The purpose of NC Baby Love Plus (NC BLP) is to improve birth outcomes and the health of women reproductive age through strengthening the perinatal systems of care, building family resilience, promoting quality services and increasing community capacity to address perinatal disparity. 

NC BLP provides case management/care coordination services to referred pregnant participants, if necessary, throughtout the interconception period with their children up to 18 months after birth. 

Childbearing women ages 15-44 who meet the following criteria: 

-  80% of women enrolled are African American or American Indian ages 15-44; 20% other racial groups

- Previous short birth interval

- Chronic condition needing education for risk reduction

- Homelessness/unstable housing

- Chronic issues with health care appointment compliance

- Previous poor birth outcome or loss

- STI infection

- History of substance abuse/depression or other mental health diagnosis

- Domestic / intimate partner violence

- No reproductive life plan or family planning method used/ or inconsistent use

- History of abuse/neglect or current CPS involvement

- Parenting skill building

- Financial concerns/lack of resources

- Lack of social support

Fathers of the baby and/or male partners of the women enrolled in the NCBLP are eligible to participate in program services.

Preconception - Provide preconception case management/care coordination services to a minimum of 40 unduplicated women.  A Famliy Outreach Worker (FOW) will:

1. Follow up with prospective program participants (within seven days of referral to the NC BLP program) to answer program related questions, initiate enrollment. 

2. Ensure that program participants have a medical home through consistent case management.

3. Conduct monthly care coordination contacts by phone or in-person' (in the office, clinic, or community location).

4. Conduct quarterly health education/support group sessions for program participants to provide education regarding the various contraceptive methods and other positive preconception and reproductive health behaviors. 

Prenatal (pregnant) - Provide case management/care coordination services to a minimum of 120 unduplicated pregnant women. A Family Care Coordinator (FCC) will: 

1. Follow up within 7 days of referral with prospective program participants to answer program related questions, initiate enrollment.

2. Ensure that program participants have a medical home through consistent case management and by ensuring they remain connected to their pregnancy medical home through attending prenatal visits and related referrals.

3. Develop an individualized care plan with each participant.  This care plan outlines the steps to be taken to address each family's identified needs.

4.  Collaborate with the Family Outreach Worker to hold group prenatal education sessions twice a month. Sessions will include topics such as: basic health during pregnancy, healthy eating; stress management, substance use, labor and birth information, care for an infant, breastfeeding, oral health, understanding perinatal mood disorders, reproductive life planning, postpartum care, including postnatal warning signs, and community support services.   

5.  Conduct monthly case management/care coordination contacts by phone, virtually, or in-person.

6.  Recruit and refer a minimum of 40 fathers/male partners to the NC BLP Dads program, ensuring a "warm handoff'' from the FCC to the Fatherhood Coordinator.

Interconception - Provide case management/care coordination services to a minimum of 40 unduplicated interconception women and a minimum of 40 unduplicated infants.  

The Family Care Coordinator will:

1.  Ensure that participating women and infants have a medical home through consistent case management and by ensuring participants remain connected to their medical home through attendance at well-woman and well-child visits and related referrals.

2.  Develop individual care plan.

3.  Conduct monthly case management/care coordination contacts by phone or in person (in the home, in the office, clinic, during group health education/support group sessions, or community location).

4.  Assess developmental growth of infants according to the child's age.  

The Family Outreach Worker will:

1. Conduct quarterly health education/support group sessions for interconception women, infants and fathers and/or male partners.  

Outreach Services to the community.

The Family Outreach Worker (FOW) will participate in a minimum of 6 community events.

Add progress for 2022 and 2023