Lessons Learned from Positive Deviant Local Health Departments in Maternal and Child Health

Local health departments (LHDs) are under increasing pressure to improve performance with limited resources. While research has found that financial resources may be associated with better health outcomes, there are some LHDs that maintain exceptional performance, even with limited budgets.Our objective was to identify and learn from LHDs in WA, FL and NY in communities that have better than expected maternal and child health (MCH) outcomes compared to peers – positive deviants. We used data from the Public Health Activities and Services Tracking database as a resource for identifying positive deviant LHDs in MCH outcomes in terms of county-level rates of teen births, late or no prenatal care, infant mortality, and the percent of low weight births. We developed a semi-structured interview protocol divided into 3 focus areas: assessment and policy development, research and evaluation, and regulatory oversight. To date, we have collected primary data through 30 hour-long phone interviews with LHD identified staff [n= 7 (70%) in WA; n=18 (75%) in FL; n=5 (31%) in NY]. We coded all data in Atlas.ti and conducted inductive thematic analysis to identify key themes across all PD LHDs. We describe our findings by overall theme as well as variations by LHD context (eg. rural, micro, metro).  Preliminary overarching themes found in the interviews included the importance of partnerships (community, school, internal) and clearly defined goals (direct services, population based, evidence-based). We found variations on themes by LHD context. Final results including data from additional interviews will be included in our presentation.