Arizona’s Health Start program, to put it simply, works. A recent study showed it improved birth weights and immunization rates for children.
Caitlin Schmidt and Rachel Leingang Arizona Daily Star and Arizona Agenda For dozens of women in Pima County, Sarah Lee is like a fairy godmother.
For Health Start, the community health worker model serves as a less intimidating and non-judgmental access point for prenatal and postnatal help for moms with risk factors that can complicate pregnancy and birth. They keep mothers on track with prenatal care, helping them have a healthy birth, and then stick around for up to two years after a baby is born, helping the new parent adjust.
"Like you're talking to a friend"Women are eligible for the program if they have one or more risk factors, which include both social and medical issues, such as marital status, living situation, race and ethnicity, education level, income, insurance type, previous complications during pregnancy and maternal age. In Pima County, Health Start also works with refugees and women in jail.
For Maricela Reiber, mom to 18-month-old Emiliana, having a community health worker to talk to helps her stay up to date on information and feedback about her daughter’s milestones and the changes she’s going through. She’s never been a mom before. She turned to Facebook groups at first and relatives whose methods seemed outdated.
“Sarah Lee's always very supportive and encouraging and motivating,” Reiber said. “And she's constantly offering that reassurance of, 'you're OK, you're doing a wonderful job, she's a happy little kid, she's taken care of.' And just having that validation has been great.” Reeves first started receiving services from Health Start two years ago, before her daughter, Charlotte, was born. Charlotte was advanced, easily surpassed expectations and needed more stimulation. Oliver, who was premature, fell behind in some areas.“It feels like you're talking to a friend, but a friend with a lot of knowledge, confidentially,” Reeves said.
The authors lauded the program’s success and recommended that community health worker services be better integrated into clinical settings as well. The authors also said more visits, better transportation and education on additional topics could strengthen Health Start. To prepare for their monthly visits with clients, community health workers review the Health Start curriculum, choosing the appropriate topics to discuss. The curriculum includes information about safe sleeping for infants, a program called “All Babies Cry,” car seat safety, oral health and more.
“As with all of our visits and curriculum, Healthy at Home is completed in a nonjudgmental way and offered as a tool,” Lee said. “It’s ultimately up to the caregiver to decide what’s best for their own household.” Community health workers also can be the first to flag signs of domestic abuse, and they are trained to talk to patients about what it is and looks like.
The current model is effective, but like anything else, it’s not perfect, Rumann, of ADHS, said. The program can’t really grow, since it receives about the same amount of funding every year. And it struggles to reach some rural communities simply because of the increased travel and cost of providing services.
The county also got permission to work with families who have children in Department of Child Safety custody, and Lee is particularly proud of the county’s work with refugee populations. Lee — one of two community health workers serving Pima County — has a caseload of about 50 clients. The county is currently looking for a third health worker to add to the team, but even with only two, there isn’t a waitlist to get into the program.
"Not just for the kids"Lee said she’s seen in many of her clients the progress they’ve made in their confidence and parenting skills after a short time with the program.
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