2011 – 2016 service delivery plan · 2020-01-05 · 2011 – 2016 service delivery plan . the...

2011 – 2016 SERVICE DELIVERY PLAN

The Healthy Start Coalition of Flagler & Volusia Counties, Inc. 109 Executive Circle Daytona Beach, FL 32114 Phone: (386) 252-4277 Fax: (386) 252-4270 www.healthystartfv.org

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EXECUTIVE SUMMARY

The Healthy Start Coalition of Flagler and Volusia Counties is pleased to present this 2011 – 2016 Five Year Service Delivery Plan. This plan is the culmination of assessment of need, analysis of resources and gaps, review of challenges, barriers and strengths, and setting of priorities and corresponding action planning.

This plan would not be possible without the dedicated professionals and stakeholders from the public and private sectors who devoted their time and expertise to the service delivery planning process. Our service delivery planning members include representation from health, human services, education, policy, consumer and the business sectors.

We have enjoyed many accomplishments since the last five year plan was completed. Our prenatal and infant screening rates have significantly increased and many of our core outcome and performance measures exceed rates accomplished by the state as a whole.

While it is good to acknowledge and celebrate successes, our true test is how well we acknowledge and address challenges and deficits. Through the process of needs assessment, our community has identified specific areas where we must focus our resources and activities. Specific challenges that are focal areas of this plan include health disparities, particularly in infant mortality, low birth weight and entry into prenatal care. In addition our community identified teen pregnancy outcomes associated with births to very young teens age 10 to 14, and subsequent births to teen mothers as an issue requiring strategic planning and action.

A new area of strategic planning and action includes response to the significant increase of babies born to women with substance abuse problems. Statewide and locally, the number of babies born with neonatal abstinence syndrome as the result of maternal substance use has become unacceptable and action must and will be focused and sustained. We currently lack the data needed to effectively target our efforts, but we are actively working with state and local partners to better understand the nature and scope of the problem. Only in this way can we efficiently target our financial and human resources. An emphasis is placed on training field staff to improve their efficacy in coordinating services and interventions with the affected population.

And finally, a major direction our Coalition looks toward in the next five years is a commitment to family engagement and empowerment. Through our work with our local stakeholders, Florida Department of Health’s Early Childhood Comprehensive Systems and Georgetown University, we have made a solid commitment to engage family consumers as equal partners in our Coalitions activities. This service delivery plan outlines this commitment in concrete terms to include integration of five critical protective factors into our service programming. We are adopting a framework known as “Strengthening Families” in order to support a systemic and comprehensive means of meeting our outcome objectives while working with families and the community to develop stronger neighborhoods and healthier children.

We are confident that this plan will serve as a guide for our service area and all those who care about the wellbeing of our future.

Dixie L. Morgese, Executive Director Healthy Start Coalition of Flagler & Volusia Counties, Inc.

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“You have been telling the people that this is the eleventh hour, now you must go back and tell the people that this is the hour.

And there are things to be considered...

Where are you living? What are you doing?

What are your relationships? Are you in right relation?

Where is your water? Know your garden.

It is time to speak your Truth. Create your community. Be good to each other.

And do not look outside yourself for the leader.”

And then he clasped his hands together, smiled, and said, “This could be a good time! There is a river flowing now very fast. It is so great and swift that there are those who will be afraid. They will try to hold on to the shore. They will feel they

are being torn apart and will suffer greatly.” “Know the river has its destination. The elders say we must let go of the shore, push off into the middle of the river, keep our eyes open, and our heads above

the water.” “And I say, see who is in there with you and celebrate. At this time in history, we are to take nothing personally, least of all ourselves. For the moment that we do,

our spiritual growth and journey comes to a halt.” “The time of the lone wolf is over. Gather yourselves!”

“Banish the word struggle from your attitude and your vocabulary. All that we do now must be done in a sacred manner and in celebration.”

“We are the ones we have been waiting for.”

Hopi Creed

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ACKNOWLEDGEMENTS

Sponsored in part by the State of Florida, Department of Health

Carrie Baird, Executive Director, One Voice for Volusia

Kimberly Beck-Frate, Halifax Health Laurie Bell, PhD, Certified Nurse-Midwife, Halifax OB/GYN Associates Pamela Carbiener, MD, Halifax OB/GYN Associates, Faculty, Florida State University Darlinda Copeland, Chief of Operations, Florida Hospital Memorial Margaret Crossman, MD, Family Health Services, Halifax Health Catherine Davis,, Stewart-Marchman ACT Behavioral Health Care Dr. Alma Dixon, Bethune Cookman University Anne K, Ferguson, MPH, Director, The Chiles Academy Charter School for Pregnant and Parenting Teens at The Bonner Center Full Service Community School Lisa Funchess, Volusia County Health Department Richard Fay, LCSW, Therapist, Infant Mental Health and Developmental Specialist, A Helping Hand, Inc. Wandrea Grier, Supervisor, Healthy Start, Stewart Marchman ACT Behavioral Health Care Rhonda Harvey, Stewart Marchman ACT Behavioral Health Care Marilyn Heck, Circuit 7, Department of Children and Families Marie Herrmann, MD, Volusia County Medical Examiner Karen Horzepa, Program Director, Children’s Advocacy Center Don Jones, Chaplain, Volusia County Sheriff’s Department Mark Jones, Executive Director, Community Partnership for Children Karen Kennedy-Tyus, Licensed Midwife, Owner/Operator, Agape Midwifery Lynn Kennedy, One Voice for Volusia W. David Kerr, Department of Juvenile Justice Patricia Kruse, PhD., Certified Nurse Midwife, Halifax OB/GYN Associates Pastor John Long, Senior Pastor, Tubman King Community Church, VITAS Innovative Hospice Care Maria Long, African American Faith-based Bereavement Initiative and Lifesong Initiative Paula Meek, Florida Hospital Memorial Birth Center Jeremy Mirabile, MD, Addiction Medicine, Stewart Marchman ACT Behavioral Health Care Patricia Modad, MD, OB/GYN Dixie Morgese, Executive Director, Healthy Start Coalition of Flagler & Volusia Counties, Inc. Leslie Pearce, Contract Manager and FIMR Coordinator, Healthy Start Coalition of Flagler & Volusia Counties, Inc. Nancy Perkins, Vice President, Outpatient Services, Stewart Marchman ACT Behavioral Health Care Cher Philio, MPA, Marketing and Education Director, Healthy Communities, Halifax Health Celeste Phillips, MD, Volusia County Health Department Barbara Preston, Healthy Start Supervisor, Outreach Community Care Network, Inc. Hussain Rawji, MD, OB/GYN, Volusia County Health Department Gladys Roman, LPN, Stewart Marchman ACT Behavioral Health Care Mary Ann Ruddy, WIC Coordinator, Volusia County Health Department Judy Ryan, Director, Children’s Medical Services Judy Seltz, Healthy Start Program Director, Stewart Marchman ACT Behavioral Health Care Bonita Sorensen, MD, Director, Volusia County Health Department Andrea Thorpe, MD, Pediatrician, Keech Street Clinic, Halifax Health Rebecca Vernon, Birth Center Director Florida Hospital Memorial Alicia Vincent, Program Director, Project WARM, Stewart Marchman ACT Behavioral Health Care Jan Wagner, Halifax Health Sue Wagner, Flagler County Schools Bonnie Welter, Nursing Director, Flagler County Health Department

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The Healthy Start Coalition of Flagler & Volusia Counties, Inc. Service Delivery Plan 2011 – 2016

Table of Contents

I. INTRODUCTION .................................................................................................................. 1 A. Healthy Start Initiative .......................................................................................................1 B. The Healthy Start Coalition of Flagler and Volusia Counties .....................................1 C. Major Accomplishments of the Past Five Years ...........................................................2

1. Community Partnerships and Initiatives ......................................................................... 2 2. Improvements in Healthy Start Service Delivery ........................................................... 7 3. FIMR Project ................................................................................................................ 10 4. Comprehensive Training Plan....................................................................................... 11 5. Service Delivery Planning Process ............................................................................... 11

II. DESCRIPTION OF PROCESS AND MODEL USED TO UPDATE THE NEEDS ASSESSMENT, RESOURCE INVENTORY AND ACTION PLAN ................................... 12

A. Summary of Data Sources .............................................................................................12 1. Florida Vital Statistics and US Census Data................................................................. 12 2. Healthy Start Screen and Service Data ......................................................................... 12 3. Fetal and Infant Mortality Review (FIMR) Data .......................................................... 13 4. Consumer and Provider Input ....................................................................................... 13 5. Community Agenda Snapshot ...................................................................................... 14 6. North East Florida Counts ............................................................................................ 14 7. Data Limitations............................................................................................................ 14

B. The Planning Process ....................................................................................................15 1. Needs Assessment ......................................................................................................... 15 2. Resource and Gap Analysis .......................................................................................... 15 3. Priorities and Strategies ................................................................................................ 16

C. Model Utilized ..................................................................................................................16 III. SUMMARY OF NEEDS ASSESSMENT FINDINGS ............................................... 18

A. Core Outcome Indicators ...............................................................................................18 1. Fetal and Infant Mortality ............................................................................................. 19 2. Birth Weight.................................................................................................................. 26 3. Entry into Prenatal Care ................................................................................................ 28

B. Contributing Risk Factors ...............................................................................................31 1. Teen Pregnancy ............................................................................................................. 31 2. Poverty .......................................................................................................................... 32 3. Sexually Transmitted Diseases (STDs) ........................................................................ 34 4. HIV Cases ..................................................................................................................... 35 5. Births to Unmarried Mothers ........................................................................................ 35 6. Single Householders in Flagler and Volusia Counties ................................................. 36

C. Analysis of Healthy Start Screening .............................................................................37 1. Overview of Significance of Screening ........................................................................ 37 2. Screening Data .............................................................................................................. 37 3. Risk Factor Findings from Screening Data ................................................................... 37

D. Analysis of Healthy Start Services ...............................................................................42 1. Service Review by Zip Code & Race ........................................................................... 42 2. Trend Analysis by Number and Intensity ..................................................................... 43

IV. SERVICE AREA RESOURCE ASSESSMENT AND INVENTORY ...................... 46

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A. Consumer Input ...............................................................................................................46 1. PYRAMID SUMMIT ................................................................................................... 46 2. Healthy Start Participant Satisfaction Survey ............................................................... 47

B. Resource Inventory .........................................................................................................48 1. Medical Providers ......................................................................................................... 49 2. Overall Resource Update .............................................................................................. 49 3. Resources Gained.......................................................................................................... 54 4. Resources Lost .............................................................................................................. 57 5. Service Gaps ................................................................................................................. 58

V. TARGET POPULATION, INDICATORS, STRATEGIES & FIVE YEAR GOALS .. 61 A. Target Population ............................................................................................................61

1. General Population Characteristics ............................................................................... 61 2. Educational Attainment ................................................................................................ 62 3. Employment and Income .............................................................................................. 64 4. Pregnancy and Young Child Profile ............................................................................. 65

B. Needs Assessment Summary .......................................................................................69 C. Changes from Previous Service Delivery Plan ...........................................................70 D. Selected Indicators and Five-Year Goals ....................................................................71 E. Strategies to Address Five-Year Goals .......................................................................72

VI. ACTION PLAN IN CATEGORY A, B, C FORMAT .................................................. 78 A. Planning Summary Sheet & Category “A” Activities ..................................................78 B. Category “B” Activities ....................................................................................................84

VII. ALLOCATION PLAN FOR SERVICE DOLLARS FOR FY 2011-2016 .............. 123 VIII. QUALITY ASSURANCE/IMPROVEMENT PLAN .................................................. 125

A. Methodology ...................................................................................................................125 B. Healthy Start Quality Monitoring Calendar ................................................................126

IX. CONCLUSION .............................................................................................................. 127 X. APPENDICES................................................................................................................... 128

Appendix A – Healthy Start Board and Coalition Members ...........................................129 Appendix B – Service Delivery Plan Committee Members and Work Plan .................132 Appendix C – Healthy Start Prenatal and Infant Risk Screening Forms ......................133 Appendix D – Methodology for SDP Outcome Objective Development and Implementation ......................................................................................................................134 Appendix E – Report on Prenatal Screening Responses by Individual Item FY2009 - 2010 .........................................................................................................................................142 Appendix F – Prenatal and Postnatal Risk Factors .........................................................144 Appendix G – Local Resource Inventory for Pregnant Women .....................................145 Appendix H – SDP Major Accomplishments over the Last Five Years ........................171 Appendix I – Service Delivery Planning Timeline ............................................................172 Appendix J – Fishbone Analysis .........................................................................................173

The Healthy Start Coalition of Flagler & Volusia Counties, Inc. 2011 – 2016 Service Delivery Plan

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I. INTRODUCTION

A. Healthy Start Initiative

In 1991, the Florida Legislature launched the Florida Healthy Start Initiative (s.282.2161, F.S.) to ensure that all babies born in the state of Florida be given the opportunity to have a healthy start in life. The goals of Healthy Start are to reduce infant mortality, reduce the incidence of low birth weight and improve the overall health of Florida’s children. The key components of the statute mandated (1) universal screening of pregnant women and newborn infants to identify those at risk of poor birth, health and developmental outcomes; (2) increased access to comprehensive, risk-appropriate maternity and well-child care and support services; (3) state-wide implementation of community-based care coordination systems; (4) expansion of Medicaid funding and expanded eligibility for pregnant women; and (5) formation of local coalitions to spearhead system change through public-private partnerships at the community level and leverage additional resources. The statute ultimately vested these coalitions with the authority to allocate state and federal dollars to purchase and oversee services for families in their communities. It is now evident that the wisdom of those legislators has contributed to saving the lives of thousands of children during the twenty years.

Healthy Start Coalitions are non-profit organizations dedicated to improving the health of pregnant woman and babies in their community. The state’s 32 Coalitions are partnerships comprised of volunteers from all segments of the community who work together to ensure that keys services are in place for pregnant women, infants and their families. Together these Coalitions participate in statewide activities as members of the Florida Association of Healthy Start Coalitions, or FAHSC. Members include local, public and private medical professionals, representatives of local hospitals, school districts and social service agencies, faith-based representatives, local business men and women, consumers of maternal and child health services and other interested community members. The comprehensive diversity and inclusion of coalition membership provides the venue for communities to come together to identify and address local health problems and implement coordinated systems of care through which the unique needs of that particular community may be met. The legislatively mandated responsibilities of each Coalition include: increasing public awareness of the issues related to infant mortality; building and maintaining broad community support; selecting and contracting with local providers for the delivery of Healthy Start services; performing on-going monitoring and evaluation of contracted services and conducting short and long range planning for the local maternal and infant populations.

B. The Healthy Start Coalition of Flagler and Volusia Counties

The Healthy Start Coalition of Flagler and Volusia Counties was founded in 1992 as the result of a collaborate effort among many local individuals, organizations and governmental entities. The founding organizations included the Constituency for Children of Volusia and Flagler Counties, the Volusia County Children & Families


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Advisory Board (formerly the Volusia County Children’s Services Council); Volusia County Health Department, Flagler County Health Department, Halifax Medical Center and the United Way of Volusia and Flagler Counties.

The Coalition’s membership has expanded significantly since inception, as has the scope and depth of its responsibilities as defined through its contracts with multiple funding entities. The Coalition’s primary objective is to work with the community through fund leveraging and allocation, strategic planning, and service delivery to improve the health of our community’s maternal and infant population.

At present, our Coalition has a structured governance with components designed to ensure quality oversight in the areas of business and financial management, service delivery, resource allocation, marketing, leadership, and fund development.

C. Major Accomplishments of the Past Five Years

Our Coalition has worked diligently with community leaders and stakeholders over the last five years to improve our system of care and increase our impact in the two-county service area. Some of our significant accomplishments are listed below:

1. Community Partnerships and Initiatives

In each community there are various systems that must coordinate and collaborate in order to improve maternal and child well-being. Research tells us that we cannot improve outcomes for a target population without making strides for the well-being of people across the life span. This cannot happen unless we understand and address a broad array of indicators related to the quality of life for our entire community. For this reason, our Coalition staff, volunteers and providers have aligned with and participated in partnerships and initiatives to ensure that we are an integral part of a continuum of care for our service area and our families.

Though there are a multitude of partnerships and initiatives we have participated in for the last five years which cannot all be listed in this report, we have summarized some of those that have had significant impact for our Coalition and our mission.

a. One Voice for Volusia

The Healthy Start Coalition has taken a leadership role in a broader coalition building initiative known as One Voice for Volusia. One Voice for Volusia advocates for efficient use of resources and data-driven outcomes and promotes system and community improvements by fostering diverse partnerships in the health and human services field. One Voice for Volusia is a neutral convener engaging leaders, organizations and individuals to develop strategies to improve the community. One Voice for Volusia has been a more global umbrella under which we have been able to garner support and momentum.


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1) Community Agenda Snapshot - This annual report is the result of hundreds of volunteers committed to making Volusia and Flagler Counties a better place to live, work and play. The motivation behind this work is to create a data-based picture of health and social service trends and conditions that are updated every year. This initiative is a long term process, community-shaped and community driven, to fulfill the goal of the initiative. It is designed to engage the community by examining data and establishing priorities to improve local health and human services.

The Community Agenda Snapshot was an instrumental document in the development of our needs assessment and service delivery plan development and is referenced throughout this document.

Our Coalition is represented on the Steering Committee of the Community Snapshot Agenda and has benefitted greatly from the experience of examining a broad array of data throughout the year and being able to contribute our expertise regarding maternal and child health and well-being.

2) Thrive by Five - One Voice for Volusia expanded upon the Community Snapshot Agenda in 2008 by focusing a special report on the data and needs of our prenatal through age five population. This resulted in the convening of stakeholders in our community who focus specifically on the target population in the form of a Thrive by Five Steering Committee and a greater collaborative. The Thrive by Five collaborative began developing a strategic plan in 2009 to make progress in core areas that impact our young families and their children. This strategic plan has gained significant momentum and has assisted stakeholders in more efficiently and collaboratively focusing our efforts. For the Healthy Start Coalition, it provides a forum that we can align with and contribute to that reduces duplication of effort and capitalizes on the ongoing convening and mobilizing of our mutual stakeholders.

a) Infant Mental Health Chapter of Volusia and Flagler Counties - This subcommittee of Thrive by Five convenes to take on special projects based on emerging trends in the community that impact families with infants and young children. The Healthy Start Coalition co-hosts these committee activities with The House Next Door, a community-based agency devoted to family counseling and well-being. In the last three years, our Chapter has focused on Fetal Alcohol Spectrum Disorder, Opiate and Opioid Addiction in pregnant women and parents with young children and how to respond as a community through training, policy development, and mobilization.

b) Starting Out Strong - Staff from One Voice for Volusia convene business leaders in order to educate and mobilize them to invest in the


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future through tactical community solutions focusing on the prenatal through age five population.

c) PYRAMID Summit - One Voice for Volusia applied for and received a technical assistance grant to the Florida Department of Health Early Childhood Comprehensive Services and Georgetown University. Representatives from these entities worked with our collaborative from fall of 2010 through with a primary objective of engaging families and caregivers as equal partners in our systems of care. This process assisted our Coalition in recognizing that although we have actively sought consumer feedback and have been fortunate to have consumers of our on various committees, we have not fully understood and integrated parent engagement. The PYRAMID Summit culminated in spring of 2011 with a two day event that enabled families and providers to unite to develop a strategic plan for ongoing parent engagement, parent involvement, and parent empowerment. Since that time, parents and providers have mobilized and united to implement strategies in the plan to include a Community Cafe model in which families have a space and venue of their own by which to support one another and develop ways in which to develop the five protective factors within their parent community in partnership with agencies. The five protective factors include:

Parental Resilience – The ability to cope and bounce back from all types of challenges

Social Connections – Friends, family members, neighbors and other members of the community who provide emotional support and concrete assistance to families

Concrete Support in Time of Need – Financial security to cover day-to-day expenses, unexpected costs, crisis services and access to formal assistance like TANF and Medicaid

Knowledge of Parenting and Child Development – Accurate information about raising children and appropriate expectations for their behavior

Social and Emotional Competence of Children – A child’s ability to interact positively with others and communicate his or her emotions effectively

This innovative and exciting development will be a major theme in our service delivery framework and aligns with statewide and national initiatives designed to improve the well-being of families and their children.


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These concepts are currently being integrated into the Thrive by Five Strategic Plan as well as the Healthy Start system of care. We are committed to leveraging funds to support and sustain this initiative.

b. Lifesong

The origins of this initiative began in 2007 during our first SIDS Sunday event, when we printed and distributed over 5,000 church fans to over 80 churches in Volusia and Flagler Counties. We have continued this event each year and connected to groups such as the Black Clergy Alliance and Bethune Cookman University, a historically Black College located in Daytona Beach. Our connection to these groups led to a more meaningful dialogue about the need for a more concerted effort to educate the Faith Community about the nature and scope of the extreme disparities in infant mortality.

Lifesong is a partnership initiative with the African American Faith Based Community to address the significant disparities in fetal and infant mortality, other health indicators, and health access. This project incorporates music, song, narrative, art and dance to engage the faith community and inspire empowerment and organization toward supporting better health outcomes. Though this initiative is in its infancy stages, our Coalition is developing meaningful and sustainable relationships with key leaders in the Faith Community. The dialogue toward improved awareness about the nature and scope of black infant mortality and health disparities is gaining momentum. Lifesong has developed a logo for branding the project and is the final stages of completing a video for presentation to the church leaders.

c. Beds for Babies

This initiative garners community support for leveraging of financial assistance to purchase safe sleep environments for families who cannot afford one as well as materials to distribute to all families about the importance of safe sleep and how to ensure babies remain safe while they sleep. In the last 5 years over $33,000.00 has been leveraged to purchase thousands of safe sleep environments for families in our community. Funds have been leveraged from Junior League, Rotary, and fundraising by private donors. We will continue to support safe sleep.

d. Leadership Development

Several activities related to leadership development have been implemented and sustained in the last five years. Interacting with the business, civic and education sectors benefits our Coalition's goals and objectives in numerous ways as described below:


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1) Childwatch - Healthy Start’s Child Watch program builds public/private partnerships with the business sector through the Chamber of Commerce Leadership program. Over 250 community leaders have experienced this program since its inception. This is a full day experience that educates leaders about the return on investment potential when maternal and child health and wellbeing is a priority in the community. Participants tour the Halifax Health Neonatal Intensive Care Unit and hear from medical and legal experts about the economic and health impact of babies who are born too small and too soon. They are then offered the opportunity to talk one on one with consumers of our Healthy Start services and participate in a panel discussion with teen mothers. Finally, they tour early childhood development environments where they can see and touch babies and toddlers who are healthy and being cared for in safe and stable environments. Participants are informed about how they can make a difference by members of our Board of Directors as the program concludes.

2) Internships - During the last Service Delivery planning cycle the Healthy Start Coalition sponsored over six internships with students from Stetson University, Drexel University, Bethune Cookman University, University of North Florida, Sewanee: The University of the South, and Daytona State College. Interns included graduate and upper graduate level students aspiring to excel in the fields of nursing, social work, human services, midwifery, and marketing.

3) Student Training - Students from the University of Central Florida School of Nursing and the Bethune-Cookman School of Nursing were provided positive learning experiences with participants in the Healthy Start and Healthy Families programs. The students received instruction on the Interconception Education curriculum, and worked with clients to assess health risks. The students then reviewed information with clients regarding health care access, family planning, nutrition, oral health, drug, alcohol and tobacco use, and physical activity. In addition, Bethune Cookman students participated in the Fetal Infant Mortality Review Case Review Team, and one student was able to coordinate with the Volusia County Medical Examiner on a fetal loss case. These opportunities assisted the academic institutions in providing real life experiences and increased their students’ understanding of maternal and child health issues.


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4) Summer Youth Employment Program - Perhaps one of the most rewarding experiences we had in supporting leadership was in the Workforce Development Summer Youth Employment Program in coordination with The Chiles Academy and Workforce Development. Our placement was a graduate from The Chiles Academy who assisted in office operations and co-facilitated focus groups with her peers to help in the development of social marketing tools for young pregnant and interconception women. This program funded 100% of the salary and we provided training that will support future employment opportunities.

5) Workforce Development and Employee Training - The Center for Business Excellence has been a valuable partner in assisting us in providing training and employment support opportunities for Healthy Start employees. Their programs and services have been an asset toward leadership development among our agency staff.

2. Improvements in Healthy Start Service Delivery

a. Core Outcome Measures

Since FY 05/06, the Coalition has made significant progress in improving prenatal and postnatal screening rates, Level 3 services, and increased volume of enhanced services to include childbirth education, breastfeeding education and support, interconception care, and in the last fiscal year, smoking cessation. The tables below reflect a comparison between these core outcome measures from the last five year service delivery plan to present.

Figure 1. Increases in Screening Rates from FY05/06 to FY10/11

Prenatal Screening Rates Postnatal Screening Rates Flagler County from 86.25 % to 109.44% from 58.10% to 79.38% Volusia County from 56.94% to 98.42 % from 53.36% to 81.82% Service Area from 60.81% to 100.07% from 53.99 % to 81.46%

Figure 2. Increase in Level 3 Services from FY05/06 to FY10/011

Flagler County from 5.87% to 10.00% Volusia County from 4.69% to 8.85% Service Area from 4.84% to 9.01%

Figure 3. Increase in Enhanced Services from FY05/06 to FY10/11

Flagler County from 3.15% to 12.04% Volusia County from 3.22% to 15.60% Service Area from 3.21% to 15.12%


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b. Vulnerable Populations

There has been a focused effort to address the needs of pregnant women and families with young children who are particularly vulnerable due to homelessness, incarceration, drug and alcohol use, HIV and other sexually transmitted diseases, age (teenagers), and domestic violence. Several strategies were developed and successfully implemented as part of our service delivery system to include:

Memorandum of Agreements with key agencies and institutions who serve these populations such as family emergency and transitional shelters, the Volusia County Branch Jail, the Domestic Abuse Council, the Community Partnership for Children, The Chiles Academy for Pregnant and Parenting Teens, and Stewart Marchman ACT Behavioral Health Care, Community Partnership for Children and the Department of Children and Families.

Specialized referral processes to streamline services to potential participants in high risk settings.

Implementation of a Women’s Intervention Specialist who can conduct outreach, screening, initial contact and assessment for women who are identified with or suspected of having a problem with alcohol or other drugs during their pregnancy. This position is responsible for coordinating access to substance abuse treatment and multi-disciplinary staffing to support appropriate interventions during pregnancy and after delivery.

Training of direct service staff regarding coordination of services for vulnerable populations.

Leverage of additional funds to expand capacity to serve eligible families. Increased community awareness through media and public presentations

about the needs and challenges of vulnerable populations. Increased enhanced services to include psychosocial counseling for families

in need who may have had difficulties accessing these services in the past. Support of Easy Access clinics utilizing midwives to reduce barriers to

receiving supportive prenatal, post partum, and interconception care. Establishment of a midwife at The Chiles Academy for Pregnant and

Parenting Teens one time weekly. Participation in the MAMA Bear program which is a collaborative staffing of

women who are pregnant and have HIV or other sexually transmitted diseases. Our involvement in this program allows us to work closely with the Volusia County Health Department, Children’s Medical Services, HIV Case Management and private providers to effectively coordinate services and follow up with identified pregnant women and their babies.

Coordination with the Early Learning Coalition to provide for stable quality child care for vulnerable families while they seek employment, attend counseling or parenting, or gain respite during crisis.

Coordination of Healthy Start Initial Contact and Assessments in the three birthing centers so that services are initiated prior to discharge from the hospital.


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Integration of the Healthy Families premiere home visiting program's assessment into the Maternal and Child Assessment Center to screen and assess families at high risk for child abuse and neglect.

c. Flagler County Prenatal Health Care

In 2008, the Coalition began a Public and Private Partnership with the Flagler County Health Department and Halifax OB/GYN Associates to address the fact that women could only be seen by the ARNP at the Flagler County Health Department through their second trimester. This lack of continuity of care resulted in interrupted prenatal care for pregnant women in Flagler County and women being lost to contact and frustrated with services. This partnership included allocation of funding resources for prenatal health care to the Flagler County Health Department as well as implementation of services by three Certified Nurse Midwives from Halifax OB/GYN Associates with obstetrician back up as needed. This allowed continuity of service from the first trimester through delivery of the baby with Healthy Start Care coordination and wrap around services.

Since the implementation of this initiative, related outcomes in Flagler County have steadily improved. Screening, first trimester entry into care, and infant mortality outcomes have seen marked improvement.

1) Fetal, Neonatal & Infant Mortality

• Decreasing trend in Infant Mortality after four years of increases. • Since 2008, a decreasing trend in Neonatal Mortality in Flagler County,

which remains lower than the State rate (which has remained fairly constant over the same time period).

2) Low Birth Weight

• Decreasing trend in Low Birth Weight for Flagler County, which also remains below the State rate.

3) Very Low Birth Weight

• Decreasing trend in Very Low Birth Weight in Flagler County, which remains lower than the State rate.

4) Entry into Prenatal Care

• Increasing trend in First Trimester Entry into Prenatal Care in Flagler County

• Significant decrease and downward trend in Late/ No Prenatal care in Flagler County


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3. FIMR Project

During the last five years, the Fetal and Infant Mortality Review activities have resulted in activities and publications to increase community and provider awareness about infant and fetal loss. FIMR now convenes a data workgroup regularly to review information related to causes of death and strengths and

weaknesses in the system in order to better coordinate with service delivery staff to address areas of need. In addition, the Coalition conducts a pre-FIMR meeting to review initial abstraction data to ensure information is properly de-identified and information is comprehensive and has been properly entered into the BASINET data system. In Fiscal Year 2010/2011 FIMR successfully completed a publication titled Project INFORM (Infant, Neonatal, and Fetal Outcomes Related to Mortality). This publication provides a comprehensive view of fetal and infant mortality in the two-county service area as well as a summary of FIMR findings and recommendations for systemic change.

In addition to Project INFORM, the FIMR committee worked with the Healthy Start Coalition Marketing Committee and local medical and service providers to develop and publish a Grief Toolkit for providers to share with families who have experienced a loss.

This toolkit is available to all providers and contains practical information about family bereavement support, interconceptional health, genetic counseling, and community resources. This toolkit is presented in an attractive folder or may be obtained through the Healthy Start website.

Our Coalition now enters all infant deaths into the BASINET data system even though the review team only reviews 28 cases annually.

Life Song An initiative with the African

American Faith based community to address infant and fetal loss

and interconception health. Project Inform

A publication designed to educate the community about FIMR &

Infant Mortality

Data Subcommittee Regular review of

FIMR data to identify trends & systemic issues.

Prenatal Access Group Public–Private Partnership to address local & state policy regarding Medicaid & access to prenatal health services

Grief Toolkit A specially designed toolkit to

help families process their grief when they have lost an

infant/child

FIMR Community Action

Group

Figure 4.


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The FIMR Community Action Group has accomplished several milestones to change service delivery and increase awareness about fetal and infant deaths and the FIMR process, itself. The Community Action Group is at the center of several activities that will continue to be integrated into the five year plan. (See Figure 4.)

4. Comprehensive Training Plan

Early in the previous Service Delivery Planning cycle, our Coalition began putting our energy toward development of a comprehensive training plan for our service delivery staff. This is a systemic way to ensure that all field staff has the knowledge, skills and competencies required to navigate an often complicated system of care. As part of the training plan requirements, we integrated cultural competence into all aspects of clinical training components.

Jennie Joseph, Founder and Director of Commonsense Childbirth and School of Midwifery provided valuable consultation and training activities during this process. This resulted in all of our field staff receiving certification in childbirth education and breastfeeding support and education. Their efficacy in these areas has improved as measured by both staff feedback and client satisfaction.

Ms. Joseph also provided organizational cultural competence training for all staff and community partners as well as Coalition agency employees.

5. Service Delivery Planning Process

The Service Delivery Planning process has been improved through systemic review of data and action planning objectives using the MAPP process (Mobilization for Action through Planning and Partnerships). The Healthy Start Coalition adjusted its timeline for Coalition meetings to ensure that quarterly reports can be reviewed publicly after the 25th of the month following a quarter. In this way, core performance measures are reviewed in relation to our action plan objectives with stakeholders convened to determine which strategies are effective and which strategies may require modification. This promotes an open evaluative process where stakeholders can openly discuss the need for programmatic or systemic change in order to meet objectives. This follows the MAPP process of Evaluation, Planning, Implementation and Action.

This provides for ongoing planning and a more informed and mobilized Coalition who participates more fully in the five year planning process because they are an active part of action planning throughout the year. This also allows our action plan to be a living guide that stakeholders are familiar with and feel empowered to change when needed.


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II. DESCRIPTION OF PROCESS AND MODEL USED TO UPDATE THE NEEDS ASSESSMENT, RESOURCE INVENTORY AND ACTION PLAN

The Healthy Start Coalition of Volusia/Flagler continually strives to identify and meet the emerging needs of the communities it serves. Information relating to local population characteristics, current and past birth outcomes, health indicator data related to birth outcomes, reported service needs, perinatal services utilization, and local area resources was compiled from multiple sources to serve as the basis for the most current Healthy Start needs assessment

Healthy Start participant feedback and information relating to specific health status and service delivery indicators are collected and compiled regularly by the coalition’s staff and management team each year. The organization periodically conducts a full comprehensive needs assessment during each service delivery planning cycle, which then serves as the foundation for the next Service Delivery Plan. The full assessment incorporates additional consumer and provider surveys, more detailed indicator and service data, and active community input and feedback, which is organized into a detailed analysis of local maternal and child health needs.

Upon completion of the analysis of the Needs Assessment findings, the Coalition identified priority areas for Action Plan development. In addition to the MAPP process (Mobilizing for Action through Planning and Partnership), we have developed a visual model which aligns data, assessment findings, priorities, strategies, and anticipated outcomes.

A. Summary of Data Sources

1. Florida Vital Statistics and US Census Data

The health status indicator and demographic data utilized in the assessment process was obtained from accessible Florida Vital Statistics databases, the Florida Department of Health’s web site, special data reports generated upon request by the Department of Health, and the U.S. Census Bureau. All of the data and information that was considered during the needs assessment and subsequent planning processes is available for review as a supplement to this document.

2. Healthy Start Screen and Service Data

In addition to serving as the entry point to the Healthy Start system of care, Healthy Start prenatal and infant screens also serve as a vital source of data that, when combined with other sources, help to create a vivid illustration of the circumstances and conditions that local consumers face each day. Data from completed Healthy Start screens is recorded daily into a statewide database. Summary reports generated by geographic location, race, ethnicity, etc. allow researchers to identify community-specific issues and trends among expecting mothers and their babies. The screening instruments address a wide variety of topics to identify potential risk factors for poor perinatal outcomes, and are often the only available documentation


13

of specific risks, behaviors and circumstances that occur within a particular community. It is important to note however, that the screening data is based on client self-report, and reflects only what was documented and processed by the individuals who administer the screen. Therefore, the information may be affected by such issues as: fear among consumers about disclosing specific behaviors, staff turnover, and inconsistent reporting methodologies. For this reason, the data generated and collected from these tools are considered as minimum estimates of the actual occurrence of each factor and/or behavior.

Healthy Start services provided throughout the state are coded on a regular basis into the Florida Department of Health’s service data management system. De-identified, aggregate reports regarding the number and type of Healthy Start services provided in each county are updated by the Department of Health on a monthly basis and are available through the Department’s website. These reports are invaluable tools in implementing effective quality management of Healthy Start services and systems of care, and for identifying and monitoring various trends in service provision

3. Fetal and Infant Mortality Review (FIMR) Data

The findings of this committee relating to the leading causes of death and relevant associated risks were compiled and discussed among the Service Delivery Plan Committee members as an integral part of the needs assessment process. A report of FIMR findings titled Project INFORM assisted the community stakeholders in reviewing, understanding, and incorporating this data.

4. Consumer and Provider Input

In addition to utilizing hard data from existing sources, Healthy Start conducts periodic surveys among local consumers, Healthy Start participants, and area medical service providers. Healthy Start participant satisfaction surveys are conducted semi-annually, while separate surveys pertaining to local consumer needs are distributed to both consumers and medical providers during each full needs assessment cycle. The surveys are intended to solicit feedback regarding existing service needs and the quality and effectiveness of existing services from targeted communities and from various perspectives. The survey process is an invaluable component to the comprehensive assessment process in that it allows for quantitative data collection and provides an avenue for both citizens and providers to express their needs and opinions regarding local programs and services.

Toward the conclusion of FY 2010/2011, the Healthy Start Coalition participated in the Thrive by Five PYRAMID Partnership Summit. (Parents and Youth Reaching Amazing Milestones with Initiative and Dedication) This was an inspiring event that yielded extremely valuable feedback from families who utilize our community’s system of care. Our ability to have meaningful guided conversations with families provided data for this plan that integrates parent engagement and empowerment as an integral part of our efforts and services.


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5. Community Agenda Snapshot

The Coalition's active role in the development of the Community Agenda Snapshot and the finalized document itself proved invaluable to the gathering of information about related indicators and data trends in our community. The heart of the Snapshot features 43 unduplicated data indicators displayed as five year trends. The original core of indicators was identified and recommended by nearly 200 community members prior to its first publication. Selected data sets from the Snapshot were used and referenced in the development of the Needs Assessment.

6. North East Florida Counts

Northeast Florida Counts is a one-stop source of population data and information about community health in a dashboard design. It is hosted by the North East Florida Planning Council and the Healthy Start Coalition of Flagler and Volusia Counties participated in indicator selection and provided monetary support for its development. The site includes and compares indicators for Baker, Clay, Duval, Flagler, Nassau, St. Johns, and Volusia Counties health with other Florida counties, the nation, and national targets (Healthy People 2020; University of Wisconsin / Robert Wood Johnson’s County Health Profiles) using more than 175 health and community sustainability indicators.

7. Data Limitations

Overall, it is important to note that all data comes with limitations. Data sets have been compiled from numerous sources and may not be perfectly aligned with one another. Some data are presented in rolling averages and others by single year with the most current data available. Any conflicting data has been verified to provide for the most accurate accounts available. Furthermore, many data sets in the Service Delivery Plan are illustrated in graph form but their sources are referenced for further review if desired.

Data that is presented by service area must also be reviewed in their proposer context. Flagler County consistently has less than 1,000 births annually and therefore may seem to show severe fluctuations, even though it may be the result of two or less incidents of an outcome indicator, such as infant mortality. This is an important factor to consider when attempting to identify trends for analysis.

Through the process of conducting needs assessment activities, we were able to identify data sets that need to be developed and analyzed more thoroughly in the future. Development of new data sets requires that initial baselines be established and that multi-year averages be determined before the data can be validated. These are described further in our Action Plan. One example is in the area of substance exposed newborns. Wherever possible, we have coordinated with local and state partners to identify sources of data that can be obtained to gain a better understanding of the nature and scope of a particular issue impacting maternal and child health and well-being.


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B. The Planning Process

The Service Delivery Planning process is an ongoing activity that takes place each quarter with reports of outcomes presented by all providers and stakeholders. The focus on the five year service delivery plan began in October 2009. A timeline of the Service Delivery Planning process is provided in Appendix I. Our timeline was designed to mobilize key stakeholders for specific tasks required to complete the five year plan. The phases of the timeline are described as follows:

1. Needs Assessment

a. Phase I - The Comprehensive Needs Assessment began with convening of the Healthy Start provider agencies to review Healthy Start Service Delivery data in relation to core performance measures and outcomes and the ongoing action planning of the Coalition.

b. Phase II - The second phase of the Needs Assessment process brought all community stakeholders together to review the findings of the provider agency group and begin to review related indicator data.

c. Phase III - The large group divided into subcommittees based on specific indicators and conducted an assessment of the indicator data in their related area. Each subcommittee identified co-chairs and developed their own timelines and meeting schedules. Healthy Start staff responded to requests for data and meeting support as needed. The large group convened one time monthly to share their findings and build consensus about action plan strategies.

Based on the preliminary needs assessment data, the following areas were chosen for further needs assessment and strategy development:

1) Infant Mortality 2) Black Infant Mortality 3) Low Birth Weight 4) Entry into Prenatal Care 5) Screening - prenatal and postnatal 6) Teen Pregnancy 7) Substance Exposed Pregnant Women and their Babies

d. Phase IV - Each subcommittee finalized their review of the available data related to their indicator and made recommendations to the whole committee for priorities and strategies. The group built consensus and established the priorities and strategies included in this plan.

2. Resource and Gap Analysis

The Healthy Start Coalition works throughout the year to maintain a directory of available resources for pregnant and post partum women and their families. In


16

addition, we update our website monthly to ensure that resources are available to families and community based providers as well as health care providers. The committee conducted a review of the Resource Guide and also conducted a systemic overview of identified gaps in the system utilizing resources such as United Way’s “211” system. This information was considered carefully as the Service Delivery Plan was developed and priorities and activities were determined.

3. Priorities and Strategies

Priorities were established based on extensive review of the data and resources and gaps. Throughout Fiscal Year 2010/2011, each subcommittee reviewed the existing strategies in their indicator area and determined which strategies should be expanded upon and which new strategies should be developed based upon available data. The entire group reconvened several times over the summer of 2011 and the final strategies were voted on.

C. Model Utilized

It is important to ensure that the findings of the Needs Assessment translate into priorities and strategies that aim to improve outcomes. Accordingly, the Coalition utilized a model which provides a logical process for aligning data, assessment, priorities, strategies and outcomes into a table format for easy viewing and action planning as illustrated on the next page. Our model is based on components of the MAPP model shown below in Figure 5.

Figure 5.


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The model shown in Figure 6 guides us in action plan development. Each Core Outcome Indicator (as discussed in Section III. Summary of Needs Assessment Findings) is isolated into an individual table which provides the framework for strategy development. Data and assessment findings are referenced in the first two columns to ensure that priorities and strategies are logically developed. Service Delivery Committee members initiated the tables and strategies which support the allocation plan. The service delivery workforce was then consulted to provide input about the feasibility of identified strategies as well as additional strategies that could be implemented in the field with existing resources. See Appendix G.

Once aligned, anticipated outcomes are established as a means for ongoing evaluation of the strategies incorporated into the Action Plan. This model serves to assist the Healthy Start Coalition accomplish the following objectives:

• Ensure the Action Plan is directly linked to the Needs Assessment. • Provide Coalition Members with a simple format for Service Delivery Plan

updates and future strategic planning that takes the elements of MAPP - Evaluate, Plan, Implement a step further.

• Provide key stakeholders with the rationale for allocation decisions and future funding requests.

• Address service gaps with targeted strategies and outcomes. • Provide a framework for Continuous Quality Improvement that is data-

driven.

Compile Data

Conduct Assessment

Identify Priorities

Develop Strategies

Review Outcomes

Implementation

Figure 6. Methodology for Service Delivery Plan Outcome Objective Development and Implementation

Figure 6.


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III. SUMMARY OF NEEDS ASSESSMENT FINDINGS

A. Core Outcome Indicators

There are multiple ways to measure maternal and child health. The health outcome indicators that were reviewed during this planning process were selected based on contractually required outcomes as well as commonly referenced state and national measures (for comparisons). For example, Infant Mortality is widely accepted throughout the United States and Florida as not only a primary indicator of maternal and child health, but also a primary indicator of the overall health of a community. Additional indicators were identified through discussions among the Service Delivery Plan Ad-Hoc Committee members during the monthly planning meetings, and supplemental data was subsequently gathered and presented if not already available. Primary indicators that were considered during the development of future goals and strategies included: female population rates, birth rates, fetal and infant death rates, low and very low birth weight rates, first trimester entry into prenatal care, late or no entry into prenatal care, rates of tobacco use, Healthy Start screening rates, and utilization of Healthy Start services. Each indicator was reviewed in detail by county, race/ethnicity, and various age groups. Specific disparities that were revealed during this process are summarized under a separate heading at the end of this section for the purpose of collective analysis.

Data related to overall births, fetal mortality and infant mortality/morbidity are from the Florida Department of Health, Office of Vital Statistics. Included are data sets by year and in rolling averages from 2005 to 2009. FIMR data are from BASINET (Baby Abstracting System and Information Network) and include a compilation of data from 2008 to 2010. For this reason, FIMR data do not have epidemiological significance and are presented as an overview of the cases reviewed and what the process revealed about those specific cases.

Figure 7. Birth Data Comparison by State and Service Area Counties 2005 – 2009.

Total Births

2005 2006 2007 2008 2009

Florida 226,219 237,166 239,120 231,417 221,246

Flagler County 689 942 988 899 869

Volusia County 5,093 5,263 5,417 5,257 5,099

Data Note: The state total for the denominator in this calculation may be greater than the sum of county totals due to an unknown county of residence on some records. Data Source: Florida Department of Health, Bureau of Vital Statistics


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Figure 7. above is a chart showing the total births in Florida as well as Flagler and Volusia Counties. Births in the state and our service area experienced a decline in the last two years.

1. Fetal and Infant Mortality

The loss of a baby is one of the most devastating experiences a family can endure. Outcomes of this nature may serve as indicators for many factors surrounding birth, including but not limited to: the health of the mother, prenatal care, and quality of the health services delivered to the mother and infant care. In addition, high infant mortality rates are often considered preventable and thus can be influenced by various education and care programs. (Source: United Health Foundation, America’s Health: State Health Rankings, 2004 Edition)

a. Fetal Mortality

Fetal deaths are reported by Florida Vital Statistics as those that occur beyond 20 weeks of gestation. As seen in Figure 8, Florida as a whole has maintained a stable rate of approximately 8.0 fetal deaths per every 1,000 live births since 1998, with the last three years (2007-2009) decreasing to an average of 7.3 fetal deaths per every 1,000 live births. Volusia and Flagler Counties decreased to below the State rate in 2002 through 2009 with some variances. Flagler County has seen a greater variance in fetal mortality, in part due to the low number of births annually.

Figure 8. Rate of Fetal Mortality by State & County, 2000-2009

Fetal Death Rates for Volusia County and the State

3.04.05.06.07.08.09.0

10.011.012.013.0

2000-2002

2001-2003

2002-2004

2003-2005

2004-2006

2005-2007

2006-2008

2007-2009

Three Year Rolling Averages

Rat

e P

er 1

000

Live

Birt

hs +

Fe

tal D

eath

s Flagler

Volusia

Florida


20

Figure 8a. Rate of Fetal Deaths by Race and Ethnicity, 2002-2008

Fetal mortality in Volusia shows a significant disparity between White and Hispanic and Black Fetal Deaths. Fetal mortality is most prevalent among Blacks in both counties. Meanwhile, rates among Hispanic mothers have varied slightly in both counties during the past decade, with fluctuations in calculated rates being attributed to a relatively low number of occurrences overall in this population group.

b. Infant Mortality

Figure 9. Rate of Infant Mortality by State, Service Area & County, 1999-2009

There have been notable fluctuations in infant mortality in both counties in the service area with a significant increase in Volusia County's rate between 2006 and 2008 even though the state remained fairly stable. During the last three year rolling average, both the state and the service area have shown a decline.

Rate of Infant Mortality by State, Service Area & County1999-2009

4.5

5.0

5.5

6.0

6.5

7.0

7.5

8.0

8.5

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

2004-2006

2005-2007

2006-2008

2007-2009

Rate

per

Tho

usan

d Li

ve B

irths

Flagler

Volusia

Florida

Volusia County Fetal Death Rates by Race and Ethnicity

0.02.04.06.08.0

10.012.014.016.018.0

2002-2004 2003-2005 2004-2006 2005-2007 2006-2008


Rat

es p

er 1

000

Live

Birt

hs

White

Black

Hispanic


21

While rates have declined overall, the disparity between Black, Hispanic and White babies show disparity, with the rate of black infant deaths showing an increase since 2007. The rate of White infant deaths is 3.2 per 1,000 live births, while Blacks show a rate of over 16.0 during the last recorded three year rolling average from 2007 to 2009.

Figure 9a. Rate of Infant Mortality with Rolling Averages for Service Area

Figure 9b. Rate of Infant Mortality by Service Area & Race and Ethnicity, 1999-2009

Among residents of both Volusia and Flagler, infants born to Black mothers were more than three times as likely of to die during their first year of life than those born to White or Hispanic women.

During 2009, the Healthy Start Coalition conducted quadrant studies to review areas of impact. Since the last planning cycle, we had targeted the 32120 zip


22

code for Black Infant Mortality. As noted in the chart below, rates declined as of 2008, the most current data we had at the time of the quadrant study.

Figure 9c.

c. Neonatal Mortality

Figure 10. Rate of Neonatal Mortality by State & County, 2000-2009

Of the babies that died before their first birthday, neonatal deaths are defined as those that died between birth and the first 28 days of life. Trends in neonatal mortality are very similar to those of overall infant mortality in both Volusia and Flagler Counties. Of the 31 total deaths in the Service area in 2009, 17 deaths occurred during the first 28 days of life.

d. FIMR Findings

The FIMR approach was developed by the American College of Obstetrics and

Rate of Neonatal Mortality By State & County, 2000-2009

2.5

3.0

3.5

4.0

4.5

5.0

5.5

2000-2002

2001-2003

2002-2004

2003-2005

2004-2006

2005-2007

2006-2008

2007-2009

3 Year Rolling Averages

Rate

Per

100

0 Li

ve B

irths

Flagler

Volusia

Florida

Infant Mortality Rates by Race and Ethnicity in 32720 DeLand

0.0

10.0

20.0

30.0

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

2004-2006

2005-2007

2006-2008

3 Year Rolling Average

Rat

e Pe

r 100

0 Li

ve B

irths

32720 White32720 Black32720 Hispanic


23

Gynecology (ACOG) and includes an abstraction of information from birth, death, medical, hospital, autopsy, and social service records. Whenever possible, family interviews are also conducted. All information is “de-identified” to ensure that the focus is on systemic strengths, challenges, and recommendations and not on individual providers. Confidentiality is a key component to the process and is strictly maintained in accordance with Florida Statutes 766.101.

The CRT is a multidisciplinary team of professionals who volunteer their time and expertise to this process. These members are representative of the public and private sector and include physicians, nurses, midwives, medical examiners, public health officials, law enforcement, academic institutions, clinical staff from various health and human services fields, and hospital administration.

The Volusia/Flagler Fetal and Infant Mortality Review (FIMR) team is comprised of medical and social service professionals including the county’s Medical Examiner, and four additional physicians (representing OB/GYN, Pediatrics, and public health), five Registered Nurses, and at least two public health representatives. The team meets quarterly to thoroughly examine all available documentation surrounding the loss of both unborn babies as well as infants that were less than one year of age at the time of death.

A Nurse Abstractor reviews all available documentation in the mother and child’s medical records (physician office and hospital), the medical examiner’s report, and vital statistics information from the Volusia County Health Department, and compiles a summary report. In addition, specially trained staff conduct a home visit and personal interview with the mother when she volunteers to develop a more complete picture of all of the factors and circumstances leading up to the death of the child. The nurse’s complete abstract report is then presented along with the findings from the interview process to the committee for a full review. All identifying information is removed in order to protect the confidentiality of the family and the various providers involved in the case.

The review process allows health professionals, support workers, and social service providers to jointly analyze each case from multiple perspectives simultaneously; and to collaboratively discuss strategies to help prevent reoccurrences of the same factors, in the same combinations, for future mothers. This process is critical in that it is often the only opportunity for all of the different providers surrounding a complicated case to come together and discuss the various needs and barriers that may have contributed to the tragic outcome. Crucial issues relating to the service system as a whole are often identified through the efforts of the FIMR team.


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Deaths Due to Leading Causes of Infant Mortality for 2009

Perinatal Conditions _____________________________ 12 Unintentional Injury _______________________________ 3 Congenital Anomalies _____________________________ 7 Heart Disease ___________________________________ 1 Sudden Infant Death Syndrome _____________________ 4 Other Causes ___________________________________ 4 (Data Source: Florida Department of Health, Office of Vital Statistics, 2009)

e. FIMR Recommendations

The following recommendations have resulted from the activities of the FIMR Case Review Team and the Healthy Start Community Coalition. These recommendations have been incorporated into a five-year Service Delivery Plan in an effort to improve outcomes in Volusia and Flagler Counties.

1) Safe Sleep

Improved provider, community and patient awareness about safe sleep and prevention of sleep-related death.

Increased distribution of safe sleep environments to those who do not have a crib or safe place for their infant to sleep.

2) Breastfeeding

Increase the number of women who successfully breastfeed their babies for a minimum of ninety days.

Ensure all direct service providers have training in breastfeeding support and that all patients receive information about the benefits of breastfeeding and where to obtain support.

3) Preconception and Interconception Health

Improve community education about the importance of health care access and positive health related behaviors for women of reproductive age. This includes family planning/baby spacing, smoking cessation, discontinuing consumption of alcohol or other drugs, achieving optimal weight, and obtaining and maintaining a permanent medical home.

Educate the community about the prevalence of obesity and the importance of incorporating this general health focus into all aspects of care. Healthy Start services for the baby should also focus on helping the mom lose her weight postpartum.


25

4) Abuse of Alcohol and Other Drugs

Provide responsive drug and alcohol treatment intervention services to patients who are affected. Respond to the growing issues associated with prescription drug use.

Provide for preconception and interconception counseling, referral and intervention for women of reproductive age who are receiving services for addiction.

Coordinate with residential, outpatient and detoxification services on behalf of pregnant and post partum women who may endanger their children as a result of their alcohol or drug use.

Coordinate with prenatal health practitioners to encourage effective screening methods for early identification and intervention for pregnant women who may be using alcohol or other drugs.

5) Prenatal Care Access

Educate Medicaid eligible women about the importance of prenatal services and the most effective ways to navigate through the health care system.

Support of EASY ACCESS centers where women can receive immediate and low or no cost prenatal health services.

Develop public/private partnerships among all sectors of the health community to ensure the most cost-effective, quality services available to low income or uninsured pregnant women.

6) Pediatric Access

Ensure newborns are linked to pediatric services BEFORE they leave the hospital.

Follow up with very high risk families within 72 hours of discharge from the hospital whenever possible.

7) Collaboration

Determine mechanisms for more effective collaboration between medical, hospital, social services and the patient to support better pregnancy outcomes.

8) Follow-Up after Loss

Develop a provider “Grief Toolkit” to assist practitioners in supporting patients who have experienced an infant or fetal loss.

Educate providers and patients in clinic and hospital settings about the availability of Healthy Start services for psychosocial support, linkage to genetic counseling, and interconception education and support.


26

Conduct public venues for families that have experienced pregnancy or infant loss as a means to provide bereavement support if needed and connect them to interconception services if they are still of reproductive age.

9) Health Disparities

Engage stakeholders in the faith community and health care profession to increase awareness of the significant disparities in maternal and child health affecting people of color.

2. Birth Weight

a. Low Birth Weight

Figure 11. Rate of Low Birth Weight by State & County, 1998-2009

Figure 11, shown above, reflects the rates of Low Birth Weight (LBW) in three year rolling averages from 1998 to 2009. While Volusia County's rate has seen a steady increase since 2004-2006, Flagler County has shown a decrease. Both rates are below the state rate. Since implementing a new prenatal model in partnership with the Flagler County Health Department in and Halifax OB/GYN Associates in 2007, which provides a one-stop approach utilizing volunteer midwives, fetal and birth outcomes and prenatal care access overall in Flagler County have shown marked improvement.

Rate of Low Birth Weight by County & State 1999-2009

65.0

70.0

75.0

80.0

85.0

90.0

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

2004-2006

2005-2007

2006-2008

2007-2009


Rat

e Pe

r 100

0 Li

ve B

irths

Flagler

Volusia

Florida


27

Low Birth Weight Rate by Race and Ethnicity of Mother

60.0

70.0

80.090.0

100.0

110.0

120.0130.0

140.0

150.0

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

2004-2006

2005-2007

2006-2008

2007-2009


Rat

e Pe

r 100

0 Li

ve B

irths

White

Black

Hispanic

Figure 11a. Low Birth Weight by Service Area and Race & Ethnicity, 1999-2009

Figure 11a, above shows 3 year rolling averages of Low Birth Weight by Service Area and Race & Ethnicity. This data reflects a disparity among Blacks babies (12.5%) with Low Birth Weight as compared to White Babies (7.0%) and Hispanic Babies (5.2%) for time period of 1998-2009.

b. Very Low Birth Weight

Figure 12. Rate of Very Low Birth Weight by State & County, 1998-2009

The findings for infants born at a Very Low Birth Weight (VLBW), less than 1,500 grams (or approximately 3 pounds) are shown above in Figure 12. This data reflects the rates of Very Low Birth Weight (VLBW) in three year rolling averages from 1998 to 2009. The State of Florida reflects a fairly constant Very Low Birth Weight rate with both Flagler and Volusia Counties below the State rate. Flagler County shows a steady decline while Volusia County shows a steady increase.

Very Low Birth Weight Rate (< 1500 Grams) by County and State

11.012.013.014.015.016.017.018.019.0

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

2004-2006

2005-2007

2006-2008

2007-2009


Rat

e Pe

r 100

0 Li

ve B

irths

Flagler

Volusia

Florida


28

Figure 12a. Rate of Flagler County VLBW Rates by Race & Ethnicity, 1999-2009

Figure 12a, above shows 3 year rolling averages of Very Low Birth Weight for Flagler County by Race & Ethnicity. This data reflects a VLBW disparity for Blacks babies with a declining trend from 2005 to 2009 and a slight increase in the Hispanic rate. The white rate has remained fairly static during the same time period.

3. Entry into Prenatal Care

a. First Trimester Entry into Prenatal Care

Figure 13. 1st Trimester Entry into Prenatal Care by State & County, 1999-

1st Trimester Entry Into Prenatal Care by State & County

70.0

75.0

80.0

85.0

90.0

95.0

1999-2001 2000-2002 2001-2003 2002-2004 2003-2005 2004-2006 2005-2007 2006-2008 2007-2009


Perc

enta

ges

FlaglerVolusia Florida

Rate of Very Low Birth Weight Rate (<1500 Grams)by Race and Ethnicity of Mother

0.05.0

10.015.020.025.030.035.040.0

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

2004-2006

2005-2007

2006-2008

2007-2009


Rate

Per

100

0 Li

ve B

irths

White

Black Hispanic


29

2009

Figure 13, shown above, reflects data of mothers entering prenatal care in the 1st trimester by state and county for the time period of 1998-2009. Most recently, from 2007-2009, data reflects a slight increase in entry in prenatal care for the State of Florida, Flagler and Volusia Counties by approximately 2%. As with many of the core indicators, Flagler County reflects a more desirable outcome in 1st trimester entry into care.

Figure 13a. 1st Trimester Entry into Prenatal Care by Service Area and Race & Ethnicity, 1999-2009

Figure 13a, above shows 3 year rolling averages of 1st trimester entry into prenatal care by percentage by Race and Ethnicity for the time period of 1998 to 2009. From 2007 to 2009, White Mothers entered care at 75% while Black mothers entered at a rate of almost 15% less during the first trimester, the same as Hispanic women. The Hispanic rate shows an increasing trend, while the Black rate continues a declining trend since 2001-2002.

1st Trimester Entry Into Penatal Care by Race & Ethnicity

55.0%

60.0%

65.0%

70.0%

75.0%

80.0%

85.0%

90.0%

95.0%

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

2004-2006

2005-2007

2006-2008

2007-2009


Perc

enta

ge

White

Black

Hispanic


30

b. Late or No Entry into Prenatal Care

Figure 14. Late or No Entry into Prenatal Care by State & County, 1999-2009

Figure 14, shown above, reflects data of mothers entering prenatal care in the 3rd trimester or not at all, by state and county for the time period of 1998-2005. In 2003-2005, data reflects a slight increase (less than 1%) of late or no entry into prenatal care for the State of Florida, Flagler and Volusia Counties with a decrease in Volusia County and the State since 2006.

Figure 14a. Late or No Prenatal Care By Service Area & Race & Ethnicity, 1999-2009

Figure 14a. above shows three year rolling averages of late or no prenatal care by Service Area and Race & Ethnicity, for the time period of 1998 to 2009. From

Percent of Late or No Prenatal Care by State & County

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

1999-2001 2000-2002 2001-2003 2002-2004 2003-2005 2004-2006 2005-2007 2006-2008 2007-2009


Perc

ent

FlaglerVolusia

Florida

Late or No Prenatal Care by Service Area & Race & Ethnicity

0.0%1.0%2.0%3.0%4.0%5.0%6.0%7.0%8.0%9.0%

10.0%

1999-2001 2000-2002 2001-2003 2002-2004 2003-2005 2004-2006 2005-2007 2006-2008 2007-2009


Perc

enta

ges

White

Black

Hispanic


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2007 to 2009, the rate of black women with late or no prenatal care increased while the White and Hispanic rates show a decrease.

B. Contributing Risk Factors

Multiple studies have indicated that the health of an infant can be affected by any combination of behavioral and social risk factors that may include the mother’s age, marital status, the family’s poverty status, whether or not the pregnancy was intended, the presence of HIV or STDs, poor education, poor nutrition, and even some cultural or religious norms and practices. The planning committee members chose supplemental indicators for this needs assessment through the Perinatal Periods of Risk* concept model for fetal and infant mortality, which employed a corresponding table of primary risk factors in Volusia/Flagler for each of the defined perinatal periods. (*Source: Centers for Disease Control and Prevention and the World Health Organization) The table assisted the members in differentiating between physical risk factors which are often un-changeable and behavioral risk factors which can typically be influenced through education and support. The tools then also allowed the members to trace core risk factors back to the time periods where they can most impact a pregnancy, in order to develop effective intervention strategies. The risk factor table is available as Appendix F in this publication.

1. Teen Pregnancy

Pregnancies among adolescents (ages 10-17 years) are a strong indicator for both current and projected healthcare and social service needs within a region. The United States has one of the highest rates of teen pregnancy and births in the western industrialized world. Some quick facts about teen pregnancy:

Teen childbearing is associated with reduced educational attainment and greater reliance upon welfare services.

Teen mothers are substantially less likely than women who delay childbearing to complete high school or obtain a GED by age 22 (66% vs. 94%).

Fewer than 2% of teens who have a baby before age 18 attain a college degree by age 30.

The children of adolescent mothers are often born at low birth weight, experience health and developmental problems, and are frequently poor, abused, and/or neglected.

Adolescent pregnancy poses a substantial financial burden to society in public assistance, child health care, foster care, and involvement with the criminal justice system.

(Source: http://www.guttmacher.org August 2010)


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Figure 15. Live Births to Teenagers (Ages 10-14 years) by State & Service Area, 2007-2009

2007 2008 2009 Mothers 10-14 Local State Local State Local State

Number 4 376 6 356 9 262 Rate per 1,000 0.2 0.7 0.4 0.6 0.6 0.5

While the total number of live births to teenagers in our Service Area is below the State rate, the number of live births to young women between the ages of 10-14 years of age has increased and has now exceeded the State rate.

Figure 15a. Live Births to Teenagers (Ages 15-19 years) by State and Service Area, 2007-2009


Number 210 8,119 230 7,286 166 6,308 Rate per 1,000 19.0 22.6 20.8 20.4 15.2 17.8

Figure 15b. Percentage of Repeat Births (Mothers Ages 15-19 years) by Service Area & State, 2007-2009


Percentage 17.0 18.6 14.9 18.5 18.7 18.9

In addition to an increase in live births to teens between the ages of 10-14, in 2009, our Service Area has also had an increase in subsequent teen births.

2. Poverty

Poverty is a major contributing factor to poor health outcomes, reduced educational attainment, and child abuse and neglect. Poverty is defined by the U.S. Office of Management and Budget as the number/percent of individuals who live below the U.S. poverty threshold, which was $21,756 for a family of two adults and two children in 2009. The number of people living in poverty has steadily increased since 2005. According to Kids Count data, in Volusia County as of 2009 there were 73,142 people living in poverty, or 15.2% of the population.


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Figure 16. Volusia County Numbers and Percentages of Persons and Children Living in Poverty

All Persons in Poverty (Number)

2005 2006 2007 2008 2009 54,854 62,089 68,393 62,490 73,142

All Persons in Poverty (Percent) 2005 2006 2007 2008 2009

11.6% 12.9% 14.1% 12.9% 15.2%

Children Under Age 18 in Poverty (Number) 2005 2006 2007 2008 2009

15,575 16,969 21,284 18,215 22,755

Children Under Age 18 in Poverty (Percent) 2005 2006 2007 2008 2009

16.2% 17.9% 22.1% 19.2% 24.3%

Figure 16a. Percent of Children under Age 18 below Poverty Comparisons for Florida and Volusia and Flagler Counties

Overall, Volusia County has the highest percentage rate of children living below the poverty level at 24.3% in 2009 as compared to Flagler at 21.9% and Florida at 21.5%. The increase from 2005 to 2009 shows increases for both the Service Area and the State of Florida. This poses a challenge for our families, our workers and our system of care.

http://datacenter.kidscount.org/data/bystate/Rankings.aspx?state=FL&ind=5318&dtm=11834





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3. Sexually Transmitted Diseases (STDs)

The occurrence of sexually transmitted diseases (STDs) is a strong indicator for unsafe sexual practices, and can be studied among specific population groups. STDs such as Chlamydia and Gonorrhea have been proven to disproportionately affect the poor, under-educated, and minority communities when compared to the general population. One significant trend in Sexually Transmitted Disease is in rates of Chlamydia, which has increased over the past three years in both Volusia and Flagler Counties.

Figure 17. Volusia County Rates of Chlamydia 2007- 2010

Figure 17a. Flagler County Rates of Chlamydia 2007, 2008, 2009, & 2010

Chlamydia Incidence Rate – Volusia County per 100,000

Chlamydia Incidence Rate – Flagler County per 100,000


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There is a growing concern about the number of young women becoming infected with STDs. Of the total 245 female cases of STDs in Flagler County in 2010, 112, or 46% were to young women between the ages of 15-19 years of age. In Volusia County, in 2010 there were a total of 1629 total female cases, 598, or 37% were between the ages of 15-19.

Source: Florida Department of Health, Division of Disease Control, Bureau of STD data files. 2010.

4. HIV Cases

Figure 18. Rate of New HIV Cases Comparison for Florida, Volusia and Flagler Counties, Per 100,000 Population, for Single Year from 2005 - 2009

The rate of new HIV cases in Volusia and Flagler Counties are below the State rate.

5. Births to Unmarried Mothers

Babies born to unmarried mothers are more likely to face poor birth outcomes when compared to their married-parent counterparts. For the period of 2007 – 2009, the Service Area total number of births was 18,524. Of these, 8,994 (49%) were to unmarried mothers. For the same time period, by race, the total number of births to White mothers was 14,954, or 81% of the total births, and 19% were to mothers who were Black. As reflected in Figure 19, for White mothers, 37% of those residing in Flagler County were unmarried. In Volusia County, 45% were unmarried. Figure 19a shows the married versus unmarried rate among Black mothers for the same time period by county, with the unmarried rate in Flagler County at 59% and in Volusia County, a very high rate of 71%.


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Figures 19. and 19a. show births by marital status for Flagler and Volusia Counties for 2007-2009 with Figure 19 reflecting births by marital status to White mothers and Figure 19a for Black mothers. Both races

Figure 19.

Figure 19a.

Source: Florida Charts, Birth Query System 2007-2009

6. Single Householders in Flagler and Volusia Counties

In 2009, of family households with children, female householders represented 7.3% of the total in Flagler (2,579) and 6.7% of the total in Volusia (12,913). Male householders represented 2.4% in Flagler and 3.5% in Volusia. While being unmarried and pregnant is identified as a risk factor, it is important to note that in our two county service area, there are a total of 5,591 male householders with children. (Family Households with Children: Flagler N=9,475 and Volusia N=47,356).

(Source: U.S. Census 2009 American Community Survey)


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C. Analysis of Healthy Start Screening

1. Overview of Significance of Screening

Healthy Start Prenatal Screening is intended to be available to all pregnant women and babies through their health care provider, and was developed to assist providers and Healthy Start staff in determining the mother’s eligibility for Healthy Start services. The tool was designed as an objective first step toward identifying any relevant risk factors or existing needs relating to the health of a woman’s pregnancy. This pre-screening for Healthy Start services has been identified as a priority opportunity for improvement in Volusia and Flagler Counties.

2. Screening Data

a. Prenatal and Postnatal Screening

As shown on the next figure, prenatal screening rates increased significantly since the last Service Delivery Plan.

Figure 20. Prenatal and Postnatal Screening Rate Comparisons from 2005 to 2010:

Prenatal Screening Rates Postnatal Screening Rates Flagler County from 86.25 % to 109.44% from 58.10% to 79.38% Volusia County from 56.94% to 98.42 % from 53.36% to 81.82% Service Area from 60.81% to 100.07% from 53.99% to 81.46%

The increase in screening rates is important because the higher the rate, the more significant the risk factor data is that we can gather from it. At the time of this report, 2010 screening data was available so it was included. When the percentage rate exceeds 100% it is because rates and percentages were based on anticipated number of births.

3. Risk Factor Findings from Screening Data

a. Prenatal Care

Entry into prenatal care is an important indicator for our service area and our Coalition has conducted several studies surrounding our rates for 1st Trimester Entry to Care and Late or No Entry to Care. Our area, as well as the State of Florida, experienced a decline in 1st Trimester Entry to Care from 2002 to 2009. In our Service Area, Flagler County has begun to see an increase since 2007, when a new model of “One Stop” prenatal services was implemented in partnership with the Flagler County Health Department. Though Flagler County has remained above the State rate, Volusia County declined below the State in 2005 and has remained lower since that time, with very small gains. (See Figure 13.) Flagler County is below the State and Volusia County in the percent of


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women with Late or No Entry into prenatal care. Volusia is above the State rate. (See Figure 14)

As with many other indicators, there is a disparity in prenatal care access between Black and White women. While women whose race is White show a steady increase in 1st Trimester entry into care since 2006 to 2009 (73% to 75%), Black women show a steady decline since 2002 (76% to 65%). In addition, the percent of women with Late or No Entry to prenatal care has increased among Black women since 2005, while rolling averages for 2007-2009 show a decline for both White and Hispanic women (See Figure 14a).

An analysis of FY 2009/2010 Prenatal Screening data showed that the Service Area postal zip code with the highest number of women with late or no entry to prenatal care was in the 32114 zip code. This area is the Greater Daytona Beach area and Holly Hill, a small city just north of Daytona Beach. Of 474 screens reviewed, 276 (58%) entered care in the first trimester while 198 (42%) entered in the second trimester or later. Of those, 17 (.4%) entered in their third trimester. Two zip codes in close proximity to 32114, are 32117, and 32118, In postal zip code 32117, of the 226 screens completed, 142 (63%) entered prenatal care in the first trimester, while 84 (59%) entered in their second trimester or later. In 32118, of 83 screens completed, 43 women entered prenatal services in their first trimester, while 40 women (48%) entered in their second trimester or later. Of those, 10 women (25%) entered in their third trimester.

Another analysis of prenatal screening information for entry into prenatal services was done on the Southeast quadrant of Volusia County, which includes New Smyrna, Edgewater, and Oak Hill. Although there is a Health Department office there, other prenatal services to this area are extremely limited and there is no birthing center at their hospital. Of the 327 screens reviewed, 229 (70%) entered prenatal care in their first trimester, while 98 (30%) entered prenatal care in the second trimester or later. Of those, 29 (30%) entered in their third trimester.

In Deltona, which is the most populated city in the two-county Service Area and located on the west side of Volusia County, a total of 533 screens were reviewed from zip codes 32739, 32728, 32738, and 32725. Of the 533 screens, a total of 378 entered prenatal care in their first trimester (71%), and 155 entered in the second trimester or later. Of those, 19 entered in their third trimester (12.3%).

A review by race shows that of the 3,761 screens reviewed, 815 were of women who self identify their race as Black. Of these 815 screens reviewed, 491 (60%) entered prenatal services in their first trimester and 324 (40%) entered in the second trimester or later. Of those, 40 women (8.1%) entered in their third trimester.


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Our Coalition will work to increase awareness about the importance and availability of care and conduct outreach activities to identify and link potential participants.

b. Marital Status

Of pregnant women of all races screened in the two county service area in 2009, 60.20% were unmarried. By county, the percentage in Flagler County was 53.80% and in Volusia County the percentage was 61.40%. Among White mothers, the percentage was 55.70% for the service area, 49.30% in Flagler and 57.00% in Volusia. For women whose race was Black, the percentage was higher at 79.40% for the service area, 71.0% in Flagler and 80.80% in Volusia.

We reviewed screening rates by postal zip codes and focused on those areas with the largest numbers. The highest percentages for unwed mothers for all races was in the 32114 zip code (central Daytona Beach) and the lowest rate was in postal zip code 32128 (Port Orange). In Flagler County, the postal zip code with the highest rate was 32110 (Bunnell) at 68.60%, the lowest in zip code 32137 (Palm Coast).

c. Unintended Pregnancies

Regardless of a mother’s health and socioeconomic circumstances, whether or not she had any prior intentions of becoming pregnant may play a large role in her health during her pregnancy and ultimately her baby’s birth outcomes and developmental outcomes. The percent of mothers who reported that they had not planned their current pregnancy increased from 10.2% in 2001 to 11.7% by 2008 and 13.5% in 2009 for the service area. Flagler County also experienced an increase in this indicator during the same time period. Flagler’s rate of 4.3% in 2001 increased to 9.60% by 2008 and 12.20% in 2009.

There were racial disparities indicated by the screening data. Black mothers in both counties were more likely than White or Hispanic mothers to report that their pregnancy was unplanned. The overall rate for White mothers in the service area who did not want to be pregnant was 9.30% in 2008 and 11.2% in 2009 as compared to Black mothers who reported a rate of 22.6% in 2008 and 23.4% in 2009.

Defining “unintended pregnancy” when reviewing screening data for the Service Area below includes responses to the screening questions regarding the timing of the pregnancy. Women who responded that they preferred to be pregnant ‘later’ or ‘not at all’ were both included in the analysis of “unintended pregnancy” below by race and by zip code. This is an important distinction and is meant to illustrate the areas where pre- and inter-conception education service is most needed.


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Screening information by zip code reveals similar trends to that of entry into prenatal care. In the 32114 zip code (Daytona Beach) of the 474 prenatal screens reviewed, 330 (70%) of the women responded that they would prefer to be pregnant later or not be pregnant at all. In the Southeast quadrant (New Smyrna, Edgewater, and Oak Hill), there were a total of 327 prenatal screens reviewed. A total of 133 (41%) responded that this was a good time to be pregnant and 194 (59%) responded that they would have preferred to be pregnant later or not be pregnant at all.

This trend indicates a need to focus on preconception and interconception education and health care access to ensure that women of reproductive age have adequate resources to prevent unwanted pregnancy.

d. Tobacco Use during Pregnancy

Tobacco use during pregnancy has been a major concern in Volusia and Flagler Counties. Smoking during pregnancy can negatively influence multiple birth outcomes; and has been proven to be especially associated with low birth weight. The rate of mothers who smoke during pregnancy in Volusia/Flagler has consistently exceeded the statewide average. In 2008 a reported 25.1% of pregnant women screened reported tobacco use during their pregnancy with a 4% decline in 2009 to 21.6%. The rate of tobacco use during pregnancy is higher among White pregnant women than those who are Black. In 2008, the percentage of White women who reported tobacco use during pregnancy was 32.4% for the service area as compared to 11.90% among Black women. In 2009, the rate among White women decreased to 27.6%, while the rate among Black women remained the relatively same at 11.8%. Overall, the decline is steadily heading downward. In 2007, the service area percentage was 25.5%, with White women at a very high percentage of 32.2%


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Figure 21. Resident Live Births to Mothers Who Smoked during Pregnancy Rolling 3 Year Percentage of Live Births

Volusia County has a disproportionate number of women who smoke during pregnancy when compared to Florida as a whole.

Figure 21a. Percentage Rates of Tobacco Use during Pregnancy for Single Years 2007- 2009 by Postal Zip Codes.

Postal Zip Code 2007 2008 2009

32110 (Bunnell, Flagler) 41.1% 25.5% 29.8% 32127 (Port Orange, Volusia) 40.8% 36.7% 29.4% 32141 (Edgewater, Volusia) 32.5% 37.1% 28.3% 32168 (New Smyrna Beach, Volusia) 28.9% 32.4% 26.4% 32174 (Ormond Beach, Volusia) 24.8% 26.4% 26.1%

Of all races, the zip code areas with the most significant rates of tobacco use during pregnancy were 32110 (Bunnell, Flagler County), 32127 (Port Orange), 32141 (Edgewater), 32168 (New Smyrna Beach), and 32174 (Ormond Beach).


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e. Education

Figure 22. Mothers with Less than High School Education, by County 2009

Mothers Education Attainment

Flagler Volusia Total

< High School 95 921 1016 High School Graduate or Higher 769 4,155 4,924

Unknown 5 23 28

Total 869 5,099 5,968 Source: Florida Charts 2009

Figure 22. shows Education Attainment of mothers in Volusia and Flagler Counties who gave birth in 2009. Of these, 18.2% of mothers residing in Volusia County did not have a high school diploma compared to 11.0% of mothers residing in Flagler County for the same period.

The children of parents who have not graduated high school or earned an equivalent degree face much higher rates of poverty, poor nutrition, inadequate healthcare, and being uninsured. Studies also indicate that babies born to mothers who have less than a high school education are more likely to be born at low or very low birth weight. While both Volusia and Flagler Counties have lower rates of babies born to under-educated mothers than the state as a whole; there is a significant difference between the rates in each of the two counties.

D. Analysis of Healthy Start Services

1. Service Review by Zip Code & Race

Figure 23. Percent of Live Births, Fetal Deaths, Infant Deaths, and Healthy Start Services

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

32110 32114 32720 32738 32164

Postal Zip Code

Live Births Fetal Deaths Infant Deaths Healthy Start Services


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Further analysis within the top ranking zip codes also revealed that services were well targeted within each community. The service utilization data indicated that services were provided proportionately to the populations with the greatest needs.

2. Trend Analysis by Number and Intensity

As a result of this expansion in services and funding, the goals of Healthy Start also expanded to include (1) increasing the intensity and duration of Healthy Start services necessary to address the identified needs of the maternal and infant population; (2) increasing the number of enhanced or wraparound services being provided; and (3) potentially increasing the number of women and infants served through care coordination by increasing Healthy Start screening rates.

In order to determine the level of achievement of these goals within the service delivery area over the past five years, the Coalition conducted an analysis of Healthy Start client service data. Sources utilized for analysis included the Healthy Start Executive Summary Reports and the GH330L reports.

a. Increase in Intensity and Duration of Services

In order to increase the intensity and duration of services, Risk Appropriate Care principles must be effectively applied to focus services on those pregnant women and infants who have been identified as the most at-risk for adverse birth, health and developmental outcomes. In the Healthy Start program, Level E and Level 1 represent the least intensive levels of service, and Level 3 the most intensive. Over the course of the last five years, the number of services and intensity increased, with programmatic adjustments for changes in the State’s allocation methodology in fiscal year 2007/2008. The Coalition worked during the last planning cycle to diversify services and developed an RFP process to increase the number of providers who could deliver care coordination services as well as enhanced services. Through the substantial increase in screening rates and assessment services to link participants to services, the volume of services increased as well as the number of participants in Level 3 services. This steady increase continued through Fiscal Year 2008/2009 with a significant decrease in Fiscal Years 2009/2010 and 2010/2011. (See Figure 24.)

b. Increase in Number of Enhanced/Wraparound Services

There are currently seven types of services designated as Healthy Start Enhanced or Wraparound services: Nutrition Education, Psychosocial Counseling, Parenting Education and Support, Childbirth Education, Breastfeeding Education and Support, Smoking Cessation and Interconceptional Education. Over the past five years, the Coalition has increased Enhanced services particularly interconception, and in the last fiscal year, significantly increased smoking cessation services in response to the need.


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c. Increase in Number Served

Figure 24. Annual Comparison of Increase in Number of Participants and Services Provided

Healthy Start Service FY06/07 FY07/08 FY08/09 FY09/10 FY10/11

Prenatal Screen 3,971 5,063 5,236 5,008 4,998

Infant Screen 4,163 5,199 5,252 4,835 5,384

Screened at Risk 2,892 4,014 4,666 5,045 6,737 Received Level 3 Service 283 559 569 781 655

# Receiving Services 5,095 7,129 7,703 8,063 7,273

# Services Received 75,554 96,899 102,228 120,133 83,979

Analysis of Healthy Start service data for Flagler and Volusia Counties also indicates that there has been a significant increase over the past five years in the number of women and infants receiving Healthy Start services when compared to the last planning cycle. The decline in Level 3 services from Fiscal Year 2009/2010 to Fiscal Year 2010/2011 has been reviewed during the needs assessment process. Several factors contributed to the decline to include: transition of service providers, review of leveling system, referral of high risk participants to Healthy Families, utilization of other community resources, and high numbers of women who are “Unable to Locate.” We respond to this decline in our action plan and will continue to monitor Level 3 services and creative outreach strategies.


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Figure 24a.

SERVICE FY05/06 FY10/11 Percent Increase Initial Contact 1,538 2,523 64% Initial Assessment 1,022 1,425 39% Care Coordination 481 2,025 321% Enhanced Services 2,118 15,537 634%

Increases in the number of participants served by type of service (initial contact, initial assessment and care coordination) since the last service delivery plan are significant, as illustrated in the table above. The most significant increases by far have occurred in initial assessment and care coordination services. There has also been a notable increase in enhanced service. Accordingly, a far greater number of at-risk women and infants are being reached and given the opportunity to participate in the program that best meets their needs, and to receive information about other available services and programs. (See Appendix H.)


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IV. SERVICE AREA RESOURCE ASSESSMENT AND INVENTORY

A. Consumer Input

1. PYRAMID SUMMIT

Healthy Start of Flagler and Volusia Counties in partnership with the One Voice for Volusia Thrive by Five Initiative identified Parent Engagement as a major area of work. Though we seek consumer input and have had minimal participation on our Board and Coalition by consumers, we recognized that engagement of families as key stakeholders and equal partners at the table is a goal we hope to strive for.

With technical assistance from the Florida Department of Health Early Childhood Comprehensive Systems and Georgetown University, we participated in what our parent/provider partnership named a PYRAMID Summit (Parents and Youth Reaching Amazing Milestones through Initiative and Dedication). This provided us with an opportunity to identify challenges facing parents as they work to access our systems of care and work strategically with them to implement improvements. A brief summary of findings is listed below:

Data collection instruments were developed by the Research and Evaluation Team at the Georgetown University National Technical Assistance Center for Children’s Mental Health to determine the utility, quality, impact, and effectiveness of the summit. While the information is not specifically designed to inform us about key indicators of the needs assessment, it provided us with valuable information about what parents want and need in order to effectively access our system(s) of care and become engaged members of our health and human services community.

Of the participants surveyed:

• There were a total of 83 respondents • 45% self identified as family members • 39% indicated they were providers • 6% self-identified as both family member and provider (suggesting they utilize the

system of care as well as provide services within the system of care)

The following increases/changes in opinion were noted by participants at the conclusion of the Summit:

Increased awareness of services and supports needed by young children and their families in Volusia & Flagler County to ensure quality of life

The Summit is a significant step for Flagler & Volusia Counties in the process of building and maintaining family involvement.

Belief in developing partnerships and collaboration between families and providers

Creating a collective sense of direction by developing an action plan


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2. Healthy Start Participant Satisfaction Survey

The Coalition’s subcontracted providers of Healthy Start services are required to distribute satisfaction surveys to all Healthy Start program participants to assess the overall level of satisfaction with Healthy Start services. The surveys are distributed on semi-annually, in September and March. Self-addressed, postage paid envelopes are provided, so that participants can mail the completed survey directly to the Coalition. Figure 25 reflects surveys distributed, returned, and satisfaction rating.

During the months of September 2010 and March 2011 the provider distributed surveys to their families.

Figure 25.

Surveys Distributed

Number of Surveys Distributed

Number of Surveys Returned

Average Satisfaction Rating

2010/2011 418 262 97%

99%-100% of the clients surveyed agreed or strongly agreed that (excludes N/A responses):

• They are treated with courtesy and respect • They receive services that are helpful • They received services when they needed them • Their home visitor helped them with their goals • Their home visitor helped them find other services that they needed • Overall, they were satisfied with the services they received • Their home visitor gave them helpful information about parenting and about

their baby’s health and development • Their home visitor spoke to them in a language they understood or had an

interpreter to help • They would recommend Healthy Start to their friends

95% of the clients surveyed agreed or strongly agreed that:

• Their home visitor spent enough time with them • Their home visitor understood and respected their culture • Their family benefited from Healthy Start • If they had a complaint it was handled well


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Between 78% and 94% of the clients surveyed agreed or strongly agreed that:

• Their ability to cope with problems and stress had improved since they started the program

• Their patience with their children had improved since they started the program.

• Their living situation improved since I started with Healthy Start

The results of FY 10/11 Healthy Start Participant Satisfaction Surveys indicate that overall, Healthy Start program participants continue to be very satisfied with services they receive through the program. This finding is consistent with findings in the last service delivery planning cycle. One decrease that is noted and indicative of the current economy is in relation to participant living situation, stress, and coping.

B. Resource Inventory

In order to ensure that our target population has access to the services they need to ensure their health and well being, it is important to regularly inventory the available resources in the community. The Coalition’s resource inventory is updated on a regular basis. To remain apprised of funding and program changes throughout the community’s social service and medical system that impact available services, Healthy Start is involved with United Way, One Voice for Volusia and the Infant Mental Health Chapter of Flagler and Volusia Counties. Our Marketing and Education Director regularly reviews our Resource Directory, which is provided to women who apply for Medicaid upon enrollment and is available to all of our participant, providers, and the community at large on our website.

A comprehensive update is conducted during each service delivery planning cycle. The comprehensive update is accomplished via medical provider surveys and coordinated reporting of changes services by Healthy Start direct service staff, Coalition staff and the Coalition’s general membership.

In the current changing economic times, resources for families are more important than ever. Our field staff receives a minimum of one training annually about access and referral to community resources. One Voice for Volusia provides an update service known as Community Connector that all providers subscribe to. New services are sent via E-mail message to over 4,000 subscribers. In addition, One Voice for Volusia holds a Health and Human Services Summit annually to bring health and human service providers from Flagler and Volusia Counties together in one forum. This summit is attended by families in the public and the event allows for our agencies to network with one another.

The United Way 211 Resource directory is another valuable tool that our agency and its subcontractors utilize to link participants with resources they may need. This comprehensive directory and phone service is available to all residents in our service area.


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1. Medical Providers

The Healthy Start Coalition of Flagler and Volusia Counties, Inc. has made progress in engaging the medical community in planning and service delivery efforts. This has resulted in an increase in referrals to Healthy Start services, despite documented risk, when a physician or health care provider interacts with a patient and recognizes factors that are associated with social determinants of health. This has also resulted in the increase in prenatal screening rates and referral for interconception services.

Healthy Start screening occurs at the first prenatal visit with the prenatal provider. Some risk may not be identified at this time because initial testing results have not been obtained. For women who fall under 185% of poverty and are eligible for medical services because of their pregnancy, preventative health and identification of medical problems may not have been previously addressed because of a lack of a medical home. The prenatal provider often is their first encounter with medical services. Identification of high blood pressure, HIV or STDs, diabetes, cancer, thyroid disorder or other chronic health problems may not be known at the time the Healthy Start screen is completed.

Our Coalition also has an integrated Assessment Center that medical providers know can connect patients with a broad array of services in the community to include Healthy Families, a premiere home visiting program with a proven track record for reducing child abuse and neglect in families who are assessed as needing services.

For this reason, referrals for factors other than the Healthy Start score, or BOOFS (Based On Other Factors) have increased in our service area. These referrals receive an initial contact and coordination with the medical provider to coordinate needed services in partnership with the medical community.

2. Overall Resource Update

a. Medical Services

Volusia County is divided into three taxing authorities who provide for funding of medical care for the indigent, or working poor who are uninsured or underinsured. On the East, Halifax Medical Center authorizes the allocation of ad valorem taxes for these services. The Volusia County Health Department provides care for women and infants but is no longer the recipient of these dollars.

The West Volusia Hospital Authority is comprised of an elected Board who allocate ad valorem tax dollars on the west side of the county. This Board provides funds for prenatal services for the Volusia County Health Department, and funding for indigent services for the local hospital, Florida Hospital Deland. Since the last planning cycle, the west side of the county has received funding for and implemented a Federally Qualified Health Center


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Over 50% of all births in Volusia County are to women on Medicaid. The initial process for Medicaid application places women on a temporary status. This can create a barrier for women when they are selecting a clinical prenatal service provider.

There are 18 prenatal service providers in Volusia County, including the Volusia County Health Department. Of these, 8 will take temporary Medicaid. Unfortunately, Volusia County is home to only one medical center (Halifax Medical Center) with a Level II NICU. Flagler County has no delivery sites. There are no Level III NICUs in Volusia or Flagler Counties

Florida Hospital delivery services have no Level II or Level III NICU. In addition, the only hospital available for delivery on the west side of Volusia County is approximately 25 miles away from our most vulnerable migrant populations of women (in the town of Pierson), who must travel far distances for care. Transportation and language barriers for this population are significant. There is a Federally Qualified Health Center in the rural area, but they do not provide prenatal services.

Flagler County has no private OB/GYN services but provides for prenatal care at the Flagler County Health Department. Flagler County has no hospital or delivery sites. Since the implementation of midwifery services with OB back-up at the Flagler County Health Department, access to care and birth outcomes have seen measurable improvements.

In the local jail system, Prison Health Services is contracted to provide for the health of inmates who are locally incarcerated in the Volusia County Branch Jail and “11-29” unit. (This refers to the term of incarceration not to exceed 11 months and 29 days.) Since the last planning cycle, the Healthy Start Coalition has worked with Prison Health Services, Volusia County Branch Jail Administration and Halifax OB/GYN Associates to develop a continuum of care for pregnant women who are incarcerated at the jail. Pregnant Inmates now receive Healthy Start screening and assessment and are assigned a care coordinator while they are incarcerated. They receive a "health care passport" that they take with them from the jail to provide information about the health care services they received during their incarceration. High risk pregnancies are coordinated with either the Volusia County Health Department or Halifax OB/GYN Associates. Healthy Start successfully negotiated a Memorandum of Understanding with the Volusia County Branch Jail and Prison Health Services to ensure that our entities work together to support the most positive outcomes through effective coordination of services.

HIV positive women have few resources for specialty OB/GYN services. However, since the last planning cycle, our service area has worked together to implement a MAMA BEAR program. This provides a coordinated multi-disciplinary staffing of pregnant women who are HIV positive or have other STDs. This staffing is conducted with the Volusia County Health Department


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surveillance and related staff, Children's Medical Services, Ryan White Case Management, and Healthy Start. This group works to ensure that pregnant women receive consistent prenatal care under Ryan White Title II and Title IV and ensure that recommended protocols are followed. This process has proved effective. We have had no reported transmission of HIV from mother to infant in the last 2 years (2008 and 2009).

Children’s Medical Services (CMS) provides medical services for children with special medical needs. Various gatekeepers, including Healthy Start assessment workers and home visitors work with families to determine eligibility or payment of these services.

Keech Street Clinic provides pediatric services in the highest risk neighborhood in the 32114 zip code area in Daytona Beach. This clinic is supported by the Halifax Hospital Authority and serves over 2,000 children annually. The majority of clients who receive care at the Keech Street Clinic are on Medicaid.

Pierson Clinic provides medical care to adults and children who reside in the rural farm area in West Volusia County. Unfortunately, this clinic does not provide prenatal services and as stated previously, is approximately 25 miles away from the nearest hospital or birthing center. Many of the women who frequent this clinic are undocumented and have language and transportation barriers.

b. Basic Needs Services (Food Banks, Housing, Etc.)

There are many social service networks in Volusia County, most of which are available on the east side of the county. The West Volusia area has limited social services, and Flagler County relies predominantly on the East Volusia Area for social services. Most social services that are available in Flagler County are funded through the County.

The Homeless Coalition of Volusia/Flagler County provides for a consolidated plan to address homelessness and ensures that funding be allocated for shelter and transitional services to women and children. These include the Domestic Abuse Council Shelter and Transitional Housing, Family Renew (transitional housing for women and children as well as in-tact families), Palmetto Place Advocates, the newly created STAR Shelter, and the Salvation Army. Halifax Urban Ministries provides for food and shelter vouchers; furthermore, additional aid is provided through many church ministries in the area.

The Neighborhood Center of Deland, Halifax Urban Ministries, and Salvation Army provide services to the homeless on the west side of Volusia County.

Project WARM (Women Assisting Recovering Mothers), of the Stewart Marchman Center for Chemical Independence, provides shelter and substance abuse treatment for pregnant and parenting women who need a residential


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setting. In conjunction with Healthy Start, Project WARM ensures that transitional living arrangements are secured as women and their children leave the treatment setting.

HIV positive women are eligible for HOPWA (Housing Opportunities for People Living with AIDS), which can provide funding for shelter and transitional housing on a temporary basis. HIV positive women are typically enrolled in Ryan White Title II case management services through the Outreach Community Care Network, where basic needs such as food, shelter, and medical services are coordinated. Outreach Community Care network coordinates closely with Healthy Start services when women identified as HIV+ become pregnant or have recently given birth. Our agencies collaborate closely to ensure that basic needs are met and that adherence to medical regimens is prioritized.

c. Substance Abuse Treatment Services

Since 2008, the state of Florida has seen a steady increase in the number of babies born with Neonatal Abstinence Syndrome as a result of use of substances by a woman when she is pregnant. The challenge of prescription drug availability and use is impacting capacity and protocol for pregnant addicted women, particularly in the second and third trimester of pregnancy.

Opioid and opiate addiction to prescription drugs and methadone create a complicated scenario when a woman is pregnant because of the potential danger of withdrawal to the developing fetus. Women on Medicaid do not have local resources for opioid maintenance during pregnancy unless they can self-pay. This often results in physicians who cannot follow medical guidelines during pregnancy when the mother is impoverished. Residential settings for pregnant addicted women in our community can only admit women when they have gone through detoxification. If the medical recommendation is to maintain a course of opioid management during pregnancy, this creates a gap in services, placing the physician in a challenging position.

Babies born to women addicted to drugs require linkage to a complicated maze of services and require careful assessment and a multi-disciplinary approach to manage effectively. Hospitals frequently interact with the Department of Children and Families, Healthy Start, and the substance abuse treatment community to work toward ensuring a baby's safety and care. In addition, referral to Children's Medical Services, Early Steps, Community Partnership for Children (Foster Care and specialized parenting), and Early Learning Coalition may be required. For this reason, the Healthy Start Coalition allocated resources for a Women's Intervention Specialist to respond to these cases and coordinate with these multiple service providers and the family to support the well-being of the baby and the hopeful recovery of the family. This important position is working with providers and the hospital system to develop community-wide protocols designed to address this growing epidemic. Effective October 1, 2011, this positions funding is being supported by leveraged funds from the County of Volusia.


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Figure 26.

Figure 26a. Withdrawal Trend Rates per 1,000 Live Births

2005 2006 2007 2008 2009

Florida 1.1 1.5 2.0 2.8 4.3

Volusia 1.2 1.3 2.0 4.8 6.7

Figure 26b. Newborn Withdrawal Trends

2005 2006 2007 2008 2009 Total Births –

Florida 226,219 237,166 239,120 231,417 221,246

NB Withdrawal –

Florida 254 347 472 648 953

Total Births – Volusia 5,093 5,263 5,417 5,257 5,099

NB Withdrawal –

Volusia 6 7 11 25 34

Measure: Hospital discharges of infants (age=0) with a diagnosis of drug withdrawal syndrome Drugs included: All drugs, including prescription and illicit ICD-9 CM Code: 779.5—Drug withdrawal syndrome in infant of dependent mother (excludes fetal alcohol syndrome)—In any diagnosis field Data source: Agency for Health Care Administration Hospital Discharge data: Limited data set Caution: The numbers and rates of hospital discharges of newborns with drug withdrawal syndrome should be interpreted and compared with caution. Diagnosis and documenting practices may vary substantially by physician, hospital, or county.


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As Figures 26a. and 26b. reflect, the rate of babies being born to women addicted to opioids (per 1,000 live births), has shown a significant increase, with the rates in Volusia above those of Florida. We are continuing to focus on improving screening, identification, intervention, and follow up for these complicated cases.

d. Other Community Based Services

Healthy Start workers coordinate with numerous community-based organizations on behalf of their participants. Each family presents its unique set of circumstances that pose both risk and resilience as they care for a newborn or young child. The changing economy and funding reductions place new challenges before our workers and increase the demand for dwindling resources.

As we worked in committees to conduct needs assessment activities and review community capacity for needed resources, several themes emerged which should be mentioned as part of the resource inventory and gap analysis.

Single mothers who live in poverty must often return to work shortly after the birth of their baby and need to be connected to workforce development, child care, and basic needs. At present, there are over 800 children on a waiting list for child care services, which limits the ability to work unless another family caregiver can support the daily needs of the baby.

There are currently over 900 children in out of home (foster care or relative) placement because of child maltreatment with hundreds more requiring completion of case plan goals to remain custodial parents of their children. The majority are children under the age of five. Increasing numbers of pregnant women have one or more children already in the child protective system.

The local Community Partnership for Children reports that over 75% of maltreatment cases are directly related to prescription drug abuse. In order to complete case plans required by the Department of Children and Families, parents must complete parenting programs, treatment for substances, and ensure that home safety/environment is supportive of the needs of their child(ren).

3. Resources Gained

Volusia County has several planning bodies responsible for ensuring the allocation of funds for various health and human services. The planning entities that impact our target population beyond the Healthy Start Coalition are Early Learning Coalition, CBC, (Community Based Care), the Homeless Coalition, PCHAP (Partnership for Comprehensive HIV and AIDS Planning), Children and Families Advisory Board, Workforce Development Board, and the Department of Children and


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Families. Though many of these planning entities have experienced reductions in funding, some have been successful in acquiring additional resources that can complement the Healthy Start service delivery system.

The following is a highlight summary of services gained since the last service delivery plan update.

a. Healthy Start Coalition Resources Gained - Prior to the beginning of the planning cycle of 2011 - 2016, the Healthy Start Coalition applied for and was recommended for funding from the County of Volusia for two separate categories. The services to be funded for these categories are listed below:

1) Prenatal Support and Centralized Parenting - This proposal provides for women's intervention services for substance exposed pregnant and post partum women, neonatal support services for families with a new baby who require support within 72 hours of discharge from the hospital or birthing center based upon risk, health navigation services, assessment services, and a planning period for working with agency providers to develop a centralized system of parenting for families with young children. Partners in this proposal who will receive subcontracts include Stewart Marchman ACT Behavioral Health Care and Agape Midwifery.

2) Family Violence Prevention and Intervention Services - This proposal provides for a total of three Community Cafe sites in collaboration with Parent Leaders, Early Learning Coalition, The Chiles Academy, Stewart Marchman ACT Behavioral Services, United Way, Community Partnership for Children and Circuit 7 Department of Children and Families. These Community Cafes are centralized access points for families, who function as equal partners in its operation. The Community Cafes are part of a framework that has been adapted by the collaborative partners known as the Strengthening Families framework. Within this framework is a full integration of the Five Protective Factors. The Five Protective Factors include parent resilience, parent knowledge of child development, practical and concrete support in times of need, social connections, and social and emotional development of children The cafe sites will have family counselors, DCF Access capability, and virtual parenting through the Parenting Wisely evidence-based parenting program. This is in alignment with the State of Florida Child Abuse and Neglect Prevention and Permanency Plan. The proposal also has funding for respite child care and assessment services for high risk families. The first Community Café site (Daytona Beach at The Chiles Academy at Bonner Center) will be implemented in October and the second and third sites (Deltona and New Smyrna) will be implemented at the beginning of calendar year 2012.

3) The STAR Family Shelter - Halifax Urban Ministries has assumed the lead role in administering the STAR Family Shelter, a 94 bed facility for homeless women and children and the medically needy population. Since


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the last planning cycle, the Healthy Start Coalition has developed a multi-agency partnership designed to coordinate services for pregnant women and women with young children. Our efforts ensure a systemic way to contact, assess, and provide care coordination to this vulnerable population. We have successfully leveraged funds from the County of Volusia in order to provide wrap around services for families in the shelter to include respite child care, case management, counseling, as well as Healthy Start services.

4) Bridge of Hope - Halifax Urban Ministries provides case management, centralized feeding, emergency room diversion medical services, and showers and laundry services at a centralized site in downtown Daytona Beach. Local churches assist the Coalition with the initiative, which provides meals daily.

5) Prevention on the Move - The Prevention on the Move program provides for a mobile unit whose primary goal is to conduct HIV rapid testing under the CLEA waiver. Through collaborative efforts with Stewart Marchman, the Volusia County Health Department and Healthy Start, this mobile unit will provide for many screening activities and health services. A Volusia County Health Department employee will be staffed on the mobile unit and will provide Prenatal and Infant screens as well as Initial Contacts for eligible recipients.

6) Northeast Florida Health Services (previously known as the Pierson Family Clinic) - This is a Federally Qualified Health Center (FQHC). Northeast Florida Health Services is located in West Volusia and provides basic medical services for migrant and farm working residents. Northeast Florida Health Services opened its doors in June 2004. While most patients reside in Volusia County, they also provide care to patients from many outlying counties, such as Lake, Putnam, and Flagler. Northeast Florida Health Services also has two family practice physicians and one part time board certified pediatrician. Their newest service site, located at 2160 Howland Blvd. in Deltona, FL, opened 100% on the Electronic Health Records system in October 2008. Services include: Pediatrics and Adolescent Medicine, Internal Medicine, Family Practice, Gynecology, School and Employment Physicals, Laboratory Testing, X-rays, Family Planning, Diabetes/Hypertension Management, and Immunizations. Though the clinic has basic pediatric services, they do not have the medical personnel needed to provide for prenatal care. Our Coalition is exploring ways to assist this clinic in obtaining the resources needed to expand.

7) Volusia County Health Department Prenatal Clinic - The Volusia County Health Department opened a prenatal clinic in Deltona, which is the most populous city in our county and is located on the west side. This has been a welcomed service that responded to the needs of that


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community, who had limited prenatal providers and a significant distance to the nearest birthing facility.

8) EASY ACCESS - With assistance from Jennie Joseph, nationally renowned midwife and founder of the JJWay™ model, the concept and implementation of EASY ACCESS was adapted by Agape Midwifery in Volusia County. This approach provides for a safety net for women who are having difficulty finalizing Medicaid approval or for some reason are not deemed eligible. Providers who identify women who have not accessed prenatal services because of systemic or other barriers can refer pregnant women to an EASY ACCESS clinic for services.

9) Cooperative Agreement with Bethune Cookman University Department of Nursing - the Healthy Start Coalition and The Chiles Academy have developed a strong relationship with the university to utilize nursing students to support breastfeeding education with teen moms at The Chiles Academy Charter School for Pregnant and Parenting Teens. This relationship provides for a more peer oriented relationship between teens and the nursing students. The Chiles Academy reports increased acceptance of and participation in breastfeeding. Because these are not code able services, we have not been able to measure outcomes.

4. Resources Lost

As with any community, Volusia and Flagler counties are often adversely impacted by policy decisions that reduce funding for our community’s social service agencies or change criteria regarding payment of services or criteria for eligibility. It is incumbent upon the Healthy Start Coalition to address gaps that are created when policy changes affect access to health care or other services needed to support women and children.

Since the last Service Delivery Plan, Volusia and Flagler Counties have lost the following social and medical services:

a. Interconception Services

1) Closing the Gap - The Healthy Start Coalition collaborated with one of its sub-recipients of home visiting services in obtaining a Closing the Gap grant, whose primary focus was on preconceptional and interconceptional care for Black women residing in the highest risk section of the 32114 zip code area in Daytona Beach. This program continued with federal funding for five years and will now be discontinued before 2012.

b. Department of Children and Families - In Deltona, the DCF office was closed for services due to funding restrictions in our circuit. Unfortunately, this area has the most residents in our county, who have been adversely impacted by the current economic situation with a high rate of unemployment


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and home/mortgage foreclosures. This makes it difficult for families to apply for needed assistance, since they have to travel to Deland or Daytona Beach in order to access DCF assistance. For this reason we included a DCF Access point in our County of Volusia Proposal.

c. Child Care Resources - Following the last legislative session, Early Learning Coalitions lost their "local option" that allowed them to allocate resources for particularly vulnerable populations to receive child care. For this reason, we included respite child care in our County of Volusia proposal.

5. Service Gaps

There are several major service gaps in Volusia and Flagler Counties which impact the health and well being of our pregnant women and infants. These are described in the bullets below:

• Dental - Dental services for uninsured pregnant and parenting women are often unavailable. Recently, the Volusia County Health Department was able to leverage some funds to provide dental services, which is being implemented but can only serve a very limited capacity. Medicaid provides dental services in the form of extractions only for adults.

• Prenatal - Pregnant women residing in the rural areas around Pierson and Seville (Northwest Volusia County) do not have prenatal providers within a 25 mile radius.

• Affordable Housing - As the economy experiences continuing downturns, the number of families who find themselves evicted from their homes or apartments continues to increase. Families who are unemployed or underemployed on a very limited income have an extremely difficult time finding affordable housing.

• Substance Abuse Treatment for Prescription Drug Addicts - The prescription drug abuse epidemic has created a gap in services for those who are addicted to prescription drugs and methadone. For pregnant women, there is a lack of available services for appropriate medical intervention in the second and third trimester of pregnancy if they cannot afford "cash up front" for methadone, bupenorphine, or other opiates or opioids that may be required for them to prevent fetal loss or kindling to the baby. Our community lacks Medicaid resources for proper management of addiction until a pregnant woman delivers her baby. Even after delivery, there is a lack of resources available for transition and detox from opiates/opioids for people with low income.

• Transitional and Emergency Shelter - With the increasing number of families facing eviction, our Healthy Start workers have difficulty working with families who find themselves homeless. The Star Family Shelter typically has a waiting list and there are few other options available. This becomes more challenging when women are pregnant and close to their delivery date.


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• Geographic/Access - In the central Daytona Beach area there are multiple health and human service resources. The Deland are on the west side of the County also has available and accessible resources to families. However, our most populous city of Deltona has significant service gaps to include lack of prenatal services, birthing services, and other basic human services such as counseling, substance abuse treatment, basic needs and recently Department of Children and Families access. In addition, the Southeast quadrant of our county, which includes New Smyrna, Edgewater, and Oak Hill, has significant resource gaps. The Volusia County Health Department has limited prenatal services in this area, but as in Deltona, access to basic needs services are lacking. And finally, the Northwest quadrant of the County is comprised of many migrant farm working populations in an isolated rural setting.

Additional gaps include: • No Level III NICU and only 1 Level II NICU in Volusia only • No delivery sites in Flagler County • Prenatal services for undocumented women particularly lacking in the Northwest • Housing for homeless pregnant teens and women • Affordable Housing for all families • Lack of specialty OB/GYN for HIV+ women • Transportation services are still inadequate in our community for people who do

not drive a car. Participants report multiple transfers and several hours just to get to and from medical appointments and work.

• Services for low income prescription addicted pregnant women in their second and third trimester

Figure 27. illustrates the Volusia County area in relation to hospitals with birthing centers (red box with an “x”). This illustration is important because it shows the distance women residing in Pierson, Deltona, and New Smyrna must travel to reach a birthing facility. These areas tend to be lacking in resources and create transportation and other barriers for families. (Flagler County is to the north and has no hospitals or birthing centers.)


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Figure 27. Map of Volusia County with Identifiers for Hospitals

x

x

x


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V. TARGET POPULATION, INDICATORS, STRATEGIES & FIVE YEAR GOALS

A. Target Population

1. General Population Characteristics

As of 2009, Volusia County was home to 507,105 residents, a decline since 2008. The majority (88%) is White, 10% are Black and 2% are reported as Other. Approximately 10% (in all races) are Hispanic.

Figure 28. Population Volusia County

Total Population (Number) 2005 2006 2007 2008 2009

494,649 503,844 508,014 510,750 507,105

Figure 28a. Population Volusia County by Race and Ethnicity

Total Population by Race and Ethnicity (Number) Race 2005 2006 2007 2008 2009 White 435,435 443,626 447,406 447,721 445,349 Black 50,676 51,449 51,698 53,690 52,555 Other 8,538 8,769 8,910 9,339 9,201 Hispanic (of any race) 42,157 45,909 50,569 53,610 51,187

Figure 28b. Volusia Population under Age 18

Population Under Age 18 (Number) 2005 2006 2007 2008 2009

98,152 99,200 99,464 99,550 97,538 Population Age 0 to 4 (Number)

2005 2006 2007 2008 2009 23,878 24,414 24,749 25,231 25,010

Figure 29. Population Flagler County

Total Population (Number) 2005 2006 2007 2008 2009

75,420 82,285 88,088 90,700 91,622







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Figure 29a. Flagler County Population by Race and Ethnicity

Total Population by Race and Ethnicity (Number) Race 2005 2006 2007 2008 2009 White 68,726 77,823 80,862 82,754 82,109

Black 8,375 9,506 10,723 10,754 10,777

Other 1,516 1,746 1,983 2,004 2,015

Hispanic (of any race) 4,396 5,429 7,515 6,873 6,050

Figure 29b. Flagler County Population under Age 18 and Under Age 4

Population Under Age 18 (Number) 2005 2006 2007 2008 2009

14,355 16,066 16,872 17,085 16,791 Population Age 0 to 4 (Number)

2005 2006 2007 2008 2009 2,934 3,383 3,641 3,887 3,930

The Service Area is comprised of the counties of Volusia and Flagler. As of 2009, the total population of the two counties was 598,727, with Volusia County being the more populous of the two.

Volusia County

In 2009, Volusia County's population decreased to an estimated 495,890. Volusia County is geographically separated into east and west, though for service delivery purposes, we analyze data in terms of quadrants. The city of Deltona, on the west, is the most populous and Daytona Beach, on the east side of the county, ranks second.

2. Educational Attainment

In 2005-2009, 89 percent of people 25 years and over in Flagler County had at least graduated from high school and 21 percent had a bachelor's degree or higher. Eleven percent was dropouts; they were not enrolled in school and had not graduated from high school.

The total school enrollment in Flagler County was 17,000 in 2005-2009. Nursery school and kindergarten enrollment was 1,600 and elementary or high school enrollment was 12,000 children. College or graduate school enrollment was 3,400.

(Source: Census, 2009 American Community Survey)





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Figure 30. The Educational Attainment of People in Flagler County, Florida in 2005-2009

Source: American Community Survey, 2005-2009

In 2005-2009, 87 percent of people 25 years and over in Volusia had at least graduated from high school and 21 percent had a bachelor's degree or higher. Thirteen percent were dropouts; they were not enrolled in school and had not graduated from high school.

The total school enrollment in Volusia County was 110,000 in 2005-2009. Nursery school and kindergarten enrollment was 12,000 and elementary or high school enrollment was 65,000 children. College or graduate school enrollment was 33,000.


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Figure 31. The Educational Attainment of People in Volusia County, Florida in 2005-2009

Source: American Community Survey, 2005-2009

3. Employment and Income

The table below shows the economic characteristics of 2010 of Flagler County, Volusia County, and the State of Florida. Of the total number of people in the labor force, Flagler reflects the most unemployment (15%), compared to Volusia County at 11% and Florida at 10.5%. Although Flagler County shows 73.6% of children with parents in the workforce and Volusia County with 65.8%, it is still significantly below Florida with 90.1% of children with all parents in the workforce. The average hourly wage of people in Flagler and Volusia County is less than Florida but the Median Household Income and Median Earnings are higher for Flagler than Volusia County or Florida. In addition, both male and female full time employees make more annually than their counterparts in Volusia County or Florida.


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Figure 32. Economic Characteristics

Economic Characteristics Flagler Volusia Florida Number Percent Number Percent Number Percent

Number in Labor Force 32,837 100% 253,875 100% 9,197,000 100%

Number in Labor Force Age 60+ (% in Labor Force) 5,370 14.1% 25,852 11.3% 1,011,185 11.0%

Number Employed (% of Labor Force) 27,983 85.2% 226,002 89.0% 8,232,000 89.5%

Children with all Parents in the Labor Force (% of Total Children) 11,652 73.6% 58,956 65.8% 911,430 90.1%

Average Hourly Wage $16.00 $17.28 $21.40

Median Household Income $50,180 $41,459 $44,736

Median Earnings (Wage or Salary Income) $27,067 $24,463 $25,861

Male, full time, year round $39,787 $37,851 $39,122

Female, full time, year round $33,475 $30,725 $32,109

4. Pregnancy and Young Child Profile

The Florida Charts system allows “at a glance” snapshot of community characteristics related to pregnancy and birth to include socio-demographic data for women of reproductive age (15 - 44) and birth family characteristics. Figures 33 and 34 provide a view of this data by rolling average from 2007-2009.


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Figure 33. Volusia County Pregnancy and Young Child Profile 2009 (or 2007 – 2009 where indicated)

Pregnancy and Young Child Profile, Volusia County

Measure Rate Type Year(s)

County Quartile 1=most favorable 4=least favorable

County Number

County Rate

State Comparison

Community Characteristics Median household income (in dollars) Dollars 2000 $35,219 $38,819

Residents below 100% poverty Percent total population 2009 59,132 11.6% 12.5%

Unemployment rate Percent 2009 11.0% 10.2%

Individuals living in owner-occupied housing Percent 2000 75.3% 70.1%

Domestic violence offenses Per 100,000 population 2007-09 3,849 755.9 611.8

Little English spoken in family (linguistically Isolated)1 Percent 2000 2.1% 5.9%

Births covered by emergency Medicaid 2 Percent of births 2007-09 179 3.4% 8.3%

Women of Childbearing Age Socio-Demographic Characteristics Total female population ages 15-44 Count 2009 86,047 3,505,324 White female population ages 15-44 Count 2009 70,914 2,672,307 Black female population ages 15-44 Count 2009 12,884 709,861 Other female population ages 15-44 Count 2009 2,246 123,156 Hispanic female population ages 15-44 Count 2009 11,275 875,713 Non-Hispanic female population ages 15-44 Count 2009 74,771 2,629,611

Birth Family Characteristics

Births to mothers ages 15-19 Per 1,000 females 15-19 2007-09 623 39.9 40.4

Repeat births to mothers ages 15-19 Percent of births 15-19 2007-09 103 16.5% 18.7%

Births to mothers > 35 Per 1,000 females > 35 2007-09 487 3.0 4.8

Total births to unwed mothers Percent of births 2007-09 2,622 49.9% 46.9%

Births among unwed mothers ages 15-19

Percent females 15-19 2007-09 561 90.1% 89.1%


Percent of births 20-54 2007-09 2,056 44.4% 41.9%

Births with father acknowledged on birth certificate Percent of births 2007-09 4,572 87.0% 86.1%

Births to mothers > 18 without high school education Percent of births > 18 2007-09 770 15.8% 16.4%

Births to mothers born in other countries Percent of births 2007-09 815 15.5% 31.9%

Volusia County has approximately 86,047 women of reproductive age, with the majority (70,914) white, and 15% (12,884) black.

Women of reproductive age (15-44) represents 17% of the Volusia County population. Several indicators are worthy of note in Volusia County to include births to unwed mothers, as stated previously, the unemployment rate among women and domestic violence offenses rate at 755.9 per 100,000, which is higher than Florida’s rate at 611.8 per 100,000 cases.

http://www.floridacharts.com/charts/MICCountyReport.aspx?datayear=2000&mindcode=0001&listorder=1&ProfileYear=2009&YearLabel=2000&indcode=0600000293





http://www.floridacharts.com/charts/MICCountyReport.aspx?datayear=2009&mindcode=0006&listorder=6&ProfileYear=2009&YearLabel=2007-09&indcode=0800000312

























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Figure 34. below shows the same profile for Flagler County for the same period. It should be noted that Flagler County’s total population is significantly lower than Volusia County and rates should be considered with this in mind.

Figure 34. Flagler County Pregnancy and Young Child Profile 2009 (or 2007 – 2009 where indicated)

Pregnancy and Young Child Profile, Flagler County

Measure Rate Type Year(s)

County Quartile 1=most favorable 4=least favorable

County Number

County Rate

State Comparison

Community Characteristics Median household income (in dollars) Dollars 2000 $40,214 $38,819

Residents below 100% poverty Percent total population 2009 8,281 8.7% 12.5%

Unemployment rate Percent 2009 14.8% 10.2%

Individuals living in owner-occupied housing Percent 2000 84.0% 70.1%

Domestic violence offenses Per 100,000 population 2007-09 598 630.0 611.8

Little English spoken in family (linguistically Isolated)1 Percent 2000 2.0% 5.9%

Births covered by emergency Medicaid 2 Percent of births 2007-09 19 2.1% 8.3%

Women of Childbearing Age Socio-Demographic Characteristics Total female population ages 15-44 Count 2009 13,247 3,505,324 White female population ages 15-44 Count 2009 11,153 2,672,307 Black female population ages 15-44 Count 2009 1,762 709,861 Other female population ages 15-44 Count 2009 331 123,156 Hispanic female population ages 15-44 Count 2009 1,061 875,713 Non-Hispanic female population ages 15-44 Count 2009 12,186 2,629,611

Birth Family Characteristics

Births to mothers ages 15-19 Per 1,000 females 15-19 2007-09 89 33.5 40.4

Repeat births to mothers ages 15-19 Percent of births 15-19 2007-09 16 18.4% 18.7%

Births to mothers > 35 Per 1,000 females > 35 2007-09 99 2.9 4.8

Total births to unwed mothers Percent of births 2007-09 376 40.9% 46.9%


Percent females 15-19 2007-09 77 87.2% 89.1%


Percent of births 20-54 2007-09 297 35.9% 41.9%

Births with father acknowledged on birth certificate Percent of births 2007-09 824 89.7% 86.1%

Births to mothers > 18 without high school education Percent of births > 18 2007-09 84 9.7% 16.4%

Births to mothers born in other countries Percent of births 2007-09 145 15.7% 31.9%

Females of reproductive age in Flagler County represent 14.5% of the total population. Flagler County’s unemployment rate for women (14.8%) is higher than Florida’s (10.2%) or Volusia County’s at 11.4%. Cases of domestic violence































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offenses, while less than Volusia County or Florida, are still high at a rate of 630 per population of 100,000 with a total number of 598 cases in 2009.


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B. Needs Assessment Summary

The Needs Assessment represents hours of research and analysis by the Service Delivery Planning Committee. Review and assessment of the data and comparison to available resources is a key element in developing the strategies for the Healthy Start Action Plan.

While Florida’s Coalitions are mandated to focus on specific indicators that directly impact maternal and child health and well-being, the needs assessment makes it clear that there are contributing factors that must be considered as we allocate resources and coordinate with stakeholders in our community.

As a brief summary to the data review, the following bulleted list narrows down critical areas that align with the analysis:

Access to prenatal care is a challenge in Volusia County, particularly for those residing in Daytona Beach, with relative geographical proximity to providers.

There is a significant disparity in access to services for pregnant women who are Black.

Almost half of the pregnancies are unintended, with a higher rate of unintended pregnancies among women who are Black.

An elevated number of women are “lost to contact” in our service system as “unable to locate.”

Level 3 (most intensive) have declined in the last two fiscal years and require strategies in order to increase.

The 32114 zip code area continues to have a disproportionate population of residents with multiple risk factors and contributing factors for low birth weight and infant mortality.

Domestic Violence occurrences in Volusia and Flagler County are impacting the well-being of women.

Prescription drugs, alcohol, and other drugs are negatively impacting families in our community.

Deltona and the Southeast quadrant of our county (Edgewater, New Smyrna, and Oak Hill) have limited resources.

The rate of women who use tobacco during pregnancy is higher than that of Florida, particularly among pregnant women who are White and reside in the Southeast quadrant of Volusia County.

The time it takes for a face to face encounter with the mother of a high risk neonate should be significantly reduced.

The number of young women (age 15-19) becoming infected with STDs is high.

The assessment information has been incorporated into related strategies in the Coalition Action Plan that will guide our activities for the next five years, with evaluation quarterly and updates annually.


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C. Changes from Previous Service Delivery Plan

Since the Coalition's last Service Delivery Plan, the health indicators our community has chosen have not changed, though new strategies have been added about how we will address them.

Infant Mortality, Black Infant Mortality, and Low Birth Weight remain, and though these outcomes may be considered ones that we do not have direct control over, our Service Delivery Planning Committee chose to retain them due to the interventions we can address at the community and individual level. The disproportionate number of women and babies impacted by opioid dependence, smoking, STD's, chronic health conditions, infection, and unsafe sleep, have resulted in our focus on strategies aimed at addressing these areas in approaches that are both direct and systemic.

Entry into prenatal care services showed improvement in Flagler County with specific systemic coordination of public and private partnerships that support easy entry, quality services, and continuity. Though the data did not show improvement in Volusia County, the efforts we employed during this last planning period have mobilized partners in Volusia County to implement a similar partnership to that of Flagler County, which is a major strategy for this planning period. For this reason, we will stay the course and focus on the implementation of this model to effect similar improvement.

Prenatal and Infant Screening rates improved significantly from the previous planning period, and though we exceeded the goals and outcomes we established, the Service Delivery Planning Committee determined that retaining screening as an indicator would ensure our continued focus on sustaining the gains we achieved. Since the strategies we employed were demonstrably effective, we have retained the majority of them with only minimal modification.

Strategies that are new based on the needs assessment and resource and gap analysis are emboldened in the tables below.


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D. Selected Indicators and Five-Year Goals

The following indicators have been selected for the focal point of the Coalition’s goals for the next five year planning cycle.

SELECTED INDICATORS CURRENT

STATUS SERVICE AREA 5-YEAR GOALS

2006-2011

SERVICE AREA 5-YEAR GOALS

2011-2016 State Local

1. Infant Mortality Rate 6.9 7.2 6.0 6.0

2. Black Infant Mortality Rate 13.2 13.8 6.0 12.0

3. Low Birth Weight 8.70% 8.20% 7.50% 8.0%

4. 1st Trimester Entry into Prenatal Care 78.28% 77.35% >87.50% >85.0%

5. Late or No Prenatal Care 4.30% 4.6% <3.31% <3.6%

6. Infant Screening 89.58% 81.46% 77.0% 90.0%

7a. Prenatal Screening Rates (Offer) 85.42% 100.7% 67.0% 100%

7b. Prenatal Screening Rates (Consent) 88.32% 91.75% 78.0% 91.0%

*Current Status is based upon the most current data: Indicators #1 – #5 are based upon calendar year 2009 data Indicators #6 – #7b. are based upon FY10/11 data (Jul-10 through Jun-11); (Source: Executive Summary July 1, 2010 –June 31, 2011)


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E. Strategies to Address Five-Year Goals

Indicators/5-Year Goals Adopted Strategies

1. Infant Mortality Rate (Reduce to 6.0)

• Continue to concentrate on marketing and training on the Healthy Start prenatal screen to better identify risk and support provider linkage to Healthy Start.

• Work with hospitals to improve infant screening rate to better identify infants at risk and improve linkages.

• Support Care Coordination services at the Volusia County Health Department.

• Provide leadership support to Infant Mental Health Chapter.

• Conduct study of evidence-based parenting programs for further implementation.

• Implement neonatal outreach coordination. • Increase breastfeeding education services through staff

training and monitoring of field staff. • Continue preconception/interconception care. • Encourage hospital birthing centers to continue to ask

"Where will your baby sleep?" and link to crib distribution when needed.

• Support assessment services at the three birthing centers.

• Coordinate with Florida SIDS Alliance to introduce legislation about safe sleep.

• Work with Hospice and Volusia County Sheriff's Chaplains to implement training to first responders.

• Provide designated staff, specialized training, and protocols regarding opioid dependence and neonatal abstinence syndrome.

• Promote and explore options for enhancing father involvement.

• Disseminate the Grief Tool Kit to providers for support and follow up when women have experienced a fetal loss/infant loss to support bereavement and health access in between pregnancies.

• Publish Project INFORM to educate the health care community about FIMR findings and strategies to reduce infant mortality.


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2. Black Infant Mortality Rate (Reduce to 12.0)

• Continue FIMR project and increase participation by Faith Community.

• Implement Lifesong Health Disparities Reduction program in the African American community, particularly in the 32114, 32117, and 32118 zip code areas.

• Continue to provide training to MomCare staff about identifying barriers to health access.

• Coordinate with Community Café project and Prevention on the Move.

• Promote and support culturally competent breastfeeding education for all women.

• Conduct Community Engagement activities in communities that are disproportionately affected.

• Implement the African American Faith Based Bereavement Initiative (AAFBI) and Day of Remembrance in key communities.

• Continue and expand “safe sleeping” education initiatives in the Faith Community.

• Continue interconception education. • Continue to promote Safe Sleep initiative and educate

mothers, fathers, and related caregivers. • Continue Healthy Start and Healthy Families

prevention programs. • Educate mothers regarding importance of pediatric

follow-up. • Utilize media to provide messaging to targeted zip

codes. • Integrate cultural competence into Comprehensive

Training Plan for home visiting and enhanced services. • Continue to train workers on education and economic

self-sufficiency goals on the FSP. • Continue to participate in the Mama Bear Program with

CMS, VCHD, and Outreach Community Care Network (HIV Case Management).

• Ensure neonatal outreach efforts reach African American women and babies at risk and link to pediatric services.


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3. Low Birth Weight (Reduce to 8.0%)

• Continue interconception education services. • Introduce interconceptional risk assessment tool to

primary care providers and facilitate implementation. • Continue smoking cessation education services for

pregnant women. • Implement outreach initiative to providers

regarding the importance of nutritional education. • Continue to maintain website and support

Text4Baby with educational information about healthy pregnancy.

• Work with medical community to provide preconception education and health services for young women of reproductive age.

• Fund Care Coordination services at Project WARM (Women Assisting Recovering Mothers) to support pregnant recovering women.

• Coordinate Healthy Start services at The Chiles Academy to coordinate with pregnant teens.

• Continue JJ Way training and comprehensive training plan updates and implementation.

• Continue marketing and education to patients, providers, and the community about infant mortality, low birth weight and healthy pregnancy.

• Implement Community Cafés in three areas of Volusia County with leveraged resources to ensure that women and families have centralized access to multi-agency services.

• Coordinate assessment services with high volume OB/GYN office(s) to promote early entry to Healthy Start services.


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4. First Trimester Entry into Prenatal Care

(Increase to >85.0%)

• Promote broad-based awareness/media campaign focused on early entry to prenatal care (in Spanish and English).

• Develop and implement public awareness & education campaign regarding the importance of 1st trimester entry into prenatal care.

• Continue to promote consumer education and awareness on Pregnancy Medicaid (SOBRA) eligibility.

• Implement education program to physicians regarding Medicaid short form.

• Implement education program to physicians regarding availability of Medicaid family planning services.

• Increase collaboration with community partners serving high risk populations to increase number and scope of consumers receiving educational information on the importance of early prenatal care.

• Implement public/private partnerships with the CHD's and private prenatal care providers to promote early entry to care, wrap around services, and continuity to birth.

• Continue to review data on ineligible prenatal cases.


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5. Late or No Prenatal Care (Decrease to <3.6%)

• Conduct Participant, Provider, and Community Awareness activities.

• Promote community education regarding the correlation between unplanned/unwanted pregnancy and late entry to care.

• Ensure Healthy Start representation at a minimum of sixteen (16) community outreach and education activities and events.

• Coordinate with local midwives with OB back-up to continue to improve health access to pregnant women.

• Coordinate with the Volusia County Health Department to implement public/private partnership with prenatal care providers.

• Coordinate with the Florida Department of Health to address the lack of cell phone contact information on MomCare participant lists.

• Work with prenatal providers to encourage accepting of temporary Medicaid (MU) status prenatal patients.

• Promote consumer education and awareness on Pregnancy Medicaid (SOBRA) eligibility.

• Implement education program to physicians regarding availability of Medicaid family planning services.

• Increase collaboration with community partners serving high risk populations to increase number and scope of consumers receiving educational information on the importance of early prenatal care.

• Continue safety net options for the provision of clinical prenatal services for uninsured women (working poor).

6. Infant Screening Rate (Increase to 90.0%)

• Coordinate with all birth centers in the service area to ensure rates are reviewed and strategies for improvement are developed in partnership.

• Continue to implement public education and awareness campaign to promote Healthy Start screening.

• Continue to implement provider and consumer incentive programs to increase screening rates.

• Coordinate with CHDs and hospitals regarding new screening changes to ensure accurate data input and understanding of greater sensitivity.


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7. Prenatal Screening Rates (Offer & Consent to Screen)

(Continue to maintain offer rate at 100%)

(Increase consent rate to 91.0%)

• Continue to employ the Marketing and Education Director to work with prenatal health providers on screening education and implementation.

• Continue Health Provider Corner on the website. • Provide technical assistance to Prison Health

Services. • Continue to maintain OB/GYN participation on the

Healthy Start Coalition and Board of Directors. • Distribute educational materials to Medical providers to

promote screening and acceptance of Healthy Start screen/services.

• Continue to implement public education and awareness campaign to promote Healthy Start screening.

• Implement provider and consumer incentive programs to increase screening rates.

• Invite OB/GYN providers to take a more active role in the FIMR process.

• Continue to review screening data and coordinate with providers to accurately and consistently conduct Healthy Start Screening.

Note: Strategies employed during previous SDP period to increase prenatal screening offer and consent rates were significantly effective and therefore no significant, new strategies have been recommended.

*Note: Bold font indicates “new” strategy (strategy that is a new addition to those previously listed).


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VI. ACTION PLAN IN CATEGORY A, B, C FORMAT

A. Planning Summary Sheet & Category “A” Activities

Reviewing data sets and resources assists the Coalition in identifying gaps and challenge areas. Without an alignment of this information to develop effective strategies that will impact outcomes, we are just poised to “know” and not to “do.” The Healthy Start Coalition has developed a format in which the data, assessment, priorities, strategies and outcomes are aligned in tables by indicators. This provides for an easy illustration to funders, constituents, and other community partners. The tables illustrating this methodology can be located in Appendix D and are referenced within the Action Plan.

Because many of the strategies developed overlap core indicators, our Action Plan and priorities outline major strategies that often address more than one core indicator.

Coalition: The Healthy Start Coalition of Flagler & Volusia Counties, Inc.

Coalition Priorities: What particular priorities, target groups, or geographic areas are targeted in your Service Delivery Plan?

1. Provider, Consumer, and Community Awareness - Providers, consumers, and the community require a comprehensive understanding about the importance of early and consistent prenatal care. This priority is designed to maintain prenatal screening rates at 100% and improve 1st trimester entry to care from the current rate of 77.35% to > 85.0% by the next planning cycle.

2. Improve Access to and Consistency of Prenatal Care – The current rates of pregnant women who are uninsured or underinsured or have difficulty applying for or obtaining Medicaid and prenatal health services are above the State rates. Lack of early and consistent prenatal care disproportionately impacts Black women in Volusia County, particularly those residing in the 32114 zip code area despite their geographic proximity to services. Challenges related to Medicaid Managed Care and Medicaid presumptive eligibility are significant barriers. This strategy takes from the lessons learned and the measurable outcome improvements in Flagler County in not only prenatal care access, but in rates of infant mortality, low birth weight, and other birth related indicators. (Improve First Trimester Entry to Care from 77.35% to 85.0%, Reduce Late or No Entry to Prenatal Care to 3.6% or below, Reduce Infant Mortality for the Service Area from 7.2 to 6.0 per 1,000 live births and Black Infant Mortality from 13.8 to 12.0 per 1,000 live births, and Improve Low Birth Weight from 8.2% to 8.0%.)

3. Continue to Update and Implement a Comprehensive Staff Training Plan - Healthy Start workers consistently encounter populations at high risk to include women who are homeless, incarcerated, drug addicted, teens, and those living in poverty. Providing a comprehensive training plan to ensure that field staff is


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prepared and have the competencies necessary to provide outreach and services to vulnerable populations with a high level of cultural competency continues to be a priority in order to reduce low birth weight and infant mortality. Our Coalition goal is to reduce low birth weight from the current rate of 8.21% to 8.0% and Infant mortality from the current rate of 7.3 to 6.0 per 1,000 live births.

4. Continue to Modify Service Delivery Approach to Respond to Trends in High Risk Populations - The rate of infants born at a low birth rate (LBW) (born at 2,500 grams or below) has experienced a slight increase. The five-year goal established by the Service Delivery Planning Committee is to reduce the LBW rate from 8.2% to 8.0%. In addition, the strategies in the action steps associated with this strategy include: increase/Improve service delivery for high risk populations, integrate services into identified facilities to enhance accessibility and participation in Healthy Start care coordination and enhanced services, maintain increased level of Enhanced Services Delivery, and continue multi-agency strategic planning to maximize resources, increase volume, and adjust service delivery accordingly.

5. Continue to Implement, Monitor and Improve The Local FIMR Case Review Process And Implement Recommended CRT Strategies - This strategy is aimed at reducing Infant Mortality and Black Infant Mortality through Case Review identification of systemic improvements and Community Action Group focus on active translation into strategic planning and implementation of recommendations. Reduce Infant Mortality from 7.2 to 6.0 per 1,000 live births.

6. Conduct Research, Planning, and Engagement Activities to More Effectively Target Resources Aimed at Reducing Black Infant Mortality - The rate of Black Infant Mortality has increased since the last service delivery planning cycle despite our efforts. The rate as of 2009 increased to 13.8 per 1,000 live births. Our goal is to reduce this rate to 12.0 or below per 1,000 live births by the next planning cycle. We are identifying specific risk factors in targeted zip codes as a result of the work accomplished during the 2006 – 2011 planning cycle. These risk factors and corresponding activities are incorporated into our action steps for this strategy.

7. Continue to Increase/Maintain Healthy Start Postnatal (Infant) Screening Rates - Infant screening rates have continued to increase in the two county service area since the last planning cycle. The current infant screening rate for the State of Florida is 87.95%, while the current rate in Volusia/Flagler is 83.93%. Our five-year goal is to increase the infant screening rate to 90% by the year 2017.

8. Implement Centralized Access Points for Families - This strategy was in the last planning cycle as an exploration and strategic planning process. Our Coalition has successfully leveraged resources and worked with community partners to implement single points of contacts with integrated programming to serve families. This strategy is designed to target specific areas of need and


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engage the community through active parent involvement, while reducing duplication of effort through improved coordination of services.

The following Planning Summary sheet provides a list of the services and providers for the Coalition’s 11/12 fiscal year, as well as whether or not the services are being funded with Healthy Start dollars.


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PLANNING SUMMARY SHEET FOR THE HEALTHY START SYSTEM

Check the “Y” column if Healthy Start money is being used. Check the “N” column if Healthy Start money is not being used.

Healthy Start System Components Provision of … Provider Y N

Begin and End Date of MOA or

Contract Outreach services for pregnant women

Healthy Communities SMA

X X

7/1/11 – 6/30/12 7/1/11 – 6/30/12

Outreach services for children Healthy Communities SMA

X X

7/1/11 – 6/30/12 7/1/11 – 6/30/12

Process for assuring access to Medicaid (PEPW & ongoing)

Flagler County Health Department Volusia County Health Department

X

X

7/1/11 – 6/30/12

Clinical prenatal care for unfunded women

Flagler County Health Department Volusia County Health Department Agape Midwifery

X

X

X

7/1/11 – 6/30/12

8/1/11 – 6/30/12 Clinical well-child care for all unfunded infants

Health Departments X

Funding to support the CHD Vital Statistics Healthy Start screening infrastructure

Volusia County Health Department

X 7/1/11 – 6/30/12

Ongoing training for providers doing screens and referrals

Healthy Communities Healthy Start Coalition

X X

7/1/11 – 6/30/12 7/1/11 – 6/30/12

Initial contact after screening SMA Agape Midwifery

X X

7/1/11 – 6/30/12 7/1/11 – 6/30/12

Initial assessment of service needs SMA Agape Midwifery

X X

7/1/11 – 6/30/12 10/1/11 – 6/30/12

Ongoing care coordination SMA X 7/1/11 – 6/30/12 Interconceptional education and counseling

SMA Agape Midwifery

X X

7/1/11 – 6/30/12 7/1/11 – 6/30/12

Childbirth education

SMA Agape Midwifery

X X

7/1/11 – 6/30/12 7/1/11 – 6/30/12

Parenting support and education SMA X 7/1/11 – 6/30/12 Nutritional counseling WIC X Provision of psychosocial counseling

To Be Determined X

Smoking cessation counseling SMA X 7/1/11 – 6/30/12 Breastfeeding education and support

SMA Agape Midwifery WIC

X X

X

7/1/11 – 6/30/12 7/1/11 – 6/30/12

Data entry into HMS Volusia County Health

Department SMA Agape

X

X X

7/1/11 – 6/30/12

7/1/11 – 6/30/12 7/1/11 – 6/30/12


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MomCare Program (SOBRA) Healthy Start Coalition X 7/1/11 – 6/30/12 Hospital based assessments Halifax Medical Center X 7/1/11 – 6/30/12

Activities required to maintain effective agency operations and to implement and monitor the Healthy Start care coordination system are documented in Category A of the action plan.

AGENCY ACTION STEPS:

Action Step Person Responsible Start Date

End Date

1. Maintain an effective and diverse Board of Directors.

Executive Director, Board of Directors 7/11 6/12

2. Provide staffing services and reports for all Board, Committee and Coalition meetings.

Executive Director, Coalition Staff 7/11 6/12

3. Develop funding allocation methodology and cost allocation plans.


4. Develop and issue timely contracts for services.

Executive Director Coalition Staff 7/11 6/12

5. Monitor contracted service providers for contract compliance and programmatic quality assurance.

Coalition Staff 7/11 6/12

6. Provide technical assistance to contracted service providers as needed. Coalition Staff 7/11 6/12

7. Maintain effective Coalition operations. Executive Director, Coalition Staff 7/11 6/12

8. Monitor agency’s compliance with all funding contracts. Coalition Staff 7/11 6/12

9. Prepare required DOH reports. Coalition Staff 7/11 6/12 10. Prepare required reports for other funding

sources. Coalition Staff 7/11 6/12

11. Seek additional sources of revenue to benefit service delivery to families.


12. Conduct organizational planning activities to maximize Coalition human resources. Executive Director 7/11 ongoing

13. Conduct performance planning to ensure competency in the administrative workforce. Executive Director 7/11 ongoing

14. Continue to maintain the Healthy Start website to improve communication to consumers, community partners, and Board members.

Executive Director, IT Staff 7/11 ongoing

15. Develop and update agreements with community partners in order to formalize methods of coordinating services on behalf of our clients.

Executive Director 7/11 ongoing

16. Provide information to the community at large about the mission and vision of the Healthy Start initiative.

Executive Director 7/11 6/12


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17. Conduct independent audit and prepare financial statements.

Executive Director, Finance Director, Auditor 9/11 12/11

18. Review Healthy Start Self Assessment process with the Coalition and Board of Directors and update regularly.

Board President, Executive Director, Coalition staff 7/11 6/12

19. Implement HMS Data System throughout Healthy Start service delivery. IT Staff, Contract Manager 10/11 6/12


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B. Category “B” Activities

PRIORITY AREA I: IMPROVE PATIENT, PROVIDER, AND COMMUNITY AWARENESS OF HEALTHY START SERVICES IN ORDER TO IMPROVE PRENATAL CARE ENTRY AND IMPROVE/MAINTAIN SCREENING RATES

1. CONTRACT REQUIREMENT OR IDENTIFIED COMMUNITY-WIDE/SYSTEM ISSUE:

a. What is the requirement or system/community-wide problem or need identified to be addressed by a strategy?

Providers, consumers, and the community require a comprehensive understanding about the importance of early and consistent prenatal care and the various processes available to access Medicaid for those who do not have adequate insurance coverage.

b. What health status indicator/coalition administrative activity is being addressed by this strategy?

Increase 1st Trimester into Prenatal Care to 85.0%

Reduce Late or No Entry into Prenatal Care to 3.60%

Increase Infant Screening Rates to 90%

Maintain Prenatal Screening Rates at 100%

c. What information, if any, was used to identify the issue/problem (i.e. HPA, FIMR, screening, client satisfaction, interviews, QI/QA)?

Issue identified with Compiled Data: DOH data by race and zip code related to prenatal care entry and screening, Feedback from consumers and providers

2. PLANNING PHASE QUESTIONS: (All Required)

a. What strategy has been selected to address this?

The strategy that has been selected to address this issue is to continue to improve access to and consistency of prenatal care for Medicaid eligible women through improved provider, patient and community education and awareness.

1A) Provider Education and Awareness

1B) Patient Education and Awareness


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1C) Community Awareness

b. What information will you gather to demonstrate that you have implemented this strategy as intended (who, what, how many, how often, where, etc.)?

In addition to related entry to care and screening data, the following information will be collected to review the success of implementing this strategy:

1A) Provider Education and Awareness – Information obtained will include provider feedback (OB/GYNs, Midwives, Hospital Staff, Office Managers, Medical Assistants, Healthy Start Providers and other Community Based Organization representatives), website tracking on the health care professional’s page, Facebook data, committee meeting lists and minutes, annual survey information, publications and informational documents distributed.

1B) Patient Education and Awareness – Information will be gathered about participant outreach and identification data, website reports (Mom and Dad’s Corner, Resource Page), Facebook data, and participant feedback from Healthy Start service staff.

1C) Community Awareness – Information will be gathered from health fairs/community events (numbers attending and numbers of literature distributed, etc.), Community Action Group members and activities, policy recommendations, number of FAHSC meetings attended, survey monkey, and number of participants attending Child Watch.

c. Where/how will you get the information?

Provider surveys are conducted as a routine part of needs assessment activities. The Healthy Start Coalition added “survey monkey” to the website in FY07/08 for easy access by providers and consumers who have access to computer technology. MomCare specialists will also gather information when possible about how useful patient information was in assisting women in linking to prenatal care and navigating through the system.

• Website hits are reviewed quarterly with the IT Manager

• Literature distributed is counted for each event

• Provider feedback is gathered in the following ways: a) Healthy Start Marketing and Education Director; b) Written and verbal feedback from SOBRA Maternity Care Advisors; c) Survey Monkey surveys developed and maintained by the Healthy Start Coalition; d) HMS screening data reports


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d. What do you expect will be the observed impact of the strategy on the system or community-wide problem/need?

Providers, participants and the community will become more knowledgeable about the importance of early and consistent prenatal care and access available systems more readily. Also, OB/GYNs will maintain their relationship with Medicaid as providers

e. What information will you gather to demonstrate this change on the system?

HMS Healthy Start screening data, number of website hits, number of Facebook “likes,” provider participation on Coalition committees and activities, provider request for educational materials (i.e., Healthy Start brochures, Motherhood Matters, Fatherhood Matters, Grief Support, Project INFORM), and feedback from MomCare Maternity Care Advisors and participants.

f. Where/how will you get the information?

Provider survey data and MomCare data, Charts, DOH screening data reports, quarterly reports from subcontracted provider, reports from Marketing and Education Director and IT staff.


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STRATEGY 1 - Improve access to and consistency of prenatal care and screening for eligible women through improved provider, patient and community education and awareness.

3. ACTION STEPS: 1A) Provider Education and Awareness

Action Steps Person Responsible Start Date End Date

1. Distribute informational material to medical providers and other key points of entry to prenatal care through the HS Marketing & Edu. Director

Healthy Start Marketing & Edu. Director, HS Contract Manager

7/11 6/12

2. Update and maintain the Healthy Start website to include relevant information for providers.

IT Director, Healthy Start Marketing & Edu. Director

7/11 6/12

3. Provide on-site presentations and technical assistance to community providers about HS, MomCare and access to prenatal care services.


7/11 6/12

4. Participate in One Voice for Volusia Thrive by Five steering committee and monthly OVV coalition meetings.


5. Participate in the Infant Mental Health Chapter of Volusia and Flagler Counties.


6. Contact the three (3) largest pediatric providers to initiate a connection to the Healthy Start system of care.

Marketing & Edu. Director

7/11 6/12

7. Attend quarterly Supervisor meetings as scheduled by the Healthy Start Contract Manager.

Marketing and Edu. Director, HS Contract Manager

7/11 6/12


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3. ACTION STEPS: 1B) Patient Education and Awareness


1. Coordinate with the Marketing Committee to develop and update materials to be used to inform women about the importance of early and consistent prenatal care and how to access the eligibility system.

Healthy Start Marketing & Edu. Director, HS Contract Manager, Coalition Members

7/11 6/12

2. Continue to disseminate Motherhood Matters and Fatherhood Matters informational newsletters to all points of entry for pregnant women.

HS Contract Manager Healthy Start Marketing & Edu. Director, Marketing Committee

7/11 6/12

3. Distribute informational materials with information about services offered and the Assessment Center local and toll free numbers to venues where pregnant women or parents with infants may convene.

HS Contract Manager Healthy Start Marketing & Edu. Director, Marketing Committee

7/11 6/12

4. Update and maintain the Healthy Start website to include relevant information for participants, potential and those in the service system. (i.e., Mom’s Corner, Dad’s Corner and the Resources Page)

IT Director, Program Director, Healthy Start Marketing & Edu. Director

7/11 6/12

5. Meet with MomCare staff monthly to identify barriers patients encounter and develop strategies for improving access.

Executive Director, Program Director, Lead MomCare Advisor

7/11 6/12

6. Annually review and update letters utilized by the MCH Assessment Center and Healthy Start and Healthy Families providers to appeal more broadly to all potential consumers of services.

Program Director, HS Contract Manager, Healthy Start Marketing & Edu. Director, SMA HS Program Director, Health Services Assessment Supervisor, Marketing Committee

1/12 6/12

7. Continue to provide midwifery services at the Chiles Academy a minimum of once a month and market to the broader community.

Executive Director, HS Contract Manager

7/11 6/12


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3. ACTION STEPS: 1C) Community Awareness


1. Facilitate and ensure Healthy Start representation in a minimum of sixteen (16) community outreach and education activities and events.


7/11 6/12

2. Continue to coordinate with local midwives with OB back-up to continue to improve health care access for pregnant women.

Executive Director, Coalition Members

7/11 6/12

3. Work with the local and state partners to access media and policy maker outlets (such as press conferences, Op Eds, PSA’s legislative briefs) aimed at increasing community awareness through news media and updating policy makers on MCH issues.

Executive Director, Marketing Committee

7/11 6/12

4. Conduct Child Watch activities one (1) time annually to educate community leaders about the importance of early and consistent prenatal care.

Executive Assistant 1/12 5/12


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PRIORITY AREA II: IMPROVE ACCESS TO AND CONSISTENCY OF PRENATAL CARE FOR PREGNANT WOMEN THROUGH SYSTEMIC COORDINATION AND POLICY DEVELOPMENT



Medicaid eligible women, undocumented women, and women without adequate health care plans face multiple barriers in receiving early and consistent prenatal care. Rates of 1st trimester entry to care and late or no prenatal care have not been improved since the last planning cycle. 1st trimester entry into care for the Service Area was at 77.35% at the end of 2009, while the State rate was at 78.28%. The State rate for late or no entry into care was 4.3%, while the rate for the Service Area was 4.6%. Implementation of accessible quality prenatal care can have a measured impact on 1st trimester entry into care as evidenced by rate improvement in Flagler County during the last planning cycle. In 2007, a new model of care was implemented at the Flagler County Health Department. Despite the rates of both the state and Volusia County declining, Flagler County's rate continued to improve steadily from 2007 to 2009. For both 1st trimester entry into care and late entry into care, Black women disproportionately do not or cannot access care.


Reduce Late or No Entry into Prenatal Care to 3.60%

Increase 1st Trimester into Prenatal Care to 85.0%


DOH data on 1st trimester entry to care and late or no prenatal care, interviews with maternity advisors, OB/GYNs, and Medicaid data.



The strategy that has been used to address this is to improve access to and consistency of prenatal care for Medicaid-eligible women through improved systemic coordination and policy development.


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Provider and participant feedback, documented activities (minutes, etc.) activities, and products associated with system improvement.

c. Where//how will you get the information?

Minutes will be maintained by Healthy Start Coalition staff. MOAs will be maintained at the Healthy Start Coalition, and feedback will be obtained from prenatal providers, MomCare Maternity Advisors, and consumers.


Positive partnerships with public and private providers of prenatal service and amore coordinated system of care, resulting in reduced late or no entry to prenatal care and increased 1st Trimester Entry into Care rates.

Additional impact will include continued participation by our health practitioners in the Medicaid program, decrease in late entry into prenatal care, continued high prenatal screening rates, and data from MomCare showing better linkage to prenatal services.


We will gather data from MomCare, DOH Healthy Start data on 1st Trimester entry to care and late or no entry to prenatal care, AHCA data and local screening and sub recipient data.


DOH reports, provider survey data and MomCare data.


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STRATEGY 2: Improve access to and consistency of prenatal care for Medicaid-eligible women through improved systemic coordination and policy development.

3. Action Steps


1. Coordinate with the Volusia County Health Department to implement the One-Stop (Brevard) model.

Executive Director

8/11 10/11

2. Meet with local legislators to gain support for effective models that improve access to prenatal care.

Executive Director

9/11 11/11

3. Work in community environments to assist women in navigating to prenatal care providers.

Healthy Start Program Director and Project Coordinator

10/11 6/12

4. Continue to support MomCare follow-up with women who apply for Medicaid.

Program Director 7/11 6/12

5. Work with representatives of the Florida Department of Health to address the lack of cell phone contact information on MomCare participant lists.


6. Continue to work with prenatal providers to encourage accepting of temporary Medicaid.


7. Continue to analyze data associated with late entry to prenatal care to educate policy makers and stakeholders about the importance of early access to prenatal care.



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PRIORITY AREA III. COMPREHENSIVE TRAINING FOR SERVICE DELIVERY STAFF



Healthy Start Supervisors, Assessment Workers, and Care Coordinators manage a complex system with high risk families on a day to day basis and are required to deliver a wide array of services designed to prevent infant mortality and low birth weight. In addition, they are faced with documentation and coding requirements in order to accurately capture the work that they do and the outcomes they are required to achieve.


Low Birth Weight, Infant Mortality


Provider reports and feedback, client feedback, supervisor feedback, direct service staff feedback.



The strategy that has been selected to address this is to continue to improve Healthy Start services through comprehensive staff development related to systemic and service delivery activities and requirements.


The following information will be gathered:

• Comprehensive training plan • Individual training learning objectives • Training sign-in sheets • Feedback/Evaluation forms



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Information will be gathered from training participants, supervisors, and presenters at each staff development offering.

d. What do you expect will be the observed impact of the strategy on the system or community-wide problem/need? • Less burn out • Better prepared and trained staff • Better staff retention • Improved management of families • Improved retention of families in Healthy Start services • Improved perception of Healthy Start services by referring providers

e. What information will you gather to demonstrate this change on the system? • Participant feedback • Family retention • Numbers of women who consent to services • Reduced number of women “lost to contact” • Better management of substance involved families • Staff retention – number of staff retained in direct service for Healthy Start


Information will come from client surveys, subcontracted provider surveys, the local HS (Netsmart) database (until 9/30/11), and the local HS (WFS) database (beginning 10/1/11).


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STRATEGY 3 - Continue to update and implement a comprehensive staff training plan.

3. Action Steps Action Steps Person Responsible Start Date End Date

1. Continue to implement minimum training requirements for all program staff positions to include interconception education, sleep-related infant death and cultural competency.

Program Director, HS Contract Manager, SMA HS Program Director

7/11 6/12

2. Obtain provider feedback about ongoing training needs.


7/11 6/12

3. Update comprehensive training plan to include COPE (Community Outreach Perinatal Educator Certification) for paraprofessional, supervisory and Assessment staff.


10/11 12/11

4. Integrate training plan requirements into policy & procedure.


1/12 3/12

5. Analyze and review evaluation and staff feedback to address the quality of the training activities presented.


7/11 6/12

6. Incorporate compliance with training plan into contract monitoring.

Program Director, HS Contract Manager

7/11 6/12

7. Integrate issues/concerns identified during contract monitoring into training plan.

HS Contract Manager, SMA HS Program Director, Program Administrative Assistant

1/12 6/12

8. Coordinate the Infant Mental Health Chapter of Volusia and Flagler Counties to provide a minimum of one community wide training activity per year.



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9. Update contracts with select Enhanced Service providers and include quality measures associated with provision of Healthy Start services and submission of data.

Program Director, HS Contract Manager

7/11 9/11

10. Update Website monthly to include Training Calendar for Community Providers.

IT Director, Program Staff Assistant, Executive Assistant, SMA HS Program Director, HS Contract Manager

7/11 6/12

11. Continue updates for training developed by Jennie Joseph (COPE – Community Outreach Perinatal Educator Certification) Culturally Competent Childbirth Education, Lactation/Breastfeeding Support & Education Cultural Competence Training and Listening Report.

Executive Director, Program Director

10/11 6/12


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PRIORITY AREA IV: INCREASE AND IMPROVE HEALTHY START SERVICES THROUGH SYSTEMIC ANALYSIS AND STRATEGIC PLANNING



Pregnant women and babies, many at high risk, who need Healthy Start services, are often closed to capacity due to limitations in types and locations of Healthy Start services in Volusia and Flagler Counties.


Low birth weight and very low birth weight


DOH reporting data, Provider data, data from the Stewart Marchman Assessment Center Netsmart data system (until 9/30/11), Well Family data system (beginning 10/1/11), medical provider feedback



The strategy that has been selected to address this is to increase and improve Healthy Start services through expansion and continued modification of service delivery approach. This strategy is comprised of the following sub-strategies:

4A) Increase/Improve service delivery for high risk populations

4B) Integrate services into identified facilities to enhance accessibility and participation in Healthy Start care coordination and enhanced services.

4C) Maintain increased level of Enhanced Services Delivery

4D) Continue multi-agency strategic planning to maximize resources, increase volume, and adjust service delivery accordingly.



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4A) Increase/Improve service delivery for high risk populations – Contract with agency that specializes in serving very high risk populations and monitor service units generated by this contract by location (i.e., homeless shelter, substance abuse treatment center, Volusia County Branch Jail, The Chiles Academy for pregnant/parenting teens, etc.). Gather information about units associated with enhanced services.

4B) Integrate services into identified facilities to enhance accessibility and participation in Healthy Start care coordination and enhanced services – We will gather data associated with service units delivered at the Volusia County Health Department and the Flagler County Health Department for assessment services and care coordination services during clinic booking days and WIC high volume periods and assessment and enhanced services with the three local hospitals that have birthing centers.

4C) Maintain increased enhanced services delivery – Service units for enhanced services to include childbirth education, lactation consulting and psychosocial counseling services.

4D) Conduct multi-agency strategic planning – Service delivery; evidence of meeting and training dates, times & participation; service units


Local HS (Netsmart) database (until 9/30/11), the local Well Family data system (beginning 10/1/11), DOH GH330L and Executive Summary reports.


Fewer families will be closed to Healthy Start due to situational or limited capacity and more women/families will receive enhanced services through Healthy Start, particularly in areas that have been underserved. As a result, low and very low birth weight rates will decrease.


Information will include number of service units, location of clients served, number of unique clients, number closed to capacity, number of women receiving enhanced services and low and very low birth weight rates.


DOH GH330L Reports, Local HS (Netsmart) database (until 9/30/11), Local HS (WFS) database (beginning 10/1/11)


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STRATEGY 4 - Increase and improve Healthy Start services through continued expansion and modification of service delivery approach.

3. Action Steps: 4A) Increase/Improve service delivery for high risk populations


1. Continue to meet regularly with the SMA HS Program Director and Marketing & Edu. Director to assess service needs for high risk populations.

SMA HS Program Director, HS Contract Manager, HS Marketing & Edu. Director, Executive Director

7/11 6/12

2. Review and update existing local HS policy and procedure for the non CHD multiple service provider care coordination system quarterly at a minimum.

SMA HS Program Director, HS Contract Manager

7/11 6/12

3. Continue HS care coordination services at Project WARM and throughout substance abuse treatment service delivery system to include interconceptional education services to an increased number of women receiving substance abuse treatment and mental health services.


7/11 6/12

4. Implement HS services at The Chiles Academy Center for Pregnant & Parenting Teens/Early Head Start facility.


7/11 6/12

5. Implement childbirth education, smoking cessation and breastfeeding support for high-risk women in multiple venues through care coordination workers.


7/11 6/12

6. Review available data associated with barriers, challenges and successes related to smoking cessation.


10/11 12/11

7. Participate in Mama Bear community collaborative for pregnant women who are HIV positive or identified with an STD.


7/11 6/12


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8. Develop/continue agreement between Healthy Start and VCHD and FCHD to determine the best way to integrate services at the prenatal clinic and/or WIC center(s).


7/11 2/12

9. Continue to utilize midwives for Healthy Start service delivery.


7/11 6/12

3. ACTION STEPS: 4B) Coordinate Healthy Start services with community based facilities to enhance accessibility and participation in Healthy Start care coordination and enhanced services


1. Continue to meet with VCHD WIC and Program Director to implement Healthy Start services in WIC clinic.


9/11 6/12

2. Continue to provide and monitor clinical prenatal services through the Flagler County Health Dept. for Flagler County women with no alternate payer source.

HS Contract Manager 7/11 6/12

3. Coordinate with Birthing Centers to determine the need for assessment services on site.

HS Contract Manager, SMA HS Program Director

10/11 6/12

4. Implement Community Cafés (Family Access) with access to Midwife for Interconception services.

Executive Director, Contract Manager, Project Coordinator

10/11 6/12

5. Seek funding sources for expanding outreach, care coordination and support services to the highest risk and most vulnerable maternal and infant populations.


7/11 6/12

6. Work with community partners to better coordinate existing systems and resources through unified referral processes.


7/11 6/12


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3. ACTION STEPS: 4C) Continue to Maintain and Increase Enhanced Services Delivery


1. Renew and amend contract for Interconceptional Care, Breastfeeding Support and Childbirth Education services (Agape).

Director of Finance & Administration, HS Contract Manager

7/11 9/11

2. Provide technical assistance to enhanced service providers re: referral processes and data reporting.

SMA HS Program Director, Health Services Assessment Supervisor, HS Contract Manager

7/11 6/12

3. Review data regarding referral into enhanced services to determine if linkages are occurring as desired.

HS Contract Manager, SMA HS Program Director,

10/11 6/12

4. Continue integration of interconceptional education services childbirth education, breastfeeding education and tobacco cessation training through Care Coordinators.


7/11 6/12

5. Review enhanced service units through data reports and contract monitoring to analyze/verify increased volume following COPE training program and tobacco cessation certification.

HS Contract Manager, SMA HS Program Director,

1/12 6/12

6. Continue to monitor goals of the interagency agreement with SMA Behavioral Services (formally Stewart-Marchman Center and ACT Corporation) to ensure Healthy Start participants are successfully linked to psychosocial services within their system.


7/11 6/12


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3. ACTION STEPS: 4D) Conduct multi-agency strategic planning to maximize resources, increase volume and adjust service delivery in order to continue to align with the methodology for Healthy Start funds


1. Continue to convene Service Delivery Planning Committee.

Executive Director, Program Director, HS Contract Manager

7/11 4/12

2. Review service data at quarterly Coalition meetings.

Executive Director, Program Director, HS Contract Manager, SMA HS Program Director

7/11 6/12

3. Meet regularly with Healthy Start supervisors to ensure consistent leveling and closure of cases.


7/11 6/12

4. Implement Women’s Intervention Specialist as part of the HS Assessment Center to respond to cases of pregnant women exposed to alcohol or other drugs during pregnancy.


11/11 6/12

5. Review data associated with Women’s Intervention Specialist to determine the need for expanded capacity.


4/12 6/12

6. Work with the Thrive by Five Committee to examine community capacity and develop multi-agency maternal and child service assessment and triage.

Executive Director, HS Coalition

7/11 6/12

7. Continue to monitor contracts and services closely and work with providers to develop performance improvement plans.


7/11 6/12


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PRIORITY AREA V. REDUCE INFANT MORTALITY AND CONTINUE TO IMPLEMENT, MONITOR AND IMPROVE THE LOCAL FIMR CASE REVIEW PROCESS AND IMPLEMENT RECOMMENDED CRT STRATEGIES



Infant mortality continues to impact families throughout Volusia and Flagler Counties.


Infant mortality


Vital statistics data, supplemental risk data (FIMR, interviews, etc), Survey data, Screening Rates indicators, and SMC data (“02 and other).



The strategy that has been selected to address this is to continue to implement, monitor and improve the local FIMR Case Review Process and implement recommended CRT Strategies. This strategy is comprised of the following sub-strategies:

5A) Continue to implement Marketing Campaign for SIDS Awareness

5B) Continue to implement and improve FIMR CRT process

5C) Continue to distribute cribs to families with no safe sleeping environment for their infant


5A) Continue to implement Marketing Campaign for SIDS Awareness – information will be gathered from newspaper advertisements, accounting of funds received, website information and number of hits to


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the page where it is listed, number of safe sleeping information packets distributed.

5B) Continue to implement and improve FIMR CRT process – information will be gathered from FIMR CRT attendance, Abstractor contract and abstraction data, maternal interview information, and CAG minutes.

5C) Continue to distribute cribs to families with no safe sleeping environment for their infant – Information will be gathered on the number of cribs purchased and distributed, and direct service feedback.


5A): Continue to implement Marketing Campaign for SIDS Awareness – Information will be clipped from the newspaper, accounting information will be entered and retrieved from the Coalition’s accounting software (QuickBooks).

5B): Continue to implement and improve FIMR CRT process – Information will be obtained from FIMR attendance sheets, Abstraction data BASINET data, and CAG minutes.

5C): Continue to distribute cribs to families with no safe sleeping environment for their infant – Crib distribution information is maintained at Healthy Start.


• FIMR CRT will retain members and identify professionals in the community who should be identified/included.

• FIMR CRT members will become more adept at reviewing fetal and infant death cases and providing valuable input and recommendations for system-wide change.

• The Community will have documented publications to assist them in understanding the nature and scope of Infant Mortality, CRT Activities, and grief and loss.

• Providers will have additional resources to assist women who have experienced a loss and a mechanism to refer them for bereavement support and interconception education and care. (Grief Toolkit)

• Healthy Start Supervisor participation in FIMR will reinforce implementation of recommendations into direct service activities.

• The community and consumers will be more knowledgeable about sleeping infant death (number of SIDS cases and sleeping infant death cases will decrease).


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• FIMR recommendations will be more effectively communicated to the direct service staff and other providers of maternal and infant care.

• Ultimately, infant mortality will decrease.


• FIMR recommendations and implemented changes. • Project INFORM Report • Provider Feedback • Training plan illustrating incorporation of recommendations for field staff. • Infant mortality data


• Vital Statistics (Infant Mortality data) • BASINET data • Provider feedback reports from Marketing and Education Director.


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STRATEGY 5 - Continue to implement, monitor and improve the local FIMR Case Review Process and implement recommended CRT Strategies.

3. ACTION STEPS: 5A) Continue to implement Marketing Campaign for SIDS/SUIDS Awareness


1. Work with Media to enhance community awareness about safe sleep and infant mortality.

Executive Director, HS Contract Manager, Marketing Committee

7/11 6/12

2. Attend National Conference in collaboration with SIDS Alliance and share information locally.


3. Present SIDS Awareness information at One Voice for Volusia Community-wide meeting.


4. Conduct a minimum of two (2) presentations at civic groups or policy-maker forums about the importance of safe sleep.


10/11 1/12

5. Continue to distribute practitioner’s toolkit on fetal and infant loss to support patient empowerment and practitioner support as well as linkage to mental health support and interconception services for women who have experienced a loss.

HS Contract Manager, Healthy Start Marketing & Edu. Director, Marketing Committee

7/11 6/12

6. Maintain information on website about safe sleep practices and SIDS risk reduction.

IT Director, HS Contract Manager, Healthy Start Marketing & Edu. Director

7/11 6/12

7. Coordinate with local child care providers to educate staff about safe sleep.


8. Collaborate with Florida SIDS Alliance Education Committee to improve safe sleep practices and reduce the risk of SIDS education in the community.


9. Participate as a member on Florida SIDS Alliance Board of Directors.



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3. ACTION STEPS: 5B) Continue to implement and improve FIMR CRT Process


1. Conduct Data Committee activities for better analysis of FIMR data and to develop a comprehensive report for community presentation.


2. Continue to distribute Project INFORM to increase community awareness about fetal and infant mortality in our service area, particularly to the provider network. Update annually as resources allow.

HS Contract Manager, Healthy Start Marketing & Edu. Director, Marketing Committee

7/11 6/12

3. Execute two FIMR abstractor contracts to ensure adequate support for FIMR Case Review Team (CRT).


4. Continue pre-planning CRT meeting. HS Contract Manager, CRT Chair, FIMR Abstractors

8/11 6/12

5. Conduct Maternal Interviews on a minimum of 33% of cases reviewed.

HS Contract Manager, SMA HS Program Director, Health Services Assessment Supervisor

7/11 6/12

6. Participate in FIMR conference calls. HS Contract Manager 7/11 6/12 7. Include participation of Faith Based

Community in the FIMR CRT. Executive Director, HS Contract Manager

7/11 6/12

8. Continue to include mandatory supervisor participation in a minimum of 1 FIMR meeting annually in Care Coordination contracts.



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3. ACTION STEPS: 5C) Continue to distribute cribs to families with no safe sleeping environment for their infant


1. Determine annual budget to purchase safe sleeping environments for program participants who cannot afford them.

Executive Director, Program Director, Director of Finance & Administration

7/11 9/11

2. Apply for funding to purchase safe sleeping environments for Healthy Start participants and other women in the community who need a safe sleeping environment for their baby.

Executive Director, Program Admin. Assistant

7/11 6/12

3. Obtain feedback from field staff and community partners regarding participant need for cribs.

Program Admin. Assistant

7/11 6/12

4. Purchase cribs and pack n’ plays for distribution by staff to program participants.

Program Admin. Assistant

7/11 6/12

5. Provide information to crib/pack n’ play recipients and program participants about SIDS prevention and safe sleep practices.

Program Admin. Assistant, Program Director, SMA HS Program Director, Program Supervisors

7/11 6/12


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PRIORITY VI. CONDUCT RESEARCH, PLANNING, AND ENGAGEMENT ACTIVITIES TO MORE EFFECTIVELY TARGET RESOURCES AIMED AT REDUCING BLACK INFANT MORTALITY



In the local service delivery area, as in Florida and the United States, health disparities and other socio-economic risks disproportionately impact the Black population. In the Flagler/Volusia service delivery area, the current Black infant mortality rate is almost three times the White and Hispanic infant mortality rates. At the end of 2009, the White infant mortality rate was 3.2 per 1,000 live births while the Black infant mortality rate was 13.8.


Black infant mortality


Vital Statistics data by race and zip code, survey data, FIMR data and census data.

2. PLANNING PHASE QUESTIONS: (All Required) –


The strategy that has been selected to address this is to conduct research and planning activities to more effectively target resources aimed at reducing black infant mortality. This strategy is comprised of the following sub-strategies:

6A) Support Culturally Competent Service Delivery

6B) Continue to work with FIMR and academic institutions to analyze data and recommend strategies to promote more positive outcomes for black infants

6C) Continue the SIDS Sunday initiative in targeted areas of high risk for black infant mortality


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6A) Support Culturally Competent Service Delivery

• JJWay Cultural Competence Training Report Recommendations and number of staff who complete Culturally Competent enhanced service training with satisfactory post test results.

• Continued evaluation of Implementation of recommendations from the report into workforce practices.

• Continued contracting with minority-based agency for delivery of care coordination services/corresponding units of service and customer satisfaction results.

6B) Continue to work with FIMR and academic institutions to analyze data and recommend strategies to promote more positive outcomes for black infants

• FIMR CRT information from BASINET • Intern products to include Project INFORM, sign in sheets from

The Chiles Academy, Healthy Start service data

6C) Continue to implement activities in targeted areas of high-risk for black infant mortality

Information gathered will include: number of black clergy addressed and receiving information about black infant mortality and sleeping infant death among black babies in Volusia and Flagler counties, and the number of churches participating in the SIDS Sunday event, the number of churches participating in the African-American Faith Based Bereavement Initiative


Information on this strategy will be obtained from FIMR CRT data, Florida Charts, BASINET, local newspapers, Healthy Start staff, Healthy Start training data base, and Florida’s Vital Statistics.


• Increase in the number of faith based communities participating in supporting SIDS Sunday and supporting prevention efforts in the community


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• Increase in the number of people aware of black infant mortality issues including safe sleeping practices, stress, depression, and maternal infection and disease

• Increase in the number of service area infants being placed in optimum sleeping position and safe sleeping environments

• Reduction in black infant mortality


• Number of Black churches receiving information re: and participating in SIDS Sunday and in Lifesong

• Signed consumer responses re: safe sleeping practices • Number of black infant mortality cases receiving a data review • Black infant mortality rate


• Distribution list of Black churches receiving information re: SIDS Sunday • Web-based consumer surveys • FIMR BASINET data • Florida Vital Statistics data


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STRATEGY 6 – Conduct research, planning and engagement activities to more effectively target resource aimed at reducing black infant mortality.

3. ACTION STEPS: 6A) Support Culturally Competent Service Delivery


1. Continue support of the JJ Way model in the Healthy Start service system.


2. Continue to implement recommendations from Jennie Joseph’s Cultural Competency training.

Executive Director

7/11 6/12

3. Provide referral to JJ Way EASY ACCESS clinics for women who cannot obtain Medicaid and have no payer source for services.

Executive Director, MomCare, HS Program Director

7/11 6/12

4. Maintain a contract for interconception education and other allowable Healthy Start services with EASY ACCESS Clinic.


7/11 6/12

5. Continue to provide interconception care among Black teens and families in the 32114 zip code area at The Chiles Academy through subcontracted midwife and Community Cafés.

Executive Director, Contract Manager

8/11 6/12

6. Continue to support outreach activities to women who may be lost to contact or may fear the system but have multiple risk factors.

Healthy Start Program Director

7/11 6/12

7. Develop and implement a training plan for Healthy Start workers and supervisors that is culturally competent and supports reducing health disparities among African American women and babies.

Executive Director, Executive Assistant

10/11 6/12

8. Utilize Bethune Cookman nursing students to support culturally competent breastfeeding education in the East Volusia area.

Program Director, Contract Manager

9/11 5/12


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3. ACTION STEPS: 6B) Continue to work with FIMR and academic institutions to analyze data and recommend strategies to promote more positive outcomes for black infants


1. Continue FIMR data workgroup and review.

HS Contract Manager, FIMR CRT

7/11 6/12

2. Isolate data sets of black infant mortality and develop a power-point for community presentations.

HS Contract Manager

7/11 6/12

3. Engage intern(s) to conduct concentrated review of unintended pregnancy (disproportionate in Black women).

HS Contract Manager, Executive Director FIMR Data Workgroup

9/11 5/12

4. Share findings with provider network, Healthy Start staff, and other stakeholders.


3. ACTION STEPS: 6C) Continue to implement community engagement activities in targeted areas of high-risk for black infant mortality


1. Obtain sponsorships for fans. Executive Director 8/11 10/11 2. Utilize Lifesong logo for new fan

design for SIDS Sunday. Executive Director, Executive Assistant

9/11 10/11

3. Contact churches through Black Clergy Alliance and coordinate delivery of fans.


4. Enlist churches in the service area to participate in the SIDS Sunday Campaign and provide church fans with SIDS prevention messages.


5. Work with Faith Based Community to obtain training in African American Faith Based Bereavement Initiative (AAFBBI) Curriculum and Training.


6. Implement Lifesong in partnership with the Faith Community.


7. Work with Tubman King Community Church and other community partners to conduct a Day of Remembrance to reach women who have experienced a pregnancy loss or infant death.

Executive Director, HS Contract Manager/FIMR Coordinator

8/11 11/11


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PRIORITY AREA VII: CONTINUE TO INCREASE/MAINTAIN HEALTHY START PRENATAL AND POSTNATAL (INFANT) SCREENING RATES



Healthy Start Postnatal (Infant) and Prenatal Screening rates in order to facilitate the earliest and most universal opportunity for entry into the Healthy Start system of care for pregnant women and at-risk newborns.

As the infant screen is the entry point into the Healthy Start system of care for at-risk newborns, maintaining increased infant screening rates screening rates will continue to be a main priority for the Coalition this year.

As the prenatal screen provides the earliest and most universal opportunity for at-risk pregnant women to enter the Healthy Start system of care, maintaining improved prenatal screening rates will be continue to be a main priority for the Coalition this year. Although the offer screening rate for 2010 was at 100%, we will continue to implement strategies for both prenatal screening.


Prenatal and Postnatal (Infant) Screening Rates


DOH screening results reports and Executive Summary Reports



Targeted Marketing to Medical Providers

The strategy that has been selected to address this is to maintain increased service area infant and prenatal screening rates through comprehensive marketing and education. This strategy is accomplished by maintaining a positive rapport with medical providers and marketing Healthy Start by providing education and technical assistance as needed.


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Targeted Marketing to Medical Providers – Information gathered will include performance-based contracting deliverables for subcontracted provider of Healthy Start Screening Education & Outreach services including number of visits to medical providers annually; numbers of incentives distributed to medical providers; number of literature/educational material distributed to medical providers as well as DOH screening reports, and error reports.


Information will be obtained through medical provider feedback from the Marketing & Education Director and DOH screening reports.


Medical providers will gain awareness about the purpose of Healthy Start and the potential benefit to their patients, thereby becoming more supportive of the overall goals and mission of the Coalition; service area prenatal and infant screening rates will increase.


Feedback/survey results from medical provider community; service area prenatal and infant screening rates


Information will be obtained from medical provider surveys conducted by subcontracted provider; quarterly reports from subcontracted provider and DOH screening results reports


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STRATEGY 7 - Maintain service area infant and prenatal screening rates through comprehensive marketing and education.

3. ACTION STEPS: Targeted Marketing to Medical Providers


1. Negotiate and execute contract with Healthy Communities for the Healthy Start Marketing & Education Director position.

Executive Director, Program Director, Director of Finance & Administration, HS Contract Manager

7/11 9/11

2. Provide technical assistance to Healthy Start Marketing & Education Director and monitor Healthy Communities contract.


3. Conduct ongoing in-service training and education to nursing staff and/or Information Management Departments at the three (3) area hospitals.

HS Contract Manager, Healthy Start Marketing & Education Director

7/11 6/12

4. Continue to survey medical providers re: HS screening to obtain and review medical provider feedback regarding screening.

Healthy Start Marketing & Education Director

7/11 6/12

5. Provide each prenatal provider with a quarterly screening report to providers to help them assess their progress or challenges.

Healthy Start Marketing & Education Director

7/11 6/12

6. Provide each hospital with a quarterly report detailing infant screening rates

Marketing & Education Director

7/11 6/12

7. Review screening rates at Coalition meetings.

HS Contract Manager, Healthy Start Marketing & Education Director

7/11 6/12

8. Monitor monthly and quarterly data report and identify providers that are not meeting established screening rates. Once identified, determine appropriate action in resolving the issue (i.e., schedule in-service, technical assistance, other)

Healthy Start Contract Manager, Healthy Start Marketing and Education Director.

7/11 6/12


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9. Provide access to an Assessment Worker in each hospital birthing facility for coordinated support and ongoing technical assistance to hospital personnel.

HS Contract Manager, Healthy Start Marketing & Education Director, SMA HS Program Director

7/11 6/12


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PRIORITY VIII. IMPLEMENT CENTRALIZED ACCESS POINTS FOR FAMILIES



The local systems for serving pregnant women and families with children who are under the age of five are often fragmented and include a degree of duplication in several components including administration and intake, assessment of service needs and data collection and maintenance. This causes families to have to access multiple service systems to obtain needed resources for themselves and their children. In addition, particular areas in our county are disproportionately impacted by health disparities for key indicators (infant mortality, low birth weight, late or no entry into prenatal care) as well as contributing factors such as rate of STDS, smoking, unplanned pregnancy, child abuse and neglect, poverty, and substance abuse. These communities often lack available health and social services resources or, even though they may be available, are complicated and have cumbersome eligibility criteria or require payment that families cannot afford. Consequently, families become frustrated, lack a voice about the service system, and when capacity is limited, the result is that some families receive no services and other families receiving multiple similar services from multiple agencies.

This system often lacks the ability to capitalize on family strengths and build the protective factors needed for families to make significant progress in reducing their risk.


This strategy addresses the legislative charge of Healthy Start coalitions to ensure systems of care that are accessible, that avoid duplication of services, and that maximize the use of available resources. Indicators that can be impacted include entry into prenatal care, infant mortality, and low birth weight.


Healthy Start screening data, poverty data, Florida Charts Early Learning Coalition Ages and Stages screening information, local HS database (Netsmart until 9/30/11) and (WFS beginning 10/1/11) assessment data (number of closures, etc.), United Way 211 Information and Referral data, Thrive by Five data, Family Feedback.


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The strategy that has been selected to address this is to conduct long term planning to systematically screen and assess families through a centralized access center to maximize resources and prevent duplication of services.


Executive representatives of these entities have formed a collaborative known as Thrive by Five. This collaborative has worked with The Healthy Start Coalition to improve Family Engagement so that families are equal partners in implementing Family Access (Community Cafés) so that collectively we can gather the following information

• How we screen families – using the Protective Factors Survey • How we conduct intake and assessment • How we maintain and track data • What services we provide • What the eligibility criteria is for services • What our performance measures and objectives are. • What is each entity’s capacity to service children

c. Where//how will you get the information?

The information from the posed questions and outcomes above will be summarized in written form to help us in determining the effectiveness of the proposed model of integration.


That families in the most high risk and underserved areas will have a “no wrong door” access center where they can be engaged and responsible partners with providers to help one another, improve our system of care, and gain access to the needed services in a less fragmented system of care.

Long-term impacts will include increased community capacity for home visiting and other services for pregnant women and children under age five and decreased duplication of services as well as increased understanding from families about the barriers and challenges that they encounter when trying to access the system. This will allow for continuous quality improvement directly related to consumer input.


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We will gather all documents and needs assessment data utilized in proposals for funding. Once implemented, we will acquire data on how many families are assisted through integrated screening and assessment, and measure mutual outcomes of the clients (immunizations of children, ASQs accomplished, number of referrals to developmental services, etc.)


Local HS database (Netsmart until 9/30/11 and Well Family beginning 10/1/11); Healthy Families database; Early Learning Coalition database; Community Cafe records, reports generated during planning process; minutes/notes from planning meetings.


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STRATEGY 8 - Implement centers to provide central points of access for and with families to maximize resources and prevent duplication of services.

3. ACTION STEPS:


1. Work with Thrive by Five Collaborative to implement ways to engage families.


2. Continue to coordinate with The Chiles Academy to implement a Family Access system (Community Café) in a full service community school.

Executive Director, Executive Board Members

7/11 6/12

3. Support clinic services at The Chiles Academy for interconception services and prenatal care.


4. Coordinate with Go Beyond to implement a system for collecting information about families accessing the center.

Executive Director, IT Manager

7/11 6/12

5. Submit funding proposals to support sustainability of the project.

Executive Director

7/11 6/12

6. Through leveraging of funds, support implementation of a Project Coordinator who can work with multiple agencies and oversee the Family Access (Community Café) model.


9/11 6/12

7. Conduct study of evidence-based and best practices parenting programs available and develop a centralized system for linking families with babies and young children to appropriate parenting services.

Executive Director, Project Coordinator

10/11 6/12

8. Meet with representatives of Child Welfare to inform them about the Community Cafe Services.


9/11 12/11

9. Conduct needs assessment to determine areas of most need for Community Cafés within Volusia Counties.



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10. Conduct forums with consumer families to build partnerships and gather data/feedback about system barriers and recommendations for improvement.

Executive Director, Program Director,

7/11 6/12

11. Promote/Implement the Five Protective Factors in the Family Access (now called Community Cafés) to align with State and National initiatives and evidence-based programming.


12. Identify a common multi-agency form for use at the Family Access Center (Community Cafe).

Executive Director, Program Director, IT Director

9/11 3/12


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VII. ALLOCATION PLAN FOR SERVICE DOLLARS FOR FY 2011-2016

Each fiscal year, an allocation plan for Healthy Start funds is developed by reviewing priorities established in the Service Delivery Plan, goals and strategies contained in the current annual action plan, progress in meeting the prior year’s contract objectives, and the performance of subcontracted providers. Coalition staff develops a proposed allocation plan based upon this information within the parameters established by the availability of resources. The proposed plan is then presented to the Coalition’s Finance and Administrative Oversight Committee for review and recommendations. The committee finalizes a recommendation for consideration by the full Board. After the Board of Directors approves a final allocation plan, staff completes contract preparations, conducts contract negotiations and facilitates contract execution. Copies of all executed contracts are provided to the Department of Health. The allocation plan is reviewed on a quarterly basis and modified if necessary in order to maximize the effectiveness with which resources are utilized in order to achieve established goals.

The Healthy Start of Flagler & Volusia Counties currently contracts with the following agencies for the provision of Healthy Start services and the required administrative components of the Healthy Start service delivery process: Flagler County Health Department, Volusia County Health Department, Healthy Communities, Stewart-Marchman Act Behavioral Health Services, Agape Midwifery Services, and the Mental Health Association of East Central FL, Inc. The FY11/12 allocation plan for Healthy Start services, including service dollars from the Base, Medicaid Waiver, and SOBRA contracts is presented on the following page.


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Following are the allocations for the period July 1, 2011 through June 30, 2012:

Services Funded Provider of Services

DOH Contract Allocation

Base Medicaid Waiver SOBRA

MomCare Program/SOBRA Administration HS Coalition $ - $ - $ 174,272

Prenatal Care for Uninsured Flagler County Health Dept. $ 11,200 $ - $ -

Agape Midwifery Services $ 4,800 $ - $ -

Screen In-take & Processing; Service Data Import Volusia County Health Dept. $ 54,000 $ - $ -

Medical Provider Screen/Program Education & Outreach Healthy Communities $ 85,000 $ - $ -

Healthy Start Services (outreach, initial contact & assessment, care coordination, enhanced services)

Stewart-Marchman Act Behavioral Health Services $ 726,375 $ 547,620 $ -

Healthy Start Services (initial contact, Child Birth Ed., Interconceptional Ed. & Support and Breastfeeding Ed. & Support)

Agape Midwifery Services $ - $ 25,000 $ -

Psychosocial Counseling Mental Health Association of East Central FL, Inc. $ - $ 2,760 $ -

Training – Direct Service Staff Multiple contracted trainers $ 25,000 $ - $ -

Program Marketing & Public Education N/A $ 10,000 $ - $ -

Healthy Start Program/Contract Management HS Coalition $ 101,819 $ 23,352 $ -

Allocations Pending (includes $46,704 temporary 10% Med. Waiver holdback)

N/A $ - $ 54,022 $ -

TOTAL $ 1,845,220 $ 1,018,194 $ 652,754 $ 174,272


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VIII. QUALITY ASSURANCE/IMPROVEMENT PLAN

Since the last Service Delivery Plan Update, additional activities have been put in place to improve the Quality Monitoring conducted by the Healthy Start Coalition to support contract compliance and continuous quality improvement (CQI) by agencies subcontracted to provide the range of Healthy Start services. Effective October 1, 2011, the Health Management Information System (HMS) began full implementation into our service system. This data will be utilized to assist administration and direct service supervisory staff in monitoring outcomes and identifying areas for further evaluation. Healthy Start staff are trained in use of the HMS system and quality controls have been integrated into the policies and procedures related to our Quality Management Plan.

In addition to adherence to the Healthy Start Standards and Guidelines, local quality indicators are established and monitored quarterly. Results of the monitoring process provide an opportunity to conduct teambuilding activities and outline a course of action and staff development needs that may be required. As stated in the Standards and Guidelines, the “quality improvement process is necessary to assure that services are:

• Provided in a manner that meets the needs of participants • Accessible and acceptable to the community and the participants • Delivered in a timely manner.

This section of the Service Delivery Plan outlines the systematic approach that is utilized by the Healthy Start Coalition as a means by which to accomplish the above objectives and work toward Continuous Quality Improvement.

A. Methodology

Monitoring the quality of service delivery and fiscal accountability among sub recipients and vendors is approached from several directions, and utilizes multiple methods. Monitoring tools are regularly reviewed to guide the Contract Manager in determining if the Standards and Guidelines and outcome measures have been met or exceeded. These tools calculate values using an Excel program, which makes the process more accurate and efficient. These tools are utilized during chart reviews and the calculations assist with follow-up performance development. The

The Healthy Start Coalition also utilizes an observation component to the site review process, which includes shadowing home visitation, assessment, and supervision activities.

Minimum Training requirements are verified by comparing the program’s staff development plan to actual training attended or educational levels achieved by service delivery staff and supervisors. Feedback and evaluation from training events are reviewed and utilized for continuous quality improvement in staff training activities and outcomes.

The leadership in each agency is kept apprised of the results of the monitoring activities and participates in active development of strategies for improvement by attending the quarterly Coalition meetings and presenting their quarterly outcomes.


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The Healthy Start Contract Manager meets monthly with the supervisors of the programs to provide ongoing technical assistance in between monitoring periods. The Contract Manager is also available for onsite Technical Assistance immediately following a monitoring to provide follow up and support successful accomplishment of the Quality Improvement Plan and implementation of corrective action if necessary.

B. Healthy Start Quality Monitoring Calendar

The model below illustrates the timelines associated with Coalition Quality Monitoring activities:

1st Quarter DOH (4th Quarter CFAB*)

July – HS On Site monitoring and chart reviews – CFAB Monthly Partnership Meeting – Supervisors Meeting – Healthy Start Coalition Meeting August – Fiscal Monitoring – CFAB Monthly Partnership Meeting – Supervisors Meeting September – Customer Satisfaction Surveys – Quality Improvement Plans completed – CFAB Monthly Partnership Meeting – Supervisors Meeting – HMS Training *Monthly invoice and data review

2nd Quarter DOH (1st Quarter CFAB*)

October – Customer Satisfaction Results

summarized and reviewed – Supervisor Meeting (HS-HF)

– CFAB weekly partnership meetings

– Weekly supervision with Family Counselor(s)

– Healthy Start Coalition Meeting

– Monitor HMS implementation plan

November – CFAB weekly partnership meetings

– Supervisors Meeting – Monitor HMS implementation plan December

– CFAB weekly partnership meetings

– Supervisors Meeting *Monthly invoice and data review

4th Quarter DOH (3rd Quarter CFAB*)

April – On Site Observation and Shadowing – CFAB Monthly Partnership Meeting – Supervisors Meeting – Healthy Start Coalition Meeting May – Customer Satisfaction Survey Results

summarized and reviewed – – CFAB Monthly Partnership Meeting – Supervisors Meeting June – CFAB Monthly Partnership Meeting – Supervisors Meeting *Monthly invoice and data review

3rd Quarter DOH (2nd Quarter CFAB*)

January – Annual Technical Assistance(HS-HF) – Fiscal Monitoring (HS-HF) – CFAB Monthly Partnership Meeting – Supervisors Meeting – Healthy Start Coalition Meeting February – Annual Technical Assistance(CFAB) – Fiscal Monitoring (CFAB) – CFAB Monthly Partnership Meeting – Supervisors Meeting March – Customer Satisfaction Surveys – CFAB Monthly Partnership Meeting – CFAB Provider 360

o

– Supervisors Meeting *Monthly invoice and data review


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IX. CONCLUSION

The Healthy Start Coalition of Flagler and Volusia Counties has developed this Service Delivery Plan with the support and consensus of key leaders of the health and human services community in our area.

Our seven main priority focus areas are in alignment with our stated purpose; 1) to ensure women receive prenatal care, 2) to reduce the incidence of infant mortality, and 3) to support and improve the health and developmental outcomes of our mothers and babies.

This plan emphasizes our recognition that making strides in reducing infant mortality and low birth weight will require focus on strategies related to social determinants of health, quality of life for our residents across the lifespan, and engagement of the entire community we serve.

Our Coalition has made significant strides in prenatal and infant screening and continues to make improvements in reaching vulnerable populations and educating our workforce to improve their ability to appropriately address the needs of our participants through risk appropriate care. We must focus our efforts on reducing Black infant mortality, and related disparities by implementing new strategies aimed at public awareness and community engagement in addition to health and human service support.

We are also committed to looking to families to be an integral part of our future planning and service delivery. Our implementation of the Strengthening Families model and the five protective factors is in alignment with national and state initiatives based on evidence-based practices. This will require ongoing leveraging of resources and development of community partnerships to build a strong village where our families can live and thrive and our future generations become the responsibility of all.

The assessment process reveals in detail specific populations and areas of risk to be targeted. Late entry into prenatal care and unintended pregnancy are contributing factors to adverse outcomes. Our ability to analyze data and more effectively allocate our resources in the areas of greatest need was an original intent of the legislation that created Coalitions in Florida.

New areas of development include training and response to increasing numbers of opioid dependent pregnant women and neonatal abstinence syndrome babies, community engagement associated with Black Infant Mortality, Neonatal Outreach for high risk newborns, and reducing subsequent births to teen mothers.


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X. APPENDICES


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Appendix A – Healthy Start Board and Coalition Members The Healthy Start Coalition of Flagler and Volusia Counties, Inc.

Coalition Board Members Name Membership Work Title Representing

The Honorable Patricia Northey Board Member - President Vice Chair Volusia County Council

Isalene Montgomery Board Member - Treasurer Internal Auditor Daytona State College, Dept. of

Internal Audit

Ray Salazar Board Member - Past President President United Way of Volusia & Flagler

Counties

Katrina Bell Board Member - Treasurer Elect

Dean of Adult Education Daytona State College

Dixie L. Morgese, CAP, ICADC Secretary Executive Director Healthy Start Coalition of Flagler

and Volusia Counties, Inc. Kassandra Blissett Board Member City Manager City of Debary

Pamela Carbiener, MD Board Member OB/GYN, Faculty, FSU School of Medicine

Halifax OB/GYN, Florida State University

Darlinda Copeland Board Member Chief of Operations Florida Hospital Memorial Medical Center

Steve Forsyth Board Member Regional President Sun Trust Bank. Bob Garcia Board Member Mayor City of Debary Eric Goire Board Member Operations Director Museum of Arts and Sciences

Patrick Johnson Board Member (ex-officio) Director Flagler County Health Department

Missy Kelly Board Member Private Citizen Community

Tracey Lasenby Board Member Director Early Childhood Services The Chiles Academy

John Meyers, MD Board Member OB/GYN OB/GYN Health Center

Jennifer Morgan Board Member Business Services Representative The Center for Business Excellence

Bonita Sorensen, MD Board Member Director Volusia County Health Department

Jessica Fox-Sznapstajler Board Member Event Marketing Manager Daytona Beach News-Journal

Loverso Walker Board Member Pastor Faith Temple C.O.G.I.C.

Diane Smith Board Member

Volusia County School Board Representative, District 5

Volusia County School Board, District 5


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The Healthy Start Coalition of Flagler and Volusia Counties, Inc. Coalition General Members

Name Representing Maryann Barry Children’s Advocacy Center Chet Bell SMA Behavioral Health Services Guerlyne Bellevue Heavenly Hands Babysitting

Dr. Margaret Crossman Family Health Center

Bob Decker Mental Health Association of Volusia County Dona Demarsh Volusia County Government Alma Dixon Odessa Chambliss Wellness Center Luckey Dunn, MD Florida State University College of Medicine Nathalie Dunning Early Learning Coalition of Flagler and Volusia Counties Anne Ferguson, MPH The Chiles Academy at The Bonner Center Lisa Funchess Volusia County Health Department/WIC and Nutrition Services Lara Glaser Early Learning Coalition of Flagler and Volusia Counties Wandrea Grier SMA Behavioral Health Services Gail Hallmon The House Next Door Livia Horne Volusia County Health Department Karen Horzepa Children’s Advocacy Center Loretta Jennings Outreach Community Care Network Karen Kennedy-Tyus, LM Agape Midwifery Patricia Kruse, PhD, CNM Halifax OB/GYN Pastor John Long III Vitas Innovative Hospice Care Linda Merrell Lobbyist Debbie Myer, LMs Birth Blessings, Inc. Nancy Perkins SMA Behavioral Health Services Cher Philio, MPH Healthy Communities Yiny Poveda Master’s in Social Work Program, UCF Gladys Roman, LPN SMA Behavioral Health Services Judy Ryan Children’s Medical Services – Volusia & Flagler Judy Seltz, CAP SMA Behavioral Health Services Bonnie Welter, RN Flagler County Health Department Suzy William, RNs Children’s Advocacy Center Bonnie Wittman Center for Women & Infants, Health-Halifax


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The Healthy Start Coalition of Flagler and Volusia Counties, Inc.

FIMR Case Review Team (CRT) Name Representing

Alex Sweeney Keech Street Clinic Bonnie Whitman Halifax Medical Center Cher Philio Healthy Communities Dixie Morgese Healthy Start Coalition of Flagler and Volusia Counties, Inc. Donald Jones Volusia County Sheriff’s Department Dr. Patricia Kruse Halifax OB/GYN Gladys Roman SMA Behavioral Health Services Dr. Hussain Rawji Volusia County Health Department Joan Hulett Health Start Abstractor Judy Ryan Children’s Medical Services Judy Seltz SMA Behavioral Health Services Karen Lawler SMA Behavioral Health Services Dr. Kathi Santi Halifax Family Clinic Leslie Pearce Healthy Start Coalition of Flagler and Volusia Counties, Inc. Linda Peterson Children’s Medical Services Margaret Vidal Florida Hospital Deland Dr. Marie Herrmann Volusia County Medical Examiner’s Office Mary Ann Ruddy Volusia County Health Department-WIC Natalie Eisenhut Dr. Pam Carbiener Halifax OB/GYN Dr. Patricia Modad Private Practice Patrick Johnson Flagler County Health Department Dr. Rene Santin Florida Hospital Memorial Medical Center Sandra Gallagher Bethune Cookman University Sandra Lennon Healthy Start Abstractor Tammy Carbonaro Volusia OB/GYN Dr. Tim Gallagher Volusia County Medical Examiner’s Office Wandrea Grier SMA Behavioral Health Services


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Appendix B – Service Delivery Plan Committee Members and Work Plan Carrie Baird, Executive Director, One Voice for Volusia

Kimberly Beck-Frate, Halifax Health Laurie Bell, PhD, Certified Nurse-Midwife, Halifax OB/GYN Associates Pamela Carbiener, MD, Halifax OB/GYN Associates, Faculty, Florida State University Darlinda Copeland, Chief of Operations, Florida Hospital Memorial Margaret Crossman, MD, Family Health Services, Halifax Health Catherine Davis,, Stewart-Marchman ACT Behavioral Health Care Dr. Alma Dixon, Bethune Cookman University Anne K, Ferguson, MPH, Director, The Chiles Academy Charter School for Pregnant and Parenting Teens at The Bonner Center Full Service Community School Lisa Funchess, Volusia County Health Department Richard Fay, LCSW, Therapist, Infant Mental Health and Developmental Specialist, A Helping Hand, Inc. Wandrea Grier, Supervisor, Healthy Start, Stewart Marchman ACT Behavioral Health Care Rhonda Harvey, Stewart Marchman ACT Behavioral Health Care Marilyn Heck, Circuit 7, Department of Children and Families Marie Herrmann, MD, Volusia County Medical Examiner Karen Horzepa, Program Director, Children’s Advocacy Center Don Jones, Chaplain, Volusia County Sheriff’s Department Mark Jones, Executive Director, Community Partnership for Children Karen Kennedy-Tyus, Licensed Midwife, Owner/Operator, Agape Midwifery Lynn Kennedy, One Voice for Volusia W. David Kerr, Department of Juvenile Justice Patricia Kruse, PhD., Certified Nurse Midwife, Pastor John Long, Tubman King Community Church, VITAS Innovative Hospice Care Maria Long, African American Faith-based Bereavement and Lifesong Initiative Paula Meek, Florida Hospital Memorial Jeremy Mirabile, MD, Addiction Medicine, Stewart Marchman ACT Behavioral Health Care Patricia Modad, MD, OB/GYN Dixie Morgese, Executive Director, Healthy Start Coalition of Flagler & Volusia Counties, Inc. Leslie Pearce, Contract Manager and FIMR Coordinator, Healthy Start Coalition of Flagler & Volusia Counties, Inc. Nancy Perkins, Vice President, Outpatient Services, Stewart Marchman ACT Behavioral Health Care Cher Philio, MPA, Healthy Communities, Halifax Health Celeste Phillips, MD, Volusia County Health Department Barbara Preston, Healthy Start Supervisor, Outreach Community Care Network, Inc. Hussain Rawji, MD, OB/GYN, Volusia County Health Department Gladys Roman, LPN, Stewart Marchman ACT Behavioral Health Care Mary Ann Ruddy, WIC Coordinator, Volusia County Health Department Judy Ryan, Director, Children’s Medical Services Judy Seltz, Healthy Start Program Director, Stewart Marchman ACT Behavioral Health Care Bonita Sorensen, MD, Director, Volusia County Health Department Andrea Thorpe, MD, Pediatrician, Keech Street Clinic, Halifax Health Rebecca Vernon, Birth Center Director Florida Hospital Memorial Alicia Vincent, Program Director, Project WARM, Stewart Marchman ACT Behavioral Health Care Jan Wagner, Halifax Health Sue Wagner, Flagler County Schools Bonnie Welter, Nursing Director, Flagler County Health Department


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Appendix C – Healthy Start Prenatal and Infant Risk Screening Forms

Please see Florida Department of Health (DOH) form DH 3134, 04/08 stock number 5744-100-3134-7, PRENATAL RISK SCREEN (4 part carbon copy: white, yellow, pink and green) and the Florida Department of Health (DOH) form DH 3135, 01/04 stock number 5744-100-3135-5, INFANT RISK SCREEN (4 part carbon copy: white, yellow, pink and green). Hard copies of forms can be ordered from the Florida Department of Health or obtained from the Healthy Start Coalition of Flagler & Volusia Counties, Inc. (Note: Infant Screens are scheduled to change in 2012).


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Appendix D – Methodology for SDP Outcome Objective Development and Implementation

Compile Data

Conduct Assessment

Identify Priorities

Develop Strategies

Review Outcomes

Implementation

Figure 1 - Methodology for Service Delivery Plan Outcome Objective Development and Implementation

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Indicator # 1: Infant Mortality Goal: 6.0 Rate as of 2009: 7.2

Data Assessment Priorities Strategies Outcomes

• DOH data by race and zip code • Supplemental risk data (FIMR,

interviews, etc.) • Survey data • Screening Rates • Indicators • SMC data (“02” and other)

• Volusia infant death rates have decreased to 7.2; however, the black infant death rate has increased to 16.4.

• Flagler & Volusia Neonatal death rate decreased to 3.

• Infant screening rates are lower than the State’s (see indicator #6).

• 17% of FIMR cases demises were referred to WIC.

• 43% of FIMR cases MOB had late entry into prenatal care.

• 68% of FIMR cases MOB had pre-existing condition.

• 34% of FIMR Cases had Maternal Infection.

• 17% were unplanned pregnancies.

• 95% of FIMR sleep related infant cases were bottle fed.

• 57% of FIMR Infant cases were sleep related.

• First responders lack sensitivity when questioning families who experienced an infant demise.

• 57% of FIMR cases reviewed substance issues were present (see indicator #9).

• Lack of grief support and follow up for families experiencing a loss.

• Increase infant screening rates • Increase Healthy Start initial

contact rates and enrollment services

• Neonatal Health provider to connect to high risk cases at birth

• Provide Healthy Start Neonatal Care Coordination Services

• Provide nutrition services • Improve access for Medical

care for the uninsured, underinsured and Medicaid

• Increase knowledge for Preconceptional and continue Interconceptional Care and Education

• Increase services for targeted zip codes

• SIDS Education Safe Sleep Campaigns

• Capture information on substance exposure for all women in treatment or other venues where substance/alcohol use is disclosed.

• Sensitivity Training for First Responders

• Continue to concentrate on marketing and training the Healthy Start Screen. Encourage hospitals to improve infant screening rate. Staff Care Coordination services at VCHD.

• Implement Neonatal Outreach Coordinator to provide services to newborns.

• Encourage breastfeeding education and continue to provide as a service delivered by the field staff.

• Provide Preconceptional and Interconceptional education.

• Hospitals continue to ask “where will your baby sleep?” Continue to educate the community on safe sleep practices and provide cribs to financially challenged families.

• Fund hospital position to conduct assessments and provide education referrals.

• Coordinate with the Florida SIDS Alliance to introduce legislation (Pennsylvania legislation) regarding Safe Sleep Education.

• Work with Hospice and Volusia County Sheriffs’ Chaplains to implement sensitivity training for first responders.

• Provide specialized training to FAWs and FSWs about Neonatal Abstinence Syndrome.

• Provide educational opportunities about SIDS and overlay to fathers prior to leaving the hospital with the baby.

• Increase local infant screening rate

• Increase initial contact rates to 95%

• Increase Hospital based FAWs to successfully enroll 80% of IC’s in HS/HF services

• Neonatal outreach attempt within 5 days of discharge for high risk

• Continue to distribute cribs or pack n’ plays to 100% of women who indicate unsafe sleep arrangements

• Monitor Healthy Start Services at WIC to increase number of participants served

• Continue Breastfeeding education by Healthy Start FAWs and Care Coordinators

• Increase Interconceptional services to women who have experienced a loss

• Increase maternal interviews of women for FIMR

• Conduct a minimum of three (3) safe-sleep “Train the “Trainer” programs annually

• Review data sets with front line Supervisors

• Introduce Safe Sleep Bill (legislation) in Florida

• Increase First Responders’ sensitivity knowledge level when interviewing families who experienced demise

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Indicator #2: Black Infant Mortality Goal: 12.0 Rate as of 2009: 13.8

Data Assessment Priorities Strategies Outcomes • DOH data by race and zip

code • Survey data • Indicators • Screening data by zip

code • FIMR data/interviews • Census data

• Infant mortality rates for Black women are over 4 times higher than whites and more than 2 times higher Hispanics.

• This has been a continual increase and previous strategies have proved ineffective.

• 32114 zip code area has elevated # of births and % of fetal and infant deaths in Volusia. (16% and 18.68%, respectively).

• Black women comprise higher percent of women with late entry or no entry into prenatal care.

• Black women disproportionately report unplanned and/or unwanted pregnancy.

• Black women disproportionately access prenatal care late in pregnancy..

• Infant mortality disproportionately occurs with unmarried Black women.

• Black women have disproportionate incidence of chronic medical conditions and infection during pregnancy.

• FIMR data shows correlation between educational level and infant mortality.

• Community engagement through an organized programming with churches and community organizations

• Access to health services for families

• Safe sleep environments and information to families before they are discharged from the hospital

• SIDS Prevention • Under educated (no high

school diploma or GED) • Integrate the five protective

factors into programming for families at risk

• Engage African American Churches and other community venues to increase awareness about the extreme disparities in health outcomes and infant mortality

• Implement Lifesong initiative in targeted zip codes 32114, 32117, 32118.

• MomCare/SOBRA – ask about potential barriers to health care & social services

• Prevention on the Move projects • Coordinate with Community Cafés in

Deltona, Daytona Beach, and New Smyrna Beach to support preconception and interconception support and parent involvement

• Continue to increase Interconceptional care/education in and around the 32114 zip code

• Preconceptional: increase planned parenthood & baby spacing education (baseline)

• Media campaigns (bus displays, church fans)

• Enhanced data sets for FIMR of Black deaths/causes

• Continue to participate in MAMA BEAR program

• Continue to implement culturally sensitive enhanced services models to include breastfeeding support and in-home childbirth education (doula services in non-traditional settings) through JJ Way model.

• Culturally sensitive SIDS and safe sleeping educational programs and materials including media campaign

• Prioritization of Black families for crib distribution

• Provide training efforts to incorporate educational and economic development goals in the FSP

• Provide in-home services within 72 hours for families with significant risk and ensure home safety, adequate support, safe sleep and linkage to pediatric services according to AAP guidelines

• Increased number of churches and civic groups who are aware of and support initiatives that improve health outcomes

• Quarterly review with front line supervisors - increased knowledge and competency of field staff

• Increased number of culturally sensitive educational materials at key distribution points and to Black HS participants

• Increase in data from CRT of Black women from FIMR

• Continued increase of Black participants who receive Childbirth Education, Interconception Care and Breastfeeding Support .

• Increased number of women with access to health services before, during, and afer pregnancy.

• Increase the number of educational goals incorporated in the FSP with successful linkages to educational opportunities and services

• Increased number of women and caregivers receiving information about safe sleep and safe sleep environments when needed.

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Indicator #3: Low Birth Weight Goal: 8.0% Rate as of 2009: 8.21%


• Vital Statistics • Florida DOH • Healthy Start Pre-natal,

Post-natal, & Infant Risk Screens

• Field staff reports • FIMR

• The rate of infants born at a Low Birth Rate (LBW) per 1000 live births has increased to 8.6 in Volusia County and has decreased to 7.3 in Flagler County. However, the Service Delivery Area is at 8.4, which is lower than the State rate of 8.7.

• The rate of infants born at a Low Birth Rate (LBW) by Race and Ethnicity per 1000 live births has increased to 7.6 for the White population and has remained the same for the Black population at 12.4. It has increased to 8.2 for the Hispanic population.

• Low Birth Weight babies are born to obese MOB.

• STDs are a contributing factor to Low Birth Weight. Rates are higher in the African-American population. Rates are higher among those between the ages of approximately 20 and 24.

• Very Low Birth Weight decreased in both Volusia (1.5 per 1000 live births) and Flagler (1.2 per 1000 live births), which is lower than the state rate of 1.6.

• Poor oral hygiene contributing factor to preterm labor

• Late Entry into Prenatal Care: 3.8% Flagler, 8.5% Volusia and Florida is at 5.6%. 4.8% are White, 8.5% Black and 7.6% Hispanic

• Hispanic low birth weight births 8.0 are higher than the state 7.1

• Prematurity and low birth weight babies born due to improved health care technology

• Pregnancy smoking rates are almost double than the state. Service area 13.76 and the state 6.86

• Provide accessible places where women can gain information about reproductive health and family planning

• Provide referrals to WIC and Nutrition Services

• Smoking Cessation Education • Healthy Start Community

Awareness • Healthy Start Services at

Volusia County Health Department WIC program

• Cultural awareness • Access for medical care for the

uninsured, underinsured and Medicaid

• Services for High Risk Case Management

• Increase family involvement in Healthy Start

• Continue to provide Interconceptional /preconceptional care education services

• Continue to provide smoking cessation education or referrals

• Continue Healthy Start services at VCHD WIC

• Improve Access for medical care for the uninsured, underinsured and Medicaid

• Continue to fund the Women’s Intervention Specialist

• Continue to maintain website with information focused on physicians and health care professionals

• Encourage the medical community to provide Preconception Education services

• Continue marketing and education related to the Healthy Start prenatal screen

• Dental referral services for pregnant women

• FAW located at high volume OB/GYN to increase Initial Contacts/Initial Assessments for pregnant women

• Annual Cultural Training • Identify the population that is

listed as “other” in MCH Health Problem Analysis

• Preconception Clinic at Chiles Academy and Bethune Cookman

• Implement Community Cafés in three areas of Volusia County to ensure that women and families have centralized access to services

• Increase number of women receiving Interconceptional education services

• Increase number of clients receiving smoking cessation education or referrals

• STDs Awareness & Education • Provide list of Medicaid Dental

Providers and/or free dental clinics

• Continue Partnership with VCHD WIC

• Provide a minimum of 1 FASD training annually

• Continue Child Watch Program annually

• Measure number of website hits and request feedback about usefulness of information provided

• Decrease teen pregnancy • Increase ICC with teen

population • Reduce smoking rates

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Indicator #4: 1st Trimester Entry into Prenatal Care Goal: >85.0% Rate as of 2009: 77.35%

Data Assessment Priorities Strategies Outcomes • Vital Statistics • Florida DOH • Healthy Start Pre/Post-natal

Screens • FIMR data • Field staff reports

• Higher than state average • Lower rate of early entry

among minorities (African American lower than Hispanic)

• Lowest rates in zip codes 32114 and 32118

• Gap in Medicaid SOBRA coverage for undocumented Hispanic mothers preventing mothers from accessing prenatal care

• Prenatal services are now available in the VCBJ

• Pregnant women in Flagler County

• African-American Women • Zip codes 32114 and 32118 • Hispanic women, especially

SOBRA-eligible • Eligible pregnant women

via MomCare/SOBRA lists • Identify pregnant women in

the jail and screen for HS • Identify pregnant and post-

partum women in substance abuse treatment, homeless shelters, and high risk neighborhoods

• Coordination with social services in Flagler County to promote early identification and link to care for pregnant women

• Media campaigns (broad-based) about the importance of early prenatal care (in Spanish and English)

• Prevention on the Move- screening of pregnant women “on the streets”

• CTG program – pre/interconceptional education for minority women (esp. African-American) in Front Porch

• Interagency coordination with providers of substance abuse and homeless services and other social services to women for early identification of pregnancy (also jail)

• Coordinate Prenatal Services with providers to develop strategies with local providers for meeting the needs of the most vulnerable populations

• Consumer and provider education regarding Medicaid eligibility and available services (media campaign, provider education, website)

• Continue MomCare and SOBRA efforts

• Work on legislative recommendations which include expanding SCHIP services to pregnant women (including undocumented women)

• Train VCBJ (Prison Health Services) on use of the prenatal screen

• Regular review of 1st trimester entry into care data for Flagler zip codes

• # of MOUs established with Flagler County Social Service Centers

• Review numbers of hits on Website

• Reduce the number of undocumented women who are turned away for diagnostic services

• Meet all outcome standards (and exceed where possible) for MomCare contacts and follow-up

• Increase by 100% the number of women in the jail who receive a HS screen and follow-up contact

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Indicator #5: Late or No Entry into Prenatal Care Goal: <3.6% Rate as of 2009: 4.6%


• Florida Vital Statistics • Department of Health • FIMR data • Pre/Post-natal Screens • Field Staff Reports

• Nearly twice as prevalent among minorities (African-American and Hispanic) when compared to whites

• *Zip code 32114 had the highest rate of late entry

• Women in the VCBJ are now receiving prenatal services

• Identification of specific barriers to access by target populations (transportation, language, Medicaid restrictions, undocumented women, lack of service providers)

• Improving access to prenatal care in Flagler County

• African-American and Hispanic mothers, especially in Palm Coast and the 32118 zip code

• Outreach for screening in target areas and high risk populations

• Homeless and Substance Using pregnant women

• Identify pregnant women in the jail and homeless shelters

• MomCare and HS/HF staffs quantify data about reported barriers

• MomCare and SOBRA eligibility and restrictions clarification

• *Targeted Fund Development to reduce barriers identified

• Provide consumer and provider education regarding Medicaid benefits and eligibility. (Develop brochures and other educational & media materials.)

• Instructions in Spanish at all health centers about how to access services

• Update website resource and referral information in Spanish

• Implement educational models for non-medical settings to reach specific groups

• Include culturally appropriate educational materials and literature in programs that serve women of reproductive ages

• Renew MOUs with homeless shelters and treatment providers about referral of pregnant women

• Renew MOU with VCBJ regarding screening & referral of pregnant women

• Provide on-going training to VCBJ Prison Health Services about administering the HS screen

• Establish baseline data and convene SDP committee to recommend additional strategies based on specific populations (geographical, by age and racial/ethnic characteristics)

• Obtain private/public funding aimed at reducing barriers to prenatal care utilizing data obtained

• Gather and review # of women “unfunded”

• Recommendations and support from providers

• Review # hits on website • Minimum of 10 sessions weekly in

non-traditional high risk settings • Review feedback obtained from

GPRA data from these projects • Make initial contact with 80% of

women referred through substance abuse treatment centers and/or homeless shelters

• Receive and make initial contact with 100% of pregnant women referred by Prison Health Services

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Indicator # 6: Infant Screening Rates Goal: 90.0% *Rate as of 2010: 81.46%


• Screening Rate data • SMC data • FIMR BASINET data • Vital Statistics

** 2010 Rate for data was available at the time of the SDP assessment.

• Infant screening rates have decreased slightly since all providers are on Electronic Birth Registration (EBR).

• Screening rates have significantly increased when providers present the screen in person.

• Processing of infant screens by VCHD has shown significant increases in time since EBR.

• Consent rates have shown a slight increase when a funded FTE is in the hospital.

• Hospitals/Birth Care Centers • Provider understands the

Healthy Start program and can present it positively to patients

• Provider understands the screening process and presents the screen in manner that encourages consent

• Provide incentive to hospital staff to give patients if they consent to the screen

• Review process used for entering screen information in the Electronic Birth Registration (EBR) database

• Community awareness

• Review data monthly and follow-up with providers that are below 80%

• Fund FTE for a Family Assessment Worker in the hospital

• Research “enhanced service” opportunities to benefit each individual hospital

• Invite hospital personnel to take a more active role in the FIMR process

• Continue to review and educate hospital personnel on how to properly administer the screen and discuss the program benefits with the mother

• Increase infant screening rates • Better coordination with

service area birth centers • More women needing services

will be linked to the MCH Assessment Center

• Increased community awareness about HS services

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Indicator #7: Prenatal Screening Rates (offer and consent) Goals: 100% (offer) & 91.0% (consent) *Rate as of 2010: 100.7% (offer) & 91.75% (consent)


• DOH Screening Data • MomCare employee feedback ** 2010 Rate for data was available at the time of the SDP assessment.

• Prenatal screening rates are above the state average.

• All providers are offering the prenatal screen to their patients.

• Most providers are receptive to feedback regarding improving their screening rates.

• Most providers are proactive in searching for information Healthy Start may have in order to help their client.

• Positive relationships have either developed or maintained between Healthy Start and providers.

• OB/GYNs with the largest percent of OB patients

• Identify offices with new staff and set up in-services to train on Healthy Start program and screening tool

• Continue marketing through the website and social network (Facebook)

• Review data monthly and follow-up with providers that are below 80%

• Determine next steps regarding feedback from the Prenatal Summit

• Invite OB/GYN providers to take a more active role in the FIMR process

• Continue to review and educate providers on how to properly administer the screen and discuss the program benefits with the mother

• Provide technical assistance to prison health services

• Coordinate with medical providers regarding referrals of screens for pregnant teens

• Increase prenatal screening rates • Better transition for pregnant

women leaving the jail • Early identification of pregnant

teens • Better coordination with are

prenatal service providers • Better linkage of high risk

pregnant women to available services


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Appendix E – Report on Prenatal Screening Responses by Individual Item FY2009 - 2010

Flagler and Volusia County Prenatal Screens Fiscal Year 2009 - 2010

Volusia Flagler Other Grand Total

Race Asian 4 1 0 5 Black 701 113 1 815 Am. Indian 1 0 0 1 Unknown 537 61 1 599 White 1919 419 3 2341

Substance Use (Special Group 02) No 3092 583 5 3680 Yes 70 11 0 81

Have felt down, depressed, hopeless? No 2490 486 4 2980 Yes 672 107 1 780 (Blank) 0 1 0 1

Ever received Mental Health Counseling? No 2649 497 4 3150 Yes 511 97 1 609 (Blank) 2 0 0 2

Illness requiring ongoing care? No 2662 464 5 3131 Yes 488 125 0 613 (Blank) 12 5 0 17

Good time to be pregnant? No 716 108 1 825 Yes 2396 476 4 2876 (Blank) 50 10 0 60

Trouble paying your bills? No 1984 398 3 2385 Yes 1154 193 2 1349 (Blank) 24 3 0 27

Average # of alcoholic drinks/week… 0 2905 533 3 3441 1 100 16 1 117 2 54 15 0 69 3 33 12 0 45 4 19 3 0 22 5 16 2 0 18 6 6 2 1 9 7 5 2 0 7 8 3 1 0 4 9 2 1 0 3 10 9 4 0 13


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12 6 0 0 6 15 1 2 0 3 19 0 1 0 1 20 2 0 0 2 24 1 0 0 1

Cigarettes per day? 0 10 2 0 12 0 (blank) 2487 467 3 2957 1 36 7 0 43 2 36 12 0 48 3 38 8 0 46 4 42 9 0 51 5 82 12 0 94 6 32 7 0 39 7 14 3 0 17 8 18 5 0 23 9 5 2 0 7 10 181 33 1 215 11 1 0 0 1 12 12 1 0 13 13 1 0 0 1 15 25 4 0 29 18 3 0 0 3 19 1 0 0 1 20 97 14 0 111 25 3 0 0 3 30 10 2 0 12 35 1 0 1 2 40 15 2 0 17 50 2 1 0 3 60 6 2 0 8 80 3 1 0 4 99 1 0 0 1

Prior to pregnancy, wanted to be… A – Pregnant now 1274 268 2 1544 B – Pregnant later 1412 243 3 1658 C – Not Pregnant 473 83 0 556 (Blank) 3 0 0 3

Trimester at 1st prenatal visit… 1 2131 428 1 2560 2 921 138 4 1063 3 105 28 0 133

(Blank) 5 0 0 5 Grand Total 3162 594 5 3761 Source: CMHC Netsmart System


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Appendix F – Prenatal and Postnatal Risk Factors

Healthy Start of Flagler & Volusia Counties Service Area Prenatal and Postnatal Factors Table Pre-Conception Pregnancy Labor & Delivery Postnatal

Physical Risk Factors

Behavioral Risk Factors

Physical Risk Factors Behavioral Risk Factors Risk Factors

Behavioral Risk Factors

Infant Physical Risk Factors

Parental Physical and Behavioral Risk

Factors

Multi-parity Poor Nutrition Prima-parity Poor nutrition Distance to hospital HIV/STDs Low Birth Weight Prima-parity Age Under 18 Smoking Plurality Smoking Delivery mode Cultural Practices Very Low Birth Weight Lack of parenting skills

Age Over 30 Alcohol Age Under 18 Alcohol Delivery complications

Family Mobility = Lack of Continuity of Care Prematurely Abusive Environment

Poverty Drug Abuse Age Over 30 Drug Abuse Self-induced labor Congenital anomalies Stress

Single Parent HIV/STD Poverty HIV/STD Other infant health conditions Depression

History of poor birth outcomes Cultural Practices Single Parent Late or No Prenatal Care

Lack of medical insurance

Chronic Health Problems

Family Mobility = Lack of Continuity of Care Weight gain Cultural Practices Low Education

Contraceptive Use Low Education

Health Conditions Caused by the Pregnancy

Family Mobility = Lack of Continuity of Care Poverty

Chronic Health Problems Low Education Single parent

Abusive Environment Poor Dental Health Parent(s) under 18

Stress Smoking

Depression Alcohol Drug Abuse

HIV/STD Cultural Practices

Family Mobility = Lack of Continuity of Care


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Appendix G – Local Resource Inventory for Pregnant Women

Resources and Information for Pregnant Women and Families First Call for Help (386)253-0563 or (877)253-9010

www.healthystartfv.org

Healthy Start services are provided by organizations below that display this tulip symbol. Adoptions Services

• Halifax Hospital-Daytona Beach (Jan Wagner) ............................................. 386-254-4008 • Florida United Methodist Children's Home (Sheri Snyder) ........................... 386-668-5223 • Embraced By Grace (non-profit/faith based agency) ..................................... 386-615-9767

http://www.embracedbygrace.org • Adoption & Counseling Services Inc. ............................................................ 772-429-3334

207 ½ East Orange Avenue ............................................................................ 877-300-8771 Fort Pierce, FL http://www.hopeforfamilies.org

Breast Feeding - Breast Pump Rentals

• Halifax Medical Center Daytona (Ellen) ........................................................ 386-254-4005 • Orange Belt Pharmacy – Deland..................................................................... 386-734-1485 • East Volusia (Christy) ..................................................................................... 386-672-9560

Breastfeeding Coordinators (available 7/24 for breastfeeding support)

• Flagler: Nancy ................................................................................................. 386-316-0377 • Daytona: Jessica .............................................................................................. 386-481-8947 • New Smyrna Beach Allison ............................................................................ 386-316-1675 • Deland: Ivy...................................................................................................... 386-481-8951 • Deland: Mary .................................................................................................. 386-214-4262 • Deltona: Kari ................................................................................................... 386-871-3251 • Breastfeeding Supervisor: Pat Koplin ............................................................. 386-316-1499

Childbirth Education Classes

• Healthy Start................................................................................................ 866-301-2066 • Christ Community Church-Daytona Beach .................................................... 386-441-8413 • Daytona Beach - Halifax Med Center ............................................................. 386-254-4008 • Daytona Beach – FL Hosp Memorial Medical Center-Birth Center .............. 386-231-1400 • Deland – Florida Hospital ............................................................................... 386-943-4560 • Deland Health Department ............................................................................. 386-943-7837 • Daytona Beach Health Department ................................................................ 386-274-0674 • Bradley Method of Natural Childbirth ............................... 800-4-A-Birth or 818-788-6662

www.bradleybirth.com

http://www.healthystartfv.org/

http://www.embracedbygrace.org/

http://www.hopeforfamilies.org/

http://www.bradleybirth.com/


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Child Care/Early Learning/Pre-Kindergarten • Early Learning Coalition................................................................................www.elcfv.org • Volusia County ............................................................................................... 386-323-2400 • Toll Free .......................................................................................................... 877-352-0065 • Flagler County ................................................................................................ 386-437-8236 • Mary McLeod Bethune Community Center ................................................... 386-253-9474

740 S Ridgewood Ave Daytona Beach FL 32114 Provides child care and day care services for children ages 1-14

Child Support Enforcement http://www.myfloridacounty.com/services/child_support/

• Daytona Beach ................................................................................................ 386-238-4898 • Toll Free .......................................................................................................... 800-622-5437

Chiropractic Care

• Alvarez Chiropractic: Deland ........................................................................ 386-734-2522 • Dr. Vivian Sullivan (Bilingual): Daytona Beach .......................................... 386-253-9007 • Hill Family Chiropractic: Daytona Beach ..................................................... 386-226-0081

Circumcision

• Halifax Family Health Center: Daytona Beach ............................................. 386-254-4166 Infant must not be over 4 weeks old Fee: $185.00; Call for information and appointment

Clinic – Free Services The Jesus Clinic: 1133 Sixth Street, Daytona Beach, FL 32117 386-253-6959 www.jesusclinic.org Hours: Monday, Wednesday & Friday 5pm - 8pm This clinic is for those that earn too much to qualify for Medicaid, but not enough to pay health insurance premiums. To qualify for care, the following criteria are verified at or before each doctor visit:

• Must be actively employed and provide one month of pay stubs. If cash pay, a letter from the employer on company letterhead faxed to clinic: 386-253-6957

• Must reside in Volusia County for the previous 3 months and provide proof of residency. Please provide a bill that shows name and address such as cable, electric, phone, etc. A current driver’s license from Volusia Co. older than 3 months will also suffice as proof of residency.

• Must provide a copy of the 2006 1040 income tax return, if a 2006 return was filed. • Must show a current Florida photo ID. • Must show a Social Security card. • Note: Income level accepted is at or below 200% of the federal poverty level. Please

check website for a chart of the figures. Clinic – Free Well Woman Check / Free Pregnancy Testing

http://www.elcfv.org/

http://www.myfloridacounty.com/services/child_support/

http://www.jesusclinic.org/


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Mondays Only – Must have an appointment No age restriction To learn more, contact: Anise Aiello, RN at 386-322-6102 or Karen Kennedy-Tyus, LM at 386-258-5400 The Chiles Academy 868 George W Ingram Blvd Daytona Beach http://schools.volusia.k12.us/chiles Good Samaritan Clinic – Free 312 W. New York Avenue, Deland 386-738-6990 Hours: Monday, Wednesday & Friday 6p.m. – 9p.m. by appointment. Patients at the free clinic must have incomes no more than 200% of the poverty level, or roughly $30,000 for one person. Financial qualification is necessary before seeing a doctor. Call for more information or to make an appointment. Northeast Florida Health Services, Inc Medical Clinic Primary healthcare for the entire family – Pediatrics through Geriatrics Please call to discuss coverage options. The WVHA card may be available for qualifying low income patients.

• Deland (386) 738-2422 • Deltona (386) 532-0515 • Pierson (386) 749-9449

Counseling – Grief

• Hospice of Flagler/Volusia ............................................................................ 800-272-2717 http://www.halifaxhealth.org/hovf/index.html

• Epiphany Catholic Church (Bonnie Stevenson) ............................................. 386-689-2283 • Begin Again Children's Grief Center .............................................................. 386-258-5100 • Adapt Behavioral Services ............................................... 386-898-5003 and 407-928-0444

Counseling - Mental Health Alcohol & Drug Treatment:

• The House Next Door (All types-also substance) ........................................... 386-734-7571 • Women Assisting Recovering Mothers .......................................................... 888-516-2296 • Adolescent Residential.................................................................................... 386-947-1334 • Stewart-Marchman ACT Behavioral Health Care ................ 888-516-2296 (after hours)

http://www.smabehavioral.org/index.html Children:

• Children's Advocacy Center for Child Victims of Abuse ............................... 386-238-3830 • “The Little House Next Door” Child Development Center ............................ 386-740-8823

Ages: Infant to Five years Hours: 6:30am – 6:00pm 133 East Church Street, Deland; Call to register

• Adapt Behavioral Services ............................................... 386-898-5003 and 407-928-0444

http://schools.volusia.k12.us/chiles

http://www.halifaxhealth.org/hovf/index.html

http://www.smabehavioral.org/index.html


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General: • Devereux Foundation ...................................................................................... 386-738-5543

http://www.devereux.org/site/PageServer • Halifax Behavioral Services ........................................................................... 386-274-5333 • The House Next Door (All types-also substance) ........................................... 386-734-7571

http://www.thehousenextdoor.org/ • Mental Health Association .............................................................................. 386-252-5785

http://www.mhavolusia.org/ Family:

• Collective Hands Family Services .................................................................. 386-255-9254 • Adapt Behavioral Services ............................................... 386-898-5003 and 407-928-0444

Services provided for individuals, couples, family therapy and parenting training. Takes Medicaid, Healthy Kids, etc. www.adapt-fl.com

• The Parent’s Place Group ............................................................................... 386-232-8623 www.rustlcsw.com 118 ½ N. Woodland Blvd. #4 Deland, FL 32720 Every Friday at 9am beginning Sept 2, 2011 for parents with children of all ages. $15, No sign up required but RSVP’s welcome by emailing [email protected]

Veterans and Family:

• Mental Health Services for EOF/OIF Veterans and Family - See local providers below: • The House Next Door Deltona, 386-860-1776, Deland, 386-738-9169 • Mental Health Association 386-252-5785 http://www.mhavolusia.org/ • Serenity House 386-258-5050 Ext 10 • Stewart-Marchman-ACT Behavioral Health Care 1-800-539-4228

Additional Counseling Information – See Pages 157-163 Consumer Products Safety Commission To obtain product safety and other agency information: http://www.cpsc.gov

• Toll free 800-638-2772 • TTY 800-638-8270

To report unsafe products: http://www.cpsc.gov/talk.html

• Toll free 800-638-2772 The hotline is available 24 hours a day, 7 days a week. Hotline staff may be reached from 8:30am – 5:00pm (Eastern Time) Messages may be left anytime after these hours. Crisis Centers and Support Groups "Multiple Birth: (Twins, Triplets etc.)"

• Daytona Beach ................................................................................................ 386-253-3092

http://www.devereux.org/site/PageServer

http://www.thehousenextdoor.org/

http://www.mhavolusia.org/

http://www.adapt-fl.com/

http://www.rustlcsw.com/

mailto:[email protected]

http://www.mhavolusia.org/

http://www.cpsc.gov/

http://www.cpsc.gov/talk.html


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• Deland ............................................................................................................. 386-532-5662 • Grace House (Deland)..................................................................................... 386-822-9797

http://www.gracehouseprc.org/ • Grace House (Edgewater) ............................................................................... 386-957-4811 • Alpha Pregnancy Center/Flagler ..................................................................... 386-586-0210 • Pregnancy Crisis Center/Daytona Beach ........................................................ 386-257-2229 • Resources for Women/Daytona Beach ........................................................... 386-760-2113 • Circle of Parents Volusia/Flagler(Nancy) .......................................... 386-734-6691 ext.162

http://www.ounce.org/password/CVolusia.asp • Healthy Start/Healthy Families ............................. 386-947-2446 Toll Free: 866-301-2066 • Central FL Pregnancy Center (Jessica) ........................................................... 386-532-4004 • La Leche League of Volusia County:

http://www.lllflorida.com/web/DaytonaBeachFL.html • Halifax LLL (Pat) ........................................................................................... 386-736-7376 • NSB/Edgewater (Cindy) ................................................................................. 386-756-7878 • West Volusia (Pat) .......................................................................................... 386-736-7376 • West Volusia (Tamish) ................................................................................... 386-747-0170 • Family Life Center – Bunnell ......................................................................... 386-437-7610 • Community Life Center – Deltona ................................................................. 386-860-9205

1961 Providence Blvd. Website: www.CLCofDeltona.org Email address: [email protected]

• Prince of Peace Social Services ...................................................................... 386-676-1695 (Serving Holly Hill & Ormond Beach as well as the homeless – Diapers, Food, Prescriptions)

Daytona State College Women’s Center Self-esteem building seminars, networking opportunities, group and individual counseling, job readiness activities and family involvement and support services. Referrals to lawyers, physicians, and emergency service providers are also available. Qualified program participants may also be eligible to receive financial assistance with tuition, books, uniform or child care. http://go.dbcc.edu/womenscenter

• Daytona Beach Campus – Bldg. 100, Rm. 218 ........................................... (386)-506-3068 • Deland Campus - Bldg. 7, Rm. 132 ................................................ (386) 785-2028 or 2039 • Deltona Center - Bldg. 1, Rm. 211 ...............................................................(386) 789-7320 • New Smyrna Campus - Bldg. 1, Rm. 110.....................................................(386) 423-6331 • Palm Coast Campus - Bldg. 2, Rm. 100C....................................... (386) 246-4871 or 4870

Dentists Dentist who accept Medicaid*:

• Lake County Dental Gregory Moo, DDS 352-735-2418(Speak with Melissa or Shalese) 3801 N Highway 19A Suite 406 Mt Dora, FL 32757

• Fortune Dental – Deland 386-740-8282 • Arvin Oberai (Winter Park) 407-678-7744

http://www.gracehouseprc.org/

http://www.ounce.org/password/CVolusia.asp

http://www.lllflorida.com/web/DaytonaBeachFL.html

http://www.clcofdeltona.org/


http://go.dbcc.edu/womenscenter


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• Marine Dental – Daytona Beach (5yrs – 21 yrs) 386-304-2677 • Ronald Jacob – Holly Hill (7yrs – 17yrs) 386-257-6518 • Uyasa Ramcharan – Winter Park (Oral Surgeon) 407-599-1221 • Douglas Powelson – Orlando (Oral Surgeon) 407-294-3300 • Flagler/Bunnell Health Dept 386-437-7350 ext. 227 • DSC-Dental Hygiene Prog.-Deland Campus 386-785-2060

(Cleaning/X-rays) • Human Services – Deland 386-436-5956 • Daytona 386-254-4675 • Orange City 386-775-5204 • New Smyrna Beach 386-423-3309 • Volusia County Health Department–Daytona Beach 386-274-0895

1845 Holsonback Dr. Daytona Beach FL 32117 • Volusia County Health Department-Deland 386-736-5194

120 E New York Ave Suite E Deland FL 32724 http://www.volusiahealth.com/ Will treat children and pregnant women on Medicaid

* All qualified dentists may choose to be providers for Medicaid. If you currently have a dental health provider, ask if they will accept your Medicaid. Doctors and Midwives Who Accept Medicaid Note: Providers on this list only accept so many Medicaid patients at a time and some may not be accepting new patients when you call them. Indicates Doctor will take temporary/emergency Medicaid DOCTORS

HOSPITAL DELIVERY

• Volusia County Health Dept Deland 386-822-6215 FL Hosp Deland • Kim Rashada, MD Deland 386-943-3618 FL Hosp Deland • Brooks & Pottinger Deland 386-736-6110 FL Hosp Deland • Advanced Women’s Specialists Orange City 386-775-8484 S

Seminole/Longwood http://www.advancedwomens.com/home

• Jose Lopez-Citron, MD Orange City 386-744-9890 S Seminole/Longwood

• Anthony Perrin, DO Lake Mary 888-495-3148 Sanford Regional • Women’s Health Resource Center/George Besong MD FL Hosp Deland • Orange City & Deland 386-774-0109 • Mid-Florida OB-GYN Winter Park 407-322-5313 Winter Park Hospital • Irwin Landau, MD Ormond Beach 386-672-0444 FL Hosp Memorial

Med • Halifax OB-GYN Daytona Beach 386-252-4701 Halifax Hospital

http://www.advancedwomens.com/home


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• John Vagovic, MD Daytona Beach 386-274-1005 Halifax Hospital • OB-GYN Health Care Daytona Beach 386-258-0123 Halifax/Fl Hosp Memorial Med • Volusia OB-GYN Daytona Beach 386-252-5858 Halifax/Fl Hosp Memorial Med • Palm Coast 386-597-7960 Halifax/FL Hosp Memorial Med • Volusia County Health Dept DB 386-274-0509 Halifax Hospital • Family Center at Halifax DB 386-254-4165 Halifax Hospital • Volusia County Health Dept NSB 386-424-2066 Halifax Hospital • Flagler County Health Dept Bunnell 386-437-7350 Halifax/Fl Hosp Memorial

Med • OB-GYN Assoc of St Augustine St Augustine 904-819-1500 Flagler Hospital

http://www.obgynstaugustine.com/ • Dr. Kardinal St. Augustine 904-824-2508 Flagler Hospital • Pulsfus & Depree St. Augustine 904-825-3629 Flagler Hospital • Dr. Larroude St. Augustine 904-797-2777 Flagler Hospital • FL Hospital Deland Women’s Wellness Center (Dr. Chait and Dr. Hudson)

777 Deltona Blvd, Suite 2 Deltona FL 32725 386-860-3791 FL Hosp Deland 151 Victoria Commons Deland, FL 386-740-4084 FL Hosp Deland

• Dr. David Teitelbaum 386-753-1414 64 Spring Vista Drive, Suite 3 Debary, FL 32713 S Seminole

For a quick reference that may be useful to individuals seeking providers in their area, go to: http://www.medicare.gov/Physician/Search/chooseprovider.asp Midwives

• A Woman’s Touch in Healthcare Sanford 407-321-3884 • Birth Blessings, Debbie Myers, L.M. Orange City 386-774-0712

[email protected] • Heart to Heart Birth Center Sanford 407-322-9944 • Agape Midwifery Service & Maternity Clinic

235 2nd Street Holly Hill FL 32117 386-258-5400 Karen Kennedy Tyus, LM Email address: [email protected]

• Jennie Joseph, LM, CPM Winter Garden 407-656-6938 [email protected] or www.commonsensechildbirth.org

Department of Children & Families Toll free 866-762-2237 www.myflorida.com/accessflorida This link will allow you to access your account and apply for all benefits. Department of Children & Families Customer Services Am I eligible for Florida Medicaid? Am I still eligible? Who is my Eligibility Worker? I moved or changed my address. I lost or misplaced my Florida Medicaid Gold Card Call 1-866-762-2237 www.myflorida.com/accessflorida

http://www.obgynstaugustine.com/

http://www.medicare.gov/Physician/Search/chooseprovider.asp


mailto:Email%20address:%[email protected]


http://www.commonsensechildbirth.org/

http://www.myflorida.com/accessflorida

http://www.myflorida.com/accessflorida


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Depression - Post Partum

• Post Partum Depression Help Line 800-773-6667 or www.healthynewmoms.org • Information Request Line 800-944-4773 • Call your Mom Care Advisors 866-690-5849 • A New Day Peer Support Group - Vertical Life Church 1331 Beville Road Daytona

Beach The support group meets 6pm – 7pm the 1st and 3rd Thursday of each month • Call your Prenatal Provider

Domestic Violence Advocacy Program

• Volusia 386-257-2297 ext.15 or 16 • Flagler 386-437-7610 • Family Health Line 800-451-2229 • Victim Advocate Office 250 N. Beach St. Daytona Beach 386-239-7720

Supports victims of violent, personal or domestic abuse by providing shelter, food, clothing, counseling and restitution assistance.

Domestic Violence Hotlines

• Flagler County (Shelter) 386-437-3505 • Volusia County (Shelter) 386-255-2102 • Florida Domestic Violence 800-500-1119 • Rape Crisis Center 386-258-7273 • Child Abuse Hotline 96-Abuse

Doula Services (Trained Labor Coach) Nancy 386-299-6541 Education

• Adult Education Center – Flagler 386-437-7563 • Chiles Academy – Daytona Beach 386-322-6102 • Teen Parent West – Deland 386-822-7896 • DSC/Daytona Beach:

http://www.dbcc.edu/ • New Directions 386-506-3068 or 386-506-3611 • Fresh Start Program 386-506-4377 • Family Literacy 386-506-3471 • St. Gerard Campus – St. Augustine 800-833-6075 or 904-829-5516

Employment

• One Stop Career Center/Daytona Beach 386-323-7001 • Deland 386-740-3232

http://www.onestops.com/ • Kelly Services/Deland 386-736-0440 Daytona Beach 386-274-2727 • Labor Finders/Deland 386-734-5532 Daytona Beach 386-255-1653 • Manpower 386-252-1221 or 386-252-1413

http://www.healthynewmoms.org/

http://www.dbcc.edu/

http://www.onestops.com/


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• South East Staffing 386-738-4118 Deland • Snelling Personnel 386-822-4700 Deland • Private Industry Council 386-258-7072 • Goodwill Self Sufficiency Job Center 386-258-8585

Family Planning Links DOH Link: http://www.doh.state.fl.us/Family/famplan/waiver.html Medicaid Link: http://www.fdhc.state.fl.us/Medicaid/Family_Planning/index.shtml Financial Counselors

• Florida Hospital Deland 386-943-4641 • Flagler County Health Department 386-437-7350 ext.240 • Volusia County Health Department (Deland) 386-822-6215 • Volusia County Health Department (Daytona Beach) 386-274-0514

Florida Medicaid Area 4 Office What services does Florida Medicaid cover? I’m getting bills for past medical services. I need a doctor/dentist who takes Florida Medicaid. I have a question about MediPass. http://ahca.myflorida.com/Medicaid/index.shtml 800-273-5880 or 904-353-2100 Faith Based Services (West Volusia)

• St. Peter Catholic Church 359 W New York Ave Deland FL 32720 386-822-6000 Food Pantry – Tue & Thur. 10am–1pm

• First Baptist Church 725 N Woodland Blvd Deland FL 32720 386-734-5085 Food, Vouchers and Utilities – Tuesday by appt only

• St. Barnabas Episcopal Church 327 W Wisconsin Ave Deland FL 32720 386-734-9708 Rent, Utilities, Clothes, RX, Dental. Tue–Fri 9:30am – 11:30am free dinner Wed.

• Bethel A.M.E Church Corner of E. Howry & Brinkley Deland FL 386-736-2324 Food & Utilities Mon & Tue 11:45am – 1:45pm Must have referral from St. Barnabas

• Trinity United Methodist 306 W Wisconsin Ave Deland FL 32720 386-734-4255 Food & Clothes Tue & Thur 9:30am – 11:30am

• First Assembly of God 1500 E Int’l Speedway Blvd Deland FL 32728 386-736-2948 Food Wed & Thur 12pm – 4pm

• St. Claire Catholic Community 2961 Day Road Deltona FL 32728 386-789-9990 Food - Call for an appt

Faith Based Services (East Volusia)

• Circle of Love Center 498 S Young St. Ormond Beach, FL 32174 386-673-3438 Tue – Fri 9am – 11am Food and clothing for the very needy

• Halifax Urban Ministries 215 Bay Street Daytona Beach, FL 32114 386-252-0156

http://www.doh.state.fl.us/Family/famplan/waiver.html

http://www.fdhc.state.fl.us/Medicaid/Family_Planning/index.shtml

http://ahca.myflorida.com/Medicaid/index.shtml


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Provides food, assistance for rent or utilities, hot showers, laundry and shelter available. Travelers’ aid helps stranded transients return to their family. Call for information & office locations.

• Catholic Charities 207 White Street Daytona Beach, FL 32114 386-255-6521 Food bags distributed Mon – Fri 12:30pm – 4:30pm, bus tokens for those seeking employment or going to government agency.

• Salvation Army 1555 LPGA Blvd Daytona Beach, FL 32117 386-236-2020 Spiritual and material help Mon – Fri 8:30am – 4:30pm

• The Basilica of St. Paul 317 Mullally St. Daytona Beach, FL 32114 386-252-5422 • Provides Salvation Army and ID vouchers, bus tokens, and referrals for food and clothing

and prescription assistance. • Daytona Rescue Mission 425 Ridgewood Ave. Holly Hill, FL 32117 386-252-5570

Hot meals Tue/Wed/Thur/Sun; food baskets & clothing Mon/Fri/Sat following 10a.m. church service.

Food - WIC (Women Infants and Children) Appointment Offices http://www.doh.state.fl.us/family/WIC/

• Daytona Beach 386-274-0676 • Deland 386-736-5320 • Deltona 386-860-7150 • New Smyrna 386-424-2074 • Bunnell/Flagler 386-437-7294 • Angelfood Ministries SERVICES SUSPENDED UNTIL FURTHER NOTICE

770-267-7015 or 888-819-3745 Fax: 770-267-8031 http://www.angelfoodministries.com A non-profit, non-denominated organization dedicated to providing food relief. No application or qualification requirements Accepts food stamps $30 per order

Friendly Food Stamp Application Assistance Deneida Paltrow, Benefits Coordinator, Second Harvest Food Bank of Central Florida When and Where: January 2010 Schedule EVERY Monday and Thursday from 9am - 2 pm Community Life Center, 1691 Providence Blvd Suite 102, Deltona EVERY Tuesday from 9am - 12 pm Deltona Presbyterian Church, 2300 Howland Blvd EVERY Wednesday from 9am – 2pm Volusia County Library Center at City Island, 105 E. Magnolia Ave., Daytona Beach All applications are submitted electronically. Re-certifications can be done as well. Questions? Call 407-423-7333.

http://www.doh.state.fl.us/family/WIC/

http://www.angelfoodministries.com/


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Funding Resources for Single Women Grants for Single Mothers http://grantsforsinglemother.org/ This site is among the web's top educational resource focused on helping single moms. Topics include single mom financial aid, scholarship resources, food and housing programs, parenting advice, and related information. Health Department Women’s Centers

• Daytona Beach 386-274-0509 • Deland 386-736-5320 • Deland 386-822-6221 • Flagler 386-274-0500 • New Smyrna Beach 386-424-2065

Health Insurance Florida Kid Care http://www.floridakidcare.org/

• Office (Jeannette) 386-323-0000 • Toll Free 888-540-5437 • TTY: 1-877-316-8748

Cover Florida www.coverfloridahealthcare.com Help Lines

• Breast Feeding Help Line 800-994-9662 • Halifax Health Help Line 386-258-4848 • Family Health Help Line 800-451-2229 • Women’s Health Help Line 800-994-9662 or www.womenshealth.org • Girls Health www.4girls.gov

Consumer health information in multiple languages available from National Library of Medicine. Information in available in 40 languages and covers nearly 250 health topics: http://nlm.nih.gov/medlineplus/languages/languages.html

• Parents Toll-Free Helpline 1-855-Drugfree (1-855-378-4373 Mon – Fri 10am – 6pm (ET) Our parent specialists are licensed social workers and psychologists with years of experience helping individuals & their families prevent and overcome substance abuse problems. http://timetogethelp.drugfree.org/parents-toll-free-help-0

HIV/Aids Support Group

• Daytona Beach 386-255-5569 • Flagler Beach 800-700-5410 • New Smyrna Beach 386-255-5569 • Diggs Miracle Care 386-323-9855

Hospital Birthing Centers (Patient Information)

• Central Florida Regional Sanford 407-321-4500 ext. 5766

http://grantsforsinglemother.org/

http://www.floridakidcare.org/

http://www.coverfloridahealthcare.com/

http://www.womenshealth.org/

http://www.4girls.gov/

http://nlm.nih.gov/medlineplus/languages/languages.html

http://timetogethelp.drugfree.org/parents-toll-free-help-0


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• Ormond Memorial (Susan) 386-676-6262 • Halifax Medical (Ellen) 386-254-4005 • Florida Deland (Karen) 386-943-4562

Housing - Apartments (Rent Based on Income):

• Mid Florida Housing - Toll Free 800-644-6125 http://www.mfhp.org/index.php

• Holly Point Apt - Holly Hill 386-252-4995 • Wedgewood Apt - Daytona Beach 386-274-2746 • Windy Pines Apt - Daytona Beach 386-274-1006 • Braemoor Dunes - Orange City 386-774-5480 • Hunters Creek –Deland 386-740-4866 • Whispering Oaks - Orange City 386-775-3515 • St. Gerard Campus – St. Augustine 800-833-6075 or 904-829-5516

Housing Assistance Volusia County (Down Payment Assistance, Owner Occupied Housing Rehabilitation, Section 8 http://www.volusia.org/community_assistance/housing.htm

• West Volusia 386-736-5955 • Daytona Beach 386-254-4648 • New Smyrna Beach 386-423-3375 • Flagler County - 904/437-3221

Housing – Homeless, Women and Families

• Coalition for the Homeless 386-252-3032 • Family Renew/Holly Hill 386-239-0861 • Family Renew/Deland 386-736-0500 • Palmetto House/Daytona Beach 386-253-4895 • Star Shelter 386-252-9400 • Neighborhood Center / Deland 386-734-8120 • Family Promise of Volusia County 386-402-4987

Located in New Smyrna beach, this is a small, faith based day shelter for homeless families that also includes social services. For information, eligibility requirements and vacancies please contact Executive Director, Brenda Rogers.

Housing – Homeless Women and Children ONLY

• Second Choice Transitional Housing • East Volusia 386-255-2102 • West Volusia 386-738-4080

Must have a goal to go to work or school. May stay up to 2 years. Center will answer the phone Domestic Abuse Council but abuse is not a criterion to qualify for housing.

http://www.mfhp.org/index.php

http://www.volusia.org/community_assistance/housing.htm


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Housing – Pregnant Teens Only (Ages 13 – 18 years) Alpha Omega Miracle Home 1835 U.S. 1 South Suite 119-235 St. Augustine FL 32084 904-823-8588 www.aomh.org/future.htm Housing - Public

• Daytona Beach 386-252-3472 • Deland 386-736-1696 • New Smyrna Beach 386-428-8171 • Ormond Beach 386-677-2069 • Flagler Beach 386-437-3221

Infant CPR Class

• Daytona Beach Red Cross...........386-226-1400 Ext 119 Internet Resources www.DrugWatch.com This site provides up-to-date information about the side effects of common prescription and over the counter medications to help educate consumers and patients. Legal Services

• Local number 386-255-6573 • Toll Free 888-379-4729 • Bar Association 800-342-8060 • Community Resource Center in Deland 910 South Adelle Avenue 386-437-3072

Attorney for bankruptcy, civil, criminal, divorce, family, wills, estates and trusts. Free consultation with Bernice Ludvick, Esq. Call for an appointment

Mammograms If you have a low income or do not have insurance and are between the ages of 40 to 64, you may be able to get a free or low-cost mammogram through the National breast and Cervical Cancer Early Detection Program in your community. To learn more, call 1-800-CDC-INFO (800-232-4696) or visit them online at: www.cdc.gov/cancer/nbccedp Midwives Who Accept Medicaid Note: Providers on this list only accept so many Medicaid patients at a time and some may not be accepting new patients when you call them.

• A Woman’s Touch in Healthcare Sanford 407-321-3884 • Birth Blessings Debbie Myers, L.M. Orange City 386-774-0712 • Heart to Heart Birth Center Sanford 407-322-9944 • Agape Midwifery Service & Maternity Clinic

235 2nd Street Holly Hill FL 32117 386-258-5400 Karen Kennedy Tyus, LM Email address: [email protected]

http://www.drugwatch.com/

http://www.cdc.gov/cancer/nbccedp

mailto:Email%20address:%20%[email protected]


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Mobile Health Unit New Dawn Women’s Clinic 407-463-1781 306 E. Church St Deland Tue 10:15am-2pm

• Limited Ultrasounds 689 Deltona Blvd Deltona Mon 10:15am-2pm • Medical Consultation • Proof of Pregnancy • Resource Assistance

Mobile Phone Health Information Pregnant women and new mothers can get health information delivered directly to their mobile phones by text message at no charge. Visit text4baby.org for more information. New Mom & Baby New moms with a baby in the first year are invited to join in activities that will support, sustain and enlighten them to be creative and be the best mom they can be. Sessions are 16 weeks and meet every Wednesday at Florida Memorial Medical Center in the Cafeteria Annex from 11am – 12:30pm. Bring your own lunch/beverage and anything needed for the baby. For more information and to register, contact Susan Bekken 386-231-3152 Parenting Classes

• Early Learning Coalition - Workshops for Parents - Free For more information, contact: • Michele Lowe at (386) 323-2400 ext. 126 • Kathy Pridemore at (386) 736-5010 ext. 107 • House Next Door in Daytona Beach & Deland 386-734-2236

Step by Step: 0-36 months Making Changes: 3-11 years Fee is $50.00 Call to register

• Halifax Behavior Center 841 Jimmy Ann Drive Daytona Beach FL 386-274-5333 Every Tuesday 6-7p.m. Babysitting and food available No reservations required Fee is $25.00

Parenting Information www.babycenter.com Topics on getting pregnant, baby, toddler, pre-schooler, big kids. Information about activities, development, emotional health, family life, finances, nutrition, fitness and much more. Paternity Testing Toll Free 888-362-2876 Poison Control 1-800-222-1222 Pregnancy Testing – Free

• Grace House – Deland 386-822-9797 • Pregnancy Crisis Center – Daytona 386-257-2229 • Resources for Women – Daytona 386-760-2113

http://www.babycenter.com/


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• Central FL Pregnancy Center – Deltona 386-532-4004 Prescriptions – Discount Cards www.FamilyWize.org Cards free of charge to everyone in our community. Go to the website to print a card, look up drug prices, and get a list of participating pharmacies. This information can also be obtained by calling 211. Safe Haven for Newborns 1-877-767-2229 www.asafehavenfornewborns.com If you couldn’t let anyone know you are or were pregnant, and you don’t know what to do, don’t abandon your baby. Call Safe Haven for Newborn’s 24-hour confidential hotline (Toll free/multi-lingual). Smoking and Pregnancy Information Nicotine May Cause Fetal Defects http://www.zeroexposure.org/index.cfm/fuseaction/Info.Smoking_info Smoking - Quit Tobacco

• Toll Free 877-822-6669 • American Cancer Society 800-227-2345 • Ormond Memorial Hospital (Freedom from Smoking) 386-676-6099 • Volusia County Health Department-Daytona Beach (Luz or Rakinya) 386-274-0601

Special Needs for Children

• Easter Seals Volusia & Flagler 386-255-4568 http://fl/vf.easterseals.com

• Children Medical Services/Toll Free 866-827-5197 or 386-238-4980 InfantSee InfantSee is a nationwide program that provides free eye exams for infants from 6 mos to 12 mos old. http://www.infantsee.org and click on Locator at the top right of the page for a location nearest you. Sterilization Services – Volusia & Flagler Counties Men – Vasectomy Women – Tubal Ligation

• Volusia County Health Department 935 North Spring Garden Avenue, Bin 201, Deland, Florida 32720 386 943-7844

Contact: Ann Bodziak Senior Community Health Nursing Supervisor/Contract Manager Mom’s Club of Deland, FL www.momsclubofdeland.org Members accepted from the following area codes: Cassadaga (32706), Deland (32720, 32723, 32724), Deleon Springs (32130), Lake Helen (32744), Pierson (32130) If you live outside these communities and would like to find a chapter in your own area, visit www.momsclub.org

http://www.familywize.org/

http://www.asafehavenfornewborns.com/

http://www.zeroexposure.org/index.cfm/fuseaction/Info.Smoking_info

http://fl-vf.easterseals.com/site/PageServer?pagename=FLVF_homepage

http://www.infantsee.org/

http://www.momsclubofdeland.org/

http://www.momsclub.org/


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Teen Parenting • The Chiles Academy - Daytona Beach 386-322-6102 • Teen Parent West – Deland 386-822-7896

Teen Parent Resources - The resources below give information for teen age parents and answers to frequently asked questions:

• http://www.teenageparent.org/ - English and Spanish • http://www.watsoneducationalservices.com - A Guide for Teen Parents (requires book

purchase) • http://www.teenparents.org/ - Teen Parent Fact Sheets • http://www.zerotothree.org/ - Helpful parenting information • http://www.teenwire.com/infocus/2006/if-20060106p405-parents.php - The rights of teen

parents Terminally Ill Children – Services American Child Photographers Charity Guild http://www.acpcg.com/nicu.htm Thrift Stores

• Our Lady of Hope, Daytona Beach 386-767-0571 • Resource for Women (Maternity & Baby, Daytona Beach 386-761-6629 • Domestic Abuse Thrift Shop & Boutique 386-761-3166

335 Beville Road, South Daytona • Christ Team Thrift Shop 386-255-4357

1236 8th Street, Daytona Beach • Secret Attic The Oaks, Ormond Beach 386-615-8430 • Secret Attic II 386-615-3837

32 N Ocean Shore Blvd, Ormond Beach • Our Father’s Closet, Deland 386-734-8350 • Neighborhood Center, Deland 386-734-8120 ext 16 • Anchor Thrift Store Contact: Karen Clancy 386-423-1660

540 N Dixie Freeway New Smyrna Beach, FL • Second Blessings Resale Boutique 386-761-6629

1369 Beville Road, Daytona Beach (Foxboro Plaza) Mon – Sat 10am – 4pm • Junior League Thrift Shop 386-253-7486

1757 N Nova Road, Holly Hill • Salvation Army / Deland 386-738-2406 • St. Vincent DePaul Society 407-574-9124 Debary & Deltona clients only

Transportation - Medicaid Non-Emergency Transportation

• LogistiCare Solutions, LLC 866-726-1469 Ultrasounds

• Keiser University: Marianne Peiffer, Ultrasound Director 386-274-5060 Ultrasounds performed by students – FREE

http://schools.volusia.k12.fl.us/chiles/

http://www.teenageparent.org/

http://www.watsoneducationalservices.com/

http://www.teenparents.org/

http://www.zerotothree.org/

http://www.teenwire.com/infocus/2006/if-20060106p405-parents.php

http://www.acpcg.com/nicu.htm


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• Resources for Women 386-760-2113 - FREE Ultrasounds for pregnancy verification ONLY

• First Fetal Photos – 3D & 4D – Fee Required Marianne Peiffer – Bunnell 386-586-5657 These sonograms are not for diagnostic purposes Please mention Healthy Start for a discount

• Visions of Life 3D/4D Fetal Ultrasound Photos – Daytona Beach 386-274-5433 Email: [email protected] Website: www.visionsoflife3d.com Elective non-medical (non diagnostic) prenatal ultrasound performed by credentialed sonographer. Call for monthly giveaway and special event information. °Must already be receiving treatment with a healthcare provider. °Must have undergone previous medical diagnostic ultrasound. °Packages start at $95.00. Discounts available for Healthy Start clients.

Veterans Services

• American Legion Post #6 1087 Biscayne Blvd. Deland 386-740-0622 Housing, utilities, food, clothing to veterans & their families Also see Counseling – Mental health

Vital Statistics

• Daytona Beach 386-947-5405 • State of Florida Vital Statistics 904-359-6900

Vital Statistics Birth Certificates Daytona Beach 386-274-0614 To request a Florida birth certificate go to: http://cdc.gov/nchs/w2w.htm To request a birth certificate from a state other than Florida, go to: http://www.cdc.gov/nchs/howto/w2w/w2welcom.htm For obtaining a driver’s license or state ID: http://www.hsmv.state.fl.us Volusia County Human Services Non-emergency related requests: Utility related appointments scheduled Monday, Wednesday & Friday. Appointment to discuss rent & mortgage assistance will be Tuesday & Thursday. Appointments are not required for emergencies such as prescriptions, prevention of utility shutoff & assistance with payment of rent. http://www.volusia.org/community_assistance/human.htm Emergency help to pay rent or utility bills:

• Daytona Beach 386-254-4675 • Deland 386-736-5956 • South Volusia 386-423-3309 • Orange City 386-775-5204


http://www.visionsoflife3d.com/

http://doh.state.fl.us/planning_eval/vital_statistics/birth_death.htm

http://www.cdc.gov/nchs/howto/w2w/w2welcom.htm

http://www.hsmv.state.fl.us/

http://www.volusia.org/community_assistance/human.htm


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WIC (Women Infants and Children) Appointment Offices http://www.doh.state.fl.us/family/WIC/

• Daytona Beach 386-274-0500 • Deland 386-822-6223 • Deltona 386-860-7150 • New Smyrna 386-424-2074 • Bunnell/Flagler 386-437-7294

Additional Miscellaneous Services:

• Duvall Rehab www.duvallhome.org An outpatient provider of physical, occupational, speech and aqua therapy for Medicaid waiver patients only. Call 386-734-2874 ext 316 for more information.

• Progress Energy Customer Assistance Program http://progress-energy.com/custservice/flares/electric/assistance.asp

• Humana Life Insurance/Junior Estate Builder Life Insurance An investment in your child’s future. $35 per year For information call Dave Smith (License # A246165) 386-676-4946

http://www.doh.state.fl.us/family/WIC/

http://www.duvallhome.org/

http://progress-energy.com/custservice/flares/electric/assistance.asp


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TXXI/Ped-I-Care Mental Health Services Providers

A Better Therapy (Individual & family counseling 740 Florida Central Parkway in home, school, & office, psychological #1080 & behavior issues – Ages 4-20) Longwood, FL 32750 Phone: (407) 774-2284 ****In Flagler, Seminole, Orange Fax (407) 774-2285 and Brevard County Schools Adapt Behavioral Services (Autism, developmental delay, home, 533 North Nova Rd. school, individual & family counseling, Suite 115 parent training, behavior analysis) Ormond Beach, FL 32174 Phone: (386) 898-5003 Fax: (386) 675-6490 Avanti Wellness Center (Psychiatric evaluations, medication 3574 US 1 management, individual & family Suite 113 counseling) St. Augustine, FL 32086 Phone: (904) 797-3115 Carl G. Austin, LMHC (Counseling) 2425 S. Volusia Avenue, Unit B-4 Orange City, FL 32763 Phone: (386) 774-9073 Carole Hull, LMHC (Addiction & adolescent counseling - 620 East New York Avenue, Suite A Ages 12 & up) Deland, FL 32724 Phone: (386) 668-5435 Fax: (386) 738-5916 Central Florida Behavioral Hospital (Residential mental health facility) 6601 Central Florida Parkway Orlando, FL 32821 Phone: (407) 370-0111 Choices-Changes LLC (Counseling & substance abuse) 2298 West Airport Blvd. Sanford, FL 32771 Phone: (407) 268-4441 Fax: (407) 323-2374


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Children’s Home Society of FL (Counseling) 2400 S. Ridgewood Ave. Ste. 32 South Daytona, FL 32119 Phone: (386) 304-7600 OR 247 W. Voorhis Ave. Deland, FL 32720 Phone: (386) 740-3839 Circle of Friends Services, Inc (Group counseling, childhood trauma, 517 Deltona Blvd., Ste. D attachment disorders, infant mental Deltona, FL 32725 health, impaired relationships, all Phone: (386) 473-4566 services provided in home) Fax: (503) 218-1848 Barbara Defazzio, LMHC Gerald Button, LMHC Sherri Creel, LMHC Coastal Mental Health Center (Psychiatrists, mental health counselors, 150 S. Palmetto Avenue social workers, ADD, anxiety, Asperger’s Ste. 103 behavioral, bi-polar, special needs, Daytona Beach, FL 32114 teen problems) Phone: (386) 254-0711 Fax: (888) 217-4124 Coastal Mental Health Center (Psychiatrists, mental health counselors, 667 Deltona Blvd. social workers, ADD, anxiety, Asperger’s Deltona, FL 32725 ADD, anxiety, Asperger’s, behavioral, Phone: (386) 574-7417 bi-polar, special needs, teen problems) Fax: (888) 217-4124 Coastal Mental Health Center (Psychiatrists, mental health counselors, 4867 NW Palm Coast Parkway social workers, ADD, anxiety, Asperger’s Ste. 1 behavioral, bi-polar, special needs Palm Coast, FL 32137 teen problems) Phone: (386) 675-4694 Fax: (888) 217-4124 Community Ties of America, Inc. (Autism, Asperger’s, developmental 1802 N. Alafaya Trail, Ste. 158 delay, behavior analysis, therapy for Orlando, FL 32826 families with developmental delay) Phone: (407) 473-4057 ****In Seminole, Orange County Schools Tim Lloyd, MS, BCBA Jennifer Biemiller, MS, BCBA


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ESP Case Management (Children who are aging out of CMS - Professionals Inc transition to adult provider) 345 Beville Road, Ste. 106 South Daytona Beach, FL 32119 Phone: (386) 760-7533 Family Mental Health (Therapy & counseling/testing, Practice - Flagler Beach profound injury & disease 701 N Central Ave management – Ages 5 to adult) Flagler Beach, FL 32136 (Not wheelchair accessible) Phone: (386) 439-1403 Theodore R. DeRoche, PhD Family Preservation Services of FL (Counseling & case management) 2500 West Lake Mary Blvd. Lake Mary, FL 32746 Phone: (407) 688-0088 Fax: (407) 688-0055 Florida Autism Center Inc (Autism, Asperger’s) 1219 Dunn Avenue (In the Easter Seals building) Daytona Beach, FL 32117 Phone: (407) 413-9550 OR 4591 Orange Blvd Sanford, FL 32771 Phone: (407) 413-9550 Chrystin Bullock Glory Psychiatric Center (Counseling, medication management) 1836 Woodward St Orlando, FL 32803 Phone: (407) 894-6980 Montes, Stella MD Halifax Behavioral Services 841 Jimmy Ann Dr (Crisis stabilization, medication Daytona Beach, FL 32114 management, counseling) Phone: (386) 274-5333 Interventions Unlimited (Autism, Asperger’s, developmental 848 Executive Drive delay – Ages 3 & up) Oviedo, FL 32792 Phone: (407) 678-8889 Jing Zhou, MS, BCBA


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Joann B Gates, PhD, Licensed (Counseling) Psychologist Gates, Joann B PhD 1201 Arapaho Ave, Suite A St Augustine, FL 32084 Phone: (904) 471-0788 La Amistad Behavioral Health Services (Residential mental health facility) 1650 Park Avenue North Maitland, FL 32751 Phone: (800) 433-1122 Medallion Health Care Services (Children who are aging out of CMS - 236 N. Frederick Ave. #2 transition to adult provider) Daytona Beach, FL 32114 Phone: (386) 341-0550 Nemours Children's Clinic - (Autism, developmental delay - Orlando Ages 3 & up) 1717 S Orange Ave Orlando, FL 32806 Phone: (407) 650-7455 Pamela E Derr, LMHC (Therapy – Ages 12 & up) 210 Moody Blvd Flagler Beach, FL 32136 Phone: (386) 503-9674 Patrick W. Gorman, Psy.D. ABPP, LLC (Neurospychology) 1870 Aloma Avenue #280 Winter Park, FL 32789 Phone: (407) 644-7792 Patrick W. Gorman, Psy.D. Psychological Associates (Counseling) 157 Hampton Point Drive Suite 3 St. Augustine, FL 32092 Phone: (904) 436-6032 Monaghan, Christy L LMHC, PhD Psychotherapy Services, Inc. (Counseling) 269 S. Matanzas Blvd. St. Augustine, FL 32080


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Phone: (904) 827-1777 OR 4475 US 1 South Ste. 303 St. Augustine, FL 32086 Phone: (904) 827-1777 Paula Mills, DS, MA, LMHC Sara J. Riley (Counseling) 397 SW Palm Coast Parkway Ste. 5 Palm Coast, FL 32137 Phone: (386) 986-2222 Fax: (386) 986-2200 Sara J. Riley, LMHC SMA Behavioral Health Services (Substance abuse) 3875 Tiger Bay Road Daytona Beach, FL 32124 Phone: (386) 947-1328 Strategies, Inc. (Behavior analysis, therapeutic services 631 Beville Rd services, behavioral consulting for South Daytona, Fl 32119 Autism Spectrum Disorder and problematic Phone: (386)-767-3752 behavior) Therapeutic Foundations, LLC (Autism, Asperger’s, developmental delay) 1181 Dal Maso Dr Daytona Beach, FL 32117 ***Services in home/school Volusia, Phone: (386) 254-8788 Flagler and Central Florida Bush, Patricia LMHC Naimoli, Dawn MA Trevon Clow Counseling (Counseling - children and adolescents) Therapies 221 N Causeway, Suite B New Smyrna Beach, FL 32169 Phone: (386) 428-4564 Clow, Trevon PhD, LMHC University Behavioral Center (Residential mental health facility) 2500 Discovery Drive Orlando, FL 32806 Phone: (407) 281-7000 Verones & Co. PLC (Counseling)


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50 Leanni Way, Ste. C1 Palm Coast, FL 32137 Phone: (386) 447-4145 Verones, Denise PhD, Jennifer Giblin, MS, Lindsey Brunswick

Medicaid/Magellan Mental Health Services Providers

Adapt Behavioral Services (Autism, developmental delay, home, 533 North Nova Rd school, individual & family counseling Suite 115 parent training, behavioral analysis) Ormond Beach, FL 32174 Phone: (386) 898-5003 Fax: (386) 675-6490 Circle of Friends Services, Inc (Group counseling, childhood trauma, 517 Deltona Blvd., Ste. D attachment disorders, infant mental Deltona, FL 32725 health, impaired relationships, all Phone: (386) 473-4566 services provided in home) Fax: (503) 218-1848 Barbara Defazzio, LMHC Gerald Button, LMHC Sherri Creel, LMHC Coastal Mental Health Center (Psychiatrists, mental health counselors, 150 S. Palmetto Avenue social workers, ADD, anxiety, Asperger’s, Ste. 103 behavioral, bi-polar, special needs, teen Daytona Beach, FL 32114 problems) Phone: (386) 254-0711 Fax: (888) 217-4124 Coastal Mental Health Center (Psychiatrists, mental health counselors, 4867 NW Palm Coast Parkway social workers, ADD, anxiety, Asperger’s, Ste. 1 behavioral, bi-polar, special needs, Palm Coast, FL 32137 teen problems) Phone: (386) 675-4694 Fax: (888) 217-4124 Coastal Mental Health Center (Psychiatrists, mental health counselors, 667 Deltona Blvd. social workers, ADD, anxiety, Asperger’s Deltona, FL 32725 behavioral, bi-polar, special needs, teen Phone: (386) 574-7417 problems) Fax: (888) 217-4124


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Halifax Behavioral Services 841 Jimmy Ann Dr (Crisis stabilization, medication Daytona Beach, FL 32114 management, counseling) Phone: (386) 274-5333 SMA Behavioral Health Services (Substance Abuse) 3875 Tiger Bay Road Daytona Beach, FL 32124 Phone: (386) 947-1328

RESOURCE LIST DISCLAIMER

No warranties

This resource list is provided “as is” without any representations or warranties, express or implied. The Healthy Start Coalition of Flagler & Volusia Counties, Inc. makes no representations or warranties in relation to this resource list or the information and materials provided on this resource list. Without prejudice to the generality of the foregoing paragraph, The Healthy Start Coalition of Flagler & Volusia Counties, Inc. does not warrant that:

this resource list will be constantly available, or available at all; or the information on this resource list is complete, true, accurate or non-misleading.

Nothing on this resource list constitutes, or is meant to constitute, advice of any kind. If you require advice in relation to any legal, financial or medical matter you should consult an appropriate professional. Limitations of liability The Healthy Start Coalition of Flagler & Volusia Counties, Inc. will not be liable to you (whether under the law of contact, the law of torts or otherwise) in relation to the contents of, or use of, or otherwise in connection with, this resource list:

to the extent that the resource list is provided free-of-charge, for any direct loss; for any indirect, special or consequential loss; or for any business losses, loss of revenue, income, profits or anticipated savings, loss of contracts or business relationships, loss of

reputation or goodwill, or loss or corruption of information or data. These limitations of liability apply even if The Healthy Start Coalition of Flagler & Volusia Counties, Inc. has been expressly advised of the potential loss. Exceptions Nothing in this resource list disclaimer will exclude or limit any warranty implied by law that it would be unlawful to exclude or limit; and nothing in this resource list disclaimer will exclude or limit The Healthy Start Coalition of Flagler & Volusia Counties, Inc.’s liability in respect of any:

death or personal injury caused by The Healthy Start Coalition of Flagler & Volusia Counties Inc.‘s negligence; fraud or fraudulent misrepresentation on the part of The Healthy Start Coalition of Flagler & Volusia Counties, Inc.; or matter which it would be illegal or unlawful for The Healthy Start Coalition of Flagler & Volusia Counties, Inc. to exclude or limit, or

to attempt or purport to exclude or limit, its liability. Reasonableness By using this resource list, you agree that the exclusions and limitations of liability set out in this resource list disclaimer are reasonable. If you do not think they are reasonable, you must not use this resource list. Other parties You accept that, as a limited liability entity, The Healthy Start Coalition of Flagler & Volusia Counties, Inc. has an interest in limiting the personal liability of its officers and employees. You agree that you will not bring any claim personally against The Healthy Start Coalition of Flagler & Volusia Counties, Inc.’s officers or employees in respect of any losses you suffer in connection with the resource list.


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Without prejudice to the foregoing paragraph, you agree that the limitations of warranties and liability set out in this resource list disclaimer will protect The Healthy Start Coalition of Flagler & Volusia Counties, Inc.’s officers, employees, agents, subsidiaries, successors, assigns and sub-contractors as well as The Healthy Start Coalition of Flagler & Volusia Counties, Inc. Unenforceable provisions If any provision of this resource list disclaimer is, or is found to be, unenforceable under applicable law, that will not affect the enforceability of the other provisions of this resource list disclaimer. This resource list disclaimer This resource list disclaimer is based on a precedent created by template-contracts.co.uk (http://www.template-contracts.co.uk/) and published by freenetlaw.com (http://www.freenetlaw.com/).

http://www.template-contracts.co.uk/

http://www.freenetlaw.com/

http://www.freenetlaw.com/


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Appendix H – SDP Major Accomplishments over the Last Five Years

Improvements in Healthy Start Service Delivery

Prenatal Screening Rates FY05/06 FY10/11 Percent Percent Flagler County Prenatal Screening Rate 86.25% 109.44% Volusia County Prenatal Screening Rate 56.94% 98.42% Service Area Prenatal Screening Rate 60.81% 100.07% Flagler number Pregnant Women 778 805 Flagler number Women screened 671 881 Volusia number Pregnant Women 5112 4566 Volusia number Women Screened 2911 4494

Postnatal Screening Rates FY05/06 FY10/11 Percent Percent Flagler County Postnatal Screening Rate 58.10% 79.38% Volusia County Postnatal Screening Rate 53.36% 81.82% Service Area Postnatal Screening Rate 53.99% 81.46% Flagler number of births 778 805 Flagler number of babies screened 452 639 Volusia number of births 5112 4566 Volusia number of babies screened 2728 3736

Level 3 Services FY05/06 FY10/11 Percent Percent Flagler Percent of Participants receiving Level 3 Services 5.87% 10.00% Volusia Percent of Participants receiving Level 3 Services 4.69% 8.85% Service Area Percent of Participants receiving Level 3 Services 4.84% 9.01% Flagler number of Participants Receiving a HS Service 511 1010 Flagler number of Participants receiving a level 3 service (ongoing face to face CC w/FSP) 30 101 Volusia number of Participants Receiving a HS Service 3646 6263 Volusia number of Participants receiving a level 3 service (ongoing face to face CC w/FSP) 171 554

Enhanced Services FY05/06 FY10/11 Percent Percent Flagler Percent of Enhanced Services 3.15% 12.04% Volusia Percent of Enhanced Services 3.22% 15.60% Service Area Percent of Enhanced Services 3.21% 15.12% Flagler number of services 9710 13855 Flagler number of Enhanced services 306 1668 Volusia number of services 56214 88896 Volusia number of Enhanced services 1812 13869


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Appendix I – Service Delivery Planning Timeline

Oct. 2009 – Sept. 2010 Oct. 2010 – Jan. 2011 Feb. 2011 – March 2011 April 2011 – June 2011 July 2011 – Aug. 2011 Review of preliminary data with Providers; Update general data with 2008 records

Providers meet in sub-committees, per indicator

Committee reviews draft; Input draft edits

Final version preliminary review; Final version completed and input final version edits

Final version final review; Input final review edits and send to DOH

Oct. – Nov. Dec. – Jan. Review of 2009 and additional data by Providers and selected community members; Update with 2009 data

Committee provides final input for draft; Finish draft document


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Appendix J – Fishbone Analysis

INCREASE 1ST TRIMESTER ENTRY TO CARE & REDUCE LATE OR NO PRENATAL CARE RATES

Provider Education and Awareness need to be improved

Policies Regarding Pregnancy Medicaid should support Public and Private Partnerships.

Educate policy makers about barriers to prenatal care access for Medicaid patients

Develop proviso language to support new model

Coordinate with hospitals and FQHC's

Participate in related community groups to include OVV and IMH

Provide education and TA to providers - get feedback

Utilize technology - website, facebook,

Patient Awareness needs to be improved

Centralize Access Points to reduce barriers for families needing services and improve outcomes.

Leverage resources to fund.

Engage parent leaders

Parent feedback

Utilize Five Protective Factors

Support midwifery services at The Chiles Academy to educate teens

Coordinate with Marketing Committee re: materials, etc.

Coordinate with MomCare

Community Awareness needs to be improved

Educate community through media, legislative briefs, PSA's etc.

Participate in a minimum of 16 community activities

Women experience difficulty gaining access to prenatal services early in pregnancy.

Increase number of prenatal providers who accept "MU"

Support MomCare program and gain feedback about barriers

Support access to Midwife.

Implement "one stop" model at VCHD

Conduct ChildWatch activities to educate community leaders.


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175

RATE OF INFANT

MORTALITY

Unsafe sleeping

Coordinate with hospitals and FAW's to identify need.

Increased Unwanted Pregnancies

ICC education

Undocumented afraid of I.D.

Access to Family Planning

Underutilization of Title X tubals - increase linkages

Raise funds for cribs & distribute

Inform public through media and awareness including SIDS Sunday.

Leverage additional resources

Education of Providers, Patients, and Community at large

Develop/implement community-wide training plan

Contract with Healthy Communities

Convene Marketing Experts in a committee to develop and implement a community-wide plan

Consumers report fragmented and complicated system of care

Participate in tb5

Conduct consumer feedback and engagement events/activities

Implement “Access Centers” for families to connect to with multi-agency partnership coordination

Increase parent engagement

Pediatric Follow-up difficult because of Medicaid privatization

Reach families in 72 hours - high rate of preventable neonatal mortality

Follow up with babies from NICU

Increase Infant Screening Rates

Continue to utilize FIMR CRT to improve service delivery

Media engagement

SIDS Sunday

Increase FIMR

Systemic delay in reaching babies after discharge

Develop and disseminate Project INFORM and Grief Toolkit


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Lack of Community Engagement/Knowledge of Disparities

Lack of follow-up after loss (Implement AAFBBI in African American Churches)

Lack of knowledge of BIM

Need strength-based model (Lifesong)

Housing areas in Midtown (DB) show disproportionate rates of LBW/VLBW, Late entry and teen pregnancy in Black population.

Pedestrian populations

Community gatekeeper involvement needed.

Need "walk-in" venues accessible with no barriers to care and parent navigators

Increase parent engagement

Lack of African American involvement in community awareness

Pediatric Follow-up difficult because of Medicaid privatization

Reach families in 72 hours - high rate of preventable neonatal mortality

Follow up with babies from NICU

Increase Infant Screening Rates

Continue to utilize FIMR CRT to improve service delivery and increase participation of Black members

Engage media outlets to highlight BIM issues.

Convene Data committee to review causes of death among cases Black fetal and infant loss

Invite Black members of Faith and medical community to CRT

Systemic delay in reaching babies after discharge

Develop and disseminate Project INFORM and Grief Toolkit

RATE OF BLACK INFANT

MORTALITY

Unsafe sleeping disproportionately impacting Black families

Coordinate with hospitals and FAW's to identify need.

Increased Unwanted Pregnancies

Gain feedback from Black consumers about service improvement

Culturally competent education is needed.

Access to Family Planning Waiver and services.

Underutilization of Title X tubals - increase linkages

Raise funds for cribs & distribute

Inform public through media and awareness including SIDS Sunday.

Leverage additional resources


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INCREASE/MAINTAIN PRENATAL AND

INFANT SCREENING RATES

Prenatal Care providers require ongoing education, technical assistance and support.

Coalition members can benefit from understanding and reviewing screening rates during general meetings.

Develop and utilize materials to enhance training of medical provider staff.

Coordinate with all prenatal providers at least one time quarterly.

Ensure timely notification to providers about their patients to sustain their support.

Request feedback from providers to improve training and education.

Coalition members will provide feedback to Marketing & Education Director regarding strategies for improvement.

Marketing and Education Director will prepare report for presentation at Coalition meetings quarterly.

Coalition members will participate in Marketing Committee.

Hospital Birthing Centers require education, support and ongoing technical assistance.

A dedicated position is needed to conduct activities associated with prenatal and infant screening.

Provide incentives to birthing centers for Healthy Start clients

Coordinate with each birthing center one time monthly at a minimum with training and tech assistance.

Provide birthing centers with a report that shows all infant screening rates.

Recruit and retain hospital administrators to Board/Coalition

Negotiate and execute contract with Healthy Communities for Marketing and Education.

Monitor contract and provide technical assistance as needed.

Marketing and Education subcontractor will meet regularly with Healthy Start supervisors

The subcontracted Marketing & Education Director will convene a Marketing Committee to support strategies related to increasing screening rates.


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REDUCE LBW/ VLBW

Staff Training is needed to translate information about PPOR into ROC

Increase access to enhanced services

Implement comprehensive Training Plan with all direct service workers

Monitor training plan compliance and integrate into policies and procedures, updates

Gain provider feedback to continuously improve training

COPE training so all workers can deliver SC,ICC, CBE and BFE

Monitor charts for enhanced services

Contract with Agape

Coordinate referrals to SMA, psychosocial services, Edinburgh scale

Improve service approach to high risk populations

Centralize services to improve access before, during, and after/in-between pregnancies

Coordinate with high risk environs - jail, shelter, etc.

Participate in MAMA Bear activities with providers

Implement Community Cafés for ongoing strengthening of families

Work with HMS and WFS to centralize intake, ensure ICC services

Continue to support midwives at FCHD

Link to WIC

Intervene to reduce smoking during pregnancy

Intervene to reduce neonatal abstinence syndrome

Ensure all direct service providers certified in smoking cessation

Implement identification and intervention at time of assessment

Conduct ongoing review of smoking data and smoking cessation intervention activities

Conduct specialized training to workers and caregivers

Participate in Task Force

Implement WIS position

Healthy Start programs and services are sponsored in part by:

The Healthy Start Coalition of Flagler and Volusia Counties, Inc. is a proud affiliate of:

109 Executive Circle Daytona Beach, FL 32114

386.252.4277

www.healthystartfv.org

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