The MOM Program: Home Visiting in Partnership With Pediatric Care
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SUPPLEMENT ARTICLE
The MOM Program: Home Visiting in Partnership With
Pediatric Care
AUTHORS: Jerilynn Radcliffe, PhD,a,b Donald Schwarz, MD,
MPH,c and Huaqing Zhao, PhD,d on behalf of the MOM abstract
Program
OBJECTIVE: Home visiting programs aim to improve child health, re-
aDepartment of Pediatrics and dDepartment of Biostatistics,
duce developmental risks, and enhance use of community resources.
The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania;
bPerelman School of Medicine, University of Pennsylvania, How these programs can work in collaboration with pediatric practice
Philadelphia, Pennsylvania; and cDeputy Mayor for Health and has been understudied. The MOM Program was a randomized con-
Opportunity, Office of the Deputy Mayor for Health and Opportunity, trolled trial of an innovative home visiting program to serve urban,
City of Philadelphia, Philadelphia, Pennsylvania
low-income children. Program aims included promoting child health
KEY WORDS
child, development, home visiting, infant, mothers, well-child
through regular pediatric visits and enhancing school readiness
visits through developmental screenings and referrals to early intervention.
ABBREVIATIONS The objective of this report was to describe the partnership with the
CI—confidence interval pediatric community and selected program results.
OR—odds ratio
METHODS: A total of 302 mothers were enrolled in the program at the
Dr Radcliffe conceptualized and designed the study, coordinated
and supervised the data collection, and drafted the initial
time of children’s birth. Eligible infants were full-term, without iden-
manuscript; Dr Schwarz participated in the conceptualization tified neurologic/genetic disorder or ICU intervention, and from high-
and design of the study, and reviewed and revised the poverty zip codes. A total of 152 were randomized to the home visiting
manuscript; Dr Zhao conducted the initial analyses and
program, with 9 visits over 3 years, scheduled before well-child visits;
reviewed and revised the manuscript; and all authors approved
the final manuscript as submitted. 150 were randomized to the control condition with no home visits.
This trial has been registered at www.clinicaltrials.gov Medical records and case notes provided information on pediatric
(identifier NCT00970853). appointments kept and program outcomes.
www.pediatrics.org/cgi/doi/10.1542/peds.2013-1021O RESULTS: Eighty-nine percent of both groups were retained throughout
doi:10.1542/peds.2013-1021O the 3-year program; 86% of the home-visited group received at least 7
Accepted for publication Aug 26, 2013 of the 9 planned home visits. Home-visited mothers were .10 times as
Address correspondence to Jerilynn Radcliffe, PhD, Department likely to keep pediatric appointments, compared with those not
of Pediatrics, The Children’s Hospital of Philadelphia, 3400 Civic visited. Barriers to service access were varied, and theory-driven
Center Blvd, CHOP North 1461, Philadelphia, PA 19104. E-mail:
approaches were taken to address these.
radcliffe@email.chop.edu
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). CONCLUSIONS: Home visiting programs can provide important part-
Copyright © 2013 by the American Academy of Pediatrics
nerships with pediatric health care providers. Integrating home visit-
ing services with pediatric care can enhance child health, and this
FINANCIAL DISCLOSURE: The authors have indicated they have
no financial relationships relevant to this article to disclose. subject warrants expansion. Pediatrics 2013;132:S153–S159
FUNDING: We are very grateful for the support of The William
Penn Foundation, The Robert Wood Johnson Foundation, The
Claneil Foundation, an anonymous donor through The Children’s
Hospital of Philadelphia, and Pew’s Home Visiting Campaign.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated
they have no potential conflicts of interest to disclose.
PEDIATRICS Volume 132, Supplement 2, November 2013 S153
Downloaded from www.aappublications.org/news by guest on March 10, 2021Home visiting programs are widely health services may be part of the in- Other key features of the MOM Program
recognized as important for promoting tervention process. Representative pro- include: 9 home visits, each occurring just
healthy outcomes in mothers and chil- grams include a 4-visit, randomized before a scheduled pediatric well-child
dren. Targeted for mothers who are controlled trial over 6 months to promote visit and including information de-
considered “at risk” for reasons of their breastfeeding and mothers’ manage- signed to increase mothers’ under-
age, income, or identified psychosocial ment of infant health problems12; a single standing of the purpose of the visit and to
issues, home visiting programs have home visit public health initiative to en- formulate any questions about their
reported success in improving child courage mothers to enroll in the Sup- child; use of a team of home visitors
and maternal health outcomes, delaying plemental Nutrition Program for Women, rather than a single visitor per family;
subsequent pregnancies, improving Infants, and Children13; an 8-session and weekly supervision meetings to
rates of maternal employment, and program (4 prenatal visits and 4 post- monitor the progress of all children en-
raising subsequent family income.1–5 natal visits spaced 2 weeks apart) over 2 rolled in the program. The final home
Home visiting programs differ greatly in months to promote maternal health14; visit occurred at infant age 33 months.
their aims, scope, and types of services and a 5-visit program over 12 months to Outcome assessment occurred at age 36
and resources they provide to parents; identify infant health problems and pro- months. Other program elements in-
they also differ in whom they target.2,6 mote receipt of immunizations.15 clude structured, model-driven check-
Some programs aim to improve the lists for each visit and use of regular
Another model for implementing a home
physical and mental health of mothers, reminder calls before home visits and
visiting program in partnership with pe-
before and after the scheduled well-child
such as increasing time to subsequent diatric care is that offered by the MOM
visits. Detailed records of attempts to
pregnancies and improving parenting Program (MOM is not an acronym but
contact mothers are kept by staff mem-
skills, whereas others address child simply the name of the program). As
bers, and these efforts are also dis-
health and development or attempt to reported earlier,16,17 the MOM Program is
cussed in the weekly staff meeting. Home
reduce child abuse. Services in these an innovative home visiting program
visitors included both lay workers and
programs may include a structured designed to serve urban, low-income
pediatric nurse practitioners. The entire
health or parenting protocol during mothers and children, evaluated home visiting team and supervisory staff
home visits, emotional support and as- through a randomized controlled trial. participate in troubleshooting regarding
sistance with referrals, or accompanying The primary aim of this trial was to making successful contacts with the
mothers and children to visits with ser- demonstrate whether participation in participant mothers. All activities are
vice providers. Accordingly, programs this home visiting program led to differ- prescribed in the program manual.
may provide parents with social support, ential changes in referral to early in-
linkages to resources, literacy education, The current report describes program
tervention and receipt of early
parenting coaches, role models, or expert retention and engagement, and the
intervention services. Earlier reports
help in maternal and child health and extent that completed home visits for
have described that those children
well-being.2 Those targeted by home vis- those in the intervention arm of the
whose mothers were randomized to re-
iting programs include teen mothers,7,8 MOM Program are related to completed
ceive the home visiting intervention
first-time mothers,3–5 mothers at risk for appointments for pediatric primary
compared with those in the control
care to illustrate partnership with the
child abuse,9 or mothers with a variety of group, which did not receive home visits,
pediatric community.
indicators of “risk” status.10,11 These were significantly more likely to be re-
programs are generally intensive in ferred to and receive early intervention.
terms of number of planned visits and METHODS
These referrals to early intervention oc-
broad in the scope of intended program curred in the context of children attend- The Human Subjects Committee of the
outcomes. ing well-child visits regularly. Attending Institutional Review Board of The
Although embracing pediatric health well-child visits was thus a key compo- Children’s Hospital of Philadelphia ap-
outcomes, home visiting programs nent of the intervention for those who proved and oversaw the conduct of this
have generally existed in parallel, had been randomized to receive home study.
rather than in partnership, with out- visits. The current report presents in-
reach efforts launched from pediatric formation on attendance for well-child Participants
practices. However, home visiting pro- visits for those in the intervention arm To be eligible for the study, mothers had
grams can target child health outcomes of the study and how this action relates to live in predetermined ZIP codes in
closely, and collaboration with child to the receipt of home visits. a large northeastern city with high
S154 RADCLIFFE et al
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poverty rates and had to have given birth child gender, level of education, employ- contact participant mothers, including
to a singleton healthy infant (weight ment status, receipt of public services, telephone calls to set up a home visit,
$2500 g; no identified genetic or de- and other social indicators. Members of home visits, telephone calls to remind
velopmental disorders). Recruitment the study team collected demographic mothers of upcoming primary care
was conducted in the postpartum unit information from the mothers through visits, and follow-up calls to determine if
of an urban academic hospital between interviews at study enrollment. mothershad keptthe scheduledprimary
July 2001 and January 2002. Partic- care visit or followed through with rec-
ipants were randomly assigned to ei- Program Retention ommendations. These program records
ther the intervention (n = 152) or Mothers who remained in the program included notation of which staff member
control (n = 150) conditions. The current from initial enrollment for 36 months completed each activity as well as the
report uses data only on the 152 in- were considered “retained” in the number of 5-minute time units spent on
tervention group mothers, who are de- program, regardless of the number of each activity. Program evaluation
scribed in Table 1. These were largely home visits that were completed. Only records were kept through the duration
high-school educated (mean 6 SD those mothers who asked to be taken of the study.
years of education: 12.0 6 1.9), African out of the program were discontinued.
American (94%), and in their early
Procedure
twenties (mean age: 23.1 6 5.6 years). Target Program Dosage
Of the children, 54% were female and To assess program involvement, re-
Similar to the approaches taken by
44% were first births. Most participants tention, dosage, and linkage to care, 2
Heinrichs18 and McFarlane et al,19 the
(74%) reported having $10 prenatal trained research assistants examined
target home visit dosage in the MOM participant charts for the intervention
visits. As described earlier,16,17 these
Program was set at, minimally, 75% group mothers and extracted and
mothers did not differ significantly from
completion of all planned home visits coded the aforementioned program
those assigned to the control group.
(eg, completion of at least 7 of the 9 implementation variables. Because
planned home visits in the first 33 mothers who had been assigned to the
Measures
months of the child’s life). control condition did not receive any
Demographic Characteristics home visits, there are no comparable
Demographic characteristics were as- Program Implementation data on program implementation for
sessed through a series of questions Program implementation was evaluated those individuals. Two checks for
regarding mothers’ age, race/ethnicity, by using staff records of all attempts to interrater reliability were conducted.
For the first 10 charts, research
TABLE 1 Comparisons of Participants Retained and Not Retained in the MOM Program Through assistants separately extracted and
Age 33 Months (N = 152) coded program implementation varia-
Baseline Variable Retained (n = 136) Not Retained (n = 16) P bles. Data were examined for con-
Maternal age, y 23.3 6 5.9 20.4 6 4.2 .06 sistency, and 95.3% agreement was
Maternal level of education, y 11.9 6 1.9 11.9 6 1.8 .97 attained. Discrepancies between the 2
No. of other children 1.0 6 1.3 0.5 6 0.6 .20
No. of months at residence 62.2 6 76.2 89.3 6 78.5 .06
coders were discussed, and necessary
No. of months pregnant when prenatal care started 2.9 6 2.0 2.8 6 1.2 .63 clarifications to coding categories were
Infant gestational age, wk 39.4 6 1.6 39.3 6 1.3 .82 agreed on. In a second interrater re-
Infant birth weight, g 3303 6 466 3246 6 367 .64
liability review, 1 research assistant
No. of prenatal visits .64
0 3 (2.0) 0 (0) independently coded a random 20% of
1–4 10 (7.4) 0 (0) all charts coded by the second research
5–9 17 (12.5) 2 (10.5) assistant; interrater reliability exceeded
$10 106 (77.9) 14 (87.5)
Pregnancy problemsa 41 (30.2) 2 (12.5) .14 95% agreement. Throughout the study,
Child gender .19 all data were double-entered and checked
Female 70 (51.5) 11 (68.8) for accuracy.
Male 66 (48.5) 5 (31.3)
Cesarean delivery 26 (19.1) 5 (31.3) .25 Data on linkage to primary pediatric
No. (%) other children in early intervention 9 (6.6) 0 (0) .52 care were available only for the in-
No. (%) other children with learning problems 7 (5.2) 0 (0) .54
tervention, home-visited mothers. Be-
Data are presented as mean 6 SD or n (%).
a Pregnancy problems include hypertension, gestational diabetes, infection, passed out, premature labor, delivery problem,
cause part of the home visiting
intrauterine growth retardation/inadequate fluid, and other. intervention involved calling mothers to
PEDIATRICS Volume 132, Supplement 2, November 2013 S155
Downloaded from www.aappublications.org/news by guest on March 10, 2021determine if they had kept their primary fit statistics of relevant nested models. enrolled at baseline and assigned to
care appointments, it was necessary to The method of generalized estimating the intervention arm of the study but
avoid calling mothers assigned to the equations for binary outcome was then were not retained until the end of the
control group to obtain similar in- used to evaluate how the home visits program.
formation (to avoid contaminating the (complete versus incomplete) were re- Program dosage results for those
control group with additional encour- lated to primary care physician visits mothers receiving home visits are
agement to keep well-child visits). Data (complete versus incomplete). The odds presented in Table 2. Mothers who re-
on whether mothers had kept sched- ratio (OR) of having completed primary ceived the target dosage (ie, having
uled appointments were collected only care physician visits for previous com- completed at least 7 of the 9 planned
through maternal report on whether pleted home visits compared with pre- home visits; n = 130 [86%]) were
the visit had occurred and, therefore, vious incomplete home visits was also compared with those who did not re-
only from mothers in the intervention determined. ceive the target dosage (n = 22 [14%])
group and not those in the control to determine if systematic differences
group. The primary care providers for RESULTS
in baseline maternal characteristics
children in the MOM Program were Program Involvement, Retention, could be identified. Mothers who re-
scattered throughout the city, and and Program Dosage ceived the target program dosage
MOM Program staff were not equipped were found to be slightly older than
Results on maternal retention are
to obtain independent verification of those who failed to receive the target
presented in Table 1. Of the 302 moth-
attendance at each scheduled visit. dosage (23.3 vs 21.3 years; P = .05) and
ers originally enrolled in the MOM
Immunization data collected from pro- were more likely to have male children
Program, 89.7% (271) completed the
viders at the completion of the study (93.3% of mothers of male children
entire 33-month program, including
permitted verification of completed received full program dosage; P = .02).
136 (89%) of those in the intervention
visits, although information on in-
(home visiting) group. Mothers who Table 3 presents home visit completion
complete visits was collected only from
were retained in the intervention arm rates, as well as information on in-
the mothers in the intervention, home-
of the MOM Program for 33 months complete visits, cumulative dropouts,
visited group.
were found to differ very little in de- and missing participants. High rates of
Statistical Analysis mographic characteristics and other completed home visits were main-
variables from those who were also tained throughout the intervention,
The number of home visits and telephone
contacts made over the course of the
program and the time needed to com- TABLE 2 Comparisons of Participants Who Did and Did Not Receive Target Program Dosage in
plete contacts were tabulated and sum- Intervention Arm of the MOM Program Through Age 33 Months (N = 152)
marized by using standard descriptive Baseline Variable Engaged (n = 130) Nonengaged (n = 22) P
statistics. Logistic regression was used to Maternal age, y 23.3 6 6.0 21.3 6 4.1 .05
determine how program characteristics Maternal level of education, y 11.9 6 1.9 11.6 6 1.7 .35
No. of other children 1.0 6 1.2 0.9 6 1.1 .75
(ie, staff background, amount of time
No. of months at residence 63.3 6 75.4 75.5 6 84.4 .49
expended for each participating mother, No. of months pregnant when prenatal care started 2.9 6 2.0 2.8 6 1.3 .61
number of telephone calls and home Infant gestational age, wk 39.4 6 1.6 39.5 6 1.2 .84
visits), and demographic characteristics Infant birth weight, g 3301 6 478 3272 6 311 .72
No. of prenatal visits .75
(ie, mother’s age, first-time mom status, 0 3 (2.3) 0 (0)
child gender) predicted program dos- 1–4 10 (7.7) 0 (0)
age. Model fitting procedures were con- 5–9 16 (12.3) 3 (13.6)
$10 101 (77.7) 19 (86.4)
ducted by first testing single covariates Pregnancy problemsa 40 (30.8) 3 (13.6) .13
with the use of simple logistic regression Child gender .02
models and then using backward selec- Female 64 (49.2) 17 (77.3)
Male 66 (50.8) 5 (22.7)
tion procedures in which all single sta-
Cesarean delivery 29 (22.3) 2 (9.1) .25
tistically significant covariate terms (P , No. other children in early intervention 9 (6.9) 0 (0) .57
.10) were included as candidates in No. other children with learning problems 7 (5.4) 0 (0) .73
a multiple logistic regression model. Data are presented as mean 6 SD or n (%). “Target program dosage” was defined as having completed at least 7 of the 9
planned home visits.
Nonsignificant terms were dropped from a Pregnancy problems include hypertension, gestational diabetes, infection, passed out, premature labor, delivery problem,
consideration iteratively based on overall intrauterine growth retardation/inadequate fluid, and other.
S156 RADCLIFFE et al
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with findings ranging from 82% (at age were found between the total amount of home visit (OR: 10.77 [95% confidence
4 months) to 91% (at age 6 months). time staff spent with each family per interval (CI): 6.05–19.17]; P , .0001).
Relatively few mothers dropped out of month, averaging 13.5 6 2.05 minutes
the home visiting program, and they for those receiving full dosage, and Predictors of Involvement
did so at fairly even rates throughout 12.1 6 5.1 minutes for those who did not Table 6 presents the final logistic re-
the duration of the program. receive full dosage. gression model predicting engage-
ment. The final multivariable logistic
Program Staff and Activity Program Results regression model showed that re-
During the 3-year program, there was Table 4 presents rates of completed ceiving the targeted dosage of the
no turnover in home visiting staff. No home and primary care provider visits home visiting intervention was associ-
statistically significant differences were throughout the intervention. Rates of ated with the total amount of staff time
found in measures of staff activity for completed well-child visits ranged (OR: 1.13 [95% CI: 1.065–1.208]), the
those mothers who did and did not re- from 26% (at age 30 months) to 90% (at number of home visits (OR: 0.74 [95%
ceive target program dosage. Mothers age 6 weeks). Rates of completed home CI: 0.599–0.924]), and child gender
who received the target program dos- visits and primary care provider visits (male versus female; OR: 3.84 [95% CI:
age received 2.25 6 0.84 follow-up calls were generally parallel, with excep- 1.171–12.64]).
per month compared with 2.19 6 1.26 tions at 15 and 30 months of age.
follow-up calls for mothers who did not Table 5 presents the logistic regression DISCUSSION
receive the full program dosage. The model between completed home and
actual numbers of home visits per medical care visits. The odds of having These results illustrate the important
month were similar: 0.51 6 0.13 home a successful health care provider visit role that home visiting programs can
visits for those receiving full program when there was a previous successful have in promoting child health outcomes
dosage; 0.60 6 0.32 home visits for those home visit were 10.77 times higher in partnership with pediatric care. For
not receiving the full dosage. Likewise, than that of having a successful health those mothers in the intervention who
no statistically significant differences care provider visit without a successful received regular home visits for their
child’s first 33 months, completing
a home visit was associated with a no-
TABLE 3 Home Visits Completed Throughout Intervention (N = 152) tably higher rate of pediatric visit com-
Child Age Completed Home Visits Incomplete Home Visits Cumulative Dropouts Missing pletion compared with those mothers in
6 wk 136 (89.4) 14 (9.2) 2 (1.3) 0 (0.0) the intervention group who did not re-
4 mo 125 (82.2) 21 (13.8) 4 (2.6) 1 (0.7) ceive a home visit just before a sched-
6 mo 138 (90.8) 9 (5.9) 5 (3.2) 0 (0.0)
9 mo 131 (86.1) 15 (9.9) 6 (4.0) 0 (0.0)
uled pediatric appointment. Attending
12 mo 133 (87.5) 11 (7.2) 8 (5.3) 0 (0.0) well-child pediatric visits is key to over-
15 mo 131 (86.2) 12 (7.9) 9 (5.9) 1 (0.7) all health and developmental monitoring
18 mo 135 (88.8) 5 (3.3) 12 (7.9) 1 (0.7)
and the provision of needed health or
24 mo 132 (86.8) 5 (3.3) 14 (9.2) 1 (0.7)
30 mo 129 (84.9) 4 (2.6) 15 (9.9) 4 (2.6) developmental intervention services.20
Data are presented as n (%). Earlier research on MOM Program out-
comes17 found that, despite equivalent
amounts of developmental delay in the
TABLE 4 Completed Home Visits and PCP Visits (N = 152)
children of the home-visited and non–
Child Age Completed Home Visit Completed PCP Visit home-visited mothers, those children
6 wk 136 (89.5) 137 (90.1) assigned to the home visiting condition
4 mo 125 (82.2) 123 (80.9)
6 mo 138 (90.8) 127 (83.6)
were significantly more likely to be re-
9 mo 131 (86.2) 116 (76.3) ferred to and receive early-intervention
12 mo 133 (87.5) 117 (77.0) services by 33 months of age. The cur-
15 moa 131 (86.2) 91 (59.9)
rent results show that the home visiting
18 mo 135 (88.8) 117 (77.0)
24 mo 132 (86.8) 125 (82.2) program also promoted primary care
30 moa,b 129 (84.9) 40 (26.3) attendance, an essential precursor to
Data are presented as n (%). PCP, primary health care provider. children receiving these important early-
a No immunizations were given to children at these visits.
b This visit was primarily used to monitor children’s enrollment into early intervention or transition into 3- to 5-year intervention services. The relatively high
programs. rate of completed well-child visits is not
PEDIATRICS Volume 132, Supplement 2, November 2013 S157
Downloaded from www.aappublications.org/news by guest on March 10, 2021TABLE 5 Results of Logistic Regression Model With Generalized Estimating Equation Relating Results from this randomly assigned
Home Visit Completion With Completed Medical Care Visits
intervention trial show promise for how
Parameter Estimate SE z OR (95% CI) P home visiting programs can augment
Visit 20.32 0.03 29.71 0.73 (0.68–0.77) ,.0001 pediatric care for children. By timing
Completed home visits 2.38 0.29 8.08 10.77 (6.05–19.17) ,.0001
home visits to occur just before pedi-
atric office visits, mothers can be more
TABLE 6 Final Logistic Regression Model Predicting Program Participation motivated to keep appointments and be
Parameter Estimate SE Wald chi-square OR (95% CI) P better equipped to use these visits
Total time 0.13 0.03 15.43 1.13 (1.07–1.21) ,.0001 optimally by understanding what to
Completed home visits 20.30 0.11 7.13 0.74 (0.60–0.92) .008 expect at the visits and to have for-
Child gender, male vs female 0.67 0.30 4.93 3.85 (1.17–12.64) .030 mulated in advance their questions for
The C statistic for the model is 0.81, indicating high goodness of fit for this model. Variables initially entered were type of staff,
staff activity type, staff time spent on outreach, maternal demographic variables, and child gender.
their health care provider. Future home
visiting programs may further expand
typically reported in reports from home American, from a defined geographic partnerships with pediatric care pro-
visiting programs. In a comprehensive urban East Coast region. These factors viders by reinforcing patient/family
review of 9 high-quality home visiting may limit the extent that conclusions can education provided at each visit and
programs,2 only 1 program, the Early be extended to programs serving moth- supporting mothers in monitoring the
Start program in New Zealand, reported ers in other geographic regions or to health status of their children. By
similarly high levels of completed pri- those serving mothers with a wider race/ extending the “reach” of pediatric care
mary care visits over 36 months.10 ethnicity range. However, because others beyond the office into the community
and homes of vulnerable families, pe-
One unexpected finding from this have described low rates of program
involvement among urban, low-income, diatric health resources can be opti-
analysis was 2 age points (15 and 30
African-American mothers,21 the high mally deployed. Similarly, by working in
months) when the association between
rates of retention and dosage in this partnership with pediatric practices,
completed home visits and well-child
care visits dropped. Although pro- sample are noteworthy. Another limita- home visiting programs can increase
gram staff encouraged mothers to tion is that unequal sample sizes were the likelihood of achieving targeted
make and keep these appointments, used in the analyses, which is due to the health outcomes for children.
mothers reported experiencing par- small sample size overall and to the rel- Although not qualifying for Maternal, In-
ticular difficulty in making appoint- atively high rates of maternal in- fant, and Early Childhood Home Visiting
ments for these visits. The American volvement within the home-visited funding as one of its “evidence-based”
Academy of Pediatrics (20) recom- intervention group. A related study models,6 a replication of the MOM Pro-
mended a visit at 15 months, although limitation is the small size of the pro- gram is underway in other areas with
this visit did not include routine gram and its staff. Programs with high rates of poverty in Philadelphia
immunizations. Although not recom- a larger number of staff members may through the Office of the Deputy Mayor
mended by the AAP (20), the program have more challenges in keeping staff for Health and Economic Opportunity, di-
included a suggestion for this visit for motivated and persistent in outreach rected by one of the study authors (DFS).
assuring that children aged 0 to 3 years efforts. The relatively small number of The replication program uses revised
in early-intervention programs who staff of the MOM Program does not al- training materials and an updated man-
were approaching the critical 36-month low for examination of specific home ual and reporting system. In establishing
transition to the 3- to 5-year-old pro- visitor characteristics that might be this replication, the program gained co-
gram had information on making that related to maternal involvement, such operation from local pediatricians in ways
transition.20 Mothers reported that the as race or educational background.22 similar to those used in the original pro-
office staff of the health care providers Finally, data on the completion of pe- gram. Presentations about the MOM Pro-
often discouraged them from these diatric office visits were collected only gram were given to local pediatric groups
visits or simply refused to offer on the home-visited mothers because regarding the importance of child de-
appointments to children at these ages we did not wish to violate the “control” velopment screening and early education
unless they were in ill health. nature of the initial group assignment through Grand Rounds presentations and
Limitations of the current study include and draw more attention to visit com- conferences. In addition, written informed
the use of a single cohort of mothers who pletion among those in the control consent was obtained from each partici-
were predominantly low-income African group. pant to allow letters documenting the
S158 RADCLIFFE et al
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child’s developmental progress to be for their patients, such as reviewing CONCLUSIONS
shared with his or her primary care lead screening at the 9-month home visit
Home visiting programs can provide
provider. Finally, observations from or introducing measles vaccination at
important partnerships with pediatric
the program are shared with pediatric the 12-month home visit. Careful plan-
health care providers. Integrating home
and obstetric staff throughout its ning with the local pediatric community
duration. Local providers have been is essential in the development and fine- visiting services with pediatric care can
appreciative of the program’s re- tuning of collaborative home visiting enhance child health, and warrant ex-
inforcement of upcoming procedures initiatives. pansion.
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PEDIATRICS Volume 132, Supplement 2, November 2013 S159
Downloaded from www.aappublications.org/news by guest on March 10, 2021The MOM Program: Home Visiting in Partnership With Pediatric Care
Jerilynn Radcliffe, Donald Schwarz and Huaqing Zhao
Pediatrics 2013;132;S153
DOI: 10.1542/peds.2013-1021O
Updated Information & including high resolution figures, can be found at:
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Downloaded from www.aappublications.org/news by guest on March 10, 2021The MOM Program: Home Visiting in Partnership With Pediatric Care
Jerilynn Radcliffe, Donald Schwarz and Huaqing Zhao
Pediatrics 2013;132;S153
DOI: 10.1542/peds.2013-1021O
The online version of this article, along with updated information and services, is
located on the World Wide Web at:
http://pediatrics.aappublications.org/content/132/Supplement_2/S153
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