Are we Serving the Most At-Risk Communities? Examining the Reach of a South Carolina Home Visiting Program




Elizabeth Radcliff, Charity B. Breneman, Elizabeth Crouch, and Icelynn Baldwin

Brief Type

Journal Publication


  • Other Models


In addition to individual-level characteristics, characteristics of the social and physical environments in which individuals reside may adversely impact health outcomes. Careful attention to the role of “place” can result in programs that successfully deliver services to those most at risk. This retrospective, cross-sectional study used geocoded residential addresses from 3090 households enrolled in a South Carolina (SC) home visiting program, 2013–2016, and corresponding years of data for maternal and child health outcomes obtained from vital records data. ZIP Code Tabulation Areas (ZCTAs) served as the primary geographic unit of analysis. ZCTAS with high volumes of birth or adverse maternal and child health outcomes for any of 10
indicators were flagged. Distribution of enrolled households across highest-risk ZCTAs was calculated. Of 379 ZCTAS with reported data, 152 had 8 or more risk flags. Of the 152 highest-risk ZCTAs, 33 also had high birth volumes. Fifty-seven of the 152 highest-risk ZCTAs had no enrollees; seven of the 33 highest-risk/highest-volume ZCTAS had no enrollees. Service delivery gaps existed despite a statewide, county-level needs assessment conducted prior to program implementation. This study suggests methods to identify service areas of need, as an ongoing effort toward program improvement. (author abstract)

Data Collection Methods

  • Program administrative record reviews



For More Information

Radcliff, E., Breneman, C. B., Crouch, E., & Baldwin, I. (2018). Are we serving the most at-risk communities? Examining the reach of a South Carolina home visiting program. Journal of Community Health. Advance online publication. doi: 10.1007/s10900-018-00606-5
Author Contact Information:
Elizabeth Radcliff


  • Program Quality, Continuous Quality Improvement, and Fidelity
  • Participant Recruitment, Retention, Engagement, and Dosage