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Home My WebLink AboutAgenda - 03-09-1999 - IIB28 ORANGE COUNTY Board of Commissioners • Action Agenda Item No. _II.B._ Action Agenda Item Abstract Meeting Date: March 9,1999 Subject: Healthy Carolinians of Orange County Department: HEALTH Public Hearing Yes X No Budget Amendment Needed Yes X No Attachments(s): Excerpt from Certification Document Information Contact: Council Membership List Health Director's Office X2411 Committee Membership List Telephone Number Case Illustration from "Medicine and Public Health" Hillsborough - 732 -8181 Chapel Hill - 968 -4501 Mebane - 227 -2031 Durham - 688 -7331 Purpose: To update Board of Health and Board of County Commissioners regarding implementation of Healthy Carolinians of Orange County. • Background: In 1995 the Board of Commissioners appointed an Orange County Healthy Carolinians Task Force at the request of three primary partners in this effort: the Orange County Health Department, the iJNC Hospitals (now UNC Health Care System), and the UNC School of Public Health. There were 60 members on the task force itself and approximately 20 on a Steering Committee. In 1995 and 1996 health data was gathered and analyzed from both primary and secondary sources. Through a community/task force process three priority areas were identified in 1997: Needs of Children, Teen Pregnancy, and Preventive Services. Working groups were established in each of the priority areas to develop objectives and strategies for accomplishing those objectives. During 1997 progress in identifying strategies in each of the working groups was very slow, primarily due to a lack of staff resources. The Teen Pregnancy group realized that while they had a worthy goal, the numbers of individuals affected were very small and the root causes of teen pregnancy were better managed in a more holistic way. Therefore, in early 1998 they recommended to the Steering Committee that their group be merged with the Needs of Children. This was accomplished and by the fall of 1998, each of the working groups had strategies for implementation identified. Each Committee had a major "kick -off' event in 1998, and has their list of strategies they would like to accomplish. Grant funds can be sought for many of the implementation efforts, however the coordination of the groups involved and the evaluation of program accomplishments is more difficult to accomplish without core support for the effort itself. The Steering Committee also realized that the task force of 60 was an unwieldy structure and that it was time to move to a more permanent structure. A Council structure of 30 -35 individuals was developed that represented a cross - section of agencies and citizens in the county. The Health Education Supervisor in the Health Department has been acting as the part -time staff/coordinator of the effort since the late fall of 1997. She prepared a document that was presented to the NC Healthy Carolinians Task Force for "certifying" the Orange County effort. While certification at this time does not bring funds directly with it, many state and foundation grant programs require evidence of multi- agency and community collaboration • to qualify for funds. 29 The original partners have contributed both in -kind as well as real dollars toward this effort. There was an original $3,000 commitment from the UNC SPH, the UNC Health Care System, and the Orange County Health Department to fund a part-time coordinator that would carry the initiative through the assessment phase, which • was accomplished by the late fall of 1997. Since that time the following contributions have been made by these partners and by other organizations: Data collection ( BFRSS and focus groups) UNC Health Care $15,000 Data analysis UNC SPH $ 8,000 (in kind) Fees for Festifall Kiwanis of Orange Co. 500 "Give Aways" at Community Events Wellspring $ 100 "Give Aways" at Community Events UNC Health Care $500 "Give Aways" at Community Events Food Lion $250 "Give Aways" at Community Events Ross Laboratories $400 Educational Materials American Cancer Society $1,500 Medical Supplies for Community Events Boehringer Mannheim $600 Flyers, posters, etc. Grapevine Printing $1,200 Full BFRSS + Access to Data UNC Health Care $40,000 Smoke Free Dining Guide Project ASSIST $ 5,000 This does not count the myriad hours devoted to community events by diverse groups such as a Girl Scout Troop, UNC School of Nursing students, Chapel Hill Pediatrics, Student Health Action Coalition, La Inglesia, American Cancer Society staff people as volunteers etc. Recommendation: The Boards receive the report. Coun& 3A • List Name First Name ." �., ., .; .::? ;Organization Name Address a r" r.' r, ` •.'• ! ` , �. ,., :; City : state Andrews Glenda YMCA 980 Airport Road Chapel Hill NC Beek Mary UNC Hospital UNC Hospital, 101 manning Dr., CB #760 Chapel Hill NC Blake Travis Kiwanis Club 9668 Highway 15 -501 Chapel Hill NC Brown Margaret Commissioners Office c% Beverly Blythe Butler Jonathan Chapel Hill Herald 220 S. Churton St. Hillsborough NC Carey Moses Piedmont Health 121 Kingston Drive Chapel Hill NC Carter Jim CH Chamber of Commerce 104 S. Estes Dr. Chapel Hill NC Kristian . Meade Chapel Hill Pediatrics 901 Willow Drive Chapel Hill odor . Tim Chapel Hill Bible Church 1200 Mason Farm Road Chapel Hill C rbett a United Voices of Efland- Cheeks 318 Lancaster Road Mebane C coley Jim Hillsborough Chamber of Commerce 150 East King Street Hillsborough C Oster Beverly UNC School of Nursing UNC at Chapel Hill, Carrington Hall, CB Chapel Hill C reeland . Sharon 0004 P.O. Box 866 Hillsborough C ray Rita Interfaith Council 207 Wilson St. Chapel Hill C and ynn Chapel Hill Svc. League 213 Collinson Drive Chapel Hill C ones Bob Recreation and Parks Klein Jonathan Physician 210 South Cameron St. Hillsborough NC Kugler Eileen Human Relations Commission Health Department Personal Health Divisio Maynard Tom OPC Mental Health 101 East Weaver St., Ste. 300 Carrboro NC ullinix Connie Community -at -Large 423 Westwood Drive Chapel Hill NC Palmer Maria Teresa Iglesia Unida del Cristo 205 Wilson Street Chapel Hill NC assmore erry Department of Aging Pendergrass Lindy Sheriffs Department Pryor-Cook Marti Department of Social Services gsbee Jill Orange County Schools 200 East King Street Hillsborough C vest Michele OC Partnership for Young Children 1829 E: Franklin St., Ste. 1200B Chapel Hill C Rose Town of CH, Public Safety 306 N. Columbia St. Chapel Hill C Searing dam Community-at -Large P.O. Box 2808 Raleigh C Seymore Rev. Bob Senior Citizens Advisor 609 Greenwood Rd. Extension Chapel Hill NC Solomon Karen Family Resource -CH Training Outreach 800 Eastowne Dr., Ste. 105 Chapel Hill NC Spalt Susan CH- Carrboro City Schools 750 S. Merritt Mill Rd. Chapel Hill NC Summers semary L. Orange County Health Department Health Director's Office illiams Ploria ROC CA P.O. Box 27 Pittsboro NC inestock im BlueCross BlueShield 1P.O. Box 2291 Durham NC w Page 1 0 0 0 Preventive Services Committee Members • W 1-+ FW Nnm : E , Ory�nttation.N :::_ ALLISON LEO UNITED VOICES OF EFLANO- CHEEKS ALLISON GEORGE MOUNT BRIGHT BAPTIST CHURCH ASHLEY MADELYN , ORANGE COUNTY DEPARTMENT ON AGING AYLSWORTH GRETCHEN GUARDIAN ul LITEM PROGRAM BECK ;MARY `)UNC HOSPITALS — BLACKWELL ELANOR" - AMERICAN LUNG ASSOCIATION BROOKS NED UNC- CHAPEL HILL BYRD CATHERINE AMERICAN CANCER SOCIETY FOSTER .BEVERLY - JUNC -CH. HAMNER ANN . DEPARTMENT-OF BKSTATISTICS HARPER JOEL CHAPEL HILL CHAMBER OF COMMERCE HENDERSON :MARGARET ORANGE COUNTY RAPE CRISIS CENTER IVES TIMOTHY ORANGE COUNTY BOARD OF HEALTH JONES ;BOB ORANGE COUNTY RECREATION AND PARKS KEANE MARYJOY KLEIN JONAT W W ORANGE FAMILY MEDICAL GROUP LEITH KATHERINE ORANGE COUNTY DEPT.ON AGING MARKIEVIACZ !DAVID AMERICAN HEART ASSOCIATION MAYNARD TOM OPC MENTAL HEALTH MORAN CHRIS INTERFAITH COUNCIL FOR SOCIAL SERVICES PASSMORE !JERRY ORANGE COUNTY DEFT. ON AGING PERRUZZI 'PAUL ! NC DIVISION OF MEDICAL ASSISTANCE PE7TITT -ALICE ORANGE COUNTY COOPERATIVE EXTENSION PHILLIPS DONNIE JUVENILE SERVICES i PRYOR -COOKE i MARTI ORANGE COUNTY DEPT. OF SOCIAL SERVICES REEVES AILINDSAY • HEELS FOR HEALTH SEYMOUR ROBERT HEALTH PROMOTION ADVISORY BOARD SIEBERT . ED • W 1-+ SIEFERT ;KAREN I ORANGE COUNTY HEALTH DEPARTMENT SILER iSHARRON ORANGE COUNTY MANAGERS OFFICE SPRIGGS .PAT CAROLWOOD'RETIREMENT COMMUNITY WATERS ; NICK EMERGENCY MANAGEMENT SERVICES VNWAMS GLORIA . ............... . ..LJOCCA. 0 a W N • • - • �J Needs of Children Committee Members Lad Nwe rFkat . Isalbn ;ANDREIMS GLENDA iYMCA BRIDGES ; RANDY ORANGE COUNTY BOARD OF EDUCATION CAREY MOSES ,ORANGE COUNTY BOAR13 OFCOMMISSIONERB CHANCER PAT McDOUGLE ELEMENTARY SCHOOL' . CROSS ALAN iCHPDP DAVIS NATE FORD CAROL DEPARTMENT OF PEDIATRICS FOXWORTH LINDA KIDSCOPE HARGRAVES FRANCES ' HOLTON MARGARET ' `CHILDREN AT RISK KRAMER t PETER OPC MENTAL HEALTH FAMILY COUNS. CTR KUGLER EILEEN ORANGE COUNTY HEALTH DEPARTMENT LEHMAN DAN jPLANNING,UNCHOSPITALS __.._..... . _.. . MATHERS MIKE 33 CHAPEL HILL TRAINING OUTREACH PROJECT MITCHELL MARINE t DOBBINS HILL FAMILY RESOURCE CENTER MORGAN JAMES . PEDERSON NEIL :CHAPEL HILL / CARRBORO SCHOOL PENDERGRASS LINDY ORANGE COUNTY POLAND SALLY l VOLUNTEER FAMILIES FOR CHILDREN RHODES MARK ; ;YSAC RIGSBEE JILL ORANGE COUNTY SCHOOLS RIVEST 'MICHELE PARTNERSHIP FOR YOUNG CHILDREN RUNYON 'CAROL `INJURY PREVENTION RESEARCH CENTER SHAFFER DENISE ; ORANGE COUNTY DEPT. OF SOCIAL SERVICES SINGER PHILIP HILLSBOROUGH FAMILY PRACTICE SMITH TERESA DAY CARE SERVICES ASSOCIATION SOLOMON KAREN CHAPEL HILL TRAINING OUTREACH PROJECT SPALT SUSAN CHAPEL HILL / CARRBORO SCHOOLS TANNENBAUM DIANNE TINNIN- MEBANE ' DONNA ' EFLAND- CHEEKS COMMUNITY CENTER W GGINS BESSIE NORTHERN ORANGE FAMILY RESOURCE CTR. W W Teen Pregnancy Committee Members W • ANDREWS GLENDA YMCA BLEY KAREN PLANNED PARENTHOOD ORANGEIDURHAM COUNTIES COMPTON BETTY .. -. UNC SCHOOL OF MEDICINE, DIV OF PEDIATRK:S DEW LAGER ANN UNC ISTITUTE OF GOVERNMENT ENGLISH ABIGAIL j FREELAND SHARON --! CONGREGATIONS IN MISSION GOODHAND KATHLEEN ORANGE COUNTY DEPT. OF SOCIAL SERVICES HATLEY L GENE . .- ..._ � BARBEE CHAPEL MISSIONARY BAPTIST - HUGHES JOHN ADOLESCENTS IN NEED MCADOO ANGENETTE I TEENS IN POWER , McGEE -- _.. - .... -- - ......... g MOOS MERRY -K :UNC SCHOOL OF MEDICINE MUWNIX CONNIE FLYNT MUWNIX HEALTH CARE .MUNSON ERIC i UNC HOSPITALS RIGSBEE .LINDA _...... _. _ _.'.ADOLESCENT PREG.* PREVENTION COALITION OF NC SCHLESINGER ' MELINDA ORANGE COUNTY HEALTH DEPARTMENT J STEIN- SEROUSSI . DOREEN . THE VWMEN'S CENTER { WALLACE KAREN ___'..COMMUNITIES IN SCHOOLS , WEISS NAN : PLANNED PARENTHOOD ORANGE /DURHAM COUNTIES WILLIAMS DONNA '!!ORANGE COUNTY SCHOOLS WILLIAMS TERESA ZOOK PAT ORANGE COUNTY HEALTH DEPARTMENT W Excerpt from Orange County Healthy Carolinians Certification Document 0 0 35 � 36 III. COMMUNITY ASSESSMENT /COUNTY INFORMATION ** See attached copy of the Orange County Community Assessment A. Population:. (1990 or most-recent) 106.000 B. Median Family Income: Per Capita Personal Income. 1994 $23. 108 C. Population Percentage Change (+ or -): (1980 -1990) 27%+ D. Percentage of Families Below Poverty Level: 14% (22% African- American, 12% Caucasian) E. Racial/Ethnic Population Breakdown (percentage): Caucasian (non - Hispanic) 81% Asian 2.5% African- American 16% Native American unavailable • Hispanic (of any origin) 1.4% Other unavailable Source -1996 Community Health Assessment (appendix 1) 22 • • IV. Task Force Action Plan A. Orange County Working Groups Process The steering committee nominated individuals to participate in each of the three working groups and appointed chair people. In September 1997, a community forum was held to inform the community about the current status of the Healthy Carolinians initiative, introduce the new three working groups, present the charges to the working groups (including a timeline) and invite community participation. Specifically, presentations at the community forum included a data review of the community assessment, information on the state initiative from DHHS staff and updates on the process of selecting priorities. The working groups met bi- weekly and established the following goals (see next pages in section IV for detailed information): • Needs of Children - To improve the potential for academic, personal and social success in children by providing a comprehensive, coordinated county -wide program aimed at preventing child abuse and neglect, a comprehensive, coordinated county -wide program aimed at preventing substance abuse in children and youth, a campaign to promote love and adequate supervision for all children. To prevent the emotional and physical problems which occur in children whose families are in distress by planning and implementing easily accessible services aimed at prevention, intervention and treatment. Teen Pregnancy - To decrease pregnancy among Orange County females less than 20 years old. Preventive Services - To improve the length and quality of life of residents in Orange County. • These goals and objectives have provided the foundation for the action plan for the Orange County Healthy Carolinians initiative. Orange County is now entering the implementation phase 37 23 38 of the initiative and has re- structured the task force to most effectively achieve the goals and • objectives and to establish a sustainable organizational structure that will continue to identify community health needs, solicit community input, and ultimately improve the health status of all people living in Orange County. The new structure is defined in the by -laws included in this application. The working groups were very successful in investigating their priority area, setting goals and objectives and recommending strategies for action. During this process, the staff met, regularly with the groups and the steering committee received regular progress reports. The process resulted in several "evolutions" of the task force. First, it was discovered that the working groups had discussed (to varying degrees) substance abuse as a possible contributing factor to their priority area. Therefore, it was decided to convene a substance abuse implementation group to address substance abuse objectives identified by the Needs of Children and Preventive • Services working groups. . Secondly, due to the relatively few numbers of people impacted directly by teen pregnancy in Orange County, it was decided to merge the Teen Pregnancy working group with the Needs of Children group. Finally, the Preventive Services working group determined that the best way to achieve their goals and strategies in nutrition and fitness was to operate as two committees in cooperation and coordination. 24 • IV. Task Force Action Plan A. Identified Need: • The leading causes of death and disability in Orange County are heart disease and cancer, preventable illnesses. B. Health Objective Area: Chronic Disease (he rt disease and cancer) • By 2008, reduce morbidity related to heart disease, stroke, cancer and diabetes measured by 25% fewer hospital admissions (due to the above conditions) and 25% reduction in length of stay in hospitals (resulting from complications of the above conditions). • By 2008, reduce age - adjusted mortality rates (per 100,000) by approximately 10% related to: '• heart disease to no more than 99 • stroke to more than 23 • • cancer to no more than 110 • diabetes to more than 30. . C. Short-term Objective/Outcome: By 2003, improve lifestyle risk behaviors by 5% in the following areas (obtained through the Behavior Risk Factor Surveillance Survey): 1. increase to 77% the number of Orange County residents who are smokefree; 2. increase to at least 44% the number of Orange County residents who engage in regular physical activity; 3. reduce to no more than 17% the number of Orange County residents who are considered "obese"; C, 39 25 40 4. reduce to no more than 12% the number of Orange County residents who have high • blood pressure; 5. increase to at least 62% the number of Orange County residents who have their cholesterol checked each year; 6. reduce the percentage of residents who are at risk for: • acute drinking (five or more drinks at one time) • chronic drinking (60 or more alcoholic drinks per month). D. Strategies used to accomplish short -term objectives /outcomes: 1. Strategy #1 and Time Line. • By 2003, modem selected lifestyle risk behaviors i. By September 1998 complete the inventory of existing low cost or no cost programs in a) nutrition, b) fitness, c) substance abuse (tobacco and alcohol) that are available to the • public. ii. By September 1998 complete the survey of community groups (churches, schools etc.) to identify program needs (e.g. why current programs are not utilized). iii. Integrate nutrition and fitness message into scheduled community events including: • La Fiesta del Pueblo - autumn 1998 (events include education, counseling, tasting, nutrition assessment, fitness tips) • Festifall - autumn 1998 (events include education, tasting and community 5K walk) • Teens in Power - ongoing programs through 1998 (events include education, nutrition counseling, tobacco education, recreation programs such as basketball, volleyball) 26 • • iv. By September 1998, design and implement a tracking system for all nutrition and fitness programs to evaluate levels of participation, participant satisfaction, and effectiveness of program plan, 2. Roles and responsibilities of agencies, businesses, churches, community members and leaders involved in the initiative. (see list of preventive services committee members) agencies - recreation and parks (fitness council) is overall "lead agency" for the committee, other agencies continue to participate in planning, promotion of events, implementation, staffing event, and evaluation efforts (Department on Aging is co- sponsoring Festifall walk). businesses - co- sponsor event, assist in promotion of events, support employees to participate or staff events churches - co- sponsor events, provide feedback to surveys regarding program utilization, • promote events, support congregants to participate and staff events, community members - participate in planning, conduct activities, promote event, staff and participate in events (Kiwanis Civic Club is co- sponsoring the Festifall walk) leaders- support all activities and act as "spokespeople" when appropriate, for media events. 3. Evaluation of Strategies: Implement tracking system to identify effectiveness of program activities, number and demographics of participants, satisfaction of participants, satisfaction of staff, types and number of events/educational programs offered. Conduct a six month follow -up with participants to identify behavior change. Maintain an "active" participant database and invite participants to engage in the annual events (Festifall walk and La Fiesta del Pueblo). • The Behavior Risk Factor Surveillance Survey will be conducted regularly to measure -the changes in behaviors outlined above. 41 27 42 4. Describe Progress to Date: is There are two events and several ongoing activities scheduled to address the chronic disease objectives to modify selected risk behaviors of poor nutrition and lack of exercise. La Fiesta del Pueblo and Festifall walk are two large -scale community -wide events with an expected participation rate of 300 people (each). Committees are in the process of planning the events. In addition, the background activities (e.g. identifying the existing programs and identifying the reasons for the lack of public participation in those programs) are being conducted by staff and committee members. It is important to note that the coordinator position is vacant pending a . decision by Orange County government. Current ongoing activities include nutrition classes in the Senior nutrition sites, nutrition (5 a day) program in the schools, regularly scheduled fitness activities for Teen in Power in Northern Orange (soon to be expanded) and the Senior Pacers walking club. Also, baseline data was established by the Behavior Risk Factor Surveillance Survey reviewed in. the Community Health Assessment. • • 28 • Task Force Action Plan (continued) Short -term Objective: • By 2003, improve lifestylexisk behaviors by 5% 1. Strategy 42 and Time Line To improve access by all county residents to the preventive services (medical, educational, therapeutic, counseling) available in Orange County. By 2003, increase by 25% the utilization of existing nutrition, .fitness and substance abuse programs; By 2003, increase by 25% the number of nutrition, fitness and substance abuse programs available at low cost or no cost to community residents; By 2003, increase by 25% the number of residents who have had a routine medical check up • within the last year (baseline 70% in 1996). By January 1999, develop plan to educate the public and professionals about the existing services in Orange County. By January 1999, establish comprehensive understanding of barriers (e.g. transportation, cultural, language) to access and begin plan to reduce those barriers (e.g. cultural sensitivity training for health care professionals, interpreter services to assist Spanish speaking clients): 2. Roles and responsibilities of agencies, businesses, churches, community members, and leaders involved in this initiative. agencies - recreation and parks (fitness council) is "lead agency" for the overall initiative. Agencies with responsibilities for providing education to the public (e.g. health department, schools, media outlets, if possible, the university), will have major responsibilities to provide • education to the P ublic. 43 29 44 businesses - fitness centers, gyms and spas will support the educational activities, provide • information on their classes offered and act as information channels to reach the public. churches - the churches serve as an information source for the community and may be sites of activities. Churches will provide information on classes offered on site and act as a referral source for community members. community members- provide consultation on development of informational strategies, assist in educational plan to reach special populations, etc. leaders - provide information on known programs in timely manner, assist in dissemination of information. 3. Evaluation Strategies All activities will include a participant evaluation which will identify where the participant learned about the event. In addition, the number of advertisements, psa's, brochures and flyers • distributed will be tracked as well as the site of distribution The evaluation of the reduction in barriers to services is more difficult to establish, however, tracking the number of minority participants in the activities, the number of bi- lingual materials distributed, number of cultural sensitivity classes and participants can be established. It is also possible (with funding) that the Healthy Carolinians council sponsor a "health perceptions" survey (similar to the Health Interview Survey) to identify patterns in utilization and changes in the barriers to access. 4. Describe Progress to Date: The Preventive Services Working Group (now a committee) began to inventory the existing nutrition and fitness programs in October 1997. Unfortunately, the United Way, the agency • responsible for maintaining the list of community resources, closed the Orange County office. 30 45 • responsible for maintaining the list of community resources, closed the Orange County office. This, in addition to the vacancy in the coordinator position, has slowed the inventory process. Now that specific events are being planned, it is proposed that the groups participating in the planning of the nutrition and fitness programs also contribute to the identification of county programs. The health department has conducted a cultural sensitivity training for all employees and has contacted the DHHS trainers and has discussed ways to encourage and support other groups to host additional sessions. Also, a protocol for interpreting services has been established and the health department is encouraging department/agency collaboration to provide bi- lingual services to clients. It is important to note that an overriding priority of the Healthy Carolinians in Orange County is • to address the disparity in health status between the white and minority populations. It is believed that major contributing factors to this disparity are the cultural barriers to health care services. Therefore, emphasis has been placed on ensuring cultural and ethnic diversity on the council, the committees and in the planning, implementing and evaluating activities to assure that the strategies used include methods to reduce barriers to services. .7 31 46 Task Force Action Plan • A. Identified Need The leading cause ofmorbidity and mortality for children in Orange County is accidents and injury. It is believed that many of these injuries are preventable and are, in fact, a result of child abuse and neglect, substance abuse and poor parenting. B. Health Objective Area Maternal and Infant Health including Teen Prey and By 2008, to reduce the incidence of substantiated child abuse and neglect by parents or other caregivers. C. Short -term Objective/Outcome: To improve the service delivery system for children, parents and families suffering from child abuse and neglect. • D. Strategy #1 and Time line (the strategies are to provide an integrated, comprehensive system for children and families as described below): By 2008, improve and coordinate the system of services to ensure. • children identified as having been neglected or physically, sexually or mentally abused will receive medical and/or psychological evaluation and treatment; • children identified as having been traumatized by witnessing violent crime or domestic violence will receive preventive and supportive services; • the development of a mentoring, buddy system for youth at risk of child abuse; • the development of child abuse prevention programs; • development of programs for children who have problems as a result of child abuse and/or • neglect; 32 . • development of programs for teen moms aimed at promoting healthy parenting and preventing repeat pregnancy; and • develop age -appropriate afterschool programs for youth age S to 17. 2. Roles and`Responsibilities of agencies, businesses, churches, community members and leaders. agencies - the health department is a "lead agency" for this initiative in collaboration with other agencies. To provide a comprehensive system of care all agencies supporting the services provided to children and parents must operate in a collaborative referral network, therefore, the role of agencies in all the activities addressing this objective, is to actively participate in the activities, share model programs and commit to collaboration., businesses - businesses can provide support for activities and participate in educational efforts • (support educational efforts to reach employee and their families about child abuse /neglect) churches - churches have a special role because they provide child care services within the community as well as being a resource for community education and referral, therefore, the churches are an integral participant in planning, implementation and serve as a site for 1��. community members - community members are the essential component of the activities by participating in the planning and implementation of the educational efforts as well as providing support to those community members (parents, families and children) most in need of these services/activities. leaders - leaders are necessary to ensure the coordination of services and agency resources to • meet the needs of community members as well as supporting the community -wide awareness and educational campaigns. 47 33 48 leaders - leaders are necessary to ensure the coordination of services and agency resources to • meet the needs of community members as well as supporting the community -wide awareness and educational campaigns: 3. Evaluation of Strategies (because the strategies involve an integrated approach to reaching children and youth, the evaluation must also use an integrated approach): The evaluation of these objectives will have multiple components with both process and outcome measures. The objectives, including improving the coordination of services for children and improving (more immediate) response for children suffering from abuse and neglect, will be measured by the agencies providing services through the Home Visiting grant. Indicators include nominal measures such as the number of referrals among agencies, number of children/families referred, number of follow -ups, % of families receiving comprehensive care (e.g. psychosocial, behavioral, medical), the length of time.between incidence of abuse and • delivery of services. The ultimate indicator of success is, of course, the incidence rate of substantiated child abuse and neglect. This information can be obtained by the Department of Social Services. Other indicators include the development of a mentoring system and number of individuals participating in the system and number and level of participation in parenting and other educational classes. 4. Describe Progress to Date: The Orange County Health Department, in close collaboration with many other agencies in Orange County, received a grant to address child abuse and neglect. The Home Visiting grant gathered the resources and the constituency necessary to establish a comprehensive program to provide a multi- disciplinary team to visit families and children in their homes. This will allow • 34 • more accurate assessment of the home situation and allow the community members who are at risk for abuse to have an advocate to ensure services are received. is • 49 35 50 Task Force Action Plan • Short-term Objective/Outcome: • By 2008, to reduce the percentage of youth under the age of 14 who have tried alcohol, marijuana, tobacco; • By 2008, to reduce the percentage of high school students who use tobacco, alcohol and marijuana; • By 2008, to provide resources to families to ensure dependent children, 17 years and younger, will be responsibly and safely supervised by responsible adults. 1. Strategy # 2 and Timeline: To improve the service delivery system for children, parents and families affected by substance abuse and improve community and school-wide prevention programs. 2. Roles and responsibilities: (see "Roles and responsibilitiesP' section above) t The schools will be a lead agency in this effort in collaboration with the substance abuse prevention committee particularly because of the evaluation component. The Youth Behavior Risk Factor Survey is conducted state -wide and is the major source of youth substance use data. 3. Evaluation of strategies: There are several objectives related to substance abuse which will be addressed by the "new" substance abuse prevention committee, however, evaluation strategies may include data from the Youth Behavior Risk Factor Surveillance Survey. As indicated in the "evaluation" section included for strategy #1, the number and level of participation in substance abuse programs, mentoring programs and afterschool activities will be recorded. In addition, the establishment of • 36 and enforcement of laws and ordinances related to the youth purchase and use of substances will is be tracked. 4. Describe Progress to Date: Implementation has not yet begun on these strategies, however, the grant monies for the Home Visiting grant have been awarded to the Orange County Health Department. • • 51 37 52 - -------------------- ------'---------------- --'— - -- --- - Part |[ Models of Medicine and Public Health Collaboration 121 53 122 Medicine & Public Health: The Power ofCollaboration Orange. County Board of Commissioners Board of Health Work Session March 9, 1999 Healthy People 2000 Report Goals: Increase the span of healthy life for Americans Reduce health disparity among Americans Achieve access to preventive services for all Americans r� u • r� �J Healthy People 2000 Report Priority Areas Health Promotion - fitness, tobacco, nutrition, mental health , violent behavior Health Protection - unintentional injuries, environmental health, oral health, food and drug safety Preventive Services - maternal and child health, cardiovascular disease, cancer, diabetes, HN, immunizations Healthy People 2000 Report Challenge: °Connuunilics milt irrnislalc national "oils mid priorities intostalc rand local (c[1ion" Governor Jun Martin established the I Iealthv Carolinian Task Force as a state wide response to the challenge County Commissioners launch the county initiative Countv Commissioners identifv the three partners as: Orange County Health Department U-NC Hospitals U}VC School of public Health The three partners recruit community members to serve on the task force Organized task force representation Developed a plan of action for assessment Community Assessment Secondary data collection and synthesis - Kev informant interviews Focus groups Task force review of preliminary report Eleven priority areas established • • 0 Task Force collapsed priorities to three _- Needs of Children Peen Pregnancv Preventive Services Working groups established for priorities Community forum held Objectives proposed to task force Working groups continue to meet to develop strategies Teen Pregnancy group stalls on identifying root causes Task Force meetings not well attended Staff resources limited to health education supervisor part -time. Structure re- organized into " l Iealthy Carolinians Council" and two committees Teen Pregnancy folded into Needs of Children effort Strategies identified and presented to Council at annual meeting in November 0 • • Strategies identified for implementation New community and agency members brought in Community kick -off events for each group held Certification of effort by state task force Assess current programs, gaps, & most pressing needs County wide summit of youth service agencies Involve more youth through OC Youth Council in activities Youth Risk Behavior Survey in schools to assess substance use & sexual activity Media campaign promoting abstinence - from sexual activity & substance use Children at -risk are involved in mentoring /support programs Focus on parents role in preventing risky behavior/ promoting effective parenting • 0 • Smoking Prevention - Restaurant Clean -Air Campaign - Smokefree Dining Day Coordinate Smoking Cessation Efforts TA`I'U Training in Schools (implement peer Program) Sedentary Lifestyles -- Re- establish Fitness Council (LT, \C in lead) 5K Walk atFestifall (multiagency) Re- establish Safe Kids Initiative (CK HD) - Bike Rodeo (Parks & Rec lead) School Walking Program (Kiwanis lead) 11) Existing Programs (Fitness Council) - Re- establish Senior Pacers (DOA lead) Nutrition La Fiesta del Pueblo (multiagency) 5K Walk participation School education (OC HD, Schools, Coop. Extension) - Health Assessments at Cormnunity Events - Children's menu alterations in restaurants 0 • "hat impacts ktcalth? r1 U 0 • C� • • bP, N i C t � '^-$y ul G • -YJ(il F p ^� '� nU ai .Ir V •td � .1-+ V � U U J � f%i P, O O (J � �' CL T i- ~ w G E G .2 tc U r • 0 r1 LJ Managed infrastructure should cut down on the number of meetings attended, vielding more "work' or service delivery time. Agencies will know more about individual services offered and can steer clients appropriately, lmproved health and well - being. UNC Health Care System as a regional and statewide resource University as a statewide and national resource Mission & experience of OCIID Contributions of partners to date Ability of partners to leverage additional resources A core staff to: -, provide continuity for agencies and community members involved -- provide a, coordination link between project and agencies -- leverage external resources for implementation projects _, gather data and provide evaluation measures of progress towards goals. C7 • 0 11 0 • •