Enhancing the Capacity of Local Health Departments to Address Birth Equity: The Institute for Equity in Birth Outcomes.

INTRODUCTION: Significant and persistent racial and ethnic disparities exist related to infant mortality and other birth outcomes. Few models exist that aim to prepare organizations to implement essential features, such as community engagement or intervening on social determinants of health. METHODS: Between 2013 and 2015, teams from seven local health departments participated in the Institute for Equity in Birth Outcomes (EI) with the goals of building capacity and implementing changes to address equity in birth outcomes. Four of the teams enrolled in the first cohort (2013-2015), and three enrolled in cohort two (2014-2015). To examine the EI effort and its impact on capacity and implementation of changes, two types of assessments were completed. Capacities of the teams in specific key areas were assessed using "Best Change Process" instruments at the completion of participation in the EI. Teams also documented on an ongoing basis implementation of interventions. The data were analyzed using descriptive statistics and Pearson Correlation tests. RESULTS: Best Change Process capacity scores were higher in the first cohort than in the second and were highly correlated with implementation of changes (Pearson's Correlation = 0.838, p = 0.037). Collectively, the teams implemented about 32 new programs, policies, practices, and systems changes aimed at addressing equity in birth outcomes. Most interventions were based on scientific recommendations and local epidemiologic data. DISCUSSION: The results of the study suggest the EI is a promising approach that may result in strong capacity and ability to implement interventions aimed at addressing equity in birth outcomes.

Assessing the Development of Collective Impact Initiatives Addressing Maternal and Child Health.

PURPOSE: To examine the extent to which communities participating in the Collective Impact Learning Collaborative (CILC) increased capacity to create conditions for collective impact (CI) to address racial disparities in maternal and child health (MCH) and align local efforts with state MCH priorities over a 12-month period. DESCRIPTION: Eight communities participated in a learning collaborative that involved the provision of technical assistance via webinars, monthly team calls, and site visits to facilitate the development of a collective impact initiative. A Ready-Set-Go approach to technical assistance was used to guide the communities through each phase of development while also providing individual assistance to teams based on their capacity at the start of participation. ASSESSMENT: A pre/post design measured change in capacity to engage in CI efforts over time. A survey designed to assess the completion of core tasks related to early indicators of CI was completed at baseline and 12 months later. Wilcoxon Signed Ranks Test and Mann-Whitney test determined statistically significant progress towards outcomes over 12 months and differences in progress between high- and low- capacity teams. CONCLUSION: In 12 months, teams with little established groundwork made significant progress, in some ways exceeding progress of more established teams. Statistically significant progress was achieved in eleven of fourteen outcomes measured. Five teams aligned local efforts with state priorities after 12 months. Findings suggest technical assistance to establish conditions for collective impact can support progress even when pre-conditions for collective impact are not previously established.

The Well-Woman Project: Listening to Women's Voices.

Purpose: The U.S. Affordable Care Act (ACA) of 2010 included the Well-Woman Visit (WWV) as one of the preventive services, which must be covered without cost sharing. Despite concerted efforts to increase access to the WWV, data from the early years of the ACA demonstrated ongoing barriers, including insufficient consumer and provider awareness of the ACA's no cost-sharing provision for preventive services. As such, 2 years after full implementation of the ACA, the Well-Woman Project (WWP) used qualitative methods to learn about women's perceptions of the WWV and barriers that affect their ability to be healthy and seek well-woman care. Methods: Women's voices were captured by Listening Sessions in eight cities and through stories from women across the United States posted to a WWP Website, or reported over a WWP toll-free phone line. Thematic analysis of Listening Sessions and stories was conducted using Dedoose software. Results: In 2016, Listening Sessions (17) were held with 156 women; in addition, stories were collected from 102 women across the United States. Women are aware of the importance of preventive care, but report multiple barriers to seeking such care. However, they are able to articulate a variety of system and policy strategies that mitigate the complexity of navigating the health care system; help women prioritize their health and accessing health care; promote positive relationships with providers; empower women to advocate for themselves and others; promote positive mental health as well as access to safe environments, healthy food, and social support systems; decrease barriers related to lack of transportation and childcare; and support the provision of trauma informed care in the health care delivery system. Conclusion: To improve women's health status and reduce inequities, making the preventive well-care visit available without cost-sharing is necessary, but not a sufficient strategy.