Selected findings from the evaluation of the federal healthy start program

Background: Initiated in 1991, the Federal Healthy Start Program includes 105 community-based projects in 39 states, the District of Columbia and Puerto Rico. Healthy Start projects work collaboratively with community stakeholders, leveraging existing resources to ensure participants' continuity of care during pregnancy through two years postpartum. We examined relationships between the required program components and long term program and birth outcomes in addition to factors that influence these relationships.

Methods: Program components and outcomes were examined using self-reported data from a 2010 Project Director Survey (N=104 projects) and 2009 performance measures data from the Maternal and Child Health Bureau Discretionary Grant Information System (N=99). We used descriptive statistics to explore bivariate relationships and multivariate linear and logistic regressions to assess independent associations between program components and achievement of long-term birth outcomes, adjusting for grantee characteristics and intermediate outcomes.

Results: In 2010, 57 projects implemented all 9 program components; 100% implemented core service components and 66% implemented core systems components. Projects implementing all program components were significantly more likely to report increased access to services; integration of prenatal, primary care, and mental health services; and screening for perinatal depression. Implementation of all program components was significantly associated with improvements in self-reported maternal and child health outcomes, but was not associated with singleton low birth weight and/or infant mortality rates.

Conclusion: The evaluation of Healthy Start programs using self-reported data and performance measures revealed a mixed set of relationships between program components and long-term maternal and child health outcomes.