1. Building Community (Health): Lessons Learned in One Community Leslie L. Clarke, Ph.D. Kari Ellingstad, M.P.H. Bill Little, MBA, M.P.H. Sarasota County Health Department Community Health Improvement Partnership

2. CHIP: Community Health Improvement Partnership Started just prior MAPP Started just prior MAPP Built with Foundation and hospital funding Built with Foundation and hospital funding Initiated by Foundation & non-profit community engagement org. with support of HD Initiated by Foundation & non-profit community engagement org. with support of HD Now managed by HD with fuller integration into HD planning and goals Now managed by HD with fuller integration into HD planning and goals

3. What we are learning (good and bad)  What seems to works  What doesn’t work  Major mistakes

4. Shared control (identifying problem, collecting data, solution building) leads to community ownership What worked: Involving Citizens in all phases Data Committee decided what data to study, how to present it, etc. Data Committee decided what data to study, how to present it, etc. Ad hoc Survey Committee developed survey Ad hoc Survey Committee developed survey What didn’t work: Too much data. Need more executive summaries/white papers Need more executive summaries/white papers Published more resultsPublished more results Subcommittee to review and summarize dataSubcommittee to review and summarize data Major Mistake: Problem focus  Use an asset-based focus to build on what was working

5. Work Local but Think Regional What worked: Community Health Action Teams Citizens focused on their towns and neighborhoods Citizens focused on their towns and neighborhoods Mapping health data at the zip code level Mapping health data at the zip code level Local strategic plans (that can interface with regional plan) Local strategic plans (that can interface with regional plan) What didn’t work: Not enough study of community or region Should have done more study of demographics- focus on poverty-health linkagesShould have done more study of demographics- focus on poverty-health linkages Too many agency presentations not enough anecdotesToo many agency presentations not enough anecdotes Didn’t engage enough key community leadersDidn’t engage enough key community leaders Many cross-county challenges to communities; needed dataMany cross-county challenges to communities; needed data Major Mistake: Developed regional focus late in process  Create both levels of focus simultaneously; establish need for each other

6. Visioning – at the Right Stage What worked: Envisioning achievable future Completed SWOT early on Completed SWOT early on Focus on the practical – what can we impact Focus on the practical – what can we impact Develop long-term plan: 5-10 years out Develop long-term plan: 5-10 years out What didn’t work: Not done soon enough Should have done right after reports were completeShould have done right after reports were complete Left with problem orientation and not visionLeft with problem orientation and not vision Should have had committee members engaged in city envisioning processesShould have had committee members engaged in city envisioning processes Major Mistake: Should have developed vision earlier  Use data and agency strengths to do visioning  Summarize and cross-correlate community assets

7. Partnerships, Built on Relationships, are Critical What worked: Citizens & agencies as partners Citizens valued for their knowledge and perspectives Citizens valued for their knowledge and perspectives All opinions are welcome; use consensus for decision-making All opinions are welcome; use consensus for decision-making Rules for meeting process helps Rules for meeting process helps Annual Community celebrations to recognize all involved Annual Community celebrations to recognize all involved What doesn’t work: Did not engage all volunteers in ways that fit their interests/skills Learn what each person wants from their involvement; work to find ways to meet need (if appropriate)Learn what each person wants from their involvement; work to find ways to meet need (if appropriate) Learn what talents each member/agency has to offer – assign based on talent and interestLearn what talents each member/agency has to offer – assign based on talent and interest Provide information in many formats for different types of learnersProvide information in many formats for different types of learners Major Mistake: Not engaging key citizens one-on-one  Personal invitation key; personal assignment of task  Need more recognition of citizen and agency volunteers  Train volunteer leaders to engage new members immediately

8. Link Local Agencies: Use Common Vision that Came from the Community What worked: Agencies working together toward local goals Development of goal from community reduces agency turf issues Development of goal from community reduces agency turf issues Support collaborative grant applications on behalf of community Support collaborative grant applications on behalf of community Build on what works: YMCA programs; Goodwill programs Build on what works: YMCA programs; Goodwill programs What doesn’t work: Engaging Voluntary orgs in vision Voluntary organizations (Rotary, Chambers, Sertoma) have own mission; don’t engage in others’Voluntary organizations (Rotary, Chambers, Sertoma) have own mission; don’t engage in others’ Don’t have community group try to fit mission of agency Don’t have community group try to fit mission of agency Major Mistake: Share mission and goals of agencies early  Like citizens, need to ask agencies what they need to get from participation  Agencies are not always used to working together; provide opportunity for collaboration

9. Some Examples of Lessons Learned: New CHIP/HD Initiatives

10. Community Solution Building: Diabetes In-Home Care Project and CHIP Centers Shared Control  CHATs identified and owned senior isolation and lack of access to health information and wellness as key problems  Citizen committees developed the Care Team solution and CHIP Centers concept  Pursued funding and are implementing interventions in collaboration of key agencies Agency Collaboration partnership with 5+ local providers to implement partnership with 5+ local providers to implement partnership with USF to add research component and for funding partnership with USF to add research component and for funding

11. Regional Solution Building: Health Leadership Project Working Local and Regional Realized we were missing regional perspective.  Established Health Leadership Project to engage Hospital CEOs and HD Directors in quarterly meetings to discuss regional, community health issues and how to work together  Bringing national experts to meet with leaders Partnerships built on relationships SCOPE facilitated first meeting with focus on individuals getting to know one another; moved beyond institutional identities and concerns SCOPE facilitated first meeting with focus on individuals getting to know one another; moved beyond institutional identities and concerns Asked for 1 year commitment to process, made publicly Asked for 1 year commitment to process, made publicly Shared Control Holding community forums with national experts as presenters on key health issues – to educate community as well as leaders Holding community forums with national experts as presenters on key health issues – to educate community as well as leaders

12. Visioning at Regional Level: Health Scorecard Visioning The Health System Assessment is done. Now what? How to make health system changes.  Crafting Health Scorecard to direct county and regional focus on shared health outcome goals.  Once goals established, learn what is being done and what is needed to implement improvements  Scorecard should help direct county funding Regional and Community Focus Establishment of County/Regional goals will give community groups common goals to target. Establishment of County/Regional goals will give community groups common goals to target. Health Scorecard will be integrated into County Health Department planning and County Balanced Scorecard measures Health Scorecard will be integrated into County Health Department planning and County Balanced Scorecard measures

13. Visioning for Public Health: Public Health Performance Standards Assessment Shared Control Realized we had not engaged all sectors in health planning  Used PHPSA process and CHIP committees to engage more sectors in assessment  Using Public Health System model to communicate shared responsibility for public health and advance planning Partnerships and Collaborations PHPSA provides opportunities for broad partnerships across many agencies; working together in many areas, how to expand PHPSA provides opportunities for broad partnerships across many agencies; working together in many areas, how to expandVisioning Will be continuing to envision community health using 10 essential services as guidelines and using community visions to inform planning Will be continuing to envision community health using 10 essential services as guidelines and using community visions to inform planning

14. Future Challenges Developing solutions to covering the uninsured and growing costs of insurance Developing solutions to covering the uninsured and growing costs of insurance Public Health Information exchanges – how to develop across community Public Health Information exchanges – how to develop across community Continued funding for all initiatives Continued funding for all initiatives