Assessing the Racine Infant Mortality Coalition s Readiness to Establish a Life Course Organization

1. Assessing the Racine Infant Mortality Coalition�s Readiness to Establish a Life Course Organization Racine, Wisconsin June 20, 2009 Facilitator: Tamara Wrenn, MA, CCE, CIMT Consultant, Practice Matters, a Subsidiary of Northern Manhattan Perinatal Partnership, Inc.

2. The following presentation was developed in collaboration with Jump at the Sun Consultants, LLC through funding provided by the City of Racine Health Department, Healthy Births Healthy Families.

3. Group Discussion Split the room in half.Split the room in half.

4. Workshop Goal Conduct an interactive workshop that demonstrates the strategic, policy and organizational implications, and programmatic structure required to move in the direction of a life course perspective and develop a MCH life course organization.

5. Workshop Objectives After completing the workshop participants will be able to: Describe the levels of upstream impact. Cite the systems required for integration to build a public health social movement. Demonstrate an understanding of the longitudinal approach to women�s health. Explore and chart the longitudinal and contextual interventions within the coalition. Analyze the coalitions current interventions using a life course approach. Analyze the coalitions readiness to build a life course organization. Question comes before next slide. How would you define a life course organization? Post responses.Question comes before next slide. How would you define a life course organization? Post responses.

6. Group Discussion

7. Traditional Perinatal Care Continuum

9. Shifting Focus � Moving Forward Research, policy and practice dictate that society move beyond the traditional focus of racial disparities in preterm birth, low birth weight and infant mortality, such as; Maternal behaviors Prenatal care utilization Psychosocial stress Infections

10. Life Course Perspective Suggests that a complex interplay of biological, behavioral, psychological, and social protective and risk factors contributes to health outcomes across the span of a person�s life. The life course perspective conceptualizes birth outcomes as the end product of not only the nine months of pregnancy, but the entire life course of the mother leading up to the pregnancy. Have someone read it. Come up with examples for each area in bold.Have someone read it. Come up with examples for each area in bold.

11. Life Course Perspective Synthesizes two longitudinal models and proposes that the increase in risk of African American women to preterm birth and LBW may be traced to. Early programming � greater exposures to stress during pregnancy, early in life and possibly utero. Cumulative pathways � not only increased exposures to stress during pregnancy, but possibly to increased �weathering� of stress over their life course resulting in greater allostatic load.

12. Life Course Theoretical Assumptions and Implication to MCH Practice Diminished role and impact of prenatal care Maternal health prior to pregnancy is key Explores and learns from history of adverse birth outcomes It will take more than one generation to equalize birth disparities Requires clinical, public policy and programmatic interventions that are longitudinally and contextually integrated Transition from strictly clinical approaches to practice to integrate a social determinants of health focus to practice Eradicate the macro dimension of racism that exists at the societal, policy and institutional levels Go through each one.Go through each one.

13. Group Discussion Review each briefly for understanding. Discuss.Review each briefly for understanding. Discuss.

14. Working Definition of a MCH Life Course Organization A MCH Life Course Organization is an entity (local/state) that develops the capacity over time to deliver integrated, continuous and comprehensive health and social services and support to women and their family members from the womb to the tomb.

15. Characteristics of a Life Course Organization Builds programmatic capacity within the agency at each stage of a woman�s life course to manage her health over the life course (Axis 1). Swims up-stream from individual interventions and designs strategies and actions at the group, organizational, community and policy levels to transform social determinants to poor health (Axis 2). If unable to build internal capacity collaborates with outside agencies and systems to create an integrated system of care to manage a woman�s health.

16. Characteristics of a Life Course Organization Unlike many maternal and child health programs that only seek to influence the health system by developing and executing a local health system action plan, a MCHLCO seeks to influence and lead their local and regional economic, political, housing, child welfare, early childhood and middle school systems of care.

17. New MCH Life Course ContinuumAxis 1

18. New MCH Life Course ContinuumAxis 1

19. MCH Life Course OrganizationSocial Determinants of Health AXIS 2 Clip Clip

20. MCH Life Course OrganizationSocial Determinants of Health AXIS 2 Remind people Remind people

21. Models Clip�Clip�

22. Models Group work identifying how each model is working within a life course framework. Structure, services, level of impact.Group work identifying how each model is working within a life course framework. Structure, services, level of impact.

23. Models Group work identifying how each model is working within a life course framework. Structure, services, level of impact.Group work identifying how each model is working within a life course framework. Structure, services, level of impact.

24. Models Group work identifying how each model is working within a life course framework. Structure, services, level of impact.Group work identifying how each model is working within a life course framework. Structure, services, level of impact.

25. Small Group Activity Use your practice sheet to answer the following questions about your case study model. List the specific interventions/strategies carried out by the organization at each life stage on Axis 1. List the specific interventions/strategies the organization engages in at each level on Axis 2. Where are its strengths on each Axis? What do you think so far about the types of life course strategies that can be undertaken? What are the benefits and challenges associated with each?What do you think so far about the types of life course strategies that can be undertaken? What are the benefits and challenges associated with each?

26. LCO as a Business Entity Organizational structure Local entity 501 (c ) 3 Local/state government Leadership Strong leadership and management Order, consistency, quality Cope with complexity Build relationships Sacrifice Create a culture of leadership Strategist Capacity Internal Collaborative Integrated systems Sustainability Funding Coordination Quality assurance Community demand Comprehensive strategy Multilevel practice

27. This is a Need to Know Section! When dealing with the research, policy and programmatic aspects of moving from the life course theory to practice there are a few key areas that are sometimes overlooked. They consist of a clinical and social mix of strategies. Share with the group how this clinical and social mixture of strategies is an important, but sometimes overlooked component of moving from theory to practice.Share with the group how this clinical and social mixture of strategies is an important, but sometimes overlooked component of moving from theory to practice.

28. MCH Life Course OrganizationClinical and Social Mix of Strategies Don�t forget to: Build a public health social movement Address racism Implement core services

29. Build a Public Health Social Movement Change the health seeking behaviors of women of childbearing age, as well as change political and health systems to develop the political will to invest in infant mortality reduction interventions. Clip Clip

30. Spectrum of Work for MCH Life Course OrganizationBuilding Public Health Social Movement Visual Aid Chapter 5: Place Matters Point out the systems involved. If internal capacity does not exist seek out collaborations, then integrate. One leadership structure.Visual Aid Chapter 5: Place Matters Point out the systems involved. If internal capacity does not exist seek out collaborations, then integrate. One leadership structure.

31. Five Point Plan to End Infant MortalityExample of a Public Health Social Movement The Citywide Coalition to End Infant Mortality called for supporting the work of five entities that had/have a record of working to improve the health and social status of poor and working class women throughout New York City. Perinatal Networks Immigrant/Ethnic Organizations Community-based Feeder Organizations Building Borough Perinatal Task Forces Community Health Centers

32. Citywide Coalition to End Infant Mortality Accomplishments to Date The coalition developed a comprehensive plan to end infant mortality in high risk communities throughout NYC by mobilizing and organizing key constituencies and public health organizations from across the city. A record $5 - $7 million dollars has been allocated yearly since 2002 by the City Council towards achieving objectives � over $75 million to date. Legislative and advocacy strategies have been instrumental. One city, one customer, one plan! 1) How is a public social health movement good for women�s health? 1) How is a public social health movement good for women�s health?

33. Addressing Racism Dr. Camara Phyllis Jones Race � social interpretation of how we look Racism � a system (consisting of structures, practices, and norms) that structures opportunity and assigns value based on the way people look. It unfairly disadvantages some individuals and communities. ClipClip

34. Three Levels of Racism Dr. Camara Phyllis Jones Internalized Acceptance of the stigmatized races of negative messages about their own abilities and intrinsic worth Personally mediated Prejudice or discrimination Institutionalized Differential access to the goods, services, and opportunities of society by race Drawing upon your own experiences come up with some examples for each category. Looking over the examples, list possible health impacts associated with each. Not necessarily direct but they can be related. Small group brainstorm, consider and discuss interventions at different levels (individual, community, societal) and different arenas (public, private) Pick one or two policies or actions you think would make the greatest differenceDrawing upon your own experiences come up with some examples for each category. Looking over the examples, list possible health impacts associated with each. Not necessarily direct but they can be related. Small group brainstorm, consider and discuss interventions at different levels (individual, community, societal) and different arenas (public, private) Pick one or two policies or actions you think would make the greatest difference

35. The Role of Racism in Birth Outcomes Emphasis facilitators CDC Social Determinants of Health Working Group Social determinants of health are factors in the social environment that contribute to or detract from the health of individuals and communities. These factors include, but are not limited to the following: Socioeconomic status Transportation Housing Access to services Discrimination by social grouping (e.g., race, gender, or class) Social or environmental stressors

36. Core Services Every life course organization must develop core services. The core services must be in line with its internal capacity. Before building internal capacity a LCO must have it�s �A Game� in place.

37. Core Services Outreach and recruitment Case management Health education Depression screens & referrals Preconception care Male involvement Interconceptional care Reproductive life planning Right now the LC perspective does not have a standard of implementation. That�s still be developed. Based on internal capacity the core services may differ from organization to organization. The idea here is that core services need to be in place. Since the LCO works throughout the lifespan it should operate using core services that provide continuous service. Original core services came from the 1989 expert panel on prenatal care.Right now the LC perspective does not have a standard of implementation. That�s still be developed. Based on internal capacity the core services may differ from organization to organization. The idea here is that core services need to be in place. Since the LCO works throughout the lifespan it should operate using core services that provide continuous service. Original core services came from the 1989 expert panel on prenatal care.

38. The non-pregnant client When the client is not pregnant the core services shift to meeting either their preconception or interconceptional needs. Recruitment and retention become more challenging. The client�s WIFM (What�s In it For Me) becomes more challenging to create. Creativity, paradigm shifts and leadership incentives for clients are required.

39. Preconception Care Focuses on the health of a woman before conception Is not glorified primary care Should include specific strategies for preventing preterm births and LBW with a focus on those areas known to be risk factors

40. Interconceptional Care Focuses on the health of a women from the conception of one pregnancy to the conception of the next Best practices would be to provide it as part of a longitudinally-integrated continuum of women�s healthcare Limited healthcare resources dictate it be targeted to women with prior adverse birth outcomes or medical problems before/during pregnancy

41. Goals of Interconceptional Care Increase access to women�s healthcare Reduce low birth weight and infant mortality Reduce racial-ethnic disparities in mother and infant health outcomes

42. Group Discussion What life stages does the mission statement reference? Axis 1 What levels of intervention does the mission statement target? Axis 2 Social determinants � level of responsibilityWhat life stages does the mission statement reference? Axis 1 What levels of intervention does the mission statement target? Axis 2 Social determinants � level of responsibility

43. Goals for a Life Course Approach Based on the twelve point plan to reduce racial-ethnic disparities in birth outcomes using a life-course approach. The goals of a life course approach are to: Address the needs of women for quality healthcare across the lifespan. Move beyond individual level interventions that are usually short lived and address it from multiple levels. Move beyond the medical model to address social and economic inequities.

44. Where are We? The mission of the coalition is to reduce infant mortality in the black communities of Racine by increasing the awareness of the causes of infant death, providing education on healthy families, healthy pregnancies, and infant care. And to encourage local involvement and support of the coalition�s efforts.

45. Where are We? Small Group Activity Working within your small groups complete the worksheets. You will be guided through the completion of each worksheet so please wait for instructions. Remember to include the committee name at the top. Select a recorder to document your findings. Select a reporter(s) to share your findings.

46. Field of Dreams�If you build it they will come� Building an MCH life course organization requires patience, commitment and sacrifice. The seeds we plant today will require at least one generation before we can see lasting changes. The knowledge that the concept and standardization of prenatal care is only 30 years old provides optimism in the face of moving the life course perspective from theory to practice.

47. Where does the RIMC go from here? Each group shares their findings. Solicit feedback using reflecting questions.Each group shares their findings. Solicit feedback using reflecting questions.

48. Seize the moment While the economy is reeling and�social service and health agencies budgets are being cut, fast companies must be nimble and take advantage of the opportunities�that are placed on�our doorstep. Develop a working committee to scan the external environment to research and then select a variety of program development funding opportunities to expand the service offerings of the MCH Life Course Organization.

49. Funding Opportunities President Obama has placed billions of dollars in the Stimulus Package to expand evidence-based home visiting programs as well as Early Head Start and Head Start programs. These program types are the foundation for building a MCH Life Course Organization.

50. Funding Opportunities President Obama has placed ten million dollars in his budget to replicate the Harlem Children�s Zone in twenty-five cities around the nation. Racine could apply for these funds ($250,000 per project) that could help them institutionalize the coalition, hire staff and set up the organizational infrastructure that will be needed as more programs are added.

51. Thank You for Your Time and Hard Work! �The wise leader is more concerned with what is than with the way he would like things to be. He is more concerned with what will work than with getting his mere opinions accepted. And he is more concerned with truth than with merely being thought right.� The Art of Leadership by J. Donald Walters