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Promising Practices

Engaging Fathers

Description: Fathers and men have long been either ignored or an add-on to maternal and infant health (MIH) programs, yet the importance of engaging them in MIH work has been increasingly noted in the past few decades.  Research findings indicate that fathers’ engagement in their children’s lives is important for fetal growth, infant and childhood development, health and social well-being. In this report we present a summary of the evidence for the role or impact of fathers across the reproductive life span: before and in-between pregnancies, during pregnancy and after delivery (pre-/inter-conception, prenatal and postnatal).

Report: Rationale and Strategies for Engaging Fathers in Maternal and Infant Health Programs

Intimate Partner Violence

Description: Pregnant women face many issues that must be overcome in the hopes that they will have a successful pregnancy and transition to motherhood. The social determinants of health model, published by the World Health Organization suggests that environment matters for all people’s health. For pregnant women, the environmental variables that impact a successful pregnancy include: safe housing and relationships, adequate food, quality perinatal care, and good maternal health. When working with women in lower socioeconomic status, it is often difficult to strategize which variable to prioritize when there are competing priorities. This report focuses on one important issue facing pregnant women: safety within their intimate partner relationships.

Report: Intimate Partner Violence: How CHWs Can Help Pregnant Women

Outreach Strategies

Description: Maternal and Infant Health (MIH) programs are essential for improving health outcomes and reducing socio-economic disparities. To this end, it is vital that underserved women and families have access to such programs. Given their presence in the priority communities, community health workers (CHWs) and home visitors (HVs) are in a unique position to connect with women in need of services. CHWs and HVs are often seen as trustworthy and knowledgeable people within their community and have access to women and families that would benefit from enrolling in MIH programs. As such, the role of the CHW and HV cannot be underestimated in outreach and recruitment into MIH programs. Resources, specifically time and money, are limited and therefore there is a need to identify effective outreach strategies. Examining the role of CHWs and HVs in conducting outreach reveals a broad scope of information which is best presented using the Social Marketing Theory, adapted to a framework for identifying and enrolling participants.

Report: Outreach Strategies for Identifying and Enrolling Women into Maternal and Infant Health Programs

Preconception & Interconception Care

Description: Preconception and Interconception are intersecting areas that span almost the entire lifespan of women. Preconception (PC) health generally refers to women’s pre-pregnancy health status.1 The goal of PC care is to identify and address physical and mental health issues, and social risk factors to women’s health and pregnancy outcomes by providing prevention and management interventions.2, 3  Similarly, Interconception (IC) health is women’s health status between pregnancies. It is important to note that the distinction between early postpartum and early interconception is not always clear, however IC generally includes the postpartum stage. 1, 4 The goal of IC care is similar to that of PC care with the addition of pregnancy spacing.2, 5

HV’s work with women within communities can be an important way for ensuring that women obtain the additional information, support and guidance for PC and IC care.  This report aims to highlight the importance of IC and PC care for communities with high needs, provides an overview of recommendations for the potential role of HV in PC and IC care, and presents evidence of the integration of HVs (from studies, reviews, recommendations, and guidelines) into the delivery of PC and IC care.

Report: Preconception and Interconception Care: The Role of the Home Visitor

Substance Use in Pregnancy

Description: The purpose of this report is to summarize the current body of information and evidence regarding drug addiction during pregnancy.  This report begins with a description of what addiction is and how it occurs.  This is followed by a synopsis of what many of the more commonly abused categories of drugs are, and some basics about how these drugs cause their effects.  Next, an overview of the rates at which the different categories of drugs are abused in the United States and among pregnant women (when such data is available), and the effects these drugs have on a developing fetus/infant and on the mother.  Finally, the report concludes with an introduction to the clinical philosophy of “Screening, Brief Intervention, and Referral to Treatment” (SBIRT), how to recognize addiction or drug use problems, and how to access local resources to provide help.

Report: Substance Use in Pregnancy

Brief Reports

Adverse Childhood Experiences (ACEs): A Summary of Promising Practices and Program Recommendations

Description: Increased public awareness has been focused on Adverse Childhood Experiences (ACE) and the ACE study in recent years.  The ACE study has brought a new understanding about links between early adversity, mental health, physical health, and long-term consequences of childhood experiences.  Talking about ACEs has helped raise awareness of child trauma across multiple disciplines, systems, and settings.  These conversations about ACEs have the potential to open doors in discussions with children, families, and providers that may lead to actions to prevent childhood adversity and promote healing for those who have experienced trauma.  ACE screenings may identify previously undisclosed trauma and adversity.  However, rushing into action without understanding the impact of trauma or without sensitivity to developing trauma-informed systems and practices could increase rather than alleviate stress.  Therefore this brief brings together resources and information from various sources to provide a context for understanding ACEs and providing best practices for trauma-informed care.

Report: Adverse Childhood Experiences (ACEs): A Summary of Promising Practices and Program Recommendations

Identifying, Prioritizing and Addressing Client Needs: Strategies for Home Visitors

Description: Community Health Workers from the Maternal and Infant Community Health Collaborative (MICHC) programs and Home Visitors from the Maternal, Infant, and Early Childhood Visiting (MIECHV) programs exclusively work in community settings among primarily disadvantaged and vulnerable populations. For simplicity in the rest of this report, the staff from these programs will be referred to as Home Visitors. While interacting with their clients, Home Visitors often encounter individuals with multiple and complex needs ranging from lack of access to health care to social, economic and behavioral issues. Some of these needs may fall within the scope of their roles and training, but other concerns may require referrals to clinical care providers or other resources.[1,2,3] This brief report highlights evidence-based and promising strategies to assist Home Visitors in identifying, prioritizing and addressing the multiple needs of the women and families they serve.

Report: Identifying, Prioritizing and Addressing Client Needs: Strategies for Home Visitors

Maternal Sleep & Sleep in Infants

Description: The National Sleep Foundation’s 1998 Women and Sleep poll found that 78% of women reported more disturbed sleep during pregnancy than at other times. Several sleep disorders can be caused or made worse by pregnancy. These disorders may include restless legs syndrome (RLS), obstructive sleep apnea (OSA), insomnia, gastroesophageal reflux disorder (GERD), and frequent nighttime urination. Once her baby is born, a mother's sleep is frequently interrupted, particularly if she is nursing. New mothers often neglect their own needs. While this may seem like normal behavior from concerned new mothers, neglecting themselves puts their health at risk. In the long run, it may have an adverse effect on both partners but is especially taxing on a mother and may affect her ability to take proper care of her child. Sleep deprivation is one of the most common post-birth side effects as well as one of the most damaging.

Community Health Workers and Home Visitors are often on the front lines of health care for women that are of childbearing age. The importance of sleep for children is something that has recently become a “hot topic” in the media. Sleep is so crucial for many different functions of our bodies, and for the ability to perform on a daily basis. Additionally, safe sleep and prevention of death from unsafe sleeping conditions is an essential topic of anticipatory guidance for all parents of newborn infants.

Report: Maternal Sleep & Sleep in Infants

Stress Management

Description: This document provides an overview of the types of stressors that can affect home visitors and subsequently impact their work with the families they serve.  As such, it defines risk factors, protective factors, and ways to protect home visitors from being negatively affected by these stressors. 

This document is intended for home visitors, agencies and their staff. The information provided within can be adapted to provide support to workers to reduce the negative impact that can be related to their work with high-risk families.  The first section introduces the reader to the types of stress that can affect staff.  The second section explores the impact of stressors on home visitors.  The third section details risk and protective factors; and the fourth section provides recommendations to organizations and individuals.  Finally, a list of resources will be provided for the reader.

Report: Understanding Stress and Stress Management for Home Visitors

Toxic Stress

Description: Communities living in poverty are constantly facing challenges, from the concern of meeting their families’ daily needs to obtaining health care and education.  For minority population living in poverty, these challenges are made worse by social and political issues tied to their race, ethnicity, language, disability, or immigration status, among others. These challenges cause stress that impacts the mind, the body and the community as a whole.  For individuals of reproductive age living in such communities, these challenges are even more detrimental to pregnancy and infant outcomes.  For program staff working to improve maternal and infant health it is important to understand the effects of these stressors and work with women and families to address these challenges and reduce the consequences.

Report: Toxic Stress and Maternal and Infant Health: A Brief Overview and Tips for Community Health Workers