| Grantees conducted home visits to
engage clients in familiar surroundings
and to better understand the environments
in which clients live. Nearly all (99
percent) grantees provided home visits
to Healthy Start clients in 2003. Seventy
six percent of grantees provided home
visits to at least three-fourths of their
pregnant clients. Meanwhile, 64 percent
of grantees provided home visits to three-fourths
of their interconceptional clients. Grantees
provided a broad array of home visiting
services, including depression screening
and treatment (84 percent), well baby
care (75 percent), and smoking cessation
and reduction services (73 percent). The
majority of grantees scheduled home visits
in accordance with client need (64 percent),
while the remainder (35 percent) reported
that they followed a specific schedule.
The reach of home visiting services
varied according to the staffing arrangement.
Grantees that relied solely on subcontracted
staff were more likely to provide home
visits to most or all of their pregnant
clients (88 percent), followed by grantees
that relied solely on direct employees
(67 percent), and grantees with mixed
arrangements (53 percent).
In addition to providing case management
and home visits to pregnant and interconceptional
women, most grantees provided services
to infants and toddlers. Of the 86 grantees
providing services to infants and toddlers,
97 percent conducted home visits to assess
their home environment and 91 percent
provided case management to coordinate
their services. Compared to grantees that
enrolled only infants whose mothers were
prenatal clients, grantees that enrolled
high-risk infants and their mothers after
delivery were more likely to offer case
management for infants and toddlers (96
percent versus 82 percent) and to offer
different levels of case management depending
on the infant’s risk status (82
percent versus 54 percent).
Completion of referrals is an important
indicator of the effectiveness of care
coordination. It may also signal the level
of collaboration within a community, to
ensure that participants receive needed
services. Grantees reported substantial
variation in the percentage of referrals
completed by pregnant and interconceptional
clients. Forty-four percent of grantees
reported that more than three-quarters
of all referrals were completed by pregnant
clients and 32 percent of grantees reported
that more than three-quarters of all referrals
were completed by interconceptional clients.
Nearly one-fifth of grantees were unable
to estimate their referral completion
rate for pregnant (18 percent) and interconceptional
(19 percent) clients.
The lower referral completion rates for
interconceptional clients compared to
pregnant clients may reflect the challenges
in delivering services to this population.
Healthy Start grantees reported that interconceptional
clients have lower retention rates and
were more likely to cite competing priorities
or lack of medical coverage as barriers
to care for their interconceptional clients.
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