1. Using the "Shaping Policy for Health” analysis tools to develop an action-oriented Plan to Improve Birth Outcomes Rebecca Allen, Senior Manager, CT Community for Addiction Recovery (CCAR) Marjane Carey, Owner and Principal, Carey Consulting Jordana Frost, State Director of Program Services, March of Dimes Erin Jones, Regional Director of Program Services, March of Dimes

2. Agenda  The charge: how it all came about  The process: DHPE Policy Analysis Tools  The players and their experience: from energy to synergy  Current status and future directions: we’re a force to be reckoned with!

3. 1 out of 9 babies in the U.S. is born before 37 weeks of completed gestation. Premature birth is the number of killer of children under the age of 5.

4. Many of the surviving babies and their families face a lifetime of physical, emotional, and financial difficulties tied to the complications and sequelae of premature birth. These include developmental delays and complications affecting breathing, vision, hearing, and digestion, just to name a few.

5. If you need a frame of reference…

6. Background  Dept. of Public Health Commissioner accepted the “ASTHO” Challenge (Association of State and Territory Health Officials) to reduce preterm birth by 8% by June 30, 2014. CT added additional component to reduce race and ethnic disparities in preterm birth.  Simultaneously, CT was 1 of 4, states selected to participate in National Governor’s Association (NGA), Learning Network to Improve Birth Outcomes. Partners include; Dept. of Public Health and Dept. of Social Services, Governor’s office, March of Dimes, New Haven Healthy Start

7. Background (cont’d)  NGA had (3) Action Steps: 1. convene a statewide meeting, 2. Conduct (10) statewide consumer focus groups, and 3. by June 30, 2013 seeking sustainable funding.  Step 1, Convene a meeting. March 13, 2013, over 8- MCH statewide partners joined together and discussed the current MCH landscape in CT. Agreed to participate in a statewide coalition to improve birth outcomes, special attention to disparities, within current statewide structure.  Step 2, Conduct focus groups. (8) consumer focus groups we held throughout CT. Included pregnant and post partum woman in (8) CT communities.  Step 3, find sustainable funding. This is where we take an up expected, but exciting turn in our project and the Plan to Improve Birth Outcomes (PIBO ) came to be.  Todays presentation will take you on our journey to become an actionable coalition.

8. The long and arduous process…

9. Prioritization Process 1) Brainstormed strategies 2) Conducted Impact Analysis 3) Conducted Stakeholder Power Analysis 4) Combined Impact Analysis and Stakeholder Power Analysis 5) Sorted by Impact Score 6) Brief interpretation notes 7) Scan of other “plans” to identify synergies 8) Aligned with AMCHP compendium to further organize strategies into nationally-recognized framework 9) Selection of top strategies to be tackled by Coalition in the next 1-5 years

10.  Directors of Health Promotion and Education (DHPE) is a professional association founded in 1946 with voting members representing the health promotion function in each state, territory, or indigenous nation  Key areas include: school health, health equity, and shaping policy for health  Shaping Policy for Health (SPH) Curriculum was developed through a CDC cooperative agreement with DHPE  Curriculum developers are from UNC (Chapel Hill) – James Emery, MPH and Carolyn Crump, PhD Background on DHPE and the Shaping Policy for Health tools

11. Prioritization Process 1) Brainstormed strategies 2) Conducted Impact Analysis 3) Conducted Stakeholder Power Analysis 4) Combined Impact Analysis and Stakeholder Power Analysis 5) Sorted by Impact Score 6) Brief interpretation notes 7) Scan of other “plans” to identify synergies 8) Aligned with AMCHP compendium to further organize strategies into nationally-recognized framework 9) Selection of top strategies to be tackled by Coalition in the next 1-5 years

12. HANDOUT Impact Analysis

14. Prioritization Process 1) Brainstormed strategies 2) Conducted Impact Analysis 3) Conducted Stakeholder Power Analysis 4) Combined Impact Analysis and Stakeholder Power Analysis 5) Sorted by Impact Score 6) Brief interpretation notes 7) Scan of other “plans” to identify synergies 8) Aligned with AMCHP compendium to further organize strategies into nationally-recognized framework 9) Selection of top strategies to be tackled by Coalition in the next 1-5 years

15. HANDOUT Stakeholder Power Analysis

16. Prioritization Process 1) Brainstormed strategies 2) Conducted Impact Analysis 3) Conducted Stakeholder Power Analysis 4) Combined Impact Analysis and Stakeholder Power Analysis 5) Sorted by Impact Score 6) Brief interpretation notes 7) Scan of other “plans” to identify synergies 8) Aligned with AMCHP compendium to further organize strategies into nationally-recognized framework 9) Selection of top strategies to be tackled by Coalition in the next 1-5 years

17. Here’s How We Pull it All Together!

18. Prioritization Process 1) Brainstormed strategies 2) Conducted Impact Analysis 3) Conducted Stakeholder Power Analysis 4) Combined Impact Analysis and Stakeholder Power Analysis 5) Sorted by Impact Score 6) Brief interpretation notes 7) Scan of other “plans” to identify synergies 8) Aligned with AMCHP compendium to further organize strategies into nationally-recognized framework 9) Selection of top strategies to be tackled by Coalition in the next 1-5 years

20. Twelve-Point Plan to Close the Black- White Gap in Birth Outcomes Improving health care access over the life course 1. Provide inter-conception care to women with prior adverse pregnancy outcomes 2. Increase access to pre-conception care to African American women 3. Improve the quality of prenatal care 4. Expand healthcare access over the life course Strengthening families and communities 5. Strengthen father involvement in African American families 6. Enhance coordination and integration of family support services 7. Create reproductive social capital in African American communities 8. Invest in community building and urban renewal Address social and economic inequities 9. Close the education gap 10. Reduce poverty among African Americans 11. Support working mothers and families 12. Undo racism Lu MC, Kotelchuck M, Hogan V, Jones L, Wright K, Halfon N. Closing the black-white gap in birth outcomes: A life-course approach. Ethn Dis. 2010;20(1 Suppl 2):S62-76.

21. CT State Health Improvement Plan (SHIP)

22. Other local, state, and national plans and players

23. Monstrous Documents

24. Plan to Improve Birth Outcomes (PIBO) 24

25. Prioritization Process 1) Brainstormed strategies 2) Conducted Impact Analysis 3) Conducted Stakeholder Power Analysis 4) Combined Impact Analysis and Stakeholder Power Analysis 5) Sorted by Impact Score 6) Brief interpretation notes 7) Scan of other “plans” to identify synergies 8) Aligned with AMCHP compendium to further organize strategies into nationally-recognized framework 9) Selection of top strategies to be tackled by Coalition in the next 1-5 years

28. Recommendations address:  Lifecourse education  Social determinants of health  Trauma prevention and trauma-informed systems of care  Family-supportive policies and program  Fatherhood  Health care integration (holistic wellbeing throughout the lifecourse)  Family planning, preconception and inter-conception health  Quality, content, and format of prenatal care  Health care systems incentives and payment reform

29. Additional strategies featured in the appendices address:  Provider knowledge of community resources  Racism  Supportive housing initiatives  Financial literacy  Community health workers  The language of mental health and stigma  Undocumented families  Midwifery care  Doula care

30. We have all the right buzzwords…

31. Pie in the sky?

32. We stumbled upon the concept of Collective Action… only to realize that’s the path we were already on!

33. Consider a flock of birds…

34. The Five Conditions of Collective Impact

35. Phases of Collective Impact

36. Determinants of Partnership Synergy Resources Money Space, Equipment and Goods Skills and Expertise Information Connections to people, organizations and groups Endorsements Convening Power Partner Characteristics Heterogeneity Level of Involvement Relationships Among Partners Trust Respect Conflict Power Differentials Partnership Characteristics Leadership Administration and Management Governance Efficiency External Environment Community Characteristics Public and Organizational policies Lasker R, Weiss E, Miller R. (2001). “Partnership synergy: a practical framework for studying and strengthening the collaborative advantage.” New York Academy of Medicine. The Millbank Quarterly Vol. 79 No. 2

37. Synergy Resources Skills and expertise of coalition members.  top level positions  working for many years in the MCH field Information  members work in different areas of MCH Partner Characteristics Heterogeneity  diverse group of state, federal, and community stakeholders Level of Involvement  69% report involved/very involved Relationship Among Partners Trust & Respect among members  worked together on past projects  group connectedness very strong. Partnership Characteristics Leadership  strength of coalition leadership  efforts to promote collaborative  listen and hear coalition members Administration & Governance  high degree of formality  planning committee communicated frequently

38. Survey Results Highest Satisfaction - 5  Commitment of Coalition to build and sustain diverse membership (4.47)  Effort to promote collaborative (4.41)  Extent to which Coalition member are listened to and heard (4.35)  Coalition meetings stay on task and run smoothly (4.27) Lowest Satisfaction - 1  Communication between the Coalition and the broader community (3.31)  State needs assessment process (3.65)  Capacity of the Coalition to advocate effectively (3.53) Members appeared satisfied with coalition activities.  71% responding they were satisfied or very satisfied to the statement my time is well spent. *SIBO is a great example of a collective impact initiative.

39. Where we have been…  The MCH Advisory Committee - up to March 2013  ·Quarterly networking meetings  The Coalition to Improve Birth Outcomes - March 2013 to September 2015  Charge to the Coalition: Produce a Plan to Improve Birth Outcomes (PIBO)

40. Where we are going…  The MCH Coalition – Started September 2015  Serves as the MICH action planning team for the State Health Improvement Plan (SHIP)  Is implementing the PIBO  Is changing MCH’s culture and tone by  Facilitating communication among Coalition members  Supporting coordination and alignment of efforts  Identifying opportunities for integration

41. Moving from Planning to Action in unison. 2016 Action Agenda for Maternal, Infant, and Child Health PIBOSHIP MCH Block Grant

42. Becoming a vehicle to move from…

43. Thank you!