Background:
The Gadsden Federal Healthy Start Program recruits African-American women of child bearing age into the program's core services of case management and education in order to improve the health conditions of preconceptional women. Gadsden County is a small rural community in north Florida with a majority of the population African-American (57%) who experience high rates of infant mortality as much as 2 to 4 times that of Whites. The leading cause of infant death in Gadsden, based on an analysis of the Perinatal Periods of Risk is prematurity which is associated with poor maternal health.

Objectives:
To improve maternal health with an "enhanced case" management model.

Methods:
Case management of high risk women prior to pregnancy is the primary program intervention to improve maternal health. Education about the risk factors associated with prematurity and poor maternal health is delivered in a group format that focuses on peer support. Women in the peer support and education groups complete a series of weekly group sessions that run approximately 8 weeks. The group discussions include topics such as nutrition, stress, maternal infections, the importance of maintaining good health to improve or prevent obesity, diabetes and other chronic diseases. However, groups are encouraged to talk about other issues that affect the perinatal period and so, many sessions include discussion around a number of other social determinants of health such as domestic violence, lack of jobs, substance abuse, and other poor environmental conditions that impact risky health behaviors and health seeking behaviors.

Results:
Preliminary findings indicate that case management is enhanced for those women who are also enrolled in the education and support group component of the program, also facilitated by the program's case managers.

Conclusion and implications for practice:
Observation of the group setting and interviews with case managers and program participants reveals that the group setting appears to be more conducive to open and frank discussions about risky behaviors that are not always revealed in the one on one case management setting. This provides the case managers opportunities to “discover” issues of their clients that can positively impact the overall effect of case management.