Mesa County Community Health Needs Assessment- A Case Study

1. Mesa County Community Health Needs Assessment- A Case Study Setting Benchmarks for the 2012-2017 Community Health Improvement Plan

2. Context • 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)

3. Blueprint Toolkit: No turning back…

4. Mesa County Continuous Quality Improvement (CQI) Model

5. Creating a Community Health Improvement Model MAPP???

6. Considering everything else? • Merging MAPP Phases with “local strategies” and research. Colorado Health Assessment and Planning System (CHAPS) Precede- Proceed Model Phases Community Assessments

7. Aligning the approaches LHD System Assessment NPHPSP Data Collection and Community Resource Inventory CHAPS II Community Health Needs Assessment (CHNA) CHAPS III • Community Assessments: • Schools Local Services Plan (3yr) • Bridges out of Poverty (2009) • Hospitals (3yr) • United Way (2005, as needed) Precede Phase 1-3 Community Themes Assessment CHAPS IV “Forces of Change” Drivers, Resources, Integrated Data

8. Considering MAPP Mobilizing Action for Partnerships and Planning (MAPP)

9. “Chunking”- Time as a constraint

10. MAPP Action & the reality of “Winnable Battles” UNINTENDED PREGNANCY SUICIDE OBESITY

11. Public Health Planning Model

12. Creating a Community Health Improvement Model

13. CHNA Process • Over 250 indicators • Aligned with State/National Benchmarks • Identify relevant community coalitions, • non-profits and governmental organizations Data Collection and Community Resource Inventory • Steering Committee • Subject Matter Content Focus Groups • Community Focus Groups • CHNA Final Report Community Health Needs Assessment (CHNA) Community Health Improvement Plan

14. 34 Measures Where Mesa 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

15. 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

16. CHNA- Who Steers the Ship? • Mesa County Health Department • Mesa County Local Emergency Planning Committee (LEPC) • Mesa County School District #51 • Mesa Developmental Services, Inc. • St. Mary's Hospital • 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

17. Content Focus Groups

18. Using 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

19. Using Content Focus Groups • Selected membership representing : • Subject Matter Experts • Health Care Professionals • Local Coalition Members • Residents who have been directly or indirectly affected

20. Using 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

21. Align with Colorado “Winnable Battles” • Clean Air • Clean Water • Infectious Disease Prevention • Injury Prevention • Mental Health and Substance Abuse • Obesity • Oral Health • Safe Food • Tobacco • Unintended Pregnancy

22. 6 Priorities to 3 Winnables Steering Committee Priorities Mesa County Winnable Battles Unintended Pregnancy Obesity Suicide • Mental Health • Family Abuse and Violence • Maternal and Child Health • Obesity • Tobacco Use • Screening and Early Detection

23. “Stories” Unintended Pregnancy “First Trimester issues need to be addressed- alcohol, smoking, and access to primary care.” “Evaluation of current programs and their outcomes is needed.” “Mesa County rates for unintended pregnancy among teens need to address the lack of teen sexual health education and ethnic factors.”

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

25. Data Source: Vital Statistics, CDPHE

26. “Stories” Obesity “Severe Needs Schools (those with a large number of students that are at 185% of FPL) and the “Working Poor” are part of the target population.” “There needs to be a community-wide effort to address this issue- the issue of “healthy minded” parenting.” “Incentives are weak in light of the perceived costs/time/effort required to maintain healthy behaviors.”

27. The latest on Obesity:

28. Data Source: CoHID, CDPHE

29. “Stories” Suicide “Substance use/abuse is a contributing factor in the majority of the cases. The likelihood of intervention decreases as poverty increases.” “Early reporting of annual figures show 2011 rates (of child and partner abuse) increasing over 2010.” “ Most services are currently response-based and public awareness for early intervention is beginning to grow.” “Stress, anxiety, depression, and substance abuse need to be addressed with collaborative efforts. Training and resources in the county seem to be lacking alignment.”

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

31. Social Determinants: Obesity Behaviors / Environment • Activity • Nutrition Determinants • 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

32. Social Determinants: Suicide Behaviors / Environment • Substance Abuse • Depression • Sense of Control Determinants • Awareness of resources • Parenting • Self esteem • Availability of resources • Coping skills • Economy • Stigma associated with seeking help • Fragmented prevention/intervention efforts

33. Social Determinants: Unintended Pregnancy Behaviors / Environment • Smoking during pregnancy • Unprotected sex in teens • Substance use during pregnancy Determinants • Parenting • Peer pressure • Self esteem • Awareness of resources • Perceived susceptibility • Perceived consequences • Coherent communication • Fragmented prevention/intervention efforts

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

35. 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

36. Efforts must be… • Sustainable • Consistent • Collaborative • Frequent • Appealing • Appropriate • Accessible • Highly Visible

37. Target 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?

38. Infrastructure 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

39. 5 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

40. CQI: 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?

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

42. References Print 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/1251586911723 Colorado Department of Public Health and Environment 2007 Child Health Survey. (2007). Retrieved May 2011, from http://www.cdphe.state.co.us/hs/yrbs/chs2007PUB.pdf Colorado Health Data: Regional Health Profiles. (2010). Retrieved May 2011, from http://www.chd.dphe.state.co.us/CHDReporting.aspx Colorado Health Information Dataset. Retrieved May 2011, from http://www.cdphe.state.co.us/scripts/htmsql.exe/cohid/brfssfrm1.hsql Community Health Needs Assessment: Bridges Out of Poverty. (2009). Retrieved October 2011, from http://www.mesahealth.org/httpdocs/pdfs/2009-Final%20Report%20April%202.pdf Injury Hospitalization Statistics. (2009). Retrieved August 2, 2011, from http://www.cdphe.state.co.us/cohid/injury.html Mesa County Maternal Child Health Dataset 2009. (2009). Retrieved May 2011, from http://www.cdphe.state.co.us/ps/mch/mchadmin/mchdatasets2009/profiles/Mesa.pdf Mesa County Youth Risk Behavior Survey. (2007). Retrieved May 2011, from http://www.health.mesacounty.us/healthpromotion/pdf/YRBS/Risky%20Behavior.pdf Omni Institute. Retrieved May 2011, from http://clientportal.omni.org/aspire/Pages/quickqueries.aspx Pregnancy Risk Assessment Monitoring System. (2009). Retrieved June 9, 2011, from http://www.cdphe.state.co.us/cohid/pramsdata.html US Census Bureau American FactFinder. (2009). Retrieved June 3, 2011, from http://factfinder.census.gov