Improving Maternal Mortality Rates and Infant Health Outcomes

Why this investment

Families involved with Washington County’s Maternal Child and Family Program’s various home-visiting programs struggled to meet their health needs during the COVID-19 pandemic. The majority of these families are on the Oregon Health Plan, Medicaid, and face income challenges. The pandemic exacerbated the already complex needs of these families due to increased difficulties accessing normal care from an OB-GYN or pediatrician. Washington County’s Maternal Child and Family Program was able to address needs that would have normally been covered by a pediatrician, such as lactation support, weight monitoring, and providing blood pressure monitors for postpartum mothers.

To promote equitable decision-making at the project level, Washington County put together an ARPA Equity Steering Committee to take a first look at project proposals. After that, projects were connected with a community-based Racial Equity Advisory Group to collaborate with culturally specific organizations and ensure the implementation of equitable strategies from the start. The Healthy Births and Family Stability and Perinatal Health Equity projects worked with families with limited income, families with disabilities, and those who identify as Black, Indigenous, Latinx, immigrants, refugees, and other people of color. Washington County’s Public Health Department also used an equity assessment tool to ensure that the County was “​​not the ultimate decision maker and that we are sharing power with the community to engage in collaborative decision making,” Collett said.

What is this investment

Washington County’s Healthy Births and Family Stability and Perinatal Health Equity projects are a part of the County’s Maternal Child and Family Program. The Maternal Child and Family Program includes four home visiting programs: Nurse Family Partnership, Babies First, CaCoon, and Family Connects. The Healthy Births and Family Stability project is able to support these programs by allowing the County to provide more families with diapers and resources for their infants, as well as in-home medical care. Additionally, by increasing the number of community health workers in Washington County through the Perinatal Health Equity project, the County was able to increase perinatal health engagement for Black and low-income families. The County also used ARPA funds to contract out to community providers to enhance their traditional health worker model, worked with school districts on social-emotional learning, and conducted parenting education.

Centering equity in the program

The Healthy Births and Family Stability and Perinatal Health Equity projects were designed to support low-income families, families with disabilities, Black, Indigenous, and Latinx families, immigrants, and refugees. The County continuously sought feedback from families in the community to ensure the program best met their needs. A community needs assessment revealed that along with nurses, people wanted home-visiting health workers from similar cultural, social, and linguistic backgrounds. A parent advisory council for the Maternal Child and Family Program also provided helpful feedback about expanding the home visiting support from only nurses to community health workers and doulas as well. The County is also restructuring its prenatal to three advisory councils, first ensuring that childcare, food, and stipends are all in place to support parental involvement. After pushing back on some statewide programs solely focused on nurse home-visiting, Rebecca Collett says, “We’re now coming in more as a support to the community, and the community is driving the decision-making.” This approach drove the County to advocate for the culturally responsive home-visitation care the community needed.

Washington County worked with an equity-focused organization to adapt the job description of community health workers and public health nurses to attract more linguistically and culturally diverse applicants. This change has led to Washington County hiring more bilingual nurses, allowing them to provide more culturally sensitive support to Washington County’s increasing Spanish-speaking population. Washington County is also hoping to increase nurse diversity by working with schools to engage young people from culturally and linguistically diverse communities.

Additional ARPA funding went to providing support to the Hillsboro Medical Center, which is a high-needs area in the epicenter of Hillsboro. This support included providing an on-the-floor labor and delivery community health worker who works side-by-side with families to help advocate for their needs.

Outcomes to date

Washington County has conducted nearly 5,000 nurse home visits in its first year, with 83 percent of families served being Hispanic. The Portland Diaper Bank has recognized Washington County as a known diaper desert, with few sustainable, accessible, and low-barrier resources for families. To combat this lack of supply, Washington County has provided 96,400 diapers to families served by their home visiting services.

Toward transformative change

In 2023, Washington County’s Maternal Child and Family Program received a $4.8 million federal grant from the Office of Health Equity to expand its doula and community health worker services. This $1.2 million annual grant is four years long, with the potential of a fifth-year renewal, and will allow the County to continue operations of the Healthy Births and Family Stability and Perinatal Health Equity projects after ARPA funding runs out. Collett highlights the importance of working with the community to implement public health programs. “If we bring the community voice to the table, then we are going to have a lot more success and a lot more movement in the perinatal maternal infant health world,” Collett says.