On the final day of the 53rd Annual Heartbeat International Conference, Jeremy Aranda, president of Life on Belay, joined of Heartbeat International President Jor-El Godsey in presenting the fruit of their teamwork in developing a tool to better measure a pregnancy center’s effectiveness in providing the love and support a pregnant woman needs along her journey. Heartbeat is the largest network of pregnancy help organizations in the U.S. and the world, and Life on Belay works to build healthy communities that care for those vulnerable among them.
Positive Intervention Metrics is designed to be a universal framework “to assess risk that is more helpful, that recognizes that it's a continuum, and that actually measures that we can make a difference,” Aranda said. “This positive framework is meant to try to bring unity and a language so that we can have dialogue.”
The risk assessment and metrics framework grew out of a collaborative project by several organizations including Human Coalition, Compass Care, Focus on the Family, and Heartbeat International. Academic research, market studies, and input from pregnancy centers all shaped the “draft” version now available for centers to work with.
The tools improve upon older approaches that have become outdated.
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Godsey said that for decades, “We did what we did with what we had, and we were actually using it to answer some different questions than the kind of questions we're asking, or we should be asking now.”
He highlighted the shortcomings of a widely used vocabulary that triages clients as either “abortion-minded, abortion-vulnerable, or likely to carry.” While such labels aimed to help centers wisely allocate scarce resources—such as ultrasound appointments with a nurse—for greatest impact, they also created what he called “bucket thinking.”
“One of the things that original framework did not help us do was understand that this [pregnancy decision-making process] is not buckets,” Godsey said. “It's a spectrum.”
“If she's ‘likely to carry,’ [we think] there's no risk there,” Aranda said. “But two hours later when she loses her very low-paying job, all of a sudden she is really high on the scale, and we don't have a way to capture that.” He added that 10 years of data showed 2% of so-called “likely to carry” women still had abortions.
What’s really working?
“As part of our methodology, we got the privilege of sitting down with all sorts of different centers and saying, ‘Tell us what you measure, tell us how you measure.’ and then asking them, ‘What do you mean by that?’” Aranda said. “We asked, ‘What’s a qualified client for you?’ And we got different definitions at every single center.”
“How can we actually talk about what strategies are working?” he asked. “We can't. So that common language is a gift. We want to bring unity, we want to be able to have meaningful dialogue, and we want to have less subjectivity in our dialogue.”
Aranda and the team developed the framework to provide centers with baseline metrics they should watch, while establishing objective definitions for those metrics, providing ways to use the data, and aiding in benchmarking for edification across centers.
As an example of a baseline metric, Godsey pointed to “speed to service,” mentioned in the keynote presentation he delivered just prior to the metrics workshop.
He said that as soon as pregnant women began calling Heartbeat’s Abortion Pill Rescue® Network (APRN), “we realized we didn't have days and weeks between the point that she talked to us on Option Line until she was able to get into the center. We had hours, even minutes.”
“A child is dying right now,” Godsey said. “So, to me, that was the linchpin for this conversation. Do we know the metrics? Do we know what they mean? How do we use them? And then how do we know to challenge each other to be better?”
Tweet This: Collaboration between pregnancy help orgs is leading to Positive Intervention Metrics to better measure pregnancy centers' effectiveness.
Women’s journeys as a continuum
“We wanted to measure her risk in a numeric way,” Aranda said. “Here's why. We wanted to be able to say, ‘At this point in time, she's here. And at this point in time, she's here. And during those two points in time, here's what we did or didn't do.’”
This kind of information would enable a center to evaluate the effectiveness of a particular intervention.
Rather than having to gauge whether a woman has transferred from one “bucket” or category to another, a numerical scale allows room for agreement “on what point in the risk score moves to which category, so that there's a standard way that we can all talk about it,” Aranda said.
At the same time, he said, research shows “her stated intent matters. That’s a really strong statement and should have weight to it.”
Aranda said thinking has shifted about what types of questions should be asked of clients to understand their level of risk.
“The research was showing that it wasn't objective factors that were putting her at risk,” he said. “It’s her subjective feeling about those things.”
“The way we ask questions matters immensely,” said Aranda. “Especially if we realize that her emotional experience is driving the risk. If we trigger something that causes the fight or flight response, we're actually increasing risk.”
One benefit to a center in using a framework like Positive Intervention Metrics is discovering a specific course of action based on data.
“We have something we really need to act on,” Aranda said. “Even saying, ‘There's less risk, but there's still some’—it changes our behavior. The catchall categories didn’t do that.
“We now can actually say, for each piece along the journey, these are the things that are making a difference,” he said.
Drafted and ready for a pilot program
Currently, Aranda said, “We’ve drafted the white paper that has the risk assessment, the metrics framework, and the better practices. We’ve had this reviewed by a bunch of different centers and by national organizations and gotten some great feedback.”
“We are really confident that we are close on all the questions, that they're the right things to be asking,” he said. “So, we have a good starting point.”
Still to be developed is a system for weighting the data.
“We may have to go to market by saying, ‘Let's take a bunch of pilot centers and let's all do this together. And then let’s look and see what the data tells us about weighting, which factors actually were more important,’” said Aranda.
“The goal is to use this room as a jumping off point,” he said. “We want to pilot this, and we want to make it the best it can be [with] people who are willing to be early in this and to refine it.”
Godsey said, “We are working to get this into Next Level™,” the client management system developed by Heartbeat international. “That's not an invitation for everybody to jump into Next Level, though you’d be welcome. But this is where we haven't gained alignment on a national level yet.
“This has been one of the issues in rolling it out, but we wanted to launch,” he said. “So, we're going to figure out a way to do it, with platforms or without platforms.”
“If any [client management] system has an open API, we can tie it in,” Aranda said. “If you’re using Next Level™, great, if you’re using eKyros, great, but we have to have the vendors allow us access.”
“So, we have to get buy-in, we have to get people all on the same page, and then it makes sense for all of them to use it,” he said.
During the lively question-and-answer session, workshop attendees expressed both frustration with their centers’ current use of metrics and agreement that improvement is needed.
One attendee, Matthew Irwin of Black Hills Pregnancy Center, said, “We have to be agile in how we're approaching this because technology and the course of business is going to change faster and faster. We can't change if we don't have data to help us to know where we're at. We can't change on feeling alone because that won't be effective.”
“So, if we can create this consortium that will help us get there, we will get there faster, even if we've tried it before,” he said. “The thing that we have to remember is we have new technology, we have new visibility, and this is going to help us along the road. We're talking about changing a generation.”
Editor's note: Heartbeat International manages Pregnancy Help News.
