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: 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 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 Obesity Heart Disease Access to Care Cancer Diabetes 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.