CHW’s largest project is the Gadsden Woman to Woman Federal Healthy Start Project, one of the nation’s original Federal Healthy Start projects. The grant was awarded in 1997, and CHW took over administration in 2000. Over the years, CHW implemented changes and improvements based on effectiveness studies and research on maternal/child health and the risk factors that impact poor health and birth outcomes.
The core services provided by the Gadsden Woman to Woman Project include case management, health and wellness education, behavioral health, and outreach. Services extend to the prenatal period and on pre-interconception care (periods before and between pregnancy) to women 14-44 years old, screening and assessments for children (0-5 years old), and peer support and counseling for adolescents and teens. Services are based on assessment results including bio-psychosocial, depression screening, and the Adverse Childhood Experience International Questionnaire.
To enhance these core services to meet best practice standards, CHW consistently looks for other sources of funding to supplement programs (Gadsden Woman to Woman Project, Brother to Brother, and CHW Behavioral Health).
Beyond the Gadsden Woman to Woman project, the CHW has been involved in statewide initiatives: the Florida Outreach Childbirth Education Program, a program development and evaluation project funded through the Centers for Disease Control to the Florida Department of Health Chronic Disease Program, and the Breastfeeding Project funded through the National Association of County and City Health Officials.
The Gadsden Woman to Woman Project offers preconception (before pregnancy), prenatal and interconception (between pregnancy) services to women, their children, and families. Services include case management, counseling, parenting, physical health assessment, nutritional education, support groups, self-development, exercise health education services, and academic and career readiness.
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The Fatherhood Program offers Federal Healthy Start Project males and other males from the community support groups, counseling, academic and career readiness, parenting, self-development services, nutritional education, and exercise health education services.
Mental/Behavioral Health services include counseling (individual, family, couples), infant mental health counseling, child-parent psychotherapy, grief and loss counseling, perinatal and postpartum depression counseling, parenting education, parenting evaluation, anger management (assessments and counseling), domestic violence counseling, assessments (biopsychosocial, in-depth clinical, attachment/bonding), pre-/post-placement adoptions competency counseling, therapeutic supervised visitation, communication delay screening, and autism spectrum disorder services (intervention services, positive behavior support, screening and referral).
CHW believes that for organizations to compete today and retain employees, employees need to feel valued and vested in the work they do. CHW also believes that fundamental characteristics of a strong organizational foundation include: a solid infrastructure, staffing composition to meet the needs of populations served, continuous opportunities for employee professional growth and development, diligent review, and refinement of practices as needed, and comprehensive evaluation activities to ensure fidelity, desired effects, and community change.
CHW’s team of professionals has over 35 years of experience in working in communities offering specialized training and technical assistance, program planning, development and implementation, evaluation and data base design and development. Training and technical assistance offered by CHW is designed to help organizations build capacity, improve the quality of services, and achieve desired outcomes. CHW customizes all training to meet an organization’s needs.
CHW offers technical assistance, training, and evaluation services in the following areas:
Needs assessment
Strategic planning
Program planning and development
Team building and collaboration
Partnership development
Community mapping and resource identification
Staff development and retention
Training includes but is not limited to motivational interviewing, emotional intelligence, conflict resolution, performance management, dealing with difficult people and situations, multigenerational workplace, strategic planning, board development, leadership and values, professional boundaries, reflective supervision, managing program data.
Evaluation development and design
Logic model development
Identification of tools and instruments
Data system and reports development
Consulting and training on data collection protocols
Data analyzing
CHW provides technical assistance to other Federal Healthy Start projects across the country to develop multi-cross site logic models designed to create common databases across multiple project sites. This initiative creates the opportunity for these projects and other projects outside of federal Healthy Start projects to conduct large scale rigorous evaluations of program effectiveness to be considered evidence-based programs. CHW continues to work with six federal Healthy Start projects in Florida.
CHW provides program planning and technical assistance to other local, state, and national community-based agencies.
Did Gadsden Federal Healthy Start participants improve their physical and mental health metric from intake to closure?
“Mental and physical health are equally important components of overall health” (Centers for Disease Control and Prevention [CDC], 2023, para. 2). The effect of poor mental health on physical health has been extensively studied and the results indicate that the affect can be deadly. Each of these two health domains (physical and mental) play a vital role in increasing overall health. As such, a method to quantify client’s physical health and mental health (PHaMH) was developed. The Gadsden Federal Healthy Start Project created the PHaMH scale, which uses elements of the Federal Healthy Start Intake form along with the results of Patient Health Questionnaire-9 (PHQ-9) and Perceived Stress Scale administered at intake and closure to create a PHaMH score.
The PHaMH score provides a snapshot of general health based on physical health behaviors and care actions in addition to the results of the depression and stress tools administered at intake. The following details the components of the PHaMH score:
Physical Health
Behaviors (tobacco, alcohol, drug use)
Care Actions (maintaining health insurance, completing a well visit, and using a clinic or doctor’s office for usual care)
Mental Health
Depression (Patient Health Questionnaire – PHQ-9)
Stress (Perceived Stress Scale – PSS)
Only cases where there were at least 60 days of services provided were used for the analysis which results in 88 cases in this comparison study.
A study was conducted that looked at single group pre-post differences for the physical and health components.
Data for the PHaMH component of the evaluation was collected onsite for the Gadsden Federal Healthy Start project in Gadsden County, Florida where the day-to-day operations of the project is conducted. A spreadsheet was created to record the values of the indicators used for the PHaMH score. Participants who enrolled in the program between January 1, 2021, through June 30, 2022, for case management or counseling services were used for this component of the evaluation. A guiding principle during the creation of the PHaMH scale was to use available data points to reduce reliance on additional data collection efforts and to minimize the number of times participants are surveyed. Intake data (pre) and closure data (post) were compared to determine change/improvement.
The results indicate a statistically significant difference in the intake and closure PHaMH scores in the positive direction which suggests that overall, clients increased their PHaMH level from intake to closure. Mental Health values were the biggest driver of the increase in PHaMH levels from intake to closure. Many of the clients experienced minor change in Physical Health levels due to the intake Physical Health values starting at a high level. The distribution of mental health level is significantly different at intake compared with closure (Chi-square=10.9939, df=4, p-value=0.0266). At intake, 22.7% of clients had a harmful or poor mental health status which decreased to 11.4% of clients at closure. At the other end of the spectrum, we see 38.6% of clients scored at the best level of mental health at intake and this percentage increased to 61.4% at closure. The distribution of physical health level at intake is almost identical to the distribution at closure (Chi-square=0.4397, df=4, p-value=0.979). At intake, 5.7% of clients had a harmful or poor physical health status which decreased slightly to 4.5% of clients at closure. At the other end of the spectrum, all fifty clients who scored good at intake also scored good at closure with one additional client moving from fair to good. With the significant difference in PHaMH score being driven by the mental health component, an analysis of the difference in mental health values was undertaken to determine whether the difference from intake to closure was greater for stress or depression. Both indicators showed statistically significant differences from intake to closure. Both showed improvement. Stress scores, on average, were higher at intake than depression scores and the change in stress scores from intake to closure showed a higher difference than depression scores.
Findings suggest that participation in the Gadsden Federal Healthy Start project is correlated with improved depression and stress as well as improved physical health, especially for those who showed poor physical health at the onset of program participation.
