Attachment D: Healthy Start Benchmarks

Healthy Start Benchmarks

Data Dictionary

June 2016

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of
Health and Human Services (HHS) under grant number UF5MC26845 for $2,843,570. This information or content
and conclusions are those of the author and should not be construed as the official position or policy of, nor should
any endorsements be inferred by HRSA, HHS or the U.S. Government.

Healthy Start Benchmarks - Data Dictionary
This manual includes a brief introduction to the Healthy Start (HS) Program Measures,
definitions and terms, and instructions for accurately capturing Healthy Start Benchmark
Measures.
Healthy Start works to improve maternal and child health outcomes in communities, nationwide.
It is an initiative of the Maternal and Child Health Bureau (MCHB), Health Resources and
Services Administration (HRSA), and the US Department of Health and Human Services (HHS).
Healthy Start programs serve communities with infant mortality rates at least 1.5 times the
national average, and high rates of low birth weight, preterm birth, and maternal mortality 1.
The Healthy Start Program has established benchmarks and goals for performance as follows.
These benchmarks will also be the performance measures for DGIS performance reporting for
Healthy Start programs.
1. Increase the proportion of Healthy Start women and child participants with health insurance to
90% (reduce uninsured to less than 10%)
2. Increase the proportion of Healthy Start women participants who have a documented reproductive
life plan to 90%.
3. Increase the proportion of Healthy Start women participants who receive a postpartum visit to
80%.
4. Increase proportion Healthy Start women and child participants who have a usual source of
medical care to 80%.
5. Increase proportion of Healthy Start women participants that receive a well-woman visit to 80%.
6. Increase proportion of Healthy Start women participants who engage in safe sleep practices to
80%.
7. Increase proportion of Healthy Start child participants whose parent/ caregiver reports they were
ever breastfed or pumped breast milk to feed their baby to 82%.
8. Increase proportion of Healthy Start child participants whose parent/ caregiver reports they were
breastfed or fed breast milk at 6 months to 61%.
9. Increase the proportion of pregnant Healthy Start participants that abstain from cigarette smoking
to 90%.
10. Reduce the proportion of Healthy Start women participants who conceive within 18 months of a
previous birth to 30%.
11. Increase proportion of Healthy Start child participants who receive the last age-appropriate
recommended well child visit based on AAP schedule to 90%.
12. Increase the proportion of Healthy Start women participants who receive depression screening
and referral to 100%.
13. Increase proportion of Healthy Start women participants who receive intimate partner violence
(IPV) screening to 100%.
14. Increase proportion of Healthy Start women participants that demonstrate father and/or partner
involvement (e.g., attend appointments, classes, etc.) during pregnancy to 90%.
15. Increase proportion of Healthy Start women participants that demonstrate father and/or partner
involvement (e.g., attend appointments, classes, infant/child care) with their child participant to
80%.
1

Healthy Start FOA

2

16. Increase the proportion of Healthy Start child participants aged <24 months who are read to by a
parent or family member 3 or more times per week to 50%

17. Increase the proportion of HS grantees with a fully implemented Community Action Network
(CAN) to 100%.
18. Increase the proportion of Healthy Start grantees with at least 25% community members and
Healthy Start program participants serving as members of their CAN to 100%.
19. Increase the proportion of HS grantees who establish a quality improvement and performance
monitoring process to 100%.

All Healthy Start grantees are expected to collect data and report performance on all 19
benchmarks, annually. Level 3 grantees have an additional benchmark to participate in the HS
CoIIN for a total of twenty. In general, Healthy Start benchmarks are aligned with national
performance to enable comparisons between the U.S. population at large and those served by
Healthy Start Program Grantees.
Definitions
This section provides definitions which are critical for consistent reporting of Healthy Start data
across grantees.
Healthy Start (HS) Participant
Every Healthy Start program is required to report the total unduplicated count of participants
receiving Healthy Start services during each reporting period. An unduplicated count refers to
the fact that a participant counts only once towards the total count regardless of the number and
type of contacts they have with the Healthy Start program.
Healthy Start participants include women of child bearing age and their children up to the age of
two.
•

Woman Participant: A woman is counted as a Healthy Start woman participant for the
purposes of benchmark reporting if she 1) is of childbearing age (generally between 15 to
45 years of age), 2) has completed the enrollment process including all required
paperwork, and 3) has one or more contacts with the Healthy Start program during the
reporting period.

•

Child Participant: A child is counted as a Healthy Start child participant if the child’s
mother is currently enrolled as a Healthy Start woman participant and the child is aged
<24 months during the reporting period. A child aged <12 months is also referred to as
an infant participant.

Women Participants by Perinatal Period
To accurately report Healthy Start benchmarks, all participants eligible for the benchmark must
be identified. Since selected benchmarks apply to specific perinatal periods, the Healthy Start
program must track all perinatal periods a woman participant experiences during the reporting
period. This is referred to as a duplicate count since the same woman may experience more than
one perinatal period during the reporting period. However, the count for each prenatal period
must be unduplicated. For example, a woman may be pregnant at the beginning of the year and
3

deliver during the year, in which case she would be counted as a pregnant participant and a postpartum participant during the reporting period, but only once in each. The four perinatal periods
are tracked:
•

Preconception Woman – This phase refers to the time period before a first
pregnancy. During this phase, the Healthy Start program works with women (and
sometimes partners) to improve their own health, and promote family planning.

•

Prenatal Woman – This phase refers to the time period from diagnosis of
pregnancy to birth.

•

Postpartum Woman – This phase refers to the time period from delivery up till
the infant is six months of age. During this phase, the Healthy Start program
works with mothers, infants and families to optimize maternal and infant health.

•

Parenting Woman – This phase refers to the time period following the
postpartum period from six months through two years of age. During this phase,
the Healthy Start program works with mothers, babies and families to strengthen
family resilience, creating a foundation for optimal child health and development.

Males
•

Males: Although males are not counted as Healthy Start participants, the Division of
Healthy Start and Perinatal Services (DHSPS) recognizes the importance of male
involvement in the health and wellbeing of women and their children. Healthy Start
programs are required to report an unduplicated count of males having one or more
contacts with the Healthy Start program regardless of whether they are affiliated with an
enrolled participant.
•

Male Partners: In addition to the total count of males having one or more
contacts with the Healthy Start program, a count of males who are affiliated with
a Healthy Start participant as a partner, husband or father of an enrolled infant is
tracked.

•

For the purposes of the benchmarks that measure male involvement, the child’s
father and/ or the Healthy Start woman participant’s partner can be the ‘involved’
party. This definition is intended to acknowledge that some father’s may not be in
a position to be involved (deceased, incarcerated, danger to mother or child, etc.)
and most, but not all, partners are male.

Enrollment
A participant is considered to be "enrolled" in the Healthy Start program after completing all
required intake paperwork/ processes. The participant continues to be considered enrolled in the
program during any reporting period that the participant has one or more contacts with the
Healthy Start program. Therefore, the term ‘enrolled’ encompasses initial enrollment and
subsequent periods.

4

Reporting Period
January 1 – December 31 (though may differ the initial reporting period)
All benchmarks are to be reported as of the last available data for each participant in
reporting year.

5

1. PERFORMANCE
MEASURE
Approach: Improve
Women’s Health
Related DGIS Measure: LC1
GOAL

The percent of Healthy Start women and child participants with health
insurance.

To increase the proportion of Healthy Start women and child
participants with health insurance to 90% (reduce uninsured to less
than 10%)

MEASURE

The percent of Healthy Start women and child participants with health
insurance.

DEFINITION

1a.
Numerator: Number of Healthy Start (HS) women participants with
health insurance as of last assessment in the reporting period.
Denominator: Number of total women HS participants in the
reporting period.
1b.
Numerator: Number of Healthy Start (HS) child participants whose
parent/ caregiver reports that the child has health insurance as of the
last assessment in the reporting period.
Denominator: Number of total child HS participants in the reporting
period.
Participants are identified as uninsured if they report not having any of
the following: private health insurance, Medicare, Medicaid, State
Children's Health Insurance Program (SCHIP), State-sponsored or
other government-sponsored health plan, or military plan at the time of
the interview. A participant is also defined as uninsured if he or she
reported having only Indian Health Service coverage, or only a private
plan that paid for one type of service such as family planning,
accidents, or dental care. For more information regarding health
insurance questions please refer to Section VII (page 35) of the 2014
National Health Interview Survey (NHIS) Survey Description

BENCHMARK DATA
SOURCES

National Survey of Children’s Health (Children’s Average 94.5%,
2011/2012), 2 National Health Interview Survey 3

GRANTEE DATA
SOURCES

Grantee data systems

2
3

http://childhealthdata.org/browse/survey/results?q=2197&r=1
http://www.cdc.gov/nchs/data/nhis/earlyrelease/earlyrelease201406.pdf

SIGNIFICANCE

4

Healthy Start participants should enroll in health insurance to receive
medical and/or health care services. While uninsured rates are
decreasing (national average 12.9%), there are several existing
disparities within race, income, and age groups. 4

http://www.gallup.com/poll/180425/uninsured-rate-sinks.aspx

7

2. PERFORMANCE
MEASURE
Approach: Improve Women’s
Health
Related DGIS Measure: HS1
GOAL

The percent of Healthy Start women participants that have a
documented reproductive life plan.

To increase the proportion of Healthy Start women participants who
have a documented reproductive life plan to 90%.

MEASURE

The percent of Healthy Start women participants that have a
documented reproductive life plan.

DEFINITION

Numerator: Number of Healthy Start (HS) women participants with
a documented reproductive life plan in the reporting period.
Denominator: Number of HS women participants in the reporting
period.
There is no formal written format for a reproductive life plan. A
participant is considered to have a reproductive life plan and included
in the numerator if there is documentation in the participant’s record
of an annually updated plan to include: 1) goals for having or not
having children; and 2) plans for how to achieve those goals.
Participants with permanent birth control are included in both the
denominator and numerator.
If a participant completes the Reproductive Life Plan questions within
the Healthy Start Screening tools during the reporting period, then
they are considered to have a documented Reproductive Life Plan.

BENCHMARK DATA
SOURCES

Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 8,
Question 14

GRANTEE DATA
SOURCES

Grantee data systems

SIGNIFICANCE

A reproductive life plan reduces the risk of unintended pregnancy,
identifies unmet reproductive health care needs, and increases the
number of women who plan their pregnancies and engage in healthy
behaviors before becoming pregnant. 5

5

http://www.cdc.gov/preconception/documents/reproductivelifeplan-worksheet.pdf

8

3. PERFORMANCE
MEASURE
Approach: Improve
Women’s Health
Related DGIS Measure:
WMH2
GOAL

The percent of Healthy Start women participants who receive a
postpartum visit.

To increase the proportion of Healthy Start women participants who
receive a postpartum visit to 80%.

MEASURE

The percent of Healthy Start women participants who receive a
postpartum visit.

DEFINITION

Numerator: Number of Healthy Start women participants who
enrolled prenatally or within 30 days after delivery and received a
postpartum visit between 4-6 weeks after delivery 6.
Denominator: Number of Healthy Start woman participants who
enrolled prenatally or within 30 days after delivery during the
reporting period.
ACOG recommends that the postpartum visit occur between 4-6 weeks
after delivery. ACOG suggests a 7-14 day postpartum visit for highrisk women. 7 A participant who has a visit prior to 4-6 weeks must still
have a visit between 4-6 weeks to meet the standard and be included in
the numerator.

BENCHMARK DATA
SOURCES

Pregnancy Risk Assessment Monitoring System (PRAMS) (91% in 14
states with no timing restriction, 2011); Healthcare Effectiveness Data
and Information Set (HEDIS) – (61.8% Medicaid HMO, 2014)

GRANTEE DATA
SOURCES

Grantee data systems

SIGNIFICANCE

Since the period immediately following birth is a time of many
physical and emotional adjustments, the postpartum visit is important
for educating new mothers on what to expect during this period and
address any concerns which may arise. Additional issues include any
health complications the mother may have and the health benefits of
breastfeeding for the mother and baby. 8

6

PRAMS measures 4-6 weeks, a visit between 28-42 days of delivery.
Note: ACOG suggests a 7-14 day postpartum visit for high-risk women.
8
http://www.aafp.org/afp/2005/1215/p2491.html
7

9

4. PERFORMANCE
MEASURE
Approach: Improve Women’s
Health
Related DGIS Measure: HS2
GOAL

The percent of Healthy Start women and child participants that have a
usual source of medical care.

To increase proportion Healthy Start women and child participants
who have a usual source of medical care to 80%.

MEASURE

The percent of Healthy Start women and child participants who have
a usual source of medical care.

DEFINITION

4a.
Numerator: Total number of Healthy Start (HS) women participants
that report having a usual source of care as of the last assessment in
the reporting period.
Denominator: Total number of women HS participants in the
reporting period.
4b.
Numerator: Total number of Healthy Start (HS) child participants
whose parent/ caregiver reports that they have a usual source of care
as of the last assessment in the reporting period.
Denominator: Total number of child HS participants in the reporting
period.

A participant is considered to have a usual source of care and
included in the numerator if the participant identifies a regular place
where they can go for routine and sick care other than an emergency
room. A participant receiving regular prenatal care from a prenatal
provider is considered to have a usual source of care.

BENCHMARK DATA
SOURCES

National Survey of Children’s Health (Children 0-5 with a Usual
Source of Care 91.7%, 2011-2012); National Health Interview Survey
(Children 0-4 with a Usual Source of Care: 97.5%, 2012-2014;
Women 18-44 with a Usual Source of Care 81.8%, 2012-2014)

GRANTEE DATA
SOURCES

Grantee data systems

10

SIGNIFICANCE

Having a usual source of medical care has been shown to improve
care quality as well as access to and receipt of preventative services. 9
Further, patients having a usual source of care reduce overall costs to
patients, employers, and health plans by reducing emergency
department visits, hospital readmissions, and inpatient visits. 10

9

Blewett LA, Johnson PJ, Lee B, Scal PB. When a usual source of care and usual provider matter: adult prevention
and screening services. J Gen Intern Med. September 2008 [Epub Ahead of Print May 28, 2008];23(9):1354-60.
10
https://www.pcpcc.org/guide/benefits-implementing-primary-care-medical-home11
http://www.hrsa.gov/womensguidelines/

11

5. PERFORMANCE
MEASURE
Approach: Improve Women’s
Health
Related DGIS Measure:
WMH3
GOAL

The percent of Healthy Start women participants who have a wellwoman visit.

To increase proportion of well-woman visits among Healthy Start
women participants to 80%.

MEASURE

The percent of Healthy Start women participants who have a wellwoman visit.

DEFINITION

Numerator: Number of Healthy Start (HS) women participants who
received a well-woman or preventive (including prenatal or
postpartum) visit in the 12 months prior to last assessment within the
reporting period.
Denominator: Total number of HS women participants during the
reporting period
A participant is considered to have a well- woman or preventive visit
and included in the numerator if she has a documented health
assessment visit where she obtained recommended preventive
services that are age and developmentally appropriate within twelve
months of her last contact with the Healthy Start Program. 11
For purposes of reporting, a prenatal visit or postpartum visit during
the twelve month period meets the standard.

BENCHMARK DATA
SOURCES

BRFSS (Women 18-44 with a past-year preventive visit: 65.2%,
2013); Vital Statistics (any prenatal care: 98.4%, 2014); PRAMS
(postpartum visit: 91%, 2011)

GRANTEE DATA
SOURCES

Grantee data systems

11

http://www.hrsa.gov/womensguidelines/

12

6. PERFORMANCE
MEASURE
Approach: Promote Quality
Related DGIS Measure: PIH1
GOAL

The percent of Healthy Start child participants who are placed to
sleep following safe sleep behaviors.

To increase proportion of Healthy Start (HS) child participants who
are placed to sleep following safe sleep practices to 80%.

MEASURE

The percent of Healthy Start child participants who are placed to
sleep following safe sleep practices (i.e., place infant on his back on a
firm sleep surface without loose bedding and no bed sharing).

DEFINITION

Numerator: Number of Healthy Start (HS) child participant (aged
<12 months) whose parent/ caregiver reports that they are placed to
sleep following all three AAP recommended safe sleep practices . 12
Denominator: Total number of HS child participants aged <12
months
A participant is considered to engage in safe sleep practices and
included in the numerator if it is reported that the baby is ‘always’ or
‘most often’ 1) placed to sleep on their back, 2) always or often
sleeps alone in his or her own crib or bed with no bed sharing, and 3)
sleeps on a firm sleep surface (crib, bassinet, pack and play, etc.) with
no soft objects or loose bedding. 13
The requirement is that the baby is placed on their back to sleep. If
they roll over onto their stomach after being placed to sleep, the
standard is met. Although safe sleep behaviors are self-reported,
programs are encouraged to observe safe sleep practices during home
visits, as possible.

BENCHMARK DATA
SOURCES

Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 7,
Question 48 (Sleep Position) and F1 (Bed Sharing). 14

GRANTEE DATA
SOURCES

Grantee data systems

SIGNIFICANCE

It is estimated that 14% of infant deaths—those categorized as
Sudden Unexpected Infant Death (SUID)—may be prevented by
changing the ways babies are put down to sleep. 15

12

http://nccd.cdc.gov/PRAMStat/rdPage.aspx?rdReport=DRH_PRAMS.ExploreByTopic&islClassId=CLA8&islTopicId=TOP23
&go=GO
13
https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/aap-expands-guidelines-for-infant-sleep-safety-and-sids-riskreduction.aspx#sthash.1nnEJQwk.dpuf
14
http://nccd.cdc.gov/PRAMStat/rdPage.aspx?rdReport=DRH_PRAMS.ExploreByTopic&islClassId=CLA8&islTopicId=TOP23
&go=GO
15

http://nappss.org/plan/background.php

13

7. PERFORMANCE
MEASURE
Approach: Promote Quality
Related DGIS Measure: PIH2
GOAL

The percent of Healthy Start child participants whose parent reports
they were ever breastfed or fed breast milk, even for a short period of
time.

To increase proportion of Healthy Start child participants that were
ever breastfed or fed breast milk, even for a short period of time to
82%.

MEASURE

The percent of Healthy Start child participants that are ever breastfed
or fed breast milk, even for a short period of time.

DEFINITION

Numerator: Total number of HS child participants aged <12 months
whose parent was enrolled prenatally or at the time of delivery who
were ever breastfed or fed pumped breast milk to their infant.
Denominator: Total number of HS child participants aged <12
months whose parent was enrolled prenatally or at the time of
delivery.
A participant is considered to have ever breastfed and included in the
numerator if the child received breast milk direct from the breast or
expressed at any time in any amount.

BENCHMARK DATA
SOURCES

Pregnancy Risk Assessment Monitoring System (83.9%, 2011); Vital
Statistics (81%, 2014); National Immunization Survey (80%, 2012)

GRANTEE DATA
SOURCES

Grantee data systems

SIGNIFICANCE

Breastmilk contains vitamins and nutrients babies need for good
health and to protect the baby from disease. Research shows that any
amount of breastfeeding is beneficial for the baby and that skin-toskin contact of breastfeeding has physical and emotional benefits.
Some studies have found that breastfeeding may reduce risk for
certain diseases while also increasing cognitive development. 16

16

http://www.nichd.nih.gov/health/topics/breastfeeding/conditioninfo/Pages/benefits.aspx

14

8. PERFORMANCE
MEASURE

The percent of Healthy Start child participants whose parent reports
they were breastfeed or fed breast milk at 6 months.

Domain: Healthy Start
Approach: Promote Quality
Related DGIS Measure: PIH2

GOAL

Increase proportion of Healthy Start child participants whose parent
reports they were breastfed or fed breast milk at 6 months to 61%.

MEASURE

The percent of Healthy Start participants that breastfeed or pumped
breast milk to feed their new baby at 6 months.

DEFINITION

Numerator: Total number of HS child participants age 6 through 11
months whose parent was enrolled prenatally or at the time of
delivery that were breastfed or were fed pumped breast milk in any
amount at 6 months of age.
Denominator: Total number of HS child participants age 6 through
11 months whose parent was enrolled prenatally or at the time of
delivery.

BENCHMARK DATA
SOURCES

CDC National Immunization Survey (51.4%, 2012)

GRANTEE DATA
SOURCES

Grantee data systems

SIGNIFICANCE

The American Academy of Pediatrics recommends breastfeeding for
the first six months because scientific studies have shown that
breastfeeding is good for both the baby’s and mother’s health. 17
Breastmilk contains vitamins and nutrients babies need for good
health and to protect the baby from disease. Research shows that any
amount of breastfeeding is beneficial for the baby and that skin-toskin contact of breastfeeding has physical and emotional benefits.
Some studies have found that breastfeeding may reduce risk for
certain diseases while also increasing cognitive development. 18

17

http://www.babycenter.com/0_how-breastfeeding-benefits-you-and-your-baby_8910.bc

18

http://www.nichd.nih.gov/health/topics/breastfeeding/conditioninfo/Pages/benefits.aspx

15

9. PERFORMANCE
MEASURE
Approach: Promote Quality
Related DGIS Measure: LC2
GOAL

The percent of Healthy Start prenatal participants that abstain from
smoking cigarettes in their third trimester.

To increase abstinence from cigarette smoking in the third trimester
among Healthy Start pregnant women to 90%.

MEASURE

The percent of Healthy Start prenatal participants that abstain from
smoking cigarettes.

DEFINITION

Numerator: Number of Healthy Start prenatal women participants
who abstained from using any tobacco products during the last 3
months of pregnancy.
Denominator: Total number of Healthy Start prenatal women
participants who were enrolled at least 90 days before delivery.
Smoking includes all tobacco products and e-cigarettes.

BENCHMARK DATA
SOURCES

Healthy People 2020 (Baseline 89.6%, 2007), Pregnancy Risk
Assessment Monitoring System (PRAMS) (89.8%, 2011); Vital
Statistics (94.4%, 2014)

GRANTEE DATA
SOURCES

Grantee data systems

SIGNIFICANCE

Research shows that smoking in pregnancy is directly linked to
problems including premature birth, certain birth defects, sudden
infant death syndrome (SIDS), and separation of the placenta from the
womb prematurely. Women who smoke may have a harder time
getting pregnant and have increased risk of miscarriage. 19

19

http://www.cdc.gov/reproductivehealth/MaternalInfantHealth/TobaccoUsePregnancy/index.htm

16

10. PERFORMANCE
MEASURE

The percent of Healthy Start women participants who conceive within
18 months of a previous birth.

Approach: Promote Quality
Related DGIS Measure: HS3

GOAL

To reduce the proportion of Healthy Start women participants who
conceive within 18 months of a previous birth to 30%.

MEASURE

The percent of Healthy Start women participants who conceive within
18 months of a previous birth.

DEFINITION

Numerator: Number of Healthy Start (HS) women participants
whose pregnancy during the reporting period was conceived within
18 months of the previous live birth.
Denominator: Total number of HS women participants enrolled
before the current pregnancy in the reporting period who had a prior
pregnancy that ended in live birth.
The interval between the most recent pregnancy and previous birth is
derived from the delivery date of the birth and the date of conception
for the most recent pregnancy.

BENCHMARK DATA
SOURCES

CDC National Survey of Family Growth, Healthy People 2020
Family Planning Goal 5; Vital Statistics 20

GRANTEE DATA
SOURCES

Grantee data systems

SIGNIFICANCE

Family planning is important to ensure spacing pregnancies at least
18 months apart to reduce health risks for both mother and baby.
Pregnancy within 18 months of giving birth is associated with
increased risk for the baby including low birth weight, small size for
gestational age, and preterm birth. Additionally, the mother needs
time to fully recovering from the previous birth. 21.

20
21

http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_03.pdf
http://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/in-depth/family-planning/art-20044072

17

11. PERFORMANCE
MEASURE
Approach: Promote Quality
Related DGIS Measure: CH2
GOAL

The percent of Healthy Start child participants who receive well child
visits.

To increase proportion of well child visits for Healthy Start child
participants’ to 90%.

MEASURE

The percent of Healthy Start child participants who receive well child
visits.

DEFINITION

Numerator: Number of Healthy Start (HS) child participants whose
parent/ caregiver reports that they received the last recommended well
child visit based on the AAP schedule well child visit as of the last
assessment within the reporting period.
Denominator: Total number of HS child participants in the reporting
period.
A participant is considered to have received the last recommended
well child visit based on the AAP schedule when they have been seen
by a healthcare provider for preventive care, generally to include ageappropriate developmental screenings and milestones, and
immunizations, in the month recommended by AAP. The AAP
recommends children age 0 to 24 months of age be seen by a
healthcare provider for preventive care at each of the following ages:
by 1 month, 2 months, 4 months, 6 months, 9 months, 1 year, 15
months, 18 months, 2 years. 22

BENCHMARK DATA
SOURCES
GRANTEE DATA
SOURCES

Grantee data systems

SIGNIFICANCE

Childhood is a time of rapid growth and change. Regular preventive
care visits are intended to assess if the child is meeting developmental
milestones around hearing, vision, nutrition, safety, sleep, diseases,
and growth as well as reduce the risk of serious disease and injury. 23

22
23

https://www.nlm.nih.gov/medlineplus/ency/article/001928.htm
https://www.nlm.nih.gov/medlineplus/ency/article/001928.htm

18

12. PERFORMANCE
MEASURE
Approach: Strengthen Family
Resilience
Related DGIS Measure:
WMH4
GOAL

The percent of Healthy Start women participants who receive
depression screening and referral.

To increase the proportion of Healthy Start women participants who
receive perinatal depression screening and referral to 100%.

MEASURE

The percent of Healthy Start women participants screened for clinical
depression using an age appropriate standardized tool and, if screened
positive for depression, received a referral for follow-up services.

DEFINITION

Two benchmarks are calculated to capture screening rates and
referral rates:
12a.
Numerator: Number of Healthy Start (HS) women participants who
were screened for depression with a validated tool during the
reporting period.
Denominator: Number of HS women participants in the reporting
period.
A participant is considered to have been screened and included in the
numerator if a standardized screening tool which is appropriately
validated for her circumstances is used. Several screening instruments
have been validated for use to assist with systematically identifying
patients with depression. 24

12b.
Numerator: Number of women participants who screened positive
for depression during the reporting period and received a subsequent
referral for follow-up services.
Denominator: Number of HS women participants who screened
positive for depression during the reporting period.
A participant is considered to have been referred for follow-up
services and included in the numerator if she is referred to a qualified
practitioner for further assessment for depression. Referral can be to
either an internal or external provider depending on availability and
staffing model.

24

http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-ObstetricPractice/Screening-for-Perinatal-Depression

19

BENCHMARK DATA
SOURCES

PRAMS (screening)

GRANTEE DATA
SOURCES

Grantee data systems

SIGNIFICANCE

Perinatal depression is one of the most common medical
complications during pregnancy and may include major and minor
depressive episodes. It is important to identify women with
depression because when untreated, mood disorders can have adverse
effects on women, infants, and families. Often, perinatal depression
goes unrecognized because the changes are often attributed to normal
pregnancy, such as changes in sleep and appetite. Therefore, it is
important and recommended that clinicians screen patients at least
once during the perinatal period for depression. Although screening is
important for detecting perinatal depression, screening by itself is
insufficient to improve clinical outcomes and must be paired with
appropriate follow-up and treatment when indicated. 25

25

http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-ObstetricPractice/Screening-for-Perinatal-Depression

20

13. PERFORMANCE
MEASURE
Approach: Strengthen Family
Resilience
Related DGIS Measure: HS5
GOAL

The percent of HS women participants who receive intimate partner
violence screening.

To increase proportion of Healthy Start women participants who
receive intimate partner violence (IPV) screening to 100%.

MEASURE

The percent of Healthy Start women participants who receive intimate
partner violence screening.

DEFINITION

Numerator: Number of Healthy Start (HS) women participants who
received intimate partner violence screening using a standardized
screening tool during the reporting period.
Denominator: Total number of HS women participants in the
reporting period.
A participant is considered to have been screened and included in the
denominator if a standardized screening tool which is appropriately
validated for her circumstances is used. A number of screening tools
have been validated for IPV screening.
Intimate Partner Violence is a pattern of assaultive behavior and
coercive behavior that may include physical injury, psychological
abuse, sexual assault, progressive isolation, stalking, deprivation,
intimidation, and reproductive coercion. These behaviors are
committed by someone who is, was, or wishes to be involved in an
intimate relationship with the participant. 26

BENCHMARK DATA
SOURCES

PRAMS

GRANTEE DATA
SOURCES

Grantee data systems

SIGNIFICANCE

Intimate Partner Violence is a substantial yet preventable public
health problem that affects women across the world. Research shows
that intimate partner violence screening differs among health care
specialties and is overall relatively low. The U.S. Department of
Health and Human Services recommends that IPV screening and
counseling to be a core part of a women’s well visit. 27

26
27

http://mchb.hrsa.gov/whusa09/hstat/hi/pages/226ipv.html
http://aspe.hhs.gov/report/screening-domestic-violence-health-care-settings/prevalence-screening

21

14. PERFORMANCE
MEASURE
Approach: Strengthen Family
Resilience
Related DGIS Measure: HS6
GOAL

The percent of Healthy Start women participants that demonstrate
father and/or partner involvement during pregnancy.

To increase proportion of Healthy Start women participants that
demonstrate father and/or partner involvement (e.g., attend
appointments, classes, etc.) during pregnancy to 90%.

MEASURE

The percent of Healthy Start women participants that demonstrate
father and/or partner involvement during pregnancy.

DEFINITION

Numerator: Number of Healthy Start (HS) prenatal participants who
report supportive father and/or partner involvement (e.g., attend
appointments, classes, etc.) in the reporting period
Denominator: Total number HS prenatal participants in the reporting
period.
A participant is considered to have support and included in the
numerator if she self- reports a partner who has a significant and
positive role in the participant’s pregnancy.
Involvement during pregnancy may include, but is not limited to:
• Attending prenatal appointments
• Attending prenatal classes
• Assisting in preparing the home for the baby e.g,, putting together
a crib
• Providing economic support
• Provide other meaningful support

BENCHMARK DATA
SOURCES
GRANTEE DATA
SOURCES

Grantee data systems

SIGNIFICANCE

Research suggests that paternal involvement has been recognized to
have an impact on both pregnancy and infant outcomes. Father
involvement during pregnancy has shown to reduce negative maternal
health behaviors, risk of preterm birth, low birth weight, and fetal
growth restrictions. 28

28

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3606253/

22

15. PERFORMANCE
MEASURE
Approach: Strengthen Family
Resilience
Related DGIS Measure: HS7
GOAL

The percent of Healthy Start child participants <24 months whose
mother reports supportive father and/or partner involvement.

To increase proportion of HS child participants <24 months whose
mother reports supportive father and/or partner involvement (e.g.,
attend appointments, classes, infant/child care) with child <24 months
to 80%.

MEASURE

The percent of Healthy Start child participants <24 months whose
mother reports supportive father and/or partner involvement.

DEFINITION

Numerator: Number of Healthy Start (HS) child participants whose
mother reports supportive father and/or partner involvement (e.g.,
attend appointments, classes, child care, etc.) during the reporting
period
Denominator: Total number of Healthy Start child participants <2
years of age.
A participant is considered to have support and included in the
numerator if the mother reports a partner who has a significant and
positive role for the child.
Involvement includes, but is not limited to: 29
• Engagement or direct interaction with the child, including taking
care of, playing with, or teaching the child
• Accessibility or availability, which includes monitoring behavior
from the next room or nearby and allowing direct interaction if
necessary
• Responsibility for the care of the child, which includes making
plans and arrangements for care
• Economic support or breadwinning
• Attending postpartum and well child visits
• Other meaningful support

BENCHMARK DATA
SOURCES
GRANTEE DATA
SOURCES

Grantee data systems

SIGNIFICANCE

Father and/or partner involvement should consider participation in
areas of medical appointments for infants, children and/or mother,
attending HS sponsored classes, prenatal care, care for infant or child,

29

http://www.cdc.gov/nchs/data/nhsr/nhsr071.pdf

23

16. PERFORMANCE
MEASURE
Approach: Strengthen Family
Resilience
Related DGIS Measure: HS8
GOAL

etc.
The percent of Healthy Start child participants age 6 through 23
months who are read to 3 or more times per week, on average.

To increase the proportion of Healthy Start child participants age 6
through 23 months who are read to 3 or more times per week to 50%

MEASURE

The percent of Healthy Start child participants age 6 through 23
months who are read to by a family member 3 or more times per
week, on average.

DEFINITION

Numerator: Number of Healthy Start children participants whose
parent/ caregiver reports that they were read to by a family member
on 3 or more days during the past week during the reporting period.
Denominator: Total number of Healthy Start child participants 6
through 23 months of age during the reporting period.
Reading by a family member may include reading books, picture
books, or telling stories.

BENCHMARK DATA
SOURCES

National Survey of Children’s Health (2011-2012)

GRANTEE DATA
SOURCES

Grantee data systems

SIGNIFICANCE

Reading to a child teaches them about communication, introduces
concepts such as numbers, letters, colors, and shapes, builds listening,
memory, and vocabulary skills, and gives them information about the
world around them. 30 The American Academy of Pediatrics (AAP)
promotes reading aloud as a daily fun family activity to promote early
literacy development as an important evidence-based intervention
beginning in infancy and continuing at least until the age of school
entry. 31

30
31

http://kidshealth.org/parent/positive/all_reading/reading_babies.html
http://pediatrics.aappublications.org/content/pediatrics/134/2/404.full.pdf

24

17. PERFORMANCE
MEASURE

The percent of Healthy Start grantees with a fully implemented
Community Action Network (CAN).

Approach: Achieve Collective
Impact
Related DGIS Measure: HS9

GOAL

To increase the proportion of HS grantees with a fully implemented
Community Action Network (CAN) to 100%.

MEASURE

The percent of Healthy Start grantees with a fully implemented
Community Action Network (CAN).

DEFINITION

Two benchmarks are calculated to capture Community Action
Network (CAN) implementation and progress towards achieving
collective impact:
Numerator: Number of related CAN measure components
implemented by the CAN in which the Healthy Start grantee
participates.
Denominator: 3 (representing total of CAN components)
This is a scaled measure which reports progress towards full
implementation of a CAN. A “yes” answer is scored 1 point; a “no”
answer receives no point. To meet the standard of “fully
implemented” for this measure, the HS grantee must answer “yes” to
all three core elements listed below:
1. Does your CAN have regularly scheduled meetings? Regular
scheduled is minimally defined as? (i.e., once a month, every quarter
during the reporting period). This can be documented by using sign in
sheets. Yes = 1 No = 0
2. Does your CAN have members from three or more community
sectors? (e.g., individuals with lived experience, Healthy Start
consumer, faith based, hospital, school setting, community based
organizations, government, business, medical provider(s), child care
provider(s)). Yes = 1 No = 0
3. Does your CAN have a twelve month work plan? This work plan
should outline the CAN’s goals, objectives, activities, entities
responsible for completing, and timelines. Yes = 1 No = 0

25

-----------------------------------------------------------------------------------Numerator: Number of related Collective Impact (CI) measure
components implemented by the CAN in which the Healthy Start
grantee participates.
Denominator: 10 (representing total points for 5 CI measure
components)
This is a scaled measure which reports progress towards full
implementation of Collective Impact. A “yes” answer is scored 2
points; “in process” is scored 1 point; a “no” answer receives no
point. To meet the standard of “fully implemented” for this measure,
the HS grantee must answer “yes” to all five core elements listed
below:
1. Does your CAN have a common agenda developed? All
participants have a shared vision for change including a common
understanding of the problem and a joint approach to solving it
through agreed upon actions. This can be documented by using a
theory of change, logic model, work plan template that captures this
information, and/or a charter.
Yes = 2
In Process = 1
Not started = 0
2. Does your CAN have Shared Measurement Systems? The CAN has
identified a common set of indicators that tracks progress/action
related to the common agenda, collects data across partners, presents
data on a consistent basis, and uses data to make informed decisions
and to hold each other accountable.
Yes = 2
In Process = 1
Not started = 0
3. Does your CAN engage in Mutually Reinforcing Activities?
Participant activities are differentiated while still being coordinated
through a mutually reinforcing plan of action. This plan of action can
be included on the work plan noted above and should include at least
two to three activities, a description of how it is believed that the
activities will impact the common agenda, how the activities will be
measured, who/what organization will take the lead, and the timeline
for implementation.
Yes = 2
In Process = 1
Not started = 0
4. Does your CAN have Continuous Communication? Consistent and
open communication is needed across the many players to build trust,
assure mutual objectives, and appreciate common motivation. A
communication plan agreed upon by stakeholders should be included
as a part of the work plan noted above.
Yes = 2
In Process = 1
Not started = 0
5. Does your CAN have a backbone infrastructure in place? Creating
and managing collective impact requires a dedicated staff and a
specific set of skills to serve as the backbone for the entire initiative
and coordinate participating organizations and agencies.
26

Documentation is shared with CAN members describing roles and
responsibilities, and skills required for staff of the entity(ies)
supporting the backbone infrastructure.
Yes = 2
In Process = 1
Not started = 0

`
GRANTEE DATA
SOURCES

Grantee data systems

SIGNIFICANCE

A CAN, is an existing, formally organized partnership of
organizations and individuals. The CAN represents consumers and
appropriate agencies which unite in an effort to collectively apply
their resources to the implementation of one or more commons
strategies to achieve a common goal within that project area.

27

18. PERFORMANCE
MEASURE

The percent of Healthy Start grantees with at least 25% community
members and Healthy Start program participants serving as members
of their Community Action Network (CAN).

Approach: Achieve Collective
Impact
Related DGIS Measure: HS10

GOAL

To increase the proportion of Healthy Start grantees with at least 25%
community members and Healthy Start program participants serving
as members of their CAN to 100%.

MEASURE

The percent of Healthy Start grantees with at least 25% community
members and Healthy Start program participants serving as members
of their CAN.

DEFINITION

Numerator: Number of community members and Healthy Start (HS)
program participants serving as members of the CAN.
Denominator: Total number of individual members serving on the
CAN.
Community Member: an individual who has lived experience that is
representative of the project’s Healthy Start target population.
Community members may include former Healthy Start participants,
fathers and/or partners of Healthy Start participants, males and family
members.
Program Participant: an individual having direct contact with Healthy
Start staff or subcontractors and receiving Healthy Start services on
an ongoing systematic basis to improve perinatal and infant health.
Specifically, program participants are pregnant women and women of
reproductive age and children up to age 2.
A CAN, is an existing, formally organized partnership of
organizations and individuals. The CAN represents consumers and
appropriate agencies which unite in an effort to collectively apply
their resources to the implementation of one or more commons
strategies to achieve a common goal within that project area.

BENCHMARK DATA
SOURCES
GRANTEE DATA
SOURCES

Grantee data systems

SIGNIFICANCE

Consumer involvement in setting the community agenda and
informing efforts to effectively meet the community’s needs is critical
to the effectiveness of the CAN.
28

19. PERFORMANCE
MEASURE

The percent of Healthy Start grantees who establish a quality
improvement and performance monitoring process.

Approach: Increase
Accountability though Quality
Improvement, Performance
Monitoring, and Evaluation
To increase the proportion of HS grantees who establish a quality
GOAL
improvement and performance monitoring process to 100%.

MEASURE

The percent of Healthy Start grantees who establish a quality
improvement and performance monitoring process.

DEFINITION

Numerator: Number of related QI measure components implemented
by the HS Grantee.
Denominator: 7 (representing the four QI components)
.
This is a scaled measure which reports progress towards full
implementation of a quality improvement and performance
monitoring process which consists of systematic and continuous
actions that lead to measurable improvement in health care services
and the health status of targeted populations. 32 . A “yes” answer is
scored 1 points; a “no” answer receives no point. To meet the
standard of “fully implemented” for this measure, the HS grantee
must answer “yes” to all seven questions:
1. Has the organization established a culture that encourages
continuous improvement of services and programs?
Yes = 1 No = 0
2. Does the organization have a structure to assess and improve
quality of care?
Yes = 1 No = 0
3. Do providers and staff have a basic understanding of QI tools and
techniques?
Yes = 1 No = 0
4. Do providers and staff understand their roles, responsibilities, and
expectations regarding QI activities? Yes = 1 No = 0
5. Does the organization routinely and systematically collect and
analyze data to assess quality of care including HS benchmarks?
Yes = 1 No = 0
6. Does the organization have resources dedicated to QI activities?
Yes = 1 No = 0
7. In the previous 12 months, has your Healthy Start project
conducted at least one QI project?
Yes = 1 No = 0

BENCHMARK DATA
SOURCES
32

http://www.hrsa.gov/quality/toolbox/methodology/qualityimprovement/part2.html

29

GRANTEE DATA
SOURCES

Grantee data systems

SIGNIFICANCE

Quality improvement and performance monitoring processes provide
a mechanism for assessing the degree to which program goals are met
and the effectiveness of corrective actions to ensure the best health
outcomes for participants.

30

20. PERFORMANCE
MEASURE

The percent of Level 3 Healthy Start Grantees that have a fully
implemented CoIIN process.

Approach: Increase
Accountability though Quality
Improvement, Performance
Monitoring, and Evaluation
Level 3 Grantees Only

GOAL

To increase the proportion of Level 3 HS grantees that have a fully
implemented CoIIN process to 90%.

MEASURE

The percent of Level 3 Healthy Start grantees that have a fully
implemented CoIIN process.

DEFINITION

Numerator: Healthy Start Grantees actively participates in the HS
CoIIN with documented participation in at least 80% of CoIIN
meetings.
Denominator: Eligible HS Grantees.
To meet the standard for this measure the HS grantee must answer
“yes”.

BENCHMARK DATA
SOURCES
GRANTEE DATA
SOURCES

HS CoIIN attendance

SIGNIFICANCE

The Healthy Start CoIIN is a partnership of Healthy Start grantees
dedicated to strengthening Healthy Start services and systems, in
order to advance program goals to reduce infant mortality and
improve birth outcomes. The HS CoIIN functions as an Advisory
Council to the Division of Healthy Start and Perinatal Services
(DHSPS). The HS CoIIN is an essential mechanism for
strengthening the HS program. Active participation by Level 3
grantees is a requirement of the HS funding.

31