Pathways to Integrate Maternal-Child Health and Nutrition Interventions to Transform Equity and Human Potential

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Admin Supplement Grant Number: 8 U01 HD115256-02, (previous FAIN: U01OD033239) Abstract Summary Strengthening maternal and child health and nutrition is critical to achieving the Healthy People 2030 Goals. Investing in integrated nurturing care interventions from preconception through childhood defines one’s developmental trajectory with benefits that accumulate across the life course and promote social justice (i.e., taking equity one step further by fixing the systems for generations to come). The COVID-19 pandemic has disrupted essential nurturing care services such as prenatal, perinatal, and pediatric services. As a result, over a million preventable child and maternal deaths are projected to occur due to extreme poverty and household food insecurity (HFI; lack of consistent access to enough healthful food for an active, healthy life due to limited financial resources). Amid COVID-19, HFI in the US tripled among households with children (~19.5%), disproportionately burdening marginalized low-income and families of color. HFI is strongly linked with racial/ethnic inequities and adverse maternal-child health and nutrition outcomes. Integrating effective food security interventions within nurturing care services as a COVID-19 response & recovery effort is an achievable strategy to promote equity. The West Las Vegas Promise Neighborhood (WLVPN) is an intervention addressing social determinants of health to reduce structural racism in historically racial/ethnic marginalized communities in Las Vegas, Nevada. The WLVPN is implemented by over 50 multi-sector partners in key life domains (health, education, employment, housing, and social justice) coordinated by Nevada Partners, Inc., with whom we have a solid collaboration. While WLVPN social intervention is a unique opportunity and platform to address endemic inequities in maternal-child mortality and food insecurity levels, it lacks focus on maternal-child health and nutrition. Therefore, our partnership with Nevada Partners, Inc. is well-placed for promoting the maternal-child component within WLVPN and advancing implementation and equity research. This implementation science project is utilizing a community-based participatory approach along with a racial equity framework to co-create WITH the community the Early Responsive Nurturing Care for Food Security (EARN-FS) intervention to integrate maternal-child health and nutrition. The EARN-FS is a system-level intervention consisting of a bundle of equity-focused implementation strategies to adapt and integrate effective food security interventions – (i) universal screening for HFI, (ii) referrals to access existing health-nutrition & other nurturing care resources within WLVPN communities, and (iii) care coordination to achieve pathways for food security. This project is designed to inform how best multi-sectoral interventions (maternal-child health and food insecurity interventions) can be integrated to promote transformation in the maternal-child health and nutrition of historically marginalized communities. A three-phase mixed-methods approach will be used to achieve the major goals of this project: Phase 1 will consist of a detailed analysis of (i) contextual barriers and facilitators to integrating effective food security interventions into maternal-child nurturing care services and (ii) baseline assessment of maternal-child socioeconomic, demographic, and health needs. Phase 2 will consist of the co-creation WITH the community of a bundle of equity-focused implementation strategies to adapt and integrate the EARN-FS intervention within maternal-child nurturing care services Phase 3 will consist of assessing implementation feasibility (phases 3A & 3B) and a hybrid type III implementation study to evaluate equity-focused implementation and effectiveness outcomes, i.e., changes in levels of food insecurity of maternal-child dyads (phase 3C).