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Mesa County Community Health Needs Assessment- A Case Study Setting Benchmarks for the 2012-2017 Community Health Improvement Plan.

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Presentation on theme: "Mesa County Community Health Needs Assessment- A Case Study Setting Benchmarks for the 2012-2017 Community Health Improvement Plan."— Presentation transcript:

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 Mesa County Continuous Quality Improvement (CQI) Model

5 Creating a Community Health Improvement Model MAPP???

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

7 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 Precede Phase 1-3 CHAPS III CHAPS IV CHAPS II Aligning the approaches

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

9 “Chunking”- Time as a constraint

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

11 Public Health Planning Model 11

12 Creating a Community Health Improvement Model

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

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 3 rd 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 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 16 CHNA- Who Steers the Ship?

17 17

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 Selected membership representing : – Subject Matter Experts – Health Care Professionals – Local Coalition Members – Residents who have been directly or indirectly affected 19 Using Content Focus Groups

20 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 20 Using Content Focus Groups

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 Mental Health Family Abuse and Violence Maternal and Child Health Obesity Tobacco Use Screening and Early Detection Mesa County Winnable Battles 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 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 30 Data Source: 2010 Coroner’s Report, Mesa County

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

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

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: – – –

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


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