Dallas Healthy Start (DHS) is a program of Parkland Health & Hospital System. DHS was originally funded in 1994 to promote healthy birth outcomes by improving the health and well being of women, adolescents, and children through promotion of healthy lifestyles, education, and the coordination of community resources. The program currently serves six target zip codes (75210, 75215, 75224, 75227, 75228 and 75237) which have the highest rates of infant mortality in Dallas County. DHS receives funding from Health Resources and Services Administration (HRSA) to focus on four core areas: Consortium, Health Education, Case Management and Outreach.

The core program components (outreach, case management, health education and consortium) are integrated together to ensure that a seamless continuum of care is provided to the targeted population. The outreach/recruitment activities are implemented in a culturally sensitive manner to identify women and infants in the project area zip codes who have high-risk health indicators and are not receiving adequate care. Women and infants are enrolled and receive case management including the coordination of care and community resources. Participants are empowered through education provided in both one-on-one and group formats. DHS has continued to make significant strides in forming new partnerships with agencies, schools, faith-based organizations and community groups. Sustainability efforts resulted in the award of a March of Dimes grant to fund an outreach worker and a mental health counselor. This allowed DHS to expand recruitment and offer more comprehensive depression screening services. The addition of a mental health counselor is a significant accomplishment as it provides an avenue for in-home counseling services for the approximately 25% of women with elevated depressing screening scores.

The Fort Worth Healthy Start Initiative is a program of Catholic Charities Diocese of Fort Worth, Inc. Catholic Charities Diocese of Fort Worth, Inc. is an independently incorporated non profit social service agency which is separately governed from the Catholic Diocese of Fort Worth. The agency has been meeting the needs of children and families in Tarrant County and surrounding areas since 1910. The project was implemented in 1998 to address issues related to the elimination of racial and ethnic disparities in perinatal health outcomes for African-American and Hispanic women in Tarrant County, Texas. The program currently serves eight target zip codes (7601, 76012, 76014, 76053, 76102, 76104, 76105, and 76112), which has the highest rates of infant mortality in Tarrant County. The project is funded by Health Resources and Services Administration (HRSA) and Catholic Charities Diocese of Fort Worth, Inc.

The core program components (outreach, case management, health education, and consortium) are integrated to ensure a continuum of care for the targeted population. Outreach is conducted by program staff through recruitment sources established by collaborative agreements. Case Management is provided by a staff of multidisciplinary Bachelor level professionals who possess similar cultural backgrounds as program participants. The case management focus for male participants is life skills training, assistance with job training and retention as well as preparing for fatherhood. Health Education courses are developed to address specific needs of each man, woman and child.

SUNNY FUTURES Healthy Start (SFHS) is located at the Harbach-Ripley Community Center a part of Neighborhood Centers Inc. NCI was awarded a planning grant in 1997 to conduct a need assessment and develop a grant that was suitable to serve a small population in the inner city of Houston, Texas. The program was funded in 1998 as one of the smaller Healthy Start Replication sites, offering the mandated Consortium Model and one additional model, Education and Training model. The mission of SFHS is to provide community-based, family-centered, comprehensive perinatal services to women, teenagers, infants and their families located in the Sunnyside, Third Ward, and Fifth Ward communities of Houston, Texas. SFHS under the auspices of Neighborhood Centers Inc., works with the SFHS Consortium, the Houston Department of Health and Human Services, Title V, and other local collaborators and service providers of maternal and child health care as a provision for the target population. This includes: care coordination services through case management, health education and training outreach as well as Consortium participation.

SFHS continues to use an innovative and interactive approach to further develop and implement the core interventions as defined by HRSA in order to eliminate disparities in perinatal health. SFHS project staff will work with the SFHS Consortium to coordinate resources and services throughout the perinatal system of the project area. SFHS will continue to coordinate activities with state and local officials to avoid duplication of services and increase service integration. Staff and provider training activities are coordinated with local medical centers, universities, managed care organizations, faith-based organizations and community-based organizations.

Healthy Start Laredo (HSL) was funded in July 2001 and is currently in its sixth year of existence. The goal of the Healthy Start Laredo program is to enhance the perinatal service delivery system to the residents of the Webb County colonias. Colonias are generally unincorporated neighborhoods or subdivisions that lack the physical infrastructure such as water, power and sewer systems that would make them safe and livable. These conditions, along with issues of transportation, are responsible for extreme disparity in access to adequate health care. Therefore, HSL utilizes a mobile medical clinic to deliver quality health care to colonia residents. The service delivery team consists of a medical team, case management team, and an outreach team to accomplish program goals. In light of the above problems, Healthy Start Laredo strategized a simple but workable solution to take perinatal services to the colonias via a mobile medical clinic.

The mobile medical clinic bypasses many of the barriers to healthcare access that colonia residents face. In partnership with a team of Promotoras (Outreach Workers), the mobile clinic is coordinated with community centers located within the colonias. The centers were constructed to facilitate interaction between residents and service providers, and they have become trusted gathering places within the communities. The mobile medical clinic will also travel to colonias that are isolated even from the centers. The primary intervention in this model is the provision of perinatal health services to women and children who would otherwise not receive them. Once a pregnant woman is referred to the mobile clinic, she is screened and treated for illnesses and conditions that might negatively impact the unborn baby’s health. Postnatal follow-up assessment and treatment, along with well and sick infant care, is also offered to all clients.

The San Antonio Healthy Start is a division of the San Antonio Metropolitan Health District. The San Antonio Healthy Start focuses on the eastern and southwestern regions of the city. These areas are of special concern due to the disparities between infant mortality rates for African Americans as well as poor birth outcomes for Hispanics residing in high risk areas. The program’s efforts are concentrated in 15 designated zip code areas within San Antonio. The attentiveness to these zip codes is based on the high incidences of poor birth outcomes and infant mortality. The target zip code areas were found to have an infant mortality rate of 12.11 per 1000 live births which is well above the national average of 6.9 per 1000 live births and the Healthy People 2010 goal of 4.5 per 1000 live births. The targeted zip codes areas are: 78154, 78202, 78203, 78205, 78207, 78210, 78211, 78215, 78217, 78218, 78219, 78220, 78239, 78244, and 78254.

Outreach staff work in the community to reach pregnant women who are not receiving adequate prenatal care. These women are referred to case managers who work closely with them to ensure they receive prenatal care and other necessary assistance for a healthy pregnancy and healthy baby. Case managers follow the family through the child’s first two years of life. A public information campaign raises awareness among county residents about infant mortality, while health education activities conducted in the community and with clients address issues that impact a healthy pregnancy, healthy baby and ultimately a healthy community.

The U.S. Health and Human Services Administration, Maternal and Child Health Bureau funded the Valley Primary Care Network (VPCN) Healthy Start Initiative for a four-year project period, which began in June 2000. The VPCN Healthy Start Program was awarded funding for additional four year period beginning August 2004 – May 2008. The mission is to ensure that children in the Texas Lower Rio Grande Valley have a healthy start in life. Women of childbearing age in the VPCN Borderplex area are less like to receive care in their first trimester, are more likely to receive inadequate care, and one-third are uninsured. The VPCN Healthy Start Program provides services to Hispanic women living in the VPCN Borderplex area through one of the four federally qualified health centers (FQHC) encouraging women to seek early and regular prenatal care. The four Community/Migrant Health Centers include Brownsville Community Health Center, Community Action Council of South Texas, Nuestra Clinica del Valle, and Su Clinica Familiar. The VPCN Borderplex area is comprised of Cameron, Willacy, Hidalgo, Starr, and Zapata Counties in the Texas Lower Rio Grande Valley.

The VPCN HSP experience to date demonstrates of the 178 new clients enrolled as of January 1, 2005, 60% of new clients enrolled have incomes between 100-85% of the Federal Poverty Level (FPL) and 34% have incomes below 100% of the FPL. 100% of the new clients have at least one risk factor for diabetes, 33 % are overweight, and 27 % are obese. These two risk factors along with, the most prevalent, a family history of diabetes, are significant given that the average age of women seeking prenatal care at the community health centers is between 19-34 years of age. During Calendar Year 2005 VPCN HSP contacted 4,463 individuals providing them with health education during community education presentations, one-to-one encounters, and local community health fairs. Of the 167 babies that were born to participants during 2005, 87% of HSP mothers initiated breastfeeding in the early postpartum period, 14% at six months continue to breastfeed and 3% at one year. In addition, Dr. Tina Fields, HSP External Evaluator, has reported that 97% of enrolled HSP infants (up to two years of age) have been fully immunized and 74% of women who delivered received adequate prenatal care. These successes demonstrate the success of community outreach, health education, and case management services provided by the VPCN HSP.