Social services key to prenatal care for uninsured
Social services key to prenatal care for uninsured
More then childbirth education needed
Good prenatal care for low-income women who are uninsured or underinsured must include social service support.
"The model of having the wraparound of the social service support available to women at their prenatal clinic site has been shown to be a really positive model," says Linda Wiitala, MSW, MPH, prenatal program manager for Catholic Charities, Seton Services in St. Paul, MN.
This is the model used by Catholic Services, and Wiitala says a presenter at a conference she attended said some think the inclusion of the psychosocial piece and financial assistance piece result in better birth outcomes. Although there is no research yet to support this conclusion, Wiitala says she has observed that social service support is important.
At Catholic Charities, the first clinic visit includes a psychosocial risk background assessment conducted by a social worker to determine if there is a history of abuse or drug and alcohol use, as well as to learn about other issues such as a person's financial and housing situation.
The patient meets with a nurse who provides prenatal health education on such topics as diet, sleep, and exercise. Also the patient sees a nurse midwife for a medical exam.
The clinic uses a nurse midwifery model but has a physician who volunteers one day a week for consultations and to do ultrasounds. The nurse midwifery group is from St. Joseph's Hospital in St. Paul, part of the health care system with which the clinic partners. If a patient's pregnancy is determined to be high risk she is referred to a regular medical clinic.
Part of the social service work is to help patients fill out applications for medical assistance that will help cover expenses. If the patient does not qualify, a private payment plan is arranged. The hospital charges a flat fee that is greatly reduced to keep the cost of the service manageable for those who can't get insurance.
During routine clinic visits for prenatal care some women continue to meet with the social worker who monitors certain situations such as abuse.
With a social service model, all types of support can be initiated for women. For example, they are helped with their nutritional needs through the federally funded women, infant, and child program that provides coupons for certain types of food.
If women have no one to support them during childbirth, they are referred to a volunteer program. Wiitala says having support through labor makes the birth a more positive experience no matter what medical interventions are needed during labor.
"We feel strongly a woman deserves that support and benefits from it as well as her child does," says Wiitala.
Education varied
While women are prepared for childbirth by attending classes on the subject as well as those on breastfeeding and newborn care, they also have opportunities to learn about things that are not usually considered part of good prenatal education. For example, they can receive counseling on finances and budgeting.
Most of the patients who use the clinic have great financial challenges and concerns about what they will do to meet expenses during the time they are off work because their job has no benefits.
Every patient receives a packet that has information on where to find resources such as baby supplies and child care for low-income families as well as medical care, counseling and other services.
Education has been tailored to fit the needs of the patient population. A day-long childbirth education class is offered on a Saturday. At one time, it was offered one night a week for six weeks but it was too difficult for women to make it to all the sessions.
A newborn care class that includes lessons on breastfeeding also is offered on a Saturday. These classes rotate every other month. Those who attend are given lunch, snacks, and ice cream sundaes at the end of the day.
Women also receive education on breastfeeding and newborn baby care while in the hospital. Lactation consultants are on hand as well.
The difficulty in serving this patient population is that it is often hard to determine where to start from a social services perspective, says Wiitala. A lot of time is spent helping clients find medical assistance.
It is important to reach the uninsured because it is a large group, and growing, says Wiitala. Many of the clients at Catholic Charities, Seton Services have full-time jobs but cannot afford to pay their portion of health insurance and many clients are immigrants.
Sources
For more information about making social services a part of prenatal care for the uninsured, contact:
- Linda Wiitala, MSW, MPH, prenatal program manager, Catholic Charities, Seton Services, St. Paul, MN. Phone: (651) 603-0223. E-mail: [email protected].
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