Although the HRSA Guidance specifies five service
components (outreach, case management, health
education, depression screening, and interconceptional
care) and four systems components (consortium,
Local Health System Action Plan, coordination
and collaboration with Title V, and a sustainability
plan), the authorizing legislation emphasizes three
service components (outreach, health education,
case management) and three systems components
(coordination with Title V, consortium, and Local
Health System Action Plan).

Based on feedback from the Healthy Start communities,
as well as from the Healthy Start Panel (HSP)
and the Secretary’s Advisory Committee on Infant
Mortality (SACIM) two service components (perinatal
depression screening and interconceptional
care) and the systems component of sustainability
were added requirements in 2001. Overall, the
service components were more likely to be implemented
than the systems components.

New required systems components in the third
cycle (2001 – 2005) included a Local Health System
Action Plan (LHSAP) and a sustainability plan. As
shown, these were implemented less frequently by
grantees in 2003 than program components that
had been required previously – this might be as a
result of the time required to fully implement new
components. Collaboration and coordination of the
various agencies and organizations involved in the
delivery of perinatal health care, particularly Title
V, was implemented by 98 percent of the grantees.