Setting Priorities

1. 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.

2. 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

3. 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

4. North Carolina Community Health Assessment Process • Phase 5 Report to the Community • Phase 6 Select Health Priorities • Phase 7 Create the CHA Document • Phase 8 Develop the Community Action Plan

5. 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

6. CHA Action Plans Due the first Friday in June following CHA, action plans must: • Be on OHCHE form (same as for HC certification) • Address priorities identified in CHA (an action plan is required for each priority listed in CHA) • Target identified at-risk groups • Align with 2010 objectives • Have multi-level interventions

7. HC Partnership Certification Action plans must: • Have objectives based on 2010 objectives • Be SMART: Specific, Measurable with a baseline, Achievable, Relevant, include realistic Timelines • Include multi-level interventions • Demonstrate collaboration: • Show a lead agency for each intervention • Engage multiple partners and define their roles • Address health disparities • Be proven effective • Evaluate impact and outcomes • Successful interventions expanded to reach more members of the priority population

8. Selection Criteria • Issue meets the criteria: • Lends itself to collaborative work • Lends itself to multi-level interventions • Aligns with 2010 objectives (at least 2) • Disparities exist • Data driven: • Issue affects many residents and is severe • More resources are needed for this issue • Feasible: • There is political will to address the issue • There’s a good chance that the problem could be reduced if given attention • People are interested in working on it • (current volunteers or stakeholders to be recruited)

9. Recommended Criteria for Selecting Health Priorities • Rate Health Problems Magnitude Seriousness of the Consequences Feasibility of Correcting

10. 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

11. Who Sets Priorities • CHA team, partnership board, and/or BOH • Participants at a community forum • Broad-based group • Community

12. How to Set Priorities • Majority vote • Nominal group technique (“dotmocracy”) • Consensus • Delphi process • Rate and rank

13. 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.

14. 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

15. Nominal Group Technique Procedures • Generate Ideas/Issues • Recording Ideas/Issues • Discussing Ideas/Issues • Voting on Ideas/Issues

16. Nominal Group Technique • Silent Generation of Ideas/Issues in Writing • Round-robin Recording of Ideas/Issues • Serial Discussion • Preliminary Vote • Discussion • Final Vote

17. Nominal Group Technique • Preparation The Meeting Room Supplies Opening Statement Outline of Statements prior to each step

18. 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

19. 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.

20. Dotmocracy • An equal opportunity facilitation process for generating and prioritizing proposals amongst a large group of people • www.dotmocracy.org/steps

21. What would work in your county?

22. Nash County Health Department 2008 Community Health Assessment

23. FACTS… Quantitative Data

24. 2006 Chronic Health Conditions • 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.

25. 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.

26. 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. 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. Access to Care Mental Health

27. Community Concerns/Priorities Qualitative Data

28. 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

29. 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)

30. Community Health Survey

31. Survey Demographics(Survey Methods)

32. NCHD Community Survey 491 responses, reflecting our county’s population

33. Community Assessment Team • Nash-Rocky Mount Public Schools Angie Miller • Cooperative Extension Janice Latour/Sandy Hall • Nash County Planning Rosemary Dorsey • Nash County Health Department Patricia Artis, Amy Doughtie, Jerome Garner • Nash County Sheriff Sara Wiggins • Down East Partnership for Children Jason Rochelle • Department of Social Services Melvia Batts • The Beacon Center (mental health) Karen Salaki • Eastern NC Medical Group Nadine Skinner, MD • Nash County Parks and Rec. Sue Yerkes • United Way Jenny Mohrbutter • Hospira Dianne Brutton • Crossworks Debra Long • Nash Health Care Cindy Worthy • Medlink Prescription Assistance Teri Taylor • Nash County Health Department Bill Hill

34. Setting Priorities...

35. Top Five! • Obesity • Heart Disease • Access to Care • Cancer • Diabetes • Sub. Abuse *** • STD *** • HIV/AIDS • Mental Health • Homicide • Infant Mortality • Teen Pregnancy • Flu • MV • Other Injuries

36. Action Planning… Priority Issue:

37. Web Page……. www.health.co.nash.nc.us

38. 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

39. 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: • Youth Risk Behavior Survey • Behavior Risk Survey/Community Opinion Survey

40. 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.