ACKNOWLEDGMENTS
Development and implementation of a Healthy Start Coalition service delivery plan requires vision and commitment from many individuals and institutions within the community. In Sarasota County, the process has involved active participation of more than 30 organizations, many individual providers of health and human services, and numerous consumers of services from both private and public health service delivery systems. The officers, Executive Board, and staff of the Coalition are delighted to acknowledge all, whether or not named in these Acknowledgments, who have worked to achieve the successes of the past six years and are committed to the next three years of progress.
As this third 3-year service delivery plan is submitted by the Coalition, we are grateful for the members of the community who have opened their minds and hearts and meetings to us; for the enlightened leadership of the Sarasota County Board of Commissioners, whose financial support of the Sarasota County Health Department has made the mission of the Healthy Start Coalition easier to accomplish in this County; for those who provide services to Healthy Start clients, including Care Coordinators and providers of wraparound services; for our colleagues in the not-for-profit sector who have embraced the vision of the Healthy Start Coalition as vital to the health of the community; for volunteers who have given thousands of hours and shared lifetimes of experience to shape our work; for business leaders who have offered financial assistance and advice; and for the pregnant women and parents of Sarasota County who have had the wisdom to seek and accept help for the benefit of their children and the community as a whole.
In particular, the preparation of this plan has been influenced by the leadership and the participation of Jack Baker of Children First’s Families First Initiative, Chair of the Executive Board; Barbara Kockmit, MA, Chair of the Health Promotion & Education Committee; Holly Anderson, past Chair of the Executive Board; Marguerite Rappaport, MPH, epidemiologist with the Sarasota County Health Department; Edna Apostol, MPH, past Chair of the Executive Board and past Chair of the Planning & Evaluation Committee; Rebecca Clapp RN, the Planning & Evaluation Committee’s liaison with Healthy Start Care Coordinators; Ginna Downing, MSW, recent mother Electra Katra, and Washington Hill, MD, member of the FIMR Case Review Team and chair of the local OB section. The 2003-04 Executive Board members of the Coalition must also be acknowledged for their support and leadership: Leland Selvey; Gilda Dennis of ABC-7 WWSB TV; Shelley Rence, Healthy Start Program Manager at the Sarasota County Health Department; City of Sarasota Mayor Richard Martin; Charlene Chirillo, RN, ICCE, of Gulfcoast South Area Health Education Center, Lucile Mobley, MSW, of the Cyesis Teen Parent Program; Carol Selvey, and Florida State Senator Lisa Carlton. Mr. Orrie Paller, volunteer advisor from the Service Corps of Retired Executives [SCORE], has contributed his time and guidance in regular meetings with the Coalition’s Executive Director since 2000.
Louise Jones, Charlotte Curtis, RN, Marie Melton, RN, Laura Pan, and Carol Graham, Ph.D., of the Florida Department of Health, have offered technical assistance and support to the Coalition during the past three years of development. William L. Little, MPH, MBA, Administrator of the Sarasota County Health Department, has provided guidance for the integration of Coalition activities with the mission of the CHD. In particular, the Florida Department of Health’s Office of Planning, Evaluation & Data Analysis, under the leadership of Meade Grigg, should be acknowledged for development of the Florida CHARTS system, a web-based source of public health data which has improved the planning and evaluation activities of the Coalition through making the current data needed for preparation of this Service Delivery Plan both available and accessible.
Members of the Florida Association of Healthy Start Coalitions, a network of the state’s 31 Healthy Start Coalitions, individually and collectively, have contributed to the effectiveness of the Healthy Start Coalition of Sarasota County through regular contacts, sharing of best practices, and working together in many large and small ways.
The recent positive outcomes in maternal and infant health in Sarasota County would not have occurred without the dedication of many other local health and human services agencies and providers. The Coalition values its collaborative relationships with Sarasota Memorial Hospital, the Community Alliance of Sarasota County, Sarasota County Government, the Child Protection Center, local staff of the Florida Department of Children & Families, the Born to Read program of the county library system, Healthy Families Sarasota, and the Sarasota County YMCA.
Linda Wilson, Administrative Assistant at the Coalition offices, deserves special mention for her tireless and compassionate support of the volunteers and management of the Coalition. Since the submission of the Service Delivery Plan for 2002-04, two other staff members have contributed significantly to the successes of this Coalition. Jennifer Highland, RN, MPH, assumed duties as Contract/Quality Manager at the time of the implementation of the Healthy Start Medicaid Waiver in late 2001. Her conscientious work with sub-contractors ensured compliance of the Coalition’s activities with the requirements of the Medicaid Waiver. And Shelly Gardner, who joined the Coalition in 1999 as a Neighborhood Health Promoter, transitioned to the related role of Maternity Care Advisor, enabling the Coalition to roll out the local MomCare program in October 2001. The dedication of Jennifer and Shelly provided a strong foundation to the Coalition’s venture into the unknown territory of the Healthy Start Medicaid Waiver three years ago. And the outcomes of their efforts to date have been positive.
The financial support of local foundations and grants from various sources during the past three years is gratefully acknowledged: The Gulf Coast Community Foundation of Venice, the Community Foundation of Sarasota County, the March of Dimes, the Downtown Sarasota Kiwanis Club, HRSA of the US Department of Health and Human Services, Johnson & Johnson, and local businesses and individual donors have made contributions that enabled the work of the Coalition to go forward and the emerging needs of Healthy Start clients to be met.
ATTESTATION OF ADOPTION OF THIS SERVICE DELIVERY PLAN
1. I hereby attest that the Executive Board of the Healthy Start Coalition of Sarasota County, Inc., approved unanimously the 2005-2007 Service Delivery Plan on December 8, 2004, as reflected in the minutes of the meeting.
2. On December 16, 2004, the general membership of the Healthy Start Coalition of Sarasota County, Inc., by unanimous vote confirmed the approval of the Service Delivery Plan by the Executive Board.
___________________________
Sarah Gorman, MA
Executive Director
I acknowledge receipt of the 2005-2007 Service Delivery Plan dated December 16, 2004.
_______________________ __________________________
Jack E. Baker Date
Executive Board Chair
Healthy Start Coalition of Sarasota County, Inc.
TABLE OF CONTENTS
Page number
I. Acknowledgments iii
II. Attestations v
III. Introduction 1
IV. Description of Process Used to Update the Service Delivery Plan
V. Summary of Findings from the Updated Needs Assessment
VI. Major Health Indicators Selected for the New Planning Cycle
VII. Target Population or Area for Receipt of Special Emphasis
VII. Factors Contributing to the Health Status Indicators in the Target Population
VIII. Consumer and Provider Input
IX. Resource Inventory
X. Service Gaps
XI. Action Plan 2005 - 2007
XII. Internal Quality Improvement/Quality Assurance Plan
XIII. External Quality Improvement/Quality Assurance Plan
XIV. Process for Allocating Funds
XV. Quarterly Report Section
XI. Selected Bibliography
XII. Appendices
SERVICE DELIVERY PLAN 2005-2007
Healthy Start Coalition of Sarasota County, Inc.
Introduction
Sarasota County, Florida
The identity of Sarasota County as a place where retired persons of comfortable means dominate the social landscape has been replaced during the last two decades by a new, dynamic mix of ages and family structures. The County's population in 2003 was reported as 350,664. In 2003, 2,987 live births took place in Sarasota County, yielding a birth rate of 8.5 per 1,000 population. In 1998, the number of live births was 2,603, or a birth rate of 8.2. Changes in the ethnic mix of the population have occurred during the past 7 years. Eastern European immigrants have swelled the population in the southern part of the county, and a number of residents speak only Russian, Ukrainian, or Polish. An increase in Sarasota's number of Hispanic residents from many nations has been observed in recent years. The percentage of increase from 1990 to 2000 in the County's Hispanic population was 140.43%, and the number of births to Hispanic mothers almost tripled from 1995 to 2003, when 416 births to Hispanic mothers were counted. Census data from 2000 indicate that at least 4.3% of the County population is now of Hispanic origin, or approximately at parity with the African-American population. In 2000, the County was home to 4,149 Hispanic or Latino residents under the age of 18.
The northern part of the County is older, more developed, more densely populated, the location of the County seat, and home to the majority of the County's black residents. The southern part of the County, including the communities of Osprey, Nokomis, Venice, North Port and part of Englewood, has more underdeveloped land, more lower-cost single-family housing, and many young families as well as refugees resettling from Eastern Europe. The community of North Port is home to the fastest-growing population in the county: the University of Florida Bureau of Economic and Business Research reported a 37.5% increase in the North Port population between 2000 and 2003, compared to just a 7% increase in Sarasota County.
The private hospitals in Venice and Sarasota do not offer a labor and delivery service. Residents in the southern part of the County often deliver in Port Charlotte, one county to the south. More than 85% of all births occur at Sarasota Memorial Hospital, the County's public hospital, with about 15% delivering elsewhere. In late 2004, a new option for labor and delivery services opened, Lakewood Ranch Medical Center, in southern Manatee County.
Healthy Start Coalition of Sarasota County
The Healthy Start Coalition of Sarasota County, Inc., incorporated in 1997 and initially funded in July 1998 by the Florida Department of Health, is one of 31 Healthy Start Coalitions in the State. As the beneficiary of Sarasota County’s favorable demographic factors in a community where health and human services receive significant local support, the Coalition has been able to establish a presence locally after 6 years of funded activities. For example, after the infant mortality rate rose during 2000, the Coalition cooperated with the County Health Department in raising awareness about preventable causes of fetal and infant mortality. The Coalition has been involved for the past three years in making recommendations concerning target outcomes for child health indicators for Sarasota County's policy framework on health and human services goals.
State and local elected officials have lent their support to the Coalition by becoming members of the Executive Board. In June 2001, County Commissioner Paul H. Mercier, State Representative Donna Clarke, and Sarasota City Commissioner Carolyn Mason were elected to the Board. Representative Donna Clarke served on the Executive Board from 2001-2003; City of Sarasota Mayor Richard Martin served from 2002-2004; and State Senator Lisa Carlton, elected in 2003, has just begun a second year of service. In September 2004, Venice City Commissioner Vicki Taylor was elected to the Board.
As of November, 2004, Coalition membership consists of 42 voting members, 4 at-large members and 8 non-voting members. Membership is dynamic, reflecting the changing landscape of health and human services in the community. All members are encouraged to participate in Coalition meetings and serve on standing committees. Twenty-three agencies are represented and 17 private citizens are members. Coalition membership represents substantial commitment by organizations, individual providers and consumers to maternal and infant care in Sarasota County. All members are volunteers who give their time and energies to improving the public education and targeted services available to reduce infant mortality and morbidity in Sarasota County. Additional volunteers participate as FIMR case review team members and advisors to the Executive Board and staff.
A list of Coalition members and the organizations they represent is included as Appendix 1 of this Plan. An Executive Board, consisting of elected officers, at-large members, and chairs of standing committees sets policy for the Coalition. A list of Board members is included as Appendix 2. The organization's By-laws are attached as Appendix 3.
The Coalition membership and other community volunteers have been heavily involved in the development of this Plan. They have participated on committees carrying out needs assessment activities and in the decision-making process regarding providers of Healthy Start services. They have participated in work groups to develop the plan, and they have provided the extensive in-kind time and service contributions needed to achieve the Coalition's mission.
Partners in Needs Assessment and Plan Development
This Plan is based on data obtained from the activities of Coalition members through its committee structure; Florida CHARTS, Office of Vital Statistics data, the USF College of Public Health, the Gulfcoast South Area Health Education Center, and Sarasota County Health Department epidemiology resources. Accessibility of current public health data and Healthy Start-specific data through Florida CHARTS has made the planning process significantly more streamlined and more attainable with limited staff resources than in the Coalition's original planning cycle, which was completed in 1998.
The charge of the Coalition to protect and promote the health and wellbeing of pregnant women and children through age three by ensuring accessibility of health care and social programs to meet the health requirements of this population has become more vital for Sarasota County than ever before. The local, regional and state partnership that has matured the Healthy Start initiative in Florida, including the implementation of the Healthy Start Medicaid Waiver in mid-2001, has enabled the local Coalition to strengthen its commitment to serve this special population.
The guidance and resource sharing of the other Healthy Start Coalitions in Florida and the staff of the Florida Department of Health have been a sustaining support to the Coalition in the preparation of this plan.
Major Accomplishments of the last Three Years:
With the leadership of a talented corps of volunteers, since 2001 the Coalition has
· Completed 3 annual RFP processes and managed on average 16 sub-contracts per year with providers of wraparound services
· Sustained a FIMR project, which to date has completed more than 165 case reviews
· Raised private funds to purchase emergency transportation, food bank supplies, and provide respite child care for Healthy Start client families
· Filled a gap in administrative support by contracting with the School Board of Sarasota County for the past 5 years to administer funds for the benefit of Cyesis, the local school for teen parents
· Issued annual reports to the community each year, highlighting Coalition priorities and accomplishments and citing trend data for infant mortality
· Instituted recognition of local contributors to the Healthy Start mission and presented these awards at each annual meeting since 2000
· Made dozens of visits to local OB and midwife offices, providing training on the Healthy Start prenatal screen
· Successfully advocated with Sarasota Memorial Hospital to move its Healthy Start infant screening from the labor and delivery floor to the mother-baby unit, resulting in a 10% improvement in infant screening rates from 2003 to the first 8 months of 2004
· Given and received Letters of Agreement or support or contracts with the following community agencies and organizations
Healthy Families Sarasota
Whole Child Sarasota Initiative
City of Sarasota Neighborhood Office
Children First
Sarasota County Library Systems
Sarasota County School Board
School Readiness Coalition
Early Steps
Children's Medical Services
· Continued to support the local Library System in implementation of Born to Read, which brought $64,000 to the community in 2003-2005
· Supported through staff participation the work of the local School Readiness Coalition, the Human Services Advisory Council, Sarasota Coalition on Substance Abuse, the Obesity Prevention Coalition, SOAR (Sarasota Openly Addresses Racism), and the Community Alliance of Sarasota County, in order to address underlying causes of poor birth outcomes and limitations on child development
· Secured funding to continue weekly support groups for pregnant women and new mothers not aligned with other human services programs, based in North Port (Values in Parenting, or VIP)
· Coordinated a collaborative training event in October 2002, attended by more than 100 local
providers, on “Perinatal Substance Abuse Intervention”
· Secured funding to hold a “Make Yours a Fresh Start Family” training, including a train-the-trainer component, in late 2004
· In fall 2003, raised $14,000 in local and private funding to initiate the first ever dedicated post partum depression services in Sarasota County (in cooperation with Bayside Behavioral Health Center), including both direct service and 2 professional education events yearly
· Sustained a campaign based on local FIMR data, "Protect Every Baby," incorporating a confidential answer-only telephone line with information on risks and protective factors for healthy pregnancy; a distinctive logo; and lapel pins, umbrellas, and certificates of appreciation imprinted with the logo and telephone number of the information line
DESCRIPTION OF PROCESS USED TO UPDATE THE SERVICE DELIVERY PLAN
NEEDS ASSESSMENT
In order to determine needs in the area of prenatal, infant and toddler health and wellbeing in Sarasota County, the Coalition undertook a multifaceted assessment process.
Interviews of Women
In July, 2003, the Coalition engaged an MSW student intern from the University of South Florida to interview 160 women in Sarasota County concerning their health status, needs for social support, and related issues. Of these, 101 women were women of childbearing age with children.
Community Focus Groups
Spring 2004
A consumer focus group and a health care provider focus group were held, with a focus on gathering information to help improve prenatal and infant screening rates statewide and locally. A total of 13 respondents participated.
Fall 2004
During September – November 2004, 10 focus groups were held throughout Sarasota County. Health Promotion & Education Committee members and community volunteers from neighborhood and faith-based organizations attended a training on focus group planning and implementation in August 2004. A total of 84 participants responded to questions about prenatal and child health. The Health Promotion & Education Committee analyzed focus group responses in October and November 2004. Transcriptions of the focus group discussions are attached to this Plan as Appendix 4, with a summary as Appendix 5; and a demographic summary of the participants in the focus groups is attached as Appendix 6. A copy of the focus group facilitator guidebook is attached as Appendix 7.
The Provider and Consumer Focus Groups included questions about missing resources and service gaps. The responses from these groups were tabulated by staff and volunteers.
Needs Surveys
During October and November 2004, current wraparound services providers, Healthy Start Care Coordinators, Coalition members, community experts, and health care providers were asked to complete a needs survey available on the Coalition’s Web site. A copy of the survey form and the aggregate results, sorted by respondent group, are attached to this Plan as Appendix 8.
Surveys of Coalition Membership
Beginning in January 2004, Coalition members were asked to complete a satisfaction survey concerning the value of their attendance at monthly meetings. Results of the surveys completed since that date are attached to this Plan as Appendix 9.
Florida CHARTS
Public health data became increasingly available to the Coalition during the period 2001-2004; and now the data that can be viewed online is an ongoing and valuable source of current planning information.
FIMR Case Reviews
The FIMR project in Sarasota County has reviewed more than 170 cases since its inception in January 1998. This project has focused on racial disparities in healthy birth outcomes and has been able to attract community volunteers not otherwise involved in the Coalition.
Technical Assistance from CHD Epidemiology
Staff from the Sarasota County Health Department have provided an analysis of poor birth outcomes by ZIP code area, enabling the Coalition to prioritize geographical areas of the County for special interventions. Through this and other support in data finding, up-to-date information has been available to the FIMR process and the Coalition's planning process throughout the past three years.
Perinatal Periods of Risk Analysis
The latest PPOR data for Sarasota County is for 1998 -2000. These data indicate that the greatest potential impact for interventions would be in the area of Maternal Health & Prematurity and the area of Maternal Care. These areas translate into a focus on preconception health promotion and prenatal health care.
South Sarasota County CHIP
A Community Health Improvement Project (CHIP) was carried out by SCOPE, in cooperation with the Sarasota County Health Department, in the southern part of Sarasota County in 2002-2004. Copies of the findings were made available to the Healthy Start Coalition. The report focuses on adult health and in particular senior health, due to the population of retirees, but does include information on infant mortality, immunization, etc.
School Readiness Data
Information about the geographical areas with the lowest percentage of 5-year-olds considered “school ready” in 2003 and 2004 was made available to the Healthy Start Coalition. These align with the ZIP code areas in the county with the poorest birth outcomes.
SUMMARY OF FINDINGS FROM THE UPDATED NEEDS ASSESSMENT
LIST OF NEEDS
The needs emerging from the assessment process described above include the following, each of which appeared in more than one set of findings:
· Health insurance coverage for pregnant women and children
· Safe, affordable housing for working families
· Safe, affordable, quality child care for children 0 - 5
· Free and low-cost transportation to access health care and human services, at extended times and locations
· Targeted education for teens on planning ahead for parenting and family life; better education of middle school and high school students concerning the benefits of delaying pregnancy and avoiding repeat pregnancy
· More health and human services and resources available in Spanish
· Free or low-cost psychotropic medication management for Healthy Start clients
· Respite care for infants and toddlers on an ad hoc basis at a high quality child care location, to reduce Healthy Start client family stress
· Better acceptance of the prenatal and postnatal screening process by professionals and pregnant women.
· Improved well woman health prior to and during pregnancy, especially among the African-American population
· Better parent education and parent understanding of child development, for mothers and fathers
· Improved professional education about the Healthy Start initiative
· Better education of providers and women about breastfeeding and services to help women overcome obstacles to breastfeeding
· Better understanding by the public of the dangers to child health posed by prenatal smoking and smoke-filled environments for children
· Better teen-parent communications to facilitate early entry into prenatal care by teens
· Neighborhood-based educational peer support groups for pregnant women and new parents
· Financial or in-kind assistance to Healthy Start families for emergency food, bassinets for newborns, breastfeeding supplies, deposits for housing and utilities, and other needs
· Lower rates of teen births
· More mental health services, including postpartum depression services
· Dental services for women and children
· Non-residential drug treatment on demand for women of child-bearing age
· Capitalizing on "teachable moments" when women of childbearing age, pregnant women, and new parents are out in the community, not just at health and human service provider locations: placement of materials at drugstores, convenience stores, etc., and education of store employees to provide initial referral.
MAJOR HEALTH INDICATORS
The major health indicators selected for this planning cycle have been chosen to comply with contract requirements and to address locally identified needs. Like any health problems, those selected are subject to direct and indirect contributing factors. The Action Plan which follows includes activities which will impact on a variety of direct and indirect contributing factors. The health indicators selected for this 3-year plan are as follows:
Infant mortality
Infant mortality is considered a "sentinel indicator" of the health status of a population. Where infant mortality is higher than expected, it can be concluded that the fundamental health status of that population, and especially the health status of the women of childbearing age among that population, is in some way compromised.
There are now approximately 3,000 live births each year in Sarasota County. The infant mortality rate has been decreasing over the past decade, despite an unusually high total in 2000. In three of the past five years, the County has achieved an infant mortality rate of less than 5.0. With the present state of medical science, and based on international comparisons of infant mortality rates for 2000, a rate of about 4.0 could be considered the best rate now achievable. To the extent that the infant mortality rate rises above 4.0, it could be said, those infant deaths are preventable. The number and rate of infant deaths during the past three years are shown in the table below.
|
NUMBER AND RATE OF INFANT DEATHS Hispanic May Be Black or White – Totals Are Accurate |
||||||
|
2001 County State |
2002 County State |
2003 County State |
||||
|
White #/rate |
9/3.7 |
839/5.5 |
13/5.2 |
892/5.9 |
13/4.9 |
907/5.8 |
|
Black #/rate |
1/3.6 |
635/13.5 |
3/11.0 |
629/13.6 |
5/18.7 |
647/13.7 |
|
Hispanic #/rate |
5/14.2 |
254/5.1 |
3/8.44 |
234/8.0 |
2/4.8 |
273/5.0 |
|
Total #/rate |
10/3.6 |
1,495/7.3 |
16/5.6 |
1,548/7.5 |
18/6.0 |
1,584/7.5 |
Data Source: Florida Department of Health, Office of Vital Statistics and Office of Planning, Evaluation & Data Analysis
Low birth weight
Low birth weight is a birth weight of less than 2500 grams, or 5.5 pounds.
Measure: The low birth weight percentage represents the number of low birth weight births divided by the total number of live births. The number and percentage of low birth weight births during the past three years are shown in the table below.
|
NUMBER AND PERCENTAGE OF LOW BIRTH WEIGHT BIRTHS Hispanic May Be Black or White – Totals Are Accurate |
||||||
|
2001 County State |
2002 County State |
2003 County State |
||||
|
White #/% |
166/6.8 |
10,349/6.8 |
145/5.8 |
10,833/7.1 |
199/7.6 |
11,190/7.1 |
|
Black #/% |
30/10.9 |
5,889/12.5 |
37/13.6 |
5,889/12.8 |
39/14.6 |
6,203/13.2 |
|
Hispanic #/% |
21/5.9 |
3,226/6.5 |
18/4.8 |
3,504/6.8 |
33/7.9 |
3,795/6.9 |
|
Total #/% |
201/7.2 |
16,812/8.2 |
193/6.8 |
17,350/8.4 |
245/8.2 |
18,047/8.5 |
Data source: Florida Department of Health, Office of Vital Statistics and Office of Planning, Evaluation & Data Analysis
Low birth weight births are predictive of a wide range of poor developmental outcomes for children, including chronic health conditions, learning delays, social delays and death prior to the first birthday. Most low birth weight births and the correlated premature delivery are preventable through better education of women of childbearing age about health and lifestyle decisions prior to conception and during pregnancy. Reduction of maternal infection and prematurity is a primary means of improving the percentage of low birth weights.
The Coalition’s smoking cessation initiative described in the Action Plan below is one of two interventions designed to impact low birthweight rates during this planning cycle. The other, detailed as a Category C Activity, is the implementation of a network of support groups for women in the neighborhoods where they live. This support group network project is referred to below as a “A Pot of Beans.”
Early entry into prenatal care
Early prenatal care begins no later than the 14th week of gestation, i.e., during the first trimester of pregnancy.
Measure: The early prenatal care percentage represents the number of women who begin prenatal care during the first trimester of pregnancy divided by the total number of live births. The early prenatal care percentage has trended slightly upward during the past three years, as shown in the table below.
|
PERCENTAGE OF ALL MOTHERS WHO RECEIVED EARLY PRENATAL CARE Hispanic May Be Black or White – Totals Are Accurate |
||||||
|
2001 County State |
2002 County State |
2003 County State |
||||
|
White % |
89.6 |
87.0 |
89.0 |
87.8 |
90.6 |
88.2 |
|
Black % |
79.0 |
75.1 |
75.5 |
77.2 |
78.0 |
78.0 |
|
Hispanic % |
84.7 |
81.7 |
86.1 |
83.7 |
85.6 |
84.2 |
|
Total % |
88.4 |
84.1 |
87.8 |
85.4 |
89.3 |
85.8 |
Data source: Florida Department of Health, Office of Vital Statistics and Office of Planning, Evaluation & Data Analysis
Early entry into prenatal care leads to improved birth outcomes. Most women who begin prenatal care early will obtain regular, ongoing care for the duration of their pregnancy.
Early prenatal care for teens merits particular surveillance. This outcome is defined as prenatal care that begins no later than the first trimester of pregnancy for women under the age of 19.
Measure: The early prenatal care for teens percentage represents the number of pregnant women under the age of 19 who begin prenatal care during the first trimester of pregnancy divided by the total number of live births to all women under the age of 19.
The number of births to teens younger than 19 in Sarasota County has decreased every year 2000 – 2003. Over the same time, the number of births to this age group has decreased statewide and nationally. Nevertheless, teens remain at higher risk for poor birth outcomes as a result of late entry into prenatal care. Access to prenatal care among teenagers is lower than for the group of all pregnant women, since teens may not have access to the information, financial resources, and/or social support needed to ensure their early entry into prenatal care. The table below shows the early prenatal care percentage for teens during the past three years, as well as the total number of births to this age group.
|
PERCENTAGE AND NUMBERS OF MOTHERS <19 WHO RECEIVED EARLY PRENATAL CARE |
|||
|
2001 |
2002 |
2003 |
|
|
County |
76%
133/175
|
68%
110/162 |
75%
119/159 |
|
State |
65%
10,088/15,411
|
67%
9,698/14,430 |
69%
9,695/14,103
|
Data source: Florida Department of Health, Office of Planning, Evaluation & Data Analysis
Early entry into prenatal care brings the teen mother into contact with a range of services, including Healthy Start, home visits, Cyesis school for teen parents, Healthy Families, counseling, childbirth education and parenting education, all of which can help her reduce or eliminate risk factors to healthy birth outcomes and the optimal growth and development of her child.
Breastfeeding rates and duration
The documented benefits of breastfeeding on bonding and attachment, infant health, and brain development make a compelling case for including the goal of increasing breastfeeding rates and duration in the Coalition's 3-year plan.
In fall 2002, the Coalition carried out a breastfeeding prevalence survey with the cooperation of 9 pediatric office sites throughout Sarasota County. Forty-seven surveys were completed. In fall 2004, the survey was repeated, this time with 16 pediatric office sites and 24 individual pediatricians participating, and 156 surveys completed. In 2003, the Coalition devoted resources to providing office-based training in lactation management and support to over 100 staff at local prenatal care and pediatric health care provider locations. The training of peer counselors who are culturally matched with the mothers seeking assistance, and the establishment of community-based breastfeeding support groups, are two interventions that will be implemented during 2005-2007.
Racial disparities in healthy birth outcomes
These disparities are evident in the tables shown above. The Coalition's FIMR project, in particular, has selected the reduction of racial disparities as a priority. The relocation of Coalition offices to the ZIP code with the County's poorest birth outcomes is a testimony to its commitment to bringing health indicators among the black community to within 20% of the rates for the population as a whole. In recent years, fetal mortality rates have been as much as 4 times greater in the black community than in the total population. Outreach to the black community at health conferences, and through collaborations with local streetfront agencies and churches, as well as the development of more culturally appropriate materials and marketing strategies, will be continued. When the “Pot of Beans” project is fully implemented, three of the neighborhood-based support groups for women will be located in primarily African-American neighborhoods.
Teen Births
Many members of the general public have the impression that a typical Healthy Start client is a teen; indeed, that all high-risk pregnancies result from teen pregnancies. In fact, the incidence of infant mortality in Sarasota County is not highly correlated with the age of the mother being less than 18. Coalition staff and volunteers are continually educating the community that the tendency to associate teen pregnancy with all poor birth outcomes is not based on fact. Although a number of Needs Survey respondents identified teen pregnancy as one of the top 3 problems in the community, because of the relatively low rate of teen births locally the Coalition has not made the reduction of the teen pregnancy rate a priority.
However, the Coalition does have a set of priorities in responding to the fact of teen pregnancies. The Coalition is concerned primarily with (1) preventing repeat births to teens, (2) ensuring that pregnant teens receive adequate prenatal care and services to meet their educational and mental health needs, and (3) preventing births to 10-14-year-olds. Members of the Coalition are concerned that local and national data suggest that 2/3 of all pregnant teens have been subjected to sexual abuse at some time in their life prior to conception; and parenting education curricula funded with Coalition resources will include information on educating their children about sexual abuse. Sarasota County government has included in its health and human services policy framework the goal of reducing the teen pregnancy rate; and the Coalition will cooperate with the County in efforts to improve the health of all pregnant teens and their children.
Coalition capacity-building
Because of the ambitious and in some cases long-term objectives of the Coalition, it will be necessary for the organization to focus on making itself ever more competent. It is in the interest of the Coalition to seek some third party review and validation of its operations and policies, in order to provide taxpayers, legislators, other funders, and consumers with objective information about the value of what the Coalition has produced using the resources made available to it by public and private sources. When the Council on Accreditation has a process available for community groups, HSCSC along with other members of the Florida Association of Healthy Start Coalitions, will seek accreditation.
In 2005, the Executive Board of the Coalition will seek to participate in Phase Two of “Building Better Boards,” an initiative of the Gulf Coast Community Foundation of Venice which provides development resources to nonprofit boards.
Conclusions Regarding the Most Compelling Needs
The most compelling needs identified, based on the data reviewed and the state contract requirements in place, are (1) to improve infant mortality rates, (2) to reduce low birth weight percentages, (3) to increase early entry into prenatal care and reduce late/no entry into prenatal care, (4) to make available services that will improve preconception health, and (5) to reduce racial disparities in healthy birth outcomes.
The risk factors that contribute to poor birth outcomes and poor child development outcomes are rarely present in isolation: the stress of poverty, self-medication with tobacco, alcohol and drugs, the threat of family violence, and the neglect of well woman health care, for example, may well be found together. The impact that Coalition activities can have on any single risk factor, such as maternal smoking, has been shown to put in motion a series of positive changes in the lives of a Healthy Start family.
Economic and educational services provided to members of racial and ethnic minorities will help to reduce risk factors for poor birth outcomes through empowering the prospective mother. The Coalition will use its influence and resources to continue to promote Born to Read, the Whole Child Project, and other initiatives that offer help to parents who want to help themselves. Research throughout the world has demonstrated that when the mother's level of education rises, the environment provided for the care and development of her children improves.
TARGET POPULATION
All women and infants who qualify as determined by prenatal and postnatal screening data, and referral for reasons other than score by local practitioners or the client herself, are eligible for Healthy Start services. Since resources are limited, target populations within this entitlement population have been determined as residents of those ZIP codes wherein the poorest pregnant outcomes are experienced. These neighborhoods include a large African-American neighborhood north of the downtown area of Sarasota; other, racially mixed areas in the city of Sarasota; and neighborhoods in the south part of the County.
The target population resides in the following ZIP codes: 34234, 34232, 34231, 34237, 34287, and 34293. These locations have not changed since 1998. However, one new ZIP code has been added: 34236, which includes downtown Sarasota, is an area that has recently received new immigrant residents and is the address of record for most of Sarasota’s homeless population. See Appendix 10 for data and map.
The racial and ethnic disparities in health outcomes which have been identified by this Coalition's needs assessment are not unique to Sarasota County. The elimination of racial and ethnic disparities in infant mortality rates is one of the goals of the national Initiative on Race, and has been named by the United States Department of Health and Human Services as one of six health status objectives by the year 2010. The black population locally has for years suffered an unacceptable rate of fetal deaths compared to the population as a whole, as well as infant mortality and low birth weight. In 2004, so far there have been 5 infant deaths reported. Although this is good news, HSCSC recognizes the need to continue surveillance of this population and remain responsive to emerging needs.
Areas in which the Coalition will intervene in order to reduce disparities include infant mortality, fetal mortality, low birth weight, and breastfeeding rates and duration.
FACTORS CONTRIBUTING TO THE HEALTH STATUS INDICATORS IN THE TARGET POPULATION
These factors have been identified through a needs survey, a FIMR project which has reviewed over 170 cases since 1998, and ongoing civic engagement on the part of Coalition staff, members and Executive Board.
Poverty, lack of access to health insurance, language barriers, cultural barriers, lack of culturally competent providers, lack of affordable housing, social isolation, lack of transportation to health appointments, poor nutrition, lack of health literacy, poor nutrition education, use of tobacco, drugs and alcohol, untreated infection, lack of well woman health care, domestic violence, sexual abuse, lack of education and job skills, lack of parenting education, sedentary life style, lack of access to affordable prenatal care, lack of access to behavioral health services, cultural norms that devalue health lifestyle choices, lack of knowledge about depression and services to treat post partum depression, untreated diabetes, obesity among children and pregnant women and misconceptions about health practices all contribute to the health status indicators identified above.
The initiation of interconception counseling within the Healthy Start model is one of the most potentially effective interventions to address the factors listed. In addition, the local initiative to provide neighborhood-based support groups for women (“A Pot of Beans” project) will extend the reach of critical information even further into the target population. Through improved service coordination, health promotion and education, and unremitting advocacy for health care access, the Healthy Start Coalition can contribute directly to mitigating the negative impact of the factors that contribute locally to undesired outcomes in maternal and child health.
CONSUMER AND PROVIDER INPUT
Eleven consumer focus groups, one provider focus group, and an on-line needs survey completed by a total of 69 respondents which included providers, community experts, and consumers have brought consumer and provider input to the development of this plan. Transcripts of the focus groups are attached as Appendix 4. A tally of the needs survey responses is attached as Appendix 8. In addition, one provider and one consumer of Healthy Start services served on the work group which developed the Action Plan. The input of these sources of information is included in the “Summary of Findings” above.
RESOURCE INVENTORY
Sarasota County is fortunate in the wealth of services available to meet many health and human services needs. Most Healthy Start clients and potential clients are able to benefit from a wide variety of services, including emergency food supplies, prenatal health care, financial assistance for medical prescriptions, supply of infant layettes, and many other forms of assistance. Sarasota County government provides revenue which the County Health Department allocates to its Healthy Start program. As a result, Healthy Start funding in this community is able to cover gaps in behavioral health services, bilingual services, and other psychosocial needs of expectant mothers, infants, and toddlers.
Several local groups have prepared health and human services inventories for Sarasota County. The Bilingual Directory of Helping Resources for Residents of Sarasota County, produced by the local Hispanic Latino Coalition, now in its 3rd printing, provides information in a pocket format. During 2004, First Call for Help, a United Way initiative that provides information and referral to callers, changed to Manasota 211. Manasota 211 is a bi-county (Manatee and Sarasota Counties) effort of the United Ways in those communities to provide a non-emergency information and referral telephone line that will direct callers to health and human services resources. Manasota 211 is able to provide current and accurate information through its capacity to accept continual updates from provider organizations. The 211 line had its debut during the 2004 hurricane season in southwest Florida, and 211 managers reported that the new service doubled the call volume formerly handled by First Call for Help. Another resource inventory, for the southern part of Sarasota County, has been compiled by the Laurel-Osprey-Venice-Nokomis Community Health Action Team, an initiative of the Community Health Improvement Project (CHIP) inaugurated in 2002 by the organization Sarasota County Openly Plans for Excellence (SCOPE) in collaboration with the Sarasota County Health Department.
Some of the highlights of the health and human services landscape in Sarasota County, with special application to Healthy Start clients and potential clients, are as follows:
Families First Initiative. Formerly the Nurturing Dads Initiative (NDI), a 4-year, half-million dollar initiative of the Community Foundation of Sarasota County in cooperation with Children First (the local Head Start provider). This project offers classes, support groups, culturally competent instruction, and multi-language materials directed to fathers. Recent funding opportunities have led to the expansion of the NDI to focus on both parents, with an emphasis on fostering the marriage or couples relationship to improve parenting.
First Step. Local detox and addictions counseling program with residential and outpatient services. In late 2004, First Step received a SAMHSA grant for a Transitional Living Center that has expanded its residential program for substance-abusing pregnant women and new mothers to a total of 2 years of service. While in the extended residential program, women receive counseling, family financial planning assistance, job placement assistance, high quality child care, and educational opportunities.
The Florida Center for Child and Family Development. This agency represents a recent merger between 2 providers of mental health and child development services. As a result, all members of a family may be served by the same provider and more outreach sites are available county-side for these crucial services. This agency is the local Healthy Families provider.
Forty Carrots Preschool and Parenting Center. This local resource for parents raises funds every year enabling them to provide parenting education classes and events without charge to participants. In past years, the Healthy Start Coalition subcontracted with Forty Carrots for parenting classes, but the current arrangement enables clients to receive high-quality parenting education without use of Healthy Start dollars. Management of Forty Carrots participates in Healthy Start Coalition activities and keeps the needs of Healthy Start clients in mind when designing new programs.
Obesity Prevention Coalition. This grass-roots organization, still in its early stage of development, brings together local professionals in health, education, and county government to share best practices and to create community-wide programs to foster better nutrition and more activity among residents of Sarasota County. In December 2004, local breastfeeding advocates, including an HSCSC staff member, presented a program on “Breastfeeding as Primary Prevention of Obesity.” The nutrition of pregnant and pre-conception women as well as infant and child nutrition will be addressed in future activities of this new coalition.
Sarasota County Health Department Mothers’ Care Center. At these facilities (one in Sarasota and one south of Venice), women receive prenatal health care. Medicaid is accepted and women with no health insurance can make arrangements for time payments on a sliding scale. As a result of the County Health Department commitment to prenatal health care, the HSCSC has been able to direct its Healthy Start resources primarily to improved psychosocial functioning of Healthy Start clients.
All Faiths Food Bank. Through this local food bank, the only one between Tampa and Fort Myers, Healthy Start Care Coordinators are able to obtain emergency food and other supplies for their clients. HSCSC pays a token amount of about 14 cents on the dollar to the food bank each month for these supplies. Healthy Start clients can also obtain food bank supplies directly, through other distribution facilities, such as those at the Salvation Army, local churches, and homeless services.
Salvation Army FAITH Program. Inaugurated in 2004, this is a residential program for families, in which parents who agree to meet certain objectives (working, taking classes in parenting and budgeting, keeping their home clean, and other goals) receive housing for up to two years. The program has benefited some Healthy Start clients, although the waiting list is long. Affordable housing is a topic currently receiving a high level of attention in Sarasota County, and some progress is being made in addressing the shortage of housing for workers in the service and tourism sectors on which the desirable lifestyle of most Sarasotans is based.
Teen Health Clinic. In late October 2004 an outreach clinic directed to the needs of African-American teens opened at Truvine Baptist Church in the Newtown community. The clinic, opened 2 evenings a week, is staffed by the Sarasota County Health Department and Planned Parenthood. Screening, wellness discussions, and referral services are free and parents are welcome to attend with their child. The clinic will offers information on contraception, diabetes prevention, STD treatment, obesity prevention, health issues and wellness.
Hispanic-Latino Coalition. This organization provides essential advocacy, information, and support services to meet the needs of the growing population of Hispanic residents in Sarasota County. Healthy Start clients are increasingly Hispanic, mostly non-English speaking, and over the past six years the need for bilingual and culturally competent services to these clients has increased threefold. The Hispanic-Latino Coalition advocates with health and human services professionals to adapt their service delivery models and staff recruitment efforts to better serve the growing Hispanic population.
Cyesis Teen Parent Program. The Sarasota County School Board maintains a stand-alone high school for teen parents. Not only academic opportunities, but many essential health and human services are provided to the students, including a high quality child care center where the teen parents can observe and receive training in essential parenting skills. Although the teen birth rate has been decreasing locally, as has been the case in the state and nation, there are still over 150 births a year to girls younger than 19, most of whom are not high school graduates. At Cyesis, many students receive a better education than they would have in a traditional high school, because the curriculum addresses all their needs. A Healthy Start Care Coordinator is assigned to this school and meets regularly with all the teen mothers. Each one is enrolled in Healthy Start.
Community Alliance of Sarasota County. This organization convened in 2001. CEOs of most of the health and human service providers in the county are members. Through its legislative agenda, the Community Alliance has lent its support to a number of issues important to the Healthy Start program in Florida, including health insurance for infants and children, Medicaid for pregnant women, a pilot program for Fetal Alcohol Syndrome study and treatment, financial assistance with car insurance premiums for foster parents, and an improved system of care for behavioral health.
Sarasota Board of County Commissioners: County Grants-in-Aid. Through the grants-in-aid process, local service providers receive about $8 million each year from county funds. These allocations are made in accordance with the county’s health and human services policy framework (copy attached as Appendix 11), and by a prioritization of service areas. In 2004, the priority area was Building Strong Children, Youth, Adults and Families. Many of the organizations receiving grants-in-aid provide services to Healthy Start clients and potential clients, including parenting education, addiction services, food supplies, child care, and child abuse prevention, at no direct cost to the Healthy Start system.
Community Foundation Leadership and Financial Assistance. There are three community foundations in Sarasota County. The Gulf Coast Community Foundation of Venice (GCCFV) and the Community Foundation of Sarasota County have each funded various programs of HSCSC during the past seven years. The Selby Foundation is another potential source of funding for innovative programs. In 2004, GCCFV initiated 2 programs that will improve the environment within which HSCSC operates. Their focus on development of social capital and their Building Better Boards initiative attempt to raise the quality of life and to improve non-profits’ infrastructure county-wide. Funded by GCCFV, HSCSC’s Executive Board members and Executive Director participated in a self-assessment in Fall 2004 which produced an evaluation of the organization’s stage of development and opportunities for growth. GCCFV has recently (post-2004 hurricane season) taken the lead in producing a comprehensive set of recommendations concerning gaps in disaster preparedness by non-profits in a 5-county region. In 2003, the Community Foundation of Sarasota County funded a pilot local project of HSCSC in collaboration with the Bayside Center for Behavioral Health at Sarasota Memorial Hospital, to provide services and professional education in post partum depression. Over the years,these foundations have enabled HSCSC to meet emerging needs and to provide Healthy Start clients with essential and timely services.
Whole Child Project. This collaboration between the United Way Success by 6 program and the School Readiness Coalition of Sarasota County, begun in 2004, fosters the concept that the years from 0 – 5 are crucial and that the community should come together to be of greater support to parents of children during these years, and should value the children themselves. The Whole Child Project will receive technical assistance (but no funding) from the Lawton Chiles Foundation and will seek to leverage business and local government resources to make the system of care for young children more comprehensive.
SPARCC. Services for victims of domestic abuse, including a shelter where mothers and children can stay. Some Healthy Start clients require these services.
Lakewood Ranch Medical Center. This facility, opened in Fall 2004, will provide obstetrical, prenatal education, and childbirth services. Just north of the Sarasota County line in Manatee County, the center will provide some Sarasota County residents with labor and delivery services.
Sarasota Memorial Health Care System. About 85% of births to Sarasota County residents each year take place at this public hospital. It also offers a full suite of childbirth education classes, parenting education classes, and lactation support. In January 2004 the hospital removed Healthy Start infant risk screening from its labor and delivery to its postpartum floor, resulting in an increase of screening rates from 59% to 78% over an 8-month period.
North County Medical Clinic. This collaboration between Manatee Rural Health Services (a Community Health Center) and Sarasota Memorial Hospital delivers health services, including health care for the uninsured, on the campus of Emma E. Booker Elementary School, a full service school in a primarily black neighborhood. The Clinic opened in 2003.
Genesis Health Services. This clinic relies on all volunteer practitioners to provide health care, behavioral health services, and dental care to the uninsured. It is located in north Sarasota, near a primarily black neighborhood but accessible to all residents. Women of childbearing age are among its clients, although it does not offer prenatal health care nor does it emphasize well woman health care.
Sarasota Coalition on Substance Abuse. This coalition targets the high levels of drug and alcohol abuse in Sarasota County with public education and awareness activities, and pro-active offering of events that are family-oriented and drug-free. Slowly, this organization is helping to shift a local culture of tolerance for high rates of alcohol consumption and it may yet have an impact on levels of illegal drug use.
Gulfcoast South Area Health Education Center. HSCSC’s efforts in professional medical education have been enhanced by collaborations with this AHEC, permitting us to offer CEUs and CMEs for activities such as lactation management and smoking cessation training.
Born to Read. This initiative of the local county library system began in 1999 as a collaboration with HSCSC. It has now grown to include most providers of services to pregnant women, infants and toddlers in the community, and the libraries have been able to sustain funding for the project for the past 5 years. Pre-literacy information for parents, library membership, and board books and puppets for babies are provided to Healthy Start clients through Born to Read.
School Readiness Coalition of Sarasota County. This organization helps HSCSC distribute information to all providers of child care in Sarasota County. They have helped the HSCSC recruit providers of respite child care for Healthy Start clients.
Sarasota United for Responsibility and Equity (SURE). This organization helps HSCSC distribute information to over 20 congregations and faith-based organizations in Sarasota County. They promote our Mother’s Day Virtual Prayer Vigil for Healthy Babies each year.
CHIP/CHAT Project. In 2002, a CHIP (Community Health Improvement Project) was instituted by SCOPE [Sarasota County Openly Plans for Excellence], the Sarasota County Health Department and local hospitals, with funding from the Gulf Coast Community Foundation of Venice. The focus was on South Sarasota County. In Fall 2004, the project presented its findings. Its health system assessment, community survey results, and data analyses have all been consulted to enhance the Healthy Start Coalition’s needs assessment process. The local CHATs (Community Health Action Teams) in 3 south County communities remain active and, despite a focus on services for elders due to area demographics, can also be engaged to address maternal and child health issues in the future.
NEW RESOURCES
The identification of current resources through the survey of providers and Healthy Start clients indicates that some positive changes have occurred since the last 3-year plan was developed. In particular, the ability of the Coalition to raise funds for client transportation needs has reduced the stress on the system imposed by limited public transportation services.
One group of new resources since 2001 is the large number of health and human service providers who have opened sites in the southern part of the County. In addition to the South County Family Health Center which opened in 2000, the North Port Health and Family Service Center opened in October 2004, providing new service locations for the County Health Department and a number of human services providers. This location makes crucial services more accessible to the many young families residing in the fastest-growing community in Sarasota County. HSCSC’s MomCare program has a presence in this North Port location and holds weekly educational support groups for pregnant women and new mothers there.
Success by 6, a program of the United Way, was initiated locally in 1998. The Sarasota County initiative has established two priorities: improved parenting education and a child care quality initiative. Success by 6 has been successful in attracting business partners to focus on the wellbeing of children 0