2011 The Palm Beach County Family Study (Full Report)

includes universal risk screening, targeted home visitation programs, and referrals and linkages to a rangeof services within and outside the system. Services also include assistance connecting with a payer sourceand/or medical home, health education/health literacy, identification of and treatment for perinataldepression, nutrition counseling, childbirth and breastfeeding education, and family support servicesranging from telephone counseling to intensive home visiting services. Qualified providers also deliverdevelopmentally appropriate early childhood therapeutic and family supportive services to eligiblefamilies and children birth to age 5 through home visits or consultations at childcare or other clientconvenientlocations. These services include parenting support/education and infant mental health/socialemotionalwellness, including parent/child bonding, family therapy, and early literacy.Early identification is a key preventive service for all pregnant and postnatal women and children birth toage 5. According to a recent description of the MCHP, in the future, the system will include two entryagencies based on assessment information. 43 There were three common entry points to the system duringthe period of this study, however: the Healthy Mothers/Healthy Babies Coalition of Palm Beach County;Healthy Start/Healthy Families; and the Women’s Health Initiative (WHIN). Mothers could enter thesystem prenatally or postnatally based on the Healthy Start Prenatal and Infant Risk Screen or a homeassessment, but a majority of mothers entered through the Healthy Mothers/Healthy Babies Coalition,whose staff of hospital liaisons administered the 10-item Healthy Start Risk Screen to as many newlydelivered mothers as possible. On this instrument, a score of 4 or higher is considered an indicator ofpossible risk, and mothers who scored 4 or higher were encouraged to accept a home visit from a HealthyStart nurse. Mothers who received lower scores were not offered a home visit but could request one. 44Subsequently, in a home visit, mothers were reassessed and identified as having service needs of E, 1, 2,or 3. Mothers assigned levels 2 and 3 were thought to need more frequent or more varied services andthus were loosely referred to as “high risk,” whereas mothers with service levels of E or 1 weredesignated as “not high risk.” Mothers who were screened or assessed at a level 3 were automaticallyassigned to intensive care coordination services. 45In the following sections, we summarize what we have learned about mothers’ use of the MCHP systemin Palm Beach County.43 Personal communication with Carol Scott and Regina Battle, CSC September 2008.44 At the time we began recruiting, the Healthy Start program included a universal home visiting component for all newly deliveredmothers. In spring 2005, the program changed to target mothers who were, based on a risk screen score, identified as most in needof and more likely to use services. Mothers in a “special low risk” group were also offered a home visit if they were younger than19, new to the county, had delivered their first child with no or only late-term prenatal care, had no identified pediatrician, haddifficulty bonding with their baby, or seemed to lack social support (personal communication with Tanya Palmer, Children’sServices Council, 2005; personal communication with Christine Walsh, Healthy Mothers/Healthy Babies Coalition, 2005).45 Risk screen and assessment scores also are likely to change over time with subsequent contacts with healthcare and otherservice providers.Chapin Hall at the University of Chicago 86