Service Delivery Plan...of Punta Gorda / Port Charlotte, Bon Secours Health Systems, Inc. Foundation, Bayfront Health Charlotte County Healthy Start Coalition, Inc. Service Delivery

Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 1 | Page

Service Delivery Plan Charlotte County Healthy Start Coalition, Inc.

October 2016 – September 2021


ACKNOWLEDGEMENTS

Over the last seven years Charlotte County Healthy Start board, staff and general members have

diligently worked “to improve birth outcomes and optimize child growth and development

through community partnerships that nurture women and families.” This mission necessitates

a comprehensive plan to assess local needs and deliver appropriate services to promote positive

maternal and child health outcomes.

The research, analysis, and development of a community-wide Service Delivery Plan (the Plan)

required input and commitment from a variety of agencies and individuals residing and/or working

in Charlotte County. The process involved creation of an 18-member Community Health

Assessment Task Force comprised of public and private health care providers, consumers of

prenatal and pediatric care, educators, representatives of agencies and organizations serving

prenatal women and infants, government representatives, and the community at large. From

consumer, provider and community surveys to public and private statistical data, volumes of facts

and information were gathered and analyzed in the creation of this Plan. Task force members,

committee members, staff, board members and volunteers reviewed and discussed materials and

participated in development of the various components of the Plan. The Board of Directors and

staff of the Charlotte County Healthy Start Coalition are extremely grateful for the generous

dedication of the many individuals who contributed to this process and to the many agencies and

organizations who serve the needs of area mothers and babies.

In particular, the preparation of this plan has been influenced by the participation and commitment

of the Coalition’s Data Committee, comprised of Anne Sawney, Community Volunteer; Sharon

Mays, WIC Program Manager, FL – DOH Charlotte County (retired); Andy Herigodt, Catholic

Charities and Diane Ramseyer, Drug Free Charlotte. Recognition must also be given to Charlotte

County Healthy Start employees Kathy Schoeck, Administrative Assistant; Pamela Bicking,

MomCare Advisor/Community Liaison, Nancy Kraus, Finance Manager, and Magi Cooper,

Executive Director. An additional note of thanks should also be given to our SDP consultant, Diane

Ramseyer, who guided us through a well-organized, cohesive assessment and plan development

process.

A debt of gratitude is owed to those agencies, organizations, and individuals who have contributed

to the Coalition’s success through financial and in-kind contributions including: Early Learning

Coalition of Florida’s Heartland, Drug Free Charlotte County, C.A.R.E, Gulfcoast South Area

Health Education Centers, United Way of Charlotte County, the Charlotte County Board of County

Commissioners, the Florida Department of Health, the Healthy Start MomCare Network, Charlotte

County Fire & EMS, Charlotte County Homeless Coalition, Intelli-Choice, Charlotte Community

Foundation, SW Florida Community Foundation, March of Dimes, Charlotte Behavioral Health

Care, Gulf Coast Community Foundation, Sunrise Kiwanis Club, Englewood Kiwanis, Zonta Club

of Punta Gorda / Port Charlotte, Bon Secours Health Systems, Inc. Foundation, Bayfront Health –


Port Charlotte, Punta Gorda Housing Authority, Peace River Quilters, Ladies of Westport Ridge

Neighborhood in Riverwood Golf Community, Rotonda West Women’s Club, Englewood Girl

Scouts, Charlotte State Bank and volunteers Betty Richardson, John Forensky, Matthew Cooper,

Mabel Amsom, Beau Billings, Elizabeth Billings, Gerry Chesney and Asheleigh Wood.

The Coalition’s success over the past years would not have been possible without the efforts of

our contracted service providers: Charlotte Behavioral Health Care for care coordination,

parenting education, psychosocial counseling and tobacco education and cessation support; Health

Department – Charlotte County for IPO, data entry and inter-conception care counseling; Bayfront

Health – Port Charlotte for childbirth and breastfeeding education and lab/sonogram services; Dr.

Michael Coffey for prenatal care services; Dr. Lenita Hanson for diabetic nutrition counseling;

Cathy James, R.N. and Sarah Pope, R.N. for childbirth education; and Maternal Fetal Medicine of

SW Florida for hi-risk pregnancy care services.

Chris LeClair, Laura Pan, Janelle Burgess, and Marcia Thomas-Simmons of the Florida

Department of Health, have also provided valuable assistance and support during the past years.

Also, information, advice and best practices shared by the Florida Association of Healthy Start

Coalitions have added to the achievements of the Coalition.

Finally, recognition must be given to the Coalition’s current Board of Directors, who have

volunteered many hours of service ensuring the Coalition’s adherence to its mission and goals:

Chair, Paula Wilman, Punta Gorda Housing Authority; Vice Chair, Michael Overway, Charlotte

County Homeless Coalition; Secretary, Anne Sawney, Community Volunteer; Treasurer, Sharon

Mays, Retired-Health Department – Charlotte County WIC Program Manager; Anne Bouhebent,

Early Learning Coalition of Florida’s Heartland, Elyse Clark, Fellowship Church - Englwood;

Andy Herigodt, Catholic Charities; Steve LeVasseur, LeVasseur Building & Remodeling; Chris

Mashintonio, Retired- Health Department – Charlotte County Vital Statistics; Gayle O’Brien,

Bayfront Health – Port Charlotte; Sue Todd, C.A.R.E. Victim Advocate; and Judith Wilson, Zonta

Club of Punta Gorda / Port Charlotte.


INTRODUCTION

Charlotte County, Florida

Charlotte County, Florida’s 29th most populous county0F 0F

1, is located on Florida’s west coast midway

between the cities of Sarasota and Fort Myers, and encompasses 694 square miles of land and 166

miles of canals. The developed and populated areas of the county are primarily located along these

waterways. December 2015 projections from Florida Legislature, Office of Economic and

Demographic Research state the county has 167,141 residents. However, July 2016 U. S. Census

data indicates a population of 173,115. According to Florida Department of Health population

estimates, the number of women of childbearing age was estimated at 19,126, or 11.5% of the total

population in 2015 and is expected to rise to 19,975, or 11.5% of the total estimated population in

2020. In 2015, women residing in Charlotte County gave birth to 1030 infants and Healthy Start

provided services to 671 women and 261 infants. MomCare’s Maternity Care Advisor provided

services to 1337 new and existing participants during the year ended June 30, 2015.

The 2020 population estimate of 174,224 residents is based upon Florida Legislature, Office of

Economic and Demographic Research which reports a predominant White population of 90.0%

and a Black or African American population of 5.7%. The percentage of individuals of Hispanic

or Latino descent has increased 1.1 % from the rate quoted in the previous Service Delivery Plan,

to a rate of 5.8% in 2015.

The number of Medicaid Emergency Alien Deliveries for the period 2009 to 2014 has dropped

drastically from 35 to 9, a decrease of 74%. This is attributed to a decline in demand for labor

associated with previous hurricane recovery and the following housing construction decline.

Four hospitals serve the Charlotte County area, however only one, Bayfront Health – Port

Charlotte, provides labor/delivery and pediatric services. In 2015, 71.5% of the births to Charlotte

County residents took place at the Charlotte County birthing facility, with another 23.5% taking

place at facilities in three contiguous counties; Lee, Sarasota and Desoto. The remaining 5% of

resident births took place outside the contiguous counties or in unknown locations.

As of July 2016, just four (4) obstetrical practices exist within the county, housing five (5)

OB/GYN physicians, a 38% reduction from the number reported in the previous SDP update.

Currently, there are no practicing midwives within the county. All four of the prenatal provider

offices are currently accepting one or more Medicaid Managed Care Plans.

Charlotte County Healthy Start Coalition, Inc.

The Charlotte County Healthy Start Coalition, Inc. was incorporated in December 1996 and

received approval from the Florida Department of Health to allocate Healthy Start services dollars

1 Florida Legislature, Office of Economic and Demographic Research – Charlotte County Profile, Dec. 2015


in September 2001. The Coalition is one of 32 statewide Healthy Start Coalitions. The Coalition

has taken an active role in identifying health problems and barriers to healthcare experienced by

prenatal women and by children birth to age three. Operating as a grassroots organization, the

Coalition has established working relationships with many of the county’s medical and human

services organizations serving young children and pregnant women and works closely with the

local Health Department’s Community Health Improvement Partnership. The Coalition was also

instrumental in forming the Charlotte County Substance-Exposed Newborn Task Force.

The Coalition has worked hard to maintain diversity and increase engagement of its volunteer

Board of Directors, which currently numbers twelve (12). Board retreats/strategic planning events

take place every two (2) years, at a minimum, and Board development/educational opportunities

are offered throughout the year. Current Board composition includes 11 (eleven) White members,

one (1) Black member, ten (10) females, and two (2) males. Educators, human services providers,

local health department, community businesses, medical providers, housing authority, faith-based,

and community service organizations are represented. A complete listing of Board members is

provided as part of Exhibit 2.

Coalition membership is less than reported in the last Service Delivery Plan of 2009, however

there is more participation by members at Coalition meetings and events than in previous years

with higher membership counts. A current listing of members and the 34 organizations they

represent is attached in Exhibit 1.

The Coalition has had many noteworthy achievements since the 2009 SDP update. One of

particular importance was the Coalition’s response to a serious increase in substance abuse and

substance-exposed newborns in the “Engaging High-Risk Moms” provider training sponsored by

the March of Dimes in 2013. The training, a family-systems approach to engaging drug dependent

mothers, was created and presented by Dr. Gayle Dakof, Research Associate Professor, Miami

Miller School of Medicine. Attendees included medical providers, family support workers, mental

health counselors, care coordinators and Healthy Start staff.

A few other educational opportunities offered by the Coalition in recent years covered topics

including Partners for a Healthy Baby curriculum, SCRIPTS curriculum, Breastfeeding educator

training, Safe Baby Training, Advancing Accountability, strategic planning, Board development,

DFS Accountability / Contracts training, cultural competency, annual Educational Baby Shower

events for high-risk mothers, human trafficking intervention, drowning prevention, and

recognizing victims of domestic violence.

The Coalition continues to offer Childbirth Education classes. Starting July 1, 2015, a free infant

car seat is offered to those participants in need who attend all 6 classes in the series (a “hold

harmless” agreement is required). It is anticipated that this incentive will continue, subject to

funding availability. Also beginning July1, 2015, the Coalition offered two (2) new classes, Infant

CPR and Safe Baby. Infant CPR is available to parents, grandparents and infant care-givers. The


Safe Baby class covers topics such as vehicle safety – Look Behind You; safe sleep; drowning

prevention; coping with crying; choosing the right caregiver; baby-proofing your home; etc. Care

Coordinators assess the need for safety equipment and items during home visits. If funding is

available, items such as stair/door gates, furniture harnesses including flat panel TV harnesses,

door alarms, cabinet locks and pack-n-play for safe sleep, are provided to parents in need, who

sign a “hold harmless” agreement.

Since the last SDP update, community outreach and awareness efforts have been expanded through

social media with the addition of health e-alerts and healthy baby tips which are broadcast to

participants and subscribers monthly and the creation of a Coalition Facebook page

Additionally, the Coalition’s web page was revised and re-formatted for viewing on computer and

smart phones. A web-consultant maintains and periodically updates web pages with maternal /

child information of importance to participants and providers.

The Coalition has also continued to prepare and distribute its quarterly newsletter and New Mom’s

Educational Totes. A total of 1939 educational totes have been provided to moms-to-be in the last

4 calendar years, equating to the distribution of over 39,000 pieces of literature on maternal/child

health topics.

In addition, Coalition staff provides program updates to the community through presentations to

service clubs, schools, hospital staff, legislators, women’s groups, Chamber of Commerce

meetings, businesses, health expos, United Way Community Impact Panel, charity events, faith-

based outreach events, community resource events and children’s festivals.

The Coalition has also been successful in securing approximately $202,000 in grant funding since

the last SDP update including the following:

▪ BonSecours Health Foundation $ 5,900.00

Prenatal care, unfunded women

▪ U. Way – Charlotte Co. $ 17,410.00

Prenatal care, Psychosocial, Diab. Ed.

▪ ELC of Fla’s Heartland $ 700.00

Educ. Baby Shower


Prenatal care, Psychosocial, Diab. Ed.

▪ SW Fla. Comm. Foundation $ 995.00

Web-based learning Mgmt. system

▪ Walmart Foundation $ 1,000.00

Diab. Educ.


▪ Char. Co. Homeless Coalition, Inc. $ 906.00

Safe sleep, Car seat safety

▪ ELC of Fla’s Heartland $ 1,000.00

New Moms Educ. Totes


Prenatal care – unfunded women

▪ U Way – Charlotte Co. $ 7,213.74

Care Coord., Psychosocial, Diab. Ed.

▪ March of Dimes $ 2,177.75

Provider training



▪ Bon Secours Health Foundation $ 15,000.00


▪ WellCare $ 414.10

Safe Sleep




Care Coord, Psychosocial, Diab. Ed.

▪ Bd, of Co. Commissioners $ 17,211.74



Care Coord., Psychosocial

▪ Bd. of County Commissioners $ 22,500.00

Care Coord., Psychosocial

▪ Bon Secours Health Foundation $ 20,000.00


▪ Charlotte Comm. Foundation $ 9,100.00

IT Infrastructure Enhancement __________

$ 201,893.33


Index

October 2016 - September 2021 Service Delivery Plan

of Charlotte County Healthy Start Coalition, Inc.

1. DESCRIPTION OF PROCESS USED TO UPDATE THE SERVICE DELIVERY PLAN ..9

2. SUMMARY OF FINDINGS FROM THE UPDATED NEEDS ASSESSMENT.................11

3. MAJOR HEALTH INDICATORS SELECTED FOR THE NEW PLANNING CYCLE ....20

4. TARGET POPULATION OR AREA FOR RECEIPT OF SPECIAL EMPHASIS ..............32

5. FACTORS CONTRIBUTING TO THE HEALTH STATUS INDICATORS IN THE

TARGET POPULATION ......................................................................................................34

6. CONSUMER AND PROVIDER INPUT...............................................................................70

7. RESOURCE INVENTORY ...................................................................................................76

8. SERVICE GAPS ....................................................................................................................96

9. HEALTH STATUS PROBLEM LINKED TO ACTION PLAN ..........................................99

10. INTERNAL QUALITY IMPROVEMENT/QUALITY ASSURANCE PLAN ..................103

11. PROCESS FOR ALLOCATING FUNDS ...........................................................................106

12. EXTERNAL QUALITY IMPROVEMENT/QUALITY ASSURANCE PLAN .................108

13. CLOSEOUT OF 2015-2016 CATEGORIES B & C............................................................112

14. NEW ACTION PLAN CATEGORIES B & C ....................................................................143

15. INDEX OF TABLES............................................................................................................165

16. INDEX OF FIGURES ..........................................................................................................168

17. EXHIBITS ............................................................................................................................169

18. END NOTES ........................................................................................................................264


1. DESCRIPTION OF PROCESS USED TO UPDATE THE SERVICE DELIVERY PLAN

As a requirement of its contract with the Florida Department of Health, the Charlotte County

Healthy Start Coalition reviews and updates the Service Delivery Plan every five years, however

a two-year extension was granted to the Coalition in 2014 by the Florida Department of Health

due to implemented program revisions. Over the past seven years the Coalition’s Board

Committees, particularly the Data Committee, and Coalition staff, have met regularly to analyze

and evaluate participant/consumer and provider surveys, focus group summaries, and statistical

data from the Florida Department of Health’s Office of Planning, Evaluation and Data Analysis

and Office of Vital Statistics.

Findings of the committees and staff were shared with the full Board of Directors and the General

Membership via reports, newsletters and presentations. Committee recommendations, as

approved by the Board, were considered in the development and update of the Annual Action Plan.

One example of this process is evident in the Coalition acting as lead in the creation of the

“Substance Exposed Newborn (SEN) Task Force of Charlotte County,” to bring stakeholders

together to address the local increase in prenatal substance abuse and the birth of substance

exposed infants.

In spring 2015, staff began a review of the previous plan and, with the assistance of a consultant,

started to organize data on area demographics along with local, state and national health indicators.

Data was gathered from sources such as, Florida Charts, the Florida Department of Health in

Charlotte County, U.S. Census, Centers for Disease Control, The Florida Behavioral Risk Survey

and appropriate medical and professional journal articles and research. Locally collected data

through surveys and Healthy Start program reporting sources was also gathered and organized for

the assessment activities of the SDP process.

The information was compiled into reference documents and in fall 2015, the Coalition invited

thirty-seven local stakeholders to participate in a Community Assessment Review Committee to

assess local maternal/child health needs and determine any gaps in service. Using a modified

APEXPH approach, eighteen individuals representing Charlotte County healthcare providers,

federally-funded clinics, Healthy Start service providers, consumers, educators, faith-based

organizations, the housing authority, local government, school system and pregnancy shelters met

for two meetings in the first quarter of 2016. The group also used email communication in between

meetings to explore the data and indicators further, reducing the need for additional meetings.

Facilitated by a consultant, the Community Assessment Review Committee members examined

the data which included comparison data for Clay, Hernando and Martin counties, as well as the

results of consumer and community surveys conducted throughout the past service delivery plan

period (See Consumer Input Section Pg 70). The group also shared insights from their community

sector, topical research and summary articles related to maternal and child health issues. Working


together with this data, research and experience, the 2016 Needs Assessment Summary and Logic

Model (Exhibit 3) was drafted to include direct and indirect indicators of poor maternal and infant

outcomes as exhibited in Charlotte County. The draft assessment and logic model were reviewed

by the Coalition’s Board of Directors and key stakeholders for additional input. This process

provided the Coalition with the ability to identify and select major health indicators for the new

planning cycle.

The Community Assessment Review Committee also evaluated local resources and determined

existing service gaps. Using this information and the priority areas, the Community Assessment

Review Committee completed their process by suggesting action steps and service activities to the

Coalition’s Board of Directors.

From April through July 2016, the Coalition Board members reviewed draft components of the

Service Delivery Plan, starting with the summary of findings from the updated Needs Assessment,

major health indicators recommended for the new planning cycle, and factors contributing to the

health status indicators in the target population.

The Coalition’s SDP consultant also worked with staff to draft additional plan components

including the resource inventory, service gaps, internal and external quality improvement/quality

assurance plans, and the funding allocation process. Input from the Community Assessment

Review Committee was also used to draft the new Annual Action Plan. Components were

reviewed by the Board of Directors for additional input and approval, resulting in the final Service

Delivery Plan.


2. SUMMARY OF FINDINGS FROM THE UPDATED NEEDS ASSESSMENT

Table 1: Summary of finding from the updated needs assessment

Demographics

2009 SDP Data Reported 2016 SDP Update Data

❖ Per the Florida C.H.A.R.T.S. website,

the County’s 2004 population was

reported to be 156,325 and estimated to

reach 175,504 by 2010.

❖ Per the July 1, 2015 U.S., census Charlotte

County’s population estimate is 173,115. This

represents a 10.74 % change from April 1, 2010

census data.1F1F

i

❖ Estimates were for the number of

women of childbearing age (15 to 44)

in Charlotte County from 2009 to 2013

to increase by 4.6% and 4.8% for the

State. Looking at the entire period of

2005-2013, the number of women of

childbearing age (15 to 44) in Charlotte

County was estimated to increase by

13.7% with the state’s number

increasing by 10.2%.

❖ Charlotte County experienced a decrease of

2.23% in women of childbearing age from 2009

to 2015, according to Florida Chart estimates.

The state saw an estimated 3.87% increase

during the same time. Between 2009 and 2010

there was a 5.43% reduction in Charlotte County

(state data shows a 0.57% increase). However,

there is a steady increase each year to 2015

(19,126 in 2015) though still short of the

reported 2009 data (19,563).2F2F

ii

❖ 2009 estimates for race and ethnicity

population statistics indicate that

92.2% of the population was White,

6.1% is Black, 1.7% is “Other Non-

White”, and 4.7% was Hispanic.

❖ 2014 estimates for race population statistics

indicate that 90.5% is White, 6.2% is Black, .3%

is Native American, 1.4% is Asian, and .1% is

Native Hawaiian or Other Pacific Islander and

1.5% two or more races. 6.7% is Hispanic.

❖ The percentage of grandparents living

in a household with one or more of

their own grandchildren under the age

of 18 where the grandparent was

responsible for the grandchildren was

41.8% in Charlotte County in 2005-07

American Community Survey 3-Year

Estimates.

❖ Data from 2014 listed by the U.S. Census reports

the percentage of grandparents living in a

household with one or more of their

grandchildren has dropped to 10.2% in Charlotte

County, 1.3% report they are responsible for one

or more grandchild under the age of 18. In 2009,

this was 0.8%.


2009 SDP Data Reported 2016 SDP Update Data

❖ 2005-07 American Community Survey

3-Year Estimates Report reports 8.7%

of persons in the county were below

the poverty level. 16.9% of families

with related children under the age of

five were below the poverty level.

2.3% of the households reported

income of less than $15,000.

❖ The median household income rose

from $36,379 in 2006 to $37,820.

❖ 2014 U.S. Census data indicates 12.7% of

persons in the county are below the poverty

level. 20.6% of children in the county are below

the poverty level, with 19.5% of families with

children below the poverty level. 11.1% of these

families are married couples with children under

18; while 36.4% are single mothers, with no

husband present.

❖ Currently, the median household income is

$44,265. For families with their own children,

the median income is $45,887; with two parent

families at $63,900. In households with only a

single parent, the median income is $38,325, but

drops to $24,559 if single mother household.

3.1% of households report income less than

$15,000 per year.

❖ Much of the recovery from the 2004

Hurricane Season, and especially

Hurricane Charley, had been

completed. The final major building,

Charlotte High School neared

completion. Housing was a major

issue during this time, as the “housing

boom” coincided with Hurricane

devastation. 2005-07 American

Community Survey 3-Year Estimates

indicates that 39.7% of persons had

rent equal to 35% or more of their

gross income. In early 2009, a

homeless shelter opened.

❖ The current down-turn in the local

housing industry and economy has

created a glut of home foreclosures and

record-high number of homes for sale.

❖ Charlotte County is experiencing an economic

improvement from an economy deflated by both

Hurricane Charley and the economic recession.

The unemployment rate is decreasing, with the

November 2015 rate documented at 5.3%.3F3F

iii

❖ Housing sales (5089) and single family building

permits (668) are up from the January 2014-

October 2014 numbers (4591 and 459) for the

same period in 2015. However, 47.6% of

renters in the county have gross rent 35% or

more of household income, an increase from the

prior reporting period in 2005-07.4F4F

iv

❖ Additionally, the 2015 “Point-in-Time”

Homeless survey reports an increase in

households who are homeless from 57 (2014) to

67.5F5F

v


Transportation

2009 SDP Update Data Reported 2016 SDP Update Data

❖ In 2008, medical trips accounted for 38%

of the use of public transportation in

Charlotte County. Dial-a-Ride is the

service provided to the general public with

a fee-per-trip cost; while Sunshine Ride

(Transportation Disadvantaged Program)

provides free or reduced cost

transportation to persons who are:

physically or otherwise disabled; 60 years

of age or older; receiving Medicaid;

qualified as Low Income; or, living in a

rural area. Rides are provided to: health

care appointments, jobs, school, shopping,

and other life-sustaining activities.

❖ A 2013 Transit Study in Charlotte County

revealed nearly 40,000 people use either

Dial-a-Ride or Sunshine Ride (now both

known as Charlotte County Transit)

annually. A survey of riders indicated

approximately 50% of riders used the

system for medical appointments.

Continued community pressure through

riders, service providers for person with

low-income status, and community

advocates continue to push for a fixed route

system. The county government continues

to study the issue and seek funding

sufficient to provide and sustain a fixed

route system. Improvements in cross-

county transportation have been made by

both Charlotte and Sarasota Counties to

enable persons to reach medical and retail

services.6F 6F

vi

Births, Screening, Prenatal Smoking


❖ In 2007, there were 1,199 resident live

births, of which 1061 (88.5%) were to

White mothers and 138 (11.5%) to Non-

white mothers. Approximately 10.6%, of

the 1,199 live births in 2007, were born to

mothers of Hispanic origin.

❖ In 2014, there were 1,007 resident live

births, of which 889 (88.3%) were to White

mothers and 81 (8%) to Black mothers.

Approximately 9.1%, of the 1,007 live

births in 2014, were born to mothers of

Hispanic origin.7F 7F

vii

❖ A total of 1189 pregnant women were

offered Healthy Start Risk Screening in

2007. 921 consented to complete the

screen. 464 (50.3%) of the women had

positive screens, with 94% consenting to

participate.

❖ In 2015, a total of 1090 women were offered

Healthy Start Risk Screening. 89.9% (n980)

consented to complete the screen. 40%

(n393) screened eligible (including “based

on other factors”), with 94.2% consenting to

participate.


❖ In 2007, the five largest zip code areas in terms of birth, in descending order, were

33952, 33950, 33948, 33983 and 33954.

However, in 2011 this had changed to

33952, 33983, 33948, 33950, 33980, as

seen below. These changes appear to be

tied to development of more affordable

housing in the top zip codes.

Zip code

2011 Births

Charlotte

33952 227

33983 120

33948 115

33950 96

33980 78

33954 76

33981 54

33982 51

33955 45

34224 44

33947 34

33953 26

34223 11

99999 (other, unknown) 7

33946 2

33949 1

Total 987

❖ In 2015, the five largest zip code areas in terms of birth, in descending order, are

33952, 33983, 33948, 33950 and 33982.

This is not a change from the previous

assessment update.

Zip code

2015 Births

Charlotte

33952 279

33983 106

33948 103

33950 96

33982 73

33954 71

33980 61

33981 59

34224 54

33955 51

33953 29

33947 19

34223 13

99999 (other, unknown) 8

33946 7

33903 1

33949 1

Total 1,031

❖ The rate of births to women who reported

smoking. Year ► 2005 2006 2007 2008 2009

Charlotte 17.8 19.7 18.4 15.6 13.0

State 7.8 7.6 7.1 6.8 6.9

❖ The rate of births to women who reported

smoking. Year ► 2010 2011 2012 2013 2014

Charlotte 16.6 13.1 14.5 18.9 14.9

State 7.0 6.7 6.6 6.6 6.4

Substance Abuse


❖ 2007 CCHSC data indicates services

provided to 16 drug-abusing mothers and 3

infants substance-exposed. In 2008

provisional data indicates CCHSC

provided services to 12 substance-exposed

infants.

❖ 2015 CCHSC data indicates services

provided to 29 drug-abusing mothers and 10

infants substance-exposed. 2672 units of

service were provided to the mothers and

875 units of service were provide through

infant exposed screening.


Infant Mortality, Poor Birth Outcomes


❖ The 2007 infant mortality rate was 5.8 per

1000 which is below the state rate of 7.1

per 1,000.

❖ The 2014 infant mortality rate was 4 per

1000 which is below the state rate of 6 per

1,000.

❖ LBW (<2500 gm.) rate is lower at 7.7%

than the state rate of 8.7% in 2007.

❖ In 2014, LBW (<2500 gm.) rate is lower at

7.2% than the state rate of 8.7%.

❖ VLBW (<1500 gm.) rate is lower at 1.0%

than the state rate of 1.6% in 2007.

❖ In 2014, VLBW (<1500 gm.) rate is lower

at 1.1% than the state rate of 1.6%.

Prenatal Care


❖ The rate of women entering prenatal care

in the first trimester during 2007 was 72%,

which is below the State rate of 75.9%.

❖ The rate of women entering prenatal care in

the first trimester during 2014 is 72.2%,

which is below the State rate of 79.4%.

❖ Late prenatal care of 5.8% or no prenatal

care of 1.1% was above the 2007 state

averages of 3.9% and 2.1%, respectively.

❖ Late prenatal care of 5.8% is above the

2014 State rate of 3.8%. However, the

county rate for no prenatal care of 1.3% is

below the 2014 state rate of 1.4%.

❖ In 2007, white women with 3rd trimester or

no prenatal care was 6.6% and 10.1% for

black mothers. State rates were 5.2% and

8.9% respectively. While, rates for non-

Hispanic women in the county were 5.9%

for Hispanic women and 7% for non-

Hispanic women in the county, as

compared to 6.7% and 5.8% in the state.

❖ In 2014, white women with 3rd trimester or

no prenatal care was 6.2% and 13% for

black mothers. State rates were 4.6% and

7.2% respectively. While, rates in the

county were 2.4% for Hispanic women and

7.5% for non-Hispanic women in the

county, as compared to 4.7% and 5.5% in

the state.

❖ Healthy Start provided prenatal care for a

limited number of uninsured women who

are ineligible for Medicaid and do not have

other resources to pay for medical care.

Grant funding has been used to augment

these expenses annually.

❖ This continues to be true for Charlotte

County Healthy Start Coalition.

❖ Per State Records, Medicaid Emergency

Alien Deliveries in Charlotte County have risen from 16 in 2004 to 31 in 2007.

❖ Per AHCA data, between July 2014 and

June 2015, there were 25 Medicaid Emergency Alien deliveries in Charlotte

County.

❖ As of July 2009, seven of the nine area

OB-GYN physicians are delivering infants

to Medicaid clients. Two are no longer

providing OB services, providing only

GYN services.

❖ As of July 2016, five OB-GYN physicians

are delivering infants to Medicaid clients.

Charlotte County pregnant women are also

eligible to receive services through a FQHC

clinic in North Port, with delivery in

Sarasota County.


Teen Births

2009 SDP Update Data 2016 SDP Update Data

❖ Birth rate of teens ages 15-19 in 2007 was

36.2 per 1,000 remaining below the state

rate of 43.2 per 1,000.

❖ Birth rate of teen’s ages 15-19 in 2014 was

23.4 per 1,000, slightly above the state rate

of 21.9 per 1,000.

❖ In 2007, the White teen (ages 15-19) birth

rate was 36.8 per 1000; the Black teen

birth rate was 29.9 per 1000. Birth rates

for Hispanic teen mothers was 61 and 35.9

for non-Hispanic mothers in Charlotte

County.

❖ In 2014, the White teen (ages 15-19) birth

rate was 16.9 per 1000; the Black teen birth

rate was 16.5 per 1000. Birth rates for

Hispanic teen mothers was 16.5 and 24.4

for non-Hispanic mothers in Charlotte

County.

❖ In 2007, one birth to a female in the 10-14

age bracket occurred in Charlotte County,

continuing the rate of 3 per 1000 versus a

statewide rate of .7 per 1000.

❖ From 2009-2014 only two births were to

mothers between the ages of 10-14. No

births in 2013 and 2014 are documented for

this age according to Florida Charts data.

❖ The number of Charlotte County teens age

18-19 giving birth in 2007 was 103

compared to 93 in 2006. The respective

rates per 1000 are 70.6 in 2006 and 77.4 in

2007. The state rate per 1000 was 74.9 in

2006 and 74.5 in 2007.

❖ The number of Charlotte County teens age

18-19 giving birth in 2014 was 50

compared to 80 in 2009. The respective

rates per 1000 are 38.9 in 2014 and 63.9 in

2009. The state rate per 1000 was 41.0 in

2014 and 66.9 in 2009.

❖ In 2007, 6.6% of mothers in the 15-19 age

entered prenatal care in their 3rd trimester

or had no prenatal care. The 2007 state

average was 8.9%

❖ In 2014, 14.3% of mothers in the 15-19 age

entered prenatal care in their 3rd trimester or

had no prenatal care. The 2007 state

average was 8.4%

❖ 7.7% of infants born to women ages 15

through 19 weighed less than 2,500 grams.

The state average in 2007 was 10.2%

❖ In 2014, 6.7% of infants born to women

ages 15 through 19 weighed less than 2,500

grams. The state average was 9.8%

❖ Statewide, 18.4% of teens ages 15-19

giving birth in 2007 had one or more

previous births. This rate for Charlotte

County in 2007 was 10.9%.

❖ Statewide, 16.3% of teens ages 15-19

giving birth in 2015 had one or more

previous births. This rate for Charlotte

County in 2015 was 14.7%.


Other Birth-Related Data


❖ In 2007, 1,188 of the 1199 births were

delivered by a hospital facility, four infants

were born at a birthing center, and seven

births took place at home. Of the 1,188

hospital births, 76% were delivered by a

physician and 22% were attended by a

midwife. The remainder of the births (2%)

was assisted by other or unknown

attendant.

❖ In 2014, 987 of the 1007 births were

delivered by a hospital facility, five (5)

infants were born at a birthing center, and

fifteen (15) births took place at home.

93.6% of births were delivered by a

physician and 5.4% were attended by a

midwife. The remainder of the births (1%)

were assisted by other or unknown

attendant.8F8F

viii

❖ Of the 1,199 births in 2007, 16.4% of the

mothers reported having less than a high

school education, compared to 20.8% for

state.

❖ Of the 1,007 births in 2014, 11.7% of the

mothers reported having less than a high

school education, compared to 13.25% for

state.

Immunizations


❖ 1,183 of the County’s 1,199 kindergarten

students had received their recommended

immunizations resulting in the County

achieving an immunization rate of 98.7%

for 2007.

❖ Kindergarten immunization rates for 2016

in Charlotte County are 94.7% as compared

to state rate of 93.7% according to Florida

Charts.

Family Planning


❖ In 2007, the Florida Department of Health

in Charlotte County provided family

planning services to 2092 persons, rising to

2371 persons in 2008.

❖ The Florida Department of Health in

Charlotte County provided Family

Planning services to 1493 women in 2013,

1019 in 2014 and 946 during 2015.

Decrease may be attributable to the

Department’s closure of primary care

services. While Family Planning services

continue, it may not be as convenient for

women to come to DOH-CC without full

services offered.


❖ The Alan Guttmacher Institute estimates that in 2006, there were 971,010 women in

Florida in need of publicly supported

contraceptive services and supplies,

meeting 35.6% (345,490) of this need

through public sector services. (Defined as

being under age 20 or aged 20–44 and

under 250% of poverty)

❖ The Alan Guttmacher Institute reports,” In 2013, 1,209,560 women in Florida were in

need of publicly supported contraceptive

services and supplies. Women are

considered to be in need of publicly

supported contraceptive services and

supplies if they have ever had sex; are aged

13–44; are able to become pregnant; are

not pregnant, postpartum nor trying to

become pregnant; and either have a family

income below 250% of the federal poverty

level or are younger than age 20.”9F9F

ix

Nutrition



in Charlotte County provided nutrition

services (WIC) to 2,160 of 3,017 eligible

participants, serving 71.6% of eligible

clients.


in Charlotte County provided nutrition

services (WIC) to 2,789 participants,

serving 89.6% of eligible clients.

❖ Breastfeeding Education and Support

services are offered through Peace River

Regional Medical Center and the County’s

WIC Program.

❖ 2007 data indicates the percentage of

Charlotte County mothers initiating

breastfeeding at birth as 73.3% and the

state percentage at 77.6%

❖ Breastfeeding Education and Support

services are offered through the WIC

Program of the Florida Department of

Health in Charlotte County. Additionally,

one (1) Healthy Start Care Coordinator can

provide and code for breastfeeding

education.

❖ 2014 data indicates the percentage of

Charlotte County mothers initiating

breastfeeding at birth as 79.4% and the

state percentage at 84.2%

❖ The Early Learning Coalition of Florida’s

Heartland reports a “scholarship” waiting

list of 398 for January 2009.

❖ The Early Learning Coalition of Florida’s

Heartland reports a “scholarship” waiting

list of 154 for December 2015.


Dental Care


❖ Only 15.6% of low-income persons

residing in Charlotte County in 2006 had

access to preventive and restorative dental

care while 24.4% have access in the State

as a whole.

❖ At the time of 2009 Update, Family Health

Centers provided limited Medicaid dental

services in Charlotte County and had plans

to expand this service to 5 days a week.

❖ Additionally, the Charlotte County Health

Department dental services at its new Port

Charlotte Clinic was closed, along with all

primary care services.

❖ 2012 data from Florida Charts indicates

that only 14% of low-income persons

residing in Charlotte County had access to

preventive and restorative dental care while

24.9% had access in the State.

❖ Family Health Centers has increased dental

services in Charlotte County, accepting

Medicaid. The Florida Department of

Health in Charlotte County opened a dental

clinic in June 2016 for Medicaid clients, up

to age 21. However, Charlotte County

residents who are uninsured or

underinsured continue to struggle to access

dental care.


3. MAJOR HEALTH INDICATORS SELECTED FOR THE NEW PLANNING CYCLE

The major health indicators to be addressed in the new planning cycle have been identified through

the analysis of statistical data, past and present, by a task force of community stakeholders. Direct

and indirect contributing factors have been considered in evaluating these health challenges.

Community data utilized was obtained from various sources, such as Florida CHARTS and U.S.

Census, as well as community input from providers and consumers obtained through surveys

(Section 6). The health issues to be addressed were prioritized and weighted based upon impact on

local infant mortality and birth outcomes. A copy of the Fishbone/Logic Model developed by the

Community Assessment Review Committee is included as part of Exhibit 3.

Issues to be targeted in the new Annual Action Plan (AAP Pg 143) include: prenatal smoking, a

focal point of strategies since the Coalition’s original 2001 Service Delivery Plan; early entry to

care; pre and interconceptional health (emphasis on pregnancy interval); racial/ethnic

disparities in maternal/child health, and build internal and programmatic capacity.

The issues targeted are a continuation of those from the previous AAP. The Coalition’s monitoring

and review process has led to adjustments and a fine tuning of the action plan as a natural course

of the Coalition process. This includes reflection of changes within the state and local systems of

care, affecting our community resources and capacity to address maternal and child health issues.

The establishment of the Community Health Improvement Partnership (CHIP) provides the

Coalition with an additional resource for capacity building and providing the community with

strategic interventions. CHIP, facilitated by the Florida Department of Health in Charlotte County,

engages a broad scope of community providers, residents and stakeholders. While focused on

community health in total, CHIP has several subcommittees to target specific community health

areas, including Maternal and Child Health. Charlotte County Healthy Start Coalition serves as

the lead for the Maternal and Child Health Committee. This committee developed a focus on entry

to care, increase awareness of PEPW, and more recently, tobacco use during pregnancy. CHIP

also provides for the Coalition with the ability to crosswalk strategies with CHIP’s Behavioral

Health and Access to Care committees.


Selected Indicators for the New Plan

The Community Assessment Review Committee chose low birth weight rates and preterm births

as the direct indicators to fetal death rates in Charlotte County. The committee explored the risk

factors identified through research by Healthy People 2020 for these indicators to identify the local

indirect indicators which likely contribute to the local direct indicators.

The committee identified that Charlotte County’s low birth weight rate of 8.2% is higher than the

Healthy People 2020 goal of 7.8%. The indirect indicators for this area were determined to be

smoking and entry to care. The rate of mothers NOT smoking while pregnant for Charlotte County

is lower at 83.9% than the goal of 98.6% for Healthy People 2020. The Charlotte County rate of

entry to care during the first trimester is 74.2%, lower than the rate of 77.9% specified as the goal

for Healthy People 2020.

As indicated above, a second direct indicator to fetal death rates in the county is preterm births.

Charlotte County preterm birth rate of 12.8% is higher than the Healthy People 2020 goal of

11.4%. The indirect indicators for preterm births were identified as pre-conception and

interconception care issues, primarily of pregnancy intervals of less than 18 months. Racial

disparities related to pre-conception and interconception care issues were also identified. Mothers

who are black have the highest rates of preterm birth (19.5%) and highest percentage of births with

a pregnancy interval of less than 18-months (44.4%).

The Logic Model/Fishbone (Exhibit 3) shows how the committee used the data it gathered to

connect fetal deaths to the direct and indirect indicators. The indirect indicators are explored in

the following sections.

► Prenatal Smoking:

According to Florida CHARTS, Charlotte County women smoke during pregnancy at a higher rate

than women in Florida as a whole. The rate for 2014 is 14.9% for Charlotte County, while the

State of Florida rate is 6.4%. This is a difference of 8.5 percentage points. However, the rate of

Charlotte County prenatal women who smoked during pregnancy has dropped from a high of 23%

in 2002 to a rate of 14.9% in 2014. There has also been a drop in smoking rates from the previous

Service Delivery Plan, which reported 2007 rates at 18.4%.

Exploring this health indicator further, the tables below include a four-county comparison. The

data in the previous SDP indicates that in 2007, Charlotte County showed the highest rates of

smoking during pregnancy among the four counties. However, Charlotte County has dropped to

the third highest, with Hernando County now being the highest rate.


Table 2: Mothers who smoked during pregnancy

Mothers Who Smoked During Pregnancy - Percentages

County 2007 2008 2009 2010 2011 2012 2013 2014

Charlotte 18.4 15.6 13.1 16.6 13.1 14.5 18.9 14.9

Clay 11.9 12.9 14.7 12.3 11.3 12.6 11 11.9

Hernando 16.4 17.2 15.1 15.1 15.2 17.1 16.9 17.7

Martin 6.2 7.1 6.6 6.5 5.9 7 7.5 6.3

State 7.1 6.8 6.9 7 6.7 6.6 6.6 6.4 Source: www.floridacharts.com

Table 3: Births to mothers who smoked during pregnancy - counts

Resident Live Births to Mothers Who Smoked During Pregnancy - Counts

Smoking Mothers Total Births

County 2010 2011 2012 2013 2014 2010 2011 2012 2013 2014

Charlotte 168 129 150 193 150 1012 987 1036 1021 1007

Clay 262 236 261 229 247 2137 2093 2077 2088 2083

Hernando 220 236 237 251 263 1461 1552 1387 1484 1488

Martin 80 70 79 88 79 1226 1185 1126 1169 1263 Source: www.floridacharts.com

Rolling year data for Charlotte County provides additional insights into the rate of smoking during

pregnancy. During this period, Charlotte County rates move up and down between 14-16%.

Table 4: Births to mothers who smoked during pregnancy - rolling year

Resident Live Births to Mothers Who Smoked During Pregnancy,

3-Year Rolling Rates

Charlotte Florida

Year Count Rate (%) Count Rate (%)

2007-09 540 15.9 47,7171 6.9

2008-10 487 15.1 45,779 6.9

2009-11 426 14.2 44,255 6.8

2010-12 447 14.7 43,328 6.8

2011-13 472 15.5 42,538 6.6

2012-14 493 16.1 42,362 6.5 Source: www.floridacharts.com

Looking at rolling year data, we see that white mothers, and non-Hispanic mothers have

dramatically higher rates of smoking during pregnancy. White mothers are at 17.2% in the most

recent rolling year data, while black mothers are at 7.6%, which is a nearly ten (10) percentage

point difference. Further, non-Hispanic mothers smoke during pregnancy at a rate of 17% as

compared to 5.6% for Hispanic Mothers – a difference of nearly twelve (12) percentage points.


However, all rates reflect an increase for each demographic area, except non-Hispanic mothers

who show a .3% decrease from 2007-09 data. The decline in births, from 1,199 in 2007 to 1,007

in 2014 also impacts the rate. For example, the rate of smoking rose just under two percentage

points for black mothers in Charlotte County from 2007-09 rate to the 2012-14 rate. However,

there was only an increase of one mother between these two periods.

Table 5: Births to mothers who smoked during pregnancy – race

Resident Live Births to Mothers Who Smoked During Pregnancy, 3-Year Rolling

Rates

Charlotte Florida

White Black White Black

Year Count Rate

(%) Count

Rate

(%) Count

Rate

(%) Count

Rate

(%)

2007-09 500 16.8 16 5.9 40,926 8.2 5,587 3.6

2008-10 453 16.2 13 4.9 39,006 8.1 5,593 3.7

2009-11 398 15.4 12 4.7 37,497 8.1 5,676 3.8

2010-12 423 16 14 5.5 36,478 8 5,592 3.8

2011-13 445 16.7 15 6.5 35,846 7.9 5,401 3.7

2012-14 464 17.2 17 7.6 35,726 7.7 5,305 3.6 Source: www.floridacharts.com

Table 6: Births to mothers who smoked during pregnancy - ethnicity

Resident Live Births to Mothers Who Smoked During Pregnancy, 3-Year Rolling

Rates

Charlotte Florida

Hispanic Non-Hispanic Hispanic Non-Hispanic

Year Count Rate

(%) Count

Rate

(%) Count

Rate

(%) Count

Rate

(%)

2007-09 12 3.4 527 17.3 2,885 1.6 44,633 9.1

2008-10 9 2.9 478 16.4 2,894 1.5 42,685 9

2009-11 10 3.6 416 15.4 2,936 1.6 41,225 8.9

2010-12 6 2.5 441 15.8 2,869 1.6 40,331 8.7

2011-13 11 4.6 460 16.4 2,841 1.6 39,590 8.6

2012-14 14 5.6 478 17 2,790 1.6 39,466 8.5 Source: www.floridacharts.com

The Coalition has joined other Coalitions across the state to implement the SCRIPTS evidence

based smoking cessation program for pregnant mothers. SCRIPTS was rolled out in Charlotte

County in early 2015. A local trainer from Drug Free Charlotte County, provides all new care

coordinators with implementation training. The Coalition will be monitoring local data in the

coming Service Delivery Plan period to evaluate the impact SCRIPTS provides in reducing our

local smoking rates during pregnancy.


► Entry to Care:

Over the period of 2007 through 2014, Charlotte County women have accessed early (first

trimester) prenatal care at a lower rate than Florida women as a whole. However, there is a steady

improvement and the Coalition maintains a goal to meet or exceed the Healthy People 2020 goal

of 77.9%.

The table below, gathered from Florida CHARTS data, shows the steady improvement in these

rates from 2007, however both echo a slight decline in 2014 for early entry into care.

Table 7: Early entry to care rates- single year

Early Entry to Care Rates – First Trimester – Single Year

2007 2008 2009 2010 2011 2012 2013 2014

Charlotte County 72% 74.6% 74.8% 73.7% 74.8% 75.2% 75.2% 72.2%

State of Florida 75.9% 76.9% 78.3% 79.3% 80.3% 80% 79.9% 79.4% Source: www.floridacharts.com

Table 8: Entry to care rates - rolling rear

Early Entry to Care Rates – First Trimester- Rolling Year

2007-09 2008-10 2009-11 2010-12 2011-13 2012-14

Charlotte County 73.7 74.4 74.4 74.6 75.1 74.2

State of Florida 77 78.1 79.3 79.9 80.1 79.8 Source: www.floridacharts.com

When compared to other counties (Clay, Hernando, Martin), Charlotte County’s rate for late or no

prenatal care is second highest, with Martin County holding the highest 3-Year Rolling rates.

Martin County, like Charlotte, has had rates slightly increase.

Table 9: Births to mothers with 3rd trimester or no prenatal care - county comparison

Births to Mothers With 3rd Trimester or No Prenatal Care

3-Year Rolling Rates County Florida

Year Count % Count %

Charlotte 2011-13 181 6.4% 27,803 4.7%

2012-14 184 6.5% 29,871 5%

Clay 2011-13 325 5.6% 27,803 4.7%

2012-14 295 5% 29,871 5%

Hernando 2011-13 124 3.1% 27,803 4.7%

2012-14 121 3.1% 29,871 5%

Martin 2011-13 218 6.5% 27,803 4.7%

2012-14 237 6.9% 29,871 5% Source: www.floridacharts.com

The good news is that the majority of pregnant women enter prenatal care during the first trimester.

Further, age does not appear to be a large factor in late entry, as the table below demonstrates.

http://www.floridacharts.com/




According to 2014 data, 36% of pregnant teens (age 15-17) do not enter care until 2nd trimester,

with only 48% entering during the 1st trimester.

Table 10: Trimester care began by age of mother - 2014 Charlotte County

2014 Trimester Care Began - Charlotte County

Mother's Age 1st

trimester

2nd

trimester

3rd

trimester

No prenatal

care

Unknown prenatal

care status Total

15-17 12 9 3 0 1 25

18-19 26 13 9 1 5 50

20-24 201 57 20 2 20 300

25-29 211 51 14 5 18 299

30-34 150 43 5 3 19 220

35-39 60 16 4 1 5 86

40-44 17 6 2 0 1 26

45+ 1 0 0 0 0 1

All Mother Age 678 195 54 12 68 1007 Source: Florida Department of Health, Office of Vital Statistics, Florida Birth Certificate - Florida residents only

The Community Assessment Review Committee also examined entry to care disparities related to

race and ethnicity. Comparing data among the four (4) counties provided additional value in

determining issues within Charlotte County. As the table below indicates, there is a higher rate of

late (or no) entry to care among mothers who are black. This is indicative within all four (4)

counties, as well as within the State of Florida. Charlotte County has seen an improvement (nearly

5% decrease), comparing 2011-13 rolling year data to that of 2012-14, while the other counties,

and even the state saw an increase in late entry rates for mothers who are black. However, among

mothers who are white, there was a slight increase in the percentage of those entering into care

late (3rd trimester) or not at all.

Table 11: Births to mothers with 3rd trimester or no prenatal care - race

Births to Mothers with 3rd Trimester or No Prenatal Care

3-Year Rolling Rates - Race County Florida White Black White Black

Year Count % Count % Count % Count %

Charlotte 2011-13 144 5.8% 22 10.2% 17,370 4.1% 8,591 6.5%

2012-14 148 5.9% 20 9.7% 18,685 4.3% 9,156 6.8%

Clay 2011-13 247 5.2% 55 8.2% 17,370 4.1% 8,591 6.5%

2012-14 212 4.4% 54 8.2% 18,685 4.3% 9,156 6.8%

Hernando 2011-13 107 3% 13 4.3% 17,370 4.1% 8,591 6.5%

2012-14 105 3% 14 4.7% 18,685 4.3% 9,156 6.8%

Martin 2011-13 175 6.1% 29 10.1% 17,370 4.1% 8,591 6.5%

2012-14 192 6.5% 29 10.4% 18,685 4.3% 9,156 6.8% Source: www.floridacharts.com



Rolling year rates for mothers who are Hispanic also improved for all four (4) counties, while late

entry for the State of Florida among mothers who are Hispanic increased.

Table 12: Births to mothers with 3rd trimester or no prenatal care - ethnicity

Births to Mothers with 3rd Trimester or No Prenatal Care

3-Year Rolling Rates- Ethnicity County Florida Hispanic Non-Hispanic Hispanic Non-Hispanic


Charlotte 2011-13 12 5.4% 169 6.4% 7,131 4.4% 20,570 4.8%

2012-14 11 4.7% 173 6.6% 7,657 4.6% 22,105 5.1%

Clay 2011-13 32 6.2% 292 5.5% 7,131 4.4% 20,570 4.8%

2012-14 27 5.1% 265 5% 7,657 4.6% 22,105 5.1%

Hernando 2011-13 15 3% 109 3.1% 7,131 4.4% 20,570 4.8%

2012-14 13 2.6% 107 3.1% 7,657 4.6% 22,105 5.1%

Martin 2011-13 93 8.8% 123 5.4% 7,131 4.4% 20,570 4.8%

2012-14 94 8.7% 142 6% 7,657 4.6% 22,105 5.1% Source: www.floridacharts.com

During the period since the Coalition’s last Service Delivery Plan, several factors have been

identified as having an impact on entry to care. One is the loss of primary care services through

the local department of health. While a free clinic and FQHC (Federally Qualified Health Center)

are present in the county, the services do not address the needs of pregnant women. Changes in

Medicaid, and loss of some OB-GYN physicians also hinder access, as does issues with

transportation.10F10F

x From 2010-16, Charlotte County Healthy Start Coalition conducted surveys of

local OB providers. The latest survey indicates that there are only four (4) OB provider offices in

the county, with only two (2) of the practices accepting all four (4) MCO plans offered in our area.

The 2013 Community Assessment conducted by United Way of Charlotte County echoes these

issues of access to care for uninsured or underinsured. One of the document’s recommendations is

to continue to address early entry to care during pregnancy, building a stronger foundation for

future child health and development success. 11F11F

xi

► “Pre” and Interconception Care:

The Community Assessment Review Committee and Coalition evaluated data on direct and

indirect factors that contribute to low birth weight and premature birth. This process helped them

to ascertain which factors are of particular impact in Charlotte County. Through this consideration,

the committee and Coalition identified a continued emphasis and targeting of comprehensive “pre”

and “interconception” care strategies and interventions as the approach to improve local rates for

healthy pregnancy interval, as well as the racial disparities identified by the assessment process.



The percentage of births with an inter-pregnancy interval of less than 18-months is higher for

Charlotte County than for the State of Florida. However, rates in the county have improved

steadily since 2008-10. At that time, the rate was 40.9% and data indicates it has dropped to 35.1%

for 2012-14. This represents a reduction of over four (4) percentage point in births with a less than

18-month interval for the county (from 2008-10 to 2012-14). This compares to a reduction for the

state, during the same period, of approximately 8.7%. A closer look at pregnancy intervals by race

and ethnicity will be discussed in the next section.

While not as low as the state rate, Charlotte County has a lower rate of births with an inter-

pregnancy interval of less than 18-months than the other comparison counties of Clay, Hernando

and Martin. The tables below present the data on inter-pregnancy interval of less than 18-months

for both the county and state.

Table 13: Inter-Pregnancy Interval less than 18 Months - Rolling Year

Births with Inter-Pregnancy Interval < 18 Months

3-Year Rolling Rates – Charlotte and State of Florida

Charlotte Florida

Count % Count %

2008-10 771 40.9% 137,856 38%

2009-11 671 39.8% 130,111 37%

2010-12 631 37.3% 126,715 36%

2011-13 583 35.4% 126,579 35.1%

2012-14 594 35.1% 128,401 34.7%


3-Year Rolling Rates- County Comparison County Florida


Charlotte 2011-13 583 35.4% 126,579 35.1%

2012-14 594 35.1% 128,401 34.7%

Clay 2011-13 1244 34.6% 126,579 35.1%

2012-14 1323 36.0% 128,401 34.7%

Hernando 2011-13 920 38.2% 126,579 35.1%

2012-14 902 37.1% 128,401 34.7%

Martin 2011-13 821 36.9% 126,579 35.1%

2012-14 850 36.5% 128,401 34.7% Source: www.floridacharts.com

It is the recommendation of the Coalition to address healthy inter-pregnancy interval through “pre”

and “interconception” health education to both men and women of child-bearing age. This also

provides the Coalition with the opportunity to address several contributing factors through one

segment of the Action Plan. Additional Pre/ICC behaviors studied locally and cited as potentially

harmful to future pregnancy outcomes included: substance abuse and behavioral health, poor



nutrition and obesity, domestic violence, maternal infections, mental illness, and a prior history of

poor pregnancy outcome.

► MCH Racial/Ethnic Disparities:

Data from 2011 through 2014 indicate a slight decrease in the number of white residents and

increases in non-white and Hispanic population groups (see tables 14 and 15 below). This follows

the trend from the previous SDP. The risk of low diversity can increase the challenge to identify

the most effective delivery of culturally-sensitive services.

Table 14: Population by Race

White Black Other

Year Charlotte State Charlotte State Charlotte State

2011 91.0% 78.5% 6.0% 16.5% 3.0% 5.0%

2012 90.8% 78.4% 6.1% 16.5% 3.1% 5.0%

2013 90.7% 78.3% 6.2% 16.6% 3.1% 5.1%

2014 90.5% 78.2% 6.3% 16.7% 3.2% 5.1% Source: The Florida Legislature, Office of Economic and Demographic Research

Table 15: Population Data - Ethnicity

Hispanic Non-Hispanic

Year Charlotte State Charlotte State

2011 5.9% 22.8% 94.1% 77.2%

2012 6.1% 23.2% 93.9% 76.8%

2013 6.2% 23.5% 93.8% 76.5%

2014 6.5% 24.0% 93.5% 76.0% Source: The Florida Legislature, Office of Economic and Demographic Research

Table 16 provides birth rate data from 2008-2014 in Charlotte County. In terms of birth rates per

1000, women who are black or Hispanic have higher birth rates than women who are white or non-

Hispanic. This table also demonstrates that the birth rate for women who are black or Hispanic is

higher than the overall birth rate. This adds support to the identified need for culturally competent

services through Healthy Start initiatives and activities.


Table 16: Birth Rates Per 1000 Total Population

Charlotte County Birth Rate Per 1000 Total Population

2008 2009 2010 2011 2012 2013 2014

White 7.3 5.9 6 5.9 6.2 6 6

Black & Other 10.9 9.4 9.5 9 8.8 7.6 7.5

Total 7.6 6.2 6.3 6.1 6.4 6.2 6.1

Charlotte County Birth Rate Per 1000 Total Population

2008 2009 2010 2011 2012 2013 2014

Hispanic 11.9 12.9 9 8.2 7.8 7.9 8.6

Non-Hispanic 7.3 5.8 6.2 6 6.3 6 5.9

Total 7.6 6.2 6.3 6.1 6.4 6.2 6.1 Source: www.floridacharts.com

The Community Assessment Review Committee considered additional data as the members made

the determination to select ethnic/racial disparities as a service plan target area. As indicated in

the opening paragraphs to this section, possible outcome disparities for mothers who are black

were revealed through examination of pregnancy interval and preterm birth data. While inter-

pregnancy intervals improved for mothers who are white, data does not echo this for mothers who

are black in Charlotte County. Mothers who are black have highest percentage of births with a

pregnancy interval of less than 18-months (44.4%). This rate for inter-pregnancy interval

increased in Charlotte County, while decreasing for the state, as shown by current rolling year

data.

Research indicates pregnancy intervals of less than 18-months is a risk factor for preterm births12F12F

xii

(See also Exhibit 4) This research has led to health organizations such as, the World Health

Organization, U.S. Department of Health and Human Services and The American College of

Obstetricians and Gynecologists, to strongly recommend women wait at least 18-24 months

between pregnancies. A woman’s body needs time to heal and reach optimal health for pregnancy

after giving birth.xiii

In the United States, women who are black have a shorter pregnancy interval rate than white

women, and, according to research, this may be a key factor in the higher rates of preterm birth

and subsequent negative birth outcomes, for mothers who are black.xiv

The following Tables 17-18 provide a look at pregnancy interval data for Charlotte County, the

State of Florida, and comparison counties, to determine if there are differences between mothers

who are white and mothers who are black. 2012-14 rates of inter-pregnancy intervals of less than

eighteen months, echo the national data. Only Clay County data, of the four comparison counties,

has a higher rate of inter-pregnancy interval of less than 18 months for mothers who are white.



Table 17: Birth with inter-pregnancy interval less than 18 months- rolling year - race


3-Year Rolling Rates - Race

Charlotte Florida


Year Count Rate

(%) Count

Rate

(%) Count

Rate

(%) Count

Rate

(%)

2008-10 670 40.7% 64 41.6% 97,530 37.6% 33,775 39.6%

2009-11 573 39.1% 62 44.0% 91,665 36.6% 32,132 38.5%

2010-12 541 36.8% 64 44.1% 88,897 35.7% 31,383 37.3%

2011-13 501 34.7% 52 41.9% 88,761 34.9% 30,985 36.1%


Looking at this area among the four (4) counties of Charlotte, Clay, Hernando and Martin, only

Clay and Charlotte did not have an improvement in rates of inter-pregnancy intervals of less than

18 months. Clay, unlike Charlotte County, also has an increase in the rates of inter-pregnancy

interval of less than 18 months for mothers who are white.

Table 18: Births with inter-pregnancy interval less than 18 months - rolling year - county comparison


3-Year Rolling Rates- County Comparison - Race White Black


Charlotte 2011-13 501 34.7% 52 41.9%

2012-14 513 34.4% 56 44.4%

Clay 2011-13 1,029 35.0% 140 32.5%

2012-14 1,116 36.6% 137 33.7%

Hernando 2011-13 813 38.3% 76 40.2%

2012-14 796 37.4% 72 38.7%

Martin 2011-13 683 35.9% 93 47.9%

2012-14 720 36.1% 82 40.4% Source: www.floridacharts.com

As the above data indicates, in Charlotte County, births of babies within less than the

recommended interval for mothers who are black occurs at a rate ten (10) percentage points higher

than for mothers who are white. This represents a 29.07% increase over the rate for mothers who

are white. Further, data (table 19) indicates mothers who are black have the highest rates of preterm

birth (19.5%) in Charlotte County. This corresponds to the aforementioned research, that links

short baby spacing rates to higher rates of preterm births (see Exhibit 4).




Table 19: Preterm births- rolling year- by race - county comparison

County Florida


Year Count Rate Count Rate Count Rate Count Rate

Charlotte 2011-13 325 12.2% 45 19.5% 57,837 12.7% 26,340 18.0%

2012-14 333 12.4% 38 16.9% 58,662 12.7% 26,286 17.9%

Clay 2011-13 649 12.7% 125 17.4% 57,837 12.7% 26,340 18.0%

2012-14 673 13.1% 126 18.0% 58,662 12.7% 26,286 17.9%

Hernando 2011-13 503 12.9% 65 18.5% 57,837 12.7% 26,340 18.0%

2012-14 480 12.6% 57 16.3% 58,662 12.7% 26,286 17.9%

Martin 2011-13 358 12.0% 59 19.4% 57,837 12.7% 26,340 18.0%


Additional health indicators related to pre and inter-conceptual care reveal potential disparities

related to race. Births to mothers who are obese rose for women who are black in both the state

and county data, although rates in Charlotte County are over two and one half percentage points

higher than the state. Further, rates for mothers who are white and obese had only one-tenth

percentage point increase during the same period, emphasizing mothers who are black (Table 21).

Rates for mothers who are Hispanic and obese are less than one percentage point higher than

mothers who are non-Hispanic. This differs from state rates that indicate a lower rate among

mothers who are obese and Hispanic (Table 22).

Table 20: Births to mothers who are obese – rolling year - by race

Births to Obese Mothers at time Pregnancy Occurred, 3-Year Rolling Rates

Charlotte Florida



2008-10 602 21.5 74 27.8 84,951 17.7 40,462 26.8

2009-11 563 21.7 69 27.1 84,289 18.1 40,879 27.5

2010-12 553 21 68 26.7 84,357 18.5 41,233 28

2011-13 568 21.3 69 29.9 86,066 18.9 42,056 28.7

2012-14 581 21.6 71 31.6 88,329 19.2 42,636 29

Source: www.floridacharts.com

Table 21: Births to mothers who are obese - rolling year - by ethnicity

Births to Obese Mothers at time Pregnancy Occurred, 3-Year Rolling Rates

Charlotte Florida Hispanic Non-Hispanic Hispanic Non-Hispanic


2008-10 64 20.7 634 21.8 32,899 17.5 95,959 20.1

2009-11 60 21.5 596 22 32,703 18.1 96,008 20.6

2010-12 49 20.6 596 21.3 32,871 18.7 96,624 21

2011-13 52 21.9 606 21.6 33,788 19.3 98,521 21.3

2012-14 57 22.7 615 21.9 35,422 19.8 100,338 21.5






4. TARGET POPULATION OR AREA FOR RECEIPT OF SPECIAL EMPHASIS

The Coalition will continue to place emphasis on efforts to address substance use during pregnancy

and substance exposed newborns to reduce the risk to healthy birth outcomes and healthy growth

and development of children.

Recent reports from the Attorney General’s Task Force on Substance-Exposed Newborns indicates

that the incidents of drug withdrawal for Charlotte County newborns have increased significantly

from two (2) in 2007 to twenty-one (21) in 2012.13F13F

xv Forming a Substance-Exposed Newborn

(SEN) Task Force during the past SDP cycle, the Coalition discovered data is difficult to obtain.

Physicians do not necessarily recognize the signs and symptoms of SEN or NAS (neo-natal

abstinence syndrome) before discharge after birth.

An informal review by the neo-natal staff at BayFront Health Port Charlotte from March 2015

through January 2016, reveals thirty-three (33) infants with documentation of exposure to

prescription drugs. Fourteen (14) were identified to have Subutex or Methadone exposure,

suggesting the mother was in treatment for opiate addiction. Opiates were the most common

substance present. It must be noted that this was not a formal examination, and some data may be

missing. The task force is working to develop a consistent data collection method with the help of

the neo-natal unit.

When substance abusing women and substance exposed infants are identified through other

processes (i.e., the mother tests positive for substance abuse) the infant will be tested by the

birthing facility. There can also be referrals from other programs. The data provided references

substances exposed infants who entered the Healthy Start program. As the table below

demonstrates, both the number of women and services has increased. 2015 saw a decrease in

women identified, but an increase in services.

Table 22: Drug-abusing women identified

Drug-abusing women identified through services

year # women # services average # services/mother

2009 9 208 23.1

2010 9 458 50.9

2011 16 1167 72.9

2012 34 2607 76.7

2013 46 3415 74.2

2014 56 4361 77.9

2015 29 2672 92.1

Additionally, Healthy Start screens provide data on the number of infants identified as substance-

exposed, and the services provided as a result. Again, while recent years show a decrease in


number of infants identified, the number of services provided have increased. Further

understanding of the types and scope of services provided may offer the task force additional

insights into the issue for Charlotte County.

Table 23: Identified substance-exposed infants through Healthy Start

Identified substance exposed infants – Healthy Start

year # infants # services average # services/infant

2009 13 330 25.4

2010 9 265 29.4

2011 16 1167 72.9

2012 22 1579 71.8

2013 22 1592 72.4

2014 14 1036 74.0

2015 10 875 87.5


5. FACTORS CONTRIBUTING TO THE HEALTH STATUS INDICATORS IN THE

TARGET POPULATION

Through the review of empirical and perceived data, the Charlotte County Healthy Start

Coalition’s Health Community Assessment Review Committee identified factors impacting the

health issues of infant mortality and fetal death. The logic model, based upon a “fishbone analysis”

model (Exhibit 3), portrays the specific risk factors and their related direct and indirect indicators.

This analysis was achieved by a methodical examination of population and demographic data;

socioeconomic data; and community health data, before narrowing the focus to maternal and child

health data. This includes information from providers and consumers, obtained from community

surveys and provider program data and input. (See Summary of Survey Section Pg 71)

During the process to update its previous SDP, the Charlotte County Healthy Start Coalition

identified the national, state and local economic crisis as a key impact for Charlotte County. All

of these factors impact maternal and child health and are reflected as indirect factors for each area

of the logic model developed in the SDP update planning process.

Demographic Data

Location

Charlotte County is located on Florida’s southern gulf coast and is bordered on the north by

Sarasota and Desoto Counties, the east by Glades County and by Lee County on the south.

Charlotte County’s 694 square miles includes 166 miles of canals, 219 miles of coastline and 12.5

miles of beaches. The developed and populated areas of the county are primarily located along

these waterways.

The two largest communities are Port Charlotte and Punta Gorda, the county seat. The

communities are located northwest and southeast along the mouth of the Peace River, which

empties into Charlotte Harbor. Some of the smaller communities within the county are Murdock,

Englewood, Grove City, Rotonda, and Cleveland. The City of Punta Gorda is the only

incorporated area in the county.

Geography helps define the county. The less populated eastern portion of the county is primarily

used for agricultural and ranching purposes, and a wildlife preserve. While the rest of the county

is more densely populated, “Locals” will explain how a series of bridges throughout the county

helps define separate communities, all with distinct community cultures. This also creates issues

for service delivery, as many residents find it difficult to access services “over the bridge” due to

lack of public transportation.


Population Data

One of the more striking population data points for Charlotte County, is our median age. Census

data available through Florida Charts provides a historical comparison of Charlotte County’s

median age with that of the State of Florida.

Table 24: Median Age, Charlotte County and State

Median age, Single Year Rates

Charlotte Florida

Year Years of Age Years of Age

2013 56.7 41.0

2012 55.9 40.8

2011 55.4 40.5

2010 54.8 40.3

2009 54.6 39.7

2000 54.3 38.7 http://www.floridacharts.com/charts/OtherIndicators/NonVitalIndRateOnlyDataViewer.aspx?cid=0300

Charlotte County experienced a slight decrease in population during 2009-10, dipping below

160,000. This was likely related to economic factors (State of Florida Office of Economic and

Demographic Research). The jobs created by the housing boom and recovery from Hurricane

Charley were gone, and those in the building and related industries moved to where jobs could be

found. However, the population increased to a reported 173,115 in the July 1, 2016 Census update.

The table below provides the most recent projections for Charlotte County. Growth is projected

to continue to grow in the community. The highest projected growth is for ages 65 and older, and

then for ages 20-34, followed by children. This indicates a need for the Coalition to strategically

plan for an increase in service needs in the coming years

Table 25: Population Projections, Charlotte County

Age

Range 2014

2020

Projection

Percent

Change

2030

Projection

Percent

Change

0-19 24,319 24,550 0.95% 27,812 14.36%

20-34 19,029 21,414 12.53% 21,956 15.38%

35-54 32,729 30,530 -6.72% 35,201 7.55%

55-64 27,644 29742 7.59% 25,178 -8.92%

65 + 63,110 74,673 18.32% 96,489 52.89%

Total 166,831 180,909 18.32% 206,636 23.86%

Source: Charlotte County Economic Development – Woods and Poole Economics, Inc. 2015 State Profile

http://www.floridacharts.com/charts/OtherIndicators/NonVitalIndRateOnlyDataViewer.aspx?cid=0300


Focusing on population data for women of child-bearing age (15-44), also demonstrates a decrease

in population of this group after 2009. However, Charlotte County population estimates for

women age 15-44 have not yet returned to numbers in 2009.

Table 26: Population Estimates - Women of Child-bearing Age Charlotte County

Charlotte County Women of Child-bearing Age

Year 15-19 20-24 25-34 35-44 Total

2009 3,568 3,040 5,600 7,355 19,563

2010 3,484 2,724 5,322 6,970 18,500

2011 3,402 2,853 5,450 6,861 18,566

2012 3,324 2,988 5,589 6,731 18,632

2013 3,321 3,206 5,821 6,768 19,116

2014 3,211 3,356 5,876 6,579 19,022

2015 3,172 3,439 6,002 6,513 19,126

Source: Florida Office of Economic and Demographic Research

Projections by the Florida Office of Economic and Demographic Research (FEDR) show a slight

increase for Charlotte County in this population group by 2020. These projections show less

teenage girls are forecasted for 2020.

Table 27: 2020 Projections for Charlotte County - Women 15-44

2020 Projections for Charlotte County Females Age 15-44

Age Total female white black nonwhite

15-17 2084 1753 266 331

18-19 1242 1038 164 204

20-24 2987 2528 369 459

25-29 3379 2876 378 503

30-34 2981 2628 256 353

35-39 3330 2959 272 371

40-44 3206 2782 300 424

Totals 19209 16564 2005 2645

Source: Florida Office of Economic and Demographic Research

The FEDR 2020 population projections for the same population (female 15-44) indicates that the

State of Florida will experience a 1.27% reduction, while Charlotte County will see a slight .43%

increase in the same demographic.

Additional information from the 2010 Census indicates that 4.1% of those families with children

under the age of 18 are single-mother households, and 1.6% are single-father households. The

number of single-father households has decreased from 2.1% as reported in the previous service


delivery plan in (2005-2007 American Community Survey), while the percentage of single parent

female households has stayed the same.

Racial and Ethnic Data

The U.S. Census provides an excellent comparison of Race and Hispanic Origin for Charlotte

County, including data from State and Nationally.

Table 28: Census Data - County, State and U.S. Race and Hispanic Origin

Race and Hispanic Origin County State US

White alone, percent, July 1, 2014, (V2014) (a) 90.5 77.8 77.4

White alone, percent, April 1, 2010 (a) 90 75 72.4

Black or African American alone, percent, July 1, 2014, (V2014) (a) 6.2 16.8 13.2

Black or African American alone, percent, April 1, 2010 (a) 5.7 16 12.6

American Indian and Alaska Native alone, percent, July 1, 2014, (V2014)

(a) 0.3 0.5 1.2

American Indian and Alaska Native alone, percent, April 1, 2010 (a) 0.3 0.4 0.9

Asian alone, percent, July 1, 2014, (V2014) (a) 1.4 2.8 5.4

Asian alone, percent, April 1, 2010 (a) 1.2 2.4 4.8

Native Hawaiian and Other Pacific Islander alone, percent, July 1, 2014,

(V2014) (a) 0.1 0.1 0.2

Native Hawaiian and Other Pacific Islander alone, percent, April 1, 2010 (a) 0 0.1 0.2

Two or More Races, percent, July 1, 2014, (V2014) 1.5 2 2.5

Two or More Races, percent, April 1, 2010 1.7 2.5 2.9

Hispanic or Latino, percent, July 1, 2014, (V2014) (b) 6.7 24.1 17.4

Hispanic or Latino, percent, April 1, 2010 (b) 5.8 22.5 16.3

White alone, not Hispanic or Latino, percent, July 1, 2014, (V2014) 84.7 55.8 62.1

White alone, not Hispanic or Latino, percent, April 1, 2010 86 57.9 63.7

Source: United States Census

Charlotte County may not be a very racially or ethnically diverse community, but there is still a

need to ensure that racial or ethnic disparities are identified and addressed.

Table 29: Charlotte County Demographics - Race

White Black & Other

Total Female Male Total Female Male Total

2012 75,368 70,856 146,224 7,583 7,303 14,886 161,110

2013 77,508 72,731 150,239 7,891 7,602 15,493 165,732

2014 77,181 72,072 149,253 7,991 7,683 15,674 164,927

2015 77,850 72,858 150,708 8,179 7,886 16,065 166,773 http://www.floridacharts.com/FLQUERY/Population/PopulationRpt.aspx


Table 30: Charlotte County Demographics - Ethnicity


Total Female Male Total Female Male Total

2012 4,963 4,926 9,889 77,988 73,233 151,221 161,110

2013 5,202 5,153 10,355 80,197 75,180 155,377 165,732

2014 5,362 5,306 10,668 79,810 74,449 154,259 164,927

2015 5,501 5,432 10,933 80,528 75,312 155,840 166,773

http://www.floridacharts.com/FLQUERY/Population/PopulationRpt.aspx

When compared with the State of Florida, the predominance of white, non-Hispanic residents in

Charlotte County is clear as well. However, there is a slight trend towards increasing diversity as

visualized in Tables 30 and 31.

Table 31: Race Comparison - Charlotte County and State

White Black Other

Year Charlotte State Charlotte State Charlotte State

2011 91.0% 78.5% 6.0% 16.5% 3.0% 5.0%

2012 90.8% 78.4% 6.1% 16.5% 3.1% 5.0%

2013 90.7% 78.3% 6.2% 16.6% 3.1% 5.1%

2014 90.5% 78.2% 6.3% 16.7% 3.2% 5.1%

Data Source: The Florida Legislature, Office of Economic and Demographic Research.

Table 32: Ethnicity Comparison - Charlotte County and State


Year Charlotte State Charlotte State

2011 5.9% 22.8% 94.1% 77.2% 2012 6.1% 23.2% 93.9% 76.8% 2013 6.2% 23.5% 93.8% 76.5% 2014 6.5% 24.0% 93.5% 76.0%

Data Source: The Florida Legislature, Office of Economic and Demographic Research.

In the Coalition’s previous Service Delivery Plan, it was anticipated both racial and

ethnic diversity would grow through the future. The trends shown in the demographic

tables confirm a rise in diversity, and decline in white population, though less than one

percentage point.


Socioeconomic Data

Economy

In 2015 Forbes ranked the City of Punta Gorda, in Charlotte County, as 40th in job growth and 80th

as best small places for jobs and careers in the U.S. 14F14F

xvi The City was also named one of the three

best places to retire on a budget by Kiplinger in 2015,15F15F

xvii and one of the top 10 safest cities in

Florida by realtor blog Movoto.16F16F

xviii

Information from the Charlotte County Economic Development Office’s January 2016 Economic

Indicator Report17F17F

xix shows the January unemployment rate of 5.6% for Charlotte County was above

the state and national rates of 5.1% and 5.3%, respectively. However, the good news is that this

is a 13.8% decrease in the unemployment rate from the previous year, indicative of the

improvement in the economic climate of Charlotte County rebuilding from economic decline

started in the past decade. The following figure from the January 2016 Suncoast Region Economic

Indicator Report18F18F

xx illustrates both the dramatic impact on employment of the economic downturn

and the community’s recovery.

Figure 1: Labor Force and Unemployment in Charlotte County

Figure Source: January 2016 Regional Economic Indicator Report – www.floridasinnovationcoast.com

The largest employers are in the area of education and health services, followed by retail sales and

government. The Economic Development Office lists Bayfront Health Punta Gorda as the number

one employer in the county, with Publix and Wal-Mart in second and third place. Of the top 20

employers in the county, nine are related to healthcare. 19F19F

xxi

According to labor data on the Charlotte County Economic Development website 20F20F

xxii there has

been job growth in education and health services, as well as government in the past year.


Construction has also had a slight increase in job growth, as have businesses associated with

construction, such as transportation and warehousing and wholesale trade.

As a Florida retirement community, leisure and hospitality is also an area of prime employment,

although there was a slight decline in jobs during 2015. According to the January 2016 Economic

Indicator Report for Charlotte County, “Tourist Development Tax Revenues’ monthly figures

were up for January with an increase of 20.3% and up for December having an increase of 0.5%.

Cumulatively for the year the figures were up 15.6% over last year.”21F21F

xxiii

Wages in Charlotte County range from an average entry level wage of $9.48 to an average

experienced wage of $22.56. The median wage is $14.02.

Another economic indicator is taxable sales. Taxable sales have increased from 2014 to 2015

across all indices. This is shown on the following table from the Charlotte County Economic

Development Office’s January 2016 Economic Indicator Report 22F22F

xxiv.

Table 33: Taxable Sales - Charlotte County

Taxable Sales ($Million)

Dec. 2014 Dec. 2015 % change Dec.

15- Dec. 16

Index of Retail Activity 160.0 147.7 8.3%

Autos and Accessories 37.8 35.9 5.4%

Building Investment 21.7 17.6 23.3%

Business Investment 29.0 24.5 18.3%

Consumer Durables 22.1 21.1 4.4%

Consumer Non-durables 99.3 95.7 3.8%

Tourism and Recreation 42.8 40.4 5.9%

Total 252.7 235.2 7.4% Source: Florida Office of Economic & Demographic Research and Charlotte County Economic Development Report Jan. 2016

Further evidence of an improvement in the local economy is the increase in housing sales. The

reported median single family home price for the area in January 2016 is $180,000. This is an

increase of nearly $15k from the January 2015 median price of $165, 075. 23F23F

xxv Housing sales and

building permits are on the rise, an additional signal of economic improvement.

Table 34: Housing Sales and Building Permits

Charlotte County Housing Sales Single Family Building Permits

Jan 2015 - Oct 2015 5,089 668

Jan 2014- Oct 2014 4,591 459 Source: http://floridasinnovationcoast.com/community_data/housing

http://floridasinnovationcoast.com/community_data/housing


The United States Census’ American Community Survey of 2014 provides additional housing and

household data particular to Charlotte County. The data reflects a decrease in rental property

vacancies, which aligns with a slightly higher rental cost. This is evident from the higher

percentage of households with a gross rent of 35% or more of household income. It is not

uncommon for rental costs to increase as supply decreases (evidence – lower vacancy rate).

Table 35: Housing Units and Household Size - 2014

2010 2014

Total Housing Units 99,422 100,959

Average Household Size (rent) 2.28 2.51

Average Household Size (own) 2.16 2.18

Occupied 71,991 70,948

Vacant 27,431 30,011

Rental Vacancy Rate 16% 14.20%

Gross rent 35% or more of Household income 46.30% 47.60%

Source: U.S. Census – American Community Survey An additional snapshot of socioeconomic factors related to poverty in Charlotte County is

demonstrated in the following table which compares the factors from November of 2014 to

November of 2015.

Table 36: Socioeconomic Measures for Charlotte County

Socioeconomic Measure- Charlotte County 2014 2015

Number of Food Stamp households (Nov 2014/2105) 11,480 11,376

Number of Medicaid recipients (Nov. 2014/2015 data) 19,644 21,312

Number of persons who are homeless (2014 and 2015 “PIT”) 511 548

Number of households who are homeless (2014 and 2015 “PIT”) 406 402

Number of households who are homeless with one or more child (2014 and 2015 “PIT”) 57 67

% of population below poverty level (2014 only - no update for 2015) 12.7% n/a

% of children under 18 year below poverty (2014 only – no update for 2015) 20.6% n/a

% of families with related children that are below poverty (2014 only–no update for 2015) 19.5% n/a

% of population unemployed (BLS Nov 2014 and 2015 data) 6.3% 5.3%

Sources: Florida DCF reports, Charlotte County WIC Program, Charlotte County Homeless Coalition Point-in-Time, US Census and Bureau of Labor

Statistics

As this table indicates, while overall economic factors (such as unemployment) may be improving

in the community, disparities in recovery still exist. The Point in Time homeless count shows an

increase in persons and families who are homeless in Charlotte County. Additionally, the number

of Medicaid recipients has increased in the past year. (Poverty data is not updated for 2015 at the

time of this SDP.)

The 2014 ALICE (Asset Limited, Income Constrained, Employed) Report 24F24F

xxvi for Charlotte County

indicates 12% of Charlotte County families are living in poverty, with an additional 28% in asset


limited, income constrained, employed households. This means 61% of households in the county

have incomes less than that which is needed to afford the basic cost of living in the county.

Adult Population Educational Data

While the percentage of individuals with no high school diploma is lower for Charlotte County

than for the state, state rates for a bachelor’s degree or higher is higher. In both cases, the overall

trend lines for Charlotte County appear to keep in line with that of the state.

Figure 2: Education Degree

Source: www.floridacharts.com – U.S. Census

Table 37: Education Rates

Charlotte County population percent

Population 25 years and over 129,515 100.0%

Less than 9th grade 4,274 3.3%

9th to 12th grade, no diploma 10,232 7.9%

High school graduate (includes equivalency) 44,683 34.5%

Some college, no degree 31,213 24.1%

Associate's degree 11,527 8.9%

Bachelor's degree 17,484 13.5%

Graduate or professional degree 9,973 7.7% Source: Charlotte County Economic Development – Woods and Poole Economics, Inc. 2015 State Profile



Charlotte County Public School System

Information provided through the Charlotte County Public Schools indicates there are currently 10

elementary schools, 4 middle schools, and 3 high schools. There is also one charter high school,

Florida SouthWestern Collegiate High School. Charlotte Technical Center offers vocational and

technical training degrees to high school students and adults, including the Charlotte Aerospace

Institute.

The public school system also provides alternative, specialty learning centers and Charlotte Virtual

School. The Academy is an alternative high school focused on developing specialized plans to

achieve a high school diploma. The Academy also serves teen moms through the HOPE (Healthy

Outcomes in Pregnancy and Education), which include childcare and health and social services.

Charlotte Harbor School is a specialty school with services for students with intellectual and

emotional/behavioral needs. The Baker Center provides early childhood programs such as Early

Head Start, Head Start, VPK and others. The school system also offers an Adult Learning Center

to help adults gain a GED.

There are also thirteen private schools, serving mostly Pre-K through 8. The majority are faith-

based. Several are also specialty schools related to juvenile behavioral or substance use issues.

As Table 38 indicates, there has been a decline in school enrollment since 2010, with the greatest

decline in the past school year. The economic downturn impacted employment, as discussed

previously. As data presented earlier indicates (Table 36), children in Charlotte County, are

most often in poverty circumstances. Families may have to move from the community in order

to obtain meaningful employment, impacting school enrollment.

Table 38: Charlotte County Public School System Enrollment Data

Charlotte County Public Schools Enrollment

School Year Total Annual Growth

2010-11 16,640 n/a

2011-12 16,413 -227

2012-13 16,352 -61

2013-14 16,266 -86

2014-15 16,131 -135

2015-16 15,424 -707

Source: Charlotte County Public Schools

Additionally, Charlotte County Public School System fell from a long standing “A” grade school

system to “B” in 2012, and then “C” in 2013 and 2014. The school system rose to “B” grade level

in 2015. The impact of school grades could also be a contributor to the decrease in enrollment.

Additionally, a charter school expanded from offering Freshman and Sophomore grades to include


all four (4) high school grades, while two charter schools developed just across the county line in

Sarasota County.

Area Colleges and Universities

As the Charlotte County Economic Development Office reports 25F25F

xxvii, within driving distance of the

county, there are twenty (20) colleges and universities offering undergraduate and master degree

programs. Two institutions have branches within the county limits.

Table 39: Area Colleges and Universities

Area Colleges and Universities

Educational Institution Location

Argosy University Sarasota

Ave Maria University Naples

Barry University Fort Myers

Eckerd College St. Petersburg

Everglades University Sarasota

Florida Gulf Coast University Fort Myers

Florida SouthWestern State College Punta Gorda/Fort Myers

Hillsborough Community College Tampa

Hodges University Fort Myers/Naples

Lake Erie College of Osteopathic Medicine & School of Pharmacy Bradenton

Keiser University Sarasota, Fort Myers

New College of Florida Sarasota

Southwest Florida College Port Charlotte

Rasmussen College Ft. Myers/Tampa

Ringling College of Art and Design Sarasota

State College of Florida Venice/Sarasota/Bradenton

St. Petersburg College St. Petersburg

University of South Florida Sarasota-Manatee North Port/Sarasota

University of South Florida Tampa

University of Tampa Tampa

Source: Charlotte County Economic Development

Early Learning and Childcare

The Early Learning Coalition of Florida’s Heartland (ELC) oversees VPK and scholarship funding

to Charlotte County. There are ten (10) DCF Gold Seal Accredited providers in Charlotte County,

according to ELC documents. 26F26F

xxviii As Table 40 indicates, there are fifty-one (51) childcare

providers, along with forty (40) VPK providers.

http://www.argosy.edu/

http://www.avemaria.edu/

http://www.barry.edu/

http://www.eckerd.edu/

http://www.evergladesuniversity.edu/index.asp

http://www.fgcu.edu/

https://www.fsw.edu/

http://www.hccfl.edu/

http://www.hodges.edu/

http://www.lecom.edu/

http://www.keiser-education.com/

http://www.ncf.edu/

http://www.swfc.edu/?abtest=yes&utm_expid=2426640-0.l5BLu0MBQtaGi11USjYVyg.1&utm_referrer=http%3A%2F%2Fwww.google.com%2Furl%3Fsa%3Dt%26rct%3Dj%26q%3Dsouthwest%2520florida%2520college%26source%3Dweb%26cd%3D1%26ved%3D0CFQQFjAA%26url%3Dhttp%253A%252F%252Fwww.swfc.edu%252F%26ei%3D41ICUv_RFIqM9AS33YG4Bw%26usg%3DAFQjCNGe8xHEfzqTw7O5Ybvzg3kbaW6v3w%26bvm%3Dbv.50310824%2Cd.eWU

http://www.rasmussen.edu/

http://www.ringling.edu/

http://www.scf.edu/

http://www.spcollege.edu/

http://www.usfsm.edu/

http://www.usf.edu/

http://www.ut.edu/


The number of Charlotte County children served by ELC rose in the past year by forty (40).

However, waiting lists for Charlotte County children also rose from December 2014 to December

2015, according to a point-in-time survey provided by ELC for the Community Assessment

Review Committee (see Table 40). Childcare issues continue to be noted as a concern in Consumer

and Provider Surveys (See Consumer and Provider Input Section Pg 70).

Table 40: Early Learning and Scholarship Data

School Readiness (Scholarship) Data

12/2014 12/2015

Scholarship Children Served 737 777

School Age on Wait List 51 61

Non-School Age on Wait List 88 93

Scholarship Wait List Total 139 154

School Readiness Providers 54 51

VPK Children 850 816

VPK Providers 43 40

Source: Early Learning Coalition of Florida’s Heartland


Community Health Data

Major Causes of Death

Cancer is the leading cause of death (age adjusted rates) in Charlotte County. The rate is lower

than the state, even though cancer falls second, below heart disease, for the state. The county is

below state rates for all causes of death, except motor vehicle crashes, cirrhosis, and

influenza/pneumonia. Stroke, Diabetes and Pneumonia/Influenza affects Blacks in Charlotte

County at a higher rate than Whites, as it does for the state. This is important information for

consideration when looking at racial disparities for maternal and child health.

Table 41: Major Causes of Death

10 Major Causes of Death Charlotte County State of Florida

White Black Hispanic All White Black Hispanic All

Cancer 147.4 128.4 48.0 144.4 159.9 157.9 118.5 158.7

Heart Disease - - - 134.3 - - - 153.4

Chronic Lower Respiratory Disease 42.0 22.5 - 40.5 43.1 24.5 24.4 41

Unintentional Injuries 35.8 - 10.6 31.8 41.7 26.5 24.0 38.8

Stroke 25.5 40.4 9.1 25.9 29.4 46.0 27.0 31.3

Chronic Liver Disease and Cirrhosis 18.2 - - 16.7 122.0 4.7 7.6 10.8

Diabetes Mellitus 13.6 25.4 9.1 14.0 17.2 40.6 17.6 19.6

Suicide 14.9 6.1 0.0 14.6 15.7 4.9 6.9 13.8

Alzheimer's Disease 13.1 10.7 29.1 13.0 17.8 14.4 18.6 17.5

Pneumonia/Influenza 12.3 19.8 - 12.3 9.1 12.7 7.5 9.7

All Causes 626.6 679.3

Source: 2015 Charlotte County Community Health Assessment

Healthy Lifestyle Indicators

Charlotte County ranks 37th in Health Outcomes and 13th in Health Factors as compared to

Florida’s sixty-six other counties.27F27F

xxix

http://charlotte.floridahealth.gov/programs-and-services/community-health-planning-and-statistics/_documents/FINAL%202015%20CHA-Charlotte.pdf


Figure 3: Health Rankings Community Health Assessment 2015

(figure source: 2015 Charlotte County Community Health Assessment)

Data from Florida Charts indicates that adults in Charlotte County are overall more active and

less obese than the State of Florida as a whole. However, county smoking and obesity levels

among adults are higher than rates in 2010. Rates for obesity, while higher in 2013 than 2010,

are still lower than the Healthy People 2020 goal, which is positive. Smoking, however, is

higher (more about smoking later in this section).

Table 42: General healthy lifestyle indicators

Lifestyle Indicators Comparing 2010 with 2013

2010 2013

County State County State Healthy People 2020 Goal

Inactive Adults - - 46.8% 52.9% -

Adults Who are Obese 21.7% 27.2% 25.9% 26.4% 30.6%

Adult Smokers 20.7% 17.1% 21.3% 16.8% 12%


There are several notable efforts in Charlotte County to improve its health. The City of Punta

was named one of the “Best Healthiest Places to Retire” by Money Magazine in 2008.28F28F

xxx




Additionally, the community has worked to encourage healthy environmental design through

walking and biking trails. Community development funding, including a portion raised through

a “penny tax” have been designated for walking trail development along the Charlotte Harbor.

However, the 2015 Community Health Assessment for Charlotte County reports that

examination of the county’s Healthiest Weight Profile identifies “built environment” issues as an

area for improvment29F29F

xxxi

Substance Abuse -Teens

Drug Free Charlotte County’s 2014-15 Community Youth Substance Use Assessment 3 0F 30F

xxxii

provides the following key priority issues for the community Coalition on substance use.31F31F

xxxiii

Key Teen Substance Abuse Assessment Findings – Examination of data clearly shows that alcohol

and marijuana are the top two substance abuse issues among Charlotte County teens. Key data

indicators for each are listed below:

Underage Alcohol Use

• 32% of Charlotte County high school teens report past 30-day use of alcohol (2014 TeeNS).

This is a one-percentage point increase from 2013 TeeNS.

• Charlotte County high school teens perceive that 79% of their peers have had alcohol in the

past 30 days (2014 TeeNS)

• Females report higher percentage of engaging in binge drinking than males with 2-4 drinks,

while males report higher percentage of 1 and then 5 or more drinks on days they drank

during the past 30 days. The 56% of male high school drinkers who drank 5 or more drinks

per day on the days they drink is 24.9 percentage points higher than state (31.1%) according

to the 2014 FYSAS.

• 8% of Charlotte County middle school teens report past 30-day use of alcohol (2014 TeeNS).

This is a two-percentage point decrease from 2013 TeeNS.

• Charlotte County middle school teens perceive that 47% of their peers have had alcohol in

the past 30 days (2014 TeeNS)

• 45% of Charlotte County high school teens participating in the 2013 Developmental Assets

Survey reported attending a party in the past year where alcohol was available

• 2014 TeeNS reports 9% of Charlotte County high school teens who reported using alcohol in

the past-30 days say that a parent gave it to them and 5% said another family member gave it

to them. 2014 FYSAS data indicates 6.5% took alcohol from a family member.

• 2014 FYSAS data shows an increase in the number of teens getting alcohol from a store rose

to 6% from 3.7% in 2012.


• 17% of Charlotte County high school teens report riding in a car with a friend who has been

drinking and 32% report riding in the car with a family member who had been drinking

(2014 TeeNS)

• 15% of Charlotte County high school teens report driving a car after they had been drinking

(2014 TeeNS)

• Age of onset (first use) of alcohol has risen to 11.51, higher than 2010 age of 10.96 (2014

TeeNS), but still too early.

Marijuana

• 29% of Charlotte County high school teens report past 30-day use of marijuana (2014

TeeNS). This is a four-percentage point increase from 2013 TeeNS.

• Charlotte County high school teens perceive that 78% of their peers have had marijuana in


• 6% of Charlotte County middle school teens report past 30-day use of marijuana (2014

TeeNS)

• Charlotte County middle school teens perceive that 39% of their peers have had marijuana in


• 19% of high school teens report driving a vehicle after using marijuana in the past 30-days

(2014 FYSAS)

• According to 2014 TeeNS data, teens the average age of onset for marijuana (as reported by

middle school teens) is less than two months (11.53) after average age of onset for alcohol

(11.51)

• Perception of harm of regular marijuana use is decreasing in both middle and high school

teens

• 82% (n166) of Charlotte County children admitted for substance abuse treatment in 2014

report marijuana as drug of choice according to data from Central Florida Behavioral Health

Network for Charlotte County admissions.

These key data points signify potential areas of impact: perception of use, perception of harm or

risk of use, educating parents to help to decrease age of onset. The Community Youth Substance

Use Assessment also identified several emerging (or re-emerging) issues. These issues are

prescription drug abuse and misuse, and tobacco and electronic cigarettes.

Prescription Drug Abuse - While the Teen Norms Survey has only reported on prescription

drugs for two years, the rates of use are of concern. Access to the medication by teens through

adults is identified as a key form of medication diversion for misuse/abuse. In the early part of

2015, the organization engaged in a four-month community education and awareness initiative


with outreach to seniors and adults about safe medication practices. Additionally, Drug Free

Charlotte County is part of the CHIP Maternal and Child Health Committee, working with

Charlotte County Healthy Start Coalition and other community partners to examine the impact of

prescription drug abuse and misuse on substance exposed newborns.

Tobacco and Electronic Cigarettes - With the slight rise in tobacco use rates, and growing

opportunities for use and misuse of electronic cigarettes, Drug Free Charlotte County continues

to develop new and evidence based approaches for preventing initiation of use, and supporting

cessation efforts for those who do smoke. Drug Free Charlotte County also works with the

Charlotte County Healthy Start Coalition to address tobacco use by women who are pregnant or

wanting to become pregnant. As part of this relationship, Drug Free Charlotte County provides

free training to all Healthy Start care coordinators in SCRIPTS, an evidence based program

designed specifically for pregnant women.

Substance Abuse- Adults

Alcohol and tobacco are the only substances tracked for adults at this time. A future Behavioral

Risk Factor Surveillance System survey will look at marijuana use, as well. The 2015 Community

Health Assessment Survey conducted by the Florida Department of Health- Charlotte County,

identified 6% of the survey participants stated someone in their household has an alcohol problem.

Further, 47% indicated exposure to cigarette smoke in the past 30-days. 32F 32F

xxxiv Both alcohol and

tobacco data is explored in following sections.

Alcohol Use – Adults - Binge drinking in adults is slightly higher in Charlotte County (18%) than

the state rate of 17.6%. The following table shows that while the rate for males in Charlotte County

is lower than the state rate, it is higher in the county for females and by each age groups. Females

do have a lower rate of binge drinking for all ages, but the peak for binge drinking in women is

ages 18-44, which falls in the range of childbearing age.

Table 43: Binge Drinking - Charlotte County Adults

Percentage of Persons Who Engage in Heavy or Binge Drinking

2013 Data

Charlotte County State

Male 20.5% 23.4%

Female 15.6% 12.2%

Age: 18-44 24.9% 24.2%

Age: 45-64 22.1% 16.9%

Age: 65+ 9.4% 7.2%




Concerns persist in the County regarding the impact the economic downturn has had on substance

abuse and mental health issues. While the economy is recovering, it can be a slower recovery for

persons experiencing disruption and stress through the downturn. This is especially true for

individuals with inadequate coping skills and those lacking a healthy, strong support system.

Tobacco Use – Adults - As indicated earlier, smoking rates have actually risen in Charlotte

County since 2010 for the general population –higher than state rate – and 77.5% higher than

Healthy People 2020 goals. While rates have steadily fallen statewide, Charlotte County

experienced growth through the first decade of 2000. Several factors may be part of this

increase. Charlotte County was the epi-center of Hurricane Charley in 2004. Even as the

community was rebuilding, the recession and economic decline hit the community hard. These

two major factors may well be contributors to the growth in smoking, due to stress.

Figure 4: Adults who are current smokers


Additionally, as the figure below indicates, smoking rates among women in Charlotte County

rose in the past five years, while rates for males has actually declined. This provides important

contextual data for the Coalition to understand, and relates to the higher rates for births to

mothers who smoke.


Figure 5: Smoking rates by sex

Source: www.myfloridacharts.com

The State uses Tobacco Settlement funds for prevention and cessation services. Agencies such as

Gulfcoast South Area Health Education Centers provide cessation support service and stress the

availability of telephone supports through the Florida Quitline. Additionally, Healthy Start Care

coordinators have been trained in SCRIPTS, the evidence-based cessation program for women

who are pregnant.

Medical Facilities

Four hospitals provide services in the Charlotte County area. Three of the hospitals are located

within the county and the fourth is located in the Sarasota County portion of Englewood, FL.

BayFront Health Punta Gorda is a Joint Commission Top Performer on Key Quality Measures®

for pneumonia, surgical care and immunization, and consists of a 208-bed facility offering an

award-winning, accredited primary stroke center, the Joint Commission Certified Joint and Spine

Academy, an accredited chest pain center, and emergency care services. Additional on-campus

services include adult inpatient psychiatric care at Riverside Behavioral Center and rehabilitation

and wellness services at the Wellness and Rehabilitation Center. In 2012, a cardiac unit was moved

to its sister hospital in Port Charlotte.33F33F

xxxv

Englewood Community Hospital located in the Sarasota County section of Englewood, FL is a

100-bed facility. This facility specializes in heart disease, emergency care, urology, orthopedics,

and a fully-equipped surgical department. 34F 34F

xxxvi


Fawcett Memorial Hospital is located in Port Charlotte, FL and holds 237 beds. Clinical specialties

include 24-hour emergency care center, a comprehensive ACoS CoC accredited cancer program,

Joint Commission accredited Stroke Center of Excellence, accredited Chest Pain Center with

Percutaneous Coronary Intervention, Joint Commission certified Orthopedic and Spine Center,

wound management and hyperbaric medicine, Inpatient and Outpatient Surgery, Minimally

Invasive Surgery, state-of-the-art cardiovascular surgery program, sports & rehabilitation services,

and many outpatient programs. 35F35F

xxxvii

BayFront Health Port Charlotte is a sister hospital to BayFront Health Punta Gorda. It is a 254-bed

full-service facility offering comprehensive services in emergency care, orthopedics and the only

licensed obstetric and pediatric units and Level II neonatal intensive care unit in Charlotte County.

The on-campus Southwest Florida Heart Center is an accredited chest pain center with

percutaneous coronary intervention (PCI) offering comprehensive cardiac services.36F36F

xxxviii

As the data indicates below, over 98% of births in Charlotte County take place in a hospital setting.

1.5% are home births, and less than 1% are in free standing birthing centers.

Table 44: Births by Facility Type

Charlotte County Births by Facility Type

2008 2009 2010 2011 2012 2013 2014

Hospital 1204 981 997 967 1021 998 987

Freestanding birth center 8 3 5 9 5 5 5

Clinic or doctor office 0 0 0 0 0 1 0

Home birth 3 5 8 8 9 14 15

En route or other place 1 2 1 3 1 3 0

Unknown 0 0 1 0 0 0 0

Total 1216 991 1012 987 1036 1021 1007 Source: www.floridacharts.com

Table 45: Births by Attendant Type

Charlotte County Births by Attendant Type

2008 2009 2010 2011 2012 2013 2014

MD 827 727 801 868 906 908 905

DO 120 123 112 26 48 37 38

Certified Nurse Midwife 243 120 72 65 54 44 38

Licensed Midwife 7 6 10 11 9 15 16

Other 19 15 14 17 19 17 10

Unknown 0 0 3 0 0 0 0

Total 1216 991 1012 987 1036 1021 1007 Source: www.floridacharts.com




Table 46: Births Delivered by Physician and Midwife

Births Delivered by Physician

MD 827 727 801 868 906 908 905

DO 120 123 112 26 48 37 38

Total 947 850 913 894 954 945 943

percent of births 77.88% 85.77% 90.22% 90.58% 92.08% 92.56% 93.64%

Births Delivered by Midwife

CNM 243 120 72 65 54 44 38

LM 7 6 10 11 9 15 16

Total 250 126 82 76 63 59 54

percent of births 20.56% 12.71% 8.10% 7.70% 6.08% 5.78% 5.36% Source: www.floridacharts.com

High-risk pregnant women and their infants are often referred to physicians practicing outside

Charlotte County. However, a Lee County based provider sees patients weekly at a Charlotte

County location and the Coalition contracts for high-risk services with that provider for certain

unfunded prenatal women.

Infants born in Charlotte County and needing higher level Neonatal Intensive Care are transferred

to Level III hospitals in Sarasota, St. Petersburg and Tampa. Lee Memorial Health Systems in

Fort Myers also provides neonatal hospitalization for some Charlotte County infants.

Currently, there are just four (4) obstetrical practices in Charlotte County and all are accepting

Medicaid clients.

No pediatric services outside of those mentioned below are offered through the local county Health

Department at this time. However, the department does offer the Growing Strong Families

Program. This program consists of two (2) Registered Nurses. The goal of the program is to

improve the health and well-being of young families especially during the prenatal period, but also

when a woman has recently delivered and risks are known to be present. A Registered Nurse

collaborates with community partners such as WIC, Healthy Start, Healthy Families and other

organizations to work with high risk pregnant women and their families. Home visits are made

with the agreement of the pregnant woman to evaluate her challenges and help develop positive

coping skills to ensure a strong family. Families and women are enrolled voluntarily into the

program. There is no dedicated State funding for this important program at this time, therefore

long-term sustainability is uncertain.

The local Health Department does provide pregnancy testing, family planning, and IPO (Improved

Pregnancy Outcome) services at its clinic site. In the past three (3) years, there has been a steady

decline in the number of women served through Family Planning Services. Loss of primary care

services through the local Health Department may be a factor in this decline.



Table 47: Family Planning Services

Family Planning Services Provided – Charlotte County

Year 2013 2014 2015

Number of Women Served 1493 1019 946

Through a Coalition contract with the local Health Dept. screening for Presumptive Eligibility for

Pregnant Women (PEPW) takes place at the local Health Dept. clinic site and provides pregnant

women with information on the Healthy Start Program and screening assessment. Information is

also provided on Healthy Start services, referrals for tobacco education and cessation support and

prenatal care services for uninsured and unfunded women, who are not eligible for Medicaid

benefits.

On an appointment basis, area women may also seek free pregnancy tests through the Pregnancy

Careline Center, a local, faith-based, not-for-profit that also provides maternity and infant clothing,

layettes, cribs, formula and food and referrals to other agencies providing needed services.

The Coalition currently contracts with Dr. Michael Coffey to provide prenatal care, at a rate equal

to, or less than, Medicaid reimbursement. These services are offered to qualified low income

women who have been determined to be ineligible for Medicaid.

Pediatrics

At the present time, nine of the twelve pediatricians in Charlotte County accept one or more MCO

(Medicaid) programs. The Florida Department of Health in Charlotte County provides

immunizations to school age children at no charge. However, since the last SDP, the Health

Department no longer provides primary care services. Family Health Centers, a federally qualified

health center, has a clinic in Charlotte County, which does offer primary services.

Immunizations

Immunization rates are fairly steady for Charlotte County. The chart on the next page provides

rolling year data on immunization rates at kindergarten. Immunizations are provided by the

Florida Department of Health in Charlotte County.


Table 48: Immunization Rates by Kindergarten

Immunization Levels in Kindergarten, 3-Year Rolling Rates

Year Charlotte Florida

Count Rate (%) Count Rate (%)

2009-11 3,325 97.4% 608,668 91.7%

2010-12 3,375 97.1% 625,057 92.0%

2011-13 3,402 95.7% 642,738 92.6%

2012-14 3,293 95.2% 647,524 92.8% Source: www.floridacharts.com

Health Care Providers

Charlotte County has lower rates of physicians than that of the state, as shown in Figure 6. This

includes OBGYN and pediatrics.

Figure 6: Health providers per 100,000


The lower rate of licensed health provider may be a factor in the recent decrease of adults who

report having a personal doctor (Figure 7).




Figure 7: Adults with personal doctor


Health Insurance

Lack of insurance, or inadequate insurance, can also be a risk to health. The U. S. Census Bureau

data for 2014 indicates that the total rate of those uninsured in Florida dropped from 20% in 2013

to 16.6% in 2014. For Charlotte County, the rate of those under age 65 who are uninsured is 23.4%

for the same time period, an improvement from the 2009 report rate of 29%.

The Florida Behavioral Risk Factor Surveillance System survey is conducted every three (3) years.

Information on health care coverage is one of the data points gathered. In Charlotte County, rates

for adults with any type of health insurance are higher than the state rate for residents who are age

18-44, but lower for those older (see Table 49 below). While higher than the state, the rate of

health insurance for those 18-44, which includes women of pregnancy age, is still just under 67%.

Table 49: Adults with any type insurance care coverage

Adults with any type of health care insurance coverage, by age group

Charlotte Florida

Year 18-44 45-64 65 & Older 18-44 45-64 65 & Older

2002 65.60% 83.70% 96.50% 73.00% 81.90% 97.00%

2007 74.80% 81.20% 98.90% 72.40% 82.70% 97.30%

2010 78.80% 82.50% 99.40% 73.00% 83.40% 98.00%

2013 66.70% 69.50% 97.30% 66.50% 76.40% 97.50% Source: Florida Behavioral Risk Factor Surveillance System data at www.floridacharts.com




More women than men in both the county and state indicated cost as a factor in not seeing a

physician from 2007-2013 (see Table 50 below). Further, for those adults who are ages 18-44, the

rate of not seeing a physician due to cost was 32.7% in 2013; while the state rate was 27.6%.

Table 50: Percentage of adults who could not see a physician due to cost

Percentage Who Could Not See Physician At Least Once Due to Cost Charlotte County State

2007 2010 2013 2007 2010 2013

Male 9.6% 19.1% 15.7% 13.3% 15.4% 18.3%

Female 16.5% 23.0% 17.2% 16.9% 19.1% 23.1%

Age: 18-44 25.9% 40.6% 32.7% 19.9% 25.3% 27.6%

Age: 45-64 13.0% 21.8% 22.5% 15.8% 17.6% 23.4%

Age: 65+ 4.1% 22.5% 3.0% 4.5% 23.4% 4.9% Source: Florida Behavioral Risk Factor Surveillance System data at www.floridacharts.com

The percentage of births covered by Medicaid in Charlotte County are at a higher rate than for the

state, as shown in Table 51. The rates are higher across races and ethnicity, as well. As noted in

the previous section on socio-economic factors (Table 36), over 20% of children in Charlotte

County live in poverty and nearly 20% of families are in poverty37F

xxxix. Given the poverty data, it is

not surprising that a higher percentage of births are paid by Medicaid in Charlotte County.

Table 51: Births covered by Medicaid

Births Covered by Medicaid, 3-Year Rolling Rates

Year Charlotte Florida

Count Rate (%) Count Rate (%)

2009-11 1,810 60.5% 316,130 48.7%

2010-12 1,897 62.5% 319,709 49.9%

2011-13 1,940 63.7% 326,607 50.9%

2012-14 1,988 64.9% 330,062 50.9%


Charlotte Florida

White Black & Other White Black & Other

Year Count Rate (%) Count Rate (%) Count Rate (%) Count Rate (%)

2009-11 1,554 60.0% 255 64.2% 203,582 43.8% 111,536 61.3%

2010-12 1,642 62.2% 255 64.6% 205,342 45.0% 113,316 62.4%

2011-13 1,692 63.5% 248 65.6% 209,638 46.0% 115,944 63.4%

2012-14 1,731 64.2% 257 70.2% 211,737 45.9% 117,120 63.6%




Charlotte Florida


Year Count Rate (%) Count Rate (%) Count Rate (%) Count Rate (%)

2009-11 168 60.2% 1,642 60.6% 86,802 48.2% 227,844 49.0%

2010-12 146 61.3% 1,750 62.6% 88,685 50.4% 229,513 49.8%

2011-13 155 65.4% 1,784 63.6% 92,159 52.5% 232,867 50.4%

2012-14 173 68.9% 1,814 64.6% 94,187 52.7% 234,502 50.4%


Dental Health

According to Behavioral Risk Factor Surveillance System data, rates for residents who could not

see a dentist in the past year due to cost are lower than state rates. However, as the data shows

below, within the county, women and residents aged 18-44 years are the most likely to have

difficulties accessing dental care due to cost. According to research published in the American

Family Physician (Silk, Douglass, et al, April 2008), poor oral health is associated with negative

pregnancy outcomes, such as preterm birth and low birth weight. 38F

xl

Table 52: Percentage who could not see a dental due to cost

Percentage Who Could Not See Dentist in Past Year Due to Cost

Charlotte County State

2007 2010 2013 2007 2010 2013

Male 9.6% 19.1% 15.7% 13.3% 15.4% 18.3%

Female 16.5% 23.0% 17.2% 16.8% 19.1% 23.1%

Age: 18-44 25.9% 40.6% 32.7% 19.9% 25.3% 27.6%

Age: 45-64 13.0% 21.8% 22.5% 15.8% 17.6% 23.4%

Age: 65+ 4.1% 3.2% 3.0% 4.5% 4.3% 4.5%


Through the last SDP period and within Charlotte County, the only consistent provider of

Medicaid-supported dental care, on a limited basis, was the local Federally Qualified Health

Center (FQHC). The Coalition is pleased to report that the Florida Department of Health in

Charlotte County opened a dental clinic for Medicaid clients, up to age 21, in June 2016.




Maternal and Child Health Factors

Overview of MCH Health Factors

The Community Assessment Review Committee examined local and state data with Healthy

People 2020 recommendations. This data is used in the Community Assessment Review

Committee’s logic model/Fishbone created through their process. As this data shows, Charlotte

County is doing well with infant, neonatal and post neonatal death rates, as well as very low birth

rate for births <1500 grams. Entry to care, pregnancy interval, and smoking during pregnancy

areas were noted as areas for Coalition focus. It should be noted, as the number of births in

Charlotte County are slightly over 1,000 per year, even one death can impact county rates and

distort the comparison to Healthy 2020 goals. This can be seen in data related to maternal deaths,

SIDS and SUID.

Table 53: Overview of MCH Factors with Healthy People 2020

Indicator 3-Year

Rolling

County

Rate

State

Rate

Healthy

People

2020

Goal

Pregnancy Interval < 18 Months 2012-14 35.1% 34.7% 29.8%

Early Prenatal Care 2012-14 74.2% 79.8% 77.9%

Preterm Birth (<37 weeks) 2012-14 12.8% 13.9% 11.4%

Infant Death Rate 2012-14 2.6* 6.1* 6*

Neonatal Death Rate 2012-14 1* 4* 4.1*

Post neonatal Death Rate 2012-14 1.6* 2.1* 2*

Fetal Death Rate 2012-14 5.9* 7.2* 5.6*

Maternal Death 2012-14 32.6** 16.2** 11.4**

Low Birth Rate < 2500 grams 2012-14 8.2% 8.6% 7.8%

Very Low Birth Rate <1500 grams 2012-14 1.2% 1.6% 1.4%

Didn't Smoke While Pregnant 2012-14 83.9% 93.5% 98.6%

%Mothers Initiated/Babies Ever Breastfed 2012-14 78.6% 82.6% 81.9%

Deaths from SIDS (Sudden Infant Death) 2012-14 1* 0.3* 0.84*

Deaths from SUID (Sudden Unknown) 2012-14 1* 1* 0.84* Sources: Healthy People 2020 and Florida Charts

*Rate per 1,000 live births **Rate per 100,000 live births

Florida Charts data provides additional data for other key health factors to add to this overview of

maternal and child health. While there has been a slight increase in multiple births, Charlotte

County remains lower than state rates. There has also been a decrease in both teen births (ages 15-


19) and repeat births to mothers of the same age. Teen births are less than 1/10 percentage point

higher than the state rate.

Table 54: Additional key MCH factors

Maternal and Infant Health Overview 2010-2012

Charlotte County State of Florida

Multiple Births 2.7% 3.2%

Birth to Teens 15-19 (Rate/1000) 30.5% 29.6%

Repeat Births to Mothers 15-19 17.4% 17.4%

Maternal and Infant Health Overview 2012-2014

Multiple Births 3.0% 3.3%

Birth to Teens 15-19 (Rate/1000) 24.4% 24.3%

Repeat Births to Mothers 15-19 15.4% 16.6% Source: www.floridacharts.com

Births

Charlotte County’s birth rate has dropped within the past five (5) years. The figure below shows

that this drop was not inconsistent with a drop in state birth rates, as well.

Figure 8: Live births, rolling year rates





Table 55: Total resident live births

Total Resident Live Births, Single Year

Rates

Total Resident Live Births, 3-Year Rolling

Rates

Charlotte Florida Charlotte Florida

Year Count Rate Count Rate Year Count Rate Count Rate

2010 1,012 6.3 214,519 11.4 2008-10 3,219 6.7 667,327 11.9

2011 987 6.1 213,237 11.3 2009-11 2,990 6.2 649,147 11.5

2012 1,036 6.4 212,954 11.2 2010-12 3,035 6.3 640,710 11.3

2013 1,021 6.2 215,194 11.1 2011-13 3,044 6.2 641,385 11.2

2014 1,007 6.1 219,905 11.2 2012-14 3,064 6.2 648,053 11.2 Source: www.floridacharts.com

A rolling 3-year comparison of birth rates for Charlotte, Clay, Hernando and Martin Counties

illustrates that Charlotte County has the lowest birth rate. As Charlotte County is one of the top

two counties with regard to highest median age, it is not surprising to see its birth rate lower in

this comparison. Only Sumter County has a higher median age (63.8) than Charlotte County

(56.7) according to Florida Charts.39F

xli

Table 56: Birth rates, multi-county

Charlotte Clay Hernando Martin STATE

2012-14 2012-14 2012-14 2012-14 2012-14

Measure

Avg.

Annual

Number

of

Events

3-Year

Rate or

Percent

Avg.

Annual

Number

of

Events

3-Year

Rate or

Percent

Avg.

Annual

Number

of

Events

3-Year

Rate or

Percent

Avg.

Annual

Number

of

Events

3-Year

Rate or

Percent

Avg.

Annual

Number

of

Events

3-Year

Rate or

Percent

Total Births

Total

Live

Births

Per 1,000

Total

Population 3,064 6.2 6,248 10.7 4,359 8.3 3,558 8 648,053 11.2

White

Live

Births

Per 1,000

White

Population 2,696 6 5,131 10.6 3,810 8 3,075 7.6 461,143 10.2

Black

&

Other

Live

Births

Per 1,000

Black &

Other

Population

366 7.9 1,093 10.9 534 10.9 472 11.1 184,048 14.6

Data Source: Florida Department of Health, Bureau of Vital Statistics

Fetal and Infant Death Rates

Fetal death rates for Charlotte County rose in 2014, but rolling year data shows a drop from

2008-10 to 2012-14 by over 1.3 percentage points. Given the rate is based upon births per 1000,

and Charlotte County’s overall number of births, its rate is impacted even by only one or two

fetal deaths. Healthy People 2020 establishes 5.6 deaths per 1000 as its target. The county falls

just above this rate with rolling year data.



Table 57: Fetal deaths

Fetal Deaths Fetal Deaths

Per 1,000 Deliveries Per 1,000 Deliveries

Single-Year Rates 3-Year Rolling Rates

Years Charlotte Florida


Count Rate Count Rate Count Rate Count Rate

2010 7 6.9 1,551 7.2 2008-10 23 7.1 4,808 7.2

2011 6 6 1,558 7.3 2009-11 20 6.6 4,678 7.2

2012 5 4.8 1,530 7.1 2010-12 18 5.9 4,639 7.2

2013 5 4.9 1,533 7.1 2011-13 16 5.2 4,621 7.2

2014 8 7.9 1,576 7.1 2012-14 18 5.8 4,639 7.1

Healthy People 2020 sets a target of 6% for infant death rate. The State of Florida does not meet

this target, but Charlotte County consistently falls below the HP2020 target. Again, it must be

acknowledged that due to the number of births in Charlotte County overall, one or two deaths

can result in a notable increase in rate.

Table 58: Infant death rates

Infant Deaths Infant Deaths

Per 1,000 Live Births Per 1,000 Live Births

Single-Year Rates 3-Year Rolling Rates




2010 5 4.9 1,400 6.5 2008-10 17 5.3 4,592 6.9

2011 5 5.1 1,372 6.4 2009-11 14 4.7 4,297 6.6

2012 3 2.9 1,285 6 2010-12 13 4.3 4,057 6.3

2013 1 1 1,318 6.1 2011-13 9 3 3,975 6.2

2014 4 4 1,327 6 2012-14 8 2.6 3,930 6.1 Source: www.floridacharts.com

Since 2012, there have been no (reported/documented) infant deaths to mothers who are black in

Charlotte County. Previously, infant deaths had been mostly higher among mothers who are

black. State rates are higher among mothers who are black consistently in all years reported in

the following table.



Table 59: Infant deaths by race, rolling year rates

Infant Deaths

Per 1,000 Live Births, 3-Year Rolling Rates

Years

Charlotte Florida



2008-10 11 3.9 6 22.6 2,444 5.1 1,908 12.6

2009-11 10 3.9 4 15.7 2,228 4.8 1,831 12.3

2010-12 8 3 4 15.7 2,135 4.7 1,687 11.5

2011-13 6 2.3 2 8.7 2,092 4.6 1,624 11.1

2012-14 7 2.6 0 0 2,082 4.5 1,578 10.8 Source: www.floridacharts.com

However, rates for infant deaths to mothers who are Hispanic in Charlotte County are higher

than state rates for 2012-14. This is an increase from no infant deaths since 2010. Again, infant

death rates, must be looked at within the context of overall number of births in Charlotte County.

While the rate for infant death for mothers who are Hispanic jumped to eight (8) from none, this

data represents two (2) deaths during the three (3) year period.

Table 60: Infant deaths by ethnicity, rolling year rates

Infant Deaths

Per 1,000 Live Births, 3-Year Rolling Rates

Years

Charlotte Florida



2008-10 2 6.5 15 5.2 1,029 5.5 3,522 7.4

2009-11 2 7.2 12 4.4 954 5.3 3,296 7.1

2010-12 0 0 13 4.7 903 5.1 3,094 6.7

2011-13 0 0 9 3.2 857 4.9 3,054 6.6

2012-14 2 8 6 2.1 857 4.8 3,000 6.4 Source: www.floridacharts.com

Maternal Deaths

Table 53, which presents county, state and Healthy People 2020 data, indicates the maternal

death rate for Charlotte County is 32.6. However, as with fetal and infant death rates, the

number of births for Charlotte County are low, given the rate is per 100,000 births. In Charlotte

County, there is no way to meet the 11.4 target rate set by Healthy People 2020, if any maternal

death occurs. One death will result in a rate over 30. The rate of 32.6 for Charlotte County

during 2012-14 was due to one (1) maternal death.




Low Birth Weight

The Healthy People 2020 goal for low birth weight (under 2500 grams) rate is 7.8%. Neither the

state (8.6%) or county (8.2%) data fall within the goal target. However, data indicates that low

birth weight rates (under 2500 grams) for Charlotte County are lower than for the State of

Florida. Table 61 provides historical data for low birth weight rates, indicating that the rate for

Charlotte has grown since the last SDP, while the state has remained mostly the same.

Table 61: Low birth weight rates

Live Births Under 2500 Grams (Low

Birth Weight), 3-Year Rolling Rates

Live Births Under 2500 Grams (Low

Birth Weight), Single Year Rates Charlotte Florida

Charlotte Florida

Year Count % Count % Year Count % Count %

2008-10 241 7.5 58,385 8.7 2010 87 8.6 18,719 8.7

2009-11 228 7.6 56,574 8.7 2011 76 7.7 18,558 8.7

2010-12 256 8.4 55,568 8.7 2012 93 9 18,291 8.6

2011-13 253 8.3 55,220 8.6 2013 84 8.2 18,371 8.5

2012-14 250 8.2 55,766 8.6 2014 73 7.2 19,104 8.7 Source: www.FloridaCharts.com

Looking at multi-county data for low birth weight indicates that Charlotte County rates are lower

than Hernando or Martin Counties, but just above the rate for Clay County.

Table 62: Multi-county data low birth weight

County Florida


Charlotte

2010-12 256 8.4 55,568 8.7

2011-13 253 8.3 55,220 8.6

2012-14 250 8.2 55,766 8.6

Clay 2011-13 489 7.8 55,220 8.6

2012-14 503 8.1 55,766 8.6

Hernando 2011-13 393 8.9 55,220 8.6

2012-14 383 8.8 55,766 8.6

Martin 2011-13 393 8.9 55,220 8.6

2012-14 383 8.8 55,766 8.6

Low birth weight (under 2500 grams) rates were also examined to determine if there are any health

disparities in Charlotte County for this indicator factor. Charlotte County rates for births under

2500 grams to white mothers has stayed fairly level at approximately 1.1%. This is just under the

state rate for 2012-14. Low birth rates for babies born to black mothers has decreased from 3.5%

in 2010-12 to 1.8% in 2012-14. This is a 48.6% reduction for Charlotte County and lower than

the state rate of 2.9%.



Table 63: Births Under 2500 Grams (Low Birth Rate) by Race

Live Births Under 2500 Grams (Low Birth Weight), 3-Year Rolling Rates - Race

Charlotte Florida



2010-12 30 1.1% 9 3.5% 5,510 1.2% 4,358 3%

2011-13 31 1.2% 5 2.2% 5,309 1.2% 4,296 2.9%


While low birth weight rates in the State of Florida for mothers who are Hispanic or non-Hispanic

have remained relatively stable at 1.3% and 1.7% respectively, rates have increased for mothers

who are Hispanic and decreased for mothers who are non-Hispanic in Charlotte County.

Table 64: Births under 2500 Grams (Low Birth Rate) by Ethnicity

Live Births Under 2500 Grams (Low Birth Weight)

3-Year Rolling Rates - Ethnicity

Charlotte Florida



2010-12 2 0.8% 40 1.4% 2,313 1.3% 7,963 1.7%

2011-13 3 1.3% 38 1.4% 2,214 1.3% 7,837 1.7%

2012-14 5 2% 32 1.1% 2,296 1.3% 7,878 1.7% Source: www.floridacharts.com

Multi-county data indicates that Charlotte County has the lowest percentage of low birth weight

births to mothers who are black and to those who are Hispanic. However, Charlotte holds the

highest percentage for births to mothers who are Hispanic.

Table 65: Multi-County Comparison - Low Birth Rate by Race/Ethnicity

Low Birth Weight (< 2500g) Births 3-Year Rolling Rates 2012-2014

Mother's Race/Ethnicity

White Black Hispanic Non-Hispanic

County Count % Count % Count % Count %

Charlotte 221 8.2 29 7.9 26 10.4 224 8.0

Clay 382 7.5 80 11.4 41 7.3 460 8.1

Hernando 324 8.5 43 12.3 46 8.5 334 8.8

Martin 206 6.7 40 13.7 68 6.2 189 7.7






Very Low Birth Weight

The very low birth weight (under 1500 grams) target for Healthy People 2020 is 1.4% of births.

Charlotte County falls under the target with 1.2%, while the state is higher than the target at 1.6%.

Table 66: Very low weight birth rates

Live Births Under 1500 Grams (Very

Low Birth Weight), 3-Year Rolling Rates

Live Births Under 1500 Grams (Very

Low Birth Weight), Single Year Rates Charlotte Florida

Charlotte Florida

Year Count % Count % Year Count % Count %

2008-10 38 1.2 10,917 1.6 2010 14 1.4 3,522 1.6

2009-11 34 1.1 10,499 1.6 2011 15 1.5 3,433 1.6

2010-12 42 1.4 10,370 1.6 2012 13 1.3 3,415 1.6

2011-13 41 1.3 10,159 1.6 2013 13 1.3 3,311 1.5

2012-14 37 1.2 10,276 1.6 2014 11 1.1 3,550 1.6 Source: www.FloridaCharts.com

Examining very low birth weight rates by race, indicates that Charlotte County was higher for

mothers who are black in 2010-12, but now has dropped over one percentage point lower than

the state rate.

Table 67: Very low birth weight rate by race - state and county

Live Births Under 1500 Grams (Very Low Birth Weight)

Charlotte Florida



2010-12 30 1.1 9 3.5 5510 1.2 4358 3

2011-13 31 1.2 5 2.2 5309 1.2 4296 2.9

2012-14 31 1.1 4 1.8 5418 1.2 4266 2.9 Source: www.FloridaCharts.com

However, Charlotte County has a slightly higher rate of very low birth weight for mothers who

are Hispanic, than the state. It is important to note the small number (count) of births with very

low birth weight to mothers who are Hispanic.

Table 68: Very low birth weight rate by ethnicity - state and county

Live Births Under 1500 Grams (Very Low Birth Weight)

Charlotte Florida



2010-12 2 0.8 40 1.4 2313 1.3 7963 1.7

2011-13 3 1.3 38 1.4 2214 1.3 7837 1.7

2012-14 5 2 32 1.1 2296 1.3 7878 1.7 Source: www.FloridaCharts.com





Examining 3-year rolling rates for multi-county rates for very low birth weight indicates that

Charlotte County has the lowest rates for very low birth weight rates by mothers who are white,

who are black, or who are non-Hispanic. Very low birth weight rates for mothers who are Hispanic

show that Charlotte County’s rate is just under the highest rate, which is held by Clay County.

Table 69: Multi-county very low birth weight rates

Very Low Birth Weight (< 1500g) Births, Three-Year Rolling Rates 2012-2014

Mother's Race/Ethnicity

White Black Hispanic Non-Hispanic

County Count % Count % Count % Count %

Charlotte 31 1.1 4 1.8 5 2 32 1.1

Clay 67 1.3 14 2 13 2.3 73 1.3

Hernando 45 1.2 12 3.4 10 1.8 48 1.3

Martin 44 1.4 10 3.4 18 1.6 39 1.6


Cesarean Section Deliveries

Healthy People 2020 has set a goal of 23.9% cesarean section deliveries to low-risk mothers.40F

xlii

The data from Bureau of Vital Statistics, on Florida Charts, does not provide insights as to the

percentage of cesarean section deliveries to mothers with low-risk. However, the Coalition and

Community Assessment Review Committee did examine overall rates for cesarean section

deliveries.

Rates for cesarean section deliveries in Charlotte County are lower than state rates. However,

cesarean section deliveries have increased since 2010, in number and rate for the county in single

year data. 3-year rolling data presents a slight decrease, by just over one (1) percentage point for

Charlotte County. This is a stronger decrease than experienced by the state for the same period.

According to the CDC, the 2014 national rate for cesarean births is 32.2%, which is lower than

both the county and state rate. 41F

xliii

Table 70: Cesarean section deliveries, single year rates

Cesarean Section Deliveries, Single Year Rates

Charlotte Florida


2010 335 33.1 80,999 37.8

2011 377 38.2 81,259 38.1

2012 373 36 81,157 38.1

2013 370 36.2 81,159 37.7

2014 346 34.4 81,678 37.1 Source: Florida Department of Health, Bureau of Vital Statistics



Table 71: Cesarean section deliveries - 3 -year rolling rates

Cesarean Section Deliveries, 3-Year Rolling Rates

Charlotte Florida


2009-11 1,096 36.7 246,605 38

2010-12 1,085 35.7 243,415 38

2011-13 1,120 36.8 243,575 38

2012-14 1,089 35.5 243,994 37.7 Source: Florida Department of Health, Bureau of Vital Statistics

Looking at cesarean section deliveries by race, indicates that in both the county and state, rates are

higher for mothers who are black. Data also shows that non-Hispanic women in the county have

higher rates for cesarean section deliveries than Hispanic women. However, state rates show that

the opposite is true – women who are Hispanic have higher rates in the state overall.

Table 72: Cesarean section deliveries by race and ethnicity


Charlotte Florida


Year Count Rate

(%) Count

Rate

(%) Count

Rate

(%) Count Rate (%)

2009-11 939 36.3 107 42 176,736 38 56,701 38.2

2010-12 933 35.4 100 39.2 173,423 38 56,192 38.2

2011-13 964 36.2 95 41.1 172,807 37.9 56,411 38.5

2012-14 962 35.7 81 36 172,460 37.4 56,747 38.7


Charlotte Florida


Year Count Rate

(%) Count

Rate

(%) Count

Rate

(%) Count Rate (%)

2009-11 103 36.9 993 36.7 74,291 41.2 170,828 36.7

2010-12 82 34.5 1,003 35.9 72,731 41.3 168,938 36.6

2011-13 82 34.6 1,038 37 72,844 41.5 168,628 36.5

2012-14 85 33.9 1,004 35.7 73,820 41.3 168,335 36.1 Source: Florida Department of Health, Office of Vital Statistics, Florida Birth Certificate. - Florida residents only.


6. CONSUMER AND PROVIDER INPUT

Consumer Input

The Charlotte County Healthy Start Coalition solicits input from the community in a number of

ways in order to identify the needs of consumers and to assess the effectiveness of maternal and

child health services provided. Below is a list of activities that have been completed since the

submission of the prior service delivery plan.

Consumer and Community Input

Activity Date

CCHSC Board Satisfaction Survey Jan. 2012

CCHSC Board Satisfaction Survey Jan. 2013

CCHSC Membership Survey Oct. 2010



CCHSC Membership Survey Dec. 2012


CCHSC Membership Skill Set Survey Oct. 2010

CCHSC Membership Skill Set Survey Oct. 2011

Children’s Literacy Survey Mar. 2012

Community Resource Survey Sep. 2010

Community MCH Indicator Survey (students) Jul. 2010

Health Disparities Survey May 2011

Health Disparities Survey Jul. 2012

Healthy Start Brochure Survey Jan. 2011

Healthy Start Brochure Survey Mar. 2011

Healthy Start Brochure Survey Apr. 2011

Healthy Start Brochure Survey Sep. 2011

Healthy Start Brochure Survey Oct. 2011


Healthy Start Brochure Survey May 2012


Healthy Start Brochure Survey Jul. 2013

Healthy Start Brochure Survey Sep. 2013

Healthy Start Brochure Survey Oct. 2013

Healthy Start Brochure Survey Nov. 2013


Healthy Start Brochure Survey Mar. 2014


Kicks Count Card Consumer Survey Summary Jul. 2011 – Jun. 2012

Maternal/Child Health Issues Survey July 2010

Mom’s Tote Content Survey Mar. 2011

Mom’s Tote Content Survey Jun. 2011

Mom’s Tote Content Survey Summary Jul. 2013–Jun. 2014


Presentation Evaluation Survey – Well Baby Care/Immunization Apr. 2013

Presentation Evaluation Survey – Family Planning Initiative Oct. 2013

Presentation Evaluation Survey – Adverse Childhood Experiences Study Dec. 2013

Presentation Evaluation Survey – Identify Theft Feb. 2014

Presentation Evaluation Survey – Early Learning Coalition Overview Apr. 2014

Presentation Evaluation Survey – Partners for a Healthy Baby Overview Aug. 2014

Presentation Evaluation Survey – Healthy Families Overview Jan. 2015

Presentation Evaluation Survey – Hospice Children’s Services Jan. 2015

Presentation Evaluation Survey – Domestic Violence & Its Effects Apr. 2015

Presentation Evaluation Survey – Identifying Human Trafficking Victims Jan. 2016

Well Baby /Immunization Presentation Survey Apr. 2013

Provider Input

All service providers include client satisfaction surveys as part of their annual service performance

measurement. Satisfaction surveys are included for the following services; Care coordination,

childbirth education, tobacco cessation, parenting education, psychosocial counseling, and

prenatal care. A summary of the survey results is reported in the Summary of Surveys Conducted

for Charlotte County Healthy Start Coalition, Inc. component of this report.

Activity Date

OB Medicaid Provider Survey Aug. 2010

OB Provider – Self Pay Fee Survey Dec. 2010

OB Provider – Medicaid Provider Survey Aug. 2010

OB Provider – Medicaid Provider Survey May 2012

OB Provider – Medicaid Provider Survey Mar. 2013

OB Provider – Diabetic Nutrition Education Survey Jun. 2011

OB Provider – MCO Plan Provider Survey Feb. 2015

Pediatric – Vaccine for Children Survey Sep. 2010

Pediatric Provider Survey May 2012

Pediatric Provider Survey Mar. 2013

Pediatric Provider Survey

Summary of Surveys Conducted for Charlotte Healthy Start Coalition

Board Satisfaction Surveys 2012 and 2013

The intent of this survey was to measure the satisfaction of Board Members as Directors of the

Coalition and to solicit recommendations for improvement. In the 2012 survey seven (7) Board

Members responded, with 86% reporting satisfaction in their experience and utilization as a Board

Member. (One (1) respondent sited being too new to assess.) Three areas of improvement were

recommended by the majority of Board Members surveyed and included: re-formatting meetings

to make better use of skills and time; increasing Board responsibility, and expanding leadership


skills. All agreed that the Coalition is an active, community-driven organization, providing

quality, cost-effective services.

Using the same survey in 2013, nine (9) Board Members reported 100% satisfaction with their

roles, however they also felt the need for increased responsibility, leadership skill development,

and better use of meeting time. The Board subsequently moved to a “consent agenda” meeting

format, still in use today, to better utilize time and allow for more meaningful discussion. Other

changes initiated by these suggestions included the re-organization of the former “Membership”

committee and resulting assignment of fund development and educational presentations to Board

members under the new “Fund Development, Education, and Community Action” committee.

CCHSC Membership and Membership Skill Set Surveys –2010-2014

Assessing public knowledge of maternal/child health issues and local public awareness needs was

the primary purpose of this survey. According to those surveys completed over the past five (5)

years, Coalition members were generally knowledgeable of the most pressing maternal/child

health issues: early entry to care, prenatal smoking, inter-conception health/awareness, substance

abuse and maternal/child health disparities. Following the closure of the local health department’s

dental program, members agreed that affordable dental services were needed. (It should be noted

that in June 2016, the local health department re-opened its dental clinic.) Overall, members were

familiar with Healthy Start services and wanted to learn more about health disparities, area services

for children, child care, parenting and postpartum depression. These comments have been

important to the Fund Development, Education and Community Action Committee in planning

guest speaker presentations. Members were also surveyed on their skill sets and how they would

benefit the Healthy Start mission.

Community Resource Survey – 2010

A survey was conducted at a Community Resource Fair hosted by the RSVP (Retired Senior

Volunteer Program) to measure the public’s knowledge of area resources and resource gaps. All

respondents felt that the following were gaps in area resources:

• Affordable childcare

• Substance abuse treatment/prevention for prenatal women

• Awareness of Medicaid availability & application

• Public transportation

In 2010 students were surveyed for their knowledge and perception of certain community maternal

and child health indicators. Results showed:


Indicator Student Perception

Births to mothers ages 15 - 19 Accurately estimated rate of teen births

Low birth weight births Accurately estimated rate of LBW births

Premature births Estimated a lower rate than “actual”

Mothers receiving ‘no” or “late” prenatal

care

Estimated a lower rate than “actual”

Mothers considered Obese before

pregnancy

Estimated a lower rate than “actual”

Mothers considered underweight before

pregnancy

Accurately estimated rate of

underweight mothers

Mothers who smoke during pregnancy Estimated a lower rate than “actual”

Guest Presentation Evaluation Surveys – 2013 -2016

General Membership meeting attendees received important information on topics associated with

Maternal/child health or the welfare of area families at regularly scheduled meetings. Following

each presentation, members were asked to evaluate the speaker and the information provided.

Evaluations were completed on these presentation topics and reflected favorably on the speaker

and material:

Family Planning Initiative

Partners for a Healthy Baby

Adverse Childhood Experience

Study

Healthy Families Overview

Identity Theft Prevention Tidewell Hospice Children’s

Services

Early Learning Coalition Overview Domestic Violence & Its Effects

Human Trafficking

Signs/Precautions

Well Baby Care & Infant

Immunization

Healthy Start Brochure Surveys – 2010 - 2014

Since the last service delivery plan update, the Coalition has continued to survey childbirth

education participants on the helpfulness of the Healthy Start brochure. The brochure is repeatedly

found to be eye-catching and effective and no changes have been recommended.

Health Disparities Survey – 2011, 2012

This survey was designed to measure the community’s understanding of maternal/child health

disparities and to identify those disparities that require further community education and


awareness. Those surveyed represented social service organizations, businesses, consumers,

government, civic organizations, faith-based organizations, educational institutions, health care

providers, youth-serving organizations, and staff. Results showed that more community

awareness and education was needed for women of childbearing age to reduce 1) the high rate of

Black low birth weight births; 2) the rate of pregnancy interval under 18 months for Whites; 3) the

rate of repeat teen births for Whites; 4) the rate of Hispanic teen births; and 5) the rate of Blacks

with no prenatal care.

Kicks Count Card Surveys 2011-2012

Local OB providers and hospital staff were provided with Kick Count Cards to share with patients

through a Healthy Start initiative in 2011 and 2012. Recipients were asked to rate the usefulness

of these tools via survey. Results showed that 67% received the flyer, 88% of those receiving the

flyer used it, and 72% of those using the flyer found it helpful. Due to the low rate of distribution,

the Coalition elected not to continue this initiative.

Moms Tote Content Survey 2011 -2014

Pregnant women who pre-registered for the birth of their child at the local birthing facility were

surveyed on the distribution of Healthy Start New Moms Totes and the usefulness of the

educational materials provided. 97% of those surveyed received the tote when pre-registering, and

94% said they found the material helpful. Information listed as most helpful included newborn

and toddler development, outlet safety covers, breastfeeding, labor and delivery, and shaken baby

prevention. Recommendations for items to add were: coupons, epidural information, additional

breastfeeding information, and pediatrician list.

OB Medicaid Provider Surveys – 2010-2016

OB providers were surveyed, at a minimum annually, for their participation as Medicaid providers.

When there were seven (7) or eight (8) OB providers practicing in the county, at least one provider

did not accept Medicaid patients. However, currently there are only five (5) OB providers

practicing in the county and all accept Medicaid participants. Two (2) of these providers accept

all four (4) MCO plans offered in our region, and three (3) others accept only two (2) of the

available MCO plans.

In addition, OB provider offices reported their patients lacked public transportation and knowledge

of area resources.

In 2012, OBs were surveyed on their knowledge of the Diabetic Nutrition Education services for

eligible prenatal women offered through Healthy Start. Six (6) of the seven (7) providers

practicing at that time were familiar with the program and felt the services helped their clients

understand the effects and management of diabetes during pregnancy. Five (5) of the six (6)


providers indicated their clients had expressed satisfaction with the program. Four (4) of the six

(6) providers said they had seen positive changes in client blood sugars.

OB providers were also surveyed to determine the area range of self-pay prenatal care and delivery

fees.

Pediatric Provider Surveys – 2010-2016

A survey to determine those pediatricians participating in the “Vaccine for Children” program

determined that five (5) of the areas nine (9) physicians participated. The remaining four (4)

referred Medicaid patients to the local Health Department for the vaccines.


7. RESOURCE INVENTORY

Medical Services – Birthing Centers & Hospitals

All Children’s

Hospital

501 6th Ave. S

St. Petersburg, FL 33701

1-800-456-4543

Florida Pediatric Regional Treatment

Center

Baby Love Birth

Center

3046 Del Prado Blvd. S

#2 E

Cape Coral, FL 33904

(239) 540-9010

Birth Suites with whirlpool tub/birthing

pool for water births

Hypnobirthing Classes

Massage Therapy

Prenatal Services

Bayfront Health

Punta Gorda

809 E. Marion Avenue

Punta Gorda, FL 33950

(941) 639-3131

24 Hr. Emergency Care

Ambulatory Care Center

Rehabilitation Center

Wellness Center

No Labor & Delivery

Bayfront Health

Port Charlotte

2500 Harbor Blvd. Port

Charlotte, FL 33952

(941) 766-4122

Breastfeeding; Childbirth & Infant CPR

Classes

Lactation Support

Milk Bank

Hospital Tours of Birthing Facility before

delivery

Level II NICU

Birthways Family

Birthing Center

4222 McIntosh Lane

Sarasota, FL 34232

(941) 366-BABY (2229)

Midwifery Care

Natural Childbirth at home or at the

Birthing Center

Water Births

Cape Coral Hospital

(Lee Health System)

636 Del Prado Blvd.


(239) 424-2000

Birth Education/Lactation Support

Family Birth Suites

Special Care Nursery

Pediatric Services

Web Nursery

Englewood

Community Hospital

700 Medical Boulevard

Englewood, FL 34223

(941) 475-6571

24 Hour Emergency Care

Pediatric Services

No Labor & Delivery


Fawcett Memorial

Hospital

21298 Olean Boulevard

Port Charlotte, FL 33952

(941) 629-1181

24 Hour Emergency Care

Limited Pediatric Services

Rehabilitation Center

No Labor & Delivery

Gulf Coast Medical

Center (Lee

Memorial Health

System)

13681 Doctor’s Way

Ft. Myers, FL 33912

(239) 343-1000

Lactation Svcs.

(239) 343-0744

Birthing Suites

Labor & Delivery

Lactation Support

Triage

Golisano Children’s’

Hospital (Lee

Memorial Health

System)

9981 S. Healthpark Dr.

Ft. Myers, FL 33908

(239) 343-5437

Level II & III Neonatal Intensive Care

Center

Regional Perinatal Intensive Care Ctr.

RPICC

Pediatric Services

On Site Ronald McDonald House

Health Park Medical

Center (Lee

Memorial Health

System)

9981 S. Healthpark Dr.

Ft. Myers, FL

(239) 343-5000

Birth Education/Lactation Support

Golisano Children’s Hospital

OB/GYN including High Risk OB care

Web Nursery

Home Birth Services 4944 Midnight Lane

Sarasota, FL 34235

(941) 351-2102

Home Births only

(no birthing center)

Prenatal & Post-Partum Care

Early Baby Care

Pre Conception Counseling

Lee Memorial

Hospital

2776 Cleveland Avenue

Fort Myers, FL 33901

(239) 343-2000

General Surgery

Level II Trauma Center

Inpatient Rehab

Oncology

No Labor & Delivery

Rosemary Birthing

Home

800 Central Ave.

Sarasota, FL 34236

(941) 330-9966

Childbirth Education

Home birth services

Infant Massage

Prenatal Services

Pre & Postnatal Yoga classes

Post-Partum Transition


Sarasota Memorial

Hospital

1700 South Tamiami

Trail

Sarasota, FL 34239

(941) 917-9000

Childbirth Ed. Classes

Lactation Support

Level III NICU

Baby Care class for newborns provided

on discharge from hospital

Sarasota Memorial

ER Center

2345 Bobcat Village Rd.

North Port, FL 34288

(941) 257-2800

Emergency Care

No Labor & Delivery

Medical Services - Other

Florida Department

of Health in

Charlotte County

1100 Loveland Blvd.


(941) 624-7200

Public Health - Multiple Services

including:

Family Planning

IPO (Improved Pregnancy Outcomes)

Growing Strong Families

Immunizations

STD Testing

WIC

Dental Clinic

Florida Department

of Health in

Charlotte County

6868 San Casa

Boulevard

Englewood, FL 34224

(941) 681-3750

WIC Services Only

Open Monday & Tuesday only

Children’s Medical

Services of SW FL

Region

6055 Rand Blvd.

Sarasota, FL 34238

(941) 361-6250

Case Management

Health Screening Diagnostic Services

Health Supportive Services

Easter Seals of SW

Florida, Gulf Coast

Regional Office

350 Braden Ave.

Sarasota, FL 34243

(941) 355-7637

Occupational, Physical and Speech

Therapies

Developmental Assessment

Information and Referral

Family Support Services

Information and

Physician Referral

Services

Bayfront Health Punta

Gorda and Port Charlotte

(941) 637-2497

Information and Physician Referral

Service


Juvenile Diabetes

Research

Foundation

International

7341 Professional Pkwy.

E

Sarasota, FL 34240

(941) 907-0811

Health Education

Community Services

Educational Programs

Support Groups

Leukemia Society of

America, Inc.

3725 W Grace St.

Tampa, FL 33607-4800

(813) 870-1099


Advocacy


Prescription Expense Assistance

Mileage Reimbursement

March Of Dimes

Birth Defects

Foundation

6314 Corporate Court

#140


(239) 433-3463


Library Audio Visual Services

Printed Materials

Workplace Wellness Program

Molina Healthcare

of Florida

(Medicaid Managed

Care Organization)

1 866-472-4585

Please go to website for

more information on

services offered:

molinahealthcare.com

Pregnancy Services for Medicaid Eligible

women

Operation PAR 946 Tamiami Trail


(941) 613-0951

536 Pine Island Rd

North Ft. Myers, FL

33903

(239) 656-7700

Substance abuse treatment center

(Methadone)

Prestige Health

Choice

(Medicaid Managed

Care Organization)

1 855-236-9281

Website:

prestigehealthchoice.com

Pregnancy Services for Medicaid eligible

women

Staywell

(Medicaid Managed

Care Organization)

1 877-247-6272


more information on

services offered:

florida.wellcare.com


women


Sunshine

(Medicaid Managed

Care Organization)

1 800-796-0530


more information on

services offered:

sunshinehealth.com


women

Virginia B Andes

Volunteer

Community Clinic

21297 Olean Blvd. Unit

B


(941) 766-9570

Provides no-cost episodic medical

services and prescription meds to

uninsured and under-served residents of

Charlotte County

Medical Services – Obstetric

Providers S

PE

CIA

L

CIR

CU

MS

TA

NC

ES

ME

DIC

AID

AC

CE

PT

ED

PR

EN

AT

AL

CA

RE

FA

MIL

Y P

LA

NN

ING

PR

EG

NA

NC

Y T

ES

TIN

G

RE

FE

RR

AL

SE

RV

ICE

S

Days

an

d H

ou

rs o

f

Op

erati

on

Coffey, Michael

2400 Harbor Blvd., Suite 14


(941) 766-4777

ACCEPTS

UNINSURED

AND

MEDICAID

INELIGIBLE

x x x x x

M-Thurs. 9:00 –

5:00

F: 9:00 – Noon

12:00 - 1:00 lunch

Family Health Centers of SW FL

13195 Metro Pkwy

Burkes Plaza Suite 8

Ft. Myers, FL

(239) 344-2348

Accepts

Medicaid

Eligible

Please call for

Office hours

Gregush, Eugene

2525 Harbor Blvd., Suite 201-A


(941) 624-3500

Accepts

Medicaid

Eligible

x x x x x

M, Tues.& Thurs.

8:00 – 5:00

Wed. & Fri.

8:00 – 4:00

12:00 - 1:00 lunch

Gulfcoast OB/GYN

2345 Bobcat Village Ctr. Unit 201


(941) 379-5343

Accepts

Medicaid

eligible

x x x x Please call for

office hours


Medical Services – Obstetric

Providers, cont.

SP

EC

IAL

CIR

CU

MS

TA

NC

ES

ME

DIC

AID

AC

CE

PT

ED

PR

EN

AT

AL

CA

RE

FA

MIL

Y P

LA

NN

ING

PR

EG

NA

NC

Y

TE

ST

ING

RE

FE

RR

AL

SE

RV

ICE

S

Days

an

d H

ou

rs o

f

Op

erati

on

Women’s Comprehensive Health

Guzman, Ruben

D’Abarno, Jennifer

Sturm, Jerome

3067 Tamiami Trail, Unit 1


(941) 766-0400

Accepts

Medicaid

Eligible

x x x x x

M & Wed.

9:00 – 4:30

Tues & Thurs.

9:00- 5:30

Fri. 9:00 - Noon

Maternal Fetal Medicine of SW FL

On Call doctor on Mondays & Friday

3420 Tamiami Trail Suite 2


(941) 391-8010

Accepts

Medicaid

Eligible


office hours

Maternal Fetal Medicine of SW FL

210 Del Prado Blvd. Suite 1


(239) 333-0593

Tuesday & Thursdays

Accepts

Medicaid

Eligible


office hours

North Port Health Center

6950 Outreach Way


(941) 861-3820

Accepts

Medicaid

Eligible

x x x x x

Prenatal Care

Services thru

Sarasota County

Health Dept.

Okomski, Charlene

2484 Carling Way

Port Charlotte, FL

(941) 205-2666

Accepts

Medicaid

Eligible

x x x x x Mon.-Fri.

7:30 – 6:00

Regional Perinatal Intensive Care

Center (RPICC)

16271 Bass Rd.

Ft. Myers, FL 33908

(239) 343-7100

Open Wednesday mornings only

Accepts

Medicaid

Eligible

x x x x

Medical Services – Pediatric

Providers

ME

DIC

AID

AC

CE

PT

ED

PE

DIA

TR

IC

CA

RE

SP

EC

IAL

TY

SE

RV

ICE

S

RE

FE

RR

AL

SE

RV

ICE

S

DA

YS

&

HO

UR

S O

F

OP

ER

AT

ION

Anarumo, Beverly

18308 Murdock Circle, Unit 103


(941) 629-3618

x 33B36Bx x Please call for

office hours

Butt, Farzana

3417 Tamiami Trail, Suite B


(941) 629-9200

x x x Please call for

office hours

Casanova, Ena

3508 Tamiami Trail, Ste. C


(941) 883-3313

x x Please call for

office hours

Cepero, Belkis

3488 Depew Ave.


(941) 764-7923


office hours

Guastavino, Ella Marie

900 East Pine Street Units 216 & 217

Englewood, FL 34223

(941) 474-5093


office hours

Dr. Susan Hegarty, Pediatrician

Family Health Centers of SW Florida

Port Charlotte Clinic

4300 Kings Hwy Suite 210


(866) 355-2348


office hours

Helgemo, Ben & Liou, Wen

2040 Tamiami Trail, Unit C


(941) 629-4464


office hours


Medical Services – Pediatric

Providers

ME

DIC

AID

AC

CE

PT

ED

PE

DIA

TR

IC

CA

RE

SP

EC

IAL

TY

SE

RV

ICE

S

RE

FE

RR

AL

SE

RV

ICE

S

DA

YS

&

HO

UR

S O

F

OP

ER

AT

ION

Holganza, Rhonda

2525 Harbor Blvd., Ste. 204


(941) 629-2922


office hours

Kuma, Ebenezer

3406 Tamiami Trail, Ste. 2


(941) 625-4919


office hours

Mayo, Margaret

3440 Conway Blvd. Suite 3A


(941) 624-4748

x x Please call for

office hours

Nwokeji, Pete - Neonatologist

Bayfront Health in Port Charlotte

2500 Harbor Blvd.


(941) 766-4122

x

LEV

EL II

NICU

On staff at

hospital NICU

Patel, Jignesh - Neonatologist

Bayfront Health Port Charlotte

2500 Harbor Blvd.


(941) 766-4122

x

LEV

EL II

NICU

On staff at

hospital NICU

Rodriguez, Luis R.

2484 Caring Way, Suite F


(941) 625-1999


office hours

Williams, Susan

17928 Toledo Blade Blvd.


(941) 743-7337

x x Please call for

office hours


Counseling Services

Center for Abuse and Rape

Emergency (C.A.R.E.)

Post Office Box 510234


(941) 639-5499

Emergency Shelter

Counseling Modalities

Mutual Support Groups

Case Management


Charlotte Behavioral

Health Care Inc.

1700 Education Avenue


(941) 639-8300


Inpatient Mental Health

Facilities

Substance Abuse Services

Crisis Intervention

Charlotte Crisis

Stabilization Unit

1700 Education Avenue,

Building C


(941) 575-0222


Services

Psychiatric Central

Intake/Assessment

Child Find (FDLRS-Florida

Diagnostic & Learning

Development)

Charlotte County Public

Schools

1445 Education Way


(941) 255-0808 ext. 3082

Free Screening for children

with developmental delays:

(learning; speaking; seeing;

hearing; walking; and playing

Child Development Skills

Children’s Home Society 1940 Maravilla Avenue


(239) 334-0222

Individual and Family Life

Family substitute Services

Adoption

Foster Care

Human Reproduction

Family Planning

Pregnancy counseling

Parental Visitation

Monitoring

Coastal Behavioral

Healthcare/ Compass

Center (Adolescents)

2208 Castillo Ave.


(941) 639-5535 “0”

Residential Treatment Facility

for adolescents age 13 – 17

with addictions and mental

health issues


Counseling Services, cont.

Department of Juvenile

Justice

South Tamiami Trail

1900-A


(941) 575-5700

Case management Counseling

Modalities

Correctional Restitution

Court Referral Programs

Florida Department of

Children Family Safety and

Foster Care

14806 Tamiami Trail


(941) 483-5922

Child Protective Services

Harbor Counseling

Services

21234 Olean Blvd. Suite 5


(941) 258-3037

Marriage, Family, Child and

Individual Counseling

Diagnostic Services

Autism Society of America 800 328-8476 Toll Free

Hotline

Website:

www.autism-society.org

Offers support groups,

quarterly newsletter, help in

funding raising efforts, and

assistance in securing

information for families

touched by autism


Health Care Inc.

1700 Education Avenue


(941) 639-8300



Facilities

Substance Abuse Services

Crisis Intervention

Charlotte County Health

Department/ HIV/AIDS

1100 Loveland Blvd.


(941) 624-7236

Diagnostic Testing

Treatment

Housing & Rent

Referrals for Food & Hygiene

thru CHAPS

Child Find & Florida

Diagnostic & Learning

Resources System

2(FDLRS)


Schools

1445 Education Way


(941) 255-0808 ext. 3082

Free Screening for children

with developmental delays:

(learning; speaking; seeing;

hearing; walking; & playing)

Child Development Skills

http://www.autism-society/


Diagnostic Services, cont.

Children’s Medical

Services

6055 Rand Blvd.

Sarasota, FL 34238

(941) 361-6250

Case Management

Health Screening Diagnostic

Services

Health Supportive Services

Easter Seals of Florida

Gulf Coast Regional Office

1650 Medical Lane


(239) 277-9818

Occupational, Physical and

Speech Therapies




Gulf Central Early Steps 4630 17th St.

Sarasota, FL 34235

(941) 487-5400 or Toll Free

866-510-5594


Early Intervention for Infants

birth to 36 months

Case Management

Juvenile Diabetes Research

Foundation International

7341 Professional Pkwy E.

Sarasota, FL 34240

(941) 907-0811

Health Education

Community Services

Prescription Expense

Assistance


Leukemia Society of

America, Inc.

3725 W. Grace St.

Tampa, FL 33607-4800

(813) 870-1099


Advocacy


Prescription Expense

Assistance



1Education Services

Career Source Southwest

Florida

1032 Tamiami Trail Unit 9


(941)235-5900

Career Development

Resume Assistance

Public Employment and

Training Programs


Health Care, Inc.

Nurturing and Parenting

Program

1700 Education Ave.


(941)639-8300

Please see services listed under

“Parenting” section


Schools (CCPS) - Healthy

Outcomes in Pregnancy

and Education (HOPE)

The Academy @ Charlotte

County Technical Center

18300 Cochran Boulevard


(941) 255-7545

For Teen Parents Enrolled in

School

Parenting Education

Crisis Intervention

Career Development

Job Training

Childcare for 0-3 years

High School Diploma

Transportation

Family, Individual and Group

Counseling


Schools (CCPS) Early

Childhood Programs/

Baker Center includes

Early Head Start

(9 weeks to 3 yrs.)

Head Start (4 yrs.)

311 East Charlotte Avenue


(941) 575-5470

Fax (941)575-5474

Parent Groups

Dental Screening

Mental Health Evaluation

Health Education

Social Development


Schools (CCPS)

Exceptional Student

Education

1445 Education Way


(941) 255-0808/call

directory for extensions for

different programs i.e. ESE

program, Ext. 4

Special Education Assessment

Educational Programs,


Occupational, Speech, Physical

and Language Therapies

Transportation

Psychological Testing

Home Instruction

Parent Counseling, Parenting

Education


Education Services, cont.


Department/WIC office in

Port Charlotte


Department /WIC office in

Englewood

1100 Loveland Blvd.


(941) 624-7210

6868 San Casa Blvd.,

Englewood, FL 34224

(941) 681-3762 Open Mon.

& Tues. only

Breastfeeding Education and

Support

Breast Pumps

Nutritional Counseling

Nutritional Supplements

Charlotte Harbor School 22450 Hancock Avenue


(941) 255-7440

Counseling Programs


Special Education

Rehabilitation

Developmental Therapies

Employment Preparation

Job Training

Charlotte County Homeless

Coalition

Bridges Out of Poverty

Program

1476 Kennesaw St.


(941) 627-4313

Website:

cchomelesscoalition.org

Program for Homeless

population to identify and

address problems related to

being homeless in an effort to

overcome obstacles preventing

them from having a place to

live

Drug Free Charlotte

County

1445 Education Way

Port Charlotte, FL

(941) 255-0808 ext. 3205

Community based educational

programs for the prevention of

substance abuse in Charlotte

County, including Parenting

Skills Program

Early Learning Coalition 2886 Tamiami Trail

Suite 1


(941) 255-1650

Assistance for locating legal

childcare programs

Financial Assistance for

childcare through scholarships

Technical assistance for

childcare providers


1Education Services, cont.

Families First 3131 Lakeview Blvd.

Port charlotte, FL 33948

(941) 255-7480 ext. 2

Health Services Supervisor

Homeless Education Project

Director of Intervention &

Dropout Prevention

School Social Workers

Goodwill/ Job Link 2325 Tamiami Trail


(941) 255-3884

Assistance with Medicaid

Applications

Employment assistance, Skills

Training for Resume prep;

interviewing skills and access to

online employment

opportunities

Gulfcoast South Area

Health Education Centers,

Inc.

2201 Cantu Ct., Suite 220

Sarasota, FL 34232

(941) 361-6602

Health Education


Tobacco Education and

Smoking Cessation Support

Multi-Cultural Education

and Alternative Programs


Schools (CCPS)

1445 Education Way


(941) 255-0808 Ext.3060

School Based Integrated

Services

YMCA Child Development

Center

14279 Tamiami Trail


(941) 629-0909

Subsidized Child Care

Child Care Information and

Referral

Child Care Provider

Recruitment, Technical and

Financial Assistance


Parenting


Health Care, Inc. /

28Parenting Program

1700 Education Ave.


(941) 639-8300

For voluntary and court

ordered/court approved

classes lasting 10 weeks that

cover a variety of topics

designed to promote positive

and effective parenting skills.

Individual, in-home classes as

well as group classes

available. Parents with

children 0-18 years can access

services.


Health Care, Inc. /

Nurturing Parents

Program (Thursday

evenings from 5:30- 6:30)

1700 Education Ave.


(941) 639-8300

Groups are parent facilitated

13 week classes to discuss a

variety of topics such as

family leadership, discipline

and teamwork, the power to

nurture, juggling work and

family life, stress

management and more


Health Care, Inc. /

34Nurturing Parents

Program at Northside

Location in Port Charlotte

(Monday Evenings from

5:00 – 6:30)

1032 Tamiami Trail Unit 1


(941)764-7988 ext. 3111

10 week parenting program

for school age children. Open

program, classes do not have

to be done in sequential order

Healthy Families of

Charlotte County

21450 Gibralter Dr. Suite 9


(941) 629-6477

Home visitation and

Parenting Education for

pregnant women and

newborns


14B1Pregnancy Services

Healthy Start Services

through


Health Care, Inc.

1700 Education Ave.


(941) 347-6460

Childbirth Education; Baby

Safety; Infant CPR classes

Psychosocial Counseling;

Referrals

Smoking Cessation


Department Clinic

1100 Loveland Blvd.


(941) 624-7201

WIC services Mon. Tues. &

Thursdays 8:30 – 4:30

Monday & Fridays 8:30 -

noon


Department in Englewood

(WIC only)

6868 San Casa Blvd.

Englewood, FL 34224

(941) 681-3762

WIC Services on Mon. &

Tues. only

Healthy Outcomes in

Pregnancy and Education

Services (HOPE)

The Academy @ Charlotte

County Technical Center

18300 Cochran Boulevard


(941) 255-7545

For Teen Parents Enrolled in

School

Parenting Education

Crisis Intervention

Career Development

Job Training

Childcare for 0-3 years

High School Diploma

Transportation

Family, Individual and Group

Counseling

Florida Center for Early

Childhood, Healthy

Families

21450 Gibralter Dr. Suite 9


(941) 629-6477

Family Support Services for

pregnant women & newborns

Abuse/ Neglect Prevention

Parenting Education

Lactation services

Bayfront Health Medical

Center

2500 Harbor Boulevard


(941) 766-4340

Breastfeeding Support for

women delivering at Bayfront

Health

Lactation services at Gulf

Coast Medical Center

(239) 343-0744 Breastfeeding support for

women delivering at Gulf

Coast Medical Center


1Pregnancy Services cont.

Pregnancy Careline 1685 Tamiami Trail Suite 4


(941) 625-5576

Pregnancy Counseling

Pregnancy Testing

Ultrasounds done under

certain circumstances


Baby Clothes, Baby Furniture

Maternity Clothing

Parenting Classes

SOLVE Maternity Homes 2205 Englewood Rd

Englewood, FL 34223

(941) 475-7408

(Main Office)

1509 8th Avenue West

Bradenton, FL 34205-6712

(941) 748-0094

Faith-Based Services

Maternity Homes

Pregnancy, Birth and

Parenting classes

Adoption assistance

Life Skills Assistance

Other Related Services

Big Brothers/Big Sisters of

the Sun Coast

Port Charlotte Town Ctr Mall

1441 Tamiami Trail Suite 385


(941)7 64-5812

Provides volunteer mentors,

family support and youth

development programs

Boys and Girls Club of

Charlotte county

17831 Murdock Circle, Unit B


(941) 979-8379

Provides positive youth

development programs and

services including education,

character development, arts &

recreation

Charlotte County Habitat

for Humanity

1750 Manzana Avenue


(941) 639-3162

Low Income Homeowner

Program; ReSale Stores

Charlotte County Human

Services

1050 Loveland Blvd.

Port Charlotte, FL 33980 (941)

833-6500

Provides temporary assistance

to income-eligible people

living in Charlotte County

including utility assistance

and case management to assist

families in achieving self-

sufficiency


Other Related Services cont.

Charlotte County Family

Services Center

21450 Gibralter Dr.


(941) 235-0688

See other agencies associated

with Family Services Ctr.

Below: Provides rental space for non-

profit organizations that offer

family support services

including after school

programs, children’s

advocacy, children’s health &

development programs

Children’s Advocacy Ctr. Of

SW Florida (239) 939-2808

(at Family Svc. Ctr. In Port

Charlotte on Tuesdays)

Family Literacy Center

(941)255-1431 Tues; Wed. &

Thurs. 9 – 3

Evenings: Mon; Tues; Wed. &

Thurs. 6 – 8

Guardian Ad Litem

(941) 613-3233

Mon. thru Fri. 9 – 5

Child Support

Enforcement Department

1777 Tamiami Trail

Suite 500


1-800-622-5437

Child Support Assistance

Child Support Wage

Assignment Assistance

Crimestoppers 1 800 780 TIPS(8477) Call to give anonymous tips

for identifying human

trafficking as well as other

crimes

Charlotte County Sheriff’s

Office

(941) 575-5361

Non-Emergency Calls

(941) 639-0013

Report Major Crimes


Other Related Services cont.

Dept. of Children and

Families

14806 Tamiami Trail

Bldg. 14830


(941) 483-5922

Medicaid Application

Food Stamps

Child Protective Services

Domestic Abuse Hotline 1 800 500-1119 Call to report domestic abuse

anonymously

Florida Kidcare 888 540-5437 Toll Free

Website:

www.floridakidcare.org

Offers affordable, low cost

health insurance for uninsured

children in Florida

Florida Abuse Hotline 1 800 962-2873 To make anonymous calls to

report elder & child abuse

Lutheran Services Florida

(LSF)

21175 Olean Blvd. Unit B


(941) 613-3870

Children & Families in Need

of Services

Individual/ Family

Counseling

School Monitoring

Case Management/referral

Substance abuse counseling

Residential Services

Our Mother’s House 221 Harbor Dr. N

Venice, FL 34285

(941) 485-6264


Case Management

Transitional Shelter for

women with 1 or 2 children

under the age of 3 for a Two

year duration

Not a Maternity Home

Punta Gorda Housing

Authority

340 Gulfbreeze Ave.


(941) 639-4344

Provides the only public

housing available in Charlotte

County

Section 8 voucher program

located here


1Other Related Services cont.

Charlotte Co. Transit,

formerly known as

Sunshine Ride/Dial A Ride

25490 Airport Rd.


(941) 575-4000

Provides door to door

transportation service for

people on Medicaid

Time Out Respite Care 24246 Harborview Road


(941) 743-3883

Relief to families of mentally

& physically disabled

children & adults who are

residents of Charlotte County

by offering services of trained

caregivers. Program services

available 24/7


8. SERVICE GAPS

The Charlotte County Healthy Start Coalition has created a Resource Inventory of Services for the

Charlotte County catchment area through the Service Delivery Plan Process (page 76). The

Community Assessment Review Committee assisted in this process through examination of

community needs and assessment of service gaps. Additional input was obtained from surveys of

community members, stakeholders, and participants (page 70). The Planning Summary Sheet for

the Healthy Start System contains the Resource Inventory’s funding documentation, as it relates

to this Service Delivery Plan (page 96). The Resource Inventory serves as a directory of services

for the community to itemize all local services related to the maternal and child health system of

care.

System of Care

The components necessary for a comprehensive system of care for prenatal women and infants to

the age of three include access to care, risk screening, care coordination, appropriate wraparound

services that promote healthy pregnancies and improve birth outcomes, and promotion of normal

child growth and development.

At the local level, prenatal women need a continuum of services which embrace childbirth

education, infant CPR and Safe Baby classes, parenting education, tobacco education and smoking

cessation support, short-term psychosocial counseling and education on women’s health during

childbearing years. Additionally, changes in the system of care during the past five to seven years

include the cessation of primary care services by the local Florida Department of Health in

Charlotte County. Obstetrical services were already in limited supply, necessitating the need of

funding for prenatal care for low-income, Medicaid-ineligible, prenatal women. The following

speaks to the community’s ability to meet these needs.

Prenatal Care – All four OB-GYN physicians deliver infants to Medicaid clients. Charlotte

County pregnant women are also eligible to receive services through a FQHC clinic in North Port,

with delivery in Sarasota County. However, there is gap in access to prenatal care for low-income,

Medicaid-ineligible women. This is addressed by the Coalition through a Purchase of Service

Agreement with a local obstetrician, based on available funding. Those in need may apply for care

through the Healthy Start Program and are most often referred by PEPW facilitators. The State

rate for OB/GYNs is 10.2 and the Charlotte County rate is 6.1 (per 100,000).xliv

High Risk Prenatal Care – This has been identified as a resource gap area for Medicaid ineligible,

low-income women. No high-risk providers are based in Charlotte County currently, however one

out-of-county provider travels to Port Charlotte weekly to provide local services, Maternal Fetal

Medicine of Southwest Florida. Charlotte County Healthy Start Coalition is receiving requests

from this agency for funding assistance for services to low-income, Medicaid-ineligible women,

but funding is limited, and need continues. Routine sonograms and lab work are done by BayFront

Port Charlotte at Medicaid, or lower, rates to the Coalition.


Pediatric and Family Practice – There are twelve (12) pediatricians in Charlotte County. There

are also two neonatologists at the NICU in BayFront Port Charlotte. Medicaid is accepted by all.

Florida Department of Health, Division of Medical Quality Assurance, provides data on the rate

of licensed physicians in the State of Florida, as well as for individual counties.xlv The State rate

of licensed pediatricians is 18.7, while the rate for Charlotte County is 8.5 (per 100,000). The

State rate of licensed physicians is 259.3 as compared to 185.5 in Charlotte County. The rate (per

100,000) of licensed family practice physicians in Charlotte County is 19.50 as compared to a state

rate of 22.80. This data points to service gaps in availability and access to health care services

which exist in Charlotte County.

Vaccinations – The Charlotte County Health Department provides free childhood vaccinations.

Availability and access appear to be appropriate, as 2014 vaccination rate was 93.7% for children

entering kindergarten. Vaccination is required in schools, unless exempted by medical or religious

reasons.

Dental Services – There continues to be a gap in the availability of dental services for persons

with Medicaid, uninsured, or Medicaid ineligible. The Family Health Care Centers (FQHC)

operates a clinic in Port Charlotte to address this need. Dental services offered through the Florida

Department of Health in Charlotte County were resumed in July 2016 for adults to the age of 21,

covered by Medicaid.

Medicaid and Presumptive Medicaid – The Community Assessment Review Committee

determined that there continues to be difficulty with the application process. Providers may not

be familiar with presumptive Medicaid eligibility (provided through the Health Department) and

pregnant women have difficulty navigating through the application process as a whole. The

Coalition is working with the Maternal and Child Health Committee of the Community Health

Improvement Partnership (CHIP) to build greater awareness of the availability of PEPW, the

process to obtain it, and what doctors can be used by which provider.

Substance Abuse Counseling – There is difficulty finding substance abuse (outpatient or

inpatient) services within Charlotte County, and residential services are provided out of county.

Prescription medication addiction hit Florida hard in the past decade. Regulations addressing

prescribing practices (pill mills) and greater community education and awareness have helped

reduce growth in addiction to prescription drugs, but the problem persists, especially for those

already addicted. Funding has increased locally and statewide for substance abuse treatment, but

gaps remain. The Coalition started a SEN Task Force which has merged with the Maternal and

Child Health Committee of CHIP. The group continues to seek data sources and support efforts

for education and awareness.

Behavioral Health Counseling – This area has unmet need due to lack of funding for short-term

counseling not covered by Medicaid, and insufficient providers for persons who are uninsured, or

Medicaid ineligible. Funding is limited for those who have Medicaid. The Coalition allocates


funding annually to provide short-term counseling for Healthy Start participants. However, if there

is a chronic behavioral health diagnosis, funding is available through Charlotte Behavioral Health

Care’s funding streams.

Domestic Violence – The county is served by the Center for Abuse and Rape Emergency (CARE).

Representatives from CARE are active on the committees and board of the Coalition. Through

their participation in the Community Assessment Review Committee, the issue of domestic

violence during pregnancy was considered.

Housing and Homelessness – The Charlotte County Homeless Coalition has limited availability

for families in its local shelter. The SOLVE Maternity Home is a home for four (4) pregnant

women in the Sarasota County portion of Englewood. Charlotte County residents may be able to

access housing services when openings exist in Sarasota, but must transfer to the Sarasota County

Healthy Start Coalition for continued care coordination services. Housing and homeless services

continue to be an area which lacks sufficient resources.


9. HEALTH STATUS PROBLEM LINKED TO ACTION PLAN

Coalition: Charlotte County Healthy Start Coalition, Inc. Month/Year of Service: __Oct 2016_

Contract Number: __COSFN-R2_______ Contract Manager: __Marcia Thomas-Simmons ___

SDPU Due Date: October 2021 AAPU Due Date: October 2017

Coalition Priorities: What particular priorities, target groups or geographic areas are targeted in

your Service Delivery Plan?

• Prenatal Smoking – which includes tobacco education and smoking cessation support

• Early Entry to Care - providing education on the importance of early and regular prenatal care,

provider screening, access to services and where/how to apply for pregnancy Medicaid assistance

• Pre and Interconceptional Health Education – pre-pregnancy health outreach and education, well

care for women, family planning education, nutrition education, teen pregnancy prevention, etc.;

with emphasis on racial/ethnic disparities in pregnancy intervals and preterm births.

• Capacity Building - reviewing internal and programmatic capacities; developing/revising

strategies for effectiveness.

Indicate Yes “Y” or No “N” in the Y/N column if Healthy Start (Department of Health) funding is

being used for the contract.

Check YES or NO column for each contract’s level of service monitored and reviewed for month.

Healthy Start Service Provider Name DOH

Y/N

$

Begin/End Date

Contract

Monitor

Review

YES

Monitor

Review

NO

Outreach services for pregnant

women

IPO /Fl DOH Char.

Co

CCPS/The Academy

H.O.P.E. Program

MomCare Program

(in-house)

Y

N

N

07/01/16-06/30/17 Y

Outreach services for children Early Steps,

F.D.L.R.S.

N

N

Process for assuring access to

Medicaid (PEPW & ongoing)

Fl DOH-Charlotte

Co.

Y 07/01/16-06/30/17 Y

Clinical prenatal care for unfunded

women

Dr. Michael Coffey

Bayfront Health/ PC

Y

Y

07/01/16-06/30/17

07/01/16-06/30/17

Y

Y


Maternal Fetal Med.

of SW Fl

Y Y

Clinical well-child care for

unfunded infants

Fam. Health Ctrs.

(FQHC)

N

CHD Vital Statistics Healthy Start

screening infrastructure

Fl DOH - Charlotte

Co.

Y 07/01/16-06/30/17 Y

HMS Data entry

Char. Behavioral

Hlth

Y 07/01/16-06/30/17 Y

Ongoing training providers doing

screens and referrals

Coalition

Fl DOH - Charlotte

Co.

Y

07/01/16-06/30/17 Y

Initial contact after screening Char. Behavioral

Hlth

Y 07/01/16-06/30/17 Y

Initial assessment of service needs Char. Behavioral

Hlth

Y 07/01/16-06/30/17 Y

Interconceptional education and

counseling

Char. Behavioral

Hlth

Y

07/01/16-06/30/17 Y

Ongoing care coordination Char. Behavioral

Hlth Care

Y 07/01/16-06/30/17 Y

Childbirth education Cathy James, R.N.

Sarah Pope, R. N.

Y

Y

07/01/16-06/30/17

07/01/16-06/30/17

Y

Y

Parenting support and education Char. Behavioral

Hlth

Healthy Fam.-Char.

Y

N

07/01/16-06/30/17 Y

Nutritional counseling WIC N 07/01/16-06/30/17 Y

Provision of psychosocial

counseling

Char. Behavioral

Hlth

Y 07/01/16-06/30/17 Y

Smoking cessation counseling GSAHEC

Char. Behavioral

Hlth

N

Y

07/01/16-06/30/17

Y

Breastfeeding education & support WIC N

Other – specify:

*TOTAL # CONTRACTS 7

Monitored/Reviewed This

Month: 7

# YES

Y

# NO

Updated 07/2014

*Enter Total # Direct Subcontracts and Current Month # Monitored Contracts on Attachment XI


I hereby certify by signature below that the above contract level of service was

monitored and reviewed for the month reported.

Signature of Provider Official Date

Magi Cooper – Executive Director

Print Provider Name and Title


APU

Internal External QA/QI

System Changes

The Internal QA/QI plan was reviewed and reported on in the next section of this SDP update.


10. INTERNAL QUALITY IMPROVEMENT/QUALITY ASSURANCE PLAN

There are four core components to the Coalition’s Quality Improvement/Quality Assurance Plan.

These include:

• By-Laws

• Board Development and Coalition Capacity-building

• Adherence to the Coalition’s adopted Policies and Procedures

• Regularly scheduled self-assessment activities

By-Laws

Coalition By-Laws are updated by the Board, as need arises. One amendment to rename and define

a standing committee was made to the By-Laws since the last SDP update, as shown in Exhibit 6,

included in this Plan.

Board Development and Coalition Capacity-building

The Board of Directors

Through its re-named Fund Development, Education and Community Action Committee,

informative, mission-related presentations, which attract new members and ensure community

involvement, have been added to General Membership meetings. From this diverse membership,

the Nominating Committee annually solicits Board candidates which have included Hispanic,

Black, and members of both genders. Currently the Board includes one Black member and two

male members. The Coalition continues to solicit more consumer participation, and Board

members and Coalition staff are also on the look-out for new Board members with a view to

diversifying membership.

Upon election to the Board, each new member meets with staff or another Board member to review

the Board Member Orientation Notebook, which includes Healthy Start and MomCare background

material, Coalition by-laws, applicable Florida Administrative Codes and statutes, Code of Ethics,

committee information, Policy Manual, cultural competency information, Board responsibilities,

Sunshine Law information, HIPAA information, Healthy Start screening information, a Board

directory, the current Needs Assessment and current contract Performance Measures and

Outcomes.

A Board assessment is conducted at least every two years to measure strengths and weaknesses,

discuss challenges and capacity, and plan for the future. In 2014 a day-long Board retreat provided

the opportunity to discuss the topics mentioned above, as well as Florida’s Managed Care program,

Healthy Start 2.5, historical MCH data and Coalition goals.


Capacity-building

The Coalition’s annual Legislative report show the number and type of organizations represented

within the Coalition during the last five years. (See chart #2 below) To build Board knowledge

and encourage membership involvement, the Coalition provided educational opportunities through

a web-based Learning Management System for directors, providers and staff. This web-based

system included Leadership Development, Healthy Start Standards and Guidelines and Data

Analysis modules. Additionally, local workshops were held on a variety of subjects and topics

that are listed in Exhibit 5. It is the intention of the Coalition to continue to make educational

opportunities available.

The Coalition also recognized the need for consumer, provider and community input and increased

efforts to survey pregnant women, families and the general public on topics including community

needs, resources, levels of knowledge, behaviors, and interest in the Healthy Start mission.

The following chart represents the number of surveys / focus groups conducted over the last four-

year period: (It should be noted these are exclusive of the Coalition’s ongoing Client Satisfaction

Surveys which are a requirement of provider contracts.)

Chart #1 2009 2010 2011 2012 2013 2014

Surveys/Focus Groups 5 2 8 2 5 4

Provider Surveys 2 2 2 2 1 0

Twelve volunteers actively serve on the Coalition’s Board of Directors. It is hoped that a soon-to-

be announced birthing facility supervisor will join the Board, bringing membership to thirteen.

Volunteers continue to play an important role in the operation and event-planning of the Coalition

by attending meetings, assisting with mailings, assembling educational information packages,

coordinating events, and conducting donation drives for baby essentials. Volunteers provide over

500 hours of service to the Coalition each year.

Policy and Procedures Manual

Adherence to established policies and procedures has been adopted as a quality standard by the

Coalition’s Board of Directors. The Coalition’s policies and procedures are reviewed annually

and updated, as needed, by the staff and the Board of Directors. Several revisions have taken place

over the past seven years and are included in the Coalition’s current Administrative and Personnel

Policy Manual which is attached to this Plan as Exhibit 7.


Policies also covered in the Coalition’s Internal QA/QI Manual include, Board orientation and

assessment, committee responsibilities, leadership development and succession plan, non-

discrimination, conflict of interest, communication plan, fiscal management, contract

management, the allocation process (as specified in the next section of this Plan),

complaints/grievances, monitoring procedures, performance measures, disaster plan, equipment

inventory, and data system security. A complete copy of the Internal QA/QI Policies of the

Coalition is on file with the DOH Contract Manager.

Self-assessment

The Coalition’s regular self-assessment activities include three components.

(1) The Coalition Board of Directors’ self-assessment which takes place at least once every

two years. This exercise allows the Coalition’s Board to measure strengths and

weaknesses and review its strategic plan for needed policy or procedural changes. Staff

is then charged with implementation of the updated policies or procedures.

(2) The membership of the Coalition is surveyed periodically to determine their level of

satisfaction with their involvement in the Coalition and to solicit suggestions for

improving the Coalition’s services to the community.

(3) Local maternal and child health consumers are surveyed for satisfaction with services

and to gather suggestion on ways to enhance the Healthy Start program.

In addition, prenatal women are asked to rate the effectiveness of Healthy Start literature annually.


11. PROCESS FOR ALLOCATING FUNDS

The Coalition engages in the following process for allocating funds. This process is repeated

annually.

April

Existing service subcontracts, including Purchase of Services (POS) Agreements are reviewed for

renewal eligibility by the Executive Director/Contract Manager and the Finance Manager. Staff

and Board members determine if there is a need for a request for proposals (RFP) for any

subcontracted service (other than POS Agreements) which has reached its maximum number of

renewals. If it is determined that an RFP is needed, the process includes publication of notice,

bidder’s conference, and determination of a submission timetable. Proposals are reviewed and

evaluated by the RFP Committee and recommendations are taken before the Board at its next

regularly scheduled meeting.

Note: In the event only one provider responds to an RFP publication, the Coalition will dispense

with the RFP process and the Contract Manager will begin negotiations for contracted services.

May

The Department of Health (DOH) Contract Manager and Executive Director of the Healthy Start

MomCare Network notify the Coalition Staff of the funding levels for their respective contracts to

be issued for the next fiscal year – (DOH funding is dependent upon passage of the Legislative

budget).

If it has been determined that an RFP is not necessary, Coalition staff (Executive Director and

Finance Manager) will review budgetary guidelines for care coordination, wraparound and

ancillary services (contractually or grant funded) and prepare recommended service changes or

expansions, based on changing community needs or developing trends. Preliminary contract

amounts for each provider are allocated from an approved services budget by the Coalition staff

based on past service/funding levels, anticipated client needs and identified gaps. Staff then draft

new services budget recommendations for Board review.

The Finance Manager and Executive Director also draft a proposed operating budget, which

incorporates the services budget.

Recommendations for the allocation of dollars, by funding source, are presented to the Board of

Directors for review/amendment and acceptance. The approved budget is then sent to the DOH

Contract Manager.

New/revised subcontracts are negotiated by the Coalition’s Executive Director. Renewed

subcontracts are negotiated and amended according to approved budget levels. At this time, the


Board reviews any RFP recommendations and votes on the provider of choice. New subcontracts

are prepared based on Board approvals.

June

New contracts between funding sources (including the DOH) and the Coalition are signed.

New contracts, contract renewals, and contract amendments are finalized, prepared and signed.

July

Subcontractors submit monthly and quarterly deliverables by the 5th or the 10th of the next month,

respectively. Invoices and all back-up documentation such as success stories, client satisfaction

surveys, and encounter forms are submitted, reviewed and approved by Coalition staff before

payment is issued. Services and documentation are also reviewed and analyzed in comparison to

prior years’ records.

Contracts are adjusted/amended with Board approval, when necessary, to ensure full utilization of

funds. The DOH Contract Manager receives copies of all approved and executed contract

amendments.


12. EXTERNAL QUALITY IMPROVEMENT/QUALITY ASSURANCE PLAN

A variety of activities help the Coalition assure that high quality services are provided to program

participants and Healthy Start service dollars are prudently used. The Coalition’s Executive

Director/QA Manager meets with sub-contracted provider representatives quarterly, reviews client

files, and provides technical assistance as needed to ensure compliance with Healthy Start

Standards and Guidelines.

The following materials continue to be used to promote service quality:

• The Healthy Start Tracking Form prepared by the Charlotte County Health

Department is monitored as a component of the Data Entry contract. This form

records the number of pre- and post-natal forms received from providers; the number

of forms forwarded to the provider of Care Coordination; the number of prenatal

forms uploaded; the number of prenatal screening forms sent to other counties.

• The Prenatal Care Provider’s Manual to the Healthy Start Screening Process and the

MomCare Program and the Postnatal Care Provider’s Manual to the Healthy Start

Screening Process have been updated and continue to be used to train provider staff

on Healthy Start screening, services and referral. The Coalition will continue to

update providers, as needed, on any changes in procedures and/or forms through

regularly scheduled provider visits.

Screening

The Coalition’s Data Committee meets a minimum of 3 times a year, evaluating important

maternal / child health data, including data on screening rates and developing trends. (Workgroup

meetings are substituted for community assessment activities when it is time for Service Delivery

Plan update.)

Screening rates are reviewed monthly by the Executive Director and staff and shared regularly

with the Data Committee and Board.

Screening statistics, gathered from Florida CHARTS, are used to monitor the overall screening

statistics as well as individual provider screening data. Both the Executive Director and

Community Liaison meet regularly with all obstetric providers and the hospital personnel

responsible for infant screening to maintain and improve screening rates.

To help facilitate completion of risk screening, information on the importance of Healthy Start

prenatal screening is included in packets provided to women applying for Pregnancy Medicaid or

testing positive for pregnancy at the Charlotte County Health Department. The Coalition’s

MomCare Maternity Care Advisor also facilitates Healthy Start screening during each client

contact and encloses a Healthy Start prenatal screening flyer in correspondence packets sent to


women who report not having completed a screen. A list of Pediatric providers has been given to

each OB office along with infant risk screening brochures and are provided to each woman at her

first prenatal appointment.

Additionally, infant screening information flyers are distributed at Healthy Start childbirth

education classes and are included in New Mom’s Tote Bags, provided to each pregnant woman

registering for the birth of her child at the local birthing facility.

Pamela Bicking, the Coalition’s Community Liaison, is charged with training providers and staff

on administration of the Healthy Start screens.

Contract performance standards

For Fiscal Year 2015-16, the following performance measures specified in the Coalition’s contract

or agreed upon with the Department of Health are included in the subcontracts executed by the

Coalition:

• Provide a minimum of 99 services to non-Medicaid enrolled women each month.

• Provide a minimum of 111 services to non-Medicaid enrolled infants each month.

• Provide a minimum of 3 ICC services per month to promote the use of family planning

services for baby spacing and maintaining positive health behaviors to prepare for a

subsequent pregnancy

• A minimum of 4 community development activities must be conducted each month.

• Agencies will collaborate to assure that the prenatal screening rate will increase to 80

percent.

• Agencies will collaborate to assure that the infant screening rate will increase to 71.8

percent.

• Percent of Healthy Start eligible participants consenting to the prenatal screen will

increase to 79 percent.

• Percent of Healthy Start eligible participants, referred to the program, who consent to

participation in Healthy Start at the time of initial contact will exceed 90.24%

• At least 95% of Healthy Start participants will receive an initial contact or an attempt

to contact within 5 working days of receipt of screen

• At least 95% of Healthy Start participants determined to be in need of an initial

assessment will receive an initial assessment or an attempt to assess within 10 working

days of an initial contact


• At least 90% of Healthy Start records will contain documentation that status of initial

contact has been sent to the healthcare provider within 30 calendar days from first

attempt to contact.

Subcontractor monitoring

1. In accordance with the Coalition’s contracts with the Department of Health and the Healthy

Start MomCare Network, subcontractors providing Healthy Start services in Charlotte

County are required to perform quarterly reviews covering the following areas:

• Review of participant records for compliance with Healthy Start Standards and

Guidelines

• Verification of provider credentials

• Verification of use of participant satisfaction survey

• Documentation of adherence to approved curriculum or plan of care in client’s

chart.

2. The Contract Manager reviews the self-report quarterly and during scheduled annual

monitoring visits. If performance deficiencies are identified additional monitoring and/or

technical assistance visits may be conducted. Technical Assistance site visits are made as

needed.

3. Site monitoring visits include a compliance review of the following:

Client invoices Participant Logs

Administrative record Personnel files

Client Satisfaction surveys Reporting requirements

Performance specifications Random sample of client records

The subcontractor monitoring visits may also include staff interviews.

4. Each provider’s internal QA/QI plan is reviewed during the site monitoring visit by the

Coalition’s Contract Manager. Documentation of these reviews is maintained in provider

subcontract files at the Coalition office.

5. Providers receive a written report within ten (10) days of each monitoring visit.

6. Corrective action plans, if required, will be submitted to the Department of Health via the

Coalition within ten (10) days of the receipt of the notification of exception. Failure to

correct deficiencies within forty-five (45) days of notification to provider can result in the

termination of provider’s contract.


7. In addition to site monitoring, monthly desk reviews of invoices submitted by providers

are conducted. Any deficiencies identified during invoice review must be resolved prior

to the Coalition’s payment of that invoice. Quarterly reports, which include record

evaluations and performance measures, must accompany invoices submitted in March,

June, September, and December.

8. The Coalition also conducts ongoing review of statistical data provided to the Contract

Manager by subcontractors.


13. CLOSEOUT OF 2015-2016 CATEGORIES B & C

2015 - 2016

ACTION PLANNING & REPORTING FORMAT

To be used with Type B Activities Item 1

1. CONTRACT REQUIREMENT OR IDENTIFIED COMMUNITY-WIDE/SYSTEM

ISSUE:

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

addressed by a strategy?

There is a need to increase the number of prenatal women with early entry to care within

the service delivery area. Women who see a health care provider early and regularly

during pregnancy have healthier babies, are less likely to deliver prematurely, and are

less likely to have other serious problems related to pregnancy.

In 2014, the rate of local women entering care in the first trimester of pregnancy declined

by 3% from the previous year and Charlotte County prenatal women continue to enter

care during the first trimester of pregnancy at a lower rate (72.2%) than the state average

of 79.4%, which also declined from the prior year. Also, the rate of Charlotte County

women reported as having “late or no” prenatal care increased from the prior year to a

rate of 7%, and continues to exceed the state average of 5.3%, which also increased from

the prior year. The Charlotte County rates for “late or no” prenatal care continue to be

higher than state average for all races and ethnicities, except Hispanic: (black prenatal

women increased to 13% vs. 7.2% state rate; white prenatal women 6.2% vs. 4.6% state

rate; and Hispanic ethnicity, 2.4%% vs. 4.7%% state rate.)

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

strategy?

This strategy will address low birth weight and premature birth.

c. What information, if any, was used to identify the issue/problem (i.e. HPA, FIMR, screening,

client satisfaction, interviews, QI/QA)?

Data from the Florida Department of Health, Office of Planning, Evaluation and Data

Analysis and Vital Statistics, screening of Healthy Start participants, community and

consumer surveys.

2. PLANNING PHASE QUESTIONS: (All Required)

a. What strategy has been selected to address this?

Steps to improve the rate of women entering care in the first trimester of pregnancy

including: community outreach and education; expansion of access to services; provider


outreach and education; reducing barriers to care; and the subsequent evaluation of the

effectiveness of the strategies selected.

b. What information will you gather to demonstrate that you have implemented this strategy as

intended (who, what, how many, how often, where, etc.)?

Monthly staff activity reports, monthly provider activity reports, report of applicable

educational material distributed quarterly, copies of published media articles and

client/community surveys will be utilized to assure that outreach and education efforts are

being made within the community.

c. Where/how will you get the information?

Information will be collected from staff, service providers, healthcare providers,

community partners, and the Department of Children and Families.

d. What do you expect will be the observed impact of the strategy on the system or community-

wide problem/need?

In Charlotte County, the number of black prenatal women entering care in the 1st

trimester will increase by 4% to 62.4%; the number of Hispanic prenatal women entering

care in the 1st trimester will increase by 1% to a rate of 77.5%; the number of white

prenatal women entering care in the 1st trimester will increase by 2% to a rate of 76%.

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

Statistical data for onset of care for area women will be gathered from the Florida

Department of Health CHARTS site and the local office of Vital Statistics.

f. Where/how will you get the information?

See above

3. ACTION STEPS:

Action Step Pers. Respon. Start Date End Date

Community Outreach and Education

1. Inform community on importance of early

and regular prenatal care, HS screening and/or

HS services through print media, social media,

etc. a min. of 4 times per month (newsletters, e-

alerts, 1st person testimonials, community

presentations, etc.)

Staff, Board, Lead

Agency for Care

Coord.,

Community

Partners

Oct 2015 Sep 2016

2. Continue to participate in the CHIP

Maternal/Child Health subcommittee to develop

and implement targeted improvement strategies.

Data Committee

Staff, Providers

Oct 2015 Jun 2016


3. Explore community partnerships to solicit

consumer input on barriers to care (i.e. Baker

Ctr., west county)

Staff, Board and

Data Committee

Oct 2015 Mar 2016

4. Provide participants with approved

culturally-appropriate educational materials

Staff and Lead

Agency for care

coordination

Oct 2015 Sep 2016

Expand Capacity for Services

5. Explore future funding sources/resources to

augment the provision of prenatal care for

financially qualified, uninsured, Medicaid-

ineligible women.

Board, staff,

Finance Cmtee

Oct 2015 Sep 2016

Provider Outreach and Education

6. Coalition will ensure at least 3 OB /Hosp.

provider visits each month to provide current

awareness and/or education information on HS

screening and program services, including

services for qualified, uninsured, Medicaid-

ineligible prenatal women.

Staff, Board,

CCHD

Oct 2015 Sep 2016

7. Coalition representative will promote “best

practice” of early entry to care (1st trimester)

through Bayfront Health Port Charlotte/OB

Committee partnership or other community

stakeholders.

Board Chair Sep 2015 Sep 2016

Reduce Barriers to Care

8. Monitor County plan for transportation

improvements; keep Coalition informed

Staff and Board Oct 2015 Sep 2016

9. Explore funding sources for transportation

vouchers


10. Identify new partners to assure continued

availability of local PEPW intake

Staff and Board Oct. 2015 Jun 2016

11. Obtain AHCA approval and use culturally-

appropriate educational materials

Staff and Board Oct. 2015 Jun 2016

Evaluate Effectiveness

12. Evaluate strategies for effectiveness and

revise as needed

Staff, Data

Committee

Jun 2016 Aug 2016

PROGRESS REPORT AS OF DECEMBER 31, 2015

1. At a minimum, 4 community outreach activities were reported for each month during the

quarter and are detailed on the Community Development Activities Reports included within the

monthly report tabs provided to the Dept..

Additionally, in November the Coalition highlighted information on prematurity prevention

through a social media e-alert (copy included in Products & Drafts section of this report.) Also,

tips on how to better understand health information and mange health issues was provided

through a social media Healthy Baby Tip in October (copy included in the Products and Draft

section of this report).


2. The ED continues to chair the CHIP Maternal/Child Health subcommittee which has

developed an English/Spanish landing page at www.pepwinfo.com (draft included in the

Products and Drafts Section of this report) on the availability of Pregnancy Medicaid. Tear-off

pads, again in English and Spanish, are to be placed in select local stores that sell pregnancy

tests, these tear-offs will direct consumers to the landing page. A letter has been drafted to the

Corporate offices of these retailers, signed by Commissioner Ken Doherty, Dianne Nugent, DON

at the local HD and Magi Cooper, Chair, CHIP-MCH asking for permission to post the tear-off

pads. The letter will be distributed personally by CHIP-MCH membership

3. During the quarter, a Board member solicited the participation of a local consumer who will

address the U. Way Impact Panel during Healthy Start’s upcoming grant request presentation.

This consumer will also present at the annual Show the Love luncheon on 2/11/16.

4. & 11. Provider staff continue to use only AHCA-approved, culturally-competent, educational

materials.

5. At the December Board meeting, members were asked to advise the Coalition of any grant

opportunities which could potentially augment future prenatal care services for qualified,

Medicaid-ineligible prenatal women.

6. The Community Liaison visited at least 3 OB providers monthly throughout the quarter and

provided education and awareness materials as noted on the Provider Education reports

submitted with the monthly reports.

The Community Liaison also provided training on screening and HS referral to new office staff

at Dr. Gregush’s office in November.

The E.D. provided infant screening training to 4 new staff members responsible for screening at

the local birthing facility in December.

10. During the quarter, the Coalition ED met with the new CFO of the local hospital who

indicated he is open to further discussion regarding having the hospital become a future PEPW

intake site. A future meeting is being scheduled.

11. The Coalition continues to submit new materials for AHCA approval, prior to distribution to

program participants.

PROGRESS REPORT AS OF MARCH 31, 2016

1. The Coalition’s social media Healthy Baby Tip for March highlighted the importance of early and

regular prenatal care. (A copy is included in the Products and Drafts section of this report.)


2. & 10. – County Commissioner Ken Doherty endorsed cover letter to local pharmacies to introduce the

CHIP MCH subcommittee’s PEPW flyers and request placement near the home pregnancy tests in their

establishments.

4. & 11. Provider staff continue to use only AHCA-approved, culturally-competent, educational

materials.

5. The Coalition received approval to extend the use of BonSecours Health System’s prenatal care grant

funding into the next fiscal year.

6. The Community Liaison visited at least 3 OB providers monthly throughout the quarter and

provided education and awareness materials as noted on the Provider Education reports

submitted with the monthly reports.

7. New Memorandum of Agreements were completed during the quarter with Charlotte County Public

Schools, Pregnancy Careline Center and Gulf Central Early Steps.

8. The staff and Board members promoted public transportation expansion efforts by distributing

information on the County’s “Try Transit Day” event, scheduled for April 20th.

PROGRESS REPORT AS OF JUNE 30, 2016

1. Community Awareness activities involved providing Healthy Start program updates and sharing

information on Healthy Start services with community partners and MCH stakeholders at EACH

(Emergency Assistance Clearing House), C-3 (Charlotte County Collective), and CHIP meetings

throughout the quarter.

Additionally, information on HS services, HS screening, preconception health, childbirth education,

breastfeeding, and safe sleep was provided to all area OBs during monthly visits by the Coalition’s

community liaison.

2. & 3. The E.D. participated in four (4) CHIP meetings during the quarter and is working to solicit

Coalition involvement by a retired OB residing in Charlotte County.

4. & 11. Additional educational materials on drowning prevention, breastfeeding, and pregnancy health

were submitted by the Coalition to, and approved by, AHCA during the quarter. Coalition and Care

Coordination staff continue to use AHCA-approved materials for distribution to program participants and

the general public.

5. In June, the Coalition prepared and submitted a grant application to the Charlotte Community

Foundation requesting funds to augment its prenatal care services for uninsured, financially-qualified

women.

6. The Coalition’s community liaison visited four (4) OB provider offices each month and distributed the

materials described in item 1 above.

7. The E.D. chairs the CHIP – MCH. Meetings are held at Bayfront Health Port Charlotte with

representatives from Healthy Families, W.I.C., Drug Free Charlotte, FL – DOH C.C.,


Community Representatives, Golisano Children’s Hospital, StayWell and Pregnancy Care Line

Center in attendance. The Committee is seeking innovative ways to improve early entry to

prenatal care (1st trimester). The PEPW poster and tear-off pads were an attempt to improve

these numbers. When the Committee convenes in August the subject will be discussed again.

8. The E.D. attends the CHIP – ACCESS meetings as necessary and receives minutes from all

meetings. This Committee is actively working towards a fixed-route public transport system

being established in CC.

9. Care Coordinators are aware that there is a limited supply of free transport vouchers available

in CC. The Coalition is able to consider on a case-by-case basis purchasing vouchers from

unrestricted funds although this has not occurred to date.

10. CBHC is willing to become a 2nd PEPW site. Once a new CEO is in place at the hospital

another approach will be made to include that facility for PEPW intake. The Baby Friendly

Hospitals initiative will be used to leverage the need at this site.

12. A draft of the AAP update was provided to the Board at the June Board meeting for review and

comment at the August meeting.

PROGRESS REPORT AS OF SEPT. 30, 2016

1. 2. 3. & 7. In August, the E.D. shared statistical data on completed PEPW applications, screening rates

and entry-to-care with CHIP MCH Subcommittee members, stressing the need to expand local PEPW

intake sites. Stakeholders were also cautioned that continued increase in “out-of-county” PEPW intake

would impact the rate of prenatal women served and the rate of infants delivered locally.

4. & 11. During the quarter, bi-lingual CDC literature on Zika prevention was approved by AHCA for use

with program participants. The information was distributed to area OB offices by the community liaison.

5. In September, the E.D. spoke with two (2) different agencies regarding potential funding for

uninsured, financially-qualified prenatal women. It is anticipated that at least one of the potential sources

will have grant funding available during this fiscal year, which the Coalition will pursue.

6. Throughout the quarter, Coalition staff exceeded the required number of provider education and

awareness visits, providing information on heatstroke prevention, infant health, HS screening, childbirth

education classes, Zika prevention, HS services, Smoking Cessation, and Text 4 Baby info.

In conjunction with Dept. of Children and Families’ August campaign, the Coalition added Born Drug

Free rack cards to its educational flyer inventory for distribution to the public. Information on the Born

Drug free initiative is also available on the Coalition’s website.

7. One of the local OB practices added two (2) new physicians during the quarter. In September, the

E.D. and representatives from the local Health Dept. met with the new OB physicians and discussed

collaboration for the Healthy Baby Initiative, importance of HS screening, and the promotion of early

entry to care.


8. The Coalition E.D. attended an open-forum discussion hosted by county government, United Way, the

Charlotte Community Foundation, Charlotte Behavioral Health Care and the Florida Dept. of Health on

aligning health and human services to improve the community. Topics of discussion included public

transportation and access to healthcare.

10. Recurring staff absences at the only county PEPWA intake location have limited and delayed

Medicaid application availability, negatively impacting the time needed for women to obtain PEPW

locally. Many local prenatal women have been forced to travel out-of-county for PEPW intake and, thus,

are obtaining out-of-county prenatal care. Charlotte County prenatal women lacking transportation may

be further delayed in obtaining Medicaid and entering care. It has been the aim of the Coalition for some

time to seek additional partners for PEPW intake.

In this regard, the E.D. met with two (2) area providers to discuss improving area entry-to-care rates by

becoming future PEPW intake sites. Both are interested and are pursuing qualification to access and

complete PEPW applications.

12. Board members approved the new AAP at the August meeting, as part of the Service Delivery Plan.

4. REPORTING PHASE ANSWERS: (To be completed for the Annual Action Plan Update)

a. Demonstrate the changes in the system/community.

Unfortunately, entry-to-care continues to be an issue at the local level. While the rate of those

with no prenatal care has improved and is below 2015 state rates for Black, Hispanic and White

mothers… early entry-to-care rates continue to be below state rates, as shown below:

2015 – 1st Trimester

Entry to Care

Charlotte Florida

All mothers 71.1 79.3

Black mothers 65.9 72.8

White mothers 72.1 81.3

Hispanic mothers 66.0 79.7

Although the Coalition has strived to educate the public on the importance of early entry-to-care,

outside factors have negatively impacted these efforts. For instance, the number of local OB

providers dropped from a high of seven (7) to a low of four (4), limiting access to care.

Additionally, recurring challenges with local access to Pregnancy Medicaid applications have

caused the need for many residents to seek assistance out-of-county. An unfortunate occurrence

for local healthcare providers, as many of those traveling out-of-county for PEPW application

also obtain prenatal care and delivery services out-of-county.

b. Will you drop/modify/expand/continue strategy next year and explain why?


With slight modification, these strategies will be continued as it is believed that, with expanded

PEPW intake sites locally, women can more easily access Pregnancy Medicaid and quickly

enroll for care with a local care provider.





ISSUE:



Pre-conception and inter-conception health education for women who may be at risk for

poor future birth outcomes due to poor previous birth outcome or loss of an infant

through death, adoption or removal from the home.


strategy?

Pre and inter-conception health issues such as obesity, poor nutrition, oral health,

substance abuse, maternal infections, poor baby spacing, and a history of poor pregnancy

outcomes are all factors that may contribute to premature births and incidents of low birth

weight.

The rate of preterm births for Charlotte County residents rose above the state average in

2014 for the first time in two years, as did the rates for preterm births for all races.

Preterm births to Hispanic and Black mothers also rose above state rates for the first time

in two years (Hispanic - 16.3% vs state rate of 13.7% and Black mothers (18.5% vs.

17.7% state average)

The county’s overall rate of low birth weight births for 2014 fell to (7.2%) dropping

below the state rate (8.7%). However, the rate of LBW births to white mothers (7.5%)

and Hispanic mothers (9.8%) exceed the state rate (7.3% - white; 7.4% - Hisp.) for the

third straight year. Additionally, the rate of very low birth weight infants born to Hispanic

mothers (3.3%) rose to exceed state rate (1.4%) for the second year in a row, even though

the county’s overall rate of very low birth weight births did not exceed the state average.



Data from the Florida Department of Health, Office of Planning, Evaluation and Data

Analysis and Vital Statistics, annual Charlotte Co. MCH Health Problem Analysis,

annual Florida Behavioral Risk Factor Surveillance System (BRFSS) Data Report,

Florida Youth Tobacco Survey, CDC, relevant media reports, responses to screening of

MomCare and HS participants at initial contact.




Outreach, education and training will be the focus of Coalition strategies to increase

community awareness of the importance of pre and inter-conception health and support

the efforts of Healthy Start Care Coordinators in the delivery of services to women who

may be at risk for poor future birth outcomes due to poor previous birth outcome or loss

of an infant through death, adoption or removal from the home.



Monthly staff and provider activity reports, quarterly staff report of method and

distribution of education materials, volunteer activity reports, consumer and community

surveys, community event reports, and area resource directories. This info will be

collected to assure that efforts are being made to educate the public on the importance of

pre and interconceptional health, especially those most at-risk.


Data will be collected from monthly/quarterly service provider reports, staff, Coalition

members, consumers, healthcare providers, community event participants and community

partners


wide problem/need?

The Coalition goals are to improve future pregnancy outcomes by

• Providing Level 3 services to a minimum of 12% of all prenatal program participants annually

• Providing Level 3 services to a minimum of 10% of all infant program participants.


Data from the Florida Department of Health CHARTS site, Vital Statistics, annual

Charlotte Co. MCH Health Problem Analysis, annual Florida Behavioral Risk Factor

Surveillance System (BRFSS) Data Report, Florida Youth Tobacco Survey, CDC,

relevant media reports, screening of HS participants.


See above

******************************************************************************


3. ACTION STEPS:


Outreach and Education

1. Through participation in

DOH/Network/FAHSC conference calls,

statewide meetings, and workgroups, advocate

for provider and staff training on Pre/ICC

services coding, service delivery

updates/revisions, WFS updates and HS 2.5

implementation.

E.D., Board Oct 2015 Sep 2016

2. Distribute educational materials to providers

and the public on pre-pregnancy and children’s

health through community events, health fairs,

meetings, provider visits, social media, etc. and

seek community partners to reach underserved

populations

Staff, Board,

Members, Lead

Agency for care

coord., volunteers

Oct 2015 Sep 2016

3. Identify & recruit potential partners to

present on MCH/ICC issues at regularly

scheduled General Membership meetings

Program/

Membership Cmtee,

staff, Board

Oct 2015 Sep 2016

4. Develop strategies to encourage

participation/input by staff of OB and Ped’s

offices in General Membership meetings and

surveys.

Prog/Membership

Cmtee, Staff, Board

Oct 2015 Sep 2016

5. Provide prenatal smokers with the Fla.

Quitline contact info for smoking cessation

support

Lead agency for Care

Coord.

Oct 2015 Sep 2016

6. Host smoking cessation support groups

through community partnerships.

Board, staff Oct 2015 Sep 2016

Monitor Provider Services / Caseloads

7. Monitor monthly care coordination report to

assure effective needs assessment and care

coordination

Staff, Lead Agency

for Care Coord.,

Board

Oct 2015 Sep 2016

8. Monitor caseload rates and establish

“benchmark” for Level 3 caseloads

E.D., Lead agency for

Care Coord.

Oct 2015 Sep 2016

9. Monitor monthly Executive Summary reports

for Prenatal and Infant screening and services

rates; report findings quarterly to the Board

Staff Oct 2015 Sep 2016

10. Offer annual cultural competency /

diversity training through facilitator

presentation, on-line learning modules, webinar

or via website links to Board members, staff,

and providers of services

Staff, Comm.

Partners, Media

Consultant

Oct 2015 Sep 2016


11. Evaluate strategies for effectiveness and

revise as needed

Board, Staff, Data

Committee

Jul 2015 Sep 2016



1. Coalition staff participated in WFS training calls, DOH Infant / Maternal Health conference calls,

FAHSC HS 2.5 conf. calls, FAHSC Finance Committee calls, FAHSC Legislative calls and

Network/MomCare calls during the quarter. The E.D. participated in FAHSC conf. calls where members

voted to pursue statewide training through collaboration with The Ounce of Prevention.

Coalition staff received WFS training for future monitoring and reporting purposes.

2. Social media E-alerts, Healthy Baby tips and quarterly newsletter for the quarter included information

on: availability of Childbirth Educ., Infant CPR and Safe Baby classes, children’s health, health literacy,

SIDS prevention, preterm birth prevention, holiday home safety, and pregnancy and diabetes.

A link to the AHCA Practitioner Resources for OB/Gyns was added to the Provider tab of the CCHSC

website during the quarter.

Educational materials on breastfeeding, screening for domestic violence, tobacco education / smoking

cessation and coping with crying were supplied to OB providers during monthly site visits. Also, info on

the importance of early and regular prenatal care and HS services was provided by the E.D. to the

Rotonda West Women’s Club in Englewood during the quarter.

2. & 5. A link to Tobacco Free Florida was included in social media to direct individuals to an on-line site

with additional information on how to quit smoking.

3. Paul DeMello, from ‘Just Against Children Drowning,” provided an emotional and informative

presentation on drowning prevention at the Coalition’s annual meeting in October. Paul is the father of

twin toddlers who drowned while in their grandmother’s care.

4. The Fund Development / Community Action and Education Committee continues to solicit guest

speakers on topics of interest to healthcare providers and MCH stakeholders.

5. Care Coordination team members continue to provide information on the Florida Quitline to prenatal

smokers and those with smokers in their household.

6. Gulfcoast South Health Education Center provided a smoking cessation support meeting at the

Coalition office in October.

7. The monthly care coordination activity report was shared with staff and the Board at each monthly

meeting.

8. A new care coordination supervisor was named in October and the E.D. met with her and management

of the lead agency for care coordination to discuss “benchmark” performance information and technical

assistance for care coordination staff.

9. Screening reports have not been available for all months in the quarter, but it is anticipated that

hospital staff changes impacted local screening rate. The E.D. met with all new hospital screening staff

and provided infant screening training in December.


10. Cultural competency / diversity information continues to be available through the Coalition’s website

and on-line learning management system.


1. In January, the Care Coordination team participated in a webinar on the use and effectiveness of the

Edinburgh Postpartum Depression screening tool.

A member of the care coordination team completed the MIECHV training for breastfeeding educators in

February.

The ED and members of the Care Coordination team participated in a local Well Family System

workshop held in March and conducted by a GoBeyond staff member. Attendees reviewed coding

procedures and use of system reports.

2. The January issue of the Coalition’s quarterly Newsletter featured an article on the importance of folic

acid for women of childbearing age.

Social media Healthy Baby Tips and e-alerts distributed during the quarter focused on drowning

prevention and water safety for children, poison prevention, early entry to prenatal care, infant CPR class

info, preparing for a healthy pregnancy, and prevention of prenatal infections.

2. & 5. The local CHIP initiative developed potential PSAs for smoking cessation during pregnancy and

surveyed community members and stakeholders to determine which messages would be utilized. (A copy

of the survey and potential messages is located in the Products and Drafts section of this report.)

3. Board members, General Members and staff received an informative presentation on Recognizing

Victims of Human Trafficking, by Linda Lusk of C.A.R.E. (Crisis and Rape Emergency Center).

4. The Community Liaison visits OB offices monthly and conducted a survey on MCO Plan participation

enrollment during the quarter. Half of the area OB providers (2) are enrolled in each of the MCO Plans

available locally. The other two (2) are enrolled in two (2) MCO Plans, assuring that area women have

choices of providers for prenatal care.

5. Care Coordination team members continue to provide information on the Florida Quitline to prenatal

smokers and those with smokers in their household.

6. The Coalition continued to host monthly smoking cessation support groups provided by Gulfcoast

Area Health Education Centers.

7. & 8. The monthly care coordination activity report was shared with staff and the Board at each monthly

meeting.

9. Screening rates were monitored with the help of the local Health Department during the quarter.

10. Cultural competency / diversity information continues to be available through the Coalition’s website

and on-line learning management system.



1. During the quarter, training was provided to staff on the use of WFS reports and tickler lists to

improve the Coalition’s ability to monitor provider performance.

2. Educational information on healthy behaviors prenatally, preeclampsia, prevention of heatstroke-

related infant deaths, infant immunization, summer safety, and hurricane preparedness was included in

monthly electronic Healthy Baby Tips and e-alerts distributed by the Coalition.

An April article in the local newspaper highlighted efforts of the local CHIP Maternal Child Health

subcommittee to address prenatal smoking. The subcommittee is chaired by the Coalition’s E.D., Magi

Cooper.

3. At the Coalition’s general meeting in April, Christopher Hall from C.A.R.E. gave a presentation on

“Living the Green Dot.” This initiative is aimed at ‘ending violence one green dot at a time’ by seeking

individuals to see themselves as the green dot in violent situations. Knowing this they can then take action

by using the 3 Ds - Direct, Delegate or Distract. The presentation was well received as evidenced by the

meeting evaluations. Alecia Cunningham, CC Homeless Coalition has agreed to give a presentation on

the “Bridges Out of Poverty” initiative.

4. The community liaison visited area Pediatricians’ offices in June to survey them on MCO Plan

enrollment and provide HS services information.

5. Care coordination staff continue to provide Quitline information to prenatal smokers enrolling in HS,

along with information about local support groups sponsored by Gulfcoast South Areal Health Education

Centers (AHEC).

6. During the quarter, the Coalition hosted two (2) smoking cessation support group meetings which were

facilitated by the local Area Health Education Center.

7. & 8. Training was provided to staff on the WFS performance reports in May, thus giving staff

additional tools for performance monitoring. Care coordination activity reports continue to be prepared

by the care coordination provider and shared monthly with the Board and staff.

9. Staff continues to monitor monthly screening rates through FDOH reports. The E.D. provided infant

screening data to the hospital’s OB nurse supervisor and offered additional screening training. Screening

challenges were shared with the Board.

10. Cultural competency training and information continues to be made available through the Coalition’s

on-line Learning Management system and its website.

11. A draft of the AAP update was provided to the Board at the June Board meeting for review and

comment at the August meeting.



1. In July Coalition and provider staff attended the FAHSC Summer training conference, which included

WFS coding training. Additionally, staff participated in on-going FAHSC/HSMN conference calls

including Claims Research, WFS Policy Group, MCO, HS 2.5, Education & Training, and Zika.

2. Through social media E-alerts, and Healthy Baby Tips information on summer safety for infants,

heatstroke prevention, maternal health/Group B Strep, Zika and pregnancy, women’s health and fitness,

and newborn screening was distributed to the community. Also, a link to CDC information on Zika and

pregnancy was added to the Coalition’s website home page.

Educational materials on heatstroke prevention for children, infant health, HS screening and services,

childbirth education, preconception health, kicks count, and safe sleep were provided to the public during

community development activities which took place in the quarter.

The ED attended the recent launch of a Milk Bank at the local birthing facility. Safe sleep onesies,

coping with crying, Infant CPR and Safe Baby class schedules were provided.

3. A guest presentation on “Bridges out of Poverty” has been scheduled for the October annual CCHSC

meeting.

4. With the CHIP Maternal/Child Health subcommittee, the E.D. helped develop a “lunch-n-learn”

presentation to be provided to OB physicians which will encourage input in MCH health issues. A draft

of the presentation is included in the Products and Drafts section of this report.

5. Care coordination staff continue to provide Quitline information to prenatal smokers enrolling in HS,

along with information about local support groups sponsored by Gulfcoast South Areal Health Education

Centers (AHEC).

6. Thirteen (13) area smokers, expressing a desire to quit smoking, attended Gulfcoast South AHEC’s

Tobacco Free smoking cessation support groups provided in July or September at the Coalition’s office.

7. The Board and staff reviewed care coordination activity reports monthly during the quarter. Coalition

staff met with care coordination staff and discussed “best practices” to enhance intake and service

delivery. Monthly stats evidenced an increase in efficiency of service delivery and coding.

8. Coalition staff and Board members continue to monitor caseload rates and level 3 services.

9. Staff utilized WFS service reports to monitor both Medicaid and non-Medicaid service levels each

month. Minimum service requirements continue to be met or exceed for contractual obligations.

10. Cultural competency training and information continues to be made available through the Coalition’s

on-line Learning Management system and its website.

11. The Board reviewed and approved AAP updates/revisions, as part of the SDP, at the August Board

meeting.




While many factors associated with poor birth outcomes improved in the last year, others

declined. Additionally, disparities continue to exist both in race and ethnicity locally.

For instance, the local overall rate for births with less than an 18-month interval between

pregnancies fell from above State average in 2014 (34.9% vs 34.6%) to below State average in

2015 (32.9% vs. 34.3%). This represents a 2% decline in local rates, as compared to a .3%

decline at the state level. While the rates for this measure for both White and Black mothers was

below State average for 2015, the rate for Hispanic mothers rose from 28.3% in 2014 to 34.9% in

2015.

For 2015, both State and local rates for overall obese mothers at occurrence of pregnancy rose

over the last year, each at approximately .5%. Overall obese mothers for Charlotte Co. currently

exceeds State rate (23.5% vs 21.9%). The rate of obese Black mothers, although below the State

rate (30.6%), remains over 6.5% higher than the same rate for obese White mothers (29.9% vs

23.2%). Hispanic obese mothers exceed the State rate by more than 2% (22.7% vs 20.6%)


Continued education and awareness is needed to improve all birth outcomes locally. This

strategy will be modified and continued in the coming year.





ISSUE:



The Coalition will work to expand membership, build internal capacity to assess area

maternal/child health needs and increase programmatic capacity to address those needs,

in accordance with the Healthy Start Standards and Guidelines.


strategy?

According to F.S. 383.216 the Coalition must assess and identify the local need for

comprehensive preventive and primary prenatal and infant health care, review and

monitor the delivery of services and make necessary annual adjustments in the design of

the delivery system, the provider composition, the targeting of services and other factors

necessary for achieving projected outcomes.



This is a component of the Coalition’s contracts with the Florida Department of Health

and the Healthy Start MomCare Network



Expand the identification and delivery of Healthy Start services through contract

negotiation, data collection/reporting, monitoring, grant-writing, community/government

partnerships, and fund-raising.



Performance reports, minutes/agendas of Board, General Membership, committee, staff

and FAHSC meetings, with handouts; HS services/monitoring reports, Coalition

newsletters, and media articles, and will assist the Board in assuring that activities

support the Healthy Start mission.



Staff, provider and HS services reports generated monthly and quarterly; recorded

meeting notes; written monitoring and performance reports are shared at regularly

scheduled Board, General Membership and Committee meetings.


wide problem/need?

Coalition Board and staff will have improved capacity to monitor the Coalition’s

contractual obligations for funding, service provision and data collection compliance

during this year of transition.


See B above.


See C above.

******************************************************************************

3. ACTION STEPS:


Expand Capacity for Service Provision

1. Negotiate contracts for quality care

coordination and wraparound services annually

based on area needs; encourage expanded

capacity for service provision

E.D., Staff, Board April 2016 June 2016

2. Monitor contracted providers for

performance and Stds. & Guidelines compliance

through monthly/qtrly reports and annual

monitoring visits

E.D/Contr. Mgr. Oct 2015 Sep 2016

3. Monitor the performance of In-house

MomCare services for compliance to Stds. &

Guidelines and contractual obligations through

monthly reports and qtrly record reviews

E.D./Contr. Mgr.,

staff, Board

Oct 2015 Sep 2016

4. Determine “Plan B” provider list for back-up

of all HS services contracts

Board, Staff Oct 2015 Aug 2016

5. The Coalition’s Data Committee (or a related

special task force) will meet a minimum of three

times per year to review community MCH

health indicators/trends, survey summaries,

screening rates, and statistical data to prioritize

needs and make action plan recommendations

Staff, members,

Board, comm.

partners, Data

committee, providers,

volunteers

Oct 2015 Sep 2016


for Board consideration at regularly scheduled

meetings.

Expand Internal Capacity

6. Explore local non-profit resources for

capacity building; clarify role of Board and staff

Board Oct 2015 Sep 2016

7. Engage Executive Committee; clarify

committee roles; develop formal fundraising

committee; revise by-laws, as necessary

Board Oct. 2015 Jun 2016

8. Explore option for a grant writer consultant Board Oct. 2015 Jun 2016

9. Advocate for education/training on use of,

and updates to, data system

E.D., Board, Lead

Agency for Care

Coord.

Oct 2015 Sep 2016

10. Expand internal data capacity and IT

resources


Community Support / Outreach

11. Utilize education and training as

mechanism to reach potential members

Program/ Membership

Cmtee, Board, staff

Oct 2015 Sep 2016

12. Identify a plan to keep local government

informed on CCHSC and its activities

Board, staff Oct 2015 June 2016

13. Maintain Board diversity for equitable

representation of the community

Prog. & Membership

Cmttee; Board, staff

Oct 2015 Sep 2016

14. Use General Membership meeting as

mechanism to gather more input on HSC

activities and capacity building



15. Hire consultant to facilitate data analysis by

Community Needs Assessment workgroup and

assist staff and Board with evaluation and

development of 5-yr. Service Delivery Plan

update, due Oct. 2016.

Board, Staff, Comm.

Partners, Providers,

Consultant

Oct 2015 Sep 2016

16. The Board will review update progress of

components of the 5-yr. SDP, including the

Needs Assessment and Annual Action Plan at

regularly scheduled meetings

Board, staff,

Committees

Oct 2015 Sep 2016


PROGRESS REPORT AS OF DECEMBER 31, 2015.

1. Additional funding was provided through the care coordination contract(s) to increase staff and

expand capability for services.

2. Monthly Care Coordination performance reports are reviewed by CCHSC management and shared at

regularly scheduled Board meetings. In addition, monthly WFS data reports are being monitored by

Coalition staff and technical assistance has been provided to care coordination team members throughout

the quarter.

3. Monthly MomCare reports are reviewed by Coalition management and shared with Board members at

regularly scheduled Board meetings. The E.D. meets regularly with MomCare staff to discuss progress,

challenges and successes.

5. Staff and the Coalition’s SDP consultant summarized MCH data for review by a community needs

assessment panel, to include Data Committee members, in January, as part of the SDP update.

6., 9., & 10. Enhancement of the Coalition’s technology infrastructure began during the quarter through

a grant received from the Charlotte Community Foundation. New computer equipment was purchased,

including 5 Surface Pros for use by Care Coordination, and work was begun to connect the Coalition to

dedicated space on a local Server.

7. The Fund Development / Community Action & Education committee has been defined to work on

fundraising efforts. Executive Committee met in November to discuss operational matters.

9. FAHSC has been responsive in providing trainings to staff and management on the WellFamily system

and its capabilities. See notes under Item 1, Action Step 1.

11. The father of young twin drowning victims provided an emotional and educational presentation on

drowning prevention at the Coalition’s Annual meeting. Recognizing victims of human trafficking will

be the topic of the January General Membership 2016 meeting presentation.

12. In October, the E.D. met with local legislative delegates and provided an update on the Healthy Start

program and its services.

13. The Board elected 2 additional representatives from the Englewood portion of Charlotte County at its

annual election in October. There are now 3 community representatives from Englewood including a

second gentleman who also joined the Board at that time.

14. General members are encouraged to participate in the business portion of those meetings and provide

input and comments.

15. & 16. Data research and compilation has taken place throughout the quarter in preparation for the

next community Needs Assessment and SDP update. The Coalition’s contracted SDP consultant

provided the Board with a progress report and activity timeline at the December meeting.



2. During the quarter, the ED/Contr. Mgr. performed on-site monitoring visits for the following services:

psychosocial counseling, data entry, IPO services, childbirth education services, high-risk prenatal care,

and lab/sonogram services. (Copies of these reports can be found in the Products and Drafts section of

this report.)

3. A monthly MomCare activity and performance report is provided to the Board at each meeting.

Additionally, the ED meets regularly with MomCare staff to review caseload levels and challenges.

MomCare program expenses are monitored monthly by the Coalition’s Finance Manager.

The Coalition’s ED was advised that Bayfront Health – Port Charlotte hired a new Lactation Consultant

in January to provide breastfeeding support services.

5. Sixteen stakeholders comprised the Community Health Assessment workgroup which met twice in the

quarter to assess local MCH trends and needs and establish service priorities recommendations for the

upcoming Service Delivery update.

6. The ED completed Board orientation to new Board members and provided each with a reference book

including Articles of Incorporation, ByLaws, performance measures, policies and procedures, committee

assignments, Conflict of Interest, the role of the Board, etc.

The BonSecours Health System grant has been extended into the upcoming fiscal year.

7. The Fund Development /Community Action & Education Committee continues to plan and implement

fund raising activities for the Coalition. Most recently, the committee conducted its annual “Show the

Love” luncheon event.

9. The ED arranged for Care Coordination staff to participate in a Well Family System workshop in

March provided by a GoBeyond staff member. The workshop focused on coding and reports.

10. In March the Coalition added enhancements to improve the server and its ability to access programs.

11. The Coalition provided an informative presentation on Human Trafficking at its January meeting.

The event was advertised and open to the public. Twenty-three people were in attendance.

12. The ED visited County Commissioner Ken Doherty who agreed to endorse the local CHIP initiative

to promote early entry to care for pregnant women by signing on to a letter requesting local pharmacies

and big box stores make PEPW information available where home pregnancy tests are sold.

15. The SDP Update consultant was engaged to assist with the SDP update process in July 2015 and

prepared a SDP update work plan and timeline. She planned and facilitated the Community MCH

Assessment workgroup meetings held during the quarter which produced statistical reference data,

indicator trends, Fishbone draft, and Needs Assessment priorities recommendations. The following is a

link to the data review PowerPoint presentation: https://www.dropbox.com/s/3k0amxhghkqk7d8/SDP%20Presentation%202016.ppt?dl=0

Coalition staff members were assigned SDP update tasks and drafted various components of the Plan

during the quarter.

https://www.dropbox.com/s/3k0amxhghkqk7d8/SDP%20Presentation%202016.ppt?dl=0


16. In January the SDP consultant presented the work plan and timeline for the SDP update to the Board.


1. Considering needs and funding, the E.D. negotiated and finalized care coordination and wraparound

service agreements with local providers prior to July 1st.

2. In addition to regular quarterly report monitoring, the E.D. conducted the annual monitoring visit for

the following services during the quarter: care coordination; parenting education and (Copies of these

monitoring reports have been included in the Products & Drafts section of this report.)

3. A monthly MomCare activity and performance report is provided to the Board at each meeting.

Additionally, the ED meets regularly with MomCare staff to review caseload levels and challenges.

MomCare program income and expenses are monitored monthly by the Coalition’s Finance Manager.

4. The completion of the SDP Community Resources List satisfies this requirement.

5. The SDP workgroup met several times during the quarter to review SDP update task progress and

component drafts, including local Needs Assessment and Action Plan steps.

7. During the quarter Board members have been actively engaged in the workings of the Coalition

through the SDP Community Assessment workgroup, Finance and Fund Development, Education &

Community Action committees. (Meeting Minutes are located in that section of this report.)

8. The Coalition will continue to seek out affordable grant writing services. Meanwhile the Coalition will

utilize staff and volunteers.

9. Staff members participated in WFS training on the use of MomCare Tickler Lists and Healthy Start

Performance Reports during the quarter.

10. During the quarter, the Coalition purchased and implemented the use of backup tapes needed to

support Server storage and backup.

11. At the April general membership meeting a guest speaker, Christopher Hall from C.A.R.E. gave a

presentation on “Living the Green Dot.” This initiative is aimed at ‘ending violence one green dot at a

time’ by seeking individuals to see themselves as the green dot in violent situations. Knowing this means

they can then take action by using the 3 Ds - Direct, Delegate or Distract. The presentation was well

received as evidenced by the meeting evaluations.

12. Wal-Mart and Dollar Tree declined to allow Healthy Start to post their PEPW tear-off pads next to

pregnancy tests in their stores as it would establish a problematic precedent. Instead the posters, with the

tear-off pads in both English and Spanish, were posted in locations around the county including the 5

public housing authorities, public libraries, WIC, school clinics, Virginia B Andes community clinic,

Dept. H&HS, etc. At the next CHIP – MCH meeting in August the # of ‘hits’ on the www.pepwinfo.com

page will be reviewed.

14. Meeting agendas include time to cover community information and input by attendees.

15. & 16 The Coalition’s SDP consultant facilitated workgroup meetings to develop and review

components of the next Plan and presented component drafts and a progress report at the June Board

meeting.

http://www.pepwinfo.com/



2. Staff and Board members continued to monitor performance utilizing monthly program activity and

services reports. The E.D. met with care coordination supervisors during the quarter to discuss “best

practices” and efficiency of service delivery. An increase in services and decrease in coding errors was

noted.

3. Staff and Board members reviewed monthly MomCare performance reports. Additionally, the

MomCare Advisor attended the summer FAHSC Training Conference in Daytona in July.

4. The E.D, met with two (2) area agencies to discuss possible provision of local PEPW intake. Both

agencies expressed interest and will pursue site certification.

6. Coalition staff began research of two (2) potential funding sources to augment prenatal care services

for uninsured, financially-qualified, Medicaid-ineligible women.

Plans for a Board Retreat are in the making. The retreat will cover strategic planning, as well as Board

roles and responsibilities.

7. Board members have been actively involved in update, review, and approval of SDP components

during the quarter.

9. Staff attendees at the Daytona FAHSC Training Conference participated in WFS coding training.

11. A guest presentation on the “Bridges Out of Poverty” program will be presented at the Coalition’s

annual meeting.

13. New representatives from the local birthing facility, the WIC office, and the community were

appointed to fill Board vacancies during the quarter.

14. Meeting agendas continue to include time for community input and updates.

15. & 16. The Coalition’s SDP consultant provided a discussion and final review of 5-year SDP

components for Board and staff members in August. All items were finalized and approved.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *



• Continued monitoring of Provider contracts allowed for agreement revisions to accommodate services now being provided by MCO Plans, such as diabetic

nutrition counseling.

• The absence of Diabetic Educators for Medicaid and uninsured women has been a

problem for some time. In a recent visit with a local OBGYN office and in light

of the fact no local endocrinologists are accepting Medicaid patients, it was

agreed that all Medicaid women be referred to the HD where the Director of WIC


who is a qualified dietician, will provide this education. Uninsured women will

receive the education outside of WIC office hours at the Healthy Start Coalition

office.

• Regular monitoring of provider performance permitted Board and staff to respond quickly to service delivery concerns and implement necessary training and

support to improve service delivery procedures.

• With the assistance of a SDP consultant, the Data Committee, and the Community

Health Assessment workgroup, the Coalition effectively moved through the

research, assessment and development processes to update all facets of its five-

year SDP.

• Increased grant-writing, fund-raising, and educational opportunities allowed the Coalition to grow its infrastructure, raise awareness, and expand Board

participation.


This strategy will be modified and will not include steps to prepare the now-completed SDP

update.


Category C Activity 15-16

Assisting Chemically Dependent Pregnant Women

And Substance Exposed Newborns

1. ANNUAL RESPONSIBILITIES FOR THIS POPULATION:

a. The Coalition must submit an action plan for assisting chemically dependent pregnant

women and substance-exposed newborns that includes action steps/strategies for multi-

agency collaboration, access to evaluations, treatment and services to substance-exposed

newborns.

b. The Coalition will submit quarterly Progress Reports that show documentation that action

steps of strategies chosen were implemented as planned or rationale as to why they were

not.


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

you make referrals for services needed?

The Coalition will continue to monitor and support the efforts of the Attorney

General’s Task Force on Substance Abuse and work to promote intervention services

for substance-abusing women at community events and encourage referral to the

Healthy Start program for pregnant women who are chemically-dependent.

Using motivational interviewing techniques, Healthy Start care coordinators will

encourage chemically dependent pregnant women to enter local treatment programs

and will provide referral for those willing to participate. Healthcare providers,

including birthing facilities, will be educated on Healthy Start services and encouraged

to refer pregnant women and substance-exposed newborns determined to be

chemically dependent to Healthy Start care coordination.

Caregivers of substance-exposed infants referred to Healthy Start by the hospital will

be offered support and provided with resources to help care for the infant.

All chemically-dependent women and substance-exposed infants in the HS program

will be monitored and tracked as Level 3 participants.

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

pregnant women and substance exposed newborns?

Recent reports from the Attorney General’s Task Force on Substance exposed

newborns indicates that the incidents of drug withdrawal for Charlotte County

newborns have increased significantly from two (2) in 2007 to twenty-one (21) in

2012. It is hoped that through education and support, chemically-dependent women

can become substance-free and the number of substance-exposed infants will decline.


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

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

etc.)

Information will be gathered annually from the Florida Dept. of Health’s CHARTS

reports, Healthy Start Services reports, Vital Statistics, CDC, and Florida Behavioral

Risk Factor Surveillance System Data Report. In addition, relevant task force and

media reports, local NICU stats and information from the screening of HS participants

will be reviewed throughout the year.

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

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

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

information and goal)

It is hoped that 30% of those chemically-dependent pregnant women enrolling in a

treatment program will complete the program and that 20% will be drug-free

following the birth of their infants.

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

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

Data on the rate of reported substance-abusing prenatal women served through

Healthy Start will be monitored monthly in hopes that numbers served will increase.

In addition, the rate of substance-exposed infants will be monitored annually, in hopes

this rate declines.

******************************************************************************

3. ACTION STEPS – add as many as needed.

Action Step Pers. Responsible Start Date End Date

1.Awareness:

The Coalition will utilize

promotional opportunities, as

described in Category B of this

report, to promote substance-abuse

intervention services for pregnant

women who are chemically

dependent.

The Coalition will educate OB

providers on the availability of HS

care coordination and referral for

Board, Staff, Care

Coordinators

Comm. Liaison,

Staff, Care

Coordinators

10/01/15

10/01/15

09/30/16

09/30/16


substance-abuse intervention services, through provider visits, as


report.

Continue to monitor the efforts of

the Atty. General’s Task Force and

maintain the link in the CCHSC

website for parents to visit the Born

Drug Free Florida website and

obtain the Helpline Number.

Staff, Media

consultant

10/01/15

09/30/16

2. Referral:

Educate providers, staff and

community partners on the process

to refer for Healthy Start Care

Coordination services

Comm. Liaison,

Staff, Care

Coordinators

10/01/15 09/30/16

3. Interagency Collaboration:

Secure interagency agreements with

local resource organizations.

Work closely with staff at the local

birthing facility to ensure referral of

substance-exposed newborns to

Healthy Start care coordination

Staff

Staff, Board, Lead

agency for Care

Coordination

Ongoing

Ongoing

09/30/16

09-30-16

4. Care Coordination:

Perform services for substance-

abusing pregnant women and

substance-exposed infants in

accordance with Chapter 12 of the

HS Stds & Guidelines

Lead agency for

Care Coordination

Ongoing 09/30/16

******************************************************************************

Action Plan for FY July 1, 2015 – June 30, 2016 (use as much space as needed)

Awareness

The Coalition will work throughout the year to promote awareness of, and referral to, Healthy

Start services for at-risk pregnant women and infants by participating in community events


and local service organizations/business meetings, utilizing social media, articles and through provider education, many of which are described within Category B of this report.

Awareness efforts will include emphasis on the need to refer chemically-dependent pregnant

women and substance-exposed infants for Healthy Start care coordination services.

The Referral Process

Prenatal Women may be referred based on the following:

• Drug abuse by her own admission

• A positive drug screen result

• A staff member witnessing the use

• A report from a reliable source (trusted family member, professional)

• Response to screening question indicating use or abuse

• Further observation / assessment of substance abuse history / patterns of use

Infants who were prenatally exposed may be referred:

• By hospital staff

• By caregiver in need of education and support

• By physician, on behalf of caregiver

Service Collaboration / Interagency Agreements

The Coalition will establish interagency agreements with local resource agencies:

• Charlotte Behavioral Health Care (residential treatment program)

• Bayfront Health – Port Charlotte (NICU)

• Healthy Families – Charlotte

• Dept. of Children and Families

• Drug Free Charlotte County

• Harbor Counseling, Methadone Program

Healthy Start Care Coordination

Pregnant chemically-dependent women or substance-exposed infants will be assigned as Level

3 (highest need) program participants.

Care coordinators will document:

• Healthy Start enrollment and all attempts to engage the woman in Healthy Start

• Comprehensive home assessment / substance use education / provision of support

services / referrals / progress / follow up, in accordance with Chapter 12 of the Healthy Start Standards and Guidelines

• Applicable pre-discharge home assessment, as per Chapter 12 of the HS Standards and

Guidelines

• Applicable reports to the Dept. of Children and Families (DCF) in accordance with Chapter 12 of the HS Standards and Guidelines

• Pertinent info on DCF representatives / investigators working with the family

• Transition to county health department, or inability to do so


Care Coordinators will also:

• Report to the Florida Abuse Hotline (1-800-96 ABUSE) if the infant or home

assessment reveals that the mother or caregiver is not able to care for the child

• Offer care coordination services to the birth mother, regardless of whether she has or will retain custody of her child.

Progress report: December 31, 2015

1. & 3 The Coalition’s ED met with the nursing supervisor and screening staff at the local

birthing facility in December to provide infant screening training and HS overview, including

services available for substance-abusing women and substance-exposed infants.

The Coalition’s website includes a link to the Born Drug Free Florida site, where parents can

obtain info on the Helpline.

2. As part of the meeting with hospital staff mentioned above, the E.D. provided training on the

referral process and supplied Healthy Start referral forms.

3. The Interagency agreement with Healthy Families Charlotte was renewed during the quarter.

4. Care coordination team members continue to provide referrals for substance-abusing women

and substance-exposed infants, in accordance with the Healthy Start Standards and Guidelines.

Progress report: March 31, 2016

1. & 2 The importance of entering pregnancy at optimal health was the focus of a social media

e-alert in January. The E.D. had follow-up meetings with hospital staff to emphasize the

importance of infant risk screening and HS referral.

3. The interagency agreement with these agencies were signed during the quarter: Charlotte

County Public Schools/ Early Childhood Programs, Charlotte Behavioral Health Care, Charlotte

County Homeless Coalition, Gulf Central Early Steps, Virginia B. Andes Community Clinic,

Gulfcoast South Area Health Education Center, Pregnancy Careline Center, and WIC.

4. Care coordination team members continue to provide referrals for substance-abusing women

and substance-exposed infants, in accordance with the Healthy Start Standards and Guidelines.

5. The CHIP Maternal Child Health Committee and the Healthy Start ED are working closely

with the hospital staff to determine the actual number of SEN and SAW. Manual data pulls are

occurring and indicate the number is greater than reported.


Progress report: June 30, 2016

1. & 2 Information on HS services was provided to area stakeholder organizations at the CHIP

Access to Care Committee meeting and to those attending the monthly Charlotte County

Collective (C3) meeting. In addition, HS Services brochures were provided for distribution to

the public at seven (7) area pediatrician offices by the Community Liaison.

3. Data on substance exposed newborns is being collected manually by hospital staff and

reported to the Coalition until a more formal process can be established. The interagency

agreements with these agencies were signed during the quarter: DCF – Pregnant Women &

Substance Exposed Newborns; Drug Free Charlotte; Early Learning Coalition of Florida’s

Heartland; Punta Gorda Housing Authority; Center for Abuse & Rape Emergencies and The

H.O.P.E. Academy.

The E.D. is working with Health Department staff to take the lead and resurrect the local SEN

Task Force by beginning regularly scheduled meetings with area stakeholders.

4. Care coordination team members continue to provide referral for substance abusing women

and substance-exposed infants, in accordance with the HS Stds. And Guidelines.

5. The ED attended a conference: Drug Endangered Children – National Alliance for Drug

Endangered Children in Manatee County on 6/13 with the ED of Drug Free Charlotte.

Progress report: Sept. 30, 2016

1. & 2 A leaflet provided by BornDrugFreeFL.com named “Your Baby’s Health Depends on

You” was provided to Care Coordinators, all 4 OBGYN offices and added to Mom totes.

3. Data on substance exposed newborns continues to be collected manually by hospital staff and

reported to the Coalition until a more formal process can be established.

The E.D. was advised by Diane Ramseyer, ED, Drug Free Charlotte, that beginning in January

2017, a student from UF would be available fulltime for 3 months and will be working on

recommendations for the required formal processes and will be based on best practices

elsewhere.

4. Care Coordinators continue to provide referral for substance abusing women and substance-

exposed infants, in accordance with the HS Std. and Guidelines.

5. The ED was invited to present at a meeting at Lutheran Family Services on 8/17. Members of

DCF were present. The ED raised the subject of SEN’s and the understanding that the official

numbers reported for SENs were not an accurate reflection of the extent of the problem in

Charlotte County. DCF staff confirmed that this was correct. The ED explained that the

Substance Exposed Newborns Taskforce would begin meeting again, DCF agreed to send a

representative.


The ED attended a Lunch ‘n’ Learn at the Health Department on 9/28… “A Baby’s Life

Shouldn’t Start with a Detox.” Diana Stark, Director of the NICU at the local birthing facility

confirmed she was still willing to Chair the Substance Exposed Newborns Taskforce when it

reconvenes.

Substance-Abusing Women / Qtrly Stats

Dec. 2015 Served: 4 # of Services: 196

Mar 2016 (Statistics unavailable at this time)

June 2016 (Statistics unavailable at this time)

Sep. 2016 Served YTD - 6

Substance-Exposed Infants / Qtryly Stats Dec. 2015 Served: 1 # of Services: 40

Mar 2016 (Statistics unavailable at this time)

June 2016 (Statistics unavailable at this time)

Sep. 2016 (Statistics unavailable at this time

******************************************************************************

4. REPORTING PHASE ANSWERS: (To be completed for the Annual Action Plan

Update)

a. Demonstrate that your action plan is reaching and making a difference for the

intended populations?

While limited statistical data has been available throughout the past year for

substance-abusing women and NAS infants, records indicate that HS Care

Coordinators referred six (6) prenatal women to substance-abuse treatment programs

during the year. Through the CHIP Maternal / Child Health Committee and Drug

Free Charlotte, the Coalition’s E.D. is working to obtain actual numbers for

substance-exposed infants on a regular basis.

Education provided to new staff in the hospital OB unit and NICU has resulted in

increased infant screening and infant referrals to HS. Additionally, hospital staff has

stepped in to re-activate and lead the local Substance Exposed Newborn Task Force,

which had become inactive earlier in the year.

b. Will you drop/modify/expand/continue the action plan next year and explain why?

This strategy will continue with only slight modification as it uses the best practices

available at the local level.


14. NEW ACTION PLAN CATEGORIES B & C

CATEGORY B




ISSUE:



There is a need to decrease the prevalence of prenatal smoking among Charlotte County mothers-to-be. In the three-year period 2012-2014, prenatal smoking occurred at an average rate of 16.1% in Charlotte County, which is almost 2.5 times greater than the state rate of 6.5% for the same time period. During the period white mothers smoked prenatally at a rate of 17.2%, as compared to the state rate of 7.7%. Additionally, Hispanic mothers smoked prenatally at the rate of 5.6%, more than three (3) times the state rate of 1.6%. The rate of those NOT smoking was 83.9% for this three-year period. The Healthy People 2020 goal for NOT smoking during pregnancy is 98.6%


strategy?

Smoking and exposure to secondhand smoke are the most prevalent preventable risk factors associated with low birth weight and premature births. Charlotte County’s preterm birth rate for the period 2012-14 is 12.8%, higher than Florida’s Healthy People 2020 goal of 11.4%. Likewise, its rate of low birth weight births is also above (8.2%) the Healthy People 2020 goal of 7.8%.



Data from the Florida Department of Health, Bureau of Vital Statistics, annual Charlotte County MCH Health Problem Analysis, responses to screening of MomCare and Healthy Start participants at initial contact.



The Coalition will work to decrease the rate of prenatal smoking within the catchment area through tobacco education and cessation support, utilizing the evidence-based Smoking Cessation and Reduction in Pregnancy Treatment (SCRIPTS) curriculum, provided by certified facilitators.


Strategies will include individual screening, education and cessation support, provider training, and collaborative efforts to reduce environmental factors that impact smoking.



Monthly activity reports from staff and providers, social media posts, participant record reviews, staff certifications, Florida Quitline reports, meeting minutes from Coalition and other area meetings, and media articles will be utilized to assure that outreach and education efforts are being made within the community.


Activity reports will be collected from staff and service providers, copies of media posts and articles will be maintained, as will minutes from Coalition and other area meetings.


wide problem/need?

Increases in public knowledge of: 1) the dangers of smoking and secondhand smoke, particularly during pregnancy 2) the resources available locally for cessation support 3) the positive health consequences of quitting smoking. Additionally, within the next five (5) years the overall rate of prenatal smoking within the catchment area will decrease to a rate less than twice the state rate for FY2012-13 (7.7%). The rate of Hispanic mothers smoking prenatally will decrease to less than 3 times the current state rate of 1.6% during the same period.


Staff reports, participant record reviews, consumer surveys and annual CHARTS statistical data on prenatal smoking available through the Health Department of Florida will be gathered.


Information will come from providers, staff, community events, Florida Quitline, and through the Florida Department of Health, Bureau of Vital Stats.


3. ACTION STEPS:


Individual Screening, Education & Support

1. All women who receive an Initial Contact through Healthy Start Care Coordination will be assessed for tobacco use.

Lead Agency for Care Coordination

Oct. 2016 Sep 2017

2. Tobacco users will be offered tobacco education and cessation support and provided information on the Florida Quitline and/or info on other methods of how to quit


Oct 2016 Sep 2017

3. The records of smokers will contain documentation of cessation counseling at each care coordination encounter including praise and reinforcement, and those services performed by certified counselors will be coded in WFS


Oct 2016 Sep 2017

Provider Training / Outreach

4. In conjunction with community partners, new care coordination service providers will be trained and certified n the use of SCRIPTS curriculum with HS participants who smoke or have household smoking.

Staff, Lead Agency for Care Coord., Community Partner (Drug Free Charlotte)

Oct 2016 Sep 2017

5. Area OB staff will receive information on smoking cessation referral procedures and/or cessation support resource info a minimum of three (3) times annually.

Staff, Comm. Liaison

Oct. 2016 Sep. 2017


6. The Coalition will provide information on the dangers of smoking and secondhand smoke during pregnancy at a minimum of 2 comm. presentation/events annually.

Staff, Lead Agency for Care Coordination, Comm. Liaison

Oct 2016 Sep 2017

7. With the CHIP MCH Subcommittee, the Coalition will assist in a media campaign to inform healthcare providers and the public on the dangers of smoking and secondhand smoke during pregnancy and the resources available for smoking cessation.

CHIP MCH Cmtee; Staff, Comm. Partners

Oct. 2016 Sep 2017

8. The Coalition will advocate for screening policies that mandate automatic referral to HS for smoking and/or substance use.

Staff, Board, Lead Agency for Care Coord.

Oct 2016 Sep 2017


9. Evaluate strategies for effectiveness and revise as needed

Staff, Data Committee; Board, Providers

Jun 2017 Aug 2017


PROGRESS REPORT AS OF DECEMBER 31, 2016:








ISSUE:



There is a need to increase the number of prenatal women with early entry to care within the service delivery area. Women who see a health care provider early and regularly during pregnancy have healthier babies, are less likely to deliver prematurely, and are less likely to have other serious problems related to pregnancy. In the 3-year period 2012 -2014, the rate of local women entering care in the first trimester of pregnancy declined by 1% from the previous 3 - year period and Charlotte County prenatal women continue to enter care during the first trimester of pregnancy at a lower rate (74.2%) than the state average of 79.8%, which also declined from the prior 3-year period. With reference to race and ethnicity, only the local rate of Hispanic mothers entering care in the first trimester increased from the prior 3-year period (73.3% to 75.4%). The rate of Charlotte County women reported as having “late or no” prenatal care increased slightly from 6.4% – 6.5% from the prior 3-year period and continues to exceed the state average of 5.0% for the same time frame. Charlotte County rates for “late or no” prenatal care also continue to be higher than state average for White and Black mothers (White 4.3% vs 5.9% State, Black 9.7% vs 6.8% State), however the rate of Hispanic mothers with late or no prenatal care fell below the State rate for the 3-year period (4.7% vs 5.1% State).


strategy?

This strategy will address low birth weight and premature birth.



Data from the Florida Department of Health, Office of Planning, Evaluation and Data Analysis and Vital Statistics, screening of Healthy Start participants, community and consumer surveys.



Steps to improve the rate of women entering care in the first trimester of pregnancy including: community outreach and education; expansion of access to services; provider outreach and education; reducing barriers to care; and the subsequent evaluation of the effectiveness of the strategies selected.




Monthly staff activity reports, monthly provider activity reports, report of applicable educational material distributed quarterly, copies of media articles and client/community surveys will be utilized to assure that outreach and education efforts are being made within the community.


Information will be collected from staff, service providers, healthcare providers, community partners, and the Department of Health.


wide problem/need?

• The community will have greater access to information on the availability of Pregnancy Medicaid.

• Within the next five years, the number of local prenatal women entering care in the 1st trimester will increase to a 3-year average of 77.9% in accordance with the Healthy People 2020 goal.

• Within the next five years, the number of local women with “late” or “no” prenatal care will decline to a 3-year average of 5.0%, or a rate equal or less than the State average


Statistical data for onset of care for area women will be gathered from the Florida Department of Health CHARTS site and the local office of Vital Statistics.


See above 3. ACTION STEPS:


Community Outreach and Education

1. Inform community on importance of early and regular prenatal care, availability of Pregnancy Medicaid, HS screening and/or HS services through traditional media, social media, public presentations etc. a min. of 4 times annually. (newsletters, e-alerts, 1st person testimonials, PSAs, community presentations, etc.)

Staff, Board, Lead Agency for Care Coord., Comm. Partners, CHIP MCH Cmtee,

Oct 2016 Sep 2017


2. Continue to participate in the CHIP Maternal/Child Health subcommittee and distribute Pregnancy Medicaid flyers at strategic locations available to the public.

Staff, Board, Comm. Partners

Oct 2016 Jun 2017

3. Continue to provide participants with approved culturally-appropriate educational materials

Staff and Lead Agency for Care Coord.

Oct 2016 Sep 2017

Expand Capacity for Services

4. Explore future funding sources/resources to augment the provision of prenatal care for financially qualified, uninsured, Medicaid-ineligible women.

Board, staff, Finance Cmtee

Oct 2016 Sep 2017

5. Monitor local MCH trends for potential barriers to care

Staff, Board, Data Cmtee., Lead Agency for Care Coord.

Nov. 2016 Sep. 2017

Provider Outreach and Education

6. Coalition will ensure at least 3 OB /Hosp. provider visits each month to provide current awareness and/or education information on HS screening and program services, including services for qualified, uninsured, Medicaid-ineligible prenatal women.

Staff, Board, CCHD

Oct 2016 Sep 2017

7. Coalition will participate in CHIP “Access to Care” Committee as advocate for MCH.

Staff, Board, Comm. Partners

Oct 2016 Sep 2017

8. Coalition will work with the local birthing facility staff to promote “best practice” of early entry to care (1st trimester) with OB providers.

Staff, Board, Comm. Liaison

Sep 2016 Sep 2017

Reduce Barriers to Care

9. Continue to monitor County plan for transportation improvements; explore funding sources for transportation vouchers, keep Coalition informed


10. Continue to explore and identify potential partners to assure continued availability of local PEPW intake

Staff and Board Oct 2016 Jun 2017

11. Obtain AHCA approval and use culturally-appropriate educational materials

Staff and Board Oct 2016 Jun 2017



Staff, Data Committee

Jun 2017 Aug 2017










ISSUE:



Pre-conception and inter-conception health education for women who may be at risk for poor future birth outcomes due to poor previous birth outcome or loss of an infant through death, adoption or removal from the home.


strategy?

Pre and inter-conception health issues such as poor pregnancy interval, obesity, poor nutrition, oral health, substance abuse, maternal infections, and a history of poor pregnancy outcomes are all factors that may contribute to premature births and incidents of low birth weight. Preterm births for the 3-year period 2012-14 occurred locally at a rate of 12.8%, above Florida’s Healthy People 2020 targeted rate of 11.4% Low birth weight births occurred in Charlotte County at a rate of 8.2% for the 3-year period of 2012-14, a rate that is higher than Florida’s Healthy People 2020 goal of 7.8% Statistical data for 2012-14 dictates that in addition to the indicators addressed earlier in this Action Plan, the following indicators need to also be addressed, along with associated racial and ethnic disparities:

• Black mothers in Charlotte Co. have the highest rate of preterm births (19.5%) and the highest percent of pregnancies with less than an 18-month interval between pregnancies (44.4%). (Healthy People 2020 has set a target goal for this measure at 29.8%.)

Additionally, Black mothers entered pregnancy with less than an 18 month interval between pregnancies at a rate 10% higher than white mothers (44.4% vs 34.4%).

• The overall rate of mothers who were obese at the time pregnancy occurred for the period of 2012-14 was 21.9%, higher than the state average for the same time period of 21.1%.

Again, the rate of Black mothers who were obese at time pregnancy occurred were almost 10% higher than the overall rate (31.6% vs 21.9%).


• The rate of Black mothers who delivered their infant(s) at less than 37 weeks gestation was 4.5% greater than the same rate for White mothers (16.9% vs 12.4%)



Data from the Florida Department of Health, Office of Planning, Evaluation and Data Analysis and Vital Statistics, annual Charlotte Co. MCH Health Problem Analysis, annual Florida Behavioral Risk Factor Surveillance System (BRFSS) Data Report, and participant records.



Outreach, education and training will be the focus of Coalition strategies to increase community awareness of the importance of pre and inter-conception health. Local outreach and education will support the efforts of Healthy Start Care Coordinators and health care providers.



Information gathered may include monthly staff and provider activity reports, monthly provider education reports, monthly community activity reports, volunteer activity reports, consumer and community surveys, community event reports, and area resource directories This info will be collected to assure that efforts are being made to educate the public on the importance of pre and inter-conception health, with emphasis on underserved populations.


Data will be collected from monthly/quarterly service provider reports, staff, Coalition members, Coalition databases, consumers, healthcare providers, community event participants, community partners, and the Florida Dept. of Health.


wide problem/need?

The Coalition goals are to improve future pregnancy outcomes by:

• Decreasing the rate of women with pregnancy interval of less than 18 months (35.1%) to a 3-yr average rate of 33.1% over the next 5 years.

• Reducing the rate of women who are obese upon entering pregnancy to a 3-yr. average of 20% over the next 5 years.

• Providing Level 3 services to a minimum of 12% of all prenatal program participants annually.

• Providing Level 3 services to a minimum of 10% of all infant program participants.



Data from the Florida Department of Health CHARTS site, Vital Statistics, annual Charlotte Co. MCH Health Problem Analysis, annual Florida Behavioral Risk Factor Surveillance System (BRFSS) Data Report, relevant media reports, screening of HS participants.


See above

****************************************************************************** 3. ACTION STEPS:



1. Through participation in DOH/Network/FAHSC conference calls, statewide meetings, and HS 2.5 workgroups, advocate for provider and staff training on “best practices” and effective service delivery

E.D., Board, Lead Agency for Care Coord.

Oct 2016 Sep 2017

2. Distribute educational materials on baby spacing, proper nutrition, pre & inter conception health and HS services to healthcare providers and underserved populations through office visits, social media and community events., a min. of four times annually.

Staff, Board, Members, CHIP MCH Cmtee, Baker Ctr., Housing Authority, churches

Oct 2016 Sep 2017

3. Identify & recruit potential partners to provide education on MCH/ICC issues at regularly scheduled General Membership meetings

Fund Dev. Educ. & Comm. Action Cmtee;

Oct 2016 Sep 2017

4. Develop media campaign on importance of “time to bond” and proper baby spacing to share with hospital, physicians, and comm. partners, i.e. housing authority, etc.

CHIP MCH Cmtee, Staff, Board, Media Consultant

Oct 2016 Sep 2017

5. Work with the local Health Dept. to support family planning services and provide WIC / nutritional counseling to prenatal women.

Staff, Lead Agency for Care Coord., HD – Char. Co.

Oct 2016 Sep 2017

6. Use AHCA approved, culturally-appropriate educational materials.

Staff, Lead Agency for Care Coord.

Oct. 2016 Sep 2017

Monitor Provider Services / Caseloads

7. Monitor monthly care coordination report / caseloads to assure effective needs assessment and care coordination for Level 3 participants

Staff, Lead Agency for Care Coord., Board

Oct 2016 Sep 2017

8. Monitor monthly Well Family System reports for Prenatal and Infant provider

Staff, Lead Agency for Care Coord.

Oct 2016 Sep 2017


services and, at a minimum report quarterly to the Board

9. Offer annual cultural competency / diversity training through facilitator presentation, on-line learning modules, webinar or via website links to Providers, staff and members.

Staff, Comm. Partners, Media Consultant

Oct 2016 Sep 2017



Board, Staff, Data Committee

Jul 2017 Sep 2017









ISSUE:



The Coalition will work to expand membership, build internal capacity to assess area maternal/child health needs and increase programmatic capacity to address those needs, in accordance with the Healthy Start Standards and Guidelines.


strategy?

According to F.S. 383.216 the Coalition must assess and identify the local need for comprehensive preventive and primary prenatal and infant health care, review and monitor the delivery of services and make necessary annual adjustments in the design of the delivery system, the provider composition, the targeting of services and other factors necessary for achieving projected outcomes.



This is a component of the Coalition’s contracts with the Florida Department of Health and the Healthy Start MomCare Network



Expand the identification and delivery of Healthy Start services through contract negotiation, data collection/reporting, monitoring, grant-writing, community/government partnerships, and fund-raising.



Performance reports, minutes/agendas of Board, General Membership, committee, staff and FAHSC meetings, with handouts; HS services/monitoring reports, Coalition newsletters, and media articles, and will assist the Board in assuring that activities support the Healthy Start mission.



Staff, provider and HS services reports generated monthly and quarterly; recorded meeting notes; written monitoring and performance reports are shared at regularly scheduled Board, General Membership and Committee meetings. d. What do you expect will be the observed impact of the strategy on the system or community-

wide problem/need?

Coalition Board and staff will have improved capacity to monitor the Coalition’s contractual obligations for funding, service provision and data collection compliance during this year of transition.


See B above.


See C above.

******************************************************************************

3. ACTION STEPS:


Expand Capacity for Service Provision

1. Continue to negotiate contracts for quality care coordination and wraparound services annually based on area needs; encourage expanded capacity for service provision

E.D., Staff, Board April 2017 June 2017

2. Monitor contracted providers for performance and Stds. & Guidelines’ compliance through monthly/qtrly reports and annual monitoring visits

E.D/Contr. Mgr., Staff

Oct 2016 Sep 2017

3. Monitor the performance of In-house MomCare services for compliance to Stds. & Guidelines and contractual obligations through monthly reports and qtrly record reviews

E.D./Contr. Mgr., staff, Board

Oct 2016 Sep 2017

4. The Coalition’s Data Committee (or a related special task force) will meet a minimum of three times per year to review

Staff, members, Board, comm. partners, Data

Oct 2016 Sep 2017


community MCH health indicators/trends, survey summaries, screening rates, and statistical data to prioritize needs and make action plan recommendations for Board consideration at regularly scheduled meetings.

committee, providers, volunteers

Expand Internal Capacity

5. Expand fund-raising efforts to support Coalition mission.

Fund. Dev., Educ. & Comm. Action Cmtee, Board, Staff

Oct 2016 Sep 2017

6. Explore grant opportunities to expand data and IT resources

Board, Staff Oct. 2016 Jun 2017

7. Advocate for education/training on use of, and updates to, data system

E.D., Board, Lead Agency for Care Coord.

Oct 2016 Sep 2017

Community Support / Outreach

8. Utilize education and training as mechanism to reach potential members

Fund Dev., Educ, & Comm. Action Cmtee, Board, staff

Oct 2016 Sep 2017

9. Identify a plan to keep local government informed on CCHSC and its activities

Board, staff Oct 2016 June 2017

10. Maintain / expand Board diversity for equitable representation of the community

Fund De., Educ. & Comm. Action Cmttee; Board, staff

Oct 2016 Sep 2017

11. Use General Membership meeting as mechanism to gather more input on HSC activities and capacity building



12. Evaluate strategies annually for effectiveness and revise as needed.

Board, Staff, Comm. Partners, Providers, Consultant

Jan 2017 Sep 2017

PROGRESS REPORT AS OF DECEMBER 31, 2016.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *





CATEGORY C ACTIVITY 16-17

Assisting Chemically Dependent Pregnant Women

And Substance Exposed Newborns

1. ANNUAL RESPONSIBILITIES FOR THIS POPULATION:

a. The Coalition must submit an action plan for assisting chemically dependent pregnant

women and substance-exposed newborns that includes action steps/strategies for

multi-agency collaboration, access to evaluations, treatment and services to substance-

exposed newborns.

b. The Coalition will submit quarterly Progress Reports that show documentation that

action steps of strategies chosen were implemented as planned or rationale as to why

they were not.


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

you make referrals for services needed?

The Coalition will continue to monitor and support the strategies implemented by the

Attorney General’s Prescription Drug Abuse and Newborn Task Force, such as “Born

Drug-Free Florida” and will work to promote intervention services for substance-

abusing women enrolled in Healthy Start. Area healthcare providers, including

birthing facilities, will be educated on Healthy Start services and encouraged to refer

pregnant women and substance-exposed newborns determined to be chemically

dependent to Healthy Start care coordination.

Motivational interviewing techniques will be used by Healthy Start care coordinators

to encourage chemically-dependent pregnant women to enter local treatment programs

and provide referral for those willing to participate. Caregivers of substance-exposed

infants referred to Healthy Start by the hospital will be offered support and provided

with resources to help care for the infant.

All chemically-dependent women and neonatal abstinence syndrome (NAS) infants in

the Healthy Start program will be monitored and tracked as Level 3 participants.

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

pregnant women and substance exposed newborns?

Reports from the Attorney General’s Task Force indicate that the incidents of drug

withdrawal for Charlotte County newborns increased significantly from two (2) in

2007 to twenty-one (21) in 2012.


Through assessment and referral for treatment, it is expected that the number of

substance-abusing women will decline and, subsequently, the number of NAS

infants.

The 2014 Progress Report from the Atty. General’s statewide Task Force states,

“Prevention programs that focus on providing education and awareness of the risks of

prescription drug abuse to pregnant women are cost-effective and can be life-saving.

Doctors and nurses well trained in drug addiction are the keystone to both preventing

and alleviating NAS.”

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

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

etc.)

Information will be gathered annually from the Florida Dept. of CHARTS reports,

Healthy Start Services reports, Vital Statistics, CDC, and Florida Behavioral Risk

Factor Surveillance System Data Report. In addition, relevant task force and media

reports, local NICU stats and information from the screening of HS participants will

be reviewed throughout the year.

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

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

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

information and goal)

It is hoped that 30% of those chemically-dependent pregnant women enrolling in a

treatment program will complete the program and that 20% will be drug-free

following the birth of their infants.

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

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

Data on the rate of reported substance-abusing prenatal women served through

Healthy Start will be monitored monthly in hopes that numbers served will increase.

In addition, the rate of substance-exposed infants will be monitored annually, in hopes

this rate declines.

******************************************************************************

3. ACTION STEPS – add as many as needed.


Action Step Pers. Responsible Start Date End Date

1.Awareness:

The Coalition will utilize

promotional opportunities, as


report, to promote substance-abuse

intervention services for pregnant

women who are chemically-

dependent.

The Coalition will educate OB

providers on the availability of HS

care coordination and referral for

substance-abuse intervention

services, through provider visits, as


report.

Continue to support the strategies

implemented by the Atty. General’s

Task Force and maintain the link in

the CCHSC website for parents to

visit the “BornDrugFreeFL” website

and obtain the Helpline number.

Board, Staff, Care

Coordinators

Comm. Liaison,

Staff, Care

Coordinators

Staff, Media

consultant

10/01/15

10/01/16

10/01/16

09/30/16

09/30/17

09/30/17

2. Referral:

Educate providers, staff and

community partners on the process

to refer for Healthy Start Care

Coordination services

Comm. Liaison,

Staff, Care

Coordinators

10/01/16 09/30/17


3. Interagency Collaboration:

Secure interagency agreements with

local resource organizations.

Work closely with staff at the local

birthing facility to ensure referral of

substance-exposed newborns to

Healthy Start care coordination

Staff

Staff, Board, Lead

agency for Care

Coordination

Ongoing

Ongoing

09/30/17

09-30-17

4. Care Coordination:

Perform services for substance-

abusing pregnant women and

substance-exposed infants in

accordance with Chapter 12 of the

HS Stds & Guidelines

Lead agency for

Care Coordination

Ongoing 09/30/17

******************************************************************************

Action Plan for FY July 1, 2016 – June 30, 20167 (use as much space as needed)

Awareness

The Coalition will work throughout the year to promote awareness of, and referral to, Healthy

Start services for at-risk pregnant women and infants through local presentations,

social/traditional media, and community events, as described within Category B of this report.


Awareness efforts will include emphasis on the need to refer chemically-dependent pregnant

women and NAS infants for Healthy Start care coordination services.

The Referral Process

Prenatal Women may be referred based on the following:

• Drug abuse by her own admission

• A positive drug screen result

• A staff member witnessing the use

• A report from a reliable source (trusted family member, professional)

• Response to screening question indicating use or abuse

• Further observation / assessment of substance abuse history / patterns of use

Infants who were prenatally exposed may be referred:

• By hospital staff

• By caregiver in need of education and support

• By physician, on behalf of caregiver

Service Collaboration / Interagency Agreements

The Coalition will maintain interagency agreements with local resource agencies:

• Charlotte Behavioral Health Care (residential treatment program)

• Bayfront Health – Port Charlotte (NICU)

• Healthy Families – Charlotte

• Dept. of Children and Families

• Drug Free Charlotte County

• Harbor Counseling, Methadone Program

Healthy Start Care Coordination

Pregnant chemically-dependent women or substance-exposed infants will be assigned as Level

3 (highest need) program participants.


Care coordinators will document:

• Healthy Start enrollment and all attempts to engage the woman in Healthy Start

• Comprehensive home assessment / substance use education / provision of support services / referrals / progress / follow up, in accordance with Chapter 12 of the Healthy

Start Standards and Guidelines

• Applicable pre-discharge home assessment, as per Chapter 12 of the HS Standards and

Guidelines

• Applicable reports to the Dept. of Children and Families (DCF) in accordance with Chapter 12 of the HS Standards and Guidelines

• Pertinent info on DCF representatives / investigators working with the family

• Transition to county health department, or inability to do so

Care Coordinators will also:

• Report to the Florida Abuse Hotline (1-800-96 ABUSE) if the infant or home

assessment reveals that the mother or caregiver is not able to care for the child

• Offer care coordination services to the birth mother, regardless of whether she has or will retain custody of her child.

Progress report: December 31, 2016

Services to Substance-Abusing Prenatal Women:

# Served: # of Services:

Dec. 2016

Mar 2017

June 2017

Sep. 2017


Substance-Exposed (NAS) Infants

# Served: # of Services

Dec. 2016

Mar. 2017

June 2017

Sep. 2017

******************************************************************************

4. REPORTING PHASE ANSWERS: (To be completed for the Annual Action Plan

Update)

a. Demonstrate that your action plan is reaching and making a difference for the

intended populations?

b. Will you drop/modify/expand/continue the action plan next year and explain why?


15. INDEX OF TABLES

Index of Tables

TABLE 1: SUMMARY OF FINDING FROM THE UPDATED NEEDS ASSESSMENT ..................................... 11

TABLE 2: MOTHERS WHO SMOKED DURING PREGNANCY ....................................................................... 22

TABLE 3: BIRTHS TO MOTHERS WHO SMOKED DURING PREGNANCY - COUNTS ................................ 22

TABLE 4: BIRTHS TO MOTHERS WHO SMOKED DURING PREGNANCY - ROLLING YEAR ................... 22

TABLE 5: BIRTHS TO MOTHERS WHO SMOKED DURING PREGNANCY – RACE ..................................... 23

TABLE 6: BIRTHS TO MOTHERS WHO SMOKED DURING PREGNANCY - ETHNICITY ........................... 23

TABLE 7: EARLY ENTRY TO CARE RATES- SINGLE YEAR ......................................................................... 24

TABLE 8: ENTRY TO CARE RATES - ROLLING REAR ................................................................................... 24

TABLE 9: BIRTHS TO MOTHERS WITH 3RD TRIMESTER OR NO PRENATAL CARE - COUNTY

COMPARISON ............................................................................................................................................ 24

TABLE 10: TRIMESTER CARE BEGAN BY AGE OF MOTHER - 2014 CHARLOTTE COUNTY ................... 25

TABLE 11: BIRTHS TO MOTHERS WITH 3RD TRIMESTER OR NO PRENATAL CARE - RACE ............... 25

TABLE 12: BIRTHS TO MOTHERS WITH 3RD TRIMESTER OR NO PRENATAL CARE - ETHNICITY ...... 26

TABLE 13: INTER-PREGNANCY INTERVAL LESS THAN 18 MONTHS - ROLLING YEAR ........................ 27

TABLE 14: POPULATION BY RACE .................................................................................................................. 28

TABLE 15: POPULATION DATA - ETHNICITY ................................................................................................ 28

TABLE 16: BIRTH RATES PER 1000 TOTAL POPULATION ............................................................................ 29

TABLE 17: BIRTH WITH INTER-PREGNANCY INTERVAL LESS THAN 18 MONTHS- ROLLING YEAR -

RACE ........................................................................................................................................................... 30

TABLE 18: BIRTHS WITH INTER-PREGNANCY INTERVAL LESS THAN 18 MONTHS - ROLLING YEAR -

COUNTY COMPARISON ........................................................................................................................... 30

TABLE 19: PRETERM BIRTHS- ROLLING YEAR- BY RACE - COUNTY COMPARISON ............................ 31

TABLE 20: BIRTHS TO MOTHERS WHO ARE OBESE – ROLLING YEAR - BY RACE ................................. 31

TABLE 21: BIRTHS TO MOTHERS WHO ARE OBESE - ROLLING YEAR - BY ETHNICITY ....................... 31

TABLE 22: DRUG-ABUSING WOMEN IDENTIFIED ........................................................................................ 32

TABLE 23: IDENTIFIED SUBSTANCE-EXPOSED INFANTS THROUGH HEALTHY START ....................... 33

TABLE 24: MEDIAN AGE, CHARLOTTE COUNTY AND STATE ................................................................... 35

TABLE 25: POPULATION PROJECTIONS, CHARLOTTE COUNTY ............................................................... 35

TABLE 26: POPULATION ESTIMATES - WOMEN OF CHILD-BEARING AGE CHARLOTTE COUNTY..... 36

TABLE 27: 2020 PROJECTIONS FOR CHARLOTTE COUNTY - WOMEN 15-44 ............................................ 36

TABLE 28: CENSUS DATA - COUNTY, STATE AND U.S. RACE AND HISPANIC ORIGIN ......................... 37

TABLE 29: CHARLOTTE COUNTY DEMOGRAPHICS - RACE ....................................................................... 37

TABLE 30: CHARLOTTE COUNTY DEMOGRAPHICS - ETHNICITY ............................................................. 38


TABLE 31: RACE COMPARISON - CHARLOTTE COUNTY AND STATE ...................................................... 38

TABLE 32: ETHNICITY COMPARISON - CHARLOTTE COUNTY AND STATE ............................................ 38

TABLE 33: TAXABLE SALES - CHARLOTTE COUNTY .................................................................................. 40

TABLE 34: HOUSING SALES AND BUILDING PERMITS................................................................................ 40

TABLE 35: HOUSING UNITS AND HOUSEHOLD SIZE - 2014 ........................................................................ 41

TABLE 36: SOCIOECONOMIC MEASURES FOR CHARLOTTE COUNTY ..................................................... 41

TABLE 37: EDUCATION RATES ........................................................................................................................ 42

TABLE 38: CHARLOTTE COUNTY PUBLIC SCHOOL SYSTEM ENROLLMENT DATA .............................. 43

TABLE 39: AREA COLLEGES AND UNIVERSITIES ........................................................................................ 44

TABLE 40: EARLY LEARNING AND SCHOLARSHIP DATA .......................................................................... 45

TABLE 41: MAJOR CAUSES OF DEATH ........................................................................................................... 46

TABLE 42: GENERAL HEALTHY LIFESTYLE INDICATORS ......................................................................... 47

TABLE 43: BINGE DRINKING - CHARLOTTE COUNTY ADULTS ................................................................. 50

TABLE 44: BIRTHS BY FACILITY TYPE........................................................................................................... 53

TABLE 45: BIRTHS BY ATTENDANT TYPE .................................................................................................... 53

TABLE 46: BIRTHS DELIVERED BY PHYSICIAN AND MIDWIFE ................................................................ 54

TABLE 47: FAMILY PLANNING SERVICES ..................................................................................................... 55

TABLE 48: IMMUNIZATION RATES BY KINDERGARTEN ............................................................................ 56

TABLE 49: ADULTS WITH ANY TYPE INSURANCE CARE COVERAGE ..................................................... 57

TABLE 50: PERCENTAGE OF ADULTS WHO COULD NOT SEE A PHYSICIAN DUE TO COST................. 58

TABLE 51: BIRTHS COVERED BY MEDICAID ................................................................................................ 58

TABLE 52: PERCENTAGE WHO COULD NOT SEE A DENTAL DUE TO COST ............................................ 59

TABLE 53: OVERVIEW OF MCH FACTORS WITH HEALTHY PEOPLE 2020 ............................................... 60

TABLE 54: ADDITIONAL KEY MCH FACTORS ............................................................................................... 61

TABLE 55: TOTAL RESIDENT LIVE BIRTHS ................................................................................................... 62

TABLE 56: BIRTH RATES, MULTI-COUNTY.................................................................................................... 62

TABLE 57: FETAL DEATHS................................................................................................................................ 63

TABLE 58: INFANT DEATH RATES .................................................................................................................. 63

TABLE 59: INFANT DEATHS BY RACE, ROLLING YEAR RATES ................................................................ 64

TABLE 60: INFANT DEATHS BY ETHNICITY, ROLLING YEAR RATES ...................................................... 64

TABLE 61: LOW BIRTH WEIGHT RATES ......................................................................................................... 65

TABLE 62: MULTI-COUNTY DATA LOW BIRTH WEIGHT ............................................................................ 65

TABLE 63: BIRTHS UNDER 2500 GRAMS (LOW BIRTH RATE) BY RACE ................................................... 66

TABLE 64: BIRTHS UNDER 2500 GRAMS (LOW BIRTH RATE) BY ETHNICITY ......................................... 66

TABLE 65: MULTI-COUNTY COMPARISON - LOW BIRTH RATE BY RACE/ETHNICITY ......................... 66

TABLE 66: VERY LOW WEIGHT BIRTH RATES .............................................................................................. 67

TABLE 67: VERY LOW BIRTH WEIGHT RATE BY RACE - STATE AND COUNTY ..................................... 67


TABLE 68: VERY LOW BIRTH WEIGHT RATE BY ETHNICITY - STATE AND COUNTY ........................... 67

TABLE 69: MULTI-COUNTY VERY LOW BIRTH WEIGHT RATES ............................................................... 68

TABLE 70: CESAREAN SECTION DELIVERIES, SINGLE YEAR RATES ....................................................... 68

TABLE 71: CESAREAN SECTION DELIVERIES - 3 -YEAR ROLLING RATES .............................................. 69

TABLE 72: CESAREAN SECTION DELIVERIES BY RACE AND ETHNICITY ............................................... 69


16. INDEX OF FIGURES

FIGURE 1: LABOR FORCE AND UNEMPLOYMENT IN CHARLOTTE COUNTY ......................................... 39

FIGURE 2: EDUCATION DEGREE ..................................................................................................................... 42

FIGURE 3: HEALTH RANKINGS COMMUNITY HEALTH ASSESSMENT 2015 ............................................ 47

FIGURE 4: ADULTS WHO ARE CURRENT SMOKERS .................................................................................... 51

FIGURE 5: SMOKING RATES BY SEX .............................................................................................................. 52

FIGURE 6: HEALTH PROVIDERS PER 100,000 ................................................................................................. 56

FIGURE 7: ADULTS WITH PERSONAL DOCTOR ............................................................................................ 57

FIGURE 8: LIVE BIRTHS, ROLLING YEAR RATES ......................................................................................... 61


17. EXHIBITS

EXHIBIT 1: COALITION GENERAL MEMBERSHIP ....................................................................................... 170

EXHIBIT 2: BOARD OF DIRECTORS ............................................................................................................... 172

EXHIBIT 3: LOGIC MODEL/FISHBONE .......................................................................................................... 174

EXHIBIT 4: PREGNANCY SPACING ................................................................................................................ 175

EXHIBIT 5: EDUCATIONAL WORKSHOPS AND PRESENTATIONS ........................................................... 176

EXHIBIT 6: BYLAWS UPDATE ........................................................................................................................ 178

EXHIBIT 7: POLICY AND PROCEDURE UPDATES ....................................................................................... 192


Exhibit 1: Coalition General Membership

21BCharlotte County Healthy Start Coalition, Inc. Membership Roster

Company Description Last First

AUTISM SPEAKS Comm. service/support MORRIS MAUREEN

BAYFRONT HEALTH PORT

CHARLOTTE Health Care Provider

BECKMAN ELIZABETH

TUCKER AMY

CARE (Crisis and Rape Emergency) Comm. service/support LUSK LINDA

TODD SUE

CATHOLIC CHARITIES Faith-based HERIGODT ANDY

CHARLOTTE COUNTY PUBLIC

SCHOOLS/ CHILDREN AND

FAMILIES FIRST

Public School System WATTS MAUREEN

COUNCIL OF CATHOLIC WOMEN Faith-based SAWNEY ANNE

CHARLOTTE BEHAVIORAL

HEALTH CARE INC

Health Care Provider

SCANLON VICKIE

GEIBLER JEAN

MARTELL JESSICA

CHARLOTTE CO. HEALTH DEPT. Health Care Provider

MAYS SHARON

MONVILLE ANNE

NUGENT DIANNE

SMITH TAMMY

ZIEGLER CHRIS

CHARLOTTE COUNTY FIRE & EMS Gov't Service HAWKINS DEE

CHARLOTTE COUNTY HOMELESS

COALITION

Comm. service/support

HOGAN ANGELA

OVERWAY MICHAEL

CHARLOTTE COUNTY HUMAN

SERVICES Information/Referrals

ANDREWS FAEZEH

CONNOR ALTHEA

COMMUNITY

ADAMS RUTH

JAMES CATHY

MASHINTONIO CHRIS

POPE SARAH

STEVENS JACQUIE

VAN NOSTRAND COURTNEY

WALKER SANDI

DEPT OF CHILDREN & FAMILIES Gov't Service STITT AARON

DEPT OF ED DIV OF BLIND SVCS Gov't Service BUTLER LAKICIA

DRUG FREE CHARLOTTE COUNTY Comm. service/support RAMSEYER DIANE

EARLY LRING COAL OF FL

HEARTLAND Comm. service/support

BOUHEBENT ANNE

SLOAN HELENA

FELLOWSHIP CHURCH Church CLARK ELYSE

FDLRS Public School System DEGILIO CINDY

GULF CENTRAL EARLY STEPS Comm. service/support FRYE BECKY

BARGER KIM

GULFCOAST SOUTH AHEC

Educational Service

MORA ANSLEY

ROSADO-MERCED XENIA


HEAD START /BAKER CENTER Public School System HANSEN NICOLE

HEALTHY FAMILIES CHARLOTTE

COUNTY Comm. service/support

BENJAMIN BONNIE

NEWMAN LINDA

KIWANIS Service Organization LEVASSEUR STEVE

MARCH OF DIMES Comm. service/support CHRISTIAN TRICIA

OB/GYN Health Care Provider COFFEY DR MICHAEL

PREGNANCY CARELINE Comm. service/support BRYNES JEANNINE

PUNTA GORDA HOUSING

AUTHORITY Housing WILMAN PAULA

STAYWELL HEALTH PLAN Managed Care Org. HOY SANDY

SUNRISE KIWANIS Service Organization THRASHER CONNIE

SW FLORIDA COMM FOUNDATION Community Foundation DOUGLAS ANNE

THE ACADEMY Public School System HAMM JACK

UNITED WAY OF CHARLOTTE CO Service Organization HUSSEY CARRIE

VIRGINIA B. ANDES Health care Provider ROBERTS SUZANNE

ZONTA CLUB Service Organization WILSON JUDI


Exhibit 2: Board of Directors

Board of Directors Term Ends

Karalee Anderson 2 yr. Term OCT 2017

2615 Myrtle Avenue Tel: 941-815-0646 1st term

Punta Gorda, FL 33950 Email: [email protected]

Anne Bouhebent 1 yr. Term OCT 2016

Executive Director 1st term

Early Learning Coalition of FL Heartland Tel: 941-255-1650 Ext. 127

2886 Tamiami Trail, Suite 1 Fax: 941-255-5856

Port Charlotte, FL 33952 Email: [email protected]

Elyse Clark 3 yr. Term OCT 2018

474 S. McCall Road Tel: 941-270-0665 1st term

Englewood, FL 34223 Email: [email protected]

Andy Herigodt 3 yr. Term OCT 2017

Catholic Charities Tel: 863-494-1068 1st term

1210 East Oak St. Fax: 863-494-1671

Arcadia, FL 34266 Email: [email protected]

Steve LeVasseur 3 yr. Term OCT 2018

Residential Contractor/Real Estate Salesman Tel: 941-875-2330 1st term

LeVasseur Building & Remodeling Email: [email protected]

7426 Ashtabula Street

Englewood, FL 34224

Chris Mashintonio 3 yr. Term OCT 2017

P.O. Box 380147 Tel: 941-421-9479 2nd term

Murdock, FL 33938 Email: [email protected]

Sharon Mays, Treasurer, 3 yr. Term OCT 2018

FL Department of Health Tel: 941-624-7260 2nd term

1100 Loveland Blvd. Email: [email protected]


Michael Overway, Vice Chair, 3 yr. Term OCT 2016

Charlotte County Homeless Coalition Tel: 941-627-4313 1st term

P.O. Box 380157 Fax: 941-627-9648

mailto:[email protected]







Murdock, FL 33938 Email:

[email protected]

Anne Sawney, Secretary, 3 yr. Term OCT 2016

21233 Knollwood Ave. Tel: 941-625-7708 2nd term


Sue Todd 3 yr. Term OCT 2017

C.A.R.E. Victim Advocate Tel: 941-475-6465 1st term

7041 Placida Road Fax: (941) 475-7715

Englewood, FL 34224 Email: [email protected]

Paula Wilman, Chair, 3 yr. Term OCT 2016

Punta Gorda Housing Authority Tel: 941-639-4344 1st term

340 Gulf Breeze Avenue Fax: 941-456-0635

Punta Gorda, FL 33950 Email: [email protected]

Judith Wilson 3 yr. Term OCT 2017

22212 Little Falls Ave. Tel & Fax: 941-380-0877 2nd term







Logic Model

Exhibit 3: Logic Model/Fishbone


Pregnancy Spacing – Child Health USA

Exhibit 4: Pregnancy Spacing


Exhibit 5: Educational Workshops and Presentations

22BEducational Workshops / Presentations

Charlotte County Healthy Start Coalition, Inc.

2010 – 2015

Year Topic

2010 Teen Parenting / The H.O.P.E. Program

Electronic Birth Registration & HS Infant Risk Screening Overview

Non-CHD HMS Training

Healthy lifestyles

Fiscal Accountability

Cultural Diversity & Competency

2011 Substance Abuse and Substance Exposure

Health Literacy

Community Inclusion

Strategic Planning

Dept. of Children & Families / Available Service

Florida Poison Control Center / Poison Prevention in the Home

Building Better Boards

Crisis and Rape Emergency (CARE) Services

Habitat for Humanity / Eligibility

2012 Home Health Safety for Children

Goodwill Job-Link

2-1-1 Information Center - Overview

HS Care Coordination Program Services / Overview

Strategic Development / Coalition Assessment

Faces of Homelessness

Charlotte Co. 10-yr. Plan to End Homelessness

Early Learning Coalition - Overview

2013 Family Planning Initiative

Developmental Disabilities

Postpartum Depression and Psychosocial Counseling

Strategic Planning / Service Delivery Planning

Well-Baby Care

Infant Immunization

Engaging High-Risk Moms – Provider Training

HS Redesign Overview

Cultural Competency Training

2014 ACES (Adverse Childhood Experiences)

Breastfeeding & the WIC Peer Counseling Program


CCHS Data Review & Strategies Input

ELC of Florida’s Heartland – Overview

Board Self-Evaluation / Strategic Planning

Identity Theft Prevention

Cultural Competency Training

2015 Healthy Families Program Services & Referral Overview

Hospice Children’s Services

Domestic Violence & its Effect on Women and Children

Cultural Competency

Drowning Prevention

2016 Human Trafficking and Precautions to Take

Live the Green Dot

Bridges Out of Poverty

Service Delivery Plan – Community Panels and Board Presentations


Exhibit 6: Bylaws Update

Bylaws - Update

Charlotte County

Healthy Start Coalition, Inc.

BY LAWS

Adopted: 09/13/2000

Amendment #1, Article 7, Section 1: 07/11/2001

Amendment #2, Article 4, Section 3B, Paragraph 1: 02/27/2002

Amendment #3, Article 4, Section 3C: 11/27/2002

Amendment #4, Article 3: 01/22/2003

Amendment #5, Article 4, Section 1: 03/08/2006

Amendment #6, Article 4, Section 3, Paragraph G: 03/08/2006

Amendment #7, Article 7, Section 1 04/12/2006

Amendment #8, Article 8, Section 1 08/09/2006

Amendment #9 Article 9, Section 4 03/14/2007

Amendment #10 Article 7, Section 1 08/12/2015


BY LAWS OF

THE CHARLOTTE COUNTY HEALTHY START COALITION, INC.

ARTICLE ONE: MISSION

Section 1. Purpose

The Charlotte County Healthy Start Coalition is authorized under the authority of the

Department of Health to implement the provisions of Florida’s Healthy Start legislation within

Charlotte County.

It is the intent of the Healthy Start legislation to provide access to prenatal care for all pregnancy

women and services for infants that promote normal growth and development.

Section 2. Goals

The Charlotte County Health Start Coalition shall endeavor to meet the following goals:

A. To identify the existing economic, social, and geographic barriers to maternal and

child health care.

B. To identify existing and potential resources for serving pregnant women and infants.

C. To assure that an adequate number of health care providers are available to assist the

under-served populations of pregnant women and infants.

D. To establish a partnership between the private and public sector, state and local

government, community alliances and networks, and maternal and child health care providers to

provide community-based coordinated care for pregnant women and infants.

Section 3. Responsibilities

In carrying out the intent of the Healthy Start legislation, the Charlotte County Coalition shall be

responsible for developing a maternal and infant health plan in accordance with Department of

Health Rule 10-D-113 F.A.C. which shall include but is not limited to the following:

A. Conduct a comprehensive community needs assessment to identify the need for

preventive and primary health care of pregnant women and infants; existing resources; and

barriers to service. These assessments shall be used to:

1. Determine the target priority groups for receipt of care.

2. Determine outcome performance objectives.


3. Identify local potential providers of services.

B. Develop a Charlotte County prenatal and infant health care service delivery plan

consistent with community objectives which incorporates all Healthy Start requirements.

C. Identify and recruit service providers and define the role of each in the service

delivery plan.

D. Participate and advise in the allocation process for available Federal, State, and

local resources.

E. Review, monitor, and advise the Family Health Services Coalition Contract Manager

concerning the performance of the service delivery system and suggest annual adjustments, if

necessary, in the design of the delivery systems, the provider composition, targeting of services,

and other factors necessary for achieving projected outcomes.

F. Build broad-based community and regional support.

ARTICLE TWO: OFFICE

Section 1. Principal Office

The principal office of this Coalition in the State of Florida shall be located in the city where the

Chairperson resides or is employed.

ARTICLE THREE: MEMBERSHIP

Section 1. General Membership

The membership of the Coalition shall consist of non-voting general members and voting general

members.

A. General members shall consist of all persons who reside, or are employed, or who

represent agencies who provide services in the Charlotte County service area who express an

interest in achieving the goals and objectives of the Coalition. All general members must

complete a Membership Application prepared by the Coalition. Only those general members

described in Subparagraph E shall be entitled to vote on Coalition matters, including, but not

limited to election of the Board of Directors.

Non-voting general members may give public comment at Coalition meetings; but, they

shall not be entitled to vote on any Coalition matters, including, but not limited to, the election of

the Board of Directors.


B. Efforts shall be made to insure that the membership is representative of the

community at large and will be representative of the racial, ethnic, and gender composition of the

communities and to the extent possible shall include the following:

1. Consumers of family planning, primary care, or prenatal care services.

2. County Health Departments.

3. Community Health Centers.

4. Hospitals, birthing centers, and other providers of maternity and/or infant care services

in the Coalition area.

5. Local medical societies.

6. Local maternal and child health advocacy interest groups and community

organizations.

7. Local health planning organizations.

8. County and municipal governments.

9. Social service organizations.

10. Local education communities.

11. Community organizations who represent or serve the target population.

12. Children’s Medical Services.

13. Local churches, synagogues, and other religious organizations.

C. Efforts shall be undertaken to insure that at least two of the members are low-income

consumers or Medicaid-eligible consumers.

D. The Board of Directors shall have the power and authority to create any additional

specific Membership classifications with voting or non-voting rights and limit the number of

Members in each classification.

E. General members who are entitled to vote on any Coalition matter, including,

but not limited to election of the Board of Directors, shall consist of the following persons:

1. Persons who represent those particular agencies or organizations that are

described in Chapter 64F-2.003, Florida Administrative Code, as amended, or

evidenced by a duly executed “Appointment of Authorized Voting

Representative Form” prepared by the Coalition. Only one such

representative from each agency or organization shall be entitled to vote. An


individual voting general member shall represent one such agency or

organization, and shall be entitled to one vote.

2. Persons who are consumers of family planning, primary care, or prenatal care

services, who, or a member of their immediate family, has received such

services in the past two years.

3. Persons who reside or are employed or who represent agencies who provide

services in the Charlotte County service area who are general members; but

who are not employed or otherwise affiliated with those agencies or

organization who already are represented by persons described in

Subparagraph 1. above. The purpose of this subsection is to limit such

organizations or agencies to only one vote at any such voting taken of voting

general members.

Section 2: Conflict of Interest

A member shall abstain from voting, or the Board of Directors, by majority vote, shall disqualify

said member from voting on an issue when a conflict of interest exists; e.g., personal or financial

benefits could result from outcome of the vote, inuring to said member or the organization to

which he/she represents. “Conflict” or “Conflict of Interest” is defined as a situation in which

regard for a private interest tends to lead to disregard of a public duty or interest. Examples of

such “conflicts of interest” include, but are not limited to, fund allocation issues, RFP proposal

reviews, and awarding of contracts.

Section 3: Voting

The annual general membership meeting shall be held in the month of October of each year. At

such annual meeting, only voting general members shall be entitled to vote for the election of

members to the Board of Directors. Only voting general members shall have the right to vote

upon any matter which requires a vote of the membership of the Coalition. In the absence of a

voting general member, the present non-voting members who represent the same agency or

organization may designate one person to represent their agency or organization as the voting

general member for that particular membership meeting.

Section 4: Property Rights

No member shall have any right, title, or interest in any of the property or assets of the Coalition,

nor shall any such property or assets be distributed to any member on the dissolution or winding

up thereof.

Section 5: Liability of Members

No member of this committee shall be personally liable for any of its debts, liabilities, or

obligations, nor shall any member be subject to any assessment.


ARTICLE FOUR: COALITION BOARD OF DIRECTORS

Section 1: Number of Board Members

The authorized number of Board members of the Coalition shall not be less than ten nor more

than eighteen. The Board will include representatives of the county health department, standing

committee members, consumer, health care providers, private businesses, and others to insure a

broad representation of the membership.

A. All members of the Board shall reside or work in Charlotte County, be a Coalition

member, and agree to perform the assigned duties.

B. Coalition Board members shall participate regularly in meetings of the Coalition and

general membership. Board members shall not miss more than three (3) consecutive meetings

without reasonable excuse to retain their status as a Board member.

C. Each Board member shall be responsible for participating in the business of the

Coalition through assigned committees, special assignments, or projects.

Section 2: Powers

All management functions shall be vested in the Coalition Board which may delegate the

performance of any duty or the exercise of any type of powers to such officers and agents as the

Board may from time to time, by resolution, designate. The Coalition Board members shall

provide direction to the Coalition, establish an annual budget for expenses, programs and

projects and monitor the expenditures in accordance with the adopted budget.

It shall meet at such times as required by the By-Laws and supervise the development of a

prenatal and infant care plan which identifies needs of women and infants in Charlotte County,

developing recommendations and priorities to meet those needs in accordance with the Healthy

Start program of Florida. The Board shall be empowered to enter into contracts or agreements

with agencies or individuals as appropriate and obtain funding sources as appropriate to carry out

the purpose of the Coalition.

Section 3: Appointment, Election, and Replacement of Board Members

A. The Coalition Board shall be made up of the representatives as outlined in Article 4,

and other members elected in accordance with the laws of the State of Florida and these By-

Laws.

B. Election and Term of Office:


Any member of the Coalition is qualified to serve on the Board. Board members shall be elected

annually at the annual meeting of the Coalition, and each Board member shall hold office for

three (3) years.

Notwithstanding the above, the initial Board of Directors named in the Articles of Incorporation

shall serve the following terms: one-third (1/3) of the initial Directors shall serve for a term of

three (3) years; one third (1/3) of the initial Directors shall serve for a term of two (2) years; and

one third (1/3) of the initial Directors shall serve for a term of one (1) year. Said terms shall

commence upon the incorporation of the corporation and said Directors shall hold office until the

respective third, second, and first annual meeting of the membership, as appropriate.

1. Not less than two meetings preceding the annual meeting, the Secretary shall provide

or cause to provide written notification to the general membership of the Board Members’ terms

scheduled to expire, and shall announce the deadline for receipt of nominations from the

membership.

2. Not less than thirty (30) days preceding the annual meeting, the Nominating

Committee shall meet and nominate persons to serve on the Coalition Board. The Committee

will establish a deadline for receipt of additional nominations from the membership of voting

general members.

3. The names of persons nominated shall be provided to the general membership of

voting general members not less than fourteen (14) calendar days prior to the annual meeting.

4. Any voting member of the Coalition may nominate additional persons to the Board.

5. Elections at the annual meeting shall be conducted by written ballot of the voting

general members present at the meeting.

C. Board members shall serve no more than two (2) consecutive terms. This limitation

shall commence with regards to the Board members elected respectively at the October 2002,

October 2003, and October 2004 annual meetings.

D. Vacancies on the Board shall exist on the death, resignation, or removal of any

Director or whenever the number of Directors authorized is increased. Vacancies shall be filled

for the unexpired portion of the term by a majority vote of the remaining Board members.

E. Any Director or officer may be removed, with cause, by a vote of two-thirds (2/3) of

the Board or three-fourths (3/4) of the general membership present at a special meeting called for

that purpose by a majority of the members. The secretary shall determine whether a majority of

members is present, based on current list of membership. At such a meeting, the vacancy caused

by the removal may be filled, as provided herein.


F. If any officer of the Coalition is unable to complete their term, replacement shall

occur as follows:

1. Chairperson cannot complete term: Vice Chairperson shall become Chairperson: the

Board will elect a new Vice-Chairperson from within its members.

2. Vice Chairperson, Secretary or Treasurer cannot complete term: the Board will elect a

new officer from its members.

G. The term of any Board member missing three (3) consecutive regular meetings

without notification and cause shall be declared vacant.

H. The Board members shall provide direction to the Coalition, establish an annual

budget for expenses, programs, and projects and monitor expenditures in accordance with the

adopted budget. It shall meet at such times as required by the By-Laws and supervise the

development of a prenatal and infant health care plan which identifies needs of women and

children in Charlotte County, develop recommendations, and priorities to meet those needs in

accordance with the Healthy Start Program for Florida. The Board shall be empowered to enter

into contract agreements with agencies or individuals as appropriate to carrying out the purpose

of the Coalition.

Section 4: Voting

A. Each member of the Board may have one vote. A designated representative may be

used for voting. Designation of a representative must be in writing.

B. A quorum of majority of the Coalition Board shall be required for the Board to

conduct business.

C. Decisions shall be made by a simple majority vote of the Board members present and

voting.

Section 5: Compensation

No Director shall receive any compensation from the corporation. Reasonable expenses, if

approved by the Coalition Board, may be reimbursed.

ARTICLE FIVE: MEETINGS

Section 1: Regular and Special Meetings

A. Regular meetings of the Coalition membership shall be held at least four (4) times a

year at a time designated by the Coalition Chairperson. The membership shall be informed by

mail of the time and place and agenda of the meeting, unless otherwise instructed.


B. Special meetings of the general membership shall be held whenever called by the

Chairperson, or on written request of at least fifty percent (50%) of the voting general members,

or fifty percent (50%) of the Coalition Board. Said meetings require at least forty-eight (48)

hours advance notice by mail or by phone, and such notice shall specify the nature of any and all

business to be conducted at the meeting.

C. The Coalition Board shall meet at least bi-monthly.

Section 2: Quorum

At least a majority of Board members shall constitute a quorum at all regular and special

meetings of the general membership.

Section 3: Chairperson and Vice-Chairperson

Meetings of the general membership and Coalition Board shall be presided by the Chairperson of

the Board or the Vice Chairperson of the Board, in his or her absence. The Board of Directors, at

the annual meeting, shall elect one of its members as Chairperson, and another of its members as

Vice Chairperson, who both shall serve until the next annual meeting.

Section 4: Minutes

Minutes of all meetings will be taken and distributed to all Board members prior to the next

scheduled meeting.

ARTICLE SIX: OFFICERS OF COALITION

Section 1: Designation of Officers

The Officers of the Coalition shall be Chairperson of the Board of Directors, the Vice-

Chairperson of the Board of Directors, the Secretary, and Treasurer.

Section 2: Election and Term of Office

Officers shall be elected by the Board of Directors at the annual meeting in October of each year.

The term of each office shall be for one (1) year.

Section 3: Vacancies

A vacancy in any office, whether due to health, resignation, removal, disqualification, or

otherwise, may be filled by the Coalition Board for the unexpired portion of the term, to be

ratified or amended by the general membership at their next regular meeting. Notice of such

action is to be provided to the general membership not less than fourteen (14) days in advance of

that meeting.


Section 4: Chairperson

The Chairperson of the Board of Directors shall preside over the Coalition and shall exercise

general supervision and control over all activities of the Coalition. He or she shall preside at all

meetings of members and Board of Directors, and shall perform all duties incident to that office

and such other duties as prescribed by the Board of Directors. The Chairperson will set the

Agenda and forward it to the Secretary to be included with the mailings.

Section 5: Vice-Chairperson

In the absence of the Chairperson of the Board of Directors, or in the event of the Chairperson’s

refusal or inability to act, the Vice-Chairperson shall perform the duties of the Chairperson, and

when so acting, shall have all of the powers of, and be subject to, all of the restrictions upon the

Chairperson. The Vice-Chairperson shall perform such additional duties as may from time to

time be assigned by the Chairperson or by the Board of Directors.

Section 6: Secretary

The Coalition Secretary shall keep minutes of the Board meetings, shall keep or cause to be kept

at the principal office of the Coalition, or such place as the Board may order, a book of minutes

of all meetings of the Board, and general membership, recording therein the time and place of

holding, names of those present and the proceedings thereof, whether regular or special, how

authorized and advertised. The Secretary shall see that all notices are duly given in accordance

with these By-Laws or as required by law, and shall perform all other duties delegated to that

office. The Secretary shall keep or cause to be kept at the principal office of the Coalition a

membership list containing the name and address of each member. The Secretary of the

Coalition shall perform secretarial duties for nominating committee, if desired.

Section 7: Treasurer

The Treasurer shall have custody of and be responsible for all monies of the Coalition, and shall

keep an accurate record of all receipts and expenditures, pay out all funds approved by the

Coalition Board; and, in general, perform all duties incidental to the office of Treasurer and such

other duties as may from time to time be assigned to him/her by the Chairperson or Coalition

Board. The Treasurer shall render to the Board of Directors upon request, an account of any or

all of the transactions of the Coalition and of the financial condition of the Coalition. The

Treasurer shall prepare or cause to be prepared an audit and certification of the corporate

financial statements at such times as may be authorized by the Directors.

Section 8: Executive Directors

The Executive Director of the Coalition shall be selected and employed by the Board of

Directors, who shall determine the terms of his or her employment. Functions of the Executive

Director shall include, but not be limited to:


1. Carrying out the policies of the Board of Directors

2. Selections, employment, and supervisions of all other employees

3. Investigating existence of and contacting research and planning grants which can

assist the Coalition in carrying out its functions.

4. Representing the Board of Directors in dealing with the public and other agencies.

5. The oversight of all committee activities

6. The building of community support for the Coalition and the recruitment of new

Coalition members.

7. Exercise general supervision and control over all activities and responsibilities of the

Coalition as established by Rule 10D-114, Florida Administrative Code, as amended.

Section 9: Removal

Any officer or agent appointed or elected by the Coalition may be removed from office by the

Coalition Board whenever in their sole judgment, the best interest of the Coalition will be served

thereby, or if other cause exists for removal.

ARTICLE SEVEN: COMMITTEES

Section 1: Standing Committees

The Board of Directors has established the following standing committees to help the Coalition

achieve its’ mission and goals:

A. Personnel Committee – The Personnel Committee shall consist of not less than three (3)

Board Members. One of them shall be appointed the chairperson of the Committee. The

purpose of the Personnel Committee is to advise the Board and executive director on issues

pertaining to the Coalition’s personnel policies and procedures; conduct the executive

director’s annual performance evaluation and advise the executive director about issues

pertaining to employees’ grievances.

B. Finance Committee – The Finance Committee shall consist of not less than three (3) Board

Members. At least one of them shall be the Treasurer of the Board who shall serve as

chairperson of the Committee. The purpose of the Finance Committee is to advise the

Board and executive director on the financial and banking matters of the Coalition; review

and evaluate financial policies, procedures, statements, audits and budgets; approve

borrowing of short and long term funds as necessary; review annually the Coalition’s

insurance coverage, and advise the Board and staff on contract allocation and management,

and in matters related to quality assurance/insurance.

C. Bylaws Committee – The Bylaws committee shall consist of not less than three (3) Board

Members. One of them shall be appointed the chairperson of the Committee. The purpose

of the Bylaws Committee is to provide guidance to the Board in the interpretation and

requirements of the Coalition’s Bylaws as well as preparing and submitting for approval

any proposed changes.

D. Data Committee – The Data Committee shall consist of Coalition members in good

standing. The chairperson of the Committee shall be elected by the Committee members


and at least one member of the Committee shall be a member of the Board of Directors.

The purpose of the Data Committee is to identify, analyze, and monitor relevant

information on health indicators, trends and disparities that may impact pregnancy

outcomes and infants’ normal growth and development in Charlotte County.

E. Nominating Committee - The Committee shall consist of Coalition members in good

standing. The committee shall consist of not less than three (3) Board Members. One of

them shall be appointed the chairperson of the Committee. The purpose of the Committee

is to recruit members for the Coalition; provide new members with an orientation to the

Coalition/Board, incentives and a welcoming package; and to nominate candidates for the

Board of Directors.

F. Fund Development, Education and Community Action Committee – The Committee shall

consist of Coalition members in good standing. The committee shall consist of not less than

three (3) Board Members. One of them shall be appointed the chairperson of the

Committee. The purpose of the Committee is to assist staff with fund raising and public

awareness events; coordinate themed-sponsored-meetings with staff; and through an

annual survey identify member satisfaction, topics of interest and potential speakers

Section 2: Study and Ad Hoc Committees

The Board of Directors may establish and prescribe the purpose, powers, and duties of ad hoc

committees which may be needed to help the Coalition carry out its objectives.

Section 3: Accountability

The chairperson of each committee shall report to, and be accountable to, the Board of Directors.

The chairperson of each committee shall present reports of its activities from time to time to the

Chairperson of the Board of Directors, at such intervals as the Chairperson of the Board of

Directors may require. The Chairperson of the Board of Directors shall coordinate action taken

by the various committees, and shall monitor the completion of Coalition Action Plan activities

in order to ensure that committee assignments are completed as required.

ARTICLE EIGHT: GENERAL PROVISIONS

Section 1: Fiscal Year

The fiscal year shall begin July 1, and end June 30, each year.

Section 2: Parliamentary Procedure

Parliamentary procedures for all meetings of members, directors, and committees shall be in

accordance with the Robert’s Rules of Order, as most recently revised, unless suspended by

majority vote of those present and voting at any meeting.


ARTICLE NINE: CONTRACTS, CHECKS, DEPOSITS, AND FUNDS

Section 1: Contracts

A. The Coalition Board may, by resolution duly adopted, authorize any officer or

officers, agent or agents of the Coalition, in addition to the officers so authorized by these By-

Laws to enter into contract or to execute and deliver any instrument in the name of and on behalf

of the Coalition. Except for purchases which do not exceed Five Hundred ($500.00) dollars, no

contract entered into by such officers or agents shall be binding upon the Coalition unless such

contract has been either authorized or ratified by resolution of the Board of Directors.

B. Reference Department of Health Rule (page 12), the Coalition may contract for

research and planning grants which can assist in carrying out its function.

C. No member of this Coalition shall be personally liable for any of its debts, liabilities,

or obligations, nor shall any member be subject to any assessment.

Section 2: Gifts and Contributions

The Coalition Board may accept on behalf of the Coalition any contribution, gift, bequest, or

devise of any property whatsoever for the general and charitable purposes of the corporation.

Section 3: Checks, Drafts, Orders of Payment

All checks, drafts, or orders for payment of money, notes or other evidence of indebtedness

issued in the name of the Coalition shall be signed by such officer or officers, agent or agents of

the Coalition and in such manner as the Coalition Board shall be determined. In the absence of

such determination, such instruments shall be signed by the Treasurer, and countersigned by one

of the other officers: Chairperson, Vice-Chairperson, or Secretary.

Section 4: Deposits

Deposits are prepared by the Administrative Assistant/designee in accordance with the

procedures outlined in the Coalition’s Policy and Procedure Manual under “Check Receipts and

Disbursements.”

Executive Director/designee reviews and makes deposit. In the event of absence by the

Executive Director, the deposit will be placed in the safe until the next deposit is made.

ARTICLE TEN: AMENDMENTS

The By-Laws of this Coalition may be amended, repealed, or added to, or new By-Laws may be

adopted by the vote of a two-thirds (2/3) majority vote of the Board, at a meeting duly called for

that purpose with a minimum of five (5) business days advance notice. Language of the

proposed amendment must be provided with the advance notification.


ARTICLE ELEVEN: DISTRIBUTION OF ASSETS

No director, officer, employee, or other persons connected with this Coalition or any other

private individual shall receive, at any time, any revenue from the operation of the Coalition

provided that this provision shall not prevent payment to any such person or reasonable

compensation for services rendered to or from the corporation in effecting any of its purpose as

shall be fixed by resolutions of the Board of Directors. No persons shall be entitled to share in

the distribution of the Coalition assets on dissolution of the corporation.

BY-LAWS ADOPTED BY BOARD OF DIRECTORS ON SEPTEMBER 13, 2000

AMENDED BY BOARD OF DIRECTORS ON JULY 11, 2001

AMENDED BY BOARD OF DIRECTORS ON FEBRUARY 27, 2002

AMENDED BY BOARD OF DIRECTORS ON NOVEMBER 27, 2002

AMENDED BY BOARD OF DIRECTORS ON JANUARY 22, 2003

AMENDED BY BOARD OF DIRECTORS ON MARCH 8, 2006

AMENDED BY BOARD OF DIRECTORS ON APRIL 12, 2006

AMENDED BY BOARD OF DIRECTORS ON AUGUST 9, 2006

AMENDED BY BOARD OF DIRECTORS ON MARCH 14, 2007

AMENDED BY BOARD OF DIRECTORS ON AUGUST 12, 2015


Exhibit 7: Policy and Procedure Updates

Policy and Procedures

CHARLOTTE COUNTY

HEALTHY START COALITION, INC.

Policy and Procedure MANUAL

This Manual has been prepared as an orientation to the Charlotte County Healthy Start Coalition

to clarify the policies and procedures to which the organization adheres.

ADOPTED APRIL 11, 2001 Revised 2/22/11 Revised 2/11/15

Revised 2/27/02 Revised 3/9/11 Revised 3/9/16

Revised 5/11/05 Revised 9/14/11








TABLE OF CONTENTS 1

ADMINISTRATIVE 2

ADDITIONAL RECORDS 3

ADMINISTRATION 4

ALLOCATION PROCESS 5

BANKING 6

CAPITAL EQUIPMENT 7

CHECK RECEIPTS AND DISBURSEMENTS 8

CONFLICT OF INTEREST 9-11

CONTRACTED SERVICES 12

DESTRUCTION OF MATERIALS 13

EMERGENCY/DISASTER PLAN 14-15

FINANCIAL REPORTS 16

FIRE AND EVACUATION PLAN 17

MATCH DEFINITION AND ALLOWABLE MATCH ITEMS 18-19

NOTICE OF MEETINGS 20

PERSONNEL RECORDS 21

PROPERTY MANAGEMENT 22

PUBLIC ACCESS TO RECORDS 23

RECORDS RETENTION 24

RECRUITMENT OF VACANCIES 25

REPORTING AND AUTHORIZATION OF EXPENDITURES 26

STAFF ORIENTATION AND IN-SERVICE TRAINING 27

PURCHASE OF SERVICE AGREEMENTS 28

COMMUNICATIONS PLAN 29-30

LEADERSHIP DEVELOPMENT & EMERGENCY SUCCESSION PLAN 31-34


NON DISCRIMINATION 35

FUND DEVELOPMENTPLAN 36-37

COMPANY ISSUED LAPTOP & CELL PHONE USE 38

SOCIAL MEDIA 39-40

PERSONNEL 41

ANNUAL REVIEW/COST OF LIVING/MERIT INCREASE 42

DISCIPLINARY PROCESS 3

EMPLOYEE BENEFITS & ELIGIBILITY 44-47

EMPLOYEE CONDUCT 48

EQUAL EMPLOYMENT OPPORTUNITY 49

GENERAL OFFICE CONDITIONS 50

MILEAGE/TRAVEL REIMBURSEMENT 51

PERFORMANCE EVALUATIONS 52

SEXUAL HARASSMENT 53

SMOKE-FREE/DRUG-FREE WORKPLACE 54

USE OF ELECTRONIC MEDIA 55

WHISTLEBLOWER 56


ADMINISTRATIVE

SUBJECT: ADDITIONAL RECORDS

POLICY: The COALITION shall maintain in addition to the Personnel file

the following records for each employee: leave record, time and

attendance record, and leave applications.

PROCEDURE:

1. The Executive Director must approve all Leaves in writing. A request for leave form that has

a portion to note the response becomes a part of the employee’s payroll record.

2. The Leave record shows the accrued and used time counted by the type of leave and is

recorded monthly.

3. Each employee shall keep a daily record of his own time that is validated by the immediate

supervisor on a monthly basis. These time sheets are submitted to the Administrative

Assistance/designee for payroll verification. Attendance is recorded bi-monthly and kept by

the Administrative Assistant/designee.


SUBJECT: ADMINISTRATION

POLICY: It shall be the policy of the COALITION to review its policies and

procedures on a regular basis and update as needed.

PROCEDURE:

1. The current policies and procedures will be reviewed each fiscal year. Policies can be

revised as needed.

2. Policy revision will be responsive to proposed changes in the operation of the

organization and assure compliance with government regulations and legal

requirements.

3. Changes can be suggested by the Board of Directors, the CCHSC Administration, the

Florida Department of Health, Coalition Staff members, and Consumers.

4. Nothing in the policies and procedures is intended to create or shall be construed as

creating an express or implied contract of employment for a definite or indefinite

term. Employment at the agency is at-will. Employees can terminate employment at

any time for any reason not prohibited by law with or without notice.


SUBJECT: ALLOCATION PROCESS

POLICY: The COALITION will have a policy concerning the allocation of funds.

PROCEDURE:

PROCESS FOR ALLOCATING FUNDS

The Coalition engages in the following process for allocating funds. This process is repeated

annually.

April

The Department of Health (DOH) Contract Manager notifies the Coalition Staff of the amounts

of contracts to be issued for the next fiscal year. The Coalition Staff (Executive Director and

Fiscal Manager) analyze utilization of Care Coordination, Wraparound Services, and Ancillary

Services (locally or grant funded) for the past year and draft a new services budget. The

Executive Director also drafts an operating budget incorporating the services budget into it.

May

Coalition Staff (Executive Director and Fiscal Manager) recommends the budget concerning

allocation of service dollars and planning dollars to the Board of Directors for acceptance or

amendments and the approved budget is then notified to the DOH Contract Manager.

June

New Contracts between DOH and the Coalition are signed.

May – June

New subcontracts are negotiated. Contract amounts for each provider are allocated from

approved services budget by the Coalition staff based on past utilizations, anticipated client need,

and identified gaps from the past year.

July – June


As subcontractors invoice for July – June, the subcontracts are reviewed and amendments are

made to them as needed. Utilization that is greater or lesser then predicted is considered. Any

amendment must maintain the total services budget within the parameters approved by the Board

of Directors. Staff will approach the Board to approve a revision of the budget if utilization

significantly differs from prediction.


SUBJECT: BANKING

POLICY: It shall be the policy of the COALITION to provide sound fiscal control

and procedures for the disbursement of funds.

PROCEDURE:

1. All funds received shall be recorded in a cash receipts journal and deposited in an authorized

bank institution, according to procedures outlined in the CCHSC By Laws, Article Nine,

Section 4.

2. There shall be established a general account for CHARLOTTE COUNTY HEALTHY

START COALITION, INC. using employer identification number of the CHARLOTTE

COUNTY HEALTHY START COALITION, INC.

3. All expenditures shall be made by check with the exception of a petty cash account that shall

be limited to $200.00. Petty cash shall be used for small incidentals under $50 and cannot be

used for travel payments. The Executive Director shall act as Fund Custodian. The

Administrative Assistant or designee will keep the records on the petty cash account.

4. Eligible signatories on each of the general accounts shall be the Chairperson, Treasurer,

Executive Director and an additional designated Coalition Board Member.

5. Expenditures or transfers of funds under $1,000 shall require one signature. Expenditures or

transfers of funds of a $1,000 or more shall require two signatures.

6. Multiple payments made to one payee during the month will be noted by the Administrative

Assistant and approved by the Executive Director.

7. Payments made to the Executive Director will be countersigned by a Board Member,

regardless of amount.

8. To avoid conflict of interest, authorized account signatories cannot countersign any check

made payable to any organization/agency with which the signatory has an interest.


SUBJECT: CAPITAL EQUIPMENT

POLICY: The COALITION shall establish guidelines regarding capital equipment

and depreciation schedules.

PROCEDURE:

1. Materials purchased are considered capital equipment if they have a value of $1,000.00 or

more and have a useful life of one year or longer.

2. Capital equipment is depreciated over five years on a straight-line basis.

3. Depreciation schedules are maintained by the Accounting firm.

4. Equipment purchased through special funding, such as contracts or grants, may be

expended over the life of the contract/grant instead of depreciated as specified above,

depending on the stipulations of the contract/grant.

Rev. 11/14/2012


SUBJECT: CHECK RECEIPTS AND DISBURSEMENTS

POLICY: It shall be the policy of the COALITION to ensure maximum internal

control of checks received and checks paid.

PROCEDURE:

1. Checks received.

a. Administrative Assistant or designee receives incoming checks, stamps for deposit, enters

in General Ledger; the Administrative Assistant/designee prepares deposit slip, and

submits to Executive Director/designee for approval.

b. Executive Director/designee reviews and makes deposits. In the event of absence by the

Executive Director, the deposit will be placed in the safe until the next deposit by the

Executive Director/designee.

c. Administrative Assistant/designee files deposit documentation, verifies deposit date and

records in appropriate journals/account register

2. Checks paid.

a. Administrative Assistant/designee prepares checks with backup documentation, including

invoices and check approval.

b. Executive Director/designee approves payments and signs checks.

c. Administrative Assistant/designee receives checks from Executive Director/designee,

prepares documentation, and mails checks.

3. Check reconciliation.

a. Bank statements are logged as received and then are provided unopened to the Executive

Director, who then provides the Administrative Assistant/designee with a copy to

reconcile. The Executive Director reviews it and a proof of cash receipt as prepared.


SUBJECT: CONFLICT OF INTEREST

POLICY: The COALITION will have a conflict of interest policy to protect the

interest of the Charlotte County Healthy Start Coalition, Inc. (the

Coalition) when it is contemplating entering into a transaction or

arrangement that might benefit the private interest of a director of the

Coalition or might result in a possible excess benefit transaction. This

policy is intended to supplement but not replace any applicable state and

federal laws governing conflict of interest applicable to nonprofit and

charitable organizations.

Article I, Definitions:

1. Interested Person

Any director, principal officer, or member of a committee with governing board delegated powers,

who has a direct or indirect financial interest, as defined below, is an interested person.

2. Financial Interest

A person has a financial interest if the person has, directly or indirectly, through business,

investment, or family:

a. An ownership or investment interest in any entity with which the Coalition has a

transaction or arrangement,

b. A compensation arrangement with the Coalition or with any entity or individual with

which the Coalition has a transaction or arrangement, or

c. A potential ownership or investment interest in, or compensation arrangement with,

any entity or individual with which the Coalition is negotiating a transaction or

arrangement.

Compensation includes direct and indirect remuneration as well as gifts or favors that are not

insubstantial. A financial interest is not necessarily a conflict of interest. Under Article II, Section

2, a person who has a financial interest may have a conflict of interest only if the appropriate

governing board or committee decides that a conflict of interest exists.

Article II, Procedures:

1. Duty to Disclose


In connection with any actual or possible conflict of interest, an interested person must disclose

the existence of the financial interest and be given the opportunity to disclose all material facts to

the directors and members of committees with governing board delegated powers considering the

proposed transaction or arrangement.

2. Determining Whether a Conflict of Interest Exists

After disclosure of the financial interest and all material facts, and after any discussion with the

interested person, he/she shall leave the governing board or committee meeting while the

determination of a conflict of interest is discussed and voted upon. The remaining board or

committee members shall decide if a conflict of interest exists.

3. Procedures for Addressing the Conflict of Interest

a. An interested person may make a presentation at the governing board or committee

meeting, but after the presentation, he/she shall leave the meeting during the discussion

of, and the vote on, the transaction or arrangement involving the possible conflict of

interest.

b. The chairperson of the governing board or committee may, if appropriate, appoint a

disinterested person or committee to investigate alternatives to the proposed

transaction or arrangement.

c. After exercising due diligence, the governing board or committee shall determine

whether the Coalition can obtain with reasonable efforts a more advantageous

transaction or arrangement from a person or entity that would not give rise to a conflict

of interest.

d. If a more advantageous transaction or arrangement is not reasonably possible under

circumstances not producing a conflict of interest, the governing board or committee

shall determine by a majority vote of the disinterested directors whether the transaction

or arrangement is in the Coalition’s best interest, for its own benefit, and whether it is

fair and reasonable. In conformity with the above determination it shall make its

decision as to whether to enter into the transaction or arrangement.

4. Violations of the Conflicts of Interest Policy

a. If the governing board or committee has reasonable cause to believe a member has

failed to disclose actual or possible conflicts of interest, it shall inform the member of

the basis for such belief and afford the member an opportunity to explain the alleged

failure to disclose.


b. If, after hearing the member’s response and after making further investigation as

warranted by the circumstances, the governing board or committee determines the

member has failed to disclose an actual or possible conflict of interest, it shall take

appropriate disciplinary and corrective action.

Article III, Records of Proceedings:

The minutes of the governing board and all committees with board delegated powers shall contain:

a. The names of the persons who disclosed or otherwise were found to have a financial

interest in connection with an actual or possible conflict of interest, the nature of the

financial interest, any action taken to determine whether a conflict of interest was

present, and the governing board’s or committee’s decision as to whether a conflict of

interest in fact existed.

b. The names of the persons who were present for discussions and votes relating to the

transaction or arrangement, the content of the discussion, including any alternatives to

the proposed transaction or arrangement, and a record of any votes taken in connection

with the proceedings.

Article IV, Compensation:

a. A voting member of the Board of Directors who receives compensation, directly or

indirectly, from the Coalition for services is precluded from voting on matters

pertaining to that member’s compensation.

b. A voting member of any committee whose jurisdiction includes compensation matters

and who receives compensation, directly or indirectly, from the Coalition for services

is precluded from voting on matters pertaining to that member’s compensation.

c. No voting member of the governing board or any committee whose jurisdiction includes

compensation matters and who receives compensation, directly or indirectly, from the

Coalition, either individually or collectively, is prohibited from providing information

to any committee regarding compensation.

Article V, Annual Statements:

Each director, principal officer and member of a committee with governing board delegated

powers shall annually sign a statement which affirms such person:

a. Has received a copy of the conflicts of interest policy,

b. Has read and understands the policy,

c. Has agreed to comply with the policy, and


d. Understands the Coalition is charitable and in order to maintain its federal tax exemption

it must engage primarily in activities which accomplish one or more of its tax-exempt

purposes.

Article VI, Periodic Reviews:

To ensure the Coalition operates in a manner consistent with charitable purposes and does not

engage in activities that could jeopardize its tax-exempt status, periodic reviews shall be

conducted. The periodic reviews shall, at a minimum, include the following subjects:

a. Whether compensation arrangements and benefits are reasonable, based on competent

survey information, and the result of arm’s length bargaining.

b. Whether partnerships, joint ventures, and arrangements with management organizations

conform to the Coalition’s written policies, are properly recorded, reflect reasonable

investment or payments for goods and services, further charitable purposes and do not

result in inurement, impermissible private benefit or in an excess benefit transaction.

Article VII, Use of Outside Experts:

When conducting the periodic reviews as provided for in Article VI, the Coalition may, but need

not, use outside advisors. If outside experts are used, their use shall not relieve the governing board

of its responsibility for ensuring periodic reviews are conducted.


SUBJECT: CONTRACTED SERVICES

POLICY: It shall be the policy of the COALITION to request three bids for

any services with anticipated cost of over $1,500.00.

PROCEDURE:

1. For all services anticipated to be over $1,500.00 (printing, accounting, insurance), the

Executive Director/Designee or Committee requesting the service shall obtain three bids.

2. Purchases over $1,500 shall require board approval.

3. The Coalition should attempt to purchase from local (Charlotte County) vendors whenever

possible.


SUBJECT: DESTRUCTION OF MATERIALS

POLICY: The COALITION shall have a policy for how to dispose of surplus,

obsolete, unserviceable, or broken office equipment with a purchase cost

of at least $100.00.

PROCEDURE:

1. The Executive Director must be made aware of the obsolete or broken equipment prior to

any disposal of it.

2. The Executive Director/designee will keep accurate records about the type, original cost

and estimated value of the item being disposed of. If the equipment is being repaired or

replaced, that cost will also be recorded.

3. The COALITION will contact the County or a firm that specialized in equipment disposal to

appropriately dispose of the broken equipment in an environmentally sound manner.

4. All items deemed obsolete or unserviceable by the Executive Director shall be disposed on

through public sale, private sale, trade-in for new equipment, or donated to a charitable

organization. Equipment cannot be given to a disqualified person under the intermediate

sanctions rules or anyone who has a business relationship with the COALITION, unless they

pay the COALITION a fair market value. Donated equipment will normally be deducted

from the COALITION’s assets.

5. Any items sold or traded in for new equipment shall be identified as such in the accounting

report.


SUBJECT: EMERGENCY / DISASTER

POLICY: The COALITION shall have a policy regarding what to do in the

event of an emergency/hurricane, etc.

PROCEDURE:

HURRICANE WATCH

The goal of hurricane watch activities will be to secure the facilities against impending damage.

Transportation will become increasingly difficult as the storm approaches, so foresight is needed.

• Hurricane Watch Activities will occur 24-48 hours before expected landfall. If a storm is expected to hit on a weekend, all preparation activities will be accomplished on the

Thursday or Friday before the expected storm.

• During the Storm Watch: Management will monitor storm activities through media

coverage and make the decision to call staff in to help with storm preparations if needed

and/or curtail regular work in order to prepare for the storm.

• Management should the office facility has needed supplies on hand, including two weeks worth of Petty Cash for use after the storm.

• Secure all records and equipment at the office facility from possible storm damage. This may include unplugging and moving things away from windows and doors.

• Management should know in advance of a storm if the property landlord will board up

the facility or if it will be the responsibility of the agency. All items outside the facility

should be secured or brought inside if possible.

• Emergency supplies to use after the storm should be on hand. (e.g. tools, water, diapers, wipes, etc.) Be sure all vehicles are filled with gasoline and have oil and water levels

checked.


• Have a list of all employees including name, birthdate, social security numbers, addresses, and phone numbers.

• Encourage providers to prepare a list of zip codes to be used to locate clients after the storm. Be sure there is a client list by program.

• Staff will be dismissed 12-24 hours to landfall, in time to secure their own homes.

• Staff should have emergency numbers and cell phone contact number for Executive Director or Designated alternative for people to call as soon as possible after the storm to

give an account of their well being.

• Executive Director or designated alternative will keep Board Chair or designated alternative updated and seek assistance if needed.

POST STORM/EMERGENCY RESPONSE

The goal is to determine the extent of the damage, security of records, assessment of the

condition of staff, providers, and clients, and establishment of a distribution system for needed

supplies.

Within six hours after the storm/emergency or four hours after daybreak the next morning

• As soon as safely possible after the storm, check the status of the office facility and security of records. Verify the availability of electricity and water. If conditions are

warranted, staff may be called in for a designated time in order to set up as a command

center and/or relief station for clients in need. Confidential records should be secured as

soon as physically possible.

• If there are any doubts concerning the safety of the facility, it will be rendered unsuitable until further assessment can be made.

• Providers will be contacted regarding their well being and the well being of the clients

they serve along with an assessment of damage to their facilities and security of records.

• Executive Director may contact local radio and television stations requesting broadcast of telephone numbers where employees are to call for further instructions.

• Staff and Contracted Providers will relay information to the E.D. as soon as possible on their whereabouts and advise when they can return to work.

Within 24 hours after the end of the storm/emergency:

• Have all emergency numbers available for participants who call in with needs.


• Determine the emergency supply needs and establish a distribution system if possible. Supplies to gather would include bottled water, diapers, wipes, formula, and canned food

with can openers.

• Determine the feasibility of returning to an evacuated facility. It must be damage free

and have electricity and water.

• Obtain phone numbers and/or whereabouts of any missing staff and list staff’s personal loss due to the storm.

• Gather information concerning the Coalition’s losses and/or needs. This would include information on Contracted Providers and their clients as well as Board members.

• Executive Director will determine if temporary or minor repairs should be made to facility and contact the landlord.

• Donations of relief items will be inventoried and then distributed to those in need. If the

facilities are in order, set times for distribution can be established for staff, providers, and

Healthy Start related clients.

RESUMING NORMAL ACTIVITIES

The Executive Director will authorize the return to normal work activities for the Coalition

office.

Rev. 2/22/2011


SUBJECT: FINANCIAL REPORTS

POLICY: It shall be the policy of the COALITION to provide a mechanism for

accurate tracking of financial condition and to provide financial reporting

to the Executive Committee and Board of Directors.

PROCEDURE:

1. Internal financial transactions will be accounted for within budget categories by the

Administrative Assistant via automated accounting software.

2. The Administrative Assistant will provide internal statements of revenues collected and

expenses paid to Executive Director on a monthly basis.

3. The Administrative Assistant will provide the following financial statements:

• Monthly budget vs. actual report

• Year to date Profits and Loss Balance statements

4. Financial statements are prepared monthly following the close of each month and presented

to the Board of Directors for approval.


SUBJECT: FIRE/EVACUATION

POLICY: The COALITION shall have a policy governing the safety of staff

in the event of a fire.

PROCEDURE:

In the event of a Fire, the following evacuation steps should be observed:

REMAIN CALM and be sure all personnel know there is a fire and need to exit.

When the fire alarm system is activated, it will simultaneously notify the Fire Department. In

addition, there are manual pull stations in the common corridors. Make sure that you are familiar

with ALL fire and evacuation exits the very first day of your employment with the Coalition.

1. If the fire is small and can be contained by extinguisher, use the extinguishers located

nearest the fire. Make sure that you are familiar with the location of all fire extinguishers

in your surrounding work area as well as those in other parts of the facility that you use.

Use of the extinguisher is as follows:

A. Stand back approximately 10 feet from the fire.

B. Hold the extinguisher upright.

C. Pull out the ring at the top of the extinguisher.

D. Free the hose from the clamp.

E. Squeeze the lever.

F. Direct the hose nozzle from side to side at the base of the fire.

Keep all involved personnel away from the smoke and extinguisher chemical fumes.


1. In the case of electrical fires, power should be turned off immediately and the plug pulled

from the receptacle if possible. This will help to reduce the heat contributing to the fire

and help to prevent possible shock to personnel fighting the fire.

2. Exit the building by the safest exit door available and wait for the fire department to arrive.

Inclement Weather Procedure

In the event of a severe weather warning, the Executive Director may cancel or abbreviate

scheduled work hours.


SUBJECT: MATCH DEFINITION AND ALLOWABLE MATCH ITEMS

POLICY: It shall be the policy of the COALITION that in-kind match is

committed and recorded in compliance with state regulations

and every effort is made to reach the mandated 25% match

requirement.

PROCEDURE:

1. Match is defined as a contribution from non-state and non-federal sources, which supports the

operation of the COALITION in carrying out its contractual responsibilities. By law, each

COALITION must contribute 25% of the State grant award each year in either cash or inkind

from local sources.

2. Match must be local and be cash or inkind.

3. No federal or state funds can be used as a match source as the statute and rule stresses the

importance of obtaining locally derived contributions.

4. In kind contributions may consist of:

a. Travel reimbursements or expenses.

b. Office space, furniture, expenses and equipment.

c. Contractual services such as conducting community needs assessments

and evaluating performance, but not direct client services.

d. Computer hardware and software.

5. All local match must be for the exclusive purpose of operating the COALITION.

6. Attending COALITION meetings can be considered a match item as long as the person is not

employed by a state or federal agency. The value of the meeting time to be calculated as

match must be the same rate for all individuals regardless of the salary or position of the

person attending the meeting and rate must be a reasonable amount.

7. If the member is a consumer, his travel expenses can be reimbursed by the COALITION

providing they fit the definition as stated in item 8 below. If the COALITION opts to pay the

consumer this amount cannot be considered match.

8. The definition of a consumer is a person who has received, or has a family member that has

received, prenatal or infant health services.

9. Cash and in-kind match begin the day the contract is executed between the COALITION and

the State.


10. If a COALITION member is reimbursed by the COALITION to attend COALITION

meetings and the travel to and from the meeting site is also reimbursed, these items cannot be

a source of match. If the COALITION does not reimburse the member for travel expense,

this expense can be considered a source of match.

11. All match claimed, whether in-kind or cash, must be allowable and necessary for the

operation of the COALITION.

12. Match, whether in-kind or cash, must be properly documented and accounted for in the

COALITION’s fiscal records. It must be reflected in the COALITION’s financial

statements.

13. In-kind match must be valued at the fair market value of the item or the average rate for the

service performed. Records documenting the method of determining the value are required

and are subject to review.


SUBJECT: NOTICE OF MEETINGS

POLICY: It shall be the policy of the COALITION to be in Compliance with

the Florida Statutes Sunshine Law.

PROCEDURE:

1. All COALITION meeting notices will be published at least five days in advance of the

meeting.

2. Notice of special meetings will be published at least 24 hours in advance of the meeting.

3. Minutes of all meetings will be provided at the next meeting.

4. Time and place of all COALITION meetings will be publicly posted (e.g. a local

newspaper).


SUBJECT: PERSONNEL RECORDS

POLICY: The COALITION retains all employee personnel records.

PROCEDURE:

1. An employee’s record contains his/her application, resume, and two required references, and

other relevant information connected with his/her employment, such as job description and

performance evaluations.

2. All records are confidential and are available only to the employee, Executive Director, and

the Board of Directors.

3. An employee desiring to see his/her personnel record should request an appointment with the

Executive Director. Any confidential reference check forms or reference letters that were

obtained in the course of the employee’s initial employment shall be removed before the

employee views the file.

4. The employee viewing his/her personnel file may not remove anything.


SUBJECT: PROPERTY MANAGEMENT

POLICY: The COALITION shall provide maximum internal control and

maintenance of materials/equipment.

PROCEDURE:

1. All materials purchased have an account to which they are charged noted by the Executive

Director or designee on purchase orders.

2. As materials are received, they are inspected and accepted by the Executive Director or

designee.

3. Equipment, such as computers, are assigned to specific staff members and assignment logs

are maintained.

4. Equipment is tagged with stickers provided by vendors of maintenance agreements to

facilitate identification when calling for service.

5. Maintenance agreements are reviewed by the Administrative Assistant/designee prior to

expiration to ascertain if quality of service provided by the vendor during the past contract

period was acceptable and if equipment should continue to be covered by contract.

6. Old equipment or broken equipment will be disposed of appropriately. (e.g. donate or find

proper disposal in the county for said equipment). The inventory will need to reflect the

changes. See “Destruction of Materials” policy.


SUBJECT: PUBLIC ACCESS TO RECORDS

POLICY: The records of CCHSC are generally open to public inspection due to IRS

rules, open records laws and the spirit of public service. However, certain

information is not open to public examination and may only be released

with the permission of the Executive Director. Questions in this area are

to be resolved by the Executive Director. If the answer to a request is

unclear the Executive Director may contact CCHSC's legal advisor for a

consultation. Record retention is governed by various rules, statutes of

limitations and common sense.

PROCEDURE:

IRS Forms

Payroll tax forms are not public information and will not be released.

IRS Forms 990 and 990A, the exempt organization information returns, must be made available

to anyone upon request. The specific rules are outlined in the instructions for form 990. All

pages, schedules and attachments, except the detailed schedule of contributors must be made

available. The prior three years of 990s and 990As must be available upon request for free

review in our office. If the requestor wishes to have a copy, that will be provided immediately or

may be mailed to the person. We ask that the person pay the legally allowed fee of $1 for the

first page and 15 cents for each additional page, plus actual postage, if applicable.

The application for exempt status, Form 1023, and the IRS determination letter are also available

to anyone upon request for a free review in our office. Copying charges are the same as for the

990 if the person wishes to take a copy. The specific rules are outlined in the instructions for the

form 990.

Florida Annual Charitable Organization Report

Although public disclosure by our organization is not required, the Florida report is available to

the public from the State Department of Regulation and Licensing. For this reason, we will

make this return available with the forms 990 and 990A.

Records Retention - (See the Records Retention section of this Manual)


SUBJECT: RECORDS RETENTION

POLICY: It shall be the policy of the COALITION to comply with state

contract obligations and in accordance with the Sarbanes-Oxley Act.

The destruction of business records and documents and intentional

document destruction must be carefully monitored.

PROCEDURE:

1. To retain all client records, financial records, supporting documents, statistical records, and

any other documents (including electronic storage media) pertinent to this contract for the period

specified in the table below after termination of this contract, or if an audit has been initiated and

audit findings have not been resolved at the end of five (5) years the records shall be retained

until resolution of the audit findings.

Type of Document Minimum Requirement

Accounts payable ledgers and schedules 7 years

Audit report Permanently

Bank reconciliations 6 years

Bank statements 6 years

Checks (for important payments and purchases) Permanently

Contracts, mortgages, notes and leases (expired) 7 years

Contracts (still in effect) Permanently

Correspondence (general) 6 years

Correspondence (legal and important matters) Permanently

Correspondence (with customers and vendors) 6 years

Deeds, mortgages, and bills of sale Permanently


Depreciation Schedules Permanently

Duplicate deposit slips 6 years

Employment applications 3 years

Expense Analyses/expense distribution schedules 7 years

Year End Financial Statements Permanently

Insurance Policies (expired) 6 years

Insurance records, current accident reports, claims, policies, etc. Permanently

Internal audit reports 6 years

Inventories of products, materials, and supplies 7 years

Invoices (to customers, from vendors) 7 years

Minutes books, bylaws and charter Permanently

Participant related papers Permanently

Payroll records and summaries 7 years

Personnel files (terminated employees) 7 years

Retirement and pension records Permanently

Tax returns and worksheets Permanently

Timesheets 7 years

Trademark registrations and copyrights Permanently

Withholding statements 7 years

3. That persons duly authorized by the department and federal auditors, pursuant to 45 CFR,

Part 92.36(I) (10), shall have full access to and the right to examine any of said records

and documents during said retention period or as long as records are retained, whichever

is later.


SUBJECT: RECRUITMENT FOR VACANCIES

POLICY: The COALITION shall seek to fill each vacant position with the

most qualified candidate.

PROCEDURE:

1. Promotion from within the organization will occur if possible.

2. The COALITION is an Equal Opportunity Employer (EOE) and will use a standard job

application form that conforms with the Civil Rights Act, EOE Amendments of 1972 and

State Human Relations Guidelines.

3. If promotions do not occur, the job will be publicly posted (e.g. newspaper).

4. The Executive Director/Designee will review all applications and conduct interviews of

possible candidates. Second interviews may be scheduled as appropriate.

5. Three references consisting of both professional and personal sources will be reviewed

before making the final selection.

6. A concise job description will be given to the applicant regarding the position.

7. The U.S. Department of Homeland Security’s E-Verify system https://e-

verify.uscis.gov/emp, will be used to verify the employment eligibility of all new employees

hired. The final decision concerning the applicant rests with the Executive Director, who

will generally consult with other personnel.

8. Once the position is filled, remaining applicants will be notified by letter that the position is

filled.

9. Nepotism is discouraged, so the COALITION will refrain from hiring relatives of any

member of the Governing Body or current employees of Healthy Start. In the event that the

https://e-verify.uscis.gov/emp

https://e-verify.uscis.gov/emp


relative’s skills and abilities represent the best possible choice available, an employment

resolution, adopted by the Board of Directors, will clearly indicate the circumstances

surrounding the decision to hire a relative.

10. When the position of Executive Director is open, the Board of Directors appoints a person to

the position. They may choose a Personnel Committee to secure applications, screen

applicants, contact candidates, evaluate qualifications, and make selection recommendations

to the COALITION. The Executive Director’s appointment for the position is based on

demonstrated qualifications and proven competence.

11. All information is filed in the employees personnel file.


SUBJECT: REPORTING AND AUTHORIZATION OF EXPENDITURES

POLICY: It shall be the policy of the COALITION that to provide sound fiscal

control through clear definition of responsibility for financial management

and through regular systematic financial reporting to the Board of

Directors.

PROCEDURE:

1. All fiscal transactions shall conform to applicable Federal regulations and laws of the State of

Florida governing the operation of non-profit corporations with respect to all grants,

contracts and contributions.

2. All required financial, tax, and other reports shall be filed timely and reported promptly.

3. All expenditures shall be governed by a budget approved by the Healthy Start Board of

Directors at the beginning of the fiscal year which begins July 1 and ends June 30th of the

next year.

4. All expenditures, with the exception of payroll, shall require an invoice/receipt and

appropriate documentation.

5. The Executive Director shall be responsible for approving all expenditures in accordance

with the approved budget and shall maintain complete records and reports. Any expenditure

requires a second signature by bank authorized signatures.

6. An inventory of all equipment, furnishings and other non-expendable items above $500 shall

be updated yearly. Each item will have an inventory number corresponding to one placed on

the item. The inventory will include the manufacturer, model number, serial number, date

acquired, location of item and under what grant or contract the item was purchased.

Condition of the equipment when inventoried should be noted.

7. The Finance Committee shall receive/review quarterly, a comparison of expenditures to date

with budget allocations by major category. Line item adjustments will be made as needed.

Line item budget shall be reported at monthly board meetings. Also, received/reviewed by

Board will be a report summarizing expenditures by contract.

8. Annually, if applicable, the Executive Director will review insurance coverage/limits with the

Coalition’s insurance agent(s). Recommendations for increases in coverage or changes

mandated by the insurer will be brought before the Board.


SUBJECT: STAFF ORIENTATION AND IN-SERVICE EDUCATION

POLICY: The COALITION will encourage an employee’s professional

growth.

PROCEDURE:

1. The Executive Director/Designee will provide each new employee with all requisite

materials for the positions, including job description, Policies and Procedures, and other

background and orientation materials.

2. The Executive Director and/or Board of Directors may schedule in-service training related to

the employee’s growth within the organization.

3. All employees are required to complete DOH Confidentiality and HIPAA training within

thirty (30) days of hire.

4. Along with provider staff, all employees and Board members will be offered Cultural

Competency education annually, components of which may be delivered through PowerPoint

presentations, links to educational components on the Coalition’s website, through the

Coalition’s on-line Learning Management System, or through the Florida Dept. of Health’s

TRAIN educational site.

5. Potential Board of Director candidates will receive Healthy Start orientation from the

Executive Director and/or an existing member of the Board, which will include presentation

and review of the Board Orientation Notebook.


SUBJECT: USE OF PURCHASE OF SERVICE AGREEMENTS

POLICY: In accordance with policies of the State of Florida, it is permissible to use a

Purchase of Service Agreement for medical services rather than a full contract. These

agreements are generally shorter, with medical providers licensed and regulated by their

professional boards.

CONDITIONS:

• There should be a need for services and a lack of willing providers.

• Services must be provided by qualified medical professionals for services within the catchment area.

• Service must be specific, medically related, economically sound and limited in scope.

• Service limitations and acceptable fees must be spelled out in the agreement.

RATES OF FEES:

• Healthy Start must be payer of last resort.

• When possible, rates shall be at or below Medicaid reimbursement rate.

• Where there is no reimbursement rate for Medicaid or there are NO providers willing to

take the Medicaid rate of reimbursement, a reasonable rate may be negotiated.

PROVIDER CONDITIONS:

• Must be willing to use Healthy Start grievance policy.

• Must be willing to solicit client satisfaction surveys.

• Must be willing to provide one of the following: individual invoices, monthly or

quarterly reports.

• Must be willing to allow Coalition to monitor records and programs.

Adopted 11/14/2012


SUBJECT: COMMUNICATIONS PLAN

POLICY: Establish and maintain consistency in mission, vision and advocacy

messaging to support CCHSC strategies and goals

PROCEDURE: Charlotte County Healthy Start Coalition Communications Plan

Mission: To improve birth outcomes and optimize child growth and development through

community partnerships that nurture women and families.

Vision: The health and well-being of mothers and children is optimized by the services of the

Charlotte County Healthy Start Coalition

Tagline: Every baby deserves a healthy start…

“Elevator speech”: The Coalition takes an active role in identifying health issues and barriers

to healthcare experienced by prenatal women and by children birth to age three. Operating as a

grassroots organization to actively address these issues, the Coalition succeeds through strong,

positive relationships with many of the county’s medical and human services organizations

which serve young children and pregnant women.

Communication is performed by those assigned in the chart below. Written

communication is submitted to the E.D. for approval prior to release or posting.


AUDIENCE/

STAKEHOLDER

CONTENT Method How

Often

Facilitated

by:

Status

Staff Internal

communications

E-mail

Staff meetings

As

needed

Monthly

All staff

E.D.

On-

going

Providers • Policy/procedure updates

• health alerts

• Contract Documentatio

n

Written notice

via US mail

and/or updates

to CCHSC

Provider web

pages

Written

notification or

e-alerts

CCHSC

Provider

website

updates

Written (2

copies)

As

needed

Monthly

Annually

E.D. or

designated

staff

member

Media

Consultant

Contr. Mgr.

/ E.D.

On-

going

On-

going

Updated

6/1/13

Providers • Grievances

• Performance Updates

• Monitoring Review

Teleconference

or written

Face-to-face;

teleconference

Face-to-Face

As

reported

At

minimum

quarterly

Annually

E.D. or QA

Mgr.

(as above)

Contr. Mgr.

None

reported

On-

going

On-

going

Media • Inquiries

All media

inquiries must

As

needed

E.D. On-

going


Charlotte Sun

Florida Weekly

Harbor Style

Magazine

WENG (1530

WIKX (92.9)

WCCF (1580)

WBCG (98.9)

• Advocacy / Outreach;

Educational

articles

be directed to

E.D.

Print articles

MailChimp(e-

alerts, website

/ facebook

posts (with

prior approval

of E.D.)

Quarterly

Monthly

Media

Consultant;

staff

On-

going

Participants /

Parents

• health alerts; qtrly.

newsletter

• Educational materials

Email; social

media,

MailChimp,

website

updates and

links through

“Parents” page

Quarterly Staff;

Consultant

Media

Consultant;

staff

On-

going

Partners /

Stakeholders /

Community

Members /

Volunteers

• Refresh

website

content

• health alerts

• educational updates

• Event notices

Text files

and/or links

Written notice

or email

Hand-

delivered to

OBs

Monthly

As

needed

Monthly

As

needed

Comm.

Liaison

Consultant,

staff

Comm.

Liaison

As above

Monthly

On-

going

On-

going


• Program Updates

Email; Flyers;

New release

Face-to-Face

at Board and

General

Membership

Meetings

Monthly

Staff,

Committees,

Provider

Reps

On-

going

Adopted: 12/10/14


SUBJECT: LEADERSHIP DEVELOPMENT & EMERGENCY SUCCESSION PLAN

POLICY: Establish procedure for leadership transition to maintain consistency in

operational and service delivery management and organization mission and

vision.

PROCEDURE: Leadership Development and Emergency Succession Plan

1. Rationale

The executive director position in a nonprofit organization is a central element in the

organization's success. Therefore, insuring that the functions of the executive director are well

understood and even shared among senior staff and volunteer leaders is important for

safeguarding the organization against unplanned and unexpected change. This kind of risk

management is equally helpful in facilitating a smooth leadership transition when it is predictable

and planned.

This document outlines a leadership development and emergency succession plan for the

Charlotte County Healthy Start Coalition, Inc. (CCHSC). This plan reflects CCHSC's Executive

Succession Policy and its commitment to sustaining a healthy functioning organization. The

purpose of this plan is to insure that the organization's leadership has adequate information and a

strategy to effectively manage CCHSC in the event the executive director is unable to fulfill

his/her duties.

2. Plan Implementation

The Board of Directors authorizes the Board Chair to implement the terms of this emergency

succession plan in the event of a planned or unplanned temporary or short-term absence.

• It is the responsibility of the Executive Director (ED) to inform the Board of Directors of

a planned temporary or short-term absence, and to plan accordingly.

• As soon as feasible, following notification of an unplanned temporary or short-term

absence, the Board Chair shall convene a Personnel Committee meeting to affirm the

procedures prescribed in this plan, or to modify them if needed.

3. Priority Functions of the Executive Director at CCHSC. (The full Executive Director position’s

description is attached to this plan.)

4. Absence definitions:


• A temporary absence (planned or unplanned) is 30 days or less and one in which it is

expected that the Executive Director will return once the events precipitating the absence

are resolved.

• A temporary short-term absence is between 30 and 90 days.

5. Temporary Staffing Strategy

a. For temporary absences (planned or unplanned) of 30 or fewer days, the Temporary

Staffing Strategy described below may become effective.

KEY E.D. Functions Temporary Staffing Strategy

Operations Management Contract/QA Manager, with oversight by Board

Member designee

Fiscal Management Accounts Receivables/ Invoice Prep. -Contract/QA

Manager

Accounts Payable Authorization – Contract/QA

Manager

Budget vs Actual – Admin. Assistant

Account Reconciliations - Coalition Treasurer

(Oversight of all Fiscal Mgmt. duties by full Board)

Human Resource Time Sheet Review / Payroll Authorization –

Contract / QA Manager and Board Chair

Compliance Monitoring /

Submission of Deliverables

Performance reporting - Contract / QA Manager,

with assistance of staff and Board oversight

FAHSC Conference calls – Contract/QA Manager

FAHSC Meet-Me-Calls – Community Liaison


Grant Reporting Contract Manager / QA Manager, with Board

oversight

Board Communication and Support Administrative Assistant, with assistance from

Contract / QA Manager

Community Relations /

Spokesperson

Contract / QA Manager or Board Member designee

Public Relations / Social Media Community Liaison / Media Consultant, with

oversight by Contract / QA Manager

b. In the event of a temporary short-term absence (planned or unplanned), the

Board of Directors shall determine if the Temporary Staffing Strategy is sufficient

for this period of time.

c. Appointing an Acting Executive Director

• Based on the anticipated duration of the absence, the anticipated return date, and

accessibility of the current executive director, the Board of Directors may appoint an

Acting Executive Director, as well as continue to implement the Temporary Staffing

Strategy.

o The first position in line to be Acting Executive Director is the current Contract /

QA Manager, unless new to staff or fairly inexperienced with CCHSC

o The second position in line is a previous Board Chair or current Board Member.

If a current Board Member accepts the position, he/she will take a temporary

leave from the Board of Directors.

o The Board may consider another appointee or the option of splitting executive

duties among designated appointees.

d. Cross-Training Plan

The Executive Director shall develop a training plan for each staff position identified in

the “Temporary Staffing Strategy” above. A copy of each training plan shall be

attached to this document.

e. Authority and Restrictions of the Acting Executive Director


The Acting Executive Director shall have full authority for day-to-day decision making

and independent action as the regular Executive Director. Decisions that shall be made in

consultation with the Board Chair and/or full Board, as specified in the Temporary

Staffing Strategy as previously outlined.

f. Compensation

o Director-level staff appointed as Acting Executive Director may receive an end

of year bonus or additional benefit. This shall be determined by the Board and

will be dependent upon available resources and the duration of the assignment.

o If staff serves as Acting Executive Director for 6 months or more, the Board of

Directors may consider a salary adjustment.

o A current or former board member appointed as Acting Director may enter into

an Independent Contractor Agreement, depending on availability of resources and

Board approval.

h. Board Oversight and Support to the Acting Executive Director

o The Acting Executive Director reports to the Board Chair. In the event the Board

Chair becomes the Acting Executive Director, the Vice President shall be

appointed Board Chair.

i. Communications Plan

o Within 48 hours after an Acting Executive Director is appointed, the Board Chair

and the Acting Executive Director shall meet to develop a communications plan

including the kind of information that will be shared and with whom.

6. Succession plan in the event of a temporary, unplanned absence – Long-term

a. Definition: A long-term absence is 90 days or more.

b. Procedures

o Procedures and conditions to be followed shall be the same as for a temporary

short term absence with the following addition:

o The Board shall give immediate consideration, in consultation with the Acting

Executive Director, to temporarily filling the management position left vacant by

the Acting Executive Director, or reassigning priority responsibilities where help

is needed to other staff. This is in recognition that, for a term of 90 days or more,

it may not be reasonable to expect the Acting Director to carry the duties of both

positions.


o The Board Chair and Executive Committee are responsible for gathering input

from staff and reviewing the performance of the Acting Executive Director

according to the organization’s Performance Review Policy. A review shall be

completed between 30 and 45 days.

6. Succession plan in the event of a PERMANENT unplanned absence.

a. Definition: A permanent absence is one in which it is firmly determined that the Executive

Director will not be returning to the position.

b. Procedures

• Procedures and conditions to be followed shall be the same as for a temporary short term

absence with the following additions:

o The Board of Directors shall consider the need to hire an Interim Executive

Director from outside the organization instead of appointing an Acting Executive

Director. This decision shall be guided, in part, by internal candidates for the

Executive Director position, the expected time frame for hiring a permanent

executive, and the management needs of the organization at the time of the

transition.

c. Hiring an Interim or Permanent Executive Director

The Board of Directors, or designated Personnel Committee, will be responsible for

candidate interviews and salary negotiations. Benefits will be dictated by the CCHSC

Policy and Procedure Manual and be in accordance with approved employment

guidelines.

Adopted: 12/10/14


SUBJECT: NON DISCRIMINATION

POLICY: The COALITION shall have a policy regarding Non Discrimination.

PROCEDURE:

Charlotte County Healthy Start Coalition, Inc. does not exclude, deny benefits to, or otherwise

discriminate against any person on the basis of race, color, religion, national origin, disability,

age, or sexuality in admission to, participation in, or receipt of the services and benefits under

any of its programs and activities, whether carried out by Charlotte County Healthy Start

Coalition, Inc. directly or through a contractor or any other entity with which Charlotte County

Healthy Start Coalition, Inc. arranges to carry out its programs and activities.

Adopted: 1/14/15


Charlotte County Healthy Start Coalition

Fund Development Plan

INTRODUCTION

The purpose of the fund development plan is to educate the board, staff and other stakeholders as

to our funding needs, to have a written plan as to how we are going about meeting those needs

and to create a “living” document to guide us in these endeavors. The Program / Membership/

Fundraising Committee initiated this plan in 2014.

CCHSC receives state funding for programming but there are many things that this funding does

not cover. Most importantly are the annual audited financial statements. This process allows

CCHSC to be eligible to seek funding from other sources. CCHSC also uses funds to purchase

diabetes test strips, transportation vouchers, infant car seats and recognition for community

partners.

MISSION STATEMENT

To improve birth outcomes and optimize child growth and development through community

partnerships that nurture women and families.

FUNDRAISING PLAN GOALS

▪ Establish a culture of fundraising that involves board, staff, and volunteers.

▪ Further develop fundraising infrastructure.

▪ Expand visibility and case for support to the community.

▪ Secure donations from: current individual donors; generate new donors and special events.

▪ Develop a strategy to retain 80% of current donors

▪ Increase annual fundraising revenue to $6,000 by 6/30/15.

▪ Secure unrestricted grant dollars.

CASE FOR SUPPORT/ KEY MESSAGES

At the Charlotte County Healthy Start Coalition, we understand that EVERY mother-to-be

should have access to the care and services she needs to deliver a happy, healthy baby. That’s

what we work toward every day by offering care coordination services, psychosocial counseling,

prenatal care, diabetic nutritional counseling, childbirth, parenting, breastfeeding education and

more to prenatal women who are at-risk for poor outcomes. Our services reach over 850

Charlotte County women and infants annually.


The importance of this comes down to healthy babies and lower costs. According to the March

of Dimes, the average medical costs for a preterm baby are more than 10 times higher than those

for a healthy full-term baby. The costs for a healthy baby from birth to first birthday average

$4,551; however, for a preterm baby, the costs average $49,033. Charlotte County Healthy Start

Coalition believes that every baby deserves a healthy start…doesn’t that sound like a good return

on investment?

KEY STRATEGIES

Strategy 1: Establish a culture of fundraising.

▪ Conduct board, staff and fundraising committee training.

▪ Expand volunteer infrastructure in fundraising by recruiting volunteers from

clients, donors, and community partners.

▪ Encourage / set expectations for Board donations (e.g. The Giving Challenge).

▪ Fundraising reports to board at every Board meeting.

Strategy 2: Further develop fundraising infrastructure.

▪ Establish an annual fundraising budget.

▪ Develop fundraising materials (e.g. fact sheets, gift range chart, etc.).

▪ Develop/upgrade fundraising database and tracking system.

▪ Strengthen Fund Development Committee through a revised committee

description, role descriptions for the members, and training.

▪ Establish fundraising policies and procedures.

▪ Revise templates: cover letters, acknowledgement letters, and proposals.

▪ Develop the website to support fundraising.

▪ Establish a “Thank You” person to ensure that all donors and volunteers are

properly thanked for their participation at each event.

Strategy 3: Expand visibility and “case for support” to the community.

▪ Establish a “story bank” of success stories, testimonials and photos.

▪ Continue conducting community presentations.

▪ Systematically feed stories to the local media.

▪ Consistently “tell the story” through the newsletter, website, presentations, events,

and media stories.

▪ Develop a PowerPoint presentation or video to support presentations; have the

families tell the story.

Strategy 4: Secure donations from individual donors.


▪ Conduct annual “Mother’s Day” campaign focused on individual donors.

Continue to develop prospect list, standardize acknowledgement and recognition.

▪ Special Events:

▪ Show the Love Luncheon

▪ Icehouse Dart Tournament

▪ Rotary Charity Challenge

▪ Quarter Auctions

Strategy 5: Secure unrestricted grant dollars.

Adopted: 2/11/15


SUBJECT: COMPANY ISSUED LAPTOP & CELL PHONE USE

POLICY: The COALITION will issue and pay for individual cellular phones/laptops for

coalition representatives who are required to be in close contact with the coalition

at all times. While cell phones/laptops are a necessary convenience, we require

that employees follow the guidelines listed below for their own and others safety.

PROCEDURE:

All employees are required to be professional and conscientious at all times when using coalition

cell phones/laptops.

• Employee will take all reasonable measures to ensure the physical and digital security of

the laptop including:

o Changing the password as often as required by the coalition.

o Ensuring that Healthy Start-provided Anti-virus and Firewall software is

functioning and updated on a regular basis.

o Locking the laptop in a secure location when it is not in use.

o To not leave the laptop in the backseat of your vehicle or any other readily-

accessible location.

• Laptops and cell phones are not to be utilized while operating a motor vehicle. If it is

necessary to take or make a phone call or use the laptop, employee will pull the vehicle to

a safe location.

• Employee will not download anything to the laptop without prior approval from the

coalition.

o This includes personal software

o All flash or external media must be scanned by anti-virus software prior to use.

• The allowance per cell phone is 1GB of data. Users who exceed their allocated data will

be expected to reimburse Healthy Start.

• If an employee is found to violate any policy or procedure in regards to participant or

confidential healthcare information, appropriate disciplinary action will be taken.

• Employee will make timely app and system updates, or request technical assistance to do

so, when the cell phone notifies them of their availability.

• In the event the laptop and/or cell phone is lost or stolen, a report must be made the next

available business day to the coalition.

• In the event of separation, all coalition property, including the laptop, cell phone, and

peripheral devices (i.e., key pads) must be returned to the coalition. The coalition

maintains inventory of all equipment.

Adopted 3/09/16


SUBJECT: SOCIAL MEDIA

POLICY: This policy governs the publication of any commentary on social media by

employees or contracted consultants of the Charlotte County Healthy Start

Coalition, Inc. For the purposes of this policy, social media means any facility for

online publication and commentary, including blogs, social networking sites such

as Facebook, LinkedIn, Twitter, Flickr, and YouTube. This policy is in addition to

and complements any existing or future policies regarding the use of technology,

computers, e-mail and the internet.

Publication and commentary on social media carries similar obligations to any other

kind of publication or commentary. All uses of social media must follow the same

ethical standards that Healthy Start employees must otherwise follow.

PROCEDURE:

Privacy

Privacy settings on social media platforms should be set at the same level as the

Healthy Start website. Other privacy settings that might allow others to post

information or see information that is personal should be set to limit access. Be

mindful of posting information that you would not want the public to see.

Content:

Social media content is to be reviewed and approved by the Executive Director or

his/her designee.

Respect copyright laws

All laws governing copyright and fair use or fair dealing of copyrighted material

owned by others are to be followed in the preparation of social media materials.

General Guidelines for the Preparation of Social Media Materials:

Protect sensitive or personal information

Monitor user comments (if enabled)


Be accurate

Correct mistakes

Be considerate

Respect copyrights and trademarks

Avoid advertisements, sponsorships and endorsements

All agency social media presences will have a consistent look and feel,

including use of the agency’s logo.

Social media users should be aware that these types of communications are

considered public records.

Sponsorships must be approved by the Executive Director prior to

publication

Only content related to agency mission and services will be broadcast via the

agency’s social media channels. Examples include:

Announcements of upcoming events, health fairs, workshops, etc.

Media releases

Links to educational videos

Public service and educational messages relating to maternal and child

health.

Twitter

Twitter is a free social networking site that allows users to send and read other

users’ updates of up to 140 characters in length. While people use Twitter in many

different ways for both personal and professional reasons, we are using Twitter at

the Healthy Start as another way to keep citizens informed about what we’re doing,

a tool to spread the word about Healthy Start and its programs, and as another way

to get feedback.

The Twitter account is maintained and updated by the coalition consultant.

Log-in Info - For log in info contact the Executive Director.


Facebook

The Healthy Start Facebook group is used to update our followers about Healthy

Start Events, relevant news articles and research studies, and any other content

relevant to Healthy Start’s mission and goals that is appropriate for all audiences.

Events – Healthy Start events may be advertised via a Facebook Event page, with

the approval of the Executive Director. Create an Event page for each event and

invite all members of the Healthy Start fanpage. In addition, request Staff and

Board Members with Facebooks to invite appropriate friends.

Login Info – A user must already have a Facebook account to be made an Admin

for the Charlotte County Healthy Start Facebook page. Once a user has created a

Facebook account, an Admin can choose “Make Admin” after the user has “Liked”

the Page. Once a user has Admin privileges, he/she can make posts to the Charlotte

County Healthy Start Coalition fan page.

All posts made to the Charlotte County Healthy Start Coalition Facebook page will

be made under the name “Charlotte County Healthy Start Coalition”, and NOT the

individual user’s name. All comments to the Healthy Start Facebook fan page

follow the same format, so be mindful of commenting on posts made by other users.

Blog

The Healthy Start blog is used for short articles that either highlight a past event,

advertise an upcoming event, or relevant news articles and research studies. E-

newsletter articles that are too long to be fully included are published on the blog

and then linked in to the E-Newsletter.

Log-in Info - For log in info contact the Executive Director.

Adopted 3/09/16


PERSONNEL

SUBJECT: ANNUAL REVIEW

POLICY: It shall be the policy of the COALITION to provide employees with an annual

review and appropriate Cost of Living and/or Merit increases as economic conditions and/or job

performance indicates and as funds allow.

PROCEDURE:

1. Employees are evaluated annually by the Executive Director and the Executive Director

will be evaluated by the members of the Board of Directors within a month of their anniversary

dates.

2. After evaluation, a recommendation for merit advancement as well as cost of living

increases can occur. If the Board of Directors authorizes such salary advancement, the

wage/salary increase will be effective the first pay period following evaluation/job anniversary

month.

Merit increase parameters (percent and amount) will be established during preparation of the

annual budget and as state funds allow.


SUBJECT: DISCIPLINARY PROCESS

POLICY: The COALITION, in order to ensure a pleasant

work environment, will have a process for handling and resolving

complaints.

PROCEDURE:

For Problems between Coworkers:

Despite the best of efforts, problems sometimes arise. Problems cannot be solved if no one else

knows about it. If you have any type of problem or suggestion regarding your job, the best thing

to do is follow the chain of command and talk it over with your Supervisor.

If you do that and the problem is still not resolved to your satisfaction within ten working days,

go back to the Supervisor and explain why you think inappropriate action was taken. If by

another ten days the matter is still unresolved, report the situation to the Chairperson of the

Board of Directors. Courtesy indicates that you inform your Supervisor of your intent to meet

with the Board and discuss the problem. Of course, any employee with a special problem may

meet first with the Chairperson of the Board. The decision of the Board of Directors in the

matter will be final.

Whatever is bothering you, it is just as important to the Board of Directors as it is to you. A

pleasant work environment takes the cooperation and understanding of everyone. Sometimes it

requires patience and effort. As in other situations where working closely with others is

required, the key to success in dealing with coworkers is “do unto others as you would have them

do unto you”.

Contingency funds will be provided in the annual budget to cover costs associated with

terminations.

For problems in employee related performance

The Executive Director/Supervisor must state the facts concerning the problem to the employee

and give the solution to the problem. The facts and what is expected is also written, signed, and

dated by both.

The warning issued to the employee will include that three months is given to improve.

Termination will occur if there is not satisfactory improvement after that time.

The Documentation will be kept on file in accordance with record retention policies.


SUBJECT: BENEFITS AND ELIGIBILITY Revised 5/14/14

POLICY: The COALITION will have a policy concerning employee benefits

PROCEDURE:

Employment Categories

1. Contract Employees: A contract employee is hired for a specific contract period and/or to

complete a specific project and is not considered an employee of Healthy Start. As such the

Contractor is not entitled to Social Security Benefits, Unemployment Benefits, or any other

benefit provided to employees of Healthy Start. Each Contractor shall have a contract in place

that is approved by the Executive Director and the Board of Directors. Each contractor shall

cover his/her own personal liability; the Board of Directors will not be liable.

2. Temporary Employee: An employee whose job is established for specific periods of time or

for the duration of specific projects or groups of assignments. Pay is a fixed hourly rate with no

entitlement to benefits or paid leave other than federal or state mandated benefits.

3. Part-Time Employees: Part-time employees must accomplish their work in thirty-two (32) or

less hours a week.

4. Full-Time Employees: A full time employee is defined as one who works thirty-three or more

hours per week. There are two (2) categories of full time employees: exempt (those who are

salaried and exempt from paid overtime) and non-exempt (those who are paid hourly and are

eligible for approved paid overtime).

Office hours will be 8:00-5:00 Monday through Friday. Flexible schedules and flex-time can

occur, if approved by the Executive Director, to offset hours worked outside of this parameter, as

clients may sometimes have to be contacted during evenings or weekends.

Benefits

The Coalition’s Employee Benefits Program is a benefit package which utilizes up to 32% of the

annual aggregate salaries of all employees. Mandatory benefits of FICA/Medicare, Worker’s

Compensation, and Florida Unemployment Tax are included in the benefit’s package and these

costs must be deducted from available benefit package funding. Residual benefit package funds

will be allocated annually for employee health insurance stipend and retirement benefits when


the employee has completed any required probationary period and becomes eligible for the

benefit.

Each eligible employee will determine election of benefits annually in accordance with the

guidelines and/or policies set forth by the State of Florida, insurer or other applicable entity.

Other insurance benefits, such as life, dental or vision insurance, may be made available to

eligible employees through the Coalition’s staff leasing agency, at the employees own expense.

All full or part time Employees

Legally required benefits for all employees are FICA (social security), Worker’s

Compensation, Unemployment Compensation, and Leave of Absence without pay.

FICA will be submitted as required by law. The ACT states the specified amount that must be

withheld from the employee’s and remitted along with the employer’s share as required by

Florida State Law.

Worker’s Compensation covers employees as required by law. In case of on the job accidents,

the employee must immediately report the accident details to the Executive Director. The

Executive Director will prepare all necessary claim forms for signatures and will submit them to

the insurance carrier on behalf of the employee.

State Unemployment Insurance covers employees as required by Florida law.

Leave of Absence without pay must be approved by the Executive Director two weeks prior to

the leave. The COALITION supports the family leave act and makes every attempt to

accommodate employees. A leave of absence should not exceed three months. Fringe benefits

will not accrue during the time off. Accrued annual leave can be applied to their leave of

absence. If annual leave is exhausted, the employee must take their leave without pay. The

employee will be assured of a job as long as there is a vacancy.

Jury Duty- an employee is required to show his/her summons for jury duty to the Executive

Director. Employees will receive full pay minus jury duty fees received. If the obligation

legitimately exceeds two pay periods, the Executive Director will determine what, if any, action

is necessary.

Military Leave- special short term ( not more than 14 days) leave will be approved. Employees

will receive full pay minus any military pay received

HEALTH INSURANCE

All full time employees of the COALITION are eligible to receive a monthly stipend of $500, to

help offset the cost of individual health insurance premiums.


Any part time employees working at least 56, but not more than 70 hours per pay period

may opt to receive a monthly stipend of $250, to help offset the cost of individual health

insurance premiums. Revised 5/14/14

RETIREMENT

All full time and part time employees are eligible for participation in the retirement plan

after the completion of six months of employment. Each employee receives a brochure with

specific descriptions of the plan and its benefits. The COALITION will contribute an amount to

match the employee’s contribution, not to exceed 4.5% annually. Employees will be vested in

accordance with the terms of the program. Revised 1/22/14

Part time Employees:

PAID TIME OFF

1. The COALITION will provide part time employees working a minimum of 25 hrs.

weekly with 4 hours of paid time off (PTO) per bi-monthly pay period in lieu of paid holidays,

sick time, annual leave, or education leave. This amounts to 96 hours annually, or 12 days off

per year, to be used at the employee’s discretion. Those working 24 or less per week will receive

1 hr. PTO per pay period which amounts to 24 hrs. annually.

2. A maximum of 8 hours will be paid for each day off.

3. The part-time employee may use a flexible work schedule to avoid working on holidays and

may elect to use PTO as holiday compensation.

4. PTO’s can be accrued to an amount equal to 1 years earned PTO.

5. Employees should request time off with as much advance notice as possible. Leave is granted

at the discretion of the Executive Director according to staffing needs and must be approved in

advance.

6. The calculation for paying a PTO is the employee’s hourly base rate times the number of

hours charged to annual leave during the pay period-or the hourly base rate times the unused

annual leave hours to a maximum of 96 hours upon termination.

7. PTO’s will be paid for the pay period submitted and approved by the supervisor, or upon

termination or status change, at the earliest pay date following the event.

8. Terminations:

i. PT Employees who have been an employee for a full six months and voluntarily

terminate employment will be paid for PTO hours, not to exceed 96 hours at the earliest pay

date following the termination date.


ii PT Employees who terminate due to death, disability, reduction in force, or retirement

will be paid for unused hours, not to exceed 96 hours, without consideration of the minimum 6

months of employment. In case of death of an employee, payment of unused annual leave shall

be made to employee’s beneficiary, estate, or as provided by law.

iii PT Employees who are terminated for a serious offense or who have not been employed six

full months, will not be paid for unused PTO’s upon termination of their employment.

RETIREMENT PLAN

1. Part time employees who have been employed for at least six months, may elect to

participate in the retirement plan, based upon the specific guidelines of the approved plan.

Full- time employees:

Holidays

All full time employees are entitled to 12 holidays per year. The actual calendar days off are

adjusted each year to account for weekends. The following holidays are observed:

New Year’s Day

Martin Luther King Day

President’s Day

Memorial Day

Independence Day

Labor Day

Veterans Day

Thanksgiving Day

The Day after Thanksgiving

Christmas Eve

Christmas Day

One (1) Floater Day

Full-time employees will be scheduled “off” on these days.


If the Holiday falls on a Saturday, it is usually observed the preceding Friday. When it falls on a

Sunday, it is usually observed the following Monday.

Full time employees, who work 40 hours per week, earn Paid Time Off (PTO’s) which can be

used for vacation days, sick days, bereavement leave, and other personal reasons.

All full time exempt employees who work 40 hours per week, are eligible to earn, thirty-three

(33) annual leave days accumulated at the rate of 11 hours per pay period.

FT, non-exempt employees working 40 hours per week are eligible to earn twenty-eight (28)

annual leave days, accumulated at the rate of 9.33 hours per pay period.

If a Holiday falls during the time of approved leave, holiday hours can be recorded on the

timecard.

Leave time is accrued from year to year. However, total accrued leave shall not exceed 40 days

annual accrual in accordance with the schedule provided.

Upon termination, accumulated leave will be paid only up to a limit of 264 hours for exempt

employees, 224 hours for non-exempt employees, and a maximum of 96 hours for eligible part

time employees, unless otherwise approved by the Board of Directors.

Employees who have unused, annual leave hours and change from full time to part time status

will systematically draw down the retained hours until below the maximum allowable accrued

amount is reached.

If using the hours for sick leave, the employee must give notice as soon as the need is known so

that adequate staff coverage can be provided.

Annual leave adjustments for a FT Employee who voluntarily terminates will be made in the

next pay period following the last day of employment.

FT Employees who are terminated without prior notice because of insubordination, dishonesty,

misconduct, etc. forfeit all rights to fringe benefits including, but not limited to, payment of

accumulated leave.


SUBJECT: EMPLOYEE CONDUCT

POLICY: The COALITION will have a policy regarding employee conduct

in respect to confidentiality and discretion in regards to

COALITION business.

PROCEDURE:

1. An employee’s conduct should speak well of their position as an employee of the

COALITION and exercise complete discretion regarding matters concerning official business.

Confidential information must be kept confidential. A confidentiality agreement form will be

signed and kept in the personnel file.

2. Conflict of Interest

Employees will not engage in any activity or conflict of interest determined to interfere with the

goals and objectives of the Coalition. An employee may expect swift and immediate action if

they deviate from this policy.

3. Political Activities

Coalition employees may not take any active part in a political campaign during working hours

or within any period of time in which they are expected to perform services for and receive

compensation from the Coalition.


SUBJECT: EQUAL EMPLOYMENT OPPORTUNITY

POLICY: The COALITION will provide opportunities for employment and advancement

without discrimination based on the following factors: race, color, religion, creed, national

origin, ancestry, disability, sex, sexual orientation, or age.

PROCEDURE:

1. Strictly follow personnel procedures that will ensure equal opportunity for all people

without regard to race, color, religion, creed, national origin, sex, sexual orientation, age,

ancestry, marital status, disability, veteran or draft status.

2. Comply with all the relevant and applicable provisions of the Americans with Disabilities Act

(“ADA”). The COALITION will not discriminate against any qualified individual with respect

to any terms, privileges, or conditions of employment because of a person’s mental or physical

disability.

3. Make reasonable accommodation wherever necessary for all employees or applicants with

disabilities, provided that the individual is otherwise qualified to safely perform the duties and

assignments connected with the job and provided that any accommodations made do not require

significant difficulty or expenses.

4. Achieve understanding and acceptance of the COALITION’s policy on Equal Employment

Opportunity by all employees and by the communities in which the COALITION operates.

5. Thoroughly investigate instances of alleged discrimination and take corrective action if

warranted.

6. Be continually alert to identify and correct any practices by individuals which are at variance

with the intent of the Equal Employment Opportunity Policy.


SUBJECT: GENERAL OFFICE CONDITIONS

POLICY: The COALITION will have rules for office conditions.

PROCEDURE:

1. Contractual Arrangements

Only the Executive Director is authorized to enter into any agreement or commitment that pays

Coalition funds to any person(s) or organization.

2. Property and Liability

The Coalition’s operations and property are covered by liability insurance. All matters

pertaining to (or situations involving) liability insurance coverage should be promptly reported to

the Executive Director.

3. News Releases

Only employees authorized by the Executive Director may release information to the news

media that represents the Coalition’s views or policy.

4. Change in Employee Records

It is very important for an employee to report all changes in their employee records to the

Coalition. This includes changes in the employee’s name, address, telephone number, marital

status, number of dependents, additional educational courses, and completed degrees.

5. Dress Code

An employee’s dress must be consistent with the professional nature of the organization.

Acceptable business casual attire should be worn at all times.

6. Long distance calls

An employee must keep complete and accurate records for all long distance calls.

Forms are supplied.

7. Travel

An employee is reimbursed for mileage on a monthly basis or as needed. Forms are supplied.

The Executive Director must approve and sign them along with the employee. Expenses must

not exceed allowable amounts.


Travel expenses are in the budget, yet employees are responsible for determining a method and

cost of travel that is economical and in the best interest of the Coalition.

The Executive Director will consult the Board of Directors to authorize travel for other

individuals that are not permanently related to the Coalition, but are engaged in a temporary

assignment with the Coalition.

Travel includes any official business assignment that takes the employee away from their regular

place of employment, when it is considered reasonable and necessary.


SUBJECT: MILEAGE/TRAVEL REIMBURSEMENT POLICY

POLICY: Recognizing the importance of staff and Board member participation in meetings

on local, regional, and state levels, a reimbursement policy is established to ensure full

involvement of Healthy Start staff and/or Board members without incurring additional expenses.

PROCEDURE:

1. Attendance at approved meetings will be reimbursed per state policy. In keeping with

state policies, the following expenses can be paid:

Airfare and/or mileage to approved meetings as appropriate. Reimbursement will be at

.445 cents per mile. Mileage is calculated from the Coalition office to the point of

destination and back.

Reimbursement of hotel accommodations. (Overnight traveling will be reimbursed for

single occupancy rate to be supported by invoice)

Meal allowance daily up to $36.00 per day.

2. Consumers who are not COALITION members but who are requested to serve on "ad hoc" or

standing committees by the COALITION Executive Director can be reimbursed with the

advance approval of the Board of Directors in accordance with the above policies.

3. All expenses must be supported by a receipt.

4. If travelers are gratuitously transported, housed, or fed by another person, they may not

submit expenses.

5. Incidental expenses such as taxi fare, tolls, registration fees, etc. are eligible for

reimbursement with appropriate documentation.

6. Authorization Forms for attendance at a convention/conference must be completed in advance

for approval.

7. Travel expense advancements (not to exceed 80% of the estimated expenses) can be

authorized by the Executive Director to lower anticipated travel costs to employees.

8. All travel reimbursements must be in accordance with state HRSR-40-1 or as amended. A

copy of HRSR-40-1 will be kept in the master files.


SUBJECT: PERFORMANCE EVALUATION

POLICY: The COALITION shall ensure that staff performs their duties well

through conducting periodic evaluation.

PROCEDURE:

Every new employee is subject to a three-month probationary period in order to assess the

person’s ability to transition into his/her specific work assignment. Benefits will accrue during

this time. Termination may occur with or without cause during the probationary period and

result in the employee not being considered for rehire or entitles to any recourse.

Employee Performance Evaluations are conducted annually, or if the Executive Director elects at

more frequent intervals. Each employee is asked to read and sign the final evaluation report,

which is filed in his/her personnel file.

If the employee disagrees with any portion of the Performance Evaluation, he/she may elect to

attach a comment to it, which will also remain in the Personnel file.

Categories outlined in the Performance Evaluation include, but are not limited to: job knowledge

and training, judgment, responsibility, initiative, versatility, creativity, diligence, quality of work,

cooperation and relationship with others, and leadership. The evaluation shall be used as a basis

for continued employment, salary increases, dismissal, and demotion.

Absenteeism is discouraged, since good attendance record is a condition of continued

employment. Chronic lateness or absenteeism creates hardship to coworkers who must carry an

additional workload. Excessive tardiness or absences without advance notice may be reason for

termination.

The COALITION requires two weeks’ notice in the event of voluntary termination.

For involuntary terminations such as death, for accrual purposes, the termination date is the date

of death.

For involuntary terminations due to layoffs and insufficient funds to employ someone for a

specific position, two weeks’ notice will be given and accrued annual leave up to the maximum

allowed is paid on the next pay period following dismissal.


Immediate termination can result from an employee’s failure to meet work standards, dishonesty,

fraud, disloyalty, misconduct, and insubordination. The decision to dismiss a staff member for

cause is made between the Executive Director and Board of Directors. Termination may be

made without prior notice for cases of insubordination, dishonesty, and fraud. In such cases an

employee forfeits all rights to fringe benefits including but not limited to payment for

accumulated leave.

For employees with poor performance, future references will only include start and end dates of

employment.


SUBJECT: SEXUAL HARASSMENT

POLICY: The COALITION shall protect employees from sexual harassment.

PROCEDURE:

Unwelcome sexual advances, requests for sexual favors and other verbal or physical contact of a

sexual nature constitute sexual harassment when:

Submission to such conduct is made either explicitly or implicitly a term or condition of an

individual’s employment;

Submission or rejection of such conduct by an individual is used as the basis for employment

decisions affecting such individual; or

1. Such conduct has the purpose or effect of substantially interfering with an individual’s work

performance or creating an intimidating, hostile, or offensive work environment.

2. Any employee that believes they have been harassed should report the misconduct to the

supervisor. If the supervisor is part of the problem, then the incident should be reported to a

member of the Board of Directors. Supervisor or Board of Directors will review the matter

and decide the best course of action that will ensure the safety and well-being of all

employees.

3. All employees are assured, by policy and the law, the opportunity to work in an environment

free of discrimination and harassment.


SUBJECT: SMOKE-FREE/DRUG-FREE WORKPLACE

POLICY: The COALITION declares non-smoking rules that promote a smoke free

environment and in compliance with the Drug-Free Workplace Act of

1998, the COALITION has established a drug-free/alcohol-free employee

work environment.

PROCEDURE:

Employees will be aware that there will be no smoking in the office or on the grounds.

Drug tests are required prior to employment.

If there is any suspicion of drug/alcohol use, the employee can be sent for a random drug tests.


SUBJECT: USE OF ELECTRONIC MEDIA

POLICY: The COALITION will have a policy that sets forth general principles for

COALITION employees to apply to the use of electronic media and services.

PROCEDURE:

Electronic media includes computers, e-mail, telephones, voicemail, fax machines, external

electronic bulletin boards, on-line services, the internet, etc. that are designed to facilitate

COALITION business communications among employees and business associates. Employees

shall use electronic media to perform their professional duties and not for personal gain or to

support or advocate for non-business related activities.

All data and other electronic messages within these systems are the property of the COALITION

and not the employees. Therefore, the use of passwords on individual files is prohibited, unless

authorized by the Executive Director.

The COALITION’s electronic media may not be used for knowingly transmitting, retrieving, or

storing any communications of a discriminatory or harassing nature, or which are derogatory to

any individual or group, or which are obscene or X-rated communications, or for “chain letters”,

or any other purpose which is illegal, against policy, or contrary to the interest of the

COALITION.

Limited, occasional, or incidental personal, non-business use of electronic media is

understandable and acceptable. However, employees need to demonstrate a sense of

responsibility and may not abuse the privilege. Any personal stored personal information on

business equipment may be accessed, reviewed, copies, deleted, or disclosed. Remember that

the system is not a private communication system, even if password protected.

The system is not intended to be a personal bulletin service. Solicitations, offers to buy and sell

goods, or services, and other personal messages to groups via the system are subject to the same

rules imposed for such messages on bulletin boards and may be prohibited.

Employees must respect the confidentiality of other people’s electronic communications and

may not attempt to “hack” into other systems or send electronic communications which attempt

to hide the identity of the sender.


Anyone obtaining electronic access to other companies or individual’s materials must respect all

copyrights and may not copy, retrieve, modify, or forward copyrighted materials except as

permitted by the copyright owner or a single copy for reference use only.

Each employee is responsible to update the computer he/she uses for the following:

Computers are equipped with an Anti-virus program that should be updated and run on a weekly

basis.

Computers should be updated of all critical updates in Window’s Update weekly. (this is found

through the start button)

Computers are equipped with an anti-spyware program that should be updated and run weekly.


SUBJECT: WHISTLEBLOWER

POLICY: This policy is to encourage Board members, staff (paid and volunteer) and others

to report suspected or actual occurrence(s) of illegal, unethical or inappropriate events (behaviors

or practices) without retribution.

PROCEDURE:

The Whistleblower should promptly report the suspected or actual event (hereinafter called

Concerns) to his/her supervisor.

If the Whistleblower would be uncomfortable or otherwise reluctant to report to his/her

supervisor, then the Whistleblower could report Concerns to the next highest or another level of

management, including to an appropriate Board member.

The Whistleblower can report Concerns with his/her identity or anonymously.

The Whistleblower shall receive no retaliation or retribution for a report that was provided in

good faith – that was not done primarily with malice to damage another or the organization.

The Whistleblower who makes a report that is not done in good faith is subject to discipline,

including termination of the Board or employee relationship, or other legal means to protect the

reputation of the organization and members of its Board and staff.

Anyone who retaliates against the Whistleblower (who reported Concerns in good faith) will be

subject to discipline, including termination of Board or employee status.

Crimes against person or property, such as assault, rape, burglary, etc., should immediately be

reported to local law enforcement personnel.

Supervisors, managers and/or Board members who receive the reports must promptly act to

investigate and/or resolve the issue.

The Whistleblower shall receive a report within five business days of the initial report, regarding

the investigation, disposition or resolution of the Concerns. It will not be possible to

acknowledge receipt of anonymously submitted Concerns.


If the investigation of a report, that was done in good faith and investigated by internal

personnel, is not to the Whistleblower’s satisfaction, then he/she has the right to report Concerns

to the appropriate legal or investigative agency.

The identity of the Whistleblower, if known, shall remain confidential to those persons directly

involved in applying this policy, unless the issue requires investigation by law enforcement, in

which case members of the organization are subject to subpoena.


18. END NOTES

End Notes

i http://www.census.gov/quickfacts/table/PST045215/12015,12

ii http://www.floridacharts.com/FLQUERY/Population/PopulationRpt.aspx

iii Bureau of Labor and Statistics

iv U.S. Census – American Community Survey

v http://gulfcoastpartnership.org/wp-content/uploads/2015/04/2015-point-in-time-data-reporting-survey-tool-rev-

1.pdf

vi https://www.charlottecountyfl.gov/CRA/Parkside/Documents/TransitLatentDemandStudy.pdf

vii http://www.floridacharts.com/charts/DataViewer/BirthViewer/BirthViewer.aspx?cid=0025

viii http://www.floridacharts.com/FLQUERY/Birth/BirthRpt.aspx

ix https://www.guttmacher.org/fact-sheet/state-facts-publicly-funded-family-planning-services-florida

x Source includes local OB providers’ surveys from 2010-2016. See Survey Summary Section for more details.

xi http://www.unitedwayccfl.org/community-data-statistics

xii http://mchb.hrsa.gov/chusa13/perinatal-risk-factors-behaviors/p/pregnancy-spacing.html

xiii http://www.cnn.com/HEALTH/9902/24/pregnancy.timing/index.html?eref=sitesearch

xiv http://www.npr.org/sections/health-shots/2014/06/05/319067247/taking-more-time-between-babies-reduces-risk-

of-premature-birth

xv http://myfloridalegal.com/webfiles.nsf/WF/RMAS-9GUKBJ/$file/Progress-Report-Online-2014.pdf

xvi http://www.forbes.com/places/fl/punta-gorda/

xvii http://www.kiplinger.com/article/retirement/T037-C000-S001-3-great-places-to-retire-on-a-budget.html

xviii http://www.movoto.com/blog/top-ten/safest-places-in-florida/

xix http://floridasinnovationcoast.com/files/documents/Qtr_Economic_Indicator_Report_January_2016.pdf

xx

http://floridasinnovationcoast.com/files/documents/January_2016_Regional_Economic_Indicator_Report_Final.pdf

http://www.census.gov/quickfacts/table/PST045215/12015,12

http://www.floridacharts.com/FLQUERY/Population/PopulationRpt.aspx

http://gulfcoastpartnership.org/wp-content/uploads/2015/04/2015-point-in-time-data-reporting-survey-tool-rev-1.pdf

http://gulfcoastpartnership.org/wp-content/uploads/2015/04/2015-point-in-time-data-reporting-survey-tool-rev-1.pdf

https://www.charlottecountyfl.gov/CRA/Parkside/Documents/TransitLatentDemandStudy.pdf

http://www.floridacharts.com/charts/DataViewer/BirthViewer/BirthViewer.aspx?cid=0025

http://www.floridacharts.com/FLQUERY/Birth/BirthRpt.aspx

https://www.guttmacher.org/fact-sheet/state-facts-publicly-funded-family-planning-services-florida

http://www.unitedwayccfl.org/community-data-statistics

http://mchb.hrsa.gov/chusa13/perinatal-risk-factors-behaviors/p/pregnancy-spacing.html

http://www.cnn.com/HEALTH/9902/24/pregnancy.timing/index.html?eref=sitesearch

http://www.npr.org/sections/health-shots/2014/06/05/319067247/taking-more-time-between-babies-reduces-risk-of-premature-birth

http://www.npr.org/sections/health-shots/2014/06/05/319067247/taking-more-time-between-babies-reduces-risk-of-premature-birth

http://myfloridalegal.com/webfiles.nsf/WF/RMAS-9GUKBJ/$file/Progress-Report-Online-2014.pdf

http://www.forbes.com/places/fl/punta-gorda/

http://www.kiplinger.com/article/retirement/T037-C000-S001-3-great-places-to-retire-on-a-budget.html

http://www.movoto.com/blog/top-ten/safest-places-in-florida/

http://floridasinnovationcoast.com/files/documents/Qtr_Economic_Indicator_Report_January_2016.pdf

http://floridasinnovationcoast.com/files/documents/January_2016_Regional_Economic_Indicator_Report_Final.pdf


xxi http://floridasinnovationcoast.com/site_selection/major_employers

xxii http://floridasinnovationcoast.com/community_data/labor_data

xxiii http://floridasinnovationcoast.com/files/documents/Qtr_Economic_Indicator_Report_January_2016.pdf, page 2.

xxiv http://floridasinnovationcoast.com/files/documents/Qtr_Economic_Indicator_Report_January_2016.pdf , page 7.

xxv http://floridasinnovationcoast.com/community_data/housing

xxvi http://www.uwof.org/sites/uwof.org/files/14UW%20ALICE%20Report_FL_Lowres_3.23.15.pdf page 137.

xxvii http://floridasinnovationcoast.com/community_data/education

xxviii http://www.elcfloridasheartland.org/images/1111/webmay.pdf

xxix http://charlotte.floridahealth.gov/programs-and-services/community-health-planning-and-

statistics/_documents/FINAL%202015%20CHA-Charlotte.pdf, page 17.

xxx http://money.usnews.com/money/personal-finance/best-places-to-retire/articles/2008/09/18/best-healthy-places-

to-retire-punta-gorda-florida

xxxi http://charlotte.floridahealth.gov/programs-and-services/community-health-planning-and-

statistics/_documents/FINAL%202015%20CHA-Charlotte.pdf page 23.

xxxii http://www.drugfreecharlottecounty.org/data/files/5/2014_community_assessment.pdf

xxxiii http://www.drugfreecharlottecounty.org/data/files/5/2014_community_assessment.pdf

xxxiv http://charlotte.floridahealth.gov/programs-and-services/community-health-planning-and-

statistics/_documents/FINAL%202015%20CHA-Charlotte.pdf, page 15.

xxxv http://www.bayfrontcharlotte.com/

xxxvi http://englewoodcommhospital.com/

xxxvii http://fawcetthospital.com/

xxxviii http://www.bayfrontcharlotte.com/

xxxix http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=CF

xl http://www.aafp.org/afp/2008/0415/p1139.html

xli http://www.floridacharts.com/charts/OtherIndicators/NonVitalIndRateOnlyDataViewer.aspx?cid=0300

xlii https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health/objectives

xliii http://www.cdc.gov/nchs/fastats/delivery.htm

xliv http://www.floridacharts.com/charts/OtherIndicators/NonVitalIndNoGrpDataViewer.aspx?cid=0330

xlv http://www.floridacharts.com/charts/OtherIndicators/NonVitalIndNoGrpDataViewer.aspx?cid=0328

http://floridasinnovationcoast.com/site_selection/major_employers

http://floridasinnovationcoast.com/community_data/labor_data



http://floridasinnovationcoast.com/community_data/housing

http://www.uwof.org/sites/uwof.org/files/14UW%20ALICE%20Report_FL_Lowres_3.23.15.pdf

http://floridasinnovationcoast.com/community_data/education

http://www.elcfloridasheartland.org/images/1111/webmay.pdf



http://money.usnews.com/money/personal-finance/best-places-to-retire/articles/2008/09/18/best-healthy-places-to-retire-punta-gorda-florida

http://money.usnews.com/money/personal-finance/best-places-to-retire/articles/2008/09/18/best-healthy-places-to-retire-punta-gorda-florida



http://www.drugfreecharlottecounty.org/data/files/5/2014_community_assessment.pdf

http://www.drugfreecharlottecounty.org/data/files/5/2014_community_assessment.pdf



http://www.bayfrontcharlotte.com/

http://englewoodcommhospital.com/

http://fawcetthospital.com/

http://www.bayfrontcharlotte.com/

http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=CF

http://www.aafp.org/afp/2008/0415/p1139.html

http://www.floridacharts.com/charts/OtherIndicators/NonVitalIndRateOnlyDataViewer.aspx?cid=0300

https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health/objectives

http://www.cdc.gov/nchs/fastats/delivery.htm

http://www.floridacharts.com/charts/OtherIndicators/NonVitalIndNoGrpDataViewer.aspx?cid=0330

http://www.floridacharts.com/charts/OtherIndicators/NonVitalIndNoGrpDataViewer.aspx?cid=0328