One of my top goals over the last 24 years has been to make Oakland County one of the best places to live, work, play, and raise a family. This includes improving the quality of life through active and healthy lifestyles. Oakland County Health Division has embraced this vision which is reflected in the creation of a community health improvement initiative known as Energizing Connections for Healthier Oakland or ECHO.

Today, I am pleased to share the official release of the ECHO Community Health Improvement Plan (CHIP). It builds on an impressive countywide community health assessment. It is also based on evidence and best practices. Created by a cross-sector partnership of organizations, the CHIP serves as a roadmap toward improving the quality of life in Oakland County through better health.

The CHIP provides a first-of-its-kind opportunity to move the mark forward on health by utilizing the data compiled from the ECHO assessments to align policies and programs around the county. Whether you choose to implement a worksite wellness initiative or enhance a community program to support the CHIP, the collective impact of many businesses and organizations collaborating on common health improvement goals will be significant.

Please join me in supporting the Community Health Improvement Plan. Visit the Oakland County Health Division website at www.oakgov.com/health for the next steps to take and ways to be involved. Together we can achieve an even healthier Oakland.

L. Brooks Patterson Oakland County Executive A Community CALL TO ACTION

Oakland County is a large, diverse community with many resources; however, many preventable health risks still exist. A healthy community is more than the absence of disease; it is the result of numerous factors, including income, education, neighborhood and community design, infrastructure quality, access to healthcare, healthy food, and opportunities to be physically active. Jaimie Clayton Oakland Family Services Building on the success of existing collaborations, the Oakland President/CEO ECHO Co-Chair County Health Division organized Energizing Connections for Healthier Oakland (ECHO), a health improvement initiative. Led by a 30-member, cross-sector Steering Committee, ECHO facilitated developing a community-driven, comprehensive health assessment and health improvement plan that addresses pressing health issues in Oakland County.

The ECHO Community Health Improvement Plan (CHIP) for Oakland County outlines goals, objectives, and actions that can Bonnie Kincaid move the needle on health for five strategic issues. Community Oakland County Medical Authority Executive Director ownership allows for measurable impact to occur as so much more ECHO Co-Chair can be accomplished by working together. This invitation to the community calls for action to address the CHIP strategic issues. Whether your organization is developing a strategic plan, building a new program, or providing ongoing services that align with the CHIP strategic issues, it is important to document and link these community-wide initiatives to build an all-inclusive approach to health improvement. Together we can fulfill the ECHO vision of healthy people connected to a thriving community.

Kathy Forzley Sincerely, Oakland County Health Division Manager/Health Officer Jaimie Clayton Bonnie Kincaid Kathy Forzley

CHIP • 2016 ii

TABLE OF CONTENTS

Oakland County Overview...... 1

Core Principles...... 6

Strategic Issues Overview...... 7

Strategic Issue - Healthy Eating...... 9

Strategic Issue - Active Living...... 15

Strategic Issue - Built Environment...... 23

Strategic Issue - Access to Care...... 31

Strategic Issue - Data & Informatics...... 39

Moving Forward...... 43

Acronyms...... 50

Endnotes...... 51

OAKLAND COUNTY HEALTH DIVISION MANAGER/HEALTH OFFICER Kathy Forzley

WRITERS Lisa McKay-Chiasson, Leigh-Anne Stafford, Carrie Hribar, Shannon Brownlee, Dan Muncey

CONTRIBUTING EDITOR Donna Genre

GRAPHIC DESIGNER Lona Bentley

PHOTOGRAPHY Oakland County Parks & Recreation, Shutterstock

PRINT Fudge Business Forms

CHIP • 2016 iv

Oakland County Overview

Oakland County is located on the northern border of sectors being Professional and Business Services (26%); the City of Detroit and Wayne County. With a population Trade, Transportation, and Utilities (18%); and Private of 1,220,798, Oakland County is the 2nd most popu- education and Health Services (16%).16 The county’s lous county in Michigan and the 32nd most populous unemployment rate dropped to 4.2% in November 2015 nationally.1,2 Oakland County is home to nearly 30% of from a high of 15% in July 2009. More than 97,000 jobs the 6-county Metro Detroit region’s population.3 Since have been added since the low point of the recession 2010, Oakland County’s population has grown by 3%, an in the first quarter of 2010.17 Oakland County is home to increase of 35,506 people which is the fastest growth nearly 1,000 firms from 39 foreign countries.18 in Metropolitan Detroit.4 Seventeen percent of Oakland County’s population is five to 17 years old, while 15% Since 1992, Oakland County has been governed under of Oakland County’s residents are age 65 or older.5 the authority of County Executive L. Brooks Patterson. Mr. Patterson’s tenure as the County Executive has Oakland County’s population consists of approximately been highlighted by a number of business practices to 79% Caucasian, 14% African American (the second expand economic development and security, including largest African American population in Michigan next to a balanced three-year, rolling, line-item budget, which Wayne County), 6% Asian (the largest Asian population has resulted in a AAA bond rating since 1998 for prudent in the state of Michigan), less than 0.5% Native Hawaiian/ fiscal policies.19 Pacific Islander, and 1% were some other race.6 An esti- mated 4% of Oakland County residents were Hispanic.6 Another important initiative of Mr. Patterson is his Nearly 14% of the population speaks a language other emphasis on quality of life in Oakland County, with a than English (compared to Michigan at 9%).7 According long-standing committee of his Business Roundtable to the U.S. English Foundation Inc., Oakland County’s that generates recommendations for improving quality 77 total languages rank second in the state and 41st of life. The ultimate goal of Mr. Patterson is to make nationally for the number of languages spoken.8 Oakland County one of the best places to live, work, and play. This emphasis on quality of life has been embraced The county has 28 school districts with 531 public by many county departments, including Oakland County and nonpublic schools.9 In the 2014-2015 school year, Health Division (OCHD) through its community health K-12 enrollment was approximately 207,000 children improvement process. and adolescents, with 188,460 from public schools and 19,026 from nonpublic schools.9

Oakland County covers an area of 907 square miles.10 It has 35,247 acres of water, including 1,468 natural lakes and the headwaters of five major rivers.11,12 Res- idents enjoy 83,087 acres of park, recreation, and open land, including 13 county parks, eight state parks, three Metroparks, and numerous local parks.12,13

Oakland County is an employment hub in Michigan, with approximately 580,000 employed workers, 262,165 of which commute from another county.14,15 Oakland County has a diverse economy, with the top three employment

CHIP • 2016 1 A CALL TO ACTION

The ECHO Community Health Improvement Plan (CHIP) national plans. Each strategic issue includes ideas for is intended to act as a blueprint to engage all sectors involvement identified for a variety of sectors, and how of the community in Oakland County. This living docu- to participate with ECHO and the improvement activities. ment will evolve as conditions, resources, and needs of the community change. The CHIP was created The CHIP is a call to action for Oakland County. Every by involving multiple voices and perspectives from governmental agency, community organization, busi- the community. ness, and individual can play a role in improving the health of our community. This plan provides a roadmap ECHO organized the plan around five strategic issues to align and link ongoing and future initiatives to make prioritized from the data and information compiled from the best use of valuable resources. As you review the the Community Health Assessment (CHA). Each strategic plan, consider how the goals and objectives align with issue has goals, objectives, and suggested actions that those within your organization and how you intend can empower those looking to participate. Additionally, to join this call to action. To get involved with the issues there are measures to track progress and tables that or actions included in the plan, please contact ECHO at describe alignments of CHIP objectives to state and [email protected].

“HEALTHY PEOPLE CONNECTED TO A THRIVING COMMUNITY” BACKGROUND

OCHD began work on its CHA and CHIP in 2013, by In December 2013, a 30-member, cross-sector Steering selecting Mobilizing for Action through Planning and Committee was assembled to oversee ECHO and Partnerships (MAPP) as a framework to guide the process. includes representatives from hospitals, human services, MAPP is a community-driven strategic planning process behavioral health, higher education, businesses, parks for improving health, developed by the National Associ- and recreation, economic development, emergency re- ation for County and City Health Officials (NACCHO). sponse, community organizations, and elected officials. OCHD titled the initiative Energizing Connections for One of the first tasks of the ECHO Steering Committee Healthier Oakland, or ECHO, and assembled a group of was creating ECHO’s vision, which is “Healthy people five staff, the ECHO Core Group, to work on this endeavor. connected to a thriving community.” ECHO engages the community in a recurring process to: Early in the process, the ECHO Steering Committee 1. Identify – Gather data to create a snapshot of engaged the community to identify their thoughts and health in the county. attitudes around the meaning of a healthy community through the use of Four Question Boards. These boards 2. Prioritize – Rank health issues and determine which were displayed at events across the county, and com- ones to address. munity members were invited to write their responses to the questions. ECHO used these answers to develop 3. Act – Develop a coordinated plan to empower all visual displays of the community’s interpretation of what partners throughout the community to help improve health means to them. the health of the county. See exhibit 1.1

2 CHIP • 2016 Exhibit 1.1: What health means to the community

A community kickoff was held in April 2014, to officially use of question boards, focus groups, and a county- launch ECHO to the community. Over 100 partners and wide survey. community members attended to learn about ECHO and sign up to participate further. This event also commenced • Local Public Health Status Assessment (LPHSA) – the start of data collection and information gathering The LPHSA team examined the delivery of essential through four assessment teams. Additionally, the ECHO public health services by all partners in Oakland Data Dashboard was introduced. The Data Dashboard County and identified strengths, weaknesses, and will serve as a one-stop shop for monitoring data and opportunities for improvement in the public health indicators in the CHIP. system. This assessment used the National Public Health Performance Standards as a tool for analysis The four assessment teams include: of service delivery.

• Community Health Status Assessment (CHSA) – The • Forces of Change Assessment (FOCA) – The FOCA CHSA team used quantitative data to identify the team looked at all the forces and associated opportun- top health conditions in Oakland County and also ities and threats that can affect a community, either examined where health inequities exist. now or in the future. Initial thoughts regarding forces and their importance to the health of the community • Community Themes & Strengths Assessment (CTSA) – were gathered in an electronic survey, and in an The CTSA team identified community assets and in-person meeting to solidify the top forces impacting perceptions about health and quality of life through Oakland County.

CHIP • 2016 3 Data collection and compilation by the four assessment data that resulted in selecting five strategic issues that teams concluded in May 2015. Each team identified top would be the focus of the ECHO Community Health themes, opportunities, and/or concerns that arose from Improvement Plan (CHIP) for Oakland County, as well the data. The ECHO Core Group assembled all the as core principles that will shape the work to come. information into summary reports that were presented to the Steering Committee in August 2015. They had The Steering Committee then completed the develop- a robust discussion about the recurring themes in the ment of goals, objectives, and suggested actions for

EXHIBIT 1.2: ECHO TIMELINE

1 ECHO Steering Local Public Health 5 Committee Orientation System Assessment (LPHSA)

Introduce committee members to the Establish team, discuss essential MAPP/ECHO framework and their services, identify organization activities, roles and responsibilities. complete performance measures instrument, discuss results, and identify the challenges/opportunities. 2 Visioning Design visioning process and hold visioning session.

DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR

3 Community Themes and Strengths Assessment (CTSA) 4 Community Health Status Assessment (CHSA) Identify team and resources; hold community dialogue and focus groups; Conduct data collection of core develop, disseminate, and collect indicators, select and collect additional community survey; and conduct inter- indicators, analyze the data and create views with residents/key leaders. a health profile, disseminate health profile, establish a system to monitor data over time, and identify the challenges/opportunities.

4 CHIP • 2016 the CHIP’s five strategic issues: healthy eating, active reference of state and national plans for each strategic living, built environment, access to care, and data and issue to finalize the plan. informatics. The suggested actions are intended as a starting point that community organizations and busi- In February 2016, the CHIP was finalized by the ECHO nesses can consider for getting involved. The ECHO Steering Committee. This is the community’s plan to im- Core Group was empowered by the Steering Committee plement, monitor and update as new information emerges to integrate evidence-based practices and a cross-section that impacts Oakland County’s health and quality of life.

7 Identify Strategic Issues Identify potential strategic issues, discuss issues – why they are strategic/urgency, prioritize issues.

Formulate 8 9 Community Health Goals and Strategies Improvement Plan (CHIP)

Develop goal statements and strate- Final report outlines action to address gies, explore implementation details, each selected priority, supporting data select and adopt strategies, and draft and responsible parties. planning report.

APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG

Organize for Action 10 Develop objectives, agree on accountability, and develop action plans. 6 Forces of Change Assessment (FOCA)

Prepare the forces of change Release CHA and CHIP 11 assessment, hold brainstorming session with team, simplify list, Launch at community event. and identify threats/opportunities.

Implementation and Monitoring 12 Create work groups and develop action plans.

CHIP • 2016 5 CORE PRINCIPLES

Core Principles • Collaboration & Community Partnership – Partners in the local public health system commit to building The ECHO Steering Committee identified the following upon the existing, strong partnership base in the core principles that will guide the health improvement county, coordinating efforts, and sharing resources. process, including the CHIP and Action Plan, and future community health assessments. • Equity – ECHO will continue to monitor the social determinants of health in Oakland County, with the ultimate goal of achieving the highest level of health • Access – Quality health and human services should for all people. be available, affordable, and easily navigable to all community members. • Civic Engagement – Oakland County residents aspire to make a difference in their communities, becoming • Education – Education is a critical component in more connected to their neighbors, and improving promoting prevention, improving health literacy, and quality of life. reducing health inequities. • Communication – Information is shared openly • Resource Awareness – Agencies actively promote among the partners in Oakland County. ECHO will and share resources among partners and clients in continue to communicate with community members the community. and residents as efforts occur to improve health.

6 CHIP • 2016 STRATEGIC ISSUES

HEALTHY ACTIVE BUILT ACCESS DATA & EATING LIVING ENVIRONMENT TO CARE INFORMATICS

Strategic Issues Goals: • Foster improvements in the built environment to The ECHO Steering Committee reviewed data and create a more connected, livable community. themes from the Community Health Assessment process and identified five strategic issues to focus action on that • Increase the consideration of health impacts in will move the needle on health in Oakland County. infrastructure decision-making and policy. • Promote and advance safe and healthy housing for Healthy Eating all residents. How can we create an environment that provides equitable access to and education about healthy eating for all community members? Access to Care How can we ensure access to integrated health services Goal: for all community members? • Increase accessibility, affordability, and consumption of healthy foods throughout Oakland County. Goals: • Improve public knowledge about available health Active Living insurance and other health resources. How can we strengthen the accessibility of resources • Improve coordination of integrated services. and opportunities to promote active living among all community members? Data and Informatics Goal: • Increase number of children and adults who lead How can we increase data use and sharing across active lifestyles in Oakland County. sectors to improve our understanding of health, service delivery, and operational efficiency? Built Environment Goal: How can we cultivate a built environment that promotes a • Improve data and information technology use to healthy, connected, thriving community? make Oakland County a leader in health informatics.

CHIP • 2016 7

STRATEGIC ISSUE - HEALTHY EATING

How can we create an environment that provides • 51% of pregnant women carrying single babies in equitable access to, and education about, healthy Oakland County had weight gain that was excessive, eating for all community members? which is higher than the Michigan average of 46%.21

Why Address Healthy Eating? • Almost 79% of adults in Oakland County are eating less than the recommended five servings of fruit and A healthy diet is a critical component of a healthy lifestyle. vegetables a day.22 Healthy eating helps reduce a person’s risk for developing obesity, osteoporosis, iron deficiency, and dental caries • 31% of the population in Oakland County lives in a (cavities). Healthy eating also helps prevent high cho- food desert, which is a low-income census tract lesterol, high blood pressure, and reduces the risk of where a substantial number of residents have low developing chronic diseases such as cardiovascular access to a supermarket or large grocery store.23 disease, cancer, and type 2 diabetes. For youth, healthy nutrition promotes optimal growth and development. • 23% of Oakland County residents live in census tracts with no healthy food outlets.24 Many factors can affect an individual’s diet and consumption of healthy foods, including their knowledge • 41% of adults in Oakland County and Michigan have about nutrition and healthy eating, as well as access to, high cholesterol, while 38.4% of adults in the United and availability of, healthy foods in their community. States have high cholesterol.25, 26 Empowering people to make healthy choices and increasing access to affordable, healthy foods can make • The leading cause of death in Oakland County is 27 great strides in improving the community’s health. heart disease.

Healthy Eating: Consulting the Data • Obesity was the number one health concern of all ECHO Community Survey respondents.28 • Slightly more than a quarter of adults in Oakland County are obese.20 • At 82.1 per 100,000, Oakland County is lower than both the State of Michigan and the United States • 36% of adults in Oakland County are overweight, for their rate of Supplemental Nutrition Assistance which is the same as the Michigan average.20 Program authorized food retailers.29

CHIP • 2016 9 HEALTHY EATING | GOAL & OBJECTIVES

Goal: Increase accessibility, affordability, and consumption of healthy foods throughout Oakland County.

OBJECTIVE SUGGESTED ACTIONS MEASURE

Organize Food Policy Council • Food Policy Council created

Increase healthy food access by • Establish baseline and increase by 5% exploring & expanding community, school, and home gardens • Percent of population with limited food access

Increase amount of healthy food donated to local pantries and free/ • Establish baseline and increase by 5% low-cost alternative food outlets

Establish Food Policy • At least one certified corner store within a 1/2 Council to increase Establish a Healthy Corner Store mile census tract designated as food desert healthy food access Certification Program in designated food deserts in Oakland County • Percent of low-income population with limited food access

Identify opportunities to expand • Establish baseline and increase by 5% access to healthy and affordable options at farmers’ markets • Percent of population with limited food access • Inadequate fruit/vegetable consumption, percent of adults age 18+

Identify opportunities to increase • Youth Risk Behavior Surveillance System, farmers’ market locations median fruit and vegetable intake

• Establish baseline and increase by 5% Identify and examine Increase education best practices for promoting • Inadequate fruit/vegetable consumption, and promotion healthy eating, cooking, and percent of adults age 18+ opportunities around hydration in the community, healthy eating • Youth Risk Behavior Surveillance System, including businesses median fruit and vegetable intake

10 CHIP • 2016 HEALTHY EATING | ALIGNMENT WITH NATIONAL & STATE PLANS

NATIONAL HEALTHY PEOPLE MICHIGAN HEALTH MICHIGAN OBESITY PRIORITY PREVENTION STRATEGY30 202031 AND WELLNESS 4X432 STRATEGIES 2014-201833

OBJECTIVE: Establish Food Policy Council to increase healthy food access

Increase the variety of Increase the proportion Encourage coalitions to healthy foods offered of Americans who have implement strategies to in communities through Increase access to access to a food retail increase the availability existing establishments, healthy and affordable outlet that sells a variety of healthy foods (mainly grocery stores, farmers’ foods in communities of foods encouraged by fruits and vegetables) markets, & community the Dietary Guidelines in communities gardens in low-access for Americans neighborhoods

OBJECTIVE: Increase education and promotion opportunities around healthy eating

Assess local community needs and expand pro- Provide nutrition informa- tion to customers (e.g., Increase the proportion grams such as community gardens and farmers’ on menus) and make Help people recognize of physician office visits markets that bring healthy options and and make healthy food that include counseling healthy foods (especially appropriate portion sizes and beverage choices or education related to Michigan-grown fruits the default in restaurants nutrition or weight and vegetables) to and other food service schools, businesses venues and communities

HEALTHY EATING | SHORT-TERM ACTIONS

• Organize Food Policy Council. • Identify best practices for community gardening.

• Examine food deserts by mapping grocery stores to • Identify opportunities to increase or improve access determine areas where there is low food access. to healthy, affordable options at farmers’ markets.

• Promote best practices for healthy eating and cooking. • Develop materials to help teach consumers to grow fruits and vegetables. • Examine best practices around healthy eating in the local business community.

CHIP • 2016 11 HEALTHY EATING | MID-TERM ACTIONS

• Establish collaborations to support gardening efforts. • In neighborhoods without full-service grocery stores, work with residents to identify local corner stores that • Develop/promote guidelines and recommendations could serve as a reliable source of healthy food within for healthy food donations. the neighborhood.

• Utilize best practice models for sustainable food outlets. • Identify and provide “How to become a Healthy Corner Store” training. • Develop partnerships to donate plants, garden boxes, and other supplies to local gardening collaborations • Increase Supplemental Nutrition Assistance Pro- for dissemination to community members. gram/Electronic Benefit Transfer (SNAP/EBT) technol- ogy use at farmers’ markets in Oakland County. • Provide education throughout the growing season on tips to successfully grow produce, through social • Increase SNAP ED programs in Oakland County. media, emails, or text messages. • Increase alternative food outlets, such as low-cost • Establish partnerships with master gardeners to produce markets, farm to school linkages, food support additional gardening efforts. pantries that offer produce and healthy foods, and non-traditional food sources, such as churches. • In food deserts, survey corner stores about current healthy food offerings.

HEALTHY EATING |LONG-TERM ACTIONS

• Increase the amount of healthy food that is donated • Establish a Healthy Corner Store Certification in areas to local pantries and free and low-cost alternative designated as a food desert in Oakland County. food outlets. • Disseminate guidelines that identify opportunities for • Increase healthy food access by expanding commu- businesses to improve healthy eating options in the nity, school, and home gardens. work environment.

12 CHIP • 2016 SECTOR IDEAS ON HOW TO BE INVOLVED

• Participate in Food Policy Council • Promote healthy eating to employees • Implement farm to institution programs • Provide healthy eating education opportunities Healthcare • Promote healthy eating in facilities and cafeterias to employees and patients • Implement prescriptions for healthy foods

• Participate in Food Policy Council • Provide healthy eating education and Behavioral information to consumers and employees Health • Promote healthy eating to employees and consumers • Connect consumers to community gardens

• Participate in Food Policy Council • Provide healthy eating education opportunities • Implement school gardens to students and employees Education • Promote healthy eating in school cafeterias • Implement farm to institution programs • Connect families to community gardens

• Participate in Food Policy Council • Provide healthy eating information to clients Human and employees Services • Work with partners to increase healthy food offerings at alternative food outlets

• Participate in Food Policy Council • Expand or sponsor community gardens • Expand the number of farmers’ markets • Work with partners to increase the number of Government • Expand EBT use at farmers’ markets alternative food outlets • Promote Healthy Corner Store Certification • Incorporate healthy eating education into in communities wellness programs

• Participate in Food Policy Council • Become a certified Healthy Corner Store • Promote healthy eating in facilities and cafeterias • Incorporate healthy eating education into Business • Identify and implement best practices to promote wellness programs healthy eating at businesses • Sponsor healthy eating opportunities in the community

• Participate in Food Policy Council • Host/sponsor healthy eating and cooking Faith-Based • Sponsor, implement, or promote alternative education opportunities Groups food outlets • Increase healthy food options and healthy • Sponsor community gardens eating education at alternative food outlets

Community/ • Participate in Food Policy Council • Host/sponsor healthy eating and cooking Volunteer education opportunities Groups • Sponsor community gardens

Parks/ • Participate in Food Policy Council • Host/sponsor healthy eating and cooking Sports/ • Sponsor community gardens education opportunities Recreation

Restaurants/ • Participate in Food Policy Council • Implement farm to institution programs Food • Promote healthy food options • Host/sponsor healthy eating and cooking Outlets education opportunities

CHIP • 2016 13

STRATEGIC ISSUE - ACTIVE LIVING

How can we strengthen accessibility of resources Active Living: Consulting the Data and opportunities to promote active living among all community members? • A little over 20% of adults in Oakland County report no physical activity in their leisure time.20

Why Address Active Living? • Over a quarter of adults in Oakland County are obese.20

Regular physical activity helps improve an individual’s • 36% of adults in Oakland County are overweight, 20 overall health and fitness, and reduces the risk for many which is the same as Michigan’s average. chronic diseases. People who are physically active live • 51% of pregnant women carrying single babies in longer and have lower risks for heart disease, stroke, Oakland County had weight gain that was excessive, type 2 diabetes, depression, and some cancers. Regular which is higher than the Michigan average of 46%.21 physical activity is an important way to control weight • The leading cause of death in Oakland County is and combat obesity. Communities that support active heart disease.27 living are also safer and promote social cohesion. • Only 41% of ECHO Community Survey respondents Personal, social, economic, and environmental factors agree that it is easy to bike or walk in their community. 28 all play a role in physical activity levels among youth, • In the ECHO Community Survey, the six focus cities adults, and older adults. Not all communities have equal identified physical activity as the 4th out of 10 top access to physical activity resources or environments health concerns.28 that support an active lifestyle. Community programs can impact the physical activity levels of its residents. • 42% of the population in Oakland County lives within Communities can introduce and sustain ways to support a half mile of a park, which rates below the median for counties in the United States.34 walking, cycling, and active transportation and increase access to recreation facilities, thereby increasing active • Obesity was the number one health concern of all living among its residents. ECHO Community Survey respondents.28

CHIP • 2016 15 Active living | GOAL & OBJECTIVES

Goal: Increase the number of children and adults who lead active lifestyles in Oakland County.

OBJECTIVE SUGGESTED ACTIONS MEASURE

Create an Active Living Network of Increase education organizations including faith-based • Active Living Network convened and promotion of community, schools, non-profits, health- • Number of organizations in the network opportunities for care, and media to promote and share active living • Number of communications disseminated information about physical activity

• Community walkability scores • Percent of population reporting that they Promote and implement strategies to lead active lives increase walking/walkable communities • Decrease percent of population with BMI greater than 30

Promote affordable family-oriented physical • Establish a baseline of physical activity activity options in the community opportunities for families

Promote affordable active living • Establish baseline percent healthy opportunities for pregnant women to weight gain support healthy weight gain

Increase number of hospitals and • Number of hospitals/physicians participating Increase access physicians supporting and issuing in a prescription for active living program to safe, affordable prescriptions for active lifestyles active living activities in the community Increase the number of community • Calendar of events for active living facilities and organizations promoting opportunities in the community and hosting active living activities

Increase active living opportunities for • Calendar of events for active living older adults in conjunction with senior opportunities for older adults centers and other community partners

Utilize volunteer groups to assist isolated • Number of volunteers providing support to individuals to become more active and isolated individuals less secluded

Increase the number of businesses, organizations, and foundations that • Number of sponsored or sponsor or fund activities to support funded activities and expand active living opportunities

16 CHIP • 2016 Promote affordable community-based • Establish baseline of community-based physical activity opportunities for children physical activity opportunities for children in the community

• Establish baseline of communities involved Increase the number of communities in Safe Routes to School and increase Increase the participating in Safe Routes to School number of children by 5% and youth who are physically active for 60 minutes Work with schools to identify per day barriers to daily recess, and promote • Report barriers, recommendations, and recommendations and research research supporting daily recess supporting daily recess

Increase the number of schools offering • Percent of school districts requiring regular 20 minutes of daily recess elementary school recess

Work with employers to increase the • Wellness assessment scores number of businesses with wellness • Number of businesses with wellness policies policies that promote active living

Increase employer Increase employer-provided incentives wellness policies • Number of employer provided incentives for mass transit and active living practices promoting and supporting active living for employees Work with employers to increase opportunities for employees to utilize • Number of employers reporting healthcare reimbursement or dependent reimbursement account policies supporting care accounts to pay for active active living living expenses

CHIP • 2016 17 ACTIVE LIVING| ALIGNMENT WITH NATIONAL & STATE PLANS

NATIONAL HEALTHY PEOPLE MICHIGAN HEALTH MICHIGAN OBESITY PRIORITY PREVENTION STRATEGY30 202031 AND WELLNESS 4X432 STRATEGIES 2014-201833

OBJECTIVE: Increase education and promotion of opportunities for active living

Work with community, Increase the proportion Provide community Assess physical activity non-profit and faith-based of physician office visits programs with a focus on levels and provide organizations to offer that include counseling changing physical activity education, counseling, low or no-cost physical or education related to behavior and building and referrals activity programs (sports, physical activity social support walking clubs)

OBJECTIVE: Increase access to safe, affordable active living activities in the community

Facilitate safe Encourage community neighborhoods that Increase legislative design and development encourage physical Facilitate access to safe, policies for the built that supports physical ac- activity where appropriate accessible, and environment that en- tivity, such as sidewalks, (e.g., sidewalks, bike affordable places for hance access to and adequate lighting, and lanes, adequate lighting, physical activity availability of physical traffic-slowing devices multi-use trails, walk- activity opportunities to improve active ways, parks, and transportation playgrounds)

OBJECTIVE: Increase the number of children and youth who are physically active for 60 minutes per day

Promote Comprehensive Encourage all school Increase proportion of School Physical Activity systems to adopt healthy Promote and strengthen adolescents who meet Program (CSPAP) that food offerings, healthy includes the following: school and early current federal physical behaviors, physical activity quality physical education learning policies and activity guidelines for programs, and discuss as the foundation, physical programs that increase aerobic physical activity with students the meaning activity before, during, & physical activity and for muscle- of health as a personal after school, staff involve- strengthening activity core value ment, and family & com- munity engagement

OBJECTIVE: Increase employer wellness policies promoting and supporting active living for employees

Implement initiatives to increase the number of Support workplace employees who are programs that increase workday physical activity, Support workplace physically active during Improve health, illness, the work day. Consider such as flextime policies, policies and programs and quality of life through feasibility of scheduling lunchtime walking groups, that increase daily physical activity alternatives as well as access to exercise equip- physical activity structural additions such ment, bicycle racks, walk- as bicycle racks, walking ing paths, and changing paths, changing facilities facilities with showers with showers

18 CHIP • 2016 ACTIVE LIVING | SHORT-TERM ACTIONS

• Create an Active Living Network of organizations • Promote community-based physical activity opportu- including non-profits, faith-based communities, schools nities for older adults. and healthcare to promote and share information about physical activity. • Partner with parks and recreation associations to improve access to physical activity opportunities • Promote affordable family-oriented physical activity for children and youth. options in the community. • Promote education and awareness of Safe Routes • Promote affordable active living opportunities for to School. pregnant women to support healthy weight gain. • Collaborate with community partners to increase • Promote affordable community-based physical activity physical activity strategies targeting children. opportunities for children in the community.

ACTIVE LIVING | MID-TERM ACTIONS

• Increase awareness about, and access to, active • Utilize volunteer groups to assist isolated individuals living opportunities for people with disabilities. in becoming more active and less secluded.

• Promote and implement strategies to increase walking • Work with Parent Teacher Associations (PTA) to and walkable communities. expand awareness, understanding, and promotion of Safe Routes to School. • Increase the number of community organizations and facilities promoting and hosting active living activities. • Increase the number of communities participating in Safe Routes to School.

ACTIVE LIVING | long-TERM ACTIONS

• Increase the number of hospitals and physicians • Increase the number of schools offering 20 minutes supporting and issuing prescriptions for active lifestyles. of daily recess.

• Work with schools to identify barriers to daily recess • Work with employers to increase the number of busi- and promote recommendations/research supporting nesses with wellness policies promoting active living. daily recess. • Create a checklist of wellness options that employers • Engage political leaders and media to increase can provide, such as reduced weight loss program awareness of Safe Routes to School opportunities. fees, walking paths, or healthcare reimbursement.

CHIP • 2016 19 SECTOR IDEAS ON HOW TO BE INVOLVED

• Participate in Active Living Network • Support and promote walking to patients Healthcare • Promote physical activity to pregnant women and employees to support healthy weight gain • Issue prescriptions for physical activity

• Participate in Active Living Network • Support and promote walking to consumers Behavioral and employees Health • Promote the linkages between physical activity and mental health • Implement wellness policies that promote active living

• Participate in Active Living Network • Identify and address barriers to daily recess Education • Increase the number of districts that participate • Increase the availability and length of daily recess in Safe Routes to Schools

• Participate in Active Living Network • Increase the number of community organizations Human • Increase wellness policies promoting active living offering active living opportunities Services • Promote community-based physical activity • Promote and support walking among clients for children and employees

• Participate in Active Living Network • Increase access to and promotion of • Increase the number of communities participating community-based physical activity programs Government in Safe Routes to Schools • Increase active living opportunities for • Implement strategies to improve older adults walkable communities • Support and promote walking to employees and public

• Participate in Active Living Network • Sponsor or promote active living opportunities Business • Increase wellness policies promoting active living • Provide incentives or reimbursement for active living expenses

Faith-Based • Participate in Active Living Network • Promote and support walking and Groups • Offer free or low-cost active living opportunities walkable communities

Community/ • Participate in Active Living Network • Offer physical activity programs across all ages Volunteer • Offer free or low-cost active living opportunities • Support isolated individuals to be more active Groups

• Participate in Active Living Network • Implement strategies to improve Parks/ • Offer free or low-cost active living opportunities walkable communities Sports/ • Offer physical activity programs across all ages • Increase access to and promote Recreation community-based physical activity programs

20 CHIP • 2016 EXHIBIT 1.3: STEP IT UP

WORKSITES: STEP IT UP! Implement workplace policies EVERYONE CAN HELP and programs to MAKE OUR COMMUNITIES promote walking. MORE WALKABLE

MEDIA: PARKS AND Spread the word RECREATIONAL about walking and AND FITNESS creating safe and FACILITIES: easy places Provide access to to walk. green spaces and recreation areas.

INDIVIDUALS SCHOOLS: & FAMILIES: Implement safe Walk with friends, routes to school and family, and work TRANSPORTATION, daily physical colleagues. LAND USE, & education programs. COMMUNITY DESIGNERS: Design safe and easy places to walk.

PUBLIC HEALTH: Provide information to plan, implement, and evaluate walking HEALTH CARE programs. PROFESSIONALS: Talk to patients about physical activity. VOLUNTEER & NONPROFIT ORGANIZATIONS: Offer free or low-cost community walking programs.

CHIP • 2016 21

STRATEGIC ISSUE - BUILT ENVIRONMENT

How can we cultivate a built environment that • 23% of Oakland County residents live in census tracts promotes a healthy, connected, thriving community? with no healthy food outlets.24

Why Address the Built Environment? • Approximately 40% of diagnosed asthma in children is believed to be attributed to residential exposure.35 The built environment includes all physical aspects of where we live, work, and play (e.g., homes, buildings, • 10.7% of Oakland County adults reported living streets, open spaces, sidewalks, and parks). The envi- with asthma.20 ronment people live in affects their health by determining their ability to be physically active, access healthy foods, • Less than 1% of the population in Oakland County and the possibility of being injured or becoming ill. Asthma uses public transportation.36 is one health condition that is often worsened by home- based exposures and is the most common chronic health • 68% of ECHO Community Survey respondents do condition among children.35 not believe there is adequate public transportation in their community.28 Uniting health partners with city planners, parks and recreation departments, or transportation providers can • While 50% of the ECHO Community Survey resp- help create communities that are purposefully healthy, ondents stated that they do not need to use public active, and well-connected. Improving the quality of transportation, 49% responded that there is no public homes in the community can also improve people’s transportation in their neighborhood, and 20% of health status by positively impacting the place where respondents stated that buses do not travel where they spend the majority of time. Working across sectors they need them.28 can help mitigate some of the health disparities caused by the built environment, and improve quality of life for • 25% of the ECHO Community Survey respondents the most vulnerable populations of the community. do not agree that it is easy to bike or walk within their community.28 Built Environment: Consulting the Data • 42% of the population in Oakland County lives within • 31% of the population in Oakland County lives in a a half mile of a park, which rates below the median food desert, which is a low-income census tract for counties in the United States.34 where a substantial number of residents have low access to a supermarket or large grocery store.23

CHIP • 2016 23 BUILT ENVIRONMENT | GOALS & OBJECTIVES

Goal: Foster improvements in the built environment to create a more connected, livable community.

OBJECTIVE SUGGESTED ACTIONS MEASURE

Increase the number of communities with • Number of Communities for a Lifetime the Communities for a Lifetime designation and increase by 5%

Increase the number • Number of communities that engage older of communities that Engage older adults in community planning adults in community planning are age-friendly

• Assessment of transportation options Increase awareness of transportation • Resource list of transportation options for options for older adults older adults

• Park audit score Encourage communities to complete • Walkability score walkability plans to improve park and • Adult physical activity rate trail access • Number of directional signage installed • Number of communities with signage Increase accessibility to parks and trails Increase the number of parks with a Safe • Develop baseline and increase by 5% Park Zone designation • Adult physical activity rate

Increase the number of communities that • Develop baseline and increase by 5% have Shared Use Agreements • Adult physical activity rate

Increase the number • Develop baseline of communities in Oakland of communities in Increase advocacy and support for Complete Streets and its health benefits County with Complete Streets and increase Oakland County by 5% with Complete to local municipalities Streets Plans • Adult physical activity rate

Develop bike share programs with business and community partners • Develop baseline of bike share programs Increase the number and increase by 5% of policies and pro- Increase the number of bike fix-it stations • Develop baseline of bike fix-it stations and grams that promote and bike racks increase by 5% cycling and bike use in Oakland County • Number of communities providing education Partner with municipalities to educate about cycling safety and road sharing about cycling safety and sharing the road with cyclists

24 CHIP • 2016 Goal: Increase the consideration of health impacts in infrastructure decision-making and policy.

OBJECTIVE SUGGESTED ACTIONS MEASURE

Complete two health impact assessments Increase the number in Oakland County, utilizing the • Number of health impact assessments of instances health ECHO partnerships is included into poli- cies and programs in non-health sectors • Number of communities engaging health Increase health representation when devel- in Oakland County representation in master plan development oping/updating community master plans and updates

“HEALTH IS WHERE WE ” LIVE, LEARN, WORK, AND PLAY - Robert Wood Johnson Foundation

Goal: Promote and advance safe and healthy housing for all residents.

OBJECTIVE SUGGESTED ACTIONS MEASURE

Identify and disseminate healthy • Asthma rates housing checklists • Lead poisoning rates

• Number of unintentional deaths from falls Implement Home Injury Prevention Program • Injury and poisoning – principal Increase the number diagnosis; hospitalization of educational programs about healthy and Develop multi-component home visiting • Asthma hospitalizations safe housing program to reduce asthma triggers • Reduce asthma deaths

Explore opportunities for Healthy • Lead poisoning rates Home Network • Asthma hospitalizations Develop Master Home • Injury and poisoning – principal Environmentalist program diagnosis; hospitalization

CHIP • 2016 25 BUILT ENVIRONMENT| ALIGNMENT WITH NATIONAL & STATE PLANS

NATIONAL HEALTHY PEOPLE MICHIGAN HEALTH MICHIGAN OBESITY PRIORITY PREVENTION STRATEGY30 202031 AND WELLNESS 4X432 STRATEGIES 2014-201833

OBJECTIVE: Increase the number of communities that are age-friendly

Facilitate access to safe, Facilitate social accessible and affordable N/A Age friendly N/A Age friendly connectedness and places for physical activity communities not communities not community engagement that can be used by all addressed in plan addressed in plan across the lifespan people of all ages and functional abilities

OBJECTIVE: Increase accessibility to parks and trails

Increase legislative Enhance cross-sector Engage in regular Facilitate access policies for the built activity. Adults need to safe, accessible, collaboration in environment that at least 2.5 hours and affordable places community planning enhance access to and of moderate intensity for physical activity, and design to promote availability of physical physical activity including parks health and safety activity opportunities per week and trails

OBJECTIVE: Increase the number of communities in Oakland County with Complete Streets Plans

Encourage community Complete Streets design and development Enhance cross-sector Policies for the built Advisory Council and that supports physical collaboration in environment that the State Transportation activity, such as side- community planning enhance access to and Commission to identify walks, adequate lighting, and design to promote availability of physical model local policies for and traffic-slowing health and safety activity opportunities complete streets devices to improve active transportation

OBJECTIVE: Increase the number of policies and programs that promote cycling and bike use in Oakland County

Encourage community Work with transportation design and development Enhance cross-sector projects to implement that supports physical collaboration in Increase the non-motorized infrastruc- activity, such as side- community planning proportion of trips ture to support residents walks, adequate lighting, and design to promote made by bicycling to walk, bike, and use and traffic-slowing health and safety public transportation devices to improve where appropriate active transportation

26 CHIP • 2016 NATIONAL HEALTHY PEOPLE MICHIGAN HEALTH MICHIGAN OBESITY PRIORITY PREVENTION STRATEGY30 202031 AND WELLNESS 4X432 STRATEGIES 2014-201833

OBJECTIVE: Increase the number of instances health is included into policies & programs in non-health sectors in Oakland County

Support workplace pol- icies and programs that Increase legislative increase workday physical Encourage small and Integrate health criteria policies for the built activity such as flextime large businesses to into decision-making, environment that policies, lunchtime walking offer worksite wellness where appropriate, enhance access to and groups, access to exercise programs for their across multiple sectors equipment, facilities, bicy- availability of physical employees activity opportunities cle racks, walking paths, and changing facilities with showers

OBJECTIVE: Increase the number of educational programs about healthy and safe housing

Promote health for Design and all through a healthy promote affordable, N/A Housing not environment including N/A Housing not accessible, safe, and considered in plan considered in plan Healthy Homes and healthy housing Communities

CHIP • 2016 27 BUILT ENVIRONMENT | SHORT-TERM ACTIONS

• Complete health impact assessments • Encourage communities to complete walkability plans to improve park and trail access. • Identify and disseminate healthy housing checklists. • Increase advocacy and support for Complete Streets • Increase the awareness of transportation options and its health benefits to local municipalities. for older adults. • Increase number of bike fix-it stations and bike racks.

BUILT ENVIRONMENT | MID-TERM ACTIONS

• Explore opportunities for a Healthy Home Network • Expand number of older adults in community planning.

• Develop a multi-component home-visiting program to • Partner with municipalities to educate about cycling reduce asthma triggers. safety and sharing the road with cyclists.

• Implement a Home Injury Prevention Program. • Develop bike share programs with businesses and community partners. • Increase the number of parks that have a Safe Park Zone designation.

BUILT ENVIRONMENT | LONG-TERM ACTIONS

• Increase health representation when developing or • Increase the number of communities with the Com- updating community master plans. munities for a Lifetime designation.

• Develop Master Home Environmentalist Program. • Increase the number of communities that have Shared Use Agreements.

28 CHIP • 2016 SECTOR IDEAS ON HOW TO BE INVOLVED

• Send health representatives to participate in • Educate patients about housing triggers for land use master planning asthma and injury prevention in the home Healthcare • Refer patients to healthy homes programs • Increase awareness of transportation options for older adults

• Send representatives to participate in land use • Advocate for the benefits of Complete Streets, Behavioral and master planning shared use agreements, and other policies that Health • Increase awareness of transportation options for promote healthy community design older adults

• Advocate for the creation of Safe Park • Engage with partners to develop shared Zone designations Education use agreements • Contribute to walkability plans

• Increase awareness of transportation options • Advocate for the benefits of Complete Streets, Human for older adults shared use agreements, and other policies that Services • Support municipalities applying for Communities promote healthy community design for a Lifetime designation • Promote and educate about healthy homes

• Obtain Communities for a Lifetime designation • Develop walkability plans • Increase use of health impact assessments • Work towards Complete Streets designation Government • Recruit health and older adult representation • Promote cycling through bike fix-it stations and when developing master plans safe bicycling education • Increase park access with Safe Park designations • Implement healthy homes programs

• Increase awareness of transportation options • Participate in health impact assessments for older adults to access local businesses • Provide input on walkability plans, shared use • Support municipalities that are applying for agreements, and other policies that support Business Communities for a Lifetime designation healthy community design • Sponsor opportunities to educate about healthy homes

• Encourage community participation in land use • Encourage collaboration across sectors Faith-Based master planning • Increase awareness of transportation options Groups • Promote and educate about healthy homes for older adults

• Encourage community participation in land use • Provide input on walkability plans, shared use Community/ master planning agreements, and other policies that support Volunteer healthy community design Groups • Increase awareness of transportation options for older adults

• Increase the number of parks with a Safe Park • Invite health and other community Parks/ Zone designation representatives when developing plans Sports/ • Increase adoption of walkability plans, shared • Sponsor bike share programs Recreation use agreements, and other policies that support • Educate about safe cycling practices healthy community design

CHIP • 2016 29

STRATEGIC ISSUE - ACCESS TO CARE

How can we ensure access to integrated health • 12.6% of Oakland County adults did not see a doctor services for all community members? due to cost, which is higher than the Healthy People 2020 9% target.20, 30 Why Address Access to Care? • 14.3% of adults in Oakland County lack a consistent Access to affordable, comprehensive, and quality health source of primary care.20 care services is a cornerstone of a healthy community. Access to care affects health disparities in a community, • 78% of women overall in Oakland County received can impact health equity, and is also an important adequate prenatal care, while only 65% of African- component of quality of life. Limited access to services American women and 66% of Hispanic women had can influence people’s ability to reach their full potential. adequate prenatal care.39 Inadequate access to care can increase emergency room usage, unnecessary hospitalizations, and healthcare costs. • Oakland County has a rate of 178.7 primary care physicians per 100,000 people.40 Integration of care begins with prevention, early detection, and treatment of behavioral health conditions at the • 15.1% of the overall population in Oakland County same time a person’s physical healthcare needs are ad- is on Medicaid;38 however, five of the six ECHO Focus dressed to achieve overall health and community health. Cities (Pontiac, Madison Heights, Hazel Park, Oak Integrating mental and emotional health promotion into Park, and Southfield) have areas where over 20% of community health and public health prevention strate- the population is enrolled in Medicaid.38 gies can make all health promotion more effective and 37 help prevent other public health issues. • 49% of the ECHO Community Survey respondents do not know if there are resources available to assist Access to Care: Consulting the Data in getting health insurance.28 • 9.3% of adults in Oakland County do not have health insurance.38

CHIP • 2016 31 ACCESS TO CARE | GOAL & OBJECTIVES

Goal: Improve public knowledge about available health insurance and other health resources.

OBJECTIVE SUGGESTED ACTIONS MEASURE

• Access to Care Workgroup convened Organize an Access to Care Workgroup • Assessments of under-served including community-based groups completed organizations, education, faith-based sectors, and clinicians to conduct a gap • Percent of residents that could not afford to go to the doctor analysis and identify under-served groups Improve awareness • Other groups identified by the gap analysis of populations unable to adequate- ly access health Provide ongoing education, assistance, insurance and other and support to community members on • Number of access points for health health resources effectively and optimally using health resource navigation insurance and health resources

Promote utilization of health system navigators to help understand health • Number of trained health system navigators insurance and accessing care

• Percent of residents uninsured Address barriers identified from the (child, adult, senior) gap analysis and identify and address • Percent of residents who usually use public inequities in access transportation to get to provider • Measures of access (inequities) Increase the percentage of residents who Update and promote the ECHO Data • Number of organizations participating in have access Dashboard as a tool for data and service Network of Care database to healthcare information

Work with partners to address cultural and linguistic barriers to obtaining and under- • Cultural and linguistic barriers identified standing health information and services

Promote Mental Health First Aid Improve awareness Training among professionals and of and education community members about behavioral • Number of trainings provided in community health services and resources Provide training to implement trauma- informed care practices to key organizations

32 CHIP • 2016 Goal: Improve coordination of integrated services.

OBJECTIVE SUGGESTED ACTIONS MEASURE

Identify barriers to accessing mental health services and prioritize actions to address barriers Increase access • Barriers to accessing mental health and referrals to services identified integrated health services • Referral plan completed Bring together stakeholders to create and implement a community-wide comprehen- sive mental health referral plan

ACCESS TO CARE | ALIGNMENT WITH NATIONAL & STATE PLANS

NATIONAL HEALTHY PEOPLE MICHIGAN HEALTH MICHIGAN OBESITY PRIORITY PREVENTION STRATEGY30 202031 AND WELLNESS 4X432 STRATEGIES 2014-201833

OBJECTIVE: Improve awareness of populations unable to adequately access health insurance and other health resources

Engage partners Reduce barriers to (employers, trade and Improve health care accessing clinical and professional organiza- quality and equity by Increase the proportion community preventive tions, health insurers, and building partnerships of persons with services, especially business associations) between provider practic- medical insurance among populations at to offer worksite es and community organi- greatest risk wellness and access to zations/resources 4 X 4 resources

OBJECTIVE: Increase the percentage of residents who have access to healthcare

Reduce barriers to Encourage individuals Improve health care accessing clinical and to get an annual quality and equity by Increase the proportion community preventive physical examination building partnerships of persons with a usual services, especially and discuss the status between provider primary care provider among populations at of the four key practices and community greatest risk health measures organizations/resources

CHIP • 2016 33 NATIONAL HEALTHY PEOPLE MICHIGAN HEALTH MICHIGAN OBESITY PRIORITY PREVENTION STRATEGY30 202031 AND WELLNESS 4X432 STRATEGIES 2014-201833

OBJECTIVE: Improve awareness of and education about behavioral health services and resources

Improve mental health Promote early through prevention and identification of mental N/A Plan does not N/A Plan does not by ensuring access to health needs and access address address appropriate, quality to quality services mental health services

OBJECTIVE: Increase access and referrals to integrated health services

Encourage healthcare Encourage healthcare professionals to provide Support implementation professionals to assess education, counseling, of community-based Improve access to physical activity levels and referrals to commu- preventive services and comprehensive, quality and dietary patterns and nity resources to help enhance linkages with healthcare services provide education, coun- individuals with their 4 clinical care seling, and referrals to healthy behaviors and community resources 4 health measures

34 CHIP • 2016 ACCESS TO CARE | SHORT-TERM ACTIONS

• Organize an Access to Care Workgroup including • Update and promote the ECHO Data Dashboard as community-based organizations, education, faith-based a tool for data and service information. sectors, and clinicians to identify under-served groups. • Promote utilization of health system navigators to help • Promote community awareness and understanding understand health insurance and accessing care. of various options for health insurance and resources. • Promote Mental Health First Aid Training among • Identify and address service gaps. professionals and community members.

ACCESS TO CARE | MID-TERM ACTIONS

• Address barriers to transportation and health insurance; • Work with partners to develop a standardized identify and address inequities in access. approach to integrated screening processes.

• Provide ongoing education, assistance, and support • Provide training to implement trauma-informed care to community members on effectively and opt- practices to key organizations. imally using health insurance and health resources. • Increase collaboration between service providers • Identify barriers to accessing mental health services. and support networks.

ACCESS TO CARE | long-TERM ACTIONS

• Work with partners to address cultural and linguistic • Bring together stakeholders to create and implement barriers to obtaining and understanding health info- a community-wide comprehensive mental health mation and services. referral plan.

CHIP • 2016 35 SECTOR IDEAS ON HOW TO BE INVOLVED

• Participate in Access to Care Workgroup to • Promote use of health system navigators to help conduct gap analysis of care and services understand health insurance and accessing care • Identify ways to address inequities found in • Increase access and referral to health services Healthcare gap analysis • Provide ongoing education, assistance, and • Work with partners to address cultural and lin- support to community members on effectively guistic barriers to obtaining and understanding using health insurance and health resources health information and services

• Participate in Access to Care Workgroup to • Provide training to implement trauma-informed conduct gap analysis of care and services care practices to key organizations • Identify ways to address inequities found in • Identify barriers to accessing mental health re- gap analysis sources and prioritize actions to address barriers Behavioral Health • Promote Mental Health First Aid Training among • Bring together stakeholders to create and professionals and community members implement a community-wide comprehensive • Provide ongoing education, assistance, and sup- mental health referral plan port to community members about effectively • Increase access and referral to health services using health insurance and health resources

• Participate in Access to Care Workgroup to • Promote use of health system navigators to help conduct gap analysis of care and services understand health insurance and accessing care • Provide public education on the availability of • Work with partners to address cultural and lin- Education services and resources in the community guistic barriers to obtaining and understanding • Promote Mental Health First Aid Training among health information and services professionals and community members

• Participate in Access to Care Workgroup to • Promote use of health system navigators to help conduct gap analysis of care and services understand health insurance and accessing care Human Services • Identify ways to address inequities found in • Work with partners to address cultural and lin- gap analysis guistic barriers to obtaining and understanding • Increase access and referral to health services health information and services

• Participate in Access to Care Workgroup to • Update and promote the ECHO Data Dashboard conduct gap analysis of care and services as a tool for data and service information • Identify ways to address inequities found in • Promote use of health system navigators to help gap analysis understand health insurance and accessing care Government • Promote community awareness/understanding • Work with partners to address cultural and lin- of various options for health insurance and guistic barriers to obtaining and understanding health resources available health information and services • Increase access and referral to health services

• Participate in Access to Care Workgroup to • Promote the ECHO Data Dashboard as a tool Business conduct gap analysis of care and services for data and service information

36 CHIP • 2016 • Work with partners to address cultural and lin- • Provide ongoing education, assistance, and guistic barriers to obtaining and understanding support to community members on effectively Faith-Based health information and services using health insurance and health resources Groups • Promote use of health system navigators to help • Provide public education on availability of understand health insurance and accessing care services and resources in the community

• Work with partners to address cultural and lin- • Provide ongoing education, assistance, and Community/ guistic barriers to obtaining and understanding support to community members on effectively Volunteer health information and services using health insurance and health resources Groups • Promote use of health system navigators to help • Provide public education on availability of understand health insurance and accessing care services and resources in the community

EXHIBIT 1.4: INTEGRATING HEALTH SERVICES

C HE LI AL B T U H

P

B

E

H

E

A R V

I A O C R A L L H A HEALT MEDIC

CHIP • 2016 37

STRATEGIC ISSUE - DATA & INFORMATICS

How can we increase data use and sharing across The ECHO Local Public Health System Assessment sectors to improve our understanding of health, identified improving data between partners as a major service delivery, and operational efficiency? opportunity for the Oakland County public health system.

Why Address Data and Informatics? Data and Informatics: Consulting the Data

Informatics is the science that studies the use and • About 6 in 10 (59%) hospitals had adopted an processing of data, information, and knowledge. In- Electronic Health Records (EHR) system with certain formatics can help create a shift in how public health, advanced functionalities in 2013.41 healthcare, and partners manage information, conduct operations, and make decisions. • 80% of Americans who have access to their health information in electronic health records use it, while Technology is rapidly advancing and agencies are 65% who don’t have access to their health informa- tasked with utilizing it for the betterment of their clients and tion say it is important to have it.42 community. Embracing data and informatics can create bridges between partners that support improved coordi- • 67% of U.S. adults age 65 & older say that access- nation of care for clients and patients. ing their medical information online is important.43 DATA & INFORMATICS | GOAL & OBJECTIVES

Goal: Improve data and information technology use to make Oakland County a leader in health informatics.

OBJECTIVE SUGGESTED ACTIONS MEASURE

Convene a Health Informatics Workgroup comprised • A Health Informatics Workgroup of representatives from healthcare, local public is convened and a schedule for health, mental health, and other partner organiza- regular meetings established tions to facilitate cross-sector information exchange Develop a Health Informatics Work- Assess the current landscape of health information group to assess exchange in Oakland County; identify current practices, • A completed assessment current and future potential opportunities, & gaps in information exchange opportunities around data use, Increase the number of informal and formal data • Number of data sharing technology, and sharing arrangements between partners arrangements health information exchange • Assess interest/opportunities for Promote cross-sector information exchange cross-sector information exchange

Expand/update the ECHO Data Dashboard and use • Number of CHIP indicators to monitor indicators in the CHIP ECHO Data Dashboard

CHIP • 2016 39 DATA & INFORMATICS | ALIGNMENT WITH NATIONAL & STATE PLANS

NATIONAL HEALTHY PEOPLE FEDERAL HEALTH IT NATIONAL STRATEGY FOR PREVENTION STRATEGY30 202031 STRATEGIC PLAN 2015-202044 INFORMATION & SAFEGUARDING 201245

OBJECTIVE: Develop a Health Informatics Workgroup to assess current and future opportunities around data use, informatics, technology, and health information exchange

Increase the proportion Expand use of Enhance Nation’s Drive collective action of persons who use interoperable health Health IT through collaboraton electronic personal health information technology Infrastructure and accountability management tools

DATA & INFORMATICS | SHORT-TERM ACTIONS

• Convene a Health Informatics Workgroup comprised • Access interest and opportunities for cross sectional of representatives from healthcare, public health, information exchange. mental health, and other partner organizations.

DATA & INFORMATICS | MID-TERM ACTIONS

• Assess the current landscape of health information • Expand and update the ECHO Data Dashboard and exchange in Oakland County, identifying current use it to monitor indicators included in the Community practices, potential opportunities, and gaps in informa- Health Improvement Plan. tion exchange.

DATA & INFORMATICS | LONG-TERM ACTIONS

• Increase the number of informal and formal data • Expand and increase access to information technology sharing arrangements between partners. and integrated data systems to promote cross-sec- tor information exchange.

40 CHIP • 2016 SECTOR IDEAS ON HOW TO BE INVOLVED

• Participate in Health Informatics Workgroup • Increase the number of informal and formal Healthcare • Help identify current practices, potential data sharing arrangements between partners opportunities, and gaps in information exchange

• Participate in Health Informatics Workgroup • Increase the number of informal and formal Behavioral data sharing arrangements between partners Health • Help identify current practices, potential opportunities, and gaps in information exchange

• Participate in Health Informatics Workgroup • Increase the number of informal and formal Education data sharing arrangements between partners

Human • Participate in Health Informatics Workgroup • Help identify current practices, potential Services opportunities, and gaps in information exchange

• Participate in Health Informatics Workgroup • Expand and update the ECHO Data Dashboard Government • Help identify current practices, potential and use it to monitor indicators included in the opportunities, and gaps in information exchange Community Health Assessment

• Participate in Health Informatics Workgroup • Expand and increase access to information Business technology and integrated data systems to promote cross-sector information exchange

• Participate in Health Informatics Workgroup • Increase access to information technology to Faith-Based promote cross-sector information exchange Groups and the increased use of data and health info- rmation in the community

Community/ • Participate in Health Informatics Workgroup • Increase access to information technology to Volunteer promote cross-sector information exchange Groups and the increased use of data and health info- rmation in the community

CHIP • 2016 41

MOVING FORWARD

Next Steps

ECHO will work with partners to implement and document Health Informatics Workgroup, to help facilitate and the activities outlined in this Community Health Improve- oversee activities. Organizations, businesses, municipal- ment Plan (CHIP). ECHO will also convene several key ities, and community members will be actively engaged stakeholder groups, including a Food Policy Council, to take ownership of, participate in, and document the Active Living Network, Access to Care Workgroup, and strategies outlined in the plan.

FOOD POLICY COUNCIL ACCESS TO ACTIVE LIVING NETWORK CARE WORKGROUP HEALTH INFORMATICS WORKGROUP HOW TO GET INVOLVED

Join ECHO to help address the complex factors that Help increase community engagement. Commit to incl- shape opportunities for people in Oakland County to uding community members, especially those impacted be healthy. No single person or organization alone can by inequities, in all aspects of planning, implementation, create such a large-scale and lasting change as can and evaluation of your programs and services. Building happen together. trusting relationships and community ownership can lead to lasting changes. Share pressing issues impacting health in Oakland to inform and influence policy and de- County. The way we communicate about our partnership Work with us cision makers to ensure that everyone equally benefits and our work is critical to our success. The narrative that from policies and practices within our county, communi- people are most familiar with is that health is a product ties and organizations. of personal responsibility. The reality is that the condi- tions in which people live, and the opportunities they Document progress through collection, reporting, and have, form the foundation for health. sharing of data and information. By evaluating and measuring our efforts we can clearly understand how Understand health and equity and how social, eco- successful we are in addressing our most pressing nomic, and environmental factors, such as racism, health issues and reducing inequities in our community. poverty, poor education, unsafe housing, and poor food access, affect health outcomes and negatively impact Follow us on the ECHO website, and Data Dashboard our entire society. at oakgov.com/health.

CHIP • 2016 43 ECHO| STEERING COMMITTEE

Alliance of Coalitions for Healthy Communities Oakland County Economic Development Marc Jeffries and Community Affairs David Schreiber Area Agency on Aging 1-B Tina Abbate Marzolf Oakland County Health Division Tony Drautz Beaumont Health System Belinda Barron Oakland County Homeland Security Ted Quisenberry Beaumont Health System Maureen Elliott Oakland County Medical Control Authority Botsford Hospital Bonnie Kincaid Margo Gorchow Oakland County Clinton River Watershed Council Parks and Recreation Anne Vaara Sue Wells Crittenton Hospital Angela Delpup Oakland County Veterans’ Services Garth Wootten Easter Seals Brent Wirth Oakland County Youth Assistance Mary Schusterbauer Henry Ford Hospital West Bloomfield Michael Feld, MD Oakland Family Services Jaimie Clayton Hope Hospitality and Warming Center Elizabeth Kelly Oakland Livingston Human Service Agency McLaren Health Care Lynn Crotty Chandan Gupte Oakland Schools Michigan Department Joan Lessen-Firestone of Health & Human Services Vicki Cooley Oakland University Patricia Wren Oakland County Board of Commissioners Shelley Taub St. John Providence Health System Jerry Blair Oakland County Board of Commissioners Helaine Zack St. Joseph Mercy Oakland Geneita Singletary Oakland County Child Care Council Susan Allen Total Management Solutions Leanne Chadwick Oakland County Community Mental Health Authority Wilson Partners Kathleen Kovach David Wilson

44 CHIP • 2016 ECHO | COMMUNITY HEALTH STATUS ASSESSMENT TEAM

ACCESS Oakland County Community Mental Whitney Litzner Health Authority Nicole Lawson Affirmations Lydia Hanson Oakland County Health Division Shane Bies Alliance of Coalitions for Healthy Communities Oakland County Health Division Julie Brenner Shannon Brownlee

Baldwin Center Oakland County Health Division D.J. Duckett Adam Hart

Beaumont Health System Oakland County Health Division Belinda Barron Jeff Hickey

Beaumont Health System Oakland County Health Division Maureen Husek Carrie Hribar

Beaumont Health System Oakland County Health Division Erin Wisely Lisa McKay-Chiasson

Common Ground Oakland County Health Division Emily Norton Dan Muncey

Easter Seals Oakland County Health Division Stephanie Wolf-Hull Anne Niquette

Meridian/Community Programs, Inc. Oakland County Health Division Erica Clute Nicole Parker

Michigan Department of Health Oakland County Health Division & Human Services Leigh-Anne Stafford Jill R. Anderson Oakland County Health Division Michigan Department of Health Kim Whitlock & Human Services Kelly Cutean Oakland Family Services Justin Rinke Michigan Department of Health & Human Services Oakland Schools Vicki Cooley Christina Harvey

Michigan State University St. John Providence Extension Oakland County Health System Nancy Hampton Jerry Blair

CHIP • 2016 45 ECHO | COMMUNITY THEMES & STRENGTHS ASSESSMENT TEAM

Area Agency on Aging 1-B Oakland County Health Division Jim McGuire Leigh-Anne Stafford

AIDS Partnership Michigan Oakland County Health Division Angelique Tomsic Mary Strobe

Alliance of Coalitions for Oakland County Youth Assistance Healthy Communities Mary Schusterbauer Marc Jeffries Oakland Livingston Baldwin Center Human Service Agency Elizabeth Longley Jason Blanks

Centro Multicultural La Familia Oakland Livingston Sonia Acosta Human Service Agency Lynn Crotty FernCare Free Clinic, Inc. Ann Heler Oakland Primary Health Services Gaohli Moua Lancaster Village Coop and Community Center Oakland University Leona Patterson Rebecca Cheezum

McLaren Oakland Children’s Oakland University Health Services Allyson Forest Rosemary Couser Oakland University Oakland Family Services Jennifer Lucarelli Rachel Crane Pontiac Southside Seventh Day Adventist Church Oakland County Health Division Betty Yancey Shannon Brownlee

Oakland County Health Division Kathy Forzley

Oakland County Health Division Jeff Hickey

Oakland County Health Division Elaine Houser

Oakland County Health Division Carrie Hribar

Oakland County Health Division Lisa McKay-Chiasson

46 CHIP • 2016 ECHO | LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT TEAM

Air MD McLaren Health Care Sandra Carolan Chandan Gupte

Area Agency on Aging 1-B McLaren Oakland Children’s Health Services Ryan Conmeadow Rosemary Couser

Area Agency on Aging 1-B Meridian/Community Programs, Inc. Andrea Mulheisen Erica Clute

Beaumont Health System Michigan Department of Health & Human Services Maureen Elliott Kiera Wickliffe Berger

Beaumont Health System Oakland County Childcare Council Maureen Husek Sue Allen

Centro Multicultural La Familia Oakland County Community Mental Sonia Acosta Health Authority Kathleen Kovach Community Housing Network Jessie Korte Oakland County Community Mental Health Authority Coventry Cares of Michigan Kristen Milefchik Carol Edwards Oakland County Community Mental Crittenton Hospital Health Authority Angela Delpup Patti Reitz

Easter Seals Oakland County Economic Development Melissa Moody and Community Affairs Whitney Calio Easter Seals Wendy Standifer Oakland County Economic Development and Community Affairs Easter Seals Kristen Wiltfang Brent Wirth Oakland County Health Division Easter Seals Administrative Services Stephanie Wolf-Hull Leigh-Anne Stafford

Enroll America Oakland County Health Division Mona Dequis Clinic Nursing Lisa Hahn FernCare Free Clinic, Inc. Ann Heler Oakland County Health Division Community Health Promotion & Haven Intervention Services Ernestine McRae Jennifer Kirby

CHIP • 2016 47 ECHO | LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT TEAM CONTINUED

Oakland County Health Division Oakland County Health Division Community Health Promotion & Outreach Services Intervention Services Mary Strobe Lisa McKay-Chiasson Oakland County Health Division Oakland County Health Division Planning & Evaluation Communicable Disease Carrie Hribar Nicole Parker Oakland County Health Division Oakland County Health Division Public Health Laboratory Services Community Nursing Barb Weberman Lynn McDaniels Oakland County Health Division Oakland County Health Division Senior Advisory Committee Emergency Preparedness Elaine Houser Heather Blair Oakland County Human Resources Oakland County Health Division Dawn Hunt Emergency Preparedness Oakland County Medical Control Authority Lindsay Gestro Bonnie Kincaid Oakland County Health Division Oakland County Senior Advisory Council Environmental Health Cam McClure Richard Peresky Oakland Family Services Oakland County Health Division Rachel Crane Environmental Health Michelle Estelle Oakland Family Services Justin Rinke Oakland County Health Division Health Education Oakland Integrated Healthcare Network Shannon Brownlee Debbie Brinson

Oakland County Health Division Oakland Livingston Human Service Agency Health Education Jason Blanks Jeff Hickey Oakland Primary Health Services Oakland County Health Division Teen Health Center Health Education Ashley Reinhardt Signa Metivier Oakland Schools Oakland County Health Division Joan Lessen-Firestone Immunization Action Plan Michelle Maloff Oakland University Patricia Wren Oakland County Health Division Manager / Health Officer Southeastern Michigan Health Association Kathy Forzley Gary Petroni

48 CHIP • 2016 ECHO | FORCES OF CHANGE ASSESSMENT TEAM

Alliance of Coalitions for Healthy Communities Hope Hospitality and Warming Center Marc Jeffries Elizabeth Kelly

Area Agency on Aging 1-B McLaren Health Care Tina Abbate Marzolf Chandan Gupte Michigan Department of Health Beaumont Health System & Human Services Belinda Barron Vicki Cooley

Beaumont Health System Oakland County Board of Commissioners Maureen Elliott Shelley Taub

Botsford Hospital Oakland County Board of Commissioners Margo Gorchow Helaine Zack

Clinton River Watershed Council Oakland County Child Care Council Anne Vaara Susan Allen

Oakland County Community Crittenton Hospital Mental Health Authority Angela Delpup Kathleen Kovach

Easter Seals McLaren Health Care Brent Wirth Chandan Gupte

Henry Ford Hospital West Bloomfield McLaren Oakland Children’s Health Services Michael Feld, MD Rosemary Couser

CHIP • 2016 49 ACRONYMS

ACRONYMS DESCRIPTION

CHA Community Health Assessment

CHIP Community Health Improvement Plan

CHSA Community Health Status Assessment

CTSA Community Themes and Strengths Assessment

EBT Electronic Benefit Transfer

ECHO Energizing Connections for Healthier Oakland

EHR Electronic Health Record

FOCA Forces of Change Assessment

K-12 Kindergarten - Twelfth Grade

LPHSA Local Public Health Status Assessment

MAPP Mobilizing for Action through Planning and Partnerships

NACCHO National Association for Counties & City Health Officials

OCHD Oakland County Health Division

SNAP ED Supplemental Nutrition Assistance Program Education

50 CHIP • 2016 ENDNOTES

1. “Annual Estimates of the Resident Population: April 1, 2010 to July 1, 2014 more information 2014 Population Estimates.” American FactFinder. Web. 13 Jan. 2016. .

2. “U.S. Total Population County Rank.” USA. Web. 21 Dec. 2015. .

3. “Michigan Total Population County Rank.” USA. Web. 21 Dec. 2015. .

4. “Cumulative Estimates of Resident Population Change and Rankings: April 1, 2010 to July 1, 2014 - State -- County / County Equivalent 2014 Population Estimates.” American FactFinder. Web. 21 Dec. 2015. .

5. “Age and Sex: 2014 American Community Survey - Oakland County, Michigan.” American FactFinder. Web. 13 Jan. 2016. .

6. “Race and Hispanic or Latino Origin: 2010.” American FactFinder. Web. 21 Dec. 2015. .

7. “Selected Social Characteristics in the United States: 2010-2014 American Community Survey 5-Year Estimates.” American FactFinder. Web. 21 Dec. 2015. .

8. “Counties With the Most Languages Spoken.” U.S. English Foundation. Web. 21 Dec. 2015. .

9. “EEM | Public Data Sets.” Centers for Educational Performance and Information. Web. 13 Jan. 2016. .

10. “Community Profiles: Oakland County.” Southeastern Michigan Council of Governments. Web. 21 Dec. 2015. .

11. “Soil Survey of Oakland County Michian.” Natural Resource Conservation Service. United States Department of Agriculture. Web. 16 Feb. 2016. .

12. “Oakland County 2015 Land Use.” Oakland County Michigan. Web. 16 Feb. 2016. .

13. “Land Use Definitions.” Oakland County Michigan. Web. 16 Feb. 2016. .

CHIP • 2016 51 14. “Means of Transportation to Work By Select Characteristics.” American FactFinder. Web. 21 Dec. 2015. .

15. “Census Bureau Reports 262,000 Workers Commute into Oakland County, Mich., Each Day.” United States Census Bureau. Web. 21 Dec. 2015. .

16. “QCEW Data Views.” U.S. Bureau of Labor Statistics. Web. 6 Jan. 2016. .

17. “Local Area Unemployment Statistics.” Bureau of Labor Statistics. Web. 19 Dec. 2015. .

18. “Advantage Oakland: Facts and Stats – Economic Data.” Oakland County Michigan. Web. 6 Jan. 2016. .

19. “Accomplishments.” Oakland County Michigan. Web. 5 Jan. 2016. .

20. “2012-2014 Michigan BRFS Regional & Local Health Department Estimates.” Michigan Department of Health and Human Services. Web. 6 Jan. 2016. .

21. “Number & Percent of Live Births by Weight Gain of Mother and by Year.” Michigan Department of Health and Human Services. Web. 6 Jan. 2016. .

22. “2011-2013 Michigan BRFS Regional & Local Health Department Estimates.” Michigan Department of Health and Human Services. Web. 7 Jan. 2016. .

23. “Community Health Needs Assessment (CHNA): Population with Low Food Access.” Community Commons. Web. 7 Jan. 2016. .

24. “Community Health Needs Assessment (CHNA): Modified Food Retail Environment Index.” Community Commons. Web. 7 Jan. 2016. .

25. “Health Indicators and Risk Estimates by Community Health Assessment Regions and Local Health Departments - Michigan.” Michigan Department of Health and Human Services. Web. 7 Jan. 2016. .

26. “BRFSS Prevalence & Trends Data.” Centers for Disease Control and Prevention. Web. 13 Jan. 2016. .

27. “Michigan and US Age-adjusted Death Rates for Leading Causes of Death.” Michigan Department of Health and Human Services. Web. 8 Jan. 2016. .

28. “Community Themes and Strengths Assessment.” Oakland County Health Division. Survey. Qualtrics. 29 July 2015. Web. 11 Jan. 2016.

52 CHIP • 2016 29. “Community Health Needs Assessment (CHNA): SNAP Authorized Food Store Access.” Community Commons. Web. 8 Jan. 2016. .

30. Surgeon General. National Prevention Council. Web. 8 Jan. 2016. .

31. Office of Disease Prevention and Health Promotion. Healthy People 2020. Web. 8 Jan. 2016. .

32. Michigan Department of Health and Human Services. Michigan Health and Wellness 4x4 Plan. Web. 8 Jan. 2016. .

33. Michigan Department of Health and Human Services. Making a Difference in Obesity, Michigan’s Priority Strategies 2014 – 2018. Web. 8 Jan. 2016. .

34. “Community Health Status Indicators (CHSI): Access to Parks.” CDC. Community Health Status Indicators. Web. 12 Jan. 2016. .

35. Beyond Health Care: New Direction to a Healthier America.” Commission on Health. Robert Wood Johnson Foundation. Web. 3 Mar. 2016. .

36. “Commuting Characteristics by Sex: 2010-2014 American Community Survey 5-Year Estimates - Oakland County, Michigan.” American FactFinder. Web. 8 Jan. 2016. .

37. “Health Care and Health Systems Integration.” Substance Abuse and Mental Health Services Administration (SAMHSA). Web. 7 Mar. 2016. http://www.samhsa.gov/health-care-health-systems-integration.

38. “Health Insurance Coverage Status: 2010-2014 American Community Survey 5-year Estimates - Oakland County, Michigan.” American FactFinder. Web. 11 Jan. 2016. .

39. “Natility Trends: Birth Characteristics and Fertility Trends.” Michigan Department of Health and Human Services. Web. 14 Jan. 2016. .

40. “Community Health Needs Assessment (CHNA): Access to Primary Care.” Community Commons. Web. 11 Jan. 2016. .

41. “More physicians and hospitals are using EHRs than before.” U.S. Department of Health and Human Services. Web. 7 Aug. 2016 .

42. “Electronic Health Records: How they connect you and your doctor.” The Office of the National Coordinator for Health Information Technology (ONC). Web. 11 Mar. 2015. .

43. “The Next eHealth Wave for Silver Surfers: Health Management.” Accenture. Web. 2015. .

44. United States Department of Health and Human Services. Federal Health IT Strategic Plan. .

45. “National Strategy for Information Sharing and Safeguarding.” The White House. Web. .

CHIP • 2016 53 acknowledgements

ECHO has partnered with organizations and individuals across the county to develop the most comprehensive Community Health Assessment (CHA) and Community Health Improvement Plan (CHIP) to date.

The CHA and CHIP are possible due to the commitment, hard work, and guidance from individuals and organizations that participated in the Steering Committee and Assessment Teams throughout this process. Your input made this plan stronger and more robust.

A special thank you is extended to Jaimie Clayton and Bonnie Kincaid for their leadership as co-chairs of the ECHO Steering Committee and Gary Petroni, Southeast Michigan Health Association, for facil- itation and guidance throughout the initiative.

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