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Milwaukee-area mom Ajah Lott knows how important it is to get to her prenatal appointments as she nears the September due date for her twins' arrival. But as a busy mom of six who also lacks child care, it would have been extremely difficult for her to get to those appointments were it not for the free child care that her doctor's office provides.

Since 2020, Ascension SE Wisconsin Hospital — St. Joseph Campus in Milwaukee has been providing child care in its Women's Outpatient Center at no cost, so that while patients are at their medical appointments their children have a safe place to stay. Students from a local nursing school staff the children's waiting area. The area recently got a facelift thanks to a partnership between St. Joseph and the city of Milwaukee.

Lott says the child care "has been a real lifesaver for me, and I'm so grateful this is available here at St. Joe's."

"It's helped me so much," she says.

Care barrier
Nicole Lorino is a nurse manager for the women's and infants' services unit at St. Joseph. She says the Children's Waiting Area has its origins in Ascension's Maternal Health Social System Initiative. Her unit launched its iteration of the initiative in 2019. Through the initiative, social workers canvassed patients and the broader community to learn about the top community needs and some of the barriers to care. Lorino says the initiative was a "labor of love" for her department, because she and her colleagues were eager to understand how they could address socioeconomic barriers patients were facing.

The canvassing revealed that top barriers to care included transportation, food insecurity, housing insecurity and child care. The department established a new system in which social workers join with clinical team members to help patients address the barriers. The social workers also deepened their partnerships in the community, which included establishing better connections with ride-sharing services, food pantries and housing providers.

To address the child care concerns, the Women's Outpatient Center partnered with the nursing school at Carroll University in Waukesha, Wisconsin, to have students babysit patients' kids in the Children's Waiting Area during medical appointments. The time the nursing students spend in the Children's Waiting Area counts toward clinical rotation hours. In recent years, St. Joseph has added partner schools beyond Carroll and expanded the program to allow college students to volunteer without those hours counting toward a requirement.

Patients going to medical appointments anywhere on campus can use the child care service. Any of their children aged 17 and under are eligible.

PopSpots
The Children's Waiting Area recently benefitted from a new partnership between St. Joseph and Milwaukee's Office of Early Childhood Initiatives. The hospital and the city renovated the Children's Waiting Area, with a downstream goal of addressing Milwaukee's elevated infant mortality rate through better care access for moms.

The waiting area upgrade also was part of an initiative of that city office to create spaces throughout Milwaukee called "PopSpots," where children can engage in intellectually stimulating activities and physical activity.

The renovation used a color scheme common to all PopSpots and added child-friendly furniture as well as books, toys, games and learning tools so that kids can engage in fun activities while in the waiting area. Beyond the hospital, the city has created PopSpots in community health centers and at bus shelters.

Healthier moms and babies
Lorino estimates that since the Children's Waiting Area became available, more than 500 kids have been cared for there, freeing up their parents or guardians for more than 350 appointments.

Lorino says research shows that when mothers attend their prenatal visits, their babies are less likely to require neonatal intensive care. She says metrics her department keeps have shown that providing free child care, as well as offering other interventions to address other care barriers through the Maternal Health Social Systems Initiative, is contributing to improved health outcomes for St. Joseph's patients and their babies. This includes decreased need for the NICU. Lorina notes that her department has created a toolkit on how to launch a child care service, in part so that other Ascension facilities could replicate the idea.

It is not just the patients who benefit, says Lorino. So do the nursing students who staff the waiting area. They get to interact with patients and their kids outside the clinical setting and to learn more about their lives. They witness how social determinants can have an impact on care.

Molly Meihak is a student at Milwaukee's Wisconsin Lutheran College who has been staffing the Children's Waiting Area on a volunteer basis on Wednesdays, playing with toys and games with the kids. She learned of the opportunity through her adviser at school after she'd expressed interest in learning about the social determinants of health and how they affect maternal health.

Meihak says this volunteerism "is really meaningful to me because I know their mom is able to focus on herself during her appointment, which is important."

She adds, "Many people in our society face a variety of barriers to get the care they need to stay healthy. Making sure these moms can get to their necessary medical appointments without worrying about child care is a great way to remove at least that barrier."

Happy kids
Lorino, the nurse manager, says it's been heartening to see the kids happily playing with the nurses. "The kids say that the nurses are so cool," she says. "One little girl said she now wants to be a nurse someday."

Patients must sign up in advance to make use of the waiting area.

Lorino finds it rewarding to see the look of relief on moms' faces as they drop off their kids and know that they are safe. "It eases their burden," says Lorino.

Patient Lott says that before the child care area became available, she had tried to take her kids into her medical appointments with her when she couldn't get child care. "But it's almost impossible to focus on you and what the doctor is saying while trying to watch your little kids, too." She adds, "If it wasn't for this service, I don't know how I'd make it to my appointments."

Crystal Ford of Milwaukee gave birth to her sixth child on May 10. She says she always uses the child care service for her children when she has appointments. "My kids are high energy and having someone watch them while I'm in my appointment helps so much," she says.

She notes that it can be very stressful trying to find child care. At St. Joseph, her kids enjoy spending time with the nurses and playing in the Children's Waiting Area.

"It's really nice here," Ford says.