THE BILL ITSELF
HB 515
Doula Support for Healthy Births Pilot Program
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A bill to be entitled
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An act relating to the Doula Support for Healthy
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Births pilot program; creating s. 383.295, F.S.;
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defining terms; establishing the pilot program in
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Broward, Miami-Dade, and Palm Beach Counties for a
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specified purpose; providing the purpose of the pilot
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program; requiring the Department of Health, in
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collaboration with its maternal and child health
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section, to implement and oversee the pilot program;
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specifying the duration of the pilot program, subject
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to funding; requiring the pilot program to target
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specified populations for enrollment; specifying
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services that must be provided under the pilot
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program; requiring the department to collaborate with
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specified entities to integrate doula services into
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existing maternal health programs and facilitate
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outreach and service delivery; authorizing the
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department to integrate doula services into existing
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maternal and child health programs as an expansion of
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the pilot program, subject to certain requirements;
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providing for funding of the pilot program; creating
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the Doula Certification Task Force within the
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department for a specified purpose; requiring the
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department to oversee and provide administrative
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support to the task force; providing for membership
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and meetings of the task force; specifying duties of
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the task force; requiring the task force to submit a
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final report of its findings and recommendations to
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the Governor and the Legislature by a specified date;
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providing for expiration of the task force; providing
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an effective date.
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WHEREAS, preterm birth is defined as a live birth before 37
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completed weeks of gestation and is associated with increased
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morbidities or ailments, such as cerebral palsy, breathing
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difficulties, feeding problems, developmental delay, and vision
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and hearing problems, and
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WHEREAS, preterm labor occurs when regular contractions
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cause the cervix to open between 20 and 37 weeks of gestation,
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which can result in a baby being born before 37 weeks of
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gestation, and the earlier the delivery, the greater the health
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risks for the baby, requiring special care in a neonatal
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intensive care unit and potentially causing long-term mental and
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physical health concerns, and
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WHEREAS, Florida's preterm birth rate has risen annually
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since 2014 to its current average rate of 10.9 percent, higher
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than the national average of 10.5 percent, and
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WHEREAS, Florida ranks among the highest in the nation for
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infant mortality, with a rate of 5.9 deaths per 1,000 births,
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higher than the national average of 5.4 deaths per 1,000 births,
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and
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WHEREAS, Florida also has one of the highest cesarean
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delivery rates in the nation at 37.4 percent, compared to the
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national average of 31.8 percent, with cesarean delivery being
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associated with increased risks to infants, including
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respiratory distress, infection, and long-term health
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complications, and
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WHEREAS, maternal mortality is defined as the annual number
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of female deaths from any cause related to or aggravated by
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pregnancy or its management, excluding accidental or incidental
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causes, during pregnancy and childbirth or within 42 days after
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termination of a pregnancy, irrespective of the duration and
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site of the pregnancy, and
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WHEREAS, Florida ranks 17th in the nation with a maternal
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mortality rate of 26.3 deaths per 100,000 births, compared to a
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national rate of 23.2 deaths per 100,000 births, and
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WHEREAS, Broward County has a maternal mortality rate of
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24.8 deaths per 100,000 live births, and an infant mortality
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rate of 5 deaths per 1,000 live births, and
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WHEREAS, Miami-Dade County has a maternal mortality rate of
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20.3 deaths per 100,000 live births, and an infant mortality
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rate of 4.8 deaths per 1,000 live births, and
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WHEREAS, Palm Beach County has a maternal mortality rate of
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33.2 deaths per 100,000 live births, and an infant mortality
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rate of 5.4 deaths per 1,000 live births, and
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WHEREAS, continued perinatal support, including the
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services provided by trained doulas, is associated with reduced
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rates of cesarean delivery and improved birth outcomes, and
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WHEREAS, Florida has ongoing challenges related to child
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safety and welfare, with statistics showing disparities in
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health and safety outcomes for children across racial and
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socioeconomic groups, and
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WHEREAS, doula care is the continuous, one-to-one
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emotional, informational, and physical support provided by a
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trained nonmedical professional to pregnant women and their
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families during pregnancy, labor, and the postpartum period, and
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WHEREAS, while doulas do not perform medical tasks, they
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provide an array of educational and support services throughout
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the birthing process to ensure that the mother has a positive
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and empowering experience, including, but not limited to,
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educational resources and information about pregnancy,
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childbirth, and postpartum care; assistance in creating a birth
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plan; continuous emotional support during labor and delivery;
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assistance with breathing techniques, relaxation, and
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positioning during labor; massage and counterpressure measures;
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facilitation of communication with medical staff; advocacy in
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and navigation of the medical setting; and postpartum support
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with newborn care and feeding, and
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WHEREAS, evidence-based support provided by trained doulas
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has been shown to enhance birth experiences, reduce cesarean
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deliveries, and improve overall health outcomes for mothers and
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infants, and
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WHEREAS, the state has a compelling interest in improving
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maternal and infant outcomes through increased access to high-
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quality doula services, NOW, THEREFORE,
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Be It Enacted by the Legislature of the State of Florida:
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Section 1. Section 383.295, Florida Statutes, is created
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to read:
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383.295 Doulas.—
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(1) DEFINITIONS.—As used in this section, the term:
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(a) "Department" means the Department of Health.
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(b) "Doula" means a nonmedical professional who provides
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health education, advocacy, and physical, emotional, and
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nonmedical support for pregnant and postpartum women before,
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during, and after childbirth, including support during
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miscarriage and stillbirth. Doulas are not clinical providers
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and are not licensed.
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(c) "Doula services" means the provision of physical,
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emotional, and informational support by a nonmedical
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professional to a pregnant woman during the prenatal,
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intrapartum, and postpartum periods. Activities may include
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childbirth education, labor support, postpartum recovery
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support, assistance with infant care, lactation support, and
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connection to community resources.
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(d) "Evidence-based" means a process in which decisions
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are made and actions or activities are carried out, based on the
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best evidence available, with the goal of removing subjective
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opinion, unfounded beliefs, or bias from decisions and actions.
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Such evidence may include practitioner experience and expertise
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as well as feedback from other practitioners and beneficiaries.
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(2) PILOT PROGRAM ESTABLISHED.—
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(a) The Doula Support for Healthy Births pilot program is
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established in Broward, Miami-Dade, and Palm Beach Counties to
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integrate doula services into existing maternal health
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initiatives, targeting pregnant and postpartum women who have
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overcome or are overcoming substance use disorders.
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(b) The purpose of the pilot program is to improve birth
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outcomes by decreasing preterm birth rates and cesarean
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deliveries, enhancing access to care, and supporting maternal
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well-being throughout the pregnancy, labor, and postpartum
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periods using evidence-based methods.
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(c) The Department of Health, through its maternal and
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child health section, shall implement and oversee the pilot
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program.
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(3) PROGRAM STRUCTURE.—
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(a) The pilot program may operate for 12 to 24 months,
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subject to funding.
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(b) The pilot program shall target the enrollment of
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pregnant and postpartum women who have overcome or are
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overcoming substance use disorders.
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(c) The following support services must be offered under
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the pilot program:
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1. Prenatal support, such as educational resources,
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personalized birth plans, and emotional support.
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2. Labor support, such as continuous emotional support,
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comfort measures, and communication facilitation.
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3. Postpartum support, such as assistance with newborn
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care, postpartum resources, and household tasks.
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4. Advocacy support, such as assistance with preferences
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and needs within medical settings and health care navigation.
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5. Comprehensive emotional support during the pregnancy
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and postpartum periods.
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(4) COLLABORATION; INTEGRATION.—
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(a) The department shall collaborate with:
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1. Health care providers, community organizations,
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community coalitions, and advocacy groups to integrate doulas
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and doula services into existing maternal health programs,
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ensuring that such doulas are trained and meet all of the
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following criteria:
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a. Demonstrate a strong understanding of the reproductive
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system, labor process, and postpartum recovery.
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b. Are proficient in hands-on techniques, such as massage,
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counterpressure, breathing exercises, and nonmedicated pain
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management.
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c. Support a client's birth plan, communicate effectively
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with medical staff, and advocate for informed consent.
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d. Provide guidance on breastfeeding, basic newborn care,
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and both the physical and emotional aspects of postpartum
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recovery.
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e. Use active listening, clear communication, and conflict
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resolution skills in interactions with clients and health care
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providers.
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f. Understand common medical complications and provide
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emotional and physical support to clients in challenging
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situations.
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g. Uphold professionalism, ethical decisionmaking, and
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legal responsibilities in doula practice.
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2. Local WIC programs, hospitals, birth centers, and
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community health centers to facilitate outreach and service
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delivery.
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(b) The department may integrate doula services into
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existing maternal and child health programs as an expansion of
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the pilot program, focusing on pregnant and postpartum women who
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have overcome or are overcoming substance use disorders. Any
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such expansion of the pilot program must include annual
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reporting requirements for the department to evaluate
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effectiveness, equity, and quality of integrating doula services
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into the existing maternal and child health programs.
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(5) FUNDING.—The pilot program shall be funded using
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appropriations for the Closing the Gap grant program established
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under ss. 381.7351-381.7356. The department shall coordinate
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with its Division of Community Health Promotion and Office of
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Minority Health and Health Equity to seek additional federal
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funds to support implementation.
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Section 2. Doula Certification Task Force.—
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(1) ESTABLISHMENT.—There is created within the Department
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of Health the Doula Certification Task Force, a task force as
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defined in s. 20.03(5), Florida Statutes, for the purpose of
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reviewing the scope of doula services and ensuring competency,
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quality, and consistency in the delivery of doula services to
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pregnant and postpartum women.
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(2) OVERSIGHT.—The Department of Health shall oversee and
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provide administrative support to the task force.
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(3) MEMBERSHIP; MEETINGS.—
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(a) The task force shall be composed of nine members.
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Three members shall be appointed by the Governor, three members
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shall be appointed by the Senate President, and three members
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shall be appointed by the Speaker of the House of
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Representatives. Of the nine members, two members must be health
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care practitioners as defined in s. 456.001, Florida Statutes,
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experienced in caring for pregnant or postpartum women, and at
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least one member must be a doula or otherwise have experience
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providing nonmedical support services to pregnant or postpartum
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women. A vacancy on the task force must be filled in the same
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manner as the original appointment. The task force shall elect a
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chair from among its members.
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(b) The task force shall meet as often as necessary to
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complete its work, but at least quarterly, at the call of the
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chair. The task force may conduct its meetings through
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teleconference or other similar electronic means.
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(4) DUTIES.—The task force shall do all of the following:
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(a) Review the scope of practice for doulas in this state,
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as well as in other states.
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(b) Establish core competencies for the provision of doula
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services.
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(c) Recommend minimum certification standards for doulas,
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which must include, but need not be limited to, all of the
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following:
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1. Possession of a high school diploma or its equivalent.
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2. Completion of a department-approved, evidence-based
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training program.
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3. A minimum number of supervised practice hours.
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4. Completion of a background screening.
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5. Education in professional ethics.
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(5) REPORT.—By January 1, 2028, the task force shall
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submit a final report of its findings and recommendations to the
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Governor, the President of the Senate, and the Speaker of the
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House of Representatives.
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(6) SUNSET.—The task force shall operate on a temporary
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basis in conjunction with the Doula Support for Healthy Births
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pilot program established under s. 383.295, Florida Statutes, as
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created by this act, and shall expire on October 2, 2029, in
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accordance with s. 20.052(8), Florida Statutes.
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Section 3. This act shall take effect upon becoming a law.