2013 SAINT LOUIS COUNTY HEALTH ASSESSMENT. Mobilizing for Action through Planning and Partnerships (MAPP) Local Public Health System Assessment

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1 2013 SAINT LOUIS COUNTY HEALTH ASSESSMENT Mobilizing for Action through Planning and Partnerships (MAPP) Local Public Health System Assessment Prepared by: Sponsored by:

2 Table of Contents Introduction...1 Executive Summary...2 Assessment Instrument...3 Assessment Participants...4 Assessment Methodology...5 Results of the LPHSA...6 Saint Louis County Department of Health Contribution to Local Public Health System Performance...8 Scores and Common Themes for Each Essential Public Health Service...9 EPHS 1: Monitor Health Status to Identify Community Health Problems EPHS 2: Diagnose and Investigate Health Problems and Health Hazards EPHS 3: Inform, Education, and Empower People about Health Issues EPHS 4: Mobilize Community Partnerships to Identify and Solve Health Problems EPHS 5: Develop Policies and Plans that Support Individual and Community Health EPHS 6: Enforce Laws and Regulations that Protect Health and Ensure Safety EPHS 7: Link People to Needed Personal Health Services and Assure the Provision of Health Care When Otherwise Unavailable EPHS 8: Assure a Competent Public Health and Personal Health Care Workforce EPHS 9: Evaluate Effectiveness, Accessibility, and Quality of Personal and Population-Based Health Services EPHS 10: Research for New Insights and Innovative Solutions to Health Problems Key Findings from the Local Public Health System Assessment List of Community Partners

3 Introduction In 2013, a broad array of public health stakeholders from St. Louis County convened as the St. Louis County Partnership for a Healthy Community. In the following months, the partnership worked towards its mission to create a healthy community through comprehensive assessments and the implementation of effective action plans by conducting a Mobilizing for Action through Planning and Partnerships process. As part of (MAPP) the overall approach to strategic community health improvement planning, the St. Louis Introduction: The Overall MAPP Process and the Forces of Change Assessment County Partnership for a Healthy Community has embarked on a community-based approach called MAPP is a which community-driven strategic planning framework assistsand communities in developing MAPP, stands for Mobilizing for Action through that Planning Partnerships. MAPP is and a tool which implementing efforts around the prioritization of public health issues and the identification of resources to helps communities improve health and quality of life through community-wide and community-driven address them as definedby byfollowing the Ten Essential Public Health Services. The MAPP process includes four assessment strategic planning. this approach, collaboration is sought by a broad representation of tools, including the Local Public Health Assessment. people who share the commitment to and have a role in the community s health and overall well-being. Organize Partnership for Success Development Visioning Four MAPP Assessments Identify Strategic Issues Formulate Goals and Strategies Evaluate al Public He Loc m Assess alth men te t Sys es of Cha Forc ssm nge ent s A se munity Themes Com gths Assessm & ent en St r Plan Action Implement Com alt h S t a m u nity H e n t tus Assess m e MAPP Model, AchievingHealthier HealthierCommunities Communities through Handbook MAPP Model, Achieving through MAPP MAPPUser s User s Handbook Within the overall MAPP process, there are four main assessment tools. One of these assessment tools is called the Forces of Change Assessment (FOCA). The FOCA is aimed at identifying forces such as The Local Public Health System (LPHSA) for St. Louisthe County was conducted April 19th, 2013 as trends, factors, or events Assessment that are or will be influencing health and quality ofonlife of the community one of the the four the MAPP process. and workassessments of the localinpublic health system. The LPHSA, described in detailover in the following section, is used understand the overall strengths and Trends are patterns time, such as migration into and out of a community or a growing weaknesses of the public health system based on the Ten Essential Public Health Services. Results from the disillusionment with government. LPHSA be analyzed with the reports from the three assessments in the population, MAPP process, will Factors are discrete elements, such asother a community s large ethnic an which urbaninclude setting,the Community Health Status Assessment (CHSA), Community Themes and Strength Assessment (CTSA), and the or the jurisdiction s proximity to a major waterway. Forces ofevents Changeare Assessment Strategic analysis these assessment informor thethe identification one-time (FOCA). occurrences, such as a of hospital closure, a results naturalwill disaster, passage of prevailing health issues and public health system issues, which will then be strategically prioritized. Goals and of new legislation. action plans will be developed for each of these priority health issues. These action plans will then be implementedduring and aligned to improve the health and well-being of thequestions: St. Louis County community. the FOCA, participants answer the following What is occurring or might occur that affects the health of our community or the local public health system? What specific threats or opportunities are generated by these occurrences? Forces to be considered should include the following categories of influence: (1) Social, LOUIS COUNTY LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT (2) SAINT Economic, (3) Political, (4) Legal/Ethical, (5) Environmental, (6) Technological, (7) Scientific, (8) Population, and other categories that the group decides are influential. 1

4 Executive Summary: Cross-Cutting Issues Throughout the Local Public Health System Assessment Throughout the discussions of the Ten Essential Public Health Services, a number of cross-cutting themes emerged in the dialogue among each group. The themes arose as strategic areas to address to improve the functioning, capacity, and effectiveness of the local public health system in St. Louis County. These include: System Coordination Long-term Partnerships and Collaboration Communication across Organizations Data and Information-Sharing To improve the provision of the Ten Essential Public Health Services and to promote and improve health and well-being of St. Louis County residents, stakeholders in the LPHS should enhance efforts to function as a coordinated system to maximize capacity and resources. Additionally, two major health issues frequently cited as gaps in the LPHS were: Substance Abuse Mental Health These health issues surfaced throughout essential service discussions as areas of critical health need for the county, and areas in which minimal coordinated efforts currently exist. Key strengths of the LPHS that were noted throughout the assessment include: Emergency Preparedness and Surveillance Monitoring and Mitigating Infectious Disease These areas emerged throughout discussions as areas in which the LPHS excels and functions well at a system-level to communicate and coordinate efforts and to leverage collective resources and capacity. 2

5 The Assessment Instrument The National Public Health Performance Standards (NPHPS) are the basis for the LPHSA. This standardized tool measures the performance of the local public health system (LPHS) defined as the collective efforts of public, private, and voluntary entities, as well as individuals and informal associations that contribute to public health within a jurisdiction. This may include organizations and entities such as the local health department, other governmental agencies, healthcare providers, human service organizations, schools and universities, faith institutions, youth development organizations, economic and philanthropic organizations, and many others. Any organization or entity that contributes to the health or well-being of a community is considered part of the public health system. Ideally, a group that is broadly representative of these public health system partners will participate in the assessment process. By sharing their diverse perspectives, all participants will gain a better understanding of each organization s contributions, the interconnectedness of their activities, and how the public health system can be strengthened. The NPHPS do not focus specifically on the capacity or performance of any single agency or organization. The instrument is framed around the Ten Essential Public Health Services (EPHS) that are utilized in the field to describe the scope of public health. For each essential service in the local instrument, the model standards describe or correspond to the primary activities conducted at the local level. The number of model standards varies across the essential services; while some essential services include only two model standards, others include up to four. The Ten Essential Services 3

6 Each EPHS model standard is scored by participants to assess system performance on the following scale: Optimal Activity (76-100%) Significant Activity (51-75%) Moderate Activity (26-50%) Minimal Activity (1-25%) No Activity (0%) The public health system is doing absolutely everything possible for this activity and there is no room for improvement. The public health system participates a great deal in this activity, but there remain opportunities for minor improvement. The public health system somewhat participates in this activity and there is opportunity for greater improvement. The public health system provides only limited activity and there is opportunity for substantial improvement. The public health system does not participate in this activity at all. NPHPS results are intended to be used for quality improvement purposes for the public health system and to guide the development of the overall public health infrastructure. Analysis and interpretation of data should also take into account variations in knowledge about the public health system among assessment participants. These variations may introduce a degree of random non-sampling error. Assessment Participants The Saint Louis County Department of Health and the St. Louis County MAPP Steering Committee, with the support of the Illinois Public Health Institute (IPHI), developed a list of over 70 agencies to be invited to participate in a full day assessment retreat. The event organizers carefully considered how to balance participation across sectors and agencies and how to ensure that diverse perspectives as well as adequate expertise were represented in each breakout group. The event drew 94 individuals from various public health system partners that included public, private and voluntary sectors representing more than 70 organizations. The composition of attendees reflected a diverse and balanced representation of partners that was apportioned as follows: Constituency Represented Total Individuals Attending Businesses 1 Colleges and Universities 4 Community Based Organizations 1 Non-Profit/Advocacy 27 Public Safety/Emergency Response 1 Faith-Based Institutions 2 Foundations 3 Long-Term Care Facilities 1 Hospitals/Health Care Systems 10 Managed Care Organizations 1 4

7 Constituency Represented Total Attended Service Providers 5 Schools 2 Board of Health or Other Governing Entities 2 Local Health Department 19 Local Government 11 State Government 4 The Assessment Methodology The assessment retreat was held on April 19th, 2013 and began with a 60-minute plenary presentation to welcome participants, provide an overview of the process and the Ten Essential Public Health Services, introduce the staff, and answer participant questions. Participants were then divided into five groups. Each breakout group was responsible for conducting the assessment for two essential public health services as follows: Group A B C D E LPHSA Group Responsibilities EPHS 1 Monitor health status to identify community health problems. EPHS 2 Diagnose and investigate health problems and health hazards in the community. EPHS 3 Inform, educate, and empower people about health issues. EPHS 4 Mobilize community partnerships to identify and solve health problems. EPHS 5 Develop policies and plans that support individual and community health efforts. EPHS 6 Enforce laws and regulations that protect health and ensure safety. EPHS 7 Link people to needed personal health services and assure the provision of health services. EPHS 9 Evaluate effectiveness, accessibility and quality of personal/population-based health services. EPHS 8 Assure a competent public and personal health care workforce. EPHS 10 Research for new insights and innovative solutions to health problems. Each group was professionally facilitated, recorded, and staffed by a note taker. The program ended with a plenary session where highlights were reported by one or more members of each group. Event organizers facilitated the end-of-day dialogue, outlined next steps to enter and analyze, and then report NPHPS data to the St. Louis County MAPP Team and retreat participants. In addition, participants were given an opportunity to provide feedback about the event and sign-up for participation in further MAPP activities. 5

8 Results of the St. Louis County Local Public Health System Assessment How well did the system perform the Ten Essential Public Health Services (EPHS)? The table and graph below together provide an overview of the local public health system s performance in each of the Ten Essential Public Health Services (EPHS). EPHS EPHS Description 2013 Score 1 Monitor health status to identify community health problems. 64 Significant 2 Diagnose and investigate health problems and health hazards in the community. 86 Optimal 3 Inform, educate, and empower people about health issues. 42 Moderate 4 Mobilize community partnerships to identify and solve health problems. 42 Moderate 5 Develop policies and plans that support individual and community health efforts. 54 Significant 6 Enforce laws and regulations that protect health and ensure safety. 55 Significant 7 Link people to needed personal health services and assure the provision of health services. 38 Moderate 8 Assure a competent public and personal health care workforce. 45 Moderate 9 Evaluate effectiveness, accessibility, and quality of personal/populationbased health services. 38 Moderate 10 Research for new insights and innovative solutions to health problems. 49 Moderate Overall Performance Score 51 Significant The Table above proivides a quick overview of the system s performance in each of the Ten Essential Public Health Services (EPHS). Each EPHS score is a composite value determined by the scores given to those activities that contribute to each essential service. The scores range from a minimum value of 0% (no activity is performed pursuant to the standards) to maximum of 100% (all activities associated with the standards are performed at optimal levels). 6

9 Summary of LPHSA Scores Moderate Activity Significant Activity Optimal Activity Highest Ranked: EPHS 2 (Diagnose and investigate health problems and health hazards) was assessed as optimal activity. Lowest Ranked: EPHS 7 (Link people to personal health services) and EPHS 9 (Evaluate effectiveness, accessibility, and quality of personal/population-based health services) were both assessed as moderate activity. Overall Performance: The average of all EPHS scores resulted in a ranking of significant activity. 7

10 Saint Louis County Department of Health Contribution to Local Public Health System Performance In addition to measuring overall system performance, the Local Public Health System Assessment assesses the contribution of the local public health agency to the total system effort for each essential public health service. For each EPHS, participants indicated the contribution of the Saint Louis County Department of Health using the numeric voting scale below: Agency contribution of 0% Agency contribution of 1-25 % Agency contribution of % Agency contribution of % Agency contribution of % The agency contribution results are presented at the end of each EPHS section, following the model standard scores and summary of strengths, weaknesses, and opportunities for improvement. The agency contribution scores represent participant perceptions regarding how much of the activity related to the model standards is directly attributed to the Saint Louis County Department of Health. There is no right or wrong answer as some EPHSs and Model Standards require more or less health department involvement than others depending on the system. These contribution scores do not represent an evaluation of either the Saint Louis County Department of Health or the performance of the local public health system. Readers should only consider whether the agency is contributing an appropriate level of service and whether any change in that contribution would influence system performance. The agency contribution should not be treated as a stand-alone indicator, but should be taken into consideration with the measures of performance for each model standard. 8

11 Scores and Common Themes for each Essential Public Health Service The following pages contain the performance score results for each Essential Public Health Service (EPHS). Each EPHS description contains the following: A description of the assessment tool and the major activities assessed for the EPHS is included under each EPHS section. LPHSA results for each EPHS are reflected in the table. The overall score and performance category are indicated along with the overall ranking of the EPHS (its score relative to the other essential services assessed). (example) (Title of EPHS) (Overall Score) (Overall Ranking) (Key questions addressed by the EPHS) (Description of what is encompassed by the EPHS) A table describes the sectors and partner representation in the EPHS section. EPHS discussion groups were organized in an effort to maximize understanding of local activities in this area. The absence of representation from key stakeholders or sectors should be taken into account when interpreting the findings from each EPHS. (example) # Organization Type # Organization Type 9

12 A table lists the model standards, descriptions, and scores. (example) (EPHS Title) (Title of Model Standard) (Description of the model standard) (Model Standard Indicators) (Title of Model Standard) (Description of the model standard) (Model Standard Indicators) (Overall Score for Model Standard) (Score) (Overall Score for Model Standard) (Score) A bar graph indicating the scores for each model standard within that essential service and the overall score for the EPHS is included below the assessment scores table for each EPHS section. Bars are color coded according to the range of the score [no activity (0%) = red; minimal activity (1-25%) = orange; moderate activity (26-50%) = yellow; significant activity (51-75%) = blue; and optimal activity (76-100%) = green]. (example) EPHS Model Standard 40 Model Standard 78 Model Standard 56 EPHS Overall Score A text box summarizing the group s assessment of the Saint Louis County Department of Health s contribution to the activities described in the essential service is also included (see next page for example). 10

13 (example) Saint Louis County Department of Health Contribution to EPHS (EPHS Title) (Model Standard Title) (51-75%) (Model Standard Title) (51-75%) (Model Standard Title) (26-50%) A narrative summarizing major discussion themes and recommendations is included below this text box. This narrative is followed by a graphic organizing group comments into categories of strength, weakness, opportunities for immediate improvement and opportunities for long-term improvement. Recorders captured the tone and content of the discussion so that major themes and recommendations could be shared with planners. The highlighted comments and themes included here should not be considered as an exhaustive evaluation of the local public health system; however, these participant perspectives should be taken into consideration in future quality improvement efforts. (example) Strengths (Summary of strengths within this EPHS as perceived by EPHS participants.) Weaknesses (Summary of weaknesses within this EPHS as perceived by EPHS participants.) Opportunities for immediate improvement (Short-term opportunities for improvement within this EPHS as perceived by EPHS participants.) Opportunities for long-term improvement (Long-term opportunities for improvement within this EPHS as perceived by EPHS participants.) 11

14 EPHS 1 EPHS 1: Monitor Health Status to Identify Community Health Problems Overall Score: 64 Significant Overall Ranking: 2nd To assess performance for Essential Public Health Service One, participants were asked to address two key questions: What s going on in our community? Do we know how healthy we are? Monitoring health status to identify community health problems encompasses the following: Accurate, ongoing assessment of the community s health status. Identification of threats to health. Determination of health service needs. Attention to the health needs of groups that are at higher risk than the total population. Identification of community assets and resources that support the public health system in promoting health and improving quality of life. Use of appropriate methods and technology to interpret and communicate data to diverse audiences. Collaboration with other stakeholders, including private providers and health benefit plans, to manage multi-sectorial integrated information systems. Group Composition and Perspectives: Partners who gathered to discuss the performance of the local public health system in EPHS 1 included: # Organization Type # Organization Type 3 Colleges and Universities 1 Managed Care Organizations 4 Health Department 3 Non-Profit/Advocacy 4 Hospitals/Health Care Systems 3 State Government 1 Local Government 1 Transportation 12

15 EPHS 1 EPHS 1: Monitor Health Status To Identify Community Health Problems Model Standard Scores 1.1 Population-Based Community Health Assessment (CHA) SIGNIFICANT 58 The local public health system (LPHS) develops a community health profile (CHP) using data from a detailed community health assessment (CHA) to give an overall look at the community s health. The CHA includes information on health status, quality of life, risk factors, social determinants of health, and strengths of the community at least every three years. Data included in the community health profile is accurate, reliable, and interpreted according to the evidence base for public health practice. CHP data and information are displayed and updated according to the needs of the community. With a CHA, a community receives an in-depth picture or understanding of the health of the community. From the CHA and CHP, the community can identify the most vulnerable populations and related health inequities, prioritize health issues, identify best practices to address health issues, and put resources where they are most needed. The CHP also tracks the health of a community over time and compares local measures to other local, state, and national benchmarks Community Health Assessment Significant Continuously update CHA with current information Moderate Community-wide use of community health assessment or CHP data Moderate Current Technology to Manage and Communicate Population Health Data SIGNIFICANT 75 The local public health system (LPHS) provides the public with a clear picture of the current health of the community. Health problems are looked at over time and trends related to age, gender, race, ethnicity, and geographic distribution are examined. Data is shown in clear ways, including graphs, charts, and maps while the confidential health information of individuals is protected. Software tools are used to understand where health problems occur, allowing the community to plan efforts to lessen the problems and to target resources where they are most needed. The Community Health Profile (CHP) is available in both hard copy and online formats and is regularly updated. Links to other sources of information are provided on websites Collect timely data consistent with current standards on specific health concerns Significant Use information from population health registries in CHAs Significant 75 13

16 EPHS 1 EPHS 1: Monitor Health Status 1.1 Community Profile 1.2 Current Technology 1.3 Registries Overall The figure to the left displays the overall score for each model standard. In this snapshot, all model standards were ranked in the significant range, with model standard 1.3 (Registries) ranked the highest. Indicators for each model are detailed on the previous page Saint Louis County Department of Health Contribution to EPHS 1 Monitor Health Status to Identify Community Health Problems Model Standard 1.1 Population-Based Community Health Assessment (CHA) 51-75% Model Standard 1.2 Current Technology to Manage and Communicate Population Health Data 51-75% Model Standard 1.3 Maintenance of Population Health Registries 26-50% Participants who focused on monitoring health status to identify community health problems discussed the need for greater communication and collaboration among organizations during their assessment processes. They discussed opportunities for partnership and information-sharing, but identified differences in assessment timelines as a barrier to collaboration. Additional barriers identified by the group included difficulties in accessing reliable, timely data, publicizing the assessment process and final report, and utilizing technology to analyze and display data. Two major gaps cited that need to be better addressed in future community assessments include mental health status and substance abuse in St. Louis County. 14

17 EPHS 1 Strengths Number of community health assessments being done in the community Good job staying on top of communicable disease updates Strong waste management and recycling program Strong epidemic surveillance system Excellent vital records registry Overall, LPHS is doing well at collecting timely data on specific health concerns Collaboration between health systems and the health department Weaknesses Lack of access to assessment data and results for the community at large Need for more youth/school obesity data Lack of good immunization data in the county Technical/legal barriers to sharing CHA results, both from state and county health department Improvements needed in maintaining mental health and substance abuse registries Chronic disease assessment is a weakness Lack of funding for assessments Opportunities for immediate improvement Collaborate with schools to increase/improve data collection on childhood obesity rates The health department should work with other agencies throughout the LPHS to disseminate their CHA and reach a wider audience Increase utilization of GIS data within the health department Opportunities for long-term improvement The health department should explicitly market updates to the CHA Increase collaboration between the health department and public health advocacy organizations 15

18 EPHS 2 EPHS 2: Diagnose and Investigate Health Problems and Health Hazards Overall Score: 86 Optimal Overall Ranking: 1st To assess performance for Essential Public Health Service Two, participants were asked to address three key questions: Are we ready to respond to health problems or health hazards in our county? How quickly do we find out about problems? How effective is our response? Diagnosing and investigating health problems and health hazards in the community encompass the following: Access to a public health laboratory capable of conducting rapid screening and high-volume testing. Active infectious disease epidemiology programs. Technical capacity for epidemiologic investigation of disease outbreaks and patterns of infectious and chronic diseases, injuries, and other adverse health behaviors and conditions. Group Composition and Perspectives: Partners who gathered to discuss the performance of the local public health system in EPHS 2 included: # Organization Type # Organization Type 3 Colleges and Universities 1 Managed Care Organizations 4 Health Department 3 Non-Profit/Advocacy 4 Hospitals/Health Care Systems 3 State Government 1 Local Government 1 Transportation 16

19 EPHS 2 EPHS 2: Diagnose and Investigate Health Problems and Health Hazards Model Standard Scores 2.1 Identification and Surveillance of Health Threats SIGNIFICANT 75 The local public health system (LPHS) conducts surveillance to watch for outbreaks of disease, disasters and emergencies (both natural and human-made), and other emerging threats to public health. Surveillance data includes information on reportable diseases and potential disasters, emergencies, and emerging threats. The LPHS uses surveillance data to notice changes or patterns right away, determine the factors that influence these patterns, investigate the potential dangers, and find ways to lessen the impact on public health. The best available science and technologies are used to understand the problems, determine the most appropriate solutions, and prepare for and respond to identified public health threats. To ensure the most effective and efficient surveillance, the LPHS connects it surveillance systems with state and national systems. To provide a complete monitoring of health events, all parts of the system work together to collect data and report findings Comprehensive surveillance system to identify, monitor and share information Significant Provide and collect information on reportable disease, potential disasters and threats Significant Best available resources to support surveillance systems and activities Significant Investigation and Response to Public Health Threats and Emergencies OPTIMAL 83 The local public health system (LPHS) stays ready to handle possible threats to public health. As a threat develops such as an outbreak of a communicable disease, a natural disaster, or a chemical, radiological, nuclear, explosive, or other environmental event a team of LPHS professionals works closely to collect and understand related data. Many partners support the response with communication networks already in place among health related organizations, public safety, rapid response teams, the media, and the public. In a public health emergency, a jurisdictional Emergency Response Coordinator leads LPHS partners in the local investigation and response. The response to an emergency event is in accordance with current emergency operations coordination guidelines Maintain instructions on how to handle communicable disease outbreaks Significant Written protocols for investigation of public health threats Significant Designated Emergency Response Coordinator Optimal Rapid response of personnel in emergency/disasters Significant Identification of technical expertise Optimal Evaluation of public health emergency response Significant Laboratory Support for Investigation of Health Threats OPTIMAL 100 The local public health system (LPHS) has the ability to produce timely and accurate laboratory results for public health concerns. Whether a laboratory is public or private, the LPHS sees that the correct testing is done and that the results are made available on time. Any laboratory used by the LPHS meets all licensing and credentialing standards Ready access to laboratories for routine diagnostic and surveillance needs Optimal Ready access to laboratories for public health threats, hazards, and emergencies Optimal Licenses and/or credentialed laboratories Optimal Written protocols for laboratories for handling samples Optimal

20 EPHS 2 ESPH 2: Diagnose and Investigate 2.1 Identification/Surveillance 2.2 Emergency Response 2.3 Laboratories Overall The figure to the left displays the overall score for each model standard. In this snapshot, model standards 2.2 (emergency response) and 2.3 (laboratories) were ranked in the optimal range, and model standard 2.1 (identification/surveillance) was ranked at the highest score in the significant range. Indicators for each model are detailed on the previous page Saint Louis County Department of Health Contribution to EPHS 2 Diagnose and Investigate Health Problems and Health Hazards Model Standard 2.1 Identification and Surveillance of Health Threats 51-75% Model Standard 2.2 Investigation and Response to Public Health Threats and Emergencies 26-50% Model Standard 2.3 Laboratory Support for Investigation of Health Threats 51-75% Participants who discussed diagnosing and investigating health problems and health hazards felt that public health surveillance and emergency preparedness are areas of strength for St. Louis County. The universities in the county are key assets and have built strong partnerships with the department of health. Participants noted that while the data collected on infectious disease is adequate, there is a need for greater surveillance of chronic disease and mental health conditions. Inadequate funding is a barrier to creating robust chronic disease and mental health surveillance. Another challenge identified by participants is that surveillance systems are rarely accessible between partners, further inhibiting information-sharing. 18

21 EPHS 2 Strengths Strong surveillance of communicable diseases, emerging infectious diseases, human-made and natural disasters Pandemic preparedness Network approach to surveillance Good partnership approach to investigating and responding to public health threats and emergency Network of 24-hour operational qualified labs Partnerships with communicable and infectious disease experts at local universities Weaknesses Need for a significant increase in federal funding and resources for mental health and chronic disease surveillance Jurisdictional issues related to incident command Opportunities for immediate improvement Further automation of webserve (inputting state lab data) Opportunities for long-term improvement Build and strengthen partnerships with mental health providers in emergency management Improve mental health surveillance Improve information flow between surveillance systems Use social media to improve surveillance 19

22 EPHS 3 EPHS 3: Inform, Educate, and Empower People about Health Issues Overall Score: 42 Moderate Overall Ranking: Tied for 7th and 8th To assess performance for Essential Public Health Service Three, participants were asked to address the following key question: How well do we keep all segments of our community informed about health issues? Informing, educating, and empowering people about health issues encompass the following: Community development activities. Social marketing and targeted media public communication. Provision of accessible health information resources at the community level. Active collaboration with personal healthcare providers to reinforce health promotion messages and programs. Joint health education programs with schools, churches, worksites, and others. Group Composition and Perspectives: Partners who gathered to discuss the performance of the local public health system in EPHS 3 included: # Organization Type # Organization Type 1 Board of Health or Other Governing Entities 5 Non-Profit/Advocacy 3 Community-Based Organizations 1 Schools 3 Health Department 3 Service Providers 3 Hospitals/Health Care Systems 1 State Government 1 Local Government 20

23 EPHS 3 EPHS 3: Inform, Educate and Empower People about Health Issues Model Standard Scores 3.1 Health Education and Promotion MODERATE 33 The local public health system (LPHS) designs and puts in place health promotion and health education activities to enable and support efforts to exert control over the determinants of health and to create environments that support health. These promotional and educational activities are coordinated throughout the LPHS to address risk and protective factors at the individual, interpersonal, community, and societal levels. The LPHS includes the community in identifying needs, setting priorities, and planning health promotional and educational activities. The LPHS plans for different reading abilities, language skills, and access to materials Provision of community health information Moderate Health education and/or health promotion activities Minimal Collaboration on health communication plans Minimal Health Communication MINIMAL 25 The local public health system (LPHS) uses health communication strategies to contribute to healthy living and healthy communities, including: increasing awareness of risks to health; ways to reduce health risk factors and increase health protective factors; promoting healthy behaviors; advocating for organizational and community changes to support healthy living; increasing demand and support for health services; building a culture where health is valued; and creating support for health policies, programs, and practices. Health communication uses a broad range of strategies, including print, radio, television, the internet, media campaigns, social marketing, entertainment education, and interactive media. The LPHS reaches out to the community through efforts ranging from one-on-one conversations to small group communication, communications within organizations and the community, and to mass media approaches. The LPHS works with many groups to understand the best ways to present health messages in each community setting and to find ways to cover the costs Development of health communication plans Minimal Relationships with media Minimal Designation of public information officers Minimal Risk Communication SIGNIFICANT 67 The local public health system (LPHS) uses health risk communications strategies to allow individuals, groups and organizations, or an entire community to make optimal decisions about their health and well-being in emergency events. The LPHS recognizes a designated Public Information Officer for emergency public information and warning. The LPHS organizations work together to identify potential risks (crisis or emergency) that may affect the community and develop plans to effectively and efficiently communicate information about these risks. The plans include pre-event, event, and post-event communication strategies for different types of emergencies Emergency communication plans Significant Resources for rapid communications response Significant Risk communication training Significant 75 21

24 EPHS Health Education and Promotion 3.2 Health Communication 3.3 Risk Communication Overall The figure to the left displays the overall score for each model standard. In this snapshot, model standard 3.2 (health communication) was ranked in minimal range, model standard 3.1 (health education and promotion) scored in the moderate range, and model standard 3.3 (risk communication) was ranked in the significant range. Indicators for each model are detailed on the previous page Saint Louis County Department of Health Contribution to EPHS 3 Inform, Educate and Empower People about Health Issues Model Standard 3.1 Health Education and Promotion 26-50% Model Standard 3.2 Health Communication 26-50% Model Standard 3.3 Risk Communication 51-75% Coordination and systems-level improvements were the focus of conversation among participants looking at how well the LPHS informs, educates, and empowers people about health issues in St. Louis County. Participants said that while there is some good health education and health messaging occurring throughout the county, these efforts are happening in isolation. Partners agreed that there is no system-level coordination for health messaging within the county, and building and sustaining partnerships is often inhibited by competition for funding and resources. Health education and messaging around sexual health, particularly in communities with disparities in sexual health, was cited as an area needing improvement. Additionally, participants conveyed the need for partners to work together to inform health policy promotion as policy change has strong potential to substantially improve public health and has been a weakness throughout the county. Emergency communication planning and risk communication was determined to be a stronger area for the LPHS, but participants expressed concern about whether information can be effectively disseminated to vulnerable populations in an emergency. For all types of health communication needs, particularly where health disparities exist, creative outreach through faith groups, the use of social media, and the placement of messaging in high frequency areas such as public transportation must be explored and improved. 22

25 EPHS 3 Strengths Very strong emergency communication Good emergency preparedness plan Good application of evidence-based public health practices Weaknesses Sexual health disparities Lack of government support Need for better communication with policymakers Inability to provide adequate information on comprehensive sex and sexual health education Reluctance to enact public health policy measures Health messages are not reaching those most in need There is a lack of funding and a large competition for the funding that is available. This competition prevents organization from partnering and working together. Fear of losing resources by coordinating with other groups Opportunities for immediate improvement Improve cultural relevance of health messaging by using the right messages and messengers Make information digestible and meaningful and place in buses and other highly visible locations in the community Utilize social media to spread health messaging Opportunities for long-term improvement Build stronger partnerships with the faith community to reach elderly and disenfranchised populations Increase coordination between nonprofit organizations and universities Increase coordination among partners Integrate health priorities in local policies and increase policy promotion 23

26 EPHS 4 EPHS 4: Mobilize Community Partnerships to Identify and Solve Health Problems Overall Score: 42 Moderate Overall Ranking: Tied for 7th and 8th To assess performance for Essential Public Health Service Four, participants were asked to address the following key question: How well do we truly engage people in local health issues? Mobilizing community partnerships to identify and solve health problems encompasses the following: Convening and facilitating partnerships among groups and associations (including those not typically considered to be health-related). Undertaking defined health improvement planning process and health projects, including preventive, screening, rehabilitation, and support programs. Building a coalition to draw on the full range of potential human and material resources to improve community health. Group Composition and Perspectives: Partners who gathered to discuss the performance of the local public health system in EPHS 4 included: # Organization Type # Organization Type 1 Board of Health or other Governing Entities 5 Non-Profit/Advocacy 3 Community-Based Organizations 1 Schools 3 Health Department 3 Services Providers 3 Hospitals/Health Care Systems 1 State Government 1 Local Government 24

27 EPHS 4 EPHS 4: Mobilize Community Partnerships to Identify and Solve Health Problems Model Standard Scores 4.1 Constituency Development MODERATE 50 The local public health system (LPHS) actively identifies and involves community partners the individuals and organizations (constituents) with opportunities to contribute to the health of communities. These stakeholders may include health, transportation, housing, environmental, and non-health related groups, as well as community members. The LPHS manages the process of establishing collaborative relationships among these and other potential partners. Groups within the LPHS communicate well with one another, resulting in a coordinated, effective approach to public health efforts so that the benefits of public health are understood and shared throughout the community Directory of organizations that comprise the LPHS Significant Identification of key constituents and stakeholders Minimal Participation of constituents in improving community health Moderate Communications strategies to build awareness of public health Moderate Community Partnerships MODERATE 33 The local public health system (LPHS) encourages individuals and groups to work together so that community health may be improved. Public, private, and voluntary groups through many different levels of information sharing, activity coordination, resource sharing, and in-depth collaborations strategically align their interests to achieve a common purpose. By sharing responsibilities, resources, and rewards, community partnerships allow each member to share its expertise with others and strengthen the LPHS as a whole. In addition, a community group may follow a collaborative, dynamic, and inclusive approach to community health improvement. It may exist as a formal partnership, such as a community health planning council or as a less formal community group Partnerships for public health improvement activities Moderate Community health improvement committee Minimal Review of community partnerships and strategic alliances Minimal 25 25

28 EPHS Constituency Development 4.2 Community Partnerships Overall The figure to the left displays the overall score for each model standard. In this snapshot, model standard 4.1 (constituency development) received the highest score in the moderate range while model standard 4.2 (community partnerships) received a lower score in this range. Indicators for each model are detailed on the previous page Saint Louis County Department of Health Contribution to EPHS 4 Mobilize Community Partnerships to Identify and Solve Health Problems Model Standard 4.1 Constituency Development 1-25% Model Standard 4.2 Community Partnerships 1-25% Participants who discussed how well the St. Louis County LPHS mobilizes community partnerships to identify and solve health problems perceived a lack of broad-based public health partnerships. While many partnerships exist, they are not comprehensive in nature and there is limited coordination among partners in the LPHS as a whole and a lack of accountability for the effectiveness of partnerships. The development of the St. Louis County Partnership for a Healthy Community to lead this assessment effort may help to address this problem. Participants agreed that there is also room for improvement in constituency development and mobilization, despite having strong engagement in a variety of organized advisory groups and public events. Engaging community members and stakeholders representing the most vulnerable populations is essential to addressing health disparities across the county. 26

29 EPHS 4 Strengths Strong engagement in planning bodies, advisory councils, and public events Directory of community organizations is well-maintained and up-to-date Many community events for the public that are used to promote health messaging Weaknesses No committee that focuses on broad based community health improvement There are a lot of partnerships that are working to improve the health of a community, but not much coordination among these partnerships No central system in place to identify overall top health needs of the community People don t know what other organizations are doing similar things Lack of focus or emphasis on wellness Opportunities for immediate improvement Increase opportunities for communication between organizations Opportunities for long-term improvement Paradigm shift from focus on disease to focus on wellness and healthy living Work to better coordinate efforts and develop a system of partnerships and accountability 27

30 EPHS 5 EPHS 5: Develop Policies and Plans that Support Individual and Community Health Efforts Overall Score: 54 Significant Overall Ranking: 4th To assess performance for Essential Public Health Service Five, participants were asked to address two key questions: What local policies in both the government and private sector promote health in our community? How well are we setting healthy local policies? Developing policies and plans that support individual and community health efforts encompass the following: Leadership development at all levels of public health. Systematic community-level and state-level planning for health improvement in all jurisdictions. Development and tracking of measurable health objectives from the community health plan as a part of continuous quality improvement strategy plan. Joint evaluation with the medical healthcare system to define consistent policy regarding prevention and treatment services. Development of policy and legislation to guide the practice of public health. Group Composition and Perspectives: Partners who gathered to discuss the performance of the local public health system in EPHS 5 included: # Organization Type # Organization Type 1 Business 2 Hospitals/Health Care Systems 1 Colleges and Universities 5 Local Government 1 Community-Based Organizations 4 Non-Profit/Advocacy 2 Foundations 1 Public Safety/Emergency Response 4 Health Department 28

31 EPHS 5 EPHS 5: Develop Policies and Plans that Suppor Individual and Community Health Efforts Model Standard Scores 5.1 Governmental Presence at the Local Level SIGNIFICANT 58 The local public health system (LPHS) includes a governmental public health entity dedicated to public health. The LPHS works with the community to make sure a strong local health department (or other governmental public health entity) exists and that it is doing its part in providing essential public health services. The governmental public health entity can be a regional health agency with more than one local area under its jurisdiction. The local health department (or other governmental public health entity) is accredited through the national voluntary accreditation program Governmental local public health presence Moderate Local health department accreditation Significant Resources for the local health department Moderate Public Health Policy Development MODERATE 42 The local public health system (LPHS) develops policies that will prevent, protect or promote public health. Public health problems, possible solutions, and community values are used to inform the policies and any proposed actions, which may include new laws or changes to existing laws. Additionally, current or proposed policies that have the potential to affect public health are carefully reviewed for consistency with public health policy through health impact assessments. The LPHS and its ability to make informed decisions are strengthened by community member input. The LPHS, together with the community, works to identify gaps in current policies and needs for new policies to improve public health. The LPHS educates the community about policies to improve public health and serves as a resource for elected officials who establish and maintain public health policies Contribution to development of public health policies Moderate Alert policymakers/public of public health impacts from policies Moderate Review of public health policies Minimal 25 29

32 EPHS Community Health Improvement Process and Strategic Planning MINIMAL 25 The local public health system (LPHS) seeks to improve community health by looking at it from many sides, such as environmental health, healthcare services, business, economic, housing, land use, health equity, and other concerns that affect public health. The LPHS leads a community-wide effort to improve community health by gathering information on health problems, identifying the community s strengths and weaknesses, setting goals, and increasing the overall awareness of and interest in improving the health of the community. This community health improvement process provides ways to develop a community-owned plan that will lead to a healthier community. With the community health improvement effort in mind, each organization in the LPHS makes an effort to include strategies related to community health improvement goals in their own strategic plans Community health improvement process Minimal Strategies to address community health objectives Minimal Organizational strategic planning alignment with community health improvement plan Minimal Plan for Public Health Emergencies OPTIMAL 92 The local public health system (LPHS) adopts an emergency preparedness and response plan which describes what each organization in the LPHS should be ready to do in a public health emergency. The plan describes community interventions necessary to prevent, monitor, and manage all types of emergencies, including both natural and intentional disasters. The plan also looks at challenges of possible events, such as nuclear, biological, or terrorist events. Practicing for possible events takes place through regular exercises or drills. A task force sees that the necessary organizations and resources are included in the planning and practicing for all types of emergencies Community task force or coalition for emergency preparedness and response plans Optimal Emergency preparedness and response plan Significant Review and revision of the emergency preparedness and response plan Optimal

33 EPHS Gov Presence 5.2 Policy Development 5.3 CHIP/Strat. Planning 5.4 Emergency Plan Overall The figure to the left displays the overall score for each model standard. In this snapshot, model standard 5.4 (emergency plan) was scored in the optimal range, model standards 5.1 (government presence) and 5.2 (policy development) were scored in the significant range, and model standard 5.3 (CHIP/Strategic Planning) scored the lowest, at the high end of the minimal range. Indicators for each model are detailed on the previous two pages. Saint Louis County Department of Health Contribution to EPHS 5 Develop Policies and Plans that Support Individual and Community Health Efforts Model Standard 5.1 Governmental Presence at the Local Level 51-75% Model Standard 5.2 Public Health Policy Development 26-50% Model Standard 5.3 Community Health Improvement Process and Strategic Planning 51-75% Model Standard 5.4 Plan for Public Health Emergencies 26-50% In this essential service, participants discussed the governmental presence, public health policy development, and community health improvement and emergency planning throughout the LPHS in St. Louis County. Participants explored how the LPHS assures the provision of essential public health services. Participants noted that going through the MAPP process is helping the health department prepare for accreditation through the Public Health Accreditation Board (PHAB). Mental health services are one significant area in which essential public health services are not being fully delivered. Participants also noted that while the LPHS has many partnerships and resources, funding limitations restrict the ability of the LPHS to fully assure the provision of the Ten Essential Public Health Services. Other barriers expressed referred back to a lack of functioning collaboratives, silos within public health, and somewhat of a divide between the St. Louis City and County. In the realm of public health policy development, participants felt that the LPHS needs to strengthen its involvement in the policy development process by helping inform the policymaking process, but noted that a lack of political will to address health issues like substance abuse is a significant barrier to the development of health policy. Participants felt that there is substantial room for improvement in the community health improvement process and strategic planning, but noted that the LPHS is taking the first steps to develop a community health improvement plan. A very strong area for the LPHS is emergency preparedness planning throughout the LPHS. Participants said that the LPHS has a good emergency response plan in place, but noted that more attention should be given to planning for vulnerable populations, such as individuals with cognitive impairments. 31

34 EPHS 5 Strengths Strong emergency preparedness and response plans SLCDOH is visible and active in the public health system There are many initiatives for good policy around food A lot of advocacy work going on Weaknesses In some cases, formal collaborations are falling apart because of funding changes Divide between St. Louis City and County There are a lot of organizations outside the United Way who need support for engaging in planning Siloing of public health organizations Lack of coordinated efforts Inadequate policies and plans to support the health needs of developmentally-disabled adults Lack of resources for the health department to adequately address mental health Opportunities for immediate improvement Create a mechanism for all partners to track progress or contributions to the health department s plan so organizations know more about each other and can partner with each other when working on the same issues Opportunities for long-term improvement Increase coordinated advocacy Foster a health in all policies mindset Create alignment between the health department and other community health improvement plans 32

35 EPHS 6 EPHS 6: Enforce Laws and Regulations that Protect Health and Ensure Safety Overall Score: 53 Significant Overall Ranking: 3rd To assess performance for Essential Public Health Service Six, participants were asked to address the following question: When we enforce health regulations, are we technically competent, fair, and effective? Enforcing laws and regulations that protect health and ensure safety encompasses the following: Enforcement of sanitary codes, especially in the food industry. Protection of drinking water supplies. Enforcement of clean air standards. Animal control activities. Follow-up of hazards, preventable injuries, and exposure-related diseases identified in occupational and community settings. Monitoring the quality of medical services (e.g., laboratories, nursing homes, and home healthcare providers). Review of new drug, biologic, and medical device applications. Group Composition and Perspectives: Partners who gathered to discuss the performance of the local public health system in EPHS 6 included: # Organization Type # Organization Type 1 Business 2 Hospitals/Health Care Systems 1 Colleges and Universities 5 Local Government 1 Community-Based Organizations 4 Non-Profit/Advocacy 2 Foundations 1 Public Safety/Emergency Response 4 Health Department 33

36 EPHS 6 EPHS 6: Enforce Laws and Regulations that Protect Health and Ensure Safety Model Standard Scores 6.1 Review and Evaluation of Laws, Regulations and Ordinances MODERATE 50 The local public health system (LPHS) reviews existing laws, regulations, and ordinances related to public health, including laws that prevent health problems, or promote or protect public health. The LPHS looks at federal, state, and local laws to understand the authority provided to the LPHS and the potential impact of laws, regulations, and ordinances on the health of the community. The LPHS also looks at any challenges involved in complying with laws, regulations, or ordinances, whether community members have any opinions or concerns, and whether any laws, regulations, or ordinances need to be updated Provision of community health information Significant Knowledge of laws, regulations, and ordinances Moderate Review of laws, regulations and ordinances Minimal Access to legal counsel Moderate Involvement in the Improvement of Laws, Regulations, and MODERATE 50 Ordinances The local public health system (LPHS) works to change existing laws, regulations, or ordinances or to create new ones when they have determined that changes or additions would better prevent, protect, or promote public health. To advocate for public health, the LPHS helps to draft the new or revised laws, regulations, or ordinances, takes part in public hearings, and talks with lawmakers and regulatory officials Identification of public health issues not addressed through existing laws Moderate Development or modification of laws or public health issues Moderate Technical assistance for drafting proposed legislation, regulations, or ordinances Moderate Enforcement of Laws, Regulations, and Ordinances SIGNIFICANT 60 The local public health system (LPHS) sees that public health laws, regulations, and ordinances are followed. The LPHS knows which governmental agency or other organization has the authority to enforce any given public health related requirement within its community, supports all organizations tasked with enforcement responsibilities, and assures that the enforcement is conducted within the law. The LPHS has sufficient authority to respond in an emergency event; and makes sure that individuals and organizations understand the requirements of relevant laws, regulation, and ordinances. The LPHS communicates the reasons for legislation and the importance of compliance Authority to enforce laws, regulations, and ordinances Significant Public health emergency powers Significant Enforcement in accordance with applicable laws, regulations, and ordinances Significant Provision of information about compliance Moderate Assessment of compliance Minimal 25 34

37 EPHS Review Laws 6.2 Improve Laws 6.3 Enforce Laws Overall The figure to the left displays the overall score for each model standard. In this snapshot, model standard 6.3 (enforce laws) was scored in the significant range, and model standards 6.1 (review laws) and 6.2 (improve laws) were scored in the moderate range. Indicators for each model are detailed on the previous page Saint Louis County DOH Contribution to EPHS 6 Enforce Laws and Regulations that Protect Health and Ensure Safety Model Standard 6.1 Review and Evaluation of Laws, Regulations and Ordinances 26-50% Model Standard 6.2 Involvement in the Improvement of Laws, Regulations, and Ordinances 26-50% Model Standard 6.3 Enforcement of Laws, Regulations and Ordinances 26-50% In this session, participants discussed the LPHS performance related to the enforcement of laws and regulations that protect health and ensure safety. This activity includes the review, evaluation, improvement, and enforcement of laws, regulations, and ordinances. Participants stated that while the LPHS does not systematically review existing public health laws, regulations, and ordinances on a regular basis, the LPHS generally does a good job of identifying public health issues that can be addressed through laws, regulations, and ordinances; but there are gaps in the enforcement and monitoring of some regulations and ordinances, especially in the areas of chemical and air pollution, due to the way these regulations and ordinances have been written. Improvement should be made in raising community awareness about existing laws, regulations, and ordinances that protect and promote public health. Participants feel there is also improvement needed in LPHS involvement and participation in the improvement of laws, regulations, and ordinances, and system-level coordination in the enforcement of laws, regulations, and ordinances throughout the county. 35

38 EPHS 6 Strengths The LPHS is doing well staying up to date with public health laws Strong support for advocacy groups drafting proposed legislation, regulations, or ordinances Weaknesses Inadequate regulation of industrial pollution, chemicals, and indoor air quality The LPHS has not adequately assured that it has the authority to act in public health emergencies Need for greater accountability and more strict enforcement of laws, regulations, and ordinances that protect public health Opportunities for immediate improvement Increase access to information about public health laws, regulations, and ordinances among the public Opportunities for long-term improvement Create training for LPHS organizations to stay up to date regarding federal, state, and local laws, regulations, and ordinances to protect the public health Create a legal advocacy group that people can go to for help if they do not have access to technical assistance when reviewing laws, regulations, and ordinances 36

39 EPHS 7 EPHS 7: Link People to Needed Personal Health Services and Assure the Provision of Health Care When Otherwise Unavailable Overall Score: 38 Moderate Overall Ranking: Tied for 9th and 10th To assess performance for Essential Public Health Service Seven, participants were asked to address the following question: Are people in our community receiving the health services they need? Linking people to needed personal health services and ensuring the provision of health care when otherwise unavailable (sometimes referred to as outreach or enabling services) encompass the following: Assurance of effective entry for socially-disadvantaged people into a coordinated system of clinical care. Culturally and linguistically appropriate materials and staff to ensure linkage to services for special population groups. Ongoing care management. Transportation services. Targeted health education/promotion/disease prevention to high-risk population groups. Group Composition and Perspectives: Partners who gathered to discuss the performance of the local public health system in EPHS 7 included: # Organization Type # Organization Type 1 Board of Health or other Governing Entities 1 Local Government 2 Colleges and Universities 4 Non-Profit/Advocacy 1 Faith-Based Organizations 5 Service Providers 2 Health Department 2 Schools 2 Hospitals/Health Care Systems 37

40 EPHS 7 EPHS 7: Link People to Needed Personal Health Services and Assure the Provision of Health Care When Otherwise Unavailable Model Standard Scores 7.1 Identification of Personal Health Service Needs of Populations MODERATE 50 The local public health system (LPHS) identifies the personal health service needs of the community and identifies the barriers to receiving these services, especially among particular groups that may have difficulty accessing personal health services. The LPHS has defined roles and responsibilities for the local health department (or other governmental public health entity) and other partners (e.g. hospitals, managed care providers, and other community health agencies) in relation to overcoming these barriers and providing services Identification of populations who experience barriers to care Significant Identification of personal health service needs of populations Moderate Develop partnerships to respond to unmet needs of the community Minimal Understand barriers to care Moderate Assuring the Linkage of People to Personal Health MINIMAL 25 Services The local public health system (LPHS) partners work together to meet the diverse needs of all populations. Partners see that persons are signed up for all benefits available to them and know where to refer people with unmet personal health service needs. The LPHS develops working relationships between public health, primary care, oral health, social services, and mental health systems as well as organizations that are not traditionally part of the personal health service system, such as housing, transportation, and grassroots organizations Link populations to needed personal health services Minimal Assistance to vulnerable populations in accessing needed health services Minimal Initiatives for enrolling eligible individuals in public benefit programs Minimal Coordination of personal health and social service Minimal 25 38

41 EPHS Personal Health Service Needs 7.2 Assure Linkage Overall The figure to the left displays the overall score for each model standard. In this snapshot, model standard 7.1 (personal health service needs) was scored in the moderate range, and model standard 7.2 (assure linkage) was scored in the minimal range. Indicators for each model are detailed on the previous page Saint Louis County DOH Contribution to EPHS 7 Link People to Needed Personal Health Services and Assure the Provision of Health Care When Otherwise Unavailable Model Standard 7.1 Identification of Personal Health Service Needs of Populations 26-50% Model Standard 7.2 Assuring the Linkage of People to Personal Health Services 0% Participants discussing the LPHS performance of EPHS 7, Link people to needed personal health services and ensure provision of health care when otherwise unavailable, noted success in identifying and understanding the access issues versus low performance related to partnering and addressing to ensure access. Participants noted that vulnerable populations, including low income individuals and immigrants, are not getting adequate health services. Incarcerated individuals were identified as the most underserved population in the county for personal health services. Assuring linkage to personal health services was deemed to be an area where substantial improvement is needed in the LPHS. Participants stated that as a system, resource sharing and coordinated efforts to assure that people have access to necessary health service is very limited and need improvement. Further, the group discussed the need for an increased focus on prevention and wellness as a priority for all populations, particularly the most vulnerable. The culture and infrastructure of the health care delivery system is not changing as rapidly as needed. 39

42 EPHS 7 Strengths Good understanding of who lacks access to health care Weaknesses Limited action being taken to address barriers to care Barriers to accessing health services and poor records for incarcerated individuals Inadequate partnering to share funding and pool resources Health care functions within an antiquated business model Public health system is reactive rather than proactive and emphasizes sick care rather than health care Health care infrastructure is not changing as quickly as needs are changing Opportunities for immediate improvement Build partnerships and look for opportunities to pool resources Opportunities for long-term improvement Improve health literacy Emphasize graduation from high school as an important social determinant of health Create a countywide strategic plan for addressing poverty 40

43 EPHS 8 EPHS 8: Assure a Competent Public Health and Personal Health Care Workforce Overall Score: 44.6 Moderate Overall Ranking: 6th To assess performance for Essential Public Health Service Eight, participants were asked to address two questions: Do we have a competent public health staff? How can we be sure that our staff stays current? Ensuring a competent public and personal health care workforce encompasses the following: Education, training, and assessment of personnel (including volunteers and other lay community health workers) to meet community needs for public and personal health services. Efficient processes for licensure of professionals. Adoption of continuous quality improvement and lifelong learning programs. Active partnerships with professional training programs to ensure community-relevant learning experiences for all students. Continuing education in management and leadership development programs for those charged with administrative/executive roles Group Composition and Perspectives: Partners who gathered to discuss the performance of the local public health system in EPHS 8 included: # Organization Type # Organization Type 1 Businesses 1 Local Government 2 Colleges and Universities 4 Non-Profit/Advocacy 4 Health Department 1 Public Safety/Emergency Response 4 Hospitals/Health Care Systems 1 Service Providers 41

44 EPHS 8 EPHS 8: Assure a Competent Public Health and Personal Health Care Workforce Model Standard Scores 8.1 Workforce Assessment, Planning, and Development MODERATE 33 The local public health system (LPHS) assesses the local public health workforce all who contribute to providing essential public health services for the community. Workforce assessment looks at what knowledge, skills, and abilities the local public health workforce needs and the numbers and kinds of jobs the system should have to adequately prevent, protect, and promote health in the community. The LPHS also looks at the training that the workforce needs to keep its knowledge, skills, and abilities up to date. After the workforce assessment determines the number and types of positions the local public health workforce should include, the LPHS identifies gaps and works on plans to fill the gaps Assessment of the LPHS workforce Moderate Identification of shortfalls and/or gaps within the LPHS workforce Minimal Dissemination of results of the workforce assessment/gap analysis Minimal Public Health Workforce Standards SIGNIFICANT 75 The local public health system (LPHS) maintains standards to see that workforce members are qualified to do their jobs, with the certificates, licenses, and education that are required by law or in local, state, or federal guidance. Information about the knowledge, skills, and abilities that are needed to provide essential public health services are used in personnel systems so that position descriptions, hiring, and performance evaluations of workers are based on public health competencies Awareness of guidelines and/or licensure/certification requirements Significant Written job standards and/or position descriptions Significant Performance evaluations Significant Life-Long Learning Through Continuing Education, Training, and Mentoring MODERATE 45 The local public health system (LPHS) encourages lifelong learning for the public health workforce. Both formal and informal opportunities in education and training are available to the workforce, including workshops, seminars, conferences, and online learning. Experienced staff persons are available to coach and advise newer employees. Interested workforce members have the chance to work with academic and research institutions, particularly those connected with schools of public health, public administration, and population health. As the academic community and the local public health workforce collaborate, the LPHS is strengthened. The LPHS trains its workforce to recognize and address the unique culture, language, and health literacy of diverse consumers and communities and to respect all members of the public. The LPHS also educates its workforce about the many factors that can influence health, including interpersonal relationships, social surroundings, physical environment, and individual characteristics (such as economic status, genetics, behavioral risk factors, and health care) Identification of education and training needs for workforce development Moderate Opportunities for developing core public health competencies Moderate Educational and training incentives Moderate Collaboration between organizations and the LPHS for training and education Moderate Education and training on cultural competency and social determinants of health Minimal 25 42

45 EPHS Public Health Leadership Development MINIMAL 25 Leadership within the local public health system (LPHS) is demonstrated by organizations and individuals that are committed to improving the health of the community. Leaders work to continually develop the local public health system, create a shared vision of community health, find ways to make the vision happen, and to make sure that public health services are delivered. Leadership may come from the health department, from other governmental agencies, nonprofits, the private sector, or from several partners. The LPHS encourages the development of leaders that represent different groups of people in the community and respect community values Development of leadership skills Minimal Collaborative leadership Minimal Leadership opportunities for individuals and/or organizations Minimal Recruitment and retention of new and diverse leaders Minimal Workforce Assessment 8.2 Workforce Standards 8.3 Continuing Education 8.4 Leadership Development Overall The figure to left displays the overall score for each model standard. In this snapshot, model standards 8.1 (workforce assessment) and 8.3 (continuing education) were scored in the moderate range, and model standard 8.4 (leadership development) was scored in the minimal range. Model standard 8.2 (workforce standards) scored the highest, in the significant range. Indicators for each model are detailed on this and the previous page. Saint Louis County DOH Contribution to EPHS 8 Assure a Competent Public Health and Personal Health Care Workforce Model Standard 8.1Workforce Assessment, Planning and Development 1-25% Model Standard 8.2 Public Health Workforce Standards 26-50% Model Standard 8.3 Life-Long Learning Through Continuing Education, Training, and Mentoring 1-25% Model Standard 8.4 Public Health Leadership Development 1-25% Participants in this session assessed the strength of the LPHS as it relates to assuring a competent public health and personal health care workforce. This discussion focused on workforce assessment, planning and development, the use of public health workforce standards, and overall workforce development activity throughout the county. The group agreed that there is substantial room for improvement in the area of workforce assessment, as they were not aware of any system in place to monitor and address gaps in the public health workforce beyond the emergency preparedness workforce. Participants assumed that most of the public health workforce have the required certificates, licenses, and education needed to do their jobs. However, participants also stated that there are not enough continuing education and training opportunities for the public health workforce and leadership development in the county. 43

46 EPHS 8 Strengths Majority of organizations within the LPHS are accredited and are in compliance with the appropriate guidelines and/or licensure and certification requirements Core public health competencies are well-utilized as the basis for hiring and performance review Weaknesses Overrepresentation of Baby Boomers in public health workforce, meaning a large percentage will be retiring soon Workforce development too focused on current workforce rather than future workforce Not enough continuing education opportunities Online trainings are not always an effective learning tool Not enough opportunities for leadership development for employees at all organizational levels Opportunities for immediate improvement Provide internships and practicum experiences for graduate and undergraduate students Open trainings put on by hospitals and corporations to organizations with no training funding Offer CEU/CMEs to incentivize further training Opportunities for long-term improvement Provide tuition reimbursement to public health workforce Build collaborations with university researchers 44

47 EPHS 9 EPHS 9: Evaluate Effectiveness, Accessibility, and Quality of Personal and Population-Based Health Services Overall Score: 37.5 Moderate Overall Ranking: Tied for 9th and 10th To assess performance for Essential Public Health Service Nine, participants were asked to address three questions: Are we meeting the needs of the population we serve? Are we doing things right? Are we doing the right thing? Evaluating effectiveness, accessibility, and quality of personal and population-based health services encompasses the following: Assessing program effectiveness through monitoring and evaluating implementation outcomes and impact. Providing information necessary for allocating resources and reshaping programs. Group Composition and Perspectives: Partners who gathered to discuss the performance of the local public health system in EPHS 8 included: # Organization Type # Organization Type 1 Board of Health or other Governing Entities 1 Local Government 2 Colleges and Universities 4 Non-Profit/Advocacy 1 Faith-Based Organizations 5 Service Providers 2 Health Department 2 Schools 2 Hospitals/Health Care Systems 45

48 EPHS 9 EPHS 9: Evaluate Effectiveness, Accessibility, and Quality of Personal and Population-Based Health Services Model Standard Scores 9.1 Evaluation of Population-Based Health Services MODERATE 38 The local public health system (LPHS) evaluates population-based health services, which are aimed at disease prevention and health promotion for the entire community. Many different types of population-based health services are evaluated for their quality and effectiveness in targeting underlying risks. The LPHS uses nationally recognized resources to set goals for their work and identify best practices for specific types of preventive services (e.g. Healthy People 2020 or the Guide to Community Preventive Services). The LPHS uses data to evaluate whether population-based services are meeting the needs of the community to the satisfaction of those they are serving. Based on the evaluation, the LPHS may make changes and may reallocate resources to improve population-based health services Evaluation of population-based health services Moderate Assessment of community satisfaction with population-based Minimal 25 health services Identification of gaps in the provision of population-based health services Moderate Use of population-based health services evaluation Minimal Evaluation of Personal Health Services MODERATE 50 The local public health system (LPHS) regularly evaluates the accessibility, quality, and effectiveness of personal health services. These services range from preventive care, such as mammograms or other preventive screenings or tests, to hospital care to care at the end of life. The LPHS sees that the personal health services in the area match the needs of the community, with available and effective care for all ages and groups of people. The LPHS works with communities to measure satisfaction with personal health services through multiple methods, including a survey that includes people who have received care and others who might have needed care or who may need care in the future. The LPHS uses findings from the evaluation to improve services and program delivery, using technological solutions such as electronic health records when indicated, and modifying organizational strategic plans as needed Personal health services evaluation Moderate Evaluation of personal health services against established standards Moderate Assessment of client satisfaction with personal health services Moderate Information technology to assure quality of personal health services Moderate Use of personal health services evaluation Moderate 50 46

49 EPHS Evaluation of the Local Public Health System MINIMAL 25 The local public health system (LPHS) evaluates itself to see how well it is working as a whole. Representatives from all groups (public, private, and voluntary) that provide essential public health services gather to conduct a systems evaluation. Together, using guidelines (such as this tool) that describe a model LPHS, participants evaluate LPHS activities and identify areas of the LPHS that need improvement. The results of the evaluation are also used during a community health improvement process Identification of community organizations or entities that contribute to the EPHS Moderate Periodic evaluation of LPHS Minimal Evaluation of partnership within the LPHS Minimal Use of evaluation to guide improvements to the LPHS No Activity Evaluation of Population- Based Health 9.2 Evaluation of Personal Health 9.3 Evaluation of LPHS Overall The figure to the left displays the overall score for each model standard. In this snapshot, model standards 9.1 (evaluation of population-based health) and 9.2 (evaluation of personal health) were scored in the moderate range, and model standard 9.3 (evaluation of LPHS) was scored in the minimal range. Indicators for each model are detailed on this and the previous page. Saint Louis County Department of Health Contribution to EPHS 9 Evaluate Effectiveness, Accessibility, and Quality of Personal and Population-Based Health Services Model Standard 9. 1 Evaluation of Population-Based Health Servic Development 26-50% Model Standard 9.2 Evaluation of Personal Health Services 26-50% Model Standard 9.3 Evaluation of the Local Public Health System 1-25% In this essential service, participants discussed LPHS performance in evaluating the effectiveness, accessibility, and quality of personal and population-based health services. The group expressed that while some organizations within the LPHS have mechanisms in place to evaluate population-based services, there is a lack of system-level coordination, and many expressed concern that the evaluations in place may not be addressing the right measures. Participants also felt that while gaps have been identified through evaluations of population-based services, there has been no subsequent action to address these gaps, noting that system change will take time and require partnership building. LPHS performance in the realm of personal health services was deemed to be stronger, largely as a result of the resources and financial motivations of hospitals and other medical providers. The group said that until this assessment, there has been no effort to conduct a system-wide evaluation of the LPHS, so performance within this realm is minimal, though initial steps are being taken to begin a system-level approach to evaluation of the LPHS. 47

50 EPHS 9 Strengths The LPHS is using data to evaluate accessibility, quality, and effectiveness of health services Weaknesses The LPHS is measuring and evaluating population-based services, but may not be selecting appropriate measures Major disconnect between what the services are and how the LPHS should address population health problems Not enough system-wide evaluation of the LPHS Opportunities for immediate improvement The LPHS should use the results of the LPHSA to make improvements to the system Opportunities for long-term improvement Organizations should partner and share data whenever possible 48

51 EPHS 10 EPHS 10: Research for New Insights and Innovative Solutions to Health Problems Overall Score: 48.6 Moderate Overall Ranking: 5th To assess performance for Essential Public Health Service Ten, participants were asked to address the following question: Are we discovering and using new ways to get the job done? Researching new insights and innovative solutions to health problems encompasses the following: Full continuum of innovation, ranging from practical field-based efforts to fostering change in public health practice to more academic efforts to encourage new directions in scientific research. Continuous linkage with institutions of higher learning and research. Internal capacity to mount timely epidemiologic and economic analyses and conduct health services research. Group Composition and Perspectives: Partners who gathered to discuss the performance of the local public health system in EPHS 10 included: # Organization Type # Organization Type 1 Businesses 1 Local Government 2 Colleges and Universities 4 Non-Profit/Advocacy 4 Health Department 1 Public Safety/Emergency Response 4 Hospitals/Health Care Systems 1 Service Providers 49

52 EPHS 10 EPHS 10: Research for New Insights and Innovative Solutions to Health Problems Model Standard Scores 10.1 Fostering Innovation MODERATE 50 Local public health system (LPHS) organizations try new and creative ways to improve public health practice. In both academic and practice settings, such as universities and local health departments, new approaches are studied to see how well they work Encouragement of new solutions to health problems Moderate Proposal of public health issues for inclusion in research agenda Moderate Identification and monitoring of best practices Significant Encouragement of community participation in research Minimal Linkage with Institutions of Higher Learning and/or Research SIGNIFICANT 58 The local public health system (LPHS) establishes relationships with colleges, universities, and other research organizations. The LPHS is strengthened by ongoing communication between academics and LPHS organizations. They freely share information and best practices, and setting up formal or informal arrangements to work together. The LPHS connects with other research organizations, such as federal and state agencies, associations, private research organizations, and research departments or divisions of business firms. The LPHS does community-based participatory research, including the community as full partners from selection of the topic of study to design to sharing of findings. The LPHS works with one or more colleges, universities, or other research organizations to co-sponsor continuing education programs Relationships with institutions of higher learning and/or research organizations Significant Partnerships to conduct research Moderate Collaboration between the academic and practice communities Moderate Capacity to Initiate or Participate in Research MODERATE 38 The local public health system (LPHS) takes part in research to help improve the performance of the LPHS. This research includes the examination of how well LPHS members provide the Ten Essential Public Health Services in the community (public health systems and services research) as well as studying what influences health care quality and service delivery in the community (health services research). The LPHS has access to researchers with the knowledge and skills to design and conduct health-related studies, supports their work with funding and data systems, and provides ways to share findings. Research capacity includes access to libraries and information technology, the ability to analyze complex data, and ways to share research findings with the community and use them to improve public health practice Collaboration with researchers Moderate Access to resources to facilitate research Minimal Dissemination of research findings Moderate Evaluation of research activities Minimal 25 50

53 EPHS Foster Innovation 10.2 Academic Linkages 10.3 Research Capacity Overall The figure to the left displays the overall score for each model standard. In this snapshot, model standards 10.1 (foster innovation) and 10.3 (research capacity) were scored in the moderate range, and model standard 10.2 (academic linkages) was scored in the significant range. Indicators for each model are detailed on the previous page Saint Louis County Department of Health Contribution to EPHS 10 Research for New Insights and Innovative Solutions to Health Problems Model Standard Fostering Innovation 1-25% Model Standard 10.2 Linkage with Institutions of Higher Learning and/or Research 1-25% Model Standard 10.3 Capacity to Initiate or Participate in Research 1-25% Participants discussing essential service ten were charged with exploring the LPHS role with research into new insights and innovative solutions to health problems. Participants rated the system s performance in fostering innovation as moderate because while some entities are engaging in research, such as hospitals and universities, there is still room for improvement from the system as a whole. Universities were recognized in the group as the driver of research throughout the LPHS. Partnerships have been built between universities and other institutions within the LPHS to leverage collective resources and capacity, but these partnerships often end when funding opportunities come to a close. Greater effort must be made to strengthen relationships and forge long-term partnerships to encourage further LPHS engagement in research and innovation. Increased collaboration with research institutions will enhance the capacity of the LPHS to initiate and participate in research. 51

54 EPHS 10 Strengths Local universities are the strongest driver of research in the LPHS Influenza vaccine research by local hospitals Hospitals are very strong in research Good collaboration between academic and practice communities Regional Health Commission does a good job of sharing data and making it easily available on its website Weaknesses The LPHS struggles to stay current with best practices Besides hospitals, the LPHS has minimal resources to conduct research to test new solutions to public health problems to see how well they work Partnership only occurs when there is a financial incentive after funding ends, partnerships break down Inadequate funding for research Opportunities for immediate improvement Identify and integrate best practices to make grant applications more competitive Opportunities for long-term improvement Further engage the community in research and efforts to create innovative solutions to health problems 52

55 Key Findings from the Local Public Health System Assessment Throughout the discussions of the Ten Essential Public Health Services, a number of cross-cutting themes emerged in the dialogue among each group. The themes arose as strategic areas to address to improve the functioning, capacity, and effectiveness of the local public health system in St. Louis County in the provision of the Ten Essential Public Health Services. These systems-level issues included system coordination, building and sustaining long-term partnerships and collaborations beyond what is necessary for individual grants, communication across organizations throughout the local public health system, and data and resource sharing to maximize the local public health system s capacity to effectively and efficiently deliver the Ten Essential Public Health Services. To improve the provision of the essential services and to promote and improve the health and well-being of St. Louis County residents, stakeholders in the LPHS should enhance efforts to function as a coordinated system to maximize capacity and resources. Key assets and strengths of the local public health system that were noted throughout the assessment and that the county should strive to capitalize on and build on include preparedness and the surveillance, monitoring, and mitigating of infectious disease. These areas emerged throughout discussions as areas in which the LPHS excels and functions well at a system-level to communicate and coordinate efforts and to leverage collective resources and capacity. Participants in the assessment noted that these are strengths in part because the system has sufficient resources to operate and significant or optimal capacity in these areas. Key weaknesses and areas of critical need include addressing substance abuse and mental health in the county, ensuring access to care for personal health needs, and informing, educating, and empowering community members about health issues. These areas surfaced throughout essential service discussions as issues of critical need for improvement in the county and areas in which insufficient resources and minimal coordinated effort exists. 53

56 Community Partners Animal Protective Association of Missouri Barnes-Jewish Hospital Barnes-Jewish West County Hospital Campus Beyond Housing BJC HealthCare City of St. Louis Department of Health Cooperating School Districts Daughters of Charity Foundation of St. Louis Housing Authority of St. Louis County International Institute of St. Louis Jewish Community Center Maternal Child and Family Health Coalition Mercy Hospital St. Louis Missouri Baptist Medical Center Missouri Department of Corrections Division of Probation and Parole Missouri Department of Health and Senior Services Eastern District Office St. Louis Missouri Foundation for Health National Alliance of Mental Illness Operation Food Search Ranken Jordan St. Anthony Medical Center St. Louis Area Business Health Coalition St. Louis County Children s Service Fund Saint Louis County Council Saint Louis County Department of Health Saint Louis County Department of Human Services Saint Louis County Health Advisory Committee St. Louis County Municipal League Saint Louis County Parks and Recreation Saint Louis County Department of Planning Saint Louis County Police Department North County (1st) Precinct St. Louis Integrated Health Network St. Louis Regional Health Commission Saint Louis University s College for Public Health and Social Justice St. Luke s Medical Center Shriners Hospital for Children Special School District of St. Louis County SSM DePaul Medical Center SSM Health Care SSM St. Mary s Health Center Trailnet United Way of Greater St. Louis University of Missouri Extension YMCA of Greater St. Louis 54

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