Transcript Slide 1

Welcome
A Life Course Theory to Practice Webinar
June 6, 2013
Housekeeping
 We will be recording this webinar and posting the link to
our website. Slides will also be available on the site.
 Phones will be muted during the webinar so everyone can
hear better.
 If you have a question, please post it via the chat function.
Questions will be taken from chat. Submit questions as
soon as they come to mind – we’ll keep track of them.
 Thank you to the WK Kellogg Foundation and to our great
partners at AMCHP!!
What is Every Woman Southeast?
 A coalition of leaders in Alabama, Florida, Georgia,
Kentucky, Louisiana, Mississippi, North Carolina, South
Carolina and Tennessee to build multi-state, multi-layered
partnerships to improve the health of women and infants in
the Southeast.
www.EveryWomanSoutheast.org
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 Join our listserv
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 Contact Sarah at [email protected] or 919-843-7865
Women’s Voices Survey
 Open until the end of June
 Available online or paper
 Easy to complete
 Will guide our work to improve
women’s health by helping us
understand barriers to care and
women’s ideas for their
community
 Email us to get started:
[email protected]
Join Your State Team
 We have 9 state teams – one
for each state.
 Find your team lead by
clicking on your state webpage
on our website.
 Contact the lead and connect.
This is a great way to link up
with the latest resources and
opportunities on
preconception health.
Today’s Webinar
Putting the Life Course
Concept into Practice: Lessons
from the Northeast Florida
Healthy Start Coalition
Why This Topic?
 Improving the health of women and infants in the
South, especially for minority communities, requires
a new way of thinking and serving.
 Increasing knowledge about the life course theory
and moving states and programs into action to apply
this theory are two key objectives for our coalition.
 Sharing resources and information about “what
works” and “ideas for change” is a third key
objective.
Objectives
 Briefly describe the life course theory and the
capacity of the approach to address health inequities
 Describe at least two strategies for integrating the
life course approach into a community-based
program
 Describe at least two challenges and opportunities in
integrating this approach into daily practice
Speakers
Faye Johnson
Director, The Magnolia Project
Carol Brady
Project Director, Florida Maternal, Infant and Early
Childhood Home Visiting Initiative (Past Director
Northeast Florida Healthy Start Coalition, Inc)
Putting the Life Course Concept
into Practice: Lessons from the
NEF Healthy Start Coalition
EveryWoman Southeast Webinar
Carol Brady, MA
Faye Johnson, BS
June 6, 2013
Snapshot of Jacksonville
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Infant mortality rate
(2012): 8.4 deaths per
1,000 live births (2005
rate 11.6)
IM driven by disparities
IM rate 2.5x higher than
White rate
25
20
Infant Mortality
Jacksonville &
Magnolia Project Area
2005-2012
20.1
16.9
15
14.6
12.9
15.4
15.3
13.9
12.9
15.9
13.6
9.5
7.9
14.1
12.8
11.7
11.6
10
13.3
12.8
7.2
9
6.7
9.7
8.8
8.1
8.4
7.1
5.8
5.5
5
8.3
7.3
4.9
2.8
0
2005
2006
2007
2008
2009
2010
White
Jacksonville
Target Area
Black
Linear (Target Area)
2011
2012
The Magnolia Project
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Focus on disparities in birth outcomes
Perinatal Periods of Risk (PPOR)
 Fetal & Infant Mortality Review (FIMR)
 Findings used to develop the Magnolia Project
 Adaptation of state, federal Healthy Start models to
address health of high-risk women before and
between pregnancies
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The Magnolia Project
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Benefits
Addressed gap in women’s health care
 Linkage to national preconception health movement
(CDC)
 Promising practice, long-term impact on outcomes
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Limitations
Still an INDIVIDUAL intervention
 “Boom-a-rang” effect (dependency model?)
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Beyond Preconception
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National MCH Life Course Summit(2008)
Goal: to promote dissemination and use of life
course approach to close black-white gap in
birth outcomes
Developed by Michael Lu, et al.
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.
Life Course Perspective
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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.
Life Course Perspective
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Life-course model BROADENS the focus of
MCH to include both health and social equity.
Socioeconomic status, race and racism, health
care, health status, stress, nutrition and weight,
and a range of other behaviors impact birth
outcomes.
Factors impact racial, ethnic groups differently
and may explain disparities despite equal access
to care during pregnancy.
Life Course Perspective
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Life course framework in MCH has
PROGRAMMATIC and POLICY implications.
Content of case management is expanded
(poverty, economic security, education)
Services are organized and delivered in ways that
build resiliency and social capital and reduce
dependency (group activities, self-care)
Requires inter-disciplinary, inter-agency
collaboration to address complex needs
Life Course Perspective
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Challenge: how to OPERATIONALIZE?
Contra Costa Health Services: 12 point plan
Goals:
Improve health care services for at-risk populations,
including communities of color & low-income
families
 Strengthen families & communities
 Address social and economic inequities over the life
course
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12 Point Plan
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Improve Health Care Services
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Strengthening Families & Communities
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Access to interconception care, preconception care,
quality prenatal care, access to health care
Father involvement, service coordination, creation of
reproductive health capital, community building &
urban renewal
Address social, economic inequities
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Close education gap, reduce poverty, undo racism
support working mothers
Life Course Perspective
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Challenge:
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How to OPERATIONALIZE life course approach
into service delivery
Opportunity:
Change the way we deliver case management
services at the Magnolia Project
 Pilot project 2009
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The Magnolia Project
Evolution of Service Delivery Model
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Most case management models focus on specific
individual risk factors.
Risk factors may include family planning, sexuality
transmitted diseases, substance abuse, smoking, and other
risk associated with poor birth outcomes.
Case management focuses on risks that are immediate (in
crisis) and long-term.
Often case managers become the primary support system
for women.
Why Change ?
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To offer women a variety of service learning that
does more that focus on surface need.
Opportunity to address the underlying social
determinants that impact birth outcomes. Such as;
finances, education, poverty, racism, family support
and connectedness.
Provide an opportunity so that women in case
management develop support among each other
once case management ends.
Life Course Perspective
Pilot
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Conducted a 6 month Integrated Life Course
Perspective case management pilot
Two levels of services offered to women enrolled in
case management
Level 1 - Individual case management involved
women that entered the program and were in crisis
which required one on one assistance.
Level 2 – Group level intervention planned,
organized and delivered by the case managers and
one community partner.
Approach
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Case managers and the Women's Intervention Specialist were
responsible for one component within the three areas of focus
in the Life Course Model.
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Education and Finance
Social Inequalities of Health
Civic Engagement
Reproductive Health
Healthy Relationships
Responsibility included determining level status
Facilitated weekly group activities
Identified additional group resources.
Managed existing caseload
Approach
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The Women’s Intervention Specialist completes
“My Life’s Journey” (assessment) with all newly
referred women
During the assessment the Women’s Intervention
Specialist markets all components of the program to
include the various group topics.
Assigned to case manager based on the assessment
of life’s strengths and challenges with the
participant to determine level of need
Outcomes of Pilot
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The group with the most participation was the
Financial Freedom Group activity “War on
Poverty”
Consisted of 3 six week group activities with and
average of 5-8 women.
Several of the women formed bonds over the six
week period.
Level of excitement leading up to the next group.
Increase in financial knowledge
Lessons Learned
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Focused on several groups simultaneously with a
new model. “Too much too fast”!
Case mangers focused primarily on the new group
activities opposed to the entire Life Course
Perspective Model
Dual role for case managers proved to be a
challenge at the beginning
Need to clarify roles continuously
Did not have an opportunity to evaluate the Goal
Attainment Scale during the process.
What Happen Next
Fully and completely implemented the New
Redesign to include lessons learned
WHY ?
Benefits
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Participants welcomed change and were excited
during the group activity.
Opportunity to address underlying social
determinants
Promoted inter-and independence, built
reproductive capital
Participants moved from relying on case managers
to becoming leaders of group activities.
Impact on participants’ self esteem
More Benefits
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Support systems continued after case
management services ended.
Information and training through numerous
group activities and individual case management.
Reinforce!
Participants have active role in tracking progress
in achieving goals (GAS).
New Case Management Model
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Women complete a “My Life’s Journey” assessment
and are assigned to Level 1 Individual Case
Management.
Information gathered during the assessment will fall
in one or more areas in the Life Course Model.
The case manager and the participant will develop a
Life Course Plan from the information gathered
during the assessment based on areas in the Life
Course Model developed by Dr. Michael Lu, MD.
The Plan
The individual Life Course Plan is participantdriven with established goals and address needs
in three areas:
 Access
to preventive health care and related risk
reduction services that improve a woman’s chances
for healthy birth in the future. This includes basic
reproductive health services, such as GYN care and
family planning, as well as care for chronic diseases
like diabetes, hypertension and obesity
Life Course Plan Continued
Areas
 Family
and Community support including
activities that provide at-risk women with the skills
to develop healthy relationships and connectedness
with communities through civic engagement and
participation.
 Reduction of poverty and social inequities that
assist participants in completing their education,
gaining job skills, confronting discrimination and
racism, and developing financial literacy.
Developing The Life Plan
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Case manager assists in the development of the participantdriven life plan through the use of 5 questions specific to
each of the three areas to identify a life plan.
 Access to preventive health care/reproductive health.
1. Do you hope to have (more) children?
2. How many children do you hope to have
3. How long do you plan to wait until you (next) become
pregnant.
4. What do you plan to do until you are ready to get pregnant
5. What can I do today to help you achieve your plan?
Reproductive Plan Questions taken from a presentation by Merry-K Moos at the
Preconception Health an Health Care Conference, October 2007.
Developing The Life Plan
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Family and Community Support
1. Who is your favorite family member?
2. How do you gain friendship with others?
3. What activities do you like?
4. Do you want to help others?
5. How can I help you develop healthy
relationships?
The questions are merely examples but necessary
in assisting participant in the development of a Life
Plan.
Group Level of Service
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Participants are enrolled in external group activities that
are specific to their Life Plan.
The groups are scheduled through external resources
relieving the case managers of the responsibility.
Case managers responsible for assisting participants in
accessing activity and encouraging participation.
Body and Soul Reproductive Health Group is
conducted at the Magnolia Project. All participants are
encouraged to complete the reproductive health group
on site, facilitated by the Health Educator.
Monitoring Progress
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Participants take an active role in monitoring
their progress in achieving their goals included
in their “Life Plans.”
The Goal Attainment Scale (GAS) is used to
determine progress.
Approach: Simplified
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Complete My Life’s Journey assessment
Assigned to case manager
My Life Journey information falls within 3 areas of
the Life Plan Model
Develop My Life Plan using questions
Begin in individual case management
Attend group activities (level 2)
Track My Life Plan Goals using a GAS tool
The Life Plan Perspective
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Change in approach = positive response from
participants, MOST staff
Model has impacted the way we do business
Use of life course framework in update of Healthy
Start Service Delivery Plan
 New collaborations in economic self-sufficiency,
community development
 How to incorporate in state HS case management??
 Developed the Make a Difference Leadership
Academy
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Group Level Experience
Outcome
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The Make a Difference!
Leadership Academy: develops
leadership skills and promotes
civic engagement
Utilizes training material
developed by the University of
Arizona in 12 weekly sessions.
Residents of vulnerable
neighborhoods.
Participants develop Community
Action Plan to move a
community to action.
Community Leadership Training
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Community Action Planning
Local Icons of Jacksonville
Leadership
Your Personal Leadership Style
Community Values
Effective Meetings
Roberts Rules of Order
Public Speaking
Conflict Resolution
Problem Solving
Sharing the Work Through Delegation
Community Diversity
Foundations of Health Inequalities
Integrating the Life Course into MCH
Service Delivery: From Theory to Practice
http://www.springerlink.com/openurl.asp?genre=
article&id=doi:10.1007/s10995-013-1242-9
Thank you!
Questions & Answers
Please submit your questions via chat. Feel free
to contact speakers after the webinar with any
additional questions.
Facilitated by Caroline Brazeel, EWSE Co -Chair
Additional Resources
The Life Course
Game
Life Course
Toolbox
www.citymatch.
org
Interactive way
to understand
the Life Course
framework.
AMCHP Life Course Resource Center
National Preconception Campaign
 Visit
ww.cdc.gov/showyourlove
or www.cdc.gov/quierete
for more information
 E-cards and more
 Check Lists


http://www.cdc.gov/preconcepti
on/showyourlove/documents/H
ealthier_Me_NonPlan.pdf
http://www.cdc.gov/preconcepti
on/showyourlove/documents/H
ealthier_Baby_Me_Plan.pdf
Thank you!
A woman's health is her capital. Harriet Beecher Stowe