First published on April 6, 2015 in observance of the COPH’s 30^th anniversary celebration.

Dr. Karen Liller has been a child and adolescent injury prevention researcher for a quarter of a century.  A professor in the USF College of Public Health’s Department of Community and Family Health and a member of the Florida Injury Prevention Advisory Group, she worked with a Tampa General program called More Health in the mid-1990s to help evaluate its health education programs.  One of those programs promoted bicycle helmets for children.

Dr. Karen Liller

“I evaluated their program, and I started observational studies of children’s bicycle helmet use in Hillsborough County,” Liller said.  “I was monitoring this because, as part of the Injury Group, I knew this bill had been denied two times before.  We were all part of the advocacy efforts with Tallahassee between the state of Florida program, More Health and the college to get this passed.”

A natural proponent of requiring kids to wear helmets when they rode their bikes, Liller had her interest piqued.  From casual observation alone, she surmised that few were.  Determined to put scientifically collected numbers to the problem, she and a cadre of her graduate students set about the task of collecting data.

From low expectations to high hopes, then action

“I was focused on unintentional injuries in children,” she said.  “Nationally, this was a huge issue.  I had some colleagues at Harborview Injury Prevention Program in the state of  Washington, and they were some of the early leaders nationally in helmet use.  So I naturally got very, very interested and started looking, started conducting observational studies, because I didn’t know:  What is the helmet use rate? “I developed and performed community observations,” she said.  “I would hire my grad assistants, and they would stand on corners doing observational surveys of kids in helmets.  We mapped out the whole county, and I had them on streets everywhere.  We had a whole protocol of where we wanted to be, because we wanted to capture observational surveys in many different places – in community sites, in schools, not near schools, etc., so we had a good idea of what was going on in Hillsborough County.”

As low as Liller’s expectations were, reality turned out to be even worse.

“I can tell you, it was pitifully low,” she said.  “For children under 16, it was about three percent.”

Liller set out on a concentrated campaign to get a helmet law passed.  It already had languished and died in two previous legislative sessions, and she was determined to make the third try count.

“I did many radio spots and TV spots and Good Morning Whomever promoting bicycle helmets as the law was working its way through the legislature,” she recalled.

“I wanted to get ahold of it,” she said, “because I knew this was a national issue, and I knew states were starting to pass laws.  Florida is a tough state to get a law passed for children’s injury prevention.  In fact, we just got the booster seat law done.  We were one of the last states to do that.  I knew it was going to be a battle.  So, I knew I’d better get started early.” Liller learned through focus groups that legislators weren’t the only people she needed to convince.  Some parents didn’t want a law telling them to put helmets on their kids’ heads.  After all, bicycle shops already were selling more helmets.  McDonald’s was giving out helmet discount coupons and safe rider certificates.  Why should there be a legal mandate?

“My answer to them was, ‘Do you have a driver’s license?  Yes?  Well, the government told you to do that.’

“It always surprised me when parents would argue with me on this issue.  The famous one for me was, ‘I rode a bike all the time when I was a kid, and I never got a head injury.’  I’d say, ‘When was that?  Where was that?’  And it would be some idyllic little community in some other state, and I’d say, ‘Try riding a bike in Tampa now, and get back to me on that.  The world has changed.  The roads have changed.  The danger level has changed.”

Clearly, the law’s chief proponent had taken on a daunting task, but being part of the state’s first college of public health had its rewards.  Dr. Charles Mahan, state health director under Gov. Lawton Chiles, was a valuable ally.  COPH was still the only school of public health in Florida, and COPH professors were trekking all the way to Tallahassee to teach weekly classes at the state health department office.  Through the department’s close working relationship with COPH, Mahan already had known Liller and had been supportive of her efforts.

Dr. Charles Mahan

“We knew that Karen was really focused on getting a child helmet law through, and certainly, we were very much in favor of that,” said Mahan, who was COPH dean by the time the measure was in its third incarnation.  Mahan had known Chiles since well before the latter began his two terms as governor.

When Mahan was a medical student at the University of Florida, Chiles became interested in his work on infant mortality.  Personal and professional bonds soon followed.

“When he was a senator, I would go around the country and hold hearings with him,” Mahan recalled.  “He would do all the talking, but I would help him figure out what to say, depending on what the issue was.”

Mahan knew the governor well enough to know he was predisposed to children’s health issues.

“Any issue related to children was something that Gov. and Mrs. Chiles were supportive of,” Mahan said.  “Anything that needed his support on children’s issues for safety or survival or whatever, he would tell the staff – me and everyone else – to make sure that it got supported.” With the encouragement of a popular governor, the proposal was gaining momentum.  The awareness raised by the news of the pending legislation helped engender educational outreaches that helped the ball roll faster.

“Betty Castor, who became president of USF, was head of education at the time,” Mahan said, “and the school systems jumped right in with educational efforts.”

Those collective efforts eventually generated the irresistible momentum that carried the measure over the finish line.

“With Charlie’s support and the governor’s, on the third attempt, it was successful,” Liller said.  “And I testified and did a variety of things locally, as well, for the bill.  A colleague of mine also did a cost-effectiveness study, and he also testified with that in Tallahassee.  I think it was a combination of all of these things.  We kept sending the legislators our research findings, and with all the backing, eventually, in 1996, the bill passed.”

A victory not etched in stone

“Bike helmets are an investment we should make to ensure our children’s health and safety,” Chiles declared as he signed the bill onto law.

The measure became effective on Jan. 1, 1997, and for the next 12 months, it was easy for anyone to live with.  A violator would receive a warning and a bicycle safety brochure.  As of Jan. 1, 1998, however, that brochure was delivered with a $17 citation.  It was a light fine as fines go, and even it could be circumvented.

“After the first year, you could get a fine if the child was riding, was under the age of 16 and didn’t have a helmet on,” Liller said, “but you could get around that if you could show evidence of a bicycle helmet.”

That, of course, was only when the law was enforced, which, according to Liller, wasn’t – and still isn’t – very often.

“Police are very reluctant,” she said.  “I talk to them about how many tickets they’ve given, and usually the answer is ‘none,’ at least in Hillsborough County.  They’re very reluctant to stop a child on a bike.”

Nonetheless, she said, by 1998, helmet use had risen exponentially, to 67 percent in Hillsborough County.  So even without much enforcement, the law was accomplishing its purpose.

“I think the law has been great,” Liller said.  “We did an analysis of its efficacy.  We did show that helmet use has gone up, and we showed that injuries have gone down.  And that was great.  That was the intent of the law.  Injury prevention does its best, many times, when there’s a policy change or a legislative change, because it just reaches more people.”

Mahan agreed. “Having it as law is a big awareness raiser,” he said.  “It gets all over the papers and the news again and again.  The legislature is considering this measure.  That’s news.  The legislature passed it today.  That’s news.  The governor signed it into law.  That’s news again.  It went into effect today, so that’s news, too.

“For the majority of parents, who care so much about their kids, just the awareness-raising and then seeing other kids out there with their helmets on helped, but it took time.  As with any legislation, it takes about three years to get a good idea through.  It’s very hard to take a new idea on regulation to the legislature.”

“It was a very exciting time,” Liller said, “because, the first couple of times, I would go to the injury meetings, we’d work on the language of the law, and it just kept getting defeated.  The first year we did it, I think we just put it out there and said, ‘Let’s just see how it goes.’  The second year, we didn’t have the information about the penalty.  I still don’t like the penalty.  I don’t to this day.  But it was a really exciting process, and I’m so glad I was part of it.”

Still, Liller knows that no law is etched in stone.  The state threw a scare into helmet proponents and safety advocates in general when it partially repealed its motorcycle helmet law by limiting the requirement to riders under 21. “We were very afraid that they were going to repeal the bicycle helmet law, too, but so far, so good,” Liller said.  “They haven’t touched that law.  I think that’s because it’s for children.  I think if we would have had that helmet law for all ages, we would have been in trouble.”

“When I was at the state health office,” Mahan said, “the helmet law was a big plus, but at the same time, we lost the motorcycle helmet law, and that’s had tremendous consequences.”

The work continues

“We want it to become a norm,” Liller said of bicycle helmet use.  “We want it to be that, when these children have children, there won’t be any question when you get on a bike.  And we’re starting to see that.”

Mahan concurred.  He said he and his wife live two blocks from an elementary school, and the progress is easily visible.

“A lot of the kids are riding their bikes to school,” he said, “and every one of them has a helmet on.”

Work since the law’s passage has been geared toward bicycle helmet give-away programs.

“If you don’t have a helmet, we can find you one,” Liller said.  “We can find a program – Safe Kids, Tampa General, we can find somewhere to get you a helmet.”

Liller’s work on the law continues to influence safety initiatives.

“Our work has been in world publications about helmet use, about laws, about how it’s done,” she said.  “The Robert Wood Johnson Foundation wants to know about strategies, and it seems that the strategies that were developed in the ’90s – people are still really interested in those.  We were always pleased that our work is often cited as an example, even though many years have passed.”

Liller said she also is gratified to see the lasting validation of her and her colleagues’ methodology.

“It’s interesting that the work that we did is still being used.  If you run a program, you do some observational surveys.  You look at that helmet use on those kids.  You don’t just ask them.  You actually watch them.”

In the intervening years, Liller’s focus has shifted to high school sports injuries, but she remains committed to the legislation she helped to bring about, and she remains engaged with it, most recently as a content reviewer for the Robert Wood Johnson Foundation and the Wisconsin Population Health Institute for strategies they want to propose for child safety seats – and yes, bicycle helmets. Her message for the naysayers remains the same.

“We’re not telling children they can’t ride bikes,” she said.  “We’re not telling children they can’t have fun or anything else we were accused of so often.  Basically, it’s just taking necessary precautions.  There’s been some literature that says we should let kids take more risks.  We don’t want to stop anyone from taking risks or having fun or getting exercise.  We just don’t want a child to die from a perfectly preventable head injury.  We’re smarter now.”

Story by David Brothers, College of Public Health.  Photos courtesy of the National Highway Traffic Safety Association, Helmets On Heads, County Mayo and other sources.

The post COPH helped drive state’s bicycle helmet law appeared first on College of Public Health News.

First published on July 13, 2015 in observance of the COPH’s 30^th anniversary celebration.

Jodi Ray is a bundle of energy when she talks about the project that has become her life’s work, Florida Covering Kids and Families, which is a part of the Lawton and Rhea Chiles Center for Healthy Mothers and Babies.

The founding program director was Mary Figg, a state representative for Hillsborough County.  After a year or two of preliminary maneuvers, the initiative began formally in 1999.  Figg had enlisted Ray, who has a master’s degree in mass communications, the year before to be program coordinator and handle all things media, including assisting her with crafting the successful request for that all-important initial grant.

“My job was to manage a multimedia campaign.  I’ve done a lot of mass communications on this job,” she said.  “In fact, I’d say I do more of that than anything else.”

The project was funded its first seven years by the Robert Wood Johnson Foundation to do outreach enrollment of children eligible for the Children’s Health Insurance Program and Medicaid.  During that time, a staff of two more than doubled to five by 2006, then, when that funding ended, was cut all too literally in half, reduced to a project director, a coordinator and a half-time assistant: essentially, a staff of 2-1/2.  Fortunately, they had a dedicated network behind them.

Jodi Ray

“We have a state coalition,” Ray said, “a large collaboration of partners from around the state and local coalitions in almost every community in the state.  We came together and said, ‘Our mission is to get uninsured into coverage.’”

The coalition was initially mandated by the RWJF grant, Ray said.  It remains active today and includes some of its original members.  No question, it answered a critical need in 2006, when half the staff was asked to keep up with an exponential work-load increase created three years earlier.

Crying on the phone

“In 2003,” she explained, “the state ended all outreach efforts for CHIP.  So they literally boxed everything up and sent it to me.  They gave me their contact lists and all of their partnerships and said, ‘Could you please take this on?’  Now granted, there were no financial resources with that at the time.”

“The state also closed enrollment for CHIP in Florida for 18 months.  As a result of that, we lost over 300,000 kids in the Florida KidCare program.  In one month alone, we lost 40,000 kids.

“There was no statewide outreach initiative except us,” she said, “me and my other 1-1/2 people.  The number of calls I got was unbelievable.  People were calling and crying.  It was terrible.”

That situation started Ray on an 18-month crusade, talking to newspaper editorial boards, legislators, community leaders, almost anyone who would listen.

Committed to moving forward, she and the coalition began implementing a plan that was as innovative as it was aggressive:  Sign up as many kids as possible to a waiting list.  When the list reached 120,000, the New York Times took notice and gave the state a boatload of blistering press.  Not long after, the governor issued an executive order to enroll all the kids on the list, and open enrollment returned permanently four months later.

In 2007, a new governor, Charlie Crist, declared the uninsured rate among children appalling.  He brought the state agencies together, Ray said, and told them to figure out how to make it better, and fast.

“One of the things they did was decide to give us some resources,” Ray said.

A state contract and marketing materials soon followed, along with help from state agency staffs on routine but time-consuming matters like mailing.  Growth was back, and with it, ramped-up after-school activities and more engagement with local businesses.

The results since have ranged from impressive to remarkable.  Since the first open enrollment period began on Oct. 1, 2013, the project has gained national media coverage for enrolling about 2.5 million previously uninsured Floridians, twice the expectation.

“We expanded to focus on all the newly eligible uninsured to help them get into whatever coverage options are available,” Ray said, “whether under the Affordable Care Act in the marketplace or Medicaid or CHIP.  One way or another, we were going to help people who didn’t have coverage get health insurance so they could get access to health care services.

“Health care services are important, and having preventive care, all those things.  We talk about all those things being necessary, but you’re not getting in the door unless you have health insurance.  So that’s what we focus on: the first step, getting people in the door.”

That may be the focus, but there’s plenty more to do.

“We also do one-on-one application,” she said.  “We have consumers that actually sit down with us and do enrollment.  We do everything that involves connecting people to health coverage.

“We even do some health literacy.  How do you use health insurance?  How do you make an appointment to see a doctor?  For many of the uninsured, these are not obvious.”

“We work with all the agencies on both the state and federal levels that are involved in implementing health coverage, and we get out there and shake the bushes.”

Media and more

As much effort as is spent on finding the uninsured, many do find FCKF first, Ray said.

“We get cold calls for everything,” she said.  “I used to wonder sometimes how people find us, but I don’t wonder that anymore.  All you have to do is help somebody.  Then that person gives your number to somebody else.  We get a lot of calls by word of mouth.  We helped someone at some point, and even years later, we get a call from that person’s family member or friend who needs help.”

“The things that consumers come in here and tell you are unbelievable, sometimes heartbreaking.  That’s the other thing that’s really tough,” she said.  “I’ve gotten calls that have made me literally get up and walk around the building a few times because the stories are terrible: the family living in a car; the kid who’s got some kind of horrible heart condition; the mother who had CHIP coverage, but something went wrong with her renewal, it got dropped, it’s Christmastime and she has no money because the asthma medication she had to pick up for her son cost $400.”

While grants provide the funding, the University of South Florida and College of Public Health make it work, Ray said.

“Our work has been very well supported by both the College of Public Health and the University.  I say this out loud every day:  I don’t think anybody doing this work could be in a better place.  I don’t think there’s any way Dr. Petersen could support our work any more than she does.  We get so much support from one end of this university to the other, and we worked with everybody through open enrollment.”

Student Health Services, the libraries, the Morsani College of Medicine and the Marshall Center were regular haunts, as were the St. Petersburg and Sarasota-Manatee campuses.

From the beginning, Ray, who became director upon Figg’s retirement in 2003, has been the media go-to person from the beginning, and that responsibility has grown as exponentially as the project itself.

“We do four press conferences a year.  I spend a ridiculous amount of time talking to reporters.  Just in the first open enrollment period alone, I probably did 80 or 90 interviews with reporters from one end of the country to the other.”

The result was major articles in The New Yorker, the New York Times and the Los Angeles Times, to name a few, as well as pieces widely disseminated by the Associated Press and Reuters, as well as personal visits from two national health secretaries.

Ray on Capitol Hill in a nationally televised discussion.

“During the first open enrollment period, we had the second-largest grant in the country,” Ray said.  “That, in itself, drew attention, and [U.S. Health and Human Services Secretary Kathleen Sebelius] came here, herself, and awarded the grant.  She came to the college, and that’s how I found out we’d gotten the grant.”

It’s little wonder, then, that what began with two people 17 years ago keeps a dozen in the USF office busy with training, policy work, education, outreach, grant-writing, communications, etc.  It’s an office full of multi-taskers, Ray said.

“We all do all of it,” she said.

Given the complexities of health insurance laws and regulations, not to mention a new set of rules for navigators, just keeping up is a task unto itself.

“We do have to make it a point to stay informed.  We’re constantly on webinars and trainings, reading policies and reading new rules.  We have our hands in a lot of different elements of public health, just because we have to.”

The toughest part of the job, she said, is not being able to help everyone.

“We still have a gap of folks who are not going to qualify for coverage they can afford because the state has not expanded Medicaid coverage,” she said.  “I’d like to see us be able to enroll everyone who has no access to health coverage.  I’d like to see that in less than five years, quite frankly.  I would hate for that to be a five-year goal.”

Ray makes it obvious that what she and her colleagues do at Florida Covering Kids and Families is what keeps her pumped with energy.

“It’s all very exciting,” she said.  “We’re right there at the front end of this, and that, in and of itself, is exhilarating.  I feel good about what we’ve been able to accomplish, so it’s all been worth the time and effort – and the stress and the exhaustion – because it’s paid off.  We’re actually having an impact, and people see it.”

Every flight needs a navigator

The federal navigator initiative aimed at getting people into the new health insurance marketplace has been a major focus of their work the past two years, as well as a major hallmark of their success.

“The navigators are tied specifically to the federal marketplace.” Ray explained, “Some states are not participating in the federal marketplace, but Florida happens to be one of those states that is.”

The federal program provides outreach enrollment funds.  The first funding opportunities began in 2013, Ray said, and her office applied for USF to get an award that would cover the state.  She and her team did all the grant writing.

“We had already been doing this work on the ground across the state to enroll kids in CHIP and Medicaid,” Ray said, “and many of the partners around the state had come to a consensus that it made perfect sense for us to be the applicant for this grant and take the lead.  So, what we did was look at the model that was already working and find a way to expand on that.”

The result was a $4.2-million award in 2013 to cover 64 of the state’s 67 counties, the exceptions being Broward, Miami-Dade and Monroe, which submitted their own applications separately.

“The second year,” Ray said, “we went back to those partners again and asked them if they would like to join us for the 2014 application.  They said yes the second time around, so the second time around, we covered all 67 counties in Florida.”

The second award was worth $5.3-million.  Ray’s group had secured million-dollar grants for their Children’s Health Insurance Program enrollments, but those, which  had been their largest to date, are easily dwarfed by the Navigator grants.

Most of the funds are vested in the people who get the job done, Ray said.

“A lot of people.  I’m a big believer that priority number one should be the human resource.  The folks on the ground.  The folks who are out there doing the education, the communication, the one-on-one application assistants, the people who know the processes.  We know from our history of doing this and tons of research that these are the folks who keep people from getting lost along the way through the process.”

In one regard, Ray said, the Navigator’s work has only begun with the enrollment stage.

“They help people navigate the enrollment process and get to the point where they can be enrolled and covered, and they’re also key to helping people appropriately use health insurance,” she said.  “We want folks not just to get in, but we want them to keep their coverage and to use their coverage properly.

“When you’re connecting people to health care coverage for the first time, these are not innately understood concepts.  Insurance is actually a pretty complicated idea, and if you’ve never used it, you really can get overwhelmed.  If you have it and you’re not using it, then the tendency to understand its value can be diminished.  The Navigators and the Florida KidCare application assisters on the ground are essential for that piece of it.  It’s not just about filling out the forms.”

The numbers tell just how busy those people on the ground have been.

“The first year, the projected enrollment for the federal health insurance marketplaces in Florida was around 450,000, give or take,” Ray said.  “We ended up enrolling – with all partners across the state, not just the USF partners – almost a million.  We doubled the projections, basically.

“The second year, the last number I saw was about 1.6 million, but that didn’t include the last month, the limited special enrollment period for people who got hit with the tax penalties.”

As impressive as those figures are, their national rank may be more so, especially given California’s stand as by far the most populous state of the union.

“The first year, every month, we came in second in the country to California,” Ray said.  “This year, our enrollment here in Florida was higher than enrollment in any other state in the country.  It’s a pretty successful initiative in Florida.”

That seems understated, especially considering that it was the work of about 90 Navigators the first enrollment period and around 150 the second round.  Ray was quick to note, however, that Navigators weren’t the only people involved.

“There are more resources that go into managing this than just the enrollment folks,” she said.  “We have IT people involved, we have human resource people involved, we have grant administrators involved.  It’s an undertaking, for sure.  It’s all a team effort.”

A niche in the state’s public health

The stakes, along with the numbers, will be higher for the third round, since the funding will be for three years.  Ray is undaunted by the change and, in fact, favors it.  For one thing, it will provide greater continuity in enrollment services, she said.

“We won’t have the start-up delays that come with a grant ending,” she explained, “and then waiting for another grant to come in.”

Given the early success but also knowing the nature of the funding world, Ray is cautiously optimistic about future Navigator grants.

“We’re keeping our fingers crossed,” she said.  “I feel like we’ve done a good job.  I think our outcomes have been really high.  Our partners at the federal level seem very pleased with the work that we’re doing.

“Florida certainly has been a shining star all the way through this.  Not because I was optimistic, but because I believed we were doing the right thing and that we knew what we were doing, I’m not surprised.  Because we didn’t go into this making up a plan of action.  We went into it with a sense of how it can be done, what the best practices were.  We had learned our lessons along the way.  We didn’t have to reinvent the wheel to do this.  All our collaborative partners made a big difference, too.

“I feel pretty good going into years three through five.  It’s going to be harder going into these years, because we’ve enrolled so many of the low-hanging fruit, so we really have to hone in on who we’re missing and whatever we need to do to make sure we’re not leaving people behind.

“This is our niche for the state of Florida in public health.  Whether it’s obesity or diabetes or getting cancer screenings, it’s very difficult for people to do anything about those things we talk about in public health if they don’t have health insurance.  So, I think we’re doing something valuable in contributing that first step to addressing some of these important public health issues that are so important.”

Story by David Brothers, College of Public Health.  Graphics courtesy of Florida Covering Kids and Families, CSPAN and Jodi Ray.

The post Kids and Families, navigator grants hallmarks of college’s state and national presence appeared first on College of Public Health News.

First published on June 4, 2015 in observance of the COPH’s 30^th anniversary celebration.

It was January 1998, and the Florida Board of Regents had just promoted one of USF’s fledgling entities to major status with sublimely understated efficiency.

Following authorizations for a BS in dance education, a degree of undetermined level in occupational therapy and an MS in physical therapy, it was the last of four single-sentence items in the typically dry language of officialdom, replete with redundancy and excessive capitalization, on a State University System memo to Dr. Thomas Tighe, then USF provost: “Established the Type I Lawton and Rhea Chiles Center for Healthy Mothers and Babies as a Type I Center (sic).”

The rationale for the Center’s status elevation cited the state’s “tremendous progress in improving the health status of pregnant women and infants, largely through the leadership of Gov. and Mrs. Chiles and Charles Mahan,” who was then USF College of Public Health dean.  Marked improvement in the state’s infant mortality rate was among the leading factors, along with the Center’s performance the previous two years as a Type IV center.

Mahan had envisioned a research, program and policy institute for maternal and infant health as early as 1988, according to the Center’s official timeline.  The Center’s originally intended location was the University of Florida, Mahan said, but that was before the state had established its first college of public health at USF.  By the time the Center was created a few years later, USF, with the only COPH in the state, had become the obvious location, and Mahan had been named COPH dean.

Charles Mahan, MD, former USF College of Public Health dean

“Gov. and Mrs. Chiles had a lot of allegiance to the University of Florida, where they met and where he got his law degree,” Mahan said.  “I was state health officer on loan from the medical school at Florida, and I was supposed to go back there, and the Chiles Center was supposed to be there.”

But having served in the same administration, Mahan was friends with Betty Castor, who had been state secretary of education under Chiles and had since become president of USF.  Mahan said she called him and personally asked him to be the dean of COPH.  He accepted, and the first “steal” from the University of Florida only naturally led to the second.

USF was the better location for the Chiles Center, Castor told the governor, as it had the only college of public health and was headed by a dean who had served him as state health officer.  It also had a Healthy Beginnings program in place that arguably was already doing some of the work the Chiles Center would do.

Dr. Betty Castor, former USF president and Florida secretary of education.  To her left is her husband, former Florida state Rep. Samuel P. Bell III.

The Florida Healthy Start Program had been created by the legislature in 1991, under the urging of Chiles, and from its inception, had included a Healthy Beginnings Program at USF.  So when Mahan was appointed COPH dean in February 1995, he was at the right place at the right time to begin realization of his vision.  A year later, the Board of Regents established the Center, and Mahan served as its founding director in addition to his duties as COPH dean.

A $2-million federal grant followed in 1997 that was specifically aimed at reducing infant mortality in Hillsborough County.  In December of that year, a gala event at Busch Gardens honored the governor and his wife and formally launched the Center.  Additional state funding came in 1998 for construction of a building and a $600,000 annual operating budget.

Former Florida first lady Rhea Chiles (third from right) and her and the late governor’s daughter, also named Rhea (fourth from right), and son Ed (center) at the Chiles Center’s groundbreaking ceremony.

“President Castor invited Gov. and Mrs. Chiles down to USF, and we toured the campus and got them to put their names on the Chiles Center,” Mahan recalled.  “And then, Gov. Chiles was great about taking me to Washington and meeting all the senators who were his friends and raising money for the building.”

That journey for federal support brought home another $800,000 for the building.  The governor and first lady then spearheaded a series of fundraisers in Daytona Beach, Lakeland, Pensacola, Tallahassee and West Palm Beach.

“The Center was originally housed in office space near Tampa International Airport on Mariner Drive,” recalled Dr. Linda A. Detman, research associate for the Center.  “I believe that was from 1996 to 1998.  The Center’s first on-campus location was in FMHI, what is now labeled on maps as the College of Behavioral & Community Sciences building.  We also had a pair of temporary trailers for added office space between FMHI and the Westside Conference Center.”

Gov. Lawton Chiles (right) and daughter Rhea with Dr. Harold Varmus, then director of the National Institutes of Health, at the dedication of Lawton Chiles House (not related to the Chiles Center).

The Center’s impressive home since 2001 puts plenty of inspiration on display for visitors and staff alike:  A photo gallery of Gov. and Mrs. Chiles, including framed moments with presidents Clinton, Carter and Bush the first; a replica of the governor’s Tallahassee conference room for his use whenever he visited; even a bronzed pair of “Walkin’ Lawton’s” famous shoes.

After all, inspiration is what it’s all about.  Over the years, the Chiles Center’s health care initiatives have racked up impressive victories, to say the least.

“At the Chiles Center, Florida Covering Kids and Families and its collaborators across the state exceeded the federal goal for Florida in enrolling people for health care coverage in the federal health insurance marketplaces,” said Dr. William M. Sappenfield, Chiles Center director and Department of Community and Family Health chair and professor.  “During the first open enrollment, about 500,000 more individuals enrolled over the initial target and reached more than 1.6 million after the second enrollment period.  Moreover, because of the success of projects like this, Florida now enrolls more people through this important health insurance program than any other state.”

William M. Sappenfield, MD, MPH, director of the Chiles Center

Sappenfield also points to one of the Center’s most recent projects, the Florida Perinatal Quality Collaborative, which has radically reduced elective early deliveries (before 39 weeks of gestation).

“Babies electively delivered before 39 weeks are at higher risk of poor outcomes, including respiratory troubles and difficulties feeding, and are at higher risk of learning, behavioral and school-related problems in childhood,” explained Detman, who oversees the project.

“It continues to make a measurable difference in the quality of health care that mothers and babies are receiving,” Sappenfield said, “through improving newborn health care at birth and reducing death and morbidity to obstetric hemorrhage.”

Another recent Chiles Center project is the Obstetric Hemorrhage Initiative begun in October 2013 with 31 Florida and four North Carolina hospitals.  The participating Florida hospitals represent more than one-forth of the state’s delivery hospitals and nearly two-thirds of all births statewide, Detman said, adding that maternal deaths from postpartum hemorrhage are the leading cause of maternal mortality in the state.

Linda Detman, PhD, program manager for the Chiles Center’s Florida Perinatal Quality Collaborative

“We are fortunate to have the enthusiasm and dedication of perinatal professionals across the state who want to be engaged in improving outcomes for mothers and infants, and we plan to grow in the number of hospitals actively engaged in one or more of our projects,” she said.

Though funding issues put an end to the Center’s branch office in Tallahassee years ago, the original main office – now an imposing office building – on the USF Tampa campus continues to thrive and achieve.

“As was initially dreamed, the Chiles Center continues to improve the health and health care of women, children and families in Florida,” Sappenfield said.  “We will continue to build upon and expand these successful collaborations to succeed in our mission of improving their health and health care.”

Gov. Chiles visits COPH and its dean, Dr. Charles Mahan, in 1995.

“We worked with Gov. and Mrs. Chiles for many years to devise and implement programs and ideas to improve the pregnancy outcomes for women and babies,” Mahan said.  “The LRCC is designed to carry out these efforts and continue to design and improve new ones for future generations.”

Story by David Brothers, College of Public Health.

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The USF College of Public Health is saying farewell to one of its esteemed faculty members, Dr. William Sappenfield, a USF Distinguished Professor and director of the Florida Perinatal Quality Collaborative (FPQC) and the Chiles Center, both housed within the college and dedicated to cutting-edge research and education promoting the health and well-being of women, children and families.

Sappenfield, a pediatrician and epidemiologist who focuses on maternal and child health, retires after serving the college for 12 years. “That’s the longest I’ve been anywhere in my career,” he noted.

Sappenfield says what he’ll miss most about his time at the COPH is the people—the students, faculty, staff and leaders. “I have had the chance to work with outstanding people,” he noted.

And they will undoubtedly miss him as well.

“It was both an honor and a privilege to work with Bill,” said Bobbi Rose, an alum of the college who also served as conference coordinator for USF Health. “He is, WITHOUT FAIL, supportive, super smart, available, ethical and caring—for his colleagues, staff, students and the community at large. We need more Bill Sappenfields in this world!”

Amy Phillips, doctoral student and alum of the college, echoes those sentiments.

“As a new master’s student in 2013, I remember meeting one-on-one with Dr. Sappenfield and he insisted I call him Bill—never Dr. Sappenfield (to this day, I still don’t know that I ever have, lol),” Phillips, currently a COPH doctoral student, recalled. “He also shared his journey to leadership with my Maternal and Child Health Leadership Scholar cohort. I am grateful for the opportunity to know and learn from him!”

Natalie Preston, director of the college’s Office of Engagement and Constituent Relations, also values the knowledge she gleaned from Sappenfield.

“I appreciate that Bill always made me feel like we were equals,” Preston said. “He was very approachable and personal. My son was quite sickly as a toddler and elementary school kid. I reached out to Bill on many occasions for his medical insight as a pediatrician. He always received me warmly and explained options in a manner that was easily understood by a non-medical professional. His demeanor is as warm and bright as his smile! Without question, I will miss him. Hopefully his best life is coming in retirement!”

Sappenfield said some of the highlights of his time at the college have been becoming a faculty member, impacting lives and careers via teaching and mentoring, leading, promoting and revitalizing the Chiles Center and fully developing the FPQC, a group that significantly impacts the health and health care of mothers and infants in Florida.

What’s next for Sappenfield as he heads off into retirement?

“Deciding what I want to do when I grow up,” he said. “That’s going to take me some time to figure out! The college has paid me to do what I so much enjoy doing.”

Here, a pictorial look back at Sappenfield’s 12 years with the college:

Story by Donna Campisano, USF College of Public Health

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Dr. Russell Kirby, a USF Distinguished Professor and perinatal epidemiology expert at the USF College of Public Health, has been honored with a mentoring award that bears his name.

Kirby became the first-ever recipient of the Russell S. Kirby Mentoring Award, presented by the National Birth Defects Prevention Network (NBDPN).

“The award,” says the NBDPN, an international group of individuals dedicated to birth defects surveillance, research and prevention, “is given to an individual who has demonstrated an outstanding commitment to mentoring, advising and building supportive environments for colleagues in the field of birth defects surveillance, research and prevention.”

The NBDPN said it presented the award in Kirby’s honor for his years of supporting the growth of birth defects programs, as well as for mentoring students, staff and other professionals.

“I was very honored to receive the award, which I did not expect,” Kirby said. “I knew that the new award was being created and would be named in my honor, but I did not anticipate I would be its first recipient.”

Kirby estimated he’s mentored “hundreds” of students and professionals on birth defects—their prevalence and prevention—over the years.

“While at USF, in addition to approximately 20 maternal and child health concentration students each year, I have sat on 36 dissertation and thesis committees, serving as major/co-major professor for 21 students,” Kirby noted. “I have also mentored numerous faculty members at USF and other universities around the country, and I have worked with program staff at birth defects surveillance programs in many states. I helped establish programs in Rhode Island, Delaware, Minnesota and Oregon, and I worked closely on projects with colleagues in Colorado, Texas, Michigan and New York. This has been in addition to my leadership for the Birth Defects Surveillance Program at USF.”

Kirby said he feels an obligation to his peers and his profession to act as a mentor to those interested in the study of birth defects.

“Mentoring is what it’s all about,” he said. “Just as others supported me in my education and early career, I feel I owe it to pay it back. Mentoring is very rewarding and generates lifelong connections and friendships that transcend our daily work.”

Story by Donna Campisano, USF College of Public Health

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The Florida Perinatal Quality Collaborative (FPQC), housed within USF’s College of Public Health (COPH), has one mission: to give Florida’s mothers, infants and families the best health outcomes possible via perinatal care that’s respectful, equitable, high quality and evidence based.

The FPQC partners with perinatal-related organizations, individuals, health professionals, advocates, policymakers, hospitals and payers (FPQC stakeholders) from around the state. The collaborative aims to develop health care quality improvement initiatives and data-driven best practices that ultimately promote the health and health care of mothers, infants and families.

A collaborative takes off

The FPQC was born in 2010.

“The need to focus on maternal and infant quality improvement issues was identified as a major issue in Florida when I worked for the Florida Department of Health (FDOH) as the state maternal and child health epidemiologist,” explained Dr. William Sappenfield, the FPQC’s current executive director. “As part of the multi-state envisioning and implementation process, we had to put together our Florida leadership team. I recruited Dr. John Curran [a now-retired neonatologist and former associate vice president for USF Health] to lead the Florida group of state partners.  As a group, we quickly recognized the need to create the Florida Perinatal Quality Collaborative, and the FPQC was established at the USF Chiles Center in 2010.”

The Chiles Center, also part of the COPH, is a multidisciplinary, community-engaged collective that promotes optimal health and health care for mothers and babies around the time of birth.

Curran was named the founding director while Sappenfield lent a supportive leadership role from his position with the FDOH. Upon arrival at USF as a COPH professor, Sappenfield became co-director. When Curran retired in 2017, Sappenfield took over at the helm of the FPQC.

“It takes more than a leader, it takes a team”

Over the last 13 years, the FPQC has developed a number of initiatives, resources and training modules to help ensure moms and their babies have the best shot at a healthy life. Some of them include:

• Postpartum Access & Continuity of Care (PACC) Initiative. Noting that as many as 40 percent of moms do not see a health care provider for postpartum care, the PACC Initiative works with women, health care providers and hospitals to provide a continuum of after-delivery care to prevent pregnancy-related deaths.

• PAIRED. This initiative works to better how families with babies in the neonatal intensive care unit (NICU) engage and communicate with staff about the care of their infant.

• Levels of Maternal Care. This program is designed to promote Florida maternity hospitals’ participation in a verification program that aims to ensure mothers are cared for at hospitals that have the expertise, equipment and resources to appropriately treat their maternal needs, thereby reducing maternal morbidity and mortality.

“The FPQC has created a strong collaborative organization that works with all major state agencies and organizations,” Sappenfield noted. “Other organizations and individuals want to work with us because of our success. In 13 years, the FPQC has gone from working with six hospitals to all 105 Florida maternity hospitals. It takes more than a leader,” he added, “it takes a great team to do this quality of work, and the FPQC has been blessed with a highly capable one. Moreover, the FPQC has provided a great learning experience for many students as graduate assistants and volunteers who have helped develop data measures, reporting systems and quality initiatives, conduct surveys, evaluate initiatives and more.”

What’s next?

While Sappenfield will be retiring later this year, the FPQC will continue to trailblaze on behalf of moms and their babies.

“It is the improvement in maternal and infant health outcomes that I am most proud of,” Sappenfield said. “The FPQC is well positioned, resourced, led and staffed to continue to make a measurable difference in the health and health care of moms and babies for years to come.”

Story by Donna Campisano, USF College of Public Health

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Faculty across several disciplines at USF Health earned National Institutes of Health funding to streamline prenatal, obstetric, pediatric, treatment, behavioral and community health care for patients with opioid use disorder.

Called CADENCE (Continuous and Data-Driven Care), the new program will better serve pregnant patients and new parents, as well as their infants, as they navigate the care they need for managing opioid dependence.

Co-principal investigators for the HD2A R61/R33 grant are Kimberly Fryer, MD, MSCR, assistant professor in the Department of Obstetrics and Gynecology in the USF Health Morsani College of Medicine, and Jennifer Marshall, PhD, CPH, associate professor in the USF Health College of Public Health, and fellow in the Lawton and Rhea Chiles Center.

The primary aim of the new program is to streamline the integration of four “clinics” – or areas that patients might typically access separately. By streamlining these disciplines, care and scheduling will be more coordinated and holistic, and health outcomes of the parent and baby could greatly improve.

The four USF Health clinics being streamlined include office based opioid treatment (OBOT), the maternal family medicine prenatal/obstetric clinic, the PEDI pediatrics clinic, and behavioral health/mental health service.

A “secret shopper” study led by Dr. Marshall a year ago found that only about 20 percent of over 1000 attempts for pregnant women with Medicaid experiencing opioid use disorder were able to set appointments for prenatal care, indicating that many providers may hesitate to take these patients because they do not have the capacity or know how to connect their patients to the addiction treatment critical to helping these patients succeed in caring for themselves and their babies.

By bringing the four primary disciplines together, patients will have access to integrated, continuous, care that will improve maternal engagement in recovery or treatment for maternal opioid use disorder at delivery, neonatal outcomes, and timely referral to early intervention.

The new CADENCE includes two components: a data stage that will create in the first two years an interactive data dashboard that tracks maternal, neonatal, and infant outcomes for pregnancies affected by opioid use disorder and pilot the CADENCE program within USF Health and Hillsborough County; and an implementation stage in the third, fourth and fifth years that will focus on measuring improvement in clinical outcomes at the program level using the data from the dashboard and assessing the implementation and costs of the CADENCE program.

This program of integrated, continuous, care will be rapidly refined using a data-driven approach towards improving maternal engagement in recovery or treatment for maternal opioid use disorder at delivery, neonatal outcomes, and timely referral to early intervention.

A long-term aim of the project is to develop a model that can be shared throughout Florida and at other academic medical programs to help pregnant women in their communities.

Reposted from USF Health Blog

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USF College of Public Health’s Dr. Heewon Gray, associate professor specializing in nutrition, and COPH PhD alumnae Drs. Acadia Buro and Whitney Fung Uy attended the Society of Nutrition Education and Behavior’s (SNEB) annual conference in Atlanta in July to share their research with a global group of attendees who came to learn more about current nutrition education and behavior research.  

Fung Uy was also awarded the 2022 SNEB Korean Society of Community Nutrition Student Award at the event, an award presented to SNEB members who have made “significant contributions to the field of community nutrition, especially for Korean Americans and/or minority populations within the U.S.”

The SNEB promotes “effective nutrition education and healthy behavior,” and the international conference draws worldwide professionals working at the “research, practice and policy nexus relational to nutrition and behavior change,” according to their website.

Buro and Fung Uy both earned their PhDs from the COPH in community and family health.

“The main theme of this year’s conference was ‘Re-engineering Nutrition Education and Behavior – Designing tech competence in your digital world.’ The goal/intention of the conference was to ‘discuss tech equity, technology and the food system, technology in the scholarship of teaching and learning, and integrating technology across the research spectrum.’ I enjoyed learning about many different studies using technology in nutrition education research,” Gray said.

Using social media to promote better nutritional choices 

Gray presented her research, “Social Media Nutrition Education Integrated With a Home Food Delivery Assistance for Low-income Pregnant Women: A Pilot Study,” published in the Journal of Nutrition Education and Behavior, which shared the feasibility of implementing a social media nutrition education intervention that integrated Facebook posts/interactions and home food delivery for pregnant women in underserved neighborhoods.

“The intervention was 6-weeks long and included weekly Facebook posts: a lesson video, goal-setting prompts, a cooking demonstration, healthy pregnancy and safe baby content, and a weekly survey,” Gray said. “Cooking ingredients were home-delivered every week by the local food bank. We conducted a mixed methods study using a series of questionnaires and semi-structured interviews.”

Gray said she worked alongside an interdisciplinary team including Dr. David Himmelgreen, professor and director of the Center for the Advancement of Food Security and Health Communities at the USF Department of Anthropology, and Dr. Deborah Austin from the community partner, REACHUP, Inc.

Feeding Tampa Bay, a local food bank, arranged and provided the food assistance component for the intervention.

“It was surprising that parents indicated that they really enjoyed cooking demonstrations in our intervention, and they wanted to have a longer intervention than 6 weeks,” Gray said. “Some participants expressed that they tried spinach and cucumber for the first time and enjoyed making dishes using new ingredients. Our results indicated that participants did more meal-planning practice, reduced intake of sweetened beverages and improved their perceived eating habits after the intervention.”

Gray said social media tools can be useful to remotely implement nutrition education interventions, especially for pregnant women in low-income neighborhoods.

“Nutrition education in pregnancy is important because poor diet quality during pregnancy is associated with adverse pregnancy outcomes, so healthy eating behaviors during pregnancy may improve health outcomes of both women and infants,” she said. “Using social media for the nutrition intervention was innovative, and our study indicated that it was feasible to implement nutrition education through social media, which was especially helpful during the COVID-19 pandemic. Learning from this project, we adapted the social media component for my current nutrition education intervention project.”

Supporting newcomers to food assistance

Fung Uy has been working in the nutrition, anti-hunger and food assistance area for almost 10 years now, and her work has grown into a balance involving research, practice and policy.

“I am extremely passionate about my research and feel confident that it can inform policymakers and also support community initiatives. Because of my research and work, I can be a better advocate for good food and a healthy life for all,” Fung Uy said.

She presented her research, “Experiences of New Visitors Seeking Emergency Food Assistance Due to the COVID-19 Pandemic,” which has also been published in the Journal of Nutrition Education and Behavior.

“Because emergency food assistance is critical in helping people become food secure, my study explored the aspects that food assistance impacted participants’ food availability, access, utilization and stability over time,” she said.

Fung Uy said the most interesting revelation of the research was hearing the participants’ experiences through the in-depth interviews, as they were seeking food assistance for the first time ever.

“Often, participants were embarrassed or uncomfortable seeking assistance, but after a few visits, they mostly felt welcomed by volunteers and staff and were grateful for the assistance,” she said. “In the study sample of 18 people, many were directly affected due to COVID, whether it was because of job or income loss, or sometimes it was fear of COVID-19 exposure and getting their family sick. As a result of financial struggles, they had to seek food assistance.”

She said participants reported often having foods they did not know how to use or did not prefer to eat.

“For example, they often received large amounts of eggplants or squash, or they received food in the pre-packed boxes that their family was allergic to. Some participants learned how to use what they got, but what was most surprising from this group was that they ended up giving those foods away and ‘made do’ with less food or found ways to buy what they needed,” she said.

This research was manuscript one of three of Fung Uy’s dissertation research, and she is in the process of submitting the remaining two. This is a topic area she said she hopes to continue focusing on to better support families that cannot afford sufficient food.

“Emergency food assistance through food banks and pantries is a critical piece of the safety net to support families who do not have enough food. People who are food insecure are more likely to have limited incomes, lower educational attainment and unaffordable housing. By working with and conducting research among the emergency food assistance system, we can provide recommendations on how to increase access to healthy food for people seeking food assistance,” she said.

SNEB Korean Society of Community Nutrition Student Award

Fung Uy earned recognition at the conference for her work as a student on the USF campus for the Campus Food Waste Recovery Project and as a community advocate for sustainable food systems.

“I have been a member of the Society of Nutrition Education and Behavior since 2013, so it is a humbling experience for me to receive the award from professionals in my field. As grateful as I am, the award is also another bonus for inspiring me to continue to be an advocate in my community,” she said.

She’s currently a post-doctoral fellow with The Gretchen Swanson Center for Nutrition (GSCN), a nonprofit research institute providing expertise in measurement and evaluation to help develop, enhance and expand programs focused on healthy eating and active living. The GSCN also works to improve food security and healthy food access and promote local food systems while applying a health equity lens.

“I am thrilled to learn from top researchers in my field as I continue my postdoc training with GSCN. I hope to continue learning and becoming a better leader to fight for a healthy, equitable and sustainable food system for our future,” she said.

Reducing ultra-processed food consumption in adolescents with autism

Buro shared findings from two analyses related to her dissertation on an intervention she developed for adolescents with autism spectrum disorder (ASD).

“The intervention, BALANCE, aims to improve long-term healthy eating habits in adolescents with ASD through eight weekly 45-minute, interactive group sessions,” she said.

The goal of the first analysis was to assess whether ultra-processed food (UPF) intake and diet quality in adolescents with ASD changed after the 8-week virtual nutrition education intervention, and findings indicated some improvements in UPF consumption and diet quality. Results varied based on participants’ baseline UPF consumption. This is a quantitative analysis of data collected from a pre-post intervention study with 22 adolescents with ASD ages 12-21 years.

Findings from the original study have been published in Autism andJournal of Nutrition Education and Behavior. 

“I also presented a qualitative analysis of data collected during the same study. The goal was to optimize a theoretical framework based on empirical data from the virtual nutrition education intervention study for adolescents with ASD,” Buro said.

Buro said the long-term goal of her research is more widespread implementation of lifestyle interventions to improve health and quality of life among vulnerable adolescent and young adult populations.

“It was surprising to see differences in diet quality and ultra-processed foods with such a small sample size. For the framework analysis, self-regulation, autonomy and family support emerged as factors important for improving healthy eating that were overlooked in the initial framework development,” she said.

Buro said the next step for this line of research is to seek funding to conduct a pilot randomized controlled trial of the BALANCE intervention to assess behavioral and metabolic outcomes. 

She’s currently a T32 Postdoctoral Fellow in the Department of Health Outcomes and Behavior at Moffitt Cancer Center focusing on developing a new independent line of research to adapt and pilot a lifestyle intervention for young adult cancer survivors. 

“My next goal is to obtain a faculty position and continue my research on behavioral interventions for vulnerable and under-resourced communities,” she said.

Abstract citations

To read more about the research noted above, reference the full citations below:

Buro, A.W. & Gray, H.L. (2022, July). O01 Optimizing a Theoretical Framework for Virtual Nutrition Education Programs for Adolescents with Autism Spectrum Disorder. [Abstract] Journal of Nutrition Education and Behavior, 54 (7), S1. Presented at the Society for Nutrition Education and Behavior conference.

Buro, A.W. & Gray, H.L. (2022, July). P073 Diet Quality and Ultra-processed Food Consumption Before and After a Virtual Nutrition Intervention for Adolescents with ASD. [Abstract] Journal of Nutrition Education and Behavior, 54 (7), S52. Presented at the Society for Nutrition Education and Behavior conference.

Fung Uy, W., Lillpopp, R.A., Martinez Tyson, D., Himmelgreen, D., Wright, L., & Gray, H.L. (2022, July). P058 Experiences of New Visitors Seeking Emergency Food Assistance Due to the COVID-19 Pandemic. [Abstract] Journal of Nutrition Education and Behavior, 54 (7), S45-S46. Presented at the Society for Nutrition Education and Behavior conference.

Gray, H.L., Gwaltney, K., Darnal, S., Jones, K., Hayes, N., Graham, M., Tapales, R., Crocker, T., & Himmelgreen, D. (2022, July). O02 Social Media Nutrition Education Integrated With a Home Food Delivery Assistance for Low-income Pregnant Women: A Pilot Study. [Abstract] Journal of Nutrition Education and Behavior, 54 (7), S1-S2. Presented at the Society for Nutrition Education and Behavior conference.

Story by Anna Mayor, USF College of Public Health

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USF College of Public Health’s (COPH) Dr. William Sappenfield, director of the USF Chiles Center, was recently named a USF Distinguished University Professor.

The Distinguished University Professor award recognizes senior faculty members who have distinguished themselves among their peers both within and outside USF. The title is awarded through a process of nomination and external peer review. Those who hold the award are identified as outstanding members of their profession.

Becoming part of this elite group of professors means Sappenfield’s responsibilities will include serving in an advisory group for the provost and president of USF, providing counsel on issues affecting the overall academic and scholarly activities of the university and giving a university-wide address during the academic year.

“I am absolutely thrilled to share with you that Dr. Bill Sappenfield has just been named a Distinguished University Professor!” said COPH Dean Donna Petersen. “These honors are highly coveted and highly competitive. Many are nominated, with only a few selected. The selection process is an arduous one involving an intensive internal and external review of the candidate’s credentials.”

After a 22-year career as a Centers for Disease Control and Prevention (CDC) epidemiologist, Sappenfield came to Florida in 2005 to serve as the Florida Department of Health’s (DOH) state maternal and child health (MCH) epidemiologist and unit director for the MCH practice and analysis unit leading research, epidemiology, evaluation and health data efforts to guide policies and programs for Florida mothers and children.

At the DOH, he joined the pregnancy-associated mortality review team, bringing his epidemiological expertise to the table and leading deeper analyses of the mortality data. He led the development of perinatal periods of risk profiles for each county and each Healthy Start coalition area in the state, giving local MCH advocates understandable data to guide policy development. He also led efforts to monitor and study Florida’s high maternal and infant mortality rates.

Sappenfield then joined the faculty at the COPH in 2011, teaching maternal and child health, epidemiology and public health practice.

“From Dean Petersen, to the faculty, staff and students, I chose the COPH because public health is our passion and translation of research into practice is valued,” Sappenfield said. “Collaborating with others is a key component of the COPH’s DNA.”

Publishing extensively on maternal and infant mortality, morbidity and related health issues, he has also focused on mentoring and teaching young professionals to serve as MCH epidemiologists in governmental public health agencies at a local, state and national level. He also trains  multidisciplinary teams of public health practitioners and community members to effectively use data to improve maternal and child health.

Sappenfield was also instrumental in developing the Florida Perinatal Quality Collaborative (FPQC) in 2011, serving first as a co-director with Dr. John Curran, and the director since 2016. 

As director of the FPQC, Sappenfield champions its mission to advance health care quality and patient safety for all of Florida’s mothers and babies through collective quality improvement efforts with state and hospital partners.  

One of Sappenfield’s most rewarding experiences at the COPH was the FPQC earning the Sapphire Award.

“The FPQC as an organization receiving the Sapphire Award recognizing leadership, excellence and innovation in nonprofit community health leadership and programming improving maternal and infant health in Florida,” Sappenfield said.

Sappenfield’s current research projects include maternal and infant mortality, chronic diseases during pregnancy, assistive reproductive technology, unintended pregnancy and contraceptive use, non-medically indicated deliveries prior to 39 weeks, population-based perinatal quality improvement efforts, access to childhood preventive dental care and use of data file linkages in maternal and child health.

“A recognition like this from your peers is always very special. It recognizes you and the value of the work that you do with others,” Sappenfield said. “You can only be effective in public health through working collaboratively with others.”

Sappenfield said that he will continue to strive to improve the health of Florida’s mothers and infants.

“This is not only a personal achievement for Dr. Sappenfield but an honor we can all share in as it contributes to the growing positive reputation of the COPH and ultimately in the larger community,” Petersen said. “We also know that none of us succeeds on our own—it takes teams of dedicated colleagues and the commitment of our highly skilled staff to complement and amplify the perseverance of a senior scholar devoted to his passion to make the world a better place, in this case, for women and children.”

Story by Caitlin Keough, USF College of Public Health

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Dr. William Sappenfield, FPQC Director, opened the meetings with a special thank you for hospital teams’ efforts during these challenging times of COVID-19 pandemic and continued staffing issues. He recognized how hospitals remained engaged with FPQC as they learned how to work through several surges of the pandemic and gave one “final push” for PROVIDE and MORE. Dr. Estefania Rubio, FPQC Data Manager, presented overwhelmingly positive outcome data, sharing progress made in many areas. PROVIDE successes included improved completion of induction and pre-cesarean checklists, and improved staff education on pain management, labor support, latent labor management, labor progress, and active labor management. MORE successes included improved rates of Hepatitis C screening; as well as improved screening for other infectious disease/mental health comorbidities, education on Narcan use, and referrals to a postpartum visit. For both initiatives, Dr. Rubio also encouraged the ongoing work of sustaining and even improving on initiative gains, as well as continuing to give attention to areas where teams may have struggled.

Kelly Rogers from the Florida Department of Health was a featured guest during the PROVIDE webinar. She thanked the teams and encouraged a continued focus to meet the Healthy People 2030 goal of 23.6% for NTSV cesareans. Dr. Chris Cogle, Florida Medicaid Chief Medical Officer, was a featured guest during the MORE event and thanked the teams for their efforts to better support mothers with substance use disorder/opioid use disorder (SUD/OUD).  

Dr. Maya Balakrishnan, FPQC Associate Director of Quality, summarized the importance of sustainability with quality improvement initiatives. She emphasized as initiatives end, progress can backslide. However, improvement can be sustained through standardization of tasks, accountability, visual management (seeing the data), problem solving, and escalation of concerns. Hospital teams learned they can tailor their strategies depending on their goals and desired improvements.

Drs. Karen Bruder and Julie DeCesare, PROVIDE Physician Leads, stressed key sustainability components including labor support, pre-cesarean huddles with a checklist, and using the “What Can Florida Do to have California’s Rates?” checklist. Dr. Jan Lanouette, MORE Physician Lead, emphasized the importance of screening for SUD/OUD, referring to treatment and continuing to work on Naloxone (NARCAN) distribution for all women with diagnosed SUD/OUD discharged from the hospital.

At the MORE event, FPQC was honored to hear from Helena Girouard, who is in recovery and is now a community liaison for women affected by OUD/SUD. Her personal story is an inspiration for all clinicians working to help affected women and families. Afterward, Jennifer Williams from the Department of Children and Families discussed how hospitals can provide Naloxone kits at discharge for women with SUD.

PROVIDE Nurse/Physician dyads also reported on their hospital groups: Nancy Travis and Chadwick Leo, Kim Huber and Cole Greves, Jane James and Karen Harris, Carol Lawrence and Julie DeCesare, and Leah Williams-Jones and Karen Bruder. Summaries of each team’s successes and plans for sustainability were shared. MORE nurse/physician coaches reported on the progress of their hospital groups: Jan Lanouette and Lindsay Greenfield, Pam Carbiener, Tracy Blue, and Amanda Snyder all gave summaries of each group’s successes and plans for sustainability.

A highlight at each celebration was the “Star Hospital Awards.” Hospitals that met criteria on participation on coaching calls, data submission, improvement on structure measures, and improved outcome measures were recognized. Each hospital received a certificate from FPQC listing their stars.

Dr. Sappenfield thanked all the hospitals again for their commitment to improving health care quality and working with FPQC. He especially thanked them for making a difference for all mothers, babies, and families across the state of Florida.

More information about PROVIDE and MORE is available at http://www.fpqc.org

Hospital teams should stay tuned for FPQC’s next maternal health QI Initiatives set to launch in October and March: 1) Postpartum Access and Continuity of Care (PACC). PACC is in development with hospital leaders, federally qualified health centers, inpatient and outpatient clinicians, community members, birth workers, and other perinatal health advocates from across Florida, and 2) a new focus on social determinants of health.

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