Padmini Parthasarathy, MPH Cheri Pies, MSW, DrPH Family, Maternal and Child Health Programs Contra Costa Health Services The Contra Costa Life Course Initiative:

Padmini Parthasarathy, MPHCheri Pies, MSW, DrPH

Family, Maternal and ChildHealth ProgramsContra Costa Health Services

The Contra Costa Life Course Initiative: Where We Have Been, and

Where We Are Going

Overview

Staff education

A 12-Point Plan to Close the Black-White Gap in Birth Outcomes

Evaluation

Challenges and Questions

Staff Education Timeline

April 2005: Michael Lu presentation to all 250 FMCH Program staff

May 2005 – December 2006: Initial interactive education sessions individual program staff meetings

January 2007 – February 2008: Refresher sessions

Education sessions with community partners during this time, as well

Staff Education Content

Theory of the Life Course Perspective

Life Course Game

Life Course Initiative activities

A 12-Point Plan

Integrating the Life Course Perspective into their work What are you currently

doing that fits with the Life Course Perspective?

How can you integrate the Life Course Perspective into future activities?

The Life Course Game

A 12-Point Plan…

To close the Black-White gap in birth outcomes

Developed by Michael Lu, M.D., MPH, et al.

Goals: Improve healthcare for African American women Strengthen African American families Reduce allostatic load on African American

women over the life course

A 12-Point Plan

How is this different from current approaches?

Goes beyond prenatal care

Goes beyond individual-level interventions

Goes beyond the medical model

Evaluation

Established Life Course Initiative Data Team, which meets regularly

Conducted survey of Family, Maternal and Child Health Programs staff

Identifying “intermediate outcomes” as measurements of success of Life Course-related activities (vs. long-term perinatal outcomes)

Staff Survey

Evaluated staff understanding of Life Course Perspective (LCP)

Gathered ideas from staff about incorporating the LCP into their work

Survey sent to 107 FMCH Programs staff

68 staff (64%) responded

Survey Questions

In your own words, how would you describe the Life Course Perspective?

What are two concepts from the Life Course Perspective and/or the 12-Point Plan that you think relate to your work?

Have you changed anything about your public health work as a result of learning about the Life Course Perspective?

Survey Questions

How have you incorporated the Life Course Perspective into your work?

What are the reasons that you have not incorporated the Life Course Perspective into your work?

What would you like to see us do in the future with the Life Course Initiative?

Summary of Staff Survey Results

72% reported that they changed something about their work as a result of learning about the LCP

Based on open-ended questions, we found that in general, staff: understood the theory of the LCP; were able to relate their work to elements of the

12-Point Plan; and had incorporated the LCP into their work in a

variety of ways

Examples of IntermediateOutcomes (For Clients)

Improved life skills/coping skills

Improved sense of well-being, empowerment, resiliency, self-efficacy

Increased bonding response to infants

Decreased stress

Increase in financial security and stability and improved financial status

Asset Development

Asset Accumulation

Asset Leveraging

Asset Preservation

Asset Creation

Asset Development

Asset Accumulation Banking services Financial education

– Credit management and counseling– Budget development and money management

Income tax assistance/tax credits, i.e. Earned Income Tax Credit (EITC)

Public benefit enrollment/eligibility

Building Economic Security Today (BEST)

With Life Course Data Team, developed a logic model for an asset development pilot project: BEST

Hosting Family Economic Success and Security training for 40 home visiting and WIC staff in October 2008

Viewing and discussing Unnatural Causes

Applying for grant funding for training and project from various sources

Building Economic Security Today (BEST)

Specific asset development strategies will vary based on program and client population

Partnering with: Contra Costa Family

Economic Security Partnership (FESP)

Earn It! Keep It! Save It! Community Financial

Resources (CFR)– Prepaid debit card

BEST: Measuring Outcomes

Staff: Increased knowledge and awareness of asset

development strategies and resources Improved skills in engaging clients to adopt

asset development strategies New practices for implementing their

knowledge and skills about asset development

BEST: Measuring Outcomes

Clients: Increased knowledge and awareness of asset

development Improved sense of self-efficacy and ability to

adopt an asset development strategy Each client will adopt at least one asset

development strategy to improve his or her financial security, such as reducing debt, obtaining their EITC, starting a savings account, and utilizing a debit card

BEST: Measuring Outcomes

System: Changes will be made to help better support

clients in utilizing asset development strategies– resource and referral materials–case management documentation systems– financial education protocols and training

guidelines

How does BEST fit intothe 12-Point Plan?

9. Reduce poverty

10. Support working mothers and families

Challenges

Making paradigm shift and gaining staff buy-in is a slow process

Learning and integrating many new concepts

Time and financial resources

Measuring success

Questions for Thought

What infrastructure changes are needed to implement and measure the outcomes of Life Course Perspective-based intervention strategies?

How do we measure the success of this paradigm shift in the reduction of inequities in MCAH outcomes?

What will success look like?