Community Health Needs Assessment Key Stakeholder Report & Summary of Findings

Transcription

1 Community Health Needs Assessment Key Stakeholder Report & Summary of Findings Mississippi Public Health Institute P.O. Box 2166 Madison, MS

2 Background Community Health Assessment (CHA) is an integral part of public health for informing, setting priorities, cataloguing assets, developing health strategies, and making policies. Through the Gulf Region Health Outreach Program (GRHOP) Primary Care Capacity Project, the MSPHI worked closely with Mississippi State Department of Health (MSDH) District IX to engage local partners, consumers, and providers to aid in the development of a community health improvement plan. Timeline Beginning in late 2012, MSPHI worked with Louisiana Public Health Institute (LPHI) to conduct a rapid community needs assessment. Upon completion of the assessment, the key stakeholder group was convened in December 2012 to identify priority needs. Ten priority needs were identified and the GRHOP project continued to promote clinic-community connections. The MSPHI utilized the MAPP process, in effort to support the PHAB accreditation process for the MSDH, to complete community assessments. In November 2013, MSPHI conducted a series of focus groups and a forces of change assessment. In December 2013, MSPHI conducted a local public health systems capacity assessment with a small stakeholder group. MSPHI then compiled the results, presenting them first to stakeholder groups at the MSDH central office and District IX, and then hosting a large key stakeholder group to develop priorities in March Finally, the key stakeholders met to discuss priority strategies in early May 2014, completing the process. Stakeholder Input Each assessment was detailed in power point presentations for the stakeholders. Invited stakeholders (n=38) represented a myriad of organizations including hospitals, public health, community health centers, community based organizations, medical / professional associations, faith based organizations, the business sector, and schools/education. In attendance at both stakeholder meetings (n = 25 and n = 22), were representatives from each of these sectors except the business sector (the gaming industry was invited but no response was received). The first meeting, held in March 27, 2014, stakeholders discussed the eight combined health priorities from the four MAPP assessments. The eight priorities presented in no particular order were: Obesity Chronic illness Preventive Care Substance abuse Mental Health Access to Healthcare Teenage Pregnancy 2

3 Tobacco Use The stakeholders then voted via electronic decision support tools provided by LPHI on their top three choices. The top three, after a tie breaker, that emerged were: 1. Mental Health 2. Obesity 3. Access to Care The stakeholders were then charged with digesting the information receive and reconvening in 3-4 weeks to discuss strategies. In the meantime, MSPHI staff researched evidence based strategies for each topic selected. MSPHI utilized County Health Rankings and Roadmaps and The Community Guide to guide the evidence based practice research. Additional evidence based resources were identified through a literature review. MSPHI staff came up with a list of 3-5 strategies for each health priority. Stakeholders were reconvened on May 1, 2014 to discuss the strategies and select priorities for implementation. MSPHI utilized a prioritization selection tool (Attachment D) based on the Ohio Health Institute s evidence based model. Modified for each health priority and for Mississippi, sub-groups utilized the tool to select the most feasible and viable strategies for District IX to implement moving forward. The meeting concluded with agreement to narrow the strategies in the arenas of patient navigation to address mental health issues, access to care, repurposing existing infrastructure for physical activity and the built environment to address obesity. Conclusion The commitment from stakeholders is high and partners have done an excellent job maintaining momentum. There were 25 stakeholders at the first meeting and 22 at the second. All but one had attended the initial meeting. Importantly, the effort can further clinic/community linkages on the Coast. The MSPHI recommends that next steps include finalization of strategies to address the three priorities. A community based participatory approach to a health improvement plan will solidify clinic/community linkages. Evaluation strategies should be incorporated for sustainability. 3

4 Attachment A: Focus Group Report Background Focus Groups for Community Health Assessment: Mississippi Public Health District 9 Community Health Assessment (CHA) is an integral part of public health for informing, setting priorities, cataloguing assets, developing health strategies, and making policies. Through the Gulf Region Health Outreach Program (GRHOP) Primary Care Capacity Project, a program in partnership with the Louisiana Public Health Institute, the MSPHI is engaging local partners, consumers, and providers to aid in the development of a community health improvement plan, which is also a goal of the MSDH as it works to gain accreditation. Accreditation requires us to measure our performance against a set of national standards, to look closely at how we operate, and to discover areas that may need improvement. The goal of accreditation is to ensure that Mississippi is served by a public health system that is both effective and efficient, and which offers the highest possible quality of services and protection. Utilization of focus group results enables the community to have a voice in the priority setting process so that decision makers can pick the most workable strategy to address the most pressing community health problems in the specific location. The results contribute to the state s public health accreditation process and state health improvement plan as well as the local community health improvement plan. How Focus Groups Were Conducted MSPHI partnered with MSDH through GRHOP to conduct community health needs focus groups in Public Health District 9, which encompasses George, Hancock, Harrison, Jackson, Pearl River, and Stone counties in the Gulf Coast area of the state. The MSPHI developed a semi-structured moderator s guide and made revisions based on MSDH feedback and GRHOP partners. Facilitators and note takers received orientation. Snowball sampling was used to recruit participants. Initial contacts for the participant list were the MSDH MAPP team in District 9 and health advocates in the communities. Each contact was asked to provide four names and contact information for residents in each locale and the MSPHI coordinator contacted potential participants for confirmation. A total of three focus groups were held with one in each of the following locations - Biloxi, Gautier, and Waveland. Participants represented typical residents who were in the target population for that particular location and whose perceptions are likely to represent individuals living in that community. A total of twenty-three residents participated in the groups. Data analysis was completed using grounded theory. Results from focus groups were read and re-read in a constant comparative analysis. Differences in focus groups among the different areas and populations were noted. Results Community Health; Challenges; Awareness; Forces of Change; Advice 4

5 Community Health Respondents described community health as services and health available to everyone within the community. When asked what a healthy community was, the respondents described communities that support each other, are clean and trash free, have little crime, and take care of the homeless. Additionally, the participants stated that health care accessibility and knowledge of health conditions and how to live healthy lifestyles is essential for a healthy community. The biggest health problems in the communities were cited as obesity, access to mental health services, lack of health professionals specifically case managers, and health insurance (lack of and affordability of). Quotes supporting the aforementioned topics, include: Getting a community to a standard of care where there is less need [makes a healthy community] Support groups are needed It takes 5 months just to get a [mental health] assessment. Family health plus support structure equals a healthy community. Barriers and Challenges Barriers and challenges to having a healthy community included many of the challenges seen across the country, especially in rural areas. Transportation was cited as an issue in two locations but not the third. Where public transportation did exist, participants stated that appointments took all day because of bus schedules and wait times at the clinics. Cost of health services, even with insurance and Medicaid, was cited as a barrier to care. Although green spaces were discussed as a strength of the community, a lack of use of parks and a lack of parks or structured exercise places in the rural areas is a challenge as was the cost of health eating. The health department was seen as a resource for some health services but not as one that encourages a healthy lifestyle. A barrier to utilization of the health department included wait times and perceptions that staff were negative towards consumers. Quotes supporting the themes for barriers and challenges include: The city bus takes your whole day so there s no time to exercise or go to the grocery. There s no outreach. We have a free gym that s not used because no one knows about it. It s too expensive to eat right or get exercise. And when you have to use the bus for everything, you don t have time. These focus groups were also asked about the barriers and challenges to receiving mental health services in the area. A lack of information and stigma about mental health issues was the central theme to barriers for access to mental health care. One person stated, Leaders don t ask or don t pay attention to mental health issues. Another challenge was that the mental health services were centered in the more urban areas, creating a challenge of access for those who lived in the rural parts of the counties. The service is here and is successful, but people don t seek the help. Awareness 5

6 Respondents were not aware of many resources that could help them have a healthy community. Farmers markets and community gardens were cited as assets, but were sporadic. Green spaces and walking trails or parks were not universally discussed as healthy community resources. Participants talked about the health services in the area, but discussed dissatisfaction with availability, accessibility, and quality of those services. When asked where the respondents get their information about health and health services, the response most often heard was word of mouth. Other sources of health information were: television, family, church, and the newspaper. Forces of Change External forces that contribute to the overall health of a community, called forces of change, emerged as a topic during the focus group discussions. Unemployment and local economics were cited as a major factor in what is perceived as a healthy community and what is needed for communities to become healthier. Systemic and individual racism and inequality among races was also an issue. Focus groups discussed that those without insurance or on public assistance had difficulty seeking care and were treated differently than those with jobs, higher income, and private insurance. Participants stated that there was a division of haves and have nots in the Gulf Coast area that contributed to how services are accessed and what services are available. Mental health needs were also discussed. Respondents stated that services exist for those in need of mental health treatment; however, the lack of coordination of mental health services and outreach is a barrier to accessing the services. Advice Each focus group shared suggestions and advice for what they need to make their communities healthier. Each group stated that there is a need to sustain programs that enter their community and that more public leadership is needed. Many individuals stated that the MSDH needs more community outreach. [People need to] take health more seriously. Pay attention to the elderly. We need a central place for information related to health. Change the needs of the people by solving the current problems and providing resources. Change minds the way people think about health. Conclusion Data from these focus groups will be used in combination with a rapid health needs assessment, local public health capacity assessment, key informant interviews and forces of change analysis to inform the selection of priority areas and strategies to improve community health. Results from these focus groups give us the full picture of the values, strengths, challenges, and differences among communities. MSPHI and MSDH will continue to work with partners in Public Health District IX to gather quantitative and qualitative data for the community health assessment process. 6

7 Attachment B: Local Public Health Systems Assessment Background Community Health Assessment (CHA) is an integral part of public health for informing, setting priorities, cataloguing assets, developing health strategies, and making policies. Through the Gulf Region Health Outreach Program (GRHOP) Primary Care Capacity Project, a program in partnership with the Louisiana Public Health Institute, the MSPHI is engaging local partners, consumers, and providers to aid in the development of a community health improvement plan, which is also a goal of the MSDH as it works to gain accreditation. Accreditation requires us to measure our performance against a set of national standards, to look closely at how we operate, and to discover areas that may need improvement. The goal of accreditation is to ensure that Mississippi is served by a public health system that is both effective and efficient, and which offers the highest possible quality of services and protection. Utilization of a local public health systems capacity assessment (LPHSA) allows stakeholders and those who work with the public health system a voice in how the system interacts to serve populations. The results contribute to the state s public health accreditation process and state health improvement plan as well as the local community health improvement plan. Conducting the Assessment MSPHI worked with the MSDH District IX office in order to get stakeholder participation. Available to participate were representatives from the health department, a health educator, a representative from GRHOP, and a representative from the community health center. Participants were given the National Public Health Performance Standards (NPHPS) Local Public Health System Assessment Instrument (Local Instrument) to review prior to a community meeting. Then the stakeholders met over a period of several hours to fill out the assessment, facilitated by MSPHI consultant. Assessment Findings The findings were based on the ten essential public health services and are outlined as such below. 1. Monitor health status to identify and solve community health problems. The team rated the capacity to meet this service at the local level MINIMAL. The local public health system does not currently conduct ongoing community health assessments but has discussed the need to do so.. Additionally, monitoring does occur at a local level but all data goes to a central state repository. Instructions regarding addressing trends and health status come down from the 7

8 same central office. District staff are interested in on-going monitoring in order to better anticipate public health needs. 2. Diagnose and investigate health problems and health hazards in the community. This service was deemed SIGNIFICANT through the LPHSA. The local systems have the ability, capacity, and authority to diagnose and investigate problems that affect public health. Specifically effective is the capacity to address emergent and disastrous outbreaks and incidents. The District has extensive experience in weather related emergencies (hurricanes Katrina, Rita, and Issac) and in outbreaks (influenza) 3. Inform, educate, and empower people about health issues. The local public health system has a lot of capacity to achieve this essential service, however, the service assessment was deemed MINIMAL to MODERATE due to several critical factors. Communication and empowerment are often reactive, not proactive. MSDH has a centralized communication system that is state driven. Local systems (FQHC, Hospital, etc) have communication departments that do not collaborate. Coordinated public health messages are not common. An obvious and significant strength is the use of the HAN (Health Awareness Network) and emergency communications plans. There is one health educator for the District. Prioritization of District health education activities could better leverage local strengths and gaps and programs, policies and partnerships at the state level through the Offices of Preventive Health Services and Field Services. 4. Mobilize community partnerships and action to identify and solve health problems. Participation in activities involving preventive health and health education activities are coordinated by the Health Educator in District IX area, creating not only a strength but a weakness as well. Other health systems participate in these activities, but due to the breadth of work that has to occur, the activities are disjointed. Therefore the capacity for this service was deemed MINIMAL. The District has a good reputation in the community and perceives a willingness among partners to mobilize and work collaboratively. 5. Develop policies and plans that support individual and community health efforts. This service is met and exceeded where public health emergencies exist. Policies and procedures surrounding emergent issues, specifically man-made and natural disasters, exist. However, ongoing assessments regarding chronic health issues or health improvement do not exist. Therefore, the capacity for this service fluctuates between NO ACTIVITY and SIGNIFICANT, depending on the situation. A cited strength was policy and statute that command the municipalities to provide infrastructure (buildings, etc.) for public health activities. Policy and environmental change 8

9 efforts have typically been reactive and the District would like to engage in proactive policy education around chronic illness, access to care and coordinated approaches to community health (eg. mental health, highway safety, Medicaid) 6. Enforce laws and regulations that protect health and ensure safety. In the six county area assessed, stakeholders identified the enforcement of existing laws and policies around public health issues a strength. Grass roots efforts are ongoing for advocacy for improved health. The capacity is MODERATE to SIGNIFCANT for this essential service. Examples of District activities include car seat safety, tobacco laws and enforcement, and environmental policies, such as water safety and marine patrol. 7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable. According to stakeholders, protocol exists to link patients and consumers to needed personal health services, but attainment of linkage is often not achieved due to personnel shortages and lack of resources. Sporadic programming exists to link special populations of existing patients (or self-identified patients) to needed services, but is largely determined by contingent funding. Outreach of health systems to unreached populations is rare; therefore this service capacity was assessed as MINIMAL. The district is interested in learning more about MSDH central office efforts to assure the provision of health care as a vehicle to improve access on the coast. 8. Assure competent public and personal health care workforce. Activities at the local level to assure a competent and solid workforce are limited to licensure activities that are centralized at the state level. Most counties in Mississippi are rated as health professional shortage areas. The greatest strength for this essential service surrounded training and continuing education. The assessment of this service was MINIMAL. At present, the District has an Acting Health Officer and Social Work Supervisor vacancies in addition to several county level vacancies. The District staff completed Evidence Based Public Health Training recently and eagerly utilizes ongoing professional development, continuing education, and central office trainings as they are available to the staff. 9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services. Currently, a CHA is in progress. Most health systems do evaluate patient population quality and satisfaction, but there is no collaborative effort to evaluate population based health services at the local level. There are NO ACTIVITY to MINIMAL efforts for this service. There are potential partners to assist with evaluation on the coast. The University of Southern 9

10 Mississippi, Coastal Family Health Center, and the Mississippi Public Health Institute are examples of existing partnerships that could be expanded help with evaluation efforts. 10. Research for new insights and innovative solutions to health problems. Research efforts for new insights or innovative solutions are not occurring at the local level and assessed as NO ACTIVITY to MINIMAL. Though health systems at the local area form meaningful partnerships for programming and potential for research, the human resources are non-existent for research to be ongoing. Public health systems and services research has been conducted in the past (eg post Katrina) but has not engaged the District Office. The GRHOP initiative offers opportunities to research innovative solutions to local problems. MSPHI will conduct a study of facilitators and barriers to patient centered care among primary care physicians in The District should be a partner in planning, conducting and reporting results. Discussion Capacity assessments should occur on a regular basis in order to be effective in transformational change for local public health systems. When coupled with other pieces of comprehensive community health assessments, the local public health system assessment information can be used in community health improvement planning. Specifically, in MSDH District IX, this information can be used to address the most notable gap in the assessment the lack of comprehensive collaboration across all health issues. The district excels in emergency and disaster preparedness and response. Strengths from these processes can be applied to other health threats, resulting in improved community health. 10

11 Attachment C: Asset Map 11

12 Attachment D: Prioritization Tool MISSISSIPPI Evidence in Action Community Guide Project (02/17/14) Evidence-Based Strategy Selection Worksheet ISSUE STATEMENT: Obesity_ Strategy / Intervention: _Built Environment Excellent Good Neutral/ Fair Poor Not Sure Strength of evidence Readiness Coordination Available Funding Political will and timing Feasibility Reach Addresses Disparities Total (out of 40) Definitions Strength of evidence: recommended rating from the Community Guide and/or is a recommendation from another authoritative source that is a more specific strategy that aligns with a broader recommendation from the Community Guide. o 5 if recommended Community Guide rating o 5 if scientifically supported What Works for Health rating o 4 if some evidence What Works for Health rating Readiness: some groundwork has been laid for the strategy in Mississippi; the strategy is already being implemented in some local communities but needs to be scaled up or spread throughout the state; low-hanging fruit Coordination: avoids duplicating current efforts and/or adds value in some way to existing work; would accelerate or expand existing work in a meaningful way Available funding: we can identify potential funding sources for implementation and/or the strategy requires minimal funding Political will and timing: the timing is right within the current political context Feasibility: realistic and can be accomplished within the project timeframe Reach: estimated number of people to be impacted by the strategy and potential to be implemented statewide in urban, suburban, and rural communities 12