First Steps

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First Steps

Revised October 28, 2007

Purpose: This category describes the First Steps Program that is designed to provide additional support services to low-income women and children to promote a healthy birth outcome. The 1989 Maternity Care Access Act, implemented as First Steps, seeks to reduce maternal and infant illness and death and increase access to maternity and infant care for low-income families (link to E-Z manual).

GUIDELINES
Most women will receive their medical care through a Healthy Options plan. Native American women may choose to enroll in a Healthy Options plan but are not required to. Undocumented women are exempted from Healthy Options enrollment.
First Steps services are provided by a network of contracted agencies in every county and include Maternity Support Services and Maternity Case Management. These services are intended to support the mother to have a healthy pregnancy and a positive birth outcome.

Maternity Support Services (MSS)

Maternity Support Services supplement medical services during pregnancy and through two months after the pregnancy ends (including termination, miscarriage or stillbirth). All Medicaid-eligible pregnant women must be offered these services.

The MSS team consists of professional Public Health Nurses, Nutritionists (separate from WIC) and Psychosocial Workers, and Paraprofessional Community Health Workers. The professional members of the team provide assessment, health education and intervention. All activities performed by the Community Health Worker are under the direction of a professional member of the team and are in support of the case plan. Additional services provided by the team may include:

Childbirth education;

Lactation consultation; and

Labor-support visits.

Maternity Case Management (MCM)

Maternity Case Management is available for women at high risk of poor pregnancy outcomes. Eligibility for MCM must be established during the pregnancy or at the hospital at delivery time, before the mother is released from the hospital. (If eligible and mother is no longer providing care, services may be provided to the father/child.) MCM helps provide ongoing needs identification and linkage to needed services. MCM may continue to the infant's first birthday.

The targeted population for MCM is high-risk pregnant or parenting Medicaid-eligible women who:

Are 17 years of age or younger; or

Use alcohol/drugs or are living in an environment in which alcohol/drugs are present; or

Demonstrate an inability to access necessary resources and/or services, and meet at least three of the following criteria:

Are homeless or staying with friends and relatives on a short-term basis or in shelters;

Are a victim of current or recent family violence or have been involved with Children's Protective Services;

Lack of a support system or have a non-involved partner;

Have medical factors related to poor outcome, i.e., diabetes, HIV/AIDS, tobacco use;

Have two or more children age four or under in the home;

Have an education of eighth grade or less;

Have a physical disability;

Have mental impairment or depression;

Enter into prenatal care after 28-weeks gestation;

Have refugee status or are fleeing another country for political or religious reasons (not undocumented aliens);

Are age 18 or 19; or

Have limited English proficiency.

WORKER RESPONSIBILITIES
The CSO plays a critical role in First Steps. Eligibility for Medicaid coverage is determined at the CSO that serves as an entry point for First Steps services.

NOTE: As part of the ongoing First Steps provider network, the CSO works with the group to establish the referral process in the local community.

Minimum service level: Refer all pregnant women found eligible for Medicaid coverage to local Maternity Support Service providers. This includes women whose eligibility is determined by a call-center or on-line application.

A Bar Code report, generated at least weekly, of all newly eligible pregnant women in the CSO can be used to refer the clients to MSS.

Ensure linkage with CSO Family Planning staff for follow-up.

NOTE: Maternity Support Services and Maternity Case Management agencies have already signed Confidentiality Agreements with DSHS and are held to the highest standards for client protection during regular program monitoring by First Steps State Staff.

Best Practice service level: Conduct an assessment of the client to determine if she is eligible for MCM. Arrange for other services if needed, i.e., shelter, food, clothing. Obtain any needed release from the client and share the assessment with the partners providing services (MSS, MCM, Pregnancy to Employment worker). Follow-up to ensure the client has connected with the needed services.

Ensure linkage with CSO Family Planning staff for follow-up.

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