Background:
Following the release of “Recommendations to Improve Preconception Health and Health Care – United States,” (MMWR, April, 2006), the Public Health Work Group of the National Select Panel on Preconception Health suggested using a “practice collaborative” approach to foster the translation of the recommendations into local public health practice. In response, CityMatCH, the national membership organization dedicated to improving the health of urban women, children and families, launched the a pilot Urban Practice Collaborative on Preconception Health, with funding from CDC's National Center on Birth Defects and Developmental Disabilities. The CityMatCH Practice Collaborative model uses a structured 18-month process with staged key components, including: 1) Development and support of intersectoral local leadership teams; 2) Transferred knowledge about cutting-edge science; 3) Fostered productive cross-city communication, collaboration, and consultation; 4) Facilitated planning and evaluation; 5) Provision of timely technical assistance; 6) Identification of what (really) works and what doesn't; and, 7) Defined models and lessons learned for other urban communities. Expected impact is at three levels: Level 1 – city-specific initiatives, Level 2 – strategic cross-city partnerships, and Level 3 – all-cities collaboration for greater systems change.
In October 2006, three cities (Hartford, CT, Los Angeles, CA, and Nashville, TN) were selected to take part in the pilot. Year one activities of the Urban Practice Collaborative on Preconception Health included (a) initial technical team site visits to each city in the first three months; (b) all-collaborative meetings (Nashville TN, April 2007 and at this Summit) for which CityMatCH adapted its Practice Collaborative MAPS (Mobilizing Actions for Prevention Strategies) planning toolkit for integrating preconception health into local practice; (c) monthly all-collaborative distance-learning and peer-exchange conference calls (Summer-Fall 2007), and (d) tailored technical assistance.
The Initial Translation Strategies (ITS) defined by the three cities are in early implementation. Hartford, CT is working toward expanding Medicaid coverage for women's preconception health care and will host a community-wide summit to build awareness and support for advancing preconception health as par of MCH. Nashville's work focuses on using young women's knowledge about their status for sickle cell and sickle cell trait as an entry point for preconception health. They are strengthening data systems about sickle cell trait and disease, integrating inherited blood disorders into EPSDT visits, and creating a public awareness campaign geared towards helping youth “Know Their Status” regarding sickle cell trait. The Los Angeles County Health Department is analyzing baseline and trend data around preconception health and health care, developing standardized tools for educating public health professionals about the importance of preconception health, and improving messages and consumer awareness of preconception health.

Objectives:
Participants in this interactive Special Session will: (1) Understand the practice collaborative approach being used in this pilot project for translating recommendations into action; (2) Learn about the first year's strategies and experiences from the three pilot cities; and (3) Offer input as informal technical consultants to the three city-teams to enhance their work and overcome apparent obstacles.

Methods:
This working session, which should follow the Public Health Work Group mini-plenary session, will have 4 components. First, a brief overview of the practice collaborative approach and methods will be provided by the moderator. Second, the leader from each pilot site will present a case study of their experience to date using a standard format: city, maternal and child health/preconception health background, initial preconception health translation strategies, progress/products/resources mobilized to date, obstacles to integration, early lessons learned. Third, a “talk-show” style, moderated panel format will be used to engage participants as informal consultants to address identified obstacles across the cities. Finally, a synopsis of key points and lessons learned will be harvested by the moderator across the pilot cities.

Results:
Results are anticipated at three levels. Participants will gain insight into both the practice collaborative process and the early impact of integrating PCH into urban public health practice in three diverse communities. Each of the three practice collaborative communities will benefit from the feedback and input from experts and peers across the nation. Early thematic lessons learned across the pilot sites will be used to shape related initiatives to advance preconception health as an integral part of local public health practice.

Conclusion and implications for practice:
The Practice Collaborative Model is a promising approach for accelerating the integration of recommendations on preconception health into existing local maternal and child health programs and policies. Early lessons learned from three diverse communities should serve well to inform other states and communities ready to strengthen and expand public health practice through preconception health.