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2013 Model Practices (Public)Application Name: 2013 Model Practices (Public) : Barry-Eaton District Health Department : HEALTHY CAPITAL COUNTIES: Collaborating for Meaningful Community Health Assessment – examining community data in a new way across three counties with a health equity lens Applicant Name: Ms. Anne K. Barna, M.A. Application Title: HEALTHY CAPITAL COUNTIES: Collaborating for Meaningful Community Health Assessment – examining community data in a new way across three counties with a health equity lens Please enter email addresses you would like your confirmation to be sent to. Practice Title HEALTHY CAPITAL COUNTIES: Collaborating for Meaningful Community Health Assessment – examining community data in a new way across three counties with a health equity lens Submitting LHD/Agency/Organization Barry-Eaton District Health Department Head of LHD/Agency/Organization Colette Scrimger Street Address 1033 Healthcare Dr Practice Contact Person Anne Barna Submitting LHD/Agency/Organization Web Address (if applicable) www.barryeatonhealth.org Provide a brief summary of the practice in this section. This overview will be used to introduce the model or promising practice in the Model Practices Database. Although this section is not judged, the judges use it to get an overall idea about your practice. You must include answers to the following questions in your response:
• Size of population in your health department’s jurisdiction
• Who is your target population/audience, what is the size of your intended population/audience for this practice and what percent of your target population did you reach?
•Provide the demographics of your target population (i.e. age, gender, race/ethnicity, socio-economic status)
• Describe the nature and gravity of the public health issue addressed
• List the goal’s and objective(s) of the practice and clearly link them to the problem or issue the practice is addressing.
• Describe the potential public health impact of the practice, and the likely effectiveness of the practice being implemented as intended, and the ease of adoption of the practice by other LHDs.
In your description, also address the following
• When (month and year) the practice was implemented.
• Briefly describe how the practice was implemented, what were major activities, and any start-up and in-kind costs and funding services.
• Outcomes of practice (list process milestones and intended/actual outcomes and impacts.
• Were all of the objectives met?
• What specific factors led to the success of this practice? This community health assessment practice structure included three counties in multi-health department jurisdiction collaboration, as well as multi-hospital collaboration. A Health Equity Data perspective resulted in going beyond including measures of social determinants, inequality, and segregation at the county level, to displaying how both health outcomes and social determinants vary based on the different living environments throughout the three county area (Eaton, Clinton, and Ingham Counties, Michigan). This approach was possible when data for the counties was pooled, then broken out in a new way, irrespective of county boundaries, but following patterns of community development and demographics. Eaton County (Barry-Eaton District Health Department jurisdiction): 107,759 Ingham County (Ingham County Health Department): 281,365 Clinton County (Mid-Michigan District Health Department jurisdiction): 75,382 The target audience was the total population of the three county area, 464,506. We directly engaged with over 146 stakeholders as part of advisory committee membership, and 98 focus group participants. Demographics of the Tri-County Area: 8% are Black/African American 6% are Hispanic/Latino 79% are White, Non-Hispanic 22% are under age 18 11% are aged 65 and older 15% of individuals live in poverty 50% of households have incomes over $50,000 a year The public health issue is providing the community at all levels with meaningful information to improve the public’s health. This includes having information that effectively communicates the root causes of health inequities. The goals were to: 1) conduct a three-county community health assessment that met multiple needs, including a)provide data at multiple levels, including regional, county, and rural, suburban and urban areas with differing levels of economic prosperity b) provide data that would be relevant by topic as well as by geographic area 2) use a health equity model to organize the data to illustrate the relationship between inequality, social, economic, and environmental factors, and health outcomes. Objectives (all met): 1. Establish the Assessment Infrastructure 2. Define Purpose and Scope of the Health Assessment 3. Collecting and Analyzing Data 4. Communicating Results The potential public health impact is that stakeholders make decisions and take actions based on understanding the root causes of ill health in the community. The likely effectiveness of this practice depends on the availability of data at the sub-county level that can be assigned to a municipality or census tract through geo-coding. Using a community health assessment that encompasses data relating to health equity (social determinants and inequity measures) should be fairly easy technically, as much of this data is available for most counties from the American Community Survey. Many communities may need to establish community readiness to examine social determinants of health concepts prior to utilizing a health equity model. Combining counties to re-group the analysis based on the community development and demographics (i.e. rural, suburban, urban) is more difficult, but should be feasible for entities with access to an epidemiologist. This practice was staffed by part-time contributions from each of the three health departments. One health department’s contribution was the expertise of an epidemiologist, another health department in overall coordination and development, and the other in general staff support. This practice was supported through contributions from area hospitals, in-kind staff time from health departments, and part of a $35,000 demonstration site grant from NACCHO for CHA/CHIP Demonstration Sites. The total cost for this CHA totaled $180,000. Overflow: Please finish the response to the question above by using this text area. Please be mindful of the word limits. Community Health Assessment: July 2011 to June 2012
Specific Process Milestones, Outcomes, and Impacts:
1. Established the projects’ “Model for How Health Happens”, October 2011
Community Advisory Committee-generated measures they would use to measure ‘whether the community was getting healthier or not’. Responses were then analyzed and grouped using a form of the socio-ecological model that addresses health inequities.
2. Established Geographic Community Groupings, November 2011
These groupings (stratifications) reflected the demographics of the various areas of the Capital Counties.
3. Qualitative Data on Health Needs and Community Assets, March 2012
Eight focus groups with participants who are likely to be underrepresented in survey data.
4. Indicator List, February 2012
5. Community Health Profile Report, June 2012
Includes the quantitative and qualitative data collected to reflect the health needs of persons in the area, and an inventory of community assets. The FINDINGS document summarizes the full report, and was released in August of 2012.
The specific factors that led to the success included the investment of significant staff time and resources. We received technical assistance from NACCHO, the Association for Community Health Improvement, and Michigan State University.
You may provide no more than two supplement materials to support your application. These may include but are not limited to graphs, images, photos, newspaper articles, etc. Describe the public health issue that this practice addresses. (350 word limit) This practice addresses the core public health function of ASSESSMENT. Under the Public Health Accreditation Board 1.0 Standards and Measures that describe the optimal local public health system performance, Domain 1 is “Conduct and disseminate assessments focused on population health status and public health issues facing the community”. More specifically under this domain, local public health departments should (1.1) Participate in or Conduct a Collaborative Process Resulting in a Comprehensive Community Health Assessment, (1.2) Collect and Maintain Reliable, Comparable, and Valid Data that Provide Information on Conditions of Public Health Performance and On the Health Status of the Population, (1.3) Analyze Public Health Data to Identify Trends in Health Problems, Environmental Public Health Hazards, and Social and Economic Factors that Affect the Public’s Health, and (1.4) Provide and Use the Results of Health Data Analysis to Develop Recommendations Regarding Public Health Policy, Processes, Programs, or Interventions.
This practice allows the local public health departments involved to better meet standard 1.4 (making better decisions) given a more detailed and accurate understanding of the public health problems faced in different areas of their jurisdiction.
What process was used to determine the relevancy of the public health issue to the community? (350 word limit) In order to meet these standards, a new approach was necessary for the Capital Counties area. Previously, data had only been available, for the most part, at the county level. While this information was useful to some extent, a pattern appeared again and again across many measures for the three counties – one county would perform the “best” (Clinton County), another the “worst” of the three (Ingham County), and the other “in the middle” (Eaton County). Often, community leaders, coalitions, and organizations would ask health departments why this pattern was happening, and while Ingham County was able to offer some detailed breakouts of their data, there was no organized effort to describe the region in a way that respected the actual nature of the communities that comprised it. There is a central urban core that touches all three counties but was located primarily in Ingham County. There are highly developed suburban townships surrounding the urban areas (1 in each of the 3 counties). There are exurban cities, including county seats, which are scattered around in each of the counties. There are rural areas that differ slightly based on the patterns of development – closer to the urban area, the rural townships can be characterized as “suburban countryside” with higher value homes placed along country roads. Rural areas that are less developed tend to be farther from the urban area, with lower value homes and farms.
Ingham County Health Department has been conducting innovative work in the area of health equity and social justice since 2006. They began offering Health Equity and Social Justice Workshops to their health department staff as well as community members in 2007 (and are still ongoing). These workshops used a model to describe health inequities that is described in the 2010 book “Tackling Health Inequities Through Public Health Practice”. Many of the participants of the Healthy! Capital Counties project had been exposed to this model of understanding health problems through participation in the workshops, including the Healthy! Capital Counties coordinator. This enhanced community readiness to adopt this model as a framework for presenting the data.
How does the practice address the issue? (350 word limit) Data in the Healthy! Capital Counties project was pooled across the three counties, and stratified based on population density (persons per square mile) and median home value, both from the 2006-2010 American Community Survey (U.S. Census). The validity of this methodology was tested by analyzing groupings based on other measures. There was a high level of statistical agreement that the groupings we used (based on population density and median home value) matched groupings based on other measures. Additionally, these geographic groupings were validated with a focus group and the Advisory Committee.
The urban areas, consisting of the cities of Lansing, East Lansing, and Lansing Charter Township, have the highest population densities of the area, and were grouped based the median home value in census tracts. The “Urban Upscale” area (population 73,431), where median home value is $183,600 or more. The “Urban Mid-Price” area (population 109,286), where median home values were between $120,900 and $183,600. The “Urban Low-Price” area (population 99,612), where median home values are less than $120,900. These groups combine municipalities and cross county boundaries.
The non-urban areas, which consisted of the majority of the land area of the three county region, were grouped based on the population density of the area, and, in the least dense areas, on the median home value of the municipality. Municipal boundaries were selected rather than census tracts to give more detail in rural areas. The “Small Cities” area (population 105,476) 1000-2500 persons per square mile. The “Inner Suburbs” area (population 73,113) 419-999 persons per square mile. The “Countryside Suburbs” area (population 67,082) less than 419 persons per square mile, and the median home value is more than $167,000. The “Farms and Fields” area (population 60,473) less than 419 persons per square mile, and the median home value is less than $167,000.
The project also organized the data to emphasize a health equity perspective. To make explicit the connection from “Health Outcomes”, to “Behaviors, stress, and physical conditions”, to “Social, Economic, and Environmental Factors”, to “Opportunity Measures” (segregation and income inequity), data were color-coded at each of these different levels.
Please list any evidence based strategies used in developing this practice. (Provide links or other materials for support) The model we used for our assessment is from the Association for Community Health Improvement’s Community Health Assessment Toolkit. http://www.communityhlth.org/
We modified the model to align with the Public Health Accreditation Board’s Standards and Measures 1.0 in relation to Community Health Assessment. http://www.phaboard.org/accreditation-process/public-health-department-standards-and-measures/
Under the Public Health Accreditation Board 1.0 Standards and Measures that describe the optimal local public health system performance, Domain 1 is “Conduct and disseminate assessments focused on population health status and public health issues facing the community”. More specifically under this domain, local public health departments should (1.1) Participate in or Conduct a Collaborative Process Resulting in a Comprehensive Community Health Assessment, (1.2) Collect and Maintain Reliable, Comparable, and Valid Data that Provide Information on Conditions of Public Health Performance and On the Health Status of the Population, (1.3) Analyze Public Health Data to Identify Trends in Health Problems, Environmental Public Health Hazards, and Social and Economic Factors that Affect the Public’s Health, and (1.4) Provide and Use the Results of Health Data Analysis to Develop Recommendations Regarding Public Health Policy, Processes, Programs, or Interventions.
Is the practice new to the field of public health? If so, answer the following questions. Yes What process was used to determine that the practice is new to the field of public health? Please provide any supporting evidence you may have, e.g. literature review. Personal communication with NACCHO staff in the fields of Public Health Accreditation and Health Equity and Social Justice, has not yielded examples from local public health departments that had previously combined jurisdictions or parts of jurisdictions in order to apply health equity concepts to the breakouts of their data. A NACCHO Webinar from May 2012 cites the CHA/CHIP demonstration sites (of which this project is one) as likely to yield practices that incorporate health equity into community health assessment processes. (http://www.naccho.org/topics/infrastructure/upload/2012_5_10-PI-TA-Slides-FINAL.pdf) The other locations cited in this presentation are those that have incorporated health equity concepts into their CHA/CHIP processes, but not in the way described in this practice; i.e. combining data across jurisdictions. How does this practice differ from other approaches used to address the public health issue? The Connecticut Association of Directors of Health has developed a Health Equity Index that compares neighborhoods within a jurisdiction; however, it does not combine data across jurisdictions to better understand patterns across regions. However, the capital area of Michigan, with its mix of a Midwestern post-industrial city, surrounding communities, and rural countryside, and county-level data availability, is different than the highly developed, densely settled New England setting of Connecticut. Additionally, while county boundaries make sense for many communities, they do not make sense for the capital area in Michigan. http://www.cadh.org/health-equity/health-equity-index.html
The Bay Area Regional Health Inequities Initiative is similar to the Healthy! Capital Counties project in that it includes eight health department jurisdictions in analyzing data for health equity. However, because the San Francisco area is highly populous, data at the neighborhood level is available within jurisdictions. For the Healthy! Capital Counties project, the key feature is that in a less populous area, it was necessary to stratify data across jurisdictions to obtain population groups large enough to compare rates. http://www.barhii.org/press/download/barhii_report08.pdf
Is the practice a creative use of an existing tool or practice? If so, answer the following questions. No What process was used to determine that the practice is a creative use of an existing tool or practice? Please provide any supporting evidence you may have, for example, literature review. What tool or practice (e.g., APC development tool, The Guide to Community Preventive Services, HP 2020, MAPP, PACE EH, etc.); did you use in a creative way to create your practice? (if applicable) (300 word limit total)
a. Is it in NACCHO’s Toolbox; (if not, have you uploaded it in the Toolbox)?
b. If you used a tool or practice to implement your practice, how was your approach to implementing the tool unique and innovative for your target area/population? How does this practice differ from other approaches used to address the public health issue? Who were the primary stakeholders in the practice? The primary stakeholders included those who sat on the project STEERING COMMITTEE. The Steering Committee consisted of representatives from each hospital system (Sparrow, McLaren Greater Lansing, Hayes Green Beach, and Eaton Rapids Medical Center) each health department’s health officer (director) and a representative from Michigan State University’s Office of Outreach and Engagement. The project had a larger, broader, COMMUNITY ADISORY COMMITTEE, which included representatives from agencies, community representatives, elected officials, organizations, health plans, and coalitions. While the number of persons who attended an advisory committee or steering committee meeting totaled 146, the number of active participants on the advisory committee was approximately 55 (as measured by e-mail opens using the tool Constant Contact). What is the LHD's role in this practice? The local health departments’ role in this practice was to serve as a neutral convener to conduct a regional community health assessment and improvement planning process that would provide information to each hospital partner as well as each health department. The health departments each supplied part of the staffing for this project. The practice of breaking the data out with a health equity perspective was conceptualized by the project coordinator based on her knowledge and experience working with communities across the capital area and the data available to those communities, and made feasible through the epidemiologists’ technical skills in developing the data stratifications. What is the role of stakeholders/partners in the planning and implementation of the practice? We directly engaged with over 140 stakeholders as part of advisory committee membership, 98 focus group participants, and 97 community participants attended community prioritization dialogue events. This meaningful community engagement of residents of all three counties is a key feature of our community health assessment. Additionally, the experience and input of many key partners who have worked regionally on previous projects (i.e. the substance abuse prevention community) was utilized to design meeting arrangements that established the project as authentically tri-county. What does the LHD do to foster collaboration with community shareholders?
Describe the relationship(s) and how it furthers the practice's goals. While the health departments provided staffing for the project, the work was funded through many sources, which added to the diversity of interests represented on the steering committee as well as the advisory committee. For example, each of four hospital systems each contributed to the financial support of the project, as well as three local health plans, and Michigan State University. In addition, MSU provided technical assistance through meaningful participation on the steering committee. The Community Advisory Committee was intentionally designed to include people from each of the three counties, and from a variety of sectors. The Health Officer from the county that had historically been least engaged with tri-county efforts in the past made personal contact (by phone or meeting) with key leaders from her county to ensure we had commitment to attend and participate in the project. This was successful and effective. Most notably, the staff made a consistent effort to rotate the county that the meetings were held in a different county. So, although they typically were held somewhere near the central area of the region (Lansing), each meeting was in a different county. This was a very important symbolic gesture to put the other counties on a more even footing with the largest county. Describe lessons learned and barriers to developing collaborations. An important lesson learned is the importance of understanding the culture of the organizations that are collaborating. For example, the hospital partners needed powerpoint slides to use to communicate the project back to their executive teams, whereas this would not be needed in a less corporate health department setting. Additionally, one barrier that arose was trying to figure out how to collaborate with the existing “indicators of well being” effort, which was an assessment project without an improvement plan component, and one without an explicit health focus. This issue has still not been resolved as entities have been hesitant to merge efforts to date. Evaluation assesses the value of the practice and the potential worth it has to other LHDs and the populations they serve. It is also an effective means to assess the credibility of the practice. Evaluation helps public health practice maintain standards and improves practice.
Two types of evaluation are process and outcome. Process evaluation assesses the effectiveness of the steps taken to achieve the desired practice outcomes. Outcome evaluation summarizes the results of the practice efforts. Results may be long-term, such as an improvement in health status, or short-term, such as an improvement in knowledge/awareness, a policy change, an increase in numbers reached, etc. Results may be quantitative (empirical data such as percentages or numerical counts) and/or qualitative (e.g., focus group results, in-depth interviews, or anecdotal evidence).
List up to three primary objectives for the practice. For each objective, provide the following information: (750 word limit per objective)
• Performance measures used to evaluate the practice: List the performance measures used in your evaluation. Depending on the type of evaluation conducted, these might be measures of processes (e.g., number of meetings held, number of partners contacted), program outputs (e.g., number of clients served, number of informational flyers distributed), or program outcomes (e.g., policy change, change in knowledge or attitude, change in a health indicator)
• Data: List secondary and primary data sources used for the evaluation. Describe what primary data, if any were collected for each performance measure, who collected them, and how.
• Evaluation results: Summarize what the LHD learned from the process and/or outcome evaluation. To what extent did the LHD successfully implement the activities that supported that objective? To what extent was the objective achieved?
• Feedback: List who received the evaluation results, what lessons were learned, and what modifications, if any, were made to the practice as a result of the data findings.
• Performance measures used to evaluate the practice: List the performance measures used in your evaluation. Depending on the type of evaluation conducted, these might be measures of processes (e.g., number of meetings held, number of partners contacted), program outputs (e.g., number of clients served, number of informational flyers distributed), or program outcomes (e.g., policy change, change in knowledge or attitude, change in a health indicator)
• Data: List secondary and primary data sources used for the evaluation. Describe what primary data, if any were collected for each performance measure, who collected them, and how.
• Evaluation results: Summarize what the LHD learned from the process and/or outcome evaluation. To what extent did the LHD successfully implement the activities that supported that objective? To what extent was the objective achieved?
• Feedback: List who received the evaluation results, what lessons were learned, and what modifications, if any, were made to the practice as a result of the data findings.
Objective 1. Establishing the Assessment Infrastructure
Outcomes:
Leadership support obtained, Staff team established, identify and obtain resources, determine level of community involvement, establish an assessment advisory committee.
Performance measures:
Commitment to participate from each hospital and health department in region, including funding agreements. Staff identified and assigned, community involvement required by NACCHO Demonstration Site Visit Agreement. Established the assessment advisory committee.
Data:
Minutes from planning meetings in spring of 2011, funding proposal and deliverable agreement, staffing assignments, agreement with NACCHO, advisory committee minutes.
Evaluation Results:
The steering committee concluded that an assessment infrastructure was set that was well funded, staffed, included leadership support, and included an advisory committee.
Feedback:
The steering committee oversaw the conduct of the infrastructure establishment phase, and reviewed the results of the process. Lessons learned included that the phase of establishing an assessment infrastructure took longer than first anticipated. It took approximately 10 months from the initial interest meeting till the first community advisory committee meeting. However, this time investment resulted in a more secure footing to move forward to the next phases.
Overflow (Objective 1): Please finish the response to the question above by using this text area. Please be mindful of the word limits. Objective 2. Define the purpose and scope of the health assessment.
Outcomes:
Identify the users and audience, Define the purpose, Specify the target population
Performance Measures:
Vision Statement, Definition of purpose, users, audience, target population.
Data:
Meeting minutes.
Evaluation Results:
The steering committee concluded that the team achieved the objective of defining the purpose and scope at the October and November Steering Committee meetings.
Feedback:
The steering committee oversaw the conduct of the purpose and scope objective, and reviewed the results of the process. Lessons learned included the importance of establishing a vision statement, and that being clear about the reasons you were conducting the assessment (in this case, to prepare for PHAB accreditation and to comply with the hospital’s IRS 990 reporting requirements regarding Community Health Needs Assessments) were also important to better define purpose and scope. Overflow (Objective 2): Please finish the response to the question above by using this text area. Please be mindful of the word limits. Objective 3: Objective 3. Collecting and Analyzing Data for the health assessment.
Outcomes: Identify Other Assessment Activities and Results, Suggest geographic groupings for analysis (i.e. rural, suburb, urban), Collect primary data (conduct focus groups), Develop Indicator List and Indicator Selection Criteria, Collect secondary data, Analyze data, and Examine community assets
Performance Measures:
Data analysis and interpretation consistent with the PHAB Standards and Measures. Includes focus group report, geographic groupings, indicator list and selection criteria, data analysis spreadsheets for secondary data, community asset mapping activity.
Data:
Community Health Profile Report.
Evaluation Results:
The steering committee concluded that the team had conducted the Collecting and Analyzing Data phase to a high standard of excellence, meeting both PHAB and NACCHO Demonstration Site standards.
Feedback:
The steering committee oversaw the conduct of the collecting and analyzing data phase, and reviewed the results of the process. Lessons learned included the need to collect additional secondary data to ensure sub-county data availability, and the benefit of being explicit with the relationship between indicators of health outcomes, behaviors, social determinants, and equity measures.
Overflow (Objective 3): Please finish the response to the question above by using this text area. Please be mindful of the word limits. What are the specific tasks taken that achieve each goal and objective of the practice? The goals were to:
1) conduct a three-county community health assessment that met multiple needs, including
a)provide data at multiple levels, including regional, county, and rural, suburban and urban areas with differing levels of economic prosperity
b) provide data that would be relevant by topic as well as by geographic area
2) use a health equity model to organize the data to illustrate the relationship between inequality, social, economic, and environmental factors, and health outcomes.
The objectives are as follows, with the specific tasks listed beneath each.
1. Establishing the Assessment Infrastructure
a. Obtain leadership support
b. Build the staff team
c. Identify and obtain resources
d. Determine level of community involvement
e. Establish an assessment advisory committee
2. Defining the Purpose and Scope
a. Identify the users and audience
b. Define the purpose
c. Specify the target population
3. Collecting and Analyzing Data
a. Identify Other Assessment Activities and Results
b. Suggest geographic groupings for analysis (i.e. rural, suburb, urban)
c. Collect primary data (conduct focus groups)
d. Develop Indicator List and Indicator Selection Criteria
e. Collect secondary data
f. Analyze data
g. Examine community assets
4. Communicating Results
a. Write Community Health Profile Report
b. Publicize report findings
c. Promote community dialogues to further engage community in assessment
What was the timeframe for carrying out these tasks? 1. Establishing the Assessment Infrastructure (April 2011 through October 2011)
f. Obtain leadership support (April-May 2011)
g. Build the staff team (June-July 201)
h. Identify and obtain resources (April 2011-June 2011)
i. Determine level of community involvement (July 2011)
j. Establish an assessment advisory committee (September-October 2011)
2. Defining the Purpose and Scope (September – November 2011)
d. Identify the users and audience (September 2011)
e. Define the purpose (October-November 2011)
f. Specify the target population (November 2011)
3. Collecting and Analyzing Data (November 2011 – March 2012)
h. Identify Other Assessment Activities and Results (November 2011)
i. Suggest geographic groupings for analysis (i.e. rural, suburb, urban) (November-December 2011)
j. Collect primary data (conduct focus groups) (January-February 2012)
k. Develop Indicator List and Indicator Selection Criteria (December 2011 – February 2012)
l. Collect secondary data (February-April 2012)
m. Analyze data (March – April 2012)
n. Examine community assets (March 2012)
4. Communicating Results (April-July 2012)
a. Write Community Health Profile Report (April-June 2012)
b. Publicize report findings (June-July 2012)
c. Promote community dialogues to further engage community in assessment (June-July 2012)
Please provide a succinct outline of some basic steps taken in implementing your practice. The community health assessment process we followed is outlined above. To specifically address the geographic stratification aspects and the health equity focus, we felt it was important to organize the analysis along the lines of the different levels of the health equity model as generated by the participants. Additionally, providing data on many of these measures using the geographic groupings we developed, allowed us to determine the impact of these groups on health. For example, the poor cardiovascular death rates in both urban and rural areas are problematic; however they may arise from different problems in terms of food access and income in the urban areas, versus lower levels of education and distance to obtain healthcare in the rural areas. Utilizing the data in the way we did allows for this insight to be apparent. What were some lessons learned as a part of your program's implementation process? The initial plan was to also report data from our local behavioral risk factor survey using the geographic grouping stratifications. This would provide a link from health outcomes to the social, economic, and environmental factors sections. However, because the survey was not designed to report data in this way, we could not generate accurate weighting calculations that we could utilize. Using unweighted data was potentially an option, however because previous county-level reports had used county weights, the results of the unweighted geographic groups would not be comparable to the weighted county results. Therefore, we determined it was best to report only the weighted results down to the county level in this report. The lesson is that utilizing data for something other than what it’s designed to do can be problematic. We intend to address this data collection issue in the next generation of our local survey. Provide a breakdown of the overall cost of implementation, including start-up and in-kind costs and funding services. The overall cost of implementation of this practice (Community Health Assessment) was as follows
Staff time from BEDHD July 2011 to June 2012 (0.8 FTE = $65,000 in Salary Fringe)
Staff time from ICHD July 2011 to June 2012 (0.6 FTE = $65,000 in Salary Fringe)
Staff time from MMDHD July 2011 to June 2012 (0.5 FTE = $40,000 in Salary Fringe)
Project materials costs, including printing, focus group incentives, interpretation, etc = $10,000
= $180,000
Funding for this phase (July 2011 to June 2012) of the project came from the following sources:
Hospital Systems $62,250
Health Plans $9,375
Michigan State University $3,750
NACCHO CHA/CHIP Demonstration Site Grant (moneys used to support the CHA) $24,750
Health Departments (in-kind) $79,875
BEDHD $31,950
ICHD $31,950
MMDHD $15,975
Is there sufficient stakeholder commitment to sustain the practice? Describe how this commitment is ensured. Currently, stakeholder partners are in the middle of developing the Community Health Improvement Plan. The plan will include goals, objectives, and recommended strategies. Then partners, especially health departments and hospitals, will each develop their response (planned actions) to the Community Health Improvement Plan. The next phase will be to bring partner actions back to a coordinated community action plan, where action is monitored and evaluated for all partners. Partners are currently in discussions to determine the best way for this to occur given available resources.
Concerning specifically the community health assessment phase, the stakeholders in this practice have demonstrated the utility of the community health assessment model that includes the three counties; and the community has been highly receptive to both the concept of assessment across the three county area as well as praising the execution of this particular iteration. Given that this report was published in 2012, the next health assessment cycle will need to publish a new report by mid-2017 for health departments, and by mid-2015 for hospitals. The three county model will likely be utilized for assessment in the future, due to the reality that this arrangement most accurately reflects the identity of the persons that live in the area.
Describe plans to sustain the practice over time and leverage resources. The three health departments participating in the project plan to continue the collaboration in order to best maximize assessment, planning, and health improvement resources. Obtaining adequate, ongoing, funding for this endeavor continues to be a challenge, as to date, funding from outside sources has only been secured for a single year (the assessment phase). Ideally, funding support would continue through community health improvement planning and implementation. However, the assessment phase, whether it occurs again in 2015 or 2017, will be another tangible opportunity to secure additional funding for assessment activities. Practice Category Choice 1: Community Assessment Practice Category Choice 2: Accreditation Practice Category Choice 3: Check all that apply. Other E-mail from NACCHO NACCHO Demonstration Site Are you a previous applicant? No |
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