By Michele Cohen Marill, Photograph by Michael Thomas, Health Affairs Vol. 41, No. 8, August 2022
Abstract:
Designed by and for Black women, a St. Louis–based group prenatal care program incorporates trauma-informed care and behavioral health services.
Article:
Fluorescent bulbs bathe the basement room in bright light as cheerful as sunshine, even though the windows only look out onto office corridors. Richelle Smith stands before a projection screen, her hands clasped, her voice loud and clear behind her COVID-19-safe black face mask. This is her moment to flip the script—to look out at maternal health providers sitting around a conference table and tell them what it’s like to be their patient.
Smith, 29, grew up in North St. Louis, just a couple of miles from the city’s downtown skyline and iconic Gateway Arch but a world away from all that they represent. Instead of projecting an image of progress and possibility, the neighborhoods north of Delmar Boulevard bear the scars of systemic neglect.
Overgrown and rubble-strewn lots mar blocks where the massive Pruitt-Igoe housing project was torn down about fifty years ago. Victorian-era houses, ghosts of a past century’s heyday, are boarded up and crumbling. Cement barriers block off tonier streets that intersect the area—a clear sign of the divisions that have isolated many of the city’s mostly poor and Black residents.
Affinia Healthcare’s federally qualified health center sits at 1717 Biddle Street, an oasis in the section of the city known as Carr Square, surrounded on all sides by red brick housing projects—some newly built, some aging and worn, some undergoing redevelopment behind chain-link fences. As with other safety-net providers that belong to the St. Louis Integrated Health Network, Affinia seeks to counteract the entrenched disadvantages of its patients. That mission led to the creation in 2016 of a new maternal health program called EleVATE, which stands for “elevating voices, addressing depression, toxic stress and equity.” It aims to improve maternal and infant health outcomes by engaging the community as a partner.
EleVATE offers group-based prenatal care with a curriculum designed by and for Black women. Groups of five to ten pregnant women and their companions (fathers, partners, relatives, or friends) meet with an obstetric clinician and group facilitator at least monthly to talk about issues in pregnancy and birth. Smith is one of six “community collaborators”—moms who joined EleVATE just after its inception in this Affinia basement conference room and who now serve on its steering committee.
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