Maternal-Child Healthcare Coordination

MOMS Orange County is a uniquely qualified community-based organization that provides access to prenatal care, health screenings, infant development screenings, health education, and referral services through monthly home visits and group classes. The Home Visitation program is a community-based, coordinated case management program.

This program was developed to address social determinants of health that contribute to health disparities in birth outcomes in under-served communities in Orange County. MOMS Orange County is guided by a central belief that every baby deserves a chance to be born healthy. Registered nurses (RN) closely supervise highly trained para-professional home visitors, Maternal Child Health Coordinators (MCHC). MOMS provides prenatal and postnatal home visitation services to approximately 3,600 at-risk pregnant women annually.

Despite the wealth of many Orange County communities, almost one in five children live in poverty. Additionally, 37.3% of the 37,256 births in Orange County in 2013 were covered by Medi-Cal, meaning that nearly 14,000 mothers were at or below 200% of the Federal Poverty Level.

Unfortunately, income is a significant factor when determining birth and maternal outcomes. Low-income, medically under-served women are more likely to be uninsured, less educated, and less aware of health issues that make them at higher risk for delivering infants with poor birth outcomes and subsequent health problems.

While MOMS Orange County realizes that it can’t change the income status of families, it strongly believes that it can impact a baby and mother’s life-long health by providing screenings, education, guidance, and resources to empower mothers to change attitudes and beliefs and adopt healthy lifestyle behaviors. MOMS Orange County’s Maternal-Child Health Coordination program is delivered via home visitation.

Maternal-Child Health Coordination provides at-risk women with specialized, in-home, one-on-one education, and support during pregnancy and through the baby’s first birthday. During pregnancy, mothers are visited monthly for prenatal health screening and are educated on prenatal care, nutrition, exercise, and stress management. After birth, the focus is on promoting the baby’s healthy growth and development and the mother’s health and well-being by establishing a medical home, tracking immunizations, promoting breastfeeding and nutrition, educating parents on early brain stimulation, screening for achievement of developmental milestones, promoting infant play and exercise, and enhancing parenting skills. Given this direct access to a large segment of low-income mothers, MOMS Orange County has a unique opportunity to screen for and address health issues such as gestational diabetes and maternal depression that can benefit from early interventions.

The mission of MOMS Orange County is to help mothers and their families have healthy babies by providing health coordination, education, and access to community services. MOMS Orange County’s vision is that all babies born in Orange County are healthy at birth.

Measures such as the percent of babies born at a low birth weight, percent of babies born premature, and the percent of babies admitted to the NICU were all markedly better for program participants when compared to many comparison benchmarks.

In collaboration with the UCI Program in Nursing Science, a logic model was developed providing a theoretical understanding of how the MOMS home visitation program contributes to the improvement in clinical outcomes. Following the development of the logic model, two research projects were funded to perform rigorous scientific research on two hypotheses on the MOMS Orange County model of care:

Hypothesis #1: MOMS Orange County model of care positively impacts birth outcomes in an low income at-risk population of pregnant women in Orange County.

Hypothesis #2: MOMS Orange County model of care positively impacts healthcare costs for births in Orange County for an at-risk population.

In November 2015, the UCI/MOMS research article was published. "A Community-Based Home Visitation Program’s Impact on Birth Outcomes" was published in the American Journal of Maternal Child Nursing (MCN). MCN is a peer review journal and is very highly respected in the field of Maternal Child Nursing. The article represents four years of effort and time from many members of the MOMS staff and the UCI Program in Nursing Science.

MOMS Orange County has been recognized by the Health Care Agency of Orange County, the Children & Families Commission of Orange County, the California Department of Health Services, and the United States Congress for its innovative work in the community and impact on the health of mothers and babies in Orange County.

MOMS Orange County mothers are educated and empowered to make wise lifestyle choices that affect their health and their babies' health, as evidenced by the 2014-2015 outcomes of the Maternal-Child Health Coordination Program:

-Only 6.6% of babies were born at a low birth weight (U.S.-8.0%, CA-6.8%, O.C.-6.3% and Santa Ana-6.8%*)
-Only 7.3% of babies were born premature (U.S.-11.4%, CA-8.8%, O.C.-7.8% and Santa Ana-8.6%*)
-Only 7.9% of babies were admitted to the NICU (31% of O.C. babies required special care at birth**)
-93% of at-risk mothers did not develop gestational diabetes during their pregnancy
-96.3% of babies were breastfed at discharge from hospital (39.6% exclusively breastfed)
*2013 Birth data - March of Dimes PeriStats
**as reported by Orange County hospitals to the Office of Statewide Health Planning & Development in 2013