Implementing One Key Question in Hawaii

Power to Decide’s One Key Question^® has an audacious goal: nothing short of transforming women’s health care. One Key Question is a tool for health and social service providers that helps start a conversation about if and when women want to get pregnant and have a child. Across Hawaii the Department of Health (DOH) and a non-profit, Healthy Mothers Healthy Babies Coalition (HMHB), have implemented One Key Question.

Kari Wheeling, a midwife, doula, and Clinical Services Director at HMHB and Wendy Nihoa, Supervisor, Women’s and Reproductive Health Section at DOH, spoke about the program's growth and success in a recent interview. 

What services do you provide to your clients, generally?

Kari: HMHB is a small non-profit whose mission is to improve the system of care for pregnant and parenting women of Hawaii. HMHB offers programs such as Cribs for Kids, Piko Pals, and Baby and Me Tobacco Free.

Wendy: The section I head is the Women’s and Reproductive Health Section (WRHS) of the Maternal and Child Health Branch, Family Health Services Division, Hawaii Department of Health. The WRHS is comprised of three units: Perinatal Support Services, Family Planning, and Adolescent Health. We do not provide direct services, rather we contract with Community Health Centers (most of which are Federally Qualified Health Centers, or FQHCs), Clinics on University Campuses, and other non-profits to provide perinatal and family planning services; and teen pregnancy prevention programs via evidence-based curriculum in the classroom settings. 

Where are you implementing One Key Question? 

Kari: HMHB received a grant from the Hawaii Chapter March of Dimes to conduct One Key Question trainings statewide. We partnered with various community clinics and perinatal provider services to conduct the trainings. The providers trained work in various settings such as home visiting, FQHCs, and public health. 

Wendy: Via providers we contract with, One Key Question is implemented in community health centers, FQHCs, clinics on university campuses. Family Planning staff have also provided training for the DOH Home Visiting Program.

Describe the patient/client population you serve with One Key Question.

Kari: HMHB does not provide direct services with One Key Question.

Wendy: We do not provide direct services however, in general, our programs focus on providing access to the uninsured, underinsured, and at-risk populations (homeless, immigrants, persons with limited English proficiency, mental health, etc.). 

How are you measuring success? 

Kari: HMHB conducted a needs assessment that was submitted to the State Maternal Child Health Branch that gave the state a baseline of where Hawaii currently stands with One Key Question.

Wendy: Based on the needs assessment MCHB-WRHS and the Pre/Inter-Conception Workgroup is considering developing a plan that will include how to measure successes. 

What has been your biggest success?

Wendy: Providers continued to sustain One Key Question with little assistance from the state; in partnership with HMHB completing the One Key Question assessment and development of an One Key Question trainer registry.    

What advice would you give others who want to implement One Key Question? 

Kari: HMHB has not implemented, however, I would recommend getting input from the people trained by One Key Question to get a better understanding of how One Key Question is being implemented. The assessment that was conducted by HMHB does begin to touch on implementation issues such as high turnover or training administrative staff who are not in a position of providing direct services. I would say that partnership is key and the importance of having the training available on a routine basis due to high turnover. Even though HMHB does not provide direct services with One Key Question, we were part of the training collaborative that helped to implement statewide.

Wendy: Ditto Kari’s response.  My one gem of advice is to identify ONE agency/organization to coordinate and document One Key Question efforts – in light of staff turnover; changes, etc.