July 2, 2013 —  The Florida Covering Kids & Families (FL-CKF) program at the University of South Florida’s Chiles Center for Healthy Mothers and Babies, was awarded a two-year, $1 million grant from the Department of Health and Human Services Centers for Medicare and Medicaid Services. This project, entitled Connecting Kids to Coverage, aims to maximize existing opportunities and structures currently in place within the statewide Florida covering Kids and Families Coalition and its network of regional collaborative partnerships to increase enrollment and retention in the Florida KidCare program.

USF’s award is among the largest of the $32 million in grants nationwide announced by DHHS to help enroll more children eligible for Medicaid and the Children’s Health Insurance Program (CHIP). These awards are part of the $140 million included in the Affordable Care Act and the Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009 for enrollment and renewal outreach.

Since joining the USF College of Public Health in 1998, Jodi Ray has made it her mission to ensure that children have access to healthcare.

“The grant will help us build on the Secretary’s Connecting Kids to Coverage Challenge to find and enroll all eligible children and support outreach strategies that have been shown to be successful in Florida,” said principal investigator Jodi Ray, program director of FL-CKF.

FL-CKF will increase the number of application assistance center networks through the state so that more  families may apply for health coverage and receive reliable assistance from trusted helpers in their own communities. Local outreach projects under this grant cover: Miami-Dade; Charlotte; Lee; Duval; Baker; Clay; St. Johns; Nassau; Broward; Hillsborough; Pinellas; Santa Rosa; Escambia; Okaloosa; Orange; and Seminole Counties.  Project participants will use grant funds to engage schools in outreach, enrollment and renewal activities through the following strategies: 

• Build upon existing networks of application assistors.
• Increase the number of school districts within the state where families may apply and receive assistance.
• Work with Florida Association of Children’s Hospitals to expand the Train-the-Trainer workshop to emergency departments and outpatient clinics within children’s hospitals statewide, as well as, add a text4baby collaboration with maternal and child health providers.
• Use community-based outreach partners to enhance the geographic areas of the local outreach projects with diverse populations and high rates of uninsured children who may qualify for Florida KidCare to identify children up for renewal and assist their families with the renewal procedures.
• Target difficult-to-reach and minority populations with the highest percentages of uninsured children partnering with Limited English Proficient (LEP) statewide.
• Enhance knowledge and expertise of application assistors through the use of technology.

USF sponsors FL-CKF, which has 14 years experience enrolling eligible children in Medicaid and CHIP.

– Photo by Aimee Blodgett, USF Communications and Marketing

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USF public health leader involved in the FDOH investigation comments

Florida’s rate of ectopic pregnancy deaths jumped in 2009-10 – an increase that may be associated with delays in obtaining care and illicit drug use, according to a new report by the U.S. Centers for Disease Control and Prevention.  The state’s rise in ectopic pregnancy deaths, published in the CDC’s Feb. 17 issue of Morbidity & Mortality Weekly Report, runs counter to the national trend of steadily declining deaths.

“It was surprising,” said one of the report’s co-authors Dr. William Sappenfield, director of the Chiles Center for Healthy Mothers and Babies at USF, who was maternal-child health epidemiologist at the Florida Department of Health when the study was conducted.

“Nationwide, ectopic pregnancy death rates are going down, because the condition has become much easier and quicker to diagnose and treat,” said Dr. Sappenfield, chair of Community and Family Health at the USF College of Public Health.

Dr. William Sappenfield of the USF College of Public Health was a co-author of the report published in the CDC’s Mortality & Morbidity Weekly.

Ectopic pregnancy occurs when an egg is fertilized outside the uterus, usually in the fallopian tube.  If it remains undetected the pregnant woman may die if the tube ruptures, leading to rapid blood loss.

Improvements in pregnancy testing, ultrasound examination and outpatient treatments, including laparoscopic surgery and medications, have contributed to the decline in deaths. This success is largely dependent on access to care so women with signs and symptoms of ectopic pregnancy can be identified and treated before tube rupture, shock and severe blood loss.

Dr. Sappenfield helped staff the multidisciplinary team investigating ectopic pregnancy deaths in Florida, based on a review of cause death, risk factors and prevention opportunities.

Florida’s ectopic pregnancy mortality ratio was similar to the national rate of 0.6 deaths per 100,000 live births during 1999–2008, but increased abruptly to 2.5 during 2009-2010.  This four-fold increase appeared to be linked in part to lack of access to care. The researchers found that the 13 women who died in the one year (2009-2010) were more likely to have collapsed from a hemorrhage before seeking care than the 11 women who died the previous decade from ectopic pregnancies. Of the eight women who collapsed during 2009-2010, six tested positive for illicit drug use.

“We clearly have not reached our potential to prevent this life-threatening condition,” Dr. Sappenfield said.

Based on their review, the investigators wrote: “Efforts to prevent ectopic pregnancy deaths need to ensure early access to care, promote awareness about early pregnancy testing and ectopic pregnancy risk, and raise public awareness about substance abuse risks, especially during pregnancy.”

While ectopic pregnancy cannot be prevented, Dr. Sappenfield said, pregnant women and those of childbearing age should not delay seeking medical attention for continuing abdominal or pelvic pain, usually 6 to 8 weeks after a missed period.  Better to quickly rule out an ectopic pregnancy than to risk future fertility and perhaps dangerous complications if the pregnancy ruptures the fallopian tube.

Story by Anne DeLotto Baier, USF Health Communications