News > What We’ve Learned: Clearing the Hurdles to Prenatal Care

What We’ve Learned: Clearing the Hurdles to Prenatal Care

Dasher Community Health Workers (CHWs) have been connecting Medicaid members with prenatal care since our pilot program began November 1, 2016.  We’ve learned a lot since then and have begun to think of connecting members with the care they need as similar to running hurdles – you need to get over the one in front of you before you even begin to think about the next one. The key to engaging this population is to determine the first hurdle, set a goal, and work from there, rather than providing too much information at once.

We’ve said before that scarcity of resources is an overwhelming prospect. Add a pregnancy to the mix, and it becomes even more overwhelming. So, Dasher’s CHWs often put quite a bit of legwork into making a contact. When the health plan identifies a member, we begin by mailing an introductory letter, followed within two to three days by a phone call. It requires persistence because an address or phone number may have changed and members are often wary of who we are. Our CHWs are not social workers. They are people with connections in the community, carefully trained and matched with the insured by geography and personality. In fact, we personality test all our CHWs for certain attributes that will make them successful with the population we serve. The goal of the pilot program is a healthy, full-term pregnancy, and the way to achieve this goal is to build relationships with the moms as well as the family units, if present. The CHW introduces herself and does a risk assessment. She asks the mom-to-be what her goals are, and then they develop a plan to eliminate barriers to meeting those goals, together.

Our CHWs have learned the key to building a trusting relationship with the people they serve is the same as building any relationship:

  • Treat people with respect.
  • Listen. We might think we know what a pregnant woman needs, but listening first helps us discover which needs are handled, and which are not.
  • Ask about stressors, worries, and fears. This allows us to anticipate and work on alleviating barriers to success.

Dasher CHWs meet with members throughout the pregnancy and two months postpartum. To date, we’ve found a number of common barriers to care. We’ve had members who haven’t kept appointments because of an outstanding balance, but a quick phone call revealed it was not a balance the member had to pay. Some members aren’t aware they need to pick a pediatrician before the baby can be discharged from the hospital. So, we provide a list of pediatricians in the member’s health plan before delivery so the mom can choose.  The immunization schedule can also be overwhelming. We provide a refrigerator magnet that lists infant immunizations and when they are due. One of the biggest hurdles can be housing. CHWs can connect members with community resources that can help them secure housing. Dasher reports case information back to the health plan, which helps its case managers guide the member from a clinical perspective. A strong CHW team with the patience to listen, build relationships, anticipate needs, and provide timely, easy-to-digest information will overcome almost any hurdle faced.

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