The State of Health of Houston/Harris County

State: TX Type: Model Practice Year: 2015

:

The State of Health of Houston/Harris County, Texas, is a comprehensive city/county community health assessment. The project began in 2006 with a 46-page joint report of local public health measures developed by the two LHDs, the Houston Department of Health and Human Services and Harris County Public Health and Environmental Services.  

The next year, additional partners were incorporated into a new city-county-wide State of Health Workgroup and a more comprehensive report was developed. Since that time, the report has steadily grown to encompass over 50 health topics in a 132-page document that resides on a dedicated website, www.houstonstateofhealth.org. The current report is sponsored by seven key public organizations in Houston/Harris County, with Workgroup members and content contributors from 14 agencies.

Topics for the report include population facts, socioeconomic indicators, health care access, health behaviors, use of preventive services, environmental health, leading causes of mortality, maternal and infant health, chronic diseases, communicable diseases, and appendices with demographic and other resource information. Topics are reported with an overview, current measures, trends, population differences, geographic distribution, economic impact, comparisons to Healthy People 2020 goals, public health actions, and sources for more information. The main document is updated every three years, and is accompanied by an Executive Summary that highlights topics of particular local concern. Publicity efforts include distribution of the State of Health report and Executive Summary to local officials and other key stakeholders, a media release at the launch of the reports, conferences introducing the document and key public health issues, and promotion of the website.

The State of Health report provides a resource for policy, planning, education, grant writing, and other local initiatives, as well as a guide for personal health decisions. Stakeholders include Houston/Harris County leaders, policy makers, healthcare professionals, public health professionals, educators, community-based organizations, funders, students, and other residents. 

The report fulfills two of the Ten Essential Public Health Services for Houston/Harris County, Texas: 1) Monitor health status to identify and solve community health problems and 3) Inform, educate, and empower people about health issues.

:
Houston Department of Health and Human Services
:
The State of Health of Houston/Harris County
  1. Description of the LHD The Houston Department of Health and Human Services (HDHHS) is the public health authority for Houston, Texas, the fourth largest city in the U.S., with an estimated 2013 population of 2.2 million, according to the U.S. Census Bureau. Established in 1840, HDHHS has grown to a department of 1,100 employees, and provides services for an increasingly racially and ethnically diverse population: 26% white, 23% black, 44% Hispanic, 6% Asian, and 1% other. Harris County Public Health and Environmental Services (HCPHES) is the public health authority for Harris County, Texas. With a staff of approximately 460, HCPHES primarily serves the areas in the county that are not a part of the City of Houston. This mostly suburban population numbers 2.1 million; the entire county population, including the City of Houston, is estimated at 4.3 million. Chartered in 1942, HCPHES serves a county population that is 33% white, 18% black, 41% Hispanic, 6% Asian and 2% other.   2. Public health issue The public health issue is the need for local and state leaders, educators, students, community organizations, funders, and residents to understand and respond to public health issues and trends in Houston/Harris County. A second priority need is to maintain local public health response to the Ten Essential Public Health Services national guidelines for public health departments. The State of Health of Houston/Harris County report meets two of the Essential Public Health Services: 1) Monitor health status to identify and solve community health problems and 3) Inform, educate, and empower people about health issues.   3. Goals and objectives The comprehensive State of Health report addresses over 50 health topics, including socioeconomic impacts, health care access, health behaviors, environmental health, maternal and infant health, chronic diseases, and communicable diseases. Topics are reported with current measures, trends, population differences, comparisons to Healthy People 2020 goals, public health actions, and sources for more information. Goals: Identify and highlight key health indicators showing the greatest challenges to the community Provide a central and accessible source to disseminate local public health data Link city-county-wide partners in a cooperative effort to inform policy makers, public health leaders, community-based organizations, funders, residents, and other stakeholders about key public health issues Objectives: Create and maintain an ongoing city-county public health workgroup to identify and regularly update community health indicators, beginning in 2006  Create easily understandable and comprehensive reports on the health status of Houston/Harris County and update every three years  Publicize the indicator information in a form readily accessible to the community, including policy makers, public health leaders, educators, students, grant writers, and other stakeholders   4. How was practice implemented/activities The report was first developed as a joint effort between the City (HDHHS) and County (HCPHES) Health Departments in 2006, based on the HCPHES annual report, which included many local health measures. The next year, additional partners were incorporated into a new city-county-wide State of Health Workgroup and a more comprehensive report was developed. Since that time, the report has steadily grown, to encompass over 50 health topics in a 132-page document that resides on a dedicated website. The current report is sponsored by seven key public organizations in Houston/Harris County, with Workgroup members and content contributors from 14 agencies. The main document is updated every three years, and is accompanied by an Executive Summary that highlights topics of particular local concern. Publicity efforts include distribution of the State of Health report and Executive Summary to local officials and other key stakeholders, a media release at the launch of the reports, conferences introducing the document and key public health issues, and promotion of the website.   5. Results/Outcomes The State of Health in Houston/Harris County report was published in 2006, 2007, 2009 and 2012. The 2015 edition is under development, with publication anticipated early in 2015. An evaluation conducted in 2014 indicated that many health/public health professionals and other residents do use the document and website, appreciate the report, and encourage efforts to expand awareness of this resource. All objectives were met, and are ongoing.   6. Public health impact The short term outcome is increased awareness of public health issues and trends in Houston/Harris County among policy makers and other key stakeholders, leading to greater funding for public health needs and the long term impact of improvement of overall health.   7. Website for program or LHD The State of Health in Houston/Harris County website: www.houstonstateofhealth.org Houston Department of Health and Human Services: http://www.houstontx.gov/health/ Harris County Public Health and Environmental Services: http://www.hcphes.org/      
1. Statement of the problem/public health issue The public health issue is the need for Houston/Harris County leaders, educators, community-based organizations, funders, students, and local residents to understand public health issues and trends, in order to make informed decisions about the policies and priorities guiding local spending, education, and public health efforts; and to guide personal health decisions. A second priority is to maintain local public health response to the Ten Essential Public Health Services national guidelines for public health departments. The State of Health of Houston/Harris County meets two of the 10 essential services: 1) Monitor health status to identify and solve community health problems and 3) Inform, educate, and empower people about health issues.   2. Target population The target population for the State of Health of Houston/Harris County is the entire population of the city and county, estimated at 4.3 million. The documents and additional information are available and free for all residents through the dedicated website at www.houstonstateofhealth.org. In addition, generally 500 hard copies of the main 132-page document and 2,000 copies of the 18-page Executive Summary are printed for distribution to key stakeholders such as city council members and agency leaders. Additional members of the population are reached through conferences that highlight the report and findings, citations in emails and publications, and others. Efforts target dissemination and distribution at conferences, to the media, to those who lead the city/county, and to others who make local funding and policy decisions. These decisions have the potential to impact the entire population.   3. What has been done in the past to address the problem? Health measures have been collected for the city and county for many years; however, these measures were often difficult to access and were found in many different sites. It was an onerous process to attempt to find an overall picture of health in Houston/Harris County. This report and website provide an easily understandable and accessible source of comprehensive local public health data.   4. Why is current/proposed practice better? OR Is it a creative use of existing tool or practice?  The current practice is better than what has been done in the past because it provides one source for a comprehensive picture of health in Houston/Harris County. The State of Health report encompasses measures from a wide range of sources, from local epidemiological reports and surveys to the national Behavioral Risk Factor Surveillance System (BRFSS) and the U.S. Census Bureau. The State of Health Executive Summary delineates public health issues of top priority as described in the State of Health report. The State of Health website serves to provide easy access and additional resources. The State of Health project, with the resulting reports for Houston/Harris County, is also a creative use of an existing practice. The practice, outlined in The Ten Essential Public Health Services, was developed with initial guidance from an Institute of Medicine report in 1988, and finalized by the Core Functions of Public Health Steering Committee in 1994. This Steering Committee involved representatives from Public Health Service Agencies, including CDC, HRSA, the Office of Disease Prevention and Health Promotion, and key national public health organizations. The committee’s statement, Public Health in America, defined the ten essential services of public health. The State of Health of Houston/Harris County meets two of the 10 essential services 1) Monitor health status to identify and solve community health problems and 3) Inform, educate, and empower people about health issues.Most medium-to-large-sized health departments provide some data on local health measures for the public, either on their websites or in print documents. Most often, these report BRFSS results for their local area. These efforts meet two of the essential public health services in a relatively basic and superficial manner. The State of Health project goes beyond these steps in terms of local participation, scope of the report, and accessibility. The project is produced by a city-county-wide team with input from multiple disciplines including mental health, education, public health, health care, local foundations, local activist groups, community members, and more. The scope of the project is extensive, and addresses over 50 topic areas. In addition to BRFSS data, the team assembles health information from the epidemiology divisions of the city and county health departments, local surveys by universities and other sources, mental health indicators from local providers, the Harris County Child Fatality Review Team, food safety inspectors, ordinance databases, hospital and emergency room visits and discharge data, CHIP and Medicaid records, U.S. Census Bureau data and more. For many topic areas, local GIS experts created maps that highlight the extent of the issue in particular ZIP codes or neighborhoods. Each chapter includes the economic impact of disease and disability, as well as cost savings from public health practices in the topic area. For example, in the Immunizations chapter, the report notes that for every $1 spent on childhood immunizations, an estimated $5 to $27 is saved, depending on the disease prevented. Information for each topic area includes: Overview—a general description of the topic as a public health concern Trends—the direction of the health issue (increasing or decreasing) over a period of time Population Differences—highlights racial/ethnic, gender, and socioeconomic disparities Economic Impact—shows the costs of the public health issue and the impact of potential savings through public health prevention and other activities Healthy People 2020—compares local measures with state and national data and Healthy People goals Public Health Actions—lists activities taken by public health organizations to address the topic area For More Information—provides links to key resource websites addressing the topic The Appendices provide: Demographic Tables—depicts demographic information for Houston and Harris County, with comparisons to Texas and the U.S., from the U.S. Census Bureau. Information includes total population, changes in population over 10 years, racial/ethnic proportions of the population, age groups, education levels, birthplace of residents, languages spoken, compositions of households, household income and poverty, veteran status, and disabled residents Maps—shows the areas of Houston/Harris County and the Houston-Baytown-Sugar Land Metropolitan Statistical Area (MSA) Frequently Used Websites—lists key resources for data, with website links Healthy People 2020 Sources—provides links to the Healthy People 2020 website and sources for comparison information Acronyms—lists acronyms used in the document, with the expanded forms for each The State of Health website provides resources in addition to the 132 page document. These include maps that can be downloaded and used, copies of past reports, links to related articles, strategic plans for the sponsor agencies, and more. The 2015 edition is now under development. New sections are being added to reflect greater awareness of current issues that impact health: gun violence, lesbian/gay/bisexual/transgender (LGBT) health measures, HPV, neighborhood environmental impacts on health status, access to behavioral health services, and flu. New members have joined the Workgroup to reflect expertise in these newly added topics. Topics for the 2015 edition include: 1. Population Facts—including demographics and trends 2. Socioeconomic Indicators—highlighting education, language and nativity, employment, income, poverty, the built environment, and homelessness as factors influencing health 3. Lesbian/Gay/Bisexual/Transgender (LGBT) Health  4. Insurance Access—looking at the high rate of uninsured (31% in Houston; 28% in Harris County), reasons for these high rates, geographic differences, and how this impacts health 5. Healthcare Access—identifying primary care and safety net providers and highlighting shortages 6. Preventable Hospitalizations and Emergency Room Visits—reporting on the high rates of hospitalizations and emergency room use, and how some of these could be prevented with greater access to primary and preventive care 7. Health Behaviors      o Tobacco Use     o Secondhand Smoke     o Nutrition     o Physical Activity     o Overweight/Obesity in Adults      o Overweight/Obesity in Youth      o Injury Risk Behaviors—including motor vehicle accidents, suicide, homicide, gun violence, family violence, and violent crime      o Child Abuse and Neglect      o Alcohol and Drug Use 8. Use of Preventive Services     o Prenatal Care      o Immunizations      o Cancer Screening      o Oral Health      o Vision Screening 9. Environmental Health     o Air Quality      o Surface Water Quality/Solid Waste      o Water for Drinking     o Food Safety     o Occupational Health     o Lead Poisoning     o Neighborhood Concerns 10. Leading Causes of Mortality 11. Maternal and Infant Health     o Adolescent Pregnancy      o Maternal Mortality      o Infant Mortality      o Fetal Mortality 12. Chronic Diseases     o Heart Disease and Stroke      o Cancer      o Diabetes      o Arthritis      o Asthma      o Metal Health Indicators  13. Communicable Diseases     o HIV and AIDS      o Sexually Transmitted Diseases      o Tuberculosis      o Vaccine-Preventable Diseases      o Flu      o Meningitis      o Hepatitis B and C      o Enteric Diseases      o Zoonotic and Vector Borne diseases 14. Appendices—with demographic information, maps, frequently used websites, Healthy People 2020 sources, expansion of acronyms, and additional information Developing the report takes the Workgroup 6-10 months, with additional time for publishing and publicizing the results.   5. Is the current practice evidence-based?  Yes, the practice is evidence-based. The State of Health report incorporates standards and guidelines from evidence-based sources such as Healthy People 2020 and the Behavioral Risk Factor Surveillance System (BRFSS), and meets requirements developed by the Public Health Accreditation Board for the accreditation of public health departments. Public Health Accreditation Standard 1.1 is “Participate in or Lead a Collaborative Process Resulting in a Comprehensive Community Health Assessment,” and the State of Health Workgroup activities and the State of Health report comply with the requirements for that collaborative assessment. HDHHS applied for accreditation this year, and recently hosted a site visit from the Public Health Accreditation Board. Both in the formal application and in discussions during the site visit, the State of Health report, Workgroup, methods, and promotion were essential to fulfilling accreditation requirements. The State of Health report was used as the primary document for the required community assessment as well as for documentation for Domain 1 (Assess Community Health Status) and Domain 7 (Access to Care). Community health assessment is a core function of public health. According to a NACCHO report citing the Public Health Accreditation Board and the Institute of Medicine of the National Academies, “the fundamental purpose of public health is defined by three core functions: assessment, policy development and assurance. Community health assessments (CHAs) provide information for problem and asset identification and policy formulation, implementation, and evaluation. CHAs also help measure how well a public health system is fulfilling its assurance function.”
1. Goal(s) and objectives of practice Goals: Identify and highlight key health indicators showing the greatest challenges to the community Provide a central and accessible source to disseminate local public health data Link city-county-wide partners in a cooperative effort to inform policy makers, public health leaders, community-based organizations, funders, residents and other stakeholders about key public health issues Objectives: Create and maintain an ongoing city-county public health workgroup to identify and regularly update community health indicators, beginning in 2006  Create easily understandable and comprehensive reports on the health status of Houston/Harris County and update every three years  Publicize the indicator information in a form readily accessible to the community, including policy makers, public health leaders, educators, students, grant writers, and other stakeholders.   2. What did you do to achieve the goals and objectives? Steps taken to implement the program The Houston/Harris County State of Health collaborative reports began with a joint effort between the city health department (HDHHS) and the county health department (HCPHES). In January of 2006, the two agencies created a State of Health report with 46 pages of local health measures, based on assessment portions of the HCPHES Annual Report. Later that year, the two health departments invited other agencies to join the project as sponsors for the upcoming year: Harris County Healthcare Alliance, Mental Health and Mental Retardation Authority of Harris County, and Harris County Hospital District. Representatives from these agencies and from the UT School of Public Health, Memorial Hermann Hospital, Baylor College of Medicine, and St. Luke’s Episcopal Health Charities formed the State of Health Workgroup. This group selected 37 key health indicators to include in the 2007 report in the areas of Physical Activity, Overweight and Obesity, Tobacco Use, Substance Abuse, Responsible Sexual Behavior, Mental Health, Injury and Violence, Environmental Quality, Immunization, and Access to Care. These measures were added to the descriptions of communicable and chronic diseases, and environmental status in the prior version. The 2007 edition of the State of Health report grew to 124 pages and over 50 health indicators, was published in hard copy, and was distributed to hundreds of policy makers and other stakeholders. The number of sponsor agencies grew to five and the Workgroup expanded to 16 members, representing nine organizations. Fifty-one content contributors were listed on the Acknowledgements page. In 2009, the project expanded again to include both the primary document of 124 pages, which was not printed, and an Executive Summary, which was printed. The Executive Summary highlighted 10 of the most crucial topics described in the main document. These topics were identified by the State of Health Workgroup as the highest priority for Houston/Harris County: Infant Mortality, Adolescent Pregnancy, Pregnancy/Infant Outcomes, Sexually Transmitted Infections, Hepatitis B and C, Immunization, Cancer, Adult Obesity, Childhood Obesity, and Behavioral Health Emergency Room Visits. Copies of the Executive Summary were distributed to over 200 attendees at a conference to present the new document and highlight the identified issues. The project also developed the dedicated website in 2009 to host the documents and other related information. This website is available at www.houstonstateofhealth.org. The primary sponsorship was moved from the Houston Department of Health and Human Services (HDHHS) to the Harris County Healthcare Alliance (HCHA), also in 2009. This move was important for the sustainability of the project, and also promoted the sense of shared participation. HCHA is a local non-profit organization with over 50 health-focused organizations as members, including those agencies that participate in the State of Health project. While its primary focus is coordinating efforts to help the uninsured gain access to care, HCHA also leads and coordinates multiple projects that are beneficial for the community (www.hchalliance.org). Moving sponsorship of the project to HCHA also served to give the project more flexibility in hiring temporary staff when needed, organizing and promoting conferences, avoiding periodic budget challenges faced by the health departments, and other functions. By 2012, the document expanded again to include Vision Screening, Neighborhood Concerns, and Solid Waste. The Mental Health Indicators chapter increased from two pages to four. This edition also incorporated data, charts, and graphs from the Health of Houston Survey conducted in 2010 by the University of Texas School of Public Health. This survey served as an expansion of BRFSS for the city and county, so measures comparable to the national BRFSS could be made for sub-county areas in Houston/Harris County. These local surveys were designed by the University of Texas researchers to have a sufficient sample size that valid conclusions could be drawn and mapping could be done for 26 ZIP code aggregates within Houston/Harris County. The Health of Houston survey interviewed respondents about typical BRFSS questions, but also added questions to create the most extensive health profile available for local neighborhood areas. Survey questions assessed multiple dimensions of health and included measures for children. For example, the Health of Houston survey asked which household members were covered by health insurance. If some members did not have health insurance, the survey then asked for the reasons why this was true. This survey added important and previously unavailable data about the health of local residents; multiple measures from this survey were added to the State of Health report. With these additions, the document grew to 132 pages. The Executive Summary led with the emerging epidemic of obesity, and identified 14 health topics of pressing concern for the Houston/Harris County area. Emphasizing obesity in youth and adults, and lack of physical exercise, this Executive Summary also identified adolescent pregnancy, prenatal care, infant/maternal mortality, insurance access, behavioral health ER access, air quality, asthma, diabetes, cancer, heart disease, and sexually transmitted diseases as those topics warranting highest priority. In 2014, a team of graduate students from the University of Texas School of Public Health, under the direction of Professor Linda Lloyd, PhD, conducted an evaluation of the project. Dr. Lloyd is Associate Dean for Public Health Practice and teaches Program Evaluation. One result of this evaluation is that the State of Health Workgroup has increased marketing efforts to ensure that more residents are aware of this resource. More detail is provided in the following Evaluation section. The 2015 edition is now under development and new members have joined the workgroup, bringing expertise in new areas such as LGBT health issues, neighborhood environmental impacts on health, media and marketing.   3. Criteria for who was selected to receive the practice?  The State of Health project strives to be of use to all Houston/Harris County residents, and others who might find the data useful. The documents are written at a level that most readers should be able to understand, with explanations, charts, graphs, pictures and website links. Use of the State of Health report and website is free and the information is not copyrighted, to make both the report and website as fully accessible and useable as possible. Those in positions to influence policy related to public health are of particular concern, and each edition of the document is distributed to hundreds of persons who fit that criteria, such as the Houston City Council and the Mayor’s Go Healthy Houston Task Force. The report is also intended to serve as a resource for the many non-profit and other community-based organizations and funders in the Houston/Harris County area. According to the 2014 evaluation, a wide range of residents and groups use the State of Health report and website. The 278 respondents to the evaluation survey each reported a primary work focus. Among the professional and community contacts, work focus was: 26% Healthcare 19% Administration 13% Public Health 13% Community Organizations  10% Policy/Program Development 7% Other 6% Grant Writer 4% Academic 3% Health Education Among the HDHHS respondents, 51% were public health, 26% were administration, 14% were healthcare, and 6% were health education. The evaluation also asked each respondent for the reason they use the State of Health report, and again, a range of uses were reported. Professional and community contacts reported the following (note that more than one response was allowed): 52% Program Development 44% Grant Writing 45% Presentations 30% Policy development 9% Academic Research 8% Other For this question, the HDHHS respondents reported: 41% presentations, 38% program development, 19% grant writing, 19% other, 16% policy development, and 11% academic research. The State of Health project goals indicate that the report is intended to be of use to community-based organizations, funders, and policy leaders. An example of how the report is used in the community follows in an email sent by Dr. Ron Cookston, Executive Director of Gateway to Care, one of the largest non-profit organizations in Houston. Dr. Cookston forwarded the following request to the 600+ recipients on his email list, asking them to to complete the State of Health evaluation survey: +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ From: Ron Cookston [mailto:ron.cookston@gatewaytocare.org] Sent: Monday, March 31, 2014 3:47 PMTo: Members and Affiliates of the Gateway to Care CollaborativeSubject: Houston/Harris County State of Health Survey email The process is beginning to prepare the next Houston / Harris County State of Health Report. If by chance any of you do not know about this report I encourage you to take a look at the report that was produced in 2012. It has been very valuable to Gateway to Care and many of you. We have used data from the report in many funding requests and it was very helpful during the last session of the Texas Legislature. I completed the survey and it really does only take 5 minutes to complete. I hope everyone will complete the survey to let them know what has been effective in the past and what you would like to recommend for the next report.Ron Cookston, Ed. D.Executive Director, Gateway to Care3611 Ennis, Houston, Texas 77004Phone: 713-783-4616 ext. 223Cell: 281-467-2490 Fax: 713785-3077Email: ron.cookston@gatewaytocare.orgWeb Site: www.gatewaytocare.org ______________________________________________________________________________From: Mayes, Lisa (HCHA) [mailto:LMayes@hctx.net] Sent: Friday, March 28, 2014 2:31 PMTo: Laurie Glaze (lglaze@Onevoicetexas.org); Ron Cookston (ron.cookston@gatewaytocare.org)Subject: Survey emailLaurie and Ron,Could you send an email to your members with the message below? Thanks!LisaDear Colleague,Will you take five minutes to complete a survey about the Houston/Harris County State of Health document and website? Here is the link to the survey http://www.instant.ly/s/TC2ta. Please complete by April 11, 2014.This document was a collaborative effort sponsored by the Harris County Healthcare Alliance, the City and County Health Departments, the UT School of Public Health, and other key players in public health. If you have used the Houston/Harris County State of Health report and website, we hope you found it interesting and useful. The Houston/Harris County State of Health work team is starting to prepare the 2015 edition. We are asking that you provide feedback to guide the team on improving the product. This evaluation is a joint project between the State of Health work group and the UT School of Public Health. The State of Health website can be accessed at www.houstonstateofhealth.org. Please forward to others who may have an interest.Thank you for your input to improve public health in our city and county. Sincerely,Lisa MayesExecutive DirectorHarris County Healthcare Alliance1310 Prairie, Houston, TX 77002office 713.368.3285 fax 713.368.3938 mobile 512.431.4121lmayes@hctx.netwww.hchalliance.org +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++   4. What was the timeframe for the practice? In the early years, the document was updated every 1-2 years. As the project has grown and become well established, the State of Health Workgroup members, including several epidemiologists, decided that updates every three years would be sufficient to stay abreast of current measures and changes in trends.   5. Were other stakeholders involved? What was their role in the planning and implementation process? What does the LHD do to foster collaboration with community stakeholders? Describe the relationship(s) and how it furthers the practice goal(s). Stakeholders are key to the project and process. Nine agencies now sponsor the State of Health of Houston/Harris County project, and 30 members from 14 organizations serve on the State of Health Workgroup. The evaluation project in 2014 sent survey links to over 2000 stakeholders, including professionals, funders, community members, and others. Input from stakeholders has led to new topic areas for each new edition of the State of Health report, with attention to emerging and pressing concerns for the local area. For example, new topics for the 2015 edition will include Gun Violence, Lesbian/Gay/Bisexual/Transgender (LBGT) Health Issues, and the new threat of Chikungunya. The two LHDs have provided the guidance, much of the impetus, and the expertise and time of their staff members to ensure that the project involves a range of stakeholders. The LHDs initially set meetings, developed a prototype for the report, and invited key local groups to attend. As the ownership of the project has been transferred to the Harris County Healthcare Alliance, the two LHDs continue to provide a great deal of staff time and expertise in assuring that the project continues, maintains quality standards, and meets the three-year timeline. In addition, the LHDs regularly invite new State of Health committee members and follow up with professional contacts to help maintain a comprehensive involvement in the project. The nine sponsor agencies provide staff time and resources to the project, such as funding, meeting space and publicity. The 30 stakeholders who comprise the State of Health Workgroup choose the topic areas and measures, collect data, and compile the report. They also create plans for kickoff conferences, lead breakout sessions, recruit interns for the project, and move all parts of the initiative forward. Current Sponsor Agencies: Harris County Healthcare Alliance Houston Department of Health and Human Services Harris County Public Health and Environmental Services Harris Health System Mental Health and Mental Retardation Authority of Harris County University of Texas School of Public Health, Center for Health Services Research Episcopal Health Charities University of Texas School of Public Health, Institute for Health Policy Harris County Pollution Control Current State of Health Workgroup Members and Content Contributors: Houston Department of Health and Human Services Harris County Public Health and Environmental Services Harris County Healthcare Alliance Harris Health System Episcopal Health Charities University of Texas School of Public Health Harris County Pollution Control Rice University Children at Risk Center for Houston’s Future Baylor College of Medicine Mayor’s Office of Environmental Programming Houston/Harris County Child Fatality Review Team Texas Department of State Health Services Lesbian Health Initiative of Houston Bureau of Animal Regulation and Control Texas Southern University   6. Any start up or in-kind costs and funding services associated with this practice? Please provide actual data, if possible. Otherwise, provide an estimate of start-up costs/ budget breakdown. Most efforts have been in-kind. The two health departments have consistently provided large amounts of staff time from their Planning/Policy sections to work on leading and developing the reports, and from their epidemiology and environmental sections to gather and report data. Other agencies have provided meeting space, staff time, research, publication of efforts, and many other kinds of assistance. Once the project was transferred to the Harris County Healthcare Alliance, their Executive Director and staff members led overall efforts; recruited new Workgroup members; paid for the temporary staff needed to help complete each edition; and financed conference costs, website development, and some printing. Costs included:Development of the website: $6,000Formatting of the document for ease of use on the website: $1,500 for each new documentPrinting costs: $5,000 to $15,000 for each edition, depending on how many books were printed Conference Cost: $1,200 for location, supplies, publicity, refreshments (local speakers did not charge for their services)Temporary staff person to help with creation of the document: $6,000 to $10,000 for each edition; we often hire MPH students from the School of Public Health In-kind: Estimated $30,000 to $50,000 in staff time to create each new edition  
  1. To what extent were your objectives achieved? Please re-state your objectives. The goals and objectives for the State of Health project and resulting reports are: Goals: Identify and highlight key health indicators showing the greatest challenges to the community Provide a central and accessible source to disseminate local public health data Link city-county-wide partners in a cooperative effort to inform policy makers, public health leaders, community based organizations, funders, residents and other stakeholders about key public health issues Objectives: Create and maintain an ongoing city-county public health workgroup to identify and regularly update community health indicators, beginning in 2006  Create easily understandable and comprehensive reports on the health status of Houston/Harris County and update every three years  Publicize the indicator information in a form readily accessible to the community, including policy makers, public health leaders, educators, students, grant writers and other stakeholders. All objectives were achieved, and are ongoing for each new edition of the State of Health report.   2. Did you evaluate your practice? Two evaluation projects were done for the State of Health. The first evaluation took place shortly after the completion of the 2006 version, and asked primarily the HDHHS staff members who worked on the project to evaluate the process and outcomes by answering the following questions: Process: What went well? Suggestions for improvement? Any comments on the team (internal/external) aspects of producing the document? Did we work well with the county and other stakeholders? Outcomes/Content: Is the content clear and well written? How is the format? Is it creative? What needs to be added? What needs to be dropped? What was well done? What needs improvement? Outcomes/Utility: Do you see the document as useful, will it benefit the community? What is the most useful aspect of the document? What do you think can be done to increase the usefulness of the document? Information from this evaluation was used to improve and expand the document for the 2007 edition. More partners were added, additional topics and measures were selected, a city-county-wide team was established, and a new format was developed for the document with expanded information on each topic. The second evaluation was completed in 2014 by a team of students at the University of Texas (UT) School of Public Health in the Program Evaluation course. The students, supervised by UT Professor Dr. Linda Lloyd, worked with a core group, including the State of Health editor, and representatives from the two LHDs (HDHHS and HCPHES), and the Harris County Healthcare Alliance. Consultation to the evaluation project came from an HDHHS public health analyst/statistician regarding survey questions and data analysis, and from the Executive Administrative Coordinator in the Director’s Office from HDHHS to assist with publicizing the survey. The Evaluation Team developed a survey instrument, which was created online through a third party platform called Instant.ly. The evaluators set up the survey questions on this website in a format that allowed survey respondents to enter their answers directly into the website. The survey instrument was reviewed by several members within the Harris County Healthcare Alliance and the two LHDs, and their input was incorporated. The survey was pilot tested among colleagues , others known to the Evaluation Team, and consultants. The survey consisted of 13 questions, some of which were required to be answered. The question formats included yes/no questions, Likert scale questions, and open-ended questions. At the beginning of the survey, if respondents answered that they had not heard of or used the Houston/Harris County State of Health report, nor had they looked at the Houston/Harris County State of Health report as a part of this survey, then they were automatically sent to the end of the survey. Those who indicated that they did use or review the State of Health report were asked to respond to further questions.   3. List any primary data sources, who collected the data, and how. The survey link was sent by email to contacts of: Harris County Healthcare Alliance (HCHA): 300 contacts Houston Department of Health and Human Services (HDHHS): 1,100 employees and 250 professional contacts Gateway to Care: 600 professional and community contacts, many of whom forward to others; total contact is estimated at 2,400 A total of 278 responses were received. Those who clicked on the link emailed in the survey request were taken to the Instant.ly website where the survey questions appeared on their computer screen.   4. List any secondary data sources used (if applicable) The Evaluation Team performed their own Internet search to determine the accessibility of the State of Health statistics and website using a variety of search parameters to evaluate this accessibility. They also enlisted colleagues to do the same search.   5. List performance measures used. Include process and outcome measures as appropriate. Survey questions included: 1. What is your primary work focus? (Grant Writer, Student, Public Health, Academic, Healthcare, Policy/Program Development, Health Education, Administration, Community Organization, Other) 2. Please indicate your highest level of education. (High School Graduate, Trade/Technical/Vocational Training, Associate Degree, Bachelor’s Degree, Master’s Degree, Professional Degree, Doctorate Degree, Other)3. Have you seen/heard of the Houston/Harris County State of Health report? 4. Have you previously used the State of Health report? 5. Have you reviewed the State of Health report as a part of this survey? 6. Please rate each item (Strongly Agree, Agree, Neutral, Disagree, or Strongly Disagree):     • The State of Health report contains useful information.    • The State of Health report is easy/convenient to access.    • The information within the State of Health report is well organized.    • The State of Health report contains information I could not find anywhere else.    • I am able to find the information/data I need in the State of Health report.    • I can find information easily on the State of Health website. 7. If you did not find the desired information in the Houston/Harris County State of Health report please specify what was needed.8. How did you first find the Houston/Harris County State of Health report? (Internet Search, Health Professional, Colleague, Professor, Don’t Recall, Other)9. What is your reason for using the State of Health report? Please check all that apply. (Grant Writing, Academic Research, Presentation, Policy Development, Program Development, Other)10. Please evaluate the usefulness of each section of the State of Health report (Very Useful, Somewhat Useful, Not Very Useful, Not At All Useful, or I did not use this section).    • Health Care Access    • Health Behaviors    • Environmental Health Indicators    • Leading Causes of Mortality    • Maternal and Infant Health    • Chronic Diseases    • Communicable Diseases    • Appendices with city/county demographics, maps, and other resources11. Would you recommend the State of Health to others?12. Please leave any additional comments you have regarding the Houston/Harris County State of Health report or website.13. How do you typically find health statistics?   6. Describe how results were analyzed Analysis of the data was completed by the Instant.ly website. The total number of responses was recorded for each item, as well as the number of responses and percentages in each category for that item. Graphs were created to display this information. The purpose of the evaluation was to gain input on the quality and usefulness of the State of Health documents and website; therefore this analysis was determined to be sufficient for the evaluation purposes.   7. Evaluation results A total of 278 responses were received; 147 from HDHHS employees and 116 from professional/community contacts. HDHHS employees, N=147     --51% of respondents designated their primary work focus as public health     --41% had seen or heard of The State of Health Report before the survey     --16% used the report prior to the survey.     --97% said that they would recommend the report to others.     --In general when looking for local health statistics other than the State of Health document:        • 60% used an internet search        • 40% used the Houston Health Department Website        • 26% used the CDC website Professional/Community Contacts: N=116     --45% of respondents designated their primary work healthcare and administration     --74% had seen or heard of The State of Health Report before the survey     --48% used the report prior to the survey.     --100% said that they would recommend the report to others.     --In general when looking for local health statistics other than the State of Health document:        • 79% used an internet search        • 33% used the State Health Department website        • 21% used the Harris County Health department website        • 23% used the Houston Health Department Website        • 25% used the CDC website Results showed that respondents used the State of Health report and website primarily for grant writing, presentations, policy development, and program development. Both groups use the Healthcare Access and Chronic Disease chapters, and the Appendices most often. All sections in the State of Health report were rated as “very useful” or “somewhat useful” by more than 90% of respondents, and 95% agreed that the State of Health report contains useful information and is well organized. Seventy-five percent of both groups (HDHHS employees and professional/community contacts) reported that they were able to find information easily on the State of Health website. However, only 55% of each group said that the State of Health report is easy/convenient to access. Most suggestions for improvement involved increasing awareness of the State of Health report and website, so more people can use it; and increasing the ease of finding the document, both on the City of Houston website and through internet searches on Google and other search engines. Feedback also suggested expansion of the mental health chapter to include information about the large numbers of persons with mental health diagnoses who are confined and treated in the jail system, and additional information on health measures available on the ZIP code/neighborhood level. The evaluators also recommended a more frequent update of public health measures as new information becomes available.   8. Were any modifications made to the practice as a result of the data findings? Based on the evaluation, a number of modifications were made: Additional key words were added to the home page of the State of Health website to ensure that internet search engines could more easily locate the site as a source of public health data and statistics. The State of Health Workgroup added a member from the Harris County Healthcare Alliance with a marketing background to assist with publicizing the document and website. The Workgroup determined to conduct a launch event routinely after each new edition is created, which increases awareness among health professionals and in the community at large.  Changes were made in the HDHHS website to ensure that the State of Health document is more easily found and accessed. Additional links are planned for the 2015 edition to enable users to reach neighborhood level data where available. The Mental Health section was expanded to include information about the large numbers of persons with mental health issues that are treated in the criminal justice system. Although not a result of this evaluation, HDHHS has decided to purchase a website dashboard from the Healthy Communities Institute, which will update public health measures available electronically, such as BRFSS, shortly after they are released. This service will augment, although not replace, the State of Health project and reports. State of Health Workgroup members are a part of this initiative, and will incorporate these new features into the purpose and design of the State of Health activities and reports. These new additions will address the evaluation recommendations for more frequent data updates.
Sustainability is a crucial aspect of the State of Health of Houston/Harris County project and reports. As local stakeholders become more aware of the resource and priority trends in public health, the sponsors and Workgroup are committed to maintaining this resource as a continuing asset for the community.   1. Lessons learned in relation to practice The core sponsors must place a priority on this project in order for it to succeed and be sustained. Initial agreement to devote resources came first from the heads of the sponsoring agencies. Then, each of these large agencies identified a “home” for the State of Health project within their agencies. For the two LHDs, this was their Planning/Policy sections. At the University of Texas, the “homes” were in the Center for Health Services Research and the Institute for Health Policy. At the Mental Health and Mental Retardation Association, the “home” was with the Outcomes Management office. For Harris Health, the “home” was in the Community Health and Wellness Department. Members of the Workgroup from these “homes” are familiar with public health data and excited to have a venue to provide this information to the community. At the Harris County Healthcare Alliance, the Executive Director has brought her marketing and publication experts to join the Workgroup, with their expertise and interest in marketing programs to reach the community. The commitment, interest and synergy of the Workgroup members propel each task forward. Funding and resource issues also have to be resolved. The LHDs face budget fluctuations in response to local and national economies, but the primary sponsor, the Harris County Healthcare Alliance, is less vulnerable in that area. The Alliance is supported by member dues and has a permanent place in the budgets of most members. The Alliance was formed by the membership to advance healthcare access and other essential concerns for the member agencies, and thus has become a stable force in Houston. The Alliance has a small staff; therefore the bulk of the in-kind staff time comes from the two LHDs and other partner agencies. This staff time is easier for the LHDs and partner agencies to devote on a continuing basis.   2. Lessons learned in relation to partner collaboration  The State of Health of Houston/Harris County would not look the same without partner collaboration. Partners work on the topics, research, data gathering, and every aspect of the project. Each partner brings strengths and resources to the table. Some important observations include: Partners appreciate a venue to present data and highlight topics that are important to them and the goals of their agencies. When their priority topics are incorporated into the State of Health project, these partners are motivated to engage in the process year after year.  New partners are added with each edition to bring new expertise in areas of new concern to public health. This keeps the Workgroup active, interested and growing. Some institutional knowledge is important. Members with prior experience bring guidance about what has been most effective in the past and how community leaders are involved. The State of Health report has to remain a community assessment. As each edition of the document is created, some Workgroup members and others in the community hope to use the document to highlight their funding needs, community activities, and other program aspects. These are worthy topics, but need to be addressed in a different forum. The State of Health is the primary community health assessment for Houston/Harris County, and this status helps to maintain its impartiality, function and sustainability.  Appreciation and recognition for each Workgroup member’s contributions are important.   3. Did you do a cost/benefit analysis? If so, describe. The Workgroup has not done a cost/benefit analysis. The State of Health project is expensive in terms of time and other resources, but has been deemed necessary for a city/county of approximately 4.3 million residents with multiple public health topics of concern.   4. Is there sufficient stakeholder commitment to sustain the practice? Describe sustainability plans Yes, stakeholder commitment will sustain the practice. The State of Health project brings important benefits to the partner agencies: A comprehensive community health assessment for the two LHDs. Both use the report for policy planning and promoting community awareness of public health concerns. The State of Health functions to provide two of the essential public health services, as well as support for the actions of the LHDs to meet accreditation standards. A resource for the many local community-based organizations and funders that need data to write and evaluate grant funding requests. A source of scientific public health data that local leaders can provide to the Texas state legislation to help with funding decisions. A resource for non-profit hospitals and others that develop their own community assessments and plans.  A venue for monitoring and promoting concerns about lack of insurance, health disparities, and other local conditions important to the strategic plans of the partner agencies. A training experience for public health students and interns, and a resource for professors and students. An opportunity for data/policy experts from the partner agencies to meet and share information about data sources, public health trends, and other various opportunities. After nearly 10 years of cooperative action to create this city-county wide public health assessment document, the sustainability of the effort has centered on several points: The Harris County Healthcare Alliance, as lead for the project, provides updates to its members, publicizes the document, and supplies funding for temporary staff, conferences, printing, the website, and other needs. Member organizations strongly support the State of Health effort. Some have noted that they see the State of Health report as the most important function of the Alliance.  The two LHDs have agreed to provide large amounts of staff time for the roles needed in publication of the document, such as editing the document, gathering and compiling internal and external data, and leading evaluation efforts. Both LHDs see the State of Health report as a needed community health assessment that is a part of their mission.  Other partner agencies see the document as an important venue for elected officials and other policy makers, as well as the public, regarding topics of importance to them. For example, Harris Health System, which provides health care for the 28% of county residents without health insurance, is concerned about maternal, fetal and infant health, among other topics. The State of Health Workgroup representative from Harris Health provides GIS mapping of areas with high infant mortality, as well as much information to help leaders, mothers and others understand the topic and areas of disparity. The representative from Harris County Pollution Control is highlighting waste pits and superfund sites in Houston/Harris County. Researchers from the University of Texas School of Public Health who have published in professional journals about the overuse of Houston emergency rooms have been able to share this information widely with local residents through the State of Health report. The State of Health of Houston/Harris County project, ongoing related activities, and resulting reports have become an integral part of the work of public health in the local area, and can be expected to continue to provide a comprehensive assessment and related resources to community members and to the local agencies that serve them.
I am a previous Model Practices applicant|Colleague in my LHD|Conference
 
Processing...


Driving Walking/Biking Public Transit  Get Directions