Transcript Life Course Theory - Every Woman Southeast

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
Overview
 The Life Course in MCH
 Implications for practice
 From theory to practice
 Planning framework
 Prenatal Care & Case
management
 Leadership Academy
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
Why now?
 Improvements in infant mortality have stalled.
Infant
Mortality
Rate
Infant
Mortality,
U.S.
U.S. 1990-2007
1990-2007
Why now?
 Racial and ethnic disparities persist.
Infant Mortality Rates by Race/Ethnicity
U.S. 2005-2007
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
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.
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
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
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.
Implications
 Life course framework in MCH has
PROGRAMMATIC and POLICY implications.
Changing practice
 Content of care is expanded
 Poverty
 Economic
 Education
security
Changing practice
 Services are organized and delivered in ways that
build resiliency and social capital and reduce
dependency
 Group care
 Self care
Changing practice
 Requires inter-disciplinary, inter-agency
collaboration to address complex needs
From Theory to Community Practice
• Planning Framework
• Case Management & Prenatal Care
• Leadership Academy
Planning Framework
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
Planning Framework
 Impact of paradigm shift
 http://nefhealthystart.org/resources-
research/plans-policies-financials/
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)
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.
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.
Prenatal Care: Centering Pregnancy
 Group prenatal care model
 Key elements:
 Self
care
 Facilitated discussion, participant-led
 Group interaction and inter-dependence
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. . .”)
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?”
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
Leadership Academy
 Graduation field trip! Jacksonville City Council
meeting to adopt budget
Cliff Notes: Life Course Service Delivery Model
Individual services
(mitigate, reduce risks)

Group services
(inter-dependence, self-reliance)

Community capacity building

Advocacy
(social determinants)
Acknowledgments
 Thanks to Michael Lu, Cheri Pies, CityMatCH
 Faye Johnson, Healthy Start board & staff
 Chartrand Foundation & other community
funders!
Thank you! [email protected]
Thank you!
[email protected]