The Florida Department of Health in Hillsborough County (DOH-Hillsborough) has over 350 staff members serving in seven divisions across Hillsborough County. The largest division in our local DOH is the Nutrition Division which employees over 100 staff members. The Nutrition division maintains an annual budget of $5.3 million from the federal allocation of the Special Supplemental Nutrition Program for Women, Infant and Children (WIC) and $133,581 federal grant funding for the Breastfeeding Peer Counselor Program. More information can be found at: http://hillsborough.floridahealth.gov
DOH- Hillsborough provides public health services to Hillsborough County, the fourth most populous county (pop. 1,408,566) (1) 1 in Florida, located on the state's central west coast. Our Nutrition division's WIC program is the third largest in the state of Florida, serving 40,031 enrolled participants. Hillsborough County includes the large metropolitan city of Tampa as well as several rural communities. WIC participants are diverse in race and ethnicity, including 64% white, 29 % black and 1% Asian, 54% identify as Hispanic. (2) In 2016, 12.1% of the County's population was living in poverty. This is a decrease of 23% from 2013 data. The median household income (dollars) is $51,681. People earning an income is at 79.4%, 27.3% are on social security, 3% receive public cash assistance, 16.1% receive Food Stamp/SNAP benefits, and 3% participate in the WIC program. The unemployed labor force is at 7.9%. The main mode of transportation is by use of a vehicle at 80.2%, followed by carpooling at 8.9% walking at 1.6% and Public Transportation at 1.5%. (1)
In 2016 Hillsborough County had the second highest rates of infant deaths in the state. (3) We joined forces with the Healthy Start Coalition of Hillsborough County (HSC) who has over 20 years of experience and dedication to reducing the infant mortality rates and improving the health of pregnant women and their families. Through this partnership, we were able to help better serve our WIC participants by implementing a Women's Infant Resource Specialist (WIRS) in 7 of our 8 WIC offices. This partnership will serve identified pregnant women receiving WIC services and their infant after birth up to one year of age. The WIRS work with the Healthy Start Central Intake and Referral System to move identified participants into existing home visitation programs, including Healthy Start, Healthy Families, and Nurse Family Partnership in an effort to help eliminate barriers, enhance linkages to health and safety education, resources and support.
The desired objectives for the WIRS of Healthy Start in the WIC clinics are to follow up with Moms regularly to ensure they are continuing their routine prenatal care, encourage and support breastfeeding as the preferred infant feeding method, provide Safe Baby education (Safe Sleep, Coping with Crying, and Choosing a Safe Caregiver) as a means of reducing infant mortality and providing linkages and concrete support to community programs. In the 1st year 447 women received education on the importance of prenatal care, 513 received breastfeeding support, 739 received education on unintentional injury risk prevention through Safe Baby and 723 were referred to concrete supports.
In the fall of 2018, Healthy Start conducted a WIRS Participation Satisfaction survey, 100% of the WIC respondents indicated that they would recommend for other Moms to visit with the WIRS while attending their WIC appointment.
(1) - Florida CHARTs - Social and Economic Factors
(2) - WIC FL-WiSE Data
(3) - Florida Charts- Infant Mortality http://www.flhealthcharts.com/FLQUERY/InfantMortality/InfantMortalityRpt.aspx
In 2015 Hillsborough County had the second highest rates of infant deaths in Florida. The same year there were 17,570 births, of which ~ 52% were enrolled in WIC. (4) The purpose of this project was to target pregnant women receiving WIC services and infants up to one year of age. Healthy Start's program is designed to screen and serve all pregnant women and infants at risk for poor outcomes. In the first year, the WIRS conducted 2688 intakes into the Healthy Start System of Care. Data from 2017 and provisional 2018 data indicate a drop in infants deaths in Hillsborough County, ranking Hillsborough third in the state for infant deaths. (3)
In the past private providers and hospitals used screening questionnaires to assess the level of risk when referring patients to the Healthy Start Central Intake and Referral System. Past systems resulted in breakdowns in communication. Many clients did not understand what they were being referred to and why. Causing delays in data processing and the follow up. The system lacked personal connection which lead to underutilized services and missed opportunities for improving resources to programs that would help improve pregnancy and birth outcomes. At the private provider's offices, Healthy Start services were limited. With this new innovative implementation of the WIRS in WIC, clients are now seen in real time and followed up regularly while being given education and support.
The WIRS model is more of a concept vs an evidence based practice at this time. However, WIRS have collaborated with different programs such as Healthy Families which is a Nationally accredited, evidence-based program that promotes parent-child interaction and childhood development among families and newborns in Hillsborough County. Healthy Families shares the same goal as WIRS which is to reduce the incidence of neglect in targeted areas and to enhance parents' ability to create a stable and nurturing home environment.
(3) - Florida Charts- Infant Mortality http://www.flhealthcharts.com/FLQUERY/InfantMortality/InfantMortalityRpt.aspx
(4) - FLCharts- Florida Birth Query System
The goal of the Women Infant Resource Specialists (WIRS) is to work with families at Hillsborough County WIC sites and assist in providing education, resources, and support to WIC participants.
The Healthy Start Coalition began with a 4-month planning phase which included key staff from the coalition and WIC. The planning phase included a needs assessment to identify WIC participants in need of additional support and allowed for the development of specific questions concerning job description, staff involvement, service delivery, and data collection. The pilot program began in 2016 with one WIRS in one WIC office with a goal of engaging 50 pregnant and postpartum women to encourage regular prenatal care and regular pediatric care for their newborns.
Healthy Start applied for a small grant of $50,000 from the Children's Board of Hillsborough County to help fund the initiative the 1st year. The Children's Board mission is to invest in partnerships and quality programs to support the success of all children and families in Hillsborough County. Due to the success of the pilot program, The Children's Board increased the funding to $378,500 annually to support the operations and expand delivery of services into seven locations with four Women Infant Resource Specialist.
Following the funding expansion, the goal of the Woman and Infant Resource Specialist (WIRS) at Women Infants and Children (WIC) program is now to provide increased access and linkages to resources and safety education for pregnant women and women with children. The Resource Specialists work with families at 7 Hillsborough County WIC sites and assist in providing education, resources, and support. The objectives are to educate on breastfeeding to increase breastfeeding initiation rates, follow up on client's compliance with receiving routine prenatal care, and to link with concrete support to help improve maternal health and birth outcomes. Education on unintentional injury prevention is provided using the Safe Baby curriculum, parents are educated on how to choose a safe caregiver for their children, prevent Shaken Baby Syndrome, and promote safe sleep in an effort to reduce infant mortality rates. Pregnant women and women with children under 1 are routed to WIRS as a part of their WIC visit to ensure that contact is made and education and referrals are provided.
The objectives for the WIRS in the WIC clinics are to follow up with Moms regularly to ensure they are continuing their routine prenatal care, encourage and support breastfeeding as the preferred infant feeding method, provide Safe Baby education (Safe Sleep, Coping with Crying, and Choosing a Safe Caregiver) as a means of reducing infant mortality and providing linkages and concrete support to community programs. We underestimated the need for having WIRS available to our WIC participants. While the main objectives were met, there were many underlying issues and concerns that still needed to be addressed by participants. The program was designed for the WIRS to educate and connect moms with resources. Due to the lack of manpower with the current caseload, WIRS were unable to maintain constant with participants.
Once a month the WIRS get together with their Healthy Start team to review outcomes, discuss logistical challenges, and brainstorm ideals. Each month they also attend the WIC monthly staff meetings to discuss clinic flow, inform staff about community resources, assess the needs of the clients, and provide program updates.
Monthly intake numbers are reviewed to assess the number of referrals received by the Women Infant Resource Specialists. Due to the findings, some staff were relocated to meet the demands of the clinics with a higher need.
In the fall of 2018, Healthy Start conducted a WIRS Participation Satisfaction survey, 100% of the WIC respondents indicated that they would recommend for other Moms to visit with the WIRS while attending their WIC appointment. At the same time, WIC staff were surveyed and asked is the WIRS program has been a valuable addition to the WIC clinic, 100% of staff responded Yes.
The referral process for clients who are unable to receive education and support on the day of their WIC appointment required WIC staff training and the development of a consistent process that improved access to education and the opportunity to receive WIRS services. The time allotted for each WIRS contact with a WIC client was underestimated and the impact on client service time was not considered and the routing of eligible clients to WIRS was adjusted to accommodate the flow of the WIC services and improve the client experience.
A WIC clinic located in an area with target population does not have the space to accommodate WIRS in the clinic. It was essential for Healthy Start and WIC staff to develop an efficient and effective referral system for clients to ensure access to the necessary education and services.
The WIRS received limited access to FL-WiSE data system's client information and this impacts the follow-ups and follow through with clients. Collaborating with WIC staff to share information according to the WIC Authorized Release of Confidential Data Agreement Healthy Start to ensure that they are accessing services and utilizing the referrals and to assess the family's outcomes.
The Healthy Start Coalition has the capacity to sustain this project because of its 20 years of experience fostering partnerships with Hillsborough County community organizations and individuals with a vested interest in maternal and child health to maximize community resources. There is buy in from Florida Department of Health-Hillsborough leadership and the Executive Director of the Healthy Start Coalition. The project is currently funded through the Children's Board of Hillsborough County through 2020. As the primary funding source continuation of the project would be dependent on their continued support of the project.
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