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Community Health Improvement plan C O L L E C T I V E L Y I M P R O V I N G T H E H E A L T H A N D W E L L - B E I N G O F I N D I V I D U A L S , F A M I L I E S A N D T H E C O M M U N I T Y . 2018 - 2020 CONTENTS Executive Summary 1 PLAN DEVELOPMENT Denton County CHIP Development 3 Community Engagement 5 Addressing Disparity & Inequity 10 COMMUNITY HEALTH IMPROVEMENT PLAN Interventions for Impact 13 Access to Care 15 Behavioral Health 21 Education & Prevention 27 Exercise, Weight & Nutrition 36 Health Outcomes – Chronic Disease 42 COLLECTIVE INFLUENCE Plans in Action 45 APPENDICIES Appendix A: Defining Key Terms 47 Appendix B: Prioritization Methodology 49 Appendix C: Collaborative Contributors 52 Appendix D: Integrated Care Infographic 60 Appendix G: CDC Recommended Immunization Schedule 61 Appendix H: PHAB Logic Model 63 EXECUTIVE SUMMARY Denton County is home to more than 800,000 unique individuals, with diverse backgrounds, Plan DevelopmentPlan 1: family units, social support systems and health needs. Local leaders, stakeholders, residents and agencies have partnered to lead our community to a healthier future. Through analyses of high-quality data sets within the 2017 Community Health Assessment, community members and diverse methodologies led to identification of health areas of concern. The identified areas of concern and recurring community themes have shaped the effort to positively impact the health and well-being of Denton County. Identified areas of concern include: Access to Care Behavioral Health Exercise, Weight and Nutrition Education and Prevention Health Outcomes: Chronic Disease This Community Health Improvement Plan will serve as the strategic guide to address identified Community Health Improvement Health Plan Community : 2 health concerns over the next three years. Partners from multiple sectors and engaged in diverse coalitions have iterated goals to tangibly move the needle on existing concerns, disparities and determinants of health. Operating with shared measurement and a common agenda as a community will allow the leveraging of the collective influence to make Denton County a healthier place to live, work, worship and play. 3: Collective Influence 4: Appendices 1 1: Plan DevelopmentPlan Each identified area of concern has community-wide goals, objectives, assets and metrics that will be implemented to move toward the established vision for the health and well-being of Denton County. To develop a common agenda, shared metrics and an inclusive community health vision, Denton County Public Health engaged community members and local pubic health system partners throughout the health assessment and improvement planning process, including: The Denton County Community Health Strategy Group provided oversight to the Health Summit and collaborative assessment process, identification of areas of concern 2 : and development of the CHIP. Improvement Health Plan Community The Community Health Summit attendees defined common language reflective of the community demographic and vision, identified a community health vision, recognized forces of change and draft community-wide goals for areas of concern. Coalitions and Leadership Teams provided implementation objectives and metrics for the CHIP, while also engaging in mutually reinforcing activites within represented agencies. The Public Health Advisory Committee provided oversight and feedback as appointees from Denton County Commissioners Court. To generate an inclusive and reflective vision for community health, the Community Health Strategy Group drafted vision statement options and values based on survey responses of what community members defined as “important factors for a healty community”. The following vision statement was adopted by the Community Health Summit attendees: 3: Collective Influence Through the collective impact model and Association for Community Health Improvement (ACHI) Community Health Assessment Toolkit, Denton County has collaboratively invested in prevention, protection and promotion of health. This plan will serve as the spring board for mutually reinforcing activities to facilitate increased access to health services, increased 4: Appendices opportunties for healthy behaviors decrease existing health disparities and promote health equity and literacy. 2 Plan development DENTON COUNTY CHIP DEVELOPMENT The Denton County Community Health Improvement Plan (CHIP) is the culmination of Plan DevelopmentPlan 1: consistent and collaborative work amongst agencies and community members dedicated to the health and well-being of Denton County. The Public Health Accreditation Board (PHAB) defines a CHIP as “a long-term, systematic effort to address issues identified in the community health assessment”.1 The CHIP is designed to be a concentration of community-driven goals and efforts to systematically address areas of concern, health disparities and determinants of health. The Denton County CHIP implementation will begin in January 2018, with the metrics established through year 2020. Annual review and revision will occur through the forum of the Denton County Health Strategy Group and Annual Community Health Summit. Visioning Texas Health Denton President, Mr. Jeff Reecer noted “community” means different things to different people – for some it may be a location, while for others it may be a group of people.2 A 2001 study published in the American Journal Community Health Improvement Health Plan Community : 2 of Public Health identified five core elements that individuals utilize to define community: • Locus: a sense of place • Sharing: Common interests and perspectives • Joint action: a source of cohesion and identity • Social ties: the foundation for community • Diversity: a social complexity within 3: Collective Influence communities3 For the purpose of this improvement plan, the “community” referenced within the CHIP is inclusive of residents of the geographic borders of Denton County, Texas and the biological, social, spiritual, and cultural groups that make up the population. 1 Public Health Accreditation Board. (2013). Standards & Measures. Version 1.5. 4: Appendices 2 Reecer, J. (Sept. 14, 2017). Paraphrased from Denton County Community Health Strategy Group. 3 MacQueen, K., McLellan, E., Metzger, D., Kegeles, S., Strauss, R., Roseanne, S., Blanchard, L., & Trotter, R. (2001). What is Community? An Evidence-Based Definition for Participatory Public Health. 3 1: Plan DevelopmentPlan Through online surveying and the inaugural Community Health Summit, Denton County residents established a definition of health and a healthy community. The adopted definition of health is an adaption from the World Health Organization definition.4 The community-defined “healthy community” mirrors the elected vision statement, encompassing adopted values including health equity and quality services. This definition is an adaption of the Healthy Communities Foundation mission statement.5 For the purpose of the CHIP, Denton County has adopted the following community-established definition of health and a healthy community: 2 : Community Health Improvement Health Plan Community HEALTH – A balanced lifestyle that promotes physical, emotional, spiritual and social well- being and the absence of disease or disparity. HEALTHY COMMUNITY - A healthy community improves the health and well-being of individuals, families and the community by promoting health equity, quality and access to care. 3: Collective Influence 4: Appendices 4 Preamble to the Constitution of WHO as adopted by the International Health Conference, New York, 19 June - 22 July 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of WHO, no. 2, p. 100) and entered into force on 7 April 1948. 5 Healthy Communities Foundation. 2017. About. Retrieved from healthcommunitiesfdn.org. 4 COMMUNITY ENGAGEMENT Plan DevelopmentPlan The Centers for Disease Control and Prevention (CDC) states “working together has a greater 1: impact on health and economic vitality than working alone”. The community health improvement process is designed to bring together community organizations, residents, stakeholders and leaders to prioritize and concert efforts to address health areas of concern.6 Denton County used the Association for Community Health Improvement (ACHI) Community Health Assessment Toolkit for the assessment and improvement planning process. The outlined steps within the toolkit coupled with the collective impact model approach served as a foundation for identifying stakeholders, engaging community members and targeting efforts. ACHI Community Health Assessment Toolkit Assessing the Community Steps 1 - 6 The 2017 Community Health Assessment was created through partnership between Denton County Public Health (DCPH), Texas Health Presbyterian Hospital Denton (THR Community Health Improvement Health Plan Community : 2 Denton) and United Way of Denton County (UWDC). Each of these organizations generated unique assessments with diverse methodologies. To promote the comprehensive nature of the improvement planning process, DCPH organized the Community Health Strategy Group as a strategic steering committee to guide the collective efforts. Qualitative, quantitative, primary and secondary data analyses were completed independently by each organization before production of the cumulative CHA document. DCPH was engaged in the assessment process, including focus 3: Collective Influence group, prioritization and survey engagement for the Texas Health Denton and UWDC needs assessment.

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