Maternal Infant Health Program (MIHP) Meets HHS Criteria

Model effectiveness research report last updated: 2019

Model overview

Theoretical approach

The Maternal Infant Health Program (MIHP) provides prenatal and postnatal home visiting to pregnant women and infants living in Michigan who are Medicaid beneficiaries. MIHP was designed to serve women and their children who receive Medicaid because they are more likely to experience adverse birth outcomes and higher rates of infant mortality and injury than families with private insurance. The model is based on the premise that early intervention can help mitigate the effects of delayed prenatal care, unintended pregnancy, and substance use during pregnancy.

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Model services

MIHP offers home visiting by a team composed of a licensed social worker, a registered nurse, an infant mental health specialist, a lactation consultant, and a registered dietitian. MIHP services aim to supplement regular prenatal and infant care by offering tailored education and counseling, care coordination, and referrals. The model is designed to serve mothers during pregnancy and up to 60 days postpartum and infants before they reach 18 months of age; it serves mothers and infants separately based on their respective needs.

To initiate services, a licensed social worker or registered nurse conducts a risk assessment with the mother or infant. The assessments are designed to identify potential health risks and cover areas such as pregnancy and overall health history, basic needs, domestic violence, substance abuse, support systems, maternal mental health, and infant safety.

Based on findings from the risk assessment, the licensed social worker and registered nurse develop an individualized plan of care for the mother and/or infant. Registered dietitians, lactation consultants, and infant mental health specialists may contribute to the plan as needed. The plan of care identifies the needs of the mother and/or infant, outlines the desired outcomes, and describes the appropriate services to fulfill the family’s needs.

Based on the plan of care, either the licensed social worker or the registered nurse will serve as the primary home visitor, but each professional will visit the family at least once. Other MIHP team members may also conduct home visits. During the visits, the home visitor may provide the following services:

  • Assistance with basic needs;
  • Education on maternal and infant health;
  • Nutrition counseling for mothers and infants;
  • Breastfeeding support;
  • Parenting education;
  • Family planning education and referrals;
  • Transportation arrangements to appointments for health care, substance abuse treatment, or support services;
  • Referrals to community services such as childbirth education and parenting classes; and,
  • Coordination between MIHP providers, medical care providers, and Medicaid insurance plans.

The home visitor uses motivational interviewing techniques and works with the family to develop goals and a plan for achieving them.

MDHHS requires providers to make every effort to visit the mother or infant at home. The mother has the right to request that some visits take place at the MIHP provider’s office or at a mutually agreed-upon community location. For maternal services, MDHHS requires at least one visit to the mother’s home during the prenatal period to assess the mother, and at least one other home visit postpartum to observe infant care and nutrition and discuss family planning. For infants, MDHHS requires that the assessment and 80 percent of other visits to be conducted at the infant’s home. Across the state, most MIHP providers serve clients exclusively or primarily in the home; there are a few clinic-based providers that include a higher complement of office visits.

MIHP uses standardized plans of care to guide service delivery. The plans of care are available on the MIHP website.

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Intended population

MIHP serves pregnant women and infants up to 18 months old who live in Michigan and receive Medicaid. A pregnant woman or infant does not need to be receiving Medicaid at the time of MIHP enrollment, but must apply in order to receive ongoing services. MIHP offers assistance with the application process. Women may enroll in MIHP at any time during their pregnancy and receive services until 60 days postpartum. Families may enroll infants, even if the mother was not enrolled in MIHP during pregnancy.

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Where to find out more

Maternal and Infant Health Program
Division of Maternal and Infant Health
Michigan Department of Health and Human Services

Phone: (833)-MI4-MIHP
Email: MIHP@michigan.gov
Website: https://www.michigan.gov/mihp/

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Effects shown in research

Maternal health

Findings rated moderate

Maternal Infant Health Program (MIHP)
Show findings details
Outcome measure Effect Follow-up timing Sample Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Adequate prenatal care
FavorableUnfavorable or ambiguousNo Effect
12 months postpartum Full sample; Michigan Medicaid 2010 birth cohort 32088 mothers Unadjusted proportion = 0.65 Unadjusted proportion = 0.63 OR = 1.06 HomVEE calculated = 0.04 Statistically significant, p < 0.05
Any prenatal care
FavorableUnfavorable or ambiguousNo Effect
12 months postpartum Full sample; Michigan Medicaid 2010 birth cohort 32088 mothers Unadjusted proportion = 0.99 Unadjusted proportion = 0.97 OR = 2.94 HomVEE calculated = 0.65 Statistically significant, p < 0.05
Appropriate postnatal visit
FavorableUnfavorable or ambiguousNo Effect
12 months postpartum Full sample; Michigan Medicaid 2010 birth cohort 32088 mothers Unadjusted proportion = 0.50 Unadjusted proportion = 0.41 OR = 1.50 HomVEE calculated = 0.25 Statistically significant, p < 0.05
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Child health

Findings rated moderate

Maternal Infant Health Program (MIHP)
Show findings details
Outcome measure Effect Follow-up timing Sample Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes

Infant death < 1 year

FavorableUnfavorable or ambiguousNo Effect
One year following birth Full sample; Michigan Medicaid 2009-2012 birth cohort 126880 infants Unadjusted proportion = 0.01 Unadjusted proportion = 0.01 OR = 0.73 HomVEE calculated = -0.19 Statistically significant, p < 0.01

Program and comparison group proportions are less than 0.010. HomVEE calculated the effect size based on the study-reported odds ratio.

Infant death < 28 days
FavorableUnfavorable or ambiguousNo Effect
28 days following birth Full sample; Michigan Medicaid 2009-2012 birth cohort 126880 infants Unadjusted proportion = 0.00 Unadjusted proportion = 0.00 OR = 0.70 HomVEE calculated = -0.22 Statistically significant, p < 0.01

Program and comparison group proportions are less than 0.005. HomVEE calculated the effect size based on the study-reported odds ratio.

Infant death 28-365 days
FavorableUnfavorable or ambiguousNo Effect
One year following birth Full sample; Michigan Medicaid 2009-2012 birth cohort 126880 infants Unadjusted proportion = 0.00 Unadjusted proportion = 0.00 OR = 0.78 HomVEE calculated = -0.15 Statistically significant, p = 0.02

Program and comparison group proportions are less than 0.005. HomVEE calculated the effect size based on the study-reported odds ratio.

Maternal Infant Health Program (MIHP)
Show findings details
Outcome measure Effect Follow-up timing Sample Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Low birth weight (<2500g)
FavorableUnfavorable or ambiguousNo Effect
Immediately post-intervention Full sample; Michigan Medicaid 2010 birth cohort 32088 infants Unadjusted proportion = 0.08 Unadjusted proportion = 0.09 OR = 0.91 HomVEE calculated = -0.06 Statistically significant, p < 0.05
Preterm birth (<37 weeks)
FavorableUnfavorable or ambiguousNo Effect
Immediately post-intervention Full sample; Michigan Medicaid 2010 birth cohort 32088 infants Unadjusted proportion = 0.11 Unadjusted proportion = 0.12 OR = 0.91 HomVEE calculated = -0.06 Statistically significant, p < 0.05
Very low birth weight (<1500g)
FavorableUnfavorable or ambiguousNo Effect
Immediately post-intervention Full sample; Michigan Medicaid 2010 birth cohort 32088 infants Unadjusted proportion = 0.01 Unadjusted proportion = 0.02 OR = 0.71 HomVEE calculated = -0.21 Statistically significant, p < 0.05
Very preterm birth (<32 weeks)
FavorableUnfavorable or ambiguousNo Effect
Immediately post-intervention Full sample; Michigan Medicaid 2010 birth cohort 32088 infants Unadjusted proportion = 0.02 Unadjusted proportion = 0.03 OR = 0.80 HomVEE calculated = -0.14 Statistically significant, p < 0.05
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Reductions in child maltreatment

Findings rated moderate

Maternal Infant Health Program (MIHP)
Show findings details
Outcome measure Effect Follow-up timing Sample Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Burns
FavorableUnfavorable or ambiguousNo Effect
12 months postpartum Full sample; Michigan Medicaid 2011 birth cohort 27320 infants Unadjusted proportion = 0.01 Unadjusted proportion = 0.01 MD = 0.00 HomVEE calculated = 0.11 Not statistically significant, p = 0.16

Program and comparison group proportions are less than 0.010. Group differences are very small.

Crush injury
FavorableUnfavorable or ambiguousNo Effect
12 months postpartum Full sample; Michigan Medicaid 2011 birth cohort 27320 infants Unadjusted proportion = 0.00 Unadjusted proportion = 0.00 MD = 0.00 HomVEE calculated = 0.00 Not statistically significant, p = 0.81

Program and comparison group proportions are less than 0.005. Group differences are very small.

Dislocations and strains and sprains
FavorableUnfavorable or ambiguousNo Effect
12 months postpartum Full sample; Michigan Medicaid 2011 birth cohort 27320 infants Unadjusted proportion = 0.01 Unadjusted proportion = 0.01 MD = 0.00 HomVEE calculated = 0.08 Not statistically significant, p = 0.62

Program and comparison group proportions are less than 0.010. Group differences are very small.

Foreign body
FavorableUnfavorable or ambiguousNo Effect
12 months postpartum Full sample; Michigan Medicaid 2011 birth cohort 27320 infants Unadjusted proportion = 0.01 Unadjusted proportion = 0.01 MD = 0.00 HomVEE calculated = 0.21 Statistically significant, p = 0.01

Group differences are very small.

Fracture lower limb
FavorableUnfavorable or ambiguousNo Effect
12 months postpartum Full sample; Michigan Medicaid 2011 birth cohort 27320 infants Unadjusted proportion = 0.00 Unadjusted proportion = 0.00 MD = 0.00 HomVEE calculated = 0.00 Not statistically significant, p = 0.33

Program and comparison group proportions are less than 0.005. Group differences are very small.

Fracture neck and trunk
FavorableUnfavorable or ambiguousNo Effect
12 months postpartum Full sample; Michigan Medicaid 2011 birth cohort 27320 infants Unadjusted proportion = 0.00 Unadjusted proportion = 0.00 MD = 0.00 HomVEE calculated = 0.42 Not statistically significant, p = 0.48

Program and comparison group proportions are less than 0.005. Group differences are very small.

Fracture skull that apart from vault or base
FavorableUnfavorable or ambiguousNo Effect
12 months postpartum Full sample; Michigan Medicaid 2011 birth cohort 27320 infants Unadjusted proportion = 0.00 Unadjusted proportion = 0.00 MD = 0.00 HomVEE calculated = 0.00 Not statistically significant, p = 0.51

Program and comparison group proportions are less than 0.005. Group differences are very small.

Fracture skull vault or base
FavorableUnfavorable or ambiguousNo Effect
12 months postpartum Full sample; Michigan Medicaid 2011 birth cohort 27320 infants Unadjusted proportion = 0.00 Unadjusted proportion = 0.00 MD = 0.00 HomVEE calculated = 0.00 Not statistically significant, p = 0.68

Program and comparison group proportions are less than 0.005. Group differences are very small.

Fracture upper limb
FavorableUnfavorable or ambiguousNo Effect
12 months postpartum Full sample; Michigan Medicaid 2011 birth cohort 27320 infants Unadjusted proportion = 0.00 Unadjusted proportion = 0.00 MD = 0.00 HomVEE calculated = -0.17 Not statistically significant, p = 0.32

Program and comparison group proportions are less than 0.005. Group differences are very small.

Internal trauma
FavorableUnfavorable or ambiguousNo Effect
12 months postpartum Full sample; Michigan Medicaid 2011 birth cohort 27320 infants Unadjusted proportion = 0.00 Unadjusted proportion = 0.00 MD = 0.00 HomVEE calculated = 0.00 Not statistically significant, p = 0.56

Program and comparison group proportions are less than 0.005. Group differences are very small.

Intracranial Injury
FavorableUnfavorable or ambiguousNo Effect
12 months postpartum Full sample; Michigan Medicaid 2011 birth cohort 27320 infants Unadjusted proportion = 0.01 Unadjusted proportion = 0.00 MD = 0.00 HomVEE calculated = 0.25 Statistically significant, p = 0.04

Program and comparison group proportions are less than 0.010. Group differences are very small.

Multiple fractures of limbs
FavorableUnfavorable or ambiguousNo Effect
12 months postpartum Full sample; Michigan Medicaid 2011 birth cohort 27320 infants Unadjusted proportion = 0.00 Unadjusted proportion = 0.00 MD = 0.00 HomVEE calculated = 0.00 Not statistically significant, p = 0.56

Program and comparison group proportions are less than 0.005. Group differences are very small.

Nerve and spinal cord
FavorableUnfavorable or ambiguousNo Effect
12 months postpartum Full sample; Michigan Medicaid 2011 birth cohort 27320 infants Unadjusted proportion = 0.00 Unadjusted proportion = 0.00 MD = 0.00 HomVEE calculated = 0.00 Not statistically significant, p = 0.81

Program and comparison group proportions are less than 0.005. Group differences are very small.

Open wounds
FavorableUnfavorable or ambiguousNo Effect
12 months postpartum Full sample; Michigan Medicaid 2011 birth cohort 27320 infants Unadjusted proportion = 0.02 Unadjusted proportion = 0.01 MD = 0.00 HomVEE calculated = 0.17 Statistically significant, p = 0.02

Group differences are very small.

Poisoning
FavorableUnfavorable or ambiguousNo Effect
12 months postpartum Full sample; Michigan Medicaid 2011 birth cohort 27320 infants Unadjusted proportion = 0.02 Unadjusted proportion = 0.02 MD = 0.00 HomVEE calculated = -0.07 Not statistically significant, p = 0.33

Group differences are very small.

Proportion of infants with at least one injury episode
FavorableUnfavorable or ambiguousNo Effect
12 months postpartum Full sample; Michigan Medicaid 2011 birth cohort 27320 infants Unadjusted proportion = 0.12 Unadjusted proportion = 0.10 MD = 0.01 HomVEE calculated = 0.08 Statistically significant, p = 0.00
Superficial injuries and contusion
FavorableUnfavorable or ambiguousNo Effect
12 months postpartum Full sample; Michigan Medicaid 2011 birth cohort 27320 infants Unadjusted proportion = 0.05 Unadjusted proportion = 0.04 MD = 0.01 HomVEE calculated = 0.14 Statistically significant, p = 0.01
Vascular injury
FavorableUnfavorable or ambiguousNo Effect
12 months postpartum Full sample; Michigan Medicaid 2011 birth cohort 27320 infants Unadjusted proportion = 0.00 Unadjusted proportion = 0.00 MD = 0.00 HomVEE calculated = -0.42 Not statistically significant, p = 0.48

Program and comparison group proportions are less than 0.005. Group differences are very small.

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In brief

Evidence of model effectiveness

Title General population Tribal population Domains with favorable effects
Maternal Infant Health Program (MIHP) Yes, Meets HHS Criteria Meets HHS criteria Does not meet HHS criteria for tribal population because the model has not been evaluated with a tribal population.
  • Child health,
  • Maternal health,

Model description

The Maternal Infant Health Program (MIHP) serves pregnant women and infants up to 18 months old who live in Michigan and receive Medicaid. The model aims to reduce rates of maternal and infant morbidity and mortality by promoting healthy pregnancies, positive birth outcomes, and healthy growth and development for infants. Home visiting is offered by a team composed of a licensed social worker, a registered nurse, an infant mental health specialist, a lactation consultant, and a registered dietitian. MIHP is designed to supplement regular prenatal and infant care by offering tailored education and counseling, care coordination, and referrals. The model serves mothers and infants separately based on their respective needs. MIHP maternal services include an assessment visit and up to nine additional monthly visits to implement the plan of care during pregnancy. Mothers are also eligible to receive care as needed up to 60 days postpartum. MIHP infant services also include an assessment and up to nine additional monthly visits in the first year of the child’s life. If needs persist, the infant may be eligible for an additional nine visits, but services must conclude before the infant reaches 18 months of age. Each home visit must last at least 30 minutes.

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Extent of evidence

Results of search and review
Number of manuscripts
At least one finding was eligible for review…
4
  …and at least one finding rated high
0
  …and at least one finding rated moderate (but none rated high)
4
  …and all findings that were eligible for review rated low or indeterminate2
0
  …but manuscript is additional source3
0

For more information, see the research database. For more information on the criteria used to rate research, please see details of HomVEE’s methods and standards.

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Summary of findings

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Criteria established by the U.S. Department of Health and Human Services

Information based on comprehensive review of all high- and moderate-rated manuscripts
CriterionCriterion descriptionCriterion met?
1High- or moderate-quality impact study?Yes
2Across high- or moderate-quality studies, favorable impacts in at least two outcome domains within one sample OR the same domain for at least two non-overlapping samples?Yes
3Favorable impacts on full sample?Yes
4Any favorable impacts on outcome measures sustained at least 12 months after model enrollment?
Reported for all research but only required for RCTs.
No
5One or more favorable, statistically significant impact reported in a peer-reviewed journal?
Reported for all research but only required for RCTs.
Yes
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