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New Health Department program puts nurses in the homes of high-risk moms, babies in Mississippi

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Through a partnership between the state Health Department and the state Division of Medicaid, Healthy Moms, Healthy Babies program places registered nurse case managers in the homes of pregnant mothers undergoing high-risk pregnancies.

Since launching, it has expanded to 23 full-time nurses and 17 part-time nurses providing services to about 640 patients around the state.

State Health Officer Dr. Daniel Edney said the program is “plugging the gap” by bringing resources to small rural communities that aren’t there.

“With limited resources for mothers and babies, a lot of our efforts are going to be directed to our highest impacted areas to help the folks in the most desperate need the fastest,” Edney said.

The way resources are distributed across the state – sparsely in rural and remote areas but plentiful in certain others – means the program must take a targeted approach.

“We can not look at Mississippi as one organism. We are really six different regions when it comes to public health in terms of populations, demographics, resources available and challenges,” Edney explained. “I have to have different strategies for different areas. The one-size fits all strategy won’t work.”

Dr. Justin Turner, chief medical officer at the state Health Department, witnessed personally how important access to quality health care for mothers is.

Turner’s wife made 23 total visits to five different hospitals or emergency rooms during her last two pregnancies.

Seven out of 23 of those visits came during her pregnancy five years ago, and the remainder of the visits came during their second pregnancy in August 2022. During her last pregnancy, she experienced “uncharacteristic pain” around month five, requiring her to be supervised by her family 24 hours a day until she gave birth.

The pain would spiral out of control resulting in psychogenic nonepileptic seizures (PNES), previously known as pseudoseizures – emotional and stress-related episodes similar to epileptic seizures but not of neurological origin.

As the number of trips increased, Turner said he had a tough time reassuring his family and himself.

“I was thinking, 'how do I continue to do what I’m supposed to do as the chief medical officer and help assist the state as a whole, when I can’t even help my wife at home?'” Turner told Mississippi Today.

For Black women in Mississippi, the pregnancy-related mortality rate increased from 51.9 to 65.1 deaths per 100,000 live births, quadruple the rate of white women (16.2). With this data in mind, fears of the worst outcome flooded both Turner and his wife’s minds.

“It was natural for me to think that my wife was going to be another statistic,” Turner explained. “She would ask me things like, ‘Baby, am I going to die?’”

The pregnancy remained a challenge until the day that she delivered their child by cesarean section. Every day prior to her being pregnant was “a day of misery,” Turner said. After delivery, his wife never experienced another pseudoseizure episode.

Turner said fortunately for his wife, she had a husband who is a doctor, an OB-GYN, support from family and friends, and a great health care team.

However, he couldn't help but think of how many mothers in Mississippi lack support. Turner said the Healthy Moms, Healthy Babies program aims to add emotional support for mothers who may be in need of it.

“For a lot of women, they benefit from the nurturing and feeling like someone is listening,” Turner continued. “The more people that’s on their team, the better it helps them to endure the process of pregnancy itself.”

As services are being provided to participants, Turner said the health department, stakeholders, policy makers and community members must collaborate to improve outcomes for mothers and their babies.

“We need to find common ground in the areas that we can improve and make sure that we are providing our moms and babies a decent chance at having a healthy pregnancy and coming into this world,” Turner said.

As a Medicaid-reimbursed program, Healthy Moms, Healthy Babies allows mothers to receive monthly targeted case management, health education, and assessments by nurses, social workers and nutritionists at no direct cost to them.

For moms with Medicaid, the services are reimbursed. Edney said the program works with uninsured moms to help them enroll in Medicaid or, if they are not eligible, will provide the services for free.

The Mississippi State Health Department declined Mississippi Today's request to interview a mother who has participated in the program.

After making contact with a mom in need, the nurse consults with the mother’s doctor, who shares why she may be considered high-risk. Common high-risk conditions include preterm labor, diabetes, multiple pregnancy losses and starting prenatal care late.

The nurse then works to mitigate her symptoms by going to the mother's home and pairing her with a multidisciplinary team of resources, such as social workers and nutritionists.

The team of health care workers educate her on the importance of prenatal care, diet plans and how to limit her chances of becoming high-risk in the future. Edney said the program is “working aggressively” to support affected Medicaid moms.

“In our last reporting from the maternal mortality review committee, 87% of deaths were Medicaid moms, and out of all of our maternal deaths, 80% were preventable,” Edney told Mississippi Today. “That is unacceptable.”

Currently, 86% of the participating mothers are Medicaid beneficiaries.

Healthy Moms, Healthy Babies monitors not only high-risk mothers but also high-risk babies up to one year of age.

Daniel Edney, M.D., is the State Health Officer. Credit: Vickie D. King/Mississippi Today

A baby is considered high risk if they are born prior to 37 weeks of gestation, weigh less than 5 pounds 8 ounces at birth, have genetic disorders, experience nutritional deficiencies, infections, or live in unsafe conditions among other factors as well.

The average age of infants enrolled in the program is less than one month old.

The goal of the program is to increase the infant's chances of survival, Edney said. Mississippi leads the nation in its rate of infant mortality.

“I know that if we continue doing what we are doing, nothing is going to change. So, if we all agree we have a problem, which I think everybody does, then this has got to change,” Edney stated. “I don’t have to convince anybody that being 50th in the nation for dead babies is a good thing, because it isn’t.”

The Health Department plans to expand the program so that more women and babies in rural communities have access to necessary care.

Around 35% of babies were born to women living in rural counties of the state, but only a quarter of maternity care providers practice there, according to the latest March of Dimes’ report.

Jillian Harper-Peavy, the state program director for Healthy Moms, Healthy Babies, said partnerships with different individuals and organizations are critical for the program to expand.

Jillian Harper-Peavy, program director for Healthy Moms/Healthy Babies, at the 2023 Black Maternal Health Conference. Credit: Courtesy of MSDH

Those organizations include community health centers; hospitals; OB-GYN offices; pediatricians; managed care organizations; and other maternal and child health programs.

“We are prioritizing outreach and engagement of patients continually, as we do want to see the program serve more pregnant women and infants,” Harper-Peavy continued. “As additional patients are enrolled, we will continue to assess our staffing capacity and plan accordingly.”

However, financial constraints have hindered its expansion.

Earlier this year, Edney asked lawmakers to fund $9 million to hire nurses needed to fully staff county health departments and Healthy Moms, Healthy Babies. The request was denied.

Now, Edney said he is seeking to redirect the funding he has and cut back in every department possible to hire the 100 or so nurses he’s identified as potential job candidates.

“I’m trying to provide core public health services around this state with a battered workforce,” Edney explained. “I try to get people to understand that while everybody else may be over COVID-19, the health department is not. We were beaten to pieces, and we’re working hard to rebuild our workforce with the resources that we have.”

Susan Bates, nurse team lead in the northeastern region of the state, manages a team of nurses who serve patients in 11 counties, seven of which are maternal health deserts: Marshall, Benton, Tippah, Pontotoc, Prentiss, Tishomingo and Itawamba.

These counties have no hospitals or birthing centers that provide obstetric care, and no practicing OB-GYNs or certified nurse midwives.

Across the state, 51.2% of counties are defined as maternity care deserts, compared to 32.6% nationally.

Bates, who cares for an average of six to 10 mothers and babies each day, has encountered women experiencing preterm labor, preterm delivery, preeclampsia, anxiety and depression. She’s also cared for premature and low-birthweight babies.

With more than 26 years of nursing experience, Bates said she aims to make every patient feel respected, valued and heard. Her approach is to listen, understand and “not just focus on checking a box.”

“I feel that it is important to establish a relationship of trust between the mother and her doctors that way we can promote and foster communication. This allows us to provide a more comprehensive care and therefore improve our patients’ outcomes,” Bates continued. “So, when we meet our patients' needs, consistently and correctly, they develop trust in us as their caregiver.”

The Corinth native previously worked for the Mississippi State Health Department for 11 years as a public health nurse, promoting and protecting the health of populations using knowledge from nursing, social and public health science.

Bates, who is certified in pediatric advanced life support and neonatal advanced life support, said caring for high-risk mothers and babies requires a calm demeanor to help the family through what can be a scary time.

“If you look at the big picture, then it may seem overwhelming, but we can’t be stopped by that. We have to know that what we are doing makes a difference to each patient,” Bates explained. “One life at a time, we’re making a difference.”

Edney said that scoring poorly in maternal and infant mortality is a “heavy burden” that requires a “heavy lift” to flip the negative trend to a positive one.

“It’ll take years, but with the work that we’re going to do with the agency, I’m convinced that we will not only get off the bottom with infant mortality,” Edney stated, “we will get off the radar.”

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

Mississippi Today

On this day in 1911

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mississippitoday.org – Jerry Mitchell – 2024-12-21 07:00:00

Dec. 21, 1911

A colorized photograph of Josh Gibson, who was playing with the Homestead Grays Credit: Wikipedia

Josh Gibson, the Negro League’s “Home Run King,” was born in Buena Vista, Georgia. 

When the family’s farm suffered, they moved to Pittsburgh, and Gibson tried baseball at age 16. He eventually played for a semi-pro team in Pittsburgh and became known for his towering home runs. 

He was watching the Homestead Grays play on July 25, 1930, when the catcher injured his hand. Team members called for Gibson, sitting in the stands, to join them. He was such a talented catcher that base runners were more reluctant to steal. He hit the baseball so hard and so far (580 feet once at Yankee Stadium) that he became the second-highest paid player in the Negro Leagues behind Satchel Paige, with both of them entering the National Baseball Hame of Fame. 

The Hall estimated that Gibson hit nearly 800 homers in his 17-year career and had a lifetime batting average of .359. Gibson was portrayed in the 1996 TV movie, “Soul of the Game,” by Mykelti Williamson. Blair Underwood played Jackie Robinson, Delroy Lindo portrayed Satchel Paige, and Harvey Williams played “Cat” Mays, the father of the legendary Willie Mays. 

Gibson has now been honored with a statue outside the Washington Nationals’ ballpark.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Mississippi Today

On this day in 1958

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mississippitoday.org – Jerry Mitchell – 2024-12-20 07:00:00

Dec. 20, 1958

Bruce Boynton played a key role in the U.S. Supreme Court case that led to the Freedom Riders protests of 1961. Credit: Jay Reeves/Associated Press

Bruce Boynton was heading home on a Trailways bus when he arrived in Richmond, Virginia, at about 8 p.m. The 21-year-old student at Howard University School of Law — whose parents, Amelia Boynton Robinson and Sam Boynton, were at the forefront of the push for equal voting rights in Selma — headed for the restaurant inside the bus terminal. 

The “Black” section looked “very unsanitary,” with water on the floor. The “white” section looked “clinically clean,” so he sat down and asked a waitress for a cheeseburger and a tea. She asked him to move to the “Black” section. An assistant manager followed, poking his finger in his face and hurling a racial epithet. Then an officer handcuffed him, arresting him for trespassing. 

Boynton spent the night in jail and was fined $10, but the law student wouldn’t let it go. Knowing the law, he appealed, saying the “white” section in the bus terminal’s restaurant violated the Interstate Commerce Act. Two years later, the U.S. Supreme Court agreed. “Interstate passengers have to eat, and they have a right to expect that this essential transportation food service,” Justice Hugo Black wrote, “would be rendered without discrimination prohibited by the Interstate Commerce Act.” 

A year later, dozens of Freedom Riders rode on buses through the South, testing the law. In 1965, Boynton’s mother was beaten unconscious on the day known as “Bloody Sunday,” where law enforcement officials beat those marching across the Selma bridge in Alabama. The photograph of Bruce Boynton holding his mother after her beating went around the world, inspiring changes in voting rights laws. 

He worked the rest of his life as a civil rights attorney and died in 2020.

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This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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‘Something to be proud of’: Dual-credit students in Mississippi go to college at nation’s highest rate

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mississippitoday.org – Molly Minta – 2024-12-20 06:00:00

Mississippi high school students who take dual-credit courses go to college at the nation’s highest rate, according to a recent report. 

It’s generally true that students who take college classes while in high school attend college at higher rates than their peers. Earlier this year, a study from the Community College Research Center at Teacher’s College, Columbia University found that nationally, 81% of dual-credit students go to college. 

In Mississippi, that number shoots up to 93%, meaning the vast majority of the state’s high school students who take college classes enroll in a two- or four-year university. 

“When we did this ranking, boom, right to the top it went,” said John Fink, a senior research associate and program lead at the research center who co-authored the study. 

State officials say there’s likely no silver bullet for the high rate at which Mississippi’s dual-credit students enroll in college. Here, “dual credit” means a course that students can take for both high school and college credit. It’s different from “dual enrollment,” which refers to a high school student who is also enrolled at a community college. 

In the last 10 years, participation in these programs has virtually exploded among Mississippi high school students. In 2014, about 5,900 students took dual-credit courses in Mississippi, according to the Mississippi Community College Board. 

Now, it’s more than 18,000. 

“It reduces time to completion on the post-secondary level,” said Kell Smith, Mississippi C0mmunity College Board’s executive director. “It potentially reduces debt because students are taking classes at the community college while they’re still in high school, and it also just exposes high school students to what post-secondary course work is like.” 

“It’s something to be proud of,” he added. 

There are numerous reasons why Mississippi’s dual-credit courses have been attracting more and more students and helping them enroll in college at the nation’s highest rate, officials say. 

With a few college credits under their belt, students may be more inspired to go for a college degree since it’s closer in reach. Dual-credit courses can also build confidence in students who were on the fence about college without requiring them to take a high-stakes test in the spring. And the Mississippi Department of Education’s accountability model ensures that school districts are offering advanced courses like dual credit.

Plus, Mississippi’s 15 community colleges reach more corners of the state, meaning districts that may not be able to offer Advanced Placement courses can likely partner with a nearby community college.

“They’re sometimes like the only provider in many communities, and they’re oftentimes the most affordable providers,” Fink said.

Test score requirements can pose a barrier to students who want to take dual-credit courses, but that may be less of a factor in Mississippi. While the state requires students to score a 19 on ACT Math to take certain courses, which is above the state average, a 17 on the ACT Reading, below the state average of 17.9, is enough for other courses. 

Transportation is another barrier that many high schools have eliminated by offering dual-credit courses on their campuses, making it so students don’t have to commute to the community colleges to take classes. 

“They can leave one classroom, go next door, and they’re sitting in a college class,” said Wendy Clemons, the Mississippi Department of Education’s associate state superintendent for secondary education. 

This also means high school counselors can work directly with dual-credit students to encourage them to pursue some form of college.

“It is much less difficult to graduate and not go to college when you already possess 12 hours of credit,” Clemons said.

Word-of-mouth is just as key.

“First of all, I think parents and community members know more about it,” Clemons said, “They have almost come to expect it, in a way.” 

This all translates to benefits to students. Students who take dual-credit courses are more likely to finish college on time. They can save on student debt.

But not all Mississippi students are benefiting equally, Fink said. Thr research center’s report found that Black students in Mississippi and across the country were less likely to pursue dual-credit opportunities. 

“The challenge like we see in essentially every state is that who’s in dual enrollment is not really reflective of who’s in high school,” Fink said.

Without more study, it’s hard to say specifically why this disparity exists in Mississippi, but Fink said research has generally shown it stems from elitist beliefs about who qualifies for dual-credit courses. Test score requirements can be another factor, along with underresourced school districts. 

“The conventional thinking is (that) dual enrollment is just … another gifted-and-talented program?” Fink said. “It has all this baggage that is racialized … versus, are we thinking about these as opportunities for any high school student?”

Another factor may be the cost of dual-credit courses, which is not uniform throughout the state. Depending on where they live, some students may pay more for dual-credit courses depending on the agreements their school districts have struck with local community colleges and universities. 

This isn’t just an equity issue for students — it affects the institutions, too. 

“You know, we’ve seen that dual-credit at the community college level can be a double-edged sword,” Smith said. “We lose students who oftentimes … want to stay as long as they can, but there are only so many hours they can take at a community college. 

Dual-credit courses, which are often offered at a free or reduced price, can also result in less revenue to the college. 

“Dual credit does come at a financial price for some community colleges, because of the deeply discounted rates that they offer it,” Smith said. “The more students that you have taking dual-credit courses, the more the colleges can lose.” 

State officials are also working to turn the double-edged sword into a win-win for students and institutions. 

One promising direction is career-technical education. Right now, the vast majority of dual credit students enroll in academic courses, such as general education classes like Composition 1 or 2 that they will need for any kind of college degree. 

“CTE is far more expensive to teach,” Clemons said.

Smith hopes that state officials can work to offer more dual-credit career-technical classes. 

“If a student knows they want to enroll in career-tech in one of our community colleges, let’s load them up,” Smith said. “Those students are more likely to enter the workforce quicker. If you want to take the career-tech path, that’s your ultimate goal.”

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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