Creating Healthy Communities Coalition

State: OH Type: Model Practice Year: 2016

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The Creating Healthy Communities Program (CHCP) at the Cincinnati Health Department is a collaborative approach to policy, system and environmental changes that support local population health. The Program includes a 60 member Coalition whose members work together to create sustainable responses to health disparity by increasing access to nutritious foods, increasing access to safe places for physical activity, increasing access to tobacco-free environments and providing chronic disease prevention and management education. The leadership team for the Coalition has included members such as: Cincinnati Health Department; Leave No Child Inside; Green Umbrella; UnitedHealthcare; Cincinnati Public School District; Anthem; Cincinnati Department of Planning and Buildings; and Mount St. Joseph University. Sectors represented by current members include: schools; businesses; transportation; local housing authority; local government departments; non-profit organizations; faith-based organizations; and other coalitions or agencies. The entire Coalition is divided into four subcommittees which include Healthy Eating, Active Living, Tobacco Free Living, and Evaluation/Capacity Building. Coalition efforts are funded by the Ohio Department of Health.

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Cincinnati Health Department
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Creating Healthy Communities Coalition
In 2013, Cincinnati ranked 18th overall and third in community/environmental indicators, but ranked only 41st in personal health indicators. This dichotomy prompted the Anthem Blue Cross and Blue Shield Foundation to invest in Cincinnati in 2014. To create the Creating Healthy Communities Strategic Plan, the American College of Sports Medicine worked with the Creating Healthy Communities Coalition and a community leadership team to conduct a root-cause analysis and community survey to identify areas within Cincinnati that have the greatest need for improvement. The priority areas identified are:• Percentage of population eating healthy food is too low;• Percentage of population being physically active is too low;• Percentage of population with chronic disease is too high and percentage of population managing their chronic conditions is too low;• Percentage of population using tobacco is too high. Due to these unhealthy lifestyle behaviors, the top 5 causes of death in Cincinnati are heart disease, cancer, stroke, chronic lower respiratory disease, and diabetes. Chronic illnesses and obesity can be overcome through implementation of Healthy Eating, Active Living and Tobacco Free Living strategies that increase access to food, provide safe outlets for physical activity, and improve air quality. Therefore, the overall goal of the Coalition is to improve population health while addressing health equity in populations experiencing the greatest health disparities in schools, communities and worksites. The City of Cincinnati, Ohio, population 298,165 according to the 2014 US Census, is made up of 52 neighborhoods. In 2014, the CHD reported, “the average Cincinnati resident lives about seventy-six years, two years less than the average American, suggesting that we are not as healthy as the nation as a whole.” Within Cincinnati, the average life expectancy varies by 20 years between neighborhoods. The CHCP has chosen three priority communities to focus efforts on to increase healthy living. Cincinnati residents in priority communities experience health disparities that are caused by unequal access to social, political, economic and environmental resources. The Centers for Disease Control and Prevention affirm that these differences create health inequities for individuals usually identifiable by race or ethnicity, education or income level, and geographic location. The prominent health inequity in all three priority communities is the lower life expectancy, an outcome of the higher than expected mortality rates for common chronic diseases. The leading causes of death include heart disease, cancer, stroke and chronic obstructive pulmonary disease. In addition, 20% or more of families have household income below the poverty level, and an average of 18% of adult residents lack a high school diploma or equivalent. The percent of residents who lack high school education and the level of poverty have a large impact on African Americans who represent at least 50% of the population in these communities. The vision of the CHCP is ‘to prevent disease by inspiring individuals and organizations to collectively engage Cincinnatians in an environment that makes healthy living accessible, popular, and fun.’ Since 2010, CHCP has become a formal coalition with a leadership team that collectively supports the mission and vision for health in Cincinnati. All coalition members were recently invited to collaborate on a Needs Assessment conducted by the American College of Sports Medicine that led to the creation of the 2015 Strategic Plan and corresponding Logic Model. The CHCP Coalition’s organizational members have received local, state and national awards and funding including the National Association of County and City Health Official’s (NACCHO) Model Practice Award and the Ohio Department of Health’s Healthy Community Award.  The goal of the CHCP Coalition is to implement and support the Creating Healthy Communities Strategic Plan: 2015-2019. The Creating Healthy Communities Strategic Plan’s overarching priorities are to increase physical activity, promote healthy eating guidelines, and decrease tobacco usage in an effort to reduce chronic disease. Primary Efforts include the following: Active Living: Crime prevention through environmental design (CPTED) is a multi-disciplinary approach to addressing criminal activity by encouraging the public to be outside and involved.  Criminal activity is deterred by implementing strategies such as additional lighting and landscaping within an environment. Healthy Eating:  Produce Perks is an incentive program serving the Greater Cincinnati and Northern Kentucky region, working to increase accessibility, affordability, and consumption of healthful foods for low-income populations – while supporting regional farmers and sustain local economies.   Tobacco Free Living:  According to the Centers for Disease Control and Prevention, policies establishing smoke-free environments are the most effective way to reduce exposure to secondhand smoke. Evidence has shown that smoke-free policies in enclosed workplace settings are associated with reduced daily cigarette consumption among employees and possibly with increased cessation among employees.  
There is a strong commitment to make the City of Cincinnati a place where each and every resident can achieve their optimal state of health and well-being. Change has occurred through a multi-sector approach in which all stakeholders are engaged, empowered, and encouraged to build a culture of health. Active Living, Healthy Eating, Tobacco Free Living, and Chronic Disease Prevention strategies of the Creating Healthy Communities Coalition are listed below. Each of the successes below are best practices recommended by the Centers for Disease Control and Prevention. Active Living School Sector—Safe Routes to School (SRTS) is a national initiative to improve safety and encourage more children to walk and bike to school. District-wide the SRTS program impacts over 33,000 students. In 2011, CHCP participated in the district-level steering committee for Cincinnati Public Schools’ (CPS) SRTS program as the Educational Advisor and the first of its kind District-Wide Travel Plan was created. Partners with the CPS SRTS program include the CHCP, Greater Cincinnati YMCA, Ohio-Kentucky-Indiana Regional Council of Governments, Executive Service Corps, City of Cincinnati Transportation and Engineering Department, GBBN Architects and Growing Well Cincinnati. Due to the success of this program ODOT has committed over 1 million dollars to the City of Cincinnati towards infrastructure improvements that will provide sustainable and long lasting environmental changes for the citizens of Cincinnati. Positive changes that have already occurred as a result of the SRTS program include the Allegiance Project and a Nature Play Path. The Allegiance Project grew out of SRTS as it addressed many parents’ concerns over the safety of children walking alone. The Project was awarded a mulit-million dollar grant from the Department of Justice to support the creation of Walking School Bus (WSB) Programs in several neighborhoods. There have been early successes since the WSB’s began in fall 2014. The program has caused: 1) WSB leaders, called Conductors, to transform into community leaders, 2) the community to be proud to have the WSBs, 3) community residents to look out for and greet the WSBs as they walk by, and 4) the Cincinnati Police to look for the WSB and if they know of the route, policemen and policewomen well be in the area to watch out for the WSB. In one of the communities targeted by the Allegiance Project a Nature Play Path will soon be installed along the WSB route. The Nature Play Path consists of several interactive play structures that will be installed just off of the sidewalk to encourage imaginative play while walking. Community Sector— In 2012, Let’s Move! Cincinnati, led by City Council member P.G. Sittenfeld, was integrated with Safe Routes to School. Three Let’s Move events were held in community parks or recreation centers and had over 800 community participants, including several health agencies such as the Center for Closing the Health Gap, Cincinnati City Parks, Creating Healthy Communities, The Black Nursing Association, Green Umbrella, and many more. Let's Move events continued in 2013, 2014, and 2015 and over 300 children per year have been exposed to various physical activities including Yoga, Tai Chi, fencing, soccer, dancing, baseball, and many more. Community Sector—According to Police District reports, communities have experienced a decrease in persons shot between 2014 and 2015; however, safe opportunities for outdoor physical activity is still a community concern. To address this concern Crime Prevention Through Environmental Design principals were implemented in 2015. Crime prevention through environmental design (CPTED) is a multi-disciplinary approach to deterring criminal behavior through environmental design in order to promote physical activity. CPTED strategies rely upon the ability to influence offender decisions that precede criminal acts. In order to reduce crime and increase the perception of safety, CPTED improvements were made to transit stops to improve community walkability as well as efforts to bring more “eyes on the streets” and well maintained sidewalks through a partnership with the Cincinnati Metropolitan Housing Authority. Healthy Eating Community Sector—The CHCP has established 7 community-farms to increase access to healthy local food. Since 2010, the CHCP’s community farms have experience annual increases in food production. The 2012 – 2014 combined production of our 7 farms was over 5,000lbs of fresh fruits/vegetables, with a participation rate of 1,000+ community members including primary gardeners, community youth, faith-based organizations, community recreation centers, food bank recipients, and senior living centers who sustain the farms. Food production is accessible to all and distributed amongst the community at large. The CHCP’s community-farms have been identified as a national leader and were asked by the Centers for Disease Control and Prevention to share a success story on the CDC website. In 2014 the Urban Farming Program received the NACCHO Model Practice Award. To address components of sustainability with the gardens, core garden groups were established at each site. For gardens located at Cincinnati Recreation Centers (CRC), a CRC Garden Network was established. The CRC Garden Network meets quarterly to share best practices, resources, and ideas. The CRC Garden Network established a transportation program to transport residents to area farmers’ markets to participate in the Produce Perks Program. Community Sector—Produce Perks is an incentive program serving the Greater Cincinnati and Northern Kentucky region, working to increase accessibility, affordability, and consumption of healthful foods for low-income populations – while supporting regional farmers and sustain local economies. Produce Perks (PP) was implemented in partnership with the CHCP, OSU Extension, Cincinnati Recreation Commission (CRCs) and a private funder to increase access to fresh fruits and vegetables by providing a $1 for $1 match up to ten dollars to incentivize the purchase of produce. CHC has continued our partnership with the CRC by creating a systems change in which the CRCs committed to transport members to the nearby six participating markets so that they could purchase fresh produce. The PP program was piloted at six farmers’ markets in 2014, with all six markets experiencing increases in new customers, EBT sales, and total market sales. To date, the program serves 10 diverse food access points and includes representation from local, regional, and national organizations. Included within the 10 food access points is a Community Supported Agriculture (CSA) program. The CSA works in conjunction with the PP program to increase affordability of healthful foods and increase different opportunities for accessing healthy foods. Future planning includes creating a statewide platform for Produce Perks to be replicated in all Ohio counties. Government Organizations Sector—In 2013, CHCP proposed a key policy initiative to address access to healthful fruits/vegetables by establishing mobile access points in identified food deserts. The uniqueness of the program and its sustained success is based on its mobility and proximity to 31,549 vulnerable residents. The Mobile Produce Vending program increases accessibility by authorizing 50 revocable permits. The program permits gardens/farmers to remotely sell their produce in communities without farmers' markets, grocery stores, or other healthful food outlets. The program simultaneously addresses critical issues of healthful food access and transportation. Tobacco Free LivingWorksite Sector—Now more than ever, workplaces are recognizing the significant link between the health and wellbeing of their employees and the organization’s economic performance. Comprehensive and effective workplace health promotion programs can save health care costs, reduce absenteeism and disability costs, and serve to improve recruitment and retention of key talent. The CHCP serves on the leadership team for the Tri-State Workplace Wellness Collaborative (TWWC). The TWWC fosters workplace cultures that promote healthy lifestyles by increasing networking and sharing of ideas and experiences among members of the regional network, and providing information about best in class workplace wellness programming. Bimonthly meetings are held to advise members on reliable health promotion resources available in the community, to inform them of key wellness initiatives and to allow them to network with other wellness professionals. The TWWC currently has members from over 100 businesses in the immediate Cincinnati area. The participating businesses include many of the largest employers in the region, most likely impacting many of the city’s 298.165 residents. From 2012-2015, with the help of CHCP, the Cincinnati Health Department, Remke Bigg’s local grocery store chain, Northern Kentucky University, and the City of Cincinnati (with over 20 sites) established a tobacco free campus and implemented a tobacco free policy using the CHCP Tobacco Toolkit Free Living. Remke Bigg’s also allowed community members to participate in their tobacco cessation classes for employees. This systems change was a great way to highlight shared services. Community Sector— The CHCP focuses it policy, system and environmental change efforts in neighborhoods of Cincinnati that experience the greatest health disparity. Using CHD mortality and life expectancy data, and population-based strategies, CHCP has effectively built relationships with community leaders, community organizations and local stakeholders in order to engage in sustainable health improvements. One such improvement includes working with the Cincinnati Metropolitan Housing Authority (CMHA) to create smoke-free environments for Cincinnati residents. Through the partnerships within the Tobacco Free Living Subcommittee which include the American Cancer Society, the American Lung Association, Cincinnati Children’s Hospital, Cradle Cincinnati, Hamilton County Public Health, and CMHA. CMHA is scheduled to transition to a Smoke-free Multi-Unit Housing Authority in 2016. The CHCP continues to provide assistance to CMHA by convening the planning meetings, holding focus groups for property managers and residents, and helping to design the implementation plan which includes resident services such as tobacco cessation. Chronic Disease Prevention Healthcare Systems Sector—The CHCP facilitates a Chronic Disease Self-Management Program using the Stanford University model in Cincinnati Health Department health centers to help patients self-manage chronic disease through personal goal setting, healthy behavior modification, and improved communication with health care providers. In collaboration with the following CHCP members--Council on Aging of Southwestern Ohio, and Cincinnati Health Department Health Centers—as well as partnership from the Kroger Corporation, the program has received support from physicians and clinic staff as well. Community Organization Sector—The Monday Campaigns is a national movement backed by leading public health schools that dedicates the first day of every week to health. Every Monday, individuals and organizations join together to commit to healthy behaviors that help end chronic preventable diseases. The CHCP, go Vibrant, Northern Kentucky Healthy Monday Coalition and Tri-State Workplace Wellness Collaborative presented the Greater Cincinnati Healthy Monday Conference on Friday, April 29, 2011, at the Duke Energy Convention Center. Approximately 150 health promotion decision makers at restaurants, schools, worksites and community organizations across the Greater Cincinnati Region were in attendance, including Peggy Neu, President of The Monday Campaigns. Three breakout sessions were held to share with participants the details of planning and implementing successful Healthy Monday initiatives in the school, community and worksite environment such as Monday Monday Miles, Meatless Monday, Quit and Stay Quit Monday, Move It Monday, and Kid’s Cook Monday. Government Sector—In 2012, all city departments participated in the Monday Miles, Meatless Monday Program, and were emailed Healthy Monday Tips to receive health insurance incentives through Healthy Lifestyles. Healthy Lifestyles is a voluntary wellness incentive program that encourages and rewards employees and their spouses/equal partners for making positive choices for better health. Employees and their eligible spouse can earn up to $500 per calendar year by meeting certain health measures and by participating in and completing program components in health education, weight management, preventive care, physical activity and other lifestyle programs. Incentives earned are deposited into a Health Reimbursement Account (HRA) to be used towards medical expenses. School Sector —In 2013, a small pilot project for 3 schools established a successful Mentoring Meals Monday program (MMM). The MMM program is a Cincinnati-based local Monday Campaign where CPS teachers served as role models for healthy eating practices by selecting a healthy lunch provided by the school and eating with children while discussing healthy behaviors. CPS teachers received Healthy Lifestyle credit for participating as mentors in the MMM program. This culminated in the National Healthy Monday Campaigns office providing $10,000 in funding to support a district-wide Mentoring Meals Program in 2014 and 2015. In 2015, over 100 teachers participated with the potential to impact approximately 33,000 students. Current partners include CHCP, Cincinnati Children’s Hospital, The Nutrition Council, TriHealth, Alliance for a Healthier Generation, Growing Well Cincinnati, and Cincinnati Public Schools.
Nutrition, Physical Activity, and Obesity|Tobacco
HEALTH PROMOTION AND WORKSITE WELLNESSThe Community Health and Environmental Health Services Division is responsible for Environmental Services, Planning and Evaluation, the Public Employees Assistance Program (PEAP), the Childhood Lead Poisoning Prevention Program, and the Health Promotion and Workplace Wellness Program at the Cincinnati Health Department. Within the Health Promotion and Worksite Wellness Program, the Creating Healthy Communities Program (CHCP) has operated for 30 years. In 2014, a full-time Project Coordinator directed the program with support from contracted consultants. The Project Coordinator oversees the entire grant and coordinates initiatives in the worksite, community, and school settings. The CHCP Project Coordinator reports directly to the City’s Assistant Health Commissioner of Community Health and Environmental Health Services. The Creating Healthy Communities Program is a collaborative approach to policy, system and environmental changes that support local population health. The Program includes a Coalition whose members work together to create sustainable responses to health disparity by increasing access to nutritious foods, increasing access to safe places for physical activity, increasing access to tobacco-free environments and providing chronic disease prevention and management education. VisionCincinnati is a community where residents care about each other and their neighbors, embrace differences, and work together to improve health and wellness. Through the Creating Healthy Communities Coalition, partners prevent and reduce diseases by inspiring individuals and organizations to collectively engage Cincinnati residents in an environment that makes healthy living accessible, popular, and fun. Each year the Coalition works in three priority communities to ensure the most vulnerable neighborhoods receive appropriate care. MissionHealth Promotion and Worksite Wellness strives to implement environmental, policy, and systems changes to foster a culture of health and empower our residents to make healthy decisions. Therefore, the Creating Healthy Communities Coalition will inspire and energize all Cincinnatian’s health and well-being through creative, fun, and innovative collaboration to create a collective impact. NeedThe top 5 causes of death in Cincinnati are heart disease, cancer, stroke, chronic lower respiratory disease, and diabetes. Chronic illnesses and obesity can be overcome through implementation of Healthy Eating/Active Living and Tobacco Free Living strategies that increase access to food, provide safe outlets for physical activity, and improve air quality. Therefore, the overall goal of the Coalition is to improve population health while addressing health equity in populations experiencing the greatest health disparities in schools, communities and worksites. CRITERIA FOR POPULATION RECEIVING MODEL PRACTICE Priority Communities Selected Evanston—The average life expectancy is 72.7 years. In 2010, there were 9,158 adults living in Evanston. Evanston is known as the educating community—where you can learn from pre-school to Ph.D. African Americans make up 67.8% of the population. Cancer, heart disease and stroke are the leading causes of death. Nearly 25% of adults have less than a high school education, and more than 25% of families have household income that falls below the federal poverty level. Recently, Interact for Health, a local foundation, awarded Evanston funds to create outdoor activities, walking tracks and to purchase an adjacent lot to the Evanston Recreation Center. Spring Grove Village/Winton Hills (SGVWH)—The average life expectancy is 75.3 years. SGVWH was a Creating Healthy Communities priority community between 2010-2014. SGVWH was selected to remain a focus area under CHC FY 15, because of existing relationships and structures that demonstrate the community’s readiness for change—especially structures that support policy, system and environmental changes related to the risk factors. According to 2012 US Census reports, 20% of adults have less than a high school education and over 60% of families have household income that falls below the federal poverty level. Southwest Millcreek Corridor (SWMC)—The average life expectancy is 69.9 years. African Americans make up 68.98 percent of the population. Major cardiovascular disease, malignant neoplasms, and unintentional injury are the leading causes of death. An average of 7.37 percent of adults have less than a high school education and 25.1 percent of families have household income that falls below the federal poverty level. TIMEFRAME Since 2010, the CHCP has implemented policy, system, and environmental changes.  However, the official Needs Assessment in 2014 set the the stage for the CHCP Strategic Plan for 2015-2019. THE INTEGRAL PARTNERSHIPSCHCP works with Community Councils and/or key stakeholders to develop plans and share information with residents. Other organizations that have community “buy-in” convene forums, like Cincinnati Recreation Centers, churches and community agencies that are well established. Additionally, each priority community has a local police department and neighborhood officer that partner with CHCP to assess current needs for the built environment and to plan improvements in community design that promote safety for persons engaging in physical activity. METRO has bus routes that are a part of the pilot exploration of ‘Green Route’ signage that promotes newly improved places for physical activity and provides information on how to get to the sites. The Produce Perks program is supported by The Ohio State University-Hamilton County Extension, Nutrition Advantage, and the existing and future farmers’ market managers. United Dairy Farmers (UDF) is also a partner in the research to explore the implementation of healthy food options in their small retail store. Cincinnati Metropolitan Housing Authority (CMHA) and the Tri-State Workplace Wellness Collaborative are instrumental partners in exploring and implementing worksite tobacco free campuses, and tobacco free multi-unit housing policies. CMHA and the TWWC participate in trainings, use toolkits and follow up checklists to ensure implementation of policies and practices that lead to tobacco free living.The CHCP has previously participated in and supported many multi-sector coalitions including: City of Cincinnati Creating Healthy Communities Coalition (CHD-CHCC), Urban Farms, Green Umbrella’s Local Food Action Team (GU LFAT), Meet Me Outdoors, and the Regional Trails Alliance, Safe Routes to Schools (SRTS), Tri-state Workplace Wellness Coalition (TWWC), Healthy Monday Campaign (Mentoring Meals Monday based in Cincinnati Public Schools), and the Health Impact Assessment Committee. THE PARTNERS’ UNIQUE ROLESThe CHCP has an accomplished and diverse membership representing 7 sectors of Cincinnati (schools, transportation, non-profits, etc.). Within their sector CHCP organization members were responsible for completing the CHANGE tool in their corresponding sector, as well as working together to achieve the other Coalition goals.Active Living—Cincinnati Police Districts worked with CHCP and Priority Community Stakeholders to access improvements for environmental design. METRO partnered with CHCP to implement CPTED improvements at transit stops to improve community walkability and explore the feasibility of implementing signage as a public transit improvement by increasing riders’ awareness of existing built environment through signage in order to empower Cincinnati citizens to make healthy lifestyle choices.Healthy Eating—OSU Extension served as the fiscal agent for Produce Perks.  CHCP implemented Produce Perks by training farmers market managers in data collection, and serving as the overall director of the program.  OSU provided cooking demonstrations to shoppers and referring shoppers to community-based healthy eating courses. United Dairy Farmers (UDF) partnered with CHCP to research healthy retail options that are consistent with evidence-based practices for increased access to produce.Tobacco Free Living—The Tri-State Workplace Wellness Collaborative (TWWC) was involved in recruiting worksite members and providing Tobacco Free Toolkits within priority communities. CHCP also provided the evaluation tool to measure implementation at worksites. Cincinnati Metropolitan Housing Authority (CMHA) partnered with CHCP to draft multi-unit housing tobacco free policies and promote tobacco cessation classes. CHCP members will promote these classes to complement the implementation of tobacco free policies. OTHER AGENCIES AND ORGANIZATIONSInteract for Health, a nonprofit foundation and a CHCP member, improves health of the people in the Cincinnati region by funding grantees proposing works relating to physical activity, healthy eating, and tobacco free living.Physical Activity: Groundwork Cincinnati / Mill Creek Planning and implementation of Mill Creek Greenway Trail Phase 5, which will add approximately 2 miles to the existing trail in the Mill Creek communities; Cincinnati Parks Foundation, Renovations to Mount Airy Playground include resurfacing and new equipment accessible for all ages and abilities.Healthy Eating: Hamilton County Public Health, work with the preschools and day cares to encourage healthy eating (project that was basis of YMCA CTG); Cincinnati Recreation Department, host community-based gardens and opportunities for healthy lifestyle activities; Civic Garden Center, support over 58 community-based gardens throughout Cincinnati; St. Leo’s Food Pantry, lead organization for the North Fairmount Providers Group currently serves 275-300 families each month (more than 1,000 persons) within North Fairmount and the neighboring communities of the Southwest Millcreek Corridor;Tobacco-free Living: American Lung Association, Cradle Cincinnati, American Cancer Society, Cincinnati Children's Hospital, Hamilton County Public Health,and Cincinnati Metropolitan Housing Authority all support and work together for smoke free environments. FUNDING CHCP efforts are funded by the Ohio Department of Health in the amount of $125,000 per year. The grant pays for 80% of the Director's salary and 50% of the Healthy Eating Coordinator, and Active Living Coordinators position with remainder going towards materials, printing, and training costs.  The Tobacco Free Living Coordinator position is covered by other funding. Although funding is only in the amount of $125,000, the coalition leverages approximately $500,000 through coalition member participation, additional grant funding, and resources.   Creating Healthy Communities 2015-2019 Strategic PlanHealthy Eating2015Implementation:  Increase access to healthy food options as evidenced by an increase in 1 SNAP Incentive Program (Produce Perks). Planning:  Explore the opportunity for creating a Healthy Food Retail (HFR) component within retail store settings (UDF)2016Implementation: Improve availability of foods from local farms by implementing policies/practices that support Community Supported Agriculture to improve access to purchasing foods from local farms ,as evidenced by an increase in 1 CSA policy/program.Increase access to healthy food options by implementing SNAP incentives (Produce Perks) within a Healthy Food Retail (HFR) outlet, as evidenced by an increase in 1 HFR component within 1 retail food outlet. Increase access to healthy food options as evidenced by an increase in 1 SNAP Incentive Program (Produce Perks).Planning: Explore the opportunity for organizations and industries to develop and implement policies/practices that support breastfeeding in the Workplace by researching best practices, assessing needs and barriers, and designing a template for implementation.2017Implementation:  Implement polices/practices that support breastfeeding in the workplace,as evidenced by an increase in 1 Worksite that will have adequate time/space for pumping.Increase access to healthy food options as evidenced by an increase in 1 SNAP Incentive Program (Produce Perks).Planning:  Explore the opportunity to increase access to healthy food options for organizations and institutions through Farm-to-Institution models.2018Implementation:  Implement policies/practices that increase access to healthy food options for organizations and institutions through implementation of Farm-to-Institution models, as evidenced by an increase in 1 Farm-to-Institution policy/program.Increase access to healthy food options as evidenced by an increase in 1 SNAP Incentive Program (Produce Perks).Planning: Explore the opportunity to increase access to fruits and vegetables within the School setting by researching best practices, assessing needs and barriers, and designing a template for implementation for Farm-to-School policy/practice.2019Implementation: Implement policies/practices that increase access to fruits and vegetables within the School setting, as evidenced by an increase in 1 Farm-to-School policy/program.Increase access to healthy food options as evidenced by an increase in 1 SNAP Incentive Program (Produce Perks).Planning:  Explore the opportunity for organizations and industries to develop policies/practices that support healthy eating by improving water availability and healthier beverage choices in public service venues. Active Living2015Implementation: Make improvements to the built environment that increases physical activity opportunities as evidenced by an increase in 1 Crime Prevention through Environmental Design (CPTED) strategy. Planning: Explore sustainable implementation of Public Transit Improvements by researching best practices, assessing needs and barriers, resolving barriers and designing an implementation plan 2016Implementation: Implementation of Public Transit Improvements that promote access to health services, parks, recreation centers, nature centers and schools as evidenced by 1 systems change within a public transit provider.Planning: Explore ways to increase access to places for physical activity via Multi-Use Trails/Bike Infrastructure by assessing current trail/bike plans, exploring best practices, prioritizing important connections and researching funding options. This year’s exploration will focus on making sure schools (Safe Routes to School,) worksites and communities are able to be connected to a larger trail network.2017Implementation: Increase access to places for physical activity via Multi-Use Trails/Bike Infrastructure as evidenced by 1 trail/bike connection. This year’s implementation will focus on making sure schools (Safe Routes to School) worksites and communities are able to be connected to a larger trail network.Planning: Explore ways to increase access to places for physical activity via Multi-Use Trails/Bike Infrastructure/Safe Streets for All Users by assessing current trail/bike plans, Safe Streets plans, exploring best practices, prioritizing important connections and researching funding options. This will help to create active transport options that can be utilized as part of a daily routine.2018Implementation: Increase access to places for physical activity via Multi-Use Trails/Bike Infrastructure/ Safe Streets by an increase of 1 trail/bike/Safe Streets connection. Planning: Explore the implementation/enforcement of physical activity strategies that fit into daily routines such as Active Transportation Commute Support, Flexible work arrangements for employees to engage in physical activity and Safe Routes to School. Look for ways to encourage use of the ever expanding active transportation network.2019Implementation: Implement/enforce physical activity strategies that fit into daily routines such as Active Transportation Commute Support, Flexible work arrangements for employees to engage in physical activity and Safe Routes to School as evidenced by an increase of 1 policy implementation/enforcement.Planning: Planning for 2019 CHC resubmission Tobacco Free Living2015Implementation: Implement and/or enforce polices/practices as evidenced by an increase in 1 Tobacco-Free Worksite Campus Policy - METROPlanning: Explore Multi-Unit Housing Tobacco-Free Policies by researching best practices, assessing needs and barriers, resolving barriers and designing an implementation plan that responds to the needs within the Cincinnati Metropolitan Housing Authority (CMHA) 2016Implementation:  Implement Multi-Unit Housing Tobacco-Free Policies by researching best practices, assessing needs and barriers, resolving barriers and designing an implementation plan that responds to the needs within the Cincinnati Metropolitan Housing Authority (CMHA)Planning:  Explore Public Spaces Tobacco-Free Policies by researching best practices, assessing needs and barriers, resolving barriers and designing an implementation plan that responds to the needs within the Cincinnati Recreation Commission2017Implementation:  Implement and/or enforce polices/practices as evidenced by an increase in 1 Tobacco-Free Public Space Campus Policy – Cincinnati Recreation CommissionPlanning:  Explore University/College Tobacco-Free Campus Policies by researching best practices, assessing needs and barriers, resolving barriers and designing an implementation plan that responds to the needs within the UC, Xavier, and Mt. St. Joseph University2018Implementation:  Implement and/or enforce polices/practices as evidenced by an increase in 1 Tobacco-Free University/College Campus Policy – UC, Xavier, and Mt. St. Joseph UniversityPlanning:  Explore Trade School/ Technical College Tobacco-Free Campus Policies by researching best practices, assessing needs and barriers, resolving barriers and designing an implementation plan that responds to the needs within the Cincinnati State Technical College2019Implementation:  Implement and/or enforce polices/practices as evidenced by an increase in 1 Tobacco-Free Trade School/Technical College Campus Policy – Cincinnati State Technical CollegePlanning: Planning for 2019 CHC resubmission Evaluation and Capacity Building 2015Implementation: Complete (1) CHANGE Tool in each priority community by June 30, 2015.Implementation: Recruit 2 new faith-based organizations and 6 new businesses to the CHC Coalition by December 31, 2015.2016Implementation: Provide case studies on Priority Community #1 based on the CHANGE Tool assessment by reporting out on progress within each sector at quarterly CHC Coalition meetings—Q1: Community-At-Large; Q2: Community Institution/Organization; Q3: Schools; Q4: Worksites.Planning: Explore ways to fund chronic disease management in each Priority Community #1Implementation: Recruit new members based on recommendations in 2015 from the various CHC Coalition subcommittees and members.Planning: Update and expand CHC Coalition binder, recruitment process and funding template to track the capacity of the organization to sustain members and acquire grant funds as individual organizations and as a cross-sector Coalition.2017Implementation: Provide case studies on Priority Community #2 based on the CHANGE Tool assessment by reporting out on progress within each sector at quarterly CHC Coalition meetings—Q1: Community-At-Large; Q2: Community Institution/Organization; Q3: Schools; Q4: Worksites.Planning: Explore ways to fund chronic disease management in each Priority Community #2Implementation: Recruit new members based on recommendations in 2016 from the various CHC Coalition subcommittees and members.Planning: Update and expand CHC Coalition binder, recruitment process and funding template to track the capacity of the organization to sustain members and acquire grant funds as individual organizations and as a cross-sector Coalition.2018Implementation: Provide case studies on Priority Community #3 based on the CHANGE Tool assessment by reporting out on progress within each sector at quarterly CHC Coalition meetings—Q1: Community-At-Large; Q2: Community Institution/Organization; Q3: Schools; Q4: Worksites.Planning: Explore ways to fund chronic disease management in each Priority Community #3Implementation: Recruit new members based on recommendations in 2017 from the various CHC Coalition subcommittees and members.Planning: Update and expand CHC Coalition binder, recruitment process and funding template to track the capacity of the organization to sustain members and acquire grant funds as individual organizations and as a cross-sector Coalition.2019Implementation: Complete 1 CHANGE Tool Assessment by December 31, 2019—Q1: Community-At-Large; Q2: Community Institution/Organization; Q3: Schools; Q4: Worksites.Planning: Explore ways to sustain chronic disease management in each Priority CommunityImplementation: Recruit new members based on recommendations in 2018 from the various CHC Coalition subcommittees and members.Planning: Update and expand CHC Coalition binder, recruitment process and funding template to track the capacity of the organization to sustain members and acquire grant funds as individual organizations and as a cross-sector Coalition.Planning: Revise and update the CHC Logic Model for 2020 and beyond  
The most critical step in our coalition is evaluation. The evaluation process helps form a clear understanding of what progress is being made toward goals and objectives and helps us distinguish between what is working and what is not working. Evaluation benefits include:• Evaluation enables you to measure and celebrate success.• Evaluation builds trust within your coalition• Funding partners rely on evaluation to make future funding decisions. The Creating Healthy Communities Coalition has a two-tiered approach to Evaluation which include process evaluation and outcome evaluation. Process Evaluation The coalition evaluates the number of coalition members.  In 2014, there were 23 coalition members and in 2015 there are 62 coalition members and 10 Leadership Team members.  The coalition is also given a survey annually to identify improvement opportunities for the following year.  Due to the survey, we identified that the meeting needed to be shortened from 3 hours to 2 hours with the first hour dedicated to a business meeting and the second hour dedicated as a working meeting.  The coalition survey also revealed the need for professional training; therefore, each quarter we provide professional development.  In 2015, the professional development classes included and overview of policy, systems, and environmental changes (PSEC 101), Evaluation, Social Marketing, and Fundraising.  Outcome Evaluation The CHANGE ToolAccording to the Centers for Disease Control and Prevention, the CHANGE tool helps community teams (such as coalitions) develop their community action plan. This tool walks community team members through the assessment process and helps define and prioritize possible areas of improvement. Having this information as a guide, community team members can create sustainable, community-based improvements that address the root causes of chronic diseases and related risk factors. It can be used annually to assess current policy, systems, and environmental change strategies and offer new priorities for future efforts.Purpose of the CHANGE Tool Identify community strengths and areas for improvement. Identify and understand the status of community health needs. Define improvement areas to guide the community towards population-based strategies that create a healthier environment (e.g., increased physical activity, improved nutrition, reduced tobacco use and exposure, and chronic disease management). Assist with prioritizing community needs and consider appropriate allocation of available resources. In order to evaluate outcomes for the work of the CHCP, the coalition completed the CHANGE Tool during the first 6 months of the grant. This assessment will serve as the baseline to measure impact pre interventions and post intervention.  With the help of the coalition, each CHD-CHCP staff member who also chairs the Healthy Eating, Active Living, Tobacco Free Living, and Evaluation Subcommittee identified organizations in the communities to be interviewed for the CHANGE Tool Assessment. Several Coalition members currently provide intervention programs, reside within, or having working relationships within the Priority communities. The Evaluation Subcommittee was trained on the CHANGE Tool, became experts on the surveys, and conducted interviews.  The results of the assessment were compiled and provided in a final report. The initial CHANGE tool rankings for each Priority Community were reported to the entire Coalition for discussion, edits and revisions. Stakeholders from the Priority Communities and/or Coalition representatives with community insights ranked the Policy and Environmental changes as well. The final report showed that organizations needed help with transitioning to smoke free environments especially agencies that have outdoor playing areas such as parks and recreation centers.  Lack of food access was also highlighted in the assessment as well as lack of transportation supporting healthy living.  The coalition will implement the Strategic Plan over the next 5 years to build the culture and change the infrastructure to support healthy living.  In 5 years the coalition will utilize the CHANGE Tool again to identify the impact.  Successes prior to 2016 are highlighted in the Responsiveness and Innovation section. 
Currently the CHCP is being sustained through Ohio Department of Health funds, coalition partnerships, collective impact, and shared visioning.  The following lessons learned have sustained the coalition: 1) Presentations on best practices keeps people current on new knowledge and wanting to be a part of the coalition as subject matter experts. 2) Allow people to come and go on the coalition. They may not be needed every year, but if they feel welcome they will always come back to support and bring new ideas. 3) Constantly evaluate if you are meeting the needs of the coalition and if you are doing work aligned with your mission and vision. 4) Involve members in every part of the coalition and give roles, assignments, and tasks. As long as members feel useful and can see that their input matters and makes a difference they will stay engaged. Yes their is sufficient stakeholder commitment to sustain the coalition and the coalition is constantly growing.  The Sustainability Plan is designed with the principles of  Collective Impact.  Collective Impact involves:• Common agenda• Shared measurement• Mutually reinforcing activities• Continuous communication
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