Catholic Health Care Advocates Papers

 Print Page

 Email Page

Catholic Identity in Health Care

K. Diane Daly, RN, CNFPE

History

The Department of Natural Family Planning at St. John’s Mercy Medical Center, established in 1977, was the first Creighton Model hospital based department to be established in the world. It was an outgrowth of the St. Louis University Natural Family Planning Center, an NFP research and service program. St. John’s Mercy Medical Center established this program which assists in fulfilling the mission of a Catholic medical center. Since the beginning of that program, the Department has served over 2700 couples. In addition, the Department has served over 1000 individuals through the Mother/Daughter and Father/Son sexuality programs. Many thousands of couples have been reached in outreach presentations, health fairs, telephone and mail correspondence, and through the media. Physicians, healthcare providers, priests, seminarians, deacons and religious have utilized the Department as a resource. In June of 1998, the service program at the Medical Center was expanded by Archdiocesan grant to house the Archdiocesan Department of Natural Family Planning. This paper will provide information about the Creighton Model service department at St. John’s Mercy Medical Center and its relationship with the Archdiocese of St. Louis.

The program teaches the Creighton Model System, Fertility Care Services (CrMS). The CrMS is a standardization, under the leadership of Dr. Thomas W. Hilgers of the Pope Paul VI Institute for the Study of Human Reproduction, of the work of Drs. John and Lynn Billings, who developed the Billings Ovulation Method. The CrMS provides an effective means to avoid pregnancy for couples in all reproductive categories (99.5% method effective —reported June, 1998, Journal of Reproductive Medicine), and it is helpful to couples achieving pregnancy, including those with infertility. The system is based on analysis of the woman’s external observations, which are biomarkers in the menstrual cycle. Couples are taught to utilize this information in planning to avoid or achieve pregnancy, according to their intentions, and for gynecologic health maintenance for the woman.

The NaproTracking system essential to the CrMS is also a cost-effective medical tool to help evaluate and treat infertility and gynecologic health problems. Among these conditions are ovarian cysts, vaginitis, cervicitis, pre-menstrual tension syndrome, and luteal phase defect. These conditions are often treated through NaProTechnology, which treats reproductive and gynecologic disorders in harmony with the couple’s fertility and is offered by Natural Family Planning Medical Consultants. The CrMS empowers a woman with the knowledge to enhance her health and the health of her family..

Learning to use the CrM Fertility Care System is accomplished through a series of individual private follow-ups after attending a group Introductory Session. These follow-ups are at two week intervals for the first two months and then spaced periodically through the first year after the Introductory Session. Private follow-ups and adequate teacher education are crucial to successful use of the method. Standardized teaching and assessment materials assure that core content is transmitted, understood and correctly applied. Standardized tools include a Vaginal Discharge Recording System, Follow-up Form, Picture Dictionary, and Pregnancy Evaluation.

Clients entering the program are of childbearing age. Sixty- five percent of the couples are married, and 18 percent are engaged. The majority enter to space children, however the number of couples coming with infertility is increasing. Referrals are 32% marriage preparation, 39 % health care providers, and 29 % word of mouth. The most common reason stated for discontinuation of the previous method of family planning is side effects or fear of side effects. Couples entering the program are from a variety of reproductive categories including post-pill, breast-feeding, pre-menopause, post-partum, infertility, or they enter for fertility awareness without a need to use a method for family planning. Ninety- three new client/couples entered in fiscal year 1999 and the demand for CrM services is increasing in the area. Because there are nine independent CrM programs in the St. Louis area, St. John’s Mercy Medical Center attracts a portion of the clients seeking CrM Services.

Entry into the Department of Natural Family Planning often is a point of entry into the Medical Center. These clients in turn often enter the health care system at SJMMC through NFP referral to a physician, sometimes requiring subsequent blood work, ultrasound, x-ray, surgical procedures, pre-natal care and delivery, or in search of a pediatrician. The program is also an entry point for other family members into the healthcare system. This includes husbands and children, parents in the aging process, and friends and colleagues through word of mouth referral. Clients who are satisfied with the CrMS look to this medical center for other areas of care.

In the CrM system the "SPICE" (Spiritual, Physical, Intellectual, Communicative, Emotional) concept of sexuality is taught. During follow-up, information is shared and appropriate referrals can be made. This includes referrals for sexual abuse, spiritual difficulties, post-abortion counseling, family, communication, or marriage difficulties, and medical difficulties. It is through the individual follow-up session and the relationship of trust that develops between the NFP provider and the client couple that such is accomplished.

Staffing at SJMMC-NFP includes co-coordinators who are registered nurses and Natural Family Planning Educators who job share in the leadership of the program, dividing fifty hours per week. There is a half-time receptionist, and two part-time office assistants. In fiscal year 2000 a full time secretary is budgeted as the Department expands and explores third party reimbursement in greater depth. Teaching is done by the co-coordinators and a staff of seven additional RN’s who are NFP practitioners. These practitioners have received their CrM education through the Pope Paul VI Institute and are certified or are seeking certification. CrM Practitioners are well-trained health professionals who interpret and refer for all types of reproductive and medical situations and abnormalities. Creighton Model providers are certified; education programs are accredited; and service programs are recognized by the American Academy of Natural Family Planning.

"Friends of Natural Family Planning" is a fundraising committee, which also assists through volunteering in the Department as needed. Medical Center volunteers assist with special projects provided by the Department, and other departments network with Natural Family Planning to assist with their goals. These departments include Development, Public Relations, Housekeeping, Food Services, Print Shop, among others. The volunteers and Friends of NFP are crucial to fundraising and special projects.

The expense to the Department of NFP is primarily in labor hours. However, the operating budget includes personnel, food services, office supplies, other supplies, travel, printing, repairs and maintenance, etc. Space, postage, phone, computer services and indirect costs are provided by the Medical Center.

Supplies include client materials, confidential file cabinets, routine office supplies and storage for supplies, slide projectors and teaching materials. A room to accommodate a group of ten to twenty people for an introductory session is needed, and a private space is required for the confidential individual/couple follow-ups, which is the basis of CrM teaching.

Revenue is primarily through client fees, grant awards, and fundraising activities. Funds have also been raised through research and sale of materials. Grants are received annually from the Archdiocese of St. Louis through the Archdiocesan Development Appeal, an annual appeal that raises funds from members of the Archdiocese for use in Archdiocesan programs. Specific grants for sexuality education have been received and, in the early years, government funds were used at the implementation of the program at SJMMC. Fundraising activities include "Treasures to be Found," a second hand sale, an annual Fashion Show, sale of Entertainment Books and Cookbooks, direct appeal to potential donors and direct mail requests. The mailing list includes 1500 names of "friends" of the program. Third party reimbursement is achieved with billing through the outpatient department.

The Friends of NFP committee, in harmony with the co-coordinators and staff of the Department, work with the Development Office to accomplish fundraising success.

There is a large latent market demand for Fertility Care Services. In the Journal of Family Practice (January, 1998), it was reported that in both population-based and clinic- based studies, one fourth of women are interested in using fertility awareness techniques to avoid pregnancy, one third are interested in them to achieve pregnancy and only about three percent were using such techniques. Therefore, outreach to the community is necessary to provide information about department services. Outreach activities include the following activities:

• Presentations are provided for the engaged, preparers of the engaged, clergy, parish communities and women’s groups. Personal visits are effective in providing information to physicians, other health care providers, and potential supporters. Newspaper, TV and radio exposure provides some recognition of the department.
• Brochures and promotional materials are distributed strategically.

• Displays are provided at Health Fairs, Pro-Life Conventions and Maternity Showers.
• High school and grade school presentations are provided on request. Topics include fertility appreciation, "SPICE" sexuality, sexually transmitted diseases with promotion of chastity, a NFP overview in the context of marriage class or Christian lifestyle class.
• Mother/ Daughter and Father/ Son programs provide an atmosphere of love and learning to discuss the important topic of growing up and fertility appreciation and to promote communication between mothers and daughters, fathers and sons. They are provided twice a year.

There are eleven separate NFP programs in the Archdiocese representing three models of NFP service. The Archdiocesan Department of Natural Family Planning, Office of Laity and Family Life coordinates NFP promotion throughout the other Archdiocesan offices and agencies. This offers opportunities for working cooperatively on projects of mutual interest and propelling the Archdiocesan plan in a more integrated fashion. The exposure of NFP also promotes referrals to the NFP service program and assists in marriage preparation, formation and education of seminarians, the continuing formation of priests, supporting a pro-life presence, and as a resource for sexuality programs. Through the collaboration of Archdiocesan services and Catholic fertility care services provided through the Department of Natural Family Planning, we move closer to realizing the vision of Pope John Paul II — to build a culture of life.