Prevention/Care Management, 2008

State of Washington

December 2007

AHRQ-funded research showing that a prenatal care program was associated with a reduction in the rate of low birth weight (LBW) infants has been used in the State of Washington to encourage continued support for the First Steps Maternity Support/Infant Case Management Program.

Nancy Anderson, MD, MPH, is the Office Chief, Family Services Health and Recovery Services Administration. Anderson notes that the AHRQ-funded research, led by Laura-Mae Baldwin, MD, MPH, of the University of Washington, has been used to respond to informational requests from the legislature. Says Anderson, "We certainly used the evaluation to 'defend' the program from [budget] cuts, and we are also using it to help us understand the populations where we should focus our efforts, given limited resources."

In 1989, the Washington State Legislature responded to a crisis in accessibility of prenatal care for low-income women and high rates of premature and low birth weight infants by enacting the Maternity Care Access Act. This legislation created the First Steps Program, which:

• Improves access to prenatal care and preventive services for children.
• Increases the number of women eligible for services.
• Provides enhanced prenatal care services for pregnant women through the First Steps Maternity Support Services.

During the first five years of the First Steps Program and its companion program, Infant Case Management, there was a dramatic increase in access to prenatal care. There were also decreases in low birth weight babies and infant mortality rates.

Kathy Chapman, Manager, Maternal and Infant Health, Office of Maternal and Child Health for the State, says, "In recent years, the rates for two key indicators in Washington State—low birth weight and infant mortality—have compared favorably with national rates, where the data can be compared."

Clinicians work with the family to assess health and basic survival needs, sanitation and safety hazards, and parental skills. The family and the clinician then create a plan for meeting identified needs, and interventions are provided. Maternity Support Services and Infant Case Management interventions, whether provided in the home or clinic setting, are based on the identified medical, dietary, and psychosocial needs.

Home visiting provides a means to reach mothers and infants who otherwise might not receive services, plus an opportunity to understand the woman and her family in context of the home environment. The visits are provided by members of an interdisciplinary team, which may include a community health nurse, dietician, behavioral health specialist, or community health worker.

AHRQ-funded research used State vital records data linked with Medicaid files from 1989-1992 to examine the change in use of prenatal care and low birth weight rates among pregnant women in Washington. The women were enrolled in the Medicaid Aid to Families with Dependent Children (AFDC) program before and after initiation of expanded prenatal services. These data were then compared with AFDC-enrolled women in Colorado, where there was no similar program.

The research findings showed that the expanded prenatal care program was associated with a significant reduction in the rate of low birth weight infants among moderately high-risk adult women—from 18 percent to 13.7 percent from 1989 to 1992.

In 2005, Medicaid and State funds paid for 39,077 births in Washington State. Of these, 27,909 women received Maternity Support Services, and 8,807 infants received Infant Case Management Services.

The First Steps and Infant Case Management Program are jointly managed by the Washington Department of Health and the Department of Social and Health Services. A network of 89 public and private agencies contracts with the Departments to provide the services in every county.

Impact Case Study Identifier: COE 08-04
AHRQ-Sponsored Activity: Research
Topic(s): Disparities, Women's Health, Pediatrics
Scope: Washington

Baldwin LM, Larson, EH, Connell, FA, et al. The effect of expanding Medicaid prenatal services on birth outcomes. American Journal of Public Health Nov 1998; 88(11:1):623-29. (HS06846)

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