In Chester County, Pa., the Healthy Start program of the Maternal and Child Health Consortium provides countywide prenatal and postpartum home visiting and case management to help promote safe pregnancies and deliveries for low-income women and prompt enrollment of children into pediatric care and health insurance programs. 

At the heart of Healthy Start are 11 Family Health Advocates, most of whom are bilingual and bicultural.  Reflecting the ethnic and cultural characteristics of their communities, Advocates provide a culturally sensitive link between expectant mothers and a complex health care and social service system. 

In a 10-year outcomes report, birth records from 2,435 births (1996 to 2005) to Healthy Start participants were compared with data of Chester County “non-participants” who gave birth during the same period.  The participants that enrolled into Healthy Start were women at highest risk for poor health outcomes (for example, 81 percent were Latino or African American).  Healthy Start participants had rates of low birth weight and preterm birth that were consistently better than national, state, and local rates.  For the time period of 1996-2005, the preterm birth rate for Healthy Start participants was 7.3 percent and surpassed the Healthy People 2010 objective to reduce preterm births to 7.6 percent of all births. 

For the same period, 5.6 percent of Healthy Start infants were born at a low birth weight.  This was just above the Healthy People 2010 national goal that low birth weight rates be reduced to 5 percent.  However, the average low birth weight rate for African American Healthy Start infants was 7.8 percent, much lower than the average low birth weight for African American infants residing in the community area (12 percent) that were not enrolled.  The average low birth weight rate for Latino Healthy Start infants was also significantly lower (4.5 percent than the low birth weight rate for Latino infants residing in the community area (7.9 percent).

The factors contributing to the success of Healthy Start include: culturally responsive staff; strong outreach component; co-location with a network of five accessible, community based offices; a comprehensive training program for home visitors; and tangible services that women value (home visits, access to health insurance, medical interpretation services, and transportation services).  For a copy of the report, please visit www.ccmchc.org.