2013-2018 La Paz County Health Department

The Healthy LA PAZ Steering Committee & Coalition

[LA PAZ COUNTY COMMUNITY HEALTH IMPROVEMENT PLAN] Developed through a collaborative process with numerous key stakeholders and community members

Community Health Improvement Plan La Paz County, Arizona 2013 – 2018

Definition

A community health improvement process uses community health assessment (CHA) data to identify priority issues that impact the public’s health. Stakeholders design strategies for action and establish structures and partnerships to implement those strategies, which are then outlined in a community health improvement plan (CHIP).

The Healthy LA PAZ Process

The Healthy LA PAZ project has followed the gold-standard model for community health assessment and improvement planning - Mobilizing for Action through Planning and Partnerships (MAPP). Using the MAPP model, La Paz County Health Department (LPCHD) invited a broad coalition of key community leaders in multiple sectors to participate in strategic planning to improve the public’s health. This process led to the creation of this CHIP and will serve as a foundation for the upcoming action cycle.

Healthy LA PAZ Vision & Values

VISION

Inspiring healthy choices by nurturing community involvement and striving towards a better health system

WE VALUE…

A strong, involved community

A clean, beautiful environment

A society that promotes health, well-being and strong social networks

A quality health care system with access for all

An availability of healthy food and lifestyle choices

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Timeline

June 2012 – December 2012: MAPP Phases 1 – 3

Organizing for success and partnership development Visioning – development of vision and values statements Performing 4 MAPP Assessments (see explanation on next page)

January 2013 – March 2013: MAPP Phase 4 Identifying strategic issues Prioritizing the top three strategic issues

April 2013: MAPP Phase 5 Formulating goals and strategies for addressing the strategic issues Creating the Healthy LA PAZ CHIP

April 2013 – May 2013: La Paz County Health Department - Strategic Agency Plan Documenting and describing LPCHD support of the CHIP

June 2013 – 2018: MAPP Phase 6 The action cycle – a stage of planning, implementation, and evaluation Formulating multi-agency, community-wide SMART objectives derived from CHIP

goals and strategies Implementing and continuously evaluating community-wide objectives

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Assessments Four assessments were conducted during Phase 3 of the MAPP process. These assessments included the following:

• Community Themes & Strengths Assessment • Forces of Change Assessment • Community Health Status Assessment • Local Public Health System Assessment

The data from the 4 MAPP Assessments helped the Healthy LA PAZ Steering Committee to identify the following three priority strategic issues for the community:

• Chronic Disease Management • Safe Neighborhoods • Infrastructure Development

Multiple stakeholders developed a number goals and strategies to address the overarching priority issues named above. The priority issues and the goals and strategies for dealing with them are described in more detail the next several pages of this CHIP.

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PRIORITY ISSUE: Chronic Disease Management

GOAL: All persons in La Paz County will be better able to prevent and/or manage chronic diseases.

STRATEGIES

• Strengthen coordination among local public health system partners to eliminate gaps in referral services

• Assess how La Paz County can improve its transit systems

• Increase awareness of available services

• Study the impact of new healthcare laws on services within La Paz County, particularly patient navigation

• Encourage workplace and community wellness events and programs

• Research and implement healthy community design ideas

• Explore how Healthy LA PAZ can decrease health disparities in the population

DATA (County Health Rankings & Roadmaps: available at http://www.countyhealthrankings.org) • La Paz County ranks #2 among all Arizona

counties for premature deaths in its population. • La Paz County ranks #1 (tied with Yuma and

Gila counties) among all Arizona counties for self-reported poor or fair health.

• La Paz County ranks #1 among all Arizona counties for the most poor physical health days among adults.

• La Paz County ranks #3 among all Arizona counties for percentage of adults with diagnosed diabetes.

• La Paz County ranks as the #5 most obese county in the state of Arizona (tying with Pinal County).

• La Paz County ranks #1 among all Arizona counties for percentage of physically inactive adults.

• La Paz County ranks #3 (tied with Graham County) among all Arizona counties for the lowest percentage of population with access to parks.

• La Paz County ranked #1 (tied with Greenlee County) among all Arizona counties for the least access to recreational facilities.

• La Paz County ranked #3 among all Arizona counties for the lowest percentage of low-income population with access to healthy foods.

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PRIORITY ISSUE: Safe Neighborhoods

GOAL: All persons in La Paz County will live in safer neighborhoods.

STRATEGIES

• Improve data sharing among agencies and jurisdictions for substance abuse, crime, domestic violence, child abuse, and bullying

• Partner with community coalitions that address neighborhood safety

• Collaborate with agency partners to support the development of citizen volunteer groups or programs (such as Volunteer in Police program or Neighborhood Watches)

• Inform the public of available resources and innovative programs for public safety

DATA

(County Health Rankings & Roadmaps: available at http://www.countyhealthrankings.org)

• La Paz County is ranked #2 of all Arizona counties for poor mental health days for adults.

• La Paz County is ranked #1 of all Arizona counties for adult excessive drinking.

• La Paz County is ranked #3 of all Arizona counties for motor vehicle crash death rate.

• La Paz County has the 6th highest violent crime rate of all Arizona counties.

• La Paz has the 6th highest homicide rate of all Arizona counties (tying with Mohave and Pinal counties).

“VOICES OF THE COMMUNITY” ONLINE SURVEY RESULTS

(from the 2013 La Paz County Community Health Assessment)

The Three Most Important Health Problems: Diabetes (41.6%), Domestic violence (36.9%), Child abuse/neglect (34.8%)

The Three Most Important Risky Behaviors: Alcohol abuse (76.5%), Drug abuse (68.4%), Being overweight (41.9%)

The Three Most Important Factors for a “Healthy LA PAZ”: Low crime/safe neighborhoods (44.3%), Good jobs and healthy economy (43.9%), Good schools (32.5%)

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PRIORITY ISSUE: Infrastructure Development

GOAL: La Paz County residents and visitors will see improvements in infrastructure, particularly in communications and transportation.

STRATEGIES

• Partner with the Focused Futures coalition to focus on communications and transportation

• Participate in the Broadband Task Force convened by the Western Arizona Council of Governments (WACOG)

• Assess how La Paz County can improve its transit systems

DATA

Source: 2013 La Paz County Community Health Assessment

FORCES OF CHANGE ASSESSMENT

FORCE

Strength/Opportunity

Weakness/Threat

INFRASTRUCTURE

• When a storm knocks down old wooden power poles, APS replaces them with stable metal ones. APS has also almost completed a very large project, replacing miles of old wooden poles with large new metal ones within the county. This major infrastructure upgrade will result in a more stable power supply (less days of power-outages) for La Paz residents and long-term visitors.

• Improvement: County residents can access local news 24/7 via online newspapers and publications (Parker Pioneer, Parker Live Online, Desert Messenger, Ribbitt News).

• Most of the county resources are located in the county seat at Parker.

• Infrastructure assets and services like the internet are concentrated in Parker. Rural areas still do not have access to broadband internet.

• Within La Paz, cellphone coverage is good for Verizon but spotty for other companies (ATT, Sprint, T-mobile).

LOCAL PUBLIC HEALTH SYSTEMS ASSESSMENT:

Two of the weakest essential functions (EF’s) of La Paz County’s local public health system are as follows (both scored “Moderate” performance):

1 Monitor Health Status To Identify Community Health Problems

8 Assure a Competent Public and Personal Health Care Workforce

The technological aspects of these “weaker” public health functions focused on: (1) access to technology; (2) infrastructure related to data sharing; (3) communication and coordination issues; and (4) employee training in technology and cross-training backup staff.

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How We Prioritized Strategic Issues for the CHIP The Healthy LA PAZ Core Support Group (composed of LPCHD leadership) and the citizen Steering Committee used the ORID method to identify cross-cutting strategic issues from assessment data. ORID stands for “Objective, Reflective, Interpretive, and Decisional” and involves holding facilitated, structured group conservations with strategic questioning.

Under the ORID method:

Step One entails asking objective questions. o (“What jumped out at you or struck you in regards to the results?”)

Step Two is to ask reflective questions. o (“Which results are consistent with your expectations and

experiences?” and “What really surprised you?”). Step Three under ORID involves interpretive questions.

o (“Which issues are already being addressed by the community?”, “Which issue could have the most profound impact if addressed?”, and “What cuts across a lot of different areas?”).

Step Four, the last step of ORID, entails decisional questions. o (“What are the top issues or problems that the community needs

to address now?”). By following ORID, the LPCHD Core Support Group and the citizen Steering Committee identified the following preliminary six strategic issues:

• Internal and external communication and coordination challenges with partners within La Paz County’s local public health system

• Low access to care for county residents • Lack of infrastructure/need for infrastructure development (particularly

communications and public transportation) • Lack of economic development and jobs • Chronic Disease Management • Safe neighborhoods (domestic violence, child abuse, substance abuse, bullying,

crime)

By unanimous vote, the citizen Steering Committee then chose what they considered to be the three most pressing strategic issues for the county (highlighted above). To guide their voting process, the Steering Committee used the “Prioritization Criteria for Strategic Issues” outlined in the next section of this CHIP.

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Prioritization Criteria for Strategic Issues The Healthy LA PAZ citizen Steering Committee used the following criteria to choose the top three priority issues for community health improvement in La Paz County:

• Size: Number of persons affected, taking into account variance from benchmark data and targets

• Seriousness: Degree to which the problem leads to death, disability, and impairs

one’s quality of life

• Trends: Whether or not the health problem is getting better or worse in the community over time

• Equity: Degree to which specific groups are affected by a problem

• Intervention: Any existing multi-level public health strategies proven to be effective

in addressing the problem

• Feasibility: Ability of organization or individuals to reasonably combat the problem given available resources

o Related to the amount of control and knowledge (influence) organization(s) have on the issue

• Value: The importance of the problem to the community

• Consequences of inaction: Risks associated with exacerbation or problem if not

addressed at the earliest opportunity

• Social Determinant/Root Cause: Whether or not a problem is a root cause or social determinant of health that impacts one or more health issues

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Moving Forward with Implementation Planning During the summer of 2013, the Healthy LA PAZ coalition will begin Phase 6 of MAPP, which entails an Action Cycle of implementation and evaluation planning. The coalition may choose to convene action groups to address each of the health priorities in this CHIP, or it may instead form an overall umbrella organization for dealing with the identified strategic issues. Implementation planning will create detailed SMART objectives (specific, measurable, attainable, relevant and time-sensitive) for the goals and strategies outlined in this CHIP for each priority issue. (Several specific objectives have already been identified by Healthy LA PAZ in previous community health improvement planning meetings.) Implementation planning will involve multiple community agencies and partners in aligning existing assets and programs with the goals and strategies outlined for each prioritized issue in this CHIP. Additionally, evaluation planning will involve the creation of assessment measures to monitor whether specific objectives are being met by involved community partners. It is expected that the actual implementation of targeted community objectives, and their subsequent evaluation for effectiveness, will take Healthy LA PAZ through a five- year cycle, one that will hopefully produce substantive, positive changes to the local public health system.

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ACKNOWLEDGEMENTS

The La Paz County Health Department (LPCHD), in conjunction with Leadership for a Healthy LA PAZ (the project Steering Committee), took on the task of assessing the county’s health strengths and weaknesses as a first step in formulating citizen-driven solutions and improvements to population health. This effort produced the 2013 Community Health Assessment (CHA), a public record of the findings and the basis for the county-wide 2013 Community Health Improvement Plan (CHIP). Many community members, agencies, and organizations provided input vital to the CHA and the CHIP. Their time, expertise, and care on behalf of the people of this county are deeply appreciated.

Leadership for a Healthy LA PAZ (Founding Steering Committee) Special thanks to all of the following founding steering committee members for their dedication to the Healthy LA PAZ project and to the shared vision of vibrant community health: Lee Ann Anderson, LPCHD Public Health Education and Prevention Division,

Program Manager Starr BearCat, Constable and Proud Neighbors of Quartzsite, Founder Maria Chavoya, Cenpatico of Arizona, Community Connections Specialist Vickie Clark, La Paz Regional Hospital, Chief Executive Officer Robin Cooper, LPCHD Public Health Education and Prevention Division, Prevention

Coordinator Jamie Enriquez, LPCHD Public Health Nursing Division, Nurse Shanana “Rain” Golden-Bear, Desert Messenger, Owner/Publisher and Proud

Neighbors of Quartzsite, President Glenn “Linc” Gilbert, La Paz County Community Resource Department, Director Diana Grazier, LPCHD Public Health Nursing Division, Director of Nursing Juan Hernandez, La Paz County Community Development Department, Code

Enforcement Officer Sharon Marchbanks, La Paz County Master Gardener Program, University of

Arizona Cooperative Extension Office, Administrative Secretary Hilda Morales, Health Choice Arizona, Senior Outreach Coordinator Katheline Ocampo, Arizona Western College – Quartzsite Campus, Academic

Support Coordinator Deniese Perez, Colorado River Regional Crisis Shelter, Executive Director Tracey Putch, Cyber D’lites Café, Owner

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La Paz County Health Department Staff (Core Support Group)

Marion Shontz, LPCHD Director Maria Elena Almada LeeAnn Anderson Greg Bachmann Mary Bierbrodt Dave Boatwright Robin Cooper Martha Duran Jamie Enriquez Diana Grazier Kristi Irwin Connie Mathewson Joyce McCluskey Brittany Milacki Tammy Minor Melanie Sarino, CHA/CHIP Coordinator Mike Sinclair Katie Turnbow, CHA/CHIP Public Information Officer and Facilitator

Voices of the Community – Photo Project

Katie Turnbow Greg Bachmann

Community Participants **

** Special thanks to the 246 anonymous community members who voiced their

views and concerns on a county-wide quality of life survey. In addition, the following community members contributed time, expertise and input to creation of the 2013 Community Health Assessment and the 2013 Community Health Improvement Plan:

Janine Acton, Western Arizona Council of Governments (WACOG) Case Manager Daniel Barbara, CRIT Department of Health & Human Services, Executive Director Steve Biro, La Paz County Emergency Manager King Clapperton, La Paz County Supervisor (District 2) Rock Cramer, Farmer, La Paz Regional Hospital Board Member

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Richard Dinolfi, Business Owner, Community Member Bonita Fernandez, CRIT Department of Health & Human Services, Tobacco

Coordinator Blain Harold, Business Owner, Community Member Chris Harper, Colorado River Indian Tribes, Citizen Jeff Harran, Buckskin Fire Department, Assistant Fire Chief Mimi Hernandez, La Paz County Emergency Management, Coordinator Yoli Holt, La Paz Regional Hospital, Case Management Director Jeanne Klingenberger, Hospice of Havasu, Executive Director Jim Lotts, Parker Unified School District, Superintendent Susan Luis-Dougherty, IHS – Colorado River Service Unit, Public Health Nursing

Supervisor Patricia Palmer, Business Owner, Community Member Amanda Parris, IHS – Colorado River Service Unit, Sanitarian, Emergency

Preparedness Coordinator Pete Sabori, Colorado River Indian Tribes Alcohol & Substance Abuse Deterrence

Program, Deterrence Officer Josh Savino, KLPZ 1380 am Radio Announcer Janice Shelton, La Paz County School Superintendent Christian Stuke, IHS – Colorado River Service Unit, Safety Officer Bruce Swart, Quartzsite First Assembly of God, Pastor Darla Tilley, Parker Community/Senior Center, Executive Director Monica Timberlake, Quartzsite Elementary School Dist. 4 Board Member,

Substance Abuse Coalition Member Hannah Ward-Harper, Colorado River Indian Tribes Police Department, Tribal

Motor Vehicle Injury Prevention Program, Administrative Coordinator D.L. Wilson, La Paz County Supervisor (District 1), President/CEO of LPC Economic

Development Corporation Melissa Wright, Parker Area Alliance for Community Empowerment (PAACE),

Director of Community Relations

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“Forging ahead in a direction of purpose for the betterment of public health enables our community partners to become part of a system that represents the fluid movement of people’s lives.“

--- Marion Shontz Chief Health Officer/Director La Paz County Health Department