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 Development Plan
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
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Plan Development
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. Community Plan Health Improvement 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: 3: Collective 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 opportunties for healthy behaviors Appendices 4: 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 Development Plan
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.
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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:
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: : CommunityPlan Health Improvement 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: 3:
Collective Influence Collective
4: Appendices 4:
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.
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COMMUNITY ENGAGEMENT Plan Development Plan 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.
The collective assessment utilized the Centers for Disease Control and Prevention (CDC) Community Health Assessment for Population Health Improvement: Resource of Frequently Recommended Health Outcomes and Determinants to
organize high-quality data.
4:Appendices
6 Centers for Disease Control and Prevention. (2015). CDC Community Health Improvement Navigator.
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PlanDevelopment Determining Areas of Concern
Through the community focus groups, surveys conducted and health trends identified within the assessment processes, the Community Health Strategy Group reviewed health areas of concern for Denton County. For additional information on methods used to incorporate community feedback and prioritize health concerns see Appendix B.
Mental Health, Mental Disorders & Substance Abuse Unique Texas Health Denton
Access to Health Services 2
Assessment :
Priority Health Needs CommunityPlan Health Improvement Priorites Exercise, Nutrition & Weight
Diabetes
Children
United Way of Denton Families
County Focus Areas Verterans
Homeless/Housing
Health/Mental Health
Preventative Care Denton County Public Health Areas of Access to Care Concern Health Outcomes Women's Health
3: 3: Recommended criteria for Influence Collective prioritization from the ACHI Community Assessment Toolkit provided guidance to further concentrate areas of concern from existing assessments and stakeholder feedback (Figure 1).
To determine importance to community members, collation of qualitative data pertaining to the potential area of concern and survey metrics translated to scoring. The synthesis of UWDC Appendices 4: focus groups and “mentions”, coupled with survey responses from Texas Health Denton and
DCPH provided indication of importance to local residents and stakeholders.
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Data analyses identified whether the area of concern is trending positively or negatively in the community. Trending health concerns are identified as metrics that Denton County performs
lower than the state, neighboring counties or is not meeting established benchmarks.
Plan Development Plan 1: Alignment with existing priorities is reflected in existing collaborative efforts in Denton County pertaining to the area of concern. Robust coalition engagement, collective impact initiatives and workgroups indicated existing assets and partnerships with influence on community needs.
Consideration of the need among vulnerable populations accounted for existing health
disparities and geographic locations experiencing health inequity. Within each identified area of
Plan concern, health disparities exist with specific populations increasingly vulnerable or experiencing inequity.
Criteria (weight) Trending Need among Importance to Alignment health vulnerable community with existing Total
concern in the populations Community Health Improvement Health Community
: : Potential members (5) priorities (3) 2 community (4) (2) Areas of Concern
Behavioral 4 4 4 4 56
health
Access to Care 4 3 4 4 49
Exercise, Weight 3 3 4 4 47
and Nutrition 3:Collective Influence Health Outcomes: 3 3 3 4 44 Chronic disease
Prevention and 3 3 2 4 41 Education
Figure 1: Prioritizing CHIP Areas of Concern
4:Appendices
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: CommunityPlan Health Improvement
Planning Goals & Strategies
More than 70 Denton County leaders, residents, stakeholders and health champions attended 3: Collective Influence Collective the inaugural Community Health Summit in 2017. The summit provided a platform for diverse agencies, community members and perspectives to be shared to generate inclusive, cohesive and attainable health improvement goals.
Community members identified potential forces of change that have the potential to impact the local public health system and community health in the coming years. Concepts surrounding collaboration, reducing silos of service delivery systems and advocacy for policies and funding presented throughout the consideration of trends, factors and events. Electronic
submission to a WordCloud generated a representative listing of identified forces of change.
4: Appendices 4:
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Subject matter experts (SMEs) facilitated round-table goal setting exercises for each of the areas of concern. Community members discussed targets for the Denton County community to
address by 2020, including consideration of assets, resources and existing efforts. Organization Plan Development Plan
1: and coalition representatives considered agency strategic plans when generating goals to ensure CHIP alignment and inclusivity.
A prioritization matrix identified one to two goals of focus per area of health concern to be included in the improvement plan. DCPH consulted with SMEs, existing collabortives and
partners to develop objectives and evidence-based strategies for CHIP implementation.
Recurring themes of conversations throughout the Community Health Summit reflect the core of improvement planning. Consistent mentions of the necessity for attention to disparities and health literacy, encouragement of collaboration, and prioritization of health education and promotion align with the ACHI toolkit and CDC Community Health Improvement Navigator.7
Through assessment, partnership, engagement and strategy, the Denton County local public health system is prepared to tangibly impact areas of health concern, leading our community to
a healthier future.
Community Health Improvement Health Plan Community
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3:Collective Influence
4:Appendices
7 Centers for Disease Control and Prevention. (2015). CDC Community Health Improvement Navigator.
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PlanDevelopment ADDRESSING DISPARITY & INEQUITY
Equity is defined as “freedom from bias or favoritism”.8 Health inequity and disparities are
reflected in variances in health outcomes and access to care within a population. The CDC indicates health equity is achieved when “every person has the opportunity to attain his or her full health potential and no one is disadvantaged from achieving this potential because of social position or other socially determined circumstance”.9
2 : :
Texas Health Denton – Local Populations Highly Impacted by Poor Health Outcomes CommunityPlan Health Improvement
3: 3:
Texas Health Denton – Local Highly Impacted Racial/Ethnic Groups by Poor Health Outcomes Influence Collective
4: Appendices 4:
8 Merriam-Webster. (2017). Equity. 9 Centers for Disease Control and Prevention. (2017). Health Equity.
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English Language Learners or English Second Language members of the Denton County community experience disparities in numerous domains. English Language Learner and special
education students have exhibited the highest rates of not passing the STAAR test on the first Plan Development Plan
1: attempt.10 Additionally, more than 60% of Denton County residents relay: “I, or someone I know, have had difficulty understanding a health professional because of a language barrier in the last 12 months”.11
Texas Health Denton Community Health Barriers
Healthy North Texas indicates that children who identify as Hispanic or Latino experience the highest rates of being uninsured. For adults in Denton County, individuals of race or ethnicity classified as “Other” have the highest percentage of being uninsured and individuals who identify as Hispanic or Latino have the second highest percentage of being uninsured.12
Individuals who are uninsured report high proportionality of delaying needed medical care. Community Health Improvement Health Plan Community
: : Additionally, individuals who are uninsured are less likely to access preventative care and 2 health care for chronic diseases.13 Percentage of Children with Health Insurance by Race/Ethnicity in 2014 Percentage of Adults with Health Insurance by Race/Ethnicity in 2014 White, non-Hispanic
Two or More Races White, non-Hispanic
Other Two or More Races
Hispanic or Latino Other
Hispanic or Latino
Black or African American 3:Collective Influence Black or African American Asian Asian 0 20 40 60 80 100 Percentage 0 20 40 60 80 100 Percentage Denton Collin Tarrant Dallas Denton Collin Tarrant Dallas
10 United Way of Denton County. (2017). 2017 Community Needs Assessment. 11 Texas Health Presbyterian Hospital. (2016). 2016 Community Health Needs Assessment.
4:Appendices 12 Healthy North Texas. (2017). Community Dashboard. County: Denton. 13 Kaiser Family Foundation. (2016). Key Facts about the Uninsured Population. Barriers to health care among nonelderly adults by insurance status, 2015.
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A recent study by Dr. Ojha, Director of the Center for Outcomes Research at JPS Health
Network identified childhood cancer patients with health insurance live longer than those without. JPS states: “The study did not attempt to explain why, but one explanation could be that children with insurance are diagnosed earlier, when their cancer is more easily treatable than advanced disease.”14
Individuals who identify as Black or African
2 : : American are disproportionally affected by CommunityPlan Health Improvement HIV in Denton County.15 Individuals living in zip codes 76201 and 76205 have the highest proportion of living below the poverty level. Zip code 76201 also Texas Health Denton Percentage of has a high percentage of households with no Population Living Below Poverty Level vehicle, increasing risk for food insecurity and limited access to care. 16
As indicated in the graphic below, the environmental factors such as Texas Health Denton Focus Group – Cultural Barriers education impact morbidity and mortality of Denton County MANY SERVICES IN THE COMMUNITY ARE residents. The aim of this RELIGIOUSLY BASED, SO SOME SERVICES MAY NOT BE
improvement plan is to OFFERED TO THOSE WHO ARE LGBT OR HAVE OTHER 3: Collective Influence Collective communally address health SPECIFIC CHARACTERISTICS. WE NEED MORE SERVICES disparities and determinants of AVAILABLE TO SMALLER MINORITY POPULATIONS AND health with an awareness of WHICH ARE NOT RELIGIOUSLY BASED. identified existing geographic and population disparities.
Impact of Education on Morbidity and Mortality
Not Reading at Less Liklihood Higher Decreased Life Economically a 3rd Grade of High School Prevalence of Expectancy by 9 Disadvantaged
Level Graduation Diabetes years at 25 4: Appendices 4:
14 Ojha, R. (2017). JPS Childhood Cancer Research. 15 Texas Department of Health and Human Services. (2016). Texas HIV Surveillance Report 16 Texas Health Presbyterian Hospital Denton. (2016). 2016 Community Health Needs Assessment.
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INTERVENTIONS FOR IMPACT
Helen Keller captured the essence of collaboration in stating, “Alone we can do so little. Plan Development Plan 17 1: Together we can do so much.” In accordance with the ACHI toolkit, areas of health concern identified are designed for alignment with strategies of community stakeholder organizations, national targets and state priorities. The ACHI toolkit also guides improvement planning to the collecitve impact model, highlighting the widespread collaboration to address complex and diverse 18
components of population health. Through various collaboratives, organizational strategic plan review, community feedback and assessment of health trend, the Denton County community identified five areas of health concern for improvement planning. Objectives and targets have been identified to guide implementation through 2020. Objectives, targets and interventions are designed to align with community priorities and evidence-based practices. The local public
Community Health Improvement Health Plan Community health system is comprised of diverse agencies, ranging from the local : : 2 healthdeapartment to food pantries to educational institutions. The CHIP is informed by and integrates the 10 essential public health services.
The following areas of concern are identified as community priorities to make Denton County a
healthier place to live, work, worship and play. Based on synthesized community response from diverse platforms, priority matrix methodologies and data analysis,
areas of concern identified were: 3:Collective Influence Access to Care Behavioral Health Education & Prevention Exercise, Weight & Nutrition
Health Outcomes: Chronic Disease
4:Appendices 17 GoodReads. (2017). Collaboration Quotes. 18 The Collective Impact Forum. (2014). What is Collective Impact?
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goals were authored to tangibly impact the health of individuals, families and populations throughout Denton County. Access to Care Goal 1: Reduce existing health disparities through increased health literacy Goal 2: Enhance equitable access to health
care and community resources 2
: : CommunityPlan Health Improvement Behavioral Health Goal 1: Increase access to preventative and integrated care Goal 2: Reduce stigma through education and community engagement Education & Prevention Goal 1: Foster a culture of healthy childhood behavior Goal 2: Promote investment in evidence-
based health education and prevention
programs Exercise, Weight & Nutrition Goal 1: Increase available access points that foster physical activity and nutritious eating Goal 2: Expand community collaboration
surrounding nutrition education and physical 3: activity Influence Collective Health Outcomes – Chronic Disease Goal 1: Develop integrated network of care coordination and system navigation
This action-oriented plan outlines goals, objectives, suggested strategies and various community partners who will contribute to outcome achievement. Recurring themes that surfaced throughout the health assessment and improvement planning process are embedded across the various areas of concern.
Recurring themes throughout assessment and planning:
Community collaboration – the necessity to focus efforts and reduce the silos of service Appendices 4: delivery systems and operations Reduction of disparities – consideration of existing health disparities and vulnerable
populations in improvement planning Health Literacy & Cultural Competency – increased attention to health literacy and cultural competency in health promotion and service delivery Health Promotion & Education – across domains the focus on community education to increase health behaviors
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Area of Concern: ACCESS TO CARE Plan DevelopmentPlan
1: A Leading Health Indicator (LHI) for Healthy People 2020 centers on the taget to increase the proportion of person with medical insurance to 100%.19 Denton County has steadily increased the number of insured adults to 84.8% and insured children to 91.7% in 2015.20 This equates to approximately 17,000 uninsured children and 79,000 uninsured adults under the age of 65 in Denton County.
According to Texas Health Denton’s community survey, over 70% of residents report personally or someone that the respondent knows has delayed seeking healthcare due to cost in the last 12 months.21 The Office of Disease Prevention and Health Promotion (ODPHP) reports that individuals without medical insurance are “more likely to lack a usual source of medical care, Community Health Improvement Health Plan Community :
2 such as a PCP, and are more likely to skip routine medical care due to costs, increasing their risk for serious and disabling health conditions.”22 According to the 2015 National Health Interview Survey, 20% of uninsured adults indicated that they went without needed care and postponed or did not get needed prescription drugs due to cost.23 Uninsured individuals not only report difficulty paying medical bills, but 21% of uninsured individuals reported medical bills led to 24
difficulty paying for basic necessities as compared to 7% of insured individuals. Healthy People 2020 metrics under the LHI Access to Care indicate prioritization of metrics to increase the proportion of persons with health insurance, a usual
3: Collective Influence primary care provider and reduction of persons who are unable to obtain or delay in obtaining necessary medical care, dental care or prescription medications.25
19 Centers for Disease Control and Prevention. (2017). 2020 LHI Topics: Access to Health Services. 20 Healthy North Texas. (2017). Community Dashboard. County: Denton. 21 Texas Health Presbyterian Hospital Denton. (2016). 2016 Community Health Needs Assessment. 22 Office of Disease Prevention and Health Promotion. (2017). 2020 LHI Topics: Access to Health Services. 23 Kaiser Family Foundation. (2016). Key Facts about the Uninsured Population. Barriers to health care among nonelderly adults by insurance status, 2015.
4: Appendices 24 Kaiser Family Foundation. (2016). Key Facts about the Uninsured Population. Problems paying medical bills by insurance status, 2015. 25 Centers for Disease Control and Prevention. (2017). 2020 LHI Topics: Access to Health Services.
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Existing disparities include the disproportionality of individuals who identify as Hispanic or Latino and race or ethnicity classified as “other”. 26 Individuals who are uninsured report high proportionality of delaying needed medical care and are less likely to access preventative care and health care for chronic diseases.27 CHIP objectives pertaining to access are focused on vulnerable populations at risk of limited health literacy or diminished access due to social determinants of health.
Policy Considerations 2
The National Association of County and City Health Officials (NACCHO) provides : CommunityHealth Impr the Compendium of NACCHO Policy Recommendations, an overview of policy statements that seek to advance public health practice. The compendium provides policy recommendations on access to health service topics including, but not limited to: Medicaid, coverage of preventative services and integration of services and supports for community health.28 NACCHO urged local health departments in
an updated 2017 policy statement to “continue to provide safety net services Plan ovement and/or perform an assurance role in their communities”.29 Federal legislation pertaining to health care reform must be considered when developing objectives surrounding access to care, with the current Affordable Care Act including the health insurance marketplace, minimum levels of health care coverage and the individual shared responsibility provision. In the 85th Texas Legislative Regular Session, important pieces of legislation designed to
enhance access to care were reviewed. Senate Bill 1107 relating to availability of telemedicine 3: 3:
services, especially for patients with mobility needs or individuals in remote areas, was signed Influence Collective by the Governor on May 27th, 2017.30 Senate Bill 1076 passed relating to amount charged to an enrollee in a health benefit plan for prescription drugs covered by the plan, disallowing copays to cost more than the prescription.31 Senate Bill 1 appropriated funding for Medicaid services
and graduate medical education expansion grants to “keep new doctors in Texas”.32
With the breadth of access to care, diverse legislation on various levels of government impacts access within Denton County. The Denton County community has identified two primary goals surrounding access to care.
26 Healthy North Texas. (2017). Community Dashboard. County: Denton. 27 Kaiser Family Foundation. (2016). Key Facts about the Uninsured Population. Barriers to health care among nonelderly adults by insurance status, 2015. 28 National Association of County and City Health Officials. (2017). Compendium of NACCHO Policy Appendices 4: Recommendations. 29 National Association of County & City Health Officials. (authored 2008, revised 2017). United States Health System for the 21st Century. 08-01.
30 Texas Legislature Online. (2017). Legislation – History SB 1107. 31 Texas Medical Association. (2017). Strength in Numbers – 85th Texas Legislative Regular Session Summary. 32 Texas Medical Association. (2017). Strength in Numbers – 85th Texas Legislative Regular Session Summary.
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Area of Concern: Access to Care
Plan Development Plan
1: Goal 1: Reduce existing health disparities through increased health literacy Objective 1.1: Increase proportion of persons who report their health care provider always explained things so that they could understand HP 2020 Target: 66% THR Survey: 65% CHIP Target: ≥ 66% by 2020 report difficulty understanding health professional due to language barrier Healthy People 2020: Health Communication and Health Information Technology33 HC/HIT-2.2: Target 66% Data Source: Medical Expenditure Panel Survey – Quality of Care Table 4.3 Survey metric: In the last 12 months, how often did this doctor explain things in a way that was easy to understand? Never; Almost Never; Sometimes; Usually; Almost Always; Always U.S. Department of Health and Human Services: “The primary responsibility for improving health literacy lies with public health professionals and the healthcare and public health systems.”34
Center for Disease Control and Prevention: Plain Language Thesaurus
Community Health Improvement Health Plan Community : :
2 Policies, Laws & Standards: Plain Language Laws – Plain Writing Act of 2010, National Health Education Standards, National Culturally and Linguistically Appropriate Services Standards35 Suggested Strategies: 1.1.1 Annual health literacy training summit for healthcare providers 1.1.2 Incorporation of health literacy into ESL programs
1.1.3 Targeted health literacy promotion for populations identified with limited health literacy, as defined by the U.S. Department of Health and Human Services Potential Partners Educational providers Coalitions & Collaboratives Healthcare providers Local ISDs Healthy Communities FQHC – Health Services of University of North
3:Collective Influence Coalition North Texas Texas Community Health Texas Health Presbyterian Texas Woman’s University Council Hospital Denton Charitable Clinics Medical City Denton Mentorship Programs – Big Coalition Medical City Lewisville Brothers Big Sisters WATCH Coalition Texas Health Flower Mound & Communities in National Public Charitable clinics Schools North Texas Health Information Coalition
Elected officials
33 Office of Disease Prevention and Health Promotion. (2017). Health Communication and Health Information
4:Appendices Technology. 34 U.S. Department of Health and Human Services. (n.d.) Quick Guide to Health Literacy. 35 Centers for Disease Control and Prevention. (2016). Health Literacy: Guidelines, Laws, & Standards.
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Goal 1: Reduce existing health disparities through increased health literacy Objective 1.2: Identify and promote crisis and risk emergency messages that include steps to reduce personal health threats for the consumer HP 2020 Target: 31.8% HP 2020 Baseline: 25.4% CHIP Target: ≥ 31.8%
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Healthy People 2020: Health Communication and Health Information Technology 2
: : CommunityPlan Health Improvement HC/HIT-12.4: Target 31.8% Data Source: CDC Crisis and Emergency Risk Communication Best Practices Study Six best practices for emergency and crisis communication: Explain what is known Explain what is not known Explain how or why the event happened Promote action Express empathy Express commitment
Policies, Laws & Standards: Emergency Planning and Community Right-to-Know Act, CDC Crisis and Emergency Risk Communication Best Practices37 Suggested Strategies: 1.2.1 Utilize CDC Crisis and Emergency Risk Communication Best Practices in DCPH Health Promotion and Communication Plan
1.2.2 Share best practices with media contacts for consideration and incorporation 3: Collective Influence Collective Potential Partners Media contacts Universities & Independent School Districts Health Emergency Alert and Response Print sources Team Online Healthcare providers Communicable Disease Response News broadcasts Public Information Officers Team Radio National Public Health Denton County Medical Reserve Corps Local municipalities Information Coalition Denton County EOC City Town County
4: Appendices 4:
36 Office of Disease Prevention and Health Promotion. (2017). Health Communication and Health Information Technology. 37 U.S. Environmental Protection Agency. (2017). Emergency Planning and Community Right-to-Know Act (EPCRA).
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Area of Concern: Access to Care
Plan Development Plan
1: Goal 2: Enhance equitable access to health care and community resources Objective 2.1: Reduce proportion of persons who report being unable to obtain or delayed in obtaining necessary medical care, dental care or prescriptions
HP 2020 Target: 9% Baseline BRFSS: 11.9% CHIP Target: ≤ 9% by 2020
Healthy People 2020: Access to Health Services38 AHS-6: MEPS National Baseline 10% Data Source: Texas Behavioral Risk Factor Surveillance System (BRFSS) – CO3Q0339 Policies, Laws & Standards: Patient Protection and Affordable Care Act Texas 85th Legislative Session: SB 1107, HB 719, SB 1 and SB 107640 Texas Medical Association provided a letter of priority issues to the Texas Legislature for
consideration in 2019 session including, but not limited to: Community Health Improvement Health Plan Community
: : Continuing efforts to improve care for women and infants 2 Evaluate prescription drug coverage and changes by health plans for chronically ill patients Expanding options for behavioral health services Texas Association of City & County Health Officials – advocating for capacity building for population health and local health departments and improvement of public health policy41
Suggested Strategies:
2.1.1 Increase availability of health system navigation support 2.1.2 Increase utilization of THR Community Connect resource 2.1.3 Promote existing health collaboratives for resource sharing and increase awareness 2.1.4 Reduce reported percentage of residents who indicate transportation as a social determinant of health
3:Collective Influence Potential Partners Student Health Services Coalitions & Collaboratives Healthcare providers State, local and county Healthy elected officials Communities FQHC – Health Services of Coalition North Texas SPAN Transit Community Health Acute care providers/hospitals Denton County Council Charitable clinics Transportation Authority Primary care providers United Way of Denton Texas 2-1-1 County Non-profit agencies
38 Office of Disease Prevention and Health Promotion. (2017). Access to Health Services
4:Appendices 39 Network of Care. (2017). Denton County. 40 Texas Medical Association. (2017). Texas Legislature. 41 Texas Association of City & County Health Officials. (2017). Advocacy.
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Goal 2: Enhance equitable access to health care and community resources Objective 2.2: Meet target of persons having a usual primary care provider HP 2020 Target: 83.9% National Baseline: 76.3% CHIP Target: ≥ 83.9% by 2020 Healthy People 2020: Access to Health Services42
AHS-3: MEPS National Baseline 76.3%
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Data Source: Medical Expenditure Panel Survey CommunityPlan Health Improvement Persons were considered to have a usual primary care provider (PCP) if they responded “yes” to: Is there a particular doctor’s office, health center or other place that person usually goes if person is sick or needs advice about person’s health? Is [PROVIDER] the person/place they would go for new health problems? Is [PROVIDER] the person/place they would go for preventative health care, such as general check-ups, examinations and immunizations? Is [PROVIDER] the person/place they would go for referrals to other health professionals when needed? Journal of Health Affairs: Patients with a PCP have “better management of chronic diseases, lower 43
overall health care costs, and a higher level of satisfaction with their care.” Policies, Laws & Standards: Patient Protection and Affordable Care Act - Title I includes provisions for “quality, affordable health care for all Americans”, including coverage of preventative services, extension of dependent coverage and prohibiting discrimination based on health status.44 Texas Primary Care Office: Works with health care providers and communities to improve access to
care for underserved populations.45 3: 3: th Texas Medical Association reports in the 85 Texas Legislature: Influence Collective SB 1107 increased patients in remote areas or with mobility needs access to telemedicine SB 1 funded medical education expansion grants to “keep new doctors in Texas”46 Suggested Strategies: 2.2.1 Legislative advocacy for continued legislation focused on access to care 2.2.2 Increased health system navigation for identification of PCPs 2.2.3 Health promotion and literacy teaching surrounding the value of a regular PCP Potential Partners Student health services Coalitions & Collaboratives Healthcare providers Elected officials Healthy Communities Health Services of North Texas Texas 2-1-1 Coalition PCPs and physician offices Non-profit agencies Community Health Charitable clinics
Council 4: Appendices 4:
42 Office of Disease Prevention and Health Promotion. (2017). Access to Health Services 43
Commonwealth of Massachusetts. (2013). The Importance of Having a Primary Care Physician. 44 U.S. House of Representatives. (2010). Compilation of Patient Protection and Affordable Care Act. 45 Texas Department of State Health Services. (2017). Texas Primary Care Office (TPCO) 46 Texas Medical Association. (2017). Strength in Numbers: 85th Texas Legislative Regular Session Summary.
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Area of Concern: BEHAVIORAL HEALTH
Development Across assessments and community feedback
Plan Plan platforms in Denton County, concerns surrounding 1: access to a coordinated behavioral health system are consistent. UWDC focus groups elicited 26 mentions of mental health services, including the lack of care 57% available, workforce needs and concerns surrounding of Denton County residents school intervention for children with mental health report mental health as a 47
needs. Nearly half of respondents to Texas Health community health problem Denton’s community survey report mental health and mental disorders as a community health need.48 Lastly, 57.14% of DCPH survey respondents identified mental health as a health problem in Denton County. In 2013, the State of Texas ranked 48th in the nation for expenditures for mental health. Mental Health America reports 59.7% of individuals in Texas with any diagnosable mental illness did not receive treatment, making the proportionality of those who seek and access treatment less
than those who do not. If statewide data were assumed locally, this would indicate
Community Health Improvement Health Plan Community : :
2 approximately 78,500 Denton County residents with any mental illness did not receive treatment in the last year.49/50 Mental health ranked second, just behind chronic disease, for health topics of concern in the Texas Health Denton secondary data analysis.51
Denton County Community-Wide Children’s Health Assessment and Planning Survey (CCHAPS) data indicates children with mental health needs are less likely to access all needed medical care.52 Sixty-four percent of parents in attendance of the 3:Collective Influence Denton County Child Health Summit in 2016 reported difficulty accessing mental health services for their child.53
47 United Way of Denton County. (2017). 2017 Community Needs Assessment. 48 Texas Health Presbyterian Hospital Denton. (2016). 2016 Community Health Needs Assessment. 49 Mental Health America. (2017). Mental Health America Access to Care 50 United Way of Denton County. (2017). 2017 Community Needs Assessment. 51 Texas Health Presbyterian Hospital Denton. (2016). 2016 Community Health Needs Assessment.
4:Appendices 52 The Center for Children’s Health led by Cook Children’s. (2015). Denton County Community-wide Children’s Health Assessment and Planning Survey. 53 Denton County Child Health Summit III. (2016). Center for Children’s Health Denton County Summit.
21
1:
Policy Considerations PlanDevelopment The 85th Texas Legislature allocated time, attention and funding to address mental health needs in Texas. HB 10 established an ombudsman for behavioral health to address consumer and provider access to care needs within the behavioral health and substance use domain. Additionally, SB 292 established a grant program to reduce recidivism, arrest and incarceration of individuals with mental illness.54 State legislation impacting children’s mental health passed, including SB 74 and HB 1600. HB 1600 requires providers to provide mental
health screening under Texas Health Steps for children ages 12 to 19 2
years of age. The National Alliance on Mental Illness (NAMI) reports : CommunityPlan Health Improvement “50% of all lifetime cases of mental illness begin by age 14”, with the average delay between symptomology and treatment being 8-10 years.55 Advocacy for additional legislation implementing integrated care can further early detection and referral to appropriate treatment. As accomplished through HB 1486 and HB 3083 in the 85th Texas Legislature, addressing the workforce crisis increases access to behavioral health care. Additional advocacy for legislation that continues to promote access through available practitioners aligns with CHIP objectives.56 Federally, President Trump declared the opioid crisis a public health emergency in October 2017. According to the New York Times, the designation “would allow for some grant money to be used to combat
opioid abuse, permit the hiring of specialists to tackle the crisis, and 3: 3:
expand the use of telemedicine services to treat people in rural Influence Collective areas.”57
*Graphic from Texas Medical th Association pertaining to the 85 Texas Appendices 4: Legislature
54 Texas Council for Developmental Disabilities. (2017). Mental Health Tracking. 55 National Alliance on Mental Illness. (n.d.) Mental Health Facts: Children & Teens.
56 Meadows Mental Health Policy Institute. (2017). 85th Regular Legislative Session: Improving the Texas State of Mind 57 New York Times. (2017). Trump Declares Opioid Crisis a ‘Health Emergency’ but Requests No Funds.
22
Area of Concern: Behavioral Health
Goal 1: Increase access to preventative and integrated care Plan Development Plan
1: Objective 1.1: Increase the proportion of adults with mental health disorders who receive treatment HP 2020 Serious Mental Illness Objective 1.1a: Identify baseline of Denton County residents aged Target: 72.3% 18 and over with a MDE within the past 12 months who received treatment by 2019 HP 2020 Major Depressive
Episode (MDE) Target: 75.9% Objective 1.1b: Increase proportion of Denton County residents aged 18 and over with MDE within the past 12 months who received treatment to HP 2020 target of 75.9% by 2020 Healthy People 2020: Mental Health and Mental Disorders58 MHMD-9.1: Target 72.3% MHMD-9.2: Target 75.9% Data Source: National Survey on Drug Use and Health Receiving treatment for MDE is defined as an adult having received treatment/counseling if s/he saw or talked to a medical doctor or other professional for MDE in the past year.
Community Health Improvement Health Plan Community Meadows Mental Health Policy Institute (MMHPI): “An effective mental health system requires : : 2 thoughtful state policy, adequate funding, and a strong local network that includes providers, hospitals, city and county officials, police and sheriff departments, and nonprofit agencies.”59 Policies, Laws & Standards: Mental Health Parity and Addiction Equity Act – coverage for mental health or substance use disorders to make benefits comparable to medical coverage60 85th Texas Legislature, HB 10 – Relating to access to and benefits for mental health conditions and
substance use disorders61
Suggested Strategies 1.1.1 Continued community collaboration surrounding behavioral health 1.1.2 Generate county-wide survey methodology for establishing baseline data 1.1.3 Increase proportion of homeless adults with mental health needs who receive treatment
1.1.4 Reduction of stigma surrounding mental health diagnoses and accessing of services 3:Collective Influence Potential Partners Cook Children’s Local law enforcement Denton County MHMR Mental health providers Local universities and ISDs Coalitions & Collaboratives United Way of Denton Non-profit agencies County Denton County Behavioral Meadows Mental Health Health Leadership Team Elected officials Policy Institute WATCH Coalition County courts
Community Health Council
58 Office of Disease Prevention and Health Promotion. (2017). Mental Health and Mental Disorders.
4:Appendices 59 Meadows Mental Health Policy Institute. (2016). 2015 Annual Report. 60 Substance Abuse and Mental Health Services Administration. (2017). Laws and Regulations. 61 Texas Council for Developmental Disabilities. (2017). Mental Health Tracking.
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1:
Area of Concern: Behavioral Health PlanDevelopment
Goal 1: Increase access to preventative and integrated care
Objective 1.2: Increase depression screening by primary care providers HP 2020 Target: 2.4% HP 2020 Baseline: 2.2% CHIP Target: ≥ 2.4% Healthy People 2020: Mental Health and Mental Disorders62 MHMD-11.1: Target 2.4%
MHMD-11.2: Target 2.3% 2
Data Source: National Ambulatory Medical Care Survey : CommunityPlan Health Improvement Denton County Behavioral Health Leadership Team Mission: Advocate and facilitate a collaborative person-centered behavioral health system to repair and restore lives. Policies, Laws & Standards: The Patient Protection and Affordable Care Act “includes a number of provisions that provide supports and incentives for States and health care providers to adopt the practice of integration of primary and behavioral health care services.”63 85th Texas Legislature, HB 1600 – Relating to certain mental health screenings under the Texas Health Steps program64 Substance Abuse and Mental Health Services Administration (SAMHSA) Primary and Behavioral
Health Care Integration Program & Center for Integrated Health Solutions (CIHS) Standard Framework
Suggested Strategies: 1.2.1 Generate awareness of CIHS Standard Framework and assess current integration 1.2.2 Advocate for legislation that facilitates greater integration of medical/behavioral health care 1.2.3 Provide resource guide to PCPs for referral of patients who screen positively for depression 1.2.4 Provide standardized depression screening tool training to PCPs or clinical staff for
administration 3: Collective Influence Collective Potential Partners Cook Children’s Mental health providers Denton County MHMR Primary care providers Inpatient hospitals Outpatient Coalitions & Collaboratives Clinicians programs
Independent Denton County Behavioral Nurses Health Leadership Team Social Workers practitioners WATCH Coalition Administrative staff Elected officials Community Health Council United Way of Denton County courts Meadows Mental Health Policy County Institute
4: Appendices 4:
62 Office of Disease Prevention and Health Promotion. (2017). Mental Health and Mental Disorders. 63 Substance Abuse and Mental Health Services Administration. (2012). Understanding Health Reform. 64 Texas Council for Developmental Disabilities. (2017). Mental Health Bill Tracking.
24
Area of Concern: Behavioral Health
Goal 1: Increase access to preventative and integrated care Plan Development Plan 1: Objective 1.3: Maintain the proportion of children with mental health needs who receive treatment HP 2020 Target: 75.8% CCHAPS Baseline: 98.43% CHIP Target: ≥ 98.5% by 2020 Healthy People 2020: Mental Health and Mental Disorders65
CCHAPS 2015 – Denton County: 1.57%
Data Source: Community-wide Children’s Health Assessment & Planning Survey (CCHAPS)66 Wellness Alliance for Total Children’s Health (WATCH) Coalition Vision: Because every child deserves hope, the Denton County community dedicates its unified resources to equip our children to reach their full potential mentally, physically and socially to achieve their maximum personal success.67 Policies, Laws & Standards: 85th Texas Legislature, HB 1600 – Relating to certain mental health screenings under the Texas Health Steps program68 SB 1021 – Relating to a report on the consolidation of the health and human services system,
including advisory committees within the system, and the re-creation of the Texas system of care Community Health Improvement Health Plan Community
: : framework 2 Suggested Strategies: 1.3.1 Become a Texas System of Care community 1.3.2 Provide Youth Mental Health First Aid to educators and child care providers 1.3.3 Incorporate children’s mental health into MMHPI Okay to Say campaign for stigma reduction
Potential Partners Denton County Juvenile United Way of Denton Justice County Denton County MHMR Cook Children’s Elected officials Coalitions & Collaboratives Pediatricians WATCH Coalition
Early Childhood Coalition Educators & child care 3:Collective Influence Denton County Behavioral providers Health Leadership Team Clinicians: Community Health Council Counselors Meadows Mental Health Policy Psychologists Institute Psychiatrists Juvenile Mental Health Court Psychiatric nurses
School nurses
65 Office of Disease Prevention and Health Promotion. (2017). Mental Health and Mental Disorders. 4:Appendices 66 Cook Children’s. (2016). Center for Children’s Health – CCHAPS Data. 67 Wellness Alliance for Total Children’s Health. (2017). About WATCH. 68 Texas Council for Developmental Disabilities. (2017). Mental Health Bill Tracking.
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1:
Area of Concern: Behavioral Health PlanDevelopment
Goal 2: Reduce stigma through education and community engagement
Objective 2.1: Increase the proportion of community members who feel confident discussing mental health 9 of 10 Texans believe it is 75% of Texans agree more CHIP Target: ≥ 75% of Denton harder to talk about mental education would make them County residents feel confident health than physical health feel more confident discussing discussing mental health by
needs mental health needs. 2020
2 : : Attitude Toward Mental Illness – 35 States, District of Columbia, and Puerto Rico, 2007 CommunityPlan Health Improvement 58.4% of Texans agree that people are “caring and sympathetic to persons with mental illness” 82.8% of Texans believe “treatment can help persons with mental illness lead normal lives” Data Source: BRFSS – CDC & SAMHSA CDC: “Negative attitudes about mental illness often underlie stigma, which can cause affected persons to deny symptoms; delay treatment; be excluded from employment, housing, or relationships; and interfere with recovery.” 69 Policies, Laws & Standards: The Okay to Say Movement, an effort led by MMPHI, is designed to “increase awareness that most mental illnesses are treatable and to offer messages of hope and
recovery to Texans and their families.”70
Okay to Say is currently in 254 Texas counties with 70+ partners. Suggested Strategies: 2.1.1 Train ≥ 100 community members in Mental Health First Aid by December 2019 2.1.2 Support existing collaboratives in providing educational and awareness sessions
A. Educational workshops provided by the WATCH Coalition 3: B. Speakers Bureau presentations provided by the DCBHLT Influence Collective C. Project Camo presentations provided by UWDC 2.1.3 Develop county-specific Okay to Say marketing/community education plan 2.1.4 Maintain the reach of the WATCH Coalition “My Feelings are a Work of Art” annual contest
2.1.5 Engage in awareness month programming, including proclamations and promotion
Potential Partners Cook Children’s Mental health providers Coalitions & Collaboratives Primary care providers Inpatient hospitals Outpatient Denton County Behavioral Clinicians programs Health Leadership Team Nurses Independent WATCH Coalition Social Workers practitioners Community Health Council Administrative staff Elected officials Meadows Mental Health Policy
Denton County MHMR United Way of Denton Appendices 4: Institute County
69 Centers for Disease Control and Prevention. (2010). Attitudes Toward Mental Illness – 35 States, District of Columbia, and Puerto Rico, 2007. Morbidity and Mortality Weekly Report. 70 Meadows Mental Health Policy Institute. (2017). Texas State of Mind. Okay to Say – Our Story.
26
Area of Concern: EDUCATION & PREVENTION The Centers for Disease Control (CDC) and Prevention
Plan Development Plan estimates that 100,000 lives per year could be saved 1: through consistent utilization of clinical prevention services in the United States.71 In a survey conducted by Texas Health Denton, 21% of local respondents identified clinical prevention services as a community need.72
Immunizations
Denton County has the highest percent of students with conscientious immunization objections in the DFW Metroplex, ranking 10th highest in the state of Texas. The National Prevention Council indicates an average of 42,000 deaths per year prevented among children who receive recommended vaccinations.73 For the 2016 – 2017 academic year, Denton County school districts’ conscientious exemptions ranged from 0.0% to 14.87%.74 Healthy People 2020 reports that each vaccinated birth cohort reduces healthcare costs by $9.9 billion
and prevents 14 million cases of disease. Healthy People also references “despite progress, Community Health Improvement Health Plan Community
: : approximately 42,000 adults and 300 children in the United States die each year from vaccine- 2 preventable diseases.”75 Twelve percent of Denton County residents identify immunizations and infectious disease as one of the greatest community health needs.76 Preventative Screenings Healthy People 2020 includes targets surrounding proportions of patients accessing age-appropriate clinical cancer screenings, promoting detection of the disease at a more treatable stage. While Denton County is slightly exceeding the Healthy People 2020 target for colorectal screenings, the county does not 3:Collective Influence meet the targets for patients accessing mammograms and Pap testing. This equates to more than 41,000 female residents over age 18 not accessing Pap testing and over 26,000 female residents over age 50 not accessing mammograms.77
71 Centers for Disease Control and Prevention. (2015). CDC Prevention Checklist. Preventative Care: Everyone needs an ounce of prevention. 72 Texas Health Presbyterian Hospital Denton. (2016). 2016 Community Health Needs Assessment. 73 National Prevention Council. (2011). National Prevention Strategy. Office of the Surgeon General, U.S. Department of Health and Human Services. 74 Texas Department of State Health Services. (2017). 2016-2017 Conscientious Exemption by School District.
4:Appendices 75 Office of Disease Prevention and Health Promotion. (2017). Immunization and Infectious Disease. 76 Texas Health Presbyterian Hospital Denton. (2016). 2016 Community Health Needs Assessment. 77 Denton County Network of Care. (2017). Public Health Assessment and Wellness. Prevention through healthcare.
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1:
PlanDevelopment
Technology
The PwC Health Research Institute reported in Top health industry issues of 2017, “The health industry lags behind other industries, such as retail and telecommunications, in the deployment of emerging technologies.” Emerging technological trends impact health care service delivery and information management systems,
while simultaneously presenting opportunities for information
2 : : sharing. CommunityPlan Health Improvement The Pew Research Center reports in 2015 76% of all internet users utilized at least one social media site, compared to 10% in 2005.78 In 2017, Facebook had 2.07 billion active users worldwide.79 The World Health Organization (WHO) highlights the public health value of social media stating, “…uses of social media can bring public health information to many more people, more quickly and directly than any time in history”.80 The utilization of social marketing in public health has been adopted by the CDC and the U.S. Department of Health and Human Services to positively influence health behaviors. Social marketing is defined as “program-planning processes that applies commercial marketing concepts and technique to promote voluntary behavior change”.81 In 2005, the CDC launched the VERB™ program, designed to promote physical activity for youth and adolescents. The national social
marketing campaign engaged educational institutions, parents and 3: 3:
children through marketing and promotional materials emphasizing Influence Collective the value of play and movement.82 Denton County recognizes the potential “A recent report by the Pew Internet and value of social media utilization and diverse American Life Project found that 80 percent of health promotion methodologies. A recurring Internet users have looked online for health theme of the 2017 Community Health Summit information, highlighting the importance of was attention to consistent health messaging public health using this modality for message and maximization of online platforms for dissemination.” social marketing. -NACCHO, 2013
4: Appendices 4:
78 Pew Research Center. (2015). Social Media Usage: 2005 – 2015. 79 Statista. (2017). Social Media & User-Generated Content.
80 McNab, C. (2009). What social media offers to health professionals and citizens. World Health Organization (87). 81 Grier, S. & Bryant, C.A. (2005). Social Marketing in Public Health. Annual Review of Public Health (26), p.319-339. 82 Centers for Disease Control and Prevention. (2007). Youth Media Campaign.
28
Policy Considerations Federally, the Patient Protect and Affordable Care Act (ACA) Title IV pertains to preventing chronic disease
Plan Development Plan and improving public health. The ACA facilitated the 1: establishment of the National Prevention Council, consisting of 17 federal departments and agencies. The Council established the National Prevention Strategy with seven priorities, including: Tobacco free living Preventing drug abuse and excessive alcohol use Healthy eating Active living Injury and violence free living Reproductive and sexual health Mental and emotional well-being
Additionally, Title I of the ACA mandates coverage of preventative services and immunizations. Community Health Improvement Health Plan Community
: : As previously referenced, individuals who are uninsured are less likely to access preventative 2 screenings. Legislation that reduces barriers to health insurance and supports affordable preventative services are anticipated to increase health equity. 83 The 85th Texas Legislature reviewed bills ranging from subject matter related to immunization exemptions to efficient use of excess food in the public school systems. The Texas Medical
Association (TMA) reports prevention successes, such as HB 3576 which will “shore up the state’s testing and screening capabilities for infectious disease”. Additionally, TMA opposed legislation such as HB 1124 relating to claiming an exemption from required immunizations was left pending in committee.84 However, numerous pieces of legislation pertaining to increased surveillance and regulations 3:Collective Influence for contentious immunization exemptions did not pass in the 85th Texas Legislature. Legislation such as HB 241 requiring health care practitioner counseling for persons claiming an immunization exemption could potentially increase health literacy and awareness of exemption impact for more informed decision making. Additionally, further incorporation of health education in school systems through the Texas Education Agency could begin proactively combating disparities in health literacy through public education. The Denton County community will continue to advocate for legislation that positively impacts public health and promotes healthy behaviors.
4:Appendices 83 Kaiser Family Foundation. (2016). Key Facts about the Uninsured Population. Barriers to health care among nonelderly adults by insurance status, 2015. 84 Texas Medical Association. (2017). Medicine’s Big Winners as Legislature Wraps Up Regular Session.
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1:
Area of Concern: Education & Prevention PlanDevelopment
Goal 1: Foster a culture of healthy childhood behavior
Objective 1.1: Increase vaccination coverage of kindergartners HP 2020 Target: 95% Denton County Baseline: CHIP Target: ≥ 95% by 2020 91.78% Healthy People 2020: Immunization and Infectious Disease85
IID-10.1 – 10.5 Target: 95% 2
Target: 95% for DTaP, MMR, polio, hepatitis B and varicella for children in kindergarten : CommunityHealth Data Source: Annual school assessment reports Denton County Data Source: Department of Health and Human Services (DSHS) Policies, Laws & Standards: CDC 2017 Recommended Immunizations for Children from Birth Through 6 Years Old86
85th Texas Legislature, DSHS School Health and Public Education 2017 Related Legislation Tracking – 6 Plan Improvement pieces of legislation filed pertaining to immunizations but were not passed, including:87 SB 54 & HB 243 – Relating to the immunization data included in and excluded from the immunization registry
HB 120 – Relating to non-medical exemptions from immunization requirements HB 241 – Relating to health care practitioner counseling requirement for persons claiming an immunization exemption on the basis of conscience, including a religious belief HB 1029 – Relating to the informed consent to immunizations for children BH 1124 – Relating to claiming an exemption from required immunizations for public school
students 3: 3:
Suggested Strategies Influence Collective 1.1.1 Increase health promotion pertaining to immunization schedule for kindergartners 1.1.2 Increase access points for back to school immunizations 1.1.3 Identify and collaborate with school districts with lowest vaccination coverage rates 1.1.4 Advocate for legislation that bolsters healthy childhood behaviors
Potential Partners Primary care providers Health educators Local school districts Elected officials Community members - parents Administrators Texas Department of Health Nurses and Human Services School boards Early Childhood Coalition Pediatricians Public Health Advisory
Committee 4: Appendices 4:
85 Office of Disease Prevention and Health Promotion. (2017). Immunization and Infectious Disease. 86 Centers for Disease Control and Prevention. (2017). 2017 Recommended Immunizations for Children from Birth
Through 6 Years Old 87 Texas Department of State Health Services. (2017). 85th Legislative Session School Health and Public Education. 2017 Related Legislation Tracking.
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Area of Concern: Education & Prevention
Goal 1: Foster a culture of healthy childhood behavior Plan Development Plan 1: Objective 1.2: Increase access to total children’s health information and resources for parents, children and community members HP 2020 State Health Objective 1.2a: Formulate WATCH Coalition workgroup focused Departments Social Marketing on social marketing and collaboration by 2018 Target: 50 State Departments
Healthy People 2020: Health Communication & Health Information Technology88 HC/HIT-8.1: Increase the number of health web sites that met 3 or more criteria for disclosing information that can be used to assess information reliability Source: National Quality Health Website Survey Reliability evaluation criteria: Disclosed the identify of the persons/organizations responsible for the site Disclosed the purpose or mission and limitations of the site Clearly differentiate between advertising and non-advertising content and stated editorial policy or authorship
Disclosed their privacy/user protection policy
Community Health Improvement Health Plan Community : :
2 Provided a mechanism for user feedback Disclosed the date of creation, update or review of the health content displayed Policies, Laws & Standards: The Center for Children’s Health by Cook Children’s – Wellness Alliance for Total Children’s Health Strategic Plan 2017- 2019: Objective 3 prioritizes social marketing and awareness campaigns The Okay to Say Movement, an effort led by MMPHI, is designed to “increase awareness that most mental illnesses are treatable and to offer messages of hope and recovery to Texans and their families.”89 Okay to Say is currently in 254 Texas counties with 70+ partners. Suggested Strategies: 1.2.1 Community partnership to develop and promote awareness campaigns 1.2.2 Health promotion planning for targeted messaging and material distribution 3:Collective Influence 1.2.3 Engage in awareness events and promote the WATCH Coalition “My Feelings are a Work of Art” annual contest 1.2.4 Partner with local governing entities to recognize awareness days through proclamations Potential Partners Cook Children’s Community members Coalitions & Collaboratives Meadows Mental Health Texas Department of Health Denton County Behavioral Policy Institute and Human Services Health Leadership Team United Way of Denton Texas System of Care WATCH Coalition County Community Health Council Elected officials
4:Appendices 88 Office of Disease Prevention and Health Promotion. (2017). Health Communication and Health Information Technology. 89 Meadows Mental Health Policy Institute. (2017). Texas State of Mind. Okay to Say – Our Story.
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1:
Area of Concern: Education & Prevention PlanDevelopment
Goal 1: Foster a culture of healthy childhood behavior
Objective 1.3: Continue monitoring children’s health issues HP 2020 Reading to Young Denton County Baseline: Objective 1.3a: Increase the Children Target: 52.6% 19.07% proportion of parents who read to their young child by 10% by
2020
90
Healthy People 2020: Early & Middle Childhood 2
: : CommunityPlan Health Improvement CCHAPS 2015 – Denton County: 19.07% Data Source: Community-wide Children’s Health Assessment & Planning Survey (CCHAPS)91 HP 2020 National Survey of Children’s Health Metric: Number of children aged 0 to 5 years whose parent report that someone in their family read to the child every day in the past week92 Policies, Laws & Standards: ReadyRosie is a “research-based comprehensive family engagement resource” that guides parents to utilize everyday experiences as teaching opportunities through the use of video and mobile technology. 85th Texas Legislature, HB 357 – Expands eligibility for free prekindergarten programs in public schools to the children of certain first responders (Enacted)
HB 2039 – Creates an early childhood certification to teach students in prekindergarten through grade three (Enacted) HB 1522 – Relating to a task force to coordinate and make recommendations on parent engagement and education programs provided by state agencies (Legislation was not passed) HB 1845, SB 484 – Relating to the availability of free prekindergarten programs in public schools
(Legislation was not passed)93 3: Collective Collective Suggested Strategies:
1.3.1 Partners with the Center for Children’s Health to review CCHAPS data Influence 1.3.2 Participate in and promote children’s health initiatives 1.3.3 Participate in annual Child Health Summit
1.3.4 Become a Texas System of Care Community Potential Partners ReadyRosie Big Brothers Big Sisters WATCH Coalition Community members Communities in Schools North Texas Early Childhood Coalition First Step Denton Boys & Girls Clubs Local school districts NewDay Services Boy Scouts & Girl Scouts Administrators Childcare centers
Mentor Denton Appendices 4: Educators Local libraries
90 Office of Disease Prevention and Health Promotion. (2017). Early and Middle Childhood.
91 Cook Children’s. (2016). Center for Children’s Health – CCHAPS Data. 92 Office of Disease Prevention and Health Promotion. (2017). Early and Middle Childhood. 93 National Conference of State Legislatures. (2017). Early Education and Child Care Bill Tracking Database.
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Area of Concern: Education & Prevention
Goal 2: Promote investment in evidence-based health education and Plan Development Plan
1: prevention programs Objective 2.1: Increase social marketing in health promotion and disease prevention HP 2020 Website Usability Objective 2.1a: Increase the promotion of health-related Target: 55.7% websites that follow established usability principles
HP 2020 State Health Objective 2.1b: Implement social marketing in local health Departments Social Marketing department’s health promotion and communications plan Target: 50 State Departments Healthy People 2020: Health Communication & Health Information Technology94 HC/HIT-8: Increase the proportion of quality, health-related websites that follow established usability principles Source: National Quality Health Website Survey Metric: Number of health-related websites that met a scoring benchmark between 10 – 19
composites (out of 19 composites) for established usability principles Community Health Improvement Health Plan Community
: : Usability principles three over-arching domains: site design, information architecture and content 2 design. For a full list of usability principles see HC/HIT-8 at www.healthypeople.gov.
In 2015, 76% of all internet users utilized at least one social media site, compared to 10% in 2005.95
Policies, Laws & Standards: World Health Organization (WHO) - “…uses of social media can bring
public health information to many more people, more quickly and directly than any time in history”96
Suggested Strategies:
Influence 2.1.1 Host annual social marketing training for health professionals and program administrators 2.1.2 Increase LHD social media presence from one to four platforms 2.1.3 Partner with WATCH Coalition for social marketing workgroup formulation
2.1.4 Generate health promotion and communication plan for LHD 3:Collective Potential Partners Media contacts Public information officers Coalitions & Collaboratives Primary care providers Elected officials Healthy Communities Coalition Health clinicians County courts WATCH Coalition Nonprofits Community Health Council Local universities Advertising, public relations and
marketing professionals Health educators
94 Office of Disease Prevention and Health Promotion. (2017). Health Communication and Health Information
4:Appendices Technology. 95 Pew Research Center. (2015). Social Media Usage: 2005 – 2015. 96 McNab, C. (2009). What social media offers to health professionals and citizens. World Health Organization (87).
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1:
Area of Concern: Education & Prevention PlanDevelopment
Goal 2: Promote investment in evidence-based health education and
prevention programs
Objective 2.2: Obtain local health department accreditation HP 2020 LHD Target: 3.7% Objective 2.2a: Obtain Public Health Accreditation Board (PHAB) Accreditation by 2020 Objective 2.2b: Obtain Project Public Health Ready Accreditation
by 2020 2
: : CommunityPlan Health Improvement Healthy People 2020: Public Health Infrastructure97 PHI-17.3: Target 3.7% Source: Public Health Accreditation Board PHAB Accreditation Standards and Measures, Version 1.0 was release to the public in July 2001, with Version 1.5 released in 2015.98 Project Public Health Ready is an accreditation program designed to strengthen training and preparedness capacity for LHDs to respond to any emergency.99 Policies, Laws & Standards: The Institute of Medicine The Future of the Public’s Health report called for “the establishment of a national Steering Committee to examine the benefits of accrediting governmental public health departments”.100 The Morbidity and Mortality Weekly Report (2017) states > 90% of accredited health departments report the accreditation process has: Stimulated quality improvement Increased accountability and transparency
Improvement management processes 3: Collective Influence Collective Suggested Strategies: 2.2.1 Formulate LHD quality improvement committee to begin generating culture of continuous quality improvement in public health 2.2.2 Host Annual Community Health Summit to garner stakeholder and community member
feedback on areas of health concern and improvement planning 2.2.3 Provide focused training on emergency response and preparedness for all LHD staff Potential Partners Neighboring counties Texas Health Presbyterian Hospital Denton DCPH staff Denton County Commissioners Court United Way of Denton Coalitions & Collaboratives County Public Health Advisory Healthy Communities Coalition Committee Elected officials WATCH Coalition Community Health Council County courts Appendices 4:
97 Office of Disease Prevention and Health Promotion. (2017). Public Health Infrastructure.
98 Public Health Accreditation Board. (2013). Accreditation Background. 99 National Association of County & City Health Officials. (2017). Project Public Health Ready. 100 Public Health Accreditation Board. (2013). Accreditation Background.
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Area of Concern: Education & Prevention
Goal 2: Promote investment in evidence-based health education and Plan Development Plan
1: prevention programs
Objective 2.3: Promote engagement in community collaboration HP 2020 LHD CHIP Target: 61% Objective 2.3a: Adopt Denton County Community Health Improvement Plan (CHIP) by 2018 Objective 2.3b: Host Annual Community Health Summit to
promote existing efforts positively impacting community health improvement Healthy People 2020: Public Health Infrastructure101 PHI-15.3: Target 61% Source: National Association of County & City Health Officials (NACCHO) Policies, Laws & Standards: Collective impact brings stakeholders and community members together to achieve social change through:102 Common agenda
Shared measurement Community Health Improvement Health Plan Community
: : 2 Mutually reinforcing activities Continuous communication Strong backbone Collaborative efforts maximize use of resources and expand reach of efforts. The Internal Revenue Service requires hospitals to:103
Conduct a community health needs assessment
Define community Complete annual reports on addressing identified health needs Requires community partnership and solicitation of feedback Suggested Strategies:
3:Collective Influence 2.3.1 Update CHA and CHIP every three years to ensure alignment with current health needs 2.3.2 Provide annual report of improvement activities through Annual Community Health Summit Potential Partners Coalitions & Collaboratives Public Health Advisory Healthy Committee Texas Health Denton Communities Denton County United Way of Denton County Coalition Commissioners Court Health Services of North Texas Community Health Council Community Health Strategy Community members Group
WATCH Coalition
101 Appendices Office of Disease Prevention and Health Promotion. (2017). Public Health Infrastructure.
4: 102 The Collective Impact Forum. (2014). What is Collective Impact. 103 Policy Institute of Ohio. (2015). Summary of community health planning requirements for hospitals and local health departments (LHDs).
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1:
Area of Concern: PlanDevelopment EXERCISE, WEIGHT & NUTRITION Across the nation, the number of people categorized as having an unhealthy weight has been increasing. An estimated 16% of adults in Denton County had a BMI of 30 or higher in 2015.104 According to the CDC, Denton County performs worse in adult obesity prevalence and adult physical activity when compared to peer counties.105 In a survey conducted by Texas Health Denton, Percentage of Residents that are 56% of respondents stated that
Obese as of 2013 obesity/overweight was a community health
2 : :
need – ranking this as the most frequently CommunityPlan Health Improvement Denton Collin Tarrant Dallas Texas reported need. Key informants relayed a need for more recreation and fitness opportunities in the built environment of Denton County.106 Percent Obese More than 20% of Denton County residents are physically inactive – meaning the individual has not participated in physical activities outside of 0 10 20 30 40 work in the past month.107 Females in Denton PERCENTAGE County report higher rates of physical inactivity
than males.108 Denton County performs slightly worse than the Adults Eating Few Fruits/Vegetables state in percent of adults consuming fruits and Daily vegetables. According to Texas Health Presbyterian Hospital Denton’s online 85.0% 80.0% 3: community survey results, 50% of respondents Influence Collective identified diet, food and nutrition as a social 75.0% determinant of health.109 70.0%
According to the BRFSS questionnaire, the Percent Adults of 65.0%
percentage of Denton County adults who report eating, on average, fewer than 5 servings of 110 fruits and vegetables per day is declining. Texas Denton
104 Sahini, L. (2016). Prevalence of Obesity among Adults by Demographic Characteristics, Risk Factors, Other Conditions, and Place of Residence, Texas, 2015. 105 United Way of Denton County. (2017). 2017 Community Needs Assessment. 106 Texas Health Presbyterian Hospital Denton. (2016). 2016 Community Health Needs Assessment. 107 Denton County Network of Care. (2017). Public Health Assessment and Wellness. Adults who are physically Appendices 4: inactive (CDC). 108 Denton County Network of Care. (2017). Public Health Assessment and Wellness. Adults who are physically inactive (CDC).
109 Texas Health Presbyterian Hospital Denton. (2016). Community Health Needs Assessment. 110 U.S. Department of Health and Human Services. (2016). Health Resources & Services Administration Data Warehouse.
36 The National Health and Nutrition Examination Survey indicates that those with a family income of 199% of the poverty threshold and below have the highest mean percent of daily calorie intake from added sugars.111 Denton County has a reported grocery store density of 0.08 per 1,000 residents and farmers’ Plan DevelopmentPlan
1: market density of 0.01 per 1,000 residents. Access to fast-food has steadily increased in Denton County since 2007, with a density of 0.65 per 1,000 residents in 2012.112
USDC Food Access Atlas The United States Department of Agriculture Denton County LI & LA, 2015 (USDA) provides the Food Access Research Atlas, depicting census tracts throughout the
United States with low-income and low access to a grocery store. The map provided indicates 6 low-income census tracts (green) with a significant number of residents more than 1 mile (urban) or 10 miles (rural) from the nearest supermarket. Additionally, the map indicates 3 low-income census tracts (yellow) where more than 100 housing units do not have access to a vehicle and are more than a ½ mile from the Community Health Improvement Health Plan Community
: 113 2 nearest supermarket. Policy Considerations Feeding America engages in active advocacy for federal funding and programing that combats hunger and increased food security in the United States. Legislative priorities for Feeding
America include, but are not limited to appropriations and budget, the Farm Bill, and the Child Nutrition Reauthorization Act.
Influence Texas Department of State Health Services Obesity Prevention Program was created in 2013 to 114 th “make healthy choices easier for Texans”. Legislation reviewed in the 85 Texas Legislature such as SB 757 relating to before-school and after-school programing that promotes healthy 3: Collective eating and physical activity and HB 367 relating to feeding hungry children through excess food in public schools would reduce food insecurity and encourage healthy childhood behaviors. Legislative advocacy for policies that will positively influence health behaviors and reduce disparities in access to nutritious foods are priorities iterated within the CHIP.
111 National Health and Nutrition Examination Survey. (2015). 2020 Topics & Objectives: Nutrition and Weight Status.
4: Appendices 112 Denton County Network of Care. (2017). Public Health Assessment and Wellness. Built environment. 113 United States Department of Agriculture. (2017). Food Access Atlas. 114 Texas Department of State Health Services. (2016). Obesity Prevention Program.
37
1:
Area of Concern: Exercise, Weight & Nutrition PlanDevelopment
Goal 1: Increase available access points that foster physical activity and
nutritious eating Objective 1.1: Reduce percentage of residents who express experiencing food insecurity HP 2020 Target: 6% Denton County Baseline: 15.9% CHIP Target: ≤ 6% by 2020
Healthy People 2020: Nutrition & Weight Status115
2 : : NWS-13: Target 6% CommunityPlan Health Improvement Data Source: Current Population Survey-Food Security Supplement (CPS-FSS) Denton County Data Source: Feeding America via Healthy North Texas Defining food insecurity: The U.S. Department of Agriculture (USDA) defines food insecurity as “limited or uncertain availability of nutritionally adequate foods or uncertain ability to acquire these foods in socially acceptable ways”.116 Policies, Laws & Standards: Federal Supplemental Nutrition Assistance Program (SNAP) – primary program of the Farm Bill, funding nutrition programs and serving low-income families in the U.S. The USDA reports “every $5 in food stamp benefits generates $9 of economic activity in local
communities”.
Additional federal food programs include, but are not limited to: Special Supplemental Program for Women, Infants, and Children (WIC), WIC Farmer’s Market Nutrition Program (FMNP) and National School Lunch Program (NSLP).117 Texas 85th Legislature, SB 1566 – Creating a grace period for students who exhaust all money in lunch
accounts, combating “lunch shaming”.118 3: 3:
The USDA offers resources including the Community Food Security Assessment Toolkit, Measuring Influence Collective Household Food Security, and Food Security and Emergency Preparedness tools.119 Suggested Strategies 1.1.1 Partner with local hunger initiatives to target access points for outreach and resources
1.1.2 Support legislation that increases access to nutritious foods
1.1.3 Reduce barriers to accessing nutritionally adequate food Potential Partners Tarrant Area Food Bank Our Daily Bread Texas A&M AgriLife Extension Mobile pantries Denton Community Food Center Denton Hunger Coalition Food pantries Denton Community Farmers Meals on Wheels Elected officials Market
WIC SPAN 4: Appendices 4:
115 Office of Disease Prevention and Health Promotion. (2017). Nutrition and Weight Status. 116 Healthy North Texas. (2017). Community Dashboard. Food insecurity rate.
117 National Conference of State Legislatures. (2017). Improving the Supplemental Nutrition Assistance Program. 118 The Texas Tribune. (2017). Gov. Abbott signs bill that seeks to end “lunch shaming”. 119 U.S. Department of Agriculture. (n.d.) Food Security.
38
Area of Concern: Exercise, Weight & Nutrition
Goal 1: Increase access points that foster physical activity and nutritious Plan Development Plan
1: eating Objective 1.2: Increase Food Environment Index Top U.S. Performers: 8.4 Denton County Baseline: 7.1 CHIP Target: ≥ 8 by 2020 Healthy North Texas 2016 Texas Index: 6.4 Index range: 0 (worst) – 10 (best) Data Source: County Health Rankings Food Environment Index: Combines the percentage of the population that is low-income and has low access to a grocery store, and the percentage of the population that did not have access to a reliable food source during the past year. 120 Policies, Laws & Standards: Federal Supplemental Nutrition Assistance Program (SNAP) – primary program of the Farm Bill, funding nutrition programs and serving low-income families in the U.S. Additional federal food programs include, but are not limited to: Special Supplemental Program for Women, Infants, and Children (WIC), WIC Farmer’s Market Nutrition Program (FMNP) and National
Community Health Improvement Health Plan Community 121
: : School Lunch Program (NSLP). 2 Texas 85th Legislature, SB 1566 – Creating a grace period for students who exhaust all money in lunch accounts, combating “lunch shaming”.122 Practice & Intervention Models: Baltimore Healthy Carryout Project, BackPack Program and Wisconsin Nutrition Education Program. 123
Suggested Strategies: 1.2.1 Generate education materials pertaining to nutrition concepts and economical food purchasing 1.2.2 Data analyses on food deserts in Denton County 1.2.3 Partner with local towns and cities for planning and zoning to increase food security
3:Collective Influence Potential Partners Tarrant Area Food Bank Our Daily Bread Texas A&M AgriLife Extension Mobile pantries Denton Community Food Center Denton Hunger Coalition Food pantries Denton Community Farmers Cities & Towns Elected officials Market Meals on Wheels SPAN WIC Local ISDs & Universities
120 Healthy North Texas. (2017). Community Dashboard. Food Environment Index.
4:Appendices 121 National Conference of State Legislatures. (2017). Improving the Supplemental Nutrition Assistance Program. 122 The Texas Tribune. (2017). Gov. Abbott signs bill that seeks to end “lunch shaming”. 123 Healthy North Texas. (2017). Community Dashboard. Food Environment Index.
39
1:
Area of Concern: Exercise, Weight & Nutrition PlanDevelopment
Goal 1: Increase access points that foster physical activity and nutritious
eating Objective 1.3: Increase percentage of adults meeting the aerobic physical activity recommendation HP 2020 Target: 47.9% Denton County Baseline: 42.3% CHIP Target: ≥ 47.9% by 2020
Healthy People 2020: Physical Activity124
2 : : National Data Source: National Health Interview Survey CommunityPlan Health Improvement Texas Department of State Health Services – Obesity Data: 2013 BRFSS125 Aerobic physical activity: light or moderate physical activity for at least 150 minutes per week or vigorous physical activity 75 minutes per week 2008 Physical Activity Guidelines for Americans: CDC guidelines for regular physical activity by age and pregnancy status126 Policies, Laws & Standards: Texas Department of State Health Services Obesity Prevention Program created in 2013 to “make healthy choices easier for Texans”.127 80th Texas Legislature, SB 556 – Established the Texas Interagency Obesity Council
Texas Department of Agriculture (TDA) administers grants including, but not limited to: Texas Feeding Texans, 3E’s Grant Programs, Urban Schools Agricultural Grant and Surplus Agriculture. TDA also oversees special projects to combat obesity and increase nutrition.128 Suggested Strategies: 1.3.1 Emphasize workplace wellness programs that incorporate a broad array of intervention and
activities that focus on the prevention and control of the most common and costly employee 3:
health problems (TX State IOC 2017 Recommendation to the Legislature) Influence Collective 1.3.2 Increase walkability of local communities 1.3.3 Promote evidence-based physical activity programming Potential Partners Physical activity programs Fitness Facilities
Texas A&M AgriLife Extension YMCA Recreational sports leagues Denton Hunger Coalition Camp Gladiator PlayTri Jazzercise Parks & Recreation departments of CrossFit Local ISDs & universities local cities and towns Elected officials Local planning and zoning Denton Area Running Club Take the First Step Initiative
Appendices 4: 124 Office of Disease Prevention and Health Promotion. (2017). Mental Health and Mental Disorders. 125 Texas Department of State Health Services. (2015). 2013 BRFSS tables_CWW. 126 Centers for Disease Control and Prevention. (2015). Physical Activity Basics.
127 Texas Department of State Health Services. (2016). Obesity Prevention Program. 128 Texas Department of State Health Services. (2017). Report to the Legislature from the Interagency Obesity Council.
40
Area of Concern: Exercise, Weight & Nutrition
Goal 2: Expand community collaboration surrounding nutrition education and Plan Development Plan
1: physical activity Objective 2.1: Promote existing collaborative efforts HP 2020 LHD CHIP Target: 61% Objective 2.1a: Generate listserv of existing coalitions and collaboratives for community engagement use by 2019
Objective 2.1b: Host Annual Comunity Health Summit to promote
existing efforts positively impacting nutrition and physical activity Objective 2.2: Increase participation in wellness events HP 2020 Healthy Weight Objective 2.2a: Host 25 vendors at annual Denton County Dash in Target: 33.9% 2018 Objective 2.2b: Increase to 1000 registered participants for the Denton County Dash Healthy People 2020: Public Health Infrastructure129 PHI-15.2: Target 61%
Community Health Improvement Health Plan Community LHD CHIP – Local Health Department CHIP created within the last 5 years : : 2 Healthy People 2020: Nutrition & Weight Status130 NWS-8: Target 33.9% Data Source: National Health and Nutrition Examination Survey Policies, Laws & Standards: Public Health Accreditation Board Standard 5.2: Conduct a Comprehensive Planning Process Resulting in a Tribal/State/Community Health Improvement Plan131
Denton County Take the First Step Initiative – relating to awareness surrounding cardiovascular disease, heart health and physical activity132 Texas Interagency Obesity Council – alignment with recommendation to the 85th Texas Legislature to support local programming that combats obesity and promotes nutritious eating Suggested Strategies:
3:Collective Influence 2.1.1 Engage in networking events and community collaborative meetings to formulate and expand partnerships 2.1.2 Incorporate promotion of physical activity events into LHD health promotion plan 2.1.3 Partner with the Nutrition Workgroup of the Healthy Communities Coalition Potential Partners Fitness facilities Community members Healthy Communities Coalition Parks & Recreation Elected officials departments of local cities Community Health Council Healthcare providers and towns Texas A&M AgriLife Extension
129 Office of Disease Prevention and Health Promotion. (2017). Public Health Infrastructure.
4:Appendices 130 Office of Disease Prevention and Health Promotion. (2017). Nutrition and Weight Status. 131 Public Health Accreditation Board. (2013). Standards & Measures. Version 1.5. 132 Denton County. (2016). Health Education.
41 1:
Plan Development Area of Concern: HEALTH OUTCOMES- CHRONIC DISEASE Denton County health providers, stakeholders and community members prioritized health outcomes for inclusion in the CHIP, with focus on the necessity for increased provider collaboration and ease of system navigation. While the Community Health Council through Texas Health Denton have determined diabetes as a focus area, round-table discussions at the Community Health Summit reflected the desire for the CHIP to expand beyond a specific diagnosis to system navigation and care coordination. 2 :
In a secondary data analysis conducted by Community Plan Health Improvement Texas Health Denton, Denton County has the most deficiency or room for improvement for “other chronic diseases”, with respiratory diseases, heart diease and stroke, and diabetes scoring more favorably. With emphasis on a network of care and collaboration surrounding health
outcomes, goals were drafted to promote health tecnologies and inforamtion sharing. A health information exchange allows indisciplinary and health professionals for varying organizations to 3: 3:
securely and appropriately access a InfluenceCollective patient’s health information. This ensures timely service delivery, avoidance of dupilication of services and completeness of the patient’s record.
Policy Considerations Legislation such as the Health Insurance Portability and Accountability Act protects patients’ confidentiality and restricts access to medical information. HealthIT provides resources to patients and their families to increase understanding surrounding your rights as a patient, as well as empowerment to access your medical record. HealthIT states “27% of individuals were unaware or didn’t believe they had a right to an electronic copy of their medical record.
Additionally, 8 in 10 individuals who have viewed their medical record online considered the Appendices 4: information useful".133
133 HealthIT.gov. (n.d.) Your Health Information, Your Rights.
42 The Office of the National Coordinator for Health Information Technology outlined targets for health information technology expansion in Connecting Health and Care for the Nation: A 10- Year Vision to Achieve an Interoperable Health IT Infrastructure. A three year target of the vision includes an interoperability roadmap, encompassing implementation of the Health
Plan DevelopmentPlan Information Technology for Economic and Clinical Health Act.134 1:
Graphic from Connecting Health and Care for the Nation: A 10-Year Vision to Achieve an
Community Health Improvement Health Plan Community Interoperable Health IT Infrastructure : 2
HealthIT indicates with “meaningful use requirements, new payment approaches that stress care coordination, and federal financial incentives are all driving interest and demand for health information exchange”. 135 Legislatively advocacy to continue incentivizing care coordination and health information exchange should drive outcomes associated with
appropriate sharing of update, electronic patient information. 3: Collective Influence
134 Office of the National Coordinator for Health Information Technology. (n.d.) Connecting Health and Care for the
4: Appendices Nation: A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure. 135 Office of the National Coordinator for Health Information Technology. (n.d.) Connecting Health and Care for the Nation: A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure.
43
1:
Area of Concern: Health Outcomes – Chronic Disease PlanDevelopment
Goal 1: Develop integrated network of care coordination and system
navigation Objective 1.1: Increase utilization of Health Information Technology HP 2020 Online Health Objective 1.1a: Increase proportion of online health information Information Target: 45% seekers who report easily accessing health information to 45% by 2020
Objective 1.2b: Begin collaboration surrounding Denton County 2 : : Health Information Exchange CommunityPlan Health Improvement Healthy People 2020: Health Communication and Health Information Technology136 HC/HIT-9: Target 45% Data Source: Health Information National Trends Survey National Rural Health Resource Center: Health Information Exchange (HIE) Toolkit comprised of resources to assist providers in understanding and implementing HIE137 Policies, Laws & Standards: Department of Health and Human Services Principles and Strategy for Accelerating Health Information Exchange – “HHS is fully committed to ensuring ubiquitous, standards-based electronic exchange of health information across all care settings through a multi- year approach that is consistent, incremental, yet comprehensive.”138 Health Information Technology for Economic and Clinical Health Act (HITECH) – promoting the implementation of electronic health records (HER) and supporting technology 139 Suggested Strategies:
1.1.1 Utilize HIE toolkit to determine “First Considerations” of HIE implementation 3:
1.1.2 Utilize HIE Policy Matrix to identify necessary policies and procedures for HIE Influence Collective 1.1.3 Complete HIE ROI Calculator to determine potential savings and implementation costs 1.1.4 Increase utilization of electronic health records in Denton County Potential Partners Medical City Denton Charitable clinics Medical City
Healthcare providers Denton Community Lewisville Health Clinic FQHC – Health Services of Texas Health Flower North Texas First Refuge Mound Ministries Texas Health Presbyterian Hospital Denton Elected officials Charitable Clinics Coalition
136 Office of Disease Prevention and Health Promotion. (2017). Health Communication and Health Information Appe 4: Technology. 137 HealthIT.gov. (n.d.) Health Information Exchange. ndices 138 The Office of the National Coordinator for Health Information Technology. (n.d.). Principles and Strategy for
Accelerating Health Information Exchange (HIE). 139 Office of National Coordinator for Health Information Technology. (n.d.) Connecting Health and Care for the Nation: A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure.
44 Collective influence
PLANS IN ACTION Now it is time to take action and lead our community to a healthier future. The CHIP is designed to align with DCPH’s organizational strategic plan, Public Health Accreditation Board
Plan Development Plan accreditation efforts, and organizational strategic plans of community partners and 1: collaboratives to support implementation efforts. DCPH will remain engaged in community collaboratives, serving on workgroups, leadership teams and coalitions, to develop work plans and logic models to implement components of the improvement plan. Denton County Public Health will host an Annual Community Health Summit in partnership with stakeholders to continue resource identification, determine project leads, facilitate collaboration and provide an annual report to community members on CHIP progress. Implementation steps to be carried out in 2018 include, but are not limited to:
Identifying lead agencies for CHIP objectives without primary lead
ImprovementPlan Identify and list resources engaged surrounding each objective Bi-annual reports to the Public Health Advisory Committee for implementation oversight Work plan and/or strategy development through existing collaboratives
Sustainability Planning
Community Health Health Community : : 2 To ensure 2020 metrics are achieved and to facilitate consistent communication, the Denton County Community Health Strategy Group will remain the executive oversight body for improvement plan implementation, assessment and adaptation. The Public Health Advisory Committee will serve in an advisory capacity for recommending modifications and tracking progress, as well as serving as a liaison to the local governing entity of Denton County
Commissioners Court. Regular progress reports and implementation efforts will be conducted through existing collaboratives including, but not limited to:
Community Health Council
3:Collective Influence Denton County Behavioral Health Leadership Team Health Communities Coalition Hunger Coalition Wellness Alliance for Total Children’s Health (WATCH) Coalition
4:Appendices
45
1:
How to Get Involved PlanDevelopment
As a Resident: Find Your Niche Identify which area of concern you feel most closely aligns with your professional role or
personal interests. You can then become involved in health improvement efforts by joining a coalition, attending informational meetings and serving as an advocate. To see potential partners you can engage with on your topic of interest, see the “potential partners” under each CHIP objective. As a Resident: Advocate
Everyone has a unique sphere of influence and opportunities for educating those around them
2 : :
about pertinent public health topics that impact your friends, neighbors and colleagues. CommunityPlan Health Improvement Become an advocate by staying informed of relevant public health information and sharing best practices. This combats misconceptions and provides those you encounter with evidence-based information. As a Public Health Partner: Strategize As your organization undergoes strategic planning, budgeting and program planning, refer back to the CHIP to access priorities of community members. This document is designed to be a reflection of data-driven, community-based needs.
As a Public Health Partner: Engage Your agency is likely engaged in programs and initiatives that influence objectives identified in the CHIP. Consider becoming engaged in a coalition, meeting with Denton County Public Health or taking lead on a CHIP objective to tangibly impact community health areas of concern. As a Public Health Partner: Advocate
Actively engage in advocacy for legislation that positively influences the health and well-being 3: Collective Influence Collective of Denton County. Remain aware of legislative priorities and opportunities to utilize your expertise to inform policy makers. This can range from calling your representative to relay your position on legislation to authoring position statements.
Denton County Public Health wants to know how you use the information compiled in this plan. Please contact us to share your efforts and learn about getting involved in a community collaborative. Denton County Public Health 535 S. Loop 288 Suite 1003 Denton, TX 76205
P: 940.349.2900 4: Appendices F: 940.349.2905 E: [email protected]
W: dentoncounty.com/health
46 Appendices Appendix A Definition of Terms
Community Health Improvement Plan: a long-term, systematic effort to address health problems on the basis of the results of assessment activities and the community health improvement process.1
Plan Development Food Environment Index: Combines the percentage of the population that is low-income and has low 1: access to a grocery store, and the percentage of the population that did not have access to a reliable food source during the past year.2
Food insecurity: Limited or uncertain availability of nutritionally adequate foods or uncertain ability to acquire these foods in socially acceptable ways.3
Health disparity: Healthcare disparities refer to differences in access to or availability of facilities and services. Health status disparities refer to the variation in rates of disease occurrence and disabilities between socioeconomic and/or geographically defined population groups.4
Health literacy: The degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.5
Health Information Exchange: Electronic health information exchange (HIE) allows doctors, nurses, pharmacists, other health care providers and patients to appropriately access and securely share a patient’s vital medical information electronically—improving the speed, quality, safety and cost of patient care.6 Community Health Improvement Plan
: 7 2 Integrated care: Combines primary health care and mental health care in one setting.
Major Depressive Episode (MDE): A person is defined as having had an MDE if s/he had a period of time in the past 12 months when s/he felt depressed or lost interest or pleasure in daily activities for 2 weeks or longer and had at least five or more of the following nine symptoms in the same 2-week period, with at least one of the symptoms being a depressed mood or loss of interest or pleasure in daily activities:
1. Depressed mood most of the day, nearly every day 2. Markedly diminished interest or pleasure in all or almost all activities most of the day, nearly Influence every day 3. Significant weight loss when not dieting or weight gain or decrease or increase in appetite nearly every day
3: Collective 4. Insomnia or hypersomnia nearly every day 5. Psychomotor agitation or retardation nearly every day 6. Fatigue or loss of energy nearly every day 7. Feelings of worthlessness nearly every day 8. Diminished ability to think or concentrate or indecisiveness nearly every day
1 National Association of City and County Health Officials. (2017). Accreditation Prerequisite Community Health Improvement Plan 2 Healthy North Texas. (2017). Community Dashboard. Food Environment Index. 3 U.S. Department of Agriculture. (n.d.). Food Insecurity. 4 National Library of Medicine. (2009). Medical subject headings. Health disparities. 4: Appendices 5 U.S. Department of Health and Human Services. (2000). Healthy People 2010. 6 HealthIT.gov. (2014). Health Information Exchange (HIE). 7 National Institute of Mental Health. (2017). Integrated Care.
47 1:
Plan Development Plan
9. Recurrent thoughts of death or recurrent suicide ideation8
Primary care provider: A physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine), nurse practitioner, clinical nurse specialist or physician assistant, as allowed under state law, who provides, coordinates or helps a patient access a range of health care services.9
Social marketing: Program-planning processes that applies commercial marketing concepts and technique to promote voluntary behavior change.10
2 : Community Health Improvement Plan Improvement Health Community
3: 3: Collective Influence
4: Appendices4:
8 Office of Disease Prevention and Health Promotion. (2017). Mental Health and Mental Disorders. 9 HealthCare.gov. (n.d.) Primary Care Provider. 10 Grier, S. & Bryant, C.A. (2005). Social Marketing in Public Health. Annual Review of Public Health (26), p.319-339.
48 Appendix B Prioritization Methodology TEXAS HEALTH PRESBYTERIAN HOSPITAL DENTON To access Texas Health Presbyterian Hospital Denton 2016 Community Health Needs Plan Development
1: Assessment, please visit: https://www.texashealth.org/Documents/System/Community/Community_Health_Needs_Ass essment/2017/THDN_CHNA_2016_Report.pdf
Methodology
Community Health Improvement Plan : 2
3: Collective Influence 3: Collective
4: Appendices
49 1:
Plan Development Plan UNITED WAY OF DENTON COUNTY To access the full United Way of Denton County 2017 Community Needs Assessment, please
visit: https://www.unitedwaydenton.org/activities/community-assets-needs-assessment. Methodology
2 : Community Health Improvement Plan Improvement Health Community
Community Survey 3: 3: Collective Influence
4: Appendices4:
50
DENTON COUNTY PUBLIC HEALTH
Plan Development Methodology 1:
Community Health Improvement Plan : 2
Community Survey
3: Collective Influence 3: Collective
4: Appendices
51
APPENDIX C 1:
Collaborative Contributors PlanDevelopment CHIP COMMUNITY CONTRIBUTORS
Community Collaboration in the CHA & CHIP Process: We would like to thank the following
individuals and organizations for their dedication of time and sharing of their expertise to generate the collaborative Denton County CHA and CHIP. Denton County Strategy Group The following individuals served as the advisory group for strategic visioning of community
health in Denton County:
2 : : LaSharndra Barbarin, MHA, CEO, Medical City Lewisville CommunityPlan Health Improvement FACHE Courtney Barnard, LMSW Regional Outreach Services Coordinator, Cook Children’s Health Care System & Wellness Alliance for Total Children’s Health Coalition Roxanne DelRio, MPA, PhD Dean Strategic Student Initiatives & Multicultural Outreach, North Central Texas College & Denton County Homelessness Leadership Team Kamilah Hasan, MS, CHW Health Education Department Manager, Denton County
Public Health & Healthy Communities Coalition Gary Henderson President & CEO, United Way of Denton County Leah Jordan Director of Community Impact, United Way of Denton County Teresa McKinney, PhD Assistant Vice President for Student Affairs, University of North Texas, Denton County Behavioral Health Leadership
Team, & Public Health Advisory Committee 3: 3:
Laurie Long, PhD Community Health Program Manager, Texas Health Influence Collective Presbyterian Hospital Denton Lacrica Olson, MPA Assistant Director of Local Systems Development, Meadows Mental Health Policy Institute & Public Health Advisory Committee
Jeff Reecer, FACHE President, Texas Health Presbyterian Hospital Denton Alex Reed, LMSW Health Planner/Trainer, Denton County Public Health Matt Richardson, DrPH, MPH Director of Public Health, Denton County Public Health Juan Rodriguez, MPH Assistant Director & Chief Epidemiologist, Denton County Public Health
Appendices 4:
52
Public Health Advisory Committee LaSharndra Barbarin, MHA, CEO, Medical City Lewisville
Plan Development Plan FACHE 1: Ronni Cade Commissioners Court appointee Teresa McKinney, PhD Assistant Vice President for Student Affairs, University of North Texas Connie Menard, MD Director, Texas Woman’s University Student Health Services Lacrica Olsen, MPA Commissioners Court appointee, Meadows Mental Health Policy Institute Melanie Vincelette, RN, BSN Director of Health Services, Lewisville Independent School District Don White Commissioners Court appointee
Community Health Summit Table Facilitators/Subject Matter Experts Courtney Cross Director of Homelessness Initiatives, United Way of Denton County
Courtney Davis Extension Agent, Texas A&M AgriLife Extension
Community Health Improvement Health Plan Community : :
2 Lisa Elliott, PhD Clinic Manager, Cook Children’s Medical Center Ashly Gould Outreach Coordinator, Denton County Public Health Kamilah Hasan, MS, CHW Health Education Department Manager, Denton County Public Health Laurie Long, PhD Community Health Program Manager, Texas Health Presbyterian Hospital Denton Sarah McKinney, CHES Immunizations Program Coodinator, Denton County Public Health Sonia Redwine, MPH, Director of Health and Mental Health Initiatives, United Way MCHES of Denton County Julie Wright, BS, CHW Diabetes Educator, Denton County Public Health
3:Collective Influence Community Health Summit Registrants
Daphne' Adams Christian Community Action Amy Allison Texas Woman's University Nichol Attar Mayhill Hospital Tricia Atzger-John Northwest ISD Ganesh Baniya University of North Texas Courtney Barnard Cook Children's Health Care System Rebecca Boardman Arabian rescue therapy Stephanie Brown Texas Woman's University
4:Appendices Latessa C Solis Mammography Jim Coffey Congressman Burgess
53
1:
PlanDevelopment
Courtney Cross United Way of Denton County Texas A&M AgriLife Extension Service - Courtney Davis Denton County
Roxanne DelRio North Central Texas College Ken Dickinson Denton Professional Hypnosis Marshall Dunbar Christian Community Action Lisa Elliott Cook Childrens Medical Center Phyllis Finley Denton County MHMR Texas Health Harris Methodist Hospital
Mandy Forbus Alliance / Texas Health Resources 2 : : Monica Glenn Representative Lynn Stucky CommunityPlan Health Improvement Matt Grebliunas City of Lewisville Mattie H Solis Mammography Elizabeth Hardin University Behavioral Health Denton Timothy Harris Texas Heath Presbyterian Hospital Denton Kamilah Hasan Denton County Public Health Gary Henderson United Way of Denton County Kristin Jeffcoat University Behavioral Health of Denton Shannon Joski Denton County Eric Keith Denton County Public Health Heather Lee Denton County Public Health Xiaoli Li University of North Texas Qiwei Li University of North Texas Laurie Long Texas Health Presbyterian Hospital Denton
Kate Lynass Denton County 3: Troy Manning Denton County MHMR Influence Collective Thad Mantaro Texas Woman's University Alice Masciarelli Denton Community Health Clinic Kim Mathis North Central Texas Are Agency on Aging
Teresa McKinney University of North Texas
Catherine McManis Texas Health Resources Constance Menard Texas Woman's University LeeAnna Mendoza Green Apple Therapy Ken Metcalf Denton County Juvenile Probation Ambreen Moorani Representative Stucky’s office Roger Muckel Span, Inc. Bhargav Muppaneni University of North Texas
Brittney Nolan Mayhill Hospital Appendices 4: Lacrica Olson Meadows Mental Health Policy Institute Marty Otero Denton Hunger Coalition Alfonso Pasquel Denton County Juvenile Probation Sharon Phillips Time4BestHealth Malika Priteheff University of North Texas
54
Crystal Pustejovsky Denton County Transit Authority Jose Luis Raymundo UTSouthwestern Medical Center
Sonia Redwine United Way of Denton County Plan Development Plan
1: Jeff Reecer Texas Health Presbyterian Hospital Denton Alex Reed Denton County Public Health Matt Richardson Denton County Public Health Deb Robertson Span, Inc. Larry Robins PediPlace Juan Rodriguez Denton County Public Health
Tera Rudloff UBH Denton Doreen Rue Health Services of North Texas Stacy S Solis Mammography Keya Sen University of North Texas Dani Shaw City of Denton Kathy Srokosz Texas Health Presbyterian Hospital Denton James Swan University of North Texas Sonia Tovar Denton County Public Health
Priscilla Wachira Denton County Public Health Community Health Improvement Health Plan Community
: : Marina Williams Solis Mammography 2 Julie Wright Denton County Public Health Chenchen Yan University of North Texas Cheng Yin University of North Texas
Texas Health Presbyterian Hospital Denton – Community Health Needs Assessment
Organizations represented in focus groups and key informant interviews:
City of Denton Denton County Public Health
Denton County Transit Authority 3:Collective Influence Denton Independent School District Denton Public Library Denton Senior Center First Refuge Ministries Health Services of North Texas Interfaith Ministries of Denton
Meals on Wheels of Denton County
North Central Texas Council of Governments Our Daily Bread
Seniors in Motion 4:Appendices Special Programs for Aging Needs Transport (SPAN) – Denton Texas Health Denton Staff
55
1:
PlanDevelopment
Texas Hunger Initiative United Way of Denton County University of North Texas, Student Health & Wellness Center Women, Infants, & Children (WIC) of Denton County
The following individuals participated in the prioritization session: Pamela Barnes Health Services of North Texas Laura Behrens Denton Fire Department
Max Calder SPAN, Inc.
2 : :
Cindy Carter Texas Health Denton CommunityPlan Health Improvement Crystal Collins Denton County Transportation Authority Jennifer Deel Texas Health Flower Mound Darrell Druery Lucent Home Health Alyson Duplantis United Way of Denton County Robin Fox City of Denton/Denton Black Chamber of Commerce Jeff Gilbert Denton Senior Center Ashly Gould Denton County Public Health Haley Hackler United Way of Denton County
Kerol Harrod City of Denton North Branch Library
Kamilah Hasan Denton County Public Health Lisa Henry University of North Texas Brenda Jackson Our Daily Bread Ginger Johnson Child Advocacy Center of Cooke County/Abigail’s Arms Teri Johnson Health Services of North Texas
Bupe Kapansa United Way of Denton County 3: Kristen Keeth SPAN, Inc./Meals on Wheels of Denton County Influence Collective Dana Kennedy Texas Health Denton Meghan Maloney United Way of Denton County Chris Martin Denton County Veterans Coalition
Ernestina Lopez United Way of Denton County
Michelle Obuong United Way of Denton County Marty Otero Texas Hunger Initiative/Denton Hunger Coalition Pam Petrides Texas Health Flower Mound Brett Pollard Texas Health Flower Mound Matt Richardson Denton County Public Health Deborah Robertson SPAN, Inc./Meals on Wheels of Denton County Norma Rodriguez Texas Health Denton
Doreen Rue Health Services of North Texas 4: Appendices 4: Danielle Shaw City of Denton/Denton County Homeless Coalition Justin Silk United Way of Cooke County Kathy Srokosz Texas Health Denton
Kayla Stewart United Way of Denton County Beth Tellez Denton County MHMR
56
Shelley Tobey Texas Health Flower Mound Laura Valentino Texas Woman’s University
Joseph Walker University of North Texas Plan Development Plan
1: Debra Warrington Texas Health Flower Mound
CHA Project Team & Hospital Leadership Laurie Long, PhD Community Health Program Manager, Texas Health Denton Mina Kini, MS, MSW Director of Multicultural & Community Health Improvement,
Texas Health Resources Catherine McMains, MPH, Community Benefit & Impact Specialist, Texas Health CPH Resources Marjeta Daja, MBA, MHA Multicultural Health Specialist, Texas Health Resources Jeff Reecer, FACHE President, Texas Health Denton Timothy Harris, MD Chief Medical Officer, Texas Health Denton Melissa Winans, MBA-HCM, Chief Nursing Officer, Texas Health Denton MSN, RN, NEA-BC
Community Health Improvement Health Plan Community : :
2 United Way of Denton County – Community Needs Assessment The following individuals contributed to this report: Co-Chairs Dr. Ling Hwey Jeng Texas Woman’s University, School of Library & Information
Studies
Bill Patterson Denton Record-Chronicle, Publisher Steering Committee Katelyn Blasavage Serve Denton Douglas Burns University of North Texas, GIS Lynn Charles Lewisville ISD
3:Collective Influence Rachel Crowe Denton County, GIS Katie Foote Texas Woman’s University, Health Studies Dr. Becky Frederickson Texas Woman’s University, Dept. of Teacher Education Jamie Kirby City of Lewisville Briley Kozak Denton ISD Adult Education & Literacy Dr. Celia Lo Texas Woman’s University, Department of Sociology & Social Work Correne Lynch-Fierro Communities in Schools of North Texas
Chris Martin Denton County Veterans Coalition Brandon McClesky First State Bank Sherri McDade Denton Housing Authority
Dr. Teresa McKinney University of North Texas, Strategic Initiatives & Wellness 4:Appendices Services Mark Merki Merki & Associates, P.C.
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1:
PlanDevelopment
Laura Mitchell City of Lewisville Ann Pape Communities in Schools of North Texas Chasz Parker Christian Community Action
Missy Rainey Social Worker/Community Volunteer Jeff Reecer Texas Health Presbyterian Hospital Denton Alex Reed Denton County Public Health Dr. Matt Richardson Denton County Public Health Rhett Richardson University of North Texas, Dept. of Communication Studies Kevin Roden ReadyRosie
Barbara Ross City of Denton 2 : : Doreen Rue Health Services of North Texas CommunityPlan Health Improvement Amber Shattuck Communities in Schools of North Texas Danielle Shaw City of Denton Claire Springer Denton ISD May Tay Denton County Medical Society Beth Tellez Denton County MHMR Louise Westin-Ferrill Health Services of North Texas
UWDC Staff & Interns
Courtney Cross Director of Homelessness Initiatives Gary Henderson President & CEO Leah Jordan Director of Community Impact John Montoya Director of Financial Stability Initiatives Kayla Stewart Director of Education Initiatives
Teddy Yan Director of Marketing 3: 3:
Dominque Campbell Intern Influence Collective Katie Chapman Intern Alyson Duplantis Intern Flor de la Garza Intern Michelle Garcin Intern
Ernestina Lopez Intern Meghan Maloney Intern Alyssa Mustaffa Intern Katie Sharbono Intern
Denton County Public Health – Community Health Assessment DCPH Accreditation Team
Tammy Eoff Health Administrator Appendices 4: Leslie Freeman Environmental Health Coordinator Joe Paul Gallo Program Manager
Kamilah Hasan Health Education Department Manager Eric Keith Assistant Program Coordinator
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Heather Lee Assistant Nursing Supervisor Brandon Manuel Assistant Bioterrorism Coordinator
Bob Martinez Bioterrorism Coordinator Plan Development Plan
1: Sarah McKinney Immunization Program Coordinator Alex Reed Health Planner/Trainer Matt Richardson Director of Public Health Isabel Rodriguez Indigent Care Coordinator Juan Rodriguez Assistant Director & Chief Epidemiologist Jennifer Romaszewski Health Services Specialist II
Monica Sanchez-Ramirez Administrative Manager Kristine Sledge Clinical Supervisor Julie Wright Program Coordinator CHA Committee Briar Deen Epidemiology Investigator Jasmine Cluck Epidemiology Investigator Matt Richardson Director of Public Health Juan Rodriguez Assistant Director & Chief Epidemiologist
Community Health Improvement Health Plan Community
: :
2
3:Collective Influence
4:Appendices
59 Appendix D CAN WE LIVE LONGER? Integrated Healthcare’s Promise
The PROBLEM
People with mental illness die earlier than the general 70 more than population and have more co-occurring health conditions. 60 68% 1in 5 50 of adults with a mental adults with mental illness have one or more illness have a chronic physical co-occurring substance 40 conditions use disorder
Co-occurrence between mental illness and other chronic health conditions:
% Mental Illness 21.9 High Blood Pressure No Mental Illness 18.8%
Mental Illness 36% No Mental Illness 21% Smoking
Mental Illness 5.9% No Mental Illness 4.2% Heart Disease
Mental Illness 7.9% No Mental Illness 6.6% Diabetes
Mental Illness 42% No Mental Illness 35% Obesity
% Mental Illness 15.7 Asthma No Mental Illness 10.6%
The SOLUTION
Primary Care The solution lies in integrated care – the coordination of mental health, substance abuse, and primary care services. Mental Integrated care produces the best outcomes Substance and is the most effective approach to caring Health Abuse for people with complex healthcare needs.
INTEGRATION WORKS
Reduce Risk Reduce Heart Disease Community-based addiction treatment can lead to... (for people with mental illnesses)
Maintenance of 35%-55% decrease in % % % ideal body weight risk of cardiovascular 35 39 26 (BMI = 18.5 – 25) disease Maintenance of 35%-55% decrease in active lifestyle risk of cardiovascular in in in (~30 min walk daily) disease inpatient ER total medical 50% decrease in risk costs cost cost Quit Smoking of cardiovascular disease
One integration program* enrolled 170 people This is with mental illness. After one year in the program, $213,000 in one month: of savings per month.
86 spent fewer nights homeless That’s $2,500,000 There were 50 in savings over the year. fewer hospitalizations for mental health Integration works. reasons It improves lives. 17 fewer nights in detox It saves lives. SAMHSA-HRSA17 fewer ER visits And it reduces healthcare costs. Center for Integrated Health Solutions
www.integration.samhsa.gov
Sources www.dsamh.utah.gov/docs/mortality-morbidity_nasmhpd.pdf Rich-Edwards JW, Manson JE, Hennekens CH, Buring JE. The primary prevention of www.samhsa.gov/data/2k11/WEB_SR_078/SR110StateSMIAMI2012.htm coronary heart disease in women. N Engl J Med. 1995;332:1758-1766. www.samhsa.gov/co-occurring/topics/data/disorders.aspx Bassuk SS, Manson JE. Epidemiological evidence for the role of physical activity www.samhsa.gov/data/nsduh/2k8nsduh/2k8results.pdf in reducing risk of type 2 diabetes and cardiovascular disease. J Appl Physiol. www.cdc.gov/features/vitalsigns/SmokingAndMentalIllness 2005;99:1193-1204. www.ncbi.nlm.nih.gov/pubmed/16912007 Hennekens CH, Increasing burden of cardiovascular disease: current knowledge and Weisner C. Cost Studies at Northern California Kaiser Permanente. Presentation to future directions for research on risk factors. Circulation. 1998;97:1095-1102. County Alcohol & Drug Program Administrators Association of California Sacramento, California. Jan. 28, 2010. Heritage Behavioral Health Center, based on data in... www.ahrq.gov/research/findings/evidence-based-reports/mhsapc-evidence-report.pdf
* A grantee of the Substance Abuse and Mental Health Services Administration’s Primary and Behavioral Health Care Integration program. At 1 month of age, HepB (1-2 Appendix E months), At 2 months of age, HepB (1-2 months), DTaP,2017 PCV, Hib, Polio, Recommended Immunizations for Children from Birth Through 6 Years Old and RV At 4 months of age, DTaP, PCV, Hib, Polio, and RV At 6 months of age, HepB (6-18 months), DTaP, PCV, Hib, Polio (6-18 months), RV, and Influenza 1 2 4 6 12 15 18 19–23 (yearly, 6 months through 18 2–3 4–6 years)* Birth month months months months months months months months years years At 12 months of age, MMR (12-15 HepB † HepB HepB months), PCV (12-15 months) , Hib (12-15 months), Varicella (12-15 months), HepA (12-23 RV RV RV months)§, and Influenza (yearly, 6 months through 18 years)* DTaP DTaP DTaP DTaP At 4-6 years, DTaP, IPV, MMR, DTaP Varicella, and Influenza (yearly, 6 months through 18 years)* Hib Hib Hib Hib Is your family PCV PCV PCV PCV growing? To protect your new baby and
yourself against whooping IPV IPV IPV IPV cough, get a Tdap vaccine. * The recommended time is Influenza (Yearly) the 27th through 36th week of pregnancy. Talk to your MMR MMR doctor for more details. Varicella Varicella Shaded boxes indicate the vaccine can be given during HepA§ shown age range.
NOTE: FOOTNOTES: See back page If your child misses a shot, * Two doses given at least four weeks apart are recommended for children aged 6 months through 8 years of age who are getting an for more you don’t need to start over, just go influenza (flu) vaccine for the first time and for some other children in this age group. information on back to your child’s § Two doses of HepA vaccine are needed for lasting protection. The first dose of HepA vaccine should be given between 12 months and vaccine- doctor for the next shot. 23 months of age. The second dose should be given 6 to 18 months later. HepA vaccination may be given to any child 12 months and preventable Talk with your child’s doctor older to protect against HepA. Children and adolescents who did not receive the HepA vaccine and are at high-risk, should be if you have questions vaccinated against HepA. diseases and the about vaccines. vaccines that If your child has any medical conditions that put him at risk for infection or is traveling outside the United States, talk to your child’s doctor about additional vaccines that he may need. prevent them.
For more information, call toll free 1-800-CDC-INFO (1-800-232-4636) or visit www.cdc.gov/vaccines/parents Vaccine-Preventable Diseases and the Vaccines that Prevent Them Disease Vaccine Disease spread by Disease symptoms Disease complications Infected blisters, bleeding disorders, encephalitis (brain Varicella vaccine protects against chickenpox. Air, direct contact Rash, tiredness, headache, fever Chickenpox swelling), pneumonia (infection in the lungs) Sore throat, mild fever, weakness, swollen Swelling of the heart muscle, heart failure, coma, DTaP* vaccine protects against diphtheria. Air, direct contact Diphtheria glands in neck paralysis, death Meningitis (infection of the covering around the brain and spinal cord), intellectual disability, epiglottitis Hib vaccine protects against Haemophilus May be no symptoms unless bacteria Air, direct contact (life-threatening infection that can block the windpipe Hib influenzae type b. enter the blood and lead to serious breathing problems), pneumonia (infection in the lungs), death May be no symptoms, fever, stomach pain, Direct contact, contaminated Liver failure, arthralgia (joint pain), kidney, pancreatic, HepA vaccine protects against hepatitis A. loss of appetite, fatigue, vomiting, jaundice Hepatitis A food or water and blood disorders (yellowing of skin and eyes), dark urine May be no symptoms, fever, headache, Contact with blood or HepB vaccine protects against hepatitis B. weakness, vomiting, jaundice (yellowing of Chronic liver infection, liver failure, liver cancer Hepatitis B body fluids skin and eyes), joint pain Fever, muscle pain, sore throat, cough, Flu vaccine protects against influenza. Air, direct contact Pneumonia (infection in the lungs) Influenza (Flu) extreme fatigue Encephalitis (brain swelling), pneumonia (infection in MMR** vaccine protects against measles. Air, direct contact Rash, fever, cough, runny nose, pinkeye Measles the lungs), death Meningitis (infection of the covering around the brain Swollen salivary glands (under the jaw), fever, MMR**vaccine protects against mumps. Air, direct contact and spinal cord) , encephalitis (brain swelling), inflam- Mumps headache, tiredness, muscle pain mation of testicles or ovaries, deafness DTaP* vaccine protects against pertussis Severe cough, runny nose, apnea (a pause in Air, direct contact Pneumonia (infection in the lungs), death Pertussis (whooping cough). breathing in infants) Air, direct contact, through May be no symptoms, sore throat, fever, IPV vaccine protects against polio. Paralysis, death Polio the mouth nausea, headache May be no symptoms, pneumonia (infection Bacteremia (blood infection), meningitis (infection of PCV vaccine protects against pneumococcus. Air, direct contact Pneumococcal in the lungs) the covering around the brain and spinal cord), death Rotavirus RV vaccine protects against rotavirus. Through the mouth Diarrhea, fever, vomiting Severe diarrhea, dehydration Children infected with rubella virus sometimes Very serious in pregnant women—can lead to miscar- MMR** vaccine protects against rubella. Air, direct contact Rubella have a rash, fever, swollen lymph nodes riage, stillbirth, premature delivery, birth defects Stiffness in neck and abdominal muscles, DTaP* vaccine protects against tetanus. Exposure through cuts in skin Broken bones, breathing difficulty, death Tetanus difficulty swallowing, muscle spasms, fever
* DTaP combines protection against diphtheria, tetanus, and pertussis. ** MMR combines protection against measles, mumps, and rubella. Last updated December 2016 • CS272886-E Appendix F
Public Health Agency Accreditation System Logic Model
June 2017
The Public Health Accreditation Board (PHAB) is committed to encouraging research to develop the science base for accreditation and systems change in public health, as well as to evaluating the accreditation program in order to continuously improve it. To support those two goals, the PHAB Research & Evaluation Committee developed and vetted a logic model that was approved by the PHAB Board of Directors in August 2010. More recently, the PHAB Research Advisory Council and the Evaluation and Quality Improvement Committee have revised the logic model. The revised logic model, which was approved by the Board of Directors in June 2017, can be found on the following page.
The logic model is designed to illustrate the contributions of PHAB (shown in yellow); stakeholders and partners, including funders, partner organizations, and researchers (shown in pink); and individual public health agencies that participate in the accreditation process (shown in blue). The model presents a logical framework of how their inputs and strategies may lead to outputs and outcomes for PHAB, participating health departments, and the public health field as a whole, including accredited health departments (shown in white). The proximate outcomes are the results that might be realized in the near term (1 – 3 years) and that are considered to be more directly related to the accreditation process. For example, because many of the standards and measures require the health department to demonstrate partnerships and community engagement activities, increased collaboration is viewed as a proximate outcome for participating health departments. Ultimate outcomes, on the other hand, are the results that are anticipated for further in the future (7-10 years) and are affected by many other factors. For example, health status is heavily influenced by the social determinants.
The logic model is an important tool to help researchers and evaluators understand the goals of accreditation so that they can systematically test the links between the work of the accreditation system and the outputs, proximate outcomes, intermediate outcomes, and ultimate outcomes, in turn. It is also a visual reminder of how the stakeholders in the accreditation enterprise can work together to achieve the goal of the voluntary national accreditation program: “to improve the health of the public by advancing and ultimately transforming the quality and performance of state, local, tribal, and territorial public health departments.”
6/21/2017 Public Health Agency Accreditation System Approved June 2017 Proximate Ultimate Inputs Strategies Outputs Intermediate Outcomes Outcomes Outcomes
Organizational Implement accreditation & Accreditation Strong, credible & Standards drive public health Improved community structure reaccreditation program: sustainable health indicators / • transformation • Board, Draft/revise standards marketed, accreditation program increased health committees & • Train agencies & site implemented, work groups visitors evaluated, & Increased science base for public equity • Staffing & •Create/maintain e-PHAB improved Standards adopted as health practice expertise performance measures Improved conditions Market program e-PHAB developed Improved identification & use of in which people can Principles for & data captured Increased participation evidence-based practices & policies be healthy standards & Improve program in accreditation from assessment •Conduct evaluation Increased use of benchmarks for • National consensus diverse agencies process Promote research evaluating performance Strengthened public standards for public throughout country health agencies health agencies & Site visitors Promote national Increased consistency in practice systems accreditation Improved Communication Funders • Encourage agencies to communication about Increased use of proven QI methods meet national standards efforts delivered public health & tools resulting in improvements in Greater equity in & seek accreditation National, Tribal, public health territorial, state, • Provide funding & TA, trainings, & QI practice regional, & local incentives tools provided capacity partners Enhanced internal & Increased inter-agency & cross- Provide TA and training Research external collaboration sector collaboration Increased capacity Researchers conducted & for optimal Conduct & disseminate disseminated Increased organizational Increased visibility & credibility of research (including best investment in public Interest, buy-in & accountability public health agencies practices) health commitment to seek Improvements & maintain made to advance Increased knowledge accreditation Prepare readiness of organizational More effective & efficient use of Increased public • Participate in training & strengths & resources recognition of public Agencies are Appropriate stability, TA weaknesses health role & value resources, & • Assess readiness accredited & complete Strengthened organizational capacity readiness to apply Legend Apply for accreditation & reaccreditation Increased awareness of & workforce importance of QI & a Accrediting QI, performance reaccreditation process supportive culture Improved responsiveness to Agency management, & Individual Public Review & share findings Report acted on & community priorities assessment Health Agencies • Develop & implement QI efforts in place Increased experience Stakeholders and improvement plan understanding of Policy changes implemented to Partners Community Agencies are community needs, promote better health outcomes & Public Health partnerships Mentor other agencies mentored assets, & inequities health equity Field