Setting Priorities

Report
Setting Priorities
Jean Caldwell Regional Consultant
Karen Ramsey, Nash County Health Department
Carolyn King, Wayne County Health Department
Sissy Lee-Elmore, Executive Director, WATCH
CHA Institute: 2/11/10 Greenville, N.C.
This session will cover:
Standards for health department
accreditation and Healthy Carolinians
certification
Criteria for setting priorities
Who sets priorities and how
Discussion of the process in Nash and
Wayne County from their 2008 CHA
North Carolina Community Health
Assessment Process
Phase 1 Establish a Community Health
Assessment Team
Phase 2 Collect Community Data
Phase 3 Analyze the County Health
Data Book
Phase 4 Combine Your County’s Health
Statistics With Your
Community Data
North Carolina Community Health
Assessment Process
Phase 5
Phase 6
Phase 7
Phase 8
Report to the Community
Select Health Priorities
Create the CHA Document
Develop the Community
Action Plan
Health Dept Accreditation
Community Health Assessment (CHA)
1.1.k: Identify leading community health
problems
List community health priorities based on
CHA findings
Include a narrative of assessment findings
Include community action plans to address
the priority issues
CHA Action Plans
Due the first Friday in June following CHA, action
plans must:
1. Be on OHCHE form (same as for HC
certification)
2. Address priorities identified in CHA (an action
plan is required for each priority listed in CHA)
3. Target identified at-risk groups
4. Align with 2010 objectives
5. Have multi-level interventions
HC Partnership Certification
Action plans must:
1. Have objectives based on 2010 objectives
2. Be SMART: Specific, Measurable with a baseline,
Achievable, Relevant, include realistic Timelines
3. Include multi-level interventions
4. Demonstrate collaboration:
 Show a lead agency for each intervention
 Engage multiple partners and define their roles
5. Address health disparities
6. Be proven effective
7. Evaluate impact and outcomes
8. Successful interventions expanded to reach more
members of the priority population
Selection Criteria
1. Issue meets the criteria:
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Lends itself to collaborative work
Lends itself to multi-level interventions
Aligns with 2010 objectives (at least 2)
Disparities exist
2. Data driven:
 Issue affects many residents and is severe
3. More resources are needed for this issue
4. Feasible:
 There is political will to address the issue
 There’s a good chance that the problem could be reduced if
given attention
5. People are interested in working on it
 (current volunteers or stakeholders to be recruited)
Recommended Criteria for Selecting
Health Priorities
Rate Health Problems
Magnitude
Seriousness of the
Consequences
Feasibility of Correcting
How Many Priorities?
At least 2 for Healthy Carolinians
certification (more for experienced
partnerships)
Not so many it will be hard to manage
multi-level interventions for all of them
Who Sets Priorities
CHA team, partnership board, and/or BOH
Participants at a community forum
Broad-based group
Community
How to Set Priorities
Majority vote
Nominal group technique (“dotmocracy”)
Consensus
Delphi process
Rate and rank
Rate Health Problems
Who should do this ?
Problem Importance
Worksheet
Use this worksheet to determine which issues
are of the greatest magnitude, are the most
serious health issues and the most feasible to
correct.
Rank Health Problems
Problem Prioritization
Worksheet
Use this worksheet to rank from highest to lowest.
The team should then review the ranking &
concensus reached about the ranking
Limit the health problems to the Top 3-6
May need to refer back to ranking list if there are
significant barriers to a top choice
Nominal Group Technique Procedures
Generate Ideas/Issues
Recording Ideas/Issues
Discussing Ideas/Issues
Voting on Ideas/Issues
Nominal Group Technique
Silent Generation of Ideas/Issues in
Writing
Round-robin Recording of Ideas/Issues
Serial Discussion
Preliminary Vote
Discussion
Final Vote
Nominal Group Technique
Preparation
The Meeting Room
Supplies
Opening Statement
Outline of Statements
prior to each step
Nominal Group Technique
Benefits
Balances Participation
Balances influence of individuals
Produces more creative ideas than interacting
groups
Produces great number of ideas
Greater satisfaction for participants
Reduces conforming influence
Leads to a greater sense of colusre and
accomplishment
Review Your Priorities
Have the team review the priorities
Ask yourself…………
Will the community support your
choices ?
Will you be able to develop an Action
Plan that will make a difference ?
If your answer is “NO” revisit the
process and consider making
changes in your choices.
Dotmocracy
An equal opportunity facilitation process
for generating and prioritizing proposals
amongst a large group of people
www.dotmocracy.org/steps
What would work in
your county?
Nash County
Health Department
2008 Community Health
Assessment
FACTS…
Quantitative Data
2006 Chronic Health Conditions
2006 Leading Causes Deaths in Nash County compared to North Carolina
250
200
150
100
50
0
Nash County
Alzheimer's
Disease
Homicide
Suicide
Other
Injuries
Motor
Vechicle
Injuries
Pneumonia
/ Influenza
Source: North Carolina State Center for Health Statistics
Diabetes
Prostate
Cancer
Lung
Cancer
Breast
Cancer
Total
Cancer
Stroke
Heart
Disease
North Carolina

Total cancer rate, which included all types of cancers, was the leading cause of death reported. The total cancer
rate was 214.4; higher than the state’s average of 194.9.

Among the different types of cancer, lung cancer ranked higher than other cancers such as breast cancer and
prostate cancer.

Heart disease was the second leading cause of death with a rate of 199.5; slightly higher than state’s average of
194.0.

Cerebrovascular disease / stroke was the third leading cause of death with a rate of 59.6; higher than state’s
average of 51.4.

Diabetes ranked as fourth leading cause of death with a rate of 34.7; higher than state’s average of 25.2. The
rate for deaths due to “other injuries” was also 34.7.

Motor vehicle related deaths were lower when compared to other injuries, ranking as 5th leading cause of death
for Nash County.
2006 BRFSS Data for Nutrition and
Physical Activity (survey data)
 In Franklin/Nash/Wilson Counties, 68.4%
reported that they increased their physical
activity during the past month, 67.7%
reported trying to increase their vegetable
consumption per day and 61.9% reported
increasing their fruit consumption per day.
Mental Health
 During 2005 to 2006, Nash
County reported a lower rate
for alcohol and drug abusers
served through treatment
centers (21.6) compared to the
state’s rate of to 45.3, The
decrease in services was due
to the reforming of mental
health services from public to
private providers.
Access to Care
 Through collaborative
partnerships, during 2004 to
2008, Nash County improved
resident access to care by
establishing medical, dental,
medication and transportation
assistance for the uninsured
population.
 Services were made available
from Nash County Health
Department, Med-Link, Harvest
Family Health Center, Tar River
Mission Clinic and Downeast
Partnership for Children.
Community
Concerns/Priorities
Qualitative Data
DEPC Assessment
 Barriers to receiving services: lack of knowledge about
services, rules that exclude people, long
waiting lists, transportation problems,
and inconvenient locations
 Health Concerns: need for affordable
health insurance, prescription drug
costs, inadequate medical services,
dental care, mental health services, health education.
 Health issues: HIV/AIDS, Teen Pregnancy, Diabetes,
Obesity, Heart Disease/HBP, Cancer, Cold/flu, Smoking
United Way Community Needs
Assessment
Six Most Pressing Problems in our community:
 Needs of the Youth Population: Educational, Physical & Emotional
 Citizen Education & Intervention in cycle of poverty, teen pregnancy,
etc.
 Needs of the Elder Population
 Economic Conditions and Related Health and Human Service
Needs
 Mental Health Care Problems
 Access to Health Care (Affordability and Funding)
Community Health Survey
Survey Demographics
(Survey Methods)
NCHD Community Survey
491 responses, reflecting our county’s population
Community Assessment Team
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Nash-Rocky Mount Public Schools
Cooperative Extension
Nash County Planning
Nash County Health Department
Nash County Sheriff
Down East Partnership for Children
Department of Social Services
The Beacon Center (mental health)
Eastern NC Medical Group
Nash County Parks and Rec.
United Way
Hospira
Crossworks
Nash Health Care
Medlink Prescription Assistance
Nash County Health Department
Angie Miller
Janice Latour/Sandy Hall
Rosemary Dorsey
Patricia Artis, Amy Doughtie, Jerome Garner
Sara Wiggins
Jason Rochelle
Melvia Batts
Karen Salaki
Nadine Skinner, MD
Sue Yerkes
Jenny Mohrbutter
Dianne Brutton
Debra Long
Cindy Worthy
Teri Taylor
Bill Hill
Setting Priorities...
Problem
Heart
Disease/Stroke
Diabetes
Flu/ Pneumonia
Mental Health
Issues
Homicide
Teen Pregnancy
Infant Mortality
STD
Cancer
Other injuries
Motor Vehicle
Injuries
Access to Care
Obesity
Size of
Problem
Seriousness of Feasibility of
Consequences Correcting
Total
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Obesity
Heart Disease
Access to Care
Cancer
Diabetes
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Sub. Abuse ***
STD ***
HIV/AIDS
Mental Health
Homicide
Infant Mortality
Teen Pregnancy
Flu
MV
Other Injuries
Top
Five!
Action Planning…
Priority Issue:
INTERVENTION
COMMUNITY PARTNERS
Web Page…….
www.health.co.nash.nc.us
Community Health
Assessment 2008
Health Departments in N.C. are required to complete
a comprehensive Community Health Assessment
every four years.
Consists of analyzing Primary & Secondary Data
Community input essential to this process
Sources of Data:
 Secondary Data: Data available through
the State Center for Health Statistics
 Primary Data: Data collected by the
Health Department to describe the health
status of the community:
1. Youth Risk Behavior Survey
2. Behavior Risk Survey/Community
Opinion Survey
Process of CHA
 Health Department Completes assessment with the
assistance of community partners
 Share findings with community
 Prioritize health needs based on findings
 Community Input essential to determining priorities
 Why you are here today – to assist in determining
the health needs of Wayne County. Refer to
materials mailed to you in your packet for CHA
findings.

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