The Life Course Approach

1. The Life Course Approach From Theory to community practice Carol Brady, MA Executive Director Northeast Florida Healthy Start Coalition, Inc. Every Woman Southeast- Webinar February 9, 2012

2. Overview • The Life Course in MCH • Implications for practice • From theory to practice • Planning framework • Prenatal Care & Case management • Leadership Academy

3. Life Course Perspective • Back to the future! • MCH historically focused on broader public health perspective • Shift 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

4. Why now? Improvements in infant mortality have stalled. Infant Mortality Rate U.S. 1990-2007 Infant Mortality, U.S. 1990-2007

5. Why now? Infant Mortality Rates by Race/Ethnicity U.S. 2005-2007 Racial and ethnic disparities persist.

6. 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

7. Synthesis of Biomedical Models Early programming Exposures in early life could influence future reproductive potential Cumulative pathways Chronic accommodations to stress results in wear & tear contributing to declining health over time.

8. 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

9. 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

10. 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.

11. Implications Life course framework in MCH has PROGRAMMATIC and POLICY implications.

12. Changing practice • Content of care is expanded • Poverty • Economic security • Education

13. Changing practice • Services are organized and delivered in ways that build resiliency and social capital and reduce dependency • Group care • Self care

14. Changing practice Requires inter-disciplinary, inter-agency collaboration to address complex needs

15. From Theory to Community Practice • Planning Framework • Case Management & Prenatal Care • Leadership Academy

16. Planning Framework

17. 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

18. Planning Framework Impact of paradigm shift http://nefhealthystart.org/resources-research/plans-policies-financials/

19. 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)

20. Case Management • The individual Life Plan is participant- driven with established goals that address needs in three areas: • Access to preventive health care • Family & community support • Reduction of poverty and social inequity • Participants are enrolled in group activities that are specific to their Life Plan.

21. 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.

22. Prenatal Care: Centering Pregnancy • Group prenatal care model • Key elements: • Self care • Facilitated discussion, participant-led • Group interaction and inter-dependence

23. 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. . .”)

24. 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?”

25. 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

26. Leadership Academy Graduation field trip! Jacksonville City Council meeting to adopt budget

27. Cliff Notes: Life Course Service Delivery Model Individual services (mitigate, reduce risks)  Group services (inter-dependence, self-reliance)  Community capacity building  Advocacy (social determinants)

28. Acknowledgments Thanks to Michael Lu, Cheri Pies, CityMatCH Faye Johnson, Healthy Start board & staff Chartrand Foundation & other community funders! Thank you! cbrady@nefhsc.org

29. Thank you! cbrady@nefhsc.org