Using the "Shaping Policy for Health” analysis tools to develop an action-oriented Plan to Improve Birth OutcomesRebecca Allen, Senior Manager, CT Community for Addiction Recovery (CCAR)

Marjane Carey, Owner and Principal, Carey Consulting

Jordana Frost, State Director of Program Services, March of Dimes

Erin Jones, Regional Director of Program Services, March of Dimes

Agenda

The charge: how it all came about

The process: DHPE Policy Analysis Tools

The players and their experience: from energy to synergy

Current status and future directions: we’re a force to be reckoned with!

1 out of 9 babies in the U.S. is born before 37 weeks of completed gestation. Premature birth is the number of killer of children under the age of 5.

Many of the surviving babies and their families face a lifetime of physical, emotional, and financial difficulties tied to the complications and sequelae of premature birth.

These include developmental delays and complications affecting breathing, vision, hearing, and digestion, just to name a few.

If you need a frame of reference…

Background Dept. of Public Health Commissioner

accepted the “ASTHO” Challenge (Association of State and Territory Health Officials) to reduce preterm birth by 8% by June 30, 2014. CT added additional component to reduce race and ethnic disparities in preterm birth.

Simultaneously, CT was 1 of 4, states selected to participate in National Governor’s Association (NGA), Learning Network to Improve Birth Outcomes. Partners include; Dept. of Public Health and Dept. of Social Services, Governor’s office, March of Dimes, New Haven Healthy Start

Background (cont’d) NGA had (3) Action Steps: 1. convene a statewide meeting,

2. Conduct (10) statewide consumer focus groups, and 3. by June 30, 2013 seeking sustainable funding. Step 1, Convene a meeting. March 13, 2013, over 8- MCH statewide

partners joined together and discussed the current MCH landscape in CT. Agreed to participate in a statewide coalition to improve birth outcomes, special attention to disparities, within current statewide structure.

Step 2, Conduct focus groups. (8) consumer focus groups we held throughout CT. Included pregnant and post partum woman in (8) CT communities.

Step 3, find sustainable funding. This is where we take an up expected, but exciting turn in our project and the Plan to Improve Birth Outcomes (PIBO) came to be.

Todays presentation will take you on our journey to become an actionable coalition.

The long and arduous process…

Prioritization Process

1) Brainstormed strategies

2) Conducted Impact Analysis

3) Conducted Stakeholder Power

Analysis

4) Combined Impact Analysis and

Stakeholder Power Analysis

5) Sorted by Impact Score

6) Brief interpretation notes

7) Scan of other “plans” to identify

synergies

8) Aligned with AMCHP compendium to further organize strategies into nationally-recognized

framework

9) Selection of top strategies to be tackled by Coalition in the next

1-5 years

Directors of Health Promotion and Education (DHPE) is a professional association founded in 1946 with voting members representing the health promotion function in each state, territory, or indigenous nation

Key areas include: school health, health equity, and shaping policy for health

Shaping Policy for Health (SPH) Curriculum was developed through a CDC cooperative agreement with DHPE

Curriculum developers are from UNC (Chapel Hill) – James Emery, MPH and Carolyn Crump, PhD

Background on DHPE and the Shaping Policy for Health tools

Prioritization Process

1) Brainstormed strategies

2) Conducted Impact Analysis

3) Conducted Stakeholder Power

Analysis

4) Combined Impact Analysis and

Stakeholder Power Analysis

5) Sorted by Impact Score

6) Brief interpretation notes

7) Scan of other “plans” to identify

synergies

8) Aligned with AMCHP compendium to further organize strategies into nationally-recognized

framework

9) Selection of top strategies to be tackled by Coalition in the next

1-5 years

HANDOUT

Impact Analysis

Prioritization Process

1) Brainstormed strategies

2) Conducted Impact Analysis

3) Conducted Stakeholder Power

Analysis

4) Combined Impact Analysis and

Stakeholder Power Analysis

5) Sorted by Impact Score

6) Brief interpretation notes

7) Scan of other “plans” to identify

synergies

8) Aligned with AMCHP compendium to further organize strategies into nationally-recognized

framework

9) Selection of top strategies to be tackled by Coalition in the next

1-5 years

HANDOUT

Stakeholder Power Analysis

Prioritization Process

1) Brainstormed strategies

2) Conducted Impact Analysis

3) Conducted Stakeholder Power

Analysis

4) Combined Impact Analysis and

Stakeholder Power Analysis

5) Sorted by Impact Score

6) Brief interpretation notes

7) Scan of other “plans” to identify

synergies

8) Aligned with AMCHP compendium to further organize strategies into nationally-recognized

framework

9) Selection of top strategies to be tackled by Coalition in the next

1-5 years

Here’s How We Pull it All Together!

Prioritization Process1)

Brainstormed strategies

2) Conducted Impact

Analysis

3) Conducted Stakeholder

Power Analysis

4) Combined Impact Analysis and Stakeholder Power Analysis

5) Sorted by Impact Score

6) Brief interpretatio

n notes

7) Scan of other “plans” to

identify synergies

8) Aligned with AMCHP compendium to further

organize strategies into nationally-

recognized framework

9) Selection of top strategies to be

tackled by Coalition in the next 1-5 years

Monstrous Documents

Plan to Improve Birth Outcomes (PIBO)

24

Prioritization Process1)

Brainstormed strategies

2) Conducted Impact

Analysis

3) Conducted Stakeholder

Power Analysis

4) Combined Impact Analysis and Stakeholder Power Analysis

5) Sorted by Impact Score

6) Brief interpretatio

n notes

7) Scan of other “plans” to

identify synergies

8) Aligned with AMCHP compendium to further

organize strategies into nationally-

recognized framework

9) Selection of top strategies to be

tackled by Coalition in the next 1-5 years

Recommendations address:

Lifecourse education

Social determinants of health

Trauma prevention and trauma-informed systems of care

Family-supportive policies and program

Fatherhood

Health care integration (holistic wellbeing throughout the lifecourse)

Family planning, preconception and inter-conception health

Quality, content, and format of prenatal care

Health care systems incentives and payment reform

Additional strategies featured in the appendices address:

Provider knowledge of community resources Racism Supportive housing initiatives Financial literacy Community health workers The language of mental health and stigma Undocumented families Midwifery care Doula care

We have all the right buzzwords…

Pie in the sky?

We stumbled upon the concept of Collective Action… only to realize that’s the path we were already on!

Consider a flock of birds…

The Five Conditions of Collective Impact

Phases of Collective Impact

Determinants of Partnership Synergy

Resources

•Money•Space, Equipment and Goods•Skills and Expertise•Information•Connections to people, organizations and groups•Endorsements•Convening Power

Partner Characteristics

•Heterogeneity•Level of Involvement

Relationships Among Partners

•Trust•Respect•Conflict•Power Differentials

Partnership Characteristics

•Leadership•Administration and Management•Governance•Efficiency

External Environment

•Community Characteristics•Public and Organizational policies

Lasker R, Weiss E, Miller R. (2001). “Partnership synergy: a practical framework for studying and strengthening the collaborative advantage.” New York Academy of Medicine. The Millbank Quarterly Vol. 79 No. 2

SynergyResources

Skills and expertise of coalition members.

top level positions

working for many years in the MCH field

Information

members work in different areas of MCH

Partner Characteristics

Heterogeneity

diverse group of state, federal, and community stakeholders

Level of Involvement

69% report involved/very involved

Relationship Among Partners

Trust & Respect among members

worked together on past projects

group connectedness very strong.

Partnership Characteristics

Leadership

strength of coalition leadership

efforts to promote collaborative

listen and hear coalition members

Administration & Governance

high degree of formality

planning committee communicated frequently

Survey Results

Highest Satisfaction - 5 Commitment of Coalition to build

and sustain diverse membership (4.47)

Effort to promote collaborative (4.41)

Extent to which Coalition member are listened to and heard (4.35)

Coalition meetings stay on task and run smoothly (4.27)

Lowest Satisfaction - 1 Communication between the

Coalition and the broader community (3.31)

State needs assessment process (3.65)

Capacity of the Coalition to advocate effectively (3.53)

• Members appeared satisfied with coalition activities. 71% responding they were satisfied or very satisfied to the

statement my time is well spent. *SIBO is a great example of a collective impact initiative.

Where we have been…

The MCH Advisory Committee - up to March 2013 ·Quarterly networking meetings

The Coalition to Improve Birth Outcomes - March 2013 to September 2015 Charge to the Coalition: Produce

a Plan to Improve Birth Outcomes (PIBO)

Where we are going…

The MCH Coalition – Started September 2015 Serves as the MICH action planning team for

the State Health Improvement Plan (SHIP) Is implementing the PIBO Is changing MCH’s culture and tone by

Facilitating communication among Coalition members

Supporting coordination and alignment of efforts

Identifying opportunities for integration

Moving from Planning to Action in unison.

2016 Action Agenda for Maternal, Infant, and Child Health

PIBO

SHIP

MCH Block Grant

Becoming a vehicle to move from…

Thank you!