From Silos to Collective Impact

by Brenda Stubbs, Triad Regional Coordinator

Do you know the old adage, “If you want to go fast, go alone. If you want to go far, go together?”

Having worked in health and human services for over 20 years – specifically in maternal and child health I have seen much progress in how community agencies work to bring about positive change in the health and health behaviors of its residents. It seems like years ago, although many programs and agencies had the overall common goal of improving the health of the community, each of these entities operated in a silo, focusing on their specific health issue; not really communicating with each other or sharing information, data or resources – in some instances, even being “territorial” over such things. Some of this could be explained by the fact that many of these programs were competing over the same funding dollars because their work overlapped in certain areas.

Fast forward to 2017, and it’s a new (and better) reality! Different agencies and programs not only recognize, but embrace the overlap in their work – and there seems to have been a call to action of sorts to collaborate and work together across programs with different specialties to affect change. There has been a realization that we can no longer look at or address just one phase of a person’s health or life in a vacuum and expect interventions to have positive impact on a population level. We really need to be looking at a person’s health from the “whole life” or “life course” perspective, and acknowledge that things can happen in one phase of a person’s life that could put them and their health on a completely different trajectory in a subsequent phase of their life.

Community agencies and programs are learning to come together and bring their expertise in different areas to the table, and be thoughtful and deliberate in their strategies to improve health. For example, the mission of the March of Dimes is to prevent premature birth, and one of our strategies in accomplishing that is to provide education about and promote good preconception health in women and men of childbearing age. A noble goal, yes – but if we are looking at it from a “whole person, whole life” perspective, it is clear that there are several other factors, socioeconomic and otherwise, that can impact a woman’s preconception health and ultimately her birth outcome. The idea of Collective Impact is to bring together experts whose programs each address a specific health issue: i.e. mental/behavioral health, substance use disorders, domestic violence, early childhood development, job training, financial self-sufficiency, trauma-informed care and so on (2)– issues that may not specifically be in the March of Dimes’ wheelhouse, but that can definitely impact a woman’s preconception health and her risk for having a preterm or low birthweight baby. Collectively, we can better identify and execute interventions that can address and improve health in ALL of these areas.

Allow me to paint a picture of how this all translates in the real world:

Over one-third of children will experience at least one — and in many cases, more than one — potentially life-altering trauma as listed on the ACE (Adverse Childhood Events) screening tool before the age of 16 (1). Some examples of ACE include being the victim of abuse, neglect or assault; growing up in a home where there is domestic violence or substance abuse; abandonment by a parent through death, divorce, incarceration, or simply being absent from the child’s life. It’s important to note that the brain is “use-dependent” (3). which means that it physiologically changes in response to specific patterns of experiences, like ongoing exposure to trauma or chronic stress.

Likewise, people with higher ACE scores are much more likely to use tobacco, develop mental health or substance use disorders, and chronic health conditions. These health problems could be presenting themselves during the preconception period, as women and men are going into their prime childbearing years, which means that these women are more likely to ­­­enter pregnancy with significant risk factors for poorer birth outcomes – preterm birth, low birthweight, and birth defects. Keep in mind that research has shown that 50% of all infant mortality and morbidity is directly related to the health of the mother prior to conception (4).

We also know that babies born prematurely – even just a few weeks early – are at much higher risk of developing behavioral and mental health disorders, as well as neurodevelopmental delays. This is due to the fact that crucial brain development in the baby occurs between 35 and 39 weeks gestation, with the frontal lobe being the last to develop. Babies born prior to 39 weeks miss some of this critical period of development and so are more vulnerable to certain disorders and delays that can result from an early birth.

We’ve learned that if mothers experience perinatal mood disorders, including postpartum depression – especially if it is severe – it can hinder critical bonding and attachment with the baby, which in turn can hinder cognitive, social and emotional development of the child. Some of these children may go on to experience adverse childhood events, for example, if mom is self-medicating with alcohol or other substances, or if the child is subjected to harassment or bullying due to his or her developmental delays.

And the cycle continues, sometimes perpetuating from generation to generation if no intervention occurs. Thus, there is a strong need for health and human service professionals with expertise in different areas of a person’s life and health to work collectively to positively impact the overall health of the community.

So, let’s urge one another as health field educators and workers to continue the progress that collective impact encourages by embracing the overlap in our work to ensure communities with healthier futures. For to care for the whole person from a whole life perspective – that is the way to affect change.



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