Arizona department of health services, office of women's and children's health health start program coordination study

              ZONA DEPARTMENT OF HEALTH
SffRVfCES
" 8 rr"" @E C ) F hi. .. a eft r5j v'qf d 1# " ':" .PJ'S AND CW LDREN'S
WEALI'I.1 START PROGRAM
COORD ON STUDY
Leadership for a Healthy Arizona
Fife Symington, Governor
State of Arizona
Jack Dillenberg, D.D.S., M.P.H., Director
Arizona Department of Health Services
Mission
To assess and assure the physical and behavioral health of all Arizonans through
education, intervention, prevention, delivery of services, and the advancement of public
policies that address current and emerging health issues in a manner that demonstrates
our efficiency, effectiveness, integrity and leadership.
Arizona Department of Health Services
Division of Public Health Services
Bureau of Community and Family Health Services
Office of Women's and Children's Health
41 1 N. 24th Street
Phoenix, Arizona 85008
(602)220-6550
"Permission to quote from reproduce materials from this publication is granted when
due acknowledgement is made. "
October 1, 1996
OfJice of the Director
1740 W. Adams Street
Phoenix, Arizona 85007-2670
(602) 542- 1025
(602) 542-1062 FAX
FIFE SYMINGTON, GOVERNOR
JACK DILLENBERG, D.D.S., M.P.H., DIRECTOR
September 30,' 1996
Representative Robert Burns
House of Representatives
1700 West Washington
Phoenix, Arizona 85007
..' :'
Dear Representative Burns: .- d-
The Arizona Department of Health Services conducted a study to assess the feasibility of
comprehensive coordination of prenatal/early childhood health outreach and prevention
programs. In accordance with the language of HB2277 [Laws 1996, Chapter 2471 for the
Arizona Children and Families Stability Act, the enclosed report on this study is provided to
you, as a member of the Joint Committee on Community Program Evaluation, which has
oversight of the study.
The report includes the results of a survey of programs that might provide services to pregnant
women and children. It includes a summary of services provided, populations served, and
program goals. The report also identifies community needs from the perspective of those
respo~diagto the survey. Finally, it nna!yzcs potential straiegies far co:laboration and
coordination of programs, including those currently employed by the Health Start Pilot
program.
If you have any questions about the report or need additional copies, please contact
Dr. Ruthann Smejkal at 602-220-6550.
Sincerely,
~acrillenber,g D DS , MPH
Dir q~di
cc: Reed Spangler
Leadership for a Healthy Arizona
HEALTH START PROGRAM COORDINATION STUDY
TABLE OF CONTENTS
I. EXECUTIVE SUMMARY
II. BACKGROUND
Ill. WHAT IS ARIZONA'S HEALTH START PROGRAM?
IV. IDENTIFICATION OF PRENATAL AND EARLY CHILDHOOD HEALTH
OUTREACH AND PREVENTION PROGRAMS IN ARIZONA 11
SURVEDYO CUMENT
GROUP 1: PREGNANCANYD CHILDH EALTHR ELATEDSE RVICES
GROUP 2: CHILDH EALTHR ELATEDSE RVICES
GROUP 3: PREGNANCRYE LATEDSE RVICES
V. ASSESSMENT OF GOALS, TYPES OF INTERVENTION AND COSTS OF
AVAILABLE PROGRAMS 2 1
GROUP 1: GOALSA ND INTERVENTIONS FOR PROGRAMPSR OVIDINPGR EGNANCAYND CHILDH EALTH
RELATESDE RVICES 2 1
GROUP 2: GOALSA ND INTERVENTIONS FOR PROGRAMPSR OVIDINCGH ILDH EALTHR ELATED
SERVICES 33
Summary 35
GROUP 3: GOALSA ND INTERVENTIONS FOR PROGRAMPSR OVIDINPGR EGNANCSYER VICES 45
Summary 47
HEALTH START PROGRAM COORDINATION STUDY
VI. ASSESSMENT OF THE NEEDS OF TARGET POPULATIONS AND
COMMUNITIES AND THE EXTENT TO WHICH CURRENT COMMUNITY
RESOURCES MEET THE NEEDS 54
VII. ANALYSIS OF PROGRAM RELATIONSHIP STRATEGIES AND BLOCK
GRANT STRATEGIES 67
VIII. PLAN FOR COORDINATING AVAILABLE SERVICES TO MINIMIZE
DUPLICATION TO SERVICE RECIPIENTS 76
PLAN FOR COORDINATION 77
IX. APPENDIX 82
APPENDIX1 : HEALTHS TARTN EIGHBORHOODANSD COMMUNITIEFSO R SFY 1996 83
Appendix 2: Suwey Document 85
Appendix 3: Respondents Sewing Pregnant Women and Providing Health Related Sewices for
Children 97
Appendix 4: Prevention and Outreach Sewices Provided by Respondents Sewing Pregnant Women
and Providing Health Related Sewices for Children 102
Appendix 5: Respondents Providing Health Related Sewices for Children But Not Sewices to
Pregnant Women 109
Appendix 6: Prevention and Outreach Services Provided By Respondents Providing Health Related
Services for Children But Not Services to Pregnant Women 113
Appendix 7: Respondents Who Sewe Pregnant Women and Who Do Not Provide Health Related
Sewices For Children 118
Appendix 8: Prevention and Outreach Services Provided by Respondents Who Sewe Pregnant
Women and Who Do Not Provide Health Related Sewices for Children 122
HEALTH START PROGRAM COORDINATION STUDY
Appendix 9: Respondents From Appendix 8 Who Also Include Children in Their Service Population,
Although They Do Not Provide Health Related Sewices For Children 127
Appendix 10: Analysis of Programs Identified by the Auditor General as Being Similar to Health
Start 130
iii
HEALTH START PROGRAM COORDINATION STUDY
EXECUTIVE SUMMARY
In 1982, Arizona began experiencing a steady decline in the rate of women receiving adequate
prenatal care. Since 1985, Arizona has also experienced persistent outbreaks of vaccine-preventable
diseases among its children, due, in part, to low immunization rates. In response to
these poor health conditions for pregnant women and young children, the Arizona Department of
Health Services (ADHS) initiated the Health Start Program in 1992. Health Start is a
neighborhood outreach program designed to assist pregnant women in communities at high-risk
for poor birth outcomes and/or inadequate immunization rates to obtain early and consistent
prenatal care and to assist their children to receive timely immunizations. This program is
delivered by Lay Health Workers, primarily in the client's home, and is intended to reduce barriers
to services. The program's mission is to educate, support, and advocate for families at risk by
promoting optimal use of community based family health and education services to reduce the
incidence of low birthweight babies, increase prenatal services to pregnant women, and improve
childhood health through a variety of means.
The Health Start Pilot Program was placed into statute in 1994 when the Arizona Legislature
established the program's overall goals and structure and expanded the family follow-up period to
the child's first four years of life. That legislation also required the Arizona Office of the Auditor
General to conduct an evaluation of the Health Start program. The first evaluation report,
completed in 1996, stated, in part, that although the ADHS Office of Women's and Children's
Health was coordinating among programs, the agency should conduct a study to assess the
feasibility of comprehensive program coordination. The report also listed several programs that it
considered similar in some way to the Health Start program. In response to that report, the
Arizona Legislature passed H.B. 2277 [Laws 1996, Chapter 2471 which required a report from
ADHS by October 1, 1996 on prenatal and early childhood health programs and a plan for
coordinating services to minimize duplication.
This report addresses the issues raised by the legislation and the Office of the Auditor General.
Section I1 identifies the programs considered by the Office of the Auditor General to be similar in
some way with the Health Start program. An analysis of those similarities and differences for
these specific programs is included in Appendix 10.
Section 111 provides information on Arizona's Health Start Pilot Program, including its mission,
goals, and service populations. The mission of the Health Start program is:
To educate, support, and advocate for families at risk by promoting optimal use of community
based family health and education services through the use of Lay Health Workers, who live in,
and reflect the ethnic, cultural and socioeconomic characteristics of the community they serve.
The Health Start Pilot Program Contractors are included in Appendix 1.
HEALTH START PROGRAM COORDINATION STUDY
EXECUTIVSEU MMARY
Section IV describes the survey process that was used to gather information about programs in
Arizona that might provide services to pregnant women and children. This survey went beyond
the programs identified by the Office of the Auditor General to ensure that as many programs as
possible were included in the future collaboration efforts by the ADHS Office of Women's and
Children's Health. The ADHS Office of Women's and Children's Health received responses from
74 agencies that in some way serve pregnant women andlor children. These agencies represent
thirteen program types. These thirteen program types fall into three program groups: Group 1
serving pregnant women and providing child health related services, Group 2 providing child
health related services (but not serving pregnant women), and Group 3 providing pregnancy-related
services (but not providing health related services to children). Of the 74 respondents in
these three groups, a total of 29 meet the criteria of providing prenatal and early childhood health
outreach and prevention programs. Ten of these 29 programs are Health Start contractors. Even
with the apparent similarities, however, each of these programs has some aspect that makes it
unique from the others -- age group, financial eligibility, ethnicity, "diagnosis", for example. In
addition, some provide a program emphasis significantly different, such as the Food and Nutrition
programs.
Section V reviews the goals and intervention strategies of these 74 programs to identify
similarities and differences. The key factors used included mission statements, goals, age range of
the program's target population, service setting, use of Lay Health Workers, special eligibility
requirements, and whether or not services were provided face-to-face or by telephone.
Although there are several types of programs in Group 1 that provide services to pregnant women
and health related services for young children, there are no responding programs in this group that
appear to be duplicative in specific mission and goals (focus), eligibility or service methodology.
Each program serves a different population, provides a different set of services or delivers services
using a different methodology. The closest program to Health Start is the Opening Doors
American Indian Outreach Project which was modeled on the Health Start program and is
administered by a current Health Start contractor. The Opening Doors program was designed
specifically for a Native American population, incorporating education on traditional cultural
beliefs into the program, and only serves the residents of three small communities. Funding for
this program will expire in December 1996.
The programs in Group 2 differ from Health Start in a number of ways. Of these, the Healthy
Families programs have the least difference in goals and the NICP programs have the greatest
difference in goals. The primary emphasis of the Healthy Families programs, however, is directed
towards the family environment rather than the physical health of the mother and child, and
providing services to pregnant women is incidental to the purpose of the Healthy Families
program.
Of the programs in Group 3, only Project Comadre is similar to the Health Start program in most
of the points of assessment. This program is based on the Health Start model, uses Health Start
HEALTH START PROGRAM COORDINATION STUDY
EXECUTIVSEU MMARY
forms for data collection and is administered by a current Health Start contractor, using grant
funding. The grant ends October 1 of this year.
Section VZ summarizes community needs from the point of view of the Health Start Contractors
and the providers responding to the survey and identifies additional sources of existing needs
assessment information. The Health Start program has been designed to address a number of these
needs; however, as can be seen from the responses of the programs to the survey, even programs
that are designed to meet needs attest to the fact that this is a monumental task. One way that all
programs can better address community needs is through improved collaboration.
Section VZZ analyzes potential strategies for collaboration and coordination of programs, including
those currently employed by the Health Start Pilot Program at both the State and Contractor levels.
Collaboration offers the greatest number of benefits of the program relationship strategies
summarized in this study, allowing for the unique needs of clients and communities to be met, yet
at the same time providing the opportunity for programs to cooperate in critical ways to avoid
duplication and maximize resources. The Health Start program uses some of these strategies to
collaborate with other programs at the state and local levels.
Because of the types of services provided by many of the respondents in this study, there are
unique opportunities for collaboration and creation of networks to expand and improve the
availability of services to the target populations. Section VZZZ includes examples of existing
coordination by the ADHS Office of Women's and Children's Health and the Health Start Pilot
Program. These activities include:
Development of a draft model on service coordination;
Development of an Intergovernmental Agreement with the Coconino County Department of
Public Health to implement a service coordination plan in the area of Page, Arizona with
Healthy Families and Health Start programs, facilitated through shared office space and
personnel;
Completion by the ADHS Office of Women's and Children's Health of the Home Visiting for
At-Risk Families Project in collaboration with several programs, including the Arizona
Department of Economic Security. Part of this work included the development of guidelines
for delivering home based services.
Representation of the Health Start Program on several interdepartmental committees, including
the ADHS System of Care Team , which provides a mechanism to coordinate service delivery
to children with special health care needs. This activity produced the Family Resource Guide.
Additional steps to future collaboration and coordination are contained in the High Level Plan for
Coordination in Section VZZZ of this report.
HEALTH START PROGRAM COORDINATION STUDY
BACKGROUND
In 1992, the Arizona Department of Health Services (ADHS) Office of Women's and Children's
Health initiated the Health Start Program in response to poor health conditions for pregnant
women and young children.' Health Start is a neighborhood outreach program designed to assist
pregnant women in communities at high-risk for poor birth outcomes and/or inadequate
immunization rates to obtain early and consistent prenatal care and to assist their children to
receive timely immunizations. In 1994, with the passage of the Arizona Children and Families
Stability Act [Laws 1994, 9th Special Session, Chapter 1, 881, the Health Start Pilot Program was
formalized and expanded.2
The 1994 legislation established the overall goals and structure for the Health Start Program and
extended the family follow-up period from two years to four years. The legislation required the
Health Start
To be delivered by Lay Health Workers
To use home visits as the primary method of service delivery
To begin services during a woman's pregnancy and continue until the child is four
years of age.
The legislation further required the ADHS to use, at a minimum, the following criteria in
establishing Health Start programs in identified neighborhoods ~tatewide:~
A high incidence of inadequate
prenatal care,
A high incidence of low birth
weight babies,
A high incidence of inadequate
infant health care, gg
Inadequate early childhood
immunizations.
' In 1982, Arizona began experiencing a steady decline in the rate of women receiving adequate prenatal care. By 1990,
Arizona ranked 45th in the nation for the number of women receiving adequate prenatal care. In addition, since 1985,
Arizona has experienced persistent outbreaks of vaccine-preventable diseases among its children. This is due in large
part to the state's low immunization rates, particularly among its disadvantaged children. In 1993, only 42.6% of two-year-
olds statewide had completed the basic series of immunizations. In rural Arizona, the rate was 40%, putting
Arizona three to thirteen percent below the national average. Current local research confirms that minority children
account for the majority of the under-immunized group and comprise the fastest growing segment of the population.
(Momson Institute for Public Policy, Kids Count Factbook: Arizona's Children 1994)
Health Start Policy and Procedure Manual, June 1, 1995; page 1-2
A.R.S. *36-697.A.
A.R.S. *36-697.A.
-
HEALTH START PROGRAM COORDINATION STUDY
BACKGROUND
In 1996, the Arizona Office of the Auditor General conducted the first annual evaluation of the
Health Start Program as required by Laws 1994, 9th Special Session, Chapter 1, 59. Finding I1 of
the Auditor General's report determined that the ADHS Office of Women's and Children's Health
needed to "increase its efforts to coordinate Health Start with other services available to pregnant
women and their families". The Auditor General was concerned that because "Health Start's
target population is broadly defined, other programs may be serving families with needs similar to
those served by Health Start". Although the Auditor General recognized that the Office of
Women's and Children's Health was coordinating among programs, the report raised the issue that
barriers to coordination remain5
The Auditor General recommended that the ADHS should conduct a formal study to assess the
feasibility of comprehensive program coordination that includes the following:
A comprehensive listing of all prenatavearly childhood health outreach and prevention
programs, including state, local, federal, and county programs.
An assessment of related programs' goals, type of intervention, availability throughout
the State, and costs.
An assessment of the needs of target populations, target communities, and current
community resources meeting these populations' needs.
An analysis of various consolidation strategies, to determine how program
consolidation, consolidation of different programs' administration, or block granting
could help the ADHS Office of Women's and Children's Health to improve
comprehensive service deli~ery.~
In particular, the Auditor General suggested that several programs in Arizona appeared to share
some of the Health Start Program's goals or services for prenatal care or post-natal and family
follow-up.
First Annual Evaluation of the Health Start Program; Office of the Auditor General; 1996; page 14.
6~bid.p;a ge 16
HEALTH START PROGRAM COORDINATION STUDY
BACKGROUND
The programs which the Auditor General identified for possible overlap were:7'
Baby Arizona
Children's Information Center
Community Health Advisor Training Project
Community Health Nursing (see NICP)
Community Nutrition Education Services
Coordinated Care (under AHCCCS Plan)
First Steps
Healthy Families
Healthy Mothers, Healthy Babies
Indian Health Services Public Health Nursing
Newborn Intensive Care Program (NICP)
Opening Doors (Havasupai, Hualapai
Reservations)
Pregnancy and Breastfeeding Hotline
Prenatal Care Initiative
Preventive Nutrition Services
Project Chance
Project Comadre
Project Thrive
Support for Obstetrical Services
Teen Prenatal Express (program closed)
Wellness on Wheels
Woman to Woman
In response to the Auditor General's report, the Arizona Legislature passed H.B. 2277 (Laws 1996,
Chapter 247 -- Supplemental Appropriation; Family Programs). This law requires the ADHS to
"conduct a study to assess the feasibility of comprehensive program coordination for the Health
Start Pilot Program". The requirements of the legislation are addressed in this report, as follows:
LAWS 1996, REQUIREMENT
CHAPTER 247
REPORT
SECTION
Sec. 2. A. 1 List of all of prenatal and early childhood health programs that are available in Sec. IV
this state at the federal, state, county and municipal levels
Sec. 2. A. 2 Assessment of goals, types of interventions and costs of available programs Sec. V
Sec. 2. A. 3 Assessment of needs of target populations and communities and to what extent Sec. VI
current community resources are meeting the needs
' Ibid.; page a-vii
Analysis of these specific programs is contained in Appendix 10.
HEALTH START PROGRAM COORDINATION STUDY
BACKGROUND
Sec. 2. A. 4. Analysis of various consolidation strategies within and among current programs Sec. VII
and administration of programs and block grant strategies to improve
comprehensive program services
Sec. 2. A. 5. Plan for coordinating all available services to minimize the duplication of the Sec. VIII
provision of services to program service recipients
HEALTH START PROGRAM COORDINATION STUDY
Ill. WHAT IS ARIZONA'S HEALTH START
PROGRAM?Q
Two health conditions in particular are considered to have a significant rippling effect throughout
an individual's life. These are lack of adequate prenatal care for pregnant women and lack of
appropriate and timely immunizations for young children. Lack of adequate prenatal care puts the
woman and her baby at risk. Lack of immunizations for a young child puts the child at risk, other
children in the community at risk, and the unborn children of pregnant women at risk.
Many Arizona women and children experience barriers that keep them from seeking or receiving
adequate prenatal care and immunizations. These barriers include social, cultural and geographic
factors. African American, Hispanic and Native American women are four times more likely than
Non-Hispanic Whites (Anglos) to receive no prenatal care. These same groups have the highest
infant mortality rates in Arizona. The low birthweight rate among African Americans is twice that
of any other group. Teens of any ethnic group are three times more likely to receive inadequate or
no prenatal care, and, therefore, are at special risk for poor pregnancy outcomes.
Since 1985, Arizona has experienced persistent outbreaks of vaccine-preventable diseases among
its children. This is due in large part to the state's low immunization rates, particularly among its
disadvantaged children. In 1993, only 42.6% of two-year-olds have completed the basic series of
immunizations. In rural Arizona, the rate drops to 40%, putting Arizona from three to thirteen
percent below the national average. Current local research confirms that minority children account
for the majority of the under-immunized group and comprise the fastest growing segment of the
population.
Arizona's Health Start Pilot Program was designed to address the critical health issues of prenatal
care and childhood immunizations and reduce barriers to service. The mission of the Health Start
Pilot Program is:
To educate, support, and advocate for families at risk by promoting optimal use of
community based family health and education services through the use of Lay Health
Workers, who live in, and reflect the ethnic, cultural and socioeconomic characteristics of
the community they serve. I
' Health Start Policy and Procedure Manual; Chapter 1; June 1, 1995
8
HEALTH START PROGRAM COORDINATION STUDY
ARIZONA'S HEALTHST ART PROGRAM
By using Lay Health Workers who reflect the ethnic, cultural and socioeconomic makeup of the
neighborhoods they serve, Health Start connects pregnant women with community resources
which provide prenatal and related infant 1 child services. The families are followed for up to four
years after the birth of the child to assist with identification of a "medical home" for each family
member and to encourage immunizations for all children in the family. The Lay Health Workers
also provide education on normal child development and parenting skills, and may serve as a
referral source in the identification of children with special needs.
Health Start recruits its Lay Health Workers from within the targeted communities, because it is
felt that they are most knowledgeable of the local customs, problems, cultures and service
systems. By utilizing neighborhood or community Lay Health Workers, Health Start strives to
assure that the program respects the differences in culture, family structure, personal and family
resources which are found in the different communities throughout the state, while addressing the
needs of women, children and their families based on the unique characteristics of the
communities in which they live. By making the program sensitive and responsive to local
concerns, Health Start promotes collaborative efforts within the community to improve the health
of women, children and their families.
Specifically, the Health Start Pilot Program is designed to:
Reduce the incidence of low birth weight babies
Increase prenatal services to pregnant women
Reduce the incidence of children affected by childhood diseases
Increase the number of children receiving age appropriate immunizations by two years
of age
Educate families on the importance of good nutritional habits to improve the overall
health of their children
Educate families on the importance of developmental assessments to promote the
early identification of learning disabilities, physical handicaps or behavioral health
needs
Educate families of the benefits of preventive health care and the need for screening
examinations, such as hearing and vision
Assist families to identify private and public school readiness programs.
The ADHS, through its Office of Women's and Children's Health, provides the criteria, policies
and requirements for developing and implementing the Health Start Program in neighborhoods
and communities. These guiding principles reflect the core requirements of the Arizona law and
also promote the community and client-centered approach that is the cornerstone of this program.
HEALTH START PROGRAM COORDINATION STUDY
ARIZONA'HS EALTHS TARTP ROGRAM
The ADHS contracts with local public and private agencies (Contractors) based on recognition of
communities with high risk of poor pregnancy and child health outcomes. The Health Start Pilot
Program contracted providers tailor the local program to meet the needs of local communities as a
way of reducing barriers to services. The role of the Contractors is to:
Recruit, train and manage the Lay Health Workers
Use Lay Health Workers to perform outreach into the designated community to enroll
pregnant women in the program
Provide basic prenatal and family health education, referral and advocacy services
(Health Start connects women and families to health services, they do not provide
these directly through the Health Start program)
Design the method of outreach and community work that best fits the geographic,
ethnic, socio-economic, etc. factors of their community
In SFY 1996, the Health Start Program operated under 12 Contractors serving 62 communities,
neighborhoods and surrounding rural areas. [Appendix 1: Health Start Neighborhoods and
Communities for SFY 1994
HEALTH START PROGRAM COORDINATION STUDY
IV. IDENTIFICATION OF PRENATAL AND EARLY
CHILDHOOD HEALTH OUTREACH AND
PREVENTION PROGRAMS IN ARIZONA
SURVEYD OCUMENT
In preparing this report, the ADHS Office of Women's and Children's Health designed a survey
instrument that requested information on service populations, eligibility requirements for services,
linkages to other programs, demographics of the populations served, numbers of clients served,
missions and goals for programs, geographic areas of services, types of service interventions,
types of services, methodology for providing services, program budget, types of staffing,
frequency and type of contact with clients by type of staff and community needs. [Appendix 2:
Survey Document] lo
The ADHS Office of Women's and Children's Health sent the survey to representatives of the
medical community; state, county and city governments; Tribes; other state agencies; and private
providers. The ADHS Office of Women's and Children's Health received 86 responses with
representation from each of the types of organization to whom surveys were sent: AHCCCS 1
health plans / hospitals I clinics (11 responses received); county and city governments I
associations / health departments (25 responses received); private health / parent / family service
providers (30 responses received); Tribes / Tribal Associations I Indian Health Services (1 1
responses received); and state agencies (9 responses received)."
Since the purpose of this report is to identify strategies for coordination among providers of
prenatal and early childhood health outreach and prevention services, the ADHS Office of
Women's and Children's Health applied several organizational assumptions in selecting the
recipients of the survey and in analyzing the responses. These organizational assumptions are:
1. Surveys should be sent to a sampling of entities who are likely to provide services to
pregnant women or provide health related services for children. In addition, surveys
were also sent to entities that provide similar services for children even if these
services cannot be strictly classified as "health".
2. Surveys should be sent to all entities cited in the Office of the Auditor General Report.
10 All of the information about programs came from written responses to the survey.
" Three responses were not used in this report because they represented services significantly different from those under
consideration -- Child Protective Services and services to children with developmental disabilities. It was felt that the
services provided by these types of respondents are significantly specialized to the needs of the population.
HEALTH START PROGRAM COORDINATION STUDY
IDENTIFICATION OF PRENATAALN D EARLYC HILDHOOHDE ALTHO UTREACH AND PREVENTION
3. Because the ADHS Office of Women's and Children's Health has the greatest amount
of direct control over the Health Start program for the purposes of developing a plan
for coordination, the responses to the survey should be categorized in groupings by
target population. These categories are:
Respondents who provide services to pregnant women and health related
services for children [most similar to the Health Start target population]
Respondents who provide health related services for children but do not
provide services to pregnant women
Respondents who provide services to pregnant women but do not provide
health related services for children
Respondents who provide other services for children or include children in
their service population. These respondents may also happen to serve
pregnant women, although the woman's pregnancy is generally not the
primary reason for entry into the program. This group was included in the
previous category because they provide some service to pregnant women.
4. The ADHS Office of Women's and Children's Health established the following
criteria to classify a respondent as providing "prenatal and early childhood health
outreach and prevention" services. Programs that provide the following services by
referral, service coordination or as direct services are considered to meet the criteria of
providing prenatal and early childhood health outreach and prevention services for this
population:
Client education on neonatal care
Client education on nutrition
Client education on prenatal care
Client education on preventive health care and child wellness
Outreach to identify pregnant women
5. Programs that predominantly use Lay Health Workers are considered most like the
Health Start Program in philosophy.
6. Programs that are predominantly home-based are considered most like the Health Start
program in service delivery methodology.
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HEALTH START PROGRAM COORDINATION STUDY
IDENTIFICATION OF PRENATAALN D EARLYC HILDHOOHDE ALTHO UTREACH AND PREVENTION
PROGRAMS
Of the 83 survey responses used in this report, a total of 74 respondents stated that they provide
some type of service to pregnant women or for children or both. These 74 respondents have been
categorized as the following 13 program types identified in Table 1 below.12.
TABLE 1: PROGRAM TYPES
As will be identified in Section V, however, there are significant differences in goals and
intervention strategies among these program types.
From survey responses, the programs were categorized into three major groupings according to
service populations. These categories are:
GROUP 1: Pregnancy and Child Health Related Services
GROUP2: Child Health Related Services
GROUP3: Pregnancy Related Services
Some programs are more difficult to categorize than others. For example, several programs
responded that they provide services to pregnant women. In fact, however, service to pregnant
12 Although it is recognized that programs like Health Start and Healthy Families might fall into more than one of the
above identified program types, because of the interest of the Legislature in these programs, a separate program type
category has been created for them.
13 Includes Community Health Nursing
HEALTH START PROGRAM COORDINATION STUDY
IDENTIFICATION OF PRENATAALN D EARLYC HILDHOOHDE ALTHO UTREACH AND PREVENTION
PROGRAMS
women may be incidental to the purpose of the program. If a woman is already receiving services
from Healthy Families, for example, and subsequently becomes pregnant, Healthy Families assists
the woman to access medical care through referrals. This is not considered a program that serves
pregnant women in the same way as the Health Start program which puts primary emphasis on the
pregnancy itself.
Twenty-six (26) of the respondents provide both services to pregnant women and an early
childhood health program. These 26 respondents represent eight (8) program types, as identified
below in Table 2:
TABLE2 : PROGRAMTY PES FOR RESPONDENTWSH O SERVEP REGNANWT OMENANPDR OVIDE
HEALTHR ELAT ED SERVICES FOR CHILDREN
The Group 1 respondents are those with an emphasis on pregnancy and early childhood health
services. One of the respondents focuses on adolescent women. Four are AHCCCS providers and
one is the Phoenix Indian Health Services, all of which focus on the direct provision of medical
services. Four Women, Infants and Children (WIC) program respondents are in this grouping.
Their focus, as will be seen in Section V, however, is on nutrition. Ten of the respondents are
Health Start providers. One respondent, Wellness on Wheels, is a medical and social services
mobile clinic in Yavapai County that provides services to a much broader population than just
pregnant women and young children. [Appendix 3, "Respondents Serving Pregnant Women and
Providing Health Related Services for Children", provides a listing of the programs by category,
the geographic areas of service, parent organization, and demographics of the population being
served.]
The respondents in Group 1 generally meet the ADHS Office of Women's and Children's Health
criteria of providing prenatal and early childhood health outreach and prevention programs by
providing some type of service -- referral, service coordination and 1 or direct services -- in the
areas of client education on neonatal care, education on nutrition, education on prenatal care,
education on preventive health care and child wellness and outreach to identify pregnant women.
There are some exceptions, however. The WIC programs appear less likely to provide services on
neonatal care and outreach to identify pregnant women. The Wellness on Wheels program
provided information on its services, including "guidance to promote health, prevent illness and
manage health problems . . . and family planning counseling and education". The Children's
Information Center only addresses education on preventive health care and child wellness. The
following programs do not appear to provide outreach to identify pregnant women: one of the
EPSDT respondentsI4, Signature Home Health Care, the Phoenix Area Indian Health Services, the
ADHSIWIC office, Wellness on Wheels, the Children's Information Center, and the Grandparents
Adopted for Parental Support (GAPS) program. [Appendix 4, "Prevention and Outreach
Services Provided by Respondents Serving Pregnant Women and Providing Health Related
Services for Children", provides information for Group 1 on prevention and outreach services.]
h
Opening Doors American Indian Outreach Project meets all of the criteria for prenatal, outreach
and prevention services and provides in-home services 85% of the time. This program, however,
is small and indicated that 95% of its service population is Native American residents of Peach
Springs, Valentine and Supai. It is administered through private grant funding by an organization
which is a current Health Start contractor. The grant expires December 3 1, 1996.
HEALTH START PROGRAM COORDINATION STUDY
IDENTIFICATIONO F PRENATAALN D EARLYC HILDHOOHDE ALTHO UTREACHA ND PREVENTION
PROGRAMS
-
A total of eighteen (1 8) of the twenty-six (26) respondents in Group 1 meet the preliminary criteria
of providing prenatal and early childhood health outreach and prevention programs. Ten of these
eighteen are the Health Start contractors. The respondents are:
AHCCCS Prenatal Case Management Program Pima Health System
Direct Teen Case Management Prenatal Notch Clinic & Case Management
Health Start (1 0 respondents) Salt River WIC Program
Las Amigas Tribal Health Maintenance and WIC Program
Opening Doors American Indian Outreach Project
14 Early, Periodic Screening, Diagnosis and Treatment program under AHCCCS Health Plan
15
HEALTH START PROGRAM COORDINATION STUDY
IDENTIFICAT~OOFN P RENATAALN D EARLYC HILDHOOHDE ALTH OUTREACHA ND PREVENTION
Twenty-four of the respondents provide health related services for children but do not serve
pregnant women. These 24 respondents are represented by the four (4) program types identified in
Table 3.
TABLE3 : PROGRAMTY PESF OR RESPONDENTWSH OP ROVIDHE EALTH
RELATEDSE RVICEFSO R CHILDREN BUT WHOD O NOTS ERVEP REGNANT
WOMEN
Although some of the respondents in Group 2 indicated that they serve pregnant women, this
service is incidental to the main purpose of the program. Generally, the service that is provided to
pregnant women in this group occurs because the woman becomes pregnant while her child is
already receiving services. In such cases the program may assist her in finding medical care or
other services. [Appendix 5, "Respondents Providing Health Related Services for Children But
Not Services to Pregnant Women", identifies the programs, their service locations and ethnicity
of clients being served.]
Respondents in Group 2 are less likely than respondents in Group 1 to meet all of the criteria of
prenatal and early childhood health outreach and prevention programs. For example, the Head
Start / Early Head Start programs generally do not provide client education on neonatal care or
prenatal care. One exception is the Phoenix Early Head Start program that provides services to
pregnant teens. The Healthy Families programs assist and coordinate services for women in the
program who become pregnant, but this is not the primary focus of the program. Neither the NICP
programs nor the Well Child programs generally provide client education on prenatal care. In
most cases none of these programs provide outreach to identify pregnant women in the
community. These factors make these programs distinctly different from Health Start and the
other programs in Group 1. [Appendix 6, "Prevention and Outreach Services Provided by
Respondents Providing Health Related Services for Children But Not Services to Pregnant
Women", provides information for Group 2 on prevention and outreach services.]
Only three (3) of the twenty-four (24) respondents in Group 2 meet the preliminary criteria of
providing prenatal and early childhood health outreach and prevention programs:
HEALTH START PROGRAM COORDINATION STUDY
IDENTIFICATION OF PRENATAALN D EARLYC HILDHOOHDE ALTHO UTREACHA ND PREVENTION
PROGRAMS
Phoenix Early Head Start indicated that it provides outreach to identify pregnant
women only for the purpose of recruitment into the program
One of the NICP respondents and the Gila County Health Department Well Child
Clinic indicated that they provide referral as a form of outreach for pregnant women
Twenty-four (24) respondents provide services to pregnant women but do not provide health
related services for children. These respondents are represented by six (6) program types
identified in Table 4."
TABLE4 : PROGRAMTY PES FOR RESPONDENTWSH OP ROVIDE SERVICETSO PREGNANT
WOMENB UTW HO DO NOT PROVIDEH EALTHR ELATEDS ERVICEFSO R CHILDREN
Respondents in Group 3 are primarily serving pregnant women. They answered "no" to the
question about providing health related services to children; however, some of these programs also
include children in their service population or provide other services to children. Their greater
emphasis is on the woman or teen mother. In one case, Healthy Mothers /Healthy Babies
Coalition, children are included in the program's focus, but its service is advocacy rather than
direct service to women or children. [Appendix 7, "Respondents Who Serve Pregnant Women
and Who Do Not Provide Health Related Services for Children", identifies the programs, their
service locations and ethnicity of clients being served.]
With the exception of the Food & Nutrition category, respondents in Group 3 are more likely to
meet the criteria of providing prenatal 1 early childhood health outreach and prevention programs
than are the respondents in Group 2. As with Group 2, however, there is not much emphasis on
outreach to identify pregnant women. This is a significant difference from the respondents in
l5 Thirteen (13) of the 23 respondents indicate that they include children in the service population, although they
answered "no7' to the question about providing an early childhood health program. These 13 programs are included in
Appendix 9.
HEALTH START PROGRAM COORDINATION STUDY
IDENTIFICATION OF PRENATAALN D EARLYC HILDHOOHDE ALTH OUTREACAHN D PREVENTION
PROGRAMS
Provided By Respondents Who Serve Pregnant Women and Who Do Not Provide Health
Related Services for Children", provides information for Group 3 on prevention and outreach
services.]
Eight (8) of the twenty-four (24) respondents in Group 3 meet the criteria of prenatal / early
childhood health outreach and prevention programs:
Choices for Teen Parents
Maternal & Child Health - Cochise County Health Department
Project CAM1
Direct Pregnancy Testing and Follow-Up
Loving Me, Loving My Baby
Project Comadre
Woman to Woman
Southern Arizona Collaboration -- Choices for Families
HEALTH START PROGRAM COORDINATION STUDY
IDENTIFICATIONO F PRENATAALN D EARLYC HILDHOOHDE ALTHO UTREACAHN D PREVENTION
PROGRAMS
Of the seventy-four (74) respondents to the survey who stated that they provide some type of
service to pregnant women or for children or both, a total of twenty-nine (29) meet the preliminary
criteria of prenatal / early childhood health outreach and prevention programs. Ten of these 29 are
Health Start programs. The programs are:
Propram Tvpe
Adolescent / Young Adult
AHCCCS, Health Plan, Indian
Health Services (IHS) and Other
Medical
Behavioral / Substance Abuse
Birthing and Pregnancy Support
Food / Nutrition
Head Start / Early Head Start
Health Start
NICP
Parental Support
Well Child
Program
Choices for Teen Parents (Group 3)
Direct Teen Case Management (Group 1)
Maternal & Child Health - Cochise County Health Department
(Group 3)
AHCCCS Prenatal Case Management (Group 1)
Pirna Health System (Group 1)
Las Amigas (Group 1)
Project CAM1 (Group 3)
Direct Teen Pregnancy Testing and Follow-Up (Group 3)
Loving Me, Loving My Baby (Group 3)
Opening Doors American Indian Outreach Project (Group 1)
Prenatal Notch Clinic & Case Management (Group 1)
Project Comadre (Group 3)
Woman to Woman (Group 3)
Salt River WIC Program (Group 1)
Tribal Health Maintenance and WIC Program (Group 1)
Phoenix Early Head Start (Group 2)
10 Health Start respondents (Group 1)
1 NICP respondent (Group 1)
Southern Arizona Collaboration - Choices for Families (Group 3)
Gila County Health Department Well Child Clinic (Group 2)
HEALTH START PROGRAM COORDINATION STUDY
IDENTIFICATION OF PRENATAALN D EARLYC HILDHOOHDE ALTH OUTREACHA ND PREVENTION
PROGRAMS
Even with the apparent similarities, however, each of these programs has some aspect that makes
it unique from the others -- age group, financial eligibility, ethnicity, "diagnosis", for example. In
addition, some provide a program emphasis significantly different from the others, such as the
Food and Nutrition programs.
HEALTH START PROGRAM COORDINATION STUDY
V. ASSESSMENT OF GOALS, TYPES OF
INTERVENTION AND COSTS'~O F AVAILABLE
PROGRAMS
In identifying similarities and differences for the respondents, the ADHS Office of Women's and
Children's Health identified key factors related to goals and types of interventions by which to
make comparisons. The key factors used to assess the goals are mission statements for the
programs and a comparison of goals. The key comparison factors to identify compatibility of
program functions for interventions include:
Age range of target population
Service setting
Use of Lay Health Workers
Special eligibility requirements
Face-to-face provision of service 1 vs telephone service
Tables 5, 6, and 7, on the following pages, display the information on goals and types of
interventions for programs in Groups 1,2 and 3 respectively.
GROUP 1; GOALSA ND /NTERVENTIONS FOR PROGRAMPSR OV~D~NG
PREGNANCYANCDH ILDH EALTHR ELATEDS ERV~CES
Table 5, "Mission, Goals and Intervention Styles for Programs that Serve Pregnant Women and
Provide Health Related Services for Children", looks at goals and interventions for the programs
providing services to pregnant women and health related services for children. This group
16 Although the survey did collect annual budget information for the programs, this report does not include a detailed
analysis of the costs of the programs. Since the scope of the programs and services identified in this report vary so
greatly, a detailed cost analysis would take significant time and require additional expertise. The budget information
provided by the respondents demonstrate that the cost of these programs ranges from a high of $45 million for the
WIC program to a low of $9,000 for a single NICP nurse in a rural part of the state. This does not tell us what the
comparative unit costs are. Work by an auditor would be required to obtain an accurate picture of cost per client or
cost per intervention of these programs.
includes the Health Start program and programs most similar to the Health Start program based on
the target service populations and the match with the criteria for prenatal and early childhood
health outreach and prevention services.
7
Comparison Based on Service Setting
HEALTH START PROGRAM COORDINATION STUDY
ASSESSMENOTF GOALS,T YPES OF ~NTERVENTIONA ND COSTSO F AVAEABLEP ROGRAMS
Health Start is primarily a home-based program, meaning that its workers visit families in their
homes. Although not all services are suited to a home-based approach, e.g., certain medical
interventions, the home-visiting approach uses the family's living environment as part of the
service strategy to overcome barriers and strengthen the family's existing personal and community
support system.I7
In addition to the Health Start programs, only 25% of the respondents who provide services to
pregnant women and health related services to children predominantly use a home-based approach.
Those that are predominantly home-based, besides the Health Start programs, are:
AHCCCS Prenatal Case Management programQ in the Phoenix Health Plan -- Focuses
specifically on improving birth outcomes and addressing prematurity and low
birthweight. It differs significantly, however, from several other programs in Group 1
in that it does not share the goals of reducing the incidence of childhood diseases, and
providing education to families on nutrition, developmental assessments, and assisting
with school readiness. The program is limited to women who are AHCCCS eligible
and enroll with this AHCCCS provider.
Signature Home Care -- Appears to be an NICP program and did not indicate that it
provides outreach services to identify pregnant women even though it stated that it
serves pregnant women. The program is limited to women who are AHCCCS eligible
and enroll with this AHCCCS provider.
GAPS -- Does not meet the criteria of a prenatal and early childhood health outreach
and prevention program although it does serve pregnant women and children through
referral and service coordination. Its primary emphasis is on prevention of child abuse
and neglect. In this, it is closer to the Healthy Families model. It does not address the
goals of reducing low birthweight and increasing prenatal services to pregnant women.
Opening Doors American Indian Outreach projectQ -- Is predominantly home-based in
the method of service delivery, is based on the Health Start model, and is administered
by a current Health Start contractor with grant monies which will be expiring shortly.
One of the programs in Group 1, Children's Information Center, is a phone based system that
provides information and referral services. The Children's Information Center is a statewide,
l7 The Home Visiting for At-Risk Families Proiect Final Report 1995; Arizona Department of Health Services - office of
Women's and Children's Health, page 9.
a Meets the criteria of a prenatal and early childhood health outreach and prevention program.
HEALTH START PROGRAM COORDINATION STUDY
ASSESSMENOTF GOALST, YPESO F INTERVENTION AND COSTSO F AVAILABLE PROGRAMS
One of the programs in Group 1, Children's Information Center, is a phone based system that
provides information and referral services. The Children's Information Center is a statewide,
bilingual toll-free number for families, caregivers, and health care professionals throughout
Arizona designed to help facilitate access to needed services for children with special needs. It
does not meet the prenatal, outreach and prevention goals in three areas -- reduction of low
birthweight births, increase in number of prenatal visits, and access to school readiness programs.
Las ~ m i ~ apsro@vid es services in a residential treatment setting. It is specially designed to serve
pregnant and post partum women who are substance abusers.
The remainder of the programs in this group are predominantly office and medical setting based.
Comparison Based on Use of Lay Health Workers
All of the Health Start contractors use Lay Health Workers. In fact, this is one of the
distinguishing factors of this program's intervention methodology. Only four other respondents
use Lay Health Workers, and none of the program types other than Health Start consistently uses
Lay Health Workers. The three programs in addition to Health Start that use Lay Health Workers
are:
AHCCCS Prenatal Case ~ana~ementin@ th e Phoenix Health Plan -- Is limited to
women who meet the income and resource test to be eligible for AHCCCS, and select
this Health Plan as their AHCCCS provider. Although it is a fully home-based
program, and shares part of the mission of the Health Start program, it does not
address several of the childhood health and public school readiness goals that are
addressed by the Health Start program. The child may later be enrolled in the
continuing medical services of the AHCCCS program, but since this enrollment is
based on an action by the parent and a continuing financial eligibility, there is no
guarantee that there will be medical follow up during the early years of childhood.
The plan does not include case management follow-up for children.
Wellness on Wheels program -- A much broader based program than just pregnant
women and young children. As a mobile clinic in West Yavapai County, it also
provides health promotion, immunizations for children and adults, referral for home
visits for children at risk of developing medical conditions, referral for developmental
screening, family planning, individual counseling, family therapy, mental health
counseling, substance abuse counseling, home visitor nursing, health assessments and
screenings for senior citizens, Medicaid eligibility screening, referral for HIVIAIDS
testing and counseling, Tuberculosis screening, diagnosis and education, and
coordination with other nutrition programs. With this broad emphasis, it does not
share all of the Health Start goals.
Opening Doors American Indian Outreach projecta --Although this program has a
mission statement similar to that of Health Start, serves the same type of population --
pregnant women and children up to 4 years of age -- and is predominantly home
HEALTH START PROGRAM COORDINATION STUDY
ASSESSMENT OF GOALST, WESO F INTERVENTION AND COSTSO F AVAILABLPER OGRAMS
based, it is designed specifically for the Native American population. In addition, the
services are localized to the areas of Peach Springs, Valentine and supai.18
Tribal Health Maintenance ~ r o ~ r a r n--/ A~lt~ho~ug@h t his program uses Lay Health
Workers, it is a specialized program with emphasis on nutritional information and
food, and, therefore, does not share mission or goals with the Health Start program.
Several of the programs in the category of serving pregnant women and providing health related
services for children do not use Lay Health Workers and are either "specialty programs" or are
limited to specific populations:
Direct Teen Case ManagementQ is limited to young women up to 17 years of age and
is located only in Yuma County.
Pima Health systemQ and Regional AHCCCS Health Plan are AHCCCS provider
organizations. Their service systems and age ranges are broader than Health Start and
have specific financial eligibility criteria. Eligibility is further linked to the coverage
area of the specific AHCCCS provider.
Prenatal Notch Clinic and Case Managemente in Coconino County does not use Lay
Health Workers and serves a broader population; however, it has a closer mission and
goal match to Health Start than many of the other programs.
Phoenix Area Indian Health Services is the Federal IHS program for American Indian
and Alaskan Native persons. Its services are delivered primarily in medical settings
by non Lay Health Workers.
The InterTribal Council of Arizona (ITCA) WIC and the Salt River WIC programs are
limited to low income, primarily Native American women and children and is a food
and nutrition program.
The ADHS WIC program also is limited to women and children up to 5 years of age
who are at nutritional risk. The WIC programs can be a supplement to services
provided by Health Start for a similar population if Health Start and WIC sites are
located in the same geographic area.
Table 5 on the following pages provides more detailed information on the program mission
statements. It also identifies where the various programs reported that they differ from Health
Start in their goals. The goals, identified in the footnote to Table 5, are derived from the goals of
the Health Start program. The survey respondents were asked to identify which of these eight goal
statements they share with Health Start. Although some of the respondents provided copies of
their goals, additional follow up work would be necessary to assess the complexity of this
18 This respondent stated that the Opening Doors program would close December 3 1, 1996
HEALTH START PROGRAM COORDINATION STUDY
ASSESSMENOTF GOALST, YPESO F INTERVENTIONAN D COSTSO F AVAILABLPER OGRAMS
information thoroughly. Table 5 identifies which goals each program stated that they did not
share.
Although there are several types of programs that provide services to pregnant women and health
related services for young children, there are no responding programs in Group 1 that appear to be
duplicative in specific mission and goals (focus), eligibility or service methodology. Each serves a
different population, provides a different set of services or delivers services using a different
methodology.
The closest program is the Opening Doors American Indian Outreach Project which was modeled
on the Health Start program and is administered by a current Health Start contractor. The Opening
Doors program was designed specifically for a Native American population, incorporating
education on traditional cultural beliefs into the program, and only serves the residents of three
small communities. Funding for this project will expire in December 1996.
In some cases, however, if these programs serve the same communities, their presence offers an
opportunity for service coordination, and they may refer to each other when they have a client with
special needs that can best be met by the more specialized providers. For example, Health Start
does not provide immunizations for children but it assists the families to receive the
immunizations, and may, therefore, help the family to enroll in AHCCCS or to seek services from
the county health department.
-
AHCCCS, i~hoenix~ r e ~ ~ d i almnedaicali 90~%;
-He al
-Il-
-M
TABLE 5: MISSION, GOALS AND INTERVENTION STYLES FOR PROGRAMS THAT SERVE PREGNANT WOMEN
-- - - - AND PROVIDE HEALTH RELATED SERVICES FOR CHILDREN - -
-- --
PROGRAM fRoGRAM LTf'"'"E- - - " ' & " ' "
- PROGRAM'S MISSION STATEMENT
-
GOALS DIFFER
TYPE SERVED SETTING HEALTH REQUIREMENT FROM HEALTH
- -- -- -- - START? - ----
Ith Plan, Health Services 1 lhome 10%
IS (L Other 1 i
Adolescent l
Young Adult
-- -- - - . --
Y e Tloow i mbsiprtrho wvee ibgihrtth r oautetcso oImf eous rb my edmecbreerass imng prematurity and l , e , f , h
- -.
Indian I Alaskan
Native or non-Indian
pregnant with Indian
father's child with
proof of paternity
Direct Teen Case 0 - 204 1
Management months
To raise American Indians' /Alaskan Natives' health 6the h
highest status possible
r 9 8'--%~;o - AHCCCS enrolled To manage a quality health care delivery system, - - - -
Health Plan, months office 5%; dedicated to providing comprehensive health care to the
IHS 8 Other medical 5%; eligible AHCCCS members residing in Pinal County.
home 1 %
I
No
a=to reduce incidence of low birthweight babies; b=to increase prenatal services to pregnant women; c=to reduce incidence of children affected by childhood
diseases; d=to increase # of children receiving age appropriate immunizations by 2 years of age; e=to educate families on importance of good nutritional habits to
improve overall health of their children; f=to educate families on developmental assessments to promote early identification of learning disabilities, physical
handicaps or behavioral health needs; g=to educate on benefits of preventive health care and need for screening examinations, such as hearing and vision; h=to
assist families to identify private and public school readiness programs
up to 17 years of age Yuma County Health Department miss~onIS to promote the
health of the commun~tya nd prevent d~sease
I
TABLE 5-- 1
I). 0....................................
- - -+
be eligible for To meet our customer's needs through the provision of a, b, h
one of lPAs payors I high quality, cost effective home care products and services
programs I AHCCCS
TABLE 5: MISSION, GOALS AND INTERVENTION STYLES FOR PROGRAMS THAT SERVE PREGNANT WOMEN
-- - AND PROVIDE HEALTH RELATED SERVICES FOR CHILDREN -- - - -- - - -- -
PRoGwM = - '7CP ~w;~E~~yiBl~in 1 PROGRAM'S MlssloN STATEMENT
TYPE SERVED SETTING HEALTH REQUIREMENT
- -- -- - --- - -
F;;g:::;
-
Medical
- tiI m a s 7" Abuse
AHCCCS,
Health Plan,
IHS & Other
Medical
months
Support Management
(moms); Children &
Adolescent Services
(children)
No
program 100%
(also medical I
offices;
hospitals, public
P~maH ealth System
-. -. - -
pregnant or 12 abuse treatment while remaining united with their children
months post partum,
substance abuser
1
0 - 240 phone 5'4
months medical go%,
home 2%, other
12%
PHS member I
AHCCCS llnked
program
- .- - -. -
No pregnant women I To promote disease and disability prevention programs in 1
children up to age 18 partnership with the community
a=to reduce incidence of low birthweight babies; b=to increase prenatal services to pregnant women; c=to reduce incidence of children affected by childhood
diseases; d=to increase # of children receiving age appropriate immunizations by 2 years of age; e=to educate families on importance of good nutritional habits to
improve overall health of their children; f=to educate families on developmental assessments to promote early identification of learning disabilities, physical
handicaps or behavioral health needs; g=to educate on benefits of preventive health care and need for screening examinations, such as hearing and vision; h=to
assist families to identify private and public school readiness programs
Vlslon To improve the quallty of l~fefo r the community and
the people we serve through an Integrated system of
health and soclal servlces
TABLE 5-- 2
h
I
TABLE 5: MISSION, GOALS AND INTERVENTION STYLES FOR PROGRAMS THAT SERVE PREGNANT WOMEN
AND PROVIDE HEALTH RELATED SERVICES FOR CHILDREN
PROGRAM PROGRAM
TYPE
AGES 1 SERVICE
SERVED SETTING
ELIGIBILITY PROGRAM'S MISSION STATEMENT GOALS DIFFER
FROM HEALTH
START? -- - -
Birthing &
Pre~nancv
Support
partum or
breastfeeding; 185%
of poverty; must
have a nutritional risk
-~- ; ; o I n ~ ~ share~s its ~ ~ r- --
months office 80% strength and vision for the enrichment of the Community . .
.to provide culturally sensitive physical, mental, and social
services . . .(etc.)
phone 4%;
office 95%;
medical 5%;
home 4 %
Food 1 Inter Tribal Council '0 - 60
- - - -. --
Food 1 ADHSMllC nutritional risk;
Nutrition reside in agency that
is providing services
1
g, f
Nutrition of Arizona WIC
Program
a=to reduce incidence of low birthweight babies; b=to increase prenatal services to pregnant women; ~ = t roe duce incidence of children affected by childhood
diseases; d=to increase # of children receiving age appropriate immunizations by 2 years of age; e=to educate families on importance of good nutritional habits to
improve overall health of their children; f=to educate families on developmental assessments to promote early identification of learning disabilities, physical
handicaps or behavioral health needs; g=to educate on benefits of preventive health care and need for screening examinations, such as hearing and vision; h=to
assist families to identify private and public school readiness programs
To empower and promote the well being of American
Indian people in northern Arizona by improving health care
provider resources and service delivery through community-based
initiatives
Opening Doors Yes must suspect
American Indian pregnancy, be
Outreach Project pregnant or
(program ends 1 delivered child within
months
TABLE 5-- 3
1 213 1/96) 1
I last 2 months
TABLE 5: MISSION, GOALS AND INTERVENTION STYLES FOR PROGRAMS THAT SERVE PREGNANT WOMEN
- - AND PROVIDE HEALTH RELATED SERVICES FOR CHILDREN
PROGRAM lROp EiMs E l T ( B i l l P I = M 1 * . 4 . S S l O N I T I I . M E N T
TYPE SERVED SETTING HEALTH REQUIREMENT
- -- - - -- - - -- - - - - -
sign informed
home 96% consent
Health Start
-
Health start.- Health Start -
Cochise County 0m-o4nt8hs jpohf.fincee 1io0%%: ;
medical 10%;
home 70%
Eloy Comienzo Sano
I Health Start
Health S G T - ~ G Z : ~ ~
IAdelante
I
live in, & reflect ethnic, cultural & socioeconomic
characteristics of community
0 - 48
months
sign informed promoting optimal use of community based family health &
education services through use of lay health workers, who
live in, & reflect ethnic, cultural & socioeconomic
characteristics of community
home; 2% I l~vein , 8 reflect ethnic, cultural & socioeconomic
characteristics of community
medical; 50%
--
area; To educate, support, & advocate for families at risk by
sign informed promoting optimal use of community based family health &
consent education services through use of lay health workers, who
live in, & reflect ethnic, cultural & socioeconomic
characteristics of community
phone 10%;
35% office; 3%
a=to reduce incidence of low birthweight babies; b=to increase prenatal services to pregnant women; c=to reduce incidence of children affected by childhood
diseases; d=to increase # of children receiving age appropriate immunizations by 2 years of age; e=to educate families on importance of good nutritional habits to
improve overall health of their children; +to educate families on developmental assessments to promote early identification of learning disabilities, physical
handicaps or behavioral health needs; g=to educate on benefits of preventive health care and need for screening examinations, such as hearing and vision; h=to
assist families to identify private and public school readiness programs
consent
TABLE 5-- 5
Yes
education services through use of lay health workers, who
live in service area;
sign informed
To educate, support, & advocate for families at risk by
promoting optimal use of community based family health &
TABLE 5: MISSION, GOALS AND INTERVENTION STYLES FOR PROGRAMS THAT SERVE PREGNANT WOMEN
-
-iA-IND P--ROV-ID TE HEAiLTH -R ELATED- SE RVICES F-OR - C HILD_R-E -N - -
I - - 7 -- -
PROGRAM'S MISSION STATEMENT GOALS DIFFER
FROM HEALTH
-- -- -- -. -- - - - START? ! - --
Mountain Park
(South Phoenix)
community 25%
-- -.
Health Start Health Start Centro
de Amistad I months 5%; medical
Immunization and 10%; home
Well-Baby Clinic 75%; exercise
program 5%
Health Start
Wheels -West
community
Clinic & Family center locations
Resource Center
--
& advocate for families at risk by
sign informed
consent
live in, & reflect ethnic, cultural & socioeconomic
characteristics of community
To educate, support, & advocate for families at risk by
promoting optimal use of community based family health &
education services through use of lay health workers, who
live in, & reflect ethnic, cultural & socioeconomic
characteristics of community
i
Health Start - North Yes
Country Community
Health Center
- - - -
support, & advocate for families at risk by
promoting optimal use of community based family health &
education services through use of lay health workers, who
live in, & reflect ethnic, cultural & socioeconomic
characteristics of community
live in service area;
sign informed
consent
- --
provide accessible, comprehensive, preventive health
to residents of rural areas of Yavapai County
based on income
0 - 48
months
a=to reduce incidence of low birthweight babies; b=to increase prenatal services to pregnant women; c=to reduce incidence of children affected by childhood
diseases; d=to increase # of children receiving age appropriate immunizations by 2 years of age; e=to educate families on importance of good nutritional habits to
improve overall health of their children; f=to educate families on developmental assessments to promote early identification of learning disabilities, physical
handicaps or behavioral health needs; g=to educate on benefits of preventive health care and need for screening examinations, such as hearing and vision; h=to
assist families to identify private and public school readiness programs
phone 4%; office
3%; medical 1%;
home 91 %; mail
1 %
TABLE 5-- 6
TABLE 5: MISSION, GOALS AND INTERVENTION SNLES FOR PROGRAMS THAT SERVE PREGNANT WOMEN
7 -- - AND PROVIDE HEALTH RELATED SERVICES FOR CHILDREN T- -- 7 -- T - -
a=to reduce incidence of low birthweight babies; b=to increase prenatal services to pregnant women; c=to reduce incidence of children affected by childhood
diseases; d=to increase # of children receiving age appropriate immunizations by 2 years of age; e=to educate families on importance of good nutritional habits to
improve overall health of their children; f=to educate families on developmental assessments to promote early identification of learning disabilities, physical
handicaps or behavioral health needs; g=to educate on benefits of preventive health care and need for screening examinations, such as hearing and vision; h=to
assist families to identify private and public school readiness programs
PROGRAM 'ROGRAM JGES "RVICE 1 LAY 1 ELIGIBILITY 1 PROGRAM'S MISSION STATEMENT GOALS DIFFER
TYPE SERVED SETTING HEALTH REQUIREMENT FROM HEALTH
.. - - -- . -. - WORKER
----A -- -- -- -- -~ -- . -. .
TABLE 5- 7
Information,
Referral,
Prevention
-. . - - - . -
Parental GAPS(Grand- (goal) TO prevent c h z abuse and neglect in identified a , b h
Support parents Adopted for !months 95% pregnancy and child families with first children
Parental Support) to 36 months of age;
first time parents of
any age; high risk for I potential child abuse
Children's
Information Center
phone 100% No None To ensure the health, safety and well being of children and
their families through communtty-based, family centered,
culturally sensitive systems of care
a, b, h
HEALTH START PROGRAM COORDINATION STUDY
ASSESSMENT OF GOALST, YPESO F INTERVENTIONA ND COSTSO F AVAILABLPER OGRAMS
GROUP 2: GOALSA ND /NTERVENTIONS FOR PROGRAMPSR OV~DINCGH ILD
HEALTHR ELATEDSE RVICES
The respondents in this category stated that they provide health related services for children.
Some of them responded "yes" to the question of serving pregnant women. However, because
service to pregnant women is not a major reason for the program or the program is not primarily
health based, these respondents were placed in Group 2. For example, some Healthy Families
respondents answered "yes" to the question about serving pregnant women; however, the primary
reason for program entry is not to receive services for pregnancy. If a woman who is enrolled in
Healthy Families becomes pregnant while her family is receiving services, Healthy Families can
help refer her to appropriate medical providers. Therefore, because services to pregnant women
are incidental to the program, these respondents have been placed in this category rather than the
"serves pregnant women" category.
Comparison Based on Service Settings
Nearly sixty-three percent (62.5%) of the respondents in Group 2 stated that they are
predominantly home-based service providers. This is a common characteristic of two of the four
program types in this group. The Well Child programs are office, medical or school-based. Most
of the Head StadEarly Head Start respondents are not home based. The one exception in this
category is the Phoenix Early Head Start program.
For those programs that are predominantly home-based:
The Healthy Families programs serve families with children up to six years of age,
which is generally older than other programs except for the AHCCCS and
community/county public health services. Health Start, for example, serves families
with children up to 4 years of age; Head Start programs generally serve 3 and 4 year
old children and NICP serves children up to 3 years of age.
Although the Healthy Families programs do provide some health related services for
children and do assist women who are enrolled in the program and subsequently
become pregnant with referrals to appropriate providers, the program is directed more
towards developmental issues for children and family stability issues than is the more
public health orientation of the Health Start program. For example, the Healthy
Families program goals are to reduce abuse and neglect, promote wellness and child
development, strengthen family relationships, promote family unity and reduce
dependency on drugs and alcoh01.'~ The Healthy Families program also bases
eligibility on a stress assessment rather than a health risk. It is generally not directed
19 A.R.S. 58-701(C): The goals ofthe Healthy Families Pilot Program include: (I) Reducing child abuse and neglect, (2)
Promoting child wellness and proper development, (3) Strengthening family relations, (4) Promoting family unity, (5)
Reducing dependency on drugs and alcohol.
HEALTH START PROGRAM COORDINATION STUDY
ASSESSMENOTF GOALST, YPESO F INTERVENTION AND COSTSO F AVAILABLPER OGRAMS
towards the public health issues of reducing low birthweight babies, increasing
prenatal services or improving pregnancy outcomes.
NICP@ , which is also home-based, has a medical focus and is specifically directed
towards reducing the mortality and morbidity of infants who are critically ill at birth.
In order to be eligible for the program, the family must have a child who spent 72 of
histher first 96 hours of life in a Newborn Intensive Care Unit (NICU) because of
medical need. The NICP provides in-home follow up nursing support services for
these infants. Children can continue to receive these services until they are 3 years of
age. These services are more medically involved than those provided through the
Health Start program and are provided by medical personnel working with the
families rather than Lay Health Workers.
The NICP is designed to improve the health status of Arizona's children by reducing
the mortality and morbidity of infants who are critically ill at birth. The program
strives to assure that risk-appropriate care is available and accessible to critically ill
newborns in Arizona regardless of geographic location and ability to pay. The
mission is accomplished by maintaining a regionalized system of transport and
hospital care and ongoing developmental follow-up.
The NICP also includes follow-up services with developmental screenings and
assessment through clinics for infants believed to be at higher risk for developmental
problems because they meet certain medical criteria.
The NICP program includes Community Health Nursing -- home-based
developmental screening, physical, and environmental assessments to identify
potential developmental delays, support and teach parents, and refer families to
intervention services in the community. The Community Health Nurse provides
guidance on child care, developmental goals, parenting skills, and makes referrals to
community resources as indicated. The Nurse reviews medications, treatments,
follow-up appointments, and clarifies issues about infant care and development. An
average of three visits are provided in the child's first year of life. This is in contrast
with Health Start, in which visits should average about once per month prenatally and
about six times during the first year of the child's life.
The Phoenix Early Head start@ program has a goal of improving and enhancing the
parent-child relationship and encouraging and supporting continuing education for
parents and caregivers. Enrollment into the program is limited to pregnant teens with
@ One of the NICP respondents met the criteria of providing a prenatal and early childhood health outreach and
prevention program although prenatal services is not the primary emphasis of this program.
@ Meets the criteria of providing a prenatal and early childhood health outreach and prevention program although
prenatal services is not the primary emphasis of this program.
HEALTH START PROGRAM COORDINATION STUDY
ASSESSMENT OF GOALST, YPESO F INTERVENTIOANN D COSTSO F AVAILABLPER OGRAMS
infants under six months of age who live in certain areas of Phoenix. It also has an
income eligibility criteria.
The remainder of the programs in this group provide services in other than a home-based setting.
Comparison Based on Use of Lay Health Workers
Two of the Head Start programs responded that they use Lay Health Workers -- the White
Mountain Apache Head Start Program and Southwest Human Development Head Start Program.
Both of there programs differ significantly from the Health Start program mission and goals
because they are primarily child development rather than mother and child health programs. In
addition, the White Mountain Apache Head Start Program is targeted to persons residing on or
near the Fort Apache Reservation. None of the Head Start programs is home-based.
The remainder of the respondents in the category of providing health related services for children
but not pregnant women serve a special population or provide a special medical service:
Well Child Clinics and Immunization programs are offered by County Health
Departments. Both of these types of programs offer services to which Health Start
and other programs make referrals, but they do not provide the type of service
coordination and family support of the other programs.
Table 6 "Mission, Goals and Intervention Styles for Programs That Provide Health Related
Services for Children But Not Services to Pregnant Women", looks at goals and interventions for
programs in Group 2 that are providing child health related services but are not primarily service
providers to pregnant women.
Summary
Several programs in Group 2 that provide health related services for children do so only as a part
of their overall program focus and responsibility. Reducing the incidence of low birthweight
babies and improving prenatal care are not generally part of their purpose. Several of these
programs generally have a specific purpose other than health. As can be expected from the
category that these programs are in and from their specific focus, most of them differ significantly
in their goals from the Health Start program. Most of them do not have a goal of reducing low
birthweight or increasing prenatal services to pregnant women. Some of them also do not share
the goals of increasing the immunization rate of children under two years of age. Generally, in
this group, the Healthy Families programs have the least difference in goals and the NICP
programs have the greatest difference in goals. The primary emphasis of the Healthy Families
programs, however, is directed more towards the family environment than towards the physical
HEALTH START PROGRAM COORDINATION STUDY
ASSESSMENT OF GOALST, YPESO F INTERVENTION AND COSTSO F AVAILABLE PROGRAMS
health of the mother and child, and providing services to pregnant women is incidental to the
purpose of the program.
TABLE 6: MISSION, GOALS AND INTERVENTION STYLES FOR PROGRAMS THAT PROVIDE HEALTH RELATED
-- - - SERVICES FOR CHILDREN BUT NOT SERVICES TO PREGNANT WOMEN
- T - - -- - --
o G E T rULIn PROGRAM'S MISSION STATEMENT -
TYPE SERVED SETTING HEALTH REQUIREMENT
CATEGORY WORKER
~ L K ~ T H
Head Start I
Early Head
-- 1 - 1 - L --- --
Head Start I
Early Head
-Start
service
phone 5%; office
20%; home 75%
Phoenix Early
Head Start
months
Clty of Phoenix
Head Start
0-6 mo
enrollme
nt; 0 - 3
years
Head Start I
Early Head
-Start
No ,pregnant teenlchild (goals) To improve I enhance the parent-child relationship.
under 6 mo to enroll; To encourage and support continuing education of parents
federal poverty and other caregivers close to the child.
No up-to-date
immun~zat~on3s ,a nd 4
year olds, at or below
federal poverty guidelines
Colorado River phone 10%;
Indian Tribes Head
Start Program home 5%
guidelines; commit to
immunize child and
36 - 48
months
To be a community leader In provldlng quallty a, b
comprehensive chlld development servlces delivered by
competent staff and collaborat~vec ommunity partnersh~ps
~n order to promote famlly well-belng and self-sufficiency
lprovide well-baby
checks; 12% of service
Igrou p must be children _ / -
phone 15%,
office 30%,
home 20%,
classroom 35%
a=to reduce incidence of low birthweight babies; b=to increase prenatal services to pregnant women; ~ = t ore duce incidence of children affected by childhood
diseases; d=to increase # of children receiving age appropriate immunizations by 2 years of age; e=to educate families on importance of good nutritional habits
to improve overall health of their children; f=to educate families on developmental assessments to promote early identification of learning disabilities, physical
handicaps or behavioral health needs; g=to educate on benefits of preventive health care and need for screening examinations, such as hearing and vision;
h=to assist families to identify private and public school readiness programs
No live within boundaries of
La Paz County,
Colorado River Indian
Tribes Reservation and
meet income guidelines
TABLE 6 -- 1
To serve the community of the Colorado River Indian
Reservation throughout the year by providing high quality,
cost effective, comprehensive, family focused child
development services.
TABLE 6: MISSION, GOALS AND INTERVENTION STYLES FOR PROGRAMS THAT PROVIDE HEALTH RELATED
- .- ---- SE-R VI-C-E S- - FOR - -- CHILDREN - -B U--T- -N- OT --- SE-R -V ICES TO PREGNANT -- W-O M-E- N-PROGRAM
T R o G m M I G E s SERVICE LAY ELlGlelLlTY PROGRAM'S MISSION STATEMENT
TYPE SERVED SETTING HEALTH REQUIREMENT
CATEGORY
I HEALTH
Head Start I Head Start 36 phone 1%; office Yes poverty guidelines; child To provide a continuum of quality, direct services for a, b, d, h
a=to reduce incidence of low birthweight babies; b=to increase prenatal services to pregnant women; c=to reduce incidence of children affected by childhood
diseases; d=to increase # of children receiving age appropriate immunizations by 2 years of age; e=to educate families on importance of good nutritional habits
to improve overall health of their children; f=to educate families on developmental assessments to promote early identification of learning disabilities, physical
handicaps or behavioral health needs; g=to educate on benefits of preventive health care and need for screening examinations, such as hearing and vision;
h=to assist families to identify private and public school readiness programs
Early Head
Start
Start1 r i t e Mountain
Early Head Apache Head Start
-
TABLE 6 -- 2
months
to 60
months
!
I
48
months
Head Start I Head Start
Early Head health screenings, Salt
-Start River Pima-Maricopa
Indian Communrty
boundaries, 3 and 4 year
olds; federal poverty
gu~dellnes
- -
4%; home 20%; 1
med~ca5l %;
home 5%; Head
a, b
,Start 90%
- - -- - --
3 to 5 years of age
Yes reside on or near Fort
Apache Resewat~ont;o
children and families. The agency serves as a partner in
Head Start Site
75%
a, b, c, d
the creation and development of programs, while
advocating for innovation in service delivery.
pp -- -- --
4 years of age; meet
ACF income guidelines
TABLE 6: MISSION, GOALS AND INTERVENTION STYLES FOR PROGRAMS THAT PROVIDE HEALTH RELATED
SERVICES FOR CHILDREN BUT NOT SERVICES TO PREGNANT WOMEN
I T I p 7 i - - - I--- --- -
- r -
-
a=to reduce incidence of low birthweight babies; b=to increase prenatal services to pregnant women; c=to reduce incidence of children affected by childhood
diseases; d=to increase # of children receiving age appropriate immunizations by 2 years of age; e=to educate families on importance of good nutritional habits
to improve overall health of their children; f=to educate families on developmental assessments to promote early identification of learning disabilities, physical
handicaps or behavioral health needs; g=to educate on benefits of preventive health care and need for screening examinations, such as hearing and vision;
h=to assist families to identify private and public school readiness programs
PROGRAM PROGRAM AGES SERVICE R [ ~ ~ PRO~GRAM'S M~ISSION S~TATEMEN~T ~GOALS ~
TYPE SERVED SETTING ALTH REQUIREMENT DIFFER
CATEGORY
- -- - - - --
2 IHEALTH --
Head Start I Havasupal Head lbs I No -
all children 3 to 5 years ~ Early Head Start months office 50%, of age llvlng In remote
area of Grand Canyon
- --- - -- -- - -- pp
Healthy
Families parent of newborn
I
I
I
-- - -- - - - I---
TABLE 6 -- 3
Healthy
Families
No blrth In prlor 3 months,
score 2 5+ on
assessment
To provlde a continuum of qual~tyd, lrect servlces for
chrldren & famllles who the agency serves as a partner In
the creatlon 8 development of programs, wh~lea dvocating
for innovat~onin service dellvery i
I
phone lo%, 2%
office, 15%
med~cal7; 3%
home
SW Human Dev. I 10 - 3
Healthy Fam~l~es
Maryvale
months
TABLE 6: MISSION, GOALS AND INTERVENTION STYLES FOR PROGRAMS THAT PROVIDE HEALTH RELATED
- - SERVICES FOR CHILDREN - - - r- - BUT T- NOT SERVICES -- TO PREGNANT WOMEN I -- - - -- --- -- - -- - ---
PROGRAM 7-&k ' 7" 'ERLAY ELlGilBlLclTY i PROGRAM'S MISSION STATEMENT GOALS
TYPE SERVED SETTING HEALTH REQUIREMENT DIFFER
CATEGORY WORKER FROM
HEALTH
Healthy I~ealthyF amilies phone 5%; office 1 No newborn 0 - 3 months of To systematically assess families strengths and needs to b
Families /age; family scores 25 promote positive parent-child interaction, enhance family
5%; home 70% points out of 100 on risk functioning and promote positive child development
assessment
!
-- --
I
- -- - - 1 - - -- - 1
Healthy Healthy Fam~lies phone 5%, office No ch~ld< 90 days old & at
Families risk of abuselneglect
/
I
- - -- - 1 - --- - - -. - - - - - - - -
Healthy Healthy Famllies 0 - 3 phone 5%, office No ,post partum women with
Families months 15%; home 90% 1 Irsk assessment on 1 family at time of birth
- -1 - -__ - 1 -- --- - -- - - --
a=to reduce incidence of low birthweight babies; b=to increase prenatal services to pregnant women; c=to reduce incidence of children affected by childhood
diseases; d=to increase # of children receiving age appropriate immunizations by 2 years of age; e=to educate families on importance of good nutritional habits
to improve overall health of their children; f=to educate families on developmental assessments to promote early identification of learning disabilities, physical
handicaps or behavioral health needs; g=to educate on benefits of preventive health care and need for screening examinations, such as hearing and vision;
h=to assist families to identify private and public school readiness programs
TABLE 6 -- 4
TABLE 6: MISSION, GOALS AND INTERVENTION STYLES FOR PROGRAMS THAT PROVIDE HEALTH RELATED
SERVICES FOR CHILDREN BUT NOT SERVICES TO PREGNANT WOMEN
- r- - 1 i -r --
I- -- . - --- - -
Healthy
Families
PROGRAM
TYPE
CATEGORY
PROGRAM PROGRAM'S MISSION STATEMENT GOALS
DIFFER
FROM
HEALTH
AGES
SERVED
Healthy Families
a=to reduce incidence of low birthweight babies; b=to increase prenatal services to pregnant women; c=to reduce incidence of children affected by childhood
diseases; d=to increase # of children receiving age appropriate immunizations by 2 years of age; e=to educate families on importance of good nutritional habits
to improve overall health of their children; f=to educate families on developmental assessments to promote early identification of learning disabilities, physical
handicaps or behavioral health needs; g=to educate on benefits of preventive health care and need for screening examinations, such as hearing and vision;
h=to assist families to identify private and public school readiness programs
No enroll immediately
following birth of at-risk
child; score on
assessment
TABLE 6 -- 5
SERVICE
SETTING
A statewide system of delivery of home-based, family- /a, b, e
centered services which promote health, prevent child
abuse, and optimize child development, which will be made
available to all families in need of such services
0 - 60
months
No family must enroll in
program prior to baby's 3
month birthdate I score
on assessment
phone 4%; home
95%; family
meetings 1 %
Healthy
Families
Healthy
Families
medical 5%;
home 90%;
other (WIC,
DES, etc.) 5%
phone 10%;
office 10%;
medical 10%;
home 70%
LAY
HEALTH
WORKER
Healthy Families TO identify, intervene early & prevent abuse & neglect of
targeted children under 5 years at risk for child abuse. . .
provide preventive 8 early intervention services to
Healthy Families
and Choices for
Families
ELIGIBILITY
REQUIREMENT
0 - 60
months
a, b, c, e, g
No mother who has had a
live birth
3
months -
216
months
identified parents . . .to promote child health & I
development. . . 1
I
Goal: The purpose of the Healthy Families America
initiative is to support parents right from the start by laying
the foundation for nationwide, voluntary home visitor
services for all new parents through a network of statewide
systems
TABLE 6: MISSION, GOALS AND INTERVENTION STYLES FOR PROGRAMS THAT PROVIDE HEALTH RELATED
- - - - - -- - -
SERVICES -F O-R - C- H-I--L DR- E-N-- B UT NOT SERVICES T-O P-R -E- GNANT ppp WOMEN -p - -
--
phone 5%; office
5%; home 50%
-- 1 1 - 1 - p - - 1 1
0 - 36 phone 10%;
months home 90%
.- Alp
PROGRAM
TYPE
CATEGORY
NlCP
No infants requiring more
than 72 hours of Level Ill
or Level ll nursery care
beginning within 96
hours of birth
PROGRAM'S MISSION STATEMENT
- - - -
~TO reduce the mortality and morbidity of infants who are a, b, c, d, e,
critically ill at birth through a statewcde system of
coordinated care Ih
---- - - --
PROGRAM ^""SERVICE
SERVED
GOALS
DIFFER
FROM
HEALTH
Newborn Intensive
Care Program
(NICP)
No 96 hours postnatal in To reduce the mortality and morbidity in NlCP infants who
NlCU for 72 hours are critically ill at birth and other children with special
health care needs who develop physical and
developmental delays, through a statewide system of
coordinated care
w;;ER"wLlw
SETTING HEALTH REQUIREMENT
a=to reduce incidence of low birthweight babies; b=to increase prenatal services to pregnant women; c=to reduce incidence of children affected by childhood
diseases; d=to increase # of children receiving age appropriate immunizations by 2 years of age; e=to educate families on importance of good nutritional habits
to improve overall health of their children; f=to educate families on developmental assessments to promote early identification of learning disabilities, physical
handicaps or behavioral health needs; g=to educate on benefits of preventive health care and need for screening examinations, such as hearing and vision;
h=to assist families to identify private and public school readiness programs
0 - 36
months
TABLE 6 -- 7
home 100% 1 No infants are post graduate
of 48 hour stay in NICU
or can be referred in
To reduce the mortality and morbidity of NlCP cnfants who a, b, h
are critically ill at birth and other children with special
health care needs who develop physccal and
developmental delays, through a statewcde system of
coordinated care
I
I
TABLE 6: MISSION, GOALS AND INTERVENTION STYLES FOR PROGRAMS THAT PROVIDE HEALTH RELATED
SERVICES FOR CHILDREN BUT NOT SERVICES TO PREGNANT WOMEN - - r --7 - -- -- - - - - -
PROGRAM PROGRAM ASGEREVSE D sSEmTvTIwNGx wHEiALETH REiELQTlGUlIBR lELMlnE NT -r PRMiRAws MISSION STATEHENT
CATEGORY
Well Child 200 % of poverty level or To build upon its successful Elementary Student Health a, b
below; uninsured Program and Children's Dental Clinic to enhance and
Services expand primary care services to children and families of
Well Child Immunization
Program
Well Child
Yes
i-Well
Child Clinics la, b, e, h
a=to reduce incidence of low birthweight babies; b=to increase prenatal services to pregnant women; ~ = t ore duce incidence of children affected by childhood
diseases; d=to increase # of children receiving age appropriate immunizations by 2 years of age; e=to educate families on importance of good nutritional habits
to improve overall health of their children; f=to educate families on developmental assessments to promote early identification of learning disabilities, physical
handicaps or behavioral health needs; g=to educate on benefits of preventive health care and need for screening examinations, such as hearing and vision;
h=to assist families to identify private and public school readiness programs
TABLE 6 -- 8
0 - 18
months
phone 20%; No
office 70%;
medical 5%;
home 5%
HEALTH START PROGRAM COORDINATION STUDY
ASSESSMENOTF GOALST, YPESO F INTERVENTIONA ND COSTSO F AVAILABLE PROGRAMS
GROUP 3: GOALSA ND /NTERVENT~ONSF OR PROGRAMPSR OV~D~NG
PREGNANCSYE RVICES
Table 7, "Mission, Goals and Intervention Styles for Programs that Serve Pregnant Women but
Do Not Provide Health Related Services for Children", looks at goals and interventions for
Group 3, programs that serve pregnant women but do not provide health related services to
children. These are programs that responded "yes" to the question of providing services to
pregnant women and "no" to the question of providing health related services for children. Some
of these respondents may also be providing other types of services for children or including
children in their service population.
Several of the respondents in Group 3 lack multiple intervention characteristics, thus making them
significantly dissimilar from the Health Start program and other respondents to this survey.
Healthy MothersIHealthy Babies Coalition is an advocacy coalition for mothers and
infants rather than a service provider. Its goal is for public education to improve
maternal and infant health. Although it shares the mission and goals of encouraging
healthy pregnancy outcomes and healthy children with the Health Start program, it
does not provide services directly or coordinate services for clients. Examples of the
types of activities performed by the Coalition(s) include public awareness campaigns,
workshops and distribution of printed materials.
Pregnancy and Breastfeeding Hotline is a bilingual, bicultural telephone based system
that is primarily focused on improving pregnancy outcomes and providing
information. It also does not provide services beyond referral directly to clients.
The Commodity Supplementary Food Program, the Extension Food and Nutrition
Education Program and the Family and Consumer Science Extension Education
program are focused on providing nutritional information and do not address the goals
of improving pregnancy outcomes or providing prenatal and childhood health
services. These programs are office or community 1 classroom-based and do not use
Lay Health Workers. The Commodity Supplemental Food Program also provides
commodity foods such as cereal, canned meats, powdered andlor canned milk, canned
fruits, canned vegetables, dried beans, peanut butter, and juices.
Comparison Based on Home-Based Service Setting
Thirty-three percent (33.3%) of the respondents in Group 3 use a predominantly home-based
service delivery methodology:
Choices for Families in Phoenix and Southern Arizona Collaboration on Choices for
Families are directed at families needing support, education and crisis intervention.
HEALTH START PROGRAM COORDINATION STUDY
ASSESSMENOTF GOALST, YPESO F INTERVENTIOANN D COSTSO F AVAILABLPER OGRAMS
Choices for Families is limited to parents under 21 years of age. These two programs
have broad mission statements and state that they share most of the Health Start goals.
Maternal and Child Health in Cochise County is directed towards adolescent mothers.
It did not indicate that its goals include developmental assessments, education on
preventive health care and screenings or assistance to identify school readiness
programs.
Loving MeILoving My Baby provides services though a variety of methodologies,
which also include telephone, office, medical settings, and seminars. Like the
Phoenix Birthing Project, this program is targeted to women in the African American
community in Phoenix.
Maternal Child Health (Phoenix Home Health) offers a maternal program for
postpartum women who are AHCCCS enrolled and members of the health plan. It
differs from Health Start, however, in a significant number of goals, particularly those
dealing with improved pregnancy outcomes, childhood diseases and immunizations
and school readiness issues.
Woman to Woman focuses specifically on pregnant women to improve birth outcomes
but does not provide services for children.
The Next Step is primarily a child abuse prevention program provided through Parents
Anonymous.
Project Comadre is modeled on Health Start and provides services in a home-based
setting using Lay Health Workers.
The remainder of the respondents in this category are not predominantly home-based and provide
specialty services or serve special populations:
Four of the respondents specifically address adolescent pregnancies and parents:
Center for Adolescent Parents in Tucson serves pregnant and parenting
adolescents who have dropped out of school. The program is to assist these
teens to overcome life barriers and become participating members of the
community.
Choices for Teen Parents in the Yuma area offers programs in a classroom
setting to pregnant or parenting teens under 2 1 years of age.
Maricopa Center for Adolescent Parents serves teen mothers between 16 and
19 years of age primarily from the Phoenix, Glendale and Peoria area. It also
offers most of its programs in a classroom setting.
Yavapai County Health Department is providing nurse case management to
pregnant adolescent girls under 18 years of agge. This is a transitional
HEALTH START PROGRAM COORDINATION STUDY
ASSESSMENOTF GOALST, YPESO F INTERVENTIOANND COSTSO F AVAILABLPER OGRAMS
program between the terminated Teen Prenatal Express program and the
program to be developed using County Perinatal Block Grant.
Project CAM1 provides substance abuse services to women over 18 who are pregnant
or parenting.
Baby Arizona assists with AHCCCS eligibility and works to ensure that women are
aware of the availability of medical care and assisted to access medical care early in
their pregnancy. The program is educational and outreach based.
First Steps is currently revising its mission statement. It serves teens and women who
are receiving services from St. Joseph's Hospital and Maricopa Medical Center. It is
not primarily home based and does not use Lay Health Workers.
Yuma County provided a response on its Pregnancy Testing program. Other services
can be provided as needed through referrals to program such as Health Start which has
a contractor in the Yuma area.
Phoenix Birthing Project is directed at improving pregnancy outcomes targeted to the
African American Community.
Surgery Referral is a medical based service through the Doctor's Health Plan. No
additional information was provided.
Comparison Based on Use of Lay Health Workers
Only one of the respondents in this category uses Lay Health Workers -- Project Comadre in Pinal
County. It is based on the Health Start model, uses Health Start forms for data collection and is
administered by a current Health Start contractor, using grant funding. The grant ends October 1,
1996. The program is limited to pregnant women and their children up to one year of age. It is
also predominantly home-based and meets all of the criteria of a prenatal and early childhood
health outreach and prevention program. Of all of the respondents in Group 3, this is the most
similar to the Health Start program.
Summary
Only one of the respondents in Group 3, Project Comadre, is similar to the Health Start program in
most of the points of assessment. It is located in the communities of Casa Grande, Coolidge and
Florence in Pinal County. There is also a Health Start provider in Pinal County that serves the
community of Eloy.
TABLE 7: MISSION, GOALS AND INTERVENTION STYLES FOR PROGRAMS THAT SERVE PREGNANT WOMEN
BUT DO NOT PROVIDE HEALTH RELATED SERVICES FOR CHILDREN
-- - . --
PROGRAM
TYPE
--
Adolescent 1
Young Adult
Adolescent 1 Choices for office 10%; pregnant or parenting TO enhance the quality of life for children and their families c, d, g, h
Young Adult Teen Parents inone 1 classroom 90% teens under 21 years of
- --- - - - - -p -- --- - -- -- -- - - -- -- ----
Center for
Adolescent
Parents
1 - I
a=to reduce incidence of low birthweight babies; b=to increase prenatal services to pregnant women; c=to reduce incidence of children affected by childhood
diseases; d=to increase # of children receiving age appropriate immunizations by 2 years of age; e=to educate families on importance of good nutritional habits
to improve overall health of their children; f=to educate families on developmental assessments to promote early identification of learning disabilities, physical
handicaps or behavioral health needs; g=to educate on benefits of preventive health care and need for screening examinations, such as hearing and vision;
h=to assist families to identify private and public school readiness programs
LAY
HEALTH
WORKER
I
TABLE 7 -- 1
ELIGIBILITY PROGRAM'S MISSION STATEMENT
REQUIREMENT
0 - 30
months
parents under 21 years of
age, 3rd trimester
pregnancy
Adolescent 1 Choices for 10 +
Adolescent 1
Young Adult
-- - I - - ----- ---
phone 5%; home
90%; parks and
stores 5%
To enhance the quality of life for children and their families a I i
Young Adult Families
I
1
I
phone 5%; office
25%; classroom
75%
phone 10%;
office 88%;
medical 2%
No
depends
on family
'~aricopaC enter 10 - 36
for Adolescent
Parents
No
a, b, h (also
completion of
I
months
and in last trimester EED)
No teen mothers between 16 To enhance the quality of life for all children and their families
and 19 years of age;
pregnant & parenting I. . .a place where teen parents who have dropped out of a, h
pregnant with first child
teens who have dropped
out of high school
school learn to overcome life barriers, enhance self esteem,
become self-sufficient & improve their life changes. . . goals
are accomplished through education, skill development &
community linkages
TABLE 7: MISSION, GOALS AND INTERVENTION STYLES FOR PROGRAMS THAT SERVE PREGNANT WOMEN
BUT DO NOT PROVIDE HEALTH RELATED SERVICES FOR CHILDREN
PROGRAM
TYPE
PROGRAM
Adolescent I
Young Adult
Adolescent I
Young Adult
phone 5%; office
1 %; medical 3%;
home 76%;
other 15%
Advocacy
AGES
SERVED
- - - -- - - - - - - - -
Maternal & Child
Health
Healthy Mothers
I Healthy Babies
Coalition
Activities
I(provides educational services)
PROGRAM'S MISSION STATEMENT
0 - 6
months
and
teens
No
phone 40%;
medical 50%;
home 10%
No iteens under 18 are case
managed by nurse; other
services provided to
women over 18; pregnant
or in need of pregnancy
,test
Maternal & Child
Health Block
Grant
SERVICE
SETTING
GOALS
DIFFER
mother under 18 years of
age
(mission under development I services being provided on
interim basis while planning Maternal & Child Block Grant)
0 - 252
months
a=to reduce incidence of low birthweight babies; b=to increase prenatal services to pregnant women; c=to reduce incidence of children affected by childhood
diseases; d=to increase # of children receiving age appropriate immunizations by 2 years of age; e=to educate families on importance of good nutritional habits
to improve overall health of their children; f=to educate families on developmental assessments to promote early identification of learning disabilities, physical
handicaps or behavioral health needs; g=to educate on benefits of preventive health care and need for screening examinations, such as hearing and vision;
h=to assist families to identify private and public school readiness programs
TABLE 7 -- 2
LAY
HEALTH
WORKER L-L --
Behavioral I
Substance
Abuse
ELIGIBILITY
REQUIREMENT
-- -- -- - -- -- -
Agency's general mlssion is to promote and prov~deq uallty
health & soclal services for vulnerable populations and to
prevent and treat illness and social problems while increasing
health awareness and behavior for all Cochise County
residents
phone 25%;
office 25%;
medical 15%;
home 25%;
other 10%
FROM
HEALTH
- -
f, g, h
CODAC BHSl
Project CAM1
none No 18 years and older
parenting or pregnant
(Philosophy) . . .work toward the empowerment of clients as lg, h
women in families, to deal more effectively with issues I
leading to alcohol and other drug abuse, by encouraging
women to take control of their lives in fostering healthy
connections. . .
TABLE 7: MISSION, GOALS AND INTERVENTION STYLES FOR PROGRAMS THAT SERVE PREGNANT WOMEN
BUT DO NOT PROVIDE HEALTH RELATED SERVICES FOR CHILDREN
PROGRAM
TYPE
Birthing &
Pregnancy
Support
Birthing &
Preanancy
Support
Birthing &
Pregnancy
support
Birthing &
Pregnancy
Support
ELIGIBILITY PROGRAM'S MISSION STATEMENT
Arizona
1
Direct
Pregnancy
Testing and
Follow-Up
phone, office
and medical
settings
First Steps 10 - 12
months
I
.!_
Loving Me, - 24
Loving My Baby months
phone 30%;
office 5%;
medical 40%;
home 10%;
community 15%
/phone 15%;
office 15%;
medical 15%;
home 50%;
seminars 5%
Yuma County Health Department mission is to promote the
health of the community and prevent disease
No targets low-income The goal of Baby Arizona is to get expectant mothers into
Joseph's Hospital or
Maricopa Medical Center.
Inpatient & follow up no
age limit. Prenatal limited
--
pregnant women who may
be Medrcaid eligible
through SOBRA or
currently enrolled in
AHCCCS -
GOALS
DIFFER
FROM
HEALTH
care as early as possible, and to ensure that they continue
that care and practice healthy habits during pregnancy.
-
a=to reduce incidence of low birthweight babies; b=to increase prenatal services to pregnant women; c=to reduce incidence of children affected by childhood
diseases; d=to increase # of children receiving age appropriate immunizations by 2 years of age; e=to educate families on importance of good nutritional habits
to improve overall health of their children; f=to educate families on developmental assessments to promote early identification of learning disabilities, physical
handicaps or behavioral health needs; g=to educate on benefits of preventive health care and need for screening examinations, such as hearing and vision;
h=to assist families to identify private and public school readiness programs
TABLE 7 - 3
TABLE 7: MISSION, GOALS AND INTERVENTION STYLES FOR PROGRAMS THAT SERVE PREGNANT WOMEN
BUT DO NOT PROVIDE HEALTH RELATED SERVICES FOR CHILDREN
PROGRAM
TYPE
LAY
HEALTH
WORKER
PROGRAM ELIGIBILITY
REQUIREMENT
Birthing 81
Prennancy
Support
Birthinn 8
Pregnancy
Support
AGES
SERVED
Maternal Child
Health (PHS)
No
SERVICE
SETTING
PROGRAM'S MISSION STATEMENT
- -- - - -
AHCCCS I post partum
mothers and PHS
members
I
la, b, c, d, h
GOALS
DIFFER
FROM
HEALTH
- --
0 - 1
month
phone 45%;
office 5%;
medical 5%;
home 45%
Perinatal Case
Management
Program
No
Birthing 8 Phoenix Birthing 0 - 12 phone 73%;
~ r e g n m c y project 1 months 1 office 2%;
Support medical 10%;
home 100%
0 - 252
months
No primary outreach is the
African American
community; prenatal
!
i
AHCCCS eligible; mother
under 20 years of age or
over 34 years of age and
at high risk due to medical,
behavioral or social
conditions
To provide realistic, individualized treatment goals to meet
the medical and social needs of pregnant APlPA members
To ensure the health, safety, and well being of pregnant lc, d, e, f, g, h
women and their families through community-based, family- ; centered, culturally sensitive systems of care 1
Birthinn 8
Pregnancy
Support
a=to reduce incidence of low birthweight babies; b=to increase prenatal services to pregnant women; c=to reduce incidence of children affected by childhood
diseases; d=to increase # of children receiving age appropriate immunizations by 2 years of age; e=to educate families on importance of good nutritional habits
to improve overall health of their children; %to educate families on developmental assessments to promote early identification of learning disabilities, physical
handicaps or behavioral health needs; g=to educate on benefits of preventive health care and need for screening examinations, such as hearing and vision;
h=to assist families to identify private and public school readiness programs
Pregnancy 8 i
Breastfeeding 1
Hotline
I
TABLE 7 -- 4
TABLE 7: MISSION, GOALS AND INTERVENTION STYLES FOR PROGRAMS THAT SERVE PREGNANT WOMEN
BUT DO NOT PROVIDE HEALTH RELATED SERVICES FOR CHILDREN
Birthing 8 /project Comadre
Pregnancy
Support medical 10%;
home 70%;
community 3%
PROGRAM
TYPE
PROGRAM
I
LAY
HEALTH
WORKER
Birthing &
Pregnancy
Support
AGES
SERVED
ELIGIBILITY
REQUIREMENT
PROGRAM'S MISSION STATEMENT
Surgery Referral 1
of Pregnancy
SERVICE
SETTING
GOALS
DIFFER
FROM
HEALTH
1 Yes
Food 8
Nutrition
i -- L - . 1 --
Commodity 0 - 71
Supplementery months
Food Program
children limited to one year
of age; pregnant women;
high risk pregnancies and
high risk families referred
to appropriate agencies
Birthing &
Pregnancy
Support 1
Parental
Support
a=to reduce incidence of low birthweight babies; b=to increase prenatal services to pregnant women; ~=tore duce incidence of children affected by childhood
diseases; d=to increase # of children receiving age appropriate immunizations by 2 years of age; e=to educate families on importance of good nutritional habits
to improve overall health of their children; f=to educate families on developmental assessments to promote early identification of learning disabilities, physical
handicaps or behavioral health needs; g=to educate on benefits of preventive health care and need for screening examinations, such as hearing and vision;
h=to assist families to identify private and public school readiness programs
To positively impact infant mortality, low birth weight and
infant immunization rates in rural Pinal County
TABLE 7 -- 5
Woman to none
Woman
I
phone20%. No 1
office 1%,
To provide prenatal outreach, support, and educat~on C, d. e, f, g, h
programs to strengthen famil~es and our community by
med~caIl %, , 1 work~ngw ith the begrnn~ngo f all fam~lies,a mother and her
home 50%,
other 28%
unborn child
I
TABLE 7: MISSION, GOALS AND INTERVENTION STYLES FOR PROGRAMS THAT SERVE PREGNANT WOMEN
BUT DO NOT PROVIDE HEALTH RELATED SERVICES FOR CHILDREN
I
PRoauM /PROGRAM AGES
SERVED
SERVICE
SETTING
LAY
HEALTH
WORKER
ELIGIBILITY
REQUIREMENT
Food &
Nutrition
low income & federal
18%; community poverty guidelines
EFNEP
Extension Food
& Nutrition
Education
Program
Food &
Nutrition
Family &
Consumer
Science
Extension
Education
- -- - - - -
PROGRAM'S MISSION STATEMENT
- -- - ---
, 1 ,
phone 20%;
home 20%;
community
center classes
60% (varies by
county)
To empower families through nutrition education to healthy
lifestyles and positive futures
No
b, c, d, f, g, h
Educational outreach from the UofA wtth various curriculum
and educational programs for limited resource or at-risk
families and youth on life skills including family and personal
development, nutrition/wellness, and family resource
management
Parental The Next Step
Support
b, c, d, f, g, h
Parental
Support
Southern
Arizona
Collaboration -
Choices for
Families
a=to reduce incidence of low birthweight babies; b=to increase prenatal services to pregnant women; c=to reduce incidence of children affected by childhood
diseases; d=to increase # of children receiving age appropriate immunizations by 2 years of age; e=to educate families on importance of good nutritional habits
to improve overall health of their children; f=to educate families on developmental assessments to promote early identification of learning disabilities, physical
handicaps or behavioral health needs; g=to educate on benefits of preventive health care and need for screening examinations, such as hearing and vision;
h=to assist families to identify private and public school readiness programs
I
support, education and
1 crisis intervention
i ,
I
-AppP - - --- - -- - - - - - - -- - -- -
TABLE 7 -- 6
No pregnant and parenting
teenagers
0 - 216
months
Parents Anonymous of Arizona strengthens families and /a, c, f, h
prevents child abuse I
I
1
I
phone 10%;
home 90%
HEALTH START PROGRAM COORDINATION STUDY
VI. ASSESSMENT OF THE NEEDS OF TARGET
POPULATIONS AND COMMUNITIES AND THE
EXTENT TO WHICH CURRENT COMMUNITY
RESOURCES MEET THE NEEDS
Development of needs assessments is an ongoing endeavor in the State of Arizona. The ADHS,
using a variety of methods, identifies needs of the Arizona populations. A significant amount of
information about the needs of Arizona's women and children has been documented by the
department and is currently being used by the ADHS and other organizations as the basis for
planning decisions regarding programs -- both what services are needed and where they are
needed.
Information used in this report came from a number of sources:
Needs assessment information from the bids of the Health Start Contractors
Responses to the survey question on the three top needs in the respondent's community
The Health Needs of Arizona's Women. Children and Adolescents. 1995-1996; Arizona
Department of Health Services - Office of Women's and Children's Health, February 1996
Improving the Health of Arizona's Women. Children and Adolescents; Annual Plan 1995-
1996; Arizona Department of Health Services - Office of Women's and Children's Health;
February 1996
The respondents to the survey identified the following needs in their communities:
Advocacy for teen parents and
their children
Awareness of service
availability
Bilingual early childhood
education
Bilingual Head Start classes
Financial support Prenatal support
Follow up and intervention Prenatal nutrition services
services for medically and
developmentally at risk infants, Prevention and intervention
particularly in rural areas Primary health and vision care
Foster homes for school age children
Full continuum of services Residential services for
substance abusing families
HEALTH START PROGRAM COORDINATION STUDY
Assessment of Needs
Bilingual social workers
Child care that is affordable and
good quality
Dental care
Developmental therapies
Emergency child care shelters
Employment training for
women
Family based services
Family support
Financial resources for teen
parents
Housing
Housing for teen parents
Immunizations
Improved access to prenatal
care
Improved services for medically
complex children to remain the
community
In-home sick child care
Increased funding for services
Outreach to families with
infants at risk due to
dysfunctional environments
Parenting and child abuse
prevention classes
Respite care
School programs for young
single mothers
Service coordination
Services for specific health
conditions, such as diabetes,
hypertension and alcoholism
Social support networking for
low income women
Substance abuse services,
particularly for substance
exposed infants
Teen pregnancy prevention
education
Table 8, "Community Needs as Identified by Survey Respondents by County Area", on the
following pages, displays the needs for the communities in which the respondent provides
services, grouped by the county in which services are provided. Since responses were not received
from providers in Graham or Greenlee Counties, there is no information provided for these
counties. There are little significant differences among the respondents by county or by program
type-
TABLE 8: COMMUNITY NEEDS AS IDENTIFIED BY SURVEY RESPONDENTS BY COUNTY AREA
STATEWIDE I NAME OF GEOGRAPHIC AREA FOR SERVICE WHAT DOES THE PROGRAM BELIEVE TO BE THE COMMUNITY'S NEEDS?
COUNTY PROGRAM DELIVERY
Arizona
--
Arizona
Arizona
Perinatal Case Coconino, Maricopa, Pima, Graham,
Management Cochise, Yuma, Navajo and Apache
Program Counties
Children's statewide via telephone
Information Center
. . .-
Pregnancy & statewide via telephone---
Breastfeeding
Hotline
- - --- --
inpatient treatment of pregnantsubstance abusers; shelters and houslng,
aggressive teen family plannlng
-- - - --
effective ways to more preventive health andcoordinated support services;
accessible preventive health and support services; early prevention and
intervention
- - - - -- - - --- - -
fewer poor pregnancy outcomes; earlier identification of women at high risk
for a poor pregnancy outcome; more women and infants accessing
preventive health and support services
- -- - . - . .- -
Arizona Inter Tribal Council Tribal - Sells, Sacaton, Tucson, education; transportation; housing
of Arizona WIC Kykotsmovi, Parker, Supai, Scottsdale,
Program San Carlos, Whiteriver, Peach Springs,
Phoenix (see service area list)
-- - -- -- - -
Arizona Healthy Mothers 1 16 sites in 14 counties; 3 subcommittee public awareness of maternal and child health issues; increase of services
Healthy Babies coalitions advocate statewide for mothers and babies, transportation assistance for maternal and ch~ld
Arizona Coalition health services in rural areas
-- - ~ - ~.- ~ -
Arizona ADHSMllC
~-
statewide
Arizona
- -- ---
Commodity statewide
Supplementery
Food Program
-- -- - - - --
family support services (summer programs for children); access to
affordable, quality health care; public transportation
- - -- -- - -- - - - -- - -- -- -
greater CSFP services for older adults; improved public Gnsportatlon
--p-....---p---- . . - ~ ~ TABLE 8 -- 1
TABLE 8: COMMUNITY NEEDS AS IDENTIFIED BY SURVEY RESPONDENTS BY COUNTY AREA
STATEWIDE I NAME OF GEOGRAPHIC AREA FOR SERVICE WHAT DOES THE PROGRAM BELIEVE TO BE THE COMMUNITY'S NEEDS?
COUNTY PROGRAM DELIVERY
Cochise
-- - - - - -- - A -- -
Healthy Families Sierra Vista, Benson, St. David,
and Choices for Tombstone, Palominas, Hereford, Fort
Families Huachuca, Huachuca City
- - . -- - - -
transportation, cheap counseling, more Head Start
-- - -- -- - -- -- - . -.- -- -- - - --
Cochise Health Start - Douglas, P~rtlevilleE, lfrida jobs, housing, maternal & child education
Cochise County
Cochise
- - - -- - - -
Maternal & Child Willcox, Douglas, Efrida, Sunizona
Health Pirtleville, Bowie, B~sbeeS, ierra Vista,
Benson. Naco
-- -. .. .
adolescent specific health care; sex education for teens; shelter for
adolescents
-- -- -- -- -- - - - - -- -
Cochise, Pima. Healthy Families Bisbee, Douglas, Naco, Pietrileville; Sierra family based services, coordination of services, continuum of services for
Santa Cruz Vistak Benson, Tombstone, Huachuaca prevention and intervention
City, Nogales, Tucson (selected zip codes)
-- - -- - - - - . -
Cochise, Santa Southern Arizona Benson, Bisbee, Douglas, Sierra Vista, family support, coordination of services, continuum of services
Cruz Collaboration - Naco, Pietrleville, Nogales, Rio Rico
Choices for
Families
Coconino
Coconino
Health Start - Page, Greenhaven; Marble Canyon; Bitter education 1 services to help youth gangs and teen pregnancy; activities I
North Country Springs; GaplCedar Ridge; Coppermine; recreational opportunities to focus on families; prevention & treatment for
Community Health Lechee; Kaibeto (all in Coconino County) drug and alcohol
Center
- -- -- - - -- - - --
Havasupai Head Havasupai Reservation in Grand Canyon
Start
- . - - -
child abuselneglect; drugslalcohol; nutrition
-. ~ - ~ ~ . . . -- - -. .. - - - -- - -
TABLE 8 -- 2
TABLE 8: COMMUNITY NEEDS AS IDENTIFIED BY SURVEY RESPONDENTS BY COUNTY AREA
STATEWIDE 1 NAME OF GEOGRAPHIC AREA FOR SERVICE WHAT DOES THE PROGRAM BELIEVE TO BE THE COMMUNITY'S NEEDS?
COUNTY PROGRAM DELIVERY
-- -- - -
Coconino San Juan Hidden Springs, Rough Rock Point, Tuba health education; chronic illness home-based care; alcoholism
Southern Paiute City, Cow Springs, Navajo Mountain (Utah)
Tribe I Health &
Human Services
Department
-- -
Gila, Pinal Medicaid I E P S D T Eloy, Coolidge, Red Rock, Toltec, San immunization, early prenatal care,
Manuel, Mammoth, Superior, Stanfield,
Maricopa, Apache Junction, Casa Grande,
Queen Creek, Sacaton, Mobile, Arizona
City
La Paz
-
Colorado River Parker, Poston; Colorado River Indian
Indian Tribes Head Reservation; Big River and Lost Lake
Start Program (California)
-- - - . - -
Bilingual Head Start classes; immunizations; substance exposed infants;
health problems such as diabetes, hypertension and alcoholism; lack of
housing; parenting classes and child abuse prevention; foster homes
- --- . . - - -- -- -- - - - - --
Maricopa City of Phoenix City of phoenix free and low cost de% and medical services; employment, education
Head Start
.- -- --
Maricopa SW Human Dev. I west Maryvale, Glendale, Phoenix
Healthy Families
Maryvale
in-home prevention, service coordination, social supports
- -- --- - - -- - - -- - - - -- - - - - - --
Maricopa Health Start Town of Guadelupe dental care; school age children need prlmaty health care and vis~onc are
Centro de Amistad
I Immunization
and Well-Baby
Clinic
-- -- --- - -- - - -- - - - - - -
Maricopa Phoenix E ~ K ~ - Phoenix Enterprize Zone: Camelback affordable, qual~tyc hild care, housing and shelters for teens and thew
Head Start south to Elliott; 43 Avenue east to 40th bab~esb; ~linguael arly childhood educat~ona nd soc~awl orkers
Street
. - -~ - -- ..- - .. ~ ~ .. . ...
TABLE 8 - 3
TABLE 8: COMMUNITY NEEDS AS IDENTIFIED BY SURVEY RESPONDENTS BY COUNTY AREA
STATEWIDE I NAME OF GEOGRAPHIC AREA FOR SERVICE WHAT DOES THE PROGRAM BELIEVE TO BE THE COMMUNITY'S NEEDS?
COUNTY PROGRAM DELIVERY
-- - - -- - -- - - -- - - pp - - - - - - -
Maricopa Head Start Central Phoenix and Paradise Valley medical services; dental services
School Dlstrlcts
- - - - - - - - - -- - - -- - - -- - -- pp -- - -- - - -
Mar~copa Healthy Famil~es Chandler, Gilbert, Mesa substance abuse, prevention services; commun~tyin volvement
-- - . -- - -
Maricopa Phoenix Birthing all of Maricopa County with primary reduce low birthweight rate; reduce rate of infant death; support services
Project outreach to the African American
community
Maricopa
--
AHCCCS; prenatal Maricopa County
case management
program
awareness; use services; duplication in outreach
-- - - -p -- - - - - -
Maricopa Maricopa Center Phoenix; Glendale; Peoria (but wilt accept financial resources for teen parents; housing resources for teen parents;
for Adolescent students from any location in the Valley) more advocacy for teen parents and their children
Parents
-- ~ -.-p-p--.--.p..---..p ..
Maricopa Health Start - El Mirage, Suprise, Queen Creek, Gila clients uninsured and underinsured; financial barriers to care - inadequate
Clinica Adelante Bend, Buckeye, Wickenberg, Aguila transportation; few referral sources; cultural barriers to care -- language,
low literacy, little education
- -- - - -- - - -- -- - ---p-p--p- -- -- - -
Maricopa Choices for Phoen~xfr om Bell Road to Baseline and financial Ir esources for teen parents; housing resources for teen ~Gents,
Families from 40th Street to 75th Avenue advocacy for teen parents and their children
..~ -- -- ~. -p .. -~ --
TABLE 8 -- 4
TABLE 8: COMMUNITY NEEDS AS IDENTIFIED BY SURVEY RESPONDENTS BY COUNTY AREA
STATEWIDE I NAME OF GEOGRAPHIC AREA FOR SERVICE WHAT DOES THE PROGRAM BELIEVE TO BE THE COMMUNITY'S NEEDS?
COUNTY PROGRAM DELIVERY
-- ... - . . .- .. - .. - ~ ~- -. --- --
Maricopa First Steps nla: recipients must be receiving services assistance to access services and resources; access to health care
through St. Joseph's or Maricopa Medical services and identifying a need to access services; child abuse prevention
Center in Phoenix
Maricopa
Maricopa
Maricopa
Maricopa
NlCP
- - -- - - - - --
Maricopa County zip codes 85007-85008;
85012; 85014; 85016; 85018; 85251 and
85257
-- --
follow up I interventionfor infants 2 risk medically, developmentally; follow
up I intervention for infants at risk -- delivery of services to those in rural
areas; outreach to families with infants at risk due to dysfunctional social
environments
-- -- - - ----- -
John C. Lincoln cactus south to Bethany Home Road; 35th primary medical and dental care; juven~c delinquency; financially needy
Ch~ldren'sH ealth Avenue east to 16th Street-- Royal Palm families
Services Junior High; Ocotillo Elementary School;
Alta Vista Elementary School; Washington
Elementary School
...-
Salt River WIC
Program
Lehi, Fountain Hills, Mesa, Phoenix,
Scottsdale. Program located on the Salt
River Indian Reservation
--
Loving Me, Loving Maricopa County
My Baby
pp - ----
clients to keep their appointments; breastfeeding rates within the program
-- - - -- - -
emergency child shelter; finances; improved public transportation
-- . . - --~--.- -- .
Maricopa Health Start - Phoenix zip codes: 85003-85009; 85012- diapers and clothing; food; transportason
Indian Community 85019; 85034 and others
Health Service
--
Maricopa Health Start - South Phoenix neighborhoods for zip
Mountain Park codes85040and85041
(South Phoenix)
education and prevention; career opportunities; economic development
- -- - -- -- - - - --
TABLE 8 - 5
TABLE 8: COMMUNITY NEEDS AS IDENTIFIED BY SURVEY RESPONDENTS BY COUNTY AREA
STATEWIDE I NAME OF GEOGRAPHIC AREA FOR SERVICE WHAT DOES THE PROGRAM BELIEVE TO BE THE COMMUNITY'S NEEDS?
COUNTY PROGRAM DELIVERY
Maricopa, The Next SG - - -
Maricopa and Pima County transportation, bilingual service; teen support
-- -- -. - -- - . -. --- . - pp -. . - -- - .. .- - - ... -- -- - - -
Maricopa, Pinal, EFNEP Extension (Maricopa Couinty) central Glendale, life skills education in parenting, nutrition, budgeting, etc; job training;
Pima Food & Nutrition Avondale, Central Mesa, Guadelupe, transportation
Education Program Phoenix, El Mirage; (Pinal County) Casa
Grande; (Pima County) South Tucson,
Davis Montham AFB; Catalina, Tohono
-- ~-
Mohave NlCP program serves state I respondant serves developmental therapies; parent support; in-home sick child care
Mohave and Colorado City
Navajo
-- - .-
Navajo County off reservation; Slow Low;
Holbrook; Winslow
~ .- - p-pp -p
Navajo, Apache White Mountain McNary, Whiteriver; HonDah; Carrizo;
Apache Head Start Cibecue in Navajo and Apache Counties
- -
Pima Health
System
---
CODAC BHSI
Project CAM1
- - - - -- - -- -.
Pima County
- --
Tucson
funding
-. -- - -
parenting techniques; child abuse preventioGubstance abuse prevention;
building self-esteem
-- - -- - - -
family planning; behavior modification; improvement education
--- .- --- .- - - -- -- -- - ---
employment training for women; social support networking for low income
women; good, low cost child care
- - - - - - -- - - - - - --- - - - -. -- . . - -
TABLE 8 -- 6
TABLE 8: COMMUNITY NEEDS AS IDENTIFIED BY SURVEY RESPONDENTS BY COUNTY AREA
STATEWIDE I NAME OF GEOGRAPHIC AREA FOR SERVICE WHAT DOES THE PROGRAM BELIEVE TO BE THE COMMUNITY'S NEEDS?
COUNTY PROGRAM DELIVERY
- ---- - -- - - - - - - pp - - - -- - - -- - - -- -- -- ---- --- - --- pp
Pima Healthy Families areas of Tucson for zip codes 85713, respite care; residential services for substance abusing families with babies
8571 1,85205,8 5745,85719 ,85635
- - . . - - - - ---- - --
Healthy Families parts of zip codes 8570