Building Community (Health): Building Community (Health):

Lessons Learned in One Lessons Learned in One CommunityCommunity

Leslie L. Clarke, Ph.D.Leslie L. Clarke, Ph.D.Kari Ellingstad, M.P.H.Kari Ellingstad, M.P.H.Bill Little, MBA, M.P.H.Bill Little, MBA, M.P.H.

Sarasota County Health DepartmentSarasota County Health DepartmentCommunity Health Improvement PartnershipCommunity Health Improvement Partnership

CHIP: CHIP: Community Health Community Health

Improvement PartnershipImprovement Partnership

Started just prior MAPP Started just prior MAPP Built with Foundation and hospital Built with Foundation and hospital

fundingfunding Initiated by Foundation & non-profit Initiated by Foundation & non-profit

community engagement org. with community engagement org. with support of HDsupport of HD

Now managed by HD with fuller Now managed by HD with fuller integration into HD planning and goalsintegration into HD planning and goals

What we are learning What we are learning (good and bad)(good and bad)

What seems to worksWhat seems to works

What doesn’t workWhat doesn’t work

Major mistakesMajor mistakes

Shared control Shared control (identifying (identifying problem, collecting data, solution problem, collecting data, solution building)building) leads to community leads to community ownershipownership

What worked:What worked: Involving Citizens in all phases Involving Citizens in all phases Data CommitteeData Committee decided what data to study, decided what data to study,

how to how to present it, etc.present it, etc. Ad hoc SAd hoc Survey Committeeurvey Committee developed survey developed survey

What didn’t work: What didn’t work: Too much data.Too much data. • Need more Need more executive summaries/white papersexecutive summaries/white papers• PublishedPublished more results more results• SubcommitteeSubcommittee to review and summarize data to review and summarize data

Major Mistake: Major Mistake: Problem focusProblem focus Use an asset-based focus to build on what was workingUse an asset-based focus to build on what was working

Work Local but Think RegionalWork Local but Think Regional

What worked:What worked: Community Health Action TeamsCommunity Health Action Teams Citizens focused on their towns and neighborhoodsCitizens focused on their towns and neighborhoods Mapping health data at the zip code levelMapping health data at the zip code level Local strategic plans (that can interface with regional plan)Local strategic plans (that can interface with regional plan)

What didn’t work:What didn’t work: Not enough study of Not enough study of communitycommunity or regionor region

• Should have done more study of demographics- focus on poverty-health Should have done more study of demographics- focus on poverty-health linkages linkages

• Too many agency presentations not enough anecdotesToo many agency presentations not enough anecdotes• Didn’t engage enough key community leaders Didn’t engage enough key community leaders • Many cross-county challenges to communities; needed dataMany cross-county challenges to communities; needed data

Major Mistake:Major Mistake: Developed regional focus late in Developed regional focus late in processprocess

Create both levels of focus simultaneously; establish need for Create both levels of focus simultaneously; establish need for each othereach other

Visioning – at the Right StageVisioning – at the Right Stage

What worked:What worked: Envisioning achievable futureEnvisioning achievable future Completed SWOT early onCompleted SWOT early on Focus on the practical – what can we impactFocus on the practical – what can we impact Develop long-term plan: 5-10 years outDevelop long-term plan: 5-10 years out

What didn’t work: What didn’t work: Not done soon enoughNot done soon enough• Should have done right after reports were complete Should have done right after reports were complete • Left with problem orientation and not vision Left with problem orientation and not vision • Should have had committee members engaged in city envisioning Should have had committee members engaged in city envisioning

processes processes

Major Mistake:Major Mistake: Should have developed vision Should have developed vision earlierearlier

Use data and agency strengths to do visioningUse data and agency strengths to do visioning Summarize and cross-correlate community assetsSummarize and cross-correlate community assets

Partnerships, Built on Partnerships, Built on Relationships, are CriticalRelationships, are Critical

What worked:What worked: Citizens & agencies as partners Citizens & agencies as partners Citizens valued for their knowledge and perspectivesCitizens valued for their knowledge and perspectives All opinions are welcome; use consensus for decision-makingAll opinions are welcome; use consensus for decision-making Rules for meeting process helpsRules for meeting process helps Annual Community celebrations to recognize all involvedAnnual Community celebrations to recognize all involved

What doesn’t work: What doesn’t work: Did not engage all volunteers Did not engage all volunteers in ways that fit their interests/skillsin ways that fit their interests/skills

• Learn what each person wants from their involvement; work to find Learn what each person wants from their involvement; work to find ways to meet need (if appropriate) ways to meet need (if appropriate)

• Learn what talents each member/agency has to offer – assign Learn what talents each member/agency has to offer – assign based on talent and interest based on talent and interest

• Provide information in many formats for different types of learners Provide information in many formats for different types of learners

Major Mistake:Major Mistake: Not engaging key citizens one-on-Not engaging key citizens one-on-oneone

Personal invitation key; personal assignment of taskPersonal invitation key; personal assignment of task Need more recognition of citizen and agency volunteersNeed more recognition of citizen and agency volunteers Train volunteer leaders to engage new members immediatelyTrain volunteer leaders to engage new members immediately

Link Local Agencies: Use Link Local Agencies: Use Common Vision that Came from Common Vision that Came from the Communitythe Community

What worked: What worked: Agencies working together toward local Agencies working together toward local goals goals Development of goal from community reduces agency turf Development of goal from community reduces agency turf

issuesissues Support collaborative grant applications on behalf of communitySupport collaborative grant applications on behalf of community Build on what works: YMCA programs; Goodwill programs Build on what works: YMCA programs; Goodwill programs

What doesn’t work:What doesn’t work: Engaging Voluntary orgs in vision Engaging Voluntary orgs in vision• Voluntary organizations (Rotary, Chambers, Sertoma) have own Voluntary organizations (Rotary, Chambers, Sertoma) have own

mission; don’t engage in others’mission; don’t engage in others’• Don’t have community group try to fit mission of agencyDon’t have community group try to fit mission of agency

Major Mistake: Major Mistake: Share mission and goals of agencies Share mission and goals of agencies earlyearly

Like citizens, need to ask agencies what they need to get from Like citizens, need to ask agencies what they need to get from participationparticipation

Agencies are not always used to working together; provide Agencies are not always used to working together; provide opportunity for collaborationopportunity for collaboration

Some Examples Some Examples of Lessons Learned: of Lessons Learned:

New CHIP/HD InitiativesNew CHIP/HD Initiatives

Community Solution Building:Community Solution Building: Diabetes In-Home Care Project Diabetes In-Home Care Project

and CHIP Centersand CHIP Centers

Shared ControlShared Control CHATs identified and owned senior isolation and CHATs identified and owned senior isolation and

lack of access to health information and wellness as lack of access to health information and wellness as key problemskey problems

Citizen committees developed the Citizen committees developed the Care TeamCare Team solution and solution and CHIP CentersCHIP Centers concept concept

Pursued funding and are implementing Pursued funding and are implementing interventions in collaboration of key agenciesinterventions in collaboration of key agencies

Agency Collaboration Agency Collaboration partnership with 5+ local providers to implementpartnership with 5+ local providers to implement partnership with USF to add research component partnership with USF to add research component

and for fundingand for funding

Regional Solution Building:Regional Solution Building: Health Leadership ProjectHealth Leadership Project

Working Local and Regional Working Local and Regional Realized we were missing regional perspective.Realized we were missing regional perspective.

Established Established Health Leadership ProjectHealth Leadership Project to engage Hospital to engage Hospital CEOs and HD Directors in quarterly meetings to discuss CEOs and HD Directors in quarterly meetings to discuss regional, community health issues and how to work regional, community health issues and how to work togethertogether

Bringing national experts to meet with leadersBringing national experts to meet with leaders

Partnerships built on relationships Partnerships built on relationships SCOPE facilitated first meeting with focus on individuals SCOPE facilitated first meeting with focus on individuals

getting to know one another; moved beyond institutional getting to know one another; moved beyond institutional identities and concernsidentities and concerns

Asked for 1 year commitment to process, made publiclyAsked for 1 year commitment to process, made publicly

Shared ControlShared Control Holding community forums with national experts as Holding community forums with national experts as

presenters on key health issues – to educate community presenters on key health issues – to educate community as well as leadersas well as leaders

Visioning at Regional Level:Visioning at Regional Level: Health ScorecardHealth Scorecard

Visioning Visioning The Health System Assessment is done. Now what? How to The Health System Assessment is done. Now what? How to make health system changes.make health system changes.

Crafting Crafting Health Scorecard Health Scorecard to direct county and regional to direct county and regional focus on shared health outcome goals. focus on shared health outcome goals.

Once goals established, learn what is being done and Once goals established, learn what is being done and what is needed to implement improvementswhat is needed to implement improvements

Scorecard should help direct county fundingScorecard should help direct county funding

Regional and Community FocusRegional and Community Focus Establishment of County/Regional goals will give Establishment of County/Regional goals will give

community groups common goals to target. community groups common goals to target. Health Scorecard will be integrated into County Health Health Scorecard will be integrated into County Health

Department planning and County Balanced Scorecard Department planning and County Balanced Scorecard measuresmeasures

Visioning for Public Health:Visioning for Public Health: Public Health Performance Public Health Performance

Standards Assessment Standards Assessment Shared Control Shared Control

Realized we had not engaged all sectors in health planningRealized we had not engaged all sectors in health planning Used PHPSA process and CHIP committees to engage Used PHPSA process and CHIP committees to engage

more sectors in assessment more sectors in assessment Using Public Health System model to communicate Using Public Health System model to communicate

shared responsibility for public health and advance shared responsibility for public health and advance planningplanning

Partnerships and Collaborations Partnerships and Collaborations PHPSA provides opportunities for broad partnerships PHPSA provides opportunities for broad partnerships

across many agencies; working together in many areas, across many agencies; working together in many areas, how to expandhow to expand

Visioning Visioning Will be continuing to envision community health using 10 Will be continuing to envision community health using 10

essential services as guidelines and using community essential services as guidelines and using community visions to inform planningvisions to inform planning

Future ChallengesFuture Challenges

Developing solutions to covering Developing solutions to covering the uninsured and growing costs the uninsured and growing costs of insuranceof insurance

Public Health Information Public Health Information exchanges – how to develop exchanges – how to develop across communityacross community

Continued funding for all Continued funding for all initiativesinitiatives