from theory to community practice the life course approach carol brady, ma executive director...
TRANSCRIPT
FROM THEORY TO COMMUNITY PRACTICE
The Life Course Approach
Carol Brady, MAExecutive Director
Northeast Florida Healthy Start Coalition, Inc.
Every Woman Southeast- WebinarFebruary 9, 2012
Overview
The Life Course in MCHImplications for practiceFrom theory to practice
Planning framework Prenatal Care & Case
management Leadership Academy
Life Course Perspective
Back to the future!MCH historically focused on broader public
health perspectiveShift 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
Why now?
Improvements in infant mortality have stalled.
Infant Mortality, U.S.1990-2007
Infant Mortality RateU.S. 1990-2007
Why now?
Racial and ethnic disparities persist.
Infant Mortality Rates by Race/Ethnicity
U.S. 2005-2007
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
Synthesis of Biomedical Models
Early programmingExposures in early life could influencefuture reproductive potential
Cumulative pathwaysChronic accommodations to stress results in wear & tear contributing to declining health over time.
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
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
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.
Implications
Life course framework in MCH has PROGRAMMATIC and POLICY implications.
Changing practice
Content of care is expanded Poverty Economic security Education
Changing practice
Services are organized and delivered in ways that build resiliency and social capital and reduce dependency Group care Self care
Changing practice
Requires inter-disciplinary, inter-agency collaboration to address complex needs
From Theory to Community Practice
• Planning Framework• Case Management & Prenatal Care• Leadership Academy
Planning Framework
Planning Framework
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
Planning Framework
Impact of paradigm shift
http://nefhealthystart.org/resources-research/plans-policies-financials/
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)
Case Management
The individual Life Plan is participant- driven with established goals that address needs in three areas:Access to preventive health careFamily & community supportReduction of poverty and social
inequity
Participants are enrolled in group activities that are specific to their Life Plan.
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.
Prenatal Care: Centering Pregnancy
Group prenatal care modelKey elements:
Self care Facilitated discussion, participant-
led Group interaction and inter-
dependence
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. . .”)
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?”
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
Leadership Academy
Graduation field trip! Jacksonville City Council meeting to adopt budget
Cliff Notes: Life Course Service Delivery Model
Individual services (mitigate, reduce risks)
Group services (inter-dependence, self-reliance)
Community capacity building
Advocacy (social determinants)
Acknowledgments
Thanks to Michael Lu, Cheri Pies, CityMatCH
Faye Johnson, Healthy Start board & staff
Chartrand Foundation & other community funders!
Thank you! [email protected]
