Community Health Workers Enhance Home Visiting Engagement of High-Risk Birthing Individuals in Segregated Neighborhoods

Posted on April 12, 2024 by Xiao Yu

This entry is part 2 of 10 in the series May 2024

Teaming up race, ethnicity, and/or language-concordant community health workers with licensed providers offers a promising strategy to enhance home visiting engagement of high-risk birthing individuals in disadvantaged communities.

Persistent racial and ethnic disparities in maternal and infant health emerge as a public health crisis in the United States. Among various strategies to improve perinatal health, enhanced prenatal care home visiting (HV) programs provide additional services to low-income birthing individuals at heightened risks of adverse outcomes. Despite of these benefits, most eligible individuals do not engage, especially racial and ethnic minority individuals. Neighborhood segregation, a manifestation of structural racism, may impose constraints on engaging eligible birthing individuals in HV. The benefits of HV cannot accrue unless high-risk birthing individuals enroll and stay engaged in services. In our “Community Health Workers: Improving Home Visiting Engagement of High-Risk Birthing People in Segregated Neighborhoods,” we examine whether race, ethnicity, and/or language-concordant community health workers (CHWs) increased HV engagement for birthing individuals in segregated neighborhoods, compared to the traditional, state Medicaid-sponsored HV program without CHW involvement.

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Addressing this question will help policymakers evaluate whether CHW-involved HV programs can help alleviate the constraints of neighborhood segregation on HV engagement, and whether such programs can effectively address fundamental causes of racial inequities related to structural racism.

In Kent County of Michigan, Strong Beginnings (SB) is an intensive HV program designed for Black and Hispanic families considered at high medical and social risks. Services are provided by CHWs partnering with nurses and social workers in the traditional, state Medicaid-sponsored HV program – Maternal Infant Health Program (MIHP). SB enhanced the MIHP by adding the unique skills of race, ethnicity, and/or language-concordant CHWs, who are well-positioned to engage birthing people of color, improve the quality and cultural competence of service delivery, and address social determinants of health. In SB, CHWs provide up to biweekly services based on an individual’s needs and preferences. These services include peer support, team-based care coordination, resource navigation, and delivery of standardized health interventions that are aligned with nurse and social worker care. A rigorous evaluation of the SB program found that SB was associated with reduced risk for adverse birth outcomes, improved prenatal and postnatal care, and reductions in racial disparities compared with usual care. The development and implementation of SB was supported by a federal Healthy Start award, the W.K. Kellogg Foundation, and recently, through a Michigan Department of Health and Human Services (MDHHS) Pay for Success Initiative.

What We Found

The CHW-teamed HV program reached more birthing individuals in segregated neighborhoods than the traditional HV program without CHW involvement (58.4% vs. 48.3%).
Participants in the CHW-teamed HV program received an average of 11.9 home visits, significantly higher than the average of 4.4 visits received by participants in the traditional HV program.
More importantly, CHWs did not replace but moderately increased home visits from nurses and social workers, especially in more segregated neighborhoods. For example, over half (51.1%) participants in the CHW-teamed HV program received at least 5 intervention visits provided by nurses and social workers, compared to about one-third (35.2%) participants in the traditional HV program.

Our study underscores the value of CHWs partnering with licensed providers in improving HV engagement in disadvantaged communities. Community-informed HV models intentionally designed for people facing disparities, such as the integration of race, ethnicity, and/or language-concordant CHWs, may provide a promising approach to reducing racial and ethnic disparities in perinatal health.

Acknowledgements

I would like to express my appreciation to all of the co-authors from Michigan State University and our community partners from Strong Beginnings, who developed and implemented the intervention and contributed to this manuscript: Cris I. Meghea, PhD; Jennifer E. Raffo, MA; Meng Ran, MS; Peggy Vander Meulen, MSN; Celeste Sanchez Lloyd, MA; and Lee Anne Roman, PhD, MSN.

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Author Profile

Xiao Yu: Xiao Yu, PhD, is an Assistant Professor in the Department of Obstetrics, Gynecology, and Reproductive Biology at Michigan State University. Dr. Yu’s work centers on structural racism and maternal health equity. She seeks to understand how community-engaged interventions can mitigate the impact of structural racism on perinatal health and health disparities.