I am not sure how to start it, but I was blessed to receive one from my DS's church in WA. What a surprise since I live in CT. Our church makes prayer shawls and so they are not interested in starting prayer quilts. I crochet shawls for our church's ministry, but there is something missing in the way the quilts work. The prayers offered specifically for the person as the group ties the quilt at the end of the service really makes these quilts special! My quilt was tied with crochet cotton. Also, her church made a special label that was printed on the computer. They left a space to use a pen to write the name of the person receiving the quilt. Good Luck with your ministry.