Healthy Start is a national demonstration initiative funded by the U.S. Department of Health and Human Services. The program is designed to identify a broad range of community-driven strategies and interventions aimed at reducing the infant mortality rate (IMR) and the number of low birth weight babies in communities battling significantly high IMR.
Pittsburgh/Allegheny County was chosen as one of the first 15 special projects nationwide due to its high infant mortality rate (IMR), especially among low-income white and African-American women. Indeed, the IMR rates among this population, particularly in the city of Pittsburgh, had been among the highest in the nation.
Healthy Start concentrates its efforts in six areas of the county with historically high infant mortality: North Side, Center City, East End and Wilkinsburg, South Side, the Western Communities, as well as Duquesne and Braddock.
Healthy Start focuses on the need to strengthen and enhance community systems of maternal and infant care. It encourages communities to fully address the medical, behavioral and psycho-social needs of women and infants by increasing awareness of infant mortality; streamlining and coordinating services between public and private agencies; and building partnerships of commitment among families, volunteers, businesses, health care and social service providers.
Healthy Start has developed effective community-based approaches to fighting infant mortality, including:
Since beginning in 1991, Healthy Start has seen a 30% decrease in IMR in the six targeted communities in Greater Pittsburgh. Among Healthy Start case-managed participants, the IMR has been reduced by 40%.
In addition to a decrease in the local teen pregnancy rate, there has been a dramatic decrease in sexually transmitted diseases. There is a strong correlation between these public health problems and low birth weight and IMR.
Over a relatively short period of time, Healthy Start has successfully executed a number of tactics to achieve its strategic goal of reducing infant mortality and low birth weight babies, including:
CASE MANAGEMENT: THE CORE TEAM MODEL
Developed as an intensive, community-based effort designed to identify strategies and interventions that aid in preventing infant mortality, Healthy Start has relied upon an innovative case management model for its participants.
Healthy Start defines case management as the coordination of services from multiple providers to meet a participant’s identified needs. Assessment, monitoring, facilitation and follow-up/reinforcement of services utilized by participants are all integral to the success of Healthy Start’s case management service. A coordinated, holistic care regimen for pregnant and parenting women and their families is a cornerstone of the Healthy Start philosophy.
An essential component of Healthy Start’s case management model is the Core Team. Based in six distinct regions, the teams cover 54 Pittsburgh neighborhoods and four other Allegheny County municipalities.
Each team, consisting of a registered nurse and specially trained outreach staff, works to ensure that participants have access to the medical care and human services necessary to assist in building healthy families. The Core Team is responsible for promoting Healthy Start, identifying prospective participants (especially women who are in need of maternal and/or child health services), encouraging healthy lifestyles and linking families with existing services and programs.
Lastly, they act as advocates, assessing the needs of pregnant women, assisting participants with the sometimes cumbersome and confusing social service and healthcare systems and encouraging personal responsibility.
In addition to assisting in the early identification of prenatal problems and postpartum follow-up care of women and infants, every member of the team is responsible for many supplementary duties.
Core Team staff duties include:
To identify prospective participants and serve as a liaison for first-time participants entering the Healthy Start system.
Ensuring that all participants are aware of and utilize fundamental services such as transportation and childcare.
It is important to note that the vast majority of the outreach staff lives in the communities they serve, which brings a higher degree of credibility in the eyes of the participants with whom they work.
Perhaps the most important aspect of the work done by members of the Core Team is home visits with participants. These visits are crucial for participants with high-risk pregnancies, new mothers who had little or no prenatal care and for recently discharged infants born at low birth weight.
The Healthy Start Core Team does not work for participants...they work with them. In a real sense, each Healthy Start participant becomes part of the team.
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