This case study has been developed based on reports and updates shared by Vanessa Parlette, Public Health Services at City of Hamilton and key lead on the development of this collective impact initiative.
The Hamilton Healthy Birth Weights Coalition serves as a model for genuine collective impact. Since entering the Youth CI program in December of 2014 (a program jointly delivered by Innoweave and Laidlaw Foundation in partnership with the Government of Ontario), the coalition has successfully clarified their population-level outcome, developed an aligned Theory of Change, begun implementation efforts, and is seeing some early impact. This case study shares the story of how an urgent issue drove necessary players in a community to integrate their efforts toward clear outcomes.
The city of Hamilton has sixteen neighbourhoods where the teen pregnancy rate is greater than 10%, compared to the Ontario average of 3.7%. Pregnant youth are more than twice as likely to smoke versus pregnant women over 20. They are also much more likely to experience multiple social risk factors, such as: lower socioeconomic status, lack of social support, homelessness, mental health problems, and substance use. Teens are more likely to develop pregnancy complications such as eclampsia, hypertension, and mood disorders. And, most importantly for this collaborative, teens have double the risk of delivering a low birth weight baby. This increases the likelihood of the baby developing long-term chronic illness, impaired physical and brain development, and consequent health and socio-economic costs.
Why Collective Impact?
Health and service systems are complex and difficult to navigate. The higher risks associated with teen pregnancy, along with the social stigma and isolation often encountered by young parents, requires a coordinated interagency response to improve the ways we work with and for young parents as a community of providers. It also requires leadership roles for youth themselves. Pregnant and parenting youth in Hamilton are advocating for a comprehensive youth-centred approach to help connect them to the right supports and information at the right time (before they need them), no matter where they first access the system. The urgency of the challenges facing young parents coupled with the lack of integrated supports necessary to overcome those challenges positioned Hamilton to benefit from the collective impact approach.
The Healthy Birth Weights Coalition became active in 2012 as a community-wide collaborative made up of more than 50 members from 30 organizations, representing: health care providers, community organizations, and researchers within the City of Hamilton (see below for full list). In the winter of 2014, the coalition began working with an Innoweave coach to refine their outcomes objectives and adapt their Theory of Change to directly align with those outcomes.
Population-level Outcome & Theory of Change
The Hamilton Healthy Birth Weights Coalition is using the Collective Impact approach to work toward the following population-level outcomes:
- Reduce the incidence of low birth weights in target postal codes by 10% over five years, by 2020.
- Reduce the incidence of low birth weight deliveries among youth under 20 years of age by 10% over five years, by 2020.
- Reduce the incidence of teen pregnancy (youth under 20 years of age) in target postal codes, demonstrated by a decreasing trend in 2020
- Decrease smoking rate among pregnant women in target postal codes by 10% in 2020
The coalition developed a strong Theory of Change to support that goal, and has been continually evolving and iterating this hypothesis over time as they continue to test its validity and learn through their implementation stage.
Young parent leadership has been integral to all phases of the Hamilton Healthy Birth Weights Coalition’s progress. In fact, collaborative research and planning with young parents has directed the development of three interrelated tools to support best possible care for pregnant youth:
- Youth Pregnancy Care Pathway: The Care Pathway aims to: help healthcare organizations better link with community resources; support a common knowledge and language; and develop shared processes, practices, and tools to support an integrated approach to working with and for pregnant and parenting youth in Hamilton. The Care Pathway is a tool for service providers, available in hard copy and online.
- Young Parent Resource Tool: The Young Parent Network has created the Young Parent Resource Tool as an online resource to help youth and providers navigate medical, mental health, and social supports available in the community. This interactive tool is linked to the web version of the Care Pathway and updated through Information Hamilton to ensure a comprehensive and current database.
- My Baby and Me Passport and Incentives Program: The “My Baby and Me” Passport has been adapted as a portable pregnancy resource and incentives program. The Passport Program is currently being piloted through the Maternity Centre of Hamilton, where pregnant youth, aged 21 and under, are invited to participate. Participants receive a passport with information about what to expect during pregnancy, resources in Hamilton, and space where young parents and their care providers can write questions or record information. The program also includes incentives, whereby participants receive a $10 grocery card and two bus tickets at each prenatal appointment. Research tells us this passport encourages self-management of care; improves access, experience, and outcomes of care; and supports mother-infant attachment.
Measuring a change in birth weight can be tracked easily, but similar to most collective impact efforts it takes a long time to see population-level impact. When developing a measurement framework, groups are encouraged to think about high-level key indicators that directly align with the population-level outcome objective, and to consider output goals from the specific strategies that then align with those high-level key indicators.
In the case of the Hamilton Healthy Birth Weights Coalition, they had to find specific measurements that helped to demonstrate their impact as they built towards population-level change. For example:
- By September 2016, system navigation tools implemented by 80% of Coalition organizations (# distributed, # of education sessions, web analytics)
- By September 2016, 100 pregnant youth enrolled in Passport Program
- By December 2016, 40% of pregnant women who smoke, and are clients of coalition organizations’ quit smoking services, are successful at reducing exposure to smoke
- By December 2016, 15% of above successfully quit smoking and remain abstinent through to childbirth
There are some early indicators of success for this collaborative in their first year. For example, a 1.5-year evaluation of the Prenatal Smoking Cessation Incentives Program shows 55% smoking reduction and a 100% increase in attendance. The youth in the Young Parent Community Researchers group have also benefitted from the supports of the Coalition and are now directing all facets of the strategy. They have lived experience and are first-hand witnesses of the impact of the Theory of Change on new young parents that enter the system.
Why has the Collective Impact approach been helpful?
Collective Impact can be a challenging approach, but the coalition in Hamilton is seeing some early progress. Vanessa Parlette, a leader in the collaborative from the Public Health Services of the City of Hamilton, attributes the growing success of the initiative to:
- Leaders across many sectors in our community committed to exploring new ways of doing things;
- Willingness of partners to put aside territorial issues and contribute in-kind resources to collaborative work;
- Support for client population and community members to direct vision and strategies; and,
- Backbone support and a dedicated staff person to oversee and manage diverse arms of the work.
Developing a common language, shared vision and goals, and aligning outcome indicators were essential steps in forming the groundwork for the Care Pathway, and continued throughout the development process. From there, forming an Action Team tasked with planning Care Pathway development and implementation was critical for moving from strategy to action, while maintaining broader input from the Coalition. Hamilton has shown that effective and continuous communication is essential to dialogue, learning, and improvement through all stages of development, implementation, and evaluation. Finally, celebrating the successes of the Coalition is key to ensure members are aware their contributions, time, and skills are highly appreciated and contributing to system change.
As the Hamilton Healthy Birth Weights Coalition implements pilot components of their Theory of Change, they are working through Innoweave’s Developmental evaluation module to build a framework that allows them to learn, adapt, and improve upon their work in real time. Innoweave and Youth CI are excited about the impact the Hamilton community is making and will continue to update this case study as the coalition moves closer to its population level outcomes.
Hamilton Healthy Birth Weights Coalition Member Organizations
|Health Care Providers||Community Care and Service Providers|