To describe the efforts of a community-based maternal and child health coalition to integrate the life course into its planning and programs, as well as implementation challenges and results of these activities. Jacksonville-Duval County has historically had infant mortality rates that are significantly higher than state and national rates, particularly among its African American population. In an effort to address this disparity, the Northeast Florida Healthy Start Coalition embraced the life course approach as a model. This model was adopted as a framework for (1) community needs assessment and planning; (2) delivery of direct services, including case management, education and support in the Magnolia Project, its federal Healthy Start program; (3) development of community collaborations, education and awareness; and, (4) advocacy and grass roots leadership development. Implementation experience as well as challenges in transforming traditional approaches to delivering maternal and child health services are described. Operationalizing the life course approach required the Coalition to think differently about risks, levels of intervention and the way services are organized and delivered. The organization set the stage by using the life course as a framework for its required local planning and needs assessments. Based on these assessments, the content of case management and other key services provided by our federal Healthy Start program was modified to address not only health behaviors but also underlying social determinants and community factors. Individual interventions were augmented with group activities to build interdependence among participants, increasing social capital. More meaningful inter-agency collaboration that moved beyond the usual referral relationships were developed to better address participants’ needs. And finally, strategies to cultivate participant advocacy and community leadership skills, were implemented to promote social change at the neighborhood-level. Transforming traditional approaches to delivering maternal and child health services and sustaining change is a long and laborious process. The Coalition has taken the first steps; but its efforts are far from complete. Based on the agency’s initial implementation experience, three areas presented particular challenges: staff, resources and evaluation. The life course is an important addition to the MCH toolbox. Community-based MCH programs should assess how a life course approach can be incorporated into existing programs to broaden their focus, and, potentially, their impact on health disparities and birth outcomes. Some areas to consider include planning and needs assessment, direct service delivery, inter-agency collaboration, and community leadership development. Continued disparities for people of color, despite medical advances, demand new interventions that purposefully address social inequities and promote advocacy among groups that bear a disproportionate burden of infant mortality. Successful transformation of current approaches requires investment in staff training to garner buy-in, flexible resources and the development of new metrics to measure the impact of the life course approach on individual and programmatic outcomes.
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Lu, M., Kotelchuck, M., Hogan, V., Jones, L., Wright, K., & Halfon, N. (2010). Closing the black–white gap in birth outcomes: A life course approach. Ethnicity and Disease, 20(1 Suppl 2), S62–S76.
Lu, M., & Halfon, N. (2003). Racial and ethnic disparities in birth outcomes: A life-course perspective. Maternal and Child Health Journal, 7(1), 13–30.
Robert Wood Johnson Foundation. (2008). Overcoming obstacles to health. Princeton: Robert Wood Johnson Foundation.
Pies, C., Parthasarathy, P., Kotelchuck, M., & Lu, M. (2009). Making a paradigm shift in maternal and child health: A report on the national MCH life course meeting. Martinez: Contra Costa Health Services.
Fine, A., & Kotelchuck, M. (2010) Rethinking MCH: The life course model as an organizing framework. U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau.
Florida Department of Health (2009). Healthy start standards and guidelines. Retrieved from: http://www.doh.state.fl.us/family/mch/hs/hstraining/hstraining.html.
Florida Department of Health (2011). Healthy start prenatal and infant executive summaries—Duval County. Retrieved from: http://www.doh.state.fl.us/planning_eval/phstats/intro.htm. Access password protected.
Peck, M. G., Sappenfield, W. M., & Skala, J. (2010). Perinatal periods of risk: A community approach for using data to improve women and infants’ health. Maternal and Child Health Journal, 14(6), 864–874.
National Fetal and Infant Mortality Review Program (2008). Fetal and infant mortality review manual: A guide for communities, 2nd Edn. Retrieved from: http://www.nfimr.org/site/assets/docs/FIMR%20Manual.pdf.
Livingood, W. C., Brady, C., Pierce, K., Atrash, H., Hou, T., & Bryant, T., 3rd. (2010). Impact of pre-conception care: Evaluation of a social determinants focused intervention. Maternal and Child Health Journal, 14(3), 382–391. Epub 2009 Aug 7.
Biermann, J., Dunlop, A. L., Brady, C., et al. (2006). Promising practices in preconception care for women at risk for poor health and pregnancy outcomes. Maternal and Child Health Journal, 10(5 Suppl), S21–S28.
Will, J. A., Hall, I., Cheney, T., & Driscoll, M. (2006). Flower power: Assessing the impact of the Magnolia Project on reducing poor birth outcomes in an at-risk neighborhood. Journal of Applied Social/Social Practice, 22(2/7), 2–15.
Jacksonville Community Council, Inc. (2008). Infant mortality study: A report to the citizens of Jacksonville. Accessed at http://www.jcci.org/jcciwebsite/documents/08%20infant%20mortality.pdf.
Pies, C., Parthasarathy, P., & Posner, S. F. (2012). Integrating the life course perspective into a local maternal and child health program. Maternal and Child Health Journal, 16(3), 649–655.
Northeast Florida Healthy Start Coalition, Inc. (2008). Healthy start service delivery plan: A life course approach to improving the health of mothers, babies, families and communities. Accessed at: http://nefhealthystart.org/wordpress/wp-content/uploads/2011/02/Healthy_Start_Service_Delivery_Plan_2009-14.pdf.
Schindler Rising, S., Powell Kennedy, H., & Klima, C. S. (2004). Redesigning prenatal care through centering pregnancy. Journal of Midwifery and Women’s Health, 49, 398–404.
Will, J., Hall, I., Cheney, T., & Slappe, J. (2012). The Camellia Project: 2011-12 annual report. Northeast Florida Center for Community Initiatives, Department of Sociology, University of North Florida.
Kiresuk, T., Smith, A., & Cardillo, J. (Eds.). (1994). Goal attainment scaling: Applications, theory, and measurement. Hillsdale, NJ: Lawrence Erlbaum Associates.
Northeast Florida Healthy Start Coalition, Inc. (2009). Consumer education and awareness campaign. Accessed at: http://nefhealthystart.org/community-initiatives/community-education-awareness-campaign.
Bryant, T. 3rd (2010). Black infant health community council social marketing campaign evaluation. Institute for Public Health Informatics and Research, Duval County Health Department.
Community voice: Taking it to the people. Accessed May 30, 2012 at http://www.communityvoiceprogram.org.
The University of Arizona, Cooperative Extension Service. Arizona Community Training. Accessed at: http://cals.arizona.edu/act.
People’s Institute for Survival and Beyond. Undoing racism workshop. Accessed at: http://www.pisab.org.
Pestronk, R. M., & Franks, M. L. (2003). A partnership to reduce African American infant mortality in Genesee County, Michigan. Public Health Reports, 118(4), 324–335.
Hogan, V. J., Rowley, D., Bennett, T., & Taylor K. D. (2011). Life course, social determinants, and health inequities: Toward a national plan for achieving health equity for African American infants—a concept paper. Maternal and Child Health Journal (Epub Jul 7).
Bandura, A. (1977). Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191–215.
Wallston, K. A., Wallston, B. S., & DeVellis, R. (1978) Development of the multidimensional health locus of control (MHLC) scales. Health Education and Behavior (6/1)1:160–170.
Support for the community engagement and education activities of the Coalition was provided by the Chartrand Foundation and the Community Foundation of Jacksonville. The Magnolia Project is funded by the U.S. Department of Health and Human Services, Health Resources & Services Administration, Maternal and Child Health Bureau (H49MC00051). The Coalition is funded by the Florida Department of Health.
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Brady, C., Johnson, F. Integrating the Life Course into MCH Service Delivery: From Theory to Practice. Matern Child Health J 18, 380–388 (2014). https://doi.org/10.1007/s10995-013-1242-9
- Life course approach
- Social determinants
- Community-based MCH programs
- Health disparities
- Theory to practice