240588 Can a place-based investment improve child health and development? Early implementation lessons from the Best Start LA Evaluation

Wednesday, November 2, 2011

Ian Hill, MPA, MSW , Health Policy Center, The Urban Institute, Washington, DC
Sarah Benatar, PhD , The Urban Institute, Washington, DC
Fiona Adams, BA , Health Policy Center, The Urban Institute, Washington, DC
Heather Sandstrom, PhD , Center on Labor, Human Services and Population, The Urban Institute, Washington, DC
Best Start LA's goal is to increase the number of children who achieve optimal health and development through home visiting for mothers of infants, community mobilization, and development of family-friendly community services. Our five-year evaluation of this “place-based initiative” employs qualitative and quantitative methods, including case studies of implementation, focus groups, a longitudinal household survey, and analysis of secondary community data, to assess whether the initiative improves child/family functioning, and expands community capacity to support families. Results will inform the development of Best Start LA initiatives in 13 other Los Angeles communities.

During year one, we interviewed 30 key informants during a multi-day site visit, and conducted focus groups with parents receiving home visiting, home visitors, and community members. Findings suggest that home visiting to high-risk mothers is benefiting the health and developmental potential of children. More than 700 parents of newborns received multiple home visits from nurses and college-educated “parent coaches,” and parents received education in breastfeeding, child health and development, parenting, home and environmental safety, and community resources. Focus groups indicated that mothers highly valued the service, formed strong bonds with coaches, and perceived improved breast feeding and parenting skills.

Community-level components of the initiative have been slower to take hold. Engaging community members, resolving tensions between community providers, and coordinating multiple out-of-sync contract schedules have all challenged the launch of place-based strategies designed to develop family-friendly communities and systems.

Household survey results in future years of the evaluation will provide definitive quantitative evidence of the intervention's impacts.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs

Learning Objectives:
Describe a place-based initiative designed to improve child/family health and development, and community capacity. Identify challenges to community mobilization and the development of community-based family support strategies. Evaluate the impacts of place-based strategies through qualitative methods.

Keywords: Child Health, Community Development

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Principal Investigator of the evaluation that is the subject of the abstract, and I possess over 20 years conducting evaluations of public health initiatives.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.