Moving Theory to Practice: The Life Course Theory and the MCAH Maternal Health Framework Connie Mitchell, MD, MPH Branch Chief, Policy Development Karen Ramstrom, DO, MSPH Branch Chief, Program Standards Maternal, Child and Adolescent Health Division MCAH Action Education Day May 18, 2011 MCAH Maternal Health Team Shabbir Ahmad, DVM, PhD Michael Curtis, PhD Chris Krawczyk, PhD Elizabeth Lawton, MHS Flojaune Griffin, PhD, MPH CDPH-MCAH Connie Mitchell, MD, MPH Karen Ramstrom, DO, MSPH Leona Shields, RN
Zhiwei Yu, MPH Melanie Estarziau, MPH Chris Borges, MA MCAH Action Education Day May 19, 2011 Learning Objectives The participant will be able to: Describe the theoretical constructs behind the development of the MCAH Maternal Health Framework, in particular the Life Course Theory and the Social Ecology Model; Apply the MCAH Maternal Health Framework to assess local program activities across the life course; Identify gaps and opportunities for agency or community action using the Life Course perspective. CDPH-MCAH MCAH Action Education Day May 19, 2011 CA MCAH and the Life Course
MCAH embraces MCH Bureau lead in applying Life Course Theory to shape MCH public health practice in the 21st century Links population science and medical science to promote health Focuses on health equity and social determinants of health CDPH-MCAH MCAH Action Education Day May 19, 2011 Womens Reproductive Health: A Life Course Approach Infant Health And Infant Care Maternity Care Child/Adolescent Health & Health Care
Pregnancy Conception Labor And Delivery Interconception Child/Adolescent Health & Health Care Womens Health & Health Care Preconception/Interconception Womens Health and Health Care Interventions Across the Lifespan CDPH-MCAH MCAH Action Education Day May 19, 2011 Guiding theoretical constructs for Maternal Health Framework
Focus on public health prevention Organized around the social ecology model Incorporating the life course perspective CDPH-MCAH MCAH Action Education Day May 19, 2011 Public Health Prevention Primary: action taken so that the disease or harmful event never occurs Secondary: action taken so that the disease or harmful event occurs, it is detected early and harm arrested. Tertiary: action taken so that if the disease or harmful event occurs, it can be stabilized, rehabilitated and overall impact minimized. CDPH-MCAH MCAH Action Education Day May 19, 2011 Social Ecology Model
Individual (Personal History) Community Sociocultural Family or Relationships (Exosystem) Milieu (Microsystem) (Macrosystem) CDPH-MCAH MCAH Action Education Day May 19, 2011 Maternal Health Framework I: Linking Public Health Prevention & Social Ecology Model Prevention Primary Secondary Tertiary
Soc Ecology Individual Family/ Relationships Community Sociocultural Milieu CDPH-MCAH MCAH Action Education Day May 19, 2011 Maternal Health Framework II: Linking Public Health Prevention & Social Ecology Model PLUS Life Course Prevention +Life Course Model Social Ecology Model I. Maximize II. Maintain health prior health during to pregnancy pregnancy III. Address
health issues that arise in pregnancy A. Individual B. Family/ Support Sys C. Community D. Social Milieu CDPH-MCAH MCAH Action Education Day May 19, 2011 Maternal Health Framework III : Contributing factors for maternal health Maximize Maintain health prior health during Life Course Model to pregnancy pregnancy Prevention + Social Ecology Model Address
health issues that arise in pregnancy Individual Basic health literacy Non-smoker Appropriate wt gain Self Care for GDM Family/ Support Sys Has a primary support person Safe home Birthing and parenting classes Bereavement support if needed Community
Access to fresh fruits and vegs School based sex & relationship ed Access to prenatal care & education Occupational safety standards in preg OB emergency drills and protocols OB QI efforts Social Milieu Access to family Legal protections for Regs to support planning services maternity leave regionalized levels Low levels of Action Education Day May 19, 2011of maternity care CDPH-MCAH MCAH poverty State PAMR review
Maternal Health Framework IV How did MCAH programs fit the framework? Prevention + Maximize health prior Life Course Model to pregnancy Maintain health during pregnancy Address health issues that arise in pregnancy BIH, AFLP, CPSP MQI trends maternal morbidity BIH, AFLP SIDS bereavement Soc Ecology Model Individual Preconception Care AFLP PYD, BIH
Family/ Support Sys Community Interconception Care Toolkit LAMH ED<39W toolkit SB LAMH CPSP CMQCC toolkit to improve health response to OB hemorrhage. RPPC, CDAPP LA LAMH Social Milieu Preconception Health Council CPSP statutes CA-PAMR statutes
CDPH-MCAH MCAH Action Education Day May 19, 2011 Roundtable Group Exercise Where do your programs or initiatives fit in? Are there gaps? Where are there opportunities for common ground with community 15 minute roundtables partners ~ to be strategic, leverage resources, 15 minute group eliminate redundancy? discussion share your ahas Can we utilize the Life CDPH-MCAH MCAH Action Education Day May 19, 2011 Course to better Maternal Health Framework IV How did MCAH programs fit the framework? Prevention +
Life Course Model Maximize health prior to pregnancy Maintain health during pregnancy Address health issues that arise in pregnancy Soc Ecology Model Individual Family/ Support Sys Community Social Milieu CDPH-MCAH MCAH Action Education Day May 19, 2011
Results/Conclusions The Maternal Health Framework is a helpful visual tool for deconstructing the multiple levels of determinants of health over time; The Maternal Health Framework is an example of implementation science, namely moving from Life Course Theory to MCAH public health practice; The Maternal Health Framework identified gaps in implementation that can direct future development. CDPH-MCAH MCAH Action Education Day May 19, 2011
