A Pilot Intervention to Strengthen Coordination Between Primary Care and Prenatal and Early Childhood Home Visiting for Vulnerable Families in Baltimore




Beth Barnet, Margo DeVoe, and Elena Klyushnenkova

Brief Type




Prenatal/early childhood home visiting (HV) targets disadvantaged pregnant women/families. Coordination with primary care (PC) might improve effectiveness, but proven strategies are lacking. Objectives: Pilot a strategy to improve coordination between PC-HV aimed at improving/creating: 1) mutual awareness; 2) relationships/trust; 3) mutually agreed content; 4)  workflows/electronic communications through dedicated staff. Design: Mixed-methods. Qualitative data used to design intervention. Piloted over 12 months, evaluated with pre/post surveys, focus groups. Setting: Baltimore family practice (UFP) and 2 HV programs in community with high rates of low bwt, infant mortality, substance abuse, developmental delay. Participants: UFP-PCPs, HV staff (from 2 sites), patients from UFP receiving services at involved HV sites. Intervention: PCP training (about HV, Pregnancy Risk Assessment (PRA) completion, workflows, new role of UFP-Care Coordinator (CC). HV staff training (discuss abnormal screenings, care plans/concerns with CC). Measures: Number, types, content of communications and who initiated. PRA data from Electronic Health Record. Pre-post PCP/HV staff surveys measured knowledge, attitudes, experiences of coordination. FU focus groups with UFP-HV pts. Results: Between 8/2017-4/2018, 18 patients enrolled, followed through 9/2018 (mean 7.2 mos). UFP PRA completion increased (pre-54.5%, post-75.4%, p<.05). Content: housing, transportation, safety, clarifying health advice, health concerns (depression, appointments, referrals). Most (79%) contacts initiated by UFP-CC trying to reach HV staff, required multiple attempts over days/weeks. At baseline, HV staff expressed low satisfaction with ease of coordinating (9% satisfied); non-significant improvement post-intervention (31% satisfied). HV staff perceived pre/post improvement in effectiveness (27% to 57%, p=.02) but reported worsening electronic access to information over time (29% to 17%). In follow up, UFP-HV pts reported coordination helped with: 1) access to primary care (e.g. help with appts), 2) help navigating referrals, 3)understanding /aligning messages from PCP/HV, 4) enhanced sense of stability/caring from UFP-CC-HV staff. Conclusions: Training PCPs/HV staff can increase mutual awareness and dedicated staff can facilitate coordination. Neither is sufficient without trusting relationships and infrastructure to support connecting in real-time. Shared access to the electronic record or secure messaging might be considered. (author abstract)

Data Collection Methods

  • Focus groups
  • Program administrative record reviews
  • Surveys or questionnaires



For More Information

Barnet, B., DeVoe, M., & Klyushnenkova, E. (2020, January 29). A pilot intervention to strengthen coordination between primary care and prenatal and early childhood home visiting for vulnerable families in Baltimore. National Home Visiting Summit. Poster session at the conference of The Ounce, Washington, DC.
Link to Poster


  • Collaboration and Coordination