The Lifecourse Initiative For Healthy Families A Wisconsin Partnership Program Funding Initiative

Quinton D. Cotton, M.S.S.A.Program Officer, UW School of Medicine and Public Health

Lecturer, UW Madison School of Social Work

Nancy Eberle, MPHAssociate Researcher, UW Population Health Institute

Minnesota Department of Health, Office of Minority Health Community Voices and Solutions Advisory Committee Forum

April 29, 2013

Presentation Outline

1. Overview of WPP2. Demographics and Infant Mortality Data3. Overview of the Lifecourse Initiative for Healthy

Families and its Planning Phase4. Evaluation Framework5. Implementation Phase6. Questions and Discussion

Partnerships for a Healthy Wisconsin

Wisconsin Partnership Program

• Overall total: – 325 grants totaling

$130M

• Since 2004:– 182 community-

academic partnership grants totaling $38.9M

– 119 education and research grants totaling $83.3M

47%

15%

31%

8%

Public Health Portfolio

Public Health Education and Training

Clinical and Translational Research

Basic Research

A LOOK AT THE NUMBERS

Infant Mortality Rates by Race/Ethnicity, Wisconsin, 1990-92 to 2008-10

Source: Wisconsin Health Facts: Racial and Ethnic Disparities in Infant Mortality. WI Dept. of Health Services, Nov. 2012

African American Births, Deaths, and Infant Mortality Rates in WI, 2006-2010

County% AA

birthsIM

rate

Brown 2% 15.8

Dane 7% 12.2

Kenosha 3% 8.2

Milw. 76% 15

Racine 6% 18.1

Rock 2% 17

Total WI 35,612 14.7Data source: WI Interactive Statistics on Health, WI DHS

LIHF communities

WI Infant Mortality Data by Race and Selected Maternal Characteristics, 2008-10

Source: Wisconsin Health Facts: Racial and Ethnic Disparities in Infant Mortality. WI Dept. of Health Services, Nov. 2012

Black/White Infant Mortality Rate Ratios, 2005-07

Comparing Wisconsin and Minnesota

Racial Demographics

2010 BirthsNH White: 74.4%;

n=50,893NH Black: 10%;

n=6845Foreign-born:

4.6% of allbirths

statewide

2010 BirthsWhite: 79.5%;

n=49,765AA/African: 10.4%;

n=6487Foreign-born:

50.5% (n=3273) of AA births

2007-09 Linked birth/infant death data files, NCHS

2007-09 Linked birth/infant death data files, NCHS

Prematurity and low birth weight are leading causes of African American infant deaths

SIDS (Sudden Infant Death Syndrome) and Co-sleeping related deaths

Infant Mortality Crisis in Wisconsin

Wisconsin’s Healthy Birth Outcomes Initiative

Lifecourse Initiative for Healthy Families (LIHF)

Improved health status of American women over the lifespan

Improved African American infant survival and health

Elimination of racial and ethnic disparities in birth outcomes

Lifecourse Perspective

Suggests that biological, psychological, behavioral and social protective and risk factors contributes to health outcomes over a person’s life span

The Lifecourse perspective conceptualizes birth outcomes as the end product of not only the nine months of pregnancy, but the entire Lifecourse of the mother leading up to the pregnancy

Root Causes

Four Cornerstone Strategies

Partnerships and Collaboration with four

Communities

Raising Public Awareness

Deliberate and Inclusive Planning

New Investments in Effective Policies and

Programs

Phase 1: Planning

Community Planning and Visioning

Formation of Lifecourse Collaboratives

Lifecourse Community Action Plans

12 Point Plan to Close the Black-White Gap in Birth Outcomes (Lu et.al., 2010)

Improving Healthcare for African American Women

• Provide interconception care to women with prior adverse pregnancy outcomes• Increase access to preconception care for African American women• Improve the quality of prenatal care• Expand healthcare access over the Lifecourse

Strengthening African American Families and Communities

• Strengthen father involvement in African American families• Enhance service coordination and systems integration• Create reproductive social capital in African American communities• Invest in community building and urban renewal

Address Social and Economic Inequities

• Close the education gap• Reduce poverty among African American families• Support working mothers and families• Undo racism

Promising Engagement Techniques

• Indigenous leadership

• ‘When a Baby Dies’ events…

• Social Media

• Testimonials/Digital Storytelling

• Meet in community locations; during evening

• Listening/feedback sessions

• Baby Showers, Health Expo, Resource Fairs

• Need to unite around a common vision

• Prioritized need for inclusion of diverse voices, particularly those voices traditionally not at the table

• Need for strong leadership able to work across institutions with stakeholders

• Need for define roles, supports, expectations and attention to the relationships between funders and communities, including grantees

• Need for strong facilitation to mediate group dynamics

• Importance of acknowledging the impact of racism

• Stakeholders sometimes want to move quickly to action

Lessons Learned During the LIHF Planning Phase: Working Towards Collective Action

Evaluating the LIHF Project

LIHF Logic Model (simplified)

Convening Agencies

LIHF Project Grants

Collabor-atives

Community Action Plans

High Quality Programs, Policies

and Strategies

Assessment, Planning and Capacity Building

LIHF Collaboratives Widespread change in individual-

family- and community-level Risk and Protective Factors

Improved AA Infant Survival

and Health

Improved AA

Women’s Health Status

Elimination of Racial

Disparities in Birth

Outcomes

Wisconsin Partnership Program Resources

UW Foundation, External Funders and

Donor Partners

Three Main Levels of Evaluation

LIHF Project Grants

Collabor-atives

High Quality Programs, Policies

and Strategies

Widespread change in individual- family- and community-level Risk

and Protective Factors

Improved AA Infant Survival

and Health

Improved AA

Women’s Health Status

Elimination of Racial

Disparities in Birth

Outcomes

3. Impact of entire LIHF projectIntermediate and long-term outcomes

1. LIHF CollaborativesCommunity/ system change efforts and outcomes

2. LIHF Project GrantsEvidence-based & promising practice programmatic outcomes

Evaluation of LIHF Project as a Whole• Primary responsibility = central evaluation team

– WPP staff and UW Population Health Inst. consultants• Focus is on changes in intermediate- and long-term

outcomes, related to the three LIHF domains• Main data sources

– Data collected by LIHF Collaboratives and project grantees

– WI PRAMS – Birth records– Publicly available data sets & systems (e.g., WISH, BRFS)

PRAMS: Efforts to increase response rates among African Americans

• Supplemental funding from WPP

• “Purple envelope campaign” for all AA births in WI

• Additional oversample in four LIHF communities

• Preliminary results showing increased response rates

Examples from Working List of Intermediate OutcomesRisk or Protective Factor

Intermediate Outcome

Indicator

Absence of high quality, culturally-competent,

E-B health care

Increased receipt of early and adequate prenatal care

% of live births to AA women in which prenatal care was adequate

Lack of inter-personal, family and community

support

Increased father involvement during pregnancy and after the birth of the child

% of AA new mothers who report the availability of support from their husband or partner during and shortly after pregnancy

Short inter-pregnancy interval

Decrease in pregnancies with very short inter-pregnancy intervals

The % of live births to AA women in which the interval since the mother’s most recent pregnancy was 6 months or less

Lack of breastfeeding

Increased # of women initiating & continuing breastfeeding

% of AA mothers who initiate breastfeeding, and % who breastfeed for six months

Racism

A reduction in the reported experience of racism just before and during pregnancy

% of AA new mothers reporting that in the 12 mos. before their baby was born they felt emotionally upset as a result of how they were treated based on their race

Working List of Long-term OutcomesLong-term Goals/ Outcomes

Indicators

Improve African American infant survival and health

% of African American live births born at low, very low and extremely low birthweight

% of African American births that are pre-term, moderately pre-term and extremely pre-term

African American infant mortality rates

Improve African American women’s health status

% of African American women who report good, very good or excellent health status

Eliminate racial disparities in birth

outcomes

Black/white difference in low birthweight

Black/white difference in preterm births

Black/white rate ratio for infant mortality

Underlying Context for Evaluation Activities

• Participatory approach with stakeholders– Evaluation workgroup with representation from each

community• Realistic expectations; meaningful change

– Long-term horizon– Avoid focusing on year-to-year changes in IM rates

• Utilize Lifecourse perspective– Look beyond infant mortality to changes in social

determinants of health– Utilize risk and protective factors

as frame for looking at outcomes

Phase 2: Implementation and Evaluation

Projects to Address Risk and Protective Factors

System and Policy Level Change

Evaluate, Communicate and Leverage Resources

Funding Priorities (informed by LIHF Community Action Plans)

• Develop peer or social support networks for pregnant women and new mothers and families (e.g., the Birthing Project USA, Patient Navigator or Community Health Worker)

• Enhance prenatal care through a group prenatal care model (e.g., Centering Pregnancy)

• Expand maternal, infant and early childhood home visitation programs in targeted areas (e.g., Nurse Family Partnership)

• Improve family access to utilization of medical homes • Improve family supports, including an increase in fatherhood

involvement and transitional and family sustaining jobs

LIHF Project Grant Snapshot

Individual grant awards range from $50,000 to $400,000

• Beloit 4 grants $500,000• Kenosha 4 grants $650,000• Milwaukee 11 grants $2,250,000• Racine 4 grants $600,000

$4,000,000Common Strategies:

• Centering Pregnancy and the Birthing Project• Father Involvement (jobs, prenatal care, men’s health)• Home Visitation

• The Lifecourse approach is an important framework for guiding policy and solving challenging

• This challenge will require many years of synergistic, innovative efforts targeting the key communities.

• Deep and sustained partnerships, along with more resources, will be essential for success.

Conclusions and Observations