Outreach and client recruitment services are the point of entry for Healthy Start projects. The ability of grantees to successfully reach, recruit, and retain clients of all backgrounds increases the likelihood that Healthy Start will be able to facilitate access to needed perinatal services. Recognizing the vital role of lay/paraprofessional staff in reaching members of the target population, almost all grantees (97 percent) involved at least some lay/ paraprofessional staff in their outreach and client recruitment efforts.

Grantees used a variety of strategies to conduct outreach and client recruitment within their target populations. Strategies included both verbal (classes) and written (brochures) approaches, as well as mass media (newspaper advertising) and 1-on-1 (canvassing) approaches to reach new clients. All grantees used referral networks (100 percent) and most used community events (99 percent), brochures (99 percent), canvassing (91percent), and classes or presentations (91 percent). Among mass media strategies, newspaper advertising (69 percent) was used more often than radio (47 percent) or television (27 percent) advertising. About one-fourth (27 percent) of grantees used a hotline to reach potential participants. On average, grantees used 6.5 strategies per project. The use of multiple outreach strategies involving diverse settings and media is designed to reach as many potential clients as possible.

Grantees used many outreach strategies to recruit those who were potentially eligible for their project. Which strategies did grantees report to be the most effective in reaching the target population? National Healthy Start program estimates of the use of different strategies were derived based on grantee estimates of the percentage of new clients who learned about their Healthy Start projects through each strategy. Responses of individual grantees were weighted by their total number of participants to obtain an aggregate estimate.

About one-in-three participants (31 percent) learned about Healthy Start through referrals from health care providers, schools, or other community agencies, which were the most often noted source of information about Healthy Start, according to Healthy Start project directors. Next in frequency were word-of-mouth or self-referrals (22 percent), canvassing of neighborhoods or community settings (15 percent), and community events (14 percent).

Although relatively few clients appear to have learned about Healthy Start through such strategies as classes or presentations (7 percent), these efforts may have served a dual purpose of providing health education to the larger community. Moreover, some strategies may have accounted for a relatively small share of participants but independently led to word-of-mouth or self-referrals. This may be particularly true in the case of mass media strategies (5 percent), such as brochures, newspapers, radio, and television.