I



I. Overview of Racial and Ethnic Disparity

Women of childbearing age in Mississippi County are at high risk of adverse perinatal outcomes due to their poverty, youth, and exposure to an environment of family and social instability. African Americans, who constituted 45% (1123 of 2493) of the birth cohort in the project area during the period from 1998-2004, are at significantly higher risk of exposure to factors associated with low birth weight and preterm delivery. Blacks’ infants are twice as likely as whites’ infants to be born to mothers under age 18, two and a half times more likely to receive three or fewer prenatal visits and twice as likely to be born with no prenatal care. African American infants in the project area were also more likely than others to have a birth weight of less than 2500 grams (risk ratio=1.67, CL 1.32,2.10) and be delivered at less than 38 weeks gestation (risk ratio=1.44 CL 1.29,1.61).

Women and their children in Mississippi County and the project area are also more likely than others in the state to belong to a single parent family and to be in poverty. Nearly 70% percent of African American children and more than a 25% of the white children under 5 were low income in the 1990 Census. Poverty remained high in 2000, according to the Census, with African American child poverty rates at 49.5% and whites at 15.8%. Nearly 60% of the women of childbearing age were enrolled in the Medicaid program during the 1997 calendar year, and Medicaid paid for 660 of the 929 births to residents of Mississippi County in FY97.

Black fetal and infant death rates are also substantially higher than white rates, although the difference is not statistically significant. The black infant mortality rate for the program area during the 1996-98 period was 12.5 (14 deaths/1123 live births) compared to 9.5 (13/1370) for white and other races. The combined fetal and infant mortality rate was 27.2 (31 fetal and infant deaths/1140 live births and fetal deaths) for blacks during this period and 18.1 whites and other races (25/1395).

II . Project Implementation

A. - Our project’s target population is principally comprised of native-born, lower income African American women, children and families living in Mississippi County. The proposed program seeks to concentrate its limited resources on the following higher risk groups within this population:

• Unmarried, first-time mothers under the age of 20

• Women with a previous LBW or preterm birth or perinatal death

• Pregnant and parenting women who are suspected of alcohol or drug abuse

• Tobacco using pregnant and parenting women

• Pregnant and parenting women exposed to domestic violence

• Women with limited physiological resources due to cognitive or emotional incapacity or illness

• Adolescents at high risk of pregnancy

• Other similar high risk factors

Four full-time Caseworkers proven outreach services to geographical assigned area of their county as well as provide transportation and parenting skills to program participants. This would give each worker a facilitative services caseload of 50 families.

The Mississippi Healthy Start staff and client recruitment practices is rooted in its strategy of deploying community-based outreach and family support workers in their home communities within the service area. These workers use the informal social networks to receive referrals and to disseminate information about the program.

These informal networks have been complemented by a rich set of program partnerships, with community-based organizations, churches, agencies and health care providers. These partners include the Arkansas Department of Health Units in the project area, Department of Human Services, Head Start and Early Head Start Centers and their Parent Councils, After School Programs such as Blytheville Community Samaritan and Boys and Girls Club. Additionally, partnerships with schools, and churches and faith-based service organizations have been implemented. These networks have been used in recruiting both program participants and community participants for programs and events.

Participants who do not fit the high risk profile identified above will be placed on the “Supportive Services” track and offered limited, case management and facilitative services as well as the opportunity for regular small group prenatal, parenting/child development, and women’s health education and support group services. High risk participants will be scheduled for intensive home visiting and case management services.

Outreach workers have been extensively involved in making presentations to different groups in their neighborhoods and posting posters with project information in food stores, Wal-Mart and other commercial centers. Additionally, the caseworkers and health educator will share responsibility to organize meetings of key community leaders to raise awareness of both the Healthy Start program and perinatal health issues.

The caseworker operates in a team along with the social worker, and health educator.

Case Management Methods. Case management is the central strategy used at the Mississippi County Healthy Start Program. Paraprofessional staff under the supervision of an experienced MA.R.C., SW provides case management services for high risk families through an intense home visiting schedule. Lower risk families receive support services, such as transportation or assistance with applying for Medicaid, that enable them to overcome specific identified barrier. Both the high and lower risk participants receive regularly scheduled risk assessments throughout the prenatal, post-natal and interconception periods.

The program participant intake procedure is as follows: When the outreach worker or other team member receives either a request for service or a referral, a case manager, either a nurse or the social worker depending on the nature of the indicated need, will set up an appointment for a home visit in which the program will be explained and the needs and concerns of the potential client are discussed. A formal enrollment form is completed during this visit and it is signed by the client. A case record is then opened on the mother and infant, if it is a post-partum enrollment. Initial risk screenings also take place at this initial meeting. A follow-up case planning meeting is then scheduled with the family. The case manager, with a team case conference if needed, will then establish an initial risk level for the participant.

Through interviews, in home observation, and interaction with household members, the case managers assess the family and care givers for their ability to care for and nurture their infants and access needed health and social services. Needed services may range from housing, job training or job finding assistance to substance abuse treatment, shelter from domestic violence, and health care. Parenting education and support are also critical parts of the case management process that contributes to healthy child development.

The case manager addresses social support, housing adequacy and prenatal and parenting knowledge at the time of intake and needs determination. A number of standard screening instruments are used for these assessments, including the Edinburgh Depression screening form, the postpartum adjustment risk factor instrument, alcohol and drug use screen (4-Ps and TWEAK), and abuse assessment screen.

Formal screening for substance abuse, domestic violence, and perinatal depression is conducted at entry into the program and then repeated when indicated. Routine depression screening is also scheduled at four to six weeks following delivery. Families with positive screening results for substance abuse (including tobacco use) or mental health needs are referred to appropriate providers for clinical assessment and treatment.

A family case management plan, covering both mother and child needs, is developed in conjunction with each participating family. These plans form the framework for case management and participant education services. Each home visit or other contact is recorded in the case record narrative.

The case managers also provide extensive one-on-one health education using, Partners for a Healthy Baby, a standard home visiting curriculum from the Florida State University Center for Prevention and Early Intervention Policy.

The Mississippi County Healthy Start Initiative procedure for schedule contacts by risk level it is that, while the contact schedule may vary depending on the needs and capacity of the participant, a typical contact schedule for a newly enrolled high risk participant will include contacts every two weeks until late in the pregnancy when weekly visits would be initiated. Following birth, a weekly visit schedule would be maintained for the first 12 weeks to ensure that mother and infant are both progressing well and to assess the level of care for the infant. These visits would include a prescribed lesson in a child development parenting readiness curriculum.. At the end of three months, a typical mother and infant would be visited monthly until the child reaches 24 month. Critical factors that affect the level of contact is the level of support from family and friends and the specific services needs required. These case manager visits would be supplemented, when needed, by visits from the outreach and family services worker for the delivery of facilitative services such as transportation.

The contact schedule for a typical lower risk client, while highly variable and dependent upon the types of issues and barriers faced by the client, will generally include monthly contact by the case manager, plus any specific service contacts required to address specific needs.

Each of the paraprofessional case managers are expected to maintain a caseload of 25 high risk participant families, for a team high risk caseload capacity of 100 families. The team in each county will serve an additional 75 lower risk families.

Client Participation. All service plans are developed in conjunction with and with the participation of the family members. They also sign and receive a copy of the jointly developed plan. Families can also initiate changes at any time and must agree to any staff initiated changes in the plan.

Referral Data Entry. Each referral is recorded in the electronic case record and paper file by the case manager. The referral is treated as an open referral until a corresponding closing entry is made which records the disposition of the referral. The case manager or project director can run a listing of open referrals at any time for the purpose of monitoring the referral process.

The medical guidelines for prenatal care adequacy used in the project will use the Kotelchuck Index for determining the adequacy of prenatal care.

One of the critical barriers facing a growing number of participants is the absence of health insurance. To address this barrier and enable our participants to establish a medical home for both mother and infant, we assist them to establish Medicaid and ARkids coverage.

Training and support to case managers. Monthly in-service training is provided to the case managers/outreach workers. This training, conducted by the Project Director with assistance from various resource persons, is supplemented by special training events during the year. Much of the training of these paraprofessionals is delivered in the context of case reviews and case conferences. There were no specific outside training events in grant activities in Calendar 2003 because of the turnover in positions and budgetary restrictions,.

Title V. The Arkansas Department of Health operates a Maternal and Infant Home Visiting Program (MIP) that provides up to three home visits for assessment of the home environment and health status of birth mothers and infants. This service is designed to strengthen child development outcomes.

The project director and county team leader will be responsible for establishing linkages and coordinating with these services in the area these case management efforts in other agencies and programs. Close working relations have been established with the two public health units in Mississippi County through the existing Healthy Start program in that county.

This major community-based initiative in Mississippi County aimed at improving local health care systems and the health status of the population. These efforts unite health service providers, community-based organizations, faith-based groups, educational institutions, and business leaders to assess community health needs and take action.

Mississippi County coalition obtained planning funds as a Rural Health Network Development sub-grantee from the Arkansas Delta Rural Development Network. The existing Mississippi County Healthy Start Program has been a central member of this effort. The local network is currently working to address three core needs identified in its assessment and priority setting process. These are:

1. Too many people live in an unstable family and neighborhood environments with unacceptable rates of violence, social disorganization, substance abuse and neglect.

2. Large numbers of people do not value long-term wellness and engage in high-risk behaviors that endanger their health and safety. These behaviors include high risk sex, substance abuse, smoking, obesity and physical inactivity, and violence.

3. Many people lack access to affordable health care and under-utilize preventive health services due to lack of or restrictions in health insurance coverage.

The applicant organization, Mississippi County Arkansas EOC, is taking the lead in organizing Mississippi County Wellness Council which will bring together the health education and wellness promoting capacity of such organizations as the Osceola and Blytheville Hospitals, Health Departments, Cooperative Extension Service, city parks and recreation departments, Boys and Girls Club, YMCA, and others in a collaborative effort to fully reach all segments of the community. The Program Director, Health Educator and other Healthy Start staff will be a critical player in these efforts.

Working with State and Federal funding agencies, several attempts have been made by the existing Healthy Start program to obtain additional funding for the Healthy Start Project. These efforts were to no avail except for the continued funding by the state’s Teen Pregnancy Prevention program which has been maintained at the $33,000 level for services to high risk adolescents.

Additional state and federal funding will continue to be elusive given the deteriorating state and federal budgets. We are more optimistic, however, about our prospects in obtaining limited state and private funding for support of the health education and promotion activities that are incorporated into the proposed Healthy Start program.

B.- A major component needed for the implementation of the Mississippi County Healthy Start intervention involves the Program Director and the paraprofessional case managers and health educator.

Rotation of personnel is the most relevant change that the project has faced during the past four years. This rotation has been due to several factors such as: One, the lack of salary increase for the last four consecutive years for all program staff including the program director. Two, lack of financial incentive such as bonus, as recognition for the case managers’ work. Three, the case manager’s burned during the implementation of the program in the last four years.

However, the Mississippi County caseworkers during this past four years have obtained a great deal of knowledge, experience, and working ethics. Three out of four case managers are currently seeking their BA in Social Work. One of the case workers is enroll in Arkansas State University and two case managers are attending at Missouri State University. Additionally, the community health educator it is also currently attending to Southeastern Missouri University located at Kenneth Missouri.

The community health educator has received intensive training through the Unwed Teen Pregnancy Prevention Grant on the “Programs That Work” approved by the Department of Education and Center for Disease Control. The community health educator has used the information learned in different settings such as Mississippi County Correctional Facility, Community Faith Groups such as Blytheville Community Samaritan and Boys and Girls Club which is an after school program.

C. - A barrier to services delivery is the increasing economic and social marginalization of the poor and poorly educated families. This leaves more and more people without hope or a sense of control in their own lives. This groups’ dependence on irregular and episodic employment, leading to an increasing share of the population being without health insurance and regular access to health care.

With the absence of public transportation in the area, transportation is a frequently cited as an underlying problem with accessing health care and needed social services.

With the absence of public transit systems in the area, transportation remains a continuing barrier to regular medical care. We provide limited transportation to assist these participants to maintain their relationship with their physician. Case managers and outreach workers also support and assist participants

On the other, the Arkansas Department of Health (ADH) has going through an intensive reorganization process for the last three consecutive years, making difficult for the program director to established solid partnership between Arkansas Department of Health, Title V and the Mississippi County Healthy Start Program. Some of the problems faced by the project director regarding the ADH reorganization are the excessive rotation of acting Title V. Additionally; the inability to obtain continuing support from the Title V regarding planning, evaluation and active intervention in the Healthy Start program.

Furthermore, the emerging of the ADH into the Arkansas Department of Human Services (ADHS) umbrella will affect the partnership between both organizations. The project director has met previously in several occasions with the new administrator of Arkansas Department of Human Services and Health (ADH-ADHS). The objective of these meetings has been the establishment of a new partnership, revision of contracts between organizations, client sharing information, and referral mechanism system, with the goal of continuing providing adequate services to the underserved Mississippi County constituents.

Finally, the Mississippi County health care system has experienced a rollercoaster in the relocation of OBGYN, MD and Family practices. This relocation has affected considerable the provision of medical services to our Healthy Start clients. Also, has live the county with only two OBGYN, one of them accepts only private insurance and the second sees all Medicaid patients. This has created an overload of patients seeking services form the OBGYN who sees Medicaid patients. Many of the patients are seeking services out of the county boundaries due to the mention above issues, making it difficult for the case managers to follow-up accurate the accessing of medical services for the pregnant consumers who are seeking prenatal services.

D.- Consortium

The Mississippi County Healthy Start consortium was established in 1998 and has been active sense then. This structure places the power for change directly into the hands of consumers, families and communities to establish and maintain programs, procedures, polices and services appropriate to the needs of the target audience.

The structure of the consortium model is base on stakeholders, service providers such as Arkansas Department of Health, Department of Human Services, Non profit organizations such as Haven (shelter for Domestic Violence). In addition, the consortium has register members of the black and Hispanic community faith organizations as well as after school programs, physicians, and consumers. The consortium’s composition is 60% women 50 % of the 60 % is black and 10% white. The 40% is composed by mean. 30% are black and 10% is Hispanic. The consortium has registered 87 % participation from its members during the fist cycle of Healthy Start (four years).

Our existing Healthy Start program has an extensive record of collaboration with the two public health units in the Mississippi County area, including shared outreach and case management services for immunizations, community health education, and joint efforts in facilitating prenatal care services, WIC, immunizations, and family planning services for participants. The chair of the current Healthy Start Consortium is a staff person from the Health Department.

The Mississippi County Healthy Start Project continues close working relationship and collaboration with the local public health agency, especially its local Women’s Clinic, family planning, WIC, Immunization and Hometown Health Improvement coalition efforts. The state MCH liaison to the project, Dr Nugent, has agreed to attend the next Healthy Start national conference with the project representatives. An important tool for collaboration is a shared electronic case record that provides common access to the Healthy Start case record (with patient and parent consent) among Health Start staff, local Department of Human Services’ staff, and Arkansas Department of Health staff.

Linkages and collaboration with others. The project also maintains collaborative planning, outreach and referral relationships with a wide number of agencies and organizations in the community. These range from the Department of Human Services for Medicaid and ARkids coverage, The Haven for domestic abuse victim shelter and counseling services, Mid-South Counseling Services for mental health services, Early Head Start for child care and development services, and the Housing Authorities.

Information about the Healthy Start project and its successes are shared through the statewide association of Community Action Agencies and a regional network of Enterprise Communities/Empowerment Zones and other community development initiatives to which Mississippi County Arkansas EOC belongs.

The consortium still has its original members which provides guidance, support in all activities concerning funding opportunities, case file reviews, public awareness, and community trainings.

Consumer input-- All the consumer representatives are encouraged to participate in the consortium meetings. The material to be review at the meetings is mail to the members previous to the consortium meeting, so members can review.

Consumer self-confidence-- The Project Director builds the self-confidence of all consumers by recognizing them during the meeting and encourages them to address the issues under discussion. Consumers who participate as members of the consortium also received training to make them familiar with the goals and objectives of the project and the consortium by-laws. They also received cards thanking them for their participation and recognizing their contribution to the meeting in project. The Project Director welcomes consumers to visit with her at any time to discuss any issues or concerns regarding the project by-laws, program implementation, services provided, and program performance as well as any budget concerns.

Utilization of suggestions—All suggestions are reviewed by the Project Director, the Consortium Chairperson and the MCAEOC Executive Director and also shared with the rest of the consortium board members, if consumer gives consent for discloser of his/her suggestion. Additionally, the suggestion has to be feasible and reasonable and within the parameters of Healthy Start’s goals.

E. Sustainability

1) Our organization does not have to apply for third party billing because the project provides only paraprofessional case management services, no opportunities have been identify for third party payments.

Several attempts were made in the past year to identify and seek additional funding for the Healthy Start Project including responding to March of Dimes, request for Proposal. These effects were to no avail except for the continued funding by the State Teen Pregnancy Prevention which was maintained at $ 33, 000 level.

2) The Project Director has made multiple attempts to obtain funding from other organizations such as Tobacco Grant Funding from the University of Pine Bluff, Arkansas and the Arkansas Department Of Health Tobacco Block Grant. This effort has been paralyzed due to the lack of commitment (policy changing regarding tobacco use in school settings) from other educational institutions that were identified as key players for the obtaining of future funding.

3) Due to the blocking of the Healthy Start Director’s efforts by other perspective partners, it was impossible to obtain funding.

II. Project Management and Governance

A. The Healthy Start Project structure is composed of four paraprofessional Case Managers, a Community Health Educator and the Project Director. Along with the hard course staff we add the Executive Director and the MCAEOC Chair board person.

B. The Project Director continues to establish links and collaboration among community agencies in Mississippi County as well as the adjoining counties. Some examples of new partnerships are the Haven domestic violence shelter, Department of Human Services for ARkids and Medicaid coverage, Mid-south Counseling for Mental Health Services, Head Start for child care and development services and Housing Authorities. Some examples of out of county contacts are West Memphis Delta Outreach Services and East Arkansas Family Center.

Additionally, the sharing training cost between different community partners has helped the Healthy Start Staff to continue to improve their professional development so better services can be provided to our consumers.

C. Some challenges identify regarding program management were the learning of new additional ROMA guidelines reporting system. This nationally mandating system which used a total different reporting system and format than MCH national performance measures doubles the staff time devoted to data collection and reporting.

Also, the loss of three case workers has also decrease considerable the numbers of consumers recruited and serve has affected the level of community services. This loss was primarily due to declining morale due to the project’s inability to offer salary increases because of the tight budget.

D. The Project Director and the bookkeeper maintain a close working relationship to ensure that all funds are distributed properly. Additionally, the Mississippi County Arkansas Economic Opportunity Commission, Inc., (MCAEOC) has hired a professional team of Auditors whom monitors the allocation of funds administrated by the MCAEOC.

E. The only contractor that the Healthy Start counts with is the New Futures For Youth whom helps with technical assistance (TA) for the Single Teen Parent Crisis Intervention Program and funding resources. This organization is funded through the State under the Pregnancy Prevention Block Grant.

F. Cultural competency has not become an issue due to a multidisciplinary and multiracial team composed by blacks, white and Hispanic staff.

III. Project Accomplishments

|Proj Period Objective |BY 04/05 |Strategy and Activities |Progress |

| | | | |

|Objective 1. By the end of 06/01/05, the |Calendar Year . By the end of |Strategy: Continue strengthened outreach to adolescents at high risk of|Through intensive family planning |

|percent of live births to residents of the |12/31/03, the percent of live births |becoming pregnant. |education 176 students adolescents have |

|project area that occur to mothers age18 and|to residents of the project area that| |family planning education through |

|younger shall be no greater than 18.0% for |occur to mothers age 18 and younger | |“Reducing the Risk” curriculum |

|African American and 14.0% for all other |shall be no greater than 20.0% for | |“The Reducing the Risk curriculum and |

|races. |African Americans and 14.0% for all |Recruitment of pregnant and parenting as well as other sexually active |“Focus on Kids” curriculum was taught to |

| |other races |at risk teens for risk reduction education and counseling (Ongoing) |87 juvenile adolescent inmates at the |

|Baseline: 28.6% of births to African | | |Mississippi County Correctional Facility |

|Americans (321/1123) and 14.2% of white and | |Case Managers to maintain mentoring relationship with at-risk teens and|Case Managers continue to monitor |

|other races (195/1370) were to mothers | |reduce barriers to obtaining needed services (Ongoing) |high-risk teens. See case file. |

|ages18 or younger during the baseline | | |A 6 Series of Community Health Education |

|period, 1996-1998-Office of Health | |Hold a Women’s Health Fair, which in part targets younger women, to |regarding HIV and STD were done in |

|Statistic, Arkansas Department of Health | |screen adolescents for pregnancy/STD risks. (By May 30, 2003) |Mississippi County Healthy Start and |

| | | |Delta Outreach Inc., Form October |

| | |Conduct 4 cycles of Reducing the risk curriculum for Middle and High |1-November 12, 2003 |

| | |School aged students in community-based youth serving organizations, |One cycle of Reducing the Risk curriculum|

| | |church youth groups, and after-school programs. |was conducted at High School. Due to a |

| | | |late partnership establishment. And a |

| | |2 class cycles completed or under way by 6/30/2003 |change of curriculum has made from |

| | |2 additional class cycles completed or underway by 12/31/2003 |Reducing the Risk to Making A Difference |

| | | |curriculum. Making A Difference |

| | | |curriculum is abstinence curriculum. |

| | | |Negotiations with Middle School still in |

| | | |progress. |

| | | | |

| | | | |

|Proj Period Objective |By 03/04 Objective |Strategy and Activities | |

|Objective 3. By the end of 06/01/05, the percent|Calendar Year 3. By the end of 12/31/04, the | | |

|of births occurring to mothers with three or |percent of births occurring to mother with three|Strategy: Continued aggressive outreach through | |

|fewer prenatal visits shall be less than 4% in |of fewer prenatal visits shall be less than 7% |“peer educators counselors” with access to hard | |

|among both African American and all other races |in among both African American and all other |to reach populations. | |

|within the program area population. |races within the program area population. | | |

| | |Each case manager will identify and recruit | |

|Baseline: During the three year, 1996-1998, | |persons who “hang with out- of school youth, | |

|baseline period, 9.3% (105/1123) of births to | |alcohol/ drug abusers, and other who are at | |

|black mothers and 3.8% (52/1370) of births to | |Risk of presenting late for prenatal care. | |

|white and other race mothers who had three of | |(Ongoing: each case manager to maintain a | |

|fewer prenatal care visits. –Office of Health | |minimum of 5 peer educators/counselors) | |

|Statistic, Arkansas Department of Health | | | |

| | |Educate peers on why prenatal care is important,| |

| | |how to make a referral, and how to reduce a | |

| | |person’s avoidance of prenatal care. | |

| | | | |

| | |Encourage neighborhood residents to call the | |

| | |local case manager when they suspect someone is | |

| | |pregnant and not seeking prenatal care. | |

Intervention: Outreach/Health Education

|Proj Period Objective |BY03/04 Objective |Strategy and Activities |Progress |

|Objective 1. By the end of | | | |

|06/01/05, the percent of live |Calendar Year 3. By the end |Strategy: Continue strengthened outreach to adolescents at high risk of becoming pregnant. |Through intensive family planning education 176 |

|births to residents of the project |of 12/31/03, the percent of | |students adolescents have family planning |

|area that occur to mothers age 18 |live births to residents of | |education through “Reducing the Risk” curriculum |

|and younger shall be no greater |the project area that occur to| | |

|than 18.0% for African American and|mothers age 18 and younger | |“The Reducing the Risk curriculum and Focus on |

|14.0% for all other races. |shall be no greater than 20.0%|Recruitment of pregnant and parenting as well as other sexually active at-risk teens for risk |Kids “ curriculum was taught to 87 juvenile |

| |for African Americans and |reduction education and counseling (Ongoing) |adolescent inmates at the Mississippi County |

|Baseline: 28.6% of births to |14.0% for all other races | |Correctional Facility |

|African Americans (321 / 1123) and | |Case Managers to maintain mentoring relationship with at-risk teens and |Case Managers continue to monitor high-risk teens.|

|14.2% of white and other races (195| |reduce barriers to obtaining needed services (Ongoing) |See case file. |

|/ 1370) were to mothers age 18 or | | |A 6 Series of Community Health Education regarding|

|younger during the baseline period,| | |HIV and STD were done in partnership with |

|1996-1998 – Office of Health | |Hold a Women’s Health Fair, which in part targets younger women, to screen adolescents for |Mississippi County Healthy Start and Delta |

|Statistic, Arkansas Department of | |pregnancy/STD risks. (By May 30, 2003) |Outreach Inc., Form October 1- November12,2003 |

|Health | | | |

| | | |One cycle of Reducing the Risk curriculum was |

| | |Conduct 4 cycles of Reducing the Risk curriculum for Middle and High School aged students in |conducted at High School. Due to a late |

| | |community-based youth serving organizations, church youth groups, and after-school programs. |partnership establishment. And a change of |

| | | |curriculum has made from Reducing the risk to |

| | | |Making a Difference curriculum. Making a |

| | |2 class cycles completed or under way by 6/30/2003 |Difference is abstinence curriculum. Negotiations |

| | | |with Middle School still in progress. |

| | |2 additional class cycles completed or underway by 12/31/2003 | |

Intervention: Outreach and Health Education

|Proj Period Objective |BY03/04 Objective |Strategy and Activities |Progress |

| | | | |

|Objective 2. By the end of |Calendar Year 3. By the end of |Strategy: Continued aggressive outreach through “peer educators/counselors” with access to |On going process. By the Project Director and |

|06/01/05, the percent of births |12/31/03, the percent of births |hard to reach populations. |Community Health Educator teaching at the High |

|occurring to mothers with first |occurring to mothers with first | |School and the Correctional Facility have generate |

|trimester care shall be 85% for |trimester care shall be no less |Each case manager will identify and recruit persons who “hang with” out-of-school youth, |referrals regarding to pregnant adolescents who |

|residents within the project area |than 78% for residents within the |alcohol/drug abusers, and others who are at high risk of presenting late for prenatal care. |presented high-risk of attending to prenatal |

|for both African Americans and all |project area for both African |(Ongoing: Each case manager to maintain a minimum of 5 peer educators/ counselors) |visits. |

|other races. |Americans and all other races. | |On daily bases the caseworkers educate the peers |

| | |Educate peers on why prenatal care is important, how to make a referral, and how to reduce a |regarding the importance of prenatal care. See case|

|Baseline: Only 69.0% (1720 / 2493)| |person’s avoidance of prenatal care. (Ongoing) |files. |

|of births were to mothers with | | |Community Representatives and neighborhood |

|first trimester care during the | |Encourage neighborhood residents to call the local case manager when they suspect someone is |residents are continually encourage |

|baseline period, 1996-1998. – | |pregnant and not seeking prenatal care. (Ongoing) | |

|Office of Health Statistic, | | | |

|Arkansas Department of Health | | |Posters have been place during the fall to promote |

| | |Strategy: Public education and promotion for first trimester care |the program among all residents. |

| | | | |

| | |Point of Sale posters and brochures for pharmacies and other vendors of home pregnancy tests. |A second round of public awareness will take place |

| | |Spring and Fall campaigns materials in place by May 1 and October 1) |in Mississippi County. Utilization of the media and|

| | | |posters placement will take place. |

| | |Recruit and educate beauty salon workers to promote early prenatal care; provide educational |The County Judge will proclaim on May 07, 2004 the |

| | |materials and posters for display and distribution through shops. (Coinciding with Spring and |National Date for Teen Pregnancy Prevention. A free|

| | |Fall point of sale campaigns) |quiz will be set up at different schools. |

| | | | |

| | |Distribute a message to all churches for the first Sunday in May and October on the importance | |

| | |of prenatal care. | |

| | | | |

Intervention: Outreach

|Proj Period Objective |BY03/04 Objective |Strategy and Activities |Progress |

| | | | |

|Objective 3. By the end of |Calendar Year 3. By the end of |Strategy: Continued aggressive outreach through “peer educators/counselors” with access to |On going process. By the Project Director and |

|06/01/05, the percent of births |12/31/03, the percent of births |hard to reach populations. |Community Health Educator teaching at the High |

|occurring to mothers with three or |occurring to mothers with three | |School and the Correctional Facility they have |

|fewer prenatal visits shall be less|or fewer prenatal visits shall be|Each case manager will identify and recruit persons who “hang with” out-of-school youth, |generate referrals regarding to pregnant |

|than 4% in among both African |less than 7% in among both |alcohol/drug abusers, and others who are at high risk of presenting late for prenatal care. |adolescents who presented high-risk of attending |

|American and all other races within|African American and all other |(Ongoing: Each case manager to maintain a minimum of 5 peer educators/counselors ) |to prenatal visits. |

|the program area population. |races within the program area | | |

| |population. |Educate peers on why prenatal care is important, how to make a referral, and how to reduce a|On daily bases the caseworkers educate the peers |

|Baseline: During the three year, | |person’s avoidance of prenatal care. (Ongoing) |regarding the importance of prenatal care. See |

|1996-1998, baseline period, 9.3% | | |case files. |

|(105 / 1123) of births to black | |Encourage neighborhood residents to call the local case manager when they suspect someone is|Community Representatives and neighborhood |

|mothers and 3.8% (52 / 1370) of | |pregnant and not seeking prenatal care. (Ongoing) |residents are continually encourage |

|births to white and other race | | | |

|mothers who had three or fewer | | | |

|prenatal care visits. – Office of | | | |

|Health Statistic, Arkansas | | | |

|Department of Health | | | |

| | | | |

Intervention: Education and Outreach

|Proj Period Objective |BY03/04 Objective |Strategy and Activities |Progress |

| | | | |

|Objective 4. By the end of |Calendar Year 3. By the end of |Strategy: Continued aggressive outreach and education to increase awareness of the importance |The caseworker encourages all pregnant participants|

|06/01/05, no more than 18% of |12/31/03, the percent of births |of birth interval. |to use a family planning that will help them to |

|births will occur with less than an|occurring with less than an 18 | |space between pregnancies. See case file |

|18 month period from the end of a |month birth interval shall be no | | |

|previous pregnancy to women 25 and |greater than 22% of all second or | | |

|under. |higher order pregnancies in the | |All the pregnant consumer received education |

| |project area. |All Healthy Start enrollees will receive routing education and encouragement to space their |regarding why is important to space between births |

|Baseline: With 1997 births, 29.9% | |pregnancies so that a minimum 18-month birth interval is achieved. |during the home visits. |

|(94 / 314) of all births to moms | |(Ongoing) | |

|under the age of 25 with a second | | |Post-partum consumers are educated, encouraged and |

|or higher order pregnancy occurred | |Postpartum women will be monitored for and encouraged to obtain annual exams and participate in|transported to receive family planning services. |

|in less than 18 months from the end| |family planning services. (Ongoing) | |

|of the previous pregnancy. The | | |Posters have been place in different stores |

|comparable rate when mothers are 25| |Health promotion campaigns will be executed and sustained through: | |

|and over is 9.0% (22 / 244) | |posters and promotional material in food stores, WIC offices, and other community sites during | |

|-- Area IX Health Management | |January and July. | |

|Area, Arkansas Department of Health| |Presentations at the Women’s Health Fair in the spring, 2002. | |

| | |focusing on birth intervals in at least one-third of the planned women’s health events to be | |

| | |held throughout the county. | |

| | |Distributing materials and beautician “talking points” on birth intervals for all beauty shop | |

| | |operators in the program area in the first week of January and July. | |

| | | | |

| | | | |

Intervention: Outreach, education, and case management

|Proj Period Objective |BY03/04 Objective |Strategy and Activities |Progress |

| | | | |

|Objective 5. By the end of 06/01/05, the percent|Calendar Year 3. By the end of | | |

|of births occurring at less than 38 weeks shall |12/31/03, the percent of births | | |

|be no greater than 25% for all births in the |occurring at less than 38 weeks shall|These objectives represent summative outcomes | |

|project area. |be no greater than 27% for all births|from the program’s total activities as described above. | |

| |in the project area | | |

|Baseline: During the 1196-1998 period, 39.4% | | | |

|(443 / 1123) of African American births occurred | | | |

|at less than 38 weeks gestation, as did 27.4% | | | |

|(375 / 1370) of births to whites and other races.| | | |

|– Office of Health Statistic, Arkansas Department| | | |

|of Health | | | |

| | | | |

|Objective 6. By the end of 06/01/05, the percent|Calendar Year 3. By the end of | | |

|of low birth weight infants born to African |12/31/03, the percent of low birth | | |

|American mothers shall be no greater than 8.0%. |weight infants born to African | | |

| |American mothers shall be no greater | | |

|Baseline: 13.6% (153 / 1123) of black and 8.2% |than 10.0%. | | |

|(112 / 1370) of white and other race births were | | | |

|to infants weighing less than 2500 grams during | | | |

|the baseline period, 1996-1998. – Office of | | | |

|Health Statistic, Arkansas Department of Health | | | |

Intervention: Local Health System Improvement

|Proj Period Objective |BY03/04 Objective |Strategy and Activities |Progress |

| | | | |

|Local Health System Improvement |Year 3. |Strategy: Organize a community coalition to develop a comprehensive |This initiative was replaced and incorporated into |

|Objective: By May 2005, develop an|By June 30, 2003, a randomized |assessment and plan to address domestic violence. |the Hometown Health Improvement Project which had |

|intimate partner and family |prevalence survey will have been | |planning funds to build a community wide coalition |

|violence community coalition whose |conducted and analyzed. |Local evaluator to develop survey instruments and random digit dialing protocol by April 15 |to identify and address high priority community |

|actions significantly reduce the | | |health needs. |

|prevalence of domestic violence as | |Coalition member agency staff volunteers recruited and trained in conducting the structured | |

|measured by a random community | |telephone interview by June1 |After a comprehensive needs assessment, the |

|survey. | | |identified focus areas are: |

| | |Phone interviewing conducted during June | |

| | | |1. strengthen marriage and families in Mississippi |

| | |Interviews analyzed and report prepared by July 30 |County, |

| |By December 31, 2003, a community | |2. Increase primary care access through a community|

| |coalition will have been founded |Hold meeting to discuss results of the survey by August 30 |effort to get a Community Health Center clinic site|

| |to advocate for policies that | |in the county. |

| |curtail and prevent domestic |Recruit core-organizing group of at least eight persons committed to prevention of family and |3. Increase community based prevention and health |

| |violence and puts victim screening|domestic violence for a series of strategy meetings. (This may be done in conjunction with |education efforts |

| |practices in place in the |Hometown Health Improvement.) | |

| |community. | |Implementation activities are currently underway. |

| | |Core organizing group recruits other members and develop action plans by October 30. | |

| | | | |

| | |Initial implementation of action plans during November and December. | |

| | | | |

| | | | |

| | | | |

Calendar Year 2004 Work plan

Intervention: Outreach/Health Education

|Proj Period Objective |BY04/05 Objective |Strategy and Activities |Progress |

| | | | |

|Objective 1. By the end of |Calendar Year 4. By the end of |Strategy: Continue strengthened outreach to adolescents at high risk of becoming | |

|06/01/05, the percent of live |12/31/04, the percent of live |pregnant. | |

|births to residents of the project |births to residents of the project| | |

|area that occur to mothers age 18 |area that occur to mothers age 18 |Recruitment of pregnant and parenting as well as other sexually active at-risk teens for risk reduction | |

|and younger shall be no greater |and younger shall be no greater |education and counseling (Ongoing) | |

|than 18.0% for African American and|than 18.0% for African Americans | | |

|14.0% for all other races. |and 14.0% for all other races |Case Managers to maintain mentoring relationship with at-risk teens and | |

| | |reduce barriers to obtaining needed services (Ongoing) | |

|Baseline: 28.6% of births to | | | |

|African Americans (321 / 1123) and | | | |

|14.2% of white and other races (195| |Hold a Women’s Health Fair, which in part targets younger women, to screen adolescents for pregnancy/STD | |

|/ 1370) were to mothers age 18 or | |risks. (By June 30, 2004) | |

|younger during the baseline period,| | | |

|1996-1998 – Office of Health | | | |

|Statistic, Arkansas Department of | |Conduct 4 cycles of Reducing the Risk/Making a Difference curriculum for Middle and High School aged | |

|Health | |students in community-based youth serving organizations, church youth groups, and after-school programs. | |

| | | | |

| | | | |

| | |2 class cycles completed or under way by 6/30/2004 | |

| | | | |

| | |2 additional class cycles completed or underway by 12/31/2004 | |

| | | | |

| | | | |

| | | | |

Intervention: Outreach and Health Education

|Proj Period Objective |BY04/05 Objective |Strategy and Activities |Progress |

| | | | |

|Objective 2. By the end of |Calendar Year 4. By the end of |Strategy: Continued aggressive outreach through “peer educators/counselors” with access to hard to reach| |

|06/01/05, the percent of births |12/31/03, the percent of births |populations. | |

|occurring to mothers with first |occurring to mothers with first | | |

|trimester care shall be 85% for |trimester care shall be no less |Each case manager will identify and recruit persons who “hang with” out-of-school youth, alcohol/drug | |

|residents within the project area |than 78% for residents within the |abusers, and others who are at high risk of presenting late for prenatal care. (Ongoing: Each case | |

|for both African Americans and all |project area for both African |manager to maintain a minimum of 5 peer educators/counselors ) | |

|other races. |Americans and all other races. | | |

| | |Educate peers on why prenatal care is important, how to make a referral, and how to reduce a person’s | |

|Baseline: Only 69.0% (1720 / 2493)| |avoidance of prenatal care. (Ongoing) | |

|of births were to mothers with | | | |

|first trimester care during the | |Encourage neighborhood residents to call the local case manager when they suspect someone is pregnant and| |

|baseline period, 1996-1998. – | |not seeking prenatal care. (Ongoing) | |

|Office of Health Statistic, | | | |

|Arkansas Department of Health | | | |

| | |Strategy: Public education and promotion for first trimester care | |

| | | | |

| | |Point of Sale posters and brochures for pharmacies and other vendors of home pregnancy tests. Spring and| |

| | |Fall campaigns materials in place by May 1 and October 1) | |

| | | | |

| | |Recruit and educate beauty salon workers to promote early prenatal care; provide educational materials | |

| | |and posters for display and distribution through shops. (Coinciding with Spring and Fall point of sale | |

| | |campaigns) | |

| | | | |

| | |Distribute a message to all churches for the first Sunday in May and October on the importance of | |

| | |prenatal care. | |

Intervention: Outreach

|Proj Period Objective |BY04/05 Objective |Strategy and Activities |Progress |

| | | | |

|Objective 3. By the end of |Calendar Year 4. By the end of |Strategy: Continued aggressive outreach through “peer educators/counselors” with access to hard to reach| |

|06/01/05, the percent of births |12/31/04, the percent of births |populations. | |

|occurring to mothers with three or |occurring to mothers with three or| | |

|fewer prenatal visits shall be less|fewer prenatal visits shall be |Each case manager will identify and recruit persons who “hang with” out-of-school youth, alcohol/drug | |

|than 4% in among both African |less than 7% in among both African|abusers, and others who are at high risk of presenting late for prenatal care. (Ongoing: Each case | |

|American and all other races within|American and all other races |manager to maintain a minimum of 5 peer educators/counselors ) | |

|the program area population. |within the program area | | |

| |population. |Educate peers on why prenatal care is important, how to make a referral, and how to reduce a person’s | |

|Baseline: During the three year, | |avoidance of prenatal care. (Ongoing) | |

|1996-1998, baseline period, 9.3% | | | |

|(105 / 1123) of births to black | |Encourage neighborhood residents to call the local case manager when they suspect someone is pregnant and| |

|mothers and 3.8% (52 / 1370) of | |not seeking prenatal care. (Ongoing) | |

|births to white and other race | | | |

|mothers who had three or fewer | | | |

|prenatal care visits. – Office of | | | |

|Health Statistic, Arkansas | | | |

|Department of Health | | | |

| | | | |

| | | | |

Intervention: Education and Outreach

|Proj Period Objective |BY04/05 Objective |Strategy and Activities |Progress |

| | | | |

|Objective 4. By the end of |Calendar Year 4. By the end of |Strategy: Continued aggressive outreach and education to increase awareness of | |

|06/01/05, no more than 18% of |12/31/04, the percent of births |the importance of birth interval. | |

|births will occur with less than an|occurring with less than an 18 | | |

|18 month period from the end of a |month birth interval shall be no | | |

|previous pregnancy to women 25 and |greater than 22% of all second or |All Healthy Start enrollees will receive routing education and encouragement to space their pregnancies | |

|under. |higher order pregnancies in the |so that a minimum 18 month birth interval is achieved. | |

| |project area. |(Ongoing) | |

|Baseline: With 1997 births, 29.9% | | | |

|(94 / 314) of all births to moms | |Postpartum women will be monitored for and encouraged to obtain annual exams and participate in family | |

|under the age of 25 with a second | |planning services. (Ongoing) | |

|or higher order pregnancy occurred | | | |

|in less than 18 months from the end| |Health promotion campaigns will be executed and sustained through: | |

|of the previous pregnancy. The | |posters and promotional material in food stores, WIC offices, and other community sites during January | |

|comparable rate when mothers are 25| |and July. | |

|and over is 9.0% (22 / 244) | |Presentations at the Women’s Health Fair in 2004. | |

|-- Area IX Health Management | |focusing on birth intervals in at least one-third of the planned women’s health events to be held | |

|Area, Arkansas Department of Health| |throughout the county. | |

| | |Distributing materials and beautician “talking points” on birth intervals for all beauty shop operators | |

| | |in the program area in the first week of January and July. | |

| | | | |

| | | | |

Intervention: Outreach, education, and case management

|Proj Period Objective |BY04/05 Objective |Strategy and Activities |Progress |

| | | | |

|Objective 5. By the end of 06/01/05, the percent|Calendar Year 4. By the end of | | |

|of births occurring at less than 38 weeks shall |12/31/04, the percent of births | | |

|be no greater than 25% for all births in the |occurring at less than 38 weeks shall|These objectives represent summative outcomes | |

|project area. |be no greater than 27% for all births|from the program’s total activities as described above. | |

| |in the project area | | |

|Baseline: During the 1196-1998 period, 39.4% | | | |

|(443 / 1123) of African American births occurred | | | |

|at less than 38 weeks gestation, as did 27.4% | | | |

|(375 / 1370) of births to whites and other races.| | | |

|– Office of Health Statistic, Arkansas Department| | | |

|of Health | | | |

| | | | |

|Objective 6. By the end of 06/01/05, the percent|Calendar Year 4. By the end of | | |

|of low birth weight infants born to African |12/31/04, the percent of low birth | | |

|American mothers shall be no greater than 8.0%. |weight infants born to African | | |

| |American mothers shall be no greater | | |

|Baseline: 13.6% (153 / 1123) of black and 8.2% |than 10.0%. | | |

|(112 / 1370) of white and other race births were | | | |

|to infants weighing less than 2500 grams during | | | |

|the baseline period, 1996-1998. – Office of | | | |

|Health Statistic, Arkansas Department of Health | | | |

IV. Project Impact

A.—

The Mississippi County Healthy Start Program involves extensive coordination and collaboration with the following agencies and providers. The state Department of Health, Arkansas designated Title V agency, operates two local health units in the program area that provide Maternity, WIC, EPSDT, immunizations, and family planning services to Healthy Start consumers. The local administrator of one of these two units is the chair of the Healthy Start Consortium. The Arkansas Health Department has also provided the program with additional grant support to reduce teen and unwed births in the county.

The local administrator of the Arkansas Department of Human Services, the agency that administers Medicaid and Children with Special Medical Needs program in Arkansas, is also an active member of the Consortium. Healthy Start also has close linkage with Mississippi County EOC Early Head Start program, which has the capacity to make of infant and toddler care services to families.

Private physicians, both pediatric and OB practitioners, and hospital staff have also participated in the operation of the community level case management system.

Additionally, the enhanced collaborative interaction among community organizations and services involved in promoting maternal and infant health and social support services can be describe in the creation of a Local Health System Action Plan (LHSAP). This plan focused on the development of a county community coalition to address issues such as accessing to prenatal care, infant mortality but also to address domestic violence and unwed teen pregnancy. These issues were incorporated into the Hometown Health Improvement (HHI) coalition for the Mississippi County.

The Project Director of the Healthy Start Initiative was one of the pioneers of this county coalition and served as a key player for the creation and success of this coalition. The HHI is the major community-based initiative of the Arkansas Department of Health, the state’s Title V agency, to improve local health care systems and health status of the population. This effort unites health service providers, community –based organizations, faith-based groups, educational institutions, and business leaders to access community health needs and take action.

An important tool for collaboration is a shared electronic case record that provides common access to the Healthy Start case record (with patient and parent consent) among Health Start staff, local Department of Human Services staff, and Arkansas Department of Health staff.

The Healthy Start, the public social entities, and the Health Department share the same participant’s eligibility criteria due to the geographical, economical and sub-development location of county inhabitants. Because our county is located in the poorest location of the Delta, it has made it easy to enroll consumers into the Healthy Start Program as an extension of services provided to this underserved population.

Some of the barriers that we have encountered were: First, the territorial issues among providers who did not receive well the program efforts at the beginning of the program implementation. This rejection was based in the misconception that we were direct service providers and this will have a negative repercussion in the economic welfare. Second, transportation, a key to job access, training and childcare is consistently cited as among the most important issues for meeting the goals of welfare reform. Yet rural areas present particular challenges for meeting individuals’ transportation, particularly for people without automobiles. Lack of transit, especially in rural areas, may limit the ability of human service agencies to move Temporary Assistance to Needy Families (TANF) recipients and other low-income residents to jobs, training opportunities and other support services. Third, High users of public transit are most likely to be of Asian, African-Americans, or Hispanic heritage; central city dwellers, particularly female workers, living alone; households with no vehicles; or low-income persons. Since these are characteristics shared by those who received Aid to Families with Dependent Children (AFDC), it would appear that transit would likewise meet the needs of adults participating in the new welfare reform program, TANF. Mobility problems, certainly disproportionately, affect poor blacks who live in inner cities. Fourth, Former Transportation Secretary Rodney Slater said transportation is the “to” in Welfare-To-Work (WtW) initiatives, realizing that many welfare recipients and the working poor have limited access to transportation. Welfare parents and others seeking employment need access not only to jobs, but other services such as daycare facilities, schools, training programs and health care providers. Persons with private automobiles take for granted the ability to plan and control work trips, errands, shopping, recreation and other trips. Lack of automobile ownership, however, limits access. Automobile ownership is associated with class in that automobiles symbolize not only status in American society, but also freedom. Fifth, Welfare dependency, unemployment and underemployment are high in this region. This has resulted in a spatial mismatch – the jobs that are available are not located in the areas with the greatest need for employment. For this reason, the provision of transportation will play a crucial role in welfare reform in the South.

As the project has become more visible in the school districts and neighborhoods, information has been circulated about the project services. Some cases have been opened by consumers themselves. Teenagers are now calling site offices to request information and to enroll in the project. As other agencies become aware of the project they are beginning to refer consumers for future services. In previous years, we have not had partnership collaboration agreements with these agencies that are making these referrals. The project has been accepted by the community, health agencies, faith community-based organizations, businesses and judicial system.

One of the major accomplishments of Mississippi County Healthy Start Initiative has been the Consortium Model. The consortium has become a valuable arena for exchanging information and offering guidelines to the project. The consortium is composed of seven consumers of childbearing age and nine representatives from community agencies.

The Mississippi County Healthy Start Consortium members have been able to take an active role for the implementation and promotion of the project goals in the community as well at the state level. A classic example of this commitment is: a) Discussion of strategies of intervention and activities to be carried out in the implementation of the project components. b) Addressing the media, c) Public awareness of the project goals by consortium members who participate in public presentation in the school district (High School) as well as at higher educational levels.

The Mississippi County Healthy Start Initiative initiated a partnership with the Arkansas Hometown Health Improvement Project because of similar principals. The program foundation is base on community focus, local control, data-based decision-making, local/state partnership and follows through with communities by adopting appropriate roles to support community strategies initiated to solve their community challenges.

The Mississippi County Healthy Start Initiative has actively participated in other community-based initiative created by the Department of Human Services (DHS) in Arkansas State. This initiative is known as Together We Can (TWC).

This program serves as a resource to help keep the family unit together. The TWC program intervenes to help eliminate placement out of home into foster care or residential facilities. The Healthy Start Project Director serves as a consultant in the decision –making process due to the fact that the program supports the child or adolescent and his/her family in developing their capacity for what the individual identify as a quality of life within their home and community. The project identify it self as a continuation of care philosophy. TWC project provide short term services to consumers at high risk. The TWC project targets consumers up to 19 years of age.

One of the consortium goals was that Mississippi County Healthy Start Initiative would implement a curriculum within the school district to address adolescent’s health beliefs and practices that contribute poor perinatal outcomes. The project has faced this task with difficulty due to several factors: a) Social behaviors and practices addressed in the Youth Risk Behavior Survey. b) Lack of support from some school board members. c) Political agendas. d) Difficulty finding a professional person who will meet the desired qualifications to occupy the health educator position. The Project Director has temporarily taken on this task and negotiations with the school district in Blytheville and Osceola cities have begun. Several presentations and meetings have taken place with Osceola High School Principal and Blytheville nurses, and teachers for health and parenting classes.

A second corner stone has been the transportation services that the project offers to the Healthy Start participants. By providing transportation services the project has gain more public recognition among private physicians as well the general public. The transportation services have been utilized as a recruiting tool by the caseworkers to reach out to families who live within the project area and that are in need of services.

Regarding to records systems the Mississippi County Healthy Start Program has established training for all the caseworkers/managers. The training process begins with an extensive orientation by the Project director. In the orientation process the caseworker/manager received training in the following categories: Mississippi County Economic Opportunity Commission, Inc. Personnel Policies, Healthy Start Goals and Objectives accord to the FY in progress, Transportation Rules and Regulations, Case File Information and Confidentiality Policies, rules and regulation regarding obtaining and keeping consumers personal, medical or any other type of information collected during any contact with the consumers.

Additionally, an important tool for collaboration is shared electronic case record that provides common access to the Healthy Start case record (with patient and parent consent) among Health Start staff, local Department of Human Services staff, and Arkansas Department of Health staff.

Furthermore, the caseworkers are responsible for the enrollment of clients and continual participation in the program. Once the consumer signs all formal documentation which states his/her participation as an active consumer of the program, the client is asked to evaluate the services provided by the caseworkers such as transportation services, satisfaction of the services provided, on time intervention of services. On the other hand, the consortium board members that are composed by community agency representatives as well as active consumers received a partnership agreement that measures the awareness, readiness and sensitivity to respond to consumer and partner issues. These surveys and measuring tools are cultural sensitive by being translated into their native language. This is an effort to establish an effective and clear communication among all partners and participants. Also, due to the ability of the Project Director to speak two different languages, it has made it easy and economical for the staff, community partners, and consumers to ask for any assistance when is necessary at no charge.

Regarding the consumer participation in the developing of assessments of implementation and intervention has been little or no participation. Most of the tools are designed by the Project Director and the Local Evaluator with the approval of the Executive Director and the Consortium Board Members.

B. Impact of the Community: The Mississippi County Healthy Start Initiative has 4 community case workers/case managers. These caseworkers are strategically located within the project area. Also these caseworkers took under their wings the outreach model. The project has been addressing the concept of “Friendly Neighborhood” idea. The caseworkers have received training to implement this concept. This concept is based in an aggressive out reach by the caseworkers toward to consumers in the community. By visiting hair salons, grocery stores, churches, day cares, business or any other major area were it could be concentration of possible consumers. The project has establish a highly motivate strategic to address and recognize caseworkers under outreach activities.

The Project director has establish a monthly recognition of the caseworker/manager who have meet the goal of enrolling 10 new consumers into the project as well a small item is giving to the caseworker. This items has been purchase by the project director form her own personal pocket.

The project counts with a newly caseworker/manager who is located in the Housing Authority Project in Blytheville Site. This caseworker/manager has 13 years of experience working with Arkansas Department of Health in Blytheville Unit under the Home Health Department. This caseworker has experience with Medicaid billing, case file review, follow-up and documentation skills along with her computer skills.

Furthermore, distribution of flyers among neighborhood friendly service provides, local establishments such as restaurants, beauty salons, health centers, convenience stores and non-profit organizations ( Haven, Red Cross), Housing Authority, Gas stations, Day Care Providers, etc.

In addition, the Healthy Start consumers have been trained in community partnership and lobbying with the objective of establishing contact with their State representatives in Washington, D.C. to further the continuation of the Healthy Start services among their communities.

C. Impact on the State-- The Mississippi County Healthy Start Initiative Program is the only site funded by the MCHB and HRSA in the State of Arkansas.

The Mississippi County Healthy Start Program involves extensive coordination and collaboration with the following agencies and providers. The State Department of Health, Arkansas designated Title V agency, operates two local health units in the program area that provide Maternity, WIC, EPSDT, immunizations, and family planning services to Healthy Start consumers. The local administrator of one of these two units is the chair of the Healthy Start Consortium. The Arkansas Health Department has also provided the program with additional grant support to reduce teen and unwed births in the county.

The local administrator of the Arkansas Department of Human Services, the agency that administers Medicaid and Children with Special Medical Needs program in Arkansas, is also an active member of the Consortium. Healthy Start also has close linkage with Mississippi County EOC Early Head Start program, which has the capacity to make of infant and toddler care services to families.

D. Local Government-- The Project director has established close relationship with the local representatives. The Mississippi County Administrator, Judge McGuire, is an active member of the Healthy Start consortium. The County’s Administrator also provides human resources to the coalition.

An extraordinary relationship has been established with the former administrator of the Arkansas Department of Health at the local level who has participated from the initial stage of the program as the consortium chairperson.

On the other hand, the relationships at the State level have been quite difficult due to two factors. One, the intensive restructuring of the Arkansas Department of Health, under the administration of Dr. Boss for a period of three consecutive years, has made the establishment of a solid relationship with Title V very difficult. Second, the emerging of the Arkansas Department of Health under the umbrella of the Department of Human Services Administration has caused a commotion not just at the state level but also at local level changing the infrastructure, services and way of conducting business.

VI. Local Evaluation

HEALTHY START LOCAL EVALUATION REPORT

PROJECT NAME: Assessment for County Hometown Health Improvement Project

TITLE OF REPORT: Community Health Assessment: Mississippi County, Arkansas

AUTHORS: Earl W. Anthes

Section I: Introduction

The impetus for this study was the Healthy Start project’s participation in the county-wide “Hometown Health Improvement” project, an effort of the Arkansas Department of Public Health to forge a community-based health improvement planning group in the county. The local evaluator facilitated several preliminary planning sessions and prepared this descriptive community health assessment to provide common background information to the group. Funding for the project was provided under a HRSA rural health network development pass through grant to the local committee.

Section II: Process

The assessment involved the compilation and comparative analysis of data from a wide array of publicly available sources, including Census, Uniform Crime Reports, labor force statistics, vital statistics, morbidity and educational test results.

The assessment was distributed to participants who discussed the implications. Two planning meeting were subsequently held to formally identify and rate priorities using the factors of problem prevalence, severity, and intervention effectiveness.

Section III: Findings/Discussions

Selected priorities were: Obesity and lack of physical activity

Family instability

Alcohol and Drug Abuse

Violence

Lack of access to primary care and mental health services

Section IV: Recommendations

Working groups were established to develop community responses and support for these needs.

Section V: Impact

The entire effort faltered and failed when the Hometown Health Improvement staff and process was de-emphasized in the shifting priorities of the Health Department and the hospital, which had provided key leadership to the effort, was scheduled to be sold to a new management company. Thus, there was little impact.

Section VI: Publications

Community Health Assessment: Mississippi County, Arkansas

HEALTHY START LOCAL EVALUATION REPORT

PROJECT NAME: Assessment of Reducing the Risk Health Education Classes

TITLE OF REPORT: Preliminary Analysis of Pre- and Post-Test Results from Participants in the Reducing the Risk Training

AUTHORS: Earl W. Anthes

Section I: Introduction

This was a formative evaluation of six groups of adolescents who had participated in the project’s modification of the Reducing the Risk health education curriculum. The evaluation was jointly conducted by the staff and the local evaluator.

Section II: Process

Six groups of adolescents, predominantly 14 and 15 year olds, were enrolled in a modified Reducing the Risk health education classes in a variety of community and school settings, including a juvenile detention center and a Boys & Girls Club. Participants completed a pre-test at the start of the course and a post-test at the end of the course. Approximately 5 months elapsed between pre- and post-testing. The six page questionnaires were designed to measure reported behavior, self-efficacy, social comfort, behavioral intention, perceived parental communications, and perceived peer and parental acceptance or disapproval of selected risk behaviors. The blind pre- and post- questionnaires were matched by using a participant generated alphanumeric string. 158 matched pre- and post- questionnaires were analyzed. A copy of the questionnaire is contained in the draft report.

Section III: Findings/Discussions

No significant change was seen in condom use, sexual activity or number of partners. There was no significant change in a 13 item attitude and belief scale, but both males and girls showed significant increases in knowledge scores. The strongest single evidence of change was in their reported perception of their parents’ reaction if the youth was found with condoms: After the course both boys and girls believed that their parents would see condom passion as a positive rather than a negative behavior.

Post-testing immediately at the end of the intervention provided little opportunity for the course content to be fully integrating into the behavior and belief of the participants. The other significant shortcoming was inadequate documentation of the modifications of the curriculum in terms of content and delivery method.

Section IV: Recommendations

Further evaluation and participants should be undertaken with a longer assessment period.

Section V: Impact

Not known.

Section VI: Publications

A draft preliminary analysis was prepared and provided to project management. A copy is in the appendices.

MCAEOC Inc.

Mississippi County Healthy Start

|Pregnant |Number |Total |Title XIX |Title XXI |Private/ |None |

|Women |Served |Served |% |% |Other % |% |

|Served | | | | | | |

|Pregnant | |84 |95% |0 | |      |

|Women | | | | | | |

|(All Ages) |84 | | | | | |

| 10-14 | 3 | |       |      | |      |

|Children |Number |Total |Title XIX |Title XXI |Private/ |None |

|Served |Served |Served |% |% |Other % |% |

|infants ................
................

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