Attachment B

Attachment B. Healthy Start Program Goals and Outcomes
Excerpt from RFTOP No. HRS13540-dp Title: An Evaluation of Core Components of the Federal Healthy
Start Program: A Cross-Site Examination, Attachment A; August 3, 2009.

Healthy Start Program Goals and Outcomes
These goals and outcomes expected to accrue for the Healthy Start program have been
conceptualized in terms of a progression from the achievement of a number of intermediate
outcomes, which are called “core program goals” to the achievement of a set of longer-term
outcomes, which are called “maternal and child outcomes.” Theoretically, improvements in core
program goals (the intermediate outcomes) should be significantly related to improvements in
maternal and child outcomes (the long-term outcomes).
The core program goals include:
1. Reduced racial and ethnic disparities in access to and utilization of health services
2. Improved local health care system
3. Increased consumer or community voice in health care decisions.
There are also a set of maternal and child outcomes that are the primary focus for evaluating
Healthy Start, and these include:
1. Birth outcomes including infant mortality and low/very low birth weight
2. Maternal health including health risk behaviors
3. Inter-pregnancy/inter-delivery interval and birth spacing
4. Child health during the first two years of life.
These maternal and child outcomes consist of improvements that are expected to occur if
program elements are successfully and completely implemented and if the core program goals
are achieved. These outcomes should be observed at a later point in the project as a result of the
intermediate outcomes being reached and only after the fully implemented program model has
been operating for a sufficient period of time.
There is also an important distinction between these two types of program outcomes or goals.
For the most part, the maternal and child outcomes are focused on Healthy Start program
participants and the gains they make in their birth outcomes, subsequent pregnancies, maternal
health, and the health of their children, while the core program goals are focused on changes that
the Healthy Start program has made in the larger community. This divergence between sets of
program outcomes or goals is derived partially from the distinction in the program elements
between service delivery and system building interventions. Whereas the service delivery
activities are aimed primarily at improving maternal and child health outcomes, the system
building interventions are aimed primarily at improving community conditions such as those
addressed by the core program goals. The underlying theory for Healthy Start is that changes
in maternal and child outcomes cannot take place unless the contextual conditions in the
larger community that contribute to or maintain problems, such as infant mortality, are
addressed. This distinction has important consequences for the measurement of program goals
and outcomes in the evaluation.