1. Perinatal Association of Kansas Conference Wichita, KS Life Course Perspective Friday, June 17, 2011 Janine Lewis, PhD(c), MPH Senior Associate, Practice Matters Executive Director, IL MCH Coalition

2. Overview Life Course Perspective MCH Life Course Continuum MCH Life Course Organizations NMPP MCH and Chronic Disease IMCHC

3. Socio-ecological framework

4. Life Course Model Life Course Model The mission of the Life Course Initiative is to reduce disparities in birth outcomes and change the health of the next generation in by achieving health equity, optimizing reproductive potential, and shifting the paradigm of the planning, delivery, and evaluation of maternal, child, and adolescent health services. Lu MC, Kotelchuck M, Hogan V, Jones L, Wright K, Halfon N. Closing the black-white gap in birth outcomes: A life-course approach. Ethn Dis. 2010;20(1 Suppl 2):S62-76.

5. A way of looking at life not as disconnected stages, but as an integrated continuum Suggests that a complex interplay of biological, behavioral, psychological, and social protective and risk factors contributes to health outcomes across the span of a persons 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. Life Course Perspective

6. 6 Early programming Early programming Experiences early in life can influence health and functions later in life Experiences early in life can influence health and functions later in life Developmental origins of health and disease Developmental origins of health and disease Timing (sensitive and critical period) and trajectory Timing (sensitive and critical period) and trajectory Cumulative pathways Cumulative pathways Accumulation of risks and insults can cause decline in health and functions over time Accumulation of risks and insults can cause decline in health and functions over time Life course chronic disease epidemiology Life course chronic disease epidemiology weathering (allostatic load) and pathway weathering (allostatic load) and pathway Life Course Perspective

7. 7 Life Course Theoretical Assumptions & Implications for MCH Practice Revised Role & Impact of Prenatal Care Revised Role & Impact of Prenatal Care Maternal Health Prior to Pregnancy is Key Maternal Health Prior to Pregnancy is Key It will Take More Than One Generation to Equalize Birth Disparities It will Take More Than One Generation to Equalize Birth Disparities Calls for Clinical & Public Health Interventions that are more Longitudinally and Contextually Integrated Calls for Clinical & Public Health Interventions that are more Longitudinally and Contextually Integrated Transition Must be Made from Strictly Clinical Approaches to Practice to Integrate a Social Determinants of Health Focus to Practice Transition Must be Made from Strictly Clinical Approaches to Practice to Integrate a Social Determinants of Health Focus to Practice

8. 8 The Life Course Perspective Lu MC, Halfon N. Racial and ethnic disparities in birth outcomes: a life-course perspective. Matern Child Health J. 2003;7:13-30.

9. 9 Life course perspective and social determinants Life course perspective and social determinants Life course theory offers an explanatory model for how social determinants influence health Life course theory offers an explanatory model for how social determinants influence health Life course perspective and health equity Life course perspective and health equity Life course theory offers an explanatory model for how health inequities develop Life course theory offers an explanatory model for how health inequities develop Life course perspective and life course health development Life course perspective and life course health development LCHD is an application of the life course theory to explain how health develops and declines over the life course LCHD is an application of the life course theory to explain how health develops and declines over the life course Life Course Perspective

10. 10 Traditional Perinatal Care Continuum Preconception Period antepartumpostpartum Interconceptional period Labor and Delivery Primary Care Preconception Counseling Prenatal Care Care throughout labor and delivery Well Child Care Postpartum Care

11. 11 New MCH Life Course Continuum Axis 1 Centering Pregnancy Child Abuse Prevention Latch- Key Program Managing Relationships Health Policy Activities Reproductive Social Capital Harlem Weight Watchers Internatal Care School Readiness Fitness & Health Activities Pregnancy Prevention Womens Health Protocol Depression Group Work Womens Health Protocol Perinatal Care UPKBeacon School College PrepPerinatal Care Reproductive Life Planning Specialty Care Harlem Birthing Center Early Head Start/ Head Start Health/ Life Stories Telling Preconception Inter- conceptional Care Chronic Disease Chronic Disease Management Chronic Disease Birth Early Child- hood Pre- Teen Teen Young Adult Women>35 Senior Citizens

12. 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. MCH Life Course Organization

13. 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. MCH Life Course Organization

14. Characteristics of a MCH Life Course Organization (LCO) Establishes an organizational structure. Builds programmatic capacity within the agency at each stage of a womans life course to manage her health over the life course (Axis 1). Swims upstream 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).

15. If unable to build internal capacity collaborates with outside agencies and systems to create an integrated system of care to manage a womans health. Characteristics of a MCH Life Course Organization

16. 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. Components of MCH LCO Organizational Structure Local Entity 501 ( c ) 3 Local State Government Coalitions/ Consortiums Leadership Strong Leadership/ Management Create a Culture of Leadership Cope with Complexity Strategist Build Relationships Sacrifice Capacity InternalCollaborative Integrated Systems Sustainability CoordinationFunding Quality Assurance Community Demand Comprehensive Strategy Multi-level Practice

18. 18 NMPP: Social Determinants of Health Axis Public Policy Initiatives Economic Empowerment Zone Supermarket Zone Expansion Policy NYC Affordable Housing Policy Community Environmental Impact St. Nick Tenant Organizing Food & Fitness Coalition Affording Housing Organizing Organizational Impact Healthy Start Consortium Diabetes Prevention Coalition Harlem Works Job Readiness Group/ Interpersonal Impact Centering Pregnancy Baby Mamas ClubConsumer Involvement Organization Individual Impact OB/GYN Medical Homes Case ManagementDepression Screening & Treatment

19. Northern Manhattan Perinatal Partnership The Northern Manhattan Perinatal Partnership, Inc. (NMPP) is a not-for-profit organization comprised of a network of public and private agencies, community residents, health organizations and local businesses. NMPP provides crucial services to women and children in Central, West and East Harlem and Washington Heights

20. Northern Manhattan Perinatal Partnership NMPPs mission is to save babies and help women take charge of their reproductive, social and economic lives. We achieve this mission by offering a number of programs that help reduce the infant mortality rate and increase the self-sufficiency of poor and working class women throughout the above communities

21. NMPP 1995 21

22. NMPP 2009

23. NMPPs Individual/Clinical Life Course Interventions Central Harlem Healthy Start Program Central Harlem Healthy Start Program Nurse Family Partnership, (NYCDOH/MH) Nurse Family Partnership, (NYCDOH/MH) Community Health Worker Program Community Health Worker Program Harlem Hospital Birthing Center Harlem Hospital Birthing Center St. Nicholas Child Welfare Preventive Program St. Nicholas Child Welfare Preventive Program Mankind Fatherhood Case Management Program Mankind Fatherhood Case Management Program Baby Steps Home Visiting Program (Healthy Families America Model) Baby Steps Home Visiting Program (Healthy Families America Model) TASA Cobra Case Management Program for Pregnant Teens

24. NMPPs Group/ Interpersonal Interventions Baby Mamas Club/Circulo de Mamas Depression Groups Baby Mamas Club/Circulo de Mamas Depression Groups Centering Pregnancy Centering Pregnancy Adolescent Pregnancy Prevention Team Adolescent Pregnancy Prevention Team Harlem Weight Watchers Program Harlem Weight Watchers Program CHHSs Consumer Involvement Organization CHHSs Consumer Involvement Organization

25. NMPPs Organizational Life Course Interventions 25 CHHS Consortium CHHS Consortium NYC Male Involvement Consortium NYC Male Involvement Consortium Comprehensive Prenatal/Perinatal Network Comprehensive Prenatal/Perinatal Network Harlem Child Welfare Network Harlem Child Welfare Network Casey Powerful Families Training Program Casey Powerful Families Training Program Harlem Health Promotion Center Harlem Health Promotion Center Sisterlink Coalition (CDC Funded) Sisterlink Coalition (CDC Funded)

26. NMPPs Community Environmental Life Course Interventions 26 NMPPs Harlem Works Job Readiness Program NMPPs Harlem Works Job Readiness Program NYC Breastfeeding Alliance NYC Breastfeeding Alliance Harlem Strategic Action Committee Harlem Strategic Action Committee ABC Asthma Coalition ABC Asthma Coalition Start-Right Immunization Coalition Start-Right Immunization Coalition St. Nicholas Houses Community Organizing Project St. Nicholas Houses Community Organizing Project

27. NMPPs Public Policy Life Course Interventions Federation of County Networks Federation of County Networks Harlem Food & Fitness Consortium Harlem Food & Fitness Consortium Citywide Coalition to End Infant Mortality Citywide Coalition to End Infant Mortality Manhattan Regional Perinatal Forum Manhattan Regional Perinatal Forum NMPPs BBKH Diabetes Coalition NMPPs BBKH Diabetes Coalition

28. 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.

29. Central Harlem Infant Mortality Rate September 13, 2006 Bureau of Vital Statistics New York City Department of Health and Mental Hygiene

30. Infant Deaths and Infant Mortality Rate by Health Center District of Residence New York City, 2001-2008 Health Center District 2001 IMR 2002 IMR 2003 IMR 2004 IMR 2005 IMR 2006 IMR 2007 IMR 2008 IMR New York City 6.16.06.56.16.05.98.15.5 Central Harlem 13.16.27.35.17.411.08.06.8 East Harlem 7.88.35.05.53.65.08.45.7 Washington Heights 5.54.27.35.94.53.82.83.7 January 2010- Bureau of Vital Statistics New York City Department of Health and Mental Hygiene

31. Central Harlem MCH Life Course Organization Birth Outcome Improvements 1990200420072008 Infant Mortality Rate 27.75.18.15.5 Low Birth Weight %19.511.110.88.9 First Trimester Prenatal Care Entry % 4889.592N/A

32. 32 Year 2002200320042005 Abuse/Neglect Reports 1574135412001208 Number of Children In Reports 2478203218551846 Abuse/Neglect Indication Rates 45.0%39.4%37.9%45.9% Number of Children in Indicated Reports 973649745885 Victimization Rates * 32.821.919.424.7 Number of Placements 449285228192 Number of Children Placed 447279220192 Number of Families Placed 288198161146 Placement Rate ** 15.19.67.46.5 Selected Child Welfare Trends, Central Harlem 2002-2005 Victimization Rate is the number of children with indicated abuse/neglect per thousand youth 17 and under in the population. is the number of children placed into foster care per 100o youth 17 and under in the population. Source: NYC Administration for Childrens Services: Office of Management Analysis

33. Other Best Practices: Municipal and State Health Departments Alameda County Public Health Department Life Course Initiative: Life Course Bill of Rights Life Span Health Services: Indiana and Nebraska DOH Integration of early childhood, perinatal and interconceptional care programs managed across the life course in 1 Division Family Wellness: Department of Human Services, Illinois

34. Illinois Maternal & Child Health Coalition Healthy Mothers, Healthy Babies Illinois Affiliate: created in 1988 (incorporated in 1989) Promote community empowerment through advocacy, policy development, consumer and professional education IMCHCs main objectives are directed to overcome critical barriers, such as poverty and racism, that prevent achievement of maternal & child wellness. Statewide, membership-based coalition: Approximately 160 members IL Maternal & Child Health Coalition

35. Illinois Maternal and Child Health Coalition Resources Our Projects: Campaign to Save Our Babies Chicago Area Immunization Campaign Illinois Coalition for School Health Centers Illinois Premature Infant Health Network www.ilmaternal.org Become a fan on Facebook! Follow us on Twitter at ILMaternal!

36. Illinois Maternal & Child Health Coalition Campaign to Save Our Mothers and Babies Awareness Mass media campaign – Closing the Gap Text4Baby Education Importance of prenatal care/medical home Primary/secondary prevention – educational classes with teen females at Robeson High School/Teamwork Englewood Partnerships with CDPH, Healthy Start, block clubs, faith-based organizations, FQHCs Advocacy Budget issues - federal and state Health care reform Comprehensive sexual health education

37. 37 Public Policy Initiatives Advocacy efforts: Immunizations, Comprehensive sex education Education of Legislators on Premature Birth Community/ Environmental Impact Public Awareness Campaigns: Immunization/Infant Mortality Collaborative efforts with CPD, CPS, CBOS Organizational Impact Campaign to Save Our Mothers and Babies Coalition for School Health Centers Group/ Interpersonal Impact Sisters Making a ChangeYouth Advisory Council Individual Impact Individual conversations Informational outlets: Webinars, newsletters IMCHC: Social Determinants of Health Axis

38. 38 Linking Women to Health, Power and Love Across the Life Span

39. Life Course Approach to Womens Health Assessment Tool- Washington, D.C Social Determinants of Health Public Policy Initiatives Community/ Environmental Organizational Group/ Interpersonal Individual BirthEarly Childhood Pre-teensTeensYoung AdultWomen 35 Seniors

40. "The journey of a thousand miles starts with a single step." Lao Tzu

41. Acknowledgements Mario Drummonds, MS, LCSW, MBA Executive Director/CEO Northern Manhattan Perinatal Partnership, Inc. Tamara Wrenn, MA, CCE, CIMT, CWC Senior Consultant, Practice Matters Brenda Jones, DHSc, MSN, WHNP-C Consultant, Practice Matters

42. For more information: Janine Lewis, MPH, PhD(c) 708-261-7564 jlewis6@gmail.com