Community Health Workers Get it Done in Philadelphia?: Examining Prenatal Care Behaviors and Psychosocial Outcomes for Mothers Enrolled in a Home Visiting Program

Over the past several years research examining the impact of paraprofessional home visitation programs on maternal and child health outcomes has been mixed. Much of the literature has focused on the impact of nurse case management, while studies that have focused on delivery of services by lay community health workers (CHW) have been more limited. Many community-based organizations (CBO) train CHWs to serve at-risk and low-income pregnant women by providing social and health services. Some studies of CHW impact have shown an increase in self-esteem, self-sufficiency, empowerment, communication skills and decision making of mothers. However, more research is needed to examine the types of support as well as the impact of CHWs on psychosocial and health outcomes. For this study, data were extracted for women enrolled in the home-visiting program administered by a CBO in Philadelphia between July 2007-December 2008. Preliminary analyses indicate most clients have health insurance (89%), receive food stamps, WIC and/or TANF/cash assistance (28%, 27%, 30%, respectively), have a medical home (95%) and access prenatal care services (98%). During this timeframe, CHWs made over 3500 contacts and spent on average 90 minutes per contact with each client. Interestingly, a larger percentage of mothers enrolled in the program planned to breastfeed than exclusively formula feed (59% vs. 39%). With many cities across the country experiencing severe budget cuts in services for low-income women, CBOs are experiencing an increase in demand for services and well-trained CHWs may be able to continue to support positive prenatal care behaviors by women.