Pima County Health Department (AZ)

Mothers in Arizona Moving Ahead, or MAMA, created and tested an effective approach to addressing poverty and its impact on the health of mothers in poverty. MAMA partnered with nonprofits and engaged community volunteers for sustained support. This relational approach recognizes the impact of social determinants, honors the priorities of the participant, and engages mothers as partners in identifying potential improvements in current health care systems. MAMA created a set of evaluation tools that showed statistically significant change in key areas of perceived stress, overall hope, overall functioning, level of perceived control over their own lives, increased knowledge of resources, and improved social capital. While mental health issues were widely reported, MAMA improved mental health on an average of four days a month.

  • MAMA is built on guiding health equity principles that mothers are co-investigators and partners, effective change agents in their lives and in the community, and the most important advocates for their family’s health. One partner said: It was inspiring to work with MAMA, because the program was delivered in a way that valued and respected the knowledge and experience of the participants. Too often, poverty intervention programs take a colonial stance and fail to recognize the intelligence already at work in the community.
  • MAMA has quantitative and qualitative evidence that demonstrates positive impact. One study showed statistically significant change in perceived stress, overall hope, overall functioning, level of perceived control over their own lives, increased knowledge of resources, and improved social capital. These evaluation tools are available to future sites.
  • MAMA provided tools to understand and describe the complexity of poverty to both participants and those in supportive roles. There was space for discovery and analysis using shared concepts and vocabulary. MAMA integrated art, photography, and video to enhance investigations and create voice. Together these created common ground, built trust, improved communication, and accelerated change — elements that supported the conversation between moms and health care professionals to examine program design in the health equity workshops.
  • MAMA engaged moms in setting and achieving their own priorities and, based on that, provided targeted support by Navigators, whether directly health-focused or not. This responsive approach allowed us to develop new components, such as the MAMA Legal Clinic to address the number of participants with legal concerns and to engage more county departments and expertise.
  • Relationships matter and MAMA’s relational approach put trust-building first, strengthening community among participants and across economic class with allies. Navigators were empathetic, culturally sensitive, and smart problem-solvers. Moms reported the importance of these relationships for sustained change.
  • The integration of allies (volunteers) was an element not typically present in many health approaches that resulted in additional supports for moms and a positive impact on volunteers.
  • MAMA created opportunities to engage with health care professionals to consider program designs as well as community efforts to address social determinants of health based on the mothers’ expertise and experience. “I felt like I was somebody in the room of somebodies,” said one mom.
  • MAMA busted silos within traditional county departments, bringing resources from both employment and training and the health department, as well as support from other county departments, such as the Public Defender’s office.
  • MAMA can grow. There is now a toolkit to support future sites, including outreach materials, program logistic documents, partner agreements, evaluation tools, and more. MAMA can provide consultations and trainings. Additionally, most participant materials have been translated into Spanish.
  • Retention was a challenge: our numbers were lower and our participants faced more barriers to economic stability and mobility than expected. Moms had high levels of unemployment, unsafe housing, and lack of transportation, as well as mental, physical and dental health issues, many untreated. The average income was $1,000.00 a month supporting four people, putting most families well below the poverty line.
  • Partners had varying levels of commitment, capacity to launch the program, and fidelity to the model. The class run by the health department and the Spanish classes run by the Community Food Bank were among the most successful, and our residential recovery partners were the most challenging.
  • Any new approach confronts challenges when changing existing operating systems. MAMA didn’t fit easily into the dominant health care delivery system of uniform interventions and measurable “dosages.” Describing and measuring the impact of a new approach is always challenging.
  • Identifying staff who can manage start up and innovation proved difficult and we lost time and traction, though in the end we had a strong team.
  • MAMA had multiple forms of program evaluation and participant assessments, possibly too many, and adjustments over the course of the program meant some data couldn’t be used. However, there is now a solid set of tools for future use.
  • Navigating the differences between two county departments with different leaders, policies, priorities, and perspectives was new territory. We had to get guidance and stay relevant to both so we didn’t drift to the periphery.

We encourage interested organizations to contact us if interested in replication. Our kit will be available soon with all required documents and tools. We are available for consultation. There is flexibility in adapting this to your community and we believe this can work in urban and rural communities. Our participants and partners were diverse, including Spanish dominant classes, and we experimented with a PAPA and a Veteran’s site with positive outcomes, indicating adaptability to other populations and settings. We designed the program to be as low-cost as possible and therefore sustainable.

  • Innovation Summary Document
  • Case Study Report