Communities Creating Change Florida s Partnership to Implement Perinatal

Communities Creating Change Florida’s Partnership to Implement Perinatal Periods of Risk

History • Three Florida Communities selected for National PPOR-PC • Sponsored by City. Mat. CH, National Offices of March of Dimes & Centers for Disease Control • Established in 1999

What is PPOR? • Developed by Brian Mc. Carthy of World Health Organization • Both an approach & data analysis method to assess infant mortality • Introduced to the U. S. in 1998 after use in developing countries

National PPOR-PC • Sixteen initial cities • Teams representing policy, data, and community • Met for two years learning and enhancing methodology and application • Common finding = need for preconceptual health care for women of child bearing age

Implications for Florida • Recognition by participants that in order to achieve continued improvement in IMR, needed to focus resources on pre and interconceptional care • Would require shifts in priority, funding, public policy

Florida’s MCH System • Florida’s Healthy Start services are initiated at time of pregnancy • Expanded Medicaid to 185% of poverty • State wide mandated risk screening offered by OB/GYN and Midwives at first prenatal appointment • Screen all infants at birth for risk status

Florida’s Healthy Start • Community Coalitions exist to plan, select providers, oversee services and allocate state and federal funds • Unique capacity to implement PPOR at the community level

Established Replication project • Seven largest counties in Florida Miami. Dade, Broward (Ft. Lauderdale), Palm Beach, Orange (Orlando), Duval (Jacksonville), Hillsborough (Tampa) and Pinellas (St. Petersburg/Clearwater) • Represent over 60% of births

Results • One year later, met with Florida Department of Health to propose changes to Florida’s Healthy Start Services • Joint committee established to review Healthy Start services and MCH system

Factors Contributing to Success • Department of Health recognition that PPOR could not be implemented without local community’s involvement • Existing system of local coalitions • State’s longstanding commitment to data driven decision making, quality and sharing • 10 year history of relationship

Barriers • Local Communities always want more data! • Logistics of changes needed in defining service population, coding and data collection issues, getting “buy in” from front line staff etc. • Anticipated barriers include “going to scale” with significant changes

Proposals/Action Steps • Add Interconceptional care model to HS services • Expand definition of “who we serve” (WCBA regardless of pregnancy status) • Connect to FIMR projects at state level • Restructure DOH to increase continuity between programs