padmini parthasarathy, mph cheri pies, msw, drph family, maternal and child

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?

For More Information

Padmini Parthasarathy925-313-6178

pparthas@hsd.cccounty.us