WELCOME DOUG JACKSON VIRGINIA DEPARTMENT OF HOUSING & COMMUNITY DEVELOPMENT TODAY WE’LL Explore how NRV Community Health Assessment findings relate to your work.

Learn how other communities are making strategic investments to address identified needs

Contribute ideas, experiences, and energy to improve health and well being in the NRV. WELCOME + INTRODUCTION

BILL FLATTERY CARILION CLINIC WELCOME + INTRODUCTION

STEPHEN CHANDLER LEWIS GALE COMMUNITY HEALTH ASSESSMENT

ASHLEY HASH CARILION NEW RIVER VALLEY MEDICAL CENTER

COMMUNITY HEALTH ASSESSMENT

MICHELLE BRAUNS COMMUNITY HEALTH CENTER OF THE NEW RIVER VALLEY

SYSTEMS AT WORK

DOUG JACKSON VA DHCD SYSTEMS AT WORK

TAKEAWAYS SYSTEMS AT WORK JESSICA WIRGAU COMMUNITY FOUNDATION OF THE NEW RIVER VALLEY

SYSTEMS AT WORK

DOUG JACKSON VA DHCD SYSTEMS AT WORK

TAKEAWAYS WEIGHING IN BY MOVING ABOUT WEIGHING IN BY MOVING ABOUT 1 Which of the CHA priorities do you perceive to be the greatest barrier for your clients/citizens? GREATEST BARRIER

A. Access to Care B. Affordable, Safe Housing C. Child Abuse / Domestic Violence D. Culture: Healthy behaviors not a priority E. Lack of knowledge of resources F. Poverty / low avg. household income G. Substance Use H. Transportation WEIGHING IN BY MOVING ABOUT 2 If we could address one priority area, which one do you think would have the greatest impact on our region? GREATEST IMPACT

A. Access to Care B. Affordable, Safe Housing C. Child Abuse / Domestic Violence D. Culture: Healthy behaviors not a priority E. Lack of knowledge of resources F. Poverty / low avg. household income G. Substance Use H. Transportation WEIGHING IN BY MOVING ABOUT 3 Which priority do you think there is the greatest energy to work on? GREATEST ENERGY

A. Access to Care B. Affordable, Safe Housing C. Child Abuse / Domestic Violence D. Culture: Healthy behaviors not a priority E. Lack of knowledge of resources F. Poverty / low avg. household income G. Substance Use H. Transportation SYSTEMS AT WORK

JEFF DINGER GILES COUNTY SYSTEMS AT WORK

JEFF DINGER GILES COUNTY

SYSTEMS AT WORK

TAKEAWAYS SYSTEMS THINKING SYSTEMS THINKING

mycorrhizal networks SYSTEMS THINKING SYSTEMS THINKING SYSTEMS SYSTEMS THINKING SEEING

The glaringly obvious only glares at you after you see it. First Steps Information Sharing Network Shared Resources Service Delivery Joint Planning

2016 2019 SYSTEMS SYSTEMS THINKING SEEING

SYSTEMS THINKING The network as part of a system, actively engaging in the system by understanding it. LEARNING TOGETHER SYSTEMS THINKING The network as part of a system, actively engaging in the system by understanding it. LEARNING TOGETHER SYSTEMS SYSTEMS THINKING SEEING

SYSTEMIC SYSTEMS THINKING SYSTEMS THINKING

Get it at donnellameadows.org SYSTEMS THINKING

Learn to read causal loops at systemsandus.com SYSTEMS THINKING But what are we trying to identify in the system? • Overlooked resources • Feedback patterns • Missed perspectives • Environmental inputs • Nontraditional partners • Leverage points • Norms • Policy implications • Patterns • Synthesis over analysis • New frames of reference • Complexity! SYSTEMS THINKING

Learn to read causal loops at systemsandus.com “We’re disrupting how we think about the community.” Jessica Wirgau “Then we get them all together.

Chris McKlarney

BARRIERS & LEAPS LUNCH DR. NOELLE BISSELL, M.D. NEW RIVER HEALTH DISTRICT KEYNOTE SPEAKERS

DR. NANCY WELCH, M.D. CHESAPEAKE HEALTH DEPARTMENT DANIELLE PORZIG HEALTHY CHEASAPEAKE Healthy Chesapeake A Unique Partnership for Addressing Population Health Needs New River Presentation| November 2019

Danielle Porzig, MPH, Healthy Chesapeake CARE Program Manager Nancy Welch, MD, MHA, MBA, Chesapeake Health District Director

12/18/2019 Declining community health status drove the formation

• Chesapeake City had declined to 44th per the annual Virginia RWJF County Health Rankings • Recent joint Community Needs Assessment conducted by the health department and hospital indicated specific focus areas for improvement • Data analysis showed large disparities in segments

of our community What are the most important HEALTH-RELATED ISSUES for our entire community?

Options Response Percent Count • Now it is 37 Mental health (depression, anxiety, stress) 92 60.9 Aging 73 48.3

Clean & healthy environment 65 43.0

Nutrition (healthy food and eating habits) 59 39.1

Obesity 58 38.4

Disabilities (physical, intellectual, sensory, 53 35.1 developmental)

Chronic Diseases (such as heart disease or diabetes) 52 34.4

Alcohol and drug abuse 50 33.1

Infectious diseases (such as flu or tuberculosis) 40 26.5

Healthy babies and mothers 36 23.8

Dental health (healthy teeth) 36 23.8

Immunizations 31 20.5

Tobacco Use 29 19.2

Sexually transmitted diseases 25 16.6

Accidental injuries 14 9.3

Data Shows Large Disparity Gaps within the city

7 7 Health Opportunity Index (HOI) Factors also show big differences

Low Health Opportunity = BAD

VDH calculates a Health Opportunity Index, or HOI, which is a composite measure comprised of 13 indices that reflect a broad array of social determinants of health affecting the community.

We are electing to work in low HOI areas initially where the impact opportunity is the greatest. Population Health Issues in Chesapeake • Food Insecurity There are an estimated 26,630 food insecure individuals in Chesapeake1 • Diabetes Prevalence At 15%, Chesapeake is 1.5 times the state average2 • Adult Obesity Prevalence 1 in 3 Chesapeake adults are obese3 • Aging There is an expected 114 percent increase in the population 65 years + projected by 20404

Source: 1 Feeding America: Map the Meal Gap 2018 2,3 Virginia Department of Health, 2015 4 Welden Cooper Population Center for Public Service, UVA How to address these community health needs?

A small working group with two representatives from the City and two from Chesapeake Regional Medical Center, under the leadership of the Health Director strategized the development of a unique concept that eventually became Healthy Chesapeake, Inc. Community leadership buy-in critical

• Inaugural interest meeting for development of Coalition led by Mayor Krasnoff and Health Director, Dr. Nancy Welch Broad Group of Initial Stakeholders Internal and External Focus Group Meetings = Initial Direction

Coalition Strategic Planning

Harbour North Focus Group Meeting Cambridge Square Focus Group Meeting Decision to establish a unique hybrid operating relationship

• The Health Director serves as the public health advisor for the Board

Chesapeake Health Department Director serves as Public Health Advisor

The Healthy Chesapeake Executive Director is contracted and participates in strategic planning and liaisons with other Health Department units for integration opportunities Chesapeake Responds: Healthy Chesapeake

Mission – Healthy Chesapeake is committed to building a culture of wellness that supports, sustains, and advocates for a healthier Chesapeake

Vision – To be ranked the healthiest community in Virginia per the Robert Wood Johnson County Health Ranking

Board – Board of Directors that provide the guidance and financial oversight of our program initiatives

Coalition – Voluntary group of citizens, community agencies, city departments, faith-based organizations, health care providers, and others that collaborate on direct service delivery

501(c)(3) – Established and operational with an Executive Director reporting to the Board and administrative and programmatic staff that support the Coalition

Strategy – Facilitate and provide support for population health programs and services developed and delivered by the Coalition in response to priorities identified by Community Needs Assessment, Chesapeake Neighborhood Quality of Life Study, Chesapeake Comprehensive Plans for Youth and 55 and Better, etc.

85 Unique Contractual Relationship with The Chesapeake Health District

• Healthy Chesapeake, Inc. is designated by the Chesapeake Health District and approved by VDH as the population health manager to lead the response to Virginia’s Plan for Well Being.

• Healthy Chesapeake, Inc. is charged with providing and ensuring: “…coordination and collaboration of all sectors of the community government, health care, education, businesses and community organizations including the faith based .. in working together to improve the conditions needed for people to be healthy.”

Plan created by statewide multi- faceted taskforce to address population health issues in Virginia. MOU with Healthy Chesapeake

• This Memorandum of Agreement between Chesapeake Health Department (CHD), and Healthy Chesapeake, Inc. (HCI), for the purpose of cooperation and coordination related to the implementation of strategic initiatives related to improvement of the population health of Chesapeake. • WHEREAS, in 2017 HCI was designated the population health manager for CHD with responsibility to implement the Plan for Wellbeing in Chesapeake.

• CHD Responsibilities 1. Subject to appropriation for CHD budget and contingent on available non-designated funding, the CHD agrees to disburse funds in support for the operation of HCI and the delivery of population health programs and services. 2. The CHD Health Director shall serve as a non-voting Public Health Advisor to the board and coalition. Important Roles

A unique hybrid/lateral structure is established by the corporate bylaws and outlines the operating process.

Healthy Chesapeake Shared Mission Healthy Chesapeake Board Coalition Collective Impact Premise Uses the Collective Impact Model

• The Coalition is a separate entity with its own chair and operating structure that includes work teams consisting of internal and external stakeholders

• The Coalition is lateral to the Board and drives the direction of the programs that are then financially supported by the Board

• The Board has two voting members from the Coalition that reinforce program priorities

• The Executive Director is an experienced community and economic development professional that facilitates the relationship between the two entities Benefits of a Nonprofit as a Health District Population Health Manager

1. Expanded the knowledge base of partners and community officials to focus on population health. 2. Expands population health response capacity with a 40+ member coalition instead of a single staff member. 3. Brings broad breadth of expertise to bear via coalition participation. 4. Extends the ability for leveraging resources 5. Reduces administrative processes and restrictive purchasing. 6. Improves the ability for resource gathering via in-kind, tax deductible giving and grant-writing eligibility. 7. Better able to serve as a neutral facilitator. 8. Allows the external contractual relationships of the Health District be extended to Healthy Chesapeake via MOU’s. Public Health is a Community Value City of Chesapeake Support

Two years after establishment and extensive community collaboration and projects, the city was approached for financial support.

City Council approved 15 cent per pack increase in cigarette tax and earmarked it for public health projects with 6 cents directed for Healthy Chesapeake, Inc.

This unique allocation for community-led health initiatives and provides Healthy Chesapeake on-going organizational stability.

Chesapeake… the city that cares! Chesapeake Regional Healthcare

As a founding partner of Healthy Chesapeake, Chesapeake Regional Healthcare has been a linchpin for this city-wide effort. With a focused commitment to addressing population health, this regional hospital has continued to provide resources, guidance, and engagement in all facets of Healthy Chesapeake. It has leveraged both financial and in-kind resources to enable this effort to develop. CRH Engagement with Healthy Chesapeake

• Program Support: ❖ Diabetes and Hypertension Community-based Response HUB in high risk area with staffing and supplies ❖ Purchase and renovation of Community Food Farmacy projected at $375,000 when completed Fall 2018

• Participation of Staff on Board and Coalition in-kind donation of $75,000 annually ❖ Board: Vice President of Operations ❖ Coalition: Vice-chair of Coalition ❖ Coalition: Mental Health & Community Ambassador work team leadership

• Space and Webhosting in-kind donation of over $40,000 annually ❖ Provision of Healthy Chesapeake Office Space, usage of board and training space, and on-going web hosting Old Dominion University

ODU through an MOU assumed the leadership role in gathering and performing the external review and evaluation for all Healthy Chesapeake projects. Healthy Chesapeake & ODU Academic Evaluations/Research

• Volunteer Management Policy • Healthy Chesapeake Program initial draft Evaluation (assistance w/ • Financial Management Policy instrument research) initial draft • Active Lifestyle Phone Surveys • Program Policies and and compilation of data Procedures initial draft • Baby Care Project Evaluation • Administrative Data Analysis • HUB Medical Intervention Data • Coordination of the SPARK Pilot Collection Project • Family Planning Program • IRB development for Cooking Evaluation Class Program evaluation • Functional Food Project • Individual gardening project Development evaluation • Assessment of transportation • Youth employment program services provided by free clinics development and evaluation • FAMIS project with DVH • An overview of evidence-based through Chesapeake Health chronic diseases prevention Department programs in Virginia and descriptions The HUB Plan for VA Well-being Diabetes and Hypertension Center Aims 3 & 4 FREE Diabetes prevention and management program within high risk communities Includes: Transportation, Testing, Cooking School, Social Work, and Food distribution through Food Farmacy PARTNERS: CRH, Health Department, Fire Department, Liberty Street Clinic, Chesapeake Care Clinic, Cooperative Extension, Foodbank, American Diabetes Association, Norfolk State University, Community Churches Case Study: Diabetes and Hypertension Management (HUB) Services and service providers confirmed

Need Providers Client referrals Southeastern Virginia Health System Chesapeake Care Clinic Free, frequent medical checks at site Chesapeake Regional Healthcare location EMS, City of Chesapeake Medical supplies and equipment Access Partnership provided Chesapeake Care Clinic Social work referral assistance Norfolk State University Kin and Kids Consulting Wellness coaching Chesapeake Health Department

Fresh food access Healthy Chesapeake

Education Chesapeake Health Department American Diabetes Association Transportation assistance To be contracted

99 Case Study: Diabetes and Hypertension Management (HUB) • Healthy Chesapeake sought and received funding from Hampton Roads Community Foundation: $147,750 over 3 years

• HUB program launched

• External evaluation performed during pilot phase by the ODU Center for Global Health

100 Case Study: Diabetes and Hypertension Management (HUB) Outcome: Decrease in hospitalizations and ER visits

Any Hospitalization in the past 9 months since starting Hub

Any ER Visit in the past 9 months since starting Hub

Any ER Visit in the past 12 months before starting Hub

Any Hospitalization in the past 12 months before starting Hub

0% 10% 20% 30% 40% 50% 60% 70% 80%

Source: Healthy Chesapeake, Summary of Findings, ODU Center for Global Health, April 2019 101 102 Case Study: Diabetes and Hypertension Management (HUB)

Outcome: Decrease in mean A1C

Source: Healthy Chesapeake, Summary of Findings, ODU Center for Global Health, April 2019 Case Study: Diabetes and Hypertension Management (HUB) Outcome: Decrease in mean arterial pressure

Source: Healthy Chesapeake, Summary of Findings, ODU Center for Global Health, April 2019 103 Case Study: Diabetes and Hypertension Management (HUB) Outcome: Improved healthy eating and active lifestyle behaviors

Daily water consumption

Daily moderate sport for at least 10 minutes

Daily Fruits and Vegetables Consumption

0% 20% 40% 60% 80% 100% 120% At 9 Months Baseline

Source: Healthy Chesapeake, Summary of Findings, ODU Center for Global Health, April 2019 104 ActiveActive CoalitionCoalition Partners Partners and and Program Active Coalition Partners and Program ProgramEngagementEngagement Engagement

105 Healthy Chesapeake ODU Projects

• Volunteer Management Policy • Healthy Chesapeake Program Evaluation • Financial Management Policy (assistance w/ instrument research) • Program Policies and Procedures • Active Lifestyle Phone Surveys • Administrative Data • Baby Care Project • Coordination of the SPARK Pilot Project • HUB Data Collection • IRB development for Cooking Class • Family Planning Program evaluation • Functional Food • Individual gardening project • Assessment of transportation services development provided by free clinics • Youth employment program • FAMIS project with DVH through Chesapeake development Health Department • An overview of evidence-based chronic diseases prevention programs in Virginia and descriptions Healthy Food Access

Opportunities for individuals to grow their own food or have access to healthy foods. Sites at community and senior locations managed by the residents and production sites at churches and schools. Pending Project : 22 Acre research, teaching and production site AIM 3 Utilization of Healthy Foods

Goal: Provide the knowledge and skills on how to eat healthier

❖ Healthy Chef is a multi-part cooking school on how to cook healthier. ❖ Use mobile cooking stations ❖ Grant PARTNERS: ✓ Hampton Roads Community Foundation ✓ The City of Chesapeake Social Services ✓ Southeast Virginia Community Foundation.

Extension Agent teaching Healthy Chef class for seniors See the Concept in Action

Healthy Chesapeake convenes and facilitates, but the Coalition partners take ownership! VA Plan for Well-Being as a Healthy Chesapeake Action Guide

Strategy: Utilize the VA Plan for Well-Being Goals and Strategies as the operational framework: • AIM 1: Healthy Connected Communities – Expand training and work-linked learning opportunities – Virginia adolescents choose not to engage in behaviors that put their well-being at risk • AIM 2: Strong Start for Children – Form neighborhood collaborative co-led by community members in under-resourced communities to identify obstacles and develop plans to address the root causes of health inequities • AIM 3: Preventative Actions – Virginians follow a healthy diet and live actively – Virginians have lifelong wellness – Expand opportunities during and after school for children to get healthy meals and the recommended amount of daily physical activity – Increase access to healthy and affordable foods in all neighborhoods – Expand programs and services eliminate childhood hunger – Help people recognize and make healthy food and beverage choices – Increase access to internet usage for aging Virginians • AIM 4: System of Health Care – Virginia has a strong primary care system lined to behavioral health care, oral health care and community support systems – Virginians obtain, process, and understand basic health information and services needed to make appropriate health decisions Melding of local, state & national priorities striving for goal of health in all policies

• County Health Rankings are used as directional benchmarks. • Virginia Plan for Well-Being correlated with the County Health Rankings. • The Chesapeake Community Action Plan and Community Health Needs Assessment currently conducted in conjunction with hospital. • The RU Ready comprehensive plan, the 55Plus comprehensive plan and the cities 2030 plan are also integrated. Plan for VA Healthy Foods Access Site Well-being Aim 1

*A Food Farmacy in a low HOI area with Chesapeake Regional Hospital. PARTNERS: • Foodbank • Farmers Market • Local Farmers • Healthy Chef Cooking School • Youth Employment • Non-profit Buffalow Family and Friends • Health Department

Concept drawings *in process Plan for VA Well-being VOICES from the community Aim 1 Health Ambassadors and Support of

Neighborhoods Engaging with the community is vitally Voices for the community and serve on our important! work-teams This Fall initiate Diabetes and Hypertension Pilot

PARTNERS: • African American Churches in low HOI • NC State Faithful Families curriculum

Peer-to-peer is a long-proven effective strategy Active Lifestyles - SPARK

Goal: Virginians Follow a Healthy Diet and Live Actively

SPARK senior and youth do and learn program-expands free meal program, social engagement, and wellness activities.

PARTNERS: ▪ Chesapeake Libraries ▪ School Nutrition Program ▪ Senior Services of Southeast VA ▪ 15 other service providers of various activities Next Steps

1. Continue to build Coalition 2. Improve internal and external communications 3. Enhance advocacy role 4. Adjust to evaluation findings

115 Next Steps

5. Determine need and role in addressing other social determinant issues; i.e.., transportation, housing, etc. 6. Expand beyond pilot areas

116 Buying Motivation: Do You Actually Buy Products?

• Fashion: Purchased to look better, feel more valued, have greater confidence, fit in/stand out. • Books/Information: Bought to further education, feel more intellectual, gain understanding, escape reality. • Furniture: Purchased for comfort, security, greater self- esteem and aesthetics. • Food: Bought for the experience, self-esteem, body- consciousness (e.g. diet food). The Generation Story

Lets go back to 1960’s America for a few minutes. Set The Stage

1.The youth of the day were fighting for liberation, equality and battling against the restrictions put in place by the previous generation.

…Afros, bell-bottom jeans, mini-skirts, lava lamps and tie dye t-shirts were all the rage.

…Things were getting- how can I put this- groovy.

2. And there was one company dominating the soft-drink industry, Coca- Cola. They were outselling their nearest competitor, Pepsi, by almost 6 to 1.

3. They’d used branding and to promote themselves as a representative of everything that made American’s proud to be American- wholesome values, tradition and national pride. Advertising

• , decided that the should stop talking about their product and instead, start talking about the user

• …and more specifically, those who saw themselves as different to the previous generation. The Pepsi Generation

In 1963 Pepsi launched an ad campaign named The Pepsi Generation.

• Pepsi took a huge chunk of Coca-Cola’s market share. The campaign had successfully advertised the type of person who bought their product, INSTEAD of their product (which was almost identical to their biggest rivals). Buying Motivation: Anybody Can Harness It

• Social media offers the perfect opportunity to target their ideal market for very low costs…

• The key selling point of your product, is not actually your product, it’s what it can help your customer achieve.

• …and all these things add up to one thing: a better version of themselves.

• People don’t buy products, they buy what the product will do TO them. Shift Your Focus

The first thing you need to do is shift your advertising focus away from your product and put the spotlight on your target market.

Whilst a beginner would spend all their time and focus advertising the second step (the product), an experienced advertiser would primarily focus their efforts on the difference between step 1 and step 3. 124 Coalition Workteams

Health Behaviors Clinical Care Social and Economic Diet and Exercise Access to Care Education Employment Healthy Chef Elizabeth Gorimani-Mundoma Family and Social Support Garden2Table Mike Andruczyk HUB Mary Trosien SPARK Kathryn Jesse Food Farmacy Mental Health

FIT Benjamin Camras

Faithful Families

Volunteer (MRC) Thomas Johnson

Current and developing programs Health Factor/Behaviors County Health Rankings Adult Obesity Physical Inactivity Access to Exercise Opportunity Alcohol Related Deaths STD Teen Births Drug Overdose Deaths

Chesapeake Trend Depictions 60 50 40 30 20 10 RANKING WITHIN STATE WITHIN RANKING 0 2014 2015 2016 2017 2018

Health Outcomes Health Factors Quality of Life Social & Economic Factors County Health Rankings Uninsured Primary Care Physician Ratio Dentist Ratio Mental Health Provider Ratio Mammogram Screening Clinical Care Violent Crime Injury Deaths Median Household Income Children reduced lunch

Chesapeake Trend Depictions 60 50 40 30 20 10

RANKING WITHIN STATE WITHIN RANKING 0 2014 2015 2016 2017 2018 Health Behaviors Clinical Care Soc & Econ. Factors Length of Life Strategic Plan Development Healthy Chesapeake Programs Year One Highlights: Garden2Table

• 11 community, production or learning gardens, including a garden and training program for Chesapeake Correctional Center female inmates • 50 individual grow box projects for low-income individuals • Seedbank launched to provide community gardens and individuals with free supplies

129 Year One Highlights: CARE

• Launched faith-based wellness program (Faithful Families) • Sponsored 10 youth and 2 senior stipends to support community programming • Supported community events, trainings, and learning activities for more than 1500 individuals

130 https://www.odu.edu/hs/centers/globalhealth Public health is not a department but rather a community value

For More Information: Dr. Nancy Welch, Health Director Chesapeake Health District [email protected]

Dr. Wendy Schofer, Coalition Co-Chair [email protected] SYSTEMS AT WORK

DOUG JACKSON VA DHCD SYSTEMS AT WORK

TAKEAWAYS SYSTEMS AT WORK TINA KING NEW RIVER VALLEY AGENCY ON AGING

SYSTEMS AT WORK

TAKEAWAYS SYSTEMS AT WORK

DOUG JACKSON VA DHCD NEXT STEPS

DOUG JACKSON VA DHCD NEXT STEPS NEXT STEPS 1

What key institutions or organizations (or type of institutions or organizations) do you believe are critical in providing stewardship for our collective next steps? NEXT STEPS 1 What are the two top things you’d ask the steering team to pursue as initial steps? WRAP UP

KEVIN BYRD NEW RIVER VALLEY REGIONAL COMMISSION CLOSING

DR. NOELLE BISSELL, M.D. NEW RIVER HEALTH DISTRICT THANK YOU