"MAMA's is like a second mom:" Client and Staff Experiences in a Comprehensive Social Risk Care Management Program Within a Perinatal Medical Home.

Introduction: Addressing persistent racial inequities in preterm birth requires innovative health care approaches. The Los Angeles County Maternity Assessment and Management Access Service Synergy Neighborhood program (MAMA's) is a perinatal medical home program designed to alleviate the impacts of chronic stress by addressing social determinants of health. It reduced odds of preterm birth rates in Black participants, yet it is unclear which program components most contributed to this reduction. This study seeks to understand the experiences of staff and clients within the MAMA's program to identify what factors decrease stress, how the program addresses racism and the challenges and opportunities of optimizing health during the COVID-19 pandemic. Methods: 21 staff and 34 clients completed semi-structured interviews from November 2020–December 2021. Separate interview guides for staff and clients explored experiences within the program, experiences during the COVID-19 pandemic, and how racism affects clients. Interviews were recorded and transcribed. Analysis used a phenomenologic framework. Coding was performed using grounded theory to identify themes. Results: Analysis revealed six key themes: Stressors clients face, barriers for undocumented, Latina, and Spanish-speaking clients, exceptional care, emotional support, naming and responding to racism and discrimination, and impacts of COVID-19 pandemic. Discussion: Staff and clients work together to address social needs in order to address chronic stress and racism in their lives, especially during the COVID-19 pandemic. Interviews revealed relationship building is a cornerstone of the program's success and plays a significant role in alleviating chronic stress in this population. Significance: It is known that chronic stress is a risk factor for preterm birth. However, little is known about the experiences of pregnant women receiving social supports in addition to medical support. Prior studies have investigated experiences of perinatal women and accessing of resources during the COVID-19 pandemic, but no studies to date have evaluated the experiences in a comprehensive medical home that addresses both social determinants of health and social needs in addition to health care needs. What this study adds: Perspectives of women at risk of preterm birth within a medical home that addresses both social and medical needs, perspectives of staff members, and an insight into what factors are deemed most impactful in reducing chronic stress, which may enable reduction in preterm birth. [ABSTRACT FROM AUTHOR]