Addressing Mental Health and Stress in Medicaid-Insured Pregnant Women Using a Nurse-Community Health Worker Home Visiting Team

Abstract

To describe the conceptual framework and program features of a nurse-community health worker (CHW) team home visiting intervention, the trial design to test the program, and the results of a comparative evaluation of prenatal program participation. In the context of a community-based, randomized trial, we compared participation in a nurse-CHW team intervention with the standard community care that included a state Medicaid program (enhanced prenatal services) with nurse home visiting. Medicaid-eligible pregnant women (n=530), who maintained their pregnancies, had a live birth, retained custody of the child, completed more than an enrollment assessment, did not move out of the county, and were not lost to follow-up. Provider reports of face-to-face prenatal contacts and demographic and psychosocial risk assessments obtained at study enrollment. Significant differences in the number of women with prenatal program contact and the total amount of contact were found, favoring the nurse-CHW team approach. More women with risk characteristics were reached in the nurse-CHW team group, with the exception of women with alcohol and drug use risks. A nurse-CHW team approach demonstrated advantage in reaching women who had barriers to participation and delivering more intensive services.