The document summarizes changes to Colorado's public health system resulting from the 2008 Public Health Act. Key points: - The Act created a unified local public health agency structure across the state and established minimum standards and services. - It led to the creation of the Office of Planning and Partnerships to coordinate implementation of the Act and develop statewide public health improvement plans. - The office works with local public health agencies to build their assessment, planning, and service delivery capacities through tools like Colorado's Health Assessment and Planning System (CHAPS).

1. PSD-EPE, OPP, CHIES Meeting of the Minds: July 21, 2011

2. The 2008 Public Health Act Office of Planning and Partnerships: History

3. New Structure in Colorado Public Health Nursing Services Public Health Act of 2008, SB08-194 County and District Health Departments The new law creates one type of local public health agency with the purpose of assuring the same level and quality of public health across the state. . Local Public Health Agency Office of Planning and Partnerships Colorado Department of Public Health and Environment

4. In statute: Former Part 5 ’s (Organized Health Departments) 15 OHDs served 24 counties & 85% of the state ’s population Provided of a broad scope of public health services Former Part 6 ’s (Nursing Services) Served 40 counties Provide public health services deemed necessary by the local board of health, mostly falling within the scope of the practice of nursing Some of these counties offered environmental health particularly Consumer Protection services “ Old ” Public Health Structure in Colorado

5. The Colorado picture in 2008… Office of Planning and Partnerships Colorado Department of Public Health and Environment Colors: Organized Health Departments White: Nursing Services : Environmental Services

6. The Public Health Act of 2008 All counties have a local public health agency (LPHA) New services prescribed are similar to the “old” Organized Health Departments State Board of Health to establish: Minimum qualifications for directors Core services and standards Funding formula The state facilitates a public health improvement plan approved by the State Board of Health All counties develop local public health improvement plans based on health assessment

7. Office of Planning and Partnerships Created in response to the Act. Purpose: Coordinate Act implementation Lead development of statewide public health improvement plans (PHIP) (2009, 2014) Lead implementation of the PHIP Guided by a Steering Committee . . .

8. Public Health Improvement Steering Committee Local Public Health Co Chair, Bonnie Koehler, Delta County Jackie Brown, Prowers County Deb Crook, Summit County John Crosthwait, Northeast HD Jeff Kuhr, Mesa County Mark Johnson, Jefferson County Jim Rada, Garfield County Jeff Stoll, Broomfield County Stacy Weinberg, Tri-County HD Jeff Zayach, Boulder County Gini Pingenot, CO Counties Inc. Lisa van Raemdonck, CALPHO CDPHE Leadership Co-Chair Chris Urbina, CEO ,Chief Med Officer Martha Rudolph, Environmental Director Roz Bedell, COO Karen DeLeeuw, Ctr Living & Chronic Disease Chris Lindley, Preventive Services Jeff Lawrence, Consumer Protection Lyle Moore, Emer. Preparedness Karin McGowan, Community Relations Lisa Miller, DCEED Alyson Shupe, CHEIS Karen Trierweiler, Ctr Families & Children Glenn Schlabs, Board of Health Chris Wiant, Caring for Colorado Tim Byers, Center for Public Health Practice

9. This first Statewide Plan is intended to build capacity. PHIP Capacity Priorities : - Core Public Health Services & Standards - Financing and Funding - Assessment and Planning - Public Health Roles & Relationships -Workforce Development -Public Health Informatics

10. Colorado ’s 10 Winnable Battles (Health Priorities) Clean Air Clean Water Injury prevention Mental Health & Substance Abuse Obesity Oral Health Prevent Infections Safe Food Tobacco Unintended Pregnancy

11. This first Statewide Plan is intended to build capacity. PHIP Capacity Priorities : - Core Public Health Services & Standards - Financing and Funding - Assessment and Planning - Public Health Roles & Relationships -Workforce Development -Public Health Informatics

12. “ Core public health services shall be defined by the state board and shall include, but need not be limited to, the assessment of health status and health risks, development of policies to protect and promote health, and the assurance of provision of the essential public health services.”

13. Assessment and Planning Vital Records and Statistics Investigate & Control Communicable Disease Prevention and Population Health Promotion Emergency Preparedness and Response Environmental Health Administration and Governance … in accordance with the 10 Essential Public Health Services

14. Core Service: Prevention and Population Health Promotion “ Develop, implement, and evaluate strategies (policies and programs) to enhance and promote healthy living, quality of life and wellbeing, while reducing the incidence of preventable (chronic and communicable) diseases, injuries, disabilities and other poor health outcomes across the life-span.”

15. Prevention and Population Health Promotion, cont ’d Furthermore, agencies are required to: 1. Promote physical health, oral health, mental and behavioral health, and environmental, health with emphasis on increasing health equity among priority populations (e.g., children, elderly, racial or ethnic populations). 2. Address identified risk factors or behaviors based on community health (e.g., tobacco use, physical activity, nutrition, teen pregnancy, sexually-transmitted infections). 3. Inform, educate, and engage the public and policymakers to build community consensus and capability to promote/support evidenced-based strategies that enable healthy personal, organizational, and community behaviors and environments. 4. Assure strategies are delivered in a culturally and linguistically appropriate manner. 5. Coordinate efforts with governmental and community partners to link individuals to health care services such as primary care (including maternal and child health), oral, specialty, and mental health care. 6. Develop community-specific solutions to address prevention priorities. 7. Promote and participate in planning for sustainable environments that support healthy living.

16. 2011 Baseline Review of LPHAs Capacity to Perform/Assure Core Services- Purpose: Catalogue current capacity of the CO system Inform core services and funding discussions Identify areas for improvement Summary to date: 46 of 54 site visits completed Assessment and Planning & Prevention and Health Promotion are two of the areas of low capacity among LPHAs

17. Adopt a revised local public health funding formula Based on population and provision of services Other programs addressing funding formulas based on new structure Streamline contracting and funding processes

18. What Do Per Capita Funds Pay For? Infrastructure-General Operating Assessment and planning expectations in scope of work Varies on how agencies apply funding Cover communicable disease reporting and investigations Cover environmental health in some LPHAs but not others Cover health promotion activities Not directly tied to core services at this time

19. LPHAs, Service Populations & Current Funding Distributions Population Served by LPHA Number of Agencies Number of Counties Served Percent of Total CO Population Served Percent of Per Capita Dollars Received 100,000 + 9 11 83% 74% 50,000-99,999 6 12 7% 10% 10,000-49,999 18 19 9% 13% Less than 9,999 21 22 1% 3% Total 54 64 100% 100%

20. New Per Capita Funding Formula Target: establish funding formula by BOH Rule, to take effect July 1, 2012 Use funding formula to further implementation of the Public Health Improvement Act Think strategically about funding to LPHAs Provide enough time for adjustments Align with other funding formulas where possible: Environmental Health and Sustainability, Emergency Preparedness, Immunization, MCH, TB, WIC

21. 2012 Per Capita Funding to LPHAs (old formula) General Fund - $5,935,190 Tobacco Settlement Fund - $ 2,045,938 Total - $7,981,128 Largest Award - $1,759,160 Smallest Award - $12,349 Average award - $145,111 Base - $11,573 (fmr Nursing Service) or $67,500 (OHD) Per capita – approx $ 1.52 (NS) or $1.27 (OHD) Regional Incentives - $10,000 per additional county

22. Ensure a comprehensive set of public health indicators are available. Develop a standardized approach to community health assessment. Establish a coordinated statewide planning process. Ensure public health planning capacity. Prepare agencies for national accreditation. Product: CHAPS-Colorado’s Health Assessment and Planning System

23. CHAPS Colorado’s Health Assessment and Planning System If you have to have an acronym, it may as well connect to Colorado!

24. C olorado H ealth A ssessment and P lanning S ystem (CHAPS) Community Health Assessment Results Public Health System Capacity Assessment Results Standardized Prioritization Process Local Public Health Improvement Plan Statewide Public Health Improvement Plan Come away with Strategic Priorities PHIP will include: -CHA Results -Capacity Assessment Results -Action Plan *Strategic Priorities Strategies Time line Goals/Objectives Role of Partners

25. CHAPS Guide: Phases Phases (or Chapters) Plan the Process Strategically Select Stakeholders Conduct a Community Health Assessment Conduct a Capacity Assessment Facilitate a Prioritization Process Develop a Public Health Improvement Plan Evaluate and Communicate Progress

26. CHAPS: Currently building the system by testing on the ground: Piloting with 15 counties-single agencies and regions Boulder, Broomfield, Pueblo, Weld, El Paso, (Routt, Jackson, Moffet) (San Miguel, Ouray, Gunnison, Montrose, Delta, Hinsdale) Identifying technical assistance needs Reviewing other state’ s models Developing standard templates, tools and formats Assuring that CHAPS aligns with PHAB/MAPP Will design an interactive website for 2012

27. Office of Planning and Partnerships

28. Our Staff: Who manages this unit and where is she? Kathleen Matthews, MPH, Director Reports to new Community Relations Director, Karin McGowan, along with Communications, Office of Health Disparities and Legislative Liaison Serves as primary liaison to all local public health agencies and connects with other state local liaisons Attends Public Health Director monthly meeting Distributes State general fund and Master settlement funds to local public health agencies Actively participates in CALPHO and other public health organizations Right now-Meeting with County Commissioners in Garfield and Mesa counties with other directors and Chris Urbina. Wishes she was here with you.

29. Our Staff: Public Health Planners Heather Baumgartner, Assessment and Planning Manager Oversees funding and technical assistance to local public health agencies for assessments and local public health improvement plans Coordinate next Statewide Public Health Improvement Plan Jill Hunsaker Ryan, MPH, Planning Consultant- 60% time, Western Slope Developing Colorado ’s Health Assessment and Planning System (CHAPS) Providing technical assistance to pilot sites Shannon Rossiter, JD, MPH, PH Planner-Administration/Governance Leading drafting of rules for Core Services and Funding formula as defined by the Public Health Act Will be providing consultation on Core Service of Administration and Governance Sharon Adams, REHS, Environmental Health Planner Consulting, planning & training related local provision of environmental health services Connects CDPHE environmental programs with local environmental health

30. Our Staff: Public Health Nurse Consultants Tsering Dorjee, MSN, MPH, RN, PHCNS-BC, Public Health Nurse Consultant (East of the Continental Divide) Kate Lujan, RN, MPH, Disease Control and Public Health Nurse Consultant 40%, (Western Slope) Duties: Developing orientations for new public health directors and staff Participating in PHNAC, Practice Advisory Council, National ASTDN, and APHA PH Nursing Section Strengthening connections with DCEED and concept of environmental health nursing Assisting with assessment and planning

31. Our Staff: Performance Improvement/Local Data Support Kierston Howard, MS, Performance Improvement Manager Funded through CDC ’s National Public Health Improvement Initiative Leading development of CDPHE ’s Strategic Planning with Karin McGowan Supporting POSITEAM and other QI efforts within CDPHE Connected to national Performance Improvement Network Alison Grace Bui, MPH, Local Public Health Data Specialist Housed in CHEIS, funded by OPP through CDC grant Provide support on data analysis/interpretation to local public agencies for assessment and planning, using the Social Determinants framework

32. Our Staff: Office Support/Vacancy Ariadne Romano, Office Manager Katy Rice, Part-Time Program Assistant Keeps up to date list of LPHAs and sends information out as requested by divisions and programs Open Position: Public Health Planner and Communications