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Patty’s Blog: “Doula Programs” posts
Doula Programs: Risk Management Strategies
Release forms are an additional tool that doula program administrators can use to limit liability.
- Use a Client Confidentiality Release Form. Notify clients that doulas will be collecting information and data about services rendered, as well as birth and postpartum outcomes for mother and baby. All programs need to collect such data in order to demonstrate their outcomes to funders and to make a case for continued funding. The information should be kept confidential, but permission of the client needs to be given.
- Use a Photographic Release Form. Have doulas and clients sign a release for their images to be used on the website, in program literature, in program reports, and so on. Photographs will help “sell” the doula program to providers, clients, and funders. A good photo will engage the viewer emotionally in the work of the doula. It tells our story in a more compelling way than any bulleted list of benefits can accomplish. Take photos of doula trainings, doulas in action, clients, and their babies. Encourage doulas and clients to share their photos. However, if you don’t have the signed release, then you don’t have permission to publish their image. The following language should suffice:
“I give [insert organization’s name] right and permission to copyright and/or publish, or use photographs of me, or in which I may be included in whole or in part, for art, education, advertising, media production, or any other lawful purpose whatsoever. I waive any right to inspect and/or approve the finished product in whatever way it may be used, including digital alterations.” (Include signature line, printed name, date, and witness.)
The Doula Programs blog provides a forum for doula program visionaries and implementers to consider common challenges, ask questions, and learn from each other. Patty Brennan is the author of The Doula Business Guide: Creating a Successful MotherBaby Business.
Doula Programs: Risk Management Strategies
Doula program administrators are advised to develop a client contract that specifies the following:
- services provided,
- limits to services,
- timeframe of services,
- expectations of the client, and
- experience level of the doulas.
Require clients to sign the contract as a condition of receiving services. In the case of language barriers or low literacy, the doula can review the contract with the client to ensure understanding. Some clients, in particular recent immigrants of questionable legal status, may be reluctant to sign forms of any kind. In such cases, program administrators may choose to waive this requirement and simply make an effort to ensure that the client understands the terms of the relationship.
The Doula Programs blog provides a forum for doula program visionaries and implementers to consider common challenges, ask questions, and learn from each other. Patty Brennan is the author of The Doula Business Guide: Creating a Successful MotherBaby Business.
Doula Programs: Risk Management Strategies
To reduce liability risk associated with running a doula program, program administrators may want to implement the following strategies (continued):
- Build in support for the doulas. If the program coordinator is not an MSW, an experienced social worker should be hired as a consultant on an as-needed basis. Her job is to help resolve any high-risk situations that the doulas might find themselves in and identify community resources for special client needs. The program coordinator assists the doulas in setting and maintaining good professional boundaries, consults with the social worker as appropriate, and identifies emerging training needs.
- Host a doula support group. A monthly doula support group can be offered as a venue for doulas to come and share tips and resources, problem solve client scenarios, and learn from each other’s mistakes. Look for ways to build a sense of community among the doulas and the program. In our program, we worked to ensure that the doulas understood that, while they had a great deal of autonomy in their one-on-one relationship with the client, they nevertheless were part of a program and were accountable to the program.
The Doula Programs blog provides a forum for doula program visionaries and implementers to consider common challenges, ask questions, and learn from each other. Patty Brennan is the author of The Doula Business Guide: Creating a Successful MotherBaby Business.
Doula Programs: Risk Management Strategies
The 16-hour (or so) bare-bones doula training is insufficient to prepare doulas for coping with the needs of high-risk moms. I recommend developing enhanced doula training that covers medical and social risk topics including:
- Signs of premature labor
- Instruction in infection risks and universal precautions
- Substance abuse risks, behaviors, and appropriate doula responses
- Symptoms of postpartum depression (differentiate “baby blues”)
- Domestic violence awareness
- Child abuse and neglect and the doula’s role
- Perinatal grief and loss support
- Client confidentiality and HIPAA laws
- Cultural competency
- Establishing and maintaining professional boundaries
- Personal safety strategies and self-defense for home visitors
- Community resources and accessing help
The Doula Programs blog provides a forum for doula program visionaries and implementers to consider common challenges, ask questions, and learn from each other. Patty Brennan is the author of The Doula Business Guide: Creating a Successful MotherBaby Business.
Doula Programs: Risk Management Strategies
Transportation of clients by car is another area of risk for doula programs. To limit the risk:
- Develop a policy regarding transportation of clients. All doula programs need to consider, and discuss with their insurance provider, the implications of doulas using their own vehicles (a) to transport clients or (b) to conduct business such as birth doulas providing prenatal or postpartum home visits, or postpartum doulas running errands for the client. One strategy to limit transportation-related risk for postpartum doulas is for the doula to drive the client’s car for errands or transportation to and from doctor visits. In this instance, doulas can be required to check for proof of registration and insurance. For their part, administrators should check the doula’s driving record and require evidence of a current driver’s license with no restrictions. Finally, doulas must ensure that all passengers are properly restrained, according to the law.
- Develop a policy regarding child car safety seats. Restrict doulas from installing child safety seats in clients’ cars OR certify the doulas in child car safety seat installation.
The Doula Programs blog provides a forum for doula program visionaries and implementers to consider common challenges, ask questions, and learn from each other. Patty Brennan is the author of The Doula Business Guide: Creating a Successful MotherBaby Business.
Doula Programs: Risk Management Strategies
Here are some additional strategies or considerations for doula program administrators to limit liability risks.
- Doulas are not babysitters. Participating postpartum doulas are prohibited from providing services in a home where no other responsible adult is present at the time services are rendered.
- Place restrictions on age. Set a minimum age of 18 years as a requirement for participating doulas. In my experience, there were a few younger women who desperately wanted to become volunteer doulas and did not meet this requirement, but we welcomed them into trainings and managed to get them involved in other ways until they could qualify.
- Do a criminal background check. Call your local police department to see what is involved in doing a criminal background check for all participating doulas and then build that cost into your budget. It is certainly a reasonable precaution to take when sending doulas into people’s homes.
The Doula Programs blog provides a forum for doula program visionaries and implementers to consider common challenges, ask questions, and learn from each other. Patty Brennan is the author of The Doula Business Guide: Creating a Successful MotherBaby Business.
Doula Programs: Risk Management Strategies
Doula program administrators, with or without liability insurance coverage, may want to consider implementing the following risk reduction strategies.
- Incorporate indemnification language into the Articles of Incorporation to protect the Board of Directors.
- Create or adopt a formal professional scope of practice document that clearly defines the doula’s role, and limits to her role, and ensure that all participating doulas adhere to it.
- Prohibit labor support at home and require doulas to meet laboring clients at the hospital or birth center. An exception can be made in the case of a planned homebirth, but only if the midwife is present in the home at all times that the doula is present (i.e., program doulas are not to be used as “labor sitters” by the midwives). It is important to note here that professional doulas often do provide very beneficial in-home reassurance and support to mothers in early labor. For the anxious first-time mother who might head off to the hospital in very early labor, only to be sent home again, the doula’s presence can help keep her calm, confident, and rested at home. However, program directors need to consider whether it is reasonable to accept the risk that a doula might be put in the position of catching a baby at home, and I recommend against accepting this risk. Program administrators may want to consider making an exception for the client who needs transportation assistance to the birth center or hospital. Given the high-risk population many doula programs are targeting, removing“access to care” barriers through transportation assistance may advisedly be a retained risk.
The Doula Programs blog provides a forum for doula program visionaries and implementers to consider common challenges, ask questions, and learn from each other. Patty Brennan is the author of The Doula Business Guide: Creating a Successful MotherBaby Business.
Doula Programs: Do You Need Insurance?
I started the Doulas Care community-based volunteer doula program in 1999. This grassroots effort was a slow one-person start up and grew to become a nonprofit program with four staff members, multiple student interns, and approximately eighty active volunteers, serving approximately 250 families per year. The program was up and running and served eight women in the first two years. As I was getting the 501(c)(3) nonprofit status secured and recruiting our initial board of directors, expansion of the doula program was put on the back burner while board members considered the issue of liability exposure.
The ensuing search for suitable insurance for our doula program proved elusive. It wasn’t merely a matter of cost, or that we couldn’t afford it. It simply didn’t exist! One group did offer insurance to individual, certified doulas. This option was not consistent with our program needs. Our volunteer base was developed on the concept that newly trained doulas seeking to fulfill certification requirements would be eager to provide support to families who otherwise could not afford to pay for doula services. The program was designed, from its inception, to serve both the doulas and the families and was framed, in part, as career development for low-income women. We could not require certification as a prerequisite for insurance when the essence of what we were doing was creating a pathway to professional certification. After exhausting available options, we opted to forego “errors and omissions” insurance and focused instead on risk-reduction strategies. More next week …
The Doula Programs blog provides a forum for doula program visionaries and implementers to consider common challenges, ask questions, and learn from each other. Patty Brennan is the author of The Doula Business Guide: Creating a Successful MotherBaby Business.
Doula Programs: Free Grant Writing Training
Do you have a doula program that you need to fund? March of Dimes Michigan wants to fund well-designed programs that improve health outcomes for moms and babies. Join yours truly and a panel of experts on June 1st for the free Writing a Winning Grant Proposal workshop in Lansing. Learn to speak “Grantese” and get your initiative funded. This program is a Pre-Conference Workshop of the Healthy Mothers Healthy Babies Michigan Conference. Can’t join us? The 2010 Writing a Winning Grant Proposal Comprehensive Training Package is available for purchase. A small investment can yield thousands of dollars for your program or initiative!
Pre-registration is required.
The Doula Programs blog provides a forum for doula program visionaries and implementers to consider common challenges, ask questions, and learn from each other. Patty Brennan is the author of The Doula Business Guide: Creating a Successful MotherBaby Business.
Doula Programs & Centering Pregnancy Model
The Centering Healthcare Institute (CHI) will host its 1st National Centering Research Symposium, “Evidence for Centering Group Care: Linking Research and Practice” in Chicago, IL on April 28-29, 2011. The meeting will include presentations of Centering studies by researcher from across the country and a keynote address, “Innovation, Integration, Inspiration: Using Groups to Transform Prenatal Care.” CHI’s mission is to change the paradigm of health services to a group care model in order to improve the overall health outcomes of mothers, babies, and new families. Centering is an evidence-based redesign of health care delivery that helps to promote: safety, efficiency, effectiveness, timeliness, culturally appropriate patient-centered care, and more equitable care.
In recent years March of Dimes has promoted the Centering Pregnancy model as an evidence-based intervention for families at risk. There may be an opportunity here for doula programs to partner with midwives and other care providers who are implementing the Centering model. The incorporation of doulas into the model makes sense and is perfectly congruent with the overall approach. It is innovative and may get the attention of funders like the March of Dimes.
The Doula Programs blog provides a forum for doula program visionaries and implementers to consider common challenges, ask questions, and learn from each other. Patty Brennan is the author of The Doula Business Guide: Creating a Successful MotherBaby Business.