Moving Toward Evidence-Based Federal Healthy Start Program Evaluations: Accounting for Bias in Birth Outcomes Studies

Meghea, Cristian; Raffo, Jennifer E.; VanderMeulen, Peggy; Roman, Lee Anne

doi:10.2105/ajph.2013.301276

Cited by 11 publications

(7 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A prior study determined that women who enroll in Strong Beginnings, when compared to other Medicaid-insured African American women in the county are more likely to be unmarried, living at a lower poverty level, and have a depression diagnosis or illicit drug use. When compared to women who enroll in EPC programs, Strong Beginnings participants are more likely to have a prior adverse birth outcomes, a history of mental health problems, depressive symptoms, or other behavioral health problems (Meghea et al 2014).…”

Section: Methodsmentioning

confidence: 99%

“…Although our results are consistent with other studies, our sample size was small. The population was recruited from a local HS program whose participants were significantly more likely to have higher percentage of medical and psychosocial risk factors than other Medicaid-insured African American women in the county or in other EPC programs (Meghea et al 2014). Therefore, our findings are applicable to women at high medical/psychosocial risk who participate in a HS or EPC type program and cannot be applied to all African American, Medicaid-insured women.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Understanding Perspectives of African American Medicaid-Insured Women on the Process of Perinatal Care: An Opportunity for Systems Improvement

Roman

Raffo

Dertz

et al. 2017

Matern Child Health J

Self Cite

171

View full text Add to dashboard Cite

Objectives To address disparities in adverse birth outcomes, communities are challenged to improve the quality of health services and foster systems integration. The purpose of this study was to explore the perspectives of Medicaid-insured women about their experiences of perinatal care (PNC) across a continuum of clinical and community-based services. Methods Three focus groups (N = 21) were conducted and thematic analysis methods were used to identify basic and global themes about experiences of care. Women were recruited through a local Federal Healthy Start (HS) program in Michigan that targets services to African American women. Results Four basic themes were identified: (1) Pursuit of PNC; (2) Experiences of traditional PNC; (3) Enhanced prenatal and postnatal care; and (4) Women's health: A missed opportunity. Two global themes were also identified: (1) Communication with providers, and (2) Perceived socio-economic and racial bias. Many women experienced difficulties engaging in early care, getting more help, and understanding and communicating with their providers, with some reporting socio-economic and racial bias in care. Delays in PNC limited early access to HS and enhanced prenatal care (EPC) programs with little evidence of supportive transitions to primary care. Notably, women's narratives revealed few connections among clinical and community-based services. Conclusions The process of participating in PNC and community-based programs is challenging for women, especially for those with multiple health problems and living in difficult life circumstances. PNC, HS and other EPC programs could partner to streamline processes, improve the content and process of care, and enhance engagement in services.

show abstract

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

Understanding Perspectives of African American Medicaid-Insured Women on the Process of Perinatal Care: An Opportunity for Systems Improvement

Roman

Raffo

Dertz

et al. 2017

Matern Child Health J

Self Cite

171

View full text Add to dashboard Cite

show abstract

“…27,64 These factors allowed us to balance measured differences between HBPB recipients and nonrecipients and ensure that those among our population of very-low-income women who received HBPB were comparable to those who did not, based on these observed characteristics. Although we could not directly test whether the propensity score controlled for all unmeasured confounding, our analysis allowed us to assess the sensitivity of our findings.…”

Section: Discussionmentioning

confidence: 99%

Unconditional Prenatal Income Supplement and Birth Outcomes

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Thus, Strong Beginnings enhanced the MIHP model by adding the unique skills of a CHW to facilitate access to services, improve the quality and cultural competence of service delivery (American Public Health Association Community Health Workers Section 2009) and address social determinants of health for African American pregnant women and infants enrolled in the program. Many African American women enrolled in the program were found to have higher psychosocial and medical risks than other Medicaid-eligible pregnant women and infants (Meghea et al 2013a).…”

Section: Introductionmentioning

confidence: 99%

Defining the Role of the Community Health Worker within a Federal Healthy Start Care Coordination Team

Raffo

Lloyd

Collier

et al. 2017

Matern Child Health J

Self Cite

View full text Add to dashboard Cite

Introduction Federal and state policies often require utilization of evidence-based home visiting programs. Measurement of specified interventions is important for tracking program implementation and achieving program outcomes. Thus, the Strong Beginnings program worked to define community health worker (CHW) interventions, a core service of the program to improve maternal and child health. Methods A workgroup consisting of CHWs, supervisors and other program staff was created in order to develop and define specific CHW interventions within a nurse or social worker care team. Basic interventions were first compared to the nurse or social worker care coordinator home visiting interventions by risk topic. The evaluator then grouped each CHW intervention into categories per risk domain using thematic analysis and assigned a CHW core function or role based on literature review findings. The workgroup confirmed the results. The workgroup then continued discussions to further enhance CHW interventions per risk domain once the general structure was created. Results The workgroup identified seven core functions and 28 maternal and child health risk topics to be addressed by the CHW. The process resulted in a detailed document of program interventions that the CHWs use to guide care. Conclusions The process helped CHWs feel more valued with their role in team care. The specified interventions will help others understand the CHW role within the care team, ensure consistent interventions are delivered across program partners, provide a foundation to better understand how specific CHW contributions are related to health outcomes, and support program sustainability.

show abstract

Moving Toward Evidence-Based Federal Healthy Start Program Evaluations: Accounting for Bias in Birth Outcomes Studies

Cited by 11 publications

References 10 publications

Understanding Perspectives of African American Medicaid-Insured Women on the Process of Perinatal Care: An Opportunity for Systems Improvement

Understanding Perspectives of African American Medicaid-Insured Women on the Process of Perinatal Care: An Opportunity for Systems Improvement

Unconditional Prenatal Income Supplement and Birth Outcomes

Defining the Role of the Community Health Worker within a Federal Healthy Start Care Coordination Team

Contact Info

Product

Resources

About