2010-2015 Service Delivery Plan

2010-2015
Service Delivery Plan

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INTRODUCTION
The Last Five Years 4
Planning the Next Five Years 6
HISTORY AND DESCRIPTION OF THE HEALTHY START COALITION OF

SARASOTA COUNTY, INC.
History of Florida’s Healthy Start Program 9
Development of Sarasota County’s Healthy Start Coalition 9
The Executive Board 10
Coalition Administration 12
Coalition Staff 12
Current Organization Chart 13
Committees 14
Coalition Membership 15
Programs 15
Events 18
Fundraising 18
Education Programs 19
Studies and Surveys 19
Annual Awards 20
Our Many Partners 22
Our Volunteers 23
SERVICE DELIVERY PLANNING SUMMARY

The APEXPH Community Process 24
The Committee 24
Data Collection Summary 25
Needs Assessment Summary and Identified Priorities 26
Resource Inventory Summary 28
The Action Plan Summary 29
Quality Monitoring and Performance Improvement Summary 30
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Comparison Between Previous and New Service Delivery Plans 31
DATA COLLECTION FOR THE 2010-2015 SERVICE DELIVERY PLAN

Data Collection 32
Sarasota County Description 32
Demographic Data Comparisons for 2005 and 2010 33
Other Demographic Data, 2008 34
Health Risk Factors for the General Population 34
Vital Statistics 35
Maternal Child Health Analysis 39
Healthy Start Prenatal Screen Data for Sarasota County for 2009 53
Healthy Start Services Data for Sarasota County 2005-2010 56
Other Data for Sarasota County 58
Zip Code Information 58
Breastfeeding Survey 60
Other Surveys 75
RESOURCE INVENTORY
Resource Inventory 80
Prenatal Care Providers 81
Birthing Facilities 82
Pediatric Care Providers 83
Providers and Partners 84
ANNUAL ACTION PLAN FOR 2010-2015

The Five Year Action Plan 88
Category B Activities – Activity 1 – Prematurity Prevention 89
Category B Activities – Activity 2 – Smoking Cessation 97
Category B Activities – Activity 3 – Reduce Substance Abuse 104
Category B Activities – Activity 4 – Reduce Obesity 110
Category B Activities – Activity 5 – Reduce Maternal Infections 116
Category B Activities – Activity 6 – Pregnancy Planning 122
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Category B Activities – Activity 7 – Reduce Elective C-Sections 129

Category B Activities – Activity 8 – Increase Breastfeeding 134
Category C Activities – Activity 1 – Reduce Health Disparities 142
ACTIVITY TIMELINES 149
QUALITY MANAGEMENT AND PROGRAM IMPROVEMENT PLAN

Internal Quality Management/Program Improvement 158
External Quality Management / Program Improvement 159
ALLOCATION PLAN AND FISCAL MONITORING

Allocation Plan for Healthy Start Funds 165
Fiscal Monitoring 154
APPENDIX
Dictionary 168
Bibliography 171
Fishbone Analysis 173
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INTRODUCTION
2010-2015 SERVICE DELIVERY PLAN
The Healthy Start Coalition of Sarasota County, Inc. is a 501(c)3 organization whose
mission is to improve the health and well-being of pregnant women, infants, and young
children in Sarasota County. We are celebrating our 12th birthday in 2010 and are looking
forward to our future. This Service Delivery Plan for 2010 – 2015 frames our priorities for
the next five years, and is based on the current health needs of our maternal and child
population.
The Last Five Years

The last five years at the Healthy Start Coalition of Sarasota County, Inc., have brought
exciting growth and troublesome challenges. The economic downturn, which was
especially serious in our area, affected many of our young families. We saw a downward
shift in the population of childbearing age women as their families moved out of the area
seeking work. The clients in our Healthy Start and MomCare Programs faced greater
challenges than usual and case managers saw a higher level of chaos in living situations.
The service providers within our system of care responded with increased oversight and
support for those having a difficult time. The enormous stress placed on pregnant
women during this time may be playing a role in the uptick of fetal and infant deaths we
experienced in 2009.
On the positive side, the accomplishments of the Coalition in the last five years increased
our capacity to respond to the needs of our clients, our maternal-child services providers,
and the families who reside in our county. In order to accomplish these endeavors, the
Coalition infrastructure was strengthened in several ways.
 We moved into a larger office at a discounted price, and opened the Pregnancy
Resource Center, a place for the public, health care providers and service
organizations to get printed information on a variety of topics spanning pre-
pregnancy through toddler age and local resources.
 The Save My Life Program was started to address the significant racial health
disparities among our African American population of women of childbearing age
and infants. The Program includes considerable outreach to locate those in need
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of assistance and regular classes and support in pre/interconception and

pregnancy health, childbirth preparation, and breastfeeding.
 We now have a Spanish-speaking childbirth educator and breastfeeding
counselor.
 Healthy Start has expanded the services provided to residents of the First Step
Mothers and Infants Program for substance abuse. We offer comprehensive Care
Coordination, psychosocial counseling, tobacco education and cessation,
breastfeeding education and support, and parenting, with an incentive program.
 The Contract Manager at the Healthy Start Coalition, who is responsible for the
subcontracts for Healthy Start services provision, increased work hours to 32 per
week with the added responsibility for Quality Management/Performance
Improvement for our state contracts.
 The Education Coordinator, who is responsible for provider and public education,
became a full-time employee. This improves our ability to train prenatal care
providers and birthing facilities on the Healthy Start Risk Screens; provide
prevention education to women of childbearing age through our peer trainers, the
Community Health Workers; participate in select health fairs, and offer small
workshops to maternal-child health and service professionals on the latest
maternal-child health research of significance to our county.
 The contracted position for fetal and infant death case abstraction in the FIMR
Program (Fetal and Infant Mortality Review) was expanded to that of FIMR
Coordinator to manage the meetings of the Case Review Team and the
Community Action and Education Group, and
assemble data reports.
 We added a part-time MomCare Supervisor
position to assure our county’s pregnant women
who have Medicaid insurance for prenatal care are
receiving all of the necessary information to engage
in care and locate resources that are needed. We
also now have a part-time Spanish speaking
MomCare Advisor.
 To help us develop a solid presence in the
community and to prepare our Board for a more
active fundraising role, we secured a grant from the Gulfcoast Community
Foundation of Venice for a full-time Communications and Development Specialist.
We have redesigned our logo, our website and our brochure, are producing e-
newsletters on at least a monthly basis, and have greatly enhanced the quality of
our printed images. The Coalition now has its own blog and twitter accounts. We
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are increasing the numbers of potential grant funders to whom we send letters of
inquiry and grant applications, building our donor data base, and organizing
fundraising events, most notably the “Evening with Healthy Start” at Sarasota
Architectural Salvage and the “Mozart Effect Concert” at Glenridge Performing
Arts Center.
 We created a Volunteer League, and have 18 active individuals since its inception.
Planning the Next Five Years

The Coalition will fulfill its mission with the help of our legislators, donors, the Florida
Department of Health, our Executive Board, staff, members, community partners, and
volunteers– all who play an important and rewarding role in assuring the health of
Sarasota County’s next generations. We do not take lightly the importance of our
mandate to bring all parties together into a cohesive group to meet the needs of our
pregnant women, new mothers and fathers, infants, children, and their families,
especially those at high risk for poor birth outcomes.
Over the last two decades measures taken to improve maternal

and infant morbidity and mortality were successful in lowering
death rates nationwide and locally. Now we face new challenges
– one of which is our state’s economic status. In 2010, the Healthy
Start Coalitions came frighteningly close to elimination by the
Florida Legislature. The Florida Association of Healthy Start
Coalitions took immediate action to summon advocates and
Boards of Directors from across the state to educate our
legislators on the vital roles we have in insuring prenatal care and
other services to pregnant women and infants in our state, and
how Coalitions across the state leveraged more than $32 million statewide to augment
state funding for our services. Our elimination would have also seriously affected
millions of dollars in Federal match funds, compounding the shortfall. The plan to
transfer Healthy Start services to county health departments was imprudent, considering
many county health departments don’t even offer prenatal care and were themselves
facing numerous budget cuts. How management of Healthy Start services could be
added to their responsibilities – in Florida, there were over 100,000 prenatal Healthy Start
clients alone—was unanswered.
In the United States, and Florida is no exception, increasingly unhealthy lifestyles are
impacting the health of future parents and their children. Economic and personal
stressors are greater than before, workloads have increased, more time is spent sitting in
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front of TVs and computers instead of being active, food marketing is fostering ill health
through intensive promotion of processed foods that have high levels of sugar and fats–
all of which impact an individual’s health and genetic changes. Recent research — known
as the life course perspective – is showing how health problems earlier in life actually
impact future pregnancies and fetal development. More women are entering pregnancies
with chronic medical conditions as a result of poor health or obesity, or have addictions to
tobacco, alcohol, prescription medications, or illegal drugs. Mothers find it more difficult
to breastfeed because of competing priorities, which can impact the life-long health of that
child. These issues seriously threaten all of the progress of the last 20 years in reducing
fetal death, prematurity, low birth weight, infant death, and maternal death.
We need you – each of you – to help us foster improved health and well-being for our
most precious little Sarasota County residents, their parents, and their families. The
Healthy Start Coalition of Sarasota County, Inc. is the only non-profit organization in
Sarasota County who assures our high-risk population of pregnant women, women
between pregnancies, and infants receive the care they need. We have a unique role
allowing us to educate the professional and lay community about the newest information
in having a healthy pregnancy and baby. Everyone has a role to play in our quest,
whether it’s sharing new information you’ve learned
with clients or your family members, taking an active
role in the community, recommitting to your working
relationship with the Coalition, becoming a member
of our Coalition, volunteering, or making a donation.
Our future—and our next generation’s future—
depends on it.
I hold in high esteem the Executive Board and Staff of the Healthy Start Coalition of
Sarasota County for their dedication and support to our mission. Their unwavering
enthusiasm and care for the young families in our county are the pillars on which this
organization is sustained.
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A special thank you to:
2010-2011 Executive Board
Shara Abrams, Chairperson

Monica Becket, Vice Chairperson
Carol Selvey, Secretary
Michael McIntosh, Treasurer
Jeff Cheng ~ Darlene Coleman ~ Catherine Cranor ~ Laura Gilkey ~ Mary Gillam ~
Mayor Kelly Kirshner ~ Carol Selvey
Honorary Members
Ed Chiles ~ Keith Fitzgerald ~ Dr. Washington Hill ~ Commissioner Carolyn Mason
Ex-Officio Members
Jenna Norwood ~ Shelley Rence
Staff and Program Coordinators
Jennifer Highland, MPH, RN, Executive Director

Janice Baxter, ACSW, Contract and Quality Manager
Ciera Galbraith, BS, Education and Development Coordinator
Anne Muir, BFA, MomCare Supervisor
Teri Endres, CDA, MomCare Advisor
Miryan McDonald, AS, Administrative Assistant and MomCare Advisor
Beth Rubin, RNC, CLC, FIMR Coordinator
Beverly Phelps, CNA, FSW, Save My Life Coordinator
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HISTORY AND DESCRIPTION OF

THE HEALTHY START COALITION OF
SARASOTA COUNTY, INC.
History of Florida’s Healthy Start Program
Florida’s Healthy Start Program was conceived in the early 1990’s when then Governor
Lawton Chiles and First Lady Rhea Chiles convened a group of community leaders and
challenged them to build local coalitions to reduce Florida's alarmingly high infant
mortality rate. As chairman of the National Commission to Prevent Infant Mortality, he
believed every child deserved a healthy start in life, and wanted communities to build
strong local coalitions to provide high-quality prenatal care for mothers and health care
for children, especially for those who are at high risk. In 1991, the Florida legislature
signed into law “The Healthy Start Program.” The state's 32 new coalitions were designed
to be partnerships made up of local public and private medical professionals, hospitals,
schools, charities, social services agencies, and individuals. Their charge was and is still is
to assess the needs of their service area, and provide moms, newborns and families with
the resources, support and help they need to have a healthy pregnancy and a healthy
birth.
Development of Sarasota County‘s Healthy Start Coalition
Originally part of the larger Healthy Start Coalition of Southwest Florida for the HRS
District 8 area, Sarasota County formed its own Coalition in order to identify and resolve
its own local, unique problems affecting our county’s pregnant women, new mothers, and
infants. The new Healthy Start Coalition of Sarasota County, Inc. was incorporated as a
501(c)3 non-profit organization on May 16, 1998, after two years of planning.
Elected in June, 1998, the first Executive Board reflected the range of individuals from the
community who were invested in improving maternal and child health and preventing
poor birth outcomes: Edna Apostol, Executive Director of the Gulf Coast South Area
Health Education Center (GCSAHEC); Eleanor Tiemann, Interested Citizen; Patti
Treubert, Childbirth Educator, Bon Secours-Venice Hospital; Gloria DeHaven,
International Board Certified Lactation Consultant and Childbirth Educator, Doctors
Hospital; Hal Hedley, Executive Director of the Child Protection Center; Shelia Williams,
District 8 SED Network; William Little, Administrator of the Sarasota County Health
Department (SCHD); and Phil Blankenship, Suncoast School for Innovative Studies.
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The Executive Board

Over the years, the Executive Board of the Coalition has been fortunate to draw
individuals from a wide range of agencies, businesses, service providers, and the
community to help us improve maternal and child health in Sarasota, thus reducing or
preventing poor birth outcomes, such as fetal death, prematurity, low birth weight, and
infant death.
The following individuals, in alphabetical order, are the past and current Board members
who have voluntarily donated their time and energy to helping the Healthy Start
Coalition of Sarasota County fulfill its goals. The organization or business listed is the
one each was associated with when serving on the Board. A star by their name denotes
holding an Executive Board Chairperson position.
 Shara Abrams, Jackson Hewitt*  William Little, Sarasota County Health

Department
 Edna Apostol, Gulf Coast South Area  Barbara Laidlaw, Sarasota County
Health Education Center* Health Department
 Holly Anderson, United Way*  Rob Lawton, International Management
Technologies, Inc.
 Migdalia Aponte, Florida Center for  Dale Lewis, Interested Citizen
Family and Child Development
 Jack Baker, Children First-Nurturing  Mayor Richard Martin*
Dads*
 Maria Beck, Michael Saunders & Co.*  Mayor Carolyn Mason
 Monica Beckett, North Port Community  Dale Mathis, Sarasota County Health
Health Action Team Department
 Phil Blankenship, Suncoast School for  Michael McIntosh, Catholic Health
Innovative Studies Initiatives
 P.J. Brooks, Sarasota School Board  Jim McMillan, Parenting Educator
 Denise Candea, Children First  Paul Mercier, County Commissioner
 John Capaccione, Yellow Cab Sarasota  Linda Mineer, Legislative Aide to

Senator Lisa Carlton
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 Senator Lisa Carlton  Lucile Mobley, Cyesis High School
 Charlene Chirillo, Gulf Coast South  Donna Norback, Sarasota Memorial

Area Health Education Center Hospital*
 Becky Clapp, Sarasota County Health  Jenna Norwood, Healthy Living Expert*
Department Healthy Start Program
 Representative Donna Clarke  Evona Poplawski, Restaurant Owner
 Sarah Cloud, Healthy Families  Representative Ron Reagan

Program*
 Kitty Cranor, Interested Citizen  Shelley Rence, Sarasota County Health
Department Healthy Start Program
 Gloria DeHaven, Doctor’s Hospital  Shelley Rine, Early Intervention
Program
 Gilda Dennis, WWSB Channel 40 TV  Chip Schaaff, LMHC, Private Practice
 Grace Dietrich, Jackson Hewitt  Carol Selvey, HealthCare Consultant
 Mary Gillam, STAR Student  Leland Selvey, Interested Citizen
 Hal Headley, Child Protection Center*  Mayor Mary Ann Servian
 Pauline Hill, Sarasota Memorial  Linda Spivey, Legislative Aide to

Hospital Senator Lisa Carlton
 Shelby Hill, STAR Student  James Taylor, Met Life Financial
Services
 Cameron Icard, Michael Saunders & Co.  Eleanor Tiemann, Interested Citizen
 Jonna Jung, SCHD  Patti Treubert, Bon Secours Venice

Hospital
 Vice-Mayor/Mayor Kelly Kirschner  Diane Weiss, Forty Carrots Family
Center
 Barbara Kochmit, SCOSA  Shelia Williams, District 8 SED Network
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Coalition Administration
At the first Board meeting for the new Coalition in June 1998, Sarah Gorman, MA, was
presented as the Executive Director. The Coalition began with a staff of two people–
starting with two lawn chairs and a table in borrowed office space! – with a budget of
$135,636. During Ms. Gorman’s tenure, the county’s population of pregnant women
increased as did the Healthy Start services and funding. In the early years, the Coalition
held eleven subcontracts for services to clients. Care Coordination, or case management,
was and still is expertly provided by the Sarasota County Health Department team of
nurses and social workers. The Enhanced Services, now called Wraparound Services,
were tendered by 10 providers for psychosocial counseling, childbirth education,
breastfeeding and parenting education and support, and tobacco cessation education and
counseling.
The first rented office was in central Sarasota County, and then was moved north to be
closer to the majority of our targeted zip codes. The Coalition was very fortunate to
relocate to the Glasser-Schoenbaum Human Services Center, a campus devoted to helping
non-profit service organizations enjoy reduced rent in order to maximize their services
funding.
When the Executive Director position became available in 2006, then Contract and Quality
Manager Jennifer Highland, MPH, RN, was promoted to Executive Director. By that time,
the increasing need for additional services and community education necessitated the
move of the Coalition to yet a larger office in the Center, the addition of staff and
expansion of programs. With the move, the Coalition was able to open the Pregnancy
Resource Center, a place for professionals and the public
to get educational materials on topics spanning the
pre/interconception periods, pregnancy health, childbirth,
breastfeeding, parenting, and local resources. The budget
for the Coalition has grown to $1.2 million. Mrs.
Highland remains as Executive Director at this time.
Coalition Staff
Over the course of its existence, the Coalition has
employed or contracted with a variety of talented and devoted individuals as staff or
project coordinators. Their names, positions, and the year they began are listed below.
Asterisks denote individuals currently on staff.
Linda Wilson, Administrative Assistant (1998); Nannette Albright, FIMR Case

Abstractor (Fetal and Infant Mortality Review Project), (2000); Claire Burnett,
FIMR Case Abstractor (2000); Dulce Capo, Community Liaison (2001); Simone
Hopkins, South Venice Neighborhood Health Promoter (2001); Shelly Gardner,
MomCare Advisor and Pot of Beans Coordinator (2001); Jennifer Highland,
Contract/Quality Manager* (2001); Anne Muir, MomCare Advisor (2002); Ellen
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Zottoli, Marcia Blotzer, Anna Brereton-Hubbard, Pam McFarland, and Susan

Merrill, FIMR Case Abstractors (2002 - 2009); Jennifer Highland, Executive
Director (2006)*; Janice Baxter, Contract and Quality Manager (2007)*; Joy Luce,
MomCare Advisor (2007); Cindy Martin, Education and FIMR Coordinator (2007);
Ellen Zottoli, Pauline Hill, and Pam McFarland, Maternal and Child Health
Provider Liaisons (2007); Miryan McDonald, Administrative Assistant and
MomCare Advisor-Spanish (2008)*; Teri Endres, MomCare Advisor (2009)*; Ciera
Galbraith, Communications & Development Specialist (2009)*; Beverly Phelps,
Save My Life Program Coordinator (2009)*; Tiffany Prater, Education Coordinator
and Community Liaison (2009)*; Cindy Martin, FIMR Coordinator (2009)*; and
Anne Muir, MomCare Supervisor (2009)*.
Current Organizational Chart

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Committees
Breastfeeding Advocates of Sarasota County (BASC) – this workgroup consists of
agencies, organizations and interested individuals working to improve breastfeeding
through education, direct services, and workplace support.
Community Action and Education Group (CAEG) – Based on FIMR priorities and other
activities of the Service Delivery Plan, this committee advises and assists in the
preparation and implementation of educational programs and activities for the
community, clients, and service providers. Agencies, organizations, and individuals
interested in working for advancement of maternal and infant health in the community
through action and education are invited to join.
FIMR Case Review Team (CRT) – Invited health care and social services professionals
and interested researchers review de-identified fetal and infant case abstractions to
determine if there were any factors which if improved may have altered the outcomes.
Annual data from FIMR is given to the Community Action and Education Group for
identification of priorities and actions.
Planning & Evaluation (P&E) – This committee collects and analyzes quantitative and
qualitative data on maternal-child health; maternal, fetal and infant morbidity and
mortality; prenatal care; community resources, etc., through published and unpublished
research studies, state and county data collection; local FIMR data; and conducts surveys,
interviews, and focus groups with pregnant women, current clients, Coalition members,
and the community as outlined in the Coalition’s Service Delivery Plan. Parties who are
interested in population-based maternal-infant health or have specialties in research or
data collection and analysis are encouraged to join our staff on this committee.
Providers’ Council – Comprised of Healthy Start Service Care Coordinators and

Wraparound Service Providers under contract. The council is a round table to discuss
services, problems, and resources needed to care for the Healthy Start client.
Substance Exposed Newborn Prevention and Protection Committee (SEN) – This

committee consists of agencies, hospitals, facilities and others who work with substance
abuse issues among pregnant women and exposed newborns. The goal is to streamline
services, improve communication, and assure presence of a safety net.
Tobacco Cessation Workgroup (TCW) – This workgroup focuses on reduction of

smoking rates among Sarasota County pregnant women and new families through
education of health care and social service professionals as well as broader community.
In addition to these Coalition committees, the Executive Board has three committees:
Finance, Governance, and Fundraising.
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Coalition Membership
Coalition membership consists of interested individuals or organizations that help the
Coalition meet the statutory requirements of the Healthy Start laws. Coalition members
help us understand the perspectives, strengths, structures, needs and assets of our
community of mothers and infants, and may serve as our partners or volunteers in
fulfilling our mission. Their relationships with us assure that we remain a viable and
strong organization. We strive to maintain a Coalition membership that represents our
county’s racial, ethnic, and gender composition.
Our current membership stands at 47 voting members and 11 non-voting members.

Thirteen members are from the private sector or Healthy Start service providers; eleven
are community or social service organizations; three are county health department
representatives; three represent hospitals or birthing centers; three represent education or
Head Start; there are two each from government and the interested citizen category; and
one each from the consumer category and health planning.
Programs
The Healthy Start Coalition of Sarasota County currently administers four programs in
order to fulfill its mission to improve the health and well-being of pregnant women,
infants, and young children. The Healthy Start Direct Services Program and the
MomCare Program are offered in English and Spanish. In addition to the programs listed
below, the Coalition has an active education program for professionals and the lay public.
A. Healthy Start Direct Services Program
1. The Healthy Start Direct Services Program provides intensive education, one-on-
one assistance and support to ensure pregnant women and families can access
prenatal care and other services that contribute to healthy birth outcomes and
healthy child development.
2. These services are delivered in a variety of settings, clinics, work and community
sites and participants’ homes as appropriate.
3. The program is a risk based program, not an income based program.
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4. Referrals to the program result from a positive score on the prenatal or infant risk
screening tool, agency referral, and self-referral.
a. Prenatal risks, identified at the first prenatal care appointment, include:
i. No high school diploma or GED
ii. Not married
iii. Depression or hopelessness
iv. Black race
v. Alcohol use in the previous three months
vi. Cigarette use in the previous three months
vii. Undesired pregnancy
viii. Previous poor birth outcome: fetal death, prematurity, low birth weight
ix. Less than 18 years of age
x. BMI <19.8 (underweight) or >35 (obese)
xi. Pregnancy interval less than 18 months
xii. Later entry into prenatal care
xiii. Ongoing medical illness
b. Infant risks, identified at birth, include:
i. Mother less than 18 years of age
ii. Mother’s age is over 18 and education is less than 12th grade or unknown
iii. Mother’s race is unknown, other than white, or is of multiple races
iv. Mother is not married
5. Number of prenatal care visits is zero, one, or unknown
i. Infant’s birthweight is less than 2000 grams or less than 4 pounds, 7
ounces.
ii. Mother used tobacco during pregnancy and the number of cigarettes per
day is more than nine or unknown.
iii. Mother used alcohol during pregnancy or alcohol used is unknown.
iv. The newborn had abnormal conditions such as hyaline membrane
disease/RDS or assisted ventilation requirements or assisted ventilation
required for 30 minutes or more or assisted ventilation required for 6
hours or more.
v. Infant has one or more congenital anomalies.
b. If an individual does not score in, referrals are accepted for risks defined by the
Coalition, such as homelessness, substance abuse, need for breastfeeding
assistance, physical abuse, etc.
6. The program serves pregnant women, infants and children up to age three, and
women who need to improve their health between pregnancies to improve future
birth outcomes.
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7. Care Coordination staff includes nurses and social workers.

8. Additional, specialized services are available to clients as needed:
a. Childbirth education
b. Breastfeeding education and support
c. Tobacco cessation and education
d. Parenting education and support
e. Interconception health education
f. Nutritional counseling
g. Psychosocial counseling
B. MomCare Program
1. MomCare is a program for pregnant women receiving pregnancy Medicaid
insurance (not those in HMOs) to assure that prenatal care is started early in order
to reduce the likelihood of poor pregnancy or birth outcomes.
2. MomCare Advisors assist clients in entry into prenatal care early, staying in
prenatal care, and assuring they receive information about local resources. There
is follow-up during and after the pregnancy.
3. Referrals to WIC, Healthy Start and others are made as needed.
C. Save My Life
1. Save My Life offers classes and support to African-American women to improve
their health and the health of their infants through pre/interconception health
education, childbirth education, and breastfeeding education and support. Infant
and fetal mortality rates among African-Americans range 2-4 times higher than
whites.
2. The Program is offered in the Newtown area of Sarasota.
3. The Coordinator of the Save My Life Programs assists local churches in adopting
the Body and Soul Program for Pregnant Women, which is a faith-based program
focused on the spiritual, mental, and physical health of pregnant church members
and others.
D. Fetal and Infant Mortality Review Project (FIMR)

1. The goal of the FIMR Project is to address systems and other problems or issues
identified in the review of fetal and infant death cases in Sarasota County.
2. Professionals review the local deaths to ascertain what risk factors or other
problems may have shaped the outcomes.
3. It is a thoroughly confidential, de-identified process.
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4. Through the process, improvements to prenatal and infant care, service systems,
community education and resource for women, infants, and families can be
recommended.
Events
The earliest achievement of the Coalition was
partnering with the Kiwanis Club of Sarasota for the
Annual Baby Shower in 1998. That partnership has
lasted twelve years and has provided numerous high
chairs, strollers, bassinettes, diapers and other needed
baby items to those who most need it.
In more than ten years of operation, the Coalition has

sponsored or co-sponsored community events, health
fairs, and fundraisers to bring awareness of our mission
to consumers and potential supporters. A partial list follows.
 Annual Baby Shower, 1998 to present

 The Mother’s Day Prayer Vigil, 2001-2005
 Recipe for Life Family Expo with Jackson Hewitt, Hyatt Sarasota & Wal-Mart, 2005
 World Breastfeeding Week Door Decorating Contest each August 1-7, 2005 to now
 Baby Love Brunch, 2006
 Ready Set Grow Family Fair, 2006 to present
 Mothers’ Day Tea, 2007- 2008
Fundraising
The Executive Board has facilitated several fundraising activities. In addition to the
establishment of Endowment Funds at the Community Foundation of Sarasota County
and the Gulf Coast Community Foundation of Venice in 2005, the following events have
been held:
 Baby Steps Sunset Beach Walk fundraiser, 2004 – 2006

 Beach Stroll n’ Roll fundraiser, 2007- 2008
 Sarasota Architectural Salvage fundraiser, “Evening with Healthy Start,” 2009 to
present
 Mozart Effect Concert fundraiser, 2010 to present
In 2009, the Coalition was awarded a grant from the Gulf Coast Community Foundation
of Venice to hire a Communications and Development Specialist, and for the first time has
a staff member to assist the Coalition in marketing and the Board in fundraising.
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Educational Programs
The Coalition has presented many educational programs throughout the years to improve
knowledge regarding maternal and child health and risk factors which contribute to poor
birth outcomes or infant morbidity and mortality. We have reached out, not only to
professionals in this field, but also women of child bearing age who are in populations
affected by health disparities. Some efforts to educate the local community include:
 The FIMR Community Forum on racial disparities in birth outcomes, 1999

 Perinatal Substance Abuse Intervention Workshop, 2002
 Introduction to Healthy Start, annually since 2003
 Post Partum Depression, 2004
 Pot of Beans Program, offering neighborhood support groups for mothers of
young children, supported by grants from the March of Dimes and the Gulf Coast
Community Foundation of Venice, 2005 - 2008
 Lactation Management for prenatal and pediatric care providers, 2003
 Protect Every Baby Campaign phone help line, 2005
 Make Yours a Fresh Start Family Training for prenatal and pediatric care
providers, and Healthy Start service providers, 2005 – 2007
 Make Yours a Breast Feeding Friendly Workplace, 2006
 “A World of Moms” Cultural Competency Workshop, 2006
 Lactation Management Course for Healthy Start Care Coordinators, 2007 and 2009
 Community Health Worker Program, a “grass roots” peer education series with
topics on oral hygiene, prevention of tobacco, alcohol and substance abuse, and
pre/interconception health, funded by the Gulf Coast South Area Health
Education Program, 2007 to present
 SIDS and Safe Sleep, 2008, 2010, 2011
 Fourth Friday Forums for maternal child health professionals, 2008 – 2009
 Fetal Alcohol Syndrome, 2010
Studies and Surveys
The Healthy Start Coalition of Sarasota County has engaged in several non-scientific
studies and surveys to examine different issues and needs of our maternal and child
population.
 Project Impact, 1999. Co-sponsored by Gulf Coast South Area Health Education
Center, Project Impact conducted interviews and studied the responses of women
regarding missed appointments with Healthy Start service providers.
20
 Breastfeeding Surveys, 2002, 2004, and 2008. The only general, maternal
population-based breastfeeding survey
in Sarasota County, conducted by the
Coalition’s Breastfeeding Data
Partnership.
 Interdisciplinary Community Health

Scholar Program, sponsored by the Gulf
Coast Area Health Education Center,
2006, 2007, 2008. The Coalition hosted
scholars in Nursing, Social Work, Public
Health or Medicine from USF to research
risks identified by fetal and infant death case reviews, and develop educational
programs for the community:
“Start Motherhood with a Healthy Mouth” - Periodontal disease as an

independent risk factor for premature labor (2006).
”Why Our Babies are Dying” – Racial health disparities in infant and fetal
death among African Americans (2007). This program led to the
development of the Coalition’s current “Save My Life” Program.
“Clean Start” – hazards of smoking, alcohol and drug abuse during

pregnancy (2008).
Annual Awards
Beginning with the Annual General Business Meeting in 2000, the Healthy Start Coalition
commenced formal recognition of the many individuals and partners who have worked
to help us fulfill our mission to improve the health and well-being of pregnant women,
infants, and young children.
Community Partners of the Year: This award is given to the nominee whose
outstanding collaboration supports pregnant women and infants in Healthy Start.
Forty Carrots Parenting Center (2000), Children First (2001), DeHaven

Construction, Inc (2002), Healthy Families Sarasota (2003), Kiwanis Club of
Sarasota (2004), Sarasota Memorial Health Care System (2005), Jackson Hewitt
Technology Services, LLC (2006), Nurturing Dads Initiative (2007), SMH Babies
Program (2008), Mothers and Infants Program of First Step (2009).
Healthy Start Families of the Year: This award is given to Healthy Start client who has
overcome obstacles to achieving goals; has demonstrated a consistent commitment to
21
their child’s health and well-being; or has demonstrated involvement with others in
need to help them meet challenges.
Danielle Gonzalez (2000), Maria Luisa Pacheco Gusman (2001), Johanna

Rouwhorst (2002), Kerri Routledge (2003), Lucia Avalos (2004), Melissa Sartori
(2005), Cara D’Antonio (2006), Timea Kurucz (2007), Megan Toale (2008), Veronica
Alvarez-Perez (2009).
Journalists of the Year: This award is given to the journalist who has best supported
the health and pregnant women and young children. (Award retired in 2005.)
Channel 40 News Team (2000), Barbara Peters-Smith (2001), Heidi Godman,

Channel 40 (2002), Peggi Paquette, Venice Gondolier (2003), Sheryl Green, ABC-7
(2004).
Lawton Chiles Award Winners: The Coalition’s highest award is given to an individual
whose contributions to prenatal and early child health in Sarasota County are
characterized by exceptional commitment, wisdom, leadership, and vision.
Dr. Norman Goldstein (2000), Caryn Driscoll (2001), Dr. Washington Hill (2002),
Bill Little (2003), Mark Perlman (2004), Hal Hedley (2005), Dr. Katharine Keeley
(2006), Dr. Patricia Blanco, (2007), Kathryn Shea (2008), Dr. Jerome Isaac (2009).
Media Partner Award Winners: This award is given to the media partner who has best
supported the health and pregnant women and young children. (New category added
in 2008.)
WEDU and the Apisdorf Foundation (2008); Jacki Barron, WFLA Channel 8 (2009).
Mission Award Winner: This award is given to an individual whose work with the
Healthy Start Coalition, Healthy Start Program, MomCare Program, or Fetal and Infant
Mortality Review Project has been of sustained, significant value in helping to achieve
our mission: “To promote the health and well-being of pregnant women, infants, and
young children.” (New category added in 2009.)
Rebecca Clapp, SCHD (2009)
Volunteers of Year: This award is given to the nominee whose contributions or

achievements have been of great support of families during pregnancy and/or their
child’s first three years.
Bea Funkhouser (2000), Merle Dimino (2001), Presbyterian Women of Church of

the Palms (2002), Sarasota Council of Concern (2003), Chip Schaaff (2004), Mothers
Helping Mothers (2005), St. Margaret’s of Scotland Episcopal Church (2006), Marty
22
Overholt (2007), Presbyterian Women of Church of the Palms (2008), Angel’s Attic
(2009).
In celebration of Coalition achievements toward the goal of awareness and improving our
mission, we note that September 19, 2006, Jennifer Highland was awarded a Leadership
Award for Florida’s Who’s Who of Prevention for her work in the county with the Make
Yours a Fresh Start Family tobacco education program for pregnant women and new
mothers.
Our Many Partners

The Coalition has been rewarded with the concern and partnership of numerous
organizations and businesses over the years. We want to thank everyone for their
support.
AARP ~ All Children’s Hospital ~ All Faiths Food Bank ~ Apisdorf Foundation ~
Born to Read ~ Child Protection Center ~ Children First ~ Children’s Committee ~
CHIP ~ Church of the Palms ~ Community Alliance ~ Community Foundation of
Sarasota County ~ Cyesis High School ~ Community Youth Development
Program ~ Department of Children and Families ~ Kiwanis Club of Sarasota ~
Early Learning Coalition ~ Early Steps ~ Emporia Productions ~ Family Living
Magazine ~ First Step Women and Infants Program ~ Florida Association of
Healthy Start Coalitions ~ Florida Center for Child and Family Development ~
Forty Carrots ~ Friendship Volunteer Center ~ Genesis Health Care ~ Glasser-
Schoenbaum Human Services Center ~ Gulf Coast Community Foundation of
Venice ~ Gulf Coast South Area Health Education Center ~ Gulf Coast Diabetes
Foundation ~ Healthy Families ~ Hispanic Latino Coalition ~ Human Services
Advisory Council ~ Jackson Hewitt ~ Jewish Children and Family Services ~ KBR
Foundation ~ Kid Care ~ Kiwanis Club of Sarasota ~ La Leche League ~ March of
Dimes ~ Mommy Magazine ~ Mothers Helping Mothers ~ Planned Parenthood ~
Newtown Health Advisory Council ~ Newtown Community Service Coalition ~
Nurturing Dads ~ ROI Media ~ SCOPE ~Salvation Army FAITH Program ~
Sarasota Architectural Salvage ~ Safe Kids Coalition ~ Sarasota County
Cooperative Extension Services ~ Sarasota County Health and Human Services ~
Sarasota County School Board ~ Sarasota Partnership for Children’s Mental Health
~ Sarasota Memorial Hospital ~ Sarasota Rotary Club ~ St. Martha’s Catholic
Church ~ Second Chance Last Opportunity ~ Truvine Church ~ United Way
23
Our Volunteers
Jesse Coleman ~ Judith Garner ~ Clara Rock Green ~ Christine Hofstra ~ Susan
Hook ~ Jo Kabobel ~ SueEllen Kaeb ~ Abigail Lindo ~ Joy Luce ~ Jessica Maule ~
Liz Murphy ~ CeCe Nguyen ~ Katie Pfost ~ Erica Shane ~ Stephanie Sierra ~ Jamee
Thumm ~ Karen Wend ~ Earl Young ~ Marie Zimmerman
24
SERVICE DELIVERY PLANNING

SUMMARY
This section provides a summary of the process we followed to develop our Service
Delivery Plan. More detailed information regarding data, identified trends and problems,
resources, and the five year plan are found in subsequent sections.
The APEXPH Community Process

The Assessment Protocol for Excellence in Public Health (APEXPH) Community Process
was the general framework for our 2010-2015 Service Delivery Planning Process. The
eight steps of this community process are:
A. Prepare.
B. Collect and analyze data.
C. Form a community health committee.
D. Indentify community health problems.
E. Prioritize community health problems.
F. Analyze community health problems.
G. Inventory community health resources.
H. Develop a community health plan.
Other models include similar core elements, and from those we utilized science-based
data in assessing health needs and selecting action steps, and setting priorities in light of
local resources – which is challenging in this difficult and uncertain economic time.
The Committee
The Healthy Start Coalition of Sarasota County had in existence at the beginning of this
process a Planning and Evaluation Committee. In preparation for assigning the task of
developing this Plan to that committee, additional representatives from the community
were invited. Invitees included individuals from a variety of local agencies,
organizations, and businesses whose target audiences include pregnant women and
young children, representing prenatal care, public health, hospital services, children’s
services, education, nutrition services, counseling services, and family planning. The
Healthy Start Program and the Healthy Start Coalition (including board and staff) were
represented, as was an advocate who works on behalf of new mothers, and is a young
mother herself. In addition, the Planning and Evaluation Committee meetings were
advertised in a local mother’s magazine and are open to anyone wanting to attend. We
25
are very grateful for the time and energy this committee devoted to their task, and thank
everyone whole-heartedly!
Monica Becket, North Port CHAT and Executive Board Representative ~ Debra
Boterf, Sarasota Memorial Hospital ~ Liz Bumpus, Sarasota County Health
Department ~ Kyle Garner, MD ~ Hal Headley, Child Protection Center ~ Rhonda
Herndon, WIC ~ Shelby Hill, Student and Executive Board Representative ~
Debbie Keyso, Healthy Families ~ Laura Gilkey, Mother and Child Advocate ~
Michael McIntosh, Executive Board Representative ~ Scott Pritchard, Sarasota
County Health Department ~ Shelley Rence, Healthy Start Program ~ Carol Selvey,
Executive Board Representative ~ Pat Wolfson, Planned Parenthood ~ and the staff
of the Healthy Start Coalition
Data Collection Summary

Prior to the development of the Service Delivery Plan, the Healthy Start Coalition’s
Planning and Evaluation Committee collected and reviewed qualitative and quantitative
data to determine our priorities for 2010-2015. The purposes of this data collection were
to:
A. Assess prenatal and child health care needs in the service catchment area (Sarasota
County).
B. Identify risk factors.
C. Determine target priority groups.
D. Determine outcome performance objectives.
E. Determine type of services needed.
F. Identify gaps.
Among the sources of data were:
 FL Charts  FL Vital Statistics  March of Dimes

 FL Agency for Health  FL Pregnancy Risk  National Institute on
Care Administration Assessment Monitoring Drug Abuse
(AHCA) System (PRAMS)
 Sarasota County Health  FL Department of  Centers for Disease
Department Health Control
 Sarasota County Fetal  Sarasota Healthy Start
and Infant Mortality Program
Review Project (FIMR)
26
Data Collection took considerable time and effort, as was expected. Wherever possible,
we looked at trends to compare data driving the last Service Delivery Plan and the new
Service Delivery Plan. The Committee took on as an additional task the collection of
information on the conditions in a community that should exist to promote healthy
pregnancies and infants, and examined direct and indirect contributing factors related to
higher priority problems. That information ultimately helped us frame the activities
chosen in response to the identified needs. Input from prenatal and pediatric care
providers and Healthy Start and MomCare clients were obtained through surveys.
Due to the explosion of information available electronically and the advancement of

health indicator data bases, the collection of maternal-child health data on federal, state,
and local levels was much easier for this service delivery planning process than it was for
the last in 2005. In addition, local demographic data, services data, and health data were
easier to access, although not all is available locally.
During the data review, the committee identified conditions in our population which
were undesirable, likely to exist in the future, and were measured as fetal or infant death,
maternal and child morbidity, or maternal-child health care systems failures. Since our
overarching goals are to reduce/continue to reduce poor birth outcomes – namely fetal
death, prematurity, low birth weight, and infant death – and maximize infant health, we
looked at data and studies related to mortality, morbidity,
risk factors, causes, and prevention.
The data presented in the Data Collection section of this

document highlight what we found. In some
instances, Sarasota County data indicated our
problems are less severe than that found statewide
or nationwide, and in other instances our problems
are more severe. The Planning and Evaluation
Committee concluded that our focus would be on pregnancy, infant
health, and interconception health. While we will still offer limited services up to age
three, it will not be our focus due to budgetary and time constraints, availability of
numerous other resources for children, and our need to concentrate on prevention of poor
birth outcomes through pre/interconception health.
Needs Assessment Summary and Identified Priorities

Sarasota County benefits from the presence of strong public and private maternal-child
health care options, greatly increasing access to care. Only a portion of county health
departments across the state offer prenatal and pediatric care, and Sarasota County is
27
fortunate to be one of them. We also have private prenatal and pediatric care providers
throughout the county and a tax-based community hospital for infant deliveries. The
presence of this strong system of care allows our Coalition to turn its attention to
expanding the availability of extensive, high quality, intensive services for at-risk clients
through case management and referrals through our programs and partnerships, and
providing community education for professionals and the women of childbearing age to
improve levels of knowledge regarding the prevention and care of maternal and infant
health care issues.
The list of trends we feel are most affecting the health of Sarasota County’s maternal-child
population at this time follows.
A. Problem #1: Sub-optimal pre/ interconception health of women of childbearing

age, which can lead to premature birth, low birth weight, or infant death.
Overall sub-optimal health of women of childbearing age who become pregnant.
Maternal health issues increase the chance of preterm birth. The rate of births
resulting from preterm labor in Sarasota County was 12% in 2008, and has steadily
increased over the last 15 years.
Smoking among pregnant women
The rate of 12.7% in 2008 is the highest rate of smoking prevalence in Sarasota County
the last three years, compared to the Florida’s rate of 6.8%, which has been declining
over the last three years.
Substance Abuse
The number of pregnant drug abusing women in Healthy Start has increased from 6%
to 9% of all Healthy Start births in the last three years. The national rate is 4%. There
were at least 170 substance exposed newborns in the Healthy Start program in 2006-
08.
Obesity
16.7% of mothers have a pre-pregnancy BMI above 30.
Maternal Infections
Half of all fetal and infant death cases reviewed in Fetal and Infant Mortality Review
(FIMR) indicated that genitourinary tract infections were present in the birth mother,
and dental or gum disease was present in at least 21%.
28
Unplanned Pregnancies
The unplanned pregnancy rate in Florida between 2000 and 2005 was 46.7%. In a
small survey conducted with Healthy Start clients in 2010, 69% did not plan their
pregnancies, and 66% of those were not using contraception.
B. Problem #2: High Cesarean section delivery rate leading to unnecessary preterm
births.
Delivery of Infants by Elective Primary Cesarean Section
Sarasota County had a C-Section rate of 39.6%, the sixth highest rate in Florida.
Sarasota Memorial Hospital C-Section rate in 2007 was 41.3%. Florida, at almost 38%,
has the second highest state rate in the United States. Our preterm birth rate is 12%,
which has increased over the last 15 years as has the C-Section rate.
C. Problem #3: Sub-optimal breastfeeding rates.
Breastfeeding
Rates for “any” breastfeeding in Sarasota County in 2008 appear to have declined
from 2004 for all measured time periods: initiation at birth (66%) and infant age of 6
months (17%) and 12 months (8%), and is below Healthy People 2010 goals of 75%,
50%, and 25%.
D. Problem #4: Significant maternal and infant health disparities, including fetal and
infant death among African-Americans.
Health of African-American women during or in between pregnancies and African-

American infants.
Fetal death rates in Sarasota County are approximately twice as high for blacks than
whites, and for infant death rates it is about four-fold, using three year rolling
averages.
Resource Inventory
Sarasota County is privileged to have numerous service providers, organizations, and

agencies to meet many of the needs of Healthy Start and MomCare clients, and women
who are between pregnancies who are at higher risk for subsequent poor birth outcomes.
The Resource Inventory section of this document lists our prenatal and pediatric care
29
providers and the birth facilities serving our county. It also lists the many providers who
we contract with to provide Healthy Start services, and where our areas of need are.
The Action Plan Summary

In general, the three methods the Coalition will use to address our priority issues are:
A. Targeted outreach to high risk populations with case management, or “Care

Coordination,” and referral services. Referral services, or “Wraparound Services”
include Breastfeeding Education and Support, Childbirth Education, Nutrition
Counseling, Parenting Education and Support, Psychosocial Counseling, Tobacco
Education and Cessation, and Interconception Education and Counseling.
B. Professional and public education in our community to increase awareness and

knowledge of the latest maternal-child public health research and help improve
quality of services to women of childbearing age and young children in order to
reduces risks for poor birth outcomes or infant morbidity/mortality.
C. Serving as an agent to unite the distinct parts of our maternal-child health system,
both public and private, in order to improve prevention strategies and care through
collaborative efforts.
Topics of focus to be addressed in one or more of the three ways listed above will include:
A. Increasing access to information on achieving better health prior to, during and
between pregnancies.
B. Providing updated tobacco cessation trainings to those who interface with pregnant
women or new parents.
C. Increasing community awareness about the levels of drug abuse among pregnant
women, seeking to improve drug screening, and enhancing treatment options.
D. Increasing community awareness about the hazards of obesity on pregnancy, fetal,
and infant health, and enhancing Healthy Start client options for managing weight.
E. Increasing community awareness regarding the risks maternal infections create which
can lead to early labor and premature birth, and focusing efforts to educate Healthy
Start and MomCare clients about importance of treatment.
F. Improving family planning education and follow-up for women of childbearing age.
G. Increasing community awareness of the dangers presented by elective Cesarean
section deliveries prior to 39 weeks of gestation.
H. Improve breastfeeding rates among Healthy Start clients and others by focusing on
breastfeeding education and support from pregnancy through the infant’s first year of
life.
30
The Action Plan section provides more in-depth information about how the Healthy Start
Coalition will address our priorities for 2010-2015. It is divided into Category “B” and
“C” activities. Category B activities are system or community-wide and Category C
activities are targeted to a specific population. The Florida Department of Health requires
that the Coalition report on these activities quarterly, and reassess these activities
annually.
Not listed in the Action Plan are those activities and responsibilities that the Coalition
carries out on a routine basis:
A. Provide training and technical assistance to prenatal care providers and birthing
facilities regarding the prenatal and infant risk screening processes.
B. Procure providers for Healthy Start services; develop and manage provider sub-
contracts, and allocate funding on an annual basis.
C. Assure that all service providers for Care
Coordination and Wraparound Services adhere
to the Healthy Start Standards and Guidelines.
D. Assist in the development of community
partnerships to enhance and improve the care of
our clients through interagency agreements.
E. Monitor data related to our activities.
F. Develop reports as required by our funding
contracts.
G. Help Medicaid-eligible women receive the prenatal care and have access to
appropriate resources through the MomCare Program.
H. Conduct the Fetal and Infant Mortality Review Project, to examine 28 fetal and infant
death cases each year to look at trends and systems issues which must be addressed.
I. Operate as a fiscally sound non-profit corporation.
Quality Monitoring and Performance Improvement (QM/PI) Summary

Quality management is a systematic approach to continuously assess and improve the
overall quality of our programs and services by identifying positive and negative
program processes, services, and outcomes. Through the quality management process
performance measures and contract deliverables are measured and analyzed.
The implementation of our updated QM/PI process is necessary to assure that services
are:
31
 provided in a manner that meet the needs of participants, and the requirements of
the program, including negotiated performance measures,
 of high quality and consistent with current standards of practice,
 accessible and acceptable to the community and to the participants, and
 delivered in a timely manner.
Comparison Between Previous and New Service Delivery Plans

There are some similarities and some differences between our 2005-2010 and 2010-2015
Service Delivery Plans. Compared to the last service delivery phase:
A. The Coalition will still be educating the public and providers about risk factors,
disparities in maternal and infant health, and new research.
B. Make Yours a Fresh Start Family is still the preferred approach for smoking cessation,
and we now need to update the training and offer refresher courses.
C. Recognition of prenatal care providers and birthing facilities with very high screening
rates will continue.
D. Maximize media usage and social networking to advertise the Healthy Start Program.
E. We will maintain the excellent working relationship with our Care Coordination
Team.
F. We will continue to conduct surveys to establish population-based breastfeeding rates
in Sarasota County.
G. Quality Monitoring and Performance Improvement are mainstays of our operations.
H. We no longer have grants for the Pot of Beans Program for new mothers, but have
transitioned to Community Health Worker peer education for women of childbearing
age.
32
DATA COLLECTION FOR THE

2010-2015 SERVICE DELIVERY PLAN
Data Collection
This section includes county demographic data, Healthy Start screening data, and
maternal-child health risks and health discrepancies of major concern. Due to the amount
of data collected, only a portion is included. The remainder can be viewed in the Service
Delivery Plan Data Binders at the Coalition Office.
Please note: There are some differences in data based on the reporting source!
Sarasota County Description

Sarasota County is located on the southwest coast of Florida. The county borders the Gulf
of Mexico with densely populated barrier islands paralleling the mainland. Most of the
population resides along the west coast of the county in the cities located between
Interstate 75 and the Gulf coast.
Sarasota County has an estimated population of 396,758. The city of Sarasota has the
largest population, following in descending order by Venice, North Port, and Englewood.
Due to the economic downturn this area has experienced over the last several years, a
demographic shift has occurred in our target population of women of childbearing age,
with a loss in the 35-44 year old age group who are white.
Racial makeup of the county is approximately 92.8% white, 4.8% black, 1.2% Asian, and
0.9% biracial. Those of Hispanic ethnicity, regardless of race, are 7.2%. English is the
primary language, while other languages commonly spoken include Spanish and
Russian/Ukranian.
Median per capita income is $28,326. Almost 10% of the households live in poverty.
Children living in poverty is higher, at 15.7%.
Provisional statistics for 2009 show a slight decline in the number of resident live births in
Sarasota County from 3,029 in 2008 to 2,907 in 2009.
33
Demographic Data Comparisons for 2005 and 2010 1
Total Population 2005 2010 Difference
All ages 370,123 396,758 +26,635
Childbearing Years 2005 2010 Difference
------ ALL ------

15-19 16,996 18,338 +1,342
20-24 13,641 14,830 +1,189
25-34 29,029 30,547 +1,519
35-44 42,125 38,595 -3,530
------ FEMALE ------
15-19 8,256 8,920 +644
20-24 6,591 7,225 +634
25-34 14,208 14,920 +712
35-44 21,158 19219 -1,939
------ WHITE FEMALE ------
15-19 7,414 7,958 +544
20-24 5,777 6,355 +578
25-34 12,901 13,417 +516
35-44 19,579 17,611 -1,968
------ NON-WHITE FEMALE ------
15-19 842 962 +120
20-24 817 870 +56
25-34 1,307 1,503 +196
35-44 1,579 1,608 +29
------ HISPANIC FEMALE, ANY RACE ------
15-19 733 930 +197
20-24 784 968 +184
25-34 1,819 2,130 +311
35-44 1,473 1,936 +463
1 http://www.floridacharts.com?FLQuery/Population/PopulationRpt.aspx
34
Other Demographic Data, 2008 2, 3
Land area - 57,144 sq mi Whites - 92.8%
Persons per square mile - 569.9 Blacks - 4.8%

Median Per Capita Income - $28,326 Asian - 1.2%
Mean Households – 149,937 Two or more races - 0.9%
Median Household Income - $49,001 Hispanic ethnicity, any race - 7.2%
Below poverty level - 9.9% Foreign born - 9.3%
Children under poverty - 15.7% Language other than English spoken at
home - 10.5%
High school graduates - 87.1% Mean travel time to work - 21.8 minutes
Health Risk Factors for the General Population 4

 No exercise 21.6%
 Few fruits and vegetables 72.7%
 Obesity 18.0%
 High Blood Pressure 28.5%
 Smoker 20.0%
 Diabetes 6.4%
2 http://quickfacts.census.gov/qfd/states/12/12115.html
3 http://datacenter.kidscount.org/data/bystate/StateLanding.aspx?state=FL
4 CDC. Behaviors Risk Factor Surveillance System, 2000-2006
35
Vital Statistics 5
Resident Births (Rate per 1,000 resident population)

2004 2005 2006 2007 2008
8.1 8.1 8.3 8.5 7.7
Resident Births (Number)
2004 2005 2006 2007 2008 2009 6
2,935 2,997 3,163 3,298 3,029 2,907
Resident Births to Mothers Under Age 20 (Number)
2004 2005 2006 2007 2008 20096
257 287 300 326 273 254
Resident Births to Mothers Under Age 20 (Percent)
2004 2005 2006 2007 2008 20096
8.8% 9.6% 9.5% 9.9% 9.0% 8.7%
Resident Teen Births Age 15-17 (Rate per 1,000)
2004 2005 2006 2007 2008
15.1 15.0 16.5 18.0 14.7
Resident Teen Births Age 15-17 (Number)
2004 2005 2006 2007 2008 20096
77 79 90 101 83 67
Resident Teen Births Age 15-19 (Rate per 1,000)
2004 2005 2006 2007 2008
31.6 34.2 34.6 36.9 30.2
Resident Teen Births Age 15-19 (Number)
2004 2005 2006 2007 2008 20096
252 282 296 324 268 250
Resident Births to Mothers Age 20-24 (Rate per 1,000)
2006 2007 2008
115.4 116.1 104.6
5http://datacenter.kidscount.org/data/bystate/stateprofile.aspx?state=FL&cat=448&group=
Category&loc=1917&dt=1%2c3%2c2%2c4
6 All 2009 Vital Statistics Data is Provisional
36
Resident Births to Mothers Age 20-24 (Number)

2006 2007 2008
792 821 747
Resident Births to Unwed Mothers (Percent)

2004 2005 2006 2007 2008 20096
36.1% 38.5% 40.3% 42.8% 42.9% 44.4%
Resident Births to Unwed Mothers (Number)
2004 2005 2006 2007 2008 20096
1,059 1,153 1,274 1,413 1,298 1,292
Resident Births to Unwed Mothers Under Age 20 (Percent)
2004 2005 2006 2007 2008
7.8% 8.3% 8.5% 8.3% 8.0%
Resident Births to Unwed Mothers Under Age 20 (Number)
2004 2005 2006 2007 2008
230 250 269 275 243
Resident Births to Unwed Mothers Age 20 and Over (Percent)
2004 2005 2006 2007 2008
28.2% 30.1% 31.8% 34.5% 34.8%
Resident Births to Unwed Mothers Age 20 and Over (Number)

2004 2005 2006 2007 2008
829 903 1,005 1,138 1,055
Resident Births Receiving Early Prenatal Care (Percent)
2004 2005 2006 2007 2008 20096
82.0% 82.7% 80.5% 79.8% 82.6% 82.3%
Resident Births Receiving Early Prenatal Care (Number)
2004 2005 2006 2007 2008 20096
2,278 2,411 2,495 2,602 2466 2,328
Resident Low Birthweight Births (Percent)
2004 2005 2006 2007 2008 20096
6.7% 7.5% 6.8% 7.4% 7.3% 6.7%
37
Resident Low Birthweight Births (Number)

2004 2005 2006 2007 2008 20096
198 225 214 244 221 196
Resident Births to Mothers with No High School Diploma or GED
(Number)
2004 2005 2006 2007 2008
546 562 631 640 558
Resident Births to Mothers who Smoked During Pregnancy (Number)
2006 2007 2008
350 439 413
Resident Births to Mothers with Prenatal WIC Participation (Number)
2006 2007 2008
1,200 1,238 1,235
Resident Births with Medicaid as Delivery Payment Source
2006 2007 2008
1,484 (47%) 1,498 (45%) 1,455 (48%)
Resident Fetal Deaths (Rate per 1,000)

2004 2005 2006 2007 2008 2009
2.7 5.3 4.1 2.4 6.6 8.9
Resident Fetal Deaths (Number)
2004 2005 2006 2007 2008 2009
8 16 13 8 20 267
Resident Infant Deaths (Rate per 1,000)

2004 2005 2006 2007 2008 2009
2.7 5.3 4.1 2.4 4.6 6.2
Resident Infant Deaths (Number)
2004 2005 2006 2007 2008 2009
8 16 13 8 14 18 7
7 Sarasota County Health Department, 2010

38
Resident Hispanic Births (Number)

2004 2005 2006 2007 2008
445 497 609 626 536
Resident Hispanic Infant Deaths (Number)
2004 2005 2006 2007 2008
1 1 4 2 5
MCH Health Problem Analysis for
Sarasota
Calendar Year 2008
Population
Sarasota Florida
Number Percentage Number Percentage
Total 392,262 18,896,559

White 369,064 94.09 15,208,029 80.48
Nonwhite 23,198 5.91 3,688,530 19.52
Black 18,119 4.62 3,147,900 16.66
Other 5,079 1.29 540,630 2.86
Data Source: Population Estimates from the Florida Legislature, Office of Economic & Demographic Research
Births
Sarasota Florida
Number Percentage Number Percentage
Total 3,029 231,417

White * 2,615 86.33 167,487 72.37
Black * 279 9.21 51,362 22.19
Other * 134 4.42 12,049 5.21
Hispanic ** 536 17.70 65,999 28.52

Non-Hispanic ** 2,490 82.21 164,315 71.00
*Regardless of ethnicity. Does not include persons whose race is unknown.
Data Source: Florida Department of Health, Office of Vital Statistics
**Regardless of race. Does not include persons whose ethnicity is unknown.
Infant Deaths - Actual vs Expected
Total Births Actual Infant Deaths Expected Infant Deaths Significance

3,029 14 18.00 N
Actual Infant Death Rate Expected Infant Death Rate

per 1,000 Births per 1,000 Births
4.62 5.94
H=Actual Rate is Significantly Higher than the Expected Rate
L=Actual Rate is Significantly Lower than the Expected Rate
N=Actual Rate is Not Significantly Different than the Expected Rate
Data Source: Department of Health - Infant, Maternal and Reproductive Health using Florida Vital Statistics data
Low Birthweight - Actual vs Expected
Total Births Actual LBW Births Expected LBW Births Significance

3,029 221 241.00 N
Actual Percent LBW Expected Percent LBW

7.30 7.96
H=Actual Rate is Significantly Higher than the Expected Rate
L=Actual Rate is Significantly Lower than the Expected Rate
N=Actual Rate is Not Significantly Different than the Expected Rate
Data Source: Department of Health - Infant, Maternal and Reproductive Health using Florida Vital Statistics data
Page 1 of 13 Florida Department of Health

Report Production Date: 3/9/05 Infant, Maternal and Reproductive Health (850) 245-4444 x. 2956
Sarasota
Calendar Year 2008
Deaths Due to Leading Causes of Infant Mortality
Perinatal Conditions 5 Unintentional Injury 1

Congenital Anomalies 4 Heart Disease 1
Sudden Infant Death Syndrome 2 Other Causes 1
Infant Mortality
Comparison Comparison
2006 2007 2008
to Previous to Florida
Sarasota Florida Sarasota Florida Sarasota Florida Year Rate
Total 13 1,713 8 1,689 14 1,667 Increased

Rate per 1000 4.1 7.2 2.4 7.1 4.6 7.2 Increased Below
White * 8 974 7 906 8 914 Increased

Black * 4 653 1 689 4 661 Increased
Rate per 1000 14.2 12.9 3.2 13.4 14.3 12.9 Increased Above
Other * 1 84 0 92 2 90 Increased
Hispanic ** 4 399 2 440 5 379 Increased

Non-Hispanic ** 9 1,303 6 1,243 9 1,275 Increased

* Regardless of ethnicity. Does not include persons whose race is unknown. Data Source: Florida Department of Health, Office of Vital Statistics
** Regardless of race. Does not include persons whose ethnicity is unknown.
Infant Mortality Rates Infant Mortality Trend

Three-Year Rolling Averages
16.0 12.0
14.0
10.0
R ate p er 1,000 B irth s
R ate p er 1,000 B irth s
12.0
10.0 8.0
All Races
8.0 White All Races
6.0
Black White
6.0 Other Black
Other
4.0
4.0
2.0 2.0
0.0
2006 2007 2008 0.0
2004-2006 2005-2007 2006-2008
2006 2007 2008 2004-2006 2005-2007 2006-2008
All Races 4.1 2.4 4.6 All Races 4.1 3.9 3.7
White 2.9 2.5 3.1 White 3.5 3.5 2.8
Black 14.2 3.2 14.3 Black 8.1 7.2 10.3
Other 8.7 0.0 14.9 Other 9.0 5.1 7.5

Sarasota
Calendar Year 2008
Neonatal Mortality
2006 2007 2008
Sarasota Florida Sarasota Florida Sarasota Florida
Year Rate
Total 4 1,122 4 1,062 8 1,061 Increased
White * 3 630 3 573 5 592 Increased



Non-Hispanic ** 2 831 3 757 4 793 Increased

**Regardless of race. Does not include persons whose ethnicity is
Neonatal Mortality Neonatal Mortality Trend

Rates Three-Year Rolling Averages
8.0 5.0
7.0 4.5
4.0
Rate per 1,000 Births
6.0
3.5
5.0
All Races 3.0 All Races
Black White
4.0 Other 2.5 Black
White Other
3.0 2.0
1.5
2.0
1.0
1.0
0.5
0.0 0.0
2006 2007 2008 2004-2006 2005-2007 2006-2008
2006 2007 2008 2004-2006 2005-2007 2006-2008
White 1.1 1.1 1.9 White 2.1 1.9 1.3
Black 3.5 3.2 7.2 Black 4.1 3.6 4.6
Other 0.0 0.0 7.5 Other 3.0 2.5 2.5

Sarasota
Calendar Year 2008
Postneonatal Mortality
2006 2007 2008
Total 9 591 4 627 6 606 Increased
White * 5 344 4 333 3 322 Decreased

Rate per 1000 1.8 2.0 1.4 1.9 1.1 1.9 Decreased Below

Hispanic ** 2 118 1 139 1 119 Same

Non-Hispanic ** 7 472 3 486 5 482 Increased


** Regardless of race. Does not include persons whose ethnicity is unknown.
Postneonatal Mortality Rates Postneonatal Mortality Trend

12.0 6.0
10.0 5.0
8.0 4.0
All Races All Races
White White
6.0 Black 3.0 Black
Other Other
4.0 2.0
2.0 1.0
0.0 0.0
2006 2007 2008 2004-2006 2005-2007 2006-2008
2006 2007 2008 2004-2006 2005-2007 2006-2008
White 1.8 1.4 1.1 White 1.4 1.6 1.5
Black 10.6 0.0 7.2 Black 4.1 3.6 5.7
Other 8.7 0.0 7.5 Other 6.0 2.5 5.0

Sarasota
Calendar Year 2008
Fetal Mortality
2006 2007 2008 Comparison Comparison

Year Rate
Total 29 1,756 39 1,840 20 1,688 Decreased
White * 24 1,020 30 1,042 17 951 Decreased

Rate per 1000 8.7 5.9 10.6 6.0 6.5 5.7 Decreased Above
Black * 5 650 8 720 3 681 Decreased

Other * 0 83 1 72 0 44 Decreased
Hispanic ** 7 446 10 430 6 411 Decreased

Rate per 1000 11.5 6.4 16.0 6.1 11.2 6.2 Decreased Above
Non-Hispanic ** 22 1,285 29 1,358 14 1,243 Decreased

* Regardless of ethnicity. Does not include persons whose race is
unknown.
Fetal Mortality Rates Fetal Mortality Trend

28.0 28.0
24.0 24.0
20.0 20.0
16.0 All Races 16.0 All Races

White White
Black Black
12.0 Other 12.0 Other
8.0 8.0
4.0 4.0
0.0 0.0
2006 2007 2008 2004-2006 2005-2007 2006-2008
2006 2007 2008 2004-2006 2005-2007 2006-2008
White 8.6 10.5 6.5 White 6.3 8.7 8.6
Black 17.4 24.8 10.6 Black 25.1 24.6 18.0
Other 0.0 6.7 0.0 Other 11.8 7.6 2.5

Sarasota
Calendar Year 2008
Low Birthweight
2006 2007 2008
Total 214 20,714 244 20,767 221 20,369 Decreased
Percentage 6.8 8.7 7.4 8.7 7.3 8.8 Decreased Below
White * 164 12,848 200 12,664 175 12,365 Decreased

Black * 43 6,822 34 7,047 40 6,948 Increased

Percentage 15.2 13.4 10.8 13.7 14.3 13.5 Increased Above
Other * 7 1,023 10 1,017 6 1,022 Decreased

Hispanic ** 32 4,948 36 4,975 25 4,800 Decreased


Percentage 7.1 9.4 7.8 9.3 7.9 9.4 Increased Below
* Regardless of ethnicity. Does not include persons whose race is
unknown.
Percentage of Low Birthweight Births Low Birthweight Births Trend

16.0 18.0
14.0 16.0
14.0
12.0
Percentage
Percentage
12.0
10.0
All Races All Races
White
10.0 Black
8.0 Black Other
Other 8.0 White
6.0
6.0
4.0
4.0
2.0 2.0
0.0 0.0
2006 2007 2008 2004-2006 2005-2007 2006-2008
2006 2007 2008 2004-2006 2005-2007 2006-2008
White 5.9 7.1 6.7 White 6.2 6.6 6.6
Black 15.2 10.8 14.3 Black 16.1 13.5 13.4
Other 6.1 6.7 4.5 Other 7.2 7.1 5.8

Sarasota
Calendar Year 2008
Very Low Birthweight
2006 2007 2008
Total 43 3,807 46 3,886 46 3,851 Same
Percentage 1.4 1.6 1.4 1.6 1.5 1.7 Increased Below
White * 34 2,075 40 2,101 29 2,112 Decreased

Black * 8 1,578 5 1,601 15 1,554 Increased


Percentage 0.9 1.2 0.7 1.4 1.5 1.5 Increased Same


*Regardless of ethnicity. Does not include persons whose race is
unknown.
Percentage of Very Low Birthweight Births Very Low Birthweight Trend

6.0 3.5
5.0 3.0
2.5
Percentage
Percentage
4.0
All Races 2.0 All Races
White White
3.0 Black Black
Other 1.5 Other
2.0
1.0
1.0 0.5
0.0 0.0
2006 2007 2008 2004-2006 2005-2007 2006-2008
2006 2007 2008 2004-2006 2005-2007 2006-2008
White 1.2 1.4 1.1 White 1.1 1.3 1.3
Black 2.8 1.6 5.4 Black 3.0 2.0 3.2
Other 0.9 0.7 1.5 Other 2.1 1.8 1.0

Sarasota
Calendar Year 2008
Births to Teens
2006 2007 2008 Compariso
Sarasota Sarasota Sarasota n to

Florida Florida Florida
Previous
Mothers 10-14
Number 4 353 2 376 5 356
Rate per 1,000 0.4 0.6 0.2 0.7 0.5 0.6 Increased
Mothers 15-17
Number 90 8,135 101 8,119 83 7,286
Rate per 1,000 16.5 23.0 18.0 22.6 14.7 20.2 Decreased
Percentage of
Repeat Births 13.1 16.5 16.7 16.2 0.0 0.0 Decreased
15-19
Births to Teens 10-14 Births to Teens 15-17

0.7 24 23.0 22.6
0.7
0.6 0.6
20.2
0.6 20
0.5 18.0
0.5 16.5
16
0.4 14.7
0.4
12
0.3
0.2 8
0.2
4
0.1
0 0
2006 2007 2008 2006 2007 2008
Repeat Births to Teens 15-19

18
16.5 16.7
16.2
16
14 13.1
12
= Sarasota
10
8 = Florida
6
0.0 0.0
0
2006 2007 2008

Sarasota
Calendar Year 2008
Reported Smoking Prevalence in Pregnancy
Mothers Who Smoked Percentage of Births

2006
Sarasota 326 10.31
Florida 17,930 7.56
2007
Sarasota 388 11.76
Florida 16,884 7.06
2008
Sarasota 386 12.74
Florida 15,656 6.77
Smoking Prevalence
14
12.7
12 11.8
10.3
10
= Sarasota
8 7.6
7.1 6.8 = Florida
2006 2007 2008
Pediatric AIDS Cases Among Persons 0 - 4 Years of Age
2006 2007 2008

Sarasota 0 0 0
Florida 16 17 9
Data Source: Florida Department of Health, Bureau of HIV/AIDS
CHD Prenatal Care Clients Offered HIV Testing
2006 2007 2008

100.00% 0.00% 100.00 % 0.00% 100.00% 0.00%

Sarasota
Calendar Year 2008
WIC Services
Persons Eligible for WIC Percentage Served by WIC
2006
Sarasota 3,941 58.30
Florida 366,895 64.22
2007
Florida 376,795 64.20
2008
Florida 457,183 76.85
Data Source: Florida Department of Health, WIC & Nutrition Services

Call the Data Management Unit of WIC & Nutrition Services at 850-245-4202 for the latest data.
Prenatal Care by Trimester of Pregnancy
1st Trimester 2nd Trimester 3rd Trimester No Prenatal Care

Sarasota 82.56% 14.63% 2.24% 0.57%
Florida 76.90% 17.34% 3.72% 2.04%
Prenatal Care by Trimester

100
82.6 = Sarasota
80 76.9
= Florida
60
40
20 17.3
14.6
2.2 3.7 2.0

0.6
0
1st Trimester 2nd Trimester 3rd Trimester None

Sarasota
Calendar Year 2008
Immunizations Among 2-Year-Old CHD Clients
Number Immunized Percentage Immunized

Sarasota Florida Sarasota Florida
2006 3,212 214,266 96.14 94.58
2007 3,197 204,043 96.91 93.56
2008 3,177 195,514 94.69 89.76
Data Source: Florida Department of Health, Bureau of Immunizations
Healthy Start Prenatal Screening and Services
2006 2007 2008

Offered Rate % 100.73 88.91 99.85 88.61 105.36 92.17
Screening Rate % 79.91 67.08 80.73 68.57 86.07 74.05
Consent Rate % 79.33 75.45 80.85 77.38 81.69 80.35
Number Percentage
Estimated Number of Pregnant Women 3,022 230,629
Offered Screen 3,184 212,564 105.36 92.17
Consenting to Screen 2,601 170,787 81.69 80.35
Positive Screen + Referred 733 55,600 28.18 32.56
Consenting to HS Participation 1,368 96,973 186.63 174.41
Received Initial Contact 1,052 56,766 76.90 58.54
Need Initial Assessment 406 31,686 38.59 55.82
Received Initial Assessment 367 24,864 90.39 78.47
Need Ongoing Care Coordination 564 28,631 53.61 50.44
Sarasota Florida
Percentage of Encounters Services per Percentage of

Clients Clients per Client Encounter Clients
Total Receiving HS Prenatal Service 1,877 6.21 3.06
Total IC/IA Only 245 13.05 2.78 2.51 12.76
Total IC/IA/Other HS Service 107 5.70 3.66 6.72 8.70
Track or Not Face-to-Face 454 24.19 5.54 2.93 19.26
Face-to-Face, without FSP 316 16.84 9.91 3.23 12.43
Face-to-Face, with FSP 199 10.60 16.41 3.54 9.11
Unable to Locate 99 5.27 4.96 1.50 12.86
Unable to Complete Initial Contact 379 20.19 2.49 1.23 15.77
Unable to Complete Initial Assessment 0 0.00 0.00 0.00 0.00

Sarasota
Calendar Year 2008
Sarasota
Clients Services Services/Client
Nutritional Assessment and Counseling 3 22 7.33
Psychosocial Counseling 243 4,795 19.73
Parenting Education 272 2,298 8.45
Childbirth Education 376 11,374 30.25
Breastfeeding Education 445 2,891 6.50
Smoking Cessation Counseling 657 4,500 6.85
Interconceptional Education & Counseling 4 6 1.50
Pregnant Drug-Abusing Women
Clients Encounters/Client Services/Encounter

Sarasota 255 10.73 3.02
Florida 2,005 9.84 4.21
Healthy Start Infant Screening and Services
2006 2007 2008

Screening Rate % 85.51 80.34 91.95 81.82 94.24 86.84
Number Percentage
Total Number of Births 3,022 230,629
Consenting to Screen 2,848 200,286 94.24 86.84
Positive Screen + Referred 300 32,291 10.53 16.12
Consenting to HS Participation 294 27,592 98.00 85.45
Received Initial Contact 739 40,572 251.36 147.04
Need Initial Assessment 323 17,444 43.71 43.00
Received Initial Assessment 297 13,586 91.95 77.88
Need Ongoing Care Coordination 390 15,071 52.77 37.15
Sarasota Florida
Percentage of Encounters Services per Percentage of

Clients Clients per Client Encounter Clients
Total Receiving HS Prenatal Service 1,232 6.95 3.00
Total IC/IA Only 211 17.13 2.05 2.72 13.21
Total IC/IA/Other HS Service 27 2.19 2.00 4.76 14.97
Track or Not Face-to-Face 326 26.46 5.35 2.53 15.49
Face-to-Face, without FSP 259 21.02 9.37 3.08 11.26
Face-to-Face, with FSP 198 16.07 16.46 3.50 8.55
Unable to Locate 46 3.73 5.15 1.80 7.73
Unable to Complete Initial Contact 144 11.69 2.44 1.25 20.56
Unable to Complete Initial Assessment 0 0.00 0.00 0.00 0.00

Sarasota
Calendar Year 2008
Sarasota
Clients Services Services/Client
Nutritional Assessment and Counseling 0 0 0.00

Psychosocial Counseling 257 5,558 21.63
Parenting Education 151 670 4.44
Childbirth Education 0 0 0.00
Breastfeeding Education 76 118 1.55
Smoking Cessation Counseling 449 3,199 7.12
Interconceptional Education & Counseling 4 4 1.00
Substance-exposed Newborns
Clients Encounters/Client Services/Encounter

Sarasota 162 12.96 3.09
Florida 1,691 13.95 4.41

53
Healthy Start Prenatal Screen Data for Sarasota County for 2009
Prenatal Screens
Race Total Prenatal Screens Percent

No Race Noted 489 18.2%
Black 225 8.4%
Other 255 9.5%
White 1711 63.8%
2680
Total No High
Prenatal School or
Race Screens GED Percent
Black 225 18 8.0%
Other 255 20 7.8%
White 1711 29 1.7%
Total
Prenatal Not
Race Screens Married Percent
Black 225 177 78.7%
Other 255 139 54.5%
White 1711 786 45.9%
Total
Prenatal
Race Screens Depressed Percent
Black 225 58 25.8%
Other 255 45 17.6%
White 1711 308 18.0%
Total
Prenatal Drug or
Race Screens Alcohol Use Percent
Black 329 21 6.4%
Other 353 22 6.2%
White 1998 206 10.3%
54
Total
Prenatal Tobacco
Race Screens Use Percent
Black 329 49 14.9%
Other 353 26 7.4%
White 1998 438 21.9%
Total
Prenatal First
Race Screens Pregnancy Percent
Black 225 63 28.0%
Other 255 93 36.5%
White 1711 627 36.6%
Total Previous
Prenatal Poor
Race Screens Outcome Percent
Black 225 12 5.3%
Other 255 9 3.5%
White 1711 39 2.3%
Total Pregnancy
Prenatal Interval <18
Race Screens Months Percent
Black 225 41 18.2%
Other 255 29 11.4%
White 1711 263 15.4%
Total
Prenatal Medical
Race Screens Condition Percent
Black 225 15 6.7%
Other 255 3 1.2%
White 1711 63 3.7%
55
Total
Prenatal
Race Screens BMI <18.9 Percent
Black 225 15 6.7%
Other 255 23 9.0%
White 1711 203 11.9%
Total
Prenatal
Race Screens BMI >35 Percent
Black 225 29 12.9%
Other 255 14 5.5%
White 1711 111 6.5%
Trimester of Entry into Prenatal Care

Total Prenatal
Race Screens 1st 2nd 3rd 1st 2nd 3rd
Black 225 141 74 10 62.7% 32.9% 4.4%
Other 255 182 58 15 71.4% 22.7% 5.9%
White 1711 1297 347 65 75.8% 20.3% 3.8%
Less than 18 years old

Age Black Other White
13
14 2 1
15 1 2 1
16 2 7
17 6 4 9
Wanted to be pregnant
Total
Prenatal
Race Screens Earlier Later Not Now Earlier Later Not Now
Black 329 4 158 80 87 1.2% 48.0% 24.3% 26.4%
Other 353 2 111 42 198 0.6% 31.4% 11.9% 56.1%
White 1998 4 769 180 1045 0.2% 38.5% 9.0% 52.3%
56
Healthy Start Services Data for Sarasota County 2005-2010
Prenatal Screening Rates Infant Screening Rates
100.00%
90.00%
80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
2004-05 2005-06 2006-07 2007-08 2008-09 2009-10
Total # women receiving services Total # infants receiving services
2500
2000
1500
1000
500
0
2004-05 2005-06 2006-07 2007-08 2008-09 2009-10
57
Percent of prenatal clients at highest risk

Percent of infant clients at highest risk
20%
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
2004-05 2005-06 2006-07 2007-08 2008-09 2009-10
Encounters per woman Encounters per infant
9
8
7
6
5
4
3
2
1
0
2004-05 2005-06 2006-07 2007-08 2008-09 2009-10
58
Other Data for Sarasota County
Delivery Payment 2007 45.4% Medicaid FL Charts

Source 47.5% Private Insurance
6.4% Self Pay
Births to Women 2008 15.9% White FL Charts
with BMI of 30 or 27.6% Black
more 9.7% Other Non-White
Births to Women 2008 6.2% White FL Charts
with BMI of 18.5 or 3.2% Black
less 9.7% Other Non-White
Births < 37 wks 2008 12% FL Charts
gestation
Drug Use Among 2008 Drug of Choice: Sarasota County
Healthy Start Marijuana – 135 Healthy Start Program
Clients Opiates – 37
Methadone - 18
Benzo – 11
Cocaine – 10
Other – 9
Total - 220
Average NICU 2009 < 1.1 lbs $333,125 Sarasota Memorial
Costs by Birth 1.1-1.7 lbs $145,479 Hospital
Weight in Pounds 1.7-2.2 lbs $138,689
2.2-3.3 lbs $84,871
3.3-4.4 lbs $35,098
4.4-5.5.lbs $11,947
Zip Code Information
Measure Year Zip Codes Source

Ten zip codes with 2008 34232, 34234, 34229, 34286, Sarasota County
this highest 34237, 34287, 34293, 34288, Health Department
numbers of births, 34239, 34233
in descending
order of
occurrence
59
Highest rates of 2008 34234, 34286, Sarasota County

late prenatal care 34287, 34232, 34237 Health Department
Highest (3 year) 2005 34234, 34275, Sarasota County
rates of low birth To 34285, 34242, 34233 Health Department
weight 2007
Highest rates of 2009 34239 (3), 34232 (2), Sarasota County
fetal death 34231(2), 34286 (2), Health Department
34234 (2), 34275 (2)
Highest rates of 2009 34287 (3), 34234 (2), Sarasota County
infant death 34232 (2), 34239 (2), Health Department
34237 (2), 34286 (2)
60
2008 BREASTFEEDING SURVEY FINAL REPORT
Overview. During the week of March 10-14, 2008, the 2008 Breastfeeding Survey was
conducted in nineteen private and public pediatric health care settings in Sarasota
County. Data obtained from this survey may be used for needs assessment and
evaluative purposes by the Healthy Start Coalition of Sarasota County, the Sarasota
County Health Department, the WIC Program (Women, Infants, and Children Nutrition
Program), local hospitals, private and public maternal child health care providers, the La
Leche League of Sarasota, and others.
The Survey Tool. The survey was designed in both English and Spanish, and was
intended to be distributed to the parent of any child 0-14 months of age visiting a
pediatric health care provider during the week of March 10-14, 2008.
Preparation of the Survey. In preparation for the survey, members of the Healthy Start
Coalition trained staff in each of the participating provider offices. The training was
comprised of succinct written instructions and a verbal review of the procedure. During
the week of the survey reminder calls were made to office personnel and reminder sheets
were passed out to providers to post in their offices. The Healthy Start Coalition
members were available to provide any technical support required during the week of the
survey and collected the surveys upon competition of the survey period.
Results. One Hundred twenty-two (122) surveys were completed and returned by
nineteen pediatricians and pediatric clinics. ZIP code information indicated that 88% of
the respondents resided in Sarasota County, 10% in Manatee County and 2% in Charlotte
County. Of those residing in Sarasota County, there is a distribution of ZIP codes
throughout the county, with the majority located south of University Avenue to north of
Vamo Road. The areas of Osprey, Venice, Nokomis, and North Port were similarly
represented.
The Healthy Start Coalition has summarized major findings below. More detailed
information can be found in the Data Tables.
61
MAJOR FINDINGS
1. Sarasota County did not meet the United States Department of Health and
Human Services Healthy People 2010 breastfeeding initiation goal: Goal, 75%;
Sarasota County, 66%.
2. Few (17%) Sarasota County infants were exclusively breastfed until six months of
age 9.
3. The greatest influences on breastfeeding were the mother’s desire, then the
influence of the husband/partner, family, and obstetrician or nurse, in that order.
4. Breastfeeding rates declined sharply after the baby was two weeks old.
5. A previous positive experience with breastfeeding was a major factor which

increased confidence in breastfeeding. Not having enough time to breastfeed and
inconvenience with school/work were major factors which decreased
breastfeeding confidence.
6. The misperception of a low milk supply was a common factor in decreased

breastfeeding confidence and a significant reason many mothers chose to
supplement with infant formula.
7. Most (89%) employed respondents did not have the opportunity to breastfeed or
pump at work.
8. Returning to work was a substantial reason many mothers chose to supplement

their baby’s breastfeeding with infant formula.
9The American Academy of Pediatrics recommends exclusive breastfeeding until at least six
months of age unless medically contraindicated. (American Academy of Pediatrics Policy
Statement on Breastfeeding and the Use of Human Milk, Pediatrics, Vol. 115, No. 2, February 2005.)
62
Breastfeeding rates for “any” breastfeeding
Healthy 2006 2008 Sarasota

2006 2008 Sarasota
People 2010 National County WIC 13
Florida Data3 County Data 12
Objective 10 Data 11 Data
75% of women
66% 56%
will initiate 74% 76%
(80/122) (30/54)
breastfeeding
50% of women
will continue
17% 13%
breastfeeding 43% 37%
(21/122) (7/54)
for at least 6
months
25% of women
will continue
8% 7%
breastfeeding 23% 18%
(10/122) (4/54)
for at least 12
months
Comments:
In 2008, 66% of mothers in Sarasota County initiated breastfeeding. This did not meet the
Healthy People 2010 objective of 75% as outlined by the US Department of Health and
Human Service’s objectives for Healthy People 2010. This rate of “any” or “ever having
breastfed” falls below both national and Florida rates.
This data shows that Sarasota County also does not meet the Healthy People 2010
objective for “any” breastfeeding at six months or twelve months. Sarasota County also
falls below national and state rates for both continuation of breastfeeding at six and
twelve months post-partum.
10 US Department of Health and Human Services. Healthy People 2010: National health promotion
and disease prevention objectives. 2000. Available at www.healthypeople.gov/Document/.
11 2006 National Immunization Survey, Centers for Disease Control and Prevention, Department of
Health and Human Services. 2006 data is based upon provisional data, final report available
August 2010. Available at www.cdc.gov/breastfeeding/data/NIS_data/ .
12 2008 Breastfeeding Survey conducted by the Healthy Start Coalition of Sarasota County.
Available at www.healthystartsarasota.org .
13 WIC – Women, Infants and Children Nutrition Program
63
Exclusive 14 breastfeeding rates compared to the American Academy of

Pediatrics Recommendations 15 and the Healthy People 2010 Objectives
The American Academy of Pediatrics recommends human milk for all infants in
whom breastfeeding is not specifically, medically contraindicated; with no
supplements given unless ordered by a physician when a medical indications
exists. Exclusive breastfeeding should continue for the first 6 months of life.
Nationally only 14% of In Florida, only 12% of In Sarasota County, 7% of

babies are exclusively babies are exclusively babies are exclusively
breastfed until at least six breastfed until at least six breastfed until at least six
months of age. 16 months of age.8 months of age.
Comments:
The American Academy of Pediatrics first released its breastfeeding recommendations in
1997, and issued a second position statement February, 2005. While the US fails to meet
the AAP’s recommendation that all babies, with few medically necessary exceptions, be
exclusively breastfed until at least six months of age, thirteen states8 meet the Healthy
People 2010 objectives of 17% of babies exclusively breastfed until at least six months of
age 17. The state of Florida and Sarasota County do not meet this objective.
14 Exclusive breastfeeding as used in this survey is defined as more than 80% of feedings are breastmilk. The
source of this definition is Labbok and Krasovec, “Toward Consistency in Breastfeeding Definitions” in
Studies in Family Planning 1990; 21 (4): 226-230.
15 American Academy of Pediatrics Policy Statement on Breastfeeding and the Use of Human Milk,
Pediatrics. Vol. 115, No. 2, February 2005.

16 2006 National Immunization Survey, Centers for Disease Control and Prevention, Department of Health
and Human Services. 2006 data is based upon provisional data, final report available August 2010. Available
at www.cdc.gov/breastfeeding/data/NIS_data/ .
17 US Department of Health and Human Services. Healthy People 2010: National health promotion and
disease prevention objectives. 2000. Available at www.healthypeople.gov/Document/.

64
Race, ethnicity, and exclusive breastfeeding in Sarasota County

Hispanic
Exclusive African-
White Non- Other 18
Breastfeeding White American
White
53% 63% 67% 50% 67%
At Birth
54/102 19
5/8 2/3 3/6 2/3
45% 63% 0% 50% 67%
At 2 weeks
46/102 5/8 0/3 3/6 2/3
32% 38% 0% 17% 67%
At 6 weeks
33/102 3/8 0/3 1/6 2/3
24% 25% 0% 0% 0%
At 3 months
24/102 2/8 0/3 0/6 0/3
8% 13% 0% 0% 0%
At 6 months
8/102 1/8 0/3 0/6 0/3
3% 0% 0% 0% 0%
At 12 months
3/102 0/8 0/3 0/6 0/3
Comments:
It appears that White Hispanic mothers in Sarasota County have the highest exclusive
breastfeeding rates, thought the sample size of that population segment was small. The
sample size for the other racial/ethnic groups was too low for the Healthy Start Coalition
to make any significant comments on breastfeeding rates.
18Asian-Pacific Islanders (2) and unknown (1).

19The denominators listed for all categories are the total number of respondents in each ethnic or
racial category.
65
Race, ethnicity, and combined exclusive and partial 20 breastfeeding

in Sarasota County
Combined Hispanic
Exclusive and African-
White Non- Other 21
Partial White American
White
Breastfeeding
61% 88% 67% 67% 100%
At Birth
62/102 22
7/8 2/3 4/6 3/3
53% 88% 0% 67% 100%
At 2 weeks
53/102 7/8 0/3 4/6 3/3
40% 88% 0% 17% 100%
At 6 weeks
41/102 7/8 0/3 1/6 3/3
29% 25% 0% 17% 67%
At 3 months
30/102 2/8 0/3 1/6 2/3
14% 13% 0% 0% 33%
At 6 months
14/102 1/8 0/3 0/6 1/3
5% 0% 0% 0% 33%
At 12 months
5/102 0/8 0/3 0/6 1/3
Comments:
When looking at combined exclusive and partial breastfeeding rates in Sarasota County,
breastfeeding rates are higher for all groups, though are still less than AAP and Healthy
People 2010 goals. The sample size for the other racial/ethnic groups was too low to
significantly determine true breastfeeding rates or to be able to compare them to whites.
20 Partial breastfeeding defined as 20-80% of feedings are breast milk.

21 Asian-Pacific Islanders (2) and unknown (1).
22 The denominators listed for all categories are the total number of respondents in each ethnic or
racial category
66
Sarasota County combined exclusive and partial breastfeeding rate

decline over 12 months
100%
90%
80%
70% 62%
60% 54%
Values
50%
38%
40%
28%
30%
20% 13%
10% 5%
0%
Birth 2 weeks 6 weeks 3 months 6 months 12 months
Timeframe
Comments:
The data shows that the decline in the breastfeeding rate (combined exclusive and partial
breastfeeding) for Sarasota County is steep and constant. The greatest drops are between
two and six weeks of age, and then again from three to six months.
As breastfeeding declines, so do the benefits for mother and baby. Benefits of
breastfeeding for at least six months (the AAP minimal recommendation) include, but are
not limited to 23:
• In mothers, breastfeeding is linked to a lower risk of type II diabetes, breast and
ovarian cancers, and post-partum depression.
• In infants, breastfeeding can lower the risk and severity of ear infections, stomach
viruses, diarrhea, respiratory infections, asthma, obesity, atopic dermatitis, both
type I and type II diabetes, childhood leukemia, sudden infant death syndrome
(SIDS), and necrotizing enterocolitis.
• Breastfeeding reduces health care costs as breastfed infants require fewer sick
visits, prescriptions, and hospitalizations.
National Women’s Health Information Center, US Department of Health and Human Services.
23
Available at www.womenshealth.gov/breastfeeding/benefits.
67
Influences on the decision to breastfeed for Sarasota County respondents

(N-93/122)
90
80
70
Number of Responses
60
50
40
30
20
10
0
Self Partner Family OB RN WIC Written Internet Friend Hospital Pediatric
Influences
Comments:
The data shows most mothers feel that they make the decision to breastfeed alone,
although it is know that cultural and societal factors throughout their lifetime
influence their thoughts regarding breastfeeding. Partners/husbands were the second
most influential reason for deciding whether to breastfeed, while family was indicated
as the next most influential. Of groups responsible for maternal-child health care, the
obstetrician and/or nurse had the greatest influence on the mother’s decision to
breastfeed.
Note: Not all women who participated in this survey were exposed to all of the
choices offered in this question (such as WIC or Healthy Start).
68
Major factors that increased and decreased confidence in breastfeeding

among respondents
Increased confidence in
Decreased confidence in breastfeeding
breastfeeding
# of # of
Event: responses Event: responses
Positive experience 6 Not enough time to 5
with breastfeeding in breastfeed/inconvenient/school/
the past work
Bonding 5 “Not enough milk” 4
Support from 5 Baby wouldn’t take breast 3
husband, mother of
breastfeeding friends
Knowledge it 4 Pain 3
improves baby’s
health
Hospital 2 Baby had problems due to what 2
mother ate, allergy
Lactating counselor 1 Sore nipples 1
Baby weight gain 1 Baby biting 1
Video 1 Baby lost weight 1
Written information 1 Mom said still good mom if didn’t 1
breastfeed
NICU RN 1 Infection 1
AA meeting 1
Comments:
The majority of mothers stated that their confidence in breastfeeding was increased by a
positive experience with breastfeeding in the past. Support from family and friends and
knowledge of increased bonding also aided in breastfeeding confidence. Inconvenience
for school/work and not enough time to breastfeed were cited as the most common reason
for decreased breastfeeding confidence. “Not enough milk” was cited as the second most
common reason for decreased confidence in breastfeeding.
69
Enrollment of respondents in WIC and Healthy Start and breastfeeding rates 24

for each category
Participation of Breastfeeding
Breastfeeding rate Breastfeeding rate
respondents in rate at 12
at birth at 6 months
program months
WIC during
pregnancy 34% 48% 2% 0%
(42/122)
Healthy Start
during pregnancy
58% 0% 0%
10%
(12/122)
WIC post-partum
28% 56% 9% 3%
(34/122)
Healthy Start
post-partum
57% 6% 1%
6%
(7/122)
Comments:
More women participated in either WIC or Healthy Start during pregnancy than post-
partum. Post-partum support in WIC shows a more positive influence on both initiation
and duration of breastfeeding than participation in the program during pregnancy.
Participation in Healthy Start post-partum shows an increase in duration only.
Note: Participation in either program listed above indicates either financial need or high
risk circumstances, both of which can have a negative influence on breastfeeding
initiation and duration. Also sample sizes for these categories were small; therefore rates
may not reflect the true rates.
24 Combined exclusive and partial breastfeeding rates

70
Breastfeeding rate for respondents who talked with or met with lactation
consultant or attended a breastfeeding class (exclusive and partial)
Participation of Breastfeeding Breastfeeding rate Breastfeeding

respondents rate at birth at 6 months rate at 12 months
Attended a breastfeeding
class while pregnant
76% 12% 4%
20%
(25/122)
Attended La Leche League
meeting(s) while pregnant
100% 50% 33%
5%
(6/122)
Talked with a lactation
consultant by phone or
after discharge 90% 14% 5%
17%
(21/122)
Meet with lactation
consultant after hospital
discharge 88% 24% 12%
14%
(17/122)
Attended La Leche League
meeting after hospital
discharge 100% 40% 20%
4%
(5/122)
Other breastfeeding
support group
100% 29% 0%
6%
(7/122)
Comments:
Mothers who attended breastfeeding support groups such as La Leche League had the
highest breastfeeding rates for both initiation and at six months. Those who went to La
Leche League meetings also had the highest breastfeeding rates at twelve months.
71
Top six reasons Sarasota County respondents choose to supplement

with infant formula
25
20
Number of responses
15
10
0
Baby "hungry" Mother didn’t Convenience Baby "didn't Returning to Mother on
ir oerception want to want" work mediation or
of insufficient breastfeed ill
milk
Reasons to supplement
Comments:
The perception of insufficient milk supply or that the baby is “hungry” is the most
significant reason for mothers in Sarasota County to supplement with infant formula. This
reasoning persists despite the fact that a woman rarely has an inadequate milk supply.
The second most common reason for supplementing with infant formula was that the
mother did not want to breastfeed.
72
Employment of Sarasota County breastfeeding (N=117/122)
60
50
Number of responses
40
30
20
10
Employment areas
Comments:
The majority of respondents listed their employment as a stay-at-home mom. The next
most common response selected was “other professional”.
73
Breastfeeding rates according to category of employment
Employment Exclusive and Exclusive and Exclusive and

category partial partial partial
breastfeeding breastfeeding breastfeeding
combined rate at combined rate combined rate
birth at 6 months at 12 months
Stay at home
66% 16% 5%
mom (N=54)
Other
Professional 83% 10% 3%
(N=20)
Food industry
64% 9% 0%
(N=11)
Hospital
100% 33% 0%
(N=6)
Clerical
80% 0% 0%
(N=5)
Retail
50% 0% 0%
(N=4)
School
0% 0% 0%
(N=2)
Nursing
100% 0% 0%
(N=2)
Grocery
50% 50% 50%
(N=2)
Newspaper
100% 0% 0%
(N=1)
Comments:
With the exception of stay-at-home mom, the numbers of respondents to each category of
employment were too small to make any generalizations. At this time, the Healthy Start
Coalition cannot state specifically which employment category in Sarasota County could
most benefit from workplace support initiatives. Further research would have to be done
in this area.
74
Percentage of employed respondents who had the opportunity to breastfeed or

pump during work hours (N=122)
Yes 11%
No 89%
Comments:
The majority of respondents selected that they did not have the opportunity to breastfeed
or pump during work hours.
75
Other Surveys
A. Summary of 11 Surveys with Healthy Start Care Coordinators

1. Range of years in job: 1.5-16 years
2. The most positive trends seen in the health of clients in the last year were:
increase in breastfeeding; decrease in smoking; early pregnancy health, in early
access to mental health counseling.
3. The most negative trends seen in the health of clients in the last year were:
increase in drug use; depression; increase in obesity; unwillingness to quit
smoking.
4. The most positive changes seen in the socioeconomic status of clients were:
increased access to resources; more intact and supportive families; increased
knowledge of importance of getting a GED or diploma; less homeless.
5. The most negative changes seen in the socioeconomic status of clients were:
unemployment; housing issues; increased stress; decrease in work opportunities.
6. In decreasing order, the services that are most helpful to clients: counseling;
classes; case management with referrals; resources available; help from Healthy
Start at any time; having public transportation; smoking cessation; WIC.
7. In decreasing order, services Care Coordinators would like to see offered were:
transportation; housing.
8. The barriers to providing the best services possible were: too much time doing
data entry; caseload is too high; too much paperwork; too much time chasing
people who don’t want Healthy Start.
9. Care Coordinators responses to “how realistic your caseload is” and “how it
should change” were across the board. Two answers each were given for
acceptable as is and less computer time so you can work with clients.
10. Care Coordinators responses to how changes in the screening process has affected
number and acuity of clients included not seeing a change, and drug use and
psychological problems.
11. “One Wish” to improve structure of the Healthy Start Program: no consistent
responses.
12. “One Wish” to improve community resources: Transportation, affordable or free
housing; in-home parenting; more resources.
76
B. Summary of 32 Surveys with Healthy Start and MomCare Clients:

1. Age range 18-39.
2. 59% white; 38% black; 3% other.
3. 9% Hispanic ethnicity; 6% Eastern European.
4. 84% had delivered baby; 16% were pregnant.
5. 69% were not planning on getting pregnant.
6. Of those not planning on getting pregnant, 66% were not using birth control.
7. Those using birth control mainly used birth control pills or male condoms.
8. 38% reported smoking prior to pregnancy; 50% of those stopped with pregnancy;
42% cut back.
9. 34% reported drinking alcohol prior to pregnancy; 91% stopped with pregnancy.
10. 9% reported street drug use; 100% of those stopped with pregnancy.
11. 38% started prenatal care within the first month of pregnancy; 44% between six
weeks and three months; 16% between four and six
months.
12. 16% had to wait six weeks or more for their first
prenatal care appointment.
13. 9% had to miss prenatal care appointments; 3% for
no transportation and 6% for inconvenient
appointment times.
14. 72% received brochures for prenatal education;
63% engaged in a discussion with Healthy Start;
and 34% in a discussion with prenatal care
providers (more than one option could be chosen).
15. 56% received formula samples at either their prenatal care provider’s office or
their birthing facility; of those 72% were from their birthing facility.
16. 72% would ask their health care provider for information or advice when needed;
others named were mother/mother-in-law, Healthy Start, father, friend, or WIC.
17. The main ways they’d like to receive health information in decreasing order were:
direct mail, by phone with a Healthy Start person, email, Healthy Start website;
Facebook, newspaper, magazine, text messages, in person with a Healthy Start
person, on phone with a MomCare person, Twitter, in person with a MomCare
person, blog.
18. 59% would report directly to ER if they had problems after hours, 34% would call
their doctor, 19% would call 911.
19. 19% did not recall having been told what to do for problems after hours.
77
20. 75% did go to the ER during their pregnancy.

21. Most were satisfied with calls they had to make to the doctor for problems.
22. 64% reported they had no need for additional services during their pregnancy or
after birth.
23. No conclusions can be drawn as to what additional services were needed, as all
answers were singular, with the exception of transportation which was reported
by 2 people.
24. 25% received no information on when to get pregnant again; 9% were told it could
be immediately; 16% were correctly told 2 years was recommended.
25. The services most Healthy Start clients had in descending order were care
coordination, breastfeeding education, psychosocial counseling, car seat class,
childbirth education, parenting education, nutrition counseling, smoking
cessation, interconception health education.
26. Services viewed as most helpful in descending order were Care Coordination,
breastfeeding education, psychosocial counseling, parenting education, car seat
class, childbirth education, smoking cessation, nutrition.
27. 84% read the packet of information sent by Healthy Start.
28. 9% wanted Healthy Start to offer housing, 6% wanted help with transportation,
6% wanted a mom’s group, other suggestions were only named once each. In
conjunction with this question, five respondents had very positive comments
about the help received from Healthy Start. There were no negative comments.
C. Summary of 7 returned surveys with Prenatal Care Providers:

1. Two prenatal provider offices said 0-10% of their clients access Healthy Start
services, two said 11-25% do, one said 51-75% do, and 2 said 76-100% do.
2. Of all the Healthy Start services listed, 5 knew that psychosocial counseling and
smoking cessation programs were offered free to Healthy Start clients; 4 knew that
Care Coordination and parenting education were offered free; 3 knew childbirth
education, 2 knew interconception health and breastfeeding education were; and 1
knew nutrition counseling was.
3. In decreasing order, the services prenatal care providers felt were most helpful
were psychosocial counseling, Care Coordination, smoking cessation, childbirth
education, breastfeeding education, parenting education, interconception health
education, and parenting education.
4. With the exception of dental care and communication classes, all additional
services the prenatal providers would like to see offered are already offered:
assistance finding housing, help with Medicaid, help with food, “be a one-stop
shop.”
78
5. All discuss alcohol use during pregnancy; 2 specifically said no alcohol use; 1 said
they discuss limitations.
6. All discuss tobacco use during pregnancy; 5 suggest ways to quit or get help; 1
discharges the client; 1 discusses limitations.
7. All discuss prescription and over-the-counter medication precautions; 2 give a list
of what’s ok.
8. All ask about street drug use; 1 refers for treatment; 3 discharge the client.
9. Five tell patients to wait 3 to 6 months to get pregnant after having a miscarriage.
10. Five tell patients to wait one year to 18 months to get pregnant after child birth.
11. Two give out formula samples.
12. Five give out breastfeeding information.
13. Five discuss prenatal vitamins or provide prenatal vitamin samples.
14. Most discuss douching with client; two said they do not.
15. All but one said to call or page the office after hours if problems occur; the one
said report to Labor and Delivery.
16. Three did not know for what reasons a patient can be referred to Healthy Start if
they don’t score a 6 or more on the screen; the others said appropriate reasons
were domestic violence, depression, drugs, prior loss, homelessness, or major
stressors (which are all correct.)
D. Summary of 8 returned surveys with Pediatricians:

1. Four pediatric offices said 0-10% of their clients access Healthy Start services, three
said 26-50% access services, and one said 11-25% do.
2. Of all the Healthy Start services listed, 100% of the pediatricians knew that
parenting education was offered free to Healthy Start clients; 75% knew that care
coordination, breastfeeding education, and nutrition counseling were offered free
to Healthy Start clients; 63% knew psychosocial counseling was; 50% for childbirth
education and smoking cessation; 38% for interconception education.
3. In decreasing order, the services pediatricians felt were most helpful were
parenting education, nutrition counseling, case management, breastfeeding
education, smoking cessation, psychosocial counseling, childbirth education,
interconception education.
4. 63% recommend at least one year of breastfeeding.
5. 63% recommend formula only as a backup if absolutely unable to breastfeed.
6. One respondent felt parents should be told of the “wonderful benefits” of formula
feeding.
79
7. 50% recommend that breastfeeding mothers avoid alcohol; 25% recommend

exercising safety precautions if the mother ingested any alcohol; 25% recommend
pumping and dumping.
8. 50% recommend that breastfeeding mother quit smoking; 25% recommend stop
smoking programs; all others at least discuss risks of smoking.
9. Most follow correct guidelines on use of prescription and over the counter
medications while breastfeeding.
10. 25% proactively discuss and advise to stop using street drugs while breastfeeding.
11. A variety of informational materials are distributed by the pediatric offices. No
formula distribution was noted.
12. 75% distribute Safe Sleep information.
13. All noted that some parents have increased concerns regarding vaccinations.
14. 88% instruct patients to call their office for problems; only one instructed them to
go to the Emergency Room.
80
RESOURCE INVENTORY
Resource Inventory:
Sarasota County is fortunate to have a coordinated system of maternal and child health
care, which includes core healthcare services, Healthy Start Care Coordination services,
Wraparound services, and Medicaid eligibility determination. We have a variety of
public and private prenatal and pediatric care providers and birthing facilities. In recent
years we have seen an increase of midwifery practices which provide further options and
are cost effective. Medicaid is accepted by most providers (except in the case of
Temporary Medicaid) and there are sliding scales and payment plans for those who do
not have insurance. Sarasota County also has a high-risk perinatology center and a
Neonatal Intensive Care Unit. There are no issues with service capacity for prenatal and
pediatric health care.
The one model of prenatal care absent in Sarasota County is a Centering Pregnancy
Program. Centering Pregnancy is an alternative to routine prenatal care. It brings women
out of examination rooms and into groups for their care, incorporating risk assessment,
education, and support into one entity. Women are placed into groups of 8 to 12 based on
estimated dates of delivery and meet for ten 90-minute prenatal or postpartum visits at
regular intervals. At these visits, standard prenatal risk assessment is completed within
the group setting, an educational format is followed that uses a didactic discussion
format, and time is provided for women to talk and share with one another. The
Coalition would welcome an opportunity to collaborate with another entity interested in
beginning a Centering Pregnancy model in Sarasota County.
We are able to provide a full range of Health Start Care Coordination and Wraparound
Services. We have the capacity to serve those who are referred via prenatal and infant
risk screening, agency referral, or self-referrals. In the last several years we have
tightened some of the eligibility guidelines in order to serve the highest risk clients and
any who need assistance with smoking cessation or breastfeeding. Our MomCare
Advisors and Healthy Start Care Coordinators are well-versed in assessing women’s
attitudes toward pregnancy and prenatal care, and provide counseling on care choices
and reassurance that their needs will be met.
81
The missing Wraparound Service providers to be recruited during the course of this
Service Delivery Plan to carry out certain activities in the Action Plan are a Healthy Start
Nutritionist, Healthy Start Interconception Education and Counseling Provider and a
Psychosocial Counselor who is also a Certified Addictions Professional.
Resources:
Prenatal Care Providers

Associates in Gynecology and Obstetrics Bee Ridge Obstetrics and Gynecology
 Dr. Wayne A. Cohen  Paul J. Leichter, MD
 Dr. John Sullivan  Ann Andrews, ARNP
 Carol Wolfson, CNM
 Marge Thirion, ARNP
Does not accept Medicaid Accepts Medicaid

Catchment area: Lee, Hillsborough, Catchment area: DeSoto, Manatee,
Sarasota, DeSoto, Manatee, Charlotte Sarasota, Charlotte
Office Hours: M-Th: 8-5; F: 9-1 Services offered: OB & GYN appointments;
Services offered: Prenatal appts and check hemoglobin levels
women’s health appts Will accept indigent patients on a case by
If client does not have insurance, case basis; self pay/payment plans
they have a self-pay program Office hrs: M & W: 9-12 & 2-5
For referrals, the clinic will give contact Tu: 9-12 & 3-6; Th: 9-12; F: 9-2
info to the doctor/agency they are referring
to and the patient has to call themselves to
set up an appointment.
SMH Physicians Services, Inc. Birthways
 Michael Finazzo, MD  Christina Holmes, LM, CPM, CD
Accepts Medicaid for current patients

Accepts Medicaid and Temporary Medicaid
Catchment Area: Sarasota, DeSoto,
Catchment Area: Sarasota, Charlotte,
Hillsborough, Manatee, Charlotte
Hillsborough, Lee, Manatee
M 9-7; T-Th 9-5; F 10-3
Rosemary Birthing Home Home Birth Services
 Harmony Miller, LM  Cathy Matthews, LM
Accepts Medicaid Accepts Medicaid and Temporary Medicaid

Catchment Area: Sarasota, Manatee Catchment Area: Sarasota, Manatee,
Hours: M.T.& Thur. 9-5pm Charlotte, Lee
82
Gulf Coast Obstetrics Gynecology Women’s Care Specialists, First

 Gary Easterling, MD Physician’s Group
 Deanna Doyle, MD  Ruth Dyal, MD
 Richard Jamison, MD  Kelly Hamel, MD
 Lee Cantwell, CNM  Michael Shroder, MD
 Laura Danner, CNM, ARNP  John Hoertz, MD
 Melanie Emery, CNM  Greg Towsley, MD
 Lisa Dorner, ARNP
 Kyle Garner, MD
Accepts Medicaid Accepts Medicaid
Catchment Area: Sarasota, Manatee, Catchment Area: Sarasota, Hillsborough,
Charlotte, DeSoto Manatee, Charlotte, DeSoto, Lee
Hours: M-F 9-5 (closed 12-1)
Sarasota County Health Department Genesis Newton Medical Group

(SCHD) Women’s Care Center, Sarasota  Dr. Thomas Vest
and North Port
 Dr. Ezier Ojeda Accepts Medicaid for prescriptions only,
 Dr. Edwin Ortiz not for office visits
 Dr. John Abu Catchment Area: Sarasota & Manatee
 Dr. Evelyn Santiago Deso accept patients without insurance that
 Dr. Arthur Howard meet federal poverty guidelines (proof of
 Dr. Sanford Estes income is required – W2 or check stubs)
 Dr. Singer
October – April: Wednesday 1-5 pm
Accepts Medicaid and Temporary Medicaid May-September: M or Th 9 am-12 pm
Catchment Area: Sarasota, Manatee, and Family Practice
Charlotte Counties Prenatal Care
Takes Indigent clients – Sliding scale OB/GYN Referrals
Obstetrics, Gynecology,
Mon, Tues, Wed: 8 am-12 pm, 1 pm-5 pm
Thurs: 10 am-2 pm, 3 pm-7 pm
Fri: 9 am-1 pm
Birthing Facilities
Sarasota Memorial Hospital Birthways Birthing Home
Located in Sarasota Located in Sarasota
Rosemary Birthing Home Homebirth Services Birthing Home
83
Lakewood Ranch Medical Center Manatee Memorial Hospital

Located in Bradenton Located in Bradenton
Peace River Hospital
Located in Port Charlotte
Pediatric Care Providers

(not listed are most of the Internal Medicine/Pediatric Dual Certified)
Farzana Butt, MD Flagel Pediatric & Family
Accepts Medicaid  Susan D. Flagel, D.O.
Located in North Port  David A. Flagel, M.D.
Accepts Medicare and Medicaid
Located in North Port
Comprehensive Childcare Associates Pediatrics of Sarasota
 Scott Featherman, MD  Ashfaq Fatmi, MD
Located in Sarasota Accepts Medicaid
Located in Sarasota
Jerome Isaac, MD, PA Nevenka Horvat, MD
Gulf Coast Pediatrics, Sarasota and Englewood Pediatrics
Venice  Ella Guastivino, MD
 Richard Perez, MD
Located in Sarasota Located in Englewood
Sarasota Children’s Clinic Pediatric Associates- Sarasota
 Michael Vacco, MD  Katherine Keeley, MD
 Carola Fleener, MD  Robert Weiss, MD
 Diane Bourlier, MD  Robert Shamsey, MD
 Lisa Ann Bernard, ARNP  Wendy B. Hurwitz, MD
Located in Sarasota
Accepts Medicaid
Located in Sarasota
Jacqueline F. Kelly, MD Eric Patrusky, DO
84
SCHD Child Health Clinic SCHD Child Health Clinic

 Lisa Abello, MD  Caridad Sanchez, MD
 Deborah McKinnis, MD
 Jean DeGuia, MD
Sunshine Pediatric Care Meyer Pediatrics

 Susan R. Mihm, MD  Ted Meyer, III, MD, FAAP
 Azima Khan, MD  Briggs Carroll, MD
Located in Venice Located in Sarasota
Mila Seguerra-Doctora, MD Steven Grogg and John Collins, MD
Accepts Medicaid Accepts Medicaid (for newborns only)
Located in Venice Located in Sarasota
Healthy Start Y N Begin and End

System Providers and Partners Yes or No Date of MOA
for HS
Components Or Contract
funding
Outreach  Prenatal Health Care Providers N
services for  SCHD Healthy Start Program Y 7-10 to 6-11
pregnant women  Healthy Families N
 First Step Mothers and Infants N
Program
 Cyesis School N
 Sarasota County Jail N
 Hospitals and Birthing Centers N
 Early Learning Coalition N
 HS WAS Providers Y 7-10 to 6-11
 MomCare Program Y 7-10 to 6-11
 Save My Life Program Y 7-10 to 4-11
Outreach  Pediatric Health Care Providers N

services for  SCHD Healthy Start Program Y 7-10 to 6-11
children  Healthy Families N
 First Step Mothers and Infants N
Program
 Cyesis School N
 Hospitals and Birthing Facilities N
 Early Learning Coalition N
85
 HS WAS Providers Y 7-10 to 6-11

 DCF N
Process for  SCHD Eligibility Office N
assuring access  MomCare Y 7-10 to 6-11
to Medicaid
(PEPW &
ongoing)
Clinical prenatal  SCHD Women’s Care Clinic N

care for all
unfunded
women
Clinical well-  SCHD Children’s Health Clinic N

child care for all
unfunded
infants
Funding to  SCHD Y 7-10 to 6-11
support the
CHD Vital
Statistics
Healthy Start
screening
infrastructure
Ongoing training  Healthy Start Coalition Y 7-10 to 6-11

for providers
doing screens
and referrals
Initial contact  SCHD Healthy Start Program Y 7-10 to 6-11

after screening
Initial  SCHD Healthy Start Program Y 7-10 to 6-11

assessment of
service needs
Ongoing care  SCHD Healthy Start Program Y 7-10 to 6-11

coordination
Interconception  SCHD Healthy Start Program Y 7-10 to 6-11

education and  Save My Life Program Y 7-10 to 4-11
counseling
86
Childbirth  Sarasota Memorial Hospital Y 7-10 to 6-11

education  Jeanie DeLa Y 7-10 to 6-11
 Charlotte County HSC N
 Lakewood Ranch Medical Center N
 Save My Life Program Y 7-10 to 4-11
 Rosemary Birthing Center N
 Birthways Family Center N 7-10 to 6-11
 Natalia Cava Y 7-10 to 6-11
Parenting  Healthy Families N

support and  JFCS Y 7-10 to 6-11
education  JFCS Healthy Children/Healthy N
Families Y 7-10 to 6-11
 SCHD N
 Forty Carrots Y 7-10 to 6-11
 MTI CPR Training Y 7-10 to 6-11
 Barbara Leverone Y 7-10 to 6-11
 Chip Schaaff (Positive Solutions
for Families) N
 Joy Luce (Positive Solutions for
Families) Y 7-10 to 6-11
 Jeanie DeLa Y 7-10 to 6-11
 Mary St. Aubin N
 Lakewood Ranch Hospital CPR Y 7-10 to 6-11
 Sarasota Memorial Hospital CPR
Nutritional  WIC N
counseling  SMH Diabetes Center N
Psychosocial  Carol Donnelly Y 7-10 to 6-11

counseling  Dolores Dunn Y 7-10 to 6-11
 JFCS Y 7-10 to 6-11
 Dora Limoncelli Y 7-10 to 6-11
 Linda Miller Y 7-10 to 6-11
 Chip Schaaff Y 7-10 to 6-11
 Mary St. Aubin Y 7-10 to 6-11
 Mary Ann Stockstill Y 7-10 to 6-11
 Samaritan Counseling Y 7-10 to 6-11
 Jeanie DeLa Y 7-10 to 6-11
 Tonine Garberino Y 7-10 to 6-11
 Monica Cherry Y 7-10 to 6-11
87
Tobacco  Chip Schaaff Y 7-10 to 6-11

education and  JFCS Y 7-10 to 6-11
cessation  Mary St. Aubin Y 7-10 to 6-11
 Gulf Coast South Area Health N
Education Center
Breastfeeding  Sarasota Memorial Hospital Y 7-10 to 6-11

education and  Save My Life Program Y 7-10 to 4-11
support  Jeanie DeLa Y 7-10 to 6-11
 Natalia Cava Y 7-10 to 6-11
 La Leche League N
 WIC Peer Counseling Program N
Data entry into  SCHD Healthy Start Program Y 7-10 to 6-11

CIS/HMC
MomCare  Healthy Start Coalition N

Program
(SOBRA)
Client  Yellow Cab Y

Transportation  Sarasota County Transit Authority Y
88
ANNUAL ACTION PLAN FOR 2010-2015
The Five Year Action Plan for the Healthy Start Coalition of Sarasota County,
Inc:
Many of our activities over the next five years will take place within our programs or will
involve collaboration with maternal-child health care providers and others who play an
instrumental role in advancing and improving the health of women of childbearing age
and their offspring. It is recognized that socio-demographic and bio-psychosocial
determinants play major roles in the health of a community, and in some regards our
ability to affect change is beyond our control. Nevertheless, the Healthy Start Coalition of
Sarasota County believes strongly in its mission:
 Improve the health and well-being of pregnant women, infants,

and young children 
It is important to us to serve a vital role in assuring private and public entities who have
individual responsibilities for care of the individual within the continuum of the
childbearing years to come together in the spirit of collaboration and a holistic framework
to address the issues which are negatively impacting the quality of life for our families
and our county. The actions described on the pages that follow call those individuals
together to work with us in making sure our young families achieve health and
happiness, free of health problems which can be prevented.
89
ACTION PLAN
2010-2015
CATEGORY B ACTIVITIES – ACTIVITY 1 – PREMATURITY PREVENTION
1. Contract Requirement Or Identified Community-Wide/System Issue:
What is the requirement or system/community-wide problem or need identified to be

addressed by a strategy?
The need to be addressed in this strategy: improvement in pregnancy and pre- and
interconception health in order to improve birth outcomes and reduce the incidence of
fetal or infant death.
What health status indicator/coalition administrative activity is being addressed by this

strategy?
The health status indicator addressed in this strategy is the prematurity rate in Sarasota
County.
This problem, which is occurring locally, statewide, and nationwide, has been recognized
by the March of Dimes and others. Premature babies are at increased risk for newborn
health complications, such as breathing and feeding problems, and temperature
regulation. Over one-third of premature babies die. Premature babies also face an
increased risk of lasting disabilities, such as mental retardation, learning and behavioral
problems, cerebral palsy, lung problems and vision and hearing loss. Two recent studies
suggest that premature babies may be at increased risk of symptoms associated with
autism (social, behavioral and speech problems). Studies also suggest that babies born
prematurely may be at increased risk of certain adult health problems, such as diabetes,
high blood pressure and heart disease. 25
Nationally, the average costs for a premature baby are 10 times that of a full-term baby:
$49,033 versus $4,551. 26 If these costs hold true for Sarasota County, this translates to
almost $18 million dollars for the 362 premature babies born in 2008.
What information, if any, was used to identify the issue/problem (i.e. HPA, FIMR,
screening, client satisfaction, interviews, QI/QA)?
Florida Charts from the Florida Department of Health indicates that in 2008, 12% of births
in Sarasota County occurred prior to the 37th completed week of gestation. While this rate
25 (March of Dimes, 2010)

90
is slightly lower than 12.6% for 2007, the general trend in the last 15 years has been
steadily upward.
2. Planning Phase Questions: (All Required)
What strategy has been selected to address this ?
As a general, overarching strategy, 27 we will implement the new “Right from the Start”
and “text4baby” campaign materials, targeted to women of childbearing age 15-44.
• The Centers for Disease Control “Recommendations to Improve Preconception

Health and Health Care---United States” 28 outlined ten recommendations to
improve preconception health to help achieve Healthy People 2010 objectives to
improve maternal and child health outcomes. These recommendations have
formed the foundation of many educational and public health programs since that
time.
27 Subsequent strategies in this Action Plan address in much more detail particular issues present
in Sarasota County that are affecting health before, during and in between pregnancies.
28 (Centers for Disease Control, 2006)
91
• The “Right from the Start” campaign has been produced by the Florida
Department of Health. The “text4baby” campaign has been produced by the
National Healthy Mothers Healthy Babies Coalition.
• These campaigns include a website, printed materials, magnets, text messaging,
etc., to inform the community about the necessity of attaining health prior to,
during, and in between pregnancies in order to reduce the chance of prematurity
and low birth weight babies.
• “Right from the Start” and “text4baby” information include the following topics:
preconception health in general (pregnancy planning, nutrition, healthy weight,
treatment of infections, avoiding harmful substances), prenatal weight gain,
interconception health (healthy pregnancy intervals, breastfeeding, safe sleep,
interacting with your baby), preterm labor, reducing stress during pregnancy,
coping with crying, and postpartum depression.
See Action Steps
What information will you gather to demonstrate that you have implemented this
strategy as intended (who, what, how many, how often, where, etc.)?
• Reports from each program representative responsible for implementation of

campaign materials.
Where/how will you get the information?
Coalition office files.
What do you expect will be the observed impact of the strategy on the system or
community-wide problem/need?
New or heightened awareness will be present among women of childbearing age about
health issues that affect birth outcomes before, during, or in between pregnancies.
Interconception Counseling services will increase by 5% per year above baseline.
80% of those who received the information through direct one-on-one counseling sessions
or in classes will state they learned new information and that the information will/did
help them address an issue in their life.
What information will you gather to demonstrate this change on the system?
Questionnaires to collect information from Healthy Start, MomCare, and Save My Life
participants regarding their receipt of materials and their usefulness.
92
From the program staff.
3. Action Steps for Activity 1:
BASC=Breastfeeding Advocates of Sarasota County; CQM=Contract and Quality Manager; EDC= Education and
Development Coordinator; CL=Community Liaison; ED=Executive Director; FPWG=Family Planning Workgroup;
HSCC=Healthy Start Care Coordination; MCA=MomCare Advisor; MCS=MomCare Supervisor; SEN=Substance
Exposed Newborn Prevention Committee; SML-Save My Life Coordinator; TCW=Tobacco Cessation Workgroup;
V=Volunteer
ACTION STEP PERSON START END

RESPONSIBLE DATE DATE
A. Local resources will be added to and updated EDC 7-1-10 6-30-15
quarterly on the Right from the Start website.
B. The Healthy Start website and social media CDS, 7-1-10 6-30-15
(Twitter, Blog, and Facebook) will advertise EC/CL, V
the Right from the Start website:
http://www.healthystartflorida.com/rfts/Eng/r
fts.asp?county=Sarasota and flyers placed on
Laundromat bulletin boards three times per
year in the five targeted zip code areas with
the most births in Sarasota County.
C. The Right from the Start, text4baby, and “Why MCS, 7-15-10 10-31-10
the Last Weeks Count” (MOD brochure) will MCA
be incorporated into the MomCare Program
with a plan for their distribution added to the
MomCare procedure.
D. The Right from the Start, text4baby, and “Why EC/CL 7-15-10 10-31-10
the Last Weeks Count” (MOD brochure) will
be incorporated into the Pregnancy Resource
Center.
E. The Right from the Start, text4baby, and “Why CQM, 10-31-10 12-31-10
the Last Weeks Count” (MOD brochure) will HSCC 2-28-11
be incorporated into the Healthy Start
Program with a plan for their distribution.
F. The Right from the Start, text4baby, and “Why SML 7-15-10 10-31-10
the Last Weeks Count” (MOD brochure) will Coordinator
93
be incorporated into the Save My Life

Program with a plan for their distribution.
G. Recruit provider for Interconception CQM 8-1-10 10-15-10

Education and Counseling for eligible Healthy 3-31-11
Start clients.
H. Right from the Start and text4baby materials EC/CL 10-15-10 12-15-10
will be distributed to prenatal and pediatric
care providers and at Health Fairs.
I. Healthy Start Coalition Website Visitors who EDC 12-1-11 12-31-11

link to the RFTS website will be asked to 12-1-12 12-31-12
participate in a survey in which questions will 12-1-13 12-31-13
be asked about increased awareness on the 12-1-14 12-31-14
importance of health before, during or in
between pregnancies, and results will be
analyzed annually.
J. Annual units of service for Interconception CQM 6-1-11 7-31-11

Health will be compared in year-end Action 6-1-12 7-31-12
Plan Updates. 6-1-13 7-31-13
6-1-14 7-31-14
K. Interconception Education and Counseling by CQM, EC/CL 10-15-10 6-30-15

a trained individual will be provided for
Healthy Start Clients eligible for referral.
L. The Interconception Education and CQM, SML 12-1-11 12-31-11

Counseling Wraparound Service Provider and 12-1-12 12-31-12
the Save My Life Coordinator will collect 12-1-13 12-31-13
information on class evaluations regarding 12-1-14 12-31-14
participants’ increased knowledge and
usefulness regarding interconception health,
and results will be analyzed annually.
Quarterly Progress Report July – September, 2010
A. Our local resources were added to the Right from the Start Website (RFTS) on 8-1-10.
B. The Right from the Start “button” was added to the HSCSC Website on 8-1-10. In
addition, the Right from the Start webpage was advertised on the HSCSC accounts for
Twitter, Facebook, and Blog. A volunteer placed the Text4Baby flyers on bulletin
boards in Laundromats in high risk zip code areas in Sarasota County. We are still
looking for a volunteer for South County.
94
C. Right from the Start material is being distributed in the Initial, Post-Enrollment and
Post-Partum Packages for both English and Spanish speaking clients. The flyer for
Text4Baby is sent in the Initial Package for English and Spanish speaking clients. The
March of Dimes “Late Preterm Development” card is sent with the Initial Package for
English and Spanish speaking clients; a sticker is attached to each card offering a free
copy of the brochure “Why the Last Weeks Count.” (This brochure is expensive so we
are trying to give clients info on late term brain development on a card and then offer
the brochure.)
D. The RFTS, Text4Baby, and “Why the Last Weeks Count” materials have been
incorporated into the Pregnancy Resource Center.
E. Not yet due.
F. The RFTS, Text4Baby, and “Why the Last Weeks Count” materials have been
incorporated into the Save My Life Program.
G. No provider has yet been recruited specifically for Interconception Education and
Counseling (ICE) due to current budget constraints and lack of ICE Healthy Start
clients. There are two potential service providers, a RN/RD and a LMHC, who are
interested. The RN/RD is providing the nutritional counseling component and the
LMHC is reviewing the whole curriculum that was developed for Sarasota HS clients
several years ago.
H. RFTS materials are being distributed to Prenatal Care Providers during this quarter’s
round of the Community Liaison’s office visits. They were distributed to Pediatric
Care Providers during the last quarter’s round of visits which was just completed.
Flyers were distributed at the Ready Set Grow Fair in August and the Boar’s Head
Employee Health Fair in October.
I. Not yet due.
J. Not yet due.
K. Currently, the HS Care Coordinators provide specific educational interconception
services individually, but do not teach the whole curriculum. See item G.
L. Not yet due.
Quarterly Progress Report October -Dec 2010
A. Local resources on the RFTS website were updated and corrected on 10-30-10.
B. Ongoing – our website displays the RFTS image with the link, and on 10-10-10 our
social media (FaceBook and Twitter) was updated with the link.
C. Completed.
D. Completed.
95
E. The Text4baby materials are being distributed through Care Coordination to

every client. The “Why the Last Weeks Count” brochures have not been
ordered due to lack of budget. If money cannot be found, we will explore
developing our own brochure. RFTS materials are not yet disseminated
through Healthy Start.
F. Completed.
G. There are no Interconception clients this quarter. The CCs provide specific
interconception education services individually based on need, but do not
teach the whole curriculum. The Nutrition Counselor is unable to take on this
additional service. One of our Spanish speaking psychosocial counselors is
interested in providing the education as it fits into her current services,
however she may not have the budget or time to provide Interconception
counseling. The current curriculum needs to be updated and expanded. We
are now exploring a collaborative effort with Planned Parenthood to provide
the IC counseling as part of their current counseling. Care Coordinators will
meet with PP staff in the next month to brainstorm curriculum and referral
process.
H. RFTS materials distributed at Boar’s Head Employee Health Fair on 10-15-10
and to health care providers who were visited between October and December.
I. Not yet due.
J. Not yet due.
K. See G.
L. Not yet due.
Quarterly Progress Report January – March, 2011
Quarterly Progress Report April – June, 2011
4. REPORTING PHASE ANSWERS: (To Be Completed For the Annual Action

Plan Update)
96
Demonstrate that you have implemented this strategy as planned (who, what, how
many, how often, where, etc.).
Demonstrate the changes in the system/community.
Will you drop/modify/expand/continue strategy next year?

97
ACTION PLAN
2010-2015
CATEGORY B ACTIVITIES – ACTIVITY 2 – SMOKING CESSATION


strategy?
The health status indicator addressed in this strategy is the persistently high smoking
rate among pregnant women in Sarasota County.
Tobacco use during pregnancy can cause a reduction in birth weight of 150-250 g,
increases the risks of intrauterine growth retardation, spontaneous abortion, placenta
previa, placenta abruption, fetal death, and preterm birth. Life-long effects to a fetus
exposed to tobacco smoking can include behavioral and developmental problems.
The MCH Health Problem Analysis for Sarasota, Calendar Year 2008, published by the
Florida Department of Health shows the percentage of births to mothers who smoke
continuing to increase in Sarasota County while it decreases in the state of Florida:
 Sarasota County
 Florida
The rate of 12.7% for 2008 is

the highest rate of smoking
prevalence in the last three
years.
2006 2007 2008

98
We will promote uniform counseling messages and support for women at risk of
continuation of tobacco use during pregnancy or between pregnancies; delivered by
service and care providers who interface with pregnant women, utilizing an
established tobacco use cessation program which incorporates the 5 A’s approach.29
• Sociodemographic background, family environment and attitudes, and ethnic

status play a role in the cessation of tobacco use among pregnant women. Those
who are at high risk of continued tobacco use during pregnancy are women of
high who have several other children, live in homes without the infant’s father, are
previous heavy previous smokers, and are exposed to daily passive smoking. A
positive attitude towards smoking also predicts continuation, even as women who
consider themselves addicted or dislike smoking find the social, psychological and
physical effects rewarding (especially for relief of stress).
• White women are more likely to quit tobacco use if they’ve attained higher
education. Black women are more likely to stop if they intend to breastfeed.
Hispanic women tend to quit based on the number of cigarettes smoked prior to
pregnancy. Also, women are more likely to quit who have previously quit for
more than one week; have a nonsmoking partner; receive encouragement to stop
tobacco use by their partner; entered prenatal care early; or believe children of
smokers are more likely to have health problems or get infections.
• Best practices for tobacco use cessation include having concurrent programs for
the general population and tobacco use cessation programs for pregnant women --
with incentives -- in all maternity care settings. Programs which include
motivational interviewing, a feedback mechanism, or a buddy system also hold
promise. 30, 31
In Sarasota County, the Gulf Coast South Area Health Education Center (AHEC) provides
individual and group support for quitting through a 5 A’s program, and encouragement
to use the Quit Line. Both AHEC and the Sarasota County Health Department participate
in the Sarasota Smoke-Free Partnership to support education and systems change toward
a smoke free environment.
See Action Steps
29 5 As of smoking cessation are Ask, Advise, Assess, Assist, Arrange

30 (Edwards, 1998)
31 (Angela Stotts, 2009)
99
• TWG minutes
• Training curricula, training records, and evaluation summaries
• Grants documentation
• Participant tracking summaries and other statistics
• Evidence of policy support in our print or social media
Coalition office files and Healthy Start Program Data.
Increase by 10% over baseline the number of Healthy Start Tobacco Cessation services
accessed by pregnant women who smoke.
Increase by 10% over baseline the number of Quitline calls accessed by pregnant women
who smoke during pregnancy.
Reduce the percentage of births to women who smoked during pregnancy.
Healthy Start Tobacco Cessation Services data; Quitline data; Percentage of births to
mothers who smoked during pregnancy.
Florida Department of Health, Office of Vital Statistics, Birth Certificate Data, GH330L.
BASC=Breastfeeding Advocates of Sarasota County; CQM=Contract and Quality Manager; EDC=

Education and Development Coordinator; CL=Community Liaison; ED=Executive Director; FPWG=Family
Planning Workgroup; HSCC=Healthy Start Care Coordination; MCA=MomCare Advisor; MCS=MomCare
Supervisor; SEN=Substance Exposed Newborn Prevention Committee; SML-Save My Life Coordinator;
TCW=Tobacco Cessation Workgroup; V=Volunteer
100

A. Apply for a Community Health Worker grant EDC 8-1-10 9-30-10
on “Tobacco Prevention and Cessation.”
B. Form a TCW comprised of Healthy Start Co-Chairs: V, 9-1-10 11-1-10

Coalition, Healthy Start Program employees EDC 12-31-10
responsible for tobacco use cessation 2-10-11
education and services, and others as deemed
necessary or who are interested.
C. The Workgroup will set up and participate in TWG, 1-1-11 4-30-11

a “Train the Trainer” workshop for Make EDC
Yours a Fresh Start Family, securing funding
for the training, if necessary, through a grant.
D. The Chair or a member of the TCW will serve V 1-1-11 1-1-12

on the Tobacco Free Partnership in Sarasota
County.
E. The Workgroup will review the Baby TWG, 4-1-11 6-30-11

Promise Incentive Program for pregnant EDC
women who reduce and/or quit tobacco use,
and determine whether to keep it, revise it, or
create a new incentive program, and secure
funding for the incentives through a grant or
donation.
F. The Workgroup will develop a method for TWG 4-1-11 6-30-11
tracking Healthy Start participants who
receive the tobacco use cessation education
and support to determine reduction, quit,
and relapse rates.
G. The Workgroup will develop a method for TWG 4-1-11 6-30-11

tracking Quitline access rates by pregnant
women.
H. The Workgroup will develop a program TWG 4-1-11 6-30-11

evaluation form for pregnant women who
received the education, to assess learning,
attitude change, and ability to reduce or quit
tobacco use.
I. The Workgroup members will set up and EDC, TWG, 7-1-11 8-31-11
train Healthy Start Care Coordinators and CQM
Wraparound Service Providers on Make
101
Yours a Fresh Start Family and the incentive

program, and will develop a tool for
participants to evaluate the training.
J. The Workgroup members will set up and EDC, TWG 10-1-11 12-31-10
train prenatal care providers and staff on the
selected program and its incentives.
K. The Workgroup members will set up and EDC, TWG 1-1-12 3-31-12
train selected staff members from five other
agencies or care providers who interface with
pregnant women on the selected program
and its incentives, i.e. WIC, Sarasota
Memorial Hospital L&D Triage and
Antepartum Staff, Healthy Families,
pediatricians, etc.
L. Provider and client evaluations will be TWG 1-1-12 2-12-12

compiled and summarized approximately 8-1-12 9-30-12
every 6 months. 3-1-13 4-30-13
M. The Workgroup members will provide TWG 4-1-12 6-30-15

technical assistance and follow-up to those
trained on an ongoing basis, and assure new
staff receive training.
N. The Coalition will advocate for and support ED, 10-1-10 11-30-10
social policy changes to reduce tobacco use, EDC 10-1-11 11-30-11
annually through its media during the Great 10-1-12 11-30-12
American Smoke-Out Month each 10-1-13 11-30-13
November, with special attention paid to 10-1-14 11-30-14
cigarette and hookah smoking.

A. Grant applied for. Awaiting a response from Gulfcoast South Area Health Education
Center.
B. A potential chairperson has been identified.
C. Not yet due.
D. Not yet due.
E. Not yet due.
F. Not yet due.
G. Not yet due.
H. Not yet due.
102
I. Not yet due.

J. Not yet due.
K. Not yet due.
L. Not yet due.
M. Not yet due.
N. Not yet due.
Quarterly Progress Report October-December, 2010

A. Received Grant from GSAHEC on 11-1-10 to hire and train 6 Community
Health Workers to provide Tobacco Prevention and Cessation education across
Sarasota County. Training was held 12-4-10.
B. One of our Psychosocial Counselors who provides smoking cessation services has
agreed to co-chair the Tobacco Cessation Workgroup. A potential list of members has
been developed. The first meeting will be held next quarterly.
C. Not yet due.
D. Not yet due.
E. Not yet due.
F. Not yet due.
G. Not yet due.
H. Not yet due.
I. Not yet due.
J. Not yet due.
K. Not yet due.
L. Not yet due.
M. Not yet due.
N. Issued Constant Contact email to members and friends regarding the Great American
Smoke-out Date, with Quit Smoking Resources and Information listed.

103

Plan Update)

104
ACTION PLAN
2010-2015
CATEGORY B ACTIVITIES – ACTIVITY 3 – REDUCE SUBSTANCE ABUSE


strategy?
The health status indicator addressed in this strategy is the increasing and alarmingly
high number of pregnant drug abusing women and substance exposed infants in
Sarasota County.
Women with drug (or alcohol) problems in pregnancy are at increased risk of miscarriage,
fetal death, placental abruption, infections and postnatal depression. Babies are at risk for
being born premature or of low birth weight, having birth defects, withdrawal symptoms
or impaired development throughout life.
• Women who have drug addiction issue often delay seeking help if they seek help
at all due to stigmatization and fear of repercussions. There are often other serious
health and mental health issues present. Increasing length of time being addicted
and concurrent health issues make addictions more difficult to treat.
• 70% of women who abuse drugs have been sexually abused by the age of 16, and
most had at least one parent who abused alcohol or drugs. 32
• Low self-esteem, little self-confidence and feeling powerless and isolated lead to
drug abuse.
• Continued use after pregnancy may lead to child neglect, physical abuse, or
childhood malnutrition.
32 (National Institute on Drug Abuse, 1994)

105
The number of pregnant drug abusing women in Healthy Start in 2006-2007 was 202, or
6% of all births. The next year it increased to 250, or 8% of all births, and in 2008-2009 it
was 275, or 9% of all births. According to the March of Dimes, 4% of pregnant women in
the U.S. use illicit drugs. 33 This local data probably under-represents drug abuse among
pregnant women throughout Sarasota County, as most private physicians do not
routinely perform drug screens on patients; not all drug abusing pregnant women are
referred to Healthy Start; and drug abuse is under-reported by users.
The number of Healthy Start services to pregnant drug abusing women in the last three
year period jumped from 6,571 to 10,404. 34 The number of encounters per each pregnant
drug abusing woman in Healthy Start has risen from 9.8 to 11.49. These changes
demonstrate the rise in the number of cases and the intensity of the services required.
During that same time period the number of substance exposed newborns increased from
135 to 170. Methadone, opiates, and marijuana are drugs of choice.
Healthy Start Services to Pregnant Drug Abusing Women

2004-2006 2006-2008
Encounters/Client 9.8 11.49
Total Services Provided 6,571 10,404
Substance Exposed Newborns, Cited in Healthy Start Records

2004-2006 2006-2008
Total: 135 170
We will seek to improve screening of and prenatal treatment for pregnant drug abusing
women through community and professional education, and advocate for routine drug
screening and readily available treatment.
Best practices cite the importance of routine screening and treatment in the reduction of
substance abuse among pregnant women, and linking that treatment with comprehensive
prenatal care. 35

34 One unit of service equals 15 minutes
35 (Universal Screening, Assessment, and Treatment of Substance Use at Prenatal Visits Improves
Obstetric Outcomes, 2009)

106
See Action Steps
• Substance Exposed Newborn Prevention Committee minutes

• Prenatal Care Provider Visit Logs and materials
• Completion of a services contract for a Healthy Start Counselor with Certified
Drug Addictions specialization
• Workshop agenda, program, and evaluations;
• Number of referrals from prenatal care provider to Healthy Start for services
• Evidence of advocacy for treatment of drug abuse for pregnant women in our
print or social media
Coalition office files; Healthy Start Program data, Florida Department of Health Office of
Vital Statistics
The number of Substance Exposed Newborns in Healthy Start will be reduced 5% each
year relative to the number of identified pregnant drug abusing women.
• The number of identified substance abusing pregnant women.

• Referrals from prenatal care providers
• Consent to treatment rates.
• The number of identified Substance Exposed Newborns.
Healthy Start Reports from the Florida Department of Health and the local Healthy Start
Program.
107


A. The Healthy Start Coalition will continue to ED 9-1-10 6-30-15
sponsor the Substance Exposed Newborn
Prevention Committee (SEN) for Sarasota
County and hold quarterly meetings.
B. Recruit a Psychosocial Counselor who is a CQM 9-1-10 12-31-10

Certified Drug Addictions Professional for
Healthy Start Wraparound Services.
C. The SEN will assist the EC/CL in developing SEN 10-1-10 12-31-10
information to present to prenatal care CL 9-1-10 10-31-10
providers and their staff about the etiology
and hazards of prenatal drug abuse,
advantages of screening pregnant women,
and how to refer to Healthy Start for services.
D. Explore the collection of data through HMS CQM, 1-1-11 3-31-11

for tracking drug abuse referrals into Healthy HSCC
Start from all prenatal care providers and the
percentage of women accepting treatment.
E. Educate/update prenatal care providers and CL and V 1-1-11 3-31-11

the information developed by the SEN.
F. Prepare for Community Workshop on “Drug SEN, EDC 4-1-11 6-30-11

Abuse among Pregnant Women in Sarasota
County,” utilizing local professionals as
speakers.
G. Present a Community Workshop on “Drug EDC, 7-1-11 8-31-11

Abuse among Pregnant Women in Sarasota SEN
County.”
H. The Healthy Start Coalition will annually ED, 4-1-11 5-31-11

advocate to the community the need to assure EDC, 4-1-12 5-31-12
readily available in- and out-patient treatment Staff 4-1-13 5-31-13
108
for pregnant women who are abusing drugs 4-1-14 5-31-14

during National Alcohol and Drug Related 4-1-15 5-31-15
Birth Defects Month each May.

A. Substance Exposed Newborn Prevention Committee (SEN) meeting was held on 9-29-
10. Minutes are included in Section D of the Quarterly Report.
B. A Certified Addictions Specialist (CAP) has not been recruited, although it is a
priority. Wraparound Services funding is currently above its monthly budgeted
amount, limiting our ability to recruit.
C. A Medical Student/volunteer created a document to be distributed during the
Community Liaison’s next set of rounds to prenatal care providers on substance abuse
during pregnancy. The document was reviewed and approved by the SEN
committee.
D. Not yet due.
E. Not yet due.
F. Not yet due.
G. Not yet due.
H. Not yet due.

A. SEN Meetings was held on December 1st. Minutes are included in Section D of the
Quarterly Report.
B. A CAP counselor has not been recruited, although it is a priority. The budget
does not allow for a contract at this time. The Provider Council meeting 1-27-
11 is devoted to Coastal Behavioral services presentation to explore how HS
clients can access their counseling services.
C. Completed.
D. Care Coordination has developed a report showing drug referrals from

prenatal providers. No report is developed to track how many of those
referred are “accepting treatment.” We do not have a system to track
individuals, just numbers at this point.
E. Not yet due.
F. Not yet due.
G. Not yet due.

109
H. Not yet due.

Plan Update)

110
ACTION PLAN
2010-2015
CATEGORY B ACTIVITIES – ACTIVITY 4 – REDUCE OBESITY


strategy?
The health status indicator addressed in this strategy is the increasing number of
pregnant women who rank as obese, with a BMI of 30 or above.
Obese women are at increased risk for gestational hypertension, preeclampsia, gestational
diabetes, spontaneous abortion, and cesarean delivery. Cesarean delivery of obese
women is particularly dangerous due to potential for additional serious complications.
Hazards to the fetus when the mother is obese are fetal macrosomia, neural tube defects,
and fetal death. Children of obese women are more likely to have childhood obesity. 36
Beginning in 2004, Florida Birth Certificates began recording the mother’s pre-pregnancy
weight and height to determine BMI. The percent of births to obese mothers in Sarasota
County is 16.7%. BMI of 30 or more has increased for all races in Sarasota County, but is
especially high for Black women. Between 2007 and 2008, the BMI decreased somewhat
for Blacks and Other Non-Whites.
Local FIMR37 data from July 2008-June 2009 shows that 30% of all demises were to women
who immediately prior to pregnancy had a BMI at 30 or more.
36 (ACOG Committee on Obstetric Practice, 2005)

37 Fetal and Infant Mortality Review Project
111
We will provide education to the community and enhance appropriate Healthy Start
services to reduce the hazards of obesity during pregnancy, utilizing the ACOG
recommendations on obesity, nutrition and exercise during pregnancy.
• Obesity is increasingly a problem for all groups, including women of child-bearing

age and pregnant women. Obesity results from an energy imbalance that involves
eating too many calories and not getting enough physical activity. The choices
people make are influenced by their relationships with family, friends, neighbors
and colleagues; their home, workplace, neighborhood and school environments;
their economic limitations; and their genetics, physiology, psychology and life
stage.
• The American College of Obstetricians and Gynecologists (ACOG) recommends

preconception counseling with provision of specific information concerning the
maternal and fetal risks of obesity in pregnancy. Protocols for nutrition, weight
gain, and exercise during pregnancy are available to prenatal care providers and
others. ACOG also recommends the continuation of nutrition counseling and
exercise program after delivery, and consultation with weight loss specialists
before attempting another pregnancy.
See Action Steps

112
• Number of visits to prenatal care provider offices by the EC/CL 38 to offer

information on obesity in pregnancy and available services in the community and
through Healthy Start.
• Number of referrals of women with a BMI of 30 or greater to Healthy Start by
prenatal care providers.
• Community Health Worker 39 Program summaries with post-evaluations from
participants who attended the peer trainings.
• Number and quality review of records of Healthy Start clients with BMI of 30 or
greater who have received standardized education on hazards of obesity and
guidelines for reducing weight, including distribution of pedometers as incentives.
• Number of referrals to Healthy Start Nutrition Counselor and outcomes, as
indicated in wraparound service provider chart reviews.
• Memorandum of Understanding with exercise or yoga program partners to offer a
reduced rate program for Healthy Start clients who have medical clearance.
Prenatal care provider visit logs; prenatal screens indicating referral to Healthy Start for
obesity; Community Health Worker contract files; QI/QA reviews of Healthy Start client
records with BMIs at 30 or above; grant file; wraparound service provider files.
Referrals to HS from health care providers for BMI>30 will increase by 5% each year
above first established baseline.
Referrals of those HS clients to Nutrition Counseling will increase by 5% each year above
first established baseline.
HS client service engagement in Nutrition Counseling will increase by 5% each year

above first established baseline.
Greater awareness in women of child-bearing age regarding the need to be at a healthy

weight during pregnancy and ability to access services when in Healthy Start.
38 Community Liaison – Healthy Start Coalition employee who provides Healthy Start screening
training and other updates to prenatal and pediatric care providers and birthing facilities.
39 Community Health Worker – trained members of the community who offer peer-to-peer
education.
113
Number of referrals from health care providers for elevated BMI; number of referrals of
Healthy Start clients to Nutrition Counseling; units of services for Healthy Start
Nutritional Counseling, and participant comments from those who attended Community
Health Worker peer trainings.
Coalition files; Healthy Start Screens, Healthy Start Records.


A. Identify and form a partnership with ED 9-1-10 12-31-10
specialized exercise or yoga programs to offer
reduced rates for obese women and pregnant
obese women in Healthy Start, according to
their physician recommendations.
B. Recruit a Nutrition Counselor for Healthy CQM 1-1-11 4-30-10

Start Wraparound Services, preferably with 8-1-10 9-30-10
experience working with high-risk women.
C. Obtain a grant to purchase pedometers for EDC 9-1-11 11-31-11

Healthy Start clients with a BMI of 30 or
above.
D. Establish a method for utilizing HMS to track CQM, 9-1-11 11-31-11

1) referrals to HS from providers for BMI>30, HSCC
2) referrals of those new HS clients to
Nutrition Counseling, and 3) engagement of
the client in Nutrition Counseling services.
E. Develop and implement a Community EDC 12-1-11 5-31-12

Health Worker Program on reducing the
114
hazards of obesity prior to pregnancy.
F. Implement standardized protocol for Healthy CQM, EDC 12-1-11 2-28-12

Start Care Coordinators to utilize with
pregnant and interconception women in
Healthy Start to instruct clients with a BMI of
30 or above on the hazards of obesity in
pregnancy and the ACOG guidelines for
reducing weight; and obtain grant to include
pedometers as incentives for increasing
activity in the absence of medical
contraindications.
G. Educate/update prenatal care providers and CL 4-1-12 6-30-12

their staff about the hazards of obesity during
pregnancy, advantages of using the HS
screen to calculate BMI, how to refer to
Healthy Start for services, and other available
services to help reduce obesity among
women of child-bearing age.
H. The Healthy Start Coalition will annually ED, 2-1-11 3-31-11

increase awareness in the community about EDC 2-1-12 3-31-12
the hazards of obesity in relation to 2-1-13 3-31-13
pregnancy and birth outcomes during each 2-1-14 3-31-14
National Nutrition month each May. 2-1-15 3-31-15

A. The name of the contact for discussing a partnership with Sarasota Memorial
Hospital’s (SMH) Healthplex has been identified, but a meeting has not yet occurred.
They have very recently started their “Moms in Motion” pregnancy exercise program,
and services are at this time free if the pregnant woman is delivering at SMH.
B. A Registered Dietician was recruited and has signed a contract for Nutritional
Services. The protocol for referrals has been set. Referrals have been made, and
services have been provided. Some clients are not following through and there have
been many no-shows. We continue the work on the further refining the steps of the
protocol which was set up between Healthy Start, WIC, and the Nutritionist.
C. No activity.
D. No activity.
E. Not yet due.
F. Not yet due.
115
G. Not yet due.

H. Not yet due.

A. The ability of Healthy Start women to attend Moms in Motion at the SMH Healthplex
is limited due to transportation issues. The complex is in far eastern Sarasota, near the
interstate, and the closest SCAT bus stop is not in walking distance. Nevertheless, we
will continue to advertise the program.
B. The Nutritionist has rented an office, and established a separate cell phone
number. Her service provision has increased every month.
C. Not yet due.
D. Not yet due.
E. Not yet due.
F. Protocol for BMI > 30 is completed and working well.

Plan Update)

116
ACTION PLAN
2010-2015
CATEGORY B ACTIVITIES – ACTIVITY 5 – REDUCE MATERNAL INFECTIONS


strategy?
The health status indicator addressed in this strategy is maternal infections which can
lead to preterm labor, premature birth, and low birth weight; all of which increase the
risk of infant mortality.
Urinary Tract Infections (UTIs) are one of the most common bacterial infections during
pregnancy. Pregnant women may or may not have any symptoms of UTI, and even if
symptoms are present, the increased pressure of a growing uterus may mask them.
Women of very low socioeconomic status are five times as likely to have a UTI. Sexual
activity increases the likelihood of UTI. Diabetic changes in the immune system also raise
the risk of UTI. UTIs are associated with fetal and maternal risks, such as kidney
infection, hypertension, amnionitis, preterm birth, intrauterine growth retardation, low
birth weight and perinatal mortality.
Gingivitis and Periodontitis, which are inflammatory, infectious diseases of the gums,
increase the risk for poor birth and pregnancy outcomes such as preterm birth, low birth
weight, and gestational diabetes. 40 Changes in hormones during pregnancy can increase
susceptibility to these problems. Women who have low incomes, belong to racial or
ethnic minority groups, or participate in Medicaid are half as likely to receive oral health
care while pregnant. Oral screenings, education, and referrals to oral health professionals
are not routinely offered during prenatal care. Not receiving information about the
importance of oral health from prenatal care providers significantly reduces the likelihood
that pregnant women will seek oral health care. 41 Some health professionals are hesitant
to provide or recommend certain oral health services to pregnant women even though
40 (X. Xiong, 2006)

41 (Idaho Department of Health, 2005)
117
these services have recently been shown to have less risk and greater benefit than
previously thought.
Genital tract infections, such as Bacterial Vaginosis, certain sexually transmitted diseases,
and HIV, can cross into amniotic fluid and result in premature rupture of membranes and
premature labor. Women of every socioeconomic and educational level, age, race,
ethnicity, and religion may be affected.
FIMR data from 2008-2009 show that in 14 of 28 fetal and infant death cases reviewed
indicated that genitourinary tract infections were present in the birthing mother. Dental
or gum disease was present in 21%, which is probably underestimated as oral health is
not always readily assessed during pregnancy.
Percentage of FIMR Fetal & Infant Death Cases

with Reported Infections
Dental or Gum Disease 21%
Genitourinary Tract Infections 50%
0% 10% 20% 30% 40% 50% 60%
We will improve public awareness of the risks of maternal infections during pregnancy
and the importance of prevention and adherence to treatment protocols.
• The best practice for reducing risk of preterm birth and low birth weight related to
symptomatic or asymptomatic UTI is routine screening and aggressive treatment
with antibiotics. 42, 43 It is important for all pregnant women to know the
symptoms of urinary tract infection, understand the dangers, and comply with
antibiotic treatment and follow-up.
• Oral health education for women of childbearing age increases awareness about
the need for good oral hygiene prior to and during pregnancy.
42 (J.E. Dezell, 2000)

43 (Rosh, 2009)
118
• Screening and treatment of genital tract infections, especially before 20 weeks of

gestation, have been found to reduce preterm birth and preterm low birth
weights. 44 Women who have had a preterm delivery in the past should be tested
for Bacterial Vaginosis when again becoming pregnant. It is important for all
pregnant women to know the symptoms of genital tract infection, understand the
dangers, and comply with antibiotic treatment and follow-up.
• Adherence to antibiotic treatment and prevention protocols can be problematic
among high-risk women. Barriers to treatment adherence include inadequate
knowledge regarding guidelines, cultural issues, personality variables, mental
illness, lack of social support, inadequate resources, and lack of adherence-related
skills. 45 Health care and other service providers should understand barriers to
treatment adherence and work closely with patients and clients diagnosed with a
maternal infection.
See Action Steps
• Fact Sheet for Healthy Start clients on “Maternal Infections”

• QI/QA reviews of Healthy Start client records who have maternal infections
• Resource List for dental health providers
• Program evaluations, curriculum and incentives for “Start Motherhood with a
Healthy Mouth” Program
• Program file for “Updated Recommendations for Treating Maternal Infections”
Coalition office files; Healthy Start records
Reduction of the percentage of FIMR reviewed cases indicating presence of a maternal

infection to 20%.
Manual calculations of types of maternal infections in FIMR cases annually.
44 (U.S. Sangkomkamhang, 2009)

45 (W.T. O'Donohue, 2006)
119
FIMR Coordinator.


A. Include in MomCare information a fact sheet MCS 11-1-10 12-31-10
on Maternal Infections, including the
information above along with oral health
during pregnancy.
B. Re-assess dental health resources in Sarasota MCS 3-1-11 4-30-11

County and produce a resource inventory.
C. Implement standardized protocol for Healthy CQM, 4-1-11 6-30-11

Start Care Coordinators to utilize with HSCC
Healthy Start clients who are known to have
been diagnosed with any genitourinary
infection. The protocol should include the
review of a fact sheet, by telephone or face-to-
face, about reporting symptoms of the
infection, following the prenatal care
provider’s treatment, filling prescriptions,
taking all of the prescribed antibiotics,
returning to the prenatal care provider if
symptoms do not abate; and attending the
follow-up appointment.
D. Co-sponsor with a community partner an ED, 8-1-11 11-30-11

educational program for prenatal care EDC
providers and others on “Updated
Recommendations for Treating Maternal
Infections.”
E. Update the Healthy Start Coalition’s “Start EDC 10-1-12 11-30-12

Motherhood with a Healthy Mouth”
120
community education program, which

includes information on brushing, flossing,
balanced nutrition, and regular dental
checkups.
F. Implement a Community Health Worker EDC 12-1-12 5-31-13

Program for the “Start Motherhood with a
Healthy Mouth.”
G. The Healthy Start Coalition will increase ED, 9-1-10 10-30-10

awareness in the community about the risks EDC 9-1-11 10-30-11
of periodontal disease during pregnancy each 9-1-12 10-30-12
Dental Hygiene month each October through 9-1-13 10-30-13
our social media (Website, Blog, Twitter, and 9-1-14 10-30-14
Facebook).

A. Not yet due. The MomCare Supervisor is investigating the available materials on
maternal infections for purchase; if not available the Coalition will develop a handout.
B. Not yet due.
C. Not yet due.
D. Not yet due.
E. Not yet due.
F. Not yet due.
G. On September 3rd the “Start Motherhood with a Healthy Mouth” page was added to
the Coalition website. It includes a banner to advertise “Start Motherhood with a
Healthy Mouth” which will remain on throughout the month of October. Our July-
September quarterly newsletter included an article on this topic, and the link to that
article was placed on our website also.

A. A fact sheet on Maternal Infections has been developed by the Coalition with
information on infections that may affect pregnancy outcomes. Topics included are
oral health, UTIs, STIs, food & animal borne infections. This fact sheet is included in
the first packet of information to all MomCare clients, both English & Spanish
speaking.
B. Not yet due.
C. Not yet due.
121
D. Not yet due.

E. Not yet due.
F. Not yet due.
G. Complete for this year.

Plan Update)

122
ACTION PLAN
2010-2015
CATEGORY B ACTIVITIES – ACTIVITY 6 – PREGNANCY PLANNING


strategy?
The health status indicator addressed in this strategy is the high rate of unplanned
pregnancies and shortened pregnancy intervals among pregnant women in Sarasota
County.
Unintended pregnancy is defined as either unwanted or mistimed (pregnancy wanted

later). Unintended pregnancies may affect the health of the fetus/infant because
unhealthy maternal behaviors are more likely to be present in absence of pregnancy
recognition. Examples of such behaviors are smoking, alcohol use, and inadequate folic
acid intake. Women with unintended pregnancies are also less likely to breastfeed. 46
Women with a family income of less than 150% of federal poverty levels have a much
higher rate of unplanned pregnancies, as do minority women, women with less education
and unmarried women. Little knowledge of emergency contraception and lower level of
general contraceptive usage or improper usage are also risk factors. Adverse childhood
experiences such as physical or sexual abuse can lead to risky sexual behavior, which can
lead to unwanted pregnancies and sexually transmitted infections.
Shortened pregnancy intervals are related to unintended pregnancies in that subsequent

births may not be planned or timed. Planned pregnancies before the recommended 18
months to two years may occur because of misinformation provided by health care
professionals or others as to the length of time necessary for proper healing and
improvement of maternal health prior to a subsequent pregnancy.
46 (Obrien, 1999)
123
Florida PRAMS data indicates in 2001, the most recent year data is available the mistimed
pregnancy rate was 36.5% and the unintended pregnancy rate was 10.2%, or for both
46.7%.
Pregnancy Planning in Florida

Data Collected from Florida PRAMS
0%
Mistimed
Planned Unplanned 36.5%
53.3% 46.7%
Unintended
10.2%
60%
50%
40%
30% Black
20% White
Other
10%
0%
Earlier Later Not Now
-10%
Prenatal Screen Results for Desired Timing of Pregnancy, 2009
Florida PRAMS data between the years 2000-2005 indicates that use of contraception at
the time of pregnancy among women with an unintended pregnancy ranged between
48.2% and 58.4%. 47 2009 Prenatal Screens in Sarasota County indicate that Black women
least desired their current pregnancy. In a small survey conducted with Healthy Start
clients in 2010, 69% of all respondents did not plan their pregnancies, and 66% of those
were not using contraception.
47 http://apps.nccd.cdec.gov/cPONDER/
124
Florida Charts data for Sarasota County on Births with Inter-pregnancy Intervals < 18
months indicates an increase in the percent of women becoming pregnant before the
recommended waiting period of 18 months to 2 years. From 2005 to 2008 the overall rate
has increased from 22% to almost 28%. The rates are highest among whites and non
whites and slightly lower among blacks.
Births with Inter-pregnancy Intervals <18 Months

35.00%
30.00%
% of Total Births
25.00%
White
20.00%
Black
15.00%
Other/Non-white
10.00%
5.00% Total
0.00%
2005 2006 2007 2008
We will offer updated family planning education to Healthy Start, MomCare, and
Healthy Families clients.
Since the entry point for Healthy Start and MomCare is pregnancy, family planning after
delivery and in between pregnancies will be our focus.
• Effective contraception is necessary for sexually active women to avoid pregnancy.

The best practice for preventing unplanned pregnancies, as cited in the Cochrane
Review, 48 is postpartum education about contraception, both short-term and long-
term, within the hospital, within one month post-partum, and in a structured
home visiting program.
• Women who hold firm in avoiding childbearing have higher motivation to do so

for reasons they have more clearly defined for themselves: they are not married,
have all the children they want, have a young baby already, or cannot afford to
raise a child. Helping a woman clarify mixed feelings and assess their own goals
requires open acknowledgment of any ambiguity regarding future childbearing.
48 (LM Lopez, 2009)

125
Women whose friends think contraceptive use is important are more likely to use
contraception, too. 49
See Action Steps
• FPWG minutes
• Training curricula, training records, and evaluation summaries
• Grant documentation
• Participant tracking summaries and other statistics
• Evidence of community education in our print or social media.
Coalition office files and Healthy Start and Healthy Family Program Data.
Healthy Start and Healthy Families clients will set family planning goals and use a
contraceptive method at increasing rates of 5% per year from the first year baseline.
Summary of client tracking records.
Healthy Start and Healthy Families Programs.

49 (Frost, 1996)
126

A. Form a FPWG comprised of Planned FPWG 4-1-12 6-30-12
Parenthood, Healthy Start Coalition, Healthy
Start Program, MomCare, Healthy Families,
and the Sarasota County Health Department
Women’s Care Clinic.
B. The Workgroup, chaired by the Planned FPWG 7-1-12 9-30-12

Parenthood representative, will research
effective family planning programs
appropriate for Healthy Start and Healthy
Families clients, which include short-term and
long-term strategies, to be carried out within
birthing facilities, within one month post-
partum, and in a home visits, by the case
workers in the Healthy Start and Healthy
Families Programs.
C. The Workgroup will secure funding as FPWG, 7-1-12 9-30-12

needed for program implementation, EDC
including trainings.
D. The Workgroup will develop a Family FPWG, 7-1-12 9-30-12

Planning Resource list to include all current MCS
locations and avenues for obtaining
contraception and update it annually.
E. The Workgroup will develop a program FPWG 10-1-12 11-30-12

evaluation form for pregnant women who
received the family planning education to
assess learning, attitude change, and ability to
access and use the chosen contraceptive
method(s).
F. The Workgroup members will set up and FPWG, CQM 10-1-12 11-30-12
train Healthy Start Care Coordinators and
Healthy Families workers on the selected
family planning program.
G. The Workgroup will develop a method for FPWG 10-1-12 11-30-12

tracking Healthy Start and Healthy Families
participants who receive the family planning
education to determine goal-setting and
contraceptive usage.
127
H. Participant evaluations and tracking will be FPWG 10-1-13 11-30-13

summarized annually. 10-1-14 11-30-14
10-1-15 11-30-15
I. The Healthy Start Coalition will increase FPWG, 5-1-11 6-30-11
awareness about the importance of reducing EDC 5-1-12 6-30-12
unintended pregnancies through its media, 5-1-13 6-30-13
each June. 5-1-14 6-30-14
5-1-15 6-30-15

A. Not yet due though the Planned Parenthood representative has been chosen and the
group may begin in 2011.
B. Not yet due.
C. Not yet due.
D. Not yet due.
E. Not yet due.
F. Not yet due.
G. Not yet due.
H. Not yet due.
I. Not yet due.

A. Not yet due though the group may begin in 2011. This activity may be merged with
Activity 1 on Interconception Health Education and Counseling.
B. Not yet due.
C. Not yet due.
D. Not yet due.
E. Not yet due.
F. Not yet due.
G. Not yet due.
H. Not yet due.

128

Plan Update)

129
ACTION PLAN
2010-2015
CATEGORY B ACTIVITIES – ACTIVITY 7 – REDUCE ELECTIVE C-SECTIONS

The need to be addressed in this strategy: reduction of preterm births.

strategy?
The indicator addressed in this strategy is the high rate of deliveries by Cesarean
Section prior to 39 completed weeks of gestation.
When miscalculation of fetal age occurs, an infant is delivered at a fetal age younger than
believed, which may result in a late preterm birth if the infant is less than 37 completed
weeks of gestation. The problems are then two-fold: Babies born by C-section are more
likely to go to the Neonatal Intensive Care Unit, have respiratory difficulties, and feeding
problems. Because important organs are still developing during the last few weeks of
gestation, late preterm delivery can result in vision or hearing problems, trouble sucking
and swallowing, and possibly long term affects such as behavioral or developmental
issues, such as Attention Deficit Disorder.
Cesarean sections are also more dangerous than vaginal births. Risks for women include
hemorrhage, reactions to anesthesia, infection, scar adhesion and increased rates of
maternal deaths. Extended post partum pain and discomfort and difficulty breastfeeding
may occur. Due to the very low VBAC 50 rate in Sarasota County – 7 VBACs at a major
birthing facility in 2007 51 -- women who have a C-section will be required to have C-
Section for subsequent births.
The Cesarean delivery rate for delivery of infants has sky-rocketed. According to Florida
Charts from the Florida Department of Health, in 2008, Sarasota County had a C-Section
rate of 39.6%, the sixth highest rate in Florida. Sarasota Memorial Hospital C-Section rate
50 Vaginal birth after Cesarean

51 (Gilkey, 2009)
130
in 2007 was 41.3%. 52 Florida, at almost 38%, has the second highest state rate in the
United States.
Cesarean deliveries are expensive. The average risk-adjusted charge in Florida in 2004
was $14,458, compared to vaginal deliveries at $7,533. 53
Percent of Cesarean Deliveries
We will improve public awareness of the potential negative health impact to moms and
babies by choosing elective C-sections prior to 39 weeks of gestation.
This is in congruence with the Florida March of Dimes’ endorsement for informing
women, the general public, businesses, and healthcare community about the importance
of pregnancy reaching at least 39 weeks and the elimination of all elective deliveries prior
to 39 weeks. 54
See Action Steps
52 (Gilkey, 2009)
53 (Agency for Health Care Administration, May, 2006)
54 (March of Dimes, Florida Chapter, 2010)
131
• Reports from each program representative that the campaign materials were
implemented.
Coalition office files.
New or heightened awareness will be present among women of childbearing age about
the dangers of Cesarean Sections done prior to 39 completed weeks of gestation.
Anecdotal information.
Cesarean section rates.
Florida Birth Certificate data.

TWG=Tobacco Use Cessation Workgroup; V=Volunteer

A. March of Dimes brochure “Why the Last MCS, 7-15-10 10-31-10
Weeks of Pregnancy Count,” or a similar MCA,
publication will be available in the Pregnancy HSCC,
Resource Center and distributed throughout SML
Coalition Programs as described in Activity 1. Coordinator
B. Utilizing March of Dime campaign ED 12-1-10 6-30-11

132
information to reduce elective primary

Cesarean sections, partner with other
maternal-child health agencies to support
policy changes which reduce elective, primary
Cesarean sections.
C. Utilizing March of Dime campaign ED, EDC 10-1-10 11-30-10

information to reduce elective primary 10-1-11 11-30-11
Cesarean sections, increase community 10-1-12 11-30-12
awareness of the hazards of elective, primary 10-1-13 11-30-13
Cesarean sections for Prematurity Awareness 10-1-14 11-30-14
Month each November through our social
media (Website, Blog, Twitter, and Facebook).

A. The brochure “Why the Last Weeks of Pregnancy Count” is available in the Pregnancy
Resource Center. For MomCare clients, a small card with information about the
importance of brain development in the last few weeks of pregnancy is distributed,
with a note to request the “Why the Last Weeks of Pregnancy Count” brochure if
desired, due to the higher prices of March of Dimes (MOD) materials. The MOD
brochure is distributed to all pregnant clients participating in Save My Life classes.
B. Not yet due.
C. Not yet due.

A. A limited number of “Why the Last Weeks of Pregnancy Count” March of Dimes
brochure, 'Why the last Weeks Count' are available and are distributed as noted in
Activity A. Funds are needed to purchase more copies for future use.
B. We have re-posted Facebook posts from “Born in Sarasota,” which has local
widespread popularity among women of childbearing age. Avoidance of elective
primary C-sections is a common topic.
C. Posted periodic updates to Healthy Start Facebook during the quarter regarding
hazards of elective, primary C-Sections, with an increased posting during November
for Prematurity Awareness Month.

133

Plan Update)

134
ACTION PLAN
2010-2015
CATEGORY B ACTIVITIES – ACTIVITY 8 – INCREASE BREASTFEEDING

The need to be addressed by this strategy: improvement in the breastfeeding initiation

and duration rates in order to improve infant and maternal health.

strategy?
The health status indicator addressed in this strategy is the suboptimal breastfeeding
rates in Sarasota County.
The short- and long-term risks to babies resulting from lack of breastfeeding have been
well-documented in professional literature for almost two decades, and include threats to
optimal health, development, and cognition. Risks also exist for mothers who don’t
breastfeed. Not breastfeeding has economic impact due to higher medical expenditures
incurred for certain children’s health problems and the loss of the mother’s work time to
attend to ill children, all of which are well-documented. Numerous professional
organizations and the Surgeon General adamantly support breastfeeding and have
developed clear guidelines for increasing breastfeeding, yet Sarasota County
breastfeeding rates appear to be falling rather than increasing.
The Healthy Start Coalition of Sarasota County, Inc. has conducted three countywide
breastfeeding surveys since 2002. The most recent survey conducted in 2008 shows that at
birth, breastfeeding rates for “any” 55 breastfeeding have fallen from 79% to 66%. At age
six months the rates have fallen from 30% to 17%; and at 12 months from 12% down to
8%. 56 One of the factors listed as “decreasing confidence in breastfeeding” was “not
enough time” due to inconvenience, school, or work. Of the 122 women surveyed who
were employed, only 11% reported they have the opportunity to breastfeed or pump at
55 “Any” breastfeeding can be exclusive, partial or token breastfeeding.

56 (Healthy Start Coalition of Sarasota County, Inc., 2008)
135
work. While the sample size for the survey was not large, the falling initiation rates
compare with decreases shown in WIC data for Sarasota County, and barriers to
breastfeeding for working mothers are consistent with larger surveys.
Breastfeeding Rates
100%
% of Women Surveyed
80%
60%
2002
40%
2008
20%
0%
At Birth/"Any" At 6 Months At 12 Months
We will improve breastfeeding rates among Healthy Start clients by working along the
continuum from pregnancy through the post-partum phase.
This includes the mother’s return-to-work, addressing best practices in concert with other
agencies and institutions regarding antenatal breastfeeding education; immediate support
of the breastfeeding mother in the birthing facility; post-partum support at home; and
preparation for the return to work.
Best practices for breastfeeding have been published by several groups. One of the most
thorough are the tenets described by the Registered Nurses Association of Ontario, a
professional group who worked with highly qualified individuals in Canada and the
United States to develop rigorous guidelines for assessing and developing breastfeeding
best practices. 57 Their goal was to promote initiation, duration, and exclusivity of
breastfeeding in term infants and improve breastfeeding outcomes for mothers and
infants.
57 (Registered Nurses of Ontario, 2003)

136
See Action Steps
• Annual Budget
• Healthy Start Reports
• Healthy Start Client Records
• Memoranda of Understanding with local Birthing Facilities
• Breastfeeding education program files
• Grant files
• Special Event files for World Breastfeeding Week activities
• BASC committee files
• EC/CL provider visit logs
Healthy Start Coalition and Healthy Start Program
Breastfeeding rates among Healthy Start clients* will increase to 65% at birth; 20% at six
months and 10% at one year. *Note that Healthy Start clients fall into the high risk
category for not breastfeeding so goals are less than Healthy People 2010 goals for the
general community.
BF notes in Healthy Start Client Records in HMS and the 2012 Breastfeeding Survey.
Healthy Start Coalition and Healthy Start Program office.

TWG=Tobacco Use Cessation Workgroup; V=Volunteer
137
ACTION STEP PERSON START END DATE

RESPONSIBLE DATE
A. Breastfeeding education and support for ED 7-1-10 6-30-15
Healthy Start clients will be funded to the
maximum amount possible based on
availability of funds and other Healthy
Start services funding needs.
B. Healthy Start breastfeeding clients will CQM 7-1-10 6-30-15

receive early post-partum breastfeeding
support from Care Coordinators and
Breastfeeding Counselors when necessary,
through face-to-face or telephone contact,
dependent upon which is more
appropriate.
C. Appropriate Healthy Start breastfeeding CQM 7-1-10 6-30-15

clients will receive a referral to an
educational session on preparing for the
return to work.
D. The Healthy Start Coalition will advocate CL 8-1-10 9-30-10

for the adoption and maintenance of
Breastfeeding Promotion Guidelines in
prenatal and pediatric care provider offices.
E. The Healthy Start Coalition will work with ED, V 9-1-10 5-31-11
the FL Department of Health’s Regional
Coordinator for Putting Prevention to Work
to establish a Breastfeeding Friendly
Workplace Program.
F. Negotiate with local birthing facilities and ED, CQM, 10-1-10 12-15-10
agencies methods for assuring that Healthy HSCC 8-1-10
Start clients receive immediate
breastfeeding education and support after
delivery, by implementing a working
agreement between the local birthing
facilities, HSCC, and Healthy Start
Breastfeeding Counselors.
G. The Healthy Start Coalition will re-establish ED 11-1-10 1-31-11

the Breastfeeding Advocates of Sarasota
County (BASC), a community workgroup
138
responsible for the promotion and support

of breastfeeding.
H. Healthy Start Care Coordinators and EDC, Selected 2-1-11 4-30-11

Healthy Families Workers will participate Trainer, CQM
in annual breastfeeding education updates,
and new employees will start with the 18
hour Breastfeeding Course.
I. BASC will advocate for the adoption and ED, EDC 2-1-11 1-31-12
maintenance of the Ten Steps to Successful
Breastfeeding for all local birthing facilities
and maternal and child health care
providers.
J. The Healthy Start Coalition will continue to EDC 7-1-10 8-31-10

offer Annual World Breastfeeding Week 7-1-11 8-31-11
Door Decorating Contests, expanding the 7-1-12 8-31-12
list of participants annually, to advertise the 7-1-13 8-31-13
benefits of breastfeeding to the public in a 7-1-14 8-31-14
novel way.
K. The Healthy Start Coalition will increase EDC, 7-1-10 8-31-10

community awareness about successful BASC 7-1-11 8-31-11
breastfeeding strategies through its media 7-1-12 8-31-12
during each World Breastfeeding Month in 7-1-13 8-31-13
August. 7-1-14 8-31-14
L. Funding will be obtained to help defray EDC 11-1-10 1-31-11

costs of Healthy Start Care Coordinator and 11-1-11 1-31-12
Healthy Family Worker education on 11-1-12 1-31-13
breastfeeding. 11-1-13 1-31-14
11-1-14 1-31-15
M. Evaluate breastfeeding rates in Sarasota BASC 10-1-12 4-30-13
County via survey in 2013.

A. Funding for Wraparound Breastfeeding Education and Support services for the
quarter was $6,765.50, an increase of 69% over Jul-Sep 2009 ($4,001.00).
B. All breastfeeding clients are receiving breastfeeding support from Care Coordinators
(CCs) and Certified Lactation Counselors (CLCs) under contract. For HS clients who
are also in WIC, the CCs, CLCs, and MomCare are partnered with the WIC peer
counselors, who contact clients early during the first trimester of pregnancy. For this
139
quarter, the clients who had outcome information showed 22 exclusive, 14 partial, and
9 no breastfeeding at birth. Our CLCs provided 530 units of service to 33 clients in
English, and 160 units to 15 clients in Spanish.
C. Breastfeeding clients received education on returning to work while breastfeeding. In
the first quarter, 11 women received the Sarasota Memorial class on this topic.
D. During this quarter during five prenatal and twelve pediatric health care provider
office visits, the Education Coordinator discussed the Breastfeeding Promotion
Guidelines developed by one of our volunteers who is a Nutritionist. One
pediatrician expressed interest in assistance from the Coalition in developing
employee policies to support breastfeeding in their office and was given a sample
policy; another pediatrician in far south county, where there are minimal resources,
requested in-office breastfeeding help for patients and was guided to WIC.
E. Our volunteer MPH Graduate Student has started a literature review and
identification of national and international businesses with Breastfeeding Friendly
policies in place. She is also registered for the upcoming “Business Case for
Breastfeeding” conference. She has started meeting with or has attempted to set up
meetings with community organizers and businesses who are developing local
breastfeeding policies:
• The Manatee County Health Department representative who is developing a
breastfeeding friendly policy;
• FL DOH Regional Coordinator for Putting Prevention to Work;
• Sarasota County Wellness Development Advisor
• A local pediatrician
F. Local licensed midwife birthing centers have verbally described their commitment of
breastfeeding support immediately after delivery; and the midwifery model places
great emphasis on learning how to breastfeed and receiving ongoing support during
the post-partum period. Our major birthing facility is under transition from having an
Internationally Board Certified Lactation Consultant staff for breastfeeding support to
having only the nursing staff provide breastfeeding support. The nurses are being
incrementally trained to become Certified Lactation Counselors. Our Contract and
Quality Manager is negotiating a plan with the hospital to allow Healthy Start CLCs
and WIC Peer Counselors to visit their clients in the hospital immediately after birth
to support breastfeeding immediately and as needed during the hospital stay.
G. Co-chairs and invitees have been identified, and the first meeting is scheduled for 11-
10-10.
H. Not yet due.
I. Not yet due.
140
J. The Annual Door Decorating Contest for breastfeeding education and support was
held 8-1 through 8-7-10 during World Breastfeeding Week. An announcement was
posted on our Healthy Start Blog on July 16th, along with posting it to Facebook and
our Twitter account. A Constant Contact E-mail was sent to potential participants on
July 19th and July 30th. A press release was sent to all local media about the upcoming
contest on July 28th. There were five participating agencies; all won recognition and
the “Golden Nipple Award.”
K. Photos of winners and their doors were placed on Blog and Facebook page on August
24th. The article “Breastfeeding: A Lifeline During a Disaster” continues to be on our
website.
L. Not yet due.
M. Not yet due.
Quarterly Progress Report October – December, 2010

A. Funding for Wraparound Breastfeeding Education and Support services for the
quarter was $10,221, a continued increase. The January fundraiser will specifically
seek local donations to support this level of service. SMH BF Education classes =
$22.56 per client; English BF Support Services = $126.72 per client; Spanish BF Support
Services=$93.00 per client.
B. Partnerships as described continue. For this quarter, the clients who had outcome
information showed 15 exclusively, 5 partially, and 8 not breastfeeding at birth.
(Note: These numbers reflect only those we have outcomes for). Our CLCs
provided 1,112 units of service to 65 clients in English, and 459 units of service
to 26 clients in Spanish; and BF classes at SMH were provided for 61 clients
with 592 units of service.
C. Breastfeeding clients received education on returning to work while breastfeeding. In
the first quarter, 17 women received the Sarasota Memorial class on this topic.
D. No activity this quarter.
E. No activity this quarter.
F. A plan with our major birthing facility is in place to allow Healthy Start CLCs and
WIC Peer Counselors to visit their clients in the hospital immediately after birth to
support breastfeeding immediately and as needed during the hospital stay. There is a
minor computer glitch with the Status Blue registration for one CLC to gain access to
the hospital which is expected to be resolved.
G. BASC has held two meetings to establish current services and review data. Meetings
were held 11-10 and 12-8.
H. Not yet due.
141
I. Not yet due.

J. Not yet due.
K. Not yet due.
L. Not activity this quarter.
M. Not yet due.

Plan Update)

142
ACTION PLAN 2005-2010

CATEGORY C ACTIVITIES – ACTIVITY 1 – REDUCE HEALTH DISPARITIES
1. List The Health Problem:
List the Risk Factor(s)

In general, infant death rates for blacks are 2 times higher than for whites. Fetal
death rates are often 2-4 times higher. In Sarasota County, we have used three year
rolling averages to examine our data because our black population is small compared
to our white population. While our black population is not limited to the Newtown
area, the 34234 zip code has traditionally had the highest levels of poor birth
outcomes.
143
List the Direct Contributing Factor(s)

Contributing to the disparate rates of fetal and infant death among blacks are:
maternal health problems, pre-eclampsia, fetal intra-uterine growth restriction,
placenta previa, premature rupture of membranes, Bacterial Vaginosis, low birth
weight, very low birth weight, preterm birth, and congenital anomalies.
List the Indirect Contributing Factor(s)

Indirect risk factors often overlap and interact. Contributing risk factors include
higher rates late or no prenatal care, economic factors; stress; racism; behaviors;
social factors; transgenerational factors; environmental factors; health care; culture;
neighborhood factors; marital status; and national, state or local policies. 58
2. Planning phase questions: (All Required)
What do you plan to do to change the level of the indirect contributing factor(s).
The Ecological Model describes fetal and infant mortality among blacks being the
result of risk factors across all levels: individual, interpersonal, institutional,
community, and public policy. The individual and community levels are two that we
can address through the Save My Life Program. Understanding the environment in
which the person lives is key.
We plan to increase and sustain education and support for preconception,

interconception, and pregnancy health in small groups or one-one one for high risk
African-American pregnant women in Newtown, which is the predominately black
area in Sarasota County which exhibits racial disparities in maternal, fetal, and
infant health.
At the same time, work will be done throughout the community with various agencies
and committees comprised specifically of Newtown residents to increase awareness
about fetal and infant death disparities, their causes, and the resources within the
community to help reduce those rates.
Describe how doing this will change the level of the indirect contributing factor(s)
Culturally, the black population has different needs and responds to them in different
ways. Individualized care is important, as is sensitivity to the social mores of the
community. Work will be done in a culturally sensitive manner, with the only
African-American Childbirth Educator in Sarasota County, who has 22 years
experience working with this population. Word of mouth is a primary source of
58 (Hogan, 2008)
144
communication in this community, and as trust and tenure of the program build,
responsiveness will increase.
strategy as intended? What will you do? (who, what, how many, how often, where,
etc.).
Activity logs kept by the project coordinator will monitor community contacts, dates
and locations of scheduled classes, and participants in classes; health outcome forms
will be kept on participants in the childbirth and breastfeeding classes.
Where/how will you get it?
From the Program Coordinator.
Related to the indirect contributing factor, what do you expect to be the immediate
EFFECT (measurable objective) of this strategy on the population who receives the
intervention/is exposed to the strategy? (changes in knowledge, attitude and
behaviors stated with baseline information and goal)
80% of classes and groups will be held because attendance, thus interest, is sufficient;
participants will improve scores on post test by 75%; 80% of birth outcome records
will be obtained for those sustaining attendance in childbirth and breastfeeding
classes.
What information will you gather to demonstrate that you effected a change in
knowledge, attitude and behaviors? (what difference will it make?)
Long term evaluation will include annual monitoring for reduction in fetal death,
infant death, low birth weight births, prematurity, and breastfeeding, and smoking
rates
From Florida Charts and Coalition surveys.
3. Action Steps for Activity C-1:

BASC=Breastfeeding Advocates of Sarasota County; EDC=Communications and Development Specialist;
CQM=Contract and Quality Manager; EC/CL= Education Coordinator/Community Liaison; ED=Executive
Director; FPWG=Family Planning Workgroup; HSCC=Healthy Start Care Coordination; MCA=MomCare
Advisor; MCS=MomCare Supervisor; SEN=Substance Exposed Newborn Prevention Committee; SML-Save
My Life Coordinator; TWG=Tobacco Use Cessation Workgroup; V=Volunteer
145

A. Attend at least four outreach activities each SML 7-1-10 6-30-11
month in the community. Coordinator
B. Participant Records on at least six new SML 7-1-10 6-30-11
contacts each month, assessing initial needs, Coordinator
providing information regarding needed
resources, and encouraging participation in
Save My Life education and support
services.
C. A minimum of three pre- or inter-conception SML 7-1-10 6-30-11
classes, one class of a childbirth education Coordinator
series, one breastfeeding class and two
breastfeeding support sessions each week.
D. Participants will improve scores on post SML 7-1-10 6-30-11
tests by at least 10 points unless maximum Coordinator
pretest scores were obtained.
E. Each “no-show” will receive at least two SML 7-1-10 6-30-11
documented attempts to contact to Coordinator
encourage participation and determine if
any alternative approaches would facilitate
better participation.
F. Participants in the Childbirth and SML 7-1-10 6-30-11
Breastfeeding Class Series will discuss Coordinator
health behavior goals with the Program
Coordinator.
G. At least one Body and Soul class, whether SML 7-1-10 6-30-11
part of a series or an individual class will be Coordinator
held at least every two months by a
participating church.
H. Grants to supplement or completely fund EDC 7-1-10 6-30-11

the program will be obtained.
146
3. Action Steps for Activity C-1:

BASC=Breastfeeding Advocates of Sarasota County; EDC=Communications and Development Specialist;
CQM=Contract and Quality Manager; EC/CL= Education Coordinator/Community Liaison; ED=Executive
Director; FPWG=Family Planning Workgroup; HSCC=Healthy Start Care Coordination; MCA=MomCare
Advisor; MCS=MomCare Supervisor; SEN=Substance Exposed Newborn Prevention Committee; SML-Save
My Life Coordinator; TWG=Tobacco Use Cessation Workgroup; V=Volunteer
Quarterly Progress Report for July – September, 2010

A. Outreach Activities this Quarter: Inspiration Praise and Worship Center Jul 8;
Second Chance Last Opportunity (SCLO) Jul 15; HSCSC Staff Meeting Jul 23;
Sarasota County Enterprise Zone Development Workshop Jul 28; Ready Set Grow
Health Fair Aug 7; Children First Daycare Aug 16; SCLO Aug 17; HIPPY Graduation
Aug 21; Newtown Community Health Action Team (CHAT) Aug 24; Newtown
Redevelopment Office Aug 26; Goodwill Agency Meeting Sep 16; Janie’s Garden
Women’s Group Sep 21; HSCSC Annual Meeting Sep 23; Newtown CHAT Sep 28.
B. Four new participant records initiated in July, five in Aug, and five in Sep. (Only
clients in CBE and BF classes are seen long enough in order to begin records.
Interconception Health class participants, which are the vast majority of participants
in Save My Life, do not complete participant records because they are generally seen
only once.)
C. Required number of classes were scheduled each week; attendee(s) were present and
classes were successfully held on the following days:
• Pre/Interconception Health classes held Jul 12, 26; Aug 9, 11, 18, 23, 25; Sep 1, 8, 13,
20, 21, 27, 28, 29.
• CBE classes held Jul 1, 8, 16, 23, 26; Aug 13; Sep 16 (two), 17, 23, 24, 30.
• BF classes held Jul 7, 14, 16, 22, 28, 30; Aug 2, 12, 26; Sep 16, 28.
• BF support sessions held Jul 6 (two), 8 (two), 21 (two), 26 (three), 29; Aug 2 (two), 9
(four), 19 (two), 23 (two), 31; Sep 2, 3 (three), 9 (two), 14 (four), 16, 21, 27, 28, 29.
D. Fifty-one post-tests were distributed after interconception and childbirth education
classes and all show improved scores.
E. All no-shows received two attempts to contact, leaving name and phone number of
Program Coordinator. When necessary, the Program Coordinator went in to the
home to provide the class if the participant could not attend a class otherwise.
F. All 12 participants discussed health behavior goals in Childbirth and Breastfeeding
class series.
G. Two Body and Soul classes were scheduled for Jul and Aug at a local Newtown
church, but were not held due to no-shows. In Sep, the Program Coordinator met
147
with a new church about sponsoring Body and Soul classes.

H. The Communications and Development Specialist (a non-DOH funded position)
applied for a $4,080 grant from the CJ Foundation for SIDS to fund the education
component of the “Beds for Babies” Campaign of the Save My Life Program. A
request was also made to the Community Foundation of Sarasota County for $6,100
for funding incentives (Pack ‘n Play basinets and umbrella strollers) for the Save My
Life Program.
Quarterly Progress Report for October-December, 2010:

A. Outreach Activities this Quarter: Second Chance Last Opportunity Oct 13; Inspiration
Praise and Worship Center Oct 20; Newtown Selby Goodwill Oct 21; Newtown
Community Health Action Team Oct 26; Breastfeeding Advocates of Sarasota County
Nov 10; Newtown Selby Goodwill Nov 18; Breastfeeding Advocates of Sarasota
County Dec 8; Newtown Selby Goodwill Dec 8; Newtown Community Health Action
Team Dec 9.
B. Eleven new participant records initiated in Oct, six in Nov and five in Dec. (Only
clients in CBE and BF classes are seen long enough in order to begin records.
Interconception Health class participants, which are the vast majority of participants
in Save My Life, do not complete participant records because they are generally seen
only once.)
C. Required number of classes were scheduled each week; attendee(s) were present and
classes were successfully held on the following days:
• Pre/Interconception Health classes held Oct 4(two), 11, 18, 19, 20, 25, 26; Nov 1(
two), 3, 8, 10, 17, 29, 30; Dec 1, 6, 7, 8, 13, 15, 29
• CBE classes held Oct 1, 8, 15, 20, 22, 27; Nov 4, (two), 10, 12, 16, 18; Dec 2, 4, 9, 28
• BF classes held Oct 7, 14, 21, 26; Nov 4, 11, 16, 29; Dec 2, 6, 9, 16, 29
• BF support sessions held Oct 4, 8 (two), 11 (three), 19 (two), 27 (two); Nov 1, 4, 8
(two), 17, 19, 29, 30; Dec 1, 2(two), 8 (three), 16 (three), 17, 28, 29
D. All post-tests distributed after interconception and childbirth education classes show
improved scores.
E. All no-shows received two attempts to contact.
F. All participants discussed health behavior goals in Childbirth and Breastfeeding class
series.
G. Two Body and Soul classes were scheduled for Oct and Nov at a local Newtown
church, but were not held due to no-shows. In Dec, the Program Coordinator met with
a new church about sponsoring Body and Soul classes in February/March.
148
H. The Communications and Development Specialist applied for a $4,080 grant from the
CJ Foundation for SIDS to fund the education component of the “Beds for Babies”
Campaign of the Save My Life Program. A request was also made to the Community
Foundation of Sarasota County for $6,100 for funding incentives. Both grants were
received and thus far six participants completed the Childbirth and Breastfeeding
class series, and incentives (Pack ’n Play) basinets were given. To promote the SIDS
education “Beds for Babies” Campaign the Program Coordinator decorated the
bulletin board at the Sarasota County Health Department Children’s Health Center
with information on sleep position for babies and reducing the risk of SIDS.
Quarterly Progress Report for January – March, 2011
Quarterly Progress Report for April – June, 2011
4. Reporting Phase Answers: (To Be Completed For the Annual Action Plan
Update)
a. Demonstrate that you have implemented this strategy as planned (who, what,
how many, how often, where, etc.).
b. Demonstrate the changes in the system/community.
c. Will you drop/modify/expand/continue strategy next year?

149
ACTIVITY TIMELINES
118
Service Delivery Plan Action Items 2010-2015
Category B, Activity 1: Prevent preterm births by improving pregnancy and pre/interconception health — Implementation of the Right From The Start (RFTS)
and text4baby campaign materials.
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN
Incorporate RFTS and text4baby materials into Pregnancy Re- Laundromat

Recruit provider for ICC. CQM
source Center, MomCare , and Save My Life . EC/CL, MCS, SML deliveries. V, AA
Incorporate RFTS & text4baby materials into HS. CQM

2010-
RFTS/text4baby info to PCPs. EC/CL
2011 Update Laundromat
Update Link both to Laundromat Update Update
website. CDS media. CDS deliveries. V, AA website. CDS website. EDC website. EDC deliveries. V, AA
2011- Annual
Laundromat
evaluation.
deliveries. V, AA
2012 EDC
Update Laundromat Update Update Update Laundromat
website. EDC deliveries. V, AA website. EDC website. EDC website. EDC deliveries. V, AA
2012- Laundromat
deliveries. V, AA
2013
2013- Laundromat
deliveries. V, AA
2014
website. EDC deliveries. V website. EDC website. EDC website. EDC deliveries. V, AA
2014-
Laundromat
2015 deliveries. V, AA

Throughout the five year period: Interconception Education and Counseling by a trained individual will be provided for Healthy Start Clients eligible for referral. CQM
Revised 2-1-11
119
Category B, Activity 2: Prevent preterm births by improving pregnancy and pre/interconception health — Promote uniform counseling messages and support on
tobacco cessation utilizing a 5 A’s approach.
Form Tobacco Use Cessation Workgroup. EC/CL, V Workgroup sets up and participates in Make Yours a Fresh Start Family
Trainings, and seeks funds for trainings if necessary. TCW, CDS
Review Baby Promise Incentive Program. TCW

2010- Media blitz on tobacco cessation
during Smoke-Out Month. CDS, ED Community Health Worker Program on hazards of
Develop tracking method for HS clients receiving
2011 smoking (“Clean Start”) through May 31st. EDC
services and Quitline referrals. TCW
Develop service evaluation tool for clients. TCW
Healthy Start Care Coordinator MYFSF for prenatal care providers. TCW, EDC MYFSF trainings for selected staff from five other
Training/Refresher Training on agencies, including Healthy Families, SMH, WIC,
MYFSF. TCW, CQM, EDC Media blitz on tobacco cessation pediatric care providers, etc. TCW, EDC
2011- Evaluation of the MYFSF Training
during Smoke-Out Month. EDC, ED
Collect and summarize provider
2012 by the participants. TCW and client evaluations. TCW
Collect and summarize provider Media blitz on tobacco cessation Collect and summarize provider
and client evaluations. TCW during Smoke-Out Month. EDC, ED and client evaluations. TCW
2012-
2013
Media blitz on tobacco cessation

2013-
2014
Media blitz on tobacco cessation

2014-
2015
Throughout the five year period: Volunteer from Workgroup serves on Tobacco Free Partnership in Sarasota County on behalf of Healthy Start. V
From April of 2012 through the end: Technical assistance for and follow-up with trained groups. TCW, EDC Revised 2-1-11
120
Category B, Activity 3: Prevent preterm births by improving pregnancy and pre/interconception health — Improve screening of and prenatal treatment for
pregnant drug abusing women.
Prepare materials on prenatal drug Prenatal care provider visits to distribute prenatal Prepare for workshop on Drug Abuse Among Preg-
abuse for prenatal care providers. SEN drug abuse information. SEN, CL nant Women is Sarasota County. SEN, EDC
2010- Recruit Certified Addictions Professional for HS Wraparound Services. Create tracking method for referrals to HS from pre- Media blitz for National Alcohol &
CQM natal care providers for treatment & percentage of Drug Related Birth Defects Month
2011 women accepting treatment. CQM, HSCC each May. EDC
Present workshop on Drug Abuse Media blitz for National Alcohol &
Among Pregnant Women is Sara- Drug Related Birth Defects Month
2011- sota County. SEN, EDC each May. EDC
2012
Media blitz for National Alcohol &

Drug Related Birth Defects Month
2012- each May. EDC
2013

2013- each May. EDC
2014

2014- each May. EDC
2015
Throughout the five year period: Continue sponsoring the quarterly Substance Exposed Newborn Prevention (SEN) Committee meetings. ED
Revised 2-1-11
121
Category B, Activity 4: Prevent preterm births by improving pregnancy and pre/interconception health — Provide community education and Healthy Start
nutrition counseling services to reduce hazards from maternal obesity.
Recruit Nutrition Counselor for HS

Wraparound Services. CQM
Media blitz on obesity hazards
during National Nutrition Month
2010- Form partnership with pregnancy exercise/yoga program for reduced each March. EDC, ED
rates for HS clients. ED
2011
during National Nutrition Month Prenatal care provider visits to issue information on
each March. EDC, ED maternal obesity and local services. CL
2011- Create tracking method for referrals to HS from health Community Health Worker Program on hazards of maternal obesity. EDC
2012 care providers for treatment obesity and percentage of
women engaging in nutrition counseling. CQM, HSCC Develop standardized protocol to be used by HSCC
with clients having BMI over 30, including distribu-
Obtain grant for pedometers for HS clients. EDC tion of pedometers (obtained by a grant). CQM, HSCC

each March. EDC, ED
2012-
2013

each March. EDC, ED
2013-
2014

each March. EDC, ED
2014-
2015
Revised 2-1-11
122
Category B, Activity 5: Prevent preterm births by improving pregnancy and pre/interconception health — Improve awareness among clients and the public
regarding risks of maternal infections during pregnancy.
Media blitz on periodontal disease Develop Dental Health Resources Develop protocol for education of
during National Dental Hygiene list for Sarasota County. MCS clients who have genitourinary or
Month each October. CDS, ED periodontal infections. CQM
2010- Include printed information on
2011 genitourinary or periodontal infec-
tions in MomCare packet. MCS
Media blitz on periodontal disease Educational program for prenatal care providers
during National Dental Hygiene on “Recommendations for Treating Maternal
Month each October. EDC, ED Infections.” EDC
2011-
2012
Update “Start Motherhood with a Community Health Worker Program on “Start Motherhood with a Healthy Mouth.” EDC
Healthy Mouth” CHW Program.
EDC
2012-
Media blitz on periodontal disease
2013 during National Dental Hygiene
Month each October. EDC, ED

during National Dental Hygiene
2013-
2014

during National Dental Hygiene
2014-
2015
Revised 2-1-11
123
Category B, Activity 6: Prevent preterm births by improving pregnancy and pre/interconception health — Increase awareness regarding the need to plan preg-
nancies to achieve improved health by the start of pregnancy.
Media blitz on risks of unin-

tended pregnancies. EDC, ED
2010-
2011
Form a Family Planning Workgroup. FPWG
Media blitz on risks of unin-

2011- tended pregnancies. EDC, ED
2012
Research and develop family planning program strate- Develop Family Planning evalua- Media blitz on risks of unin-
gies appropriate for Health Start and Healthy Families tion tool for clients. FPWG tended pregnancies. EDC, ED
clients. FPWG
2012- Train HS & HF staff on Family
Secure funding in preparation for training HS and HF Planning program strategies. FPWG
2013 Workers on the strategies. FPWG, EDC
Develop tracking method for HS clients
Develop Family Planning Resources list. FPWG, MCS receiving Family Planning Education. FPWG
Update Family Planning Resources Summarize Family Planning client Media blitz on risks of unin-
list. FPWG, MCS evaluations annually. FPWG tended pregnancies. EDC, ED
2013-
2014
Update Family Planning Resources Summarize Family Planning client Media blitz on risks of unin-
list. FPWG, MCS evaluations annually. FPWG tended pregnancies. EDC, ED
2014-
2015
Revised 2-1-11
124
Category B, Activity 7: Prevent preterm births — Increase awareness of the dangers of elective C-sections prior to 39 completed weeks of gestation.
Media blitz on dangers of elective Support policy changes to reduce elective primary C-sections prior to 39 wks gestation. ED
primary C-sections prior to 39 wks
gestation for Prematurity Month
2010- each November. CDS, ED
Incorporate “Why the last weeks count” materials into Pregnancy
2011 Resource Center, MomCare , and Save My Life . EC/CL, MCS, SML
Incorporate “Why the last weeks count” into HS. CQM
Media blitz on dangers of elective

2011- each November. EDC, ED
2012

2013

2014

2015
Revised 2-1-11
125
Category B, Activity 8: Improve infant and maternal health — Increase breastfeeding initiation and duration rates.
Negotiate MOA with birthing facilities regarding immediate BF support for HS clients. CQM HS Care Coordinators and HF staff will participate in
annual BF updates; new HS employees will partici-
10 Steps Guidelines to Pediatric Providers. EC/CL
pate in 18 hour BF Course.. EDC, CQM
2010- WBFW Door Contest. EC/CL Seek funds for BF training as needed. EDC
BASC will advocate for the adoption and maintenance of the Ten Steps to Successful
Media blitz for World Breastfeeding Re-establish the “Breastfeeding Advocates of Sarasota
2011 Week in August. CDS County” (BASC) ED
Breastfeeding for all local birthing facilities and maternal-child health providers. BASC
Establish 1-2 Breastfeeding Friendly Workplace Programs. ED, V
WBFW Door Contest. EDC Seek funds for BF training as needed. EDC HS Care Coordinators and HF staff will participate in
Media blitz for World Breastfeeding
Week in August. EDC
2011-
BASC will advocate for the adoption and maintenance of the Ten Steps to Successful Breastfeeding for all local birthing facilities
2012 and maternal-child health providers. BASC
Week in August. EDC
2012-
Prepare and administer the 2013 Breastfeeding Survey. BASC
2013
Week in August. EDC
2013-
2014
Week in August. EDC
2014-
2015
Throughout the five year period: Fund and provide breastfeeding education and support to maximum amount possible based on availability of funds. ED
Throughout the five year period: BF clients will receive in-hospital and early BF support and obtain referrals to a class on returning to work as appropriate. CQM Revised 10-1-10
126
Category C, Activity 1: Address African-American maternal-child health disparities — Increase high risk education and support for preconception, interconcep-
tion and pregnancy health through the “Save My Life Program.”
On a weekly basis, offer at least 3 pre/interconception health classes; 1 class of a childbirth ed series, 1 BF class & 2 BF support sessions. SML
On a monthly basis, attend four outreach activities in Newtown and identify six new contacts each month. SML
2010- On a bi-monthly basis, offer at least 1 Body and Soul class in a participating church. SML
2011 Obtain grant funding for the SML Program. CDS
2012 Obtain grant funding for the SML Program. EDC
Obtain grant funding for the SML Program. EDC

2013

2014

2015
Revised 2-1-11
158
QUALITY MANAGEMENT AND PROGRAM

IMPROVEMENT PLAN FOR 2010-2015
Internal Quality Management / Program Improvement:

A. Policies and procedures – Activities of the Healthy Start Coalition of Sarasota County,
Inc., adhere to the policies and procedures of these four guiding documents. These
documents are reviewed by Board and/or Staff annually to assure our activities are in
compliance with the rules and guidelines.
1. Executive Board Bylaws
2. Employee Handbook
3. Policy and Procedure Manual
4. Healthy Start Standards and Guidelines
B. Contract Compliance – The Healthy Start Coalition will abide by the terms and
conditions of its funding contracts.
1. The Healthy Start Coalition will review all contract terms and conditions at the
beginning of each contracted period.
2. Special attention will be paid to goals, requirements, timelines, reporting and

deliverables.
3. The Executive Director will assign staff to all or parts of the contract to assure
terms are met.
4. Ongoing communication with the funder is maintained, especially when needed

due to unexpected circumstances, lack of clarity, uncertainties, or problems.
C. Data Collection – Appropriate and accurate data sources will be utilized to measure
expected outcomes based on the funder’s contract requirements.
1. Monthly, quarterly, or annual quantitative or qualitative measures will be taken as

dictated.
D. Board development activities – The Board development activities of the Coalition

include annual training, education, and leadership opportunities. Activities include:
159
1. Recruitment of community, business, and

philanthropic leaders with previous Board
experience or willingness to prepare for their role
through education and mentorship.
2. Orientation to goals and activities of the Healthy

Start Coalition of Sarasota County, Inc.
3. Participation in ongoing opportunities for non-profit

organizations and their boards to enhance roles and
responsibilities through education.
E. Disaster readiness – The Disaster Plan is reviewed 95
F. annually by the staff. Disaster responses will be coordinated with the Glasser-
Schoenbaum Human Services Center and the Healthy Start Program. In addition,
Wraparound Service Providers are required to have individual disaster plans for their
offices, at least in relation to their Healthy Start clients.
External Quality Management / Program Improvement:

The Healthy Start Coalition of Sarasota County, Inc., uses a systematic approach to ensure
high quality services and continuous program improvement. This process involves
ongoing evaluation of outcome measures and revision of goals and program components.
A. Goals
1. Assure that the Coalition operates in compliance with DOH contract requirements
and established standards and procedures which outline outcome and
performance measures.
2. Assure Healthy Start services are provided in a manner that meets the needs of
participants and assures quality care.
3. Routinely monitor services and service delivery as required and as client needs
dictate.
To achieve these goals, the staff of the Coalition will perform the activities described in
the Service Delivery Plan and QM/PI plan; conduct assessment of services as required;
identify strengths and weaknesses; incorporate into our Service Delivery Plan and QM/PI
strategies to improve performance and outcomes; and provide follow-up to assure goals
are being met. Our QM/PI Plan is part of our Service Delivery plan and is open for
viewing by the public.
160
B. Services – The HSCSC is responsible for obtaining sub-contracts and monitoring the
quality of the following services:
1. Healthy Start Care Coordination (DOH Base and Waiver Contracts)

a. Risk Screening
b. Initial Contact
c. Initial Assessment
d. Ongoing Care Coordination
e. Tracking
2. Healthy Start Wraparound Services (DOH Waiver Contract)
a. Tobacco cessation, education and support
b. Breastfeeding education and support
c. Parenting support and education
d. Nutritional counseling
e. Psychosocial counseling
f. Childbirth education
g. Interconception education and counseling
3. MomCare Program (SOBRA)

a. Facilitate early entry into prenatal care of Medicaid clients
b. Facilitate access to community services including Healthy Start Care
Coordination
c. Register client with a prenatal care provider if necessary
d. Facilitate client completion of risk screen, WIC services, and ongoing prenatal
care
e. Educate prenatal care providers on risk screen requirements and Healthy Start
referrals
4. Fetal Infant and Mortality Review Project (FIMR)

a. Reveal infant mortality factors by case abstraction and case reviews
b. Establish a case review team and a community action team
161
c. Record information from each team and educate the community

d. Recommend community solutions based on team findings
C. Outcome and performance measures – Our basic outcome and performance measures
are mandated by Florida statutes and the Healthy Start Standards and Guidelines.
The Healthy Start Coalition of Sarasota County Inc., utilizes these guidelines in the
formation of our Service Delivery Plan and subcontracts. We promote our vision for
excellent services through negotiations with subcontractors, and include additional
precise and relevant measures of performance.
D. Assessment of quality – Quality assessments utilize several methods: surveys, record

reviews and data evaluation. Qualitative and quantitative data are extracted from:
1. Healthy Start and Care Coordination Reports

2. Fiscal reports
3. Vital Statistics
4. Executive Summaries
5. Florida CHARTS
6. Staff interviews and observations
7. Provider’s logs
8. Record Reviews
9. HSCC And Wraparound Service Provider Quarterly Assessment Tools (based on
contract performance requirements)
10. HSCC and WAS Provider Annual Site Visit Reports (based on contract
performance requirements)
11. Clients satisfaction surveys, interviews, and focus groups
12. Other sources as needed
E. Performance Improvement Plans – Deficiencies found that are not in compliance with
outcome and performance measures require submission of Performance Improvement
Plans which outline corrective actions. Status reports must be submitted every three
months for long-term situations and finally when the deficiencies are corrected. When
determining corrective strategies, the following will be considered: impact on
participants, support of leadership, system capability, staff training needs, and
available funding.
F. Contract Management Activities
1. The Healthy Start Coalition of Sarasota County, Inc. (HSCSC) will obtain and
manage contracts with Florida Department on Health (DOH) and in turn, will
162
award and manage sub-contracts with agencies and individuals who provide
direct services to Healthy Start clients in compliance with DOH contract
requirements, the current Healthy Start Standards and Guidelines, and the current
Service Delivery Plan.
2. Wrap Around Services (WAS) Sub-Contracts
a. Ongoing needs assessment process includes formal and informal feedback

from Care Coordination Team, Provider Council meetings, community input
noted at all community organizational meetings, and information gathered at
all HSCSC committees and sponsored meetings throughout each year.
Applications for Contracts are written in accordance
to demonstrated needs;
b. Service procurement is performed through

recommendations of care providers, legal notices in
the newspaper, and current contract renewals;
c. Distribution of applications for

contracts is provided through electronic
transmissions and hard copy mailings to interested
providers who have requested applications. The
Contract and Quality Manager sets the time table
according to the schedules of everyone involved in
the application review and contract signature process. Applications require
hard copy submissions within this time table;
d. The Contract and Quality Manager receives applications and convenes the
Application Review Committee that includes the HSCSC Executive Director,
Care Coordination Program Administrator, and at least 3 community network
agency staff who are not directly involved with Healthy Start WAS providers.
The meeting occurs as soon after application due date as possible;
e. The Review Committee evaluates and makes recommendations to fund or not

fund based on applicant qualifications and if previously contracted, their
utilization and quality of performance, and service needs. Service needs
include geographic area, client, and special groups. Minutes and applications
are documented and saved for 6 years;
163
f. The Contract and Quality Manager develops the contracts, including Standard
Contract and Contract Attachment with exhibits based on delivery of specific
services and the requirements of the Coalition BASE and WAIVER contracts
with the state DOH;
g. The budget allocation methodology includes budget planning by the Executive

Director, with input from the accountant based on the Florida DOH contract
amounts, with final approval from the Board of Directors. The Executive
Director and the Contract and Quality Manager then allocate amounts for each
subcontract based on prior utilization, and service needs as determined by
input from the Care Coordination Team, Provider Council, community
organizations, and information gathered at all HSCSC committees and
sponsored meetings throughout each year;
h. Contracts are signed by the Board Chair and provider before the contract is in
effect. The Contract and Quality Manager retains one copy of each contract for
ongoing Quality Assurance, and submits a copy to the DOH Contract
Manager;
i. On-going Quality Assurance is detailed in each contract and includes formal

monthly, quarterly and yearly assessments of service delivery through chart
reviews, site visits, and contract compliance checklists.
j. Training of New Subcontractors occurs at the first Provider Council meeting

held after July 1. This training includes a review of contracts, all exhibits and
forms, and Coding.
3. Care Coordination Subcontract
a. The current subcontract with Sarasota County Health Department (SCHD) is

reviewed and updated by the Coalition’s Contract and Quality Manager. The
review includes updating the Standard Contract and Contract Attachment and
exhibits based on any changes in delivery of specific services and any new
requirements of the Coalition BASE and WAIVER contracts with the state
DOH.
b. The budget allocation methodology includes budget planning by the Executive

Director, with input from the accountant based on the Florida DOH contract
amounts and final approval of the Board of Directors.
164
c. The updated subcontract is reviewed by SCHD’s Care Coordination Program

Administrator and SCHD Division Director and prepare for negotiation.
d. SCHD Care Coordination Program Administrator, Division Director, HSCSC

Contract and Quality Manager and Executive Director meet to negotiate final
details of the sub-contract before signatures by SCHD Administrator and
HSCSC Board Chair. Contracts are signed by the Board Chair and provider
before the contract is in effect. The Contract and Quality Manager retains one
copy for ongoing Quality Assurance, and submits a copy to the DOH Contract
Manager;
e. On-going Quality Assurance is detailed in the contract and includes formal

monthly, quarterly and yearly assessments of service delivery through chart
reviews, site visits, and contract compliance checklists.
f. Training occurs at the first Care Coordinator Team meeting held after July 1,
and includes specifics in the contract and Coding.
165
ALLOCATION PLAN AND

FISCAL MONITORING
Allocation Plan for Healthy Start Funds

In the spring of each year, the Florida Department of Health notifies the Healthy Start
Coalitions of their next year’s funding amounts for the Base, Waiver, and SOBRA
contracts. These contracts fund Coalition administration and planning, Healthy Start
Program direct services (Care Coordination and Wraparound Services), and the MomCare
Program. There are very specific rules produced by the Department which outline exactly
how each contract’s funding can be expended.
The Healthy Start Coalition utilizes QuickBooks for its budgeting and financial
accounting. The funding amounts from the state are inputted in separate columns, or
“silos,” to differentiate the sources of income. The line item expenditures are categorized
as they most normally would be based on accounting principles, with some minor
variations to make it easier to track expenses requiring special attention by the state.
The Coalition’s Contract Manager prepares financial data on the previous year’s usage
and anticipates what next year’s budgeting should be. Historical usage, new contracts
approved by the Contracts Committee, new needs and activities, performance and other
factors are taken into consideration during this process. The Executive Director and the
Accountant prepare general allocations for administration and planning, and the Contract
Manager’s recommendations for subcontract funding. Throughout the entire process,
rules on expenditures are used in making allocation decisions. The draft of the budget is
presented the Finance Committee of the Executive Board. Once the committee approves
it, the full Executive Board votes on it.
Fiscal Monitoring
Subcontractors for Wraparound Services are notified that Healthy Start is the payor of last
resort, and if they accept the client’s insurance they must do so instead of billing Healthy
Start. Their contracts outline specific deliverables that require documentation of the
services they’ve provided and the time period in which they were provided. Proper
coding and client identification is mandatory. The Contract Manager is first to review
their invoices for accuracy and completeness.
166
The subcontractor for Care Coordination must submit more extensive accounting of
expenditures. The Contract Manager for the Coalition is also the Quality Manager, and
during this process also reviews Healthy Start Reports indicating the services that have
been provided.
Funding usage is monitored throughout the year. Amendments may be made to adjust
allocations to providers who have more or less services than anticipated, especially near
year end. The Budget to Actual Reports for all Coalition activities are produced quarterly
and are submitted with other financials to the Treasurer of the Board of Directors for
review. Our Contract Manager at the state is notified of any unresolved issues.
~ End ~
167
APPENDIX
168
DICTIONARY
1. Amnionitis – Inflammation or infection of the amniotic sac (what surrounds the

fetus in the uterus.
2. Antenatal – The time between conception and birth.
3. Asymptomatic – Without signs or symptoms of disease or illness.
4. Bacterial Vaginosis – A change or disruption in what is normal bacteria in the
vagina.
5. Birth Outcomes – Measurements of births that include racial, ethnic and
geographic considerations and how they affect prenatal care.
6. BMI – Body Mass Index - statistical measure of body weight based on a person's
weight and height used to determine the amount of a person’s body fat.
7. Cesarean Delivery - The delivery of a fetus through a surgical incision through the
abdominal wall (laparotomy) and uterine wall.
8. Demise – To stop living to die.
9. Fetal Death – The death of a fetus inside the uterus before the actual birth.
10. Fetus – Developing human from about 2 months after conception to birth.
11. Genital Tract – The organs involved in reproduction. In a male they include the
penis, testicles, and prostate. In a female, they include the clitoris, vagina, cervix,
uterus, fallopian tubes and ovaries.
12. Gestational Diabetes - Gestational diabetes is a type of diabetes that occurs only
during pregnancy. Like other forms of diabetes, gestational diabetes affects the
way your body uses sugar (glucose) — your body's main source of fuel.
13. Gestational Hypertension - A condition of pregnancy marked by high blood
pressure and excess protein in your urine after 20 weeks of pregnancy.
14. Infant Death - Includes deaths in the first 28 days of life. (Neonatal mortality)
15. Interconception/Preconception - A set of interventions to identify and modify
biomedical, behavioral and social risks to a woman’s health or pregnancy outcome
through prevention and management. The goal of the care is two-fold: improve
the woman’s health and help reduce health risks to her future baby.
16. Intrauterine Growth Restriction – The poor growth of the baby while in the womb.
17. Late Preterm Birth - Infants born between 34 and 36 weeks gestation, referred to as
"late preterm,"
18. Low Birth Weight - Low birth weight refers to infants who weigh less than 5.5
pounds at birth.
169
19. Macrosomia – A birth weight greater than 4000 to 4500 grams. At least 8 pounds
13 ounces or greater.
20. Miscarriage – A pregnancy loss that occurs before 20 weeks of gestation.
21. Motivational Interviewing - A directive, client-centered counseling style for
eliciting behavior change by helping clients to explore and resolve ambivalence, it
is more focused and goal-directed.
22. Neural Tube Defect - Neural tube defects are birth defects of the brain and spinal
cord.
23. Passive smoking - Is the inhalation of smoke, called secondhand smoke (SHS) or
environmental tobacco smoke (ETS), from tobacco products used by others.
24. Pedometer - Is a battery-operated device that measures and records the number of
steps an individual takes based on the body's movement.
25. Perinatal Mortality - The number of late fetal deaths, 28 weeks or more gestation,
and neonatal deaths that occur in the first seven days.
26. Placenta Previa – The placenta is attached to the uterine wall close to or covering
the cervix.
27. Placental Abruption - A placental abruption is a serious condition in which the
placenta partially or completely separates from your uterus before your baby's
born.
28. Postnatal - Is the period beginning immediately after the birth of a child and
extending for about six weeks.
29. Pregnancy Interval – Is the period of time between one pregnancy to the next
pregnancy.
30. Prenatal - Referring to both the care of the woman during pregnancy and the
growth and development of the fetus.
31. Premature Rupture of the Membranes - A rupture (breaking open) of the
membranes (amniotic sac) before labor begins. If PROM occurs before 37 weeks of
pregnancy, it is called preterm premature rupture of membranes (PPROM).
32. Preterm Birth – The birth of a baby before the 37th week of gestation.
33. Protocol - A protocol is a set of guidelines or rules.
34. Sociodemographic –
35. Socioeconomic - A family's socioeconomic status is based on family income,
parental education level, parental occupation, and social status in the community.
170
36. Spontaneous Abortion - the spontaneous end of a pregnancy at a stage where the
embryo or fetus is incapable of surviving, generally defined in humans at prior to
20 weeks gestation.
37. Substance Exposed Newborn – this includes a mother's abuse of a dangerous
drug, narcotic drug or alcohol during pregnancy if the child is demonstrably
adversely affected at birth or within the first year of birth.
38. Urinary Tract Infection - An infection that begins in your urinary system. Your
urinary system is composed of the kidneys, ureters, bladder and urethra.
171
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173
FISHBONE ANALYSIS
HEALTHY START COALITION OF SARASOTA COUNTY – HEALTH PROBLEM ANALYSIS IN FISHBONE DIAGRAM
CATEGORY B – ACTIVITY 1
Health Problem Risk Factors Direct Contributing Risk Factors Indirect Contributing Risk Factors
Increased Risk of Infant Birth less than 37 weeks ♦ Birth intervals less than 2 years ♦ Lack of heightened awareness
Mortality gestation (prematurity) ♦ Previous premature birth regarding the impact of poor
Increased Risk of Infant ♦ Inadequate nutrition leading to maternal health on pregnancy
Morbidity either obesity or underweight and fetal growth
♦ Breathing and ♦ Maternal infections ♦ Poor maternal health prior to
Feeding Problems ♦ Maternal and fetal exposure to pregnancy
♦ Temperature harmful environmental ♦ Limited access and availability
Regulation chemicals, such as toxic of preconception or
♦ Cerebral Palsy pesticides, cigarette smoke, etc. interconception health services
♦ Developmental ♦ Maternal and fetal exposure to ♦ Indifference to family planning
Delays or dangerous drugs or alcohol ♦ Late or no prenatal care to
Retardation ♦ High maternal stress identify and treat maternal
♦ Ongoing Behavior ♦ Maternal age <20 or >40 health problems
and Learning ♦ Multiple fetuses, usually ♦ Poor eating patterns in the
Problems resulting from artificial family
reproductive therapy ♦ Difficulty quitting smoking
♦ Inadequate screening for risks ♦ Difficulty controlling exposure
by service providers to environmental toxins
♦ Elective C-sections prior to 39 ♦ Dysfunctional family patterns or
wks gestation substance abuse
♦ Domestic violence or sexual
abuse
♦ Poverty
♦ Fear, powerlessness
♦ Threatened homelessness
♦ Multiple jobs
♦ Cultural norms
Service Delivery Plan for 2010-2015
wks gestation substance abuse
abuse
♦ Poverty
♦ Multiple jobs
♦ Cultural norms
wks gestation substance use
abuse
♦ Poverty
♦ Multiple jobs
♦ Cultural norms
abuse
♦ Poverty
♦ Multiple jobs
♦ Cultural norms
abuse
♦ Poverty
♦ Multiple jobs
♦ Cultural norms
abuse
♦ Poverty
♦ Multiple jobs
♦ Cultural norms
abuse
♦ Poverty
♦ Multiple jobs
♦ Cultural norms
Suboptimal Infant Insufficient breastmilk intake by Maternal Factors: ♦ No planning before pregnancy
Health infants not in accordance with ♦ Fear of pain; inability to resolve to breastfeed
♦ Respiratory and ear the minimum recommendations pain ♦ Did not attend breastfeeding
infections from the American Academy of ♦ Perception of lack of adequate course
♦ Asthma Pediatrics (exclusive milk supply ♦ Lack of a continuum of support
♦ Gastrointestinal breastfeeding for the first 6 ♦ Apprehension seeking help and from health care providers, the
infections and months of life; with the addition problem misidentification community, family or friends,
constipation of complementary foods at 6 ♦ Interference with social life pre-pregnancy to postpartum
problems months and continuation of BF ♦ Returning to work ♦ Lack of information on over-
♦ Immune system up until at least one year of age), ♦ Maternal smoking coming barriers to breastfeeding
immaturity causing alteration in ingestion of ♦ Maternal depression or anxiety ♦ Cultural unacceptability
♦ Eczema optimal nutrients, antibodies ♦ Inverted or cracked nipples ♦ Lack of regulation of formula
♦ Overweight and other vital components of ♦ Use of medications that inhibit marketing to the public and
breastmilk which maximize lactation health care providers
health. ♦ Severe or chronic illness ♦ Insufficient maternal leave from
♦ Unresolved engorgement employment and/or lack of
♦ Clogged milk ducts breastfeeding support by
employers
Infant factors:
♦ Unwanted pregnancy
♦ Prematurity
♦ Race
♦ Low birth weight
♦ Young age (<25 years)
♦ Hyperbilirubinemia causing
♦ Low education (less than high
infant lethargy or mother is
school education)
asked to stop breastfeeding by
♦ Being unmarried
health care professional
♦ Hypotonia
♦ Ankyloglossia (tongue-tie)

Fetal and Infant Racial health disparities for ♦ Low and very low birth weight ♦ Higher rate of late or no
Mortality African-American pregnant ♦ Premature birth prenatal care
women and infants leading to ♦ Fetal intrauterine growth ♦ Economic factors and poverty
higher mortality and morbidity restriction ♦ Stress
rates. ♦ Congenital anomalies ♦ Racism
♦ Maternal health problems ♦ Health behaviors
♦ Pre-eclampsia ♦ Social factors
♦ Placenta previa ♦ Transgenerational factors
♦ Premature rupture of ♦ Environmental factors
membranes ♦ Cultural norms
♦ Bacterial Vaginosis ♦ Neighborhood factors
♦ Marital status

2010-2015 Service Delivery Plan

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2010-2015 Service Delivery Plan

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2010-2015

Service Delivery Plan

HISTORY AND DESCRIPTION OF THE HEALTHY START COALITION OF

SERVICE DELIVERY PLANNING SUMMARY

Comparison Between Previous and New Service Delivery Plans 31

DATA COLLECTION FOR THE 2010-2015 SERVICE DELIVERY PLAN

ANNUAL ACTION PLAN FOR 2010-2015

Category B Activities – Activity 7 – Reduce Elective C-Sections 129

ACTIVITY TIMELINES 149

QUALITY MANAGEMENT AND PROGRAM IMPROVEMENT PLAN

ALLOCATION PLAN AND FISCAL MONITORING

The Last Five Years

of assistance and regular classes and support in pre/interconception and

Planning the Next Five Years

Over the last two decades measures taken to improve maternal

A special thank you to:

2010-2011 Executive Board

Shara Abrams, Chairperson

Staff and Program Coordinators

Jennifer Highland, MPH, RN, Executive Director

HISTORY AND DESCRIPTION OF

History of Florida’s Healthy Start Program

Development of Sarasota County‘s Healthy Start Coalition

The Executive Board

 Shara Abrams, Jackson Hewitt*  William Little, Sarasota County Health

 Denise Candea, Children First  Paul Mercier, County Commissioner

 John Capaccione, Yellow Cab Sarasota  Linda Mineer, Legislative Aide to

 Senator Lisa Carlton  Lucile Mobley, Cyesis High School

 Charlene Chirillo, Gulf Coast South  Donna Norback, Sarasota Memorial

 Sarah Cloud, Healthy Families  Representative Ron Reagan

 Grace Dietrich, Jackson Hewitt  Carol Selvey, HealthCare Consultant

 Mary Gillam, STAR Student  Leland Selvey, Interested Citizen

 Hal Headley, Child Protection Center*  Mayor Mary Ann Servian

 Pauline Hill, Sarasota Memorial  Linda Spivey, Legislative Aide to

 Jonna Jung, SCHD  Patti Treubert, Bon Secours Venice

Linda Wilson, Administrative Assistant (1998); Nannette Albright, FIMR Case

Zottoli, Marcia Blotzer, Anna Brereton-Hubbard, Pam McFarland, and Susan

Current Organizational Chart

Providers’ Council – Comprised of Healthy Start Service Care Coordinators and

Substance Exposed Newborn Prevention and Protection Committee (SEN) – This

Tobacco Cessation Workgroup (TCW) – This workgroup focuses on reduction of

Our current membership stands at 47 voting members and 11 non-voting members.

A. Healthy Start Direct Services Program

7. Care Coordination staff includes nurses and social workers.

D. Fetal and Infant Mortality Review Project (FIMR)

In more than ten years of operation, the Coalition has

 Annual Baby Shower, 1998 to present

 Baby Steps Sunset Beach Walk fundraiser, 2004 – 2006

 The FIMR Community Forum on racial disparities in birth outcomes, 1999

Studies and Surveys

 Interdisciplinary Community Health

“Start Motherhood with a Healthy Mouth” - Periodontal disease as an

“Clean Start” – hazards of smoking, alcohol and drug abuse during

Forty Carrots Parenting Center (2000), Children First (2001), DeHaven

Danielle Gonzalez (2000), Maria Luisa Pacheco Gusman (2001), Johanna

Channel 40 News Team (2000), Barbara Peters-Smith (2001), Heidi Godman,

Rebecca Clapp, SCHD (2009)

Volunteers of Year: This award is given to the nominee whose contributions or

Bea Funkhouser (2000), Merle Dimino (2001), Presbyterian Women of Church of

Our Many Partners

SERVICE DELIVERY PLANNING

The APEXPH Community Process

Data Collection Summary