Maternal  Engagement  in    The  MOM  Program:      Work  in  Progress  

Jerilynn  Radcliffe,  PhD  May  15,  2014  

 Center  for  Prenatal  and  Perinatal  Health  DispariGes  

The  Children’s  Hospital  of  Philadelphia  

PotenGal  Conflicts  of  Interest  

•  I  have  received  grant  support  from  The  William  Penn  FoundaGon,  the  Robert  Wood  Johnson  FoundaGon,  an  anonymous  donor  to  CHOP,  and  the  Pew  Center  for  the  States  for  this  research.  

•  I  receive  other  research  funding  from  the  NaGonal  InsGtute  of  Health,  Columbia  University,  and  the  Society  of  Pediatric  Psychology.  

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Home  VisiGng  Programs  

•  Promote  healthy  outcomes  for  mothers  and  children  – Mothers:    employment,  fewer  subsequent  pregnancies,  family  income  

– Children:    behavior  and  developmental  outcomes  

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The  MOM  Program  

•  DemonstraGon  home  visiGng  program  •  Mothers  were  randomized  to  receive  either  home  visits  or  no  home  visits    

•  Overall  program  goal:    mothers  keep  appointments  for  well  child  care  and,  if  needed,  enroll  children  in  early  intervenGon  

 

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More  about  The  MOM  Program  

•  Program  staff  included  2  nurse  pracGGoners  and  2  community  workers,  who  worked  as  a  team  

•  Mothers  were  visited  by  a  member  of  the  team,  but  not  always  the  same  person  

•  Weekly  group  supervision  allowed  for  problem-­‐solving  around  hard-­‐to-­‐reach  mothers  

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MOM  Program  Mothers  

•  Average  age,  23.3  years  •  95.2%  African  American  •  On  average,  had  one  other  child  when  enrolled  in  program  

•  Completed  12  years  of  educaGon  •  55%  had  female  children  •  All  lived  in  ZIP  Code  regions  of  Philadelphia  with  high  rates  of  poverty  

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Geographic  DistribuGon  of  MOM  Mothers  

7  Poverty  in  Philadelphia  

Residences  of  MOM  Mothers  at  Program’s  End  

Results  from  The  MOM  Program  RCT  

•  Home-­‐visited  children  were  significantly  more  likely    – To  be  referred  for  early  intervenGon  services  – To  receive  early  intervenGon  services  – To  aaend  Head  Start  

•  There  were  no  group  differences  in  – Number  or  Gming  of  immunizaGons  – Number  of  subsequent  pregnancies  – Child  cogniGon  

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What  Makes  a  Program  EffecGve?  

•  RetenGon:    staying  in  the  program  from  start  to  finish  – Typically,  around  50%  are  retained  in  home  visiGng  programs  

•  Engagement:    receiving  the  recommended  “dose”  of  the  intervenGon  – Keeping  at  least  75%  of  planned  visits,  based  on  other  studies  of  home-­‐based  intervenGons  for  mothers  and  children  

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MOM  Program  Results  

•  RetenGon:    89%  of  all  mothers  in  The  MOM  Program  completed  the  three-­‐year  program;  84%  of  all  mothers  completed  the  five-­‐year  program  

•  Engagement:    86%  of  all  mothers  in  the  intervenGon  arm  of  the  program  (130  of  152)  completed  at  least  7  of  9  the  planned  home  visits  

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Other  Program  Results  

•  Engagement:    Mothers  who  were  “engaged”  were  slightly  older  (23  versus  21  yrs  old)  and  more  likely  to  have  male  children  than  those  who  were  “not  engaged”  

•  Appointment  keeping:    Mothers  who  had  completed  a  home  visit  were  more  than  10  Gmes  as  likely  to  keep  a  well  child  visit.  

 

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LimitaGons  

•  Mothers’    and  staff  input  were  not  included  in  evaluaGng  engagement    

Next  Steps  

•  Replicate  The  MOM  Program  to  see  if  posiGve  results  from  this  model  “hold”  – Currently  in  process  in  North  Philadelphia  

•  Examine  the  development  of  engagement  in  parGcipant  mothers  throughout  their  involvement  with  the  program  

•  Study  staff  perspecGves  on  the  process  of  engaging  mothers  in  home  visiGng  

QualitaGve  Study  Methods  •  Maternal  engagement  evaluated  via  a  minimum  of  2  individual  interviews  conducted  with  up  to  15  mothers  throughout  their  two-­‐year  MOM  Program  

•  Also  evaluated  home  visitor  experiences  of  engaging  mothers  via  focus  groups.  

•  Interviews/focus  groups  audio  recorded  and  professionally  transcribed,  analyzed  using  nVivo  sonware.  

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Preliminary  Results:    Mothers  

•  All  mothers  African  American  (mean  age  26.6  years)  with  poverty-­‐level  incomes,  enrolled  in  MOM  Program  at  Gme  of  child’s  birth.  

•  Reasons  for  enrollment  –  “to  be  the  best  mother  I  can  be”  –  “find  resources  for  my  child”  –  “do  things  beaer  than  with  my  older  children”  

•  Mothers  found  the  home  visits  helpful,  but  wanted  more  frequent  visits  and  more  material  goods  provided.  

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Preliminary  Results:    Home  Visitors  

•  Home  visitors’  mean  age  48.7  years,  50%  African  American,  30%  LaGna,  20%  Caucasian.  

•  Reported  barriers  to  maternal  parGcipaGon  – CompeGng  work  and  school  demands  – UnsupporGve  family  members  –  Inconsistent  telephone  service  

•  Reasons  for  mothers’  program  involvement  – Wish  to  receive  goods  instead  of  potenGal  benefit  of  being  more  able  to  advocate  for  their  infants  

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Conclusions  (so  far)  

•  Observed  discordance  in  maternal  and  home  visitor  percepGons  of  engagement  in  home  visiGng  points  to  need  to  establish  consensus  on  program  expectaGons  at  Gme  of  enrollment  and  throughout  the  program.  

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ImplicaGons  for  Policy  and  PracGce  •  Mothers  of  all  ages  living  in  poverty  benefit  from  home  

visiGng  programs,  even  those  who  are  not  young  or  first-­‐Gme  mothers  

With  refinements  that  we  derive  from  our  qualita5ve  research,  home  visi5ng  programs  will  be  more  sustainably  effec5ve  in  improving  health  outcomes  for  vulnerable  mothers  and  children.  

Collaborators  

•  Donald  Schwarz,  MD,  MPH,  Deputy  Mayor  for  Health  and  Economic  Opportunity,  City  of  Philadelphia  

•  Linda  Hock-­‐Long,  PhD,  Director  of  Research,  Family  Planning  Council,  Philadelphia  

•  Staff  of  The  MOM  Program,  Health  Center  #5,  Philadelphia  

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Acknowledging  those  who  have  supported  our  work….  

•  The  William  Penn  FoundaGon  •  The  Pew  Center  on  the  States  

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References    •  Radcliffe,  J.,  Schwartz,  D.,  &  Zhao,  H.    (2013).    The  MOM  Program:    Home  visiGng  in  

partnership  with  pediatric  care.    Pediatrics  (132);  S153-­‐159.      

•  Radcliffe,  J.,  &  Schwarz,  D.F.    (2012).    Maternal  engagement  in  home  visiGng:    The  MOM  Program.    Zero  to  Three,  in  press.      

•  Schwarz,  D.F.,  O’Sullivan,  A.L.,  Guinn,  J.,  Mautone,  J.A.,  Carlson,  E.C.,  Zhao,  H.,  Zhang,  X.,  Esposito,  T.L.,  Askew,  M.,  &  Radcliffe,  J.  (2012).    PromoGng  early  intervenGon  through  a  randomized  controlled  home  visiGng  program.    Journal  of  Early  Interven5on,  34(1),  20-­‐39.  DOI  10.1177/1053815112451849    

 •  Schwarz,  D.F.,  Radcliffe,  &  O’Sullivan,  A.    (2009).    The  MOM  Program:  A  cost-­‐

effecGve  randomized  controlled  intervenGon  to  address  the  developmental  needs  of  children  living  in  poverty.    Annals  of  Behavioral  Medicine,  37,  2009  Supplement,  s59.      

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