Are We Serving the Most At-Risk Communities? Examining the Reach of a South Carolina Home Visiting Program
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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.
KeywordsProgram reach Geographic information systems GIS Home visiting
The authors thank Gretchen Matthews with the University of South Carolina, for her editorial review.
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.
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