Performance Improvement 1999. Maternal and Child Health


TITLE: The Implementation of Healthy Start: Lessons for the Future

ABSTRACT: The Healthy Start program was begun in 1991 to demonstrate innovative ways to reduce infant mortality by 50 percent over five years (later changed to 6 years) in areas with some of the highest rates. The National Evaluation of the program includes a cross-site process component and an outcome study of the initial 15 sites. The report summarized here is the final product from the process component. This report features an analysis of the factors that facilitated or impeded implementation in 14 of the 15 original projects. (A separate report will be issued on the Northern Plains project.) Qualitative data from site visits and focus groups of clients and providers were used in conjunction with a client data set and interviews with postpartum women. The study found that program elements include: (1) community involvement through a consortium and other community empowerment strategies; (2) outreach and case management, generally using lay workers for many functions; (3) nontraditional support services, such as transportation and nutrition education; (4) enhanced clinical services, building on an existing delivery system; and (5) community-wide public information campaigns. Clients and providers gave positive feedback about Healthy Start services. This process study found that local communities can, with substantial Federal funding, develop and implement innovative approaches to reducing infant mortality. The extent to which projects were able to manage effectively--that is, to develop and execute sound administrative procedures, recruit and retain a strong staff (especially senior staff) and monitor contractors--made the difference between successful and less-than-successful implementation. The final report of the National Evaluation, due in March 2000, will discuss the issue of whether these projects have led to a measurable reduction in infant mortality. (See PIC ID 5610)

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Karen Thiel Raykovich, Ph.D.

PHONE NUMBER: 301-443-3070

PIC ID: 5610.1

PERFORMER ORGANIZATION: Mathematica Policy Research, Inc. Washington, DC