Transcript Life - CityMatCH

Integrating the Life
Course Model into Case
Management Services
NORTHEAST FLORIDA HEALTHY START COALITION, INC.
Presenters: Carol Brady, MA
Faye Johnson, BS
July 15, 2009
Snapshot of Jacksonville
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Infant mortality rate (2007): 9 deaths per 1,000
live births (2005 rate was 11.6)
IM driven by disparities
42% of births to Blacks & other nonwhites
 Blacks historically have poorer outcomes in Jax than
other urban areas of state
 IM rate 2x higher than White rate
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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 meeting (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
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The Magnolia Project
Case Management has Evolved
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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.
What was Done
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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
Finance
Reproductive Health
Healthy Relationships
Responsibility included determining level status
Facilitated bi-weekly group activities
Identified additional group resources.
Managed existing caseload
How
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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
Need to clarify roles continuously
Did not have an opportunity to evaluate the Goal
Attainment Scale during the process.
What’s Next
Fully and completely implement the New
Redesign to include lessons learned
WHY ?
Benefit of Integrating The Life Course
Perspective into Case Management
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The participants welcomed the change and were
excited during the group activity.
An opportunity to address the social determinants
that influence poor birth outcomes
Promoted inter-and independence while building
reproductive capital in the community.
The approach can contribute to improved self
esteem among the women enrolled in case
management.
More Benefits
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Participants developed support systems that
continued after case management services
ended.
Received a wealth of information and training
through numerous group activities and
individual case management. Reinforce!
Participants will have an opportunity to take an
active role in tracking progress in achieving
goals included in their life plans (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.
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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’ responsibilities include notifying
management of any external groups, assisting
participants with access to the activity and encouraging
participation
Body and Soul Reproductive Health Group is
conducted at the Magnolia Project where clinic services
are provided. 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.
Example of GAS Tool
Simplified
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Complete My Life’s Journey assessment
Assigned to my case manager
My Life Journey information falls within 3 areas of
the Life Plan Model
Develop My Life Plan using 5 questions
Begin in individual case management
Attend group activities (level 2) ensuring that my
plan has continuity.
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??
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Questions? Thank you!