1. Padmini Parthasarathy, MPH Cheri Pies, MSW, DrPH Family, Maternal and Child Health Programs Contra Costa Health Services The Contra Costa Life Course Initiative: Where We Have Been, and Where We Are Going

2. Overview Staff education A 12-Point Plan to Close the Black-White Gap in Birth Outcomes Evaluation Challenges and Questions

3. 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

4. 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?

5. The Life Course Game

6. 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

7. 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

8. 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)

9. 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

10. 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?

11. 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?

12. 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

13. Examples of Intermediate Outcomes (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

14. Asset Development Asset Accumulation Asset Leveraging Asset Preservation Asset Creation

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

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

22. 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

23. 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?

24. What will success look like?