The MOM Program: Home Visiting in Partnership With Pediatric Care

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SUPPLEMENT ARTICLE

The MOM Program: Home Visiting in Partnership With
Pediatric Care
AUTHORS: Jerilynn Radcliffe, PhD,a,b Donald Schwarz, MD,
MPH,c and Huaqing Zhao, PhD,d on behalf of the MOM                     abstract
Program
                                                                       OBJECTIVE: Home visiting programs aim to improve child health, re-
aDepartment    of Pediatrics and dDepartment of Biostatistics,
                                                                       duce developmental risks, and enhance use of community resources.
The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania;
bPerelman School of Medicine, University of Pennsylvania,              How these programs can work in collaboration with pediatric practice
Philadelphia, Pennsylvania; and cDeputy Mayor for Health and           has been understudied. The MOM Program was a randomized con-
Opportunity, Office of the Deputy Mayor for Health and Opportunity,     trolled trial of an innovative home visiting program to serve urban,
City of Philadelphia, Philadelphia, Pennsylvania
                                                                       low-income children. Program aims included promoting child health
KEY WORDS
child, development, home visiting, infant, mothers, well-child
                                                                       through regular pediatric visits and enhancing school readiness
visits                                                                 through developmental screenings and referrals to early intervention.
ABBREVIATIONS                                                          The objective of this report was to describe the partnership with the
CI—confidence interval                                                  pediatric community and selected program results.
OR—odds ratio
                                                                       METHODS: A total of 302 mothers were enrolled in the program at the
Dr Radcliffe conceptualized and designed the study, coordinated
and supervised the data collection, and drafted the initial
                                                                       time of children’s birth. Eligible infants were full-term, without iden-
manuscript; Dr Schwarz participated in the conceptualization           tified neurologic/genetic disorder or ICU intervention, and from high-
and design of the study, and reviewed and revised the                  poverty zip codes. A total of 152 were randomized to the home visiting
manuscript; Dr Zhao conducted the initial analyses and
                                                                       program, with 9 visits over 3 years, scheduled before well-child visits;
reviewed and revised the manuscript; and all authors approved
the final manuscript as submitted.                                      150 were randomized to the control condition with no home visits.
This trial has been registered at www.clinicaltrials.gov               Medical records and case notes provided information on pediatric
(identifier NCT00970853).                                               appointments kept and program outcomes.
www.pediatrics.org/cgi/doi/10.1542/peds.2013-1021O                     RESULTS: Eighty-nine percent of both groups were retained throughout
doi:10.1542/peds.2013-1021O                                            the 3-year program; 86% of the home-visited group received at least 7
Accepted for publication Aug 26, 2013                                  of the 9 planned home visits. Home-visited mothers were .10 times as
Address correspondence to Jerilynn Radcliffe, PhD, Department          likely to keep pediatric appointments, compared with those not
of Pediatrics, The Children’s Hospital of Philadelphia, 3400 Civic     visited. Barriers to service access were varied, and theory-driven
Center Blvd, CHOP North 1461, Philadelphia, PA 19104. E-mail:
                                                                       approaches were taken to address these.
radcliffe@email.chop.edu
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).        CONCLUSIONS: Home visiting programs can provide important part-
Copyright © 2013 by the American Academy of Pediatrics
                                                                       nerships with pediatric health care providers. Integrating home visit-
                                                                       ing services with pediatric care can enhance child health, and this
FINANCIAL DISCLOSURE: The authors have indicated they have
no financial relationships relevant to this article to disclose.        subject warrants expansion. Pediatrics 2013;132:S153–S159
FUNDING: We are very grateful for the support of The William
Penn Foundation, The Robert Wood Johnson Foundation, The
Claneil Foundation, an anonymous donor through The Children’s
Hospital of Philadelphia, and Pew’s Home Visiting Campaign.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated
they have no potential conflicts of interest to disclose.

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Home visiting programs are widely             health services may be part of the in-          Other key features of the MOM Program
recognized as important for promoting         tervention process. Representative pro-         include: 9 home visits, each occurring just
healthy outcomes in mothers and chil-         grams include a 4-visit, randomized             before a scheduled pediatric well-child
dren. Targeted for mothers who are            controlled trial over 6 months to promote       visit and including information de-
considered “at risk” for reasons of their     breastfeeding and mothers’ manage-              signed to increase mothers’ under-
age, income, or identified psychosocial        ment of infant health problems12; a single      standing of the purpose of the visit and to
issues, home visiting programs have           home visit public health initiative to en-      formulate any questions about their
reported success in improving child           courage mothers to enroll in the Sup-           child; use of a team of home visitors
and maternal health outcomes, delaying        plemental Nutrition Program for Women,          rather than a single visitor per family;
subsequent pregnancies, improving             Infants, and Children13; an 8-session           and weekly supervision meetings to
rates of maternal employment, and             program (4 prenatal visits and 4 post-          monitor the progress of all children en-
raising subsequent family income.1–5          natal visits spaced 2 weeks apart) over 2       rolled in the program. The final home
Home visiting programs differ greatly in      months to promote maternal health14;            visit occurred at infant age 33 months.
their aims, scope, and types of services      and a 5-visit program over 12 months to         Outcome assessment occurred at age 36
and resources they provide to parents;        identify infant health problems and pro-        months. Other program elements in-
they also differ in whom they target.2,6      mote receipt of immunizations.15                clude structured, model-driven check-
Some programs aim to improve the                                                              lists for each visit and use of regular
                                              Another model for implementing a home
physical and mental health of mothers,                                                        reminder calls before home visits and
                                              visiting program in partnership with pe-
                                                                                              before and after the scheduled well-child
such as increasing time to subsequent         diatric care is that offered by the MOM
                                                                                              visits. Detailed records of attempts to
pregnancies and improving parenting           Program (MOM is not an acronym but
                                                                                              contact mothers are kept by staff mem-
skills, whereas others address child          simply the name of the program). As
                                                                                              bers, and these efforts are also dis-
health and development or attempt to          reported earlier,16,17 the MOM Program is
                                                                                              cussed in the weekly staff meeting. Home
reduce child abuse. Services in these         an innovative home visiting program
                                                                                              visitors included both lay workers and
programs may include a structured             designed to serve urban, low-income
                                                                                              pediatric nurse practitioners. The entire
health or parenting protocol during           mothers and children, evaluated                 home visiting team and supervisory staff
home visits, emotional support and as-        through a randomized controlled trial.          participate in troubleshooting regarding
sistance with referrals, or accompanying      The primary aim of this trial was to            making successful contacts with the
mothers and children to visits with ser-      demonstrate whether participation in            participant mothers. All activities are
vice providers. Accordingly, programs         this home visiting program led to differ-       prescribed in the program manual.
may provide parents with social support,      ential changes in referral to early in-
linkages to resources, literacy education,                                                    The current report describes program
                                              tervention and receipt of early
parenting coaches, role models, or expert                                                     retention and engagement, and the
                                              intervention services. Earlier reports
help in maternal and child health and                                                         extent that completed home visits for
                                              have described that those children
well-being.2 Those targeted by home vis-                                                      those in the intervention arm of the
                                              whose mothers were randomized to re-
iting programs include teen mothers,7,8                                                       MOM Program are related to completed
                                              ceive the home visiting intervention
first-time mothers,3–5 mothers at risk for                                                     appointments for pediatric primary
                                              compared with those in the control
                                                                                              care to illustrate partnership with the
child abuse,9 or mothers with a variety of    group, which did not receive home visits,
                                                                                              pediatric community.
indicators of “risk” status.10,11 These       were significantly more likely to be re-
programs are generally intensive in           ferred to and receive early intervention.
terms of number of planned visits and                                                         METHODS
                                              These referrals to early intervention oc-
broad in the scope of intended program        curred in the context of children attend-       The Human Subjects Committee of the
outcomes.                                     ing well-child visits regularly. Attending      Institutional Review Board of The
Although embracing pediatric health           well-child visits was thus a key compo-         Children’s Hospital of Philadelphia ap-
outcomes, home visiting programs              nent of the intervention for those who          proved and oversaw the conduct of this
have generally existed in parallel,           had been randomized to receive home             study.
rather than in partnership, with out-         visits. The current report presents in-
reach efforts launched from pediatric         formation on attendance for well-child          Participants
practices. However, home visiting pro-        visits for those in the intervention arm        To be eligible for the study, mothers had
grams can target child health outcomes        of the study and how this action relates        to live in predetermined ZIP codes in
closely, and collaboration with child         to the receipt of home visits.                  a large northeastern city with high

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SUPPLEMENT ARTICLE

poverty rates and had to have given birth                       child gender, level of education, employ-                    contact participant mothers, including
to a singleton healthy infant (weight                           ment status, receipt of public services,                     telephone calls to set up a home visit,
$2500 g; no identified genetic or de-                            and other social indicators. Members of                      home visits, telephone calls to remind
velopmental disorders). Recruitment                             the study team collected demographic                         mothers of upcoming primary care
was conducted in the postpartum unit                            information from the mothers through                         visits, and follow-up calls to determine if
of an urban academic hospital between                           interviews at study enrollment.                              mothershad keptthe scheduledprimary
July 2001 and January 2002. Partic-                                                                                          care visit or followed through with rec-
ipants were randomly assigned to ei-                            Program Retention                                            ommendations. These program records
ther the intervention (n = 152) or                              Mothers who remained in the program                          included notation of which staff member
control (n = 150) conditions. The current                       from initial enrollment for 36 months                        completed each activity as well as the
report uses data only on the 152 in-                            were considered “retained” in the                            number of 5-minute time units spent on
tervention group mothers, who are de-                           program, regardless of the number of                         each activity. Program evaluation
scribed in Table 1. These were largely                          home visits that were completed. Only                        records were kept through the duration
high-school educated (mean 6 SD                                 those mothers who asked to be taken                          of the study.
years of education: 12.0 6 1.9), African                        out of the program were discontinued.
American (94%), and in their early
                                                                                                                             Procedure
twenties (mean age: 23.1 6 5.6 years).                          Target Program Dosage
Of the children, 54% were female and                                                                                         To assess program involvement, re-
                                                                Similar to the approaches taken by
44% were first births. Most participants                                                                                      tention, dosage, and linkage to care, 2
                                                                Heinrichs18 and McFarlane et al,19 the
(74%) reported having $10 prenatal                                                                                           trained research assistants examined
                                                                target home visit dosage in the MOM                          participant charts for the intervention
visits. As described earlier,16,17 these
                                                                Program was set at, minimally, 75%                           group mothers and extracted and
mothers did not differ significantly from
                                                                completion of all planned home visits                        coded the aforementioned program
those assigned to the control group.
                                                                (eg, completion of at least 7 of the 9                       implementation variables. Because
                                                                planned home visits in the first 33                           mothers who had been assigned to the
Measures
                                                                months of the child’s life).                                 control condition did not receive any
Demographic Characteristics                                                                                                  home visits, there are no comparable
Demographic characteristics were as-                            Program Implementation                                       data on program implementation for
sessed through a series of questions                            Program implementation was evaluated                         those individuals. Two checks for
regarding mothers’ age, race/ethnicity,                         by using staff records of all attempts to                    interrater reliability were conducted.
                                                                                                                             For the first 10 charts, research
TABLE 1 Comparisons of Participants Retained and Not Retained in the MOM Program Through                                     assistants separately extracted and
            Age 33 Months (N = 152)                                                                                          coded program implementation varia-
                   Baseline Variable                           Retained (n = 136)        Not Retained (n = 16)         P     bles. Data were examined for con-
Maternal age, y                                                     23.3 6 5.9                  20.4 6 4.2            .06    sistency, and 95.3% agreement was
Maternal level of education, y                                      11.9 6 1.9                  11.9 6 1.8            .97    attained. Discrepancies between the 2
No. of other children                                                1.0 6 1.3                   0.5 6 0.6            .20
No. of months at residence                                          62.2 6 76.2                 89.3 6 78.5           .06
                                                                                                                             coders were discussed, and necessary
No. of months pregnant when prenatal care started                    2.9 6 2.0                   2.8 6 1.2            .63    clarifications to coding categories were
Infant gestational age, wk                                          39.4 6 1.6                  39.3 6 1.3            .82    agreed on. In a second interrater re-
Infant birth weight, g                                             3303 6 466                  3246 6 367             .64
                                                                                                                             liability review, 1 research assistant
No. of prenatal visits                                                                                                .64
   0                                                                    3 (2.0)                  0 (0)                       independently coded a random 20% of
   1–4                                                                 10 (7.4)                  0 (0)                       all charts coded by the second research
   5–9                                                                 17 (12.5)                 2 (10.5)                    assistant; interrater reliability exceeded
   $10                                                                106 (77.9)                14 (87.5)
Pregnancy problemsa                                                    41 (30.2)                 2 (12.5)             .14    95% agreement. Throughout the study,
Child gender                                                                                                          .19    all data were double-entered and checked
   Female                                                              70 (51.5)                11 (68.8)                    for accuracy.
   Male                                                                66 (48.5)                 5 (31.3)
Cesarean delivery                                                      26 (19.1)                 5 (31.3)             .25    Data on linkage to primary pediatric
No. (%) other children in early intervention                            9 (6.6)                  0 (0)                .52    care were available only for the in-
No. (%) other children with learning problems                           7 (5.2)                  0 (0)                .54
                                                                                                                             tervention, home-visited mothers. Be-
Data are presented as mean 6 SD or n (%).
a Pregnancy problems include hypertension, gestational diabetes, infection, passed out, premature labor, delivery problem,
                                                                                                                             cause part of the home visiting
intrauterine growth retardation/inadequate fluid, and other.                                                                  intervention involved calling mothers to

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determine if they had kept their primary      fit statistics of relevant nested models.                        enrolled at baseline and assigned to
care appointments, it was necessary to        The method of generalized estimating                            the intervention arm of the study but
avoid calling mothers assigned to the         equations for binary outcome was then                           were not retained until the end of the
control group to obtain similar in-           used to evaluate how the home visits                            program.
formation (to avoid contaminating the         (complete versus incomplete) were re-                           Program dosage results for those
control group with additional encour-         lated to primary care physician visits                          mothers receiving home visits are
agement to keep well-child visits). Data      (complete versus incomplete). The odds                          presented in Table 2. Mothers who re-
on whether mothers had kept sched-            ratio (OR) of having completed primary                          ceived the target dosage (ie, having
uled appointments were collected only         care physician visits for previous com-                         completed at least 7 of the 9 planned
through maternal report on whether            pleted home visits compared with pre-                           home visits; n = 130 [86%]) were
the visit had occurred and, therefore,        vious incomplete home visits was also                           compared with those who did not re-
only from mothers in the intervention         determined.                                                     ceive the target dosage (n = 22 [14%])
group and not those in the control                                                                            to determine if systematic differences
group. The primary care providers for         RESULTS
                                                                                                              in baseline maternal characteristics
children in the MOM Program were              Program Involvement, Retention,                                 could be identified. Mothers who re-
scattered throughout the city, and            and Program Dosage                                              ceived the target program dosage
MOM Program staff were not equipped                                                                           were found to be slightly older than
                                              Results on maternal retention are
to obtain independent verification of                                                                          those who failed to receive the target
                                              presented in Table 1. Of the 302 moth-
attendance at each scheduled visit.                                                                           dosage (23.3 vs 21.3 years; P = .05) and
                                              ers originally enrolled in the MOM
Immunization data collected from pro-                                                                         were more likely to have male children
                                              Program, 89.7% (271) completed the
viders at the completion of the study                                                                         (93.3% of mothers of male children
                                              entire 33-month program, including
permitted verification of completed                                                                            received full program dosage; P = .02).
                                              136 (89%) of those in the intervention
visits, although information on in-
                                              (home visiting) group. Mothers who                              Table 3 presents home visit completion
complete visits was collected only from
                                              were retained in the intervention arm                           rates, as well as information on in-
the mothers in the intervention, home-
                                              of the MOM Program for 33 months                                complete visits, cumulative dropouts,
visited group.
                                              were found to differ very little in de-                         and missing participants. High rates of
Statistical Analysis                          mographic characteristics and other                             completed home visits were main-
                                              variables from those who were also                              tained throughout the intervention,
The number of home visits and telephone
contacts made over the course of the
program and the time needed to com-           TABLE 2 Comparisons of Participants Who Did and Did Not Receive Target Program Dosage in
plete contacts were tabulated and sum-                    Intervention Arm of the MOM Program Through Age 33 Months (N = 152)
marized by using standard descriptive                            Baseline Variable                            Engaged (n = 130)        Nonengaged (n = 22)           P
statistics. Logistic regression was used to   Maternal age, y                                                     23.3 6 6.0                  21.3 6 4.1            .05
determine how program characteristics         Maternal level of education, y                                      11.9 6 1.9                  11.6 6 1.7            .35
                                              No. of other children                                                1.0 6 1.2                   0.9 6 1.1            .75
(ie, staff background, amount of time
                                              No. of months at residence                                          63.3 6 75.4                 75.5 6 84.4           .49
expended for each participating mother,       No. of months pregnant when prenatal care started                    2.9 6 2.0                   2.8 6 1.3            .61
number of telephone calls and home            Infant gestational age, wk                                          39.4 6 1.6                  39.5 6 1.2            .84
visits), and demographic characteristics      Infant birth weight, g                                             3301 6 478                  3272 6 311             .72
                                              No. of prenatal visits                                                                                                .75
(ie, mother’s age, first-time mom status,         0                                                                  3 (2.3)                    0 (0)
child gender) predicted program dos-             1–4                                                               10 (7.7)                    0 (0)
age. Model fitting procedures were con-           5–9                                                               16 (12.3)                   3 (13.6)
                                                 $10                                                              101 (77.7)                  19 (86.4)
ducted by first testing single covariates      Pregnancy problemsa                                                  40 (30.8)                   3 (13.6)             .13
with the use of simple logistic regression    Child gender                                                                                                          .02
models and then using backward selec-            Female                                                             64 (49.2)                 17 (77.3)
                                                 Male                                                               66 (50.8)                  5 (22.7)
tion procedures in which all single sta-
                                              Cesarean delivery                                                     29 (22.3)                  2 (9.1)              .25
tistically significant covariate terms (P ,    No. other children in early intervention                               9 (6.9)                   0 (0)                .57
.10) were included as candidates in           No. other children with learning problems                              7 (5.4)                   0 (0)                .73
a multiple logistic regression model.         Data are presented as mean 6 SD or n (%). “Target program dosage” was defined as having completed at least 7 of the 9
                                              planned home visits.
Nonsignificant terms were dropped from         a Pregnancy problems include hypertension, gestational diabetes, infection, passed out, premature labor, delivery problem,

consideration iteratively based on overall    intrauterine growth retardation/inadequate fluid, and other.

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SUPPLEMENT ARTICLE

with findings ranging from 82% (at age                          were found between the total amount of                      home visit (OR: 10.77 [95% confidence
4 months) to 91% (at age 6 months).                            time staff spent with each family per                       interval (CI): 6.05–19.17]; P , .0001).
Relatively few mothers dropped out of                          month, averaging 13.5 6 2.05 minutes
the home visiting program, and they                            for those receiving full dosage, and                        Predictors of Involvement
did so at fairly even rates throughout                         12.1 6 5.1 minutes for those who did not                    Table 6 presents the final logistic re-
the duration of the program.                                   receive full dosage.                                        gression model predicting engage-
                                                                                                                           ment. The final multivariable logistic
Program Staff and Activity                                     Program Results                                             regression model showed that re-
During the 3-year program, there was                           Table 4 presents rates of completed                         ceiving the targeted dosage of the
no turnover in home visiting staff. No                         home and primary care provider visits                       home visiting intervention was associ-
statistically significant differences were                      throughout the intervention. Rates of                       ated with the total amount of staff time
found in measures of staff activity for                        completed well-child visits ranged                          (OR: 1.13 [95% CI: 1.065–1.208]), the
those mothers who did and did not re-                          from 26% (at age 30 months) to 90% (at                      number of home visits (OR: 0.74 [95%
ceive target program dosage. Mothers                           age 6 weeks). Rates of completed home                       CI: 0.599–0.924]), and child gender
who received the target program dos-                           visits and primary care provider visits                     (male versus female; OR: 3.84 [95% CI:
age received 2.25 6 0.84 follow-up calls                       were generally parallel, with excep-                        1.171–12.64]).
per month compared with 2.19 6 1.26                            tions at 15 and 30 months of age.
follow-up calls for mothers who did not                        Table 5 presents the logistic regression                    DISCUSSION
receive the full program dosage. The                           model between completed home and
actual numbers of home visits per                              medical care visits. The odds of having                     These results illustrate the important
month were similar: 0.51 6 0.13 home                           a successful health care provider visit                     role that home visiting programs can
visits for those receiving full program                        when there was a previous successful                        have in promoting child health outcomes
dosage; 0.60 6 0.32 home visits for those                      home visit were 10.77 times higher                          in partnership with pediatric care. For
not receiving the full dosage. Likewise,                       than that of having a successful health                     those mothers in the intervention who
no statistically significant differences                        care provider visit without a successful                    received regular home visits for their
                                                                                                                           child’s first 33 months, completing
                                                                                                                           a home visit was associated with a no-
TABLE 3 Home Visits Completed Throughout Intervention (N = 152)                                                            tably higher rate of pediatric visit com-
Child Age       Completed Home Visits           Incomplete Home Visits           Cumulative Dropouts           Missing     pletion compared with those mothers in
6 wk                    136 (89.4)                       14 (9.2)                         2 (1.3)               0 (0.0)    the intervention group who did not re-
4 mo                    125 (82.2)                       21 (13.8)                        4 (2.6)               1 (0.7)    ceive a home visit just before a sched-
6 mo                    138 (90.8)                        9 (5.9)                         5 (3.2)               0 (0.0)
9 mo                    131 (86.1)                       15 (9.9)                         6 (4.0)               0 (0.0)
                                                                                                                           uled pediatric appointment. Attending
12 mo                   133 (87.5)                       11 (7.2)                         8 (5.3)               0 (0.0)    well-child pediatric visits is key to over-
15 mo                   131 (86.2)                       12 (7.9)                         9 (5.9)               1 (0.7)    all health and developmental monitoring
18 mo                   135 (88.8)                        5 (3.3)                        12 (7.9)               1 (0.7)
                                                                                                                           and the provision of needed health or
24 mo                   132 (86.8)                        5 (3.3)                        14 (9.2)               1 (0.7)
30 mo                   129 (84.9)                        4 (2.6)                        15 (9.9)               4 (2.6)    developmental intervention services.20
Data are presented as n (%).                                                                                               Earlier research on MOM Program out-
                                                                                                                           comes17 found that, despite equivalent
                                                                                                                           amounts of developmental delay in the
TABLE 4 Completed Home Visits and PCP Visits (N = 152)
                                                                                                                           children of the home-visited and non–
Child Age                                Completed Home Visit                                       Completed PCP Visit    home-visited mothers, those children
6 wk                                            136 (89.5)                                              137 (90.1)         assigned to the home visiting condition
4 mo                                            125 (82.2)                                              123 (80.9)
6 mo                                            138 (90.8)                                              127 (83.6)
                                                                                                                           were significantly more likely to be re-
9 mo                                            131 (86.2)                                              116 (76.3)         ferred to and receive early-intervention
12 mo                                           133 (87.5)                                              117 (77.0)         services by 33 months of age. The cur-
15 moa                                          131 (86.2)                                               91 (59.9)
                                                                                                                           rent results show that the home visiting
18 mo                                           135 (88.8)                                              117 (77.0)
24 mo                                           132 (86.8)                                              125 (82.2)         program also promoted primary care
30 moa,b                                        129 (84.9)                                               40 (26.3)         attendance, an essential precursor to
Data are presented as n (%). PCP, primary health care provider.                                                            children receiving these important early-
a No immunizations were given to children at these visits.
b This visit was primarily used to monitor children’s enrollment into early intervention or transition into 3- to 5-year   intervention services. The relatively high
programs.                                                                                                                  rate of completed well-child visits is not

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TABLE 5 Results of Logistic Regression Model With Generalized Estimating Equation Relating                                              Results from this randomly assigned
             Home Visit Completion With Completed Medical Care Visits
                                                                                                                                        intervention trial show promise for how
       Parameter                      Estimate             SE                z                 OR (95% CI)                     P        home visiting programs can augment
Visit                                  20.32              0.03           29.71              0.73 (0.68–0.77)               ,.0001       pediatric care for children. By timing
Completed home visits                   2.38              0.29            8.08             10.77 (6.05–19.17)              ,.0001
                                                                                                                                        home visits to occur just before pedi-
                                                                                                                                        atric office visits, mothers can be more
TABLE 6 Final Logistic Regression Model Predicting Program Participation                                                                motivated to keep appointments and be
           Parameter                      Estimate          SE        Wald chi-square              OR (95% CI)                 P        better equipped to use these visits
Total time                                  0.13           0.03              15.43              1.13 (1.07–1.21)           ,.0001       optimally by understanding what to
Completed home visits                      20.30           0.11               7.13              0.74 (0.60–0.92)            .008        expect at the visits and to have for-
Child gender, male vs female                0.67           0.30               4.93              3.85 (1.17–12.64)           .030        mulated in advance their questions for
The C statistic for the model is 0.81, indicating high goodness of fit for this model. Variables initially entered were type of staff,
staff activity type, staff time spent on outreach, maternal demographic variables, and child gender.
                                                                                                                                        their health care provider. Future home
                                                                                                                                        visiting programs may further expand
typically reported in reports from home                               American, from a defined geographic                                partnerships with pediatric care pro-
visiting programs. In a comprehensive                                 urban East Coast region. These factors                            viders by reinforcing patient/family
review of 9 high-quality home visiting                                may limit the extent that conclusions can                         education provided at each visit and
programs,2 only 1 program, the Early                                  be extended to programs serving moth-                             supporting mothers in monitoring the
Start program in New Zealand, reported                                ers in other geographic regions or to                             health status of their children. By
similarly high levels of completed pri-                               those serving mothers with a wider race/                          extending the “reach” of pediatric care
mary care visits over 36 months.10                                    ethnicity range. However, because others                          beyond the office into the community
                                                                                                                                        and homes of vulnerable families, pe-
One unexpected finding from this                                       have described low rates of program
                                                                      involvement among urban, low-income,                              diatric health resources can be opti-
analysis was 2 age points (15 and 30
                                                                      African-American mothers,21 the high                              mally deployed. Similarly, by working in
months) when the association between
                                                                      rates of retention and dosage in this                             partnership with pediatric practices,
completed home visits and well-child
care visits dropped. Although pro-                                    sample are noteworthy. Another limita-                            home visiting programs can increase
gram staff encouraged mothers to                                      tion is that unequal sample sizes were                            the likelihood of achieving targeted
make and keep these appointments,                                     used in the analyses, which is due to the                         health outcomes for children.
mothers reported experiencing par-                                    small sample size overall and to the rel-                         Although not qualifying for Maternal, In-
ticular difficulty in making appoint-                                  atively high rates of maternal in-                                fant, and Early Childhood Home Visiting
ments for these visits. The American                                  volvement within the home-visited                                 funding as one of its “evidence-based”
Academy of Pediatrics (20) recom-                                     intervention group. A related study                               models,6 a replication of the MOM Pro-
mended a visit at 15 months, although                                 limitation is the small size of the pro-                          gram is underway in other areas with
this visit did not include routine                                    gram and its staff. Programs with                                 high rates of poverty in Philadelphia
immunizations. Although not recom-                                    a larger number of staff members may                              through the Office of the Deputy Mayor
mended by the AAP (20), the program                                   have more challenges in keeping staff                             for Health and Economic Opportunity, di-
included a suggestion for this visit for                              motivated and persistent in outreach                              rected by one of the study authors (DFS).
assuring that children aged 0 to 3 years                              efforts. The relatively small number of                           The replication program uses revised
in early-intervention programs who                                    staff of the MOM Program does not al-                             training materials and an updated man-
were approaching the critical 36-month                                low for examination of specific home                               ual and reporting system. In establishing
transition to the 3- to 5-year-old pro-                               visitor characteristics that might be                             this replication, the program gained co-
gram had information on making that                                   related to maternal involvement, such                             operation from local pediatricians in ways
transition.20 Mothers reported that the                               as race or educational background.22                              similar to those used in the original pro-
office staff of the health care providers                              Finally, data on the completion of pe-                            gram. Presentations about the MOM Pro-
often discouraged them from these                                     diatric office visits were collected only                          gram were given to local pediatric groups
visits or simply refused to offer                                     on the home-visited mothers because                               regarding the importance of child de-
appointments to children at these ages                                we did not wish to violate the “control”                          velopment screening and early education
unless they were in ill health.                                       nature of the initial group assignment                            through Grand Rounds presentations and
Limitations of the current study include                              and draw more attention to visit com-                             conferences. In addition, written informed
the use of a single cohort of mothers who                             pletion among those in the control                                consent was obtained from each partici-
were predominantly low-income African                                 group.                                                            pant to allow letters documenting the

S158        RADCLIFFE et al
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SUPPLEMENT ARTICLE

child’s developmental progress to be                     for their patients, such as reviewing               CONCLUSIONS
shared with his or her primary care                      lead screening at the 9-month home visit
                                                                                                             Home visiting programs can provide
provider. Finally, observations from                     or introducing measles vaccination at
                                                                                                             important partnerships with pediatric
the program are shared with pediatric                    the 12-month home visit. Careful plan-
                                                                                                             health care providers. Integrating home
and obstetric staff throughout its                       ning with the local pediatric community
duration. Local providers have been                      is essential in the development and fine-            visiting services with pediatric care can
appreciative of the program’s re-                        tuning of collaborative home visiting               enhance child health, and warrant ex-
inforcement of upcoming procedures                       initiatives.                                        pansion.

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PEDIATRICS Volume 132, Supplement 2, November 2013                                                                                                      S159
                                  Downloaded from www.aappublications.org/news by guest on March 10, 2021
The MOM Program: Home Visiting in Partnership With Pediatric Care
          Jerilynn Radcliffe, Donald Schwarz and Huaqing Zhao
                        Pediatrics 2013;132;S153
                     DOI: 10.1542/peds.2013-1021O

Updated Information &         including high resolution figures, can be found at:
Services                      http://pediatrics.aappublications.org/content/132/Supplement_2/S153
References                    This article cites 20 articles, 6 of which you can access for free at:
                              http://pediatrics.aappublications.org/content/132/Supplement_2/S153
                              #BIBL
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                Downloaded from www.aappublications.org/news by guest on March 10, 2021
The MOM Program: Home Visiting in Partnership With Pediatric Care
          Jerilynn Radcliffe, Donald Schwarz and Huaqing Zhao
                        Pediatrics 2013;132;S153
                     DOI: 10.1542/peds.2013-1021O

The online version of this article, along with updated information and services, is
                       located on the World Wide Web at:
     http://pediatrics.aappublications.org/content/132/Supplement_2/S153

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