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The Connecticut Coalition to Improve Birth Outcomes at Work:
Using policy analysis tools to identify priorities and recommendations.

The Coalition developed the Plan in collaboration with the Governor’s Office; Connecticut March of

Dimes; New Haven Healthy Start; the Department of Social Services; and over 80 members

representative of the several maternal and child health (MCH) stakeholders and initiatives in the state of

Connecticut. During the process of developing policy recommendations for inclusion in the Plan, three

workgroups composed of coalition members were convened around three focus areas: mental health,

oral health, and reproductive health.

After defining the problem, based on a thorough assessment of the Connecticut perinatal landscape,

and following an initial brainstorming that generated over 70 diverse recommendations, the Coalition

engaged in a prioritization effort. In order to use a systematic process that was verifiable, driven by

evidence, and that could be aligned with current national MCH frameworks, the Coalition planning

committee proposed to use the Shaping Policy for Health (SPH) policy analysis tools developed through

a cooperative agreement between Directors of Health Promotion and Education (DHPE) and the Centers

for Disease Control and Prevention (CDC).2

Two members of the Coalition’s planning committee, Jordana Frost and Tiffany Cox, attended the
5-part SPH training program and served as technical assistants (TAs) for the Coalition workgroups. After

sharing a brief overview and orientation to the tools with Coalition members, technical assistants met

with individual workgroups as they followed the process outlined in the SPH policy analysis tools,

utilizing the Impact Analysis Matrix and the Stakeholder Power Analysis Matrix.

The first step involved developing impact categories. These are outcomes that the workgroup members

would like to realize. They then categorized these outcomes into overarching goals, and connected

them to the potential strategies generated by the Coalition brainstorming session. Guided by a review of

the literature and evidence‐based practices, workgroup members began the impact analysis process,

which involved consideration of how each potential strategy might impact each desired outcome. By

assigning weighted impact scores to each potential strategy based on its possible impact on the desired

outcomes, the workgroups were able to prioritize their best recommendations from those that received

the highest scores.

A stakeholder analysis followed, in which workgroup members compiled a list of possible stakeholders in

their focus area. Using this list, they identified which stakeholder or partners would likely be in support

of each potential strategy, neutral, or opposed to it. They also assigned a value representing the level of

power that stakeholder groups might have and in what sphere of influence, i.e. public, political and

bureaucratic. This allowed the workgroups to predict how feasible a potential strategy might be, based

on the amount of support or opposition it may receive.

The final step in the process was to combine all the previous work into one document for review by the

full coalition. Using this document the planning committee identified the highest ranked potential

strategies, and analyzed them in terms of alignment and synergy with state and national frameworks,

plans, and theories (i.e. the Twelve Point Plan to Close the Black‐White Gap in Birth Outcomes, Healthy

Connecticut 2020: Connecticut’s State Health Improvement Plan, the AMCHP Comprehensive

Compendium of Initiatives to Improve Birth Outcomes and Reduce Infant Mortality).3–5

To allow for a greater degree of organization and further synergy identification, the potential strategies

were then organized into tiers based on Frieden’s Health Impact Pyramid. Frieden’s Health Impact

Pyramid provides a framework for understanding the impact of different types of public health

interventions.6 The 5‐tier pyramid starts with Tier 1 at the base which represents interventions that

impact the largest number of people with the least amount of individual effort required. These are

interventions that address socioeconomic factors and other social determinants of health. Each tier has

potential to impact a smaller number of people ascending up the pyramid. Tier 2 represents

interventions that strive to change environments, making healthy choices the easier choices. Tier 3

represents long‐lasting and protective clinical interventions for individuals. Tier 4 is where ongoing

clinical interventions can be found; and Tier 5 interventions, which impacts the smallest number of

people, includes education and counseling. Having a balanced mix of interventions will help to achieve

the best outcomes.6

It was during this categorization process that the planning committee realized that the work of Coalition

members had led to an overwhelming focus on broad population‐based efforts that improve all

families’ overall quality of life, health, and wellbeing and less on individual‐based clinical and health

counseling interactions. This inclination is very much in line with the most current research literature

suggesting strong connections between cumulative stress and health throughout one’s life course.

 

The collective strategies developed by the individual workgroups were presented at a Coalition meeting

in May 2014. Each Coalition member present voted on which top three strategies should be given

priority during upcoming Coalition efforts. To avoid duplicative approaches, a concerted effort was put

forth to identify organizations in the state that may be already pursuing some of the strategies and

whose work could be supported and enhanced by the Coalition. This approach also affords the

Coalition the opportunity to partner with other stakeholders in the state that may be able to take the

lead on strategies that did not rise to the top of the Coalition’s list of recommendations, yet have the

potential to significantly impact our shared goal of improving birth outcomes through the reduction

and ultimate elimination of disparities.