BBC Charge and Core Approaches

Recommended Core Approaches for Improving Pregnancy and Birth Outcomes

Based on the community assessment, literature review, and community input, the following proven or promising approaches are recommended for implementation through community-based, collaborative networks (Best Babies Collaboratives) to improve pregnancy and birth outcomes.

	1. Policy & Advocacy
	2. Community Building
	3. Health Education & Messaging
	4. Social Support
	5. Prenatal Care Quality Improvement
	6. Inter-conception Care
	7. Outreach
	8. Case Management

Policy and Advocacy – Institutional and public policy can have a profound impact on birth outcomes. The objective of this strategy is to strengthen local capacity to promote healthy births through policy and advocacy initiatives. The LA Best Babies Network takes the lead to develop a community based perinatal health policy agenda.

Community Building – Much as “it takes a village to raise a child”, it takes a community to promote healthy births. The goal of this strategy is to promote healthy births through increasing the community's infrastructure, changing societal norms and expanding the social capital in Los Angeles County . The Healthy Births Learning Collaboratives are envisioned as one mechanism through which the Healthy Births Initiative is undertaking Community Building .

Health Education and Messaging –Health education is the primary means for changing risk behaviors and promoting healthy behaviors during pregnancy and interconception. Presently much of the prenatal health education takes place at the prenatal visits. The goal is to expand the reach of health education through multiple channels at multiple levels. The aims of the Healthy Births Initiative are to change not only individual behaviors but also interpersonal (partners, families, and peers) support, community and social norms, institutional (worksite, health care systems) practices, and public awareness and public policy. Successful health education interventions are characterized by the following characteristics:

Grounded in scientific theory,
Capable of reaching the target population, and the target population is capable of reaching the desired outcomes,
Use of multiple channels,
Guided by formative research,
Developed and implemented with community partnership, and
Core content driven by community-identified priorities (e.g. nutrition, stress, teen pregnancy prevention) as well as scientific evidence.

Social Support –Stress and mental health were identified as a priority areas in several LA County regions, and a growing body of scientific literature links psychosocial stress to adverse birth outcomes, particularly preterm birth and LBW. The goal of this approach is to promote healthy births and interconception by providing psychosocial support to pregnant and parenting women, men and families. This approach calls for a multi-level approach, consisting of 1) strengthening the capacity of partners and families to provide psychosocial support (e.g. male involvement program, family resource center), 2) building community support and social capital related to reproductive health (e.g. support groups and changing social norms), and 3) enhancing systems capacity to provide case management and home visitation.

Prenatal Care Quality Improvement – Prenatal care remains the most widely used population-wide intervention for improving birth outcomes. The goal of this approach is to improve the quality and content of prenatal care by assisting providers to implement standard, evidence-based, and nationally recommended Clinical Practice Guidelines in culturally competent ways. Eight core components of prenatal care have been identified for which evidence-based best practice standards have been established; each practice standard must include cultural and linguistically appropriate practices and health information.

The components of prenatal care selected for focused improvement are:

Smoking cessation
Prenatal nutrition
Prenatal breast feeding education and support
Intimate partner violence
Maternal depression
Infection and Inflammation related to urinary and reproductive tract infections and periodontal disease
Substance use and abuse
Pre-gestational and Gestational Diabetes
Cultural competency

Additionally, the Breakthrough Series (BTS) has been identified as the single most promising methodology for bringing about prenatal care quality improvement. BTS is a collaborative healthcare quality improvement method that incorporates the basic elements for improving care in health systems at the individual, community, and institutional, levels. The goal of this model is to rapidly change the system through which prenatal care is provided to promote client centered, up-to-date clinical management through team care and community partnership.

The BTS has proven successful in improving the care and health of individuals with long term illnesses such as, diabetes, heart disease, and asthma and can easily and effectively be applied to caring for pregnant women*. Implementing this recommendation will bring together 10 to 15 teams of providers and staff trained in the BTS techniques for integrating rapid quality improvement cycles, the components of organizational and systems change, and the content and principles of standard evidence-based clinical guidelines and cultural competency. Teams will work collaboratively for one year to develop and share the plans that are implemented in their practices and their outcomes.

Interconception Care – Women with prior poor birth outcomes are at risk for having another poor birth outcome during their subsequent pregnancy. The goal of this approach is to reduce the recurrence of adverse birth outcomes by providing interconception care for women who have had a

prior early preterm or VLBW birth,
fetal or infant death,
pregnancy affected by preventable congenital anomalies, or
adolescent pregnancy.

The core components of interconception care consists of 1) risk assessment, 2) health promotion, 3) medical and psychosocial interventions, and 4) outreach and case management. Best practice standards have been established for each component, and a toolkit has been developed for implementing interconception care.

Outreach – Even if a system is in place to provide quality prenatal and interconception care to every pregnant and parenting woman and family in Los Angeles , it will have limited impact if women do not access prenatal/interconception care, particularly those at risk for poor birth outcomes. Prenatal care access has been identified as a priority across Los Angeles County . The goal of this approach is to improve access to prenatal and interconceptional care for at-risk women and families. Several local and national evidence-based best practice models have been identified, and an Outreach Brief has been developed for implementing outreach activities.

Case Management – The objective of case management is to connect pregnant and parenting women and families to the services they need. Similar to outreach, several effective local and national evidence-based best practice models have been developed, including the Nurse Family Partnership (the Olds Model) which begins in pregnancy and uses professional home-visiting public health nurses to follow families for two and one-half years, and the Healthy Start program which uses a combination of professional and lay workers to provide the case management.

Briefing documents on each Core Approach are available by clicking on the following link: www.LABestBabies.org/resources/publications.htm