By RENEE STOVSKY
Thanks to the success of a pilot program targeting maternal, prenatal and infant health at California Hospital Medical Center, approximately 14,800 more Los Angeles-area families soon will be eligible for services to ensure the best start possible for mothers and babies.
"Welcome Baby," an initiative of First 5 LA, addresses three main goals: that children maintain a healthy weight, that children are safe from abuse and neglect, and that children are ready for kindergarten. First 5 LA oversees the Los Angeles County allocation of funds from California's Proposition 10, which helps to pay for health care, education and child development programs for children up to age 5 and their families. All women in a designated area and/or hospital are eligible, regardless of income level or risk factors.
"Welcome Baby" client Dena Turnstall cradles her newborn Greenly Taylor. His toddler sister Taylor Evelyn Lopez is in the background. (Photo: MoNesha La Violette)
Prop 10, otherwise known as the California Children and Families Initiative, was voted into law in 1998. It adds a 50-cent per pack tax on cigarettes (and a comparable tax on other tobacco products) and generates $590 million annually to fund services that promote healthy lifestyles and school readiness.
Impressive outcomes
Welcome Baby, launched in 2009, has enrolled more than 4,000 maternity patients through Dignity Health's California Hospital in the last three years, according to Lili McGuinness, clinical supervisor for the program and a staff member for Maternal and Child Health Access. That non-profit agency conducts home visits as the subcontractor who is implementing and managing the program in partnership with California Hospital. With the help of nurses and "parent coaches," who are part of a multi-disciplinary team with backgrounds in health, nursing, child development and social work, Welcome Baby addresses prenatal testing, home safety, breast-feeding, nutrition, attachment, postpartum depression, infant assessments and growth and development milestones.
Outcomes have been so impressive that grants have been announced this year to begin Welcome Baby programs in the following Los Angeles County community hospitals:
- Northridge Hospital Medical Center, Northridge, a member of Dignity Health
- St. Mary Medical Center, Long Beach, a member of Dignity Health
- St. Francis Medical Center, Lynwood, a member of Daughters of Charity Health System
- Providence Little Company of Mary Medical Center San Pedro, a member of Providence Health & Services
- Providence Holy Cross Medical Center, Mission Hills, a member of Providence Health & Services
- White Memorial Medical Center, Los Angeles
- Citrus Valley Medical Center — Queen of the Valley Campus, West Covina
- Long Beach Memorial Medical Center, Long Beach
- Antelope Valley Partners for Health on behalf of Antelope Valley Hospital, Lancaster
At California Hospital, about 1,400 of the 4,000 mothers who delivered there last year participated in Welcome Baby, says McGuinness. "It's a universal program, but 98 percent of our families are low-income, high-risk clients. So, in addition to promoting overall health and wellness, we emphasize ensuring health care coverage and linking participants to other community resources for basic needs like food and housing."
High touch
Though the Welcome Baby program is offered to all patients who give birth at California Hospital, those mothers who come from "Best Start" communities designated by First 5 LA — poor areas with health disparities — are entitled to nine prenatal, postpartum and hospital visits, called "touches," with parent coaches, from pregnancy through the baby's first nine months. Other mothers receive four touches, a hospital visit and three postpartum home visits.
For Best Start participants, Welcome Baby begins with a first or second trimester home visit, where clients receive not only advice but also a tote bag with diapers. This is followed by a second touch consisting of a phone call check-in. During the third trimester, another home visit is made, and families receive a parenting DVD. Immediately after birth, there is a postpartum visit in the hospital. Three days after mother and baby are released from the hospital, a nurse visits the home, bringing along a pillow to help position a breast-feeding baby and a home medical kit. When the baby is 2 to 4 weeks old, another home visit occurs, and the family receives a new parent kit.
A seventh touch, which is another phone check-in, occurs when the baby is 2 months old. When the baby is 3 or 4 months old, parent coaches make another home visit, armed with home safety items and developmental toys. The final touch is scheduled when the baby is 9 months old, and includes a home visit, assessment and more developmental toys.
Tackling health disparities
As a result of the support the Welcome Baby program provides, says McGuinness, disparities in return to provider visits for preventive postpartum care are virtually eliminated. The pilot project showed that 87 percent of Best Start participants received timely postpartum care — at an even higher rate as private commercial insurance populations. Breast-feeding rates were also similar to those in greater Los Angeles County, despite lower socioeconomic status and a high number of Latina and African-American patients, many of whom traditionally resist the practice because of cultural issues or work-related problems.
Healthy families
"I've been in love with the Welcome Baby program since the very first time I heard about it," says Joyce Elliott, a nurse and director of women's services at St. Mary Medical, which received an initial $425,000 grant in March to begin implementing the program.
"It meets new mothers at their own levels; we can then help them set goals and achieve them together," Elliott explains. "If we can support families with newborns through the first nine months, life usually starts to normalize at that point. And if there are special needs, by then we will be able to connect clients to other community-based resources."
Elliott's enthusiasm is shared by Lillian Lew, director of Families in Good Health at St. Mary.
"We are in a unique position to take advantage of this program," she says. "While California Hospital partnered with a nonprofit community organization, Maternal and Child Health Access, to develop its program, we already have the capacity to do home visits as subcontractors."
That's because, she says, St. Mary started offering home visits for pregnant women in 1987 as part of a health project for Southeast Asians.
"At the time, our Long Beach community included large numbers of Cambodian refugees. Many times women would arrive at the emergency room to give birth without any prenatal care whatsoever. So we began a comprehensive bilingual, bicultural program through our own obstetrics department," she says. "Now we also have a significant Latino population, and we are a hot spot for teen pregnancies. Welcome Baby will give us the ability to provide even more outreach."
It takes a team
Once trained in First 5 LA's protocol, St. Mary is planning to staff two Welcome Baby teams, each consisting of a nurse, parent coach supervisor and three parent coaches, to help address the needs of at least 1,200 of the approximately 2,000 mothers who give birth at the hospital each year.
Lew said that the St. Mary Welcome Baby home visits would start this month. She estimates the Welcome Baby grant for fiscal 2014 will total about $1.58 million. "We are anticipating huge changes in how we can support mothers who often have language barriers and no education or experience in baby care."
Maternal well-being
Nancy Tsuyuki, manager of community health at Providence Little Company of Mary Medical Center San Pedro, also is looking forward to Welcome Baby to bolster her hospital's home visit program. The facility received an initial $450,000 grant from First 5 LA and plans to assemble one professional parent coach team to help serve the 700 mothers who deliver there annually.
"About 180 of our deliveries per year are from the Wilmington area, which is a Best Start community. It is extremely poor — about 98 percent of the children there qualify for the free or reduced price lunch program — and it has a huge immigrant population," she says. "Many of the new mothers-to-be have no more than a third or fourth grade education and need lots of assistance with pregnancy issues and parenting skills."
Based on Providence Little Company of Mary's experience with another First 5 LA program called "Baby Friendly," which emphasizes breast-feeding, Tsuyuki has high hopes for Welcome Baby.
"We know that the increase in breast-feeding rates in our community will help reduce rates of breast and ovarian cancer and diabetes in moms and reduce rates of obesity, ear infections and respiratory problems in children," she says. "Since many of our new moms never see a doctor again after delivery, being able to provide postpartum visits can only be beneficial for maternal and baby well-being as well."
Building healthy communities
At St. Francis Medical Center, Welcome Baby project director Celeste Goff is busy searching for a community partner to help implement the program after receiving an initial grant of $429,000 from First 5 LA.
"With a birthrate of 5,100 a year, our target is to put three parent coach teams together to serve 2,000 moms," she says. "Eventually we hope to reach 80 percent of our families through the home visit program."
That, of course, will take a lot of time, intense training and monetary support. The hospital anticipates adding 20 full-time positions for the home visitation staff and eight full-time, plus one part-time hospital positions for liaison, outreach and administration.
For fiscal 2014, St. Francis received between $2.2 million for its Welcome Baby program. Both Goff and Bryan Grassman, director of foundation relations, believe the program is extremely worthwhile, especially because it speaks to the mission of the hospital.
"We strive to serve those who are sick and living in poverty," says Goff. "So many of our families are struggling, and pregnancy means another person on the way who will need care. This (program) can help ensure that parents are equipped with all the tools available to make having a baby a good experience that will lead to a lifetime relationship of learning and emotional and spiritual growth."
Adds Grassman, "Because of health disparities, we tend to have worse outcomes in our area when it comes to factors like hypertension, obesity and diabetes. This program is about wellness and building healthier communities. By providing prevention early on, we may be able to remove obstacles families will face later in life."