Padmini Parthasarathy, MPH

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Applying the Life Course Perspective in a Local
MCAH Program

• Padmini Parthasarathy, MPH
• Cheri Pies, MSW, DrPH
• Family, Maternal and Child
• Health Programs, Contra Costa Health Services

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Acknowledgements

• Drs. Michael Lu and Neal Halfon, UCLA
• Dr. Paula Braveman, UCSF
• Contra Costa Health Services
• Cheri Pies, Director, FMCH Programs
• Chuck McKetney, Epidemiologist
• Debbie Casanova, Evaluator
• Dawn Dailey, Program Manager

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Overview

• The Life Course Perspective
• Health Equity and Social Determinants of Health
• Life Course Game
• Contra Costa Life Course Initiative
• Our Road Map
• Our First Destination Building Economic
  Security Today (BEST)

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Life Course Perspective

• 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

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Percent of Mothers who Received Early Prenatal
Care, by Race/Ethnicity, Contra Costa, 2004-2006
Source Contra Costa Countys Automated Vital
Statistics System (AVSS)
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Rate of Low Birth Weight Births (per 100 live
births), by Race/Ethnicity, Contra Costa,
2002-2004
Source California Department of Health Services,
Birth Statistical Master Files, 2002-2004
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Infant Mortality Rate (per 1,000 live births), by
Race/Ethnicity, Contra Costa, 2003-2005
Source California Department of Health Services,
Birth Statistical Master Files and Death
Statistical Master Files, 2002-2004
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The Life Course Perspective(Lu and Halfon, 2003)
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Key Concepts

• Early Programming
• Cumulative Pathways

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Latina Paradox

• Latinas living in the United States but born
  abroad have birth outcomes similar to White women
• Birth outcomes worsen with each following
  generation

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Disparity, Inequality,or Inequity?

• HEALTH DISPARITY INEQUALITY difference in the
  health status of two groups
• HEALTH INEQUITY systematic and unjust
  differences in the distribution of illness and
  disease differences are unnecessary and
  avoidable
• Not all inequalities are unjust, but all
  inequities are the product of unjust
  inequalities.

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Social Advantage and Health Across Lifetimes and
Generations
Prepared for the Robert Wood Johnson Foundation
by the Center on Social Disparities in Health at
the University of California, San Francisco.
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The Life Course Game
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The Life Course Initiative

• Launched in 2005
• A 15-year initiative
• Based on the Life Course Perspective and a
  12-Point Plan to close the Black-White gap in
  birth outcomes

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Life Course Initiative Goals

• Reduce health disparities and health inequities
• Optimize reproductive potential
• Create a paradigm shift in MCH work

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Life Course Initiative Goals

• To change the health of a generation

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Life Course Initiative Activities

• Staff education
• Laying the groundwork with higher- level
  management
• Interconception care
• Evaluation
• Developing a new intervention

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Evaluation

• Established Life Course Initiative Data Team,
  which meets regularly
• Conducted survey of Family, Maternal and Child
  Health Programs staff
• Identifying intermediate outcomes as
  measurements of success of Life Course-related
  activities (vs. long-term perinatal outcomes)

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Our Road MapA 12-Point Plan

• To close the Black-White gap in birth outcomes
• Goes beyond prenatal care
• Goes beyond individual-level interventions
• Goes beyond the medical model

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Our Road Map A 12-Point Plan

• 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 life course

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Our Road Map A 12-Point Plan

• 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

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Our Road Map A 12-Point Plan

• Close the education gap
• Reduce poverty
• Support working mothers and families

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Our Road Map A 12-Point Plan

• Undo racism

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Our First Destination

• Increased financial security and stability and
  improved financial status

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Building Economic Security Today (BEST)

• Asset development pilot project
• Reduce disparities and inequities in health
  outcomes by improving financial security and
  stability
• Home visiting programs WIC

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How does BEST fit intothe 12-Point Plan?

• Reduce poverty
• Support working mothers and families

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Generational Financial Fitness

• Children learn about how to manage money from
  their parents
• Financial education for parents now ? financial
  stability in next generation

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Project Activities

• Life Course Data Team Evaluation Plan
• Staff trainings
• Unnatural Causes
• Applying for grants
• Partnerships
• Developing home visiting and WIC interventions

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Intermediate Outcomes

• Staff
• Increased knowledge
• Improved skills
• New practices

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Intermediate Outcomes

• Clients
• Increased knowledge
• Improved ability
• Adopt at least one asset development strategy

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Intermediate Outcomes

• System
• Stronger community partnerships
• More supportive health and human services system
• Integration of asset development strategies into
  FMCH Programs infrastructure
• BEST project development documentation

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Long-Term Outcomes

• Family income for daily living maximized
• Preservation of and increase in financial assets
• Increased financial security and stability, and
  improved financial status
• Increased access to care, improved housing,
  better neighborhoods, increased food security,
  decreased violence, etc.
• Improved health outcomes and financial status
• for future generations

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Challenges

• Making paradigm shift and gaining staff buy-in is
  a slow process
• Addressing financial status and security
  sensitively
• Learning and integrating many new concepts
• Time and financial resources
• Measuring success

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Lessons Learned

• Flexible timeline in order to accommodate program
  priorities
• Opportunities to collaborate with new partners
• Develop evaluation plan while developing program
  interventions
• Unique approach re-energizes both staff and
  community partners

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What will success look like?
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For More Information

• Padmini Parthasarathy
• 925-313-6178
• pparthas_at_hsd.cccounty.us