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 Welcome Family Massachusetts: A Gateway into the Early Childhood System of Care

Stetler photo.jpgby Katie Stetler, MPH
CDC Public Health Prevention Service Fellow, on behalf of the Welcome Family Massachusetts Team
In September 2013, the Massachusetts Department of Public Health (MDPH), using federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) funds, launched the Welcome Family Massachusetts program. The program was created to improve population health and well-being and build a seamless system of care for families and young children in Massachusetts.

Welcome Family offers a one-time nurse home visit to all mothers with newborns, regardless of age, income, risk or prior birthing experience, providing an entry point into a larger system of care for all families. Research suggests that the Welcome Family model will improve health and developmental outcomes for women and families in Massachusetts, including reduced risk for infant hospital readmission;[1] increased rates of breastfeeding,[2] immunization,[3] well-child visit attendance,[4] and postpartum visit attendance;[5] increased identification of families needing services[6] and connections to other services (such as MIECHV programs);[7] and reduced stigma about home visiting.[8]

Feature 2.jpgWelcome Family is active in four Massachusetts MIECHV communities, with the goal of expanding statewide. The 90-minute visit by a maternal and child health nurse is offered up to eight weeks postpartum. During the home visit, the nurse conducts screenings focused on six core areas: unmet health needs, maternal and infant nutrition, substance use, emotional health, interpersonal violence, and a clinical assessment of mother and infant health. The nurse also provides brief interventions and referrals to services as needed. Families receive a Welcome Family bag with gifts and information to support mom and baby.

In the first year of implementation, 500 mothers received a nurse home visit. Nurses made a total of 1,143 referrals to community-based services in response to needs identified during the visits, with an average of two referrals per visit. An evaluation of Welcome Family is underway to measure program outcomes and impact.

MDPH is collaborating with state and community partners to implement, improve and expand the program. Through a Welcome Family Learning Collaborative, the pilot communities test and share strategies for program improvement. The Welcome Family Advisory Committee – with representatives from local agencies, physicians, hospitals, health insurers, and state agencies – advises on systems building and program sustainability.

MDPH is actively pursuing third-party reimbursement to sustain Welcome Family, including studying Medicaid rates for similar universal or short-term maternal home visiting programs nationwide; developing cost projections; and outlining program benefits, including health outcomes and Healthcare Effectiveness Data and Information Set (HEDIS) measures. This will allow Welcome Family to expand across Massachusetts and continue beyond the MIECHV grant.

[1] Dodge KA, Goodman WB, Murphy RA, et al. Randomized controlled trial of universal postnatal nurse home visiting: impact on emergency care. Pediatrics 2013;132(2):S140–146.
[2] Bashour H, Kharouf M, Abdulsalam A, et al. Effect of postnatal home visits on maternal/infant outcomes in Syria: a randomized controlled trial. Public Health Nursing 2008; 25(2):115–25.
[3] Benatar S, Sandstrom H, Hill I, et al. Best Start LA Pilot Community Evaluation: Annual Outcomes Report, Year 3. Prepared by The Urban Institute and University of California, Los Angeles. July 2012.
[4] Braveman P, Miller C, Egerter S, et al. Health service use among low-risk newborns after early discharge with and without nurse home visiting. J Am Board Fam Pract 1996;9(4):254–60.
[5] Ghilarducci E, McCool W. The influence of postpartum home visits on clinic attendance. J Nurse Midwifery 1993;38(3):152–8.
[6] Svenson J, Kaplan B, Hatcher P. Evidence that Universally-Offered Home Visiting Finds Families at Risk. Presented at the 130th Annual Meeting of the American Public Health Association. Philadelphia, PA. November 12, 2002.
[7] Benatar S, Sandstrom H, Howell E, et al. Effects of Welcome Baby Home Visiting: Findings From the 24-Month Child & Family Survey. Prepared by The Urban Institute and University of California, Los Angeles. August 2014.
[8] Dodge KA, Goodman WB, Murphy RA, et al. Implementation and randomized controlled trial evaluation of universal postnatal home visiting. Am J Public Health 2012;104(1):S136–143.