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The commercial sexual exploitation (CSE) of children is a human rights concern. In 2014, California created the Commercially Sexually Exploited Children (CSEC) Program, giving child welfare agencies guidance and funding to address CSE. Our program implementation study gathered data from multiple sources and focused on opportunities for continuous quality improvement and cross-system collaboration. Key findings highlight the importance of effective collaboration, training, staffing, data management, and system coordination to support young people experiencing CSE. [ABSTRACT FROM AUTHOR]

Objectives Strategies to prevent preterm birth are limited. 17 Alpha-Hydroxyprogesterone Caproate (17P) injections have been shown to be effective, but the intervention is under-used. This mixed methods study investigates barriers and facilitators to 17P administration among Medicaid and CHIP participants enrolled in Strong Start for Mothers and Newborns, a federal preterm birth prevention program. Methods Twenty-seven awardees with more than 200 sites in 30 states, the District of Columbia, and Puerto Rico enrolled approximately 46,000 women in Strong Start from 2013 to 2016. Participant data, including data on preterm birth and 17P, was collected for each woman. Intensive interviews (n = 211) conducted with Strong Start program staff and providers (n = 314) included questions about 17P provision. Results Of women whose data included a valid response regarding 17P initiation, 3919 had a prior preterm birth and current singleton pregnancy; 14.95% received 17P. Barriers to 17P administration include late entry to prenatal care, administrative burden of preauthorization, cost risks to providers, limits in scope of practice for non-physician providers, and social barriers among participants. Facilitators for provision include streamlined work flows and the option of home administration. Conclusions for Practice A universal insurance authorization process could mitigate many barriers to 17P use. Providers need continuing education regarding the effectiveness of 17P, and expanding scope of practice for non-physician prenatal care providers would increase access. Targeted program interventions can help to overcome social barriers Medicaid participants face in accessing care. Streamlined work processes and the option of home health services are two effective program-based facilitators for providing 17P to a Medicaid population., Author(s): Caitlin Cross-Barnet [sup.1] , Brigette Courtot [sup.2] , Sarah Benatar [sup.2] , Ian Hill [sup.2] , Emily Johnston [sup.2] , Morgan Cheeks [sup.2] Author Affiliations: (Aff1) Center for Medicare [...]

Objectives: To observe gestational diabetes mellitus (GDM) prevalence among participants receiving enhanced prenatal care through one of three care models: Birth Centers, Group Prenatal Care, and Maternity Care Homes. Materials and Methods: This study draws upon data collected from 2014 to 2017 as part of the Strong Start II evaluation and includes data from nearly 46,000 women enrolled across 27 awardees with more than 200 sites throughout the United States. Descriptive and statistical analyses utilized data from participant surveys completed upon entry to the program and a limited chart review. Results: A total of 6.3% of Strong Start participants developed GDM during their pregnancy. Rates varied significantly and substantially by model. After adjusting for participant risk factors, we find that Birth Center participants of all races and ethnicities experienced significantly lower rates of GDM than women of the same race/ethnicity in Maternity Care Homes. Conclusions: The lower rates of gestational diabetes among women receiving Birth Center prenatal care suggest the need for further investigation of how prenatal care approaches can reduce GDM and address health disparities. [ABSTRACT FROM AUTHOR]

Background: Medicaid pays for approximately half of United States births, yet little research has explored Medicaid beneficiaries' perspectives on their maternity care. Typical maternity care in the United States has been criticized as too medically focused while insufficiently addressing psychosocial risks and patient education. Enhanced care strives for a more holistic approach. Methods: The perspectives of participants in the Strong Start for Mothers and Newborns II initiative, which provided enhanced prenatal care to women covered by Medicaid or the Children's Health Insurance Program (CHIP) during pregnancy through Birth Centers, Group Prenatal Care, and Maternity Care Homes, are evaluated. Strong Start intended to improve care quality and birth outcomes while lowering costs. We analyzed data from 133 focus groups with 951 pregnant or postpartum women who participated in Strong Start from 2013 to 2017. Results: The majority of focus group participants said that Strong Start's enhanced care offered numerous important benefits over typical maternity care, including considerably more focus on women's psychosocial risk factors and need for education. They praised increased support; nutrition, breastfeeding, and family planning education; community referrals; longer time with practitioners; and involvement of partners in their care. Maternity Care Home participants, however, occasionally voiced concerns over lack of practitioner continuity and short clinical appointments, whereas Group Prenatal Care participants sometimes said they could not attend visits because of lack of childcare. Conclusions: Medicaid and CHIP beneficiaries reported positive experiences with Strong Start care. If more Medicaid practitioners could adopt aspects of the prenatal care approaches that women praised most, it is likely that women's risk factors could be more effectively addressed and their overall care experiences could be improved. [ABSTRACT FROM AUTHOR]

The article looks at a research done in order to investigate the cost savings for maternity care using Medicaid, social health care program in U.S. Topics discussed include use of data related to maternal and infant services from the Family Health and Birth Center in Washington D.C., increased cost of maternity care in the country, and difference in cost between Medicaid birth center care and usual care. The study conclude that the birth center care could save more money using the Medicaid.

Pregnancy-related hypertensive disorders can cause morbidity and mortality. Low-dose aspirin (LDA) reduces risk. This paper aims to assess Medicaid beneficiaries' risk factors for preeclampsia and their providers' clinical use of LDA in the federal Strong Start for Mothers and Newborns II initiative. Twenty-seven awardees with more than 200 care sites served almost 46,000 women. This mixed-methods analysis assesses rates of risks, incidence of pregnancy-related hypertensive disorders, and assessment of care teams' LDA knowledge and reported prescription practices. Many Strong Start participants had risk factors that merited LDA, but most practices reported inconsistent or non-existent prescribing. Use varied within the three care models and among all provider types. Ancillary care team members often had no knowledge of LDA's benefits, resulting in lost opportunities for educating patients and assessing adherence to LDA use. Clear policies and well-integrated care teams could increase evidence-based use, improve pregnancy outcomes, and promote women's lifelong cardiovascular health. [ABSTRACT FROM AUTHOR]

The federal Strong Start for Mothers and Newborns initiative supported alternative approaches to prenatal care, enhancing service delivery through the use of birth centers, group prenatal care, and maternity care homes. Using propensity score reweighting to control for medical and social risks, we evaluated the impacts of Strong Start's models on birth outcomes and costs by comparing the experiences of Strong Start enrollees to those of Medicaid-covered women who received typical prenatal care. We found that women who received prenatal care in birth centers had lower rates of preterm and low-birthweight infants, lower rates of cesarean section, and higher rates of vaginal birth after cesarean than did the women in the comparison groups. Improved outcomes were achieved at lower costs. There were few improvements in outcomes for participants who received group prenatal care, although their costs were lower in the prenatal period, and no improvements in outcomes for participants in maternity care homes. [ABSTRACT FROM AUTHOR]

Background: Medicaid pays for approximately half of United States births, yet little research has explored Medicaid beneficiaries' perspectives on their maternity care. Typical maternity care in the United States has been criticized as too medically focused while insufficiently addressing psychosocial risks and patient education. Enhanced care strives for a more holistic approach., Methods: The perspectives of participants in the Strong Start for Mothers and Newborns II initiative, which provided enhanced prenatal care to women covered by Medicaid or the Children's Health Insurance Program (CHIP) during pregnancy through Birth Centers, Group Prenatal Care, and Maternity Care Homes, are evaluated. Strong Start intended to improve care quality and birth outcomes while lowering costs. We analyzed data from 133 focus groups with 951 pregnant or postpartum women who participated in Strong Start from 2013 to 2017., Results: The majority of focus group participants said that Strong Start's enhanced care offered numerous important benefits over typical maternity care, including considerably more focus on women's psychosocial risk factors and need for education. They praised increased support; nutrition, breastfeeding, and family planning education; community referrals; longer time with practitioners; and involvement of partners in their care. Maternity Care Home participants, however, occasionally voiced concerns over lack of practitioner continuity and short clinical appointments, whereas Group Prenatal Care participants sometimes said they could not attend visits because of lack of childcare., Conclusions: Medicaid and CHIP beneficiaries reported positive experiences with Strong Start care. If more Medicaid practitioners could adopt aspects of the prenatal care approaches that women praised most, it is likely that women's risk factors could be more effectively addressed and their overall care experiences could be improved., (© 2019 Wiley Periodicals, Inc.)