Setting PrioritiesJean Caldwell Regional Consultant

Karen Ramsey, Nash County Health DepartmentCarolyn 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 prioritiesWho sets priorities and howDiscussion 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 DataPhase 3 Analyze the County Health

Data BookPhase 4 Combine Your County’s Health

Statistics With Your Community Data

North Carolina Community Health Assessment Process

Phase 5 Report to the CommunityPhase 6 Select Health PrioritiesPhase 7 Create the CHA DocumentPhase 8 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 findingsInclude 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 CertificationAction plans must:1. Have objectives based on 2010 objectives2. Be SMART: Specific, Measurable with a baseline,

Achievable, Relevant, include realistic Timelines3. Include multi-level interventions 4. Demonstrate collaboration:

Show a lead agency for each intervention Engage multiple partners and define their roles

5. Address health disparities6. Be proven effective7. 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 issue4. 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 forumBroad-based groupCommunity

How to Set Priorities

Majority voteNominal group technique (“dotmocracy”)ConsensusDelphi processRate 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/IssuesRecording Ideas/IssuesDiscussing Ideas/IssuesVoting on Ideas/Issues

Nominal Group Technique

Silent Generation of Ideas/Issues in Writing

Round-robin Recording of Ideas/IssuesSerial DiscussionPreliminary VoteDiscussionFinal 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 Conditions2006 Leading Causes Deaths in Nash County compared to North Carolina

0

50

100150

200

250

Heart

Dis

ease

Str

oke

Tota

l

Cancer

Bre

ast

Cancer

Lung

Cancer

Pro

sta

te

Cancer

Dia

bete

s

Pneum

onia

/ In

fluenza

Moto

r

Vechic

le

Inju

ries

Oth

er

Inju

ries

Suic

ide

Hom

icid

e

Alz

heim

er's

Dis

ease

Nash County

North Carolina

Source: North Carolina State Center for Health Statistics

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.

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

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 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

Setting Priorities...

ProblemSize of

ProblemSeriousness of Consequences

Feasibility of Correcting Total

Heart Disease/Stroke

Diabetes

Flu/ PneumoniaMental Health

Issues

Homicide

Teen Pregnancy

Infant Mortality

STD

Cancer

Other injuriesMotor Vehicle

Injuries

Access to Care Obesity

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…

INTERVENTION COMMUNITY PARTNERS

Priority Issue:

www.health.co.nash.nc.us

Web Page…….

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 DataCommunity 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 Survey2. Behavior Risk Survey/Community

Opinion Survey

Process of CHA

Health Department Completes assessment with the assistance of community partners

Share findings with communityPrioritize health needs based on findingsCommunity Input essential to determining prioritiesWhy 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.