1. FROM THEORY TO COMMUNITY PRACTICE The Life Course Approach Carol Brady, MA Executive Director Northeast Florida Healthy Start Coalition, Inc. Every Woman Southeast- Webinar February 9, 2012

2. Overview The Life Course in MCH Implications for practice From theory to practice  Planning framework  Prenatal Care & Case management  Leadership Academy

3. Life Course Perspective Back to the future! MCH historically focused on broader public health perspective Shift 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

4. Why now? Improvements in infant mortality have stalled. Infant Mortality, U.S. 1990-2007 Infant Mortality Rate U.S. 1990-2007

5. Why now? Racial and ethnic disparities persist. Infant Mortality Rates by Race/Ethnicity U.S. 2005-2007

6. 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

7. Synthesis of Biomedical Models Early programming Exposures in early life could influence future reproductive potential Cumulative pathways Chronic accommodations to stress results in wear & tear contributing to declining health over time.

8. 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

9. 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

10. 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.

11. Implications Life course framework in MCH has PROGRAMMATIC and POLICY implications.

12. Changing practice Content of care is expanded  Poverty  Economic security  Education

13. Changing practice Services are organized and delivered in ways that build resiliency and social capital and reduce dependency  Group care  Self care

14. Changing practice Requires inter-disciplinary, inter-agency collaboration to address complex needs

15. From Theory to Community Practice Planning Framework Case Management & Prenatal Care Leadership Academy

16. Planning Framework

17. 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

18. Planning Framework Impact of paradigm shift http://nefhealthystart.org/resources- research/plans-policies-financials/

19. 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)

20. Case Management The individual Life Plan is participant- driven with established goals that address needs in three areas:  Access to preventive health care  Family & community support  Reduction of poverty and social inequity Participants are enrolled in group activities that are specific to their Life Plan.

21. 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.

22. Prenatal Care: Centering Pregnancy Group prenatal care model Key elements:  Self care  Facilitated discussion, participant-led  Group interaction and inter-dependence

23. 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...”)

24. 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?”

25. 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

26. Leadership Academy Graduation field trip! Jacksonville City Council meeting to adopt budget

27. Cliff Notes: Life Course Service Delivery Model Individual services (mitigate, reduce risks)  Group services (inter-dependence, self-reliance)  Community capacity building Advocacy (social determinants)

28. Acknowledgments Thanks to Michael Lu, Cheri Pies, CityMatCH Faye Johnson, Healthy Start board & staff Chartrand Foundation & other community funders! Thank you! cbrady@nefhsc.orgcbrady@nefhsc.org

29. Thank you! cbrady@nefhsc.org