padmini parthasarathy, mph cheri pies, msw, drph family, maternal and child
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Applying the Life Course Perspective in a Local MCAH Program. Padmini Parthasarathy, MPH Cheri Pies, MSW, DrPH Family, Maternal and Child Health Programs, Contra Costa Health Services. Acknowledgements. Drs. Michael Lu and Neal Halfon, UCLA Dr. Paula Braveman, UCSF - PowerPoint PPT PresentationTRANSCRIPT
Padmini Parthasarathy, MPHCheri Pies, MSW, DrPH
Family, Maternal and ChildHealth Programs, Contra Costa Health Services
Applying the Life Course Perspective in a Local MCAH Program
Acknowledgements
Drs. Michael Lu and Neal Halfon, UCLA
Dr. Paula Braveman, UCSF
Contra Costa Health Services: Cheri Pies, Director, FMCH Programs Chuck McKetney, Epidemiologist Debbie Casanova, Evaluator Dawn Dailey, Program Manager
Overview
The Life Course Perspective
Health Equity and Social Determinants of Health
Life Course Game
Contra Costa Life Course Initiative
Our Road Map
Our First Destination: Building Economic Security Today (BEST)
Life Course Perspective
A way of looking at life not as disconnected stages, but as an integrated continuum
Suggests that a complex interplay of biological, behavioral, psychological, and social protective and risk factors contributes to health outcomes across the span of a person’s life
Percent of Mothers who Received Early Prenatal Care, by Race/Ethnicity, Contra Costa, 2004-200693.1
82.3 81.5
90.3
87.6
7476788082848688909294
White African-American
Latina Asian/PacificIslander
CCC Overall
Perc
ent
Source: Contra Costa County’s Automated Vital Statistics System (AVSS)
Rate of Low Birth Weight Births (per 100 live births), by Race/Ethnicity, Contra Costa, 2002-2004
6.2
12.9
5.6
7.86.8
0
2
4
6
8
10
12
14
White African-American
Latino Asian/PacificIslander
CCC Overall
Rate
Source: California Department of Health Services, Birth Statistical Master Files, 2002-2004
Infant Mortality Rate (per 1,000 live births), by Race/Ethnicity, Contra Costa, 2003-2005
2.8
8.8
4.94.1
0123456789
10
White African-American Latino CCC Overall
Rate
Source: California Department of Health Services, Birth Statistical Master Files and Death Statistical Master Files, 2002-2004
The Life Course Perspective(Lu and Halfon, 2003)
Protective factors
Risk factors
Key Concepts
Early Programming
Cumulative Pathways
Latina Paradox
Latinas living in the United States but born abroad have birth outcomes similar to White women
Birth outcomes worsen with each following generation
Disparity, Inequality,or Inequity?
HEALTH DISPARITY = INEQUALITY = difference in the health status of two groups
HEALTH INEQUITY = systematic and unjust differences in the distribution of illness and disease; differences are unnecessary and avoidable
Not all inequalities are unjust, but all inequities are the product of unjust inequalities.
Social Advantage and Health Across Lifetimes and Generations
Prepared for the Robert Wood Johnson Foundation by the Center on Social Disparities in Health at the University of California, San Francisco.
The Life Course Game
The Life Course Initiative
Launched in 2005
A 15-year initiative
Based on the Life Course Perspective and a 12-Point Plan to close the Black-White gap in birth outcomes
Life Course Initiative Goals
Reduce health disparities and health inequities
Optimize reproductive potential
Create a paradigm shift in MCH work
Life Course Initiative Goals
To change the health of a generation
Life Course Initiative Activities
Staff education
Laying the groundwork with higher- level management
Interconception care
Evaluation
Developing a new intervention
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)
Our Road Map:A 12-Point Plan…
To close the Black-White gap in birth outcomes
Goes beyond prenatal care
Goes beyond individual-level interventions
Goes beyond the medical model
Our Road Map: A 12-Point Plan
1. Provide interconception care to women with prior adverse pregnancy outcomes
2. Increase access to preconception care for African American women
3. Improve the quality of prenatal care
4. Expand healthcare access over the life course
Our Road Map: A 12-Point Plan
5. Strengthen father involvement in African American families
6. Enhance service coordination and systems integration
7. Create reproductive social capital in African American communities
8. Invest in community building and urban renewal
Our Road Map: A 12-Point Plan
9. Close the education gap
10. Reduce poverty
11. Support working mothers and families
Our Road Map: A 12-Point Plan
12. Undo racism
Our First Destination
Increased financial security and stability
and improved financial status
Building Economic Security Today (BEST)
Asset development pilot project
Reduce disparities and inequities in health outcomes by improving financial security and stability
Home visiting programs & WIC
How does BEST fit intothe 12-Point Plan?
9. Reduce poverty
10. Support working mothers and families
Generational Financial Fitness
Children learn about how to manage money from their parents
Financial education for parents now financial stability in next generation
Project Activities
Life Course Data Team: Evaluation Plan
Staff trainings
Unnatural Causes
Applying for grants
Partnerships
Developing home visiting and WIC interventions
Intermediate Outcomes
Staff:
Increased knowledge
Improved skills
New practices
Intermediate Outcomes
Clients: Increased
knowledge Improved ability Adopt at least one
asset development strategy
Intermediate Outcomes
System: Stronger community partnerships More supportive health and human
services system Integration of asset development strategies
into FMCH Programs’ infrastructure BEST project development documentation
Long-Term OutcomesFamily income for daily living maximized
Preservation of and increase in financial assets
Increased financial security and stability, and improved financial status
Increased access to care, improved housing, better neighborhoods, increased food security, decreased violence, etc.
Improved health outcomes and financial statusfor future generations
Challenges
Making paradigm shift and gaining staff buy-in is a slow process
Addressing financial status and security sensitively
Learning and integrating many new concepts
Time and financial resources
Measuring success
Lessons Learned
Flexible timeline in order to accommodate program priorities
Opportunities to collaborate with new partners
Develop evaluation plan while developing program interventions
Unique approach re-energizes both staff and community partners
What will success look like?
