Addressing Disparities in Maternal and Child Health Through Interconceptional Care in Healthy Start

Healthy Start is the first national program to have an explicit focus on the interconceptional care (IC) period. Healthy Start requires follow-up “from the end of one pregnancy to either the next pregnancy or 24 months postpartum, whichever comes first.” The results of an electronic on-line survey of 95 Healthy Start grantee (funded in 2001-5) project directors provide a “point-in-time snapshot” of the implementation of the Healthy Start program component on interconceptional care. In addition, in-depth interviews with Healthy Start staff and participant telephone surveys from participants in eight sites provide information on the implementation of interconceptional care. Results of the project director survey revealed that Healthy Start grantees employed case management staff from a wide spectrum of disciplinary backgrounds, including lay/paraprofessional (71%), social work (66%), nursing (60%), and public health (14%). Although most grantees provided health education services related to IC, fewer addressed medical risk factors such as hypertension, diabetes and obesity. IC services varied by predominant case management background; grantees with predominantly social work staff were more likely to follow clients for two years and those with predominantly lay staff were less likely to provide postpartum needs assessments, smoking cessation/reduction, and obesity-related services. Implications for the future are to improve tracking of participant outcomes in the interpregnancy period, provide more resources to IC counseling and medical risk factors, and assist predominantly “lay” case managers to emphasize the IC period.