Rhode Island Community-based Maternal Support Services

Despite a decreasing global trend, maternal mortality (MM) and severe maternal morbidity (SMM) in the United States continue to increase. Black, Indigenous, and People of Color (BIPOC) have disproportionately higher rates of MM. The causes of SMM/MM and the associated disparities are complex and multidimensional, but there is increasing awareness of the important role of social determinants of health (SDOH) - the conditions in which people are born, grow, live, work, and age - on perinatal outcomes. Addressing perinatal health disparities requires a multipronged approach targeting not only the health system and clinical factors that contribute to inadequate care, but also the social needs of patients from communities experiencing disparities.

The purpose of this project is to improve perinatal health outcomes in RI by bringing together the hospital, community health workers (CHWs), doulas, and community-based organizations in participatory model for integrating community-based maternal support services (COMSS). The COMSS program will be implemented in 6 prenatal clinics in Rhode Island.

Under a universal screening protocol, all patients at active COMSS sites will be screened by nurses at the first prenatal visit and repeated in the second trimester, third trimester, at delivery and 2-6 weeks postpartum for three sets of risk factors for adverse perinatal outcomes including high risk SDOH (safe housing, food insecurity, lack of reliable transportation). Patients who screen positive will be assigned to a care manager who will work with CHWs to provide care navigation, care linkage, and connection and/or with community-based partner services to address food, housing and transportation needs. Patients will be followed by the care team until at least 3 months postpartum, when they will be transitioned to primary care.

Randomization into the COMSS program will occur at the clinic level in a stepped wedge cluster randomized trial. All clusters (i.e prenatal clinics) begin the study in baseline conditions and are randomly assigned to cross-over to the intervention condition at pre-determined time points in a sequential, staggered fashion until all groups receive the intervention. Data from all sites will be collected pre and post intervention.

• SDOH screening - Number of prenatal clinics in Rhode Island where COMSS bundle is operational [Time frame: from enrollment through 6 weeks postpartum]
• SDOH screening - # birthing persons screened [Time frame: from enrollment through 6 weeks postpartum]
• SDOH screening - # receiving case management [Time frame: from enrollment through 6 weeks postpartum]
• Rate of cesarean births among low-risk nulliparous patients [Time frame: delivery]
• Proportion of patients who receive adequate prenatal care [Time frame: from enrollment through date of delivery]
• Proportion of patients who get screened for postpartum depression [Time frame: from 4-8 weeks postpartum]
• Proportion of pregnant people abstinent from alcohol [Time frame: from enrollment through date of delivery]
• Proportion of pregnant people abstinent from illicit drugs [Time frame: from enrollment through date of delivery]
• Infant death [Time frame: delivery through 1 year of life]
• Preterm birth [Time frame: Delivery]