THE NATIONAL HEALTHY START PROGRAM

1. Healthy Start UpdateMeeting of the Secretary’s Advisory Committee on Infant MortalityWashington DC, November 14, 2012 Hani K. Atrash MD, MPHDirectorDept. of Health and Human Services (HHS)Health Resources and Services Administration (HRSA)Maternal and Child Health Bureau (MCHB)Division of Healthy Start and Perinatal Services (DHSPS)

2. THE NATIONAL HEALTHY START PROGRAM Established as a Presidential Initiative in 1991 to reduce infant mortality disparities in high-risk populations through community-based interventions • 1991-1997: 15 sites • 1994-1997: 7 additional sites • 1998-2001: additional funding made available to “Replicate best models/lessons learned from demonstration phase with existing sites serving as resources centers”; • 20 Mentoring(1998-2001) • 50-76 New Communities(1998-2001)

3. THE NATIONAL HEALTHY START PROGRAM • Established as a Presidential Initiative in 1991 to Reduce infant mortality disparities in high-risk populations through community-based interventions • 1991-1997: 15 sites • 1994-1997 : 7 additional sites • 1998-2001: additional funding made available to “Replicate best models/lessons learned from demonstration phase with existing sites serving as resources centers”; • 20 Mentoring(1998-2001) • 50-76 New Communities(1998-2001) 105 grants operating 163 local sites in 39 states plus DC and PR

4. THE NATIONAL HEALTHY START PROGRAM • Objectives: to implement evidence-based practices and innovative community-driven interventions to promote and improve the quality of health care for women and infants. • Approach: work collaboratively with stakeholders and consumers in the community to leverage existing assets at both the service and system levels to ensure continuity of care from pregnancy through 2 years following delivery • Core program goals: • Reduce racial and ethnic disparities in access to and utilization of health services, • Improve local health care systems, • Increase consumer or community voice in health care decisions.

5. THE NATIONAL HEALTHY START PROGRAM 9 core components: • Service Components: • Outreach and participant recruitment, • Health education, • Case management, • Maternal depression screening, and • Interconception care services; • Systems-building components: • Implementation of a consortium, • Development of local health system action plans, • Development of sustainability measures, and • Collaboration and coordination with Title V

6. HEALTHY START AND PERINATAL SERVICES • In 2010, over 90% of all healthy start sites were implementing all 9 core components* • Most healthy start sites offer the following services:* • Home visiting, • Breastfeeding support and education, • Smoking and other tobacco use cessation, • Healthy weight services, • Male and family involvement, • Domestic/intimate partner violence screening, and • Child abuse screening or services *A profile of Healthy Start: Findings from the Evaluation of the Federal Healthy Start Program 2012

7. THE NATIONAL HEALTHY START PROGRAM Reported outcomes • Activities in support of the core components • Awareness of important health priorities • Increased access to services available for participants • Improved systems of care • Participant involvement in programs • Maternal and child health outcomes • Program activities • Staff composition, education, training, and skills • Collaboration and systems building activities

8. THE NATIONAL HEALTHY START PROGRAM Statistics 2010 - The Good News We have done an outstanding job in improving outcomes • Number of infant deaths in HS sites = 90 Expected number of infant deaths = 166* IMR in HS sites = 4.67 compared with 6.15 nationally and 11.63 for Blacks • Number of babies born low birth-weight =1877 • Low birth-weight rate =10% compared with 8.10 nationally and 13.53 for blacks • Number of babies born very low birth-weight = 316 • Very low birth-weight rate 1.7% compared with 1.44 nationally and 2.98 for blacks *Estimated number of infant deaths are race adjusted.

9. THE NATIONAL HEALTHY START PROGRAM Statistics 2010 – Our Challenge We serve a tiny proportion of women • Number of pregnant women served per year = 30,759 • Number of women served during interconception period = 28,876 • Number of babies born per year = 19,273 0.49% of the 3,953,593 babies born nationally • Number of infant deaths in Healthy Start sites = 90 0.37% of the 24,586 infant deaths nationally

10. All US Deliveries in 2010 = 3,953,593 HS Deliveries in 2010 = 19,273 0.49%

11. All US Infant Deaths in 2010 = 24,586 HS Infant Deaths in 2010 = 90 0.37%

12. THE NATIONAL HEALTHY START PROGRAM Why are we talking about transformation? We have a responsibility to: • Demonstrate effectiveness with a focus on health outcomes • Demonstrate sustainability and impact on systems • Scale up and disseminate interventions to serve the larger population We must respond to critics and acknowledge and act on the need to change

13. THE NATIONAL HEALTHY START PROGRAM – 3.0 Updated Goals • Assure Access to healthcare across life-course continuum • Promote Resilience: positive coping skills, financial literacy, interpersonal communication, healthy relationships, and faith and social capital • Improve Quality and support translational research from bedside to curbside to policy • Enhance System Integration: vertical, horizontal, and longitudinal • Drive Community Transformation

14. Drive Community Transformation –Place-Based, Systems Approach • Health system • A “medical home” for women’s health that offers pre- and interconception care, quality prenatal and intrapartum care, systems navigation and integration, and cost-control platform; • Educational system • A “pipeline to success” that begins early with “baby college” and quality early childhood education, “promise academy” and youth development programs; • Economic system • An “opportunity incubator” that combines macroeconomic policies (e.g. empowerment or enterprise zones) with capital development (e.g. microfinance), business incubation and job training, financial literacy and asset development for families, and high-functioning safety net programs; and • Community system • A “healthy community” that promotes environmental justice, healthy foods and physical activities, strong fatherhood and families, and racial equity.

15. The Five Pillars of HS 3.0

16. Reinventing Healthy Start – ApproachesThe A,B,C,D, and E Assessment Blueprint Capacity-Building Development Evaluation & Quality Improvement

17. Reinventing Healthy Start - Approaches Assessment: community readiness for change and project’s capacity for leading change Blueprint: common design to local needs and capacities Capacity-Building: community engagement, transformative leadership, systems design, improvement and innovation, measurement, mapping and evaluation, and policy and advocacy Development: social capital, political capital, and venture capital Evaluation & Quality Improvement: focus on process & outcome and leading to quality improvement

18. Next Steps Build on What We Already Have • Review current literature • Review advice and guidance from key stakeholders • Convene healthy start transformation taskforce • Multidisciplinary group with diverse backgrounds and expertise • Credible group whose input will be highly respected and accepted

19. Current Thinking • Standardized components and practices • Place-based systems approach • Common benchmarks focused on the 5 pillars • Strong evaluation platform • Scientifically rigorous • Evidence based • Quality improvement

20. Contact Us Hani K. Atrash MD, MPH Director Division of Healthy Start and Perinatal Services hatrash@hrsa.gov Tel 301-443-7678