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Padmini Parthasarathy, MPHCheri Pies, MSW, DrPH
Family, Maternal and ChildHealth ProgramsContra Costa Health Services
The Contra Costa Life Course Initiative: Where We Have Been, and
Where We Are Going
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Overview
Staff education
A 12-Point Plan to Close the Black-White Gap in Birth Outcomes
Evaluation
Challenges and Questions
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Staff Education Timeline
April 2005: Michael Lu presentation to all 250 FMCH Program staff
May 2005 – December 2006: Initial interactive education sessions individual program staff meetings
January 2007 – February 2008: Refresher sessions
Education sessions with community partners during this time, as well
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Staff Education Content
Theory of the Life Course Perspective
Life Course Game
Life Course Initiative activities
A 12-Point Plan
Integrating the Life Course Perspective into their work What are you currently
doing that fits with the Life Course Perspective?
How can you integrate the Life Course Perspective into future activities?
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The Life Course Game
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A 12-Point Plan…
To close the Black-White gap in birth outcomes
Developed by Michael Lu, M.D., MPH, et al.
Goals: Improve healthcare for African American women Strengthen African American families Reduce allostatic load on African American
women over the life course
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A 12-Point Plan
How is this different from current approaches?
Goes beyond prenatal care
Goes beyond individual-level interventions
Goes beyond the medical model
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Evaluation
Established Life Course Initiative Data Team, which meets regularly
Conducted survey of Family, Maternal and Child Health Programs staff
Identifying “intermediate outcomes” as measurements of success of Life Course-related activities (vs. long-term perinatal outcomes)
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Staff Survey
Evaluated staff understanding of Life Course Perspective (LCP)
Gathered ideas from staff about incorporating the LCP into their work
Survey sent to 107 FMCH Programs staff
68 staff (64%) responded
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Survey Questions
In your own words, how would you describe the Life Course Perspective?
What are two concepts from the Life Course Perspective and/or the 12-Point Plan that you think relate to your work?
Have you changed anything about your public health work as a result of learning about the Life Course Perspective?
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Survey Questions
How have you incorporated the Life Course Perspective into your work?
What are the reasons that you have not incorporated the Life Course Perspective into your work?
What would you like to see us do in the future with the Life Course Initiative?
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Summary of Staff Survey Results
72% reported that they changed something about their work as a result of learning about the LCP
Based on open-ended questions, we found that in general, staff: understood the theory of the LCP; were able to relate their work to elements of the
12-Point Plan; and had incorporated the LCP into their work in a
variety of ways
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Examples of IntermediateOutcomes (For Clients)
Improved life skills/coping skills
Improved sense of well-being, empowerment, resiliency, self-efficacy
Increased bonding response to infants
Decreased stress
Increase in financial security and stability and improved financial status
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Asset Development
Asset Accumulation
Asset Leveraging
Asset Preservation
Asset Creation
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Asset Development
Asset Accumulation Banking services Financial education
– Credit management and counseling– Budget development and money management
Income tax assistance/tax credits, i.e. Earned Income Tax Credit (EITC)
Public benefit enrollment/eligibility
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Building Economic Security Today (BEST)
With Life Course Data Team, developed a logic model for an asset development pilot project: BEST
Hosting Family Economic Success and Security training for 40 home visiting and WIC staff in October 2008
Viewing and discussing Unnatural Causes
Applying for grant funding for training and project from various sources
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Building Economic Security Today (BEST)
Specific asset development strategies will vary based on program and client population
Partnering with: Contra Costa Family
Economic Security Partnership (FESP)
Earn It! Keep It! Save It! Community Financial
Resources (CFR)– Prepaid debit card
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BEST: Measuring Outcomes
Staff: Increased knowledge and awareness of asset
development strategies and resources Improved skills in engaging clients to adopt
asset development strategies New practices for implementing their
knowledge and skills about asset development
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BEST: Measuring Outcomes
Clients: Increased knowledge and awareness of asset
development Improved sense of self-efficacy and ability to
adopt an asset development strategy Each client will adopt at least one asset
development strategy to improve his or her financial security, such as reducing debt, obtaining their EITC, starting a savings account, and utilizing a debit card
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BEST: Measuring Outcomes
System: Changes will be made to help better support
clients in utilizing asset development strategies– resource and referral materials–case management documentation systems– financial education protocols and training
guidelines
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How does BEST fit intothe 12-Point Plan?
9. Reduce poverty
10. Support working mothers and families
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Challenges
Making paradigm shift and gaining staff buy-in is a slow process
Learning and integrating many new concepts
Time and financial resources
Measuring success
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Questions for Thought
What infrastructure changes are needed to implement and measure the outcomes of Life Course Perspective-based intervention strategies?
How do we measure the success of this paradigm shift in the reduction of inequities in MCAH outcomes?
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What will success look like?