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Baltimore Healthy Start: A Community-At-Risk Strategy for Reducing Perinatal Disparities

By Alma Roberts
CEO, Baltimore Healthy Start, and President, National Healthy Start Association

Women and children participating in the Baby Buggy ParadeEvery day at Baltimore Healthy Start, Inc., we work against overwhelming odds to improve the health and well-being of pregnant and postpartum women, their babies and families. We provide comprehensive supportive services in the communities where they live - services designed to encourage life-long wellness. We conduct door-to-door outreach to enroll pregnant and postpartum women who reside in some of the most fragile communities of Baltimore. We use a collection of evidence-based tools to offer intensive case management to clients that includes home-visiting, medical care coordination, health education and emergency needs assistance - all designed to improve family functioning, parenting, infant well-being and self-sufficiency, and to reduce poor pregnancy outcomes and infant mortality.

In the course of our 21 years, Baltimore Healthy Start has provided services to more than 15,000 extremely vulnerable pregnant and postpartum women in Baltimore - and successfully improved pregnancy outcomes among our clients. Here's one example: the rate of very low birth weight (VLBW) babies (defined as under 1,500 grams - this is a significant risk factor of infant mortality since one in four very VLBW babies dies before the age of one). From 2007 to 2009, the VLBW rate in Baltimore city was three percent for African-American babies and one percent for white babies. But the VLBW rate for our Baltimore Healthy Start clients - the vast majority of whom are African American - was 0.8 percent. By virtue of our high rate of enrollment of pregnant women in our service areas, this success translates into overall improvements in pregnancy outcomes and infant health citywide. Further, we have developed innovative strategies that take advantage of our regular contact and the trust established between program staff and clients, to act as an effective liaison between the community and formal systems of care.

Healthy Start's longstanding strategy is built on the concept of a community at risk. This means that many of the factors influencing perinatal health and contributing to racial disparities in perinatal outcomes cluster geographically. We recognize that residents in the communities we serve are subject to stressors and other forces that are likely to manifest themselves in poor birth outcomes. So Healthy Start fully engages women and infants in case management services based on where they live - above and beyond individual risk factors. This strategy facilitates early detection and rapid response to emerging risk factors.

To recruit and enroll pregnant and postpartum women in Healthy Start, a team of recruitment specialists is deployed in each of the service area communities. These individuals are trusted members of the community who deliver health messages in a culturally relevant manner, serving as a key link between BHS and the community. A BHS Community Consortium also acts in concert with program staff and management in all aspects of the organization.

Although Baltimore Healthy Start was originally conceived as a social support and care coordination program, we have developed a history of responding to emerging clinical care needs among our clients. When important preventive care is not being accessed in a timely manner, Baltimore Healthy Start has assumed a direct diagnostic and health care delivery role in time-sensitive situations to prevent negative health outcomes for women and families and excessive costs to the health care system. Some examples include:

  • Responding to signs and symptoms of pre-term labor at regularly scheduled home visits with expedited urgent care follow-up at hospitals when indicated
  • Reducing further risk from perinatal infections through early detection, and outreach and treatment of male partners to prevent re-infection
  • Intervention by a home-based nurse practitioner that brings individualized family planning education and contraceptive dispensing to women in their own communities
  • Conducting expedited prenatal work-ups for newly pregnant women not yet enrolled in entitlement programs by our OB/GYNs.

There is no doubt that Healthy Start organizations in Baltimore and 104 other cities and towns across the country are critical to the effort to reduce infant mortality in low-income and minority communities. By engaging with moms-to-be and new mothers as active partners in their own perinatal care, we've been able to produce better outcomes and inspire other community-based organizations toward the same success.

10/5/2012 10:16:00 AM