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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

				
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