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Project Name: Integrated Maternal Health Services (U2E)
Applicant Title: UNIVERSITY OF ALABAMA AT BIRMINGHAM
Abstract Text: The purpose of this project is to improve maternal health in Alabama by demonstrating the effectiveness and feasibility of a multi-disciplinary maternal health care model that will expand access to high quality maternal health care and integrated primary care and behavioral health services. The proposed model, Improving Alabama Maternal Outcomes through Multi-Disciplinary Services (AL-MOMS), includes risk assessment and stratification by Medicaid managed care organizations (Alabama Coordinated Health Networks [ACHNs]) who refer high risk clients to a nurse visitation program (Nurse-Family Partnership) for more intensive assessment and care coordination services, obstetric medical management that includes the use of Certified Nurse-Midwives (CNMs), followed by referral to a primary care medical home after delivery. Access to integrated behavioral health care and connections to community resources are also key components of the AL-MOMS model, which positively impacts social determinants of health for the multi-generational family system. The goal of AL-MOMS is to improve maternal health outcomes in Alabama by increasing access to quality, equitable, comprehensive care for pregnant and postpartum people who experience health disparities and have limited access to basic social and health care services. During each year of the five-year grant, the AL-MOMS model will be implemented in a new region of the state. A total of 27 of Alabama’s 67 counties will be incorporated into the AL-MOMS project over the five-year period; all 27 counties are medically underserved and 23 are rural, including four highly distressed Black Belt counties. In 2020, an average of 56% of births in the targeted counties were paid for by Medicaid and included over 10,500 births. In each grant year and region, the AL-MOMS model will launch a CNM into an already established maternity practice and delivery facility by providing funding for one year of support and will implement a regional NFP team to begin nurse home visitation. A locally recruited behavioral health expert, either psychiatric-mental health nurse practitioner (PMHNP) or licensed independent clinical social worker (LICSW), will be embedded in each regional care team for priority access for mental health needs of clients receiving care from any AL-MOMS affiliated maternity care provider. Within the first year following delivery, patients enrolled with a participating AL-MOMS maternity provider will be referred to a local primary care provider, who may be a family physician or NP, where a standard medical home will be established. By the end of each grant year, it is expected that Alabama Medicaid will begin reimbursement for all regional components of the AL-MOMS model, thus sustaining the model in each region. A hallmark of the AL-MOMS model will be regional monthly maternity health roundtables for medical, nursing, community providers and community members with lived experience of local maternity care. The interdisciplinary regional roundtables will be organized and hosted by the regional coordinators and held virtually to address topics that are impacting local and regional maternity outcomes. Lastly, AL-MOMS recruited providers will be connected to maternity workforce training offered in association with the Alabama Perinatal Quality Collaborative (ALPQC), the Alabama Maternal Health Task Force (AL-MHTF), and state and national maternal health organizations. These trainings will include topics related to culturally and linguistically appropriate services, implicit bias, social determinants of health (SDoH), trauma informed care, motivational interviewing, and other health equity and best practices topics.