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 Best Babies Zone: A Collaborative Initiative to Improve Birth Outcomes and Transform Communities

By Cheri Pies, MSW DrPH
Clinical Professor, MCH Program, DrPH Program, MSW/ MPH Concurrent and Dual Degree Programs, University of California Berkley School of Public Health

Carly Strouse, IBCLC
Co-Chair, Alameda Breastfeeding Coalition

Wendy Hussey, MPH
Assistant Director, Maternal & Child Health Program, University of California Berkeley

For several decades, interventions aimed at reducing infant mortality have focused on medical and technological innovations. Despite large investments in improving health care access and supportive services for families, mothers and babies, significant racial-ethnic and socioeconomic disparities in maternal and child health persist. A focus on the life course perspective and a return to some of our early roots in maternal and child health have taught us that opportunities to achieve better birth outcomes and improved health for all must begin where community residents live, work, learn and play. We know that tending to the range of social and environmental, as well as biological, aspects of people’s lives is essential to improving the quality of life in our communities. The Best Babies Zone (BBZ) Initiative, funded by the W.K. Kellogg Foundation, is a bold national multiyear, multi-sector endeavor focused on implementing strategies not only to improve access to quality health care, but also to align and transform educational, economic, and community systems in specific geographic areas.

The BBZ Initiative is currently working with local community groups in three cities – Cincinnati, OH; New Orleans, LA; and Oakland, CA – to develop, implement and evaluate a model for cross-sector collaboration to reduce infant mortality and improve birth and early childhood outcomes in specific geographic zones in these communities. Key national partners and leading MCH consultants are providing leadership and technical assistance for the Initiative. These partners include AMCHP, CityMatCH, and the National Healthy Start Association, as well as Milton Kotelchuck (evaluation), Mario Drummonds (development and sustainability), Lorraine Lathen (media and marketing strategy) and Amy Fine (place-based efforts and policy). By the end of our current three-year grant period (2012-2015), the work of these initial sites will serve as a blueprint for future BBZ site development and implementation in other cities around the United States. Our work includes working with community residents to identify a specific zone where change is needed and establishing a broad collaborative to work across four sectors – health, economic development, early care and education, and community systems – to achieve collective impact, and cultivating a public health social movement within the city and specifically the zone to address the social determinants of health.

While BBZ is currently focusing its efforts at the local level, we also are expanding our networks to include Title V agencies and state MCH programs. Title V agencies and state MCH programs play vital roles in policy and program development, and bridge important gaps between local MCH programs and federal efforts. The BBZ local sites need the support and experience of partnerships with Title V agencies and state representatives to advance a meaningful systems change approach to the social determinants of health. This means working with existing MCH programs to find opportunities for collaboration, coordination and consultation. As BBZ moves into the next phase of scaling up and working with more communities around the country, it will be imperative that we work in concert with state Title V and MCH program to achieve our shared outcomes and reach our shared goals. For the BBZ Initiative, this means that every baby born in a Best Babies Zone is born healthy into communities that enable them to thrive and reach their full potential. We look forward to working with our Title V and state MCH partners. Join us at the AMCHP meeting in January for a full report on where we are with BBZ, next steps for this work, and discussing specific strategies for building and implementing effective and essential partnerships with Title V and state MCH partners.

The Best Babies Zone Initiative represents a paradigm shift from traditional MCH approaches to improving infant, maternal and family health outcomes. Building on the lessons learned from National Healthy Start programs and others, our work within the three zones reminds us that improving community health must be a collaborative effort among community residents, community-based organizations, local businesses, schools, parks and recreation centers, transportation alliances, and more, as well as partners from our city, state and federal programs. Join us in our efforts to achieve community transformation to improve the health of all children for generations to come.

 

Highlights from the AMCHP July Meeting Connecting the Dots: A National Meeting on Improving Birth Outcomes

Full proceedings from the meeting will be available soon. In the meantime, here is a brief background and highlights from the meeting.

National momentum is growing to address stagnating declines in infant mortality and persistent disparities among populations within the United States. In recent years, there has been a rapid proliferation of initiatives aimed at improving birth outcomes. These activities use different mechanisms and are focused on risk factors or outcomes such as elective deliveries, preconception health or equity to improve birth outcomes including:

  • Bringing states together from the same region to share strategies, best practices and develop initiatives with measurable outcomes
  • Changing care financing
  • Implementing public awareness campaigns or quality improvement projects
  • Facilitating collaborative learning among states
  • Engaging communities in place-based programs

These initiatives present an important opportunity to assess how diverse stakeholders can meld, collaborate and coordinate effectively to maximize the impact of these efforts. In July 2013, with the support of the W.K. Kellogg Foundation, AMCHP convened 50 key leaders in maternal and child health (MCH) from across federal and state agencies and associations in Washington, DC.

During the meeting, these stakeholders discussed the multiple initiatives to improve birth outcomes and identify areas of connectivity and commonality and issues related to disconnect in coordination and implementation. Prior to the meeting, representatives reviewed the landscape of initiatives and existing national recommendations and guidance, including the January 2013 Recommendations for HHS Action and Framework for a National Strategy [to Reduce Infant Mortality] released by the Secretary’s Advisory Committee on Infant Mortality (SACIM).

The day-long meeting focused on five core areas for discussion: 1) eliminating racial and ethnic disparities, 2) access to preventive and primary care, 3) fostering partnerships and collective impact, 4) financing of services and supports, and 5) quality improvement.

Highlights of Key Take-Aways from the Meeting

  • Recognition of important momentum and opportunities (e.g., ACA) but concern for lack of national common vision among key groups
  • Need for more ‘implementation strategies’ and improved coordination among key groups
  • Need for redefining the postpartum period (e.g., provider reimbursement)
  • Need for development of benchmarks to better monitor access to care for all women, including women in non-Medicaid expansion states
  • Need for continuing to target resources on health disparities and health inequities