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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Last spring, the USF College of Public Health debuted a new hands-on course called “Community Application of Public Health Science” (CAPHS). It was developed for MPH students with the aim of giving them real-world experience in public health program evaluation.

COPH professors Drs. William Sappenfield and Jennifer Marshall designed and led the course.

“One of the comments we kept hearing from the community partners who hire our graduates was that while they had the tools and knew the steps, they didn’t know how to complete a project from start to finish,” said Sappenfield. “We wanted to develop a course that would allow students to work with community groups on a project and produce something that was of benefit to the actual people they’re working with.”

Sappenfield and Marshall teamed with St. Joseph’s Children’s Wellness and Safety Center. The students could choose to evaluate one of three of the center’s programs:

• Family Access to the Mobile Medical Clinic

• Child Developmental Screening Program

• HPV Vaccination in the Mobile Medical Clinic

Most of the evaluation work, done according to Centers for Disease Control and Prevention (CDC) guidelines, was performed in the classroom, with St. Joseph’s participating in person or over the phone.

Some of the methods students used in their evaluations, said Marshall, included secondary data analysis and mapping; interviews with program partners, staff and participants; family surveys; and observational visits. Results were shared with staff and their community stakeholders via reports and presentations.

Samantha Scott, who received her MPH this summer with a concentration in maternal and child health, worked on the Child Developmental Screening Program. She and her team partnered with St. Joseph’s developmental specialist to provide the program leaders with an overview of the children they serve, their developmental screening results and the referral process for intervention services.

“I choose this course because I wanted to take what I learned in the classroom, apply it to a real-world setting and gain hands-on experience before graduating,” said Scott, who noted that the course gave her greater career confidence. “We didn’t just learn how to complete an evaluation. We produced a tangible report that was valuable to the community. This kind of skill set will help set me apart in the field.”

The course will be offered again in spring 2020, says Sappenfield.

“The feedback we got from the students was overwhelmingly positive,” he said. “They feel confident that they can take their work to the next level. And it’s a win for the college as well, as one of our initiatives is to get students more field experience.”

Story by Donna Campisano, USF College of Public Health

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The Florida Perinatal Quality Collaborative of the USF College of Public Health held its 2017 annual conference on April 27 and 28 in Tampa, Fla.

The sixth annual conference attracted more than 220 obstetricians, neonatologists, nurses, midwives, and public health and quality improvement stakeholders from across the state.

Perinatal health care professionals joined a statewide conversation on improving the quality of healthcare for mothers, infants, and families at this year’s event.

Lee Health Team receiving the John Curran Quality Improvement Award Ribbon. (Photo by Caitlin Keough)

Dr. John Curran, founding director of the FPQC, presented the FPQC’s first annual John Curran Quality Improvement Award.

This award recognizes a Florida hospital that has made a measurable and sustained positive change in a major perinatal quality improvement issue through the implementation of quality improvement activities within the previous three years.

This year’s winner was Lee Health for their project “Decreasing Maternal Morbidity in a Multi-Hospital System.”

Lee Health received a ribbon and will be recognized at a celebration at their health system hospitals. The University of Florida Jacksonville received an honorable mention for their project “Successful Reduction of Moderate-Severe Intraventricular Hemorrhage (IVH) Using an IVH Bundle: A Quality Improvement Project.”

Heather Barrow of High Risk Hope shared the story of her hospital stay on bed rest and in the neonatal intensive care unit, pointing out key interactions with hospital staff and highlighting how care providers can better interact and empower patients during and after their hospital stay.

“[Providers can be a] match in the darkness, for patients rather than a fire extinguisher,” Barrow said.

Attendees also enjoyed the addition of the parent perspective on a panel to discuss challenges with the periviable infant, which also included an ethicist, an obstetrician, and a neonatologist.

Dr. Sonja Rasmussen of the Centers for Disease Control and Prevention and Dr. Carina Blackmore of the Florida Department of Health presented on the latest information regarding Zika.

Judette Louis and Jessica Brumley presented on Reduction of Peripartum Racial/Ethnic Discrimination (Photo courtesy of FPQC)

Paula Meier, director for clinical research and lactation in the neonatal intensive care unit at Rush University Medical Center in Chicago presented on mother’s milk for very low birth weight infants and the science on the limitations of donor human milk. She also presented best practices that optimize high-dose long exposure to mother’s own milk in the neonatal intensive care unit.

B.Z. Giese, director of the South Carolina Birth Outcomes Initiative, provided an overview of the improvements in infant mortality made through the initiative, as well as how to implement immediate postpartum long-acting reversible contraception (LARC) to improve birth outcomes.

Dr. Maren Batalden, associate chief quality officer at the Cambridge Health Alliance in Massachusetts, presented a conceptual model for co-production of care with patients and families, explaining the degree to which health outcomes related to quality and safety are inevitably co-produced and how engaging with patients can lead to better partnerships and outcomes.

Heather Murphy, CNM, demonstrating supporting vaginal birth skills. (Photo courtesy of FPQC)

William M. Sappenfield, director of the FPQC, presented the State of the Collaborative, bringing stakeholders and attendees up-to-date on statewide collaborative efforts to improve health care quality for mothers and infants. He also announced the upcoming FPQC initiatives: Access LARC, Promoting Primary Vaginal Deliveries (PROVIDE), and Neonatal Abstinence Syndrome (NAS). Recruitment for PROVIDE and Access LARC will launch in summer of 2017, and the NAS project in the summer of 2018.

Attendees also participated in a number of break-out sessions that provided the opportunity for sharing experiences, discussion, and exploration of new areas of perinatal quality improvement.

Small group session topics included: Racial and ethnic health disparities; Florida hospitals working on neonatal abstinence syndrome; supporting vaginal birth skills for nurses; antibiotic stewardship; the FPQC’s perinatal quality indicator system and new birth certificate accuracy pilot project; the FPQC’s mother’s own milk initiative panel of hospital participants; a panel of the FPQC’s hypertension in pregnancy initiative participants; and, a panel from Jacksonville’s pilot to increase access to immediate postpartum LARC.

Tampa General Hospital Team with their poster on Implementation of Intermittent Auscultation in Low Risk Laboring Women. (Photo courtesy of FPQC)

This year’s poster session, in which hospitals and organizations shared their obstetric and neonatal quality improvement initiatives and research, included awards for best poster.

The grand prize was a tie: “Lacto-Manufacturing: Establishing the Need for a NICU Milk Room and Milk Room Technicians” from a team at Winnie Palmer Hospital for Women and Babies; and “Implementation of Intermittent Auscultation for Low Risk Laboring Women” from a team at Tampa General Hospital.

An honorable mention was given to a team from the Florida Department of Health for their poster “Ten Years of Pregnancy-Related Deaths in Florida, 2006-2015.”

The FPQC has started planning for the 2018 conference, which will take place Thursday and Friday, April 19-20, 2018 in Tampa.

Conference attendees at the FPQC’s 2017 annual conference. (Photo by Caitlin Keough)

Story by Emily Bronson, Florida Perinatal Quality Collaborative

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From molecular discoveries to health policy applications, Drs. Maureen Groer and William Sappenfield have built impressive careers working to improve perinatal care.

Many parents may never understand how the health of their children begins long before birth, but USF Health’s Maureen Groer, PhD, and William Sappenfield, MD, MPH, are both passionate about translating research into better health care and outcomes for mothers and babies.

Dr. Groer, who holds a PhD in physiology, is a pediatric nurse, family nurse practitioner and the Gordon Keller Professor at the USF College of Nursing. She works primarily at the micro level – examining the molecular mechanisms underlying immunology, biology and behavior and how the “crosstalk” among these systems may affect the health of infants and their mothers.

USF College of Nursing’s Maureen Groer, RN, PhD, FAAN, a nurse physiologist with more than 35 years experience, studies underlying biobehavioral mechanisms affecting the health of infants and their mothers.

Dr. Sappenfield, a pediatrician and epidemiologist, is professor and chair of Community and Family Health at the USF College of Public Health, director of the Lawton and Rhea Chiles Center for Healthy Mothers and Babies, and co-director of the Florida Perinatal Quality Collaborative.   He works at the macro level – joining a variety of stakeholders to distill population data about diseases and their risk factors, treatment patterns and socioeconomic conditions into meaningful policies and practices to improve the health of mothers and babies.

William Sappenfield, MD, MPH is an epidemiologist and professor at the USF College of Public Health.

Using the power of meaningful data to help transform perinatal care quality

Even though he is a board-certified pediatrician, Dr. Sappenfield decided to embark on a career of public health research and practice instead of entering a traditional medical practice following his residency. He earned a master’s of public health degree from Harvard and completed postdoctoral training in preventive medicine and applied epidemiology at the Centers for Disease Control and Prevention (CDC).

“I fell in love with public health, because it was a way I could impact the health of children and families on a population basis, not just one child at a time,” Dr. Sappenfield said. “Knowing I can work with others to make a true measurable difference in lives of mothers, children and families gives me all energy I need to get up every day and go again.”

One of Dr. Sappenfield’s key academic achievements to help transform quality of care for pregnant women and newborns has been co-founding and co-directing the Florida Perinatal Quality Collaborative (FPQC) with John Curran, MD, professor of pediatrics and an associate vice president at USF Health.

The FPQC provides leadership and technical assistance to public and private partners across the state, often joining perinatal quality collaboratives in other states to launch health care quality improvement initiatives. Physicians, nurse midwives, nurses, public health professionals, hospitals, advocates, policy makers and payers voluntarily and collectively work together on select evidence-based initiatives to make measurable improvements in Florida’s maternal and infant health outcomes.

“Most of the initiatives we’re funded to do at $100,000 to $200,000 per year have been saving millions of dollars in costs while also improving health care and the quality of lives of mothers and babies,” Dr. Sappenfield said.

For example, one of FPQC’s first successes was its participation in a March of Dimes-supported, multistate pilot project to reduce escalating rates of early elective deliveries – inductions of labor and C-sections without a medical reason before a baby reaches a full 39 weeks gestational age.  Babies delivered before full term are at higher risk for serious complications, including respiratory distress, brain injuries, learning disabilities, and breastfeeding problems.

Excerpts from USF Health News. Read the full story here.

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How are CHIPRA quality demonstration States improving perinatal care?

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A board-certified pediatrician, Dr. William Sappenfield never entered traditional medical practice. While finishing his residency, he decided he wanted to enter academics, instead. Following the advice of his father, a professor and associate dean at a medical school, he applied to an NIH-CDC research training program.

“I fell in love with public health,” said Sappenfield, Community and Family Health professor/department chair and director of the Lawton and Rhea Chiles Center for Healthy Mothers and Babies. “Even though I liked the idea of taking care of children and families one at a time, I became enamored with the ability to help multiple children and families at the same time by using epidemiology as a tool.”

A widely recognized pioneer in his field, Sappenfield received the U.S. Health Resources and Services Administration’s Maternal and Child Health Bureau Director’s Award “for outstanding leadership and mentoring in promoting MCH epidemiologists nationwide” at the Association of Maternal and Child Health Programs annual conference in Washington, D.C., in late January.

Dr. Bill Sappenfield holds his HRSA Director’s Award at the AMCHP conference flanked by Dr. Michael Lu and Michelle Lawler.

Dr. Russell Kirby, USF Distinguished Professor and Marrell Endowed Chair in the Department of Community and Family Health, and COPH alumna Jordana Frost, MPH, also received recognition at the event, which drew more than 900 leading MCH professionals. Kirby delivered the keynote address.

The HRSA Director’s Award is considered a career recognition.

“The MCHB Associate Administrator annually presents this award to a few selected individuals who have made noteworthy national-level contributions to the health of infants, mothers, children, adolescents and children with special health care needs,” wrote Michele Lawler, acting director of HRSA’s Division of State and Community Health. Lawler specifically noted Sappenfield’s “years of service and … numerous contributions to the MCH field.”

“And it’s for that that he’s being recognized – for the quality improvement measures that have been disseminated with some pretty decent success here in Florida, as well as taking evidence-based best practices and reducing variation in the care of mother and baby,” said Dr. John Curran, who co-founded and co-directs the Florida Perinatal Quality Collaborative with Sappenfield.

Stressing the roles that others have played in the process, Sappenfield is humbly proud of his pioneer status.

“I started out in a field that didn’t exist at the time I started,” he said, “and then I’ve been able to contribute – with others – toward developing it into an active profession that’s making a difference for mothers and children.

“Maternal and child health epidemiology, when I started, was not even a term. No one even knew what it was. There were some people doing a little bit of perinatal epidemiology, but nothing as broad as MCH. They had cancer research, they had cardiovascular. They even had a little bit of birth defects research, but no one was as broad as maternal and child health.”

Curran, who is joint faculty with MCH and the Department of Pediatrics at the Morsani College of Medicine, helped recruit Sappenfield for the USF College of Public Health and makes it clear that he’s glad he did. Among a host of other things, Curran credits Sappenfield for the “complete rejuvenation” of the Chiles Center. In the bigger picture, Curran lauds Sappenfield’s choice of academics over medical practice.

Bill M. Sappenfield, MD, MPH

“Bill is recognized for being probably the premier perinatal epidemiologist in the country,” Curran said. “Here, in an academic environment, he has graduate students, he’s attracting a following rapidly, and he has less direct influence from governmental funding and constraints. He’s working very hard for a brighter future, and I think this award is a tribute to his success.”

In 1987, Sappenfield became the first career MCH epidemiologist for the Centers for Disease Control.

“There had been others who had been practicing like this,” he explained with typical humility, “but it was the first time CDC recognized it as an actual program where we put, not trainees, but actual professionals in the field.”

“He had memorable achievements in maternal and child health in South Carolina, which is where I first learned about him,” Curran said. “His interest was in where mothers should deliver their babies and would the outcome be better if they were in a more sophisticated center versus a simple birthing center. His paper from then – it’s 25 years ago – is still often quoted in the literature and now has been resurrected by the obstetricians.”

In the succeeding decades, numerous colleges have begun offering MCH epidemiology concentrations and MCH epi doctoral degrees. A biennial conference draws in excess of 500 attendees. Public health organizations – 16 to be exact – have begun giving MCH epi awards. A professional journal is widely circulated. When Sappenfield isn’t a contributor, someone else likely is citing or quoting his work.

“We now train people to work on maternal and child health issues,” he said, “recognizing that they’re not individual issues – that what might affect birth defects might also affect prematurity, which also affects infant mortality, and it all might relate to the whole life course of the mother. Did she have a teen birth? Did she have adequate education?

“All of those pieces are wrapped up together, and we know that we need to train people who have that broader perspective of family and how that broader perspective actually needs to affect policy and program in an applied public health perspective, just like you would infectious disease epidemiology when you’re trying to deal with outbreaks.”

Sappenfield’s role as a ground-floor member of the field has included mentoring countless post-doctoral fellows and young professionals.

While directing the CDC’s MCH epi program and focusing it squarely on expansion into a national effort, he chaired the first committee on MCH epi awards and did some of the early work on fetal and infant death reviews.

He is credited with leading the development of Perinatal Periods of Risk, an infant mortality analytical method that has become the standard of practice for communities to assess infant mortality and address those risks.

“The concept of toxic stress on the pregnancy period as well as the early child development period, have become major directions of interest of the Maternal and Child Health Bureau, an agency with a long history of achievements but a new direction,” Curran noted. “Bill is seen as one of the leaders of that direction.”

Sappenfield’s long list of recognitions include the National MCH Epidemiology Leadership Award. It was just days before the AMCHP conference that he learned he would be receiving the HRSA’s Director’s Award, recognition at a time in his career when he has already seen some of his former students and mentees gain national recognition of their own.

“I was humbled to get the award,” Sappenfield said. “Michael Lu, who presented it to me, is one of the leading researchers and advocates for the life course approach for children, and he came to one of the training institutes that I had arranged. That was how he got some of his first exposure to MCH epidemiology. He liked what he saw and has embraced that as a core component of his work.

“It’s just humbling when you have people who you’ve been working with who think what you’re doing deserves recognition. It’s always nice to be recognized by your peers.”

“This is major national recognition,” Curran said. “It’s a recognition of an impact on the outcomes for mothers and children that Bill achieved from a long career as an epidemiologist with a lot of achievements, and it is very well deserved.”

With their various AMCHP awards are, from left, Jordana Frost, Dr. Bill Sappenfield and Dr. Russ Kirby from USF, and Dr. Milt Kotelchuck from Harvard University.

Related story:
Dr. Russell Kirby receives McQueen Award, delivers keynote speech at AMCHP Conference

Story by David Brothers, College of Public Health.  Photos courtesy of Eric Younghans, USF Health Communications, and Dr. Bill Sappenfield.

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Dr. William Sappenfield named a 2013 Health Care Hero finalist

William M. Sappenfield, MD, MPH, professor in the USF College of Public Health and director of the Lawton and Rhea Chiles Center for Healthy Mothers and Babies, was a finalist for the 2013 Health Care Heroes Award.  Sponsored by the Tampa Bay Business Journal, Sappenfield was honored at an awards dinner on October 17 at the Renaissance Vinoy Resort and Golf Club in St. Petersburg.

As a finalist in the physician category, the Business Journal noted Dr. Sappenfield for his work championing maternal and infant health issues with the March of Dimes, the Chiles Center, and the USF College of Public Health.

Dr. Bill Sappenfield is chair of the Department of Community and Family Health, home to more than 10 concentrations that lead to MPH, MSPH, DrPH, and PhD degrees.  Additionally, the department offers several dual degrees, graduate certificates, and special programs.

Excerpt from USF Health News

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