The St. Mary’s County Health Department (SMCHD) functions as the local health authority for St. Mary’s County, Maryland, guided by a commitment to fostering healthy lifestyles, opportunities, and environments for all residents within the county. The jurisdiction encompasses a population of 114,468 individuals, per the U.S Census Bureau, and has experienced a notable 31.7% surge in population since 2000.

Demographically, St. Mary’s County is characterized by a diverse composition comprising 77.5% White, 15.2% Black or African American, 5.7% Hispanic or Latino, 3.0% Asian, 0.5% American Indian, 0.1% Pacific Islander, and 3.7% Two or More Races. While the median household income is $95,864, the county faces certain challenges related to healthcare coverage, with 5% of individuals under 65 lacking health insurance and 3.6% of children falling into the uninsured category.

SMCHD aimed through its Improved Pregnancy Outcome (IPO) and Thrive By Three (TBT) Programs to mitigate barriers and improve access to prenatal care, customized specifically for undocumented and refugee women residing in St. Mary’s. Recognizing the pivotal role of prenatal care in averting pregnancy complications and managing potential health risks for both mothers and infants, this program sought to address disparities observed in late or inadequate prenatal care among Hispanic women, with 10.1% receiving inadequate prenatal care compared to lower numbers for other ethnic groups.

The significance of extending essential health services to undocumented and refugee women cannot be overstated considering the multifaceted challenges they encounter due to immigration status, linguistic barriers, fear of deportation, lack of insurance, and constrained financial resources. By prioritizing prenatal care accessibility for these marginalized groups, SMCHD effectively tackled barriers and diminished health inequities within the Hispanic Community, facilitating an environment where families could aspire to nurture healthy and happy families with equal opportunities.

The IPO/TBT Programs provide care coordination to undocumented and refugee pregnant women until six months postpartum and center their efforts on ensuring these individuals access adequate, effective, and equitable healthcare. Service provisions under this program encompass support, including Medicaid enrollment, comprehensive care coordination spanning prenatal, primary care, behavioral health, and dental visits, in-person or facilitated interpretation services, access to community resources, and education on critical topics such as vaccinations, safe sleep practices, and breastfeeding support.

Activities and Dates:

December 2018 - SMCHD hired its first Spanish-Speaking Interpreter

July 2021 - SMCHD created the IPO Program in response to $70,000 that was freed up in another unit within the agency.

November 2021 - Dr. Joyce Neal signs FY22 contract via Improved Pregnancy Outcomes funding to collaborate with SMCHD to provide prenatal care to undocumented women.

January 2022 - Joana Naranjo, bilingual staff member, hired.

July 2022 - SMCHD awarded Thrive By Three funding from the Maryland Department of Health

July 2022 - June 2023 - The Improved Pregnancy Outcomes Program merges into the Thrive By Three Program.

August 2022 - Dr. Joyce Neal signs FY23 contract to collaborate with SMCHD to provide prenatal care to undocumented women.

July 2023- The Healthy Babies Equity Act is live. Joana and the SMCHD Medicaid team enrolled all Thrive By Three clients into Maryland Medicaid for Medicaid coverage for prenatal care.

October 2023 - Dr. Joyce Neal is no longer delivering babies. Clients are now seen by MedStar Medical Group Women’s Healthcare in Leonardtown.

December 2023 - Contract executed to provide transportation for clients.

As of December 19, 2023, the program enrolled 63 women across the Improved Pregnancy Outcomes and Thrive By Three Programs, resulting in 44 births, with 39 occurring at full term. Dr. Joyce Neal delivered 37 babies before she retired from delivering babies in October 2023. 32 women have enrolled in the Healthy Babies Equity Act for prenatal care coverage. 107 individuals have received safe sleep education. A total of 121 referrals have been made to community resources. 13 household members have received vaccinations to protect the newborn. Facilitated by partnerships and robust service provisions, the program's success stems from proactive community engagement efforts via various channels, including reproductive health clinics, language services, community referrals, and the dedicated efforts of bilingual staff members who have earned esteem and trust within the Latino community.

Aligned with Healthy People 2030 objectives, the Thrive By Three Program stands as a testament to enhanced health outcomes for both mothers and infants while championing health equity within St. Mary’s County. Community outreach initiatives, engagement at local events, and the establishment of a Health Equity Team reinforce SMCHD’s commitment to fostering inclusive, informed, and equitable healthcare practices.

The Thrive By Three Program emphasizes regular, meaningful engagement with enrolled clients and a strong understanding and education of available public resources promoting the availability and security of services within the tight-knit Hispanic Community living in St. Mary’s County. The program has been highly successful through partnerships the SMCHD has with community partners and from the services the SMCHD offers to undocumented families. Referrals routinely come from our SMCHD reproductive health clinic, language services team, the Judy Center, and via client word of mouth. Joana Naranjo has become a respected and trusted public health worker in the Latino community.

SMCHD actively engages with target populations, fostering collaborations across sectors to effect meaningful policy changes. Noteworthy measures, including the development of a health equity data dashboard, highlight SMCHD’s proactive stance in monitoring and addressing health disparities within the community.

The Thrive By Three Program regularly participated in community engagement events, including Community Baby Showers, local Church events, women's events for Hispanic Families, and Outreach Events through the St. Mary’s County Public School System. The SMCHD has a Health Equity Team with a dedicated Coordinator and Community Health Worker who connects with target populations and coordinates with partners across sectors on meaningful policy and change. A health equity data dashboard was developed to monitor health disparities.

Overall, the Thrive By Three Program represents a beacon of successful intervention, exemplifying SMCHD's unwavering commitment to fostering equitable healthcare and nurturing a healthier future for all within St. Mary’s County.

Learn more about the Thrive By Three Program by visiting smchd.org/infants-and-children.

Providing Prenatal Care to Undocumented Individuals living in St. Mary’s County, Maryland

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