«Chapter 3: Healthy Start Risk Screening Introduction Healthy Start legislation requires that all pregnant women and infants be offered screening for ...»
Chapter 3: Healthy Start Risk Screening
Healthy Start legislation requires that all pregnant women and infants be offered
screening for risk factors that may affect their pregnancy, health, or development. The
prenatal and infant (postnatal) Healthy Start risk screens assess risk factors for adverse
health outcomes so that identified individuals may then be referred more expeditiously to
the appropriate services for their needs. This process makes for a holistic approach to the patient’s care and encourages continued participation in prenatal and infant health care. (Healthy Start risk screening instruments may be found in Appendix B.) Successful targeting of Healthy Start resources requires establishing and maintaining a network of providers who participate in prenatal and infant (postnatal) risk screening and are well-informed about screening procedures and knowledgeable about the services available to participants referred to the Healthy Start program.
It is also imperative that every pregnant woman and parent of a newborn understand the value of risk screening and ask their prenatal care provider and birthing facility staff, respectfully to complete the Healthy Start screening form. Health care providers need to receive ongoing education regarding the benefits of the Healthy Start program as it relates to their patients and have an understanding of the importance of offering each patient the risk screen in a manner that encourages consent. Furthermore, the providers must understand how to make appropriate referrals to community resources for factors other than score.
Consequently, it is critical that Healthy Start care coordinators provide feedback to providers who refer participants to Healthy Start. Providing this feedback reinforces the value of the program to providers and encourages good screening practices.
Definition of Service Healthy Start risk screening is the collection of information on the designated prenatal and infant screening forms. The forms are scored to assess risk and identify those women and infants most vulnerable of experiencing adverse health outcomes.
Screening differs from assessment in that screening only identifies those most likely to be at increased risk; an assessment is necessary to determine service needs.
Standards and Criteria Standard 3.1 The Healthy Start coalition will assure that providers receive training on how to present the Healthy Start screen in a manner that encourages consent, and how to explain the concept of Healthy Start as well as the benefits of Healthy Start screening.
20 Chapter 3: Healthy Start Risk Screening Revised April 2009
3.1.a Healthy Start coalition designates responsibility for training prenatal care providers and birth facilities staff who provide Healthy Start screening.
3.1.b Documentation of training is included in the coalition progress reports. The documentation includes training dates, participants (individual or group), and curriculum determined by the coalition.
Standard 3.2 Each Healthy Start coalition will assure the development and implementation of a public relations strategy designed to achieve universal Healthy Start prenatal and infant risk screening.
3.2.a All providers of Healthy Start care coordination participate in the development and implementation of the strategy.
3.2.b All training and education related to Healthy Start screening is provided with consideration to cultural, language, educational/literacy, and accessibility needs of the participant.
Standard 3.3 All prenatal care providers and delivering facilities will use the Healthy Start prenatal and infant risk screening instruments designated by the Department of Health and provided by the county health department.
3.3.a Each provider forwards the completed Healthy Start risk screening form within five working days of completion of the screen to the county health department in the county where screening occurred.
3.3.b Each county health department where the screening occurs checks the screens for accuracy, obtains corrections as necessary, and then forwards the appropriate copies of the Healthy Start screen to the county health department in the participant’s county of residence or enters the screening form data into the Health Management System (HMS) as appropriate, within five working days.
3.3 c. The county health department in the participant’s county of residence enters the screening form data into HMS, and then forwards all screens with appropriate patient consent and referral to the Healthy Start care coordinator within five days.
Additionally, each county Healthy Start program forwards a copy of all Healthy Start screens on which the participant responds "yes" to consent for release of information to the Healthy Families Florida (HFF) provider unless otherwise determined by local agreement with Healthy Families. Healthy Start staff does not calculate HFF risk scores.
Procedures for sharing the cost of providing copies of the screening forms shall be based on local agreement between Healthy Start and Healthy Families Florida.
Standard 3.4 Each Healthy Start coalition’s and county health department’s quality management/program improvement (QM/PI) system will include a Healthy Start screening component.
The QM/PI screening component consists of, at a minimum, an annual review and assessment of screening reports identifying critical screening issues and plans to address problems.
Standard 3.5 Each Healthy Start care coordinator and coalition will receive updated technical assistance and/or training related to Healthy Start screening.
Information provided through technical assistance and/or training is disseminated to each Healthy Start care coordinator and coalition through a locally determined mechanism.
Guidelines Background: The Healthy Start screening instruments were initially developed in 1992 by a workgroup that included physicians, nurses, social workers, researchers, program specialists, and other professionals knowledgeable in the field of maternal and child health. The purpose of the screening instruments is to identify pregnant women and infants who are more likely to experience adverse outcomes. For pregnant women the adverse outcome is pre-term labor and/or low birth weight, and for infants the adverse outcome is infant death between 28 and 364 days after birth.
The instruments were created after extensive research and analysis of risk factors, and a statewide workgroup then approved the forms. The risk screens are evaluated annually to determine their success in identifying those women and infants most at risk for adverse outcomes. Studies that have linked birth outcomes to Healthy Start infant screening data indicate that infants who score 4 or more on the Healthy Start screen are six times more likely to experience postneonatal infant mortality than those who score less than 4.
Risk Ratios: Each risk factor scored on the Healthy Start screening tool is associated with higher risk for poor health outcomes. The strength of the association is expressed as a “risk ratio.” For example, if a pregnant woman has experienced a previous poor pregnancy outcome, she is 2.02 times more likely to experience preterm birth or to deliver a low birth weight infant than a woman who has not experienced a previous poor pregnancy outcome. In this analysis, preterm birth is defined as a birth before 37 weeks of gestation and low birth weight is defined as less than 2500 grams. The risk ratio for each factor is provided in the chart below.
Healthy Start services are provided with risk reduction in mind. Because some risk factors cannot be changed with interventions (e.g., single marital status, race, or age), it is necessary to assess the situations that underlie the risk factor or are caused by the risk factor. (For example, if a single woman does not have the social supports needed to 1 Risk screening score from Prenatal Screening form #DH 3134, 4/08.
2 Based on 113,502 births in 2005 linked to prenatal screening data.
Each risk ratio is adjusted for associations with all other risk factors in the table.
3 Risk screening score from Infant Screening form #DH 3135, 01/04.
4 Based on 313,791 births in 2005 and 2006 linked to 855 postneonatal death records.
Each risk ratio is adjusted for associations with all other risk factors in the table.
ensure the best outcomes for her pregnancy, care coordination services may be critical to ensure her access to services.) Population Served: Florida statute requires that Healthy Start risk screening is offered to all pregnant women at their first prenatal visit by their prenatal health care provider. In addition, Florida statute requires that Healthy Start infant (postnatal) risk screening is offered by the birthing facility to parents or guardians of all infants born in Florida before leaving the facility.
Services Provided: The assurance of a comprehensive Healthy Start risk screening system includes the following components.
Health Care Providers and Delivery Facility Staff:
• Explain Healthy Start Program and the benefits of Healthy Start Screening
• Complete risk screen instrument
• Score risk screen instrument
• Explain score, as appropriate
• Refer for program services as appropriate
• Forward screening Instrument to local county health department
County Health Departments:
• Provide blank Healthy Start screens to prenatal healthcare providers and delivery facilities
• Receive completed screens
• Check screens for accuracy and obtain corrections as necessary (computer system or manually as appropriate)
• Enter prenatal screen data into HMS and forward Healthy Start prenatal and infant screens to CHD care coordinator in county of residence within five working days, as appropriate
• Maintain an administrative file for all screening forms of county residents on which the client declined to be screened, was not referred, or declined the program.
Parameters: Pregnant women and infants are screened only once for Healthy Start.
Prenatal risk screening and referral for positive score should occur at the first prenatal visit or the earliest time thereafter. Referrals for reasons other than score are sometimes necessary but must be made judiciously. (See Table 3.1) Potential program participants may, however, enter the program at any time subsequent to their negative screening and/or referral by a self-referral or a referral from a community resource.
Note: When entry into the Healthy Start program occurs based on factors other than screen score, pregnant women and infants are not re-screened.
Infant risk screening and referral for positive score should occur at the time of delivery.
Referrals for reasons other than score are sometimes necessary but must be made judiciously. Potential program participants may, however, enter the program at any time subsequent to their negative screening and/or referral by a self-referral or a referral from a community resource. (See Table 3.1)
Service Delivery Activities Related to Establishing and Maintaining a Provider Network for Healthy Start Screening: The first step in establishing and maintaining a provider network for screening is to identify the agency responsible for this activity. This may be the coalition, the county health department, or another designated agency.
1. Identifying and informing local providers about the Healthy Start program and risk screening
2. Reviewing and monitoring their screening practices, including providing feedback on their screening practices on a quarterly basis.
1. Identifying and Informing Local Providers:
The agency designated by the local coalition for establishing and maintaining the provider network for Healthy Start screening will contact providers of prenatal and infant health services to inform them of their responsibility related to Healthy Start risk screening. Providers of prenatal care and birthing facilities are required by the Healthy Start legislation (§383.14, F.S.) to offer Healthy Start prenatal or infant risk screening, respectively.
6. Requirements related to Prenatal risk screens are to be sent to the county health department in the getting completed prenatal and county where the prenatal screen was completed within five working days of infant screens to the local completion of the screen.
county health department.
Risk factor information for the infant (postnatal) screen is taken from the Certificate of Live Birth. The infant (postnatal) risk screening form is then sent with the Certificate of Live Birth to the county health department in the county where the infant was born within 5 working days of birth.
7. How to refer a pregnant woman or infant, regardless of Pregnant women or infants can be referred for Healthy Start care risk screen score, for Healthy coordination services regardless of their score on the Healthy Start risk
Start care coordination screen in the following ways:
services if in the community 1) If the referral is to be made at the same time the risk screen is resource’s, woman’s, or administered, the health care provider may indicate on the risk screening family’s judgment the woman form that the woman or infant is referred and “specify” reasons for referral on or infant needs the services. the screening instrument as indicated.
2) If the determination is not made at the time of the screening, the (* Referrals for reasons other community resource may directly refer the woman or infant to the Healthy than score should be used Start care coordination provider upon assessment of actual or potential judiciously and with factors associated with high risk.