Expanding a Home Visiting Model

 Does expanding a federal Healthy Start home visiting case management model, to include a nurse, nutritionist, and clinical mental health counselor, impact selected health outcomes in high risk African American women before and after pregnancy?

 The Gadsden federal Healthy Start Project provides outreach, education, and case management services in a small rural community in north Florida with significant disparities in infant death rates for African Americans.  The leading cause of Black infant death in this community is prematurity due to poor maternal health, according to the Perinatal Periods of Risk “adapted” model (used for small communities) conducted in 2009.

 Project needs assessments revealed significantly high rates of stress and depression as well as high rates of obesity, high blood pressure, diabetes, and other chronic diseases in its preconception participants.  To address these risk factors, the home visiting case management staff, including 4 professional social workers, was expanded to include a professional nurse, nutrition educator, and clinical mental health counselor.

 All staff were trained on the new “Bio- psychosocial” interdisciplinary team approach and how it works with the participants.  All team members have a clear understanding of the goals and objectives of the model and how they are translated into individualized case planning.

 A study was conducted that looked at single group pre-post test differences for the following variables: ◦ Blood Pressure ◦ Physical Activity ◦ Water Intake ◦ Body Mass Index ◦ Waist Circumference ◦ Depression ◦ Stress ◦ Health Literacy

 Participants were non-pregnant African American women (14-44) who were assessed as being at risk for a subsequent poor birth outcome. (CDC recommended risk criteria)  The study included 31participants who were enrolled in the program for case management services for at least six months between January and December, 2010.

 Program evaluation goals were established to measure progress and all goals were exceeded: ◦ Blood Pressure Goal (25%):Exceeded by 50% ◦ Physical Activity Goal (35%):Exceeded by 1% ◦ Water Intake Goal (35%):Exceeded by 14% ◦ Body Mass Index Goal (35%):Exceeded by 3% ◦ Waist Circumference Goal (5%):Exceeded by 56% ◦ Depression Goal (10%):Exceeded by 29% ◦ Stress Goal (10%):Exceeded by 43% ◦ Health Literacy Goal (25%):Exceeded by 19%

 A two tailed t-test (alpha =.05) was conducted for each of the pre-post test mean differences. ◦ Blood Pressure: to Not significant ◦ Physical Activity (min.): to Not significant ◦ Water Intake (oz.): to Significant ◦ Body Mass Index: to Not significant ◦ Waist Circumf. : 42.6 to Significant ◦ Depression: 7.54 to 7.48 Not significant ◦ Stress: to Significant ◦ Health Literacy: to 57.5 Significant

 Preliminary findings suggest that a bio- psycho-social interdisciplinary team approach does have an impact on selected health outcomes of high risk African American women (14-44).  A more rigorous evaluation of this approach is recommended.

 Maurine Jones, PhD.   Sharon Ross-Donaldson, MSW. LCSW.   Carol Gagliano, MA 