1. Paula Braveman, MD, MPH Reggie Caldwell, LCSW
What We Know
Paula Braveman, MD, MPH
Reggie Caldwell, LCSW

2. The Problem
2-3 times higher rates of adverse birth outcomes among African American babies
4 times higher ratio of maternal mortality among African American women
Traditional prenatal care has not improved birth outcomes
but some promising results from Centering Pregnancy

3. The Science
The birth outcome patterns suggest that social factors are involved. Prime suspects include:
Stress – especially chronic, e.g., due to discrimination &/or economic hardships ; plausible physiologic pathways
Social support may directly improve health; affects health behaviors; buffers stress effects
Empowerment --Self-efficacy plays key role in health behaviors; key to escaping poverty; lack of control at work strongly linked with heart disease
Empowerment-focused group approaches may be more effective than 1:1 (based on theory and data)
In other words: SSE WAS ON THE RIGHT TRACK!

4. Rationale for Revising BIH
Great work happening, but varied across sites so impossible to evaluate impact
Bring BIH up to date with science
More emphasis on systematically addressing social factors as key determinants of health and health behaviors
Focus efforts to maximize impact

5. The Revised BIH Model
Combined the best of original BIH models with promising practices: Amplified SSE strength-based group intervention, supported by empowerment- & referral-oriented case mgmt
Goal: Decrease disparities by improving African American infant and maternal health
May not be able to see a difference in birth outcomes, especially short-term
But current science tells us that at the least, if we focus, we can strengthen maternal capacity, behaviors, & social support, which should improve maternal and infant health

6. Intermediate Outcomes
Conceptual Framework
Intermediate Outcomes
BIH Activities
INDIVIDUAL
Increased health knowledge
Increased healthy behaviors
Increased empowerment through improved life skills and coping skills
Increased receipt of quality medical, social & mental health services
Decreased unplanned pregnancy
Increased social support both for & among the women
Decreased stress by mobilizing resources and services
Improved parenting
Increased bonding between mother & infant
Improved infants’ developmental milestones
COMMUNITY
Increased community and provider knowledge & cultural competence
Increased community partnerships & linkages among service agencies
Decreased stressors in the community through community & provider/agency action
Improved understanding among community and providers of influence of social inequities on health
INDIVIDUAL
Services provided to African-American women, infants, and their families & partners include:
Referrals to medical, social & mental health services
Health education
Social and group support
Identifying resources
Self-advocacy
COMMUNITY
Promote community and provider engagement and advocacy
Educate community and providers about influence of social inequities on health
Problem
Poor birth outcomes
Social isolation
Lack of health knowledge
Lack of access to quality health care
Poverty
Racism
Environmental stressors
Maximizing impact of the program (numbers served & effect size)
Lack of cultural awareness and skills among providers
Ultimate Goal
To improve African American infant and maternal health in California and
decrease Black:White health disparities and social inequities for women and infants
GUIDING PRINCIPLES
1. Comprehensive and integrated: Address multiple risk factors and use multiple strategies
2. Multi-level: Address individual, community, service systems and societal levels, with empowerment focus
3. Collaborative: Partner with community providers and agencies with similar activities
4. Community-driven: Developed, implemented and evaluated by local communities
5. Evidence-based: Developed from proven or promising strategies; impact is measurable
6. Culturally competent: Designed & implemented in a culturally-competent manner
7. Staff training and professional development: Conducted to ensure the BIH activities are provided effectively
DRAFT

7. To Impact Maternal & Infant Health, BIH Needed To:
Decrease isolation/increase social support
Build self-esteem and empower women to make better choices about their health
Decrease stress/improve coping skills
Involve communities

8. Program Tenets Promote and support healthy pregnancy and parenting.
Build on client’s strengths to enrich them, their families and their community by empowering them to make healthy decisions
Culturally relevant and honor the unique history and traditions of people of African descent
Address issues important to African American women
Reduce disparities by improving African American maternal and infant health.

9. Black Infant Health Program - Revised Model
Recruitment
Meets program requirements?
Yes
Program Completion
Complete ICP
Complete Life Plan
Complete Case Closure No
Intake
Program orientation and consent
Referrals
Prenatal Assessment 1
Initiation of Individual Client Plan (ICP)
Case Conferencing
Standardized health promotion message
&
Refer out to appropriate agency
Case
Management
that compliments
the group sessions
Group Sessions
11-20
1-10
Birth
Postpartum
Prenatal
Core Intervention

10. Groups
Use facilitative learning to access and enhance women’s knowledge and skills
Group format means women draw strength from each other
Skill-building to achieve better physical and mental health
Weekly personal goal setting culminating in the creation of a Life Plan
Focus on empowerment to:
Make good choices to have a healthy pregnancy
Be a good role model for one’s child.

11. Challenges Identified
Staff
Resistant to change
Reluctant about the revised model’s success
Great facilitation
Focused on “What If’s”
Clients
Retaining them in groups (transportation and child care issues)
Motivation for long-term participation/competing priorities

12. Themes from the Progress Report
Successes
Challenges
Some staff are having difficulty embracing the new model
New data book
Client transportation
Time for case conferences and other staff meetings
Serving clients with multiple stressors
Collaborations with providers, community partners, and Board
Received or applied for a grant
Positive feedback from clients about new model
In-kind donations
Flexibility by training all staff as group facilitators

13. The “Magic” is Happening
Staff
Clients
I learn about myself while I conduct the group
It’s challenging and worth it!
I used harm reduction strategies to help a pregnant client stop smoking
A place where negative messages are countered with positive ones
I now have a vision for my life
The group constantly reminds me that we ALL have talent
How to we keep the “magic” going?

14. Implementation Timeline
Activity
Start Date
Transition begin for Group 1
7/1/10
Official start for Group 1
11/1/10
Feedback from Group 1 of the revised model
Revise intervention based on feedback
7/1/11
Transition begins for Group 2
Official start date for Group 2
10/1/11
Interim Report of Findings
2/1/12
Feedback from Group 1 and 2 of the revised model
Final Report of Findings
1/1/13
Reconvene Expert Panel
~2/1/13
3/1/13
Transition begins for Group 3
4/1/13
Official start for all sites
7/1/13