The Contra Costa Life Course Initiative:
Where We Have Been, and
Where We Are Going
Padmini Parthasarathy, MPH
Cheri Pies, MSW, DrPH
Family, Maternal and Child
Health Programs
Contra Costa Health Services
Overview
Staff education
A 12-Point Plan to
Close the Black-White
Gap in Birth
Outcomes
Evaluation
Challenges and
Questions
Staff Education Timeline
April 2005: Michael Lu presentation to all 250
FMCH Program staff
May 2005 – December 2006: Initial interactive
education sessions individual program staff
meetings
January 2007 – February 2008: Refresher sessions
Education sessions with community partners during
this time, as well
Staff Education Content
Theory of the Life
Course Perspective
Life Course Game
Life Course Initiative
activities
A 12-Point Plan
Integrating the Life
Course Perspective
into their work
 What are you currently
doing that fits with the
Life Course
Perspective?
 How can you integrate
the Life Course
Perspective into future
activities?
The Life Course Game
A 12-Point Plan…
To close the Black-White gap in birth outcomes
Developed by Michael Lu, M.D., MPH, et al.
Goals:
 Improve healthcare for African American women
 Strengthen African American families
 Reduce allostatic load on African American
women over the life course
A 12-Point Plan
How is this different from
current approaches?
Goes beyond prenatal care
Goes beyond individual-level
interventions
Goes beyond the medical
model
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)
Staff Survey
Evaluated staff
understanding of Life Course
Perspective (LCP)
Gathered ideas from staff
about incorporating the LCP
into their work
Survey sent to 107 FMCH
Programs staff
68 staff (64%) responded
Survey Questions
In your own words, how would you describe the
Life Course Perspective?
What are two concepts from the Life Course
Perspective and/or the 12-Point Plan that you
think relate to your work?
Have you changed anything about your public
health work as a result of learning about the Life
Course Perspective?
Survey Questions
How have you incorporated the Life Course
Perspective into your work?
What are the reasons that you have not
incorporated the Life Course Perspective into
your work?
What would you like to see us do in the future
with the Life Course Initiative?
Summary of Staff Survey Results
72% reported that they changed something about
their work as a result of learning about the LCP
Based on open-ended questions, we found that in
general, staff:
 understood the theory of the LCP;
 were able to relate their work to elements of the
12-Point Plan; and
 had incorporated the LCP into their work in a
variety of ways
Examples of Intermediate
Outcomes (For Clients)
Improved life skills/coping skills
Improved sense of well-being, empowerment,
resiliency, self-efficacy
Increased bonding response to infants
Decreased stress
Increase in financial security and stability
and improved financial status
Asset Development
Asset Accumulation
Asset Leveraging
Asset Preservation
Asset Creation
Asset Development
Asset Accumulation
 Banking services
 Financial education
– Credit management and counseling
– Budget development and money management
 Income tax assistance/tax credits, i.e. Earned
Income Tax Credit (EITC)
 Public benefit enrollment/eligibility
Building Economic Security Today
(BEST)
With Life Course Data Team, developed a logic
model for an asset development pilot project:
BEST
Hosting Family Economic Success and Security
training for 40 home visiting and WIC staff in
October 2008
Viewing and discussing Unnatural Causes
Applying for grant funding for training and project
from various sources
Building Economic Security Today
(BEST)
Specific asset development
strategies will vary based on
program and client
population
Partnering with:
 Contra Costa Family
Economic Security
Partnership (FESP)
 Earn It! Keep It! Save It!
 Community Financial
Resources (CFR)
– Prepaid debit card
BEST: Measuring Outcomes
Staff:
 Increased knowledge and awareness of asset
development strategies and resources
 Improved skills in engaging clients to adopt
asset development strategies
 New practices for implementing their
knowledge and skills about asset
development
BEST: Measuring Outcomes
Clients:
 Increased knowledge and awareness of asset
development
 Improved sense of self-efficacy and ability to
adopt an asset development strategy
 Each client will adopt at least one asset
development strategy to improve his or her
financial security, such as reducing debt,
obtaining their EITC, starting a savings account,
and utilizing a debit card
BEST: Measuring Outcomes
System:
 Changes will be made to help better support
clients in utilizing asset development
strategies
– resource and referral materials
– case management documentation systems
– financial education protocols and training
guidelines
How does BEST fit into
the 12-Point Plan?
9. Reduce poverty
10. Support working
mothers and
families
Challenges
Making paradigm shift
and gaining staff buy-in is
a slow process
Learning and integrating
many new concepts
Time and financial
resources
Measuring success
Questions for Thought
What infrastructure changes are needed to
implement and measure the outcomes of Life
Course Perspective-based intervention
strategies?
How do we measure the success of this
paradigm shift in the reduction of inequities in
MCAH outcomes?
What will success look like?