Building Healthy Communities Conference At the Intersection of Community Development & Health: Innovative Approaches Robert Kahn , Associate Chair, Community Child Health, Cincinnati Children’s Martha Halko , Deputy Director, Cuyahoga County Board of Health Angela Mingo , Community Relations Director, Nationwide Children’s Hospital October 23, 2014
Goal • To highlight strategies, initiatives, and programs where there is collaboration between community and health organizations geared toward improving community health
Overcoming Obstacles to Health, Robert Wood Johnson Foundation, 2008
Attributes Adequate funding Shared vision, goals Skilled leadership Mutual respect Established relationships, communication Innovation Collaboration history Existing models, best practices
Changing the Outcome, Closing the Gap Population health work • Asthma and housing • Community agency - health care collaborations • Beyond collaborations to networked production • Moving beyond health care • hospital level • clinic level
Population Health Initiative Hamilton County: 190,000 children age birth -17yrs Goal and Initiatives Purpose Lead, advocate and collaborate to measurably improve the health of local children and reduce disparities in targeted populations High Level Measures By June 30 2015, • Reduce the use of the ED and inpatient services by 20% in children with asthma covered by Medicaid
CCHMC
CCHMC has 90+% of all asthma admissions in county Quintile 1: • 18 admits among 29,000 kids 0.6 per 1000 • Quintile 5: • 299 admits among 17,900 kids • 16.7 per 1000 Beck (2013)
Who are the critical partners? • Pharmacies • Cincinnati Public Schools • Cincinnati Health Department • Community Development Corp • Community health workers • Legal Aid Society
Cincinnati Asthma Admissions and Neighborhood Asthma Hotspots
Legal Aid Housing Cases Mapped Against Neighborhood Asthma Hotspots
Attacking social determinants directly
Avondale and Asthma – Neighborhood approach Engaging Legal Aid: Child-Health Law Partnership 181 total utilizations – 130 ED visits, 51 admissions 14 Days Since Previous Utilization 12 10 8 6 4 2 0 01/01 01/10 01/20 02/08 02/15 02/24 02/29 03/12 03/15 03/21 03/25 04/04 04/11 04/15 04/25 05/10 05/22 05/28 06/15 06/30 07/10 07/17 07/25 08/08 08/18 08/28 09/01 09/04 09/11 09/13 09/24 10/02 10/08 10/11 10/16 10/21 10/29 11/06 11/09 11/18 11/26 12/10 12/12 12/17 12/23 12/29 2012 Date of Utilization Days Since Previous Utilization Average Days Between Utilizations Control Limits Beck ( 2014 )
Avondale Beck (2014)
Avondale “Heat map” of building code violations Beck & D. Jones (2014)
Avondale CHOICE Buildings to be refurbished by The Community Builders Beck (2014)
Avondale Beck (2014)
Network of care community health worker Legal Aid schools pharmacy CHOICE building case manager Figure. Collaborations between agencies serving children with complex chronic conditions. Acad Ped 2012
Moving beyond health care: Hospital Population Health Initiative Hamilton County: 190,000 children age birth -17yrs Goal and Initiatives Purpose Lead, advocate and collaborate to measurably improve the health of local children and reduce disparities in targeted populations By June 30 2015, •Reduce the use of the ED and inpatient services by 20% in children with asthma covered by Medicaid •Reduce infant mortality by 15%, 20 infant deaths per year •Reduce the occurrence of unintentional pediatric injuries 30% •Reverse the trend of increasing childhood obesity in grades K-3 • Early mental health promotion and intervention • School readiness and Grade 3 reading
Preterm birth in Hamilton County
Moving beyond health care: Clinics What A Prepared Clinic Potential Exceptional health for every child, together Maslow’s Hierarchy of Needs Collaborations Will Detect Unemployment; lack Achieving of high school degree; potential higher level job training Esteem & Overwhelmed new Respect parents; lack of parenting role models Belonging Domestic violence; mental health issues; inadequate education services Safety Hunger; homelessness; denial or delay of benefits; utility shut offs Basic Human Needs Henize, Kahn (2013)
Lessons • Shared vision – change outcomes, close the gap - and intentionality (thank you, Ozie) • Population denominator approach – Otherwise great silos, lousy outcomes – Measurement and analytic capacity • Building network of partnerships – Span missions, but also daily operations, data • Building innovation and improvement capacity – community capacity for design thinking, QI, measurement • Funding – hospital, foundation, … ACO?
100 150 200 250 50 0 Camp Washington Avondale Linwood-E. End-California Elmwood Plc. S. Cumminsvil-Millvale Corryville N. Avondale-Paddock Hills Injury rate per 1000 children aged 1-4 years, 3 year average (2010- Mt. Auburn Fairfax N. Fairmount-English Woods Golf Manor Lockland-Arlington Hts. Reading Winton Hills Walnut Hills Over The Rhine W. End Winton Place Bond Hill S. Fairmount Norwood Evanston Silverton Lower Price Hill/Queensgate St. Bernard Evanston-E.Walnut Hill Roselawn E. Price Hill Terrace Pk. W. Price Hill Pleasant Ridge Wyoming Madisonville Sedamsville-Riveside Carthage Greenhills Fairview-Clifton College Hill Mt. Lookout-Columbia Tusculum Westwood 2012) Northside Springfield Oakley Mt. Washington Hartwell Fay Apt. N. College Hill Univ. Heights Mt. Airy Cheviot Lincoln Hts. Delhi Amberley Village Anderson Blue Ash Clifton Riverside-Sayler Park Harrison Twp. Hyde Park Colerain Mt Healthy Kennedy Hts. Mt. Lookout Mariemont Evendale Deer Park Madeira Indian Hill Columbia Forest Park Green Montgomery Springdale Sharonville Sycamore Newtown Glendale Woodlawn CBD Riverfront-Mt. Adams Crosby Whitewater Miami Symmes Harrison Addyston-N. Bend Cleves Loveland
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