The Great Rivers United Way’s project, Improving Maternal and Child Health Outcomes through Great Rivers HUB and Community Health Worker/Doula Workforce Expansion, expanded their Community Health Worker (CHW)/doula program to provide holistic, culturally responsive prenatal and postpartum support for high-risk families in La Crosse County. Using the evidence-based Pathways Community HUB model, the project addressed both clinical needs and social determinants of health, supported 60 mothers and their families, contributed to healthy birth outcomes and strengthened a sustainable, community-based workforce model to advance maternal and child health equity.
The Challenge
Pregnant individuals and families in the La Crosse County area who are insured through Medicaid or are uninsured face a higher risk for poor maternal and infant health outcomes, including low birthweight, due to a combination of clinical needs and unmet social determinants of health. While traditional prenatal care coordination exists, it often does not provide the continuous, holistic and household-centered support needed to address barriers such as housing instability, transportation challenges, substance use and limited access to culturally responsive care, especially during the postpartum period.
Evidence-based approaches such as Community Health Workers (CHWs) and doulas have been shown to improve birth outcomes, yet access to these services remains limited for individuals most at risk. Doula care, while highly effective, is often financially inaccessible, and workforce capacity for both CHWs and doulas is limited by short-term funding and unclear sustainability pathways. In addition, while Great Rivers HUB has demonstrated promising outcomes using CHWs, the integration of a dually trained CHW/doula role was still new to the region.
Project Goals
To address this gap and to improve birth outcomes in the La Crosse County area, this project aimed to establish a broader network of support for pregnant individuals and their families by expanding the diversity of trained Community Health Workers (CHWs)/doula positions in the area. Great Rivers HUB had four goals in this expansion plan:
Hire and train two CHW/doula positions representing a diverse range of populations.
Develop a model for sustainability of the CHW/doula positions that can be shared broadly around the state.
Enroll 60 mothers/families throughout the course of the grant to meet both clinical and social determinants of health needs.
Decrease the number of low birthweight births for enrollers in the program when compared to similar demographic populations in the general community.
Results
Through this grant, Great Rivers HUB expanded and tested a dually trained Community Health Workers (CHWs)/doula model to deliver holistic prenatal and postpartum support for families in La Cross County. In partnership with the Family & Children’s Center, the project successfully hired and trained CHW/doula positions and maintained service delivery despite staffing transitions during the grant period. When initial hires left the organization, the grant allowed Great Rivers HUB to recruit, train and deploy replacement CHW/Doulas, ensure continuity of care and progress toward project goals.
Over the full grant period, the program enrolled 60 mothers and served an additional 28 children, reaching 88 total participants across adult, pregnant and pediatric populations. CHW/doulas worked closely with participants to identify and address both clinical needs and social determinants of health using the Pathways Community HUB model. As a result, the program completed 743 Pathways, representing resolved needs related to health care access, housing stability, food security, transportation and other factors that influence maternal and infant health outcomes.
The project also demonstrated positive birth outcomes among a population with high risk factors. During the initial phase of the project, 15 births were supported, with 87 percent resulting in infants born at normal birthweight. The two low-birthweight infants were enrolled later in pregnancy but were born full term and did not require neonatal intensive care. Over the full duration of the grant, 27 healthy births occurred, including eight during the final year, reinforcing the effectiveness of the CHW/doula model in supporting healthy pregnancies and deliveries. In addition, CHW/doula support contributed to improved postpartum outcomes, including increased breastfeeding initiation among participating mothers.
The project also strengthened referral pathways and partnerships across the region. Great Rivers HUB sustained and expanded a referral network that includes health systems, health plans and community-based organizations, increasing awareness of and access to CHW/doula services. A new partnership with Gundersen Health System supported recruitment of additional CHW/doula positions and laid the groundwork for rural expansion of perinatal support services, including connections to Gundersen’s Pregnancy Addiction and Social Support (PASS) clinic.
Lasting Impact
This project produced lasting systems-level impact by strengthening the sustainability and visibility of the CHW/doula workforce model. Through the grant, Great Rivers HUB developed a standardized care protocol for CHW/doula positions, supporting consistent, high-quality care delivery and improving onboarding, training and workforce stability moving forward. The project also advanced a reimbursement-based sustainability model, positioning CHW/doula roles to be supported beyond grant funding through outcome-based pathways and payer partnerships.
In addition, the success of this project sparked interest in the CHW/Doula model. Local health systems and rural community-based organizations have since begun exploring or implementing similar roles, including supporting doula training for existing CHWs and creating new CHW/Doula positions.
