Case Study 7
Partnering for Improved Infant Health in Stanislaus County
Funding for this fact sheet was provided by the Centers for Disease Control and Prevention under Cooperative Agreement Numbers 5U38HM000449-02 and HM08-80502CONT09. The contents of this document are solely the responsibility of the National Association of County and City Health Officials (NACCHO) and do not necessarily represent the official views of the sponsor.
Trendsetting in Central California
In the heart of central California, Stanislaus County stretches more than 1,500 square miles and is divided by the north-flowing San Joaquin River. With a rich agricultural tradition rooted in California's wine, nut, and dairy industries, the county includes everything from small farming towns to “bedroom communities” for San Francisco commuters. While the communities that make up Stanislaus may not be as well known for trendsetting as their Bay Area neighbors, members of the Stanislaus County public health system were among the first in the nation to set the tone for community-driven health improvement, and they're beginning to see the fruits of their labor.
Stanislaus County is home to just over half a million people, primarily of European and Latino origin. Stanislaus County, like others in the Central Valley, has chronically higher rates of poverty and unemployment and lower educational attainment than the state as a whole. As a rapidly urbanizing county, Stanislaus County's health challenges don't always reflect those seen in other parts of the golden state. For example, a recent California County Health Status Profiles report revealed that Stanislaus County bears a disproportionate burden of chronic disease and poor infant health outcomes as compared to other counties in the state (Health Services Agency/Public Health Community Assessment, Planning and Evaluation Unit, 2010). Further, the county's infant mortality, low birth weight, and premature birth rates are all higher than state averages. According to one of the county's epidemiologists, in many ways, health outcomes in the Central Valley have more in common with Appalachia than with other counties in California.
Since 2002, the Stanislaus County Health Services Agency has used the Mobilizing for Action through Planning and Partnerships (MAPP) process to engage public health partners and county residents in community health assessment and improvement. Now in their second iteration, partnerships between local governmental agencies and grassroots, community-based organizations have grown, and Stanislaus County is continuing to make inroads toward improving priority health outcomes.
During Stanislaus's first iteration of MAPP, data from the 2003 comprehensive health assessment—especially concerns about troubling infant health outcomes—inspired community leaders to develop what soon became known as Family Resource Centers. This new community resource, first piloted in 2005, began with three locations and has since grown to include ten sites distributed throughout the county. Family Resource Centers are funded largely through Proposition 10—the California Children and Families Act—with contracts managed by the Stanislaus County Health Services Agency. Family Resource Centers are embedded in the communities they serve and act as independent nonprofit organizations.
Members of the Stanislaus Health Services Agency cite the creation and development of Family Resource Centers among the proudest and most profound outcomes of MAPP. The centers grew out of a combination of initiatives, namely MAPP and asset-based community development and partnership efforts that occurred throughout the county in the first part of the millennium. Data and partnerships generated by the MAPP process created the foundation for Family Resource Centers.
Family Resource Centers represent a new anchor in the communities that make up Stanislaus County and provide opportunities for community residents to access everything from mental health services to the Healthy Birth Outcomes program, an education and support service for pregnant and parenting women and teens. Further, according to a local health educator, the Family Resource Centers have become a trusted venue for residents to exchange information about community-based activities and initiatives occurring throughout Stanislaus.
Community-wide concern about the health of Stanislaus's youngest residents initiated the design and promotion of the Healthy Birth Outcomes program, which now serves as one of the Family Resource Centers' foundational programs in cooperation with the Health Services Agency and the Children and Families Commission. The Healthy Birth Outcomes program focuses on improving birth and child health outcomes by increasing the number of babies born at term and at adequate weights and by improving family functioning and maternal/child support systems. The program consists of three components: intensive case management services (for women with medical problems such as diabetes, substance abuse, and behavioral health issues), community-based services, and provider/county outreach. Services include assessment, service plan development, prenatal care referral, medical/preventive health services, social services, infant care/parenting education, and support services (Stanislaus County, n.d.). Annual enrollment has grown from 306 women in 2005 to 554 women in 2009.
In a county where prematurity, infant mortality, and low birth weight are chronic challenges, local epidemiologists are thrilled to finally report progress. According to one of the county's epidemiologists, the percentage of premature births among women enrolled in the Healthy Birth Outcomes program (5 percent) is lower than the rest of the county (11.1 percent) as a whole, despite the fact that some of the women enrolled are experiencing “high-risk” pregnancies.
Looking Back and Moving Forward
Looking back on a decade's worth of partnerships, planning, and action, Stanislaus County Health Services Agency's MAPP mastermind, Cleopathia Moore, notes that “if you spend the time up front, the results will pay off. Not the short term, but the long-term gain.” Public health staff members in Stanislaus are eager to share the range of new programs and relationships that have formed as a result of MAPP—from policy initiatives to reduced obesity rates to the establishment of a Certified Farmers' Market and a new walking trail. As a local health educator put it, “The process takes on a life of its own and starts developing like in a web. Everybody took something and developed it further.” Looking toward the decade ahead, there's no doubt that the growing sense of community, new partnerships, and focus on system change will aid public health stakeholders as they continue to tackle chronic and emerging health challenges in Stanislaus.
1. What were the major health issues affecting Stanislaus County?
2. What is the purpose of Stanislaus Family Resource Centers?
3. How has the MAPP process benefited Stanislaus County?