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6 Presentation on the First Thousand Days Program Patrick Catalano introduced the next speaker, Richard Sass. Sass founded the Contact Wellness Foundation as his personal contribution to health care reform, reflecting his desire to move beyond his previous work in the delivery of innovative medical products to the creation of motivational tools leading to positive health behavior changes. RICHARD SASS, CHAIRMAN, CONTACT WELLNESS FOUNDATION The First Thousand Days program, which focused on children from conception through 2 years of age, includes a wellness algorithm and is based on the relatively new science of the developmental origins of health and disease. If the fetus is biologically programmed by the mother from the very point of conception, then it is all the more urgent to direct pregnant women who are at risk of diabetes, obesity, and other chronic conditions into preventive care as early as possible. Compared with the standard prenatal protocol, the First Thousand Days protocol increases both the frequency and the duration of time a woman is involved in prenatal care. The standard prenatal protocol consists of 11 10-minute visits; the First Thousand Days protocol calls for an additional 40 hours of visits. Using a mental health promotion approach, the program encourages each pregnant woman to assemble her own small group of six or eight people, which might include her mother, 55
56 DISSEMINATION OF THE PREGNANCY WEIGHT GAIN GUIDELINES grandmothers, husband or significant other, neighbors, or friends, and would meet weekly in a loving and supportive atmosphere to talk about weight gain and other health-related goals and objectives. To the extent that the group is successful in encouraging the woman to improve her metabolic function, normalize her glucose, exercise more, and make healthy behavioral choices, it can help set the stage for a healthy pregnancy and a healthy baby. The proposed protocol has three additional elements: (1) a facilitator for the group, who would meet with the group initially and then be available by cell phone and e-mail; (2) a toolkit that includes glucose monitoring, A1C monitoring, resources for calculating and tracking BMI and blood pressure measurements, and other tools to help the pregnant woman monitor her progress throughout her pregnancy; and (3) a $1,000 529 education savings plan for the baby as an incentive to motivate the mother to reach her goals for her 40 weeks of pregnancy. The money in the plan would be available for the child to use for higher education or vocational school. The Contact Wellness Foundation is seeking funding for the project from foundations and other sources, including Wall Street. The ultimate goal of the project is to develop a large demonstration across an entire state, which could be marketed to the rest of the country as a for-profit activity through the sales of the toolkit and social impact bonds.