1. June 6, 2013 Welcome A Life Course Theory to Practice Webinar

2. Housekeeping We will be recording this webinar and posting the link to our website. Slides will also be available on the site. Phones will be muted during the webinar so everyone can hear better. If you have a question, please post it via the chat function. Questions will be taken from chat. Submit questions as soon as they come to mind – we’ll keep track of them. Thank you to the WK Kellogg Foundation and to our great partners at AMCHP!!

3. What is Every Woman Southeast? A coalition of leaders in Alabama, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina and Tennessee to build multi-state, multi-layered partnerships to improve the health of women and infants in the Southeast.

4. www.EveryWomanSoutheast.org

5. Our Blog

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7. Join us! Join our listserv http://www.surveymonkey.com/s/FQS2P3W http://www.surveymonkey.com/s/FQS2P3W Bookmark our website www.everywomansoutheast.orgwww.everywomansoutheast.org Follow the blog: www.everywomansoutheast.comwww.everywomansoutheast.com “Like” our Facebook page (Every Woman Southeast) and Pin our page! Contact Sarah at sarahv@med.unc.edu or 919-843-7865

8. Women’s Voices Survey Open until the end of June Available online or paper Easy to complete Will guide our work to improve women’s health by helping us understand barriers to care and women’s ideas for their community Email us to get started: everywomansoutheast@gmail.com

9. Join Your State Team We have 9 state teams – one for each state. Find your team lead by clicking on your state webpage on our website. Contact the lead and connect. This is a great way to link up with the latest resources and opportunities on preconception health.

10. Putting the Life Course Concept into Practice: Lessons from the Northeast Florida Healthy Start Coalition Today’s Webinar

11. Why This Topic? Improving the health of women and infants in the South, especially for minority communities, requires a new way of thinking and serving. Increasing knowledge about the life course theory and moving states and programs into action to apply this theory are two key objectives for our coalition. Sharing resources and information about “what works” and “ideas for change” is a third key objective.

12. Objectives Briefly describe the life course theory and the capacity of the approach to address health inequities Describe at least two strategies for integrating the life course approach into a community-based program Describe at least two challenges and opportunities in integrating this approach into daily practice

13. Speakers Faye Johnson Director, The Magnolia Project Carol Brady Project Director, Florida Maternal, Infant and Early Childhood Home Visiting Initiative (Past Director Northeast Florida Healthy Start Coalition, Inc)

14. Putting the Life Course Concept into Practice: Lessons from the NEF Healthy Start Coalition EveryWoman Southeast Webinar Carol Brady, MA Faye Johnson, BS June 6, 2013

15. Snapshot of Jacksonville Infant mortality rate (2012): 8.4 deaths per 1,000 live births (2005 rate 11.6) IM driven by disparities IM rate 2.5x higher than White rate Infant Mortality Jacksonville & Magnolia Project Area 2005-2012

16. The Magnolia Project Focus on disparities in birth outcomes Perinatal Periods of Risk (PPOR) Fetal & Infant Mortality Review (FIMR) Findings used to develop the Magnolia Project Adaptation of state, federal Healthy Start models to address health of high-risk women before and between pregnancies

17. The Magnolia Project Benefits Addressed gap in women’s health care Linkage to national preconception health movement (CDC) Promising practice, long-term impact on outcomes Limitations Still an INDIVIDUAL intervention “Boom-a-rang” effect (dependency model?)

18. Beyond Preconception National MCH Life Course Summit(2008) Goal: to promote dissemination and use of life course approach to close black-white gap in birth outcomes Developed by Michael Lu, et al. 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.

19. 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.

20. Life Course Perspective Life-course model BROADENS the focus of MCH to include both health and social equity. Socioeconomic status, race and racism, health care, health status, stress, nutrition and weight, and a range of other behaviors impact birth outcomes. Factors impact racial, ethnic groups differently and may explain disparities despite equal access to care during pregnancy.

21. Life Course Perspective Life course framework in MCH has PROGRAMMATIC and POLICY implications. Content of case management is expanded (poverty, economic security, education) Services are organized and delivered in ways that build resiliency and social capital and reduce dependency (group activities, self-care) Requires inter-disciplinary, inter-agency collaboration to address complex needs

22. Life Course Perspective Challenge: how to OPERATIONALIZE? Contra Costa Health Services: 12 point plan Goals: Improve health care services for at-risk populations, including communities of color & low-income families Strengthen families & communities Address social and economic inequities over the life course

23. 12 Point Plan Improve Health Care Services Access to interconception care, preconception care, quality prenatal care, access to health care Strengthening Families & Communities Father involvement, service coordination, creation of reproductive health capital, community building & urban renewal Address social, economic inequities Close education gap, reduce poverty, undo racism support working mothers

24. Life Course Perspective Challenge: How to OPERATIONALIZE life course approach into service delivery Opportunity: Change the way we deliver case management services at the Magnolia Project Pilot project 2009

25. The Magnolia Project Evolution of Service Delivery Model Most case management models focus on specific individual risk factors. Risk factors may include family planning, sexuality transmitted diseases, substance abuse, smoking, and other risk associated with poor birth outcomes. Case management focuses on risks that are immediate (in crisis) and long-term. Often case managers become the primary support system for women.

26. Why Change ? To offer women a variety of service learning that does more that focus on surface need. Opportunity to address the underlying social determinants that impact birth outcomes. Such as; finances, education, poverty, racism, family support and connectedness. Provide an opportunity so that women in case management develop support among each other once case management ends.

27. Life Course Perspective Pilot Conducted a 6 month Integrated Life Course Perspective case management pilot Two levels of services offered to women enrolled in case management Level 1 - Individual case management involved women that entered the program and were in crisis which required one on one assistance. Level 2 – Group level intervention planned, organized and delivered by the case managers and one community partner.

28. Approach Case managers and the Women's Intervention Specialist were responsible for one component within the three areas of focus in the Life Course Model.   Education and Finance   Social Inequalities of Health   Civic Engagement   Reproductive Health   Healthy Relationships Responsibility included determining level status Facilitated weekly group activities Identified additional group resources. Managed existing caseload

29. Approach The Women’s Intervention Specialist completes “My Life’s Journey” (assessment) with all newly referred women During the assessment the Women’s Intervention Specialist markets all components of the program to include the various group topics. Assigned to case manager based on the assessment of life’s strengths and challenges with the participant to determine level of need

30. Outcomes of Pilot The group with the most participation was the Financial Freedom Group activity “War on Poverty” Consisted of 3 six week group activities with and average of 5-8 women. Several of the women formed bonds over the six week period. Level of excitement leading up to the next group. Increase in financial knowledge

31. Lessons Learned Focused on several groups simultaneously with a new model. “Too much too fast”! Case mangers focused primarily on the new group activities opposed to the entire Life Course Perspective Model Dual role for case managers proved to be a challenge at the beginning Need to clarify roles continuously Did not have an opportunity to evaluate the Goal Attainment Scale during the process.

32. What Happen Next Fully and completely implemented the New Redesign to include lessons learned WHY ?

33. Benefits Participants welcomed change and were excited during the group activity. Opportunity to address underlying social determinants Promoted inter-and independence, built reproductive capital Participants moved from relying on case managers to becoming leaders of group activities. Impact on participants’ self esteem

34. More Benefits Support systems continued after case management services ended. Information and training through numerous group activities and individual case management. Reinforce! Participants have active role in tracking progress in achieving goals (GAS).

35. New Case Management Model Women complete a “My Life’s Journey” assessment and are assigned to Level 1 Individual Case Management. Information gathered during the assessment will fall in one or more areas in the Life Course Model. The case manager and the participant will develop a Life Course Plan from the information gathered during the assessment based on areas in the Life Course Model developed by Dr. Michael Lu, MD.

36. The Plan The individual Life Course Plan is participant- driven with established goals and address needs in three areas:   Access to preventive health care and related risk reduction services that improve a woman’s chances for healthy birth in the future. This includes basic reproductive health services, such as GYN care and family planning, as well as care for chronic diseases like diabetes, hypertension and obesity

37. Life Course Plan Continued Areas   Family and Community support including activities that provide at-risk women with the skills to develop healthy relationships and connectedness with communities through civic engagement and participation.   Reduction of poverty and social inequities that assist participants in completing their education, gaining job skills, confronting discrimination and racism, and developing financial literacy.

38. Developing The Life Plan Case manager assists in the development of the participant- driven life plan through the use of 5 questions specific to each of the three areas to identify a life plan.   Access to preventive health care/reproductive health. 1. Do you hope to have (more) children? 2. How many children do you hope to have 3. How long do you plan to wait until you (next) become pregnant. 4. What do you plan to do until you are ready to get pregnant 5. What can I do today to help you achieve your plan? Reproductive Plan Questions taken from a presentation by Merry-K Moos at the Preconception Health an Health Care Conference, October 2007.

39.   Family and Community Support 1. Who is your favorite family member? 2. How do you gain friendship with others? 3. What activities do you like? 4. Do you want to help others? 5. How can I help you develop healthy relationships? The questions are merely examples but necessary in assisting participant in the development of a Life Plan. Developing The Life Plan

40. Group Level of Service Participants are enrolled in external group activities that are specific to their Life Plan. The groups are scheduled through external resources relieving the case managers of the responsibility. Case managers responsible for assisting participants in accessing activity and encouraging participation. Body and Soul Reproductive Health Group is conducted at the Magnolia Project. All participants are encouraged to complete the reproductive health group on site, facilitated by the Health Educator.

41. Monitoring Progress Participants take an active role in monitoring their progress in achieving their goals included in their “Life Plans.” The Goal Attainment Scale (GAS) is used to determine progress.

42. Approach: Simplified Approach: Simplified Complete My Life’s Journey assessment Assigned to case manager My Life Journey information falls within 3 areas of the Life Plan Model Develop My Life Plan using questions Begin in individual case management Attend group activities (level 2) Track My Life Plan Goals using a GAS tool

43. The Life Plan Perspective Change in approach = positive response from participants, MOST staff Model has impacted the way we do business Use of life course framework in update of Healthy Start Service Delivery Plan New collaborations in economic self-sufficiency, community development How to incorporate in state HS case management?? Developed the Make a Difference Leadership Academy

44. Group Level Experience Outcome The Make a Difference! Leadership Academy: develops leadership skills and promotes civic engagement Utilizes training material developed by the University of Arizona in 12 weekly sessions. Residents of vulnerable neighborhoods. Participants develop Community Action Plan to move a community to action.

45. Community Leadership Training Community Action Planning Local Icons of Jacksonville Leadership Your Personal Leadership Style Community Values Effective Meetings Roberts Rules of Order Public Speaking Conflict Resolution Problem Solving Sharing the Work Through Delegation Community Diversity Foundations of Health Inequalities

46. Integrating the Life Course into MCH Service Delivery: From Theory to Practice http://www.springerlink.com/openurl.asp?genre= article&id=doi:10.1007/s10995-013-1242-9 Thank you!

47. Please submit your questions via chat. Feel free to contact speakers after the webinar with any additional questions. Facilitated by Caroline Brazeel, EWSE Co-Chair Questions & Answers

48. Additional Resources

49. The Life Course Game Life Course Toolbox www.citymatch. org www.citymatch. org Interactive way to understand the Life Course framework.

52. AMCHP Life Course Resource Center

53. National Preconception Campaign Visit ww.cdc.gov/showyourlove or www.cdc.gov/quierete for more information ww.cdc.gov/showyourlovewww.cdc.gov/quierete E-cards and more Check Lists  http://www.cdc.gov/preconcepti on/showyourlove/documents/H ealthier_Me_NonPlan.pdf http://www.cdc.gov/preconcepti on/showyourlove/documents/H ealthier_Me_NonPlan.pdf  http://www.cdc.gov/preconcepti on/showyourlove/documents/H ealthier_Baby_Me_Plan.pdf http://www.cdc.gov/preconcepti on/showyourlove/documents/H ealthier_Baby_Me_Plan.pdf

54. Thank you! A woman's health is her capital. Harriet Beecher Stowe