Academic journal article Health and Social Work

Facilitators of Well-Functioning Consortia: National Healthy Start Program Lessons

Academic journal article Health and Social Work

Facilitators of Well-Functioning Consortia: National Healthy Start Program Lessons

Article excerpt


Since the earliest days of the profession, social workers have been leaders in facilitating interorganizational collaborations to improve service delivery. Charitable societies in England and the United States during the late 1800s, for example, were designed to coordinate the work of private agencies attempting to address the needs of poor people (Cox & Garvin, 1995). More than a century later, social workers are still major players in hospital-based consortia, coalitions of health and social service agencies, and other collaborative partnerships concerned with improving services while controlling costs. Furthermore, social workers have been instrumental in the work of a new form of partnership--community-based consortia. Unlike coalitions and hospital or health care consortia, whose members tend to be representatives of organizations (Caplan, Lefkowitz, & Spector, 1992; Mizrahi & Rosenthal, 1992), community-based consortia typically include individual consumers and community members as well as organizational representatives. The goal of such consortia often involves strengthening integrated service delivery systems in a manner that helps empower the people and communities who are working together for a common goal or mission (Bailey & McNally Koney, 1995; Fawcett et al., 1995; Kreuter, Lezin, & Young, 2000).

For this article we used findings from a multisite case study (Thompson et al., 2000) to examine factors facilitating well-functioning community-based consortia in Healthy Start programs to reduce infant mortality. The study was conducted by PolicyLink, a national policy, research, communications, and capacity-building organization founded in 1999 with the goal of advancing a new generation of policies, guided by the wisdom and experience of local constituencies, to achieve social and economic equity and build strong, organized communities.


When the national Healthy Start Initiative was inaugurated in 1991, the United States ranked 22nd in the world in infant mortality (U.S. Department of Health and Human Services, 1996), and African American babies were dying at more than twice the rate of white infants (Kotch, Blakely, Brown, & Wong, 1992). Administered directly by the Health Resources and Services Administration (HRSA) and later its Maternal Health Bureau, the national Healthy Start Initiative was designed to cut infant mortality rates in half in five years at 15 demonstration sites. The infant death rates in the sites chosen were at least one-and-one-half times the national average. With the exception of the Northern Plains area, which had a high proportion of Native Americans, the original Healthy Start communities had populations that were at least 50 percent African American, and five had sizable Latino populations (Howell, Dulvaney, McCormick, & Raykovich, 1998). Demographic shifts and the addition of 74 new sites by the late 1990s increased racial and ethnic diversity, but African Americans remain the primary racial/ethnic group involved in the program.

The Healthy Start Initiative was founded on the premise that "communities themselves could best develop the strategies necessary to attack the causes of infant mortality and low birth weight, especially among high risk populations" (Badura, 1999, p. 263). HRSA mandated that at each participating site the health department, nonprofit organization, or other entity serving as the program's grantee agency organize a consortium that included consumers, service providers, public and private community groups, and other stakeholders (HRSA, 1991). Through the consortia, "substantive and informed" community participation was to take place at every stage of the program (HRSA, 1991), with the goals of system change and service integration for women and infants and empowerment of the local community (HRSA, 1996).

After nine years as a demonstration program, the Healthy Start Initiative became a permanent program under the Children's Health Act of 2000 (P. …

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