L ocal health departments (LHDs) play a central role in providing maternal and child health services in the public health system and are increasingly collaborating with academic institutions to advance evidence-based public health [1-3]. Academic-practice partnerships typically represent a formal affiliation between an academic institution and a public health practice organization [4]. Luo and colleagues estimated that 82.4% of LHDs engaged in partnerships (ie, networking, coordinating, cooperating, collaborating) to advance maternal and child health, however, only 27.4% of these partnerships represented collaborations [5]. There is a need to understand how LHDs successfully leverage partnerships to advance evidence-based maternal and child health [5]. In an effort to improve birth and child health outcomes, the North Carolina General Assembly legislated recurring funding in the amount of $2,500,000 (Session Law 2015-241) to invest in evidence-based programs shown to reduce infant mortality and improve birth and health outcomes for children from birth to 5 years of age [6]. In fiscal year 2016, the North Carolina Division of Public Health (DPH) launched the Improving Community Outcomes for Maternal and Child Health (ICO4MCH) program establishing an academic-practice partnership between the University of North Carolina at Chapel Hill (UNC) Gillings School of Global Public Health, DPH, and LHDs to improve birth and child health outcomes. This paper describes the implementation of a maternal and child health program in North Carolina using a collective impact framework, the principles of implementation science, and a health equity approach to address adverse birth and child health outcomes. It presents lessons learned from leveraging existing relationships to develop and sustain an academic-practice partnership that strengthened implementation. Methods The ICO4MCH Program The ICO4MCH program is housed in the Women's and Children's Health Section of DPH. The program was designed to address 3 overarching aims: 1) improve birth outcomes, 2) reduce infant mortality, and 3) improve the health of children from birth to 5 years. The evidence-based strategies (EBSs) from which the grantees could select to address the 3 program aims included:

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In 2016, the North Carolina Division of Public Health launched the Improving Community Outcomes for Maternal and Child Health program to invest in evidence-based programs to address three aims: improve birth outcomes, reduce infant mortality, and improve health outcomes for children 0 to 5 years old. Five grantees representing 14 counties were awarded 2 years of funding to implement one evidence-based strategy per aim using a collective impact framework, the principles of implementation science, and a health equity approach. Local health departments served as the backbone organization and provided ongoing support to grantees and helped them form community action teams (CATs) comprising implementation team members, community experts, and relevant stakeholders who met regularly. Focus groups with each grantee’s CAT were held during 2017 and 2019 to explore how CATs used a collective impact framework to implement their chosen evidence-based strategies. Results show that grantees made the most progress engaging diverse sectors in implementing a common agenda, continuous communication, and mutually reinforcing activities. Overall, grantees struggled with a shared measurement system but found that a formal tool to assess equity helped use data to drive decision making and program adaptations. Grantees faced logistical challenges holding regular CAT meetings and sustaining community expert engagement. Overtime, CATs cultivated community partnerships and multicounty collaboratives viewed cross-county knowledge sharing as an asset. Future collective impact initiatives should allow grantees more time upfront to form their CAT to plan for sustained community engagement before implementing programs and to incorporate a tool to center equity in their work.

The utilization of shared decision-making practice in maternal health care has the potential to improve the overall pregnancy, birth, and postpartum experience. This issue of the NCMJ highlights various programs and initiatives aimed at improving maternal health outcomes, including efforts to build a more diverse perinatal workforce.

Purpose Long-acting reversible contraception (LARC) is encouraged as a strategy to address racial disparities in birth outcomes. Black woman-led organizations and stakeholders recommend a thoughtful integration of Reproductive Justice for any LARC programs. This paper will describe how one state-funded maternal and child health program reconceptualized an evidence-based strategy (EBS) focused on increasing access to LARC, to a broader strategy that incorporated principles of Reproductive Justice to improve birth outcomes. Description: In 2016, North Carolina established the Improving Community Outcomes for Maternal and Child Health (ICO4MCH) program. As part of this program, five county health departments were awarded funding to “increase access to LARC”. Noting community partners’ concerns with this strategy, ICO4MCH leadership revised the strategy to focus on using the Reproductive Justice framework to improve utilization of reproductive life planning and access to LARC. Leaders modified the strategy by changing performance measures and scope of work/deliverables required by grantees. Assessment Using quarterly reports and focus group data from ICO4MCH grantees, we identified key steps communities have taken to prioritize Reproductive Justice. Key findings include that sites hosted Reproductive Justice trainings for team members and changed language describing family planning services. These activities were tailored to fit community context and existing perceptions about reproductive health services. Conclusion The ICO4MCH program was able to modify a LARC EBS to better emphasize Reproductive Justice. Local agencies desiring to shift their LARC programs should include and value feedback from those with lived experience and partner with organizations committed to Reproductive Justice.