Impact at-risk pregnancies by changing women’s unhealthy behavior

Intervention impacts bottom line by increasing access to system

Grocery store clerks in South Central Los Angeles wear buttons on their shirts promoting a mentoring program for pregnant women who need help accessing health care. When a woman pays for her groceries with a Women, Infants, and Children check (a government subsidy to promote good nutrition), the clerk asks if she is getting prenatal care. If not, she is referred to the outreach program called MotherNet LA.

The women who follow up on the referral are assigned to a community health worker who visits them in their homes on a regular basis to educate them on health issues, take them to the doctor when necessary, and even demonstrate how to prepare nutritious meals. The worker continues to follow the mother until the child is 3 years old.

MotherNet LA has found mentoring extremely successful. In the two years the program has been operating, there have been no repeat pregnancies, and 60% of the new moms have found employment or returned to school. Ninety-eight percent of the women breast-feed their babies, and 60% of the babies’ fathers are involved in the support and care of the child.

The outreach workers with MotherNet LA are community members trained by health care professionals to help families from their own cultural and socioeconomic background access important health services and information.

"In areas where there is a high incidence of infant mortality, many women perceive barriers to the system. Either they feel no one treats them appropriately, they don’t understand the importance of health care, or they don’t have transportation to prenatal care," says Maryjane Henning, BSN, MPA, director of the MotherNet America program based in Sterling, VA.

Public and private health care groups that have implemented MotherNet programs across the United States find that training lay people to educate their neighbors is an effective method of early intervention and prevention of health care problems. (For information on the training process, see story, p. 15.)

According to Sterling, VA-based International Medical Services for Health (INMED), which oversees the MotherNet program, lay home visiting has many financial benefits. It can help avoid the $14,000 to $30,000 spent per low-birth-weight baby in the first month of life in a neonatal intensive care unit. Also, such programs can reduce the $487,000,000 spent nationally every year on hospitalization, rehabilitation, special education, and foster care involved in child abuse and neglect cases. It also can help avoid the $300 to $52,000 spent per unvaccinated child to treat resulting complications.

The MotherNet America program operates in communities across the United States. It was created by INMED, an organization that implements community directed public health projects around the world, in partnership with The National Commission to Prevent Infant Mortality, which has since disbanded. Public and private agencies and health care organizations began using the curriculum and implementation manual to create MotherNet programs in 1993. (For information on how to obtain materials, see source box, p. 17.)

Long term key to success

The program goals are to improve the birth and life outcomes for the women enrolled and their family members, says Henning. Making sure the woman has prenatal care is only the first step. Education includes baby care, family planning, problem-solving skills, and stress reduction techniques.

"It is a very comprehensive program, and it works because it happens over time, and it is consistent. The women are seen at least once a month and in some cases once a week, depending on the needs of the individual," she says.

The community health workers keep records of their home visits and meet regularly with a nurse and a social worker involved in the management of the case. These workers might have 10 to 40 clients, depending on the intensity of each case. In addition to education, the community health worker identifies problems and makes sure the woman is referred to the appropriate agency.

In January 1998, a Women’s Wellness Source-book created by INMED was introduced so that community health workers can answer questions about other pertinent health issues in addition to maternity issues. (To order a copy, see source box, p. 17.) Community health workers carry the sourcebook with them on home visits to answer their clients’ questions on such topics as aging, cancer, diabetes, heart disease, HIV, and substance abuse. "We found that the home visitor often is asked many health questions because family members might have diabetes, heart disease, or asthma," explains Henning.

The grocery store in South Central LA is a creative method of referral to MotherNet. When told of the program, the manager agreed to let the clerks participate. They were simply told how the program works so they could pass the word to pregnant women who came through their check- out line. However, most referrals are by more traditional methods. These methods include schools, maternity clinics, government agencies, and churches. The community health workers also approach pregnant women they meet in their neighborhoods.

A referral from a clinic might be made because staff notice that the woman needs more individual attention than a clinic social worker can provide. For example, at the Imperial Heights Clinic in Los Angeles, the social worker was struggling to find a way to help a pregnant teen-ager comply with her health care regimen. The teen was deaf and demanded more time than the social worker could devote to the case. (For information on a mentoring program designed for teens, see story, above.)

"We referred her to MotherNet, and she was paired with a resource mom who established a relationship with her. She made it through her pregnancy and did very well," says Revonia Truby, MSN, RNP, coordinator for clinical services at Imperial Heights Clinic.

One problem the community health worker identified was that the teen had difficulty communicating. To help resolve the problem, MotherNet helped enroll her in a school that taught signing.

Before a woman is enrolled in the program, her knowledge, attitude, and behavior regarding her health and the health of her family is evaluated. It is also evaluated postpartum, and at the baby’s first and second birthdays. The evaluation is completed by the community health worker with the aid of a questionnaire. Questions include:

• Do you feel comfortable talking to nurses and doctors about your female problems?

• Do you think it is important that a woman get prenatal care as early as possible?

• How would you rate your eating habits? Good, very good, bad, very bad?

"Initially, the women are very uncomfortable with the medical delivery system. They have poor self-esteem and poor eating habits," Henning says. "By the time they exit the program, they are navigating the system on their own, making sure their babies see a doctor, and they know how to find resources in the community."