Strong Start
Program overview
Enhancing pre-natal care: The Strong Start for Mothers and Newborns initiative (Strong Start) is a maternal health initiative sponsored by the U.S. Department of Health and Human Services (HHS). Strong Start helps new mothers access one of three enhanced prenatal care models: maternity care homes, group prenatal care, and birth centers. Participants in each of the three prenatal care models have lower C-section rates than the national average and breastfeeding rates at least as high as the national average.
Federally funded, locally operated: As part of its Strong Start model, HHS awards funding to a variety of local partners, ranging from healthcare systems to birthing centers, to implement one of the three approved models. Strong Start programming targets mothers who receive CHIP or Medicaid benefits. All sites must pursue a goal of reducing preterm birth among Strong Start participants and decreasing the rate of low birth weight among Strong Start newborns.
Choosing a model according to existing strengths: Strong Start sites may implement any of the three approved prenatal care models: (1) the maternity care home provides one central place for mothers to receive all necessary care, with providers coordinating to deliver care in that same location; (2) the group prenatal care model provides health assessment, education, and support for pregnant women through group visits to promote healthy behaviors and optimize birth outcomes; and (3) the birth center model places midwives in a lead role, providing substantial education and psychosocial support.
Holistic, relationship-centered care: All Strong Start models emphasize the relationship between the participants and their care provider, which provides a vehicle for education as well as social and emotional support. Additionally, all models match participants with a peer counselor to provide holistic maternal supports. These supports include routine health assessments, health education (e.g., covering nutrition, stress management, and more), and social services (e.g., transportation assistance).
One study with a less-rigorous design suggests that Strong Start is a promising strategy for promoting positive health outcomes for expecting parents and families with young children.
- A 2015 impact evaluation found that participants in all three prenatal care models have lower C-section rates than the national average and breastfeeding rates at least as high as the national average.
Invest in peer counselor relationships: An evaluation of Strong Start found that participants consistently rated their peer counselor as a critical part of the program’s success. To ensure peer counselors are developing strong relationships with their patients and that their knowledge base is useful to participants, replicating organizations should organize standardized training for peer counselors.
Choose recruiting language carefully: In an evaluation studying multiple Strong Start implementation sites, one site from the evaluation found that new mothers were attracted to a “perks” and “opportunities” framing of Strong Start recruiting materials. Another site found success in avoiding a message that singled out Medicaid and CHIP enrollees as needing “extra” supports. As such, Strong Start programs should emphasize the potential benefits of the program in recruiting materials without stigmatizing eligible mothers.
Use data to increase participant retention: Some Strong Start centers struggle with retention, either because clients experience barriers to participation (e.g., transportation costs) or because they determine the program is not valuable to them. Programs can increase participant retention by regularly assessing the barriers that participants face and their experiences in the program. By collecting these data, programs can more quickly and appropriately adapt to meet participant needs.
Create a referral process for providers: In an evaluation of Strong Start sites, program staff identified healthcare provider referrals as a highly effective recruitment method. As such, implementing organizations that provide a significant amount of health care services should introduce their staff to the Strong Start program and create a clear referral process. For small organizations, partnerships with other health care organizations may provide a strong source of referrals.