Once upon a time, our UVM maternity students would follow one patient on the postpartum unit and then do a home visit to check in and provide help as needed. Our enrollment is now far too high to even consider it.

Amy,

 Thank you - do all postpartum mothers get visits? Were the home visits through the hospital, a visiting home agency or a grant-funded healthy start program?

Joan

I  have a DNP student that has incorporated these concepts into the Family Nurse Partnerships program and is in the process of evaluating the impact. I would be happy to talk more with you about that. Have you reviewed the CDC inter conception materials/toolboxes? The Wisconsin Assoc of Perinatal Care has great materials for this work.

Teresa,

 Thank you for your excellent suggestions. You are the second person who spoke so highly about what is being done in Wisconsin. Can I ask how your student is measuring impact?

Again--thank you.

She will be reviewing prenatal assessments that all women who are interested in home visitations in the county complete. This will provide information about whether or not they participated in home visitation. The home visitation program has a inter conception intervention. She will have the length of time between birth of the last child through conception with this next pregnancy. The goal is > 16 mos.

Before trying to help, I would like to focus on what is meant by 'high risk'.  Once this term is specified, then it is possible to look at specific programs.  I hope that gives you a start, Frank

Frank,

 You ask an important question. In my 30 + years clinical experience, different disciplines use the term slightly different. Thus, I am finding that a plethora of programs exist in large urban areas, but often time, each program has a specific focus.  From my nursing perspective,  I conceptualize high-risk holistically occuring due to an array of biological, psychological and social factors. I seek  exemplar integrated intervention programs that integrate linkages between medical clincal care and community-based interventions addressing such risks that disproportionaltely occur more in socio-economically disadvantaged neighborhoods and areas.

Thank you!

May I suggest looking at the German postpartum program?  I am an American midwife working in Germany.  Here 8 weeks of postpartum home

visits are paid by the insurance and there is a plethora of information about it, including rates of breastfeeding and postpartum hospital visits.  The system works quite well as I have seen in my 20 years of working with it.  In situations where families need more psycho-social support than we can give there is a program which provides referrals and can run up to one year.  

Hello Joan,

You may wish to look at the Child Health Queensland Hospital and Health Service Child Health Clinics.  They work with protocols that screen and refer back to the GP.  There is also a tertiary service that the nurses can refer into for immediate assistance should they come across a crisis situation.

Hope that helps,

Frank

Frank & Janice,

How can I find out more about the details of such postpartum care programs in Germany & in Queensland Hospital. Specifically, if we wanted to model such programs. --how many times a week are home visits conducted? Who exactly goes out to the home (training - is it a nurse or community worker)? Who pays for these services (ministry of health vs. health insurance?) 

Thank you!

Hi Joan,

I have published an article in "Value in Health" about the assessment of a public health program centered on the notion of risk. The measurement model is based on a 2*2 matrix relating the category of care (preventive/curative) to the level of analysis (individual/population).

The model represents a comprehensive and general way of looking at the nature of public health program and its outcomes. It is also an overall tool to classify and organize the different actions and interventions that have been carried out.

Guerrero, I. (2010). Assessing the economic value of public health programs based on risk: the case of the cancer plan in France. Value in health, 13(5), 552-556.

Hope that helps

IG