Moving Theory to Practice: The Life
Course Theory and the MCAH Maternal
Health Framework
Connie Mitchell, MD, MPH
Branch Chief,
Policy Development
Karen Ramstrom, DO, MSPH
Branch Chief,
Program Standards
Maternal, Child and Adolescent Health Division
MCAH Action Education Day
May 18, 2011
MCAH Maternal Health Team
Shabbir Ahmad, DVM, PhD
Michael Curtis, PhD
Chris Krawczyk, PhD
Elizabeth Lawton, MHS
Flojaune Griffin, PhD, MPH
CDPH-MCAH
Connie Mitchell, MD, MPH
Karen Ramstrom, DO, MSPH
Leona Shields, RN
Zhiwei Yu, MPH
Melanie Estarziau, MPH
Chris Borges, MA
MCAH Action Education Day
May 19, 2011
Learning Objectives
The participant will be able to:
• Describe the theoretical constructs behind the
development of the MCAH Maternal Health
Framework, in particular the Life Course Theory
and the Social Ecology Model;
• Apply the MCAH Maternal Health Framework to
assess local program activities across the life
course;
• Identify gaps and opportunities for agency or
community action using the Life Course
perspective.
CDPH-MCAH
MCAH Action Education Day
May 19, 2011
CA MCAH and the Life Course
• MCAH embraces MCH Bureau lead in
applying Life Course Theory to shape
MCH public health practice in the 21st
century
– Links population science and medical science
to promote health
– Focuses on health equity and social
determinants of health
CDPH-MCAH
MCAH Action Education Day
May 19, 2011
Women’s Reproductive Health:
A Life Course Approach
Infant Health
And Infant
Care
Maternity
Care
Conception
Child/Adolescent
Health &
Health Care
Labor
And
Delivery
Child/Adolescent
Health &
Health Care
Women’s Health &
Health Care
Preconception/Interconception
Women’s Health and Health Care
Interventions Across the Lifespan
CDPH-MCAH
MCAH Action Education Day
May 19, 2011
Guiding theoretical constructs for
Maternal Health Framework
• Focus on public health prevention
• Organized around the social ecology
model
• Incorporating the life course perspective
CDPH-MCAH
MCAH Action Education Day
May 19, 2011
Public Health Prevention
• Primary: action taken so that the disease
or harmful event never occurs
• Secondary: action taken so that the
disease or harmful event occurs, it is
detected early and harm arrested.
• Tertiary: action taken so that if the
disease or harmful event occurs, it can be
stabilized, rehabilitated and overall impact
minimized.
CDPH-MCAH
MCAH Action Education Day
May 19, 2011
Social Ecology Model
Individual
(Personal
History)
Community Sociocultural
Family or
Relationships (Exosystem)
Milieu
(Macrosystem)
(Microsystem)
CDPH-MCAH
MCAH Action Education Day
May 19, 2011
Maternal Health Framework I:
Linking Public Health Prevention & Social Ecology Model
Prevention
Primary
Secondary
Tertiary
Soc Ecology
Individual
Family/
Relationships
Community
Sociocultural
Milieu
CDPH-MCAH
MCAH Action Education Day
May 19, 2011
Maternal Health Framework II:
Linking Public Health Prevention & Social Ecology Model
PLUS Life Course
Prevention
I. Maximize II. Maintain
+Life Course health prior
health during
Model to pregnancy pregnancy
Social
Ecology Model
III. Address
health issues
that arise in
pregnancy
A. Individual
B. Family/
Support Sys
C. Community
D. Social Milieu
CDPH-MCAH
MCAH Action Education Day
May 19, 2011
Maternal Health Framework III :
Contributing factors for maternal health
Prevention + Maximize
Life Course Model health prior
Social Ecology
to pregnancy
Model
Maintain
health during
pregnancy
Address
health issues
that arise in
pregnancy
Individual
Basic health literacy
Non-smoker
Appropriate wt gain
Self Care for GDM
Family/
Support Sys
Has a primary
support person
Safe home
Birthing and
parenting classes
Bereavement
support if needed
Community
Access to fresh
fruits and vegs
School based sex &
relationship ed
Access to prenatal
care & education
Occupational safety
standards in preg
OB emergency drills
and protocols
OB QI efforts
Social Milieu
Access to family
Legal protections for
Regs to support
planning services
maternity leave
regionalized levels
CDPH-MCAH
MCAH
Low levels
of Action Education Day May 19, 2011of maternity care
poverty
State PAMR review
Maternal Health Framework IV – How
did MCAH programs fit the framework?
Prevention +
Life Course Model
Maximize health prior
to pregnancy
Maintain health
during pregnancy
Address health
issues that arise in
pregnancy
Preconception Care
AFLP PYD, BIH
BIH, AFLP, CPSP
MQI trends
maternal morbidity
BIH, AFLP
SIDS bereavement
Soc Ecology Model
Individual
Family/ Support Sys
Community
Interconception Care
Toolkit
LAMH ED<39W
toolkit
SB LAMH
CPSP
CMQCC toolkit to
improve health
response to OB
hemorrhage.
RPPC, CDAPP
LA LAMH
Social Milieu
Preconception Health
Council
CPSP statutes
CA-PAMR statutes
CDPH-MCAH
MCAH Action Education Day
May 19, 2011
Roundtable Group Exercise
• Where do your programs or
initiatives fit in? Are there
gaps?
• Where are there opportunities
for common ground with
community partners ~ to be
strategic, leverage resources,
15 minute
roundtables
eliminate redundancy?
• Can we utilize the Life Course
15 minute group
to better communicate the
discussion –
share your “aha’s”
value of MCAH?
CDPH-MCAH
MCAH Action Education Day
May 19, 2011
Maternal Health Framework IV – How
did MCAH programs fit the framework?
Prevention +
Life Course Model
Maximize health
prior to
pregnancy
Maintain health
during pregnancy
Address health
issues that arise
in pregnancy
Soc Ecology Model
Individual
Family/
Support Sys
Community
Social Milieu
CDPH-MCAH
MCAH Action Education Day
May 19, 2011
Results/Conclusions
• The Maternal Health Framework is a helpful
visual tool for deconstructing the multiple levels
of determinants of health over time;
• The Maternal Health Framework is an example
of implementation science, namely moving from
Life Course Theory to MCAH public health
practice;
• The Maternal Health Framework identified gaps
in implementation that can direct future
development.
CDPH-MCAH
MCAH Action Education Day
May 19, 2011