Healthy Start projects serve a culturally diverse population. As a result, all projects employ strategies to ensure a culturally competent staff. Of the 95 grantees, 86 percent indicated that they hired staff who represented the racial and ethnic makeup of their target population; 64 percent provided cultural competence training/sensitivity training; and 44 percent required contractors to hire diverse staff that were racially/ethnically similar to the target population. Whether a grantee performed 1, 2, or all 3 of these activities was distributed fairly evenly, with 35 percent indicating that they performed 1, 36 percent indicating that they performed 2, and 28 percent indicating that they participated in all of these activities to ensure culturally competent staff.

Seventy-four grantees indicated that their target population included individuals whose preferred language was other than English (data not shown). Within this group, the number of other languages spoken was 1 or 2 languages (62 percent of grantees), 3 or 4 languages (20 percent), or 5 or more languages (18 percent). In addition, grantees reported a variety of ways to communicate with their participants who did not speak English. Of the 74 grantees to which this applied, the grantees primarily used 3 strategies: assigning participants to Healthy Start staff who spoke their preferred language (77 percent); enlisting participants’ friends or family members to translate (46 percent); and/or contracting with outside agencies for translation/interpretation services (30 percent).

More than one-third of grantees found it challenging to ensure the cultural competence of Healthy Start staff (data not shown). The most frequently reported challenge was a lack of culturally competent applicants who met job specifications (reported by 19 percent of grantees), followed by strong competition in the community for culturally competent staff (18 percent). Only two percent of the grantees indicated that there was inadequate funding to hire culturally appropriate staff.

Healthy Start participants have diverse medical and social needs that can lead to adverse perinatal outcomes if not addressed during pregnancy or the interconceptional period (up to two years postpartum). Thus, a multidisciplinary approach to case management is intended to ensure that people with a variety of skills and experience are involved in care coordination to meet the needs of participants. Healthy Start grantees employed case management staff from a wide spectrum of disciplinary backgrounds, including lay/paraprofessional (71 percent), social work (66 percent), nursing (60 percent), and public health (14 percent). The strong use of lay/paraprofessional staff reflects their unique position as members of both the community and the Healthy Start staff. This dual role may enhance the projects’ ability to address cultural and language barriers as well as obtain buy-in from the community.

Three-quarters of all grantees (74 percent) employed case management staff from two or more disciplinary backgrounds. The predominant staff background was multidisciplinary (45 percent), followed by social work (22 percent), lay/paraprofessional (17 percent), and nursing (16 percent).¹ Although lay/paraprofessionals represented the most common type of case management staff background, they were often part of a multidisciplinary team. Data shown in Figure 5 on page 5.

¹Predominant case management staff background is defined as
lay/paraprofessional, social work, or nursing when a grantee
employeed 75 percent or more of their FTE staff from a single
disciplinary background. Multidisciplinary programs are those
in which no one single disciplinary background predominates;
instead, they are staffed from a mix of lay/paraprofessional,
social work, nursing, and other disciplines.

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