Padmini Parthasarathy, MPH Cheri Pies, MSW, DrPH Family, Maternal and Child Health Programs, Contra Costa Health Services Applying the Life Course Perspective in a Local MCAH Program

Acknowledgements Drs. Michael Lu and Neal Halfon, UCLA Dr. Paula Braveman, UCSF Contra Costa Health Services:  Cheri Pies, Director, FMCH Programs  Chuck McKetney, Epidemiologist  Debbie Casanova, Evaluator  Dawn Dailey, Program Manager

Overview The Life Course Perspective Health Equity and Social Determinants of Health Life Course Game Contra Costa Life Course Initiative Our Road Map Our First Destination: Building Economic Security Today (BEST)

Life Course Perspective A way of looking at life not as disconnected stages, but as an integrated continuum Suggests that a complex interplay of biological, behavioral, psychological, and social protective and risk factors contributes to health outcomes across the span of a person ’ s life

Percent of Mothers who Received Early Prenatal Care, by Race/Ethnicity, Contra Costa, Source: Contra Costa County’s Automated Vital Statistics System (AVSS)

Rate of Low Birth Weight Births (per 100 live births), by Race/Ethnicity, Contra Costa, Source: California Department of Health Services, Birth Statistical Master Files,

Infant Mortality Rate (per 1,000 live births), by Race/Ethnicity, Contra Costa, Source: California Department of Health Services, Birth Statistical Master Files and Death Statistical Master Files,

The Life Course Perspective (Lu and Halfon, 2003) Protective factors Risk factors

Key Concepts Early Programming Cumulative Pathways

Latina Paradox Latinas living in the United States but born abroad have birth outcomes similar to White women Birth outcomes worsen with each following generation

Disparity, Inequality, or Inequity? HEALTH DISPARITY = INEQUALITY = difference in the health status of two groups HEALTH INEQUITY = systematic and unjust differences in the distribution of illness and disease; differences are unnecessary and avoidable Not all inequalities are unjust, but all inequities are the product of unjust inequalities.

Social Advantage and Health Across Lifetimes and Generations Prepared for the Robert Wood Johnson Foundation by the Center on Social Disparities in Health at the University of California, San Francisco.

The Life Course Game

The Life Course Initiative Launched in 2005 A 15-year initiative Based on the Life Course Perspective and a 12-Point Plan to close the Black- White gap in birth outcomes

Life Course Initiative Goals Reduce health disparities and health inequities Optimize reproductive potential Create a paradigm shift in MCH work

Life Course Initiative Goals To change the health of a generation

Life Course Initiative Activities Staff education Laying the groundwork with higher- level management Interconception care Evaluation Developing a new intervention

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)

Our Road Map: A 12-Point Plan… To close the Black-White gap in birth outcomes Goes beyond prenatal care Goes beyond individual- level interventions Goes beyond the medical model

Our Road Map: A 12-Point Plan 1.Provide interconception care to women with prior adverse pregnancy outcomes 2.Increase access to preconception care for African American women 3.Improve the quality of prenatal care 4.Expand healthcare access over the life course

Our Road Map: A 12-Point Plan 5.Strengthen father involvement in African American families 6.Enhance service coordination and systems integration 7.Create reproductive social capital in African American communities 8.Invest in community building and urban renewal

Our Road Map: A 12-Point Plan 9.Close the education gap 10.Reduce poverty 11.Support working mothers and families

Our Road Map: A 12-Point Plan 12.Undo racism

Our First Destination Increased financial security and stability and improved financial status

Building Economic Security Today (BEST) Asset development pilot project Reduce disparities and inequities in health outcomes by improving financial security and stability Home visiting programs & WIC

How does BEST fit into the 12-Point Plan? 9.Reduce poverty 10.Support working mothers and families

Generational Financial Fitness Children learn about how to manage money from their parents Financial education for parents now  financial stability in next generation

Project Activities Life Course Data Team: Evaluation Plan Staff trainings Unnatural Causes Applying for grants Partnerships Developing home visiting and WIC interventions

Intermediate Outcomes Staff:  Increased knowledge  Improved skills  New practices

Intermediate Outcomes Clients:  Increased knowledge  Improved ability  Adopt at least one asset development strategy

Intermediate Outcomes System:  Stronger community partnerships  More supportive health and human services system  Integration of asset development strategies into FMCH Programs’ infrastructure  BEST project development documentation

Long-Term Outcomes Family income for daily living maximized Preservation of and increase in financial assets Increased financial security and stability, and improved financial status Increased access to care, improved housing, better neighborhoods, increased food security, decreased violence, etc. Improved health outcomes and financial status for future generations

Challenges Making paradigm shift and gaining staff buy-in is a slow process Addressing financial status and security sensitively Learning and integrating many new concepts Time and financial resources Measuring success

Lessons Learned Flexible timeline in order to accommodate program priorities Opportunities to collaborate with new partners Develop evaluation plan while developing program interventions Unique approach re-energizes both staff and community partners

What will success look like?

For More Information Padmini Parthasarathy