3 rd National Summit on Preconception Health and Health Care Improving Preconception Health in a New Era of Health Car

1. 3rd National Summit on Preconception Health and Health CareImproving Preconception Health in a New Era of Health CareJune 12 -14, 2011 Preconception Health: a Gateway to Improving the Health of Women Across the Lifespan Tamara Wrenn, MA, CCE, CIMT, CWC Executive Director, Just Us Women Productions, LLC Senior Consultant, Practice Matters 914-595-2065 Info@Justuswomen.org

2. Achieving Success • The objective of this abstract is to demonstrate the existing capacity for using the Life Course Perspective (LCP) framework to catapult preconception health care to the next level.

3. National MCH System Challenges Centers for Disease Control and Prevention. National Center for Health Statistics. VitalStats. http://www.cdc.gov/nchs/vitalstats.htm.  Accessed June, 2011 *All 2009 data is preliminary birth data

4. National MCH Systems Challenges Centers for Disease Control and Prevention. National Center for Health Statistics. VitalStats. http://www.cdc.gov/nchs/vitalstats.htm.  Accessed June, 2011 *All 2009 data is preliminary birth data

5. National MCH Systems Challenges Health People 2010 Data: National Vital Statistics System Mortality and Natality (NVSS-M, NVSS-N), CDC, NCHS. June 2011 Healthy People 2020 Data: National Vital Statistics System (NVSS), CDC, NCHS, June 2011

6. Working Definition Preconception Care Preconception care is a set of interventions that identify and modify biomedical, behavioral, and social risks to a woman’s health and future pregnancies.  It includes both prevention and management, emphasizing health issues that require action before conception or very early in pregnancy for maximal impact.  The target population for preconception care is women of reproductive age, although men are also targeted by several components of preconception care.  The overarching goal of preconception care is to provide: 1) screening for risks, 2) health promotion and education, and 3) interventions to address identified risks. Source: National center on Birth Defects and Developmental Disabilities, http://www.cdc.gov/ncbddd/preconception/whatispreconception.htm

7. Recommendations to Improve Preconception Health and Health Care • Individual responsibility across the lifespan • Consumer awareness • Preventive visits • Intervention for identified risks • Interconception care • Pre-pregnancy checkup • Health insurance coverage for women with low incomes • Public health programs and strategies • Research • Monitoring improvements Johnson K, Posner SF, Biermann J, et. al. 2006

8. Traditional Perinatal Care Continuum ? Labor and birth Primary care Interconceptionalperiod Preconception Antepartum Labor and birth Postpartum Postpartum visit Prenatal care Well baby care Source: Practice Matters

9. Life Course Perspective • The life course perspective conceptualizes birth outcomes as the end product of not only the nine months of pregnancy, but the entire life course of the mother leading up to the pregnancy. • 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.

10. We Are the Life Course

11. Implications for Strategic Planning Preconception Health and Health Care • Theory (early programming/timing) • LCP points to the importance of the earliest experiences and exposures (early programming) and of critical or sensitive periods throughout life, in shaping the health of individuals and populations. • Strategic Planning/Practice • Critical/sensitive periods of development • Preconception • Early childhood • Adolescence • Interconceptional • Intergenerational Fine & Kotelchuck, 2010

13. Implications for Strategic Planning Preconception Health and Health Care • Theory (longitudinal approach/timeline) • Health develops over a person’s lifespan and across generations. • Strategic Planning/Practice • Linkages to systems and services at critical life stages • Addressing the needs of family members and support systems simultaneously • Following the cohort from birth through the senior years to impact generations Fine & Kotelchuck, 2010

14. New MCH Life Course Continuum (Axis 1) Source: Practice Matters

15. Implications for Strategic Planning Preconception Health and Health Care • Theory (health equity and environment) • “LC seeks to explain health disparities across populations and communities • …avoidable differences in health among groups of people who have different levels of social and economic advantages or disadvantages (e.g., …low income or education, members of a racial or ethnic group historically discriminated against). Braveman and Barclay (2009) • Strategic Planning/Practice • Upstream approach to addressing the social determinants of health • Health equity strategies that focus on linkages that address socio-economic factors; education, employment, housing, family support systems. • Develop policies at the federal, state and local level that remove barriers and obstacles; address racism Fine & Kotelchuck, 2010

16. MCH Life Course Organization Social Determinants of Health Ladder (Axis 2)

17. Policy Implications for Preconception Health Care within a Life Course Framework

18. Moving Forward into a New Era of Health Care

19. Examples of Developing an Agenda for Change • Maternal and Child Health Life Course Research Network (MCH LCRN)-September 2010, the Center for Healthier Children, Families and Communities was awarded a three-year grant from the federal Maternal and Child Health Bureau (MCHB) to develop a Maternal and Child Health Life Course Research Network (MCH LCRN). RESEARCH/EDUCATION • AMCHP/CityMatCH Women’s Preventive Health-With funding from the Centers for Disease Control and Prevention’s Division of Reproductive Health (DRH) and the Health Resources and Services Administration’s Maternal and Child Health Bureau (MCHB), AMCHP and CityMatCH aim to build state and local capacity to promote safe motherhood and enhance women’s health before, during and after pregnancy. POLICY • The reviews of federal Healthy Start as a community-based core service centered program have focused on its impact on birth outcomes and the delivery of varied case management services to at-risk women living in vulnerable communities across our nation. The true success of federal Healthy Start has been the fact that this network of projects is successfully emerging as a delivery system for addressing not just community needs specific to maternal and child health but for enhancing access to a continuum of care and social supports for vulnerable populations that include comprehensive preventive services, women’s health, and care coordination of chronic diseases both in clinic and other group settings and in participant homes (National Healthy Start Association, Federal Healthy Start Initiative: A National Network for Effective Home Visitation and Family Support Services, 2010). PRACTICE/PROGRAM PLANNING

20. Real Time Examples of LCP Programs and Funding Opportunities • Contra Costa Health Services – The Life Course Initiative, a 15 year Family, Maternal, and Child Health Initiative • The Building Blocks Collaborative – partnership of Alameda County organizations and the Alameda County Public Health Department • Northern Manhattan PerinatalPartnership, Inc. • Harlem Children’s Zone • Life Course Initiative for Healthy Families – Wisconsin Partnership Program • Magnolia Place Community Initiative – Unities Children’s Bureau with 70 plus other private and public organizations • Promise Neighborhoods Programs • Community Transformation Grants

21. Limitations • Additional research and program evaluation on the long term efficacy of this methodology; • Limited integration of preconception health and LCP at an academic level; • and, the continuation of silo focused traditional approaches to improving perinatal outcomes.

22. Key Points • Preconception health is a gateway for broader conversations about women’s wellness. • Health practices and policies with an individual focus have finite success. • Researchers have been advocating for broadening the spectrum of improving health using life course for over a decade.

23. Resources • Rethinking MCH: The Life Course Model as an Organizing Framework: A Fine, M Kotelchuckn http://www.hrsa.gov/ourstories/mchb75th/images/rethinkingmch.pdf • Johnson K, Posner SF, Biermann J, et al. Recommendations to improve preconception health and health care: Unites States: a report of the CDC/ATSDR Preconception Care work group and the select Panel on Preconception Care. MMWR Morb Mortal Weekly Report Rep 2006; 55:1 -23 • Contra Costa Health Services http://cchealth.org/groups/lifecourse/pdf/lci_fact_sheet.pdf • The Building Blocks Collaborative http://www.acphd.org/AXBYCZ/Admin/Publications/Building_Blocks_Collaborative.pdf • HRSA/MCHB Life Course Resource Guide http://mchb.hrsa.gov/lifecourseapproach.html • Promise Neighborhoods http://www2.ed.gov/programs/promiseneighborhoods/index.html • Community Transformation Grants http://www.healthcare.gov/news/factsheets/grants05132011a.html • Northern Manhattan Perinatal Partnership http://www.sisterlink.com/ • Harlem Children’s Zone http://www.hcz.org/ • Lifecourse Initiative for Health Families http://www.med.wisc.edu/wisconsin-partnership-program/lihf-request-for-proposals/1405 • Magnolia Place Community Initiative http://www.all4kids.org/magnolia-place-community-initiative.html

24. Achieving Health Equity by: Building a Social Movement, Investing in Ideas, Executing Tasks, Returning Results! Linking Women to Health, Power and Love Across the Life Span

25. Thank you for your time and attention! Tamara Wrenn, MA, CCE, CIMT, CWC 914-595-2065 Info@justuswomen.org