CTG LT Presentations And Handouts 2013 - Schsa

Data Sharing:g Clinical DataKeyy qquestionsHow much of a concern is access topreventive services for hypertension, highcholesterol,h l t l andd didiabetesb t iin your community?it ?What are the most effective andlow cost interventions that couldlow-costimprove access to these preventiveservices?Have you usedCHWs before?What are existingprograms’strengths andweaknesses?What are thestrengths andweaknesses ofCHW programs?What alreadyexists?

Data Sharing:g Clinical DataKeyy qquestionsWhat are the most effective and lowcost interventionscose ve o s thata couldcou d improvep oveaccess to these preventive services?“Use of CHW to educate on basics/create awareness. Tag on,drop in clinic where after each class [patient] can have BPchecked, and can weigh in. These are documented on small cardsand are brought back each time they are checked thesechecked these can alsobe shared with the PCP.”

Data Sharing:g Clinical DataKeyy qquestionsHow much of a concern is access to preventive servicesfor hypertension, high cholesterol, and diabetes inyour community?“I would say 7 a large segment of the population is not diagnosed and doesn’t getprimary care and therefore doesn’t see the need until the crisis happens, and then youhave a cascading effect of ill health for a long period of time as a chronic disease.”“I would say 8 because of the large number of persons we have who are uninsured orunderinsured.”“10 because in that combination, that encompasses a lot of the lifestyle diseases,including obesity, inactivity, all the cardiac major risk factors.”

Data Sharing:g Clinical DataKeyy qquestionsWhat are the strengths and weaknesses ofCHW programs?“See who is trained some kind of evaluation of the people who are involved with the patients. Itwould probably not be a problem finding enough people but you have to make sure it’s in theircurriculum.”“Yes, you need the CHWs to be able to be outreach and advocacy, but you also need to be a littlepest under the skin to convince people to continue to take their medication or if there’s some barrierthat they can’t get their medication or don’t take [it]”“Funding theFunding the secondary obstacle is that there is not a sense of urgency here Because ourcommunity is so economically challenged, that people are focused on day-to-day, paycheck-topaycheck issues and consequently their health is a secondary, a tertiary issue. As a consequence theydon’t have the level of internal urgency about the long-term investment in their health.”

Data Sharing:g Clinical DataOverall Gap in recommending versus successfully implementingpreventive screenings may be a good opportunity toutilize CHWs/health care studentsChallenges include training, moving toward a medicalhome type model to include other health care workersCHWs can carry out the counseling, follow-up, and timeintensive motivational interviewing that supports otherpractitioners’ recommendations for preventive andchronich i didisease care

Data Sharing: Community HealthAAssessmenttHealth dataCombined assessment of clinicalpreventive services areaPolicy scans Tobacco, (HEAL in progress)Key informant interviews (inp g )progress)Focus Groups (in progress)Asset Inventories HEAL, Tobacco

Data Sharing:g Tobacco Control Policy ScanM th d lMethodology Obtainedlocal ordinances from all citiesand compiled a listing of similarities anddifferences Research: TobaccoLaws Affecting California 2012,ChangeLab Solutions AmericanALung AAssociation in CCalifornia,lfSState offTobacco Control 2012 American Nonsmokers’ Rightsg Foundation,,Municipalities with Local 100% Smokefree Laws2011

Data Sharing:g Tobacco Control Policy ScanG l off theGoalsh SScan CurrentCtStStatet LawsL ReviewLocal Laws IdentifyOpportunities

Data Sharing:g Tobacco Control Policy ScanTobacco Secondhand SmokeLaws in California Workplacesp– Labor Code Section 6404.5**Smoke in an enclosed space Exemptions Multi Unit Residence **Multi-UnitSubject to workplace smoking prohibition Civil Code Section 1947.5: landlord can prohibitsmoking or other tobacco productsprod cts State, County, and City Buildings****Allows for stronger local level ordinances

Data Sharing:g Tobacco Control Policy ScanTobacco Secondhand SmokeLaws in California Tot Lots and Playgrounds ** 2 ft.25f off playgroundld or tot lotslSchoolsUnder Federal Law Labor code Daycare Facilities**Licensed day care center and licensed family daycare homeh Labor code Health Care, Day Care or Head Starts ServicesFederally funded Labor code

Data Sharing:g Tobacco Control Policy ScanTTobaccobSSecondhanddh d SmokeS kLaws in California SmokingS kiProhibitedP hibit d ini VehiclesV hi l withith ChildChildren Public Transit Systems Airplanes and Trains Youth buses and public vehicles Adoption of local secondhand smoke laws Localgoverning body may completely ban thesmoking of tobacco or regulate smoking in anymanner not inconsistent with state law

Data Sharing:g Tobacco Control Policy ScanMunicipalitiesMi i li i withi h LLocall 100%Smokefree LawsSource: AMERICAN NONSMOKERS’ RIGHTS FOUNDATION

Data Sharing:g Tobacco Control Policy ScanL l OrdinancesLocalO di AmericanLung Association’s State ofTobacco Control 2012 Report tracksprogress on key tobacco control policies Eachcounty code and city municipal code inthree key areas: SmokefreeS k foutdoortdairi Smokefree multi-unit housing Reducingg tobacco sales

Data Sharing:g Tobacco Control Policy ScanL l OrdinancesLocalO di

Policyy TypeypTwo Types off Policiesl VoluntaryV l t NonNon-VoluntaryVoluntary

Data Sharing:g Asset MappingAAssetswithini hi 95354 andd 95351

Data Sharing:g Asset MappingAAssets&OOpportunities 95354 Promotoras RedevelopmentpFocus SoccerPark, Sidewalks, andInfrastructures AgencyCollaboration TuolumneRiver Trust City of Modesto Healthy Start/School

Data Sharing:g Asset MappingAAssets&OOpportunities 95351 HEALFunding from Kaiser Farmer’s Market & CSA Safe Routes Funding Agencyg y Collaboration Cityof Modesto School District BHRS

SWOT AnalysisyCCorePrinciplesPi i l Useand expand the evidence base for localpolicy and environmental changes thatimprove health Advance health equity and reduce healthdisparities Maximize health impact through preventionRReviewi DataD t PProvidedid dSelf ExerciseGroup Discussion

SWOT AnalysisyS lf ExerciseSelfEi

SWOT AnalysisyGGroupDiDiscussioni

Grant Priorityy AreasThree GThGrant PPriorityi i AAreasWhat is CTIP?Determine strategies(policy/systems change) withthese parameters: CDCCCGGrant Priority AAreasCore PrinciplesF ibilitFeasibilityCommunity Readiness

The Planningg ProcessThis is the first meeting to determine thestrategies for each grant priority areaShare the data and strategies with theCoalition and communityObtain feedback2nd meeting in January to finalize strategies,with Coalition and community feedbackCoalition will work on details of CTIP3rd meetingi to approve theh finalfi l CTIP

ImportantpDates2nd CTG Strategic Planning Meeting Thursday, January 10th12 30 – 3:30p12:303 30CTG Coalition Meetingg (feedback)() Friday, January 18th11:30 – 1:00pQuarterly Leadership TeamMeeting (Finalize CTIP) Thursday, February 28th12:30 – 2:00p

Q tiQuestions

CHA FindingsFi diHighlights,Hi hli htPart IILeadership Team Strategic PlanningMeetingJanuary 10, 2013Made possible with funding from the Centers for Disease Controland Prevention.

Communityy Health AssessmentComponentsCtDemographic dataHealth dataPolicy/environmental scansKey informant interviewsFocus groupsg pAsset inventoriesCombined assessment of clinicalpreventive services area

Recap:p CHA Highlights,g gPart IComponentsHealth dataPolicy scans T bTobacco,CPSAsset inventories HEAL, TobaccoCombined assessment of clinicalpreventive services area

New: CHA Highlights,g gPart IIK IInformantKeyfInterviewsIiFocus Groups (preliminary)Policy/Environmental Scan HEALInsightss g s fromo PRISMSM Dashboardas boa d

Key Informant Interviews OVERVIEW12 kkey iinformantsft interviewedi t idTo assess community’s readiness forchange – 2 interventionsRestriction on tobacco use in multi unithousingRestrictions on advertising of unhealthyfood, beverage and tobacco products atcorner stores

Keyy Informant Interview FindingsgH l h Eating,HealthyE iAActivei LivingLi iTopic: Restrictions on Advertising of UnhealthyProducts in Store FrontsCommunity Readiness Scores Few efforts already exist, and the communityis not very knowledgeable about theseLeaders and the community believe the issueis a concernSome resources are available for use inaddressing the issue

Keyy Informant Interview FindingsgH lth Eating,HealthyE tiActiveA ti LivingLi iTopic: Restrictions on Advertising of UnhealthyProducts in Store FrontsSynthesis Issue competes with many others for time, money,and resourcesKnowledge of the impact of unhealthyadvertising on purchasing is lowPotentially untapped resources in youthleadership, Family Resource Centers (FRCs)Schools an “overtapped”overtapped resourceConsider the business perspective

Focus Groups:p OverviewA small group of people (8-12)(8 12) who cometogether to share their thoughts and ideas on:HEAL - Unhealthy Advertisements in CornerStorefronts Male/Female Adults, Spanish speakersMale/Female Adults, English SpeakersMale Youth, English SpeakersFemale Youth, English SpeakersTobacco-Free Livingg - Smoke-Free Multi-UnitHousing Male/Female Adults, Spanish speakers, SmokersMale/Female Adults, English Speakers, SmokersMale/Female Adults, Spanish speakers, Non-SmokersMale/Female Adults, English Speaker, Non-Smokers

HEAL Focus Groupp FindingsgU h lth AdvertisementsUnhealthyAd tit ini CornerCStorefrontsSt f tBrand loyalty begins at an early age and impactspurchasingpuc as g decisionsdec s o s anda d behaviors,be av o s, wwhichc ccrossossinto different culturesAdvertisement and product placement in storestargets specific demographics (i.e. tobacco adsplaced low to target children, placement of soda,candy and tobacco products at point of purchase,which lead to negative health impacts)Supportive of the Lee Law, but questionedenforcement (lack of)

Tobacco Focus GrouppS k FSmoke-FreeMulti-UnitM lti U it HousingH iCCurrentlyconducting participantrecruitment T l k MTurlock,Modesto,d t RiverbankRi b k andd PattersonP ttSScheduledh d l d tto hholdld ththe ffocus groups llatertthis month

Stanislaus County School DistrictsL l WellnessLocalW llPolicyP li ReviewR iSchools play an essential role in reducing the rates of childhoodobesity and a strong Local Wellness Policy (“LWP”).LWP is an important tool for school districts to improve bothstudent health and learning capacity.LWPs can develop coordinated and efficient strategies byintegrating nutrition education, physical activity, and healthyfoods throughout the school day and school environment.environmentHealthy, Hunger-Free Kids Act of 2010 recently updated theprevious requirements for LWPs, adding provisions that insuregreater accountability through broader community engagement,engagementimplementation plans, evaluation, and reporting. All school districts receiving federal funds via the National School LunchProgram and must be implemented 2013 – 2014 school year.

Local Wellness Policyy ReviewCommissioned a team of law and ppolicyy expertspfromChangeLab Solutions to review 25 Local WellnessPolicies from school districts across Stanislaus CountyThe main goals of the review were:To assess the overall strength and compliance levels ofLWPsW across the countyTo highlight areas of improvement to meet pending andexistingg federal and state standardsTo offer best practices and innovative policy solutionsthat will maximize positive student health outcomes andposition Stanislaus County schools districts as a nationalleader in school wellness policy

Stanislaus County Two Model PoliciesCA School Boards AssociationNational Alliance for NutritionDesigned by school districts, countyoffice of education, etc.Designed by PH organizations i.e.,American Heart Association,American Diabetes Association, etc.Specific to school wellness policies, ithas crafted model language basedon national and state requirementsand offers a guidebook withworksheets to support school districtsthrough the process of adapting themodel wellness policy to reflect therealities on the ground for eachjurisdiction.15 School Districts1 – Combined1 – OtherThe National Alliance for Nutritionand Activity (NANA) promotesfederal policies that facilitatehealthier eating and physicalactivity.NANA was instrumental in the effortto pass the Healthy, Hunger-FreeKid ActKidsA t (HHFKA) iin 2010 andd hashled the push for the CDC to increaseresources directed to nutrition andphysical activity promotion.8 School District

OpportunitiesppHealthy Hunger-Free Kids Act of 2010Healthy,Continues the existing requirements for LWPsand adds a number of important newrequirementsMust be implemented by 2013/14 Guidelinesbecome available this FallCNAP – Subject Matter Experts

Healthy, Hunger-Free Kids Act of 2010Existing Requirements:Goals for:Nutrition education Physical activity Other school-based activities to promote student wellness Nutrition guidelines for all food served or availableatt schoolh l A wellness policy for each school Plan for measuringg implementationp Identify a school wellness coordinator Stakeholder involvement of parents, students, schoolf d staff,foodt ff schoolh l board,b d andd administratorsd i it trequired in development of policy

Healthy, Hunger-Free Kids Act of 2010New Requirements:Goals for Nutrition promotionPhysicalyeducation teachers and school healthprofessionals required within stakeholdersStakeholder involvement in implementation,review,iandd updatedoff policiesli iRequirement for public notification (students,parents, and others in the community) of LWPcontents and updatesRequirement to designate one or more schooldistrict or school officials to ensure LWPcompliance at each school

Insightsg from PRISM DashboardH d tHandoutsPRISM Simulation Results DashboardNNumericali l simulationi l i resultsl ((projectedjd iimpacts off thehinterventions)Strengths and weaknesses of PRISM leversCaveats about the PRISM modelKey to indicators measured in PRISM

Insightsg from PRISM DashboardKey FindingsTobacco: Most effective interventions may also be themost difficult to implement,pbut have the greatestgimpact on long-term population healthHealthy Eating: Levers as described have minimal orno impactActive Living: Levers have moderate impact butrequire significant resources and reachClinical Preventive Services: Levers can have highimpact but require further strategy on servicedelivery; should emphasize primary and secondaryprevention

ImppactInsights from PRISM DashboardBroad hypertensionscreeningLocal cigarette taxJoint use agreementsfor physical activityReducing sodium atmom ‘n’n poprestaurantsDifficultyHigher-level policy interventions often have greater impact thanpor programsp gon health indicators both now andvoluntaryy policiesin the future, but may be more difficult to implement

Insightsg from PRISM DashboardFood for thoughtCTG aims for—and PRISM models—population-level impactsWe can adjust an intervention’s effectivenessby choosing population, strategy, and scopewiselyy Example: sodium reduction in school lunchesinstead of mom ‘n’ pop restaurantsImpact may be maximized by pairinginterventions Social marketing jointly with junk food andcigarettesgLimited ability of PRISM to model these

Questions

Break

Review Preliminaryy Priorities & SWOTPlPleasetakek a moment to review

Brainstorm & Discuss CTIP Priorities4 Priorities per Area:Tobacco-Free LivingHealthyy Eating,g, Active LivinggHigh Impact Clinical Preventative ServicesConsiderations:Use and expand the evidence base for local policyand environmental changes that improve healthAdvance health equity and reduce health disparitiesMaximize health impact through prevention

Finalize CTIP Priorities

Next Stepsp & ImportantpDatesCTG Quarterly Leadership Team MeetingThursday, February 28th12:30 – 2:00pm830 Scenic Dr. – ModestoMartin Conference RoomCTG Coalition Meeting (Strategic Planning)Friday, January 18th11:30 – 1:00pm830 Scenic Dr.Dr – ModestoMartin Conference Room

Stanislaus CountyCommunity Transformation Grant (CTG)Vision:To create healthier communities by making healthy living easier where people work, live, learn, andplay.Mission:Prevent disease and promote health equity among Stanislaus County residents.Grant Priority Areas:‐‐‐Tobacco‐Free LivingHealthy Eating and Active LivingHigh‐Impact Quality Clinical Preventive ServicesOverarching Goals and Strategies (Healthy People 2020):‐‐‐‐Attain high quality, longer lives free of preventable disease, disability, injury, and prematuredeath.Achieve health equity, eliminate health disparities, and improve the health of all groups.Create healthy and safe physical environments that promote good health for all.Promote quality of life, healthy development and healthy behaviors across all life stages.CDC Core Principles:‐‐‐Use and expand the evidence base for local policy and environmental changes that improvehealthAdvance health equ

Southwest Side Sid Central e Southeast Side Central Legend 17.4 Southeast South West Side Side South 20.5 Central 20.6 North Side 20.9 South Side 22.2 West Side 24 0 E t C t l Central 24.0 East Central 24.3 South Central 26.7 Northeast Side 35.3 Southwest Central