Iowans Thrive Blog
Featuring stories, research, and news on Iowa's movement to respond to ACEs
Nine2Thrive™ was created to help pregnant moms experiencing significant stress access the support they need for a healthy and successful pregnancy. Having support and resources—including safe and affordable housing, healthy food, and mental health care—improve not only the well-being of parents, but also their child. Reducing parent stress creates a buffering protection that allows babies to have a strong foundation for lifelong healthy development as they begin to grow in the womb.
A recent evaluation of the Nine2Thrive™ model in its second year found the following results and lessons learned that can inform similar efforts to prevent ACEs.
HOW IT WORKS
Iowa ACEs 360 supported EveryStep in launching the Nine2Thrive™ model in 2019, and since then, EveryStep has expanded the program to six clinics, five in urban Polk County and one in rural Wayne County.
During a prenatal visit at a clinic, an obstetrician or midwife uses a screening tool to identify any potential concerns that could impact the health and well-being of mother and baby. If a concern is identified, the mother is connected to a Nine2Thrive™ support specialist. The support specialist coordinates referrals to local services and resources that can benefit the entire family and follows up with the mother throughout her pregnancy.
An evaluation of the program showed success in reaching women who are struggling to access the services and supports they need during pregnancy. When the model was embedded into the clinic, where a health care provider could provide a warm handoff to a support specialist, the program especially fostered stronger connections with teenage moms who are often more hesitant to engage in services. The model of serving women where they receive care instead of where they live also allowed Nine2Thrive™ to serve women across a region, when most services are limited to specific counties.
Mothers participating in the program noted a decrease in stress levels, which is important to the health of the baby. Most participants had positive birth outcomes measured by the mother’s level of prenatal care and their babies being born at term and at normal weight. These outcomes are promising because many women in Nine2Thrive™ have lower socioeconomic status and lower educational attainment, which is associated with higher risk for poor birth outcomes.
Nine2Thrive™ also increased referrals to programs that provide maternal and child health services. Many of these programs do not serve families until a baby is born, but with a trusting relationship established with a support specialist during pregnancy, families felt comfortable reaching out with concerns and being connected to services postpartum.
1. Time for building relationships is important.
The Nine2Thrive™ model is based off the 1st Five model that screens young children and families during well-child check-ups and refers families to additional support if needed. But in that model, a pediatrician has more time to spend with a family during a doctor’s visit, while a prenatal visit often lasts only a few minutes. Having a screening tool that can quickly identify concerns and establishing strong relationships with health care staff ensured that Nine2Thrive™ was a priority in prenatal patient care.
Also important is establishing trust with pregnant women who are referred to the program at a time when they often feel vulnerable and uncertain. Allowing women to help select which of their needs to address first led to greater buy-in and follow-through from patients.
2. Champions are needed throughout the health system.
Without a health care provider championing the program within the clinic, referrals dropped, and the program’s impact dwindled. Instead of focusing on just one champion who could leave at any point, Nine2Thrive™ staff noted a need to build champions throughout the system, including administrators and clinic support staff. Co-locating the program within the health care clinic especially made it easy as providers could refer patients without having to set up a separate appointment.
3. Screening should be conducted universally.
Instead of screening patients only when there is a concern, screening should be implemented for all patients to identify concerns providers may not even be aware of. Providers should think of screening tools not from the perspective of “why would I refer?” but instead, “why wouldn’t I refer?”
4.Flexibility allows the program to best serve moms.
Not having requirements on income level or geographic region allowed more women who needed support to participate in the Nine2Thrive™ program. Staff also had flexibility to support women postpartum. This was important because mothers developed trusting relationships with support specialists and would reach out with concerns, such as with depression or anxiety after a baby’s birth, and staff could connect to services during this critical period of a baby’s development.
Nine2Thrive™ is one important strategy for improving outcomes for children and families. Learn about why prenatal support is important and other strategies to support parents during this critical time: