Community Health Improvement Plan

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1 Clark County, Ohio ~ Community Health Improvement Plan (CHIP): 1 Year Update ~ September 30, 2014 Clark County, Ohio ddereweres Community Health Improvement Plan Update The Community Health Assessment and Improvement Plan for Clark County is an effort that began in 2012 and with an assessment of the health of the Clark County population. The assessment informed a Health Improvement Plan created through collaboration of many community agencies and residents. These essential partners continue to demonstrate their commitment to Clark County wellness as they continue task force work in the five areas of focus for the Improvement Plan. Fall 2014 Winter/Spring 2015 Spring 2015 Summer 2015 Fall/Winter 2015 Spring 2016 Proposed Plan for Upcoming Assessments Activities Community Health Improvement Plan Updates/Revisions Community Health Assessment and Group Evaluation (CHANGE) Tool Completion Youth Risk Behavior Survey Administration Clark County Behavioral Risk Factor Surveillance System (BRFSS) Administration Clark County Community Health Assessment (primary and secondary data analysis) Community Health Improvement Plan Network of Care: Clark County Data Through the Ohio Department of Health, Clark County has access to a dashboard comparing Clark County statistics to state, national and Healthy People 2020 standards. Visit and select Public Health to search for data. Please call the epidemiologist at Clark County Combined Health District (937) for questions or assistance to navigate the site. Note: When using the site, be aware that the age of the data may vary from the data in the most recent Community Health Assessment. Updated 10/01/2014 (3) If you would like to receive occasional correspondence regarding the Community Health Improvement Plan in Clark County, send an to to indicate your interest. 1

2 Manage Chronic Disease Healthy Births and Sexuality Clark County, Ohio ~ Community Health Improvement Plan (CHIP): 1 Year Update ~ September 30, 2014 Goals Identify and engage pregnant women in first trimester prenatal care. Improve access to care and optimize health care resources. Outcome Identified Development of a uniform message for all agencies to use (for both positive and negative pregnancy tests) Assessment of the community s patient navigator capacity to meet the need Healthier babies Have a plan in place to assess eligibility and enroll people in Medicaid. Establish a method to track the impact of having more organizations and professions recognizing, agreeing to, and supporting the plan Federal dollars coming into the community to support health care services are maximized Medical homes for Medicaid beneficiaries with chronic conditions Strategies Increase the focus on outreach and education about early signs of pregnancy, and ways to improve access to pregnancy testing. Strategy 2: Gradually build capacity to serve women if strategy 1 is successful. Provide community education about what Medicaid expansion will mean for Clark County. Strategy 2: Articulate the role of lead agencies in the community that have a bearing on the goal. Action Plan Strategy 1 Action 1: Inventory the list of those agencies and/or programs that provide pregnancy tests and those who first come in touch with the target population. Action 2: Help the community as well as teens to understand the need for prenatal care. Action 3: Develop a deepening and sustained relationship with the schools so that education about abstinence, contraception, pre-conception care, and prenatal care is delivered. Action 4: Engage Primary Care Providers in educating teens (beginning at about the age of 15). Strategy 2 Action 1: Add capacity to Patient Navigator Programs in Clark County to serve the increased number of women who are entering earlier into prenatal care. Strategy 1 Action 1: Use campaign to convince people to sign up for Medicaid so they have a Medical home (physician) and get preventive care. Action 2: Promote the Rocking Horse Center, a Federally Qualified Healthcare Center (FQHC), resources. Action 3: Conduct physician education so that physicians refer Medicaid eligible clients to the FQHC, because its Medicaid reimbursement rate is more favorable. Strategy 2 Action 1: Define an agreed-upon role for the FQHC. Action 2: Define the role of health professionals. Action 3: Define the role of the Department of Job and Family Services in directing people to care. Action 4: Define the role of the Hospital and its physicians who have taken a leadership role in speaking out about care for the uninsured. Progress Report September 2014 A written tool has been drafted with the intent to communicate services offered in Clark County for women who are seeking a pregnancy test and follow- up services. The tool will help agencies assist women and families to enter into prenatal care early in pregnancy. Memorandums of Understanding (MOUs) are being negotiated and signed between agencies to allow a common understanding of the purpose of the tool, the intended scope of use and the maintenance of the tool. The Task Force continues to meet regularly in person, but is also utilizing a Facebook page for efficient/effective communication between Task Force members. Funding raised by Community Mercy Foundation is being utilized by Rocking Horse Community Health Center (RHC) to increase capacity to accept referrals to primary care from Springfield Regional Medical Center (SRMC). RHC has hired two new Nurse Practitioners. SRMC and RHC have designed a process to navigate clients without a medical home to primary care at RHC. The first target group of clients who are being referred in this new process are those who are: 1) admitted to SRMC; 2) with a diagnosis of diabetes; 3) who do not have a medical home. A scorecard is under development, which will be a key tool in tracking measures of progress. Note: intent of referral project is to expand to diagnoses other than diabetes once process has demonstrated efficiency. Discussion regarding Congestive Heart Failure has begun. Some steps to address challenges with clients being able to afford diabetic testing supplies. Next Steps As of September 2014 Finalize the written communication tool; print and distribute Measure the utilization or the impact of the tool in identifying and engaging pregnant women in the first trimester prenatal care Brochure about RHC with appointment information is being finalized; tool will be made available to the case managers on SRMC inpatient units Develop tool to track outcomes Consider formalized expansion of referral program Continue to work on availability of diabetic testing supplies and medications Assess the capacity of the various diabetic education programs in the community; potentially increase patient navigation to appropriate programs RHC is planning to become an ADA certified diabetic education and selfmanagement site Supported 2014 Covering Clark County Initiative led by RHC and supported by many Clark agencies. The campaign increased awareness of new options for health coverage through Medicaid expansion and the Affordable Care Act. Expand Task Force membership Updated 10/01/2014 (3) If you would like to receive occasional correspondence regarding the Community Health Improvement Plan in Clark County, send an to to indicate your interest. 2

3 Improving Mental Health Prevent Obesity Clark County, Ohio ~ Community Health Improvement Plan (CHIP): 1 Year Update ~ September 30, 2014 Goals Outcome Identified Strategies Action Plan Progress Report September 2014 Next Steps As of September 2014 Change school culture to impact child and family wellness by: 1) increasing knowledge about food and exercise choices; 2) modifying systems and programs that can aid such choices Select an evidence-based program to address nutrition and exercise in one school. Target activities to families with things like family walking clubs, healthy cooking. Test the efficacy of the program and expand; align community resources. Implement a child health, multidimensional, school-wide, evidence-based program in Lincoln Elementary as a pilot program to determine what works and then scale up to additional schools. Strategy 1 Action 1: Establish a community-wide partnership with the selected school. Action 2: Establish a data baseline so that results can be measured. Action 3: Select a program that benefits all students like a community garden, family walking club, etc., with some elements that support a cohort of students to embed peer support. Action 4: Engage all partners. In the few months immediately after the CHIP formation, there was some after-school programming that occurred at select Springfield City Elementary school buildings; however, the desire was for a more formalized program showing some sustainability and measurement. Recently, it became clear that the Obesity Task Force of the CHIP has many of the same goals and target groups as a project that has been occurring in the schools, Healthy Students, Healthy Communities, and the 2 work groups were combined. The Child and Family Health Services funding passed down to communities through the health districts; in the current grant year, there is now an allowance to use the funding to plan and implement the CATCH program. Implementation of the CATCH program as an after-school program in three of the Springfield City School Districts Evaluation of CATCH program Opportunities for expansion as more resources would be directed to this program include: o More intense programming (with increased number of sessions during the program) o o Expansion to other schools Expansion from after-school only programming to integration of CATCH program throughout the school day Promote the mental health and well-being of youth in Clark County for the nearand longterm Redirect EMS frequent users to appropriate care and reduce 911/EMS overuse so as to direct resources to where they are more effective Significant reduction of externalizing problems at the end of the academic year for participating schools. Expand to other schools Participating students will have substantially lower prevalence risk behavior; will have higher rates of high school completion. Hospital and EMS data exchange process is developed. Data exchange system implemented; clinical pathway management model developed. : Potentially $80,000 saved annually. Implement the Good Behavior Game (GBG) eventually in all school buildings in Clark County. Develop and implement a Hospital/Clinic EMS data exchange and a better clinical pathway management model. Action 1: Create Nurturing Environments The umbrella under which GBG stands. Action 2: Use Kernels (fundamental units of behavioral influence that underlie effective prevention and treatment for the most common and costly problems of behavior and an increase in the prevalence of well-being). Action 1: Establish a better clinical pathway management model vis-à-vis a 911 Emergency Communication Nurse System (ECNS) Nurse Navigator. Action 2: The ECNS takes a more detailed history of the complaint and determines the most appropriate response/destination. Action 3: Connect with the non ED partners/services, and specifically with that patient s health network (PCP, medical home, and Urgent care clinics). Action 4: Educate the population about the 911 system. Houston, Texas experienced a measurable impact on call volume from doing so. Action 5: Establish face to face contact by a health and human service team which is shown to permanently reduce calls from frequent users. Progress Report for Mental Health & Recovery Board of Clark, Greene, Madison Counties (MHRB) co-sponsored 6 trainings to different target groups educating approximately 100 Clark County teachers and professionals. Through MHRB funding, capacity is being created within the agency WellSpring, to support expansion in interested Clark County schools. Training of WellSpring staff is occurring. Funding by Community Health Foundation was secured by Family and Children First Council and was used to purchase kits. State Mental Health and Addiction Services grant awarded in September 2014 to increase classroom-based training and coaching for Clark Schools. Progress Report for Investigation into practices being used to serve and redirect (if appropriate) frequent users of EMS services. One concept is paramedicine ; however, barriers to its implementation include liability that occurs when EMS workers work outside the scope of emergency response. Met with Medicaid representatives to investigate the possibility of a funding model that would allow a discipline to be paid for the type of interventions needed to meet client needs without utilization of 911/EMS calls. A Memorandum of Understanding (MOU) between Springfield Fire and Rescue and United Senior Services (USS) is underway as an alternate intervention to reach out to frequent 911 users, establish link to services and care in order to reduce EMS/911 usage. Next Steps Continue Implementation of PAX GBG Aim to secure commitments from 6 schools to train 40 teachers in 2015 Increase awareness of community kernels of PAX GBG Next Steps Finalize MOU between USS and Springfield City Division of Fire and EMS Introduction and training for USS personnel and volunteers Implementation and Measurement of Impact of USS outreach Updated 10/01/2014 (3) If you would like to receive occasional correspondence regarding the Community Health Improvement Plan in Clark County, send an to to indicate your interest. 3

4 Preventing Substance Abuse Clark County, Ohio ~ Community Health Improvement Plan (CHIP): 1 Year Update ~ September 30, 2014 Goals Outcome Identified Strategies Action Plan Progress Report September 2014 Next Steps As of September 2014 Mobilize a community coalition to address substance abuse issues in Clark County. Build, coalesce, develop the baseline data to drive insight to interventions Interventions are begun which are data-driven; measurable outcomes may be available by this time Use the data to evaluate the effectiveness of the interventions; promote resilience and decrease risk factors in individuals, families, and communities; reduce the incidence of substance abuse Model practices from the Strategic Prevention Framework to assess community readiness, determine resources available, and to develop a datadriven method. Action 1: Assess prevention needs based on epidemiological data. Work toward a central clearinghouse of substance abuse data. Action 2: Form an Adult death review committee to review mortality data. Action 3: Build prevention capacity by addressing the need for more professionals, more data capacity, and more effective interventions. Action 4: Develop a strategic plan that uses data to inform priority strategies. Note: The CHIP Report addresses a number of sub-strategies under these 4 Action items. For further detail on interest in Project DAWN or SOLACE, please see CHIP or contact the Mental Health Task Force. Established a Clark County Substance Abuse Prevention and Treatment Coalition. Purchased 100 Narcan kits for Clark County. Created a local letter which warns incarcerated persons about their elevated risk for overdose if returning to similar use levels after incarceration Collected data from multiple agencies to establish baseline description of the local issues. Increased media coverage to educate about addiction. In process of implementing an adult/youth survey in community. Continue gathering data to quantify the community s substance abuse Continue to increase awareness of substance abuse and community interventions Create a death review committee for all drug-related deaths in Clark County. Implement training for families and friends regarding Narcan use Educate businesses about substance abuse Identify or create Opiate Abuse resources online ******** Quality of Life Survey Clark County Purpose The Clark County Quality of Life Survey is a tool to gather information about the priorities and perceptions of community members. This information is used to evaluate the alignment of the Community Health Improvement Plan with the perspectives of the Clark County residents. Graphs are used to report the results of this survey and are included in the following pages. Method Data collection for this survey occurred between June -May 2014 The survey tool included 3 parts: o Community Health o Demographics o Quality of Life The demographic collection was crucial during the analysis of the information and allowed for weighting to assure the sample size represented the distribution of the population of Clark County with regards to geography, age, sex, race, and ethnicity. Updated 10/01/2014 (3) If you would like to receive occasional correspondence regarding the Community Health Improvement Plan in Clark County, send an to to indicate your interest. 4

5 Clark County, Ohio ~ Community Health Improvement Plan (CHIP): 1 Year Update ~ September 30, In the following list, what do you think are the most important factors for a "Healthy Community"? (Those factors which will improve the quality of life in a community.) In the following list, what do you think are the most important "risky behaviors" in our community? (Those behaviors which have the greatest impact on overall community health.) 160 In the following list, what do you think are the most important "health problems" in our community? (Those problems which have the greatest impact on overall community health.) 60.0% How would you rate the overall health of our community? % % % % 10.0% 0.0% Very unhealthy Unhealthy Somewhat healthy Healthy Very healthy Updated 10/01/2014 (3) If you would like to receive occasional correspondence regarding the Community Health Improvement Plan in Clark County, send an to to indicate your interest. 5

6 Clark County, Ohio ~ Community Health Improvement Plan (CHIP): 1 Year Update ~ September 30, 2014 Approximately how many hours per month do you volunteer your time to community service? (e.g., schools, voluntary organizations, churches, hospitals, etc.) 60.0% How would you rate your own personal health? 60.0% 50.0% 50.0% 40.0% 40.0% 30.0% 30.0% 20.0% 20.0% 10.0% 10.0% 0.0% None 1-5 hours 6-10 hours Over 10 hours 0.0% Very unhealthy Unhealthy Somewhat healthy Healthy Very healthy 1 (NO!) (YES!) Quality of Life Questions Are you satisfied with the quality of life in our community? 7.7% 20.3% 35.2% 29.1% 7.7% Are you satisfied with the health care system in the community? 14.6% 25.8% 31.1% 21.8% 6.6% Is the community a good place to raise children? 6.3% 18.3% 40.1% 27.2% 8.2% Is this community a good place to grow old? 9.4% 13.4% 35.4% 30.8% 11.0% Is there economic opportunity in the community? 13.2% 28.0% 39.5% 16.7% 2.7% Is the community a safe place to live? 5.6% 20.4% 39.5% 27.4% 7.0% Are there networks of support for individuals and families during times of stress and need? 4.3% 12.0% 31.5% 39.4% 12.8% Do all individuals and groups have the opportunity to contribute to and participate in the community's quality of life? 4.7% 12.6% 40.4% 33.0% 9.3% Do all residents perceive that they - individually and collectively - can make the community a better place to live? 8.6% 27.0% 39.6% 19.7% 5.1% Are there a broad variety of health services in the community? 5.1% 17.9% 35.5% 30.9% 10.6% Is there a sufficient number of health and social services in the community? 6.0% 19.0% 31.8% 32.9% 10.3% Are there levels of mutual trust and respect increasing among community partners as they participate in collaborative activities to achieve shared community goals? 6.8% 23.5% 42.6% 23.2% 3.8% Is there an active sense of civic responsibility and engagement, and of civic pride in shared accomplishments? 7.8% 20.4% 47.9% 19.6% 4.2% Updated 10/01/2014 (3) If you would like to receive occasional correspondence regarding the Community Health Improvement Plan in Clark County, send an to to indicate your interest. 6

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