Winnebago Community Health Assessment Project Presented by Captain Lynn Lowry April 28, 2011

1. Winnebago Community Health Assessment Project Presented by Captain Lynn Lowry April 28, 2011

2. Objectives • Look at the Indian Community Health Profile Project Toolkit (ICHPP) as starting point resource • Describe the Winnebago Community Health • Assessment Journey • Identify recommendations from the lessons-learned by the Winnebago Community Health Assessment process

3. Overall Goal The goal of all Indian Health programs is: To elevate the health of American Indians and Alaskan Natives to the highest possible level

4. What is a Community Health Assessment?

5. The Indian Community Health Profile Project Toolkit From Northwest Tribal Epidemiology Center http://www.npaihb.org/resources/project_toolkits/ • The ICHPP is an instrument for assessing overall community health, which • Uses a broad definition of health • It covers multiple domains of health: physical, mental, environmental, and social • Generates data that are useful and usable at the community • level • Contains 15 recommended health indicators • Works within the context and interest of communities • Engages the community in systematic approach to • eliminating health disparities

6. Flow diagram of the Indian Community Health Profile process. Develop indicators Create working group Conduct data collection Identify priority health concerns Report indicator results Tribal interest in & support for improved health Use indicator results, to identify priorities for action Re-apply indicators to measure progress toward improved health Design action strategies Implement strategies

7. The 15 recommended Health Indicators From ICHPP • Socio-demographic Two measureable indicators • Health Status Four measureable indicators • Mental Health and Functional Status Eight measurable indicators • Environment Two measurable indicators

8. Winnebago Community Health Assessment Project Goal Develop a strategic plan to improve health delivery services for the Winnebago community through health assessment and community engagement activities

9. Winnebago Community Health Assessment Project Purpose/Objectives • Promotes opportunities for community engagement in a systematic approach to improve the health status of community and community members • Promotes opportunities in: • Defining current overall health status • Implementing activities to improve overall health status • Measuring overall health status on a regular basis • to determine the amount of improvement

10. Winnebago Community Health Assessment Project Workgroup and Consultants Winnebago Community Health Assessment Workgroup (WCHAW): Tipi Means, Health Educator LCDR Nichole Vetter, RN, Public Health Nurse Pat Medina, MS, Tribal Health Administrator CAPT Lynn Lowry, MSN, Director of Public Health Nursing Nicky Solomon, Community Advocate Ruby Bellanger, Community Advocate Consultants: Maurine Orwa, PhD, Northern Plains Tribal Epidemiology Center, Aberdeen Area Tribal Chairmen’s Health Board Shinobu Watanabe-Galloway, PhD, College of Public Health, University of Nebraska Medical Center

11. Winnebago Community Health Assessment Project INITIAL Timeline Revise Project goals and finalize workgroup membership Finalize list of indicators Revise BFRSS/YRBS survey questionnaires EPI center site visit Prepare survey interviewer training materials Train survey interviewers Obtain Tribal Council approval for Project Customize Project Activity Log Form a Working Group, Choose a leader Draft Community Health Profile Timeline Meet with EPI center for partnership and technical assistance Jun 2006 Aug 2006 Oct 2006 Dec 2006 May 2006 Jul 2006 Sept 2006 Nov 2006 Work on resolution for Tribal Council Finalize Community Health Profile Timeline Announce Project to Community and invite volunteer participation Formalize Technical Assistance Partnership with EPI center and invite to Winnebago for site visit Draft Indicator list, define community, review existing models Get technical feedback Prepare Project Summary IRB approval Review copy of ICHP Manual, conduct pre-planning meeting and begin project readiness checklist Obtain permission from data managers/custodians to access data sources Develop data abstract forms/data base Develop and apply population-based sampling scheme for survey

12. Continued… Evaluation-ongoing Assess what worked, what did not work and why Assess adequacy of time project, resources and preparation Assess whether changes should be made to indicator list Conduct Surveys Abstract data from existing sources for quality Review data from existing sources for quality Design original data collection procedures Design data base Identify audience and purpose of different reports Create reports (different formats) Publicize reports to community members and professional groups Conduct analysis with technical assistance Reform final calculations for indicators Jan 2007 Mar 2007 May 2007 July 2007 Feb 2007 Apr 2007 June 2007 Aug 2007 Develop data reports/summaries Collect original data Make plans for using result in program planning and management Set tentative date for next round of indicator assessment Identify key people to regroup for next round Begin planning for development of long range Health plan for the Winnebago Tribe, utilizing results from Community Health Assessment project

13. Winnebago Community Health Assessment Project Activities Phase I Phase II • Developed workgroup • and steering committee • Identified and analyzed • the existing health data • Developed two health • status reports • Conducted community focus • groups and survey to obtain • community inputs • Analyzed focus group • and survey data • Prepared presentation • and final project report

14. To understand the health status and concerns of • Winnebago Community: • 1. Examined the existing data such as: • - Winnebago Hospital data • - Community surveys (e.g. tobacco, risk factors) that have • already been implemented before this project • Collected new data through: • - Survey: Young Adults • - Focus Groups: Adult women/men, housing program, seniors

15. PHASE 1 Winnebago Community Health Assessment Indicator list A.Demographic Characteristics of Winnebago Community Residents B. Health Status of American Indian People in Nebraska C. Use of Preventive Care and Health Behavior D. Environmental Health

16. Phase 2 FOCUS GROUPS AND SURVEYS

17. Focus Group Facilitator Training

18. Objectives and Expected Outcomes of Focus Groups • Identify concerns and priority areas among community members • Find out community members’ experience with the health care system • Identify ways to improve health status of the community

19. Focus Group Topics • Health concerns and priority areas • Experience with the health care system • Ways to improve the community • health status

20. Major Themes and Recommendations Perception of Community Health

21. A. Perception of Community Health • 1. Pessimism • 2. Mental health; drug and alcohol problems • 3. Chronic diseases • Obesity • Children and youth • Spiritual decline/ineptness

22. B. Health Care Experience • “Only visit clinic and hospital when I am very sick” • Appointments • 3. Misdiagnosis • Needs for specialists and improved quality of care • Referral and follow-up problem • Provider-patient communication and interaction • Praises for Dr. McNamara • Pain management is poor, especially for the elderly • CHRs • ER and PA • Billing problems

23. C. Recommendations to Improve Community Health • Roles of “Self” • (Individual Community Members) • Roles of “Community” • Roles of “Health Care System • and Providers”

24. CHA STEERING COMMITTEE RECOMMENDATIONS

25. 1.DEVELOP ADVISORY HEALTH BOARD A. Charge for Advisory Health Board B. Recommendation for Board Membership

26. IMPROVE REFERRAL • AND INPATIENT FOLLOW-UP PROCESSES • Needs for Improved Referral • and Follow-up • B. Establish Improved Case • Management Process • Establish Improved • Discharge Plan Process

27. 3. IMPROVE THE PROVIDER-PATIENT RELATIONSHIP AND COMMUNICATION • Needs for Improved Relationship • and Communication • Recommendation: Reinstate the • Clinical Rotations

28. 4. IMPROVE THE AFTER-HOUR ER CARE • Needs for Improved ER Care • Evaluate the Current ER • Care/Services

29. 5. ENGAGE COMMUNITY TO IMPROVE THE COMMUNITY HEALTH STATUS • Interventions • Develop and Implement • Intervention Activities

30. 6. ENGAGE THE COMMUNITY TO IMPROVE THE COMMUNITY HEALTH STATUS • A. Accountability and Monitoring • Monitor progress and conduct a • follow-up evaluation

31. Project Status • Phase I: Completed • Developed workgroup and steering committee • Identified and analyzed the existing health data • Developed two health status reports • Phase II Completed November 2008 • Conducted community focus groups and survey • to obtain community inputs • Analyzed focus group and survey data • Prepared presentation and final project report • Phase III: Timeline to be determined • Implement activities to improve community health • status • Measure health status on a regular basis to • determine the amount of improvement

32. Summary • Existing health data shows a need for • improvement in the community’s health status • Community members expressed their concerns • about health care system • Based on community inputs, CHA Workgroup • made several specific recommendations • including the establishment of the Advisory • Health Committee to follow up with these • concerns