Appendix: CHIP Planning Process 1

Appendix A: List of CHIP Steering Committee

Alegent/Creighton - Mikki Frost, Director Community Benefit and Healthier

Communities

Alegent/Creighton - Beth Llewellyn, Vice President, Mission Integration

Board of County Commissioners - Chris Rodgers, Member

Board of Health - Marty Wilken, Ph.D., Member

Charles Drew Health Center - Richard Brown, Ph.D., Chief Executive Officer

Children's Hospital - Martin Beerman , Vice President, Marketing & Community Relations

DCHD - Adi Pour, Ph.D., DCHD Director

DCHD - Mary Balluff, Chief, Community Health and Nutrition Services

DCHD - Kenya Love, Community Health Planner

Live Well Omaha - Anne Meysenberg, Chief Executive Officer

Live Well Omaha - Jamie Summerfelt, Board Chairman

Methodist Hospital - Mark Burmester, Vice President, Strategic Planning & Business Development.

Methodist Hospital - Jeff Prochazka, Director of Strategic Planning

One World Community Health Center - Andrea Skolkin, Chief Executive Officer

UNMC - Leslie Spethman, Gift Officer/Community Relations Liaison

Appendix: CHIP Planning Process 2

Appendix B: Visioning Exercise

Objective: To create a picture of the future that motivates us to action Tool: Three drafted examples of vision statements Description of Exercise: DCHD facilitated the exercise by defining the objective of a vision statement. Next, three examples of vision statements were provided for the steering committee to review. The committee had a choice, they could agree on one of the drafted statements, could revise the statement, or dismiss the drafts completely and start with a new statement altogether. The committee decided to revise one of the three drafts.

The vision statement

“Douglas County is a thriving community where optimal heath is assured to ALL.”

Appendix: CHIP Planning Process 3

Appendix C: Circle of Involvement Exercise

Objective: To identify community stakeholders that should be involved in the MAPP process Tool: Circle of Involvement Handouts Description of Exercise: Part 1) Brainstorm community partners the steering committee was given a list of different types of sectors. Based on the sectors the committee brainstormed by being asked to think about all the organizations to include business, government, not for profit, foundations etc. Part 2) Review the “Circles of Involvement to Develop Key Relationships for Implementation” diagram handout to define the different circles of involvement.

Core Circle - does most of the day to day work and are intricately involved in the plan

Circle of Engagement - May not be the prime movers of implementing the plan but may be called on to help with specific tasks.

Circle of Champions - Hold positions of leadership and are or need to be committed to the plan.

Part 3) Circle of Involvement Placement The steering committee placed the individuals brainstormed in part 1 of the exercise in the corresponding circle of involvement. As a result the planning group was formed. In turn the planning group utilized the same process to identify individuals for the affinity groups. The convened groups each played an essential role in developing the community health improvement plan.

Appendix: CHIP Planning Process 4

Appendix: CHIP Planning Process 5

Appendix: CHIP Planning Process 6

Appendix: CHIP Planning Process 7

Appendix D: CHIP Planning Group Group Sectors and Type of Organizations

Community Representatives Carol Russell Julie Canas Governmental agencies Douglas County Health Department/ Board of Health City Of Omaha Douglas County Commissioners Medical Care Providers Alegent Creighton Health Blue Cross and Blue Shield of Nebraska Nebraska Methodist Health System One World Community Health Center, Inc. The Nebraska Medical Center Charles Drew Health Center Coventry Health Care Visiting Nurse Association Metro Omaha Medical Society Boys Town National Research Hospital Children’s Hospital & Medical Center United Healthcare of the Midlands Inc. Omaha Oral Health Collaborative Region Six Behavioral Health Care Education Creighton University Omaha Public Schools University of Nebraska at Omaha University of Nebraska Medical Center Metro Community College Omaha Archdioceses Elkhorn Public Schools Bennington Public Schools Valley Public Schools Ralston Public Schools Millard Public Schools Westside Public Schools Criminal Justice Baird Holm Law, LLP Omaha Police Department

Faith Community United Methodist Ministries New Era Baptist Convention Business Community ConAgra Mutual of Omaha RDG Planning and Design Union Pacific Railroad Bland and Associates Valmont Industries, Inc. AON Consulting Inc. SM Stevens and Associates, LLC Greater Omaha Chamber of Commerce NP Dodge The Trek Store of Omaha Philanthropy Omaha Community Foundation Sherwood Foundation Community Based Organizations Nonprofit Association of the Midlands National Safety Council, Greater Omaha Chapter Urban League of Nebraska Wellness Council of the Midlands YMCA of Greater Omaha Girls Inc. Live Well Omaha Catholic Charities American Red Cross Women’s Center for Advancement United Way of the Midlands Empowerment Network Latino Center of the Midlands Eastern Nebraska Office on Aging NE Urban Indian Health Coalition Building Bright Futures

Black Print: Live Well Omaha members

Appendix: CHIP Planning Process 8

Appendix E: Community Poll and Results

Top 3 Health Issues in Douglas County, NE

1. Select the top 3 health issues that are most important to the Douglas County community

Diabetes in adults

Access to health services across the lifespan

Heart disease & stroke in adults

Maternal & infant health across the lifespan

Mental health across the lifespan

Obesity & nutrition across the lifespan

Oral health in adults

Sexual activity across the lifespan

Substance abuse across the lifespan

Injury & safety/violence in children/adolescents

Asthma in children/adolescents Feedback

Appendix: CHIP Planning Process 9

The community vote results

Answer Options Response %Percent Response Count

Access to health services across the lifespan 54% 389

Asthma in children/adolescents 5% 39

Diabetes in adults 21% 149

Heart disease & stroke in adults 12% 89

Injury & safety/violence in children/adolescents 19% 139

Maternal & infant health across the lifespan 23% 166

Mental health across the lifespan 55% 397

Obesity & nutrition across the lifespan 61% 443

Oral health in adults 5% 36

Sexual activity across the lifespan 21% 154

Substance abuse across the lifespan 20% 143

Total Responses 721

0%

10%

20%

30%

40%

50%

60%

70%

Re

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Per

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Areas of Opportunity

Appendix: CHIP Planning Process 10

Appendix F: Criteria & Prioritization Matrix Exercise

Size/scope of the problem - # of people affected or percentage of the population with the problem (If more people are affected, it may be of higher priority (i.e. 25% of Youth within North East Omaha). Seriousness of the problem - Morbidity rates, mortality rates, and the degree to which there is urgency for the intervention. (A problem with a high death rate may be of higher priority than a problem with no life-threatening consequences). Resources available or affordable - The funding available for a program, and/or the potential funding available for a program. Consider resources broadly, i.e. time, personnel, and expertise available. Measurable outcomes - The ability to quantify and review results and outcomes (i.e. available data sources). Based on the CHIP timeframe, is it possible to see outcomes (i.e. 3-5 years). Effectiveness of strategies - The degree to which an intervention is available to address the health problem. Availability of evidence-based strategies to address multiple wins, and/or other systems that is more effective for intervention. Economics - Makes economic sense to address the problem and/or the economic consequences if a program is not carried out. Community fit - The community acceptance of a program, or is it the right thing to address in our community. Political will/ Political influence - The extent of committed support among key decision makers for a particular policy solution to a particular problem

Appendix: CHIP Planning Process 11

Directions: Evaluate each health priority listed to the following criteria by marking, 1(YES) or 0(NO) in each column, if the corresponding priority meets the criteria. Count and total the number of times 1(YES) is written.

Eleven Health Priorities

Size/Scope of the problem

Seriousness of the problem

Resources available or affordable

Measurable outcomes

Effective Strategies

Economic Community Fit

Political will/ Political Influence

TOTAL

Access to health services across the lifespan

Asthma in children/ adolescents

Diabetes in adults

Heart disease & stroke in adults

Injury & safety/violence in children/ adolescents

Maternal & infant health across the lifespan

Mental health across the lifespan

Obesity & nutrition across the lifespan

Oral health in adults

Sexual activity across the lifespan

Substance abuse across the lifespan

Appendix: CHIP Planning Process 12

Appendix G: Four Step Decision Tree and Nominal Group Process Exercise

Step 1

Group leader/facilitator presents and explains preliminary results.

Step 2

The group may discuss, and/or review their ideas and recommendations for health priorities using criteria, matrix, and CHNA.

Step 3

After discussion, vote-using cards on top three priorities identified from community input. Each planning member had three of each, red, yellow, green cards.

Step 4

Utilize decision tree and/or Nominal process below to proceed

Priorities-Group Discussion on Community

Input & Vote

Agree with Community Rankings

Build consensus to utilize community input

priorities

Community Rankings are Final Product

Somewhat Agree with Community Rankings with minor changes

Modify the number/how many priorities chosen

Modify Priorities that were

chosen

leave out or swap out any?

Vote on modifications Results are the final

product

Don't Agree with Community Rankings

Identify priorities group agrees can be eliminated

Nominal Process

with remaining priorities

Appendix: CHIP Planning Process 13

Green Votes - Consensus on Community Rankings

A. Consensus on the top three community rankings with no changes B. The community rankings are the final product. (STOP HERE) Yellow Votes - Somewhat Agree with Community Rankings

A. Follow the steps below to modify top 3 choices - A. Modify the number/how many priorities chosen B. Modify Priorities that were chosen (i.e. leave out and/or swap out priorities). C. Vote on changes (cards)

B. Results of the modifications are final products Red Votes - Do Not Agree with Community Rankings

A. Follow the steps below to re-rank top 3 priority choices - A. Identify priorities that can be eliminated B. Give 3 stickers to each group member C. Each member of the group individually places a dot by one of the remaining health

priorities D. The leader/facilitator will tally the results on flip chart. E. Give each health priority a total score and determine top 3-5 priorities based on total

score F. Vote on re-ranked priorities (cards)

B. Results of the new ranking are the final product

Appendix: CHIP Planning Process 14

Appendix H: Guiding Principles Exercise

Objective: Draft general guidelines which set the foundation for how the affinity groups will operate or develop goals, objectives and activities for the set health priorities. Tool: Example of guiding principles; definition provided by Leadership Strategies, Inc. V08.1 Description of Exercise: Definition DCHD facilitated a discussion to describe guiding principles defined as a vehicle for operationalizing an organizations values, beliefs and traditions. Draft Example of Guiding Principles/Values The group broke up into smaller groups around each priority area and was given the following example of guiding principles -

Focus on prevention to ensure holistic health (health literacy & self-advocacy, policy/systems change)

Multiple aspects of health (primary, dental, mental)

Incorporate actions to address health equity.

Ensure evidence-based programs are data informed, allowing for demonstration of need/ impact.

Incorporate actions to address health equity (language/cultural barriers, geographic limitations)

Incorporate communication strategies.

Incorporate existing community resources for programming, personnel The groups were asked what critical values or beliefs do we hold that could impact the way we go about achieving? The small groups had the option to work from the draft or define new guiding principles. Each group converted the statements they brainstormed and developed guiding principles for each priority area.

Appendix: CHIP Planning Process 15

Appendix I: CHIP Affinity Groups

Affinity Group 1-Access to Health Service Nebraska Cancer Coalition* Sherwood Foundation VNA Charles Drew Health Center Coventry Metro Community College Building Healthy Futures* Planned Parenthood of the Midlands * Alegent/Creighton Nebraska Methodist Hospital System CDHC Girls Inc. Affinity Group 2-Obesity & Nutrition CDHC Con Agra Foods RDG Planning and Design Mutual of Omaha Creighton Alegent Creighton Health Diabetes Association * YMCA WIC* Food Bank for the Heartland* Activate Omaha* Midwest Dairy Council * Hunger Free Heartland* Affinity Group 3-Violence/Safety & Injury CDHC DC Board of Health Alegent/Creighton Women Center for Advancement Empowerment Network Omaha Police Department Urban League of NE Impact One * OPS Douglas County Corrections * Domestic Violence Council formerly known as DVCC * Voices for Children * Project Harmony * 100 Black Men * Juvenile Assessment Center * Douglas County Youth Center * Omaha 360 * City Parks & Recreation* *New Organizations

Children’s Respite Care Center * Child Saving Institute * Boys & Girls Club of the Midlands * NE State Probation * Hope Center * Habitat for Humanity * Salvation Army * CFCI * JJS * Justice for Our Neighbors * Ben Gray EIS Office Precinct Advisory Groups Affinity Group 4- Behavioral Health Region Six Behavioral Health Care Alegent/Creighton Health DC Community Mental Health Center-John Sheehan Community Alliance* Ne Urban Indian Health Coalition Bennington Public Schools Boys Town Hospital Clinics UNO North Omaha Care Council * Catholic Charities March of Dimes* Additional Contacts Omaha Association for the Education of Young Children-* Project Extra Mile * Heartland Family Service* Salvation Army-KROC Center* South Omaha Community Care Council * State of Nebraska * YES * Nebraska Children's Home * Metro Area Continuum of Care for the Homeless* Lutheran Family Services* Human Rights & Relations Department (City of Omaha)* Hispanic Chamber of Commerce* Gallup* Fred Leroy Center* Educators Health Alliance * Black Family Health & Wellness Association* AHEC* African American Young Professionals* MOTAC* Omaha Healthy Start* Behaven Kids*

Appendix: CHIP Planning Process 16

Appendix J: Capacity Matrix

Name of Org. & Program Title of the program & org.

Program Contact

Intervention or Model

Services activities covered by program Use codes below E.g.) a, b, d

Demographics Target population including, age, sex, social-economic status of the population.

Goals/obj. of Program Efforts intended to attain goals

Duration& Intensity length of programs

Outcomes Impact of using the model/ intervention. The actual result of the program.

Geographic Area Served County

Funding Source of financial support for the program

Services Provided a = health literacy/prevention intervention d= nontraditional clinics/health services f= youth support services b = health education e = after hours clinic/health services g = family Support c=culturally appropriate services h= social/emotional support

i= low cost services k= information and referrals l= coordination Services j= underinsured/uninsured support services

Geographic Area Served: NE, NW, SE, SW, Western Douglas

Appendix: CHIP Planning Process 17

Appendix K: Implementation Plan Template

Date Created: Date Reviewed/Updated:

PRIORITY AREA: Nutrition & Physical Activity

GOAL: ABC County will implement policies that support residents in achieving a healthy diet and increased physical activity.

PERFORMANCE MEASURES How We Will Know We are Making a Difference

Short Term Indicators Source Frequency

By DATE, decrease the percentage of adults engaging in no physical activity from x% toy%

WI-BRFS Annual

By DATE, decrease the percentage of adults eating less than five servings of fruits and vegetables daily from x% toy%

WI-BRFS Annual

By DATE, increase the percentage of WIC infants ever breastfed from x% toy% WI-DHS (PedNSS) Annual

Long Term Indicators Source Frequency

By DATE, decrease the percentage of overweight adult from x% toy% WI-BRFS Annual

By DATE, decrease the percentage of obese adults from x% toy% CHR Annual

OBJECTIVE #1: By DATE, increase the number of ABC County municipalities that are working towards adopting local complete street policies from # to #

BACKGROUND ON STRATEGY Source: Complete Streets Program http://www.completestreets.org/ Evidence Base: “Urban design and land use policies” recommended by The Guide to Community Preventive Services Policy Change (Y/N): Yes

ACTION PLAN

Activity Target Date

Resources Required

Lead Person/ Organization

Anticipated Product or Result

Progress Notes

Attend training on WI’s complete street legislation and assess expected impact on ABC County by discussing with Highway Dept.

12/31/12 Staff time Travel

Amy Adams, ABC Health Department

Increased knowledge Written resources Assessment of impact

Finish photo voice project, targeting the communities of X, Y, and Z

4/30/13 Staff time Volunteer time Travel Cameras

Amy Adams and Physical Activity Team Volunteers

Photo display/ presentation for each community

Find at least 1 street/road in each 4/30/13 Staff time Amy Adams Graphic

Template Implementation Plan Wisconsin CHIPP

Infrastructure Improvement Project

Appendix: CHIP Planning Process 18

community and graphically design a complete street.

presentation of desired design for each community’s selected street

Conduct walkability/ bike ability checklists in those communities.

5/31/13 Staff time Volunteer time Travel

Amy Adams and Physical Activity Team Volunteers

Completed assessment for each community

Create a presentation for city councils about the new state law, using photo voice and complete street pictures.

8/30/13 Staff time Susie Smith, ABC Health Officer Terri Thomas, ABC Hospital

PowerPoint presentation and packet of materials

Present to city councils and invite to go on a walk audit.

10/31/13 Staff time Susie Smith Terri Thomas

Presentation and walk audit completed

Follow up with city council chair after meeting

11/30/13 Staff time Susie Smith Discussed next steps

Announce approved policy to the community collaboratively with the city council (if approved)

12/31/13 Staff time Terri Thomas Press release Press coverage

Appendix: CHIP Planning Process 19

Appendix L: CHIP Lead Organizations

Alegent - Creighton Health

Children’s Hospital

Douglas County Health Department

Eastern Nebraska Community Action Partnership

Food Bank for the Heartland

Hope Medical Coalition

Kim Foundation

Live Well Omaha

Methodist Health Systems

Metro Omaha Medical Society

Omaha360

Region 6 Behavioral Healthcare

The Nebraska Medical Center

University of Nebraska Medical Center

UNMC Government Relations

Wellness Council of the Midlands