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Group Services For Pregnant and parenting Women

An Exploratory Study

Executive Summary

Since First Steps expanded eligibility for maternity care to 185% of the Federal Poverty Level (FPL) in 1989, the number of deliveries funded by Medicaid has increased from 17,984 in FY 1988 to 36,915 in CY 2004. In addition to prenatal and postpartum medical care, First Steps clients are eligible for Maternity Support Services (MSS) which includes risk assessment, education, intervention, and counseling. Along with an increase in the number of clients served, annual payments for MSS rose from $360 per client in 2001 to $570 in 2005.

Offering services in a group setting instead of one-on-one has the potential to lower per client costs, improve patient outcomes, and increase patient social support. To explore group service provision, we studied seven programs offering group services to pregnant and parenting women in Washington State. Key program characteristics were identified through interviews and written surveys with group facilitators and program managers. We present our findings to serve as a resource for program managers and providers who may seek to offer services to pregnant and parenting women in a group setting.

Major Findings

Although each program targets a distinct population and offers a wide variety of services, similarities emerged. As summarized in Table 1, programs shared common characteristics regarding program leaders and group facilitators, recruitment methods, incentives, and partnerships with community organizations.

Program representatives indicated that most clients benefit from participating in group services. Pregnant and parenting women participating in group services benefit by:

• Creating their own social support network and relationships with peers.
• Realizing that others have similar issues and concerns.
• Receiving more information from facilitators and other group members.
• Learning and reinforcing new skills by participating in group activities, such as experiential learning exercises.
• Spending more time with providers and, thereby, receiving more education and services.

Providers also benefit by offering group services to clients. It is much more efficient for providers to present information once to a group than to do so repeatedly to individuals throughout the day. Serving more clients in a two-hour group session than in two hours of individual visits lowers per patient costs and allows providers to spend more time with clients.

Implementation Considerations

Adopting a group service model for MSS has the potential to contain per client costs while maintaining or increasing service quality. State program managers offered the following innovative and thoughtful ideas that could be implemented in the context of MSS.

• Assess client’s “readiness” for group participation using a screening tool.
• Receive assistance providing food and nutrition education by forming partnerships with programs, such as Women, Infants, and Children or the Expanded Food and Nutrition Education Program.
• Offer groups based on risk factors prevalent in the client population; for example, smoking cessation groups or diabetes support groups.
• Gain community support, recognition, and linkages to additional services by creating partnerships with other programs and organizations.
• Ensure groups are led by effective and skilled facilitators by keeping group service provision optional for MSS providers.

State program managers also considered the challenges of providing MSS in a group setting, including evaluating the effectiveness of group services with respect to birth outcomes, balancing MSS core services with the members’ interests, and ensuring providers understand the subtleties of providing group services. Measurable outcomes should be defined before program initiation. If possible, outcome measures should support program goals or relate to the client’s well-being. To keep clients engaged, First Steps’ Basic Health Messages might be incorporated into various group activities, such as games, group discussions, or experiential activities.

Offering MSS in a group setting is one way to provide high quality services while addressing increasing client caseloads and service costs. Key factors among these group services programs were visionary leaders, effective facilitators, incentives (particularly food), outreach conducted by recruiters known to members of the target population, and community partnerships.

Conclusion

The seven groups included in this study are particularly remarkable for their responsiveness to identified community needs. While community needs and target populations differed across the seven sites, similar strategies were developed to meet these needs and serve the clients. Group leaders implemented common strategies to achieve successful groups—groups with regular attendance, relevant and client-centered curricula, and the potential to be self-sustaining. Even more important, successful groups provide the benefits of social support to promote and reinforce healthy behaviors, socialization and personal development, education and information.

Group services are becoming more widespread in medical care throughout the U.S. By recognizing basic factors critical to group facilitation, a wide range of providers have the opportunity to improve client services with this cost-effective strategy and to meet unique needs of their community members.
 

Modified: Friday September 14 2007

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