Leveraging an Academic-Practice Partnership to Improve Maternal and Child Health Outcomes in North Carolina

Abstract

L ocal health departments (LHDs) play a central role in providing maternal and child health services in the public health system and are increasingly collaborating with academic institutions to advance evidence-based public health [1-3]. Academic-practice partnerships typically represent a formal affiliation between an academic institution and a public health practice organization [4]. Luo and colleagues estimated that 82.4% of LHDs engaged in partnerships (ie, networking, coordinating, cooperating, collaborating) to advance maternal and child health, however, only 27.4% of these partnerships represented collaborations [5]. There is a need to understand how LHDs successfully leverage partnerships to advance evidence-based maternal and child health [5]. In an effort to improve birth and child health outcomes, the North Carolina General Assembly legislated recurring funding in the amount of $2,500,000 (Session Law 2015-241) to invest in evidence-based programs shown to reduce infant mortality and improve birth and health outcomes for children from birth to 5 years of age [6]. In fiscal year 2016, the North Carolina Division of Public Health (DPH) launched the Improving Community Outcomes for Maternal and Child Health (ICO4MCH) program establishing an academic-practice partnership between the University of North Carolina at Chapel Hill (UNC) Gillings School of Global Public Health, DPH, and LHDs to improve birth and child health outcomes. This paper describes the implementation of a maternal and child health program in North Carolina using a collective impact framework, the principles of implementation science, and a health equity approach to address adverse birth and child health outcomes. It presents lessons learned from leveraging existing relationships to develop and sustain an academic-practice partnership that strengthened implementation. Methods The ICO4MCH Program The ICO4MCH program is housed in the Women's and Children's Health Section of DPH. The program was designed to address 3 overarching aims: 1) improve birth outcomes, 2) reduce infant mortality, and 3) improve the health of children from birth to 5 years. The evidence-based strategies (EBSs) from which the grantees could select to address the 3 program aims included:

Using the Wilder Collaboration Factors Inventory to Strengthen Collaborations for Improving Maternal and Child Health

“…To reduce infant mortality, two teams implemented a tobacco reduction intervention; the other three supported breastfeeding. To improve children's health, two teams addressed secondhand smoke exposure; two implemented parenting programs, and another implemented both a parenting program and nurse home visiting (Morgan et al 2020).…”

“…Funders increasingly require collaboration toward sustainable improvement (Gillam et al 2016). One such example has been Improving Community Outcomes for Maternal and Child Health (ICO4MCH), funded by the North Carolina General Assembly (Morgan et al 2020). ICO4MCH began with 2-year funding cycles, the first being June 1, 2016-May 31, 2018, from the state Division of Public Health to five local health departments with a combined service area of 14 counties.…”

Collective Impact Partnership and Backbone Organizations as Enablers of Children’s Well-Being

“…Improving specifically the health of children or their parents (oral health, maternal and child health, chronic disease prevention, early childhood development) was the objective for the following partnerships reported by Grumbach et al 2017 2020, and Morgan et al (2020). Some of these healthfocused CI initiatives' stated goal was to reduce health-or developmental disparities among minorities (Grumbach et al 2017;Wilk and Cooke 2015).…”

“…Some of these healthfocused CI initiatives' stated goal was to reduce health-or developmental disparities among minorities (Grumbach et al 2017;Wilk and Cooke 2015). Within these articles, partnerships varied and included local professionals such as local health departments (e.g., Morgan et al 2020), but also, for example, experts outside the community giving lectures on the health-related topic that was relevant to the local community (Wilk and Cooke 2015). One report included a description of the specific "site-coordinator" who was actively searching for collaborative partners among local health service providers (Wilk and Cooke 2015).…”

“…For some CI initiatives, an executive committee consisting of representatives of the participating organizations took on the role of the backbone organization (e.g., Blake-Lamb et al 2018) while in other multiregional CI initiatives backbone support was organized locally with added support provided by a university team across regions functioning as an academic practice partnership (e.g., , Morgan et al 2020. In one CI initiative, a multiagent management group (MMG) including leaders from all relevant sectors, such as social and health services, education, early childhood education, local NGOs, and the churches and also supported by a private consultant, was acting as the initiatives backbone.…”