Perinatal community health workers: Lessons from California

Birth outcomes nationwide are characterized by wide disparities in maternal morbidity and mortality. One potential solution to mitigating these disparities has been to increase access to doulas—traditionally defined as individuals who provide emotional, informational, and physical support around and during the time of birth. However, support with navigating challenges throughout the entire perinatal course, which may be almost two years including both the prenatal and postpartum periods, is critical for individuals who face barriers to optimal pregnancy outcomes because of socioeconomic status or systemic racism.
There is increasing recognition of the need for a professional such as a perinatal community health worker (CHW), described by the Institute for Medicaid Innovation as a support worker who “utilizes the general skills of a CHW … and combines them with specific expertise related to pregnancy, birth, and postpartum care.” With shared lived experience or closeness to the community served, CHWs act as trusted liaisons among clinicians, social services, and the community and are optimally suited to implement psychosocial screenings, address social needs, and connect to resources as needed. While some of the roles of a perinatal CHW are distinct from the birth-focused roles of a doula, many doulas also fulfill the roles of a perinatal CHW. Here, we are focusing on the non-birth setting (prenatal and postpartum periods) and use the term perinatal CHW to reference a set of responsibilities and skills, rather than a specific type of training/certification/title.
The US government is increasing investment in whole-person approaches to perinatal care for Medicaid-insured individuals through the new Transforming Maternal Health (TMaH) Model announced by the Centers for Medicare and Medicaid Services (CMS) in December 2023, which specifically references increasing access to perinatal CHWs as part of its key pillars. Many health care payers, including state Medicaid programs that disproportionately cover people from Black and Brown communities, already have benefits that increase access to perinatal CHW-like services. As more programs develop, it is critical to consider how they should be designed to ensure they are accessible and impactful.
Over the past several decades, California, where we are based, has implemented several Medicaid and public health programs designed to provide “wraparound” care and support in the perinatal period. Here, we share our collective learnings that show the value of perinatal CHWs and recommend sustainable and systematic approaches for policy makers designing new perinatal CHW programs or restructuring existing ones, including those state Medicaid programs that will be participating in CMS’s TMaH Model. (author introduction) #P4HEwebinarOctober2024