June 6, 2013

WelcomeA Life Course Theory to Practice

Webinar

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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Putting the Life Course Concept into Practice: Lessons

from the Northeast Florida Healthy Start Coalition

Today’s Webinar

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 WebinarCarol Brady, MA

Faye Johnson, BS June 6, 2013

Snapshot of Jacksonville

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

2005 2006 2007 2008 2009 2010 2011 20120

5

10

15

20

25

7.97.2 6.7 7.1

5.5 5.8

2.8

4.9

11.6

9.5 99.7

8.4 8.17.3

8.3

20.1

14.615.4 15.3

15.9

8.8

13.3 12.8

16.9

12.9 12.913.9 13.6

11.712.8

14.1

White JacksonvilleTarget Area Linear (Target Area)Black

Infant MortalityJacksonville &

Magnolia Project Area2005-2012

The Magnolia Project

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

The Magnolia Project

Benefits Addressed gap in women’s health care Linkage to national preconception

health movement (CDC) Promising practice, long-term impact on

outcomes Limitations

Still an INDIVIDUAL intervention “Boom-a-rang” effect (dependency

model?)

Beyond Preconception

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

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

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

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

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

12 Point Plan Improve Health Care Services

Access to interconception care, preconception care, quality prenatal care, access to health care

Strengthening Families & Communities Father involvement, service coordination,

creation of reproductive health capital, community building & urban renewal

Address social, economic inequities Close education gap, reduce poverty,

undo racism support working mothers

Life Course Perspective

Challenge: 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

The Magnolia ProjectEvolution of Service

Delivery Model 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 ?

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

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 Case managers and the Women's Intervention

Specialist were responsible for one component within the three areas of focus in the Life Course Model.

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 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

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 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

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

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

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 participant- driven 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

Case manager assists in the development of the participant-driven 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 have3. 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 pregnant5. What can I do today to help you achieve your plan?

Reproductive Plan Questions taken from a presentation by Merry-K Moos at thePreconception Health an Health Care Conference, October 2007.

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.

Developing The Life Plan

Group Level of Service 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

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

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

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

Group Level Experience Outcome

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

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 MCHService Delivery: From Theory to Practicehttp://www.springerlink.com/openurl.asp?genre=article&id=doi:10.1007/s10995-013-1242-9

Thank you!

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

Questions & Answers

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 moreCheck Lists

http://www.cdc.gov/preconception/showyourlove/documents/Healthier_Me_NonPlan.pdf

http://www.cdc.gov/preconception/showyourlove/documents/Healthier_Baby_Me_Plan.pdf

Thank you!

A woman's health is her capital. Harriet Beecher Stowe