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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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