A Collaborative Community Health Assessment and Community Health Improvement Plan

State: IL Type: Model Practice Year: 2013

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Kane County, Illinois is home to 515,269 people in 30 municipalities. Non-Hispanic whites constitute 59% of total population, a drop from 68% in 2000, while Hispanics now comprise 31% of the total population, an increase from 24% in 2000. Kane County has the largest proportion of Hispanics in the state. Children less than 18 years of age make up 34% of Kane’s population. The unemployment rate, at 10.3% in 2010, has increased significantly in the past few years, doubling from 1990 to 2010. Poverty rates have increased by two thirds to 11.1% in Kane County. One third of African-Americans in Kane County are below the poverty level compared to one in five Hispanics and one in twenty whites. 24% of female-headed households were below the poverty level.

This practice had three objectives:

• Leverage funding from various county partners to conduct a truly comprehensive community health assessment.

• Influence partners to align planning and funding decisions to maximize efforts across the county to improve the health of all residents.

• Share the findings of the assessment so it can be utilized by all residents and organizations serving Kane County.

The Kane County Health Department 2011 Community Health Assessment (CHA) blended different tools and used various methods of outreach to include as many people as possible in the process. Many organizations work with partners on assessment, but we were able to take advantage of the convergence of requirements for public health and healthcare organizations to conduct CHAs. The partners participated in and funded the assessment with KCHD. Other local health departments should be able to reach out to their partners and attempt a joint assessment since many are required to conduct assessments. Agencies that need to update strategic plans would also be willing to invest in a collaborative assessment to collect a more robust set of data than if they did it alone. The key to a successful partnership is having a good relationship with hospitals and other agencies in the county and being flexible to meet their needs for a CHA. The KCHD Executive Director approached hospitals in Kane County in the fall of 2010 to propose collaborating on a comprehensive CHA that would meet the needs of each agency and demonstrate a model commitment to jointly addressing population health in the county. He also solicited the INC Board, a partnership of seven township mental health boards, and the United Way of Elgin and the Fox Valley United Way to support and fund the assessment. The CHA Partnership was formally adopted in February 2011 with the two United Way agencies joining in May 2011. The major activities for the partnership included meetings to create the questionnaire for the phone survey and focus groups. BRFSS questions were used as the foundation for the survey, and the vendor was able to provide additional survey questions from other national surveys. All participated in the data review and had input on the strategies and action items selected for the CHIP.Funding sources included the partnership and totaled $110,400 for the survey, $25,000 for the focus groups and $2,000 for partial data analysis. KCHD staff time to facilitate meetings, analyze data, and create reports were all provided in-kind.

The outcomes were:

• Completed phone survey, July 2011

• Completed focus groups, November 2011

• Completed data analysis and findings to the public for comment, November 2011

• Completed customized data books for each partner, which includes data for primary service areas and compared to county, state, and national figures, January 2012

• Completed, customized, professionally designed reports for partners June 2012 All outcomes met the target dates, except for the customized professional reports which were not finished in Q1 of 2012 due to delays in gathering partner-specific details.

All of the objectives for this practice were met:

• A comprehensive assessment completed with funding provided by a variety of partners and reaching all ZIP codes – 100% of the targeted population

• The results of the assessment were used by the partners to focus their plans and funding decisions in alignment with the health department’s priorities and strategies

• The assessment results were disseminated in unique ways

The success of the practice is evident in the positive response to the process evaluation and the implementation of partner plans which specifically tie in with the priorities and strategies selected for the CHIP. This alignment of priorities shows their commitment to the process and demonstrates the power of working together to improve health.

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Kane County Health Department
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A Collaborative Community Health Assessment and Community Health Improvement Plan
Kane County, Illinois is home to 515,269 people in 30 municipalities. Non-Hispanic whites constitute 59% of total population, a drop from 68% in 2000, while Hispanics now comprise 31% of the total population, an increase from 24% in 2000. Kane County has the largest proportion of Hispanics in the state. Children less than 18 years of age make up 34% of Kane’s population. The unemployment rate, at 10.3% in 2010, has increased significantly in the past few years, doubling from 1990 to 2010. Poverty rates have increased by two thirds to 11.1% in Kane County. One third of African-Americans in Kane County are below the poverty level compared to one in five Hispanics and one in twenty whites. 24% of female-headed households were below the poverty level. This practice had three objectives: • Leverage funding from various county partners to conduct a truly comprehensive community health assessment. • Influence partners to align planning and funding decisions to maximize efforts across the county to improve the health of all residents. • Share the findings of the assessment so it can be utilized by all residents and organizations serving Kane County. The Kane County Health Department 2011 Community Health Assessment (CHA) blended different tools and used various methods of outreach to include as many people as possible in the process. Many organizations work with partners on assessment, but we were able to take advantage of the convergence of requirements for public health and healthcare organizations to conduct CHAs. The partners participated in and funded the assessment with KCHD. Other local health departments should be able to reach out to their partners and attempt a joint assessment since many are required to conduct assessments. Agencies that need to update strategic plans would also be willing to invest in a collaborative assessment to collect a more robust set of data than if they did it alone. The key to a successful partnership is having a good relationship with hospitals and other agencies in the county and being flexible to meet their needs for a CHA. The KCHD Executive Director approached hospitals in Kane County in the fall of 2010 to propose collaborating on a comprehensive CHA that would meet the needs of each agency and demonstrate a model commitment to jointly addressing population health in the county. He also solicited the INC Board, a partnership of seven township mental health boards, and the United Way of Elgin and the Fox Valley United Way to support and fund the assessment. The CHA Partnership was formally adopted in February 2011 with the two United Way agencies joining in May 2011. The major activities for the partnership included meetings to create the questionnaire for the phone survey and focus groups. BRFSS questions were used as the foundation for the survey, and the vendor was able to provide additional survey questions from other national surveys. All participated in the data review and had input on the strategies and action items selected for the CHIP.Funding sources included the partnership and totaled $110,400 for the survey, $25,000 for the focus groups and $2,000 for partial data analysis. KCHD staff time to facilitate meetings, analyze data, and create reports were all provided in-kind. The outcomes were: • Completed phone survey, July 2011 • Completed focus groups, November 2011 • Completed data analysis and findings to the public for comment, November 2011 • Completed customized data books for each partner, which includes data for primary service areas and compared to county, state, and national figures, January 2012 • Completed, customized, professionally designed reports for partners June 2012 All outcomes met the target dates, except for the customized professional reports which were not finished in Q1 of 2012 due to delays in gathering partner-specific details. All of the objectives for this practice were met: • A comprehensive assessment completed with funding provided by a variety of partners and reaching all ZIP codes – 100% of the targeted population • The results of the assessment were used by the partners to focus their plans and funding decisions in alignment with the health department’s priorities and strategies • The assessment results were disseminated in unique ways The success of the practice is evident in the positive response to the process evaluation and the implementation of partner plans which specifically tie in with the priorities and strategies selected for the CHIP. This alignment of priorities shows their commitment to the process and demonstrates the power of working together to improve health.
Responsiveness The public health issue that this practice addresses Community health assessment is a core function of public health and an important tool to use in setting priorities, guiding health, land use and transportation planning, program development, coordination of community resources, and creation of new partnerships to improve the health of the population. The results are used to define improvement areas and guide a community toward implementing and sustaining policy, systems, and environmental conditions that improve community health. The results also assist the community in prioritizing needs which lead to the appropriate allocation of available resources. The health assessment provides an evidence-based core foundation for improving the health of a community. Community Health Assessment generates a snapshot of our county’s health at the present time. Secondary data analysis provides crucial information that cannot be gathered through a simple phone call, but often the available data can be several years old. Our assessment gave us information for 2011 and allowed us to compare it to other county, state of Illinois, and national statistics. The assessment is the foundation for the county’s Community Health Improvement Plan (CHIP). For the first time, the assessment was funded by and completed with the five hospitals serving Kane County, two of the largest United Way chapters, and a local mental health 708 Board. These organizations have participated in the past, but not in this leadership and funding role. This group, the Community Health Assessment Partnership, met regularly to design the survey, select questions for focus groups, and provide expertise throughout the process. Instead of completing assessments separately, as has traditionally been done, we were able to pool our resources and complete the most comprehensive CHA ever undertaken by the county. IRS regulations under the Affordable Care Act require hospitals to complete a health assessment every three years, and by working together, we gathered data from all areas of the county, both quantitative and qualitative. The two United Way agencies and the 708 Board were about to update their strategic plans and having a robust assessment allowed them to utilize the most up-to-date information about the county to guide their work for the next several years. The process used to determine the relevancy of the public health issue to the communityCommunity health assessments and community health improvement plans are an important resource for the community by providing evidence of existing issues in the county and concrete plans for addressing them. The Kane County Health Department Community Health Improvement Plan (CHIP) is updated once every five years, but progress reports or “Vital Signs”, are created by the department to ensure that the plan is evaluated every one to two years. The Vital Signs report shows progress on the priorities selected for the plan and adjustments are made as necessary. By monitoring the progress, KCHD provides the community with evidence that programs and policies are benefitting them and gives them the assurance that their needs are being met. The most recent progress report was comprehensive, spanning the five years since the last community health assessment was completed. Entitled, “Progress Report on Strategy Implementation 2007-2011” this report was presented as a part of the health assessment and shared with stakeholders and members of the community through webinars, press releases, and presentations. This process allowed a diverse group of people to see the progress since our last assessment and determine what needed to be addressed in the updated community health improvement plan. Through this evaluation, KCHD examined the prior action plan priorities and determined that the next version of the plan should consider more up-to-date data and include various partners in the community so plans align and use data specific to each service area. It is critical that all residents of the county have access to the care they need, whether it is through private physicians, hospitals, social service agencies, or other health care providers in the county. The partnership allows each agency to focus on its service area population and see the bigger picture of what is happening throughout the county. This overarching picture keeps health planning efforts aligned and leads to a better use of scarce resources and improved community health. How the practice address the issueThis practice helps address the issue of a comprehensive community health assessment because the alignment of the CHA process leverages limited assessment dollars, enhances the ability of multiple agencies to conduct a robust assessment, and reduces the duplication of efforts across the county, saving money that is better spent on implementation. Our partnership has brought groups together that serve areas of the county which have higher rates of poverty, disease, and mental health issues. These agencies can easily see where there is a greater need for services and they can target their efforts to assist those who will benefit the most from increased services. Creating reports by specific areas reveals disparities that were not easily visible before the 2011 CHA. For example, the county can be divided into three planning areas, North, Central, and South. The results from the assessment showed the percent of adults reporting their overall health was good or very good was 54.8. However, when looking at the rates by planning area, the North was 49.9%, Central 68.8%, and South 52%. We see that two areas of the county need additional attention and this level of detail is possible because of our comprehensive CHA. Each partner agency received a customized data book and final report from KCHD which includes results specific to its service area. The reports allow agencies to make program decisions based on the information gathered for their communities and they have the confidence knowing that their resources are being utilized effectively. The integration of medical, mental health and social service agencies assures consideration of all determinants of health and supports targeted intervention going forward. In September 2012, one of the partnership hospitals launched a mini-grant application for organizations and the requirements include strategies outlined in the CHIP. Their community benefit money is directly tied to the hospital’s goals, which are in turn aligned with the CHIP. One United Way agency launched an effort to improve kindergarten readiness for children in its service area, which is a priority and strategy from the CHIP, and the other is working on one in its service area.   Innovation Evidence based strategies used in developing this practiceIn creating the partnership, the executive director read the following journal article that analyzed collaboration across multiple sectors to improve health: http://educationforhealth.net/EfHArticleArchive/1357-6283_v14n2s4_713664997.pdf We also used evidence from NACCHO, including the following summary of a national discussion on community health assessment which included examples of collaborative assessments. http://www.naccho.org/topics/infrastructure/mapp/loader.cfm?csModule=security/getfileandamp;pageid=201357 Another example of a study measuring the effectiveness of working collaboratively on identified community health priorities is found in the following article: http://www.springerlink.com/content/mg23063hk115k4w1/fulltext.pdf This article studied how local health departments could work with community agencies, with additional funding, to address community health problems. They found it to be beneficial to residents and the agencies involved and even without funding, is an effective method to improve public health. This practice is new to the field of public healthProcess used to determine that the practice is new to the field of public healthCommunity Health Assessment can be completed by any organization, but it is the joint assessment we conducted and led that makes the practice unique. The Affordable Care Act requirements for hospitals are new and having a local health department create a partnership to assist them in their planning efforts is a unique way for the department to build a stronger relationship with the hospitals and pool resources to create a truly comprehensive CHA. The MAPP process calls for broad participation in the CHA process but our assessment went a step further with a formal agreement signed by agency executives and the county board chairman to jointly lead and fund a comprehensive assessment. A review of the literature confirms the importance of aligning the individual-level health services with population-based public health strategies (Lasker et al, Promoting Collaborations that Improve Health. Education for Health 14. No. 2. 2001). Instead of working separately on similar problems, our partners see how working together to improve community health will benefit their organizations and their clients/patients. For example, if a certain area has a high smoking rate, which may lead to other diseases later in life, KCHD can share its expertise in smoking cessation programs with a partner organization that serves members of that community. The partner organization can work directly with residents, using evidence-based practices developed by the health department. This allows the department to focus on a larger number of issues and they can allocate resources to address other needs in the county. How this practice differ from other approaches used to address the public health issueAgencies may fund and conduct CHAs alone and may duplicate work completed by other agencies. The CHAs may lack true community input and participation, which leads to less reliable data. This approach does not benefit the community because each agency will be working with different assessment results and plans and programs will not align with others. In the end, the residents may not receive the services they need because the data used was not comprehensive enough to identify the primary needs in a community. It also differs in that most are done with secondary data analysis and focus groups. This practice does not allow for generalization of data across a county because it is not a random sample of residents. Perhaps the only people who turned out for a focus group are from one city that has a unique set of issues and residents from another town may have differing needs. This CHA practice differs from others because it was jointly led and funded by agencies from multiple sectors (medical, mental health, social service) which brought a diverse perspective to the process and helped craft effective survey questions. Because certain organizations wanted more questions on income and education, we utilized a novel format, Community Cafés, which brought together residents in a relaxed setting and allowed them to interact with specially trained facilitators. The findings from these groups were unequaled, particularly the information gathered in the Spanish-speaking session, and would not have been possible without funding and input from the partnership.
Primary StakeholdersThe primary stakeholders included the Kane County Health Department, the five hospitals in Kane County, United Way of Elgin, Fox Valley United Way, and the INC Board, which is the mental health council for a portion of the county. The information gathered is available to the general public through our website and can be used by any agency to learn more about the health profile of our residents and how their work can help improve the health of their clients. LHD's roleThe KCHD was the lead member of the partnership, coordinating and facilitating meetings, working with vendors to setup the focus groups and community cafes, and providing expert analysis of the data gathered as part of the phone survey and secondary data. The department executed the Memoranda of Understanding with all the partners, securing the signatures of all parties involved. The department was also responsible for creating specialized reports for each partner, including the results of the phone survey, secondary data analysis, and focus groups. The reports highlight the key findings in each partner’s service area as well as a several graphs and tables showing the results from the data analysis. In addition, the data is available on the KCHD website in an easy-to-use format which allows visitors to view data based on the information they seek. A key component of the practice is sharing the results of the data analysis and asking for public participation on setting the priorities for the county’s Community Health Improvement Plan. The department created two webinars, one a detailed review of the assessment and another executive summary version.These webinars provided new data and information about the social and economic profile of Kane County, an update on the key health indicators from our last community health improvement plan, and detailed results from the comprehensive telephone health survey conducted earlier in the year. As a companion to the webinar, the department created a survey using Survey Monkey which asked participants to reflect on what they have seen, prioritize the nine key opportunities for community health improvement identified by KCHD through the community health assessment, and provide simple demographic information for use in analyzing the survey results. Based on this feedback, the department identified the top issues facing the county and selected them as priorities for the updated Community Health Improvement Plan. In addition, the results from the focus groups were summarized for the partners so they could include that information in their strategic planning initiatives for 2011. Stakeholders/partnersThe stakeholders were involved in the planning of the two separate sections of the community health assessment process. The five hospitals and INC Board were part of the committee from the beginning, helping to choose how we wanted to do the assessment (phone vs. paper survey), which vendor to use, questions asked, and how the results would be presented to them. The questions were reviewed over several months, with the input of the Northern Illinois Public Opinion Lab staff who helped locate and craft questions that were comparable to other surveys and answered the most pressing questions by the partners. For example, the mental health section was changed and a different set of questions was used based on feedback from the INC Board. The child survey included a more robust question set about immunizations that were critical for partners and agencies with whom KCHD works on a regular basis. Partner agencies have areas of expertise beyond those of the department and allowed us to create a truly comprehensive survey that addressed issues important to each agency. The two United Way organizations were added to the team after the questions were finalized for the phone survey, but they provided input on the focus groups and Community Cafés and Community Meetings. All partners had input on the questions used at the focus group sessions and how the groups were divided up (by age and income level). All partners provided marketing assistance for the focus groups helping to recruit participants and providing thank you gifts for attendees. Finally, all partners agreed to guide funding and program decisions based on the results of the CHA and the priorities and strategies selected for the CHIP. The local health department has continually met with the primary stakeholders throughout the assessment process, through face-to-face meetings, e-mail messages, and electronic forums like the department website and survey tool. Beyond the primary stakeholders, the department organizes and facilitates various community groups in the county, including the Breastfeeding Coalition, All our Kids (AOK) Network, Elgin and Aurora Circles of Wise Women, Healthy Places Coalition, Health and Wellness Coalition, and the Kane County Mental Health Council. The department understands the importance of engaging community stakeholders in planning efforts to combine resources and address the key opportunities for community health improvement identified through the CHA process. An example of how our collaborative CHA is helping to align efforts is the AOK Network Strategic Plan update. The group is working on an update to their plan and they have been able to utilize the results of the community health assessment to identify priority health issues for their organization, which focuses on early childhood. During the early stages of the assessment, leaders from that group asked for more information about parental opinions on immunizations for their children. We were able to include an expanded set of questions on our phone survey and we presented those results to them during a strategic planning meeting held in October. They have a better understanding of what parents think about immunizations and can create messages for parents and primary care physicians to help increase the immunization rate in the county. Without our relationships with community stakeholders, we would not have been able to provide them with the expanded vaccine data and they would continue to rely on other means of gauging parental attitudes toward immunizations. Lessons learnedWorking with a diverse group of organizations to conduct the assessment presented a few challenges. Trying to include survey questions that would address issues for hospitals, social service agencies, and the health department, took time to balance everyone’s needs. We wanted to keep the questionnaire manageable and short enough so that people would be willing to complete the entire survey. However, we all wanted to include as many questions as possible because we knew this was a unique chance to collect data on a large sample of residents in the county. Because the county was looking at integrating land use, transportation, and health into its upcoming master plan, we wanted to include questions that addressed issues like neighborhood walkability and public transportation. Having Northern Illinois University staff there helped keep the process running smoothly as they would give us estimates on how long the survey would take and suggested how we could use other questions to collect answers more efficiently. In the end, all partners were satisfied their needs were being met through the phone survey and focus groups. Another lesson learned in this practice is that sometimes trying to recruit residents for focus groups can be difficult, despite the assistance of our partners. We were able to conduct 12 traditional focus groups, but it was difficult for the university to find enough people for the groups. We also organized several Community Cafés where we provided dinner and child care for participants to make it easier for parents to attend. Unfortunately, we had to cancel a number of them because of a lack of participants. We instead decided to reach out to existing groups and organizations and attend one of their meetings to gather qualitative data for our assessment. Being flexible was the key to making the focus groups a success and we have learned that we will have to create several plans for generating resident participation and feedback as part of the assessment process. Tasks taken that achieve each goal and objective of the practiceThe specific goals included creating a formal partnership to conduct the CHA, sharing the data with all county residents and organizations, and working with the partners and other organizations to align strategies with the CHA/CHIP. To achieve the first objective, the executive director reached out to the hospitals to seek their support for a joint assessment that was funded by the group and would meet their Affordable Care Act requirements for community assessment. He also reached out to the local mental health board, recognizing their input and the resulting data collection would be invaluable for many agencies serving the community. Finally, to ensure we included the social determinants of health, he asked the two largest United Way agencies in to join the assessment. The second goal was met by coming up with a dissemination plan for the data which included many different tools. The department used webinars as the primary means of dissemination to give people a choice as to when they can hear and see the results.The team also held a community meeting and open houses as another way of reaching out to the public in a face-to-face forum. We also utilized print media, video technology and social media to inform people about the CHA and where they could find the results. The third goal was met by including the partner organizations in the selection of the priorities for the CHIP, which were based on the CHA results, and asking them to consider aligning their work with the strategies selected. Most importantly, the department invited a group of leaders from a diverse group of organizations to participate in a CHIP implementation workshop in the spring of 2012. A nationally-known expert led the group in a hands-on review of methods for prioritizing strategies and implementing plans. Four groups were created, with the members from agencies with expertise in each of the four priorities identified in the CHIP. This meeting kicked-off the implementation of the plan and helped the leaders understand how their work ties in with the county’s plan and how they can align their work with it. Time frame for carrying out these tasksThe overarching timeframe for carrying out the tasks was for the full assessment to be completed by fall 2011 and the companion Community Health Improvement Plan to be adopted in Spring 2012. On a smaller scale, we had planned on releasing the first assessment data to the public in the Fall 2011, which we did. The qualitative assessment took longer to complete and was finished and analyzed in November 2011. The process started in November 2010 with a kick-off meeting to bring the potential partners together and discuss the options. The formal partnership was created a few months later, after the signing of the Memorandum of Understanding in February 2011, and the phone survey started shortly thereafter. The first implementation meetings were scheduled to begin shortly after the plan was adopted, in spring 2012, and it was held in May, 2012. Implementation meetings continue today. Outline of some basic steps The first step was to identify and engage key partners that had a need for a community health assessment, were working on issues identified in past community health action plans, and had financial resources to contribute to a comprehensive, joint assessment. Next the partnership was formalized and everyone agreed on the methodology for the assessment. From here, a vendor was selected and the partners created a questionnaire for the survey and focus groups. Upon completion of the survey and focus groups, the data was analyzed and a plan for dissemination of the results was created by KCHD. The results were shared with the entire community and their feedback was used in creating the priorities and strategies for addressing the health issues. After the priorities and strategies were selected, they were shared with partner agencies and the public for feedback and comment. Once the comment period was over, the plan was presented to the Board of Health for adoption. The next step was working on implementation of the plan with the partners and then extending it to other organizations in the county through a kick-off workshop held in May 2012. Implementation of the plan continues today, with more organizations working on aligning their work with that of KCHD. Lessons learnedWe learned a few lessons during the implementation of this collaborative CHA and the writing of the Community Health Improvement Plan (CHIP). We had to balance the medical view of health with our more overarching view that health is influenced by the built environment, education, and income as well as health behaviors. We had to share our knowledge with the partners so they understood why we wanted to include priorities and strategies in our CHIP that related to these factors and why they were included in their formal summary reports. On a procedural level, we learned that ensuring we held regular meetings with the partners and understanding the time constraints of partners and stakeholders was important for keeping the partners engaged. For example, we held meetings in the central part of the county to make it more convenient for all partners to travel to it. However, partners asked us if we could hold the meetings either first thing in the morning or at the end of the day because it was difficult for them to drive back and forth from their offices for the meeting. It was easier for them to start their day or end their day with a meeting. As a result, we moved our meeting times to accommodate their request. We also learned that people do not have time to sit through two hour in-person presentations, particularly when the information is available online. Our presentation of the assessment results had a poor turnout and we attribute it to time constraints. Many stakeholders cannot afford to let staff attend long meetings because reductions in staff limit the time they have available for attending community meetings and presentations like this one. We also learned that we can have buy-in without a financial incentive to do so, as is evidenced by agencies voluntarily aligning their community benefit plans with the assessment priorities and strategies without financial support from KCHD. Cost of implementationThe overall cost of the implementation was the cost of the collaborative health assessment. It included the phone survey which was $110,400, the focus groups and community meetings which were $25,000, and the in-depth analysis which was $2,000. In-kind costs were the health department staff time spent on the assessment process, data analysis, and facilitating the partnership meetings and included the following positions, in order of time devoted to the collaborative CHA practice: • Epidemiologist • Health Planner • Assistant Director for Community Health Resources • Executive Director • Health Communications Coordinator All funding received from the partners was used for the assessment and did not contribute to staff salaries. The funding agreement between the university performing the assessment and the partnership stipulated that KCHD would pay the full amount and invoice each partner separately for their agreed upon share of the cost. No other funding was used for the CHA.
Objective 1:The first objective for the community health partnership was to lead a truly comprehensive and robust assessment by combining financial and staff resources from other agencies in the county. The performance measures used for this objective include how many agencies participated in the assessment, the sectors represented, how often they attended meetings, and how they used the data presented to them. Each partner agency that participated in conducting the assessment signed a formal Memorandum of Understanding (MOU) that detailed the amount of resources pledged to the assessment (both financial and staff expertise) and the deliverables for each agency at the end of the assessment. The five hospitals serving Kane County all signed the Inter-Agency MOU as well as the mental health board president. Two additional agencies joined the partnership after the MOU was signed. The two United Way agencies executed an agreement with KCHD agreeing to participate in the partnership and to provide funding for the assessment. The MOU and agreements are evidence that KCHD was able to assemble a partnership for the assessment that would produce robust data for the county to be used in planning and funding decisions by all agencies involved. In addition, regular meetings were held throughout the process, seven total, where all partner agencies were invited to provide input on survey questions, focus group questions, and receive updates on the assessment progress.The formal evaluation conducted on the collaborative CHA practice included a survey which asked stakeholders throughout the county about their experience with the CHA process. This survey was conducted by a doctoral student at a local university. He created a survey which asked specific questions relating to the assessment data itself, the method of presentation, and usefulness of the information presented. In addition, a survey distributed through Survey Monkey asked questions about the information presented in the webinars and asked for feedback on the process. This survey was created by the health department and was available as a link through the assessment results webinars, on printed flyers, and on the department’s website. The department learned through the formal evaluation that the responses support a collaborative effort for the next community health assessment. The second recommendation, based on the analysis of the survey results is, “Build on the overwhelmingly positive assessment of the usefulness of the 2011-12 collaborative assessment, and begin planning now for the next Kane community health assessment and health improvement planning process.” This evidence will guide our preparations for the next assessment and will help us attract partners for another collaborative community health assessment. The results of the evaluation were shared with all individuals who were invited to participate in the formal survey, which included over 1,000 subscribers to the KCHD newsletter, Health Matters. The department is in the process of uploading the results to the KCHD website. Objective 2:The second objective was to work with agencies to align strategies with organizations across the county to improve the health of all residents. This goal was measured through the following questions from the formal evaluation survey conducted by a doctoral student: • The CHA document serves as a resource to prioritize and plan services (Likert Scale) • The CHA Document serves as a resource to guide a comprehensive health promotion strategy (Likert Scale) • How will you use information from the CHA in developing, implementing, and evaluating your programs? (Open-ended question) An additional measure is from announcements from partner agencies that specifically mention that their work is aligning with the CHIP strategies. The formal evaluation was conducted by the doctoral student after the CHA/CHIP process was completed and consisted of a survey sent to all subscribers of the department’s electronic newsletter Health Matters. The responses to the three questions above were collected and analyzed and the results are as follows. 92% of respondents said the document serves as a resource to prioritize and plan services and 92% said the document serves as a resource to guide a comprehensive health promotion strategy (the responses were “agree” and “strongly agree” with the statement). The following comments were received for the open-ended question: “Will be used for hospital strategic planning”; “Analyzing the data and use it for program development and community benefit planning”; “The data can be used to support new planned health promotion activities at the school level”; “We will use the plan in developing priorities to best utilize our limited resources.” Based on these survey findings, the department learned that agencies were planning on using the CHA and CHIP to base their planning efforts in the future and direct funding to strategies identified in the final report and met the objective of having organizations align their efforts with the CHA/CHIP.We also are aware of one hospital system that launched a mini-grant call for proposals as part of their community benefit program. In the application, they mentioned that their work is aligned with some of the strategies in the new KCHD CHIP, which again demonstrates that funding decisions and programs are based on the results of the CHA. Knowing other agencies are willing to work together on implementation, the department will continue to present the results of the CHA and the CHIP report to a diverse group of organizations, even those outside traditional health-related fields, to encourage them to consider health in all their plans and policies. The results of the evaluation were shared with all individuals who were invited to participate in the formal survey, which included over 1,000 subscribers to the KCHD newsletter, Health Matters. The department is in the process of uploading the results to the KCHD website. Objective 3:The third objective was to share the results of the assessment with the entire community using new methods for dissemination of information. Instead of producing a printed report and posting it on the KCHD website, we wanted to share the information in novel ways. The performance measure used for this objective is the number of methods used and the number of views/attendees for each method. We shared CHA results through two webinars created using SlideRocket, a full presentation and executive summary version which were recorded and available for viewing on our website. Press releases informing the public of the assessment and how they could view the results were distributed. We held a community meeting, where we invited the public to see a presentation of the results by the executive director of the department and included a QandA session. We created a video, posted on our website and Facebook page, inviting the public to attend the meeting and see the results on our website. The results were also shared with the public at two open houses, where the general public was invited to comment on the results and give input on what health problems should be addressed. A survey was used to gather feedback from the webinars and community meeting. The results were shared on the KCHD Facebook and Twitter pages and were featured in the department’s monthly e-newsletter Health Matters. The results were presented at a KC Board of Health meeting, which was open to the public and covered by the local press. The executive director was interviewed by a local TV station about the assessment and the video was posted on Vimeo. An interactive GIS map which allows visitors to see the results of the CHA by area of the county is available. Finally, the results are available on the KCHD website and a special page for the CHA was created to hold all information gathered as part of the assessment as well as the final CHIP. The following methods were measured: Full Presentation Webinar: 139 unique viewers Executive Summary Webinar: 124 unique viewers Press Releases: 6Community Meeting Participants: 5 Video: 40 plays Open House Participants: 60 Survey Responses: 85 Facebook Posts: 10 Tweets: 12 Articles in Health Matters: 6 We learned that it is best to over-communicate, using a variety of tools, to reach the largest population possible. The use of traditional tools, like posting to a website, holding a meeting or conducting a survey, combined with non-traditional tools like social media, video, and webinars allowed us to reach a greater cross-section of the county than the traditional tools alone. Social media uses the power of networking to reach a large number of people with one message. The community meeting was heavily promoted, but the small turnout taught us that people may not have the time to sit through a two hour presentation and QandA session or 90 minute webinar. The recorded webinars were well received, based on the survey results. 93% of survey respondents agreed that the webinars were an effective way to share the community health assessment results and 93% said they would like KCHD to utilize this format for future presentations. However, the low turnout for the longer version confirms that most people prefer a shorter summary with the knowledge they can access more data on the website. Having many different tools to communicate the results of the community health assessment and accompanying community health improvement plan was an improvement over the last assessment completed five years ago. Internet-based tools like Facebook, Twitter, SlideRocket, and Vimeo did not exist five years ago or were not used as much as they are now. The results from the formal evaluation survey show that “the vast majority those responding to this question [perceived barriers to their involvement] did not perceive or identify barriers to their involvement. A handful of respondents felt that time and travel were barriers to their participation and others felt that the CHA activities and opportunities for involvement were not well publicized.” This positive feedback indicates that the objective was a success and the continued use of a variety of tools is the best way to share information with the public. The results of the evaluation were shared with all individuals who were invited to participate in the formal survey, which included over 1,000 subscribers to the KCHD newsletter, Health Matters. The department is in the process of uploading the results to the KCHD website.
Stakeholder CommitmentCommunity health assessment provides the evidence necessary to identify health problems, prioritize them, and create plans that improve the overall health of our residents. Based on the overwhelmingly positive feedback from the evaluation and anecdotal evidence, the 2011 Community Health Assessment was a success. The members of the current Community Health Assessment Partnership have all used the data gathered to make evidence-based strategic plans and funding decisions. One hospital has a mini-grant program that specifically mentions the alignment of their community benefit funding with the KCHD Community Health Improvement Plan. One United Way office is funding a new, long-term kindergarten readiness program that is directly tied to one of the CHIP strategies. The partners have customized reports which they are sharing with their stakeholders and clients, showing their involvement with the assessment and planning process and how it has benefitted them. Their commitment to another collaborative, comprehensive community health assessment is ensured in several ways. First, the hospitals must conduct a community health assessment every three years, according to regulations under the Affordable Care Act. For each hospital to conduct an assessment of this depth and quality, they would spend five times as much money as they did for this collaborative assessment. The two United Way organizations and the mental health board also use assessment for strategic planning, setting goals, and funding and will need to collect updated information in the next few years. In a down economy, the ability to pool funding resources with other agencies and use the collective purchasing power to conduct a robust assessment with qualitative and quantitative data is the best way to use limited resources. The funding saved can then be used on the implementation of community benefit plans, strategic plans, and other goals defined by agencies. SustainabilityThe health department works closely with the current funding partners and will begin working on a plan for the next assessment. The department has applied for funding through the Robert Wood Johnson Foundation to explore cross-jurisdictional community health assessment, with our proposal including two other counties in the Chicago metropolitan area and a hospital consortium group. This funding is designed to better understand the opportunity and impact of cross-jurisdictional sharing among public health agencies. Should we receive funding, our next assessment will be comprised of new partners from other counties which include hospital systems that have facilities in Kane County and were part of the 2011 Community Health Assessment Partnership. This will lay the foundation for a continued partnership on the assessment. Should we not receive funding, all current partners will be invited to participate in the process again and, using our extensive network of coalitions, agencies, and partnerships, we will invite new partners to the table. Based on the positive results of the evaluation, we will have other organizations interested in joining the collaborative CHA practice and our continued evaluation of it will ensure it will continue for many years to come.
 
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