Findings from the Evaluation of Baby U: An in-Home Intensive Case Management Model for Improving Early Childhood Outcomes

Background:  Historically, the most disenfranchised communities are the ones with the highest rates of teen pregnancy and the worst perinatal outcomes. Baby University (Baby U) is a partnership between a small southeastern city, Blue Cross Blue Shield, and a local nonprofit agency, whose mission is to improve perinatal outcomes in the poorest neighborhoods and to prepare children for lifelong learning using evidence-based strategies. Key strategies include intensive case management, small caseload size, frequent engagement, linkages to community partner services, and shared data. Baby U has collaborated with the college of social work’s research and public service center to evaluate the following questions: 1) How well do outcomes of Baby U clients compare to those of the neighborhood, county, and state? 2) Are there improvements to individual indicators of well-being over time?

Methods:  A process and impact program evaluation was implemented to assess the effectiveness of this evidence-based intervention and provide ongoing feedback for program improvement. Pre- and post-test analysis of several measures of wellbeing were conducted. Program participants were recruited through the neighborhood schools, referrals from partner agencies and at community events. As of October 2018, Baby U’s clientele consisted of 178 open case families (representing 337 adults and 398 children) and 39 program graduates.

Perinatal outcomes such as prenatal care during pregnancy, low birth weight, and infant mortality were assessed by comparing Baby U client outcomes to administrative data at the state, county, and neighborhood level. Comparison outcome data were provided by the Hamilton County Health Department. Baby U perinatal outcome data includes open cases and program graduates.

Indicators of well-being were collected using instruments designed to assess families’ self-sufficiency, parenting skills, home health and safety, and children’s development: the Arizona Self-Sufficiency Matrix (SSM), the Ages and Stages Questionnaire (ASQ®-3), the Protective Factors Survey (PFS), and a home safety survey (HSS). Each of these four assessments is administered at enrollment and at six-month intervals thereafter.

Results: A significantly higher rate of Baby U clients received prenatal care in comparison to administrative data for the county, state, and neighborhoods. Baby U clients also had significantly lower rates of low birth weight and infant mortality.

ASQ®-3 results demonstrate statistically significant improvement in the domain of gross motor function. SSM results demonstrate statistically significant increases across 13 domains of life skills and self-sufficiency. PFS results demonstrate statistically significant increases in family functioning and resiliency, protective factors against child abuse according to the Center for the Study of Social Policy (CSSP)’s Strengthening Families Framework model. HSS results demonstrate statistically significant increases in overall household safety as well as in five specific domains of household safety.

Implications: Baby U’s intensive case management model produces better outcomes for children and families living in low-income neighborhoods. Future plans include a fidelity study, with a longer-term view toward determining the replicability of this model in other cities and settings.