FROM THEORY TO COMMUNITY PRACTICE

The Life Course Approach

Carol Brady, MAExecutive Director

Northeast Florida Healthy Start Coalition, Inc.

Every Woman Southeast- WebinarFebruary 9, 2012

Overview

The Life Course in MCHImplications for practiceFrom theory to practice

Planning framework Prenatal Care & Case

management Leadership Academy

Life Course Perspective

Back to the future!MCH historically focused on broader public

health perspectiveShift in focus over last decade

Individual knowledge, skills Community, provider education Individual interventions

Efforts to improve birth outcomes limited to nine months of pregnancy

Improvements in maternal and infant survival

Why now?

Improvements in infant mortality have stalled.

Infant Mortality, U.S.1990-2007

Infant Mortality RateU.S. 1990-2007

Why now?

Racial and ethnic disparities persist.

Infant Mortality Rates by Race/Ethnicity

U.S. 2005-2007

Beyond pregnancy

Birth outcomes reflect life course of mother, not just pregnancy

Proposed by Michael Lu & Neal Halfon (2003)

Synthesis of two biomedical models Early programming Cumulative pathways

Synthesis of Biomedical Models

Early programmingExposures in early life could influencefuture reproductive potential

Cumulative pathwaysChronic accommodations to stress results in wear & tear contributing to declining health over time.

Life Course Perspective

Lu MC, Halfon N. Racial and ethnic disparities in birth outcomes: a life-course perspective.Matern Child Health J. 2003;7:13-30

Life Course Perspective

Approach suggests a complex interplay of biological, behavioral, psychological and social protective factors contributes to health outcomes across the span of a person’s life.

Factors impact racial, ethnic groups differently and may explain disparities despite equal access to care during pregnancy.

Life course models BROADENS the focus of MCH to include both health & social equity

Life Course Perspective

Rather than focusing on risks, behaviors & services during pregnancy, CUMULATIVE effects of health, life events are examined

Health & socioeconomic status of one generation directly affects the health status --- and REPRODUCTIVE HEALTH CAPITAL – of the next one.

Implications

Life course framework in MCH has PROGRAMMATIC and POLICY implications.

Changing practice

Content of care is expanded Poverty Economic security Education

Changing practice

Services are organized and delivered in ways that build resiliency and social capital and reduce dependency Group care Self care

Changing practice

Requires inter-disciplinary, inter-agency collaboration to address complex needs

From Theory to Community Practice

• Planning Framework• Case Management & Prenatal Care• Leadership Academy

Planning Framework

Planning Framework

The Healthy Start program: individual case management and risk reduction services, not directly responsible for addressing social determinants.

Plan strategies developed on two levels: What actions can be implemented through

Healthy Start? What partnerships are needed between Healthy

Start and other organizations working to address social equity?

Looks at four phases: Infancy Childhood & Adolescence Preconception Pregnancy & Childbirth

Planning Framework

Impact of paradigm shift

http://nefhealthystart.org/resources-research/plans-policies-financials/

A Life Course Case Management Model

Pilot new model at the Magnolia Project, federal HS initiative in Jacksonville that uses a preconception strategy to address racial disparities in birth outcomes.

Two stage approach: Crisis stabilization, deal with immediate

risks Longer term work to change trajectory

(Life Plan)

Case Management

The individual Life Plan is participant- driven with established goals that address needs in three areas:Access to preventive health careFamily & community supportReduction of poverty and social

inequity

Participants are enrolled in group activities that are specific to their Life Plan.

Benefits

Addresses the social determinants that influence poor birth outcomes.

Promotes inter-and independence while building reproductive capital in the community.

Contributes to improved self esteem of participants.

Hard work! Staff vs. participant response.

Prenatal Care: Centering Pregnancy

Group prenatal care modelKey elements:

Self care Facilitated discussion, participant-

led Group interaction and inter-

dependence

Leadership Academy

Grant from a community foundation to raise awareness about infant mortality and its impact on the African American community

Response to study: community most impacted by IM does not recognize it as a problem (“babies die. . .”)

Leadership Academy

Make a Noise! Make a Difference! social marketing campaign

Successfully raised awareness about infant mortality and contributing factors

“Now we know. . .what do we do about it?”

Leadership Academy

Make a Difference! Leadership Academy

Grassroot leadership curriculum developed by University of Arizona Extension Office.

Modified to focus on infant mortality & impact of community factors

“Community icons”12 weeks

Leadership Academy

Graduation field trip! Jacksonville City Council meeting to adopt budget

Cliff Notes: Life Course Service Delivery Model

Individual services (mitigate, reduce risks)

 

Group services (inter-dependence, self-reliance)

Community capacity building

Advocacy (social determinants)

Acknowledgments

Thanks to Michael Lu, Cheri Pies, CityMatCH

Faye Johnson, Healthy Start board & staff

Chartrand Foundation & other community funders!

Thank you! cbrady@nefhsc.org

Thank you!

cbrady@nefhsc.org