Project Abstract
Healthy Start of Southern Oregon – Eliminating Disparities in Perinatal Health
Grantee Organization
Project Location
Number of Participants served per year
Project Start Date
Project End Date
Project Funding
Health Care Coalition of Southern Oregon
Josephine, Douglas, Jackson Counties
500
September 1, 2014
May 31, 2019
$750,000 per year
The purpose of Healthy Start of Southern Oregon is to reduce disparities in infant
mortality, reduce adverse perinatal health outcomes, and improve a broad array of
perinatal health indicators, including birthweight, entry to pre-natal care, and number of
births to adolescents. This will be accomplished by using community-based approaches
to service delivery, and facilitating access to comprehensive health and social services for
women, infants, and their families who live in rural areas of Southern Oregon. Healthy
Start of Southern Oregon will target women and families at critical or sensitive periods in
the lifespan, where there is heightened opportunity to build or strengthen health including
the following periods: preconception, interconception, pregnancy, early childhood, and
early parenthood.
The project, located in rural Southern Oregon, will contract with Public Health
Departments, safety-net Community Health Centers, and other community agencies in
Jackson, Josephine and Douglas Counties to provide outreach, case management and
service coordination to 500 women residing in the rural areas of these counties. Outreach
activities will identify and recruit high-risk women and families in specific communities,
defined by zip code boundaries, that experience elevated infant mortality rates arising as
the result of poverty and either rural or cultural isolation. Risk assessment and case
finding will identify needs and appropriate levels of service. Service coordination will
link families to medical homes, increase health insurance coverage, and support
preventive services for women before, during, and after pregnancy. Preventive services
will include screening for depression, substance use, and violence; childhood
developmental screening; trauma-informed practices; comprehensive health education
using evidence-based approaches; father engagement and fatherhood programming; and
parenting education. Ongoing quality improvement, performance monitoring and
evaluation will identify best practices and measure effectiveness.
In addition to providing essential service coordination and case management at the local
level, this project aims to drive collective impact and systems change at the regional
level. The applicant organization, Health Care Coalition of Southern Oregon, is a nonprofit organization that acts as the collaborative backbone organization for its member
agencies, Public Health Departments and safety-net Community Health Centers. Health
Care Coalition is well-positioned to serve as a catalyst for collective impact at the
broader, regional level, and will achieve this by working through Community Action
Networks, referred to as Perinatal and Early Childhood Collective Impact Networks
(PECIN).
These networks will support coordination, integration, and mutually
reinforcing activities among health, social services, and other providers and key leaders
in the community.
Intervention efforts will take into account that there are multiple levels of influence on
perinatal health behaviors and outcomes, and that many of the most important
determinants of perinatal outcomes predate pregnancy, and present outside of the clinical
domain. An individual’s health is influenced by not only genetic predisposition and
personal behaviors, but by a complex interplay of these biological determinants with
social and familial relationships, institutional and organizational factors, community
factors, and public policy. Healthy Start of Southern Oregon will use a life course
approach that combines a focus on the individual’s current conditions and biology, with a
whole-person, whole-family, whole-community systems approach. Its intervention efforts
to improve perinatal outcomes will address all of the following:

Individual or “downstream” level factors – Working directly with individuals and
with individual behaviors, by doing individual case management with high-risk
women, including risk assessment; development of care plans and case
management; and linkage to appropriate services.

Population-based or “mainstream” level factors – Working at the population level
with Public Health Departments and Community Health Centers to increase
access to medical care; implement universal screening and other preventive
clinical practices for earlier detection of risk, and earlier intervention; assure that
essential maternal and child health (MCH) services are available in the
community; provide linkages and systems coordination; monitor and assess MCH
services; and gather community-wide data.

Policy and social change or “upstream” level factors – Working at the regional
community-wide level with a Perinatal and Early Childhood Collective Impact
Network (PECIN) to enhance community capacity; to create multi-sector
coordination and linkage (vertical, horizontal and longitudinal) within and
beyond the health care system; and to create collective impact to increase health
equity and affect the social determinants of health.
Healthy Start of Southern Oregon will work at the individual, community, and regional
levels, to link and integrate health systems across the life span and across generations,
maximizing individual and community protective factors, and minimizing risks. While
achieving high quality health care is critical, achieving optimal lifelong health goes
beyond medical/clinical practice, goes beyond current public health practice, and requires
a strategic agenda for change by working at the policy and systems level.
The ultimate outcome of this project will be collective impact activities that go beyond
interventions aimed at changing individual behavior or providing treatment to individuals
for specific conditions, to changing environments, and impacting root cause social
determinants of health.