1. Cheri Pies, MSW, DrPH Padmini Parthasarathy, MPH Family, Maternal and Child Health Programs Contra Costa Health Services A Life Course Approach to MCH Epidemiology: Practice and Policy

2. Overview Who we are What we have been doing What we have struggled with Where we are going (we hope!)

3. Where is Contra Costa County?

4. Contra Costa Demographics Population is increasing in size –As of January 2007: 1,042,341 –Increase of 29.7% since 1990 and 9.9% since 2000. –Will increase by an additional 3.2% by 2010 and 18.7% by 2020 19.6% of Contra Costa residents live below 200% of the poverty line

5. Racial/Ethnic Makeup of Contra Costa County, 2005 & 2050

6. The Life Course Initiative 15-year initiative Engaging MCH Program and other county staff, as well as community partners Reducing health disparities overall Improving reproductive potential New way of working in MCH

7. Why we are doing this Paradigm shift Changing the health of a generation

8. Current Life Course Epi Activities Regular meetings of a Life Course Initiative Data Team Survey of Family, Maternal and Child Health Programs staff –Evaluated staff understanding of Life Course Perspective –Gathered ideas from staff about incorporating the Life Course Perspective into their work

9. Current Life Course Epi Activities, cont. Identifying “intermediate outcomes” as measurements of success of Life Course-related activities (vs. long-term perinatal outcomes) Examples of intermediate outcomes (for clients): –Improved life skills/coping skills –Improved sense of well-being, empowerment, resiliency, self-efficacy –Increased bonding response to infants –Decreased stress –Improved financial stability

10. Challenges Selecting which factors to measure and determining whether they in fact impact birth outcomes (i.e. racism, poverty, neighborhood characteristics, health outcomes) Measuring factors over time Lack of local information for many measures Difficulty in identifying the appropriate measures for evaluating policy and system changes

11. Challenges, cont. Often policy change has to precede behavior change Local health departments and other local agencies are not research settings and may not have the epidemiological capacity to do this kind of work

12. The Life Course Perspective in Practice Preconception care for middle school-age youth: After-school groups for girls and boys –Health education –Reproductive life planning –Skills-building –Peer leadership –Links to school-based health services –Parent involvement and education

13. Discussion Questions What measures should we use to evaluate the success of this project from a Life Course Perspective? How would we obtain this information?

14. What would success look like?

15. Session Discussion Questions What would we do differently if the Life Course Perspective were our current paradigm? How do we measure the changes, if any, of this paradigm shift in the reduction of racial/ethnic disparities in birth outcomes? What infrastructure changes would be needed to implement and measure the outcomes of Life Course intervention strategies? What are the next steps?