HEALTH & COST IMPACT OF MATERNAL-CHILD ADVOCATE SERVICES

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Home visits by a team of nurses and community residents trained as Maternal Child Health Advocates (MCHAs) can provide effective and culturally sensitive intervention to improve health outcomes for inner. city mothers and infants. If successful, this innovative model of health care delivery would address the persistently high U.S. infant mortality rates more cost-effectively than professional nurses' home visits. This randomized trial of 125 intervention and 125 control infant-mother dyads will evaluate the maternal and infant health outcomes and infant health costs of REACH-Futures, a project that provides home visits by a nurse-MCHA team in a low income community with high infant mortality. Mothers are recruited prenatally or immediately after delivery, and services are provided until the infant is twelve months old. The MCHA-nurse team approach is based on the WHO Primary Health Care model which is used widely in developing countries to facilitate access to health care. The content of the intervention and the training of the MCHAs is based on an ecological model of interrelated maternal, infant, and social-environmental factors that interact over time to affect maternal and infant outcomes. A strong theoretical base should make the program readily replicable throughout the nation. Compared to the control group, mothers in the intervention group are predicted to attain more favorable maternal psychological well-being, better coping skills, and higher utilization of prenatal, family planning and preventive postpartum care. Infants in the intervention group should show more optimal health care utilization, favorable growth and development, fewer preventable mortalities, less instances of abuse and neglect, and fewer accidents. Although infants may not experience fewer illnesses, earlier recognition through preventive health care and prompt treatment should reduce the duration of illnesses, hospitalizations, as well as the cost of acute care visits. Consequently, overall health care costs in the first year of life are expected to be lower for the intervention infants than the control infants. This innovative health care delivery intervention has not been widely used and evaluated in the U.S., especially for inner city minorities. If we can demonstrate that the intervention is effective and lowers costs through a careful evaluation, our model would be transferred to other inner city sites throughout the nation.