Core Approaches

Everything should be made as simple as possible, but no simpler.

Albert Einstein

Recommended Core Approaches for Improving Pregnancy and Birth Outcomes

These eight promising or proven core approaches have been identified through community assessment and input, and a review of the literature. They are to be implemented by community-based, collaborative networks (Best Babies Collaboratives).

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

Policy and Advocacy Institutional and public policy can have a broad influence on local birth outcomes. The objective of policy and advocacy is to strengthen the capacity of the community to promote healthy births. LA Best Babies Network is the lead in developing a community-based perinatal health policy agenda.

Community Building Just as it takes a village to raise a child, it takes a community to promote healthy births. This strategy increases healthy births by strengthening the community's infrastructure, shifting societal norms, and expanding social capital.

Health Education and Messaging Health education is the primary means of discouraging risky behaviors and promoting healthy ones, during pregnancy, and interconception. Most prenatal health education takes place during prenatal doctor visits. The goal here is to expand health education to multiple channels and  levels. The Healthy Births Initiative seeks to change not just individual behaviors, but interpersonal ones (between partners, families, and peers), community and social norms, institutional practices (within worksites and healthcare systems), public awareness, and public policy.

Successful health education interventions have the following characteristics:

  • They are grounded in scientific theory.
  • They are capable of reaching the target population, and the target population is capable of attaining the desired outcomes.
  • They communicate via multiple channels.
  • They are guided by formative research.
  • They are developed and implemented in partnership with the community.
  • Core content is dictated by community-identified priorities (e.g. nutrition, stress, teen pregnancy-prevention), as well as scientific evidence.

Social Support Stress and mental health have been identified as priorities in several regions of LA County, and a growing body of scientific literature links psychosocial stress to adverse birth outcomes, particularly preterm birth and low birthweight. The goal of this approach is to promote healthy births and interconception health through psychosocial support for pregnant and parenting women, men, and families.

This calls for a three-pronged approach:

  1. Strengthening the capacity of partners and families to provide psychosocial support (e.g. male involvement programs, family resource centers).
  2. Building community support and social capital related to reproductive health (e.g. support groups and changing social norms).
  3. Enhancing systems-capacity to provide case management and home visitation.


Prenatal Care Quality Improvement
Prenatal care is accessed by a high percentage of women in LA County, and therefore remains the most common intervention for improving birth outcomes. This approach is designed to improve the quality and content of prenatal care, by helping providers to adopt a set of standard, evidence-based, and nationally recommended Clinical Practice Guidelines, and to carry them out in a culturally competent fashion.

Below are the core components of prenatal care with established, evidence-based best practice standards. In addtion, care and health information should be delivered with senstitivty to cultural and linguistic needs.

  PDF  Version Breastfeeding Promotion and Support
  PDF  Version Case Management/Home Visitations
  PDF  Version Community Outreach
  PDF  Version Cultural Competency
  PDF  Version Domestic Violence/Intimate Partner Violence
  PDF  Version Family Resource Centers
  PDF  Version Health Education and Health Messaging
  PDF  Version Interconception Care
  PDF  Version Involving Fathers
  PDF  Version Legislative Advocacy
  PDF  Version Maternal Stress
  PDF  Version Prenatal Care Quality Improvement
  PDF  Version Smoking/Tobacco Use
  PDF  Version Substance Abuse

 

The Breakthrough Series (BTS) has been identified as the most promising model for bringing about rapid, prenatal care-quality improvement. BTS is a collaborative system that improves care at the individual, community, and institutional level. Its goal is to rapidly change systems in order 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 chronic illnesses, such as diabetes, heart disease, and asthma, and is easily and effectively applied to the care of pregnant women.

Implementation brings together 10 to 15 teams of clinical providers and staff. Each team is trained in the BTS techniques for integrating rapid quality improvement cycles, the components of organizational and systems change, the content and principles of standard, evidence-based clinical guidelines, and cultural competency. Teams become part of a collaborative, and over the course of 18 months, share outcomes and lessons learned with each other.

Interconception Care Women who have had a poor birth outcome are at increased risk for a reccurence. The goal of this approach is to reduce adverse birth outcomes by providing interconception care for women who have:

  • Given birth to a preterm or Very Low Birthweight baby.
  • Suffered a fetal loss or infant death.
  • Had a pregnancy affected by preventable congenital anomalies.
  • Given birth as an adolescent.

The core components of interconception care are

  1. risk assessmet
  2. health promotion
  3. medical and psychosocial interventions
  4. outreach and case management.

Best practice standards have been established for each component, and a toolkit developed for implementing interconception care.

Outreach Access to prenatal care has been identified as a priority throughout the County. The goal of this approach is to increase access to prenatal and interconception care for at-risk women and families. Several local and national evidence-based best practice models have been identified, and a brief has been developed for implementing outreach activities.

Case Management Case managers connect pregnant and parenting women and families to the services they need. There are a number of existing effective, local and national evidence-based best practice models, including the Nurse Family Partnership (the Olds Model), which begins in pregnancy, and has professional, home-visiting public health nurses visit a family for two and a half years, and the Healthy Start program which employs both professional and lay workers as case managers.