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Black Infant Health (BIH)

2015-2018 Evaluation of the California Black Infant Health Program

BIH group session

The Maternal, Child, and Adolescent Health Division (MCAH) supports the development, implementation and evaluation of the Black Infant Health (BIH) Program.  

The 2015-2018 BIH Program evaluation covered three state fiscal years (July 1, 2015 – June 30, 2018) and focused primarily on implementation of the prenatal group-based model of the BIH Program across 17 sites in 15 local health jurisdictions (LHJs) throughout California. MCAH evaluated the BIH model released in 2015 through a Request for Supplemental Information (RSI).

The evaluation focused on determining if the prenatal group-based model was implemented as intended (see BIH Group Based Model Core Elements) and what impacts on participants' intermediate health outcomes occurred after participation in the Program. Intermediate health outcomes are the short-term health milestones that indicate positive movement toward the long-term goal of healthy birth outcomes1 for Black people.

The evaluation used a mixed-methods approach of qualitative and quantitative data collection.

  • Information about staff and program context came from quarterly and annual reports produced by LHJs, staff surveys, staff group reflections and staff questionnaires.
  • Information about how the program was implemented came from data collection forms on group and other service delivery provided by LHJ staff.
  • Information about participants came from baseline and follow-up assessments, participant group reflections and post-program satisfaction surveys.
  • Comparative population data was included from California's Maternal and Infant Health Assessment (MIHA)2 survey and Birth Statistical Master Files3.
  • A stakeholder engagement process was undertaken to increase the transparency and validity of the report findings and conclusions.

Navigate the sections below to learn more about the evaluation results and how the evaluation was conducted.

Results of the BIH Evaluation: Data Briefs

Intermediate Outcomes Among Prenatal Group Model Participants:  Brief Summary

  • The BIH prenatal group model is achieving its intended intermediate outcomes. Data for a sample of participants that attended an average of 7.2 groups and 5.1 life planning meetings showed significant positive change in 13 of the 18 intermediate health and health-related outcomes examined.

  • Five indicators related to healthy behaviors were analyzed but did not show change after prenatal group model participation or showed negative change. Further analysis is needed to better understand this result.

  • Results support BIH as a promising strategy to improve the health of Black birthing people and their families.

Services Received and Services Provided During Prenatal Group: Brief Summary

  • Most participants that enrolled in BIH started prenatal group and life planning services attended on average 5.9 out 10 prenatal group sessions (7 are recommended) and 3.3 life planning meetings (4 are recommended) throughout six months of program engagement.
  • The Program delivered services mostly as intended. Two trained facilitators delivered most group sessions, with more than 70% of sessions delivered without skipped or modified activities and more than 80% providing the required food during sessions.
  • The average size of groups (4.8) was below the recommended (5) and ideal sizes (8-12).

Participant and Staff Perceptions about the Program: Brief Summary

  • Most participants that filled out a satisfaction survey had a positive experience with the Program and most of them would refer others to BIH.
  • Both direct service staff and managers appeared to have positive perceptions about their work and work environments, with a few noteworthy exceptions related to available resources and work-related stress.
  • Feedback from both participants and staff reflects that their perception is that the Program is achieving its intermediate health outcomes.

Participants Served

  • The BIH Program enrolled a unique subset of the eligible population during the three years examined. These findings could inform program improvements like outreach efforts and structure.

  • BIH participants appeared more exposed to harmful experiences and faced greater obstacles to health (for example, higher proportion living in neighborhoods with concentrated poverty) than did the eligible population of Black women and birthing people in the same California jurisdictions.

  • BIH participants also exhibited key protective factors, including utilization of WIC, low pre-pregnancy alcohol use, and long interpregnancy intervals.

Contextual Conditions that Supported the Implementation of the Prenatal Group Model

  • Sites varied in their abilities to implement the prenatal group model as intended. The contextual conditions sites operated in, as measured by the presence of ideal conditions, also varied. The findings presented in this brief show which contextual conditions were related to more successful program delivery.

  • Several ideal contextual conditions were associated with more than one indicator of program implementation success, highlighting the importance of supporting these conditions:

    • Local Program Leadership that values BIH and provides supplemental local monetary support;

    • Positive staffing practices (e.g., brief vacancies, cultural competency);

    • Provision of participant motivators, such as gift cards, door-to-door transportation, and full meals during group meetings;

    • Presence of a Community Advisory Board; and

  • Staff that believes the Program has value for participants and has positive perceptions of their work environment. Continuous organizational efforts to improve the identified contextual conditions at local sites should lead to improvement in implementation of the BIH prenatal group model.

BIH Program Evaluation Questions and Methods Overview

Below describes the five main overarching evaluation questions that were explored, the sources of data used, samples sizes, and a brief description of the methodological approaches used and their limitations.The results of the evaluation are included in companion data briefs. 

BIH Sites and Years of Data Included in the Evaluation

The BIH Program was implemented in 17 sites across 15 LHJs during FYs 2015-2016, 2016-2017, and 2017-2018 (Table 1). Figure 1 shows a map of all BIH implementing jurisdictions and sites

Figure 1. Map of Black Infant Health (BIH) Local Health Jurisdictions and Implementing Sites, FY 2015-2018.

Map of Black Infant Health (BIH) Local Health Jurisdictions and Implementing Sites for fiscal year 2015-2018

Table 1. Black Infant Health (BIH) Program Local Health Jurisdictions (LHJs) and Implementing Sites, FY 2015-2018.

Local Health Jurisdiction Implementing Site (Agency)
Alameda County Alameda County Health Care Services Agency
City of Long Beach City of Long Beach Health and Human Services
Contra Costa County Contra Costa County Health Services
Fresno County Fresno County Human Services System
Kern County Kern County Public Health Service Department
Los Angeles County City of Pasadena Public Health Department (City of Pasadena is a Health Jurisdiction, subcontractor of Los Angeles County Department of Public Health)
Children's Bureau of Southern California (TCB, subcontractor of Los Angeles County Department of Public Health)
The Children's Collective, Inc. (TCC, subcontractor of Los Angeles County Department of Public Health)
Great Beginnings for Black Babies (GBBB, subcontractor of Los Angeles County Department of Public Health)
Riverside County County of Riverside Department of Public Health
Sacramento County County of Sacramento Department of Health & Human Services
San Bernardino County San Bernardino County Department of Public Health
San Diego County Neighborhood House Association (subcontractor of San Diego County Health and Human Services Agency)
San Francisco County Westside Community Services (subcontractor of San Francisco County Department of Public Health)
San Joaquin County San Joaquin County Public Health Services
Santa Clara County Santa Clara County Public Health Department
Solano County Solano County Health and Social Services Department

The model that was evaluated started implementation in 2015 in 12 LHJs. The fiscal year 2015-2016 was a startup year when the sites were getting familiarized with the model and hiring staff. Two large LHJs joined later, San Bernardino in April 2016 and Los Angeles in March 2017, limiting the amount of data available for this evaluation. In total, we report on three fiscal years of data for 12 LHJs, 2.25 years for San Bernardino and 1.33 years for Los Angeles County (excluding Pasadena), the largest health jurisdiction (Table 2).

Table 2. 2015-2018 Black Infant Health (BIH) Program Evaluation: Timeline.

Reporting Period

 (July 1, 2015 through… )

Fiscal Years

Cumulative  Fiscal Years for
San Bernardino County

Cumulative Fiscal Years for
Los Angeles County

June 30, 2016 1.0 0.25
December 31, 2016 1.5 0.75 zero-
March 30, 2017 1.75 1.0 zero-
June 30, 2017 2.0 1.25 0.33
December 31, 2017 2.5 1.75 0.83
June 30, 2018 3.0 2.25 1.33


  1. State Infant Mortality Collaborative: Infant Mortality Toolkit . State Infant Mortality (SIM) Toolkit: A Standardized Approach for Examining Infant Mortality. November 1, 2013. Accessed May 12, 2021.
  2. California Maternal and Infant Health Assessment (MIHA) Survey , Maternal and Infant Health Indicators in Counties Served by the BIH Program. California Department of Public Health; 2019.
  3. 2015-2017 California Birth Statistical Master File.  Data prepared by the California Department of Public Health, Maternal, Child, and Adolescent Health Division.
  4. Fuzzy Set Qualitative Comparative Analysis Software  (fsQCA).  Accessed May 12, 2021.

  5. Ragin CC.  Set relations in social research: evaluating their consistency and coverage.  Political Analysis 2006; 14(3): 291-310.
  6. Introduction to Generalized Linear Mixed Models . UCLA: Statistical Consulting Group. Accessed May 12, 2021.

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