Systems-Level Work to Support Home Visiting and Promote Maternal and Infant Health Equity [Competency 4: Critical Thinking]
MCH Leads Health Equity Edition – In order to advance health equity for MCH populations, beginning January 2023, MCH Leads will feature trainees’ health equity-focused work. We look forward to highlighting trainees’ experiences supporting the health and well-being of vulnerable and underserved populations and communities. Also, their work assessing and addressing the underlying causes of health disparities–and their efforts to promote diversity, equity, and inclusion–ultimately improving MCH outcomes. In addition, we encourage trainees to reflect on how the MCH Leadership Competencies are applicable to their health equity-focused stories.
Candace Jarzombek (she/her) is a second-year Master of Public Health candidate at Boston University Center of Excellence in Maternal and Child Health, with degree certificates in Community Assessment, Program Design, Implementation, and Evaluation, and Maternal and Child Health. Before moving to Boston, she graduated from Purdue University with her bachelor’s degree in Speech, Language, and Hearing Sciences, and Brain and Behavioral Sciences. During the summer of 2022, Candace participated in the Title V MCH Internship Program at the Virginia Department of Health, where she conducted an exploratory evaluation of one of the state’s maternal and infant home visiting programs. She currently works as a research assistant at Boston University’s Catalyst Center, the national center for health insurance and financing for children and youth with special health care needs. Her professional interests include maternal health, child development, and family wellbeing through trauma-informed and equity-centered approaches. Connect with Candace on LinkedIn!
In the summer of 2022, I had the opportunity to work with the Virginia Department of Health (VDH), Division of Child and Family Health, through the Title V MCH Internship Program, on an environmental scan and programmatic evaluation regarding a maternal and infant home visiting program called BabyCare. At the outset of my internship, my co-intern and I were tasked with identifying strategies for developing BabyCare into an evidence-based program, but as we learned more about BabyCare, the home visiting landscape in Virginia, and the federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program, our focus broadened. With the overarching goal of promoting equitable access to maternal and infant home visiting services across Virginia, we worked toward developing recommendations to strengthen and expand BabyCare.
Background on the BabyCare Program
BabyCare is a home visiting program for Medicaid-enrolled pregnant and postpartum individuals and their infants that is delivered by public health nurses in Virginia’s Local Health Districts (LHD). It is funded by the Virginia Department of Medical Assistance Services (VDMAS), the state Medicaid agency, as a targeted case management program. Key program components include behavioral health risk screening, case management, and coordination and referral to resources such as primary medical care, early intervention services, and WIC, among other resources. Nurse home visitors also provide pregnancy, childbirth, and child development education to participants. To be eligible for the program, a family must be experiencing one or more psychosocial, medical, or nutritional risk factors that are defined by VDMAS.
The program is considered evidence-informed, as LHDs use up-to-date guidelines from sources such as the Centers for Disease Control and Prevention (CDC) to inform their work; however, the program is not evidence-based, as it has not gone through the rigorous research and review process required by MIECHV standards.
Competency 4: Critical Thinking
While some LHDs have strong BabyCare programs, others have faced challenges with implementation. Initially, our goal was to identify how BabyCare could become an evidence-based program, which could open new funding streams, but we soon learned from interviews with public health nurses and our research into the process for becoming a MIECHV-designated evidence-based home visiting model that we needed to take a different approach. LHDs valued the flexibility of the existing model, which allowed them to tailor their home visiting curricula and services to the specific needs of their geographic area. For example, one LHD developed their own home visiting curriculum with month-by-month pregnancy education that they regularly update, while another LHD with a larger Spanish-speaking population uses an existing evidence-informed curriculum that is available in both English and Spanish.
Using critical thinking skills, my co-intern, preceptors, and I refined our investigation question. Rather than asking how BabyCare could become evidence-based, we asked whether it should become evidence-based as defined by the MIECHV standards, and what other strategies VDH could use to support the program. We listened to the voices and perspectives of LHD staff and representatives from evidence-based home visiting models in the state to develop recommendations to best meet the needs of all stakeholders. Our investigation ended with some solutions, but more importantly, more questions for how VDH and VDMAS could partner to support LHD needs and enable the expansion of BabyCare.
Advancing Health Equity
BabyCare and other home visiting models in Virginia promote health equity through taking a passionate and individualized approach to meeting families’ needs. Evaluations of one LHD’s BabyCare program have shown impacts on infant health outcomes such as premature birth and low birthweight. In addition to positive effects on health measures, BabyCare nurses reported that program participants received critical social support from the program and were connected to other needed resources. The American Academy of Pediatrics supports the use of high quality community-based home visiting programs to address health disparities.1 With this knowledge, I wanted to be sure that the recommendations I put forth at the end of my internship would help provide increased access to these services throughout the state, particularly in areas that did not have other home visiting programs. The recommendations for VDH, which included working closely with LHDs interested in expanding BabyCare to identify their needs and developing a centralized resource hub for BabyCare programs, aimed to support LHDs in the critical work they do to ensure that parents have the culturally responsive and community-based resources they need to thrive.
- Duffee JH, Mendelsohn AL, Kuo AA, et al. Early Childhood Home Visiting. Pediatrics. 2017;140(3):e20172150. doi:10.1542/peds.2017-2150
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