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Reorganization not expected to affect Central Healthy Start

The program for pregnant women and infants faces a $1.5-million spending cut.


© St. Petersburg Times, published February 4, 2001

Citrus County won't change its Healthy Start coalition as Florida reorganizes the popular program for pregnant women and infants, a top state official predicted last week.

Gov. Jeb Bush and the Department of Health's proposed spending plan calls for a $1.5-million (33 percent) cut in Healthy Start administration costs. The savings would be achieved largely by reducing the number of Healthy Start coalitions from 32 to 22.

Coalitions and their governing boards, which are composed of health professionals and volunteers, are the administrative overseers of Healthy Start. Many coalitions are composed of several counties.

Citrus is part of Central Healthy Start, whose other member counties are Hernando, Lake and Sumter.

State money for Healthy Start goes to the coalitions, which in turn hire providers to work with pregnant women and infants. In Citrus, that provider is the county health department.

Budget planners are reviewing several proposed consolidations. Though changes are always possible, none of those scenarios involve Central Healthy Start.

"I don't think that it will" change, said Les Beitsch, deputy secretary for health in the Department of Health, during an interview last week.

Marnie Shanbhag, program director for Central Healthy Start, said she would prefer the state keep Central's membership the same. A bigger coalition obviously would result in a bigger geographic area for the governing board and its staff to cover.

Oversight and input usually come best from smaller groups, she said.

"We're not saying Healthy Start isn't important, (that it) doesn't matter," Beitsch said. Rather, the state's goal is to maintain the good parts and trim unnecessary expenses.

Even if Central's membership roster remains the same, Shanbhag hopes the coalition's $150,000 administrative budget doesn't take a cut.

That money pays for community education, outreach and special training of doctors and nurses who treat at-risk infants and pregnant women. Such work isn't considered a Healthy Start "service," but it does go a long way toward identifying which women and children most need help.

Central receives almost $770,000 per year to provide services. The budget reductions and program reorganization do not contemplate any cut in that money.

Healthy Start began almost 10 years ago at the direction of then-Gov. Lawton Chiles. It is designed to help women have healthy pregnancies and children have healthy early childhoods.

To do this, the program seeks to identify pregnant women and newborns who have specific risks -- low birth weight children, for example, or women who smoke or abuse alcohol during pregnancy -- and then provide services necessary to reduce those risks.

During the fiscal year that ended in September, 98 percent of all pregnant women in Citrus were offered a Healthy Start screen when they sought prenatal care, records showed. Of the women who consented to answer questions, 29 percent were deemed "at risk" and eligible to receive services, such as home visits or smoking cessation classes.

The women are free to accept or decline services as they wish. Those who accept are assigned a case worker, who help make sure the women receive necessary medical care and nutrition.

Healthy Start screenings also are supposed to be completed each time a child is born. The parents may decline to participate.

Even if the child qualifies for services because of any number of risk factors -- birth weight, health condition, poverty -- the parents aren't obliged to accept.

During the 1999-2000 fiscal year, 325 women and 225 infants in Citrus County received at least one Healthy Start service, records showed.

Home visits, particularly after the child is born, are a big part of Healthy Start's success, experts have said. Specially trained professionals work with the parents and help monitor the child's health.

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