Floridas Universal Risk Screening

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Floridas Universal Risk Screening

• Carol Graham, Ph.D, Dan Thompson, MPH, and
• Melanie Simmons, M.S.
• Florida State University, Center for Prevention
  and Early Intervention Policy, Consultants to
  Florida Department of Health

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The Rest of the Team

• MCH Evaluation, Grants, and Special Projects
• Team
• Cheryl Clark, Angel Watson, Bob Peck
• Office of Health Planning, Data, and
• Evaluation
• Meade Grigg, Rhonda White, Karen Freeman, Ron
  Humphries

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The Rest of the Team

• Maternal and Child Health Unit
• Cindy Lewis, Susan Bulecza, Marie Melton, Mike
  Mason, David Blodgett, Earl Brown, Sherry Lange,
  Emma Scurti, Tara Edinburg, Peggy Ott, Barbara
  Colston, Laura Pan, Sally Wendt, Felisha Dickey,
  Susan Potts, Donna Marshall, Trish Mann,
  Charlotte Curtis, Sonia Rosier-Clark, Patti
  Armstrong

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Components of Floridas Healthy Start

• Increased Medicaid Eligibility
• Universal Risk Screening
• Healthy Start Coalitions
• Healthy Start Services
• SOBRA/Choice Counseling

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reductions
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Statutory Authority

• Healthy Start Legislation 383.011 F.S.
• Universal Screening 383.14 F.S
• Healthy Start Coalitions383.216 F.S.

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HEALTHY START SERVICES
Care Coordination Smoking Cessation Psychosocia
l Counseling Parenting Support and
Education Childbirth Education Breastfeeding
Education Support Nutritional Counseling

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Screening Process

• FL Statute
• Risk factors are determined by extensive
  research, literature review, and statistical
  analysis
• Healthy Start Coalitions Community Liaisons

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Screening Process (Cont)

• Risk screening is performed by prenatal care
  providers and by delivering facilities
• Referrals to care coordination are by score,
  and/or by professional or self referral

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Universal Screening Instruments

• Prenatal Screen
• Predictive of preterm birth (34 weeks since LMP)
  and LBW
• 40 screen positive
• 61 of adverse outcomes occur within the 40
• Women with positive scores are 1.8 times as
  likely to experience preterm birth or to have a
  low birth weight infant

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Universal Screening Instruments

• Infant Screen
• Predictive of Postneonatal death
• 10 screen positive
• 51 of postneonatal deaths occur within the 10
• Infants with positive scores are 9.1 times as
  likely to die during the postneonatal period

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Screening Rates

• Prenatal
• (10/99-09/00)
• Estimated Pregnant Women - 202,382
• Screens Offered/Percentage 159,233
• (78.7)
• Consenting to Screen/Percentage 115,926
• (57.28)

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Screening Rates

• Infant
• (10/99-09/00)
• Number of Births
• 202,382
• Screened/Percentage 151,055
• (74.6)

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Unadjusted Risk Ratios for Adverse Outcome from
the Prenatal Screen, 1998 Birth Cohort
Risk Ratio for Women who Scored
Positive Statistically Significant Risk
Ratios Not Statistically Significant Risk Ratios
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Healthy Start Prenatal Women Screened By Risk
Factor and Relative Risk Ratios by Risk
Factor For women who gave birth in 1998 whose
birth record matched a prenatal
screen..Relative risk is for preterm delivery
before 34 weeks gestation and LBW under 2000
grams
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Healthy Start Prenatal Women Screened By Risk
Factor and Relative Risk Ratios by Risk
Factor(continued)
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Healthy Start Infants by Risk Factor and Risk
Ratios
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Healthy Start Infants by Risk Factor and Risk
Ratios
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Monthly Healthy Start Reports

• Healthy Start Infant Screening Results
• Healthy Start Prenatal Screening Results
• Alphabetical Listing of Infant Clients by Month
• Alphabetical Listing of Prenatal Clients by
  Month

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Quarterly Healthy Start Reports

• Healthy Start Infant by Zip Code
• Healthy Start Prenatal by Zip Code
• Healthy Start Infant Screening by
• Hospital
• Healthy Start Prenatal by Provider
• Name and ID
• Healthy Start Prenatal Screening by
• Provider ID

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Using the Data to Evaluate the Program

• Evaluation Using Screening Data Allows Us To Show
  Relation Between Healthy Start Services and
• Reduced Risk of Low Birth Weight

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Odds Ratios for Birth Weight Below 2500 grams
for Infants Born in 1999 to Mothers Screened
with the Health Start Prenatal Screen 1
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Odds Ratios for Birth Weight Below 2500 grams
for Infants Born in 1999 to Mothers Screened
with the Health Start Prenatal Screen 1
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Odds Ratios for Birth Weight Below 2500 grams
for Infants Born in 1999 to Mothers Screened
with the Health Start Prenatal Screen 1
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Odds Ratios for Birth Weight Below 2500 grams
for Infants Born in 1999 to Mothers Screened
with the Health Start Prenatal Screen1
1 Based on 75,461 birth records matched to
Healthy Start Screening records. 26,501 were
classified as Healthy Start and 48,960 were
classified as not Healthy Start for a total of
75,461. 2 p.05 Significantly Greater at the .05
alpha level
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Additional Uses

• Increasing Local Capacity for Analysis
• Community Partnerships
• Example Healthy Families Florida
• Identification of PAMR Cases
• Child Abuse analysis

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Issues

• Consent and confidentiality
• Need for expansion
• Future need and capacity for analysis

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EVERY CHILD DESERVES A