Mesa County
Community Health Needs
Assessment- A Case Study
Setting Benchmarks for the 2012-2017
Community Health Improvement Plan
Context
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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:
No turning back…
Mesa County
Continuous Quality Improvement (CQI) Model
Creating a Community Health
Improvement Model
Considering everything else?
• Merging MAPP Phases with “local strategies”
and research.
Colorado Health Assessment and
Planning System (CHAPS)
Precede- Proceed
Model Phases
Community Assessments
Aligning the approaches
LHD System Assessment
Data Collection and Community
Resource Inventory
NPHPSP
CHAPS II
Precede
Phase 1-3
Community Assessments:
Schools Local Services Plan (3yr)
Community Health
Needs Assessment
(CHNA)
CHAPS III
Bridges out of Poverty (2009)
Hospitals (3yr)
United Way (2005, as needed)
CHAPS IV
Community Themes
Assessment
“Forces of Change”
Drivers, Resources,
Integrated Data
Considering MAPP
Mobilizing Action for Partnerships and Planning (MAPP)
“Chunking”- Time as a constraint
MAPP Action & the reality of
“Winnable Battles”
UNINTENDED
PREGNANCY
SUICIDE
OBESITY
Public Health Planning Model
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Creating a Community Health
Improvement Model
CHNA Process
Data Collection and
Community Resource
Inventory
•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
Needs Assessment
(CHNA)
Community Health
Improvement Plan
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
What are your “Priority Areas”
• Mental Health
• Unintended
Pregnancy
• Prenatal Health
• Tobacco Use
• Obesity
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Family Abuse and Violence
Screening
Oral Health
Sexually Transmitted
Disease’s
• Unintended Injuries
CHNA- Who Steers the Ship?
• 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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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
Using Content Focus Groups
• 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 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
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Align with Colorado
“Winnable Battles”
• Clean Air
• Clean Water
• Infectious Disease
Prevention
• Injury Prevention
• Mental Health and
Substance Abuse
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Obesity
Oral Health
Safe Food
Tobacco
Unintended
Pregnancy
6 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 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.”
Mesa County Births with First Trimester Care
90%
88%
87.7%
86.0%
86%
84.4%
84%
82%
81.5%
79.9%
80%
78%
76%
2006
2007
Data Source: Epidemiology, Planning, and Evaluation Branch, CDPHE
2008
2009
2010
Mesa County Hispanic and Non-Hispanic Teen Birth Rates
for Ages 15-19 Years
120
Rate per 1,000
100
80
Hispanic
60
Non-Hispanic
40
20
0
2005
2006
2007
2008
25
Data Source: Vital Statistics, CDPHE
2009
“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 issuethe issue of “healthy minded” parenting.”
“Incentives are weak in light of the perceived costs/time/effort
required to maintain healthy behaviors.”
The latest on Obesity:
Data Source: CoHID, CDPHE
“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.”
Suicide Rates for 2009 - 2010
25
23.2
Rate per 100,000
20
18.4
15
11.3
10
5
0
Mesa County
Colorado
30
Data Source: 2010 Coroner’s Report, Mesa County
Nation
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
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
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
Common Determinants
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Parenting
Availability of resources
Self esteem
Awareness of resources
Perceived consequences
Fragmented prevention/intervention efforts
Coherent communication
Perceived norms
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…
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Sustainable
Consistent
Collaborative
Frequent
Appealing
Appropriate
Accessible
Highly Visible
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?
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
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
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?
Thank You
• Comments/Questions/Suggestions:
– MesaAPC@mesacounty.us
– 970-683-6619
– http://health.mesacounty.us/APC2
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