Overview of Maternal and Child Health Program

Why do we do Maternal and Child Health home visitation programs? All local health departments in Wyoming are tasked with maternal and child health home visitation via state statute (Wyoming Statute: Title 35, Chapter 27, Public Health Nurses Infant Home Visitation Services). Offer services to pregnant women, prenatally and post natal Priority is first time mothers Medicaid births are also prioritized (goal is to reach 90% of Medicaid births in county and 75% of all other births)

Why do we do Maternal and Child Health home visitation programs? Goal is to give pregnant women and families, particularly those considered to be at-risk, necessary resources and skills to raise children who are physically, socially, and emotionally healthy and ready to learn. Critical activities provided by the public health nurse during home and/or office visits include: supporting preventive health and prenatal practices assisting mothers on how best to breastfeed and care for their babies helping parents understand child development milestones and behaviors promoting parents’ use of praise and other positive parenting techniques working with mothers to set goals for the future, continue their education, and find employment and child care solutions.

Published Findings on MCH Nurse Home Visitation Olds DL, et al. Long-term effects of home visitation on maternal life course and child abuse and neglect: fifteen-year follow-up of randomized trial. JAMA. 1997; 278(8):637- 643. This program of prenatal and early childhood home visitation by nurses can reduce the number of subsequent pregnancies, the use of welfare, child abuse and neglect, and criminal behavior on the part of low-income, unmarried mothers for up to 15 years after the birth of the first child. Olds DL, et al. Effects of Nurse Home-Visiting on Maternal Life Course and Child Development: Age 6 Follow-up Results of a Randomized Trial. Pediatrics. 2004; 114(6). This program of prenatal and infancy home-visiting by nurses continued to improve the lives of women and children at child age 6 years, 4 years after the program ended. Olds DL, et al. Effects of Nurse Home Visiting on Maternal and Child Functioning: Age-9 Follow-up of Randomized Trial. Pediatrics. 2007; 120(4). By child age 9, the program reduced women's rates of subsequent births, increased the intervals between the births of first and second children, increased the stability of their relationships with partners, facilitated children's academic adjustment to elementary school, and seems to have reduced childhood mortality from preventable causes.

Best Beginnings Program at CNCHD Best Beginnings is a free, voluntary home visiting program for mothers/families that provides visits by a Registered Nurse during pregnancy and throughout the first three years of the child’s life. A Registered Nurse can assess and answer questions related to pregnancy, delivery, postpartum, newborn care and breastfeeding. Best Beginnings improves birth outcomes, reduces rates of child abuse, strengthens families, enhances child health and development outcomes, and promotes family stability.

Welcome Home at CNCHD The Welcome Home Program supports all new mothers with home and/or phone visits.  Registered Nurses are available to assess and answer questions related to postpartum, newborn care and breastfeeding.  Referrals to community resources are made as needed, and a gift is provided for the newborn. Our services are free of charge.

Nurse Family Partnership(NFP) at CNCHD NFP is a voluntary program for first time moms that provide home visits by a Registured Nurse during pregnancy and throughout the first two years of their child’s life. The three main goals are to: Improve pregnancy outcomes Improve child health and development Improve the family’s economic self-sufficiency Some of the benefits noted in this evidence-based program are: 48% reduction in child abuse and neglect and a financial savings in areas such as health care delivery, child protection, education, criminal justice, mental health, welfare and public assistance. For more information on the NFP program please visit:  www.health.wyo.gov/familyhealth/mch/index.html and www.nursefa milypartnership.org.

Children’s Special Health (CSH) at CNCHD Children’s Special Health is a program for infants and children with special health care needs that require more than routine and basic care. CSH provides payment for specialty medical care and coordination of care for children with an approved condition and diagnosis. The Genetic and Endocrine Specialty Clinics are held at Casper-Natrona County Health Department. For more information please visit www.health.wyo.gov/familyhealth/csh/index.html.

Preparing for Parenthood Classes Free RN instructed classes on: Newborn Care Postpartum Care Infant Feeding The participants of the Preparing for Parenthood classes are then provided CPR training free of charge courtesy of the Public Health Emergency Preparedness team.

CNCHD Stats for 2017 2017 Visits at-a-glance Prenatal 271 pregnant women Post-natal 499 moms, >499 babies Children with special health needs 152 children and their families Prenatal Visits (include Best Beginnings and NFP programs) 271 pregnant women 58 of these included Medicaid Presumptive Eligibility visits Post natal Visits (total: 499 mom/baby pairs) Welcome Home Program: 354 mom/baby pairs NFP Program: 145 mom/baby pairs Children’s Special Health Program 110 visits (RN case management with family units) Additional 42 high risk maternal and newborn intensive care referrals Preparing for Parenthood Classes 4 quarterly classes held in 2017 33 total participants Breast Pump Program 27 hospital-grade breast pumps provided to breastfeeding moms in 2017 24 reimbursed by Medicaid or private insurance 3 pumps were donated to uninsured mothers who had no ability to pay

How do we measure success of this program? Improvement in maternal and newborn health Reduction in child injuries, abuse, and neglect Improved school readiness and achievement Reduction in crime or domestic violence Improved family economic self-sufficiency Improved coordination and referral for other community resources and support

Measures of success (statewide data) Among families who enrolled in home visitation programs in Wyoming, 88% of primary caregivers had an increase in household income in 12 months after enrolling in the program. Screened 100% of mothers who had been enrolled for at least 90 days for domestic violence during the first three months (Source: HRSA Home Visiting Program, Wyoming State Fact Sheet: https://mchb.hrsa.gov/sites/default/files/mchb/MaternalChildHealthI nitiatives/HomeVisiting/pdf/wy.pdf)

The Need for Maternal and Child Health Services in Natrona County Maternal Smoking Trends in Cesarean Deliveries Maternal Education Level Maternal Weight Gain Teen births Preterm births

Primary Cesearean Deliveries

WIC Enrollment

Women who report smoking in 3mo prior to pregnancy but quit before pregnancy

Women who report smoking in 3mo prior to pregnancy who quit smoking during pregnancy

Percent of Women Who Report Smoking During Pregnancy

Women who receive “Early” Prenatal Care (i.e. first trimester care)

Maternal Education

Pre-Pregnancy BMI – Maternal Obesity

Partner Violence: Partner Blamed You for Violence

Partner Violence: Partner Didn’t Want Pregnancy

Partner Violence: Partner Forced Sex

Partner Violence: Partner Puts You Down

Partner Violence: Partner Threatens Violence

Partner Violence: Partner Throws, Pushes, Hits, or Chokes

Maternal Stressor: Partner and I Argued More in Past 12mo

Maternal Stressor: Couldn’t Pay Bill

Maternal Stressor: Homelessness

Maternal Stressor: Recently Lost Job

Maternal Stressor: Moved to a New Address

Maternal Stressor: Partner Lost Job

Maternal Stressor: Partner Went to Jail

Maternal Stressor: Had a Physical Fight

Maternal Stressor: Separated from Partner

Maternal Stressor: Had Sick Family Member

Maternal Stressor: Someone Close Used Drugs

Food Insecurity

Food Insecurity

Current Alcohol or Tobacco Use