Maternal and Child Health Bureau - Healthy Start Program

Healthy Start Program

The History of Healthy Start
Healthy Start began in a small area of Oahu, Hawaii in 1985 as a child abuse prevention demonstration project. The home visiting program was so successful it was expanded to other area of the state, and as word of the demonstrated positive outcomes spread, Hawaii's Healthy Start became a model for parenting education programs nationwide. In the early 1990s, Healthy Families America and the National Healthy Start Association began to standardize and credential programs to ensure effectiveness and research-based practices. In 2010, ironically, Hawaii's Healthy Start Program is at risk for cancellation due to budget cuts.

Healthy Families America
Healthy Families America is a national program model designed to help expectant and new parents get their children off to a healthy start. Families participate voluntarily in the program and receive home visiting and referrals from trained staff. By providing services to overburdened families, Healthy Families America fits into the continuum of services provided to families in many communities.

The program was launched in 1992 by Prevent Child Abuse America (formerly known as the National Committee to Prevent Child Abuse) in partnership with Ronald McDonald House Charities and was designed to promote positive parenting, enhance child health and development and prevent child abuse and neglect.

In most regions, HFA services are expressed as the Healthy Start Program. Healthy Start is a voluntary family support and parent education home visiting program. It helps first-time families give their newborn children the best start in life.

Healthy Start offers all first-birth families, around the time their baby is born, free screening and information. Parents receive information on topics like child development, infant care and keeping their baby healthy, and learn about what's going on in their communities to support new families.

Many families are eligible for home visits with a trained parent coach, or Family Support Worker, who coaches them as they build their skills as parents and help their baby be safe and healthy, grow and learn.

The goal of Healthy Start is to increase the number of children ready for school and reduce the likelihood of child abuse and neglect in participating first-birth families by improving parenting skills, enhancing family functioning, and increasing families' connections with other resources. Healthy Start has shown that it works to reduce child maltreatment and increase children's readiness for school.

National Healthy Start Association
The National Healthy Start Association (NHSA) is an advocacy and networking group for Healthy Start programs. The mission of the National Healthy Start Association is to promote the development of community-based maternal and child health programs, particularly those addressing the issues of infant mortality, low birthweight and racial disparities in perinatal outcomes.

As part of its mission, the NHSA supports the expansion of a wide range of activities and efforts that are rooted in the community and actively involve community residents in their design and implementation. • Educate its members, the public at large, federal, state and local policymakers and elected officials on the need for and effectiveness of community-based programs to reduce infant mortality, low birthweight, and racial disparities in perinatal outcomes. • Provide a nationwide communications and technical assistance network for the exchange and dissemination of "models that work." • Increase public awareness concerning the needs of pregnant women, infants, children and families. • Identify common factors that impact maternal and child health status and develop strategies to sustain Healthy Start and other community-based maternal and child health programs. • Collect and analyze data and publish reports on evaluation findings and lessons learned from Healthy Start programs.

Healthy Start programs rely on standards set by Healthy Families America. HFA is based upon a set of critical program elements, defined by more than 20 years of research. Over the past several years, states across the country have embraced the critical elements of HFA and are working toward implementing statewide home visitation policies and programs. The critical elements represent the field's most current knowledge about how to implement successful home visitation programs.

All affiliated and credentialed HFA programs adhere to these critical elements which provide the framework for program development and implementation. Staff are trained on the critical elements. Programs are credentialed based on adherence to the critical elements. In addition to helping assure quality, the critical elements allow for flexibility in service implementation to permit integration into a wide range of communities and provide opportunities for innovation.
The following are descriptions of each critical element.
Service Initiation
Initiate services prenatally or at birth.

Use a standardized (i.e. in a consistent way for all families) assessment tool to systematically identify families who are most in need of services. This tool should assess the presence of various factors associated with increased risk for child maltreatment or other poor childhood outcomes (i.e. social isolation, substance abuse, parental history of abuse in childhood).

Offer services voluntarily and use positive outreach efforts to build family trust.
Service Content
Offer services intensively (i.e. at least once a week) with well-defined criteria for increasing or decreasing frequency of service and over the long-term (i.e. three to five years).

Services should be culturally competent such that the staff understands, acknowledges, and respects cultural differences among participants; staff and materials used should reflect the cultural, linguistic, geographic, racial and ethnic diversity of the population served. Services should focus on supporting the parent as well as supporting parent-child interaction and child development.

At a minimum, all families should be linked to a medical provider to assure optimal health and development (e.g. timely immunizations, well-child care, etc.) Depending on the family's needs, they may also be linked to additional services such as financial, food, and housing assistance programs, school readiness programs, child care, job training programs, family support centers, substance abuse treatment programs, and domestic violence shelters.

Services should be provided by staff with limited caseloads to assure that home visitors have an adequate amount of time to spend with each family to meet their unique and varying needs and to plan for future activities (i.e., for many communities no more than 15 families per home visitor on the most intense service level. And, for some communities the number may need to be significantly lower, e.g. less than 10).
Staff Characteristics
Service providers should be selected because of their personal characteristics (i.e. non-judgmental, compassionate, ability to establish a trusting relationship, etc.), their willingness to work in or their experience working with culturally diverse communities, and their skills to do the job. Service providers should have a framework, based on education or experience, for handling the variety of situations they may encounter when working with at-risk families. All service providers should receive basic training in areas such as cultural competency, substance abuse, reporting child abuse, domestic violence, drug-exposed infants, and services in their community.

Service providers should receive intensive training specific to their role to understand the essential components of family assessment and home visitation (i.e. identifying at-risk families, completing a standardized risk assessment, offering services and making referrals, promoting use of preventive health care, securing medical homes, emphasizing the importance of immunizations, utilizing creative outreach efforts, establishing and maintaining trust with families, building upon family strengths, developing an individual family support plan, observing parent-child interactions, determining the safety of the home, teaching parent-child interaction, managing crisis situations, etc.).

Service providers should receive ongoing, effective supervision so that they are able to develop realistic and effective plans to empower families to meet their objectives; to understand why a family may not be making progress and how to work with the family more effectively; and to express their concerns and frustrations so that they can see that they are making a difference and in order to avoid stress-related burnout.

Links for more information:

Prevent Child Abuse America

Healthy Families America

National Healthy Start Association

Ronald McDonald House Charities