Preventing Low Birth Weight in Illinois: Outcomes of the FamilyCase Management ProgramAbstract Objectives: In the mid 1980’s the federal governmentpassed legislation allowing states to expand their Medicaidprograms for pregnant women. States were also offeredmatching funds for “enhanced” prenatal care services. TheIllinois Family Case Management (FCM) Program targetslow-income women and aims to reduce barriers to prenatalcare and infant healthcare utilization and also provides healtheducation. We evaluated the outcome of the Illinois FamilyCase Management Program (FCM) in preventing low birthRodrigo Silva partially funded through a fellowship from CityMatCH,Omaha, Nebraska.R. SilvaThe University of Texas Health Science Centerat Houston School of Public Health,Houston, TexasR. SilvaU. S. Centers for Disease Control and Prevention,Atlanta, GeorgiaM. ThomasWinnebago County Health Department,Rockford, IllinoisM. ThomasUniversity of Illinois at Chicago School of Public Health,ChicagoM. Thomas ()General Dynamics,1400 Key Blvd Ste 1200, Arlington, VA 22209e-mail: MikeT@uic.eduR. Caetano · C. AragakiThe University of Texas Health Science Center at Houston Schoolof Public Health Dallas Regional Campus,Dallllas, Texasweight in Winnebago County. Methods: A total of 6,440 participantswere included in this study. Logistic regression wasused to test whether number of visits or total hours of visitationwere significant protective factors against low birthweight. Results: While participating in the FCM Programresulted in a lower rate of low birth weight delivery, neitherincreasing time with a family case manager nor increasingnumber of visits showed statistically significant additionalprotection against low birth weight delivery after adjustmentfor potential confounding factors. Conclusion: In order tofurther improve program outcomes, efforts need to includeimproving quality of interventions or developing new interventionsrather than simply increasing the amount of currentintervention for each participant. The cost effectiveness ofshifting FCM Program efforts away from infants (aged 0–1 year) towards improved prenatal interventions should beevaluated.Keywords Case Management . Illinois/epidemiology .Infant . Low birth weight . PregnancyOutcome/epidemiology . Prenatal Care/organization &administrationBackgroundThe high number of low birth weight infants, defined asweighing less than 5 pounds, 8 ounces (<2500 g) at birth,in the United States continues to concern public health professionals.Low birth weight has been shown to be associatedwith elevated rates of infant mortality and with childhoodillnesses and disabilities, such as cerebral palsy andchronic lung disease [1–4]. If these babies survive infancy,there is also an increased risk for the development of behavioralproblems and poor academic achievement as childhoodSpringer482 Matern Child Health J (2006) 10:481–488progresses [5–7]. Studies consistently show an associationbetween low socioeconomic status and low birth weight [8].The Family Case Management (FCM) Program, a Medicaidprogram created in Illinois in 1996, targets low-incomewomen and reduces barriers to prenatal care and infanthealthcare utilization. FCM continued an initiative called“Healthy Moms/Healthy Kids” that operated from 1993 to1996. On July 1, 1997, oversight of the FCM Program wastransferred from the Illinois Department of Public Health tothe newly-created Illinois Department of Human Services.The establishment and evolvement of the FCM program canbe traced to the 1985 Institute of Medicine (IOM) report onlow birth weight. The 1985 IOM report promoted the enrollmentof all pregnant women into a system of prenatalcare to reduce low birth weight [9]. The federal governmentpassed legislation allowing states to expand their Medicaidprograms for pregnant women. States were also offeredmatching funds for “enhanced” prenatal care services. Theseservices augment traditional prenatal care medical visits andcan include care coordination, case management, risk assessment,nutritional counseling, health education, and homevisiting.FCM services are provided to low-income (below 300%of the federal poverty guidelines) pregnant women, infantsand children residing in Illinois by employees of local publichealth departments. The outreach staff identifies and enrollspregnant women in FCM. Participation is voluntary. SocialWork (BSW or similar degree) and Registered Nurse (RN)Case Managers perform comprehensive assessments, educationalsessions, and referrals to link clients to necessaryhealth, education, and social services. Case Managers assistclients in obtaining early and continuous prenatal andpediatric health services. This service is typically providedduring visits to the FCM office rather than by home visitsor telephone contact. The health department itself doesnot provide any prenatal medical care. Documentation ofclient information is done in Cornerstone, a statewide, computerizedsystem. Several other public health programs inIllinois utilize Cornerstone, namely the Women, Infant, andChildren (WIC) and Immunizations Programs, in an effortto consolidate client information and reduce paperwork andduplication for clients served. Case Managers follow a writtenlist of interventions to guide activities during prenatalvisits (Fig. 1).The target population for FCM intervention is low-incomewomen, typically a woman in her early 20s with a highschool education, who may not have a car, lacks a familialemotional and financial support system, and is often stressedby daily realities that increase the likelihood of negativebirth outcomes. The FCM Program strives to provide somesocial support for these women by guiding them through thecomplexities of the health care system during pregnancy andone year after delivery.In hopes of decreasing the rate of low birth weight infantsin Winnebago County, the local FMC Program wasintegrated into the local Federally Qualified Healthcare Center,local Medicaid office, and local public health pregnancytesting clinic. This allowed improved early recruitment ofeligible women into the FMC Program. In 2000, WinnebagoCounty Health Department estimated that 90% of Medicaidenrolledpregnant women participated in the FMC Programand that one-third of all live births in the county were to mothersparticipating in the FMC Program (unpublished data).The state policy guidance for the FMC Program policy requiresonly one prenatal visit (preferably completed duringthe first trimester) with the bulk of attention offered to mothersafter delivery as they care for an infant. In hopes offurther preventing low birth weight, the FCM Program inWinnebago County began an initiative to aggressively recruitwomen into three standard prenatal visits during eachtrimester of pregnancy. Additional specialized visits, beyondthe three standard visits, were offered based upon risk assessment.Since additional funding was not available for thisinitiative, increased work load was accommodated using existingstaffing resources.This analysis of the FCM Program in Winnebago County,Illinois, is an attempt to answer whether or not the additional
prenatal interventions provided additional prevention
of low birth weight infants. The following hypotheses will be
tested. (1) Women enrolled in the FCM program who spent
the most number of hours with a Case Manager will achieve
better outcomes (fewer low birth weight deliveries), and (2)
women with a greater quantity of intervention (number of
contacts with a Family Case Manager) will have fewer low
birth weight babies. Winnebago County is located in northern
Illinois, west of Chicago. The largest city is Rockford,
where half of the county’s 278,418 residents live. In 1999,
the median household income was $43,886 for the county
with 9.6% persons living below the federal poverty definition
[10]. In 2000, the county population was 1.7% Asian, 6.9%
Latino, and 10.5% Black residents [10].
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