Healthy Babies Perinatal Education Survey

Last Update: 7.18.07

Thank you for completing the Healthy Babies Perinatal Education Survey. This survey is an important part of the work of the Anne Arundel County Healthy Babies Coalition. The information you provide will help identify strengths and possible gaps in perinatal education programs offered to Anne Arundel County families. It will also help identify what training topics might interest County service providers.

Instructions: Please check all answers that apply and fill in the blanks for "other." We ask that you send a separate e-mail and attach your schedule of classes (if applicable) or fax them to Laurie Fetterman at 410-222-7294. When completing this form, please tab down the survey to make your selections and click submit when you are finished. Do not select the enter key, doing so will automatically submit your form.

If you have any questions, contact Laurie B. Fetterman, M.S.W., at hdfett00@aacounty.org or 410-222-7203.

Healthy Babies Perinatal Education Survey

Name of Program or Service offered:
1. What is your target audience?
    Pregnant women of all ages
    Postpartum women of all ages
    Pregnant teenagers
    Parenting teenagers
    Fathers
    Grandparents
    Siblings
    Women contemplating pregnancy
    Other
2. What type of education is provided?
    Distribution of educational materials only
    Individual in-person education/counseling
    Individual phone-based education/counseling
    Group/class education/counseling
    Referral to other services only
    Other
3. In what zip codes is the program/service offered?
4. What is the program/service setting?
    Anne Arundel County Department of Health clinic
    Birthing center
    Community health center or clinic
    Hospital
    In-home
    Provider office
    Other
5. Whom do you service?
    Anne Arundel County residents only
    High-risk patients
      African American women
      Women with chronic health problems
      Teenage mothers
      Pregnant women over age 35
      Women with a previous pregnancy loss
      Women who are eligible to participate in Health Choice (Medicaid)
    Only patients referred by a health care provider
6. What topics are addressed in the program/service?
    Baby care basics (e.g. safe sleep, injury prevention)
    Birth experience/Labor and delivery
    Breastfeeding
    Parenting skills
    Postpartum issues (e.g. depression, birth control)
    Preconception health/Pregnancy planning
    Pregnancy basics
    Nutrition during pregnancy
    Refresher pregnancy class
    Refresher birth class
    Sibling preparation
    Other
7. How accessible is the program/service?
    Onsite daycare provided
    Children can attend with parents
    Near public transportation
    Program offered during the daytime, Monday-Friday
    Program offered during the evening, Monday-Friday
    Program offered during the weekend
    Transportation assistance available
    Spanish language interpretation available
8. What is the cost for the program/service?
    Free/No cost
    Sliding scale
    $10 or less
    More than $10 but less than $30
    $30 to $50
    More than $50
9. How frequently is the program/service offered?
    Annually
    Quarterly
    Monthly
    Weekly
    Other
10. Please provide a brief description of the program/service:
11. The Healthy Babies Coalition is trying to identifiy the training needs of County health care and social service providers. Please indicate what topics your organization would be interested in attending a training about:
    Baby care basics
    Breastfeeding
    Disparities and cultural competence
    Postpartum issues
    Preconception health/pregnancy planning
    Pregnancy basics
    Other
12. Would you like to join the Healthy Babies Coalition?
    I would like to join the Healthy Babies Coalition
    I would like more information about the Healthy Babies Coalition
Please provide your contact information in case we need to clarify any of the information provided.
Name:
Title:
E-mail Address:
Organization:
Telephone:
Fax:
   

Reminder: We ask that you send a separate e-mail and attach your schedule of classes (if applicable) or fax them to Laurie Fetterman at 410-222-7294.

Thank you. If you have any questions or for more information, contact Laurie B. Fetterman, M.S.W., by e-mail or phone, 410-222-7203.