Community Involvement in Florida’s Healthy Start Cheryl L. Clark, MPH, RHIA

1. Community Involvement in Florida’s Healthy Start Cheryl L. Clark, MPH, RHIA Infant Maternal & Reproductive Health Florida Department of Health Judi Vitucci, PhD Healthy Start Coalition of Pinellas County

2. Preface • In 2004, AMCHP Action Learning Lab on Perinatal Disparities assisted states in developing effective strategies to reduce adverse perinatal outcomes • Community involvement/engagement named as a key component to successful interventions/strategies • FL DOH began process to institutionalize community involvement in the Florida Healthy Start Program

3. What is Community? “a group of people with diverse characteristics who are linked by social ties, share common perspectives, and engage in joint action in geographical locations or settings” (McQueen et al, 2001)

4. Community Involvement/Engagement “…the process of working collaboratively with and through groups of people affiliated by geographic proximity, special interest, or similar situations to address issues affecting the well-being of those people.” (CDC/ATSDR Committee on Community Engagement, 1997)

5. Objectives of Community Involvement -1(Emmel & Conn, 2004) • Realize the primary goal of community involvement is to address inequalities in health and work towards a healthier population • Assist communities in addressing health disparities through releasing self-confidence to identify needs and advocate • Plan and provide services that are responsive to community issues defined by community members. • Emphasize role of communities in planning, implementing, and evaluating health care and other services.

6. Objectives of Community Involvement - 2 (Emmel & Conn, 2004) • Work with the existing community networks and organizations communities create and provide support to direct the capacity communities have. • To ensure individuals who represent their community are supported, linked, and accountable to a wide community network • To allocate adequate resources to community involvement activities to initiate and sustain relationships • Demonstrate tangible benefits to be gained from community involvement.

7. Community Partnering Model(Best et al, 2003) • Integration of empowerment, behavior and organizational orientations • Empowerment: focus on process, participation, shared power and ownership • Behavior: focus on outcomes, evidence-based strategies/interventions, identifying/changing risk behaviors • Organization: focus on structure, service integration, efficiency/accountability and management of information

8. Community Involvement in Federal Healthy Start: Logic Model (PolicyLink, 2000)

9. Florida Healthy Start is a statewide initiative to reduce infant mortality and the number of low birthweight infants • A primary goal is the early identification factors associated with adverse birth outcomes through universal offer of risk screening to Florida’s pregnant women and infants • Collaborative partnerships with statewide network of 33 Healthy Start coalitions • Oversight of process of identifying pregnant women and infants at risk for adverse outcomes • Care coordination of prenatal and postnatal services based on individually assessed needs: prenatal and infant care, psychosocial services, childbirth education, smoking cessation

10. Community Involvement Starts at Home • Healthy Start Standards & Guidelines • Primary reference for Florida’s Healthy Start Program • Logical place for community involvement platform • New chapter developed specifically to address community involvement and its components in Healthy Start Program • Cultural competency • Communications, training and technical assistance • Involvement in service planning, delivery & assessment • Feedback mechanisms

11. HSSG Community Involvement Chapter Development

12. Pilot of Community Involvement Chapter • Piloted chapter prior to implementation • 9 months retrospectively and 3 month active • Pilot coalitions are diverse in region and population • Bay, Franklin & Gulf Healthy Start Coalition • Northeast Florida Healthy Start Coalition • Healthy Start Coalition of Pinellas County

14. Implementation in Pinellas County, FloridaComponent: Cultural Competency • Cultural Competency Training for Coalition staff, board and community • Disseminated Cultural Competency Self Assessment tool • Cultural Competency DVD produced by Office of Minority Health • Developing shorter, web-based, training for providers • Community-wide training (Medical Grand Rounds, 2 day conference, nationally recognized speakers on cultural competency and disparities for community forums)

15. Implementation in Pinellas County, FloridaComponent: Communications, Training & Technical Assistance • Providing orientation, on-going information, training and assistance on perinatal issues and trends • Newspaper inserts; letters to the editor • Publishing articles in Spanish magazines • Sending informational postcards to churches • Presentations for community venues • Service clubs, Chamber of Commerce, Mothers Clubs, Faith-based “health ministries” • Conducting/participating in health fairs, community baby showers & other community events • Providing opportunities for consumers tell their “story” to legislators and the Board • Meetings with legislators about perinatal issues and legislative needs

16. Implementation in Pinellas County, FloridaComponent: Service Planning, Delivery & Assessment • Collecting data and conducting community assessments on factors that influence outcomes • Establishing partnerships & community networks for collaborative efforts to reduce perinatal disparities • Staff actively participates in 50+ community groups on a monthly basis • Ensure representation of the communities’ diversity

17. Implementation in Pinellas County, FloridaComponent: Feedback Mechanism • Types • Focus groups • Customer satisfaction surveys • Staff satisfaction surveys • Evaluation of trainings and events • Community Forums • Follow-up process for issues/complaints received

18. Pilot Site SurveyNoted Benefits • Improved efforts: • Involvement of community-based and grassroots organizations in assessment, planning, and funding allocation activities • Providing information, education, and assistance to the community on a regular basis • Standardization of reporting practices • Improved provision of cultural competency training (greatest impact) • No significant increase in workload, but a new focus is required

19. Pilot Survey ResultsNoted Challenges • New data collection tools needed • Multifactorial reasons for health disparities make it difficult to implement strategies/see results in short time frames • Politics of unfunded care • Women’s health before pregnancy a key factor to outcomes • Funding for interconceptual care • New $$ for strategies • Difficult to keep community involved due to competing interests

20. Community Involvement Chapter & Initiative Evaluation • FSU Center for Early Intervention & Prevention Policy performing evaluation of chapter and chapter development process • A baseline pre-implementation survey from sample of Florida Healthy Start coalition staff • Statewide post-implementation survey scheduled in late spring 2007 to assess implementation

21. Challenges for Community Involvement Initiatives(Bramson & Buss, 2002) • Leaders - Community • Public leaders: Unwilling to share power, listen to and respect participants’ views • Participants: Not willing to find common ground, consensus building, or compromise • Both parties: Involvement of inappropriate people • Key perspectives are not represented to adequately address the issues • Resources • Time: Intensive follow-up needed for decisions or strategies • Money • Logistical support: access and travel to meetings, childcare, etc. • Facilities

22. Recommended Community Involvement Policy & Strategies – Accomplishments • Invest in coalition building, community organizing and advocacy • Use community-building approach to develop place-based health programs • Use community-driven health assessment to determine priorities • Use local residents in community outreach and to access cultural gaps • Improve linkages between policies for community/regional development and health (PolicyLink, 2000)

23. Recommended Community Involvement Policy & Strategies – Next Steps • Improve data collection and community health indicator measurements • Enhancement of knowledge and research • Assessment of impact of community involvement • Understanding interaction between environment, socioeconomic conditions and health outcomes • Continued education & support for professionals & staff on benefits of community involvement • Provide legislative and policy support for community involvements strategies and initiatives (PolicyLink, 2000)

24. Community Involvement Initiative Expansion • Not enough to only apply to Healthy Start functions and activities • Expansion needed to all MCH programs and DOH initiatives • Current • Prenatal, Infant & Interconceptional Care • Women’s Health • Family Planning • Future • County Health Departments • Subcontracted providers and program services • FL DOH Office of Minority Health

25. Questions?

26. References • Best A, Stokols D, Green LW, Leischow S, Holmes B & Bucholz K. 2003. An integrative framework to translate theory into health promotion strategy. American Journal of Health Promotion, 18 (2), 168-176. • Bramson RA, Buss T. 2002. Methods for whole system change in public organizations and communities: An overview of the issues. Public Organization Review: A Global Journal 2: 211–221. • CDC/ATSDR Committee on Community Engagement. 1997. Principles of Community Engagement. Atlanta, GA: Centers for Disease Control. • Emmel N, Conn, C. 2004. Towards community involvement: Strategies for health and social care providers. Nufield Portfolio Programme Report, No. 12. • MacQueen KM, McLellan E, Metzger DS, Kegeles S, Strauss SP, Scotti R, Blanchard L & Trotter, RT. 2001. What is community? An evidence-based definition for participatory public health. American Journal of Public Health, 91: 1929 - 1938. • McGinnis M. 2004. Build health leadership with emphasis on diversity mind map. Available: http://www.wkkf.org/DesktopModules/WKF.00_DmaSupport/ViewDoc.aspx?LanguageID=0&CID=1&ListID=28&ItemID=13771&fld=PDFFile • National Center for Cultural Competence Website. Georgetown University. Available at: http://www11.georgetown.edu/research/gucchd/nccc/ • PolicyLink. 2000. Community Involvement in federal Healthy Start. Oakland, CA: PolicyLink. • PolicyLink. 2002. Reducing health disparities through a focus on communities. Oakland, CA: PolicyLink.