Moms start by meeting with a social worker to identify their top priorities and work on navigating resources available in the community. As the patient’s needs and goals evolve, their social worker reevaluates and offers additional support. “Our social workers have that wealth of knowledge to make the right referrals,” Ellis said. “They can connect moms to food banks and programs to get baby items like diapers, car seats, breast pumps, and formula. They help apply for WIC or disability benefits. They help with housing and transportation to appointments or even to a grocery store if a mom lives in a food dessert.” MOM has helped patients get blood pressure monitors, pay utility bills, and even get supplies for their period. “Our social workers target what each mom really needs,” Ellis said. “We don’t just tell her to take care of herself and her baby when she doesn’t have the means to do so. We fill those gaps.” In its first year, MOM supported over 150 patients, with new moms enrolling all the time. Ellis can think of numerous success stories. After a mom showed photos of bullet holes riddling her apartment, social workers helped her with a deposit on rent in a safer neighborhood. Another mom was connected with Meals on Wheels after she asked to step out of a pediatrics visit so her kids wouldn’t overhear her share her concerns about not having enough to eat. Several dads admitted they were overwhelmed by caring for both their partner and baby until the MOM team stepped in to help. “This program has meant so much because it provides security,” Ellis said. “It helps improve the health not only of our moms and babies, but of the entire household.” The benefit reaches beyond individual lives. Ellis said the long-term goal is to reduce preterm births and improve maternal mortality and morbidity rates in the Mid-South. As Regional One Health looks to build a new campus, the MOM program is an opportunity to emerge as a national leader in complex care and maternal care. With that in mind, Ellis and her team are exploring opportunities to fund the program after their grant expires in June of 2026. “We’re looking at ways to continue to provide our moms with what they need. This program benefits moms, families, and the entire community,” she said. “It is an alternative model that can really set us apart from everyone else. As we look to the future with a new facility, Regional One Health can set the bar as a leader in maternal care.” Regional One Health is honored to partner with the Tennessee Department of Health to secure vital support for mothers through the Practice Transformation and Extension arm of Tennessee’s Healthcare Resiliency Program. To support Regional One Health, visit regionalonehealthfoundation.org REGIONAL ONE HEALTH FOUNDATION 13
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