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- What initiatives and efforts are the 17 states participating in MIHOPE-Strong Start implementing to promote prenatal health and positive birth outcomes?
- Who are the major stakeholders involved in states’ efforts to promote prenatal health, improve birth outcomes, and implement home visiting?
- How are states funding initiatives and efforts to promote prenatal health, improve birth outcomes, and implement home visiting?
Rates of poor birth outcomes remain high in the United States. In 2015, 9.6 percent of U.S. infants were born preterm and 8.1 percent were born with low birth weights (Martin, Hamilton, Osterman, Driscoll, & Mathews, 2017).
To address poor birth outcomes in the United States, the Centers for Medicare and Medicaid Services (CMS) developed the Strong Start for Mothers and Newborns (Strong Start) initiative. The Strong Start initiative is studying enhanced prenatal care approaches aimed at reducing preterm births among Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries who are at high risk for poor birth outcomes.
As part of the Strong Start initiative, CMS, in partnership with the Administration for Children and Families and the Health Resources and Services Administration, established the Mother and Infant Home Visiting Program Evaluation ― Strong Start (MIHOPE-Strong Start). MIHOPE-Strong Start is evaluating the effectiveness of evidence-based home visiting for improving birth outcomes, maternal and infant health, health care use, and prenatal care use among women enrolled in Medicaid or CHIP as compared to mothers who may receive other services available in the community.
To better understand the larger service systems within which prenatal care and home visiting programs operate at the state level, MIHOPE-Strong Start conducted interviews with staff from state agencies and other non-governmental entities working to improve birth outcomes in the states participating in MIHOPE-Strong Start. This report presents the findings from this qualitative substudy, which provides a snapshot of the range of state efforts to promote prenatal health and improve birth outcomes, including home visiting.
The goal of this substudy was to describe the landscape of state Medicaid and the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program efforts to promote prenatal health, improve birth outcomes, and implement home visiting in the states participating in MIHOPE-Strong Start. Respondents answered questions about program goals and outcomes their agencies prioritize, initiatives and efforts to promote prenatal health and positive birth outcomes, key stakeholders involved in these efforts, support provided to local programs, funding mechanisms, and challenges and accomplishments.
Key Findings and Highlights
- States included in the report have launched multipronged efforts to promote prenatal health and improve birth outcomes. These efforts are intended to make advances toward several goals, including increasing access to prenatal care, reducing infant mortality, addressing neonatal substance exposure, and reducing disparities in preterm birth rates.
- Interview respondents identified a broad cross-section of stakeholders and partners. Common stakeholders and partners involved in efforts to promote prenatal health, improve birth outcomes, and implement home visiting include public agencies, national organizations, and collaborative groups. Some examples include departments of health, human services, and education; child welfare agencies; advisory groups; committees; task forces; and workgroups.
- Respondents from all 17 states mentioned using a variety of funding mechanisms. The most common funding sources mentioned were MIECHV, the Title V Maternal and Child Health Block Grant Program, Temporary Assistance for Needy Families, and general-purpose state tax funds. In 9 of the 17 states, Medicaid funds are used in some way for home visiting.
A total of 40 interviews with representatives from the 17 states participating in MIHOPE-Strong Start contributed to the qualitative analysis and study findings. Interviews were conducted with program administrators from state agencies that administer MIECHV programs, state Medicaid agencies, and other entities involved in home visiting in the participating states. Interviews were transcribed and coded using a stage model of content analysis, which first identified content relevant to the primary interview questions, and then coded that content using conventional content analysis to identify themes through repetition and patterns in the data.
Mariel Sparr, Alexandra Joraanstad, Grace Atukpawu-Tipton, Nicole Miller, Julie Leis, and Jill Filene (2017). Promoting Prenatal Health and Positive Birth Outcomes: A Snapshot of MIECHV and Medicaid State Efforts. OPRE Report 2017-65. Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.
- Administration for Children and Families
- Children’s Health Insurance Program
- Centers for Medicare and Medicaid Services
- Health Resources and Services Administration
- Maternal, Infant, and Early Childhood Home Visiting
- MIHOPE-Strong Start:
- Mother and Infant Home Visiting Program Evaluation ― Strong Start
- Strong Start:
- CMS’ Strong Start for Mothers and Newborns initiative