How effective is the Healthy Start program?

Challenge

The Health Resources and Services Administration’s (HRSA’s) Healthy Start program improves outcomes and reduces racial and ethnic disparities in maternal and infant health. The program provides funding to communities across the U.S. and territories that are experiencing high rates of adverse outcomes in infant mortality, preterm birth, low birth weight, and maternal illness. The program aims to reduce health disparities by focusing on the clinical and non-clinical factors that impact health outcomes.

Solutions

Westat is conducting a comprehensive evaluation to assess Healthy Start program implementation nationally. This includes examining program efforts at promoting health equity; community collaborations to facilitate coordination of clinical and non-clinical social services; participants’ utilization of program services; and the impact of services in improving their health outcomes. Additionally, the evaluation involves a transformative component. Westat is examining how local Healthy Start programs engage with health systems and with other programs and policies at the local and state levels to impact positive change in their community.

To answer the research questions, Westat’s evaluators are using multiple sources of primary and secondary data. These data are collected from Healthy Start grantees, their participants, and community collaborators, as well as from one U.S. state’s vital records. The evaluators are conducting both qualitative and quantitative analysis of data from interviews and surveys administered by Westat and of program and participant data reported by Healthy Start grantees to HRSA. Qualitative analysis is highlighting the complex and rich community contexts in which Healthy Start programs implement services to address health disparities. Quantitative analysis, particularly with the use of statistical models, is assessing the impact of Healthy Start dosage on an array of maternal and child health outcomes. Additionally, the evaluators are completing a propensity score analysis with the vital records data for confirmatory analysis of the dosage models.

In addition, Westat is providing capacity-building support to the Healthy Start grantees. Westat has convened webinars with the grantees to provide information on the national evaluation and to assist them with their own evaluations and reporting.

Results

Findings from the mixed-methods evaluation will show the effectiveness of the program on individual-level outcomes and highlight the role of organizational and community-level factors on the successes and challenges of Healthy Start activities and services.

Evaluation results will provide HRSA with information to guide future program and policy decisions related to infant and maternal health in high-risk communities. Program efforts can be directed at improving health outcomes before, during, and after pregnancy to reduce the well-documented racial/ethnic differences in rates of infant death and adverse perinatal outcomes in these communities.