Objectives From 2016 to 2018 Florida documented 1471 cases of Zika virus, 299 of which were pregnant women (Florida Department of Health, https ://www.flori dahea lth.gov/disea ses-and-condi tions /mosqu ito-borne disea ses/surve illan ce.html, 2019a). Florida's response required unprecedented rapid and continuous cross-sector communication, adaptation, and coordination. Zika tested public health systems in new ways, particularly for maternal child health populations. The systems are now being challenged again, as the Coronavirus COVID-19 pandemic spreads throughout Florida. This qualitative journey mapping evaluation of Florida's response focused on care for pregnant women and families with infants exposed to Zika virus. Methods Fifteen focus groups and interviews were conducted with 33 public health and healthcare workers who managed outbreak response, case investigations, and patient care in south Florida. Data were thematically analyzed, and the results were framed by the World Health Organization's (WHO) Healthcare Systems Framework of six building blocks: health service delivery, health workforce, health information systems, access to essential medicines, financing, and leadership and governance (World Health Organization, https ://www.who.int/healt hsyst ems/strat egy/every bodys _busin ess.pdf, 2007, https ://www.who.int/healt hinfo /syste ms/monit oring /en/, 2010). Results Results highlighted coordination of resources, essential services and treatment, data collection, communication among public health and healthcare systems, and dissemination of information. Community education, testing accuracy and turnaround time, financing, and continuity of health services were areas of need, and there was room for improvement in all indicator areas. Conclusions The WHO Framework encapsulated important infrastructure and process factors relevant to the Florida Zika response as well as future epidemics. In this context, similarities, differences, and implications for the Coronavirus COVID-19 pandemic response are discussed.
The Florida Early Childhood Comprehensive Systems (ECCS) Impact Project focuses on improving the developmental health of infants and young children by supporting place-based community initiatives through a Collaborative Improvement and Innovation Network (CoIIN) approach. The CoIIN is a multidisciplinary team that fosters collaboration and coordination among agencies and community residents. A team at the University of South Florida conducted an independent evaluation of the ECCS Impact Project in Liberty City (LC), Miami, Florida, starting with a community assessment to gain a better understanding of local assets, needs and priorities. This community assessment was completed in collaboration with LC ECCS. Across the first two years of the initiative, the community assessment included methods such as geographic information system mapping; attending and planning meetings; conducting focus groups with parents, residents, and community providers; engaging in virtual and walking tours; and hosting interactive mapping workshops. The multimethod approach contributed to a community assessment that was comprehensive and holistic and that encompassed multiple perspectives. Results of the process included authentic engagement across community sectors and levels of influence and learning and reflection on community strengths, resources, and priorities to facilitate organization for positive change.
Early Childhood Comprehensive Systems (ECCS) grants help states and communities improve early childhood systems to support child development, equitable access to quality services and supports, and family well-being. Truly interdisciplinary, ECCS promotes cross-sector systems change initiatives that focus on integrating health care, mental health, social services, and family support broadly and within communities with concentrated risk factors that negatively impact child health and development. Florida was 1 of 12 states funded from 2016 to 2021 to use a Collaborative Improvement and Innovation Network (CoIIN) approach to do this work. Through community-driven initiatives that focus on policy, partnerships, and practices, Florida ECCS committed to ensuring equitable opportunities for families and young children who may face barriers due to residing in disenfranchised communities. This article describes the process of evaluating this multiyear community-led, place-based initiative that leveraged cross-sector state-level support and used a variety of methods to track evolving ECCS processes and outcomes.
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