Healthy Start
Among the Ojibway, Odawa and Potawatomi people, Tribal communities in Michigan collectively known as the People of the Three Fires, women, infants and families often do not receive the healthcare and prevention services that they need to maintain good health. A variety of factors contribute to compromised maternal and child health (MCH) within Native American communities. These include high rates of smoking, substance abuse, domestic violence and chronic diseases such as diabetes, obesity, and cancer. Excessive post neonatal deaths and SIDS, which are two to four times greater than for Whites, are significant concerns. In addition, many American Indians suffer from the profound effects of racism and inter-generational grief. The Michigan Inter-Tribal Council subcontracts with 8 tribal/urban sties to offer Healthy Start services: Bay Mills Indian Community, Hannahville Indian Community, Keweenaw Bay Indian Community, Lac Vieux Desert Band, Little Traverse Bay Bands, Saginaw Chippewa Tribe, the Grand Rapids Metro Area, and American Indian Health & Family Services of Southeast Michigan.
Based on the premise that community-driven strategies are needed to address factors contributing to infant mortality, low birth weight, and other adverse perinatal outcomes in high-risk populations, Healthy Start (HS) projects focus on improving maternal and child health outcomes by increasing access to and use of health services for women and their families while strengthening local health systems and increasing consumer input into these systems of local care. Indeed, a unique program hallmark is Healthy Start’s focus on developing and mobilizing strong community coalitions, tribal, local, and State governments, the private sector, providers, and neighborhood organizations.
To reduce the factors that contribute to the Nation’s high infant mortality rate, particularly in American Indian and other disparate minority groups, HS provides intensive services. Services are tailored to the needs of high risk pregnant women, infants and mothers in geographically, racially, ethnically, and linguistically diverse communities with exceptionally high rates of infant mortality.
Core Strategies: Through the implementation of evidence-based practices and innovative community-driven interventions, HS works with individual tribal communities to build upon their resources (outreach, health education, case management, utilization of prenatal/postnatal care) to improve the quality of and access to health care for women and infants at both service and system levels. At the service level, beginning with direct outreach by community health workers to women at high risk, HS projects ensure that mothers and infants have ongoing sources of primary and preventive health care and that their basic needs (housing, psychosocial, nutritional and educational support and job skill building) are met. Following risk assessments and screening for perinatal depression and other risk factors, case managers provide linkages with appropriate services and health education for risk reduction and prevention. Mothers and infants are linked to a medical home and followed, at a minimum, from entry into prenatal care through 2 years after delivery (interconceptional).
At the system level, every HS project has developed a consortium composed of neighborhood residents, perinatal care clients or consumers, medical and social service providers, as well as faith and business community representatives. Together these key stakeholders and change agents address the system barriers in their community, such as fragmentation in service delivery, lack of culturally appropriate health and social services, and barriers to accessing care. HS projects also have strong collaborative linkages with state programs including Title V MCH Block Grant, Medicaid, State Child Health Insurance Program, and with local perinatal systems such as community health centers.
The close connection between these services can assist in reducing significant risk factors such as smoking and alcohol use, while promoting behaviors that can lead to healthy outcomes for women and their families. These positive relationships and risk-reduction interventions, which begin during the perinatal period, continue to be monitored for both mother and baby for two years after delivery to sustain positive health benefits and to ensure that mothers and infants remain linked to ongoing sources of primary care.
Background: Originally established in 1991, 15 locations around the country were funded as HS Demonstration Projects. Since then, the program has been authorized and has grown to include 99 communities in 38 States, the District of Columbia, and Puerto Rico. Communities that are served by HS have large minority populations with high rates of unemployment, poverty and major crime. Parents at highest risk for adverse perinatal health outcomes typically have less than a high school education, low income and limited access to safe housing. Within their community, the number of perinatal providers is limited; regular access to these providers is challenged by long commutes accomplished only with help from friends for those living in rural areas or on crowded public transportation in urban areas. While each project is unique, using local input to shape strategies, all projects share the same “core” program goals: to reduce racial and ethnic disparities in access to and use of health services; to improve local health care systems; and, to increase consumer or community voice in health care decisions.
Current Activities: Since 1997 the Michigan Inter-Tribal Council has successfully provided Healthy Start case management, health education, advocacy and referral services to Native American families at seven sites. As late as 1996, there were no MCH services in most of the State designed for Native women and infants. Since the introduction of Healthy Start, the downward trend of Native American infant mortality within the project area seems to be continuing, with the disparity gap narrowing between White and American Indian infants. Other impressive trends include a marked increase in first trimester prenatal care, an increase in those securing a medical home, increased screening for pregnancy and postpartum health risks, and increased use of culturally competent elements in policies, guidelines and trainings.
The project goals are to increase access to and use of perinatal and interconceptional services for Native Americans and improve perinatal outcomes. The provision of core services of outreach and recruitment, case management, health education, interconceptional care, and depression screening and referral will be central to the project using a variety of standard, cultural and innovative methods. Nurses and outreach workers at each site coordinate care and education for up to two years postpartum as part of seamless case management. Community members participate in project development and implementation. The Michigan Inter-Tribal Council designs strategies and partnerships to effectively address prevalent maternal and child issues and promote MCH systems improvements using a well-coordinated consortium, community education, provider training, and collaboration with State Title V personnel and other MCH agencies.
All projects address the needs of their respective community by implementing a set of five core services and four system-building interventions. The five core services are direct outreach services and client recruitment; case management; health education services; screening and referral for maternal depression; and interconceptional continuity of care through the infant’s second year of life. In addition, projects are expected to engage in a number of system-building efforts to strengthen local health systems and to bring a consumer or community voice to efforts to improve maternal and infant health. The four system-building interventions that grantees are expected to establish are: utilization of community consortia and provider councils to mobilize key stakeholders and advise local grantees; development of a local health action plan; collaboration and coordination with Title V services; and development of a plan for continuation of services and project work beyond the grant period. All of these projects provide services that cover prenatal and interconceptional care for women and health care for infants for populations in the target areas.
Recent Presentations
Inter-Tribal Council of Michigan visual presentations are available for download