Background:
Interconceptional care (ICC) became a core component of the national Healthy Start (HS) program in 1991, providing services to high-risk women and children for up to two years postpartum to improve outcomes and reduce disparities. ICC services include risk assessment, health education, care for medical complications, and services to promote healthy environments for women and children.

Objectives:
Little is known about the ICC services provided by HS programs, including services offered, barriers to obtaining services, and outcomes (e.g., breastfeeding, infant sleep position, multivitamin use, birth spacing). This presentation synthesizes results of two surveys conducted under HRSA's national evaluation of the HS program.

Methods:
The National Survey of Healthy Start Programs was conducted during late 2004, and includes responses from 95 of the 96 HS programs. The Survey of Healthy Start Program Participants, conducted during late 2006, includes responses from 644 participants who had infants 6-12 months of age at the time of the survey, with a response rate of 79 percent among those who were eligible to respond. HS participant outcomes were compared to outcomes from the Early Childhood Longitudinal Survey.

Results:
All programs provided education related to infant sleep position and breastfeeding, but fewer programs addressed women's medical risk factors such as hypertension, diabetes, and obesity. Programs reported that barriers to providing ICC included transportation and housing issues, lack of insurance coverage, and more pressing needs among participants. Tracking of participant outcomes was limited, especially related to birth spacing. The participant survey revealed that HS participants had higher breastfeeding rates than a comparable national sample and were more likely to put their infants to sleep on their backs. However, two-thirds reported they never took a multivitamin and one-third indicated they had not received advice on how long to wait before their next pregnancy. Finally, access to care for women was significantly lower than for infants.

Conclusion and implications for practice:
This study has implications for (1) improving HS programs (including followup of medical risk factors, tracking of participant outcomes), (2) expanding postpartum Medicaid coverage, and (3) pursuing research on the effectiveness of ICC, best practices in retaining participants, and features of ICC that are culturally appropriate.