Promoting infant health through home visiting by a nurse-managed communityworker team

This article describes the Resources, Education and Care in the Home progra m (REACH-Futures), an infant mortality reduction initiative in the inner ci ty of Chicago built on the World Health Organization (WHO) primary health c are model and over a decade of experience administering programs to reduce infant mortality through home visits. The program uses a nurse-managed team , which includes community residents selected, trained, and integrated as h ealth advocates. Service participants were predominately African American f amilies. All participants were low-income and resided in inner-city neighbo rhoods with high unemployment, high teen birth rates, violent crime, and de teriorated neighborhoods. Outcomes for the first 666 participants are compa red to a previous home-visiting program that used only nurses. Participant retention rates were equivalent overall and significantly higher in the fir st months of the REACH-Futures program. There were two infant deaths during the course of the study, a lower death rate than the previous program or t he city. Infant health problems and developmental levels were equivalent to the prior program and significantly more infants were fully immunized at 1 2 months. The authors conclude that the use of community workers as a part of the home-visiting team is as effective as the nurse-only team in meeting the needs of families at high risk of poor infant outcomes. This approach is of national interest because of its potential to achieve the desired out comes in a cost-effective manner.