Planning is an important part of Healthy
Start. The HRSA Guidance required each
grantee to develop a Local Health System
Action Plan (LHSAP) that identified one
or two priority goals that could be achieved
within the third grant cycle. The intent
of this requirement was to focus the plan
on improvements related to the perinatal
systems of care and to ensure that the
process involved collaboration with relevant
organizations, especially Title V maternal
and child health agencies.
Of the 95 grantees that responded to
the survey, 80 grantees (84 percent) reported
having an LHSAP as of December 2003. Among
them, 54 grantees (68 percent) indicated
that their action plan was developed specifically
for their Healthy Start project while
26 grantees (32 percent) reported that
their action plan was not exclusive to
Healthy Start, but contained goals that
the Healthy Start project was addressing.
The Guidance required that the LHSAP
be linked to the State Title V plan, although
only half of the grantees reported that
this occurred. More than three-quarters
of the grantees involved the consortium
as required. Less than half of the grantees
involved local Title V agencies (43 percent)
or local governmental agencies (40 percent)
other than the local health department
(e.g. city housing authority).2
Less than half of the grantees (46 percent)
reported that consumers were involved,
although they may have participated as
part of the consortium or through key
community partners.3
The 80 grantees with a LHSAP indicated
that they used, on average, four methods
to identify plan priorities. Discussions
with various stakeholders were the most
frequently reported method used to identify
priorities, including discussions with
community organizations or agencies (74
percent), providers (66 percent), the
consortium (64 percent), and less frequently,
consumers (55 percent).
In addition to conducting discussions
with community partners, grantees reported
using a variety of data sources to help
identify goals, including findings from
a local (or State) mortality review program
(45 percent), another needs assessment
(such as Title V or United Way-initiated
plans) (45 percent), and their own needs
assessment (44 percent). Overall, 80 percent
of grantees with a LHSAP used existing
data sources to help identify goals, including
37 percent that used a single data source,
32 percent that used 2 sources, and 11
percent that used all 3.
Grantees identified goals that were most
often service-oriented (40 percent). About
one-third of the identified goals were
systems-oriented, with fewer goals that
were program-outcome related (20 percent)
and health-outcome related (19 percent).
Although most grantees reported a great
deal of progress in meeting their goals,
they also identified resource constraints
as a major barrier. Resource barriers
may also be reflected in the fact that
several grantees did not have plans or
had not finalized their goals at the point
in the grant cycle during which the survey
was administered.
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