Life Course Theory - Every Woman Southeast
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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]