service delivery plan...of punta gorda / port charlotte, bon secours health systems, inc....
Post on 04-Jul-2020
0 Views
Preview:
TRANSCRIPT
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 1 | Page
Service Delivery Plan Charlotte County Healthy Start Coalition, Inc.
October 2016 – September 2021
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 2 | Page
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 –
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 3 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 4 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 5 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 6 | Page
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
▪ U. Way – Charlotte Co. $ 11,046.00
Prenatal care, Psychosocial, Diab. Ed.
▪ SW Fla. Comm. Foundation $ 995.00
Web-based learning Mgmt. system
▪ Walmart Foundation $ 1,000.00
Diab. Educ.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 7 | Page
▪ Char. Co. Homeless Coalition, Inc. $ 906.00
Safe sleep, Car seat safety
▪ ELC of Fla’s Heartland $ 1,000.00
New Moms Educ. Totes
▪ BonSecours Health Foundation $ 20,000.00
Prenatal care – unfunded women
▪ U Way – Charlotte Co. $ 7,213.74
Care Coord., Psychosocial, Diab. Ed.
▪ March of Dimes $ 2,177.75
Provider training
▪ U. Way – Charlotte Co. $ 14,164.00
Care Coord., Psychosocial, Diab. Ed.
▪ Bon Secours Health Foundation $ 15,000.00
Prenatal care, unfunded women
▪ WellCare $ 414.10
Safe Sleep
▪ BonSecours Health Foundation $ 10,000.00
Prenatal care, unfunded women
▪ U. Way – Charlotte Co. $ 14,750.00
Care Coord, Psychosocial, Diab. Ed.
▪ Bd, of Co. Commissioners $ 17,211.74
Care Coord., Psychosocial, Diab. Ed.
▪ U. Way – Charlotte Co. $ 10,405.00
Care Coord., Psychosocial
▪ Bd. of County Commissioners $ 22,500.00
Care Coord., Psychosocial
▪ Bon Secours Health Foundation $ 20,000.00
Prenatal care, unfunded women
▪ Charlotte Comm. Foundation $ 9,100.00
IT Infrastructure Enhancement __________
$ 201,893.33
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 8 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 9 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 10 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 11 | Page
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%.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 12 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 13 | Page
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
2009 SDP Update Data Reported 2016 SDP Update Data
❖ 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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 14 | Page
❖ 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
2009 SDP Update Data Reported 2016 SDP Update Data
❖ 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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 15 | Page
Infant Mortality, Poor Birth Outcomes
2009 SDP Update Data Reported 2016 SDP Update Data
❖ 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
2009 SDP Update Data Reported 2016 SDP Update Data
❖ 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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 16 | Page
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%.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 17 | Page
Other Birth-Related Data
2009 SDP Update Data Reported 2016 SDP Update 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
2009 SDP Update Data Reported 2016 SDP Update Data
❖ 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
2009 SDP Update Data Reported 2016 SDP Update Data
❖ 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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 18 | Page
❖ 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
2009 SDP Update Data Reported 2016 SDP Update Data
❖ In 2007, the Florida Department of Health
in Charlotte County provided nutrition
services (WIC) to 2,160 of 3,017 eligible
participants, serving 71.6% of eligible
clients.
❖ In 2014, the Florida Department of Health
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 19 | Page
Dental Care
2009 SDP Update Data Reported 2016 SDP Update Data
❖ 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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 20 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 21 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 22 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 23 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 24 | Page
► 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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 25 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 26 | Page
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
Year Count % Count % Count % Count %
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 27 | Page
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%
Births with Inter-Pregnancy Interval < 18 Months
3-Year Rolling Rates- County Comparison County Florida
Year Count % Count %
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 28 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 29 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 30 | Page
Table 17: Birth with inter-pregnancy interval less than 18 months- rolling year - race
Births with Inter-Pregnancy Interval < 18 Months
3-Year Rolling Rates - Race
Charlotte Florida
White Black White Black
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%
2012-14 513 34.4% 56 44.4% 90,071 34.5% 31,091 35.5% Source: www.floridacharts.com
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
Births with Inter-Pregnancy Interval < 18 Months
3-Year Rolling Rates- County Comparison - Race White Black
Year Count % Count %
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).
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 31 | Page
Table 19: Preterm births- rolling year- by race - county comparison
County Florida
White Black White Black
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%
2012-14 343 11.2% 57 19.5% 58,662 12.7% 26,286 17.9% Source: www.floridacharts.com
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
White Black White Black
Year Count % Count % Count % Count %
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
Year Count % Count % Count % Count %
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
Source: www.floridacharts.com
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 32 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 33 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 34 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 35 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 36 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 37 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 38 | Page
Table 30: Charlotte County Demographics - Ethnicity
Hispanic Non-Hispanic
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
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%
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 39 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 40 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 41 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 42 | Page
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 Healthy Start Coalition, Inc. Service Delivery Plan 43 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 44 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 45 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 46 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 47 | Page
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%
Source: www.floridacharts.com
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 48 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 49 | Page
• 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
the past 30 days (2014 TeeNS)
• 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
the past 30 days (2014 TeeNS)
• 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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 50 | Page
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%
Source: www.floridacharts.com
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 51 | Page
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
Source: www.floridacharts.com
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 52 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 53 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 54 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 55 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 56 | Page
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
Source: www.floridacharts.com
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).
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 57 | Page
Figure 7: Adults with personal doctor
Source: www.floridacharts.com
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 58 | Page
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%
Births Covered by Medicaid, 3-Year Rolling Rates
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 County Healthy Start Coalition, Inc. Service Delivery Plan 59 | Page
Births Covered by Medicaid, 3-Year Rolling Rates
Charlotte Florida
Hispanic Non-Hispanic Hispanic Non-Hispanic
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%
Source: www.floridacharts.com
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%
Source: www.floridacharts.com
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 60 | Page
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-
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 61 | Page
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
Source: www.floridacharts.com
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 62 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 63 | Page
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
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
Years Charlotte Florida
Years Charlotte Florida
Count Rate Count Rate Count Rate Count Rate
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 64 | Page
Table 59: Infant deaths by race, rolling year rates
Infant Deaths
Per 1,000 Live Births, 3-Year Rolling Rates
Years
Charlotte Florida
White Black White Black
Count Rate Count Rate Count Rate Count Rate
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
Hispanic Non-Hispanic Hispanic Non-Hispanic
Count Rate Count Rate Count Rate Count Rate
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 65 | Page
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
Year Count % Count %
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%.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 66 | Page
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
White Black White Black
Year Count Rate Count Rate Count Rate Count Rate
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%
2012-14 31 1.1% 4 1.8% 5,418 1.2% 4,266 2.9% Source: www.floridacharts.com
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
Hispanic Non-Hispanic Hispanic Non-Hispanic
Year Count Rate Count Rate Count Rate Count Rate
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
Source: www.floridacharts.com
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 67 | Page
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
White Black White Black
Year Count Rate Count Rate Count Rate Count Rate
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
Hispanic Non-Hispanic Hispanic Non-Hispanic
Year Count Rate Count Rate Count Rate Count Rate
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 68 | Page
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
Source: www.floridacharts.com
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
Year Count Rate (%) Count Rate (%)
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 69 | Page
Table 71: Cesarean section deliveries - 3 -year rolling rates
Cesarean Section Deliveries, 3-Year Rolling Rates
Charlotte Florida
Year Count Rate (%) Count Rate (%)
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
Cesarean Section Deliveries, 3-Year Rolling Rates
Charlotte Florida
White Black White Black
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
Cesarean Section Deliveries, 3-Year Rolling Rates
Charlotte Florida
Hispanic Non-Hispanic Hispanic Non-Hispanic
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 70 | Page
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 Oct. 2011
CCHSC Membership Survey Oct. 2012
CCHSC Membership Survey Dec. 2012
CCHSC Membership Survey Oct. 2013
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 Jan. 2012
Healthy Start Brochure Survey May 2012
Healthy Start Brochure Survey May 2013
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 Jan. 2014
Healthy Start Brochure Survey Mar. 2014
Healthy Start Brochure Survey May 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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 71 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 72 | Page
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:
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 73 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 74 | Page
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)
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 75 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 76 | Page
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.
Cape Coral, FL 33990
(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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 77 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 78 | Page
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.
Port Charlotte, FL 33980
(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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 79 | Page
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
Information and Referral
Advocacy
Family Support Services
Prescription Expense Assistance
Mileage Reimbursement
March Of Dimes
Birth Defects
Foundation
6314 Corporate Court
#140
Fort Myers, FL 33919
(239) 433-3463
Information and Referral
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
Port Charlotte, FL 33952
(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
Please go to website for
more information on
services offered:
florida.wellcare.com
Pregnancy Services for Medicaid eligible
women
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 80 | Page
Sunshine
(Medicaid Managed
Care Organization)
1 800-796-0530
Please go to website for
more information on
services offered:
sunshinehealth.com
Pregnancy Services for Medicaid eligible
women
Virginia B Andes
Volunteer
Community Clinic
21297 Olean Blvd. Unit
B
Port Charlotte, FL 33952
(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
Port Charlotte, FL 33952
(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
Port Charlotte, FL 33952
(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
North Port, FL 34288
(941) 379-5343
Accepts
Medicaid
eligible
x x x x Please call for
office hours
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 81 | Page
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
Port Charlotte, FL 33952
(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
Port Charlotte, FL 33952
(941) 391-8010
Accepts
Medicaid
Eligible
x x x x Please call for
office hours
Maternal Fetal Medicine of SW FL
210 Del Prado Blvd. Suite 1
Cape Coral, FL 33990
(239) 333-0593
Tuesday & Thursdays
Accepts
Medicaid
Eligible
x x x x Please call for
office hours
North Port Health Center
6950 Outreach Way
North Port, FL 34287
(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
Port Charlotte, FL 33948
(941) 629-3618
x 33B36Bx x Please call for
office hours
Butt, Farzana
3417 Tamiami Trail, Suite B
Port Charlotte, FL 33952
(941) 629-9200
x x x Please call for
office hours
Casanova, Ena
3508 Tamiami Trail, Ste. C
Port Charlotte, FL 33952
(941) 883-3313
x x Please call for
office hours
Cepero, Belkis
3488 Depew Ave.
Port Charlotte, FL 33952
(941) 764-7923
x x x Please call for
office hours
Guastavino, Ella Marie
900 East Pine Street Units 216 & 217
Englewood, FL 34223
(941) 474-5093
x x x Please call for
office hours
Dr. Susan Hegarty, Pediatrician
Family Health Centers of SW Florida
Port Charlotte Clinic
4300 Kings Hwy Suite 210
Port Charlotte, FL 33980
(866) 355-2348
x x x Please call for
office hours
Helgemo, Ben & Liou, Wen
2040 Tamiami Trail, Unit C
Port Charlotte, FL 33948
(941) 629-4464
x x x Please call for
office hours
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 83 | Page
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
Port Charlotte, FL 33952
(941) 629-2922
x x x Please call for
office hours
Kuma, Ebenezer
3406 Tamiami Trail, Ste. 2
Port Charlotte, FL 33952
(941) 625-4919
x x x Please call for
office hours
Mayo, Margaret
3440 Conway Blvd. Suite 3A
Port Charlotte, FL 33952
(941) 624-4748
x x Please call for
office hours
Nwokeji, Pete - Neonatologist
Bayfront Health in Port Charlotte
2500 Harbor Blvd.
Port Charlotte, FL 33952
(941) 766-4122
x
LEV
EL II
NICU
On staff at
hospital NICU
Patel, Jignesh - Neonatologist
Bayfront Health Port Charlotte
2500 Harbor Blvd.
Port Charlotte, FL 33952
(941) 766-4122
x
LEV
EL II
NICU
On staff at
hospital NICU
Rodriguez, Luis R.
2484 Caring Way, Suite F
Port Charlotte, FL 33952
(941) 625-1999
x x x Please call for
office hours
Williams, Susan
17928 Toledo Blade Blvd.
Port Charlotte, FL 33948
(941) 743-7337
x x Please call for
office hours
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 84 | Page
Counseling Services
Center for Abuse and Rape
Emergency (C.A.R.E.)
Post Office Box 510234
Punta Gorda, FL 33951
(941) 639-5499
Emergency Shelter
Counseling Modalities
Mutual Support Groups
Case Management
Information and Referral
Charlotte Behavioral
Health Care Inc.
1700 Education Avenue
Punta Gorda, FL 33950
(941) 639-8300
Counseling Modalities
Inpatient Mental Health
Facilities
Substance Abuse Services
Crisis Intervention
Charlotte Crisis
Stabilization Unit
1700 Education Avenue,
Building C
Punta Gorda, FL 33950
(941) 575-0222
Inpatient Mental Health
Services
Psychiatric Central
Intake/Assessment
Child Find (FDLRS-Florida
Diagnostic & Learning
Development)
Charlotte County Public
Schools
1445 Education Way
Port Charlotte, FL 33948
(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
Fort Myers, FL 33901
(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.
Punta Gorda, FL 33950
(941) 639-5535 “0”
Residential Treatment Facility
for adolescents age 13 – 17
with addictions and mental
health issues
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 85 | Page
Counseling Services, cont.
Department of Juvenile
Justice
South Tamiami Trail
1900-A
Punta Gorda, FL 33950
(941) 575-5700
Case management Counseling
Modalities
Correctional Restitution
Court Referral Programs
Florida Department of
Children Family Safety and
Foster Care
14806 Tamiami Trail
North Port, FL 34287
(941) 483-5922
Child Protective Services
Harbor Counseling
Services
21234 Olean Blvd. Suite 5
Port Charlotte, FL 33952
(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
Charlotte Behavioral
Health Care Inc.
1700 Education Avenue
Punta Gorda, FL 33950
(941) 639-8300
Counseling Modalities
Inpatient Mental Health
Facilities
Substance Abuse Services
Crisis Intervention
Charlotte County Health
Department/ HIV/AIDS
1100 Loveland Blvd.
Port Charlotte, FL 33980
(941) 624-7236
Diagnostic Testing
Treatment
Housing & Rent
Referrals for Food & Hygiene
thru CHAPS
Child Find & Florida
Diagnostic & Learning
Resources System
2(FDLRS)
Charlotte County Public
Schools
1445 Education Way
Port Charlotte, FL 33948
(941) 255-0808 ext. 3082
Free Screening for children
with developmental delays:
(learning; speaking; seeing;
hearing; walking; & playing)
Child Development Skills
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 86 | Page
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
Fort Myers, FL 33907
(239) 277-9818
Occupational, Physical and
Speech Therapies
Developmental Assessment
Information and Referral
Family Support Services
Gulf Central Early Steps 4630 17th St.
Sarasota, FL 34235
(941) 487-5400 or Toll Free
866-510-5594
Developmental Assessment
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
Mileage Reimbursement
Leukemia Society of
America, Inc.
3725 W. Grace St.
Tampa, FL 33607-4800
(813) 870-1099
Information and Referral
Advocacy
Family Support Services
Prescription Expense
Assistance
Mileage Reimbursement
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 87 | Page
1Education Services
Career Source Southwest
Florida
1032 Tamiami Trail Unit 9
Port Charlotte, FL 33953
(941)235-5900
Career Development
Resume Assistance
Public Employment and
Training Programs
Charlotte Behavioral
Health Care, Inc.
Nurturing and Parenting
Program
1700 Education Ave.
Punta Gorda, FL 33950
(941)639-8300
Please see services listed under
“Parenting” section
Charlotte County Public
Schools (CCPS) - Healthy
Outcomes in Pregnancy
and Education (HOPE)
The Academy @ Charlotte
County Technical Center
18300 Cochran Boulevard
Port Charlotte, FL 33948
(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
Charlotte County Public
Schools (CCPS) Early
Childhood Programs/
Baker Center includes
Early Head Start
(9 weeks to 3 yrs.)
Head Start (4 yrs.)
311 East Charlotte Avenue
Punta Gorda, FL 33950
(941) 575-5470
Fax (941)575-5474
Parent Groups
Dental Screening
Mental Health Evaluation
Health Education
Social Development
Charlotte County Public
Schools (CCPS)
Exceptional Student
Education
1445 Education Way
Port Charlotte, FL 33948
(941) 255-0808/call
directory for extensions for
different programs i.e. ESE
program, Ext. 4
Special Education Assessment
Educational Programs,
Developmental Assessment
Occupational, Speech, Physical
and Language Therapies
Transportation
Psychological Testing
Home Instruction
Parent Counseling, Parenting
Education
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 88 | Page
Education Services, cont.
Charlotte County Health
Department/WIC office in
Port Charlotte
Charlotte County Health
Department /WIC office in
Englewood
1100 Loveland Blvd.
Port Charlotte, FL 33980
(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
Port Charlotte, FL 33980
(941) 255-7440
Counseling Programs
Educational Programs
Special Education
Rehabilitation
Developmental Therapies
Employment Preparation
Job Training
Charlotte County Homeless
Coalition
Bridges Out of Poverty
Program
1476 Kennesaw St.
Port Charlotte, FL 33948
(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
Port Charlotte, FL 33952
(941) 255-1650
Assistance for locating legal
childcare programs
Financial Assistance for
childcare through scholarships
Technical assistance for
childcare providers
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 89 | Page
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
Port Charlotte, FL 33952
(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
Educational Programs
Tobacco Education and
Smoking Cessation Support
Multi-Cultural Education
and Alternative Programs
Charlotte County Public
Schools (CCPS)
1445 Education Way
Port Charlotte, FL 33948
(941) 255-0808 Ext.3060
School Based Integrated
Services
YMCA Child Development
Center
14279 Tamiami Trail
North Port, FL 34287
(941) 629-0909
Subsidized Child Care
Child Care Information and
Referral
Child Care Provider
Recruitment, Technical and
Financial Assistance
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 90 | Page
Parenting
Charlotte Behavioral
Health Care, Inc. /
28Parenting Program
1700 Education Ave.
Punta Gorda, FL 33950
(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.
Charlotte Behavioral
Health Care, Inc. /
Nurturing Parents
Program (Thursday
evenings from 5:30- 6:30)
1700 Education Ave.
Punta Gorda, FL 33950
(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
Charlotte Behavioral
Health Care, Inc. /
34Nurturing Parents
Program at Northside
Location in Port Charlotte
(Monday Evenings from
5:00 – 6:30)
1032 Tamiami Trail Unit 1
Port Charlotte, FL 33953
(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
Port Charlotte, FL 33952
(941) 629-6477
Home visitation and
Parenting Education for
pregnant women and
newborns
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 91 | Page
14B1Pregnancy Services
Healthy Start Services
through
Charlotte Behavioral
Health Care, Inc.
1700 Education Ave.
Punta Gorda, FL 33950
(941) 347-6460
Childbirth Education; Baby
Safety; Infant CPR classes
Psychosocial Counseling;
Referrals
Smoking Cessation
Charlotte County Health
Department Clinic
1100 Loveland Blvd.
Port Charlotte, FL 33980
(941) 624-7201
WIC services Mon. Tues. &
Thursdays 8:30 – 4:30
Monday & Fridays 8:30 -
noon
Charlotte County Health
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
Port Charlotte, FL 33948
(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
Port Charlotte, FL 33952
(941) 629-6477
Family Support Services for
pregnant women & newborns
Abuse/ Neglect Prevention
Parenting Education
Lactation services
Bayfront Health Medical
Center
2500 Harbor Boulevard
Port Charlotte, FL 33952
(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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 92 | Page
1Pregnancy Services cont.
Pregnancy Careline 1685 Tamiami Trail Suite 4
Port Charlotte, FL 33948
(941) 625-5576
Pregnancy Counseling
Pregnancy Testing
Ultrasounds done under
certain circumstances
Information and Referral
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
Port Charlotte, FL 33948
(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
Port Charlotte, FL 33948
(941) 979-8379
Provides positive youth
development programs and
services including education,
character development, arts &
recreation
Charlotte County Habitat
for Humanity
1750 Manzana Avenue
Punta Gorda, FL 33950
(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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 93 | Page
Other Related Services cont.
Charlotte County Family
Services Center
21450 Gibralter Dr.
Port Charlotte, FL 33952
(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
Port Charlotte, FL 33948
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 94 | Page
Other Related Services cont.
Dept. of Children and
Families
14806 Tamiami Trail
Bldg. 14830
North Port, FL 34287
(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
Port Charlotte, FL 33952
(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
Information and Referral
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.
Punta Gorda, FL 33950
(941) 639-4344
Provides the only public
housing available in Charlotte
County
Section 8 voucher program
located here
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 95 | Page
1Other Related Services cont.
Charlotte Co. Transit,
formerly known as
Sunshine Ride/Dial A Ride
25490 Airport Rd.
Punta Gorda, FL 33950
(941) 575-4000
Provides door to door
transportation service for
people on Medicaid
Time Out Respite Care 24246 Harborview Road
Port Charlotte, FL 33980
(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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 96 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 97 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 98 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 99 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 100 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 101 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 102 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 103 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 104 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 105 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 106 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 107 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 108 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 109 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 110 | Page
• 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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 111 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 112 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 113 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 114 | Page
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
Staff and Board Oct 2015 Sep 2016
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).
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 115 | Page
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.)
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 116 | Page
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.,
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 117 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 118 | Page
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?
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 119 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 120 | Page
ACTION PLANNING & REPORTING FORMAT
To be used with Type B Activities Item 2
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?
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.
b. What health status indicator/coalition administrative activity is being addressed by this
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.
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, 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.
2. PLANNING PHASE QUESTIONS: (All Required)
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 121 | Page
a. What strategy has been selected to address this?
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.
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 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.
c. Where/how will you get the information?
Data will be collected from monthly/quarterly service provider reports, staff, Coalition
members, consumers, healthcare providers, community event participants and community
partners
d. What do you expect will be the observed impact of the strategy on the system or community-
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.
e. What information will you gather to demonstrate this change on the system?
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.
f. Where/how will you get the information?
See above
******************************************************************************
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 122 | Page
3. ACTION STEPS:
Action Step Pers. Respon. Start Date End Date
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
Evaluate Effectiveness
11. Evaluate strategies for effectiveness and
revise as needed
Board, Staff, Data
Committee
Jul 2015 Sep 2016
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 123 | Page
PROGRESS REPORT AS OF DECEMBER 31, 2015
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 124 | Page
10. Cultural competency / diversity information continues to be available through the Coalition’s website
and on-line learning management system.
PROGRESS REPORT AS OF MARCH 31, 2016
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 125 | Page
PROGRESS REPORT AS OF JUNE 30, 2016
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 126 | Page
PROGRESS REPORT AS OF SEPT. 30, 2016
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 127 | Page
4. REPORTING PHASE ANSWERS: (To be completed for the Annual Action Plan Update)
a. Demonstrate the changes in the system/community.
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%)
b. Will you drop/modify/expand/continue strategy next year and explain why?
Continued education and awareness is needed to improve all birth outcomes locally. This
strategy will be modified and continued in the coming year.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 128 | Page
ACTION PLANNING & REPORTING FORMAT
To be used with Type B Activities Item 3
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?
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.
b. What health status indicator/coalition administrative activity is being addressed by this
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.
c. What information, if any, was used to identify the issue/problem (i.e. HPA, FIMR, screening,
client satisfaction, interviews, QI/QA)?
This is a component of the Coalition’s contracts with the Florida Department of Health
and the Healthy Start MomCare Network
2. PLANNING PHASE QUESTIONS: (All Required)
a. What strategy has been selected to address this?
Expand the identification and delivery of Healthy Start services through contract
negotiation, data collection/reporting, monitoring, grant-writing, community/government
partnerships, and fund-raising.
b. What information will you gather to demonstrate that you have implemented this strategy as
intended (who, what, how many, how often, where, etc.)?
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.
c. Where/how will you get the information?
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 129 | Page
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.
e. What information will you gather to demonstrate this change on the system?
See B above.
f. Where/how will you get the information?
See C above.
******************************************************************************
3. ACTION STEPS:
Action Step Pers. Respon. Start Date End Date
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 130 | Page
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
Board Oct 2015 Sep 2016
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
Board Oct 2015 Sep 2016
Evaluate Effectiveness
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 131 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 132 | Page
PROGRESS REPORT AS OF MARCH 31, 2016
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 133 | Page
16. In January the SDP consultant presented the work plan and timeline for the SDP update to the Board.
PROGRESS REPORT AS OF JUNE 30, 2016
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 134 | Page
PROGRESS REPORT AS OF SEPT. 30, 2016
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.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
4. REPORTING PHASE ANSWERS: (To be completed for the Annual Action Plan Update)
a. Demonstrate the changes in the system/community.
• 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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 135 | Page
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.
b. Will you drop/modify/expand/continue strategy next year and explain why?
This strategy will be modified and will not include steps to prepare the now-completed SDP
update.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 136 | Page
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.
2. PLANNING PHASE QUESTIONS: (All Required)
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 137 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 138 | Page
substance-abuse intervention services, through provider visits, as
described in Category B of this
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 139 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 140 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 141 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 142 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 143 | Page
14. NEW ACTION PLAN CATEGORIES B & C
CATEGORY B
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 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%
b. What health status indicator/coalition administrative activity is being addressed by this
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%.
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, Bureau of Vital Statistics, annual Charlotte County MCH Health Problem Analysis, responses to screening of MomCare and Healthy Start participants at initial contact.
2. PLANNING PHASE QUESTIONS: (All Required)
a. What strategy has been selected to address this?
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 144 | Page
Strategies will include individual screening, education and cessation support, provider training, and collaborative efforts to reduce environmental factors that impact smoking.
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 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.
c. Where/how will you get the information?
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.
d. What do you expect will be the observed impact of the strategy on the system or community-
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.
e. What information will you gather to demonstrate this change on the system?
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.
f. Where/how will you get the information?
Information will come from providers, staff, community events, Florida Quitline, and through the Florida Department of Health, Bureau of Vital Stats.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 145 | Page
3. ACTION STEPS:
Action Step Pers. Respon. Start Date End Date
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
Lead Agency for Care Coordination
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
Lead Agency for Care Coordination
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
Outreach and Education
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
Evaluate Effectiveness
9. Evaluate strategies for effectiveness and revise as needed
Staff, Data Committee; Board, Providers
Jun 2017 Aug 2017
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 146 | Page
PROGRESS REPORT AS OF DECEMBER 31, 2016:
4. REPORTING PHASE ANSWERS: (To be completed for the Annual Action Plan Update)
a. Demonstrate the changes in the system/community.
b. Will you drop/modify/expand/continue strategy next year and explain why?
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 147 | Page
ACTION PLANNING & REPORTING FORMAT
To be used with Type B Activities Item 2
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 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).
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 148 | Page
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 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 Health.
d. What do you expect will be the observed impact of the strategy on the system or community-
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
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, 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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 149 | Page
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
Staff and Board Oct 2016 Sep 2017
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
Evaluate Effectiveness
12. Evaluate strategies for effectiveness and revise as needed
Staff, Data Committee
Jun 2017 Aug 2017
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 150 | Page
PROGRESS REPORT AS OF DECEMBER 31, 2016
4. REPORTING PHASE ANSWERS: (To be completed for the Annual Action Plan Update)
a. Demonstrate the changes in the system/community.
b. Will you drop/modify/expand/continue strategy next year and explain why?
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 151 | Page
ACTION PLANNING & REPORTING FORMAT
To be used with Type B Activities Item 3
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?
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.
b. What health status indicator/coalition administrative activity is being addressed by this
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%).
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 152 | Page
• 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%)
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, annual Charlotte Co. MCH Health Problem Analysis, annual Florida Behavioral Risk Factor Surveillance System (BRFSS) Data Report, and participant records.
2. PLANNING PHASE QUESTIONS: (All Required)
a. What strategy has been selected to address this?
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.
b. What information will you gather to demonstrate that you have implemented this strategy as
intended (who, what, how many, how often, where, etc.)?
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.
c. Where/how will you get the information?
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.
d. What do you expect will be the observed impact of the strategy on the system or community-
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.
e. What information will you gather to demonstrate this change on the system?
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 153 | Page
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.
f. Where/how will you get the information?
See above
****************************************************************************** 3. ACTION STEPS:
Action Step Pers. Respon. Start Date End Date
Outreach and Education
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 154 | Page
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
Evaluate Effectiveness
10. Evaluate strategies for effectiveness and revise as needed
Board, Staff, Data Committee
Jul 2017 Sep 2017
PROGRESS REPORT AS OF DECEMBER 31, 2016
4. REPORTING PHASE ANSWERS: (To be completed for the Annual Action Plan Update)
a. Demonstrate the changes in the system/community.
b. Will you drop/modify/expand/continue strategy next year and explain why?
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 155 | Page
ACTION PLANNING & REPORTING FORMAT
To be used with Type B Activities Item 4
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?
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.
b. What health status indicator/coalition administrative activity is being addressed by this
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.
c. What information, if any, was used to identify the issue/problem (i.e. HPA, FIMR, screening,
client satisfaction, interviews, QI/QA)?
This is a component of the Coalition’s contracts with the Florida Department of Health and the Healthy Start MomCare Network
2. PLANNING PHASE QUESTIONS: (All Required)
a. What strategy has been selected to address this?
Expand the identification and delivery of Healthy Start services through contract negotiation, data collection/reporting, monitoring, grant-writing, community/government partnerships, and fund-raising.
b. What information will you gather to demonstrate that you have implemented this strategy as
intended (who, what, how many, how often, where, etc.)?
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 156 | Page
c. Where/how will you get the information?
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.
e. What information will you gather to demonstrate this change on the system?
See B above.
f. Where/how will you get the information?
See C above.
******************************************************************************
3. ACTION STEPS:
Action Step Pers. Respon. Start Date End Date
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 157 | Page
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
Board Oct 2016 Sep 2017
Evaluate Effectiveness
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.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
4. REPORTING PHASE ANSWERS: (To be completed for the Annual Action Plan Update)
a. Demonstrate the changes in the system/community.
b. Will you drop/modify/expand/continue strategy next year and explain why?
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 158 | Page
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.
2. PLANNING PHASE QUESTIONS: (All Required)
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 159 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 160 | Page
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
substance-abuse intervention
services, through provider visits, as
described in Category B of this
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 161 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 162 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 163 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 164 | Page
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?
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 165 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 166 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 167 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 168 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 169 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 170 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 171 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 172 | Page
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: Karalee_moversandshakers@yahoo.com
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: abouhebent@elcfh.org
Elyse Clark 3 yr. Term OCT 2018
474 S. McCall Road Tel: 941-270-0665 1st term
Englewood, FL 34223 Email: etclark@carefl.org
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: charity2@embarqmail.com
Steve LeVasseur 3 yr. Term OCT 2018
Residential Contractor/Real Estate Salesman Tel: 941-875-2330 1st term
LeVasseur Building & Remodeling Email: slevasse@gmail.com
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: northportnana@yahoo.com
Sharon Mays, Treasurer, 3 yr. Term OCT 2018
FL Department of Health Tel: 941-624-7260 2nd term
1100 Loveland Blvd. Email: sharonmays@flhealth.gov
Port Charlotte, FL 33952
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 173 | Page
Murdock, FL 33938 Email:
Michael.Overway@cchomelessCoalition.org
Anne Sawney, Secretary, 3 yr. Term OCT 2016
21233 Knollwood Ave. Tel: 941-625-7708 2nd term
Port Charlotte, FL 33952 Email: annesawney@gmail.com
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: suetodd@carefl.org
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: paula@puntagordaha.org
Judith Wilson 3 yr. Term OCT 2017
22212 Little Falls Ave. Tel & Fax: 941-380-0877 2nd term
Port Charlotte, FL 33952 Email: judiw5@comcast.net
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 174 | Page
Logic Model
Exhibit 3: Logic Model/Fishbone
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 175 | Page
Pregnancy Spacing – Child Health USA
Exhibit 4: Pregnancy Spacing
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 176 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 177 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 178 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 179 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 180 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 181 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 182 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 183 | Page
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:
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 184 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 185 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 186 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 187 | Page
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:
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 188 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 189 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 190 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 191 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 192 | Page
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
Revised 8/10/05 Revised 11/14/12
Revised 6/14/06 Revised 12/12/12
Revised 7/12/06 Revised 1/22/14
Revised 3/14/07 Revised 5/14/14
Revised 11/14/07 Revised 12/10/14
Revised 2/11/09 Revised 1/14/15
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 193 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 194 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 195 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 196 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 197 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 198 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 199 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 200 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 201 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 202 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 203 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 204 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 205 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 206 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 207 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 208 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 209 | Page
• 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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 210 | Page
• 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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 211 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 212 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 213 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 214 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 215 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 216 | Page
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).
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 217 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 218 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 219 | Page
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)
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 220 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 221 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 222 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 223 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 224 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 225 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 226 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 227 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 228 | Page
AUDIENCE/
STAKEHOLDER
CONTENT Method How
Often
Facilitated
by:
Status
Staff Internal
communications
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 County Healthy Start Coalition, Inc. Service Delivery Plan 229 | Page
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
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 230 | Page
• 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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 231 | Page
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:
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 232 | Page
• 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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 233 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 234 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 235 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 236 | Page
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, Inc. Service Delivery Plan 237 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 238 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 239 | Page
▪ 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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 240 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 241 | Page
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)
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 242 | Page
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 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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 243 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 244 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 245 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 246 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 247 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 248 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 249 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 250 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 251 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 252 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 253 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 254 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 255 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 256 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 257 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 258 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 259 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 260 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 261 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 262 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 263 | Page
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.
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 264 | Page
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
Charlotte County Healthy Start Coalition, Inc. Service Delivery Plan 265 | Page
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
top related