Background:
The Healthy Births Initiative (HBI) is a $28 million investment by First 5 LA, dedicated to improving pregnancy and birth outcomes in Los Angeles County. Modeled on evidence-based practices, the goals of the HBI are intended to facilitate organizations working together to link and build on existing services to improve outcomes for all pregnant women and their families; focus on reducing risks for subsequent birth outcomes; and build sustainable networks to address the needs of pregnant women and their families.
The vision of the HBI is to optimize the health and well-being of each mother, child and family in Los Angeles County and to optimize the potential for early childhood development, intellectual capacity and lifelong good health. The expected outcomes of the Healthy Births Initiative are to bring about system-wide change; enhance services provided to pregnant and parenting women; improve the quality of care before, during and beyond pregnancy; enhance the capacity of perinatal service providers; increase family and community support for healthy birth outcomes; and improve access to quality prenatal care.
Los Angeles County is the most populated county in the nation, with approximately 10 million residents. One out of every 27 babies born in the U.S. is born in LA County. One out of two women pays for prenatal care with Medi-Cal. Every year in LA County, more than 15,000 babies are born prematurely, and more than 10,000 are born weighing 5.5 pounds or less. Over forty-one percent of women in Los Angeles age 15-44 live below 200% of the federal poverty level. Countywide, African-Americans have the highest rates of both infant mortality and low birth weight of all ethnic groups. Over half the infants who die in the county are Latino. Significant regional and racial/ethnic disparities persist.
The LA Best Babies Network is the coordinating arm of the HBI and supports the Best Babies Collaboratives, Healthy Birth Learning Collaboratives, Care Quality Improvement, Policy /Advocacy and Networking components of the HBI. Four Best Babies Collaboratives (BBCs) consisting of 32 organizations were organized by geographic region to identify high risk pregnancies and provide direct support services to reduce disparities in birth outcomes. Agencies included are WIC, faith-based organizations, case management/home visitation providers, advocacy groups, and local community based clinics and hospitals. Together these organizations deliver a plethora of services to pregnant and parenting families focused on reducing adverse birth outcomes. Services provided include: home visitation; intensive case management; health education and social support groups; and referrals to legal services; transportation resources; medical care; mental health; substance abuse and tobacco cessation programs. All BBCs meet quarterly to discuss opportunities for shared learning, innovative strategies, lessons learned and sustainability. The BBCs also convene with other perinatal stakeholders for LA Best Babies Network's annual county-wide “Healthy Births Through Healthy Communities: Partner's Symposium” where agencies are provided the opportunity to share information about their programs to a larger audience. The BBCs are charged with integrating services to provide: Case Management/Home Visitation for women at highest risk, Interconception Care, Social Support, Outreach and Health Education.

Objectives:
•Interconception care (ICC) as an approach to reduce risks in subsequent pregnancies will be highlighted. •Methods for implementing ICC among community-based networks will be described. •A model for collaborative learning will be introduced

Methods:
: Each BBC is charged with identifying pregnant women and teens or new mothers who are at-risk for adverse pregnancy outcomes. The BBCs then follow them during pregnancy and for two years post partum. Clients receive intensive case management/home visitation, health promotion, and other services to address identified psychosocial, life course and health issues such as nutrition, mental, behavioral, and dental health, and increase access to and utilization of care for family planning, diabetes and other chronic health conditions before, during and between pregnancies The BBCs focus outreach efforts on at-risk women and families who have: experienced a prior early preterm or had very low birth weight infant, fetal or infant death, pregnancy affected by preventable congenital anomalies, adolescent pregnancy, and diabetes or other chronic health problems associated with adverse pregnancy outcomes. The core components of the BBCs ICC plans are 1) risk assessment, 2) outreach and health promotion, 3) medical and psychosocial interventions, and 4) and case management. The BBCs develop individualized client care plans and track client goals, visits, exclusive breastfeeding rates, the management of chronic conditions, and other outcomes via a web-based data registry. This system allows for ongoing reporting, opportunities for continuing education and assessment of progress. The registry tracks the number of high risk women case managed by each BBC, the number of recommended visits, referrals, care plans and comprehensive needs assessments. In addition, the system supports the evaluation of each BBC's interventions as well as sharing of outcomes and results between BBCs. This special session will have a panel presentation of the Lead organizations presenting their interconception care implementation strategies. LA Best Babies Network will also highlight the use of a web-based registry and learning session for continued quality improvement and sharing lessons learned.

Results:
Now in the third year of implementation, a total of 753 women are being provided case management support by the Best Babies Collaboratives. In addition, the BBCs outreach efforts have reached over 37,000 pregnant and parenting women/teens and provided Health Education & Messaging services to over 166,000

Conclusion and implications for practice:
The Best Babies Collaborative's interconception care plans serve as a model for future community-based programs to improve pregnancy and birth outcomes. An investment in interconception care through community-wide collaboration focused on reducing risks in subsequent pregnancies is a key strategy to promote on a wider scale. Publicly financed interconception care has the potential to reduce adverse pregnancy outcomes in high-risk populations.