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					Preventive Health and Health Services
            Block Grant



        D-R-A-F-T Work Plan
 Original Work Plan for Fiscal Year 2010
         Submitted by: Virginia
Contents                                                   Page

Executive Summary                                             3

Statutory and Budget Information                              5

Budget Detail                                                 6
Summary of Allocations                                        7

Program, Health Objectives, and 10 Essential                  8
Services

Adult and Older Adult Dental Program                          8
21-2 Unt reat ed dental decay                                 8
CHAMP ION                                                    13
19-2 Obesity in adults                                       15
19-3 Overweight or obesity in children and                   17
adolescents
Chronic Disease Prevention and Cont rol for Healt hy         20
Communities
7-10 Community health promotion programs                     21
Chronic Disease Self-Management Program                      26
7-10 Community health promotion programs                     27
Community Water Fluoridation                                 30
21-9 Community water fluoridation                            30
Dent al Disease Reduction Program                            34
21-1 Dental caries experience                                35
Injury Prevention                                            40
15-13 Unintentional injury deaths                            40
OFHS Research and Analysis - Surveillance                    44
Program
23-2 Public health access to information and                 45
surveillance data
Sexual Assault Intervention and Education Program            48
15-35 Rape or attempted rape                                 49
Virginia S uicide Prevention Program                         53
18-1 Suicide                                                 53




                                                       2
                                            Executive Summary

This work plan is for the Preventive Health and Health Services Block Grant (PHHSBG) for Federal Year
2010. It is submitted by the Virginia Department of Health as the designated state agency for the
allocation and administration of PHHSBG funds.

Funding Assumptions: The total award for the FY 2010 Preventive Health and Healt h Services Block
Grant is $2,017,317. This amount is based on a funding update allocation table distributed by CDC in
June 2009. Proposed allocation and funding priorities for FY 2010 funds are also allocated to program
areas that address the following Healthy People 2010 national health status objectives:

Community Health Promotion (HO 7-10): $367,000 of this total will be used to fund the Chronic Disease
Prevention and Control Program and the Chronic Disease Self Management Program. Funds will be
used to support staff, provide training, and develop partnerships in order to increase health promotion
programs throughout the state and improve chronic disease outcomes.

Unint entional Injury (HO 15-13): $350, 000 of this total will be utilized to support staff within the Division of
Injury and Violence P revention and fund 90+ community prevention projects statewide that address
leading injury areas as well as emerging and local injury issues.

Sexual Assault-Rape Crisis (HO 15-35): $15,006 of this total is a mandatory allocation to the Virginia
Department of Health, which provides this funding through a contract with the Virginia Sexual and
Domestic Violence Action Alliance (the Action Allianc e) to provide statewide coordination of sexual
assault advocacy, data collection on victim services and outcomes, technical assistance, training and
other support to local sexual assault crisis centers and ot her professionals working to improve the
community response to sexual assault.

Suicide (HO 18-1): $90,000 of this total will be used to support Virginia’s Suicide Prevention Program,
which utilizes SAMHSA approved evidence -based suicide prevention programs. Funds will be used to
provide public awareness events, training materials, trainer stipends, and a statewide stakeholder
meeting.

Obesity (HO 19-2, Adult and 19-3, Children): $300,000 of this total will be used to fund the
Commonwealth’s Healt hy Approach and Mobilization Plan for Inactivity, Obesity, and Nutrition
(CHAMPION) Program, which addresses obesity in adult s and children. Funds will support the
implementation of community-based projects and support staff in the Division of WIC and Community
Nutrition Services who will provide training and technical assistance to select community projects.

Dent al Disease (HO 21-1): $263,837 of this total will be utilized to support the Dental Disease Reduction
Program, which will provide treatment services (screenings, fluoride varnish, dental sealants) by
professional dental staff to school age children in targeted communities throughout the state.

Adult Dental Dec ay (HO 21-2): $88,000 of this total will fund the Adult and Older Adult Dental Program.
The program will increase access to oral health services through the implementation of an oral health
program for adult women of child-bearing age and a pilot project for older adults. The program will
provide education, training, and dental services.

Community Water Fluoridation (HO 21-9): $149,663 of this total will be used to maintain Virginia’s
optimal community water fluoridation level by supporting the Community Water Fluoridation coordinat or
position and utilizing funds for equipment upgrades, monit oring water systems, and providing training,
education, and technical assistance.

Public Health Information Access and Surveillance Data (HO 23-2): $100,581 of this total will be used to
fund a part-time statistical analyst position to increase the availability of dat a through national survey data
sets. Funds will also be used to support the increase of the BRFSS sample size.



                                                        3
Administrative costs associated with the Preventive Health Block Grant total $207, 230, which is 10% of
the grant. The grant application is prepared under federal guidelines, which require that states use funds
for activities directed toward the achievement of the National Health Promotion and Disease Prevention
Objectives in Healthy People 2010.


Funding Rationale: Under or Unfunded, Data Trend




                                                     4
5
                    Budget Detail for VA 2010 V0 R0

Total Award (1+6)                                     $2,072,317

A. Current Year Annual Basic
  1. Annual Basic Amount                              $1,898,978
  2. Annual Basic Admin Cost                          ($189,897)
  3. Direct Assistance                                        $0
  4. Trans fer Amount                                         $0
  (5). Sub-Tot al Annual Basic                        $1,709,081

B. Current Year Sex Offense Dollars (HO 15-35)
  6. Mandated Sex Offense Set Aside                    $173,339
  7. Sex Offense Admin Cost                            ($17,333)
  (8.) Sub-Total Sex Offense Set Aside                 $156,006

(9.) Total Current Year Available Amount (5+8)        $1,865,087

C. Prior Year Dollars
  10. Annual Basic                                           $0
  11. Sex Offense Set Aside (HO 15-35)                       $0
  (12.) Tot al Prior Year                                    $0

13. Total Available for Allocation (5+8+12)           $1,865,087



Summary of Funds Available for Allocation

A. PHHSBG $'s Current Year:
  Annual Basic                                        $1,709,081
  Sex Offense Set Aside                                 $156,006
  A vailable Current Year PHHSBG Dollars              $1,865,087

B. PHHSBG $'s Prior Year:
  Annual Basic                                               $0
  Sex Offense Set Aside                                      $0
  A vailable Prior Year PHHSBG Dollars                       $0

C. Total Funds Available for Allocation               $1,865,087




                                   6
           Summary of Allocations by Program and Healthy People 2010 Objective


Program Title           Health Objective      Current Year       Prior Year   TOTAL Year
                                              PHHS BG $'s      PHHS BG $'s    PHHS BG $'s
Adult and Older         21-2 Unt reat ed           $88,000               $0      $88,000
Adult Dental            dental decay
Program
Sub-Total                                            $88,000            $0        $88,000
CHAMP ION               19-2 Obesity in             $150,000            $0       $150,000
                        adults
                        19-3 Overweight or          $150,000            $0       $150,000
                        obesity in children
                        and adolescents
Sub-Total                                           $300,000            $0       $300,000
Chronic Disease         7-10 Community              $325,000            $0       $325,000
Prevention and          health promotion
Cont rol for Healt hy   programs
Communities
Sub-Total                                           $325,000            $0       $325,000
Chronic Disease         7-10 Community               $42,000            $0        $42,000
Self-Management         health promotion
Program                 programs
Sub-Total                                            $42,000            $0        $42,000
Community Water         21-9 Community              $149,663            $0       $149,663
Fluoridation            water fluoridation
Sub-Total                                           $149,663            $0       $149,663
Dent al Disease         21-1 Dental caries          $263,837            $0       $263,837
Reduction Program       experience
Sub-Total                                           $263,837            $0       $263,837
Injury Prevention       15-13 Unintentional         $350,000            $0       $350,000
                        injury deaths
Sub-Total                                           $350,000            $0       $350,000
OFHS Research           23-2 Public health          $100,581            $0       $100,581
and Analysis -          access to
Surveillance            information and
Program                 surveillance data
Sub-Total                                           $100,581            $0       $100,581
Sexual Assault          15-35 Rape or               $156,006            $0       $156,006
Intervention and        attempted rape
Education Program
Sub-Total                                           $156,006            $0       $156,006
Virginia S uicide       18-1 Suicide                 $90,000            $0        $90,000
Prevention Program
Sub-Total                                          $90,000              $0        $90,000
Grand Total                                     $1,865,087              $0     $1,865,087




                                                7
State Program Title: Adult and Older Adult Dental Program

State Program Strategy:

Program Goal: The Adult and Older Adult Dental Program goal is to improve access to dental services
for the adult and older adult, especially those adults who are indigent or in nursing homes.

Program Health Priority: Link people to health services.

Primary Strategic Partnerships: The partnerships that are critical for these projects to succeed include
those with other agencies, internal and external, that deal wit h the oral he alth issues of the elderly. Those
partners include the Virginia Association of Area Agencies on Aging, Virginia Association of Nursing
Homes, Department of Juvenile Justice, Richmond Redevelopment and Housing Authority, and the
Virginia Dental Association (VDA ). The Office of Family Health Services Research and E valuation Team
will be a partner in the assessment and evaluation portion of this project.

Evaluation Methodology: Survey questions will be reviewed by the OFHS Research and E valuation
Team, as well as through technical assistance from the Association of State and Territ orial Dental
Directors (ASTDD). Response rates will be used to help det ermine the validity of the survey results.

The oral health aide project will be evaluat ed through surveying the facility regarding a number of short
term outcome measures including the number of residents with improved oral health care, improved
patient and family satisfaction, and a decrease in emergency room visits to assess dental issues. Prior to
commencing the project, a clinical survey of a sample of residents will be conducted using the Oral
Hygiene Index (OHI), a method for classifying the oral hy giene status of a patient. The OHI can be used
over time to monitor progress in corrective interventio ns, and will be conducted at the end of the pilot.
Finally, health professionals (physicians and dentists) who work with specific nursing homes will also be
surveyed as to the effectiveness of the training and aide program and how it has benefited their p atients.
They will also complete pre and post tests to evaluat e the extent to which trainings were effective.


State Program Setting:
Senior residence or center

FTEs (Full Time Equivalents):
Full Time Equivalents positions that are funded with PHHS Block Grant funds.

Posi tion Title: Dental Hygienist
State-Level: 0% Loc al: 50% Other: 0% Total: 50%

Total Number of Posi tions Funded: 1
Total FTEs Funded: 0.50


National Health Objective: HO 21-2 Untreated dental decay

State Health Objective(s):

Between 10/ 2009 and 09/2010, increas e the number of adults and older adults who have access to oral
health services.
Baseline data:




                                                      8
Baseline:
According to the most recent national survey data, 27% of adults aged 35 to 44 years had untreated
dental decay in 1998–2004. According to the National Nursing Home Survey, only 19% of all nursing
home residents received dental services in 1997.

Data Source:
National Nursing Home Survey

State Health Problem:

Health Burden: Throughout the past decades, there have been significant improvements in the oral
health status of American adults. Through the implement ation of community fluoridation and prevention
efforts, the prevalence of dental diseas e has declined among the adult population. Compared to previous
generations, a higher percentage of adults are maintaining their natural teeth, especially among older
adults. In fact, the prevalence of complete tooth loss (edentulism) has significantly decreased during the
past twenty years from 33% to 20% among 55-64 year old adults and from 2% to 0.4% among younger
adults 18-34 years. Despite these successes in adult oral health, not all adults have benefited from
advances in oral health care and dental diseas e prevention efforts. As a result, adverse oral health
outcomes continue to persist in the adult population, creating additional challenges for further reducing
the prevalenc e of dental disease for all adults. Furthermore, adults who suffer from poor oral health are
also more likely to experience decrements to their overall health with a reduced quality of life compared to
adults who maint ain good oral health. Therefore, public healt h strategies need to identify and address
health dis parities among the population in order to effectively improve the oral health needs of all adults.

According to the 2000 Surgeon General report, most U.S. adults experience signs of gum disease and
untreated tooth decay, which persists predominantly among adults of low -socioeconomic (SES) status.
 Oral health is an integral component of total wellness. The importance of oral health was spotlighted
with the release of Oral Health in America: A Report of the Surgeon General, in 2000. This report
focused on the oral healt h of all Americans and was the first of its kind to show the mouth as the "mirror
for general health and well-being‖. The report reminded us all that oral health meant more than just
sound teeth and that "Ignoring oral health problems can lead to needless pain and suffering,
complications that can devastate well-being and financial and social costs that significantly diminish
quality of life and burden American society". In recent years, researchers have found more and more
evidence linking bacteria in the mouth to many systemic conditions. For example, while the direct link
between oral bacteria and heart disease and stroke is unknown, people with gum disease are twice as
likely to have certain types of heart disease and people diagnosed wit h acute cerebrovascular ischemia
were found more likely to have an oral infection when compared to those in control groups. People with
diabetes are more likely to have periodontal disease than people without diabet es. In fact, periodontal
disease is often considered the sixth complication of diabetes, causing bone and ti ssue loss at a greater
rate and making the diabetic condition harder to control.

While slightly less than two-thirds of American adults report ed visiting a dentist within the past year, adults
of lower SES status were even less likely to receive an ann ual dental visited compared to adults of higher
SES. As a result, low SES populations are less likely to benefit from the early detection of oral health
problems and prophylaxis treatment. These findings are consistent with those of the Virginia BRFSS.

Dent al insurance status is perhaps the most salient predictor of oral health care access, including annual
visits to the dentist. However, the percentage of adults with dental coverage is lower compared to the
proportion of adults who receive medical insurance. Socioeconomic status and race/ethnicity are
significant factors related to dental care access among American adults. Adults with low educ ational
attainment (less than a high school education) and those living below the poverty level were leas t likely to
visit the dentist within the previous year. Gender and race/et hnicity were also important factors related to
dental care access as females and white, non-Hispanic adults were more likely to report an annual dental
visit compared to adult males and minorities.




                                                       9
Age is affiliated with utilization of dental services. With increasing age, there is a decline in the
percentage of older adults who access dental services. This is despite the demonstrated need for care
among the elderly. In fact, as the U.S. population has aged, there has been a resultant increase in the
decay rate in older adults such that persons aged 65 years and older have more decay than children less
than 14 years who live in an area with nonfluoridated water. Furthermore, the elderly are more likely to
experience oral health complications that require extensive treatment compared to younger adults.

Additionally, in the most recent national survey (NHANES III), nearly half of all individuals aged 75 years
or older had root caries on one or more teeth. A comparison of NHA NES I and NHANES III—for which
data were collected in 1971–1974 and 1988–1994, respectively—reveals that the percentage of teeth
with caries (treated or untreated) decreased for individuals between the ages 18 and 54 years but
increased for those between the ages of 55 and 74 years. The progression of root caries in an individual
with little or no saliva can be quite rapid, and the restoration of these lesions is often technically
challenging.

―A State of Decay - The Oral Healt h of Older Americans‖, released in 2003 by Oral Health Americ a,
provides evidenc e of a crisis among the elderly with regard to oral health. In this report, Virginia received
a failing grade of ―F‖ for dental coverage of older Americ ans, highlighting the need for increased access to
oral health services for thes e individuals. Other reports, such as the Centers for Disease Control and
Prevention (CDC) ―The Oral Healt h of Older Americans,‖ document the unmet oral health needs of older
adults nationally.

Oral health problems in older adults can affect overall well being, ability to eat, nutritional status, and the
incidence of cert ain systemic infections such as aspiration pneumonia. Residents of institutions face
additional barriers to obt aining dental services. Often, residents have multiple chronic diseases, take
medications that affect their oral health, or have diseases or disabilities that make brus hing and flossing
their teeth difficult or impossible. Virginia B RFSS data shows an inc rease in the prevalence and severity
of toot h loss with increasing age. While approximately 10% of 18 to 24 year old adults reported at least
one missing toot h as a result of tooth decay or gum disease, 80% of adults over the age of 64 years had
experienced tooth loss. As anticipated, loss of all teeth was predominately concent rated among the
elderly population.

The target population includes adults and older adults in Virginia. The disparate population includes
indigent adults and older adults specifically including thos e in assisted living and nursing home facilities
and low-income women of child bearing age that visit local health department clinics.

Target Population:
Number: 886,574
Ethnicity: Hispanic, Non-Hispanic
Race: African American or Black, American Indian or Alaskan Native, Asian, Native Hawaiian or Other
Pacific Islander, White, Other
Age: 20 - 24 years, 25 - 34 years, 35 - 49 years, 50 - 64 years, 65 years and older
Gender: Female and Male
Geography: Rural and Urban
Primarily Low Income: Yes

Di sparate Population:
Number: 100,000
Ethnicity: Hispanic, Non-Hispanic
Race: African American or Black, American Indian or Alaskan Native, Asian, Native Hawaiian or Other
Pacific Islander, White, Other
Age: 20 - 24 years, 25 - 34 years, 35 - 49 years, 50 - 64 years, 65 years and older
Gender: Female and Male
Geography: Rural and Urban
Primarily Low Income: Yes
Location: Entire state



                                                      10
Target and Disparate Data Sources: U.S. Census Bureau; Virginia Association of Nursing Homes;
Virginia Department of Health

Evidence Based Guidelines and Best Practices Followed in Developing Interventions:


Other: Best practices from the Associaiton of State and Territorial Dental Directors

Surveillance: The Surgeon General’s Report on Oral Health (S GROH) stated, ―having state-specific and
local data that augment national data is critical in identifying high -risk populations and in addressing oral
health dis parities.‖ The report furt her proposed that implementation strategies to overcome barriers in
oral health disparities should include building and supporting epidemiologic and surveillance efforts to
identify patterns of disease and populations at risk.

Best Practice Guidelines for Oral Health Surveillance from ASTDD include:
Impact/Effectiveness: A state-based oral healt h surveillance system contains a core set of measures that
describes the status of important oral health conditions and behaviors. These measures serve as
benchmarks for assessing progress in achieving good oral health. An oral heal t h surveillance system
communicates data and information to responsible parties and to the public in a timely manner.

Efficiency: Data collection is managed on a periodic but regular schedule. Cost -effective strategies are
used in collecting, analyzing and communicating surveillance data.

Collaboration/Int egration: Partnerships are established to leverage resources for data collection. Data
and findings from the surveillance system are used to integrate oral health into other health programs.


Funds Allocated and Block Grant Role in Addressing this Health Objective:
Total Current Year Funds Allocated to Health Objective: $88,000
Total Prior Year Funds Allocated to Health Objective: $0
Funds Allocated to Disparate Populations: $88, 000
Funds to Loc al Entities: $88,000
Role of Block Grant Dollars: No ot her existing federal or state funds
Percent of Block Grant Funds Relative to Other State Health Department Funds for this HO:
100% - Total source of funding

                 ESSENTIAL SERVICES –OBJECTIVES – ANNUAL ACTIVITIES

Allocated funds are used to achieve Impact & Process Objective outcomes and to carry out Annual
Activities that are based on E vidence Based Guidelines and Best Practices identified in this work plan.

Essential Service 7 – Link people to services

Objective 1:
Increase access to oral health service s
Between 11/ 2009 and 09/2010, the Division of Dental Health will increase the percent of adults and older
adults that have access to oral health services from 19 to 25.
Annual Acti vities:
1. Develop educational program
Between 11/ 2009 and 09/2010, develop an educational program for women of child bearing age
regarding oral health and its impact on overall health, pregnancy outcomes and their children’s oral
health.

2. Implement the oral health women's program




                                                      11
Between 11/ 2009 and 09/2010, implement the oral health women’s program in local health departments,
community healt h centers, and free clinics where women at risk receive family planning and other routine
medical services.

3. Provide training
Between 11/ 2009 and 09/2010, provide hands-on training regarding the provision of oral health services
to staff in nursing homes in targeted areas.

4. Pilot a program for older adults
Between 11/ 2009 and 09/2010, pilot a program to link older adults to care thr ough working with local area
agencies on aging, dental components and volunteers, and the Virginia Dental Health Foundation.
Dentist volunteers will screen the patients at senior café and other locations in a targeted area. Care will
be coordinated for referrals for treatment to public or private dentists with reimbursement provided at a
nominal fee.

5. Provide denture service s
Between 11/ 2009 and 09/2010, maintain two local health department dental clinics providing denture
services for low income senior citizens.




                                                    12
State Program Title: CHAMPION

State Program Strategy:

Program Goal: CHAMPION’s program goals include:

    1.   Prevention and control of obesity and ot her related risk factors through Virginians making healthy
         food choices and increasing physical activity;
    2.   Promotion of policy and environmental changes that support obesity prevention;
    3.   The reduction in prevalence and incidence of overweight and obesity levels among Virginians
         reached through increasing community lead interventions and programs


Program Health Priority: The obesity epidemic continues to be one of the most urgent health problems
facing Virginia today. The prevalence of overweight and obesity in the Commonwealth has increased
steadily over the past decade.

Data from the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System
(BRFSS) reveals that from 1996 to 2008 the percentage of obese Virginia adults increased from 15.9
percent in 1996 to 25.7 perc ent in 2007. Presently, nearly 62 percent of Virginia adults are considered
either overweight or obese. In addition to increased prevalence of obesity among all adults, disparities
continue to exist. In Virginia, prevalenc e of obesity among white, non -Hispanic is 23.6% compared to
black, non-Hispanic at 34.5% and Hispanic, 24.7%. In addition to racial/ethnic disparities, geographic
disparities are apparent in Virginia. Using BRFSS data for health districts reveal that Sout hwest Virginia
has the highest obesity rate followed by Hampton Roads, Roanok e, Cent ral, Blue Ridge, and Nort hern
VA.

Healt h behavior is complex and is influenc ed by a variety of factors. The key to prevention and treatment
of obesity in Virginia will be to bring changes from many directions, at multiple levels, and through
collaboration within and between many groups. This social-ecological approach encompasses multiple
levels of risk factors and health determinants: individuals, families and social networks, cultural
characteristics including social and cultural norms and cultural differences, communities, systems of
services, the built and natural environments, laws and political processes, and the interactions and
reciprocal influences among them.

Primary Strategic Partners:

The Division of WIC and Community Nutrition Servic es (DWCNS), which houses CHAMP ION, has
fostered a number of collaborative relationships and strategic partnerships both internally and externally.
CHAMP ION’s primary strategic partnerships include the Mat ernal Child Health Block Grant (MCH),
Preventive Health and Healt h Services Block Grant (PHHS), Virginia Women, Infants and Children (WIC)
Program, and Governor Kaine’s Healthy Virginians initiative.


Beginning in July 2009, the General Assembly of Virginia expanded the role of the Virginia Tobacco
Settlement Foundation to include childhood obesity. The new, Virginia Foundation for Healthy Youth
(VFHY) and CHAMP ION have created a strong partnership providing an aligned strategic approach to
utilize the strengths and reach of both part ners.


Evaluation Methodology: The CDC Framework for Program E valuation will be used to evaluat e the
implementation of the CHAMPION Obesity Prevention initiative. Surveillance data from the CDC
Behavioral Risk Factor Surveillanc e System (BRFSS), The Pediatric Nutrition Surveillanc e System
(PedNSS), CDC Pregnancy Risk Assessment Monitoring System (PRAMS) and WIC will be used to
evaluate the programs progress towards the overall program goal of the prevention and control of
overweight and obesity in Virginia.



                                                     13
The Virginia Youth Survey will provide an internal view of health behaviors among Virginia’s youth. In
addition, data will be collected from the VFHY expanded survey to include childhood obesity risk factors.

CHAMP ION rec ommended programs include a program evaluation instrument for communities to assess
outcomes at the community level. Funded and non-funded participating communities will be required to
submit an evaluation summary report to DWCNS, allowing opportunity for aggregated data collection of
local projects.


State Program Setting:
Business, corporation or industry, Child care center, Community based organization, Community health
center, Faith based organization, Home, Local health department, Medic al or clinical site, Parks or
playgrounds, Rape crisis center, Schools or school district, Senior residence or center, State health
department, University or college, Work site

FTEs (Full Time Equivalents):
Full Time Equivalents positions that are funded with PHHS Block Grant funds.

Posi tion Title: Obesity Prevention Coordinator
State-Level: 60% Local: 0% Other: 0% Total: 60%
Posi tion Title: Obesity Prevention Dietitian
State-Level: 0% Loc al: 60% Other: 0% Total: 60%
Posi tion Title: Physical Activity Coordinator
State-Level: 60% Local: 0% Other: 0% Total: 60%
Posi tion Title: Health Educator Senior
State-Level: 0% Loc al: 60% Other: 0% Total: 60%
Posi tion Title: Division Director
State-Level: 10% Local: 0% Other: 0% Total: 10%
Posi tion Title: Nutrition Services Manager
State-Level: 10% Local: 0% Other: 0% Total: 10%
Posi tion Title: Technology Manager
State-Level: 10% Local: 0% Other: 0% Total: 10%
Posi tion Title:      Policy Analyst
State-Level: 20% Local: 0% Other: 0% Total: 20%
Posi tion Title: Training Supervisor
State-Level: 0% Loc al: 20% Other: 0% Total: 20%
Posi tion Title: Division Trainer
State-Level: 0% Loc al: 20% Other: 0% Total: 20%

Total Number of Posi tions Funded: 10
Total FTEs Funded: 3.30


National Health Objective: HO 19-2 Obesity in adults

State Health Objective(s):
Between 10/ 2009 and 09/2010, reduce the rates of obese adults from 25.7 percent to 20 percent and
overweight adults from 35.8 percent to 30 perc ent.

Baseline:
25.7% of Virginia adults obese, 35. 8% adults overweight




                                                    14
Data Source:
2008 Centers for Disease Cont rol and Prevention, Behavioral Risk Factor Surveillance System Data
(BRFSS)

State Health Problem:

Healt h Burden: Obesity is considered an individual clinical condition; however it is now recognized as a
public health threat because of its detrimental health impact on American communities. Obesity and
overweight have been shown to increase an individual’s risk of many diseas es and health conditions,
including hypertension, osteoarthritis, high chol esterol, type 2 diabet es, coronary heart disease, stroke,
gallbladder disease, sleep apnea, respiratory problems and some cancers.

Overweight and obesity rates in Virginia have increased significantly among adults and children over the
last two decades. Poor diet and physical inactivity are the two most important contributing factors. In
addition to increasing rates of overweight and obesity, disparities continue to exist. When analyzed by
race and ethnicity, BRFSS data reveals that 34.5 perc ent of Black, Non-Hispanic Virginians and 24.7
percent of Hispanic Virginians are considered obese. When examining Virginia obesity trends by gender,
data indic ates almost 26 percent of males are considered obese and 25.7 percent of adult females are
considered obese. Dat a also reveals that in Virginia, 43.9 percent of males are considered overweight
and 29.4 percent of adult females are considered overweight.

The 2007 B RFSS revealed that 50.5 percent of Virginians reported that they are not getting the daily
allotment of recommended physical activity and 23.6 percent reported not engaging in any physical
activity in the past month. The survey also revealed that 73. 7 percent of Virginians do not consume the
recommended number of servings of fruits and veget ables.

In 2006, Virginia received a C in our efforts to control obesity from the University of Baltimore Obesity
Report Card. This was an improvement from receiving a D in obesity control. Virginia is moving in the
right direction addressing our obesity problem; however there is much more work to be done.

Target Population:
Number: 7,642,884
Ethnicity: Hispanic, Non-Hispanic
Race: African American or Black, American Indian or Alaskan Native, Asian, Native Hawaiian or Other
Pacific Islander, White, Other
Age: 20 - 24 years, 25 - 34 years, 35 - 49 years, 50 - 64 years, 65 years and older
Gender: Female and Male
Geography: Rural and Urban
Primarily Low Income: Yes

Di sparate Population:
Number: 5,380,804
Ethnicity: Hispanic, Non-Hispanic
Race: African American or Black, American Indian or Alaskan Native, Asian, Native Hawaiian or Other
Pacific Islander, White, Other
Age: 20 - 24 years, 25 - 34 years, 35 - 49 years, 50 - 64 years, 65 years and older
Gender: Female and Male
Geography: Rural and Urban
Primarily Low Income: Yes
Location: Entire state
Target and Disparate Data Sources: U.S. Census Bureau

Evidence Based Guidelines and Best Practices Followed in Developing Interventions:
Guide to Community Preventive Servic es (Task Force on Community Preventive Se rvices)
MMWR Recommendations and Reports (Centers for Disease Control and P revention)




                                                     15
Other: CDC Rec ommends: The Prevention Guidelines System (CDC)
Healt hy People 2010

Funds Allocated and Block Grant Role in Addressing this Health Objective :
Total Current Year Funds Allocated to Health Objective: $150,000
Total Prior Year Funds Allocated to Health Objective: $0
Funds Allocated to Disparate Populations: $6,000
Funds to Loc al Entities: $69,890
Role of Block Grant Dollars: Supplemental Funding
Percent of Block Grant Funds Relative to Other State Health Department Funds for this HO:
75-99% - Primary sourc e of funding

                 ESSENTIAL SERVICES –OBJECTIVES – ANNUAL ACTIVITIES

Allocated funds are used to achieve Impact & Process Objective outcomes and to carry out Annual
Activities that are based on E vidence Based Guidelines and Best Practices identified in this work plan.

Essential Service 4 – Mobilize Partnerships

Objective 1:
Hold regional meetings
Between 10/ 2009 and 06/2010, the CHAMPION Obesity Prevention Team will increase the number of
regional meetings held from 2 to 6.
Annual Acti vities:
1. Hold community reengagement conference
Between 10/ 2009 and 01/2010, hold community reengagement conferences that will focus on Roanoke,
Cent ral, Blue Ridge, and Northern Virginia. The attendees will include community members representing
faith-bas ed groups, schools, civic organizations, local coalitions, non -profit organizations, businesses,
local chamber of commerce, health departments, parks and recreation, and other community
stakeholders

Activities to complete the impact objective include: procuring facilities to hold the 4 regional meetings,
appropriate staff travel approved, recruitment of community members to participat e in the regional
meeting, finalizing the Agenda for each meeting, preparing presentations and participants packets,
distributing information pertaining to CHAMP ION’s mini-grant opport unities, administering the regional
meeting evaluation, and measuring the success of the regional meeting in mobi lizing stakeholders.

Objective 2:
Provide community mini-grants
Between 10/ 2009 and 09/2010, the CHAMPION Obesity Prevention Team will increase the number of
mini-grants allocated for the implementation and evaluation of CHAMP ION recommended programs from
4 to 14.
Annual Acti vities:
1. Fund 10 community projects
Between 10/ 2009 and 09/2010, staff will submit a request for procurement (RFP); the RFP will be for up
to 10 community mini-grants. Staff will select community groups to receive funding. Staff will provide
training and technical assistance for funded programs. Staff will collect required program and process
evaluations.


National Health Objective: HO 19-3 Overweight or obesity in children and adolescents

State Health Objective(s):




                                                     16
Between 10/ 2009 and 09/2010, reduce the rate of overweight children from 16 percent to 12 percent, and
children at risk for becoming overweight from 12 percent to 10 percent.

Baseline:
16 percent of Virginia’s children ages 2-5 are overweight, 12 percent are at risk for overweight

Data Source:
2008 Virginia WICNet data; 2006 Pediatric Nut rition Surveillance System

State Health Problem:

Health Burden: Obesity is associated with significant healt h problems in the pediatric age group and is
an important early risk factor for much of adult morbidity and mortality.

The 2007 National Survey of Children’s Health found that nearly 31 percent of Virginia’s 10 to 17 year
olds are overweight or obese, mirroring the national average of 31 percent. In Virginia, highlights from the
2003 survey of 4th grade students indicate that 28 percent of participants were overweight and an
additional 17 percent were found ―at risk‖ for being overweight. According to dat a based on the
November 2008 enrollment in the Virginia WIC program, 16 percent of children ages 2-5 who participate
in the program are overweight and 12 percent are ―at risk‖ for overweight.

In 2006, Virginia received a C in both our efforts to control obesity and control childhood overweight
prevalence from the University of Baltimore Obesity Report Card. This was an improvement from
receiving an F in 2004 for childhood overweight and a D in obesity control. Virginia is moving in the right
direction addressing our obesity problem; however there is much more work to be done.

Target Population:
Number: 52,096
Ethnicity: Hispanic, Non-Hispanic
Race: African American or Black, American Indian or Alaskan Native, Asian, Native Hawaiian or Other
Pacific Islander, White, Other
Age: Under 1 year, 1 - 3 years, 4 - 11 years, 12 - 19 years
Gender: Female and Male
Geography: Rural and Urban
Primarily Low Income: Yes

Di sparate Population:
Number: 31,323
Ethnicity: Hispanic, Non-Hispanic
Race: African American or Black, American Indian or Alaskan Native, Asian, Native Hawaiian or Other
Pacific Islander, White, Other
Age: Under 1 year, 1 - 3 years, 4 - 11 years
Gender: Female and Male
Geography: Rural and Urban
Primarily Low Income: Yes
Location: Specific Counties
Target and Disparate Data Sources: Virginia WIC participation ages 2-5 years old from selected health
districts, counties, cities.

Evidence Based Guidelines and Best Practices Followed in Developing Interventions:
Guide to Community Preventive Servic es (Task Force on Community Preventive Services)
MMWR Recommendations and Reports (Centers for Disease Control and P revention)

Other: CDC Rec ommends: The Prevention Guidelines System (CDC)
Healt hy People 2010




                                                    17
Funds Allocated and Block Grant Role in Addressing this Health Objective :
Total Current Year Funds Allocated to Health Objective: $150,000
Total Prior Year Funds Allocated to Health Objective: $0
Funds Allocated to Disparate Populations: $6,000
Funds to Loc al Entities: $69,890
Role of Block Grant Dollars: Supplemental Funding
Percent of Block Grant Funds Relative to Other State Health Department Funds for this HO:
75-99% - Primary sourc e of funding

                 ESSENTIAL SERVICES –OBJECTIVES – ANNUAL ACTIVITIES

Allocated funds are used to achieve Impact & Process Objective outcomes and to carry out Annual
Activities that are based on E vidence Based Guidelines and Best Practices identified in this work plan.

Essential Service 4 – Mobilize Partnerships

Objective 1:
Hold regional meetings
Between 10/ 2009 and 06/2010, the CHAMPION Obesity Prevention Team will increase the number of
regional meetings held from 2 to 6.
Annual Acti vities:
1. Hold community reengagement conference
Between 10/ 2009 and 01/2010, hold community reengagement conferences that will focus on Roanoke,
Cent ral, Blue Ridge, and Northern Virginia. The attendees will include community members representing
faith-bas ed groups, schools, civic organizations, local coalitions, non -profit organizations, businesses,
local chamber of commerce, health departments, parks and recreation, and other community
stakeholders

Activities to complete the impact objective include: procuring facilities to hold the 4 regional meetings,
appropriate staff travel approved, recruitment of community members to participat e in the regional
meeting, finalizing the Agenda for each meeting, preparing presentations and participants packets,
distributing information pertaining to CHAMP ION’s mini-grant opport unities, administering the regional
meeting evaluation, and measuring the success of the regional meeting in mobilizing stakeholders.

Objective 2:
Provide mini-grants to communitie s
Between 10/ 2009 and 09/2010, the CHAMPION Obesity Prevention Team will increase the number of
mini-grants allocated for the implementation and evaluation of CHAMP ION recommended programs from
5 to 15.
Annual Acti vities:
1. Fund 10 community projects
Between 10/ 2009 and 09/2010, staff will submit a request for procurement (RFP) to VDH for up to 10
community mini-grants. Staff will select community groups to receive funding and conduct staff training
for appropriate programs. Staff will provide training and technical assistance for funded group and collect
required program and process evaluations.




                                                     18
State Program Title: Chronic Disease Prevention and Control for Healthy Communities

State Program Strategy:

Program Goal: To reduce occurrences, disabilities and deat hs due to chronic diseases, in Virginia.

Program Health Priority: Chronic diseases are a major contributor to the premat ure death and disability
of American adults. Not only does chronic diseas es account for 70 perc ent of all deaths in the Unit ed
States but more than 90 million Americ ans (about 30 percent of the U.S. population) live with chronic
illnesses. An estimated 2.2 million Virginians live with a chronic disease.

Modifiable behaviors that contribut e to the development and/or complications of major chronic diseases
include: physical inactivity, healthy weight maintenanc e, and use of tobacco products. In addition,
improper care of an existing health condition such as high blood pressure or diabetes can lead to co-
morbidity of chronic diseases.

The Division of Chronic Disease Prevention and Cont rol will provide resources, public and professional
education, consultation, and public health leadership related to the reduction of the bur den of chronic
diseases. This assistance will be provided to health districts, community agencies, and other health care
professionals in Virginia.

Initiatives foc us on improved health status for those at high risk for development of chronic diseases.
Activities include conducting community assessments; developing behavior change strategies for risk
reduction (nutrition, physical inactivity, and smoking); and providing professional education and training in
support of risk reduction activities. A strong chronic disease prevention program supports promoting
healthy behaviors, expanding the use of early detection practices, providing health education in
community, school and worksite settings, and working to develop healthy communities

Primary Strategic Partners:
Internal - Asthma Control Project, Comprehensive Cancer Control Project, Heart Disease and Stroke
Prevention Project, Diabetes Prevention and Control Project, Healthy Communities Initiative, Virginia
Canc er Registry, Tobacco Use Control Project, Virginia Chronic Disease Self Management Program,
Office of Minority Health and Healt h Policy, and Behavioral Risk Factor Surveillance System.

External – Heart Disease and Strok e Alliance, Virginia Diabet es Council, Local Tobacco Use Control
Coalitions, Virginia Cancer Plan Action Coalition, Virginia Asthma Coalition, Local Health Districts, privat e
and non-profits health agencies

Program Evaluation Methodology:
The division follows CDC’s format for program evaluation, using formative evaluation including needs
assessments, monitoring processes such as process indicators, reports, and surveys, and tracking short -
term (e.g. adoption of policies, environmental changes) and long term outcomes using data sources such
as the Behavioral Risk Factor Surveillance System (BRFSS), hospital discharge and morbidity data.


State Program Setting:
Business, corporation or industry, Community based organization, Faith based organization, State health
department

FTEs (Full Time Equivalents):
Full Time Equivalents positions that are funded with PHHS Block Grant funds.




                                                      19
Posi tion Title: Director, Division of Chronic Disease Prevention a
State-Level: 60% Local: 10% Other: 0% Tot al: 70%
Posi tion Title: Chronic Disease Control Program Supervisor
State-Level: 25% Local: 10% Other: 0% Tot al: 35%
Posi tion Title: Epi/Evaluator Manager
State-Level: 5% Loc al: 5% Other: 0% Total: 10%
Posi tion Title: Health Disparities Specialist
State-Level: 5% Loc al: 5% Other: 0% Total: 10%
Posi tion Title: Administrative Specialist
State-Level: 90% Local: 10% Other: 0% Tot al: 100%

Total Number of Posi tions Funded: 5
Total FTEs Funded: 2.25


National Health Objective: HO 7-10 Community health promotion programs

State Health Objective(s):
Between 10/ 2009 and 09/2010, the Division will maintain the 200 partner agency relationships to increase
the number of local healt h districts, community agencies, and health partner agencies who will initiate
comprehensive chronic disease prevention activities (in partnership with the state health department)
aimed at reducing the burden of chronic diseases.

Baseline:
The division currently has 200 partner agencies (including coalitions, workgroups, and non governmental
groups, cancer-reporting facilities, and health districts). The number of communities and/or sectors
conducting comprehensive chronic disease prevention activities is three.

Data Source:
Chronic Disease projects’ reports and contact tracking system.

State Health Problem:

Health Burden: In Virginia, heart disease, cancer, and stroke are the top three leading causes of death
and diabetes is the sixth leading cause of death as cited in the Virginia Vital Statistics Report. These
chronic diseases form the cornerstone for a comprehensive chronic disease prevention program.

In 2008, results from the Behavioral Risk Factor Surveillance System identified that 16.4 percent of
respondents smoke and 61.6 percent of respondents could be at risk for health problems relat ed to being
overweight or obese. In 2007, 50.5 percent of respondents had not participated in 30+ minutes of
moderate physical activity five or more days per week, or vigorous physical activity for 20+ minutes three
or more days per week.

The cost of people with chronic diseas es account for more than 75 percent of the nation's medic al-care
costs and chronic diseases account for one third of the years of potential life lost before age 65. For
Virginia, the costs of chronic diseas e exceed $24.6 billion.

African American, Hispanics, people living with disabilities, and older adult populations are the disparate
populations for chronic diseases such as heart disease, stroke, cancer, diabetes, arthritis, and asthma.

Target Population:
Number: 1,003,000
Ethnicity: Hispanic, Non-Hispanic
Race: African American or Black, American Indian or Alaskan Native, Asian, Native Hawaiian or Other
Pacific Islander, White, Other
Age: Under 1 year, 1 - 3 years, 4 - 11 years, 12 - 19 years, 20 - 24 years, 25 - 34 years, 35 - 49 years, 50



                                                     20
- 64 years, 65 years and older
Gender: Female and Male
Geography: Rural and Urban
Primarily Low Income: No

Di sparate Population:
Number: 90,000
Ethnicity: Hispanic, Non-Hispanic
Race: African American or Black, American Indian or Alaskan Native, Asian, Native Hawaiian or Other
Pacific Islander, White, Other
Age: Under 1 year, 1 - 3 years, 4 - 11 years, 12 - 19 years, 20 - 24 years, 25 - 34 years, 35 - 49 years, 50
- 64 years, 65 years and older
Gender: Female and Male
Geography: Rural and Urban
Primarily Low Income: No
Location: Entire state
Target and Disparate Data Sources: U.S. Census Bureau

Evidence Based Guidelines and Best Practices Followed in Developing Interventions:
Guide to Community Preventive Servic es (Task Force on Community Preventive Services)
MMWR Recommendations and Reports (Centers for Disease Control and P revention)


Other: Recommendations by the National Association of Chronic Dis ease Directors

Funds Allocated and Block Grant Role in Addressing this Health Objective :
Total Current Year Funds Allocated to Health Objective: $325,000
Total Prior Year Funds Allocated to Health Objective: $0
Funds Allocated to Disparate Populations: $150,000
Funds to Loc al Entities: $0
Role of Block Grant Dollars: No ot her existing federal or state funds
Percent of Block Grant Funds Relati ve to Other State Health Department Funds for this HO:
100% - Total source of funding

                ESSENTIAL SERVICES –OBJECTIVES – ANNUAL ACTIVITIES

Allocated funds are used to achieve Impact & Process Objective outcomes and to carry out Annual
Activities that are based on E vidence Based Guidelines and Best Practices identified in this work plan.

Essential Service 3 – Inform and Educate

Objective 1:
Maintain community partners/coalitions
Between 10/ 2009 and 09/2010, the Division of Chronic Disease P revention and Control will maintain 200
community part ner relationships to increase healthy behaviors (including early screening and /or self
management for chronic diseas es) in the areas of physical activity, tobacco use control, and healthy
weight through planned, coordinated, evidence-based, and community-based practices.
Annual Acti vities:
1. Conduct re search for local health distri cts
Between 10/ 2009 and 09/2010, conduct res earch and coordinate obtaining educational and
implementation resources for local health districts and partner agencies.

2. Develop surveillance data
Between 10/ 2009 and 09/2010, continue to develop and update a list of accessible surveillance data and
evaluation sourc es, and identify system gaps.




                                                     21
3. Update health indicators
Between 10/ 2009 and 09/2010, update and distribute chronic disease health indicators by health district.

4. Develop chronic di sease report
Between 10/ 2009 and 09/2010, develop a plan for analysis, writing and distributing a 2011- 2012 chronic
disease issue highlight report.

5. Partner to expand chronic disease interventions
Between 10/ 2009 and 09/2010, part ner with categorically funded projects to coordinate and expand
chronic disease interventions into Virginia worksites.

Objective 2:
Provide key chronic di sease prevention and control message s
Between 10/ 2009 and 09/2010, the Division of Chronic Disease P revention and Control staff will increase
the number of partner agencies routinely using division resources for chronic disease education and
interventions from 15 to 20.
Annual Acti vities:
1. Develop marketing strategies
Between 10/ 2009 and 09/2010, continue to develop marketing strategies to coordinate chronic disease
resources and key messages.

2. Promote chronic di sease prevention message
Between 10/ 2009 and 09/2010, continue to promote the message, ―Chronic Disease Prevention: You
Can‖, through web-based technology and media outlets in Virginia.

3. Develop outreach materials
Between 10/ 2009 and 09/2010, continue to develop out reach materials for health disparate p opulations
including older adults, those with disabilities and others regarding risks for chronic diseases.

4. Publish report
Between 10/ 2009 and 09/2010, the Division’s What ’s Happening Report is publis hed and distributed on a
quarterly basis.

5. Promote resources
Between 10/ 2009 and 09/2010, continue to promote the Division as a resource using the theme ―You
Can… contact us.‖


Essential Service 4 – Mobilize Partnerships

Objective 1:
Continue the development of partnerships within VDH and with other organizations
Between 10/ 2009 and 09/2010, the Division of Chronic Disease P revention and Control staff will maint ain
6 part nerships that support the reduction of chronic disease in Virginia.
Annual Acti vities:
1. Implement ManyOne partnership activity
Between 10/ 2009 and 09/2010, the ManyOne Partnership Team will continue to implement at least one
activity designed to increas e understanding of and opport unities for partnering.

2. Promote chronic di sease self management
Between 10/ 2009 and 09/2010, explore ways to promote chronic disease self-management and living
healthy lives with chronic conditions among partner agencies.


Essential Service 8 – Assure competent workforce



                                                    22
Objective 1:
Increase the number of partner agencies using evidence -based strategies
Between 10/ 2009 and 09/2010, the Division of Chronic Disease P revention and Control staff will maint ain
50 community partners using evidence -based strategies and best practices in chronic disease prevention.
Annual Acti vities:
1. Update website
Between 10/ 2009 and 09/2010, update website with Chronic Disease Prevention and Control Program
Guides and Best Practices reports.

2. Chronic di sease prevention and control training
Between 10/ 2009 and 09/2010, plan, conduct, and evaluate state chronic disease prevention and control
at least one training for community project coordinators, and part ner agencies with a projected audience
of at least 75 professionals.

3. Promote use of evidence-based practice s
Between 10/ 2009 and 09/2010, the ManyOne training , policy and systems change team will continue to
identify and promote use of evidenced -based, chronic disease prevention training curric ulums and
practices, which will be shared with community partners and coalitions.

Objective 2:
Increase the knowledge, skills, and abilities of health promotion staff
Between 10/ 2009 and 09/2010, the Division of Chronic Disease P revention and Control staff will maint ain
6 programs and 350 people participating in educational opportunities working in the field of health
promotion and chronic disease prevention and control.
Annual Acti vities:
1. Professi onal education and continuing education units
Between 10/ 2009 and 09/2010, continue to provide support and market professional education
opportunities and continuing education units for certified health education specialists (CHES ) within the
state.

2. Participation in NACDD and DPHE
Between 10/ 2009 and 09/2010, continue to participate in the activities/events of the National Association
of Chronic Disease Directors (NACDD) and the Directors of Health Promotion and Education (DHPE),
which provides information and linkages to funding sources, national directives for chronic disease and
health promotion, and guidance on emerging issues for these areas, these events include training
webinars and teleconferenc es.


Essential Service 9 – Evaluate health programs

Objective 1:
Provide consultative service s, educational strategies, and resources
Between 10/ 2009 and 09/2010, the Division of Chronic Disease P revention and Control staff will maint ain
6 state coalitions or task groups and 22 local coalitions of Virginia health professionals that use chronic
disease data reports and resources.
Annual Acti vities:
1. Provide consultation and technical assi stance
Between 10/ 2009 and 09/2010, continue to provide consultation and technical assistance to health
districts and community agencies to improve project implementation, promote use of social determinants
of health, and evaluation of services that focus on risk reduction for chronic diseas e in Virginia.

2. Strategic plan implementation
Between 10/ 2009 and 09/2010, continue implementation of state chronic disease prevention and control
strategic plan.




                                                    23
3. Upgrade chronic di sease prevention data
Between 10/ 2009 and 09/2010, continue to upgrade the chronic disease prevention data and evaluation
collection systems and work with local health districts in utilizing data from this system.

4. Update stati stical source s
Between 10/ 2009 and 09/2010, review current statistical sources (BRFSS, mortality and hospital
discharge) and update statistics used by chronic disease prevention project areas to reflect currently
available data sources.




                                                    24
State Program Title: Chronic Disease Self-Management Program

State Program Strategy:

Program Goal: To implement and expand CDSMP, to include the Diabetes Self -Management Program,
in the Commonwealth based on identified need, by training personnel in interested health districts and
other agencies/organizations who work with populations of adults living with a chronic disease.

Program Health Priority: The CDSMP has four main priorities: 1) to assist adults who are living with a
chronic disease in managing the day-to-day issues of the disease; 2) to assist patients in taking
responsibility for the management o f their disease; and 3) to increas e knowledge and skills of patients
living with a chronic disease to improve overall health and decrease utilization of health care resources;
4) to expand CDSMP to include the DSMP.


Primary Strategic Partners: Stanford University, Virginia Diabetes Council, Healt h Promotion for People
with Disabilities Task Force, Carilion Healt h System, Heart Disease and Stroke Alliance, Virginia Arthritis
Action Coalition, Virginia Asthma Coalition, Cancer Plan Action Coalition, local health districts, Area
Agencies of Aging, Virginia Department on Aging, and Sentara Obici Hospital.


Evaluation Methodology: The Division of Family and Community Medicine in the School of
Medicine at Stanford University conducted the initial evaluation of the program through a randomized
controlled trial. The study was completed in 1996, and has been replicat ed in Maryland, Florida, Vermont,
Alaska and New York. Over 1,000 people with heart disease, lung disease, stroke or arthritis participated
in a randomized, controlled test of the program, and were followed for up to three years. The following
key components of effective condition management were assessed among program participants: health
status (disability, social/role limitations, pain and physical discomfort, energy/fatigue, short ness of breath,
psychological well-being/distress, depression, health distress, self-rated general health), health care
utilization (visits to physicians, visits to emergency departments, hospital stays, and nights in hos pital),
self-efficacy (confidence to perform self-management behaviors, confidence to manage disease in
general, confidence to achieve outcomes), and self-management behaviors (ex ercise, cognitive symptom
management, mental stress management/relaxation, us e of community resources, communication with
physician, and advance directives).

The Division of Chronic Disease Prevention and Cont rol utilizes the evaluation forms developed by
Stanford University for the CDSMP and DSMP. The coordinator will collect data from the different
programs pre and post implementation to note successes. The coordinator will conduct site visits to the
local programs to document program successes and barriers, and to assure program implementation
fidelity. The CDSMP evaluations results showed:
      51% of participants had arthritis
      47% of participants had diabetes
      48% of participants had other chronic condition
      34.7% of participants reporting showed an increase in knowledge about managing their chronic
          condition
      27.6% of participants reporting showed an increase in self-efficacy
      51.7% of participants reporting showed an increase in management of cognitive symptoms


State Program Setting:
Community based organization, Community health center, Faith based organization, Medic al or clini cal
site, Senior residence or center, Tribal nation or area

FTEs (Full Time Equivalents):
Full Time Equivalents positions that are funded with PHHS Block Grant funds.




                                                       25
Posi tion Title: CDSMP Coordinator
State-Level: 100% Local: 0% Other: 0% Tot al: 100%

Total Number of Posi tions Funded: 1
Total FTEs Funded: 1.00


National Health Objective: HO 7-10 Community health promotion programs

State Health Objective(s):
Between 10/ 2009 and 12/2010, increas e the number of health districts from four to eight that have an
established community health promotion program that addresses multiple Healthy People 2010 foc us
areas.

Baseline:
Four health districts

Data Source:
Division of Chronic Disease Prevention and Control, Virginia Department of Health

State Health Problem:

Health Burden: Chronic diseases are defined by the Centers for Disease Control and Prevention (CDC)
as those diseases that are prolonged, do not resolve spontaneously, and for which a complete recovery is
rarely achieved. Heart disease, cerebrovascular disease (also called stroke), cancer, asthma, diabet es,
and arthritis, some of which are among the top ten leading causes of death in Virginia. All of these leading
causes of death are impacted by risk factors such as lack of physical activity, improper nutrition, lack of
physical activity, and stress. All of these risk factors are discussed in the CDSMP, with sessions devoted
to information and resources needed to develop skills to reduce the risk and increase healthy lifestyle
behaviors. Chronic disease conditions are the major cause of illness, disabilities, and deat h in the United
States.

Approximately 90 million, or 30 percent, of the U.S. population has a chronic disease. This translat es to
an estimated 2.2 million Virginians living with a chronic disease. Chronic diseas e accounts for
approximately 75 percent of the nation’s $1.4 trillion health care costs each year; for Virginia this would
be approximately $24.6 billion.


The 2006 Chronic Disease Data Report reveals:
 In Virginia, the estimated cost associated with art hritis-related hospitalization is over $426 million.
 There were 29,934 hospitalizations in Virginia due to cancer in 2003, for total charges of $704 billion.
     The average charge per stay was over $27,000.
 Cardiovascular disease is the most costly chronic disease based on total hospitalization charges. In
     2003, there were 111,933 hospitalizations with a primary diagnosis of a cardiovascular -related
     condition and a secondary diagnosis of diabetes, with estimated costs of $165.8 million.


The target populations for the CDSMP are adults, in Virginia, living with a chronic disease. The program
also targets persons caring for or living wit h an adult who has a chronic disease. Special emphasis will be
placed on conducting CDSMP in areas of the Commonwealth where there are limited health care
resources and access to care.

Special emphasis will be placed on conducting the CDSMP in areas of the Commonwealth where there
are limited resources and access to care. Currently, the Lenowisco Health District is conducting the




                                                     26
program in the Sout hwest part of the state, and staff will work to expand the program’s implementation in
this area. The CDSMP coordinator will target implement ation of the program in areas of the
Commonwealth which have a higher prevalence of heart disease, stroke, high blood pressure, diabetes
and ot her chronic conditions, e.g. Crater, Cumberland Plateau, Eastern Shore, Mount Rogers, Norfolk,
Piedmont, Richmond City and Southside Virginia. These health district s were chosen based on a review
of the 2006 Chronic Disease Burden Report. That dat a indicates these areas to have a higher prevalence
of many chronic conditions.

Target Population:
Number: 200
Ethnicity: Hispanic, Non-Hispanic
Race: African American or Black, American Indian or Alaskan Native, Asian, Native Hawaiian or Other
Pacific Islander, White, Other
Age: 20 - 24 years, 25 - 34 years, 35 - 49 years, 50 - 64 years, 65 years and older
Gender: Female and Male
Geography: Rural and Urban
Primarily Low Income: No

Di sparate Population:
Number: 100
Ethnicity: Hispanic, Non-Hispanic
Race: African American or Black, American Indian or Alaskan Native, Asian, Native Hawaiian or Other
Pacific Islander, White, Other
Age: 20 - 24 years, 25 - 34 years, 35 - 49 years, 50 - 64 years, 65 years and older
Gender: Female and Male
Geography: Rural and Urban
Primarily Low Income: Yes
Location: Specific Counties
Target and Disparate Data Sources: 2006 Chronic Diseas e Burden Report

Evidence Based Guidelines and Best Practices Followed in Developing Interventions:


Other: The CDSMP/DSMP was developed by researchers at Stanford University and is recognized as an
evidence-based program. A complete report on the measures used and their psychometric properties can
be found in Outcome Meas ures for Health Education and Other Health Care Int erventions, by Lorig,
Stewart, Ritter, González, Laurent and Lynch, 1996.

Funds Allocated and Block Grant Role in Addressing this Health Objective :
Total Current Year Funds Allocated to Health Objective: $42,000
Total Prior Year Funds Allocated to Health Objective: $0
Funds Allocated to Disparate Populations: $500
Funds to Loc al Entities: $0
Role of Block Grant Dollars: No ot her existing federal or state funds
Percent of Block Grant Funds Relative to Other State Health Department Funds for this HO:
100% - Total source of funding

                ESSENTIAL SERVICES –OBJECTIVES – ANNUAL ACTIVITIES

Allocated funds are used to achieve Impact & Process Objective outcomes and to carry out Annual
Activities that are based on E vidence Based Guidelines and Best Practices identified in this work plan.

Essential Service 3 – Inform and Educate

Objective 1:




                                                    27
Increase knowledge and skills in self-management and self-efficacy
Between 10/ 2009 and 09/2010, the Division of Chronic Disease P revention and Control staff will conduct
10 CDSMP and DSMP programs for trained personnel in health districts, community agencies, and 28
health partner agencies.
Annual Acti vities:
1. Market and target CDSMP training
Between 10/ 2009 and 09/2010, the part-time CDSMP coordinator will renew the CDSMP license and
maintain DSMP license from Stanford University’s licensing offic e. Target and market CDSMP and
DSMP training to staff in Crater, Cumberland Plateau, Eastern Shore, Mount Rogers, Norfolk, Piedmont,
Richmond City, and Southside Health Districts due to their high rates of chronic disease (Chronic Disease
in Virginia: A Comprehensive Data Report, 2006 Edition).

2. Conduct CDSMP classe s
Between 10/ 2009 and 09/2010, request paperwork for course material distribution. Purchase required
program materials. Conduct CDSMP and DSMP classes and complete evaluations. Plan and conduct the
leader’s training.

3. Maintain CDSMP website
Between 10/ 2009 and 09/2010, update the CDSMP website with CDSMP and DSMP workshops and
training information.

4. Provide technical assi stance and monitor program fidelity
Between 10/ 2009 and 09/2010, provide technical assistance to all trainers and leaders in CDSMP and
DSMP. Attend all leader training to monitor program fidelity.

Objective 2:
Evaluate participant knowledge gain
Between 10/ 2009 and 09/2010, the CDSMP coordinat or will analyze 200 participant evaluations to
determine inc rease in knowledge and skills in self-management and self-efficacy.
Annual Acti vities:
1. Analyze evaluation results
Between 10/ 2009 and 09/2010, collect, analyze, and report participant pre and post test results. At least
50% of participants will have a 10% increase in knowledge and skills.




                                                    28
State Program Title: Community Water Fluoridation

State Program Strategy:

Program Goal: Because Virginia has met the 2010 objective, the goal of the Community Water
Fluoridation (CWF) program is to maintain the number of Virginia’s citizens served by optimal community
water fluoridation. Community water fluoridation is defined as adjusting and monitoring fluoride to reach
optimal concentrations in community drinking water. National health objectives call for 75% of the U.S.
population served by community water systems to be drinking optimally fluoridated water by 2010.


Program Health Priority: Priorities for the program are to ensure safe and effective adjustment of
community water to provide optimal fluoridation to reduce dental disease rat es, as well as, monitoring
water systems for compliance to rigid standards. The CWF Program also monitors localities with high
natural fluoride and provides educational information to practitioners and residents in those geographic
areas. One public health strategy is to promote community water fluoridation through funding to initiate
fluoridation or replace outdated equipment.


Primary Strategic Partnerships: Primary strategic partnerships for the CWF Program include the
Virginia Department of Health Offic e of Drinking Water (ODW) and associated field offices, the Virginia
Rural Water Association and local governments.


Evaluation Methodology: E valuation methodology for the CWF program includes monitoring of
fluoridated water systems through reviewing monthly fluoridation operational reports and inspection
surveys of water treatment plants, collect, interpret, and compile monthly fluoride operational reports of all
fluoridated water systems, and export to the Centers for Disease Control and Prevention (CDC) Water
Fluoridation Monitoring System (WRFS), as well as, site visits to funded localities.


State Program Setting:
Other: local government

FTEs (Full Time Equivalents):
Full Time Equivalents positions that are funded with PHHS Block Grant funds.

Posi tion Title: Community Water Fluoridation Coordinator
State-Level: 100% Local: 0% Other: 0% Tot al: 100%

Total Number of Posi tions Funded: 1
Total FTEs Funded: 1.00


National Health Objective: HO 21-9 Community water fluoridation

State Health Objective(s):
Between 10/ 2009 and 09/2010, continue to provide 94% of Virginians with optimally fluoridated
community water by ongoing monit oring and by updating and maintaining the existing water fluoridation
equipment.

Baseline:
93.8% of Virginians currently served.




                                                      29
Data Source:
CDC WRFS. Virginia population receiving service from public water systems.

State Health Problem:

Health Burden: Over the last half century, children’s dental health has improved remark ably under the
tandem of influences of fluoride and modern dental care. However, because of lack of access to
preventive servic es, many children still suffer needlessly from dental diseas es and conditions. Dental
caries (tooth decay) remains the most common chronic disease among children. Only the common cold,
the flu and ear infections occur more often among toddlers and young children. Tooth decay in children is
four to five times more common than asthma, the second most common chronic disease. Chronically
poor oral health is associated with failure to thrive in toddlers , compromised nut rition in children, and
cardiac dysfunction or life threatening infections in adulthood. Poor oral health has also been relat ed to
decreased school performance and poor self-esteem.

Dent al disease is now a chronic problem among low-income populations. Key markers of dental health
and the use of servic es for dent al problems, such as untreated decay and lost teeth, show that low-
income populations bear a disproportionate level of dental diseas e. Today 80% of tooth decay is now
found in only 25% of school -age children. Dental surveys conducted in Virginia have consistently shown
that children that participate in the free lunc h program have higher decay levels than those children that
do not participate in the program. This trend was confirmed in a statewide comprehensive dental survey
recently conducted to determine the disease status of the teet h of school children in Virginia. In 1999, a
total of 5,300 children from 204 schools were randomly selected to participat e in the survey. All indicators
of dental disease were higher in children who participate in the free lunch program.

Dent al caries (i.e., tooth dec ay) is an infectious, multifactorial diseas e afflicting most persons in
industrialized count ries. Dental caries is not self-limiting. Today, all residents are exposed to fluoride to
some degree, and widespread use of fluoride has been a major factor in the decline in the prevalence
and severity of dental caries in the United States and other ec onomic ally developed countries. Although
this decline is a major public health achievement, the burden of disease is still considerable in all age
groups. Many older adults have health conditions or take medications that reduce their salivary flow and
increase their risk for dental caries. Some have difficulties with self-care and often fac e challenges
related to access to professional dental care. Many studies indicate community water fluoridation
reduces root caries in older adults (Grembowski, et al JADA 1992; Eldridge and Beck 1987, Brustmann
1986, Burt el al 1986 and Stamm, J D Res, 59 (A ) 408: 1980). The CDC states adults also benefit from
fluoride, rather than only children, as was previously assumed.

Approximately 6 million citizens are served by community water systems out of 7.1 million Virginians. The
first system to fluoridate in Virginia was the Town of Fries, which initiated water fluoridation in June 1952.
However, the majority of initiations of community water fluoridation occurred from 1970 to 1980. As such,
the majority of the infrastructure of Virginia's fluoridated water systems is 20 to 30 years old. The next
five years are projected to reflect increased requests for funding, as systems need to be upgraded to
maintain their fluoridation status. Fluoridated water remains the most equitable and cost-effective method
of delivering fluoride to members of a community, regardless of an individual’s age, educational
attainment or income level.

Cost Burden: CDC’s recommendations on the use of fluorides and the Surgeon General’s Report on
Oral Health (SGROH) agree that fluoridation was cost effective relative to other int erventions to prevent
dental caries. Their conclusions are consistent with the Community Guide’s systematic review of the
economic evaluations that reported fluoridation to be cost saving. The Community Guide’s economic
review found that costs of fluoridation vary greatly by water system, with lower costs in systems serving
larger populations. The median cost per person per year ranged from $2.7 0 among 10 systems serving <
5000 people to $0.40 among 35 systems serving > 20,000 (1997 dollars). The CDC states that every $1
invested in community water fluoridation saved $38.00 in avoided dental treatment cost. Fluoridation can
be provided to an individual for a lifetime for the national approximate cost of an amalgam filling of



                                                      30
$65.00. Fluoridation is a safe, effective and cost-saving preventive healt h measure to reduce dent al
disease and reaches the total community regardless of socio -economic and other disparities. In high
natural fluoride areas reducing fluoride to optimal levels can eliminate the additional cost of bottled water,
the need to trans port alternative water sources as well as increas e the desirability of raising a family
within the community.

Target Population:
Number: 6,000,000
Ethnicity: Hispanic, Non-Hispanic
Race: African American or Black, American Indian or Alaskan Native, Asian, Native Hawaiian or Other
Pacific Islander, White, Other
Age: Under 1 year, 1 - 3 years, 4 - 11 years, 12 - 19 years, 20 - 24 years, 25 - 34 years, 35 - 49 years, 50
- 64 years, 65 years and older
Gender: Female and Male
Geography: Rural and Urban
Primarily Low Income: No

Di sparate Population:
Number: 6,000,000
Ethnicity: Hispanic, Non-Hispanic
Race: African American or Black, American Indian or Alaskan Native, Asian, Native Hawaiian or Other
Pacific Islander, White, Other
Age: Under 1 year, 1 - 3 years, 4 - 11 years, 12 - 19 years, 20 - 24 years, 25 - 34 years, 35 - 49 years, 50
- 64 years, 65 years and older
Gender: Female and Male
Geography: Rural and Urban
Primarily Low Income: No
Location: Entire state
Target and Disparate Data Sources: U.S. Census Bureau

Evidence Based Guidelines and Best Practices Followed in Developing Interventions:
Guide to Community Preventive Servic es (Task Force on Community Preventive Services)


Other: Best Practice Criteria for CWF programs as recommended by the Association of State and
Territ orial Dental Directors include:

Effectiveness: The effectiveness of community water fluoridation in preventing dent al caries has been
established by extensive research. Other measures for effective CWF programs include: compare the
percentage of population served by public water systems with optimally fluoridated wat er to Health y
People 2010 objective; document the number of communities or public water systems with optimally
fluoridated water and document the percent of fluoridated systems consistently maintaining optimal levels
of fluoride (documentation of monthly monitoring co nsistent with CDC's WFRS).

Sustainability: Demonstrate sustainability through the number of years that identifiable water fluoridation
program at state level has operated and the number of systems initiating, continuing, or discontinuing
water fluoridation annually.

Collaboration: Demonstrate partnerships/coalitions with key stakeholders and organizations.


Funds Allocated and Block Grant Role in Addressing this Health Objective :
Total Current Year Funds Allocated to Health Objective: $149,663
Total Prior Year Funds Allocated to Health Objective: $0
Funds Allocated to Disparate Populations: $53, 000
Funds to Loc al Entities: $53,000



                                                      31
Role of Block Grant Dollars: No ot her existing federal or state funds
Percent of Block Grant Funds Relative to Other State Health Department Funds for this HO:
100% - Total source of funding

                ESSENTIAL SERVICES –OBJECTIVES – ANNUAL ACTIVITIES

Allocated funds are used to achieve Impact & Process Objective outcomes and to carry out Annual
Activities that are based on E vidence Based Guidelines and Best Practices identified in this work plan.

Essential Service 7 – Link people to services

Objective 1:
Provide optimal community water fluoridation
Between 10/ 2009 and 09/2010, the Division of Dental Health (DDH) will maintain 6 million Virginia
residents on optimal community water fluoridation.
Annual Acti vities:
1. Upgrade equipment
Between 10/ 2009 and 09/2010, DDH will cont ract with communities to upgrade fluoridation equipment in
six areas to maintain optimum fluoride levels.

2. Monitor water systems
Between 10/ 2009 and 09/2010, DDH will monitor 142 water systems monthly in Virginia that adjust
fluoride for 6 million individuals and report to the CDC Water Fluoridation Reporting System.

3. Provide education
Between 10/ 2009 and 09/2010, DDH will provide education for customers, healt h professionals and
communities regarding the health benefits of fluorides and fluoridation in VA.

4. Provide training
Between 10/ 2009 and 09/2010, DDH will collaborate with VDH Office of Drinki ng Water and Salem Water
Treatment Plant to provide training for water works operators.

5. Provide technical assi stance
Between 10/ 2009 and 09/2010, DDH will provide technical assistance to VDH staff regarding adjusted
fluoride levels in individual commu nities across the state.




                                                    32
State Program Title: Dental Disease Reduction Program

State Program Strategy:

Program Goal: The Dental Disease Reduction Program (DDRP ) is designed to prevent dental caries
(tooth decay) and reduce the burden and cost of this chronic disease.

Program Health Priorities: Link people to oral health prevention services are the primary priority of the
DDRP. Priorities for the Dental Disease Reduction Program (DDRP ) include preventing disease through
population-based topical fluoride and sealant programs, assuring for the provision of dental care in
underserved areas, improving care for high risk populations, evaluating programs and monitoring the oral
disease status of Virginia’s residents.

Primary Strategic Partners: The Division of Dental Health (DDH) and the DDRP have partnerships
within the Virginia Department of Health (V DH) including the Division of WIC and Community Nutrition
Services, the Policy and Assessment Unit in the Office of Family Health Services, the Offi ce of
Community Health Services including local health departments, and the Office of Healt h Policy and
Planning. Valuable external partnerships exist with the Virginia Dent al Association, Virginia Dental
Hygiene Association, Virginia Department of Educ ation, Virginia Department of Medical Assistance
Services, Virginia Commonwealth University (VCU) School of Dentistry, Boy’s and Girl’s Club of Virginia,
Virginia Head Start Collaborative Project at the Department of Social Services, providers of Children wi th
Special Needs and other members of the Virginians for Improving Access to Dental Care (VIA DC)
Coalition.

Program Evaluation Methodology: In performing the public health core function of assessment and
evaluation, the Division of Dental Healt h (DDH) has conducted oral healt h surveys, needs assessments
and surveillance. Surveys have been utilized to assess samples of a defined population through clinical
open mouth screenings, in addition to the use of questionnaires. DDH has also conducted needs
assessments, including a statewide assessment in 2009.

 A surveillance system provides the functional capacity for data collection and analysis, and the timely
dissemination of information derived from these data to persons who can undertake effective pre vention
and cont rol activities. Currently, DDH participates in the Virginia Behavioral Risk Factor Surveillance
System and the National Oral Healt h Surveillance System, which monitors the burden of oral disease,
utilization of the oral health care delivery system, and the status of community water fluoridation. Surveys
and screenings are instruments for conducting oral health surveillance for evaluating program
effectiveness. DDRP will utilize screenings and questionnaires to evaluate the effectiveness of the
collection of oral health indices in programs. Screening will also be utilized to evaluate the ongoing
effectiveness of the fluoride varnish program. Baseline data are being collected prior to the application of
varnish to det ermine the prevalence o f early childhood caries and changes in diseas e status based on
applications of varnish. A three year evaluation is underway of the fluoride rinse program that will
conclude in late 2009. This year’s projects include a comparison of data collected throug h dental sealant
programs in traditional and newly expanded dental hygiene protocols. Activity sheets on the numbers of
children receiving dental sealants in the school sites will be submitted to DDH. VDH quality assuranc e
standards will be followed including clinical inspection during and aft er the project, as well as through
following the Best Practices Criteria established by the Association of State and Territorial Dental
Directors outlined below. The Seal Americ a program utilizes a database program in Epi Info, ―SEALS, ‖
that will be utilized to enter and evaluate the dental sealant project. Children who have received sealants
will also be evaluated clinically for retention of sealants placed last year.


State Program Setting:
Local health department, Medic al or clinical site, Schools or school district




                                                      33
FTEs (Full Time Equivalents):
Full Time Equivalents positions that are funded with PHHS Block Grant funds.

Posi tion Title: Dental Hygienist
State-Level: 0% Loc al: 20% Other: 0% Total: 20%
Posi tion Title: Dental Hygienist
State-Level: 0% Loc al: 20% Other: 0% Total: 20%
Posi tion Title: Dental Hygienist
State-Level: 0% Loc al: 20% Other: 0% Total: 20%
Posi tion Title: Dental Hygienist
State-Level: 0% Loc al: 20% Other: 0% Total: 20%
Posi tion Title: Dental Hygienist
State-Level: 0% Loc al: 20% Other: 0% Total: 20%
Posi tion Title: Dental Hygienist for CS HCN
State-Level: 60% Local: 0% Other: 0% Total: 60%
Posi tion Title: Dental Assistant
State-Level: 10% Local: 50% Other: 0% Tot al: 60%
Posi tion Title: Epidemiologist
State-Level: 80% Local: 0% Other: 0% Total: 80%
Posi tion Title: Dentist (for the sealant program)
State-Level: 0% Loc al: 20% Other: 0% Total: 20%

Total Number of Posi tions Funded: 9
Total FTEs Funded: 3.20


National Health Objective: HO 21-1 Dental caries experience

State Health Objective(s):

Between 10/ 2009 and 09/2010, the Division of Dental Health will increase the number of high-risk
children provided with dental services from 13,951 to 21,674.


Baseline:
13,951 children -- 416 children have been provided wit h fluoride varnish in selected counties; 60 children
have rec eived treatment services, 431 children received dental sealants and 13,044 children were
screened for oral disease.

Data Source:
Division of Dental Health

State Health Problem:

Health Burden: Children’s dental health has improved remarkably under the influences of fluoride and
modern dental care over the last century. However, because of lack of access to preventive services,
many children still suffer from dent al diseases and conditions, which are preventable. Dental caries
(tooth decay) remains the most common chronic disease among children. Only the common cold, the flu
and ear infections occur more often among toddlers and young children. Tooth decay in children is four
to five times more common than asthma, the second most common chronic disease. Chronically poor
oral health is associated wit h failure to thrive in toddlers, compromised nutrition in children, and cardiac
dysfunction or life threatening infections in adulthood. Poor oral health has also been related to
decreased school performance and poor self-esteem. Dental diseas e is now a chronic problem among
low-income populations who bear a disproportionate level of dent al disease. According to the National
Healt h and Nutrition Examination Survey (NHANES), oral disease is primarily concentrat ed in a small




                                                     34
segment of the population with 80% of toot h decay found in only 25% of school -age children. Virginia
dental studies have consistently shown that children enrolled in the free lunch program have higher decay
levels than those children that do not participat e in the program. This finding was confirmed in a 1999
statewide comprehensive dent al survey, which documented the oral health status of school children in
Virginia. All indicators of dental disease were higher among children enrolled in the free lunch program
relative to non-enrolled children.

Demographics such as race and et hnicity are more likely t o put a child at risk for oral disease and reduce
the probability that they will receive treatment. Previous Virginia studies have consistently demonstrated
that Hispanic children have the highest prevalence of unt reat ed decay followed by black children a s show
below. Culturally appropriate health promotion and disease prevention initiatives are needed to help
these populations understand the importance of good oral health and place a high priority in obtaining
dental care.

Children who suffer the most dental diseas e are least likely to have access to oral health care services.
 In 1996, the Office of the Inspector General of the U.S. Department of Health and Human Services
(DHHS ) reported that only one in five Medicaid eligible children received routine preventive dental
services. According to a 2002 NHANES survey, lower -income children were much more likely to have
unmet dental treatment needs relative to their more affluent counterparts.

A 1994 Robert Wood Johnson Foundation (RWJF) survey indicated that dental care was the most
commonly reported unmet health care need in the U.S. Moreover, unmet dental care was twice as likely
to be reported compared to medical care.

The Maternal and Child Health Bureau’s definition of CSHCN is ―...those who have or are at increased
risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health
and related services of a type or amount beyond that required by children generally.‖ According to the
National Survey of Children with Special Healt h Care Needs Chartbook, overall, 15% of Virginia children
have special needs compared to 13% nationally. In young children (birth to 5 years), the prevalence of
special healt h care needs is higher in Virginia than nationally (9% versus 7.8%). The same national
survey also showed that families ranked unmet dental care needs for their children as the greatest health
care issue. Accessing dental care was the second highest health issue.

Maintaining good oral health is a significant issue for individuals with special needs of all ages, and their
oral health status impacts their general health. Some individuals with special needs have oral health
problems that are similar to their peers who possess the cognitive and motor abilities t o maint ain oral
health and are able to cooperate during dental treatment. However, many individuals with special needs
have severe dental decay or periodontal disease caused by their medical condition or developmental
disabilities. These individuals have cognitive deficiencies, physical limitations, and/ or behavior problems
that compromise self-care and may require additional management for dental care.

State oral health programs can contribute significantly to improving oral health access and quality for low
income children through professional development for dental staff and training for non-dental health
providers (e. g., physicians and nurses) to make the necessary referrals for early dental treatment.

Preschool and elementary school children (birth to 13 years) are the primary targets for dental disease
prevention activities. The target population is estimated at 500,000 and includes male and female
students of all races.

Target Population:
Number: 500,000
Ethnicity: Hispanic, Non-Hispanic
Race: African American or Black, American Indian or Alaskan Native, Asian, Native Hawaiian or Other
Pacific Islander, White, Other
Age: Under 1 year, 1 - 3 years, 4 - 11 years
Gender: Female and Male



                                                     35
Geography: Rural and Urban
Primarily Low Income: Yes

Di sparate Population:
Number: 50,000
Ethnicity: Hispanic, Non-Hispanic
Race: African American or Black, American Indian or Alaskan Native, Asian, Native Hawaiian or Other
Pacific Islander, White, Other
Age: Under 1 year, 1 - 3 years, 4 - 11 years
Gender: Female and Male
Geography: Rural and Urban
Primarily Low Income: Yes
Location: Entire state
Target and Disparate Data Sources: U.S. Census Bureau

Evidence Based Guidelines and Best Practices Followed in Developing Interventions:
Guide to Clinical Preventive Services (U.S. Preventive Services Task Force)
Guide to Community Preventive Servic es (Task Force on Community Preventive Services)
MMWR Recommendations and Reports (Centers for Disease Control and P revention)


Other: Best Practices Association of State an d Territorial Dental Directors

Funds Allocated and Block Grant Role in Addressing this Health Objective :
Total Current Year Funds Allocated to Health Objective: $263,837
Total Prior Year Funds Allocated to Health Objective: $0
Funds Allocated to Disparate Populations: $263,837
Funds to Loc al Entities: $192,367
Role of Block Grant Dollars: Supplemental Funding
Percent of Block Grant Funds Relative to Other State Health Department Funds for this HO:
50-74% - Significant source of funding

                 ESSENTIAL SERVICES –OBJECTIVES – ANNUAL ACTIVITIES

Allocated funds are used to achieve Impact & Process Objective outcomes and to carry out Annual
Activities that are based on E vidence Based Guidelines and Best Practices identified in this work plan.

Essential Service 7 – Link people to services

Objective 1:
Increase number of school children w ith preventive fluoride varnish
Between 11/ 2009 and 09/2010, the Division of Dental Health will increase the number of preschool
children in selected high-risk counties with preventive fluoride varnis h application, assessment and oral
health education from 679 to 5,016.
Annual Acti vities:
1. Provide education, asse ssment and dental varnish
Between 11/ 2009 and 09/2010, employ wage dental hygienists (or nurses) to provide education,
assessment and dental varnish for 4,904 low-income children enrolled in WIC Programs in target ed
programs in Virginia (Dinwiddie, Hopewell, Buckingham, Newport News, York, Buchanan, Dickinson, and
Eastern Shore).

2. Provide screenings and asse ssment
Between 11/ 2009 and 09/2010, screen 4,264 children during the assessment portion of the fluoride
varnish program for decayed, missing and filled primary teeth. E valuate all children and parents using the
parental questionnaire.




                                                     36
3. Evaluate fluoride varnish projects
Between 11/ 2009 and 09/2010, collect, analyze, and report on fluoride varnish projects.

4. Identify program participants
Between 01/ 2010 and 08/2010, identify 30 children in four health districts who do not have access to
dental ins urance and who cannot cooperate for traditional care.

5. Provide dental treatment
Between 01/ 2010 and 09/2010, provide comprehensive treatment to targeted children to complete care.
Receive detailed reports of services provided.

Objective 2:
Increase access to preventive and treatment service s.
Between 11/ 2009 and 09/2010, the Division of Dental Health will increase the number of low-income
children screened for dental sealants from 547 to 800 children.
Annual Acti vities:
1. Identify program participants.
Between 11/ 2009 and 09/2010, provide services through a targeted dental sealant project in the
Piedmont, Crater and Henrico Health Districts utilizing mobile dental vans to provide dental sealants to
650 low-income children.

2. Collect and analyze program data
Between 01/ 2010 and 09/2010, collect dental sealant data, enter into the CDC SEALS software, analyze
data and produce a report.

3. Coordinate dental screenings
Between 01/ 2010 and 06/2010, coordinate sentinel school dental screenings of a repres entative number
of children of third grade children.

Objective 3:
Increase access to treatment service s
Between 11/ 2009 and 09/2010, the Division of Dental Health will increase the number of children with
special needs who have access to preventive and treatment services from 0 to 5,000 children enrolled in
Care Connection for Children Centers statewide.
Annual Acti vities:
1. Provide training
Between 11/ 2009 and 09/2010, provide training for medical providers regarding fluoride varnish training
for children with special needs.

2. Conduct asse ssment of children with special health care needs
Between 11/ 2009 and 09/2010, develop a dental health survey questionnaire and assess the oral health
care needs of CS HCN, the oral health knowledge of the families, and their abi lity to access care for their
child.

3. Develop training for trainers
Between 11/ 2009 and 09/2010, develop and provide training for the 60 home visitors wit h Virginia’s Home
Visitor Consortium in three health districts (Southside, Lenowisco and Cumberland Plat eau).

4. Provide dental hygienists training
Between 11/ 2009 and 09/2010, provide training and technical assistance for the dental hygienists in
Cumberland Plateau and Lenowisco Healt h District in order to provide services to the Care Connection
for Children Centers and at events with CSHCN families in attendance.




                                                     37
State Program Title: Injury Prevention

State Program Strategy:

Program Goal: The goal of the V DH Injury Prevention Program is to reduc e the burden of injury deat hs
and hospitalizations among Virginians by 2% by 2010.


Program Health Priority: In Virginia, injury is the leading cause of death for persons between the ages
of 1 and 34. The Injury Prevention Program will support the start -up of community based injury prevention
projects, resources, and training to reduce injuries related to burns, falls, poisoning, traumatic brain and
spinal cord injury, fractures, and asphyxiation (from suffocation and drowning) among at risk populations.


Primary Strategic Partners: In addition to collaborating with relevant programs in the VDH Offices of
Family Healt h Services, Emergency Medical Services, and the Chief Medical Examiner, the VDH Division
of Injury and Violence Prevention partners with a variety of organizations and agencies at the local level
(including Safe Kids coalitions, Red Cross chapters, schools, child care centers, fire and police
departments) and at the state level (including but not limited to the Departments of Social Services,
Criminal Justice Services, Education, Aging, Rehabilitative Services, Fire Programs, Motor Vehicles and
Trans port ation, Perinatal Councils, the VA Poison Network, BIKE Walk Virginia, AAA divisions, VA Fire
and Life Safety Coalition, Brain Injury Association of VA, Drive Smart Virginia).


Evaluation Methodology: Outcomes of awareness and training activities will be assessed through
tracking of activities; monitoring of audience expos ures to information provided; and behavior change that
results from activities. Changes in injury will be assessed t hrough annual analysis of Virginia injury
hospitalization and deat h data.


State Program Setting:
Child care center, Community based organization, Faith based organization, Home, Schools or school
district, Senior residence or center, University or college, Other: Fire or police departments

FTEs (Full Time Equivalents):
Full Time Equivalents positions that are funded with PHHS Block Grant funds.

Posi tion Title: Community Injury Prevention Coordinator
State-Level: 0% Loc al: 10% Other: 0% Total: 10%
Posi tion Title: Research and Dat a Coordinat or
State-Level: 10% Local: 5% Other: 0% Total: 15%
Posi tion Title: Youth Suicide Prevention Coordinator
State-Level: 10% Local: 0% Other: 0% Total: 10%
Posi tion Title: Executive Sec retary
State-Level: 5% Loc al: 0% Other: 0% Total: 5%

Total Number of Posi tions Funded: 4
Total FTEs Funded: 0.40


National Health Objective: HO 15-13 Unintentional injury deaths




                                                    38
State Health Objective(s):

Between 10/ 2009 and 09/2010, reduce deaths caused by unintentional injury prevention by 2% from
34.87 to 32.78 per 100,000 population.




Baseline:
The unintentional injury death rate in Virginia during 2006 was 34.87 per 100,000 population.

Data Source:
Virginia Center for Health Statistics

State Health Problem:

Health Burden: In Virginia, injury is the leading cause of death for pers ons between the ages of 1 and
40. Sixty-six percent of these deaths were the res ult of unintentional injuries. In 2007, 3,965 Virginians
died as a result of unintentional injury. Furthermore, in 2007, Virginia hospitals reported 42, 093 hospital
discharges for injury. The vast majority (82 percent) of injury hospitalizations in Virginia resulted from
unintentional causes. Because of its toll on youth (19 years of age and youn ger), injury accounts for more
years of productive life lost than all other causes of death. In 2007, 355 yout h died as a result of injury
before reaching their twentieth birthday. Again, the majority (69% ) of these deaths were due to
unintentional injuries. In 2007, Virginia hospitals reported 4,533 injury-related discharges for children and
adolescents 19 years of age and younger, with 72% being unintentional in nature. Unint entional injury
death rates were highest for the elderly. The three leading exter nal causes of unintentional injury
hospitalization for Virginians were: falls, motor vehicle traffic injuries, and poisoning.

In 2007, hospital injury discharge alone resulted in over $1 billion in billed charges to public and private
payers. The average median charge was $15,913 per episode of care. A little over half of the discharges
listed a government source, mainly Medicare (81%) and Medicaid (16%) as the ex pected payer. The
average length of stay for an episode of care due to an injury was 5 days. Patients aged 75 and older had
the longest total and average length of stay and incurred the highest charges.

Target Population:
Number: 1,244,000
Ethnicity: Hispanic, Non-Hispanic
Race: African American or Black, American Indian or Alaskan Native, Asian, Native Hawaiian or Other
Pacific Islander, White, Other
Age: Under 1 year, 1 - 3 years, 4 - 11 years, 12 - 19 years, 65 years and older
Gender: Female and Male
Geography: Rural and Urban
Primarily Low Income: No

Di sparate Population:
Number: 55,000
Ethnicity: Hispanic, Non-Hispanic
Race: African American or Black, American Indian or Alaskan Native, Asian, Native Hawaiian or Other
Pacific Islander, White, Other
Age: Under 1 year, 1 - 3 years, 4 - 11 years, 65 years and older
Gender: Female and Male
Geography: Rural and Urban
Primarily Low Income: Yes
Location: Entire state
Target and Disparate Data Sources: U.S. Census Bureau



                                                     39
Evidence Based Guidelines and Best Practices Followed in Developing Interventions:


Other: CDC Res earch and Guidelines on Fall Prevention
Virginia Data on Leading Causes of Falls
Best or Promising Practices (Safe Kids Worldwide, Home Safety Council, STIPGA, Children's Safety
Network, Harborview Injury Prevention and Research Center)


Funds Allocated and Block Grant Role in Addressing this Health Objective:
Total Current Year Funds Allocated to Health Objective: $350,000
Total Prior Year Funds Allocated to Health Objective: $0
Funds Allocated to Disparate Populations: $315,000
Funds to Loc al Entities: $275,000
Role of Block Grant Dollars: Supplemental Funding
Percent of Block Grant Funds Relative to Other State Health Department Funds for this HO:
50-74% - Significant source of funding

                ESSENTIAL SERVICES –OBJECTIVES – ANNUAL ACTIVITIES

Allocated funds are used to achieve Impact & Process Objective outcomes and to carry out Annual
Activities that are based on E vidence Based Guidelines and Best Practices identified in this work plan.

Essential Service 3 – Inform and Educate

Objective 1:
Implement injury prevention projects
Between 01/ 2010 and 09/2010, the Division of Injury and Violence Prevention (DIVP) staff will implement
93 injury prevention projects that reflect the leading injury areas identified in the Virginia Unintentional
Injury Prevention Strategic Plan (poisoning, drowning, fractures, burns, suffocation, traumatic brain
injury/spinal cord injury) through contract with organiz ations in local communities throughout the
Commonwealth.
Annual Acti vities:
1. Imnplement community injury prevention program s
Between 01/ 2010 and 09/2010, contract with local communities to implement 93 community injury
prevention programs in local communities throughout the Commonwealth. Thirteen (13) communities will
implement injury prevention programs that reflect the leading injury areas identified in the Virginia
Unint entional Injury Prevention Strategic Plan (poisoning, drowning, fractures, burns, suffocation,
traumatic brain injury/spinal cord injury). Eighty (80) local communities will implement injury prevention
projects that address emergi ng and local injury issues.

Objective 2:
Conduct traumatic brain injury media campaign
Between 10/ 2009 and 09/2010, the Division of Injury and Violence Prevention (DIVP) will conduct 1
media and print campaign targeting adult children and caregivers of older adults about the prevention of
traumatic brain injury through the prevention of falls among older adults.
Annual Acti vities:
1. Implement media campaign
Between 10/ 2009 and 09/2010, implement media campaign to prevent TB I among older adults through
the prevention of falls. The campaign will be implemented in a targeted community/region and will re-air
previously developed :30 and :60 radio PSAs and print media. The media campaign will be targeted to
adult children and caregivers of older adults and will direct them to available resources.




                                                     40
State Program Title: OFHS Research and Analysis - Surveillance Program

State Program Strategy:

Program Goal: Increase the availability of public health data for analysis and decision making.
Information is an essential tool for the Office of Family Health Servic es to carry out the core functions and
the essential public healt h services for the Commonwealth. Having reliable data readily available is
critical at all levels from the identification of needs, to program planning and evaluation. The Office of
Family Healt h Services (OFHS) Policy and Assessment Unit works to develop the capacity to meet
customers’ needs for reliable, accurate, timely, and relevant public health information and to assure its
use in decision-making. The unit performs periodic needs assessments and develops and updates an
ongoing surveillance plan that includes timely data from sources such as Behavioral Risk Factor
Surveillance System (BRFSS), vital records, insurance claims, and hospital discharges (VHI).

Program Health Priority: The program priority is to monitor health status, provide data for program
evaluation, increase the OFHS internal capacity to analyze data and conduct needed health servic es
research and provide data and reports for external partners such as local health districts. This unit
carries out many functions including the following: working with local health districts to improve access to
morbidity and mortality data and reports; developing and implementing surveys; developing and linking
information systems; and analyzing and displaying routine surveillance data as well as res ponding to
emerging data issues.

Through surveillance, VDH is able to identify high -risk populations for premature death and dis ability.
Disparate population groups that receive substandard medical care or have less accessibility to a health
care system are also identified. Responsibilities toward disparate populations encompass preventing
epidemics and the spread of disease; protecting against environment al hazards; preventing injuries;
encouraging healthy behavior; helping communities recover from disasters; and ensuring the quality and
accessibility of health services. The PHHS Block Grant supports a portion of the projects of the Policy
and Assessment Unit within the Office of Family Health Services.

Primary Strategic Partners:
OFHS Internal Partners:
Child and Adolescent Health Division
Women’s and Infants’ Healt h Division
WIC and Community Nutrition Services Division
Dent al Health Division
Injury and Violence P revention Division
Chronic Disease Prevention and Cont rol Division

OFHS External Partners:
VDH Division of Vital Statistics
35 District Healt h Departments
Virginia Commonwealth University
Department of Medical Assistance Services

Program Evaluation Methodology: The evaluation criteria will be the timely completion of the
objectives and activities listed.


State Program Setting:
State health department

FTEs (Full Time Equivalents):



                                                      41
Full Time Equival ents positions that are funded with PHHS Block Grant funds.

Posi tion Title: OFHS Statistical Analyst
State-Level: 50% Local: 0% Other: 0% Total: 50%

Total Number of Posi tions Funded: 1
Total FTEs Funded: 0.50


National Health Objective: HO 23-2 Public health access to information and surveillance
data

State Health Objective(s):
Between 10/ 2009 and 09/2011, the Office of Family Health Servic es (OFHS ) will increase the B RFSS
sample size from 5,000 to 6,000 to increase the availability of data for leading health indicat ors, health
status indicators, and priority data needs which includes information on disparities at the state and local
levels.

Baseline:
The current BRFSS sample size is 5,000. BRFSS dat a has not been fully documented and made
available on the OHFS Data Mart, which is a desktop querable system.

Data Source:
OFHS Data Mart; BRFSS; OFHS Website.

State Health Problem:

Health Burden:
It is important for P HHS -funded programs in Virginia to measure progress toward achieving the t argeted
health status objectives. There are problems with the specificity of available databases and the ability to
link different dat a sets that would indicate mortality, morbidity and preventable risk exposure for chronic
diseases. Record linkage has become increasingly useful in health care administration, demographic
studies, the provision of health statistics, and in health res earch. Record linkage will enable OFHS to
maintain a comprehensive database and permit many different types of health care related res earc h and
outcomes.

Population-based dat a for behavioral risk factors that are specific to racial and ethnic groups have not
been readily available. This data would be useful in setting priorities for public healt h programs. The
Virginia hospital discharge data set has significant potential that has not been fully utilized

The Behavioral Risk Factor Surveillance System (BRFSS) sample size increased to 5,000 starting from
the calendar year 2003. However, the current sample size requires aggregation of three years of data in
order to provide health district level estimates of risk behaviors. An increased B RFSS sample will allow
more effective analysis of healt h risk behaviors at both the state and health district levels using an annual
file that would not require aggregate dat a.

Local health districts, managed care organizations, and hospitals have expressed an interest in having
access to population-based data on health risk behaviors so that they can better plan, deliver, and
evaluate health promotion and disease prevention programs. OFHS remains committed to creating
easier access to data systems such as the BRFSS and Health Statistics. An office-level memorandum of
agreement with the Center for Health Statistics has been establishe d that eliminates the need for
individual programs to negotiate data requests. As a result, complete 1990-2008 birth and deat h
certificate data and population data by age, sex, race ethnicity and locality is now readily available to
OFHS staff through the development of a data mart. This eliminates redundant data loading and makes
reports across OFHS programs more comparable. Efforts are also underway to make data more




                                                      42
available to the district health departments and the public through the use of Fact Sheets, reports and the
OFHS website. Virginia BRFSS data are now available on the internet on a limited basis. Using Instant
Atlas software, the BRFSS dat a can be geographically displayed by health districts. In the future,
additional data can be geographically displayed by health districts. There is a continued need to ex pand
public access to other health related data sources including social indicat ors that impact health
disparities. There is a continuing financial challenge associated with the collec tion of BRFSS data and
maintaining an adequate sample size to allow for reporting at the health district level. There is also a
continued need for staff support to develop and disseminate reports related to risk factors for chronic
disease.

Target Population:
Number: 5,471,916
Infrastructure Groups: State and Local Health Departments, Boards, Coalitions, Task Forces, Community
Planning, Policy Makers, Community Based Organizations, Research and Educational Institutions

Di sparate Population:
Number: 1
Infrastructure Groups: State and Local Health Departments, Boards, Coalitions, Task Forces, Community
Planning, Policy Makers, Community Based Organizations, Research and Educational Institutions

Evidence Based Guidelines and Best Practices Followed in Developing Interventions:
No E vidence Based Guideline/Best Practice A vailable

Funds Allocated and Block Grant Role in Addressing this Health Objective :
Total Current Year Funds Allocated to Health Objective: $100,581
Total Prior Year Funds Allocated to He alth Objective: $0
Funds Allocated to Disparate Populations: $0
Funds to Loc al Entities: $0
Role of Block Grant Dollars: Supplemental Funding
Percent of Block Grant Funds Relative to Other State Health Department Funds for this HO:
Less than 10% - Minimal source of funding

                 ESSENTIAL SERVICES –OBJECTIVES – ANNUAL ACTIVITIES

Allocated funds are used to achieve Impact & Process Objective outcomes and to carry out Annual
Activities that are based on E vidence Based Guidelines and Best Practices identified in this work plan.

Essential Service 1 – Monitor health status

Objective 1:
Increase the availability of data
Between 10/ 2009 and 09/2010, the Policy and Assessment Unit will increase the number of health -
related national survey datasets available in the OF HS Data Mart from to from 2 CDC SLA ITS surveys
that have been loaded and cleaned to 3 data sets loaded, cleaned, and fully documented.
Annual Acti vities:
1. Load, clean, fully document, and release survey data in the OFHS Data Mart
Between 10/ 2009 and 09/2010, provide dat a from national surveys and Virginia specific surveys such as
PRAMS, the Virginia Youth Survey and B RFSS. Each dataset and its documentation will be made
available on the OFHS Data Mart. Key demographic variables including age groups and race/ethnicity
will be recoded to be consistent with other datasets in the Data Mart. Data dictionaries for existing and
newly created variables will be prepared. After each dataset is released, a brief int roduction and training
will be provided to the OFHS Epidemiology Workgroup and other external data users.

Objective 2:
Increase the BRFSS sample size to 6000 completed surveys annually




                                                     43
Between 10/ 2009 and 09/2010, the Policy and Assessment Unit will increase the number of BRFSS
survey samples from 5,000 to 6,000 completed surveys.
Annual Acti vities:
1. Increase BRFSS sample size
Between 10/ 2009 and 09/2010, the BRFSS sample size will be increased to result in 6,000 completes
surveys. The increase in the sample size will provide the 35 local health districts more effective and
timely estimates of risk behaviors that will result in more effective program planning and evaluation. The
increase in sample size will also provide a more representative sample for state level planning and
evaluation efforts. The 35 health districts, as well as health care organizations, depend on this dat a in
order to target at risk populations and to plan, deliver, and evaluate their health promotion and disease
prevention programs. Increasing contractual costs to conduct the BRFSS and the lack of sufficient
federal funding has jeopardized the ability to maintain a sufficient sample size.




                                                    44
State Program Title: Sexual Assault Intervention and Education Program

State Program Strategy:

Program Goal: The goal of the Sexual Assault Intervention and Education program is to reduc e the
number of sexual assault victimizations.

Program Health Priority: Rape and sexual assault are a public healt h problem in Virginia. In 2007, there
were 5,009 forcible sex offenses reported to the Virginia police. (Source: Crime in Virginia, Virginia State
Police, 2007). In cases of sexual assault, however, the victim is often hesitant to report the crime to law
enforcement officials. It has been estimated that the actual incidence of sex ual assault is at least three
times higher than police reports (U.S. Department of Justice, Bureau of Justice Statistics, 1998).

Primary Strategic Partners: The Virginia Department of Health will contract with the Virginia S exual and
Domestic Violence Action Alliance (the Action Allianc e) to provide statewide coordination of sexual
assault advocacy, data collection on victim services and outcomes, technical assistance, training and
other support to local sexual assault crisis centers and ot her professionals working to improve the
community response to sexual assault.

The PHHSBG set-aside allows the Action Alliance to provide advocacy and support to victims and
survivors of sexual assault and their families and friends, crisis centers, and professional s offering
services to survivors. The Action Alliance provides technical assistance, information, training, coordination
and ot her resources to centers that provide direct victims services. Direct victims services include:

 hotlines for support and information
 crisis intervention in courtrooms, hospitals and other community settings
 counseling, support and accompaniment.


The Action Alliance and the sexual assault crisis centers also provide professional and public education
programs to raise awareness about sexual assault and existing prevention and intervention efforts.

E valuation Methodology: The program will complete outcome and process evaluations.


State Program Setting:
Community based organization, University or college, Other: Sexual assault crisis centers

FTEs (Full Time Equivalents):
Full Time Equivalents positions that are funded with PHHS Block Grant funds.

Posi tion Title: Co-Director
State-Level: 30% Local: 0% Other: 0% Total:     30%
Posi tion Title: Co-Director
State-Level: 20% Local: 0% Other: 0% Total:     20%
Posi tion Title: Training Manager
State-Level: 10% Local: 0% Other: 0% Total:     10%
Posi tion Title: Advocacy Manager
State-Level: 15% Local: 0% Other: 0% Total:     15%
Posi tion Title: Resources Manager
State-Level: 30% Local: 0% Other: 0% Total:     30%
Posi tion Title: Public Awareness Manager
State-Level: 45% Local: 0% Other: 0% Total:     45%




                                                      45
Posi tion Title: Training Coordinator
State-Level: 25% Local: 0% Other: 0% Total: 25%
Posi tion Title: Child and Yout h Advocacy Manager
State-Level: 15% Local: 0% Other: 0% Total: 15%
Posi tion Title: Technical Assistance Manager
State-Level: 10% Local: 0% Other: 0% Total: 10%

Total Number of Posi tions Funded: 9
Total FTEs Funded: 2.00


National Health Objective: HO 15-35 Rape or attempted rape

State Health Objective(s):
Between 10/ 2009 and 09/2014, reduce the number of forced sexual assaults report ed to police in Virginia
by 2%.

Baseline:
5,009 forcible sex offenses in 2007

Data Source:
Crime in Virginia, Virginia State Police, 2007

State Health Problem:

Health Burden:
In 2007, there were 5,009 forcible sex offenses reported to the Virginia police. (Source: Crime in Virginia,
Virginia State Police, 2007). In cases of sexual assault, however, the victim is often hesitant to report the
crime to law enforcement officials. It has been estimated that the actual incidence of sexual assault is at
least three times higher than police reports (U.S. Department of Justice, Bureau of Justice Statistics,
1998).

Virginia’s sexual assault crisis centers annually provide services to approximately 10,000 victims of
sexual assault. In FY2005, Virginia sexual assault crisis centers provided services to 9,795 new victims of
sexual assault.

The annual cost of sexual violence is a staggering $127 billion. (Miller, Ted, Cohen, Mark and Wiersema,
Brian. 1996. Victim Costs & Consequences: A New Look. Washington, D. C. National Institute of Justice
Report, U.S. Department of Justice)

Researchers estimate that the 1.1 millio n rape victims suffer 1.45 million rape victimizations annually.
That means annual rape victimizations average 1.27 per victim. Multiplying 1.27 by the $81,400 quality of
life loss per rape victimization yields estimated quality of life losses of $103,400 per rape victim. (Victim
Costs and Consequences: A New Look, Series: NIJ Researc h Report, January 1996)

Victim-related revenue by mental health care providers in 1991 was estimated to be between $5.8 billion
and $6.8 billion, with about one-half of that amount caused by crimes committed that year and the
remainder by child abuse years earlier.

Target Population:
Number: 10,000
Ethnicity: Hispanic, Non-Hispanic
Race: African American or Black, American Indian or Alaskan Native, Asian, Native Hawaiian or Other
Pacific Islander, White, Other
Age: Under 1 year, 1 - 3 years, 4 - 11 years, 12 - 19 years, 20 - 24 years, 25 - 34 years, 35 - 49 years, 50
- 64 years, 65 years and older



                                                     46
Gender: Female and Male
Geography: Rural and Urban
Primarily Low Income: No

Di sparate Population:
Number: 10,000
Ethnicity: Hispanic, Non-Hispanic
Race: African American or Black, American Indian or Alaskan Native, Asian, Native Hawaiian or Other
Pacific Islander, White, Other
Age: Under 1 year, 1 - 3 years, 4 - 11 years, 12 - 19 years, 20 - 24 years, 25 - 34 years, 35 - 49 years, 50
- 64 years, 65 years and older
Gender: Female and Male
Geography: Rural and Urban
Primarily Low Income: No
Location: Entire state
Target and Disparate Data Sources: Crisis center service delivery figures

Evidence Based Guidelines and Best Practices Followed in Developing Interventions:
No E vidence Based Guideline/Best Practice A vailable

Funds Allocated and Block Grant Role in Addressing this Health Objective :
Total Current Year Funds Allocated to Health Objective: $156,006
Total Prior Year Funds Allocated to Health Objective: $0
Funds Allocated to Disparate Populations: $0
Funds to Loc al Entities: $0
Role of Block Grant Dollars: No ot her existing federal or state funds
Percent of Block Grant Funds Relative to Other State Health Department Funds for this HO:
100% - Total source of funding

                ESSENTIAL SERVICES –OBJECTIVES – ANNUAL ACTIVITIES

Allocated funds are used to achieve Impact & Process Objective outcomes and to carry out Annual
Activities that are based on E vidence Based Guidelines and Best Practices identified in this work plan.

Essential Service 4 – Mobilize Partnerships

Objective 1:
Increase community partnerships
Between 10/ 2009 and 09/2010, the Virginia Sexual and Domestic Violence Action Alliance and local
sexual assault crisis centers will increase the number of identified community partnerships promoting
survivor involvement in community education and services from 8 to 10.
Annual Acti vities:
1. Conduct a three-day workshop
Between 10/ 2009 and 09/2010, the Virginia Sexual and Domestic Violence Action Alliance will support
the development and delivery of Camp Mabon, a three-day workshop in a wilderness environment for
survivors of sexual violence working with local sexual assault crisis centers.

2. Expand sexual violence exhibit
Between 10/ 2009 and 09/2010, the Virginia Sexual and Domestic Violence Action Alliance will maintain,
expand and update the A rt of Surviving as a cooperative exhibit with local sexual assault crisis centers,
amplifying the voices of survivors and making connections between surviving sexual violence, creative
expression, spirituality and healing.

3. Conduct statewide meetings




                                                     47
Between 10/ 2009 and 09/2010, the Virginia Sexual and Domestic Violence Action Alliance will collaborate
with statewide sexual violence partners (including the Virginia Department of Health) to conduct three
statewide meetings for staff and directors of sexual assault crisis centers for the purpose of training,
information sharing and networking.

Objective 2:
Increase capacity to provide comprehensi ve service s
Between 10/ 2009 and 09/2010, sexual assault crisis centers will increas e the percent of crisis centers
with full accredited status with the Action Alliance from 69% to 79%.
Annual Acti vities:
1. Di stribute monthly newsletter
Between 10/ 2009 and 09/2010, the Action Alliance will distribute monthly issues of Res onance, a
newsletter for service providers including sexual assault crisis center employees, to an average of 300
persons per issue.

2. Offer on-si te visi ts
Between 10/ 2009 and 09/2010, the Action Alliance will offer on-site visits to each new sexual assault
crisis center agency director and provide a written resource packet on agency management,
accreditation, and services of the Action Alliance.

3. Review the accreditation process
Between 10/ 2009 and 09/2010, the Action Alliance will review the 2008-2009 accreditation proc ess to
determine how well the proc ess met the goals of supporting consistent and effective servic es throughou t
the Commonwealth and make revisions as necessary to improve the process.

4. Coordinate the peer accreditation process
Between 10/ 2009 and 09/2010, the Action Alliance will coordinate the peer Accreditation process for
sexual assault crisis centers to promot e accountability and consistency of services across the
Commonwealth.

5. Operate and provide training on VAdata
Between 10/ 2009 and 09/2010, the Action Alliance will continue to operate VAdat a, the statewide data
collection system, on behalf of local sexual assault crisis centers and sexual violence advocacy agencies
and state funders, including providing local, regional and state reports, and providing training for sexual
assault crisis centers on using the new loc ality/regional reports and how to produce customized reports.

6. Di stribute resource materials
Between 10/ 2009 and 09/2010, the Action Alliance will translate Documenting Our Work survivor forms
into Spanish and distribute to sexual assault crisis centers using Documenting Our Work so that survivors
can anonymously evaluate their servic es.

7. Conduct training
Between 10/ 2009 and 09/2010, the Action Alliance will conduct a three-day training retreat for sexual
assault crisis center staff and volunteers, Action Alliance members, and allied professionals.

8. Publish re source
Between 10/ 2009 and 09/2010, the Action Alliance will publish the Revolution journal as a resource for
professionals working to end sexual violence. One edition will focus on the intersection of substance
abuse, mental health issues, and sexual and domestic violence.




                                                    48
State Program Title: Virginia Suicide Prevention Program

State Program Strategy:

Program Goal: Virginia’s Suicide Prevention Program seeks to maintain and build on the suicide
prevention infrastructure and to address the needs identified in the Commonwealth’s suicide prevention
plans: The Youth Suicide Plan and the Commonwealth Lifespan Plan. The specific goals of the program
are to: (1) raise awareness about risk factors for suicide and encourage help seeking; (3)
improve comprehensive community based prevention and early intervention initiatives in the
Commonwealth; (4) provide state leadership to secure broad -bas ed support for suicide prevention in
Virginia.

Primary Strategic Partners: DIVP works closely with several stakeholder agencies and organizations in
implementing the Virginia Suicide Prevention Programs goals and objectives. Strategic partnerships
have been developed with the Department of B ehavioral Health (DB HDS ), the Virginia Cha pter of the
National Association of the Mentally Ill (NAMI), Department of Veterans Services (DVS ), Departments of
Aging (DOA ), the Department of Education (DOE), the Department of Criminal Justice Servic es (DCJS ),
local crisis centers, local suicide preve ntion coalitions, and the Suicide Prevention Coalition of Virginia.
The plan is to continue to work with these existing partners and include others as warranted.

Evaluation Methodology:
In 2006 the University of Virginia completed an evaluation of the QPR and ASIS T gatekeeper training
being done under the VDH Suicide Prevention Program. That evaluation concluded that ―the results
provide support for the benefit of gatekeeper training for school personnel to identify potentially suicidal
students‖. DIVP’s staff epidemiologist will continue to coordinate on -going program evaluation and data
collection. Trainings will be evaluated through participant surveys, contract performanc e will be
monitored, and data will be collected on the exposures to public awareness campaigns and materials
disseminated.


State Program Setting:
Community based organization, Schools or school district, Senior residence or center, Work site, Other:
Community service boards and Military veterans centers

FTEs (Full Time Equivalents):
Full Time Equivalents positions that are funded with PHHS Block Grant funds.

Total Number of Posi tions Funded: 0
Total FTEs Funded: 0.00


National Health Objective: HO 18-1 Suicide

State Health Objective(s):
Between 10/ 2009 and 09/2011, Reduce the suicide death rate by 2% from a rate of 12.07 per 100,000 to
11.8 per 100,000.

Baseline:

The suicide death rate in Virginia was 12.07 per 100,000 population in 2008.
The suicide death rate in Virginia among 10 -24 year olds in 2008 was 8.46 per 100,000 population.
The suicide death rate in Virginia among elderly 65 and older in 2008 was 16.37 per 100,000 population.




                                                     49
Data Source:
Virginia Vital Statistics

State Health Problem:

Health Burden: Each year in Virginia (2008), over 938 people die from suicide and over 5,121 are
hospitalized due to non-fatal suicide attempts. In Virginia, suicide rates are highest among Virginian’s 45-
54 years of age and the elderly 65 and older. Among youth, 10-24 years of age, suicide is the third
leading cause of death (following unintentional and homicides). Half (49%) of all suicides in Virginia eit her
disclose intent or have a history of suicide attempts. Suicides can be prevented through increased
awareness of the warning signs of suicide and training in suicide prevention/intervention.

Target Population:
Number: 6,358,892
Ethnicity: Hispanic, Non-Hispanic
Race: African American or Black, American Indian or Alaskan Native, Asian, Native Hawaiian or Other
Pacific Islander, White, Other
Age: 12 - 19 years, 20 - 24 years, 25 - 34 years, 35 - 49 years, 50 - 64 years, 65 years and older
Gender: Female and Male
Geography: Rural and Urban
Primarily Low Income: No

Di sparate Population:
Number: 940,577
Ethnicity: Hispanic, Non-Hispanic
Race: African American or Black, American Indian or Alaskan Native, Asian, Native Hawaiian or Other
Pacific Islander, White, Other
Age: 65 years and older
Gender: Female and Male
Geography: Rural and Urban
Primarily Low Income: No
Location: Entire state
Target and Disparate Data Sources: Virginia Vital Records

Evidence Based Guidelines and Best Practices Followed in Developing Interventions:


Other: Suicide Prevention Resource Centers Best Practice Registry

Funds Allocated and Block Grant Role in Addressing this Health Objective :
Total Current Year Funds Allocated to Health Objective: $90,000
Total Prior Year Funds Allocated to Health Objective: $0
Funds Allocated to Disparate Populations: $26, 600
Funds to Loc al Entities: $0
Role of Block Grant Dollars: Supplemental Funding
Percent of Block Grant Funds Relative to Other State Health Department Funds for this HO:
Less than 10% - Minimal source of funding

                  ESSENTIAL SERVICES –OBJECTIVES – ANNUAL ACTIVITIES

Allocated funds are used to achieve Impact & Process Objective outcomes and to carry out Annual
Activities that are based on E vidence Based Guidelines and Best Practices identified in this work plan.

Essential Service 3 – Inform and Educate




                                                     50
Objective 1:
Provide education regarding suicide prevention
Between 10/ 2009 and 09/2010, local crisis center pers onnel, local suicide prevention trainers, and key
personnel at VDH, Department of Aging, and Department of Veterans Services will implement 5 one -day
community training events to inform members of the community about suicide prevent ion and available
mental health resources.
Annual Acti vities:
1. Implement community acitivities regarding sui cide prevention
Between 11/ 2009 and 06/2010, VDH will contract with 5 local crisis centers to plan and implement one -
day community activities to inform the public about suicide warning signs, facts and myths surrounding
suicide, and available resources for those who may be in suicidal crisis.

2. Di stribute prevention brochure s
Between 11/ 2009 and 09/2010, VDH will disseminate suicide prevention brochures to youth, elderly and
military veterans. These brochures will contain information on suicide warning signs, how to help a
person in crisis, mental health recourses, and local and national hotline numbers. The brochures will be
available for distribution at conferences, trainings, and for order online.


Essential Service 8 – Assure competent workforce

Objective 1:
Provide training
Between 11/ 2009 and 09/2010, suicide prevention trainers from across Virginia and key personnel from
DBHDS, DOE, DVS, DOA, DCJS, and DIVP will conduct 80 training sessions to key stakeholders and the
general public to inform them on how to recognize the warning signs of suicide, ask someone if they are
having thoughts of suicide, perform risk assessments, and establish safe plans.
Annual Acti vities:
1. Purchase materials and conduct training
Between 11/ 2009 and 09/2010, VDH will contract with local suicide prevention trainers across the state to
provide suicide prevention trainings (AS IS T, SafeTALK, QPR). These trainings will be conducted in
collaboration with the Departments of Behavioral Health, Education, Veterans Services (Wounded
Warrior Program), and Aging. VDH will also purchase the training materials for the ASIS T training
(handbook, workbook, and quick reference wallet card).

2. Host stakeholder meeting
Between 11/ 2009 and 09/2010, in collaboration with DBHDS, DOE, DVS, DOA, and DCJS, DIVP will host
a key stakeholder meeting that will be attended by representatives of each participating agency and the
general public. The meeting will feature presentations that specifically address challenges of the
unemployed, the elderly, first responders, medical providers, and vet eran populations.




                                                    51

				
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