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Mobilizing Action Through Planning
and Partnerships (MAPP):
The Cowlitz County, Washington
Journey
September 21st, 2005
Sue Grinnell, Director
Cowlitz County Health Department
Paul Youmans, Director
Pathways 2020
Presentation Objectives
Share experiences from a local attempt at
MAPP process
Share lessons learned from the local process
2
Cowlitz County, Washington
Rural community – 50 miles north of Portland
and 130 miles south of Seattle
Population approximately 95,000
Gateway to Mt St Helens
Resource economy
92% Caucasian population
High Unemployment
Low educational attainment
Poor Health Status Indicators
3
Cowlitz County Health
Department
Associated with the County Government
Oversight provided by County Commissioners (3)
who also serve as the Board of Health
25 staff
1 lead supervisor and no other exempt staff
Community and Environmental Health Programs
Beginning of process – subcontracted
epidemiologist using local funds
4
Pathways 2020
Non Profit organization based out of the
Cowlitz Economic Development Council
History
Membership
Mission
Report card
5
MAPP Overview
Cowlitz County TWEAKED
MAPP Process
• Attended a one day introduction to MAPP process (HD)
• Agreement to go forward on the process
• Worked together to identify all known/existing
assessments
• Very limited resources to complete work:
• No new staff
• No additional dollars identified
• Identified who would do what and what assessments
would be used
• Utilized the Pathways existing membership as the core
group
• Utilized the Pathways vision
7
The Four Assessments
Community Themes and
Strengths
Local Public Health System
Community Health Status
Forces of Change
Community Themes and Strengths
Assessment
The Community Themes and
Strengths Assessment
answers the following
questions:
"What is important to our
community?"
"How is quality of life perceived
in our community?"
"What assets do we have that
can be used to improve
community health?"
Quality of Life Survey
Pathways 2020
Focus Groups
Pathways 2020
Cowlitz Quality of Life Survey
Used the MAPP Quality of Life survey
example as the basis
Utilized the County Health Department
contracted Epidemiologist for review and
guidance
Distributed to various locations
1004 respondents
Outcomes
10
Cowlitz Results:
What Do You Think Are the Most
Important (3) Factors for a Healthy
Community?
Low crime / safe neighborhoods
Good schools
Good jobs and healthy economy
Good place to raise a family
Strong family life
0 10 20 30 40 50 60
Percent of Respondents
11
Cowlitz Results:
Is This Community a Safe Place to
Live?
Poor Excellent
4% 3% Very Good
Fair
22%
24%
Good
47%
12
Cowlitz Results:
Do All Residents Perceive That They-
Individually and Collectively –
Can Make the Community a Better Place to Live?
Don't Not
know / Answered
refused to 3%
answer
24%
No
47%
Yes
26%
13
Local Public Health System Assessment
The Local Public Health System
Assessment (LPHSA) answers
the following questions:
“What are the components,
activities, competencies,
and capacities of our local
public health system?"
"How are the Essential
Services being provided to
our community?"
LPHSA Survey
Cowlitz County Health
Dept
Local Public Health System
Police
Home Health
EMS Community Churches Corrections
Centers MCOs
Health
Department
Parks
Schools
Elected
Doctors Hospitals Officials Nursing Mass Transit
Philanthropist Homes
Environmental
Civic Groups Health
CHCs Fire
Tribal Health
Economic
Laboratory Drug Mental Employers
Development
Facilities Treatment Health
Cowlitz County Local Public
Health System Assessment
Reviewed the National Performance Standards
Reviewed Washington State Performance
standards
Worked with Health Department contracted
Epidemiologist to develop survey
Distribution was through our Health Alert
Network List
Sent out a cup of tea with the survey and letter
16
Cowlitz Results:
What Resources Does Your Agency Lack?
(56% of respondents reported lacking adequate resources)
Ability to Public Trained
anaylsis awareness skilled staff
data for / media 14%
population 13% Technology
s 14%
7%
Building /
Space
19% Funds
33%
17
Community Health Status Assessment
The Community Health
Status Assessment (CHSA)
answers the following
questions:
"How healthy are our
residents?"
"What does the health
status of our community
look like?”
Utilized the 11 data
categories from the CHSI
project
Cowlitz County
Health Dept
Cowlitz Community Health
Assessment
Met with local community assessment work
group
Reviewed the community health status
indicators selected data from MAPP
examples
Reviewed other local health community
health
Created a data template with the final
selected indicators and data sources
19
Community Health Status
Assessment Indicator
Component Areas
Demographic
Socio-economic
Health resource availability
Quality of life
Behavioral Risk factor surveillance system survey
Environmental health indicators
Social and Mental Health’
Maternal and Child Health
Death, Illness and injury
Infectious Disease
Sentinel events 20
Data Template: Cowlitz County
Health Indicators
21
Maternal Smoking During
Pregnancy
40%
Percent of Live Births
35%
30%
25%
Cowlitz
20%
State
15%
10%
5%
0%
1998 1999 2000 2001 2002 2003
Year of Live Birth
22
Percent of Adults That Smoke
23
22.8
22.6
22.4
Cowlitz
22.2 Washington
22 United States
21.8
21.6
21.4
Percent of Adults
Source: Behavioral Risk Factor Surveillance System (BRFSS), Centers for 23
Disease Control and Prevention and Washington Department of Health.
Percent of Adults That Are
Obese or Overweight
(Body Mass Index >25)
68
66
64
62
Cowlitz
60
Washington
58 United States
56
54
52
2001 2003
Source: Behavioral Risk Factor Surveillance System (BRFSS), Centers for 24
Disease Control and Prevention and Washington Department of Health.
Percent of Women Starting
Prenatal Care in First Trimester
of Pregnancy
84
Percent of All Live Births
82
80
78
76
74
72
Cowlitz Washington United States
25
Source: VISTA, Vital Registration System. Annual Statistical Files, Birth
Certificate Data: Washington State Department of Health
Cowlitz Results:
Community Health Status Indicators
Assessment Findings
High rate of pregnant women with lack of high
school education, Medicaid, smoking
Low rate of educational attainment
24% tobacco use
Youth substance abuse
High rate obesity/ low rate physical activity
STD rates
26
Forces of Change Assessment
The Forces of Change
Assessment answers
the following questions:
"What is occurring or
might occur that affects
the health of our
community or the local
public health system?“
"What specific threats or
opportunities are
generated by these
occurrences?"
Scenario planning project
Pathways 2020
Cowlitz Forces of Change
Assessment
Pathways 2020 Scenario Planning
Picture of our future
Victimized
Legacy
Destiny
Focus on workforce development
Buy in from the business community
EDC provided $5,000 for this project
Used by community partners
28
Cowlitz Results:
Forces of Change Assessment
Findings
Strategies
Create medical and education partnerships to
address health care occupation needs
Provide better and earlier advisement on
vocational and educational paths to careers
Utilize national skills standards and skill
assessment tools to advance and educate local
workforce
Maintain and enhance local social services
collaborations for workforce development
29
Cowlitz Results:
Forces of Change Assessment
Findings
Necessary community improvements
Develop or expand opportunities to train and
attract community leaders
Streamline all processes for new business
Support improvements in local transportation
Provide more social and recreational activities
for youth and adults
Promote life long learning
30
Cowlitz County Report Card
Healthy Lifestyles
Economy
Education
Families
Community
Environment
Hopes and Dreams
Diversity
31
Identify Strategic Issues
Strategic issues are
fundamental policy
choices or critical
challenges that must be
addressed in order for a
community to achieve its
vision.
Strategic Issues Relationship Diagram
Relationship to Vision: Community Places a High Value on Healthy People
Community Themes
•Provide more social/
and Strengths Community members
recreational opptys for
youth and adults Assessment do not feel it is a safe
place to live
Forces of
Change
Assessment Strategic Issue:
How can we
Encourage Local Public
Low commitment to school Healthy Health System
Lifestyles? Assessment
22% of respondents monitor
health status of their program
populations
Obesity Community Health
Physical activity Status Assessment
Sexual Transmitted Infections
High rate of drug use
33
Strategic Issues Relationship Diagram
Relationship to Vision: Community Places a High Value on Education
____________________
•Community has not needed
Community Themes
education until recently
•Promote life long learning and Strengths Community values
•Beginning change in Assessment Good schools
demographics
Forces of
Change
Assessment Strategic Issue:
How can we
Enhance Local Public
Low commitment to school Learning Health System
Opportunities? Assessment
DASA Needs
Assessment Lack of trained skill staff
•Educational attainment (bachelor degrees) Community Health
•High rate of dropouts Status Assessment
34
Strategic Issues Relationship Diagram
Relationship to Vision: Community Places high value on Healthy Families
Community Themes
and Strengths •Community does not
Promote more social feel like they
and recreational oppty Assessment
can make a
for youth and families difference
Forces of
Change
Assessment Strategic Issue:
How can we
•Family conflict Strengthen Local Public
•Family management problems Families, Parents, Health System
•Community disorganization Children and Assessment
Elderly ?
•Faith based opptys not
DASA Needs being utilized
Assessment •More programs in community
geared towards youth
(concentrated in Longview/Kelso)
not
Community Health Elderly
•Foster parent Status Assessment •Community disorganization
•Domestic violence
•Child abuse
35
Priority Area:
Healthy Lifestyles
Physical Activity /Nutrition
Awarded a 50K Grant (Preventive Health Block Grant Funds)
Sub contracted with Pathways 2020 for facilitation
Formed a Healthy Lifestyles Coalition
Completed various community assessments
Kaiser Permanente offered funds for the development of a
web page
Methamphetamine
Meth initiative
Maternal smoking
Maternal smoking Summit
36
Priority Area:
Education
Reducing the number of high school dropouts
Southwest Washington Workforce
Development Council
Working on strategies to meet the needs of the
health industry
Collaboration for vocational offerings – Skills
Center
Support afterschool programs and early
childhood education
37
Priority Area:
Strengthening Families
Formation Of A A Children Psychiatric Coalition
Utilization Of DASA Funding For County Prevention
Specialist –
Working To Empower Communities Through
ABCD
Appreciative Inquiry
Communities That Care
Out-based Community Services
Establishment Of One Local Agency To Be Identified As The
Parenting Resource Collaboration
Grant Writing Collaborative
Seniors First organization
38
Priority Area:
Infrastructure
Community Assessment Workgroup
Community workgroup focused on data
Resource Directory
Community Data Repository
Local webpage with data links and other
information
39
Cowlitz County
Lessons Learned
Ongoing process
Make information available as soon as possible
Resource tracking
Continuing re/education of partners
Organizing for success
Can be done with limited resources
Increased collaboration
Provides credibility for collaboration
40
Contact Information
Sue Grinnell, Director
Cowlitz County
Health Department
grinnells@co.cowlitz.wa.us
www.co.cowlitz.wa.us/health
Paul Youmans, Director
Pathways 2020
youmans@cowlitzedc.com
41
