California MHTF Community Embedded Workforce Awards

The California MHTF, in partnership with fiscal intermediary MOMS Orange County, funded community-based organizations (CBOs), maternal health hubs, and other organizations embedded in their local communities to identify and invest in sustainable business models and best practices that align with the needs of local communities and are developed for, by, and with California's community birth workers.

The Community Embedded Workforce Awards seek to promote connection, collaboration, and support the community birth workforce’s impact on positive maternal health outcomes by strengthening the workforce's ability to 1) establish sustainable infrastructure (e.g., collectively negotiate and establish business partnerships and integrated pathways for care with key stakeholders, including health plans), and 2) collectively identify and disseminate replicable high-quality, evidence-based best practices.

A pregnant person and child shop for groceries in a local market.

Goals of the Community Embedded Workforce Awards

Strengthen Business Capacity

Develop replicable CBO business operations and capacity for collaboration, including with managed care plans

Share Best Practices for Birth Services

Disseminate replicable best practices for community birth services and strengthen connections with health care and public health systems

Enable Peer Training

Connect CBOs with one another to facilitate ongoing mentoring, training, and shared learning

Increase Access to Birth Services

Increase the number of patients, including Medi-Cal members, served by community embedded maternal health organizations

Prioritize Key Patient Populations

Increase the number of community birth workers who can provide high-quality, respectful, and trauma-informed services in different languages in key regions with community birth worker shortages

Sustain Existing Organizations

Support existing CBOs, hubs, and other organizations that understand the needs of their local communities and provide high-quality, evidence-based care and services

Strengthening and Sustaining California's
Community Birth Workforce Capacity

A doula helps a pregnant woman position herself on an exercise mat.

Strengthening Capacity: Northern California

Building Capacity: Northern California
A doula visits a new mom in her home

Strengthening Capacity:
Bay Area

Strengthening Capacity: Bay Area
A pregnant woman is supported by her husband.

Strengthening Capacity:
Central Valley

Strengthening Capacity: Central Valley
Maternal health professionals gather at a networking event.

Strengthening Capacity:
Santa Cruz & San Benito Counties

Strengthening Capacity: Santa Cruz/San Benito
A doula assists a pregnant woman while her husband supports her.

Strengthening Capacity:
Southern California

Strengthening Capacity: Southern California

Key Learnings & Recommended Solutions

Key Learning: Trauma-Informed Care in Health Care Communications

  1. Accessibility: There is a need for increased accessibility to midwifery services for Medi-Cal recipients.
  2. Trauma Awareness: Care providers should focus on understanding the individual experiences of patients using a trauma-responsive approach.
  3. Comprehensive Programs: Importance of comprehensive support services for families experiencing trauma.
  4. Effective Communication: Use of plain, compassionate language and validation of experiences are key to fostering trust and understanding in healthcare communication.
  5. Principles of Trauma-Informed Care: Core principles include safety, trustworthiness, peer support, collaboration, empowerment, and cultural humility.

Key Learning: Closing Feedback Loops on Patient Experiences

  1. Patient Navigators: Establishing patient navigators can bridge communication gaps between patients and healthcare systems, facilitating the collection and feedback of patient experiences.
  2. Follow-Up Practices: Follow-up with patients after providing feedback helps demonstrate care and accountability within the health system.
  3. Transparency: Regularly sharing summaries of feedback and communicating changes is crucial for maintaining trust in healthcare practices.
  4. Technology Solutions: The introduction of tech platforms could enhance community feedback processes and ensure responsiveness from organizations.

Key Learning: Maternal Levels of Care Perceptions

  1. Mandated Care Levels: There is a strong call for mandated transparency and standardization in maternal levels of care to improve awareness and care transitions.
  2. Concerns with Implementation: The implementation of these care levels should not lead to liability issues for healthcare providers regarding patient education.
  3. Staffing and Support: Healthcare facilities are facing challenges such as staffing shortages that impact the level of in-person care provided to patients, particularly in postpartum settings.

Key Learning: Needs Following Maternity Service Closures

  1. Comprehensive Care Plans: Public health agencies must quickly devise plans to ensure continued access to maternity services in affected communities.
  2. Community-Based Support: Accessible prenatal provider networks and transportation services are essential to fill gaps left by service closures.
  3. Mental Health Resources: Increased mental health support and trusted channels for patient feedback are critical for affected communities.

Key Learning: Successful Practices in Perinatal Risk Assessment

  1. Digital Tools and Early Detection: Utilization of digital tools and streamlined scoring systems aids in the timely identification of risk factors in pregnant individuals.
  2. Follow-Up and Coordination: Consistent follow-up care, particularly for high-risk populations, is vital for improving health outcomes.
  3. Interdisciplinary Collaboration: Collaboration among various health disciplines facilitates comprehensive patient assessments and care.

Key Learning: Barriers to Timely Risk Identification

  1. Stigma and Systemic Barriers: Stigma around seeking help, fragmented mental health services, and social determinants like poverty are prevalent barriers.
  2. Resource Limitations: Limited access to timely referrals and follow-up care challenges the ability of mothers to receive necessary support promptly.
  3. Logistical Challenges: Practical issues, such as the need for new parents to leave home shortly after birth and limited transportation options, impede access to care.

Key Learning: Data Availability and Needs

  1. Access to Current Data: Respondents emphasize the need for updated and disaggregated data to inform practice and policy making, particularly regarding racial and ethnic disparities.
  2. Tracking System Improvements: There is a call for improved tracking systems for maternal health care services to aid in comprehensive service coordination.

Key Learning: Coordination Between Sectors

  1. Collaborative Grants and Initiatives: Successful partnerships among various stakeholders, including hospitals and community organizations, have led to effective doula programs and initiatives addressing maternal mental health.
  2. Cross-Sector Task Forces: Collaborative efforts during crises, like the COVID-19 pandemic, have proven effective in resource allocation and maternal health support.

Key Learning: Engagement with Stakeholders

  1. Community and Consumer Input: It is critical to involve community members in decision-making processes to enrich the perspectives of those receiving care.
  2. Midwife Representation: There is a strong desire for increased involvement of licensed midwives in task forces and professional group discussions to address maternal health issues effectively.
Recommended Solutions

Proposed solutions to these issues include innovative models for collaboration, the establishment of mentorship structures, and the necessity of addressing gaps in funding for underserved communities. Recommendations stress the importance of documentation and dissemination of best practices, the need for multi-year flexible funding, and the creation of bridge funds to assist organizations during payment delays.

A community midwife teaches a pregnant person about the fetus's position during pregnancy.

What is a Community Embedded Birth Worker?

For the purposes of this funding opportunity, a community embedded birth worker is someone who is trained and experienced in providing physical, emotional, and informational support to an individual who is pregnant, in labor and delivery, between pregnancies (interconception), preparing for a pregnancy (preconception), or recovering from a pregnancy loss, as well as support for the caregivers of birthing patients.

A community embedded birth worker:

  • Is physically located in or near the community and is part of its collaborative networks
  • Provides services or pursues initiatives that directly meet local health care needs and are shaped by the community’s health outcomes
  • Maintains a mutually beneficial, two-way flow of learning, services, or resources that go into the local community; and local community health knowledge informs the embedded entity
  • Builds and maintains continuous trusting relationships with key stakeholders
  • Possesses significant knowledge of the local community’s health history and all health-related social needs
  • Is a member or has staff/partners who identify as members of the local community being served, with knowledge of the local community’s health needs
  • Fosters sustainable change by identifying and nurturing the existing resources, knowledge, and assets within the local community

We acknowledge there are numerous professions that serve California’s birthing communities and populations. However, for the purposes of this funding opportunity, the above is the working definition of community embedded birth worker.

About the Awards

Purpose The purpose of this funding mechanism is to increase and deepen the impact of community embedded birth workers on positive maternal health outcomes by establishing sustainable and replicable birth worker business and maternal health best practices and policies that align with the needs of the local communities served and are developed for, by, and with California’s community birth workers.

Amounts The California MHTF's fiscal intermediary, MOMS Orange County, distributed nine awards in the amount of $30,000-$50,000 each, totaling $382,500 in funding.

  • Awardees are CBOs, maternal health hubs, or other organizations embedded in their local communities serving prenatal or postpartum families to enhance high-quality, evidence-based, innovative, and community centered maternal health services.
  • Funds were awarded via an expedited grant application process open statewide in California.

Team Awards Applicants were encouraged to apply as Applicant Teams to demonstrate capacity for partnership building and birth service collaborations within their local communities and geographic regions. Applicant Teams submitted one application that described the project and how each organization will contribute to reaching the goal. Each organization had to meet eligibility requirements. Separate budgets for each organization on the Applicant Team were required. Each organization requested a separate amount so, when applying as an Applicant Team, the total project budget would be higher than $50,000. Each organization on an Applicant Team received their own funding, and therefore must have met the requirements of being tax-exempt under Section 501(c)(3) of the Internal Revenue Code; not a private foundation or Type III supporting organizations; and must be based in California.

A doula guides a pregnant patient and their partner through physical exercises.
A webinar attendee joins the event from their laptop wearing a headset.

Selection Criteria

Awardees are 501(c)(3) non-profits and demonstrated the following:

  • Success in providing high-quality, evidence-based, and community centered maternal health services, including to populations that are currently underutilizing services
  • Direct birth work (e.g., perinatal community health workers, doulas, promatoras) for at least two years
  • Past and current experience serving clientele who are impacted by structural deficiencies when accessing, utilizing, or receiving Medi-Cal (or similar) services
  • Active participation in a community network that includes public health, health care, and social services
  • Capacity to serve a clientele with a range of health care and health-related social needs and lived experiences, and perinatal and postpartum risk
  • Serving populations most likely to be impacted by negative health outcomes, and/or with high rates of maternal mortality and severe maternal morbidity
  • Being well established and positioned for partnership with other entities
  • Possessing leadership and expertise to inform best practices
  • Supporting areas experiencing community birth worker shortages

Alignment with California MHI This project aligns with the overarching goals of California MHI in that it strengthens high-quality, respectful, and trauma-informed care to promote the sustainability of community-based services, as well as collaboration across public health, health care, and the community to improve risk communication and care coordination. It also aligns with the findings and recommendations of DHCS’ Birthing Care Pathway, which emphasizes the importance of capacity building and technical assistance support for services that can be provided in-place and in-community.

To promote alignment with the overarching goals of California MHI:

  • Preference was given to applicants that have demonstrated success in providing high-quality, respectful, and trauma-informed care for American Indian/Alaska Native (AIAN) communities, Black communities, and populations that face barriers accessing and receiving health care services.
  • Preference was also given to applications whose objectives focus on addressing key health-related social drivers of maternal mortality and severe maternal morbidity, such as efforts addressing maternal mental health or other maternal health-related social needs.