For Keri Morrill, working as a community health worker (CHW) at North Country HealthCare for the Arizona Health Start Program in Flagstaff for the past 11 years has been much more than a standard, 40-hour-a-week job.
Her work brings her into her clients’ lives, where she does home visits, goes with them to appointments, attends births, and much more. She meets with each client several times per month while they are enrolled in the Health Start Program, walking with these mothers through their pregnancy, birth, and the first two years of their child’s life.
When she has a client in need, Morrill uses her vast experience and extensive connections to assist them. Sometimes, she checks an online Flagstaff Facebook page to find people willing to donate baby goods or she stops by the local Cedar Closet thrift store, where the Assistance League of Flagstaff loads up her RAV4 with baby supplies, furniture, or anything the mother may need.
“I am trying to better a person’s situation,” Morrill said. “They didn’t try to get in that situation. If they don’t get a leg up, they won’t be able to get out of it.”
Evaluating Health Start’s Impact from 2006 to 2016
Morrill is just one of the many Health Start CHWs making a difference for high risk mothers throughout Arizona. A recently published Health Start Program Evaluation Impact Report details the impact of the CHW program on the health of mothers, infants, and young children.
Authorized by Arizona Department of Health Services, the Health Start Program Evaluation Impact Report authors are: Samantha Sabo, associate professor, Northern Arizona University’s Center for Health Equity Research (CHER) and the Department of Health Sciences; Kelly McCue, senior research coordinator, CHER; Patrick Wightman, lead analyst, Center for Population Science and Discovery, University of Arizona; Dulce Jiménez, research coordinator, CHER; and Sara Rumann, Health Start Program Manager, Bureau of Women’s and Children’s Health, Arizona Department of Health Services.
Health Start Program findings
The evaluation team analyzed Health Start enrollment data and state birth certificate records from 2006 to 2016 to assess the program’s impact on low birthweight and preterm birth outcomes, prenatal care attendance, and on-time child immunizations for Health Start participants. They compared records from 7,212 women enrolled in Health Start to 53,948 women not enrolled in the program.
The study found that mothers who participated in the Health Start Program had better health outcomes compared to mothers who did not participate in the program, with particularly positive results among mothers from vulnerable populations.
For example: Teen mothers enrolled in the program had significantly fewer preterm births among teens, American Indian mothers and mothers with a pre-existing health risk such as diabetes or hypertension had fewer low birthweight births, and Latina mothers had fewer very low birthweight and extremely low birthweight births.
Low birthweight outcomes are relatively rare occurrences, but their reduction in adverse birth outcomes can result in substantial economic savings. For example, the early healthcare costs associated with a surviving infant with extremely low birthweight is approximately $202,700 compared to $1,100 for an infant with healthy birthweight.
While there were only 16 fewer cases of extremely low birthweight among Health Start mothers compared to women not enrolled in Health Start, this reduction translates to an estimated cost savings of $3.2 million for the state. The researchers note that these costs, when they occur in already disadvantaged populations such as Health Start participants, would likely magnify and multiply over time.
“CHWs are a global workforce supporting mothers and children from every background and society,” Sabo said. “CHWs as home visitors in Arizona are a highly trained workforce who facilitate safer, more supported pregnancies and babies born healthy and ready to thrive.”
The study also found that the children of mothers in the Health Start Program were more likely to have all their immunizations competed by age 2, compared to children whose mothers were not enrolled in the program.
“The results highlight the positive impact CHWs can have in a number of areas and the findings with respect to childhood immunization are especially encouraging,” Wightman said. “Of the outcomes and behaviors we looked at, facilitating vaccine take-up among children is where CHWs probably have the most direct influence and where, not coincidentally, I would say, we also find the largest effect, relative to the comparison groups.”
Wightman said that Health Start Program families are still showing higher rates of adherence to CDC recommendations several years after participation, which underscores the lasting and long-term impact of the program.
“The key findings of the Arizona Health Start Program Evaluation Report illustrate that participation in the CHW-centered home visiting intervention has a statistically significant positive impact on the health and wellbeing of Arizona mothers and children, especially those affected by health disparities,” Rumann said. “The findings in the report will assist the Arizona Health Start Program to strengthen and expand services to additional vulnerable populations and to enhance education and additional resources to support positive maternal and child health outcomes.”
What did the researchers recommend?
The report authors found that because of their unique ability to be in a client’s home consistently, CHWs are able to educate clients on the importance of immunizations and to discuss their fears and safety concerns frankly, breaking through any barriers through consistent support, care, and encouragement.
- Integrating CHWs as a cost-effective healthcare workforce in community-based and clinical settings.
- Supporting CHWs as primary interventionist, to work with Latina, American Indian, rural-residing, and teen mothers to improve birthweight, prenatal care utilization, and child immunization uptake.
- Providing CHWs with additional resources and training to support their capacity to connect with each client more frequently during pregnancy, including before and after each prenatal care appointment.
- Developing and expanding transportation assistance to all Health Start Program sites to address a potential barrier to perinatal care services (e.g. prenatal care visits, child immunization appointments).
- Strengthening education topics covered by CHWs (e.g., healthy weight, pre-existing health conditions).
“It’s long overdue for CHWs in Arizona to be included in any team or organization serving pregnant women and postpartum women,” Sabo said. “If there were a magic bullet, it is a Health Start CHW home visitor who provides families relevant and trustworthy information and serves as the link to the community resources needed for a healthy life.”
Creating a path for CHWs to continue their education
Throughout her career as a CHW in the Health Start Program, Morrill has assisted almost 700 high-risk mothers. She visits her clients regularly and educates them on nutrition, breastfeeding, safety, and baby milestones. Morrill is a certified car seat technician, is trained in infant massage, and is a doula.
“Most [Health Start mothers] look at me as a friend, a confidant. They feel safe telling me about some of their most personal stories, which is humbling to me,” Morrill said. “ … I always praise them, and I try to give them tips and encouragement. When I see them doing something positive, I try to point that out.”
To help her clients to be even more successful, Morrill has gone back to school to become an international board certified lactation consultant.
As a single mother of two children, one who was premature and had complications at birth, Morrill said she knows how important it is to have someone invest in you and to assist you when you need it most.
“I am a community health worker, but I feel I am a bit of a counselor as well,” Morrill said. “ … With this job, I feel like I found my purpose in life.”
“Community health workers like Keri change the world. They understand better than any health professional what mothers are feeling and experiencing,” McCue said. “I am blown away by how much effort and time and love go into making a difference for every client, and it really is no wonder that we are seeing the positive impact of Health Start community health workers in the data. We knew it was true, but now we can shout about it!”
McCue hopes these findings will encourage program expansion within Arizona, and influence other states to create or expand similar programs in their communities.