Healthy Babies Program at Maternity Care Coalition – Pennsylvania
Healthy Babies is one of multiple programs offered by Maternity Care Coalition (MCC) through its MOMobile services. The organization has been serving families in the Philadelphia low-income communities since 1980, providing services and support to underserved pregnant mothers, parents, and children.
Healthy Babies is a wrap-around home visiting and referral program that supports pregnant and parenting women with substance use disorder (SUD)and infants affected by neonatal abstinence syndrome (NAS) or neonatal opioid withdrawal syndrome (NOWS) through the first 18 months of life. The vision for this program was developed after learning about the experiences and challenges encountered by neonatologists, pediatricians, mental health professionals, delivery hospitals and community partners in providing care to this patient population.
Community Collaborations and Referrals
Pregnant women and new mothers are referred to Healthy Babies by Keystone First Managed Care Organization (MCO), local hospitals, obstetrics clinics, and recovery programs. The Healthy Babies team confers with the referring organizations on deciding the best way to make first contact with a pregnant woman or new mother and engage her to utilize the program’s services. While the program is offered through the MCO, the participation is voluntary. The program enables staff members to meet some parents at the location of the referring organization so there is immediate engagement and mothers do not have to be placed on a waiting list for services. The program staff serving in a perinatal Community Health Worker capacity, are called Advocates. Many Advocates are coming from the same communities as the women or caregivers and have a good understanding of the challenges they face.
Building a Therapeutic Alliance
The Advocates start building a therapeutic alliance with the mothers and caregivers as early as possible. The first contact with the program is generally over the phone when the Advocates discuss the options for the preferred location for the first meeting, such as, at home, delivery hospital, a fast-food restaurant, or even a park. The program hopes that families can establish a positive and long-term relationship with a specific Advocate who will support them during pregnancy and for up to 18 months postpartum. A strategy for building trusting relationships with the parents is by supporting them in establishing health goals, and continually asking for the parents’ input and highlighting the progress towards achieving these goals. The overarching goal for the Advocates is on facilitating access to all the services available through the program, rather than focusing only on the challenges related to substance use.
Throughout the entire time of collaboration, Advocates treat parents and caregivers as partners in all aspects related to the care of the infant. While Advocates work to engage the infants’ kindship or foster caregivers and any other family members, the Advocates may be the only support a family has. The team creates a supportive community for the family and are often the only people celebrating with the mothers a successful delivery, the achievement of recovery goals, or the baby reaching their developmental milestones.
Multidisciplinary Care and Medical Home
Advocates introduce mothers to the community pediatricians and ensure that both mothers and infants can receive coordinated care and services in the medical home framework.
Additional to Healthy Babies, MCC provides a diversity of other supports and services for families, including home visiting, behavioral and therapeutic services, breastfeeding support, case management, and peer support via parenting groups. These services are offered in the community or virtually. Material resources such as clothing, diapers, cribs, etc. are also offered as needed.
Through the MOMobile Family Therapy Program, mental health professionals provide services to families in their home or via telehealth. This program was initiated when it became evident that many mothers in recovery were having difficulty in accessing mental health care in the community due to lack of childcare or transportation, among other barriers. Every mother receives a mental health screening and mothers with severe mental health conditions are referred to a psychiatrist.
Care Coordination
Healthy Babies does not provide direct services and treatment for SUD; however, the program supports mothers and caregivers during their treatment and recovery, re-engages parents in treatment if needed, or provides referrals for an assessment. Mothers are referred to primary care physicians and obstetricians for their own medical care. Advocates are available to meet with families at a medical appointment to offer support or to prepare families for the medical appointment. Healthy Babies addresses social determinants of health and assesses families for food insecurity, adverse childhood experiences and domestic violence. As needed, Healthy Babies staff connects families with the most appropriate programs and benefits, including housing and job training.
Families may also receive home visits from other MCC programs such as, Early Head Start or Healthy Families America. Initially, families are visited weekly, but the frequency of the visits is flexible and can be adjusted over time to meet each family individual needs. The home visiting programs use an evidence base curriculum called Growing Great Kids which celebrates families’ strengths and goals and implicitly aims to prevent child maltreatment. Home visitors emphasize positive parenting and provide interactive activities for mothers and infants to increase parental attachment and bonding.
Care Accessibility
To ensure all the programs offered through MCC, including Healthy Babies are accessible, parents can receive transportation through their state insurance, Keystone First, or through a Medicaid service called, LogistiCare. During the COVID-19 pandemic, the Healthy Babies staff learned that telehealth is not for everyone, but virtual home visiting can facilitate a greater number of visits for certain families that need them. Some parents preferred the virtual visits, especially those who needed flexibility and had scheduling constraints, while others did not initially have the technology needed to meet online. MCC provided free tablets and internet services for clients in those situations. Other families were hesitant when it came to telehealth home visits due to other privacy concerns.
Training
As Advocates are key to ensuring support for families through their recovery, all Healthy Babies staff are well trained. Advocates receive eight weeks of training, that covers several topics including, maternal and child health, motivational interviewing, trauma-informed care, breastfeeding, substance use, and mental health. External organizations are contracted to provide specialized training for all home visitors at MCC. All staff are trained to use a patient-centered, nonjudgmental, strength-based, harm reduction approach to supporting mothers in their recovery.
Many of the Healthy Babies Advocates have similar backgrounds to the mothers with whom they are working. Recognizing that the work environment can reactivate some Advocate’s own trauma, MCC offers selfcare training to their staff and Advocates. Home visiting staff also receive support around caring for their own families during the pandemic and are offered weekly yoga, self-compassion, and selfcare classes.
Funding and Evaluation
The Healthy Babies program is entirely funded by the state’s Keystone First Medicaid insurance. The MCC has a research and evaluation team and has recently started to evaluate the Healthy Babies training and data entry. This formal evaluation is separate from past data tracking which was used to inform logic models around family outcomes. Other MCC programs have been evaluated by the University of Pennsylvania and Keystone First Medicaid.
Advice for Other Practices
The Healthy Babies team emphasizes that other practices and organizations wishing to work with this patient population, should not try to do it alone. They recommend that pediatricians and other community organizations engage a home visiting program, which are often underutilized. In doing so, pediatricians and community programs serving parents in recovery can focus on their area of expertise and will not have to worry about how a family will get to an appointment or whether they will follow-up with a referral. The strength of the Healthy Babies program lays in its ability to offer wrap around services and follow-up on various referrals, so pediatricians and other clinicians can focus on the medical aspects of care. The team also recommends hiring home visitors or other staff that have had similar life experiences in order to build trusting relationships with parents and families.