Service Delivery Plan 2018-2021 - Healthy Start of Hardee ... · 6 In addition to the Service...

Healthy Start Coalition of Hardee, Highlands and Polk Counties, Inc.

Service Delivery Plan

2018-2021

A plan for providing community-based services that promote and support healthy pregnancies, babies and

families.

Action Plan Update Submitted to the Florida Department of Health

July 31, 2019

Healthy Start Coalition of Hardee, Highlands and Polk Counties, Inc. 650 E. Davidson Street

Bartow, FL 33830 www.healthystarthhp.org

http://www.healthystarthhp.org/

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TABLE OF CONTENTS

ACKNOWLEDGMENTS ................................................................................................. 3

CATEGORY A ................................................................................................................. 7

INTRODUCTION .................................................................................................. 8

CHARACTERISTICS OF COALITION AREA ..................................................... 9

WORKPLAN AND TIMELINE .......................................................................... 12

COLLABORATION ............................................................................................. 13

COALITION PROGRAMS .................................................................................. 13

SUMMARY OF DATA SOURCES & METHODS OF COMMUNITY INPUT ... 20

PRIMARY DATA COLLECTION ....................................................................... 21

COMMUNITY NEEDS ASSESSMENT AND INVENTORY .............................. 30

CATEGORY B ACTIVITY ............................................................................................. 31

OUTCOME OBJECTIVES, STRATEGIES AND ACTION STEPS ..................... 32

CATEGORY C ACTIVITY ............................................................................................. 45

OUTCOME OBJECTIVES, STRATEGIES AND ACTION STEPS ..................... 46

APPENDICES................................................................................................................. 50

APPENDIX A – ATTENDEES OF SERVICE DELIVERY PLAN FORUMS ...... 51

APPENDIX B – HEALTHY START SURVEYS/QUESTIONNAIRES ............... 52

PRENATAL PROVIDER SURVEY .......................................................... 53

HOSPITAL/BIRTHING FACILITY SURVEY ......................................... 55

PEDIATRICIAN PROVIDER SURVEY ................................................... 58

CONSUMER SURVEY - ENGLISH .......................................................... 60

CONSUMER SURVEY - SPANISH .......................................................... 63

FOCUS GROUP QUESTIONNAIRE ........................................................ 66

APPENDIX C – SOURCE REFERENCES........................................................... 68

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ACKNOWLEDGMENTS

We extend our sincere thanks to leaders in this community, as without their true

dedication to this process, this plan would not be possible. They devoted their time and talent

to assist the Healthy Start Coalition of Hardee, Highlands & Polk Counties, Inc. in developing

this three-year maternal and child health service delivery plan.


Board of Directors and Coalition Staff

Board of Directors 2017-2018

Cynthia Acevedo – President

Healthy Families Highlands

Angela Forte – President-Elect

Consultant

LaTonya Smith – Treasurer Joules Wellness Concepts

Wendy Amos – Secretary Life Coach

John Meyer – Past President Central Florida Health Care, Inc.

Meghan Garland – SDP Chair Frontier Nursing University

LaTonnja Key

Teen Parent Program/Childcare Services Polk County Public Schools

Amanda Lucero, ARNP-C

Customized Wellness

Carolyn Espina New Life Center for Family Preservation

Janet Walker Tri-County Human Services, Inc.

Dr. Pamela Schwartz

Innovative Gynecology & Obstetrics, PA

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Ex-Officio Members (Service Providers)

Dr. Eliza McCall-Horne – Children’s Home Society (Highlands)

Deedree Zerfas – FDOH (Hardee & Polk)

Healthy Start Coalition Staff Charlene Edwards, MPA, Executive Director

Lyle Duncan, Finance Director

Holly Parker, Provider Liaison

Tonya Akwetey, Community Liaison

Spring Dority, Contracts Coordinator

Dr. Lynn Marshall, Education & Training Coordinator

Savannah O’Steen, Polk Teen Pregnancy Prevention Coordinator

Connie Nalley, Nurse Family Partnership Supervisor

Terry Linderman, Office Manager

Margaretta Delgado, Finance Manager

Marcia McCall, Youth Leadership Team Specialist

Raymond Clay, Youth Leadership Team Specialist

Gloria Camacho, MomCare Advisor

Sarah Donaldson, Nurse Family Partnership Home Visitor

Idalmy Rios, Nurse Family Partnership Home Visitor

Evelyn Lugo, Part-time Nurse Family Partnership Data Entry

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SERVICE DELIVERY PLAN COMMITTEE

In October 1997 the Service Delivery Plan Committee was formed as a permanent

Coalition committee to develop the Service Delivery Plan and oversee its implementation. In

FY 2017-2018 the committee continues to oversee the implementation of the new plan and

each annual action plan. Meghan Garland, Board Member, continues to chair the committee,

which includes members representing the three county health departments, the United Way of

Central Florida, Children’s Home Society, Board members and other community partners

from our tri-county service area. The purpose of the committee is to examine primary and

secondary data presented by the Coalition, identify barriers to maternal and child health care,

and to establish and monitor the effectiveness of Coalition strategies addressing priority

maternal and child health issues.

Service Delivery Plan Committee Members

Aisha Alayande Drug Free Highlands

Becky Razaire Tri-County Human Services

Shaneal Allen Healthy Families Polk

Charlene Edwards Healthy Start Coalition of

HHP, Inc.

Penny Borjia United Way of Central

Florida

Eliza McCall-Horne Children’s Home Society /

Healthy Start

Dee Zerfas FDOH Polk

Ermelinda Centeno Tri-County Human Services

Kristin Casey FDOH Hardee

Holly Parker Healthy Start Coalition of

HHP, Inc.

Tonya Akwetey Healthy Start Coalition of

HHP, Inc

Jean Osborne Children’s Home Society /

Healthy Start

Sylvie Grimes FDOH Polk

Jackie Rawlings Tri-County Human Services

Meghan Garland Frontier University

Ann Claussen Central Florida Health Care

Lillian Nolan Healthy Families Polk

Khalila Montague FDOH Highlands - WIC

MaryAnn Higgins

Children’s Home Society / Healthy Start

Sarah Pitts

Children’s Home Society / Healthy Start

Spring Dority

Healthy Start Coalition of HHP, Inc.

Dorthia Barrera Children’s Home Society /

Healthy Start

Lynn Marshall Healthy Start Coalition of

HHP, Inc.

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In addition to the Service Delivery Plan Committee’s regularly scheduled meetings, a

Service Delivery Plan Forum was held on April 12, 2016 in Hardee County, May 31, 2016 in

Highlands County and June 23, 2016 in Polk County to obtain community input. The forums

included presentations for each county on maternal child health data as well as overviews of

the provider and consumer survey data and summaries of consumer focus groups. Subsequent

to the presentations, attendees were assigned to Action Plan focus area workgroups. The

workgroups included Infant Mortality, Provider Education and Screen Rates, Community

Awareness and Education, Access to Care and Interconception Care. Many community

representatives who participated in the planning forums are listed in APPENDIX A.

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CATEGORY A

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HEALTHY START COALITION OF HARDEE, HIGHLANDS

AND POLK COUNTIES, INC.

2018 - 2021 SERVICE DELIVERY PLAN

INTRODUCTION

The Healthy Start Coalition of Hardee, Highlands and Polk Counties, Inc. is pleased to

present our 2018-2021 Service Delivery Plan. This plan is the product of an assessment of

community needs, including an analysis of current resources and service gaps; challenges,

strengths, and barriers to service delivery; concluding with tangible priorities and

corresponding action plans.

The Coalition consists of members who represent every facet of the Coalition area. The

task of completing this plan would not have been possible without their dedication of time,

expertise, and desire to improve the health outcomes of families residing in Hardee, Highlands

and Polk counties. Our community partners are inclusive of the public and private sector, social

services, public health, local women’s health professionals, civic organizations, mental health,

hospital, education, consumer, and business.

Several informative community forums were held to educate and assess the community

on maternal and child health issues, including infant morbidity and mortality, low birth weight,

prematurity, and birth disparities. Distribution of surveys was designed to gather community

input on perceived health and social needs.

The Coalition focused on ensuring that there was diversity throughout the assessment

process and current collaborations and partnerships were acknowledged. The Coalition has

continued with integrity to develop a community-based, data-driven, Service Delivery Plan.

This three-year plan will assist us in creating a stronger community that will improve pregnancy

outcomes, infant/child health, health disparities, and social inequities.

Utilizing a positive life-course perspective approach to improve the health of our

families includes a focus on health disparities, particularly in the areas of black infant mortality,

low birth weight, preterm birth and preconception and interconception care. We recognize that

much of this work is done within the community and will also influence our prenatal and

postnatal screening rates. The life-course model broadens the focus of maternal and child

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health to include root, intermediate and immediate causes that define infant mortality rates.

Many factors such as socioeconomic factors, nutrition, and accessibility, are factors that have

a disproportionately negative impact on racial and ethnic minorities.

This Service Delivery Plan summarizes our commitment to our mission and vision

statements and to the ones we serve. We are confident it will serve as a guide for our work and

will evolve and expand as we strive to ensure that “every baby has a healthy start.”

This Service Delivery Plan records the strategies and activities that will drive the

Healthy Start Coalition of Hardee, Highlands and Polk Counties, Inc. over the next three years.

The plan includes an appendix providing the instruments used for the consumer, provider and

stakeholder surveys, as well as, the tools used for the focus groups.

CHARACTERISTICS OF THE COALITION AREA

Hardee County

Hardee County is a very rural county and has an estimated 2015 population of 27,502

residents, which reflects a 0.8% decrease since the 2010 census. Hardee County’s population

is comprised of 88.5% white, 7.6% black or African American and 2.5% of the population

identify themselves as American Indian, Asian or Native Hawaiian/Pacific Islander.

Approximately 43.1% of Hardee County residents identify themselves as of Hispanic or Latino

origin. Forty-five percent (45%) of individuals age five and above speak a language other than

English at home. In 2014, almost one in three (31%) of the county’s population lived below the

poverty level, and 44.5% of the county’s children live below the poverty level. Seventeen

percent (17%) of the population are women ages 15-44. Sixty-four percent (64%) of the

residents are under the age of forty-five.

There is no child birth/delivering facility in the county, therefore all births to residents

of Hardee County occur in other counties. The majority of these women (95%) delivered in

neighboring Highlands, Polk, and Sarasota Counties. Only two hospitals, Lakeland Regional

Health and Sarasota Memorial, have Level 3 Neonatal Intensive Care Units (NICU). Since

the last Service Delivery Plan, there has been a fluctuation in prenatal care provider sites in

Hardee County, where the county health department no longer provides prenatal care. There

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is only one clinic site, Central Florida Health Care, that provides prenatal and well woman

(OB/GYN) care to the residents of Hardee County.

Highlands County

Highlands County has an estimated 2015 population of 99,491 residents, which is a

0.7% increase from the 2010 census population. Highlands’ population is comprised of 85.6%

white, 10.6% black or African-American and 2.2% of the population identify themselves

American Indian, Asian or Native Hawaiian/Pacific Islander. Approximately 18.4% of

Highlands County residents identify themselves as of Hispanic or Latino origin. Slightly more

than 19% of the county’s population lives below the poverty line. Thirty percent (30%) of the

county’s children live below the poverty line. Nearly 14% of the population are women ages

15-44. Forty-two percent (42%) of the residents are under the age of forty-five.

There are two child birth/delivering facilities located in Highlands County. Most

women deliver at one of these two hospitals; some choose to deliver at neighboring Polk

County hospitals. Since Central Florida Health Care and the Highlands County Health

Department discontinued prenatal services, there are only five prenatal providers to provide

prenatal and well woman care to residents of Highlands County. High-risk women and infants

are transferred to neighboring Polk, Hillsborough or Orange Counties for Level 2 and Level 3

Neonatal Intensive Care Unit (NICU) facilities for delivery and/or care.

Polk County

Polk County is a partially urban and partially rural county. It is the largest in

geographical area of the tri-county region and is comprised of 2,010 square miles. Polk County

is Florida’s 9th most populous county. The 2015 estimate is that Polk County has a population

of over 650,092, which is an increase of 8% from 2010. Polk county residents are comprised of

79.7% white, 15.7% black or African-American and 2.4% of the population identifying

themselves as American Indian, Asian or Native Hawaiian/Pacific Islander. Approximately

20% of Polk County residents identify themselves as of Hispanic or Latino origin. Nearly 19%

of the county’s population lives below the poverty level. Twenty-nine percent (29%) of the

county’s children live below the poverty line. Approximately 18% of the population are women

ages 15-44. Fifty-five percent (55%) of the residents are under the age of forty-five.

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There are four child birth/delivery facilities located within Polk County, of which

Winter Haven Women’s Hospital has a Level 2 Neonatal Intensive Care Untit (NICU) and

Lakeland Regional Health will soon open a Level 3 Neonatal Intensive Care Unit (NICU).

Some women are transferred to other facilities located in Osceola, Hillsborough or Orange

counties. One birthing center is also located in Polk County. Some Polk County women

deliver in neighboring Hillsborough, Osceola and Orange Counties. Fifteen providers with

eighteen clinic sites are available to provide OB/GYN care to residents of Polk County. This

represents the loss of one provider and three clinic sites since the last plan update.

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WORK PLAN AND TIMELINE

Component Responsible Party Date Due

Population Demographic

Description

Healthy Start Coalition – HHP

Service Delivery Planning Committee College Research Student

5/31/2016

Narrative Draft Healthy Start Coalition – HHP Executive Director

6/1/2016

Data Collection ▪ MCH/CHARTS ▪ Hardee Health Care Task

Force ▪ Highlands CHIP ▪ Polk – Tonya & Dee will

provide

Healthy Start Coalition – HHP Service Delivery Planning Committee

FIMR/DATA Committees ▪ CRT & CAG

College Research Student

8/31/2016

Focus Groups ▪ Community Partners ▪ HS Clients ▪ NFP Clients ▪ New Family consumers

Healthy Start Coalition - HHP

Service Delivery Planning Committee FIMR/Data Committees

▪ CRT & CAG

9/30/2016

Identification of Priority/Target Populations and issues

(FORUM)


FIMR/Data Committees ▪ CRT & CAG ▪ General Membership

9/30/2016 updated

Surveys ▪ Provider

o OB/GYN o Delivery Facility o Pediatric

▪ Client o HS o NFP

Healthy Start Coalition- HHP Service Delivery Planning Committee

FIMR/Data Committees

11/15/2016

Draft Fishbone Analysis Healthy Start Coalition – HHP ▪ Executive Director

11/30/2016

Draft Issues, Strategies, & Action Steps

Healthy Start Coalition – HHP Service Delivery Planning Committee FIMR/Data Committees

▪ CRT & CAG

1/31/2017

Final Issues, Strategies &

Action Steps

Healthy Start Coalition – HHP

Service Delivery Planning Committee

FIMR/Data Committees ▪ CRT & CAG

3/31/2017

Resource Inventory Report Healthy Start Coalition – HHP 3/31/2017

Service Delivery Plan Final


FIMR/Data Committees

1/19/2018

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COLLABORATION

In the process of working to achieve the Coalition’s maternal and child health goals,

community groups and individuals have established productive working relationships.

Working together on committees has led to creative approaches and solutions to funding

programs, which maximize available resources. The networks generated have led to more cost-

effective, cooperative delivery of services. Key collaborative efforts in partnership with

community members, or sponsored by the Coalition, are identified below and throughout this

Service Delivery Plan narrative.

• Client Focus groups in all three counties

• Focus group in high risk/high disparity zip code

• FDOH Polk Birth Disparity Initiative

• Surveys

• Prenatal Providers

• Hospital Delivery Facilities

• Pediatric Providers

• Consumers

COALITION PROGRAMS

Fetal and Infant Mortality Review Project (FIMR)

Fetal Infant Mortality Review (FIMR) Project for the Healthy Start Coalition of

Hardee, Highlands and Polk Counties, Inc. is a tri-county action-oriented process of

community-based fetal and infant mortality reviews aimed at addressing factors and issues that

affect infant mortality and morbidity. This process continually assesses, monitors, and works

to improve service systems, influence policy, community education, direct planning efforts that

will lower mortality rates, and identify resources for women, infants, and families. The

Coalition’s FIMR project is funded by the Florida Department of Health (FDOH) and is linked

to 11 funded initiatives in Florida and nationally with more than 175 projects in 28 states.

There is a multi-disciplinary team of professionals on the Case Review Team (CRT) in

our tri-county area. This committee uses patient-blinded and case abstracted information from

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a variety of records and interviews. The purpose of the review is to discover patterns of

contributing factors and develop strategies for system and community change. In each fiscal

year, the CRTs review a total of 28 randomly selected fetal and infant deaths. Analysis of year-

end data reveals that prematurity, pre-existing medical conditions, obesity, and poverty were

the leading causes of death.

In all three counties, FIMR Community Action Groups (CAGs) develop and

implement recommendations based on the CRT findings. As a result of these findings, the

Coalition, along with the CAGs, have worked to improve Healthy Start screen rates and

expand patient and provider education on the value of Healthy Start services. In addition, we

have provided community education on the importance of prevention of prematurity, need for

early prenatal care, access to care, signs and symptoms of preterm labor, and interconception

care.

Below are some additional highlights of our local CAGs:

❖ Hardee County Community Action Group meets every other month. FIMR, infant mortality

data and Healthy Start updates are given when appropriate at each meeting.

❖ Highlands County Community Action Group meets monthly. CAG members collaborate to

provide maternal child health education and resource information about access to care, obesity,

and birth spacing to women of childbearing age and families with young children. Other

projects include participation in the March of Dimes March for Babies Walk, Safe Sleep

Awareness Month, Child Abuse Awareness Prevention Month, Prematurity Awareness Month

activities, breastfeeding resource information review, and family planning.

❖ Partnering with the Polk County Health Department to provide Continuing Education Units

to nurses and midwives who attend the tri-county Case Review Team meetings. The Polk CAG

has created the Safe Sleep Task Force that focuses primarily on reducing sleep-related deaths in

infants.

The Healthy Start Coalition’s Beds 4 Babies Project is an important part within our FIMR

Project to help prevent and alleviate sleep-related deaths due to families not having adequate

resources to provide a safe sleep environment for their infant. This project is supported in part

by funding from GiveWell Community Foundation, Florida Citrus Growers, and donations.

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Coordinated Intake and Referral - CONNECT

The goal of the Coordinated Intake and Referral process is to provide the best services

for families by prioritizing their needs and preferences and minimizing duplication of services.

The process will ensure effective use of local resources and collectively track what happens to

each family.

Collaborating Home Visiting Agencies include:

❖ Healthy Start Program

o Hardee - Florida Department of Health in Hardee County

o Highlands - Drug Free Highlands

o Polk - Florida Department of Health in Polk County

❖ Nurse Family Partnership

o Highlands - Healthy Start Coalition

o Polk - Early Learning Coalition

❖ Healthy Families Program

o Hardee

o Highlands

o Polk

❖ Early Head Start

o Redlands Christian Migrant Association

❖ Parents as Teachers

o Hardee - Step Up Suncoast

CONNECT – Connecting the community through coordination of services among

collaborating home visiting agencies of the Coordinated Intake and Referral Project.

Beds 4 Babies Project

The Beds 4 Babies Project was developed in 2006 in response to an alarming increase

in accidental suffocation deaths due to infants co-sleeping with an adult or another sibling or

sleeping in a non-approved crib/furniture. The Beds 4 Babies Project provides a Graco portable

crib, two portable crib sheets, a HALO SleepSack Swaddle, and a children’s board book titled

“Sleep Baby, Safe and Snug”, to families in need that do not have the means to provide a safe

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and separate place for their infant to sleep, as funding is available. Families are also educated

on the importance of safe sleep practices and provided safe sleep information. Since the

implementation of the Beds 4 Babies Project, more than 5,000 portable cribs have been

distributed to families throughout the tri-county area.

The Coalition collaborates with local community partners throughout the tri-county

area to provide Safe Sleep Trainings and information about the Beds 4 Babies Project. Referrals

are made by Healthy Start service providers, Healthy Families, MomCare, DCF, WIC,

birthing facilities, the Polk County School Board’s Teen Parent Program, Redlands Christian

Migrant Association, East Coast Migrant Head Start Project, and other local agencies.

The Beds 4 Babies Project is funded in part through generous donations and grants

within the tri-county area.

Centering Pregnancy

In 2017 The Coalition applied for and received a March of Dimes Grant to implement

the Centering Pregnancy model of Group Prenatal Care at Grace & Heart in Highlands County

and Innovative Obstetrics and Gynecology in Polk County. This model of group care is

patient-centered and has been shown to have an 86% appointment compliance rate. Additional

statistics indicate women are 33% less likely to have a preterm birth or low birth weight baby.

Centering Pregnancy incorporates health assessment, education and support to expectant

parents in a group setting.

Group prenatal care participants have increased time with their provider and receive

more information and health education as a result. The educational topics covered in Centering

Pregnancy include nutrition, exercise, infant care and feeding, postpartum issues, abuse,

parenting, communication, labor and delivery, and self-esteem.

Ultimately, the goals and the benefits of operating this model of prenatal care are to

reduce preterm births, low birth-weights and infant mortality.

Interconception Care

The Healthy Start Coalition of Hardee, Highlands & Polk Counties, Inc. instituted an

Interconception component in 2006-2007. Based on the Center for Disease Control’s

Preconception Recommendations and Healthy Start Standards & Guidelines, the Coalition

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uses a FDOH approved Interconception Care curriculum (ICC) to provide education to

women between pregnancies who are identified as having risk factors that may lead to poor

pregnancy outcomes.

Teen Pregnancy Prevention

The Teen Pregnancy Prevention Alliance (TPPA) was initially formed as a small group

of women interested in preventing teen pregnancy in Hardee, Highlands and Polk Counties.

The group expanded and focused their efforts and strategies on program implementation and

evaluation. TPPA was formally established in 1994 as an action group of the Healthy Start

Coalition of Hardee, Highlands, and Polk Counties. The Polk TPPA evolved into the funded

and staffed Polk Teen Pregnancy Prevention Alliance and the Coalition continues to partner

with the TPPA’s in Hardee and Highlands Counties. In each county, TPPA is comprised of

members from sectors of the community including private business, public health, social

services, law enforcement, schools, youth, parents, elected officials, and the faith community.

Hardee County Teen Pregnancy Prevention Alliance

Since the last Service Delivery Plan, Hardee TPPA has worked closely with many

community organizations to continue working with the youth in the county to reduce teen

pregnancy. Hardee TPPA works in collaboration with community wide partners distributing

information on teen pregnancy and other healthy teen choices. Hardee County receives

funding from Heartland for Children for events and education throughout the county. In 2017-

2018 Hardee TPPA worked on a logic model that will help guide them through their efforts in

preventing teen pregnancy and encouraging teens to make healthy choices in all aspects of their

lives. TPPA members in Hardee County hope to make a shift in their efforts to focus more on

changing policy throughout the county. In May, in honor of Teen Pregnancy Prevention

Month, Hardee County offers teens in the middle school a ‘Healthy Choices’ event, where

middle school students receive information on making healthy choices and learn about issues

they face every day.

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Highlands County Teen Pregnancy Prevention Alliance

Highlands County TPPA works closely with other community organizations to bring

teen pregnancy/STD prevention and making healthy choices education to the youth in the

community. Highlands County TPPA receives funding from Heartland for Children for

education and events throughout the community. Highlands TPPA hosts an annual event for

teens in the county to learn about teen pregnancy/STD prevention and making healthy

choices. Highlands County also partners with different community organizations to bring

awareness to teen pregnancy/STD prevention throughout the county. Through a partnership

with WellCare, a managed care organization, and Healthy Start Coalitions, the TPPA

Program Coordinator was able to hire two contracted Health Educators to implement a

program called the Health Improvement Project (HIP) for teen girls in the community. There

were four sessions that lasted four weeks each and started in August 2017. Although this was

a pilot program, WellCare recognizes the importance of teen pregnancy and STD prevention

in Highlands County and would like to offer more classes to teen girls in this community.

Polk County Teen Pregnancy Prevention Initiative

In March 1999, Daniel Haight, MD, then Director of the Polk County Health

Department, provided the Polk County Board of County Commissioners (BoCC) with a

presentation on the Polk County teen pregnancy crisis. The BoCC was alarmed by the statistics

presented. From this presentation, County Commissioners and TPPA organized a countywide

summit held in August 1999. This summit helped inform the community about teen

pregnancy, identified what programs and resources were available, and provided motivation

to seek recommendations for possible solutions.

Summit discussions proved the need for a Polk County Teen Pregnancy Prevention

Coordinator to organize countywide prevention activities. A small planning group comprised

of representatives from the Polk County Health Department (PCHD), Polk Works, Board of

County Commissioners (BoCC), the Healthy Start Coalition, and several other individuals

agreed to fund a Polk County Teen Pregnancy Prevention Initiative and house it at the

Coalition. Polk Works, BoCC, PCHD, and the Healthy Start Coalition funded the Initiative

and a countywide coordinator was recruited and employed.

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The Coordinator position is currently supported and funded by the Polk County voter

approved ½ cent sales tax for Indigent Health Care, the Polk County Health Department, and

Heartland for Children. The TPPA Program Coordinator is responsible for coordination of

Polk TPPA monthly meetings, planning participation in community awareness events and

planning Polk TPPA events. There are three major events that are hosted annually by Polk

TPPA; “Let’s Talk” Month in October, Faith Leaders event in February, and in honor of Teen

Pregnancy Prevention Month in May, Polk TPPA hosts a Teen Summit. Through a

partnership with WellCare and the Healthy Start Coalitions, the TPPA Program Coordinator

was able to begin teaching Health Improvement Project (HIP) classes in Polk County. There

were four sessions that lasted four weeks and began in August. Although it was a pilot program,

WellCare hopes to continue the program for more classes.

The mission of the Polk Teen Pregnancy Prevention Alliance is to reduce the risk of

pregnancy in Polk County through the collaboration of agencies and empowerment of our

youth and community. During the months of August through December the members of Polk

TPPA worked on a 2018 Action Plan. This plan outlines the initiatives and events planned to

meet Polk TPPA objectives and ultimately the goal of reducing teen pregnancies and STDs.

The goal is that the Action Plan be updated regularly to make sure to stay on track to meeting

the goal and objectives. Polk TPPA is committed to creating an environment that supports

parents and empowers youth to maximize their potential without the limitations imposed by

pregnancy, childbearing, and parenting.

Since 2006, Heartland for Children has funded a Youth Program Specialist (YPS). The

job of the YPS is to work with the Youth Leadership Team (YLT), work closely with schools,

Department of Juvenile Justice, foster care youth and other prevention programs to teach teen

pregnancy/STD prevention and leadership skills. The YPS develops and tracks the Youth

Leadership Team meetings, community service hours for teens, community activities, and

works with YLT members on informational and awareness activities. The mission of the Polk

YLT is to educate and promote teen pregnancy prevention efforts in Polk County through the

Teen Pregnancy Prevention Alliance. YLT is made up of teens ages 10-19 who reside in Polk

County. YLT members care for the health, well-being and safety of themselves, peers, family

and community. YLT members strive to be leaders in our community today, tomorrow and

for years to come. There are big changes coming to the Polk YLT. In the next year, the Youth

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Prevention Specialists will reach additional areas of Polk County by starting additional YLT

groups. YLT groups will meet in Winter Haven, Haines City and Bartow.

Starting in the Summer of 2018, The TPPA Program Coordinator, along with the Youth

Program Specialists, will be using the evidence-based curriculum, Teen Outreach Program

(TOP), to teach in Polk County schools, to foster care youth, and throughout the community.

SUMMARY OF DATA SOURCES AND METHODS OF COMMUNITY INPUT

The Healthy Start Coalition of Hardee, Highlands and Polk Counties, Inc. utilized

several data sources to identify existing and emerging maternal and child health issues. The

following is a description and the methodology utilized.

Methodology

It is important to have a comparison standard in order to determine favorable versus

unfavorable health outcomes. A comparison of various secondary data sources was made

based on certain Florida state standards with regards to maternal and child health. A

description of the process undertaken to determine the health indicators addressed in this study,

along with a list of the secondary data sources that were used follows.

Sources of Secondary Data

The primary source of secondary data was the Community Health Assessment

Resource Tool Set, Florida Department of Health –CHARTS 2015 MCH data, Office of

Planning, Evaluation and Data Analysis. The CHARTS data analysis consisted of three year

rolling averages for the years 2013 through 2015, noting changes since the last Service

Delivery Plan baseline data of 2006-2008.

Indicators selected by the SDPC:

• Births to mothers ages 15-44



• Births to mothers under age 18

• Repeat births to mothers ages 15-19

• Fetal mortality

• Infant deaths - Neonatal deaths -Post-neonatal deaths

• Low birth weight -Very low birth weight

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• Late/no prenatal care

• First trimester entry into prenatal care

• Maternal weight and obesity

• Substance use/abuse among pregnant women and substance exposed

newborns

• Maternal mental health

Further analysis of secondary data included analysis of infant mortality and comparison

to state averages. Infant mortality data for all three counties was accomplished by using the

model of analysis recommended by Dr. William Sappenfield. The model examines root,

intermediate and immediate causes of infant mortality including:

• Economic, educational and access to care factors;

• Race/ethnicity and cultural disparities;

• Low and very low birthweight and preterm births

Comparison to state averages for each county was completed on key indicators by age

and race to identify positive or negative trends.

PRIMARY DATA COLLECTION

“Research has shown that a web of biological, environmental, economic, social, and

psychosocial factors have influence on perinatal health outcomes. To effectively understand,

address, and affect these potential casual factors, Healthy Start Coalitions should continuously

identify and assess the varied factors within their catchment areas that impact systems of

perinatal care and perinatal health outcomes. One way to identify those factors is assessing the

community needs and resources.” Healthy Start Standards & Guidelines Chapter 22 rev. 2012.

The Consumer Survey - consists of a brief, simple and anonymous questionnaire that is

offered, on a voluntarily basis to community members at large during Healthy Start events and

activities. This survey is designed to gather both qualitative and quantitative data from a variety

of sources in the community. Information to be gathered includes, but is not limited to, gender;

primary residence ZIP code; race/ethnicity; age groups (from 15-85+); number of children less

than 3 years old living in the residence; employment & insurance status; information access;

family planning practices; problems encountered when seeking health services for the

respondent or for his/her family; any gaps in services for pregnant women; and problems

22

getting appointments for prenatal care. Based on the available data, due diligence will be put

forth to target the areas reporting the greatest disparities. Another data collection method to be

undertaken is community focus groups in various sites such as churches, community centers,

and businesses. The person(s) administrating the survey will make sure that the participants

understand each question and will provide clarity as needed.

A copy of the consumer survey can be found in APPENDIX B.

The Focus Group survey - is designed to capture the barriers as listed below for women in

Hardee, Highlands & Polk Counties. Barriers to Service: Transportation difficulties

Excessive waiting periods Inability to pay for services or lack of third-party coverage Lack

of child care Lack of mental health services, Illegal or alien status Lack of knowledge

of where to seek care and the importance of seeking prenatal care Lack of knowledge of

birthing options Lack of knowledge of the danger of alcohol, smoking and drug use Lack

of information about breastfeeding Language barriers Cultural barriers inconsistent

information about Healthy Start services.

A copy of the Focus Group Survey can be found in APPENDIX B

Provider survey - surveys were mailed and hand delivered to 45 prenatal providers and 40

pediatric providers. All birthing facilities in the catchment area were also surveyed. Of the

90 surveys sent out, only 12 responded.

23

Birth Rates

BIRTH RATES TO MOTHERS 15-44, ALL RACES

Hardee Highlands Polk

2005-07 18.5 11 14.5

2008-10 17.3 10 12.8

2011-13 14.1 9 11.9

2014-16 14.3 9.2 12.2

Florida Charts Data

02468

101214161820

2005-07 2008-10 2011-13 2014-16

RA

TE P

ER 1

00

0

Births to Mothers Ages 15-44, All Races


24

BIRTHS TO WOMEN WITH LATE OR NO PRENATAL CARE

(Self-Reported Percentages)


2012 10.0 5.0 6.3

2013 6.9 5.6 5.7

2014 10.0 9.7 5.1

2015 9.5 8.0 6.4

2016 7.4 11.7 6.6

Florida Charts Data

0

2

4

6

8

10

12

14

2012 2013 2014 2015 2016

Births to Women - Late or No Prenatal Care

Hardee Highlands Polk Florida

25

BIRTHS TO WOMEN LESS THAN 37 WEEKS GESTATION

(Percentage)


2012 6.9 11.6 9.7 10.2

2013 8.5 9.4 9.8 10.0

2014 8.7 9.2 9.8 9.9

2015 8.2 10.3 9.1 10.0

2016 9.8 11.4 9.5 10.1

Florida Charts Data

0

2

4

6

8

10

12

14

2012 2013 2014 2015 2016

Births to Women Less Than 37 Weeks Gestation


26

BIRTHS TO WOMEN WHO WERE OBESE AT TIME PREGNANCY OCCURRED

(Three Year Rolling Average-Percentage)


2011-2013 27.3 27.3 27.6 20.8

2012-2014 28.9 26.5 27.8 21.1

2013-2015 30.1 28.8 28.2 21.5

2014-2016 31.7 30.9 29.1 22.5

Florida Charts Data

0

5

10

15

20

25

30

35

2011-2013 2012-2014 2013-2015 2014-2016

Births to Women who were Obese at time Pregnancy Occurred


27

Mortality Indicators

Fetal Death Rate

Fetal mortality is the death of a fetus or baby after 20 weeks’ gestation. The rate is the

number of fetal deaths per 1,000 live births. Fetal mortality and the fetal mortality rate reflect

the health and well-being of the population’s women of reproductive age and their pregnancies,

as well as the quality of healthcare available. Fetal mortality information is used by local

governments and organizations to identify areas in need and designate available resources.

In the last 6 years, Healthy Start Coalition of Hardee, Highlands and Polk Counties, Inc. has

experienced a relatively stable rate of fetal deaths.

FETAL DEATH RATES 2011-2016


2011 5.1 10.8 8.3 7.3

2012 5.1 4.4 8.1 7.1

2013 7.7 7.0 8.1 7.1

2014 7.2 11.6 6.5 7.1

2015 5.1 10.8 8.9 6.8

2016 2.6 9.5 6.2 6.8

0

2

4

6

8

10

12

14

2011 2012 2013 2014 2015 2016

Fetal Deaths to All Mothers, All Races 2011-2016


28

Neonatal Death Rates

Neonatal mortality is the death of a live-born baby prior to the 28th day of life. This

rate is strongly correlated with low birthweight. Neonatal mortality and the neonatal

mortality rate reflect the health and well-being of the population’s women of reproductive age

and their infants, as well as the quality of the healthcare available. Neonatal mortality

information is generally associated with risk factors and issues related to pregnancy and birth

and is used by local governments and organizations to identify areas in need and designate

available resources.

NEONATAL DEATH RATES 2011-2016


2011 5.1 3.3 6.7

2012 5.1 12.1 8.1

2013 2.6 3.5 6.8

2014 7.2 8.5 6.8

2015 5.1 3.3 8.6

2016 0 3.2 4.4

Florida Department of Health Division of Public Health Statistics & Performance Management,

Florida Charts Indicator Information.

0

2

4

6

8

10

12

14

2011 2012 2013 2014 2015 2016

Neonatal Death Rate by State and County 2011-2016


29

Post Neonatal Death Rate

POSTNEONATAL DEATHS, ALL RACES


2012 2.6 4.4 3.7

2013 0 0 2.8

2014 0 1.1 2.6

2015 0 1.1 2.5

2016 0 0 2.7

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

2012 2013 2014 2015 2016

Rat

e p

er 1

00

0

Postneonatal Deaths, All Races


30

COMMUNITY NEEDS ASSESSMENT AND INVENTORY

A Community Health Needs Assessment is a systematic process used to identify the

gaps between the current and desired health outcomes in a community while taking into

account differences between the perceived needs of the community and the documented

epidemiological needs. A needs assessment also serves as the foundation for developing the

planning processes to improve population health through collaboration among community

organizations. By clearly identifying community strengths and weaknesses, resources can be

directed toward developing and implementing effective solutions to improving health

outcomes. A data-driven needs assessment provides concrete evidence that leads to the

prioritization of needs and determines the most effective and efficient interventions for

achieving the desired results.

Health needs assessments consist of several components in order to accurately analyze

the current population health status, determine the barriers encountered by the target

population, and develop a timely implementation plan that will lead to improved health

outcomes. Data are gathered from primary and secondary sources in an effort to adequately

identify community needs and assets. For the purpose of developing and executing this Service

Delivery Plan, primary research is continuously collected in the form of client and provider

surveys. Secondary data for health indicators will be gathered from the following sources: The

Florida Department of Health Florida CHARTS, County Health Rankings, U.S. Census

Bureau, PRC Child & Adolescent Community Health Needs Assessment, Florida Department

of Children and Families, Florida Department of Education (FLDOE), Enhanced HIV/AIDS

Reporting System (eHARS), and FIMR data obtained when available.

31

CATEGORY B

32

STRAGEGY 1: Conduct a minimum of 3 community development activities of the Healthy

Start Coalition of Hardee, Highlands and Polk County Inc. per quarter. The Coalition will

work with community partners on social determinants of health which impact birth

outcomes.

Contract Requirement or Identified Community/System Issue

A. What is the requirement or system/community-wide problem or need identified to be

addressed by a strategy? The Coalition is required to inform the community providers

regarding perinatal issues and trends, develop a membership that is a representative of the

population served and provide advocacy regarding MCH issues. The Community Outreach

and Education and Training departments provide required Healthy Start staff training. The

development of a social media campaign to address targeted MCH identified issues is

important.

B. What health status indicator/coalition administrative activity is being addressed by this

strategy? The strategy responds to the following standards in Chapter 22 of the Healthy

Start Standards and Guidelines: 22.1, 22.2, 22.6, 22.7, and 22.8 SUIDS deaths are addressed

by safe sleep messages.

C. What information, if any was used to identify the issue/ problem (i.e. Community

Health Improvement Planning Assessments, FIMR, screening, client satisfaction,

interviews, QI/QA)? Our contract with the Florida Department of Health and Chapter 22 of

the Healthy Start Standards and Guidelines along with Healthy Start and Healthiest Baby

Initiative Needs Assessment regarding service delivery issues were resources that were used

to identify the issue/problem. SUIDS was also identified through vital statistics and FIMR

reviews.

Planning Phase Questions

A. What strategy has been selected to address this? The strategy includes the following: (a)

Community education/outreach and training for Healthy Start service provider staff and

community partners on specific MCH issues. (b) Voting membership meetings, (c)

publication of newsletters.

B. What information will you gather to demonstrate that you have implemented this

strategy as intended (who, what, how many, how often, where, etc.)? The Coalition will

track the production and distribution of newsletters; the number of voting members and

meeting attendance; usage of Coalition website; number of legislative visits; the number and

type of media coverage; how many and what kind of trainings are conducted; attendance;

evaluations and continued coverage of any social media campaigns.

C. Where/how will you get the information? Information with be collected from the

following: Meeting attendance and agendas; Coalition records on material distribution and

legislative visits; web administration reports; Coalition files for media coverage; training

33

sign-in sheets and results from training evaluations and social media campaign

implementation.

D. What do you expect will be the observed impact of the strategy on the system of

community-wide problem/need? We expect the following: Coalition membership to

increase and become more informed as they continue to understand and support the work of

the Coalition; membership that is representative of the population; improved advocacy

efforts and funding; informed and trained service delivery staff with increased engagement

and intensity of services; improved consumer awareness regarding safe sleep environments

and other infant mortality issues.

E. What information will you gather to demonstrate these changes of the system?

Number of voting members and racial/ethnic distribution; result of legislative session key

advocacy issues affecting MCH and Healthy Start; funding for services; engagement of

Healthy Start clients and intensity of services; FIMR reviews and data analysis on sleep

environment, SUIDS and infant mortality rate. The Child Abuse Death Review (CADR)

data will also be included.

F. Where/how will you get the information? Advocacy efforts will be monitored to see if

they result in additional funding. Information will be obtained from a voting membership list

maintained and updated by the Coalition, WFS reports, FIMR reviews, CHARTS reports

and Vital Statistics data.

Action Steps Person Responsible Start

Date

Completion

Date

1.1 Develop and distribute at least two

newsletters per year.

Community Liaison

7/18 6/21

1.2 Develop and implement at least one

annual membership meeting.

Community Liaison

Provider Liaison

Education and

Training Coordinator

Coalition Staff

7/18 6/21

1.3 Continue membership recruitment

and development activities to ensure

the membership represents the racial,

ethnic, gender composition of the

catchment population.

Community Liaison

Provider Liaison

Education and


7/18 6/21

1.4 Annual presentation to the BOD

and the Plan Development Committee

of the status of the Service Delivery

Plan and Key MCH indicators

Executive Director

7/18 6/21

34

1.5 Provide advocacy activities and

opportunities for the key MCH issues

Executive Director

and Community

Liaison

7/18 6/21

1.6 Maintain Healthy Start Coalition

website www.healthystarthhp.org

Office Manager 7/18 6/21

1.7 Provide the following Healthy Start

system of care trainings as needed:

SCRIPT, Interconception Care, FSU

Partners for Healthy Baby, Safe Baby,

Edinburgh, Mothers and Babies ASQ 3

and ASQ SE

Education and


and Community

Liaison

7/18 6/21

STRATEGY 2: Maintain the Healthy Start Prenatal Risk Screening Rate at 70% of all

women who give birth; maintain the Healthy Start Infant Risk Screening rate at 75% of all

newborns. Provide educational visits to providers as required by contract.


A. What is the requirement or system/community wide problem or need identified to be

addressed by a strategy? Increasing the prenatal and infant risk screening rates is a core

outcome measure for the Department of Health. Risk screening is the point of identification

and entry into the Healthy Start System of Care and, therefore, a critical point in the System

of Care to ensure engagement.


strategy? Administrative activity includes the Coalition being responsible for ensuring that

health care providers are trained on the prenatal and infant risk screen. The health status

indicators are infant mortality, low birth weight and other poor birth outcomes which are

indicators the screen addresses.

C. What information, if any, was used to identify the issue/problem (i.e. Community


interviews, QI/QA)? Community Health Improvement Plan Assessments, FIMR, screening,

client & Provider surveys, client satisfaction, interviews, QA/QI, Healthy Start prenatal and

infant cohort, infant death analysis and prenatal and infant screen process.


A. What strategy has been selected to address this? The selected strategy includes provider

and consumer education/training on the importance of the Healthy Start Prenatal and Infant

Risk Screen and the Healthy Start System of Care by the Provider Liaison.

http://www.healthystarthhp.org/

35

B. What information will you gather to demonstrate that you have implemented this

strategy as intended (who, what, how, many, how often, where, etc.)? We will review

the number of providers that were trained on the risk screening instruments; the frequency of

visits to provider offices and the materials distributed at those visits; provider screening

rates; hospitals and screens offered and completed by the appropriate staff and referred into

Healthy Start for ongoing care coordination.

C. Where/ how will you get the information? Provider Liaison and FDOH - Polk are

responsible for getting screens to FDOH for uploading to HMS. Information will be

collected from Florida CHARTS and the Well Family System.

D. What do you expect will be the observed impact on the strategy on the system of

community-wide problem/need? The prenatal and infant risk screening rates will be

maintained or increased, and pregnant women and infants who need ongoing care

coordination will be referred for appropriate services. As a result of these services, lag time

will be reduced.

E. What information will you gather to demonstrate these changes on the system? Healthy

Start will gather Prenatal and Infant Risk Screening reports by county, hospital and provider;

Healthy Start will also refer to the Healthy Start Prenatal Upload Report. The Executive

Summary Reports and WFS reports will be used to gather information on the engagement

rates.

F. Where/ how will you get information? These reports are available on the Healthy Start

Reports website at http://www.floridacharts.com/hs/index.asp.


Date

Completion

Date

Prenatal Health Care Providers

2.1 Conduct at least an annual in-

service on Healthy Start with prenatal

health care providers.

Provider Liaison 7/18 6/21

2.2 Have three separate newsletters

annually: A Provider Connection,

Mommy Matters and Mommy Knows

Best.


2.3 Contact prenatal health care

provider via note cards, phone calls and

personal visits, and provide feedback

on MCH issues.


2.4 Provide written or verbal feedback

to providers regarding screen issues

including lag time in submission to the

Provider Liaison

FDOH HS team staff

7/18 6/21

http://www.floridacharts.com/hs/index.asp

36

FDOH for processing through monthly

review of prenatal health care provider

screening rates.

2.5 Distribute via provider newsletter,

prenatal risk screening rates by each

prenatal health clinic/office to each

provider—annually


2.6 Provide offices with a guide to

facilitate efficient screening and

reduces lag time.


2.7 Continue attendance at regional

Community Liaison meetings to share

best practices and work on statewide

work group related to screening rates.


2.8 Conduct in- services on Healthy

Start with hospitals birth certificate

departments as needed.


2.9 Develop and distribute discharge

packets to all parents of newborns.

Packets will have strong Healthy Start

brand identification.


3.0 Educate prenatal moms about

screening rates and Coordinated Intake

& Referral calls. (CI&R).

CI&R Supervisor 7/18 6/21

STRATEGY 3: Develop and distribute FIMR data about the underlying causes of fetal and

infant death and to improve maternal health by addressing chronic health conditions.

Contract Requirement Identified Community/System Issue


addressed by a strategy? This strategy relates to consumer and physician education related

to safe sleep, maternal chronic illnesses, Alcohol Tobacco and Other Drugs (ATOD) use and

prematurity prevention physician education on clinical management related to a reduction in

a preterm birth rate. The strategy also relates to improving maternal health by addressing

chronic health conditions, stress and depression.


strategy? This strategy addresses fetal and infant mortality, prematurity and low birth

weight.



37

interviews, QI/QA)? FIMR case reviews and information from the Child Death Review

Committee is used to identify issues.


A. What strategy has been selected to address this? Consumer awareness and education has

been used to address this issue.

B. What information will you gather to demonstrate that you have distributed this

strategy as intended (who, how many, how often, where, etc.?) We will distribute

educational materials, conduct presentations, bring awareness on social media platforms,

distribute newsletters and update our company website. We will gather training information

including: dates and times, agendas and rosters of who attends meetings.

C. Where/how will you get the information? Staff will continue to use a spreadsheet

developed to capture all of the Vital Statistics/Death Certificate information on all infant

deaths in the Coalition catchment area.

D. What do you expect will be the observed impact of the strategy on the system or

community-wide problem/need? We expect to continue to improve the relationship and

understanding of these issues between consumers and community partners.

E. What information will you gather to demonstrate these changes on the system? We will

gather data from FIMR case review data and complete infant death Vital Statistics data.

F. Where and how will you get the information? We get the information from the FIMR

review process.


Date

Complete

Date

3.1 FIMR Strategy includes community

partners and consumers providing

education to physicians on the FIMR

process and use the infant death

certificate information in development

of strategies related to infant mortality.

This could be accomplished through

the pathways, presentations,

newsletters, provider visit trainings and

other training venues.

FIMR Coordinator

FIMR committees

Provider Liaison

CI&R

Community Liaison

7/18 6/21

38

3.2 Identify community partners who

provide services for clients, eligibility

criteria, and referral process.

FIMR Committee

Provider Liaison

FIMR Coordinator

Community Partners

11/18 6/21

3.3 Educate frontline staff etc. to

transmit information

Community Partners

Provider Liaison

FIMR Coordinator

11/18 6/21

3.4 Create a Memorandum of

Understanding

Executive Director

Contracts

Coordinator

Community Partners

11/18 6/21

STRATEGY 4: Address Maternal Stress and Depression though the Healthy Start system of

care and collective impact at the community level.



addressed by a strategy? Maternal stress and depression is a community-wide problem

that is a risk factor for prematurity and VLBW births which impact neonatal and infant

deaths.


strategy? Prematurity, VLBW births, neonatal deaths and infant deaths.

39


Health Improvement, FIMR, screening client satisfaction, interviews, QI/QA)? We will

use FIMR and Health Problem Analysis, Community Health Improvement Plan

Assessments, and management reports from the WFS.


A. What strategy has been selected to address this? We will implement intervention

pathways that are developed through the HS pathways system of care; increase social

awareness and support, address barriers to receiving counseling services and improve the

collective impact with community partners such as Peace River Center and Tri-County

Human Services.


strategy as intended (who, how many, how often, where, etc.?) We will gather

information from the WFS which will include reports on services and implementation of

intervention pathway-numbers identified, numbers referred based on pathway and numbers

who received services.

C. Where/how will you get the information? The Coalition will get their information from

the WFS and records from Healthy Start chart reviews, provider monitoring and meetings.


community-wide problem/need? We expect an increase of women who are identified and

served who have stress or PPD. We expect the same results for women receiving the

Mothers and Babies curriculum or mental health care facility referrals.


gather information from the WFS management reports, provider chart reviews and

additional matrices that have been developed.

F. Where and how will you get the information? We will get the information from the

WFS and provider chart reviews during regularly scheduled monitoring.


Date

Completion

Date

4.1 Providers and supervisors will

routinely implement PPD Screening

and intervention Pathway during

Healthy Start services and refer to

counseling if required.

Education and


HS Provider

Supervisors

HS Care

Coordinators

7/18 6/21

4.2 Develop MOU’s for service

provision, priority services and

Executive Director 7/18 6/21

40

advocacy with community partners:

Domestic Violence Coalition, Central

Florida Behavioral Health Network,

Peace River Center and Tri-county

Human Services

4.3 Monitor the results of the Edinburg

Screening

Education &


HS Provider

Supervisors

11/18 6/21

4.4 Monitor the number of sessions

completed for Mothers & Babies

Program

Education &


HS Provider

Supervisors

11/18 6/21

STRATEGY 5: Decrease the number of women with an inter-pregnancy interval < 18

month.



addressed by a strategy? Higher percentage of women in the tri-county area with a short

inter-pregnancy interval vs. state rate.

B. What health status indicator/coalition administrative activity is being addressed by

this strategy? Prematurity, VLBW births, neonatal and infant deaths.


Healthy Improvement, FIMR, screening client satisfaction, interviews, QI/QA)? MCH

data, QA monitoring, provider chart reviews, provider commentary, Florida CHARTS data

and consumer surveys.


A. What strategy has been selected to address this? Addressing cultural issues and beliefs of

clients related to family planning, access to family planning, the use of LARCS and other

birth control, lack of education of medical providers on importance of pregnancy intervals

and access to family planning services.



information from the WFS which will include reports on services for ICC and outcome data

on birth control use, training attendance and evaluation results. Other information will also

include Title X Family Planning waiver enrollment and client compliance with postpartum

visit schedule.

41

C. Where/how will you get the information? We will get the information from data

collection from FDOH - Polk, Florida Charts, client reports, and other qualified providers

who share information as well the WFS.


community-wide problem/need? We expect post-partum visit rates to improve, increased

interconception care services, increased consumer education on the myths of LARCs and

reduced proportion of women with short inter-pregnancy intervals.


gather pertinent data from Florida CHARTS and the WFS.


Date

Completion

Date

5.1 Encourage HS clients to schedule

post-partum visit prior to discharge

after birth

Education and


Care Coordinators

Provider Liaison

7/18 6/21

5.2 Work with FPQC on issues related

to LARC access

Executive Director

FIMR Coordinator

Provider Liaison

Community Liaison

7/18 6/21

5.3 Develop protocol for Healthy Start

staff to ensure clients on Medicaid are

linked with the Family Planning

Medicaid Waiver and Title X after

birth

Education and


Executive Director

CI&R committee

7/18 6/21

5.4 Staff training on cultural issues and

beliefs in regard to Baby spacing and

the use of LARCS - Long Active

Reversible Contraception.

Education &


Executive Director

7/18 6/21

STRATEGY 6: To improve identification and engagement of high-risk clients in Healthy

Start system of care and to increase intensity and duration of services in Healthy Start

system of care.



addressed by a strategy? Identification and engagement of high-risk clients and increased

intensity of duration.

42


strategy? Prematurity, VLBW births, neonatal deaths and infant deaths.


Health Improvement Plan, FIMR, screening client satisfaction, interviews, QI/QA)?

Executive Summary Reports, WFS reports, providers reports, chart reviews, and FIMR case

summaries.


A. What strategy has been selected to address this? Healthy Start staff training, Coordinated

In-Take and Referral Project, development of CI&R protocols, and implementation of

Intervention Pathways described under other strategies.



information from WFS reports on identification, referrals, services-dosage and duration by

site and executive summary reports.

C. Where/how will you get the information? We will get the information from WFS reports,

and Florida CHARTS.


community-wide problem/need? We expect improved engagement rates, increased service

intensity and duration from all the home visitation service providers.


analyze referral sources and service reports from all home visiting sites.

F. Where and how will you get the information? We will get the information from the WFS

and provider agencies.


Date

Completion

Date

6.1 Expand HS relationships with WIC,

Nemours Children specialty care and

prenatal clinics, Central Florida Health

Care, hospitals and birthing centers.

Provider Liaison

7/18 6/21

6.2 Develop staff training plan:

motivational interviewing, cultural

competency, relationship of risk factors

to outcomes, community resources and

E & T Coordinator 7/18 6/21

43

all screening and intervention

pathways.

STRATEGY 7: To create a system for the effective use of home visiting programs



addressed by a strategy? Identification and engagement of high-risk clients and increased

intensity of duration.

B. What health status indicator/coalition administrative activity is being addressed by

this strategy? Prematurity, VLBW births, neonatal deaths and infant deaths.


Health Improvement Plan, FIMR, screening client satisfaction, interviews, QI/QA)?

Executive Summary Reports, WFS reports, providers reports, chart reviews, and FIMR case

summaries.


A. What strategy has been selected to address this? Healthy Start staff training,

Coordinated In-Take and Referral Project, development of CI&R protocols, and

implementation of Intervention Pathways described under other strategies.



information from WFS reports on identification, referrals, services-dosage and duration by

site and executive summary reports.

C. Where/how will you get the information? We will get the information from WFS

reports, and Florida CHARTS.


community-wide problem/need? We expect improved engagement rates, increased

service intensity and duration from all the home visitation service providers.

E. What information will you gather to demonstrate these changes on the system? We

will analyze referral sources and service reports from all home visiting sites.

F. Where and how will you get the information? We will get the information from the WFS

and provider agencies.


Date

Completion

Date

7.1 Establish a Home Visitation

Advisory Committee

Executive Director

Contracts

Coordinator

CI&R Supervisor

7/18 6/21

44

7.1a Provide data to HVA committee

as outlined in scope of services of

FDOH contract

Contracts

Coordinator

Executive Director

CI&R Supervisor

7/18 6/21

7.2 Adopt CONNECT as the

community wide logo for marketing

CI&R

Coalition 7/18 6/21

7.3 Sign MOUs & BAAs with home

visiting agencies

Executive Director 7/18 6/21

7.4 Develop a marketing campaign for

CONNECT, Facebook/Social Media,

DOH website, HF Website, 211, Aunt

Bertha

CI&R Committee 7/18 6/21

7.4a Educate Providers Provider Liaison

Community Liaison

CI&R Committee

7/18 6/21

45

CATEGORY C

46

ASSISTING CHEMICALLY DEPENDENT PREGNANT WOMEN AND SUBSTANCE-

EXPOSED NEWBORNS



addressed by a strategy? The Coalition must submit an action plan for assisting

chemically dependent pregnant women and substance-exposed newborns that includes

action steps/strategies for multi-agency collaboration, access to evaluations, treatment and

services to substance-exposed newborns. The Coalition will submit progress reports that

shows documentation that action steps of strategies chosen were implemented as planned or

rationale as to why they were not.


A. What do you plan to do for these populations? As part of your action plan how will you

make referrals for services needed? The Coalition and Healthy Start providers will work

with other community agencies to identify and refer mothers who present with a substance

abuse problem and/or have a substance-exposed newborn to the appropriate service

providers within the county.

B. Describe how doing this will change the system of care to chemically dependent

pregnant women and substance exposed newborns? It will assist by identifying the

mothers and infants in a timely manner and provide them the assistance they need to have

wrap-around support to address the issues that contribute, cause, and determine their

outcomes.

C. What information will you gather to demonstrate that you have implemented this

strategy as intended? What will you do? (who, what, how many, how often?)

1) Healthy Start data and performance report.

2) Documentation of referrals received from community partners

3) Consumer surveys.

D. What do you expect to be the immediate EFFECT (measurable objective) of this

strategy on the population who receives the intervention/exposed to the strategy?

(for example, changes in knowledge, attitude and behaviors stated with baseline

information and goal). By assessment, education and awareness we expect the mother to

gain knowledge on the immediate effects of not using substances for her own health and the

improved health/outcome of her child.

E. What information will you gather to demonstrate that you effected a change in

knowledge, attitude and behaviors? (for example, what difference will it make?) We

will use Executive Summary Reports, Healthy Start Prenatal and Infant ADHOC Reports,

individual surveys on knowledge gained and behavior change, as well as Healthy Start

screening data that will reflect the decrease in number of cases.

47


Date

Completion

Date

C.1. Educate OB providers of local

statistics; encourage substance use

screening for all pregnant women.

Work with prenatal providers on

educating mothers on available

resources within the community

Executive Director

Provider Liaison

7/18 6/21

C.2. Educate and refer mothers to

providers that offer services for

substance abuse/exposure

Healthy Start care

coordinators

7/18 6/21

C.3. Review annually the data on

identified mothers and babies to

determine effectiveness of strategies

Executive Director

Community Liaison

7/18 6/21

C.4. Attend community agency

meetings that address substance abuse

and other related service

Executive Director

Community Liaison

7/18 6/21

C.5. Implement ATOD Screening and

Intervention pathways

Education &


7/18 6/21

C.6. Continue SCRIPT implementation

& increase the number of women who

smoke to participate in SCRIPT

Education &


7/18 6/21

C.7. Develop MOUs with community

partners: Nemours, Heart of Florida

Regional Medical Center, Peace River,

Tri-County Human Resources, DCF

Contracts

Coordinator

Executive Director

7/18 6/21

C.8. Become trained in Tobacco Free

Florida practices and Baby and Me

Tobacco Free curriculum

Education &


HS Provider

Supervisors

HS Care

Coordinators

7/18 6/21

C.9. Staff training on S-Birth Education &


HS Provider

Supervisors

HS Care

Coordinators

11/18 6/21

C.10. Monitor the results of the S-Birth

screening

Education &


HS Provider

Supervisors

11/18 6/21

C.11. Increase the number of women

who smoke to participate in SCRIPT

Education &


11/18 6/21

48

HS Care

Coordinators

Community Partners

The Healthy Start Coalition of Hardee, Highlands and Polk Counties, Inc. and partners will

continue to analyze the most current data as received, so that the strategies and action plans will

be appropriate to achieve the desired outcomes. It will not be a single intervention, but a series of

community partnerships that will assist with addressing the identified issues. Four components

will exist in our continued planning: 1) early and continued risk assessment, 2) health promotion

and counseling, 3) medical and/or psychosocial intervention, 4) identifying substance-abusing

mothers and substance-exposed newborns.

The plan is to address the whole family. The desire is to educate the community that change and

improvement can be achieved by working one generation to the next. A healthy mother starts with

her grandmother and mother. The cultural practices that may have a significant bearing on our

health disparities are generational. These strategies are developed to change the thought process

and address behaviors, thus improving outcomes. These ideas will be a part of the overall process

to continuously identify risks: medical, environmental, psychosocial and other. The Healthy Start

Coalition of Hardee, Highlands and Polk Counties, Inc. is dedicated to improving the outcomes

for mothers and babies.

Collaboration with Department of Children & Families Circuit 10

Plan of Safe Care for Prenatal Substance Use (CFOP170-8):

In accordance of the Comprehensive Addiction and Recovery Act (CARA) of 2016, The Coalition

will work with local hospitals and child welfare professionals to ensure the development of the

Plan of Safe Care at the earliest point of the mothers use or the infant’s exposure has been

identified. A plan of safe care must be developed, implemented and monitored for infants under

one year old who have been affected by exposure to controlled substances or alcohol. Controlled

substances include both prescription drugs not prescribed to the parent or not administered as

prescribed (CFOP 170-8).

As required by s. 383.14 all attending health care providers are required to refer infants identified

as prenatally exposed to alcohol and controlled substances for early intervention, remediation and

prevention services. This process will begin with a referral to the Coordinated Intake and Referral

unit.

When initiated, the Healthy Start Coalition will collaborate with other stakeholders and partners to

provide services for infants and families affected by prenatal exposure to alcohol and controlled

substances, including but not limited to:

• Other home visitor programs

• Healthy Families

• ELC

• County Health Departments

• CPT

• CMS

49

• Substance abuse treatment

• DCF

• Early Steps

When invited by the Child Welfare professionals, the Healthy Start Coalition provider will

participate in the 21-day plan of safe care staffing. The staffing participants will discuss the

following, including but not limited to: (1) the progress of the parent(s)’ substance misuse

treatment, (2) any parenting concerns/ parental capacity, (3) victim-child(ren)’s developmental

concerns/ needs, if any, (4) any other additional service provider input, (5) any follow up needed

prior to closing the DCF investigation, and (6) potential date of DCF case closure.

50

APPENDICES

51

APPENDIX A

ATTENDEES OF SERVICE DELIVERY PLAN FORUMS

Jackie Rawlings Aisha Alayande Meghan Garland Ann Claussen

Tri-County Human Services Drug Free Highlands Frontier University / Midwife Central Florida Health Care

Lillian Nolin Dee Zerfas Leslie Bond Becky Weekes

Healthy Families Polk FDOH Polk County - HS FDOH Hardee County - HS Children’s Home Society

David Acevedo Maryanne Higgins Becky Razaire Shannon Hartwig

Children’s Home Society - HS Healthy Start - Highlands Tri-County Human Services Lakeland Regional Health

Penny Borgia Khalila Montaque Dorthia Barrera Jean Osborne

United Way of Central Florida FDOH Highlands - WIC Healthy Start - Highlands Healthy Start - Highlands

Ermelinda Centeno Nancy Zachary Sylvie Grimes Maria Santoyo

Central Florida Health Care RCMA FDOH Polk County Healthy Start - Hardee

Maria Lucatero Chase Webber Gayle Hernandez Sarah Pitts

Healthy Start - Hardee Heartland for Children RCMA Children’s Home Society - HS

Holly Parker Tonya Akwetey Charlene Edwards Spring Dority

HSC – Provider Liaison HSC – Community Liaison HSC – Executive Director HSC – Contracts Coordinator

Stephanie Rosser Nilsa Lebron Migdalia Colon Xiomara Nieves-Jimenez

FDOH Highlands - WIC FDOH Highlands - WIC FDOH Highlands - WIC FDOH Highlands - WIC

Gladys Walker Carolina Santana Paige Thompson Valorie Hunt

FDOH Highlands - WIC FDOH Highlands - WIC FDOH Highlands - WIC FDOH Highlands - WIC

John Gountas Michael Ham-Ying Ronald Lund Donna Wissing

FDOH Highlands County Central Florida Health Care Central Florida Health Care Florida Hospital

Anna Edgar Angel Leyva Dr. Joy Jackson Kristin Casey

Florida Hospital FDOH Hardee County FDOH Polk & Hardee FDOH Hardee County

Beatrice Zamorano Julia Hermelbracht Stefania Sweet Georgeann Singletary

RCMA DCF FDOH Hardee County FDOH Hardee County

Erin Norsworthy Andrea Hagan T.J. Blankinship Adriana Arce

Heartland for Children Heartland for Children Drug Free Hardee Peace River Center

Alice Simandl Kristin Normand

Hardee County Sheriff’s Office Polk Early Learning Coalition

52

APPENDIX B

HEALTHY START SURVEYS

53

Healthy Start Coalition of Hardee, Highlands, and Polk Counties, Inc.

PRENATAL PROVIDER SURVEY

Please assist us in developing our Service Delivery Plan by answering these questions.

PROVIDER/CLINIC NAME________________________________________________

LOCATION: ___________________________________________________________

COUNTY AND SERVICE AREA: ___________________________________________

Days and Hours of Operation: _________________________________________________

Name/Title of Person Completing Survey: __________________________________________

1. How many OB patients do you see, on average, in a typical month? _______________________

How many new OB patients do you see, on average, each month? ________________________

2. Do you have bilingual staff or provide interpreter services? __No__ Yes (If yes, check if: __Spanish,

__Creole, __Other: _______________

3. Do you screen your patients for the following? ___Alcohol ___Substance abuse ____STI/STD ___HIV ____Other infections ___Other:____________________________ ___No, my office does not routinely offer these screenings

4. Are you a Medicaid provider? ___Yes ___No if yes, continue,

Approximately what % of your patients is on Medicaid? ______%

Will you accept a pregnant woman if she has applied for Medicaid and approval is pending? __Yes __No Will you accept a pregnant woman with share of cost Medicaid? __Yes __No

5. For private pay clients, do you have a fee based on income (sliding scale fee)? __Yes __No 6. Will you accept a pregnant woman when she calls for an appointment if she has not made arrangements for payment of services? __Yes __No

7. How long does it take to get an initial OB appt? _______________________ 8. Why do you think women do not receive prenatal care in their 1st trimester? ________________________________________________________________________________________________________

9. Do you discuss family planning with your patients? If yes, when ___________________________

(While pregnant, postpartum, etc.)

10. When requested, do you provide a tubal ligation promptly after delivery? __Yes __No

If no, why? ______________________________________________________________________________________________

11. What type of follow up/ referrals does your office provide after a negative pregnancy test? ___Family Planning ___Fertility Specialists ____Interconception counseling ___Safe Sex

54

12. Do you provide patient education on the following?

__Breastfeeding __Pre/Interconception counseling __Baby Spacing __Smoking cessation __Nutrition __Fertility referrals __Safe sex practices __Oral Hygiene __Pre Term Labor Sign __Weight Management __ Postpartum Depression __Safe Sleep/Back to Sleep Other: ___________________ 13. What are your greatest barriers in addressing the needs of your patients? (CHECK ALL THAT APPLY)

__Medicaid/insurance eligibility process __Medicaid reimbursement process __Lack of knowledge on where to refer patient for help __Transportation problems of patient __Literacy level of patient __Lack of resources to case manage the patient __Language/cultural barriers __Missed appointments by patients __Liability/malpractice insurance __Under insured/uninsured __Childcare __Other: (please list) ____________________________________________ 14. What is needed most by your office to better address the needs of your patients?

________________________________________________________________________________

15. Which agencies/services do you use as referral sources for you clients? (CHECK ALL THAT APPLY)

__County Health Department __ Mental health service agencies __Substance Abuse services __United Way Information & Referral __ Subsidized Childcare __ Breastfeeding support __Healthy Families __WIC __ Healthy Start __Planned Parenthood __Family Support Services __Teen parent services __Literacy/ESL services __MomCare __KidCare __Childbirth education __Migrant __Transportation Assistance __DCF __Grief Support __211 __Nurse Family Partnership __Other: (please list) ______________________________________ 16. Does your office offer the Healthy Start Prenatal Risk Screen to all of your patients? __Yes ___No

If no, why not? _______________________________________________________________________

17. Do you have any barriers in working with the Healthy Start program?

___ Lack of knowledge on the Healthy Start Risk Screening Instrument ___ Lack of knowledge of what to do with the screening once completed ___ Receive no feedback once a patient is referred to Healthy Start ___ Have a difficult time reaching the Healthy Start case manager ___ Return of incorrect screening forms ___ other: (please list) ________________________________________________________________

18. What types of services are offered through the Healthy Start program?

__Patient education (Childbirth, breastfeeding, etc.) __Smoking Cessation __Case management services __Home Visitation services __Counseling for mental health __Nutrition counseling __Family Planning education __Not familiar with any services offered __Other _______________________________________________________________________________

20. How can Healthy Start help you better serve your patients? ____________________________________

___________________________________________________________________________________

Rev. 05/16

55

Healthy Start Coalition of Hardee, Highlands, and Polk Counties, Inc. HOSPITAL/BIRTHING FACILITY SURVEY

Please assist us in developing our Service Delivery Plan by answering these questions.

FACILITY NAME: ________________________________________________

LOCATION: ___________________________________________________________

LEVEL OF HOSPITAL: ___________________________________________________ Name/Title of Person Completing Survey: __________________________________________ 1. How many Triage patients do you see, on average, in a typical month? _________________ 2. How many deliveries do you have, on average, in a typical month? ___________________ 3. How many NICU patients do you serve, in a typical month? ____________________ 4. How many NICU patients do you transfer, in a typical month? __________________ 5. How many OB patients without prenatal care do you see, on average, each month? _____

6. Do you have bilingual staff or provide interpreter services? ______No_____ Yes (If yes, check if: __Spanish, __Creole, __Other: _______________)

7. Do you screen your patients for the following? ___Alcohol ___Substance abuse ____STI/STD ___HIV ____Other infections (List):____________________ ___Other:____________________________ ____ PPD ___No, our hospital does not routinely offer these screenings unless they have no prenatal care.

8. Are you a Medicaid provider? ___Yes ___No if yes, continue, part A.

A. Approximately what % of your patients are on Medicaid? ______% 9. For self pay/uninsured patients, do you have a fee based on income (sliding scale fee)? __Yes __No 10. What are the reasons given by your patients for not receiving prenatal care? ________________________________________________________________________________________________________ ________________________________________________________________________________________________________

11. Do you discuss family planning with your patients? If yes, when _____________________ ________________________________________________________ (While pregnant, postpartum,

etc.)

56

12. When requested, do you provide a tubal ligation promptly after delivery? __Yes __No If no, why? ________________________________________________________________

13. What bereavement services are available at your facility? _____________________________ 14. What type of follow-up does your facility offer families who are bereaved? ________________ _________________________________ 15. Do you provide patient education on the following?

__Breastfeeding __Pre/Interconception counseling __Baby spacing __Smoking cessation __Nutrition __Fertility referrals __Safe sex practices __Oral Hygiene __Pre Term labor danger signs __Weight Management __ Post-Partum Depression __Safe Sleep/Back to Sleep __Infant CPR __ Apnea Monitoring

16. What are your greatest barriers in addressing the needs of your patients? (CHECK ALL THAT APPLY)

__Lack of knowledge on where to refer patient for help __Transportation problems of patient __Literacy level of patient __ Availability of PT/OT follow-up locally for NICU babies __Language/cultural barriers __ Availability of follow-up locally for HIV babies __ Availability of Pediatricians that accept Medicaid __ Availability of Special needs follow up __Other: (please list) __________________________________________________________________________

17. What is needed most by your facility to better address the needs of your patients?

________________________________________________________________________________

________________________________________________________________________________

18. Which agencies/services do you use as referral sources for your patients? (CHECK ALL THAT APPLY)

__County Health Department __ Mental Health service agencies __Substance Abuse services __United Way Information & Referral __ Subsidized Childcare __ Breastfeeding support __Healthy Families __WIC __ Healthy Start __Planned Parenthood __Family Support Services __Teen parent services __Literacy/ESL services __MomCare __KidCare __Childbirth education __Migrant __Transportation Assistance __Department of Children & Families __Grief Support __211 __ Early Development Services for NICU patients __Other: (please list) ___________________________________________________________________

19. Does your facility offer the Healthy Start Risk Screen to all of your newborn patients/parents? __Yes ___No

If no, why not? _______________________________________________________________________

20. Does your facility have a designated registrar for completing the Birth Certificate and Healthy Start Screen? ____ Yes _____ No

57

21. Do you have any barriers in working with the Healthy Start program?

___ Lack of knowledge on the Healthy Start Risk Screening Instrument ___ Lack of knowledge of what to do with the screening once completed ___ Receive no feedback once a patient is referred to Healthy Start ___ Have a difficult time reaching the Healthy Start case manager ___ Return of incorrect screening forms ___ Other: (please list) ________________________________________________________________

________________________________________________________________________________

22. What types of services are offered through the Healthy Start program?

__Patient education (Childbirth, breastfeeding, etc.) __Smoking Cessation __Case management services __Home Visitation services __Counseling for mental health __Nutrition counseling __Family Planning education __Not familiar with any services offered __Other _______________________________________________________________________________

23. How can Healthy Start better serve your patients?__________________________________________

______________________________________________________________________________________________

58

Healthy Start Coalition of Hardee, Highlands, and Polk Counties, Inc. PEDIATRICIAN PROVIDER SURVEY

Please assist us in developing our Service Delivery Plan by taking a few minutes to fill out and return this brief survey so we know how to better serve you.

PROVIDER/CLINIC NAME________________________________________________

LOCATION: ___________________________________________________________

COUNTY AND SERVICE AREA: ___________________________________________

DAYS/HOURS OF OPERATION: ___________________________________________

1. What type of service do you refer your clients to on a regular basis? (Check all that apply)

___ County Health Department ___ Winter Haven Hospital Behavioral Health ___ United Way Information & Referral/2-1-1 ___ Subsidized Child Care ___ Healthy Families ___ Early Learning Coalition ___ Peace River Center ___ La Leche League/Lactation Consultant ___ WIC ___ Mom’s Morning out Groups ___ Central Florida Healthcare ___ Family Fundamentals ___ Planned Parenthood ___ Mental Health Serves/Agencies ___ Migrant Family Programs ___ DCF

___ Healthy Start ___ Substance Abuse Treatment Services

2. How many patients do you see, on average, in a typical month? _______________________

3. What is your greatest barrier in addressing the needs of your at risk patients? ___ Medicaid eligibility process ___ Medicaid reimbursement process ___ Lack of knowledge on where to refer patients for help ___ Transportation problems of patient ___ Low literacy level of patient ___ Lack of resources to case-manage the patient ___ Language/cultural barriers ___ Child Care ___ Missed appointments by patients ___ Other: (Please list)_________________________________________

4. What additional services does your office need to better address the needs of your at risk patients? ______________________________________________________________________________________ ______________________________________________________________________________________

59

5. Do you screen your patients for the following? ___Alcohol ___Substance abuse ____STI/STD ___HIV ____Other infections ___Other:____________________________ ____Domestic Violence ___No, my office does not routinely offer these screenings

6. Do you have bilingual staff or provide interpreter services? __No

__ Yes (If yes, check if: __Spanish, __Creole, __Other: _______________

INFANT CARE

7. Are you a Medicaid provider? ___Yes ___No

If yes:

Will you accept a newborn of a mother whose delivery was paid for by Medicaid? ___Yes ___No

How long will you provide care without a Medicaid card? ______________________

Approximately what percentage of your practice is on Medicaid? __________________

8. Do you provide education on the following? ____Pre/Interconception counseling ____Baby Spacing ____Shaken Baby ____Well Baby Care ____Nutrition ____Safe Sleep/SIDS ____Car Seat Safety ____Water Safety ____Other

9. A. For private pay clients, do you have a fee based on income (sliding scale fee)? __Yes __No B. Will you accept a patient when she/he calls for an appointment if she has not made arrangements for payment of services? __Yes __No 10. Do you have any barriers in working with the Healthy Start program?

___ Lack of knowledge on the Healthy Start Postnatal Risk Screening Instrument or referral process ___ Receive no feedback once a patient is referred to Healthy Start ___ Have a difficult time reaching the Healthy Start case manager ___ I do not routinely work with the Healthy Start Program If not, why? __________________________ ___ other: (please list) ________________________________________________________________

11. What types of services are offered through the Healthy Start Program? (Check all that apply)

___ Patient Education (Childbirth preparation, breast-feeding, etc.) ___ Smoking Cessation ___ Case Management Services ___ Home Visitation Services ___ Counseling for Mental Health ___ Nutrition Counseling ___ Family Planning Education ___ Not familiar with any services offered ___ Other: _______________________________

Name/Title of Person Completing Survey: __________________________________________

Thank you for taking the time to complete this survey. If we can be of any assistance in providing information about Healthy Start services or current maternal and child health issues being addressed by the Coalition, please do not hesitate to call our office at (863) 534-9224. Rev. 05/16

60


Consumer Survey – 2016 Please take a few minutes to answer the following questions. You do not have to put your name on the paper. Pick the answer or answers that are most true for you. This information will help us plan how best to meet the health care needs of you and your family. If you have any questions you can call our office (863-534-9224).

Zip Code and City of Residence: __________________ Date________

Are you: Pregnant now - Due date: ______ Already had baby - Date:______

1. How old are you? ______________________________________

2. What is your race or ethnicity?

___Black ___Haitian ___Hispanic ___White ___Asian ___Other – (please list) ___________________________________

3. Are you? (check one): Single Married Living with Partner Separated Divorced Widowed

4. How much do you work? Full-time (35+ hr/wk) Work at home Part-time (less than 35 hours/wk) Unemployed

5. How old were you during your first pregnancy? _____

6. How many times have you been pregnant? _____

7. How many children do you have? ______

8. Did you or your partner use birth control before getting pregnant? If so, what kind (Check ALL that apply) Yes_____ No____

Birth control pills IUD Diaphragm Natural Family Planning Methods Depo-Provera Shot Patch Male condom Female condom Sponge Vaginal Ring (NuvaRing) Tubal Ligation Breastfeeding Vasectomy

9. Before your pregnancy, did you do any of the following? If yes, complete checklist indicating what action you took once you learned you were pregnant.

I did not stop or cut back

I cut back I stopped I stopped, but started again after my baby was born

Smoke cigarettes/use tobacco

Smoke marijuana

Take prescription medication

Drink alcohol

Use street/club drugs

61

10. Where did you or do you go for prenatal care /pregnancy care? Doctor/midwife office Health Department Other: ___________________________________________________________

11. How far along (days/weeks) were you when you called for your first appointment? ___Days ___Weeks

12. How long did you have to wait (days/weeks) for your appointment? ___Days ___Weeks

14. I missed (how many) ____ prenatal appointments for the following reasons: No one to take care of your children Afraid of medical tests

No way to get to the clinic or office inconvenient office hours Couldn't get time off work No appointments were open Couldn't get a doctor or nurse to take you as their patient Medicaid transportation wouldn’t take your other children Didn't have enough money or insurance to pay for your visits Something else: ____________________________________________________

15. Did you change your provider during your pregnancy? Yes – why? __________________________ No

16. Did you have to visit the Emergency Room for pregnancy related issues? Yes-why? ____________________________ No 17. How much weight did you gain with your pregnancy? _______

18. Did your Doctor discuss healthy weight gain with you? Yes No

19. For these next items, think about how satisfied you were with the care you received during your pregnancy. Circle the best answer.

Very

Satisfied

Somewhat Satisfied

Not

Satisfied

Not sure/ Don’t

remember a. The amount of time you had to wait after you arrived for your visits?

1

2

3

4 b. The amount of time the doctor or nurse spent with you during your visits?

1

2

3

4 c. The advice you received on how to take care of yourself and the baby?

1

2

3

4 d. The hours the office or clinic were open? 1 2 3 4

e. The understanding and respect that the staff showed toward you as a person?

1

2

3

4 f. The way the doctor/midwife/nurse answered your questions?

1

2

3

4

62

20. Did you receive information (brochures, discussion with doctor, nurse, or midwife) on any of the following: Check all that apply:

Breastfeeding Childbirth Education Street or club drug use Parenting Skills Pre-term labor prevention Adult seat belt safety Infant sleeping position Drinking alcohol/use of alcohol products Baby kick-counts Smoking cigarettes/use tobacco Shaken Baby Syndrome Nutrition Medical care for your baby Postpartum Depression Baby spacing Importance of an Infant car seat Immunizations (shots) for you and care for your baby Environmental or work hazards Over the counter medications (aspirin, Advil, herbal drugs, etc.) Family Planning/Birth control

21. What type of delivery did you have?

Vaginal Planned C-Section Emergency C-Section NA/I have not yet delivered 22. How did you pay for your prenatal care/delivery?

Medicaid Private Insurance Self-pay Other: _______________________ 23. Did you return to your doctor/nurse/midwife after your delivery?

Yes – If yes, how long after you delivered? ______________________ No Not sure/don't remember NA/I have not yet delivered

24. Did you pick out a pediatrician (baby doctor) before your baby's delivery?

Yes No 25. How do you look up information? Do you use a computer, smart phone, other________ Do you regularly use a computer for email/connect with others? Please check all that you use:

Facebook Twitter Read blogs look up health information Read local news Printed materials/paper other __________________________

26. Would you prefer to receive information through a website? Yes No 27. Do you use your phone to text messages? Yes No

28. What services, if any, did you feel you needed during pregnancy or after birth but could not get? _____________________________________________________________________________ 29. As a parent of an infant/small child, I would most like to learn more about: _______________________________________________________________________________________ Any other comments: _________________________________________________________

THANK YOU FOR TAKING THE TIME TO COMPLETE THIS SURVEY

Return by mail: 605 E. Davidson St., Bartow FL 33830 By fax: 863.519-8111 or [email protected]

If you are interested in being part of a focus group to discuss some of the issues in this survey please complete this portion. Your survey responses will be kept confidential. NAME: _________________________ TELEPHONE #:_________________

63


Encuesta del Consumidor – 2017

Favor de tomar unos minutos en contestar las siguientes preguntas. No tiene que incluir su nombre en este papel. Seleccione la respuesta o respuestas que sean más

verdaderas para usted. Ésta información nos ayudara a mejorar las necesidades del cuidado de salud para usted y su familia. Si tiene alguna pregunta puede llamar a

nuestra oficina al (863) 297-3043.

Código Postal y Ciudad de Residencia:__________________ Fecha________

Esta usted: Embarazada ahora/Fecha de cuando va a dar a luz:_______________ Ya tuvo su bebé/Fecha de nacimiento:_________________

1. ¿Que edad tienes?______________________________________

2. ¿Cual es tu raza o étnica?

___Negro ___Haitiano ___Hispano ___Blanco ___Asiático ___Otro – (favor de indicar) ___________________________________

3. ¿Es usted? (selecciona uno): Soltera Casada Separada Divorciada Viviendo en union libre con su pareja Viuda

4. ¿Cuál es tu estado de empleo?

Tiempo-completo (35 horas por semana o más) Desempleada Tiempo-parcial (menos de 35 horas por semana) Trabaja desde casa

5. Qué edad tenias en tu primer embarazo? _____

6. Cuantas veces has estado embarazada? _____

7. Cuantos niños tienes? ______

8. Tu o tu pareja usaron anticonceptivos antes de quedar embarazada? Sí la respuesta es sí, que fue lo que usaron (Selecciona todo lo que aplique) Sí_____ No____

Píldora para el control de la natalidad IUD Diafragma Métodos naturales para la planificaion familiar inyección Depo-Provera Parche Condón Masculino Condón Femenino Esponja Anillo vaginal (NuvaRing) Ligadura de trompas Lactancia Vasectomía

9. Antes del embarazo, hicistes algo de lo siguiente: Si la respuesta es si, completa la lista indicando que

acción tomaste una vez que descubristes que estabas embarazada.

No pare el

uso

Disminuí

el uso

Discontinué

eI uso

Pare, pero empecé de nuevo después del

nacimiento de mi bebé Fumar cigarillo/uso

de tabaco

Medicina recetada Consumo de alcohol

Uso de drogas

ilegales

10. A donde fuiste o a donde vas para tu cuidado prenatal/cuidado de embarazo?

Oficina de Medico Privado/Partera Departamento de Salud

Otro: ___________________________________________________________

64

11. Qué tan avansado estaba tu embarazo cuando llamaste para tu primera cita?

___Días ___Semanas

12. Cuanto tiempo tuviste que esperar para tu primer cita? ____Días ____ Semanas

13. Perdí ____ citas prenatales por las siguientes razones:

Nadie quien cuidará de mis hijos Miedo a examenes medicos No habia manera de como llegar a la clinica e oficina Horas incovenientes No me pude salir del trabajo No citas disponibles No encontre médico o enfermera que me aceptara como su paciente Transportación del Medicaid no pudo llevar conmigo a mis otros hijos No tenia suficiente dinero o seguro médico para pagar mis citas

Algo más: ____________________________________________________

14. ¿Cambiaste de médico durante tu embarazo? Sí – porque? __________________________ No

15. ¿Tuviste que visitar el hospital o sala de Emergencia por problemas relacionados con tu embarazo?

Sí - porque?____________________________ No

16. ¿Cuanto peso aumentaste durante tu embarazo? _______

17. ¿Te hablo tu médico sobre el aumento de peso saludable durante tu embarazo?

Sí No

18. Para lo siguiente, piensa que tan satisfecha estas con el cuidado que recibiste en tu embarazo. Círcula tu mejor respuesta.

Bien

Satisfecha

Más o menos

Satisfecha

No

Satisfecha

No segura/ No

recuerdo a. ¿La cantidad de tiempo que tuviste que esperar después de llegar a tus citas?

1

2

3

4 b. ¿La cantidad de tiempo que el médico o enfermera tomo contigo durante tus citas?

1

2

3

4 c. ¿Los consejos que recibiste en cómo cuidar de ti y de tu bebé?

1

2

3

4 d. ¿El horario de la oficina o clínica?

1 2 3 4

e. La compresión y el respeto que el personal demostro hacia ti como persona?

1

2

3

4 f. La manera en cómo el médico/enfermera/partera contesto tus preguntas?

1

2

3

4

19. Recibiste información (folletos, discusión con su médico, enfermera, o partera) en cualquier de lo siguiente: Indique todo lo que aplique:

Lactancia Clases de parto Drogas ilegales Apoyo sobre crianza Prevención sobre el parto prematuro Seguridad del cinturón para adultos Información sobre como acostar al bebé a dormir Contar el movimiento del bebé

65

Consecuencias por sacudir a un bebé Nutrición Depresión Posparto Espacio para bebé Cuidado de salud para bebé Vacunas para el cuidado de su bebé Importancia sobre el asiento de seguridad para bebés Los peligros ambientales o en el trabajo Consumo de alcohol/uso de productos alcoholicos Apoyo para dejar de fumar/uso de tabaco Planificación Familiar/Metodos anteconceptivos Medicamentos no recetados (aspirina, Advil, medicamentos a base de hierbas, etc.)

11. ¿Que tipo de parto tuviste?

Vaginal Cesariá Planeada Cesariá de Emergencia NA/Aun no e tenido a mi bebé

12. ¿Que metodo de paga usaste para tu cuidado prenatal o para el parto? Medicaid Seguro medico privado Pago por propia cuenta

Otra ____________________________

13. ¿Después del parto, regresaste a ver a tu médico, enfermera o partera?

Sí – sí la respuesta es sí, ¿cuanto tiempo después del parto? ______________________

No No segura/no recuerdo NA/Aun no e tenido a mi bebé

14. ¿Eligiste un pediatra (doctor para bebés) antes de dar a luz a tu bebé?

Sí No

15. Por lo regular, usas una computadora para revisar el correo electrónico, buscar información o conectarte con otros? Favor de seleccionar todo lo que apliqué :

Facebook /Myspace Twitter Leer blogs Buscar información sobre la salud Leer las noticias locales Otro: (liste) ____________________________________

25. ¿Prefieres recibir informacion atravez del internet? Sí No

26. ¿Usas el teléfono para recibir mensajes de texto? Sí No

27. ¿Hay algunos servicios de los cuales sientes que no recibiste durante tu embarazo o espués de dar a luz y que te hubiera gustado recibir? ___________________________________________________________________________

28. Como padre de un bebé o niño pequeño, me gustaria aprender más sobre: ________________________________________________________________________________

Cualquier otro comentario: ________________________________________________________

GRACIAS POR TOMAR TIEMPO EN COMPLETAR ESTA ENCUESTA Enviar por correo: 301 3rd St. NW, Ste 200, Winter Haven, FL 33881 Enviar por fax: (863) 297-3045

Si estas interesada en ser parte de un “focus group” para hablar sobre algunos de los problemas en esta encuesta favor de completar esta porcion. Tus respuestas son estrictamente confidenciales.

NOMBRE:_________________________ NUMERO DE TELÉFONO:_________________

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APPENDIX C

SOURCE REFERENCES

SOURCE REFERENCES American Congress of Obstetricians and Gynecologists, National Fetal and Infant Mortality Review Program, FIMR Project Links, retrieved from http://www.acog.org/departments/dept_notice.cfm?recno=10&bulletin=1267 March of Dimes, Quick Reference Fact Sheets, Stillbirth, retrieved from: http://www.marchofdimes.com/professionals/14332_1198.asp#causes March of Dimes, Quick Reference Fact Sheets, Smoking during Pregnancy, retrieved from: http://www.marchofdimes.com/professionals/14332_1171.asp March of Dimes Task Force on Nutrition and Optimal Human Development. 2002. Nutrition Today Matters Tomorrow: A Report from the March of Dimes Task Force on Nutrition and Optimal Human Development. March of Dimes, Pregnancy & Newborn, Health Education Center, retrieved from http://www.marchofdimes.com/pnhec/240_1031.asp United States Department of Health and Human Services, Office on Women’s Health. 2009. Frequently Asked Questions: Prenatal Care. Healthy Start Coalition of Hardee, Highlands and Polk Counties, Inc. 2016. Polk County Teen Pregnancy Prevention Alliance 2015. State of Florida, Department of Health, Office of Planning, Evaluation, and Data Analysis. Community Health Assessment Resource Tool Set, 2015. National Association of County and City Health Officials. 2004. Mobilizing for Action through Planning and Partnerships. U.S. Department of Health and Human Services. The 2015 HHS Poverty Guidelines. Florida State University Center for Prevention and Early Intervention Policy. 1997. Florida’s Children: Their Future Is In Our Hands. Healthy Start Coalition of Hardee, Highlands and Polk Counties, Inc. Fetal and Infant Mortality Review Summaries, 2014-2016. U.S. Census Bureau, American Fact Finder and Quick Facts. United States Census 2015 and State and County Quick Facts. October 2015 and April 2016.

http://www.acog.org/departments/dept_notice.cfm?recno=10&bulletin=1267

http://www.marchofdimes.com/professionals/14332_1198.asp#causes

http://www.marchofdimes.com/professionals/14332_1171.asp

http://www.marchofdimes.com/pnhec/240_1031.asp

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