Mesa County Mesa County Community Health Needs Community Health Needs Assessment- A Case StudyAssessment- A Case Study

Setting Benchmarks for the 2012-2017 Setting Benchmarks for the 2012-2017 Community Health Improvement PlanCommunity Health Improvement Plan

ContextContext

• 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)

Blueprint Toolkit: Blueprint Toolkit: No turning back…No turning back…

Mesa County Continuous Quality Improvement (CQI) Model

Creating a Community Health Creating a Community Health Improvement ModelImprovement Model

MAPP???

• Merging MAPP Phases with “local strategies” and research.

Community Assessments

Precede- ProceedModel Phases

Precede- ProceedModel Phases

Colorado Health Assessment and Planning System (CHAPS)

Considering everything else?Considering everything else?

LHD System AssessmentNPHPSP

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

PrecedePhase 1-3Precede

Phase 1-3

CHAPS III

CHAPS IV

CHAPS II

Aligning the approachesAligning the approaches

Considering MAPPConsidering MAPP

Mobilizing Action for Partnerships and Planning (MAPP)

““Chunking”- Time as a constraintChunking”- Time as a constraint

MAPP Action & the reality of MAPP Action & the reality of “Winnable Battles”“Winnable Battles”

OBESITYSUICIDE

UNINTENDED PREGNANCY

Public Health Planning Model

11

Creating a Community Health Creating a Community Health Improvement ModelImprovement Model

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 ProcessCHNA Process

34 Measures Where Mesa 34 Measures Where Mesa County Ranks Below Colorado 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

What are your “Priority Areas”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

• 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

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CHNA- Who Steers the Ship?CHNA- Who Steers the Ship?

17

Using Content Focus GroupsUsing 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

• Selected membership representing :– Subject Matter Experts– Health Care Professionals– Local Coalition Members– Residents who have been directly or

indirectly affected

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Using Content Focus GroupsUsing 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

20

Using Content Focus GroupsUsing Content Focus Groups

Align with Colorado Align with Colorado “Winnable Battles”“Winnable Battles”

• Clean Air • Clean Water • Infectious Disease

Prevention • Injury Prevention • Mental Health and

Substance Abuse

• Obesity • Oral Health • Safe Food • Tobacco • Unintended

Pregnancy

6 Priorities to 3 Winnables6 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

““Stories” Unintended PregnancyStories” Unintended Pregnancy

““First Trimester issues need to be addressed- alcohol, smoking, First Trimester issues need to be addressed- alcohol, smoking, and access to primary care.”and access to primary care.”

““Evaluation of current programs and their outcomes is needed.”Evaluation of current programs and their outcomes is needed.”

““Mesa County rates for unintended pregnancy among teens need Mesa County rates for unintended pregnancy among teens need to address the lack of teen sexual health education and ethnic to address the lack of teen sexual health education and ethnic

factors.” factors.”

87.7%

86.0%

84.4%

81.5%

79.9%

76%

78%

80%

82%

84%

86%

88%

90%

2006 2007 2008 2009 2010

Mesa County Births with First Trimester Care

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

25Data Source: Vital Statistics, CDPHE

““Stories” ObesityStories” Obesity

““Severe Needs Schools (those with a large number of students Severe Needs Schools (those with a large number of students that are at 185% of FPL) and the “Working Poor” are part of the that are at 185% of FPL) and the “Working Poor” are part of the

target population.”target population.”

““There needs to be a community-wide effort to address this issue- There needs to be a community-wide effort to address this issue- the issue of “healthy minded” parenting.”the issue of “healthy minded” parenting.”

““Incentives are weak in light of the perceived costs/time/effort Incentives are weak in light of the perceived costs/time/effort required to maintain healthy behaviors.”required to maintain healthy behaviors.”

The latest on Obesity:The latest on Obesity:

Data Source: CoHID, CDPHE

““Stories” SuicideStories” Suicide

““Substance use/abuse is a contributing factor in the majority of the cases. The Substance use/abuse is a contributing factor in the majority of the cases. The likelihood of intervention decreases as poverty increases.”likelihood of intervention decreases as poverty increases.”

““Early reporting of annual figures show 2011 rates (of child and partner abuse) Early reporting of annual figures show 2011 rates (of child and partner abuse) increasing over 2010.”increasing over 2010.”

“ “ Most services are currently response-based and public awareness for early Most services are currently response-based and public awareness for early intervention is beginning to grow.”intervention is beginning to grow.”

““Stress, anxiety, depression, and substance abuse need to be addressed with Stress, anxiety, depression, and substance abuse need to be addressed with collaborative efforts. Training and resources in the county seem to be lacking collaborative efforts. Training and resources in the county seem to be lacking

alignment.” alignment.”

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

Social Determinants: ObesitySocial 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

Social Determinants: SuicideSocial 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

Social Determinants: Social Determinants: Unintended PregnancyUnintended 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

Common Determinants Common Determinants

• Parenting • Availability of resources• Self esteem • Awareness of resources• Perceived consequences• Fragmented prevention/intervention efforts• Coherent communication• Perceived norms

Work toward efforts to…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

Efforts must be…Efforts must be…

• Sustainable• Consistent• Collaborative• Frequent• Appealing • Appropriate• Accessible• Highly Visible

Target Population ConsiderationsTarget 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?

Infrastructure ImplicationsInfrastructure 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

5 year Improvement Cycle5 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

CQI: Lessons LearnedCQI: 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?

Thank YouThank You

• Comments/Questions/Suggestions:– MesaAPC@mesacounty.us– 970-683-6619– http://health.mesacounty.us/APC2

ReferencesReferencesPrint Sources:Havlik, D.M. (2010). Mesa County Coroners Office. Suicide in Mesa County 2010.

Electronic Sources:Colorado Department of Human Services. (2011). Retrieved September 2011, from http://

www.colorado.gov/cs/Satellite/CDHS-ChildYouthFam/CBON/1251586911723Colorado Department of Public Health and Environment 2007 Child Health Survey. (2007). Retrieved May 2011, from

http://www.cdphe.state.co.us/hs/yrbs/chs2007PUB.pdfColorado Health Data: Regional Health Profiles. (2010). Retrieved May 2011, from

http://www.chd.dphe.state.co.us/CHDReporting.aspxColorado Health Information Dataset. Retrieved May 2011, from

http://www.cdphe.state.co.us/scripts/htmsql.exe/cohid/brfssfrm1.hsqlCommunity Health Needs Assessment: Bridges Out of Poverty. (2009). Retrieved October 2011, from

http://www.mesahealth.org/httpdocs/pdfs/2009-Final%20Report%20April%202.pdfInjury Hospitalization Statistics. (2009). Retrieved August 2, 2011, from http://www.cdphe.state.co.us/cohid/injury.htmlMesa County Maternal Child Health Dataset 2009. (2009). Retrieved May 2011, from

http://www.cdphe.state.co.us/ps/mch/mchadmin/mchdatasets2009/profiles/Mesa.pdfMesa County Youth Risk Behavior Survey. (2007). Retrieved May 2011, from

http://www.health.mesacounty.us/healthpromotion/pdf/YRBS/Risky%20Behavior.pdfOmni Institute. Retrieved May 2011, from http://clientportal.omni.org/aspire/Pages/quickqueries.aspxPregnancy Risk Assessment Monitoring System. (2009). Retrieved June 9, 2011, from

http://www.cdphe.state.co.us/cohid/pramsdata.htmlUS Census Bureau American FactFinder. (2009). Retrieved June 3, 2011, from http://factfinder.census.gov