A Preliminary Evaluation Model for Illinois' High Risk Infant Follow-up Program in Suburban Cook County *

BACKGROUND:  The Adverse Pregnancy Outcome Reporting System (APORS) is a surveillance system which collects reports on specific birth outcomes and conditions in the state of Illinois. All infants reported to APORS are eligible for the High Risk Infant Follow-Up Program (HRIF). HRIF serves families by assigning a public health nurse for a minimum of six visits in the first 2 years of life, providing services including developmental assessments and resource referrals. This project sought to establish a preliminary evaluation model for HRIF in suburban Cook County (SCC), Illinois.

METHODS:   A sample of 293 infants was obtained using random sampling with replacement from primarily closed HRIF cases meeting criteria for modifiable diagnoses. The evaluation examined HRIF using both program process and infant outcome measures. Infant outcomes were examined by improvement in infant’s physical, cognitive, and social development. Physical growth was assessed utilizing age-specific weight, length, and head circumference percentiles collected at birth and final HRIF visit. Cognitive and social development was assessed via five categories from the Ages and Stages Questionnaire administered at initial and final visit. Wilcoxon signed rank sum test was used to compare outcome development variables at birth and final visit. Chi-square test was used to compare findings for both process and outcome variables among geographic regions. Separate logistic regression models were established for each developmental outcome variable with length of time in HRIF as the primary exposure. 

RESULTS:   Significant improvement was seen in weight, head circumference, and communication skills between first and last visit. All other developmental outcome variables showed no significant improvement. Birth weight, communication skills scores and problem solving skills scores differed significantly among regions. Infants in HRIF for over 18 months had significantly decreased odds of having improved communication skills than those with shorter follow-up. No associations were seen between length of time in HRIF and all other improvement in outcome variables.

CONCLUSIONS:   Generally, HRIF for SCC is meeting or exceeding its process expectations. The evaluation identified key developmental outcome measures of success (i.e. communication skills).   Conversely opportunities for improvement were identified (i.e. gross motor skills).  The lack of significant findings surrounding length of time in HRIF and developmental outcomes, indicates a need for further evaluation of the programs processes and consideration of a more robust HRIF exposure variable to capture its impact on infant outcomes. The limitations in the evaluation surrounding available resources and data emphasize the need for increased systematic support of evaluation efforts.