Division of Community Health Promotion

Bureau of Family Health Services

A major goal of the Bureau of Family Health Services is to assist communities in developing and implementing comprehensive and coordinated systems of care for women, children and families to assure that health care is available and accessible and that there are smooth transitions from one care provider/environment to another. Funded by a variety of federal grants, state sources and partners at the local level, the Bureau provides program development, policy direction, and technical assistance to county health departments, local community-based coalitions, and other service providers. The array of programs that are offered cross the lifespan and are designed to provide comprehensive, family centered, culturally and linguistically appropriate quality services and/or linkages to other quality services within the community.

The Bureau of Family Health Services has five major sections covering a broad array of service areas and initiatives: Child and Adolescent Health; Infant, Maternal and Reproductive Health; the Public Health Dental Program; Refugee Health Program; and the Sexual Violence Prevention Program. These include, but are not limited to: the Healthy Start Initiative; maternal and child health services; family planning; pregnancy support; adolescent health; basic, full service and comprehensive school health services (Pre-K-12); and dental services to improve and maintain the oral health of all of Florida's citizens. The Bureau also provides contract management and oversight for the Healthy Start Coalitions, Pregnancy Associated Mortality Review, Fetal and Infant Mortality Review, the Sexual Violence Prevention Program, the Adolescent Health Program, Maternal and Child Health, and the Public Health Dental Program.

Sexual Violence Prevention Program

The Sexual Violence Prevention Program is federally funded by the Centers for Disease Control and Prevention through grants from the National Center for Injury Prevention and Control for Rape Prevention Education and Training, the Preventive Health and Health Services Block Grant for Sexual Assault Victim Services, and the U.S. Department of Justice Office on Violence Against Women's Sexual Assault Services Formula Grant Program. The Sexual Violence Prevention Program also receives state funding from the "The Sexual Battery Victims" Access to Services Act" and the Rape Crisis Program Trust Fund (RCPTF). The Act created a funding system for distribution of monies generated by a $151 surcharge assessed on offenders convicted of sexual battery, including many of the aggravated battery and battery offenses. While the clerk of the court retains $1 of the surcharge as a service fee, $150 goes to the Rape Crisis Program Trust Fund. This Act also authorizes the department to contract with a statewide, nonprofit association called the Florida Council Against Sexual Violence, Inc. (FCASV) who is committed to victims and survivors of sexual violence and the rape crisis programs who serve them. FCASV subcontracts with rape crisis centers throughout the state to serve victims and enhance services. Pursuant to a two-year general revenue appropriation by the Florida Legislature, the Sexual Violence Prevention Program also receives funding for the Palm Beach County Victim Services and Rape Crisis Center to provide services to primary and secondary victims of sexual assault

The Sexual Violence Prevention Program, through contracted providers, supports primary sexual violence prevention-related activities throughout Florida. Activities include educational presentations; operation of hotlines; training programs for professionals; efforts to increase awareness in underserved communities; social norms marketing campaigns, special projects and providing services to sexual violence victims. The program also implements county health department guidelines and internal policies on sexual and domestic violence.

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Sexual Violence Prevention Program website

Family Planning Services

The Department of Health (DOH) is responsible by legislative mandate (section 381.0051, Florida Statutes) to make available to Florida citizens of childbearing age, comprehensive medical knowledge, assistance, and services relating to the planning of families, birth control, and maternal health care. Family planning plays a key role in the prevention of unintended pregnancy. Preventing unintended pregnancy improves birth outcomes and reduces the incidence of abortion. An important goal of the family planning program is to improve the health of Florida's women and children by reducing unplanned and unwanted pregnancies and promoting positive pregnancy outcomes.

Comprehensive family planning services are available to both males and females in all 67 counties through the local county health departments. County health departments provide family planning services on a voluntary basis in a confidential manner. Clients receive culturally sensitive information about basic female and male reproductive anatomy and physiology, and the value of fertility regulation in maintaining individual and family health. This information assists clients with making an informed decision regarding the use of contraception. Clients have access to FDA approved contraceptive methods. County health departments provide services on a sliding scale fee based on client family income and size. Clients with incomes at or below 100% of the federal poverty level do not pay fees for services.

In 1997, the Florida Legislature directed the Agency for Health Care Administration (AHCA) to apply for a federal waiver to extend Medicaid family planning services for postpartum women. AHCA and DOH developed the application for the waiver jointly. The waiver extended family planning services to all postpartum women who had a Medicaid financed pregnancy related service during the past 24 months and lost Medicaid coverage. Beginning December 2006, the 24 months of waiver services were extended to all women between the ages of 14 and 55 who lost full Medicaid benefits; desire family planning services; are at or below 185% This will include those recipients losing Medicaid HMO coverage. Women covered through SOBRA Medicaid will have auto-enrollment during the first 12 months of losing Medicaid. Non-SOBRA covered women have to apply for the first year of service. All women enrolled in the family planning waiver program will have an active re-determination of eligibility after 12 months of family planning waiver eligibility.

AHCA and DOH submitted an application for another extension of the waiver with the same population and eligibility requirements as the previous extension for the period of December 1, 2009 through November 30, 2012. The Centers for Medicaid and Medicare Services (CMS) granted several extensions through June 2011 during the review process. The Medicaid Family Planning Waiver was approved for the period of June 24, 2011 through December 31, 2013.

AHCA reported that since the beginning of the first family planning waiver demonstration project period beginning in 1998, as of September 2009, a total of 247,321 women have received services. During the recent CMS extensions and review process, the number of women served decreased. The first automated notices generated on July 3, 2011 included 25,330 women.

For every $1.00 spent on family planning services an estimated $4.36 is saved as a result of averting expenditures for public insurance programs that support women with unintended pregnancies and their infants. These estimates of savings do not include longer term savings, such as fewer exceptional needs school age children due to fewer low-birth weight babies or lower rates of child abuse. Child abuse is more likely to occur in low-birth weight babies or babies from unplanned and unwanted pregnancies.

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Family Planning Services website

Healthy Start

The Healthy Start program assists pregnant women, interconceptional women, infants, and children up to age 3 to obtain the health care and social support needed to reduce the risks for poor maternal and child health outcomes including infant mortality, and to promote good health and developmental outcomes. Every pregnant woman and every child born in Florida is eligible for Healthy Start Prenatal or Infant Risk Screening and the program goal is universal screening. The program invites pregnant women and infants to participate in Healthy Start services if they score positive on the Healthy Start screening instrument.

The Healthy Start program services include risk assessment, nutrition counseling, care coordination, breastfeeding education and support, tobacco cessation counseling, assessment of service needs, interconceptional 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 medical prenatal and child health care as payer of last resort. There are 32 Healthy Start Coalitions and 1 CHDs covering all of Florida’s 67 counties supporting the implementation of the Healthy Start initiative. The coalitions' membership includes business, professional and political leaders, health care providers, consumers, educators and representatives from professional and community associations. These coalitions have the authority to plan and develop improved local maternal and child health service delivery systems.

All of the Healthy Start Coalitions completed thorough community needs assessments and developed outcome based service delivery plans. The coalitions update these plans every five years. In addition, each year they submit an annual action plan to the Department of Health.

In conjunction with the Florida Association of Healthy Start Coalitions and the Agency for Health Care Administration, the Department of Health submitted a Medicaid 1915(b) waiver for Healthy Start services as an amendment to the Medicaid Waiver in January 2001. The Centers for Medicare & Medicaid Services (CMS) approved and formally signed the amendment on June 7, 2001. In June 2011, CMS extended authority for the waiver through August 31, 2011 and the reapplication is under review at this time.. This extension and the additional funding, the Healthy Start program is able to serve pregnant women, infants and children most at-risk through increased care coordination, while also increasing the intensity and duration of care and services provided to match their risk and need.

The waiver has also enabled the Healthy Start coalitions to establish MomCare, a system to ensure that Medicaid-eligible pregnant women are linked to prenatal care and have access to care management services during their pregnancy. Through the provision of these services to high-risk pregnant women, MomCare has become an integral part of the maternal and child health service delivery system, helping ensure the best possible outcomes. In total the waiver provided $ 18,890,817 in federal funds during FY 2009-2010 to support services to Florida's Medicaid-eligible pregnant women and children.

Every pregnant woman and every child born in Florida is eligible for Healthy Start Prenatal or Infant Risk Screening and the program goal is universal screening. The program invites pregnant women and infants to participate in Healthy Start services if they score positive on the Healthy Start screening instrument. They may also participate through self-referral or if in the judgment of their health care providers they would benefit from Healthy Start services.

The Department of Health and the Department of Children and Families have an agreement that facilitates the process of Medicaid eligibility. County health department staff and other selected prenatal care providers determine whether the pregnant woman is presumptively eligible for Medicaid and help the patient to access Medicaid services. By ensuring that Medicaid is the third party payer for Medicaid eligible women, there are more county health department dollars available for non-Medicaid eligible infants and pregnant women.

Additional education is provided through the Family Health Line, a toll-free hotline (1-800-451-2229) that promotes the importance of early and continuous prenatal and infant care. The hotline provides information on health and social services, substance abuse treatment, childbirth education, WIC, immunizations, well baby care, Medicaid, prenatal care, family planning, Medicaid Family Planning Waiver, breastfeeding support, and other pregnancy-related services. The hotline also helps callers obtain needed information, referrals, supportive counseling, and advocacy assistance. The hotline staff assists callers with issues such as application for Medicaid, access to prenatal care direct services and family planning direct services.

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Healthy Start website

Comprehensive Child Health

County Health Departments (CHDs) provide a variety of health services for infants and children and their families. Clinics serve eligible children through 21 years of age. The scope of services varies among counties, determined by need and the local availability of resources. All counties provide immunizations and varied levels of child health supervision that includes periodic health history, physical examinations, and laboratory screening tests for such health status indicators as lead and anemia. Some health departments are able to provide acute episodic care with referral and follow-up activities for the ill or injured child.

Infant and child health services also include developmental screening, risk assessment, and parent education. Injury prevention on topics such as car safety seats, bicycle safety, drowning prevention, fire safety, poisoning prevention, and substance abuse prevention education are emphasized, but many other topics for health education are delivered to children and their families in the clinical and community setting. CHDs also provide linkages with Women, Infant, and Children (WIC) nutrition services and oral health and dental services for eligible children.

CHDs receive and process the Healthy Start infant screens, identifying the infants at increased risk of infant mortality. These children and their families are referred for care coordination and other risk appropriate services based upon community needs assessment and prioritization of resources through a collaborative process between the local Healthy Start Coalitions and public and private providers. The county health department may serve as a medical home for children taken into the custody of the Department of Children and Families when necessary.

The Childhood Lead Poisoning Prevention Program and maternal and child health staff work cooperatively to ensure that children with elevated blood lead levels receive timely follow-up testing and case management. As part of the Childhood Lead Poisoning Surveillance program, statewide laboratory surveillance is conducted in the Bureau of Environmental Public Health Medicine within the Division of Environmental Health on blood lead levels in children. These data facilitate the follow-up of children with elevated blood lead levels. Screening guidelines, provider education and technical assistance is provided for the assessment of risk, screening, and follow-up. Additionally, public health nurses are integrated into the process and provide assessment, case management, counseling, education and referrals for children with elevated blood lead levels, whether screened by public or private providers.

Maternal and Child Health (MCH) staff participates in an advisory capacity, serving as a health resource for infant and child health initiatives. Examples of these initiatives are: Fetal and Infant Mortality Reviews, State Oral Health Improvement Plan for Disadvantaged Persons, Child Abuse Death Review Teams, March of Dimes Prematurity Workgroup, and Reach Out and Read Florida. These initiatives work towards improving the health of Florida's infants, children and youth. Staff is also working with the Governor's Office of Adoption and Child Protection on the state's five year Florida Child Abuse Prevention and Permanency Plan: January 2010 - June 2015. The intent of the five year plan and its implementation is to ensure that all of Florida's children live in an environment that fosters healthy social, emotional, intellectual, and physical development.

In addition, Child and Adolescent Health staff is responsible for the Early Childhood Comprehensive Systems (ECCS) Project. The ECCS Project is funded by the Maternal and Child Health Bureau of the Health Resources and Services Administration (HRSA). The purpose of this project is the implementation of a comprehensive early childhood system that promotes the health and well being of young children ages 0-5 in Florida, enabling them to enter school ready and able to learn. These efforts involve a broad range of public and private early childhood agencies, parents and communities who share the goal of promoting the health and well-being of children through the grants five key components: 1) Health insurance and the medical home, 2) Early care and education, 3) Mental health and social-emotional development, 4) Family support and parenting education, and 5) Collaborative governance and comprehensive systems of care development.

The ECCS has developed a multi-agency team which consists of representatives from numerous partnering agencies and family advocate organizations, all of whom work with or have interest in children ages birth to five and are willing to work to improve the early childhood system in Florida. Each multi-agency team member is a champion for comprehensive early childhood systems within their respective organization. They serve as a communication link between their agency and the work underway through the ECCS grant.

Comprehensive child health services provided include the following:

• Primary and preventative health care, including comprehensive screening, assessment, intervention, counseling and education is provided for eligible well children and sick-children.
• A child health check-up is provided to Medicaid eligible children from birth through age 21 according to the periodicity table recommended by Medicaid. This care includes extensive counseling and education in child growth and development, injury prevention, infant and child mental health, parenting education, age appropriate discipline, and other important parenting issues.
• CHDs provide community information including the latest research findings and recommendations to reduce the risk of SIDS and accidental death. A brochure was developed to educate parents on the importance of a safe sleeping environment for infants.
• In cooperation with the environmental health staff, public health nurses provide assessment, case management, counseling, education and referrals for children with elevated blood lead levels, whether screened by public or private providers.
• Health education is an integral component of county health department service delivery. County health departments provide individual, family, and community education on topics, such as parenting education, child growth and development, health maintenance, safety, child abuse and neglect, and domestic violence prevention. Other education programs include the Shaken Baby Prevention Campaign; the Safe Sleep Campaign to lessen the incidence of SIDS and accidental death, bicycle helmet use, car safety seats and seat belt use, tobacco and substance abuse prevention, and HIV/STD prevention.
• The provision and tracking of immunizations are part of every child health program. All CHDs participate in Florida SHOTS (State Health Online Tracking System) a free, statewide, centralized online immunization regist
• All children are eligible to receive these services. Payment is determined by a sliding fee scale based on family income. Eligibility for Healthy Start services for infants and children to age 3 is based on their Healthy Start screening score, self referral, or if in the judgment of their health care providers they would benefit from Healthy Start services.

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School Health

The School Health Services Program provides the health services mandated in ss. 381.0056, 381.0057, and 402.3026, F.S. The Department of Health, in cooperation with the Department of Education, has the responsibility to supervise the school health program and provide periodic program reviews. Each county school health program develops a biennial school health services plan that identifies local implementation strategies and responsible parties for the provision of health services in public schools. School health services are provided statewide through the combined efforts of county health departments, local school districts, and community partners such as health taxing districts, universities, hospitals and others.

Basic School Health: County health departments in all 67 counties are responsible for assuring that students in Pre-K through 12th grade have access to health services that assess, protect and promote their health. These services include:

• Record review and follow-up to assure that all incoming students have a school entry health exam, immunization for grade-level, and that any chronic health problems are being addressed;
• Vision, hearing, growth and development, and scoliosis screening in grade levels mandated by Chapter 64F-6.003, Florida Administrative Code that provide early identification and remediation of problems which may impact a student's ability to learn;
• Nursing assessment, health care planning and delegation for the provision of school-based health services needed by students in order to attend school;
• Planning and provision of emergency health services for students who are injured or become acutely ill at school;
• Participation in curriculum development for health education;
• Consultation with parents and school personnel on health issues that interfere with a student's ability to fully participate in school activities;
• Record review, screening, and participation in meetings for the placement of students in exceptional education programs.

Comprehensive School Health Services: County health departments in 46 counties are responsible for the provision of basic school health services and enhanced services which focus on promoting the health of students, reducing risk-taking behavior, and reducing teen pregnancy. The site-specific activities are approved in the locally designed grants. Enhanced services include:

• Expanded nursing case management, and when indicated, medical and mental health assessments and counseling for students with chronic health problems or students at risk of school failure or dropout;
• Expanded screening beyond those mandated by grade level, including screening for other health risk factors such as high blood pressure, smoking, and drug or alcohol use. to assure early identification and remediation of health problems and risks that can impact a student's current and future health status and ability to succeed in school;
• Health education and social interventions to promote healthy lifestyles and limit risk-taking behavior including premature sexual activity which could result in sexually transmitted diseases and/or pregnancy.
• Case management of pregnant and parenting students so they receive pre-natal services and support services after giving birth so they may return to school.

Full Service Schools: All 67 counties have Full Service School programs in schools with high numbers of medically underserved, high-risk students. Designated full service schools provide basic school health services and additional health and social services to students on school grounds. Full service schools form partnerships with community-based services providers that donate in-kind services to full service school students and their families. The donated services may include:

• Nutritional services,
• Basic medical services,
• Economic services,
• Parenting skills,
• Mental health and substance abuse counseling,
• Counseling for abused children,
• Counseling for children at high risk for delinquent behavior and their parents, and
• Adult education

Client Eligibility Criteria:

Basic School Health: All students in grades Pre-K-12 who attend public schools and participating non-public schools.

Comprehensive School Health Services: All 369,634 students who attend one of the 504 public schools designated by the county health departments and local school districts as a Comprehensive School.

Full Service Schools: All 299,530 students who attend one of the 413 public schools designated by the local county health departments and school district as a Full Service School.

Number of Annual Students/Services

During 2009-10, county school health programs provided 21,912,218 services to 2.62 million Pre-K-12 students in approximately 3,556 Florida schools. A total of 15,022,220 direct school health services were provided by the Basic School Health Services program, 3,604,385 by the Comprehensive School Health Services Projects, and 3,285,613 through Full Service Schools.

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School Health Services Program website

Adolescent Health Program

The Adolescent Health Program provides technical assistance and resources to promote healthy youth development. The purpose of the program is to enhance the skills and improve the health status of Florida’s adolescents and young adults through opportunities and programs developed in collaboration with families, communities, schools and other public and private organizations throughout Florida. The program works with county health departments, community agencies, state agencies, parent groups and other stakeholders to address adolescent health issues.

Adolescent Health Program sponsored projects are intended to reinforce positive attitudes, healthy behaviors and activities, and reduce risk-taking behaviors, such as sexual activity, substance abuse, suicide, and behaviors that increase the risk of unintentional injury and chronic disease. The program provides a network of community-based support to help adolescents succeed as they move into adulthood by focusing on the "assets" of individual youth and their families.

The Adolescent Health Program is responsible for oversight of the Teen Pregnancy Prevention Program and the Abstinence Education Program, both of which have a positive youth development focus. Staff of the Adolescent Health Program also participates with various task forces and workshops that address adolescent health. The State Adolescent Health Coordinator is a member of the National State Adolescent Health Coordinators Network which is composed of State Adolescent Health Coordinators from each state in the United States. The Network focuses on development of a national adolescent health resource center to address the health needs of adolescents, implementation of State Title V performance measures focused on youth outcomes, and collaboration to develop new programs that address current adolescent health issues.

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Early Childhood Comprehensive Systems (ECCS) Project

The Child and Adolescent Health staff is responsible for the Early Childhood Comprehensive Systems (ECCS) Project. The ECCS Project is funded by the Maternal and Child Health Bureau of HRSA. The purpose of this project is the implementation of a statewide early childhood system that promotes the health and well being of young children ages 0–5 in Florida, supporting their health, education and social emotional development, and getting them prepared to enter school able to learn.

The ECCS Multi-Agency Team which consists of representatives from numerous partnering agencies and family representatives, all of whom work with or have interest in children ages birth to five, work together to improve the early childhood system. The five key components of focus include access to: 1) Health insurance and medical homes, 2) Social/emotional development and mental health services for young children, 3) Early care and education, 4) Parenting education, 5) Family support. This team partners with the newly formed State Early Childhood Advisory Council, an advisory council to the Florida Children and Youth Cabinet, which is charged with providing overarching direction and coordination all services for young children and their families.

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Public Health Dental Program

The Public Health Dental Program leads the Department of Health's efforts to improve and maintain the oral health of all persons in Florida. The Dental Program has four primary functions. It provides a statewide direction for policy related to oral health issues; it promotes and administers oral health education and preventive dental programs; it collects and analyzes data on oral health; and it supports the provision of direct dental care services through the County Health Departments (CHD) and other public and private organizations.

• Provides direction on oral health policy.
• Researches and recommends policy change that can improve inequities in access to oral health care services in the state.
• Facilitates collaborative efforts of statewide oral health stakeholders in relation to oral health policy.
• Promotes cost-effective community and school-based oral health educational and preventive activities.
• Supports school-based fluoride mouth rinse and sealant programs.
• Promotes and implements community water fluoridation for eligible communities throughout the state and monitors new and existing systems to maintain optimal fluoride levels.
• Encourages early childhood caries preventive programs using non-dental staff.
• Strives to integrate oral health into general health programs such as WIC, Heart Disease, Diabetes, Cancer, and Obesity programs.
• Provides consultative and technical assistance to maternal and child health programs, school health programs, WIC programs, schools, state and federal government entities, community and professional organizations and private citizens.
• Collects and analyzes statewide and local oral health data.
• Monitors state and county oral health status, dental treatment needs, and utilization of dental services.
• Facilitates the continued development of an integrated, coordinated oral health system between the public and private sectors.
• Evaluates and promotes the development of efficient and effective programs.
• Supports the provision of direct dental care services.
• Promotes collaboration among statewide dental and other health care providers.
• Provides consultative and technical assistance to state and professional organizations.
• Provides technical assistance, evaluation, administrative support, and quality assurance guidance to CHD dental programs which include on-site facilities, mobile units, contractual arrangements and teledentistry.
• Administers CHD categorical dental funding and administers dental contracts with a variety of public and private organizations.

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Public Health Dental Program website

Refugee Health Program

The goal of the Refugee Health Program (RHP) is to be a leader in providing culturally sensitive health services to persons who have fled their home country due to persecution (political, religious, or economic) in search for a better life and self-sufficiency in the U.S. The RHP reviews overseas medical examination records and provides health assessments and immunizations to refugees to enhance personal health status and protect Florida's public health. The RHP provides these services through funding from the federal Office of Refugee Resettlement and the Florida Department of Children and Families, Refugee Services.

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Refugee Health Program website