Transcript It Takes A Region: the West Central Public Health and

“It Takes A Region: the West
Central Public Health and
Environment Collaborative,
An innovative approach to public
health practice”
Peg Mewes, Director, Montrose County
Health and Human Services
Carol Dawson, Coordinator, West Central
Public Health Partnership
Richard Thompson, Environmental Health
Official, West Central Region
Change in the air…
“It is not the strongest of species that
survive, nor the most intelligent, but
the one most responsive to change.”
Charles Darwin
Serving our customers?
Delta * Gunnison* Hinsdale *
Montrose * Ouray * San Miguel
About the region…
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9,569 sq miles of mostly mountainous terrain, much of
which is public lands, on Colorado’s western slope
A rural, frontier region, population 93,440
Region wages 67.3% of state av. with % of poverty higher
than state
Region has highest number of uninsured in the state
Largest producer of coal (45.8% of coal mined in Co.) and
increasing in oil and gas production
Tourism extremely important to region. Two major ski
resorts and yr. round recreational and outdoor activities
abound
Montrose County, most populous, regional trade center and
agricultural hub
Delta County has the only health department in the region
West Central Region population by
year and county, 1990-2005
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Region grew
52.2%, a rate
of increase
higher than
the state in
that time
period
(42.9%)
100,000
90,000
80,000
San Miguel
70,000
Ouray
60,000
Montrose
50,000
Hinsdale
40,000
Gunnison
30,000
Delta
20,000
10,000
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The beauty of it all…
The beauty of it all…
The beauty of it all…
Fall 2005, the growing problem…
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A challenged public health and environment
infrastructure
Growing population with largest number of
uninsured in the state
Aging public health workforce (50% over age 50)
and lack of qualified human and financial
resources to replace
Strained and inadequate financial resources
Healthy People 2010 priorities addressed based
on funding and not good community assessment
and strategic planning
Inadequate Environmental Health resources
“If you are ready to criticize a
system, be equally ready to offer
assistance to improve it.”
Armando Sanchez, Educator
The Colorado Trust…
Mission:
The Colorado Trust is dedicated to advancing the
health and well-being of the people of Colorado
“Colorado’s public health system is widely
decentralized…This scattered system, combined
with the continuing decline of federal, state, local
public health budgets, has increased the need for
the on-going coordination and provision of
essential public health services. Weaknesses in
the public health infrastructure, compromise the
ability to protect Coloradoans from emerging
health threats…
The Colorado Trust 2005 annual report p. 15
The Opportunity…
Fall 2005, The Colorado Trust’s
Partnerships for Health Initiative
“The Colorado Trust’s eight year (20052013) $8.6 million Partnerships for Health
Initiative is designed to help improve the
coordination of health services at the
community level.” The Initiative supports
14 community health partnerships
statewide to help partnerships build,
strengthen and sustain the infrastructure
of Colorado communities by proactively
addressing public health issues.
Initiative overview
In the Beginning…Gunnison
County takes the initiative
“I not only use all the brains I have,
but all that I can borrow.”
Woodrow Wilson, 28th President of the
US
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Gunnison County takes the lead
Grant written Nov. 2005 for $10,000 6
month planning grant. Awarded by The
Colorado Trust in Dec. 2005
The goal: to initiate discussions regionally
to address how to make the best use of
existing and future resources and how to
work together to assess our community and
share resources to address all Healthy
People 2010 focus areas and public health
performance standards
Healthy People 2010 focus area #23 Public
Health Infrastructure chosen
“Action springs not from thought
but from readiness for
responsibility” Dietrich Bonhoeffer,
German theologian
Jan. 24, 2006 Gunnison County
BOCC hosts regional BOCC
representatives and county
administrators. Public Health and
Environment staff from the six
counties and CDPHE local liaison staff
also attend. Facilitation provided by
The Trust. Results: Unanimous
decision to move forward with
“Strength is derived from unity.
The range of our collective vision is
far greater when individual insights
become one.” Andrew Carnegie
Successive meetings of the EH and PH staff in the
six counties define:
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The mission, vision and values of the
Partnership
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The role of the Partnership coordinator and
organizational structure
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The Intergovernmental Agreement
4.
“employees” of the Partnership
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The strategic plan, collaborative ideas into goal
areas
West Central Public Health
Partnership
Mission
The mission of the West Central
Public Health Partnership is to build
and strengthen public health and
environment infrastructure by
identifying and implementing
collaborative projects that benefit the
counties of Delta, Gunnison,
Hinsdale, Montrose, San Miguel and
Ouray
West Central Public Health
Partnership
Vision
We envision a public health
partnership that protects the people
and environment in our six county
region, promotes health and prevents
disease, resulting in optimal health
for all our citizens as our region
grows and becomes more diverse.
Criteria for projects
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Must have some degree of benefit to
all six counties
Must be measurable
Must be demonstrated best practices
and/or evidenced based
Must not ultimately add to the
current work load of the individual
counties
Must be realistic and attainable
Goal areas of the strategic plan
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Formalization of the regional
partnership
A regional health assessment
Prevention and decreasing the
incidence of food borne illness
(regional food safety classes and a
regional environmental health
official)
Maximize public health resources for
pandemic planning
Accomplishments…meeting the
goal areas of the strategic plan
In July 2006, Gunnison County
received the Implementation grant
from The Colorado Trust for the
region to complete the strategic
plan.
$187,500 over two and a half years
with additional $187,500 grant to
follow for additional 2 ½ years
Goal #1: Formalization of the
Partnership
Accomplishments:
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An IGA (Intergovernmental
Agreement) was signed by the BOCC
in each of the six counties
Partnership coordinator job
description was written and
coordinator for the Partnership hired
Operating guidelines for the
Partnership
Goal #2: Regional Health
Assessment
Accomplishments:
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Indicators to be assessed and tracked
for the regional health assessment
were identified
Staff obtained
First regional health assessment was
completed December 2007
Goal #3 Improve safe food
preparation practices in retail
establishments
Accomplishments:
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Expanded Partnership to include CSU
Extension Service and developed
available, consistent food safety
classes in each county throughout
the region. Classes available in
English and Spanish
Hired regional EH official and
purchased regional equipment for EH
Goal #4 Maximize Pandemic
Planning resources
Accomplishments:
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Regional pandemic planner hired to
assist counties in completing phase 1
and scope of work as outlined in the
pandemic planning contract to each
county
A word about the Food Safety
Works classes…
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63 classes
690 participants
Pre and Post test
show aggregate
increases in
knowledge
Classes in English
and Spanish in
most counties
Montrose County takes the lead in
hiring EH official for region
“Help your brothers boat across and yours will reach the
shore”
Hindu Proverb
Background:
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Montrose County had only one part time food inspector.
The new regional position would help provide additional FTE
for the growing needs of the county
 Ouray County had no EH official
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Delta County is only health department in region
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Gunnison and Hinsdale Counties insufficient EH FTE.
Majority of resources earmarked for building/planning
needs
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San Miguel County has sufficient resources except for surge
capacity
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Public Health nurses vulnerable without EH support
Environmental Health Strategy
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Use Delta County as a Model
Look for opportunities to expand EH
Services across counties
Endeavor not to disrupt any EH
Service currently being provided.
CORE BELIEFS
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A competent, qualified, functioning health
department consist of Public Health Nursing and
Environmental Health collaborating together with
support from Epidemiology and a number of
specialized support functions from a state PH.
Public Health delivered in this way saves $$$.
Delivery of services is best done when conducted
at a local level.
There are some cost savings at the local level for
counties to cooperate and still retain many of the
benefits of local services, that enables smaller
counties to have services and expertise not
otherwise available.
Regional EH, Accomplishments
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Regional EH official hired part time and
progressed to full time with additional part
time staff
Food safety classes in each county
Regional radon testing and education
School chemical safety awareness and
monitoring
Increased EH support for public health
nurses and staff
“One finger can’t lift a pebble” Hopi saying
Grant & Contract Programs
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Food Service Inspections in Gunnison, Montrose
& Ouray Counties (CDPHE Contract)
Non Community Water System Inspections in
Gunnison, Hinsdale, Montrose & Ouray
Radon Awareness Grant From CDPHE
School Chemical Safety Grant from EPA
Environmental Justice grant to conduct Lead
Poisoning and Indoor Air Quality Awareness
(applied to EPA in June for region)
EH Accomplishments continued
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Equipment purchased for use within region
laptop, GPS devises, indoor air
quality equipment, etc.
Partnership developed with septic haulers
regionally. The first Wastewater/Biosolids
conf. held
Regional consumer protection contracts
and agreements
Additional EH capacity and support for all
counties in the region when needed
New Partnerships…
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“Genius is the capacity for seeing
relationships where lesser men see none.”
William James
Wastewater and Biosolids Issues
in Western Colorado
Transporting, Disposal, and Recycling
Challenges…
Challenges continued
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Geographic and weather related travel to
meetings
Time away from the office, especially for
the agencies with one staff
Not all counties benefit equally from all
projects
Communication is slower
All six counties are not equally invested in
the Partnership
Greater need in some counties
Implementation of SB 194
“If you always do what you’ve
always done, you’ll get what you’ve
always gotten.” Author unknown
Evaluation…
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Role of Tri West. Surveys evaluating the
Partnership for The Trust
Indicator directly related to health
outcomes…”Improve safe food preparation
practices in retail establishments”
1. # of food safety classes and
pre/post test evaluation
2. data on violations/county/yr.
3. # of reportable food borne diseases
per county per year
Blueprints developed by Tri West
The Future…
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Regional Educational/Marketing campaign to
educate region’s population on results of
assessment and indicators needing improvement
Develop means of keeping regional assessment
indicators current and updating assessment
annually to show trends and emerging issues
EH planning, regional contracts
Baseline assessment of PH and EH infrastructure,
programs and funding in preparation for SB194
implementation
More structure for the Partnership
Grant continues additional 2 ½ years. $187,500
after January 2009. ??? Projects to be
undertaken
“Never doubt that a small group of
thoughtful, committed citizens can
change the world; indeed, it’s the
only thing that ever has.”
Margaret Mead, Am. Anthropologist