New and Improved Healthy Start Universal Prenatal Risk Screen

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New and Improved Healthy Start Universal Prenatal
Risk Screen

• Presented by Bettina Thompson
• Orange County Healthy Start Coalition

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True or False

• Every pregnant woman should be encouraged to
  consent to completing the Healthy Start screening
  form.

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The Correct Answer Is

• True
• 383.14(1)(a) and 383.011(1)(e), F.S. this form
  must be completed by the health care provider for
  every pregnant woman and submitted to the local
  county health department.

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What women are eligible to participate in the
Healthy Start Program?

• First time pregnant women only
• Women with health problems only
• Women whose household income is below a certain
  level only
• Women who receive a certain score on their
  prenatal risk screen only
• All pregnant women who need or want services

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The Correct Answer Is

• E. All pregnant women who need or want services

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What is Healthy Start

• The Orange County Healthy Start Program is funded
  by the Orange County Healthy Start Coalition.
• ALL pregnant women and infants up to age 3 are
  eligible to receive FREE Healthy Start services
  regardless of their
• marital,
• economic
• immigration status.
• The Healthy Start program is voluntary and all
  information shared is kept confidential.

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Healthy Start Services Include

• Outreach
• Care coordination to assure access to needed
  services
• Childbirth education
• Parenting education and support
• Nutrition counseling
• Psychosocial counseling
• Tobacco education and cessation assistants
• Breastfeeding education and support
• Interconception education and counseling.
• Many other services to address individual
  indentified risk

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The Healthy Start and Prenatal Provider
Partnership

• Prenatal Care (the cornerstone)
• Healthy Start (the supplement)
• Improved Pregnancy Outcomes for Floridas Moms
  and Babies

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How Can I Make Healthy Start Work for My
Patients?

• For a patient to be referred to the Healthy Start
  program the following must occur

• Complete and submit a screening form
• Complete all sections of the screen
• Obtain signature, initials of patient consenting
  to screening and release of information
• Sign as the provider or healthcare professional
  referring patient
• Indicate reason for referral - score or specify
  for other factors.

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Screening Laws
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Florida Statues

• 383.14(1)(a) - Requires the primary health care
  provider to send the Healthy Start screening
  reports directly to the local Office of Vital
  Statistics (via Healthy Start Program Office).
  Vital Statistics must maintain the
  confidentiality of the information and may not
  release the information unless it has a signed
  consent to do so.

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Florida Administrative Code (Rule)

• 64C-7.009 (1) Prenatal Risk Screening
  Procedures
• (a) The health care provider delivering prenatal
  services shall assure that a prenatal risk
  screening instrument is completed and risk status
  is determined at the pregnant woman's initial
  visit.
• (b) The health care provider shall use the
  prenatal risk screening instrument and scoring
  mechanism determined by the department.
• (c) The health care provider shall assure that at
  the initial visit the pregnant woman receives an
  explanation of Healthy Start services and is
  informed of her risk status as determined by the
  prenatal risk screening instrument.
• 64C-7.010(1) Prenatal Risk Screening Records
• (a) The health care provider shall maintain a
  completed copy of the Healthy Start Prenatal Risk
  Screening Instrument in the pregnant women's
  medical record.

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Revision of the Risk Screen

• A Scientific Model

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Revision Components

• Research Workgroup
• Question Development Workgroup
• Program Workgroup
• Consumer and Provider Focus Groups
• Consumer Telephone surveys
• Pilot
• Final Form

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INTRODUCTION

• Help us improve you and your babys health
• Answers are Confidential
• Free Services from Healthy Start Program
• Not based on income or type of insurance

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Healthy Start Screening Questions
Not Graduated High School
Not Married
Felt down or depressed
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Healthy Start Screening Questions
Black Race
Alcohol Use
Tobacco Use
Not wanting to be Pregnant
First pregnancy
Previous Poor Outcome
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DEMOGRAPHIC INFO
Age less than 18
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CONSENT STATEMENT
Specific Info Release
DECLINE STATEMENT
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IF PATIENT DECLINES PARTICIPATION IN SCREENING
DECLINE STATEMENT
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PROVIDER SECTION
Provider Information
Additional Screening Questions
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PROVIDER SECTION
BMI lt19.8 or gt35 Chart located on back of page 2
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PROVIDER SECTION
Interpregnancy Interval less than 18 months See
question 15 for date last pregnancy ended
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PROVIDER SECTION
2nd trimester entry into prenatal care
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PROVIDER SECTION
Patient has an illness requiring ongoing medical
care
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Scoring the Screen

• Positive score is 6 points

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Scoring the Screen
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Scoring the Screen contd.
Screening Score Goes Here
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Referral Options
If score 5 or less and no other risk factors
exist, check not referred
Check referred if score 6 or referred based on
reasons other than score
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Risk Factor Scores

• (1) No high school
• degree or GED
• (1) Not married
• (1) Depression
• (3) Black Race
• (1) Alcohol use
• (1) Tobacco use
• (1) Not wanting to be
• pregnant
• (2) First pregnancy
• (3) Previous Stillbirth

• (3) Previous Premature birth
• (3) Previous Low birth weight
• birth
• (1) Age less than 18
• (1) BMI less than 19.8
• (2) BMI greater than 35.0
• (1) Interpregnancy interval of
• less than 18 months
• (2) Illness requiring ongoing
• medical care
• (1) 2nd Trimester at first
• prenatal visit

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Other Safety Concerns and Immediate Needs
Requiring Referral

• Knowledge or suspicion of current
• Domestic violence
• Sexual abuse
• Child abuse or neglect
• Substance abuse
• Diagnosed mental illness (such as severe
  depression episodes, bipolar, personality
  disorder, schizophrenia, etc.)
• HIV positive status
• Hepatitis B positive status
• Safety concerns noted by the health care provider
  on the Healthy Start screening form
• Language barriers
• Others, using professional judgment

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Screen Exampleslink to prenatal risk screen
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Client 1 (calculate score)

• Graduated High School
• Not married
• No children lt 5
• No children with special needs
• Good time to be pregnant
• Has not felt down
• Has felt alone
• Has not received mental health services
• Has not been hit or hurt
• Has trouble paying bills

• Race is black
• Did drink 1 per week
• Did not smoke
• Want to be pregnant later
• First pregnancy
• Age 21
• BMI is 29
• 2nd trimester
• Does not have ongoing illness

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Patient Healthy Start Screening Score Is

• Not married (1)
• Race is black (3)
• Did drink 1 per week (1)
• First pregnancy (2)
• 2nd trimester (1)
• Total Healthy Start Score (8)

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Client 2 (calculate score)

• Graduated High School
• Married
• No children lt 5
• No children with special needs
• Good time to be pregnant
• Has not felt down
• Has not felt alone
• Has not received mental health services
• Has not been hit or hurt
• Has no trouble paying bills

• Race is Other Hispanic
• Did drink 1 per week
• Did smoke 3 per day
• Want to be pregnant later
• Not first pregnancy
• No previous poor birth outcomes
• Age 31
• Last pregnancy ended 09/2007
• BMI is 22
• 2nd trimester
• Ongoing illness asthma

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Patient Healthy Start Screening Score Is

• Did drink 1 per week (1)
• Did smoke 3 per day (1)
• Last pregnancy ended 09/2007 (1)
• 2nd trimester (1)
• Ongoing illness asthma (2)
• Total Healthy Start Score (6)

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Client 3 (calculate score)

• Not Graduated High School
• Not Married
• No children lt 5
• No children with special needs
• Good time to be pregnant
• Has felt down
• Has not felt alone
• Has not received mental health services
• Has not been hit or hurt
• Has no trouble paying bills

• Race is White
• Did not drink
• Did smoke1per day
• Want to be pregnant later
• Not first pregnancy
• No previous poor birth outcomes
• Age 17
• Last pregnancy ended 09/2007
• BMI is 39
• 1st trimester
• No ongoing illness

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Patient Healthy Start Screening Score Is

• Not Graduated High School (1)
• Not Married (1)
• Has felt down (1)
• Age 17 (1)
• Last pregnancy ended 09/2007 (1)
• BMI is 39 (2)
• Total Healthy Start Score (7)

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Processing the Completed Screen

• Ensure that all information is complete and the
  form is signed appropriately.
• Give the green copy to the patient.
• Place the pink copy in the patients medical
  chart.
• Mail the remaining portions (white yellow)
  within five (5) business days to
• Orange County Health Department
• Attn Healthy Start Program Office
• 475 W Story Rd, Ocoee, FL 34761

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Medicaid Reimbursement

• Healthy babies save tax payer dollars. Florida
  Medicaid recognized this potential savings and
  therefore reimburses OB providers for completing
  the Healthy Start Prenatal Risk Screen.
• An enhancement of up to 162.24 to the antepartum
  visit reimbursement is offered if the screen is
  completed.

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Any Questions About Services?

• Healthy Start Contacts
• Orange 407-254-6822
• Osceola 407-343-2113
• Seminole 407-665-3277
• Lake 904-742-6320
• Sumter 904-793-2701
• Please click here to certify completion
• Insert Link Here