In 2012, with the support of the Abell Foundation and other funders, the Johns Hopkins Harriet Lane Clinic (HLC) launched the Preconception Women’s Health and Pediatrics Initiative to connect low-income new mothers with health care to address chronic health conditions, improve their health, and prevent unwanted pregnancies. HLC is a busy pediatric clinic located at The Johns Hopkins Hospital that serves a predominantly low-income patient population: 90 percent of its patients are eligible for public insurance (Medicaid or CHIP). The project grew out of research conducted at HLC showing that the mothers of children attending the clinic had very high rates of unplanned pregnancies and very low rates of insurance and connection to a primary health care provider. Based on these findings, HLC designed a pilot project to provide access to health care for mothers via pediatric clinics.
The first phase of the initiative included a needs assessment and development of a screening and intervention protocol for mothers of infants presenting to pediatric practices. The screening tool is designed to identify health concerns, insurance status, and connection to a health care provider. The project will train pediatricians to respond to issues identified by this tool. In addition, the project offers Long Acting Reversible Contraception (LARCs) to mothers of infants seen at participating pediatric clinics, to address their needs for effective contraceptive care.
Guided by information gathered in the needs assessment, the initiative is focused on increasing access to health care for low-income mothers and addressing their unmet health needs. The screening and intervention protocol is being implemented at five pediatric clinics that serve primarily low-income families. Physicians and health educators work at each of the sites to address the mothers’ health concerns identified by the screening tool and connect them with additional resources as needed.
The initiative includes an outcome evaluation that will assess access to, and utilization of, primary care, contraceptive services, and prenatal care; increased contraception rates and decreased rapid repeat pregnancies; improved control of chronic illnesses; improved nutrition status; decreased rates of smoking; decreased rates of depression; and decreased rates of intimate partner violence. In addition, a cost-effectiveness analysis will focus on preventing costs of unintended pregnancies and resulting infant health problems.