Missouri’s Home Visiting Programs
By Melinda Sanders
Section Administrator, Section for Healthy Families and Youth
Missouri Department of Health and Senior Services
Dr. Sharmini V. Rogers, MBBS, MPH, Chief
Bureau of Genetics and Healthy Childhood
Section for Healthy Families and Youth
Karen Schenk, RN. BS
Public Health Consultant Nurse
The Missouri Department of Health and Senior Services offers two types of home visiting programs that serve low-income women both prenatally and post partum, along with their index infant(s), who have been identified as ”at-risk” for poor pregnancy and infant health outcomes and/or child abuse and neglect. These women are considered to be “at-risk” due to socioeconomic status, education level, age or prior history. Both programs follow these women and children up to age 2. The programs’ goals are to assist the women improve their health-related behaviors; assist/teach parents to provide more responsible care for their children; and improve the family’s economic self-sufficiency by helping parents develop a vision for their own future.
The Building Blocks of Missouri is an evidence-based nurse home visiting program based on the nationally replicated home visiting program, the Nurse Family Partnership® (NFP). The program has been replicated in Missouri through the Missouri Department of Health and Senior Services since 1999 and is funded through the Title V MCH Block Grant. The department contracts with three providers serving 17 counties in the state and the city of St. Louis to replicate the program. The program follows the Model Elements established by the NFP for the replication of its model. Program enrollment is open to low income, first time mothers who enter the program prior to the 28th week of pregnancy and continues through age 2 of the index child. The Missouri program has had good outcomes including increasing the number of women who enter prenatal care during the first trimester, decreasing smoking in pregnant women, increasing immunization rates, increasing birth spacing, decreasing low birth weight and premature infants, decreasing physical abuse by the partner, and increasing the number of women completing school and gainfully employed.
The Missouri Community Based Home Visiting Program (MCBHV) was developed in 1997 by the Missouri Department of Health and Senior Services in collaboration with the University of Missouri, Sinclair School of Nursing as the Families at Risk Model. Some modifications were made to the model in 2000 and the name was changed to the Missouri Community Based Home Visiting Program. The program utilizes registered nurses and family support workers (licensed practical nurses, social workers, or high school graduates with experience in early childhood). Registered nurses are required to do one post partum visit but may do additional visits as the need arises. The target population is specific for each individual site, but addresses the needs of families in the specific geographic area who are most at-risk of infant mortality or morbidity, and child abuse or neglect. Currently the program is funded to serve 250 women annually through Title V MCH Block Grant funds; however, due to attrition and additional funding obtained by some of the providers, the program served 815 women in 2009. There are currently 10 providers serving 11 counties in Missouri. In 2011, the program will be revised to encourage each site to serve at least 50 percent multiparous women, and to require use of the Partners for a Healthy Baby curriculum, developed by Florida State University, as the standardized curriculum. The program has far reaching effects including increasing first trimester enrollment in prenatal care, decreasing the number of infants born low birth weight and preterm, increasing breastfeeding rates, increasing immunization rates well above the state rate, and increasing the number of women who take folic acid prenatally and interconceptionally.