Healthy Community Collaborative

Summary of Steps for Community Health Assessment, Capacity Assessment, Choosing a Population Health Focus Area and Developing a Community Health Improvement Plan

Process and Timeline April-November 2011

In April 2011, El Paso County Public Health (EPCPH) and Penrose-St. Francis Health Services convene community health leaders for a brainstorming and discussion session about health issues in El Paso County. This group becomes the Healthy Community Collaborative (HCC). HCC’s initial endeavor related to submitting an application for a Community Transformation Grant (CTG) funding from the Affordable Care Act. Funding was sought to support building capacity to develop a community collaborative to address diet and exercise, tobacco use and risk factors for heart disease. The CTG application is submitted with HCC members reviewing content and providing letters of support.

After the CTG grant application was submitted, EPCPH began facilitating a process with HCC to direct efforts towards developing a Community Health Improvement Plan. Using the model developed by Colorado Department of Public Health and Environment (CDPHE) called Colorado Health Assessment and Planning System (CHAPS), we organized our efforts into 4 major activities:

  • Interpreting results from the Community Health Assessment (CHA)
  • Completing a Capacity Assessment
  • Choosing a Focus Area for improving population health
  • Developing a Community Health Improvement Plan (CHIP)

June 2011:The HCC Leadership Team met to compose a vision and mission statement for the collaborative. The Leadership Team also determines what their process and responsibilities will be, which included taking on primary responsibility to review and react to data from EPCPH’s Community Health Assessment (CHA), evaluating results from HCC Capacity Assessment and making recommendations for a population health focus area for the CHIP.

July 2011:EPCPH Epidemiology staff collect, analyze and display data for the CHA. CDPHE releases the Colorado Winnable Battles which outlines high priority areas in population health that will be targeted for intervention statewide over the next 5 years. The CO Winnable Battles include:

  • Clean Air
  • Clean Water
  • Injury Prevention
  • Infectious Disease Prevention
  • Mental Health and Substance Abuse
  • Obesity
  • Oral Health
  • Safe Food
  • Tobacco
  • Unintended Pregnancy

EPCPH organized CHA around these Winnable Battles and based on available data, we presented information for oral health, motor vehicle, injury, mental health, substance abuse, unhealthy weight, access to care, communicable diseases, sexually transmitted infection (STI), unplanned and teen pregnancy, tobacco use, and morbidity/mortality. Data was stratified by sex, age, income, education, and race/ethnicity to determine where health inequities exist. The HCC Leadership Team met to review preliminary CHA data.

August 2011:EPCPH staff conduct key informant interviews with members of the HCC Leadership Team to get more feedback on population health issues and how they impact the work of their organization and the community at-large. The Leadership Team meets to review additional CHA data. The full HCC has its first quarterly meeting to review and approve the mission and vision statements, learn about the CTG application, and preview CHA data. The HCC charges the Leadership Team with determining focus area(s) for the CHIP.

September 2011:EPCPH develops a capacity assessment survey to measure potentially available resources within the community to address population health topics, which have been refined to unhealthy weight, tobacco, mental health, substance abuse, motor vehicle injury, STI and teen pregnancy, and oral health. The capacity assessment was disseminated to the full HCC for completion by their agencies. Fifteen completed assessments are returned for evaluation.

October 2011:The CTG grant was not funded; however, the HCC group continues working on health improvement efforts and will apply for future funding opportunities as they arise. The HCC Leadership Team meets to discuss the burden of disease in the community for each topic area by reviewing health indicator data and national costs of poor outcomes related to these diseases or conditions. The Team ranks the relative burden for each topic area based on their determination of the effect of each health issue on the community as a whole. The Team ranks (in order) unhealthy weight, mental health and substance abuse, tobacco, STI and teen pregnancy, motor vehicle injury, and oral health. These scores will be used in combination with outcomes from the capacity assessment, key informant interviews, and information about potential evidence-based interventions (EBI) to help the Team determine which health area will become a focus for the CHIP.

November 2011:The HCC Leadership Team meets to review and discuss the burden ranking outcomesand capacity assessment outcomes. Potential EBIs for each health areas are discussed to help Team members understand what population-based interventions might be possible in each health area. The Team discusses these items and then ranks each health focus area to determine community priorities. Unhealthy weight and mental health are the top two ranked priorities. The Team discusses how many topic areas it can positively affect in a five year time frame. It is determined by the Team that they can focus on one health area and they select unhealthy weight as the focus. This decision is reached in part because another community collaborative (led by Community Health Partnership, which works closely with many members of HCC) is going to focus on mental health and the Team believes this other group has the ability to make progress on mental health issues. Further, the Team acknowledges that interventions directed at affecting unhealthy weight will need to address mental health as a cofactor to the behaviors that lead to poor diet, physical inactivity and unhealthy weight. The Leadership Team will make its recommendations to the full collaborative at their quarterly meeting on November 30. In addition, EPCPH will facilitate next steps towards writing the CHIP.

November 22, 2011