared with employers or used for advertising/sales
purposes without permission. Health information can only be shared for
particular reasons, such as doctors consulting about a patient's care
or making sure nursing homes are giving proper care. Providing the list
of names and addresses of mothers who have given birth in a particular
hospital or county may violate the privacy of health information according
to the HIPAA act. This is probably the strictest interpretation of the
new policy. However, in some counties hospital personnel view the newsletters
as health information and thus see no violation of HIPAA regulations.
a. There are six solutions for getting the address list:
ii. Confidentiality Agreement
One solution (used in Clark, Kewaunee, Oconto, Vilas, Forest County
and others) is for the Extension Agent to sign a confidentiality
agreement with the hospital or health department that states the
mailing list will not be shared and will only be used for mailing
the newsletters.
The Extension Agent to sign a confidentiality agreement with the
hospital or health department that states the mailing list will
not be shared and will only be used for mailing the newsletters.
The confidentiality agreement can state that the newsletters provide
free health information (you can remind the hospital or health department
that HIPAA does not prevent them from mailing health outreach publications
to their clients, and our joint newsletter project is another part
of their health education outreach). This allows project partners
more flexibility in setting up a system to prepare the newsletters
for mailing. In Kewaunee County, they have a "Memo of Understanding"
that allows Public Health to provide Extension with the names and
addresses of all new parents in the county. In Oconto County, both
Extension agents sign the confidentiality agreement and the Public
Health Department provides the list of names. Parents who receive
the newsletters have the opportunity, each month, to ask to be removed
from the list.
In some counties (Kewaunee, Clark, Waupaca, others) the confidentiality
agreement is only in effect for one year and then the list of names
must be dropped after that point. In Oconto County, they are able
to keep the names on the list until parents have received all 3
years of the parenting newsletters (unless parents request to be
taken off the list).
ii. Permission Form
Have parents sign a permission form agreeing that their name and
address can be shared for purposes of receiving the newsletters.
In Iowa County, for example, mothers sign a permission form at the
hospital to receive all 3 years of the parenting newsletters. This
is part of a standard permission form that also asks parents if
they want their baby's picture taken and the birth announcement
put in the newspaper. Someone from the local Family Resource Center
is responsible for collecting the permission slips. In Washington
County, at one hospital the Birth Center gets a release from parents
that allows the hospital to send out the newsletters. In this particular
instance the hospital liaison doesn't see a problem with mailing
the parenting newsletters to new mothers, since this person believes
the newsletter is not considered "marketing" under HIPAA
regulations. A second hospital in Washington County also sends Parenting
the First Year out to all new mothers, and sees no problems with
HIPAA. However, they take subscriptions for Parenting the Second
and Third Years. In Douglas County, the WIC clinic also has permission
forms that parents can sign to receive the newsletters. However,
only parents who use the clinic have the opportunity to sign up,
so many parents are missed.
iii. Birth Announcements
Another solution is to get the names of new parents from birth announcements
in the newspapers. This method is often used by researchers who
need to recruit a sample of children of a particular age. You can
add addresses to your mail list each day, or go to the library once
each month to collect a month’s worth of names and addresses.
In some counties, however, the hospitals will not put birth announcements
in the newspaper without parents' permission.
iv. Staff Assistance
In some places (e.g. St. Croix and Dunn Counties) the hospitals
use their own staff to put the mailing labels on the newsletters,
so no one outside of the hospital staff sees the names (thus, confidentiality
is not an issue). In Dane County, someone from the hospital staff
remains in the room while volunteers from Kiwanis clubs prepare
the mailings (including putting on the address labels). Thus the
patient information is never "out of sight" of the hospital
staff.
v. Permission Form for Additional Newsletters
In some counties (Adams, Iowa, Kewaunee, Walworth, others) where
parents are already receiving Parenting the First Year,
they have tried including a permission card in the 12 month issue
or sending a postcard asking parents if they would like to continue
receiving the newsletters (Parenting the Second and Third Years).
However, this hasn't worked very well, since distribution has been
cut by half or more. In Iowa County they moved from doing this to
having parents sign a permission form in the hospital. If you send
out renewal postcards with one of the last monthly issues of Parenting
the First Year, there is now a Spanish
version of the renewal postcard available.
vi. Welcome Letter
In Sheboygan County the Public Health Department sends new parents
a Welcome Letter that includes the first issue of Parenting the
First Year and a subscription form if they would like to continue
receiving the newsletters. The Public Health nurses then encourage
families to sign up for the newsletters.
2. Difficult Partners
In some cases one partner may take certain actions on their own, for
example stopping distribution or delivering all newsletter issues at
once without telling the other partners. In other cases, some partners
may begin to lose enthusiasm for funding the project (as budgets are
stretched) or for providing addresses (because of HIPAA).
What can you do? In many counties, community partners like the local
Kiwanis clubs help the project stay on track by keeping the hospital
and health department involved and working together. Holding regular
(annual or bi-annual) meetings of the partners to keep everyone talking,
and doing evaluations to show the impact the newsletters are having
locally will help you maintain enthusiasm for the project (see "How
do I create a local partnership for distribution"). As in any collaboration,
the key is regular communication. Avoid the temptation to ignore this
project just because it runs so smoothly most of the time.
3. Partners want to give
all 12 newsletters at once
This is a common idea, since it appears to be much easier (no sorting
to be sure parents receive the correct issue) and to save on postage.
The only problem: It undercuts the effectiveness of the newsletter intervention.
A study in California evaluated the effectiveness of monthly age-paced
delivery compared to quarterly delivery (3 issues at a time). Parents
who received the newsletters monthly, compared to those who received
them quarterly, reported reading more of the newsletters and making
more positive changes in their parenting behaviors and attitudes. A
good metaphor (especially for use with health care professionals): It
would be a lot easier to give children their immunizations by drinking
them in orange juice, since children hate getting shots, but we don't
do it this way because we have no reason to think immunizations would
be effective if given this way. The same is true of our methods of delivery
of the newsletter intervention. We know it works when delivered monthly,
we have no evidence it works when delivered all at once, and we have
some evidence that reducing the age-pacing of delivery undercuts the
effectiveness.
4. How can we reach families who speak Spanish?
In some counties (Marathon, Manitowoc, others) the hospital or health
department includes Spanish-speaking parents on the regular mailing
list, but specifies that they should receive the Spanish version of
the newsletter. They keep a supply of the Spanish edition, “El
Primer Año del Bebé,” on hand for this (you can
have these printed by all the same methods as the English edition).
If you send out renewal postcards with the last issue of El Primer Año
del Bebé to see if parents are interested in receiving Parenting
the Second and Third Years (El Segundo y Tercer Ano del Nino),
there is now a Spanish version of the
renewal postcard available. In Waukesha County, at one of the hospitals
(with a small number of Spanish-speaking parents), the hospital nurses
contact the person at the hospital who is in charge of the newsletters
and that person takes care of each one of the Spanish mailings individually.
However, in some counties (Dane, Wood, others) the hospitals don't want
to put Spanish-speaking families on the mailing list for receiving the
newsletters, because many of these families (e.g. seasonal workers)
move around a lot so their addresses change frequently (and hospitals
end up with newsletters being returned). One solution hospitals have
used is to give all 12 issues of the Spanish version of Parenting
the First Year (El Primer Año del Bebé)
to parents when they leave the hospital. Another solution that has been
tried in Wood County is to have physicians who mostly serve Hispanic
families give out several issues of the newsletters to families when
they bring their child in for check-ups. A third solution has been to
have WIC clinics and home visitors hand deliver Spanish versions of
the newsletters to parents.
5. How do you keep track of parents
who change addresses?
In some counties (Waupaca, Marathon, others) that contract with a
mailing service, the service contacts the Extension office if addresses
change. In counties that use bulk mailing, if you notify the post office
they will collect newsletters that can't be delivered because of address
changes. However, you must pick the newsletters up from the post office.
In Kewaunee County they pick up the returned newsletters once a month,
while in Wood County they pick them up every three months, then drop
those addresses from their mail list.
6. How do you
keep track of parents who give birth in neighboring counties or states?
In many parts of the state, the local project sends the parenting newsletters
to all parents giving birth at the hospital, regardless of what county
(or even state) they live in. In some places, two or more Extension
Family Living Agents in adjoining counties partner to run a project
with a mail list from a hospital that serves their multiple counties.
This method of partnering even works across state lines, for example
the Extension Agent from Buffalo and Pepin Counties has partnered with
the Extension Agent in Wabasha County (Minnesota), because the parents
in these 3 counties all use the maternity ward in St. Elizabeth’s
Hospital on the Minnesota side of the border. In other parts of the
state, rather than forming a partnership to distribute the newsletters
across county or state lines, the Extension and health offices simply
share information about births and addresses. For example, the hospitals
that serve Florence County are in Michigan. In this particular case,
the Extension agent in Iron County, Michigan sends the list of birth
names and addresses to the Extension agent in Florence County. Hospitals
that serve adjoining counties may have a similar system. In summary,
there are many ways to handle this issue, and the best way for you will
depend upon local opportunities and constraints.
7. How can we identify
new parents who move into our county or adopt?
You can ask local pediatricians and child care providers to inform
parents (who are new to the community or have adopted) about the newsletters
(perhaps providing an initial issue) and to encourage parents to contact
you (their local Extension agent) about getting on the mailing list
for the newsletters. In addition, you can ask them to post this flyer informing parents about the Parenting the First Year newsletter. If the hospital sends out the newsletter, the pediatrician
could ask to have the parents' names added to the mailing list. Another
idea is to include information about the parenting newsletters in the
Welcome Packets that the Chamber of Commerce provides to new families
in the community.
8. Can we distribute
the newsletters electronically?
Illinois Extension has been experimenting with this. They send a monthly
email to families, reminding them that the monthly newsletter is available
for them, and giving them a “click-able” link to the newsletter
on the Internet. (They actually send Illinois parents directly to our
Wisconsin web site!) Of course, this method cannot reach families who
do not have Internet access. We will let you know as soon as our colleagues
in Illinois have evaluated this method of distribution.
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