5. 12-Point Plan Framework
5
Adapted from “12-Point Plan to Close the Black-White Gap in Birth
Outcomes: A Life Course Approach” by Lu, Kotelchuck, Hogan, Jones,
Wright, & Halfron
6. Perinatal Health Strategic Plan
•Objective
• To address improving infant mortality, maternal
mortality, maternal morbidity, and the health
status of men and women of childbearing age
•Goal 1
• Improve the health care for women
•Goal 2
• Strengthen families and communities
•Goal 3
• Addressing social and economic inequities
6
8. 8
MethodsData Collection
•Created a user-friendly guide of the
Perinatal Health Strategic Plan
•Gathered feedback from key
stakeholders and community members
through Key Informant Interviews and
Focus Groups
•Derived themes from data by analyzing
feedback according to alignment with the
Plan
10. 10
MethodsData Collection – Focus Groups
•Focus Groups
•Goal 1 -Forsyth County
•Goal 2 -Lee County
•Goal 3 -Edgecombe-Nash Counties
11. 11
MethodsData Collection – Focus Groups
Questions
1.What about this goal excites you the
most?
2.What is already happening in your
community that aligns with this goal?
3.What do you see being the most
challenging to address within this goal?
4.Which points would you like to see
happen in your community?
12. 12
MethodsData Collection – Key Informant Interviews
•Key Informant Interviews
•Government Public Health Employees
•Other Government Employees
•Non-Profit Organization Executives
•Academic Researchers
•Faith Leaders
13. 13
MethodsData Collection – Key Informant Interviews
Questions
1.Are you doing any work that is similar to work
outlined in this plan?
2.How do you or your organization see yourself
fitting into these goals and points?
3.If you were not held back by funding, staff,
regulations, etc., what strategies and action
steps would you add to those points?
4. What barriers would hold you back from
accomplishing this?
18. 18
Results
Summary of Goals Being Addressed
• Goal 1
• Government-funded MCH Programs
• Examples: Be Smart, Young Moms Connect, Baby
Love Plus, Healthy Start, SisterLove, Federally-
Quality Health Centers
• Goal 2
• Community Programs
• Examples: Triple P, The Male’s Place, StriveNC
• Goal 3
• Community Activities
• Examples: Research on health disparities, Faith-
based donations for families in need
23. 23
Preconception HealthGoal 1 – Point 2
• Challenges to address:
• Community concerns about safety of Long-Acting Reversible
Contraceptives (LARCs) and other forms of birth control
• Community Suggestions:
• Create teen centers to comfortably discuss health issues
• Partner local health department and local colleges together to
assist with Preconception Peer Education (PPE) programs
• Life Planning
• Integrate life planning into all current state-funded programs
• Create health-focused curriculum that teaches
preconception health and life planning in high school
• Create a centering program for Family Planning
24. 24
Breastfeeding
“I breastfed but I had to stop because I
work third shift and it’s hard to get a
hold of HR just to get a private room…
and the bathrooms are nasty.”
25. 25
Breastfeeding
Goal 1 – Point 3
•Community Suggestions:
• Increase awareness about the pros of breastfeeding
to businesses and work places
• Increase support for breastfeeding after discharge
(e.g. home visits)
• Giving businesses incentives for being
breastfeeding-friendly
• Educate women and men to eliminate stigma around
breastfeeding
26. 26
Medicaid
“Medicaid does not always fully
support our women”
“We need support for transitioning
from Medicaid for Pregnant Women to
full Medicaid.”
27. 27
MedicaidGoal 1 – Point 4
•Challenges to address:
• Longer care for mothers after delivery
• Coverage transition from MPW to full Medicaid
• Termination of coverage if not requesting child
support (even in the cases of domestic violence)
•Community Suggestions:
• Expand Medicaid
•One-payer system with preconception and
perinatal health
28. 28
Physician Education
“Our doctors live in a money-driven
culture; they should be asking moms
about things like vitamins, what’s
going on in life, is your body healing
well?”
29. 29
Physician Education
Goal 1 – Cross-cutting
•Challenges to address:
• Disconnect between medicine and preventative
care
•Community Suggestions:
• Create consistent birth plans for patients
• Establishing empathy with their patients (ex. Being
late to appointments)
• Integrate Positive Parenting Program (Triple P) into
well-child visits
• Hiring health educators in private practices
32. 32
Fatherhood Inclusion
“Father-friendly waiting areas are
needed. We could have car magazines
in waiting rooms, men and women on
posters… We say we want fathers
involved but what are we really
doing?”
33. 33
Fatherhood Inclusion
Goal 2 – Point 5
•Community Suggestions:
•Have father-inclusive medical visits
•Add fatherhood components to existing
programs
•Example: Adding a subcommittee to
advisory councils
34. 34
Community Collaboration
“Stop duplicating, start working
together.”
“Bring the top leaders at the state
together to learn about what each
other does. Start at the state and work
down the chain to the community.”
35. 35
Community Collaboration
Goal 2 – Point 6
•Community Suggestions:
• Create a database of services provided within the
state for referrals and resources
• Partnering with local Area Health Education Centers
(AHECs) to create yearly workshops on Life Planning
•Potential Partnerships:
• Engage college students to work within the plan
• Partner with diversity programs
• Partner with Black Nurses Association, Old North
State Medical Society, and Maya Angelou Center for
Health Equity
36. 36
Transportation
“Our county is very rural. There is no
public transportation. This is a major
barrier to health.”
“Transportation is an ongoing issue for
many programs – especially
transporting children.”
37. 37
Transportation
Goal 2 – Point 8
•Challenges to address:
• Limitations on getting to care for children and
non-Medicaid patients
• Limitations on getting to educational
opportunities
•Community Suggestions:
• Partner with faith-based organizations and other
non-profits to provide transportation to medical
care
41. 41
Education
Goal 3 – Point 9
•Community Suggestions:
• Begin college preparation earlier in schools
• Provide more money to low-performing schools
• Provide racially-inclusive curriculums to instill
confidence in minority students
•Program Suggestions:
• Create outreach program to increase language and
literacy skills of students who have fallen behind
• Hire caseworkers and tutors to assist with students
academically at-risk
• Create courses on how to fill out Free Application for
Federal Student Aid (FAFSA)
42. 42
Poverty
“Investing in teaching communities
how to be sustainable is the only work
that will eliminate health disparities and
achieve health equity. For example,
farming could alleviate unemployment
within the black community and supply
the community with fresh foods to
promote health.”
43. 43
Poverty
Goal 3 – Point 10
•Community Suggestions:
• Provide land and other necessary resources for
minority communities to cultivate their own food
• Improve housing assistance programs to teach
participants homeownership
•Program Suggestions:
• Develop programs that will help families develop
strategic plans to end their individual poverty
44. 44
Parental Leave and Child Care
“We must increase time off for
mothers. They should not be required
to use sick and vacation time.”
“My son is 5 years old and I am still
making up for the time I took off during
my maternity leave.”
45. 45
Parental Leave and Child Care
Goal 3 – Point 11
•Challenges to address:
• Mothers having to use vacation and sick leave
as maternity leave
•Community Suggestions:
• Provide businesses with incentives for paid parental
leave and in-house childcare
• Increase subsidized child care programs and public
preschool programs
46. 46
Racial Equity
“The biggest barrier in doing the work
we all intend on doing is White
Supremacy. We use ‘Black faces’
instead of ‘Black leadership’ and call it
diversity.”
47. 47
Racial Equity
Goal 3 – Point 12
•Community Suggestions:
• Mandate racial equity trainings for the state and all
entities that receive state funding immediately after
hiring
• Require on-going Anti-Racism certifications
• Create an analysis of discriminating practices (past
and present)
• Emphasize the importance of representation in all
institutions
• Create more diverse hiring practices for leadership
positions
49. 49
Cross-Cutting Issues
“We must be personable and invested
in patients’ lives.”
“We need support for women who
have substance addictions; Women
are afraid to seek help due to legal
repercussions.”
50. 50
Cross-Cutting Issues
“Education isn’t sinking in for pregnancy
and STI’s even though it’s on TV and all
over. We need money for advertising. There
is no budget outlined for media, so we can’t
promote ourselves at the Health
Department. We have a new fatherhood
coordinator, but the community doesn’t
know about them because of the difficulty in
getting the word out…”
51. 51
Cross-Cutting Issues
Additional Results
•Areas to strengthen:
• Mental Health
• Substance Use and Misuse
• Domestic Violence
•Outreach:
• Going where the consumers are
• Department of Social Services, Walmart
• Investing in marketing and promotion
• Frameworks Software, Media Advertisements
53. Barriers
•Funding and training – “We have workforce
needs in rural areas.”
•Short-staffed – “We would like to go back to
Centering for prenatal care, but are short-
staffed.”
•Miseducation and Fear – “Many see LARCs
as a form of sterilization and do not understand
risk factors”
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54. Barriers
•Participation– “We should provide incentives
such as a point system for rewards, use
athletes or celebrities for promotional purposes,
centered around the interests of participants,
and have a welcoming group name.”
•Transportation – “It takes 40 minutes to get
from one side of the county to a clinic and
those rural areas have the lowest SES”
•Not Enough Time – “Doctors average seeing a
patient for 8 minutes.”
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55. Barriers
•Lack of coordination – “In public health,
we have an application and knowledge
gap.”
•Federal regulations – “HIPAA makes it
challenging to create a system to connect
services provided amongst agencies for
referrals and resources.”
•White Supremacy – “There is a lack of
trust between minorities and institutions.”
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