September 2013

NCIPH partners on model CHA collaboration in Wake County

The unprecedented partnership to conduct a Community Health Assessment in Wake County has successfully identified several areas of need, and with county residents, has selected priorities to be addressed over the next three years: poverty and unemployment, health care access and utilization, and mental health and substance use.

In the May issue of Impact, we reported that some of the state's leading medical centers had joined forces this year to conduct a comprehensive Community Health Assessment in Raleigh and the surrounding urban and rural areas of Wake County. NCIPH helped facilitate this effort.

Later in May, community forums were held throughout Wake County where residents were invited to hear the main findings from the assessment and vote on the priority issues.

A community health assessment is conducted every three to four years to identify the health status, concerns, and resources of a community as part of a county-wide strategic health planning process. The new Affordable Care Act requires all not-for-profit hospitals to assess the health needs of the community they serve and to create an implementation strategy demonstrating that they are meeting the community's needs. Additionally, community health assessments are required as part of local public health agency accreditation processes in North Carolina and nationally.

To avoid multiple community health assessments and duplication of planning efforts, Wake County Human Services established a partnership with three local hospitals (WakeMed Health and Hospitals, Duke Raleigh, and Rex Healthcare), Wake Health Services, United Way of the Greater Triangle, Wake County Medical Society, and Urban Ministries to complete a joint assessment. Additionally, more than 60 non-profit, government, faith-based, education, media, and business organizations participated in the process.

"We know that with all of us working together, we can create a healthier community while having a better idea of where we need to focus our resources over the next few years," said Sue Lynn Ledford, health director for Wake County. "Wake can be a model for other health departments, hospitals, and community organizations wishing to do this kind of collaboration."

Through a competitive bidding process, the North Carolina Institute for Public Health (NCIPH) received a contract to coordinate data collection and analysis, develop community prioritization methods, and create the final community health assessment report document. NCIPH has a long history of assisting with community health assessments, participating in assessments of 39 out of 100 counties. In addition, since 2009, NCIPH has participated in 11 community health assessments in multiple NC counties using a widely validated cluster sampling methodology to conduct primary data collection.

"This project had an incredibly fast turnaround of six months," said Anna Schenck, PhD, MSPH, director of NCIPH and associate dean for public health practice at the UNC Gillings School of Global Public Health. "But we were pleased to have the opportunity to work with an engaged team of funding partners and community stakeholders so committed to achieving their goals.”

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ALBD Learning Networks help grantees share experience, challenges even after grants end

participants at ALBD gathering
Through a range of activities, from creative engagement at grantee meetings to consultative site visits, ALBD’s learning network activities help forge lasting connections.

When the Healthy Kids, Healthy Ozarks community partnership  in Harrison, Ark., was  trying to improve the area’s trail system and sidewalks network, Active Living By Design staff suggested they turn to their peers in Columbia, Mo., another Midwestern town that had been extremely successful  with such improvements. This was the beginning of several face-to-face meetings between the two communities to exchange ideas and learn from each other. 

“Their first exchange was when Ian Thomas, the project director Columbia, was invited to Harrison to speak at a conference about ways to make their city more biking and pedestrian friendly. As he was leaving his hotel, Ian commented that the street running in front of it would be a perfect candidate for a ‘road diet,’” said Mary Beth Powell, MPH, Active Living By Design deputy director.

A road diet???

But the concept made sense to the folks in Harrison when Thomas explained that reducing road’s four lanes to three would slow traffic and provide room on either side for bike lanes. Thereafter, a delegation from Harrison traveled to Columbia to see such a plan in action. Bicycles were provided so they could see how the new lanes and safe crossings encouraged citizens to ride bikes or walk around town. Columbia’s mayor explained that better, safer sidewalks and bike lanes connecting throughout the city were not only good for residents’ health, but also good for business. The City of Harrison embraced the concept and implemented the road diet several months later. “Peer-to-peer learning has helped Harrison make big strides in a short period of time,” Powell said.

The relationship between Harrison and Columbia is just one example of how Active Living By Design (ALBD) supports community partnerships through learning networks that are fostered at conferences, through webinars and in other peer-to-peer exchanges.

“We bring people together to mentor each other and to share challenges, ideas and success stories,” said Sarah Strunk, MHA, ALBD director. “In North Carolina and around the country, it’s one of the foundations of our work.”

Joanne Lee, MPH, ALBD senior project officer, said that ALBD has seen the value of the learning networks since the program’s beginning.

“We provide technical assistance tailored to grantees and their specific projects, and we’ve also seen the value of connecting them to share real, on-the-ground experience,” Lee said.

At conferences and convenings, grantees learn from ALBD and other experts in the fields of healthy eating and active living, but they also benefit from hearing about each other’s issues and challenges. For example, grantees across North Carolina who are part of the Healthy Food Systems project, sponsored by Blue Cross and Blue Shield of North Carolina Foundation, get together about twice a year for education and exchange.

“In the agenda, we include an informal, optional dinner that provides some time for networking,” Lee said. “We’ve learned that it’s one of the grantees’ favorite times of the convening. They build natural relationships then that become invaluable in the future.”

group ready for a bicycle ride
A group from the Healthy Kids, Healthy Ozarks community partnership in Harrison, Ark., checks out the bike lanes and safe crossings in Columbia, Mo. The trip was one example of how the two cities helped each other, a  result of networking opportunities provided by ALDB.

That unstructured time often prompts the most important exchanges, says Tim Schwantes, MPH, MSW, ALBD project manager.

“When you’re setting up a meeting, your instinct tells you to fill every moment with presentations and information sessions,” he says. “But when you give people the opportunity, they can find deeper and richer ways to connect than we could even imagine. Maybe they’re just sitting beside someone at lunch, and suddenly find themselves deep in conversation about what works and what doesn’t.”

ALBD staff members find great satisfaction in seeing relationships develop among grantees and community partnerships.

“If they only hear about successes, they get a false sense of the work,” Schwantes said. “But when they hear about successes and challenges from one another, they get creative with ideas and find innovative ways to succeed, despite the obstacles. I’d like to think ALBD fosters a safe environment where people are comfortable sharing both the good and bad. That’s where the real learning happens.”

Powell adds, “These relationships often last longer than the grants do. When the funding is over, they can still pick up the phone and share ideas that keep their initiatives moving forward.”

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Preliminary study results show large variation in public health spending across North Carolina

Anna Schenck
Anna Schenck

In the May issue of Impact, we announced that UNC Chapel Hill had received funding from the Robert Wood Johnson Foundation to conduct a two-year study on new methods and measures to assess the impact of the economic recession on public health outcomes.

Results from the first year of that study are available now, providing details about the amount of money spent per capita by each local health department in North Carolina. Analysis of the information shows a wide variation in spending across the state. For example, in 2008, the average amount spent per person by local health departments was $87, but it varied from $35 to $218, depending on the county.

“In these initial analyses, we have characterized the cost part of the equation,” said Anna Schenck, PhD, director of the North Carolina Institute for Public Health at the UNC Gillings School of Global Public Health. “We should not expect that local health departments that spend more per person will necessarily have better health outcomes. Some local departments may have higher expenses because they are working in poorer conditions. The cost of delivering public health services is influenced by a number of variables, including the demographic and health characteristics of the population and presence – or lack – of other health services.”

The preliminary analyses have not yet accounted for these variables, she said. Future analyses, however, will adjust for these characteristics. The next phase of the study will focus on the benefits provided by local health department expenditures. When both the cost and benefits can be assessed together over time, then a clearer picture of how to measure the value of public health will emerge, Schenck said.

“Our goal is to advance the methods used to measure costs and benefits of public health services,” Schenck said.  Previous public health studies have measured benefits in terms of reduced mortality. In this study, we are leveraging the Integrated Cancer Information and Surveillance System (ICISS) data which contain insurance claims from multiple payers, to assess the impact of public health spending on morbidity and the use of health care services. This will provide us with better tools to measure the return on investment in public health.”

Initial results are available on the NICPH website.

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NCIPH upgrades training registration system

Here are some upcoming training sessions:

30th Annual North Carolina School Nurse Conference
October 21-22, 2013

Management and Supervision for Public Health Professionals
Begins October 28, 2013

STD Nurse Clinician Training (STD ERRN)
Begins September 18, 2013

For information on more upcoming programs, click here.

NCIPH staff members have launched an improved training registration system for training programs and conferences sponsored by the UNC Gillings School of Global Public Health. The new system, Meetingtrak/CE (MT), is designed to simplify registration for continuing education activities and allow participants to track courses they have taken. The new system includes course details, people profiles, registrations, session attendance, and continuing education credit.

Another new system, Etrak (ET) complements MT by providing a secure, integrated, real-time registration and payment web module with immediate credit card authorization. ET links participants to the registration system using any standard Internet browser. Attendees can create and update their own profiles, register for courses and sessions, and pay registration fees. ET also  generates emails confirming receipt of registration and credit card transaction details.

“The staff has listened to suggestions from people who’ve taken courses and attended conferences in the past,” said Kathy Cheek, NCIPH business manager. “We’ve worked hard for months to develop a system that will make registration easier but also allow participants to keep track of what courses they’ve completed.”

Here are some of the new features:

  • Record multiple types of credits offered
  • Document actual credits earned by attendees
  • Track attendance history
  • Set up courses quickly and easily with speaker profiles, room setup, A/V, and food and beverage
  • Register  a group of attendees with a batch registration process
  • Has waitlist and guest capabilities
  • Create and administer online evaluations and surveys for courses and sessions

For more information, contact: Kathy Cheek at kathy_cheek@unc.edu.

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Preparedness Research Center’s staff making final push to complete projects

NC Preparedness and Emergency Response Research Center

Staff at the North Carolina Preparedness and Emergency Response Research Center (NCPERRC) are working hard to complete the fifth year of research to strengthen and improve public health preparedness capacity through systems and services research. NCPERRC has received support for five years from the Centers for Disease Control and Prevention (CDC).

Most of the Center’s work has focused on North Carolina’s preparedness capacity.

For example, in October 2008, the center began a study of support and services provided by public health regional surveillance teams (PHRSTs) to local health departments. The NC Division of Public Health (NC DPH) used the findings to reorganize the teams. Some of the services that had previously been provided by the PHRSTs were redistributed to NC DPH, including epidemiology and surveillance services, which were moved to the Communicable Disease Branch of NC DPH.

In February 2013, the project again surveyed local health department (LHD) staff to learn about the support and services provided by the four restructured teams. Of 69 potential types of assistance, only 14 were received by more than half the LHDs surveyed in 2012. Because of the redistribution of services, it is not surprising that the overall number of services provided by teams has declined. However, the results indicate that several services that are still the domain of the new regional teams were reported as received by fewer LHDs in 2012 than 2009. Further study is needed to assess the provision of services to LHDs by the Communicable Disease Branch.

Vulnerable & At-Risk Populations Resource GuideThe Vulnerable and At-Risk Populations Guide project grew out of a request by NC DPH to assist LHDs to plan for needs in their counties. The online resource guide, developed last year, offers a custom list of resources with accompanying jurisdictional maps. This year, the research team is working with other states and jurisdictions to modify and adapt the tool. In addition, the project team is evaluating the use of the Guide and its applications to state and local preparedness planning. Results of this project will be integrated into two state-based mapping systems (outside NC) and will enhance information about social vulnerability across local, regional, and state planning efforts.

In the Center’s first four years, staff focused on evaluating public health surveillance systems in North Carolina. This year, CDC tasked NCPERRC to describe the features that a national biosurveillance‐based situational awareness information system should have. The research team gathered information and, in May, convened a national panel of surveillance experts to identify and prioritize the core business processes necessary for state and local biosurveillance systems. The team will generate estimates of the activity costs and workforce capacity to design, develop and manage these information systems.

For these last two projects, NCPERRC currently is preparing a proposal to CDC to support working with partners to develop infrastructure for national implementation.

For more information on NCPERRC work:

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