Addressing Mental Health and Stress in Medicaid-Insured Pregnant Women Using a Nurse-Community Health Worker Home Visiting Team


Lee Anne Roman, Department of Obstetrics, Gynecology and Reproductive Biology, Institute for Health Care Studies, Michigan State University, A-126 East Fee Hall, East Lansing, MI 48824. E-mail:


ABSTRACT Objective: To describe the conceptual framework and program features of a nurse-community health worker (CHW) team home visiting intervention, the trial design to test the program, and the results of a comparative evaluation of prenatal program participation.

Design: In the context of a community-based, randomized trial, we compared participation in a nurse-CHW team intervention with the standard community care that included a state Medicaid program (enhanced prenatal services) with nurse home visiting.

Sample: Medicaid-eligible pregnant women (n=530), who maintained their pregnancies, had a live birth, retained custody of the child, completed more than an enrollment assessment, did not move out of the county, and were not lost to follow-up.

Measurements: Provider reports of face-to-face prenatal contacts and demographic and psychosocial risk assessments obtained at study enrollment.

Results: Significant differences in the number of women with prenatal program contact and the total amount of contact were found, favoring the nurse-CHW team approach. More women with risk characteristics were reached in the nurse-CHW team group, with the exception of women with alcohol and drug use risks.

Conclusions: A nurse-CHW team approach demonstrated advantage in reaching women who had barriers to participation and delivering more intensive services.