Facilitators of well-functioning consortia: national Healthy Start program lessons

Building Cross-Institutional Collaborative Infrastructure and Processes: Early Lessons From the Chicago Cancer Health Equity Collaborative

BACKGROUND

Addressing cancer health disparities requires a multitiered, comprehensive approach. The Chicago Cancer Health Equity Collaborative (ChicagoCHEC) was established as a tri-institutional partnership to advance cancer health equity through scientific discovery, education, and community engagement.

OBJECTIVES

Large-scale partnerships rarely document the challenges encountered when establishing processes and operations in the formative years of engagement. We outline selected lessons learned from the first three years of ChicagoCHEC in hopes that future collaborations may be better poised to hit the ground running and create the needed infrastructure for a strong, effective, and sustainable partnership.

LESSONS LEARNED

Unifying a diverse group of stakeholders under a shared mission is imperative. A shared governance structure, in which all individuals understand the aims of partnership and can facilitate progress, is crucial for success. Ongoing monitoring of collaborative processes should occur and attention should be given to the optimization of communications.

CONCLUSIONS

Large-scale collaborative research and education projects across institutions can be challenging, particularly when establishing a working infrastructure and aligning priorities. However, the benefit of establishing key processes in the early years of the collaborative process can lead to high-quality research output, impact, and a sustainable partnership.

Use of Comparative Case Study Methodology for US Public Health Policy Analysis: A Review

CONTEXT

There is growing recognition that policies influence population health, highlighting the need for evidence to inform future policy development and reform.

OBJECTIVES

This review describes how comparative case study methodology has been applied to public health policy research and discusses the methodology's potential to contribute to this evidence.

METHODS

English-language, peer-reviewed articles published between 1995 and 2012 were sought from 4 databases. Articles were included if they described comparative case studies addressing US public health policy. Two researchers independently assessed the 20 articles meeting review criteria.

MAIN OUTCOME MEASURES

Case-related characteristics and research design tactics utilized to minimize threats to reliability and validity, such as the use of multiple sources of evidence and a case study protocol, were extracted from each article.

RESULTS

Although comparative case study methodology has been used to analyze a range of public health policies at all stages and levels, articles reported an average use of only 3.65 (out of 10) research design tactics.

CONCLUSION

By expanding the use of accepted research design tactics, public health policy researchers can contribute to expanding the evidence needed to advance health-promoting policies.

Pregnancy and birth outcome improvements for American Indians in the Healthy Start project of the Inter-Tribal Council of Michigan, 1998-2008

American Indians living in Michigan experience disproportionately high rates of infant mortality. This 11-year (1998-2008) cohort study evaluated impacts of a Healthy Start (HS) program administered by the Inter-Tribal Council of Michigan (ITCM) on perinatal outcomes. Women who enrolled in ITCM's HS program ("exposed") were compared with non-enrolled ("unexposed") for four outcomes: low birth weight (LBW), small for gestational age, preterm birth, and inadequate prenatal care. To classify exposed and unexposed women and their children, Michigan vital records data were linked with HS enrollment records to identify participants and non-participants among all American Indian births. Logistic regression was used to calculate odds ratios for the four outcomes of interest. Analyses were stratified for high and low access to care based on Medically Underserved Area (MUA) designation for a woman's county of residence. Of 4,149 American Indian births during the period, 872 were to women who enrolled prenatally in HS. Although unstratified analysis showed no differences between HS participants and non-participants, stratified analyses demonstrated that participants from MUA counties had decreased odds of LBW and inadequate prenatal care. Results suggest that in MUA counties where participants and non-participants are at similar risk for poor outcomes, HS may be reducing barriers and improving outcomes. In non-MUA counties participants had similar outcomes as non-participants. These results may reflect a wider disparity in risk factors between the two groups in non-MUA counties. The complex interplay among need, access, and benefit complicates analyses and suggests the importance of more in-depth and focused studies.

Integrating Assessment and Evaluation Into Partnership Initiatives

Communities nationwide have formed cross-sector partnerships to face the needs of an aging population, particularly for the purpose of improving long-term supportive service systems. Research is limited on how evaluation strategies are incorporated into partnership work, especially in the field of aging. This retrospective qualitative study reviewed administrative and key informant interview data to examine how 15 community partnerships (CPs) within the Community Partnerships for Older Adults (CPFOA) national program incorporated evaluation into their work. The four overarching lessons drawn from our inquiry suggest that effective CPs: (a) incorporate both formative and summative methods into evaluation, (b) use and develop the knowledge and skills of its members, (c) support flexible and creative evaluation methods and strategies, and (d) use internal and external resources to support evaluation efforts, particularly with nontraditional partners. There is a need for continued research to capture the methodological complexity of partnership evaluation.

Healthy start program participation: the consumers' perspective

In 1991, the federal Maternal and Child Health Bureau developed the Healthy Start Initiative as a comprehensive community-based program to eliminate the high rates of poor pregnancy outcomes among women of color. To date, few studies of the programmatic outcomes of this Initiative have examined the views of Healthy Start consumers. To understand the benefits of Healthy Start from their consumers' perspective, the Pittsburgh Allegheny County Healthy Start project conducted a survey of 202 of their Healthy Start participants in 2003. The participants completing the survey reported benefits of participating in the program including stress reduction, receiving resources and referrals, and consistent social support of program staff. According to the project's annual statistics, Healthy Start has improved pregnancy outcomes among African American women participants in the Pittsburgh community. However, and according to these participants, the quality of staff and consumer connectedness, availability and consistency of material resources, and social support are as critical as more traditional health interventions to their satisfaction, motivation to participate, and willingness to refer others to the program. Women of color will often forego health services perceived as intimidating and/or culturally insensitive, but programs such as the Healthy Start Initiative offer a critical link that encourages participation and, as a result, improves maternal and child health status.

Community-based perinatal depression services for African American women: the healthy start model

A variety of factors place African American women at risk for depression. Unfortunately, a behavioral health system insensitive to these women's needs exacerbates their risk. Recent reports recommended that mental health services be accessible and acceptable to women of color and include comprehensive, culturally appropriate case management. The federal Healthy Start Initiative, a national maternal and child health program to reduce infant mortality and low birth weight, is an often-overlooked resource for responding to perinatal depression among African American women. Pittsburgh/Allegheny and Fayette County Healthy Start, Inc., offers a case example of the Healthy Start model to address depression.