Variation in unexpected complication rates is more likely to be related to hospital rather than patient characteristics in Florida. The high proportion of variation explained by hospital factors suggests potential opportunities for improvement, and identifying specific complication categories may provide focus areas. Some of the opportunities may be related to differences in hospital coding practice.

Background The Florida Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program delivers evidence-based home visiting services to over 1400 families each year. Home visitors are integral in providing resources for families to promote healthy pregnancy, child development, family wellness, and self-sufficiency. Due to the nature of this work, home visitors experience work-related pressures and stressors that can impact staff well-being and retention. Objectives The purpose of this study was to understand primary sources of work-related stress experienced by home visitors, subsequent effects on their engagement with program participants, and to learn of coping mechanisms used to manage stress. Methods In 2015, Florida MIECHV program evaluators conducted ten focus groups with 49 home visitors during which they ranked and discussed their top sources of work-related stress. Qualitative analysis was conducted to identify emergent themes in work-related stressors and coping/supports. Results Across all sites, the burden of paperwork and data entry were the highest ranked work-related stressors perceived as interfering with home visitors’ engagement with participants. The second-highest ranked stressors included caseload management, followed by a lack of resources for families, and dangerous environments. Home visitors reported gratification in their helping relationships families, and relied on coworkers or supervisors as primary sources of workplace support along with self-care (e.g. mini-vacations, recreation, and counseling). Conclusions for practice Florida MIECHV home visitors across all ten focus groups shared similar work-related stressors that they felt diminished engagement with program participants and could impact participant and staff retention. In response, Florida MIECHV increased resources to support home visitor compensation and reduce caseloads, and obtained a competitive award from HRSA to implement a mindfulness-based stress reduction training statewide.

Home visitors in the Florida MIECHV program served as trusted confidants that helped families navigate social services. Future research should focus on the impact that home visiting has on immigrant health and whether this impact is maintained over time.

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Our university, based data center has curated statewide data on short-term, involuntary examinations for mental illness/co-occurring disorders for over two decades. We recently began receiving petitions and orders for longer-term civil commitment from Clerks of Court. We are currently developing a system to curate data on involuntary assessments/treatment for substance use disorders. The involuntary examination data have been used to produce 100+ ad hoc reports for a variety of stakeholders, a statutorily required annual report, as well as to inform the state legislature, advocates, agencies, and several statewide taskforces relating to criminal justice and mental health initiatives. Data from documents are currently received and entered in a) hard copy via the mail, b) securely scanned and transferred either via SFTP or with secure transfer to our University's Box.com account, or c) direct provider entry into a secure web portal. Our University's IT environment has evolved, with an escalation of organizational and policy changes related to the merging of two IT units. While this merging has led to innovation, it has also presented operational, organizational and logistical challenges. Discussed in this presentation will be a) these IT challenges, b) the pros and cons of form submission methods, c) how choice of submission method is informed by the capabilities of those submitting the documents in addition to, the resources and capabilities of our center within the context of current funding, as well as d) how this impacts choices made about data entry, data quality and use of the data for analyses.