Assessing the Effectiveness of the Healthy Beginnings System of Care

Purpose: In order for systems of care to be effective, families must be appropriately screened and directed to the services most beneficial to them. Ideally, families with more need will be more likely to be designated as in need of services, will receive the most intensive services, and will be enrolled in services for the longest periods of time. Also, ideally, service providers will serve as a link to other services and supports available in the community. This paper examines the extent to which the Palm Beach County Healthy Beginnings (HB) system has been able to achieve these outcomes.

Methods: The analyses in this paper are based on survey, HB administrative and vital statistics data gathered on 531 mothers who gave birth in Palm Beach County in 2004 and 2005. The research questions addressed are the following:

 What are the characteristics of mothers determined to be “at-risk” in the initial screening?

 Which mothers received treatment services in the HB system?

 What are the characteristics of mothers who receive more intensive treatment services or more days of service?

 Which mothers received referrals from the HB system?

 Why did mothers leave the HB system? What characteristics are associated with different HB termination codes?

 To what extent are mothers who receive HB services more likely to access other services and supports in the community?

Results: We found that the HB risk screen did a particularly good job of identifying mothers who were educationally and/or economically disadvantaged, were teenagers when their first child was born, or had a low birth weight baby. However, the screen did not identify mothers with other risk characteristics found to be negatively associated with child outcomes. We also found that an “at-risk” designation was, as expected, related to whether or not a mother received services, but that many “not at-risk” mothers still received services. We also found some evidence that mothers with greater needs were more likely to receive services. In addition, however, we found unexplained race/ethnic and nativity differences in the likelihood of receipt of services. We also found some evidence that mothers with greater needs were more likely to receive more intensive services. Finally, we found that, among mothers who received services, those who received more days of services may have had greater needs.

Implications: To improve the number of families who receive needed services, consideration should be given to expanding the risk factors included in the screening instruments to include items related to number of children, maternal functioning, and social support, and if feasible, short screens for depression and access to social support. Second, mothers receiving services might be monitored to ensure that those with risk factors especially detrimental to child development are more likely to receive services and for longer periods of time. Attention should also be paid to whether different demographic groups with similar levels of need are experiencing equal access to services.