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HealthConnect One Community-Based Doula Program

Category

Child & Family Health

Child's Age

Prenatal, 0-1 years

Participant

Parents/Guardian

Languages

English, Spanish

Brief Description

Community-based doula program providing trauma-informed, extended, intensive support to birthing families prenatally, during labor, and postpartum to assist with breastfeeding, attachment, and early parenting.

Expected Impact

  • Increase in percentage of mothers receiving adequate prenatal care 
  • Increase in the percentage of babies delivered at term 
  • Increase in the percentage of babies with a birthweight over 2500g 
  • Increase in the percentage of mothers breastfeeding at birth 
  • Increase in the percentage of babies being breastfed at the end of the program and/or 6 weeks, 3 months, and 6 months
  • General increase in positive parenting practices during the first several months postpartum
  • General increase in mothers waiting until 4 months to provide solid foods to infants 
  • General increase in breastfeeding duration and exclusivity in minority populations (African American and Hispanic)
  • General decrease in the number of c-sections

Core Components for Model Fidelity

  • Doula Care:
    • Home visit/virtual visits 
    • Encouraging well baby checkup 
    • Encouraging postpartum follow up 
    • Lactation support 
    • Referrals as appropriate 
    • Postpartum group support 
    • Postpartum Depression Screening 
    • Contraceptive counseling/Family planning 
    • Culturally appropriate care or traditional postpartum care 
    • Newborn/Infant development 
  • Agency Accreditation:
    • Employ women who are trusted members of the target community 
    • Extend and intensify the role of breastfeeding peer counselor/community-based doula with families from early pregnancy through at least the first months postpartum
    • Collaborate with community stakeholders/institutions and use a diverse team approach 
    • Facilitate experiential learning using popular education techniques and the HealthConnect One training curriculum 
    • Value the doula’s work with salary, supervision and support 
  • Use of Brightspace Learning Management System:
    • Provided by Health Connect One 
    • Training of Trainers and Community Convening
    • Peer Counselor and Community-Based Doula Curriculum 
    • Peer Counselor and Community-Based Doula Program Management Guide 
    • Community-Based Doula Accreditation Program  

For more information, visit the HealthConnect One Community-Based Doula Program webpage.

Languages Materials are Available in

English, Spanish

Delivery Mode

In-person/virtual home visits and labor/delivery setting.

Dosage

Home Visits: Delivery includes 12 prenatal and 12 postpartum visits, twice a month between 28 and 36 weeks, once a week between 36 weeks and 8 weeks postpartum, and once a month after 8 weeks postpartum. Continue until the child is 6 months or no longer breastfed. 
 
Labor/Delivery Setting: Continuous support beginning in early labor and for at least 2 hours postpartum.

Infrastructure for Implementation

Prior to implementation, sites must: 

  • Complete the application process and discuss application with HealthConnect One staff.
  • Host a Community Convening (4-hour online meeting)—This meeting allows local community members to get involved and share questions/concerns, as well as identify the facilitators and training personnel.
  • Host Training of the Trainers (Four 4-hour sessions online). HC One facilitates the training of trainers and encourages all partner sites to collect baseline data and/or do a community assessment before the program implementation. The assessment focuses on what sites will use for metrics of success, how they will collect data, and what outcomes they want to collect data on.  
  • Identify participants for the Community-based Doula 20-session training and host training.  
  • Gain access to HealthConnect One data systems.  

Space: Most replication sites have taken place within a not-for-profit organization. HealthConnect One has also worked with implementing organizations working to build their non-profit status as they are replicating the CBD model.

Staffing Requirements

Staff members required for implementation include: 

  • Project Coordinator (0.5 FTE): At least 3-5 years program management experience, at least 1-2 years supervisory experience, preferably with “reflective supervision" approach 
  • Community-Based Doulas (2 FTEs): must be representative of the communities they serve and trained by HC One to provide services. Each CBD serves 8-12 participants in a week and provides approximately 35-50 births per year.  

Additional staffing considerations include: 

  • Program Director 
  • Program Manager 
  • Training Facilitators

Descriptions of these roles can be found in the Community-Based Doula Management Guide, which is provided by HC One after sites sign the contract agreement.

Training for Model Fidelity

HealthConnect (HC) One will provide sites with Technical Assistance and other support throughout the recruitment and hiring process. This includes providing the Community Doula Management Guide. HC One will support new sites as doulas begin to deliver services to the birthing families. HC One will consider what policies the site needs to have in place to implement effectively. 

Training is provided by HC One through Brightspace. The training workshops cover the following topics:  

  • Labor and Birth Support
  • Breastfeeding Support
  • Childbirth Education 
  • Introduction to Equity Framework
  • Orientation to Trauma-Informed Care 

HC One recommends completing training once a week for 20 weeks, with each session lasting 3-4 hours with additional time necessary for assignments and observations required for certification; the amount of time for this component of training is dependent upon community needs and available opportunities for observation. HC One recommends training at least 8-15 participants in each session.  
 
Community doula training entails: 

  • 20 sessions Conversations with expectant mothers and learning about routine prenatal visits  
  • Observations of...
    • 1 childbirth class 
    • 1 lactation class or support group 
    • 6 home visits during the prenatal and postpartum period (3 each) 
    • 3 births 
  • After observations are completed, trainees begin accompanying mothers during labor and birth. 
  • If funding allows, the doula may have one mentored birth after completing several births independently. 

For more information, visit Community Doula Training.

Contact Information

https://www.healthconnectone.org/our-work/community_based_doula_program/
 
Jacqueline Lambert: Community-Based Doula Manager & Trainer; 662-402-6611, training@healthconnectone.org

Cost Estimates

Cost estimates of training are dependent upon the level of support. 

  • Direct Training of Community-based Doula (CBD) online: $60,000
  • CBD Program Replication Fee for organizations: $20,000 virtual OR $30,000 in-person
  • Project Management: cost varies 

Additional costs associated with implementation include: 

  • Replication fee- $35,000 per site (one-time expense)
  • Program supplies, training supplies, and equipment- approximately 5% of the site’s budget
  • CBD training and salaries- 50% of the site's budget, with a recommended salary of $35,000/year per doula at 2 FTEs. 
  • Project Coordinator training and salary- 25% of the site’s budget, with a recommended salary of $40,000 per year at 0.5 FTE.

Purpose Service Code (PSC)

5413 - Prenatal/Newborn Services

Program Identifier (PID)

HealthConnect One (HC One) Community Doula Model

Minimal Outputs for NCPC Reporting

FY 24-25:

  • Number of parents/guardians partcipating†

†Select Family Support Programs data collection will include basic demographic data for parent/guardian participants including Race, Ethnicity. Data on interpretation and transportation will be collected when appropriate. 

Minimal Outcomes for NCPC Reporting

FY 24-25:

  • Increase in parent use of services

Minimal Measures for NCPC Reporting

FY 24-25:

  • Parent use of services calculation 

NOTE: As of 2023, HealthConnect One is currently transitioning to a new data collection system. The measure reported to NCPC may subsequently change once the data collection system is established.

NCPC Evidence Categorization

Evidence Based- 4 publications, including 3 randomized control trials and 1 program evaluation using unadjusted comparison groups.

Research Summary

The studies included represent three randomized control trials and a program evaluation. Hans et al. (2013)1 found that parents supported by a community doula showed more encouragement and guidance for their children. The infants were less likely to be distressed for longer periods of time and mothers responded more promptly to the distress at 4 months (no difference between comparison groups at 12 or 24 months). At 4 months, the doula group was less likely to show high-risk parenting attitudes (not assessed at 12 or 24 months). As for parent stress, at 12 months the doula mothers were less stressed. There were no differences at 4 or 24 months. Edwards et al. (2013)2 found that overall that significantly more intervention mothers initiated breastfeeding than the standard care mothers (63.9% vs. 49.6%). More intervention mothers waited until 4 months before introducing solid foods (21.3% vs 12.5%) and only 5.6% had introduced these foods before 6-weeks of age, in comparison to 17.9% of standard care mothers. In 2018, Hans, Edwards, & Zhang3 found that intervention mothers were more likely to attend a childbirth class and less likely to use pain medication during birth. There were no significant differences for Caesarean deliveries, postpartum depression, re-hospitalization rates, preterm birth, low birthweight, admission to NICU, or timing of pediatric checkups. Intervention mothers were more likely to initiate breastfeeding, use a car seat immediately, and practice safe sleep. However, there were no differences by 3 months postpartum. The Perinatal Revolution program evaluation4 found that Black and Hispanic mothers participating in the community doula program breastfed for longer and more exclusively than the comparison group mothers. The doula program participants also showed lower C-section rates (24% vs. 30%). The small number of Tribal participants experienced high breastfeeding rates and low C-section rates as well, indicating effectiveness in Tribal communities. 

  1. ^ See Hans et al. (2013). This randomized control trial included all African American mothers, a majority of whom received Medicaid. The doulas were also African Americans from local communities that shared commonalities with the mothers. Doulas were trained through Chicago Health Connected and all became certified birth educators and ¾ became certified lactation counselors. The comparison group mothers received usual prenatal care and social services. The intervention mothers received 2-3 postpartum home visits and 3-4 prenatal visits. The doulas were in contact with the mothers about 12 times postnatally. Measures used include video recordings of parent-child interactions coded using the Parent-Child Observation Guide (PCOG), the Adult-Adolescent Parenting Inventory, and the Parenting Stress Inventory-Short Form.
  2. ^ See Edwards et al., (2013). This randomized controlled study examined the relationship between participation in a community doula intervention, breastfeeding, and the introduction of complimentary foods. African American women under the age of 21 participated and either received standard prenatal/postpartum care or received support from a community doula. The doulas visited the mother’s home an average of 10 times prenatally, 12 times during the postpartum period, and attended about 80% of the births. Among other topics, they encouraged the mothers to bond with their babies, create healthy habits, and helped them learn about birth, breastfeeding, and introducing solid foods. The breastfeeding trend continued at the 6-week mark, though the percentages had dropped (28.7% vs. 16.8%), and by 4 months there was no longer a significant difference. Although the duration effects are moderate, it is still important to consider the short-term benefits of increasing breastfeeding rates and delaying solid foods during infancy. Measures used include medical records and maternal interviews.
  3. ^ See Hans, Edwards, & Zhang (2018). This randomized control trial considers the relationship between mothers receiving doula-home-visits and birth/postpartum outcomes. Most participants were African American or Latinx and under 26 years old. Participants received support from a doula and a home visitor or case management (control group). The home visitor worked on the mother-infant relationship, child development and safety, and creating an education/work plan. Prenatally and immediately after birth/during the first weeks of postpartum, the doula focused on pregnancy and postpartum health, preparation for birth, bonding, breastfeeding, and newborn care. Due to the combination of interventions, it is difficult to isolate the effects of just one of the interventions. Overall, this study provides evidence that home-visits from doulas can impact the use of positive parenting and infant-care practices. Measures used include interviews with the mothers and the Center for Epidemiological Studies-Depression Scale.
  4. ^ See HealthConnect One (2014). The program evaluators collected data from 8 community-based doula programs around the country. Participants were low income, had limited education, and a majority were Black or Hispanic (also included a small percentage of American Indian) and under 25 years old. Evaluators completed analysis using unadjusted comparison groups. Non-significant, but promising results included higher rates of skin-to-skin contact after birth, low epidural use by the Hispanic population, and an increase of alternative pain management techniques. A notable limitation is that the populations used for the comparison group may not have equally matched. Data was collected using the evaluation tool, Doula Data, that has 419 variables focusing on history, prenatal/postpartum contacts, labor, and birth. The evaluators note that because it is not a research tool there may be inaccurate data in the system.

Researched Population

  • Birthing families
  • Medically underserved
  • Uninsured or underinsured
  • Disproportionately affected by Healthcare  
  • People with lower incomes
  • people from racial and ethnic minority groups
  • Adolescent parents

Clearinghouse and Compendium References

Association of Maternal and Child Health Programs- rated “Best Practice” 
 
Healthy Start EPIC Center (NICHQ)- rated “II (Promising practices—Innovative practices employed in the field, based on state-of-science knowledge about what works to improve outcomes, and gathering evidence of effectiveness)” 
 
National Home Visiting Resource Center- rated Emerging

Edwards, R. C., Thullen, M. J., Korfmacher, J., Lantos, J. D., Henson, L. G., & Hans, S. L. (2013). Breastfeeding and complementary food: Randomized trial of community doula home visiting. Pediatrics, 132(Supplement 2), S160-S166. https://doi.org/10.1542/peds.2013-1021P 

Hans, S. L., Edwards, R. C., & Zhang, Y. (2018). Randomized controlled trial of doula-home visiting services: Impact on maternal and infant health. Maternal and Child Health Journal, 22(1), S105-S113. https://doi.org/10.1007/s10995-018-2537-7

Hans, S. L., Thullen, M., Henson, L. G., Lee, H., Edwards, R. C., & Bernstein, V. J. (2013). Promoting positive mother-infant relationships: A randomized trial of community doula support for young mothers. Infant Mental Health Journal, 34(5), 446-457. https://www.doi.org/10.1002/imhj.21400 

Health Connect One. (2014). The perinatal revolution.



Local Partnerships Currently Implementing

Local Partnerships in purple have adopted HealthConnect One Community-Based Doula Program. Local Partnership contact information can be found here.