Program Description:

Based on the premise that community-driven strategies are needed to address factors contributing to infant mortality, low birth weight, and other adverse perinatal outcomes in high-risk populations, Healthy Start (HS) projects focus on improving maternal and child health outcomes by increasing access to and use of health services for women and their families while strengthening local health systems and increasing consumer input into these systems of local care. Indeed, a unique program hallmark is Healthy Start’s focus on developing and mobilizing strong community coalitions, local and state governments, the private sector, providers, and neighborhood organizations.

To reduce the factors that contribute to the Nation’s high infant mortality rate, particularly in African-American and Latina women, HS provides intensive services. Services are tailored to the needs of high risk pregnant women, infants and mothers in geographically, racially, ethnically, and linguistically diverse communities with exceptionally high rates of infant mortality.

Core Strategies:

Through the implementation of evidence-based practices and innovative community-driven interventions, HS works with individual communities to build upon their resources (outreach, health education, case management, utilization of prenatal/postnatal care) to improve the quality of and access to health care for women and infants at both service and system levels.  At the service level, beginning with direct outreach by community health workers to women at high risk, HS projects ensure that mothers and infants have ongoing sources of primary and preventive health care and that their basic needs (housing, psychosocial, nutritional and educational support and job skill building) are met.  Following risk assessments and screening for perinatal depression and other risk factors, case managers provide linkages with appropriate services and health education for risk reduction and prevention.  Mothers and infants are linked to a medical home and followed, at a minimum, from entry into prenatal care through two years after delivery (interconceptional).

At the system level, every HS project has developed a consortium composed of neighborhood residents, perinatal care clients or consumers, medical and social service providers, as well as faith and business community representatives.  Together these key stakeholders and change agents address the system barriers in their community, such as fragmentation in service delivery, lack of culturally appropriate health and social services, and barriers to accessing care.  HS projects also have strong collaborative linkages with state programs including Title V MCH Block Grant, Medicaid, State Child Health Insurance Program, and with local perinatal systems such as community health centers.

The close connection between these services can assist in reducing significant risk factors such as smoking and alcohol use, while promoting behaviors that can lead to healthy outcomes for women and their families. These positive relationships and risk-reduction interventions, which begin during the perinatal period, continue to be monitored for both mother and baby for two years after delivery to sustain positive health benefits and to ensure that mothers and infants remain linked to ongoing sources of primary care.

All projects address the needs of their respective community by implementing a set of five core services and four system-building interventions.  The five core services are:

• case management
• education services
• screening and referral for maternal depression
• interconceptional continuity of care through the infant’s second year of life
• outreach