1. Mesa County Community Health Needs Assessment- A Case Study
Setting Benchmarks for the Community Health Improvement Plan

2. Context Health Leadership Consortium (since 2007)
Colorado Public Health Act & PPHR (2008)
Dartmouth Atlas (2009)
Mesa County Health Department Advanced Practice Center -Blueprint for the Use of Volunteers in Hospitals and Rural Medical Centers (2009) (health.mesacounty.us/MesaAPC)
Reorganization (2010); New Director (Jan. 2011)
Health Informatics Program (Summer 2011)

3. Blueprint Toolkit: No turning back…

4. Continuous Quality Improvement (CQI) Model
Mesa County
Continuous Quality Improvement (CQI) Model

5. Creating a Community Health Improvement Model
MAPP???

6. Considering everything else?
Merging MAPP Phases with “local strategies” and research.
Colorado Health Assessment and Planning System (CHAPS)
Precede- Proceed
Model Phases
Community Assessments

7. Aligning the approaches
LHD System Assessment
NPHPSP
Data Collection and Community Resource Inventory
Community Assessments:
Schools Local Services Plan (3yr)
Bridges out of Poverty (2009)
Hospitals (3yr)
United Way (2005, as needed)
Community Health Needs Assessment (CHNA)
Community Themes Assessment
“Forces of Change”
Drivers, Resources, Integrated Data
Precede
Phase 1-3
CHAPS III
CHAPS IV
CHAPS II

8. Considering MAPP
Mobilizing Action for Partnerships and Planning (MAPP)

9. “Chunking”- Time as a constraint

10. MAPP Action & the reality of “Winnable Battles”
UNINTENDED PREGNANCY
SUICIDE
OBESITY

11. Public Health Planning Model
Forces of change are the recommendations for programs and policies that can be initiated to arrive at a different outcome.

12. Creating a Community Health Improvement Model

13. CHNA Process Data Collection and Community Resource Inventory
Over 250 indicators
Aligned with State/National Benchmarks
Identify relevant community coalitions,
non-profits and governmental organizations
Data Collection and Community Resource Inventory
Steering Committee
Subject Matter Content Focus Groups
Community Focus Groups
CHNA Final Report
Community Health Needs Assessment (CHNA)
Community Health Improvement Plan

14. 34 Measures Where Mesa County Ranks Below Colorado
Child abuse rates • Juvenile property crime rates • Live births where mothers gained an appropriate amount of weight • Incidence of invasive cancer • Incidence of cancer of the lung and bronchus • Incidence of invasive cancer of the cervix • Incidence of invasive cancer of the prostate • Salmonella incidence • Motor vehicle hospitalization • Percent of adults 18+ who are obese • Suicide hospitalizations • Percent of adults 18+ with arthritis • Heart attack hospitalizations • Number of homes tested for radon • Children who were physically active in the past 7 days • Adults who currently smoke cigarettes • Women who smoked during the last three months of pregnancy • 3rd grade children with caries • Women who experienced major stress before delivery • High school student that felt sad or hopeless • Students who considered suicide • Women who drank alcohol during the last three months of pregnancy • High school drinking • Adults with poor health • Poor physical health • Poor mental health • Adults who visited the dentist • Adults who have had a flu shot • Adult cholesterol screening • Papanicolaou smears • Adult FOBT screening • Influenza hospitalizations • major congenital anomalies • Adults who have asthma

15. What are your “Priority Areas”
Mental Health
Unintended Pregnancy
Prenatal Health
Tobacco Use
Obesity
Family Abuse and Violence
Screening
Oral Health
Sexually Transmitted Disease’s
Unintended Injuries

16. CHNA- Who Steers the Ship?
City Of Grand Junction
Colorado West Regional Mental Health
Community Hospital
Family Health West
Hilltop
Marillac
Mesa County 211
Mesa County Department of Human Services
Mesa County Health Department
Mesa County Local Emergency Planning Committee (LEPC)
Mesa County School District #51
Mesa Developmental Services, Inc.
St. Mary's Hospital

17. Content Focus Groups

18. Using Content Focus Groups
Discussion during the focus groups covered:
Mental Health
Obesity
Maternal and Child Health
Family Abuse and Violence
Tobacco Use
Screening and Early Detection

19. Using Content Focus Groups
Selected membership representing :
Subject Matter Experts
Health Care Professionals
Local Coalition Members
Residents who have been directly or indirectly affected
Draft legislation Public Health revitalization act
Standardize delivery of public health services across the state in each county. If you are new to MC and it seems like public health in MC is different than the county you came from that is true!

20. Using Content Focus Groups
Identify determinants of behaviors and environmental factors
Identify community resources and gaps
Suggest additional data
Recommend possible areas for program/policy implementation and/or public health improvements
Draft legislation Public Health revitalization act
Standardize delivery of public health services across the state in each county. If you are new to MC and it seems like public health in MC is different than the county you came from that is true!

21. Align with Colorado “Winnable Battles”
Clean Air
Clean Water
Infectious Disease Prevention
Injury Prevention
Mental Health and Substance Abuse
Obesity
Oral Health
Safe Food
Tobacco
Unintended Pregnancy

22. 6 Priorities to 3 Winnables
Steering Committee Priorities
Mesa County Winnable Battles
Mental Health
Family Abuse and Violence
Maternal and Child Health
Obesity
Tobacco Use
Screening and Early Detection
Unintended Pregnancy
Obesity
Suicide

23. “Stories” Unintended Pregnancy
“First Trimester issues need to be addressed- alcohol, smoking, and access to primary care.”
“Evaluation of current programs and their outcomes is needed.”
“Mesa County rates for unintended pregnancy among teens need to address the lack of teen sexual health education and ethnic factors.”

24. Data Source: Epidemiology, Planning, and Evaluation Branch, CDPHE

25. Data Source: Vital Statistics, CDPHE

26. “Stories” Obesity
“Severe Needs Schools (those with a large number of students that are at 185% of FPL) and the “Working Poor” are part of the target population.”
“There needs to be a community-wide effort to address this issue- the issue of “healthy minded” parenting.”
“Incentives are weak in light of the perceived costs/time/effort required to maintain healthy behaviors.”

27. The latest on Obesity:

28. Data Source: CoHID, CDPHE

29. “Stories” Suicide
“Substance use/abuse is a contributing factor in the majority of the cases. The likelihood of intervention decreases as poverty increases.”
“Early reporting of annual figures show 2011 rates (of child and partner abuse) increasing over 2010.”
“ Most services are currently response-based and public awareness for early intervention is beginning to grow.”
“Stress, anxiety, depression, and substance abuse need to be addressed with collaborative efforts. Training and resources in the county seem to be lacking alignment.”

30. Data Source: 2010 Coroner’s Report, Mesa County

31. Social Determinants: Obesity
Behaviors / Environment
Activity
Nutrition
Determinants
Parenting skills
Video games/TV in place of physical activity
Parents have no time
Availability of resources
Self esteem
Awareness of resources
Perceived consequences
Perception of cost of healthy foods
Fragmented prevention/intervention efforts

32. Social Determinants: Suicide
Behaviors / Environment
Substance Abuse
Depression
Sense of Control
Determinants
Awareness of resources
Parenting
Self esteem
Availability of resources
Coping skills
Economy
Stigma associated with seeking help
Fragmented prevention/intervention efforts

33. Social Determinants: Unintended Pregnancy
Behaviors / Environment
Smoking during pregnancy
Unprotected sex in teens
Substance use during pregnancy
Determinants
Parenting
Peer pressure
Self esteem
Awareness of resources
Perceived susceptibility
Perceived consequences
Coherent communication
Fragmented prevention/intervention efforts

34. Common Determinants Parenting Availability of resources Self esteem
Awareness of resources
Perceived consequences
Fragmented prevention/intervention efforts
Coherent communication
Perceived norms

35. Work toward efforts to…
Address parents’ role in children's health and well being
Communicate, over and over, the existence of key community resources
Identify and align community resources: when many programs work independently to address an issue, those agencies compete for clients and resources
Implement continuous, far-reaching campaigns to address social norms, perceived consequences, and perceived benefits

36. Efforts must be… Sustainable Consistent Collaborative Frequent
Appealing
Appropriate
Accessible
Highly Visible

37. Target Population Considerations
Families at or below 200% of Federal Poverty Level (Obesity, Unintended Pregnancies, Unhealthy Pregnancies, Domestic Violence)
Hispanic Teens (Unintended Pregnancies)
Young and Middle Age Males (Suicide)
Other?

38. Infrastructure Implications
Community Health Improvement plan will include recommendations for:
Continued Assessment and Evaluation: County Data and Information Advisory Consortium (CODIAC).
Defining improvements in “Partnerships” that result in alignment and prioritization
Working with the community to develop sustainability plans for programs that are demonstrating success.
Evidence-based practices to address issues

39. 5 year Improvement Cycle
Population Health Advisory Committee will oversee all 3 Winnable Battle initiatives
Suicide Prevention Summit
“LiveWell” obesity campaign to address “Health Eating and Active Living” (HEAL)
Teen Sexual Health and Pregnancy Prevention Coalition

40. CQI: Lessons Learned
Know your data- where it comes from and what is important
Indicators- do you gather local data?
Steering Committee for Needs Assessment and Data Review
Population Health Advisory Committee to guide “Improvement” processes over the long run
“Prioritization”- quantitative vs. “thumbs up”
Health Informatics Infrastructure?

41. Thank You Comments/Questions/Suggestions: MesaAPC@mesacounty.us

42. References
Print Sources: Havlik, D.M. (2010). Mesa County Coroners Office. Suicide in Mesa County Electronic Sources: Colorado Department of Human Services. (2011). Retrieved September 2011, from Colorado Department of Public Health and Environment 2007 Child Health Survey. (2007). Retrieved May 2011, from Colorado Health Data: Regional Health Profiles. (2010). Retrieved May 2011, from Colorado Health Information Dataset. Retrieved May 2011, from Community Health Needs Assessment: Bridges Out of Poverty. (2009). Retrieved October 2011, from Injury Hospitalization Statistics. (2009). Retrieved August 2, 2011, from Mesa County Maternal Child Health Dataset (2009). Retrieved May 2011, from Mesa County Youth Risk Behavior Survey. (2007). Retrieved May 2011, from Omni Institute. Retrieved May 2011, from Pregnancy Risk Assessment Monitoring System. (2009). Retrieved June 9, 2011, from US Census Bureau American FactFinder. (2009). Retrieved June 3, 2011, from