Member to Member

We asked members to share examples of how they identify and use evidence-based practice in their states.

Striving toward Evidence-Based or Research-Informed Service Delivery: Florida’s Healthy Start Program

Carol Scoggins, M.S.
Program Administrator, Maternal and Child Health, Infant, Maternal and Reproductive Health Section, Florida Department of Health

In 1991, the Florida Legislature gave statutory authority for the Florida Healthy Start Program, which assists pregnant women, interconception women, infants, and children up to age three, to obtain the health care and social support needed to reduce the risks for poor MCH outcomes including infant mortality. The program also promotes good health and developmental outcomes for all mothers, infants and children in Florida.

The services of the Healthy Start Program include risk assessment, nutrition counseling, care coordination, breastfeeding education and support, tobacco cessation counseling, assessment of service needs, interconception education and counseling, referrals and linkages, childbirth education, parenting education, psychosocial counseling, developmental screening, anticipatory guidance, accident prevention, substance abuse prevention education, and in-home visitation. Program services may vary according to the specific community needs and may include funding for prenatal and child health care as a payer of last resort.

Each coalition conducts its own assessment and develops its own service plan every five years, allowing Healthy Start programs to serve diverse and varied populations and geographic areas. However, this has created difficulty in demonstrating the impact of Healthy Start statewide. Representatives from the Florida Department of Health and members of the Florida Association of Healthy Start Coalitions determined that a redesign of the program was warranted.

In 2011, the Florida Department of Health and the Florida Association of Healthy Start Coalitions began a process to redesign the provision of Healthy Start core service components. The department entered into a two-year contract with a consultant, to develop an evidence-based program planning process to direct the redesign of the Healthy Start Program. The goal is to improve maternal and infant health outcomes for Florida residents by improving service delivery effectiveness through evidence-based or research-informed service delivery.

The redesign process reviewed and evaluated the Florida Healthy Start program components to assess which are research-informed and evidence-based. The process also proposed changes; developed a comprehensive plan for implementing the redesign to ensure program quality and fidelity; identified key effective program elements, processes, and quality indicators to be monitored during implementation and maintenance; and developed a modular evaluation of the redesign of the program that can be implemented in phases.

The department is currently in the implementation phase. During the first year of implementation, beginning July 2013, the Florida Association of Healthy Start Coalitions will begin training on the models selected: Prenatal Plus and Partners for a Healthy Baby. In the subsequent fiscal year, training will begin on the Parents as Teachers program.

The redesign will use the results-based accountability performance measure framework which identifies two types of accountability: population level and performance. This framework will determine who was served, the amount of services provided, quality assurance measures, and client outcomes such as changes in knowledge, behavioral changes, and mother and infant outcomes.