Public Health Overview
In 2006, we enter the 17th year of First Steps Services statewide, and the anniversary of the Washington State Legislature's
passage of the Maternity Care Access Act. This act reduced maternal and infant illness and death and increased access to
maternity and infant care for low-income families. These goals have been significantly achieved over these 17 years
Looking back, the number of births in Washington State has remained stable, 79,644 in 1990- 1992 compared to 79,813 in 2000 - 2002.
The proportion of births with Medicaid-paid maternity care increased statewide from 36.1% to 43.1% during this time period.
Note: Much of this increase is attributed to the expansion of Medicaid eligibility, and improved prenatal access through the
First Steps program. [WA DSHS. Research & Data Analysis Division. County profiles. April 2004. p. 1.]
Of those MAA families, 22,428 (67.7%) received one or more Maternity Support Services visits; 10,426 (31.5%) received at least
one month of Maternity Case Management, or Infant Case Management as it is called since October 2003.
For up to date county information on Maternal Child Health data, the Pregnancy Risk Assessment Survey, or other health data
reports prepared by our Health Statistics and Assessment Program, please stay on our website and look for "Health" and then
"Data" or search on "data and statistics".
First Steps Goals
To increase the number of women who enter prenatal care in the first trimester.
To assess the needs of the pregnant, postpartum and parenting mother/family and initiate referral and interventions
to address the identified needs.
To support the pregnant, postpartum and parenting mother/family in accessing appropriate needed service(s) and
provide advocacy in assisting the client to achieve planned goals.
To provide preventive health services designed to supplement medical visits.
To provide parenting education for the promotion of healthy lifestyles, and a safe and nurturing environment for
the pregnant woman, the infant and family.
To prevent unintended pregnancies.
To reduce the incidence of domestic violence, to increase the awareness of the cycle of violence and to provide
information about safety and resources.
To prevent child abuse and neglect.
Target Population
The targeted population is pregnant women eligible from the Medical Assistance Administration who have risk factors that
could lead to unhealthy pregnancy and parenting outcomes. The risk factors include low income status, lack of support
system, mental or physical disability, age 21 years or less, substance use or presence in the environment, homelessness,
current or recent domestic violence victim, lack of medical care, medical factors related to poor birth outcome, late
entry into prenatal care, limited English proficiency, refugee status, and limited education.
Beneficiaries
Pregnant women and infants who receive early interventions and medical care.
The children and other family members also benefit directly through improved health behaviors and access to health
care, social and supportive services.
Health care consumers and the general public will benefit from containment of health care costs through early
assessments and referrals, and intervention and prevention activities that result in healthy newborns.
The general population will benefit as these families are able to maintain or achieve independent lifestyles and
the infants and children of these families have the opportunity to mature to be productive members of society.
Most Important Outcome Measures
Healthy newborns and mothers as shown in a decline in infant and maternal morbidity.
Health behaviors exhibited by clients (e.g., improved dietary intake; increased exercise; decreased tobacco, alcohol
and drug use; early access to pre-natal care, use of car seat restraint; immunizations that are current; environmental safety).
First Steps Staff and Services
If you are pregnant and eligible for medical coupons, you are eligible for First Steps Services. If you are not eligible for medical
coupons, there are services available to assist you also. The following First Steps support service providers are available to you
and your family throughout pregnancy and, at a minimum, until two months following delivery.
A Public Health Nurse can meet you in the privacy of your home, or in conjunction with WIC/First Steps Clinic services. The nurse
helps to assess your needs, provide support, provide health education, counseling, and advocacy regarding issues that might be in
your life such as:
Sign/symptoms of complications/changes during pregnancy
Use of resources
HIV Risk Reduction
Exercise
Stress Reduction
Addictive Behaviors inc tobacco cessation
Family Planning
Immunization
Weight Gain
Infant/Newborn Assessment
Problem Solving Skills
Home Safety
Preparation for Labor, Delivery and Parenting Role
Healthy Relationships
Body/emotional changes during postpartum
Body/emotional changes during pregnancy
Post - partum care
Breast Feeding
Our staff Behavioral Health Specialist/Social Worker can provide clinic or home-based psychosocial assessment,
referrals, and counseling regarding issues such as::
Communication/Problem solving Conflict Resolution
Anger Management
Physical and Mental Abuse
Chemical Dependency
Depression
Relationships
Short Term Crisis Intervention Counceling
Anxiety
Mother/Infant Attachment
The staff Nutritionist can provide clinic or home-based nutrition assessments, education, and counseling regarding
issues such as:
Pre-pregnant weight and weight gain
Infant Breast Feeding
Diabetes
Adaptation of food intake to individualized needs
Teen Nutrition
Anemia
Meal planning
Our staff Community Health Worker can provide home-based role modeling, education, advocacy, access, and support
regarding issues such as:
Meal Preparation
Budgeting
Public Transportaion
Filing out Forms/Applications
Playing with children
Baby Equipment/Supplies
Housing
Home Safety and Car seats
Our staff Infant Case Manager can help you:
Decide what services you and your family need(medical, educational, social)
Enroll in services you choose
" Coordinate and link you with services to meet your needs
What problems or concerns you are having with service
Your Case Manager will be able to work with you by phone and/or in your home or any other setting. Services may
be provided until your baby is twelve (12) months old.
The entire First Steps Program Team (Behavioral Health/Social Worker, Community Health Worker, Infant Case Manager,
Nutritionist, Nurse) can see you in the privacy of your homes or in our First Steps Clinic operating directly with
WIC services both in Everett and in Lynnwood.
People can self-refer or get more information by calling Snohomish Health District at 425.339.5230 or
e-mail to chquestions@shd.snohomish.wa.gov
