A Path Towards Reproductive Justice: Incorporating a RJ Framework into North Carolina's Improving Community Outcomes for Maternal and Child Health Initiative.

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.

Using a Collective Impact Framework to Implement Evidence-Based Strategies for Improving Maternal and Child Health Outcomes.

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.

Ballism after stroke responds to standard physical therapeutic interventions.

OBJECTIVE: To report the effects of noninvasive standard physical therapy (PT) interventions on an involuntary movement disorder after stroke. DESIGN: Single case with clinical follow-up over 2 years. SETTING: Inpatient stroke and rehabilitation services and outpatient clinic. PARTICIPANT: A man with acute bilateral ballism after unilateral subthalamic infarction. INTERVENTIONS: Rhythmic coordinated bilateral limb movements and firm tactile stimulation to the hand. MAIN OUTCOME MEASURES: We had not anticipated that dyskinesia itself would specifically improve during treatment. Consequently, we used qualitative clinical observations, including review of videotaped performance, and self-reported limb control. Hypotheses concerning treatment effects were developed after data collection. RESULTS: Involuntary movements recurrently improved within treatment sessions. CONCLUSIONS: PT may improve dyskinesia after stroke. The benefit may be adjunctive or alternative to current invasive treatments of movement disorders after brain injury and merits confirmation. The improvements are consistent with current research indicating that (1) intact cortical, subcortical, cerebellar, and spinal areas interact to generate bilateral rhythmic limb movements that can overcome dyskinesia and (2) tactile stimulation can improve motor deficits associated with basal ganglia disorders. Finally, because functional activities assessments improved our evaluation of ballism, these should be routinely used along with conventional neurologic examination to assess involuntary movement disorders.

Application of ventilatory strategies to enhance functional activities for an individual with spinal cord injury.

BACKGROUND AND PURPOSE: This case report describes the benefits of teaching an individual with C6 tetraplegia how to use ventilatory movement strategies during functional activities and to thereby improve her level of independence. CASE DESCRIPTION: The client was a 25-year-old woman with C6 tetraplegia. Her goal was to become independent in 3 functional tasks: leaning forward in her wheelchair, repositioning her feet on her footplates of the wheelchair, and performing a lateral lean pressure relief. She was evaluated performing each task with her own ventilatory strategy, which was a valsalva maneuver. Then, she was taught specific ventilatory strategies for each activity and was re-evaluated to determine if the new strategy increased her ability to perform the task. OUTCOMES: This client was unable to perform each activity while using a valsalva maneuver as her self-selected ventilatory strategy. After learning the appropriate ventilatory strategy to use while performing each task, she became independent with each activity. DISCUSSION AND SUMMARY: Clinicians are encouraged to incorporate teaching appropriate ventilatory strategies to a client while the client is performing functional tasks to improve outcomes. Less than 30 seconds is needed to instruct a client in the appropriate ventilatory strategy. Many clients are able to learn ventilatory strategies in a short period of time and therefore improve their ability to perform tasks. This training can be a valuable asset to the current functional training that is needed for a client with tetraplegia.