Advertisement

Are We Serving the Most At-Risk Communities? Examining the Reach of a South Carolina Home Visiting Program

  • Elizabeth RadcliffEmail author
  • Charity B. Breneman
  • Elizabeth Crouch
  • Icelynn Baldwin
Original Paper
  • 41 Downloads

Abstract

In addition to individual-level characteristics, characteristics of the social and physical environments in which individuals reside may adversely impact health outcomes. Careful attention to the role of “place” can result in programs that successfully deliver services to those most at risk. This retrospective, cross-sectional study used geocoded residential addresses from 3090 households enrolled in a South Carolina (SC) home visiting program, 2013–2016, and corresponding years of data for maternal and child health outcomes obtained from vital records data. ZIP Code Tabulation Areas (ZCTAs) served as the primary geographic unit of analysis. ZCTAS with high volumes of birth or adverse maternal and child health outcomes for any of 10 indicators were flagged. Distribution of enrolled households across highest-risk ZCTAs was calculated. Of 379 ZCTAS with reported data, 152 had 8 or more risk flags. Of the 152 highest-risk ZCTAs, 33 also had high birth volumes. Fifty-seven of the 152 highest-risk ZCTAs had no enrollees; seven of the 33 highest-risk/highest-volume ZCTAS had no enrollees. Service delivery gaps existed despite a statewide, county-level needs assessment conducted prior to program implementation. This study suggests methods to identify service areas of need, as an ongoing effort toward program improvement.

Keywords

Program reach Geographic information systems GIS Home visiting 

Notes

Acknowledgements

The authors thank Gretchen Matthews with the University of South Carolina, for her editorial review.

Funding

This study was funded in part by Children’s Trust of South Carolina and the Maternal, Infant, and Early Childhood Home Visiting program, supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under CFDA# 93.870, Grant # X10MC29503. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Health Resources and Services Administration. (2017). Home visiting. Retrieved September 13, 2018, from https://mchb.hrsa.gov/maternal-child-health-initiatives/home-visiting-overview.
  2. 2.
    Olds, D. L., Kitzman, H. J., Cole, R. E., Hanks, C. A., Arcoleo, K. J., & Anson, E. A.., et al. (2010). Enduring effects of prenatal and infancy home visiting by nurses on maternal life course and government spending: Follow-up of a randomized trial among children at age 12 years. Archives of Pediatrics & Adolescent Medicine, 164(5), 419–424.CrossRefGoogle Scholar
  3. 3.
    Glazner, J., Bondy, J., Luckey, D., & Olds, D., and Denver, C. O. (2004). Final report to the administration for children and families: Effect of the nurse family partnership on government expenditures for vulnerable first-time mothers and their children in Elmira, NY, Memphis, TN. Washington, DC: Office of Planning Research & Evaluation, Administration for Children & Families, U.S. Department of Health & Human Services.Google Scholar
  4. 4.
    Aos, S., Lieb, R., Mayfield, J., Miller, M., & Pennucci, A. (2004). Benefits and costs of prevention and early intervention programs for youth (Technical Appendix; Document No. 04-07-3901). Olympia: Washington State Institute for Public Policy.Google Scholar
  5. 5.
    Health Resources and Services Administration, Maternal and Child Health Bureau. (2012) Guidance for meeting legislatively-mandated reporting on benchmark areas, demographic data, and service utilization data. Retrieved June 25, 2018, from https://mchb.hrsa.gov/sites/default/files/mchb/MaternalChildHealthInitiatives/HomeVisiting/tafiles/guidanceoct2012.pdf
  6. 6.
    Sallis, J. F., & Owen, N. (2002). Ecological models of health behavior. In K. Glanz, B. K. Rimer & F. M. Lewis (Eds.), Health behavior and health education: Theory, research, and practice (Vol. 3, pp. 462–484). San Francisco: Jossey-Bass.Google Scholar
  7. 7.
    Jilcott Pitts, S. B., Keyserling, T. C., Johnston, L. F., Smith, T. W., McGuirt, J. T., & Evenson, K. R., et al. (2015). Associations between neighborhood-level factors related to a healthful lifestyle and dietary intake, physical activity, and support for obesity prevention polices among rural adults. Journal of Community Health, 40(2), 276–284.CrossRefGoogle Scholar
  8. 8.
    Macintyre, S., Maciver, S., & Sooman, A. (1993). Area, class and health: Should we be focusing on places or people. Journal of Social Policy, 22, 213–234.CrossRefGoogle Scholar
  9. 9.
    Kaplan, G. A. (1996). People and places: Contrasting perspectives on the association between social class and health. International Journal of Health Services, 26(3), 507–519.CrossRefGoogle Scholar
  10. 10.
    Diez Roux, A. V. (2001). Investigating neighborhood and area effects on health. American Journal of Public Health, 91(11), 1783–1789.CrossRefGoogle Scholar
  11. 11.
    Marmot, M. (2005). Social determinants of health inequalities. Lancet, 365(9464), 1099–1104.CrossRefGoogle Scholar
  12. 12.
    Acevedo-Garcia, D., Osypuk, T. L., McArdle, N., & Williams, D. R. (2008). Toward a policy-relevant analysis of geographic and racial/ethnic disparities in child health. Health Affairs, 27(2), 321–333.CrossRefGoogle Scholar
  13. 13.
    Cubbin, C., Marchi, K., Lin, M., Bell, T., Marshall, H., & Miller, C., et al. (2008). Is neighborhood deprivation independently associated with maternal and infant health? Evidence from Florida and Washington. Maternal and Child Health Journal, 12(1), 61–74.CrossRefGoogle Scholar
  14. 14.
    Krieger, N., Chen, J. T., Waterman, P. D., Soobader, M. J., Subramanian, S. V., & Carson, R. (2003). Choosing area based socioeconomic measures to monitor social inequalities in low birth weight and childhood lead poisoning: The Public Health Disparities Geocoding Project (US). Journal of Epidemiology and Community Health, 57(3), 186–199.CrossRefGoogle Scholar
  15. 15.
    Luo, Z. C., Wilkins, R., & Kramer, M. S. (for the Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System). (2006). Effect of neighbourhood income and maternal education on birth outcomes: A population-based study. Canadian Medical Association Journal. 174(10), 1415–1420.CrossRefGoogle Scholar
  16. 16.
    Messer, L. C., Vinikoor, L. C., Laraia, B. A., Kaufman, J. S., Eyster, J., & Holzman, C., et al. (2008). Socioeconomic domains and associations with preterm birth. Social Science & Medicine, 67(8), 1247–1257.CrossRefGoogle Scholar
  17. 17.
    Fisher-Owens, S. A., Soobader, M. J., Gansky, S. A., Isong, I. A., Weintraub, J. A., & Platt, L. J., et al. (2016). Geography matters: State-level variation in children’s oral health care access and oral health status. Public Health, 134, 54–63.CrossRefGoogle Scholar
  18. 18.
    Messer, L., Kaufman, C., Dole, J. S., Savitz, N., D. A., & Laraia, B. A. (2006). Neighborhood crime, deprivation, and preterm birth. Annals of Epidemiology, 16(6), 455–462.CrossRefGoogle Scholar
  19. 19.
    Rural Health Information Hub. (2017). Rural Health: State Guides, South Carolina 2017. Retrieved September 13, 2018, from https://www.ruralhealthinfo.org/states/south-carolina.
  20. 20.
    Hale, N., Shull, K., Maletic, A., Wilson, R., & Kraeff, C. (2010). South Carolina evidence based home visiting needs assessment. Columbia: South Carolina Department of Health and Environmental Control, Maternal and Child Health Bureau, Title V Program.Google Scholar
  21. 21.
    Rajaratnam, J. K., Burke, J. G., & O’Campo, P. (2006). Maternal and child health and neighborhood context: The selection and construction of area-level variables. Health & Place, 12(4), 547–556.CrossRefGoogle Scholar
  22. 22.
    van Vuuren, C. L., Reijneveld, S. A., van der Wal, M. F., & Verhoeff, A. P. (2014). Neighborhood socioeconomic deprivation characteristics in child (0–18 years) health studies: A review. Health & Place, 29, 34–42.CrossRefGoogle Scholar
  23. 23.
    United States Census Bureau. TIGER/Line Shapefiles and TIGER/Line Files. Geography: ZIP Code Tabulation Areas (ZCTAs) (2010). Retrieved August 14, 2018, https://www.census.gov/geo/reference/zctas.html.
  24. 24.
    Grubesic, T. H., & Matisziw, T. C. (2006). On the use of ZIP codes and ZIP code tabulation areas (ZCTAs) for the spatial analysis of epidemiological data. International Journal of Health Geographics, 5, 58.CrossRefGoogle Scholar
  25. 25.
    Public Health Statistics and Information Services: Division of Biostatistics and Health GIS. (2005). South Carolina Community Assessment Network (SCAN) Pregnancy Risk Assessment Monitoring System (Prams). Retrieved September 24, 2018, from https://scdhec.gov/vital-records/sc-vital-records-data-and-statistics.
  26. 26.
    Ohio Department of Health, Division of Family and Community Health Services. (2011). Affordable Care Act Maternal, Infant, and Early Childhood Home Visiting Program. Phase 3: Updated state plan (OMB Control NO. 0915 – 0336). Retrieved October 15, 2018, from http://www.odh.ohio.gov/~/media/odh/assets/files/mch/miechvphase3updatedstateplan.ashx.
  27. 27.
    American Academy of Family Physicians, Inc, J. S. Health Resources and Services Administration. (2018). Uniform Data Systems (UDS) Mapper. Retrieved August 14, 2018, from https://www.udsmapper.org/zcta-crosswalk.cfm.
  28. 28.
    Maternal Infant and Early Childhood Home Visiting Technical Assistance Coordinating Center (MIECHV TACC). (2015). MIECHV issue brief on family enrollment and engagement. Rockville: U.S. Department of Health and Human Services.Google Scholar
  29. 29.
    Sparr, M., & Zaid, S. (2017). State-Led Evaluations of Family Engagement: The Maternal, Infant, and Early Childhood Home Visiting Program. OPRE Report #2017-39. Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.Google Scholar
  30. 30.
    Rushton, G. (2003). Public health, GIS, and spatial analytic tools. Annual Review of Public Health, 24, 43–56.CrossRefGoogle Scholar
  31. 31.
    Dubowitz, T., Williams, M., Steiner, E. D., Weden, M. M., Miyashiro, L., & Jacobson, D., et al. (2011). Using geographic information systems to match local health needs with public health services and programs. American Journal of Public Health, 101(9), 1664–1665.CrossRefGoogle Scholar
  32. 32.
    Nykiforuk, C. I., & Flaman, L. M. (2011). Geographic information systems (GIS) for health promotion and public health: A review. Health Promotion Practice, 12(1), 63–73.CrossRefGoogle Scholar
  33. 33.
    Glasgow, R. E., Vogt, T. M., & Boles, S. M. (1999). Evaluating the public health impact of health promotion interventions: The RE-AIM framework. American Journal of Public Health, 89(9), 1322–1327.CrossRefGoogle Scholar
  34. 34.
    Carlson, T., York, S., & Primomo, J. (2011). The utilization of geographic information systems to create a site selection strategy to disseminate an older adult fall prevention program. The Social Science Journal, 48(1), 159–174.CrossRefGoogle Scholar
  35. 35.
    MacQuillan, E. L., Curtis, A. B., Baker, K. M., Paul, R., & Back, Y. O. (2017). Using GIS mapping to target public health interventions: Examining birth outcomes across GIS techniques. Journal of Community Health, 42(4), 633–638.CrossRefGoogle Scholar
  36. 36.
    Children’s Trust of South Carolina. (2018). Home visiting in South Carolina. Retrieved August 14, 2018, from http://schomevisiting.org/.
  37. 37.
    Krieger, N., Waterman, P., Chen, J. T., Soobader, M. J., Subramanian, S. V., & Carson, R. (2002). Zip code caveat: Bias due to spatiotemporal mismatches between zip codes and US census-defined geographic areas—the Public Health Disparities Geocoding Project. American Journal of Public Health, 92(7), 1100–1102.CrossRefGoogle Scholar
  38. 38.
    Children’s Trust of South Carolina. (2018). Home visiting. Retrieved August 14, 2018, from https://scchildren.org/local-partners/home-visiting/.

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Elizabeth Radcliff
    • 1
    Email author
  • Charity B. Breneman
    • 1
  • Elizabeth Crouch
    • 1
  • Icelynn Baldwin
    • 2
  1. 1.Rural and Minority Health Research Center, Department of Health Services Policy and Management, Arnold School of Public HealthUniversity of South CarolinaColumbiaUSA
  2. 2.Children’s Trust of South CarolinaColumbiaUSA

Personalised recommendations