Accelerating Upstream Together
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In our Year 3 in Review, we reflected on HRSA/MCHB’s strategic paradigm “Accelerate Upstream Together”. Over the next few newsletters, we’ll take a deeper dive into what we’re doing at the LCIRN around each of these topics, and where we need your help to move the work forward!
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Accelerate means to work faster to improve maternal and child health outcomes and eliminate disparities. At the LCIRN we are approaching this in three ways.
1. Making the switch from describing to intervening.
As researchers, we want to understand as much as possible about the processes that lead to healthy development and the ways that they can get off track. While observational epidemiological studies are invaluable, multiple studies that describe, essentially, the same associations are of limited use, and at a certain point we have to stop describing and start intervening. Process studies are still a part of our research portfolio - but only with a view to developing an intervention that can bring about an improvement in health status at individual and population levels. Making this switch is not easy. Observational studies are quicker and frankly easier to perform. Planning, developing, designing, piloting and fielding a new intervention can take years, and can appear daunting to a new researcher whose research output is being closely monitored. Fortunately, we have senior investigators in the network who have experienced this path and are willing to provide mentorship to our scholars and junior researchers, as well as advocating for greater recognition of the work of intervention development in the faculty review process.
Join Us: Please consider advocating at your own institution for increased recognition of faculty effort in intervention development, especially interventions that are to be delivered in community settings and have a focus on health equity.
2. Funding Pilot Studies
The LCIRN has made a commitment to supporting pilot studies that hold real promise for the development of new approaches to interventions. These pilot studies are being conducted by our LCIRN node members, who are mid-level or senior researchers testing an intervention in preparation for applying for funding for a larger study; and by our LCIRN Scholars, a diverse group of more junior researchers most of whom are taking their first steps in intervention research. Scholar Keisha Wint, for example, is piloting an intervention designed to help preschool teachers support children when they grieve.
3. Stacking and Bundling Effective Interventions
This approach takes interventions that already have a strong evidence base and links them together through an integrated delivery system to a targeted population such that the overall impact is greater than that of any one intervention alone. Drs. Michael Msall and Susan Hintz are developing the “Success After Prematurity” node around this concept – identifying and scaffolding existing interventions, then filling in the gaps, to ensure that low-income families of preemies have access to the resources and interventions they need to give their children the best opportunities for development.
Bundled interventions may be particularly effective when they address social determinants of health – e.g., Dr. Adam Schickedanz, leader of the LCIRN Adversity, Adaptation and Resilience Node has been studying the impact of medical-financial partnerships as a way to improve child and family health. Mark Feinberg, leader of the Family Health Development Node is studying new ways to couple his evidence-based co-parenting intervention, Family Foundations, with financial coaching. Scroll down to read more about his study.
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Intervention Spotlight: Family Foundations + Financial Coaching
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We asked PI Mark Feinberg to give us an update on his new study which aims to combine the Family Foundations preventive intervention with a financial coaching intervention.
Overview of the intervention:
We have begun a line of work that seeks to mitigate disparities between low-income and wealthier parents and children by providing education and skills-based coaching to expectant, low-income parents in financial management and co-managing household and child-related financial matters. We are developing a new prevention approach by adapting and integrating two evidence-based models: (1) a model of financial education and coaching for low-income individuals deployed by Capital Good Fund, a Rhode Island-based non-profit working in six states; and (2) a preventive intervention developed at PSU that helps first-time parents build supportive coparenting relationships (Family Foundations; FF).
Why was this adaptation needed? How will it help to accelerate progress?
There is great potential synergy in integrating the two areas: Finances are a major source of conflict among couples, particularly low-income couples who already have a high level of financial instability. Financial strain and interparental conflict contribute to key factors that undermine children’s development and well-being: parental stress and depression, father disengagement, and harsh parenting. This innovative project will not only integrate financial education and coaching with support for positive, cooperative coparenting, but also develop new material that supports low-income parents in extending coparenting skills (communication, problem-solving, joint family management) to cooperation and coordination around financial responsibilities.
What makes this a life course intervention?
This approach is based in a life course health framework as financial strain and interparental conflict are linked risk factors for young children's development, affecting basic physiological and psychological self-regulatory capacities with implications for health throughout the lifespan.
What are the next steps?
To create the integrated program, we are first conducting qualitative interviews with racially/ethnically diverse, low-income parents to understand their experiences and concerns in the pregnancy and early childhood periods. We will then develop the adapted program, gain feedback on the new material from low-income parents, and finally conduct a pilot test to assess feasibility and generate data to support an NIH RO1 application for a randomized trial.
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Items of Interest
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The Health Impact of Evictions: authors Dana Goplerud, Kathryn Lefiheit, and Craig Evan Pollack explore ways in which eviction can be a traumatic experience for children, with potential for far-reaching consequences on health.
- Recordings from The Hasting’s Center Health Equity Summit are available online. Sessions included “The Political Determinants of Health”, “The Evidence Base for Health Equity”, “Addressing Health Inequities through Law and Policy”, and “Finding and Fixing Structural Barriers to Equitable Healthcare in the Clinic”
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Child Health and climate change: a scoping review and an expanded conceptual framework examines the evidence base for the potential impact of climate change on child health and well-being, identifying additional needs to study overlooked populations and geographic regions.
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Stress in Utero: COVID chaos and babies’ future health: Drawing on life course research, this article examines the ways in which the impacts of unusually high stress in utero might persist for decades in some US babies born during the pandemic.
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Reducing inequities in early childhood mental health: how might the neighborhood built environment help close the gap? A systematic search and critical review: This review examined relationships between aspects of the built environment and children’s mental health, concluding that the overall evidence supports an association between greater access to neighborhood green space and better mental health, but that most studies focused on mental health difficulties rather than pathways to optimal mental health.
- For a fascinating deep-dive on biological embedding across timescales, please check out the PNAS special feature on timing which is free online.
- The February 2022 issue of Health Affairs focuses on Racism and Health. Four overview articles orient the reader to the complex relationship between racism and health. Other articles provide new evidence, analysis, and narratives on the topic.
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This project is supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) under award UA6MC32492, the Life Course Intervention Research Network. The information, content, and/or conclusions are those of the author and should not be construed as the official position of, nor should any endorsements be inferred by HRSA, HHS, or the US Government. any endorsements be inferred by HRSA, HHS, or the US Government.
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