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Home visits offer window into mother, infant well-being

December 21, 2012 — A visit to homes of disadvantaged mothers and at-risk newborns can provide a health care team with unique insights into how a family is faring—more than might be revealed at often rushed visits at a clinic or hospital.This was one of the insights shared at the 7th Annual Maternal and Child Health Symposium, titled “Home Visiting: Delivering the Goods,” held November 30, 2012 in FXB G-12. The event was sponsored by Harvard School of Public Health’s Maternal and Child Health/Children, Youth, and Families Concentration.“Going to a person’s home may be a very effective way of providing personalized care” said event organizer Marie McCormick, Sumner and Esther Feldberg Professor of Maternal and Child Health in HSPH’S Department of Society, Human Development, and Health. Visits to homes can be eye-openers, said Deborah Allen, SM ’80, SM ’86, SD ’98, director of the Bureau of Child, Adolescent and Family Health of the Boston Public Health Commission, who moderated the symposium. “When you see families in the medical setting, the focus is on medications rather than how the treatment fits into their life.”Home visits play a key role in the health care reform movement. Funding has been allocated to states under the Affordable Care Act (ACA) to establish maternal-child home visitation programs based on models proven effective at enhancing parenting skills and improving child development Massachusetts, for instance, received $43 million.

The ACA funding underscores the need to determine which home visits are most effective. “There is this opportunity now [with the funding] and it’s terribly important not to waste it,” said Karin Downs, assistant director for clinical affairs in the Division of Perinatal, Early Childhood and Special Health Needs of the Massachusetts Department of Public Health.

But home visits can be used for other purposes.  For instance, Margaret Parker MPH ’10, a pediatric neonatologist, discussed a Boston Medical Center an educational program she directs in which pediatric residents rotating through the neonatal intensive care unit also visit discharged patients in their homes. Elizabeth Woods, professor of pediatrics at Harvard Medical School, told of successes with home visits conducted as part of the Community Asthma Initiative she heads at Boston’s Children’s Hospital to improve medication use and reduce emergency room visits and hospitalization. Other speakers discussed how home visits can help new moms with breastfeeding and infant bonding, help monitor for mental health issues or violence in the home, and reduce maternal isolation by helping new mothers connect with other parents.

Despite many positives associated with home visits, the speakers said there are also challenges—in funding, reimbursement, and determining the most effective team composition (physician, social worker, community health workers, and/or paraprofessionals) for home visits.

“Home visits are not a panacea,” said Downs. “We’re one piece of the puzzle. We can’t do it without good communication in the community, good political will, and good coordination of care between agencies.”

Watch a video of the symposium.

–Marge Dwyer

photo: iStock.com/James Pharaon