Implementing HealthConnect One's® Community-Based Doula Program

Model implementation summary last updated: 2015

The information in this implementation report reflects feedback, if provided, from this model’s developer as of the above date. The description of the implementation of the model(s) here may differ from how the model(s) was implemented in the manuscripts reviewed to determine this model’s evidence of effectiveness. Inclusion in the implementation report does not mean the practices described meet the HHS criteria for evidence of effectiveness. Please see the Effectiveness button on the left for more information about any research on the effectiveness of the model, including any version(s) of the model with effectiveness research. Versions of the model that are described in the Adaptations and enhancements section of this implementation report may include (1) versions that were identified by the model’s developer and (2) versions that have been implemented by researchers and have manuscripts that HomVEE rated high or moderate, but that are not supported by the model’s developer.

Model overview

Theoretical approach

The Community-Based Doula Program connects underserved women to doulas, members of the local community trained to provide support during pregnancy, delivery, and the early postpartum period. Doulas serve as a liaison between families and the health care system, aiming to connect families to resources and bridge language and cultural barriers. The model is based on the belief that intervening during this period can foster women’s confidence and create long-term support networks.

The Community-Based Doula Program uses a range of service delivery methods to support women. Services are provided at hospitals and clinics, at home, and by telephone. The HomVEE review is based on Community-Based Doula Programs in which home visiting was the primary service delivery strategy.

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Implementation support

HealthConnect One (HC One) provides training, technical assistance, accreditation, and evaluation services to sites implementing the Community-Based Doula Program. The model was first implemented in 1996 as a four-year pilot in Chicago, under the name the Chicago Doula Project, and is now being replicated nationwide. The program is designed to be integrated into a replication site’s programmatic framework, either as an addition to an existing program, or as a stand-alone model added to an organization’s program offerings. Thus, replication sites may refer to their programs using local names. HC One assists agencies in adapting the essential components of the model to their existing program structure.

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Intended population

HC One’s Community-Based Doula Program targets underserved, low-income pregnant women. Local sites can further refine the target population based on their communities’ needs, by focusing, for example, on teenagers, tribal communities, non-English speaking immigrants, or women undergoing addiction treatment.

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Targeted outcomes

The program’s overall goals are to enhance infant health, strengthen families, and establish family supports. The program aims to achieve these objectives by improving prenatal care; decreasing medical interventions during labor and delivery, such as epidurals and cesarean-section deliveries; improving birth experiences (such as by shortening length of labor); increasing breastfeeding rates; delaying subsequent pregnancies; and enhancing mother-child interactions and parenting skills.

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Model services

Doulas establish an ongoing relationship with mothers beginning in pregnancy and continuing during the early postpartum period. Doulas conduct home visits, accompany women to prenatal appointments, and are present during labor, delivery, and in the first few postpartum hours to provide physical and emotional support. Community-based doulas use a list of priority topics to plan home visits. During prenatal home visits, doulas assess families’ needs and strengths, help them develop a birth plan, promote positive health behaviors, and facilitate access to prenatal care and other resources. Postpartum visits focus on supporting breastfeeding; fostering positive parent-child interactions; providing information on infant development, care, and safety; and referring mothers to community resources to address other health or environmental concerns. Other services may include telephone calls and center-based classes and parenting groups.

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Model intensity and length

Beginning early in pregnancy, doulas conduct weekly, hour-long prenatal visits. The visits include a combination of home and prenatal clinic visits. The first postpartum home visit occurs within 24 hours of discharge, followed by three to five visits during the first week, two to three visits the second week, and weekly visits for at least eight more weeks. Based on evaluation findings, HC One recommends a minimum of six prenatal and eight postpartum visits.

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HealthConnect One’s Community-Based Doula Program operates in 52 sites in the following states (as of August 2014): Arizona, California, Colorado, Georgia, Illinois, Indiana, Michigan, Minnesota, Missouri, New Jersey, New Mexico, New York, Pennsylvania, South Carolina, Texas, Washington, and Wisconsin.

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Adaptations and enhancements

The Community-Based Doula Program is designed to be adaptable, and HC One helps organizations customize the program to address local needs and objectives. The model has been adapted for use with pregnant and parenting teens, mothers in residential drug treatment programs, and tribal communities.

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Implementation notes

The information contained on this page was last updated in June 2015. Recommended further reading lists the sources for this information. In addition, the information contained in this profile was reviewed for accuracy by the HealthConnect One in April 2015. HomVEE reserves the right to edit the profile for clarity and consistency.

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