This blog, on access to maternal and child health care, is part of the Building New Foundations series.
The COVID-19 pandemic, along with the economic downturn it brought and the racial inequities it exacerbated, exposed cracks in our system of early childhood services. Across early care and education, family support, maternal and child health, and other family-focused services, these events have heightened the need for policy leaders, providers, advocates, and families to work together to build new foundations for our youngest children, prenatal to age five.
To understand how early childhood systems responded to the crises, the Pritzker Children’s Initiative-funded National Collaborative for Infants & Toddlers (NCIT) interviewed 101 public and private leaders—from grassroots to state level—during the summer of 2020. Focusing on people in five states (IL, LA, MA, NM, OH) and on many tribal leaders as well as leaders who work with multiple tribes, we learned of opportunities to create a stronger system for the future.
The BUILD Initiative wrote blogs about the opportunities those on the front lines have seen in their particular areas of work—Part C Early Intervention, maternal and child health, race equity, and others. The blogs are based on interviews performed by Eva Carter, ECE Consultant; Harriet Dichter, BUILD Consultant; Kay Johnson, Johnson Group Consulting; Saeed Mirfattah, M.A., CPCC; and Gail Nourse, MSW.
The Pandemic Reminds Us That Access to Healthcare is a Basic Human Right That We Are Not All Afforded
The pandemic has shown me the awe-inspiring ability of maternal and child health professionals to grow and be flexible, and of the community to collaborate. I have seen, for example, the resiliency and resourcefulness of our staff as they transitioned to a virtual platform while keeping our patients engaged, all without missing a beat. And, I have witnessed the flexibility and unity of the healthcare system to convert to virtual health visits (i.e., telephone or web conferencing). I have observed large health care systems, such as ACCESS, engage in meaningful collaborations with local community-based organizations and work cooperatively with them to meet needs. For example, the Masks for MOMS campaign was established in partnership with key MCH stakeholders to ensure all pregnant and parenting women have access to washable fabric masks in order to attend medical appointments. Here are some other changes I have seen.
The Addition of Telehealth
Telehealth is an important innovation for our field as there are several barriers that have prevented our families from accessing care during the pandemic including transportation, lack of childcare, etc. Telehealth has permitted them to overcome some of those barriers. Overall, our encounters have shifted from in-person visits to virtual ones, but we are now reaching patients who were hard to reach in the past. Before, we would have to mail patients about their missed appointments, but since the pandemic, more patients are at home and it is easier to connect with them. Further, providers are getting to know patients well through telehealth, as this model of care allows for more time to engage patients in their personal setting and promotes the benefits of human connection. Additionally, our families enrolled in supportive programs, such as the Westside Healthy Start (WHS) program, have expressed sincere gratitude for our support during such unprecedented times and appreciated that the majority of their needs are being met. In my opinion, telehealth has addressed a gap in care that we didn’t think we could close. This is not to downplay the importance of physical touch, but the many benefits of telehealth are clear.
The far less optimistic side of telehealth, and one for which we must find solutions, is that many families we work with often lack WiFi, or even access to appropriate technological resources. Traditional places in which families used to access these types of resources, such as the local libraries, are now closed due to the pandemic. So, while I believe aspects of telehealth should be continued after the current crisis, as this is another way to reach people, we have to develop an environmental infrastructure that provides equitable access to WiFi, and other technological equipment (e.g., laptops and tablets) for all of our families. An example of this can be seen in our local schools systems here in Chicago. Educational leaders have partnered with Internet-based companies and have attempted to eliminate structural disparities by providing families with a “hot spot,” for learning purposes. Nevertheless, much more needs to be done to remove barriers to healthcare access and utilization.
Service Delivery Changes
With the enrollment of pregnant women into our WHS program remaining steady and the high degree of medical needs of the high-risk women we serve, we have had to institute a virtual consent form. This has required training of our patients, some of which has been done in person.
In addition to telehealth, staff have stayed connected with patients by using: their smart phones; Microsoft Teams to engage the community in providing information on some of the barriers families are experiencing (i.e., unemployment, food insecurity); and Zoom. Some patients use Facebook Messenger because they do not have a secure landline, but it is not HIPPA-compliant, so care must be taken. In addition, staff have been sending educational text messages and connecting patients with Text4baby to provide information about the perinatal health phase.
From an administrative standpoint, I feel more connected to my staff than ever before. While previously I was on-site and running from meeting to meeting, now I am able to connect with them and learn what the barriers to their success are and strategically create innovative activities for them to meet their overall professional goals.
We are all adapting to the virtual work and training environment. We have had to provide staff training on the use of technology with the MCH population. I did not anticipate the degree of support staff would need to get up to date on the tools needed.
Before the pandemic, we were participating in a training on implicit bias. Acknowledging the importance of health equity work, we decided to continue the training via Zoom. This has worked well, as have many other virtual MCH trainings we have found, for example, the online community health worker trainings provided by Texas Health and Human Services. What we have learned during this time is that we have to accommodate the learning styles of everyone. We have observed that meetings should not last longer than 1 to 1.5 hours and that learning objectives should be met in 20-30-minute chunks of time. We have found that this keeps staff engaged and eager to learn.
Through our Healthy Start program, we focus on women who want to get involved in a process that will address some of the barriers they experience in health care, the community, and in other ways. We teach them leadership, speaking, and advocacy skills and how to become involved civically. In this way, we have been able to position them through the MCH Family Council, which is supported by the Illinois Department of Public Health and EverThrive of Illinois. We convened this group during the pandemic to advise the state, and the women are still participating. For example, we recently had a conversation about reproductive health and access to family planning. We still are seeing women involved at the policy level, articulating their experiences and helping with solutions. These women are at the policy table and the community table. They are sharing resources and are on the front line. They are an important voice; they are vessels of communication and change.
This is not really new; our WHS program started working with both entities to capture the voices of families served about three years ago. There are several MCH Family Councils throughout Illinois; it is a great that the state understands the importance of these women serving on the council and the need to mobilize such an important group. Through our collaborative efforts, and engagement efforts on a state and national level, many of the women serving on the MCH Family Council have expanded their leadership skills and some now have jobs in community health organizations.
Quality Remains at the Forefront
Within our organization, we have continued to work to ensure that continuity of care is at the forefront. The quality workgroups are looking at the total number of prenatal patient on-site visits and telehealth appointments more closely to ensure that we are reaching out and meeting the needs of those patients in one of those two ways. Working in tandem with our internal MCH supportive programs, we are using a comprehensive approach to focus staff efforts on determining when patients will deliver and on providing the necessary support to get them ready for labor and delivery. The MCH programs are intentional about human connections, and work closely with women to ensure their post-partum care appointments are taking place, and educating them on the benefits of choosing a family planning option within the first six to eight weeks of delivery.
A New Future
Much of what I have witnessed during the pandemic has encouraged me to envision of a new future for maternal and child health. I propose the following:
- Seamless Care Within a System. As an MCH professional, I am big on the life course theory. If the foundation is cracked, nothing can be fixed. I think we should be at a point where we see the life course as a seamless point of care. But there are multiple examples of where this is not the case, for example, the mother’s transition from pregnancy to interconception or the child’s transition from infancy to early childhood. Every phase of the life span should build off and flow seamlessly into the other but current health policies do not explicitly state how this should happen nor do they support this notion in its entirety, which leads to inequities.
- Required Partnership with Community Organizations. Over the last few months, there has been a lot of talk about the need to partner with grassroots community-based organizations that focus on health and racial equity, diversity, and inclusion. In my opinion, there is now an opportunity for funders to strongly recommend that request for applications include language that impels backbone organizations to connect with organizations doing this type work to receive funding, instead of reinventing the wheel and duplicating services.
- Continued Use of Web-Based Platforms. Telehealth and other internet-based methods of communication should remain in use after the pandemic. We have learned that much can be accomplished in this manner and that in-person visits are not always necessary. As a parent of a special needs child, I have experienced how the pandemic has put an end to some services (e.g., occupational therapy, etc.). Utilizing virtual health visits has helped to address some of my child’s processing issues, and other issues that can be supported via technology.
- Training for Local, State, and Federal Leaders Serving the Maternal and Child Health Population. The pandemic has called for many healthcare leaders to change how they lead during a natural disaster. There are many leadership trainings that train healthcare leaders on MCH competencies, how to lead teams, and manage workflow processes, but there are no leadership trainings based on individual roles (e.g., director, manager, project manager, etc.). In order to see consistent leadership across the entire health system, there should be some level of standardization among roles. So, if I move to another state and acquire an MCH director position, my skills should translate to that role. As a leader, I should not feel that I need constant training to meet the base requirements of a of similar role in another state.
- Greater Unity at Federal Level. In partnership with our federal partners, I believe there is a way to minimize siloed work. HHS provides a lot of support to healthcare organizations; it would be helpful if all programs supporting women, children, and men had some level of intersectionality. Also, there is a need to develop universal standards or benchmarks and collect data that shows the effectiveness of community-based initiatives in addressing health disparities, as well as promoting family unity.
Toward Healthcare for Everyone
For marginalized families, there are so many barriers to accessing health care. As a society, if we begin to shift our focus to ensuring that all people are treated in accordance with the Declaration of Human Rights, barriers resulting from structural racism will be minimized. The pandemic has underscored the need for MCH leaders to work collaboratively with mothers, fathers, and families to advocate for equitable services and treatment based on the most basic human rights. As Article 25 of the Declaration notes: 1.) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control; and 2.) Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection.
About the Author
Timika Anderson-Reeves, MSW, CLC is Director of Maternal Child Health & Women’s Health Community Integration at Access Community Health Network (ACCESS) and serves as the Project Director of the ACCESS Westside Healthy Start program, in Chicago. With a focus on the maternal health and child health (MCH) population up to age of 18 months, and men’s health, she has worked in the field for over 17 years. Timika is passionate about assisting mothers, their male partners, and families with the essential resources that will enable them to have positive birth outcomes. She advocates on behalf of all families to ensure their voices are heard at the local, state, and national level and envisions a society free of inequities and based on the tenets of the Declaration of Human Rights.