Beginnings Guides Blog
Last time in this space I told Mandy’s
about the depressed 8-month old
who transformed over the course of
one week of simple everyday interactions.
The story illustrates the scientific
work of Bowlby and Robertson on the stages
children move through when separated
from their mothers due to hospitalization.
Mandy was well beyond the first stage
in a child’s response to separation: Protest.
This stage is marked by wailing and sobbing in confusion,
fear, grief at being
She was also beyond Stage 2: Despair.
The child becomes more hopeless and
apathetic. She withdraws. Like Mandy. This
going quiet is not settling in.
It is giving up and shutting down.
Mandy was well into Stage 3:
Detachment (or Denial). She had suppressed all
emotion, including - maybe
especially, feelings for her mother. She hardly
noticed when her mother left.
She was so withdrawn that she sought no
mothering at all. Now, i would recognize that as a sign
of major psychological trauma.
There are many lessons in Mandy’s
story. More on that next time. s
history of attachment theory and the stages of separation, plus a good
bibliography, see Van Der Horst, FCP
& Van Der Veer, R. (2009). Separation and Divergence:
The untold story of
James Robertson’s and John Bowlby’s Theoretical Dispute on Mother-Child
Separation. Journal of the History of the
Behavioral Sciences, Vol. 45(3), 236–252. Published
Wiley Periodicals, Inc.
I twisted my knee. Before long it is too sore to ignore, so I
check with a
physical therapist at the gym. He says he can fix it and that he
preferred provider on my insurance; his services will be fully covered.
I visit him nine times over two months. My knee is better.
But my mind is boggled.
A week after the final scheduled PT session, I get a nine page so-called
“Explanation of Benefits” from my health plan. For each visit, there is
on which I’m not-billed separately for Exercise Therapy,
Body Movement Therapy,
and Muscle or Nerve Trai.
I’m not sure what that third item is, or if I had it, or why the provider
billed $50, the plan
allows $33.46, so I owe $33.46.
The Note says
“3024”. So I
hunt through the pages and find a
section labeled NOTES.
Here is Note 3024 (their caps): SEE THE “REHABILITATION
SECTION IN THE ALLOWANCE SCHEDULE OF YOUR CERTIFICATE OF
Looking further, I see on the back of each page that if I
with the payment decision, I can “submit a request for appeal
180 days of this notice”. It
should be in writing and include
copies of my medical records.
Who has their medical records?
I can’t object to the decision since I can’t determine what the
procedure is. I don’t have a clue what the price should be.
I give up and take the stack of papers to my husband; he’s a
After a 15 minutes pouring
over the pile, we conclude that
not-a-bill says the services, including the mystery procedure “Nerve
are covered, at least
partly, but the insurer is not
going to pay;
perhaps because while the individual deductible has been
the family deductible
has not. But the the employer says
there is no
deductible on our plan... It seems the take home message is, “You
get a bill.” Hardly and EOB.
More like a “Not-an- Explanation of No-Benefits.
This story would suggest that, despite the PhD and 30 years in
services, I have low health
literacy. That is, I do not have the capacity
to process and understand
information necessary to make appropriate
health decisions. Likewise for my
husband the trial lawyer.
I’ve been impatient with the Plain Language crowd, thinking that
we all know about readability and jargon and all that by now.
I am wrong. Really wrong.
Keep at it Plain
This is the last in our series
using the SAM
pregnancy and parenting for low skilled readers who may be new
to the healthcare system.
For a good cultural fit
match readers’ LLE
Leonard and Cici Doak, authors
of the SAM,
concluded that most communication errors
in healthcare are caused
by cultural gaps
between patients and providers,particularly
gaps in Logic, Language &
Experience - LLE.
For anyone in health communications
-that’s everyone in healthcare, it’s an acronym
Logic refers to a way of
thinking about health, illness, treatment.
Because of their
specialized training, healthcare professionals have
a special way of thinking.
For example, to a clinician who sees 30
sick people per day, illness is normal,
another day at work, the usual
But to those 30 sick people, their illness is exceptional, a
major source of physical, emotional,
spiritual and financial stress for
a whole family, a reason to miss work and
suspend the usual routine.
The clinician’s routine challenge may be the
patient’s life changing
event. Consider, too differences between Western and
between medical specialties, between medicine and public health,
between medicine and
health promotion. A challenge for all health
communicators is to understand and
match the learner’s logic about
Language refers to a way
about health, illness, treatment
Of course, logic and language
To a professional the problem
may be hypertension exacerbated by
obesity; to the patient the problem is
bad blood making it hard to walk up the
stairs. In the West, we describe epilepsy
as a disease - abnormalities in brain
cells that cause seizures. Elsewhere,
epilepsy is described as blessing - a sign that the person may be
“the spirit catches you and you fall down”. Other language issues are
English is the language of the
If you are not proficient in English, you will struggle
every level. And even if you are, you may still
struggle when simple English
terms like stool and screen,
minor and routine take on a whole new medical meaning.
Or when simple concepts like walking and pus
or go home
on a whole new vocabulary like ambulation
Latin and Greek are the
language of medicine.
Terms are long and technical, so a natural short hand
emerges. As public relations director for a hospital that
specializes in heart
surgery, I encountered more than
one family who objected to hearing staff refer
their loved one as “the cabbage
in 206”. They were using shorthand for coronary
artery bypass, thinking and
talking about the patient as his procedure and
Experience refers to
participation in events as a basis of knowledge
A clinician lives in the
hospital or clinic. S/he is intimately familiar with
the technology. S/he is in
charge and in control. Everything is organized
for his or her convenience and
efficiency. His or her status comes from
specialized knowledge. In many cases, the patient has no
and very limited knowledge. That means no basis on which to judge
quality, weigh options, or interpret
instructions. At that same hospital,
two patients who had open heart surgery by
the same surgeon on the
same day were re-admitted two weeks later. Their doctor had
them to “take it easy.”
Both complied. One ran 3 miles instead of
his usual 5. The other never
got off the couch.
Who is responsible for
bridging the gap?
Federal, state and local laws,
Medicare and Medicaid regulations,
and accrediting bodies clearly state it is
the healthcare providers’
duty to communicate in a way the patient and family
SAM says Superior health education materials match the readers
and present images and examples that are realistic and and positive.
Beginnings Guides are intended for a broad
national audience. It’s
intent is to be as
culture-neutral as possible. We chose cover
art by Laurel Burch in which our testers saw
whatever was important to
Last words on SAM: Only
readers know for sure
SAM is an at-your-desk review. It cannot tell you that your
is easy to understand and use. Only the intended learners can tell you
that they learn
easily from your document. SAM helps you get your
materials to the point where
they are ready for Reader Verification
Interviews. More on that next time.
In this Part 10 of our series using
the SAM - Suitability Assessment of Materials
- to evaluate Beginnings Guides, we address layout,
the architecture of the page.
Like the architecture of a building, layout makes
a page inviting or intimidating,
easy or physically demanding to navigate,
memorable or nondescript. SAM
eight factors that substantially influence the suitability of health
materials by making the process of reading painless or not. We will
take them in
order. But first, I will add one essential item that SAM leaves
out and that all page
design should respect
gravity rules layout
Reading demands physical skill,
concentration and time, all of which may be in
short supply. The information
architect must ensure that none of the reader’s
effort and time are wasted, or
worse, sacrificed to design.
We read from the top left corner of
the page and work our way across and down;
left to right and back again to the
bottom right corner. Page design
this efficient pattern and avoid disturbing reading
rhythm. In testing, on average
percent of readers showed good comprehension of information that complied
reading gravity compared to 32 percent of readers of the same information
pages that required them to work against reading gravity. Learn more and see
Reading gravity explains many of the
suitability factors for layout.
illustrations adjacent to related text.
SAM says photos or other graphics
should be placed adjacent to the text that they
explain. Ideally the text is to
the left of the graphic (so you read it, then see the
explanatory graphic) and a caption
below the graphic. Otherwise,
the illustration becomes a distraction and
it easy to predict the flow of information
That means the content follows a
logical sequence and is presented consistently.
and the usual progress of pregnancy. Each of the six booklets uses
the same section
heads and text addresses similar subjects in consistent order
(e.g. Your Baby’s
Growth and Development). Warning Signs are always located on
the back cover;
they change by stage of pregnancy; no searching is required.
visual cues to direct attention to key content
For example, Beginnings Guides highlight key messages by displaying them in bold
in a box with 10% cyan( light blue) screen. Research suggests the light
screen attracts the eye
without interfering with comprehension. A cell phone
icon alerts the reader to a condition that
warrants a call to the doctor.
the page clean
Simple design works best for readers.
A cluttered page looks hard to read, and
most likely is. Testers may say the over-designed page
is more attractive, but
color in a supporting role
Color attracts the eye. Use it to lead
the reader to key content. Or to lure the
eye up to the “fallow corner” at the
upper right. Check to make sure the color
does not pull the eye against reading
gravity like it does below.
lines short - 30 to 50 characters and spaces
Remember the reading eye moves from
left to right
and back again. At the end of the line, the eye returns
starting place and drops down to the next line.
Unless something is in the way.
Then it has to search
for what is next,and be lost to the distraction.
high contrast between type and paper.
contrast is low, reading is difficult. For comprehension, black type on
says use non-gloss (matte) finish. Glossy paper carries a reflection which
can be distracting. However, other testing showed no difference in
A coated stock repels fingerprints and is more durable.
Beginnings Guides get a Superior rating for
complying with all these factors most
Material with fewer than three factors present or
that just looks uninviting or hard to
read is Inadequate.
instrument. It will
complete the review of graphic elements begun in
Today we consider lists, tables, charts and forms.
can facilitate learning if they engage the reader to interact with the
information, make choices, and take action. To meet this goal, the purpose
of the list must be made
immediately clear through a headline or subhead
(see Road Signs
brief instructions, as needed.
Example: Beginnings Pregnancy Guide (Page 65) includes a list of what to
take to the hospital or birthing center for childbirth. This is important
content to increase confidence and reduce anxiety, especially for the
many women for whom childbirth is their
first hospital experience.
“Pack you bag” is a clear simple
headline that clarifies the purpose of the
list. Two short introductory
sentences tell when to pack and indicate the
list includes “all you will
need.” Check boxes are included to
interaction. The list is
broken up with a subhead: “Pack for
indicating the next
Explanations and directions are
essential. When presenting how-to
information, a bulleted list is easier and quicker to read and use than
paragraph. An example clarifies
the instruction and instills confidence.
When preparing instructions, think
through who will use the information
and how will they use it. Where are they
likely to be when the want and
need the information. What might they be doing?
Who might be with
them? What might get in the way? What might be confusing? What format
will be most accessible?
Focus on what-to-do. Be specific. Omit all
reference to what not to do (it is equivalent to static).
Example: Every pregnant woman
wonders how she will know she is in labor
and what to do when labor begins. Beginnings Pregnancy
Guide (page 72-73 )
presents step-by-step instructions under the headline “Are you in labor? Walk
to find out.” Steps are numbered and presented in
logical order: 1.Notice
contractions. 2. Walk 3. Time your contractions. 4. Call your doctor. Key
information is highlighted: “True labor
contractions get longer, stronger
and closer together” . Instructions for
calling include who to call, when to
call, what questions to anticipate, what
to say, what if you get an answering
service, what if you cannot call; and
finally, what to expect at the hospital.
shows a woman walking with hands on pregnant belly, noticing her
essential instructions with a few representative learners with no prior
experience and little knowledge of your topic. Invite them to read your
instructions and tell, or better show you what they would do. You will find
out quickly if the
directions are too brief to use the graphic or follow the
independently in likely circumstances. For Beginnings,our standard
is that the learner can find and follow the
necessary instructions in the middle
of the night while throwing up.
gets a Superior rating on the SAM for providing step-by-step
with examples that build self-efficacy. Graphics--lists, charts,
forms-- presented without explanations are not suitable in health
NEXT: Typography: type sizes, fonts,
I had an
extraordinary hour- long conversation with about 35 medical residents
and attendings in an inner city teaching hospital last week. I was invited to
on health literacy at their Grand Rounds*. I met them in
their beautiful auditorium, which was
elaborately equipped and designed for
I decided to model what I teach. I took on the role
of a home visitor. I resolved
to empower this “family” to move toward their best possible desired outcome
reflective questions that would lead them to formulate their response
literacy in their institution and their practices. As home visitors point
this is scary; who knows what might happen?
I set my intention to be fully present with them,
especially if things got dicey.
I reminded myself to avoid “duct tape moments”. Those happen when a visitor
needs duct tape on her mouth to
resist giving advice, answering questions families
can answer themselves, or telling them what to do.
I told the physicians I would like to engage them in
a reflective conversation.
The intent of the discussion would be to think
together about what health literacy
means to them, their hospital, and their
patients; about how would they know if
they were addressing health literacy
thoroughly and well; what's
and what's in the way or missing. By the end of the hour, if we
were good, they
would name action steps that they are willing and able to take
next week. They
One ‘burning question” from the group was What IS
health literacy? So we started
with the story
of my Dad’s fall in the
driveway last summer and my family’s
experience with him in the ER and the hospital (not their
hospital). I asked them
to listen for three perspectives of health literacy. 1)
“Low health literacy” as
clinically defined (inability to understand (read) basic information needed to
health decisions); 2) health literacy as a personal and community asset
use to manage their health and healthcare and to build healthy
3) “hyper health literacy” - a term I coined to describe
extreme levels of medical
knowledge and familiarity with healthcare documents
which can leave health
professionals unable to communicate effectively with
those outside the professions.
disrespected and unappreciated, too
The physicians were engaged, participative,
thoughtful, reflective, and at times,
defensive. Generally a tough, stressed,
brilliant group. It was not an easy
conversation. The doctors revealed feeling
unappreciated. “They treat us like
waiters. They say, ‘I want this and this and
that,” one attending said. “The
respect is gone,” said another.
Some thought my dad had low health literacy and
probably could not read well
since he did not know if he had a kyphoplasty* and
did not know whether his
testosterone and prostrate had been checked. (He’s an
avid reader - but not
of medical journals) A few defended the doctor for asking Dad to repeat what
happened, although he had told the story many times already that day, his
injuries made it difficult to talk, he was on a pain cocktail, and it was
in the chart, which the doctor did not read. “We hear something new each time,
she said.” Fair enough. How could you do it
differently to save the patient some
of the difficulty and save yourself some
The Chief Resident chided me for not being more
assertive. He said when the
doctor burst into the room late at night, woke us
up, pointed at me and asked
Dad, “Who is she and what is her relationship?”, I
could have stood up and asked
him who he was and what was he doing there. Good
point. It reminded me of
quote attributed to Melvin
Belsky, M.D: It’s not enough for the doctor to stop
playing God, you have to get off your knees. Next time.
What do you
want and how will you know you’ve got it?
The doctors said they would know they are addressing
health literacy fully and
well when patients are more compliant; and they
acknowledged that an informed
patient might reasonably choose not to comply.
Another sign: patients would ask
more questions. Good one.
supporting them in addressing health literacy were good training and
good policies. In the
way, no surprise, was limited time with patients. More
troubling was some
attitudes about patients. A young
woman resident said,
"they are just irresponsible, you give them info and
they leave it on the bed".
The group suggested several reasons why
that might happen - they thought
they were going to get the same information
from the pharmacist; they were
overwhelmed with info and instructions; no one
discussed the information and
its importance with them. One physician complained that his
the Internet and come in with information. He considered that a
problem, rather than a sign of an engaged patient,
The reflection lead the doctors to name steps they
will take in the next week to
address health literacy. For example, instead of
asking the patient to repeat their
story for each provider, they might read the
notes and say something like
understand this is what happened... “ and ask for specifics as
needed. At discharge
talk with the patient about how they will apply instructions to cope and
recover at home. They might encourage patients with a new diagnosis to make a
of questions for the follow-up visit, and then be sure to ask them for it. A simple
suggestion was to look the
patient in the eye when talking with them. My best lecture
could not have
generated this collaborative action planning.
The Power of
to engage people, bring them to their own solutions, and move
them to actions that
they are willing and able to take. These doctors showed
that they are response-able
for health literacy in their institution. Hear me applauding.
Notes & Reference
The reflective process described here is part of
TED* - The Empowerment Dynamic
described by David Emerald. Visit powerofted.com/. Order the book The
TED* or the new TED* and Diabetes. s
is a surgical procedure designed to stop the pain caused by a spinal fracture
This continues our discussion of what makes materials easier or
harder to read,
We are using the instrument to assess the suitability ofBeginnings
Road signs reduce anxiety,
Working through information on a tough subject is like driving a
rental car in unfamiliar
territory. You need road signs to know where you are
now, and what’s ahead. Without
them, it’s easy to feel anxious, get confused
and go a long way in the wrong direction.
Road signs enable drivers and readers
to more easily find what they are looking for, and
arrive there focused and
Road signs in information -- on paper or on screen -- are
headlines and subheads. They
alert the reader to expect what’s coming next and
prepare her to think about (process
and understand) the announced topic.
Without good subheads, the reader is likely to
bypass the information or
miss the point.
Subheads break up a sea of
A text-heavy page
can be intimidating and discouraging to anyone, and especially those
unaccustomed to reading by learning. Judicious use of subheads, in bold type,
more readable, an essential first step toward being read.
A good easy-to-read sentences contain one thought. An easy to
read paragraph contains
two or three thoughts about the same topic. A subhead
announces what is coming in
the next one to three paragraphs.
Put a verb in it. A
good subhead is more than a label. It should be a short basic sentence.
You can tell your subheads are useful
if, when the reader takes in only
and subheads on a page, she gets the most important points.
Sometimes you will need
levels of heads and subheads. Note that this section
starts with a subhead, in bold type,
on its own line, with no punctuation. Then
this paragraph starts with a secondary subhead.
The topic is still subheads, but now we are talking about a different aspect of
The second-level subhead
is in bold type, but inline with the text and using a period to
from the text.
Be consistent. On the
road, drivers expect freeway signs to look different from state
and local street signs. If
they were inconsistent they would be distracting,
less informative, harder to
learn from. Navigating through a page is equally aided by
SAM says at least half of
topics must have a road sign
rating since nearly all topics are announced just before the reader
gets to them.
Starting on p 86, the text leads the parent/reader through an exploration of
new baby’s body. The
previous paragraphs’ subheads are “Get to know your baby” and
“Do not give Baby
your cold”. So now the reader understands why she would explore the
and, we hope, she has washed her hands, and is ready for the next section:
“Explore Baby’s body”.
Then, uh-oh, a label for a subhead. In this case the label
functions on its own to tell
parents where they are in the exploration. Body
parts are labeled consistently and
the discussion moves logically from head to toe. Second level subheads
that highlight things to notice. Under “Eyes”, the second level subheads are “Baby
have blood spots”, “Baby might look cross-eyed”, “Baby may cry without tears”
and “Yellowish discharge from the corner of the eyes is normal”. Each of these
information about something that mothers said they worry or wonder
To make information easier to read, lead your reader through the
text with good
Next: A new section on
graphics starts with the Cover
Guides to promote maternal health literacy. So the Guides need to
fit the audience, US pregnant women including those
with low resources and
limited literacy, and to facilitate use of health
information and services. In Part
3 addresses two
additional factors that determine the literacy demand of information,
style and sentence construction.
Style is Conversational
Easy-to-use health information uses a
conversational tone. Read aloud the information
you are reviewing It should sound like something you
would actually say to a person
sitting with you. Some clinicians may pan a
conversational style as “unscientific” or
“unprofessional”, a reflection of professional
training that rewards multisyllabic latinized
terms in long complex sentences like this one as
demonstration of deep knowledge.
But that is not the point here.
The point is to make the information
easy to understand, personalize, and apply in
real life. Conversational tone is familiar and expected, so quickly grasped
intimidating. Rather it invites reflection and interaction.
Conversation nearly always uses the
active voice: “ Jason hit the ball” is active. I can see
the action in my
mind’s eye. “The ball was hit” is
passive; it creates an incomplete mental
picture. It does not engage the
Conversation uses short simple
sentences, and sometimes incomplete sentences. No
embedded information. In the
first paragraph above, the third sentence intentionally
phases and embeds mostly irrelevant information about professional
demonstrating that long involved sentences and extraneous facts slow reading
and reduce comprehension. So instead of
“Patients are advised to take vitamins daily”;
say it the regular way:
“Take your vitamins every day”.
Guides get a Superior rating for using conversational style and simple
Construction: Context first
The way the sentence is built makes a
big difference in comprehension. Readers recall
the last thing they read, that
is, the end of the sentence. Starting with what the reader
provides context and increases understanding.
Start with the context - the part the
reader already knows: “While you are pregnant....”;
end with new information:
“...your uterus is big enough to hold the baby. Right after
birth, it shrinks
to the size of a grapefruit.” (Beginnings Pregnancy Guide Book 6 page
If I state the new information first, the reader is likely to miss
or forget it.
SAM gives an Adequate rating to
materials that present the context first half the time.
Beginnings Guides get a
Superior rating for consistently providing context before new
Vocabulary & Road Signs
removal of some, or all, of the foreskin (or prepuce) from the penis; the most
common surgical procedure in the US.
The American Academy of
Pediatrics published a new policy statement on circumcision
this week In Pediatrics. If you just read the
abstract and the headlines, this jumps out:
Evaluation of current evidence indicates that the
health benefits of newborn male
circumcision outweigh the risks and that the
procedure’s benefits justify access to this
procedure for families who choose
it. In other words, health plans should
Private insurance typically covers circumcision, so we’re
talking about Medicaid, which covers
41% of births.
Circumcision costs $400-600. I
have not heard parents clamoring for this service. Have you?
In fact fewer parents have been
choosing circumcision. Reported
The Task Force strongly
recommends the development of educational materials for providers
practitioners’ competency in discussing circumcision’s benefits and risks with
parents. Let’s exercise some critical health
literacy skills to consider the content
discussions. (How to present the content is another discussion)
The Policy Statement refers
readers to the Technical Report
but there is no bibliography or
list of studies considered. The
report simply mentions prevention of urinary tract infections,
HIV, transmission of some sexually transmitted infections, and penile cancer.
Let’s look at three of these:
Urinary tract infections
(UTI) are rare, usually limited
to the first year of life (usually the first
month for boys), much more common
in girls (but no circumcision is recommended for girls).
While it is may be
correct to say that UTIs are 10 times more common in uncircumcised boys,
is not informative and is misleading. The numbers are tiny; 0.1% - one tenth of
or one in one thousand
circumcised baby boys get a UTI vs. 1.1% of uncircumcised boys. So the
best possible preventive effect is a 1% reduction in risk. One study estimates it would take 195
circumcisions (about $10,000) to prevent one urinary tract infection, which
would be readily
treated with antibiotics. hmmm...
The World Health Organization declared
three years ago that circumcision
any strategy to prevent HIV infection in men in parts of the world where
less than 20 percent of
boys are circumcised. Notably,
there are six African countries where men are more likely to be
HIV+ if they've been circumcised. On the other hand, Scientific American
reports 3 randomized
trials in different settings consistently showed a 55 to 65% reduction in new HIV
newly circumcised African adult males. However, that
conclusion relies on the (big) assumption
that all the subjects in different
countries, cultures and religions had similar sexual practices;
and controversy remains over how circumcision protects. It seems
logical that if circumcision
was that effective against HIV, the epidemic could
not survive as it has in the US.
asking: Why does uncircumcised Europe have lower HIV and STD
rates than more circumcised
While the policy is not about women, it seems worth mentioning that a randomized controlled
trial into male-to-female transmission showed women were 54% more likely to be infected by
a circumcised man than by an “intact”
man. Circumcised or not, you still
have to use a condom!
Penile cancer is rare, even among uncircumcised men. 1570 new cases are expected in 2012,
and 310 deaths. Risks appear a bit
lower for men circumcised in childhood and a bit higher
for those circumcised
as adults. hmmmm
American Cancer Society concludes:
In the end, decisions
about circumcision are highly
personal and depend more on social and religious
factors than on medical evidence.
This is essentially what
AAP said; the policy is about covering the cost through health insurance
It seems to me
this policy presents nothing new for practice, but shores up the industry built
up around circumcision and now waning as fewer parents elect circumcision. That
would be better spent on primary care for mothers.
time. What to tell Parents?
We’ve gone social! We started Tweeting
2011. We’re also on
parenting and health literacy is on Twitter. Social media
allows us to
monitor and contribute to related online discourse and resources.
Beginnings WebMother Simone Snyder
follows 1490 tweeters to keep
us up to the minute on the latest developments in
have a combined following of over
100,000. An additional 190+ follow
posts directly by phone or email. You can also just
check in at your
I am happily surprised by the range of
interest. Beginnings followers
include individual parents and grandparents,
physicians, nurses, nutritionists,
SIDS specialists, injury prevention experts,
health coaches, child advocates,
nine March of Dimes programs around the
country, several United Ways and
Head Starts, literacy groups in the US and
Canada, child care organizations
and women’s clinics. Major organizations tuned in to our work include the
Maternal Child Health Bureau, CityMatCH, American Association of Maternal
Health Programs, Early Intervention Family Alliance, Child Health USA,
MCH, HelpMeGrow, Text4baby.
to follow us and participate in the conversation
You can expect 10-15 quality posts a week on topics ranging from Health
Literacy, Maternal Child Health, to tips for home visitors and expecting parents.
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