The impact on clients of a community-based infant mortality reduction program: the National Healthy Start Program Survey of Postpartum Women.

OBJECTIVES: This study assessed the effect of the national Healthy Start Program on its clients. METHODS: We used a cross-sectional survey of a sample from Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) rosters of women less than 6 months postpartum who were residents of Healthy Start Program areas. RESULTS: Healthy Start clients revealed higher sociodemographic risk, but not behavioral risk, for adverse pregnancy outcome than other area residents. They did not differ from other residents in receipt of services except for a greater likelihood of receiving case management, using birth control at the time of the interview, and rating their prenatal care more highly. CONCLUSIONS: The Healthy Start Program succeeded in enrolling women at high risk. It had little effect on the immediately concluded pregnancy, but it might influence future outcomes.

Smoking reduction activities in a federal program to reduce infant mortality among high risk women.

OBJECTIVES: To determine the smoking cessation/reduction services offered to pregnant women by federally funded Healthy Start projects designed to reduce infant mortality. DESIGN: Information was obtained by questionnaires sent to all Healthy Start projects in 1999. Responses were received from 76 sites. SETTING: The federal government selected the Healthy Start sites on the basis of infant mortality rates that were much in excess of the national average. PATIENTS: The projects served largely minority clients. Most of the women were poor and eligible for Medicaid. MAIN OUTCOME MEASURES: The services that projects offered to pregnant smokers, the priority given the smoking related activities, and whether more should be done. RESULTS: Only 23% of the sites thought that they were doing enough to help pregnant smokers stop or reduce smoking. The sites felt the national office should develop a manual of best practices, provide client materials, and organise workshops. While three quarters of the sites expected home visitors to counsel pregnant smokers, less than half provided training in this area during orientation, but most visitors received on-the-job training. Only 64% of sites gave smoking cessation/reduction activities high priority in comparison to other objectives of home visiting. CONCLUSIONS: Although Healthy Start sites were aware of the importance of smoking cessation/reduction activities for their clients, they offered a limited range of services. These projects, and others with similar objectives serving similar populations, need a better understanding of the time and money such interventions require and greater belief in their effectiveness, along with more funds, staff training and materials, and office systems that promote counselling.

Back to the future: community involvement in the Healthy Start Program.

This article discusses how community involvement is incorporated into Healthy Start, a major initiative to reduce infant mortality in selected communities with disproportionately high levels of infant mortality. Based on site visits to each of the fifteen original Healthy Start project areas, we discovered that two main community involvement strategies were used: a service consortium model and a community empowerment model. In the service consortium model, the community is involved primarily through a consortium of local providers, other professionals, and some governmental representatives who help to plan services. The community empowerment model involves the community by engaging neighborhood-based groups, contracting with community-based organizations, employing community residents as lay workers in the Healthy Start program, and creating other economic development initiatives. Important lessons drawn from this study are that the purpose and commitment to community involvement is not always clear; that it is difficult to involve community residents; that efforts to involve the community are extremely labor intensive; that given monetary incentives, it is easier to involve community providers than residents; that community involvement may conflict with efficient program operations; that increased community involvement may create program goals that differ from the program's original goals; and that community involvement may slow program development.