PSD-EPE, OPP, CHIES Meeting of the Minds: July 21, 2011

The 2008 Public Health Act

Office of Planning and Partnerships:History

New Structure in ColoradoNew Structure in Colorado

Public Health Nursing Services

Public Health Act of 2008, SB08-194

County and District Health Departments

The new law creates one type of local public health agency with the purpose of assuring the same level and quality of public health across the state.

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Local Public Health Agency

Office of Planning and Partnerships Colorado Department of Public Health and Environment

In statute:

Former Part 5’s (Organized Health Departments)o 15 OHDs served 24 counties & 85% of the state’s populationo Provided of a broad scope of public health services

Former Part 6’s (Nursing Services)o Served 40 countieso Provide public health services deemed necessary by the local

board of health, mostly falling within the scope of the practice of nursing

o Some of these counties offered environmental health particularly Consumer Protection services

“Old” Public Health Structure in Colorado

Office of Planning and Partnerships Colorado Department of Public Health and Environment

The Colorado picture in 2008…

Colors: Organized Health Departments White: Nursing Services : Environmental Services

The Public Health Act of 2008 All counties have a local public health agency (LPHA) New services prescribed are similar to the “old”

Organized Health Departments State Board of Health to establish:

Minimum qualifications for directors Core services and standards Funding formula

The state facilitates a public health improvement plan approved by the State Board of Health

All counties develop local public health improvement plans based on health assessment

Office of Planning and Partnerships

Created in response to the Act.

Purpose: Coordinate Act implementation Lead development of statewide public health improvement plans (PHIP)

(2009, 2014) Lead implementation of the PHIP

Guided by a Steering Committee . . .

Public Health ImprovementSteering Committee

Local Public Health

Co Chair, Bonnie Koehler, Delta CountyJackie Brown, Prowers CountyDeb Crook, Summit County John Crosthwait, Northeast HDJeff Kuhr, Mesa CountyMark Johnson, Jefferson CountyJim Rada, Garfield CountyJeff Stoll, Broomfield County Stacy Weinberg, Tri-County HDJeff Zayach, Boulder County

Gini Pingenot, CO Counties Inc.Lisa van Raemdonck, CALPHO

CDPHE Leadership

Co-Chair Chris Urbina, CEO ,Chief Med OfficerMartha Rudolph, Environmental DirectorRoz Bedell, COOKaren DeLeeuw, Ctr Living & Chronic Disease Chris Lindley, Preventive Services Jeff Lawrence, Consumer ProtectionLyle Moore, Emer. PreparednessKarin McGowan, Community RelationsLisa Miller, DCEEDAlyson Shupe, CHEISKaren Trierweiler, Ctr Families & Children

Glenn Schlabs, Board of HealthChris Wiant, Caring for ColoradoTim Byers, Center for Public Health Practice

This first Statewide Plan is intended to build capacity.

PHIP Capacity Priorities:-Core Public Health Services & Standards -Financing and Funding

-Assessment and Planning

-Public Health Roles & Relationships

-Workforce Development

-Public Health Informatics

Colorado’s 10 Winnable Battles (Health Priorities)

• Clean Air• Clean Water• Injury prevention• Mental Health &

Substance Abuse• Obesity

• Oral Health• Prevent Infections• Safe Food• Tobacco• Unintended

Pregnancy

This first Statewide Plan is intended to build capacity.

PHIP Capacity Priorities:-Core Public Health Services & Standards -Financing and Funding

-Assessment and Planning

-Public Health Roles & Relationships

-Workforce Development

-Public Health Informatics

“Core public health services shall be defined by the state board and shall include, but need not be limited to, the assessment of health status and health risks, development of policies to protect and promote health, and the assurance of provision of the essential public health services.”

Assessment and PlanningVital Records and StatisticsInvestigate & Control Communicable DiseasePrevention and Population Health PromotionEmergency Preparedness and ResponseEnvironmental HealthAdministration and Governance… in accordance with the 10 Essential Public Health Services

Core Service: Prevention and Population Health Promotion

“Develop, implement, and evaluate strategies (policies and programs) to enhance and promote healthy living, quality of life and wellbeing, while reducing the incidence of preventable (chronic and communicable) diseases, injuries, disabilities and other poor health outcomes across the life-span.”

Prevention and Population Health Promotion, cont’d

Furthermore, agencies are required to:1. Promote physical health, oral health, mental and behavioral health, and environmental,

health with emphasis on increasing health equity among priority populations (e.g., children, elderly, racial or ethnic populations).

2. Address identified risk factors or behaviors based on community health (e.g., tobacco use, physical activity, nutrition, teen pregnancy, sexually-transmitted infections).

3. Inform, educate, and engage the public and policymakers to build community consensus and capability to promote/support evidenced-based strategies that enable healthy personal, organizational, and community behaviors and environments.

4. Assure strategies are delivered in a culturally and linguistically appropriate manner.5. Coordinate efforts with governmental and community partners to link individuals to

health care services such as primary care (including maternal and child health), oral, specialty, and mental health care.

6. Develop community-specific solutions to address prevention priorities.7. Promote and participate in planning for sustainable environments that support healthy

living.

2011 Baseline Review of LPHAs Capacity to Perform/Assure Core Services-

Purpose: Catalogue current capacity of the CO system Inform core services and funding discussions Identify areas for improvement

Summary to date: 46 of 54 site visits completed Assessment and Planning & Prevention and Health Promotion are

two of the areas of low capacity among LPHAs

Adopt a revised local public health funding formula Based on population and provision of services Other programs addressing funding formulas based on new

structureStreamline contracting and funding processes

What Do Per Capita Funds Pay For?

Infrastructure-General OperatingAssessment and planning expectations in scope of workVaries on how agencies apply funding

Cover communicable disease reporting and investigations Cover environmental health in some LPHAs but not others Cover health promotion activities

Not directly tied to core services at this time

LPHAs, Service Populations & Current Funding Distributions

Population Served by

LPHA

Number of Agencies

Number of Counties Served

Percent of Total CO

Population Served

Percent of Per Capita

Dollars Received

100,000 + 9 11 83% 74%50,000-99,999

6 12 7% 10%

10,000-49,999

18 19 9% 13%

Less than 9,999

21 22 1% 3%

Total 54 64 100% 100%

New Per Capita Funding Formula

Target: establish funding formula by BOH Rule, to take effect July 1, 2012

Use funding formula to further implementation of the Public Health Improvement Act

Think strategically about funding to LPHAs Provide enough time for adjustmentsAlign with other funding formulas where possible:

Environmental Health and Sustainability, Emergency Preparedness, Immunization, MCH, TB, WIC

2012 Per Capita Funding to LPHAs (old formula)

General Fund - $5,935,190Tobacco Settlement Fund - $ 2,045,938Total - $7,981,128Largest Award - $1,759,160Smallest Award - $12,349Average award - $145,111Base - $11,573 (fmr Nursing Service) or $67,500 (OHD)Per capita – approx $ 1.52 (NS) or $1.27 (OHD)Regional Incentives - $10,000 per additional county

Ensure a comprehensive set of public health indicators are available. Develop a standardized approach to community health assessment. Establish a coordinated statewide planning process.Ensure public health planning capacity.Prepare agencies for national accreditation.

Product: CHAPS-Colorado’s Health Assessment and Planning System

CHAPSColorado’s Health Assessment and Planning System

If you have to have an acronym, it may as well connect to Colorado!

Colorado Health Assessment and Planning System (CHAPS)

Community Health

Assessment ResultsCommunity Health

Assessment Results

Public Health System Capacity Assessment

Results

Public Health System Capacity Assessment

Results

Standardized Prioritization Process

Standardized Prioritization Process

Local Public Health Improvement Plan

Local Public Health Improvement Plan

Statewide Public Health Improvement Plan

Statewide Public Health Improvement Plan

Come away with Strategic Priorities

PHIP will include: -CHA Results -Capacity Assessment Results -Action Plan *Strategic Priorities Strategies Time line Goals/Objectives Role of Partners

CHAPS Guide: Phases

Phases (or Chapters)1.Plan the Process2.Strategically Select Stakeholders3.Conduct a Community Health Assessment4.Conduct a Capacity Assessment5.Facilitate a Prioritization Process6.Develop a Public Health Improvement Plan7.Evaluate and Communicate Progress

CHAPS: Currently building the systemby testing on the ground:

Piloting with 15 counties-single agencies and regions Boulder, Broomfield, Pueblo, Weld, El Paso, (Routt, Jackson,

Moffet) (San Miguel, Ouray, Gunnison, Montrose, Delta, Hinsdale)

Identifying technical assistance needsReviewing other state’s modelsDeveloping standard templates, tools and formatsAssuring that CHAPS aligns with PHAB/MAPPWill design an interactive website for 2012

Office of Planning and Partnerships

Our Staff: Who manages this unit and where is

she?

Kathleen Matthews, MPH, Director Reports to new Community Relations Director, Karin McGowan, along with

Communications, Office of Health Disparities and Legislative Liaison Serves as primary liaison to all local public health agencies and connects

with other state local liaisons Attends Public Health Director monthly meeting Distributes State general fund and Master settlement funds to local public

health agencies Actively participates in CALPHO and other public health organizations Right now-Meeting with County Commissioners in Garfield and Mesa

counties with other directors and Chris Urbina. Wishes she was here with you.

Our Staff: Public Health Planners

Heather Baumgartner, Assessment and Planning Manager Oversees funding and technical assistance to local public health agencies for assessments and

local public health improvement plans Coordinate next Statewide Public Health Improvement Plan

Jill Hunsaker Ryan, MPH, Planning Consultant- 60% time, Western Slope Developing Colorado’s Health Assessment and Planning System (CHAPS) Providing technical assistance to pilot sites

Shannon Rossiter, JD, MPH, PH Planner-Administration/Governance Leading drafting of rules for Core Services and Funding formula as defined by the Public Health

Act Will be providing consultation on Core Service of Administration and Governance

Sharon Adams, REHS, Environmental Health Planner Consulting, planning & training related local provision of environmental health services Connects CDPHE environmental programs with local environmental health

Our Staff: Public Health Nurse Consultants

• Tsering Dorjee, MSN, MPH, RN, PHCNS-BC, Public Health Nurse Consultant (East of the Continental Divide)

• Kate Lujan, RN, MPH, Disease Control and Public Health Nurse Consultant 40%, (Western Slope)

• Duties:o Developing orientations for new public health directors and staffo Participating in PHNAC, Practice Advisory Council, National ASTDN, and

APHA PH Nursing Sectiono Strengthening connections with DCEED and concept of environmental

health nursingo Assisting with assessment and planning

Our Staff: Performance Improvement/Local Data Support

Kierston Howard, MS, Performance Improvement Manager Funded through CDC’s National Public Health Improvement Initiative Leading development of CDPHE’s Strategic Planning with Karin McGowan Supporting POSITEAM and other QI efforts within CDPHE Connected to national Performance Improvement Network

Alison Grace Bui, MPH, Local Public Health Data Specialist Housed in CHEIS, funded by OPP through CDC grant Provide support on data analysis/interpretation to local public agencies for

assessment and planning, using the Social Determinants framework

Our Staff:Office Support/Vacancy

Ariadne Romano, Office Manager

Katy Rice, Part-Time Program Assistant Keeps up to date list of LPHAs and sends information out as requested by

divisions and programs

Open Position: Public Health Planner and Communications