1. Overview of Maternal and Child Health Program

2. 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)

3. 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.

4. 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):
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 ; 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 ; 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.

5. 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.

6. 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.

7. 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:   milypartnership.org.

8. 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 

9. 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.

10. 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

11. 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

12. 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: nitiatives/HomeVisiting/pdf/wy.pdf)

13. 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

14. Primary Cesearean Deliveries

15. WIC Enrollment

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

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

18. Percent of Women Who Report Smoking During Pregnancy

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

20. Maternal Education

21. Pre-Pregnancy BMI – Maternal Obesity

22. Partner Violence: Partner Blamed You for Violence

23. Partner Violence: Partner Didn’t Want Pregnancy

24. Partner Violence: Partner Forced Sex

25. Partner Violence: Partner Puts You Down

26. Partner Violence: Partner Threatens Violence

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

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

29. Maternal Stressor: Couldn’t Pay Bill

30. Maternal Stressor: Homelessness

31. Maternal Stressor: Recently Lost Job

32. Maternal Stressor: Moved to a New Address

33. Maternal Stressor: Partner Lost Job

34. Maternal Stressor: Partner Went to Jail

35. Maternal Stressor: Had a Physical Fight

36. Maternal Stressor: Separated from Partner

37. Maternal Stressor: Had Sick Family Member

38. Maternal Stressor: Someone Close Used Drugs

39. Food Insecurity

40. Food Insecurity

41. Current Alcohol or Tobacco Use