The HS CoIIN’s efforts to standardize the screening process are based on the goal to ensure sustainability of the program in order to mobilize more communities and create more equity for our families in need. The screening tools were designed to include questions addressing comprehensive risks and strengths for each perinatal period, to capture the HS benchmarks, and to align with the national evaluation.

Sources for Healthy Start screening tool questions included a range of standardized surveys, practice guidelines and tested valid and reliable instruments, including One Key Question®[1], the NIDA Quick Screen, the Patient Health Questionnaire-2 (PHQ-2), the Everyday Discrimination Scale (Short Version), and the Social Support Survey Instrument-modified. Questions were selected through a participatory process that included incorporating feedback from Healthy Start programs and other stakeholders through a public commenting period and lessons learned through pilot testing.

These tools reflect our effort to incorporate your feedback and the feedback gathered from grantees during the CoIIN comment period and OMB public comment process in a short time period, while maintaining:

  • The evidence base of each question
  • The intent and flow of each tool
  • The multiple purposes of the tools – Care Coordination and Evaluation

Throughout the development of the screening tools, the CoIIN workgroups worked diligently to ensure the tools were built upon the strengths of the Healthy Start program, i.e., they are rooted in the community, multidisciplinary, comprehensive, and incorporate a culturally competent, family centered approach.

The HS CoIIN screening tools support HS grantees in conducting standardized screenings according to a defined methodology that yield customized participant results, and they allow for HS Grantees to meet their participants “WHERE THEY ARE” to provide actionable, high impact services and/or referrals for services.

The HS CoIIN recognizes that standardization is an ambitious endeavor. Challenges include the need to align data collection, reporting and training to implement the screening tools. BUT standardizing the screening tools helps:

  • deliver consistent quality services for participants;
  • validate Healthy Start by demonstrating impact of Healthy Start on participants;
  • advance Healthy Start by providing data that can drive program level improvements; and
  • sustain Healthy Start by demonstrating positive participant outcomes.
[1]  The evidence-based ONE KEY QUESTION® name and program are the intellectual property of the Oregon Foundation for Reproductive Health (OFRH). The OFRH continues to develop supporting evidence for the efficacy of the question and provision of follow-up preconception and/or contraception services (directly or through referral) tailored to each participant’s unique answer. OFRH would like to: 1)  know which programs are using ONE KEY QUESTION®, and 2) support programs to ensure best practice in follow-up activities. The Healthy Start EPIC Center encourages Healthy Start programs implementing the screening tools to contact the developers at This is an opportunity for Healthy Start Programs to contribute to the scientific evidence base related to reproductive life planning, and to avail their programs of materials and technical support.